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A randomized trial evaluated whether resection of lymph nodes that appeared macroscopically normal during surgery for ovarian cancer would lead to improved outcomes. Progression-free and overall survival were unaffected, and resection was associated with longer operations and more complications.

We estimate (1) sexual activity and sexual desire in women living with and without a partner across the age range in Germany and (2) changes over 11 years. A representative survey of 1345 (response rate: 65%) women between 18 and 99 years from 2016 was compared to a survey of 1314 women age 18–91 from 2005 (response rate: 53%). Sexual activity was assessed as having been physically intimate with someone in the past year; frequency of sexual desire was rated for the past 4 weeks. In 2016, the great majority of women living with a partner were sexually active and indicated sexual desire until the age of 60, which decreased thereafter. Compared to 2005, fewer women cohabited with a partner. Across the age range, women living without a partner reported considerably less sexual activity and desire. The overall proportion of women reporting partnered sexual activity decreased from 67% to 62% in 2016, and absent sexual desire increased from 24% to 26%. Declines of sexual activity and desire affected mostly young and middle-aged women. The decline of sexual activity and desire seems to be due to a reduced proportion of women living with a partner. There was also a generation effect with younger and middle-aged women without a partner becoming less sexually active and experiencing less desire compared to the previous survey. While surveys were methodologically comparable, interpretations are limited by the absence of longitudinal data.

Purpose To investigate sexual health in breast cancer survivors and their partners, focusing on sexual satisfaction, changes in satisfaction with partner sexuality before vs. after the diagnosis, and unmet informational needs on sexual health in the context of breast cancer. Methods Breast cancer patients and their partners were surveyed at a single time point 1–5 years after having completed primary therapy for breast cancer as part of a cross-sectional study. Study participants completed self-report-questionnaires covering personal characteristics, a question on satisfaction with partner sexuality before (retrospective assessment) versus after the diagnosis (based on the Sexual Medicine Questionnaire for Chronic Diseases (SFCE)), the EORTC (European Organisation for Research and Treatment of Cancer) Sexual Health Questionnaire (EORTC QLQ-SH22) together with the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30), and a questionnaire assessing sexual health care. Descriptive statistics were used to summarize demographic and clinical data. For group comparisons, dyadic dependencies were accounted for, applying paired t tests when normality (Shapiro–Wilk test) was met and Wilcoxon signed-rank test otherwise. Results A total of 128 participants (64 patients, 64 partners) were enrolled. Sexual satisfaction did not differ between patients ( M  = 55, SD = 20.9) and partners ( M  = 56.7, SD = 20) ( t test, p  = 0.46). A positive correlation was found between patients’ and partners’ sexual satisfaction ( r  = 0.62, p  < 0.0001). Satisfaction with partner sexuality was lower after diagnosis ( p  < 0.001, r  = 0.54)—with both patients and partners being less satisfied after the diagnosis (M = 2.58, SD = 0.95) than before ( M  = 3.14, SD = 0.74). Overall, 75% of the study participants reported not having received information about sexual health issues related to breast cancer, while 64% expressed a desire for more information. Conclusion The findings of this study highlight the importance of considering couple dynamics in breast cancer care. Patients and partners have unmet needs concerning sexual health in the context of breast cancer. Addressing sexuality may improve quality of life and psychosocial adjustment. Future research should include larger, more diverse samples and focus on assessing sexuality and sexual health as multidimensional constructs in line with WHO (World Health Organization) definitions.

Objectives To assess the value of new magnetic resonance imaging (MRI) techniques in cervical cancer. Methods We searched PubMed and MEDLINE and reviewed articles published from 1990 to 2016 to identify studies that used MRI techniques, such as diffusion weighted imaging (DWI), intravoxel incoherent motion (IVIM) and dynamic contrast enhancement (DCE) MRI, to assess parametric invasion, to detect lymph node metastases, tumour subtype and grading, and to detect and predict tumour recurrence. Results Seventy-nine studies were included. The additional use of DWI improved the accuracy and sensitivity of the evaluation of parametrial extension. Most studies reported improved detection of nodal metastases. Functional MRI techniques have the potential to assess tumour subtypes and tumour grade differentiation, and they showed additional value in detecting and predicting treatment response. Limitations included a lack of technical standardisation, which limits reproducibility. Conclusions New advanced MRI techniques allow improved analysis of tumour biology and the tumour microenvironment. They can improve TNM staging and show promise for tumour classification and for assessing the risk of tumour recurrence. They may be helpful for developing optimised and personalised therapy for patients with cervical cancer. Teaching points • Conventional MRI plays a key role in the evaluation of cervical cancer. • DWI improves tumour delineation and detection of nodal metastases in cervical cancer. • Advanced MRI techniques show promise regarding histological grading and subtype differentiation. • Tumour ADC is a potential biomarker for response to treatment.

Background and Objectives: Extremely preterm infants (<28 weeks’ gestation) face high risks of morbidity and mortality, and the optimal mode of delivery for this population is debated. This retrospective study evaluated the impact of delivery mode (vaginal vs. cesarean section) on neonatal outcomes in extremely preterm infants. Materials and Methods: Ninety-two singleton births at 22 + 0 to 25 + 6 weeks of gestation were analyzed. Primary endpoints were survival to discharge; intraventricular hemorrhage (IVH); necrotizing enterocolitis (NEC); and arterial umbilical cord pH. Secondary endpoints included APGAR scores; preterm premature rupture of membranes (PPROMs); and pathological vaginal microbial colonization. Results: Survival to discharge did not differ significantly between vaginal delivery (84.8%) and cesarean section (93.5%) (p = 0.140). No significant differences were observed for NEC, APGAR scores, or umbilical arterial cord pH. IVH occurred more often after vaginal birth (47.8% vs. 30.4%, p = 0.080). In multivariable analysis, male sex was significantly associated with adverse outcome (p = 0.041); while PPROM showed a borderline association (p = 0.079). Complete antenatal corticosteroid administration was more frequent in the cesarean group (p = 0.021) and represented a relevant confounder. Conclusions: Delivery mode had no significant effect on survival in this cohort, though IVH tended to occur more frequently after vaginal birth. Male sex and complete antenatal corticosteroid exposure were key determinants of neonatal outcome. Prospective studies are needed to establish evidence-based recommendations.

Psychosexual impairments in women with polycystic ovary syndrome (PCOS), often linked to depression, low self-esteem, and negative body image, significantly reduce quality of life. Although metabolic dysfunctions such as insulin resistance and obesity are key features of PCOS, their impact on psychosexual health remains poorly understood. This cross-sectional study aimed to examine the association between metabolic markers and psychosexual functioning in PCOS patients. Participants were recruited from the University Medical Center Mainz and diagnosed using the Rotterdam criteria. Assessments included hormonal and metabolic parameters - such as insulin resistance, body mass index (BMI), fatty liver index (FLI), and visceral adiposity index (VAI) - as well as psychosexual health, using the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). Logistic regression analyses revealed that visceral adiposity was associated with reduced sexual desire (odds ratio (OR) 2.56, p=0.016), and higher BMI (≥25 kg/m²) with reduced sexual satisfaction (OR 3.56, p=0.049). Elevated insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR) >5) and FLI (≥60) were associated with increased anxiety and depression, respectively. Overall, higher metabolic burden correlated with impaired sexual function and mental health. These findings highlight the importance of integrating metabolic and psychosexual assessments in PCOS care to better address patients' comprehensive well-being.

Background The clinical importance of tumor-infiltrating cluster of differentiation 4 (CD4) T cells is incompletely understood in early breast cancer. We investigated the clinical significance of CD4, forkhead box P3 (FOXP3), and B cell attracting chemokine leukocyte chemoattractant-ligand (C-X-C motif) 13 (CXCL13) in early breast cancer. Methods The study is based on the patient population of the randomized FinHer trial, where 1010 patients with early breast cancer were randomly allocated to adjuvant chemotherapy containing either docetaxel or vinorelbine, and human epidermal growth factor receptor 2 (HER2)-positive patients were also allocated to trastuzumab or no trastuzumab. Breast cancer CD4, FOXP3, and CXCL13 contents were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR), and their influence on distant disease-free survival (DDFS) was examined using univariable and multivariable Cox regression and Kaplan-Meier estimates in the entire cohort and in selected molecular subgroups. Interactions between variables were analyzed using Cox regression. The triple-negative breast cancer (TNBC) subset of the HE10/97 randomized trial was used for confirmation. Results High CXCL13 was associated with favorable DDFS in univariable analysis, and independently in multivariable analysis (HR 0.44, 95% CI 0.29–0.67, P ≤ 0.001), most strongly in TNBC (HR 0.39, 95% CI 0.19–0.79, P = 0.009). No significant interaction with chemotherapy or trastuzumab administration was detected. Neither tumor CD4 content nor FOXP3 content was associated with DDFS. The favorable prognostic influence of CXCL13 was confirmed in the HE10/97 trial patient population with TNBC (HR 0.30, 95% CI 0.09–0.93; P = 0.038). Conclusions The results provide a high level of evidence that humoral immunity influences the survival outcomes of patients with early breast cancer, in particular of those with TNBC. Trial registration The study reports retrospective biomarker analyses in the prospective FinHer trial and the prospective HE10/97 trial. ISRCTN76560285 . Registered on 18 March 2005. ACTRN12611000506998 . Registered on 16 May 2011.

Endometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis. Between 6.sup.th to 27.sup.th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VAS.sub.P, PDI.sub.P ), as well as the pain intensity and pain disability since implementation of social distancing measures (VAS.sub.I, PDI.sub.I). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as [DELTA]VAS and [DELTA]PDI. Pain experience and social support were assessed by a 5-point Likert scale. 285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening; p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms; p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p<0.001) of participants and 30.0% (p<0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p<0.001) and 31.5% (p<0.001) of participants reported less social support from their partner, family and friends. Physical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic.

Although the immunohistochemical expression of the transmembrane sialoglycoprotein podoplanin (D2-40) has been repeatedly reported as a factor of prognosis in various tumor entities—its potential prognostic relevance in squamous cell carcinomas of the vulva remains to be evaluated. In the present study, we evaluated 68 patients with primary vulvar carcinomas (VC) and analyzed the cytoplasmic/membranous immunohistochemical expression of podoplanin in viable tumor cells and cancer-associated fibroblasts (CAFs) within the adjacent peritumoral stroma. To determine potential associations between podoplanin expression and traditional clinicopathological parameters (e.g., tumor stage, infiltration depth, groin lymph node metastasis), as well as with local recurrences, metastases, and patient’s overall survival, subsequent data analysis was conducted using Spearman correlation analysis, Fisher’s exact test and the log-rank test (Mantel-Cox). Although our results did not substantiate a positive correlation of podoplanin expression in tumor cells or CAFs with traditional histomorphological parameters, we propose a prognostic potential of podoplanin as a tissue-based biomarker in HPV-associated VC. In our exploratory pilot study, we observed a significantly improved overall survival in this distinct subgroup (Log-rank (Mantel-Cox) test; p  = 0.0399). The results of our retrospective study may support the expectations that podoplanin, a common and widely available antibody, could be used as a tool for prognostic purposes in the future. Further research and validation are necessary before these markers can be implemented in clinical practice.

Vasa previa is a rare condition. However, since the increase in assisted reproductive technologies (ARTs), clinicians are more frequently confronted with this complication. In this study, we present five cases of vasa previa prenatally diagnosed from a tertiary referral hospital with approximately 2000 births yearly. Accurate prenatal diagnosis and sufficient management before the onset of labor improve the outcome of pregnancies complicated with vasa previa.