BACKGROUND: There are reports that exogenous pulmonary surfactant (PS)participating in acute asthma attacks in rats with asthma and has correlation with epidermal growth factor(EGF) and expression of EGFmRNA.OBJECTIVE: To observe the effect of PS on EGF and EGFmRNA in asthmatic rats.DESIGN: Controlled experimental study on experimental animals.SETTING: Respiratory departmentof a military medical university affiliated hospital.MATERIALS: The experiment was completed in Laboratory 2 of Experiment Animal Center; Immunohistochemistry Laboratory, Department of Pathology of Fourth Military Medical University of Chinese PLA from April 2004 to July 2004. Sixty male SD rats weighting 100 - 120 g were provided by the Experiment Animal Center of the Fourth Military Medical University of Chinese PLA. The animals were randomly divided into 3 groups, that is normal control group, asthma control group(asthma group) and PS treatment group (treatment group) with 20 rats in each group.METHODS: The models of asthmatic rats were established. 1mL of immunogen stock suspension and 1 mL trachitis vaccine were injected intraperitoneally into the rats in the asthma group and treatment group respectively, and the normal control group were treated with the same volume of saline. Two weeks after being allergic, 10 g/L oval bumin were given to the asthma group and treatment group. The normal control group was given saline ultrasonic nebulization for 20 minutes; the treatment group was performed atomizing inhalation PS 100 mg/kg driving by oxygen before each provocation. The expression of EGF was detected with immunohistochemistry and the expression of EGF mRNA was detected with reverse transcription-polymerase chain reaction (RT-PCR).MAIN OUTCOME MEASURES: The onset condition of the rats in each group and the comparison of the level of EGF and the expression of EGFmRNA in lung tissue of the bronchus.RUSULTS: There were 20 rats entered the result analysis in each group. Onset rate of asthma in asthma group [90% (18/20) ] was higher than that in the treatment group[5% ( 1/20) ] (x2 = 28.97, P ＜ 0.01 ). The image analysis of the EGF expression showed that the absorbance in the asthma group(9. 652 ± 1. 086) was higher than that in the normal control group (3. 267 ± 0. 986) ( t = 18. 552, P ＜ 0.01 ). The absorbance in the treatment group(4. 132 ± 1. 012) was similar to that in the control group( P ＞ 0.05);The electrophoresis bands of mRNA amplified products in each group showed that in the normal control group the expression was weak and it was strong in the asthma group. The expression in the treatment group was obviously weaker than that in the control group.CONCLUSION: Exogenous PS can reduce the onset of asthma and its mechanism might be related with inhibiting the synthesis and release of EGF.

Objective To evaluate the value and feasibility of Microsim medical simulation training system in medical students' clinical thinking training. Method 96 students of 5-year program of medicine of Grade 2009 and Grade 2010 were the research object. These students were randomly divided into two groups (group A:After 3 weeks' clinical practice in respiratory medicine, taking 1 week Microsim training. group B: Taking 4 weeks clinical practice in respiratory medicine. Each group has 48 students.). The examination and teaching satisfaction of the two groups were observed after the end of the internship. SPSS 17.0 statistical software was used to analyze the collected data (measurement data matching t test, counting data by chi-square test). Results The Microsim system score: group A was (89.37±7.18), group B was (61.95±15.34). The difference between groups was statistically signifi-cant. The following scores suggested the assessment of students' ability of clinical thinking: ability to analyze problems [group A (89.95±4.02) vs. group B (75.51±6.34)], the ability to deal with the prob-lem [group A (78.81±8.09) vs. group B (59.67±9.33)], treatment scheme [group A (86.74±6.59) vs. group B (70.39±7.05)] and the treatment effect [group A (88.61±8.16) vs. group B (63.54±11.48)]. In these aspects, the two groups had statistically significant difference, but communication [group A (82.47 ±5.23) vs. group B (84.09 ±3.72)] had no statistically significant difference between the two groups. 89.6% (43) of the participants believed that the Microsim medical simulation training system could significantly improve the clinical thinking ability, but only 58.3% (28) of the students believed that the basic theory of knowledge could be consolidated. Conclusion Microsim medical simulation training system can improve the students' ability of clinical thinking and clinical comprehensive treat-ment ability. It can be used as an effective complement to clinical practice teaching.

Gout is a common metabolic disease. Gouty arthritis is associated with the deposition of urate crystals in the synovial fluid or para-articular soft tissues, which often affects the hands, feet, wrists, ankle and knees joints. However, the shoulder joint is unusual involved. In the present study, a 49-year-old male patient complained of right shoulder pain for 9 months and aggravating with limited range of motion for 2 weeks. Physical examination showed that the external rotation was 10° and hand back was S 5 of the right shoulder. The MRI showed shoulder joint effusion and intra-articular loose bodies. The patient was admitted to the hospital with the diagnosis of "loose bodies of the right shoulder with synovial chondromatosis possibly". Arthroscopic examination revealed that a lots of urate crystals were deposited on synovium, cartilage and rotator cuff. Loose bodies removal and joint debridement were performed. Histopathologic examination of the specimen demonstrated synovitis hyperplasia with urate crystals deposition. Shoulder gouty arthritis characterized by pain and limited movement. The imaging of tophi depends on the calcium-containing deposits. Tophus with calcium deposits can be found on X-ray and CT. MRI can not only evaluate the tophus but also the evaluate the other intra-articular pathologies. Due to no typical manifestations and specific images of shoulder gouty arthritis, pathological diagnosis is the "gold standard". Shoulder arthroscopy provide a minimal invasive technique in diagnosing and treating of the shoulder disease. Undoubtedly, it could be a reliable diagnosis and treatment method for shoulder gouty arthritis.

Objective To investigate the differences in expression of Mohawk (MKX) transcription factors and collagen of types Ⅰ and Ⅲ in anterior cruciate ligament (ACL) gratis between 2 remodeling outcomes under arthroscopy.Methods Enrolled for this study were 17 patients who had undergone arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and secondary arthroscopic exploration 48 to 131 months (average,83.1 months) after removal of tibial internal fixator at Department of Sports Medicine,The First Affiliated Hospital to Shenzhen University from March 2017 to December 2017.They were divided into a good remodeling group (11 cases) and a fair remodeling group (6 cases) according to the graft quality under arthroscopy (synovial and vascular coverage,and apparent tension,thickness and retear of the grafts).During the secondary arthroscopic procedures,biopsy of the central ACL grafts was performed.Moreover,normal ACL tissues were harvested from 8 contemporary controls of ＜ 60 years old who underwent total knee replacement.Immunohistochemical assay and quantificational real-time polymerase chain reaction were conducted to detect the expression of transcription factors and collagen of types Ⅰ and Ⅲ in all the samples.Results In the samples from good remodeling and control groups,there were abundant well-arranged collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells;in the fair remolding group,the collagen fibers of types Ⅰ and Ⅲ and MKX-positive cells were much decreased in number and the fibers were not well arranged.The former 2 groups scored in immunohistochemical assay significantly higher than the latter one (P ＜ 0.05).qRT-PCR showed that the expression levels of MKX gene (0.44 ± 0.30),COL1A1 gene (0.52 ± 0.27) and COL3A1 gene (0.60 ± 0.22) in the fair remolding group were significantly lower than in the control group (1.00 ± 0.00,1.00 ± 0.00 and 1.00 ± 0.00) and than in the good remolding group (0.97 ± 0.67,0.99 ±0.38 and 1.00 ± 0.35) (P ＜ 0.05).Conclusion Good remodeling ACL grafts with histological maturation under arthroscopy are more similar to normal ACL than fair remodeling ACL grafts in expression of MKX transcription factors and collagen of types Ⅰ and Ⅲ.

The drug formulation design of self-emulsifying drug delivery systems (SEDDS) often requires numerous experiments, which are time- and money-consuming. This research aimed to rationally design the SEDDS formulation by the integrated computational and experimental approaches. 4495 SEDDS formulation datasets were collected to predict the pseudo-ternary phase diagram by the machine learning methods. Random forest (RF) showed the best prediction performance with 91.3% for accuracy, 92.0% for sensitivity and 90.7% for specificity in 5-fold cross-validation. The pseudo-ternary phase diagrams of meloxicam SEDDS were experimentally developed to validate the RF prediction model and achieved an excellent prediction accuracy (89.51%). The central composite design (CCD) was used to screen the best ratio of oil-surfactant-cosurfactant. Finally, molecular dynamic (MD) simulation was used to investigate the molecular interaction between excipients and drugs, which revealed the diffusion behavior in water and the role of cosurfactants. In conclusion, this research combined machine learning, central composite design, molecular modeling and experimental approaches for rational SEDDS formulation design. The integrated computer methodology can decrease traditional drug formulation design works and bring new ideas for future drug formulation design.