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Alternative therapy of menopausal vegetative disorders in women taking the metabolic status into account 考虑到新陈代谢状况的妇女更年期植物神经紊乱替代疗法
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.18370/2309-4117.2023.69.80-88
О.А. Taran, D. Konkov, O. Bulavenko, T. V. Lobastova, O.B. Malinina, N.M. Homon, I.R. Pyvniuk
Research objectives: to study the clinical effectiveness of alternative complex therapy of vegetative syndrome in menopausal patients using L-arginine and xylitol drugs. Materials and methods. The clinical prospective study included 50 patients in the early postmenopausal period with natural menopause, neurovegetative and psychoemotional manifestations of the climacteric syndrome. According to the Life extension strategy, patients received intravenous L-arginine (Tivortin drug) and xylitol solution with electrolytes (Xylat drug) for endothelial protection and correction of insulin resistance in order to treat climacteric syndrome. Modified Kupperman menopausal index, serum triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein levels were determined in all women. Examinations were performed before the start of therapy and 3 months after the end of treatment.Results. The Life extension therapeutic strategy as an alternative comprehensive therapy of the vegetative syndrome in menopausal patients contributed to a reliable reduction of the manifestations of the climacteric syndrome. The advantage of combined therapy involving L-arginine and xylitol was manifested in a significant decrease in diastolic blood pressure (p = 0.043); reduction of the Kupperman index (p = 0.002) and the average score of vasomotor symptoms (p = 0.02). There was also a significant decrease in the serum level of insulin (p = 0.00007), HOMA index (p = 0.01), low-density lipoproteins (p = 0.04), and triglycerides (p = 0.03). The selected therapy was well tolerated during the observation period.Conclusions. The combined therapy involving L-arginine and xylitol in the early postmenopausal period with neurovegetative and psychoemotional manifestations of the climacteric syndrome had a pronounced clinical effect, which consisted in a significant reduction of vegetative disorders and stabilization of carbohydrate and lipid metabolism. The given therapeutic strategy can be considered as an alternative therapy in patients with climacteric disorders when phytotherapy is ineffective and when there are contraindications or limitations to menopausal hormone therapy. The results of this study showed the safety of the Life extension strategy.
研究目的:研究使用 L-精氨酸和木糖醇药物替代复合疗法治疗更年期患者植物神经综合征的临床效果。材料与方法。该临床前瞻性研究纳入了 50 名绝经后早期患者,这些患者具有自然绝经、神经-植物神经和心理-情感表现的更年期综合征。根据生命延续策略,患者接受静脉注射 L-精氨酸(Tivortin 药物)和含电解质的木糖醇溶液(Xylat 药物),以保护血管内皮和纠正胰岛素抵抗,从而治疗更年期综合征。对所有妇女的改良库伯曼更年期指数、血清甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白和极低密度脂蛋白水平进行了测定。检查在治疗开始前和治疗结束后 3 个月进行。生命延续治疗策略作为更年期患者植物神经综合征的替代综合疗法,有助于有效减少更年期综合征的表现。L-精氨酸和木糖醇联合疗法的优势表现在舒张压显著降低(p = 0.043)、库伯曼指数降低(p = 0.002)和血管运动症状平均得分降低(p = 0.02)。血清中的胰岛素水平(p = 0.00007)、HOMA 指数(p = 0.01)、低密度脂蛋白(p = 0.04)和甘油三酯(p = 0.03)也明显下降。在观察期间,所选疗法的耐受性良好。L-精氨酸和木糖醇联合疗法对绝经后早期伴有神经活力和精神情绪表现的更年期综合征有明显的临床效果,包括显著减少植物神经紊乱、稳定碳水化合物和脂质代谢。对于植物疗法无效、有更年期激素疗法禁忌或限制的更年期综合征患者,可以考虑将上述治疗策略作为替代疗法。这项研究结果表明,延长生命策略是安全的。
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引用次数: 0
Changes in the microbiome in women with polycystic ovary syndrome 多囊卵巢综合征妇女微生物组的变化
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.30-35
V.V. Artyomenko, N.M. Nastradina, H.V. Kozhukhar
The gut microbiome (GM) is actively studied in terms of its impact on the development of oncological pathology, immune diseases, and metabolic disorders. Women with polycystic ovary syndrome (PCOS) have an imbalance of GM, which indirectly affects the intestinal mucosal barrier. Compared with non-obese patients and a healthy population, obese individuals with PCOS have increased numbers of Enterobacteriaceae, decreased numbers of Lactobacillus and Bifidobacterium, and changes in GM are associated with inflammation and insulin resistance.Fecal microbiota transplantation is a new method of treating inflammatory bowel diseases. GM regulation to improve the metabolism of PCOS may be one of the potential options for the future treatment of PCOS, but the specific mechanism of its action remains to be investigated.There is increasing evidence that probiotics, prebiotics, and synbiotics are effective treatment options for PCOS patients. Studies show that probiotics can restore the diversity of the GM of mice with PCOS, reduce the disruption of the flora and improve the reproductive function of the mice.The altered microbiome of the lower genital tract in PCOS can cause changes that are related to hormone levels during the menstrual cycle. Studies show that the vaginal microbiome of women with PCOS differs from healthy women due to the domination of Mycoplasma, Prevotella, Gardnerella, Actinomyces, Enterococcus, and Atopobium.The level of female sex hormones is associated with the composition of the oral cavity microbiome, which is associated with such oral pathology as periodontal disease. A study of periodontal pathogens and their prevalence in women with PCOS found that healthy women had higher levels of Peptostreptococcus and a higher percentage of women infected with Treponema denticola.New views on the management of women with PCOS indicate the importance of considering microbiome changes and open up new therapeutic opportunities. Research in this area is still ongoing, and additional studies are needed to clarify the microbial composition in women with PCOS.
肠道微生物组(GM)在肿瘤病理、免疫疾病和代谢紊乱的发展方面的影响被积极研究。多囊卵巢综合征(PCOS)女性GM失衡,间接影响肠黏膜屏障。与非肥胖患者和健康人群相比,肥胖多囊卵巢综合征患者肠杆菌科数量增加,乳酸菌和双歧杆菌数量减少,GM的变化与炎症和胰岛素抵抗有关。粪便菌群移植是一种治疗炎症性肠病的新方法。转基因调控改善PCOS代谢可能是未来治疗PCOS的潜在选择之一,但其具体作用机制仍有待研究。越来越多的证据表明,益生菌、益生元和合成菌是治疗多囊卵巢综合征患者的有效选择。研究表明,益生菌可以恢复PCOS小鼠基因多样性,减少对菌群的破坏,改善小鼠的生殖功能。多囊卵巢综合征患者下生殖道微生物群的改变会导致月经周期中与激素水平相关的变化。研究表明,由于支原体、普雷沃氏菌、加德纳菌、放线菌、肠球菌和异托霉素的主导地位,多囊卵巢综合征女性的阴道微生物群与健康女性不同。女性性激素的水平与口腔微生物群的组成有关,而口腔微生物群又与牙周病等口腔病理有关。一项关于牙周病原体及其在多囊卵巢综合征妇女中的患病率的研究发现,健康妇女的胃链球菌水平较高,感染密螺旋体的妇女比例较高。关于女性多囊卵巢综合征管理的新观点表明,考虑微生物组的变化和开辟新的治疗机会的重要性。这方面的研究仍在进行中,需要进一步的研究来阐明多囊卵巢综合征妇女体内的微生物组成。
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引用次数: 0
Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy 妊娠高血压不同阶段胎儿多普勒血流参数变化的特点
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.66-69
Vol. V. Podolskyi, V.V. Podolskyi, V.M. Znak
Research objectives: to determine the resistance index, pulsatile index and systolic-diastolic ratio in the fetal middle cerebral artery, fetal aorta and umbilical artery in women with gestational hypertension (GH).Materials and methods. The main group included 50 pregnant women with GH, the control group included 50 healthy pregnant women. Blood pressure level and ultrasound dopplerometric indicators of fetal blood flow were determined at the 20th, 25th, 30th, 35th, and 40th weeks of pregnancy.Results. Changes in Doppler blood flow indicators in the umbilical artery in women of the main group were observed earlier than changes in these indicators in the fetal aorta, namely from the 30th week of pregnancy: the resistance index was 0.46 ± 0.08, the pulsatility index was 0.8 ± 0.23, the systolic-diastolic ratio was 2 ± 0.19, and in women of the control group these indicators were 0.69 ± 0.17, 1.46 ± 0.21 and 3 ± 0.33, respectively.At the 35th week of pregnancy, the trend towards a decrease in dopplerometric indicators of blood flow in the umbilical artery in women of the main group continued, the value of these indicators was: resistance index – 0.42 ± 0.09, pulsatility index – 0.68 ± 0.23, systolic diastolic ratio – 1.8 ± 0.16, and in women of the control group these indicators were 0.68 ± 0.13, 1.43 ± 0.11 and 2.94 ± 0.24, respectively.The lowest Doppler parameters of blood flow in the umbilical artery in women of the main group were at 40th week: resistance index – 0.37 ± 0.07, pulsatility index – 0.63 ± 0.21, systolic-diastolic ratio – 1.6 ± 0.13, and in women of the control group these indicators were 0.67 ± 0.11, 1.4 ± 0.1, and 2.87 ± 0.21, respectively.Conclusions. Blood flow indicators in the aorta and umbilical arteries, as well as in the middle cerebral artery of the fetus in women with GH differ from such indicators in healthy women. Decreased blood flow may indicate a risk of hypoxia and neurological problems for fetus. Therefore, it is important to diagnose GH in time and monitor fetal blood flow indicators using ultrasound to prevent possible complications and preserve the fetus and mother health.
研究目的:测定妊娠期高血压(GH)妇女胎儿大脑中动脉、胎儿主动脉和脐动脉的阻力指数、搏动指数和收缩压舒张比。材料和方法。主组50例GH孕妇,对照组50例健康孕妇。分别于妊娠第20周、第25周、第30周、第35周和第40周测定血压水平和胎儿血流超声多普勒指标。主组妇女脐动脉多普勒血流指标的变化早于胎儿主动脉多普勒血流指标的变化,即从妊娠第30周开始:阻力指数为0.46±0.08,脉搏指数为0.8±0.23,收缩压舒张比为2±0.19,对照组妇女这些指标分别为0.69±0.17,1.46±0.21和3±0.33。妊娠第35周,主组妇女脐动脉血流多普勒指标继续下降,阻力指数为- 0.42±0.09,搏动指数为- 0.68±0.23,收缩压舒张比为- 1.8±0.16,对照组分别为0.68±0.13、1.43±0.11和2.94±0.24。主组妇女脐动脉血流多普勒参数最低在第40周:阻力指数- 0.37±0.07,脉搏指数- 0.63±0.21,收缩压-舒张比- 1.6±0.13,对照组妇女这些指标分别为0.67±0.11,1.4±0.1和2.87±0.21。生长激素妇女胎儿的主动脉和脐动脉以及大脑中动脉的血流指标与健康妇女的这些指标不同。血流量减少可能表明胎儿有缺氧和神经系统问题的危险。因此,及时诊断GH,利用超声监测胎儿血流指标,对预防可能出现的并发症,保护胎儿和母亲的健康具有重要意义。
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引用次数: 0
New therapeutic opportunities in improving the antenatal management of obese women 改善肥胖妇女产前管理的新治疗机会
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.58-64
I.A. Zhabchenko, O.R. Siudmak, I.S. Lishchenko, T.M. Kovalenko, O.M. Bondarenko
Research objectives: to assess the effectiveness of the developed treatment complex on the course of pregnancy and childbirth in obese women.Materials and methods. 135 pregnant women were examined depending on the degree of obesity and received treatment. The women were examined and treated in the Department of Pathology of Pregnancy and Childbirth, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine” during 2019–2021.The developed medical complex included: Miofolic 2 sachets/day 3 months before pregnancy and throughout the gestation period; in case of insufficiency or deficiency of vitamin D, this vitamin was prescribed in a dose of 4000 IU/day; magnesium citrate 250–300 mg/day during pregnancy; micronized progesterone vaginally 200–400 mg/day in the II phase of the menstrual cycle before conception and up to 34 weeks of gestation (if necessary); individual programs of prenatal psychological rehabilitation using psychophysical exercises were used depending on the psychosomatic disorders.Results. it was found that the number of pregnant women of older reproductive age is increasing. There was a decrease in pre-pregnancy weight (which was positively reflected in the subsequent course of pregnancy) at the 3 months before the onset of pregnancy in women with lifestyle modification (diet therapy, dosed physical activities) and who intake a developed treatment complex at the pre-gravid stage.A peculiarity of the somatic morbidity of pregnant women was the combination of various types of extragenital diseases. Significant differences were found between chronic diseases of the cardiovascular system and diseases of the gastrointestinal tract and liver compared to the control group. The course of pregnancy largely depended on the reproductive system status before fertilization – an increase in the frequency of infertility was noted with an increase in the woman’s body mass index.Pregnant women who received the developed treatment complex had fewer pregnancy complications, the frequency of which was not significantly different from the control group. At the same time, against the background of the treatment, their lipid profile and vitamin and mineral supply improved. All this had a positive effect on the pregnancy outcomes.Conclusions. Developed medical complex including myo-inositol, starting from the pre-gravid period and throughout pregnancy, helps to reduce insulin resistance in obese women, improve the lipid profile and normalize the leptin level, which has a positive effect on the course of pregnancy and childbirth and improves perinatal outcomes.
研究目的:评估开发的治疗组合对肥胖妇女妊娠和分娩过程的有效性。材料和方法。135名孕妇根据肥胖程度接受了检查并接受了治疗。这些妇女在妊娠和分娩病理科(SI“O.M.)接受检查和治疗在2019-2021年期间,乌克兰NAMS的卢基扬诺娃儿科,产科和妇科研究所。已开发的医疗综合体包括:妊娠前3个月和整个妊娠期每天2小袋叶酸;在维生素D不足或缺乏的情况下,这种维生素的剂量为4000 IU/天;孕期柠檬酸镁250-300毫克/天;在怀孕前的月经周期第二阶段和妊娠34周(如有必要),阴道微量黄体酮200-400毫克/天;根据不同的心身障碍,采用心理物理训练的产前心理康复个体化方案。调查发现,生育年龄较大的孕妇数量正在增加。在怀孕开始前3个月,改变生活方式(饮食治疗,有剂量的体育活动)并在怀孕前阶段接受成熟的综合治疗的妇女,孕前体重有所下降(这在随后的怀孕过程中得到积极反映)。孕妇躯体疾病的一个特点是多种外阴疾病的结合。与对照组相比,心血管系统慢性疾病、胃肠道和肝脏疾病之间存在显著差异。怀孕的过程在很大程度上取决于受精前的生殖系统状态——随着女性体重指数的增加,不孕症的频率也会增加。接受先进治疗方案的孕妇妊娠并发症较少,其发生率与对照组无显著差异。同时,在治疗的背景下,他们的血脂和维生素和矿物质的供应得到改善。所有这些都对妊娠结局有积极的影响。发达的包括肌醇在内的医疗综合体,从孕前到整个妊娠期,有助于降低肥胖妇女的胰岛素抵抗,改善血脂,使瘦素水平正常化,对妊娠和分娩过程产生积极影响,改善围产期结局。
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引用次数: 0
Vitamin D supplementation in bacterial vaginosis 细菌性阴道病的维生素D补充
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.36-42
T.F. Tatarchuk, L.V. Kalugina, T.I. Kvasha, R.O. Mnevets
Research objectives: to evaluate the effect of vitamin D supplementation (Olidetrim) in the complex anti-relapse therapy of bacterial vaginosis (BV) in women of reproductive age.Materials and methods. The study included 63 women of reproductive age with BV and with a level of 25-hydroxyvitamin D below 75 nmol/l, who were divided into groups: the main group included 32 women who were prescribed standard therapy (metronidazole 500 mg twice a day for 7 days) and cholecalciferol (Olidetrim) 4000 IU/day with subsequent continuation of its intake in a dose 2000 IU/day for up to 6 months; the comparison group included 31 women, who were not intake vitamin D preparation during the standard therapy and during the next 6 months of observation.After treatment, women provided completed questionnaires and self-collected vaginal swabs 1, 3, and 6 months after beginning of the study or before BV relapse. Evaluation of Gram-stained smears was carried out by microscopy according to Hay/Ison criteria, where BV corresponded to type III. The level of 25-hydroxyvitamin D in blood serum was determined by the chemiluminescent immunoassay method before the start of thestudy and at 3 and 6 months of follow-up.The primary endpoint was BV recurrence at any post-treatment interval; the patients were offered a second treatment in this case.Results. Vitamin D deficiency at the beginning of the study was detected in 12 (37.5%) patients of the main group and in 13 (41.94%) women of the comparison group, an insufficient level – in 20 (62.5%) patients of the main group and in 58.06% women of the comparison group.Patients complained of pathological vaginal discharge, itching, burning and dyspareunia lasting from 1 week to 2 months. At the seven-day course of basic BV therapy all participants noted the normalization of discharge and the absence of vaginal discomfort. Positive dynamics were also observed according to the gynecological examination.One month after the treatment, 4 (12.5%) participants of the main and 6 (19.36%) women of the comparison group noted the recovery of symptoms. Absence of BV recurrence after 3 months was noted by 25 (78.12%) women of the main group and 16 (51.61%) women of the comparison group (p = 0.054), that was confirmed by the laboratory tests. At the same time, the level of 25-hydroxyvitamin D in the main group increased by 43.37% (p = 0.05), and in the comparison group it did not differ from the initial level. There were no complaints in 24 (75.0%) patients after 6 months, however, a laboratory-confirmed normal state of the vaginal microbiome was observed in 22 (70.96%) participants of the main group and in 14 (45.16%, p = 0.07) women of the comparison group. Continuation of vitamin D intake at a dose of 2000 IU/day for the next 3 months demonstrated maintenance of the 25-hydroxyvitamin D level within normal values (81.7 ± 6.23 nmol/l in the main group vs. 38.51 ± 5.43 nmol/l in comparison group, p = 0.05).Conclusions. A decrease in the frequency of
研究目的:评价维生素D补充剂(Olidetrim)在育龄妇女细菌性阴道病(BV)复合抗复发治疗中的作用。材料和方法。该研究纳入了63名患有BV且25-羟基维生素D水平低于75 nmol/l的育龄妇女,她们被分为两组:主要组包括32名妇女,她们接受标准治疗(甲硝唑500毫克,每天两次,持续7天)和胆钙化醇(Olidetrim) 4000 IU/天,随后继续以2000 IU/天的剂量摄入,持续6个月;对照组包括31名妇女,她们在标准治疗期间和接下来的6个月观察期间没有摄入维生素D制剂。治疗后,女性在研究开始后1、3和6个月或BV复发前提供完整的调查问卷和自行收集的阴道拭子。显微镜下根据Hay/Ison标准对革兰氏染色涂片进行评估,其中BV对应于III型。在研究开始前和随访3个月和6个月时,采用化学发光免疫分析法测定血清中25-羟基维生素D的水平。主要终点是BV在任何治疗间隔内的复发;在这种情况下,患者接受了第二次治疗。在研究开始时,在主要组的12名(37.5%)患者和对照组的13名(41.94%)女性中检测到维生素D缺乏症,主要组的20名(62.5%)患者和对照组的58.06%女性中检测到维生素D缺乏症。患者主诉病理性阴道分泌物、瘙痒、灼烧和性交困难,持续1周至2个月。在为期7天的BV基础治疗过程中,所有参与者都注意到分泌物正常化和阴道不适的消失。根据妇科检查也观察到积极的动态。治疗1个月后,主组4人(12.5%)、对照组6人(19.36%)症状恢复。3个月后,主组25例(78.12%)无BV复发,对照组16例(51.61%)无BV复发(p = 0.054)。同时,主组25-羟基维生素D水平提高43.37% (p = 0.05),对照组与初始水平无差异。6个月后24例(75.0%)患者无主诉,但试验组22例(70.96%)患者阴道菌群检测正常,对照组14例(45.16%,p = 0.07)患者阴道菌群检测正常。在接下来的3个月里,继续以2000 IU/天的剂量摄入维生素D, 25-羟基维生素D水平维持在正常值范围内(主组为81.7±6.23 nmol/l,对照组为38.51±5.43 nmol/l, p = 0.05)。在维持正常维生素D水平期间,发现女性BV复发频率降低,因此建议在标准治疗中加入胆钙化醇补充剂(Olidetrim)。对于复发性BV患者,建议长期监测血清维生素D水平,以便及时处方补充。
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引用次数: 0
Modern approaches to the therapy of genital herpes in women 女性生殖器疱疹的现代治疗方法
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.94-98
L.B. Markin, O.O. Matviіenko, O.O. Korytko, K.L. Shatylovych
Genital herpes (GH) is a common sexually transmitted disease caused by the herpes simplex virus (HSV). It is characterized by lifelong infection and periodic reactivation. Until recently, GH was more often caused by HSV type 2 (HSV-2), but now it very common infection cases by HSV type 1 (HSV-1) and in some countries are even more common than HSV-2. More than 400 million people currently have GH caused by HSV-2 in the world. In the United States nearly one in five adults (approximately 40 million people) are infected with HSV-2. About 1 million new infections occur every year.Recently, much attention has been paid to the issue of new approaches to GH therapy in women. The problem is extremely urgent, since this infection is very common in the world. The main causes of GH are HSV-1 and HSV-2.Approaches to the treatment of GH differ depending on the type of virus (HSV-1 or HSV-2), as well as the absence or presence of clinical manifestations. The analysis of literature data shows that is there are two ways of GH treatment: episodic antiviral therapy, when patients undergo short courses of antiviral therapy during GH relapse, or suppressive antiviral therapy, when patients take medication daily to prevent relapses.Our clinical experience allows us to recommend the ukrainian drug Virostat (manufacturer “Kyiv Vitamin Plant”) for the treatment of HSV infection in women. The scheme of treatment with the Virostat depends on whether these are the first manifestations of infection or its recurrence.There are no approved vaccines for the treatment and prevention of GH, therefore, active prevention and early diagnosis increase the chances of safe and effective treatment of GH in women of different age groups and at different stages of the disease.
生殖器疱疹(GH)是由单纯疱疹病毒(HSV)引起的一种常见的性传播疾病。它的特点是终身感染和周期性再激活。直到最近,生长激素更多地是由2型HSV (HSV-2)引起的,但现在,1型HSV (HSV-1)感染病例非常常见,在一些国家甚至比2型HSV更常见。目前世界上有4亿多人患有2型单纯疱疹病毒引起的生长激素。在美国,近五分之一的成年人(约4000万人)感染了2型单纯疱疹病毒。每年约有100万新感染病例。最近,人们对妇女生长激素治疗的新方法给予了很大的关注。这个问题非常紧迫,因为这种感染在世界上非常普遍。GH的主要病因是HSV-1和HSV-2。治疗生长激素的方法因病毒类型(HSV-1或HSV-2)以及有无临床表现而异。对文献资料的分析表明,生长激素的治疗有两种方式:一种是间歇性抗病毒治疗,即患者在生长激素复发期间接受短期抗病毒治疗;另一种是抑制性抗病毒治疗,即患者每天服用药物以防止复发。我们的临床经验使我们能够推荐乌克兰药物Virostat(制造商“基辅维生素厂”)用于治疗妇女HSV感染。用病毒抑制剂治疗的方案取决于这些是感染的首次表现还是复发。目前还没有批准用于治疗和预防生长激素的疫苗,因此,积极预防和早期诊断可以增加不同年龄组和不同疾病阶段妇女安全有效治疗生长激素的机会。
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引用次数: 0
Diagnosis and treatment of iron‑deficiency anaemia in pregnancy and postpartum 妊娠期和产后缺铁性贫血的诊断和治疗
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.70-74
C. Breymann, C. Honegger, I. Hоsli, D. Surbek
Iron deficiency occurs frequently in pregnancy and can be diagnosed by serum ferritin-level measurement (threshold value < 30 μg/L). Screening for iron-deficiency anemia is recommended in every pregnant women, and should be done by serum ferritin-level screening in the first trimester and regular hemoglobin checks at least once per trimester. In the case of iron deficiency with or without anaemia in pregnancy, oral iron therapy should be given as first-line treatment. In the case of severe iron-deficiency anemia, intolerance of oral iron, lack of response to oral iron, or in the case of a clinical need for rapid and efficient treatment of anaemia (e.g., advanced pregnancy), intravenous iron therapy should be administered. In the postpartum period, oral iron therapy should be administered for mild iron-deficiency anemia (haemorrhagic anemia), and intravenous iron therapy for moderately severe-to-severe anemia (Hb < 95 g/L). If there is an indication for intravenous iron therapy in pregnancy or postpartum, ironcontaining drugs which have been studied in well-controlled clinical trials in pregnancy and postpartum such as ferric carboxymaltose must be preferred for safety reasons. While anaphylactic reactions are extremely rare with non-dextrane products, close surveillance during administration is recommended for all intravenous iron products.
缺铁在妊娠期经常发生,可通过血清铁蛋白水平测定(阈值<30μg / L)。建议对所有孕妇进行缺铁性贫血筛查,并应在妊娠早期进行血清铁蛋白水平筛查,每三个月至少进行一次血红蛋白常规检查。在缺铁伴或不伴妊娠贫血的情况下,口服铁治疗应作为一线治疗。在严重缺铁性贫血、口服铁不耐受、对口服铁缺乏反应的情况下,或在临床需要快速有效治疗贫血的情况下(例如,晚期妊娠),应给予静脉注射铁治疗。在产后,轻度缺铁性贫血(出血性贫血)应口服铁治疗,中重度至重度贫血(Hb <95 g / L)。如果有妊娠期或产后静脉补铁的指征,则出于安全考虑,必须优先使用经妊娠期和产后临床对照良好的含铁药物,如三羧基麦芽糖铁。虽然非右旋糖酐产品的过敏反应极为罕见,但建议所有静脉注射铁产品在给药期间密切监测。
{"title":"Diagnosis and treatment of iron‑deficiency anaemia in pregnancy and postpartum","authors":"C. Breymann, C. Honegger, I. Hоsli, D. Surbek","doi":"10.18370/2309-4117.2023.68.70-74","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.70-74","url":null,"abstract":"Iron deficiency occurs frequently in pregnancy and can be diagnosed by serum ferritin-level measurement (threshold value < 30 μg/L). Screening for iron-deficiency anemia is recommended in every pregnant women, and should be done by serum ferritin-level screening in the first trimester and regular hemoglobin checks at least once per trimester. In the case of iron deficiency with or without anaemia in pregnancy, oral iron therapy should be given as first-line treatment. In the case of severe iron-deficiency anemia, intolerance of oral iron, lack of response to oral iron, or in the case of a clinical need for rapid and efficient treatment of anaemia (e.g., advanced pregnancy), intravenous iron therapy should be administered. In the postpartum period, oral iron therapy should be administered for mild iron-deficiency anemia (haemorrhagic anemia), and intravenous iron therapy for moderately severe-to-severe anemia (Hb < 95 g/L). If there is an indication for intravenous iron therapy in pregnancy or postpartum, ironcontaining drugs which have been studied in well-controlled clinical trials in pregnancy and postpartum such as ferric carboxymaltose must be preferred for safety reasons. While anaphylactic reactions are extremely rare with non-dextrane products, close surveillance during administration is recommended for all intravenous iron products.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Features of mental and reproductive health, functional state of the organism of female military servicemen who suffered concussion during combat actions 女军人在战斗中遭受脑震荡的心理和生殖健康特征及机体功能状态
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.8-15
A.V. Serbeniuk
Research objectives: establishing an association between the state of mental health, the functional state of body systems, clinical and anamnestic data on reproductive health in female combat participants who suffered a concussion.Material and methods. The study included 487 women of reproductive age who took part in hostilities and suffered a concussion and who were divided into 2 groups – the main group (211 women with post-concussion syndrome) and a comparison group (246 women without the post-concussion syndrome). The control group included 30 healthy civilian women of reproductive age without any trauma episodes in the anamnesis. Concussion symptoms were determined by Cicerone K.D., PCL, Wein, Spielberger – Hanin, Beck questionnaires.Results. The participants of the main group and the comparison group were comparable in terms of age, social status, anthropometric data, parameters of menstrual, ovulatory and reproductive functions, gynecological, somatic and infectious diseases. Patients with post-concussion syndrome have a duration of menstruation 1.07 times (p < 0.001) longer compared to women without post-concussion syndrome; painful menstruation in 1.47 times more often (p < 0.0001), heavy menstruation in 1.64 times (p < 0.003) more often. The infertility duration in patients with post-concussion syndrome is 1.29 times longer (p < 0.0001) compared to women without post-concussion syndrome. 69.27% of women who took part in hostilities and suffered a concussion have a history of ureaplasmosis or bacterial vaginosis: chlamydia and bacterial vaginosis occur in every third patient, ureaplasmosis in 41.61% patients. Chlamydia trachomatis is detected in patients with post-concussion syndrome 1.64 times (p < 0.0007) more often than in patients without this syndrome.Conclusions. Women who suffered concussions during hostilities have significant problems with physical and mental health due to the impact of brain injury and stress factors associated with military actions. Solving this problem requires the development of a comprehensive program that will include medical and psychological support for female military personnel and creation of high-quality medical and psychological rehabilitation of female veterans aimed at their full adaptation to peaceful life.
研究目的:建立脑震荡女性战斗参与者的心理健康状态、身体系统功能状态、生殖健康的临床和记忆数据之间的联系。材料和方法。这项研究包括487名育龄妇女,她们参加了敌对行动并遭受了脑震荡,她们被分为两组——主要组(211名患有脑震荡后综合症的妇女)和对照组(246名没有脑震荡后综合症的妇女)。对照组为30例健康平民育龄妇女,无任何创伤性记忆事件。脑震荡症状由Cicerone k.d., PCL, Wein, Spielberger - Hanin, Beck问卷确定。主要组和对照组的受试者在年龄、社会地位、人体测量数据、月经、排卵和生殖功能参数、妇科、躯体和传染病等方面具有可比性。脑震荡后综合征患者月经持续时间为1.07倍(p <0.001),比没有脑震荡后综合征的女性更长;痛经在1.47倍以上(p <0.0001),月经重者1.64次(p <0.003)更经常。脑震荡后综合征患者不孕持续时间延长1.29倍(p <0.0001),与没有脑震荡后综合征的女性相比。参加敌对行动并遭受脑震荡的妇女中有69.27%有尿原体病或细菌性阴道病的病史:衣原体和细菌性阴道病占三分之一,尿原体病占41.61%。沙眼衣原体在脑震荡后综合征患者中的检出率为1.64 (p <0.0007)高于无此综合征的患者。在敌对行动中遭受脑震荡的妇女由于受到与军事行动有关的脑损伤和压力因素的影响,在身心健康方面存在严重问题。解决这一问题需要制定一项综合方案,其中包括为女军人提供医疗和心理支持,并为女退伍军人提供高质量的医疗和心理康复,以使她们充分适应和平生活。
{"title":"Features of mental and reproductive health, functional state of the organism of female military servicemen who suffered concussion during combat actions","authors":"A.V. Serbeniuk","doi":"10.18370/2309-4117.2023.68.8-15","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.8-15","url":null,"abstract":"Research objectives: establishing an association between the state of mental health, the functional state of body systems, clinical and anamnestic data on reproductive health in female combat participants who suffered a concussion.Material and methods. The study included 487 women of reproductive age who took part in hostilities and suffered a concussion and who were divided into 2 groups – the main group (211 women with post-concussion syndrome) and a comparison group (246 women without the post-concussion syndrome). The control group included 30 healthy civilian women of reproductive age without any trauma episodes in the anamnesis. Concussion symptoms were determined by Cicerone K.D., PCL, Wein, Spielberger – Hanin, Beck questionnaires.Results. The participants of the main group and the comparison group were comparable in terms of age, social status, anthropometric data, parameters of menstrual, ovulatory and reproductive functions, gynecological, somatic and infectious diseases. Patients with post-concussion syndrome have a duration of menstruation 1.07 times (p < 0.001) longer compared to women without post-concussion syndrome; painful menstruation in 1.47 times more often (p < 0.0001), heavy menstruation in 1.64 times (p < 0.003) more often. The infertility duration in patients with post-concussion syndrome is 1.29 times longer (p < 0.0001) compared to women without post-concussion syndrome. 69.27% of women who took part in hostilities and suffered a concussion have a history of ureaplasmosis or bacterial vaginosis: chlamydia and bacterial vaginosis occur in every third patient, ureaplasmosis in 41.61% patients. Chlamydia trachomatis is detected in patients with post-concussion syndrome 1.64 times (p < 0.0007) more often than in patients without this syndrome.Conclusions. Women who suffered concussions during hostilities have significant problems with physical and mental health due to the impact of brain injury and stress factors associated with military actions. Solving this problem requires the development of a comprehensive program that will include medical and psychological support for female military personnel and creation of high-quality medical and psychological rehabilitation of female veterans aimed at their full adaptation to peaceful life.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Benefits and limitations of clinical assessment of abnormal vaginal discharge etiology 异常阴道分泌物病因的临床评估的益处和局限性
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.48-56
T.M. Tutchenko, T.F. Tatarchuk, L.О. Borysova, E.F. Chaikivska
Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”.A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination.This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicineto prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.
阴道分泌物异常(AVD)是一种常见的综合征。许多基于证据的指南都涉及阴道分泌物的管理:国际性传播感染联盟(IUSTI)和世卫组织阴道分泌物管理指南(2018年);美国妇产科学会(ACOG)实践公告第215号“非妊娠患者的阴道炎”(2020);美国疾病控制和预防中心(CDC)性传播疾病治疗指南(2021年)等。2022年12月,乌克兰卫生部批准了经修订的"阴道分泌物异常"临床指南和医疗护理标准。AVD治疗的一个特殊方面是频繁复发。在阴道感染复发过程的病因学的许多假设中,在混合形式的情况下识别所有病原体的困难的临床方面值得特别注意。因此,在临床检查阶段,有必要假定AVD的混合病因或非典型的单一感染过程的可能性。本文综述了阴道分泌物pH值测定在诊断AVD病因的临床阶段和对实验室结果的解释中的作用。阴道pH值检测是诊断AVD病因的临床阶段的重要组成部分。这种可行和快速的研究可以客观地确定阴道生态失调与乳酸和乳酸值的减少,这需要在检查过程中进一步的实验室诊断。它也是诊断细菌性阴道病的Amsel标准和评估绝经期阴道萎缩程度的阴道健康指数的组成部分。阴道pH值检测提高了对难以发现的感染和罕见原因的AVD的诊断。此外,这种方法对远程医疗也很有用,可以防止不必要的医疗检查、实验室测试和自我治疗,反之亦然,可以确认是否需要进行专家咨询。
{"title":"Benefits and limitations of clinical assessment of abnormal vaginal discharge etiology","authors":"T.M. Tutchenko, T.F. Tatarchuk, L.О. Borysova, E.F. Chaikivska","doi":"10.18370/2309-4117.2023.68.48-56","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.48-56","url":null,"abstract":"Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”.A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination.This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicineto prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immunohistochemical markers of the activity of apoptosis and proliferation in women with adenomyosis who had papillary thyroid carcinoma 甲状腺乳头状癌合并子宫腺肌病患者细胞凋亡和增殖活性的免疫组织化学标志物
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.18370/2309-4117.2023.68.16-21
M.D. Tronko, A.O. Danylova, L.V. Kalugina, N.V. Kosei, T.M. Kuchmenko, Y.M. Bondarenko
Research objectives: to evaluate the activity of apoptosis and proliferation mechanisms of eutopic endometrium in patients with adenomyosis who had a history of papillary thyroid carcinoma (PTC).Materials and methods. 63 women of reproductive age were examined: group I – 31 patients with adenomyosis and PTC in history, group II – 32 patients with adenomyosis and normal thyroid status. The intensity of pelvic pain was assessed using a visual analog scale in all women. The material for morphological research was obtained with Pipelle biopsy of the endometrium in the secretory phase of the menstrual cycle. A morphological study was performed on 30 biopsies of eutopic endometrium (15 samples from patients of group I and 15 samples from patients of group II). An immunohistochemical study was performed using monoclonal antibodies to cell-specific markers Bcl-2 (DAKO, clone 124) and Ki-67 (DAKO, clone MIB-1).Results. High expression of Bcl-2 was detected in the endometrial glandular epithelial cells (EGECs) in 70% and 62.5% of samples in group I and II respectively (р > 0.05), the number of Bcl-2-positive cells was significantly higher in samples from group I (80.0 ± 13.1% versus 60.0 ± 15.2% in group І and ІІ respectively, р < 0.05). In endometrial stromal cells (ESCs) high expression of Bcl-2 was detected in 90% and 100% of samples from group I and II respectively (р > 0.05), no significant difference in the number of positive cells was found between groups (18.9 ± 12.2% and 12.6 ± 9.1% in group І and ІІ respectively, р > 0.05). Expression of Ki-67 was detected in the EGECs in 70% and 62.5% (р > 0.05) of samples in group І and ІІ respectively and in the ESCs in 100% of samples from groups I and II respectively. The immunocytochemical Ki-67 labelling index was much more prominent in group I (45.0 ± 11.4% versus 25.8 ± 16.7% EGECs (р < 0.05); 26.5 ± 10.2% versus 16.3 ± 8.9% ESCs (р < 0.05) for group I and II respectively).Conclusions. Altered proliferation of the eutopic endometrium with marked resistance to apoptosis was found in reproductive aged female with adenomyosis and PTC in history, that is can be considered as a marker of the aggressiveness of the disease course in this cohort of patients.
研究目的:探讨有甲状腺乳头状癌(PTC)病史的子宫腺肌病患者异位子宫内膜的凋亡活性及增殖机制。材料和方法。研究对象为63例育龄妇女:ⅰ组- 31例既往有子宫腺肌病和PTC的患者,ⅱ组- 32例甲状腺功能正常的子宫腺肌病患者。所有女性盆腔疼痛强度采用视觉模拟量表评估。形态学研究的材料是在月经周期的分泌期对子宫内膜进行管道活检获得的。对30例异位子宫内膜活检(ⅰ组15例,ⅱ组15例)进行形态学研究,采用细胞特异性标志物Bcl-2 (DAKO,克隆124)和Ki-67 (DAKO,克隆mb -1)单克隆抗体进行免疫组化研究。ⅰ组和ⅱ组分别有70%和62.5%的样本在子宫内膜腺上皮细胞(EGECs)中高表达Bcl-2 (p < 0.05)。0.05), I组bcl -2阳性细胞数显著高于І和ІІ组(80.0±13.1%,分别为60.0±15.2%);0.05)。在子宫内膜基质细胞(ESCs)中,Bcl-2的高表达分别在I组和II组的90%和100%中检测到(p < 0.05)。0.05),各组间阳性细胞数差异无统计学意义(І组为18.9±12.2%,ІІ组为12.6±9.1%;0.05)。Ki-67在EGECs中表达的比例分别为70%和62.5% (p < 0.05)。0.05), 1组和2组的ESCs分别为100%。免疫细胞化学Ki-67标记指数在I组更为显著(45.0±11.4% vs 25.8±16.7%)。0.05);26.5±10.2% vs . 16.3±8.9% (p < 0.05);I组和II组分别为0.05)。在历史上患有子宫腺肌病和PTC的育龄女性中发现异位子宫内膜增生改变,对细胞凋亡有明显的抵抗,可以认为这是该队列患者病程侵袭性的标志。
{"title":"Immunohistochemical markers of the activity of apoptosis and proliferation in women with adenomyosis who had papillary thyroid carcinoma","authors":"M.D. Tronko, A.O. Danylova, L.V. Kalugina, N.V. Kosei, T.M. Kuchmenko, Y.M. Bondarenko","doi":"10.18370/2309-4117.2023.68.16-21","DOIUrl":"https://doi.org/10.18370/2309-4117.2023.68.16-21","url":null,"abstract":"Research objectives: to evaluate the activity of apoptosis and proliferation mechanisms of eutopic endometrium in patients with adenomyosis who had a history of papillary thyroid carcinoma (PTC).Materials and methods. 63 women of reproductive age were examined: group I – 31 patients with adenomyosis and PTC in history, group II – 32 patients with adenomyosis and normal thyroid status. The intensity of pelvic pain was assessed using a visual analog scale in all women. The material for morphological research was obtained with Pipelle biopsy of the endometrium in the secretory phase of the menstrual cycle. A morphological study was performed on 30 biopsies of eutopic endometrium (15 samples from patients of group I and 15 samples from patients of group II). An immunohistochemical study was performed using monoclonal antibodies to cell-specific markers Bcl-2 (DAKO, clone 124) and Ki-67 (DAKO, clone MIB-1).Results. High expression of Bcl-2 was detected in the endometrial glandular epithelial cells (EGECs) in 70% and 62.5% of samples in group I and II respectively (р > 0.05), the number of Bcl-2-positive cells was significantly higher in samples from group I (80.0 ± 13.1% versus 60.0 ± 15.2% in group І and ІІ respectively, р < 0.05). In endometrial stromal cells (ESCs) high expression of Bcl-2 was detected in 90% and 100% of samples from group I and II respectively (р > 0.05), no significant difference in the number of positive cells was found between groups (18.9 ± 12.2% and 12.6 ± 9.1% in group І and ІІ respectively, р > 0.05). Expression of Ki-67 was detected in the EGECs in 70% and 62.5% (р > 0.05) of samples in group І and ІІ respectively and in the ESCs in 100% of samples from groups I and II respectively. The immunocytochemical Ki-67 labelling index was much more prominent in group I (45.0 ± 11.4% versus 25.8 ± 16.7% EGECs (р < 0.05); 26.5 ± 10.2% versus 16.3 ± 8.9% ESCs (р < 0.05) for group I and II respectively).Conclusions. Altered proliferation of the eutopic endometrium with marked resistance to apoptosis was found in reproductive aged female with adenomyosis and PTC in history, that is can be considered as a marker of the aggressiveness of the disease course in this cohort of patients.","PeriodicalId":21103,"journal":{"name":"Reproductive Endocrinology","volume":"239 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Reproductive Endocrinology
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