Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm.

AIM: To explore the risk factors of oculomotor nerve palsy (ONP) in patients with intracranial aneurysm (IA) and develop a nomogram model for predicting ONP of IA patients. METHODS: A total of 329 IA patients were included. Logistic regression analysis was applied to identify independent factors, which were then integrated into the nomogram model. The performance of the nomogram model was evaluated by calibration curve, receiver operating curve (ROC), and decision curve analysis. RESULTS: Univariate and multivariate logistic regression analysis indicated posterior communicating artery (PCoA) aneurysm [hazard ratio (HR)=17.13, P<0.001] and aneurysm diameter (HR=1.31, P<0.001) were independent risk factors of ONP in IA patients. Based on the results of logistic regression analysis, a nomogram model for predicting the ONP in IA patients was constructed. The calibration curve indicated the nomogram had a good agreement between the predictions and observations. The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve (AUC) of 0.863. The decision curve analysis showed that the nomogram was powerful in the clinical decision. PCoA aneurysm (HR=3.38, P=0.015) was identified to be the only independent risk factor for ONP severity. CONCLUSION: PCoA aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients. The nomogram established is performed reliably and accurately for predicting ONP. PCoA aneurysm is the only independent risk factor for ONP severity.

Impact of workplace violence against nurses' thriving at work, job satisfaction and turnover intention: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the interrelationships between workplace violence, thriving at work and turnover intention among Chinese nurses and to explore the action mechanism among these variables. BACKGROUND: Workplace violence is a dangerous occupational hazard globally, and it is pervasive in the health service industry. As a corollary, workplace violence may produce many negative outcomes among nursing staff. Consequently, it hinders nurses' professional performance and reduces nursing quality. DESIGN: A cross-sectional online survey was conducted. METHODS: A total of 1,024 nurses from 26 cities in China were recruited from February-May 2016. An anonymous questionnaire was used in this survey. Participants' completed data were collected using a demographics form and a 26-item questionnaire consisting of scales addressing workplace violence, thriving at work, job satisfaction, subjective well-being and turnover intention. To evaluate multivariate relationships, some multiple linear hierarchical regression analyses were performed. RESULTS: Workplace violence significantly negatively influenced nurses' job satisfaction and thriving at work, and significantly positively influenced nurses' turnover intention. Job satisfaction significantly predicted thriving at work and turnover intention. Job satisfaction not only fully mediated the relationship between workplace violence and thriving at work, but also partially mediated the relationship between workplace violence and turnover intention. Subjective well-being moderated the relationship between workplace violence and job satisfaction and the relationship between workplace violence and nurses' turnover intention. CONCLUSIONS: Adverse effects of workplace violence were demonstrated in this study. Decreases in job satisfaction were a vital mediating factor. The moderating effect of subjective well-being was helpful in reducing the harm of workplace violence to nurses and in decreasing their turnover intention. RELEVANCE TO CLINICAL PRACTICE: Workplace violence and its negative impact on nursing work should not go unnoticed by nursing managers. Nurses' subjective well-being is critical in controlling and mitigating the adverse effects of workplace violence.

Patients' perceptions of service quality in China: An investigation using the SERVQUAL model.

BACKGROUND AND AIM: The doctor-patient relationship has been a major focus of society. Hospitals' efforts to improve the quality of their medical services have been to reduce the probability of doctor-patient conflicts. In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality. METHODS: Twenty-seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics. RESULTS: There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients' perceptions of service quality are lower than their expectations. CONCLUSIONS: According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients.

Overexpression of Transforming Acidic Coiled Coil­Containing Protein 3 Reflects Malignant Characteristics and Poor Prognosis of Glioma.

Gliomas are malignant primary brain tumors with poor prognosis. Recently, research was indicative of a tight connection between tumor malignancy and genetic alterations. Here, we propose an oncogenic implication of transforming acidic coiled-coil-containing protein 3 (TACC3) in gliomas. By comprehensively analyzing the Chinese glioma genome atlas (CGGA) and publicly available data, we demonstrated that TACC3 were overexpressed along with glioma grade and served as an independent negative prognostic biomarker for glioma patients. Functions' annotations and gene sets' enrichment analysis suggested that TACC3 may participate in cell cycle, DNA repair, epithelium-mesenchymal transition and other tumor-related biological processes and molecular pathways. Patients with high TACC3 expression showed CD133⁺ stem cell properties, glioma plasticity and shorter overall survival time under chemo-/radio-therapy. Additionally, a TACC3 associated the miRNA-mRNA network was constructed based on in silico prediction and expression pattern, which provide a foundation for further detection of TACC3-miRNA-mRNA axis function. Collectively, our observations identify TACC3 as an oncogene of tumor malignancy, as well as a prognostic and motoring biomarker for glioma patients.

Research on mouse model of grade II corneal alkali burn.

AIM: To choose appropriate concentration of sodium hydroxide (NaOH) solution to establish a stable and consistent corneal alkali burn mouse model in grade II. METHODS: The mice (n=60) were randomly divided into four groups and 15 mice each group. Corneal alkali burns were induced by placing circle filter paper soaked with NaOH solutions on the right central cornea for 30s. The concentrations of NaOH solutions of groups A, B, C, and D were 0.1 mol/L, 0.15 mol/L, 0.2 mol/L, and 1.0 mol/L respectively. Then these corneas were irrigated with 20 mL physiological saline (0.9% NaCl). On day 7 postburn, slit lamp microscope was used to observe corneal opacity, corneal epithelial sodium fluorescein staining positive rate, incidence of corneal ulcer and corneal neovascularization, meanwhile pictures of the anterior eyes were taken. Cirrus spectral domain optical coherence tomography was used to scan cornea to observe corneal epithelial defect and corneal ulcer. RESULTS: Corneal opacity scores (x±s) were not significantly different between the group A and group B (P=0.097). Incidence of corneal ulcer in group B was significantly higher than that in group A (P=0.035). Incidence of corneal ulcer and perforation rate in group B was lower than that in group C. Group C and D had corneal neovascularization, and incidence of corneal neovascularization in group D was significantly higher than that in group C (P=0.000). CONCLUSION: Using 0.15 mol/L NaOH can establish grade II mouse model of corneal alkali burns.

Annexin A2 silencing enhances apoptosis of human umbilical vein endothelial cells in vitro.

OBJECTIVE: To study the effects of inhibited Annexin A2 (ANXA2) on human umbilical vein endothelial cells (HUVECs) in vitro. METHODS: Short hairpin RNA (shRNA) targeting ANXA2 was designed and cloned into double marked lentivirial vector GV248 for RNAi to generate the recombinant expression plasmids, which were stably transfected into HUVECs. The protein and mRNA expression levels of ANXA2 were analyzed by western blotting and real-time polymerase chain reaction, respectively. Cell proliferation (cell counting kit-8 assay), apoptosis (flow cytometry analysis), the expression (western blotting) and the activity of caspases (enzyme-linked immunosorbent assay) were used to assess the effects of silencing ANXA2 on HUVECs in vitro. RESULTS: The plasmids to express ANXA2-specific shRNA were constructed and were infected into HUVEC resulting in the stably transfected experimental (ANXA2-shRNA), control (control-shRNA) and mock (no plasmid) cell lines, which were verified with western blot and real-time PCR. HUVEC/ANXA2-shRNA showed an inhibition rate 91.89% of ANXA2 expression compared to the mock HUVEC. ANXA2 silencing cell strain obviously presented a lower cell proliferation activity compared to the control and mock HUVECs, with an inhibition rate 82.35% on day 7 in vitro. FACS analysis indicated that the HUVEC/ANXA2-shRNA cells undergoing apoptosis increased by 102.61% compared to the mock HUVECs (P < 0.01). Moreover, the activity levels of caspase-3, caspase-8 and caspase-9 in HUVEC/ANXA2-shRNA cells were increased and the activated cleaved caspase-3, cleaved caspase-8 and cleaved caspase-9 were upregulated evidently compared with that of the control and mock HUVECs by 56.29%, 89.59% and 144.58% (P < 0.01). CONCLUSIONS: shRNA-mediated silencing of ANXA2 could not only be able to suppress HUVECs proliferation but to upregulate the enzyme activity of caspases, which bring to an increase of cell apoptosis. This work suggested that ANXA2 may represent a useful target of future molecular therapies.

Altered microRNA expression profiles in retinas with diabetic retinopathy.

Rats with streptozotocin (STZ)-induced diabetes were studied in order to identify abnormal microRNA (miRNA) expression profiles in diabetic retinopathy (DR) and to ascertain miRNAs associated with DR. Histopathologically, we observed characteristic features of DR in rats at 10 weeks after STZ injection. Investigation of miRNA expression profiles in the retinas of control and diabetic rats using miRNA microarrays revealed that many miRNAs were abnormally expressed in DR. On the basis of their fold changes and probability values, a total of 37 miRNAs were selected for further validation by real-time PCR analysis. The results showed that 11 miRNAs were significantly upregulated and 6 miRNAs were notably downregulated in DR. Furthermore, these changes in retinal miRNA expression levels paralleled the course of DR. Levels of miR-182, miR-96, miR-183, miR-211, miR-204, and miR-124 were significantly increased during the progress of DR, whereas miR-10b, miR-10a, miR-219-2-3p, miR-144, miR-338, and miR-199a-3p were significantly decreased. Our data indicate that the aberrant miRNA expression profiles in DR are associated with the development of DR. Modulation of retinal miRNA expression levels may provide a potential therapeutic strategy for DRs.

Annexin A2 promotes choroidal neovascularization by increasing vascular endothelial growth factor expression in a rat model of argon laser coagulation-induced choroidal neovascularization.

BACKGROUND: Choroidal neovascularization (CNV) is a common cause of visual loss in the elderly patients with age-related macular degeneration and represents the growth of subretinal new vessels in the macular region. This study aimed to investigate the relationship between annexin A2 (ANXA2) and vascular endothelial growth factor (VEGF) in CNV. METHODS: In a rat model of argon laser coagulation-induced CNV, the mRNA expressions of the annexins and VEGF protein expression in the retina were detected using fluorescent real-time polymerase chain reaction (PCR) and immunohistochemistry, respectively. The interactions between ANXA2 and VEGF in both a retinal pigment epithelial cell line RPE-J and the rat model of CNV were examined by means of RNA interference, real-time PCR, Western blotting, enzyme-linked immunosorbent assay (ELISA) and histopathological examinations. RESULTS: Fundus fluorescein angiography (FFA) showed that argon laser coagulation of the retina induced stable CNV models in the rats. Two to three weeks after the coagulation, ANXA2 and VEGF expressions in the coagulated area in the retina and choroid increased to the peak level, while the other annexin members (ANXA4, ANXA5, ANXA7 and ANXA11) showed no obvious changes. In RPE-J cells and the CNV model, RNA interference of ANXA2 gene significantly lowered the VEGF protein and mRNA expressions, and application of an adenoviral vector containing ANXA2 gene markedly increased VEGF expressions in the rat model of CNV, but produced no significant effects on the expressions of the kinase insert domain-containing receptor (KDR) or the fms-like tyrosine kinase (Flt-1). The expression of KDR inhibited the increment in ANXA2 expression, but VEGF and Flt-1 did not directly affect ANXA2 expression. CONCLUSION: Besides the role as a plasminogen and the receptor of tissue plasminogen activator, ANXA2, which is under regulation of KDR via a negative feedback mechanism, also participates in neovascularization by regulating VEGF expression through a positive feedback mechanism.

Quality nursing care as perceived by nurses and patients in a Chinese hospital.

AIMS AND OBJECTIVES: To explore and compare nurses and patients perceptions of quality nursing care. BACKGROUND: It is important to measure both nurses and patients perceptions of quality nursing care. To date, however, no study on nurses' perceptions of quality nursing care has been conducted specifically in the Chinese setting. DESIGN: Descriptive, comparative study with 221 nurses and 383 patients in 18 non-ICU inpatient nursing units. METHODS: Data were collected using the Perception of Quality Nursing Care Scale. RESULTS: The results showed that the overall mean score and each category mean score, as perceived by nurses and patients, were high. There was a statistically significant difference between nurses' and patients' perceptions of quality nursing care based on the following categories: staff characteristics, care-related activities and progress of nursing process. However, similarities in perception have also been identified in some categories. CONCLUSIONS: The findings indicate that nurses and patients had differing views of quality nursing care, because they may have had different standards and ways in which they viewed these characteristics of care. Improvements are needed regarding certain aspects of patient information and support for patients' psychological needs. RELEVANCE TO CLINICAL PRACTICE: It is a challenge to nurses when taking collaborative action to meet patients' expectations and needs, however, it will move nursing practice in Chinese hospitals forward.

[Management of primary angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens implantation].

OBJECTIVE: To evaluate the efficacy and safety of phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract. METHODS: Twenty-six cases(28 eyes) with simple cataract and 60 cases(70 eyes)of PACG with cataract, including 14 eyes of preclinical APACG, 29 eyes of paroxysmal APACG, 27 eyes of CPACG. Visual acuity distributed from hand movement to 0.8. Phacoemulsification and intraocular lens implantation were performed and patients were followed up for(8.5+/-4.5) months. RESULT: In simple cataract group, postoperative IOP did not decrease(t=1.9201, P>0.05); in preclinical APACG group, postoperative IOP decreased (t=3.9910, P<0.01); in paroxysmal APACG group, postoperative IOP decreased (t=4.7441, P<0.01); in CPACG groups, postoperative IOP decreased (t=4.4976, P<0.01). In APACG and CPACG groups postoperative antiglaucoma medication reduced. In APACG and CPACG groups, angle of anterior chamber was widen. Preoperative central and peripheral ACD of APACG and CPACG were much less than those of postoperative. In 56 eyes of PACG, visual acuity was corrected in 48 eyes(85.7%) including 28 eyes(50%) with corrected visual acuity>0.5. CONCLUSION: The phacoemulsification with foldable posterior chamber intraocular lens implantation is beneficial for PACG with cataract, and the curative efficacy of APACG is better than that of CPACG.

[Expression of vascular endothelial growth factor and its receptor in experimental choroidal neovascularization in rat].

OBJECTIVE: To study the expressions of vascular endothelial growth factor and its receptor FLK1 in krypton laser-induced choroidal neovascularization (CNV) in Brown Norway rat. METHODS: Thirty anesthetized male Brown Norway rats received krypton laser (647 nm, 360 mW, 50 micro m, 0.05 s) to induce CNV. Fundus fluorescein angiography examinations were performed just before euthanasia on days 3, 7, 14, 21, 28 and 56 after laser photocoagulation. The retina was processed for histopathology analysis. VEGF mRNA, VEGF and FLK1 expressions were demonstrated using in situ hybridization and immunohistochemistry staining respectively. RESULTS: VEGF mRNA expression was mainly observed in the vascular endothelial cells, the ganglion cells, the inner nuclear layers, the retinal pigment epithelial cells in normal retina and the vascular endothelial cells of normal choroid of BN rat. VEGF mRNA expressed in the vascular endothelial cells, the ganglion cells, the inner nuclear layers, lesion of outer nuclear layers in retina on days 3 after photocoagulation, but CNV wasn't detected. The level of VEGF mRNA expression in retina was decreased after 3 days (P < 0.01). CNV was firstly observed on day 7 after photocoagulation by FFA and histopathology. The area and density of positively stained cells for VEGF mRNA in CNV were increased during the development of CNV (P < 0.01) and no significant change after days 21 (P > 0.05). FLK1 was detected in the vascular endothelial cells, the ganglion cells of normal retina and the vascular endothelial cells of choroid. The staining of FLK1 was positive in laser induced CNV after days 7, the level of the receptor expression was increased during the development of CNV (P < 0.01) and was not significantly changed after days 21 (P > 0.05). CONCLUSIONS: VEGF and its receptor FLK1 accumulation and combination in the lesion of retina and choroid are related to choroidal neovascularization induced by laser.

[Expression and signification of pigment epithelium-derived factor in experimental choroidal neovascularization of rat].

OBJECTIVE: To investigate the expression and signification of pigment epithelium-derived factor in choroidal neovascularization (CNV) induced by krypton laser on Brown Norway rat. METHODS: Five groups of 30 rats were photocoagulated by krypton laser in single eye to induce CNV. 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks after photocoagulation, The retina was processed for histopathology, in situ hybridization of PEDF mRNA, immunohistochemistry of PEDF and FVIIIR:Ag. RESULTS: CNV was formed 1 week after photocoagulation, and reached its peak at 3 weeks. PEDF mRNA, PEDF expressed in the ganglion cells, inner nuclear layer, retinal pigment epithelial cells in normal BN retina. After photocoagulation, the expression of PEDF mRNA and PEDF was observed in the ganglion cells, inner nuclear layer, retinal pigment epithelial cells, and the lesions of outer nuclear layer and choroid; the expression of PEDF in the lesions was weaker than that at the edge of the lesions. From 3 days to 4 weeks, the expression density of FVIIIR:Ag gradually increased, however, the expression density of PEDF mRNA and PEDF in the lesions decreased (P < 0.05). The expression of FVIIIR:Ag was inversely correlated with that of PEDF during the development of CNV (r = -0.84, P < 0.05). CONCLUSIONS: CNV is inversely correlated with PEDF. The down-regulation of PEDF may be one of the main reasons for the formation and development of CNV.

[Study on the experimental model of krypton laser-induced choroidal neovascularization in the rats].

OBJECTIVE: To evaluate the feasibility of krypton laser-induced choroidal neovascularization (CNV) model in the Brown Norway rats in order to establish the foundation for studying the mechanism of CNV and for the development of treatment for CNV. METHODS: Experimental eyes in 33 rats were received a series of 10 krypton red laser (647 nm) lesions per eye (360 mW, 50 micro m, 0.05 s). Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed, then the rats were sacrificed immediately, the eyes were enucleated and processed for histopathologic examination and transmission electron microscopy on days 3, 7, 14, 21, 28 and 56. RESULTS: CNV was firstly appeared on day 7 after photocoagulation, reaching the peak on day 21. The incidence of CNV was 76.0%. Disciform leakage staining appeared in the FFA. ICGA showed that the disciform area was filled with CNV. CNV was ascertained by light microscopy and electron microscopy. The thickness of laser-induced CNV was increased from day 7 to day 21 (P < 0.01) and no significant progress occurred after day 21 (P > 0.05). CONCLUSIONS: The present studies demonstrated that krypton laser photocoagulation could be used to produce choroidal neovascularization experimental model in the Brown Norway rat. CNV can be induced rapidly by the method, persists for a long period and at a high successful rate.