Effect of Polyphenol Supplementation on Memory Functioning in Overweight and Obese Adults: A Systematic Review and Meta-Analysis.

Negative health consequences of obesity include impaired neuronal functioning and cell death, thus bringing the risk of impaired cognitive functioning. Antioxidant properties of polyphenols offer a possible intervention for overweight people, but evidence for their effectiveness in supporting cognitive functioning is mixed. This review examined evidence from randomized controlled trials concerning the effect of polyphenols on tasks requiring either immediate or delayed retrieval of learned information, respectively, thus controlling for differences in cognitive processes and related neural substrates supporting respective task demands. Searches of the PubMed/Medline, PsycInfo, and Scopus databases identified 24 relevant primary studies with N = 2336 participants having a BMI ≥ 25.0 kg/m2. The participants' mean age for the 24 studies exceeded 60 years. Respective meta-analyses produced a significant summary effect for immediate retrieval but not for delayed retrieval. The present findings support a potential positive effect of chronic supplementation with polyphenols, most notably flavonoids, on immediate retrieval in participants aged over 60 years with obesity being a risk factor for cognitive impairment. We recommend further investigation of this potential positive effect in participants with such risk factors. Future research on all populations should report the phenolic content of the supplementation administered and be specific regarding the cognitive processes tested.

Polyphenol supplementation and executive functioning in overweight and obese adults at risk of cognitive impairment: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Increasing evidence indicates a link between obesity and cognitive impairment. Furthermore, there is limited literature regarding the effect of polyphenols, a plant derived compounds, on executive functioning in an overweight/obese population at-risk of cognitive impairment. The aim of the present systematic review and meta-analysis of randomized controlled trials is to examine the effect of polyphenol supplementation on executive functions in overweight and/or obese populations at risk of cognitive impairment. METHODS: A comprehensive literature search was conducted from inception to March 2023 using four electronic databases: PubMed/Medline, PsycInfo, Scopus and Cochrane trials library. Published primary research studies in English that compared the effect of polyphenols with placebo on executive function in overweight/obese adults were considered eligible for the meta-analysis. Jadad scale was used for the methodological quality rating of the included studies. Hedges g with 95% confidence intervals (CI) for endpoints were calculated using random effect model where applicable. Rosenthal's Fail-safe N, funnel plots, the Begg and Mazumdar's rank correlation test (Kendall's S statistic P-Q), Egger's linear regression test, and Duval and Tweedie's trim-and-fill test were identified for potential use as appropriate, to examine publication bias. Sensitivity analysis was conducted to examine the robustness of the results. RESULTS AND CONCLUSION: A total of 23 RCT studies involving N = 1,976 participants were included in the review. The results of the meta-analysis revealed a non-significant effect for polyphenol supplementation on executive function (g = 0.076, CI = -0.018 to 0.170). Observations from primary studies within the meta-analysis showed a potential positive effect of polyphenol supplementation in a younger population at-risk of cognitive impairment and it is recommended to investigate this further in future studies. Moreover, the variability of the tasks used to examine executive functions as well as the adequate reporting of supplement's phenolic composition is a limitation that future work should also consider.

Polycystic Ovary Syndrome Detection Machine Learning Model Based on Optimized Feature Selection and Explainable Artificial Intelligence.

Polycystic ovary syndrome (PCOS) has been classified as a severe health problem common among women globally. Early detection and treatment of PCOS reduce the possibility of long-term complications, such as increasing the chances of developing type 2 diabetes and gestational diabetes. Therefore, effective and early PCOS diagnosis will help the healthcare systems to reduce the disease's problems and complications. Machine learning (ML) and ensemble learning have recently shown promising results in medical diagnostics. The main goal of our research is to provide model explanations to ensure efficiency, effectiveness, and trust in the developed model through local and global explanations. Feature selection methods with different types of ML models (logistic regression (LR), random forest (RF), decision tree (DT), naive Bayes (NB), support vector machine (SVM), k-nearest neighbor (KNN), xgboost, and Adaboost algorithm to get optimal feature selection and best model. Stacking ML models that combine the best base ML models with meta-learner are proposed to improve performance. Bayesian optimization is used to optimize ML models. Combining SMOTE (Synthetic Minority Oversampling Techniques) and ENN (Edited Nearest Neighbour) solves the class imbalance. The experimental results were made using a benchmark PCOS dataset with two ratios splitting 70:30 and 80:20. The result showed that the Stacking ML with REF feature selection recorded the highest accuracy at 100 compared to other models.

Diagnostic and Prognostic Role of Serum Omentin and NGAL Levels in Egyptian Breast Cancer Patients.

Background: Breast cancer (BC) is globally the main cause of cancer-related deaths in women. Tumor biomarkers have significant role in diagnosis and predicting the prognosis and decide the specific therapy to each patient. Aim: In this study, we investigated whether omentin and NGAL levels were altered in patients with breast cancer and the relationship between these markers and their clinicopathological parameters. Subjects and Methods. This study included 120 patients with breast cancer and 30 healthy individuals served as controls. We measured the serum level of omentin and NGAL by ELISA technique. Results: Our results showed that there were statistically significant differences in serum omentin and NGAL levels between two groups. Also, in breast cancer patients, there was significant difference between omentin level, the same results with NGAL level and patient's age, tumor size, lymph node, and metastasis. No significant relationship was found between omentin level and tumor grade, ER, PR, and HER2. The cutoff value for the prediction of breast cancer was determined at >113.2 ng/ml for omentin and >145.3 ng/ml for NGAL with a sensitivity of 91.7% and 100%, specificity of 100% and 80%, positive predictive value of 100% and 90.9%, negative predictive value of 85.7% and 100%, and accuracy of 94.4% and 93.3%, respectively. In conclusion, serum omentin and NGAL can be used as strong diagnostic markers for breast cancer.

Social media utilization, preferences, and patterns of behavior in patients with gynecologic pelvic pain.

BACKGROUND: Social media is increasingly becoming a health resource for people suffering from complex and debilitating health conditions. A comprehensive understanding of how and why social media and the Internet are used among patients with chronic gynecologic pain will allow for the intentional development and incorporation of web-based tools into patient care plans. OBJECTIVE: This study aimed to determine whether gynecologic patients with pain are more likely to use social media and the Internet to understand and manage their condition than those without pain. The survey was designed to explore how gynecologic patients with and without pain use and interact with social media and other web-based health resources and the clinical, personal, and demographic factors influencing these behaviors. STUDY DESIGN: Patients presenting with a new complaint to a gynecologist at 1 of 6 Fellowship in Minimally Invasive Gynecologic Surgery-affiliated hospital systems were screened, consented, and assigned to pain and no-pain groups. Participants were surveyed about social media and Internet use, symptoms, bother, physician selection, motivation, trust, and demographic information. Survey responses were compared using the Fisher exact tests, odds ratios, and risk ratios from standard tabular analysis, univariate or multivariate tests of means, and regression analyses, as appropriate. RESULTS: Of 517 participants included in the study, 475 (92%) completed the survey, 328 (69.1%) with pain and 147 (30.9%) without pain. Study participants in the pain group reported more than double the odds of using social media than those without pain (37.8% vs 19.7%; odds ratio, 2.47; 95% confidence interval, 1.54-3.96) and triple the odds of using the Internet (88.4% vs 69.4%; odds ratio, 3.37; 95% confidence, 2.04-5.56) to understand or manage their condition. Participants with pain were more likely than those without pain to engage in social media at a higher level (3.5 vs 1.7 on a scale of 0 to 10; P<.0001), be motivated by interpersonal elements of online engagement (Hotelling's T2=37.3; P<.0001), prefer an interactive component to their online health resource (35.6% vs 24.3%; risk ratio, 1.46; 95% confidence interval, 1.00-2.20; P=.0433), be influenced by others in their choice of a gynecologist (0.37 vs 0.32 on a scale of 0 to 1; P=.009), use social media as a coping tool (38.3% vs 17%; P=.0001), trust information found on social media (31.4% vs 16.7%; P=.0033), and trust other women with the same condition, informal health resources, and personal sources more and doctors and formal health resources less (P=.0083). Participants in both groups reported higher levels of social media engagement with higher levels of symptom bother (28% increase in engagement with every doubling of bother level (P<.0001). CONCLUSION: Patients with gynecologic pain were more likely than those without pain to use social media and the Internet to understand and manage their condition. Patients with pain engaged in and trusted social media at a higher level, with engagement rising directly with bother level.

Postoperative Urinary Retention Rates after Autofill versus Backfill Void Trial following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

STUDY OBJECTIVE: To compare the rate of postoperative urinary retention (POUR) after total laparoscopic hysterectomy (TLH) using the autofill vs the backfill void trial. Secondary objectives were to compare the time to discharge from the recovery room, rate of postoperative urinary tract infection (UTI), perceived bladder condition, the effect of bladder function on life, and patient satisfaction. DESIGN: Randomized controlled trial. SETTING: Single academic medical center. PATIENTS: Women who underwent TLH by conventional laparoscopy or robotic-assisted laparoscopy for benign non-urogynecologic indications. INTERVENTIONS: After TLH, participants were randomized to have an autofill void trial (group A) or a backfill void trial once they were able to ambulate (group B). Failure rate, time to discharge, and UTI rate were assessed. Participants completed the patient perception of bladder condition and the incontinence impact questionnaire-short form questionnaires. Patient satisfaction was assessed. Multiple regression analysis was performed to determine the predictors of POUR. MEASUREMENTS AND MAIN RESULTS: Eighty-two participants completed the study after randomization, 42 in group A and 40 in group B. There were no statistically significant differences in demographic or perioperative outcomes. Seven participants had POUR in group A (16.7%) and 11 in group B (27.5%) (p = .36), respectively. The median time to discharge was 176 minutes for group A (160.5, 255.5) and 218 minutes for group B (180, 265) (p = .01), respectively. There were no statistically significant differences in rate of postoperative UTI (p >.99), patient perception of bladder condition scores (p = .24), incontinence impact questionnaire-short form scores (p = .23), and patient satisfaction scores (p = .26). A stepwise logistic regression analysis did not demonstrate any predictors of POUR. CONCLUSION: Backfill void trial once the participant was able to ambulate was not superior to the autofill void trial with respect to the rate of POUR. The autofill void trial resulted in faster same-day discharge.

Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood disability globally. Botulinum toxin A injections are widely used to manage limb spasticity in children with CP. Intramuscular botulinum toxin A has been used in the upper limbs of children with CP to manage preoperative and postoperative pain, facilitate nursing, and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity. The aim of this review was to assess the evidence for the effect of botulinum toxin A injections used to manage upper limb spasticity in children with spastic CP. Specifically, we examined the role of botulinum toxin A as an adjunctive treatment to other physical therapy modalities. Additionally, we analyzed the associated complications. METHODS: The literature extraction process involved 4 phases: identification, screening, eligibility, and inclusion. We used a combination of Google Scholar, PubMed, and ScienceDirect. The choice of the search terms was based on the Medical Subject Headings. We extracted the relevant studies using a combination of words or terms related to (1) patient population, (2) pathology, (3) clinical intervention, and (4) anatomical distribution of pathology. Studies were included if they were randomized controlled trials conducted on children and/or adolescents with CP targeting the upper extremities in which botulinum toxin A was used as an adjunctive treatment to a primary intervention. RESULTS: The literature extraction process yielded 15 randomized controlled trials for inclusion in this review. The total number of participants enrolled in the included studies was 499, with 255 in the intervention group (51%) and 244 controls (49%). All participants in the eligible studies had unilateral spastic CP except for those in 4 studies (27%) with 198 participants (40%) that included a heterogeneous sample of unilateral and bilateral spastic CP. The mean age of participants in the intervention group ranged from 2.6 to 10.7 years among the individual studies. The mean age of participants in the control group ranged from 3.1 to 10.55 years among the individual studies. This review indicated that botulinum toxin A had a positive effect on the degree of spasticity and cosmetic appearance of the injected upper limb. The results with respect to functional gains and quality of life were either conflicting or not significant. CONCLUSIONS: Randomized controlled trials of botulinum toxin A injection in the treatment of upper limb spasticity in children with CP used variable outcome measures and yielded mixed results. Overall, there is some evidence to support the use of botulinum toxin A as an adjuvant treatment to other physical therapy regimens or placebo to reduce spasticity in the short term. There is insufficient evidence to support its use as an adjunctive treatment to improve upper limb function or quality of life. The complications were acceptable and did not outweigh the clinical gains incurred. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cinnamon Shows Antidiabetic Properties that Are Species-Specific: Effects on Enzyme Activity Inhibition and Starch Digestion.

Despite considerable research the evidence around the antidiabetic properties of cinnamon remains equivocal, and this may be due to varietal differences which is an aspect that is understudied. This study systematically compared the anti-hyperglycaemic properties of the four major commercial cinnamon types used around the world (Chinese; Cinnamomum cassia [CC], Indonesian; C. burmanii [IC], Vietnamese; C. loureirii [VC], and Ceylon; C. zeylanicum [SC]). LC-MS analysis showed distinct diffrences in the phytochemical profiles of cinnamon with SC showing the lowest coumarin concentration. CC and IC had the highest polyphenol levels and antioxidant potential, and all four types differed significantly in their content (P < 0.001). All cinnamon types showed potent species-specific effects on starch digestion enzyme activity inhibition (P < 0.001), CC was most effective against α-amylase and all four strongly inhibited α-glucosidase compared to acarbose. Cinnamon significantly reduced starch breakdown during oral (P = 0.006) and gastric (P = 0.029) phases of gastro-intestinal digestion with IC and SC showing consistent effects. No effects of cinnamon were seen in the intestinal phase. IC, VC and SC showed the greatest potential to inhibit formation of advanced glycation endproducts (AGEs) during digestion. In conclusion, cinnamon demonstrates anti-hyperglycaemic properties, however effects are species-specific with best overall properties seen for Ceylon cinnamon.

In Search of Mobile Applications for Urogynecology Providers.

INTRODUCTION: Thousands of medical applications (apps) are available for mobile devices. Finding accurate, health care provider-centered apps may be time consuming and frustrating for urogynecologists. The objective of this study was to identify and evaluate urogynecology (urogyn) apps using a modified APPLICATIONS scoring system. MATERIALS AND METHODS: Urogyn apps were identified from the Apple iTunes and Google Play Stores using the following 10 MeSH terms: urogynecology, incontinence, prolapse, urinary tract infection, pelvic surgery, fecal incontinence, defecation disorder, voiding disorder, urethral diverticulum, and fistula. Patient-centered and inaccurate apps were excluded. The remaining apps were evaluated with a modified APPLICATIONS scoring system, which included both objective and subjective criteria to determine each app's ability to aid in clinical decision making and to provide informational data. Objective rating components were price, paid subscription, literature referenced, in-app purchases, Internet connectivity, advertisements, text search field, interplatform compatibility and incorporated images, figures, videos, and special features. Subjective rating components were ease of navigation and presentation. RESULTS: Our search yielded 133 and 235 apps in the Apple iTunes and Google Play Stores, respectively. Only 8 apps (4 of which were in both stores) were determined to be accurate and useful; these were evaluated using the modified APPLICATIONS scoring system. The top-rated app was Practical Urology. CONCLUSION: Few accurate clinical decision-making and informational apps exist for urogynecologists. Apps varied by comprehensiveness and quality. This study highlights the importance of systematically reviewing and rating medical apps. It also emphasizes the need for developing accurate apps for urogynecologists that improve health care provider performance and patient outcomes.

Fallopian tube perfusion in ex-vivo and in-vivo laparoscopic hysterectomy specimens: potential application for uterine transplantation.

STUDY QUESTION: Is there perfusion to the fallopian tubes in ex-vivo and in-vivo uteri at the time of total laparoscopic hysterectomy (TLH), as observed using laser angiography with indocyanine green (ICG)? SUMMARY ANSWER: The fallopian tubes may have perfusion from the utero-ovarian vasculature alone. WHAT IS KNOWN ALREADY: The fallopian tubes are perfused by the uterine and utero-ovarian vessels. Perfusion can be measured using laser angiography with ICG. STUDY DESIGN, SIZE, DURATION: This prospective pilot cohort study included 15 women, ages 32-59 years old, who underwent TLH with bilateral salpingectomy for benign indications. PARTICIPANTS/MATERIALS, SETTING, METHODS: In five participants, TLH was performed and the utero-ovarian artery was cannulated ex vivo and injected with ICG. The other 10 participants underwent the in-vivo protocol. The mesosalpinx and uterine vessels were transected in the partial protocol. Colpotomy was also performed in the complete protocol. All fallopian tubes were imaged using laser angiography with ICG. The relative fluorescence and the fluorescence intensity ratio (length of fluorescent fallopian tube/total length of fallopian tube) of the fallopian tubes were measured in the ex-vivo and in-vivo protocols, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: Ex vivo, the fimbria of the ipsilateral fallopian tube had 47% median relative fluorescence as compared to the contralateral fallopian tube, which had 2.4% median relative fluorescence. In vivo, the post-ICG fluorescence intensity ratios were 0.61 ± 0.40 for the partial protocol, and 0.78 ± 0.30 for the complete protocol, with mean differences of 0.37 (95% CI: 0.23-0.50, P < .0001) and 0.22 (95% CI: 0.12-0.31, P < 0.0001), respectively, between the pre-procedure and the post-ICG fluorescence intensity ratios. Greater than 0.75 fluorescence intensity ratios (i.e. >75% tubal length fluorescence) was seen in 60% of fallopian tubes. LIMITATIONS, REASONS FOR CAUTION: This is a pilot study with a small sample size and pathologic uteri, which would not be appropriate for uterine transplantation. No conclusions can be made regarding the functionality of the fallopian tubes. WIDER IMPLICATIONS OF THE FINDINGS: The fallopian tubes may have perfusion with the utero-ovarian vasculature alone, potentially allowing for future animal studies regarding tubal viability in recipients of uterine-tubal transplants. If successful, human uterine-tubal transplantation may allow for spontaneous conception rather than IVF. STUDY FUNDING/COMPETING INTEREST(S): No external funding was used. S.F., P.F.P., K.A.S. and R.F. have no conflicts of interest to report. M.L.S. is an educational consultant for Medtronic (Dublin, Republic of Ireland) and Applied Medical (Rancho Santa Margarita, CA, USA), as well as a stockholder for SynDaver Labs (Tampa, FL, USA). S.E.Z. is an educational consultant for Applied Medical (Rancho Santa Margarita, CA, USA) and is on the advisory board for AbbVie Inc. (Chicago, IL, USA). TRIAL REGISTRATION NUMBER: Not applicable.

Development and Validation of a Simulation Model for Laparoscopic Colpotomy.

OBJECTIVE: To develop a realistic simulation model for performance of laparoscopic colpotomy and evaluate its construct and face validity. METHODS: A simulation model was developed and constructed using polyvinyl chloride piping, a uterine manipulator, and synthetic vaginal tissue paired with a commercially available laparoscopic trainer. An observational study was conducted to validate the simulation model for use as a teaching tool. Construct validity was measured through performance evaluation of novice and expert surgeons using a standard and modified Global Operative Assessment of Laparoscopic Skills scale with possible score ranges of 5-25 and 5-40, respectively. Expert surgeons included attending surgeons across various gynecologic subspecialties who teach total laparoscopic hysterectomy to trainees and perform more than 50 total laparoscopic hysterectomies annually. Novice surgeons included residents who perform total laparoscopic hysterectomy as part of their training. Standards were set using a modified contrasting groups approach. Interrater reliability was calculated using Kendall's τ correlation coefficient. Participants were surveyed regarding the realism of the model and its utility as a teaching tool to assess face validity. RESULTS: Five expert and 15 novice surgeons volunteered to participate. Expert surgeons scored higher than novice surgeons on the Global Operative Assessment of Laparoscopic Skills scale (22.8±1.52 vs 13.53±2.69, respectively) with a mean difference of 9.27 (95% CI 7.12-11.4, P<.01) and on a modified Global Operative Assessment of Laparoscopic Skills scale (36.9±2.19 vs 22.6±3.95, respectively) with a mean difference of 14.30 (95% CI 11.2-17.4, P<.01). Suggested passing range was set at 30.5-32.5 out of 40 total points. Kendall's τ interrater reliability was 0.86 (95% CI 0.798-0.923) and 0.87 (95% CI 0.818-0.922), respectively. All participants agreed that the training model was useful for teaching and learning laparoscopic colpotomy and for assessing the learner's ability to perform colpotomy before live surgery. CONCLUSION: This validated simulation system offers novice surgeons an opportunity to practice the skill set necessary to perform laparoscopic colpotomy efficiently and may be used as an educational tool.

Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy.

BACKGROUND AND OBJECTIVES: Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH. METHODS: This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or nonbarbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion. RESULTS: Indocyanine green (ICG) was visible at the vaginal cuff in all participants. Optimal dosage was determined to be 7.5 mg of ICG per intravenous dose. Mean time to appearance for ICG was 18.4 ± 7.3 s (mean ± SD) before closure and 19.0 ± 8.7 s after closure. No significant difference (P = .19) was noted in judged perfusion in open cuffs after colpotomy with a monopolar (48.9 ± 26.0%; mean ± SD) or ultrasonic (40.2 ± 14.1%) device. No difference was seen after cuff closure (P = .36) when a monopolar (70.9 ± 21.1%) or ultrasonic (70.5 ± 20.5%) device was used. The use of barbed (74.1 ± 20.1%) or nonbarbed (66.4 ± 20.9%) sutures did not significantly affect estimated closed cuff perfusion (P = .19). Decreased cuff perfusion was observed with longer instrument activation times in open cuffs (R2 = 0.3175). CONCLUSION: Laser angiography during RATLH allows visualization of vascular perfusion of the vaginal cuff. The technology remains limited by the lack of quantifiable fluorescence and knowledge of clinically significant levels of fluorescence.

Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence.

INTRODUCTION AND HYPOTHESIS: Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term. METHODS: This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015. Patients were divided into "absent," "weak" and "good" preoperative PFM strength (aPFM, wPFM and gPFM, respectively) based on a modified Oxford scale. Failure rates were determined by a composite of subjective and objective anatomic outcomes. Subjects who underwent re-operations or procedures for recurrent prolapse of the anterior compartment were considered failures. A p value < 0.05 was considered statistically significant. RESULTS: Two hundred ninety-nine patients were included. The aPFM (n = 36), wPFM (n = 115) and gPFM (n = 148) groups had similar descriptive statistics, except subjects in the aPFM and wPFM groups were significantly older than the gPFM group (p = 0.008). All groups underwent similar reconstructive surgeries. Average length of follow-up of 143.9 weeks (41 to 717 weeks) was similar among the three groups (p = 0.472). For the primary outcome of composite failure, aPFM had significantly more anterior vaginal wall recurrences than both the wPFM and gPFM groups, 13.89% vs. 3.48% and 4.05%, respectively (p = 0.033). CONCLUSIONS: Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.

Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review.

Surgical adhesions can lead to significant consequences including abdominopelvic pain, bowel obstruction, subfertility, and subsequent surgery. Although laparoscopic surgery is associated with a decreased risk of adhesion formation, methods to further decrease adhesions are warranted. We systematically reviewed literature addressing the management, prevention, and sequelae of adhesions in women undergoing laparoscopic gynecologic surgery. We searched PubMed, EMBASE, EBSCOhost, and Cochrane Central Register of Controlled Trials and found 6566 records. The primary outcome was adhesion formation. The secondary outcomes were abdominopelvic pain, quality of life, subfertility, pregnancy, bowel obstruction, urinary symptoms, and subsequent surgery. After applying inclusion and exclusion criteria, 52 studies remained for qualitative synthesis. Risk of bias assessments were applied independently by 2 authors. There was evidence that Hyalobarrier Gel (Anika Therapeutics, Bedford, MA), HyaRegen NCH Gel (Bilar Medikal, Istanbul, Turkey), Oxiplex/AP Gel (Fziomed, Inc., San Luis Obispo, CA), SprayGel (Confluent Surgical Inc., Waltham, MA), and Beriplast (CSL Behring, LLCm King of Prussia, PA) all decrease the incidence of adhesions. Adept (Baxter, Deerfield, IL) significantly decreased de novo adhesion scores of the posterior uterus. Using an integrated treatment approach to pelvic pain significantly improved pain and quality of life compared with standard laparoscopic treatment. Lastly, Hyalobarrier Gel Endo (Anika Therapeutics, Bedford, MA) placement led to a higher pregnancy rate than no barrier usage. Our findings underscore the need for high-quality trials to evaluate the efficacy of surgical techniques, adhesion barriers, and other treatment modalities on the management and prevention of adhesions and their clinical sequelae. This review was registered on PROSPERO (ID = CRD42017068053).

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery.

STUDY OBJECTIVE: To compare the amount of patient displacement when a memory foam pad is used versus a bean bag with shoulder braces. The secondary aim was to evaluate for postoperative extremity symptoms including pain, numbness, and weakness. DESIGN: A prospective randomized pilot study (Canadian Task Force classification I). SETTING: A single academic institution. PATIENTS: Women ≥18 years of age undergoing laparoscopic or robotic gynecologic surgery. INTERVENTIONS: Patients were randomized to be positioned on the memory foam pad (group A) or the bean bag with shoulder braces (group B) preoperatively. The patients' positions were measured before and after the procedure, and the displacement was recorded. Patients were followed postoperatively and questioned regarding upper extremity or lower extremity weakness, numbness, and pain. Demographic characteristics were collected using the electronic medical record. MEASUREMENTS AND MAIN RESULTS: Forty-three patients were included in the study (22 in group A and 21 in group B). The demographic and intraoperative characteristics of the patients were similar in both groups. The patients in group A moved a mean distance of 3.80 ± 3.32 cm, whereas those in group B moved a mean distance of 1.07 ± 1.93 cm (p = .002). A Pearson correlation coefficient did not yield a correlation between patient displacement and age, body mass index, length of surgery, or pathology weight. In group A, 2 patients had lower extremity numbness, and 1 patient had upper extremity numbness. In group B, 1 patient had upper extremity pain, and 1 patient had both upper and lower extremity numbness. These patients had complete resolution of their symptoms within the first 2 weeks postoperatively, with the exception of 1 patient in group A whose lower extremity numbness resolved 3 months postoperatively. CONCLUSION: Positioning patients on the bean bag with shoulder braces resulted in significantly less displacement during gynecologic laparoscopic surgery when compared with the memory foam pad. All postoperative extremity numbness, weakness, and pain were temporary and resolved completely in our cohort. A larger study would be necessary to determine the true incidence of peripheral nerve injuries because these are rare complications of laparoscopic surgeries.

Identification and Evaluation of Medical Translator Mobile Applications Using an Adapted APPLICATIONS Scoring System.

IMPORTANCE: With an increasing number of patients requiring translator services, many providers are turning to mobile applications (apps) for assistance. However, there have been no published reviews of medical translator apps. OBJECTIVE: To identify and evaluate medical translator mobile apps using an adapted APPLICATIONS scoring system. DESIGN: A list of apps was identified from the Apple iTunes and Google Play stores, using the search term, "medical translator." Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase, were excluded. The remaining apps were evaluated using an adapted APPLICATIONS scoring system, which included both objective and subjective criteria. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the United States. SETTING: The Apple iTunes and Google Play stores. PARTICIPANTS: Medical translator apps identified using the search term "medical translator." Main Outcomes and Measures: Compilation of medical translator apps for provider usage. RESULTS: A total of 524 apps were initially found. After applying the exclusion criteria, 20 (8.2%) apps from the Google Play store and 26 (9.2%) apps from the Apple iTunes store remained for evaluation. The highest scoring apps, Canopy Medical Translator, Universal Doctor Speaker, and Vocre Translate, scored 13.5 out of 18.7 possible points. CONCLUSIONS AND RELEVANCE: A large proportion of apps initially found did not function as medical translator apps. Using the APPLICATIONS scoring system, we have identified and evaluated medical translator apps for providers who care for non-English speaking patients.

An Evaluation of Mobile Applications for Reproductive Endocrinology and Infertility Providers.

OBJECTIVE: To identify and rate reproductive endocrinology and infertility (REI) mobile applications (apps) targeted toward REI providers. DESIGN: A list of REI apps was found in both the Apple iTunes and Google Play stores using the following seven MeSH terms: reproductive endocrinology, REI, infertility, fertility, In Vitro Fertilization, IVF, and embryology. Patient-centered apps were excluded. The remaining apps were then evaluated for accuracy using reliable references. SETTING: Mobile technology. PATIENTS/INTERVENTIONS: None. MAIN OUTCOME MEASURES: Accurate apps were evaluated for comprehensiveness (the extent of the ability to aid in clinical decision-making) and rated with objective and subjective components using the APPLICATIONS scoring system. RESULTS: Using the seven REI-related MeSH terms, 985 apps and 1,194 apps were identified in the Apple iTunes and Google Play stores, respectively. Of these unique apps, only 20 remained after excluding patient-centered apps. Upon further review for applicability to REI specifically and content accuracy, only seven apps remained. These seven apps were then rated using the APPLICATIONS scoring system. CONCLUSION: Only 0.32% of 2,179 apps reviewed for this study were useful to REI providers. There is potential for further mobile resource development in the area of REI, given the limited number and varying comprehensiveness and quality of available apps.

Identification and Rating of Gynecologic Oncology Applications Using the APPLICATIONS Scoring System.

BACKGROUND: Currently, there are thousands of medical applications (apps) on the market potentially leading to app overload. Finding useful and accurate apps may be time-consuming and frustrating to gynecologic oncologists. INTRODUCTION: The objective of this study is to identify and rate gynecologic oncology (gyn-onc) apps using the APPLICATIONS scoring system. MATERIALS AND METHODS: A list of nonconsumer gyn-onc apps was identified from the Apple iTunes and Google Play Stores. Based on reliable references, inaccurate apps were excluded. The remaining apps were rated with the APPLICATIONS scoring system, which uses both objective and subjective measures. RESULTS: Of 748 apps identified, 11 (1.5%) were found to be both useful and accurate to gyn-onc providers. The apps with the lowest scores were calculator apps, while those with the highest scores were informational apps. DISCUSSION: We found useful and accurate calculator, screening, staging, and informational apps. However, a large number of the apps found were considered inaccurate or non-gyn-onc specific. CONCLUSIONS: Our systematic method for identifying and rating apps with the APPLICATIONS scoring system can be applied within other subspecialties of obstetrics and gynecology and other specialties of medicine to offer providers with apps in clinical care.

Rating Pregnancy Wheel Applications Using the APPLICATIONS Scoring System.

OBJECTIVE: To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. METHODS: A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to the Internet, advertisements, text search field, interdevice compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. RESULTS: A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. CONCLUSION: More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes. LEVEL OF EVIDENCE: III.