Patient satisfaction and follow-up adherence to glaucoma case management clinic in China.

AIM: To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes. METHODS: In this cross-sectional study, a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire. Clinical data was obtained from the case management system. Follow-up adherence was defined as completing each follow-up within ±30d of the scheduled time set by ophthalmologists during the study period. RESULTS: Average satisfaction scored 78.65±7, with an average of 4.39±0.58 across the seven dimensions. Age negatively correlated with satisfaction (P=0.008), whilst patients with follow-up duration of 2 or more years reported higher satisfaction (P=0.045). Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence (OR=0.97, 95%CI, 0.95-1.00, P=0.044). Additionally, patients with suspected glaucoma (OR=2.72, 95%CI, 1.03-7.20, P=0.044) and those with an annual income over 100 000 Chinese yuan demonstrated higher adherence (OR=5.57, 95%CI, 1.00-30.89, P=0.049). CONCLUSION: The case management model proves effective for glaucoma patients, with positive adherence rates. The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Self-management challenges and support needs among patients with primary glaucoma: a qualitative study.

BACKGROUND: Self-management plays an important role in the disease management of glaucoma patients. The effectiveness of the program can be improved by assessing the patient's perspective and needs to tailor self-management support. Most studies have focused on assessing one of these self-management behaviours, such as medication adherence, and there is a lack of systematic assessment of the support needs and challenges of self-management for patients with glaucoma. Therefore, in this study, we conducted an in-depth investigation into the self-management challenges and support needs of patients with primary glaucoma, providing a basis for nursing staff to implement self-management support. METHOD: The phenomenological method and semistructured interviews were used in this study. A total of 20 patients with primary glaucoma were recruited between June and December 2022. Colaizzi's analysis method was used to analyse the interview data. RESULTS: Challenges for patients include becoming an expert in glaucoma, managing negative emotions, adapting to daily life changes and resuming social activities. To address these challenges, four themes of patient self-management support needs were identified: (1) health information support, (2) social support, (3) psychological support, and (4) daily living support. CONCLUSION: Patients with primary glaucoma experience varying degrees of challenge in dealing with medical, emotional, and social aspects. Comprehending the support needs of patients, healthcare professionals should deliver targeted, personalized and comprehensive self-management interventions to enhance their capacity of patients to perform self-management and improve their quality of life.

Use of non-contact hopping probe ion conductance microscopy to investigate dynamic morphology of live platelets.

Circulating platelets are anucleated and multi-functional cells that participate in hemostasis and arterial thrombosis. Multiple ligands and mechanical forces activate platelets, leading to cytoskeletal rearrangement and dramatic shape-changes. Such dramatic changes in platelets membrane structures are commonly detected by optical and electron microscopy after platelets are fixed. We have recently developed a method to study the membrane morphology of live platelets using Hopping Probe Ion Conductance Microscopy (HPICM). We have successfully used this technology to study the process of platelet microvesiculation upon exposure to selective agonists. Here, we further discussed technical details of using HPICM to study platelet biology and compared results from HPICM to those from conventional atomic force microscopy and scanning electron microscopy. This method offers several advantages over current technologies. First, it monitors morphological changes of platelets in response to agonists in real time. Second, platelets can be repeatedly scanned over time without damages brought by heat and prolong light exposure. Third, there is no direct contact with platelet surface so that there will no or minimal mechanical damages brought by a cantilever of a conventional atomic force microscopy. Finally, it offers the potential to study platelet membrane ion channels, which have been technically challenging up-to-date. Our data show that HPICM has high-resolution in delineating changes of platelet morphology in response to stimulations and could help to unravel the complex role of platelet in thrombus formation.

Phosphoinositide 3-kinase pathway mediates early aldosterone action on morphology and epithelial sodium channel in mammalian renal epithelia.

Involvement of phosphoinositide 3-kinases (PI3Ks) in early aldosterone action on epithelial sodium channel (ENaC) in mammalian renal epithelia was investigated by hopping probe ion conductance microscopy combined with patch-clamping in this study. Aldosterone treatment enlarged the cell volume and elevated the apical membrane of renal mpkCCDc14 epithelia, which resulted in enhancing the open probability of ENaC. Inhibition of PI3K pathway by LY294002 obviously suppressed these aldosterone-induced changes in both cell morphology and ENaC activity. These results indicated the important role of PI3K pathway in early aldosterone action and the close relationship between cell morphology and ENaC activity in mammalian renal epithelia.

High-dose glucocorticoid aggravates TBI-associated corticosteroid insufficiency by inducing hypothalamic neuronal apoptosis.

Emerging experimental and clinical data suggest that severe illness, such as traumatic brain injury (TBI), can induce critical illness-related corticosteroid insufficiency (CIRCI). However, underlying mechanisms of this TBI-associated CIRCI remain poorly understood. We hypothesized that dexamethasone (DXM), a synthetic glucocorticoid, which was widely used to treat TBI, induces hypothalamic neuronal apoptosis to aggravate CIRCI. To test this hypothesis, we have evaluated the dose effect of DXM (1 or 10mg/kg) on the development of acute CIRCI in rats with fluid percussion injury-induced TBI and on cultured rat hypothalamic neurons in vitro (DXM, 10(-5)-10(-8)mol/L). Corticosterone Increase Index was recorded as the marker for CIRCI. In addition, MTT and TUNEL assays were used to measure the viability and apoptosis of hypothalamic neurons in primary culture. Moreover, high-resolution hopping probe ion conductance microscopy (HPICM) was used to monitor the DXM-induced morphological changes in neurons. The incidence of acute CIRCI was significantly higher in the high-dose DXM group on post-injury day 7. Cellular viability was significantly decreased from 12h to 24h after the treatment with a high-dose of DXM. A significantly increase in TUNEL positive cells were detected in cultured cells treated with a high-dose of DXM after 18h. Neurites of hypothalamic neuron were dramatically thinner and the numbers of dendritic beadings increased in neurons treated with the high dose of DXM for 12h. In conclusion, high-dose DXM induced hypothalamic neurons to undergo apoptosis in vivo and in vitro, which may aggravate TBI-associated CIRCI.

Characterization of two mammalian cortical collecting duct cell lines with hopping probe ion conductance microscopy.

We morphologically and physiologically characterized Madin-Darby canine kidney (MDCK) cell and mouse principal cell of kidney in cortical collecting duct (mpkCCD) via hopping probe ion conductance microscopy, transepithelial electrical resistance (TEER) measurements, and single-channel recordings. The specific membrane structures of microvilli and tight junctions were clearly observed in MDCK and mpkCCD cell monolayers. The electrophysiological functions of epithelial Na(+) channel in MDCK and mpkCCD cells were further characterized by measuring amiloride-sensitive TEER values for the whole-cell monolayer and detecting the ion channel activities with patch clamping. Our results provide more morphological and functional information to help better utilize these two mammalian CCD cell lines for mechanism studies of sodium absorption and reabsorption in the distal nephron.

Real-time investigation of acute toxicity of ZnO nanoparticles on human lung epithelia with hopping probe ion conductance microscopy.

Recent studies have proved that zinc oxide nanoparticles (nZnO) can cause acute lung epithelial inflammation and respiratory toxicity; however, the mechanism of such acute negative effect on lung epithelia is still unclear. In this study, early responses of living human alveolar epithelial A549 cells after exposure to nZnO were investigated by noncontact hopping probe ion conductance microscopy (HPICM) that was combined with the patch-clamp technique. Continuous repetitive high-resolution HPICM scannings observed that 100 µg/mL nZnO treatment caused acute damage to A549 cell membrane within 1.5 h. Such membrane damage was reflected in a significantly elevated lactate dehydrogenase (LDH) level in cell culture medium after 3 h of nZnO exposure. The combined HPICM and patch-clamp technique can easily perform whole-cell patch-clamp recordings, which demonstated that nZnO treatment even could inhibit the activities of ion channels in A549 cells within 15 min. The HPICM technique is shown to be capable of detecting the acute toxicity of nZnO on living cells in real time and helping to elucidate the mechanism of its action.

Investigation of morphological and functional changes during neuronal differentiation of PC12 cells by combined hopping probe ion conductance microscopy and patch-clamp technique.

PC12 cells derived from rat pheochromocytoma can differentiate into sympathetic-neuron-like cells in response to nerve growth factor (NGF). These cells have been proved to be a useful cell model to study neuronal differentiation. NGF induces rapid changes in membrane morphology, neurite outgrowth, and electrical excitability. However, the relationship between the 3D morphological changes of NGF-differentiated PC12 cells and their electrophysiological functions remains poorly understood. In this study, we combined a recently developed Hopping Probe Ion Conductance Microscopy (HPICM) with patch-clamp technique to investigate the high-resolution morphological changes and functional ion-channel development during the NGF-induced neuronal differentiation of PC12 cells. NGF enlarged TTX-sensitive sodium currents of PC12 cells, which associated with cell volume, membrane surface area, surface roughness of the membrane, and neurite outgrowth. These results demonstrate that the combination of HPICM and patch-clamp technique can provide detailed information of membrane microstructures and ion-channel functions during the differentiation of PC12 cells, and has the potential to become a powerful tool for neuronal research.

High-resolution morphological identification and characterization of living neuroblastoma SK-N-SH cells by hopping probe ion conductance microscopy.

It is well known that heterogeneous neuroblastoma (NB) has three different phenotypic variants; the differentiation and transdifferentiation among them increase the complexity of this cancer. However, high-resolution characterization of their morphology has not been addressed by conventional microscopy. Under the help of high-resolution hopping probe ion conductance microscopy, we demonstrated that three morphologically distinct cell populations exist in live NB SK-N-SH cell line. Among these three types cells, N-type cells had the smallest cell volume and the biggest height, S-type owned the biggest cell volume and the smallest height, and I-type was intermediate between N- and S-type. The difference of microvilli morphology rendered I- and N-type cells with a higher RMS than S-type cells. These high-resolution morphologic criteria can provide more direct information to distinguish different cell types in NB tumor, and may give a hand to the development of new therapies and diagnosis.

[High-resolution patch-clamp technique based on feedback control of scanning ion conductance microscopy].

The ion channels located on the cell fine structures play an important role in the physiological functions of cell membrane. However, it is impossible to achieve precise positioning on the nanometer scale cellular microstructures by conventional patch-clamp technique, due to the 200 nm resolution limit of optical microscope. To solve this problem, we have established a high-resolution patch-clamp technique, which combined commercial scanning ion conductance microscopy (SICM) and patch-clamp recording through a nanopipette probe, based on SICM feedback control. MDCK cells were used as observation object to test the capability of the technique. Firstly, a feedback controlled SICM nanopipette (approximately 150 MOmega) non-contactly scanned over a selected area of living MDCK cells monolayer to obtain high-resolution topographic images of microvilli and tight-junction microstructures on the MDCK cells monolayer. Secondly, the same nanopipette was non-contactly moved and precisely positioned over the microvilli or tight-junction microstructure under SICM feedback control. Finally, the SICM feedback control was switched off, the nanopipette slowly contacted with the cell membrane to get a patch-clamp giga-ohm sealing in the cell-attached patch-clamp configuration, and then performed ion channel recording as a normal patch-clamp electrode. The ion channel recordings showed that ion channels of microvilli microstructure opened at pipette holding potential of -100, -60, -40, 0, +40, +60, +100 mV (n=11). However, the opening of ion channels of tight-junction microstructure was not detected at pipette holding potential of -100, -40, 0, +40, +100 mV (n=9). These results suggest that our high-resolution patch-clamp technique can achieve accurate nanopipette positioning and nanometer scale high-resolution patch-clamp recording, which may provide a powerful tool to study the spatial distribution and functions of ion channel in the nanometer scale microstructures of living biological samples.

[Hopping probe scanning ion conductance microscopy and its applications to topological imaging of live neuronal cells].

As a new kind of non-contacting high-resolution scanning probe microscopy, hopping probe scanning ion conductance microscopy (HPSICM) overcomes the disadvantages of the continuous feedback-control scanning mode of the conventional scanning ion conductance microscopy (SICM), which has been restricted to imaging relatively flat biological samples. The basic operation principles of HPSICM were briefly introduced in this paper. Then the high-resolution 3D morphological images of the two live neuronal cell lines, SK-N-SH cells and NGF-differentiated neurite PC12 cells, were respectively acquired in their physiological culture environment using HPSICM. It is demonstrated that HPSICM provides a powerful microscopy for in-depth studying the microstructures and their dynamic changes of live neuronal cells in real time.