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March 18, 2011

In Research

grad student with optical device

Research associate Kye-Sung Lee works with a  prototype device developed by Jannick Rolland that
can take high-resolution images under the skin’s surface without removing the skin. Researchers say that in the future it may eliminate the need for many biopsies to detect skin cancer.

Imaging under the skin

Jannick Rolland, the Brian J. Thompson Professor of Optical Engineering, has developed an optical technology that provides unprecedented images under the skin’s surface. The aim of the technology is to detect and examine skin lesions to determine whether they are benign or cancerous without having to cut the suspected tumor out of the skin and analyze it in the lab. Instead, the tip of a roughly one-foot-long cylindrical probe is placed in contact with the tissue, and within seconds a clear, high-resolution, 3D image of what lies below the surface emerges.

Rolland presented her findings at the 2011 annual meeting of the American Association for the Advancement of Science in Washington, D.C.

“My hope is that, in the future, this technology could remove significant inconvenience and expense from the process of skin lesion diagnosis,” Rolland says. “When a patient walks into a clinic with a suspicious mole, for instance, they wouldn’t have to have it necessarily surgically cut out of their skin or be forced to have a costly and time-consuming MRI done. Instead, a relatively small, portable device could take an image that will assist in the classification of the lesion right in the doctor’s office.”

The device uses a unique liquid lens technology developed by Rolland and her team for a process known as Optical Coherence Microscopy. In a liquid lens, a droplet of water takes the place of the glass in a standard lens. As the electrical field around the water droplet changes, the droplet changes its shape and therefore changes the focus of the lens. This allows the device to take thousands of pictures focused at different depths below the skin’s surface. Combining the images creates a fully in-focus image of all of the tissue up to 1 millimeter deep in human skin. Because the device uses near infrared light instead of ultrasounds, the images have a precise, micron-scale resolution instead of a millimeter-scale resolution.

The process has been successfully tested in living human skin and several papers on it have been published in peer-reviewed journals. Rolland says that the next step is to start using it in a clinical research environment so its ability to discriminate between different types of lesions may be assessed.

Pathology study tracks uterine changes with mifepristone

Research continues to show that the controversial abortion drug mifepristone might have another use, as a therapeutic option besides hysterectomy for women who suffer from severe symptoms associated with uterine fibroids.

The Medical Center in 2004 began investigating mifepristone, part of a class of drugs known as progesterone receptor modulators (PRMs), to treat fibroids, which affect roughly half of all women younger than 50. Results showed the drug shrank the fibroids and greatly improved the quality of life for the women involved in the clinical trial.

But concern over whether PRMs could cause tissue changes that signal uterine cancer dampened a growing interest in the drug. The latest Medical Center study, which appears in Human Pathology, demonstrates that PRMs do not appear to trigger cancerous or precancerous lesions in the lining of the uterus, at least in the short term.

“Our biggest concern was cancer, and although we saw significant changes in the endometrial tissue specific to the action of PRMs, all of the changes were benign and well characterized in the laboratory,” says lead investigator Julietta Fiscella, a clinical assistant professor of pathology and laboratory medicine and director of pathology at Highland Hospital.

Fiscella analyzed 152 tissue samples from 53 premenopausal women in the Rochester area, who volunteered to take mifepristone at very low doses for up to 18 months to alleviate symptoms such as pain and heavy bleeding. She compared samples of unexposed endometrial tissue to samples from women who took the drug in 2.5 mg or 5 mg dosages.

The changes most evident in the drug-exposed tissue included fluid-filled glands that appeared as scattered, benign cysts of varying size and some abnormal blood vessels. The features were consistent in 86 percent of the drug-exposed samples, with no statistical differences between the two doses, the study said.

An international panel of pathology experts also conducted a blind review of the 152 samples and confirmed Fiscella’s findings, she says. The results suggest that if mifepristone or PRMs with similar properties are eventually approved for treatment of uterine fibroids, pathologists will have a reliable way to track and compare the effects of different doses and treatment schedules on patients during their childbearing years.

Women who miscarry can have long-lasting mental health problems

The depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child, according to a study led by Medical Center researchers and published online by the British Journal of Psychiatry.

“Our study clearly shows that the birth of a healthy baby does not resolve the mental health problems that many women experience after a miscarriage or stillbirth,” says Emma Robertson Blackmore, an assistant professor of psychiatry at the Medical Center and the lead researcher. “This finding is important because, when assessing if a women is at risk of antenatal or postnatal depression, previous pregnancy loss is usually not taken into account in the same way as other risk factors such as a family history of depression, stressful life events, or a lack of social support.”

Pregnancy loss by miscarriage or stillbirth affects more than an estimated 1 million women in the United States annually. Between 50 and 80 percent of women who experience pregnancy loss become pregnant again.

The researchers studied 13,133 pregnant women in the United Kingdom who were taking part in a long-term study known as the Avon Longitudinal Study of Parents and Children. The women were asked to report the number of previous miscarriages and stillbirths they had experienced. They were assessed for symptoms of depression and anxiety twice during their pregnancy and four times after giving birth, at 8 weeks, 8 months, 21 months and 33 months. The majority of women reported no miscarriages. But 2,823 women, or 21 percent, reported having one or more previous miscarriages, while 108 reported having one previous stillbirth and three women had two previous stillbirths.

“We found no evidence that affective symptoms associated with previous prenatal loss resolve with the birth of a healthy child. Rather, previous prenatal loss showed a persisting prediction of depressive and anxiety symptoms well after what would conventionally be defined as the postnatal period,” the researchers concluded.

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