The Tibet Autonomous Region (hereinafter referred to as Tibet) is located on the border of the country, with a harsh natural environment and an average elevation of over 4 000 meters. Currently, the total permanent population of the region is about 3.65 million, distributed over 1.2 million square kilometers of land. The land is vast and sparsely populated, making it extremely difficult to allocate medical resources. The above objective reasons make it difficult for patients in Tibet to seek medical treatment in a timely manner, and there are multiple complications when seeking medical treatment. In terms of inguinal hernia disease, the proportion of patients with inguinal incarcerated hernia is relatively high. Due to poor medical conditions, patients have poor awareness of seeking medical treatment, and lack of understanding of the disease, leading to serious complications and even death caused by inguinal incarcerated hernia. With the releasing of clinical guidelines, advances in equipment and materials, and updates in treatment concepts and anatomical understanding, laparoscopic inguinal hernia repair has been vigorously promoted. The promotion of new medical technologies in Tibet is relatively lagging behind. In recent years, with the strong support of the China Hernia Society and the Chinese Hernia Collegen of Surgeons, minimally invasive treatment related to hernia disease has been promoted in Lhasa since 2016, especially for inguinal hernia. At present, minimally invasive technology for treating inguinal hernia has been widely promoted to tertiary hospitals in Tibet. Through publicity, patients can seek medical attention in a timely manner, significantly reducing the incidence of inguinal incarcerated hernia. Based on litera-tures and clinical practice, the authors explore the promotion, application, and historical significance of minimally invasive surgery for hernia in Tibet.

Objective To analyze probable risk factors to Henoch-Sch?nlein purpura (HSP) in Tibetan children so as to bring evidences for correct identification of high-risk children in plateau areas. Methods 140 high-altitude Tibetan children with HSP admitted to Shannan People's Hospital of Tibet Autonomous Region from October 2015 to October 2018 were enrolled, and 140 high-altitude Tibetan healthy children and 140 plain area HSP children were selected as the control. Gender, age, family history, allergy, past history (rheumatic disease, autoimmune disease, asthma), clinical phenotype, biochemical markers (antibody positive rate, platelet count and hemoglobin), clinical efficacy and recurrence were retrospective analyzed. The risk factors of HSP in the high-altitude Tibetan children were analyzed by univariate and multivariate Logistic regression analysis. Results It was shown by univariate analysis that the proportion of allergic history and past history of high-altitude HSP children was higher than those of high-altitude healthy children (allergic history: 35.7% vs. 11.4%, past history: 21.4% vs. 5.7%, both P < 0.05). Compared with plain area HSP children, the age of high-altitude HSP children was increased (years old: 6.5±2.3 vs. 5.3±2.2), the clinical phenotype was more complex (37.9% vs. 57.1% for simple skin and limb type, 21.4% vs. 14.3% for abdominal type, 28.6% vs. 21.4% for renal type, 7.1% vs. 5.0% for brain or lung type, 5.0% vs. 2.2% for complex type), the positive rate of antibody was increased (64.3% vs. 50.0%), platelet count was decreased (×109/L: 116.2±12.3 vs. 176.8±35.4), hemoglobin level was increased (g/L: 125.6±15.7 vs. 113.8±10.9), recurrence rate was lower (4.3% vs. 10.7%), and the difference was statistically significant (all P < 0.05). It was shown by multivariate Logistic regression analysis that age, allergic history and past history were independent risk factors for HSP in high-altitude Tibetan children [age: odds ratio (OR) = 1.263, 95% confidence interval (95%CI) = 1.063-1.968; allergic history: OR = 1.765, 95%CI = 1.326-2.452, past history: OR =1.421, 95%CI = 1.102-2.232, all P < 0.05]. Clinical phenotypic and biochemical indexes were important risk factors affecting the clinical efficacy of high-altitude Tibetan HSP children (non-simple skin and limb type: OR = 2.123, 95%CI =1.623-2.869; antibody positive: OR = 1.865, 95%CI = 1.502-2.768; both P < 0.05). Conclusions It is different of HSP occurrence in Tibetan children from plateau and plain areas. Attention should be paid to screening age, allergy history, past history, clinical phenotype, antibody positive and other high risk children. Early and effective intervention can improve clinical curative effect and reduce recurrence.

OBJECTIVE: To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area. METHODS: From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard. RESULTS: The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up. CONCLUSION Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.
Male ; Female ; Humans ; Child ; Child, Preschool ; Adolescent ; Bone Wires ; Forearm ; Altitude ; Treatment Outcome ; Fractures, Bone/surgery* ; Fracture Fixation, Internal/methods* ; Radius Fractures/surgery* ; Fracture Fixation, Intramedullary/methods*