Background: High-altitude environments present unique challenges to brain adaptability. This study aimed to explore the brain magnetic resonance imaging (MRI) characteristics of neurologically normal Tibetan neonates, and to compare brain volumes and myelination status across different altitude levels. Methods: This was a case-control exploratory study. A total of 30 neurologically normal infants in the high-altitude group (altitude: 3,650 m) and a total of 30 neurologically normal infants in the sea-level group (altitude: 4 m) were included in the study. The infants in the two groups were matched 1:1 using propensity score matching (PSM) for gestational age at birth, birth weight, sex, and postnatal age at MRI examination. The primary outcomes were differences in volumetrically segmented tissue (lateral ventricles, gray matter, and white matter) and intracranial volume (ICV) between the two groups. We further compared the differences among altitude subgroups. Myelination status was also assessed using the T1-weighted/T2-weighted (T1w/T2w) ratio. Results: Compared with the sea-level group, ICV was significantly increased in the high-altitude group, an increase that appeared to be primarily attributable to larger gray matter and lateral ventricular volumes. The T1w/T2w ratio in the middle cerebellar peduncle (MCP) was significantly lower in the high-altitude group than the sea-level group. In the altitude subgroup analysis, ICV was found to be significantly increased in altitude subgroup 2 (4,000-4,800 m) but not in altitude subgroup 1 (3,500-4,000 m). Conclusions: ICV was significantly increased in the high-altitude group compared to the sea-level group, especially in altitude areas above 4,000 m. Additionally, delayed myelination in the MCP was observed in the high-altitude group.

Introduction: The incidence of venous thromboembolism (VTE), a leading cause of morbidity and mortality worldwide, exhibits considerable geographical variability. Although VTE is well-documented in low-altitude settings, the role of high-altitude (HA) environments on the occurrence of VTE remains unclear. Here, we aimed to address this gap by examining the prevalence of VTE at the HAs of the Tibet Autonomous Region, China, offering a unique perspective on how altitude influences VTE risk.  Methods: In this retrospective analysis, we reviewed the medical records from the Tibet Autonomous Region People's Hospital between January 2018 and December 2023. We included 1,084 patients diagnosed with VTE in this quantitative synthesis and comprehensively analysed demographic data, clinical outcomes, and anticoagulant treatment patterns. We used statistical methods, including logistic regression, to identify potential risk factors and explore the relationship between HA and VTE incidence. Results: The prevalence of VTE in the Tibet Autonomous Region People's Hospital between 2013 and 2023 increased annually from 0.74% to 1.12%. Additionally, VTE was mainly associated with the 18–64-year age group, low haemoglobin levels, and hypertension at HA regions. The occurrence of VTE among residents of HA areas was more common than that reported for lower-altitude populations. Conclusion: This study highlights the critical influence of HA environments on VTE prevalence and the need for tailored healthcare approaches. The unique patterns of anticoagulant therapy after discharge highlight the importance of personalized treatment plans. Overall, our findings contribute to the global understanding of VTE at HA regions and the development of tailored treatment for patients with VTE from HA areas. ### Competing Interest Statement he authors have declared that no competing interests exist. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This retrospective study was approved by the Medical Ethics Committee of Tibet Autonomous Region People's Hospital (Approval No: ME-TBHP-25-KJ-028) with a waiver of informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.

BACKGROUND:Feeding difficulties significantly impact neonatal well-being. This study explores the clinical characteristics, etiologies, and diagnostic practices for full-term neonates with feeding difficulties in neonatal intensive care units (NICUs). METHODS:This retrospective cohort study recruited full-term infants admitted to NICUs participating in the China Neonatal Genome Project from March 2017 to December 2021, diagnosed with feeding difficulties persisting >72 h. RESULTS:Among 220 patients, the most common symptoms were poor sucking (39.5%), vomiting (22.3%), and dysphagia (14.1%). High-yield diagnostic modalities included genetic tests (83/220, 37.3%), brain imaging (70/145, 48.3%), laryngoscopy (47/54, 87.0%), and muscle biopsy (12/28, 42.9%). A definitive etiology was identified through clinical evaluation in 100 cases (45.5%), 48 of which (21.8%) were subsequently confirmed by genetic testing. In an additional 35 cases (15.9%), genetic results contributed to diagnostic clarification or revision. Compared to neonates without genetic disorders, the 83 patients with genetic disorders were more likely to have persistent feeding difficulties, reduced muscle tone, craniofacial deformities, urinary and reproductive system malformations, and a need for invasive respiratory support (P < 0.05 for all). CONCLUSION:Identifiable etiologies were found in over 60% cases, with genetic disorders representing a significant subset. Selective genetic testing and targeted diagnostic strategies are essential for managing feeding difficulties in this vulnerable population. IMPACT:Feeding difficulties in full-term neonates admitted to NICUs remain under-recognized compared to those in preterm infants. This study provides a comprehensive overview of their clinical features and underlying etiologies, highlighting a substantial proportion with identifiable causes, including genetic and non-genetic factors (e.g., neuromuscular and gastrointestinal). By outlining the diagnostic yield of key modalities and their clinical relevance, our findings offer practical guidance for early evaluation of feeding difficulties in this vulnerable population.

BACKGROUND:Hypoxic ischemia (HI) is one of the common causes of neonatal brain injury, leading to neurodevelopmental disorders such as cerebral palsy, epilepsy, and cognitive deficits. In this study, we evaluated neuroprotective effects of vitamin C on the neonatal HI brain injury mouse model. METHODS:Brain damage measurement, sensorimotor function in the neonatal period, learning and memory ability in adulthood were carried out in mice treated with vitamin C daily for 7 consecutive days following HI brain injury at postnatal day 7. RESULTS:Vitamin C treatment significantly reduced the hippocampus damage area, infarction volume, hippocampal neuron loss, and suppressed the neuroinflammation after HI injury. Additionally, it improved performance on neonatal sensorimotor function tests and learning and memory ability in adulthood. CONCLUSIONS:Vitamin C reduced brain injury and improved functional recovery in the neonatal hypoxic ischemia brain damage (HIBD) model. IMPACT:Vitamin C treatment significantly reduced neuron loss and suppressed the neuroinflammation after hypoxic-ischemic brain injury. Vitamin C treatment enhanced sensorimotor functions in neonates and improved cognitive abilities in adults after hypoxic-ischemic brain injury. Vitamin C could be an attractive candidate drug in clinical trials of hypoxic-ischemic encephalopathy therapy.

BACKGROUND:The electrical activity of the brain is sensitive to oxygen availability. However, no studies have yet reported on the brain electrical activity of newborns in plateau and plain regions. METHODS:Neonates were admitted to the Department of Neonatology at Kunming Children's Hospital and Fudan University Children's Hospital, where they underwent EEG monitoring (P3/P4/F3/F4) from January 2020 to December 2022. The inclusion criteria were as follows: absence of neurological symptoms and signs, no infection during hospitalization, no abnormal waveform and obvious pseudo-error of EEG, and the corrected gestational age ≥35 weeks at EEG monitoring. A total of 136 cases were recruited, with equal representation from both the plateau group (Kunming group, KM group) and the plain group (Fudan group, FD group) at the respective institutions. Each patient had one EEG monitoring recording, each with 410 quantitative electroencephalogram (qEEG) signal features extracted. Besides, demographic information (sex, birthweight, corrected gestational age) were included in the regression analysis for the sample group. qEEG signal features were used to predict corrected gestational age by Gradient Boosting Machine in each sample group. RESULTS:Twenty signal features in the KM group exhibited higher values compared to those in the FD group, whereas ten signal features were lower (p < 0.05) corrected by demographic information. Higher signal features tend to occur in individuals with less corrected GA (Pearson correlation coefficient -0.32, p value = 6.63e-11). The prediction model for the plains (FD model) demonstrated a coefficient of determination (R²) of 0.72 in FD group but reduced performance R² of 0.47 in KM group. Similarly, the plateau model (KM model) showed performance R² of 0.6 in KM group but 0.37 in FD group. CONCLUSION:The results indicate that brain maturity in newborns from plateau regions may lag behind that of their peers from plain regions. Therefore, the brain maturity prediction model based on qEEG needs to be re-generated for different altitudes. IMPACT:We first explored the healthy neonatal brain development from the moderate altitude and evaluated the differences of neonatal brain development between plateau and plain areas by quantitative electroencephalogram (qEEG) signals. We found the brain maturity in newborns from plateau regions may lag behind that of their peers from plain regions. The brain maturity prediction model based on qEEG needs to be re-generated for different altitudes.

Background and Objective: Coronavirus disease 2019 (COVID-19) has been a most important global issue since December 2019. Although for children, the clinical course of COVID-19 is milder, it may still cause a multi-system inflammatory syndrome and has rendered 22,000 deaths among children and young people. The objective of this review is to provide up-to-date information about COVID-19 related mortality and relevant risk factors in children and young people. Methods: Searches for studies were conducted using PubMed and Web of Science, with a date time up to April 22, 2022. Only publications in English were included. Key Content and Findings: With the Omicron being the dominant circulating variant, the absolute risk of death from COVID-19 is extremely low in children and young people. We found that those who are with multiple co-morbidities, from non-white ethnic groups, and in low- and middle-income countries might have increased risk of intensive care unit admission and death. And vaccination is always critical to reduce the incidence of severe COVID-19 cases. Conclusions: This review provides an overview of the COVID-19 related mortality and relevant risk factors. Since this disorder continues to evolve, a prompt diagnosis and treatment strategy will allow for the best possible care and outcome for patients with COVID-19.

Further evidence is needed to explore the impact of high-altitude environments on the neurologic function of neonates. Non-invasive techniques such as cerebral near-infrared spectroscopy and amplitude-integrated electroencephalography can provide data on cerebral oxygenation and brain electrical activity. This study will conduct multiple cerebral near-infrared spectroscopy and amplitude-integrated electroencephalography monitoring sessions at various time points within the first 3 days postpartum for healthy full-term neonates at different altitudes. The obtained data on cerebral oxygenation and brain electrical activity will be compared between different altitudes, and corresponding reference ranges will be established. The study involves 6 participating centers in the Chinese High Altitude Neonatal Medicine Alliance, with altitude gradients divided into 4 categories: 800 m, 1 900 m, 2 400 m, and 3 500 m, with an anticipated sample size of 170 neonates per altitude gradient. This multicenter prospective cohort study aims to provide evidence supporting the impact of high-altitude environments on early brain function and metabolism in neonates.

Introduction: The partial oxygen pressure in the air decreases with increasing altitude. This study was designed to compare the pulse oxygen saturation (SpO(2)) among well full-term neonates at different altitudes during their first 2 h after birth and to establish cutoff values of SpO(2) identifying hypoxemia between 30 and 120 min after birth. Methods: A multisite prospective cohort study was conducted at five participating hospitals from the Chinese High Altitude Neonatal Medicine Alliance. Healthy full-term infants were recruited and divided into four groups based on the altitude. Preductal SpO(2) was recorded at 10 min, 10-30 min, and 30-120 min after birth. The 2.5th percentile of the SpO(2) distribution range was considered as the cutoff for identifying hypoxemia at each altitude. Results: A total of 727 infants were eligible for analysis. The SpO(2) of neonates at different altitudes increased with the time after birth. A higher altitude was associated with lower SpO(2), especially Shangri-La (3,509 m) and Yushu (4,360 m). The cutoff SpO(2) for identifying hypoxemia during 30-120 min after birth were 94% in Xishuangbanna (847 m), 92% in Kunming (1,983 m), 89% in Shangri-La (3,509 m), and 83% in Yushu (4,360 m). Conclusion: An increase in altitude, especially Shangri-La (3,509 m) and Yushu (4,360 m), had a significant impact on SpO(2) among healthy full-term neonates during their first 2 h of life. Establishing the cutoff value of SpO(2) for identifying hypoxemia during the early postnatal period serves to optimize the oxygen therapy at different altitudes.

在药品零差价、"医药分家"政策的冲击下,传统调剂型药师的职能转变迫在眉睫[1].国家和社会对医院药学服务质量的要求不断提高,为了提高调剂速度和质量,医院调剂药品必须改变目前的人工调剂方式.然而在西藏地区大部分医院不仅未能实现自动化调剂,并且仍旧处于住院患者口服药品整盒发放的模式.口服用药的准确性和卫生安全性仅靠医护指导和患者的依从性,存在很大的用药安全隐患.

目的 探讨采用多学科团队协作模式(MDT)结合PDCA质量管理工具对医院麻醉药品和精神药品管理产生的成效.方法 以改进前的2016年麻醉药品和精神药品处方为对照组,以应用管理工具后2021年麻醉药品和精神药品处方为观察组,对比药品使用情况、处方合理率等指标.结果 观察组麻醉药品和精神药品的处方不合理处方率明显低于对照组(7.17％VS 22.72％).结论 在医院麻醉药品和精神药品管理中运用MDT协作模式结合PDCA质量管理工具,使得管理质量显著提高,该方法值得在医院药事管理中推广.

《全球化学品统一分类和标签制度》(GHS)是联合国在全球范围内积极推进的统一标准,已被广泛采用.作为国际协议成员国之一,我国正在积极推动GHS在国内的全面实施.使用符合标准的化学品安全标签既是国家行政部门合规管理的要求,也是有效传递化学品安全信息、保障公众生命财产安全的有效措施.利用GHS中的危险化学品安全标签可以有效传递化学品的危险特性信息和安全性信息,而利用二维码能够实时、便捷地查阅相关数据和信息并进行数据维护.将GHS与二维码相结合用于医疗机构危险化学品的安全管理,可有效提升医务人员及患者的安全防护意识,提高医疗机构对危险化学品的管理效率.本研究通过对GHS的概述,结合医疗机构所使用危险化学品的相关特性,对GHS与二维码结合的安全标签在医疗机构危险化学品安全管理中的应用进行了思考,以增强医疗机构危险化学品管理工作的系统性、规范性、高效性和科学性,为广大医患群体提供便捷、高效、规范的安全保障.

目的 比较西藏第一批国家组织药品集中带量采购政策(简称"国家集采")落实前后患者用药情况,可为医疗机构药学部门及临床科室用药提供参考.方法 通过提取医院门诊就诊患者基本信息和处方信息,筛选2019年1月1日至2021年8月30日使用过西藏第一批国家集采目录中药品的患者,比较患者在执行国家集采政策前后使用规律、换药、加药数据的变化情况,分析年龄段及性别对其用药依从性的影响.结果 样本共5887例,病种主要分布于心血管系统(72.96％)、抗感染治疗(11.72％)、内分泌系统(7.71％).患者用药规律性总体呈现V字,中年患者用药依从性较低,需有针对性地做用药教育;男性患者用药规律性总体高于女性患者.长期服药患者的用药持续情况与用药时长呈负相关.国家集采政策落实前后患者换药数据无统计学差异,男性患者换药数据不同年龄组间有差异;调整剂量患者人数较少;集采政策落实后患者换药时会出现用药不规律情况.结论 国家组织集中带量采购政策落实前后,患者换药数据无明显差异;用药服务需按年龄段、性别分侧重点进行;患者换药后需增强其用药规律性相关用药教育;机构制定政策时应关注患者需求,及时改进政策提高患者用药依从性.

近年我国不断有唑来膦酸注射液用药后引起发热、关节痛、肌肉痛、低钙性抽搐及心律失常等病例报道.现将1例唑来膦酸注射液治疗老年女性骨质疏松症后引起血肌酐升高的不良反应进行分析. 1 病例 患者女性,70岁,因纳差、腹胀、呕吐4月查病因为入院,既往有糖尿病、高血压病、类风湿关节炎、冠心病、4年前跌倒后"腰椎滑脱、骨裂"以及诊断骨质疏松3年等多种慢性疾病病史;个人史、婚育史、家族史无殊.入院查体:生命体征平稳,心肺腹查体无殊,双下肢不肿,老年综合评估方面存在营养不良风险、衰弱、失眠、失能以及多重用药.

目的 分析我院用药错误(Medication error,ME)发生原因并提出改进措施.方法 回顾性分析我院2019年1月～2020年12月上报的用药错误报告55例患者.分别为ME的级别、内容、引发因素、引发人员和发现人员,进行归纳总结.结果 ME 级别.:A级 1.82％(1例)、B 级72.73％(40例)、C级21.82％(12例)、D 级3.64％(2例),无E-I级的报告;ME内容:品种错误43.64％(24例)、用量错误18.18％(10例)、数量错误16.36％(9例)、规格错误7.27％(4例)、剂型错误、给药途径错误;ME引发因素:技术不熟练22.58％(14例次)、药名相似20.97％(13例次)、货位相邻占12.90％(8例次),其余依次为疲劳7例、知识欠缺5例、外观相似4例、抄方错误3例、拼音相似、设备故障及培训不足各2例,缩写和其他因素各占1例;引发ME人员:药师61.11％(33例),医师38.89％(21例);发现ME人员:药师64.81％(35例),医师29.63％(16例),护士 3.70％(2例),患者或家属1.85％(1例).结论 上报数量与国内其他同等级医院相比稍低,需进一步提高医务人员安全用药意识,鼓励所有医务人员主动参与到用用药安全中.

Coronavirus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable morbidity and mortality worldwide. The clinical manifestation of COVID-19 ranges from asymptomatic or mild infection to severe or critical illness, such as respiratory failure, multi-organ dysfunction or even death. Large-scale genetic association studies have indicated that genetic variations affecting SARS-CoV-2 receptors (angiotensin-converting enzymes, transmembrane serine protease-2) and immune components (Interferons, Interleukins, Toll-like receptors and Human leukocyte antigen) are critical host determinants related to the severity of COVID-19. Genetic background, such as 3p21.31 and 9q34.2 loci were also identified to influence outcomes of COVID-19. In this review, we aimed to summarize the current literature focusing on human genetic factors that may contribute to the observed diversified severity of COVID-19. Enhanced understanding of host genetic factors and viral interactions of SARS-CoV-2 could provide scientific bases for personalized preventive measures and precision medicine strategies.

目的 通过文献计量学及可视化分析方法针对CYP2C19基因与氯吡格雷关系,研究其现状、热点及发展趋势.方法 以Web of Science数据库为数据源,使用VOSviewer 1.6.13绘制网络图谱,分析CYP2C19基因与氯吡格雷的研究趋势.结果 共检索出符合要求的文献202篇,发文量整体呈逐年上升趋势;研究方向集中在药理学、心血管系统学和血液学方面;发文量最多的杂志是Thrombosis Research;最多的作者是Hulot J S.结论 氯吡格雷的基因多态性研究从早期药物代谢逐步发展到真实世界不良临床结局.目前研究热点为基于血小板功能和基因检测的精准治疗,从多基因位点、病理生理学、药物相互作用等多因素评价疗效差异.

随着医疗人才“组团式”援藏工作的逐年深入开展,北京协和医院药剂科向西藏自治区人民医院药剂科派出了5批援藏专家,将协和经验与西藏实际相结合,不断思考和创新,积累并传递经验,在硬件完善、药事管理、临床药学建设、自动化设备引进、信息系统完善、人才培养、科研及患者服务方面取得了一定成效.通过总结药剂科5年来对口支援工作经验,分析对口支援工作中存在的问题,对药剂科援藏工作未来运行模式进行探讨并提出相关建议.

BACKGROUND:Accurate detection of cerebral oxygen saturation (rSO2) may be useful for neonatal brain injury prevention, and the normal range of rSO2 of neonates at high altitude remained unclear.OBJECTIVE:To compare cerebral rSO2 and cerebral fractional tissue oxygen extraction (cFTOE) at high-altitude and low-altitude areas in healthy neonates and neonates with underlying diseases.METHODS:515 neonates from low-altitude areas and 151 from Tibet were enrolled. These neonates were assigned into the normal group, hypoxic-ischemic encephalopathy (HIE) group, and other diseases group. Near-infrared spectroscopy was used to measure rSO2 in neonates within 24 h after admission. The differences of rSO2, pulse oxygen saturation (SpO2), and cFTOE levels were compared between neonates from low- and high-altitude areas.RESULTS:(1) The mean rSO2 and cFTOE levels in normal neonates from Tibet were 55.0 ± 6.4% and 32.6 ± 8.5%, significantly lower than those from low-altitude areas (p < 0.05). (2) At high altitude, neonates with HIE, pneumonia (p < 0.05), anemia, and congenital heart disease (p < 0.05) have higher cFTOE than healthy neonates. (3) Compared with HIE neonates from plain areas, neonates with HIE at higher altitude had lower cFTOE (p < 0.05), while neonates with heart disease in plateau areas had higher cFTOE than those in plain areas (p < 0.05).CONCLUSIONS:The rSO2 and cFTOE levels in normal neonates from high-altitude areas are lower than neonates from the low-altitude areas. Lower cFTOE is possibly because of an increase in blood flow to the brain, and this may be adversely affected by disease states which may increase the risk of brain injury.

A 50-year-old female patient was treated with diammonium glycyrrhizinate enteric-coated capsules for about 22 months irregularly due to repeated abnormal liver function, which was changed to compound glycyrrhizin 3 tablets thrice daily later. After 4 months of treatment with compound glycyrrhizin, the patient developed myalgia with fatigue and the symptoms gradually aggravated, resulting in weakness of limbs and difficulty in walking. Compound glycyrrhizin were stopped for 1 week, but the symptoms were not improved, with a blood pressure of 160/100 mmHg. Laboratory tests showed blood potassium 1.9 mmol/L, alanine aminotransferase (ALT) 54 U/L, aspartate aminotransferase (AST) 104 U/L, creatine kinase (CK) >2 200 U/L, myoglobin 542.1 μg/L, and blood pH 7.56. Intravenous and oral potassium supplementation and symptomatic treatments were given. Three days later, the symptoms of myalgia and fatigue were markedly improved and the blood potassium returned to 3.5 mmol/L. Two weeks later, the patient′s muscle strength recovered and the blood pressure was 100/71 mmHg. Laboratory tests showed blood potassium 4.2 mmol/L, ALT 45 U/L, AST 38 U/L, and CK 44 U/L. Aldosterone postural stimulation test and captopril challenge test were performed for definite diagnosis, showing normal aldosterone level and decreased renin concentration. Pseudoaldosteronism complicated with hypokalemic rhabdomyolysis was diagnosed, which was considered to be related to long-term administration of glycyrrhizic acid preparations.