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 explore the value of electrocardiagraphy and risk stratification in patients with early repolarization syndrome( ERS ). Methods All of 271 eases were divided into three groups: 7 ERS patients with cardiac events (syncope,clinical sudden death or incompleted, ventricular fibrillation and induced ventricular fibrillation during electrophysiological), 82 ERS patients without cardiac events, and 182 cases without heart disease who were matched for age and sex. QRS interval,Tpeak-Tend (TpTe) interval,corrected QT interval(QTc) and QT deviation degree (QTd) in surface ECG were compared among the three groups. Results TpTe interval in ERS patients with cardiac events was significantly longer than that in ERS patients without cardiac events and the control subjects [ ( 123.3±22.4 ) ms vs (87.7±15.5 ) ms; ( 123.3±22.4) ms vs (83.5±15.1 ) ms, P < 0.05 ]. There was no significant difference in QRS interval, QTc and QTd among three groups. Conclusion TpTe interval in ECG might be useful in risk stratification with ERS, but further research is needed.

OBJECTIVE:To observe therapeutic efficacy of zoledronic acid in the treatment of acute pain of vertebral compres-sion fractures during different courses. METHODS:207 patients with acute thoracic or (and) lumbar vertebral compression frac-tures were selected and randomly divided into trial group(107 cases)and control group(100 cases). Control group was given calci-um carbonate(1 200 mg/d)diclofenac sodium sustained-released tablet(75 mg/d).Trial group was additionally given zoledronic ac-id 5 mg added into 5%Glucose solution 100 ml,intravenous dripping for 15-30 min,on the basis of control group. RESULTS:Af-ter treatment,VAS score of two group decreased significantly,and trial group the decrease was more significant than control group,with statistical significance (P<0.05),there was no statistical significance in VAS score between course≤one month and one month 0.05);after 4d treatment,there was statistical significance in VAS score between course≤one month and one month 0.05);after one week,there was statistical significance in VAS score between one month 2 months (P<0.05).CONCLUSIONS:Zoledronic acid may partly alleviate the pain of acute vertebral fractures,the analgesic effect is more clear in early stage.

Objective To investigate the relation of autophagy and postherpetic neuralgia in elderly patients,and provide new methods for prevention and treatment of postherpetic neuralgia.Methods One hundred thirty-five specimens were obtained from elderly patients with herpes zoster,containing 83 patients with herpes zoster plus neuralgia and 52 cases with non-neuralgia herpes zoster.The level of autophagy was determined by acridine orange-stain.The protein expressions of autophagy marker protein LC3 and autophagy related protein Beclinl were detected by Western blot.Results Flow cytometer detection after acridine orange-stain showed that mean fluorescence intensity (MFI) of herpes zoster plus neuralgia patients was 0.775±0.068 and non-neuralgia herpes zoster patients was 0.342±0.025.The level of autophagy of non-neuralgia herpes zoster patients was significant lower than herpes zoster plus neuralgia patients (P＜0.05).The expressions of autophagy marker protein LC3 and autophagy related protein Beclin1 detected by Western blot also showed the level of autophagy of non-neuralgia herpes zoster patients was decreased compared with herpes zoster plus neuralgia patients.Conclusions High level autophagy is risk factor for postherpetic neuralgia in elderly patients.

Objective: To explore the effect of the aortic arch type on technical indicators in patients with carotid artery stent implantation.
Methods: We retrospectively analyzed 224 consecutive patients treated in Fu Wai hospital for unilateral carotid artery stent implantation from 2011-01 to 2012-12. We summarized the catheter category, type and the operating techniques including ① retracement, turn and insertion of the catheter, ② retracement, turn of catheter+the guidance of guide wire,③ retracement, turn of catheter+the guidance of guide wire+the supporting of another catheter, ④ using special graphic catheter+the guidance of guide wire+the supporting of another catheter. The procedural X-ray exposure time, dosage of contrast agent and operation related complications were recorded. According to Myla classiifcation, the aortic arches were divided into Myla I, Myla II and Myla III types.
Results: There were 7/224 (3.1%) patients with Myla I aortic arch, 113 (50.4%) with Myla II aortic arch and 104 (46.4%) with Myla III aortic arch. A total of 48/104 (46.2%) Myla III patients used special techniques (tech③, tech④), it was more than the patients with Myla I, (1/7,14.3%) and Myla II (17/113, 15.0%), P<0.01. The patients with Myla III aortic arch had the longer X-ray exposure time and used the higher dose of contrast agent, all P<0.01. The procedural success rate in patients with
Myla III was 96.2%, it was lower than those with Myla I (100%) and Myla II (100%), P=0.045. The procedural complication rate in patients with Myla III was 22.1%, it was higher than those with Myla I (0%) and Myla II (8.9%), P=0.007.
Conclusion: The aortic arch type is the important inlfuential factor for the techniques used in carotid stent implantation. There were more dififculties and complications for stent implantation in patients with Myla III aortic arch.

Objective To investigate the clinical effect of minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope on treating Rockwood type Ⅲ acromioclavicular joint dislocation.Methods A retrospective case control study was conducted to analyze the clinical data of 62 patients with Rockwood type Ⅲ acromioclavicular dislocation admitted to the Traditional Chinese Medicine Hospital of Wuxi from January 2015 to January 2018.There were 34 males and 28 females,aged 18-71 years,with an average age of 43.7 years.Among the patients,32 were treated with minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope (TightRope group),and 30 with conventional double Endobutton technique (Endobutton group).The operation incision size,operation time,intraoperative blood loss,Constant-Murley score of shoulder joint function and postoperative complications were compared between the two groups.Results All patients were followed up for 6-14 months,with an average of 10.4 months.Compared with Endobutton group,TightRope group had smaller incision size [(1.6 ± 0.9) cm vs.(7.7 ± 2.6) cm],shorter operation time [(45.7 ± 21.1) minutes vs.(58.3 ± 16.7) minutes],and less bleeding during operation [(12.2 ±7.3) ml vs.(76.6 ± 12.2) ml],and the differences were statistically significant (P ＜ 0.05).The Constant-Murley scores of the two groups were significantly improved after operation (P ＜0.05),and there was no significant difference between the two groups in the Constant-Murley score 6 months after operation (P ＞ 0.05).In the Endobutton group,two patients had partial reduction loss of acromioclavicular joint caused by loosening of internal fixation,which was not dealt with because of no symptom,and one patient had coracoid fracture 1 month after operation which was treated with clavicular hook plate fixation.There was no related complication in the TightRope group.Conclusion For Rockwood type Ⅲ acromioclavicular joint dislocation,minimally invasive reconstruction of coracoclavicular ligament with adjustable locking TightRope shows the advantages of small incision,short operation time,and less bleeding,which is worthy of clinical application.

Objective To observe the clinical effect of pulsed radiofrequency electrotherapy combined with acupuncture or electroacupuncture in treating neuralgia after herpes zoster infection.Methods Eighty-eight patients were divided into a control group,an electroacupuncture group,a pulsed electrotherapy group and a combined group using a random number table.The 4 groups were routinely given gabapentin and tramadol,while the electroacupuncture group was additionally treated with electroacupuncture,the pulsed electrotherapy group received radiofrequency irradiation of the dorsal root ganglion,and the combined group was given CT-guided pulsed radiofrequency electrotherapy combined with electroacupuncture or acupuncture.Before the treatment and 15 days and 1 month afterward,everyone was evaluated using a visual analogue scale (VAS) for pain intensity,the Hamilton anxiety (HAMA) and depression (HAMD) scales and the short form 36 (QOL-SF36) quality of life assessment.The area of painful skin was also measured.Results There were no significant differences among the 4 groups at the outset in any of the measurements.Significant improvement was observed in all of the measurements 15 and 30 days after the treatment except in the control group.The combined group was by then significantly better than the other 3 groups.Their dosage of gabapentin and tramadol had decreased significantly compared with the other groups after 3 months of treatment.Conclusion CT-guided pulsed radiofrequency electrotherapy combined with acupuncture or electroacupuncture is safe and effective for treating post-herpes neuralgia.It is worthy of clinical application and promotion.

Objective To observe the clinical effect of combining extracorporeal shock waves with pulsed radiofrequency irradiation of the dorsal root ganglia in the treatment of spinal cord-derived abdominal pain. Methods A total of 88 patients were randomly divided into a control group, a shock wave group, a pulsed irradiation group and a combination group, each of 22. All of the patients were given etocoxib and pregabalin medication for 3 weeks. In ad-dition to the drugs, the shock wave group received extracorporeal shock wave therapy, and the irradiation group re-ceived pulsed radio frequency irradiation of the dorsal root ganglia. The combination group received both. A visual an-alogue scale was used to assess perceived pain. The quality of life short form 36 ( QOL-SF36) , Hamilton anxiety scale and Hamilton depression scale were administered to all 4 groups before the treatments and after 1, 4 and 12 weeks of the treatments. The development of diseases, gastrointestinal function, medical treatment and medical expenses of the 4 groups were observed for two years after the treatments. Results After 4 weeks of treatment, the average scores of all four groups in all of the evaluations had improved significantly compared with before the treatment. In combination group′s average results were significantly better than those of the other 3 groups from 4 weeks until 12 weeks after the treatment. During the subsequent two years that group′s gastrointestinal symptoms, hospital visits and medical expen-ses were all significantly lower, on average, than those of the other groups. Conclusion Extracorporeal shock waves combined with pulsed radio frequency irradiation of the dorsal root ganglia has significant clinical efficacy for alleviating spinal cord-derived abdominal pain. It can significantly reduce medical costs and is worthy of clinical pro-motion.

Objective To observe the clinical efficacy and safety of non-surgical spinal decompression com-bined with intervertebral foramen injection in the treatment of lumbar intervertebral disc herniation. Methods Nine-ty-six patients were randomly divided into a control group, a decompression group, an injection group and a combined group. All of the subjects were given loxoprofen sodium and chestnut seed extract. The decompression group was trea-ted with non-operative spinal decompression. The injection group received intervertebral foramen injections. The com-bined group received both treatments. Pain perceptions, quality of life perceptions and lumbar dysfunction were ob-served before the treatment, and 2 days, 1 month, 6 months and 12 months afterward. Results There were no sig-nificant differences among the groups in average pain perceptions quantified using a visual analogue scale ( VAS) be-fore the treatment. The average scores on a 36-item short-form health survey, the Oswestry disability index and a Jap-anese Orthopedic Association instrument also were not significantly different. All of those indicators had improved sig-nificantly in the decompression, injection and combined groups at 1, 6 and 12 months after the treatment, but the combined group′s average indicators were all significantly better than the other groups′ averages at the same time points. All of the significant improvements in the combined group′s averages occurred in the first month after the com-bined treatment. Conclusion Non-operative spinal decompression has a synergistic effect with intervertebral fora-men injection in treating patients with lumbar disc herniation. Their combined effect is better than either treatment a-lone. Their combined effect is lasting, safe and has few complication risks. It is worthy of clinical application.

Objective:To observe the effect of functional electrical stimulation (FES) combined with an ankle-foot orthosis (AFO) and gait training on lower limb motor function, gait parameters and the joint angles of hemiplegic stroke survivors.Methods:Thirty-two stroke survivors who met the inclusion criteria were selected and randomly divided into a control group ( n=10), an orthosis group ( n=10), and a combination therapy group ( n=12). In addition to routine medication and rehabilitation, the control group received only gait training, the orthosis group received gait training and an AFO and the combination therapy group was given FES, an AFO and gait training. All three groups were treated for four weeks. Then, the Fugl-Meyer lower extremity assessment (FMA-LE), the Brunnstrom lower extremity assessment (BRL), and Functional Ambulation Categories (FACs) were used to evaluate the lower limb motor function and walking ability of the three groups. The gait parameters of the three groups were quantified using a three-dimensional gait analyzer, and the changes in the hemiplegic gait before and after treatment were compared among the three groups. Results:After the treatment the average FMA-LE, FAC and BRL scores, time-space parameters, and joint angle parameters of all three groups had all improved significantly. After the intervention the average indicators in the combined therapy group (including stride frequency, stride length and walking speed) were all significantly better than in the other two groups.Conclusions:Adding FES to gait training with an AFO can effectively improve lower limb motor function and the walking ability of hemiplegic stroke survivors.