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Publisher: Springer-Verlag (Total: 2350 journals)

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Showing 1 - 200 of 2350 Journals sorted alphabetically
3D Printing in Medicine     Open Access  
3D Research     Hybrid Journal   (Followers: 20, SJR: 0.214, h-index: 10)
4OR: A Quarterly J. of Operations Research     Hybrid Journal   (Followers: 10, SJR: 1.073, h-index: 25)
AAPS J.     Hybrid Journal   (Followers: 21, SJR: 1.192, h-index: 74)
AAPS PharmSciTech     Hybrid Journal   (Followers: 7, SJR: 0.718, h-index: 54)
Abdominal Imaging     Hybrid Journal   (Followers: 14, SJR: 0.723, h-index: 60)
Abhandlungen aus dem Mathematischen Seminar der Universitat Hamburg     Hybrid Journal   (Followers: 4, SJR: 0.447, h-index: 12)
Academic Psychiatry     Full-text available via subscription   (Followers: 23, SJR: 0.492, h-index: 32)
Academic Questions     Hybrid Journal   (Followers: 8, SJR: 0.135, h-index: 6)
Accreditation and Quality Assurance: J. for Quality, Comparability and Reliability in Chemical Measurement     Hybrid Journal   (Followers: 26, SJR: 0.378, h-index: 30)
Acoustical Physics     Hybrid Journal   (Followers: 11, SJR: 0.355, h-index: 20)
Acoustics Australia     Hybrid Journal  
Acta Analytica     Hybrid Journal   (Followers: 7, SJR: 0.387, h-index: 6)
Acta Applicandae Mathematicae     Hybrid Journal   (Followers: 1, SJR: 0.624, h-index: 34)
Acta Biotheoretica     Hybrid Journal   (Followers: 4, SJR: 0.419, h-index: 25)
Acta Diabetologica     Hybrid Journal   (Followers: 17, SJR: 1.318, h-index: 46)
Acta Endoscopica     Hybrid Journal   (Followers: 1, SJR: 0.113, h-index: 8)
acta ethologica     Hybrid Journal   (Followers: 4, SJR: 0.465, h-index: 23)
Acta Geochimica     Hybrid Journal   (Followers: 6)
Acta Geodaetica et Geophysica     Hybrid Journal   (Followers: 2, SJR: 0.294, h-index: 13)
Acta Geotechnica     Hybrid Journal   (Followers: 7, SJR: 1.818, h-index: 22)
Acta Informatica     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 32)
Acta Mathematica     Hybrid Journal   (Followers: 12, SJR: 8.021, h-index: 47)
Acta Mathematica Hungarica     Hybrid Journal   (Followers: 2, SJR: 0.53, h-index: 29)
Acta Mathematica Sinica, English Series     Hybrid Journal   (Followers: 6, SJR: 0.406, h-index: 30)
Acta Mathematica Vietnamica     Hybrid Journal   (SJR: 0.451, h-index: 5)
Acta Mathematicae Applicatae Sinica, English Series     Hybrid Journal   (SJR: 0.22, h-index: 20)
Acta Mechanica     Hybrid Journal   (Followers: 21, SJR: 0.898, h-index: 52)
Acta Mechanica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.426, h-index: 29)
Acta Metallurgica Sinica (English Letters)     Hybrid Journal   (Followers: 7, SJR: 0.525, h-index: 18)
Acta Meteorologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.524, h-index: 14)
Acta Neurochirurgica     Hybrid Journal   (Followers: 6, SJR: 0.833, h-index: 73)
Acta Neurologica Belgica     Hybrid Journal   (Followers: 1, SJR: 0.348, h-index: 27)
Acta Neuropathologica     Hybrid Journal   (Followers: 5, SJR: 6.61, h-index: 117)
Acta Oceanologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 17)
Acta Parasitologica     Hybrid Journal   (Followers: 10, SJR: 0.581, h-index: 28)
Acta Physiologiae Plantarum     Hybrid Journal   (Followers: 2, SJR: 0.551, h-index: 39)
Acta Politica     Hybrid Journal   (Followers: 13, SJR: 0.658, h-index: 20)
Activitas Nervosa Superior     Hybrid Journal  
adhäsion KLEBEN & DICHTEN     Hybrid Journal   (Followers: 6, SJR: 0.103, h-index: 4)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 22, SJR: 0.871, h-index: 15)
Adhesion Adhesives & Sealants     Hybrid Journal   (Followers: 9)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 15, SJR: 0.795, h-index: 40)
Adsorption     Hybrid Journal   (Followers: 4, SJR: 0.774, h-index: 52)
Advances in Applied Clifford Algebras     Hybrid Journal   (Followers: 4, SJR: 0.319, h-index: 15)
Advances in Atmospheric Sciences     Hybrid Journal   (Followers: 36, SJR: 0.959, h-index: 44)
Advances in Computational Mathematics     Hybrid Journal   (Followers: 19, SJR: 1.255, h-index: 44)
Advances in Contraception     Hybrid Journal   (Followers: 3)
Advances in Data Analysis and Classification     Hybrid Journal   (Followers: 51, SJR: 1.113, h-index: 14)
Advances in Gerontology     Partially Free   (Followers: 8, SJR: 0.141, h-index: 3)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 27, SJR: 1.397, h-index: 42)
Advances in Manufacturing     Hybrid Journal   (Followers: 3, SJR: 0.2, h-index: 4)
Advances in Polymer Science     Hybrid Journal   (Followers: 43, SJR: 0.637, h-index: 89)
Advances in Therapy     Hybrid Journal   (Followers: 5, SJR: 0.79, h-index: 44)
Aegean Review of the Law of the Sea and Maritime Law     Hybrid Journal   (Followers: 6)
Aequationes Mathematicae     Hybrid Journal   (Followers: 2, SJR: 0.882, h-index: 23)
Aerobiologia     Hybrid Journal   (Followers: 3, SJR: 0.511, h-index: 36)
Aesthetic Plastic Surgery     Hybrid Journal   (Followers: 9, SJR: 0.821, h-index: 49)
African Archaeological Review     Hybrid Journal   (Followers: 16, SJR: 0.612, h-index: 24)
Afrika Matematika     Hybrid Journal   (Followers: 1, SJR: 0.248, h-index: 6)
AGE     Hybrid Journal   (Followers: 7, SJR: 1.358, h-index: 33)
Ageing Intl.     Hybrid Journal   (Followers: 7, SJR: 0.337, h-index: 10)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3, SJR: 0.529, h-index: 55)
Agricultural Research     Hybrid Journal   (Followers: 4)
Agriculture and Human Values     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 49)
Agroforestry Systems     Hybrid Journal   (Followers: 19, SJR: 0.64, h-index: 56)
Agronomy for Sustainable Development     Hybrid Journal   (Followers: 11, SJR: 1.732, h-index: 59)
AI & Society     Hybrid Journal   (Followers: 8, SJR: 0.171, h-index: 19)
AIDS and Behavior     Hybrid Journal   (Followers: 13, SJR: 2.006, h-index: 71)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4, SJR: 0.706, h-index: 19)
Akupunktur & Aurikulomedizin     Full-text available via subscription   (Followers: 1)
Algebra and Logic     Hybrid Journal   (Followers: 5, SJR: 0.566, h-index: 18)
Algebra Universalis     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 22)
Algebras and Representation Theory     Hybrid Journal   (Followers: 1, SJR: 0.868, h-index: 20)
Algorithmica     Hybrid Journal   (Followers: 8, SJR: 0.898, h-index: 56)
Allergo J.     Full-text available via subscription   (Followers: 1, SJR: 0.183, h-index: 20)
Allergo J. Intl.     Hybrid Journal   (Followers: 2)
Alpine Botany     Hybrid Journal   (Followers: 5, SJR: 0.729, h-index: 20)
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3, SJR: 1.392, h-index: 32)
AMBIO     Hybrid Journal   (Followers: 11, SJR: 1.094, h-index: 87)
American J. of Cardiovascular Drugs     Hybrid Journal   (Followers: 16, SJR: 0.864, h-index: 39)
American J. of Community Psychology     Hybrid Journal   (Followers: 27, SJR: 1.237, h-index: 83)
American J. of Criminal Justice     Hybrid Journal   (Followers: 8, SJR: 0.634, h-index: 13)
American J. of Cultural Sociology     Hybrid Journal   (Followers: 15, SJR: 0.283, h-index: 3)
American J. of Dance Therapy     Hybrid Journal   (Followers: 4, SJR: 0.175, h-index: 13)
American J. of Potato Research     Hybrid Journal   (Followers: 2, SJR: 0.558, h-index: 35)
American J. of Psychoanalysis     Hybrid Journal   (Followers: 20, SJR: 0.293, h-index: 13)
American Sociologist     Hybrid Journal   (Followers: 12, SJR: 0.18, h-index: 13)
Amino Acids     Hybrid Journal   (Followers: 8, SJR: 1.362, h-index: 83)
AMS Review     Partially Free   (Followers: 4)
Analog Integrated Circuits and Signal Processing     Hybrid Journal   (Followers: 7, SJR: 0.21, h-index: 37)
Analysis and Mathematical Physics     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 7)
Analysis in Theory and Applications     Hybrid Journal   (Followers: 1)
Analysis of Verbal Behavior     Hybrid Journal   (Followers: 5)
Analytical and Bioanalytical Chemistry     Hybrid Journal   (Followers: 32, SJR: 1.096, h-index: 123)
Anatomical Science Intl.     Hybrid Journal   (Followers: 2, SJR: 0.301, h-index: 26)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3, SJR: 2.212, h-index: 69)
Animal Cognition     Hybrid Journal   (Followers: 18, SJR: 1.122, h-index: 55)
Annales françaises de médecine d'urgence     Hybrid Journal   (Followers: 1, SJR: 0.156, h-index: 4)
Annales Henri Poincaré     Hybrid Journal   (Followers: 3, SJR: 1.377, h-index: 32)
Annales mathématiques du Québec     Hybrid Journal   (Followers: 4)
Annali dell'Universita di Ferrara     Hybrid Journal   (SJR: 0.504, h-index: 14)
Annali di Matematica Pura ed Applicata     Hybrid Journal   (Followers: 1, SJR: 1.167, h-index: 26)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18, SJR: 1.182, h-index: 94)
Annals of Combinatorics     Hybrid Journal   (Followers: 4, SJR: 0.849, h-index: 15)
Annals of Data Science     Hybrid Journal   (Followers: 11)
Annals of Dyslexia     Hybrid Journal   (Followers: 10, SJR: 0.857, h-index: 40)
Annals of Finance     Hybrid Journal   (Followers: 29, SJR: 0.686, h-index: 14)
Annals of Forest Science     Hybrid Journal   (Followers: 7, SJR: 0.929, h-index: 57)
Annals of Global Analysis and Geometry     Hybrid Journal   (Followers: 1, SJR: 1.136, h-index: 23)
Annals of Hematology     Hybrid Journal   (Followers: 16, SJR: 1.117, h-index: 62)
Annals of Mathematics and Artificial Intelligence     Hybrid Journal   (Followers: 12, SJR: 0.593, h-index: 42)
Annals of Microbiology     Hybrid Journal   (Followers: 10, SJR: 0.402, h-index: 26)
Annals of Nuclear Medicine     Hybrid Journal   (Followers: 4, SJR: 0.68, h-index: 45)
Annals of Operations Research     Hybrid Journal   (Followers: 10, SJR: 1.186, h-index: 78)
Annals of Ophthalmology     Hybrid Journal   (Followers: 12)
Annals of Regional Science     Hybrid Journal   (Followers: 7, SJR: 0.405, h-index: 42)
Annals of Software Engineering     Hybrid Journal   (Followers: 13)
Annals of Solid and Structural Mechanics     Hybrid Journal   (Followers: 9, SJR: 0.553, h-index: 8)
Annals of Surgical Oncology     Hybrid Journal   (Followers: 14, SJR: 1.902, h-index: 127)
Annals of Telecommunications     Hybrid Journal   (Followers: 9, SJR: 0.315, h-index: 25)
Annals of the Institute of Statistical Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.931, h-index: 31)
Antonie van Leeuwenhoek     Hybrid Journal   (Followers: 5, SJR: 0.992, h-index: 87)
Apidologie     Hybrid Journal   (Followers: 4, SJR: 1.14, h-index: 57)
APOPTOSIS     Hybrid Journal   (Followers: 8, SJR: 1.554, h-index: 87)
Applicable Algebra in Engineering, Communication and Computing     Hybrid Journal   (Followers: 2, SJR: 0.354, h-index: 27)
Applications of Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.274, h-index: 20)
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 42, SJR: 0.575, h-index: 80)
Applied Biochemistry and Microbiology     Hybrid Journal   (Followers: 16, SJR: 0.267, h-index: 26)
Applied Cancer Research     Open Access  
Applied Categorical Structures     Hybrid Journal   (Followers: 2, SJR: 0.361, h-index: 21)
Applied Composite Materials     Hybrid Journal   (Followers: 49, SJR: 0.705, h-index: 35)
Applied Entomology and Zoology     Partially Free   (Followers: 3, SJR: 0.554, h-index: 34)
Applied Geomatics     Hybrid Journal   (Followers: 3, SJR: 0.323, h-index: 9)
Applied Geophysics     Hybrid Journal   (Followers: 8, SJR: 0.541, h-index: 13)
Applied Intelligence     Hybrid Journal   (Followers: 11, SJR: 0.777, h-index: 43)
Applied Magnetic Resonance     Hybrid Journal   (Followers: 4, SJR: 0.358, h-index: 34)
Applied Mathematics & Optimization     Hybrid Journal   (Followers: 6, SJR: 0.955, h-index: 33)
Applied Mathematics - A J. of Chinese Universities     Hybrid Journal   (SJR: 0.275, h-index: 8)
Applied Mathematics and Mechanics     Hybrid Journal   (Followers: 5, SJR: 0.37, h-index: 26)
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 63, SJR: 1.262, h-index: 161)
Applied Physics A     Hybrid Journal   (Followers: 9, SJR: 0.535, h-index: 121)
Applied Physics B: Lasers and Optics     Hybrid Journal   (Followers: 24, SJR: 0.983, h-index: 104)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 8, SJR: 0.677, h-index: 47)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 11, SJR: 0.288, h-index: 15)
Applied Solar Energy     Hybrid Journal   (Followers: 18, SJR: 0.251, h-index: 6)
Applied Spatial Analysis and Policy     Hybrid Journal   (Followers: 4, SJR: 0.351, h-index: 9)
Aquaculture Intl.     Hybrid Journal   (Followers: 22, SJR: 0.613, h-index: 40)
Aquarium Sciences and Conservation     Hybrid Journal   (Followers: 1)
Aquatic Ecology     Hybrid Journal   (Followers: 33, SJR: 0.646, h-index: 44)
Aquatic Geochemistry     Hybrid Journal   (Followers: 4, SJR: 0.764, h-index: 39)
Aquatic Sciences     Hybrid Journal   (Followers: 13, SJR: 1.172, h-index: 53)
Arabian J. for Science and Engineering     Hybrid Journal   (Followers: 5, SJR: 0.345, h-index: 20)
Arabian J. of Geosciences     Hybrid Journal   (Followers: 2, SJR: 0.417, h-index: 16)
Archaeological and Anthropological Sciences     Hybrid Journal   (Followers: 20, SJR: 1.056, h-index: 15)
Archaeologies     Hybrid Journal   (Followers: 12, SJR: 0.397, h-index: 13)
Archiv der Mathematik     Hybrid Journal   (Followers: 1, SJR: 0.597, h-index: 29)
Archival Science     Hybrid Journal   (Followers: 58, SJR: 0.804, h-index: 22)
Archive for History of Exact Sciences     Hybrid Journal   (Followers: 8, SJR: 0.28, h-index: 15)
Archive for Mathematical Logic     Hybrid Journal   (Followers: 2, SJR: 0.946, h-index: 23)
Archive for Rational Mechanics and Analysis     Hybrid Journal   (SJR: 4.091, h-index: 66)
Archive of Applied Mechanics     Hybrid Journal   (Followers: 5, SJR: 0.865, h-index: 40)
Archives and Museum Informatics     Hybrid Journal   (Followers: 141)
Archives of Computational Methods in Engineering     Hybrid Journal   (Followers: 5, SJR: 2.841, h-index: 40)
Archives of Dermatological Research     Hybrid Journal   (Followers: 7, SJR: 0.9, h-index: 65)
Archives of Environmental Contamination and Toxicology     Hybrid Journal   (Followers: 14, SJR: 0.846, h-index: 84)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 16, SJR: 0.695, h-index: 47)
Archives of Microbiology     Hybrid Journal   (Followers: 8, SJR: 0.702, h-index: 85)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 56)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2, SJR: 1.092, h-index: 13)
Archives of Sexual Behavior     Hybrid Journal   (Followers: 10, SJR: 1.198, h-index: 74)
Archives of Toxicology     Hybrid Journal   (Followers: 17, SJR: 1.595, h-index: 76)
Archives of Virology     Hybrid Journal   (Followers: 5, SJR: 1.086, h-index: 90)
Archives of Women's Mental Health     Hybrid Journal   (Followers: 14, SJR: 1.264, h-index: 50)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Archivum Immunologiae et Therapiae Experimentalis     Hybrid Journal   (Followers: 2, SJR: 1.2, h-index: 42)
ArgoSpine News & J.     Hybrid Journal   (SJR: 0.102, h-index: 3)
Argumentation     Hybrid Journal   (Followers: 5, SJR: 0.295, h-index: 18)
Arid Ecosystems     Hybrid Journal   (Followers: 2)
Arkiv för Matematik     Hybrid Journal   (Followers: 1, SJR: 0.948, h-index: 22)
Arnold Mathematical J.     Hybrid Journal   (Followers: 1)
Arthropod-Plant Interactions     Hybrid Journal   (Followers: 2, SJR: 0.797, h-index: 17)
Arthroskopie     Hybrid Journal   (Followers: 1, SJR: 0.145, h-index: 8)
Artificial Intelligence and Law     Hybrid Journal   (Followers: 11, SJR: 0.288, h-index: 25)
Artificial Intelligence Review     Hybrid Journal   (Followers: 14, SJR: 0.948, h-index: 48)
Artificial Life and Robotics     Hybrid Journal   (Followers: 9, SJR: 0.231, h-index: 14)
Asia Europe J.     Hybrid Journal   (Followers: 5, SJR: 0.247, h-index: 9)
Asia Pacific Education Review     Hybrid Journal   (Followers: 11, SJR: 0.371, h-index: 17)
Asia Pacific J. of Management     Hybrid Journal   (Followers: 16, SJR: 1.676, h-index: 50)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 12, SJR: 0.353, h-index: 13)
Asia-Pacific Financial Markets     Hybrid Journal   (Followers: 2, SJR: 0.19, h-index: 15)
Asia-Pacific J. of Atmospheric Sciences     Hybrid Journal   (Followers: 19, SJR: 1.006, h-index: 14)
Asian Business & Management     Hybrid Journal   (Followers: 9, SJR: 0.41, h-index: 10)
Asian J. of Business Ethics     Hybrid Journal   (Followers: 9)
Asian J. of Criminology     Hybrid Journal   (Followers: 5, SJR: 0.263, h-index: 8)
AStA Advances in Statistical Analysis     Hybrid Journal   (Followers: 2, SJR: 0.681, h-index: 15)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5, SJR: 0.195, h-index: 5)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  

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Journal Cover Archives of Gynecology and Obstetrics
  [SJR: 0.695]   [H-I: 47]   [16 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1432-0711 - ISSN (Online) 0932-0067
   Published by Springer-Verlag Homepage  [2350 journals]
  • New associate editor: PD Dr. T. Burkhardt
    • Pages: 1079 - 1079
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4739-z
      Issue No: Vol. 297, No. 5 (2018)
       
  • Letrozole versus clomiphene citrate in polycystic ovary syndrome: a
           meta-analysis of randomized controlled trials
    • Authors: Shifu Hu; Qiong Yu; Yingying Wang; Mei Wang; Wei Xia; Changhong Zhu
      Pages: 1081 - 1088
      Abstract: Purpose Polycystic ovary syndrome (PCOS) is a common endocrine disturbance affecting women in the reproductive age group. The present study aimed to compare the effects of letrozole (LE) and clomiphene citrate (CC) for ovulation induction in women with PCOS. Methods The PUBMED, Web of Science, and EMBASE databases were screened systematically for randomized controlled trials (RCTs) published from database inception to July 2017. Results Eleven RCTs involving 2255 patients were included, and data were independently extracted and analyzed using 95% risk ratios (RRs) and confidence intervals (CIs) based on a random- or fixed-effect model (as appropriate). Meta-analyses of nine RCTs comparing LE and CC ovulation induction, followed by timed intercourse, indicated that the former significantly increased the ovulation rate (RR = 1.18; 95% CI 1.03–1.36, P = 0.01), pregnancy rate (RR = 1.34; 95% CI 1.09–1.64, P = 0.006), and live birth rate (RR = 1.55; 95% CI 1.28–1.88, P < 0.00001). However, LE and CC did not differ significantly in terms of the multiple pregnancy and abortion rates. Furthermore, LE for ovulation induction significantly improved the pregnancy rate after IUI. Conclusion LE is superior to CC for ovulation induction in patients with PCOS.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4688-6
      Issue No: Vol. 297, No. 5 (2018)
       
  • Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian
           women: a systematic review and meta-analysis
    • Authors: Sahar Sabour; Mohsen Arzanlou; Hamid Vaez; Giti Rahimi; Amirhossein Sahebkar; Farzad Khademi
      Pages: 1101 - 1113
      Abstract: Purpose Bacterial vaginosis (BV) is a vaginal disorder which occurs either symptomatic or asymptomatic because of an imbalance between H2O2-producing Lactobacillus and Gardnerella vaginalis in the vagina. This systematic review and meta-analysis is the first to determine the prevalence of BV in pregnant and non-pregnant women in Iran. Methods We used national (SID, Irandoc, Iranmedex and Magiran) and international (PubMed, Scopus, Google Scholar and ISI web of knowledge) electronic databases to systematically search and collect available studies using related keywords (up to 1 December 2017). Inclusion and exclusion criteria were defined to select eligible studies. Results The overall prevalence of BV among Iranian women was 18.9% (95% CI 14–25). Gardnerella vaginalis was the most prevalent isolated bacteria. The prevalence of BV in non-pregnant women was 28% (95% CI 15.1–45.9) which was higher compared with pregnant women who had a prevalence of 16.5% (95% CI 12.5–21.6). Conclusion The present review revealed a high prevalence of BV in non-pregnant women. Given that BV is associated with a series of reproductive complications such as infertility, taking preventive measures such as awareness of patients as well as monitoring and controlling of syndrome are essential.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4722-8
      Issue No: Vol. 297, No. 5 (2018)
       
  • Evaluation of cesarean scar after single- and double-layer hysterotomy
           closure: a prospective cross-sectional study
    • Authors: Nur Betül Tekiner; Berna Aslan Çetin; Lale Susan Türkgeldi; Gökçe Yılmaz; İbrahim Polat; Ali Gedikbaşı
      Pages: 1137 - 1143
      Abstract: Background We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery. Methods This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single- (n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded. Results No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length and depth of the scar defect. Conclusion Single- or double-layered closure of the uterus does not seem to affect the size of the uterine scar defect detected on SIS 3 months following the first cesarean delivery.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4702-z
      Issue No: Vol. 297, No. 5 (2018)
       
  • Efficacy of aromatherapy for reducing pain during labor: a randomized
           controlled trial
    • Authors: Rajavadi Tanvisut; Kuntharee Traisrisilp; Theera Tongsong
      Pages: 1145 - 1150
      Abstract: Background Many strategies for labor pain management have been studied, including aromatherapy, which is a noninvasive, alternative medicine used as an adjunct for labor pain control. Nevertheless, the results were contradictory. Therefore, we conducted this study to determine the effectiveness of aromatherapy for reducing pain during labor. Methods A randomized controlled trial was carried out on Thai laboring primigravidae who were a low-risk singleton pregnancy undergoing vaginal delivery. All participants, both study and control group, received standard obstetric care. Aromatherapy was only provided to the study group during the first stage of labor. The women rated their pain intensity by rating scales at different stages of labor. The primary outcome was pain scores and the secondary outcomes were necessity of painkiller usage, labor time, aromatherapy-associated complications, route of delivery, and Apgar scores. Results A total of 104 women were recruited, 52 in each group. Baseline characteristics and baseline pain scores were comparable. The median pain score of latent and early active phase was lower in the aromatherapy group, 5 vs 6 and 7 vs 8, respectively. The mean differences of pain scores between latent and early active phase and the baseline were significantly lower in the aromatherapy group, 1.88 vs 2.6 (p = 0.010) and 3.82 vs 4.39 (p = 0.031), respectively. Late active phase pain scores and other perinatal outcomes were not significantly different. Conclusion Aromatherapy is helpful in reducing pain in latent and early active phase, and can probably be used as an adjunctive method for labor pain control without serious side effects.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4700-1
      Issue No: Vol. 297, No. 5 (2018)
       
  • The risk of placenta accreta following primary cesarean delivery
    • Authors: Gil Zeevi; Dan Tirosh; Joel Baron; Maayan Yitshak Sade; Adi Segal; Reli Hershkovitz
      Pages: 1151 - 1156
      Abstract: Objective To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS. Study design In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: ‘Unplanned 1’ (first stage—up to 10 cm), ‘Unplanned 2’ (second stage—10 cm) and ‘Elective’ prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately. Results We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the ‘Unplanned 1’ group, 7.2% (n = 15) in the ‘ Unplanned 2’ group and 80.8% (n = 167) in the ‘elective’ group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01). Conclusions The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4698-4
      Issue No: Vol. 297, No. 5 (2018)
       
  • Tubal restorative surgery for hydrosalpinges in women due to in vitro
           fertilization
    • Authors: Xiaoming Yu; He Cai; Xingbang Zheng; Junyan Feng; Jing Guan
      Pages: 1169 - 1173
      Abstract: Objective The study was carried out to clarify the IVF outcome after laparoscopic neosalpingostomy for infertile patients affected by hydrosalpinx stage III. Materials and Methods: From January 2010 to June 2015, 91 subjects of hydrosalpinx stage III were treated in out center by laparoscopic surgery before IVF cycle. 43 underwent neosalpingostomy (group 1) and the remaining 48 underwent salpingestomy (group 2). We compared these patients and their IVF outcomes after two different surgical techniques. Results There were no significant differences between the two groups, except a higher number of patients with bilaterial hydrosalpinges was noted in the neosalpingostomy group (79.1% vs. 56.3%, respectively). 25 patients with neosalpingostomy and 29 with salpingectomy achieved pregnancy by IVF. The ongoing pregnancy rate per cycle in group 1 and group 2 was 51.1 and 47.2%, respectively. Two cases of ampullary ectopic pregnancies were noted in group 1 and one case of right tube interstitial pregnancy in group 2. No significant difference was observed in live birth rate between the groups (48.9% vs. 45.3%, respectively). Conclusions The outcomes of IVF after neosalpingostomy were matchable with salpingectomy. For patients desire to preserve fallopian tubes, we recommend laparoscopic neosalpingostomy as an alternative choice to manage moderate hydrosalpinx before IVF.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4695-7
      Issue No: Vol. 297, No. 5 (2018)
       
  • Expression of semaphorin class 3 is higher in the proliferative phase on
           the human endometrium
    • Authors: Gustavo Dias Ferreira; Edison Capp; Julia Jauckus; Thomas Strowitzki; Ariane Germeyer
      Pages: 1175 - 1179
      Abstract: Purpose The semaphorins are related to angiogenesis and cell proliferation depending on the tissue. The purpose of this study was to assess gene expression of class 3 semaphorin (SEMA3A-F) and protein expression of semaphorin 3A (SEMA3A) within human endometrium throughout the menstrual cycle. Methods Gene expression of SEMA3A-F was analyzed by real-time PCR (qRT-PCR) and protein expression of SEMA3A was analyzed by ELISA in endometrial biopsies in the proliferative and secretory phase of the menstrual cycle. Results Gene expression of SEMA3A, SEMA3C, SEMA3D, and SEMA3E was statistically significant decreased in secretory compared to proliferative phase endometrium (p < 0.05). Accordingly, SEMA3A protein expression in the secretory phase was lower than protein expression in proliferative phase endometrium (p ≤ 0.05). Conclusion SEMA3A, 3C, 3D, and 3E are possibly related to cell proliferation in the endometrium, being more expressed in the proliferative phase of the cycle. This finding may stimulate studies of class 3 semaphorins as a possible target for treatment of endometrial pathologies.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4719-3
      Issue No: Vol. 297, No. 5 (2018)
       
  • Is intrauterine device a risk factor for failure of conservative
           management in patients with tubo-ovarian abscess' An observational
           retrospective study
    • Authors: Victoria Kapustian; Ahmet Namazov; Odeliya Yaakov; Michael Volodarsky; Eyal Y Anteby; Ofer Gemer
      Pages: 1201 - 1204
      Abstract: Purpose Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. Methods In this retrospective case–control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72 h was followed by surgical intervention. Results The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p = 0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5 ± 6.6 vs. 13.1 ± 4.6, p = 0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6 ± 21.4 vs. 49.6 ± 20.6 mm, p = 0.02). Conclusion The surgical intervention rate in TOA patients with and without IUD was similar.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4690-z
      Issue No: Vol. 297, No. 5 (2018)
       
  • A retrospective comparative study evaluating the efficacy of adding
           intra-arterial methotrexate infusion to uterine artery embolisation
           followed by curettage for cesarean scar pregnancy
    • Authors: Ling Gao; Yan-yan Hou; Feng Sun; Wei Xia; Yi Yang; Tian Tian; Qin-fang Chen; Xiao-cui Li
      Pages: 1205 - 1211
      Abstract: Purpose The study aimed to compare the efficacy of intra-arterial methotrexate (MTX) infusion combined with uterine artery embolisation (UAE) and uterine curettage with that of UAE and curettage without MTX infusion for the treatment of cesarean scar pregnancy (CSP). Methods In this retrospective study, data of CSP patients admitted from January 2011 to July 2015 were obtained from electronic patient records. Clinical information at baseline and after treatment were extracted and analyzed. Results A total of 93 CSP patients were included, with 57 patients receiving UAE followed by curettage (UC) and 36 patients receiving intra-arterial MTX infusion followed by UAE and curettage (MUC). The baseline characteristics were not significantly different between the two groups. Without additional intervention, 32 (88.9%) patients were successfully treated by MUC, and 49 (86.0%) patients were successfully treated by UC, defined by discontinued ectopic conceptus growth, normalized serum β-human chorionic gonadotropin (β-hCG) level, ceased vaginal bleeding and preservation of uterus, with no significant difference between the two groups. Additionally, intra-operative blood loss volume and post-operative bleeding events were not significantly different between the two groups. However, serum β-hCG decline on the first day after surgery was significantly promoted, and the hospitalization length and the time needed for serum β-hCG normalization were significantly shortened by addition of intra-arterial MTX infusion. Conclusions Adding intra-arterial MTX to UAE and curettage significantly promoted post-operative recovery, though success rate and bleeding events were not significantly affected, suggesting that addition of intra-arterial MTX might not be necessary.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4686-8
      Issue No: Vol. 297, No. 5 (2018)
       
  • Does post-operative radiochemotherapy improve survival in high-grade
           endometrial cancer patients' Results of a population-based cohort
           analysis of a cancer registry
    • Authors: Sophia Scharl; Thomas Papathemelis; Karin Kronberger; Michael Gerken; Anton Scharl; Oliver Kölbl; Monika Klinkhammer-Schalke
      Pages: 1245 - 1253
      Abstract: Purpose Adjuvant treatment of high-grade endometrial cancer varies greatly due to the lack of definitive results from controlled randomized trials on the subject. In a retrospective study, we sought to investigate the influence of post-operative radio-, chemo, and radiochemotherapy on survival time and recurrence rates among high-grade endometrial cancer patients. Methods 284 high-grade endometrial cancer patients (FIGOI–III, or unknown classification) diagnosed between 1998 and 2015 were retrospectively analyzed. All patients underwent surgery. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared for post-operative treatment modalities of radiotherapy alone (RT), chemotherapy alone (CTX), radiochemotherapy (RCT), and observation (OBS). Results Post-operative RCT and RT resulted in a significantly improved 5-year OS of 94.1% (HR 0.104, CI 0.013–0.809) and 62.1% (HR 0.615, CI 0.390–0.969), respectively, compared to 43.6% for OBS. CTX did not significantly improve OS leading to a 5-year OS of 56.5% (HR 0.783, CI 0.224–2.740). 5-year recurrence rate was lowest for patients treated with RCT (5.3%). 5-year RFS was 94.1% for the RCT group and proved to be significantly superior to 58.8% for RT (HR 9.034, CI 1.184–68.948), 56% for CTX (HR 12.738, CI 1.337–121.346), and 37.4% for OBS (HR 16.407, CI 2.127–126.575), respectively. In comparison with OBS, RT alone resulted in a significant improvement in RFS (HR 0.551, CI 0.354–0.856). Conclusions Our retrospective population-based study indicates a survival benefit from treating high-grade endometrial cancer with post-operative RCT. Randomized controlled trials are needed to minimize potential confounding parameters and further clarify the subject.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4708-6
      Issue No: Vol. 297, No. 5 (2018)
       
  • Biologic meshes and synthetic meshes in cancer patients: a double-edged
           sword: differences in production of IL-6 and IL-12 caused by acellular
           dermal matrices in human immune cells
    • Authors: Maria Margarete Karsten; Sabine Enders; Julia Knabl; Verena Kirn; Peter Düwell; Brigitte Rack; Jens-Uwe Blohmer; Doris Mayr; Darius Dian
      Pages: 1265 - 1270
      Abstract: Purpose In 2005, Breuing et al. first described the use of acellular dermal matrices (ADMs) in breast cancer patients. ADMs are assumed to be safe to use in an oncologic setting, but data from controlled studies are still needed. Here, we investigate the effects of ADMs on the production of interleukin (IL)-6 and IL-12, key regulators of immune suppression and activation. Methods Strattice (ST), CollaMend (CM), and Biodesign (BD) biologic meshes and TiLoop, a synthetic mesh (TL), were used in this study. We isolated myeloid dendritic cells (MDCs), untouched plasmacytoid dendritic cells (pDCs), naïve B cells, and CD8+ T cells and co-cultured these cells with either the biologic meshes or TL. As positive controls, we used CpG ODN 2216 or lipopolysaccharide (LPS). The cytokine concentrations of IL-12p70 and IL-6 were determined after 7 days using sandwich ELISA sets. Results There were highly significant differences between the ADMs and TL in terms of their ability to stimulate immunologic responses. IL-6 expression was significantly increased in B cells (p = 0.0006131) and T cells (p = 0.00418) when comparing TL and ADMs. We also identified significant differences in IL-12 production by B cells (p = 0.0166) and T cells (p = 0.003636) when comparing TL and ADMs. Conclusions Despite the assumed lack of an immunological response to ADMs, in our experimental study, human immune cells reacted with significantly different cytokine profiles. These findings may have implications for the potential activation or suppression of effector cells in cancer patients and could explain some of the post clinical post surgical signs of ADMS like skin rush and seroma.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4710-z
      Issue No: Vol. 297, No. 5 (2018)
       
  • Endoscopy-assisted inguinal lymphadenectomy in vulvar cancer
    • Authors: Aiwen Le; Jie Xiong; Zhonghai Wang; Xiao yun Dai; Tian hui Xiao; Rong Zhuo; Ya hong Xu; Rui Yuan
      Pages: 1277 - 1283
      Abstract: Objective To explore the feasibility and efficiency of video endoscopic inguinal lymphadenectomy (VEIL) for vulvar cancer. Methods We evaluated 46 patients with vulvar cancer. Treatment included VEIL using the hypogastric subcutaneous approach (VEIL-H, 17 patients), VEIL with the limb subcutaneous surgical approach (VEIL-L, 8 patients), and open inguinal lymphadenectomy (OIL, 21 patients). All patients underwent radical vulvectomy; we evaluated operative time, the amount of bleeding, SF score, recurrence rate, etc. Results The durations of VEIL-H and VEIL-L were 170.79 ± 18.92 and 180.12 ± 17.88 min, respectively, which were longer than that of OIL (100.68 ± 11.37 min; P = 0.028). Bleeding volumes in the VEIL-H and VEIL-L groups were 15.23 ± 2.17 and 17.16 ± 2.35 ml, respectively; there were significantly lower than that of the OIL group (36.68 ± 3.48 ml; P = 0.021). The numbers of unilateral lymph nodes harvested were similar in all groups. The duration of hospitalization in VEIL group was shorter than that of the OIL group. There were less skin and lymphatic complications after VEIL than after OIL. Total SF-36 scores were significantly higher in the VEIL group than that in the OIL group (P = 0.032). There were no statistically significant differences in local recurrence, distant metastasis, and mortality among the three groups. Conclusion VEIL for vulvar cancer treatment is effective, with the advantages of short hospitalization stay, less bleeding, and reduced postoperative complications comparing the OIL.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4732-6
      Issue No: Vol. 297, No. 5 (2018)
       
  • Conventional in vitro fertilization (IVF) or intracytoplasmic sperm
           injection (ICSI): which is preferred for advanced age patients with five
           or fewer oocytes retrieved'
    • Authors: Hui Liu; Haibin Zhao; Guanling Yu; Mei Li; Shuiying Ma; Haozhen Zhang; Keliang Wu
      Pages: 1301 - 1306
      Abstract: Purpose To investigate the clinical outcomes of conventional IVF and ICSI in female patients aged 40 years and over with no more than five oocytes retrieved and non-male factor infertility. Methods A retrospective study of a cohort of 644 patients undergoing IVF/ICSI treatment. The 534 female patients aged ≧ 40 years with no more than five oocytes retrieved and non-male factor infertility undergoing their first conventional IVF cycles were assigned in IVF group. The rest of 110 patients aged 40 years and over with no more than five oocytes retrieved and non-male factor infertility undergoing first ICSI cycles were recruited in ICSI group. Results Our results showed the clinical pregnancy, live birth and miscarriage rates were similar between the IVF and ICSI groups (21.59% vs. 13.25%, P > 0.05; 12.16% vs. 6.02%, P > 0.05; 43.68% vs. 54.55%, P > 0.05; respectively), however, the implantation and cumulative live-birth rates were significantly higher in the IVF compared to the ICSI group (15.11% vs. 7.75%, 14.59% vs. 5.56%, P < 0.05), though the IVF group had a lower normal fertilization rate (61.56% vs. 76.00%, P < 0.001). Conclusions Our study provides strong evidences that the conventional IVF exhibits advantages over the ICSI method in non-male factor infertility for advanced age patients with five or fewer oocytes retrieved.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4696-6
      Issue No: Vol. 297, No. 5 (2018)
       
  • Outcomes of poor responders following growth hormone co-treatment with
           IVF/ICSI mild stimulation protocol: a retrospective cohort study
    • Authors: Kun Chu; Wenjuan Pang; Ningxia Sun; Qing Zhang; Wen Li
      Pages: 1317 - 1321
      Abstract: Purpose No research has studied the effect of GH co-treatment in mild stimulation protocol for poor responders. We therefore conducted this retrospective analysis to assess the outcome of IVF/ICSI cycles after the adjunct GH use to the mild stimulation protocol in poor responders. Methods 132 poor responders who received mild stimulation protocol at Reproductive Medicine Center of Changzheng Hospital from January 2014 to December 2016 were included in this study. Good-quality embryo rate, clinical pregnancy rate, and live birth rate were compared between the GH group (n = 61) and control group (n = 71). Results IVF good-quality embryo rate (68.1 versus 51.5%; P = 0.008*) and ICSI good-quality embryo rate (53.9 versus 36.7%; P = 0.045*) was significantly higher in the GH group. Though the clinical outcomes did not reach a statistically significant difference between the two groups due to the limited sample size, there was a trend of higher rate in GH group in the aspect of clinical pregnancy rate (52.4 versus 47.1%; P = 0.609) and live birth rate (35.7 versus 27.5%; P = 0.392). Conclusion The results suggested that the adjuvant GH treatment in mild stimulation protocol for poor responders could significantly improve good-quality embryo rate, and might therefore improve the clinical outcomes.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4725-5
      Issue No: Vol. 297, No. 5 (2018)
       
  • Comment to the letter by Drs. Safiri and Ashrafi-Asgarabad
    • Authors: Yaakov Melcer; Ron Maymon; Marina Pekar-Zlotin; Zvi Vaknin; Moty Pansky; Noam Smorgick
      Pages: 1333 - 1333
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4730-8
      Issue No: Vol. 297, No. 5 (2018)
       
  • Does she have adnexal torsion' Prediction of adnexal torsion in
           reproductive age women: methodological issues
    • Authors: Saeid Safiri; Ahad Ashrafi-Asgarabad
      Pages: 1335 - 1336
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4736-2
      Issue No: Vol. 297, No. 5 (2018)
       
  • Comment to the letter of Dr. Yeon-Suk Kim et al.
    • Authors: Rudy Leon De Wilde
      Pages: 1337 - 1337
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4731-7
      Issue No: Vol. 297, No. 5 (2018)
       
  • RE: Pathobiology of myomatosis uteri: the underlying knowledge to support
           our clinical practice
    • Authors: Yeon-Suk Kim; Tae-Hee Kim; Hae-Hyeog Lee; Kisung Song
      Pages: 1339 - 1341
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4737-1
      Issue No: Vol. 297, No. 5 (2018)
       
  • Correction to: Predictors of cerclage failure in patients with singleton
           pregnancy undergoing prophylactic cervical cerclage
    • Authors: K. Taghavi; M. L. Gasparri; D. Bolla; D. Surbek
      Pages: 1343 - 1343
      Abstract: The original version of this article unfortunately contained a mistake. The presentation of Table 3 was incorrect. The corrected Table 3 is given below.
      PubDate: 2018-05-01
      DOI: 10.1007/s00404-018-4727-3
      Issue No: Vol. 297, No. 5 (2018)
       
 
 
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