As a new method of modern teaching,the computer assisted instruction(CAI) is widely used in every field in modern education. In this paper,the author explores the existed problems and the necessary qualities of using CAI for college teachers in microbiology experimental teaching.

Objective To construct the multiple antigenic peptide (MAP) gene and E. coli ex-pression system, based on the out membrane protein OmpL1, LipL21 and LipL32 from Leptospira interro-gans, and better understanding of the immunological activity of the recombinant protein. Methods Using MI3KE display and Western blot, the advantage epitopes of OmpL1, LipL21 and LipL32 were identified and used to synthesize a new gene, then its prokaryotic expression system was constructed. The expression of re-combinant protein was determined by SDS-PAGE. The immunity activity of the recombinant protein was iden-tified by Western blot and ELISA. Results The synthetic gene was effectively expressed in E. coli and mainly presented in soluble form. The expression protein could react with the antileptospirosis antibodies in rabbit and human sera, which contained different serogroups. Conclusion The recombinant MAP gene of leptospires was successfully constructedand and expressed in E. coli. The recombinant protein had a good immune activity, and could cross-reacted with antileptospirosis antibodies from different serogroups.

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD).Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015.The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission.The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA),Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA),CKD-EPI creatinine equation (EPI_Cr),CKD-EPI cystatin C equation (EPI_CysC),CKDEPI creatinine-cystatin C equation (EPI_Cr_CysC),simplified MDRD (MDRD) and China MDRD equations.The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed.Results A total of 403 CKD participants were enrolled in the study,with 228 male patients and a mean age of (54.9± 18.4) years.The main primary diseases were chronic glomerulonephritis (43.7％) and diabetic nephropathy (13.2％).The median concentration of serum creatinine and cystatin C were 117.5 (69.7,242.4) μmol/L and 1.80 (1.13,3.31) mg/L,respectively.The median values of Ccr_BSA,eCcr_BSA,MDRD,China MDRD,EPI_Cr,EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1,96.2),51.9 (23.3,93.2),53.6 (23.0,97.4),52.2(22.4,94.1),53.2 (22.1,97.3),35.1 (15.4,67.0) and 49.1 (22.8,82.3) ml · min-1 · (1.73 m2)-1,respectively.There was well agreement among MDRD,China MDRD and EPI_Cr equations,while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr,MDRD,China MDRD,eCcr_BSA,Ccr_BSA equations).Compared with EPI_Cr_CysC equation (the reference equation),EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞ 30％ of the reference equation calculations (1-P30),30.8％] while Ccr_BSA equation showed the lowest (1-P30,42.4％).EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference,11.7 ml·min-1 · (1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference,22.8 ml· min-1 ·(1.73 m2)-1].Conclusions The agreement among equations derived only from creatinine is better;while it exhibits some differences between equations with cystatin C and equations derived only from creatinine.The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.

Objective:To analyze the distribution, clinico-pathologic features, and survival status of different subtypes in axillary lymph node-negative invasive breast cancer patients. Methods:In this study, data of 183 patients were included and retrospectively ana-lyzed in terms of age distribution, clinico-pathologic features, disease-free survival (DFS), and overall survival based on different sub-types (luminal, basal-like, and HER-2 over-expression). Results:No significant differences in age, tumor size, and TNM stage was ob-served among different subtypes. The relapse rates of luminal, basal-like, and HER-2 over-expression subtypes were 3.9% (4/102), 20.4% (10/49), and 6.3% (2/32), respectively (P=0.002). The death rates of luminal, basal-like, and HER-2 over-expression subtypes were 2.0%(2/102), 6.1%(3/49), and 3.1%(1/32), respectively (P>0.05). Kaplan-Meier analysis showed that the DFS of basal-like sub-type was much lower compared with that of the luminal and HER-2 over-expression subtypes (P=0.002). Cox analysis showed that the subtype was an independent prognostic indicator (P=0.001). Conclusion:In node-negative invasive breast cancer, no significant differ-ences in age distribution, tumor size, and TNM stage was observed among different subtypes. The basal-like subtype has the worst prog-nosis. Therefore, subtype is an important independent prognostic indicator.

Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer. Background and purpose: With the development of the means of preoperative diagnosis and treatment of breast cancer, ifne needle puncture no longer seems to be popular with the clinical use. The safety and effectiveness of fine needle aspiration as preoperative diagnosis of breast cancer are controversial. This study was aimed to investigate the application of fine needle aspiration (FNA) of breast cancer and association between FNA and recurrence and metastasis for 30 years in our hospital. Methods:A total number of 1 260 patients with breast cancer treated in Peking Union Medical College Hospital from 1975 to 2006 were reviewed in two groups for clinical characters, recurrence, and survival rate. The two groups were FNA and non-FNA. Results:The positive rate of FNA was 61.4%and the highest rate was inⅣstage (100%). StageⅡandⅢwere the major ones in FNA group (45.2%). The local recurrence (7.0%vs 6.4%), recurrence and metastasis (13.2%vs 14.0%), 5-year (82.0%vs 81.0%) and 10-year disease free survival rates (51.0%vs 64.0%) have no signiifcant difference between FNA and non-FNA groups. Conclusion:FNA is still one of the most important methods for preoperative investigation of breast cancer.

Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.

Objective To study the clinical characteristics,diagnosis,and treatment of paratyphoid fever A (fever A) complicated with severe kidney damage. Methods The data were retrospectively reviewed.Results The symptoms of poisoning and gastrointestinal symptoms as well as the slightly abnormal urinalysis (proteinuria, hematuria) appeared early, which got worse along with the progression of the disease. The symptoms of urinary system and azotemia appeared in the worst period. After treatment with antibiotic, 4 patients recovered early.Conclusion Paratyphoid fever A can cause severe kidney damage, with non-specific symptoms at the early stage. The seriousness of the abnormal of urine test can't be ignored as those provides the basis for the early diagnosis. The early use of antibiotic is the key to avoid and lessen the serverity of kidney damage.

Objective To discuss the clinical characteristics and treatment of upper cervical spine injuries in the elderly. Methods A retrospective study was done on clinical data of 28 elderly patients ( > 60 years old) with upper cervical spine injuries treated from January 2003 to December 2007. There were 20 males and 8 females, at age range of 60-86 years (mean 68.1 years). Injury causes included slip in 16 patients, traffic injury in eight and fall from height in four. Atlas fractures occurred in five patients and axis ones in 15,of which there were eight patients with odontoid fractures, six with C2 vertebral arch fractures and one with C2 body fractures. Upper cervical spine injury was combined with lower cervical spine injuries in five patients. There were combined atlantoaxial injuries including odontoid fractures combined with lateral atlas fracture in one and edontoid fractures combined with anterior atlas arch fracture in one. Atlantoaxial dislocation occurred in one patient and combined spinal injury in four. Of all, eight patients were treated conservatively, eight with open surgical operation and 12 with minimally invasive surgery. Results The average hospital stay was 16.5 days, with no statistical difference be-tween conservative treatment group and open surgical operation group ( P > 0.05 ). While the average hos-pital stay in minimally invasive surgery group was shorter than that in conservative treatment and open sur-gical operation groups ( P < 0.05 ). Of all, two patients in conservative treatment group and one in open surgical operation group died and the other 25 patients were followed up for average 16.8 months (9-56 months). The satisfaction rate was 50% in conservative treatment group, 72% in open surgical operation group and 75% in minimally invasive surgery group. Complications occurred in four patients in conserva-tive treatment group, three in open surgical operation group and two in minimally invasive surgery group. Conclusions With odontoid fracture the most common injury type, upper cervical spine injuries arema-inly caused by low-energy force and characterized by low mobidity of spinal cord injuries and high possi-bility of missed diagnosis in the elderly patients. The surgical treatment especially minimally invasive surgery can bring good results compared with conservative methods.

Objective To explore different treatment choices for unilateral cervical facet locking. Methods The study involved 32 patients with cervical unilateral facet locking. Successful reduction by the skull traction was done in eight patients, of whom three were fixated by the head and neck chest plas-ter after a month of traction. Five patients were treated with anterior decompression and internal fusion fixation. The other 23 patients resulted in failure of traction and then were treated with anterior reduction, discectomy and internal fusion fixation in 14 patients, subtotal vertebral decompression and bone graft fix-ation in three, posterior open reduction and anterior bone graft fixation in one, posterior reduction, fixation and internal fusion fixation in three and posterior reduction and decompression plus anterior discectomy decompression and bone graft fixation in two. Due to misdiagnosis, one patient was treated with anterior decompression and fusion eight months after injury. Results A follow-up for average 18 months showed cervical instability in two patients who were treated with only traction, without fusion. The patients treated with anterior cervical fusion obtained bone union after 12 weeks, with satisfactory cervical physiological curvature and vertebral height. There were no internal fixation complications or neurological complications. Conclusions The treatment of lower cervical unilateral facet locking needs a compre-hensive considerations on whether there associates with disc injury, posterior column fractures or spinal cord injuries. As for patients with lower cervical unilateral facet locking combined with traumatic cervical disc herniation, the anterior reduction and decompression is the choice of treatment. While for those with-out disc herniation, traction or posterior open reduction and fixation can be carried out directly.

Objective To clone mcp1, mcp2 and mop3 genes that encoding methyl-accepting chemotaxis proteins(MCP) of Campy/obacter jejuni for construction of their prokaryotic expression systems, and to establish chemotactic model in vitro of the microbe for determining chemotaxis-inducing substances and to understand relationship among MCPs and chemotactic inducers. Methods The segments of mep1, mcp2 and mcp3 genes were amplified by PCR and then sequenced after T-A cloning. Prokaryofic expression systems of the genes were subsequently constructed. SDS-PAGE pins Bin-Rod Gel Image Analyzer were used to examine the expression of target recombinant proteins rMCP1, rMCP2 and rMCP3, and Ni-NTA affinity chromatography was performed to purify the rMCPs. Rabbits were immunized with each of the three rMCPs to obtain antisera. Immunodiffusion assay was performed to measure the titers of antisera. IgG in each of the antisera were extracted by ammonium sulfate precipitation and DEAE-32 ion exchange chromatography, and IgG F(ab')2 were then prepared by pepsin enzymolysis and Sephadex G-100 chromatography. Chemotactic model in vitro of C. jejuni based on HAP( hard-agar plus) method was established to determine the chemo-taxis-inducing effect of eight candidate substances. Chemotaxis inhibition test based on IgG F(ab')2 bloc-king was applied to determine the function and diversity of MCPs. Results The segments with expected si-zes amplified from mcp1, racp2 and mcp3 genes were obtained by PCRs, and their nucleotide and putative amino acid sequences were completely same as the reported. The constructed prokaryotic systems could effi-ciently express rMCPs with the yields about 10% of the total bacterial proteins. Immunization with rMCP1, MCP2 and rMCP3 enables the rabbits to produce specific antibody. All the antisera had 1: 4 immunodiffusion titers. Both bovine bile and sodium deoxycholate(DOC) were able to induce ehemotactie movement of C. je-juni in a dosage-dependent manner ( P < 0.05 ). When MCP1 and MCP2 were blocked with their IgG F(ab')2, the ehemotaetic ability of C. jejurd were remarkably decreased (P <0. 05). However, MCP3 blocking did not affect the chemotaxis ( P > 0.05 ). Conclusion The C. jejuni MCPs are successfully ex-pressed in this study. Bovine bile and DOC are the inducers for chemotaxis of C. jejuni, and MCP1 and MCP2 are involved in the process of ehemotaxis iadueed by DOC.