Nodular Form Research Articles

The Perception of Contraceptive Practice Among Female Patients Treated With Isotretinoin in Saudi Arabia.

Background Practicing and following a Pregnancy Prevention Program (PPP) is crucial to prevent isotretinoin-induced teratogenicity. Our study aims to assess the current practice of dermatologists about PPP when prescribing oral isotretinoin and the compliance of the patients toward contraceptive methods. Methods The research used a cross-sectional design and utilized a probability sampling method in Saudi Arabia. An online self-administered questionnaire was used to collect data that included female participants who were previously treated/being treated with isotretinoin for acne. Data was analyzed using SPSS (IBM Inc., Armonk, New York). Results Our study examined 359 female patients receiving isotretinoin treatment. Isotretinoin was primarily used for severe nodular forms of acne resistant to regular treatment 229 (63.8%). Regarding awareness, 326 (90.8%) were familiar with isotretinoin's teratogenic effects, and 112 (31.2%) were familiar with the Saudi Food and Drug Authority's Pregnancy Prevention Program. Physicians were among the most prevalent information sources 254 (71%). In terms of isotretinoin usage, 227 (63.2%) had one course. Regarding contraceptive practice, 167 (46.5%) were informed about the necessity of a negative pregnancy test before starting treatment, and 29 (50.9%) of those who received more than two courses had good awareness. Conclusion The study identified a notable awareness gap among the participants, as over two-thirds demonstrated a poor awareness level regarding isotretinoin. A significant proportion of participants were informed about the importance of contraceptive practices, including the necessity of a negative pregnancy test before, during, and after treatment.

The influence of polymorphism of genes associated with breast cancer on the effectiveness of drug antitumor therapy

Background. Increasing the survival rate of breast cancer patients is a problem all over the world and directly depends on the early detection of a malignant tumor. Genome-wide associative studies (GWAS) as a minimally invasive method may be used in determining risk of breast cancer or detection at an early stage. The increase in the number of patients with disseminated breast cancer in the Republic of Kazakhstan makes it necessary to search for molecular genetic markers of breast cancer for their use in the diagnosis and treatment of patients with this pathology.Aim. To retrospectively estimate the correlation of the effectiveness of drug antitumor therapy for breast cancer with gene polymorphism.Materials and methods. The study included the results of genotyping biomaterial samples on high-density DNA chips (venous blood of 1,277 Kazakh patients (in the third generation) with a verified diagnosis of breast cancer with locally advanced and disseminated breast cancer who received anticancer therapy), clinical data of patients, data on the clinical efficacy and toxicity of drug therapy. GWAS data (genotypes) associated with identified responses to chemotherapy drugs were compared with similar data recorded in international databases.Results. The family history study showed 16.52 % of women in the questionnaires had a family history of various types of ESR, and 86.25 % of them had a burden of breast cancer in women of the first degree of kinship. The average age of patients with breast cancer was 48.79 ± 11.44 years. According to the TNM classification, cancer in situ was detected in 4.78 % of patients, stage I of the disease was recorded in 15.27 %, stage II in 63.43 %, stage III in 12.60 %, stage IV in 3.92 % of patients. The vast majority of the patients (96.9 %) had a nodular form of breast cancer. The distribution of the patients by tumor phenotype: luminal type A was found in 20.4 % of patients, luminal type B in 38.3 %, luminal type B with HER2 overexpression in 14.3 %, HER2 positive form in 11.9 % of cases, 12.4 % of patients had an aggressive form – triple negative breast cancer. 18 main genotypes were identified in the Kazakh population as a result of the analysis of associations of the effectiveness of neoadjuvant chemotherapy (its individual components, according to chemotherapy regimens) and individual gene polymorphisms.Conclusion. An associative relationship between different types of gene polymorphism and the characteristics of response to various chemotherapeutic drugs used in the treatment of breast cancer has been confirmed. The obtained results formed the basis for the development of recommendations for making changes to the clinical practice of the Republic of Kazakhstan in order to use them in identifying a genetic predisposition to breast cancer and the effectiveness of drugs used in treatment.

The particularities of connective fibers from the wall of varicose veins extirpated by cryostripping.

The varicose vein affects more than 30% of the general population. Significantly increased rates were noticed in women and older population. From the histopathological point of view, venous arterialization, smooth muscle cell hypertrophy, and hyperplasia are the main changes noticed in varicose vein disease. Some of the main therapeutic methods used in the management of varicose disease are injection sclerotherapy, conservative, surgical, saphenous vein inversion and removal, high saphenous ligation, ambulatory phlebectomy, transilluminated powered phlebectomy, endovascular management, cryostripping. The aim of this study was to evaluate the morphology of connective fibers from the wall of the varicose veins extirpated by cryostripping. The study included 109 samples taken by cryostripping method. Hematoxylin-Eosin, Masson's trichrome, Silver and Orcein staining were applied. The assessment of fibers was made according to score values between 0 and 3. It was found no major structural differences in terms of alterations of collagen fibers induced by the applied surgical procedure. It was noticed duplications and multiplications of the internal elastic lamina, as diffuse and nodular forms. Depletion of elastic fibers at the media was a lesion identified in most of the specimens. The depletion of reticulin fibers correlates with the accumulation of collagen fibers, which partially or completely replace the network in the media and intima. No correlation was found between changes in the reticulin network and the time between prelevation and buffered formalin fixation, the maximum time investigated being five days. The Orcein staining in the venous vessel evaluation panel may be a useful investigation.

Epidemiological, Pathological, and Molecular Studies on Sheeppox Disease Outbreaks in Karnataka, India.

An epidemiological study spanning twelve years has revealed that sheeppox disease is both widespread and endemic, predominantly surging during the winter and summer seasons. This investigation focused on sheeppox across 11 field outbreaks, involving 889 animals from non-migratory flocks across six districts in Karnataka, in the southern peninsula of India. Among these, 105 animals exhibited clinical signs suggestive of sheeppox, such as lesions on the body, and 95 cases were confirmed through PCR testing. The overall positivity rate for sheeppox stood at 10.68% (95 out of 889 animals). The incidence of sheeppox was notably higher in animals aged between 1 and 2 years and was more prevalent in females. Affected animals displayed symptoms including respiratory distress, weakness, fever, loss of appetite, depression, and various skin lesions ranging from papular to pock lesions across their bodies. There was a significant increase in total leukocyte count, while hemoglobin levels, red blood cell counts, and hematocrit values significantly decreased. On gross examination, sheeppox lesions, varying from vesicular to nodular forms, were predominantly found on hairless areas of the body. Microscopic examination of skin lesions revealed extensive changes, such as hyperkeratosis, parakeratosis, acanthosis, hydropic degeneration, and necrosis of epithelial cells, along with characteristic intracytoplasmic viral inclusions. The lungs exhibited type-II pneumocyte hyperplasia and proliferative bronchiolitis, also with intracytoplasmic inclusions. Confirmation of the sheeppox virus was achieved through PCR and subsequent sequence analysis. Phylogenetic analysis of the full-length P32 and RPO30 gene demonstrated homology with sheeppox isolates from various parts of India and neighboring countries, indicating that Indian sheeppox viruses are highly lineage-specific and correlate with the host of origin. Based on these findings, it is recommended to implement a homologous vaccination strategy, utilizing selective host/viral strains to enhance protection in susceptible animals.

Psychosomatic status of women of reproductive age with adenomyosis

The objective: to study the impact of adenomyosis on the psychosomatic status of women of reproductive age.Materials and methods. A complex clinical-laboratory and instrumental prospective examination for women with adenomyosis was conducted in 224 patients aged 30 to 50 years (average age – 42.0±1.8 years). These patients were included in the main group of the study. The patients of the main group were divided into two subgroups depending on the form of adenomyosis: Group I – diffuse form – 106 women, Group II – nodular form – 118 women.The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.To assess the psychosomatic status of patients with adenomyosis we used the Aleksandrowicz method: a questionnaire of neurotic disorders – symptomatic (QND- S).Results. The conducted studies established that the largest number of patients were 36–40 years old – 92 (41.1±3.3%) women in the main group, and 37 (44.0±5.4%) women in the control group. A total of 152 (67.9±3.1%) patients of the main group were of reproductive age, 72 (32.1±3.1%) patients were of perimenopausal age.In patients with adenomyosis disorder of the menstrual cycle in the form of hyperpolymenorrhea was found in almost every third patient, and algomenorrhea – in almost every second person. The diagnosis was established for the first time in 8.49±2.7% of patients in Group I (9 women) and 3.38±1.8% in Group II (4 women).Less than 5 years of the disease was observed in 34.91±4.6% of patients of the Group I (37 women) and in 51.69±4.6% of the Group II (61 women). From 5 to 10 years, the disease was observed in 56.60±4.8% of patients of the Group I (60 women) and in 44.93±4.6% of the Group II (53 women). Affective stress (up to 15.50%), sleep disorders (up to 20.22%), anxiety-phobic disorders (up to 11.18%) were determined most often.Conclusions. In the vast majority of patients of reproductive age who have adenomyosis with pain syndrome, the personal characteristics are dominated by symptoms such as anxiety-phobic and depressive disorders, affective tension, sexual, obsessive and anankastic disorders.

OCCURRENCES OF SOLID INCLUSIONS OF SILICATE AND BASE METAL SULFIDE MINERALS IN CHROMITITE OF KHANOZAI OPHIOLITE, PAKISTAN: EVIDENCE FROM MELT EVALUATIONS

Chromitite bodies occur in the wide mantle portion of Khanozai ophiolite. This peridotite is largely composed of harzburgite, dunite and minor lherzolite. Chromitite occurs in Khanozai ophiolite mainly in massive, disseminated, banded and nodular forms. The Khanozai chromitites contains a variety of silicate and BMS mineral inclusions. They include anhydrous silicates like olivine, clinopyroxene, hydrous silicate inclusions of amphibole, and BMS mineral inclusions such as millerite, chalcopyrite, stibnite, and occasional pyrite and linnaeite. The silicate mineral inclusions occur as monomineralic as well as polymineralic phases. The shapes of these inclusions tend to follow the growth plane of host chromite. Textures and forms of these inclusions reveal that some inclusions were trapped during magmatic stage, whereas many inclusions were trapped during recrystallization of chromite. BMS inclusions are millerite, chalcopyrite, and stibnite. They occur isolated inclusions and at some places associated with silicate mineral inclusions. It is suggested that these BMS inclusions were generated due to the separation of sulfide-bearing liquid from silicate magma.

Systemic lupus erythematosus in a 15-year-old female with multiple splenic nodules: A case report

BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory disease primarily affecting young females. SLE can invade any organ, and various forms of splenic invasion have been reported. Manifestations include splenomegaly and splenic infarction, rupture, and calcification. The study encountered a rare case of splenic involvement, with nodules of various sizes without calcifications or ruptures. CASE SUMMARY A 15-year-old girl presented with arthralgia, weight loss, fever, increased levels of inflammatory markers, and positive antinuclear antibody test results. The patient was diagnosed with SLE. She was asymptomatic while taking steroids and hydroxychloroquine. Ten months after discharge, the patient developed a fever and abdominal pain. Lupus enteritis was suspected, and abdominopelvic computed tomography (AP-CT) was performed. There were no specific findings in the gastrointestinal tract, but multiple splenic nodules were observed. Infection or hemangioma was considered; however, no specific radiological findings were observed. A biopsy of the spleen was performed to determine the possibility of malignancy. The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris. Based on the biopsy results, the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants. CONCLUSION As disease activity increased, multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed. Spleen invasion by SLE can appear in multiple nodular forms and patterns. Therefore, physicians should consider these findings when differentiating these nodules from infections and malignancies.

АРТРОСКОПИЧЕСКАЯ ХОЛОДНО-ПЛАЗМЕННАЯ АБЛЯЦИЯ ПРИ РЕДКИХ ЗАБОЛЕВАНИЯХ СИНОВИАЛЬНОЙ ОБОЛОЧКИ КОЛЕННОГО СУСТАВА. КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

Background. Over a long period, an open capsular synovectomy technique was recommended for villous nodular synovitis and synovial chondromatosis of the knee joint. However, such surgical treatment is accompanied by significant trauma to the joint tissue and frequent postoperative recurrence. Currently, it is advisable to assess the possibilities of modern treatment methods (arthroscopic cold plasma ablation) for rare diseases of the knee joint. The aim of the study. To assess the possibilities of arthroscopic cold plasma ablation in a series of clinical observa-tions of the surgical treatment of patients with rare diseases of the knee joint synovium in a statistically small sample. Material and methods. Surgical treatment was performed in 14 patients with diseases of the knee joint synovium. We carried out clinical and radiological examinations, computed tomography and magnetic resonance imaging, multi-detector computed tomographic angiography, ultrasound examination, Dopplerography of the vessels of the lower extremities, biochemical examination of synovial fluid, arthroscopy with targeted biopsy and subsequent morphological examination of the synovial membrane. Results. In 7 patients with pigmented villous nodular synovitis, the following surgeries were performed: in 1 patient with the diffuse form – an open subtotal capsular sinovectomy; in 6 patients with the nodular form – an arthroscopic partial cold plasma capsular sinovectomy of the knee joint. In 7 patients with synovial chondromatosis, an arthroscopic removal of cartilage flaps and partial cold plasma ablation of synovial folds and knee joint villi were carried out. Conclusion. Arthroscopic cold plasma ablation with bipolar electrodes in various modes of the Qvantum-2 (Arthro-Care, USA) using anterior, posterolateral and suprapatellar approaches makes it possible to carry out less traumatic and radical, without damaging deep layers of cartilage and capsule, surgical treatment of rare diseases of the knee joint synovium. In diffuse forms of pigmented villous nodular synovitis, it is advisable to continue comparative studies of various surgical methods of capsular sinovectomy (open and arthroscopic techniques).

Features of the vagina microbiotope in patients with adenomyosis

The objective: to assess the composition of the vaginal microbiota in women of reproductive age with adenomyosis.Materials and methods. A comprehensive clinical-laboratory and instrumental prospective examination of 224 patients aged 30 to 50 years (average age – 42.0±1.8 years) with adenomyosis, who were included in the main study group, was conducted. The patients of the main group were divided into 2 subgroups depending on the form of adenomyosis – I group (diffuse form) included 106 women, II group (nodular form) – 118 persons. The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.Patients underwent microscopic examination of vaginal secretions, bacterioscopic examination of vaginal smears, stained according to Gram. Lactobacillus cultures were identified by polymerase chain reaction (PCR) and 16S ribosomal ribonucleic acid analysis.​Results. During the microscopic examination of the vaginal secretion, more than 15 leukocytes in the field of view were detected in 84 (37.5±3.2%) patients of both groups: in 40 (47.9±3.3%) patients of the I group and in 44 (52.1±3.3%) – II group. During the bacterioscopic examination of vaginal swabs, stained according to Gram, no gonococci and trichomonads were found in the main group. Candida fungi were detected microscopically in 158 patients (70.5±3.1%) of the main group: in 71 (66.9±4.6%) of the I group and in 87 (33.1±4.3%) of II group.Genotyping results showed that lactobacilli isolated from women with adenomyosis belonged to seven species: Lactobacillus fermentum, Lactobacillus iners, Lactobacillus gasseri, Lactobacillus amnionii, Lactobacillus jensenii, Lactobacillus crispatus, and Lactobacillus delbrueskii. The majority of lactobacilli strains have high inhibitory activity against all test strains, except for Candida albicans (39 cases, 46.4%). High adhesion to human erythrocytes was determined by 54.7% (46 cases) of the studied cultures.All lactobacilli strains were resistant to metronidazole, 83.3% (70 cases) to kanamycin, 57.1% (48 cases) to vancomycin, all strains were sensitive to roxithromycin, amoxiclav, and ampicillin. Moderate sensitivity to gentamicin and cefazolin was found in 51.9% (43 cases) of cultures, peroxide-forming activity in 80.9% (68 cases).The use of quantitative diagnostic thresholds has led to significant improvements in diagnostic performance. PCR showed 88% sensitivity and 95% specificity for Gardnerella vaginalis and 96% sensitivity and 97% specificity for Atopobium vaginae.Conclusions. It has been established that bacterial vaginosis and microorganisms associated with bacterial vaginosis are independently associated with adenomyosis. The results of the study confirmed that vaginal microorganisms, which are usually diagnosed in women with adenomyosis, ascend to the endometrium from the vagina vertically, which leads to infection of the upper parts of the genital tract.

Clinical and radiological efficacy of a new conservative treatment for fibrocystic disease

Background. Long-lasting dyshormonal breast diseases in women represent a risk factor for breast cancer, especially in patients with atypia. Clinical manifestations of fibrocystic breast disease (FBD) and mastopathy, including high-intensity pain cause psychoemotional discomfort and reduce the quality of life of women. The search for effective management strategies for mastopathy with an antiproliferative effect is highly relevant.Aim. To assess clinical and radiological efficacy of a new conservative treatment for FBD, “Evening primrose oil” administered orally for 6 months in women with symptomatic FBD.Materials and methods. This randomized, blind, placebo-controlled trial included 144 patients with clinical FBD manifestations (pain and tension in the breast). Patients were randomly assigned to one of the two treatment groups. Women in group I received “Evening primrose oil”, whereas women in group II received placebo (ascorbic acid) for 6 months. We measured the dynamics of radiological findings (at mammography and ultrasound examination) in the breast before and after treatment, as well as pain intensity using the visual-analog scale.Results. Patients in group I with all types of FBD (diffuse mastopathy, nodular, and mixed forms) demonstrated positive dynamics and BI-RADS category downgrading within 6 months. In the placebo group, the examination after 6 months demonstrated no significant changes in the breast and no BI-RADS category downgrading among women with diffuse mastopathy. Some patients with nodular and mixed FBD receiving placebo had negative dynamics after 6 months (as demonstrated by mammography and ultrasound examination; BI-RADS category upgraded from II to III, p<0.01). Patients receiving “Evening primrose oil” also showed positive dynamics in their clinical manifestations, including decreased breast pain (from 7.8 to 1.8 on the visual analog scale). By contrast, patients receiving placebo had no changes in their breast pain intensity after 6 months (from 7.3 to 7.1 on the visual analog scale), which resulted in poorer psychoemotional state in 55.6 % of women.Conclusion. Our new treatment strategy for FBD patients with clinical and radiological manifestations in the breast demonstrated high efficiency and can be implemented into routine clinical practice.

Diagnosis and evaluation of nontuberculous mycobacterial pulmonary disease

Background: Nontuberculous mycobacteria (NTM) represent a broad spectrum of acid-fast bacilli, excluding the pathogens responsible for tuberculosis and leprosy. Over 200 species have been identified and classified as NTM, based on shared phenotypic characteristics. These bacteria are prevalent in diverse environments and are implicated in NTM pulmonary disease (NTM-PD), resulting from interactions between the host, the environment, and the microorganism.Current Concepts: Diagnosing NTM-PD necessitates a comprehensive approach. It is essential to identify the risk factors, including underlying lung conditions, compromised immune responses, and other host-specific factors. The clinical diagnosis considers pulmonary or systemic symptoms aligned with the disease and the exclusion of alternative pulmonary disorders. Radiological evaluations, such as chest X-rays and computed tomography scans reveal patterns indicative of the disease, including fibrocavitary and nodular bronchiectatic forms. Microbiological criteria are fundamental to the diagnostic process and require a minimum of two positive cultures from separate sputum samples or a single positive result from invasive techniques, such as bronchoscopy or biopsies.Discussion and Conclusion: As there are multiple phenotypes of NTM-PD, it is necessary to assess the likelihood of the disease in individuals with increased risk factors. A combination of the clinical, radiological, and microbiological criteria is essential for the accurate diagnosis of NTM-PD. Once diagnosed, a thorough assessment is necessary to guide appropriate management decisions.

The effectiveness of using a combination of laser radiation with wavelengths of 585 nm and 1064 nm in the treatment of patients with basal cell skin cancer.

Background: Basal cell skin cancer is the most common skin malignancy, and its incidence has been rapidly increasing throughout the world in recent decades.
 Aims: To study the effectiveness of using laser radiation with a wavelength of 585 nm and 1064 nm in a sequential (sequential) combined mode for the treatment of patients with superficial and nodular forms of basal cell skin cancer using dermoscopic and confocal microscopic in vivo examination.
 Materials and methods: The study included 30 patients with histologically confirmed basal cell skin cancer, who received treatment in the conditions of the Consultative and Diagnostic Center of the State Research Center of Dermatovenereology and Cosmetology of Russian Ministry of Health in the period from 2020 to 2021, using a pulsed dye laser (wavelength 585 nm) and long-pulse neodymium laser (wavelength 1064 nm).
 Results: In the subgroup of patients with the nodular form of basal cell carcinoma (n=15): in 11 patients the duration of treatment was 1 procedure, in 3 patients 2 procedures, in 1 patient 3 procedures. In the subgroup of patients with superficial basal cell carcinoma (n=15 ): in 2 patients the course of treatment was 2 procedures, in 13 patients 1 procedure. Patients have now completed treatment and are being followed up with visits every 6 months for 3 years. According to dermoscopic and confocal microscopic studies, there is no evidence of continued growth and relapse in all patients. No side effects or adverse events were recorded.
 Conclusions: The combined sequential use of 585 nm and 1064 nm laser radiation may be an effective treatment for patients with low-risk basal cell skin cancer of recurrence. The results of our study indicate that clinical tumor removal without scarring can be achieved and may be an alternative treatment option for those who do not wish to use traditional surgical approaches.

Gene expression changes of angiogenesis factors during basal skin cancer laser treatment

Background: Basal cell carcinoma is the most widespread malignant skin neoplasm. Angiogenesis is critical for the growth and metastasis of malignant tumors.
 Aims: To study the levels of representation of transcripts in the foci of basal cell skin cancer before and after the therapy of genes for angiogenesis proteins and their receptors.
 Materials and methods: The study included 31 patients with confirmed basal cell skin cancer who received treatment, using a pulsed dye laser and long-pulsed neodymium laser. The patients provided skin punch biopsies from BCC lesions and after therapy from the same localization. The gene expression was analyzed with real-time reverse transcription PCR using endogeneous control, and the gene expression ration changes during the therapy were calculated according to Livaks double delta formulae.
 Results:
 An increased expression of the matrix metalloproteinase MMP9 and the tachykinin precursor TAC1 genes were revealed in skin biopsy samples of the superficial and nodular form of basal cell skin cancer during laser pulsed therapy. The expression of tumor necrosis factor TNF, epidermal growth factor receptor EGFR, fibroblast growth factor FGF2 genes increases to a lesser extent.
 It was shown that the expression of the calcitonin-related polypeptide alpha CALCA gene in the skin of patients is at basal level, which makes it possible to exclude the influence of the neuropeptide on the basal cell skin cancer pathogenesis.
 Conclusions:
 Among the factors of neoangiogenesis potentially influencing the development of basal cell skin cancer, the leading role of expression of the MMP9 matrix metalloproteinase and TAC1 precursor protein of tachykinin has been shown. Simultaneous changes in the level of these proteins may be due to neuroimmune interactions in the epidermis, which is probably realized by mast cells as the microenvironment of the basal cell carcinoma.

The features of PD-L1 expression in tumor stromal cells, peritumoral microvessels and isolated clusters of tumor cells in breast cancer tissue and their correlation with clinical and morphological characteristics of breast cancer

Objective: to study the features of PD-L1 expression in tumor stromal cells, peritumoral microvessels, and isolated clusters of tumor cells in breast cancer (Bc) tissue and their correlation with the clinical and morphological characteristics of Bc.Material and Methods. The study included 158 patients with newly diagnosed invasive BC. PD-L1 expression was studied by immunohistochemistry. statistical analysis was performed using statistica 12.0 software.Results. PD-L1 expression in peritumoral microvessels occurred in 41.4 and 61.7 % of cases with t1–2 and T3–4 (p=0.020), and in 39.8 and 51.7 % of cases with N0–1 and N2–3 (p=0.008), respectively. In isolated clusters of tumor cells, the marker expression was observed in 28.0 and 52.5 % of cases in nodular and diffuse forms of BC (p=0.005); in 25.9, 39.3 and 66.7 % of cases at stages I–IIb, IIIa–IIIc and IV (p=0.011); in 30.3, 26.2, 40.0 and 52.5 % of cases in T1, T2, T3 and T4 (p=0.040); and in 28.2 and 45.5 % of cases in N0–1 and N2–3 (p=0.030), respectively. Nuclear expression of PD-L1 was also detected in stromal cells, and was observed in 28.8 and 55.0 % of cases with nodular and diffuse forms of BC (p=0.003), in 17.6, 52.5 and 75.0 % of cases in early, locally advanced and metastatic BC (p<0.001), in 21.2, 28.7, 80.0 and 55.0 % of cases in T1, T2, T3 and T4 (p=0.002), in 21.7, 35.3, 51.4 and 55.0 % of cases with N0, N1, N2 and N3 (p=0.005), in 49.0 and 29.0 % of cases with negative and positive status of PR (p=0.014), in 30.3 and 52.8 % of cases with HER2-negative and HER2-positive BC status (p=0.014), respectively.Conclusion. The data indicate the relationship between PD-L1 expression and BC progression. The determination of PD-L1 expression in peritumoral microvessels and isolated tumor cell clusters, as well as nuclear expression of the marker, can be used to clarify the prognosis of the disease.

Improving the oxidation resistance of carbon fibers via B4C coating by modified boron oxide chemical vapor deposition

Carbon fiber is one of the engineering materials frequently used in high-temperature applications despite its very poor oxidation resistance. To enhance the oxidation resistance of C fibers and improve the service temperature, boron carbide coatings were prepared by the modified reactive boron oxide chemical vapor deposition (BOCVD) method. For the coating process, a tube furnace system was utilized. Experiments were performed at 1100–1400 °C for up to 6 h under a flowing Ar atmosphere. Coatings were analyzed by SEM, Raman, XRD, and XPS analysis. B4C coatings were found to be in nodular form around 30–50 nm. Oxidation tests performed in flowing air up to 1500 °C by DTA-TG analysis and oxidation mechanisms were explained in details. We revealed that the base oxidation resistance increased up to 180 °C with no net mass gain or loss.

Prevention of endometriosis recurrence after surgical treatment

Introduction. The relevance of studying the mechanisms underlying the development of adenomyosis is determined not only by its high prevalence reaching 40% among reproductive aged women, but also by its association with unexplained infertility (60%), as well as woman’s quality of life impairment.Aim. To enhance efficiency of therapy after surgical treatment of endometriosis and minimize the risk of disease recurrence.Materials and methods. In a cohort prospective comparative study conducted on the basis of the gynecological department of the Inozemtsev City Clinical Hospital, 80 patients of reproductive age who underwent organ-preserving treatment for external genital endometriosis and nodular adenomyosis were included. Dienogest (Zafrilla) was prescribed to 65 patients at a dose of 2 mg/day (1 tablet) from day 2 after surgical treatment continuously for 6 months, taking into account contraindications to its use, 15 patients refused to take the drug in the postoperative period, and made up the control group.Results. The results of the study showed that after surgical treatment of external genital endometriosis and the nodular form of adenomyosis and the appointment of suppressive therapy with Zafrilla, after 3 months, the intensity of the pain syndrome was transformed according to the VAS, NRS, B&B scales by one step, and after 6 months it decreased to a slight (p < 0.05), which contributed to the improvement of the quality of life of patients based on the EHP-30 questionnaire. The long-term results of the study allow us to recommend the drug Zafrilla, with high compliance, good tolerance, a favorable safety profile, in order to reduce pain, the intensity of menstrual flow, and prevent recurrence of the disease based on 24 months of observation.Conclusion. An integrated approach to the treatment of external genital endometriosis and nodular adenomyosis, including surgical treatment and suppressive therapy with Zafrilla, made it possible to realize reproductive function in 48% of patients. Taking dienogest for 24 weeks provided effective relief of pain, alleviated the symptoms of the disease, as well as improved the quality of life and realized reproductive plans.

Precursor B-sejtes lymphoblastos lymphoma cutan tünetei

The case of a 15-year-old boy diagnosed with cutaneous and subcutaneous infiltration of precursor B-cell lymphoblastic lymphoma is presented. The patient’s first skin symptoms appeared 4 months prior to the first hospitalization. According to the parents, it was diagnosed as lipoma by his family doctor and his dermatologist. The differential diagnosis of the case and the clinical features of the pediatric dermatological conditions presenting in nodular form are briefly reviewed.

An Atypical Case of Pulmonary Sarcoidosis

Abstract Sarcoidosis is a multisystem, granulomatous, inflammatory disease, of uncertain aetiology, ubiquitous, much more common in the female population. The age at onset is usually between 30 and 50 years, also having a second peak of incidence in the immediate post-menopausal period. Respiratory system or lymphatic system involvement is present in about 90% of sarcoidosis cases, usually being short-lived and self-limiting, but sometimes the disease can become chronic and less often it can progress to irreversible pulmonary fibrosis, complicated with pulmonary hypertension followed by chronic pulmonary heart disease with cardio-respiratory failure and death. We present the case of a patient presenting a rare, nodular form of sarcoidosis, in which multiple calcifications, both parenchymal and lymphatic, were identified by imaging, most likely with a long-term evolution of the disease beforehand, but with a completely preserved pulmonary function.

Хирургическое лечение базалиомы внутреннего угла глазной щели с закрытием дефекта свободным лоскутом. Клинический случай

Basal cell carcinoma is a tumor of the basal layer of the skin epithelium. It occupies an intermediate position between benign and malignant tumors. It develops from atypical basal cells of the epidermis and follicular epithelium. It does not metastasize. The occurrence on the lower eyelid is about 65 %, on the medial canthus about 15 %, on the upper eyelid about 15 % and on the lateral canthus 5 % of cases. Usually the neoplasm is painless, but more invasive basal cell carcinomas with perineural germination into the tissues of the eyelid and orbit can cause pain [1, 3]. The choice method of treatment of this disease is surgical. The operation is performed under a microscope, which allows to remove the altered tissues as much as possible and correctly match the edges of the donor material. To replace the surgical defect, a type of plastic was chosen: plastic with local tissues, free skin plastic. The skin flap was taken from the upper eyelid of the fellow eye [2]. There are several types of basal cell carcinomas: nodular, flat, and superficial. The nodular form is most common. A distinctive feature in most cases is pearl shade and waxy or translucent consistency of the tumor, more noticeable on the raised edges of the neoplasm. A characteristic and important symptom is telangiectasis marked at the edges of the neoplasm [1]. Initially, a painless nodule appears on the skin gradually, the nodule spreads over the area, accompanied by formation of ulcers, due to disturbance of blood supply and turns into ulcerative-nodular form. Ulceration can bleed. Further, basal cell carcinoma turns into a flat plaque with a peeling surface, a node protruding above the surface of the skin, or into a deep ulcer that destroys the underlying tissues. With advanced forms or inadequate treatment, the tumor can grow into the lacrimal pathways, the orbit and occasionally into the cranial cavity. The sprouting of orbital tumor causes diplopia and dislocation of the eyeball. Spontaneous regression is rare [3]. There are the following types of treatment: radiation, surgical, combined, medicinal, cryogenic, laser [4, 5]. Radiation, laser, cryogenic methods of treatment are carried out in a specialized cancer center. The surgical method is based on excision within healthy tissues with the least traumatization or destruction of surrounding tissues. Excision of a part of the eyelid weakens its horizontal tension; this circumstance requires special restorative techniques to prevent scarring. The choice method of the defect closure is the method of lateral displacement, plastic with a free flap or pedicle flap [4, 5]. Key words: basal cell carcinoma; surgery of basal cell carcinoma; plastic surgery with a free flap.

Comprehensive Analysis of the Clinical and Pathological Presentation of Nodular Lepromatous Leprosy: A Prospective and Multidisciplinary Evaluation

Nodular lepromatous leprosy, an atypical and advanced manifestation of lepromatous leprosy, constitutes a significant clinical and diagnostic challenge in the dermatologic disease landscape. In the present study, a comprehensive and multidimensional inquiry of this leprosy variant is undertaken to provide an enriched understanding of its clinical phenotype and underlying pathologic profile. This article is based on a prospective investigation involving a series of patients with nodular lepromatous leprosy, in which detailed clinical, histopathological and immunohistochemical analyses were performed. Through the integration of clinical findings with microscopic evaluations, the distinctive features of this nodular form are delineated, highlighting its diversified clinical presentation, which may include cutaneous nodules, peripheral nerve involvement and advanced systemic dissemination. Histopathological analysis highlights the diffuse infiltration of infected Schwann cells in the dermal nodules, as well as Langerhans cell hyperplasia and intense inflammatory response. In addition, immunohistochemical implications are explored, revealing increased expression of inflammatory markers and the involvement of immunomodulatory cells in the pathogenesis of the disease. Overall, this article seeks to fill the gap in the medical literature regarding nodular lepromatous leprosy by providing a comprehensive and up-to-date assessment of its clinical presentation and pathologic basis. The information derived from this study may not only enrich the current understanding of lepromatous leprosy as a whole, but also guide future research toward more precise and personalized therapeutic approaches for this particular clinical variant.