Vol 22, No 1 (2020)

Controversial issues of clinical, laboratory and instrumental diagnostics of ovarian tumors of reproductive women (literature review)
Podzolkova N.M., Osadchev V.B., Babkov K.V., Safonova N.E.

The problem of differential diagnostic of benign and malignant tumors in the early stages is one of the most significant in practical gynecology. Now clear criteria for the diagnosis and screening of ovarian tumors are not developed. Early stages of disease are asymptomatic and even when first symptoms appeared, patients often don’t consult a doctor or doctor doesn’t recommend surgical treatment preferring dynamic observation. Modern diagnostic of ovarian tumors can’t be based on one method of research and requires a whole complex of diagnostic measures which determines the individual plan of treatment in each case. The most modern methods for studying are complex using of biomarkers, including creation mathematical risk models of ovarian tumor malignancy, based on instrumental and laboratory techniques. Despite on the successes in the detection of ovarian tumors, it is needed to study new modern methods of early preoperative diagnostic in different age periods, and especially those women who planes realize reproductive function.

Gynecology. 2020;22(1):7-13
Possibilities and prospects of conservative therapy for endometriosis, as a chronical progressing disease (review of literature)
Pestrikova T.Y., Yurasova E.A., Yurasov I.V.

Relevance. Endometriosis is a common gynecological disease that affects up to 10% of women of reproductive age worldwide and is the main cause of pain and infertility. Endometriosis is a disease, although it has been known for a long time, nevertheless, in many ways it represents terra incognita for modern medicine.

Aim. Analysis of literature on the feasibility of long-term and the use of the drug dienogest 2 mg (Vizanne), which has a positive effect on the quality of life of patients with endometriosis.

Materials and methods. To write this review, a search was made for domestic and foreign publications in Russian and international search engines (PubMed, eLibrary, etc.) over the past 13 years. The review included articles from peer-reviewed literature.

Results. The review presents data on the difficulties of verifying the diagnosis of endometriosis due to a combination of this pathology with pain, infertility, abnormal uterine bleeding. The pathogenesis of the origin of endometriosis-associated pain is presented. The efficacy of the use of the drug dienogest (Vizanne), which has a powerful antiproliferative effect that reduces the main symptoms of endometriosis (pain, bleeding), is substantiated. The expediency of long-term and safe use of the drug dienogest (Vizanne), which has a positive effect on the quality of life of patients with endometriosis, has been proved.

Conclusions. Numerous scientific publications confirm the feasibility of prolonged use of the drug dienogest (Vizanne), to achieve remission during endometriosis.

Gynecology. 2020;22(1):14-18
Needs, expectations and doubt users of hormonal contraceptives
Dikke G.B.

Description. The review is presented by modern publications, reflecting the importance of high-quality patient counseling when choosing a method of contraception and the factors that influence it. The choice of combined oral contraceptive (COC) is determined by the need for reliable and safe contraception, expectations for an improved quality of life, and doubts about the frequency of side effects and effects on reproductive and somatic health. Modern COCs containing natural hormone (estradiol valerate), a new gestagen (dienogest) with a dynamic regime and a shortened hormone-free interval (2 days) satisfy the COC requirements of most women from menarche to menopause when contraception is required. An improvement in the profile of menstrual bleeding (a decrease in blood loss in 88% of users) and sexual functioning (increased libido, arousal, and maintaining the cyclical nature of sexual behavior) has been shown. Estradiol valerate does not affect metabolism, has a low risk of thromboembolic events (the adjusted risk of venous thromboembolism compared to other COCs is 0.4) and a low frequency of failure due to side effects (1.7%). This tool is characterized by high efficiency (adjusted Pearl index – 0.42) and user satisfaction (78.1–80.2%).

Conclusion. COCs with estradiol valerate/dinogest in 26/2 mode, fully satisfying the requirements of women for contraception, contributes to high adherence to it, that is, consistent and correct use, which contributes to the long-term use of the selected COC and ensures the quality of life of women for many years.

Gynecology. 2020;22(1):33-37
The occurrence of human papillomavirus types in the formation of neoplastic transformation of the epithelium of the cervix in “lesser abnormalies”
Sycheva E.G., Nazarova N.M., Burmenskaya O.V., Prilepskaya V.N., Trofimov D.Y.

Aim. To assess the frequency of human papillomavirus (HPV) occurrence according to the IARC classification in patients with “lesser abnormalie” of cervical epithelial lesions and analyze their role in the formation of SIL.

Materials and methods. The study included 129 HPV-positive women aged 18–45 years (average age 34 to 11 years) with cytological conclusion NILM, ASCUS or LSIL. Patients are divided into 3 groups depending on the results of the cytological smear: 1 group (NILM/HPV) – 66 (51.2%), 2 group (ASCUS/HPV) – 28 (21.7%), 3 group (LSIL/HPV) – 35 (27.1%). During dynamic observation for 24 months. A comprehensive clinical-laboratory examination was carried out, including HPV-typing, cytological examination, extended colposcopy every 6 months, sighting biopsy of the cervix (according to the indications).

Results. According to the results of the pathomorphological study, squamous intraepithelial lesions neoplasia (cervical intraepithelial neoplasia – CIN+) was verified in 59 (71.9%) of the results of the study: LSIL (CIN I) – 53 (64.6%), HSIL (CIN II–III) – 6 (4.6%). The morphological diagnosis of LSIL (CIN I) was established in 1 group (NILM/HPV+) in 20 (55.6%), 2 groups (ASCUS/HPV+) – 9 (32%), 3 group (LSIL/HPV) – 24 (68.6%); HSIL (CIN II–III) in group 1 – 2 (5.6%), in 2 group – 3 (10.7%) and in the 3 group – 1 (2.9%).

Conclusions. In patients with “lesser abnormalies” of cervical lesions in the formation of CIN+ participated HPV group 1 – in 79.1%, groups 2A – in 5.5%, groups 2B – in 15.4% of cases. The HPV high carcinogenic risk (group 1) was involved in the formation of HSIL (CIN II–III). The neoplastic transformation of the cervical epithelium of the studied patients was caused by the persistence of HPV 16, 58, 39, 18, 51, 68, 56, 82, 35, 52, 53, 35 types.

Gynecology. 2020;22(1):19-22
Expression of MSX1, HOXA11 and TP53I3 in the endometrium associated with the onset of pregnancy after repeated failed IVF attempts in patients with tubo-peritoneal factor infertility
Knyazeva E.A., Kuznetsova M.V., Burmenskaya O.V., Donnikov A.E., Kalinina E.A.

Relevance. The success of the in vitro fertilisation (IVF) program, among other factors, depends on the readiness of the endometrium to accept the embryo. It is believed that this is possible during the so-called «implantation window», the timing of which can be shifted under the influence of various factors. Evaluation of endometrial receptivity and the «implantation window» based on analysis of endometrial gene expression before embryo transfer is a promising approach for predicting the likelihood of pregnancy in IVF programs.

Aim. To construct a classifier based on the expression of endometrial genes for predicting the outcome of an IVF program in patients with tubal-peritoneal infertility factor and repeated failed IVF attempts in history.

Materials and methods. Before the IVF program, a genome-wide transcriptome profiling of endometrial samples of 15 women with tubal-perioneal infertility factor and repeated unsuccessful IVF attempts in history was carried out using Affymetrix arrays. Potential genes capable of classifying IVF program outcomes were selected, after which the expression of these genes was analyzed by qPCR-RT in the endometrium of 47 women to construct IVF outcome classifiers based on the expression of pairs or triples of genes.

Results. A classifier based on the expression of the triple of genes MSX1 (HOX7), HOXA11, and TP53I3 made it possible to determine the onset of pregnancy in an IVF program with a sensitivity of 73% and a specificity of 71% with an area under the ROC-curve (AUC) of 0.738 (95% confidence interval 0.577–0.898). Earlier, a relationship was found between the expression of these genes and receptivity of the endometrium, which suggests that these genes play a role in the onset of the «implantation window».

Conclusions. The use of a classifier based on the genes MSX1 (HOX7), HOXA11, and TP53I3 can determine the readiness of the endometrium to accept an embryo and create an individual prognosis of the outcome of an IVF program in women with tubal-peritoneal infertility factor and repeated failed IVF attempts in history.

Gynecology. 2020;22(1):23-28
Androstenedione as a potential predictor of ovarian response in assisted reproductive technology programs
Burduli A.G., Kitsilovskaya N.A., Sukhova Y.V., Vedikhina I.A., Ivanets T.Y., Chagovets V.V., Starodubtseva N.L., Frankevich V.E.

Aim. To assess the possibility of using androstenedione levels in blood serum and follicular fluid to predict ovarian response in assisted reproductive technology programs and to conduct a comparative analysis of the results obtained by 2 methods – chemiluminescent immunoassay (CLIA) and high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS).

Materials and methods. A prospective study included 55 couples who received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer program therapy. The patients were divided into 3 groups depending on the ovarian response to stimulation: 1st (1–3 oocytes, n=4), 2nd (4–9 oocytes, n=27), 3rd (over 10 oocytes, n=24). Androstenedione levels were measured in blood serum obtained on the day of transvaginal ovarian puncture and in follicular fluid samples with CLIA and HPLC-MS/ MS methods at the laboratories of Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology.

Results. On the day of transvaginal ovarian puncture, the serum androstenedione levels, which were measured by HPLC-MS/MS, were increasing with an increase of the number of oocytes obtained. The CLIA method revealed a difference in the androstenedione levels between the groups with the number of oocytes obtained of less than 3 and more than 10. Moreover, the androstenedione levels measured by CLIA were significantly different between the patient groups (p<0.05).

Comparison of serum androstenedione levels measured by CLIA and HPLC-MS/MS, showed high correlations between the values [ñ=0.73 (p<0.001)], which makes it possible to use both methods equally, given the existing equipment of the clinical base.

Conclusion. Prediction of ovarian response to stimulation is an important step in assisted reproductive technology programs. Measuring androstenedione concentration in blood serum on the day of transvaginal ovarian puncture with highly specific methods (CLIA and HPLC-MS/MS) can be used to predict the degree of ovarian response along with the traditional assessment of the ovarian reserve based on determining anti-Mullerian hormone levels in the early follicular phase of the menstrual cycle.

Gynecology. 2020;22(1):38-44
The experience of using fesoterodine in patients with overactive bladder in the older age group
Ermakova E.I.

Aim. To evaluate the effectiveness and tolerability of the drug fezoterodin in older patients with оveractive bladder (OAB).

Materials and methods. In 2019, 50 women with OAB aged 50 to 82 years (average age was 67.5±12.5 years) were treated in the framework of donation of the drug fezoterodin (Toviaz). The patients were divided into two groups: group 1 included 25 women had received treatment with fesoterodine dose of 4 mg per day for 12 weeks, group 2 consisted of 25 women, the fesoterodine dose to 8 mg per day for 12 weeks. The diagnosis of OAB was confirmed by a urodynamic study.

Results. 48 (96%) patients out of 50 completed a 12 week course of treatment. The efficacy and tolerability of the drug fezoterodin in both groups was 93.7%. Mild adverse events (dry mouth, constipation, blurred vision) were observed in 11 (22.9%) patients out of 48 treated. None of the women had cognitive impairment (memory impairment, decreased concentration, drowsiness, impaired thinking and orientation).

Conclusion. Our experience with M-cholinoblocator fezoterodin showed statistically and clinically significant improvements in all symptoms of OAB, as well as good tolerability of the drug in patients aged 50 to 82 years.

Gynecology. 2020;22(1):45-49
The role of orexin A in pathophysiological mechanisms of sleep disorder in postmenopausal women
Ebzieva Z.K., Yureneva S.V., Ivanets T.Y.

Aim. To conduct a comparative analysis of serum orexin A levels in women of different age periods with and without sleep disorder and vasomotor symptoms. To evaluate the dynamics of orexin A levels under menopausal hormone therapy.

Materials and methods. The study included 50 postmenopausal women and 30 women of reproductive age with a regular menstrual cycle. Using block randomization, patients are divided into 3 groups: group 1 (main group), n=25, -STRAW+ 10 (+1b and +1c), – patients with sleep disorder and vasomotor symptoms; group 2 (comparison group), n=25, STRAW+ 10 (+1b and +1c), – patients with vasomotor symptoms without sleep disorder; group 3 (control group), n=30, STRAW+ 10 (-4), – women of reproductive age without sleep disorder. Group 1 patients were given menopausal hormone therapy. A comparative analysis was carried out using the questionnaire for assessing menopausal symptoms severity by the Greene Scale (the Greene Climacteric Scale) and Rating Scale for subjective sleep characteristics. After 12 weeks of treatment, a control examination was performed.

Results. In group 1 women, the serum orexin A levels were significantly higher compared to the women without the symptoms. The link between the orexin A levels and menopause syndrome severity was established. A significant decrease in the menopausal symptoms severity after 12 weeks of menopausal hormone therapy was shown. It was accompanied by a 1,3-fold decrease in orexin A levels.

Conclusions. The obtained data indicate the possible role of orexin A and the orexin neuropeptide system in the pathogenesis of sleep disorder and vasomotor symptoms in postmenopausal women.

Gynecology. 2020;22(1):50-54
Role of immunocorrection therapy in comprehensive treatment of patients with inflammatory diseases of female genital organs
Shchukina N.A., Vinitskiy A.A.

Aim. Analysis of gynecological diseases structure in which immunocorrection with Polyoxidonium® was prescribed, determination of a preferential drug form (suppositories 12 mg/lyophilisate 6 mg), assessment of its clinical effectiveness.

Outcomes and methods. Observational program of clinical efficacy of Polyoxidonium® (12 mg suppositories or 6 mg lyophilisate) used along with standard treatment in 8975 women with inflammatory diseases of female genital tract in 20 regions of the Russian Federation in accordance with international standards of good epidemiological practice (GEP).

Results. The overall assessment of Polyoxidonium® used along with the standard treatment in patients with inflammatory diseases of female genitals was 4.17±0.75 points (4 – marked improvement; 5 – full recovery). The drug was significantly more effective in vaginitis (4.36±0.68 points) and cervicitis (4.40±0.74 points) compared with standard therapy. In PID the most effective drug form was lyophilisate.

Conclusion. The drug is well tolerated, practically free of side effects and addiction, convenient in use and is compatible with any treatment regimen. In the treatment of lower genital tract inflammatory diseases, it is optimal to use the drug in the form of suppositories while in the treatment of PID in the form of a lyophilisate.

Gynecology. 2020;22(1):55-58
Pregravid preparation and pregnancy management of women with endometriosis in the in vitro fertilization program: a clinical case
Tetelyutina F.K., Shestakova O.V., Dolgova O.N., Shirobokova L.M.

The presented clinical case of a patient with infertility and a combination of various forms of endometriosis was the basis for discussing the optimal choice of tactics for managing these patients.

Gynecology. 2020;22(1):29-32

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