OBJECTIVE:To develop a predictive risk score for superficial peritoneal endometriosis (SPE) in patients with negative examination and imaging, based on symptoms and quality of life measures. DESIGN:Multicenter nested case-control study conducted from September 2022 to January 2024 at 18 certified endometriosis centers in Austria, Germany, and Switzerland. Women undergoing first-time surgery for suspected endometriosis had surgical findings documented using the #ENZIAN classification. Only women with isolated peritoneal endometriosis or no endometriosis were included in this analysis. Subjects completed standardized preoperative questionnaires, which assessed pain characteristics, symptom duration, analgesic intake, sexual function (FSFI), and health-related quality of life (EHP-30). Multiple imputation, logistic regression, and receiver operating characteristic curve analyses were performed. SUBJECTS:Of 845 women in the full study cohort, 229 met inclusion criteria, completed all questionnaires, and had complete surgical data available: 121 (53%) had SPE only, and 108 (47%) had no endometriosis. A validation cohort of 268 subjects (206 [77%] SPE and 62 [23%] no endometriosis) was analyzed. EXPOSURE:Pain-related variables, internally validated by bootstrapping, and externally validated in an independent cohort. MAIN OUTCOME MEASURES:Surgically diagnosed peritoneal endometriosis RESULTS: Severe dysmenorrhea (odds ratio [OR] 2.01; 95% CI, 1.14-3.53) and pain duration >3 years (OR 2.40; 95% CI, 1.40-4.11) were significantly associated with SPE. Dyspareunia, dysuria, dyschezia, pain only during menses, analgesic intake, family history, health-related quality of life, and sexual function were not. A 5-item predictive score (maximum six points) showed moderate discrimination in the development cohort (area under the curve [AUC] 0.64; 95% CI, 0.57-0.72), with similar performance on internal validation (AUC 0.64; 95% CI, 0.57-0.71). External validation demonstrated no predictive value (AUC 0.49; 95% CI, 0.41-0.58). CONCLUSION:Although severe dysmenorrhea and long duration of symptoms were associated with SPE, symptom profiles and functional questionnaires were insufficient for accurate prediction. The calculated score performed modestly internally but failed external validation. Given that symptoms common to endometriosis are also reported in women with other etiologies of pelvic pain, symptom-based models appear inadequate for reliable identification of SPE. Integrating clinical factors with biomarkers or emerging diagnostic technologies may be necessary to improve noninvasive diagnostic accuracy. Clinicians and patients should be aware of the high rate of negative surgical findings when making the decision to proceed with laparoscopy versus considering conservative medical therapies instead.

The study aimed to evaluate the long-term outcomes of surgical management in patients with peritoneal endometriosis, focusing on postoperative pain trajectories, re-operation rates, fertility outcomes, and the potential influence of hormone therapy. This retrospective study included 67 patients with histologically confirmed peritoneal endometriosis who underwent laparoscopic surgery. Surgical management consisted of excision in 62.7

Endometriosis is a chronic inflammatory disease associated with substantial impairment of quality of life. Although the #ENZIAN classification enables detailed anatomical characterization of disease distribution, its relevance for predicting patient-reported outcomes after surgery remains uncertain. Clarifying this relationship is essential for patient counseling and outcome-oriented surgical decision making. This multicenter study, registered on ClinicalTrials.gov (NCT05624567), prospectively recruited consecutive women aged 18 to 50 years undergoing surgery for suspected endometriosis at certified endometriosis centers in Austria, Germany, and Switzerland. Only women with surgically and histopathologically confirmed endometriosis who completed the baseline Endometriosis Health Profile-30 (EHP-30) questionnaire were included in the final analysis. Disease localization was classified intraoperatively using the #ENZIAN and rASRM systems. Quality of life was assessed using the EHP-30 questionnaire preoperatively and at 6 and 12 months after surgery. Longitudinal changes and predictors of quality-of-life outcomes were analyzed using ordinal logistic regression models. A total of 627 women were included at baseline, with 430 and 325 completing 6- and 12-month follow-up, respectively. Surgical treatment was associated with a marked and clinically meaningful improvement in quality of life, with EHP-30 scores improving significantly within the first 6 months after surgery and remaining stable at 12 months. This improvement was observed consistently across all #ENZIAN compartments, including deep infiltrating and multifocal disease. Anatomical disease distribution and rASRM stage were not significantly associated with baseline quality-of-life or postoperative recovery trajectories. In contrast, baseline symptom burden and complete surgical resection emerged as the strongest predictors of early postoperative quality-of-life improvement. Surgical treatment of endometriosis was associated with substantial and sustained improvement in patient-reported quality of life, independent of anatomical disease distribution as classified by #ENZIAN. These findings suggest that meaningful postoperative benefit can be achieved across all disease localizations and underscore the importance of focusing on symptom severity and surgical completeness rather than anatomical staging alone. Incorporating patient-reported outcome measures alongside anatomical classification is essential for comprehensive evaluation of treatment success.

Abstract Background Endometriosis is a highly prevalent, hormone-driven chronic disease characterized by the growth of endometrial tissue outside the uterine cavity. Despite its impact, the mechanisms underlying the disease’s pathogenesis remain poorly understood. We hypothesized that not only the ectopic endometrium of women with endometriosis differs from that of women without the disease, but also the eutopic endometrium. Accordingly, this study aimed to identify potential differences in basal expression of hormone receptors, their responses to hormonal treatment, as well as general morphology and growth factor dependencies among organoids derived from the endometrium of women without endometriosis and from the eutopic and ectopic endometrial tissues of patients with endometriosis. Methods Patient-derived organoids were established from the endometrium of women without endometriosis and from the eutopic and ectopic endometrial tissue of patients with endometriosis. To determine optimal culture conditions, primary isolates were seeded in parallel in medium containing the WNT signaling activators WNT3a and R-spondin-1 (RSPO1) or in medium supplemented with RSPO1 alone to evaluate WNT pathway requirements. Organoids were exposed to 17β-estradiol (E2), progesterone (P4) with cAMP, and the WNT inhibitor XAV939. The expression of estrogen receptor alpha and beta (ESR1, ESR2), progesterone receptor (PGR), and aromatase (CYP19A1) was measured via qPCR. Organoid morphology, growth, and aromatase expression were determined by brightfield and immunofluorescence imaging. Relative gene expression was calculated using the comparative CT method (ΔΔCT) to evaluate hormone responses across groups. Results Organoids derived from control donors and from eutopic endometrium of endometriosis patients exhibited robust long-term growth in medium supplemented with WNT3a and RSPO1, whereas ectopic endometriotic organoids proliferated best in medium containing only RSPO1, indicating reduced dependence on exogenous WNT pathway activation. Basal ESR1 and PGR expression was lower in lines from endometriosis patients than in control lines, indicating reduced E2 sensitivity and P4 responsiveness. ESR2 levels were uniformly low across groups. Upon E2 stimulation, ESR1 expression was consistently suppressed, whereas PGR expression was strongly induced in ectopic organoids (29.9-fold, ***p < 0.001), in eutopic organoids (13.5-fold, *p = 0.016), and to a lesser extent in organoids from women without endometriosis (5.2-fold, p = 0.069). P4-mediated downregulation of PGR required WNT inhibition. The effectiveness of amended hormonal stimulation with XAV939 in downregulating PGR in organoids was validated at the protein level via Western blotting (WB). Sporadic aromatase expression was detected exclusively in organoids derived from endometriosis patients. Conclusions These findings demonstrate that the eutopic endometrium of endometriosis patients exhibits altered responses to hormone stimulation. In this regard, it mirrors the characteristics of ectopic lesions more closely than those of endometrium from women without endometriosis. These results suggest that the endometrium plays an intrinsic role in the pathophysiology of endometriosis, providing a strong basis for future mechanistic studies.

Human biofluids serve as indicators of various physiological states, and recent advances in molecular profiling technologies hold great potential for enhancing clinical diagnostics. Leveraging recent developments in laser-based electric-field molecular fingerprinting, we assess its potential for in vitro diagnostics. In a proof-of-concept clinical study involving 2533 participants, we conducted randomized measurement campaigns to spectroscopically profile bulk venous blood plasma across lung, prostate, breast, and bladder cancer. Employing machine learning, we detected infrared signatures specific to therapy-naïve cancer states, distinguishing them from matched control individuals with a cross-validation ROC AUC of 0.88 for lung cancer and values ranging from 0.68 to 0.69 for the other three cancer entities. In an independent held-out test data set, designed to reflect different experimental conditions from those used during model training, we achieved a lung cancer detection ROC AUC of 0.81. Our study demonstrates that electric-field molecular fingerprinting is a robust technological framework broadly applicable to disease phenotyping under real-world conditions.

The number of young breast cancer (BC) patients is increasing in both high- and low-income countries. It is known that this population is at risk for more aggressive tumor phenotypes, larger tumor size at diagnosis and poorer prognosis. It is the aim of this population-based analysis to identify trends of therapy, tumor biology and prognosis during a period of 11 years in young patients under the age of 40. In this analysis, data of young BC patients (< 40 years) from two breast centers were collected and analysed. The focus was a summary of data regarding tumor phenotypes, treatment, and survival in young BC patients. Out of 11,954 patients with invasive BC who were eligible to the analysis, 781 (6.5

Purpose PROM after 37 weeks of gestation occurs in approximately 10% of pregnancies. When spontaneous onset of labour does not follow, induction is recommended to decrease the risk of infection for both mother and child. However, there is no clear consensus on whether induction before 24 h after PROM results in fewer complications compared to induction after > 24 h. Material and methods This retrospective observational study analysed the outcomes of 3174 women with PROM admitted to the delivery room of LMU Women's Hospital between 10/2015 and 09/2020. We evaluated whether timing of labour induction was associated with maternal or newborn postpartum infection rates. Results Comparing women with spontaneous onset of labour to those who underwent induction, no significant differences were found in maternal CRP or leukocyte levels, fever, endometritis, or Group B streptococcus colonization. However, intrapartum antibiotic therapy was significantly higher in the induction group. When the induction group was subdivided based on the interval from PROM to induction, no significant differences were observed in maternal infection parameters, need for antibiotics, postpartum length of hospital stay, or endometritis. For newborn infections, a significant difference in CRP levels was found, with higher levels in the groups with "induction < 12 h" and "> 24 h". Conclusion The presented data suggests that waiting for spontaneous contractions within the first 24 h after PROM was not associated with the risk of infection if no initial signs for infection are present. However, beyond 24 h, the risk of infection increased. These findings support current recommendations regarding the timing of induction after PROM.

Introduction: Since the risk of developing breast cancer (BC) increases with age, it is primarily a challenge for the older population. Older patients are often affected by comorbidities and frailty. The aim of this study was to determine the impact of adjuvant therapy on quality of life in older BC patients, considering their global health status including comorbidities. Methods: All BC patients aged 60 years old and above at initial diagnosis, who had been treated at the Breast Center of the LMU University Hospital of Munich, Germany, between 2010 and 2013, were eligible for participation. Quality of life was assessed by validated questionnaires. With a self-developed questionnaire, we assessed patients' general health status, oncological therapy as well as the Barthel Index and Charlson Comorbidity Index (CCI) as instruments of the geriatric assessment. Results: Data collected from 276 patients were included. Health-related quality of life (HRQoL) was affected by chemotherapy in the areas of physical function, mobility, fatigue, burden of disease, and financial difficulties. Regarding endocrine therapy, HRQoL was only affected in the area of burden of disease. A higher CCI and BMI as well as polymedication were significantly correlated with worse HRQoL. Conclusion: This cross-sectional, retrospective analysis indicates that chemotherapy affects HRQoL negatively in several quality of life areas in the first 3 years after the initial diagnosis of BC. CCI, obesity, and polymedication also impact on HRQoL. This knowledge should be incorporated into the treatment decision-making process and targeted measures should be offered to support older patients.

Optimal delivery mode for vaginal breech birth at term remains controversial, with varying recommendations across international guidelines. This study aimed to evaluate common perceptions and outcomes associated with VBB using retrospective data, including benefits of cesarean section, maternal and neonatal risks. We conducted a monocentric, retrospective cohort study over 21 years at a German tertiary perinatal center, examining term breech deliveries. Outcomes were compared between planned cesarean section and intended vaginal breech birth, with the latter group further categorized by successful and unsuccessful vaginal breech birth attempts. Of all deliveries, 3.6% (3172) were singleton breech presentations beyond 36 weeks gestation. Among these, 2501 cases (78.8%) were planned cesarean sections, while 671 cases (21.2%) were intended vaginal breech births. Within the intended vaginal breech birth group, 524 (78%) achieved vaginal delivery, whereas 147 (22%) required secondary cesarean section. Maternal outcomes showed significant differences in blood loss (p < 0.001) and hospital stay (p < 0.001), favoring the vaginal breech birth group with lower blood loss and shorter hospital stays. However, neonatal interventions, including bag-mask ventilation and resuscitation, were significantly more frequent in the vaginal breech birth group (p < 0.001), along with increased short-term neonatal morbidity such as neonatal infections (p < 0.001), transient tachypnea (p = 0.002), and hypoxic-ischemic encephalopathy (p = 0.008). The findings highlight an increase in intended vaginal breech births with a high rate of successful vaginal deliveries. Vaginal breech birth was associated with fewer maternal complications but elevated short-term neonatal morbidity. The results underscore the importance of individualized counseling and skilled provider presence when considering vaginal breech birth, supporting informed maternal choice and optimized delivery outcomes.

The global increase in interest in endometriosis highlights the importance of further investigations concerning this so-called benign gynecological disease. Owing to their severe presentation of symptoms, patients suffer from an enormous impact on their health-related quality of life (HRQoL). While the paper-based assessment of quality of life via, e.g., the “Endometriosis Health Profile-30 questionnaire (EHP-30)” seems to be largely accepted and implemented, the electronic measurement of this patient-reported outcome (ePRO) is still rarely applied. This study aimed to analyze the acceptance and usability of electronic assessments of HRQoL in endometriosis patients via the online platform CANKADO. The study was conducted at the Department of Gynecology and Obstetrics of LMU Munich between January 2022 and February 2023. Sixty conservatively treated patients with endometriosis were recruited for the randomized cohort study, followed by randomization due to their planned interrogation modality (n paper-based = 23, n online-based = 17). Afterwards, a HRQoL assessment via the EHP-30 questionnaire was performed. An evaluation of the interrogation modalities was performed at 0, 6 and 12 months. The metric or categorical variables were compared via Fisher’s exact test or the Mann‒Whitney U test. Correlation analysis was performed by calculating the Kendall Tau coefficient or Eta coefficient. Forty patients completed evaluation forms at T0 (0 months), with n = 23 evaluating the paper-based interrogation modality and n = 17 evaluating the online version. At all the time of assessment, more than 80

STUDY QUESTION:Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system? SUMMARY ANSWER:Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis. WHAT IS KNOWN ALREADY:Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success. STUDY DESIGN, SIZE, DURATION:This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS:The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed. MAIN RESULTS AND THE ROLE OF CHANCE:Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]). LIMITATIONS, REASONS FOR CAUTION:A larger study population is needed to clinically define relevant sub-groups based on localization of lesions. WIDER IMPLICATIONS OF THE FINDINGS:The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites. STUDY FUNDING/COMPETING INTEREST(S):This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study. TRIAL REGISTRATION NUMBER:Clinical Trials NCT05624567.

Background:The decision-making process regarding adjuvant treatment in estrogen receptor-positive (ER+), HER2-negative early-stage breast cancer (EBC) is often not sufficient, when based on established clinicopathological parameters. Additional prognostic tests could facilitate these decisions. This paper compares the well-validated invasion marker urokinase plasminogen activator/plasminogen activator inhibitor-1 (uPA/PAI-1) with the Prosigna® assay, which is based on the PAM50 gene signature. Prosigna® also provides a prognostic risk assessment (risk of recurrence, Prosigna®-ROR), taking tumor burden and the intrinsic molecular subtype into account. Methods:From October 2013 to April 2014, we selected 42 postmenopausal EBC patients (ER+/HER2-) from the database of the Breast Centre of the University of Munich (LMU). In the context of therapy decision-making, uPA/PAI-1 testing had already been performed on the selected patients' fresh frozen tumor tissue. The patient's data were pseudonymized, and the Prosigna® assay was performed retrospectively using archived Formalin-fixed paraffin-embedded tumor samples. A 5-year follow-up was carried out in March 2021. Results:All patients (n = 42) had ER+/HER2-negative invasive breast cancers. According to Prosigna®, 22 (52.4%) tumors were classified as low-risk, 14 (33.3%) as intermediate-risk, and 6 (14.3%) as high-risk. Among the 22 Prosigna® low-risk tumors, 13 (59.1%) were classified as uPA/PAI-1 low-risk and 9 (40.9%) were classified as uPA/PAI-1 high-risk. The 14 Prosigna® intermediate-risk tumors divided into 6 (42.9%) uPA/PAI-1 low-risk and 8 (57.1%) uPA/PAI-1 high-risk. Among the 6 patients classified as high-risk using Prosigna®-ROR, one (16.7%) was classified as low-risk and the other 5 (83.3%) as high-risk using uPA/PAI-1. The comparison of the intrinsic subtypes (luminal A, luminal B, basal-like) based on Prosigna® assay with the risk groups of uPA/PAI-1 showed only poor correlation. A 5-year follow-up with the endpoints ipsilateral recurrence, contralateral recurrence, distant metastasis, and death could be obtained in 67% (28/42) of the initially included patients. In two of these cases, one of these events occurred. The risk stratification of uPA/PAI-1 and Prosigna® did not match in these tumors. Conclusion:In luminal EBC, there is only limited concordance between risk group classification according to the Prosigna®-ROR, Prosigna®-luminal subtypes, and risk classification by uPA/PAI-1. Risk classification by uPA/PAI-1 compared to the Prosigna® assay resulted in a larger high-risk group with a clear recommendation for adjuvant chemotherapy (CTX). A larger study population in a prospective setting and more detailed outcome data would be necessary to understand the clinical relevance of the observed discrepancies. Only one evidence-based guideline-recommended prognostic test should be used in a single patient for CTX decision-making.

Introduction: Medical treatment of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) targets prostate smooth muscle tone for rapid relieve of symptoms and prostate size to prevent disease progression. Recently, EAU guidelines introduced phytomedicines for treatment of LUTS/BPH. Phytosterols may reduce the risk of prostate diseases and seem to be the smallest common denominator between different phytotherapeutic preparations. Thus, we investigated the effects of the highly concentrated phytosterol β-sitosterol on human prostate smooth muscle contraction and cellular functions, including contraction and growth of prostate stromal cells. Materials and Methods: APOPROSTAT® forte capsules (>70% β-sitosterol, ethanol extract of Pinus pinaster) were dissolved in ethanol. Contractions were induced in human prostate tissues (n = 100) obtained from radical prostatectomy and assessed in organ bath setups. Cytoskeletal organization, proliferation, viability, cytotoxicity, and contraction in stromal cells (WPMY-1) were assessed using phalloidin staining, EdU, colony formation, CCK-8, flow cytometry, and matrix collagen assays. Results: APOPROSTAT® forte (0.1–30 µg/mL) inhibited adrenergic, non-adrenergic, and neurogenic contractions of human prostate tissues by up to 71%, 69%, and 63%, respectively, in a dose-dependent manner. In WPMY-1 cells, it reduced proliferation and actin organization by up to 67% and 75% after 72 h, without affecting viability or inducing cytotoxicity. Colony formation decreased by up to 60% after 168 h, and contraction in collagen matrix assays was reduced by 57% in a concentration- and time-dependent manner. Conclusions: The natural phytosterol β-sitosterol effectively inhibits both prostate contraction and growth with a favorable safety profile, supporting its beneficial role in LUTS management through phytotherapy.

The aim of this retrospective study was to analyze the prognostic value of cytoplasmic versus nuclear expression of the vitamin D receptor (VDR) in breast cancer (BC) tissue samples and to relate the results to clinicopathological parameters. VDR expression was assessed in 319 primary breast cancer patients using the Remmele and Stegner immunoreactive scoring (IRS) system. Follow-up data were obtained from the Munich Cancer Registry. The correlation with overall survival (OS) and disease-free survival (DFS) was calculated using univariate and multivariate analyses. Correlation analysis revealed a correlation between nuclear VDR expression and improved outcomes for both OS (p=0.004) and DFS (p=0.001). Conversely, cytoplasmic VDR expression was significantly associated with a shorter OS (p=0.003) and DFS (p<0.001). Additionally, both cytoplasmic and nuclear VDR expression were found to be independent markers of DFS (p<0.001; p=0.021) when examined alongside clinicopathological parameters. Moreover, nuclear VDR expression was positively associated with lower lymph node invasion (pN; p=0.01). For triple-negative patients, cytoplasmic VDR expression was found to have a significant inverse correlation with DFS (p<0.001). Lastly, the ratio of VDR nuclear/cytoplasmic was identified as an auxiliary independent marker of DFS and OS. These findings strongly indicate that the subcellular localization of VDR is crucial in determining BC prognosis. The expression of nuclear VDR appears to have a protective effect, while cytoplasmic VDR is associated with a more aggressive disease course. The data may help identify subgroups of patients with high-risk BC, possibly leading to specific options for targeted tumor therapy.

Background/Objectives: Histone modifications play a key role in the regulation of gene transcription, with alterations in these modifications influencing trophoblast invasion and migration, crucial for placental development. Previously, we observed reduced trimethylated histone H3K4me3 and acetylated H3K9ac levels in the placentas of women with preeclampsia, associated with impaired transcriptional access. This study aims to investigate the impact of SARS-CoV-2 infection on histone modifications in placentas. Methods: Immunohistochemical Staining and Double-staining Immunofluorescence were performed on placentas of patients during after a SARS-CoV-2 infection during pregnancy as well as vaccinated and not vaccinated controls. Results: Our findings reveal that both H3K4me3 and H3K9ac are significantly reduced in placentas following SARS-CoV-2 infection during pregnancy, with more pronounced alterations observed compared to infections during birth. Additionally, vaccination did not exhibit a stronger effect than infection itself on histone modifications. Conclusions: Reduced H3K9ac and H3K4me3 suggest a more repressive chromatin state, likely silencing key placental genes through increased HDAC activity. These epigenetic changes may impair placental function and lead to pregnancy complications, underscoring the need for further research.

OBJECTIVES:The chemokine CCL22 is recognized for recruiting immunosuppressive regulatory T-cells (Treg) that contribute to disease progression in various tumor entities helping them to evade the host immune response. Our study aims to identify the expressing cell types and to evaluate the prognostic significance of CCL22 secretion and its association with Treg invasion in endometrial cancer (EC), an immunogenic cancer. METHODS:Specimens from 275 patients with EC and 28 healthy controls were screened immunohistochemically for CCL22. Immunofluorescence double-staining for CCL22 and different immune cell markers was performed. In vitro regulation of CCL22-expression was examined in EC cell lines (Ishikawa+, RL95-2) and human PBMCs in coculture settings via qPCR and ELISA. RESULTS:Elevated CCL22 staining in tumor cells and CCL22-positive M1-macrophages in tumordistant areas were significantly associated with increased overall survival (OS). Conversely, high, secretory-appearing staining in the peritumoral and intratumoral stroma correlated with reduced OS. Although the analysis of the in vitro coculture model of epithelial tumor- and immune cells revealed PBMCs as the primary source of CCL22, we could confirm expression of the chemokine also in the EC epithelial cells. CONCLUSION:Our study suggests that CCL22 in EC is associated with OS, dependent on its location and the cell type producing it. Intracellular upregulation and extracellular secretion must be considered separately when investigating CCL22 expressing cell types in EC. These results may provide evidence for CCL22-mediated Treg recruitment in EC as a potential future therapeutic target.

Gestational diabetes mellitus (GDM) is a common condition during pregnancy. The prevalence of GDM is continuously increasing worldwide. Due to accessible diagnostic methods and a clear understanding of risk factors, GDM can be effectively diagnosed and managed. Galectins may influence immunomodulatory and inflammatory processes. This study examines the expression of galectin-7 in the placentas of women with gestational diabetes (GDM), compares it to its expression in healthy pregnancies, and evaluates the associated clinical outcomes. The placentas of 40 healthy women and 40 GDM placentas were included in the cohort. The expression level of galecin-7 was measured in the syncytiotrophoblast (SCT) and in the decidua of the placenta by immunohistochemistry and double immunofluorescence staining. The evaluation was performed by an immunoreactivity score (IRS). The study results show an increased expression of galectin-7 in the SCT and the decidua of GDM placentas as compared to the placentas of the control group. Elevated levels of galectin-7 were observed in both the nucleus and the cytoplasm. This study investigated the hypothesis that galectins are involved in pathophysiological processes of gestational diabetes. Statistical analysis of gene expression patterns confirmed that galectin-7 is indeed upregulated in GDM placentas. Further studies are needed to show the correlation of galectin-7 and the development and maintenance of gestational diabetes mellitus.

Postpartum depression (PPD) is a severe complication in the postpartum period and equals a major depression occurring in the first weeks after delivery. During the COVID-19 pandemic, an increased incidence of PPD was observed. For this reason, we conducted an intervention study to test the effectiveness of the “7mind”-app, an app-based mindfulness training program, in the prevention of PPD. For this purpose, 145 women who gave birth between March and September 2021 were observed up to six months postpartum, with 80 women using the “7mind”-app. The BSF (Berlin Mood Questionnaire) and the EPDS (Edinburgh Postnatal Depression Scale) were used to measure depressive symptoms at different time points and were supplemented by questionnaires regarding COVID-related anxieties. The BSF showed a significant improvement over time in the categories “anxiety” (p < .001) and “fatigue” (p < .001). Regarding the EPDS, there were no significant differences between the intervention and control groups. With a mean EPDS of 7.6 prepartum and 7.4 postpartum, our sample group can be classified as a low-risk collective. Furthermore, there were no significant differences between the control and intervention groups with regard to COVID-19-related anxiety. However, a comparison of the correlation analysis of COVID-19-related fears over time showed a clear advantage of the intervention. In particular, fear of the consequences of maternal COVID-19 infection increased significantly in the control group over time (r = 0.98, p = 0.040), while there was no significant change in the intervention group (r = −0.39, p = 0.218). In conclusion, the intervention with the app “7mind” seems to lead to a clear benefit in the prevention of general anxiety and COVID-19-related anxieties, but needs further research to represent a valid intervention for the prevention of PPD.

Purpose: Lower urinary tract symptoms (LUTS) consist of voiding and storage symptoms. While the therapeutic efficacy of current LUTS medications is limited, and with more than 20% of patients suffering from mixed symptoms, current guidelines offer nothing more than combining monotherapies. An individualized approach is urgently warranted, and phytomedicines have become an integral part of patient-empowerment in therapeutic shared-decision making processes. Therefore, we aimed to investigate patients' preference of phytomedicines and treatment adherence at the dawn of an era leaving alpha 1-blocker monotherapies behind. Patients and Methods: A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 300 patients during their visits from January 2022 to December 2022. Results: With 73% (218/300), most of our study cohort had either taken one or more or were currently on prescription medication for LUTS/BPH. Patients were prescribed alpha 1-blockers (72%), followed by 5 alpha-reductase inhibitors (21%), and phosphodiesterase-5-inhibitor (5%), while antimuscarinics and beta 3-agonists were rarely prescribed. However, 41% (89/218) of our patients, who were taking medication for LUTS, had taken or were currently taking phytomedicines, making this the second most common drug class in our patient cohort. Patients scored the efficacy of phytomedicines at a mean in the lower third, but 87% of patients attributed excellent tolerability, and only 9% experienced side effects. While 43% of patients recommended phytomedicines for other patients, two-thirds of patients thought phytomedicines should be covered by statutory health insurance. Conclusion: We found that phytomedicines were the second most common drug class taken by LUTS patients at our hospital. Reasons may be easy availability as over the counter medication and a superior safety profile with less bothersome side effects than commonly prescribed drug classes. Taken together, phytomedicines may be able to bridge an important gap in LUTS pharmacotherapy to provide sufficient treatment adherence where prescription drug classes fail, and ultimately, adequate improvement of symptoms. However, patients need to be counseled on potentially limited efficacy.