Immune checkpoint inhibitors (ICIs) have made great progress in the field of oncology, becoming one of the indispensable therapeutic approaches. However, the hyperprogressive disease (HPD) following treatment, observed in a few patients, has raised widespread clinical concern due to its association with rapid disease deterioration. Despite the extensive researches on HPD in recent years, its definition, underlying mechanisms, predictive methods, and management strategies remain unclear. The indications of ICIs in gynecologic cancer were approved relatively later, and there were few reports and studies on HPD after immunotherapy. This article reviews the incidence, influencing factors, mechanisms, differentiation from pseudoprogression, prevention and management of HPD caused by ICIs and its occurrence in gynecologic cancer, in order to promote the research on HPD after ICIs treatment in gynecological malignant tumors, and provide reference and help for the safe application of ICIs in gynecological malignant tumors.

Immune checkpoint inhibitors (ICIs) have made great progress in the field of oncology, becoming one of the indispensable therapeutic approaches. However, the hyperprogressive disease (HPD) following treatment, observed in a few patients, has raised widespread clinical concern due to its association with rapid disease deterioration. Despite the extensive researches on HPD in recent years, its definition, underlying mechanisms, predictive methods, and management strategies remain unclear. The indications of ICIs in gynecologic cancer were approved relatively later, and there were few reports and studies on HPD after immunotherapy. This article reviews the incidence, influencing factors, mechanisms, differentiation from pseudoprogression, prevention and management of HPD caused by ICIs and its occurrence in gynecologic cancer, in order to promote the research on HPD after ICIs treatment in gynecological malignant tumors, and provide reference and help for the safe application of ICIs in gynecological malignant tumors.

In view of the problem of slow development of intensive care medicine in Xizang, the research team made full use of the national partner assistance to Xizang, gathered resources across all cities in Xizang, and formed a national academic platform for critical care medicine in plateau areas. Adhering to the academic orientation with hemodynamics as the main topic, critical care ultrasound as the bedside dynamic monitoring and evaluation method, and blood flow-oxygen flow resuscitation as the core connotation, we have achieved the goals of improving the critical care talent echelon throughout Xizang, driving the overall progress of intensive care medicine in Xizang, making a figure in China, and focusing on training of top-notch talents.

Objective To summarize the imaging findings of intracranial central nervous system(CNS)malformations children in the high-altitude plateau(Xigaze city).Methods We retrospectively reviewed the imaging data of the suspected patients having CNS malformations,which enrolled either by the clinic or by the ultrasound in the Shigatse People's hospital from June,2019 to June,2023.All imaging data were interpreted by two experienced radiologists with consensus reading.Imaging characteristics were recorded roughly by primary/secondary,supra-/subtentorial malformation type and the corresponding clinical symptoms.Results A total of 36 children were included in this study,including 19 patients≤1 year old(including 2 newborns),7 patients between 1 and 3 years old,and 10 patients>3 years old.Seven cases underwent MRI examination,others having CT scan.Polygyria and pachygyria malformation were the most common type of congenital neurological malformations(7 cases,31.8%),followed by cystic changes of the cerebral parenchyma(3 cases,13.6%).Cerebral atrophy was the most common type of secondary CNS abnormalities group(8 cases,57.1%),followed by communicative hydrocephalus(3 cases,21.4%).Five patients in the congenital group and 4 patients in the secondary CNS group had the complex malformations.There were 8 dead cases(all in the≤1-year-old group),12 cases having neurological sequelae,1 case with normal development and 15 cases with loss of follow-up.There were no significant differences between primary and secondary CNS group regarding the final outcome.Conclusion In this study,gyrus developmental malformation and encephalatrophy were the most common etiologies in infants'CNS malformations.Reasonable use of imaging modalities will help depict the complicated CNS malformations and design individual treatment.

Hepato-pancreato-biliary diseases (HPBD) are often complicated. The diagnosis and treatment of HPBD involve many disciplines. The malignant degree of hepatobiliary pancreatic system is high, and the prognosis of patients is poor. The multidisciplinary team (MDT) brings specialists from different disciplines together to make a comprehensive and individualized treatment for patients. MDT is emerging in HPBD in recent years. MDT helps improve the accuracy of diagnosis and prognosis. However, there are still some controversies and obstacles in the application of MDT for patients with HPBD. We reviewed the development, current status and experience of MDT in the field of HPBD, analyze the current controversy and obstacles, and providing reference for its future application.

Objective To analyze the clinicopathological features and immunohistochemical expression of meningiomas in the Tibetan population in Tibet,and improve the understanding of meningiomas. Methods The clinical and pathological data of all the meningiomas diagnosed by pathology in Tibet Autonomous Region People's Hospital from April 2013 to March 2021 were analyzed retrospectively.All the cases underwent immunohistochemical staining of trimethylation of lysine 27 on histone H3 (H3K27me3),mucin 4 (MUC4),somatostatin receptor 2 (SSTR2),progesterone receptor,epithelial membrane antigen,glial fibrillary acidic protein,vimentin,S-100,P53,and Ki-67.The histopathological features and the staining results were observed under a light microscope. Results A total of 116 cases of meningiomas were included in this study,with the male-to-female ratio of 1.0∶2.6 and the age of 4-73 years.The main clinical symptom was headache.The imaging examination showed that 114 cases had single lesions and 2 cases had multiple lesions.The tumors were located in the cranium (108 cases) and spinal canal (8 cases).The maximum diameter of the tumors ranged from 0.3 cm to 10.0 cm,with a mean of (5.7±2.2) cm.In terms of microscopic grading and histological types,the 116 cases included 111 cases of WHO grade Ⅰ (including 53 cases of fibrous type,20 cases of meningothelial type,24 cases of transitional type,10 cases of psammomatous type,etc.),4 cases of WHO grade Ⅱ (3 cases of atypical type and 1 case of clear cell type),and 1 case of WHO grade Ⅲ (papillary type).The immunohistochemical staining showed H3K27me3 expression absent in 9 cases (9/116,7.8%),MUC4 positive in 64 cases (64/116,55.2%),SSTR2 positive in 101 cases (101/116,87.1%).Eighty cases had follow-up results,among which 71 cases had no recurrence,while 9 cases recurred. Conclusions Meningioma is the most common tumor in the central nervous system in the pathological file of Tibet.It mainly attacks the middle-aged female patients,occupying the parasagittal sinus,falx,and convex surface of the brain.Fibrous meningioma of WHO grade Ⅰ is common,while the meningiomas of WHO grades Ⅱ and Ⅲ are rare.The expression degree of MUC4 is higher in meningothelial and transitional meningiomas but lower in fibrous meningiomas.There may be no correlation between the absence of H3K27me3 expression and prognosis.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Histones ; Humans ; Male ; Meningeal Neoplasms/diagnosis* ; Meningioma/diagnosis* ; Middle Aged ; Retrospective Studies ; Tibet ; Young Adult

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.