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Background We investigated the association between exercise habits before or after thyroidectomy and incident type 2 diabetes mellitus (T2DM) in patients with thyroid cancer. Methods An observational cohort study of 69,526 thyroid cancer patients who underwent thyroidectomy for the treatment of thyroid cancer between 2010 and 2016 was performed using the Korean National Health Information Database. Regular exercise was defined as mid-term or vigorous exercise at least 1 day in a week based on a self-reported questionnaire. Patients were divided into four groups according to exercise habits before and after thyroidectomy: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. Results During a median follow-up of 4.5 years, 2,720 (3.91%) patients developed T2DM. The incidence of T2DM per 1,000 person years was lower in patients who performed regular exercise before or after thyroidectomy than in persistent non-exercisers (10.77 in persistent non-exerciser group, 8.28 in new exerciser group, 8.59 in exercise dropout group, and 7.61 in exercise maintainer group). Compared with the persistent non-exerciser group, the new exerciser group (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.78–0.97), the exercise dropout group (HR 0.81, 95% CI 0.72–0.91), and the exercise maintainer group (HR 0.84, 95% CI 0.76–0.93) had lower risks of incident T2DM. Exercising < 1,500 MET-minutes/week in the exercise maintainer group was associated with a lower risk of incident T2DM compared with persistent non-exercisers (< 500: HR 0.80, 95% CI 0.67–0.96, P  = 0.002; 500 to < 1,000: HR 0.81, 95% CI 0.71–0.93, P  < 0.001; 1,000 to < 1,500: HR 0.81, 95% CI 0.69–0.94, P  < 0.001). Conclusions Regular exercise before or after thyroidectomy was associated with a lower risk of incident T2DM in patients with thyroid cancer. Graphical Abstract

G protein–coupled receptors (GPCRs) activate cellular responses ranging from odorants to neurotransmitters. Binding an agonist leads to activation of a heterotrimeric G protein (GP) that stimulates external signaling. Unfortunately, the mechanism remains unknown. We show for 15 class A GPCRs, including opioids, adrenergics, adenosines, chemokines, muscarinics, cannabinoids, serotonins, and dopamines, that interaction of an inactive GP, including Gs, Gi, Go, G11, and Gq, to the inactive GPCR, containing the intracellular ionic lock between transmembrane (TM) helices 3 and 6, evolves exothermically to form a precoupled GPCR-GP complex with an opened TM3-TM6 and the GP-α5 helix partially inserted into the GPCR but not activated. We show that binding of agonist to this precoupled GPCR-GP complex causes the Gα protein to open into its active form, with the guanosine diphosphate exposed for signaling. This GP-first paradigm provides a strategy for developing selective agonists for GPCRs since it is the pharmacophore for the precoupled GPCR-GP complex that should be used to design drugs.

Structural integrity of seawater pipelines in nuclear power plants is a very important issue. In accordance with the operating technical guidelines, the human operators directly enter the pipe and inspect it at every maintenance test. However, in this regard, safety issues such as narrow space and harmful gas are emerging every year. In response to these needs, a quadruped robot that can inspect underground pipes and assist workers has been developed. The robot has an articulated robotic arm that can receive an impact sound of hammering a pipe wall to test pipe integrity. The state of the pipe was examined using a Convolutional Neural Network algorithm. On the other hand, moving in a plumbing environment requires stable walking ability. To determine the gait sequence, a hierarchical gait controller is proposed. The hybrid controller, which consists of joint impedance and torque control, calculated from Model Predictive Control, can switch the gait modes comparing the reference and the current foot contact condition at each control cycle.

To evaluate the prevalence of chronic kidney disease (CKD) and progression rate to CKD in elderly patients with type 2 diabetes mellitus (T2DM). We investigated the medical records of 190 elderly patients (65 years or older) with T2DM from 2005 to 2011 in 6-month increments. Mean follow-up duration was 64.5 months. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or the presence of albuminuria. The mean age was 70.4 years and mean diabetes duration was 10.6 years. Among all the participants, 113 patients (59.5%) had CKD. The eGFR was significantly decreased between baseline (65.7±15.0 mL/min/1.73 m²) and the end of follow-up (52.7±17.5 mL/min/1.73 m², P<0.001). At the end of follow-up, the prevalence of eGFR <60 mL/min/1.73 m² had increased by 61.6% (at baseline, 44.2%). Furthermore, in patients with eGFR ≥60 mL/min/1.73 m², the progression rate to more than CKD stage 3 was 39.6% at the end of follow-up; 30.2% of elderly diabetic patients had progressed to albuminuria from normoalbuminuria. Kaplan-Meier analysis showed that the time interval to worsening nephropathy was significantly shorter in elderly patients with diabetes duration ≥10 years than in those with diabetes duration <5 years (P=0.018). CKD was commonly observed in older patients with T2DM, and the progression rate to CKD is also high. Consequently, it is important to identify and manage CKD as early as possible in elderly patients with T2DM, especially in those with diabetes duration ≥10 years.

Aims/Introduction We aimed to determine the hospital‐based prevalence and clinical features of fulminant type 1 diabetes mellitus in Korea. Materials and Methods We identified all patients with diabetes who regularly visited the Endocrinology outpatient clinics at eight centers for a period >1 year between January 2012 and June 2017. We investigated their medical records retrospectively. Results During this period, 76,309 patients with diabetes had been regularly followed up. Among them, 913 (1.2%) patients had type 1 diabetes mellitus . There were 462 patients with type 1 diabetes mellitus whose data at the time of the first diagnosis could be identified (359 and 103 with non‐ketosis and ketosis onset, respectively). Of these, 15 (3.2% of type 1 diabetes mellitus, 14.6% of ketosis onset diabetes) patients had fulminant type 1 diabetes mellitus. The median ages at diagnosis were 40 and 27 years in the fulminant type 1 diabetes mellitus and non‐fulminant type 1 diabetes mellitus groups, respectively. The patients with fulminant type 1 diabetes mellitus had higher body mass index, lower glycated hemoglobin and fasting/peak C‐peptide, and lower frequent glutamic acid decarboxylase antibody‐positive rate (P =0.0010) at diagnosis. Furthermore, they had lower glycated hemoglobin at the last follow‐up examination than those with non‐fulminant type 1 diabetes mellitus. Conclusions In this study, the prevalence of type 1 diabetes mellitus was 1.2% among all patients with diabetes, and that of fulminant type 1 diabetes mellitus was 3.2% among those newly diagnosed with type 1 diabetes mellitus. The glycated hemoglobin levels were lower in patients with fulminant type 1 diabetes mellitus than in those with non‐fulminant type 1 diabetes mellitus at diagnosis and at the last follow‐up examination. We provide novel information on the prevalence and clinical features of fulminant type 1 diabetes mellitus in Korea.

In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.

In this Letter, an actual Ah‐throughput‐based novel health indicator (HI) of battery module is proposed for its second life. The state of health (SOH) of a battery cell is generally evaluated by the cell capacity. However, it is difficult to define the SOH of a battery module since it consists of inconsistently aged cells. To represent module aging and the inconsistency, this Letter utilizes the actual Ah‐throughput, which is the total amount of current suppliable to a load, as the module HI. Ah‐throughput is affected by loss from cell balancing control, which is necessary for the safe and efficient operation of a battery system. The larger the inconsistency, the more balancing operation is needed. Therefore, the proposed HI can evaluate the module health reflecting the inconsistency from a balancing perspective. For the implementation of the HI, its derivation and calculation algorithm are presented. Finally, the effectiveness is verified by various case studies with an experimental setup consisting of a series‐connected cells and an active cell balancer.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations.

Metabotropic γ-aminobutyric acid receptor (GABA B R), a class C G protein-coupled receptor (GPCR) heterodimer, plays a crucial role in the central nervous system. Cryo-electron microscopy studies revealed a drastic conformational change upon activation and a unique G protein (GP) binding mode. However, little is known about the mechanism for GP coupling and activation for class C GPCRs. Here, we use molecular metadynamics computations to predict the mechanism by which the inactive GP induces conformational changes in the GABA B R transmembrane domain (TMD) to form an intermediate pre-activated state. We find that the inactive GP first interacts with TM3, which further leads to the TMD rearrangement and deeper insertion of the α5 helix that causes the Gα subunit to open, releasing GDP, and forming the experimentally observed activated structure. This mechanism provides fresh insights into the mechanistic details of class C GPCRs activation expected to be useful for designing selective agonists and antagonists. Despite its crucial role in the central nervous system, little is known about the activation mechanism of GABA B receptor. Here, the authors predict that the inactive G protein induces conformational changes of the receptor to form an intermediate state.

As the performance of devices that conduct large-scale computations has been rapidly improved, various deep learning models have been successfully utilized in various applications. Particularly, convolution neural networks (CNN) have shown remarkable performance in image processing tasks such as image classification and segmentation. Accordingly, more stable and robust optimization methods are required to effectively train them. However, the traditional optimizers used in deep learning still have unsatisfactory training performance for the models with many layers and weights. Accordingly, in this paper, we propose a new Adam-based hybrid optimization method called HyAdamC for training CNNs effectively. HyAdamC uses three new velocity control functions to adjust its search strength carefully in term of initial, short, and long-term velocities. Moreover, HyAdamC utilizes an adaptive coefficient computation method to prevent that a search direction determined by the first momentum is distorted by any outlier gradients. Then, these are combined into one hybrid method. In our experiments, HyAdamC showed not only notable test accuracies but also significantly stable and robust optimization abilities when training various CNN models. Furthermore, we also found that HyAdamC could be applied into not only image classification and image segmentation tasks.