Pediatric acute lung injury/acute respiratory distress syndrome (ALI/ARDS)refers to a special syndrome with high mortality, acute progressive respiratory failure with loss of epithelial and endothelial integrity induced by severe stress reaction and/or inflammation reaction because of pulmonary and/or extrapulmonary diseases.Corticosteroids are routinely used in patients with ALI/ARDS for many years. Corticosterioids play an important role in every link of the therapy of ALI/ARDS because of the effect of anti-fibrosis and anti-inflammation, but it is unclear why the effect of treatment is very different in individual. The use of corticosteroid in the treatment of ALI/ARDS has been subject of great controversy and debate over the years. Recent researches indicate that the effect of glucocoticoids treatment is related with the number and affinity of the receptor for glucocorticoids.

From the medicinal economy development in Jiangsu province and medicinal high vocational characteristics, the article analyses how to make higher vocational education adapt to the continued developing requirements and how to open up medicinal personnel training pattern . The text also introduces the experience in vocational education reformation in Xuzhou vocational college of pharmaceutics.

Rheumatic disease is a kind of autoimmune disease,which can damage all of tissues and organ,the respiratory system is commonly involved.Interstitial lung disease(ILD) is the most prevalent respiratory manifestation.ILD of unknown etiology in immunocompetent patients is rare in children,but it can increase the mortality obviously.Therefore,we should improve the knowledge of rheumatic diseases-ILD,earlier diagnosis and treatment are very important for the life quality of children.

The teaching methods in anesthesiology practice to traditional Chinese medicine students was discussed.Watching for the first step, then simulation and manipulation on patients should be abided by. Paying more attention to patients’ safety and avoiding any fault to patients should be emphasized . The one to one and hand by hand teaching method should also be used to train the students' clinic thought and practical ability.

The presence of the cervical artery sulcus ring was found on the atlas in 56 out of 346 air pilots. The X ray appearance could be classified as follows. Type Ⅰ:Complete sulcus ring in 32 cases, in whom the sulcus might be complete unilaterally or bilatrally. Type Ⅱ: Incomplete or half ring in 18 cases. This type could be further divided into Ⅱ a , consisting of 4 persons with half ring in the anterior aspect, andⅡ b , half ring posteriorly in14 persons. Type Ⅲ: Broken ring in 6 persons. It is an anatomic variation, which may be have some relationship to vertigo. It is suggested that the presence of cervical artery sulcus ring on atlas should be taken as an disqualification factor in air pilot recruitment.

Objective To summarize the clinical diagnosis and treatments of 55 reflux laryngitis (RL) pa-tients, and to study the relationship between gastroesophageal reflux disease (GERD) and RL. Methods The pa-tients went through the following diagnostic process consisting of the collection of medical history, laryngoscopy, gastroscope, X-ray barium meal examination, vocal evaluation, therapy of anti-acid and anti-reflux. Results The laryngeal manifestations of RL mainly consisted of laryngeal discomfort or foreign body sensation (89. 1%), chronic cough (36.4 % ), hoarseness (20 % ), laryngeal pain (18. 2 %), even severe aspiration or laryngismus (10.9%) and so on. With the laryngoscopy we could see congestion in arytenoids area (67.3%), swelling or pachynsis of a mucosal fold in interarytenoid area (43.6%), edema of true or false vocal cord(40%), a little dropsy staying in piriform sinus (32.70% ), contact ulcer or granuloma on posterior extremity of a vocal cord (20 % ), artificial sulcus under vocal cords (16.4 %). RL patients might have mild voice disorder, among whom 65.5 percent displayed ten-sion dysphonia. Fundamental frequency (F0), jitter, shimmer and normalized noise energy (NNE) of RL patients increased. Compared with the controls, there were significant differences (P<0. 05) except for the F0 of female pa-tients. The manifestation and physical symptoms were improved or disappeared after the treatment with proton pump inhibitor (PPI). Conclusion RL is one of the important manifestations of GERD out of digestive tract. Typi-cal RL manifestation is mainly a pathological process in the postero-glottis. Clinically, PPI can be used as not only a treatment but also a tentative diagnosis of RL.

Objective To study the clinical feature of 26 cases which were diagnosed pathologically as cerebral amyloid angiopathy ( CAA ) and to improve the level of diagnosis.Methods The clinical characteristics of the 26 cases with CAA in our hospital from 1983 to 1999 were retrospectively reviewed and analyzed,including previous history,clinical manifestation,and laboratory examination.Results Of the 26 CAA patients,there were 17 men and 9 women with age ranging from 45 to 78 years.Eight patients (30.7％ ) had the history of hypertension; 6 cases (23.1％ ) suffered from diabetes; 2 patients(7.6％ ) were taking anticoagulant or antiplatelet agents in whom serious CAA and multiple hemorrhages were histopathologically confirmed by autopsy.There were 20 cases diagnosed as cerebral hemorrhage,including 2 patients with single lobe hemorrhage,8 patients with multiple lobe hemorrhage,5 patients with putamen hemorrhage,2 patients with cerebral ganglion hemorrhage,2 patients with cerebellar hemorrhage,and 1 patient with brain stem hemorrhage.Of the 26 CAA patients,there were 2 patients with subaracchnoid hemorrhage,1 patient with hemorrhagic cerebral infarction,1 patient with basal ganglia infarction,1 patient with basilar artery occlusion,1 patient with subdural hematoma.The clinical manifestation of the 20 cases diagnosed as cerebral hemorrhage included headache,limb palsy,coma,and hyperspasmia.Conclusions CAA always begin as cerebrovascular disease symptoms with or without hypertension.The most common manifestation of CAA is lobe hemorrhage,while the CAA-related hemorrhage seldom occurs in basal ganglia,cerebellum and brainstem.CAA can also manifest cerebral infarction and subarachnoid hemorrhage.Anticoagulant (warfarin) or antiplatelet agents (aspirin) maybe a contributing factor for CAA-related hemorrhage.

Purpose To study the clinicopathological features, immunophenotype and differential diagnosis of spindle cell rhabdomyosarcoma in adults (SRMS).Methods The clinical,pathologic and immunohistochemical features were evaluated in 9 cases of SRMS in adults.Results Nine cases of SRMS in adults were retrieved from the pathological archive of this hospital. 7 cases were male and 2 were female. Patients age ranged from 20 to 80 years (median,45 years). The head and neck region,including the right mandible, pharyngeal portion, nasopharynx, and left maxillary,was the most commonly affected area, accounting for 44% of the cases, followed by forearm, waist, thigh, leg and testis(1 case each). Tumor size varied from 2 to 14 cm (median 5.9 cm).Histologically, all the tumors were mainly composed of cellular bands and fascicles of atypical spindlE-shaped tumor cells with a variable number of spindled or polygonal rhabdomyoblasts.In addition, focal areas reminiscent of interstitial sclerosing were presented in 2 cases, and pseudovascular structures were noted in 2 cases, loosely myxoid stroma were detected in 1 case and small solid areas with mild pleomorphic tumor cells were present, but lacking bizarre pleomorphic rhabdomyoblasts. Immunohistochemically, the tumor cells were positive for vimentin, desmin, CD99 and MyoD1; Myogenin and MSA were positive in most of the cases (6/9 and 7/9 each); The remaining antibodies(S-100, CD34,CK and HMB-45) were all negative. Follow-up information was available in all the cases, ranged from 6 months to 4 years, revealed paravenous metastases of the peritoneal cavity in one patient with testis tumor and liver metastases in one patient with leg tumour. 4 patients developed local recurrences and 2 patients died of the disease.Conclusions SRMS is a rare neoplasm in adults,and most commonly occurs in male with preferential involvement in the head and neck region. It appears a more aggressive clinical course in adults. Morphologically, SRMS in adults should be differentiated from other spindle cell tumors.

Objective To discuss the clinical and pathological features of herniation secondary to cerebral infarction. Method Clinical and pathologic characteristics of 50 cases died of herniation due to cerebral infarction were analysised. Results The clinical manifestations,such as consciousness disturbance,pupillary change,hemiplegia or tetraplegia were detected in all 50 cases,the average time from onset to herniation was (3.36?1.12)d,the time herniation to death was 20 h～7 d,average about (1.5?0.98)d. The large size cerebral infarctions caused by internal carotid artery,middle cerebral artery and/or vertebral artery occlusion were pathologically confirmed.hemorrhagic cerebral infarctions caused by cerebral embolism were found in 25 cases and the ischenmic infarctions caused by cerebral thrombosis in 25 caese.Site of infarction were cerebral hemisphere (31 cases), brain stem (15 cases), supratentorial and infratentorial brain (4 cases).Of the 50 cases,36 cases had hippocampal gyrus herniation,36 cases with cerebellur throat-almond herniation,18 cases with central herniation,17 cases with cingulated gyrus herniation,and 27 cases with sphenoidal crest herniation. Usually there were several herniation existing in the same patient. Among 50 cases,11cases had two kinds of herniation,10 cases with three kinds of herniation,9 cases with four kind of herniation, and 5 cases with five kinds of herniation.Conclusions Herniation secondary to cerebral infarction were mainly presented in the large size cerebral infarction caused by internal carotid artery or middle cerebral artery occlusion.the time of herniation was in early stage of disease.Most of patients were hippocampal gyrus herniation and cerebellur throat-almond herniation.Usually there were several herniation existing in the same patient.

Objective To discuss the clinical characteristics and pathological changes of basilar artery aneurysm.Methods The clinical materials and brain topography results were analyzed retrospectively in 4 patients with basilar artery aneurysm.Results The onsets of disease in all cases were acute and common manifestations were coma,positive meningeal irritation sign and ocular dyskinesis.3 cases showed hypertention,2 cases presented with hemiparalysis,all cases died of herniation.3 cases of basilar artery trunk fusiform aneurysm and 1 case of basilar artery furcation saccular aneurysm were detected in autopsy.There were aneurysm rupture,subarachnoid hemorrhage and swell,necrosis,softening,gliosis of brain tissue confirmed pathologically in all cases.Conclusion Hypertension is probably the most important cause of aneurysm rupture.Signs and symptoms of subarachnoid are the most common manifestation when basilar artery aneurysm ruptures with poor prognosis.Herniation is the main cause of death.