Objective To enhance the quality of medical service for Chinese patients through research of service quality from Chinese medical personnel. Methods ServQual scale was used for infection medical staffs randomly by sampling questionnaire in Beijing, Shanghai, Chengdu, Chongqing, Guangzhou and Nanning. The data collected were entered and analyzed using SPSS 20.0. Statistical methods included frequency, factor analysis, reliability analysis, correlation analysis, independent samples t test, one-way analyses of variance, simultaneous regression analysis and structural equation model analysis. Results The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.970. The Cronbach’sαfor the reliability analysis was 0.975. The Pearson correlation coefficients were 0.624-0.874 and statistically significant. Undergraduates felt good, PhD students felt bad;the doctors felt bad;managers felt good. Standard 5 dimensions of the regression coefficients were positive, including empathy (β = 0.288), reliability (β =0.241) impacting on perceived service quality mostly. The control ability and stability of the standard error of perceived service quality directly effected value were 0.646 and 0.382, respectively. Conclusions Medical staffs of infectious disease department have poor perception of service quality. Hospitals should improve awareness and of clinicians and deepen the reform of the medical care system.

Objective To investigate the association between HBV genotypes and characteristics of rtA181 mutation. Methods Total of 85 chronic hepatitis B (CHB) patients who appeared rtA181 mutation after nucleos(t)ide analogs (NAs) therapy were enrolled in this study. Levels of serum ALT, AST, HBV DNA and HBsAg titers were monitored during therapy. HBV reverse transcriptase genes were amplified and sequenced to identify genotypes and resistance mutations. Virions and HBsAg in HepG2 cell with rtA181 mutation were also compared between genotypes B and C. Results The majority of sera contained HBV genotypes B (15.7%) and C (84.3%). There were no significant difference of rtA181 mutant patterns between genotypes (P> 0.05). After emergence of rtA181 mutation, serum ALT, AST, HBV DNA levels and HBsAg titers were decreased than that at baseline (P<0.05), while these characteristics were not different between genotypes B and C (P>0.05). In cellular experiment, there were no significant differences between genotypes B and C not only in HBV virions but also in HBsAg titres (P>0.05). Conclusions No differences of clinical characteristics and cellular results were found in rtA181 mutation of HBV genotypes B and C.

Objective To explore the prevention of IL-18 or anti-IL-18-mAb to the immune liver fibrosis model induced by repeated injection of concanavalin A in BALB/c mice and its mechanism. Methods Total of 120 BALB/c mice were divided into four groups, control group mice (Ga) were injected weekly with normal saline, concanavalin A group was divided into Gb, Gc, Gd. All mice were injected with concanavalin A (15 mg/kg) once a week. Moreover, Gc, Gd mice were injected weekly with IL-18 (7.5 mg/kg) and anti-IL-18-mAb (10 mg/kg) 2 hours before treatment with concanavalin A, respectively. Twenty-four hours after concanavalin A challenge at 1, 5, 12 and 20 weeks, 3 mice were killed by vena orbitalis, repectively. The sera were storaged at 4℃for detecting of up TNF-αand IFN-γby ELISA. The liver of mice in different groups were excised and fixed in 10%formalin for HE staining and Masson staining or frozen in liquid nitrogen for immunohistochemical staining forα-SMA. After extracting of total RNA from liver tissue, MMP-2 and TIMP-1 A messenger RNA were amplified by reverse transcription polymerase chain reaction (PCR). Products were electrophoresed on agrose gel containing ethidium bromide and visualized under ultraviolet light. Densitometric RT-PCR data were standardized withβ-actin signals. Results After experiment, the number of dead mice of Ga, Gb, Gc and Gd were 0, 6, 15 and 3, respectively. There were significant difference on each group (P<0.05). At the fifth week of experiment, hepatocellular necrosis in IL-18 administered group mice had become widespread throughout the lobule. Evidence of liver fibrosis was observed during this period. However, at the twelfth week of experimemt, bridging fibrosis and large fibrosis strip in the parenchyma with hepatocellular necrosis was detectable in Gb, but at twentieth week, only the small fibrosis strip had been found in anti-IL-18-mAb administered group mice by HE staining and Masson staining. The serum levels of TNF-αand IFN-γin IL-18 administered group were higher than that in concanavalin A group and anti-IL-18 administered groups (P<0.05). Moreover, immunohistochemical staining forα-SMA indicated that the semi-quantu scores in IL-18 administered group were more than concanavalin A group and anti-IL-18-mAb administered groups (P<0.05). MMP-2-mRNA, TIMP-1-mRNA expression levels increased signifigantly compared with concanavalin A group and anti-IL-18-mAb administered group (P<0.05). Conclusions The immune liver fibrosis model induced by repeated injection of concanavalin A in BALB/c mice could be worsened by IL-18 administration and block by anti-IL-18 mAb administraion.

Objective To investigate the dynamic change of hepatitis B virus quasispecies within complete genome during the early stage of IFN-αtreatment and its impact on virological response. Methods Sixteen patients with chronic hepatitis B receiving IFN-αtreatment were investigated. HBV DNA was extracted from serum sample at baseline and week 12. The complete genome of HBV was amplified, then cloned and sequenced. The quasispecies heterogeneity of HBV complete genome was depicted at baseline and week 12. Results The quasispecies heterogeneity of the genome except for C-ORF were comparable in three groups at baseline and week 12. The quasispecies diversity at amino acid levels of responders within C-ORF were higher than that of non-responders at baseline. The quasispecies diversity within the C-ORF of partial responders was reduced in the early stage of IFN-αtreatment. Furthermore, the mean genetic distance at amino acid levels of partial responders was significantly higher than that of the non-responders at week 12. The evolutionary rate was not different between non-responders and partial responders. Conclusions In the immune clearance phase, the patients who had greater viral quasispecies diversity within C-ORF at amino acid level had more chance to obtain the early virological response during IFN-αtreatment.

Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+T cell counts. Group A had CD4+T cell below or equal to 50 cells/μl (n=81) and group B had CD4+T cells over 50 cells/μl (n=83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B (35.8%vs. 22.9%) although without statistical significance (P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B (41.9%vs. 16.8%) with statistical significance (P<0.01). Conclusions The patients with CD4+T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+T cell count (≤ 50/μl) should routinely undergo MRI examination.

Hepatitis B virus (HBV) reactivation after chemotherapy or immunosuppressive therapy is a cause of liver-related morbidity and mortality. Not all chronic hepatitis B patients will lead to HBV reactivation. The incidence is 0.3%-30.2%according to the reports. The mechanism of HBV reactivation is still unclear, but it is believed that the viral load is increasing due to the suppression of immune response. No uniform diagnostic criteria are available. HBV reactivation can be confirmed by an increase of serum HBV DNA level. Recently, awareness of reactivation of occult HBV has been improved, especially in HBV endemic area. Preemptive antiviral therapy was the best approach to prevent the HBV reactivation. HBV reactivation can lead to acute hepatitis, severe hepatitis and acute liver failure. Therefore, it is worthy of great attention and further study. Antiviral therapy is safe and effective to prevent HBV reactivation.