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[Abstract ] Objective Chronic renal disease,a common and frequent disease,is the most cause inducing chronic renal failure. There is an important guiding significance for renal biopsy in the diagnosis,treatment and prognosis of renal disease.The aim of this study was to analyze the characteristics of renal biopsy and the relation between pathological types and clinical presentation in Tibet. Methods Between June 2011 and December 2013 in General Hospital of Tibetan Military Command, Lhasa, percutaneous renal biopsy were per-formed in 107 renal patients.In this study, the gender, age, pathologic entities, and clinical manifestation were analyzed retrospectively. The final diagnosis was made by the clinical manifestation, laboratory examination,and pathologic results. Results The mean age at renal biopsy was 29.8 ±12.2(10~66)years in 47 male cases (43.9%) and 69 female cases (56.1%).This includes 75 Tibetan cases (70.1%), 31 Han cases (28.9%), and Bai cases (1.0%).The primary glomerular disease was 95.3%and the secondary glomerular disease was 4.7%in the total 107 cases.Fourty-four point three percent of the primary glomerular disease were male cases and 100%of secondary glomerular disease were female cases.The main pathological type of the primary glomerular disease was podocyte nephropathy (43.9%), followed by membranous nephropathy (18.7%), IgA nephropathy (11.2%), focal segmental glomerulosclerosis (9.3%) and mesangiocapillary glomerulonephritis (5.6%).The clinical manifestations of 107 cases were classified as syndrome of nephrotic syn-dromn(69.1%),urinary abnormalities(14.9%),isolated macrographic haematuria (3.7%),chronic renal failure(2.8%).Among the nephrotic syndrome,podocyte disease was 63.5%,membranous glomerulopathy was 18.9%,focal segmental glomeruolsclerosis was 8.1%,and membranoproliferative glomerulonephritis was 5.4%. Conclusion The primary glomerulonephritis was the most common glomerular diseases at high altitude area in Tibet.The most frequent type of pri-mary glomerular nephritis was podocyte disease, and the most frequent type of secondary glomerular nephritis was Henoch-Schonlein purpura glomerulonephritis.
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Objective To investigate the effect of treatment and mechanism with hyperbaric oxygenation and doxazosin in pa-tients with Ⅲ type prostatitis in plateau .Methods A total of 94 patients with Ⅲ type prostatitis were divided randomizedly into hyperbaric oxygenation group (n=28) ,doxazosin treated group (n=31) and hyperbaric oxygenation and doxazosin combining trea-ted group (n= 35) .And then they were evaluated in 8 weeks treatment respectvely by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and adverse events .Prostate fluid and semen routine were examed .Results All three groups got the improved CPSI after treatment ,oxygenation-doxazosin combining treated group(82 .9% )was better than that of oxy-genation and doxazosin treated group(73 .7% and 70 .0% )(P<0 .05) .Results of prostate fluid and semen routine examination of combining treated group were significantly improved than before (P<0 .05) .No complications occurred .Conclusion Combination of hyperbaric oxygenation and doxazosin is a safe and effective therapy in the treatment of Ⅲ type prostatitis in plateau .
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Objective To investigate the features and prevention measures of complications secondary to severe traumatic hemorrhagic shock (THS) of different crowds in plateau (3 658 meters above the sea level).Methods A retrospective study was conducted on 591 severe THS patients undergone traditional resuscitation (traditional resuscitation group,n =103) from October 1976 to October 1990 and integrated treatment (integrated treatment group,n =488) from October 1991 to October 2012.The patients included native Tibetans,Han immigrants in plateau (≥ 3 months) and Han people who entered plateau rapidly (＜ 7 days).Outcome of the two treatments was compared.Results With regard to the traditional resuscitation group,native Tibetans sustained the main complications including stress ulcer (n =2),pulmonary edema (n =1),MODS (n =3) and death (n =3) ； Han immigrants in plateau sustained the main complications including stress ulcer (n =9),pulmonary edema (n =8),ARDS (n =3),cerebral edema (n =1),acute renal failure (n =3),disseminated intravascular coagulation (DIC) (n =2),MODS (n =13) and death (n =11)； Han people who entered plateau rapidly sustained the main complications including stress ulcer (n =5),pulmonary edema (n =4),ARDS (n =4),cerebral edema (n =2),acute renal failure (n =3),DIC (n =2),MODS (n =6) and death (n =4).Whereas in contrast to the relevant patient crowds in the traditional resuscitation group,the native Tibetans,Han immigrants in plateau and Han people who entered plateau rapidly presented significant reduction of complication rate and mortality rate in the integrated treatment group.Conclusions (1) Traditional resuscitation for severe THS patients in plateau results in much more complications with quick occurrence,high incidence,rapid progression,high severity and high mortality.Moreover,the complications are more severe in Han people who entered plateau rapidly than in the Han immigrants in plateau and native Tibetans.(2) The incidence of complications and death rate are significantly reduced after integrated treatment.(3) Han people who entered plateau rapidly present larger dependence on integrated treatment than the Han immigrants in plateau and native Tibetans.
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OBJECTIVE@#To improve the diagnostic and therapeutic efficiency for secondary laryngeal tuberculosis through an analysis on the clinical features of patients with this disease.@*METHOD@#A retrospective study was made among 49 cases with laryngeal tuberculosis treated in Tibetan General Hospital of Chinese PLA, and the clinical data were carefully analyzed to summarize the clinical experience of this disease.@*RESULT@#Of 49 patients, 24 cases had 1 year history, 11 cases had 1 to 3 years, 9 cases had 3 to 5 years, 5 cases had 5 years or more. Thirty-eight patients had the history of tuberculosis and 11 had none. Thirty-four patients had taken anti-tuberculosis drugs but none had standard therapy as demanded. All cases had mild general symptoms (mild fever, night sweats, weight loss, et al) and atypical local symptoms (hoarseness, sore throat). Therefore, 42 cases were misdiagnosed as non-specific chronic laryngitis, of which 15 cases got worse after oral administration or inhaling of steroid hormones. Seven persons were misdiagnosed as laryngeal cancer. All patients were confirmed pulmonary tuberculosis by X ray exam or CT scanning. Twelve cases had strong positive PPD tests and 2 cases were detected positive by sputum smear. All patients was treated by standard systematic and local chemical therapy against tuberculosis (inhaling of antituberculosis drugs for 1 to 2 months). All were cured but one died in a road accident, and none had recurrence after 1- to 9- year follow-up.@*CONCLUSION@#All of those the patients with long period hoarseness and sore throat should take chest CT scan or X-ray exam for the highest incidence of pulmonary tuberculosis at high altitudes. CT scanning is the prefer for its high resolution. Pathological biopsy and diagnostic therapy should be taken to make accurate diagnosis. Usually steroid hormones should not be recommended.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Altitude , Retrospective Studies , Tibet , Tuberculosis, Laryngeal , Diagnosis , Drug TherapyABSTRACT
Objective To study the effects of duration of migration from sea-level to high-altitude on cerebral hemodynamic parameters and their ethnic differences.Methods This randomized comparative study recruited 5 groups of healthy male subjects which were native Hans at sea-level (NHS),Han migrants from sea-level to high-altitude (HMSH,where HMSH-a for residence duration of 4 days,HMSH-b for 1 year,and HMSH-c for 5 years),and native Tibetans at high-altitude (NTH).Color duplex Doppler sonography (CDDS) was used to measure bilateral vertebral and internal carotid arterial diameters,mean flow velocities.The heart rate,arterial blood pressure,and arterial oxygen saturation were also recorded simultaneously,and in combination,hemoglobin was measured to assess total cerebral blood flow (TCBF),total cerebrovascular resistance (TCVR),and total cerebral oxygen supply (TCOS).Results After migration to high-altitude,Hans' TCVR and TCBF maintained the level of NHS after transient changes during early stage (P<0.05),and the TCBF was markedly higher than that of NTH (P<0.05);while the blood pressure and TCOS increased abruptly (P<0.05) at the beginning and kept for a relatively long time at a constant level which were higher than those of NTH all the time (P<0.05).Conclusions Han migrants can acclimate to high-altitude by adaptive change of cerebral blood flow over a short time and maintain a constant adaptability which is always weaker than that of native Tibetans.CDDS can be used for non-invasive measurement of actual cerebral blood flow,and is of good value in the study on high-altitude-related cerebral hemodynamics.
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Objectives To analyze the relationship between the multi-organ hypoxia damage and the death of acute high altitude sickness severe case. Methods 3220 cases from 1956. 06 to 2005.06 in the hospital were reviewed by questionnaire and the cases in MODS or death were screened out. The cause of death and feature were analyzed by the data as clinical symptom, physical signs and auxiliary examination. Results 281 cases complicated by MODS (include 35 dead cases) were found out by review. The incidence with MODS is 8.73% , and the death rate was 1.09%. The masculine incidence rate of the clinical symptom, physical signs and auxiliary examination in death were 2. 86% ~65. 71% , 2. 86% ~ 100% and 14. 29% ~ 100% , respectively. The MODS incidence in dead cases was 100%. Compared with the curing group, the MODS number, cardiac functional disturbance, brain disorder and renal functional disturbance in the death group had a significantly high incidence rate in all the 281 cases with MODS( P <0.05). With dependability analysis, there were a significantly direct correlation relationship between the death in the severe cases with acute high altitude sickness and the number of MODS ( r = 0. 3473, P < 0.001). Conclusion Hypoxia to the damage of multi-organ function play an important role in death of the severe cases with acute high altitude sickness in high attitude area, and the functional disturbance of important organs as heart, brain and kidney is the most important cause to death.
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OBJECTIVE To investigate the storage time and the origin of bacteria for disinfection package for combat readiness under natural environment in inland and plateau situation.METHODS We prepared double-cotton operation dressing packet,apparatus package,as well as dressing and apparatus mixed packet each with 72 pieces,respectively.Packages were deposited within closed and opened storage boxes under natural environment in depository for combat readiness,respectively after vacuum steam sterilization.Three different kinds of packages each with 3 items were put inside each box.After sterilization,total of 9 items with each 3 from one type of package were taken randomly from each group every time for bacterial culture by different time.At the same time,samples of the air and depot boxes in warehouse for combat readiness were collected and cultured as well as analyzed for bacterial homology.RESULTS In Chongqing,all packages were negative for bacteria on the 40th day after sterilization,while 2 packages were positive for bacteria on the 49th day.In Lhasa,4 packages were positive in opened group on the 106th day after sterilization.On the 122nd day,6 packages were positive in opened group and 1 item was positive in closed group.The dominant bacteria are bacilli and staphylococci both in the air and depot boxes of the warehouse for combat readiness.CONCLUSIONS The storage time for disinfection package under natural environment in different areas correlates closely with the local environmental and climatic situations.The bacteria of the package were confirmed to be from the air.The effective storage time for disinfection package would be prolonged by standardization of the disinfection procedure,and control multiple environmental factors affecting microorganisms.
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Electrolyte disturbance was prominent in patients with severe acute mountain sickness. In these patients hypoxia caused water and salt retension together with vasoactive substances and excessive free radicals might play important roles in the development of multiple organ dysfunction syndrome (MODS). More attention should be given to electrolyte monitoring in dealing with these severe mountain sickness in field.
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OBJECTIVE To observe Staphylococcus aureus(SAU) infection at high altitude and plain after gunshot injury. METHODS Used 7.62mm bullets to injure posterior limbs of piglets with the same age.We got contusing tissues in different time after injury,to make bacteriologic examination,identify and make a statistic analysis of SAU. RESULTS The main infection was caused by SAU after gunshot injury in two regions.From contusing tissues in two regions,the rate of contamination caused by SAU in Chongqing and Lasa was 48% and 18%,respectively.The time of SAU colonization was 3 hours at high altitude,and less 3 hours at plain.The velocity of reproduction of SAU at high altitude for 12 hours was 5-6 passages,and at plain was 4-6 passages for 3-6h.The time of remaining relative steady state between tissues and germs was 48 hours at high aititude and 24 hours at plain.The difference of the number of SAU between two regions after injury 3-36 hours was significant,But after 36 hours the difference was unsignificant. CONCLUSIONS At high altitude region,SAU is the main germ that causes contamination after gunshot injury,the velocity of reproduction of SAU is slower than that at plain,the time of infection is delayed obviously.
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0.05),and the levels of Fib and D-dimer were obviously higher but AT-Ⅲ was obviously lower in 2 NS groups than those in normal control group(P
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Objective To explore the significance and effect of NO treatment on plasma ET, NPY, ANP and CGRP in acute high altitude diseases(AHAD) patients. Methods 47 AHAD patients were randomly divided into two groups, one group receiving routine medicine treatment (n=23), and the other group receiveing NO treatment (n=24). The level changes of serum NO, plasma ET, NPY, ANP and CGRP and clinical symptom score were compared before and after treatment in the two groups. Results The levels of plasma ET, NPY, ANP and CGRP, and clinical symptom score remarkably decreased after treatment in two groups, while serum NO and CGRP levels remarkably increased (P
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Objective To study the effect of Gaoyuankang capsule on the serum nitric oxide (NO) content and plasma atrial natriuretic peptide(ANP), calcitonin gene-related peptide(CGRP) and endothelin(ET) content in great numbers of entrants landing at high altitude rapidly and its significance. Methods 2150 new soldiers, who swiftly entered plateau by air from plain, were randomly divided into experimental group (EG,n=1150) and control group (CG,n=1000). EG continually orally took Gaoyuankang capsules for 3 days before boading a plane. CG orally took placebo. The changes of serum NO content and plasma ANP, CGRP and ET content before and after entering plateau, and the incidence of acute high altitude disease (AHAD) after entering plateau were compared between the two groups, each group containing 40 randomly selected soldiers. Results NO and CGRP concentration of CG remarkably decreased after entering plateau than before entering plateau, while ANP and ET levels remarkably increased after entering plateau than before entering plateau (P
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Objective To reproduce an animal model of acute hepatic failure at high altitude areas for use in the research of extracorporeal artificial liver support. Methods General condition, survival time, relevant biochemistry indexes and pathological changes of the pigs treated by two peritoneal injections of thioacetamide in the dose of 50mg/kg, 100mg/kg and 150mg/kg respectively. Results All the pigs in the 3 experimental groups displayed clinical symptoms and signs and biochemistry changes similar to that of human patients with acute hepatic failure, and the 100mg/kg group may be the most ideal model. Conclusion The animal model of pig treated with two peritoneal injections of thioacetamide 100mg/kg is suitable for the research of extracorporeal artificial liver support for hepatic failure at high altitude.
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AIM: To explore the pathogenic mechanism of high altitude pulmonary edema(HAPE). METHODS: Haemodynamic changes and effects of 100 percent oxygen breathing were measured by Swan-Ganz thermistor catheters, high altitude healthy volunteers were served as controls. RESULTS: The important features of haemodynamic changes in HAPE: (1)Pulmonary arterial pressure was raised; (2)Pulmonary arterial resistance and cardiac output were raised; (3)Pulmonary artery wedge pressures and right atrial pressure were normal; (4)Pulmonary arterial pressure and resistance were induced by oxygen breathing. CONCLUSIONS: The normal pulmonary artery wedge pressures with a high cardiac output indicated that HAPE was recognized as a form of noncardiogenic pulmonary edema. The pulmonary hypertension may play an important role in the development of HAPE.
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Objective To observe the effect of the therapy using NO with plateau air balance on acute high altitude disease.Methods Forty-seven acute high altitude disease patients were selected and divided into two groups randomly: twenty-three cases as a routine drug treatment group which used the protocol of inhaling oxygen and the drugs including Aminophylline,DEX and Frusemide,while twenty-four cases as a NO treatment group which only used the protocol of inhaling 0.001% NO gas air balanced in plateau(altitude 3,658 m)twice daily,an hour each.Observe the two groups' clinical symptoms,physical signs and clinical symptom's scores before and after the three day treatment.Results The clinical symptoms,physical signs and clinical symptom's scores of the two groups after the three day treatment improved significantly.The effect of the NO treatment group was more significant(the drug group P
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Hospital construction is essentially disciplinary construction and personnel development. Improving the quality of department heads in an all round way and bringing into full play their potential and enthusiasm will be of great significance in promoting disciplinary and hospital construction and development. To give play to the role of department heads, it is imperative to enhance their quality, bring into full play their potential and enthusiasm, and appropriately handle relationships with them. Only by doing so can marked achievements be made in hospital construction and development.
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AIM: To compare the effects of hypoxia on expression of vascular endothelial growth factor (VEGF), iNOS and eNOS mRNA in cultured umbilical vein endothelial cells (UVECs) obtained from Tibetan and Han. METHODS: UVECs were obtained from native Tibetan and immigrant Han, respectively and cultured under hypoxia conditions (0.5% oxygen) for 2 h, 4 h, 12 h, and 24 h and normoxic conditions. VEGF, iNOS and eNOS mRNAs were detected with methods of RT-PCT. RESULTS: VEGF and iNOS mRNAs were up-regulated while eNOS mRNA depressed by hypoxia similarly in Tibetan and Han UVECs. CONCLUSION: Our results suggest that the changes of VEGF, iNOS and eNOS mRNA expression are common pathways in the mechanisms of hypoxic responses.
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AIM: To evaluate the prophylactic effect of aminophylline on the pulmonary hypertension rebound reaction to exposure to NO in the hypoxic pigs. METHODS: The 10 pigs undergone Swan-Ganz catheter, the mPAP was measured with a Physio-recording instrument and PaO 2 was measured with a blood gas analyzer, when breathing NO for 30 minutes and suddenly stopping breathing NO, administing aminophylline 0.25 g, followed by 30 minutes with room air. The respiratory rate and heart rate were also monitorried with a Hewlett-Packard portable monitor. RESULTS: The mPAP of the acute hypoxic pig was induced significantly after breathing 10 -5 NO. When suddenly stopping breathing NO, the induced mPAP became more and more high, the level of the mPAP in 5 minutes was similar to the values before absorbing NO, the mPAP in 10 minutes was higher than values before absorbing NO, while the level of PaO 2 was lower than the values before absorbing NO; but suddenly stopping breathing NO, administing aminophylline, although the induced mPAP became high, the speed was slower than the controls, the level of the mPAP in 30 minutes still was lower than the values before absorbing NO. CONCLUSION: Aminophylline has preventive effects on the pulmonary hypertension rebound reaction to exposure to NO in the hypoxic pigs.