Application of PDCA cycle in improving the teaching quality of stomatology standardized residency training / 中华医学教育探索杂志

In order to improve the teaching quality of stomatology standardized residency training, the method of PDCA cycle quality management was tried, and 8 stomatology teachers were evaluated by 4 rounds of improvements. The evaluation included theoretical knowledge teaching satisfaction, operational skills teaching satisfaction, teaching level, teacher quality assessment, teaching quality supervision group evaluation and other indicators. The comprehensive teaching ability of all the teachers recruited in this study was significantly improved after 12 months of PDCA cycle training. The results suggest that the application of PDCA cycle helps stomatology teachers to provide high quality training to residents and provide the reference for the management of clinical teaching.

[Impact of long-term highly active antiretroviral therapy on bone metabolism in AIDS patients].

OBJECTIVE: To evaluate the influence of long-term highly active antiretroviral therapy (HAART) on bone metabolism in patients with acquired immune deficiency syndrome (AIDS). METHODS: A total of 82 AIDS patients who received HAART in the First Affiliated Hospital of Zhejiang University Medical School during January 2012 and May 2016 were enrolled in the study. Patients were divided into TDF group (n=41) and AZT group (n=41), and glomerular filtration rate (GFR), serum calcium, serum phosphate and serum ALP levels in 6, 12, 18, 24 and 30-month during the treatment were analyzed in both groups. RESULTS: Both TDF-based and AZT-based therapies significantly improved CD4(+) T-cell levels of the patients, and no significant difference was observed between the groups. Compared with the baseline, GFR [(120.71±62.85) vs(110.08±39.18) mL/min] and serum phosphate [(1.25±0.19) vs(1.22±0.21) mmol/L] levels rose after 6-month treatment in TDF group, but the difference was not statistically significant (P>0.05); Serum ALP [99.0(79.5-124.0) U/L vs 80.0(60.5-96.0) U/L] and serum calcium [(2.32±0.12) vs(2.25±0.17) mmol/L] levels rose significantly (P<0.05). As treatment continued, the levels of GFR, serum calcium and serum phosphate declined, while the serum ALP number was still increasing. After 30 months of HAART, the level of serum calcium [(2.16±0.15) vs(2.25±0.17) mmol/L], serum phosphate [(1.06±0.17) vs(1.22±0.21) mmol/L], GFR [(98.13±30.43) vs (110.08±39.18) mL/min] declined significantly (P<0.05) in TDF group, while serum ALP [110.0(98.5-120.5) U/L vs 80.0(60.5-96.0) U/L, P<0.05] increased. In AZT group, serum calcium and serum ALP levels rose and GFR level was declined (P<0.05), while serum phosphate level was not significantly changed during the treatment (P>0.05). Compared with AZT group, there were greater changes on the levels of GFR, serum calcium, serum phosphate and serum ALP in TDF group. CONCLUSION: HAART is effective for patients with AIDS, and TDF-based therapy may have significant impact on bone metabolism of the patients, which needs close monitoring and timely intervention or adjustment if necessary.

Kaposi's sarcoma-associated herpesvirus infection in chronic hepatitis B patients / 中华传染病杂志

Objective To study Kaposi's sarcoma-associated herpesvirus(KSHV)infection in chronic hepatitis B(CHB)patients and its correlation with hepatitis B virus(HBV)replication and treatment-related factors.MethodsEnzyme-linked immunosorbent assay(ELISA)with recombination protein KSHV ORF65 was employed to detect the KSHV antibody and real-time polymerase chain reaction(PCR)was performed to detect KSHV DNA and HBV DNA in CHB patients.Age,HBV replication and licorice preparation treatment of patients were further analyzed.Comparison of rates was done using X~2 test.Results KSHV ORF65 antibody positive rates were 27.3% in 161 male CHB patients and 30.0% in 50 female patients(X~2=0.135,P＞0.05).The KSHV infection rates were increased with age,but this tendency was not obvious in patients older than 40 years old.The highest infection rate was in age group of 31-40 years old which was 37.1%.The positive rate of HBV DNA in CHB patients with KSHV infection was 73.5%,which was 56.3% in uninfected patients(X~2=3.969,P＜0.05).The average plasma level of KSHV DNA in patients treated with licorice preparations was 204.7 copy/mL and that in patients without licorice preparation treatment was 533.9 copy/mL.Eight patients were KSHV DNA positive(KSHV DNA＞ 100 copy/mL)in 16 patients treated with licorice preparations and 23 were positive in 33 patients without licorice preparation treatment.Conclusions The KSHV infection rates are increased with age of CHB patients.KSHV infection may interfere with HBV replication and licorice preparations may suppresss KSHV replication in vivo.

Molecular epidemiology of hepatitis B virus in child carriers / 中华临床感染病杂志

Objective To investigate the molecular epidemiology of hepatitis B virus(HBV) in child carriers. Methods Blood samples were collected from children under 15 in Jiangsu and Zhejiang provinces. Enzyme immunoassay(EIA) and microparticle enzyme immunoassay(MEIA) were applied to screen hepatitis B surface antigen(HBsAg) positive children. Nested-PCR and real time PCR were used to amplify the HBV S gene and detected HBV DNA loads. S gene sequence and three-dimensional structure were analyzed by the DNASTAR and VMD1.8.6, respectively. SPSS 12.0 software was applied for data processing. Results A total of 64 HBsAg-positive cases were found in the screened children, from which 41 HBV S gene sequences were obtained. The average HBV DNA loads were(4.15±0.79)×10~7 copies/mL in 64 HBV carriers. Among 41 sequences. genotype C, B and B+C accounted for 82.93%(34/41), 12.19%(5/41)and 4.88%(2/41), respectively; and the serotypes were adr(34/39,87.18%), adw(4/39,10.24%) and ayr (1/39, 2.56%) with 2 strains unable to be sub-typed. The most common variants of "a" determinant in HBV S gene were 129 site Q→F(glutamine→phenylalanine), 145 site G→R(glycine→lysine), 131 site S→N(serine→asparagine)and 144 site C→A(cysteine→alanine), and the mutation frequencies were 12.20%(5/41), 4.88%(2/41), 2.27%(1/41)and 2.27%(1/41), respectively . The total mutation frequency was 21.95%(9/41). The S protein spatial structures of 129 site "Q→F" and 145 site "G→R" were entirely different from that of the wild strain. Conclusion Wild strain of HBV(C/adr) is predominant in the children HBV carriers, exhibiting a high replication, and the HBV vaccine should be still effective.