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.

The morbidity of hyperuricemia(HUA) has showed an increasing tendency in recent years,along with the improved social living conditions.HUA has been proved to be closely related to kidney diseases,metabolic diseases and cardiovascular diseases.However,people pay little attention to the relationship between uric acid and renal diseases in pediatrics,and the relevant studies and progress are lacking.Now a review is made about the metabolism of uric acid,the etiology and pathogenesis of HUA,and the relationship between HUA and kidney diseases or drugs,in order to pay attention to the relationship between HUA and kidney diseases.

Objective To discuss the application of internal fixation technique in eyebrow lift and infrabrow excision blepharoplasty.Methods With the incision within eyebrow or infrabrow excision incision,fixation of the eyebrow to the brow periosteum using 4-0 silk thread and then suturing the upper and lower border of the incision could lift the eyebrow and correct the ptosis of upper eyelid skin and fishtail lines.Results All the 138 cases got good results,showing that the eyebrow and upper eyelid skin ptosis and lateral fishtail lines were all corrected.Conclusions Internal fixation technique can get better results in eyebrow lift and infrabrow exicion blepheraplasty surgery.

The technique of chimeric antigen receptor-engineered T cells (CAR-T) is combined single chain antibody and T-cell activation modification and has specific and durable killing effect on tumors.It had achieved stunning results on clinical trials of B lymphocytic leukemias,B lymphomas and solid tumors.Meanwhile it also had potential risk on the off target effects,cytokine release syndrome,graft versus host disease and so on.This paper briefly reviews the principal of CAR-T cellular mechanism,advantages and clinical applications.

Adenovirus,respiratory syncytial virus,influenza virus type A and B,cytomegalovirus and EB virus are the mainly etiology of severe pneumonia in children.New type of virus,such as influenza-H1N1 virus,avian influenza virus(H5N1 or H7N9) can also be epidemic in pediatric population.Ribavirin is effective drugs in the treatment of respiratory syncytial virus and adenovirus pneumonia.Acyclovir or ganciclovir is used for EB virus or immune deficiency and irnmunosuppressive patients with CMV pneumonia.Current opinin strongly recommend treatment with oral oseltamivir as soon as possible in influenza and seasonal influenza.Oseltamivir reduces the severity,duration of the symptoms of influenza,and reduces the frequency of secondary illnesses and exacerbation of underlying conditions.Zanamivir and peramivir may be effective in patients infected with influenza virus,including oseltamivir-resistant virus.Some Chinese medicine such as maxingshigan-yinqiaosan can obtain similar effect of oseltamivir in treatment of influenza virus infection.

Early goal-directed therapy ( EGDT ) emerged as a novel approach for reducing septic shock mortality and the EGDT protocol requires invasive patient monitoring to guide resuscitation with intra-venous fluids.EGDT was incorporated into guidelines published by the international Surviving Sepsis Cam-paign,but remains controversial.Recently,large randomized trials showed that EGDT did not significantly de-crease mortality in patients with septic shock compared with usual care.Fliud resuscitation and monitoring is the most important in septic shock.Therefore the EGDT is still valuable in present stage.Further,development practical methods for accurately assessing optimal fluid administration is needed.

Objective To investigate the clinical effect and changes in cellular immune of children with Tourette 's syndrome in treatment with Ningdong granule and haloperidol.Methods 48 cases of children with Tourette's syndrome from February 2015 to February 2016 in hospital were selected and randomly divided into the observation group and control group with 24 cases in each group.The patients of two groups were all treated with conventional treatment, including mental relaxation, reverse muscle relaxation therapy and self-training.The patients of control group were treated with haloperidol, and on the basis of the control group, the patients of observation group were treated with Ningdong granule.The clinical effect, the levels of TNF-ɑ, IL-12, CD3, CD4, CD8, CD4/CD8 were compared before and after treatment between two groups, and recorded the incidence of adverse reactions in two groups of children.Results After the treatment, the total effective rate of the observation group was 91.6%, which was significantly better than the control group 66.6%, the difference was statistically significant (P<0.05).The levels of TNF-ɑ, IL-12, CD8 of the observation group were significantly lower than those of the control group (P<0.05), the levels of CD3, CD4, CD4/CD8 of the observation group were significantly higher than those of the control group, the difference was statistically significant (P<0.05).There were constipation, dizziness, drowsiness, fatigue, poor appetite, tachycardia and other adverse reactions occurred in both two groups, and the incidence of adverse reactions in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05).Conclusion The combination of Ningdong granule and haloperidol in the treatment of children with Tourette 's syndrome is effective and can improve the cellular immune function .

The improvement of oxygenation basis on prone positioning in acute respiratory distress syndrome (ARDS) includes increased end-expiratory lung volume,improved ventilation-perfusion (V/Q) matching,and drainage of secretions.Randomized controlled trials report that prone position ventilation in patients with ARDS tends to reduce mortality rates,especially when used in conjunction with lung protective strategies and greater prone positioning durations.At present,the available data suggest that early prone positioning may provide benefit to ARDS with severe hypoxemia.keeping in mind that a risk of positioning-related complications will have to be taken into account when weighing the risk to benefit for patient with ARDS.There is still limited information available of prone position ventilation application in pediatric ARDS.

Malignant tumor is a serious threat to human health and its pathogenesis is complex , which caused by interaction of a variety of carcinogenic factors in the human body .SALL4 gene is a kind of newly dis-covered gene and it plays an important role in function of embryonic stem cell due to its protein transcription fac -tor with C2H2 zinc finger domain.Studies found that this gene mutation often results in occurrence of malignant tumor.This paper will summarize the molecular mechanism of SALL 4 in the occurrence and development of malig-nant tumor and its diagnosis and treatment on malignant tumor .

Obiective To detect the carotid-femoral pulse wave veloeity(CF-PWV) and evaluate relation in pulse pressure (PP) and pulse wave velocity ('PWV), and prove the effect of dynamic error analysis system on pulse wave velocity measure. Methods 486 cases with essential hypertension were detected with carotid-femoral pulse wave velocity. The dynamic error was controlled in three kinds of condition: 15%>error>10%, 10%>error>5% and 5%>error, which PWV values were tested repeatedly with the effect of different errors observed. At the same time the blood pressure was measured and the pulse pressure was calculated. Results The pulse wave velocity which pulse pressure ≥60mm Hg (1mm Hg=0.133 kPa) was significantly higher than pulse pressure <60turn Hg [(14.2± 2.34)m/s and (8.5±1.81)m/s, P<0.001] . Pulse wave velocity and pulse pressure and age showed a significant positive correlation (pulse pressure r=0.529, P=0.000; age r= 0.331 P=0.003).When dynamic error is more than 10% and less than 15%, the diversity of PWV values showed the significance of statistics. Conclusion The effect of dynamic error analysis system on pulse wave velocity measure, less error test pattern is advantageous to enhance accuracy. The pulse pressure is closely related to pulse wave velocity. Arterial pulse wave velocity is a new evaluation of the indicators of arterial stiffness, and it's more scientific, accurate and eonvenient.