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An obstacle Varying-Parameter Vibrant Mastering Circle with regard to Resolving Time-Varying Quadratic Programming Problems With A number of Constraints.
OBJECTIVE To evaluate novel surgical variations of laparoscopic ovarian drilling (LOD) and compare with standard bilateral LOD. DATA SOURCES Electronic databases were searched including Cochrane database, CENTRAL, Ovid MEDLINE, Embase, PsycINFO, PubMed, Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, ISRCTN, The Chinese Clinical Trial Register in February 2019. METHODS OF STUDY SELECTION Randomized controlled trials (RCTs) evaluating LOD for patients with clomiphene-resistant polycystic ovary syndrome (PCOS) and infertility, reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by two authors, respectively. RESULTS Twenty RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study's limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and found to be moderate to very low. Live births were only reported by four studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I2 = 75%), ovulation (p = .08, I2 = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (one RCT) and micro-LOD (three RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and anti-Mullerian hormone or antral follicle numbers following LOD was inconclusive. CONCLUSIONS Unilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant PCOS, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted. OBJECTIVE To demonstrate and contrast two techniques of laparoscopic management of interstitial ectopic pregnancies. DESIGN Stepwise demonstration of the technique with narrated video footage SETTING Tertiary referral centre in Manchester, United Kingdom INTERVENTION Non-tubal ectopic pregnancies typically involve the cervix, ovary, myometrium, caesarean scar and the interstitial portion of the fallopian tube. U0126 Interstitial ectopic pregnancies account for 2% of all ectopic pregnancies1 and is caused by implantation of a fertilised embryo within the proximal and intramural portion of the fallopian tube2. They represent specific challenges in diagnosis as well as management and are associated with increased morbidity and mortality when compared to tubal ectopic pregnancies3. The techniques for minimal access surgical management includes laparoscopic cornuectomy and cornuostomy. We present two cases of interstitial ectopic pregnancies managed laparoscopically using the two different techniques. Case 1 - A 33 yearand 2D ultrasound scan confirmed the presence of a gestational sac with a yolk sac and fetal pole within the left interstitial space. A slow fetal heart action was seen. A diagnosis of a left interstitial ectopic pregnancy was further confirmed on 3D Ultrasound scan. Laparoscopic cornuostomy was performed as demonstrated on attached video. Operating time was 38 minutes with minimal blood loss. A day 7 serum HCG was 364 iu/l. CONCLUSION While more research is needed to determine the optimal surgical technique for management of interstitial ectopic pregnancies, the potential risks and benefits of different techniques should be discussed with the patient and an individual decision should be made. This often depend on the desire for future fertility and previous gynaecological history. STUDY OBJECTIVE The aim of this study was to temporally and externally validate the ultrasound-based endometriosis staging system (UBESS) to predict the level of complexity of laparoscopic surgery for endometriosis. DESIGN A multi-center international retrospective diagnostic accuracy study was carried out between January 2016 and April 2018 on women with suspected pelvic endometriosis. SETTING Four different centres with advanced ultrasound and laparoscopic services were recruited (one for temporal validation and three for external validation). PATIENTS Women with pelvic pain and suspected endometriosis. INTERVENTIONS All women underwent a systematic transvaginal ultrasound (TVS) and were staged according to the UBESS system, followed by classification of laparoscopic level of complexity according to the Royal College of Obstetricians and Gynaecologists (RCOG) levels 1-3. MEASUREMENTS UBESS I, II and III were then correlated with the RCOG level 1, 2 and 3, respectively. Comparison between temporal and extern RCOG level 3) in the absence of bowel endometriosis were excluded (n=54), the sensitivity of UBESS III to correctly classify RCOG level 3 increased from 85.7% to 96.7% at the temporal site (n=42) and from 67.6% to 96.0% at the external sites (n=12) (p less then 0.005). CONCLUSION The results from this external validation study suggest UBESS in its current form is not generalizable unless there is bowel DE and/or cul-de-sac obliteration present. The major limitation appears to be the misclassification of women who require surgical ureterolysis in the absence of bowel endometriosis. STUDY OBJECTIVE The perioperative surgical home (PSH) is a recent innovation in perioperative care delivery that coordinates the pre-, intra-, and post-operative elements of surgical care under one organizational umbrella. Although significant research supports the efficacy of individual elements of the PSH in improving outcomes, there is not a published systematic review of the efficacy of entire PSH programs in improving patient outcomes. This article summarizes descriptions of PSH programs available in the literature and examines outcomes of original studies of PSH implementation. DESIGN We conducted a systematic literature review to identify relevant articles on PSH implementation and synthesize our findings. SETTING The studies included in our review took place at multiple academic and community hospitals in the United States. PATIENTS Patients involved in the PSH studies included surgical patients of various ages and ASA classifications in various surgical specialties. INTERVENTIONS All studies included in our review involved the implementation of a PSH program.
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