OBJECTIVES: This study aimed to investigate the perception of dental outpatient care quality from multiple perspectives of administrators, physicians, nurses, and patients and propose nursing care quality evaluation indices that are consistent with the clinical reality to provide reference for the construction of a scientific, systematic, and comprehensive dental outpatient care quality evaluation system. METHODS: A total of 39 interviewees, including 7 administrators, 11 doctors, 11 nurses, and 10 patients, were selected for semi-structured in-depth interviews in five regionally representative tertiary-level A stomatological specialty hospitals nationwide during January-April 2024 by using a multistage sampling method. Colaizzi 7-step analysis was used to analyze and summarize the interview data. Themes were extracted on the basis of the Structure-Process-Outcome (SPO) three-dimensional quality assessment model. RESULTS: Five main themes and 15 secondary themes were extracted from three quality dimensions: structure, process, and result. The related topics of structural quality were as follows: disinfection and isolation norms, equipment and consumable management, nursing manpower ratio and nurse education structure, and emergency capability. The related topics of process quality were as follows: pre-diagnosis risk assessment, patient triage and guidance, communication and attitude, health education, humanistic care, continuous care, specialty operation, and four-hand operation. The related topics of result quality were as follows: satisfaction, adverse event management and analysis, effective complaints and disputes. CONCLUSIONS Structure quality is the foundation, process quality is the core, and result quality is the key in the evaluation of the quality of oral outpatient care. The standardization of disinfection and isolation, equipment and consumable management, allocation of reasonable nursing manpower and post capacity, implementation of high-quality nursing services, and improvement of the quality and satisfaction of medical cooperation are necessary guarantees to ensure the quality of oral outpatient care.
Humans ; Quality of Health Care ; Ambulatory Care/standards* ; Dental Care/standards* ; Outpatients

OBJECTIVES: This study aimed to construct an evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model and provide an objective standard for the evaluation of nursing quality in outpatient dental clinics. METHODS: Through literature review, multi-subject interviews, and expert meetings, the first draft of the evaluation index for nursing quality management in outpatient dental clinics was formulated. The Delphi method was adopted to select and invite 15 experts in the fields of hospital infection management, nursing management, and specialized oral care from across the country to modify the first draft. RESULTS: The positive coefficients of the experts in the two rounds of consultation were 86.7% and 92.3%, respectively. The total authority coefficients of the experts were 0.791 and 0.717, respectively. The mean scores of the importance and feasibility of the third-level indices in the two rounds of consultation were all ≥4.333; the coefficients of variation were all ≤0.150; and the Kendall's coordination coefficients were 0.308 and 0.184 respectively, with P<0.05 for all. These results indicated that the experts were motivated to participate in this study. They recognized the importance and feasibility of the overall items in this index system, and their opinions were relatively consistent. Finally, an evaluation index system, which included 3 first-level indices, 7 second-level indices, 22 third-level indices, and 69 index connotations, for nursing quality management in outpatient dental clinics was determined. The weights of the three first-level indicators were all 0.333. Patient satisfaction (0.076, outcome dimension), hand hygiene (0.061, outcome dimension), chair care ratio (0.057, structural dimension), and turnover rate (0.057, structural dimension) were the top tertiary indicators in terms of portfolio weight. CONCLUSIONS The construction method of the evaluation index system for nursing quality management in outpatient dental clinics is scientific and reliable. It can provide a reference for the evaluation of the management level of nursing quality in outpatient dental clinics and promote the continuous improvement of nursing quality in outpatient dental clinics.
Humans ; Dental Clinics ; Delphi Technique

Objective:To investigate the correlation of the emm genotypes and virulence genes with the isolation sites of Group A Streptococcus (GAS). Methods:It was a retrospective study.The specimens were collected from children with impetigo in Beijing Children′s Hospital, Capital Medical University from 2006 to 2008 for GAS isolation and identification.A total of 24 GAS strains were isolated from 16 children with impetigo, among which 7 pairs of strains were isolated from the throat and skin of 7 children, and 1 pair of strains was isolated from the vulva and skin of one child, and the remaining 8 GAS strains were isolated from the skin pus samples of 8 children.Polymerase chain reaction was applied to detect the emm genotypes and 13 virulence genes ( speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ and ssa). The correlation of the emm genotypes and virulence genes with the isolation sites of GAS strains was analyzed. Results:In this study, four emm genotypes were detected, including emm1.0 (15/24), emm12.0 (4/24), emm22.0 (2/24) and emm160.0 (1/24), and one subtype emm12.19 (2/24) was detected as well.The carrying rates of 13 virulence genes speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ and ssa were 58.3%, 100%, 91.7%, 100%, 50.0%, 12.5%, 54.2%, 66.7%, 16.7%, 25.0%, 12.5%, 100% and 91.7%, respectively.All strains carried 5 to 11 virulence genes and they all carried speB, speF and smeZ.There were significant differences in the carrying rate of speA and speJ among the strains with different emm genotypes (all P<0.05). There was no significant difference in the distribution of virulence genes between skin isolates and pharyngeal isolates, including the 5 pairs of strains carrying the emm1.0 genotype (all P>0.05). Conclusions:The distribution of virulence gene of GAS in children with impetigo is significantly correlated with the emm genotype, rather than the isolation site.

Objective To explore the impact of bisphenol A(BPA)exposure on liver lipid metabolism in C57BL/6J mice and uncover the mechanisms at work.Methods Male C57BL/6J mice,aged eight weeks,were stratified into six cohorts:a control group on a standard diet(ND),a group on a standard diet with low-dose BPA(BPA-50 ND),a group on a standard diet with high-dose BPA(BPA-500 ND),a control groupon a high-fat diet(HFD),a group on a high-fat diet with low-dose BPA(BPA-50 HFD),and a group on a high-fat diet with high-dose BPA(BPA-500 HFD).Dosages for the low-and high-dose BPA groups were 50 and 500 μg/(kg·d),respectively,administered via gavage over a duration of 12 weeks.Hepatic tissue underwent histological examination through he-matoxylin and eosin(HE)staining.Furthermore,the expression levels of miR-122-5p and miR-143-3p in hepatic tissue,in addition to interleukin(IL)-6 and IL-10 in peripheral serum,were quantitatively measured employing quantitative reverse transcription-polymerase chain reaction(qRT-PCR)and enzyme-linked immunosorbent assay(ELISA),respectively.Results Histopathological analysis via HE staining indicated intact hepatic lobule archi-tecture in the ND group,whereas other groups displayed variable degrees of lipid droplet accumulation and damage to hepatic lobules.Notably,supplementation with BPA,particularly in conjunction with a high-fat diet,led to a progressive increase in IL-6 levels and a decrease in IL-10 levels in peripheral blood.In the context of a standard diet,an augmentation in BPA concentration corresponded with a decline in the expression of miR-122-5p and miR-143-3p.Conversely,within the high-fat diet cohort,enhanced BPA concentrations were associated with increased expressions of these microRNAs.Pearson correlation analysis disclosed a significant positive correlation between the expression of miR-122-5p and miR-143-3p and the level of IL-10 in the standard diet group(P＜0.01).In the high fat diet group,the expression level of miR-122-5p was positively correlated with the concentration of IL-6(P＜0.05),and the expression level of miR-143-3p was negatively correlated with the concentration of IL-10(P＜0.05).Conclusion BPA can induce the occurrence and progression of nonalcoholic fatty liver disease(NAFLD)by regulating the expression of miR-122-5p and miR-143-3p and regulating the levels of inflammatory factors IL-6 and IL-10.

Background::Cluster of differentiation 8 (CD8 T) cells play critical roles in eradicating human immunodeficiency virus (HIV)-1 infection, but little is known about the effects of T cells expressing CD8 at low levels (CD8 low) or high levels (CD8 high) on HIV-1 replication inhibition after HIV-1 invasion into individual. Methods::Nineteen patients who had been acutely infected with HIV-1 (AHI) and 20 patients with chronic infection (CHI) for ≥2 years were enrolled in this study to investigate the dynamics of the quantity, activation, and immune responses of CD3 +CD8 low T cells and their counterpart CD3 +CD8 high T cells at different stages of HIV-1 infection. Results::Compared with healthy donors, CD3 +CD8 low T cells expanded in HIV-1-infected individuals at different stages of infection. As HIV-1 infection progressed, CD3 +CD8 low T cells gradually decreased. Simultaneously, CD3 +CD8 high T cells was significantly reduced in the first month of AHI and then increased gradually as HIV-1 infection progressed. The classical activation of CD3 +CD8 low T cells was highest in the first month of AHI and then reduced as HIV-1 infection progressed and entered the chronic stage. Meanwhile, activated CD38 -HLA-DR +CD8 low T cells did not increase in the first month of AHI, and the number of these cells was inversely associated with viral load ( r = -0.664, P = 0.004) but positively associated with the CD4 T-cell count ( r = 0.586, P = 0.014). Increased programmed cell death protein 1 (PD-1) abundance on CD3 +CD8 low T cells was observed from the 1st month of AHI but did not continue to be enhanced, while a significant T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif (ITIM) domains (TIGIT) abundance increase was observed in the 12th month of infection. Furthermore, increased PD-1 and TIGIT abundance on CD3 +CD8 low T cells was associated with a low CD4 T-cell count (PD-1: r = -0.456, P = 0.043; TIGIT: r = -0.488, P = 0.029) in CHI. Nonetheless, the nonincrease in PD-1 expression on classically activated CD3 +CD8 low T cells was inversely associated with HIV-1 viremia in the first month of AHI ( r = -0.578, P = 0.015). Notably, in the first month of AHI, few CD3 +CD8 low T cells, but comparable amounts of CD3 +CD8 high T cells, responded to Gag peptides. Then, weaker HIV-1-specific T-cell responses were induced in CD3 +CD8 low T cells than CD3 +CD8 high T cells at the 3rd and 12th months of AHI and in CHI. Conclusions::Our findings suggest that CD3 +CD8 low T cells play an anti-HIV role in the first month of infection due to their abundance but induce a weak HIV-1-specific immune response. Subsequently, CD3 +CD8 low T-cell number decreased gradually as infection persisted, and their anti-HIV functions were inferior to those of CD3 +CD8 high T cells.

‍Traditionally， the progression from compensated liver cirrhosis to decompensated liver cirrhosis has been considered an irreversible point in the natural history of the disease； however， with the suppression of underlying etiology， cure， and disease regression， this view is challenged by an increasing number of new evidence， and the idea of “recompensation of liver cirrhosis” is gradually being accepted. In recent years， scholars in China and globally have been exploring the specific definition of recompensation of liver cirrhosis and the clinical features of patients. By summarizing the recent studies on recompensation of liver cirrhosis in China and globally， integrating existing views， and analyzing related research evidence， this article points out the main challenges in the field of recompensation at this stage， including the lack of in－depth clinical and basic research， the need to define recompensation in the context of NAFLD， and related ethical issues， in order to provide new directions for future research in this field.

‍Nonalcoholic fatty liver disease （NAFLD） is a group of highly heterogeneous diseases closely associated with metabolic dysfunction. Sarcopenia is a syndrome caused by a continuous decline in muscle mass， strength， and function， and it is often accompanied by NAFLD. Insulin resistance is the main pathological mechanism for sarcopenia and NAFLD， and in addition， factors such as changes in proteins and branched‍-‍chain amino acid， hyperammonemia， intestinal flora， and endocrine dysfunction can also lead to sarcopenia and NAFLD. With the deepening of clinical research， many published prospective studies have confirmed the existence of a bidirectional and complex pathophysiological relationship between sarcopenia and NAFLD. This article reviews the bidirectional relationship between sarcopenia and NAFLD， discusses the common pathogenesis of sarcopenia and NAFLD， summarizes the challenges faced in this field， and proposes new directions for the research on the bidirectional relationship between NAFLD and sarcopenia.

Objective:To investigate the comprehensive ability and influencing factors of clinical medicine graduates from a medical college in Xi'an, and provide a scientific basis for improving the training model and comprehensive ability of clinical medicine students.Methods:Based on the Chinese Undergraduate Medical Education Standard-Clinical Medicine Specialty (2016 Edition), we conducted a self-designed questionnaire, the Clinical Medicine Graduate Comprehensive Ability Evaluation Questionnaire, containing 62 items in 4 dimensions, selected the clinical medicine graduates as the research objects by random sampling method, used SPSS 22.0 to make data analysis, and performed multiple linear regression to analyze its influencing factors.Results:Clinical medicine graduates had the highest score in the field of clinical competence (3.05±0.84), followed by the field of professionalism (2.48±0.81), and the lowest score was in the field of science and academics (1.89±0.68). The top three scores of each factor were clinical practice ability (3.39±0.76), theoretical knowledge mastery (3.55±0.48) and medical knowledge mastery (2.98±0.81). The three factors with the lowest scores were literature search ability (1.31±0.64), global health issues (1.49±0.82) and self-improvement willingness and ability (1.81±0.73). Using the multiple stepwise regression method to analyze the influencing factors of comprehensive ability, the optimal equation was obtained: Y=8.412+0.063 X6+0.190 X8+0.266 X10+0.031 X11+0.187 X12 ( X6, working level; X8, academic performance ranking; X10, practical teaching satisfaction; X11, mode of teaching satisfaction; X12, Re-education satisfaction after graduation). Among them, the higher the practical teaching satisfaction, the satisfaction of re-education and the satisfaction of teaching mode after graduation, the higher the student's performance ranking, and the higher the comprehensive ability score of clinical graduates. Graduates whose employment level was in a general hospitals had higher comprehensive ability scores than those of grassroots hospitals such as community/township hospitals. Conclusions:In the process of training clinical medicine students, we should improve the quality of practical teaching and the teaching model, increase the training of science and academic fields, increase the investment in re-education of primary medical institutions, and raise the satisfaction of graduates in education, so as to improve the clinical medicine profession comprehensive ability of graduates.

Objective:To study the correlation between the time within the target range of blood glucose and the reduction of muscle mass in middle-aged and elderly patients with type 2 diabetes (T2DM).Methods:A total of 245 middle-aged and elderly T2DM patients admitted to the Second People′s Hospital of Hefei from December 2020 to December 2021 were selected. All enrolled patients wore MeiQi blood glucose monitor to obtain time in range (TIR), time above range (TAR), time below range (TBR), mean amplitude of glycemic excursions (MAGE), coefficient of variation (CV), blood glucose standard deviation (SD), largest amplitude of glycemic excursions (LAGE), which was for assessing blood sugar fluctuation. The incidence of muscle mass reduction and sarcopenia was statistically analyzed, and the differences invarious observation indicators between the muscle mass reduction group and the non muscle mass reduction group were compared. Spearman correlation analysis was used to investigate the correlation between clinical indicators and limb skeletal muscle mass index (ASMI), and logistic regression was used to analyze the influencing factors of muscle mass reduction in middle-aged and elderly T2DM patients.Results:The prevalence of muscle mass loss in 245 T2DM patients was 25.71%(63/245), and the prevalence of sarcopenia was 13.06%(32/245). There were statistically significant differences in age, gender, body mass index (BMI), blood phosphorus, homeostatic model assessment of insulin resistance (HOMA-IR), urine albumin creatine ratio (ACR), 25 hydroxyvitamin D, diabetes nephropathy (DN) patient proportion, ASMI, grip strength, and 5 sit up test times between the muscle mass reduction group and the non muscle mass reduction group (all P<0.05). The TIR of the muscle mass reduction group was lower than that of the non muscle mass reduction group, while the TAR and mean blood glucose (MG) were higher than those of the non muscle mass reduction group, with statistically significant differences (all P<0.05). ASMI was negatively correlated with age, males, and HOMA-IR (all P<0.05), but positively correlated with BMI and 25 hydroxyvitamin D (all P<0.05). ASMI was positively correlated with SD and TIR (mean P<0.05), and negatively correlated with CV, LAGE, TAR, and MG (all P<0.05). The results of univariate regression analysis showed that age, male gender, DN, and TAR were risk factors for muscle mass reduction, while BMI, 25 hydroxyvitamin D, and TIR were protective factors for muscle mass reduction (all P<0.05). After adjusting for other related factors, TIR remained a protective factor for decreased muscle mass (all P<0.05). Conclusions:TIR is an independent protective factor for muscle mass loss in middle-aged and elderly T2DM patients, and the incidence of muscle mass loss can be reduced by increasing TIR levels in clinical practice.

ObjectiveIn the treatment of acute gouty arthritis （AGA）， western medicine is mostly used for anti-inflammatory and analgesic purposes to control the blood uric acid level， but some patients are still at risk of poor control and recurrent attacks. Chinese medicinal prescriptions， potent in resisting inflammation and relieving pain， are able to stabilize the blood uric acid level， reduce acute attacks， and improve the clinical efficacy of western medicine. However， there is a lack of evidence to support their use as evidence-based medicine. This study employed network Meta-analysis （NMA） to evaluate the efficacy and safety of common Chinese medicinal prescriptions in the treatment of AGA， aiming to provide evidence-based medical evidence for the clinical use of Chinese medicinal prescriptions in the treatment of AGA. MethodChinese and English databases were searched for prospective cohort studies and randomized controlled trials （RCTs） on Chinese medicinal prescriptions against AGA from database inception to December 1， 2022. Stata software and Review Manager were used for statistical analysis. ResultForty-four papers with 3 564 cases involved were included in the current NMA. In terms of reducing blood uric acid， the cumulative probability results showed that Mahuang Lianyao Chixiaodou Tang showed optimal efficacy （87.60%）. In terms of relieving joint pain， Danggui Niantongtang and Guizhi Shaoyao Zhimutang showed optimal efficacy （92.00% and 82.30%）. In terms of improving erythrocyte sedimentation rate （ESR）， Simiaowan was superior to other prescriptions （87.00%）. In terms of reducing C-reactive protein （CRP）， Simiaowan and Baihutang modified with Guizhitang showed superior efficacy （76.00% and 66.10%）. In terms of safety， except for the basic treatment group， Mahuang Lianyao Chixiaodou Tang had the lowest probability of adverse events， and Danggui Niantongtang had the highest probability of adverse reactions during treatment. According to the results of cluster analysis， Mahuang Lianyao Chixiaodou Tang and Simiaowan are effective and safe. ConclusionAccording to the results of NMA， Chinese medicinal prescriptions can assist in the treatment of AGA and improve the effectiveness of western medicine. For patients with AGA， clinicians can choose Mahuang Lianyao Chixiaodou Tang or Simiaowan as an auxiliary drug for routine western medicine treatment.