Vol 21, No 6 (2019)

REVIEW
Biomarkers of cervicovaginal fluid for the diagnosis of cervical diseases associated with human papilloma virus (literature review)
Prilepskaya V.N., Mheryan A.N., Akopian A.S., Nazarova N.M., Dovletkhanova E.R., Abakarova P.R., Starodubtseva N.L.
Abstract

Human papillomavirus (HPV) is one of the main pathogens of genital tract infections, which can lead to malignant transformation of cells of the cervix, vagina, vulva and anus. Approximately 90% of cervical intraepithelial neoplasia cases and 99% of cervical cancer cases occur in HPV-positive patients. However, the presence of HPV in the patient’s body can not be considered as a marker of progression or regression of the pathological process. The need to determine further tactics of examination and management of women with HPV-associated diseases of the cervix States the search for molecular genetic markers of neoplastic transformation in order to predict the risk of cervical neoplasia and cervical cancer. Diagnostic systems based on determination of biomarkers in cervicovaginal fluid (CVJ) can become convenient for application in clinical practice. The panel of CVJ proteins allows to make the exact characteristic of a condition of bodies of female reproductive system, including at neoplastic processes of a cervix of a uterus. The biomarkers identified in the CVJ can be used as informative tests to improve the accuracy of diagnosis of pathological changes in the cervix and to determine the risk criteria for the development of malignancy.

Gynecology. 2019;21(6):6-11
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Local angiogenic effects of hormonal contraception: literature review
Nabieva K.R., Burlev V.A., Mejevitinova E.A., Ilyasova N.A.
Abstract

The processes of angiogenesis are one of the key in the functioning of the reproductive system in women. Studies on cyclic angiogenesis in the reproductive system have allowed us to single out a separate area of scientific research and to obtain results that have important scientific and practical value. The processes of cyclic angiogenesis in the organs of the reproductive system are studied in sufficient detail. At the same time, the issues of the influence of various methods of hormonal contraception on the relationship of angiogenic growth factors, hemostasis, regional hemodynamics remain unstudied. The assumption that such a relationship plays a significant role in the functioning of the endometrium, and modification of these factors can occur with various methods of exposure, including the appointment of hormonal contraception, can serve as a scientific research subject with a large practical component.

Gynecology. 2019;21(6):16-20
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Opportunities for ovarian reserve preservation in the treatment of oncological diseases
Dobrokhotova J.E., Morozova K.V.
Abstract

This article presents the data of multi-year research on the problem of ovarian reserve preservation in cancer patients. The review includes 64 literary sources. The review provides the main methods for ovarian function preservation during the treatment of malignant diseases in patients of reproductive age. Given the increasing number of cancer patients in the group of patients of reproductive age, modern medicine is faced with the task not only to provide effective anticancer treatment, but also to try to preserve ovarian function in order to maintain hormonal levels and fertility. Unfortunately, most cancer treatment methods inhibit ovarian function. Thanks to modern approaches, there are medicinal methods for protecting against ovarian inhibition, which allows to maintain hormonal function and come back to solve reproductive problems after recovering from cancer.

Gynecology. 2019;21(6):21-25
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Estrogen metabolism: why it’s so crucial to keep the balance?
Yakushevskaya O.V., Yureneva S.V., Protasova A.E.
Abstract

Aim. To analyze and systematize the available information on pathogenetic mechanisms of hormonal carcinogenesis.

Materials and methods. The review includes data from foreign articles published in PubMed and Medline and national works posted on elibrary.ru over the past 20 years.

Results. Currently, the term «estrogen» is often used in the context of hormonal carcinogenesis. According to most researchers, it should not fit into the narrow framework of receptor-mediated proliferation induced by estrogens in target tissues. The concept of “estrobiome” as a combination of all mechanisms providing the realization of estrogen effects should include not only hormones and “native” receptors themselves, but also the enzymes involved in their synthesis, estrogen metabolites, intestinal microbiota, as well as genetic and epigenetic factors.

Conclusions. When analyzing cancer risk, it is necessary to comprehensively assess contributing factors and hormonal-metabolic preconditions for neoplastic process.

Gynecology. 2019;21(6):31-35
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Follicular fluid and assisted reproductive technology programs outcomes (literature review)
Burduli A.G., Kitsilovskaya N.A., Sukhova Y.V., Vedikhina I.A., Ivanets T.Y., Chagovets V.V., Starodubtseva N.L., Frankevich V.E.
Abstract

The review presents data on metabolites in the follicular fluid (FF) from the perspective of reproductive medicine and their use in order to predict outcomes of assisted reproductive technology (ART) programs. It considers various components of this biological medium (hormones, lipids, melatonin, etc.) with an assessment of their predictive value in prognosis of the effectiveness of in vitro fertilization (IVF) programs. The data on experimental directions in this field and the prospects for their use in clinical practice are presented. The article emphasizes that the growing clinical need and the unsolved problem of increasing the effectiveness of ART programs determine the need for further studies of the FF composition.

Materials and methods. The review includes data related to this topic from foreign and Russian articles found in PubMed which were published in recent years.

Results. Given the established fact of a direct effect of FF composition on growth and maturation of oocytes, and further, on the fertilization process, various FF metabolites are actively investigated as non-invasive markers of quality of oocytes/embryos. The article provides data on the experimental directions in this field and the prospects for their use in clinical practice. However, clinical studies of a relation between various FF metabolites levels and outcomes of IVF programs are contradictory.

Conclusion. Owing large economic cost for treatment of infertility with IVF, there is need for expansion and intensification of studies to identify and use reliable predictors in prognosis of ART programs outcomes.

Gynecology. 2019;21(6):36-40
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Management of menopausal women with a history of endometriosis
Ermakova E.I., Yureneva S.V.
Abstract

Aim. To formulate a position statement on the management of the menopause in women with a past history of endometriosis from the point of view of evidence-based medicine.

Materials and methods. Review of domestic and foreign literature, position of IMS and EMAS.

Results. The article describes the main modes snd ways of introducing MHT and their advantages. The expert position on the management of patients with a history of endometriosis during surgical and natural menopause is highlighted. Information on the prevalence and methods of treatment of postmenopausal endometriosis is given.

Gynecology. 2019;21(6):41-44
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Vitamin D as a factor for improving the quality of life in women after 50 years (literature review)
Pestrikova T.Y., Yurasova E.A., Knyazeva T.P.
Abstract

Relevance. Public health is one of the key factors in the development of the economy and at the same time an objective indicator of quality of life. Currently, the number of women over 50 years old is progressively increasing, and their growing social inclusion will determine the desire for active and healthy longevity. In this regard, the public health policy in the country should follow the path of increasingly large-scale financing of projects of a healthy lifestyle, not concentrating expenses only on medical care.

Aim. Analysis of literature on the feasibility of using vitamin D as a factor that improves the quality of life of women in the perimenopausal period and in menopause.

Materials and methods. To write this review, we searched for domestic and foreign publications in Russian and international search engines (PubMed, eLIBRARY, etc.) over the past 20 years. The review included articles from peer-reviewed literature.

Results. The review outlines a wide range of biological properties of vitamin D involved in the regulation of many important physiological functions. The negative effect of vitamin D deficiency is presented not only on the development of cancer, cardiovascular diseases, but also on the increase in the severity of menopausal syndrome. It has been established that the use of colecalciferol (vitamin D3) in combination with menopausal hormone therapy contributes to the normalization of carbohydrate, lipid and calcium phosphorus metabolism, improves the neuropsychic state of patients, which makes it possible to actively use colecalciferol in routine clinical practice in menopausal syndrome.

Conclusions. Numerous positive effects of colecalciferol (vitamin D3) allow the use of the drug as a means to increase social adaptation, and, consequently, improve the quality of life.

Gynecology. 2019;21(6):48-50
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Features of ambulatory and stationary treatment of patients with endometriosis
Oboskalova T.A., Gluhov E.Y., Astryuhina I.I.
Abstract

Background. Most common clinical manifestations of endometriosis (N80) include pelvic pain and infertility, while adenomyosis is associated with abnormal uterine bleeding. At present, approach to the treatment of endometriosis has been revised towards shifting surgery to the second-line therapy; medications are considered as the first-line therapy: gonadotropin releasing hormone agonists, progestogens, aromatase inhibitors.

Aim. Comparison of clinical and anamnestic characteristics and therapeutic procedures in women who were treated on an outpatient basis and those who were hospitalized and underwent surgical intervention.

Materials and methods. Clinical-anamnestic and morphological characteristics were studied in two groups of women: 1st group (n=27) received drug therapy, 2nd group (n=28) underwent surgical intervention.

Results and discussion. In the 1st group, 25.9% of patients received microdosed combined oral contraceptives which contain dienogest as a progestogen component, 44.4% of patients received monotherapy with dienogest, and 22.2% of patients received dydrogesterone in a prolonged mode. In the 2nd group, 39 foci of endometriosis, isolated and in a combination of various loci, were revealed during surgery, of which 30.8% were ovarian cysts, 10.2% were foci on the sacro-uterine ligaments, 23.1% were on the pelvis peritoneum. Surgical approach was determined by the urgency of intervention, an expect localization of endometriosis foci, a comorbidity of endometriosis with another pathology of the internal genitalia, 82.1% of surgery were performed by laparoscopic approach.

Conclusions. The choice of treatment method depends on the severity of symptoms, the severity of endometriosis, the woman age and her reproductive intentions. When choosing a surgical treatment, one should be guided not only by the need for the most radical removal of endometriosis foci, but also should consider a surgical approach to minimize discomfort and provide a good quality of life after surgery. A three-stage model for the management of patients with endometriosis is proposed, which includes an assessment of treatment effectiveness and the need to develop a rehabilitation program.

Gynecology. 2019;21(6):51-56
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LECTURE
The use of progesterone during pregnancy in women with epilepsy as an alternative to the correction of doses of anticonvulsants
Tsallagova E.V., Generalov V.O., Sadykov T.R.
Abstract

Pregnancy is the most dangerous period in terms of interruption of even persistent and long-term remission. At the same time increasing the dose of anticonvulsant increases the risk of teratogenic effects.

Aim. to assess the possibility of using progesterone to prevent relapse of epileptic seizures during pregnancy.

Materials and methods. 38 pregnant patients with epilepsy with clinical remission before pregnancy, with relapse of epileptic seizures in I trimester of pregnancy, age 31.8±1.4 years. Dydrogesterone in a dose of 10 to 60 mg/day was prescribed after the relapse of remission. Anticonvulsant dosage was not changed. The blood progesterone concentration and EEG control was carried out.

Results. During pregnancy, the level of progesterone in the blood gradually increased from 77.8 nmol/l at 7–8 weeks of pregnancy to 521.1 nmol/l at 36–37 weeks of pregnancy, without exceeding the limits. EEG results did not deteriorate. None of the patients had seizures during pregnancy.

Conclusion. Progesterone therapy is an adequate and safe alternative to increasing the dose of anticonvulsants in case of recurrent seizures during pregnancy.

Gynecology. 2019;21(6):12-15
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ORIGINAL ARTICLE
Morphological changes in the fallopian tubes in patients with ectopic pregnancy
Titova G.P., Damirov M.M., Anchabadze I.V., Medvedev A.A.
Abstract

Relevance. Ectopic pregnancy is an urgent condition which may lead to intraabdominal hemorrhage and woman death. In recent years, the frequency of this pathology is significantly increasing. However, morphological changes in the fallopian tubes in patients with this disease remain understudied.

Aim. To study morphological changes in the fallopian tubes in patients with ectopic pregnancy with various variants of the clinical course.

Materials and methods. The morphological study included 130 patients who had laparoscopic surgery for ectopic pregnancy. Comprehensive morphological study of the fallopian tubes removed during surgery was conducted.

Results and discussion. The article presents the morphological changes in the fallopian tubes in patients with ectopic pregnancy. Implantation of a fertilized egg in the fallopian tube led to significant changes in its macro- and microstructure, which were due to invasion of the chorionic villi and involved all layers of the tube wall, differing only in depth and prevalence. The most pronounced morphological changes in various segments of the tube were revealed in the endosalpinx.

Conclusion. The combination of morphological changes in different layers of the tube is related to a chronic non-specific productive endomyosalpingitis with luminal deformation, which was one of the main causes of this disease development.

Gynecology. 2019;21(6):26-30
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CLINICAL CASE
Giant paraovarial cyst in 16-years old adolescent: a case-report
Kumykova Z.K., Batyrova Z.K., Kruglyak D.A., Uvarova E.V., Chuprynin V.D., Buralkina N.A., Ezhova L.S.
Abstract

The article describe a rare clinical observation of a giant paraovarian cyst in a teenage girl with laparoscopic removal. The presence of giant cyst in the abdominal cavity in adolescent girls requires a multidisciplinary approach, taking into account visual diagnostic methods, preference for MRI, followed by the participation of experienced teams of highly qualified specialists in order to conduct a «minimally invasive» organ-preserving treatment.

Gynecology. 2019;21(6):45-47
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