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With the aggravation of aging and the increasing demand of the elderly for pension and medical services,the old-age model of medical care combined with nursing emerges as the times required.Traditional Chinese medicine medical institutions have the advantages and opportunities in the process of developing integrated medical and nursing services,such as the treatment and prevention of chronic diseases,the increasing demand of the elderly for integrated medical and nursing institutions,and the strong support of the state for integrated medical and nursing institutions.However,they are also facing challenges and difficulties such as imperfect team,weak market competition and low payment ability.Through the analysis of opportunities and challenges for TCM medical institutions,this paper provides corresponding counter measures and suggestions for their development.
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Objective To apply robotic surgery of early ovarian malignancy tumors clinically and evaluate its feasibility in management for early ovarian cancer. Methods Using the da Vinci robotic surgical system, seven patients with early ovarian malignancy tumors (stage Ⅰ) underwent robotic surgery from April 2012 to September 2013. The average age was 45.7 years. Robotic surgeries approaches contained salpingo-oophorectomy,para-aortic lymphadenectomy, pelvic lymphadenectomy, omentectomy and appendectomy. Perioperative and follow-up clinical data were recorded. Results All robotic surgeries were successfully completed without the conversion to laparotomy. The mean operative time was 225 minutes (100-330 minutes). The average estimated blood loss was 171 ml (20-600 ml). No patients received blood transfusions. No intraoperative and postoperative complications were observed. The average number of pelvic lymph node dissected were 18.3 (11-34). The average number of para-aortic lymph node dissected were 3.7 (3-4). The mean follow-up time was 26.0 months after surgery (20-36 months). Currently, all patients had no tumor recurrence and survived. Conclusion Robotic surgery is feasible as a novel alternative approach in the treatment of early ovarian malignancy tumors.
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Objective To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse.Methods From January 2012 to December 2013,3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively.Operation time,blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated.Results Three patients were treated by robotic sacral hysteropexy successfully.The mean operation time was 221 minutes (210-240 minutes),mean blood loss was 45 ml.One case with Ⅱ degree perineal laceration patients simultaneously perineal repair,neither intranor post-operative complications occurred.The mean postoperative recovery exhaust time was 16 hours.At three months of follow-up,all 3 patients got satisfaction.Although one patient at the first six months of postoperation had leakage of urine when coughing,instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear.Conclusion Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.
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Objective To evaluate the high-risk human papillomavirus(HR-HPV)detection and thinprep cell test(TCT)in the diagnosis of cervical lesion by comparison with pathological findings.Methods The data collected from Dec.2004 to Dec.2006 from 690 patients who had undergone HR-HPV detection,TCT and pathology examination with electronic colposcopy in the Department of Obstetrics and Gynecology,General Hospital of PLA were analyzed retraspactively.Results Among the 690 patients,the coincidence between the findings of TCT and pathology was 22.34%(42/188)for low-grade squamous intraepithelial lesion(LSIL),58.33%(56/96)for high-grade squamous intraepithelial lesion(HSIL)and 100%(16/16)for cervical cancer.The number of patients with the cytological diagnosis of abnormal squamous cells(ASC),LSIL,HSIL and cervical cancer was 315,188,96 and 16,respectively.Among them,the positive rate of HR-HPV of ASC,LSIL,HSIL and cervical cancer was 53.96%(170/315),77.12%(134/188),80.21%(77/96)and 100%(16/16),respectively.Pathologic examination through electronic colposcopy revealed the number of patients with the diagnosis of inflammation,CINⅠ/HPV,CINⅡ/CINⅢ and invasive cancer was 425,81,157 and 27,respectively.Among them,the positive rate of HR-HPV in inflammation was 43.29%(184/425),CINⅠ/HPV 74.93%(60/81),CINⅡ/CINⅢ 91.72%(144/157)and invasive cancer 92.5%(25/27).Among the 690 cases,413 were HR-HPV positive,55.45%(229/413)of which showed CINⅠ/HPV or higher.277 cases were HR-HPV negative,and 87.01%(241/277)of which showed inflammation,12.99%(36/277)of which showed CINⅠ/HPV or higher,and 5.42%(15/277)of which showed CINⅡ/CINⅢ and invasive cervical cancer.Among 315 cases with ASC,170 cases were HR-HPV positive,41.76%(71/170)of which showed CINⅠ/HPV or higher,including 69.01%(49/71)CINⅡ/CINⅢ and invasive cervical cancer.145 cases were HR-HPV negative,only 4.83%(7/145)of which was CINⅡ/CINⅢ and invasive cervical cancer,and 90.34%(131/145)of which was inflammation.Conclusion HR-HPV detection and TCT are feasible for cervical lesion screening.Cytology combined HR-HPV test is favorable for shunting management in cervical lesions.
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Objective To discuss the clinical significance of human papilloma virus (HPV) infection in cervical cancer and to explore the feasibility of detecting the infection with microarray from paraffin-embedded specimens of cervical cancer. Methods From May 2005 to February 2007, 48 patients with cervical carcinoma, including 37 cases with cervical squamous cell carcinoma and 11 cases with cervical adenocarcinoma, were analyzed retrospectively. After DNA extraction from the paraffin-embedded tissues, 23 HPV subtypes were detected by the use of microarray after amplification by polymerase chain reaction (PCR) and hybridization. Results 44 cases of cervical cancer were found to be high-risk HPV positive genotypes. The HPV infection rate was 91.7%. The HPV infection rate in cervical squamous cell carcinoma was 94.6% (35/37), and in cervical adenocarcinoma was 81.8% (9/11). Among them, 33 cases were found to have single infection, accounting for 75.0% of the infection rate. There were 11 cases of mixed infection, among them 9 cases were found to have double infection and 2 cases with multiple infection, accounting for 20.5% and 4.6%, respectively, of the infection rate. The infection rate of HPV16, the main genotype, was 90.9% (40/44). The infection rate of HPV18, the second ranking subtype, was 27.3% (12/44). Infection with HPV52, 33, 59, and 68 genotypes was lower in incidence. Among 35 cases of cervical squamous cell carcinoma, the infection rates of HPV16 and HPV18 were 91.4% (32/35) and 22.9% (8/35), respectively. Among 9 cases of cervical adenocarcinoma, the infection rate of HPV16 and HPV18 were 88.9% (8/9) and 44.4% (4/9), respectively. Conclusion Multiple HPV genotypes can be detected from paraffin-embedded tissues with microarray technique in high sensitivity and specificity, and it is useful to study the pathogenesis and prevention of cervical cancer.