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Background: Melasma is a chronic skin condition that adversely impacts quality of life. Although many therapeutic modalities are available there is no single best treatment for melasma. Oral tranexamic acid has been used for the treatment of this condition but its optimal dose is yet to be established. Objectives: We used network meta-analysis to determine the optimal dose of oral tranexamic acid for the treatment of melasma. Methods: We conducted a comprehensive search of all studies of oral tranexamic acid for the treatment of melasma up to September 2020 using PubMed, EMBASE and the Cochrane Library database. The quality of the studies was evaluated using the Jadad score and the Cochrane’s risk of bias assessment tool. Only high quality randomised controlled trials were selected. Some studies lacked standard deviation of changes from baseline and these were estimated using the correlation coefficient obtained from another similar study. Results: A total of 92 studies were identified of which 6 randomized controlled trials comprising 599 patients were included to form 3 pair-wise network comparisons. The mean age of the patients in these studies ranged from 30.3 to 46.5 years and the treatment duration ranged from 8 to 12 weeks. The Jadad scores ranged from 5 to 8. The optimal dose and duration of oral tranexamic acid was estimated to be 750 mg per day for 12 consecutive weeks. Limitations: Some confounding factors might not have been described in the original studies. Although clear rules were followed, the Melasma Area and Severity Index and the modified Melasma Area and Severity Index were scored by independent physicians and hence inter-observer bias could not be excluded. Conclusion: Oral tranexamic acid is a promising drug for the treatment of melasma. This is the first network meta-analysis to determine the optimal dose of this drug and to report the effects of different dosages. The optimal dose is 250 mg three times per day for 12 weeks, but 250 mg twice daily may be an acceptable option in poorly adherent patients. Our findings will allow physicians to balance drug effects and medication adherence. Personalized treatment plans are warranted.

目的：醫院處於新冠肺炎（COVID-19）大流行的最前線。除了感染控制措施，有效的管理策略也同樣重要。本篇旨在介紹台灣某大型社區醫院的防疫管理作為。方法：本文報導該醫院各院區在2020及2021年間的防疫作為。所實施的管理策略包括：定期防疫會議、出入口管制、戶外發燒篩檢站、病房管制、主動發掘門診與住院疑似個案、戶外領藥站、資源重新配置與防疫物資分配、防疫指引編寫、遠距醫療照護與檢疫所設置。結果：經過兩年的努力，一家6,301人的大型社區醫院中，院內感染極少（＜1%）。2020及2021年從戶外領藥站分別釋出了25,050及15,057張處方。通訊診療在2020及2021年服務了10,194個病人。另一方面，集中檢疫所服務了6,867個病人。結論：面對COVID-19大流行的再次出現，透過分享本文的經驗，期望可以為地球村做出貢獻。Purpose: Hospitals are at the frontline of the COVID-19 pandemic. In addition to infection control measures, effective administrative strategies are equally important. We aimed to present administrative measures implemented in a large community hospital in Taiwan. Methods: We report strategies administered to all of the hospital branches in 2020 and 2021. The strategies included regular administrative meetings, entrance control, outdoor fever screen station, ward control, proactive inpatient and outpatient case identification, outdoor walk-through dispensary, resource allocation and distribution of supplies, guidelines, telemedicine and group quarantine. Results: After years of effort, nosocomial infection in a large community hospital of 6,301 staff remained minimal (＜1%). We filled 25,050 and 15,057 prescriptions in the outdoor walk-through dispensary in 2020 and 2021, respectively. We served 10,194 patients using telemedicine in 2020 and 2021. On the other hand, we served 6,867 people in group quarantine. Conclusion: By sharing our experience we may contribute to the global community in face of the re-emergence of COVID-19 pandemic.

目的：環境安全是醫療服務的前提，我們藉由e化消防安檢，更快速便利地提升醫護人員的消防檢核能力及防火識能，以提供醫護人員及病人更安全的場所。 方法：針對醫院共50個單位創新建置e化消防安檢二維條碼(QR Code)，制定查核項目，建置完成後進行系統操作教育訓練，單位火源責任者每週至少進行一次環境消防查核。 結果：全院使用率從建置初期的10.9%提升至82.0%，藉由即時通報維修、異常數據統計分析及根本原因改善，異常發生後的修繕效率提升了34.6%。 結論：本文為國內醫院第一個實施的e化消防自主安檢系統，可精準掌握單位防火設備的改善方向，除有效預防火災，亦同時具備減少紙資源用量、節省作業時間、資料儲存更便利等良好的附加價值，透過日常檢查可預防火災、減少設備及人員損失。 Purpose: Environmental safety is a prerequisite for medical services. By implementing e-fire safety inspection, we rapidly and conveniently improved the fire inspection ability and fire literacy of medical personnel and thus provided a safer place for both staff and patients. Methods: We developed fire safety inspection QR Codes for 50 departments in the hospital, designated inspection items, and conducted system operation education and training. The person in charge of the fire source in the department conducted environmental fire inspection at least once a week. Results: The utilization rate of the e-fire safety inspection system increased from 10.9% initially to 82.0%. The statistical analysis of abnormal data and root cause improvement indicated that the repair efficiency after an abnormal event increased by 34.6% through immediate notification and repair. Conclusion: We reported the implementation of the first e-fire safety inspection system in Taiwan. The accurate use of fire protection equipment not only prevented fire effectively but also provided the additional benefits of reducing the amount of paper needed, saving operation time, and making data storage easier. Routine e-fire inspection prevented fire and reduced equipment and manpower losses. &nbsp

Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss. The present consensus provides suggestions on diagnosis, evaluation, treatment, and follow-up strategies for nAMD from a panel of 11 practicing ophthalmologists. The experts suggest that the baseline visit for nAMD management should include a comprehensive ophthalmologic examination via a multimodal approach consisting of visual and anatomical evaluation. Patients diagnosed with nAMD should be subjected to treatment with the goal of maintaining visual function while diminishing anatomical disease activity and minimizing treatment burden. Currently, anti-VEGF therapy is the main treatment strategy for nAMD, and evaluation involving comprehensive ophthalmologic examination within 1 month of completion of the loading phase comprising three monthly injections is recommended to guide subsequent management. Either a treat-and-extend or pro re nata regimen can be considered for the maintenance phase of anti-VEGF therapy, and the regimen should be chosen and adjusted according to disease activity, reimbursement criteria, financial burden, and patient preferences. In the event of inactive nAMD or poor treatment outcomes, after thorough evaluation and patient education, anti-VEGF therapy may be stopped. The consensus provides practical nAMD management guidelines for ophthalmologists and fellow healthcare professionals.

(1) Background: To analyze the association between long-term changes in serum IgG4 levels and the clinical course of patients with IgG4-related ophthalmic disease (IgG4-ROD). (2) Methods: Retrospective analysis of 25 patients with IgG4-ROD. (3) Results: Mean age at diagnosis was 60.68 years. Fifty-six percent of patients had bilateral ocular involvement and 32% had systemic associations. The ocular structures involved were the lacrimal gland (76%), orbital soft tissue (36%), extraocular muscle (20%) and infraorbital nerve (20%). According to last follow-up, 9 (36%) patients had normalized IgG4 levels, and 16 (64%) patients had elevated IgG4 levels. Patients with normalized IgG4 levels had better response to initial steroid treatment and attained a significantly lower IgG4 level after treatment (p = 0.002). The highest IgG4 levels were at baseline and disease recurrence, and lowest after initial treatment. At final follow-up, IgG4 levels differed in patients with remission (mean 326.25 mg/dL) and stable disease (mean 699.55 mg/dL). Subgroup analysis was performed in patients with remission, categorized according to whether IgG4 levels were normalized (9 patients) or elevated (10 patients) on last follow up. The elevated group had a higher percentage of bilateral disease, lacrimal gland involvement and recurrence. (4) Conclusions: IgG4-ROD patients with a greater response to initial steroid therapy were more inclined to have normalized IgG4 levels in the long term. Some patients remained in remission despite persistently elevated IgG4 levels, and had regular follow-up without treatment.

Objectives: Myopia is the most common refractive vision disorder. In recent years, several studies have suggested that the alteration of the exosomal protein levels in the aqueous humor (AH) is associated with the development of several eye diseases. Therefore, we aimed to explore the exosomal protein profile of the AH from myopia patients. Methods: Exosomes were isolated from the AH. The quality, concentration, and size distribution of exosomes for each patient were measured using nanoparticle tracking analysis system. Then, the exosomal proteins were purified and digested by trypsin for liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Results: There was no significant difference observed between the myopia and control when comparing the concentration and size distribution of exosomes in the AH for each sample. Based on LC-MS/MS analysis, myopia patients had higher and more complex exosomal peptide content. We found two proteins that were common in AH exosomes and eight proteins that were highly expressed in the myopia group. Conclusions: Our results provide pioneering findings for the exploration of the exosomal protein profile in myopia development. Further studies may provide significant information for the diagnosis, clinical treatment, and prognosis of myopia.

Background/Purpose Reactivation of herpes viruses poses threat to corneal graft survival. This study evaluated the presence of herpes simplex virus type 1 (HSV-1), HSV type 2 (HSV-2), and cytomegalovirus (CMV) DNA in recipient corneas and the aqueous humor of patients undergoing penetrating keratoplasty (PKP), and the impact on graft survival. Methods This retrospective study reviewed 90 eyes of 71 patients underwent PKP between 2008 and 2016. Cornea and aqueous humor samples were sent for polymerase chain reaction (PCR) testing for viral DNA. The main outcomes were PCR results and graft survival. Results Recipient corneas tested positive for HSV-1 in 47 eyes (52.2%), for HSV-2 in 24 eyes (26.7%), and for CMV in seven eyes (7.8%). Aqueous humor tested positive for HSV-1 in 44 eyes (48.9%), for HSV-2 in 25 eyes (27.8%), and for CMV in eight eyes (8.9%). The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure (p = 0.005), whereas corneal HSV-1 DNA was not. The presence of HSV-2 DNA had no significant impact on graft survival. Aqueous CMV DNA was associated with higher risk of graft failure in univariate model, but not in multivariate model. Conclusion There were high positive rates of HSV-1, HSV-2, and CMV DNA in recipient corneas and aqueous humor at the time of PKP, even among patients not suspected of latent viral infection. The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure.

Sleep disorders pose a serious threat to human, which may cause variety diseases. Recent reviews on the epidemiology examine that gastroesophageal reflux disease (GERD) has different levels of causality about asthma, chronic dry cough, sleep apnea, non-cardiac chest pain, chest tightness, and chronic bronchitis. The relationship between sleep disorders and GERD has been explained in various ways, but only limited reports on the complication rates in Taiwan. The objective of this follow-up study is to evaluate the risk of incident GERD in Taiwanese people with sleep disorders from January 1, 2000 to December 31, 2012. We used the Taiwan’s National Health Insurance Research Database to conduct a nationwide population-based cohort study to assess the risk of incident GERD in people with sleep disorders. A total of 66,133 sleep disorders patients and 264,532 non-sleep disorders controls were included. Sleep disorders was a risk factor of incident GERD (adjusted hazard ratio being 1.722, 95% CI 1.69–1.76, p

Deep learning (DL) algorithms are used to diagnose diabetic retinopathy (DR). However, most of these algorithms have been trained using global data or data from patients of a single region. Using different model architectures (e.g., Inception-v3, ResNet101, and DenseNet121), we assessed the necessity of modifying the algorithms for universal society screening. We used the open-source dataset from the Kaggle Diabetic Retinopathy Detection competition to develop a model for the detection of DR severity. We used a local dataset from Taipei City Hospital to verify the necessity of model localization and validated the three aforementioned models with local datasets. The experimental results revealed that Inception-v3 outperformed ResNet101 and DenseNet121 with a foreign global dataset, whereas DenseNet121 outperformed Inception-v3 and ResNet101 with the local dataset. The quadratic weighted kappa score (κ) was used to evaluate the model performance. All models had 5–8% higher κ for the local dataset than for the foreign dataset. Confusion matrix analysis revealed that, compared with the local ophthalmologists’ diagnoses, the severity predicted by the three models was overestimated. Thus, DL algorithms using artificial intelligence based on global data must be locally modified to ensure the applicability of a well-trained model to make diagnoses in clinical environments.

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student’s myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4–6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children’s myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work ( OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities ( OR = 0.85) or moderate or vigorous physical activities ( OR = 0.82) was associated with lower risk. Near work (β = 0.06), outdoor activity (β = −0.04), and outdoor recess (β = −0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children’s time outdoors and in physical activities and reduce their time on near work.

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has a great potential to enhance medical workflow and improve health care quality. Of particular interest is practical implementation of such AI-based software as a cloud-based tool aimed for telemedicine, the practice of providing medical care from a distance using electronic interfaces. Methods: In this study, we used a dataset of labeled 35,900 optical coherence tomography (OCT) images obtained from age-related macular degeneration (AMD) patients and used them to train three types of CNNs to perform AMD diagnosis. Results: Here, we present an AI- and cloud-based telemedicine interaction tool for diagnosis and proposed treatment of AMD. Through deep learning process based on the analysis of preprocessed optical coherence tomography (OCT) imaging data, our AI-based system achieved the same image discrimination rate as that of retinal specialists in our hospital. The AI platform's detection accuracy was generally higher than 90% and was significantly superior (p < 0.001) to that of medical students (69.4% and 68.9%) and equal (p = 0.99) to that of retinal specialists (92.73% and 91.90%). Furthermore, it provided appropriate treatment recommendations comparable to those of retinal specialists. Conclusions: We therefore developed a website for realistic cloud computing based on this AI platform, available at https://www.ym.edu.tw/~AI-OCT/. Patients can upload their OCT images to the website to verify whether they have AMD and require treatment. Using an AI-based cloud service represents a real solution for medical imaging diagnostics and telemedicine.

Objective Different lifestyles may contribute to chronic diseases or a health condition. We aimed to study trends in lifestyle habits among community-dwelling older people. Methods This retrospective time-trend study enrolled 429 108 participants from the Senior Citizen Health Examination in Taiwan over ten years (2001-2010). We analysed lifestyle habits including smoking, alcohol, betel nut chewing, milk drinking, fruit and vegetable intake, car driving and motorcycle riding. Joinpoint regression was used to identify changes in trend. Results The overall rate of smoking, alcohol and betel nut chewing was 8.2%, 18.1% and 0.3%, respectively. Smoking rates decreased gradually, but alcohol and betel nut chewing increased. We found that milk drinking, fruit and vegetable intake and car driving initially increased and then later decreased. The change in the trend was in 2003. Conclusion There were significant turning points in milk drinking, fruit and vegetable intake and car driving. Implementation of strategies to change the behaviors of citizens about the intake of fruit and vegetable and milk drinking is important.

Background The current National Health Insurance scheme in Taiwan reimburses 3 initial plus 4 additional injections of ranibizumab 0.5 mg for eligible patients with neovascular age-related macular degeneration (nAMD). The Ranibizumab AMD Clinical Efficacy in Real-world practice (RACER) study aimed to observe the effectiveness of ranibizumab injections under this reimbursement system. Methods RACER was a 12-month, prospective, observational study conducted in treatment-naïve, adult Taiwanese patients with nAMD. Patients received intravitreal ranibizumab 0.5 mg injections in adherence with local prescribing information. Results Of 161 patients enrolled, 114 (70.8%) completed the 12-month study. Overall, patients received a mean (standard deviation [SD]) of 4.3 (1.7) ranibizumab injections. The mean (SD, [95% confidence interval], P value) gain in best-corrected visual acuity (BCVA) from baseline at Month 3 was 5.2 (12.2, [3.1, 7.3] letters, P P = 0.0352). Mean central retinal thickness also decreased from baseline at Months 3 and 12 (both P Conclusions Treatment with ranibizumab 0.5 mg resulted in significant improvements in visual outcomes among treatment-naïve Taiwanese patients with nAMD. Early treatment and frequent dosing in the real-world setting may be the key to achieving better outcomes.

Objectives: Retinal vein occlusions (RVO) are associated with systemic risk factors. However, the ocular occlusive events might also influence a patient&rsquo, s systemic condition. This study tried to investigate serum biomarkers associated with oxidative stress, before and after intravitreal anti-vascular endothelial growth factor (aVEGF) therapy in patients with RVOs. Methods: Newly-onset RVO patients were categorized into two groups: comorbid with macular edema requiring aVEGF therapy (treatment group) and no edema (observation group). Age and sex-matched patients (who received cataract surgery) were included as the control group. Intravitreal ranibizumab with a pro-re-nata regimen were administered. Serum samples were collected prior to treatment, at 6 and 12 months after therapy/observation and were collected once before controls who received cataract surgery. mRNA expression of sirtuin-1, its downstream genes, anti-oxidative biomarkers, and proinflammatory cytokines were measured. Results: There were 32, 26, and 34 patients enrolled in the treatment, observation, and control groups, respectively. The expressions of sirtuin-1 and its downstream genes were significantly lower in patients with RVO compared with the control group. Sirtuin-1 gene expression increased after 1 year of aVEGF therapy in the treatment group but remained unchanged in the observation group. Biomarkers of oxidative stress and proinflammatory cytokines were reduced after 1 year of aVEGF therapy. These biomarkers remained with no changes in the observation group. Conclusions: Our study showed that the systemic oxidative stress increased in RVO patients. The aVEGF therapy could alter the gene expression of anti-oxidative proteins and reduce systemic oxidative stress in these patients.

Additional file 1: Table S1. Eligibility Criteria for NHI reimbursement [4]. Table S2. Colour fundus photography results compared with baseline (ITT population). Table S3.Baseline demographics, ocular and disease characteristics for patients with nAMD treated with ranibizumab 0.5 mg, by subgroups (ITT population).

Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 5Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Ophthalmology, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; 7Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; 8Global Health Economics and Outcomes Research, Allergan Singapore Pte. Ltd., Singapore, Singapore; 9Datalytics Pty Ltd, Kingston, ACT, Australia Objectives: To characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes. Methods: Retrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).Results: Between 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P

Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly. The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older. FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78–2.95) or during the previous year (OR = 2.60, 95% CI: 2.16–3.14). Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.

Compared with conventional penetrating keratoplasty, Descemet's stripping automated endothelial keratoplasty (DSAEK) more effectively maintain global integrity and rapid vision rehabilitation with less ocular surface disorders in patients with endothelial dysfunction. Here, we report a case of a 76-year-old woman who experienced opacification of a hydrophilic intraocular lens (IOL) approximately 10 months after DSAEK. The patient with no history of systemic disease developed pseudophakic bullous keratopathy in the right eye 2 years after undergoing cataract surgery. The best-corrected visual acuity (BCVA) of the right eye was Snellen 0.01 when presented to our hospital. DSAEK was arranged and performed smoothly. However, the graft detached over the upper part of the cornea on postoperative day 1. Thus, rebubbling was performed immediately. After the procedure, the graft was well attached, and the cornea became clear gradually. The BCVA returned to Snellen 0.6. However, progressive opacification over the anterior surface of the IOL was observed 10 months postoperatively. Vision deteriorated to 0.5 with various refractive errors during 2-year follow-up. IOL exchange may be considered if the vision is getting worse. IOL opacification may result from a direct contact between the IOL surface and exogenous air, particularly in a hydrophilic IOL, and can be a rare but significant complication after DSAEK. Clinicians planning to perform DSAEK should consider the composition of the IOL, the amount of intracameral air, duration of air filling, and high intraocular pressure.

Myopia is the most common refractive disorder in Eastern Asia. The development of myopia is associated with the cooperation of various ocular tissues. Exosomes in the aqueous humor (AH) have been implicated to modulate intracellular communications by transferring exosomal miRNAs and proteins between cells. These exosomal miRNAs and proteins are likely involved in the pathogenesis of various eye diseases. In this study, we aimed to explore human exosomal miRNA profiles and their roles in myopia development. AH samples were collected from 16 patients (8 myopia and 8 control) undergoing routine cataract surgeries. Exosomes were isolated from AH of each individual using the ExoQuick solution. The numbers and sizes of exosomes were not significantly different between the myopia and control groups. The individual exosomes of the same group were pooled to purify RNA. Unexpectedly, the myopia group contained 2.78-fold total RNA amount than that in the control group. Thereafter, miRNA profiles were analyzed using the OpenArray system. We thus found 15 myopia-specific miRNAs and four myopia-absent miRNAs. By using bioinformatics analysis, we identified six well-known myopia-associated genes that are potential targets of five myopia-specific miRNAs (has-miR-582-3p, has-miR-17-5p, has-miR-885-3p, has-miR-19b-3p, and has-miR-450b-5p). These genes are cholinergic receptor muscarinic 2 (CHRM2), cyclic nucleotide-gated channel beta 3 (CNGB3), vascular endothelial growth factor A (VEGFA), adenosine A2a receptor (ADORA2A), insulin-like growth factor 1 (IGF1), and lumican (LUM). Moreover, CHRM2 may be a target of myopia-absent miRNA (has-miR-378a-5p). In conclusion, we show the expression profiles of AH-derived exosomal miRNAs and their potential roles in myopia development.

Current medical surgical navigation allows surgeons to use the surgeon as a more accurate aid. However, most Dicom images are projected onto another screen, and it is quite inconvenient for the doctor to perform surgery on the patient while watching another screen. This paper takes brain surgery as an example, using augmented reality technology based on image target positioning system, combined with smart phone, can instantly display the image of Dicom superimposed on the patient's head to provide surgical assistance for doctors. The surgical vision is more intuitive and focused. This paper is also implemented on Android smart phones to prove the feasibility of this technology.

The aim of this study was to determine whether students' exposure to digitally projected, multimedia teaching material under naturally varying classroom lighting conditions is associated with myopia risk and severity.A population-based, cross-sectional study in 2012 of children in grades 4-6 across 87 schools in Taiwan.Students (N = 3,686) reported demographic information, outdoor time, physical activity and near work. Parents provided their myopia status. Student-reported multimedia teaching frequency and classroom lighting levels were confirmed with direct observation. School nurses conducted vision screening and ophthalmologist referral. Myopia status and severity were measured by spherical equivalent refraction; SE ≤-0.5 dioptres was coded as myopic. Binary logistic and tobit regression were used to estimate the contributions of classroom multimedia exposure and lighting to myopia risk and severity controlling for risk factors.Age, parental myopia and hours of near work increased the odds of myopia and predicted greater severity. Physical activity and outdoor time predicted lower risk and severity. Multimedia exposure in relatively bright classrooms was associated with greater odds of myopia. Classroom lighting levels during multimedia teaching were inversely related to severity; exposure frequency was unrelated.Multimedia exposure under brighter classroom conditions may contribute to the myopia incidence in schoolchildren.Teaching with digital projection technology is increasingly prevalent. This may increase children's odds of developing myopia, which has far-reaching and lifelong deleterious effects. School nurses should raise awareness of and promote strategies that reduce this risk, including working with children, parents, school personnel and system leaders to adopt eye-healthy behaviours, practices and policies.目的: 本研究旨在确定学生在自然变化的教室照明条件下面对数字投影的多媒体教材是否与近视风险和近视严重程度有关。 设计: 在2012年,对台湾87所学校4-6年级学生进行的一项基于人口的横断面研究。 方法: 学生(N = 3686)报告了人口统计信息、户外时间、体育锻炼和近距离用眼机会。父母提供了他们的近视状况。通过直接观察确认了学生报告的多媒体教学频率和教室照明度。学校护士进行了视力普查以及转诊至眼科医生处。通过等效球镜度数衡量了近视状况和近视严重程度;近视度数大于50屈光度(SE≤-0.5)则被编码为近视。使用二元逻辑和tobit回归估算教室多媒体暴露和照明对近视风险和风险因素导致的严重程度。 结果/发现: 年龄、父母近视和近距离用眼时长增加了患近视的几率,并预示着严重程度更高。进行体育锻炼和户外活动可降低风险和严重程度。在相对明亮的教室里使用多媒体,学生患近视的几率更大。使用多媒体进行教学过程中的教室照明度与近视严重程度呈反比。使用多媒体频率与近视严重程度无关。 结论: 在较明亮的教室环境中,使用多媒体可能导致学生患上近视。 影响: 数字投影教学技术日益普遍。这可能会增加儿童患近视的几率,而近视会会产生深远并且终生有害的影响。驻校护士应提高意识并推广可降低此风险的策略,包括儿童、家长、学校工作人员和教育系统管理者共同努力,采取有益于眼睛的行动、方法和策略。.

AimTo investigate the protective behaviours of longer near work distance, discontinuing near work and more time outdoors in recess from parent self-report in the myopia prevalence and progression among myopic children aged 9–11 years.MethodsMyopia Investigation study in Taipei is a longitudinal population-based study that enrolled elementary school students in Taipei. We provided vision and refraction examination every 6 months. Spherical equivalent (SE) of cycloplegic refraction ≤−0.50 Diopter (D) is defined as myopia. Total 10 743 (70.4%) students completed 2-year refraction data and questionnaire. The myopia prevalence and progression (difference of SE) in baseline, 6, 12, 18 and 24 months were compared by generalised estimating equations.ResultsChildren with persistent protective behaviour had significant lower prevalence of myopia. The protective impact was statistically significant from 6 to 24 months. In 2 years follow-up, risk ratio after adjusting the background variables and the other two behaviours in near work distance, near work time and outdoor time were 0.71, 0.89 and 0.77. In SE analysis, after adjusting the other two behaviours, near work distance >30 cm (−0.7 vs −1.04 D; p<0.001), discontinuing near work every 30 min (−0.77 vs −0.96 D, p=0.005) and more time outdoors in recess from parent self-report (−0.75 vs −0.98 D; p=0.012) revealed protective impacts on diminishing myopia progression from 6 to 24 months.ConclusionIn myopic children aged around 10 years in Taipei, longer distance in near work, discontinuing near work every 30 min and more outdoor time from parent self-report are protective behaviours in myopia prevalence and progression in 6–24 months.