Objective To explore the impact and prediction of social support, life stress, coping style on learning burnout in middle school students.Methods A total of 306 middle school students were investigated with adolescent student burnout inventory, middle shool psychological stressors questionnaires, social support rating scale for juveniles and simplified coping style questionnaire.Results The scores of learning burnout were 44.30±8.45.The moderate learning burnout accounted for 31.9％.There were no differences between social support,life stress,coping style(P＞0.05).There were significant differences in social support ((46.57± 12.50) vs (50.03 ± 10.63))between male and female(t=-2.536, P＜0.05).There was positive correlation between learning burnout and life stress and negative coping style(r=0.146-0.301, P＜0.05) ,and negative correlation between learning burnout and social support and positive coping style (r=-0.301--0.231, P＜0.01).The learning stress (β=0.435), teacher stress (β=0.157), support availability (β=-0.204), negative coping style (β=2.668) were the mainly influencing factors of learning burnout in middle school students ,which can predict 26.4％ variation of learning burnout in middle school students.Conclusion Learning stress, teacher stress, support availability, negative coping style are the mainly influencing factors of learning burnout in middle school students.

Objective To analyze the clinicopathologic features and prognosis of early stage cervical adenosquamous carcinoma and adenocarcinoma.Methods Clinical data of 62 patients with cervical adenosquamous carcinoma,149 patients with adenocarcinoma and 2 687 patients with squamous carcinoma of stage Ⅰ B-Ⅱ A,who received surgical treatment and adjuvant radiotherapy from June 2006 to February 2012 were retrospectively analyzed.The Chi-square test,Kaplan-Meier method,log-rank test and logistic regression were used for statistical analysis.Results In patients with adenosquamous carcinoma,adenocarcinoma and squamous carcinoma,the rates of lymph node metastasis were 33.6％ (50/149),29.0％ (18/62) and 22.0％ (591/2 687),deep stromal invasion were 64.4％ (96/149),75.8％ (47/62) and 55.3％ (1 486/ 2 687) and corpus invasion were 26.2％ (39/149),25.8％ (16/62) and 6.7％ (181/2 687),respectively.Those pathological parameters in adenosquamous carcinoma and adenocarcinoma were higher than those in squamous carcinoma (χ2 =12.170,P=0.002;χ2 =14.660,P=0.001;χ2 =97.732,P=0.000).There were no difference between adenocarcinoma and adenosquamous carcinoma in proportion of massive tumor (≥4 cm) [38.9％ (58/149) vs.35.5 (22/62),χ2 =0.220,P =0.639],lymph node metastasis (χ2 =0.410,P =0.522),corpus invasion (χ2 =0.003,P =0.956),deep stromal invasion (χ2 =2.595,P =0.107) and low differentiation[38.9％ (58/149) vs.48.4％ (30/62),χ2 =1.612,P=0.204].The median follow-up period was 45 (3-92) months.Multivariate analysis showed that corpus invasion (P =0.014,RR =3.393,95％CI:1.280-8.991),age (P=0.000,RR =1.077,95％ CI:1.037-1.117) and stage (P =0.007,RR =0.275,95％ CI:0.108-0.699) were prognostic factors of adenosquamous carcinoma.Age (P =0.006,RR =1.025,95 ％ CI:1.007-1.043) and lymph node metastasis (P =0.000,RR =2.525,95％ CI:1.547-4.120) affected the prognosis of adenocarcinoma.The median survival times for adenocarcinoma,adenosquamous carcinoma and squamous carcinoma were 45,46 and 56 months (adenosquamous carcinoma vs.squamous carcinoma:χ2 =1.347,P =0.246;adenosquamous carcinoma vs.adenocarcinoma:χ2 =1.808,P=0.179).There were no difference in recurrence rates between adenosquamous carcinoma and squamous carcinoma[14.0％ (7/50) vs.7.6％ (175/2 298),χ2 =1.968,P=0.161],and between adenosquamous carcinoma and adenocarcinoma [14.0％ (7/50) vs.22.1％ (27/122),χ2 =1.478,P =0.224].Conclusions Clinicopathologic features are similar between stage Ⅰ B-Ⅱ A cervical adenosquamous carcinoma and adenocarcinoma.Corpus invasion,age and stage are the leading indicators affecting the prognosis of adenosquamous carcinoma.Age and lymph node metastasis are the factors affecting the prognosis of adenocarcinoma.There are no difference in survival and prognosis between adenosquamous carcinoma and adenocarcinoma.

Objective To compare the curative effect of laparoscopic and laparotomic operation for elderly Chinese women with cervical cancer. Methods The randomized controlled trials (RCT) and case controlled trials (CCT) were collected by searches of WanFang database, CNKI, VIP, China Biology Medicine (CBM) , PubMed. Data were extracted from these trials and data analysis was performed by RevMan 5.2.9. Results There were no RCTs, however, a total of 10 CCTs met the inclusion criteria and had data extracted for this review. The baseline characteristics of the laparoscopic group were similar to those of the laparotomic group. Comparing to laparotomic group, the laparoscopic group have longer operation time (MD =32.60, 95%CI: 5.65~59.55, P = 0.020), less amount of bleeding (MD = -94.01, 95%CI: -130.65 ~ -57.37, P = 0.000), smaller number of lymph node dissection(MD = 1.69, 95%CI: 0.67 ~ 2.72, P = 0.001), earlier anus exhaustion (MD=-17.09, 95%CI: -21.19 ~ -12.98, P = 0.000) and shorter hospital stays (MD = -4.30, 95%CI: -5.57 ~ -3.02, P = 0.000). There was significant difference between the two groups. But there was no statistical significance in postoperative indwelling catheter time (MD = -0.67, 95%CI: -1.92 ~ 0.58, P = 0.290) and surgical complications incidence (OR=0.62, 95%CI: 0.27 ~ 1.42, P = 0.260) between the two groups. Conclusion Laparoscopic management has the advantages of less traumatic and recovered quickly, and did not increase the incidence of complications. Laparoscopic operation is an ideal procedure for elderly Chinese women with cervical carcinoma.

Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma.Methods A total of 62 patients with cervical adenosquamous carcinoma,149 patients with cervical adenocarcinoma,and 2687 patients with cervical squamous cell carcinoma,all of whom were in stage Ⅰ B-Ⅱ A and were treated from 2006 to 2012,were enrolled,and some of them received postoperative pelvic radiotherapy ± para-aortic extended field radiation ±afterloading radiotherapy.The chemotherapy regimen consisting of DDP,TP,and FP was given to these patients.The chi-square test was used for comparison of general clinical data,the Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis.Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639).The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000).In the patients treated with surgery and radiotherapy,those with adenosquamous carcinoma had the shortest median survival time,followed by those with adenocarcinoma and squamous cell carcinoma (P =0.134,0.787);in the patients treated with surgery and concurrent chemoradiotherapy,those with adenocarcinoma had the shortest median survival time,followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131,0.643),and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P =0.000).In the patients with adenosquamous carcinoma and adenocarcinoma,the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037,0.003),but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861,0.655).In the patients with adenosquamous carcinoma,the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P =0.003) and prolonged median overall survival and disease-free survival (both increased by 17 months) (P=0.811,0.799),as compared with those treated with postoperative radiotherapy,while in the patients with adenocarcinoma,the median overall survival and disease-free survival were reduced by 11 and 9 months,respectively (P=0.330,0.115).Conclusions Compared with postoperative radiotherapy,postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis.Compared with radiotherapy,postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.

Objective To investigate the dosage and safety of insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs for the treatment of hyperglycemia in elderly hip fracture.Methods Patients with hip fracture and hyperglycemia who required insulin pump therapy were divided into 2 groups according to age:elderly group (patients aged over 65 years,n=42) and non-elderly group (patients aged under 65 years,n=43).All patients were treated with insulin aspart in continuous subcutaneous insulin infusion plus oral antidiabetic drugs combined with diet therapy.Dosages of aspart insulin and adverse effects were compared between the two groups.Results There were no significant differences in basic aspart dosage and additional premeal dosage between elderly and non-elderly groups [(0.29±0.09) IU/kg vs.(0.30±0.07) IU /kg,(0.27±0.09) IU/kg vs.(0.27±0.07) IU/kg,both P＞0.05].The incidences of hypoglycemia with and without symptoms in elderly versus non-elderly groups were 4.8％ vs.4.7％ and 14.3％ vs.18.6％,which had no significant differences between the two groups (P＞0.05).Hypoglycemia accompanied by consciousness disorders,allergy,nonhealing and slow healing wounds were not found in the two groups.The ratio of oral antidiabetic drugs including metformin,glimepiride,and glycosidase inhibitor had no differences between the two groups.Conclusions Aspart insulin in continuous subcutaneous insulin infusion is effective and safe in the treatment of acute severe hyperglycemia in elderly patients with hip fractures when combined with diet therapy and oral antidiabetic drugs.

Treatment of gynaeeological cancer frequently results in the loss of ovarian function and menopausal syndrome.The most effective treatment is hormone replacement therapy (HRT).According to the current studies,HRT does not increase the risk of recurrence or death in patients with early stage endometrial cancer and uterine leiomyosarcomas. The safety of HRT in ovarian cancer patients is inconclusive. Cervical squamous cell carcinoma, vaginal cancer and vulvar cancer are not contraindications for HRT. Estrogen replacement therapy (ERT) is contraindicated for low-grade endometrial stromal sarcomas. Therefore,after integrated risk assessment and discussion,patients with severe menopausal symptoms can be treated with HRT to improve the quality of life.

Objective To investigate the pathogenesis,high risk factors,clinical characteristics,methods of diagnosis and treatment,and prognosis of vaginal intraepithelial neoplasia (VAIN).Methods The clinical data of thirteen cases of VAIN treated in Zhejiang Provincial Cancer Hospital dated Mar.2002 through Dec.2008 were reviewed and analyzed retrospectively.Results Twelve of 13 VAIN cases were performed the human papillomavirus(HPV) detection with 92% (11/12) HPV positive rate.None of the cases shown specific clinical manifestation.Among the 13 cases,6 of them accompanied with cervical cancer,4 cases with cervical intraepithelial neoplasia (CIN ),and 3 cases with vulvar intraepithelial neoplasma (VIN).Five cases synchronously diagnosed with cervical lesion and 3 with vulva lesion were underwent surgery,while the other 5 cases were diagnosed metachronously.Among 8 cases underwent surgery,1 case with CIN underwent argon plasma coagulation (APC) after surgery,1 case with the positive edge of VIN underwent APC.During follow up,1 case with locally advanced cervical cancer underwent radiotherapy again,3 cases with VAIN received APC,while 1 cervical cancer cases with VAIN received no treatment.The average follow-up time was 25.6 months (range 6-87 months).Two cases died of cervical cancer metastasis.The other 11 cases were normal and still alive.None of them progressed to invasive carcinoma.Conclusions The main reason of VAIN is HPV infection.There are not specific clinical manifestations,usually diagnosed when reviewing cervical or vulva lesions and rarely progressed to invasive carcinoma.The main treatment of VAIN is surgery with the adjuvant treatment of APC.

Objective To explore the use of rhomboid skin flap in expanded skin flap transfer. Methods A rhomboid skin flap was designed if the top soft part could not be fully utilized after expanded in a rotation skin flap. The flap pedicels were designed near the incision side. It should be ensured that ra-tio of the length to the width of the composite flap, which was composed of the rhomboid skin flap and the rotation skin flap, was 2.5∶1.0. Results Among these 11 patients with re-designed rhomboid skin flaps in the rotation skin flaps, the ratio of the length to the width reached to 3∶1 in some cases, but 2. 5∶1.0 in most cases. All the skin flaps survived, except one patient with disturbance of blood circulation in a small area and one with mild congestion. Conclusion The expanded soft tissue can be fully and rationally utilized to repair the skin defect in this design. Attention should be paid to the ratio of the length to the width of the composited flap, and it is better to select axial flap as the composite flap for safety. This method is safe, and worthy of recommendation.

To investigate the chemical constituents of hemostatic extract of Pyrola calliantha H. Andres, the extract was subjected to chromatographic separation and purification. Along with some known compounds, a new naphthaquinone derivative was isolated and identified as 2-(1, 4-dihydro-2, 6-dimethyl-1, 4-dioxo-3-naphthalenyl)-3, 4, 5-trihydroxylbenzoic acid by physicochemical and spectroscopic analysis.

Objective To explore the molecular mechanism by which promyelocytric leuxemia (PML) suppresses human gallbladder cancer cell line (GBC-SD) growth.Methods GBC-SD cells were infected by green fluorescent protein recombinant adenovirus (Ad-GFP), GFP-positive cells were examined by microscopy.Cultured gallbladder carcinoma cells (GBC-SD) were infected with Ad-PML or Ad-control.Cell death was detected by DNA laddering and TUNNEL analysis.Cell cycle was analyzed by flow cytometer.Results An infection efficiency of 100% can be achieved at a concentration of 100 multiplicity of infection (MOI).The growth rate of the Ad-PML-infected GBC-SD cells was significantly inhibited.DNA laddering was detected at 72 h post-infection.The amount of apoptotic cells significantly increased in the Ad-PML-infected GBC-SD cells without evident alterations in cell cycle distribution.Conclusion PML suppresses growth of human gallbladder cancer cell line GBC-SD by inducing apoptosis.