Brain metastases are the most severe tumorous spread during breast cancer disease. They are associated with a limited quality of life and a very poor overall survival. A subtype of extracellular vesicles, exosomes, are sequestered by all kinds of cells, including tumor cells, and play a role in cell-cell communication. Exosomes contain, among others, microRNAs (miRs). Exosomes can be taken up by other cells in the body, and their active molecules can affect the cellular process in target cells. Tumor-secreted exosomes can affect the integrity of the blood-brain barrier (BBB) and have an impact on brain metastases forming. Serum samples from healthy donors, breast cancer patients with primary tumors, or with brain, bone, or visceral metastases were used to isolate exosomes and exosomal miRs. Exosomes expressed exosomal markers CD63 and CD9, and their amount did not vary significantly between groups, as shown by Western blot and ELISA. The selected 48 miRs were detected using real-time PCR. Area under the receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy. We identified two miRs with the potential to serve as prognostic markers for brain metastases. Hsa-miR-576-3p was significantly upregulated, and hsa-miR-130a-3p was significantly downregulated in exosomes from breast cancer patients with cerebral metastases with AUC: 0.705 and 0.699, respectively. Furthermore, correlation of miR levels with tumor markers revealed that hsa-miR-340-5p levels were significantly correlated with the percentage of Ki67-positive tumor cells, while hsa-miR-342-3p levels were inversely correlated with tumor staging. Analysis of the expression levels of miRs in serum exosomes from breast cancer patients has the potential to identify new, non-invasive, blood-borne prognostic molecular markers to predict the potential for brain metastasis in breast cancer. Additional functional analyzes and careful validation of the identified markers are required before their potential future diagnostic use.

Background: Pelvic palpation is a core component of every Gynecologic examination. It requires vigorous training, which is difficult due to its intimate nature, leading to a need of simulation. Up until now, there are mainly models available for mere palpation which do not offer adequate visualization of the concerning anatomical structures. In this study we present a 3D printed model of the female pelvis. It can improve both the practical teaching of gynecological pelvic examination for health care professionals and the spatial understanding of the relevant anatomy. Methods: We developed a virtual, simplified model showing selected parts of the female pelvis. 3D printing was used to create a physical model. Results: The life-size 3D printed model has the ability of being physically assembled step by step by its users. Consequently, it improves teaching especially when combining it with commercial phantoms, which are built solely for palpation training. This is achieved by correlating haptic and visual sensations with the resulting feedback received. Conclusion: The presented 3D printed model of the female pelvis can be of aid for visualizing and teaching pelvic anatomy and examination to medical staff. 3D printing provides the possibility of creating, multiplying, adapting and sharing such data worldwide with little investment of resources. Thus, an important contribution to the international medical community can be made for training this challenging examination.

Herbert SL, et al. J Breast Cancer. 2023 May;26:e23. https://doi.org/10.4048/jbc.2023.26.e23

Purpose: Although therapy and psychosocial care for patients with breast cancer and gynaecological cancer has improved in the last years, there are still many issues that require further investigation. Unmet supportive care needs can lead to a lower adherence to treatment and a lower quality of life. Patients’ needs seem to be highest during the time of treatment. Thus, this study investigated needs and quality of life. Methods: In this German prospective study, we enrolled 292 patients with breast cancer and gynaecological cancer during the time of treatment. Data on needs were assessed using instruments that had proven feasible in earlier studies. Data on quality of life (QoL) were assessed using the European Organization for Research and Treatment of Cancer QoL Core Questionnaire (EORTC QLQ-C30). We investigated correlations between needs and sociodemographic data as well as quality of life. Results: Among all cancer entities we observed that 150 patients (51.5%) showed unmet information needs, 221 patients (75.7%) showed at least one high supportive care need, and 91 patients (31.2%) had psychological care needs. Data showed statistically significant correlations between these needs and sociodemographic data as well as quality of life. These correlations generally showed small to medium effect sizes. Older women showed less supportive care needs (r = − 0.24; p < 0.001), (r = − 0.15; p = 0.010). Furthermore, recruitment after surgery was associated with statistically significant higher information needs (r = 0.14; p = 0.015), whereas recruitment during chemotherapy was associated with statistically significant less information needs (r = − 0.15; p = 0.013). Positive correlations were shown for the level of received information and physical functioning (r = 0.12; p = 0.047), social functioning (r = 0.16; p = 0.009) and global quality of life (r = 0.19, p = 0.002) as well as satisfaction with information and physical (r = 0.16; p = 0.006), social (r = 0.24; p < 0.001), cognitive functioning (r = 0.14; p = 0.017) as well as global quality of life (r = 0.25; p < 0.001). Negative correlations were reported for information needs and emotional functioning (r = − 0.12; p = 0.035) and global quality of life (r = − 0.15; p = 0.011). Supportive care needs also correlated negatively with physical (r = − 0.23; p < 0.001), role (r = − 0.23; p < 0.001), emotional (r = − 0.35; p < 0.001), cognitive (r = − 0.24; p < 0.001), social functioning (r = − 0.30; p < 0.001), and global quality of life (r = − 0.35; p < 0.001). Also, patients with at least one high supportive care need correlated negatively with role (r = − 0.15; p = 0.014), emotional (r = − 0.23; p < 0.001), social functioning (r = − 0.30; p = 0.001), and global quality of life (r = − 0.35; p < 0.001). There was no statistical significance concerning cancer side. Thus, both groups are reported together. Furthermore, there was no statistical significance concerning disease status. Conclusion: Overall, this study highlights the importance of tailored information and supportive care interventions. Addressing these needs, particularly in terms of information provision and psychosocial support, could lead to improved quality of life and better overall patient outcomes.

Purpose: Electrosurgery is the gold-standard procedure for the treatment of cervical dysplasia. The quality of the outcome depends on the accuracy of performance, which underlines the role of adequate training of surgeons, especially, as this procedure is often performed by novice surgeons. According to our knowledge, medical simulation has up until now lacked a model, which focuses on realistically simulating the treatment of cervical dysplasia with the concerning anatomy. Methods and result: In our work, we present a model created using 3D printing for holistically simulating diagnostic, as well as surgical interventions of the cervix, as realistically as possible. Conclusion: This novel simulator is compared to an existing model and both are evaluated. By doing so, we aim to provide novice gynecologists with standardized and high-quality simulation models for practicing to improve their proficiency.

Research question: Does complete resection of endometriosis improve embryo quality as assessed by morphokinetic parameters using time-lapse microscopy? Design: For this retrospective study we analysed 237 fertilised, cultured and transferred embryos from 128 fresh IVF and/ or ICSI transfer cycles. Endometriosis was confirmed or excluded by laparoscopy. Patients were stimulated with recombinant FSH using GnRH agonist and antagonist protocols. After fertilisation, a time-lapse incubation system was used for observation. Embryo quality was assessed using the KIDScore™ D3 and D5 implantation data algorithm. Results: The analysis showed a median KIDScore™ D5 of 2.6 (on a scale of 1 to 9.9) for embryos from patients with endometriosis without complete resection. The control group without endometriosis achieved a score of 6.8 (p = 0.003). The median score for embryos from endometriosis patients with complete resection was 7.2, which was a significant increase compared to embryos from patients without complete resection (p = 0.002). We observed an effect size of r = 0.4 for complete resection versus no resection of endometriosis using the KIDScore™ D5. There were no differences in KIDScore™ D3 between the three patient groups. Pregnancy and miscarriage rates showed the same clinical trends. In three of our four case series of patients who underwent IVF/ ICSI cycles before and after complete resection, we found a marked improvement in embryo quality after complete resection. Conclusions: Complete resection of endometriosis could significantly improve the otherwise poor embryo quality of patients undergoing IVF-procedures. The data, therefore, strongly support recommending surgery to patients with endometriosis prior to assisted reproduction.