Laparoscopic myomectomy videos on WebSurg and YouTube: does peer review process make a difference?

Objective: This study aimed to evaluate the quality of laparoscopic myomectomy videos on YouTube and WebSurg. Material and Methods: We searched using the keyword "laparoscopic myomectomy" on WebSurg and selected surgical interventions in the gynecology section. Eleven videos on WebSurg were enrolled. We selected the 22 most-relevant videos on YouTube to create a comparison group, with a ratio of 1:2. Sound in videos, number of subscribers, views, likes, and comments, number of days since videos were uploaded and durations of videos were recorded. View/day, like/view, like/subscriber, and view/subscriber ratios were calculated. The videos were evaluated with usefulness score (US), global quality scoring (GQS), modified discern score (mDS) and laparoscopic surgery video educational guidelines (LAP-VEGaS). Results: The view/day ratio was lower in WebSurg compared to YouTube [1.3 (1.9) vs. 7.5 (30.6), respectively; p=0.039]. No difference was found between WebSurg and YouTube in terms of US, GQS and mDS. On LAP-VEGaS assessment, WebSurg was found to be superior to YouTube in terms of intraoperative findings [2 (1-2) vs. 1 (0-2), p=0.001], additional materials [1 (0-2) vs. 1 (0-1), p=0.041], audio/written commentary [2 (2-2) vs. 2 (0-2), p=0.037], image quality [2 (2-2) vs. 2 (0-2), p=0.023], questions and total score [12 (11-13) vs. 10.5 (4-13), p=0.006]. The proportion of high-quality video was higher in WebSurg compared to YouTube, when the cut-off value of total score of 11 or 12 was used as 10 (100%) vs. 10 (50%), p=0.011 and 9 (90%) vs. 5 (25%), p=0.001, respectively. Conclusion: WebSurg was better compared to YouTube in terms of quality of laparoscopic myomectomy videos.

Intertwin membrane cord insertion in dichorionic twin pregnancy: The description and comparison with other umbilical cord insertion types.

PURPOSE: Multiple pregnancy is associated with high perinatal mortality and morbidity. Abnormal cord insertions more common in twin pregnancies compared to singleton pregnancies and velamentous cord insertion is related with poor pregnancy outcomes. There is no definition of velamentous cord insertion into the intertwine membrane between two fetuses in the literature. METHODS: In our single-center cross-sectional study, monochorionic-diamniotic and dichorionic-diamniotic twins who were admitted to our clinic between 18 + 0 and 23 + 6 weeks of pregnancy were enrolled in this study. We evaluated fetal, placental, and umbilical cord abnormalities in addition to fetal growth restrictions and weight discordance by ultrasonography. RESULTS: Although abnormal cord insertion frequency was significantly higher in monochorionic twins (p = 0.003), intertwin membrane cord insertion could only occur in dichorionic twins. In cases with cord insertion anomaly; FGR and weight discordance was observed more frequently (p < 0.001 and p = 0.003, respectively). Weight discordance, the presence of abnormal cord insertion and abnormal UAD were found as statistically significant predictors of FGR (p < 0.001, p = 0.021, and p < 0.001, respectively). CONCLUSION: Intertwin membrane insertion is a novel umbilical cord insertion abnormality. The presence of abnormal umbilical cord insertion is a risk factor for poor pregnancy outcomes in twin pregnancies.

The EpiDiverse Plant Epigenome-Wide Association Studies (EWAS) Pipeline.

Bisulfite sequencing is a widely used technique for determining DNA methylation and its relationship with epigenetics, genetics, and environmental parameters. Various techniques were implemented for epigenome-wide association studies (EWAS) to reveal meaningful associations; however, there are only very few plant studies available to date. Here, we developed the EpiDiverse EWAS pipeline and tested it using two plant datasets, from P. abies (Norway spruce) and Q. lobata (valley oak). Hence, we present an EWAS implementation tested for non-model plant species and describe its use.

EpiDiverse Toolkit: a pipeline suite for the analysis of bisulfite sequencing data in ecological plant epigenetics.

The expanding scope and scale of next generation sequencing experiments in ecological plant epigenetics brings new challenges for computational analysis. Existing tools built for model data may not address the needs of users looking to apply these techniques to non-model species, particularly on a population or community level. Here we present a toolkit suitable for plant ecologists working with whole genome bisulfite sequencing; it includes pipelines for mapping, the calling of methylation values and differential methylation between groups, epigenome-wide association studies, and a novel implementation for both variant calling and discriminating between genetic and epigenetic variation.

Atypical Presentation of Swyer Syndrome.

BACKGROUND: Swyer syndrome is a rare type of disorder of sex development and typically presents with delayed puberty and primary amenorrhea. We describe an unusual presentation of this condition. CASE: A 17-year-old female patient with typical thelarche and adrenarche presented with primary amenorrhea. Pelvic ultrasound showed normally developed uterus and bilateral ovoid hypoechoic structures suggestive of gonads. Laboratory investigations revealed highly elevated gonadotrophins with estradiol level within a range typical for a female of reproductive age and chromosome analysis showed a 46,XY karyotype. Histopathological examination of the gonadectomy specimens revealed gonadoblastoma and dysgerminoma with no functional ovarian or testicular tissue. SUMMARY AND CONCLUSION: This report reminds us the possibility of diagnosis of Swyer syndrome in the presence of normal pubertal development and normal sex steroid levels considered to be produced by gonadoblastoma.

Efficacy of a New Crosslinked Hyaluronan Gel in the Prevention of Intrauterine Adhesions.

BACKGROUND AND OBJECTIVES: The authors sought to assess the effect of the use of a new crosslinked hyaluronan (NCH) gel on the prevention of intrauterine adhesions (IUAs) in women underwent curettage in the second trimester. METHODS: Between June 2016 and September 2017, 60 patients who underwent curettage for retained placental tissue after medically induced or spontaneous pregnancy loss in the second trimester were enrolled in the study. The patients were randomly assigned to 1 of 2 groups: Group 1 patients received curettage plus NCH gel (intervention group), and group 2 patients received curettage alone (control group). The main outcomes were the rate and severity of IUA formation, which were assessed by follow-up hysteroscopy performed in the ensuing 2-6 months. RESULTS: The hysteroscopic findings were available for 20 patients in group 1 and 28 patients in group 2. IUAs were observed in 6 patients in group 2, while no IUAs was observed in group 1 (P = .007). IUAs were staged as mild in 4 patients (14.28%) and moderate in 2 patients (7.14%) in group 2 according to the American Fertility Society classification of IUAs. CONCLUSIONS: Our study demonstrates that NCH gel appears to be able to reduce the formation of IUAs in women who undergo curettage in the second trimester, although larger controlled, randomized, multicenter studies are needed to confirm these results.

Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages.

OBJECTIVE: To determine the perinatal outcomes of selective termination in dichorionic twin pregnancies discordant for major but non-lethal fetal anomalies performed at different gestational ages. METHODS: Thirty-one dichorionic twin pregnancies that underwent selective termination for discordant major but non-lethal fetal anomalies between January 2004 and February 2015 were retrospectively reviewed. The patients were grouped into three, according to the gestational age at which selective termination of pregnancies was performed; Group 1 (15-19 weeks), Group 2 (20-24 weeks) and Group 3 (30-33 weeks). Perinatal outcomes in all the three groups were reviewed and analyzed. RESULTS: The overall live birth, term birth and pregnancy loss rate were 93.6%, 54.8% and 9.6%, respectively. The overall live birth rate was 66.6% in Group 1, this rate was 100% in Group 2 and Group 3 (p = 0.01). The rate of pregnancy loss was significantly higher in Group 1 (p = 0.01). The overall preterm delivery rate was 38.7%. While the overall preterm delivery rate was significantly higher in Group 3 (p = 0.04), the rate of extremely and very preterm birth was significantly lower (p = 0.03). CONCLUSION: Late selective feticide performed during the third trimester of pregnancy seems to be a safe approach and can be offered as an alternative method to reduce the total pregnancy loss and extremely and early pre-term birth rates.

Reproductive Outcomes of Hysteroscopic Septoplasty Techniques.

BACKGROUND AND OBJECTIVES: Since little is known regarding the correlation between different techniques used during hysteroscopic septoplasty and reproductives outcomes, we amied to evaluate the results of two different techniques of hysteroscopic septoplasty (HS). METHODS: Data were retrospectively reviewed on 49 patients who underwent HS for symptomatic septate uterus from January 1, 2010, through April 30, 2014. The patients were divided into 2 groups based on the HS technique used. Group I consisted of 27 patients who underwent HS by monopolar hook cautery with the operating hysteroscope. Group II consisted of 22 patients who had the procedure performed with scissors and guided by an office hysteroscope. All the procedures in the both groups were performed in the operating room under general anesthesia. Pregnancy outcomes within the first year after HS for both groups were evaluated. RESULTS: Reproductive outcomes were obtained from 44 patients who attempted to conceive after HS within the first year. In the 25 patients in group I, 23 had pregnancies, of which 15 (65.2%) continued to term, 3 (13%) ended in a preterm live birth, and 5 (21.7%) ended in loss of pregnancy (abortion). In the 19 patients in group II, there were 17 pregnancies, of which 11 (64.7%) continued to term, 2 (11.7%) ended in a preterm live birth, and 4 (23.5%) ended in first- or second-trimester abortion. The overall live-birth rate was 78.2% in group I and 76.4% in group II (P = .85). CONCLUSIONS: Our data show that the rates of pregnancy that reach term and overall rates of live births are similar between the 2 HS techniques. Additional studies are needed to evaluate the impact of the techniques on reproductive outcomes.

The level of quality of radiology services in Turkey: a sampling analysis.

PURPOSE: To determine the quality of radiographs, which have been referred from 40 different institutions for consultation, to discuss the causes of wasted resources, and to present possible solutions. MATERIALS AND METHODS: Five experienced radiology instructors determined the types of radiological examinations referred for consultation (conventional radiography, mammography, computed tomography and magnetic resonance imaging), the institutions at which they were performed (university or state hospital, private health center), and assessed the coverage area, field of vision (FOV), and dosage of x-ray. They also investigated problems in film processing, defects in sequence-printing windows, checked window levels, and checked the amount and timing of contrast material used. According to these criteria, the reviewers subjectively classified each radiograph as: 1. Poor, examination should be completely repeated, 2. Fair, examination should be partially repeated, 3. Good, accepted as adequate, no need for an additional examination, 4. Excellent, examination was as it should be. RESULTS: We reviewed 120 radiological examinations from 40 different institutions in 4 reference centers. Frequency of problems determined for each category was as follows: coverage area 32.5% (39/120), FOV 16% (14/86), X-ray dosage 16% (15/94), film processing 31% (37/120), sequence or window 65% (53/81), window level 44% (36/81); contrast material 51% (25/49), timing of contrast material 61% (30/49). Only 22% of the examinations were classified as excellent, whereas 47% required complete or partial repetition. CONCLUSION: Approximately half of the radiological examinations in our sampling required partial or complete repetition. Health, ethical, and economic aspects of the problem necessitates the prompt application of measures to establish radiological quality control and standardization procedures.