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Polycystic ovary syndrome (PCOS) is a common disease that has an effect on approximately 10% of women of childbearing age. Although there is evidence regarding the role of lifestyle factors in the development of PCOS, the exact etiology remains unclear. Additionally, metformin is used in the treatment of PCOS but its role remains unclear. We compared the effects of lifestyle modification (LSM) + metformin and metformin alone on PCOS. We performed a systematic review by searching electronic databases for publications until December 2019. The primary endpoints were clinical outcomes, such as menstrual cycles and pregnancy rates, and the secondary endpoints were anthropometric, metabolic, and androgenic parameters. The meta-analysis revealed that there was no significant difference in the improvements in the menstrual cycles between LSM and metformin alone (weighted mean difference [MD] = 1.62) and between LSM + metformin and LSM (MD = 1.20). The pregnancy rates and body mass indices were not significantly different between LSM and metformin alone (MD = 1.44 and −0.11, respectively). LSM reduced insulin resistance (MD = −0.52) and increased serum levels of sex hormone-binding globulins (MD = 8.27) compared with metformin. Therefore, we suggest recommending lifestyle modifications actively to women with PCOS if they do not have indications for metformin.

(1) Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and endocrine disorders among women of reproductive age. Previous studies have employed lifestyle interventions to manage anovulatory infertility and endocrine disorders. However, the effect of lifestyle interventions on the metabolic index remains ambiguous; (2) Methods: Data were obtained through a systematic search of the Ovid-Medline, Ovid-EMBASE, and Cochrane Library databases. Two reviewers independently reviewed the literature in two stages. A consensus was achieved through discussions regarding the final selection of the literature; (3) Results: This study observed that the group that underwent lifestyle modifications displayed significant improvement in reproductive function compared to the control group. Combination therapy with diet and exercise resulted in improved fasting insulin levels, compared to monotherapy with diet or exercise. Moreover, moderate weight loss (a minimum of 5%) resulted in an improved metabolic index. The subgroup analysis revealed that the group that underwent lifestyle modifications had a significantly higher number of patients with improved menstrual cycles, compared to the control groups; (4) Conclusions: Lifestyle modification using combination therapy is a promising therapeutic approach that can be employed in the management of PCOS patients with obesity. This scenario warrants further studies with larger sample sizes to develop ideal treatment protocols.

ObjectivesTo evaluate the deep learning models for differentiating invasive pulmonary adenocarcinomas (IACs) among subsolid nodules (SSNs) considered for resection in a retrospective diagnostic cohort in comparison with a size-based logistic model and expert radiologists.MethodsThis study included 525 patients (309 women; median, 62 years) to develop models, and an independent cohort of 101 patients (57 women; median, 66 years) was used for validation. A size-based logistic model and deep learning models using 2.5-dimension (2.5D) and three-dimension (3D) CT images were developed to discriminate IAC from less invasive pathologies. Overall performance, discrimination, and calibration were assessed. Diagnostic performances of the three thoracic radiologists were compared with those of the deep learning model.ResultsThe overall performances of the deep learning models (Brier score, 0.122 for the 2.5D DenseNet and 0.121 for the 3D DenseNet) were superior to those of the size-based logistic model (Brier score, 0.198). The area under the receiver operating characteristic curve (AUC) of the 2.5D DenseNet (0.921) was significantly higher than that of the 3D DenseNet (0.835; p = 0.037) and the size-based logistic model (0.836; p = 0.009). At equally high sensitivities of 90%, the 2.5D DenseNet showed significantly higher specificity (88.2%; all p < 0.05) and positive predictive value (97.4%; all p < 0.05) than other models. Model calibration was poor for all models (all p < 0.05). The 2.5D DenseNet had a comparable performance with the radiologists (AUC, 0.848–0.910).ConclusionThe 2.5D DenseNet model could be used as a highly sensitive and specific diagnostic tool to differentiate IACs among SSNs for surgical candidates.Key Points• The deep learning model developed using 2.5D DenseNet showed higher overall performance and discrimination than the size-based logistic model for the differentiation of invasive adenocarcinomas among subsolid nodules for surgical candidates.• The 2.5D DenseNet demonstrated a thoracic radiologist–level diagnostic performance and had higher specificity (88.2%) at equal sensitivities (90%) than the size-based logistic model (specificity, 52.9%).• The 2.5D DenseNet could be used to reduce potential overtreatment for the indolent subsolid nodules or to select candidates for sublobar resection instead of the standard lobectomy.

Aquaculture assumes a pivotal role in meeting the escalating global food demand, and shrimp farming, in particular, holds a significant role in the global economy and food security, providing a rich source of nutrients for human consumption. Nonetheless, the industry faces formidable challenges, primarily attributed to disease outbreaks and the diminishing efficacy of conventional disease management approaches, such as antibiotic usage. Consequently, there is an urgent imperative to explore alternative strategies to ensure the sustainability of the industry. In this context, the field of epigenetics emerges as a promising avenue for combating infectious diseases in shrimp aquaculture. Epigenetic modulations entail chemical alterations in DNA and proteins, orchestrating gene expression patterns without modifying the underlying DNA sequence through DNA methylation, histone modifications, and non-coding RNA molecules. Utilizing epigenetic mechanisms presents an opportunity to enhance immune gene expression and bolster disease resistance in shrimp, thereby contributing to disease management strategies and optimizing shrimp health and productivity. Additionally, the concept of epigenetic inheritability in marine animals holds immense potential for the future of the shrimp farming industry. To this end, this comprehensive review thoroughly explores the dynamics of epigenetic modulations in shrimp aquaculture, with a particular emphasis on its pivotal role in disease management. It conveys the significance of harnessing advantageous epigenetic changes to ensure the long-term viability of shrimp farming while deliberating on the potential consequences of these interventions. Overall, this appraisal highlights the promising trajectory of epigenetic applications, propelling the field toward strengthening sustainability in shrimp aquaculture.

Hematological analysis is essential for patients who are supported by a mechanical circulatory support (MCS). The laboratory methods used to analyze blood components are conventional and accurate, but they require a mandatory turn-around-time for laboratory results, and because of toxic substances, can also be hazardous to analysis workers. Here, a simple and rapid point-of-care device is developed for the measurement of plasma free hemoglobin (PFHb) and hematocrit (Hct), based on colorimetry. The device consists of camera module, minimized centrifuge system, and the custom software that includes the motor control algorithm for the centrifuge system, and the image processing algorithm for measuring the color components of blood from the images. We show that our device measured PFHb with a detection limit of 0.75 mg/dL in the range of (0–100) mg/dL, and Hct with a detection limit of 2.14% in the range of (20–50)%. Our device had a high correlation with the measurement method generally used in clinical laboratories (PFHb R = 0.999, Hct R = 0.739), and the quantitative analysis resulted in precision of 1.44 mg/dL for PFHb value of 14.5 mg/dL, 1.36 mg/dL for PFHb value of 53 mg/dL, and 1.24% for Hct 30%. Also, the device can be measured without any pre-processing when compared to the clinical laboratory method, so results can be obtained within 5 min (about an 1 h for the clinical laboratory method). Therefore, we conclude that the device can be used for point-of-care measurement of PFHb and Hct for MCS.

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently manifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and Integrative Medical Services (CIMS)—a multimodal program consisting of acupuncture, cupping, and manual therapy—have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered eight times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline and weeks 4, 8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline and weeks 4, 8, and 12. Repeated-measures two-factor ANOVA assessed the main effects and time × group interaction. Results: Mean VAS (experimental vs. control) was 4.73 ± 1.67 vs. 4.70 ± 1.95 at baseline; 3.74 ± 1.68 vs. 4.66 ± 1.60 at week 4; 3.93 ± 2.03 vs. 4.79 ± 1.55 at week 8; and 3.98 ± 1.98 vs. 4.98 ± 1.68 at week 12. The significant time × group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time × group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS.

We adopted a vision-based tracking system for augmented reality (AR), and evaluated whether it helped surgeons to localize the recurrent laryngeal nerve (RLN) during robotic thyroid surgery. We constructed an AR image of the trachea, common carotid artery, and RLN using CT images. During surgery, an AR image of the trachea and common carotid artery were overlaid on the physical structures after they were exposed. The vision-based tracking system was activated so that the AR image of the RLN followed the camera movement. After identifying the RLN, the distance between the AR image of the RLN and the actual RLN was measured. Eleven RLNs (9 right, 4 left) were tested. The mean distance between the RLN AR image and the actual RLN was 1.9 ± 1.5 mm (range 0.5 to 3.7). RLN localization using AR and vision-based tracking system was successfully applied during robotic thyroidectomy. There were no cases of RLN palsy. This technique may allow surgeons to identify hidden anatomical structures during robotic surgery.

Caspases have been extensively studied as critical initiators and executioners of cell death pathways. However, caspases also take part in non‐apoptotic signalling events such as the regulation of innate immunity and activation of nuclear factor‐κB (NF‐κB). How caspases are activated under these conditions and process a selective set of substrates to allow NF‐κB signalling without killing the cell remains largely unknown. Here, we show that stimulation of the Drosophila pattern recognition protein PGRP‐LCx induces DIAP2‐dependent polyubiquitylation of the initiator caspase DREDD. Signal‐dependent ubiquitylation of DREDD is required for full processing of IMD, NF‐κB/Relish and expression of antimicrobial peptide genes in response to infection with Gram‐negative bacteria. Our results identify a mechanism that positively controls NF‐κB signalling via ubiquitin‐mediated activation of DREDD. The direct involvement of ubiquitylation in caspase activation represents a novel mechanism for non‐apoptotic caspase‐mediated signalling. Activation of Drosophila innate immune receptors leads to DIAP2‐dependent ubiquitylation and activation of the initiator caspase DREDD. Ubiquitination of DREDD is needed for expression of antimicrobial genes in response to a bacterial infection.

Three distinct superoxide dismutases (SODs)—copper/zinc-SOD (SOD1), manganese-SOD (SOD2), and extracellular copper/zinc-SOD (SOD3)—were identified from a primitive chondrostean fish, Acipenser baerii, enabling the comparison of their transcriptional regulation patterns during development, prelarval ontogeny, and immune stimulation. Each A. baerii SOD isoform (AbSOD) shared conserved structural features with its vertebrate orthologs; however, phylogenetic analyses hypothesized a different evolutionary history for AbSOD3 relative to AbSOD1 and AbSOD2 in the vertebrate lineage. The AbSOD isoforms showed different tissue distribution patterns; AbSOD1 was predominantly expressed in most tissues. The expression of the AbSOD isoforms showed isoform-dependent dynamic modulation according to embryonic development and prelarval ontogenic behaviors. Prelarval microinjections revealed that lipopolysaccharide only induced AbSOD3 expression, while Aeromonas hydrophila induced the expression of AbSOD2 and AbSOD3. In fingerlings, the transcriptional response of each AbSOD isoform to bacterial infection was highly tissue-specific, and the three isoforms exhibited different response patterns within a given tissue type; AbSOD3 was induced the most sensitively, and its induction was the most pronounced in the kidneys and skin. Collectively, these findings suggest isoform-dependent roles for the multigene SOD family in antioxidant defenses against the oxidative stress associated with development and immune responses in these endangered sturgeon fish.

Background: Early cognitive training is important to prevent cognitive decline in patients with mild cognitive impairment (MCI) or dementia. Therefore, developing an application that can provide evidence-based cognitive training is necessary for patients with MCI or dementia. Method: This study aimed to develop and evaluate Smart Brain, an evidence-based application that provides comprehensive cognitive training tailored to this population. The application was developed using an ADDIE (analysis, design, development, implementation, and evaluation) model. A systematic review of databases, including Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and CINAHL, was conducted up to April 15, 2021, to identify key content areas. Additionally, a survey of 100 participants highlighted the need for features such as cognitive games, health notes, social networking services, and goal achievement. Result: The application was developed with distinct user and administrator interfaces to support engagement and monitoring. Usability testing involved 7 experts and 11 elderly individuals with MCI or dementia from a daycare center. Based on usability feedback, features such as the time limits for cognitive games were refined. The final application integrates cognitive games, physical exercises, emotional support, and health management tools to address user needs comprehensively. Conclusion: Smart Brain holds significant potential to improve the quality of life and cognitive health of elderly individuals with MCI or dementia. Its usability and functionality make it a promising tool for community-based interventions.