BACKGROUND: Critical incidents are natural and man-made disasters arising suddenly, which are beyond the ability of the individuals to resist or control. In the situation of stress, individuals feel stuck, and are unable to control the situation.OBJECTIVE: To confirm the assessment model of stress response to critical events and the interventional effect of social support, general self-efficacy and coping efficacy.DESIGN: A randomized sampling, questionnaire-based investigation.PARTICIPANTS: We selected 1016 college students of 17 provinces or cities including Beijing, Guangzhou, Hefei, Jilin, Jiangsu, Jiangxi , Liaoning, Sichuan, Inner Mongolia, Shandong , Shanghai, Hebei, Tianjin,Wuhan, Zhejiang , Chongqing and so on as subjects. Totally 708 college students selected from the above regions received the same survey one year later.METHODS: Depression and anxiety state of the subjects were investigated with Center for Epidemiological Studies Depression Scale (CESD)and Anxiety Inventory (SAS) during SARS. Social support condition was investigated with Social Support Rating Scale, authorized by Xiao Shuiyuan. Related items were amended considering used among college students. The subscale was integrated into 3 subscales including group-support, friend-support and social support utilization. One year later, stress response to SARS was investigated again with self-made coping efficacy scale, self-esteem scale and self-efficacy scale and SARS Stress Response Questionnaire, which included 13 items measuring the students in three aspects: cognitive evaluation to SARS epidemic, such as "I believe human beings can conquer SARS in the end"; panic to SARS, like "worrying about SARS sweats me and makes me feel shiver sometimes"; and defense response to SARS, as "In order to prevent SARS, I have to wear respirator in the public". As far as cognitive, panic emotion and defense behaviors were concerned. The coping efficacy developed by the author covered 18items, such as "I'm afraid that I can not deal with things", "I have enough confidence to conquer any difficulty", and namely as friability, confidence and intelligence.RESULTS: ① The two investigated results were compared through assessment of covariation. There was a significant difference in cognitive condition, panic emotion and defense behavior; that was to say, the stress response to SARS had been obviously relieved . ② Social support and SARS stress response model x2=8.654,df=4,P=0.07;criterion fit index NFI= 1, RFI =0.997 and IFI =1, RMSEA=0.034. ③self-efficacy confirmative factor analysis showed the following: x2=0.536,df=2,P=0.765;x2/df=0.268, NFI=1, RFI=1, IFI=1 and CFI=1, RMSEA=0.000. ④The discriminating and convergent validity of coping efficacy questionnaire was as follows. The coefficient was 0.633 with general efficacy questionnaire, 0.530 with self-respect (SES), 0.481 with CESD, 0.387 with anxiety (SAS), and -0.003 with living events. ⑤ A structural equation model about general self-efficacy, coping efficacy and SARS stress response was established: x2 =2.722 df=3, P=0.437; NFI=1, RFI=0.999,IFI=1, CFI=1, RMSEA=0.068. The model fitted well. According to the data, coping efficacy affected SARS stress response negatively (the coefficient was -0.59)CONCLUSION: ① The three-dimensional assessment model assessed the stress response to critical incidents including cognitive adjustment, emotional response and behavioral tendency. The three-dimensional model stood the test while assessing SARS stress response. Compared with the assessment of emotional disorders, such as depression and anxiety, the model was more sensitive. ②Social support played a vital role in the stress response to critical incidents as a buffer or a regulator. It showed more influence on emotional disorders than on SARS stress response. ③Coping efficacy was a measurable intervening variable, which deserves more attention to in the stress response to critical incidents. Compared with general self-efficacy, coping efficacy had a greater intervening effect on SARS stress response.

ObjectiveTo explore the theoretical construct of network values and design the network values questionnaire.MethodsThis research was to design the network values questionnaire based on an open-ended inventory survey,overviews of former studies and counseling of experts.Through stratified sampling,832 college students were investigated by the network questionnaire.The data were examined by item analysis,factor analysis,reliability and validity analysis.ResultsThe network values was a multi-dimensional construct which had three factors.The three factors cumulative total explained variance was 50.719％,52.545％ and 50.510％.The questionnaire's internal consistency reliability was 0.931 and 0.809-0.874 for the three subscales.The questionnaire's split-half reliability was 0.902 and 0.772-0.864 for the three subscales.ConclusionThe theoretical construct of network values is rational.The questionnaire has good reliability and validity.

Objective:To investigate relationship between parents'marital relationship and intergenerational transmission of value orientation of marriage and love among college students.Methods:Totally 712 families inclu-ding a college student and his/her parents from 9 universities were surveyed.The Marital Health Test (MHT)was used to assess parents'marital relationship and transmission of value orientation of marriage and love from father and mother.The structural equation modeling and stepwise multiple regression were used to analysis the relationship between parents'marital relationship and intergenerational transmission of value orientation of marriage and love a-mong college students.Results:Moderate correlations (r =0.24 -0.58,Ps <0.01 )were found between parents'marital relationship and transmission of value orientation of marriage and love from father and mother.Path analysis suggested that paths from parents'marital relationship to paternal transmission and maternal transmission were statis-tically significant (path coefficient was 0.59 and 0.75).Grouping regression analysis showed that the influences of parents 'marital relationship of same-sex transmission (R2 =0.49,0.35 ) were greater than opposite-sex transmission.Conclusions:The findings indicate that parents'marital relationship could facilitate the intergeneration-al transmission of value orientation of marriage and love.Moreover,the influences of parents'marital relationship of same-gender transmission may be greater than opposite-sex transmission.

Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal goiter underwent surgical resection,in 74 by low collar incision,12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension,8 cases by unilateral or bilateral infrahyoid muscles transection,8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs.Results Resection was performed successfully in all cases.Hoarseness occurred in 7 cases,4 cases recovered after one month,3 cases did not improve because of tumor invasion of laryngeal recurrent nerve.Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months.102 patients were followed up for 1 to 3 years without recurrence.Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision.CT scanning and chest X radiograph are decisive for the surgical approach.

Objective To explore the expression of Bcl-6 mRNA in the Tfh cells of HIV/AIDS patients and the relationship between Bcl-6 mRNA and the progression of HIV/AIDS.Methods This experiment chose 60 patients who were confirmed by HIV antibody test positive,during May 2014 to November from AIDS Research Institute in the First Affiliated Hospi-tal,Henan College of Traditional Chinese Medicine.According to the amount of CD4+T cells,the patients with HIV/AIDS were divided into A(CD4<200 cells/μl),B(200 cells/μl500 cells/μl)three groups.The Tfh cells expressed CD4+ CXCR5 + ICOS+ and lymphocyte subpopulation including T,B and NK cells were detected by flow cytometry (FCM).The expression of Bcl-6 mRNA levels were detected by reverse transcription-polymerase chain reaction (RT-PCR).The association between Tfh cells and Bcl-6 mRNA,B cells were analyzed.Results The expression of Bcl-6 mRNA from patients of A,B and C three groups was increased than in healthy individuals (2.94±0.91,2.27±0.62,2.15± 0.351,P <0.05).The percent of Tfh cells from group A patients was higher than group C patients (5.88±3.01 vs 1.26± 0.87,P =0.032)and also the healthy control group (5.88±3.01 vs 0.78±0.42,P =0.004).The percentage of NK cells and B cells in HIV/AIDS patients was no statistically significant.Correlation analysis showed that there was positive corre-lation between the proportion of Tfh cells and Bcl-6 mRNA (r=0.799,P =0.000).And Tfh cells were observed no relation-ship with B cells (r=-0.083,P =0.657).Conclusion The changes of Bcl-6 mRNA and Tfh cells may be related to the progression of HIV/AIDS.

Objective: To explore the therapeutic role of bedside continuous blood purification(CBP) in children with severe acute pancreatitis(SAP). Method: The clinical and laboratory data of 11 children with SAP who were admitted to Pediatric Intensive Care Unit (PICU) of Shanghai Children′s Hospital from June 2013 to May 2016 were analyzed, including using pediatric critical illness score (PCIS) and pediatric risk of score mortality (PRISM)-Ⅲ score to assessing the severity of the disease.For those patients with severe organ dysfunction, CBP treatment was used when conventional therapy was not efficient.The evolution and prognosis of the disease were observed and analyzed.The measurement data were analyzed by Wilcoxon signed rank test. Result: From June 2013 to May 2016, 11 cases with SAP were treated in PICU, of whom 7 cases had combined multiple organ dysfunction syndrome(MODS). After conservative treatment for 12-24 h, 6 cases with SAP deteriorated aggressively and were treated with CBP.PRISMA and PRISMA flex machines were used with Gambro PRISMA filter, and continuous venovenous hemodiafiltration(CVVHDF) or high volume hemofiltration (HVHF) were chosen as the therapy model.All 6 SAP patients survived after bedside CBP treatment(the median time spent on CBP were 48.5(48.0, 55.5) h). The serum concentration of amylase before and after the CBP treatment were respectively 675(495, 1 334)vs.176(136, 246) U/L, lipase 551(385, 1 075)vs.143(117, 185) U/L, CRP 168(125, 192) vs. 67(28, 87) mg/L, and inflammatory cytokines(TNF alpha 67.2(51.0, 72.9)vs. 22.6(19.3, 31.0) ng/L, IL-6 47.8(35.2, 88.4)vs. 23.6(20.3, 42.9) ng/L, IL-10 21.3(16.8, 23.9)vs. 35.6(26.5, 38.6) ng/L), which were obviously improved after CBP treatment(all P<0.05). And after CBP treatment, partial pressure of oxygen(PaO₂)/fraction of inspiration O₂(FiO₂) (192(101, 208)and 240(207, 267) mmHg, 1 mmHg=0.133 kPa), MAP (58.3(56.3, 62.5) and 83.3(74.0, 87.4) mmHg) and PCIS scores (66(62.5, 72)and 92(89, 94) scores) were higher (all P<0.05). Conclusion CBP in critically ill with SAP can rapidly reduce blood amylase and lipase, help to keep the stable internal environment, block the systemic inflammatory response, improve the organ functions and maintain the fluid balance.CBP treatment may be a potential therapy in children with SAP.

Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia. Results: A total of 85 patients met the inclusion criteria. The serum phosphorus levels at the 4 indicated time points were (1.4±0.5), (0.7±0.3), (0.8±0.3), (0.9±0.4) mmol/L, respectively (F=45.21, P<0.05). Among the children, 66 cases (78%) had hypophosphatemia during CBP. The incidences of moderate and severe hypophosphatemia were 32 (48%) and 9 (14%), respectively. There were 41 patients with CBP replacement rates of (35-49) ml/(kg·h), while 44 patients with CBP replacement rates of 50-70 ml/(kg·h). There were significant differences at 48-72 h during CBP, the end of CBP and on the next day after CBP ((0.8±0.4) vs. (0.5±0.2), (1.0±0.3) vs. (0.6±0.2), and (1.1±0.4) vs. (0.8±0.2) mmol/L; t=7.672, 4.060, 14.440, P<0.05). Atotal of 9 cases were treated with sodium glycerophosphate. Among the 85 children, 24 (28%) patients died while 61 (72%) survived. There were no significant differences between the two groups in serum phosphorus levels at the indicated time points ((1.4±0.5) vs. (1.4±0.5), (0.7±0.3) vs. (0.7±0.3), (0.7±0.3) vs. (0.8±0.3), and (1.0±0.3) vs. (0.9±0.3) mmol/L, respectively, P>0.05). Conclusions Hypophosphatemia is prone to occur during CBP, which probably related to the replacement rate. There was no significant relationship between hypophosphatemia and mortality in critically ill children after giving phosphorus supplementation.

Objective To investigate the clinical value of liquid-based cytology and cell paraffin blocks combined with immu-nocytochemical examination in cytopathologic diagnosis of hydrothorax and ascites.Methods One hundred and fourteen cases of hydrothorax and ascites sample were collected.The detection positive rates were compared between the liquid-based cytology and cell paraffin blocks combined with immunocyochemical examination.The suspected positive and positive cases were performed the immunocytochemical examination for further judging benign and malignancy and histological source.Results 114 cases of hydro-thorax and ascites samples,36 cases(31.58%)of positive were diagnosed by liquid-based cytologyamong and 55 cases(48.24%)of positive were diagnosed by cell paraffin blocks combined with immunocytochemical examination,the difference was statistically sig-nificant(P<0.01).There were 55 cases of malignant hydrothorax and ascites,45 cases were hydrothorax and 10 cases were ascites, in hydrothorax,there were 32 cases of lung adenocarcinoma,3 cases of small cell lung cancer,4 cases of breast cancer,1 case of en-dometrial carcinoma,1 case of lymphatic hematopoietic system tumor and 4 cases of unknown origin;in ascites,there were 2 cases of ovarian cancer,1 case of digestive system tumor,1 case of endometrial cancer,1 case of lymphatic hematopoietic system tumor and 5 cases of unknown origin.Conclusion The cell paraffin blocks combined with immunocytochemistry can significantly improve the positive detection rate of hydrothorax and ascites,and helps to judge the source of tissue.

OBJECTIVETo assess the value of central venous-to-arterial carbon dioxide difference [ P( cv-a) CO₂] in evaluation of disease severity and prognosis in children with septic shock who already had central venous oxygen saturation (ScvO₂) higher than 70% after early resuscitation.

METHODIn this prospective study, 48 septic shock children seen in Shanghai Children's Hospital, Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014. 36(75.0%) were male, 12 (25.0%) were female, the average age was (31.9 ± 24.5) months. The critically ill patients with septic shock were treated to achieve ScvO₂greater than 70% depending on early goal-directed therapy (EGDT). All patients were divided into two groups, based on P(cv-a)CO₂, low P(cv-a)CO₂group with P(cv-a)CO₂< 6 mmHg (1 mmHg = 0.133 kPa) and high P(cv-a)CO₂group with P(cv-a)CO₂≥ 6 mmHg. The parameters of hemodynamics including mean blood pressure (MAP), heart rate (HR), central venous pressure (CVP), perfusion-related parameters [ScvO₂, P(cv-a)CO₂, serum lactate (Lac), Lac clearance rate], pediatric critical illness score, PRISMIII score, and 28 days in-hospital mortality were recorded for all patients.

RESULTOf the 48 cases with septic shock whose ScvO₂was higher than 70%, 17 patients (35.4%) had high P(cv-a)CO₂( ≥ 6 mmHg) and 31 (65.6%) had lower P(cv-a)CO₂(<6 mmHg). There were no significant differences between the 2 groups of patients in age, PRISMIII score and PCIS (P > 0.05 ), but Lac and P(cv-a)CO₂values were significantly different ( P < 0.05). Low P(cv-a) CO₂group patients had lower 28 days mortality than high P(cv-a) CO₂group[11/17 vs. 32.3% (10/31), P < 0.05]; 24 h after resuscitation, compared with high P(cv-a) CO₂group, low P(cv-a) CO₂group patients had lower Lac values [(2.0 ± 1.3) vs.( 2.7 ± 1.2) mmol/L, P < 0.05]. Low P(cv-a) CO₂group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs. (44 ± 21)h, P < 0.05], 24 h Lac clearance rate was significantly higher for low P(cv-a) CO₂group than for high P(cv-a) CO₂group[ (31 ± 10) % vs. (26 ± 6)%, P < 0.05].

CONCLUSIONWhen ScvO₂> 70% was achieved after early resuscitation in septic shock children, P(cv-a) CO₂is a sensitive biomarker to assess tissue perfusion, and high P(cv-a) CO₂group patients had poor outcome.

Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; blood ; Central Venous Pressure ; Child, Preschool ; China ; Critical Illness ; Female ; Heart Rate ; Hemodynamics ; Hospital Mortality ; Humans ; Infant ; Lactic Acid ; blood ; Male ; Oximetry ; Prognosis ; Prospective Studies ; Resuscitation ; Severity of Illness Index ; Shock, Septic ; blood ; therapy

BACKGROUND: Gallbladder cancer (GBC) is the most common malignant tumor of biliary tract. Isoliquiritigenin (ISL) is a natural compound with chalcone structure extracted from the roots of licorice and other plants. Relevant studies have shown that ISL has a strong anti-tumor ability in various types of tumors. However, the research of ISL against GBC has not been reported, which needs to be further investigated. METHODS: The effects of ISL against GBC cells in vitro and in vivo were characterized by cytotoxicity test, RNA-sequencing, quantitative real-time polymerase chain reaction, reactive oxygen species (ROS) detection, lipid peroxidation detection, ferrous ion detection, glutathione disulphide/glutathione (GSSG/GSH) detection, lentivirus transfection, nude mice tumorigenesis experiment and immunohistochemistry. RESULTS: ISL significantly inhibited the proliferation of GBC cells in vitro . The results of transcriptome sequencing and bioinformatics analysis showed that ferroptosis was the main pathway of ISL inhibiting the proliferation of GBC, and HMOX1 and GPX4 were the key molecules of ISL-induced ferroptosis. Knockdown of HMOX1 or overexpression of GPX4 can reduce the sensitivity of GBC cells to ISL-induced ferroptosis and significantly restore the viability of GBC cells. Moreover, ISL significantly reversed the iron content, ROS level, lipid peroxidation level and GSSG/GSH ratio of GBC cells. Finally, ISL significantly inhibited the growth of GBC in vivo and regulated the ferroptosis of GBC by mediating HMOX1 and GPX4 . CONCLUSION ISL induced ferroptosis in GBC mainly by activating p62-Keap1-Nrf2-HMOX1 signaling pathway and down-regulating GPX4 in vitro and in vivo . This evidence may provide a new direction for the treatment of GBC.
Animals ; Mice ; Carcinoma in Situ ; Chalcones/pharmacology* ; Ferroptosis ; Gallbladder Neoplasms/genetics* ; Glutathione Disulfide ; Kelch-Like ECH-Associated Protein 1 ; Mice, Nude ; NF-E2-Related Factor 2/genetics* ; Reactive Oxygen Species ; Humans