Use of SEM/EDX methods for the analysis of ambient particulate matter adhering to the skin surface.

BACKGROUND: The skin is exposed to numerous particulate and gaseous air pollutants. The ones that need particular attention are the particles that adhere to the skin surface, which can later cause direct skin damage. This study aimed to characterize air pollution (AP) particles adhered to the human skin by using scanning electron microscopy (SEM) combined with X-ray dispersive energy spectrometry (EDX). METHODS: Tape stripping was performed from six healthy volunteers exposed to urban AP to collect stratum corneum samples from the cheeks and forehead. The samples were analysed using SEM equipped with EDX system with a silicon drift detector at an accelerating voltage of 20 keV. After the preliminary examination, the particles were located and counted using 1000× magnification. Each particle was analysed, increasing magnification up to 5000× for precise dimension measurement and elemental composition analysis. At least 100 fields or a surface of approximately 1 mm2 were examined. RESULTS: Particles adhered to the skin were identified in all samples, with a particle load ranging from 729 to 4525. The average area and perimeter of all particles identified were 302 ± 260 µm2 and 51 ± 23 µm subsequently, while the equivalent circular diameter was, on average, 14 ± 6 µm. The particles were classified into ten groups based on morphology and elemental composition. Chlorides were the most numerous particle group (21.9%), followed by carbonaceous organic particles (20.3%), silicates (18%), carbonates (16.4%), metal-rich particles (14%), and a minor number of bioaerosols, quartz-like, and fly ash particles. CONCLUSION: The SEM-EDX analysis provides evidence of the contamination of exposed skin to various airborne PM of natural or anthropogenic origin. This method may provide new insights into the link between exposure to AP and AP-induced skin damage.

PRIMARY OVARIAN SYNOVIAL SARCOMA - A CASE REPORT.

Synovial sarcoma is an aggressive soft tissue sarcoma, which most often occurs in the limbs near the joints. It accounts for 5-10% of all soft tissue sarcomas. It extremely rarely affects the pelvis. So far, only 4 cases of primary involvement of the adnexa have been described. We present a case of a 77-year-old female patient diagnosed with a rapidly growing pelvic formation, subsequently diagnosed as monophasic synovial sarcoma of the ovary. Synovial sarcoma derived from the adnexa is a rare disease that is virtually unknown. The diagnosis is complex, and there is a poor prognosis.

CORRELATIONS OF SERUM VITAMIN D WITH METABOLIC PARAMETERS IN ADULT OUTPATIENTS WITH DIFFERENT DEGREES OF OVERWEIGHT / OBESITY COMING FROM AN URBAN COMMUNITY.

OBJECTIVE: To describe the correlations between serum 25(OH) vitamin D and anthropometric and metabolic parameters in adult outpatients of both sexes with different BMI coming from an urban community. SUBJECTS AND METHODS: 264 subjects referred for obesity assessment participated - 109 men and 155 women (20-60 years). Body weight and height, waist circumference (WC), blood pressure were recorded. Body composition was assessed by bioelectrical impedance (BIA) on a Tanita BC 420 MA analyzer (Tanita Inc., Japan). Serum 25(OH)D Total, Insulin, High-sensitivity C-reactive protein, blood glucose, total, HDL-cholesterol and triglycerides were measured. The insulin resistance index was calculated (HOMA-IR). Participants with BMI>25.0 kg/m2 underwent standard 75 g OGTT. Statistical analysis was performed on an IBM SPSS Statistics 19.0 for Windows platform (Chicago, IL). RESULTS: Normal weight was found in 27.2 % of the participants, 24.6 % had overweight, 29.2 % -class I obesity, and 18.9 % - class II or III. Vitamin D was weakly and inversely correlated to different variables in the whole group - such as weight, WC, WC/Height, % body fat and HOMA-IR index (r=-0.231, -0.283, -0.307, -0.339, -0.328 respectively, all p<0.001). Building subgroups based on BMI led to loss of significance. Backward analysis revealed Total-C/LDL-C ratio, and LDL-C/HDL-C ratio as strongest predictors of serum vitamin D (p=0.001; R2=0.204). CONCLUSION: The association of vitamin D with blood pressure, plasma lipids, glucose and insulin is very weak on an individual level. However, several obesity indices (WC, WC/height ratio, % Body fat from BIA) might be used as a screening tool for subjects at risk for vitamin D deficiency.

Inherited Thrombophilias Could Influence the Reproductive Outcome in Women with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with different reproductive complications in the affected women. Inherited thrombophilias are genetic factors increasing the risk for thromboembolism and recurrent pregnancy loss, but their influence on other reproductive disturbances in SLE patients has not been completely clarified. Two hundred and twenty-three Caucasian women (112 with SLE and 111 controls) were included in the study. Complete reproductive history of all SLE patients was carefully obtained. Genotyping for the FVLeiden, FIIG20210A, and MTHFRC677T polymorphisms was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. No significant differences in the prevalence of the FVLeiden, FIIG20210A, and MTHFRC677T polymorphisms between patients and controls were established. Patients with FVLeiden had fewer pregnancies (0.57 ± 0.98 vs. 2.18 ± 1.58; p = 0.007) than the others, while no significant differences in the reproductive history of FIIG20210A carriers and non-carriers were observed (p >0.05). In the SLE group, 41.67% of women with the MTHFRC677T TT genotype had at least one miscarriage in comparison to only 14.00% of the other female patients (p = 0.030). While the prevalence of the investigated thrombophilias was similar in patients with SLE and healthy women, a substantial influence of the inherited prothrombotic factors on the reproductive history of patients was revealed. The investigations of the FVLeiden and MTHFRC677T polymorphisms in SLE patients could help to identify women at highest risk for reproductive failure and thus, further studies in other ethnic groups would be of strong clinical importance.

[DISSEMINATED PERITONEAL LEYOMYOMATOSIS--PRACTICAL APPROACH TO DIAGNOSIS].

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the presence of multiple histologically benign smooth muscle nodules on the surface subperitoneal tissue simulating macroscopic peritoneal carcinomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery, the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent. The knowledge of DPL is necessary to develop methods of prevention, and individualized treatment depending on the pathogenesis and clinical manifestations in each patient.

[PROGNOSTIC MODELS IN MODERN MANAGEMENT OF VULVAR CANCER].

AIM: The aim of the research was to evaluate and analyse prognosis and prognostic factors in patients with squamous cell vulvar carcinoma after primary surgery with individual approach applied during the course of treatment. MATERIALS AND METHODS: In the period between January 2000 and July 2010, 113 patients with squamous cell carcinoma of the vulva were diagnosed and operated on at Gynecologic Oncology Clinic of Medical University, Pleven. All the patients were monitored at the same clinic. Individual approach was applied to each patient and whenever it was possible, more conservative operative techniques were applied. The probable clinicopathological characteristics influencing the overall survival and recurrence free survival were analyzed. Univariate statistical analysis and Cox regression analysis were made in order to evaluate the characteristics, which were statistically significant for overall survival and survival without recurrence. A multivariate logistic regression analysis (Forward Wald procedure) was applied to evaluate the combined influence of the significant factors. While performing the multivariate analysis, the synergic effect of the independent prognostic factors of both kinds of survivals was also evaluated. RESULTS: Approaching individually each patient, we applied the following operative techniques: 1. Deep total radical vulvectomy with separate incisions for lymph dissection (LD) or without dissection--68 (60.18 %) patients. 2. En-bloc vulvectomy with bilateral LD without vulva reconstruction--10 (8.85%) 3. Modified radical vulvactomy (hemivulvectomy, patial vulvactomy)--25 (22.02%). 4. wide-local excision--3 (2.65%). 5. Simple (total /partial) vulvectomy--5 (4.43%) patients. 6. En-bloc resection with reconstruction--2 (1.77%) After a thorough analysis of the overall survival and recurrence free survival, we made the conclusion that the relapse occurrence and clinical stage of FIGO were independent prognostic factors for overall survival and the independent prognostic factors for recurrence free survival were: metastatic inguinal nodes (unilateral or bilateral), tumor size (above or below 3 cm) and lymphovascular space invasion. On the basis of these results we created two prognostic models: 1. A prognostic model of overall survival 2. A prognostic model for survival without recurrence. CONCLUSIONS: Following the surgical staging of the disease, were able to gather and analyse important clinicopathological indexes, which gave us the opportunity to form prognostic groups for overall survival and recurrence-free survival.

[DISSEMINATED PERITONEAL LEYOMYOMATOSIS AFTER LAPAROSCOPIC MORCELLATION--A CASE REPORT].

We presented a case of 41-year-old patient underwent two laparoscopic Myomectomies and current laparotomy regarding suspection of necrotic leiomyoma. Intraoperative finding was suggestive of disseminated malignancy, but gefrir study showed benign smooth muscle tumors. The patient underwent total hysterectomy with right adnesectomy and total omentectomy. After histological and immunohistochemical study of the entire macroscopic material the final diagnosis was disseminated peritoneal leiomyomatosis. This disease is rare, but in recent years, in connection with the widespread introduction of laparoscopic surgery the reports of disseminated peritoneal leiomyomatosis occurring after laparoscopic morcellation, were frequent.

[Uterine smooth muscle tumors--direction of differentiation and morphological features].

Uterine smooth muscle tumors /USMT/ are the most common tumors of the female reproductive system. The main aim of the clinical histological classification and the grading of MGMT is to predict their progression. The diagnosis of USMT has of the following stages: the determination of the direction of differentiation of the tumor and the defining the morphological features (the mitotic index, the tumor necrosis and the cellular atypia). In each of them there are specific problems. This indicates, that the USMT are therapeutic and clinical challenge.

A comparative analysis of vertical and horizontal fixation disparity in sentence reading.

Humans have two, frontally placed eyes and during reading oculomotor and sensory processes are needed to combine the two inputs into a unified percept of the text. Generally, slight vergence errors, i.e., fixation disparities, occur but do not cause double vision since disparate retinal inputs fall into Panum's fusional area, that is, a range of disparity wherein sensory fusion of the two retinal images is achieved. In this study, we report benchmark data with respect to the mean magnitude and range of vertical compared to horizontal fixation disparities for natural reading. Our data clearly fit to an elliptical pattern of Panum's fusional area that corresponds with theoretical estimates. Furthermore, when we examined disparity-driven vergence adjustments during fixations by comparing monocular with binocular reading conditions, we found that only horizontal fixation disparities increased significantly under conditions of monocular stimulation. Also, no significant vertical fine-tuning (vergence adjustment) was observed for vergence eye movements during reading fixations. Thus, horizontal and vertical fixation disparities and vergence adjustments during reading showed quite different characteristics, and this dissociation is directly related to the functional role of vergence adjustments: vertical fusion - and vertical vergence - subserve the maintenance of a single percept and stereopsis by keeping the eyes in register and allowing for horizontal fusional processes to successfully operate over a vertically aligned input. A reliable and stable vertical alignment is, thus, a pre-requisite over which horizontal fusional responses (and depth perception) can work most efficiently - even in a task like reading.

Vergence responses to vertical binocular disparity during lexical identification.

Humans typically make use of both eyes during reading, which necessitates precise binocular coordination in order to achieve a unified perceptual representation of written text. A number of studies have explored the magnitude and effects of naturally occurring and induced horizontal fixation disparity during reading and non-reading tasks. However, the literature concerning the processing of disparities in different dimensions, particularly in the context of reading, is considerably limited. We therefore investigated vertical vergence in response to stereoscopically presented linguistic stimuli with varying levels of vertical offset. A lexical decision task was used to explore the ability of participants to fuse binocular image disparity in the vertical direction during word identification. Additionally, a lexical frequency manipulation explored the potential interplay between visual fusion processes and linguistic processes. Results indicated that no significant motor fusional responses were made in the vertical dimension (all p-values>.11), though that did not hinder successful lexical identification. In contrast, horizontal vergence movements were consistently observed on all fixations in the absence of a horizontal disparity manipulation. These findings add to the growing understanding of binocularity and its role in written language processing, and fit neatly with previous literature regarding binocular coordination in non-reading tasks.

[Uterine smooth muscle tumors--determination of clinical behavior and classification].

The establishment of the clinical behavior of uterine smooth muscle tumors /USMT/ is an essential stage of modern diagnostics. There are significant differences in the criteria determining the malignant potential of smooth muscle gynecological tumors. Generally USMT generating diagnostic problems are classified into: clinically benign tumors; clinically malignant tumors with benign morphological features; smooth muscle tumors of uncertain malignant potential (SMTUMP) and lesions whose smooth muscle differentiation is not obvious. The knowledge in this area is essential for an adequate therapeutic approach.

[Primary malignant melanoma of the vagina and treatment options: a case report].

OBJECTIVE: To present and analyze the clinical characteristics, treatment, and treatment options for a patient with primary malignant melanoma of the vagina and review of literature. CLINICAL CASE: A 71-year-old patient with a history of vaginal bleeding caused by four tumor growths located in the vagina is presented. The size of each formation was about 2 cm. Three of them were located in the proximal two-thirds of the anterior wall of the vagina and one in the distal third. Excisional biopsy was performed of the lesion located near the entrance of the vagina. Histopathological examination revealed that it was a malignant melanoma of the vagina, which was confirmed immunohistochemically. After ruling out a tumor of an unknown primary site, the patient underwent radical hysterectomy type IV total vaginectomy and pelvic lymph node dissection. Hystological examination proved a clinically asymptomatic melanoma lesion of the uterine cervix. After surgery, the patient was given chemotherapy with Dacarbasine and monthly immunotherapy with BCG vaccine. The patient survived 21 months after surgery without developing a local relapse and died of distant metastases in the spine. CONCLUSION: Radical surgery for primary melanoma of the vagina is a secure way of achieving locoregional control of multifocal disease. The wide local excision can be used in unifocal lesions with security in achieving clean surgical margins.

[Assessment of factors with possible influence over the duration of laparoscopic hysterectomy].

UNLABELLED: The duration of an operative intervention is directly related to the seriousness of the operative trauma. MATERIAL AND METHODS: A group of 14 factors with possible influence over operative time was investigated on the basis of the analysis of 635 laparoscopic hysterectomies accomplished over a six-year period (2004-2010) at the Oncogynecological Clinic at "Georgi Stranski" University Hospital for Active Treatment, and "St. Marina" Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Pleven, Bulgaria. RESULTS: The factors which prolong the operative time statistically significant are uterine prolapse, as an: indication for operation, emergence of complications, hemotransfusion, enlarged uterus to the size of m. l. IV-V and increase in the body mass index by 1 kappag/m2, while previous conization and every following year of accomplishment of a laparoscopic hysterectomy significant shorten operative time. CONCLUSION: The fact that previous abdominal operations do not affect the duration of laparoscopic hysterectomy significant, indirectly supports the proposition that they are not a contraindication for the given operative procedure.

[Surgical treatment of locally advanced vulvar cancer: report on two cases].

UNLABELLED: The aim of the study was to define the notion of locally advanced vulvar cancer (LAVC) and approaches to treatment by presenting clinical cases encountered by the authors. MATERIALS AND METHODS: The clinical cases described present different views on therapeutic approaches to cases with LAVC. Apart from cases of primary advanced vulvar cancer, there exist cases, in which primary treatment was applied. In such cases, however, involvement of adjacent structures was a result from recurrence of the disease. LAVC implies that the primary or recurrent tumour cannot be treated solely by radical removal of the vulva. Modem treatment of LAVC include ultraradical surgery, radiotherapy, chemoradiotherapy, or a combination of these methods. Studies have confirmed the hypothesis that megovoltage radiotherapy can yield a significant regression of LAVC that makes it possible to apply more sparing surgical resections and preserve the functions of adjacent organs, thus improving life quality. CONCLUSION: Surgical treatment of LAVC without preoperative chemoradiotherapy is recommendable only in cases of resectable tumours, possibly with non-metastatic and primarily resectable regional lymph nodes.

[Pregnancy and malignant melanoma].

The authors review on a rare pregnancy accompanying disease--Melanoma malignum. After the definition are presented the epidemiology, etiology, pathogenesis, pathomorphology, clinical forms, diagnosis, differential diagnosis, treatment and prevention. Described are the effects of the pregnancy on this malignant disease and the impact of it during the pregnancy.

Target silencing of disease-associated B-lymphocytes by chimeric molecules in SCID model of pristane-induced autoimmunity.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the generation of autoantibodies against a diverse array of self-antigens. The B cells producing immunoglobulin G (IgG) antibodies to double-stranded DNA appear to play a main role in the disease progression. Their specific elimination is a reasonable mechanism for effective therapy of SLE. The presently used approaches for silencing autoreactive disease-associated B cells are nonspecific and more precise therapies are needed. We have previously constructed a chimeric protein molecule consisting of several DNA-mimotope peptides coupled to a rat monoclonal anti-mouse CD32 (FcγRIIb) antibody. The mineral oil pristane induces a lupus-like syndrome in non-autoimmune mice leading to the development of glomerulonephritis and lupus-associated autoantibodies. In the present paper, using a pristane-induced autoimmune model in SCID mice, we analyzed the ability of the chimeric antibody to suppress selectively the autoreactive B lymphocytes by cross-linking B-cell surface immunoglobulin receptors with the inhibitory IgG FcγRIIb receptors. Treatment with DNA-like chimeric molecules inhibited B- and T-cell proliferation, restricted the number of anti-DNA antibody-producing cells and suppressed the generation of IgG anti-DNA antibodies. In contrast, phosphate buffered saline (PBS)-injected control mice experienced an increase of disease-associated antibody levels and developed glomerulonephritis similar to pristane-treated donor Balb/c mice.

[The expression of p16(INK4a) and Ki-67 in atrophic-hyperplastic and dysdysplastic lesions of the vulva].

UNLABELLED: The aim of present study is to investigate the immunohistochemical expression of tumor suppressor gene p16(INK4a) and proliferative marker Ki-67 in dysplastic vulvar lesions and nondysplastic ones. MATERIALS AND METHODS: 30 female patients (mean age = 49.5 +/- 4.5) - Ca in situ (n = 2), VIN (n = 10), lichen sclerorosus (n = 8), squamous cell hyperplasia (n = 1), mixed vulvar dystrophy (n = 5), papilloma (n = 1), condyllomata accuminata (n = 3) are separated into two groups (first group of non-dysplastic- and second group of dysplastic lesions). The immunohistochemical method with monoclonal antibody for identification of p16(INK4a) and Ki-67 was applied. RESULTS: P16(INK4a) is expressed in 1 patient (5.56%) in first group and in 8 patients (66.67%) in second group (chi2 = 84.93; p < 0.001). Ki-67 is positive in 4 patients (22.22%) in first group and in 12 of cases (100%) in second group (chi2 = 41.3; p < 0.001). CONCLUSIONS: There is a significant statistical difference between immunohistochemical expression of p16(INK4a) and Ki-67 in HPV-associated dysplastic and non-dysplastic vulvar lesions.