The Need of Differential Diagnosis Between Vulvar Lichen Sclerosus and Autoimmune Dermatoses in Adolescent Girls.

INTRODUCTION: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which can manifest in prepubertal or adolescent patients. The prevailing theories point to autoimmune and genetic factors. The primary symptoms of VLS typically include vulvar itching, discomfort, dysuria, and constipation. Physical examination often reveals a characteristic figure 8 pattern, involving the labia minora, clitoral hood, and perianal region. However, these symptoms and the age of onset are nonspecific and require differentiation from autoimmune dermatoses such as bullous diseases, pemphigus diseases, epidermolysis bullosa acquisita, and dermatitis herpetiformis. We performed this study to distinguish VLS from autoimmune dermatoses, and in doing so, uncover the underlying causes of chronic vulvar changes. This knowledge will enable healthcare providers to offer appropriate medical care to affected patients. METHODS: The study was conducted between July 2020 and February 2021, with a sample of 55 girls aged 2-18 years who did not have any systemic diseases. The study group was composed of 20 girls previously diagnosed with vulvar lichen sclerosus, while the control group included 35 girls without VLS. Questionnaires regarding the medical history of the children were completed by their legal guardians. Blood samples were collected and analyzed biochemically to assess human immunoglobulin A (IgA), IgG, and IgM antibodies against various substrates, including the desmosome of stratum spinosum, basement membrane zone, desmoglein 1 (DSG1), desmoglein 3 (DSG3), BP180-NC16A-4X, BP230gC, pemphigoid antigen, collagen type VII NC1, transitional epithelium, gliadin (GAF-3X), endomysium (EMA), and cellular nucleus (ANA). RESULTS: The analysis of the study group revealed that the most commonly observed signs and symptoms included: itching, soreness, burning sensations, and excoriation, as well as erythema or/and pallor of the skin and perineal mucosa. Among the assessed antibodies, only anti-GAF3x antibodies and ANA antibodies were detected. However, the results did not reach statistical significance (p > 0.5).

The Potential Coexistence of Autoimmune Thyroid Diseases and Pediatric Vulvar Lichen sclerosus.

INTRODUCTION: Vulvar lichen sclerosus (VLS), a chronic inflammatory skin disorder, often coexists with autoimmune thyroid disease (AITD). VLS presents with subtle symptoms including vulvar itching and discomfort. Clinically, a "Figure 8" pattern involving the labia minora, clitoral hood, and perianal region is often observed. It is prevalent both in pre-pubertal girls and women aged 40-60, and the link between VLS and AITD remains unclear, with proposed causes including autoimmune, hormonal or genetic factors, and environmental triggers. This study addresses the lack of research on the association in children, aiming to investigate the largest group of underage girls to date. AIM: This study aimed to investigate the coexistence of thyroid autoimmune diseases in girls diagnosed with vulvar lichen sclerosus (VLS) and to assess the presence of antibodies for specific thyroid autoimmune diseases. MATERIALS AND METHODS: Our study was conducted from July 2020 to February 2021, involving a sample of 55 girls aged 2-18 years old, all free from systemic diseases. The study group comprised 20 girls previously diagnosed with vulvar lichen sclerosus (VLS), while the control group included 35 girls without VLS. Legal guardians completed questionnaires detailing the medical history of their children. Blood samples were collected from all participants and subjected to biochemical analysis. The presence of human IgG antibodies against thyroid peroxidase and IgG antibodies against thyroglobulin was assessed using the immunoenzymatic method with commercially available ELISA kits. RESULTS: In the study group, common symptoms included itching, soreness, burning sensation, excoriation, and erythema or pallor of the skin and perineal mucosa. An evaluation of anti-thyroglobulin and anti-thyroid peroxidase antibodies revealed no statistical significance between the study and control groups (anti-TG p = 0.379, anti-TPO p = 0.96). Family history of autoimmune diseases showed no significant correlation with anti-thyroid antibodies in girls. Although no significant relation between VLS occurrence and antibody levels was found, it emphasizes the need for multidisciplinary medical care. Further research with larger patient groups is necessary.

Possibilities of Increasing the Durability of Dies Used in the Extrusion Process of Valve Forgings from Chrome-Nickel Steel by Using Alternative Materials from Hot-Work Tool Steels.

This study refers to an analysis of the dies used in the first operation of producing a valve forging from chromium-nickel steel NC3015. The analyzed process of manufacturing forgings of exhaust valves is realized in the co-extrusion technology, followed by forging in closed dies. This type of technology is difficult to master, mainly due to the increased adhesion of the charge material to the tool substrate as well as the complex conditions of the tools' operations, which are caused by the cyclic thermo-mechanical loads and also the hard tribological conditions. The average durability of tools made from tool steel WLV (1.2365), subjected to thermal treatment and nitriding, equals about 1000 forgings. In order to perform an in-depth analysis, a complex analysis of the presently realized technology was conducted in combination with multi-variant numerical simulations. The obtained results showed numerous cracks on the tools, especially in the cross-section reduction area, as well as sticking of the forging material, which, with insufficient control of the tribological conditions, can cause premature wear of the dies. In order to increase the durability of forging dies, alternative materials made of hot work tool steels were used: QRO90 Supreme, W360, and Unimax. The preliminary tests showed that the best results were obtained for QRO90, as the average durability for the tools made of this steel equaled about 1200 forgings (with an increase in both the minimal and maximal values), with reference to the 1000 forgings for the material applied so far.

Possibilities of Increasing the Durability of Punches Used in the Forging Process in Closed Dies of Valve Forgings by Using Alternative Materials from Tool Steels and Sintered Carbides.

This study refers to an analysis of the durability of forging tools applied in the second operation of producing a valve forging from the chromium-nickel steel, NC3015. Due to the extreme working conditions of the tools, caused by cyclic thermo-mechanical loads, the average durability of tools made from tool steel WLV (1.2365) equals about 1500 forgings. An in-depth, complex analysis was performed on the technology, using macroscopic tests combined with a measurement of the wear/allowance on the tool working surface through 3D scanning; microstructural tests by means of light microscopy; observations of the changes taking place on the working surface with a scanning electron microscope; microhardness measurements; and multi-variant numerical simulations. It was established that the key issue is the proper selection of the process technological parameters, such as the input material and tool temperature, friction, lubrication, tribological parameters, type of tool material, or punch design, because even small changes made to them significantly affect the service life of forging punches. Therefore, to increase the durability of the forging dies, alternative materials made of W360, as well as two high speed steels, S600 and S705, were applied. However, the implemented punch materials did not bring the assumed effect of increased durability, as the highest average durability of steel W60 equaled only 1500 forgings, whereas in the case of the tool steels, this was below 900 forgings. For this reason, at the further stage, punches with sintered carbide inserts were introduced, which made it possible to significantly improve the durability up to the level of as many as 20,000 forgings, which, at the same time, points to a promising direction of further studies on the use of materials and solutions of this type.

Metallographic Evaluation of Increased Susceptibility to Intermediate Embrittlement of Engine Valve Forgings Made of NCF 3015 High Nickel and Chromium Steel.

This paper focused on determining the increased tendency of cracking after the die forging process of high nickel and chromium steel. The increase in carbon content in austenitic nickel-chromium steel promoted the tendency of valve forgings to forging intergranular crack on the valve head. Attention was paid to issues related to the chemical composition of the material to be considered when hot forming nickel-chromium steel components. Optical and scanning electron microscopies were used to examine the microstructure and fracture features of the samples removed from a fractured valve head. The embrittlement was due to microcavity formation at grain boundaries. Creep theory at grain boundaries was used to explain crack formation. The tensile behavior was interpreted from the evolution of the microstructure during deformation and referred to intermediate brittleness to explain the effect of carbon. It was found that the increased carbon content of the nickel-chromium steel and the strong undercooling observed at the edges of the valve head are factors that promote a reduction in grain boundary cohesion and enhance intermediate temperature embrittlement. Finally, it was found that the formation of a heterogeneous structure manifested by the presence of grain boundary M23C6-type carbides in the austenitic matrix was most likely related to the occurring brittleness.

The analysis of coexistence of celiac disease and vulvar lichen sclerosus in girls.

OBJECTIVES: Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease of unclear etiology. Recent studies show that 15-34% of cases in adult women and 14% in girls coexist with allergies or autoimmune diseases, among others - celiac disease (CD). Most of the research on the coexistence of VLS and autoimmune diseases has been carried out on a group of adult women. Literature data on this issue are very scarce. MATERIAL AND METHODS: The presented work is a pioneering project in which we tried to elucidate a possible relationship between celiac disease and lichen sclerosus in girls. The aim of the research was to study the antibodies characteristic of celiac disease in girls with VLS. The control group consisted of 35 heathy adolescent girls and the study group consisted of 20 girls aged 2-18 years old diagnosed with vulvar lichen sclerosus recruited at the Gynecological Clinic for Girls at the Women's Health Center in Katowice. RESULTS: There were no significant differences in the concentrations of antibodies characteristic for CD in the blood serum between the studied groups. CONCLUSIONS: The main limitation of our study was the small size of the study group. It is therefore legitimate to conduct further research on a larger study group to find themutual correlations between the analyzed antibodies and the onset and the course of VLS in girls. The finding of a positive correlation between the coexistence of VLS and CD may prevent potentially serious, long-term complications.

Occult Autoimmune Background for Epilepsy-The Preliminary Study on Antibodies Against Neuronal Surface Antigens.

Objective: The objective of the study was to determine the incidence of antibodies against neuronal surface antigens (NSA-ab) in patients with different types of epilepsy, in comparison with the subjects diagnosed with immune-mediated disorders. Methods: Forty patients with drug-resistant epilepsy (DRE) of unknown origin, 16 with post-stroke epilepsy, and 23 with systemic autoimmune disorders (SAD) with CNS involvement were included. NSA-ab were sought in serum using indirect immunofluorescence method. Relationships were analyzed between presence of NSA-ab and clinical presentation. Results: NSA-ab was detected in the sera from five patients: anti-DPPX in one patient, anti-AMPAR1/R2 in two, anti-LGI1 in one and, in one case, both anti-CASPR2 and DPPX IgG. Out of these five patients, three represented the SAD subgroup and two the DRE subgroup. None of the patients with post-stroke epilepsy was positive for NSA-ab. Significance: Autoimmune etiology is worth considering in patients with drug-resistant epilepsy of unknown origin. The presence of NSA-ab in patients with systemic autoimmune disorders may be caused by unspecifically enhanced autoimmune reactivity. NSA-ab seem not to be related to epilepsy resulting from ischemic brain injury.

Wear Analysis of Forging Tools Used in an Industrial Production Process-Hot Forging in Closed Dies of the "Head-Disk" of an Engine Valve Forging.

The article performs an analysis of the durability of punches applied in the process of producing a valve forging from chromium-nickel steel. A forging of this type is made in two operations: coextrusion of a long shank, followed by finishing forging in closed dies of the valve head. The product obtained in this way (after other additional finishing procedures) constitutes the key element of the combustion engine (resistant to high pressures and temperatures) in motor trucks. Unfortunately, a significant problem in this production process is a relatively low durability of the forging tools, especially the punch used in the second forging operation. The key element at this stage, deciding about the punch's further operation, is the area of the so-called "calotte". The short-term life of the tools results from very hard performance conditions present during the forging process (periodical high mechanical and thermal loads, long path of friction). The latter cause intensive abrasive wear as well as high adhesion of the forging material to the tool surface. Based on the performed studies, including the following: technology analysis, numerical modelling, macro analyses combined with 3D scanning of tool sections as well as microstructural tests and hardness measurements, it was established that it is crucial to properly select the process parameters (charge and tool temperature, tribological conditions), as even slight changes introduced into them significantly affect the operation time of the forging tools. Mastering and proper implementation of the analyzed forging technology requires numerous further studies and tests, which will enable its perfection and thus increase the durability of the tools as well as the quality of the produced items.

The Impact of the Lubricant Dose on the Reduction of Wear Dies Used in the Forging Process of the Valve Forging.

The paper presents the results of research on the influence of the settings of lubrication and cooling system parameters (solenoid valve opening time and lubricant feed pressure in terms of its quantity) in order to select the optimal lubricating conditions and thus reduce the wear of the dies used in the first forging operation of the valve forging made of high-nickel steel. Based on the observation of lubrication in the industrial process, it was found that a significant part of the lubricant fails to reach the die cavity, reaching the outside of it, which causes die wear due to seizure resulting from adhesion of the forging material to the tool surface as well as high lubricant consumption and dirt in the press chamber. The authors proposed their own mobile lubricating and cooling system, which allows for a wide range of adjustments and provided with automatic cleaning procedures of the entire system, unlike the fixed lubrication system used so far in the industrial process. First, tests were carried out in laboratory conditions to determine the highest wettability and the lubricant remaining inside the tool cavity. These tests determined the lubrication system parameter settings that ensured that the greatest amount of lubricant remains in the cold die cavity without the forging process. Then, to verify the obtained results, tests were carried out in the industrial process of hot die forging of valve forgings for short production runs of up to 500 forgings. The results were compared with the measurement of changes in the geometry of tools and forgings based on 3D scanning and surface topography analysis with the use of SEM (Scanning Electron Microscope). For the best results (the variant of the setting of the dose and the time of exposure to lubricant), the forging process was carried out with the use of a new tool up to the maximum service life.

Analysis of Multiple Risk Factors for Seronegative Rate of Anti-Tick-Borne Encephalitis Virus Immunization in Human Serum.

Background and objectives: Tick-borne encephalitis virus (TBEV) infections have been the cause of threatening outbreaks for many years. Apart from several physical and chemical methods to prevent tick bites, active vaccination of people highly exposed to infection is still the most important strategy of prevention. However, in some subjects, the lack of or low response to TBEV antigens is observed. The aim of the current study was to assess the prevalence of seronegative rate for anti-TBEV antibodies and the risk factors for waning immunity. Materials and Methods: 2315 at least primary vaccinated subjects from the high risk group for TBEV infections participated in this study. A commercial enzyme-linked immunosorbent assay (ELISA) test was used for the assessment of anti-TBEV IgG serum level. Results: Data showed that 86.2% of subjects who underwent vaccination were positive for anti-TBEV antibodies within 5 years. As much as 13.8% of subjects that underwent primary or primary and booster vaccination were barely protected after vaccination. Women and subjects under 60 years underwent more effective protection but sex and older age was not a risk factor for being a subject of waning immunity. A logistic regression showed that both a longer time since the vaccination and a lower number of booster doses constantly increased the chance of lost anti-TBEV antibodies. Conclusions: This study demonstrates that the vaccination schedule should be reevaluated. The extension of the interval of booster immunization is risky and all subjects should be surrounded by care consisting of more frequent monitoring of serum antibodies by personalized schedule to adjust the frequency of subsequent doses of booster vaccination.

Support Possibilities for 3D Scanning of Forging Tools with Deep and Slim Impressions for an Evaluation of Wear by Means of Replication Methods.

This article discusses the problems related to the use of non-contact 3D scanning techniques and their support by means of replication methods for the analysis of the geometrical changes in deep tool impressions used for the forward extrusion of valve-type elements assigned for motor truck engines. The 3D scanning method, despite its unquestionable advantages, also has certain limitations, such as scanning the inner surfaces of deep cavities. This is caused by the fact that the larger the angle between the reflected laser light and the normal direction to the measured surface, the larger the area covered for the analysis, yet at the same time, the higher the measurement error. The authors performed an analysis of the geometrical loss of the tools as well as the corresponding replication masses, together with a discussion of the results related to minimization of the measuring errors. For the analyzed tool, the maximum angle during direct scanning was 40 degrees, which unfortunately does not enable an analysis of the entire pattern, while for larger angles, it is necessary to make the measurement by indirect scanning, i.e., by replicating the cavity imprint of the tool. Therefore, for a given geometry, the reflection angle should be determined individually.