Background: Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units. Patients and Methods: The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry. Results: Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52–0.93) in the adjusted Cox model. Conclusions: Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process.

The acrosome reaction is a crucial step during gamete interaction in all species, including man. It allows spermatozoa to penetrate the zona pellucida and fuse with the oocyte membrane. Spermatozoa unable to undergo the acrosome reaction will not fertilize intact oocytes. This article concentrates on the characteristics and regulatory mechanisms of the acrosome reaction in human spermatozoa. During recent years, various entities found in the vicinity of the ovulated oocyte have been identified as stimulators of the acrosome reaction, of which zona protein is considered the prime physiological inducer in vivo. The steroid hormone progesterone has been shown to evoke critical responses in sperm cells leading to the acrosome reaction. Calcium has also been shown to play a central role during the acrosome reaction. Calcium flux is induced specifically by progesterone in capacitated and uncapacitated sperm cells, whereas only capacitated spermatozoa are able to subsequently complete the acrosome reaction. Progesterone as well as zona protein has been shown to evoke crucial responses within human spermatozoa, shedding light on the cascade of intracellular signalling events leading to the completion of the acrosome reaction. Furthermore, chemical agents which bring about the reaction in vitro, such as the ionophores ionomycin or A23187, have been used to shed light on its regulatory mechanisms. A number of molecules have been postulated to regulate the acrosome reaction in mammals, for example a galactosyl-transferase and a sperm protein tyrosine kinase. In addition, a novel protein, termed SAA-1, that was first detected on human spermatozoa is discussed with respect to its potential role as a regulatory protein closely involved in the initiation of the acrosome reaction.

Background State-of-the art therapy for recurrent ovarian cancer (ROC) suitable for platinum-based re-treatment includes bevacizumab-containing combinations (eg, carboplatin/paclitaxel, carboplatin/gemcitabine) or the most active non-bevacizumab regimen: carboplatin/pegylated liposomal doxorubicin (PLD). This head-to-head trial compared a standard bevacizumab-containing regimen versus carboplatin/PLD combined with bevacizumab. Methods In this multicentre, open-label, randomised, phase 3 trial, eligible patients had histologically confirmed epithelial ovarian, primary peritoneal, or fallopian tube carcinoma with first disease recurrence >6 months after first-line platinum-based chemotherapy, and were aged ≥18 years with Eastern Cooperative Oncology Group performance status 0-2. Patients were stratified by platinum-free interval, residual tumour, prior anti-angiogenic therapy, and study group language, and centrally randomised 1:1 using randomly permuted blocks of size two, four, or six to six intravenous cycles of carboplatin (AUC 4, day 1) plus gemcitabine (1000 mg/m 2 , days 1 and 8) every 3 weeks or six cycles of carboplatin (AUC 5, day 1) plus PLD (30 mg/m 2 , day 1) every 4 weeks, both given with bevacizumab (15 mg/kg every 3 weeks or 10 mg/kg every 2 weeks) until disease progression or toxicity. The primary endpoint was investigator-assessed progression-free survival (PFS). Efficacy data were analysed in the intention-to-treat population (all randomised patients). Safety was analysed in all patients who received at least one dose of study drug. This completed study is registered with ClinicalTrials.gov number NCT01837251.