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The effectiveness of natural killer (NK) cells transferred adoptively in combating solid tumours is limited by challenges such as their difficulty in penetrating tumours from the bloodstream and maintaining viability without the support of interleukin-2 (IL-2). Genetically modified NK-92MI cells, which can release IL-2 to sustain their viability, have been identified as a promising alternative. This adaptation addresses the negative consequences of systemic IL-2 administration. The role of PSD-95/discs large/ZO-1 (PDZ)-binding kinase (PBK) in cancer development is recognized, but its effects on immunity are not fully understood. This study explores how PBK expression influences the ability of NK-92MI cells to infiltrate ovarian tumours. Elevated levels of PBK expression have been found in various cancers, including ovarian cancer (OV), with analyses showing higher PBK mRNA levels in tumour tissues compared to normal ones. Immunohistochemistry has confirmed increased PBK expression in OV tissues. Investigations into PBK's role in immune regulation reveal its association with immune cell infiltration, indicating a potentially compromised immune environment in OV with high PBK expression. The small-molecule inhibitor HI-TOPK-032, which inhibits PBK, enhances the cytotoxicity of NK-92MI cells toward OV cells. It increases the production of interferon-γ and tumour necrosis factor-α, reduces apoptosis and encourages cell proliferation. Mechanistic studies showed that contact with OV cells treated with HI-TOPK-032 upregulates CD107a on NK-92 cells. In vivo studies demonstrated that HI-TOPK-032 improves the antitumour effects of NK-92MI cells in OVCAR3Luc xenografts, extending survival without significant side effects. Safety assessments in mice confirm HI-TOPK-032's favourable safety profile, highlighting its potential as a viable antitumour therapy. These results suggest that combining NK-92MI cells with HI-TOPK-032 enhances antitumour effectiveness against OV, indicating a promising, safe and effective treatment strategy that warrants further clinical investigation. [ABSTRACT FROM AUTHOR]

Purpose: Digitalization plays a critical role and is beginning to impact every part of the patient journey, from drug discovery and data collection to treatment and patient-reported outcomes. We aimed to evaluate the status quo and future directions of digital medicine in the specialty of gynecology and obstetrics in Germany. Methods: An anonymous questionnaire was distributed via the German Society of Gynecology and Obstetrics newsletter in December 2022. The questionnaire covered the domains baseline demographic information, telemedicine, digital health applications (DIGAs), and future expectations. Results: In all, 91 participants completed the survey. Median age was 34 years; 67.4% (60 of 89) were female and 32.6% (29 of 89) were male. About 10% (9 of 88) have prescribed DIGAs to date and 14% (12 of 86) offer telemedical appointments. Among those who do not use digital medicine, very few plan to do so in the near future. Reasons include missing software interfaces, lack of time to try out new things, lack of knowledge, lack of monetary compensation (66.3%), and employee concerns. A majority agreed that digitalization will help to save time and improve patient care and that intelligent algorithms will aid clinicians in providing patient care to women. Conclusions: The status quo and future directions of digital medicine in gynecology and obstetrics in Germany are characterized by contradicting expectations regarding the benefits of digital medicine and its actual implementation in clinical routine. This represents an important call to action to meet the requirements of modern patient care. [ABSTRACT FROM AUTHOR]

Purpose: Hospital information systems (HIS) play a critical role in modern healthcare by facilitating the management and delivery of patient care services. We aimed to evaluate the current landscape of HIS in the specialty of gynecology and obstetrics in Germany. Methods: An anonymous questionnaire was distributed via the German Society of Gynecology and Obstetrics newsletter in December 2022. The questionnaire covered the domains baseline demographic information, satisfaction with daily use, satisfaction with implementation, and degree of digitization. Results: Ninety-one participants completed the survey. Median age was 34 years; 67.4% (60 of 89) were female, and 32.6% (29 of 89) were male. Of the survey participants, 47.7% (42 of 88) were residents, 26.1% (23 of 91) senior physicians, and 9.1% (8 of 88) medical directors. The degree of digitization of clinical documentation is mainly mixed digital and paper-based (64.0%, 57 of 89) while 16.9% (15 of 89) operate mainly paper-based. The current HIS has been in use on average for 9 years. The median number of different software systems used in daily routine is 4. About 33.7% (30 of 89) would likely or very likely recommend their current HIS to a colleague. Conclusions: The current landscape of HIS in gynecology and obstetrics in Germany is characterized by a high heterogeneity of systems with low interoperability and long service life; thus, many healthcare professionals are not satisfied. There is both a need to enhance and an interest in modernizing the technological infrastructure to meet today's requirements for patient care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the implementation of intervention packages for postpartum hemorrhage (PPH) management in pregnant women hospitalized in a High Obstetric Complexity Unit in a Latin American country. Methods: Retrospective cohort study including pregnant women with PPH attended between January 2011 to December 2019. Three periods of time were defined according to management strategies We performed univariate and multivariate robust Poisson regression logistic models for each of the outcomes derived from each period. Results: We included 602 patients. There was a reduction in period 3 of the incidence of massive PPH (16% versus 12% P < 0.001, relative risk [RR] 0.61, 95% confidence interval [CI] 0.44–0.85; P = 0.003), major surgery (24%, 13%, 11%, P = 0.002, RR 0.54, 95% CI 0.33–0.883; P = 0.014), and admission to the intensive care unit (ICU) (14%, 7%, 6.1%, P = 0.0, RR 0.40, 95% CI 0.17–0.96 P = 0.00). Conclusion: The implementation of PPH intervention packages in a hospital in a middle‐income country from Latin America, led to a significant decrease in the incidence of massive bleeding, the rate of major surgery, and the ICU stay of pregnant women affected by this condition. Synopsis: Intervention packages for PPH in LMICs enable integrated care for early detection of PPH risk, early recognition, and interventions to reduce its progression. [ABSTRACT FROM AUTHOR]

Uterine cancers are classified into cancers of the corpus uteri (uterine carcinomas and carcinosarcoma) and corpus uteri (sarcomas) by the AJCC staging system (eighth edition). Endometrial carcinoma is the most common amongst these with prolonged estrogen exposure being a well-known risk factor. The FIGO staging system for endometrial carcinoma is primarily surgical and includes total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Imaging is useful in the preoperative evaluation of tumor stage, especially assessment of myometrial invasion and cervical stromal extension. Dynamic contrast enhanced MRI with DWI has a high staging accuracy and is the preferred imaging modality for primary evaluation with contrast-enhanced CT abdomen being indicated for recurrent disease. PET/CT is considered superior in evaluation of lymph nodes and extra pelvic metastases. [ABSTRACT FROM AUTHOR]

Objective: To identify and describe the certainty of evidence of gynecology and obstetrics systematic reviews (SRs) using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Method: Database searches of SRs using GRADE, published between 1 January 2016 to 31 December 2020, in the 10 "gynecology and obstetrics" journals with the highest impact factor, according to the Journal Citation Report 2019. Selected studies included those SRs using the GRADE approach, used to determine the certainty of evidence. Results: Out of 952 SRs, ninety-six SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Sixty-seven SRs (7.04%) rated the certainty of evidence for specific outcomes. In total, we identified 946 certainty of evidence outcome ratings (n = 614 RCT ratings), ranging from very-low (42.28%) to low (28.44%), moderate (17.65%), and high (11.63%). High and very low certainty of evidence ratings accounted for 2.16% and 71.60% in the SRs of NRSs, respectively, compared with 16.78% and 26.55% in the SRs of RCTs. In the SRs of RCTs and NRSs, certainty of evidence was mainly downgraded due to imprecision and bias risks. Conclusions: More attention needs to be paid to strengthening GRADE acceptance and building knowledge of GRADE methods in gynecology and obstetrics evidence synthesis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether students' attitude towards online learning in Gynecology and Obstetrics changed during the COVID-19 pandemic. We further examined which variables impacted students' satisfaction with digital learning.Methods: A specifically developed questionnaire was used from June 2020-July 2021 for N = 234 medical students participating in the course "Gynecology and Obstetrics" at University of Heidelberg. Thirty-five items were repeatedly applied in different cohorts to assess structure- and content-related quality of teaching. In addition, their influence on overall satisfaction with digital teaching was analyzed by applying investigative analyses like multiple regression and extreme group comparisons.Results: Especially items associated with content-related quality of teaching (β = 0.24), organization of teaching (β = 0.25) and subjective learning success (β = 0.27) seemed to be relevant predictors for overall satisfaction with courses. Fears and changes due to the pandemic situation also played a role for a subgroup of students. Aspects linked to technical quality of teaching, interactions with teachers and students or advantages of web-based learning appeared to play a subordinate role for overall satisfaction with digital teaching. Comparisons of ratings over time revealed that teaching evaluations almost remained the same.Conclusion: Our results give several hints regarding how digital teaching should be designed and how it can be improved. Further studies are needed to validate our results and to develop methods to improve digital teaching in medicine. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this survey was to assess medical students' opinions about online learning programs and their preferences for specific teaching formats during COVID 19 pandemic. Methods: Between May and July 2020, medical students who took an online gynecology and obstetrics course were asked to fill in a questionnaire anonymously. The questionnaire solicited their opinions about the course, the teaching formats used (online lectures, video tutorials featuring real patient scenarios, and online practical skills training), and digital learning in general. Results: Of 103 students, 98 (95%) submitted questionnaires that were included in the analysis. 84 (86%) students had no problem with the online course and 70 (72%) desired more online teaching in the future. 37 (38%) respondents preferred online to traditional lectures. 72 (74%) students missed learning with real patients. All digital teaching formats received good and excellent ratings from > 80% of the students. Conclusion: The survey results show medical students' broad acceptance of the online course during COVID 19 pandemic and indicates that digital learning options can partially replace conventional face-to-face teaching. For content taught by lecture, online teaching might be an alternative or complement to traditional education. However, bedside-teaching remains a key pillar of medical education. [ABSTRACT FROM AUTHOR]

Introduction: TAP (transversus abdominis plane block) is part of multimodal postoperative analgesia used in various gynecological, abdominal and urological surgeries. Transverse abdominis plane (TAP) block is a type of peripheral nerve block which involves the innervation of the nerves covering the anterior abdominal wall (T6-L1 anterior branch). It contains intercostal, subcostal, iliohypogastric, and ilioinguinal nerves. They are responsible for the innervation of the skin, muscles and parietal peritoneum of the anterior and posterior abdominal wall. As part of multimodal analgesia, it accelerates recovery and mobilization of the patient, reduces stress response, and significantly minimizes and eliminates the use of opioids in postoperative analgesia, thus reducing all their side effects (sedation, vomiting, reduced intestinal motility, negative effects during the infant breastfeeding). It is done preoperatively before surgical incision, or most often, at the end of surgical procedure, before the patient's awakening. Before the TAP block, the written consent of the patient should be obtained and the possible risks, benefits, alternatives of pain therapy should be discussed. Contraindications are absoule and they involve patient's refusal, allergy to local anesthetic, infection at the site of the block. Coagulopathy and surgery at the site of the block are relative. Materials and methods: the following is required for TAP block: ultrasound-linear probe (10-14Hz), sterile cover, gel. The aria is aseptically cleaned, sterile gloves are used, a local anesthetic, usually 0.25% of ropivacaine/bupivacaine/levobupivacaine, is loaded into a 20ml syringe, and with the help of 50-100mm (22-25G) block needles the prescribed dose for TAP block is administered. Monitoring is also required, as well as resuscitation equipment and lipid emulsion. Ultrasound identifies 3 muscles of the abdominal wall, externus obliqus (EO), internus obliqus (IO), transversus abdominis (TA). The method itself is simple; with the ultrasound quidance, the needle is placed between the IO and the TA, the fascia is pierced and a local anesthetic is applied. There are several approaches with respect to the anatomical location of the block: subcostal, lateral and posterior approache, which can subsequently be combined depending on surgical field, and thus we have unilateral blocks, dual and bilateral TAP blocks. Rare complications include: failure, bleeding (hematoma), infection, LA systemic toxicity, intraperitoneal injection, visceral injury (intestines, liver), transient nerve injury. Conclusion: TAP block as a multimodal analgesia is the most optimal when applied after a cesarean section, it significantly reduces postoperative pain, delays the time to the first, reduces the total consumption of analgesics, accelerates mobilization and facilitates breathing and expectoration. TAP block is an alternative to spinal morphine application for postoperative analgesia. Safe, with very few complications, efficient, easy to perform and inexpensive. Ultrasound increases the success of the block and minimizes complications!. [ABSTRACT FROM AUTHOR]

Purpose: General conditions in the health-care system in Germany have changed dramatically in recent years. Factors affecting this include above all demographic change, rapid developments in diagnostic and therapeutic options, and the application of economic criteria to the health-care sector. This study aimed to establish the current status quo regarding conditions of work and training for young doctors in gynecology and obstetrics, analyze stress factors, and suggest potential improvements.Methods: Between October 2015 and March 2016, a web-based survey was carried out among residents and members of the German Society for Gynecology and Obstetrics. The electronic questionnaire comprised 65 items on seven topics. Part of the survey included the short version of a validated model of professional gratification crises for analyzing psychosocial work-related stress.Results: The analysis included a total of 391 complete datasets. Considerable negative findings in relation to psychosocial work pressure, time and organizational factors, quality of specialty training, and compatibility between work and family life and work and academic tasks were detected. A high level of psychosocial work pressure is associated with more frequent job changes, reduced working hours, poorer health among physicians, and a lower subjectively assessed quality of care.Conclusions: Greater efforts are needed from all the participants involved in patient care to achieve high-quality training and working conditions that allow physicians to work in a healthy and effective way. These aspects are all prerequisites for sustainably maximizing the resource "physician" and for ensuring high-quality patient care. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy (LA) is the standard treatment of acute appendicitis for the general population; however, there is still some doubt regarding its safety for pregnant patients. Therefore, the purpose of this study is to investigate and compare the maternal outcome of pregnant patients with acute appendicitis following either an open appendectomy (OA) or LA from a population-based database. Methods: This study is based on the National Health Insurance Research Database. Patients with both ICD-9-CM codes for appendicitis (540.9, 540.0, and 540.1) and pregnancy (V22) in the same admission were considered to have acute appendicitis during pregnancy. These patients were divided into three groups according to the type of treatment: LA, OA, and non-operative treatment. Outcome measures that were compared between the groups included maternal complications such as preterm labor, abortion, and the need of cesarean section. Besides, the differences of medical expenditure and length of hospital stay between the groups were also analyzed. Results: From 2005 to 2010, a total of 859 pregnant women who had acute appendicitis were identified. They had increased risks for preterm labor, abortion, and increased requirement of cesarean section compared to the control group (i.e., those without acute appendicitis). Among the three groups, the non-operated group has the highest risk of preterm labor. Patients who underwent LA did not have any increased risk of maternal complications compared to the OA group. Furthermore, LA patients had shorter hospital stay than OA. Conclusion: Compared to non-operative treatment, appendectomy is the preferred treatment for pregnant patients who have acute appendicitis. LA can be performed safely in pregnant patients without bringing additional maternal complications compared to OA. [ABSTRACT FROM AUTHOR]

Purpose: Research into the activities of German medical specialist associations during the Nazi period is still in its initial stages even today. In the field of gynecology and obstetrics as well, most representatives of the discipline continued to take an attitude based on 'concealment and forgetting', even after the turn of the millennium. In order to break with this approach, the Bavarian Society for Obstetrics and Gynecology ( Bayerische Gesellschaft für Geburtshilfe und Frauenheilkunde, BGGF) commissioned an interdisciplinary research group to focus on clarifying its Nazi past for the purposes of a history of the institution on the occasion of its centenary. Methods: The research was based on the Society's archive. When the files were found to show conspicuous gaps for the Nazi period, the investigation was extended into the role of BGGF representatives and members who were active at the time. In some cases, it was possible to draw on existing studies and to supplement the available information from additional archival sources. Results: It was found that the BGGF started at a very early stage to marginalize and ignore its 'non-Aryan' members. No official decision to exclude such members was apparently taken, however. Many representatives and honorary members of the society were involved in promoting and carrying out eugenic sterilizations, simultaneously conducting abortions on some victims, and they at least shared responsibility for forced abortions among Ostarbeiterinnen ('Eastern workers', forced laborers from Eastern Europe). Accompanying unethical research that was mainly intended to garner academic prestige for the physicians involved was never discussed at the Society's conferences. Representatives of the Society who were substantially incriminated were able to continue their careers almost without interruption after 1945. [ABSTRACT FROM AUTHOR]

Objective To determine the spectrum of etiology and the incidence of healthcare-associated infections (HAIs) among gynecologic and obstetric patients. Methods In a descriptive survey, data were analyzed from in-patients at the Department of Gynecology and Obstetrics, University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic, between January 2007 and December 2011. Results Among 21 937 patients treated during the study period, there were 189 (0.86%) cases of HAI. Gynecologic patients had a higher incidence of HAIs (1.31%) compared with pregnant women (0.60%). The incidence of HAI was 0.13% after laparoscopic surgery, 0.63% after a minor gynecologic intervention, and 3.73% after major surgery. Vaginal delivery (0.36%) represented a low risk of HAI. Compared with vaginal delivery, the incidence of HAI increased twofold for planned cesarean delivery (0.64%), and tenfold for emergency cesarean delivery (3.63%). The majority of causative microorganisms (72.7%) were susceptible to penicillin antibiotics. None of the patients died as a result of HAI. Conclusion The incidence of HAIs at a university hospital in the Czech Republic was very low. Antibiotic resistance was only a minor problem, and the incidence of multiresistant strains was rare. [ABSTRACT FROM AUTHOR]

Background: To find the most efficacious method to minimize the side effects and maximize the advantages of laparoscopic surgery, this study aimed to define and document a gasless, single-incision abdominal access technique for the management of benign ovarian cysts. Methods: During a 1½ year period, 55 women underwent surgery for a benign ovarian cyst. Conventional carbon dioxide (CO) laparoscopy was used for 33 of the women, and 22 of the women underwent a novel, gasless, single-incision laparoscopic surgery. An abdominal access pathway through a single intraabdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intra-umbilical entry without the use of trocars. Thus, the new technique was called keyless abdominal rope-lifting surgery (KARS). Two operative groups were compared to assess the feasibility of the new technique. Results: All the operations could be performed by KARS without conversion to CO laparoscopy or laparotomy. However, for two patients in the conventional laparoscopy group, minilaparotomy had to be performed for tissue retrieval. Although the two techniques had many similar results, the total operative times and the abdominal access times in the KARS group were significantly longer than in the conventional laparoscopy group ( p < 0.05). Simple oral analgesics were adequate for postoperative pain relief in both groups. Conclusions: The KARS technique is a gasless, single-incision laparoscopic procedure that can be performed safely and effectively in terms of cosmesis, postoperative pain, and fertility preservation for the management of benign adnexal pathologies. [ABSTRACT FROM AUTHOR]

The majority of data published on robotic surgery in gynecologic oncology has focused on patient outcomes and surgical data. We have found that technical challenges due to the complexity of the robotic technology create a separate set of issues, adding time and difficulty to the actual surgical procedure. This study focuses on these technical problems and identifies pitfalls and potential solutions in robotics. All patients who underwent robotic surgery for gynecologic oncology indications from August 2006 through July 2008 were eligible for inclusion in the study. Data collected prospectively included demographics, surgical and clinicopathologic data, and technical problems with the robotic equipment. One hundred thirty-seven patients underwent robotic surgery during the study period. A total of 11 cases (8.02%) were associated with problems with robotic technology: 2/11 (18.2%) involved malfunction of robotic arms, 2/11 (18.2%) involved light or camera cords, and the remainder included a variety of problems, including malfunction of Maylard bipolar instrument [1/11 (9.1%)], power failure requiring reboot of robot [1/11 (9.1%)], port problems [2/11 (18.2%)], and 3/1 (27.3%) had miscellaneous problems. An estimated average of 25 min was added to each of these 11 cases in order to solve robot-related technological problems. No cases required conversion to laparotomy. All problems were solved by the robotic surgeon with the assistance of robotic surgery staff. Surgeons performing robotic surgery must become familiar with troubleshooting robotic technology. Several issues related to technical problems may arise, delaying progression of the case, and potential solutions were identified. As this technology is implemented, robotic surgeons must be trained to solve problems related to the robotic technology and associated equipment. Failure to do so may add time and technical difficulty to robotic cases. [ABSTRACT FROM AUTHOR]

This study aimed to compare the safety and efficacy of laparoscopy and laparotomy in the surgical treatment of early endometrial cancer, especially in obese women. The results obtained after laparoscopic surgical treatment of early endometrial cancer (International Federation of Gynecology and Obstetrics (FIGO) stage 1 or 2) in patients between 1996 and 2007 were compared with an age- and tumour-matched historical group of patients treated with laparotomy between 1988 and 1996. All the patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic ± paraaortic lymphadenectomy. Both groups included 120 patients with a preoperative diagnosis of early endometrial cancer. The postoperative diagnosis was endometrial cancer stage 1 or 2 for 89% of the cases in both groups. The mean operating time was 170 min for the laparotomy group compared with 178 min for the laparoscopy group (nonsignificant difference). The estimated intraoperative blood loss was significantly greater in the laparotomy group, and the hospital stay was significantly shorter in the laparoscopy group. The results show that early endometrial cancer can be treated effectively by laparoscopy. Because of this study’s retrospective design, the results should be interpreted with caution. However, the advantages of this method for obese patients are evident. The age and weight of these patients should not be used as a contraindication for laparoscopy. [ABSTRACT FROM AUTHOR]

The rapid growth of public spending and the need to assess its impact on the welfare system has made the studies of productivity in the public sector an important subject. This paper is concerned with the specification and estimation of total factor productivity growth using the primal panel data approach. The total factor productivity growth is decomposed into technical change and scale components. Several competing models are used to explore whether there are any similarities in the estimates of total factor productivity growth and technical change among these models. The models are estimated using different estimation methods. Some of the models, although assuming a Cobb–Douglas technology, exhibit firm-specific technical change. These models are used to measure productivity growth in departments of gynecology and obstetrics in Sweden. Empirical results show evidence of large and negative rate of productivity growth. In comparison among different specifications proposed, the level and the time pattern of productivity measures vary substantially across models and estimation methods. [Copyright &y& Elsevier]