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• Wheat germ improved markers of glucose homeostasis in overweight adults. • Wheat germ reduced the pro-inflammatory adipokine, resistin. • Gut microbiota and gut integrity markers were unaffected by wheat germ. Wheat germ (WG), a by-product of flour milling, is rich in bioactive substances that may help improve health complications associated with increased adiposity. This study investigated the effects of WG on gut health, metabolic, and inflammatory markers in adults classified as overweight. We hypothesized that WG, because of its many bioactive components, would improve gut health and metabolic, and inflammatory markers in overweight adults. Forty adults (18–45 years old) and with a body mass index between 25 and 30 kg/m2 participated in this single-blinded randomized controlled pilot study. Participants consumed the study supplements containing 30 g of either cornmeal (control, CL) or WG daily for 4 weeks. Primary outcome variables were gut health markers including gut microbiota, gut integrity markers, and fecal short-chain fatty acids, whereas secondary outcome variables included metabolic and inflammatory parameters assessed at baseline and at the end of supplementation. Thirty-nine participants (n = 19 and 20 for CL and WG group, respectively) completed the study. The genus Faecalibacterium was significantly higher in the WG group compared to CL post-supplementation but no significant changes in other gut health markers, short-chain fatty acids, inflammatory markers, and lipid profiles were observed. Compared with baseline, WG improved markers of glucose homeostasis including insulin (P =.02), homeostatic model assessment of insulin resistance (P =.03), glycated hemoglobin (P =.07), and the pro-inflammatory adipokine, resistin (P =.04). However, these parameters after intervention were not different with control. Our findings suggest that WG supplementation have modest effects on gut health but may provide an economical option for individuals to improve glycemic control. Daily consumption of 30 g of wheat germ supplement for 4 weeks by adults classified as overweight maintained the bacterial genus Faecalibacterium and improved several markers of glucose homeostasis including insulin, HOMA-IR, and HbA1c, and reduced the pro-inflammatory adipokine, resistin. Abbreviations: HbA1c, glycated hemoglobin; HOMA-IR, homeostatic model assessment of insulin resistance. [Display omitted] [ABSTRACT FROM AUTHOR]

To describe the rate and odds of 30-day postoperative complications among patients undergoing minimally invasive total (TH) compared to supracervical (SCH) hysterectomy for endometriosis. A cohort study of prospectively collected data. American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. Patients with a diagnosis of endometriosis undergoing hysterectomy. We compared short-term (30-day) complications, defined according to the Clavien-Dindo classification, for patients who underwent Minimally invasive TH and SCH for endometriosis. To identify the adjusted odds of postoperative complications, multivariable regression analysis, including age, race, ethnicity, BMI, medical comorbidities, ASA classification, uterine weight, concomitant procedures, and wound class, was performed. Our primary outcome was the risk of any postoperative complications according to the surgical approach. A total of 6,772 patients were included, 326 (4.8%) underwent SCH, 6,446 (95.2%) underwent TH. The two groups were comparable, however those undergoing SCH were older (41.03 years vs. 39.30 years, p < 0.001) and less often tobacco users (13.8% vs. 19.4%, p = 0.011). Total operative time was marginally shorter in the TH group (mean 133.28 minutes vs. 140.89 minutes, p = 0.050). The incidence of any complication within 30 days postoperatively was significantly lower in the SCH group compared to the TH group (3.7% vs. 8.5%, p = 0.002). Both minor complications (2.8% vs. 5.5%, p = 0.034) and major complications (1.5% vs. 3.7%, p = 0.045) were less frequent in the SCH group compared to the TH group. Minimally invasive SCH is associated with a lower rate of short-term postoperative complications when compared to TH for patients with endometriosis. Further research is warranted to explore the factors associated with lower complication risks in SCH, and the long-term outcomes and potential for re-operation for patients undergoing hysterectomy for endometriosis. [ABSTRACT FROM AUTHOR]

To determine the association between age and postoperative complications following laparoscopic hysterectomy for treatment of uterine fibroids. A cohort study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). N/A. Patients who underwent laparoscopic/robotic-assisted hysterectomy for fibroid uteri between 2012 and 2020. Total and supracervical hysterectomy. We compared postoperative outcomes according to age groups. Multivariable regression analysis adjusting for confounders was performed. Hysterectomy for uterine fibroids was performed on 63,546 patients during the study period, of which 3% were <35 years old (n=1,842), 35% were aged 35-45 years (n=22,290), 50% were aged 45-55 years (n=31,802), and 12% were aged ≥55 years (n=7,612). A post-hoc analysis comparing age group pairs across racial groups revealed that Black individuals undergo hysterectomy at younger ages (<45) compared to older ages (p<0.05). Thirty-day postoperative complications were reported in 6.8% of cases (n=4,315) of which 4.7% were considered minor and 2.6% major, according to the Clavien-Dindo classification. In multivariable regression analysis, compared to the <35 years old group, all other age groups had lower odds of minor complications [≥35-<45, aOR 95%CI 0.60 (0.49-0.73); ≥45-<55, aOR 95%CI 0.56 (0.46-0.68); ≥55 aOR 95%CI 0.46 (0.36-0.57)]. The ≥55 years group also had lower odds of major complications compared to the youngest group [aOR 95%CI 0.65 (0.47-0.89)]. When stratifying age according to the median (<46 vs. ≥46), older age was associated with a significant decrease in minor [aOR 95%CI 0.90 (0.83-0.97)] and major [aOR 95%CI 0.87 (0.78-0.96)] complications. Patients undergoing hysterectomy for uterine fibroid management at an older age exhibit a lower likelihood of postoperative complications compared to younger patients. The factors driving this trend necessitate further research. Potential factors may include disease severity which could prompt hysterectomy at younger ages. This observation is noteworthy given the disproportionately younger age at hysterectomy among Black individuals. [ABSTRACT FROM AUTHOR]

To describe the rate and odds of short-term postoperative complications among patients undergoing minimally invasive total (TH) compared to supracervical (SCH) hysterectomy for uterine fibroids. Prospective cohort study. American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. Patients with a diagnosis of uterine fibroids. Minimally invasive TH and SCH. We compared characteristics of women who underwent TH and SCH and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification. Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The primary outcome were the risks of any, minor and major postoperative complications according to surgical approach. A total of 56,740 and 6,383 patients underwent minimally invasive TH and SCH respectively. Operative time was shorter (142.45 vs. 150.55 minutes, p<0.001), and the proportion of uterine weight >250 g was lower (37.6% vs. 45.1%, p<0.001) in the TH group. The rates of any (6.9% vs. 5.3%, p<0.001), minor (4.7% vs. 4.1%, p<0.037), and major (2.7% vs. 1.6%, p<0.001) complications were higher in the TH group. In multivariable regression analysis, SCH was independently associated with lower risk of any [aOR 95% CI 0.75 (0.66-0.84)], minor [aOR 95% CI 0.86 (0.75-0.98)], and major [aOR 95% CI 0.57 (0.46-0.70)] complications compared to TH. Compared with TH, SCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. While previous studies reported comparable postoperative outcomes in both surgical approaches, data are limited and not focused on uterine fibroids as the surgical indication. The current study findings can aid in shared decision-making prior to MIS for uterine fibroids. [ABSTRACT FROM AUTHOR]

To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. Retrospective cross-sectional study. AAMC databases were queried for demographic information between 2011 and 2023. AAGL FMIGS fellows and graduates. The actual-to-expected (AE) ratio of each race, ethnicity, and sex was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based on ACGME Data Resource Books on OBGYN residents and on national information obtained from the US Census Bureau. A total of 477 fellows were in training between 2011-2023. Of those, race and ethnicity information were available in 347 (72.7%) of cases, and sex information was available in 409 (85.7%) of cases. Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p=0.027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and Asian fellows' was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)]. White fellows' representation was lower compared to OBGYN residents' distribution and general US population, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows representation was lower than expected. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology. [ABSTRACT FROM AUTHOR]

To study characteristics and identify factors associated with manuscript publication of oral abstracts presented at gynecologic surgery societies' annual meetings. A cross-sectional study. Oral abstracts from four national gynecologic surgical societies including AAGL, AUGS, SGO, and SGS. N/A. N/A. We reviewed all oral abstracts presented at four major gynecologic surgery meetings in 2018. Oral abstracts subsequently published as peer-reviewed manuscripts were compared to those that were not published. Descriptive statistical analysis and multivariable regression analyses were conducted to identify factors independently associated with peer-reviewed manuscript publication. A total of 396 oral presentation abstracts were identified: 205 from AAGL, 84 from AUGS, 79 from SGO, and 28 from SGS. The overall journal publication rate was 47.4% (188/396). The rate of publication of oral abstracts was 35.1% (72/205) for those presented at AAGL, 73.8% (62/84) for AUGS, 53.2% (42/79) for SGO and 42.9% (12/28) for SGS. In the univariate analysis, most variables were significantly associated with publication, including type of society meeting, higher number of authors, females as first and last authors, higher first and last authors' H-index, academic affiliation, higher number of study participants, randomized controlled trials, and multicenter studies. In multivariable regression analysis, the following variables were independently associated with journal publication: last author's H-index [aOR 95% CI 1.02 (1.00-1.03)], academic center affiliation [aOR 95% CI 2.29 (1.20-4.37)], and randomized controlled trials [aOR 95% CI 2.47 (1.12-5.47)]. In multivariable regression analysis including type of society meeting, AUGS presentation was associated with full-manuscript publication compared to AAGL presentation [aOR 95% CI 2.84 (1.32-6.10)]. In gynecologic surgery research, last researcher's H-index, academic affiliation, randomized controlled trial design and type of societal meeting are associated with increased odds of an oral abstract ultimately reaching manuscript peer-reviewed publication. [ABSTRACT FROM AUTHOR]

To study the trends in route for radical hysterectomy during 2021-2020, and to evaluate post-operative complications before and after the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial. Prospective cohort study. American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. Patients who underwent radical hysterectomy for cervical cancer. Minimally invasive (MIS) and laparotomy radical hysterectomy. We divided the cohort into two groups– MIS vs. laparotomy. The primary outcomes were the trends in MIS radical hysterectomy over the years and complications rate stratified by periods, before and after the publication of the LACC trial in 2018. Thirty-day postoperative complications were defined using the Clavien-Dindo classification system. A total of 2,984 patients were included, 1,453 (48.7%) underwent MIS and 1,531 (51.3%) underwent laparotomy. There was a significant increase in the MIS approach from 2012 to 2016 (45.6% to 75.3%, p<.001), and a significant decrease in MIS during 2018-2020 (50.4% to 13.5%, p<.001). Before the LACC trial 38.8% patients underwent laparotomy, and after the trial 84.7% patients underwent laparotomy (p<.001). The proportion of minor complications was lower before the LACC trial (16.9% vs. 20.4%, p=.040). Any complications or major complications proportions were comparable between groups. In a comparison of MIS vs. laparotomy during the entire study period, patients in the MIS group had lower rates of any complications (16.4% vs. 26.1%, p<.001) and minor complications (12.3% vs. 22.5%, p<.001). The rate of major complications was similar in both groups. In multivariable regression, only Non-White race was independently associated with any complications' occurrence [aOR 95%CI 1.43 (1.00-2.03)]. This study suggests that while the proportion of MIS radical hysterectomy decreased abruptly and significantly following the LACC trial, and the proportion of laparotomies increased concomitantly, there was no change in the rate of major postoperative complications. [ABSTRACT FROM AUTHOR]

Our objective was to examine the correlation between age and postoperative complications following laparoscopic hysterectomy for endometriosis. cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). N/A. Patients who underwent laparoscopic (including robotic-assisted laparoscopy) hysterectomy for endometriosis between 2012 and 2020. Laparoscopic hysterectomy for a primary indication of endometriosis. During the study period, 6,768 patients underwent hysterectomy for endometriosis, with 624 (9.2%) under 30 years old, 2,790 (41.2%) between 30 and 40 years old, 2,863 (42.3%) between 40 and 50 years old, and 491 (7.2%) aged 50 or older. Thirty-day postoperative complications occurred in 8.3% of cases (n=561), with major complications accounting for 3.6% (n=241). Multivariable regression analysis, adjusting for race/ethnicity, comorbidities, concomitant procedures performed, and uterine size, revealed a significantly lower rate of major complications in patients aged 50 or older compared to patients under 30 years old [adjusted odds ratio (aOR), 95% confidence interval (CI) 0.4 (0.19-0.84)]. The rate of any complications was also noted to be lower, [aOR 95% CI 0.56 (95% CI 0.34-0.92)]. Further analysis, relative to the median age of 39 years, underscored a significantly lower risk of major complications in patients older than 39 compared to their younger counterparts, [aOR 95% CI 0.69 (95% CI 0.53-0.90)]. There was no significant difference in the rate of minor postoperative complications between age categories. Among patients undergoing hysterectomy for endometriosis, women aged 39 or older exhibited a lower risk of major postoperative complications compared to patients under age 39. Further investigation is warranted to elucidate the underlying reasons for this observation. Possible factors to explore include the severity of the disease necessitating earlier hysterectomy among younger patients or the interplay between disease state, age, and hormonal status. [ABSTRACT FROM AUTHOR]

A rapid and efficient enzymatic procedure for the preparation of an immobilized β-galactosidase has been described. In a first step, soybean peroxidase was used to catalyze the polymerization of a strategically activated phenol ( N –Succinimidyl 3–(4–hydroxyphenyl)propionate, known as Bolton-Hunter reagent). The phenolic support was directly employed for immobilizing β–galactosidase from Bacillus circulans (ATCC 31382, β–Gal–3), giving rise to a new biocatalyst subsequently applied in the synthesis of a β–galatodisaccharide (Gal–β(1–3)–GlcNAc and Gal–β(1–3)–GalNAc). The reaction proceeded with high conversion rates and total regioselectivity. Reusability assays were performed with the same reaction conditions finding that the immobilized enzyme retains about 55% of its activity after eight batches. Finally and based on our results, the two-step enzymatic procedure presented here is a good and green alternative to the preparation of carbohydrates with biological activities. [ABSTRACT FROM AUTHOR]

To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). A retrospective cohort study. A tertiary, university affiliated medical center. We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Diagnostic and operative laparoscopy. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

To compare oncological outcomes of women with stage II -IIIc endometrial cancer (EC) who underwent minimally invasive surgery (MIS) versus laparotomy. A retrospective cohort study. Academic multi-center. Consecutive women with EC treated at 11 Israeli institutions between 2002 and 2017 were recorded in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with stage II -IIIc were stratified into groups by intentional route of surgery; MIS vs. laparotomy. Clinical, pathological and outcome data were compared. MIS and laparotomy. Three hundred and four women met criteria: 200 underwent laparotomy and 104 MIS. Women in the MIS group were younger, had lower rate of diabetes and lower CA-125 level. Women who underwent laparotomy had higher grade EC and more advanced stage disease; Odds Ratio (OR) and 95% Confidence Interval (CI) 0.34 (0.21-0.56) and 0.56 (0.34-0.92), respectively. Brachytherapy rate was comparable between groups (p=0.715). In a multivariable analysis, including age, comorbidities, disease stage, tumor grade and lymph-vascular space invasion, MIS was not associated with an increased risk for recurrence, progression or decreased overall survival. However, patients operated by MIS had higher risk to recur locally (vaginal cuff or pelvic) (26.9% vs. 16.5%, p=0.032, OR, 1.86, 95% CI 1.05-3.30). MIS was the only independent factor associated with local recurrence, adjusted OR, 2.09, 95% CI 1.12-3.90. In women with stage II-IIIc EC, MIS was associated with an increased risk for local recurrence compared to laparotomy. [ABSTRACT FROM AUTHOR]

To study the collateral effect of the actions taken to limit the spread of the COVID-19 pandemic by comparing the characteristics and outcomes of women who underwent laparoscopy for suspected adnexal torsion (AT) during the pandemic to pre-pandemic periods. A retrospective cohort study. A tertiary, university affiliated medical center. We included all women who underwent laparoscopy for suspected AT between March 2011 and February 2021. We compared the COVID-19 pandemic period, beginning at the first lockdown in Israel (March 15 2020, to February 8 2021, group 1) to a parallel period in 2019-2020 (group 2) and to a nine years period preceding the pandemic, between 3/2011-2/2020 (group 3). Diagnostic and operative laparoscopy. Ninety-seven laparoscopies were performed in group 1, 82 in group 2, and 635 in group 3. Groups 1 and 2 were comparable in age, obstetrical history, sonographic characteristics of adnexa and clinical presentation. The rate of women presenting following IVF treatment was lower in group 1 [OR 95% CI 0.22 (0.06-0.86), p<0.023]. Time from admission to decision to operate was shorter in group 1 (162 vs. 232 minutes, p=0.028). In the comparison between groups 1 and 3, baseline characteristics were comparable. The rate of women presenting following IVF treatments was lower [OR 95% CI 0.15 (0.04-0.49), p<0.001], the time from admission to surgery was shorter (544 vs. 748 minutes, p=0.005), and the rate of surgically confirmed AT was lower [59 (60.8%) vs. 455 (71.7%), p=0.030, OR (95% CI) 0.61 (0.39-0.95)] in group 1. Our data underline differences in the time from admission to surgery during the COVID-19 pandemic, and in the rate of women presenting with suspected AT following IVF treatments. These findings may reflect a change in medical resources during the pandemic. [ABSTRACT FROM AUTHOR]

Highlights: [•] Pre-pubertal and adult dentate gyrus shows differences in intrinsic excitability and local circuit activity. [•] The effects of stress on dentate gyrus functioning are age-dependent and sex-dependent. [•] Sex is an important parameter in the sensitivity to stress of the dentate gyrus local circuit. [•] Interactive age/sex/stress effects on the dentate gyrus underlie its role in hippocampal function. [ABSTRACT FROM AUTHOR]

Highlights: [•] The basal, not the lateral nucleus of the basolateral amygdala modulates plasticity in the dentate gyrus. [•] Characteristics of basal amygdala modulation of hippocampal plasticity depend on intensity of activation. [•] These variations may explain the dual effects of stress on aspects of memory. [ABSTRACT FROM AUTHOR]

To develop a predictive score for pre-operative adnexal torsion diagnosis. A retrospective cohort study between 2011 and 2020. A tertiary, university affiliated medical center. Overall, 546 women with 615 separate episodes of suspected adnexal torsion. Diagnostic laparoscopy. We collected clinical characteristics, sonographic findings and laboratory results of suspected adnexal torsion episodes. We compared those who had adnexal torsion confirmed in laparoscopy (72%) and those who had adnexal torsion ruled out (28%). Pregnancy and assisted reproductive technology treatments were more common in the confirmed torsion group [OR 95% CI 2.3(1.46-3.71), P <0.001, and 4.24(2.21-8.13), P<0.001 respectively], while previous pelvic surgery was less common [OR 95% CI 0.54(0.37-0.77), P=0.001]. More patients in the confirmed torsion group appeared painful on admission [OR 95% 2.37(1.64-3.42), P<0.001], were more likely to have visual analogue score > 7 [OR 95% CI 1.95(1.36-2.80), P=0.001] and to experience vomiting [OR 95% CI 2.53 (1.68-3.81) P<0.001]. On ultrasound scan, an enlarged ovary [OR 95% CI 2.36(1.62-3.44), P<0.001], a higher maximal diameter of affected adnexa (P<0.01) and absent doppler flow [OR 95% CI 1.83(1.01-3.30) P=0.04] were more common in the confirmed torsion group. Neutrophils to Lymphocytes ratio (NLR) above 3.5 was more common in the confirmed torsion group [OR 95% CI 2.09 (1.42-3.07) P<0.001]. On multivariate regression analysis, vomiting, NLR>3.5 and enlarged ovary finding in ultrasound scan were independently associated with adnexal torsion [OR 95% CI 2.78(1.21-6.36), 3.15(1.42-6.97) and 2.80(1.33-5.88) respectively]. Considering a basal rate of 50% for adnexal torsion if clinical suspicion was raised, the rate of torsion was 69.7% with one, 84.4% with two, and 93.1% with three predicting factors present. Our predictive score may improve pre-operative adnexal torsion diagnosis and reduce rates of unnecessary laparoscopies. [ABSTRACT FROM AUTHOR]

To develop a risk score for surgically proven recurrent adnexal torsion (rAT), among women with a previous adnexal torsion proven surgically. A retrospective cohort study between 2011 and 2020. A tertiary, university affiliated medical center. All women with a history of surgically confirmed adnexal torsion, who underwent surgical diagnostic procedure due to a suspected rAT. Overall, 115 women were included. Operative laparoscopy. We collected demographic and clinical characteristics, sonographic findings and laboratory results of all suspected rAT cases that subsequently underwent surgery. We compared cases with adnexal torsion to cases without, as confirmed by operative laparoscopy. Adnexal torsion was identified in 86 (74.8%) of the surgical procedures. Age and pregnancy rates were similar in both groups. Women with adnexal torsion had less prior pelvic surgeries (excluding prior adnexal torsion) [OR(95%CI) 0.24(0.09-0.59), p=0.001], prior oophoropexy [OR(95%CI) 0.36(0.13-0.97), p=0.04] or right adnexal tenderness [OR(95%CI) 0.21 (0.08-0.52), p<0.001] on physical examination. The proportion of virgin women [OR(95%CI) 7.41(0.94-58.2), p=0.04], pregnancies following assisted reproductive technology [OR(95%CI) 4.6(1.01-21.12), p=0.03] and enlarged ovaries [OR(95%CI) 2.88(1.15-7.21), p=0.02] was higher in the adnexal torsion group. The affected ovary's size was significantly larger in the torsion group (p=0.001). After multivariate analysis, four risk factors remained significantly independently associated with adnexal torsion. Previous pelvic surgery [aOR(95%CI) 0.06(0.007-0.54), p=0.01] and right side pain [aOR(95%CI) 0.05(0.008-0.33), p=0.002] were negatively associated with adnexal torsion. A larger maximal diameter of the affected ovary [aOR(95%CI) 1.78(1.08-2.93), p=0.02] and enlarged ovary [aOR(95%CI) 7.40(1.28-42.59), p=0.02] were positively associated with adnexal torsion. Our risk score enables to predict a true positive rAT that may assist clinicians in decision management in cases of suspected rAT. [ABSTRACT FROM AUTHOR]

To develop a risk score calculator for the prediction of adnexal torsion during pregnancy. A retrospective cohort study between 3.2011-4.2020. Tertiary medical center. All women who underwent surgical diagnostic procedure due to suspected adnexal torsion in pregnancy. Overall, 156 women were included. Operative laparoscopy. We collected demographic and clinical characteristics. The presence or absence of adnexal torsion during the surgical procedure was recorded. Adnexal torsion was identified in 131 (83.9%) of the surgical procedures. The rate of previous ovarian torsion was lower in the torsion group [OR(95%CI) 0.29(0.11-0.79), p=0.01]. Pregnancy following assisted reproductive technology (ART) was more common in the torsion group [OR(95%CI) 7.0(1.99-24.54), p<0.001]. Reported left sided pain was lower in the torsion group [OR(95%CI) 0.41(0.17-0.97), p=0.04], while duration of symptoms <8 hours was higher [OR(95%CI) 7.31(1.65-32.43), p=0.002], as was pain score (0-10) (mean 8.5 vs. 7.2, p=0.007). On physical examination, women appeared in more pain in the torsion group, had more peritoneal irritation, and less left adnexal tenderness [OR(95%CI) 4.34(1.74-10.8), p=0.001; 4.59(1.67-23.23), p=0.02; 0.27(0.11-0.66), p=0.003, respectively]. In blood analysis, white blood cells concentration was higher in the torsion group (11.3 vs. 9.9 K/microL, p=0.01), as was the neutrophils to lymphocytes ratio (3.4 vs. 2.5, p=0.01) and the maximal diameter of the affected ovary (70 vs. 55 mm, p=0.02). After multivariate analysis, three risk factors remained significantly independently associated with ovarian torsion; previous ovarian torsion was negatively associated [aOR(95%CI) 0.24(0.04-0.80), p=0.03], while ART and women that appeared in pain were positively associated [aOR(95%CI) 9.8(2.22-43.6), p=0.003; 3.8 (1.23-12.18), p=0.02, respectively]. Calculated risk for adnexal torsion was 0%, 68.2%, 90.4% and 100% in the presence of 0, 1, 2 and 3 risk factors respectively. Our risk score calculator may assist clinicians in the prediction of adnexal torsion during pregnancy. [ABSTRACT FROM AUTHOR]

We have used frequency-dependent inhibition, a form of short-term plasticity mediated by the activation of inhibitory interneurons, to characterize in vivo alterations in local circuit activity and plasticity in the dentate gyrus of the anesthetized rat. The application of the GABA-A receptor blocker, bicuculline, induced a transient reduction in frequency-dependent inhibition, indicating that this form of local circuit activity is GABA-mediated. Delivering theta burst stimulation to the perforant pathway of the hippocampus induced long-term potentiation of the population excitatory post-synaptic potential, reflecting the potentiation of the perforant path-dentate gyrus granule cell synapses. Concomitantly, theta burst stimulation caused a lasting reduction in frequency-dependent inhibition. In aged rats, long-term potentiation could be induced to the same level as in young rats, but while in young rats frequency-dependent inhibition was concomitantly reduced, frequency-dependent inhibition in the old rats did not show this form of plasticity.Our results indicate that theta burst stimulation induces a form of local circuit plasticity independently of its known capacity to induce synaptic plasticity, and that this form of local circuit plasticity is compromised in aging. Based on these results we propose a potential role for plasticity at the level of the local circuit in learning and memory. [Copyright &y& Elsevier]

To demonstrate the feasibility of inguinal sentinel lymph node detection in recurrent vulvar melanoma using ICG fluorescence technique. Radical local excision and sentinel lymph node biopsies for recurrent vulvar melanoma. The injection of ICG tracer was followed by visualization of sentinel lymph nodes using an Image1 S Rubina system (Karl Storz, Germany). Tertiary hospital. one patient, 17 months after primary surgical excision and sentinel lymph biopsy for vulvar malignant melanoma. Injection of ICG tracer around the border of the lesion. Bilateral sentinel nodes were successfully identified and removed. Detection of sentinel lymph nodes in recurrent vulvar melanoma is feasible. ICG tracer can be considered for sentinel mapping in recurrent vulvar cancer. [ABSTRACT FROM AUTHOR]

To compare oncological outcomes of women with high-grade endometrial carcinoma (HGEC) who underwent surgery by minimally invasive surgery (MIS) versus laparotomy. A retrospective cohort study. Academic multi-center. Consecutive women with HGEC cancer treated at 11 Israeli institutions between 2002 and 2017 were accrued in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with HGEC were stratified into two groups by route of surgery; MIS vs. laparotomy by an intention to treat. Clinical, pathological and outcome data were compared. MIS and laparotomy. Six hundred and seventy-eight women met the inclusion criteria: 160 underwent MIS and 518 laparotomy. The two groups were comparable in demographic and clinical characteristics. Local recurrence was more common in the MIS group, Odds Ratio (OR) 95% Confidence Interval (CI) 2.80 (1.80-4.36). Disease progression rates were comparable (p=0.537). In a multivariable analysis, including age, comorbidities, disease stage, CA-125 and lymph-vascular space invasion, MIS was not associated with an increased risk for either overall recurrence rate, disease progression, or overall survival. Independent risk factors for local recurrence were diabetes, stage III-IV, LVSI and MIS, adjusted OR 95% CI 3.30 (1.69-6.48). In women with HGEC, MIS is associated with higher rates of local recurrence as compared to laparotomy. [ABSTRACT FROM AUTHOR]

We aimed to investigate the predisposing factors for recurrent ectopic pregnancy (REP) following single-dose methotrexate (MTX) treatment. A retrospective cohort study. A tertiary medical center. All patients diagnosed with a first EP and treated by intention of single-dose regimen of intramuscular MTX. Cases (REP) and controls (first-time only EP) were compared in order to identify risk factors for REP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. 272 women were included in the cohort of the study. Of those 22 (8.1%) had a REP. Women in the REP group had higher proportion of history of abortions (45.4% vs. 23.6%, p=0.02), higher rates of previous pelvic surgery and a history of both pelvic and uterine surgery (45.4% vs. 6.4%, 4.5% vs. 1.6%, respectively, p<0.001). Conception by assisted reproductive technology (ART) was more common among the non REP group (22.9% vs. 4.5%, p=0.04). Success of single-dose MTX treatment was lower in the REP group compared to the non REP group (36.3% vs. 65.7%, p=0.006). A history of prior pelvic surgery was independently associated with the occurrence of a REP (OR 17.6, 95% CI 4.9-63.1, p=0.001). Treatment success of single-dose MTX was independently protective for REP (OR 0.25, 95% CI 0.08-0.76, p=0.02). Among women with EP, attention should be paid to women with previous pelvic surgery. Efforts should be made in order to achieve medical treatment success to prevent REP. [ABSTRACT FROM AUTHOR]

The role of conservative management of CSP has been previously reported with conflicting results reported. In this retrospective study, we aimed to further evaluate its role and better delineate the subsequent reproductive outcomes A retrospective cohort study. A large university hospital (Hadassah Medical Center Hospitals, Israel, Jerusalem) between November 2014 to April 2017 All patients diagnosed with a CSP and treated by intention of conservative management with systemic methotrexate (MTX). A comparison of maternal and gestation characteristics was performed between treatment success and failure groups Thirty seven cases of CSP were encountered. Overall, 29/37 (78.3%) were treated by systemic injection of MTX while the other 21.7% had combined systemic and local (i.e. intra-sac) MTX treatment. Invasive intervention was needed in 5 (13.5%) cases (failure group). Cases who were converted to surgical treatment had higher number of previous cesarean deliveries (median 4 vs. 2, p=0.002). In logistic regression modeling, the number of prior cesarean deliveries in the past was the only factor found independently associated with conversion to surgical management Odds Ratio 2.02, 95 % Confidence Interval 1.03,3.94. Majority of future pregnancies had term pregnancy with one preterm delivery due to severe intrauterine growth restriction Systemic MTX therapy is a safe and effective strategy for the treatment of CSP with favorable subsequent reproductive results and a low conversion rate for surgical management. Patients with high order of previous cesarean deliveries should be considered for early surgical treatment rather than a medical one. [ABSTRACT FROM AUTHOR]

Tubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA. A retrospective cohort study. A tertiary university-affiliated hospital during 2007-2018 Ninety one patients were diagnosed with a TOA and underwent a trial of conservative management with intravenous antibiotics. Patients who eventually underwent surgical intervention were compared with patients managed conservatively. Overall, 39/91 (42.8%) underwent an invasive intervention subsequent to failed antibiotic treatment. Patients who experienced conservative treatment failure had higher medians of inflammatory markers as CRP (15.7 vs. 10.8 mg/L, p=0.02), WBC count (14.2 vs. 12.4 1,000/mm3, p=0.04) and platelet count (374 vs. 295 109/L, p=0.04) at admission. Higher levels of CA-125 at admission were found in those who required an invasive intervention (57 vs. 30 U\ml, p=0.02) as well. The largest diameter of TOA at admission was higher in those who required an invasive intervention as compared to those who were successfully treated conservatively ((75 mm. vs. 57 mm, p=0.01). CA-125 level was found to be the only independent factor associated with conservative treatment failure (OR; 95% confidence interval [CI], 1.27, 1.08-1.48, p=0.03). Elevated CA-125 serum levels were found to be associated with failure of conservative parenteral antibiotic therapy for TOA. This finding should be better evaluated in a prospective manner. [ABSTRACT FROM AUTHOR]

To compare the clinical characteristics and sonographic findings of adnexal torsion between pregnancy trimesters. A retrospective cohort study between 2011 and 2020. A tertiary, university affiliated medical center. Overall, 122 pregnant women with 131 separate episodes of surgically proven adnexal torsion. Laparoscopy for confirmation and treatment of adnexal torsion. We collected demographic and clinical characteristics as well as sonographic findings and laboratory results of all adnexal torsion episodes. We compared the three trimesters of pregnancy. Overall, 92 of the episodes occurred during 1st trimester, 29 and 10 occurred during 2nd and 3rd trimester, respectively. The majority of cases were right sided (61%). Pregnancy achieved following assisted reproductive technology (ART) was more common in the 1st trimester group (p<0.001). Visual analogue scale score of >6 was more common in 1st and 3rd trimester, compared to 2nd trimester (p=0.02). Gastrointestinal symptoms were also more common among patients in the 1st trimester (p<0.007). The mean diameter of affected adnexa was similar in all trimesters, while the non-affected adnexa was marginally significantly smaller in the 2nd and 3rd trimesters. In approximately one third of all cases ultrasound findings included at least one specific feature: edematous ovary, absent doppler flow or presence of whirlpool sign. Absent doppler flow was more common in the 2nd and 3rd trimester compared to the 1st trimester (p<0.03), and the presence of ovarian teratoma was more common in the 2nd and 3rd trimesters, compared to the 1st (p=0.05). Duration from admission to surgery was significantly longer in the 2nd and 3rd trimesters (p=0.002). We found differences in the clinical, sonographic and laboratory manifestations of adnexal torsion in each trimester of pregnancy. When assessing pregnant patients with suspected adnexal torsion, these differences may assist in ameliorating an accurate diagnosis. [ABSTRACT FROM AUTHOR]

To investigate the predisposing factors for recurrent adnexal torsion (rAT) in patients who had surgical intervention for primary adnexal torsion (pAT). A retrospective cohort study between 2011 and 2020. A tertiary, university affiliated medical center. 358 women with a primary occurrence of surgically proven adnexal torsion. Adnexal detorsion, with adjuvant cystectomy, salpingectomy or salpingoophorectomy by laparoscopy. We collected demographic and clinical characteristics, sonographic findings and laboratory results of all pAT episodes. We compared those who had experienced rAT to those who had not. The study included 358 women. Of those, 35 (9.8%) had a rAT. Women who experienced rAT were younger (mean age 26 vs. 30, p=0.01) with higher proportion of age ≤15 [Odds Ratio (OR) 95%CI 4.4(1.80-11.1)]. A history of hysterectomy was positively associated with rAT [3(8.6%) vs. 1(0.3%), p=0.003]. Pregnancy rates during pAT were comparable between study groups. However, rAT was associated with lower gestational age at pAT (mean 9 weeks vs. 12 weeks, p=0.01) and conception by assisted reproductive technologies [OR 95%CI 6.0(1.21-29.65), p=0.02]. Clinical characteristics did not differ between groups except smaller ovarian cyst diameter in those with rAT (mean 42 vs. 59 mm. p<0.001). Laparoscopic detorsion alone was associated with rAT [OR 95%CI 2.13 (1.02-4.42), p=0.03], while a performance of cystectomy was negatively associated with rAT [OR 95% CI 0.10 (0.01-0.79), p=0.006]. On multivariate regression analysis, only age ≤15 and cyst diameter were independently associated with the risk for rAT [aOR 95% CI 5.0(1.09-23.2) and 0.68(0.50-0.93), for each 10 mm increase of cyst diameter, respectively]. Recurrent adnexal torsion is more common than previously thought. Younger age and smaller ovarian cyst at pAT are independently associated with the risk for future recurrence of adnexal torsion. These factors should be considered when contemplating oophoropexy at pAT. [ABSTRACT FROM AUTHOR]

To investigate the effectiveness of single dose methotrexate (MTX) regimen in cases of cesarean scar pregnancy (CSP). A retrospective cohort study of all CSPs from a tertiary medical center between the years 2011-2019. Conservative management included treatment with systemic MTX with ultrasound (US) guided needle aspiration of the gestational sac in the presence of fetal heartbeat. We divided the cohort into two groups: women that were treated according to the conservative protocol, and women treated with additional curettage or hysteroscopy. Maternal and gestational characteristics were compared between the groups. N/A The final study cohort included 32 women diagnosed with CSP and treated according to the conservative protocol. N/A 16(47.1%) women underwent additional US guided needle aspiration. Nineteen patients(59.4%) had a successful conservative treatment. Baseline maternal characteristics were similar in both groups. There was no difference between the two groups in the time from last cesarean delivery(25 month vs 32, respectively, p=0.31), gestational age(47 vs 49 days respectively, p=0.63), gestational sac size(23 vs. 21 mm, respectively, p=0.54), level of βHCG at presentation(17049 vs. 18612, respectively, p=0.77), or evidence of fetal heart beat(48% vs. 54%, respectively, p=0.71). The presence of gestational sac hematoma upon admission was identified as a negative predictive factor for successful conservative management(5.3% vs 38.5%,OR [95%CI] 11.2, (1.1-112.5),p=0.02). Single dose MTX is an effective mode of treatment in cases of CSP. The presence of a gestational sac hematoma on US was identified as a negative predictor for successful conservative treatment of CSP. No other predictive factors were identified. [ABSTRACT FROM AUTHOR]

To assess the outcome of the treatment of cesarean scar pregnancy (CSP) with single dose methotrexate (MTX-SD) versus multiple dose MTX (MTX-MD) protocols. A retrospective cohort study from two tertiary medical centers between the years 2011-2019. N/A The study cohort included all CSPs cases from the two centers. 32 women in the MTX-SD and 32 women in the MTX-MD groups. MTX-SD, practiced in one medical center, included a single dose of systemic MTX-SD followed by ultrasound guided needle aspiration of the gestational sac in cases with fetal heartbeat. MTX-MD, practiced in the other medical center, included four consecutive doses of MTX, and local KCL in cases with fetal heartbeat. Characteristics and outcomes were compared between both groups. Baseline characteristics did not differ between groups. In the MTX-SD group, the median dose number was one, versus three in the MTX-MD group. In 16 (50%) of the cases of the MTX-SD and in 12 (37.5%) of the cases of the MTX-MD, fetal heartbeat was present and US guided aspiration or KCL injection were performed, respectively. There was no significant difference between the MTX-SD and the MTX-MD groups in total days of admission (17±9.3 vs. 17±12.8 days respectively, p=0.94), need for invasive procedures (12.5% vs. 18.7% respectively, p=0.24), readmission rate (31.3% vs. 21.9% respectively, p=0.39) and need of blood products (15.6% vs. 3.1% respectively, p=0.19). Both MTX-SD and MTX-MD protocols offer high success rate with a relatively low complication rate in the treatment of CSP, with no significant differences between groups. [ABSTRACT FROM AUTHOR]

We aim in our study to evaluate whether there is a significant difference between women presenting with primary tubal ectopic pregnancy (EP) or recurrent ectopic pregnancy (REP) that are treated medically with methotrexate (MTX). A retrospective cohort study. A tertiary medical center during 2010-2018. All patients diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. Cases (REP) and controls (first-time only EP) were compared. 262 patients had primary EPs and 32 had a REP. Women with REP had significantly higher gravidity order and higher incidence of previous abortions (5 vs. 3, median, p<0.001, 59.3% vs. 32.8%, p<0.001, respectively). Women with REP had a higher proportion of a history of previous surgery in general, and specifically pelvic surgery (46.8% vs. 20.6%, p<0.001, 24.4% vs. 7.2%, p<0.001, respectively). Treatment success was lower in the REP group (40.6% vs. 66.4%, p=0.006). The only preoperative determinant independently associated with REP was higher gravidity) Odds Ratio 1.22, Confidence Interval 1.03-1.46, p=0.02. Our study suggests that while women with REP may not represent a unique sub-group of women with EP, medical treatment success with a single-dose regimen of MTX is lower than expected and hence different regimens should be considered. [ABSTRACT FROM AUTHOR]

The use of intraoperative sonographic guidance for second trimester elective dilation and curettage (D & E) procedure reduces the incidence of uterine perforation. Nevertheless, the role of intraoperative sonographic guidance during curettage procedure following second trimester medical induction has not been evaluated. We aim to evaluate the effect of intraoperative sonographic guidance during curettage procedure following second trimester uterine evacuation. A retrospective cohort study. A Gynecology department at a tertiary university‐affiliated medical center. Patients undergoing second trimester medical induction up to 23 6/7 weeks estimated gestational age who underwent uterine curettage after delivery of the fetus. Women undergoing curettage procedure under continuous ultrasound guidance were compared with those undergoing curettage without ultrasound guidance. One hundred ninety four patients underwent a curettage without intraoperative sonographic guidance, while 79 underwent the procedure utilizing intraoperative sonographic guidance. The overall rate of composite adverse outcome was higher among those undergoing curettage under intraoperative sonographic guidance as compared with no sonographic guidance (39.2% vs. 20.6%, P=0.002). Placental morbidity (12.6% vs. 5.6%, P=0.04) and infectious complications (7.5% vs. 2.5%. P=0.05) were more frequent among those undergoing curettage using intraoperative sonographic guidance. In a multivariate logistic regression analysis, intraoperative ultrasound guidance was the only independent factor positively associated with an adverse outcome (P=0.001). Procedure time was longer when ultrasound guidance was used; 9:52 min. vs. 6:58 min. (P<0.001). Intraoperative ultrasonography guidance during curettage after second trimester uterine evacuation is associated with a higher complication rate than no guidance. [ABSTRACT FROM AUTHOR]

Several studies have tried to identify early markers for treatment outcome after methotrexate (MTX) treatment for an ectopic pregnancy (EP) including pretreatment and day 4 hCG levels and corresponding ratio, and hCG increment during the initial 24 hours following treatment, with conflicting results. We aim to re‐evaluate the role the aforementioned markers in the earlier identification of treatment success in a large cohort of women. A retrospective cohort study. A tertiary medical center during 2010-2018. All women diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. A comparison of maternal and gestation characteristics was performed between treatment success and failure groups. 292 women treated with single-dose intramuscular MTX for EP during were included in this study. Treatment success rate with a single dose of MTX of the overall cohort was 62.7% (183/292). Only two independent determinants were significantly associated with the treatment success: initial 24 hours hCG percentage of increment (adjusted odds ratio [OR]: 1.82; 95% confidence intervals [CI]: 1.26, 2.63; p < 0.001) and percentage hCG change in day 1 to 4 (adjusted odds ratio [OR]: 1.12; 95% confidence intervals [CI]: 1.02, 1.21; p < 0.001). The optimal cut-off points for prediction of treatment success are increment of less than 17% in pre-treatment 24 hours and a decrease of more than 22% in day1-4 hCG. A low rise in hCG levels 24 hours prior to treatment with MTX, alongside a decline in hCG levels from day 1 to day 4 may predict success of medical treatment of EP. [ABSTRACT FROM AUTHOR]

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune condition often presenting in the form of a neuropsychiatric disorder. Ovarian dermoid cyst has been described as a possible instigator of this state with surgical therapy often leading to substantial clinical improvement. We aim to describe our hospital's experience and highlight the importance of ultra sound in the diagnosis and treatment of Anti-NMDAR encephalitis. A case series. All women were treated at the gynecology department of a tertiary teaching hospital between January 2013 and December 2018. We describe 3 cases of anti-NMDAR encephalitis. In the first case a 33 y/o woman presented with headaches, dizziness, and seizures for the first time in her life and later, developed aphasia. In the second case, a 37 y/o woman was referred to the emergency room with acute confusion, delusions and hallucinations and in the third case, a 32 y/o woman appeared with psychosis and seizures. All three were diagnosed with ANTI NMDA antibodies and an ultrasound examination revealed a dermoid cyst ranging from 1 to 4 cm, and in one case the cyst was not detected by CT-scan. All women underwent ovarian resection and continued immunosuppressive medical therapy with gradual improvement in their condition. We show that even small dermoid cysts may evoke antibody titer rise emphasizing the importance of performing early gynecologic ultrasound for women with new-onset encephalitis. ANTI-NMDAR encephalitis caused by dermoid cyst is an important entity which can easily go misdiagnosed. Early cystectomy or ovarian resection and immunosuppressive treatment are key elements in the management of such cases. [ABSTRACT FROM AUTHOR]

An abstract of the article "Amygdala Modulation of Memory-Related Processes in the Hippocampus: Potential Relevance to PTSD," by M. M. Tsoory and colleagues is presented.