Association between dietary carbohydrate intake percentage and epilepsy prevalence in the NHANES 2013-2018: a cross-sectional study.

BACKGROUND: Epilepsy is a neurological disorder characterized by recurrent seizures. We aimed to investigate the association between the percentage of dietary carbohydrate intake (DCI) and epilepsy prevalence among American adults. METHODS: We analyzed the data from 9,584 adults aged 20-80 years who participated in the National Health and Nutrition Examination Survey from 2013 to 2018. Logistic regression was applied to explore the association between the percentage of DCI and epilepsy prevalence. RESULTS: A total of 146 (1.5%) individuals with epilepsy were enrolled in this study. The average age of the participants was 56.4 years, and 5,454 (56.9%) individuals were female. A high DCI was associated with an increased prevalence of epilepsy (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.11-18.69; P = 0.035) after adjusting for age, sex, marital status, race/ethnicity, educational level, family income, body mass index, smoking status, drinking status, hypertension, diabetes, and cardiovascular disease. Stratified analyses indicated a positive correlation between DCI and epilepsy prevalence in adults with different characteristics. Compared with individuals in quartile 1 of DCI (<40.5%), those in quartile 4 (>55.4%) had an adjusted OR for epilepsy of 1.72 (95% CI, 1.09-2.73, P = 0.02, P for trend = 0.012). CONCLUSIONS: A high percentage of DCI was associated with an increased prevalence of epilepsy. The risk of epilepsy increased 3.5-fold with a 1% increase in DCI. These results suggest an important role of DCI in the dietary management of epilepsy.

Correlation Analysis of Multi-Scale Ictal EEG Signals in Juvenile Myoclonic Epilepsy.

BACKGROUND: To explore the time-frequency structure and cross-scale coupling of electroencephalography (EEG) signals during seizure in juvenile myoclonic epilepsy (JME), correlations between different leads, as well as dynamic evolution in epileptic discharge, progression and end of seizure were examined. METHODS: EEG data were obtained for 10 subjects with JME and 10 normal controls and were decomposed using gauss continuous wavelet transform (CWT). The phase amplitude coupling (PAC) relationship between the 11th (4.57 Hz) and 17th (0.4 Hz) scale was investigated. Correlations were examined between the 11th and 17th scale EEG signals in different leads during seizure, using multi-scale cross correlation analysis. RESULTS: The time-frequency structure of JME subjects showed strong rhythmic activity in the 11th and 17th scales and a close PAC was identified. Correlation analysis revealed that the ictal JME correlation first increased in the anterior head early in seizure and gradually expanded to the posterior head. CONCLUSION: PAC was exhibited between the 11th and 17th scales during JME seizure. The results revealed that the correlation in the anterior leads was higher than the posterior leads. In the perictal period, the 17th scale EEG signal preceded the 11th scale signal and remained for some time after a seizure. This suggests that the 17th scale signal may play an important role in JME seizure.

Investigations on the EPR g factors and local structures for the orthorhombic and tetragonal Cu2+ centers in Pb[Zr0.54Ti0.46]O3.

The defect models of the orthorhombical and tetragonal Cu2+ centers in Pb[Zr0.54Ti0.46]O3 are attributed to Cu2+ ions occupying the sixfold coordinated octahedral Ti4+ site with and without charge compensation, respectively. The electron paramagnetic resonance (EPR) g factors gi (i = x, y, z) of the Cu2+ centers in Pb[Zr0.54Ti0.46]O3 are theoretically studied by using the perturbation formulas of a 3d9 ion under orthorhombically and tetragonally elongated octahedra. Based on the calculation, the impurity off-center displacements are about 0.253 and 0.162 Å for the orthorhombical and tetragonal Cu2+ centers, respectively. Meanwhile, the planar Cu2+-O2- bonds are found to experience the relative variation ΔR (≈0.102 Å) along the a- and b-axes for the orthorhombical Cu2+ center due to the Jahn-Teller (JT) effect. The theoretical EPR g factors based on the above local structures agree well with the observed values.

Theoretical studies on the local structure and spin Hamiltonian parameters for Cu2+ ions in LiTaO3 crystal.

The local structure and spin Hamiltonian parameters (SHPs) g factors (gx , gy , gz ) and the hyperfine structure constants (Ax , Ay , Az ) for Cu2+ doped in the LiTaO3 crystal are theoretically investigated by the perturbation formulas for a 3d9 ion under rhombically elongated octahedral based on the cluster approach. The impurity Cu2+ was assumed to occupy the host trigonally-distorted octahedral Li+ site and experience the Jahn-Teller (JT) distortion from the host trigonal octahedral [TaO6 ]10- to the impurity rhombically elongated octahedral [CuO6 ]10- . Based on the calculations, the impurity-ligand bond lengths parallel and perpendicular to the C2 -axis are found to be R|| (≈ 2.305 Å) and R⊥ (≈ 2.112 Å) for the studied [CuO6 ]10- cluster, with the planar bond angle θ (≈ 78.2°). Meanwhile, the ground-state wave function for Cu2+ center in LiTaO3 was also obtained. The calculated SHPs based on the above local lattice distortions agree well with the experimental data, and the results are discussed.

Personal PM2.5 Elemental Components, Decline of Lung Function, and the Role of DNA Methylation on Inflammation-Related Genes in Older Adults: Results and Implications of the BAPE Study.

Epidemiological evidence of the effects of PM2.5 elements on lung function and DNA methylation is limited. We conducted a longitudinal panel study of 76 healthy older adults aged 60-69 years in Jinan, China, from September 2018 to January 2019. We periodically measured individual 72 h PM2.5 and element concentrations, lung function, and DNA methylation levels of eight inflammation-related genes. We used linear mixed-effect models to investigate the effects of exposure to personal PM2.5 elements on the lung function and DNA methylation. Mediation analysis was used to investigate the underlying effect mechanism. Negative changes in the ratio of forced expiratory volume in 1 s to forced vital capacity, ranging from -1.23% [95% confidence interval (CI): -2.11%, -0.35%] to -0.77% (95% CI: -1.49%, -0.04%), were significantly associated with interquartile range (IQR) increases in personal PM2.5 at different lag periods (7-12, 13-24, 25-48, 0-24, 0-48, and 0-72 h). Arsenic (As), nickel, rubidium (Rb), selenium, and vanadium were significantly associated with at least three lung function parameters, and IQR increases in these elements led to 0.12-5.66% reductions in these parameters. PM2.5 elements were significantly associated with DNA methylation levels. DNA methylation mediated 7.28-13.02% of the As- and Rb-related reduced lung function. The findings indicate that exposure to elements in personal PM2.5 contributes to reduced lung function through DNA methylation.

Hydrogen-Binding-Initiated Activation of O-H Bonds on a Nitrogen-Doped Surface for the Catalytic Oxidation of Biomass Hydroxyl Compounds.

Hydrogen binding of molecules on solid surfaces is an attractive interaction that can be used as the driving force for bond activation, material-directed assembly, protein protection, etc. However, the lack of a quantitative characterization method for hydrogen bonds (HBs) on surfaces seriously limits its application. We measured the standard Gibbs free energy change (ΔG0 ) of on-surface HBs using NMR. The HB-accepting ability of the surface was investigated by comparing ΔG0 values employing the model biomass platform 5-hydroxymethylfurfural on a series of Co-N-C-n catalysts with adjustable electron-rich nitrogen-doped contents. Decreasing ΔG0 improves the HB-accepting ability of the nitrogen-doped surface and promotes the selectively initiated activation of O-H bonds in the oxidation of 5-hydroxymethylfurfural. As a result, the reaction kinetics is accelerated. In addition to the excellent catalytic performance, the turnover frequency (TOF) for this oxidation is much higher than for reported non-noble-metal catalysts.

Binding Energy as Driving Force for Controllable Reconstruction of Hydrogen Bonds with Molecular Scissors.

Hydrogen bonds are one of the most important directional intermolecular interactions and play key roles in chemical and biochemical systems, but there is still a lack of prediction and understanding of their control. Herein, hydrogen-binding energy (EHB) acted as a driving force for controllably reconstructing hydrogen bonds with molecular scissors. We related hydrogen-binding energies of the donor-acceptor couple (EHB,2) and the donor itself (EHB,1) and ΔG based on ΔG = a1EHB,1 + a2EHB,2 + a3. When EHB,1 and EHB,2 satisfy the condition ΔG < 0, the acceptor is predicted as molecular scissors with sufficient reconstruction capacity in breaking the initial hydrogen bonds and forming new ones. Remarkably, we developed an experimental method to determine the EHB values by a linear equation as a function of chemical shifts (δ) ([Formula: see text]), which is innovational since in the former research EHB can only be deduced from empirical formulas and DFT calculation. On that basis, the hydrogen bonds of α-cellulose were broken and re-formed in molecular scissors-consisting deep eutectic solvents, leading to the white powder transforming into a hydrogel and colorless and transparent thin film materials with distinct crystalline structure, surface flatness, and morphology.

Flexible, Transparent, and Hazy Cellulose Nanopaper with Efficient Near-Infrared Luminescence Fabricated by 2D Lanthanide (Ln = Nd, Yb, or Er) Metal-Organic-Framework-Grafted Oxidized Cellulose Nanofibrils.

Three-dimensional (3D) bulk materials, such as metal-organic frameworks (MOFs) and inorganic phosphors, show the properties of large backscattering and stress concentration, which result in low mechanical and inferior transmittance when these materials are hydridized with a polymer matrix. Inspired by the "reinforcement" effects of two-dimensional (2D) materials, such as grapheme, C3N4, MoS2, and Mxene, it was interesting to examine a 2D lanthanide (Ln)-based MOF-grafted natural polymer (nanocellulose) with the goal of achieving light emission, transparency, and good mechanical properties. A series of near-infrared (NIR) luminescent cellulose nanopapers were prepared via 2D Ln-MOF-grafted (2,2,6,6-tetramethylpiperidin-1-yl)oxyl-oxidized cellulose nanofibrils (tCNFs; Ln = Nd, Yb, or Er). In addition to efficient NIR luminescence, these Ln nanopapers exhibited good flexibility, transparency (>90%), and mechanical properties (>28 MPa). Notably, the haze of these nanopapers was increased by 93-95% from 26% due to compositing with 2D Ln-MOFs, which prevented dense packing among the cellulose and formed air cavities in the nanopaper, inducing internal light scattering and improving optical haze. Moreover, these flexible Ln nanopapers exhibited efficient NIR luminescence, which, together with optical haze and transparency, offered an opportunity for utilization in paper-based anticounterfeiting, NIR-light-emitting diodes, or light softening devices.

Long-read sequencing identified intronic repeat expansions in SAMD12 from Chinese pedigrees affected with familial cortical myoclonic tremor with epilepsy.

BACKGROUND: The locus for familial cortical myoclonic tremor with epilepsy (FCMTE) has long been mapped to 8q24 in linkage studies, but the causative mutations remain unclear. Recently, expansions of intronic TTTCA and TTTTA repeat motifs within SAMD12 were found to be involved in the pathogenesis of FCMTE in Japanese pedigrees. We aim to identify the causative mutations of FCMTE in Chinese pedigrees. METHODS: We performed genetic linkage analysis by microsatellite markers in a five-generation Chinese pedigree with 55 members. We also used array-comparative genomic hybridisation (CGH) and next-generation sequencing (NGS) technologies (whole-exome sequencing, capture region deep sequencing and whole-genome sequencing) to identify the causative mutations in the disease locus. Recently, we used low-coverage (~10×) long-read genome sequencing (LRS) on the PacBio Sequel and Oxford Nanopore platforms to identify the causative mutations, and used repeat-primed PCR for validation of the repeat expansions. RESULTS: Linkage analysis mapped the disease locus to 8q23.3-24.23. Array-CGH and NGS failed to identify causative mutations in this locus. LRS identified the intronic TTTCA and TTTTA repeat expansions in SAMD12 as the causative mutations, thus corroborating the recently published results in Japanese pedigrees. CONCLUSIONS: We identified the pentanucleotide repeat expansion in SAMD12 as the causative mutation in Chinese FCMTE pedigrees. Our study also suggested that LRS is an effective tool for molecular diagnosis of genetic disorders, especially for neurological diseases that cannot be positively diagnosed by conventional clinical microarray and NGS technologies.

GPCR structure and function relationship: identification of a biased apelin receptor mutant.

Biased ligands of G protein-coupled receptors (GPCRs) may have improved therapeutic benefits and safety profiles. However, the molecular mechanism of GPCR biased signaling remains largely unknown. Using apelin receptor (APJ) as a model, we systematically investigated the potential effects of amino acid residues around the orthosteric binding site on biased signaling. We discovered that a single residue mutation I109A (I1093.32) in the transmembrane domain 3 (TM3) located in the deep ligand-binding pocket was sufficient to convert a balanced APJ into a G protein signaling biased receptor. APJ I109A mutant receptor retained full capabilities in ligand binding and G protein activation, but was defective in GRK recruitment, ß-arrestin recruitment, and downstream receptor-mediated ERK activation. Based on molecular dynamics simulations, we proposed a molecular mechanism for biased signaling of I109A mutant receptor. We postulate that due to the extra space created by I109A mutation, the phenyl group of the last residue (Phe-13) of apelin rotates down and initiates a cascade of conformational changes in TM3. Phe-13 formed a new cluster of hydrophobic interactions with the sidechains of residues in TM3, including F1103.33 and M1133.36, which stabilizes the mutant receptor in a conformation favoring biased signaling. Interruption of these stabilizing interactions by double mutation F110A/I109A or M113A/I109A largely restored the ß-arrestin-mediated signaling. Taken together, we describe herein the discovery of a biased APJ mutant receptor and provide detailed molecular insights into APJ signaling selectivity, facilitating the discovery of novel therapeutics targeting APJ.

Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Overexpression of miR-582-5p Inhibits the Apoptosis of Neuronal Cells after Cerebral Ischemic Stroke Through Regulating PAR-1/Rho/Rho Axis.

OBJECTIVE: The purpose of this study was to explore the role of miR-582-5p/proteinase-activated receptors type I (PAR-1)/Rho/Rho in neuronal cell apoptosis after cerebral ischemic stroke (CIS). METHODS: In vivo mouse model of CIS induced by middle cerebral artery occlusion and in vitro model induced by oxygen-glucose deprivation/reoxygenation (OGD/R) in N2A cells was established. The expressions of miR-582-5p, PAR-1, RhoA, and ROCKII in brain tissues and N2A cells were detected. Neuronal cell apoptosis was detected by flow cytometry. RESULTS: We found that miR-582-5p expression was decreased and the expressions of PAR-1, RhoA, and ROCKII were increased in CIS mice and OGD/R model. Moreover, miR-582-5p negatively regulated PAR-1, and overexpression of miR-582-5p inhibited the activation of Rho/Rho pathway by downregulating PAR-1, thus reducing OGD/R-induced neuronal cell apoptosis. CONCLUSIONS: Our results suggested that miR-582-5p overexpression could regulate Rho/Rho-kinase signaling pathway via targeting PAR-1, thereby governing the apoptosis of neuronal cells after CIS.

Identification of Human Anti-HIV gp160 Monoclonal Antibodies That Make Effective Immunotoxins.

The envelope (Env) glycoprotein of HIV is the only intact viral protein expressed on the surface of both virions and infected cells. Env is the target of neutralizing antibodies (Abs) and has been the subject of intense study in efforts to produce HIV vaccines. Therapeutic anti-Env Abs can also exert antiviral effects via Fc-mediated effector mechanisms or as cytotoxic immunoconjugates, such as immunotoxins (ITs). In the course of screening monoclonal antibodies (MAbs) for their ability to deliver cytotoxic agents to infected or Env-transfected cells, we noted disparities in their functional activities. Different MAbs showed diverse functions that did not correlate with each other. For example, MAbs against the external loop region of gp41 made the most effective ITs against infected cells but did not neutralize virus and bound only moderately to the same cells that they killed so effectively when they were used in ITs. There were also differences in IT-mediated killing among transfected and infected cell lines that were unrelated to the binding of the MAb to the target cells. Our studies of a well-characterized antigen demonstrate that MAbs against different epitopes have different functional activities and that the binding of one MAb can influence the interaction of other MAbs that bind elsewhere on the antigen. These results have implications for the use of MAbs and ITs to kill HIV-infected cells and eradicate persistent reservoirs of HIV infection. IMPORTANCE: There is increased interest in using antibodies to treat and cure HIV infection. Antibodies can neutralize free virus and kill cells already carrying the virus. The virus envelope (Env) is the only HIV protein expressed on the surfaces of virions and infected cells. In this study, we examined a panel of human anti-Env antibodies for their ability to deliver cell-killing toxins to HIV-infected cells and to perform other antiviral functions. The ability of an antibody to make an effective immunotoxin could not be predicted from its other functional characteristics, such as its neutralizing activity. Anti-HIV immunotoxins could be used to eliminate virus reservoirs that persist despite effective antiretroviral therapy.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

AIMS AND OBJECTIVES: To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. BACKGROUND: China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. DESIGN: Prospective. METHODS: A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. RESULTS: Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. CONCLUSION: Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. RELEVANCE TO CLINICAL PRACTICE: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.

[Wavelet entropy analysis for ictal electroencephalogram signals of child absence epilepsy].

The integral and individual-scale wavelet entropy of electroencephalogram (EEG) were employed to investigate the information complexity in EEG and to explore the dynamic mechanism of child absence epilepsy (CAE). The digital EEG signals were collected from patients with CAE and normal controls. Time-frequency features were extracted by continuous wavelet transformation. Individual scale power spectrum characteristics were represented by wavelet-transform. The integral and individual-scale wavelet entropy of EEG were computed on the basis of individual scale power spectrum. The evolutions of wavelet entropy across ictal EEG of CAE were investigated and compared with normal controls. The integral wavelet entropy of ictal EEG is lower than inter-ictal EEG for CAE, and it also lower than normal controls. The individual-scale wavelet entropies of 12th scale (centered at 3 Hz) of ictal EEG in CAE was significantly higher than normal controls. The individual-scale wavelet entropies for α band (centered at 10 Hz) of ictal EEG in CAE were much lower than normal controls. The integral wavelet entropy of EEG can be considered as a quantitative parameter of complexity for EEG signals. The complexity of ictal EEG for CAE is obviously declined in CAE. The wavelet entropies declined could become quantitative electrophysiological parameters for epileptic seizures, and it also could provide a theoretical basis for the study of neuromodulation techniques in epileptic seizures.

Isolation and characterization of an HIV-1 envelope glycoprotein-specific B-cell from an immortalized human naïve B-cell library.

With the recent development of single B-cell cloning techniques, an increasing number of human immunodeficiency virus type 1 (HIV-1)-specific broadly neutralizing antibodies have been isolated since 2009. However, knowledge regarding HIV-1-specific B cells in vivo is limited. In this study, an HIV-1-specific B-cell line was established using healthy PBMC donors by the highly efficient Epstein-Barr virus transformation method to generate immortalized human naïve B-cell libraries. The enrichment of HIV-1 envelope-specific B cells was observed after four rounds of cell panning with the HIV-1 envelope glycoprotein. An HIV-1 envelope-specific stable B-cell line (LCL-P4) was generated. Although this cell line acquired a lymphoblastic phenotype, no expression was observed for activation-induced cytidine deaminase, an enzyme responsible for initiating somatic hypermutation and class switch recombination in B cells. This study describes a method that enables fast isolation of HIV-1-specific B cells, and this approach may extend to isolating other B-cell-specific antigens for further experiments.

Contrasting liquid imbibition into uncoated versus pigment coated paper enables a description of imbibition into new-generation surface-filled paper.

The transport of print fluids into paper is directly dependent on the imbibition characteristic of the paper including both the z-, x- and y-directions. As the measurement of free liquid imbibition into the paper thickness (z-direction) is difficult experimentally, due to the thin nature of paper, in this paper we resort to imbibition along the y-direction of paper to analyse and explore the possibility of understanding the mechanistic differences between wicking into uncoated unfilled paper versus that of controllable pigment-filled paper and paper coating. Considering the classical imbibition dynamic, the measured imbibition was characterised firstly with respect to [Formula: see text] and secondly with respect to linear t. It is shown that the wicking behaviour of uncoated unfilled paper follows neither the classical viscous drag balance model of Lucas-Washburn ([Formula: see text]) nor the more comprehensive inertia-included imbibition described by Bosanquet. However, by increasing the filler load into the surface layer of the paper, the imbibition dynamic is seen to revert to the Bosanquet model. Thus, when using highly filled papers, the imbibition dynamic for printing liquid shows a fast imbibition at the initial stages dominated by inertial plug flow, and then transits to the Lucas-Washburn viscosity-dominated imbibition component over longer time.

Using the Delphi method to develop nursing-sensitive quality indicators for the NICU.

AIMS AND OBJECTIVES: To develop nursing-sensitive quality indicators consistent with current medical practices in Chinese neonatal intensive care units. BACKGROUND: The development of nursing-sensitive quality indicators has become a top priority in nursing management. To the best of our knowledge, there has been no objective, scientific and sensitive evaluation of the quality of neonatal intensive care unit nursing in China. DESIGN: A modified Delphi technique was used to seek opinions from experts about what should be used and prioritised as indicators of quality care in neonatal intensive care unit nursing. METHODS: Based on a literature review, we identified 21 indicators of nursing-sensitive quality in the neonatal intensive care unit. Our group of 11 consultants chose 13 indicators to be discussed using the Delphi method. In October and November 2014, 39 neonatal intensive care unit experts in 18 tertiary hospitals spread across six provinces participated in two rounds of Delphi panels. RESULTS: Of the 13 indicators discussed, 11 were identified as indicators of nursing-sensitive quality in the neonatal intensive care unit: rate of nosocomial infections, rate of accidental endotracheal extubation, rate of errors in medication administration, rate of treatment for pain, rate of peripheral venous extravasation, rate of compliance with handwashing techniques, incidence of pressure ulcers, incidence of noise, the bed-to-care ratio, the proportion of nurses with greater than five years neonatal intensive care unit experience and incidence of retinopathy. CONCLUSIONS: The 11 neonatal intensive care unit nursing-sensitive indicators identified by the Delphi method integrated with basic Chinese practices provide a basis for nursing management and the monitoring of nursing quality. RELEVANCE TO CLINICAL PRACTICE: This study identified nursing-sensitive quality indicators for neonatal intensive care unit care that are suitable for current clinical practice in China.

Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China.

BACKGROUND: Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking. OBJECTIVE: This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China. METHODS: Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR. RESULTS: Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count. CONCLUSIONS: Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs.