OBJECTIVE: To explore the relationship between high altitude polycythemia (HAPC) and peptic ulcer bleeding, in order to provide the evidence for the clinical diagnosis and treatment of peptic ulcer disease in Tibet of China. METHODS: A retrospective case-control study was conducted. Patients who hospitalized in the Department of Gastroenterology with the diagnosis of peptic ulcer bleeding from January 1, 2015 to April 30, 2021 in Tibet Autonomous Region People's Hospital were enrolled in the case group, and patients who hospitalized in the Department of Urology without tumor and without the history of peptic ulcer and gastrointestinal bleeding during the same period were selected as the control group. In the study, 1 ∶ 1 case matching was conducted between the two groups according to the gender, age (±2 years), ethnic group (Tibetan, Han), and the residence altitude level (grouped by < 4 000 m or ≥4 000 m), and 393 cases were included in the case group and the control group respectively. All the patients had lived in Tibet with the altitude >2 500 m for more than 1 year, and with age ≥ 18 years. The risk factors of peptic ulcer bleeding (place of residence, smoking, alcohol, the use of NSAIDs/anticoagulants, and combined with chronic diseases, such as HAPC, hypertension, diabetes mellitus, heart disease, hyperlipidemia, cerebrovascular disease, chronic lung disease, joint disease) were analyzed and compared between the two groups. RESULTS: There were 28 (7.1%) patients with HAPC in the case group, and 5 (1.3%) in the control group. The incidence of HAPC in the case group was significantly higher than those in the control group, P < 0.001, and the OR value was 5.953. Multivariate Logistic regression analysis showed that HAPC (OR=5.270, 95%CI: 1.806-15.380), living in cities and towns (OR=2.369, 95%CI: 1.559-3.602), alcohol (OR=3.238, 95%CI: 1.973-5.317) and the use of NSAIDs/anticoagulants (OR=20.584, 95%CI: 2.639-160.545) were the independent risk factors for peptic ulcer bleeding in Tibet. After adjusting for the possible confounding factors, such as living in cities and towns, alcohol, and the use of NSAIDs/anticoagulants, HAPC was associated with an increased risk of peptic ulcer bleeding in Tibet, and the OR value was 5.270. CONCLUSION HAPC was associated with a significantly increased risk of peptic ulcer bleeding in Tibet. Patients with HAPC and peptic ulcer should be diagnosed and treated actively, in order to avoid gastrointestinal bleeding and other serious complications.
Adolescent ; Altitude ; Case-Control Studies ; Humans ; Peptic Ulcer/epidemiology* ; Polycythemia/epidemiology* ; Retrospective Studies ; Risk Factors

OBJECTIVETo analyze the relationship between neonatal hypoxia and polycythemia and to study clinical characteristics of Tibetan neonates whose family lived in Tibetan plateau for generations and Han neonates whose family moved to the plateau.

METHODFrom Jan. 2005 to Oct. 2006, totally 739 patients were hospitalized in the ward of neonatology of the hospital. Of these patients, 40 (20 were Tibetan and the other 20 were Han) with neonatal polycythemia. The clinical features, transcutaneous oxygen saturation (TcSO₂), peripheral routine tests and myocardial enzyme profile were studied.

RESULTThe values of hemoglobin (Hb), hematocrit (HCT), and erythrocyte count (RBC) of the Han neonates were significantly higher than those of the Tibetan newborns. Han neonates with polycythemia had lower TcSPO₂ than Tibetan neonates (P < 0.01). Comparison of myocardial enzymes showed that Han neonates had higher CKMB than that of Tibetan groups before treatment (P < 0.01), troponin was not significantly different between the Han and Tibetan groups before treatment (P > 0.05). The major common clinical manifestations of the Han and Tibetan newborns were tachypnea, cyanosis, irritability, weak reflexes and hypoxemia. The Han neonates additionally had poor responses, apnea, lower muscle tone, confusion and asphyxia.

CONCLUSIONThe clinical characteristics, TcSO₂, peripheral blood routine tests and myocardial enzyme profile are helpful in diagnosis and treatment of neonatal polycythemia. Newborn infants born to mothers who moved to the plateau area may be more susceptible to neonatal polycythemia and are prone to impairments of other organs, esp. the functions of the heart and brain.

Altitude ; Altitude Sickness ; epidemiology ; ethnology ; Cardiomyopathies ; epidemiology ; ethnology ; Erythrocyte Count ; Ethnic Groups ; Female ; Hematocrit ; Hemoglobins ; analysis ; Humans ; Hypoxia ; epidemiology ; ethnology ; Infant, Newborn ; Male ; Polycythemia ; epidemiology ; ethnology

BACKGROUNDPolycythemia vera (PV) is a malignant disorder of hemaopoietic stem cells which is characterized by clonal hyperproliferation and a low rate of apoptosis. This study was to assess endogenous erythroid colony (EEC) formation in the bone marrow of PV patients and determine its clinical significance.

METHODSThe bone marrow mononuclear cells of 26 patients with PV, 2 patients with secondary erythrocytosis (SE), and 19 normal controls were cultured by Marsh's method for EEC evaluation, and the clinical significance was evaluated.

RESULTSEECs appeared in 25 patients with PV but not in 2 patients with SE and 19 normal controls. The number of EECs and the EEC ratio [EEC/erythropoietin (EPO)-dependent colony forming unit-erythroid (CFU-E)] in PV patients positively correlated with hemoglobin (Hb) levels. Their EEC number did not correlate with white blood cell (WBC) counts, platelet (PLT) counts, or leukocyte alkaline phosphatase (LAP) scores. Their EEC did not correlate with serum EPO levels. Fifteen patients with PV were treated with hydroxyurea (Hu) and/or interferon-alpha (IFN-alpha). Their EEC ratio before treatment positively correlated with the treatment time required for complete remission (CR) and negatively correlated with the time before relapse. The EEC numbers of 7 PV patients treated with Hu/IFN-alpha decreased after the blood cell counts dropped to normal levels. There was a positive correlation between the EEC ratio and the incidence of attacks of vascular thrombosis in PV patients. The numbers of apoptosised bone marrow mononuclear cells in PV patients were lower than those in normal controls. The EEC numbers of PV patients negatively correlated with the rate of apoptosis of bone marrow mononuclear cells.

CONCLUSIONSEEC formation is characteristic in PV patients. EEC number in PV patients positively correlates with Hb levels, the time required for CR, and the incidence of attacks of vascular thrombosis. EEC number negatively correlates with the time before relapse. Bone marrow suppressive treatment might decrease EEC number. Thus, EEC number is a sensitive and specific parameter reflecting the abnormal hematopoietic clone burden induced by polycythemia vera. EEC number is an important diagnostic parameter for PV patients.

Adult ; Aged ; Apoptosis ; Colony-Forming Units Assay ; Erythroid Precursor Cells ; physiology ; Erythropoiesis ; Erythropoietin ; blood ; Female ; Humans ; Male ; Middle Aged ; Polycythemia Vera ; blood ; therapy ; Thrombosis ; epidemiology

A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.
Adult ; Aged ; Androgens/adverse effects* ; Drug Implants ; Hematocrit ; Hormone Replacement Therapy/methods* ; Humans ; Hypogonadism/drug therapy* ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Polycythemia/epidemiology* ; Retrospective Studies ; Testosterone/adverse effects*