AIM:To investigate the effect of fibroblast growth factor 21(FGF21)on high glucose-induced oxidative stress in retinal pigment epithelial(RPE)cells and to clarify the underlying molecular mechanisms.METHODS:Single-cell sequencing data from the GEO database were analyzed to determine the expression profile of the FGF21 receptor FGFR1 in RPE cells. Human ARPE-19 cells were cultured and randomly assigned to control, high glucose(30 mmol/L), and high glucose+FGF21 analog treatment groups, with additional siFGFR1 and PI3K inhibitor groups. Cell viability in different treatment groups was assessed using CCK-8 assay, intracellular reactive oxygen species(ROS)levels were quantified using DCFH-DA fluorescent probing combined with immunofluorescence staining and flow cytometry. Transcriptome sequencing was performed on cells from the high glucose group and high glucose+FGF21 group to analyze the enrichment level of the PI3K/Akt signaling pathway. Western blotting was performed to detect phosphorylation levels of PI3K/Akt pathway components.RESULTS:Single-cell sequencing revealed specific expression of FGFR1 in RPE cells of retinal tissues from diabetic model mice. Under In vitro experiments, high glucose(30 mmol/L)exposure reduced ARPE-19 cell viability by 49.7% and increased ROS levels by approximately 2-fold. Whereas treatment with the FGF21 analog(60 ng/mL)restored cell viability and attenuated high glucose-induced ROS accumulation. Mechanistic studies demonstrated that FGFR1 knockdown inhibited the antioxidative stress of FGF21. Further validation of the molecular mechanism revealed that high glucose significantly suppressed the PI3K/Akt pathway activation(the levels of p-Akt and p-PI3K were decreased by 33.9% and 36.6%, respectively), while FGF21 effectively reversed this inhibitory effect and restored the expression of p-Akt and p-PI3K. Treatment with the PI3K inhibitor LY294002 inhibited the cytoprotective effect of FGF21 and significantly increased the ROS-positive cells, these findings confirm that PI3K/Akt signaling is indispensable downstream mechanism for FGF21 to exert its effects.CONCLUSION:FGF21 alleviates high glucose-induced oxidative stress and cellular injury in RPE cells by activating the PI3K/Akt signaling pathway through its receptor FGFR1.

Schizophrenia is a severe mental illness primarily managed with medication.In recent years,with the rapid development of virtual reality(VR)technology,its application effect in mental illness has been widely concerned.This review aims to explore the application of VR technology in schizophrenia treatment and to provide references for clinical practice.By reviewing randomized controlled trials from both domestic and international sources,the therapeutic efficacy of VR technology in treating schizophrenia was evaluated.The findings consistently demonstrated that VR technology has a positive effect on hallucinations,cognitive function,stress management and emotional control,and social function recovery in schizophrenia.

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

Objective To apply 360 degree evaluation in competence assessment of community general practice trainers.Methods The 360 degree evaluation questionnaire was designed by authors and the evaluation was applied to assess the personal comprehensive quality,competence in general practice and teaching of 16 general practice trainers in Fenglin Community Health Service Center of Shanghai Xuhui District.Results The scores of personal comprehensive quality,competency in general practice and teaching were 7.73 ± 0.73,6.91 ± 0.91 and 6.44 ± 1.38,respectively.The total scores from different evaluators were 6.93 ± 0.12 for peers,6.68 ± 0.74 for hospital executives,8.17 ± 0.12 for nurses and 6.43 ± 0.89 from self evaluation (F =27.91,P =0.000).Conclusion The variance between different evaluators in 360 degree evaluation can avoid bias of single one.The results of 360 degree evaluation show that the teaching ability of community general practice trainer is relatively low,suggesting the training of teaching ability should be strengthened for these trainers.

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Objective To evaluate a normative and systematic training mode for teachers of community general practice.Methods A total of 16 general practice teachers,who came from Fenglin community health service centre in Shanghai,participated three-stage training mode during March 2011 to February 2012.The clinical competence evaluation and questionnaire survey were conducted before and after training.Fifty trainees trained by the teachers also received clinical competence evaluation.Results After the three-stage training,the test score in medical knowledge,physical examination and clinical skills of the teachers did not change significantly (P =0.794,0.674 and 0.326).The self assessment questionnaire survey of general practice teachers indicated a significant increase,especially in practice capability (t =-2.840,P =0.015) and overall quality (t =-3.017,P =0.011).After training by the teachers,the medical knowledge (t =-9.200,P =0.000),physical examination (t =-9.947,P =0.000) and clinical skills (t =-14.828,P =0.000) of 50 trainees increased markedly.Conclusions Differed from conventional training courses,the three-stage training enhances teaching ability and overall quality of community general practice teachers,and provides a effective training model.

Objective To survey on the knowledge,attitude and practice about hypertention in elderly patients and its relation to blood pressure control.Methods A sampling survey on the knowledge,atitude and practice about hypertention were carried out in a target population of 47 572 elderly hypertensive patients from 5 communities in Xuhui District of Shanghai during May 2011 to July 2011.Total 3800 questionairres were distributed and 3328 responded with a response rate of 87.5％.Results Among 3328 responders,3036 were aged above 65 years with a mean age of (76 ±7) years and 43.3％ were males.The rates of knowledge about hypertension were 88.5％-97.8％.General practitioners in out-patient service were the major source of knowledge.Raults revealed that 81.9％ had received health education before;81.8％ requied a regular health education; 67.2％ had self-tested blood pressure weekly; 89.6％ controlled salt intake; 66.8％ attended outdoor activities weekly with (5.6 ±2.1) times a week and (45 ±28) min each time.The blood pressure control rate in uncomplicated hypertensive patients was higher than those complicated with diabetes,coronary heart disease or stroke (62.3 ％ vs.17.0％,P ＜ 0.01).Knowing high blood pressure was related to salt intake (OR =3.364,P ＜ 0.01),hoping a regular health education about hypertension (OR =1.718,P ＜ 0.01) were factors contributing to blood pressure control in uncomplicated hypertensive patients; while self-testing blood pressure once or twice a month(OR =2.572,P ＜ 0.01)was contributing factor to blood pressure control in complicated hypertensive patients.Conclusions Elderly hypertensive patients from communities in Shanghai have enough knowledge,positive attitude but lack practices.General practitioners should carry out personalized and stronger health education focued on behavioral changes for those patients.

Objective To explore establishment of indicator system to evaluate basic capacities of trainers of training for community general practitioners (GPs) to standardize their capacity building and management.Methods Questionnaire survey was conducted among 190 trainers of training for community health managers and GPs who were involved in community health-care and health-care service management in 12 districts of Shanghai to investigate what basic capacities the trainers should have.Delphi expert consultation method was used to construct an evaluation indicator system.Firstly, an evaluation form was formulated based on the preceding questionnaire.Then, two rounds of expert consultation were carried out with 28 experts specialized in general practice, training for GPs, public health and health management.The last step was to set up an evaluation indicator system based on experts' opinions with statistical analysis.Results The newly-established system consisted of five first-grade indicators including comprehensive performance, capacities and personal willingness, background of education and career, personal potential for professional development, capacity in general practice and capacity in training for GPs, and 57 second-grade indicators.Activity coefficient of the experts was all 100%, authority coefficients of the experts were 0.85,and harmonious coefficient of importance of the evaluation was 0.190 and 0.225 ( all P ＜ 0.01 ),respectively, in two rounds of Delphi consultation.Conclusions The preliminarily established indicator system to evaluate capacities of trainers of training for community GPs in diverse aspects can be used as reference for quality critria in selection of trainers of training for community GPs.