Objective: To explore the effects of the bi-directional referral system from the perspective of the medical service consumer.Methods: A balanced panel data which was adjusted by Propensity Score Matching was employed to evaluate the effects of two-way referral system using difference-in-difference (DID) for the 2013 and 2015 data.The evaluation indicators including actual cost sharing ration, out-of-pocket cost per unit, the possibility of high cost, annual inpatient visits and length of hospital stay per unit were used.Results: Compared with the control group, the two-way referral system resulted in an 11.3% (P<0.001) increase in actual cost sharing ratio and an increase of 0.710 (P<0.001) annual inpatient visits in the intervention group.However, the policy did not significantly reduce the possibility of high-cost medical expenses and reduce the length of hospitalization and the annual cost hospitalization.Conclusion: Based on the key findings of the analysis of this study, the two-way referral system has beneficial effects on reducing inpatient financial burden and optimizing resource allocation.

Objective To evaluate the clinical effects of small-incision orbicularis-levator fixation technique for monocular double-eyelid blepharoplasty.Methods Data were collected in 56 patients (5 males and 51 females) with monocular double eyelid from January 2013 to January 2014.All patients underwent small-incision orbicularis-levator fixation blepharoplasty.To ensure the symmetry between the two eyelids,extensive study and design might be done before the surgery,including the positon of incisions,the amount of tissue removed,the tightness of sutures fixation during surgery,and so on.Results All patients were successfully operated and were performed postoperative follow-up for 19.3±3.4 months.MRI was taken on their upper eyelids preoperatively and 6 months postoperatively.Before the surgery,the MRI orbicularis oculi muscle thickness were 4.08±0.74 U in the left side and 4.81±1.05 U in the right (t=2.66,P＜0.05);the areas of orbit fat were 84.26±9.75 U2 in the left and 93.85±12.15 U2 in the right (t =3.21,P＜0.05).As for 6 months postoperatively,the MRI orbicularis oculi muscle thickness were 4.07±0.69 U in the left side and 4.37±0.99 U in the right (t=1.46,P=0.15);the areas of orbit fat were 82.88±8.81 U2 in the left and 85.30±11.94 U2 in the right (t =1.21,P=0.23).Fifty-four patients were satisfied with surgery,the eyelid's crease turned narrow in 1 case and disappeared in 1 case.Those 2 cases were adjusted by secondary surgery using the same method.Conclusions Small-incision orbicularis-levator fixation blepharoplasty has a high success rate,with acceptable bilateral symmetry and slight scar.

Objective:To identify the factors associated with long-term survival and guide the decision for primary surgery in patients with advanced high-grade serous ovarian cancer(HGSOC).Methods:In this case-control study, clinical parameters, including surgical and non-surgical associated factors, were collected and compared between the patients with short-term (<2 years) and long-term (>5 years) survival who all underwent primary debulking surgery (PDS) followed by carboplatin and paclitaxel chemotherapy from January 2004 to December 2016. Univariate analysis was examined by chi-square test and multivariate analysis was performed by logistic regression analysis.Results:There were 95 cases long-term survival (LTS group) and 77 cases short-term survival (STS group) in 698 newly diagnosed HGSOC patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅲc and Ⅳ who met include and exclude criteria. (1) Univariate analysis showed that the proportion of complete cytoreduction with no visible residual disease (R0) at PDS and platinum sensitivity in LTS group were significantly higher than those in STS group ( P<0.01). The surgical complexity score (SCS), the preoperative serum CA 125 level and the ascites volume in the LTS group were significantly lower than those of the STS group (all P<0.05). In the LTS group, the preoperative incidence of lesions in retrograde peritoneum of the bladder, serosal and mesangial membrane of the small intestine, upper abdominal peritoneum and liver parenchyma were significantly lower than those in the STS group (all P<0.05). Multivariate logistic regression analysis showed that platinum sensitivity ( OR=0.016, 95% CI: 0.004-0.063, P<0.01), ascites volume >500 ml ( OR=3.193, 95% CI: 1.285-7.930, P=0.012), and SCS ≥8 ( OR=17.433, 95% CI: 2.281-133.25, P=0.003) were independent factors affecting long-term survival ( P>0.05). (2) Totally 37 of 95 in long-term survival and 16 of 77 in short-term survival achieved R0 cytoreduction at PDS. Univariate analysis showed that preoperative serum CA 125 level, preoperative lesion score, preoperative lesion (DS) score, ascites volume, platinum sensitivity,and SCS were significantly correlated with the R0 PDS (all P<0.05). Multivariate analysis showed that ascites volume >500 ml ( OR=5.199, 95% CI: 2.015-13.409, P=0.001), DS >2 ( OR=15.264, 95% CI: 5.843-39.874, P<0.01) and SCS ≥4 ( OR=4.176, 95% CI: 1.618-10.777, P=0.003) were independent factors associated with R0 cytoreduction. In patients with DS ≤2 or SCS <4, but not those with DS >2 or SCS ≥4, R0 cytoreduction was significantly associated with long-term survival. Conclusion:The intrinsic biology of tumor is the factor influencing long-term survival of advanced HGSOC patients, and those who present with wide intraperitoneal metastases and need to remove multiple organs may not benefit from R0 cytoreduction.