Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.

Objective:To evaluate the efficacy of laser subepithelial keratomileusis(LASEK) for the treatment of myopia and astigmatism with a thinner cornea.Methods:Eyes(128) from 67 patients were divided into 2 groups,preoperatively,according to the refractive degree.Group I contained 28 eyes with spherical and cylindrical refraction at-2.5 ~-6.0 DS and 0 ~ 2.0 DC,respectively.Group II contained 100 eyes with spherical and cylindrical refraction at-6.25 ~-14.0 DS and 0 ~-2.0 DC,respectively.Following-up was lasted over half a year and the results were compared.Results:The rates of eyes that achieved vision of 0.5 or better after operation in group Ⅰ and Ⅱ were respectively 76 % and 39 % at one week,89 % and 67 % at 1 month,93 % and 56 % at 6 months.The rates of eyes after operation in group Ⅰ and Ⅱ were respectively 93 % and 56 % for spherical refraction within?1.0 DS,and 96.43% and 76% for cylindrical refraction within?1.0 DC.Conclusion:LASEK was safer and more effective in treating low to moderate myopia with astigmatism than in treating high myopia with astigmatism.

Objective:To evaluate the experience of perioperative care of phacofragmentation with vitrectomy.Methods:During 2000 to 2005,A group of 29 eyes in 29 patients underwent phacofragmentation with vitrectomy:Their lens nucleus were sank in vitreous cavity for different kinds of causes.The proficient nursing cooperation and perioperative care were retrospected analyzed.Results:The therapeutic effects after the operations were satisfactory.The post-operative best corrected visual acuities were between 0.1-0.5.No severe complications occurred.Conclusion:Right pre-operative instructions,sufficient preparation,and proficient nursing cooperation can ensure the success of the operation.