Objective:To analyse the clinical significance of selective single embryo transfer by time-lapse mo-nitoring(TLM)or conventional morphology assessment(CMA)in vitro fertilization/intracytoplasmic sperm in-jection and embryo transfer(IVF/ICSI-ET),and to initially explore the predictive value of Raman spectral analy-sis of embryo culture medium for clinical pregnancy rate.Methods:The study is a prospective randomized con-trolled clinical trial.We assigned 139 patients treated with IVF/ICSI-ET in Reproductive and Genetics Center of Suzhou Municipal Hospital from April 2019 to July 2020,which were randomly assigned to either the CMA or the TLM group.We performed selective single-embryo transfer(fresh cycle and FET)after selecting the optimal em-bryos with TLM or CMA respectively.If the patient's first embryo transfer was unsuccessful,a second one would be performed to compare the differences in the cumulative live birth rate of embryo transfer and other pregnancy outcomes between the two groups.Meanwhile,we collected 15 μl of embryo culture medium at day 3 after IVF/ISCI fertilization for Raman spectroscopy analysis.Results:There were no differences in cumulative live birth,cu-mulative clinical pregnancy,cumulative premature birth,cumulative early spontaneous abortion,cumulative ectopic pregnancy and LGA or SGA between TLM and CMA groups(P＞0.05).The Neonatal sex ratio in the TLM group was lower than that in the CMA group,but the difference was not significant(P＞0.05).Raman spectros-copy analysis of embryo culture medium predicted the clinical pregnancy rate with 67.21％accuracy.Conclu-sions:In young women with a good ovarian reserve,the advantage of using TLM to evaluate embryos is not obvi-ous,so we should remain vigilant that embryo selection based on morphokinetic parameters may affect the sex ratio.Raman spectroscopic analysis of embryo culture medium is not yet able to effectively predict the planting ability of embryos.

Objective:To provide data support for the improvement of aeromedical support by summarizing the disease characteristics and analyzing the change pattern of disease spectrum for the temporarily grounded military flying personnel assessed in the annual physical examination.Methods:The clinical data of military flying personnel who were assessed as temporary grounding in the annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from 2012 to 2021 were retrospectively analyzed. They were divided into 2012—2016 group and 2017—2021 group with a 5-year span. The distributions of disease, age and aircraft type were statistically compared between 2 groups of temporarily grounded military flying personnel.Results:A total of 522 flying personnel, aged from 23-55 years and flew 100-20 000 h, were enrolled. There were 242 cases in 2012—2016 group and 280 cases in 2017—2021 group. Compared with 2012—2016 group, 2017—2021 group was found 9 new diseases. Among the top 10 diseases in 2017—2021 group, the proportion of pulmonary nodules, hypertension, diabetes, abnormal tumor indicators, positive fecal occult blood was increased, and the proportion of thyroid nodules, abnormal liver function, arrhythmia was decreased. There was a significant difference in the age distribution between 2 groups of temporarily grounded military flying personnel ( χ2=20.97, P<0.001). The proportion of flying personnel aged ≥40 years old was increased in 2017—2021 group. The proportion of fighter-trainer pilots and bomb-transporter flying personnel increased in 2017—2021 group, and the difference was significant ( χ2=14.66, P=0.001). Conclusions:In recent years, more diseases, mostly occult diseases, are found in the disease spectrum of the temporarily grounded military flying personnel. Since some insidious diseases require more time to observe their convalescent effect and the influence to flight but the routine phone follow-up is called within 2 months of discharge, so a long-term and effective follow-up mechanism is suggested.

Objective:To analyze the results of low-dose lung CT screening for military flying personnel, and to explore its influence on aeromedical identification.Methods:The imaging and aeromedical identification data of military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou were analyzed retrospectively. According to the imaging manifestations, the enrolled low-dose lung CT results were divided into the following 6 categories: no obvious abnormality, old lesions, pulmonary nodules, pulmonary bullae, pulmonary inflammatory lesions and extrapulmonary diseases. The detection rates of various examination results were statistically analyzed. The military flying personnel were divided into 20-29 years group, 30-39 years group, 40-49 years group and 50-59 years group, and they were divided into fighter pilots, bomb-trans-helicopter pilots, and bomb-trans-helicopter crew members according to the post. The differences in various examination results of flying personnel were compared among different age groups and post groups. The influence of examination results on the aeromedical identification results was analyzed in accordance with the 3-level conclusions as not affecting the conclusion of aeromedical identification, leading to the decline of health grade and leading to temporary grounding. The overall significance level α=0.05, and the pairwise comparison with P< α/statistical times was statistically significant. Results:A total of 2 274 flying personnel was enrolled. The detection rates of various examination results from high to low was no obvious abnormality (45.82%), old lesions (37.55%), pulmonary nodules (14.86%), pulmonary bullae (6.73%), pulmonary inflammatory lesions (2.59%) and extrapulmonary diseases (1.85%). There was significant difference among examination results of different age groups ( χ2=183.43, P<0.001). The detection rate of no obvious abnormality was the highest in 20-29 years group and 30-39 years group; the detection rate of old lesions was the highest in 40-49 years group and 50-59 years group. The detection rate of no obvious abnormality decreased with age, and the detection rate of old lesions increased with age (both P< α/6=0.008). The detection rate of pulmonary nodules in 40-49 years group was higher than that in 30-39 years group; the detection rate of pulmonary bullae in 50-59 years group was higher than that in the other age groups; the detection rates of pulmonary inflammatory lesions in 40-49 years group and 50-59 years groups were higher than those in the other age groups; the detection rate of extrapulmonary diseases in 50-59 years group was higher than that in 20-29 years group, and the differences were statistically significant (all P<0.008). There was significant difference in the results of flying personnel among different post groups ( χ2=33.78, P=0.001). The detection rate of no obvious abnormality in bomb-trans-helicopter crew members group was lower than that in bomb-trans-helicopter pilots group and fighter-trainer pilots group, but the detection rates of old lesions and pulmonary nodules were higher than those in the other groups, the differences were statistically significant (all P< α/3=0.017). The detection rate of pulmonary bullae in fighter-trainer pilots group was lower than that in bomb-trans-helicopter crew members group, and the difference was statistically significant ( P<0.017). Although majority of the detected results had no effect on the results of aeromedical identification, there was a significant difference in the proportion of health grade decline and temporary grounding caused by different detected diseases (Fisher exact test value was 82.81, P<0.001). Conclusions:Low-dose lung CT screening plays an important role in the physical examination and aeromedical identification for military flying personnel. It can be routinely used during the annual physical examination for flying personnel, and the aeromedical identification standards and strategies for lung related diseases should be updated synchronously.

Objective:To improve the understanding of craniocerebral diseases and aeromedical assessment from the perspective of imaging by analyzing the results of craniocerebral MRI examination of military flying personnel.Methods:The results of craniocerebral MRI examination were retrospectively analyzed among the military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from September of 2020 to December of 2021. They were divided into 20-29 years group, 30-39 years group, 40-49 years group, 50-59 years group according to the age, and they were divided into fighter pilots, bomb-transporter pilots, helicopter pilots, air combat/technical personnel according to the aircraft type and post. The detection of craniocerebral MRI examination results of the flying personnel in different age groups and aircraft type and post groups were compared. The influence of abnormal results on the conclusion of aeromedical assessment was analyzed. The α level of statistical analysis was set at 0.05, and the difference was statistically significant with P< α/statistical count for pairwise comparison among groups. Results:Among the craniocerebral MRI examination results of 975 military flying personnel, 473 cases were with no obvious abnormality, 194 were anatomical variation of Willis circle, 27 were congenital brain malformation, 54 were cerebrovascular disease, 279 were white matter hyperintensities (WMHs), 22 were tumor and tumor-like lesions, 26 were arachnoid cyst, 29 were empty sella, 7 were intracranial calcinosis and 2 were craniocerebral trauma. The proportion of no obvious abnormality in 20-29 years group and 30-39 years group were higher than those in other age groups; the detection rates of WMHs in 40-49 years group and 50-59 years group was higher than those in the other age groups; the detection rates of cerebrovascular diseases and empty sella in 50-59 years group were higher than those in the other age groups, and the differences were significant (all P< α/6=0.008). The proportion of no obvious abnormality in fighter pilots and helicopter pilots were higher than those in others; the detection rate of WMHs in air combat/technical personnel was higher than that in others; the detection rate of arachnoid cyst in bomb-transporter pilots was higher than that in fighter pilots, and the differences were significant (all P< α/6=0.008). Most of the abnormal results detected by craniocerebral MRI examination had no significant impact on the conclusion of aeromedical assessment, and those with greater impact were cerebrovascular disease, tumor and tumor-like lesions (both P< α/351=0.001). Conclusions:The MRI examination not only preliminarily explains the basic characteristics of the distribution of craniocerebral diseases among military flying personnel of different ages, aircraft types and posts from the perspective of imaging, but also provides the basis for dynamic follow-up and accurate aeromedical assessment.

Objective:To provide data support for the improvement of aeromedical support by summarizing the disease characteristics and analyzing the change pattern of disease spectrum for the temporarily grounded military flying personnel assessed in the annual physical examination.Methods:The clinical data of military flying personnel who were assessed as temporary grounding in the annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from 2012 to 2021 were retrospectively analyzed. They were divided into 2012—2016 group and 2017—2021 group with a 5-year span. The distributions of disease, age and aircraft type were statistically compared between 2 groups of temporarily grounded military flying personnel.Results:A total of 522 flying personnel, aged from 23-55 years and flew 100-20 000 h, were enrolled. There were 242 cases in 2012—2016 group and 280 cases in 2017—2021 group. Compared with 2012—2016 group, 2017—2021 group was found 9 new diseases. Among the top 10 diseases in 2017—2021 group, the proportion of pulmonary nodules, hypertension, diabetes, abnormal tumor indicators, positive fecal occult blood was increased, and the proportion of thyroid nodules, abnormal liver function, arrhythmia was decreased. There was a significant difference in the age distribution between 2 groups of temporarily grounded military flying personnel ( χ2=20.97, P<0.001). The proportion of flying personnel aged ≥40 years old was increased in 2017—2021 group. The proportion of fighter-trainer pilots and bomb-transporter flying personnel increased in 2017—2021 group, and the difference was significant ( χ2=14.66, P=0.001). Conclusions:In recent years, more diseases, mostly occult diseases, are found in the disease spectrum of the temporarily grounded military flying personnel. Since some insidious diseases require more time to observe their convalescent effect and the influence to flight but the routine phone follow-up is called within 2 months of discharge, so a long-term and effective follow-up mechanism is suggested.

Objective:To analyze the results of low-dose lung CT screening for military flying personnel, and to explore its influence on aeromedical identification.Methods:The imaging and aeromedical identification data of military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou were analyzed retrospectively. According to the imaging manifestations, the enrolled low-dose lung CT results were divided into the following 6 categories: no obvious abnormality, old lesions, pulmonary nodules, pulmonary bullae, pulmonary inflammatory lesions and extrapulmonary diseases. The detection rates of various examination results were statistically analyzed. The military flying personnel were divided into 20-29 years group, 30-39 years group, 40-49 years group and 50-59 years group, and they were divided into fighter pilots, bomb-trans-helicopter pilots, and bomb-trans-helicopter crew members according to the post. The differences in various examination results of flying personnel were compared among different age groups and post groups. The influence of examination results on the aeromedical identification results was analyzed in accordance with the 3-level conclusions as not affecting the conclusion of aeromedical identification, leading to the decline of health grade and leading to temporary grounding. The overall significance level α=0.05, and the pairwise comparison with P< α/statistical times was statistically significant. Results:A total of 2 274 flying personnel was enrolled. The detection rates of various examination results from high to low was no obvious abnormality (45.82%), old lesions (37.55%), pulmonary nodules (14.86%), pulmonary bullae (6.73%), pulmonary inflammatory lesions (2.59%) and extrapulmonary diseases (1.85%). There was significant difference among examination results of different age groups ( χ2=183.43, P<0.001). The detection rate of no obvious abnormality was the highest in 20-29 years group and 30-39 years group; the detection rate of old lesions was the highest in 40-49 years group and 50-59 years group. The detection rate of no obvious abnormality decreased with age, and the detection rate of old lesions increased with age (both P< α/6=0.008). The detection rate of pulmonary nodules in 40-49 years group was higher than that in 30-39 years group; the detection rate of pulmonary bullae in 50-59 years group was higher than that in the other age groups; the detection rates of pulmonary inflammatory lesions in 40-49 years group and 50-59 years groups were higher than those in the other age groups; the detection rate of extrapulmonary diseases in 50-59 years group was higher than that in 20-29 years group, and the differences were statistically significant (all P<0.008). There was significant difference in the results of flying personnel among different post groups ( χ2=33.78, P=0.001). The detection rate of no obvious abnormality in bomb-trans-helicopter crew members group was lower than that in bomb-trans-helicopter pilots group and fighter-trainer pilots group, but the detection rates of old lesions and pulmonary nodules were higher than those in the other groups, the differences were statistically significant (all P< α/3=0.017). The detection rate of pulmonary bullae in fighter-trainer pilots group was lower than that in bomb-trans-helicopter crew members group, and the difference was statistically significant ( P<0.017). Although majority of the detected results had no effect on the results of aeromedical identification, there was a significant difference in the proportion of health grade decline and temporary grounding caused by different detected diseases (Fisher exact test value was 82.81, P<0.001). Conclusions:Low-dose lung CT screening plays an important role in the physical examination and aeromedical identification for military flying personnel. It can be routinely used during the annual physical examination for flying personnel, and the aeromedical identification standards and strategies for lung related diseases should be updated synchronously.

Objective:To improve the understanding of craniocerebral diseases and aeromedical assessment from the perspective of imaging by analyzing the results of craniocerebral MRI examination of military flying personnel.Methods:The results of craniocerebral MRI examination were retrospectively analyzed among the military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from September of 2020 to December of 2021. They were divided into 20-29 years group, 30-39 years group, 40-49 years group, 50-59 years group according to the age, and they were divided into fighter pilots, bomb-transporter pilots, helicopter pilots, air combat/technical personnel according to the aircraft type and post. The detection of craniocerebral MRI examination results of the flying personnel in different age groups and aircraft type and post groups were compared. The influence of abnormal results on the conclusion of aeromedical assessment was analyzed. The α level of statistical analysis was set at 0.05, and the difference was statistically significant with P< α/statistical count for pairwise comparison among groups. Results:Among the craniocerebral MRI examination results of 975 military flying personnel, 473 cases were with no obvious abnormality, 194 were anatomical variation of Willis circle, 27 were congenital brain malformation, 54 were cerebrovascular disease, 279 were white matter hyperintensities (WMHs), 22 were tumor and tumor-like lesions, 26 were arachnoid cyst, 29 were empty sella, 7 were intracranial calcinosis and 2 were craniocerebral trauma. The proportion of no obvious abnormality in 20-29 years group and 30-39 years group were higher than those in other age groups; the detection rates of WMHs in 40-49 years group and 50-59 years group was higher than those in the other age groups; the detection rates of cerebrovascular diseases and empty sella in 50-59 years group were higher than those in the other age groups, and the differences were significant (all P< α/6=0.008). The proportion of no obvious abnormality in fighter pilots and helicopter pilots were higher than those in others; the detection rate of WMHs in air combat/technical personnel was higher than that in others; the detection rate of arachnoid cyst in bomb-transporter pilots was higher than that in fighter pilots, and the differences were significant (all P< α/6=0.008). Most of the abnormal results detected by craniocerebral MRI examination had no significant impact on the conclusion of aeromedical assessment, and those with greater impact were cerebrovascular disease, tumor and tumor-like lesions (both P< α/351=0.001). Conclusions:The MRI examination not only preliminarily explains the basic characteristics of the distribution of craniocerebral diseases among military flying personnel of different ages, aircraft types and posts from the perspective of imaging, but also provides the basis for dynamic follow-up and accurate aeromedical assessment.

Objective:This study aimed to explore the feasibility and clinical value of monitoring the progression of early kidney injury in type 2 diabetic patients by assessment of the urinary C-terminal agrin fragment (uCAF) with enzymatic chemiluminescence immunoassay.Methods:A total of 251 patients with type 2 diabetes, who attended the Second Affiliated Hospital of Wenzhou Medical University from October 2018 to March 2020, were included in this retrospective analysis. One hundred and fifty-six participants undergoing health check-up at the Second Affiliated Hospital of Zhejiang University School of Medicine in February 2021 served as controls. Basic clinical information, glycosylated hemoglobin type A 1c and serum creatinine values were recorded, and urine specimens were collected for urinary creatinine, urinary α 1 microglobulin(uα 1M), urinary immunoglobulin G (uIgG), urinary albumin, urinary N-Acetyl-B-D-glycosaminidase (uNAG) and uCAF measurements. Based on the estimated glomerular filtration rate (eGFR), 251 patients were classified into G1~G5 stage groups with 116, 22, 28, 55 and 30 patients in each group. One hundred and sixty-six patients with early diabetic kidney disease (stage G1-G3) were divided into subgroups A1 (79), A2 (48) and A3 (39) according to the urinary albumin/creatinine ratio (UACR), the uα1M levels were divided into uα1M subgroup 1 (83 cases), uα1M subgroup 2 (42 cases), and uα1M subgroup 3 (41 cases), and uIgG subgroup 1 (83 cases), uIgG subgroup 2 (42 cases), and uIgG subgroup 3 (41 cases) according to uIgG levels. The Spearman method was used to analyze the correlation between uCAF levels and eGFR, UACR, uα1M and uIgG levels. Results:(1) The linear range of the uCAF detected by enzymatic chemiluminescence immunoassay was 3.97-2 000.00 ng/ml, with a detection limit of 2.28 ng/ml, intra-batch coefficients of variation of 1.15% and 1.57%, inter-batch coefficients of variation of 1.63% and 5.78%, and a biological reference interval of <95.35 μg/g Cr. (2) The uCAF level and positive rate (UACR≥30 mg/g) increased with the decrease of eGFR from G1-G3, uCAF level was negatively correlated with eGFR value ( r=-0.543, P<0.000 1), and the positive rate increased from 24.14% (28/116) to 85.71% (24/28) from G1-G3. The uCAF level and positivity rate decreased with the decrease of eGFR from G4 to G5. uCAF level was positively correlated with eGFR value ( r=0.495, P<0.001), and the positivity rate decreased from 30.91% (17/55) to 23.33% (7/30) from G4 to G5. (3) In patients with early diabetic kidney disease, uCAF levels and positivity rates increased gradually with the increase of UACR. uCAF levels were positively correlated with UACR values ( r=0.602, P<0.001), and the uCAF positivity rate reached 21.52% (17/79) in the A1 subgroup. (4) uCAF level was positively correlated with uα1M and uIgG levels in patients with early diabetic kidney disease ( r=0.757, 0.596, both P<0.001). Conclusion:Analytical performance of enzyme chemiluminescence immunoassay for the detection of CAF is satisfactory and could be used a biomarker for monitoring damage and progression of early diabetic kidney disease in patients with type 2 diabetes.

Objective:To explore the effect of emergency nursing based on de-escalation thinking in patients with acute pancreatitis.Methods:From January 2019 to December 2020, 156 patients with acute pancreatitis in the Emergency Department of Beijing Friendship Hospital, Capital Medical University were retrospectively selected as the research object by convenience sampling. According to different nursing methods, the patients were divided into the control group and the intervention group with 78 cases in each group. The control group received routine nursing, and the intervention group implemented emergency nursing based on de-escalation thinking on the basis of the control group. The incidence of complications, treatment effect and nursing satisfaction were compared between the two groups.Results:The incidence of complications in the intervention group was lower than that in the control group, the total treatment effective rate was higher than that in the control group, and the patients in the intervention group were more satisfied with nursing skills, health education, and emergency measures than the control group, with statistical differences ( P<0.05) . Conclusions:Emergency nursing based on de-escalation thinking in patients with acute pancreatitis can effectively reduce the incidence of complications, improve the first aid effectiveness, and nursing satisfaction, which is worthy of clinical application.

Objective To trace human umbilical cord mesenchymal stem cells (MSCs)labelled by USPIO-PLL which were transplanted into mouse subcutaneous xenotransplanted lung cancer by using 3.0T MR,to investigate the relationship between MSCs and VEGF expression and tumor angiogenesis by using SABC immunohistochemical method and to comprehensively analyze the effect of MSCs transplantation on lung cancer.Methods Cultured MSCs and poly lysine (PLL)was as a transfection agent which was magnetically labeled by USPIO and implanted into mice with subcutaneous xenotransplanted lung cancer through the tail vein.MRI was performed at pre-transplantation, 1 d and 10 d after transplantation and the tissues were performed by immunohistochemistry respectively.Results (1)MSCs could reach the tumor area at the first day after the transplantation and be monitored by MRI.MSCs increased at the 10th day.MRI signal intensity was reducedand the difference was statistically significant (P <0.05).The inhibitory rate of the 1st day and 10th day was positive;(2)At the 10th day after the transplantation,the rate of the VEGF positive expression in MSCs group was 86.67％,the value of MVD was 44 .22 ± 12 .36 ,and the rate of the VEGF positive expression in NS group was 26 .67 ％ ,the value of MVD was 20 .29 ±8.47 (P <0.05).Conclusion Tracing stem cell transplantation in vivo can be proceeded effectively by using 3.0T MR.Stem cell has bidirectional effect on lung cancer which inhibites the tumor growth by directional chemotaxis and differentiation,and also enhances expression of VEGF and angiogenesis at a certain extent.