[Purpose]To analyze the results of upper gastrointestinal cancer screening in rural areas of Lhasa from 2015 to 2019.[Methods]Upper gastrointestinal cancer screening program was conducted among residents aged 40～69 years old from 3 rural project sites in Lhasa selected by cluster sampling method from 2015 to 2019.The detected malignant tumors and precancerous le-sions were treated and confirmed by pathological examination.The detection rate of esophagus and stomach cancer were calculated by region,sex and age and compared by x2 test.[Results]A total of 1 399 people underwent gastroscopy,among whom 1 288 completed pathological biopsy(92.07％).Three cases of esophageal cancer were detected with a detection rate of 0.21％(3/1 399),all of which were advanced squamous cell carcinoma.Eight cases of gastric cancer were detected with a detection rate of 0.57％(8/1 399),and 2 cases were early gastric cancer.The detection rate of low-grade and high-grade epithelial neoplasia of gastric mucosa was 0.64％(9/1 399)and 0.21％(3/1 399),respectively.There was no significant difference in the detection rate among different regions,sexes and age groups(all P＞0.05).[Conclusion]The detection rate of upper gastrointesti-nal cancer in screening population in Lhasa is lower than the national average level.Men and the elderly are important target populations for upper gastrointestinal cancer screening,and increasing participation rates is necessary for more effective screening outcomes.

[Purpose]To analyze the results of upper gastrointestinal cancer screening in rural areas of Lhasa from 2015 to 2019.[Methods]Upper gastrointestinal cancer screening program was conducted among residents aged 40～69 years old from 3 rural project sites in Lhasa selected by cluster sampling method from 2015 to 2019.The detected malignant tumors and precancerous le-sions were treated and confirmed by pathological examination.The detection rate of esophagus and stomach cancer were calculated by region,sex and age and compared by x2 test.[Results]A total of 1 399 people underwent gastroscopy,among whom 1 288 completed pathological biopsy(92.07％).Three cases of esophageal cancer were detected with a detection rate of 0.21％(3/1 399),all of which were advanced squamous cell carcinoma.Eight cases of gastric cancer were detected with a detection rate of 0.57％(8/1 399),and 2 cases were early gastric cancer.The detection rate of low-grade and high-grade epithelial neoplasia of gastric mucosa was 0.64％(9/1 399)and 0.21％(3/1 399),respectively.There was no significant difference in the detection rate among different regions,sexes and age groups(all P＞0.05).[Conclusion]The detection rate of upper gastrointesti-nal cancer in screening population in Lhasa is lower than the national average level.Men and the elderly are important target populations for upper gastrointestinal cancer screening,and increasing participation rates is necessary for more effective screening outcomes.

Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective:To explore the effect of enhanced recovery nursing pathway in the enhanced recovery after surgery of perioperative patients with hepatic echinococcosis.Methods:From November 2017 to February 2019, simple random sampling was used to select 160 hepatic echinococcosis patients with surgery admitted to Shannan People's Hospital of Tibet Autonomous Region as the research object. Patients were randomly divided into experimental group and control group, 80 cases in each group. Patients in control group received general surgical routine nursing, and experimental group carried out enhanced recovery nursing pathway on the basis of routine nursing. The postoperative rehabilitation indicators, pain scores and postoperative complications were compared between the two groups.Results:The time of first exhaust time and defecation in experimental group was (3.77±3.05) h and (23.81±17.29) h, which was earlier than (13.27±8.58) h and (37.79±18.23) h in control group, and the differences were statistically significant ( t=4.265, 4.975; P<0.01) . The pain scores of experimental group at 2, 4, 8, and 24 hours after surgery were (1.08±1.04) , (1.61±0.85) , (1.13±0.70) and (0.26±0.41) lower than those [ (2.41±1.20) , (2.94±0.96) , (2.94±0.96) , (1.33±0.90) ]of control group, and the differences were statistically significant ( t=7.501, 9.250, 13.650, -8.720; P<0.01) . There were 2 cases (2.50%) of lung infection in experimental group and 13 cases (16.25%) in control group. The incidence in experimental group was lower than that in control group, and the difference was statistically significant (χ 2=8.901, P<0.01) . Conclusions:The standardized nursing model based on the enhanced recovery nursing pathway is conducive to the postoperative rehabilitation of patients with hepatic echinococcosis, shortens the hospital stay, and reduces postoperative lung infection complications, which is worthy of further promotion.

Purpose: The purpose of this study was to retrospectively compare the clinical characteristics and imaging features on (CEUS) of combined hepatocellular cholangiocarcinoma (CHC) with those of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Methods: The clinical information and CEUS features of 45 patients with CHC from 2015 to 2019 and 1-to-1-matched control subjects with HCC and CC (45 each) were compared. Results: Simultaneous elevation of α-fetoprotein (AFP) and cancer antigen (CA) 19-9 was more common in CHC than in HCC and CC. In the arterial phase, hyperenhancement (homogeneous and heterogeneous) was more common in CHC (73.3%) and HCC (100%), while peripheral rimlike enhancement was more common in CC (55.6%). In the portal phase, marked washout was significantly more frequent in CHC and CC than in HCC (42.2% and 53.3% vs. 6.7%). In the delayed phase, marked washout was more common in CHC (82.2%) and CC (93.3%) than in HCC (40.0%). The washout time (WT) was much shorter in CHC and CC than in HCC (33.8±13.1 seconds and 30.1±11.6 seconds vs. 58.4±23.5 seconds). Using the combination of simultaneous elevation of AFP and CA 19-9 with marked washout in the delayed phase and a WT <38 seconds or arterial hyperenhancement to differentiate CHC from HCC or CC, the accuracy, sensitivity, and specificity were 74.4%, 93.3%, and 55.6% and 71.1%, 80.0%, and 62.2%, respectively. Conclusion Although some CEUS imaging features of CHC, HCC, and CC overlap, the combination of tumor markers and CEUS features can be helpful in differentiating CHC from HCC and CC.

Objective:To investigate the clinical characteristics and possible influencing factors of the extraintestinal manifestations (EIM) in patients with Crohn′s disease (CD) .Methods:Clinical data of 623 patients diagnosed as CD at Department of Gastroenterology, Shanghai Tenth People′s Hospital, from January 2008 to January 2018 were retrospectively analyzed. These patients were divided into two groups according to whether EIM was complicated. Univariate analysis was used to evaluate the clinical features, and multivariate analysis was used to reveal the risk factors of EIM. Fisher′s exact test was used to analyze the associations among various EIMs.Results:Among 623 CD patients, 422 (67.7%) were male and 201 (32.3%) were female; the median age at diagnosis was 31.0 years old (23.0 to 43.0 years old) ; the medium follow-up time was 53.5 months (29.0 to 84.0 months) . One hundred and twelve patients (18.0%) complicated with EIM, including 86 cases with one EIM, 22 case (19.6%) with two EIM, 3 case (2.7%) with three EIM, and 1 case (0.9%) with four EIMs simultaneously. Oral involvement was found in 84 cases (75.0%) , joints and bones in 36 cases (32.1%) , skin in 17 cases (15.2%) , and eye in 7 cases (6.3%) . Compared to patients without EIM, those with EIM had higher ratios of female (41.1% vs. 30.3%) , ileocolic (L3) type (52.7% vs. 37.6%) , non-stenosis and non-penetration (B1) type (69.6% vs. 54.2%) , diarrhea or fever as the first symptom (43.8% vs. 32.5%, 14.3% vs 6.5%) and steroids administration (53.6% vs. 39.3%) , while they had lower ratios of distal ileum (L1) type (19.6% vs. 36.8%) , stenosis (B2) type (26.8% vs. 37.0%) , penetration (B3) type (3.6% vs. 8.8%) , infliximab treatment (46.4% vs. 60.7%) , and abdominal surgery (14.3% vs. 24.1%) (all P<0.05) . Multivariate analysis showed that female ( OR = 1.665, 95% CI: 1.067-2.600, P = 0.025) , colonic type ( OR = 1.996, 95% CI: 1.072-3.718, P = 0.029) , ileocolic type ( OR = 2.568, 95% CI: 1.490-4.427, P = 0.001) , B1 type (B1 vs. B3: OR = 2.977, 95% CI: 1.015-8.726, P = 0.047; B1 vs. B2: OR = 1.882, 95% CI: 1.168-3.302, P = 0.009) and fever ( OR = 2.276, 95% CI: 1.170-4.430, P = 0.015) were the independent risk factors of EIM in CD patients. The oral lesion was significantly associated with spondylarthritis and skin diseases, and the spondylarthritis was closely associated with skin and eyes lesions (all P<0.05) . Conclusions:Female, colon involvement, B1 type and fever are the high risk factors of EIM for CD patients. Various EIM possess certain associations with each other.

Objective:To investigate the clinical characteristics and possible influencing factors of the extraintestinal manifestations (EIM) in patients with Crohn′s disease (CD) .Methods:Clinical data of 623 patients diagnosed as CD at Department of Gastroenterology, Shanghai Tenth People′s Hospital, from January 2008 to January 2018 were retrospectively analyzed. These patients were divided into two groups according to whether EIM was complicated. Univariate analysis was used to evaluate the clinical features, and multivariate analysis was used to reveal the risk factors of EIM. Fisher′s exact test was used to analyze the associations among various EIMs.Results:Among 623 CD patients, 422 (67.7%) were male and 201 (32.3%) were female; the median age at diagnosis was 31.0 years old (23.0 to 43.0 years old) ; the medium follow-up time was 53.5 months (29.0 to 84.0 months) . One hundred and twelve patients (18.0%) complicated with EIM, including 86 cases with one EIM, 22 case (19.6%) with two EIM, 3 case (2.7%) with three EIM, and 1 case (0.9%) with four EIMs simultaneously. Oral involvement was found in 84 cases (75.0%) , joints and bones in 36 cases (32.1%) , skin in 17 cases (15.2%) , and eye in 7 cases (6.3%) . Compared to patients without EIM, those with EIM had higher ratios of female (41.1% vs. 30.3%) , ileocolic (L3) type (52.7% vs. 37.6%) , non-stenosis and non-penetration (B1) type (69.6% vs. 54.2%) , diarrhea or fever as the first symptom (43.8% vs. 32.5%, 14.3% vs 6.5%) and steroids administration (53.6% vs. 39.3%) , while they had lower ratios of distal ileum (L1) type (19.6% vs. 36.8%) , stenosis (B2) type (26.8% vs. 37.0%) , penetration (B3) type (3.6% vs. 8.8%) , infliximab treatment (46.4% vs. 60.7%) , and abdominal surgery (14.3% vs. 24.1%) (all P<0.05) . Multivariate analysis showed that female ( OR = 1.665, 95% CI: 1.067-2.600, P = 0.025) , colonic type ( OR = 1.996, 95% CI: 1.072-3.718, P = 0.029) , ileocolic type ( OR = 2.568, 95% CI: 1.490-4.427, P = 0.001) , B1 type (B1 vs. B3: OR = 2.977, 95% CI: 1.015-8.726, P = 0.047; B1 vs. B2: OR = 1.882, 95% CI: 1.168-3.302, P = 0.009) and fever ( OR = 2.276, 95% CI: 1.170-4.430, P = 0.015) were the independent risk factors of EIM in CD patients. The oral lesion was significantly associated with spondylarthritis and skin diseases, and the spondylarthritis was closely associated with skin and eyes lesions (all P<0.05) . Conclusions:Female, colon involvement, B1 type and fever are the high risk factors of EIM for CD patients. Various EIM possess certain associations with each other.

Objective: To explore the relationship between glycemic control and visceral adiposity index (VAI) among type 2 diabetes mellitus (T2DM) patients.Methods: A community-based epidemiological field study for patients with T2DM aged ≥ 40 years was conducted in China.Every participant underwent physical examinations, biochemical tests of fasting glucose, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and so on, and a questionnaire, including anthropometric characteristics, lifestyle, disease history, family history, and medication use.Those participants with HbA1c ≥7.0% were classified as the poorly controlled in our analysis of relationship between glycemic control and VAI.Anthropometric characteristics, lifestyle, and biochemical indexes of the participants were compared among the groups of different VAI levels.Logistic models were applied in multiple analysis adjusting for possible confounders.Results: A total of 1 607 patients with T2DM were recruited in our analysis with a mean age of (59.4±8.1) years and an average T2DM duration of (7.0±6.4) years.Among them, 78.3% were on hypoglycemic therapy.The cutoff points of quartiles of VAI were calculated for the males and females, respectively.According to the ascending order of the quartiles of VAI, the participants were divided into four groups, i.e.Q1, Q2, Q3, and Q4.The poor glycemic control rate for these groups were 60.6%, 65.7%, 70.1%, and 71.0%, respectively (Trend χ2=12.20, P<0.001).After adjustment for age, gender, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL-C, smoking, cardio-cerebral vascular disease (CVD) history, hypoglycemic therapy, T2DM duration, and family history of diabetes, the Logistic regression models showed that the glycemic control rate was significantly associated with VAI levels among the patients with T2DM.Compared with the participants in group Q1, the ORs of poor glycemic control for those in groups Q2, Q3, and Q4 were 1.239 (95%CI 0.918 to 1.672), 1.513 (95%CI 1.117 to 2.050), and 1.535 (95%CI 1.128to 2.088), respectively (trend P=0.003).With each quartile increase in VAI, the OR of poor glycemic control was 1.162 (95%CI 1.054 to 1.282).Conclusion: The glycemic control among the patients with T2DM is significantly associated with VAI.High level of VAI is an indicator of poor glycemic control.

To understand the role of respiratory syncytial virus (RSV) in children with acute respiratory infections (ARI) in Tibet Autonomous Region and the contribution of two major groups of RSV, nasopharyngeal aspirates (NPA) were collected from hospitalized children with ARI in Department of Pediatrics, Tibet People's Hospital in Lasa, Tibet from April to July in 2011 and tested for seven common respiratory viruses and human metapneumovirus (hMPV) by direct immunofluorescence assay (DFA). Total RNAs were extracted from RSV positive samples by DFA and reverse transcripted to cDNA. Nested-PCR was employed to determine the genogroups of RSV, which were confirmed by real time-PCR and sequence analysis for G protein encoding gene. The Characteristics and variations of G genes from RSV in this project were identified by sequence comparison with those G genes in GenBank. Out of 167 samples, 65 were positive for respiratory viruses with a total positive rate of 38.9%, including 45 (69.2%, 45/65)positive samples for RSV. Among 42 samples that were positive for RSV and genotyped, 40 were identified as group A and 2 as group B. Sequence analysis of full-length G genes for 7 RSV of group A indicated that all of these belonged to subgroup GA2. The nucleotide identities between RSVs from Tibet and prototype A2 strain were 90.7%-91.8%, with 86.5%-87.2% identities of amino acid. The mutations of amino acids were mainly located in both ends of a highly conserved region in the ectodomain of the G proteins. The data indicated that RSV was the most important viral etiologic agent of ARI in spring of 2011 in Tibet and group A of RSV was predominant during the study period. High divergence existed in the ectodomain of G proteins of RSVs from Tibet.
Acute Disease ; Amino Acid Sequence ; Female ; Humans ; Infant ; Male ; Molecular Sequence Data ; Phylogeny ; Respiratory Syncytial Virus Infections ; virology ; Respiratory Syncytial Viruses ; chemistry ; classification ; genetics ; isolation & purification ; Respiratory Tract Infections ; virology ; Sequence Alignment ; Tibet ; Viral Proteins ; chemistry ; genetics

OBJECTIVETo investigate the viral etiology and clinical features of hospitalized children with acute respiratory tract infections in Tibet.

METHODNasopharyngeal aspirate samples were collected from children with acute respiratory tract infection hospitalized at the department of Pediatrics, Tibet Autonomous Region People's Hospital from April to July, 2011. The specimens of nasopharyngeal aspirate were screened for antigens of 7 common respiratory viruses by direct immunofluorescence (DIF) [respiratory syncytial virus (RSV), adenovirus (ADV), parainfluenza viruses type I-III, influenza virus A and B] and human metapneumovirus. Clinical data of the children were analyzed by statistical software SPSS16.

RESULTA total of 167 children with acute respiratory tract infections hospitalized from April to July 2011 were enrolled in this investigation. Sixty-five out of 167 specimens were positive for viral antigens. The virus positive rate for specimens was 38.9% (65/167). Two of 65 positive specimens were positive for 2 virus antigens (RSV + influenza B) and (hMPV + parainfluenza virus type III), respectively. RSV was detected in 45 cases (67.2%, 45/67) which was the most predominant, followed by parainfluenza virus type III detected in 7 cases (10.4%, 7/67), ADV in 6 cases (9.0%, 6/67), parainfluenza virus type I in 4 cases (6.0%, 4/67), influenza virus type B in 3 cases (4.5%, 3/67), and hMPV in 2 cases (3.0%, 2/67). In addition to clinical manifestations of pneumonia, such as cough and shortness of breath, only 3 virus positive cases (6.67%) presented with wheezing, but the signs of severe cyanosis, fine rales in lung were common. Most of the children in this study recovered soon, only a few younger children with underlying diseases or complications had severe illness.

CONCLUSIONVirus is an important pathogen for acute respiratory infections for hospitalized children in Tibet. RSV was the most predominant etiological agent, especially for those younger than 3 years old.

Acute Disease ; Adolescent ; Age Distribution ; Child ; Child, Hospitalized ; Child, Preschool ; Female ; Fluorescent Antibody Technique, Direct ; Humans ; Infant ; Male ; Nasopharynx ; virology ; Respiratory Syncytial Virus Infections ; epidemiology ; pathology ; virology ; Respiratory Syncytial Virus, Human ; isolation & purification ; Respiratory Tract Infections ; epidemiology ; pathology ; virology ; Tibet ; epidemiology ; Virus Diseases ; epidemiology ; etiology ; pathology ; virology ; Viruses ; classification ; isolation & purification