Knowledge, Attitudes, and Practice of General Practitioners Toward Screening of Age-Related Hearing Loss in Community: A Cross-Sectional Study in Shanghai, China.

Background: Age-related hearing loss (ARHL) is experiencing a continuously rising in prevalence among the elderly worldwide. General practitioners (GPs) may have a unique position in its community detection and management. Objective: This study aims to assess the KAP of GPs regarding ARHL through questionnaire, to investigate the role of them in the management and to propose strategies for the hearing screening within the community. Methods: An online survey was administered to 1173 GPs, selected from 56 community health centers (CHCs) in Shanghai during April to June 2022. A scale endorsed by a panel of multidisciplinary experts was used to assess knowledge (7 items), attitudes (12 items), and practice (10 items). A mean score was computed and converted into a scale ranging from 0 to 100. Odds ratios (ORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. Results: A total of 1022 GPs completed the questionnaire with response rate 87.13%. The average scores are 69.90 ± 32.27, 66.09 ± 7.15, and 59.89 ± 21.99 for Knowledge, attitude, and practice, respectively. 24.3% of participants achieve a complete score of knowledge, whereas 5.48% receive zero. 11.6% consider ARHL as not a disease. Above 30.0% are not familiar with the screening tool. 10.8% refuse to undergo hearing screening. Higher levels of compliance in practice are found in the participants with higher levels of knowledge (OR=1.409, p=0.000) and more favorable attitude (OR=1.028, p=0.000). Male (OR=0.708, p=0.036) is associated with lower levels of attitudes. Conclusion: GPs have a low level of ARHL knowledge, a lack of positive attitude towards the detection and management of it, and lower awareness in practice. Further research is required to gain a more comprehensive understanding of the attitudes held by GPs and explore more accessibility strategies.

Development and validation of the screening tool for age-related hearing loss in the community based on the information platform.

INTRODUCTION: Currently, age-related hearing loss has become prevalent, awareness and screening rates remain dismally low. Duing to several barriers, as time, personnel training and equipment costs, available hearing screening tools do not adequately meet the need for large-scale hearing detection in community-dwelling older adults. Therefore, an accurate, convenient, and inexpensive hearing screening tool is needed to detect hearing loss, intervene early and reduce the negative consequences and burden of untreated hearing loss on individuals, families and society. OBJECTIVES: The study harnessed "medical big data" and "intelligent medical management" to develop a multi-dimensional screening tool of age-related hearing loss based on WeChat platform. METHODS: The assessment of risk factors was carried out by cross-sectional survey, logistic regression model and receiver operating characteristic (ROC) curve analysis. Combining risk factor assessment, Hearing handicap inventory for the elderly screening version and analog audiometry, the screening software was been developed by JavaScript language and been evaluated and verified. RESULTS: A total of 401 older adults were included in the cross-sectional study. Logistic regression model (univariate, multivariate) and reference to literature mention rate of risk factors, 18 variables (male, overweight/obesity, living alone, widowed/divorced, history of noise, family history of deafness, non-light diet, no exercising habit, smoking, drinking, headset wearer habit, hypertension, diabetes, hyperlipidemia, cardiovascular and cerebrovascular diseases, hyperuricemia, hypothyroidism, history of ototoxic drug use) were defined as risk factors. The area under the ROC curve (AUC) of the cumulative score of risk factors for early prediction of age-related hearing loss was 0.777 [95% CI (0.721, 0.833)]. The cumulative score threshold of risk factors was defined as 4, to classify the older adults into low-risk (< 4) and high-risk (≥ 4) hearing loss groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the screen tool were 100%, 65.5%, 71.8%, and 100.0%, respectively. The Kappa index was 0.6. CONCLUSIONS: The screening software enabled the closed loop management of real-time data transmission, early warning, management, whole process supervision of the hearing loss and improve self-health belief in it. The software has huge prospects for application as a screening approach for age-related hearing loss.

Study on the correlation of the TLR4/MyD88 axis with the degree of inflammatory response in patients with synovitis of the knee joint.

This work aims to provide a novel reference for future diagnosis and treatment of synovitis of the knee joint (SKJ) by analyzing the correlation of the TLR4/MyD88 axis with the degree of inflammatory response in SKJ patients. First, this study retrospectively analyzed the clinical data of 46 SKJ patients (research group, RG) treated in our hospital from January 2021 to December 2022 and 52 concurrent healthy controls (control group, CG). Concentrations of TLR4, MyD88 and inflammatory factors (IFs) in peripheral blood were measured, and differences in TLR4 and MyD88 between groups were observed to explore the diagnostic performance of the two for SKJ. Additionally, the correlation of TLR4 and MyD88 with IFs and Western Ontario Mac Master (WOMAC) scores in SKJ patients was discussed. Through the above experiment, we found that TLR4 and MyD88 presented higher mRNA levels in RG than in CG (P<0.05), both of which had excellent diagnostic efficiency for SKJ. Pearson correlation coefficients identified a positive correlation of TLR4 and MyD88 mRNA with IFs and WOMAC scores (P<0.05). Therefore, The TLR4/MyD88 axis is activated in SKJ patients and is strongly related to the intensification of inflammatory responses.

Ferroptosis: mechanisms and advances in ocular diseases.

As an essential trace element in the body, iron is critical for the maintenance of organismal metabolism. Excessive iron facilitates reactive oxygen species generation and inflicts damage on cells and tissues. Ferroptosis, a newly identified iron-dependent type of programmed cell death, has been implicated in a broad set of metabolic disorders. Ferroptosis is mainly characterized by excess iron accumulation, elevated lipid peroxides and reactive oxygen species, and reduced levels of glutathione and glutathione peroxidase 4. The vast emerging literature on ferroptosis has shown that numerous diseases, such as cancers, neurodegeneration, and autoimmune diseases, are associated with ferroptosis. Meanwhile, recent studies have confirmed the relationship between ferroptosis and eye diseases including keratopathy, cataract, glaucoma, retinal ischemia-reperfusion injury, age-related macular degeneration, retinitis pigmentosa, diabetic retinopathy, and retinoblastoma, indicating the critical role of ferroptosis in ocular diseases. In this article, we introduce the primary signaling pathways of ferroptosis and review current advances in research on ocular diseases involving iron overload and ferroptosis. Furthermore, several unanswered questions in the area are raised. Addressing these unanswered questions promises to provide new insights into preventing, controlling, and treating not only ocular diseases but also a variety of other diseases in the near future.

Exosomes: a new way of protecting and regenerating optic nerve after injury.

As an important part of the central nervous system (CNS), the optic nerve usually cannot regenerate directly after injury. Therefore, treating the injury and restoring the function of the optic nerve are a historical problem in the medical field. Due to the special anatomical position of the optic nerve, the microenvironment needed for protection and regeneration after injury is lacking. Therefore, preventing the continued loss of neurons, protecting the functional nerves, and promoting the effective protection of nerves are the main ways to solve the problem. Exosomes are nano-sized vesicles with a diameter of 30-150 nm, composed of lipid bilayers, proteins, and genetic material. They have key functions in cell-to-cell communication, immune regulation, inflammation, and regeneration. More and more shreds of evidence show that exosomes not only play an important role in systemic diseases such as cancer, cardiovascular diseases, and brain diseases; they also play a key role in ophthalmological diseases. This article reviews the role of exosomes in the protection and regeneration of the optic nerve after optic nerve injury in related experimental studies and clinical treatment methods. GRAPHICAL ABSTARCT: .

Short-wavelength blue light contributes to the pyroptosis of human lens epithelial cells (hLECs).

PURPOSE: The purpose of this study is to examine the effect of short-wavelength blue light (SWBL) on cultured human lens epithelial cells (hLECs). The pathogenesis of cataracts after SWBL exposure is discussed. METHODS: HLE-B3 hLECs were randomly divided into 3 groups: the NC group, which was grown in a dark incubator; the acetyl (Ac)-Tyr-Val-Ala-Asp-chloromethyl ketone (AC-YVAD-CMK) treatment group; and the SWBL exposure group. After SWBL (2500 lux) irradiation (for 8, 16, 24, and 32 h), caspase-1 and gasdermin D (GSDMD) expression levels in HLE-B3 hLECs were examined using ELISA, immunofluorescence staining, and Western blotting analyses. Double-positive staining of hLECs for activated and inhibited caspase-1 was used to determine pyroptosis in HLE-B3 hLECs. RESULTS: SWBL led to hLEC death, but a caspase-1 inhibitor suppressed cell death. The flow cytometry results also confirmed the dose-dependent effect of SWBL irradiation on the pyroptotic death of hLECs. Caspase-1 and GSDMD expression levels in all hLEC groups changed with blue light exposure times (8, 16, 24, and 32 h) and were higher in the AC-YVAD-CMK and SWBL exposure groups than in the NC group. The immunofluorescence results revealed higher GSDMD-N expression in the cell membrane of both the AC-YVAD-CMK and SWBL exposure groups than in the NC group. CONCLUSIONS: Based on the data, SWBL induces pyroptotic programmed cell death by activating the GSDMD signalling axis in HLE-B3 hLECs. These results provide new insights into the exploitation of new candidates for the prevention of cataracts.

Role of Blueberry Anthocyanin Extract in the Expression of SIRT1 and NF-κB in Rat Lens Epithelial Cells in Experimentally Induced DM.

PURPOSE: To investigate the mechanism of the protective effects of blueberry anthocyanin extract (BAE) against oxidative stress and the roles of SIRT1 and NF-κB in the pathogenesis of diabetic cataracts. METHODS: Male SD rats were randomly divided into a control group (group A) and an experimental group. The rats in the experimental group were intraperitoneally injected with streptozotocin (STZ) (60 mg/kg). Rats with blood glucose levels ≥16.7 mmol/L were considered to have DM. The rats in the experimental group were subdivided into group B (distilled water by oral gavage: 10 ml/kg/day), group C (5% blueberry anthocyanin extract by oral gavage: 10 ml/kg/day), and group D (15% blueberry anthocyanin extract by oral gavage: 10 ml/kg/day), with 15 rats in each group. At the end of 8 weeks, some biochemical parameters, including the expression of SIRT1 and NF-κB by qRT-PCR and western blotting and the activity of SOD and GSH, were measured in lens epithelial cells (LECs). RESULTS: The lenses of the rats in the control group appeared transparent during the entire 8-week period. Four weeks following STZ injection, cataracts gradually progressed in the experimental rats. SIRT1 expression was upregulated in groups B, C and D compared to the control group. However, the expression of NF-κB decreased in the experimental groups with increasing doses of BAE (p < .05). Our study also showed that the activity of the SOD enzyme and GSH in the LECs of the rats in the experimental group increased with higher doses of BAE. CONCLUSIONS: The results indicated that BAE significantly delayed the progression of diabetic cataracts in rats. These effects may be due to the dose-dependent antioxidant activity of BAE, which is mediated by enhanced SOD and GSH activities, SIRT1 expression and reduced NF-κB expression. Abbreviations: SD rat: Sprague-Dawley rat; BAE: Blueberry anthocyanin extract; LECs: Lens epithelial cells; SOD: Superoxide dismutase; GSH: Glutathione; DM: Diabetes mellitus; SIRT1: Silent information regulator protein-1; STZ: Streptozotocin; PBS: Phosphate-buffered saline.

Mapping epileptic directional brain networks using intracranial EEG data.

The human brain is a directional network system, in which brain regions are network nodes and the influence exerted by one region on another is a network edge. We refer to this directional information flow from one region to another as directional connectivity. Seizures arise from an epileptic directional network; abnormal neuronal activities start from a seizure onset zone and propagate via a network to otherwise healthy brain regions. As such, effective epilepsy diagnosis and treatment require accurate identification of directional connections among regions, i.e., mapping of epileptic patients' brain networks. This article aims to understand the epileptic brain network using intracranial electroencephalographic data-recordings of epileptic patients' brain activities in many regions. The most popular models for directional connectivity use ordinary differential equations (ODE). However, ODE models are sensitive to data noise and computationally costly. To address these issues, we propose a high-dimensional state-space multivariate autoregression (SSMAR) model for the brain's directional connectivity. Different from standard multivariate autoregression and SSMAR models, the proposed SSMAR features a cluster structure, where the brain network consists of several clusters of densely connected brain regions. We develop an expectation-maximization algorithm to estimate the proposed model and use it to map the interregional networks of epileptic patients in different seizure stages. Our method reveals the evolution of brain networks during seizure development.

Role of short-wavelength blue light in the formation of cataracts and the expression of caspase-1, caspase-11, Gasdermin D in rat lens epithelial cells: insights into a novel pathogenic mmechanism of cataracts.

BACKGROUND: With the popularity of blue-rich light-emitting diode (LED)-backlit display devices, our eyes are now exposed to more short-wavelength blue light than they were in the past. The goal of this study was to investigate the pathogenesis of cataracts after short-wavelength light exposure. METHODS: Sprague-Dawley (SD) rats were selected and randomly divided into a control group (10 rats each for the 4-, 8-, and 12-week groups) and an experimental group (10 rats each for the 4-, 8-, and 12-week groups). The rats in the experimental group were exposed to a short-wavelength blue LED lamp for 12 h per day. After exposure to the blue LED lamp, the rats were maintained in total darkness for 12 h, after which a 12-h light/dark cycle was resumed. The intensity of the lamp was 3000 lx. At the end of the short-wavelength blue LED lamp exposure (for 4, 8, and 12 weeks), the expression levels of caspase-1, caspase-11 and gasdermin D (GSDMD) were examined in rat lens epithelial cells (LECs) using qRT-PCR and Western blot analyses. An illuminance of 2500 lx was used to study the potential effect of blue LED light on HLE-B3 hLECs in vitro. AC-YVAD-CMK, a caspase-1 inhibitor, was used to confirm the pyroptosis of LECs by flow cytometry. RESULTS: After 6 weeks, cataracts developed in the experimental rats (4/20 eyes). The clarity of the lens gradually worsened with the duration of exposure. Twelve weeks later, all of the rat eyes had developed cataracts. The expression levels of caspase-1, caspase-11 and GSDMD at 4, 8, and 12 weeks were significantly higher in the samples from rats exposed to a short-wavelength blue LED lamp than in the samples from control rats (p<0.05). The proportions of double-positive hLECs were significantly increased in the 5-h and 10-h short-wavelength blue light exposure subgroups compared with the 5-h and 10-h caspase-1 inhibitor subgroups (p < 0.05). CONCLUSION: The data indicate that pyroptosis plays a key role in cataract induction after short-wavelength blue light exposure. This study might provide new insights into a novel pathogenic mechanism of cataracts.

A low-rank multivariate general linear model for multi-subject fMRI data and a non-convex optimization algorithm for brain response comparison.

The focus of this paper is on evaluating brain responses to different stimuli and identifying brain regions with different responses using multi-subject, stimulus-evoked functional magnetic resonance imaging (fMRI) data. To jointly model many brain voxels' responses to designed stimuli, we present a new low-rank multivariate general linear model (LRMGLM) for stimulus-evoked fMRI data. The new model not only is flexible to characterize variation in hemodynamic response functions (HRFs) across different regions and stimulus types, but also enables information "borrowing" across voxels and uses much fewer parameters than typical nonparametric models for HRFs. To estimate the proposed LRMGLM, we introduce a new penalized optimization function, which leads to temporally and spatially smooth HRF estimates. We develop an efficient optimization algorithm to minimize the optimization function and identify the voxels with different responses to stimuli. We show that the proposed method can outperform several existing voxel-wise methods by achieving both high sensitivity and specificity. We apply the proposed method to the fMRI data collected in an emotion study, and identify anterior dACC to have different responses to a designed threat and control stimuli.

The development and impact of primary health care in China from 1949 to 2015: A focused review.

High-quality primary health care (PHC) services are associated with better health outcomes and positive health equity. Providing PHC services to all inhabitants is one of the Chinese government's health care objectives. However, an imbalance between people's increasing health needs and effective health service utilization exists in China. The objective of this review is to identify evidence for PHC development in China and to summarize the challenges as a reference for the future improvement of China's PHC system. Literature searches related to China's PHC were performed in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan-fang databases. Related data were collected from the China Statistical Yearbook on Health and Family Planning 2003-2016, the China National Health Accounts Report 2015, and An Analysis Report of National Health Services Survey in China, 2013. The PHC network and the population's health have improved in China in recent years, with general practitioners as "gatekeepers" who have gradually taken the initiative to offer health services to residents. The limitation of input and shortages of resources and skilled health care providers may restrict the sustainable development of China's PHC system. Therefore, policy support from the government is necessary.

[Effect of electroacupuncture at "Sanyin" acupoints on cellular immune function in rats with chronic abacterial prostatitis].

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Sanyin" acupoints (bilateral "Jiayin" and "Zhongyin") on the cellular immune function of rats with chronic abacterial prostatitis (CAP), so as to explore its mechanism underlying relieving CAP. METHODS: Forty male Wistar rats were randomly divided into four groups: control, model, medication (Cernilton) and EA (n = 10 rats/group). The CAP model was made by injection of allogeneic prostatein purification liquid + Freund's complete adjuvant (1:1) and diphtheria, pertussis, tetanus (DPT) vaccine (0.5 mL). EA was applied to bilateral "Jiayin" acupoints (located at the bilateral groins at the horizontal level of the upper border of the pubic symphysis) and "Zhongyin" [the midpoint between the "Huiyin" (CV 1) and the scrotum root, punctured with filiform needle] for 20 min, once daily for two therapeutic courses (15 days/course, one day break between the two courses). Rats of the medication group were given with oral administration of Cernilton (13 mg/kg) once daily for 15 days. Following killing the rats under deep anesthesia, the prostate wet weight, and prostate index (prostate weight/body weight) were determined. Pathological changes of the prostate tissue were examined by light microscope after sectioning and haematoxylin (HE) staining. Plasma levels of CD4+ Th- and CD8+ T-lymphocytes were assayed with flow cytometry. RESULTS: Compared with the control group, the morphological structure of prostate tissues of rats in the model group was severely damaged (proliferation of the prostate epithelium and inflammatory cell infilitration), which was relatively milder in the EA group. The plasma CD4+ level and CD4+/CD8+ ratio were significantly lower in the model group than in the control group (P < 0.01, P < 0.05). Compared with the model group, plasma CD4+ levels were significantly increased in both medication and EA groups (P < 0.05, P < 0.01), and the CD4+ level of the EA group was considerably higher than that of the medication group (P < 0.05). The ratio of CD4+/CD8+ in the EA group was remarkably higher than that in the model group (P < 0.05). No significant differences were found among the four groups in the prostate weight, prostate index and plasma CD8+ levels (P > 0.05). CONCLUSION: EA stimulation of "Sanyin" points is beneficial to relieve chronic abacterial prostatitis, which may contribute to its effect in strengthening the cellular immune function via upregulation of plasma CD4+ and CD4+/ CD8+ levels.

[Decreasing effect of electro-acupuncture at Sanyin points on inflammatory cytokines in autoimmune prostatitis rats].

OBJECTIVE: To observe the changes of inflammatory cytokines in autoimmune prostatitis (AIP) rats treated by electro-acupuncture (EA) at Sanyin points. METHODS: We selected 40 Wistar male rats in this study, 10 as normal controls, and the other 30 made AIP models by intradermal injection of protein purification liquid from the prostate of allogeneic male rats with dual immune adjuvant. Then we randomly divided the AIP models into a model, a Cernilton control and an EA group of equal number, the latter two groups treated by Cernilton enema and EA, respectively. After 15 days of treatment, all the animals were sacrificed for detection of the levels of TNF-alpha, iNOS, MDA and T-AOC in the prostate tissue. RESULTS: Compared with the normal controls, the model rats showed significantly elevated TNF-alpha expression ([15.31 +/- 1.36] vs [32.20 +/- 1.65] pg/ml, P < 0.01), iNOS activity ([0.81 +/- 0.33] vs [1.25 +/- 0.23] U/ml, P < 0.01) and MDA content ([0.66 +/- 0.14] vs [0.91 +/- 0.21] nmol/ml, P < 0.05), but markedly reduced T-AOC activity ([1.56 +/- 0.16] vs [1.11 +/- 0.15] U/ml, P < 0.01). In comparison with the model group, the EA group exhibited significantly reduced levels of TNF-alpha ([17.32 +/- 2.69 ] pg/ml, P < 0.01), iNOS ([0.98 +/- 0.5 ] U/ml, P < 0.05) and MDA ([0.70 +/- 0.20] nmol/ml, P < 0.05), but remarkably increased level of T-AOC ([1.44 +/- 0.26] U/ml, P < 0.05). CONCLUSION: Electro-acupuncture at Sanyin points can protect the prostate tissue from morphological damage and reduce inflammatory reaction by decreasing pro-inflammatory cytokine activity, vascular permeability and inflammatory cell infiltration and increasing the activity of the antioxidant defense system.