Objective·To investigate the predictive value of the Clinical Frailty Scale(CFS)in the long term outcomes in acute myocardial infarction(AMI)patients who completed in-hospital cardiac rehabilitation(CR).Methods·A total of 501 AMI patients treated in the Cardiology Center of Shanghai Sixth People's Hospital,Shanghai Jiao Tong University of Medicine from May 2020 to May 2022 were prospectively enrolled,with their baseline clinical data collected.The patients completed graded in-hospital CR and were assessed by CFS based on their completion of CR before discharge.Patients were then categorized into three groups(norm group,vulnerable group and frail group)according to their CFS level.The difference in 1-year major cardiovascular event(all-cause death and re-hospitalization for heart failure)rates among the three groups was investigated.Logistic regression analysis was performed to explore the effective risk factors relevant to the outcomes,and receiver operator characteristic(ROC)curves were generated to analyze the prognostic value.Finally,an optimal prediction model was developed.Results·The CFS level in AMI patients who completed CR was positively correlated with age and peak pro-B-type natriuretic peptide(peak proBNP),and inversely correlated with gender difference(P<0.05).Accompanied with the elevated CFS level,the incidence of both outcomes increased,and there were significant differences in all-cause death(2.6%,5.6%and 15.2%,P=0.002),and while no significant differences in re-hospitalization for heart failure among the three groups(19.6%,22.2%and 24.2%).All-cause death of the frail group was significantly higher than that of the norm group(P=0.004),while there was no significant difference between the vulnerable group and the norm group.CFS could sensitively predict the 1-year all-cause death in AMI patients(β=1.89,OR=6.61,P=0.001),and the risk model combined with CFS had the best predictive effect(AUC=0.845,P=0.000).Conclusion·Assessment by CFS in AMI patients who completed in-hospital CR contributes to identifying AMI patients with high risk of all-cause death in 1 year.

Objective To establish a GC method for simultaneous determination of volatile index components of octyl acetate,benzylacetone,myristicin and dehydrocostus lactone in Tibetan medicine Bawei Chenxiang powders.Methods A GC method was used with octyl acetate,benzylacetone,myristicin and dehydrocostus lactone as indicator components,SH-WAX capillary column(30 m×0.25 mm,0.25 μm)and temperature programming were used,the carrier gas was nitrogen,the inlet temperature was 220 ℃,the detector temperature was 240 ℃,with split injection volume of 1 μL.Results The concentrations of octyl acetate,benzylacetone,myristicin and dehydrocostus lactone showed a good linear relationship with peak area(r＞0.999 5)in the range of 12.44-124.43 μg·mL-1,2.90-29.01 μg·mL-1,15.95-159.45 μg·mL-1,15.62-156.15 μg·mL-1,respectively;the average recovery rates were 100.40％(RSD=1.55％),97.80％(RSD=1.41％),99.50％(RSD=0.77％)and 99.50％(RSD=0.85％)(n=6).Conclusion The method has good specificity,precision,repeatability and accuracy,and can be used for the determination of volatile index components in Bawei Chenxiang powders.

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.

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 study the clinical efficacy of laparoscopic radical cholecystectomy in the treatment of stage Ⅲ gallbladder cancer.Methods:The clinical characteristics and postoperative follow-up data of 184 patients (male 66, and female 118) who underwent radical cholecystectomy for stage Ⅲ gallbladder cancer at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from May 2015 to May 2022, were retrospectively analyzed. The age was (67.0±8.6) years old (range 38 to 85 years old). There were 71 patients in the laparoscopic group and 113 in the open group. The general medical data, surgery-related indicators and complications were analyzed. Follow-up was completed by outpatient visits and by telephone.Results:The laparoscopic group showed better postoperative alanine aminotransferase [67.5 (40.0, 138.5) vs. 104.0 (45.0, 252.2) U/L] and aspartate aminotransferase [41.5 (26.0, 71.2) vs. 53.0 (30.2, 153.5) U/L] recovery, higher albumin levels [32.05 (30.18, 35.20) vs. 30.50 (27.70, 33.50) g/L], earlier abdominal drainage tube removal [8.00(6.00, 10.25) vs. 10.00(6.00, 13.00)d], shorter hospital stay [10.00(8.00, 15.25) vs. 14.00(9.00, 19.00) d] and lower incidences of complications [(14.1%(10/71) vs. 31.9%(36/113)] when compared with the open group (all P<0.05). The 1 year (49.1% vs 61.0%), 2 years (24.0% vs. 28.5%), 3 years (16.0% vs. 14.5%) overall survival ( P=0.640), and the 3 years progression-free survival (18.3% vs. 15.0%, P=0.463) showed no significant difference between the 2 groups. Conclusion:Laparoscopic surgery for AJCC TNM stage Ⅲ gallbladder cancer showed comparable results with open surgery. When compared with open surgery, laparoscopic radical resection of gallbladder cancer had the advantages of earlier removal of abdominal drainage tube, lower incidence of postoperative complications, and shorter hospital stay.

Objective:To study the effect of preoperative transcatheter arterial chemoembolization (TACE) on postoperative complications after hepatectomy in patients with hepatocellular carcinoma (HCC) by propensity score matching analysis.Methods:Of 1 666 patients with HCC undergoing hepatectomy in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology and Tianyou Hospital of Wuhan University of Science and Technology from March 2015 to March 2021 were retrospectively screened. Of 262 patients were enrolled, including 236 males and 26 females, aged (50.3±11.8) years. Of 131 patients were enrolled in both the single surgery group and the combined group (preoperative TACE + surgical resection). Factors affecting the complications after hepatectomy in patients with HCC were analyzed using univariate and multivariate logistic regression method.Results:After matching the propensity score, the incidence of postoperative complications in the single surgery group was 22.1% (29/131), lower than that in the combined group [41.2% (54/131), χ 2=11.02, P<0.001]. The incidence of bile leakage in the single surgery group [2.3% (3/131)] was also lower than that in the combined group [(9.2% (12/131), χ 2=5.73, P=0.017]. Multivariate logistic regression analysis showed that the combined group ( OR=2.43, 95% CI: 1.28-4.61, P=0.007) had an increased incidence of postoperative complications, so did patients with a preoperative alpha-fetoprotein > 400 μg/L, anatomic hepatectomy, long operation time, and hilar occlusion. Conclusion:Preoperative TACE could be a risk factor for postoperative complications in patients with HCC, especially for the postoperative biliary leakage.

Objective:To evaluate the effectiveness of hepatitis B prevention and control in Tibet Autonomous Region by comparative analysis of the results of seroepidemiological surveys of hepatitis B in 2014 and 2020.Methods:The required sample size was calculated based on the estimated HBsAg positivity rates of permanent residents aged 1-4, 5-14, 15-29, and 30-69 years. A total of 7 163 people and 4 802 people were required in 2014 and 2020, respectively. The subjects were selected by stratified multistage cluster random sampling method, using questionnaires to obtain basic information, and 5 ml of venous blood was collected from each subject to detect HBsAg, anti-HBs, and anti-HBc, and rechecked the HBsAg positive samples. SPSS 22.0 software was used to analyze the survey results, calculate the positive rate and 95% confidence interval.Results:A total of 7 069 people were investigated in 2014 and 4 913 people in 2020. In 2020, the positive rate of HBsAg, anti-HBs, and anti-HBc was 9.20% (452/4 913), 37.11% (1 823/4 913), and 32.75% (1 609/4 913), respectively, and decreased by 22.95%, 15.54%, and 1.92% as compared with the rate in 2014. The positive rate of HBsAg of people aged 1-, 5-, 15- and 30-69 years in 2020 was 2.23% (8/358), 2.85% (20/701), 6.86% (69/1 006) and 12.46%(355/2 848), respectively, decreased by 61.82%, 62.75%, 54.81% and 24.21% as compared with the rate in 2014. The positive rate of anti-HBs of people aged 1-4 years was 52.79% (189/358), 10.30% increased compared with 2014; for people aged 5-, 15-, and 30-69 years was 32.67% (229/701), 37.67% (379/1 006) and 36.03%(1 026/2 848), respectively, decreased by 20.84%, 14.13% and 16.52% as compared with the rate in 2014. The positive rate of anti-HBc of people aged 1-, 5-, 15-, 30-69 years was 4.19% (15/358), 6.42%(45/701), 21.07% (212/1 006), and 46.95% (1 337/2 848), respectively, decreased by 59.63%, 58.93%, 50.49%, and 12.10% as compared with the rate in 2014.Conclusions:The prevention and control of hepatitis B in Tibet have made partial achievements. The prevalence of HBsAg among people aged 1-69 years in 2020 had declined compared with 2014, but it is still at a high epidemic level. People have a high risk of HBV infection for a low level of anti-HBs. It is necessary to strengthen the vaccination of hepatitis B further and effectively implement the strategy of blocking mothers and children of the hepatitis B virus.

Objective:To summarize the repair experience and clinical characteristics of cleft lip and palate in Tibet.Methods:From August 2020 to August 2021, patients with cleft lip and palate treated during the period of corresponding author aid to Tibet were included. The American Association of Anesthesiologists (ASA) was used to assess the anesthesia risk before operation. For the cleft lip repair, Millard rotation advancement technique and reconstruction of nasal-labial muscle tension lines group were used. Modified Von Langenbeck technique was adopted for cleft palate repair. The amount of blood loss and short-term postoperative complications such as hematoma, infection, wound dehiscence, flap circulation disorder and palatal fistula were counted. The Likert five-point scale was used to evaluate the surgical satisfaction of patients with cleft lip and the audiometric evaluation method was used to assess the improvement of cleft palate speech. The data were statistically analyzed by SPSS 20.0 software. The measurement data were expressed by Mean±SD. P<0.05 was considered statistically significant. Results:A total of 46 patients were included, including 26 males and 20 females, aged from 2 to 57 years, with a median of 32 years. There were 36 patients with cleft lip or secondary deformities after cleft lip surgery and 10 patients with cleft palate. Among the 46 cases, ASA Ⅰ was 39, and ASA Ⅱ, ASA Ⅲ were 5 and 2, respectively. There were 5 patients with congenital heart disease, including 2 cases of patent ductus arteriosus and 3 cases of patent foramen ovale. Pulmonary hypertension was found in 8 cases. The average blood loss during the repair of cleft lip and cleft palate was 30 ml and 50 ml, respectively. No postoperative complications such as hematoma, infection, wound dehiscence and palatal fistula occurred. The patients were followed up for 6 to 24 weeks, with an average of 8 weeks. The crista philtra point on the affected side of the patients with cleft lip was fully lowered and was basically symmetrical with the healthy side. The bilateral nostril symmetry was significantly improved compared with that before surgery, and the nasal columella was in the middle. The cleft palate was all closed and the mobility of soft palate was improved. All patients were satisfied with the surgical results, with an average satisfaction score of 4.5. The mean preoperative speech score of patients undergoing cleft palate repair was 1.4 ± 0.5 and the postoperative was 4.3 ± 0.5 ( t=16.16, P<0.001). Conclusion:Compared with the plain area, patients with cleft lip and palate in Tibet have the characteristics such as delayed treatment, the complex of deformity and often combined with other congenital organ malformation. In order to get good result and higher satisfaction rate, it is recommended to use classical surgical technique for the above deformity repair. It is also important to carefully evaluate the risk of general anesthesia.

Objective:To summarize the repair experience and clinical characteristics of cleft lip and palate in Tibet.Methods:From August 2020 to August 2021, patients with cleft lip and palate treated during the period of corresponding author aid to Tibet were included. The American Association of Anesthesiologists (ASA) was used to assess the anesthesia risk before operation. For the cleft lip repair, Millard rotation advancement technique and reconstruction of nasal-labial muscle tension lines group were used. Modified Von Langenbeck technique was adopted for cleft palate repair. The amount of blood loss and short-term postoperative complications such as hematoma, infection, wound dehiscence, flap circulation disorder and palatal fistula were counted. The Likert five-point scale was used to evaluate the surgical satisfaction of patients with cleft lip and the audiometric evaluation method was used to assess the improvement of cleft palate speech. The data were statistically analyzed by SPSS 20.0 software. The measurement data were expressed by Mean±SD. P<0.05 was considered statistically significant. Results:A total of 46 patients were included, including 26 males and 20 females, aged from 2 to 57 years, with a median of 32 years. There were 36 patients with cleft lip or secondary deformities after cleft lip surgery and 10 patients with cleft palate. Among the 46 cases, ASA Ⅰ was 39, and ASA Ⅱ, ASA Ⅲ were 5 and 2, respectively. There were 5 patients with congenital heart disease, including 2 cases of patent ductus arteriosus and 3 cases of patent foramen ovale. Pulmonary hypertension was found in 8 cases. The average blood loss during the repair of cleft lip and cleft palate was 30 ml and 50 ml, respectively. No postoperative complications such as hematoma, infection, wound dehiscence and palatal fistula occurred. The patients were followed up for 6 to 24 weeks, with an average of 8 weeks. The crista philtra point on the affected side of the patients with cleft lip was fully lowered and was basically symmetrical with the healthy side. The bilateral nostril symmetry was significantly improved compared with that before surgery, and the nasal columella was in the middle. The cleft palate was all closed and the mobility of soft palate was improved. All patients were satisfied with the surgical results, with an average satisfaction score of 4.5. The mean preoperative speech score of patients undergoing cleft palate repair was 1.4 ± 0.5 and the postoperative was 4.3 ± 0.5 ( t=16.16, P<0.001). Conclusion:Compared with the plain area, patients with cleft lip and palate in Tibet have the characteristics such as delayed treatment, the complex of deformity and often combined with other congenital organ malformation. In order to get good result and higher satisfaction rate, it is recommended to use classical surgical technique for the above deformity repair. It is also important to carefully evaluate the risk of general anesthesia.

Quantity is the key factor to ensure the safety and effectiveness of medicines. It is very important to study and determine the traditional measuring units and their quantity values of Tibetan medicine. Based on the literature records of Tibetan medicine and combined with modern experimental verification and investigation research, this study determined the reference, name, and conversion rate of traditional measuring units of Tibetan medicine. Meanwhile, through large sample sampling and repeated quantification of refe-rence of basic units, its weight and volume were clarified. The modern SI volume and weight unit values corresponding to the traditional volume and weight units of Tibetan medicine were deduced, and the correctness, reliability, and practicability of these determination results were demonstrated. This study also put forward some specific suggestions and reference values for formulating the standards of measuring units of weight and volume of Tibetan medicine. It is of great significance in guiding the processing, production, and clinical treatment of Tibetan medicine, and promoting the standardization and standardized development of Tibetan medicine.
Medicine, Tibetan Traditional ; Reproducibility of Results