Objective To compare the efficacy of operative and non-operative methods in the treatment of severe thoracic trauma in Tibetan Plateau.Methods A retrospective case-control study was conducted to analyze 286 patients with severe thoracic trauma admitted to the Shigatse People's Hospital from August 2016 to October 2018.There were 206 males and 80 females,aged 13-71 years [(34.3 ±11.6) years].The duration from injury to hospital ranged from 2 to 49 hours [(22.8 ± 8.3) hours].The causes of injury including fall from height in 109 patients,traffic injury in 98,crush injury in 32,blunt injury in 29,cattle head injury in 9,knife stab injury in 6 and other causes in 3.The injury severity score (ISS) varied from 16 to 48 points on admission [(24.2 ± 8.8) points].A total of 159 patients underwent operation (Operation group) and 127 patients underwent non-operative treatment (Non-operation group).The ISS score was (25.2 ± 8.3)points in Operation group and (23.7 ±7.9)points in Non-operation group.The length of hospital stay,intensive care unit (ICU) care time,complication rate and mortality were recorded in two groups.The correlation of ISS and age with mortality was investigated.Results The length of hospital stay was (12.2 ± 3.8) days in the Operation group and (19.7 ± 5.8) days in the Non-operation group (P ＜ 0.05).In the Operation group,27 patients were admitted to the ICU and stayed for (4.7 ± 1.3)days,and in the Non-operation group 33 patients were admitted to the ICU and stayed for (11.7 ± 3.2) days (P ＜ 0.05).The complication rate was 17.6％ in the Operation group and 31.5％ in the Non-operation group (P ＜0.05).Two patients died in the Operation group,with the mortality rate of 1.3％;six patients died in the Non-operation group,with the mortality rate of 4.7％,with no statistical difference (P ＞ 0.05).There were statistically significant differences in the age of death between the Operation group and the Non-operation group (P ＜ 0.05).The differences in the ISS score and age between the survival and death patients within the two groups were statistically significant (P ＜0.05).Logistic regression analysis showed age (OR =1.090,95％ CI 1.002-1.186) and ISS (OR =1.058,95％ CI 1.027-1.090) were slqnificantly related to mortality.Conclusions For severe thoracic trauma in Tibetan Plateau,operative treatment can shorten the length of hospital stay and ICU care time and reduce the incidence of complications.The mortality ratio of the two groups has no significant difference.Age and ISS may be the high risk factors for death of severe thoracic trauma patients.

Objective:To study the clinical characteristics and management strategies of patients with chronic obstructive pulmonary disease (COPD) in high-altitude areas.Methods:An observational cross-sectional study was conducted in 79 stable COPD patients who visited the outpatient of Respiratory Medicine at Tibet Autonomous Region People′s Hospital and Peking University Third Hospital from August 3 rd 2020 to November 30 th 2020. Patients were divided into Lhasa group ( n=44) and Beijing group ( n=35). The differences of clinical characteristics including demographic characteristics, risk factors, respiratory symptoms, comorbidities, medications and spirometry were analyzed. Further comparative analysis was conducted on the clinical characteristics of smokers ( n=15) and non-smokers ( n=29) in Lhasa group. Results:The proportion of female patients and biofuel exposure in Lhasa group was significantly higher than Beijing group (56.8% vs 0, 86.4% vs 0, both P<0.001). The proportion of smokers in Lhasa group was significantly lower than Beijing group (34.1% vs 100%, P<0.001). The mean score of COPD assessment test (CAT) in Lhasa group was significantly higher than Beijing group (21.27 vs 9.17, P<0.001). The proportion of acute exacerbations ≥2 in the past year in Lhasa group was significantly higher than Beijing group (31.8% vs 11.4%, P=0.032). The median percentage of forced vital capacity in the first second of predicted value (FEV 1%pred) of patients in Lhasa group was significantly higher than Beijing group (63% vs 38%, P<0.001). The proportion of patients treated by inhaled corticosteroid/long-acting β 2-agonist (ICS/LABA) and inhaled long-acting muscarinic antagonists (LAMA) in Lhasa group was significantly lower than Beijing group (4.5% vs 60.0%, 0 vs 65.7%, both P<0.001). There were no significant differences in CAT score, number of acute exacerbations in the past year and lung function between smokers and non-smokers in Lhasa group. Conclusions:Compared with those patients in Beijing, the majority of patients with COPD living in Lhasa are female, with a low proportion of smokers and a high proportion of biofuel exposure. Although their lung function is better, their respiratory symptoms are more severe with more acute exacerbations in the past year, and most patients do not receive standardized medication.

Objective:To observe and evaluate the safety and efficacy of anti-vascular endothelial growth factor (VEGF) in the treatment of eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in Lhasa, Tibet.Methods:A retrospective case series. From September 2018 to January 2022, a total of 41 patients (41 eyes) with BRVO-ME, who were diagnosed in Department of Ophthalmology of Tibet Autonomous Region People’s Hospital, were included in this study. There were 21 eyes in 21 males and 20 eyes in 20 females. The median age was 53 (31,75) years. There were 24 patients with hypertension (58.8%, 24/41). Best corrected visual acuity (BCVA), ocular pressure, fundus color photography and optical coherence tomography (OCT) were performed in all eyes. The BCVA was performed using the international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The foveal macular thickness (CMT) was measured by OCT. All eyes were treated with intravitreous injection of anti-VEGF drugs, once a month, among which 23 eyes (56.1%, 23/41) received intravitreous injection of ranibizumab (IVR), and 18 eyes (43.9%, 18/41) received intravitreous injection of conbercept (IVC), and were grouped accordingly. There was no significant difference in age ( Z=-0.447), gender composition ( Z=-0.485), logMAR BCVA ( t=-1.591), intraocular pressure ( t=-0.167) and CMT ( t=-1.290) between two groups ( P>0.05). During the follow-up, the same devices and methods were used at baseline to perform relevant examinations, and the changes of BCVA, intraocular pressure, CMT and new cardiovascular and cerebrovascular events were compared between baseline and the last follow-up. logMAR BCVA, intraocular pressure and CMT were compared between baseline and last follow-up using Student t test. The comparison of injection times and follow-up time between IVR group and IVC group was conducted by Mann-Whitney U test. Results:At baseline, logMAR BCVA, intraocular pressure, and CMT were 0.852±0.431, (12.5±2.5) mm Hg (1 mm Hg= 0.133 kPa), and (578.1±191.1) μm, respectively. At the last follow-up, the number of anti-VEGF drug treatments was (2.7±1.2) times; logMAR BCVA and CMT were 0.488±0.366 and (207.4±108.7) μm, respectively, with CMT > 250 μm in 14 eyes (34.1%, 14/41). Compared with baseline, BCVA ( t=4.129) and CMT ( t=-0.713) were significantly improved, with statistical significance ( P<0.001). The injection times of IVR group and IVC group were (2.6±0.9) and (3.0±1.5) times, respectively. There were no significant differences in the number of injection times ( t=-1.275), logMAR BCVA ( t=-0.492), intraocular pressure ( t=0.351) and CMT ( t=-1.783) between the two groups ( P>0.05). No new hypertension, cardiovascular and cerebrovascular events occurred in all patients during follow-up. At the last follow-up, there were no eye complications related to treatment modalities and drugs. Conclusion:Short-term anti-VEGF treatment can improve the visual acuity of BRVO secondary ME patients and alleviate ME in Lhasa, Tibet. The safety and efficacy of ranibizumab and conbercept were similar.

Hepatitis E virus (HEV) infection is a main global public health issue. HEV can be zoonotically transmitted across species, and swine is recognized as a major reservoir of HEV. However, information is lacking on the prevalence of HEV infection in Tibet of China, where raw pork and mixed farming of different species of domestic animals are consumed traditionally. In this study, swine serum was collected for HEV IgM and IgG antibodies test from five regions in Tibet of China. Meanwhile, HEV RNA was detected in swine sera. HEV has a high prevalence trend in Tibetan swine. Swine serum anti-HEV IgM antibody positive rate was as high as 7.6%, the positive rate of anti-HEV IgG antibody was 1.8%, the positive rate of HEV RNA also was 7.6%, the virus titers in serum was above 1.7×10⁷ copies/mL, and there were different epidemic trends in five regions. In conclusion, antibody detection and RNA detection showed that swine in Tibet had a higher incidence of HEV infection. HEV infection in Tibetan swine is more serious and management should be strengthened to avoid cross-infection between humans and animals and outbreaks in Tibet.

Altitude ; China/epidemiology* ; Community-Acquired Infections/epidemiology* ; Humans ; Pneumonia/etiology* ; Tibet