Increasing demand for health services brings an opportunity for the development of health service industry, and the development is based on qualified talent support from Traditional Chinese Medicine (TCM) education. This article expounded that developing health service is the realistic demand for deepening TCM education reform from the direction, number and quality of talent cultivation, and proposed the measures of deepening TCM education to train TCM health services: establish mechanism for co-ordination of supply and demand of TCM talents under the direction of market and guidance of government; form and optimize multilevel, multi-standard and multi-grade talent cultivation system; build talent evaluation mechanism and cultivation goals focusing on post competency.

Objective To discuss the clinical characteristics and treatment methods of lumbar disc herniation in adolescent and to in-crease the awareness of lumbar disc herniation among orthopedists.Methods Retrospectively reviewed the clinical data of 201 adolescent pa-tients(aged 20 years or less)with lumbar disc herniation who were admitted in General Hospital of Shenyang Military Area Command from January 2001 to December 2010.Analyzed the clinical characteristics and treatment methods,and compared the VAS score and ODI score be-fore operation,one week after operation and at the last follow up.Meanwhile,the complications were observed and compared.Results Among the 201 patients,187 patients(93.0%)presented with low back pain with or without radiating pain,20 patients(10.0%)presented with leg pain for the first symptom.There were only 97 patients(48.3%)were diagnosed with lumbar disc herniation for their first diagnosis in other hospital.Totally 70 patients(34.8%)had a history of trauma before the onset.The most common segments were L4 /L5 (101 cases,50.2%) and L5 /S1 (70 cases,34.8%).There were 140 patients treated by microendoscopy discectomy(MED),25 patients treated by percutaneous endoscopic lumbar discectomy(PELD),and 36 patients treated by open lumbar discectomy(OLD).All the patients were followed up for more than 12 months with averagely followed up for(22.9 ±11.7)months.There was significant improvement one week after operation and at the last follow up compared with the preoperative VAS score and ODI score,and the differences were statistically significant(P <0.05).The rate of postoperative complications was 3.6%,4.0%,8.3% in patients with MED,PELD and OLD respectively.Conclusion Diagnosis of LDH in adolescent is usually delayed.Increase the awareness of lumbar disc herniation could help orthopedists to get a exact medical history,per-form a directed physical examination,and order appropriate imaging studies.Minimally invasive surgery is an effective method to treat lumbar disc herniation in adolescent.

Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

Objective To explore the clinical diagnostic and therapeutic characteristics，prognostic factors of pailents with primary clear cell carcinoma of the cervix.Methods The clinical,pathologic and follow-up data of patients with primary clear cell carcinoma of the cervix treated in our hospital from Jan 2003 to Dec 2006 were collected and analyzed retrospectively.The relative literature was reviewed.ResultsFive patients with primary clear cell carcinoma of the cervix were treated(1 case stage Ⅰ b1，2 of stage Ⅰ b2，1of stage Ⅱ a，1 of stage Ⅳa).The mean age was 40.2 years(32 to 50 years).The primary symptom was mostly irregularly vaginal bleeding(3/5)and clinical type was predominantly(4/5)endophytie growth.The positive rate of cervical cytologic examination was 2/4,the negative rate of cervical human papillomavirus(HPV)DNA examination was 4/4.Serum CA125 level was abnormal(62.5 to 592.1 kU/L)before operation and when relapse occurred,and returned to normal after operation.All of five patients underwent operation,pathologic examination showed that three patients with infihration in deep 1/2 myomctrium of cervix,and two patients with infiltration in cervix-corpus juncture.Four patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy.All of four patients underwent four courses of chemotherapy with fluorouracil(5-FU)and carboplatin，one patient(stage Ⅱ a)was added with intracavitary brachytherapy.None of the four patients had relapse or metastasis after a follow-up of 10 to 44 months.The patient with stage Ⅳ a underwent firstly hysterectomy and prerectum mass removal.Pelvic relapse occurred three months after operation and the patient then underwent the second operation，external beam radiotherapy and intracavitary brachytherapy and 8 courses of chemotherapy with paclitaxel(taxol) and carboplatin.There was no relapse or metastasis after a follow-up of 26 months.Conclusions Primary clear cell carcinoma of the cervix may be unrelated to HPV infection.It shows predominantly endophytic growth and tends toward deep infiltration in cervix and extending to uterine corpus.Operation combined with chemotherapy with carboplatin and 5-FU or taxol may lead to relatively perfect short-term therapeutical effect.Serum CA125 can help to monitor prognosis.Objective To study the clinical characteristics，treatment modalities.and prognosis of cervical adenosquamous carcinoma.Methods The data of 21 patients with adenosquamous cervical cancer who were admitted into Zhongnan Hospital，Wuhan University from Jan 2001 to Dec 2005 were analyzed retrospectively.Six patients received Surgical therapy only and 15 patients received combined therapy.ResultsSeven cases were with positive pelvic lymph node metastases and 3 cases were with ovarian metastases.The median survival time of the combined therapy group and surgical therapy group was 54 and 20 months，respectively.In stage Ⅰ and stage Ⅱ patients，the median survival time of the combined therapy group and surgical therapy group was 66 and 20 months,respectively.The difference was significant between the two groups(P＜0.05).ConclusionsCombined therapy should be given to patients with adenosquamous carcinoma of the cervix.Surgical therapy and chemotherapy play an important role in the management and prognosis of adenoquamous carcinoma of cervix.Preserve of ovary for patients with adenosquamous carcinoma of the cervix should only be done when the ovary is confirmed free from any malignant involvement by pathology.

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mammography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50-60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453), and both of them were high. There was no significant association between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Objective:To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy.Methods:From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study.Results:There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （ P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （ P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （ P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （ P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively ( P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions:The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.

In this study,the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated.From March to August,2009,17618 women,from Wufeng area of Hubei province,China,were recruited to screen breast diseases by using breast infrared diagnostic apparatus.Other diagnostic methods,such as B-mode ultrasound,X-ray mammography,needle biopsy and pathological examination were,if necessary,used to further confirm the diagnosis.The screening showed that 5990 of 17618 cases (34.00％) had breast diseases,5843 (33.16％) had mammary gland hyperplasia,48 (0.27％) had breast fibroadenoma,ll (0.06％) had breast carcinoma,and 88 (0.50％) had other breast diseases.The peak morbidity of breast cancer was found in the women aged 50-0 ages.The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8,0.157％) in comparison with that in the subjects younger than 50 years old (n=3,0.024％) (u=2.327,P＜0.05).It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years,while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40.Compared with the patients elder than or equal to 40 years old (n=3289,27.46％),the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases,47.18％; P＜0.001).However,there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453),and both of them were high.There was no significant association between the morbidity of breast diseases and cervical cancer.Since the morbidity of breast diseases was higher among young women,more attention should be paid to the screening of breast diseases among young women for early diagnosis.