Altitude sickness is a disease caused by series of physiological and pathological changes and compensatory adaptation changes caused by acute or chronic exposure to high altitude hypoxia.High altitude pulmonary edema(HAPE)and high altitude cerebral edema are life-threatening diseases that are likely to develop;chronic high-altitude sickness,if not taken seriously,can affect various systems of the patient.This article reviews the drug prevention and treatment of three types of altitude sickness,HAPE,high altitude polycythemia(HAPC),and high altitude pulmonary hypertension(HAPH),to provide a reference for the rapid adaptation of people entering high altitudes and the health care of high-altitude residents.

The gradual progression of the"team-based"medical talent aid initiative in Tibet has prompted our hospital to respond to the national call by dispatching medical team members to the Tibetan Medicine Hospital in Biru County,Naqu City,Tibet Autonomous Region for short-term flexible assistance.This paper takes short-term counterpart support work as a case study to analyze the implementation,challenges and achievements of the aid efforts,and proposes recommendations for a sustainable development mechanism for future assistance initiatives.During the counterpart support period,the medical team members built upon a unique foundation of Tibetan medicine and pharmacology,actively explored specialty construction,promoted appropriate technologies,and initiated remote consultations.Achievements were made in disease diagnosis and treatment processes,enhance-ment of medical technology,and talent cultivation.

Klebsiella pneumoniae can cause a variety of infectious diseases, especially in immunocompromised population. The emergence of multidrug-resistant hypervirulent Klebsiella pneumoniae has greatly limited the choice of treatment for Klebsiella pneumoniae infection, and the exploration of new treatment strategies is imminent. In the process of infection, there is a complex interaction between the programmed cell death of host cells and the invasion of Klebsiella pneumoniae. This paper mainly reviewed the research progress in several mechanisms of programmed cell death such as pyroptosis, apoptosis, necroptosis and autophagy caused by Klebsiella pneumoniae.

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*

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.

Background: Domestic yaks are the most important livestock species on the Qinghai-Tibetan Plateau. Adult female yaks normally breed in the warm season (July to September) and enter anestrous in the cold season (November to April). Nevertheless, it is unclear how ovarian activity is regulated at the molecular level. Objectives: The peculiarities of yak reproduction were assessed to explore the molecular mechanism of postpartum anestrus ovaries in yaks after pregnancy and parturition. Methods: Sixty female yaks with calves were observed under natural grazing in Haiyan County, Qinghai Province. Three yak ovaries in pregnancy and postpartum anestrus were collected. RNA sequencing and quantitative proteomics were employed to analyze the pregnancy and postpartum ovaries after hypothermia to identify the genes and proteins related to the postpartum ovarian cycle. Results: The results revealed 841 differentially expressed genes during the postpartum hypoestrus cycle; 347 were up-regulated and 494 genes were down-regulated. Fifty-seven differential proteins were screened: 38 were up-regulated and 19 were down-regulated. The differential genes and proteins were related to the yak reproduction process, rhythm process, progesterone-mediated oocyte maturation, PI3K/AKT signaling pathway, and MAPK signaling pathway categories. Conclusions Transcriptome and proteomic sequencing approaches were used to investigate postpartum anestrus and pregnancy ovaries in yaks. The results confirmed that BHLHE40, SF1IX1, FBPX1, HSPCA, LHCGR, BMP15, and ET-1R could affect postpartum hypoestrus and control the state of estrus.

Aim To explore the effect of Tanxiang Qingyan Tablets on rat model with chronic bronchitisand the effect of MyD88/NF-κB/ICAM-1 signaling pathway expression in bronchopulmonary tissues of rats.Methods A rat model of chronic bronchitis was established by smoking method combined with lipopolysaccharide(LPS,2g·L-1)tracheal injection.The rats were randomly divided into normal group,sham operation group,model group,and positive drug(Guilong Ruikening tablets)1 g·kg-1)group,Tanxiang Qingyan Tablet high,medium and low dose(1.44,0.72,0.36 g·kg-1)group,with intragastric interventionin continuous 15 days.The pathological changes of bronchopulmonary tissues were observed by HE staining,and the infiltration of bronchial inflammatory cells was counted; ELISA method was used to detect the contents of tumor necrosis factor(TNF-α)and interleukin 10(IL-10)in peripheral serum; Western blot and immunohistochemical methodswere employed to detectmyeloid cell differentiation protein 88(MyD88),nuclear transcription factor-κB(NF-κB)and anti-intercellular adhesion molecule 1(ICAM-1)protein expression in bronchopulmonary tissues.Results Compared with normal group and sham operation group,the bronchial mucosal epithelial cells of model group were severely damaged,the alveolar septum was widened,the bronchial inflammatory infiltrationsignificantly increased,the serum TNF-α levels significantly increased,IL-10 levels decreased, and MyD88,NF-κB and ICAM-1 protein expression levels increased significantly(P<0.05,0.01)in bronchopulmonary tissues; compared with model group,the pathological damage and inflammatory changes of the bronchopulmonary tissues of rats in Tanxiang Qingyan Tablet group were reduced,and the serum TNF-α content was significantly reduced,IL-10 content did not change significantly,and MyD88,NF-κB and ICAM-1 protein expression levels in bronchopulmonary tissues were significantly down-regulated(P<0.05,0.01).Conclusions Tanxiang Qingyan Tablets can effectively improve bronchopulmonary tissue inflammatory infiltration,which may be related to reducing the release of inflammatory mediators such as TNF-α and regulating the expression of MyD88/NF-κB/ICAM-1 signaling pathway.

Objective:To compare the complete blood count of children under 5 years old in outpatient department of pediatrics in general hospitals in Shanghai and Shigatse, and to explore the incidence and risk factors of anemia among children in different regions.Methods:Complete blood count of 19 863 children in outpatient department of pediatrics of Shanghai Ninth People′s Hospital in 2018 and 2 476 children in outpatient department of pediatrics of Shigatse People′s Hospital in 2018 were retrieved. The value of haemoglobin (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were analyzed. The types, incidence and degree of anemia in different regions were compared. The information during pregnancies, supplementary foods, residence and educational level of mothers of anemic children in Shigatse area and Shanghai were collected.Results:The incidence of nutritional anemia in Tibetan children was higher than that in Shanghai, with mild to moderate anemia predominating in Tibetan area and mild anemia predominating in Shanghai. The incidence of anemia in Shigatse area was 41.32% (1 023/2 476), which was higher than that in Shanghai [14.35%(2 852/1 9 863)], and the difference was statistically significant ( P<0.05) .The incidence of mild anemia was 84.65% (866/1 023) in Shigatse and 94.81% (2 704/2 852) in Shanghai, with statistically significant difference ( P< 0.01). The incidence of moderate anemia in Shigatse was 14.08% (144/1 023) higher than that in Shanghai 5.05% (144/2 852), with statistically significant difference ( P<0.01). The incidence of severe anemia in Shigatse was 1.27% (13/1 023) higher than that in Shanghai 0.14% (4/2 852), with statistically significant difference ( P<0.01). Through the analysis of the questionnaires, being from pastoral areas, low educational level of mothers, poor nutrition during pregnancy, premature delivery, pure breastfeeding irregular maternity examinations and unreasonable supplementary food were related to nutritional anemia in ≤1 year-old babies. Conclusions:Nutritional iron deficiency anemia in the main type of anemia among children in both areas. Compared with Shanghai, the incidence of anemia of children in Tibet was higher, which may be caused by different feeding habits, cultural level and economic income between different regions. It is imperative to establish and improve the management of pregnant and lying-in women in Tibet, and provide scientific feeding and healthy lifestyle.

Objective:To report the clinical outcome of finger replantation in Tibetan plateau.Methods:From August, 2018 to August, 2019, a total of 12 patients with 15 amputed digits treated in the Department of Emergency of Lasa People’s Hospital. All these cases were performed replantation without exclusion, including 4 cases of machine-mangled injury, 3 cases of steel rope crushing injury, 4 cases of electric saw injury, and 1 case of rotation avulsed injury. Replantations were performed under microscope by a fresh team of microsurgery surgeons. Antibiotics, anticoagulants and vasodilators were prescribed postoperatively. Application of oxygen inhalation through nasal tube and warm room temperature were advised. Tabaco and coffin were strictly forbidden postoperatively. All patients were regular followed-up after operation.Results:Twelve out of total 15 amputed digits successfully replanted, 3 digits turned to necrosis eventually. The survival rate was 80% (12/15). All cases were followed up for 4-16 months. According to the Functional Evaluation Standard of Replantation by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 3 digits, good in 7 digits, fair in 1 digit, poor in 4 digits. The excellent and good rate was 66.6%(10/15).Conclusion:In this group, the survival rate and excellent and good rate of finger replantation in Tibetan plateau is unexpected high. Thus, it is deducible that digit amputation can be successfully replanted with good functional result when meticulous microsurgical techniques are applied, although the unique adverse factors of Tibetan plateau exist.