Polycystic ovary syndrome (PCOS) affects up to 20% of women but remains poorly understood. It is a heterogeneous condition with many potential comorbidities. This review offers an overview of the dysregulation of the reproductive and metabolic systems associated with PCOS. Review of the literature informed the development of a comprehensive summarizing ‘wiring’ diagram of PCOS-related features. This review provides a justification for each diagram aspect from the relevant academic literature, and explores the interactions between the hypothalamus, ovarian follicles, adipose tissue, reproductive hormones and other organ systems. The diagram will provide an efficient and useful tool for those researching and treating PCOS to understand the current state of knowledge on the complexity and variability of PCOS.

Background Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects 4% to 21% of people with ovaries. Inaccessibility or dissatisfaction with clinical treatment for PCOS has led to some individuals with the condition discussing their experiences in specialized web-based forums. Objective This study explores the feasibility of using such web-based forums for clinical research purposes by gathering and analyzing laboratory test results posted in an active PCOS forum, specifically the PCOS subreddit hosted on Reddit. Methods We gathered around 45,000 posts from the PCOS subreddit. A random subset of 5000 posts was manually read, and the presence of laboratory test results was labeled. These labeled posts were used to train a machine learning model to identify which of the remaining posts contained laboratory results. The laboratory results were extracted manually from the identified posts. These self-reported laboratory test results were compared with values in the published literature to assess whether the results were concordant with researcher-published values for PCOS cohorts. A total of 10 papers were chosen to represent published PCOS literature, with selection criteria including the Rotterdam diagnostic criteria for PCOS, a publication date within the last 20 years, and at least 50 participants with PCOS. Results Overall, the general trends observed in the laboratory test results from the PCOS web-based forum were consistent with clinically reported PCOS. A number of results, such as follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone, were concordant with published values for patients with PCOS. The high consistency of these results among the literature and when compared to the subreddit suggests that follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone are more consistent across PCOS phenotypes than other test results. Some results, such as testosterone, sex hormone–binding globulin, and homeostasis model assessment–estimated insulin resistance index, were between those of PCOS literature values and normal values, as defined by clinical testing limits. Interestingly, other results, including dehydroepiandrosterone sulfate, luteinizing hormone, and fasting glucose, appeared to be slightly more dysregulated than those reported in the literature. Conclusions The differences between the forum-posted results and those published in the literature may be due to the selection process in clinical studies and the possibility that the forum disproportionally describes PCOS phenotypes that are less likely to be alleviated with medical intervention. However, the degree of concordance in most laboratory test values implied that the PCOS web-based forum participants were representative of research-identified PCOS cohorts. This validation of the PCOS subreddit grants the possibility for more research into the contents of the subreddit and the idea of undertaking similar research using the contents of other medical internet forums.

Convolutional neural networks (CNNs) have become a useful tool for a wide range of applications such as text classification. However, CNNs are not always sufficiently accurate to be useful in certain applications. The selection of activation functions within CNN architecture can affect the efficacy of the CNN. However, there is limited research regarding which activation functions are best for CNN text classification. This study tested sixteen activation functions across three text classification datasets and six CNN structures, to determine the effects of activation function on accuracy, iterations to convergence, and Positive Confidence Difference (PCD). PCD is a novel metric introduced to compare how activation functions affected a network’s classification confidence. Tables were presented to compare the performance of the activation functions across the different CNN architectures and datasets. Top performing activation functions across the different tests included the symmetrical multi-state activation function, sigmoid, penalised hyperbolic tangent, and generalised swish. An activation function’s PCD was the most consistent evaluation metric during activation function assessment, implying a close relationship between activation functions and network confidence that has yet to be explored.

BACKGROUND Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects 4% to 21% of people with ovaries. Inaccessibility or dissatisfaction with clinical treatment for PCOS has led to some individuals with the condition discussing their experiences in specialised online forums. OBJECTIVE This study explores the feasibility of using such online forums for clinical research purposes by gathering and analysing laboratory test results posted in an active PCOS forum. METHODS These self-reported forum-posted laboratory test results were compared with values in the published literature to assess whether results were concordant with researcher published values for PCOS cohorts. Ten papers were chosen to represent published PCOS literature, with selection criteria including Rotterdam diagnosis of PCOS participants, a publication date within the last 20 years, and at least 50 PCOS participants. RESULTS Overall, the general trends observed in the laboratory test results from the PCOS online forum were consistent with clinically reported PCOS. A number of results, such as FSH (follicle stimulating hormone), fasting insulin and AMH (anti-Mullerian hormone), were concordant with published PCOS patient values. The high consistency of these results among the literature, and when compared to the subreddit, suggests that FSH, fasting insulin and AMH are more consistent across PCOS phenotypes than other test results. Some results, such as testosterone, SHBG (sex hormone binding globulin) and HOMA-IR (an index for assessing insulin resistance), were between that of PCOS literature values and normal values, as defined by clinical testing limits. Interestingly, other results including DHEA-S (dehydroepiandrosterone-sulphate), LH (luteinizing hormone) and fasting glucose appeared to be slightly more dysregulated than reported in literature. CONCLUSIONS The differences between the forum-posted results and those published in the literature may be due to the selection process in clinical studies and the possibility that the forum disproportionally describes PCOS phenotypes that are less likely to be alleviated with medical intervention. However, the degree of concordance in most laboratory test values implied that the PCOS online forum participants were representative of research-identified PCOS cohorts.