The goal of gastrointestinal endoscopy anesthesia management is to effectively calm and re-lieve pain while minimizing related adverse reactions and ensuring patient safety.Hypoxemia is the most com-mon adverse event during painless gastrointestinalendoscopy,and severe hypoxemia can cause cardiac and brain accidents.Therefore,how to prevent and reduce the occurrence of hypoxemia isa hot topic in clinical re-search.This article reviews the methods of preventing and reducing hypoxemia in general painless gastrointes-tinal endoscopy,and provides a reference for the selection of appropriate sedation and ventilation strategies for general painless gastrointestinal endoscopy anesthesia.

OBJECTIVE To study the toxicity-reducing effects and mechanisms of Niuhuang Jiedu Tablets(NHJDT)by gas chromatography-mass spectrometry(GC-MS)metabolomics.METHODS 24 mice were randomly divided into control,realgar(1.0 g·kg-1)and NHDJT(1.0 g·kg-1)groups with 8 mice in each group.The liver and kidney of mice were collected for patho-logic examination after 14 d oral administration to mice.The content of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in liver and creatinine(Cr)and uric acid(UA)in kidney was also determined.The differences of endogenous metabolites in liver and kidney were further analyzed by GC-MS metabolomics.RESULTS The contents of ALT and AST in the liver as well as the Cr and UA in kidney of mice were significantly changed after NHJDT intervention(P<0.05).NHJDT alleviated the pathological dam-age of liver and kidney in mice.A total of 17 biomarkers related to detoxification were screened,including citric acid,ascorbic acid,asparagine,levodopa and phenylalanine.The changes of metabolites mainly involved in glutamine and glutamate metabolism,arginine biosynthesis,tryptophan metabolism,tyrosine and tryptophan biosynthesis,and phenylalanine metabolism.CONCLUSION NHJDT with compound compatibility could reduce the hepatorenal toxicity of realgar.The detoxification mechanism may be related to the regu-lation of amino acid metabolism.

Objective:To investigate the diagnostic performance of different thyroid imaging reporting and data systems (TI-RADS) in the diagnosis of medullary thyroid carcinoma (MTC) .Methods:A total of 160 thyroid nodules diagnosed as MTC by postoperative pathology from Aug. 2011 to Aug. 2022 at the First Affiliated Hospital of Zhengzhou University were included. Additionally, 160 papillary thyroid carcinomas (PTC) and 160 benign nodules were randomly selected as controls during the same period. Differences in gender, age, nodule diameter and various ultrasound features were observed. The nodules were classified according to American College of Radiology (ACR) TI-RADS, artificial intelligence (AI) TI-RADS and Chinese (C TI-RADS). Then, receiver operating characteristic curve (ROC) were plotted to calculate the diagnostic value. The Kendall concordance coefficient was used to evaluate the interobserver consistency of each TI-RADS system.Results:There was no statistically significant difference in gender among the three groups ( χ2=1.17, P=0.558). However, significant differences were observed in age and nodule diameter ( F=12.08,40.12, P<0.001 for both). The area under ROC (AUC) for diagnosing MTC and benign nodules using ACR, AI, and C-TIRADS were 0.762, 0.773, and 0.761, respectively, with no statistically significant differences ( Z=1.33, 0.01, 0.87, P=0.183, 0.994, 0.386). However, the sensitivity of C TI-RADS (87.5%) was lower than that of ACR and AI TI-RADS (both 95.0%) ( P=0.018). After combining the biopsy threshold, the false negative rate of C-TIRADS was lower than that of ACR (30.6% vs. 41.3%) ( P=0.048) and AI TIRADS (30.6% vs. 43.1%) ( P=0.020). The inter-observer diagnostic consistency of C-TIRADS was superior to ACR (0.884 vs. 0.819, P<0.001) and AI TIRADS (0.884 vs. 0.839) ( P<0.001) . Conclusions:AI and ACR TI-RADS have higher sensitivity in diagnosing MTC, while C TI-RADS has a lower puncture missed diagnosis rate. AI has similar diagnostic performance to ACR TI-RADS and can replace ACR TI-RADS.

Atherosclerosis(AS), characterized with the accumulation of lipids on the vessel wall, is an immune-related inflammatory disease which promotes the progression of cardiovascular diseases(CVD). The imbalance of Treg/Th17 accelerates the progression of AS. Yangyin Huoxue Prescription(YHF)is an efficient traditional Chinese medicine used in the treatment of AS, but the effects of YHF on the balance of immunity have still not been clarified. This project was designed to investigate the effects of YHF on the imbalance of Treg/Th17 and AS in ApoE-/- mice induced by high-fat diet(HFD). ApoE-/- mice were given HFD to induce AS and administered low-dose YHF(18 g/kg)or high-dose YHF(36 g/kg)for 20 weeks. Atherosclerotic plaque area was analyzed by oil red O staining. Serum lipids were measured by biochemical kits. Treg or Th17 cells in peripheral blood were detected by flow cytometry. mRNA and protein expression of Foxp3 and RORγt of aortas were determined by qRT-PCR, Western blot and immunohistochemistry. Splenic CD4+T cells of mice were isolated and activated by anti-CD3/CD28, and then treated with lipopolysaccharide(LPS)and YHF. The expression of mRNA and protein of Foxp3 and RORγt were detected by qRT-PCR and immunofluorescence. It was found that YHF reduced the plaque area, decreased lipid level and increased the ratio of Treg cells in peripheral blood. Moreover, YHF increased mRNA or protein expression of Foxp3 in aortas in vivo or CD4+T cells in vitro while decreasing mRNA or protein expression of RORγt. These results suggested that YHF can regulate the imbalance of Treg/Th17 in ApoE-/- mice induced by HFD, and reduce the inflammatory stimulation of LPS on CD4+T cells, thereby improving AS.

Objective: To study the current development of thoracic surgery in China. Methods: Chinese Society for Thoracic and Cardiovascular Surgery and Chinese Association for Thoracic Surgeons jointly conducted a network survey to directors of thoracic surgery departments in the tertiary hospitals in China from November to December 2018. The contents of the survey included the basic information of the hospital and the status of thoracic surgery department in the hospital. Rank sum test was used to compare the data between different regional hospitals Results: A total of 636 tertiary hospitals participated in the survey. The total number of beds for thoracic surgery departments was 30 646, with M(Q_R) of 40(20) (range: 3 to 393) for each hospital. The total number of thoracic surgeons was 6 747, with M(Q_R) of 9(6) (range: 1 to 75) in each hospital. In 2015, a total of 312 425 operations were performed in the 636 hospitals, with M(Q_R) of 268(484.5) (range: 4 to 8 320) for each hospital. The total number of lung cancer surgeries was 146 601 in 2015, with M(Q_R) of 100(216) (range: 0 to 6 911) operations in each hospital. The total number of esophageal cancer operations was 67 076, with M(Q_R) of 40(95) (range: 0 to 1 550) in each hospital. Minimal invasive thoracic surgery was performed in 94.3% (601/636) of the hospitals, with 86.6% (551/636) of hospitals carried out video-assisted thoracoscopic (VATS) lobectomy. Among the hospitals performing VATS lobectomy, 89.3% (492/551) of them started to perform the technique after 2006, and 93.1% (513/551) of them do single-direction thoracoscopic lobectomy. A total of 403 640 VATS lobectomies had been performed until 2015, including 163 682 cases of single-direction thoracoscopic lobectomy. In 2015, 73.74% (108 116/146 601) lung cancer operations and 37.44% (25 110/67 076) of esophageal cancer resections were performed by minimally invasive technique. The development level of hospitals among eastern, middle and Western China was different significantly on number of doctors, number of total operations, number of lung cancer surgeries, proportion of minimally invasive lung cancer surgery, number of esophageal cancer surgeries, and proportion of minimally invasive esophageal cancer surgery (χ²∶7.65 to 60.8, all P<0.05). Conclusions The discipline of thoracic surgery, especially the minimally invasive thoracic surgery in China is now experiencing a rapid development. The proportion of minimally invasive lung cancer surgery is higher than that of in the developed countries. However, unbalanced development among different regions is still a great challenge in China.

Objective To analyze the efficacy of high-frequency ultrasound in the clinical diagnosis of carpal tunnel syndrome (CTS),and to study the suitable diagnostic indicators and criteria of CTS for Chinese population.Methods High-frequency ultrasound was used to scan the median nerves of 67 CTS wrists and 67 normal wrists at the entrance,the middle and the outlet of carpal tunnels,and measured the cross-sectional area,diameter and flattening rate.Statistical analysis was used to evaluate the sensitivity,specificity,and AUC of ROC curve of the different parts of carpal tunnels.Results Compared with normal subjects,the CTS patients has larger cross-sectional area,diameter and flattening value of the median nerve in different parts of the carpal tunnel,and the differences are statistically significant (all P＞0.05).Among the measured indicators,the cross-sectional area of the median nerve at the entrance of the carpal tunnel has a better AUC value and good diagnostic sensitivity and specificity.Conclusion High-frequency ultrasonography has potential clinical significance for CTS diagnosis.The cross-sectional area of the median nerve at the entrance of the carpal tunnel can be used as a CTS diagnostic indicator for Chinese population,and it has good diagnostic sensitivity and specificity.

Objective To build an analytic hierarchy process (AHP) of the medical selection for the high performance fighter pilot. Methods According to the consulting results from aeromedical experts ,an AHP model and expert′s judgment matrix were built and checked upon the consistency. Then ,the relative weights of evaluation indexes were calculated.The method was preliminarily applied in the medical selection of high performance fighter pilot. Results An AHP evaluation model of medical selection for high performance fighter pilot was constructed ,including 5 first level indexes of basic physiological function , flight physiological endurance , psychological basis , mental ability , physical fitness and ergonomics ,and 23 second level indexes.The relative weights of 5 first level indexes were 0.172 8 ,0.224 1 ,0.178 5 ,0.289 1 and 0.135 5 corresponding to basic physiological function ,flight physiological endurance , psychological basis , mental ability , physical fitness and ergonomics.The model was applied to comprehensively evaluate the physiological and psychological indexes of 16 hight performance fighter pilot candidates.The scores in turn from high to low were 7.79 ,7.45 ,7.24 ,7.17 ,7.15 ,6.92 ,6.81 ,6.59 ,6.24 ,6.02 ,5.96 ,5.85 ,5.83 ,5.71 ,5.26 and 5.20. Conclusions The AHP provides new method and reference to high performance fighter pilot selection and the application accumulates data and experience for other objective evaluation researches.

Objective To provide objective basis to the authorities for making health policies and aeromedical support measures by investigating the disease spectrum and its variations of the Air Force flying personnel who are grounded by medical reasons. Methods The data of the medical grounding flying personnel of Air Force ,that were collected by the cluster sampling from January 1st , 1987 to December 31st ,2002 ,were retrospectively investigated.The database entry was completed by EpiData 3.0 and the double entry verification was used to ensure the quality.Data collation and statistical analysis were conducted by Excel 2003 and SPSS 11.5. Results ①From 1987 to 2002 ,the youngest age of medical grounding flying personnel of Air Force was 22 years old ,the oldest age was 52 years old ,and the average age was 33.42 years old.The number of the grounding personnel younger than or equal to 35 years old accounted for 62.98%,while the personnel older than 40 years old for 13.89%.②The most common disease that caused the grounding from 1987 to 2002 was neuropsychiatric disease ,that was 164.61 times of the blood system disease which ranked 12th in spectrum.③The top ten diseases in the spectrum of the single disease that caused the grounding from 1987 to 2002 were headache ,syncope ,neurasthenia ,gastric ulcer ,viral hepatitis B ,hypertension , chronic gastroenteritis ,deaf ,ear barometric dysfunction and refractive errors.The composition ratio of top 10 diseases accounted for 58.24%.The top three were functional diseases. Conclusions The medical grounding flying personnel of Air Force show a trend to younger age.Functional diseases account for high proportion.Both flying personnel and aeromedical support personnel should pay attention to these.Taking preventive measures and strengthening the medical interventions are suggested.

Objective To build an analytic hierarchy process (AHP) of the medical selection for the high performance fighter pilot. Methods According to the consulting results from aeromedical experts ,an AHP model and expert′s judgment matrix were built and checked upon the consistency. Then ,the relative weights of evaluation indexes were calculated.The method was preliminarily applied in the medical selection of high performance fighter pilot. Results An AHP evaluation model of medical selection for high performance fighter pilot was constructed ,including 5 first level indexes of basic physiological function , flight physiological endurance , psychological basis , mental ability , physical fitness and ergonomics ,and 23 second level indexes.The relative weights of 5 first level indexes were 0.172 8 ,0.224 1 ,0.178 5 ,0.289 1 and 0.135 5 corresponding to basic physiological function ,flight physiological endurance , psychological basis , mental ability , physical fitness and ergonomics.The model was applied to comprehensively evaluate the physiological and psychological indexes of 16 hight performance fighter pilot candidates.The scores in turn from high to low were 7.79 ,7.45 ,7.24 ,7.17 ,7.15 ,6.92 ,6.81 ,6.59 ,6.24 ,6.02 ,5.96 ,5.85 ,5.83 ,5.71 ,5.26 and 5.20. Conclusions The AHP provides new method and reference to high performance fighter pilot selection and the application accumulates data and experience for other objective evaluation researches.

Objective To provide objective basis to the authorities for making health policies and aeromedical support measures by investigating the disease spectrum and its variations of the Air Force flying personnel who are grounded by medical reasons. Methods The data of the medical grounding flying personnel of Air Force ,that were collected by the cluster sampling from January 1st , 1987 to December 31st ,2002 ,were retrospectively investigated.The database entry was completed by EpiData 3.0 and the double entry verification was used to ensure the quality.Data collation and statistical analysis were conducted by Excel 2003 and SPSS 11.5. Results ①From 1987 to 2002 ,the youngest age of medical grounding flying personnel of Air Force was 22 years old ,the oldest age was 52 years old ,and the average age was 33.42 years old.The number of the grounding personnel younger than or equal to 35 years old accounted for 62.98%,while the personnel older than 40 years old for 13.89%.②The most common disease that caused the grounding from 1987 to 2002 was neuropsychiatric disease ,that was 164.61 times of the blood system disease which ranked 12th in spectrum.③The top ten diseases in the spectrum of the single disease that caused the grounding from 1987 to 2002 were headache ,syncope ,neurasthenia ,gastric ulcer ,viral hepatitis B ,hypertension , chronic gastroenteritis ,deaf ,ear barometric dysfunction and refractive errors.The composition ratio of top 10 diseases accounted for 58.24%.The top three were functional diseases. Conclusions The medical grounding flying personnel of Air Force show a trend to younger age.Functional diseases account for high proportion.Both flying personnel and aeromedical support personnel should pay attention to these.Taking preventive measures and strengthening the medical interventions are suggested.