Objective To investigate the impact of high altitude on human gastric mucosa and its underlying mechanisms. Methods Twenty-five native Tibetans with chronic mountain sickness CMS residing at high altitude (4500 m) were examined for ultrastrueture and pathological changes of gastric mucosa. The other 25 native Tibetans residing at low altitude (＜2000 m) were served as control.The expression of hypoxia-inducible factor (HIF)-1α in human gastric mucosa was detected with immunohistochemistry. Results The color of gastric mucosa presented dark in patients with CMS.The histopathological examination showed significant differecnce in incidence of cnronc body gastritis and atrophic gastritis between CMS group and control group (P＜0. 05). The transmission electronic microscopy revealed that the epithlieal cells of gastric mucosa were impared in CMS group compared to control group. The expression of HIF-1α protein was increased in CMS group in comparison of control group (102.94± 34.04 vs 14.04 ± 6.53, P＜0.05). Conclusions The high altitude may involve in damage of gastric mucosa and the up-regulation of HIF-1α protein may involve in its mechanism.

Objective:To report the clinical outcome of finger replantation in Tibetan plateau.Methods:From August, 2018 to August, 2019, a total of 12 patients with 15 amputed digits treated in the Department of Emergency of Lasa People’s Hospital. All these cases were performed replantation without exclusion, including 4 cases of machine-mangled injury, 3 cases of steel rope crushing injury, 4 cases of electric saw injury, and 1 case of rotation avulsed injury. Replantations were performed under microscope by a fresh team of microsurgery surgeons. Antibiotics, anticoagulants and vasodilators were prescribed postoperatively. Application of oxygen inhalation through nasal tube and warm room temperature were advised. Tabaco and coffin were strictly forbidden postoperatively. All patients were regular followed-up after operation.Results:Twelve out of total 15 amputed digits successfully replanted, 3 digits turned to necrosis eventually. The survival rate was 80% (12/15). All cases were followed up for 4-16 months. According to the Functional Evaluation Standard of Replantation by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 3 digits, good in 7 digits, fair in 1 digit, poor in 4 digits. The excellent and good rate was 66.6%(10/15).Conclusion:In this group, the survival rate and excellent and good rate of finger replantation in Tibetan plateau is unexpected high. Thus, it is deducible that digit amputation can be successfully replanted with good functional result when meticulous microsurgical techniques are applied, although the unique adverse factors of Tibetan plateau exist.

Objective To analyze the etiological or associated factors and the treatment of patients with atrial fi brillation in high altitude areas in Tibet. Methods The clinical data of atrial fi brillation patients hospitalized in our hospital during January 2012 to Jane 2016 were analyzed retrospectively. Results (1) A total of 442 patients (male:female,1.2:1) were included in the study with ages of 30-96(65.9±12.3) years. The percentages of paroxysmal, persistent and permanent atrial fi brillation were 14.9%, 69.2%, and 15.8% respectively. The associated factors of atrial fi brillation included hypertension (53.4%), rheumatic heart disease (7.5%),chronic mountain sickness (10.6%), coronary heart disease(5.7%), hyperthyroidism (6.1%) and diabetes (9.0%).(2)Only 42 patients (9.5%) had evaluation with CHADS2score during hospitalization and actually 74.6% patients scored≥2. Twenty-one patients were restored to sinus rhythm during hospitalization and no patients had radiofrequency ablation.Conclusions The associated factors of atrial fi brillation in high altitude areas are similar to other areas. Thrombosis risk evaluation and anticoagulation therapy was not sufficient. Rhythm control rate was low and development of radio frequency ablation therapy should be considered.

ObjectiveTo investigate the clinical features of postpartum hemolytic uremic syndrome (PHUS) in Tibetan women, and to improve the diagnosis and treatment of PHUS.MethodsFrom January 2013 to June 2018, 11 patients diagnosed with PHUS in the Tibet Autonomous Regional People's Hospital were enrolled. Clinical manifestations, laboratory testing results, treatments and outcomes were retrospectively analyzed. A descriptive statistical analysis was applied in this study.ResultsThe average age of the 11 patients was (27.0±6.2) years old, and all were Tibetans. Five of them delivered by cesarean section and eight complicated by hypertension. The onset of PHUS was 1-3 d after delivery. The mean hemoglobin concentration [(73.5±26.3) g/L] and platelet count [(51±31)×109/L] remarkably decreased. Patients' renal functions were also significantly impaired with an average serum creatinine level of (517±184)μmol/L. Nine women required hemodialysis, seven received plasma infusion and six underwent glucocorticoid therapy. No patients received plasma exchange or eculizumab therapy due to limited resources. Seven out of the nine patients who underwent hemodialysis could withdraw from dialysis.ConclusionsPHUS is relatively rare, and characterized by acute onset after birth and severe conditions, especially renal injury. However, most patients would have better prognosis after active treatment.