Background The improvement of the eye care system has being a strong guarantee for blindness prevention.However,medical resources of eye care in Tibet autonomous region cannot jet meet the effective requirement.Knowing the present situation of medical resources of eye care in Tibet can help reasonably allocate scarce medical resources.Objective This survey was to understand the status of eye care in Tibet area.Methods A questionnaire-based study was performed in Lhasa from April 2016 to June 2016,human resources,equipments were issued toward to all level of medical structures and answered by eye doctors.Results The coverage of the questionnaires was 100％ in Tibe area,and the effective response rate was 100％.Up to 2015,Tibet autonomous region had a total of 21 medical institutions with eye clinical ability with 1/151 000 per capita according to the Tibetan population released by national statistics bureau in 2014 and without any eye hospitals or eye clinics.In the 21 medical hospitals,19 (90.5％) had professional eye doctors,13 (61.9％) had independent eye departments,and 11 (52.4％) had operating room special for eye surgeries.One hundred and twenty ward beds were set in Tibet,and 1.6 eye doctors served in average for 100 000 Tibetan.Only 3 eye doctors with master degree and 14 eye nurses in Tibet area.There were a few elementary diagnostic and surgical instruments with an average of 326.2 eye simple operations in 2015.Conclusions The human resources and equipments as well as instruments are still insufficient for eye care in Tibet autonomous region,particularly in community-and county-level.

This study was aimed to observe the therapeutic effect of liver cirrhosis treated with Tibetan medicine . A total of 70 liver cirrhosis identified cases were orally administrated with Tibetan medicine for 45 days. The results showed that the cure rate, improvement rate, ineffective rate, and total effective rate were 24 . 29% ( 17/70 ) , 67 . 14% ( 47/70 ) , 8 . 57% ( 6/70 ) , and 91 . 43%. There were no significant differences on the routine tests of blood , urine , stool and renal function before and after the treatment . It was concluded that Ti-betan medicine has unique therapeutic effects in the treatment of liver cirrhosis without any obvious poisonous or side effect .

Objective:To explore the effect of MOOC in Tibetan medical physiology teaching.Methods:According to the different implementation of teaching mode, 65 clinical undergraduate students of Batch 2017 in Medical College of Tibet University were randomly divided into MOOC teaching group (22 students), MOOC PBL teaching group (21 students) and traditional teaching group (22 students). The test scores and teaching evaluation scores of the three groups were compared, and the teaching evaluation scores of MOOC team among the three teaching modes were compared. SPSS 25.0 was used for statistical analysis, and One-Way ANOVA was used to compare the three groups of data.Results:The scores of the main questions and the total scores of the classroom test from high to low were: MOOC PBL teaching group, MOOC teaching group and traditional teaching control group. Except for multiple-choice questions and fill-in-the-blank questions, the scores of other questions and total scores were all statistically significantly different ( P<0.05). The scores of students on interest in learning, learning initiative, knowledge memory, classroom situation, learning efficiency and the total score of teaching evaluation ranked from high to low were: MOOC PBL teaching group, MOOC teaching group and traditional teaching group ( P<0.05). In contrast, the scores of students on teaching interaction and classroom management in traditional teaching group were higher than those in MOOC PBL teaching group and MOOC teaching group ( P<0.05). The scores of MOOC teaching team on saving time, saving materials, teaching efficiency, learning goal achievement, students' acceptance, improving learning interest, learning initiative and total score of teaching effect from high to low were: MOOC PBL teaching group, MOOC teaching group and traditional teaching group ( P<0.05). Conclusion:The application of MOOC can improve the teaching effect and quality of the physiology teaching for medical students in Tibet.

Objective To monitor the situation of iodine deficiency disorders (IDD) in Tibet,and to provide a background information of iodine nutritional status of residents before adjustment of iodine concentration.Methods According to the method of population proportionate sampling (PPS),27 counties were selected to carry out IDD surveillance.One primary school was selected in each county.Forty children aged 8-10 from each primary school were sampled to examine thyroid volume,and edible salt samples were collected from their home to determine salt iodine.In addition,12 of the sampled children,15 pregnant women and 15 lactating women from three townships near the selected schools were chosen to detect urinary iodine.The methods of B-ultrasonography,oxidation-reduction titration (GB/T 13025.7-1999) and arsenic cerium catalytic spectrophotometry (WS/T 107-2006) were used to determine thyroid volume,salt iodine and urinary iodine,respectively.Results One thousand and eighty-one children aged from 8 to 10 were examined,and their goiter rate was 1.9％ (20/1 081).Seven hundred and fifty-eight salt samples were determined,and the median salt iodine level was 38.3 mg/kg and the consuming rate of qualified iodized salt was 88.1％(758/668).Meanwhile,urine samples of 522 children aged 8-10,267 pregnant women and 336 lactating women were also tested,and their median urinary iodine level was 166.1,132.7,138.1 μg/L,respectively.Conclusions The results show that the goiter rate and urinary iodine level of children aged from 8 to 10 have reached the national standard of IDD elimination (＜5％,100-300 μg/L),while the residents consumption rate of qualified iodized salt is still lower than the national standard (90％).In particular,the iodine nutrition of pregnant women is inadequate,which is lower than the national standard (urinary iodine 150 μg/L).It is still necessary to strengthen the monitoring of salt iodine as well as iodine nutrition in special groups in the future,and strengthen health promotion at the same time.

Objective To investigate the prevalence rate of hypertension among 30 to 70 years old Tibetan citizens in Lhasa municipality. Methods A total of 371 Tibetan men and women aged between 30 to 70 years old were included in this cross-sectional epidemiological study with simple random sampling from October to November 2006. All participants were requested to fill in a Standard questionnaire, blood pressure was measured, body mass index and waist and hip circumference ratio were calculated. Results The overall prevalence rate of hypertension was 40. 2%(36. 6% in men vs. 40. 9% in women, P=0.921). Prevalence rate of hypertension increased with age(r = 0. 995, P ＜ 0. 001). The age-standardized prevalence of hypertension was 37.6%(38. 0% in men and 37. 5% in women). Awareness rate of hypertension was 70. 9%, treatment rate of hypertension was 38. 1%, and control rate of hypertension was 2.4%. Conclusions There was a high prevalence rate and poor control rate of hypertension among 30 to 70 years old citizens of Lhasa. Intensive medical care aimed to better control of blood pressure should be applied to this population.

Objective:In order to establish a painless delivery detection system in plateau area, promote the concept of painless delivery, reduce the cesarean section rate, the clinical study of painless childbirth in Tibet was carried out.Methods:150 primiparas in Lhasa People's Hospital from January 2018 to Juen 2019 were prospectively collected, which were randomly divided into sufentanil and ropivacaine groups (group A, n=50) and fentanyl and ropivacaine (group B, n=50) and the control group without analgesia (group C, n=50); The general conditions of the patients before and after delivery were collected. The visual analogue scale (VAS) score was used to observe and record the delivery process and results. The Apgar score of newborns was performed, and the umbilical artery blood was taken for blood gas analysis. Results:The first and second stage of labor in group A and B were shorter than those in group C ( P<0.05); there was no difference in the third stage of labor and postpartum bleeding between the three groups ( P>0.05). The VAS scores of groups A and B were lower than that of group C ( P<0.05), while there was no difference between group A and group B ( P>0.05). There was no difference in pH value of umbilical artery blood between the three groups ( P>0.05). The umbilical artery blood PO 2 of group A and group B was higher than those of group C ( P<0.05), while there was no difference between group A and group B ( P>0.05). The umbilical artery blood PCO 2 of group A and group B was lower than that of group C( P<0.05), while there was no difference between group A and group B ( P>0.05). The cesarean section rate in group C was higher than that in groups A and B ( P<0.05). There was no difference in fetal heart rate, fetal distress, and neonatal asphyxia among the three groups ( P>0.05). There was significant difference in the overall incidence of adverse conditions in the three groups ( P<0.05). The Apgar scores of the newborns in groups A and B were higher than those in the C group at 1 min postpartum ( P<0.05), while there were no difference in the Apgar scores among the three groups at 5 and 10 min postpartum ( P>0.05). Conclusions:Painless delivery in plateau area can reduce the pain of delivery and the rate of cesarean section, and has high safety and reduce the adverse effects on mothers and infants, which is worthy of clinical promotion.

Objective: To explore the effects of internet-based quiz on pathophysiological teaching. Methods: undergraduates from two different classes (41 of batch 2107 from nursing and 49 of batch 2016 from pharmacy) taught by the same teacher were enrolled in the study and randomized into quiz group and control group to compare their teaching effect. Indexes evaluated were scores of midterm exam and final exam, students' teaching evaluation scores and teachers' self-evaluation scores. T test for data analysis was performed by SPSS 20.0. Results: the scores of each general question and the total scores of midterm exam in the quiz group were higher than those in the control group, with statistically significant differences (P<0.005), except for the scores of short-answer and discussion questions. The scores of each general question and the total scores of final exams in the quiz group were higher than those in the control group, with statistically significant differences (P<0.005). Scores of knowledge memory, learning efficiency, learning interest, learning activeness and students' evaluation for the same teacher in the quiz group were significantly higher than those in the control group. There were no significant differences between two groups in the scores of classroom management, teacher's professional ethics, teaching democracy, homework, teaching capacity and teaching interaction. When using these two teaching methods, the scores of teachers for comprehending students' study, motivating students to study, saving working time, saving resources and teachers' self-evaluation in the quiz group were higher than those in the control group, with statistically significant differences (P<0.05). There were no statistical differences between two groups in the scores of classroom management, teacher's professional ethics, teaching democracy, homework, teaching capacity and teaching interaction. Conclusion Internet-based quiz is an effective way to improve students' study, so as to improve the teaching quality.

Objective To explore the status of iodine nutrition and iodine deficiency disorders in the pasturing areas and agricultural regions in Tibet. Methods 30 families were selected respectively in pastoral Dangxiong county and agricultural Qushui county of Lasa. Drinking water and edible salt were collected for testing the iodine contents. In each type of the following populations including children aged 8-10, women of child-bearing age and male adults, 50 subjects were randomly sampled to examine their urinary iodine contents. Among them, 50 children and 50 women were randomly selected for goiter examination by palpation. Results Water iodine content was less than 2μg/L, both in pasturing area and in agricultural areas. There was no iodized salt used in the families of pasturing areas, while 90% people consumed iodized salt in agricultural areas. The median of urinary iodine in pasturing area was 50.2 μg/L, significantly lower than that of agricultural area (193.2μg/L). However, the goiter rate of children and women in pasturing area was significantly lower than that in agricultural area. Conclusion Although iodine intake of populations in pasturing area of Tibet was severely deficient, there was no epidemic of Iodine Deficiency Disorders. This phenomenon noticed by the researchers deserved further investigation.

Objective:To investigate the clinical characteristics and surgical effects of acute calculous cholecystitis (ACC) in high altitude area of Tibet.Methods:The retrospective cohort study was conducted. The clinicopathological data of 182 ACC patients who underwent surgery in the 954th Hospital of Army from January 2016 to December 2020 were collected. There were 56 males and 126 females, aged (41±13)years. Of the 182 patients, 61 cases undergoing open cholecystec-tomy were divided into the open group, and 121 cases undergoing laparoscopic cholecystectomy (LC) were divided into the laparoscopic group. Observation indicators: (1) clinical characteristics of ACC in high altitude area; (2) surgical situations; (3) postoperative complications; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postopera-tive complications of patients up to October 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Results:(1) Clinical characteristics of ACC in high altitude area. Of the 182 patients, cases with symptom duration as <3 days, 3 days to 1 month, >1 month and ≤12 months, >12 months were 37, 43, 57, 45, respectively. Seventy-seven of the 182 patients were combined with other diseases before surgery. (2) Surgical situations. Two cases in the open group were found common bile duct stones during the operation, and underwent choledochotomy and T-tube drainage. Nine cases in the laparoscopic group were converted to laparotomy, including 3 cases with severe abdominal adhesion and ineffective hemostasis, 6 cases with anatomical variation of Calot triangle. The conversion to laparotomy rate was 7.438%(9/121). The other patients in the open group and the laparoscopic group completed surgery successfully. The operation time, volume of intraoperative blood loss, time to postoperative first out-of-bed activities, time to postoperative first flatus, cases with indwelling drainage tube, cases with acute simple cholecystitis, acute suppurative cholecystitis, acute gangrene cholecystitis, gallbladder perforation of disease pathological type, postoperative white cell count, postoperative neutrophil percentage, duration of postoperative hospital stay were (109±42)minutes, 50(45,100)mL, (16.1±1.5)hours, (31.4±11.9)hours, 33, 25, 27, 6, 3, (6.8±1.9)×10 9/L, 72.7%±7.4%, (7.3±1.7)days for the open group. The above indicators were (98±43)minutes, 20(20,50)mL, (12.9±1.4)hours, (26.7±12.1)hours, 51, 56, 51, 9, 5, (7.1±2.4)×10 9/L, 70.5%±8.7%, (6.4±1.7)days for the laparoscopic group. There were significant differences in the volume of intraopera-tive blood loss, time to postoperative first out-of-bed activities, time to postoperative first flatus, duration of postoperative hospital stay between the two groups ( Z=?6.75, t=14.41, 2.46, 3.45, P<0.05). There was no significant difference in the operation time, cases with indwelling drainage tube, diseases pathological type, postoperative white cell count, postoperative neutrophil percentage between the two groups ( t=1.66, χ2=2.33, 0.84, t=?0.71, 1.66, P>0.05). (3) Postoperative complica-tions. Postoperative complications occurred in 7 of the 61 patients in the open group and 5 of the 121 patients in the laparoscopic group. There was no significant difference in the postoperative complications between the two groups ( χ2=2.46, P>0.05). (4) Follow-up. Of the 182 patients, 115 cases including 35 cases in the open group and 80 cases in the laparoscopic group were followed up for 12(range, 3?24)months. During the follow-up, 1 case of the 35 patients in the open group had abdominal pain and jaundice, which was diagnosed as choledocholithiasis. The patient was improved after stone removal with endoscopic retrograde cholangiopancreatography. Two cases of the 35 patients in the open group had upper abdominal pain with fever and were improved after anti-infection treatment. Of the 80 patients in the laparoscopic group, 1 case had upper abdominal pain and 1 case had dyspepsia and anorexia, respectively. The two cases were improved after symptomatic treatment. Conclusions:Patients with ACC in the high altitude area of Tibet have high ratio of preoperative complications, long diseases history and high incidence rates of pyogenic perforation of the gallbladder. Patients with ACC in the high altitude area undergoing LC is safe and effective. Compared with open cholecystectomy, LC have less volume of intraoperative blood loss, faster postoperative recovery and shorter duration of postoperative hospital stay.

This paper is intended to analyze the driving force behind and main strategies for innovation and development of individual protective equipment in extreme environments by the U.S.Armed Forces,and outline the current develop-ments and representative achievements of individual protective equipment by the U.S.Armed Forces for environments of high altitude,extreme cold and extreme heat.It is recommended that the top-level design be adopted,physiological modeling and analysis technologies for big data be given more attention,key technologies be innovated,and intelligent,information-based and lightweight new individual medical protective equipment be developed with more effort.