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 evaluate the clinical efficacy and prognostic factors in multiple myeloma (MM) patients treated with autologous hematopoietic stem cell transplantation (auto-HSCT). 【Methods】 The clinical data of 155 MM patients newly diagnosed and suitable for transplantation in our hospital from 2014 to 2021 were retrospectively analyzed. They were divided into auto-HSCT group and non-auto-HSCT group according to the treatment mode. The clinical efficacy, overall survival (OS) and progression-free survival (PFS) of the two groups were compared. Furthermore, the prognostic factors of auto-HSCT group were analyzed. 【Results】 ① There were 51 patients in auto-HSCT group and 104 patients in non-auto-HSCT group. There was no statistical difference in baseline characteristics except age between the two groups. ② Hematopoietic reconstruction was achieved in all patients in auto-HSCT group, and no transplantation-related mortality was found. ③ The clinical efficacy of pre-and post-transplantation was compared in auto-HSCT group. sCR/CR rate was significantly increased after transplantation (P=0.041). The effective remission rate (≥VGPR) was also higher (P=0.05). As for the best efficacy, sCR/CR rate and effective remission rate were both significantly higher in auto-HSCT group than in non-auto-HSCT group (P=0.001). ④ In auto-HSCT group, by the end of follow-up, the median OS was not reached, the median PFS was 30.5 months, and 3-year OS and PFS was 87% and 40.3%, respectively. In non-auto-HSCT group, the median OS was 61 months, the median PFS was 21 months, and 3-year OS and PFS was 65.3% and 33.1%, respectively. It indicated that OS was significantly prolonged in auto-HSCT group (P=0.004). PFS was also prolonged but without significant difference (P=0.065). ⑤ Analysis of prognostic factors in auto-HSCT group showed that decreased PLT (P=0.038) and increased serum-adjusted calcium (P=0.017) were independent risk factors for OS, decreased PLT (P=0.005), female (P=0.018) and disease status of PR or worse before transplantation (P=0.012) were independent risk factors for PFS. 【Conclusion】 Auto-HSCT can improve the remission rate, prolong OS in MM patients, and possibly prolong PFS. Increased serum-corrected calcium and decreased PLT are independent prognostic factors for OS in patients treated with auto-HSCT. Decreased PLT, female, and disease status of PR or worse before transplantation are independent prognostic factors for PFS.