Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health ...

Low Health Literacy and Health Outcomes: An Updated Systematic Review

基礎講座 電気泳動(Electrophoresis)

Recent discoveries are redefining our view of cellular senescence as a trigger of tissue remodelling that acts during normal embryonic development and upon tissue damage. To achieve this, senescent cells arrest their own proliferation, recruit phagocytic immune cells and promote tissue renewal. This sequence of events - senescence, followed by clearance and then regeneration - may not be efficiently completed in aged tissues or in pathological contexts, thereby resulting in the accumulation of senescent cells. Increasing evidence indicates that both pro-senescent therapies and antisenescent therapies can be beneficial. In cancer and during active tissue repair, pro-senescent therapies contribute to minimize the damage by limiting proliferation and fibrosis, respectively. Conversely, antisenescent therapies may help to eliminate accumulated senescent cells and to recover tissue function.

Cellular senescence: from physiology to pathology.

Cellular senescence, a process that imposes permanent proliferative arrest on cells in response to various stressors, has emerged as a potentially important contributor to aging and age-related disease, and it is an attractive target for therapeutic exploitation. A wealth of information about senescence in cultured cells has been acquired over the past half century; however, senescence in living organisms is poorly understood, largely because of technical limitations relating to the identification and characterization of senescent cells in tissues and organs. Furthermore, newly recognized beneficial signaling functions of senescence suggest that indiscriminately targeting senescent cells or modulating their secretome for anti-aging therapy may have negative consequences. Here we discuss current progress and challenges in understanding the stressors that induce senescence in vivo, the cell types that are prone to senesce, and the autocrine and paracrine properties of senescent cells in the contexts of aging and age-related diseases as well as disease therapy.

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Cellular senescence in aging and age-related disease: from mechanisms to therapy

Ocular drug delivery has been a major challenge to pharmacologists and drug delivery scientists due to its unique anatomy and physiology. Static barriers (different layers of cornea, sclera, and retina including blood aqueous and blood–retinal barriers), dynamic barriers (choroidal and conjunctival blood flow, lymphatic clearance, and tear dilution), and efflux pumps in conjunction pose a significant challenge for delivery of a drug alone or in a dosage form, especially to the posterior segment. Identification of influx transporters on various ocular tissues and designing a transporter-targeted delivery of a parent drug has gathered momentum in recent years. Parallelly, colloidal dosage forms such as nanoparticles, nanomicelles, liposomes, and microemulsions have been widely explored to overcome various static and dynamic barriers. Novel drug delivery strategies such as bioadhesive gels and fibrin sealant-based approaches were developed to sustain drug levels at the target site. Designing noninvasive sustained drug delivery systems and exploring the feasibility of topical application to deliver drugs to the posterior segment may drastically improve drug delivery in the years to come. Current developments in the field of ophthalmic drug delivery promise a significant improvement in overcoming the challenges posed by various anterior and posterior segment diseases.

Ocular Drug Delivery

Purpose Vascular endothelial growth factor (VEGF) regulates microvascular endothelial permeability, and the permeability of Schlemm's canal (SC) endothelium influences conventional aqueous humor outflow. We hypothesize that VEGF signaling regulates outflow facility. Methods We measured outflow facility (C) in enucleated mouse eyes perfused with VEGF-A164a, VEGF-A165b, VEGF-D, or inhibitors to VEGF receptor 2 (VEGFR-2). We monitored VEGF-A secretion from human trabecular meshwork (TM) cells by ELISA after 24 hours of static culture or cyclic stretch. We used immunofluorescence microscopy to localize VEGF-A protein within the TM of mice. Results VEGF-A164a increased C in enucleated mouse eyes. Cyclic stretch increased VEGF-A secretion by human TM cells, which corresponded to VEGF-A localization in the TM of mice. Blockade of VEGFR-2 decreased C, using either of the inhibitors SU5416 or Ki8751 or the inactive splice variant VEGF-A165b. VEGF-D increased C, which could be blocked by Ki8751. Conclusions VEGF is a paracrine regulator of conventional outflow facility that is secreted by TM cells in response to mechanical stress. VEGF affects facility via VEGFR-2 likely at the level of SC endothelium. Disruption of VEGF signaling in the TM may explain why anti-VEGF therapy is associated with decreased outflow facility and sustained ocular hypertension.

VEGF as a Paracrine Regulator of Conventional Outflow Facility.

PURPOSE: To report the various types of glaucoma among West African patients presenting to an eye clinic in Ghana. METHODS: A complete evaluation was performed in 198 consecutive Ghanaian glaucoma patients. Main outcome measures included intraocular pressure, visual acuity, gonioscopy findings, visual field, and total number of glaucoma medications. RESULTS: The most common form of glaucoma was primary open-angle glaucoma (44.2%). Open-angle glaucoma suspects also comprised a large percentage of the group (30.5%). Chronic angle-closure glaucoma was diagnosed in 6.6% of the patients. CONCLUSIONS: Primary open-angle glaucoma is the most common form of glaucoma being treated in this outpatient eye clinic in Ghana. Chronic angle-closure glaucoma was the second most common form of glaucoma in this series and was usually undiagnosed due to a lack of gonioscopic evaluation. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in this region. Pseudoexfoliation and pseudoexfoliation-associated glaucoma were not seen in this population.

Survey of glaucoma in an eye clinic in Ghana, West Africa.

Background
Oxidative stress is one of the major factors that trigger photoreceptor apoptosis. To investigate whether resveratrol, a potent antioxidant and small molecule activator of the FoxO pathway, would be neuroprotective against photoreceptor cell death in a rodent model of retinal detachment.

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Protective Effects of Resveratrol in Experimental Retinal Detachment

Objective To correlate losses of retinal thickness in the perifoveal area in glaucoma as measured by the Retinal Thickness Analyzer (Talia Technology Ltd, Israel) with optic nerve and visual field changes in glaucoma patients and suspects. Methods Observational case series of 55 consecutive patients from the Glaucoma Service who either presented with a diagnosis of glaucoma or were referred for evaluation of suspected glaucoma. The Retinal Thickness Analyzer (Talia Technology, Ltd.) was used to obtain retinal thickness maps. Retinal thickness analysis, visual field testing, and stereophotography of the optic nerve head were performed, and a glaucoma specialist who was masked to patient status and identity data randomly graded the level of severity of each parameter. Spearman rank correlations were used to assess the relationships among the three numerical measures. Results Retinal thickness losses correlated more strongly with severity of optic nerve head cupping (r = 0.75), whereas both of these measures correlated less strongly with the severity of visual field loss (r = 0.54). Conclusions Retinal thickness measurements at the posterior pole provide another measure of neural loss in glaucoma, and may help in the clinical assessment of optic nerve cupping. However, there are limitations of the technology that must be considered.

Correlation among retinal thickness, optic disc, and visual field in glaucoma patients and suspects: a pilot study.

Purpose To report a series of cases involving Ex-PRESS Miniature Glaucoma Device exposure and discuss the surgical techniques we used to remove the shunts. Methods A retrospective chart review was performed to identify all patients who were referred for Ex-PRESS Miniature Glaucoma Device exposure between January 2004 and December 2005. Demographic information, time to exposure, surgical technique for device implantation and removal, and patient outcomes after device removal were abstracted from the identified charts. In addition, we describe a surgical technique used to remove the exposed Ex-PRESS Miniature Glaucoma Devices. Results Six patients (8 eyes) experienced Ex-PRESS Miniature Glaucoma Device exposure. The average time to exposure was 8.5 months. In 2 eyes, the shunt had been inserted under a half-thickness scleral flap; in both these eyes and 1 additional eye, Mitomycin-C had been used during shunt insertion. At presentation with tube shunt exposure, all eyes had normal or elevated intraocular pressure. In 5 eyes, visual acuity worsened after the device was removed. All 8 patients required concomitant glaucoma surgery with device removal. Conclusions As an increasing number of patients undergo filtration surgery with Ex-PRESS Miniature Glaucoma Devices, anterior segment surgeons should be aware of the potential for device exposure and methods for device removal.

Pratap Challa

Papers

VEGF as a Paracrine Regulator of Conventional Outflow Facility.

Survey of glaucoma in an eye clinic in Ghana, West Africa.

Protective Effects of Resveratrol in Experimental Retinal Detachment

Correlation among retinal thickness, optic disc, and visual field in glaucoma patients and suspects: a pilot study.

Exposure of Ex-PRESS Miniature Glaucoma Devices: case series and technique for tube shunt removal.