第十二届国际高原医学大会报告摘要选登

3871(大会论文编号)

WHOLEBRAINCOMPUTEDTOMOGRAPHYPERFUSIONOFPATIENTSWITHVARYINGDEGREESOFHIGH-ALTITUDEPOLYCYTHEMIA：PRELIMINARYSTUDYWITHAMULTIDETECTORCOMPUTEDTOMOGRAPHY

SUN Yanqiu，HU Junjie，ZHANG Yonghai

Department of Radiology，Qinghai Provincial People′s Hospital，Xining，China

Objective：The aim of this study was to investigate the changes in computed tomography perfusion(CTP)in patients with varying degrees of high-altitude polycythemia(HAPC)using a multidetector CT(MDCT).

Results：The changes of CBV，CBF，and MTT in the basal ganglia area of the control group were 43.87±7.89，3.21±0.48，and 5.00±0.98，respectively，compared to changes of 38.18±5.25，3.82±0.45，and 6.53±1.29 in patients with mild，moderate and severe HAPC(P=0.007，0.013，0.002).

Conclusions：Patients with different degrees of HAPC had lower perfusion changes than healthy volunteers.The amount of perfusion in basal ganglia area decreased with increasing severity of disease.

3873

EFFECTOFGEOGRAPHICALALTITUDEONCORONARYARTERYDIAMETERANDMYOCARDIALPERFUSIONINHEALTHYVOLUNTEERS

SUN Yanqiu，HUANG Xiaoshan，ZHANG Yonghai

Department of Radiology，Qinghai Provincial People′s Hospital，Xining，China

Objective：To determine whether there were any changes in coronary artery diameter and myocardial perfusion in healthy patients at different geographical altitudes.

MaterialsandMethods：This study was performed in healthy volunteers with approval from the institutional review board of Qinghai Provincial People′s Hospital.Thirty-one healthy volunteers including 18 cases of moderate altitude(1500-2500m)and 13 cases of high altitude(2500-4500m)with no known cardiac disease were enrolled.All patients underwent coronary computed tomography angiog-raphy and myocardial perfusion imaging with a wide coverage CT scanner(Revolution CT，GE Healthcare).Two investigators independently measured the diameter of the left main coronary artery(LM)and right coronary artery(RCA).In addition，myocardial blood flow，myocardial blood volume，and mean transit time were calculated.Differences between groups(moderate altitude group and high altitude group)were analyzed using Mann-Whitney U test.

Results：There was a significant difference in the diameters of the LM(3.66±0.25；4.62±0.50，P=0.000)and RCA(3.65±0.40；4.08±0.44，P=0.000)between patients from moderate altitude and high altitude.No significant difference was observed in the perfusion parameters of the 16 segments of the myocardium between groups.

Conclusions：Based on the results of this study，the diameter of coronary artery increased with increasing altitude in healthy volunteers.However，the change of altitude had no significant influence on myocardial perfusion.

3874

STUDYOFGLOBALREGISTRYOFACUTECORONARYEVENTSANDTHROMBOLYSISINMYOCARDIALINFARCTIONRISKSCORES′APPLICATIONINTHERISKSTRATIFICATIONANDPROGNOSTICEVALUATIONINPATIENTSWITHACUTECORONARYSYNDROMEINQINGHAI

HE Wujian，LIN Ling，CHEN Zhenying

Qinghai Provincial People′s Hospital，Xining，China

Objective：To compare the risk stratification ability and prognostic evaluation values of global registry of acute coronary events(GRACE)and thrombolysis in myocardial infarction(TIMI)risk score in patients with acute coronary syndrome(ACS)in Qinghai.

Methods：The clinical data of 385 patients with ACS treated in our hospital from January 2014 to October 2015 were analyzed to calculate the GRACE and TIMI risk scores of each patient.The main adverse cardiovascular events(MACE)within 30 days of the onset and 1 year after discharge were followed up.The receiver operating characteristic(ROC)curves of two kinds of scoring are depicted and the area under the curve(AUC)is compared.

Results：There was no statistic difference between the risk stratification in patients with ACS by means of GRACE score and TIMI score(χ2=0.316，P=0.854).What is more，the higher the GRACE and the TIMI risk scores were，the higher the incidence rate of MACE was in patients within 30 days of onset and 1 year after discharge(P<0.01).Taking 143 points of GRACE risk score as the cut-off value，the sensitivity and specificity of predicting MACE within 1 year after discharge were 89.93% and 90.83%，respectively.

Conclusions：GRACE and TIMI risk scores could be used in the risk stratification of patients with ACS in Qinghai.GRACE risk score held a higher predictive value in predicting recent adverse cardiovascular events in patients with ACS.

3881

PREVALENCEANDSHUNTTYPESOFRIGHT-TO-LEFTSHUNTINPATIENTSWITHMIGRAINEINPLATEAUAREA

SUN Haixia

Qinghai Provincial People′s Hospital，Xining，China

Objective：To analyze the prevalence，shunt types，and shunt volume of right-to-left shunt(RLS)in patients with migraine in middle-high-altitude area and further to analyze the relationship between migraine and RLS by conducting right heart contrast echocardiography on the patients.

Methods：Fifty-six patients diagnosed with migraine in neurology department of our hospital from June 2016 to August 2017 were enrolled.(Consistent with the diagnosis of The International Classification of Headache Disorders 3rd Edition Beta Version，ICHD-3β).(Fifteen[female 11]had migraine with aura and 41[female 21]were in the migraine without aura group and 50 were in the healthy group.)All patients underwent right heart contrast echocardiography.The test was performed during normal ventilation and during Valsalva maneuver，recording the maximal microbubbles within 20 seconds as the extent of shunt volume of RLS.

Results：The prevalence of RLS and large RLS in the migraine with aura group(MA+)was higher than that of migraine without aura group(MA-)(60.3% vs.34.5%，P<0.001；28.7% vs.10.4%，P<0.001).There was no difference among groups in terms of positive rate of medium and minor RLS(P=0.131；P=0.065).The prevalence of RLS and large RLS in the MA-group was higher than that of healthy group(35.7% vs.24.6%，P<0.001；15.7% vs.8.2%，P<0.001).There was no difference among groups in terms of positive rate of medium and minor RLS.

Conclusions：Prevalence of RLS in patients with migraine in plateau area(including MA+and MA-)was higher than that of healthy group，and large shunts take a predominate percentage in all those shunts.There was no difference among groups in terms of positive rate and shunt types of medium and minor RLS.There is an association between RLS and migraine，especially when the shunt is large.

3884

COGNITIVEANDNEUROIMAGINGCHANGESINHEALTHYIMMIGRANTSUPONRELOCATIONTOHIGHALTITUDE：APANELSTUDY

CHEN Xiaoming

Fourth Military Medical University，Xi′an，China

Background：Cognitive and neuroimaging changes under chronic high-altitude exposure had never been followed up and dynamically assessed before.

Objectives：To investigate the cognitive and brain structural/functional alterations during chronic high-altitude exposure.

Methods：Sixty-nine college freshmen who immigrated to Tibet were enrolled and followed up for 2 years.Neuropsychological tests，including verbal/visual memory and simple/recognition reaction time，were utilized to determine whether the subjects′ cognitive function had changed in response to chronic high-altitude exposure.Structural magnetic resonance imaging(MRI)and resting-state functional MRI were used to quantify brain gray matter(GM)volumes，regional homogeneity(ReHo)，and functional connectivity(FC)alterations before and after exposure.Areas with both GM and ReHo alterations were used as seeds in inter-regional FC analysis.

Results：The subjects showed significantly lower accuracy in memory test and longer reaction time after exposure to high altitude.Neuroimaging analysis showed markedly decreased GM volume and ReHo in the left putamen.FC analysis seeding of the left putamen showed significantly weakened FCs with superior temporal gyrus，anterior/middle cingulate gyrus，medial frontal gyrus，and other brain regions. In addition，decreased ReHo was found in the superior temporal gyrus，superior parietal lobule，anterior cingulate gyrus，medial frontal gyrus，and anterior cerebellum lobe，whereas increased ReHo was found in the hippocampus.Differences of ReHo/FCs before and after high-altitude exposure in multiple regions showed significant correlation with the cognitive changes.

Conclusions：Cognitive functions such as working memory and psychomotor function are impaired during chronic high-altitude exposure.Putamen may play an important role in chronic hypoxia causing cognitive impairment.

3886

STUDYONTHEEXPRESSIONOFp38MAPKINRATSWITHSEVEREACUTEPANCREATITIS-ASSOCIATEDLUNGINJURYUNDERHIGHALTITUDEANDLOW-OXYGENENVIRONMENT

ZHU Haihong

People′s Hospital of Qinghai Province，Xining，China

Objective：To investigate the expression of p38 MAPK in the serum of severe acute pancreatitis(SAP)combined with lung injury and its clinical significance in hypoxic environment.

Method：An artificial SAP model was established by injecting sodium taurocholate into the pancreatic subcutum of Wistar rats.The models were randomly placed at four different altitudes of 400，2300，3500，and 4300 m，and each large group was randomized.The rats were divided into F group，P1h group，P6h group，P12h group，and P24h group.Western blot was used to detect the changes of p38 MAPK activity in the pancreas and lung tissues，respectively.Reverse transcription-polymerase chain reaction(RT-PCR)was used to detect the expression of p38 MAPK mRNA in the two tissues.

Result：In the same altitude，the expression of p38 MAPK and p38 MAPK mRNA in pancreas and lung tissue increased with the prolongation of rat SAP in each time group(P<0.05).With the elevation of altitude，the expression of p38 MAPK and p38 MAPK mRNA in pancreas and lung tissues increased significantly(P<0.05).

Conclusions：With the elevation of altitude and the prolongation of duration，the severity of SAP lung injury gradually increases.The activation and overexpression of p38 MAPK in the pancreas and lung tissue may be one of the causes of SAP lung injury.

3888

THEEXPRESSOFMMP-9ONSEVEREACUTEPANCREATITISINTHEHIGHALTITUDE

BAI Yanlin

Department of General Surgery，People′s Hospital of Qinghai Province，Xining，China

Objective：To investigate the expression and changes of the concentration of matrix metalloproteinase 9(MMP-9)in the serum of the severe acute pancreatitis(SAP)patient who lives in the high altitude and to explore clinical significance.

Methods：Using enzyme-linked immunosorbent assay，the level of the concentration of MMP-9 in the serum of people of the SAP(36 cases)and healthy persons(39 cases)was detected.

Results：The concentration of MMP-9 showed significant increase in values(P<0.05)on the SAP patient，namely it was 12.56±3.00 ng/mol and in the healthy group it was 3.49±0.63 ng/mol.The concentration of MMP-9 in SAP patients with lung injury differed from those without lung injury(P<0.05).The values were 13.60±2.78 and 10.09±1.94 ng/mol，respectively.

Conclusions：The results showed that the concentration of MMP-9 has significant changes in the serum of the SAP patient in the high altitude.This means that expression of MMP-9 may be involved in the progression of SAP and closely relates to lung injury in SAP patients.

3892

HYPOXIAPROTECTSCARDIOMYOCYTESFROMERASTIN-INDUCEDFERROPTOSIS

BAI Yuting

QingHai University，Xining，China

Objective：Ferroptosis is a newly iron-dependent form of cell death that is associated with many diseases，such as cancer，ischemia reperfusion injury，and neurotoxicity.The aim of this study was to investigate whether hypoxia regulates cardiomyocytes ferroptosis.

Methods：H9c2 cells were propagated in a hypoxic incubator and normoxic incubator.Proliferation of cells and effect of hypoxia on the lethality of erastin were determined by CCK8 assay.The migration ability was analyzed by transwell and wound healing assays.Lipid reactive oxygen species(ROS)was measured by C11-BODIPY staining coupled to flow cytometry. Immunoprecipitation and immunoblotting investigate whether SENP1 deSUMOylated HIF-1α and ACSL4 in H9c2 cells.

Results：Compared with normoxic conditions，hypoxic H9c2 cells were decreased in cell viability，migration，invasion，and less sensitive to erastin.Moreover，we found that hypoxia increased the lipid ROS but attenuated the erastin-induced lipid ROS in H9c2 cells.The expression of ACSL4 was remarkably downregulated in hypoxic H9c2 cells that treated with erastin.SENP1 overexpression was also less sensitive to erastin and suppressed the erastin-induced ROS generation.Immunoprecipitation and immunoblotting investigation showed that SENP1 deSUMOylated HIF-1α and ACSL4 in H9c2 cells.

Conclusions：Our studies have identified that hypoxia depresses ferroptosis of cardiomyocytes through regulating ACSL4 deSUMOylation.

3903

MULTIGENEINTERACTIONSUNDERLYINGGENETICADAPTATIONTOHIGHALTITUDEINHIGHLANDERTIBETANS

SU Bing1，CUI Chaoying2，HE Yaoxi1，QI Xuebin1，OUZHU-luobu Ouzhuluobu2，ZHENG Wangshan1，GUO Yongbo1，ZHANG Hui1，WU Tianyi3

1.Kunming Institute of Zoology，Chinese Academy of Sciences，China；2.Tibetan University School of Medicine，Chi-na；3.National Key Laboratory of High Altitude Medicine，High Altitude Medical Research Institute，China

The Qinghai-Tibetan Plateau represents the highest elevation of human occupation.It serves as the ideal geographic region of studying genetic adaptation of human populations to high altitude.Previous genetic studies have identified many candidate genes showing signals of Darwinian positive selection in indigenous Tibetans.Combing population genetic approaches with functional assays，we have demonstrated that EPAS1and EGLN1are the two key genes showing dramatic allelic divergence between highlander Tibetans and lowlander Han Chinese，and the Tibetanenriched mutations in these two genes contribute to the blunted regulation of hemoglobin levels at altitude.We also identified other genes explaining the adaptive physiological changes of Tibetans，including genes involved in heme metabolism，blood nitric oxide regulation，and pulmonary arterial pressure.Importantly，these genes interact with each other to maintain physiological homeostasis in Tibetans to cope with hypobaric hypoxia.

3905

EXPRESSIONOFMERLINPROTEININFEMALECERVICALCANCEROFHAN，TIBETAN，ANDHUINATIONALITIESINQINGHAI

ZHANG Jianqing，WEI Chunmei，YANG Xing，ZHANG Man

Qinghai Kangle Hospital，Xining 810000，China

Objective：To explore the expression of the Merlin protein in normal cervix and cervical normal cervix were 90.0%，91.9% and 86.7% respectively cancer of the Han，Tibetan and Hui nationalities in Qinghai.

Methods：Immunohisto-chemical staining was performed to detect the expression of Merlin in 108 cases of cervical carcinoma(40 cases of Han，38 cases of Tibetan and 30 cases of Hui nationality)and 107 cases of normal cervix(40 cases of Han，37 cases of Tibetan and 30 cases of Hui nationality).

Results：The positive expression rates of Merlin in and those in cervical carcinoma were 17.5%，18.4% and 16.7% respectively.There was significantly statistical difference(P<0.05).However，there was no significant difference in the positive rates of Merlin between cervical carcinoma among different ethnic groups(P>0.05).The expression of Merlin was not correlated with age，FIGO stage，lymph metastasis and cell differentiation(P>0.05)in cervical carcinoma of three ethnic groups.

Conclusions：The decrease or even deletion of Merlin may be involved in the development of cervical cancer，and it plays an important role in cervical cancer.The expression of Merlin exerts no effect on the occurrence of cervical cancer and it is not associated with the clinical characteristics of the patients，suggesting that it may not be involved in the invasion and metastasis of cervical cancer.

3907

BLUNTEDNITRICOXIDEREGULATIONINTIBETANSUNDERHIGH-ALTITUDEHYPOXIA

HE Yaoxi1，QI Xuebin1，OUZHU-luobu Ouzhuluobu2，LIU Shiming3，LI Jun4，SU Bing1，CUI Chaoying2

1.Kunming Institute of Zoology，Chinese Academy of Sciences，China；2.Tbetan University School of Medicine，Chi-na；3.High Altitude Medical Research Institute，China；4.Tibetan Fukang Hospital，China

Nitric oxide(NO)is an important molecule for vasomotor tone，and elevated NO signaling was previously hypothesized as a unique and adaptive physiological change in highland Tibetans.However，there has been lack of NO data from Tibetans living at low altitude and lowlander immigrants living at high altitude，which is crucial to test this hypothesis.In this study，through cross-altitude(1990-5018m)and cross-pop- ulation(Tibetans and Han Chinese)analyses of serum NO metabolites(NOx)of 2086 individuals，we demonstrate that although Tibetans have a higher serum NOx level than lowlanders，Han Chinese immigrants living at high altitude show an even higher level than Tibetans.Consequently，our data contradict the previous proposal of increased NO signaling as the unique adaptive strategy in Tibetans.Instead，Tibetans have a relatively lower circulating NOx level at high altitude.This observation is further supported by data from the hypoxic experiments using human umbilical vein endothelial cells and gene knockout mice.No difference is detected between Tibetans and Han Chinese for endothelial nitric oxide synthase(eNOS)，the key enzyme for circulating NO synthesis，suggesting that eNOS itself is unlikely to be the cause.We show that other NO synthesis-related genes(e.g.，GCH1)carry Tibetan-enriched mutations significantly associated with the level of circulating NOx in Tibetans.Furthermore，gene network analysis revealed that the downregulation and upregulation of NOx are possibly achieved through distinct pathways.Collectively，our findings provide novel insights into the physiological and genetic mechanisms of the evolutionary adaptation of Tibetans to high-altitude hypoxia.

3908

ARELIABLENOMOGRAMMODELTOPREDICTTHERECURRENCEOFCHRONICSUBDURALHEMATOMAAFTERBURR-HOLESURGERY

YANG Mingfei

Qinghai Provincial People′s Hospital，Xining，China

Objective：We established a reliable nomogram model to predict the recurrence of chronic subdural hematoma(CSDH)after burr-hole surgery.

Methods：We retrospected 514 patients who were treated in our hospital between January 2010 and November 2017，and included 231 patients in this study.We used univariate and binary logistic regression analyses to select the significantly related predictors for recurrence.Subsequently，we established the nomogram model using these predictors and validated it.

Result：The total rate of recurrence after initial surgery for CSDH was 14.29%(33 of 231 patients)during the following 3 months.We found that preoperative hematoma volume(>121mL)，postoperative residual cavity volume(>72mL)，computed tomography scan imaging appearance(hyperdense and mixed-dense type)，and age(>65years)were significantly related to recurrence.By using these predictors，a nomogram model was established to predict the recurrence.We used 50% recurrence rate as the classification cut-off， with the corresponding points of 252 to validate the nomogram model.The accuracy of predicting the recurrence of CSDH calculated by the binary logistic regression model was 91.7%.

Conclusions：This nomogram model had a high preciseness to predict the recurrence of CSDH and needs more external validation in the future.

3909

ULTRASOUND-GUIDEDPERCUTANEOUSMICROWAVEABLATIONFORHEPATICALVEOLARECHINOCOCCOSIS：APRELIMINARYSTUDY

GUO Jianqin

Qinghai Provincial People′s Hospital，Xining，China

Objective：To evaluate safety and efficacy of ultrasound-guided percutaneous microwave ablation(MWA)for hepatic alveolar echinococcosis.

Methods：A total of 26 lumps of hepatic alveolar echinococcosis in 21 patients were treated with ultrasound-guided MWA from January 2016 to December 2017 in Qinghai Provincial People′s Hospital.The 21 patients were selected based on the following inclusion criteria：(1)for single lesion：diameter=5 cm；(2)for multiple lesions：diameter of each lesion=3 cm，and the number of lesions=3；and(3)for palliative treatment：5 cm

Results：All of the procedures were technically successful，and the average volume reduction rate of the 26 lumps was 74.1% at 6-month follow-up.After the treatment，the patients′ abdominal pain was relieved apparently.And liver functions were not affected by MWA.In addition，21 lumps(80.8%)were completely ablated with obvious volume reduction and significant calcification(>70%)at 6-month follow-up，and no evidence of recurrence was demonstrated.Five lumps(19.2%)were partially ablated，with volume reduction and partial calcification(>50%).Besides，complications and metastasis were not observed.

Conclusions：Ultrasound-guided percutaneous MWA for hepatic alveolar echinococcosis is safe and effective，without apparent complications and metastasis.

3913

ASSOCIATIONSOFHIGH-ALTITUDEPOLYCYTHEMIAWITHPOLYMORPHISMSINITGAVANDEPAS1INCHINESEHANANDTIBETANPOPULATIONS

KANG Longli

Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Au-tonomous Region，Xizang Minzu University，China

High-altitude polycythemia(HAPC)is characterized by hyperplasia of erythrocyte，a chronic plateau disease characterized by headache，dizziness，and fatigue.Although chronic hypoxia is the main cause of HAPC，the fundamental pathophysiological process and related molecular mechanisms responsible for its development remain largely unclear. In this study，we hope to explore the pathogenesis of HAPC by studying the differences between the susceptible genes(ITGAV and EPAS1)in Han and Tibetan populations.The study recruited 200 subjects，140 of whom were HAPC patients(70 Han and 70 Tibetans)，and 60 healthy people were randomly selected as healthy controls.We sequenced the ITGAV and EPAS1 genes through the second-generation sequencing technology，and obtained rs3832041，rs3738918，and rs16828136 in ITGAV that were associated with decreased HAPC susceptibility in Han populations.The rs75591953 and rs75984373 of EPAS1 gene were associated with reduced risk of HAPC.The rs3738919，rs3795865，and rs2887831 of the ITGAV gene in the Tibetans were related to the increased risk of the disease.Our results showed that the polymorphisms of ITGAV and EPAS1 were significantly correlated with susceptibility to HAPC in Chinese Han and Tibetan populations. This work was supported by the National Natural Science Foundation of China(Grant Nos.31460286，31660307，and 31260252).

3914

IMPACTOFTIBETANMEDICINEQISHIWEIZHENZHUWANONBEHAVIOROFPARKINSON′SDISEASEMODELRATS

CUI Haiyan

Tibet National University of Nationalities，China

To observe the effect of Tibetan medicine Qishiwei Zhenzhu Wan on behavior of Parkinson′s disease(PD)model rats.Tibetan medicine low-，median-，and high-dose groups were given 90，180，and 360 mg/kg by gavage，respectively.Rats in each group were gavaged once every day for 4 weeks.After intervention，rotational behavior experiment，balancing rod experiment，and body torsion pendulum experiment were carried out.Compared with that in the model group，the latency time in the medication groups was shortened in balancing rod experiment；total layout time in the Tibetan medicine low- and high-dose groups was shortened.In body torsion pendulum experiment，rats′ uninjured side torsion pendulum frequency in the Tibetan medicine low- and high-dose groups was lower than that in the model group.The Tibetan medicine Qishiwei Zhenzhu Wan might improve PD rats′ motor function.

3916

STUDYONTHEBIOLOGICALVIABILITYANDBOUNDARYRANGEOFHEPATICALVEOLARECHINOCOCCOSISBYTHECONTRAST-EN-HANCEDULTRASONOGRAPHYANDARFIINTHEPLATEAUAREA

ZHANG Yuying

Qinghai Provincial People′s Hospital，Xining，China

Objective：To study the biological viability and boundary range of hepatic alveolar echinococcosis(HAE)by the contrast-enhanced ultrasonography(CEUS)and acoustic radiation force impulse elastography(ARFI).

Methods：Twenty-seven cases with HAE underwent ARFI and CEUS examination and were confirmed by operation and pathology.

Results：Two-dimensional sonography of HAE showed unclear boundary，heterogeneous middle hyperechoic nodules，and the maximum area was(6.08±4.47)cm2in 27 lesions.CEUS of HAE showed nonenhancement in three phases and black hole sign.Circumferential enhancement on the periphery of the lesion was seen synchronized with the liver parenchyma and showed fast in and slow out.The maximum area was(8.87±4.83)cm2.The area of ECUS was larger than two-dimensional sonography in HAE(P<0.05).The mean shear wave velocity of the interior and the boundary range and the surrounding liver tissues of HAE were statistically different by ARFI(P<0.05)，there were significant differences between groups(P<0.05).

Conclusions：CEUS and ARFI examination can determine the biological viability and boundary range of migrating zone around HAE，which is valuable for guiding treatment，judging curative effect，and predicting prognosis.

3917

STUDYONSUSCEPTIBILITYOFTUBERCULOSISANDGENEPOLYMORPHISMINTIBETANPOPULATIONINCHINA

HU Qunying

Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Au-tonomous Region，Xizang Minzu University，China

Chinese Tibetans live in the plateau area and have relatively special geographical environment and genetic characteristics.Tuberculosis is a disease affected by interaction of environmental and genetic factors. Hence，studies on the relationship between susceptibility to tuberculosis and gene polymorphism in Chinese Tibetans are of great significance for the prevention and control of tuberculosis in Tibet.However，there are few related studies on genes except HLA-II genes and vitamin D receptor(VDR)genes.Chen et al.have showed that VDR-ff genotype may be a susceptibility genotype of mycobacterium tuberculosis-positive tuberculosis patients among Chinese Tibetans by detecting the Fok1 and Taq1 polymorphisms in the VDR gene in their population and analyzing the relationship between the two polymorphisms and culture and acid-fast staining of mycobacterium tuberculosis.Li Suzhi et al.used the polymerase chain reaction/sequence-specific primer method to analyze the polymorphisms of HLA-Ⅱ genes in Tibetan patients with tuberculosis.The results showed that HLA-DRB1 0901，DQA1 0101，and -DQB1 0301 were closely related to tuberculosis susceptibility.Our study found five loci that may be associated with increased risk of tuberculosis in them for the first time.These studies have provided some pieces of evidence for the role of immune and genetic factors in the pathogenesis of tuberculosis in Tibetans in China.

3918

DEADAPTATIONOFTHECARDIORESPIRATORYSYSTEMINHIGH-PLATEAUTIBETANYOUTHAFTERMIGRATIONTOTHEPLAINS：ACASE-CONTROLSTUDY

ZHAO Fengcang

Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region，Xizang Minzu University，China

To study the cardiorespiratory changes in Tibetan plateau youth after migration to the plains，and to investigate the correlation between these changes and the time spent in the plains.We randomly chose 60 native Tibetan youth who had moved to the plains and were examined to ensure that they had no disease caused by other factors(case group)and 60 healthy students(control group).The cardiac structure and function，pulmonary artery pressure，mitral and tricuspid valve flow velocity，and other indicators were measured at three time points：just after moving to the plains，1 year after moving to the plains，and 3 years after moving to the plains.The differences between the case and control group were then statistically analyzed.The Tibetan youth had enlarged right heart structure(anteroposterior diameter of the right atrium and right ventricle)that did not show recovery changes with the extension of time spent in the plains.After entering the plains，the initially altitude-induced increases in pulmonary artery pressure gradually returned to normal，heart rate increased over time to the level of controls，mitral and tricuspid flow velocity significantly increased，and cardiac function indicators tended to gradually increase.The changes in the mentioned indicators were associated with the time spent in the plains.These pre liminary findings need to be confirmed by further studies.

3919

EFFECTIVENESSOFPEEREDUCATIONONPULMONARYTUBERCULOSISPREVENTIONAMONGCOLLEGESTUDENTSINTIBET，CHINA：ACLUSTERRANDOMIZEDTRIAL

ZHANG Jinjing

Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region，Xizang Minzu University，China

Tuberculosis is an infectious disease and is a leading cause of death worldwide.In China，the province with the highest incidence of tuberculosis among students is Tibet.This study aimed to evaluate the effectiveness of peer education on pulmonary tuberculosis prevention among nonmedical college students in Tibet，China.Stratified cluster sampling was used，four colleges′ students in Tibet were enrolled and randomly divided into intervention group(571 people)and control group(563 people).In the intervention group，peer education was conducted；in the control group，the publicity pages were released.A self-de-signed questionnaire was used to investigate the knowledge，attitude，and behavior level of the two groups before and 1 month and 6 months after intervention.Analysis of variance of repeated measurement data showed the scores of pulmonary tuberculosis prevention knowledge，attitude，and behaviors in the intervention group were all higher than those in the control group，and the difference was statistically significant(P<0.05).In both groups，the difference of knowledge and attitude scores among different time points were also statistically significant(P<0.05).But，in the intervention group，scores of behaviors had no significant statistical difference between 1 month and 6 months after the intervention(P>0.05).The opposite results were obtained in the control group.Therefore，peer education and releasing publicity pages could both improve college stu-dents′ knowledge and attitude toward pulmonary tuberculosis prevention.But，on behavior level，the effectiveness of peer education was more persistent.

3920

THECHANGESONLYMPHOCYTESUBSETSOFTHEPATIENTSWITHHIGH-ALTITUDEPOLYCYTHEMIAATDIFFERENTPLATEAUALTITUDES

Gu Songqing

Qinghai Provincial People′s Hospital，Xining，China

Objective：High-altitude polycythemia(HAPC)is a common chronic altitude disease，which occurs in people who live in the plateau.The patients with HAPC have a series of pathological and physiological change such as excessive erythrocytosis and increased blood viscosity.To observe the changes on lymphocyte subsets of the patients with HAPC，we detected the lymphocyte subsets(CD3+，CD4+，CD8+，CD4/CD8，CD56+，and CD19+)of the patients(35 cases in altitude between 3300 and 4200m and 43 cases in altitude >4200m)with HAPC(according to the 2004 international conference on plateau medical standard HGB>210g and HCT>65%).

Methods：From the patients，2 mL of fasting blood was collected，which are mixed with EDTA anticoagulant. Lymphocyte subsets were detected by using the U.S.Beckman-Coulter company EpicsXL flow cytometer and reagents.

Results：The lymphocyte subsets〔CD3+(84.8±7.80)，CD4+(46.34±11.51)，and CD4/CD8(1.48±0.74)〕of the patients in 4 200 m compared with the lymphocyte subsets〔CD3+(73.4±7.58)，CD4+(29.98±6.30)，and CD4/CD8(0.9±0.38)〕of the patients in 3 300 m were significantly different(P<0.05).The lymphocyte subsets〔CD8+(35.71±10.96)，CD56+(20.06±10.1)，and CD19+(8.35±3.69)〕of the patients at 4 200 m compared with the lymphocyte subsets〔CD8+(36.7±10.3)，CD56+(18.35±6.24)，and CD19+(10.07±3.13)〕of the patients at 3 300 m were not statistically different(P>0.05).

Conclusions：The changes in the physiopathology such as excessive erythrocytosis，increased blood viscosity，and disordered circulation may be caused by hypoxia，hypobaric hypoxia，and poor environment.It is very significant to research the changes of cellular immune function in the patients with HAPC，and then enhance the cellular immune function.

3922

EFFECTOFHYPOXIAONANGIOGENESIS-RELATEDFACTORSINK562CELLS

FENG Jianming

Qinghai Provincial People′s Hospital，Xining，China

Objective：The purpose of this study was to investigate the mechanism of angiogenesis under hypoxia in K562 cells.

Method：The K562 cells were transfected with HIF-1α+/-gene.K562 cells transfected with the empty virus were used as the control group.The cells were harvested after 72 hours of cultivation under hypoxia.The expression of HIF-1α and angiogenesis-related factors mRNA was detected by RT-PCR.The concentration of angiogenesis-related factors in the culture supernatant was detected by enzyme-linked immunosorbent assay.

Results：The expression of ANG-II and VEGF mRNA in the HIF-1α-group was lower than that in the HIF-1α+group.The expression of TGF-β1 mRNA was higher in the HIF-1α- group than in the control group and the HIF-1α+group.ANG-II mRNA expression in the HIF-1α+group was higher than that in the control group.TGF-α was not detected and the culture supernatant concentration of ANG-II in the HIF-1α+group was lower than that in the control group.Whereas the VEGF concentration in the HIF-1α+group was higher than that in the control group.The levels of TGF-β，VEGF，and TNF-α in the HIF-1α-group were lower than those in the control group.

Conclusions：HIF-1α mRNA positively regulates the expression of ANG-II and VEGF mRNA.And it inhibits ANG-II and promotes the autocrine ability of VEGF and TNF-α in K562 cells.High HIF-1α upregulates the expression of TGF-α mRNA without stimulating autocrine of TGF-α under hypoxia.The effect of high HIF-lα mRNA on TGF-β1 is exactly the opposite of TGF-a.It is suggested that hypoxia and HIF-1α affect the expression and autocrine of angiogenesis-related factors in K562 cells.

3923

EFFECTOFHIF-1αONANGIOGENESIS-RELATEDFACTORSINK562CELLSUNDERNORMOX

Li Wenqian

Qinghai Provincial People′s Hospital，Xining，China

Objective：The aim of this study was to observe levels of angiogenesis-related factors in K562 cells.

Method：The K562 cells were transfected with HIF-1α+/-gene.Transfected K562 cells were used as overexpression and interference group，respectively.K562 cells transfected with the empty virus were used as control group.The cells were harvested after 72 hours of cultivation under normoxic conditions.HIF-1α expression and angiogenesis-related fac-tors mRNA were detected by RT-PCR.The concentration of angiogenesis-related factors in the culture supernatant was detected by enzyme-linked immunosorbent assay.

Results：HIF-1α mRNA expression in the overexpression group was higher than that in the control and interference groups.HIF-1α mRNA expression in the interference group was lower than that in the control group.Expression of ANG-I，ANG-II，TGF-α，and VEGF mRNA in the interference group was lower than that in the overexpression group，and TGF-β1 mRNA expression in the interference group was higher than that in the overexpression group.Expression of ANG-I and VEGF mRNA in the interference group was lower than that in the control group.TGF-α was not detected and the culture supernatant concentration of ANG-I and TNF-α in the interference group was lower than that in overexpression group，whereas VEGF concentration in the interference group was higher than that in the overexpression group.

Conclusions：HIF-1α mRNA positively regulates ANG-I，ANG-II，TGF-α，and VEGF mRNA and promotes the ability of ANG-I and TNF-α to secrete itself in K562 cells，but does not stimulate autocrine of TGF-α.HIF upregulation can inhibit the expression and autocrine ability of TGF-β1.It is suggested that HIF-1α affects mRNA expression and autocrine of angiogenesis-related factors in K562 cells.

3924

EFFECTOFHYPOXIAONTHEEXPRESSIONOFERYTHROIDTRANSCRIPTIONFACTORS

XIE Youbang

Qinghai Provincial People′s Hospital，Xining，China

Objective：The purpose was to observe the expression levels of HIF-1α and erythroid transcription factors in bone marrow erythrocytes in chronic altitude sickness and K562 cells.To investigate the effect of hypoxia and erythroid transcription factors on the erythrocytes hematopoiesis.

Method：Bone marrow erythroid CD235a cells of chronic mountain sickness(CMS)were obtained by using magnetic activated cell sorting as CMS group and healthy persons as control group.The expression of HIF-1α and erythroid transcription factor mRNA was tested by RT-PCR in bone marrow CD235a cells of CMS.K562 cells were transfected by interfered with HIF-1α gene.Transfected K562 cells with carried and interfered with HIF-1α gene were used as overexpression and interference groups，respectively.The cells were harvested after culture under normoxic conditions for 72 hours.The expression of HIF-1α and erythroid transcription factors was detected by RT-PCR.

Results：The results showed that the expression of HIF1- and GATA1 mRNA in the CMS group was higher than that in the control group，whereas there was no significant difference in the mRNA levels of NFE2，c-MYB，FOG-1，LMO2，β-globin，and α-globin.The expression of FOG-1 and α-globin mRNA in the overexpression group was higher than that in the interference group.The mentioned differences were statistically significant(P<0.05).

Conclusions：The axis of hypoxia-HIF-1-erythroid-specific genes(GATA-1，FOG-1，and β-globin)plays an important regulatory role in hypoxia-induced erythroid hematopoiesis.

3926

CIRCULATIONMICRORNAs IN HIGH-ALTITUDE POLYCYTHEMIA

LIU Junli

Qinghai University Affiliated Hospital，Xining，China

Objectives：To clarify the differences of miRNAs expression in patients with high-altitude polycythemia(HAPC)and establish the circulating miRNAs and target genes network.

Methods：We used microarray and real time polymerase chain reaction to investigate the differential expression of circulating miRNAs.miRBase，Mirranda，and Targetscan were utilized to analyze the potential targets for miRNAs.We appraised the predicted target genes of miRNAs in gene-term enrichment analysis using KEGG(Kyoto Encyclopedia of Genes and Genomes)pathway analysis.

Results：Thirty-three miRNAs were significantly down-regulated and six miRNAs were upregulated in HAPC patients.A total of 2322 candidate genes were predicted as target genes by Targetscan，and 23，513 genes by miRanda，and 7560 genes by miRbase.Taken together，we selected 863 genes to ascertain target genes for HAPC associate miRNAs.To overview HAPC-associated miRNAs and candidate genes，a network draft was mapped that involved miRNAs and the target genes.Furthermore，top 10 signaling pathways including MAPK signaling pathway，insulin signaling pathway，fatty acid metabolism，and so on were found by KEGG pathway.

Conclusions：These results suggest that the network involving miRNAs and target genes may play an important role in HAPC.However，the specific mechanism needs further verification.This study was funded by the Natural Science Foundation of China (Grant No.31571231)，Natural Science Foundation of China(Grant No.81360300)，Natural Science Foundation Innovation team Project of Qinghai Province，China(Grant No.2014-ZJ-922)，The Program of International S&T Cooperation of Qinghai Province，China(Grant No.2015-HZ-810).

3927

RELATIONSHIPBETWEENCHRONICOBSTRUCTIVEPULMONARYDISEASEANDARTERIOSCLEROSISINTHEELDERLYATHIGHALTITUDE

LING Shang

Qinghai Province People′s Hospital，Xining，China

Objective：To explore the relationship between chronic obstructive pulmonary disease(COPD)and arteriosclerosis in the elderly at high altitudes，risk factors for atherosclerosis in elderly COPD patients at high altitudes.

Methods：Forty-two patients with COPD stabilization in Xining area were selected as observation group and 40 pa-tients from health examination group were taken as control group.The two groups were recorded and compared for age，gender，smoking index，homocysteine(HCY)，triglycerides(TG)，total cholesterol(TC)，high-density lipoprotein(HDL-C)，low density lipoprotein(LDL-C)，pulmonary function，and carotid intima-media thickness(IMT).

Results：Smoking index，FEV1%，and IMT comparison of the two groups were statistically significant(P<0.05).Gender ratio，HCY，and lipid(TG，TC，HDL-C，and LDL-C)levels of the two groups were compared，and the difference was not statistically significant(P>0.05).Correlation analysis showed that IMT was positively correlated with age and smoking index(r=0.081 and 0.596，P<0.05)and negatively related to FEV1(r=-0.540，P<0.05).Dual Logic regression analysis showed that age，smoking index，and FEV1 are risk factors for IMT.

Conclusions：Elderly COPD patients at high altitudes are prone to arteriosclerosis；age，smoking index，and FEV 1% may be the risk factors for arteriosclerosis.

3931

mIR-17REGULATES HYPOXIA-INDUCED ANGIOGENIC GROWTH FACTOR SECRETION IN MESENCHYMAL STEM CELLS BY TARGETING HIF-1α

XU Qinqin1，SUN Huiyan2，GE Rili3，WANG Lisheng2

1.Qinghai Provincial People′s Hospital，Xining，China；2.Beijing Institute of Radiation Medicine，China；3.Research Center for High Altitude Medicine，Qinghai University，Xining，China

Hypoxia affects the angiogenic activity of bone marrow-derived mesenchymal stem cells(BM-MSCs)through multiple signal pathways and post-transcriptional regulation of functional genes.miR-17-92 is a hypoxia response micro-RNA cluster that plays important roles in tumor initiation and development.However，little is known about the roles of miR-17-92 in hypoxia-induced angiogenic growth factor secretion in MSCs.In this study，we detected that miR-17，miR-18，and miR-19 are downregulated in BM-MSCs under hypoxia condition，whereas miR-92 is upregulated.Mean-while，the secretion of angiogenic growth factors such as hepatocyte growth factor(HGF)，vascular endothelial growth factor(VEGF)，and angiopoietin-1 was significantly upregulated.Transduction of miR-17 inhibitors resulted in increased HGF and VEGF secretion in BM-MSCs.miR-17-92-transduced BM-MSCs grow slower in hypoxia than that in normoxia.Furthermore，we also validated that HIF-1α is a target of miR-17 by using dual-luciferase reporter assay.Transduction of miR-17 mimics also results in the downregulation of HIF-1α in BM-MSCs.We concluded that hypoxia-induced down-regulation of miR-17 regulates the secretion of angiogenic growth factors of BM-MSCs under hypoxia.

3932

HIGHERSERUMFERRITININTIBETANANDHANPOPULATIONSWITHDIABETESLIVINGONTHETIBETANPLATEAU

BAI Zhenzhong

Qinghai Medical College of Qinghai University，Xining，China

Objective：Tissue iron has emerged as a significant risk factor for diabetes.Pathways that sense and regulate iron and oxygen interact，but few studies examined the interactions of hypoxia and iron in determining diabetes risk in human populations.Accordingly，metabolic phenotyping with analysis of iron homeostasis in both Tibetan and Han Chinese living at 2 300～3 900 m altitudes was conducted.

Researchdesignandmethods：Data were collected on Tibetan and Han Chinese living at intermediate altitudes.Iron homeostatic and metabolic parameters including homeostasis model assessments(HOMA)，hemoglobin A1c，serum ferritin，and transferrin saturation were determined.

Results：Serum ferritin is higher in both Tibetan groups than in the respective Han groups，and higher in each diabetic group than in nondiabetic people of the same ethnicity.Serum iron and transferrin saturation were also higher in the Tibetan diabetic population than in the Tibetan nondiabetic population.Serum iron was significantly correlated with ferritin levels in the four combined groups(r2=0.07313，P<0.05)and even stronger in the Tibetan diabetic group(r2=0.2702，P<0.05).HOMA-β was negatively correlated with ferritin in the Tibetan combined groups(r2=0.020，P<0.05)，and HOMA-IR tended to be positively correlated with ferritin(r2=0.018，P<0.05).

Conclusions：Iron parameters differ both between Han and Tibetans and between diabetic groups and nondiabetic groups of both populations.High ferritin，which in these cohorts reflects iron status，is a risk factor for diabetes in both groups，although how iron status relates to the diabetes phenotype differs between the two groups，possibly related to their differing histories of adaptation to high altitude.

3933

CLINICALSTUDYONTHECOMBINEDTARGETEDTHERAPYOFHER-2PROTEINPOSITIVECHE-MOTHERAPYINADVANCEDGASTRICCANCERINXINING

Jie Kan

Qinghai Provincial People′s Hospital，Xining，China

Objective：To observe the effect of trastuzumab combined with chemotherapy in advanced gastric cancer in Xining.

Method：Between January 2013 and December 2015，we randomly assigned 40 HER-2-positive advanced gastric cancer patients in Xining to chemotherapy combined with trastuzumab and chemotherapy alone.The chemotherapies used in this trial were XELOX and FOLFOX4.According to the RECIST criteria to evaluate the objective effect after 6 weeks treatment，the patients who achieved PR and SD continue the original chemotherapy until 126 days.Then they were continued on maintenance treatment.The overall survival，progression-free survival，and objective response rate were compared between the two groups.

Result：All patients in the groups completed the expected treatment.Median overall survival was 13.87 months for the group of chemotherapy combined with trastuzumab versus 11.14 months for the chemotherapy alone(P=0.0032).Median progression-free survival was 6.71 months for the group of chemotherapy combined with trastuzumab versus 5.49 months for the group of chemotherapy alone(P=0.0241).Objective response rate was 45.0% for the group of chemotherapy combined with trastuzumab versus 35% for the group of chemotherapy alone(P=0.5186).

Conclusions：The overall survival and progression-free survival were significantly longer in chemotherapy combined with trastuzumab than in chemotherapy alone in HER-2 overexpression advanced gastric cancer patients in Xining.

3941

HIGH-LEVELMATRILIN-2EXPRESSIONINTHEOSTEOARTHRITISPATIENTSINXININGAREA

LUO Junming，LI Xiaona，DUAN Zhili，LUO Xiaoqin

Qinghai Provincial People′s Hospital，Xining，China

Background： Osteoarthritis(OA)is one of the most common and disabling diseases in the elderly，affecting nearly 80% of individuals of older than 75 years.Our previous results suggested that all the family members of matrilins contributing to the balance of matrilins filament network of extracellular matrix matrilin-2 consist of a large filamentous network in the body，which may act as adapter molecule connecting other proteins and proteoglycans in the extracellular matrix and play an important role in communication or balance between the extracellular matrix and epithelial cells.

MaterialsandMethods：Articular cartilage from 18 total knee arthroplasty patients from Xining area(2260m high altitude)was studied by immunohistochemistry.Immunohistochemistry was carried out using the avidin-biotin complex methods.Control sections on the same slide were treated with preimmunolized rabbit serum to replace the primary antibody.

Results：Expression and distribution of matrilin-2 in OA articular cartilage were studied by immunohistochemistry.In this study，matrilin-2 significantly increased expression in articular cartilage，including surfacing area，proliferating，and hypertrophic areas.

Conclusions：Matrilin-2 may play an important role in the communication of matrix to matrix and matrix to cells and may be used as a potential biomarker in the early stage of OA of articular cartilage.

3944

CLINICOPATHOLOGICALANDMOLECULARCHARACTERISTICSOFSYNCHRONOUSGASTRICADENOCARCINOMAANDGASTROINTESTINALSTROMALTUMORSINXININGAREA

CAO Falong，LUO Junming

Qinghai Provincial People′s Hospital，Xining，China

Gastric synchronous tumors that consist of both gastrointestinal stromal tumor(GIST)and adenocarcinoma are rare.We reported six cases of adenocarcinoma with GIST and five cases of GIST in the stomach with special immunohistochemical characteristics(positive for CDll7，Dogl，and CD34)and direct sequencing for c-kit and PDGFR-a.By means of immunohistochemical analysis，all GIST cells expressed CD117，CD34，and Dog l in all six concurrent adenocarcinomas and GIST.The direct sequencing analysis demonstrated that exon 11 c-kit mutations were present in two of six synchronous tumors and four of five GISTs alone.One of the two exon 11 c-kit mutations in synchronous adenocarcinomas with GISTs was an uncommon mutation of CTT>CCA at amino acid 576，and the other was GTT deletion at amino acid 560.The mutation was a homozygous A>G mutation in exon 12 of the gene(amino acid 567)of PDGFR-a.We concluded that exon 11 mutations were the most important mutations in both synchronous cases of adenocarcinoma and GIST and GIST alone of the stomach.The mutation rate was higher in the GIST alone than in synchronous adenocarcinoma with GIST.

3946

MIR-122INHIBITSERYTHROIDDIFFERENTIATIONOFHEMOPOIETICSTEMCELLINCHRONICHYPOXICENVIRONMENT

LIU Huihui

Department of Hematology，Qinghai University Affiliated Hospital，Xining，China

Background/Aims：In our previous study，we found that MIR-122 was upregulated in Tibetan versus Chinese Han，whether it regulates erythropoiesis and its detail mechanisms are unkown.

Methods：Circulating MIR-122 in plasma was detected in patients with chronic mountain sickness(CMS)through real time polymerase chain reaction.To evaluate the function of MIR-122 during erythroid differentiation，CMS mice were injected with MIR-122 mimics(100μg/20g per 3 days)and MIR-122 inhibitors(100μg/20g)through tail vein，and flow cytometry was employed to detect the expression of Ter119+.We screened the potential target protein of MIR-122 through bioinformatics software such as Target scan 6 and Pictar and identified it through luciferase report and performing MIR-122 gain and loss of function experiments on HepG2 cells and CMS mice.The level of EPO in HepG2 cells and mice plasma was detected through Western bloting and enzyme-linked immunosorbent assay.

Results：The expression of MIR-122 was significantly reduced in CMS patients versus control(P=0.01).MIR-122 inhibited erythroid differentiation.Overexpression of MIR-122 suppresses the expression of Ter119+in bone marrow mononuclear cells of CMS mice(P=0.01).MIR-122 directly target EPO in vivo and in vitro.Overexpression of MIR-122 led to decreased EPO expression(P=0.05)，and EPO was upregulated when MIR-122 expression was inhibited(P=0.01).

Conclusions：MIR-122 plays an important biological function by regulating EPO in the differentiation of hematopoietic progenitor cells in chronic hypoxic environment.This study was funded by the Natural Science Foundation of China(No.31571231)，Natural Science Foundation of China(No.81360300)，Natural Science Foundation Innovation team Project of Qinghai Province，China(No.2014-ZJ-922)，and The Program of International S&T Cooperation of Qinghai Province，China(No.2015-HZ-810).

3950

RESEARCHONRESTINGHEARTRATE，QTcINTERVAL，Tp-TEINTERVAL，ANDBLOODPRESSUREBETWEENTWOHEALTHYYOUNGPEOPLEOFTIBETANANDHANNATIONALITYINTHEPLATEAUAREAATDIFFERENTELEVATIONS

SU Xiaoling，LIANG Fuli

Qinghai Provincial People′s Hospital，Xining，China

Objectives：To investigate the differences in resting heart rate，QTc interval，TP-TE interval，and blood pressure between two healthy young people of Tibetan and Han nationality in the plateau area at different elevations and degrees of hypoxia；To preliminarily clarify the effects of different elevations on healthy young people and the risks of them getting potential cardiovascular diseases；and to provide the basis for the prevention of the occurrence and development of cardiovascular disease.

Methods：The subjects were divided into eight groups according to elevation，ethnicity，and gender.In the same period of time，medical and physical examinations and all routine tests were carried out.Electrocardiograph was used to record the 12-lead body surface electrocardiogram.Meanwhile，mercury sphygmomanometer was used to monitor the blood pressure of the subjects.

Results：Resting heart rate and blood pressure of young people in Yushu were lower than those who were in the same ethnic group in Xining.The resting heart rate of Tibetans was lower than that of Han nationality at the same elevation.Compared with those in Xining，the QTc interval and TP-TE interval of the people in Yushu were prolonged.These differences were statistically significant.At the same elevation，there was no statistically significant difference in QTc interval，TP-TE interval，and blood pressure between young people of different nationalities.

Conclusions：Resting heart rate and blood pressure in young healthy population in Yushu were lower than those in Xining.QTc interval and TP-TE interval were longer than those in Xining.The resting heart rate of Tibetan was lower than that of Han nationality at the same elevation. Moreover，the risk of cardiovascular and cerebrovascular diseases of different nationalities may not be different.

3956

CROSS-ALTITUDEANALYSISSUGGESTSATURNINGPOINTATTHEELEVATIONOF4500mFORPOLYCYTHEMIAPREVALENCEINTIBETANS

QI Xuebin1，ZHANG Hui1，HE Yaoxi2，CUI Chaoying3，OUZHULUOBU Na3，SU Bing2

1.Chinese Academy of Sciences，China；2.Kunming Institute of Zoology，Chinese Academy of Sciences，China；3.High Altitude Medical Research Center，School of Medicine，Tibetan University，China

Tibetans are well adapted to high-altitude environments，and with a great majority of them living at the elevation of 4 500 m.It is understood that the relatively low hemoglobin(Hb)concentration in Tibetans protects them from polycythemia(red cell overproduction).In general，Tibetans showed lower Hb concentration than Han immigrants residing in Tibet，and there was a linear correlation of Hb concentration with altitude.To test whether there is a turning point of elevation for polycythemia incidence in Tibetans，we collected data of Hb concentration from nearly 8 000 Tibetan individuals residing in 20 geographic regions throughout the Qinghai-Tibetan Plateau，with eleva- tions ranging from 2 227 to 5 018 m.For populations living <4 500 m，the average Hb levels are low and incidences of polycythemia are rare，an indication of adaptation for Tibetans at relatively low altitude.In contrast，the average Hb levels and incidences of polycythemia deviated from the linear expectation for the high elevations(>4500m).In particular，at 5 000 m，the majority of the population(67% in males and 65% in females)are subject to polycythemia.The nonlinear regression curves indicate that the Hb levels increase slowly with elevations from 2 200 to 4 500 m，and then sharply after 4 500 m.The same pattern was observed for the curve of incidence of polycythemia.We showed that the elevation of 4 500 m marks a sharp increase of Hb concentration and incidence of polycythemia in Tibetan populations living above the elevation of 4 500 m，which may reflect the altitude limit for Tibetans′ adaptation to high altitude.

3958

ASSOCIATIONBETWEENGENETICPOLYMORPHISMSOFHIF-2αGENEANDHIGH-ALTITUDEPULMONARYHYPERTENSIONINHANPOPULATION

CHANG Rong

Qinghai Provincial People′s Hospital，Xining，China

Objective：To test the hypothesis that the single nucleotide polymorphisms(SNPs)in HIF-2α gene are associated with the susceptibility to high-altitude pulmonary hypertension(HAPH)in Han population in China.

Methods：To those who emigrated to plateau(average altitude 3300 m)and have been living there for >20 years from the Han population，the method of overall random was used to enroll 49 HAPH patients as the case group(HAPH group)and 39 people free of HAPH as the control group.The Sanger chain termination method was used to detect the SNPs in HIF-2α gene.

Results：The genotype and frequencies of rs1562453 were CC(49.0%)，CT(46.9%)，and TT(4.1%)in the HAPH group，and the locus′s genotype and frequencies were CC(76.9%)，CT(17.9%)，and TT(5.1%)in the control group.The alleles and frequencies of rs1562453 were C(72.4%)and T(27.6%)in the HAPH group，and the locus′s alleles and frequencies were C(85.9%)and T(14.1%)in the control group.Their genotypes and alleles frequencies were of significant difference between the two groups(genotypesP=0.017；alleleP=0.031).Meanwhile，the genotype and frequencies of rs1867785 were AA(46.9%)，AG(46.9%)，and GG(6.1%)in the HAPH group，and the locus′s genotype and frequencies were AA(74.4%)，AG(25.6%)，and GG(0.0%)in the control group.The alleles and frequencies of rs1867785 were A(70.4%)and G(29.6%)in the HAPH group，and the locus′s alleles and frequencies were A(87.2%)and G(12.8%)in the control group.

Conclusions：The SNPs of rs1562453 in HIF-2α gene may be associated with the development of HAPH among Chinese Han population，and individuals with the genotype CT may be more vulnerable to HAPH than those who carry the genotype CC，and allele T may be a risk factor for HAPH.

3959

THERESEARCHONVON WILLEBRAND FACTOR，VON WILLEBRAND FACTOR CLEAVING PROTEASE，AND THROMBOSPONDIN1LEVELS IN PLASMA OF PATIENTS WITH CHRONIC MOUNTAIN SICKNESS AND CHRONIC HYPOXIA EXPOSURE

DANZENG Nuoyang

Research Center for High Altitude Medicine，China

Objective：To explore the role of von Willebrand factor(vWF)，von Willebrand factor cleaving protease(vWF-CP)，and thrombospondin 1(TSP1)in the occurrence of chronic mountain sickness(CMS)and chronic hypoxia exposure.

Methods：Enzyme-linked immunosorbent assay was used to assess plasma level of vWF，ADAM13，and TSP1 in 28 CMS patients，28 healthy plateau natives，and 28 healthy Xining citizens.

Results：Plasma vWF level of the CMS group was higher than that in the plateau healthy group and Xining healthy group(P<0.05).Plasma level of vWF-CP in the CMS group and plateau healthy group was lower than that in the Xining healthy group(P<0.05).The plasma TSP1 level in the CMS group was higher than that in the plateau healthy group and Xining healthy group(P<0.05).

Conclusions：vWF，vWF-CP，and TSP1 may be related to the occurrence of CMS.vWF-CP has been changed in chronic hypoxia exposure，which may have guiding significance for the early prevention of CMS.

3960

OBSERVATIONOFTHEEFFICACYOFLEFLUNOMIDECOMBINEDWITHHORMONETREATMENTONPATIENTSWITHIgANEPHROPATHYINHIGH-ALTITUDEAREA

LIU Wenhua

Qinghai Provincial People′s Hospital，Xining，China

Objective：Observing the efficacy of leflunomide combined with hormone treatment on patients with IgA nephropathy in high-altitude area.

Methods：Thirty patients with IgA nephropathy were selected and were divided into the experimental group and the control group randomly.The experimental group was treated with hormone combined with leflunomide and the control group was treated with only hormone.The urine protein quantitation and serum albumin of those patients were detected after weeks 12 and 24 of treatment.

Results：After 24 weeks of treatment，four patients were completely relieved，six patients were effective，and two patients were treated ineffectively in the experimental group；therefore，one patient was completely relieved，five patients were effective，four patients were treated ineffectively，and three patients relapsed in the control group.After 12 weeks of treatment，urine protein quantification decreased and serum protein increased in the experimental group，of which the difference between the experimental group and the control group was statistically significant(P<0.05).

Conclusions：Compared with using only hormone，leflunomide combined with hormone has a significant effect on patients with IgA nephropathy at high-altitude area，which can reduce urinary protein effectively，increase serum albumin，and reduce recurrence rate.

3963

LUNGFUNCTIONAMONGADULTTIBETANPOPULATIONLIVINGAT2300AND5300mINTIBET

BIANBA Bianba，YUZHEN Yuzhen，QULA Qula，CUI Chaoying，OUZHULUOBU Ouzhuluobu

Tibet University Medical College，China

Tibetans have lived at high altitude longer than any other high-altitude population.We previously reported the data of long function among 9- to 10-year-old children in Tibet.This study compared lung function values of forced vital capacity(FVC)，forced expiratory volume in 1 second(FEV1)，forced expiratory flow at 25% of FVC(FEF25)，forced expiratory flow at 50% of FVC(FEF50)，and forced expiratory flow at 75% of FVC(FEF75)in adults living at various altitudes in Tibet.A cross-sectional study of lung function was performed among adult native Tibetans living at 2 300 and 5 300 m above sea level.The crude value of FVC and PEF was significantly higher in Tibetan adults living at 2 300 m than in Tibetans living at 5 300 m above sea level.Linear regression models were constructed for determining the relationship between the outcome variable(FVC)and the selected covariates.The difference between the Tibetans living at two different altitudes disappeared after adjusting by gender and height.Furthermore，the predicted value for lung function was significantly lower than the measured value.

3964

MICRORNA-29α EXERTS AN ANTICANCER EFFECT BY MODULATING Sp1IN GLIOMA CELLS

LU Zhongsheng

Qinghai Provincial People′s Hospital，Xining，China

Objective：To explore the microRNA regulatory mechanism of Sp1 expression in gliomas，and to provide the exact experimental theoretical basis for the diagnosis and treatment of glioma.

Methods：(1)The expression levels of Sp1 mRNA and miR-29α were detected by real-time polymersae chain reaction(PCR)in human normal glial cells and four glioma cells，respectively.The expression of Sp1 protein was detected using Western blot.(2)The expression of Sp1 mRNA and protein was detected after miR-29α overexpression by miR-NC/29α mimcs and si-NC/Sp1，real-time PCR，and Western Blot，respectively，after transient transfection with Lipofectamine 2000.(3)Bioinformatics analysis software TargetSpy and online database Targetscan，miRBase prediction shows that miR-29α can target Sp1 3′UTR region，with dual fluorescence experiment testing whether miR-29α directly binds with the specific sequence of Sp1 3′UTR region.

Results：In glioma cells，the expression of miR-29α is low and transcription factor Sp1 is highly expressed，and miR-29α is capable of direct targeting of 3′UTR specific sequences of Sp1.Of miR-29α and Sp1 functional analysis showed that miR-29α can inhibit tumor metastasis and invasion，whereas Sp1 can enhance the ability of tumor metastasis and invasion.After the overexpression of miR-29α，the expression of Sp1 mRNA and protein was downregulated.

Conclusions：miR-29α may be a tumor suppressor gene，during the progression of gliomas，by inhibiting the expression of Sp1 to inhibit the development of tumors.By studying the inhibitory effect of miR-29α on Sp1 gene，it may be helpful to improve our understanding of the pathogenesis of gliomas and provide a reliable theoretical basis for the diagnosis and treatment of gliomas.

3967

THECHANGESANDSIGNIFICANCEOFPERIPHERALANDCENTRALIMMUNECELLSAFTERHYPOXICPRECONDITIONINGANDISCHEMICBRAINDAMAGEINRATS

LU Huang

Qinghai Provincial People′s Hospital，Xining，China

In 1990，Kitagawa K carried out cerebral ischemic preconditioning(2 minutes×2 times)in the gerbil.During this experiment，the majority of hippocampal neurons in the most vulnerable area of the hippocampal CA1 region survived 1 day later after a severe repeated cerebral ischemia lasted for 5 minutes，which thus confirmed the protective effect of hypoxia(ischemic)preconditioning.In the present experiment，rats in the simple cerebral infarction group，hypoxic preconditioning group(under simulated 5 500 m altitude using low pressure oxygen cabin，3 hours at the same time period per day for 7 days)，and hypoxic preconditioning + cerebral infarction group were selected as the subjects of the study.The changes and effect of the immune system in brain protection under hypoxic preconditioning were investigated by comparing the scores of nerve function，the area of cerebral infarction，and the changes of expression in peripheral immune cells(T lymphocytes and natural killer cells)and central immune cells(microglia，oligodendrocytes，and astrocytes).

Conclusions：First hypoxia preconditioning can alleviate neurological defect symptoms and reduce the cerebral infarction area after ischemic brain damage，playing a role in brain protection；second，the expression level of microglia in rats with cerebral infarction is decreased after hypoxic preconditioning，with a reduction in activated number of cells，indicating that hypoxia preconditioning is likely to inhibit further activation of microglia cells and thereby to inhibit their neurotoxicity and exert the neural protect function；oligodendrocytes and astrocytes may be involved in cerebral protection in case of hypoxia preconditioning.

3968

INTERVENTIONALTREATMENTOFACUTEMASSIVEHEMOPTYSISOFTUBERCULOSISINTHEQINGHAI-TIBETPLATEAU

WU Zhaoyu，LI Yu

Affiliated Hospital of Qinghai University，Xining，China

To study the clinical value of bronchial arterial embolization in the treatment of acute massive hemoptysis of pulmonary tuberculosis in the plateau area.Thirty-two patients with acute massive hemoptysis with pulmonary tuberculosis underwent conservative medical treatment and were treated with interventional embolization.Selective bronchial artery embolization therapy on the bronchial artery，internal mammary artery，intercostal artery，and infraorbital artery was performed，as well as contralateral bronchial arteriography.Among the 32 patients，26 cases were successfully embolized once，and hemostasis was achieved immediately；hemoptysis was significantly reduced in 5 cases，and 1 case was treated with embolization again to stop bleeding with an effective rate of 100% without serious complications.Clearly showing the blood supply artery，standard catheter operation，and reasonable choice of embolization agent are the keys to successful operation and reduction of complications.The development of primary pulmonary disease and the establishment and opening of collateral vessels are the main factors for recurrent bleeding after embolization；familiar with the anatomical variation of bronchial arteries and side branch involvement in bleeding is an important guarantee for the safety and effectiveness of interventional treatment of tuberculous hemoptysis.

3969

APOPTOSISOFPANCREATICCELLSINRATSWITHSEVEREACUTEPANCREATITISATHIGHALTITUDE

LIU Linxun ，WU Xinming

Qinghai Provincial People′s Hospital，Xining，China

Objective：To evaluate the role of apoptosis in plateau severe acute pancreatitis(SAP)and the mechanism of apoptosis in SAP by measuring the serum amylase，histopathology score，and the expression of apoptosis index，HIF-1α and Fas/FasL，of pancreatic adenoid cells at different altitudes，and to explore the pathogenesis of SAP in high altitude to better explore the pathogenesis of SAP in plateau.The diagnosis and treatment of SAP provide a theoretical basis.

Methods：Ninety-six SPF grade healthy male Wistar rats were randomly divided into three large groups，all rats were sacrificed and the serum and pancreas tissues were collected.The content of serum amylase was measured with an automatic biochemical analyzer，the pathological changes were observed by HE staining in some pancreatic tissues，the apoptosis index of pancreatic adenoid cells was measured by TUNEL，and the expression of HIF-1，Fas，and FasL in pancreatic tissue was measured by immunohistochemical SP method.

Results：There was a significant difference in HE score and FasL expression between the three elevation groups(P<0.05).Compared with AI at the same time point，the AI of pancreatic adenocarcinoma in P group at three elevations decreased gradually with the increase of altitude，and there was a significant difference(P<0.05).

Conclusions：(1)SAP in plateau area is caused by hypoxia that leads to the decrease of apoptosis；(2)Fas/FasL participates in the pancreatic acinus，the conduction of apoptosis；(3)FasL can represent the high and low levels of inflammation to some extent.

3983

THEEXPRESSIONOFIMMUNOMOLECULESCD35，CD44，CD58，ANDCD59ONERYTHROCYTESINPERIPHERALBLOODOFPATIENTSINCHRONICMOUNTAINSICKNESS

ZHU Mingming，CUI Sen，LI Zhanquan

Affiliated Hospital of Qinghai University，Xining，China

Objective：To study the expression of immune molecules including CD35，CD44，CD58，and CD59 on erythrocytes in peripheral blood among patients in chronic mountain sickness(CMS)，and to explore the changes of the immune function and clinical value in CMS.

Methods：The expression levels of CD35，CD44，CD58，and CD59 on the surface of mature erythrocytes in peripheral blood of CMS patients(30 cases)were detected by flow cytometry.

Results：The positive rates of CD35，CD44，and CD58 on erythrocyte surface in peripheral blood of patients in CMS were significantly lower than those of the normal control group with statistically significant difference(P<0.05)，and the expression of CD59 was not statistically significantly different(P>0.05).

Conclusions：The immune function of erythrocyte in peripheral blood with patients in CMS decreases and provides the basis for the weakening of body resistance and the occurrence and prevention of infection in CMS.

3990

CEREBROVASCULARRESERVE：DIFFERENCESBETWEENHEALTHYTIBETANANDHANETHNICITIESATDIFFERENTALTITUDESREVEALEDBYMETHAZOLAMIDETEST-BASEDCOMPUTEDTOMOGRAPHYPERFUSION

ZHANG Yonghai，LI Yaodong

Qinghai Provincial People′s Hospital，Xining，China

Purpose：To investigate the differences of cerebrovascular reserve capacity between healthy Tibetan and Han ethnicities and its relationship with different altitudes.

Methods：Forty cases of healthy Tibetan and Han ethnicities at the middle and high altitude underwent pre- and postmethazolamide test-based computed tomography perfusion(Revolution，GE).Data of cerebral blood flow(CBF)，cerebral blood volume(CBV)，mean transit time(MTT)，and cerebrovascular reserve(CVR)were processed with SPSS 21.0 software，separately.

Results：Both CBF and CBV increased，with MTT decreased on postprovocation test.Compared with preprovocation test，there were statistical CBV differences in ROIs，except for in temporal and occipital lobes of Han at middle altitude，in thalamus of Han at high altitude，for MTT in frontal lobe of Tibetan at middle altitude，in temporal lobe and thalamus of Tibetan at high altitude，and in lenticular nucleus of Tibetan and Han at middle altitude.There were no CVR differences in frontal，temporal，and occipital lobes，and lenticular nucleus，and thalamus between Tibetan and Han at middle altitude；however，CVR in temporal lobe and lenticular nucleus of Tibetan were significant higher than those in Han at high altitude.In Tibetans，CVR measured at middle and high altitude，was shown to be significantly different in frontal，temporal，and occipital lobes，as well as the thalamus.Whereas，in Han，CVR was only shown to be significantly different in the frontal lobe and thalamus，where CVR at high altitude was found to be greater than when measured at middle altitude.

Conclusions：CVR capacity at high altitude is higher than that at middle altitude in both Tibetan and Han ethnicities.CVR capacity at high altitude in Tibetan is higher than that in Han ethnicity.

4000

APPLICATIONANDEFFECTOFOBSERVATIONOFNRS2002ONNUTRITIONALRISKSCREENINGOFELDERLYCHRONICOBSTRUCTIVEPULMONARYDISEASEPATIENTSATHIGH-ALTITUDEAREATODETECTMALNUTRITION

Li Na

Qinghai Provincial People′s Hospital，Xining，China

Objective： To observe the nutrient status and clinical outcome before and after the efficacy of anti-infection in the treatment in hospitalized elderly chronic obstructive pulmonary disease(COPD)patients at high-altitude area.

Methods：Nutritional Risk Screening Scale(NRS2002)was used to perform nutritional risk screening for 60 elderly patients with COPD at high-altitude area.Body mass index，serum albumin，and prealbumin were measured before and after the efficacy of anti-infection in the treatment，and complications and length of hospitalization were observed after anti-infection.

Results：Patients with NRS2002 score=3 points were 28 cases，and patients with NRS2002<3 points were 32 cases，the incidence rate of nutritional risk was 53.33%；there were significant differences of body mass index，serum albumin and prealbumin，complication，and length of hospitalization before and after anti-infection between patients with NRS2002 score=3 points and patients with NRS2002 <3 points(P<0.05).

Conclusions：There is a high nutritional risk in elderly COPD patients at high-altitude area.Implementation of nutritional risk screening for such patients can detect the potential malnutrition and improve the clinical symptoms.