Cluster-Based Pairwise Contrastive Loss for Noise-Robust Speech Recognition.

This paper addresses a joint training approach applied to a pipeline comprising speech enhancement (SE) and automatic speech recognition (ASR) models, where an acoustic tokenizer is included in the pipeline to leverage the linguistic information from the ASR model to the SE model. The acoustic tokenizer takes the outputs of the ASR encoder and provides a pseudo-label through K-means clustering. To transfer the linguistic information, represented by pseudo-labels, from the acoustic tokenizer to the SE model, a cluster-based pairwise contrastive (CBPC) loss function is proposed, which is a self-supervised contrastive loss function, and combined with an information noise contrastive estimation (infoNCE) loss function. This combined loss function prevents the SE model from overfitting to outlier samples and represents the pronunciation variability in samples with the same pseudo-label. The effectiveness of the proposed CBPC loss function is evaluated on a noisy LibriSpeech dataset by measuring both the speech quality scores and the word error rate (WER). The experimental results reveal that the proposed joint training approach using the described CBPC loss function achieves a lower WER than the conventional joint training approaches. In addition, it is demonstrated that the speech quality scores of the SE model trained using the proposed training approach are higher than those of the standalone-SE model and SE models trained using conventional joint training approaches. An ablation study is also conducted to investigate the effects of different combinations of loss functions on the speech quality scores and WER. Here, it is revealed that the proposed CBPC loss function combined with infoNCE contributes to a reduced WER and an increase in most of the speech quality scores.

Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report.

BACKGROUND: Congestive ischemic colitis is a rare subtype of ischemic colitis with an unknown pathophysiology. Excluding conservative management, such as fasting, no established treatment exists; therefore, surgical intervention should be considered in some cases if symptoms worsen. Current literature suggests that anti-inflammatory agents may effectively treat congestive ischemic colitis. CASE SUMMARY: We present the case of a 68-year-old female patient who underwent laparoscopic left hemicolectomy for transverse colon cancer 3 years ago. Postoperatively, follow-up included an annual colonoscopy and abdominal computed tomography (CT) at a local clinic. However, progressive erythema and edema of the sigmoid colon were observed 1 year postoperatively. Upon admission to our hospital, she complained of abdominal pain and diarrhea. Abdominal CT showed thickening of the sigmoid colon walls, and colonoscopy revealed erythema, edema, and multiple ulcers with exudate in the sigmoid colon. CT angiography showed engorgement of the sigmoid vasa recta without any vascular abnormalities. The diagnosis was congestive ischemic colitis, and we treated the patient with anti-inflammatory agents. After 2 mo of glucocorticoid therapy (20 mg once daily) and 7 mo of 5-aminosalicylate therapy (1 g twice daily), the ulcers completely healed. She has not experienced any recurrence for 2 years. CONCLUSION: Anti-inflammatory therapy, specifically glucocorticoids and 5-aminosalicylate, has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.

Endometriosis-Related Chronic Pelvic Pain.

Endometriosis, which is the presence of endometrial stroma and glands outside the uterus, is one of the most frequently diagnosed gynecologic diseases in reproductive women. Patients with endometriosis suffer from various pain symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. The pathophysiology for chronic pain in patients with endometriosis has not been fully understood. Altered inflammatory responses have been shown to contribute to pain symptoms. Increased secretion of cytokines, angiogenic factors, and nerve growth factors has been suggested to increase pain. Also, altered distribution of nerve fibers may also contribute to chronic pain. Aside from local contributing factors, sensitization of the nervous system is also important in understanding persistent pain in endometriosis. Peripheral sensitization as well as central sensitization have been identified in patients with endometriosis. These sensitizations of the nervous system can also explain increased incidence of comorbidities related to pain such as irritable bowel disease, bladder pain syndrome, and vulvodynia in patients with endometriosis. In conclusion, there are various possible mechanisms behind pain in patients with endometriosis, and understanding these mechanisms can help clinicians understand the nature of the pain symptoms and decide on treatments for endometriosis-related pain symptoms.

Roll-Pressed Silicon Anodes with High Reversible Volumetric Capacity Achieved by Interfacial Stabilization and Mechanical Strengthening of a Silicon/Graphene Hybrid Assembly.

Application of Si anodes is hindered by severe capacity fading due to pulverization of Si particles during the large volume changes of Si during charge/discharge and repeated formation of the solid-electrolyte interphase. To address these issues, considerable efforts have been devoted to the development of Si composites with conductive carbons (Si/C composites). However, Si/C composites with high C content inevitably show low volumetric capacity because of low electrode density. For practical applications, the volumetric capacity of a Si/C composite electrode is more important than gravimetric capacity, but volumetric capacity in pressed electrodes is rarely reported. Herein, a novel synthesis strategy is demonstrate for a compact Si nanoparticle/graphene microspherical assembly with interfacial stability and mechanical strength achieved by consecutively formed chemical bonds using 3-aminopropyltriethoxysilane and sucrose. The unpressed electrode (density: 0.71 g cm-3 ) shows a reversible specific capacity of 1470 mAh g-1 with a high initial coulombic efficiency of 83.7% at a current density of 1 C-rate. The corresponding pressed electrode (density: 1.32 g cm-3 ) exhibits high reversible volumetric capacity of 1405 mAh cm-3 and gravimetric capacity of 1520 mAh g-1 with a high initial coulombic efficiency of 80.4% and excellent cycling stability of 83% over 100 cycles at 1 C-rate.

In Situ Synthesis of Amorphous GeSe/CNT Composite via Defective-carbon-mediated Chemical Bonding for Ultrastable Na Ion Storage.

Herein, we report the in-situ synthesis of amorphous GeSe/CNT composite via defective-carbon-mediated chemical bonding for ultrastable Na-ion storage. Structural defects in CNTs play a crucial role in the chemical bonding and bonding strength in GeSe/CNTs composites. Specifically, the bonding strength tends to increase with increasing defect concentrations of CNTs. Remarkably, the strong chemical bonding between GeSe and CNTs significantly weakens Ge-Se bonds and promotes amorphization of GeSe, thus facilitating a reversible conversion reaction and enhancing Na-ion diffusion. Consequently, GeSe/CNTs composite exhibits outstanding cyclability of 87.9% even after 1000 cycles at 1 A g-1 and a high-rate capability of 288.3 mA h g-1 at 10 A g-1 . Our work presents a promising approach for the amorphization of electrode materials enabled by the defective-carbon-mediated strong chemical bonding for Li-, Na-, and K-ion batteries.

Molecular Detection of Phytoplasmas of the 16Srâ and 16SrXXXâ ¡ Groups in Elaeocarpus sylvestris Trees with Decline Disease in Jeju Island, South Korea.

Phytoplasmas were discovered in diseased Elaeocarpus sylvestris trees growing on Jeju Island that showed symptoms of yellowing and darkening in the leaves. Leaf samples from 14 symptomatic plants in Jeju-si and Seogwipo-si were collected and phytoplasma 16S rRNA was successfully amplified by nested polymerase chain reaction using universal primers. The sequence analysis detected two phytoplasmas, which showed 99.5% identity to 'Candidatus Phytoplasma asteris' and 'Ca. P. malaysianum' affiliated to 16SrI and 16SrXXXII groups, respectively. Through polymerase chain reaction-restriction fragment length polymorphism (RFLP) analyses using the AfaI (RsaI) restriction enzyme, the presence of two phytoplasmas strains as well as cases of mixed infection of these strains was detected. In a virtual RFLP analysis with 17 restriction enzymes, the 16S rRNA sequence of the 'Ca. P. asteris' strain was found to match the pattern of the 16SrI-B subgroup. In addition, the phytoplasmas in the mixed-infection cases could be distinguished using specific primer sets. In conclusion, this study confirmed mixed infection of two phytoplasmas in one E. sylvestris plant, and also the presence of two phytoplasmas (of the 16SrⅠ and 16SrXXXⅡ groups) in Jeju Island (Republic of Korea).

The efficacy of gonadotropin-releasing hormone agonist treatment before hysteroscopic myomectomy for large-sized submucosal leiomyoma.

To evaluate the efficacy and safety of a gonadotropin-releasing hormone (GnRH) agonist for treating large-sized submucosal leiomyoma before hysteroscopic myomectomy. The data were retrospectively collected from patients who underwent a hysteroscopic myomectomy for a submucosal leiomyoma >3.5 cm in size from January 2009 to December 2018. The patients were divided into the GnRH group and the control group according to whether they were pretreated before surgery. A total of 61 patients were included in the study, 31 in the GnRH agonist group and 30 in the control group. At diagnosis, the maximum leiomyoma diameter was similar between the 2 groups (4.67 ± 0.6 cm in the GnRH agonist group vs 3.82 ± 0.6 cm in the control group, P = .061). After pretreatment with the GnRH agonist, the maximum diameter was significantly smaller in the GnRH agonist group compared to the control group (3.82 ± 0.6 vs 4.33 ± 0.8 cm, respectively, P = .004). The leiomyoma volume in the GnRH agonist group decreased by 55.6%, from 41.68 ± 15.7 to 23.19 ± 10.4 cm3, which led to significant differences in leiomyoma volume between the 2 groups (23.19 ± 10.4 cm3 in the GnRH agonist group vs 33.22 ± 24.7 cm3 in the control group, P = .042). The GnRH agonist group showed a shorter operation time (37.7 vs 43.9 minutes, P = .040) and less uterine distention media was used (6800 vs 9373.3 mL, P = .037) compared to the control group. Postoperative complications such as estimated blood loss, remnant leiomyoma, and recurrence were similar between the 2 groups. Treatment with a GnRH agonist before hysteroscopic myomectomy for large submucosal leiomyoma might decrease the volume of the leiomyoma, reduce operation time, and the amount of uterine-distension media used without surgical complications.

Two-Step Joint Optimization with Auxiliary Loss Function for Noise-Robust Speech Recognition.

In this paper, a new two-step joint optimization approach based on the asynchronous subregion optimization method is proposed for training a pipeline model composed of two different models. The first-step processing of the proposed joint optimization approach trains the front-end model only, and the second-step processing trains all the parameters of the combined model together. In the asynchronous subregion optimization method, the first-step processing only supports the goal of the front-end model. However, the first-step processing of the proposed approach works with a new loss function to make the front-end model support the goal of the back-end model. The proposed optimization approach was applied, here, to a pipeline composed of a deep complex convolutional recurrent network (DCCRN)-based speech enhancement model and a conformer-transducer-based ASR model as a front-end and a back-end, respectively. Then, the performance of the proposed two-step joint optimization approach was evaluated on the LibriSpeech automatic speech recognition (ASR) corpus in noisy environments by measuring the character error rate (CER) and word error rate (WER). In addition, an ablation study was carried out to examine the effectiveness of the proposed optimization approach on each of the processing blocks in the conformer-transducer ASR model. Consequently, it was shown from the ablation study that the conformer-transducer-based ASR model with the joint network trained only by the proposed optimization approach achieved the lowest average CER and WER. Moreover, the proposed optimization approach reduced the average CER and WER on the Test-Noisy dataset under matched noise conditions by 0.30% and 0.48%, respectively, compared to the approach of separate optimization of speech enhancement and ASR. Compared to the conventional two-step joint optimization approach, the proposed optimization approach provided average CER and WER reductions of 0.22% and 0.31%, respectively. Moreover, it was revealed that the proposed optimization approach achieved a lower average CER and WER, by 0.32% and 0.43%, respectively, than the conventional optimization approach under mismatched noise conditions.

Successful delayed delivery of the second twin by evacuating the cord prolapsed first fetus and emergent cerclage: a report of 2 cases.

BACKGROUND: In twin pregnancies, the cord prolapse of either fetus during the pre-viable period leads to fetal death but can also cause an intrauterine infection, leading to death or prematu-re birth of the remaining fetus. However, there are no validated protocols to prolong the gestational period or decrease the morbidity and mortality of the remaining fetus. CASE PRESENTATION: The present cases were PPROM and cord prolapse very early during the second trimester (around 17 weeks in the first case and 19 weeks in the second case). The first fetus was evacuated, and cervical cerclage was performed at 23 and 20 weeks in the two cases, respectively. After maintaining the pregnancy, the second baby was born around 27 and 39 weeks in the first and second cases, respectively. The delivery interval between the first and second fetuses was 46 days in the first case and 126 days in the second case. CONCLUSION: If cord prolapse is identified at a pre-viable time in twin fetuses, evacuation and cerclage should be performed as soon as possible after the cord prolapse to reduce intrauterine infection and increase the survival chances of the remaining fetus.

End-to-End Model-Based Detection of Infants with Autism Spectrum Disorder Using a Pretrained Model.

In this paper, we propose an end-to-end (E2E) neural network model to detect autism spectrum disorder (ASD) from children's voices without explicitly extracting the deterministic features. In order to obtain the decisions for discriminating between the voices of children with ASD and those with typical development (TD), we combined two different feature-extraction models and a bidirectional long short-term memory (BLSTM)-based classifier to obtain the ASD/TD classification in the form of probability. We realized one of the feature extractors as the bottleneck feature from an autoencoder using the extended version of the Geneva minimalistic acoustic parameter set (eGeMAPS) input. The other feature extractor is the context vector from a pretrained wav2vec2.0-based model directly applied to the waveform input. In addition, we optimized the E2E models in two different ways: (1) fine-tuning and (2) joint optimization. To evaluate the performance of the proposed E2E models, we prepared two datasets from video recordings of ASD diagnoses collected between 2016 and 2018 at Seoul National University Bundang Hospital (SNUBH), and between 2019 and 2021 at a Living Lab. According to the experimental results, the proposed wav2vec2.0-based E2E model with joint optimization achieved significant improvements in the accuracy and unweighted average recall, from 64.74% to 71.66% and from 65.04% to 70.81%, respectively, compared with a conventional model using autoencoder-based BLSTM and the deterministic features of the eGeMAPS.

In Situ Growth of Novel Graphene Nanostructures in Reduced Graphene Oxide Microspherical Assembly with Restacking-Resistance and Inter-Particle Contacts for Energy Storage Devices.

Graphene is extensively investigated for various energy storage systems. However, the very low density (<0.01 g cm-3 ) of graphene nanosheets has hindered its further applications. To solve this issue, a controlled assembly of 2D graphene building blocks should be developed into graphene microspheres with high packing density, and restacking of graphene should be prevented to ensure an electrochemically accessible surface area during the assembly. Furthermore, graphene microspheres should have multiple 1D external conductive architecture to promote contacts with the neighbors. This study reports in situ growth of novel graphene nanostructures in reduced graphene oxide microspherical assembly (denoted as GT/GnS@rGB) with restacking resistance and interparticle contacts, for electrochemical energy storage. The GT/GnS@rGB showed high gravimetric (231.8 F g-1 ) and volumetric (181.5 F cm-3 ) capacitances at 0.2 A g-1 in organic electrolyte with excellent rate capabilities of 94.3% (@ 0.2 vs 10 Ag-1 ). Furthermore, GT/GnS@rGB exhibited excellent cycling stability (96.1% of the initial capacitance after 100 000 charge/discharge cycles at 2 A g-1 ). As demonstrated in the electrochemical evaluation as electrode materials for electrical double-layer capacitors, unique structural and textural features of the GT/GnS@rGB would be beneficial in the use of graphene assembly for energy storage applications.

Raman Scattering Study on the Influence of E-Beam Bombardment on Si Electron Lens.

Microcolumns have a stacked structure composed of an electron emitter, electron lens (source lens), einzel lens, and a deflector manufactured using a micro electro-mechanical system process. The electrons emitted from the tungsten field emitter mostly pass through the aperture holes. However, other electrons fail to pass through because of collisions around the aperture hole. We used Raman scattering measurements and X-ray photoelectron spectroscopy analyses to investigate the influence of electron beam bombardment on a Si electron lens irradiated by acceleration voltages of 0, 20, and 30 keV. We confirmed that the crystallinity was degraded, and carbon-related contamination was detected at the surface and edge of the aperture hole of the Si electron lens after electron bombardment for 24 h. Carbon-related contamination on the surface of the Si electron lens was verified by analyzing the Raman spectra of the carbon-deposited Si substrate using DC sputtering and a carbon rod sample. We report the crystallinity and the origin of the carbon-related contamination of electron Si lenses after electron beam bombardment by non-destructive Raman scattering and XPS analysis methods.

Usefulness of sentinel lymph node mapping using indocyanine green and fluorescent imaging in the diagnosis of lymph node metastasis in endometrial cancer.

The lymph node status is the most important prognostic factor for endometrial cancer. This study aimed to assess whether sentinel lymph node mapping (SLNM) is applicable in endometrial cancer. A retrospective review of patients with endometrial cancer who were diagnosed and treated in Asan Medical Centre from September 2015 to December 2017 was conducted. One hundred patients underwent robotic (da Vinci®) or laparoscopic surgical treatment, including SLNM with indocyanine green (ICG) fluorescence detection using the Firefly® and NIR/ICG systems. At least one lymph node area was observed in 100% of SLNM cases. Sentinel node detection and frozen biopsy were performed in all cases, and all patients with metastasis were found on SLNM. The sensitivity and negative predictive value were both 100% in the patient-by-patient and station-by-station analyses. SLNM appears to be a feasible method to reduce the morbidity and increase the detection rate in early-stage endometrial carcinoma.What is already known on this subject? There are studies that it is safe to diagnose the possibility of lymph node metastasis through sentinel lymph node mapping in endometrial cancer.What do the results of this study add? In this study, it is shown that the accuracy of sentinel lymph node mapping is 100% accurate.What are the implications of these findings for clinical practise and/or further research? Therefore, total lymphadenectomy will not be necessary for the future.

Deep-Learning-Based Detection of Infants with Autism Spectrum Disorder Using Auto-Encoder Feature Representation.

Autism spectrum disorder (ASD) is a developmental disorder with a life-span disability. While diagnostic instruments have been developed and qualified based on the accuracy of the discrimination of children with ASD from typical development (TD) children, the stability of such procedures can be disrupted by limitations pertaining to time expenses and the subjectivity of clinicians. Consequently, automated diagnostic methods have been developed for acquiring objective measures of autism, and in various fields of research, vocal characteristics have not only been reported as distinctive characteristics by clinicians, but have also shown promising performance in several studies utilizing deep learning models based on the automated discrimination of children with ASD from children with TD. However, difficulties still exist in terms of the characteristics of the data, the complexity of the analysis, and the lack of arranged data caused by the low accessibility for diagnosis and the need to secure anonymity. In order to address these issues, we introduce a pre-trained feature extraction auto-encoder model and a joint optimization scheme, which can achieve robustness for widely distributed and unrefined data using a deep-learning-based method for the detection of autism that utilizes various models. By adopting this auto-encoder-based feature extraction and joint optimization in the extended version of the Geneva minimalistic acoustic parameter set (eGeMAPS) speech feature data set, we acquire improved performance in the detection of ASD in infants compared to the raw data set.

Triethoxysilane-derived SiOx-assisted structural reinforcement of Si/carbon nanotube composite for lithium-ion battery.

Herein, triethoxysilane-derived SiOx is used as a robust adhesive anchor to bind Si nanoparticles (NPs) and carbon nanotubes (CNTs) to prepare a structurally reinforced Si/CNT microsphere composite. The chemical reaction between the silanol groups of triethoxysilane with the hydroxyl groups on the Si surface and acid-treated CNTs induce strong chemical bonds between the Si NPs and CNTs and among neighboring CNTs, facilitating electron-conduction pathways and structural integrity of the composite, even under severe stress/strain. Thus, the structurally reinforced Si/CNT/SiOx microsphere composite exhibits superior cyclability: ∼88% of its initial capacity of 1112 mA h g-1 is retained after 100 cycles at 0.5 A g-1. Moreover, the Si/CNT/SiOx composite exhibits a negligible change in electrode thickness after 100 cycles. The stable electrochemical behavior and negligible change in the electrode thickness are attributed to the maintenance of the electron-conduction pathways and structural integrity of the Si/CNT/SiOx composite, enabled by the binding of neighboring CNTs with the SiOx anchor.

Effect of serotonin-norepinephrine reuptake inhibitors for patients with chemotherapy-induced painful peripheral neuropathy: A meta-analysis.

BACKGROUND: To compare the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) treatment for chemotherapy-induced peripheral neuropathy (CIPN) METHODS:: Two authors independently searched MEDLINE, Embase, Cochran Library, and Web of Science to identify and review articles published from January 1998 until December 2018 according to selection criteria. Outcomes were expressed as mean difference, the pooled odds ratio, or relative risk in a meta-analysis model. RESULTS: A total of 10 studies were included in this meta-analysis: 6 randomized-controlled studies and 4 observational studies. Meta-analysis showed that CIPN was improved after treatment with SNRI (standardized mean difference = 2.20; 95% confidence interval, 0.90-3.49; I = 93% in 3 randomized controlled studies). Somnolence and insomnia occurred in <15% of patients. Incidence of somnolence was lower than with pregabalin treatment, and insomnia was comparable to that in expectant management or pregabalin treatment. Incidence of nausea and vomiting was higher than in expectant management, but no significant difference was found when compared to expectant management. CONCLUSION: From the several available studies suitable for indirect comparison, SNRI shows excellent efficacy and tolerability to CIPN. SNRI could provide an important treatment option for CIPN.

Magnéli Phase Titanium Oxide as a Novel Anode Material for Potassium-Ion Batteries.

Recently, K-ion batteries (KIBs) have attracted attention for potential applications in next-generation energy storage devices principally on the account of their abundancy and lower cost. Herein, for the first time, we report an anatase TiO2-derived Magnéli phase Ti6O11 as a novel anode material for KIBs. We incorporate pristine carbon nanotube (CNT) on the TiO2 host materials due to the low electronic conductivity of the host materials. TiO2 transformed to Magnéli phase Ti6O11 after the first insertion/deinsertion of K ions. From the second cycle, Magnéli phase Ti6O11/CNT composite showed reversible charge/discharge profiles with ∼150 mA h g-1 at 0.05 A g-1. Ex situ X-ray diffraction and transmission electron microscopy analyses revealed that the charge storage process of Magnéli phase Ti6O11 proceeded via the conversion reaction during potassium ion insertion/deinsertion. The Magnéli phase Ti6O11/CNT composite electrode showed long-term cycling life over 500 cycles at 200 mA g-1, exhibiting a capacity retention of 76% and a high Coulombic efficiency of 99.9%. These salient results presented here provide a novel understanding of the K-ion storage mechanisms in the extensively investigated oxide-based material for Li-ion batteries and Na-ion batteries, shedding light on the development of promising electrode materials for next-generation batteries.

Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: a meta-analysis.

OBJECTIVE: To evaluate the effect of pretreatment with combined oral contraceptives (COC) on outcomes in women with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology for subfertility. METHODS: Two authors independently searched MEDLINE, EMBASE, and the Cochran Library to identify and review articles published from October 1995 until December 2018 according to selection criteria. Outcomes are expressed as mean difference and odds ratio (OR) in a meta-analysis model. RESULTS: A total of seven studies were included in this meta-analysis: one randomized controlled study and two prospective and four retrospective cohort studies. Meta-analysis showed that the COC pretreatment did not affect rate of clinical pregnancy (OR = 0.93, 95% confidence interval CI 0.65-1.34, I2 = 76%) or ovarian hyperstimulation syndrome (OR = 0.90, 95% CI 0.57-1.44, I2 = 0%). However, the rate of miscarriage in the COC group was significantly higher (OR = 1.33, 95% CI 1.02-1.72, I2 = 9%) and the rate of cumulative live birth was significantly lower compared with the control group (OR = 0.72, 95% CI 0.54-0.98, I2 = 55%). Subgroup analysis showed higher rates of miscarriage and lower rates of cumulative live birth in studies with a gonadotropin-releasing hormone (GnRH) antagonist protocol (OR = 1.69, 95% CI 1.17-2.44, I2 = 0% and OR = 0.38, 95% CI 0.29-0.50, respectively). CONCLUSION: Pretreatment with COC in women with PCOS before assisted reproductive technology may have an adverse effect on clinical outcomes, especially with a GnRH antagonist protocol.

Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis.

OBJECTIVE: To compare the efficacy of levonorgestrel releasing intrauterine system (LNG-IUS) with other treatments as a postoperative maintenance therapy for endometriosis in terms of pain reduction, recurrence prevention, side effects and patients' satisfaction. STUDY DESIGN: We searched MEDLINE, EMBASE, and the Cochrane Library from January 1986 until February 2018. Two evaluators independently extracted and reviewed prospective and retrospective articles based on pre-determined selection criteria. Outcomes were expressed as mean difference (MD), risk ratios (RR) or odds ratios (OR) in a meta-analysis model, using Revman software. RESULTS: Among the 962 studies, 7 studies were selected: 7 studies included 4 randomized controlled trials with 212 patients, 1 prospective cohort study with 88 patients, and 2 retrospective studies with 191 patients. A meta-analysis showed that LNG-IUS was significantly effective in reducing pain after surgery (MD = 12.97, 95% confidence interval (CI): 5.55-20.39), with a comparable effect to gonadotropin-releasing hormone analogues (MD = -0.16, 95% CI: -2.02 to 1.70). LNG-IUS was also effective in decreasing the recurrence rate (RR = 0.40, 95% CI: 0.26-0.64), with an effect comparable to OC (OR = 1.00, 95% CI: 0.25-4.02) and danazol (RR = 0.30, 95% CI: 0.03-2.81). Furthermore, patients' satisfaction with LNG-IUS was significantly higher than that with OC (OR = 8.60, 95% CI: 1.03-71.86). However, vaginal bleeding was significantly higher in the LNG-IUS group than in the gonadotropin-releasing hormone analogue group (RR = 27.0, 95% CI: 1.71-425.36). CONCLUSION: Our meta-analysis found a positive effect of LNG-IUS as a postoperative maintenance therapy for endometriosis on pain relief, prevention of dysmenorrhea recurrence, and patients' satisfaction.

Decreased blood pressure associated with in-vehicle exposure to carbon monoxide in Korean volunteers.

BACKGROUND: Carbon monoxide (CO) is one of the primary components of emissions from light-duty vehicles, and reportedly comprises 77% of all pollutants emitted in terms of concentration. Exposure to CO aggravates cardiovascular disease and causes other health disorders. The study was aimed to assess the negative effects by injecting different amounts of CO concentration directly to human volunteers boarding in the car. METHODS: Human volunteers were exposed to CO concentrations of 0, 33.2, and 72.4 ppm, respectively during the first test and 0, 30.3, and 48.8 ppm respectively during the second test while seated in the car. The volunteers were exposed to each concentration for approximately 45 min. After exposure, blood pressure measurement, blood collection (carboxyhemoglobin [COHb] analysis), medical interview, echocardiography test, and cognitive reaction test were performed. RESULT: In patients who were exposed to a mean concentration of CO for 72.4 ± 1.4 ppm during the first exposure test and 48.8 ± 3.7 ppm during the second exposure test, the COHb level exceeded 2%. Moreover, the diastolic blood pressure was decreased while increasing in CO concentration after exposure. The medical interview findings showed that the degree of fatigue was increased and the degree of concentration was reduced when the exposed concentration of CO was increased. CONCLUSION: Although the study had a limited sample size, we found that even a low concentration of CO flowing into a car could have a negative influence on human health, such as change of blood pressure and degree of fatigue.