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 investigate the clinical effect of postauricular island flap in reconstruction of anterior auricular defect.Methods:Twelve patients with auricular tumors were retrospectively analyzed in the Department of Aesthetic Plastic and Craniofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. After the tumors were completely removed, the skin defects were repaired with retroauricular island flaps, and the clinical results of the flaps were observed.Results:All the twelve postauricular island flaps were survived postoperatively. One of the flaps had the disorder of blood supply. After puncture with the needle, the congestion was drained out and the flap survived finally. During 1 to 2 years' follow-up, all patients were well satisfied with the surgical results.Conclusions:The posterior auricular island flap in reconstruction of anterior auricular defect has the advantages of simple and easy operation, high survival rate, small scar in the donor area and good aesthetic effect, which is worthy of clinical promotion.

Objective:To explore the pathogenesis of primary hemophagocytic syndrome with UNC13D and MYO5A gene mutations.Methods:A case of adult hemophagocytic syndrome with gene mutation of UNC13D and MYO5A admitted to The 940th Hospital of the Joint Logistic Support Force of the PLA on January 28, 2022 was retrospectively analyzed in terms of laboratory examination, gene atlas of its close relatives and prognosis, and related literature was reviewed.Results:The patient was finally diagnosed with primary hemophagocytic syndrome, and chemotherapy was performed twice with hemophagocytic lymphohistiocytosis(HLH)-2004 regimen. The HLA matching of his cytoplasm was semi-compatible. Considering that his cytoplasm carried blood-macrophage related genes, it was not suitable to be selected as a donor, and there were no other suitable relatives. He was transferred to another hospital for allogeneic hematopoietic stem cell transplantation, but failed to receive allogeneic hematopoietic stem cell transplantation during telephone follow-up, and died.Conclusion:The gene mutation of primary hemophagocytic syndrome is the gold standard for the diagnosis of primary HLH. There may be dual gene inheritance pattern in primary HLH, and the combination of immune disorder caused by viral infection and genetic factors may lead to the pathogenesis of primary HLH.

Objective:To analyze the prevalence of poor vision and spatial distribution characteristics among primary school students in Shenzhen.Methods:A cross-sectional study was conducted.Vision screening among primary school students in Shenzhen was carried out by myopia screening hospitals organized by Shenzhen Myopia Prevention and Control Center for Children and Adolescents using the logarithmic visual acuity chart in 2019.The prevalence of poor vision in different districts, different genders and different grades was calculated.Spatial distribution of the prevalence of poor vision was analyzed with Arcgis 10.2 software.This study adhered to the Declaration of Helsinki.Written informed consent was obtained from guardian of each subject.The study protocol was approved by an Ethics Committee of Shenzhen Eye Hospital (No.20201230-06).Results:A total of 1 044 545 students received the visual acuity examination.The prevalence of poor vision among primary school students in Shenzhen in 2019 was 53.4%(557 748/1 044 545). The prevalence of poor vision among primary school students in the former Shenzhen Special Economic Zone was 56.7%(172 771/304 532), which was higher than 52.0%(384 977/740 013) in areas outside the former Shenzhen Special Economic Zone, and the prevalence of poor vision among girls was 56.7%(268 201/473 164), which was higher than 50.7%(289 547/571 381) among boys, and the differences were statistically significant ( χ2=192.412, 375.434; both at P<0.001). As the grade increased, the prevalence of poor vision firstly decreased and then increased, showing an increasing tendency in general.The prevalence rate of poor vision among primary school students among grade 1 to 6 was 49.8%(99 615/200 203), 44.0%(86 521/196 800), 47.2%(82 848/175 331), 54.5%(89 737/164 731), 60.8%(96 271/158 298), and 68.9%(102 756/149 182), respectively, and a significant difference was found ( χ2=2 871.017, P<0.001). The global Moran I index in Shenzhen was 0.278.The local Moran I index and Geary coefficient in Guangming District were 0.933 and 0.78, respectively.The prevalence of poor vision in Guangming District and its surrounding areas was a low-low cluster. Conclusions:The prevalence of poor vision among primary school students in Shenzhen is spatially aggregated.

Objective:To explore the selection strategy of blastocyst transfer number in freeze-thaw cycle for women over 40 years old, so as to provide reference for reducing twin rate and improving perinatal clinical outcome.Methods:A retrospective analysis was made of 377 patients who underwent freeze-thaw blastocyst transplantation in the reproductive center of Guangdong Maternal and Child Health Hospital from January 2017 to December 2019. They were divided into single blastocyst and double blastocyst transplantatio groups according to the number of blastocyst transplantation. The clinical pregnancy rate, implantation rate, abortion rate, live birth rate, premature delivery rate, twin rate and singleton delivery rate were compared between the two groups.Results:⑴There was no significant difference between two groups regarding the majority of baseline characteristics, including age at retrieval, age at transfer, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (FSH), anti Mullerian hormone (AMH), endometrial thickness at transfer day, number of oocytes retrieved, Gn starting dose, Gn days, Gn dosage, embryos at cleavage stage and top-quality embryos ( P>0.05). ⑵ There was no significant difference in the rate of implantation, early pregnancy loss, late pregnancy loss and live birth between two groups ( P>0.05). ⑶ The preterm birth rate was higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group, albeit not reaching significant difference (31.7% vs 12.5%, P=0.083). ⑷ The clinical pregnancy rate and the twin pregnancy rate was significantly higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group ( P<0.05). ⑸ The singleton birth rate was significantly lower in the double blastocyst transplantation group compared with the single blastocyst transplantation group (75.61% vs 95.83%, P<0.05). Conclusions:In women ≥40 years old, transferring a single blastocyst can result in live birth rate that is similar as transferring two blastocysts while dramatically reducing the risk of twin pregnancy rate and increasing singleton birth rate.

Objective: To explore the effect of applying the digital technology in the reconstruction of congenital microtia. Methods: CT data of 40 patients with congenital microtia were collected by using software (Mimics 17.01) and three-dimensional printing. And the three-dimensional reconstruction of costal cartilage and ear model was performed. The effectiveness and feasibility of the digital assisted technology in the reconstruction of congenital microtia could be established, by contrasting the pre-three-dimensional reconstruction and the morphology of the costal cartilage harvested during surgery and comparing the imaging data of the auricles before and after surgery. Results: 40 patients were satisfied with the appearance of the auricle after the restoration. The rib cartilage obtained during the operation was consistent with the preoperative data simulation. The trauma of the operation and the operation time were reduced. There was no statistically significant difference between both auricle length and width for the reconstructed ear and those of the normal ear, auricle length mean (62.10±6.82)mm vs (60.31±6.18)mm, auricle width mean (26.10±2.26)mm vs (25.40±2.32)mm, P>0.05, respectively. Conclusions The application of digital assisted technique in congenital microtia correction could accurately display the tissue structure of the operation area, which was helpful to preoperative design, reduce intraoperative injury and achieve satisfactory surgical result .

Misuse and abuse of veterinary antimicrobial agents have led to an alarming increase in bacterial resistance, clinical treatment failure, and drug residues. To address these problems, consistent and appropriate dosage regimens for veterinary antimicrobial agents are needed. Pharmacokinetics/Pharmacodynamics (PK/PD) models have been widely used to establish rational dosage regimens for veterinary antimicrobial agents that can achieve effective prevention and treatment of bacterial diseases and avoid the development of bacterial resistance. This review introduces building methods for PK/PD models and describes current PK/PD research progress toward rational dosage regimens for veterinary antimicrobial agents. Finally, the challenges and prospects of PK/PD models in the design of dosage regimens for veterinary antimicrobial agents are reviewed. This review will help to increase awareness of PK/PD modeling among veterinarians and hopefully promote its development and future use.
Anti-Infective Agents ; Bacterial Infections ; Drug Residues ; Humans ; Treatment Failure ; Veterinarians

Objective: To explore procedure of the one-stage surgery with prolonged tissue expansion in microtia reconstruction and treatment of related complications. Methods: 211 patients had undergone the one-stage surgery of microtia reconstruction with prolonged tissue expansion in Department of Aesthetic Plastic and Maxillofacial Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from June 2016 to June 2017. A retrospective study of these data was conducted for standardization of surgical procedure, treatment of postoperative complications, improvement of the existing technology. Results: 211 patients had finished the follow-up, of which 10 had complications. The complications included 4 cases of hematomas, 3 cases of expander exposures, 2 infections, and disorder on blood supply of the flap with severe headache in 1 case. We removed hematoma by washing and drainage, repositioned the exposed expander by standard debridement surgery again, controlled infection by systemic or topical application of effective antibiotics, andrelieved severe headache by reducing injection volume. After these treatments, all the patients were able to undergo the next stage surgery of ear reconstruction. Conclusions Emphasizing standardization of surgical procedure, appropriate treatment of postoperative complications and improvement of tissue expansion was beneficial for performing the next stage surgery of ear reconstruction.

Objective To analyze CT findings in adhesive intestinal obstruction caused by different adhesion pattern.Methods Clinical data of 83 adhesive intestinal obstruction cases proved by laparotomy were reviewed.Before surgery two experienced abdominal radiologists randomly double blindly inspected and evaluated the CT findings,as to whether there was intestinal obstruction,the severity of obstruction,the site of obstruction,the adhesion type of obstruction and the diagnosis of strangulated intestinal obstruction,the consensuses were accomplished by discussion.Results The accuracy of diagnosis was 100％ for the existence of obstruction,the severity of obstruction and the site of obstruction.There were intra-abdominal hernia caused by intestinal adhesion (44 cases),a cluster of loop (12 cases),bowel twisted angle (8 cases),the intestine and abdominal adhesions (6 cases),intestinal adhesion contracture stenosis (5 cases),adhesive band compression (4 cases),intestinal volvulus caused by adhesion (1 case).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of CT in diagnosing strangulated intestinal obstruction were 78％,47％,100％,100％,73％,respectively.Conclusion CT can clearly diagnose different adhesion pattern leading to ileus and ensuing strangulation.

ObjectiveTo investigate the clinical features of postpartum hemolytic uremic syndrome (PHUS) in Tibetan women, and to improve the diagnosis and treatment of PHUS.MethodsFrom January 2013 to June 2018, 11 patients diagnosed with PHUS in the Tibet Autonomous Regional People's Hospital were enrolled. Clinical manifestations, laboratory testing results, treatments and outcomes were retrospectively analyzed. A descriptive statistical analysis was applied in this study.ResultsThe average age of the 11 patients was (27.0±6.2) years old, and all were Tibetans. Five of them delivered by cesarean section and eight complicated by hypertension. The onset of PHUS was 1-3 d after delivery. The mean hemoglobin concentration [(73.5±26.3) g/L] and platelet count [(51±31)×109/L] remarkably decreased. Patients' renal functions were also significantly impaired with an average serum creatinine level of (517±184)μmol/L. Nine women required hemodialysis, seven received plasma infusion and six underwent glucocorticoid therapy. No patients received plasma exchange or eculizumab therapy due to limited resources. Seven out of the nine patients who underwent hemodialysis could withdraw from dialysis.ConclusionsPHUS is relatively rare, and characterized by acute onset after birth and severe conditions, especially renal injury. However, most patients would have better prognosis after active treatment.