[Possibilities of multiphoton microscopy for the diagnosis of the vulvar lichen sclerosus]. / Vozmozhnosti mul'tifotonnoi mikroskopii dlya diagnostiki skleroticheskogo likhena vul'vy.

BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic and recurrent dermatosis of an inflammatory nature with severe focal atrophy of the skin. Connective tissue changes are polymorphic and are still not taken into account in histological diagnostics due to the difficulty of interpreting routine histological methods. In this work, we use multiphoton microscopy (MPM) as a new imaging technique that provides detailed information about the organization of collagen fibers in the dermis based on a non-linear second harmonic generation (SHG) process. OBJECTIVE: To determine the degree of connective tissue damage in lichen sclerosus using standard histological techniques and to reveal the diagnostic capabilities of multiphoton microscopy. MATERIAL AND METHODS: We studied 42 biopsies with a histopathological diagnosis of VLS and 10 biopsies of normal vulvar skin. Histological, histochemical and immunohistochemical evaluation was used in comparison with MPM data. Quantitative analysis included the determination of the thickness, length of collagen fibers and the average intensity of the SHG signal. RESULTS: A comprehensive study of the skin showed 4 groups of changes that can be regarded as the degree of the dermis damage: initial, mild, moderate, severe. The affected area at the initial and mild degree has subtle changes, however, it is reliably identified by quantitative analysis of the SHG signal. So, the initial degree is characterized by thin (1.3-1.8 µm) long (56-69 µm) collagen fibers, with a moderate degree, the fibers are thickened (3.4-4.3 µm) and fragmented (22-37 µm). The affected area in moderate and severe cases undergoes homogenization, which is associated with the deposition of extremely thin (0.6-0.9 µm) short (16-28 µm) collagen fibers and the expression of type V collagen. CONCLUSION: Multiphoton microscopy in the second harmonic generation mode is a reliable method for identifying collagen fibers in tissues. The study made it possible to identify 4 degrees of the dermis damage in vulvar lichen sclerosus.

Cross-Polarization Optical Coherence Tomography for Clinical Evaluation of Dermal Lesion Degrees in Vulvar Lichen Sclerosus.

The aim of the study was to identify different degrees of dermal lesions in vulvar lichen sclerosus (VLS) using cross-polarization optical coherence tomography (CP OCT) based on attenuation coefficient to detect disease early manifestations and to monitor the effectiveness of treatment. Materials and Methods: The study included 10 patients without pathology and 39 patients with VLS diagnosed histologically. CP OCT was performed in vivo on the inner surface of the labia minora, in the main lesion area. From each scanning point, a 3.4×3.4×1.25-mm3 3D data array was obtained in 26 s. CP OCT examination results were compared with histological examination of specimens stained with Van Gieson's picrofuchsin.Quantitative analysis of OCT images was performed by measuring the attenuation coefficient in co-polarization and cross-polarization. For visual analysis, color-coded charts were developed based on OCT attenuation coefficients. Results: According to histological examination, all patients with VLS were divided into 4 groups as per dermal lesion degree: initial (8 patients); mild (7 patients); moderate (9 patients); severe (15 patients). Typical features of different degrees were interfibrillary edema up to 250 µm deep for initial degree, thickened collagen bundles without edema up to 350 µm deep for mild degree, dermis homogenization up to 700 µm deep for moderate degree, dermis homogenization and total edema up to 1200 µm deep for severe degree.Pathological processes in dermis during VLS like interfibrillary edema and collagen bundles homogenization were visualized using CP OCT method based on values of attenuation coefficient in co- and cross-polarization channels. However, CP OCT method appeared to be less sensitive to changes of collagen bundles thickness not allowing to distinguish thickened collagen bundles from normal ones with enough statistical significance. The CP OCT method was able to differentiate all degrees of dermal lesions among themselves. OCT attenuation coefficients differed from normal condition with statistical significance for all degrees of lesions, except for mild. Conclusion: For the first time, quantitative parameters for each degrees of dermis lesion in VLS, including initial degree, were determined by CP OCT method allowing to detect the disease at an early stage and to monitor the applied clinical treatment effectiveness.

[Influence of chemosensional disorders on taste preferences in cancer patients who are receiving oral nutrition supplements].

Chemosensory disorders (CSD) such as disorders of taste and smell are one of the causes of malnutrition in cancer patients. The aim of the research was to evaluate the influence of CSD on taste preferences in cancer patients receiving oral nutritional supplements (ONS). Material and methods. The procedure involves 100 oncological patients (26 men, 74 women; 57.0±1.2 years old). The taste preferences in these patients were assessed using a digital rating scale during ONS. All patients had cancer outside the head and neck area and underwent specific treatment. The functional status on the ECOG scale was 0-II. All patients had indications for DPP (ESMO scale >2 points). Patients were offered a mixture of sweet (banana, coffee, vanilla) and unsweetened (vegetable, chicken soup) tastes in a disposable 30 ml container. The patient was asked to take a sip and evaluate the smell, taste, strength of taste and density (consistency) of the sample on a digital rating scale from 0 to 5 points, where 0 - I do not feel, 5 - I feel excellent. The maximum possible number of points for each sample was 20. Results. Signs of CSD (score <10) were detected in 69% of patients [95% confidence interval (CI) 59.5-77.7]. In this group, the frequency of choosing unsweetened tastes for ONS was 59.4% (95% CI 47.5-70.8), sweet - 40.6% (95% CI 29.2-52.5). In the group of patients without signs of CSD, the frequency of choosing savory tastes was 29.0% (95% CI 14.1-46.7), sweet - 71.0% (95% CI 53.3-85.9) (р=0.0049). Conclusion. The presence of CSD significantly affects the taste preferences of cancer patients and significantly increases the likelihood of choosing products for ONS with unsweetened taste (unsweetened foods).

Evaluation of the Association of rs4680 COMT Polymorphism and Clinical Parameters of the Tumor in Colorectal Cancer (a Pilot Study).

We analyzed association of rs4680 polymorphism of catechol-O-methyltransferase (COMT) gene with clinical parameters of the tumor in patients with colorectal cancer (n=100). Based on the classification of the tumor according to the TNM system, groups were formed taking into account the size and spreading of the primary tumor (T1+T2 vs Т3+Т4) and the presence of regional (N0 vs N1) and distant metastases (M0 vs M1). An association of the AA genotype with an almost 7-fold increased capacity for invasive tumor growth was found (p<0.05; according to recessive (AA vs GG+GA) and codominant (AA vs GG) inheritance models). A positive relationship of minor allele A with increased malignancy of tumor cells was revealed at the trend level. No significant associations with either regional or distant metastasis were found.

[Oral nutrition supplements: applied classification of formulas and basic rules of their prescribing in oncology].

The analysis of current data concerning the use of oral nutrition supplements (ONS) in cancer patients has been performed. The aim of the research is improving the effectiveness of medical nutrition in cancer patients by clarifying terms, definitions, developing an applied classification of ONS formulas and outlining the basic approaches for their use. MATERIAL AND METHODS: Using the keywords «cancer¼, «oral nutritional supplements¼, and «siping¼, the literature was searched in such databases as eLIBRARY (elibrary.ru) and MEDLINE (ncbi.nlm.nih.gov) in Russian and English. RESULTS AND DISCUSSION: The definition of this type of nutritional support has been given. The applied classification of ONS formulas has been made. Depending on the energy and protein content, presence of some specific nutrients, osmolarity, nitrogen/non-protein kilocalories ratio and viscosity, they were divided into 3 groups. For the initial assessment of nutritional status of the cancer patient, the European society for medical oncology scale (ESMO, 2008) is the most appropriate. Emphasis is placed on the importance of maintaining physical activity. CONCLUSION: An approximate algorithm of ONS prescribing in oncology has been formulated.

[M1-OPIOID RECEPTOR AND CATECHOL-O-METILTRANSFERASE GENES POLYMORPHISM EFFECTS ON PERIOPERATIVE PSYCHOLOGICAL CONDITION OF THE PATIENTS AND THE EFFECTIVENESS OF POSTOPERATIVE ANALGESIA WITH OPIOIDS].

OBJECTIVE: To evaluate the influence of µl-opioid receptor (OPRM1) 118A>G and catechol-O-methyltransferase (COMT) 1947G>A gene single nucleotide polymorphisms (SNP) combinations on postoperative opioid analgesia (POA) efficacy. MATERIAL AND METHODS: In 100 consecutive patients scheduled for major urologic surgeries the SNPs of OPRM1 118A>G and COMT 1947G>A (real-time PCR), preoperative anxiety and depression level (HADS scale), POA efficacy ("Pain Out" questionnaire) have been assessed. RESULTS: Preoperative anxiety and depression, additional analgesia requirements, severity of nausea, drowsiness and incidence of vomiting were higher in OPRM1 118G allele carriers. Maximum pain intensity and pain-related restriction of mobility on first postoperative day were lower in homozygous carriers of COMT 1947A. The best response to POA in view of preoperative anxiety, analgesia efficacy and severity of nausea has been revealed in carriers of combination COMT-OPRM1 AA-AA. CONCLUSIONS: SNPs of OPRM1 118A>G and COMT 1947G>A affect the preoperative patients psychological status and POA efficacy.

[Impact of genetic factors on severity of side effects of opioids in patients after major surgical interventions].

The rate of the opioids side effects (SE) occurrence, as well as their mutual connection with possible variants of a single-nucleotide polymorphism (SNP) of genes of a µ1-opioid receptor (OPRM1) 118A>G and catechol-O-methyltranspherase (COMT) 1947G>A were studied in patients after surgical interventions of large volumes in the first postoperative day the rate of the narcotic analgetics SE occurrence have constituted: nemesis--56%, vomiting--17%, dizziness--61%, cutaneous pruritis--17%. Occurrence of central SE of opioids may be caused by the SNP COMT 1947G>A genes: the sedation depth is two times more in the genes AA and GA carriers, in comparison with such in the gene GG carrier (p < 0.05). Gastrointestinal SE may be connected with genes SNP OPRM1 118A>G and COMT 1947G>A: the nemesis occurrence rate is more in the genes OPRM1 AG+GG, COMT GA and GG carriers (p < 0.05), vomiting--in 2,8 times more in the OPRM1 AG+GG genes carriers, than in the group OPRM1 AA (p < 0.05). The severity of cutaneous SE of opiates may be dependent on the variant of SNP COMT 1947G>A: in genotype GG the cutaneous pruritis rate is in 2.9 times more, than in the AA+GA group (p < 0.05).

[Surfactant replacement therapy increases life-span of patients with acute respiratory distress syndrome].

The aim of the study is the evaluation of the influence of surfactant replacement therapy on the life-span of patients with acute respiratory distress syndrome (ARDS) in fatal cases. It has been determined, that in patients, were died from ARDS, exogenous surfactant therapy increases life-span from the moment of establishing of diagnosis of syndrome to fatal outcome. The initial functional state of lungs does not influence on life-span of patients with ARDS, but administration of exogenous surfactant is the important predictor of its increase.

[Opiates do not guarantee an adequate analgesia after large-volume open operations on the abdominal cavity organs].

Efficacy of systemic application of opiates (promedol) for the pain relief after big open abdominal operations, using visual-analogue scale (VAS), was estimated in 50 patients. During 36-48 h postoperatively analgesia was inadequate (VAS in a rest state more than 3 points and while movement--more than 4 points). Intensive pain (VAS 6 points and more) was noted in 58% of patients, while they are moving, and in 26%--in a rest state. Inadequate anesthesia may constitute one of causes of excessive systemic inflammatory reaction development in patients postoperatively.

[Systemic inflammatory response syndrome and anti-endotoxin immunity after the operations on the abdominal cavity organs].

The blood plasma level of albumin, C-reactive protein, common and specific antiendotoxinal immunoglobulins (Ig) was investigated in 52 patients after performance of large operations on the abdominal cavity organs. On the third postoperative day the blood concentration of albumin and antiendotoxinal Ig was low, while of C-reactive protein-high. It must be concluded, that the systemic inflammatory answer syndrome occurrence and the antiendotoxinal immunity inhibition after the operation are caused by the microorganisms translocation and interaction of specific antibodies with endotoxin.

[Systemic inflammatory reaction, antiendotoxin immunity and polyorgan insufficiency in patients of the intensive therapy departments].

The connection of C-reactive protein (CRP) and the antiendotoxin immunoglobulins (Ig) levels with lethality of the Intensive Therapy Department (DITH) patients was studied up. In 45 patients after hospitalization there were analyzed the levels of CRP, general and the specific antiendotoxin Ig. In 14 patients, who, suffering polyorgan insufficiency (POI), subsequently died, the CRP content was hightened and the antiendotoxins IgG concentration--reducted. The conclusion was formulated, that systemic inflammatory reaction and POI are connected with bacterial translocation phenomenon. Determination of CRP and the antiendotoxin IgG levels may be used for delineation of a group of the DITH patients owing high risk of POI occurrence and lethality.

[Assessment of nutritional status in patients, operated on the colon].

In 54 patients, operated on the colon, the indexes of nutritive status - body mass index, the shoulder circumference, the circulating albumin level and the leukocytes count - were estimated on the third and the tenth postoperative day. On the third day after the operation the lowering of these indexes was noted in the patients. Postoperative disorders of nutrition after colonic interventions have multifactorial mechanism of pathogenesis and need complex approach for their correction.

[The state of the pulmonary surfactant system in patients with the acute pulmonary damage syndrome]. / Sostoianie sistemy surfaktanta legkikh u bol'nykh s sindromov ostrogo povrezhdeniia legkikh.

There were examined the surface-active properties and phospholipidious contents of the breathed out air condensate and the general respiratory compliance (C) in 21 patients with an acute pulmonary damage syndrome (APDS), caused by pancreonecrosis, peritonitis, polytrauma, sepsis. The lowering of the surface activity, reducing of phosphatidylcholine content and raising of phosphatidylethanolamine level, significant C lowering were noted. Such changes were more pronounced in patients, which have died subsequently. This testifies the profound inhibition of the pulmonary surfactant system activity in patients with APDS. It is expedient to apply the exogenic surfactant preparations for the treatment of patients with APDS.