Clinical characteristics and treatment modalities of vulvovaginal atrophy in genitourinary syndrome of menopause

Background: Genitourinary syndrome of menopause (GSM) causes symptoms such as vaginal dryness, dysuria, repetitive urinary tract infection and urinary urgency may affect daily activities, sexual relationships, and overall quality of life. The aim of the study was to provide the clinical characteristics of VVA patients in South Korea and the effectiveness as well as complications of the currently used low dose estrogen vaginal suppository.Methods: 52 women who has visited the outpatient gynecology clinic of the National Health Insurance Service Ilsan Hospital from January 2018 to December 2019 were recruited as study subjects. For the analysis of the clinical characteristics, subjective symptoms described by the patient’s own words such as vaginal dryness, pain, dysuria, dyspareunia, or no symptoms at all were included. Objective signs such as thinning of vaginal rugae, mucosal dryness, and mucosal fragility and the presence of petechiae were recorded.Results: Vaginal dryness was the most common complaint (92.3%). Thinning of the vaginal rugae was the most commonly noted objective sign (73.1%). Of the 52 subjects, 31 (59.6%) refrained from using the low dose estrogen vaginal suppository. The most common reason for not being able to use the suppository was the inability to insert the suppository (32.3%).Conclusions: Although patient-reported symptoms and clinical objectivity through physical examination are two components in diagnosing VVA, further study is warranted for a more objective and discriminatory diagnosis criteria for VVA. As the only available treatment modality was low dose vaginal estrogen suppository, comparison with other treatment modalities were not available

Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation

Most pancreatic ductal adenocarcinomas (PDAs) show solid growth pattern, but ductal adenocarcinomas may demonstrate intratumoral cystic appearance or accompany peritumoral non-neoplastic cystic lesions, thus mimicking cystic pancreatic tumors on imaging studies. The histopathologic findings for PDA with cystic feature are divided into neoplastic and non-neoplastic cysts. Neoplastic cystic changes include large-duct type cysts (microcystic appearance), neoplastic mucin cysts (macrocystic appearance), colloid carcinomas (mucinous noncystic adenocarcinomas), and degenerative cystic change usually caused by hemorrhagic necrosis of tumor. Non-neoplastic cystic changes include retention cysts caused by ductal obstruction and pseudocysts caused by tumor-associated pancreatitis. Depending on the presence, size, number, and configuration of cystic changes, PDA should be differentiated from various types of cystic neoplasms. This pictorial essay provides histopathologic classification of PDAs with cystic features along with the corresponding cross-sectional imaging findings, and their differential diagnosis

Fully immersive virtual reality exergames with dual-task components for patients with Parkinsons disease: a feasibility study

Abstract Background Dual-task training in Parkinsons disease (PD) improves spatiotemporal gait parameters, cognition, and quality of life. Virtual reality (VR) has been used as a therapeutic tool for patients to participate in activities in a safe environment, engage in multisensory experiences, and improve motivation and interest in rehabilitation. This study aimed to investigate the feasibility of fully immersive VR exergames with dual-task components in patients with PD. Methods We developed VR exergames (go/no-go punch game, go/no-go stepping game, and number punch game) to improve habitual behavior control using motor–cognitive dual-task performance in patients with PD. The participants underwent 10 sessions 2–3 times a week, consisting of 30min per session. The Unified Parkinsons Disease Rating Scale, Timed Up and Go test (TUG) under single- and dual-task (cognitive and physical) conditions, Berg balance scale (BBS), Stroop test, trail-making test, and digit span were evaluated before and after intervention. The Simulator Sickness Questionnaire (SSQ) was used to assess VR cybersickness. Usability was assessed using a self-reported questionnaire. Results Twelve patients were enrolled and completed the entire training session. The mean age of participants was 73.83 ± 6.09years; mean disease duration was 128.83 ± 76.96months. The Hoehn and Yahr stages were 2.5 in seven patients and 3 in five patients. A significant improvement was observed in BBS and Stroop color–word test (p = 0.047 and p = 0.003, respectively). TUG time and dual-task interferences showed positive changes, but these changes were not statistically significant. The median SSQ total score was 28.05 (IQR: 29.92), 13.09 (IQR: 11.22), and 35.53 (IQR: 52.36) before, after the first session, and after the final session, respectively; the differences were not significant. Overall satisfaction with the intervention was 6.0 (IQR: 1.25) on a 7-point Likert-type scale. Conclusions Fully immersive VR exergames combined with physical and cognitive tasks may be used for rehabilitation of patients with PD without causing serious adverse effects. Furthermore, the exergames using dual-task components improved executive function and balance. Further development of VR training content may be needed to improve motor and dual-task performances. Trial registration NCT04787549 (https://clinicaltrials.gov/ct2/show/NCT04787549)This study was supported by Grant no. 03-2020-2020 from the Seoul National University Hospital Research Fund

Pivotal-based inference for a Pareto distribution under the adaptive progressive Type-II censoring scheme

This paper proposes an inference approach based on a pivotal quantity under the adaptive progressive Type-II censoring scheme. To exemplify the proposed methodology, an extensively employed distribution, a Pareto distribution, is utilized. This distribution has limitations in estimating confidence intervals for unknown parameters from classical methods such as the maximum likelihood and bootstrap methods. For example, in the maximum likelihood method, the asymptotic variance-covariance matrix does not always exist. In addition, both classical methods can yield confidence intervals that do not satisfy nominal levels when a sample size is not large enough. Our approach resolves these limitations by allowing us to construct exact intervals for unknown parameters with computational simplicity. Aside from this, the proposed approach leads to closed-form estimators with properties such as unbiasedness and consistency. To verify the validity of the proposed methodology, two approaches, a Monte Carlo simulation and a real-world data analysis, are conducted. The simulation testifies to the superior performance of the proposed methodology as compared to the maximum likelihood method, and the real-world data analysis examines the applicability and scalability of the proposed methodology

Elevated fasting insulin predicts the future incidence of metabolic syndrome: a 5-year follow-up study

<p>Abstract</p> <p>Background</p> <p>There is controversy about the specific pathophysiology of metabolic syndrome (MS) but several authors have argued that hyperinsulinemia is a key feature of the cluster. We aimed to assess whether the baseline insulin levels could predict the development of MS in a well characterised cohort of otherwise healthy adults who were followed over a five year period.</p> <p>Methods</p> <p>We identified 2, 350 Koreans subjects who did not have MS in 2003 and who were followed up in 2008. The subjects were divided into 4 groups according to the baseline quartiles of fasting insulin, and the predictors of the incidence of MS were analyzed using multivariate regression analysis.</p> <p>Results</p> <p>Over the follow up period, 8.5% of the cohort developed MS. However, 16.4% of the subjects in the highest quartile of the insulin levels developed MS. In a model that included gender, age, the smoking status, the exercise level, alcohol consumption and the systolic blood pressure, the subjects in the highest quartile of the insulin levels had more than a 5 times greater risk of developing MS compared that of the subjects in the lowest quartile. This predictive importance remained significant even after correcting for all the individual features of MS.</p> <p>Conclusions</p> <p>These data suggest that high baseline fasting insulin levels are independent determinants for the future development of MS.</p

Evaluating the added benefit of CT texture analysis on conventional CT analysis to differentiate benign ovarian cysts

PURPOSEWe aimed to evaluate the benefit of adding CT texture analysis on conventional CT features of benign adnexal cystic lesions, especially in identifying mucinous cystadenoma.METHODSThis retrospective study included patients who underwent surgical removal of benign ovarian cysts (44 mucinous cystadenomas, 32 serous cystadenomas, 16 follicular/simple cysts and 43 endometriotic cysts) at our institution between January 2015 and November 2017. The CT images were independently reviewed by an abdominal radiologist (reviewer 1) and a resident (reviewer 2). Both reviewers recorded the conventional characteristics and performed texture analysis. Based on reviewer 1’s results, two decision trees for differential diagnosis were developed. Reviewer 2’s results were then applied to the decision trees. The diagnostic performances of each reviewer with and without the decision trees were compared.RESULTSSeveral conventional features and texture analysis parameters showed significant differences between mucinous cystadenomas and other benign adnexal cysts. The first decision tree selected septum number and thickness as significant features, whereas the second decision tree selected septum number and the mean values at spatial scaling factor (SSF) 0. Reviewer 1’s performance did not change significantly with or without the use of the decision trees. Reviewer 2’s interpretations were significantly less sensitive than reviewer 1’s interpretations (p = 0.001). However, when aided by the first and second decision trees, Reviewer 2’s interpretations were significantly more sensitive than reviewer 1’s interpretations (86.4%, p < 0.001; 72.7%, p = 0.001).CONCLUSIONThis study suggests the benefit of CT texture analysis on conventional images to differentiate mucinous cystadenoma from other benign adnexal cysts, particularly for less experienced radiologists

Enhanced Generative Adversarial Networks for Unseen Word Generation from EEG Signals

Recent advances in brain-computer interface (BCI) technology, particularly based on generative adversarial networks (GAN), have shown great promise for improving decoding performance for BCI. Within the realm of Brain-Computer Interfaces (BCI), GANs find application in addressing many areas. They serve as a valuable tool for data augmentation, which can solve the challenge of limited data availability, and synthesis, effectively expanding the dataset and creating novel data formats, thus enhancing the robustness and adaptability of BCI systems. Research in speech-related paradigms has significantly expanded, with a critical impact on the advancement of assistive technologies and communication support for individuals with speech impairments. In this study, GANs were investigated, particularly for the BCI field, and applied to generate text from EEG signals. The GANs could generalize all subjects and decode unseen words, indicating its ability to capture underlying speech patterns consistent across different individuals. The method has practical applications in neural signal-based speech recognition systems and communication aids for individuals with speech difficulties.Comment: 5 pages, 2 figure