The photophysical properties and biocompatibility of this probe, namely (OMeTPA)2-Pyr for live cell imaging were systematically investigated, with observed large Stokes shifts, high photostability, and low cytotoxicity. Furthermore, we demonstrated that (OMeTPA)2-Pyr could permeate live cell membranes for labeling. The proposed mechanism of this probe was the binding and shafting through membrane integral transport proteins by electrostatic and hydrophobic interactions. These salient and novel findings can facilitate the strategic design of new pyrazine-fused charge-neutral molecular platforms as fluorescent probes, for long-term  Using fluorescent probes for long-term monitoring of live cells is the key to understanding and modulating molecular events happening within organelles, unraveling the physiological dynamics. Recently reported fluorogenic probes involve the D-A (donor–acceptor) type platforms such as substituted acetylnaphthalene derivatives , BODIPYsvia triphenylamine (TPA)-based probes  with hydrophilic pyridinium salt moiety  may happen that interferes the sensitivity and signal to noise ratio of fluorescent probes . Therefot moiety , demonstt moiety . Therefot moiety .In view of current challenges in probing molecular platforms, we have synthesized a D-A-D type probe with a rational design. The consideration for the molecular design is to retain photostability and imaging brightness by expanding the degree of π-conjugation and enhancing the intramolecular charge transfer effect through the D-A-D configuration. Pyrazine was chosen as the core acceptor moiety, which reacted with 4-methoxytriphenylamine as the donor group. The lone-pair electrons of the terminal O and N atoms in the TPA groups were able to efficiently delocalize the π-bonds. As the LUMOs are relatively concentrated on the pyrazine core, the intramolecular charge transfer (ICT) effect would be promoted upon excitation during the imaging process to ensure the photostability . Synthesvia spectroscopy.Introduction of the bulky 4-methoxy-TPA substituents as donor on the pyrazine core as the acceptor orchestrated the electronic distribution and photophysics property of the fused D-A-D type compound . It was From spectroscopy, (OMeTPA)2-Pyr was found with a quantum yield ΦFL = 0.36 and lifetime τ= 1.42 ns in DMF. In accord with the DFT calculation, the spectra have shown the existence of an intramolecular charge transfer (ICT) excited state in the D-A-D system. Two absorption bands of 289 nm (n→σ*) and 416 nm (n→π*) were observed in the UV-Vis spectrum, which were relatively insensitive to polarity changes in solvents . The maxaga plot  in respoFrom the spectroscopy-measured excited-state dipole moment data alongside DFT calculation, the electron transfer process can be seen in this D-A-D molecular system. The obtained DFT values of redox potentials indicate that the subunits interact very weakly in the ground states. Introduction of electron-donating methoxy groups enhanced the electron push-pull effect and the conjugate level of the D-A-D molecule. Meanwhile, due to the rotation of the 2-phenylpyrazine single bonds between the donor and acceptor, activation of the ICT process was observed accompanying by conformational changes in molecular geometry and therefore, induced the formation of twisted intramolecular charge transfer (TICT) states apart from the excited state charge transfer .Considering the use of (OMeTPA)2-Pyr for live cell probing under physiological environments, the fluorescent property was then tested in the gradient mixture of DMF with water (protic solvent). Intensity of maximum fluorescence increased with water fraction range 30–70%. Dynamic light scattering measurement has found a smaller average diameter (19 nm) and a fewer polydispersity index (0.305) of the probe in aqueous solution than in DMF solvents . AttribuUsing the aromatic heterocycle with two nitrogen atoms, the pyrazine core could affect the protonation and hydrogen-bond formation with the membrane integral transport proteins and facilitate the live cell membrane permeability. To validate this hypothesis, (OMeTPA)2-Pyr was docked into the binding site of the human asialoglycoprotein receptor ASGPR . The maximum binding affinity between (OMeTPA)2-Pyr and the ASGPR was predicted to be -5.6 kcal/mol. The probe adopted a compact conformation to bind at the site of the ASGPR . The pro® Red (Pearson correlation 35.7%). The linear fluorescence intensity was measured using ImageJ; the average diameter of the stained points was 1.27 mm with high uniformity  imaging results  showed tiformity . 2-Pyr in live cell imaging were further examined. Photo-bleaching, which is a common challenge for many organic probes were not observed in this case. Live Hela cells precultured with (OMeTPA)2-Pyr were exposed to constant 405 nm laser illumination, the intracellular fluorescence intensity was recorded over time by confocal microscopy and calculated by ImageJ software. Results have showed that (OMeTPA)2-Pyr exhibited constant fluorescence emission and the relative intensity remained over 70% after 2 h illumination, suggesting the photostability of (OMeTPA)2-Pyr inside live cells . The bioA pyrazine-bridged D-A-D type fluorescence probe, namely (OMeTPA)2-Pyr, was designed and synthesized. This charge neutral probe was found selectively binding to membrane transporter protein and thus, could be taken by live cells for cytoplasm imaging. The advantages of photostability and long-term labeling render great potential to develop a novel molecular platform for long-term live cell imaging.2. After cooling the solution to room temperature, the reaction mixture was poured into a 250 ml separatory funnel to separate the organic phase and using CH2Cl2 to extract the aqueous phase. Then, the combined organic phase was dried by MgSO4 and concentrated by rotavapor. At last, the residue was purified by a silica gel column (Hexane:DCM = 1:1) to afford (OMeTPA)2-Pyr as a yellow solid . 1HNMR : δ = 3.81 , 6.86 , 7.01 , 7.11 , 7.85 , 8.91  ppm; 13CNMR : δ = 55.46, 114.75, 119.69, 127.07, 127.17, 127.65, 140.19, 149.21, 149.98, 156.26 ppm. HRMS (EI) m/z: calcd for C44H38N4O4 = 686.29; found [M+1]+ = 687.2965.In a 50 ml Shrek tube, the mixture of 2,5-dibromopyrazine , 4-methoxy-N-(4-methoxyphenyl)-N---phenyl)aniline ,Pd2 (dba)3 ,SPhos , and Cs2CO3  in toluene/H2O  was stirred at 85 °C for 24 h under the protection of NHighest occupied (HOMO) and lowest unoccupied (LUMO) Kohn–Sham orbitals were conducted by TDDFT/B3LYP/6-31G* for C/H/O/N based on the optimized molecular geometries in the ground state and first excited state. The orbital energies shown in parentheses were established with DFT calculations using Gaussian 09 software package. The optimized geometry and space plots were visualized using Multiwfn and VMD software.www.rcsb.org). AutoDockTools 1.5.6 package (www.pymol.org).Dock vina 1.1.2 was used to investigate the binding mode between (OMeTPA)2-Pyr and the membrane transporter human asialoglycoprotein receptor (ASGPR). The 2D structure of the (OMeTPA)2-Pyr was drawn and converted to a 3D structure by ChemBio3D Ultra 14.0 software. The 3D structure of ASGPR (PDB ID: 1DV8) was downloaded from the RCSB Protein Data Bank ( package  was empl2 overnight. The cells were cultured for 40 min in DMEM spiked with (OMeTPA)2-Pyr (1.5 μg/ml) and commercial trackers. The cells were washed with PBS (1 ml) and placed in fresh culture medium. Then, the cells were analyzed by confocal fluorescence microscopy (Leica SP8) using the following filters: λex = 405 nm and λem = 420–550 nm for (OMeTPA)2-Pyr signal, λex = 552 nm and λem = 587–657 nm for the Mitotracker Red signal, and λex = 638 nm and λem = 710–880 nm for the RedDotTM1 signal. The fluorescence signals of MitoRed, RedDotTM1, and (OMeTPA)2-Pyr inside cells were merged using Photoshop CS 5.0. The fluorescence values and distributions were analyzed by the software of ImageJ.Cells were seeded on 35 mm glass-bottom dishes (NEST) and incubated in DMEM culture medium at 37 °C in 5% COTo determine the biocompatibility of (OMeTPA)2-Pyr against different cell types, 4T1 and HeLa cells were seeded in the 96-well plate with 5 × 103 cells per well and incubated overnight in DMEM culture medium. The cells were washed with PBS once and then incubated in fresh culture medium containing various amounts of (OMeTPA)2-Pyr  for 48 h respectively. After washing with PBS twice, the cells received CCK-8 analysis following the manufacturer’s protocols.


Mucormycosis is a rare opportunistic infection, usually seen in diabetics, immunocompromised, or those with coronavirus disease 2019 (COVID-19). Gastrointestinal involvement is uncommon but often deadly. We report a case of gastrointestinal mucormycosis causing intestinal perforation in a non-diabetic, COVID-19 negative, immunocompetent woman, associated with puerperal sepsis.A 22-year-old woman presented to our center on post-natal day five, following delivery with insertion of an intrauterine contraceptive device (IUCD). She had complaints of breathlessness, fatigue, and giddiness. Examination revealed tachycardia, tachypnea, hypotension, and bilateral pedal edema. Following appropriate investigations, she was diagnosed with puerperal sepsis with pre-renal acute kidney injury. Imaging was suggestive of retained products of conception, and she subsequently underwent dilation and evacuation (D&E) on day eight of admission. Following brief symptomatic improvement, on day 10 of admission, she developed vomiting, abdominal distension, and pain, with obstipation. Erect X-ray showed air under the diaphragm, suggestive of perforation. She emergently underwent laparotomy with limited right hemicolectomy, ileostomy with mucous fistula. Intraoperative findings revealed a closed-loop obstruction involving terminal ileum, with two perforations. The biopsy report later revealed colonization of Mucor and hemorrhagic necrosis along the entire length of the resected specimen. She was started on amphotericin B, and after a slow recovery, was discharged.Gastrointestinal mucormycosis is rare and has a mortality rate of 94%. It is usually seen in those with predisposing factors for mucormycosis. This is the first report of mucormycosis associated with puerperal sepsis. It is typically acquired via ingestion and may cause perforation, where mortality is further increased. Diagnosis can only be confirmed by histopathology demonstrating the characteristic morphology of Mucor. Treatment requires resection of necrotic tissues, intensive treatment with amphotericin B, and correction of predisposing factors. Our case highlights the need for a high degree of suspicion for mucormycosis in patients with intestinal perforation, even if immunocompetent, and its potential association with puerperal sepsis. Mucorales [Mucormycosis is a rare opportunistic infection caused by fungi of the order ucorales . Common ucorales , and in ucorales . Contribucorales . While tucorales . We repoA 22-year-old woman with an obstetric score of para 2, living 2 (P2L2) underwent a full-term vaginal delivery with episiotomy at another center. She delivered a healthy baby, following which, on the same day, an intrauterine contraceptive device (IUCD) was inserted; she was later discharged. On post-natal day five, she suddenly developed breathlessness, fatigue, and giddiness. At this point, she was brought to our center.Examination revealed tachycardia (heart rate - 138/minute), tachypnea (respiratory rate - 44/min), hypotension (systolic blood pressure - 70 mmHg), and bilateral pedal edema, with an oxygen saturation of 94%. Local examination revealed foul-smelling vaginal discharge and a gaping episiotomy wound. Her investigations are summarised in Table In view of shock, she was intubated and shifted to the intensive care unit (ICU), and started on inotropes. Vaginal toileting was done, and a wound swab was sent. Emergency lower limb Doppler scan revealed no deep vein thrombosis. Her potassium was corrected, and a diagnosis of puerperal sepsis with pre-renal acute kidney injury was made.Staphylococcus aureus, with blood cultures showing no growth. Based on sensitivity results, she was started on meropenem, vancomycin, metronidazole, and colistin. Her total leucocyte count ranged from 20,000 to 25,000/uL, her platelet count ranged from 75,000 to 247,000/uL, and her creatinine improved to 0.60mg/dL. Contrast-enhanced computed tomography (CECT) of the pelvis showed a bulky uterus with heterogenous hyperdense content in the endometrial cavity with dimensions 3 x 4 x 5 cm, suggestive of retained products of conception, with no evidence of IUCD , she developed four spikes of fever, ranging from 102˚C to 104˚C. In view of fever, tests for malaria and dengue, Weill Felix test, Widal test for typhoid, and a reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 were all performed; they all came negative. Wound and cervical swabs later showed She subsequently underwent dilation and evacuation (D&E) under general anesthesia. On post-natal day 12 (day eight of admission), she was extubated, and then shifted out from the ICU.She briefly improved symptomatically, but two days later, on day 10 of admission, she developed vomiting, abdominal distension, and pain, with obstipation. Erect X-ray showed air under the diaphragm, suggestive of gastrointestinal perforation Figure .Ultrasound abdomen revealed pneumoperitoneum with septated ascites, hollow viscus perforation, and dilated bowel loops. She underwent an emergency laparotomy, followed by a limited right hemicolectomy, ileostomy with mucous fistula. Intraoperative findings revealed a closed-loop obstruction involving terminal ileum, gangrene of terminal ileum for about 40 cm length involving the ileocecal junction and proximal 5 cm of the cecum. The terminal ileum had two perforations, and approximately 60 mL of pus had collected in the right iliac fossa.On postoperative day two (day 12 of admission), she developed a burst abdomen, which was conservatively managed. The biopsy later revealed mucosal and serosal colonization of Mucor along the entire length of the resected specimen, along with hemorrhagic necrosis Figure .She was immediately started on colistin and amphotericin B, and vacuum-assisted closure was done in two sittings for burst abdomen. After a slow recovery, she was discharged with one month of amphotericin B and advised daily dressing of her surgical site.Mucorales are ubiquitous in nature. Infection i.e. mucormycosis is most commonly due to Rhizopus species. Pathologically, mucormycosis is characterized by aggressive angioinvasion, causing tissue necrosis [Fungi of the order necrosis . While rnecrosis . In Indinecrosis , with COnecrosis . GIT invnecrosis . It is unecrosis . Our patGastrointestinal mucormycosis is typically acquired via ingestion. The stomach is most commonly involved, followed by the colon and the ileum. Symptoms vary according to the site involved but are nonspecific. Abdominal pain and distension, associated with nausea and vomiting are the most common . It may Helicobacter pylori infections [In India, gastrointestinal perforation is usually due to infectious causes, such as tuberculosis, typhoid, and fections . MucormyDue to its high mortality, rapid diagnosis and treatment are essential. Imaging findings in the appropriate context may be suggestive - in small bowel mucormycosis, as in our case, the findings are those of multifocal ischemia . HoweverTo our knowledge, this is the first case of gastrointestinal mucormycosis associated with puerperal sepsis in English literature. Our patient developed abdominal symptoms after the improvement of septic manifestations. With appropriate surgery and antifungal therapy, she recovered well.Clostridium difficile [While pregnancy and the postpartum period have an increased risk of infections such as tuberculosis, due to complex changes in the immune system to prevent allograft rejection of the fetus , no predifficile , no suchThe gastrointestinal tract is a rare site of infection in mucormycosis. It may present as intestinal perforation, even in those without traditional risk factors for mucormycosis, such as diabetes mellitus, COVID-19, or immunocompromise. These cases tend to have a poor prognosis, so, in such patients, a high degree of suspicion for mucormycosis is needed. Rapid action is needed for the perforation to avoid a fatal outcome. After histopathological confirmation of mucormycosis, therapy with amphotericin B and correction of the underlying factors for mucormycosis are needed. Finally, our case highlights the potential association of puerperal sepsis with mucormycosis.


Sjögren’s syndrome is a chronic autoimmune disease characterized by systemic dysfunction of exocrine glands, mainly the salivary and lachrymal glands. Sjögren’s syndrome consists of two forms: primary Sjögren’s syndrome, which is characterized by dry eyes and dry mouth without autoimmune diseases; and secondary Sjögren’s syndrome, which is characterized by symptoms associated with other autoimmune diseases, such as systemic lupus erythematosus. Disease severities vary considerably from mild glandular dryness to severe glandular involvement with numerous extraglandular and systemic features. Sensorineural hearing loss is sometimes observed in both primary and secondary Sjögren’s syndrome. This review article consists of (1) Pathology of Sjögren’s syndrome, (2) Clinical manifestation of Sjögren’s syndrome, (3) Autoimmune inner ear disease, (4) Histoanatomical features of the inner ear, (5) Immunological characteristics of the inner ear, (6) Pathophysiology of autoimmune inner ear disease, (7) Treatment for sensorineural hearing loss in Sjögren’s syndrome, and (8) Future direction. Finally, we introduce a recently developed disease model of salivary gland inflammation and discuss future expectations for the treatment of sensorineural hearing loss in Sjögren’s syndrome. The pathophysiological features of SS are based on lymphocyte infiltration into the exocrine glands, mainly dry salivary and lacrimal glands, associated with extraglandular variable symptoms, such as a fever, lymph node swelling, or joint pain, induced by autoimmune reactions due to activated lymphocytes and released cytokines, chemokines, and immunoglobulins. The primary form of SS is not associated with other diseases, whereas the secondary form is complicated by other autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), scleroderma, and ulcerative colitis .Among the extraglandular symptoms, neurological involvement of peripheral and central nerve systems is sometimes observed in patients with SS; however, hearing impairment is not well recognized in these patients, partly because of its general occurrence in a gradual manner as the natural consequence of aging. Because early treatment with steroids has been reported to successfully minimalize the progression of hearing loss, the early detection of sensorineural hearing loss (SNHS) in the SS patients is considered important .We herein review the characteristic features of hearing loss in SS, focused on the pathophysiological and immunological mechanism as well as the treatment of SNHS. The autoimmune disease SS has worldwide distribution, and its clinical characteristics vary by ethnicity. The Big Data Sjögren Project Consortium conducted a multivariate logistic regression analysis involving 20 centers from 5 continents in January 2016 on an international multi-center registry designed in 2014. An analysis of this registry included 7748 women 93%) and 562 men (7%), with a mean age at diagnosis of primary SS of 53 years old, 95% of which listed ethnicity. This study demonstrated that SS was diagnosed on average 7 years earlier in black/African Americans compared with white patients. The female to male ratio was highest in Asian patients (27:1) and lowest in black/African American patients (7:1) [% and 562The main symptoms of SS include ocular and oral dryness caused by autoimmunity in the exocrine glands (sicca symptoms) . SS shouThe function of the inner ear is to convert sound information transmitted as vibrations into electrical signals and transmit them to the brain via the cochlear nerve. Sound enters the outer ear, reaches the eardrum in the middle ear, and travels to the inner ear via the ossicles attached to the eardrum. The inner ear consists of the cochlea, responsible for hearing, and the vestibule, responsible for balance. Vibration of the auditory ossicles causes the lymph fluid to vibrate, and the hair cells convert the vibrations into electrical signals that are transmitted to the cochlear nerve. Hair cells line the inside of the cochlea, and the frequencies assigned to each hair cell depend on where they are located. Hearing loss occurs when these hair cells are damaged by immune response . AIED is an inner ear dysfunction characterized by progressive and fluctuating tinnitus, vertigo, and SNHL. No definite, widely accepted markers for the diagnosis of AIED have been established, but the clinical diagnostic criteria are approximately defined as follows: (a) progressive, bilateral SNHL of ≥30 dB at ≥1 frequency; and (b) SNHL determined to be idiopathic based on a clinical evaluation, blood examinations, and magnetic resonance imaging (MRI) or computed tomography (CT) findings .In a previous study, almost 30% of patients with AIED had coexisting systemic autoimmune disease, such as SLE, RA, or SS ,6. SNHL Regarding primary SS, it was estimated that approximately one-quarter of patients suffer from high-frequency hearing loss due to cochlear dysfunction as detected by impedance audiometry or auditory brainstem procedures . In an eThe cochlea is the part of the inner ear involved in hearing, consisting of a base plate between the vestibular floor and the scala tympani floor. The movement of the stapes is transmitted as waves propagating through the inner ear fluid at 2 and 1/2 turns of the cochlea. The envelope signal shows the amplitude distribution of the entire basal lamina corresponding to each frequency. Frequency-specific motion of the organ of Corti causes depolarization of inner and outer hair cells by bending stereocilia. High-frequency sounds stimulate corresponding ganglion cells in the base of the cochlea, whereas low-frequency sounds stimulate those in the apex. Electrical impulses are then transmitted through the auditory nerve to the brain, which edits and perceives the transmitted information as complex sounds. The sound enters through the entrance of the cochlea, so hair cells near the entrance are heavily exposed to sound at all frequencies and wear out over time. Age-related hearing loss includes sounds mainly at high frequencies because of damage to hair cells on the inlet side of the affected cochlea . The damThe inner ear is separated by a blood/labyrinth barrier and is considered to be immunologically inactive, just like the brain ,37. HoweAIED is an unusual form of progressive non-age-related SNHL and sometimes associated with vertigo. It occurs in both ears with cochlear and vestibular symptoms that progress over time and affect both ears. (a)Contribution of systemic circulating antibodies against inner ear antigens leading to antibody-dependent cell-mediated cytotoxicity with the activation of the complement system . For exa(b)FcR-mediated activation of inflammatory reaction by immune complex deposition . The imm(c)Autoinflammatory microvasculitis in labyrinthine arteries. The vascular ischemia associated with vasculitis caused atrophy of the stria vascularis and hair cell death, and, in the advanced stage, the progression of inflammation induced necrosis or cochlear fibrosis of the local tissue ,45.(d)Abnormal reaction of cytotoxic T cells integrated into the inner ear . In a prThe following immunologic mechanisms are presumed to be involved in the pathophysiology of inner ear dysfunction due to autoimmune diseases:The inner ear lacks lymphoid tissue and has a blood inner ear barrier, which once made the inner ear an immunologically unique organ. However, recent studies have shown that the cells responsible for the local immune response are largely resident macrophages involved in maintaining inner ear homeostasis and immunity . These iIt is clinically important that early diagnosis and early treatment are effective for SNHL ,48. In SCiorba et al.  searchedGreen L et al.  reportedLiu YC et al.  conducteLuetje CM  reportedFor SNHL in SS patients, steroid treatment has only been reported to be effective during the early phase of hearing loss .In a 2021 study, Saito described the characteristics of McH/lpr-RA1 mice and proposed their use as a new mouse model for autoimmune sialadenitis . MRL/lprThe strength of this article is that only a few case reports had described the treatment of patients with Sjögren’s syndrome and hearing loss, and our review article will be informative for clinicians who treat the patients. As a limitation of this article, basic research on the inner ear is essential to determine the cause of hearing loss in Sjogren’s syndrome, whereas only a small number of basic research papers have been published.Underlying systemic autoimmunity, including SS, should always be considered in patients with vestibular symptoms, such as vertigo, tinnitus, and ear fullness or with progressive and variable hearing loss. The early diagnosis of AIED is crucial to avoid missing the opportunity to administer appropriate treatment. The development of molecular-targeted drugs for immune disorders is steadily progressing, and tissue macrophages in the inner ear may be potential therapeutic targets of hearing loss.


The performance of patients fitted with hearing aids dictates the applicable measures to be taken.To assess the benefits and degree of satisfaction of adult and elderly patients fitted with hearing aids in a service accredited by the Brazilian Public Health Service.This descriptive cross-sectional study included 34 individuals with bilateral hearing loss aged 18 and above who had never been offered hearing aids. Scales “Hearing Handicap Inventory for Adults” and “Hearing Handicap Inventory for the Elderly Screening Version” were used to assess the benefits yielded by the hearing aids. Scale “Satisfaction with Amplification in Daily Life” was used to gauge patient satisfaction. The first two were applied on the day the patients were fitted with hearing aids and one month later, whereas the third was applied only one month after the patients had been fitted with the hearing aids.After the subjects were offered hearing aids, significant reductions were seen in the difficulties they experienced as a consequence of hearing loss. The scores in the Satisfaction with Amplification in Daily Life scale indicated a high degree of satisfaction among patients. These results were not statistically different when gender and age (adult/elderly) subgroups were compared.The subjects included in the study have benefitted from being fitted with hearing aids and have been very happy with the outcome of the treatment. Communication is a vital skill for any individual. It allows the acquisition of knowledge and experience, in addition to playing a key role in social and family interactions. When communication is impaired, the establishment of personal relationships is hampered, leading individuals to isolation and depressionFor a long time, hearing impairment was deemed as an incapacitating disease. A lot has been done in recent years to destigmatize deafness and promote improvements in the quality of life of individuals with hearing lossAuditory rehabilitation may be defined as a process designed to allow patients to overcome the barriers to enjoying a fuller participation in daily living activities and mitigate the handicap experienced by the hearing impairedThe auditory rehabilitation process enables individuals to retrieve their social lives and participate in group activities, thus improving their self-esteem and well-beingAmong other things, the auditory rehabilitation process contemplates the fitting of hearing aids.These devices have been developed and improved with the purpose of reducing the deleterious effects of hearing lossHowever, the process of selecting and fitting hearing aids can only be effectively completed and produce good outcomes when the patient wears the device properly. And in order for patients to comply with the treatment, they need to see the benefits of wearing hearing aids and be happy with the outcomes produced by the deviceThe performance of hearing aids as reported by their users offers guidance to health care professionals as they choose a course of action, in addition to allowing patients to recognize the advantages of wearing the devices over experiencing the hardships of hearing loss, improving compliance to treatment and overall patient satisfactionMonitoring patient satisfaction levels and their perceptions while wearing hearing aids is an important step in the assessment of clinical procedures and care quality goals of health services. Once the factors connected to patient satisfaction are identified, health services can significantly improve the effectiveness of the care they provideObjective measurements involving formal tasks of speech recognition, or subjective tests based on the benefits perceived by the patients and the difficulties they experience in their daily lives, can be used to gauge the benefits and handicaps patients face while wearing hearing aidsSelf-assessment scales have been used to evaluate treatment plans and the effectiveness of rehabilitation. Effectiveness can be measured as a function of the reduction of disabilities and handicaps, areas of concentration, and patient satisfactionThe scales most frequently used to assess the benefits yielded by hearing aids are the Hearing Handicap Inventory for Adults (HHIA)When patient satisfaction is considered, Satisfaction with Amplification in Daily Life (SADL)Given the facts described above, the, of using these scales lies in the insights they offer into patient perceptions over communication impairments, making it possible to monitor subjects in the long term and to identify their actual auditory needs in addition to the ones observed through routine audiological testing.In the State Capital of Rondônia, a large portion of the population goes through the process of selecting and being fitted with hearing aids at the Limiar - Hearing Assessment and Rehabilitation Clinic - a private high complexity service affiliated to the Brazilian Public Healthcare System (SUS) as per appointment by Ordinance 589 from October 8, 2004. This facility is a reference center in the State for auditory care and serves local patients along with individuals coming from the country and neighboring States, caring out approximately 70 hearing aid fittings per month, 30 of which in first-time hearing aid users.Therefore, this study aimed to verify the benefits yielded by hearing aids and the level of satisfaction of adult and elderly individuals fitted with hearing aids in the service mentioned above, in addition to correlating these findings with age (adult and elderly subjects) and gender.This descriptive cross-sectional study was assessed and approved by the institution's Research Ethics Committee of the São Lucas faculty under the protocol # 23,854. The study was carried out at a high complexity health care facility (Limiar) affiliated to the Brazilian Public Healthcare System (SUS).Data collection took place in June and July of 2012. All participants signed an informed consent term in which they were explained the study's purposes and method.Patients had to meet the following enrollment criteria: age of 18 years or older; bilateral hearing loss of any kind and degree; recently fitted with digital bilateral, behind-the-ear, or intracanal hearing aids (new users); agree to join the study and sign an informed consent term. No distinction was made between users of behind-the-ear and intracanal hearing aids, given that a study previously carried out at this center failed to identify differences in the levels of satisfaction of users of either device typesSubjects with unilateral hearing loss, individuals who had previous experience wearing hearing aids, patients who failed to complete the fitting process, and subjects unwilling to sign the informed consent term were excluded from the study.The mean number of new hearing aid fittings in adult and elderly patients within a period of two months - 54 - was used as a reference to calculate the size of the sample and the period for which data collection would occur. Considering an error of 10% and a level of confidence of 95%, the size of the sample was set at 35 consecutive patients.However, one subject did not comply with the fitting process and was excluded from the sample. Therefore, 34 individuals - 20 males and 14 females - were included in the study. Fourteen subjects were adults, with a mean age of 41.7 years, and 20 were elderly, with a mean age of 72.5 years.The benefits yielded by the hearing aids were measured through the HHIAThe HHIA and the HHIE-S are made up of two subscales: Social/Situational and Emotional. The first looks into the impacts of hearing loss upon daily living activities, while the second assesses the attitudes and emotional responses to having hearing lossPatients are asked to respond to specific situations and consider whether they represent difficulties to them. The HHIA includes 25 items, 12 in the Social/Situational subscale and 13 in the Emotional subscale.The score attained in the scale is analyzed as follows: questions answered with a ‘No' are given zero points; ‘Sometimes' is scored as two points; ‘Yes' answers are given four points. The ratings on the HHIA may range from 0%, indicative of no perception of a handicap, to 100% for significant handicap, i.e., lower scores represent fewer difficulties in emotional, social, and situational contexts connected to hearing loss, while higher scores imply more difficulties.The HHIE-S scale is made of 10 questions. The five questions in the social/situational subscale are designed to identify difficulty-causing situations and find whether hearing loss affects the individual's behavior in the given circumstances. The emotional subscale, also with five questions, is used to assess the attitudes and emotional responses displayed by individuals faced with hearing loss. Scores under 16% indicate absence of handicap; scores between 18% and 42% suggest mild to moderate perception of a handicap; scores above 42% are indicative of severe or significant perception of a handicap.Patient satisfaction with hearing aids was assessed with the Brazilian Portuguese version of the SADL scale as offered by its authorsThe SADL scale includes 15 items divided into four subscales: positive effect ; negative features ; personal image .Seven answer options are offered in each question: not at all; a little; somewhat; medium; considerably; greatly; tremendously. The answers are graded based on a seven-point scale, in which the lowest score is one, for ‘not at all', and the highest is seven, for ‘tremendously', indicating lesser and greater levels of satisfaction respectively. Questions 2, 4, 7 and 13 are reversed items, i.e., scores of seven are given to ‘not at all' answers and scores of one are attributed to ‘tremendously' answers.Patients were advised to assign a score from one to seven to each question.th percentile; the 80th percentile was used as a reference for satisfied users; patients with scores above the 80th percentile were deemed as very satisfied with their hearing aids . Assessed variables included age, gender, level of satisfaction, and benefit.The compiled data sets were analyzed with ANOVA statistical tests with significance set at 5% , indicating patients were more appreciative of their well-being and the quality of life produced as an outcome of wearing hearing aids, rather than sticking to cosmetic concerns.Along the same lines, subjects of both genders were very satisfied with the use of amplification, as also reported in other studiesThe improvement in sound quality and the technology upgrades made to hearing aids are believed to have had significant impact on the increase in the levels of satisfaction observed among hearing aid users, which led to higher levels of device acceptance.Satisfaction and benefits are apparently related. According to the literatureThis study revealed that adult and elderly patients of both genders had significant reductions in their auditory handicap after they were fitted with hearing aids, in addition to perceiving the benefits and being very satisfied with their hearing aids.


Few studies have evaluated the association between polyunsaturated fatty acids (PUFAs) and hearing levels. This study aimed to investigate the association between serum PUFAs and hearing threshold shifts in US adults.We investigated 913 adults from the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Multivariate linear regression analyses were conducted to evaluate associations between PUFA and hearing threshold shifts.Overall, 11 serum PUFAs were inversely associated with low-frequency thresholds, especially in men, and were positively related to high-frequency thresholds, particularly in the 40–59 years old cohort. Furthermore, some serum PUFAs were positively associated with both hearing threshold subgroups in women.Some PUFAs tend to be beneficial for low-frequency hearing status and detrimental to the high-frequency hearing threshold. The male sex may play a protective role in this association, while the female sex and middle age may be detrimental in the effect of PUFAs on hearing function. Hearing loss (HL) is the most common sensory deficit in humans. More than 30 million adults in the United States, nearly 15% of the total population, have some degree of HL –4. The eThe cochlea in the inner ear is highly vascularized and is supplied by a single feed artery . It is aTo date, there have been only a few population-based studies investigating the association between PUFAs and the risk of hearing impairment –15, threhttps://www.cdc.gov/nchs/nhanes/Index.htm). The NHANES data were approved by the National Center for Health Statistics Institutional Review Board in accordance with the Declaration of Helsinki. Informed consent was obtained from all the eligible subjects.This study utilized publicly accessible data from the NHANES website  of the Centers for Disease Control and Prevention. The survey is combined with a series of physical examinations, interviews, and laboratory tests and uses a complex, multistage, probability sample design to be representative of the civilian, noninstitutionalized US population. Cross-sectional data examined in this study were collected from participants enrolled in the 2011–2012 cycle of the NHANES, as this is the only cycle containing results of serum fatty acid tests. The complete selection procedure for the study is shown in https://wwwn.cdc.gov/Nchs/Nhanes/2011-2012/FAS_G.htm#LBXED1).Serum samples were processed, stored, and shipped to the Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA for testing. Fasting serum fatty acid concentrations were measured by electron capture negative-ion mass spectrometry based on a modification of the method outlined by Lagerstedt et al. . More dehttps://wwwn.cdc.gov/Nchs/Nhanes/2011-2012/AUX_G.htm).Standardized pure-tone air conduction audiometric measurements were conducted in a dedicated sound-isolated room by a trained examiner. Hearing thresholds were tested on both ears of the participants at frequencies between 500 and 8,000 Hz. Pure-tone average (PTA) hearing thresholds were calculated at low  and high  frequencies. More details about the audiometry procedure and analytical methods are available on the NHANES website , diabetes, hypertension, serum cotinine, firearm noise exposure, occupational noise exposure, and recreational noise exposure. Information on age, sex, race/ethnicity, education level, diabetes, hypertension, and noise exposure was obtained from the in-home self-reported questionnaire. BMI data were calculated from the weight and height data recorded during the physical examination. Diabetes was defined as “other than during pregnancy, ever been told by a doctor or health professional had diabetes or sugar diabetes.” The answer of “borderline” was also considered as diabetes . HyperteN = 913) was divided into tertiles for each PUFA, from the lowest concentration of each PUFA to the highest level, with almost the same number of subjects in each tertile (33%). The range of PUFA values for each tertile is shown in p-value of less than 0.05 was considered statistically significant.The study used Fatty Acid Subsample 2 Year Weight of the 2011–2012 NHANES cycle to estimate representative measures for the United States population, following the guidelines of the NCHS , 19. Serp < 0.05).The study sample included 913 participants that included 439 women  and 474 men  aged between 20 and 69 years, sampled from the US population. The means ± SD of low-frequency and high-frequency PTA hearing thresholds were 7.37 ± 7.65 and 21.82 ± 18.70 dB, in male participants, respectively, and 7.50 ± 7.75 and 16.20 ± 12.83 dB in female subjects, respectively. The average high-frequency hearing status of men was worse than that of women. The education levels of men were lower than those of women. The BMI of men was higher than that of women, and men were more likely to be overweight than women. The level of serum cotinine, the biomarker of passive and positive smoking exposure, was higher in men than that in women. Men were exposed to more firearm noise, occupational noise, and recreational noise than women , AA and DHA were inversely related to low-frequency PTA, while EDA, HGLA, and DPAn-6 showed positive associations with high-frequency PTA. However, significant p for trend was not observed among the tertiles of 6 other PUFAs and hearing threshold shifts .p for trend = 0.0457, 0.0216, 0.0020, 0.0017, 0.0014, and 0.0457, respectively, all p for interaction <0.05; p for trend = 0.0020, p for interaction = 0.0371; p for trend = 0.0386, 0.0008, and 0.0057, p for interaction = 0.0004, 0.0230, and 0.0313, respectively; p for trend = 0.0168 and 0.0307, p for interaction = 0.0004 and 0.0027, respectively), so as ALA with high-frequency PTA  in women  or by self-report , 12, 14.The results of our study showed that AA and DHA were inversely associated with low-frequency PTA after adjusting for related cofounders and that EDA and DHA were inversely related to low-frequency PTA in men. The benefit of PUFAs on low-frequency hearing levels was almost consistent with findings of previous population-based and animal studies –14, 20. Though in general, some PUFAs were found to be beneficial for the low-frequency hearing threshold, and EDA, HGLA, and DPAn-6 showed a positive association with high-frequency PTA. DTA, DPAn-6, EPA, and DHA in participants aged 40–59 years and HGLA in participants aged 20–59 years were positively associated with high-frequency PTA. EDA and DPAn-6 were positively associated with low-frequency PTA in women, and ALA was associated with high-frequency PTA in women. There are some pieces of evidence to show the detrimental effect of PUFAs on the hearing status and auditory development, which support our findings –28. The Our study has several strengths, including the large and nationally representative sample cohort extracted from the NHANES. The selection was standardized to achieve minimized selection bias. Furthermore, standardized, audiometric testing was used to measure the pure-tone hearing threshold. Participants with abnormal otoscopic examination results, tympanogram compliance ≤ 0.3 ml, or poor-quality results in tympanogram were excluded to avoid analyzing data for conductive or mixed hearing loss. Our analyses were further adjusted for confounding factors that included age, sex, race, education level, BMI, diabetes, hypertension, serum cotinine level, and noise exposure that could result in a misinterpretation. The effects of PUFAs on both low-frequency and high-frequency hearing levels were estimated, with the result of broader frequency estimates than those in previous research studies , 12, 14.Despite these strengths, this study also has some limitations, which should be mentioned. The results of this study did not permit a temporal relation to be examined because of the cross-sectional design of the NHANES . AlthougAccording to the results of the NHANES data analyses, some serum PUFAs were inversely associated with low-frequency PTA, especially in men, while others were positively related to high-frequency PTA, particularly in the 40–59 years old cohort. Furthermore, some of the serum PUFAs were positively associated with both hearing threshold subgroups in women. In general, serum PUFAs tended to be beneficial for low-frequency hearing status and detrimental to the high-frequency hearing threshold. The male sex may play a protective role in this association, while the female sex and middle age may be detrimental in the effect of PUFAs on hearing function.https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2011.Publicly available datasets were analyzed in this study. This data can be found at: LL, ZJ, and XT completed the conceptualization. LL made a formal analysis of the data, wrote the original draft, and completed the methodology. ZJ and XT completed the review and editing, revising, and final approval and are accountable for all aspects. All authors have approved the final manuscript as submitted.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Sanghuangporus, a medicinal and edible homologous macrofungus as “forest gold”, which has good effects on antioxidation, boosting immunity and curing stomachache. Here, the diversity and functional group of fungi associated with the fruiting body of the most widely applied S. vaninii were characterized by high-throughput sequencing and FUNGuild tool for the first time.The microbial symbionts of macrofungal fruiting body have been shown to play momentous roles in host growth, development, and secondary metabolism. Nevertheless, there is no report on the fungal diversity of Phellinus corrected to Sanghuangporus. Simultaneously, the reads allocated into non-host fungal operational taxonomic units were largely dominated by Ascomycota, Sordariomycetes, Sordariales, Mortierellaceae, and Mortierella. Furthermore, the endophytic fungi were assigned into three trophic modes of “saprotroph” (53.2%), “symbiotroph” (32.2%), and “pathotroph” (14.1%), in which the category of “plant pathogen” was highest enriched with relative abundance of 91.8%, indicating that the endophytic fungi may have the potential to adjust the growth and metabolism of host S. vaninii.Total 11 phyla, 34 classes, 84 orders, 186 families, and 328 genera were identified in the fruiting body, and our results revealed that the fungal community was dominated by the host fungal taxonomy with absolute superiority (more than 70%), namely, Basidiomycota, Agaricomycetes, Hymenochaetales, Hymenochaetaceae, and genus of Sanghuangporus via coculture, as well as to explore the relationship between macrofungi and their associated endophytes.Altogether, this report firstly provided new findings that can be inspiring for further in-depth studies to exploit bioactive microbial resources for increased production of The online version contains supplementary material available at 10.1186/s12866-022-02663-2. Phellinus linteus, Inonotus sanghuang, P. baumii, and P. igniarius for many years. “Sanghuang” and its similar species were classified into Basidiomycota, Agaricomycetes, Hymenochaetales, Hymenochaetaceae, and a new genus of “Sanghuangporus Sheng H. Wu, L.W. Zhou & Y.C. Dai” by multigene fragment-based phylogenetic analysis until 2015 [Sanghuangporus fungi exist throughout the world, in which S. vaninii can be widely artificially cultivated and be also far more popular with customers in China [Sanghuangporus consequently still could not meet the requirements of the market.Mushroom-forming macrofungi are momentous natural resources of food and medicine in the market owing to the various and affluent metabolites –3, amongin China , 7. Givein China , the proSanghuangporus of “forest gold” has attracted the extensive attention of researchers. In addition, it was found that the contents of active compounds and their biological activities in artificial cultivated fruiting bodies of Sanghuangporus were higher and stronger than those in wild ones [Sanghuangporus production, including mutation breeding [Pseudomonas putida isolated from the fruiting body of Agaricus bisporus could stimulate the extension of host mycelia but restrain the hyphal branching frequency [Dietzia, Ewingella, Pseudomonas, Paenibacillus and Rodococcus were able to promote the growth of host pine mushroom (Tricholoma matsutake), whereas the remaining bacteria including Mycetocola and Stenotrophomonas had the negative impacts on host growth irrelevant to their various enzyme activities such as chitinase, cellulase, and protease [Bacillus and Pseudomonas were the predominant taxa of host Shiraia fruiting body, in which the Pseudomonas isolates could stimulate the production of photosensitive drug (hypocrellin A) extracted from Shiraia [Tuber melanosporum, T. magnatum, etc., were able to secret volatile organic compounds or to regulate mycorrhizal synthesis [T. aestivum by using the Illumina MiSeq method [Sanghuangporus fruiting body also remain unknown.Owing to the abundant bioactive metabolites including phenolic, flavonoid, polysaccharide, etc. and their conspicuous pharmacological activities such as antitumor, antioxidant, anti-inflammatory, and antimicrobe abilities –12, the ild ones , 14. Thebreeding , the optbreeding , the impbreeding , and thebreeding . It was requency . In receprotease . Our pre Shiraia . In addi Shiraia . Afterwaynthesis –25, but q method . NeverthS. vaninii by means of high-throughput sequencing, which has become a powerful means to provide more rapid and distinguishable analysis on the microbial communities including predominant groups, rare clusters, and even some unknown species compared with the culture-dependent method [Bacillus and Pseudomonas with higher frequency of occurrence based on both culture-dependent and next-generation sequencing approaches, whereas other members of Paenibacillus and Sphingomonas were common in Illumina sequences but scarce in isolation cultures [Sanghuangporus fruiting body, contributing to a better understanding of the diversity and functional attribute of fungicolous fungi.Against this background, we herewith wish to investigate the fungal community structure of cultivated fruiting body of the most popular t method , 24, 26.cultures . To our S. vaninii were collected from the bag-cultivated surface at their mature stage from September to October 2021, in Mahe Industrial Park of Edible Fungi of Yulin  for 1 min and 75% ethanol for 30 s, and then washed with aseptic water for 5 times and dried with sterile tissue. In order to test the efficiency of fruiting body surface sterilization, an essential control experiment was set up by coating sterile distilled H2O (200 uL) derived from the last step of surface sterilization on fungal isolation media in common use, such as potato dextrose agar and Martin medium. No microorganism growth was discovered on the medium plates after 8 days of incubation at 28-30oC, demonstrating that above sterilization means was successful in killing or at least inhibiting the growth of the epiphytic or environmental microbes [260/OD280 = 1.8-2.0) and concentration (20-30 mg/100 mg sample) of DNA specimens were measured by using Agilent 2100 Bioanalyzer  and then sealed at -20oC.Fresh fruiting bodies of fication . In shormicrobes –29. Afte-1 each forward and reverse primers (ITS1F/ITS2R), made up to the final volume with double distilled water (dd H2O). The same volume of ddH2O instead of template DNA was added to above PCR system as a negative control group. The PCR reaction of ITS1 rDNA was implemented under the following procedures reported by Thijs et al. (2017) [oC, followed by 25 cycles of 60 s at 95oC, 60 s at 50oC, and 60 s at 72oC, and then a final 7 min extension step at 72oC was executed using T-100 thermal cycler .The fungal-specific primers ITS1F (5’-CTTGGTCATTTAGAGGAAGTAA-3’) and ITS2R (5’-GCTGCGTTCTTCATCGATGC-3’) were used to amplify the ITS1 region of ITS rDNA gene . The PCR. (2017)  with a mS. vaninii fruiting body were submitted into the National Center for Biotechnology Information database  with the SRA accession number of PRJNA820174.Above PCR products were subsequently corroborated by 2% (w/v) agarose gel. The DNA bands with the correct size were excised and purified using AMPure XT beads , whose correct size was about 500 base pairs (bp) equaled to the PCR products (approximately 400 bp) of ITS plus the sequencing connector (approximately 100 bp) of gel recovered products. After purification, the PCR products of ITS1 rDNA regions were quantified using Qubit system . The libraries were then assessed by Agilent 2100 Bioanalyzer and sequenced by high-throughput Illumina NovaSeq PE250 platform  . At preshttps://www.arb-silva.de/), all OTUs were sorted out by using the plug feature-classifier of QIIME2 [http://www.stbates.org/guilds/app.php) was applied to identify the functional groups of endophytic fungal community [The resulting 239,569 raw sequences were merged using the method reported by Zhang et al. (2014) , filteref QIIME2 , which wommunity . In brieommunity .C = 1 - (n1/N), where C represents the Good’s coverage, n1 represents the number of OTUs with only one sequence, and N represents the total number of sequences in the sample draw.The calculation and comparative analysis of alpha diversity  between three groups of samples were carried out by QIME2 (version 2020.06), and then the drawing was accomplished using R package (version 3.5.2). The calculation formula of Coverage was as follows: S. vaninii , class of Agaricomycetes (76.8%), order of Hymenochaetales (71.8%), and family of Hymenochaetaceae (71.7%), were indeed dominant with absolute superiority of relative abundances in community structure , Phlyctochytrium (1.8%), Cladosporium (1.6%), Fusarium (0.7%), and Rhizophlyctis (0.6%) , Chytridiomycota (3.1%), and some other groups with a small percentage , followed by Phlyctochytrium, and other non-dominant fungi including Botryotinia, Plectosphaerella, and Aspergillus were only related to “pathotroph”. The dominated Rhizophlyctis and other non-dominant fungi including Lulwoana, Trichocladium, Polyporus, Schizothecium, Calycina, Submersisphaeria, Archaeorhizomyces, Botryotrichum, Cuphophyllus, Lepista, and Humicola were only related to “saprotroph”. Some non-dominant fungi including Russula, Cortinarius, Lactarius, Tomentella, Laccaria, Cadophora, and Leptodontidium were only related to “symbiotroph”  can be divided into trophic modes with “pathotroph”, “saprotroph” and “symbiotroph”, in which “saprotroph” was highest enriched with relative abundance of 53.2% (Supplementary Table S2). On the basis of Confidence of highly probable, the 25 genera of endophytic fungi with the highest abundance (Supplementary Table S3), namely Top25, were then selected and visualized with trophic mode as horizontal ordinate and relative abundance as longitudinal coordinate Fig. . And speellinus 9.9%, follSuillus grevillei, among which the isolates Pseudomonas sp. could remarkably promote the growth of host mycelia, whereas Streptomyces sp. possessed an inhibitory effect [Pseudomonas sp. from the A. bisporus fruiting body, promoted their host growth by the secretion of cellulase and indole-3-acetic acid [Lyophyllum decastes by enhancing the non-volatile taste components including amino acid, protein, soluble sugar, etc. of host hyphae [P. fulva SB1 from Shiraia fruiting body was found to provoke the yields of intracellular biosynthesis and extracellular excretion of medicinal perylenequinonoids of the host fungus [Sanghuangporus were also still ignored.It has been demonstrated that macrofungal fruiting bodies could harbor a broad spectrum of microbes, especially the bacterial diversity and physiological role on host fungi were widely explored and reported in many researches , 43. Fory effect . Xiang etic acid . Xu et at hyphae . In our t fungus . In termt fungus –49, but Sanghuangporu fruiting body by using a more advantageous culture-independent method of Illumina NovaSeq sequencing. The sequencing results furnished us with a more comprehensive data (865 OTUs) of the fungal diversity in S. vaninii fruiting body. As we expected, a large number of the ITS1 reads corresponded to the host fungal taxonomy  of the host fungi could make full use of the surrounding nutrition by decomposing the cultural substrate or attacking their tree hosts such as Moru and Populus [Phlyctochytrium, Botryotinia, Aspergillus, etc.  [Paxillus and Xercomus fruiting bodies were able to secret some volatile compounds influencing the growth and development of mycoparasitic fungus. And our previous study demonstrated that the endophytic P. fulva could induce mass sporulation and photosensitizer production of host fruiting bodies of Shiraia [Our research attempted to address the potential function of endophytic fungi in cultivated  Populus , 55 for . (2012) , the Bas Shiraia .S. vaninii for the first time by high-throughput sequencing technique in this paper. Although the specific impacts and mechanisms of endophytic non-host fungi on the growth and metabolism of host-fungus S. vaninii need further investigation, the present work provided fundamental data for the active microbial excavation of associated sources. Since microbe’ co-culture inspired by the natural microbial community structure is becoming one of “One Strain, Many Compounds (OSMAC)” strategies to enhance chemodiversity [Sanghuangporus may be improved tremendously by its non-host endophytes in the future.In summary, due to the microbes have important influences on the growth, development and active metabolite biosynthesis of hosts, we successfully analyzed and characterized the community composition and trophic mode diversity of fungi associated with the fruiting body of iversity , 62, we Below is the link to the electronic supplementary material.Supplementary material 1: Table S1. Taxonomic classification of OTUs detected from Sanghuangporus vaninii fruiting body with total ITS rDNA read numbers. Table S2. The fungal OTUs associated with S. vaninii fruiting body were annotated into trophic modes. Table S3. Trophic modes annotation of associated fungi at genus level. Table S4. Trophic modes and their guilds annotation of fungi associated with S. vaninii fruiting body.


Turner syndrome is a frequent genetic disorder that affects female individuals and covers a large phenotypic variability. Scientific literature suggests an association between hearing loss and Turner syndrome, but it remains a controversial topic.To associate the cytogenetic alteration with the audiometric profile of individuals with Turner syndrome.Cross-sectional study, with a hospital-based, convenience sample. Patients diagnosed with Turner syndrome were included and those with difficulty understanding the audiometry and/or other associated syndromes were excluded. The participants were studied with pure tone audiometry.Of the 65 patients included, 36.9% had X chromosome monosomy and 63.0% had other alterations. Regarding the audiometry, 64.6% had normal thresholds and 35.3% had hearing impairment. Of these, 30.4% had hybrid hearing loss, 26.0% alteration at 6 and/or 8 kHz, 17.3% had conductive hearing loss, 13.0% sensorineural loss and 13.0% had mixed hearing loss. We observed that the mild degree was the most frequent one. There was no statistically significant association between the cytogenetic type of Turner syndrome and the presence or absence of hearing loss, or with the type and degree of hearing loss.The cytogenetic alteration in Turner syndrome was not associated with the audiometric profile, which showed variability regarding the type and degree of hearing loss. Turner syndrome (TS) is a genetic, relatively frequent and complex abnormality that affects female individuals and is cytogenetically characterized by sex chromosome monosomy (45X) in mosaicism or not, or by structural alterations. Eventually, the Y chromosome or part of it can be found.2pectus excavatum.TS occurs with a wide variety of anatomical and functional alterations. The clinical picture is variable, with the most common being short stature, immaturity of sexual development, short neck, renal and cardiovascular abnormalities, in addition to a triangular-shaped face, small nose, retrognathism, ogival palate, small jaw and dental malocclusion and some visual alterations , low hair implantation on the nape of the neck and Considering the great phenotypic variability and the several comorbidities that can be associated with TS, some studies have suggested an association between hearing loss and TS.The presence of recurrent chronic otitis media, which contributes to conductive hearing loss, can be explained by the presence of ogival palate in TS, a characteristic that facilitates the occurrence of respiratory disorders and thus hinders the elimination of secretions, which can result in middle ear infections.Middle ear alterations have been found at a higher percentage in children with TS than in the population of healthy children, even though this disorder is commonly diagnosed in childhood. The authors point out that congenital anatomical changes of the auditory tube, which may be present in TS, can be one of the most probable causes.In addition to middle ear alterations found in TS, other hearing disorders have also been reported. One of them is early presbycusis, due to estrogen deficiency. Progressive sensorineural hearing loss can also be observed, usually starting at mid-frequencies, which can reach high frequencies with advancing age. This type of loss is related not only to age, but also to the early occurrence in individuals with a monosomy, rather than other types of chromosomal alterations.Knowing the relevance that the sense of hearing has in the lives of individuals and its important role regarding aspects of learning, oral communication and language development,The aim of this study was to associate the cytogenetic type to the audiometric profile of patients with TS.A descriptive and cross-sectional study was carried out, after being approved by the research ethics committee of instituto de puericultura e pediatria Martagão Gesteira (IPPMG/UFRJ), under number 1864085. All individuals who agreed to participate signed the free and informed consent form and the term of assent, when necessary.This was a hospital-based convenience sample consisting of individuals with a cytogenetic diagnosis of TS, aged 9–39 years old, from the medical genetics and pediatric endocrinology services of IPPMG/UFRJ and the endocrinology service of the hospital universitário Clementino Fraga Filho (HCFF/UFRJ).Participant selection was carried out through evaluation of medical records and subsequent anamnesis. The inclusion criteria included having a diagnosis for TS with numerical or structural karyotype alterations (lymphocyte culture). The exclusion criteria included the coexistence of another genetic condition (another associated syndrome) and/or the impossibility of performing the audiometry due to the lack of understanding of the requested tasks.Instituto Nacional de Educação de Surdos), which belongs to the ministry of education. The procedures were performed by three trained audiologists, during a single consultation. An Interacoustics audiometer, model AD 229b, was used in the test, which was calibrated annually, according to ISO 1994.The hearing assessments were carried out in the audiology division of the national institute of deaf education  Type 1: X chromosome monosomy; (b) Type 2: other cytogenetic alterations, such as structural changes and mosaicism.A careful otoscopic inspection of the external auditory canal was performed to visualize the tympanic membrane and possible identification of individuals with a foreign body and/or a wax plug, which would prevent the correct attainment of tonal thresholds.Then, pure tone audiometry was performed, aiming to determine the audiologic thresholds. The procedure was carried out inside an acoustic booth with the use of headphones, where tonal values were assessed by air at frequencies of 250–8000 Hz and by bone conduction at frequencies of 500–4000 Hz. Thresholds were obtained through the descending/ascending technique.A normal audiometry was considered as the presence of audibility thresholds up to 25 dB in all frequencies.Aiming to designate hearing loss by type, the following classifications were used: conductive, mixed; sensorineural, alteration at 6 and/or 8 kHz.To designate the degree of hearing loss, the World Health Organization classification  was usedp < 0.05.A descriptive analysis was performed, with frequency distribution and measures of central tendency and dispersion at the exploratory level, and the Chi-Square test was used to assess the association between the variables: normality and hearing impairment (G1 and G2) with cytogenetic alterations  and Fisher's exact test to calculate the probability of association between the variables type and degree of loss with karyotype. The sample showed a normal distribution, according to the Shapiro–Wilk test. Analysis of variance (ANOVA) was used to study the influence of age on groups G1 and G2. The statistical significance was set at Initially, 70 patients were enrolled, with a mean age of 19.4 years (±7.84). Four patients were excluded because they were unable to understand the tasks proposed in the tests, and one patient, for having a genetic comorbidity (Trisomy 13).Thus, 65 participants were included: the minimum age was 9 years and the maximum was 39 years. The mean age was 19.1 years (±7.1). Twenty-four (36.9%) patients had X-chromosome monosomy (Type 1) and 41 (63.0%) had other alterations (Type 2).When analyzing the pure tone audiometry responses, we observed that 42 participants (64.61%) had thresholds within the normal range at all evaluated frequencies (G1), whereas 23 (35.3%) had some type of hearing loss (G2). Regarding the degree of hearing loss, 60% of the sample had mild degree, 20% moderate and 20% had a severe degree. It was not possible to identify the degree of loss in 13 participants, as they had hybrid hearing loss or alteration at 6 and 8 kHz.No statistically significant association was identified between the cytogenetic type (Type 1 and Type 2) and the audiometry result (G1 and G2) and between the cytogenetic type (Type 1 and Type 2) and the type and degree of hearing loss .Table 1Dp-value obtained was 0.07 and, therefore, not statistically significant  test between groups was used, in which the nificant . HoweverIn studies that associate hearing loss and TS, the sample is usually mostly constituted of individuals with 45X, with this cytogenetic type being found in 50% of cases with TSIt is known that hearing loss may be associated with TS.Mild hearing loss was the most frequent and profound hearing loss was not identified in the sample. These results are in agreement with a similar study, which evaluated 52 individuals with TS, aged between 7 and 37 years old, which observed that the participants with hearing loss had a higher frequency of mild, moderate and moderately severe hearing loss, in decreasing order, whereas none had a profound degree of loss.As a limitation of this study, we can point out the small number of participants. However, studies with larger samples still show different results,20The importance of pure tone audiometry in the diagnosis of hearing loss is undeniable. Although there are several audiological tests at present, pure tone audiometry is still considered the most relevant stage of audiological evaluation, which allows detecting the presence, type and degree of hearing loss.The type of cytogenetic alteration did not influence whether the individual had or did not have hearing loss, the type and degree of loss. The audiometric profile in TS was varied, with normal hearing function being the most frequent one. Among the hearing alterations identified, there was great variability regarding the type and degree of hearing loss.The authors declare no conflicts of interest.


Aim: to estimate the prevalence of hearing loss in a representative sample of elderly people (aged 65 or over) in the city of Rio de Janeiro. Material and Method: a prospective, cross-sectional population-based study with 238 elderly people aged 65 years or more (198 women and 40 men). Results: the prevalence of hearing loss was 39.4% (better ear) and 61.6% (worse ear) in the female group, 60% (better ear) and 77.5% (worse ear) in the male group, and 42.9% and 64.3% in the study population. Mild hearing loss was the most prevalent level of hearing loss. Conclusion: the prevalence of hearing loss in the study population was significant and in accordance with others relevant international epidemiological studies. Longitudinal studies are needed to better understand age-related hearing loss.Hearing loss in the elderly is one of the most frequent chronic diseases.  A number of papers have noted the age-related decline of hearing sensitivity in humans;Various authors have discussed the consequences of hearing loss in the elderly.Many authorsBrazil has witnessed a significant growth of its elderly population. Currently, there are 16,8 million people aged 60 years or more in the country, in a total population of 183 million people.21 It is expected that this number will grow to 32 million by 2024. Brazil is thus included in the world scenario of increased human longevity, which has reached previously unthought-of limits.According to the national health policy for physically challenged personsIt is important to know the prevalence of hearing loss in the elderly, as this information can support specific policies and public services for this age group. According to the national health policy for physically challenged persons,This paper aimed to estimate the prevalence of hearing loss in an elderly population in the city of Rio de Janeiro, in Brazil, based on auditory thresholds measured by standard pure tone audiometry.A cross-sectional population-based study was made in 2004 of elderly people aged 65 years or above, registered in an open university for elderly persons in the city of Rio de Janeiro. The sample was composed of 238 subjects selected randomly from the office registry.The study sample was recruited in an open university where the entrance requirement is to be aged 60 years or over. Various courses are offered in this project for elderly persons, who are autonomous and independent people.The baseline sample included subjects that had registered in the institution between 1993 and 2004; the approximate total number was 3,500 people. The sample population included subjects aged 65 or above that had registered in 2004.The sample was composed of 258 people (218 women and 40 men) who met the inclusion criteria. Talks were given in the university facilities about age-related hearing loss to guide and inform the subjects about the ongoing study before recruiting of previously selected individuals. Subjects were invited to participate in person, during the talks and by telephone. The talks were given after institutional approval had been obtained.There were 238 subjects that decided to participate in this study out of the total sample, which was composed of all of the 40 men and 198 women . The 20 women that did not participate were invited by telephone; six of them had moved to other cities, one had a diagnosis of dementia, two had been diagnosed as depressed, and 11 did not participate for personal reasons.The state of Rio de Janeiro has the highest rate of elderly persons in Brazil (12.8%), of which most are women. On average women live eight years longer than men.Great care was taken when comparing genders in our sample, given the numeric difference between men and women.We made a sample calculation to assess the power of our sample based on national health policy estimates for physically challenged persons; these estimates suggest a 30% prevalence of hearing loss in the Brazilian elderly population. We used a 95% confidence level and a 6% acceptable error level. These calculations allowed us to establish that 211 subjects would represent the baseline population.The research project was sent to the Research Ethics Committee (CEP08/2004) of the Social Medicine Institute/UERJ and of the institution that was responsible for the Open University project, and was approved. All of the participants signed a free informed consent form.The audiological assessment was made by the audiology team of the Instituto Nacional de Educação de Surdos (INES). INES is a federal public agency that belongs to the Education Ministry; it is a national center for research and study and a school for about 500 deaf students. Pure tone audiometry was part of a detailed evaluation of auditory function in the elderly subjects. Part of the assessment clinical history taking that included information about the health and social history of each patient, and meatoscopy.We used the Interacoustic-AD27 for pure tone audiometry calibrated according to ISO/DIS standards.26 The tone was presented separately to each ear through TDH-39 earphones in an appropriate acoustical environment. We used the ascending method to assess airway auditory thresholds at 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz. Bone transmission was measured at 0.5, 1, 2, 3, and 4 kHz. Masking was used when necessary. The procedures were conducted according to ISO 8253-1 standards.12 Pure tone averages (PTAs) were calculated at 0.5, 1, 2, and 4 kHz, according to the Editorial Guidelines for the description of inherited hearing loss.27 The ear with the best PTA was considered the better ear, and the worse PTA defined the worse ear. The frequency tone threshold where subjects presented no specific sensitivity was defined at 120 dB HL.The World Health Organization (WHO)Bilateral hearing loss was present when the PTA was above 25 dB HL in both ears. Unilateral hearing loss was present when the PTA in one ear was equal to or below 25dB dB HL and above 25dB HL in the other ear, or when there was a value over 50dB HL in at least one frequency. Asymmetric hearing loss was present when there was a more than 10 dB HL difference between ears in at least two frequencies, where the PTA in the best ear was equal to or below 25 dB HL. Symmetrical hearing loss was defined when all of the abovementioned options were excluded. These criteria were defined according to the Editorial Guidelines for description of inherited hearing loss.Mixed hearing loss was defined in audiometry when the bone conduction PTA was above or equal to 25dB HL and a GAP/PTA air-bone equal to or over 15 dB HL. Conduction hearing loss was defined in audiometry when the bone conduction PTA was below or equal to 25 dB HL and a GAP/PTA air-bone equal to or over 15 dB HL. In both cases subjects were referred to the ENT specialist. Subjects with cerumen obstruction returned for the assessment after having the obstruction removed.The group of elderly women was composed of 198 women aged between 65 and 84 years (mean: 71.7 years) and the group of elderly men was composed of 40 men aged between 65 and 81 years (mean: 71.9 years). The sample population contained 238 subjects aged between 65 and 84 years (mean: 71.8 years).In the women’s group (M65-84), 39.4% had some degree of hearing loss in the best ear; 61.6% had some degree of hearing loss in the worst ear. Unilateral hearing loss was found in 21.2% of women; symmetrical hearing loss was found in 22.7% of women and bilateral asymmetric hearing loss was found in 17.7% of women.In the men’s group (H65-81), 60% had some degree of hearing loss in the best ear; 77.5% had some degree of hearing loss in the worst ear. Unilateral hearing loss was found in 17.5% of men; symmetrical hearing loss was found in 25% of men and bilateral asymmetric hearing loss was found in 35% of men.In our total sample, 42.9% had some degree of hearing loss in the best ear; 64.3% had some degree of hearing loss in the worst ear. Unilateral hearing loss was found in 17.6% of elderly subjects; bilateral symmetrical hearing loss was found in 23.1% of elderly subjects and bilateral asymmetric hearing loss was found in 20.6% of elderly subjects.Our results are similar to those in other epidemiological studies,Two investigations on hearing have been made based on the epidemiological Framingham Heart Study,The results of a paper by Davis A.29 in the United Kingdom revealed a 60% prevalence of hearing loss for the best ear in subjects whose mean was age 75.5 years. Our findings show a 42.9% prevalence in the best ear for a mean age of 71.8 years. The results are relatively similar when we consider the age difference.Cruickshanks et al.The Swedish Gerontological and Geriatric population Study of GöteborgThe 30% prevalence of hearing loss among people aged 65 years or more that is stated by the national health policy for physically challenged personsThere was a higher percentage of subjects with mild hearing loss, a finding in common with other international papers.13The symmetrical type was the most frequent form of hearing loss, which suggests that hearing loss was related to age. There was, however, a higher rate of asymmetrical hearing loss in the male group compared to the female group; this could be explained by a greater exposure of men to noise at work and in leisure activities, to cardiovascular conditions, to smoking, and to other factors such as alcohol abuse, which have also been mentioned in papers relating hearing loss, gender and aging. Our sample, however, is relatively small, which does not allow us to generalize our findings.The prevalence of hearing loss in our sample was high. There is, therefore, an urgent need to make diagnostic and specific therapeutic units available in public health services for this population group, which is still socially active.Audiology for the elderly is a recent development in public health,Another important finding is that there was a higher prevalence of mild hearing loss in all groups with hearing loss. Such information points to a need for preventive public health measures against further auditory loss. More effective policies than those currently available are needed to provide hearing aids.A further measure would be to offer specific auditory retraining programs for the elderly that present hearing loss, which could increase their quality of life. Such programs would foster adaptation and daily use of hearing aids and could increase social interactions for this age group. Auditory retraining, language and communication techniques substantially facilitate the communication process, which may be altered even if there is mild hearing loss.We believe that it is important to record the prevalence of hearing loss in subjects aged 65 years or more, based on a population study in the city of Rio de Janeiro. We hope to involve as many professionals and other people as possible by providing information and guidance about the social and health consequences and implications of hearing loss in the elderly.


Cardiovascular risk factors are associated with worse hearing, but the role of mid-life physical activity (PA) on hearing loss at older ages is yet to be investigated.Among 3,198 participants of the Atherosclerosis Risk in Communities study, we investigated the association between self-reported mid-life PA (meets PA recommendations [≥150 minutes of moderate-to-vigorous PA/week] vs. not) and hearing loss (audiometric battery [pure-tone and speech-in-noise]) at older ages. We estimated differences in hearing between those who met and did not meet PA recommendations at mid-life and at late life adjusting for demographics, medical conditions, and noise exposure.43.3% participants met PA recommendations at mid-life. These participants, compared to those who did not meet recommendations, had lower better hearing by 1.51  decibels, and 0.37  more words identified in the speech-in-noise test.Meeting PA recommendations in mid-life was associated with better hearing at older ages.


The relationship between hearing impairment and nutrition has been extensively investigated; however, few studies have focused on this topic in working-age adults by income level. Herein, we aimed to determine the differences in hearing impairment among working-age adults by income level and identify the nutritional factors that affect hearing loss in various socioeconomic groups. Seven-hundred-and-twenty participants had hearing impairment, while 10,130 had normal hearing. After adjustment for propensity score matching, income and smoking status were identified as significant variables. By assessing the relationship between hearing impairment and nutrient intake by income level using multiple regression analyses, significant nutrients differed for each income category. Carbohydrate and vitamin C levels were significant in the low-income group; protein, fat, and vitamin B1 levels were significant in the middle-income group; and carbohydrates were significant in the high-income group. Income was significantly associated with hearing impairment in working-age adults. The proportion of individuals with hearing impairment increased as income decreased. The association between hearing impairment and nutritional intake also differed by income level. Our findings may enable the establishment of health policies for preventing hearing impairment in working-age adults by income level. Hearing loss (HL) is a major public health concern affecting an estimated 360–554 million adults and children worldwide . There iSince the economic status of Korea has markedly changed since 1960, with a transition to Westernized nutritional behavior, a study of the association between income and dietary intake is needed to reveal the factors affecting HL. Thus, this study aimed to investigate the association between income and HL and identify the key nutritional factors that affect HL using cross-sectional data from the fifth Korean National Health and Nutrition Examination Survey (KNHANES). Public health professionals and policymakers should devote effort to increasing food availability, accessibility, and affordability among low-income adults with HL.The subjects underwent the pure-tone audiometry (PTA) as a standard protocol  in a double-walled single-room audio booth.Pure-tone thresholds were obtained for air conduction at 250, 500, 1000, 2000, 4000, and 8000 Hz. Audiological data were reported in accordance with the methods recommended by the Hearing Committee of the American Academy of Otolaryngology Head and Neck Surgery, and the average PTA was calculated using the following formula: (5000 Hz + 1000 Hz + 2000 Hz + 4000 Hz)/4. Hearing impairment was defined as an average PTA score of >40 dB.Raw data from the fifth (2010–2012) KNHANES were analyzed in this study. The KNHANES consists of health, nutrition, and checkup surveys, and is performed to produce statistics with representation and reliability of national and provincial units of health, health consciousness, behavior, food, and nutrition . Common A circular survey of 192 survey units and 3840 households was conducted annually with a total of 25,534 samples, including 8958 in 2010, 8518 in 2011, and 8058 in 2012. A total of 10,850 people were selected as the final participants; thus, 3259 people younger than 20 years or older than 65 years and 11,425 who did not respond to the survey or did not take the test were excluded. The study was approved by Wonju Severance Christian Hospital (IRB number: CR321349).Four income-related variables are included in the data. In several studies, the monthly household income quartile is often chosen to represent income. However, in this study, individual income variables were selected rather than household income as each household member had different personal characteristics based on their occupation or lifestyle. To identify the stark differences between income levels, we select the quintile individual income variable and classified it into very low, low, middle, high, and very high. The low and very low categories were recombined into low, high and very high were recombined into high.The individuals were divided into age categories of 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, and 60–64 years. . The Organization for Economic Cooperation and Development classifies the working-age population as individuals aged 15–64 years. Individuals over 65 years of age were also excluded from the analysis because geriatric HL may act as a confounding factor. When the participants were asked “Have you ever worked in a noisy place such as that with a mechanical sound or generator for more than three months?” their responses were recorded as “yes” or “no”. However, if their response was “no memory”, it was excluded. The participants were asked, “Have you ever been married?” If yes, which of the following is your current marital status: “Spouse present and live together” or “Spouse present but do not live together”? If participants were never married, they were classified as “unmarried.” Furthermore, if their answer was “No spouse due to spouse death” or “No spouse due to divorce”, the Divorced & Bereavement category was selected. If their response was “no memory”, it was excluded. A total of four categories were established for the question “How often do you drink?”: “not at all in the last year”, “less than once a month”, and “once a month” as non-drinkers or “two to four times a week” as drinkers. Smoking status was divided into three categories: “never smoked”, “less than five packs (100 cigarettes)”, and “more than 5 packs (100 cigarettes)”.The KNHANES includes screening items that measure waist circumference, blood pressure, high-density lipoprotein cholesterol (HDL-C), fasting glucose, and triglyceride level, which define metabolic syndrome. Metabolic syndrome was defined according to the diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel. The diagnostic criteria were abdominal obesity (waist circumference >90 cm for men and >80 cm for women), high-neutrality fat (>150 mg/dL), low HDL-C (<40 mg/dL for men and <50 mg/dL for women), and high blood pressure (130/85 mm Hg or higher).Nutritional surveys included food safety, food intake frequency, and food intake surveys . The food intake frequency survey included variables of weekly intake frequency and average intake per serving, and the daily nutrient intake calculated therein is the generated variable. The 2012–2019 food safety survey based on the US Household Food Security/Hunger Survey module. An integrated analysis could not be performed because of these changes. The food intake frequency survey was conducted using a simple food intake frequency survey table consisting of 63 food items until the 2nd year of the 5-year period (2011). However, the validity of the 112 food items from the 3rd year of the 5-year period (2012) was verified. Using a quantitative food intake frequency survey table, the intake frequency and serving amount for each item were investigated. The semi-quantitative food intake frequency survey of 112 food items (2012) and the food intake frequency survey (2010–2011) consisting of 63 food items comprised the items in the two survey tables, although the items were the same. As the responses and frequencies were different, an integrated analysis could not be performed. Therefore, the food intake survey was based on food intake content  one day before the survey. The variables included energy, water, protein, fat, carbohydrate, fiber, ash, calcium, phosphorus, iron, sodium, potassium, vitamin A, carotene, retinol, vitamin B1, riboflavin, niacin, and vitamin C; these variables represent the sum of the daily nutrient intakes from all foods and foods consumed by an individual during the day.t-test and chi-square tests were used to determine whether demographic characteristics  affect HL and to compare prevalence rates. The level was considered significant when the p-value was less than 0.05.The analysis was conducted using SAS 9.4 . The To reduce the influence of age, sex, and noise exposure, which are known as risk factors for heating impressions, 1:3 propensity score matching was performed using the three variables to properly determine the effect of other variables on HL.Simple and multiple regression models were used to determine the association between hearing impairment and demographics, habits, medical histories, and nutritional intakes.p < 0.0001). In the no hearing impairment and hearing impairment groups, the proportion of women was significantly higher than that of men (p < 0.0001). Noise exposure was also statistically significant (p < 0.0001). In the no-hearing impairment group, the proportion of people with a high income was 40.72%. In the hearing impairment group, people with a low income were the most common at 42.36%, but income was not statistically significant (p = 0.0508). The number of participants with “unmarried” status was the highest in each group, with statistical significance (p < 0.0001). The percentage of non-smokers in the no hearing impairment and hearing impairment groups was 62.38% and 53.19%, respectively.The participants’ general characteristics according to hearing impairment status are shown in p < 0.0001). Alcohol consumption was 56.79% and 46.53% in their groups, respectively, with “2–4 times/month” the most frequent response. In the hearing impairment group, 9.58% drank “≥4 times/week,” which was significantly higher than that in the non-hearing impairment group (p < 0.0001). There were more targets without metabolic syndrome that were statistically significant (p < 0.0001). Among the items that aided in the diagnosis of metabolic syndrome, waist circumference (p = 0.0015), fasting glucose level (p < 0.0001), hypertension (p < 0.0001), and triglyceride level (p < 0.0001) were statistically significant, while HDL-C level was not statistically significant (p = 0.3606).The proportion of participants who smoked “over 5 packs” of cigarettes in the hearing impairment group was 45.14%, significantly higher than that of the no hearing impairment group (p < 0.0001). In terms of sex, HL was observed more frequently in women than in men . We were able to control for sex confounding factors by implementing PSM. When participants were exposed to noise, their likelihood of not having HL was reduced . Furthermore, the higher the income level, the higher the likelihood of no HL .The general characteristics of the study participants on the multiple regression analysis are shown in The results of the 1:3 PSM using age, sex, and noise exposure, which are known risk factors for hearing impressions, are shown in p < 0.0001). In the no-hearing impairment group, the proportion of people with a high income was 43.8%. In the hearing impairment group, the proportion of people with a low income was 42.36%, and income was a statistically significant variable (p = 0.0012). In the no hearing impairment and hearing impairment groups, most participants were “unmarried”; however, the differences relative to the other groups were not statistically significant (p = 0.2692).The general characteristics of the participants according to hearing impairment status in the matched data are shown in p = 0.0444).Among the no hearing impairment group, 56.25% were non-smokers, which was higher than that of the hearing impairment group of 53.19%, respectively. Furthermore, 45.14% of smokers in the hearing impairment group reported “over 5 packs,” a significantly higher proportion than that of the no hearing impairment group (p = 0.4389). There were more targets without metabolic syndrome that were not statistically significant (p = 0.6212). Among the factors used to diagnose metabolic syndrome, waist circumference (p = 0.6274), HDL-C (p = 0.8609), fasting glucose (p = 0.5709), hypertension (p = 0.5095), and triglycerides (p = 0.8656) were non-statistically significant variables.The proportion of alcohol consumption between the no hearing impairment and hearing impairment groups was not significant (p = 0.0013). An increased prevalence of smoking also increased the likelihood of a no HL status .The general characteristics of the participants in the matched data based on multiple regression analysis are shown in The differences in nutritional intake between normal hearing and hearing loss groups according to income using simple regression analysis are shown in p = 0.031), as did a higher vitamin C intake . In the middle-income group, the protein, fat, and vitamin B1 levels were statistically significant. A lower protein intake reduced the risk of HL , as did a higher fat intake . A reduced vitamin B1 intake decreased the risk of HL . In groups with a high income, a lower carbohydrate intake decreased the risk of HL .The differences in nutritional intake between the normal hearing and HL groups according to income using multiple regression are shown in p < 0.0001). “Profound” was the most common in “Low-income,” “Severe” in “Middle-income,” and “Moderate” in “High-income”.The distribution of HL degree by income group is shown in p = 0.031; and OR = 1.302, p = 0.0074, respectively). In the middle-income group, the protein, fat, and vitamin B1 intakes were statistically significant variables. This is similar to a Korean study that reported that vitamin C intake was associated with HL and a French study that found that vitamin B1 intake reduced the risk of HL [This study confirmed the correlation between income and HL and verified the major nutrients affecting HL from the 5th 2010–2012) KNHANES. Based on the reported epidemiological and clinical factors, income was the most significant risk factor for HL. Carbohydrate and vitamin C intakes were significant in the low-income group. Lower carbohydrate and higher vitamin C intake reduced the risk of HL , as did a higher vitamin C intake . In the middle-income group, a lower protein intake reduced the risk of HL , while an increased fat intake reduced the risk of HL . A reduced vitamin B1 intake also decreased the risk of HL . In the high-income group, carbohydrate intake was a statistically significant variable; a low carbohydrate intake reduced the risk of HL . Therefore, income level should be considered when concerning the relationship between hearing impairment and nutrient intake. Studies reported that the incidence of HL is higher in low- and middle-income countries such as Cameroon, where nutrient intake is poor, compared to high-income countries. Furthermore, adolescents in underdeveloped countries were found to consume dairy products, meat, fruits, and vegetables as specified in the WHO dietary guidelines, but they suffer from vitamin A deficiency as they do not consume the required amount [Similar to these studies, HL was also correlated with income level, and it was showed that nutritional intake according to income level influenced the onset of hearing loss. In the low-income group, a lower carbohydrate intake reduced the risk of HL (OR = 0.78, d amount ,27. Low-d amount ,29,30. TOur findings will be useful for the study of health policies related to HL. When establishing food- and nutrition-related policies or welfare programs, there is a need for differentiated nutrition interventions and management by social class. Active government support is also required, especially for low-income single-person households that are vulnerable to nutritional deficits. The need for food and nutrition support programs for the underprivileged has been recognized in many countries, with governments directly managing and operating such programs. In Korea, the Nutrition Plus Project was implemented in 2005 to establish a lifelong health management system for its citizens . In the To prevent HL, different nutrients are important for each income group. Carbohydrate and vitamin C levels were higher in the low-income group; protein, fat, and vitamin B1 levels were crucial in the middle-income group; and carbohydrates were the main target nutrients for the high-income group. Overall, this study provides direction for HL-preventing public health policies.