Objective To investigate the epidemiological characteristics and risk factors of hyperhomocysteinemia(HHcy)in military aircrew.Methods A retrospective study was conducted on 506 aircrew convalescents undergoing health examination from September 2023 to April 2024.Demographic,lifestyle,and biochemical data were analyzed.The risk factors of HHcy were identified by x2 test and multivariate Logistic regression.Results The HHcy detection rate was 21.94%(111/506),with a median homocysteine(Hcy)level of 11.75(9.70-14.30)μmol/L.Multivariate analysis revealed that smoking(OR=2.093,95%CI:1.313-3.336),service in conventional fighter aircraft(OR=1.716,95%CI:1.063-2.770),elevated low-density lipoprotein cholesterol(LDL-C)(OR=2.510,95%CI:1.413-4.458),and elevated bilirubin(OR=2.360,95%CI:1.509-3.691)were independent risk factors for HHcy(all P<0.05).Conclusion There is a high prevalence of HHcy in military pilots.It is strongly associated with smoking,aircraft type,and metabolic abnormalities.It is recommended to incorporate Hcy testing into routine physical examination,implement risk factor-based stratified interventions,and establish an atherosclerotic cardiovascular diseases early warning system integrating vascular imaging and risk assessment,aiming to reduce cardiovascular risks and safeguard combat effectiveness.

Objective To analyze the current research on cardiovascular diseases in pilots using bibliometric methods,so as to provide reference for future researches.Methods Articles indexed by China National Knowledge Infrastructure(CNKI)were selected as the research objects.The time window ranged from January 1990 to February 2024,and the keywords"pilot or flight personnel"and"cardiovascular"were selected to search for all published literatures on cardiovascular diseases in pilots.CiteSpace 6.1.R6 software was used to analyze the authors,institutions,and keywords of the included literatures,and a visual analysis graph was drawn.Results A total of 198 articles were included in this study.The journal with the most published articles was the Chinese Journal of Aerospace Medicine and Aviation Military Medicine.The author with the most published articles was Wang Lujin,followed by Zheng Jun.The institution with the most published articles was Air Force General Hospital(Air Force Medical Center).Risk factors,hypertension,and health assessment were hot keywords.The emerging word was medical appraisal.Conclusion The literatures of cardiovascular diseases among pilots are mainly published in aviation medical journals,forming a research team led by Wang Lujin and Zheng Jun.Research cooperation is mainly within the research team members,with less cooperation between research institutions.The research hotspots are risk factors of cardiovascular disease,hypertension,and health identification,and the forefront of research is the medical identification of cardiovascular diseases among pilots.With the increasing importance of cardiovascular diseases among pilots,it is necessary to strengthen cooperation among research institutions in the future,promote high-quality development in this field,and focus on strengthening scientific research in the prevention of cardiovascular diseases to maintain the physical and mental health of pilots.

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Objective:To investigate the clinical characteristics and survival outcomes of patients with nasopharyngeal carcinoma (NPC) complicated by multiple primary malignancies (MPCs) in a real-world setting.Methods:A retrospective study was performed on 238 NPC patients with MPCs who received radical radiotherapy at Fujian Cancer Hospital between January 1st, 2004 and December 31st, 2023. The primary endpoints were overall survival (OS) and cumulative survival rate. Survival analysis was conducted using the Kaplan-Meier method with log-rank / Breslow tests, and univariate analysis of prognostic factors was performed using the Cox proportional hazards model.Results:A total of 246 primary malignant tumors were identified in 238 patients, involving 12 organ systems and 39 tumor types. The most common coexisting malignancies occurred in the respiratory and intrathoracic organs [25.2% (62/246)], followed by digestive organ malignancies [22.8% (56/246)], malignancies of the lip, oral cavity, and pharynx [22.8% (56/246)], and thyroid and other endocrine gland malignancies [15.4% (38/246)]. The median OS was 186 months, and the 3-, 5-, and 10-year cumulative survival rates were 90.84%, 85.25%, and 69.45%, respectively. Poorer survival was associated with male sex, age>48 years at onset, locally advanced disease (stage IVA), synchronous MPCs and/or digestive system malignancies, fewer total cycles of chemotherapy, and lack of concurrent or adjuvant chemotherapy.Conclusions:In patients with NPC, MPCs most frequently involve the respiratory system, digestive system, and head and neck organs (including the thyroid). Male sex, older age, locally advanced primary NPC, synchronous and/or digestive system MPCs, fewer chemotherapy cycles, and lach of concurrent or adjuvant chemotherapy were significantly associated with poorer prognosis.

Mental health records have been well utilized in various industries or groups both within and outside the mili-tary.However,due to insufficient attention,lack of technology,and poor talent stability,the effectiveness of mental health re-cords is low.This article investigates psychological cadres during a major task to understand the current situation of the establish-ment and use of mental health records in the military.It finds that there is a phenomenon of"building but not flowing,storing but not using",and identifies issues such as inconsistent standards,poor circulation,insufficient content,and disordered manage-ment.Based on this,the article discusses the safeguards and basic content for the construction of mental health records.The dis-cussion concludes that mental health record content should include general information about officers and soldiers,the develop-ment of psychological services,records of psychological rehabilitation(including psychological measurement results,etc.),and other supplementary materials(such as physical health status,personal life history,etc.).It is necessary to standardize mental health measurement,mental health education,mental health training,psychological counseling interviews,psychiatric assess-ment,and psychiatric rehabilitation.Support must be provided in terms of systems,personnel,and technology,and a dynamic management and use mechanism and information security control responsibilities must be implemented.This will promote the or-derly development of military mental health work and,in turn,ensure the mental health of officers and soldiers.

Mental health records have been well utilized in various industries or groups both within and outside the mili-tary.However,due to insufficient attention,lack of technology,and poor talent stability,the effectiveness of mental health re-cords is low.This article investigates psychological cadres during a major task to understand the current situation of the establish-ment and use of mental health records in the military.It finds that there is a phenomenon of"building but not flowing,storing but not using",and identifies issues such as inconsistent standards,poor circulation,insufficient content,and disordered manage-ment.Based on this,the article discusses the safeguards and basic content for the construction of mental health records.The dis-cussion concludes that mental health record content should include general information about officers and soldiers,the develop-ment of psychological services,records of psychological rehabilitation(including psychological measurement results,etc.),and other supplementary materials(such as physical health status,personal life history,etc.).It is necessary to standardize mental health measurement,mental health education,mental health training,psychological counseling interviews,psychiatric assess-ment,and psychiatric rehabilitation.Support must be provided in terms of systems,personnel,and technology,and a dynamic management and use mechanism and information security control responsibilities must be implemented.This will promote the or-derly development of military mental health work and,in turn,ensure the mental health of officers and soldiers.

Objective:To investigate the clinical characteristics and survival outcomes of patients with nasopharyngeal carcinoma (NPC) complicated by multiple primary malignancies (MPCs) in a real-world setting.Methods:A retrospective study was performed on 238 NPC patients with MPCs who received radical radiotherapy at Fujian Cancer Hospital between January 1st, 2004 and December 31st, 2023. The primary endpoints were overall survival (OS) and cumulative survival rate. Survival analysis was conducted using the Kaplan-Meier method with log-rank / Breslow tests, and univariate analysis of prognostic factors was performed using the Cox proportional hazards model.Results:A total of 246 primary malignant tumors were identified in 238 patients, involving 12 organ systems and 39 tumor types. The most common coexisting malignancies occurred in the respiratory and intrathoracic organs [25.2% (62/246)], followed by digestive organ malignancies [22.8% (56/246)], malignancies of the lip, oral cavity, and pharynx [22.8% (56/246)], and thyroid and other endocrine gland malignancies [15.4% (38/246)]. The median OS was 186 months, and the 3-, 5-, and 10-year cumulative survival rates were 90.84%, 85.25%, and 69.45%, respectively. Poorer survival was associated with male sex, age>48 years at onset, locally advanced disease (stage IVA), synchronous MPCs and/or digestive system malignancies, fewer total cycles of chemotherapy, and lack of concurrent or adjuvant chemotherapy.Conclusions:In patients with NPC, MPCs most frequently involve the respiratory system, digestive system, and head and neck organs (including the thyroid). Male sex, older age, locally advanced primary NPC, synchronous and/or digestive system MPCs, fewer chemotherapy cycles, and lach of concurrent or adjuvant chemotherapy were significantly associated with poorer prognosis.

Objective To study the effect of leucine rich repeat kinase 2(LRRK2)on pain sensitivity in neuro-pathic pain(NP)rats and explore its possible mechanism.Methods 48 SD rats were randomly divided into four groups:sham surgery(Sham),model,LRRK2 inhibitor(MLi-2),and LRRK2 inhibitor+p3 8 mitogen activated pro-tein kinase(MAPK)agonist(MLi-2+Anisomycin),with 12 rats in each group.The NP rat model was induced by chronic constriction injury(CCI)of the sciatic nerve.Intrathecal injection of MLi-2(1 mg/kg,10 μl)or Anisomy-cin(20 μmol/L,10 μl)was started from the 8th day after surgery,once a day for 7 consecutive days.Pain sensi-tivity tests were conducted before surgery(day 0)and on postoperative days 7 and 14,respectively.The changes in mechanical withdrawal threshold(MWT)and paw withdraw thermal latency(PWTL)were analyzed in each group of rats.ELISA was used to detect the levels of interleukin-1 β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)in the dorsal horn of the rat spinal cord.Nissl staining was used to observe the pathological changes of neurons in rat spinal cord tissue.Immunofluorescence staining was used to observe the expression levels of ionized calcium-binding adapter molecule-1(Iba-1),a marker of microglia in the spinal cord of rats.Western blot was used to detect the protein expression levels of LRRK2,p-p38 mitogen activated protein kinase(MAPK),p38 MAPK,and Iba-1 in the dorsal horn of the rat spinal cord.Results Compared with the sham group,the model group showed a significant decrease in MWT and PWTL in the right hind limb of rats(P＜0.01).The levels of IL-1,IL-6,and TNF in the spi-nal dorsal horn tissue,as well as the expression levels of LRRK2,Iba-1 proteins and p-p38 MAPK/p38 MAPK pro-tein ratio significantly increased(P＜0.01).The proportion of Iba-1 positive cells in the spinal cord tissue signifi-cantly increased(P＜0.01),while Nissl bodies were significantly reduced(P＜0.01).Compared with the model group,the MLi-2 group showed a significant increase in MWT and PWTL in the right hind limb of rats(P＜0.01),a significant increase in Nissl bodies(P＜0.01),a significant decrease in the proportion of Iba-1 positive cells in the spinal cord tissue(P＜0.01),and a significant decrease in the levels of IL-1,IL-6,and TNF and the expression levels of LRRK2,Iba-1 proteins and p-p38 MAPK/p38 MAPK protein ratio(P＜0.01).However,Anisomychin in-tervention could activate the p38 MAPK signaling pathway and partially reverse the beneficial effects of MLi-2 on pain sensitivity and neuroinflammation in rats with neuropathic pain.Conclusion Inhibiting the expression of LRRK2 can alleviate pain sensitivity in NP rats induced by microglia activation mediated neuroinflammation,and its mechanism of action may be related to regulating the p38 MAPK signaling pathway.

Objective To investigate the role and mechanism of silent information regulator 1(SIRT1)-NOD-like receptor protein 3(NLRP3)axis in the effect of remifentanil against ischemia-reperfusion injury(IRI)in rat livers.SD rats were randomly divided into sham operation group(sham group),IRI group,IRI+remifentanil pretreatment group(IRI+RPC group),IRI+SIRT1 inhibitor EX-527 group(IRI+EX-527 group)and IRI+RPC+EX-527 group,with 8 rats in each group.The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),interleukin(IL)-1β and IL-18 of rats in each group were detected.The liver tissue pathology was observed.The apoptosis rate of hepatocytes in rats was detected.The expressions of SIRT1,NLRP3,cleaved cysteinyl aspartate specific proteinase-1(Cleaved Caspase-1)and Gasdermin D(GSDMD)proteins in rat liver tissue were detected.Results Compared with the sham group,the liver tissue pathological score and hepatocyte apoptosis rate of rats in the IRI group were increased,the serum ALT,AST,LDH,IL-1β,and IL-18 levels were increased,the relative expression of SIRT1 protein in liver tissue was decreased,and the relative expression of NLRP3,Cleaved Caspase-1,and GSDMD proteins were increased(all P<0.05).Compared with the IRI group,the liver tissue pathological score and hepatocyte apoptosis rate of rats in the IRI+RPC group were decreased,the serum ALT,AST,LDH,IL-1β,and IL-18 levels were decreased,the relative expression of SIRT1 protein in liver tissue was increased,and the relative expression of NLRP3,Cleaved Caspase-1,and GSDMD proteins were decreased;the liver tissue pathological score and hepatocyte apoptosis rate of rats in the IRI+EX-527 group were increased,the ALT,AST,LDH,IL-1β,and IL-18 levels were increased,the relative expression of SIRT1 protein in liver tissue was decreased,and the relative expression of NLRP3,Cleaved Caspase-1,and GSDMD proteins were increased(all P<0.05).Compared with the IRI+RPC group,the liver tissue pathological score and hepatocyte apoptosis rate in the IRI+RPC+EX-527 group were increased,the levels of ALT,AST,LDH,IL-1β,and IL-18 were increased,the relative expression of SIRT1 protein in liver tissue was decreased,and the relative expression of NLRP3,Cleaved Caspase-1,and GSDMD proteins were increased(all P<0.05).Conclusions SIRT1 may participate in the regulation of remifentanil against rat liver IRI by inhibiting NLRP3 mediated cell pyroptosis.