Objective To establish normal reference values of video head impulse test(vHIT)for civil avia-tion student pilots to provide a reference basis for the accurate assessment of the vestibular function of civil aviation student pilots.Methods Forty civil aviation student pilots in the theoretical training phase were randomly selected for vHIT.The average gain of the vestibulo-ocular reflex(VOR)and the asymmetry ratios of the semicircular ca-nals were compared.Results The VOR values for the right horizontal,anterior,and posterior semicircular canals were 1.05±0.07,0.92±0.13,0.81±0.09,respectively.For the left horizontal,anterior,and posterior semicir-cular canals,the values were 1.00±0.06,0.85±0.10,0.86±0.10,respectively.There was no compensatory sac-cade in any of the subjects.The asymmetry ratios of bilateral horizontal,left anterior-right posterior,and right an-terior-left posterior semicircular canals were 5.56％±3.64％,9.65％±4.74％,8.68％±7.07％,respectively.Conclusion This study establishes vHIT normal reference values for civil aviation student pilots,providing an ob-jective basis for their selection and vestibular function evaluation.

Objective To establish normal reference values of video head impulse test(vHIT)for civil avia-tion student pilots to provide a reference basis for the accurate assessment of the vestibular function of civil aviation student pilots.Methods Forty civil aviation student pilots in the theoretical training phase were randomly selected for vHIT.The average gain of the vestibulo-ocular reflex(VOR)and the asymmetry ratios of the semicircular ca-nals were compared.Results The VOR values for the right horizontal,anterior,and posterior semicircular canals were 1.05±0.07,0.92±0.13,0.81±0.09,respectively.For the left horizontal,anterior,and posterior semicir-cular canals,the values were 1.00±0.06,0.85±0.10,0.86±0.10,respectively.There was no compensatory sac-cade in any of the subjects.The asymmetry ratios of bilateral horizontal,left anterior-right posterior,and right an-terior-left posterior semicircular canals were 5.56％±3.64％,9.65％±4.74％,8.68％±7.07％,respectively.Conclusion This study establishes vHIT normal reference values for civil aviation student pilots,providing an ob-jective basis for their selection and vestibular function evaluation.

Objective:To analyze the efficacy and safety of FOLFOX-hepatic arterial infusion chemotherapy (HAIC) combined with targeted immunotherapy for initial unresectable hepatocellular carcinoma.Methods:A retrospective analysis was conducted on the data of initial unresectable hepatocellular carcinoma patients who visited Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2022 to June 2023. A total of 51 patients were enrolled, including 47 males and 4 females, with the age of (56.1±10.7) years. All 51 patients received HAIC combined with immune targeted therapy. After each HAIC combined with immune targeted therapy, the efficacy was evaluated according to the modified response evaluation cirteria in solid tumor (mRECIST). Objective response rate and disease control rate were calculuted. The conversion surgery rate and adverse events during treatment were recorded. Follow up patients' disease progression and survival status, and meanwhile analyze prognosis.Results:According to mRECIST assessment, the number of patients with complete remission, partial remission, disease stability, and disease progression were 4 (7.8%), 27 (52.9%), 14 (27.4%), and 6 (11.8%), respectively. The disease remission rate was 60.8%(31/51), and the disease control rate was 88.2%(45/51). After HAIC combined with immune targeted therapy, 13 patients underwent liver cancer resection, with a surgical conversion rate of 25.5%(13/51). The median progression free survival of 51 patients was 14.2 months, and the median overall survival has not yet been reached. The progression free survival rates of 51 patients at 6 and 12 months were 90.2% and 64.7%, respectively, and the cumulative survival rates at 6 and 12 months were 100% and 86.3%, respectively. During the treatment period, all patients experienced various degrees of adverse reactions, 38(75.5%) patients were grade 1-2 adverse accidents, which could be relieved and controlled after corresponding treatment.Conclusion:FOLFOX-HAIC combined with targeted immunotherapy provides an effective and safe treatment option for unresectable hepatocellular carcinoma, offering surgical resection opportunities for unresectable hepatocellular carcinoma patients.

Objective:To develop corresponding aviation otitis media intervention measures by investigating and analyzing the related factors in civil aviation aircrews.Methods:A total of 4 789 civil aviation aircrews were selected as the subjects of observation. The incidence of aviation otitis media among civil aviation aircrew was evaluated by 7-items Eustachian Tube Dysfunction Questionnaire, and the possible influencing factors were investigated and statistically analyzed.Results:All 4 789 survey questionnaires were validate. In this survey, the total flying hours was mainly 1 000-5 000 h, and the main aircraft was A320. There were 613 out of 4 789 civil aviation aircrews had suffered from aviation otitis media/secretory otitis media, accounting for 12.80%. In which 91.96% had no ear discharge or watery discharge, 70.81% had not experienced rhinitis/sinusitis, and more than 90% had no tonsil hypertrophy, no thin or calcified tympanic membrane, no history of surgery for the eustachian tube or middle ear cavity, and no ear tightness or occasional ear tightness that resolves spontaneously. The severity of ear tightness was mainly distributed in 0-3 points range, accounting for 88.70%. In which 43.62% were with no ear tightness and 45.10% were with mild ear tightness. Among the 4 789 civil aviation aircrews, the severity of ear tightness of left and right ears had the highest incidence rate of 1 point, followed by 2 points, and the incidence rate of 3-7 points was relatively low. The incidence rate of 1-2 points was significantly higher than that of 3-7 points, and the difference was significant (( χ2=2 135.68-7 623.25, P=0.001-0.004). Conclusions:Most of the Chinese civil aviation aircrews have good eustachian tube function, but there are still a few cases of aviation otitis media. Regular inspections and timely and effective interventions are crucial for protecting the eustachian tube function and reducing the incidence of aviation otitis media in civil aviation aircrews.

Objective:To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma.Methods:A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test.Results:The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH 2O (1 mmH 2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH 2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences ( P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH 2O vs. (280.44 ± 36.56) mmH 2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences ( P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference ( P<0.05). Conclusions:ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.

Objective:To develop corresponding aviation otitis media intervention measures by investigating and analyzing the related factors in civil aviation aircrews.Methods:A total of 4 789 civil aviation aircrews were selected as the subjects of observation. The incidence of aviation otitis media among civil aviation aircrew was evaluated by 7-items Eustachian Tube Dysfunction Questionnaire, and the possible influencing factors were investigated and statistically analyzed.Results:All 4 789 survey questionnaires were validate. In this survey, the total flying hours was mainly 1 000-5 000 h, and the main aircraft was A320. There were 613 out of 4 789 civil aviation aircrews had suffered from aviation otitis media/secretory otitis media, accounting for 12.80%. In which 91.96% had no ear discharge or watery discharge, 70.81% had not experienced rhinitis/sinusitis, and more than 90% had no tonsil hypertrophy, no thin or calcified tympanic membrane, no history of surgery for the eustachian tube or middle ear cavity, and no ear tightness or occasional ear tightness that resolves spontaneously. The severity of ear tightness was mainly distributed in 0-3 points range, accounting for 88.70%. In which 43.62% were with no ear tightness and 45.10% were with mild ear tightness. Among the 4 789 civil aviation aircrews, the severity of ear tightness of left and right ears had the highest incidence rate of 1 point, followed by 2 points, and the incidence rate of 3-7 points was relatively low. The incidence rate of 1-2 points was significantly higher than that of 3-7 points, and the difference was significant (( χ2=2 135.68-7 623.25, P=0.001-0.004). Conclusions:Most of the Chinese civil aviation aircrews have good eustachian tube function, but there are still a few cases of aviation otitis media. Regular inspections and timely and effective interventions are crucial for protecting the eustachian tube function and reducing the incidence of aviation otitis media in civil aviation aircrews.

Objective:To explore the diagnosis, treatment and aeromedical assessment of parotid pleomorphic adenoma for civil pilot.Methods:The diagnosis, treatment and aeromedical assessment of a class I pilot with parotid pleomorphic adenoma were analyzed. Related literatures were reviewed.Results:The 54-year-old male pilot was found a mass behind the right earlobe in the routine annual physical examination. B-ultrasound examination showed solid nodule in the right parotid gland. The mass and superficial parotid glands were removed and the facial nerve was dissected. Pathology showed pleomorphic adenoma of the right parotid gland. No complications were found in physical examination 2 months after the operation. The masticatory function and facial nerve function were good and CT showed no obvious abnormalities. The pilot was finally qualified for flying. No tumor recurrence or other complications were found 5 months after returning flight. B-ultrasound showed changes after partial resection of the right parotid gland and no other abnormalities were found.Conclusions:Parotid pleomorphic adenoma may be ignored easily at its early stage. The pilot with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To explore the diagnosis, treatment and aeromedical assessment of parotid pleomorphic adenoma for civil pilot.Methods:The diagnosis, treatment and aeromedical assessment of a class I pilot with parotid pleomorphic adenoma were analyzed. Related literatures were reviewed.Results:The 54-year-old male pilot was found a mass behind the right earlobe in the routine annual physical examination. B-ultrasound examination showed solid nodule in the right parotid gland. The mass and superficial parotid glands were removed and the facial nerve was dissected. Pathology showed pleomorphic adenoma of the right parotid gland. No complications were found in physical examination 2 months after the operation. The masticatory function and facial nerve function were good and CT showed no obvious abnormalities. The pilot was finally qualified for flying. No tumor recurrence or other complications were found 5 months after returning flight. B-ultrasound showed changes after partial resection of the right parotid gland and no other abnormalities were found.Conclusions:Parotid pleomorphic adenoma may be ignored easily at its early stage. The pilot with proper treatment and good postoperative recovery can be qualified to flight.

Object:This study aims to compare the efficacy, acceptability and tolerability of cognitive behavior therapy (CBT), pharmacotherapy, and their combination therapy for acute panic disorder via network Meta-analysis.Methods:Electronic databases including PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for relevant randomized controlled clinical trials from their inception up to March 24, 2021. The outcomes were efficacy (remission rate and response rate), acceptability and tolerability. Network Meta-analysis was adopted with random effects, and estimated relative risk (RR) for all effects of CBT, CBT plus medications, selective serotonin-reuptake inhibitors(SSRIs), serotonin-noradrenaline-reuptake inhibitors(SNRIs), tricyclic antidepressants(TCAs), monoamine oxidase inhibitors(MAOI), benzodiazepines(BZD), noradrenergic-reuptake inhibitors(NRI), and others. This study used gemtc package in R for network analysis, Review Manager for quality assessment, and GRADEPro for evidence assessment, respectively.Results:Identified citations (7 173) included 72 trials comprising 12 293 patients. The treatment measures with higher remission rate and response rate than placebo included CBT+drug( RR:2.4, 95% CI: 1.7-3.5), CBT( RR:1.8, 95% CI:1.4-2.3), SNRI( RR:1.8, 95% CI:1.5-2.2), BZD( RR:1.6, 95% CI:1.4-1.9), SSRI( RR:1.5, 95% CI:1.4-1.7), TCA( RR:1.5, 95% CI: 1.4-1.8)(remission rate in brackets); Among them, CBT combined with medications was better than SSRI, SNRI and TCA. The acceptability of BZD was better than placebo but its tolerability was inferior. Besides, the tolerability of SSRI and TCA was inferior to placebo. Conclusions:CBT combined with medications is more effective than BZD alone and the antidepressants alone. CBT combined with medications may selected the first-line treatment for panic disorder.

Object:This study aims to compare the efficacy, acceptability and tolerability of cognitive behavior therapy (CBT), pharmacotherapy, and their combination therapy for acute panic disorder via network Meta-analysis.Methods:Electronic databases including PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for relevant randomized controlled clinical trials from their inception up to March 24, 2021. The outcomes were efficacy (remission rate and response rate), acceptability and tolerability. Network Meta-analysis was adopted with random effects, and estimated relative risk (RR) for all effects of CBT, CBT plus medications, selective serotonin-reuptake inhibitors(SSRIs), serotonin-noradrenaline-reuptake inhibitors(SNRIs), tricyclic antidepressants(TCAs), monoamine oxidase inhibitors(MAOI), benzodiazepines(BZD), noradrenergic-reuptake inhibitors(NRI), and others. This study used gemtc package in R for network analysis, Review Manager for quality assessment, and GRADEPro for evidence assessment, respectively.Results:Identified citations (7 173) included 72 trials comprising 12 293 patients. The treatment measures with higher remission rate and response rate than placebo included CBT+drug( RR:2.4, 95% CI: 1.7-3.5), CBT( RR:1.8, 95% CI:1.4-2.3), SNRI( RR:1.8, 95% CI:1.5-2.2), BZD( RR:1.6, 95% CI:1.4-1.9), SSRI( RR:1.5, 95% CI:1.4-1.7), TCA( RR:1.5, 95% CI: 1.4-1.8)(remission rate in brackets); Among them, CBT combined with medications was better than SSRI, SNRI and TCA. The acceptability of BZD was better than placebo but its tolerability was inferior. Besides, the tolerability of SSRI and TCA was inferior to placebo. Conclusions:CBT combined with medications is more effective than BZD alone and the antidepressants alone. CBT combined with medications may selected the first-line treatment for panic disorder.