It has always been an important policy of the Chinese government to provide aid and assistance for the development of Tibet. With nearly one-eighth of China’s total land areas and about 0.002% of China’s total population, the Tibet Autonomous Region lags behind the domestic average level in medical education and is in bad need for medical professionals. The West China Center of Medical Sciences (WCCMS) of Sichuan University has managed to introduce US projects to set up the West China–Tibet Telemedical Education System to transmit medical courses in a real-time and interactive way. Based on this system, WCCMS has established a model for assisting the Tibet University Medical College through transmitting medical courses, training their medical faculty, sending WCCMS faculty to work in Tibet and admitting medical teachers and students from Tibet to study and be trained at West China Medical School and Hospital.
Objectives Retrospective analysis of the Tibetan convulsive status epilepticus (CSE) for the aetiology, prognosis and its influencing factors in Tibet area. Methods Through electronic patient record, making “epilepsy”, “status epilepticus ”, “epileptic seizure” as keywords, convulsive status epilepticus patients in the People’s Hospital of Tibet Autonomous Region hospitalized from January 2015 to December 2020 were retrospectively observed, gathering their clinical data and aided examinations furthermore, and the prognoses were returned by telephone, meanwhile the functional status of those patients was assessed by the modified rankin scale. and the causes differ in gender, age, out-of-hospital antiepileptic treatment, family history of epilepsy and history of epilepsy were analyzed. The prognostic factors were analyzed by logistic regression. Results A total of 2 254 hospitalized patients with epilepsy were retrieved, including 331 CSE patients aged 14~84 years, 219 males and 112 females. There were 36 lost calls, 62 CSE deaths (21.01%), and 4 adverse outcomes (non-death)(1.7%).There were statistically significant differences in etiology of CSE in different ages and history of epilepsy (P<0.05), but there were no statistically significant differences in gender, out-of-hospital antiepileptic treatment, progression of refractory status epilepticus and family history of epilepsy. Cerebrovascular disease was the main cause of CSE in people aged 45 and over (54 cases), while the main cause of CSE in people aged under 45 was unknown (104 cases).Among the patients with previous history of epilepsy, the highest proportion was unknown cause [117 cases (48.8%)]; Among patients without a history of epilepsy, cerebrovascular disease [34 cases (37.4)] was the most common cause of CSE. Multivariate logistic regression analysis of prognostic factors of CSE showed that gender, age, GCS and electrolyte disorder had statistically significant effects on the death of CSE patients (P<0.05), while altitude and their duration and other factors had no statistically significant effects on the death of CSE patients (P>0.05). ConclusionsCerebrovascular disease is the leading cause of CSE in people aged 45 and over. Male, advanced age, low GCS score at discharge, and electrolyte disorder were risk factors.
Objective To primarily test the reliability and validity of the Kashin-Beck Disease (KBD) affected big joints function assessing system for adult Tibetans in Rangtang County. Method From June to July 2009, 142 KBD patients were investigated with the function assessing system in Rangtang County of Ngawa. Cronbach’s α coefficient was calculated to estimate internal consistency reliability. Pearson’s r for the correlation of the items with the total score of the scale was computed to test the internal validity. Principal component factor analysis with varimax rotation analysis was conducted to explore construct validity. Result Both the response and complete rates of the scale were 100%. The time for completing the scale was 7.8±3.4 minutes. Cronbach’s α was 0.857, which revealed satisfactory internal consistency reliability. Pearson correlation analysis revealed significant correlation between the scores of each item and the total score of the scale (Plt;0.05). Pearson’s r value of each item was more than 0.4, only except the items of “sitting with legs crossed” and “standing at attention”. The principal factor analysis extracted three latent factors explaining 68.1% of the variation together. The latent factors weights of the items were over 0.4 except the items of “standing at attention”, "taking food” and “wiping after defecation”. Conclusion The reliability and validity of KBD affected big joints function assessing system for adult Tibetans in Rangtang County was good in this primary test, the function assessing system has to be widely applied and further assessed among Tibetans suffered with KBD, in order to provide a standard evaluation criterion in KBD integrate control.
ObjectiveTo evaluate the diagnostic value of interferon-gamma release assay (TB-IGRA) for tuberculosis in the Tibetan. MethodsFrom January 2014 to December 2014, suspected Tibetan tuberculosis patients were enrolled from AVIC 363 Hospital and underwent TB-IGRA test. All patients were also underwent smear test for Mycobacteria. The diagnostic value of TB-IGRA test for Tibetan TB patients was analyzed. ResultsA total of 77 suspected Tibetan tuberculosis patients were included. According to the diagnostic criteria, of the 77 suspected patients, 50 were diagnosed as TB patients, and 27 were diagnosed as not-TB patients. The sensitivity and specificity of TB-IGRA test was 86% and 81.5%. While the sensitivity and specificity of smear test were 22% and 100%, respectively. ConclusionThe TB-IGRA test is superior to smear test, and is the fast and sensitivity test for diagnosing Tibetan TB patients.
ObjectiveTo analyze the clinical features of psychogenic non-epileptic seizures (Psychogenic nonepileptic seizures, PNES) in Tibetan population in Tibet, so as to help clinicians identify the disease.MethodsRetrospective analyzed the clinical data of patients with PNES in the Department of Neurology, People's Hospital of Tibet Autonomous Region from June 2016 to December 2018.ResultsIn general clinical data, there were significant differences between male and female patients in the results of video electroencephalogram (EEG) monitoring the non-epileptic seizures (P< 0.05). There were no significant differences in mean age, mean onset time, family history of epilepsy, head injury and marital status between male and female patients (P> 0.05). There was no significant difference in symptoms between male and female, but there were differences among different age groups (P> 0.05). In the onset age, the main manifestation was young women, but there was no significant difference in the onset of PNES among different age groups.ConclusionsThere was significant differences between male and female PNES petients, but no significant differences in onset time, marriage and family history of epilepsy between the male and female patients with PNES in Tibet. The clinical manifestations of PNES were different in different ages of patients in Tibet.
Tibetan population has been living in Tibet plateau for more than thousands of years ago. Although, the environment is unlikely to be an ideal place for residence. They have evolved genetical and physiological adaptions living in Tibetan highlands. In recent several years, foreign scientists have noticed that lung cancer mortality is reduced at high altitude. Many in vitro and in vivo experiments explored the mechanism of this phenomenon. In this review we discuss the lung cancer incidence and mortally of Tibetan population, as well as the possible underlying mechanism including oxygen level, radiation, inhalable particulate matter, metabolism, hypoxic induced factor pathway and immune system. But, the clinical data as well as basic researches of Tibetan population remain insufficient, which required further investigation.
In order to further promote the construction of healthy Tibet, West China Hospital of Sichuan University, which has rich experience in providing assistance to Tibetan areas, has proposed a new model of “136” assistance to Tibet. In this new model, the demand of the assisted hospital is the center. Technology, talent and management as three core elements are starting point. Six special topics were taken as the dimensions, including specialist capacity building, technology popularization, establishment of chronic disease prevention and treatment system, appropriate talent training, hospital management training and model effect evaluation. This paper introduces the structural framework of the model and its application in Tibetan hospitals. It also puts forward the problems existing in the work of assisting Tibet and gives relevant suggestions, aiming to provide a reference for the improvement and perfection of medical aid work in Tibet.
Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan-Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.
West China Hospital of Sichuan University as a national-level regional medical center in the western part of the country, focused on the actual situation in Tibet and actively carried out precision health poverty alleviation work. Guided by " precision”, the hospital has built a close-knit medical association – Hospital of Tibet People’s Government in Chengdu Office, and through the comprehensive improvement of medical care, teaching, scientific research, and management, creates a medical and health service system with Tibet characteristics. Combining " blood transfusion” and " hematopoietic” to build a " West China Model” for precision health poverty alleviation, West China Hospital of Sichuan University fully demonstrates the public welfare and responsibility of a national-level regional medical center, and constantly exerts regional radiation and leading role, promotes the medical and health service system continuous improvement in Tibet.
ObjectiveTo investigate the risk factors,characteristics and prognosis in Tibetan patients with venous thromboembolism. MethodsTibetan patients with VTE from plateau area,admitted in West China Hospital from January 2010 to December 2012,were recruited in the study. The VTE diagnosis was confirmed by CT pulmonary angiogram (CTPA) or vascular ultrasound examination. Risk factors,clinical symptoms,signs and laboratory tests were retrospectively investigated and follow-up by telephone interview was conducted. Results31 Tibetan VTE patients with 16 males and 15 females were included. The investigation of risk factors revealed that 15 patients suffered from obese(48.3%),10 patients suffered from highly viscous hyperlipidemia(32.3%). The most common clinical symptom was dyspnea(29%),followed by chest pain(19.4%),hemoptysis(16.1%) and cough(12.9%). The common signs were lower extremity edema(73.3%) and lung rale(36.7%). All the patients received anticoagulation therapy,and inferior vena caval filters were implanted in 2 patients. In two years' follow-up after discharge,2 patients died of tumor,2 died of pulmonary embolism,6 patients suffered from chronic embolization syndrome with lower extremity edema or pain,1 patient suffered from pulmonary hypertension after embolization,and thrombus in 20 patients disappeared or recanalized. ConclusionTibetans long-termly reside in high altitude areas with the eating habits of high-fat diet,which may increase the incidence of acquired risk factors such as viscous hyperlipidemia and obesity. There are no specific clinical symptoms and signs among Tibetan VTE patients,with dyspnea as the most common symptom and lower extremity edema as the most common sign. Patients with risk factors which can be eliminated in a short term have better prognosis.