Amyloid‐beta (Aβ) oligomer is known to contribute to the pathophysiology of age‐related macular degeneration. Herein, we aimed to elucidate the in vivo and in vitro effects of Aβ _1‐42 application on retinal morphology in rats. Our in vivo studies revealed that intracerebroventricular administration of Aβ _1‐42 oligomer caused dysmorphological changes in both retinal ganglion cells and retinal pigment epithelium. In addition, in vitro studies revealed that ARPE‐19 cells following Aβ _1‐42 oligomer application had decreased viability along with apoptosis and decreased expression of the tight junction proteins, increased expression of both phosphor‐AKT and phosphor‐GSK3β and decreased expression of both SIRT1 and β‐catenin. Application of conditioned medium (CM) obtained from mesenchymal stem cells (MSC) protected against Aβ _1‐42 oligomer‐induced retinal pathology in both rats and ARPE‐19 cells. In order to explore the potential role of peptides secreted from the MSCs, we applied mass spectrometry to compare the peptidomics profiles of the MSC‐CM. Gene ontology enrichment analysis and String analysis were performed to explore the differentially expressed peptides by predicting the functions of their precursor proteins. Bioinformatics analysis showed that 3‐8 out of 155–163 proteins in the MSC‐CM maybe associated with SIRT1/pAKT/pGSK3β/β‐catenin, tight junction proteins, and apoptosis pathway. In particular, the secretomes information on the MSC‐CM may be helpful for the prevention and treatment of retinal pathology in age‐related macular degeneration.

Background: When a new disease such starts to spread, the commonly asked questions are how deadly is it? and how many people are likely to die of this outbreak? The World Health Organization (WHO) announced in a press conference on January 29, 2020 that the death rate of COVID-19 was 2% on the case fatality rate (CFR). It was underestimated assuming no lag days from symptom onset to deaths while many CFR formulas have been proposed, the estimation on Bays theorem is worthy of interpretation. Hence, it is hypothesized that the over-loaded burdens of treating patients and capacities to contain the outbreak (LSBHRS) may increase the CFR. Methods: We downloaded COVID-19 outbreak numbers from January 21 to February 14, 2020, in countries/regions on a daily basis from Github that contains information on confirmed cases in >30 Chinese locations and other countries/regions. The pros and cons were compared among the 5 formula of CFR, including [A] deaths/confirmed; [B] deaths/(deaths + recovered); [C] deaths/(cases x days ago); [D] Bayes estimation based on [A] and the outbreak (LSBHRS) in each country/region; and [E] Bayes estimation based on [C] deaths/(cases x days ago). The coefficients of variance (CV = the ratio of the standard deviation to the mean) were applied to measure the relative variability for each CFR. A dashboard was developed for daily display of the CFR across each region. Results: The Bayes based on (A)[D] has the lowest CV (=0.10) followed by the deaths/confirmed (=0.11) [A], deaths/(deaths + recoveries) (=0.42) [B], Bayes based on (C) (=0.49) [E], and deaths/(cases x days ago) (=0.59) [C]. All final CFRs will be equal using the formula (from, A to E). A dashboard was developed for the daily reporting of the CFR. The CFR (3.7%) greater than the prior CFR of 2.2% was evident in LSBHRS, increasing the CFR. A dashboard was created to present the CFRs on COVID-19. Conclusion: We suggest examining both trends of the Bayes based on both deaths/(cases 7 days ago) and deaths/confirmed cases as a reference to the final CFR. An app developed for displaying the provisional CFR with the 2 CFR trends can improve the underestimated CFR reported by WHO and media.

Background: Citation analysis has been increasingly applied to assess the quantity and quality of scientific research in various fields worldwide. However, these analyses on spinal surgery do not provide visualization of results. This study aims (1) to evaluate the worldwide research citations and publications on spinal surgery and (2) to provide visual representations using Kano diagrams onto the research analysis for spinal surgeons and researchers.Methods: Article abstracts published between 2007 and 2018 were downloaded from PubMed Central (PMC) in 5 journals, includingSpine, European Spine Journal, The Spine Journal, Journal of Neurosurgery: Spine, and Journal of Spinal Disorders and Techniques. The article types, affiliated countries, authors, and Medical subject headings (MeSH terms) were analyzed by the number of article citations using x-index. Choropleth maps and Kano diagrams were applied to present these results. The trends of MeSH terms over the years were plotted and analyzed.Results: A total of 18,808 publications were extracted from the PMC database, and 17,245 were affiliated to countries/areas. The 12-year impact factor for the five spine journals is 5.758. We observed that (1) the largest number of articles on spinal surgery was from North America (6417, 37.21%).Spineearns the highest x-index (= 82.96). Comparative Study has the highest x-index (= 66.74) among all article types. (2) The United States performed exceptionally in x-indexes (= 56.86 and 44.5) on both analyses done on the total 18,808 and the top 100 most cited articles, respectively. The most influential author whose x-index reaches 15.11 was Simon Dagenais from the US. (3) The most cited MeSH term with an x-index of 23.05 was surgery based on the top 100 most cited articles. The most cited article (PMID = 18164449) was written by Dagenais and his colleagues in 2008. The most productive author was Michael G. Fehlings, whose x-index and the author's impact factor are 13.57(= √(13.16*14)) and 9.86(= 331.57/33.64), respectively.Conclusions: There was a rapidly increasing scientific productivity in the field of spinal surgery in the past 12 years. The US has extraordinary contributions to the publications. Furthermore, China and Japan have increasing numbers of publications on spinal surgery. This study with Kano diagrams provides an insight into the research for spinal surgeons and researchers.

Background: Cardiovascular disease causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids (hyperlipidemia) have attracted substantial attention regarding the abuse of health care resources and to implement preventive measures for such abuse. Duplicative prescriptions may occur by patients receiving redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient’s wandering among hospitals. Objective: We evaluated the degree of duplicative prescriptions in Taiwanese hospitals for outpatients with three types of medications (antihypertension, antihyperglycemia, and antihyperlipidemia), and then used an online dashboard based on mobile health (mHealth) on a map to determine whether the situation has improved in the recent 25 fiscal quarters. Methods: Data on duplicate prescription rates of drugs for the three conditions were downloaded from the website of Taiwan’s National Health Insurance Administration (TNHIA) from the third quarter of 2010 to the third quarter of 2016. Complete data on antihypertension, antihyperglycemia, and antihyperlipidemia prescriptions were obtained from 408, 414, and 359 hospitals, respectively. We used scale quality indicators to assess the attributes of the study data, created a dashboard that can be traced using mHealth, and selected the hospital type with the best performance regarding improvement on duplicate prescriptions for the three types of drugs using the weighted scores on an online dashboard. Kendall coefficient of concordance (W) was used to evaluate whether the performance rankings were unanimous. Results: The data quality was found to be acceptable and showed good reliability and construct validity. The online dashboard using mHealth on Google Maps allowed for easy and clear interpretation of duplicative prescriptions regarding hospital performance using multidisciplinary functionalities, and showed significant improvement in the reduction of duplicative prescriptions among all types of hospitals. Medical centers and regional hospitals showed better performance with improvement in the three types of duplicative prescriptions compared with the district hospitals. Kendall W was 0.78, indicating that the performance rankings were not unanimous (Chi square2=4.67, P=.10). Conclusions: This demonstration of a dashboard using mHealth on a map can inspire using the 42 other quality indicators of the TNHIA by hospitals in the future.

Background: Ophthalmology authors in mainland China, Hong Kong, or Taiwan were interested in knowing their individual research achievements (IRAs). This study was to evaluate the most cited authors, institutes, and regions in the mainland, Hong Kong, and Taiwan in the field of ophthalmology in the recent 10 years using the hx-index and to display the result with visual representations. Methods: Using the PubMed search engine to download data, we conducted an observational study of citation analyses in affiliated research institutes and regions (provinces/areas) of all ophthalmology authors since 2010. A total of 19,364 published articles from 22,393 authors in the mainland, Hong Kong, and Taiwan were analyzed. The x-index and the Kano model were complemental to the hx-index in identifying IRAs. A pyramid plot was used to illustrate the importance of the author-weighted scheme (AWS) used in evaluating IRAs in academics. The hx-index combining both advantages of the h and x-index was proposed to assess individual IRAs. Furthermore, we drew Results: There is a significant rise over time in the number of publications. The top-ranking regions in hx-index were Shanghai (26.82), Guangdong (25.82), and Beijing (25.81). We demonstrated that Dr Wu from Taiwan published 144 articles in PMC and used the example to explain the importance of AWS when IRAs were assessed. Conclusions: With an overall increase in publications in the field of ophthalmology, contributions assessed by hx-indexes and the AWS should be encouraged and promoted more in the future.

Pediatric cataracts are a significant cause of childhood blindness globally.¹ A better understanding of the etiologies for pediatric cataracts is crucial for ensuring optimal clinical outcomes for these vulnerable patients. Uveitis is one of the most common ophthalmologic conditions affecting pediatric eyes and is known to be associated with an increased risk for cataract formation.^2,3 Other factors that could contribute to this risk for cataract formation include the use of steroid eye drops and other immunosuppressive medications commonly prescribed for uveitis management. While the exact mechanisms remain unknown, certain animal models have demonstrated that immunosuppressive agents can adversely affect the growth of lens epithelial cells, potentially leading to cataract formation.⁴ Additionally, intraocular surgeries could lead to a postoperative increase in inflammation within the vitreous.⁵ Such a postoperative increase in inflammation could then potentially cause damage to lens proteins through oxidative stress. Although inflammation may be one of the important links between uveitis and cataract formation, the actual pathophysiological mechanism behind cataract development among patients younger than 18 years with uveitis remains unknown. However, as pediatric patients are known to have immature blood-ocular barriers,⁶ it is possible that this immaturity may play a crucial role in initiating or perpetuating intraocular inflammatory reactions, subsequently leading to cataracts. This is because the eye is normally an immune-privileged site due to the blood-ocular barrier. However, when this barrier is disrupted, it can allow infiltration of inflammatory cells, leading to intraocular inflammatory reactions or uveitis. This has potential implications for future cataract development, supported by previous laboratory studies suggesting that oxidative stress may be integral to cataract formation.⁷ For example, Lesiewska et al⁸ demonstrated higher concentrations of oxidative products like superoxide dismutase among cataract eyes compared with noncataract eyes. It is also possible that the combination of other factors, such as inherited pro-cataract mutations in the SOX2 gene, could further increase the susceptibility of patients younger than 18 years in developing cataracts, especially after uveitis (eFigure 5 in Supplement 1). However, these hypotheses remain speculative, and as of now, no study, to our knowledge, has definitively established a conclusive association between all of these mediating factors in the context of uveitis and cataract development.