Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.201804
N. Aganezova, S. Aganezov, K. E. Gogichashvili
Aim. To evaluate the expression of steroid receptors (estrogen [ER] and progesterone [PR]) in the endometrium during the implantation window in females with a history of fertility disorders in "thin" and "absolutely thin" endometrium versus healthy females. Materials and methods. A prospective comparative study was conducted. The study group (n=42) included patients with "thin" endometrium (7 mm M-echo 5 mm at cycle days 1113 according to ultrasound); the comparison group (n=10) included females with "absolutely thin" (5 mm according to ultrasound in the pre-ovulatory days) endometrium (females in both groups had a history of infertility and miscarriage of unclear reasons in the anamnesis); the control group included 16 healthy fertile females. A Pipelle biopsy of the uterine mucosa was performed on day 68 after ovulation, and a peripheral blood sample was obtained to measure the concentration of sex steroids (estradiol [E2] and progesterone [P]). Endometrial samples were examined by histological and immunohistochemical methods (ER, PR expression). Results. All study participants had an ovulatory cycle of P16.1 nmol/L (day 68 after ovulation) and normal estrogen levels (E2, pmol/L). E2/P was similar in all cohorts (p0.05 for all measures). ER and PR expression in the endometrium similar to those in healthy females was detected in 20% of patients in the study and comparison groups (M-echo = 4.83.1 mm): 21% (9/42) and 20% (2/10), respectively. ER and PR expression in the endometrial glands and ER expression in the endometrial stroma were significantly different (p0.05) from healthy females in 79% (41/52) of patients with "thin" endometrium and 80% (8/10) of patients with "absolutely thin" endometrium. No differences in the ER or PR expression in the endometrium in females with hypoplastic endometrium were found (p0.05). Conclusion. The M-echo value does not accurately determine endometrial hormonal-receptor abnormalities: 20% of the study participants with hypoplastic endometrium had ER and PR expression comparable to those in healthy females. No differences were found in the expression of endometrial estrogen and progesterone receptors in females with "thin" and "absolutely thin" endometrium.
的目标。评估有生育障碍史的女性在“薄”和“绝对薄”子宫内膜与健康女性在着床窗口期间子宫内膜中类固醇受体(雌激素[ER]和孕酮[PR])的表达。材料和方法。进行前瞻性比较研究。研究组(n=42)包括子宫内膜“薄”的患者(根据超声，周期第1113天m -回声为7 mm, 5 mm);对照组(n=10)为子宫内膜“绝对薄”(排卵前超声显示为5mm)的女性(两组女性均有不孕症和原因不明的流产史);对照组包括16名健康的育龄女性。排卵后第68天行子宫黏膜导管活检，取外周血标本测定性类固醇(雌二醇[E2]、孕酮[P])浓度。采用组织学和免疫组化方法检测子宫内膜标本(ER、PR表达)。结果。所有研究参与者的排卵周期为P16.1 nmol/L(排卵后第68天)，雌激素水平正常(E2, pmol/L)。E2/P在所有队列中相似(所有测量值p0.05)。研究组和对照组(M-echo = 4.83.1 mm)分别有20%(9/42)和20%(2/10)的患者子宫内膜ER和PR表达与健康女性相似。79%(41/52)的“薄”型子宫内膜患者和80%(8/10)的“绝对薄”型子宫内膜患者的子宫内膜腺ER和PR表达以及子宫内膜间质ER表达均与健康女性有显著差异(p0.05)。子宫内膜发育不全女性子宫内膜ER和PR的表达差异无统计学意义(p0.05)。结论。m回声值不能准确判断子宫内膜激素受体异常:20%子宫内膜发育不全的研究参与者的ER和PR表达与健康女性相当。子宫内膜“薄”和“绝对薄”的女性子宫内膜雌激素和孕激素受体的表达没有差异。
{"title":"Endometrial receptivity in women of reproductive age with \"thin\" and \"absolutely thin\" endometrium","authors":"N. Aganezova, S. Aganezov, K. E. Gogichashvili","doi":"10.26442/20795696.2022.6.201804","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201804","url":null,"abstract":"Aim. To evaluate the expression of steroid receptors (estrogen [ER] and progesterone [PR]) in the endometrium during the implantation window in females with a history of fertility disorders in \"thin\" and \"absolutely thin\" endometrium versus healthy females. \u0000Materials and methods. A prospective comparative study was conducted. The study group (n=42) included patients with \"thin\" endometrium (7 mm M-echo 5 mm at cycle days 1113 according to ultrasound); the comparison group (n=10) included females with \"absolutely thin\" (5 mm according to ultrasound in the pre-ovulatory days) endometrium (females in both groups had a history of infertility and miscarriage of unclear reasons in the anamnesis); the control group included 16 healthy fertile females. A Pipelle biopsy of the uterine mucosa was performed on day 68 after ovulation, and a peripheral blood sample was obtained to measure the concentration of sex steroids (estradiol [E2] and progesterone [P]). Endometrial samples were examined by histological and immunohistochemical methods (ER, PR expression). \u0000Results. All study participants had an ovulatory cycle of P16.1 nmol/L (day 68 after ovulation) and normal estrogen levels (E2, pmol/L). E2/P was similar in all cohorts (p0.05 for all measures). ER and PR expression in the endometrium similar to those in healthy females was detected in 20% of patients in the study and comparison groups (M-echo = 4.83.1 mm): 21% (9/42) and 20% (2/10), respectively. ER and PR expression in the endometrial glands and ER expression in the endometrial stroma were significantly different (p0.05) from healthy females in 79% (41/52) of patients with \"thin\" endometrium and 80% (8/10) of patients with \"absolutely thin\" endometrium. No differences in the ER or PR expression in the endometrium in females with hypoplastic endometrium were found (p0.05). \u0000Conclusion. The M-echo value does not accurately determine endometrial hormonal-receptor abnormalities: 20% of the study participants with hypoplastic endometrium had ER and PR expression comparable to those in healthy females. No differences were found in the expression of endometrial estrogen and progesterone receptors in females with \"thin\" and \"absolutely thin\" endometrium.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78009533","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.202024
I. Lapina, Y. Dobrokhotova, V. Taranov, Y. Sorokin, T. G. Chirvon, Anastasiya A. Malakhova
Introduction. Obesity, due to its high prevalence and relevance, can be considered an epidemic of modern society. Obesity-related microcirculatory vascular disease and chronic inflammation with endothelial dysfunction are associated with adverse effects on reproductive potential. Sulodexide reduces the risk of hemostatic complications in patients planning pregnancy due to its polypotent effect, which is especially important in metabolic disorders and comorbidities. Therefore, it is promising to assess the effectiveness of integrated management of obese patients as part of pregnancy planning. Aim. To modify the complex treatment of obesity in patients planning pregnancy to reduce the risk of reproductive losses and gestational complications. Materials and methods. The prospective analysis included 92 patients with grade 1 obesity. According to the clinical protocols and guidelines of the Reproductive Health Professional Medical Association, 46 patients in the control group (group 1) were prescribed treatment to reduce the body mass index, including lifestyle correction, folic acid, and vitamin D. Patients in the comparison group (Group 2, n=46) also received endotheliotropic agent sulodexide. The treatment efficacy was analyzed based on the frequency of pregnancy, the change of laboratory markers of endothelial dysfunction, the incidence of gestational complications, and reproductive losses. Results. The study showed that in comparison group patients, the frequency of pregnancy (58.7% of cases in Group 1, 71.7% in Group 1), favorable course of the first trimester (39.1% in Group 1, 63.0% in Group 2), and delivery at term (30.4% in Group 1, 56.5% in Group 2) were higher compared to the control group. There was also a more significant decrease in the body mass index and endothelial dysfunction factors (homocysteine level in group 1 before treatment was 172.4 mol/L, and 141.8 mol/L after treatment; 191.7 mol/L before treatment and 91.4 mol/L after treatment in Group 2, respectively) in patients receiving complex treatment with sulodexide. Analysis of the pregnancy course showed a lower risk of gestational diabetes (33.3% in Group 1 and 13.8% in Group 2). Conclusion. Treatment of obesity in patients planning pregnancy requires a complex effect aimed at correcting lifestyle, reducing body weight, restoring the endothelial layer, and reducing the severity of chronic inflammation, thus improving reproductive outcomes and minimizing the risk of gestational complications.
{"title":"Obesity and pregnancy: possible ways to overcome complications and improve reproductive outcomes","authors":"I. Lapina, Y. Dobrokhotova, V. Taranov, Y. Sorokin, T. G. Chirvon, Anastasiya A. Malakhova","doi":"10.26442/20795696.2022.6.202024","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.202024","url":null,"abstract":"Introduction. Obesity, due to its high prevalence and relevance, can be considered an epidemic of modern society. Obesity-related microcirculatory vascular disease and chronic inflammation with endothelial dysfunction are associated with adverse effects on reproductive potential. Sulodexide reduces the risk of hemostatic complications in patients planning pregnancy due to its polypotent effect, which is especially important in metabolic disorders and comorbidities. Therefore, it is promising to assess the effectiveness of integrated management of obese patients as part of pregnancy planning. \u0000Aim. To modify the complex treatment of obesity in patients planning pregnancy to reduce the risk of reproductive losses and gestational complications. \u0000Materials and methods. The prospective analysis included 92 patients with grade 1 obesity. According to the clinical protocols and guidelines of the Reproductive Health Professional Medical Association, 46 patients in the control group (group 1) were prescribed treatment to reduce the body mass index, including lifestyle correction, folic acid, and vitamin D. Patients in the comparison group (Group 2, n=46) also received endotheliotropic agent sulodexide. The treatment efficacy was analyzed based on the frequency of pregnancy, the change of laboratory markers of endothelial dysfunction, the incidence of gestational complications, and reproductive losses. \u0000Results. The study showed that in comparison group patients, the frequency of pregnancy (58.7% of cases in Group 1, 71.7% in Group 1), favorable course of the first trimester (39.1% in Group 1, 63.0% in Group 2), and delivery at term (30.4% in Group 1, 56.5% in Group 2) were higher compared to the control group. There was also a more significant decrease in the body mass index and endothelial dysfunction factors (homocysteine level in group 1 before treatment was 172.4 mol/L, and 141.8 mol/L after treatment; 191.7 mol/L before treatment and 91.4 mol/L after treatment in Group 2, respectively) in patients receiving complex treatment with sulodexide. Analysis of the pregnancy course showed a lower risk of gestational diabetes (33.3% in Group 1 and 13.8% in Group 2). \u0000Conclusion. Treatment of obesity in patients planning pregnancy requires a complex effect aimed at correcting lifestyle, reducing body weight, restoring the endothelial layer, and reducing the severity of chronic inflammation, thus improving reproductive outcomes and minimizing the risk of gestational complications.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"2 3534 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77802089","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.201897
M. Orazov, E. Silantyeva, V. Radzinsky, L. Mikhaleva, E. A. Khripach, E. Dolgov
The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice. Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.
{"title":"Efficacy of laser remodeling in the genitourinary syndrome of menopause: A review","authors":"M. Orazov, E. Silantyeva, V. Radzinsky, L. Mikhaleva, E. A. Khripach, E. Dolgov","doi":"10.26442/20795696.2022.6.201897","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201897","url":null,"abstract":"The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the \"gold standard\" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice. \u0000Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82327212","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.201957
M. Andreeva, K. Zakharova
Cervical inflammatory disease associated with papillomavirus infection is one of the most common inflammatory diseases of the pelvic organs and plays a role in developing cervical dysplasia and cancer. Over the past 15 years, Russia has seen an increase in the proportion of neglected cervical cancer cases. Currently, the management and treatment strategy for cervicitis associated with human papillomavirus (HPV) and cervical intraepithelial dysplasia ranges from monitoring with HPV testing and cytological control to excision and cervical conization. The immune status determines the course of the papillomavirus infection, which may be transient, latent, or persistent. In most cases (7080%), HPV is eliminated spontaneously. The detection of HPV DNA with clinical and morphological changes indicates a latent course of the disease. The complex use of clinical data and morphological and molecular biological studies results is most promising in identifying early prognostic markers of cervical malignancy. It is the basis for further search for cervical precancer progression pathogenetic markers.
{"title":"HPV-associated cervicitis","authors":"M. Andreeva, K. Zakharova","doi":"10.26442/20795696.2022.6.201957","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201957","url":null,"abstract":"Cervical inflammatory disease associated with papillomavirus infection is one of the most common inflammatory diseases of the pelvic organs and plays a role in developing cervical dysplasia and cancer. Over the past 15 years, Russia has seen an increase in the proportion of neglected cervical cancer cases. Currently, the management and treatment strategy for cervicitis associated with human papillomavirus (HPV) and cervical intraepithelial dysplasia ranges from monitoring with HPV testing and cytological control to excision and cervical conization. The immune status determines the course of the papillomavirus infection, which may be transient, latent, or persistent. In most cases (7080%), HPV is eliminated spontaneously. The detection of HPV DNA with clinical and morphological changes indicates a latent course of the disease. The complex use of clinical data and morphological and molecular biological studies results is most promising in identifying early prognostic markers of cervical malignancy. It is the basis for further search for cervical precancer progression pathogenetic markers.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87591284","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.202023
I. I. Kutsenko, E. I. Kravtsova, L. A. Kholina, O. V. Tomina
According to various studies, the overall population incidence of latent iron deficiency (LID) ranges from 70% and more. However, routine tests cannot detect LID during preconception examination and in the first trimester of pregnancy; therefore, women receive no proper treatment, and iron deficiency manifest in the second and third trimesters of pregnancy. LID causes hypoxia, leading to pregnancy, labor, and postpartum complications. Aim. To evaluate the effectiveness of iron with folic acid supplements compared to vitamin-mineral complexes in pregnant women with LID to improve maternal and perinatal outcomes. Materials and methods. A prospective cohort non-interventional study (observational program) in real clinical practice was conducted. In total 461 pregnant women aged 19 to 35 with LID were included in the study. During the study, women were divided into two groups according to the method of LID correction: administration of iron sulfate 247.25 mg, which corresponds to an iron content of 80 mg + folic acid 350 g (Gyno-Tardyferon), or vitamin-mineral complexes with an iron content of 1418 mg. Routine complete blood count, serum iron, serum ferritin, and transferrin were monitored over time. Results. Gyno-Tardyferon showed high therapeutic and prophylactic efficacy; the rate of favorable outcomes was 100% and 35% for multivitamin iron-containing complexes. No LID progression to manifest iron deficiency during pregnancy can also be considered a favorable outcome. Conclusion. The results showed that timely treatment of LID with an iron-containing medication (Gyno-Tardyferon) prevents manifested iron deficiency and hemic and circulatory hypoxia, which ultimately reduces the rate of pregnancy, labor, and postpartum complications.
{"title":"Latent iron deficiency therapy in pregnant women","authors":"I. I. Kutsenko, E. I. Kravtsova, L. A. Kholina, O. V. Tomina","doi":"10.26442/20795696.2022.6.202023","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.202023","url":null,"abstract":"According to various studies, the overall population incidence of latent iron deficiency (LID) ranges from 70% and more. However, routine tests cannot detect LID during preconception examination and in the first trimester of pregnancy; therefore, women receive no proper treatment, and iron deficiency manifest in the second and third trimesters of pregnancy. LID causes hypoxia, leading to pregnancy, labor, and postpartum complications. \u0000Aim. To evaluate the effectiveness of iron with folic acid supplements compared to vitamin-mineral complexes in pregnant women with LID to improve maternal and perinatal outcomes. \u0000Materials and methods. A prospective cohort non-interventional study (observational program) in real clinical practice was conducted. In total 461 pregnant women aged 19 to 35 with LID were included in the study. During the study, women were divided into two groups according to the method of LID correction: administration of iron sulfate 247.25 mg, which corresponds to an iron content of 80 mg + folic acid 350 g (Gyno-Tardyferon), or vitamin-mineral complexes with an iron content of 1418 mg. Routine complete blood count, serum iron, serum ferritin, and transferrin were monitored over time. \u0000Results. Gyno-Tardyferon showed high therapeutic and prophylactic efficacy; the rate of favorable outcomes was 100% and 35% for multivitamin iron-containing complexes. No LID progression to manifest iron deficiency during pregnancy can also be considered a favorable outcome. \u0000Conclusion. The results showed that timely treatment of LID with an iron-containing medication (Gyno-Tardyferon) prevents manifested iron deficiency and hemic and circulatory hypoxia, which ultimately reduces the rate of pregnancy, labor, and postpartum complications.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78248967","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.201749
A. U. Hamadyanova, Afzal H. Tuhtaboev, Venera A. Shafieva, Elena A. Kolodyazhnaya, Julia R. Mansurova, A. Muratova, Arina A. Andreeva, Julia A. Muzafarova
Estetrol (E4) is a steroid hormone found in the urine of pregnant women in 1965. E4 is produced only during pregnancy and enters the maternal bloodstream through the placenta. Its concentration in maternal human plasma increases during pregnancy, reaching a maximum by the end of pregnancy (1 ng/mL). The pharmacological properties of E4 make it a promising agent for hormonal therapy and contraception. To date, phase II and III studies have shown promising results with the combination of 15 mg of E4 and 3 mg of drospirenone: this combined oral contraceptive has shown a good effect with a neutral metabolic effect. However, evidence is scarce about the effect of the new combination on the breast and bone tissue. Further studies are needed to consolidate the available data and to investigate possible side effects of prolonged use of E4-containing combined oral contraceptives compared to known ethinylestradiol and estradiol-containing combinations.
{"title":"Estetrol: a new estrogen component in combined oral contraceptives: A review","authors":"A. U. Hamadyanova, Afzal H. Tuhtaboev, Venera A. Shafieva, Elena A. Kolodyazhnaya, Julia R. Mansurova, A. Muratova, Arina A. Andreeva, Julia A. Muzafarova","doi":"10.26442/20795696.2022.6.201749","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201749","url":null,"abstract":"Estetrol (E4) is a steroid hormone found in the urine of pregnant women in 1965. E4 is produced only during pregnancy and enters the maternal bloodstream through the placenta. Its concentration in maternal human plasma increases during pregnancy, reaching a maximum by the end of pregnancy (1 ng/mL). The pharmacological properties of E4 make it a promising agent for hormonal therapy and contraception. To date, phase II and III studies have shown promising results with the combination of 15 mg of E4 and 3 mg of drospirenone: this combined oral contraceptive has shown a good effect with a neutral metabolic effect. However, evidence is scarce about the effect of the new combination on the breast and bone tissue. Further studies are needed to consolidate the available data and to investigate possible side effects of prolonged use of E4-containing combined oral contraceptives compared to known ethinylestradiol and estradiol-containing combinations.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74571528","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.201990
A. Fomina, A. Borbat, E. Karpulevich, Anton Yu. Naumov
Background. Neural networks are actively used in digital pathology to analyze histological images and support medical decision-making. A common approach is to solve the classification problem, where only class labels are the only model responses. However, one should understand which areas of the image have the most significant impact on the model's response. Machine learning interpretation techniques help solve this problem. Aim. To study the consistency of different methods of neural network interpretation when classifying histological images of the breast and to obtain an expert assessment of the results of the evaluated methods. Materials and methods. We performed a preliminary analysis and pre-processing of the existing data set used to train pre-selected neural network models. The existing methods of visualizing the areas of attention of trained models on easy-to-understand data were applied, followed by verification of their correct use. The same neural network models were trained on histological data, and the selected interpretation methods were used to systematize histological images, followed by the evaluation of the results consistency and an expert assessment of the results. Results. In this paper, several methods of interpreting machine learning are studied using two different neural network architectures and a set of histological images of breast abnormalities. Results of ResNet18 and ViT-B-16 models training on a set of histological images on the test sample: accuracy metric 0.89 and 0.89, ROC_AUC metric 0.99 and 0.96, respectively. The results were also evaluated by an expert using the Label Studio tool. For each pair of images, the expert was asked to select the most appropriate answer ("Yes" or "No") to the question: "The highlighted areas generally correspond to the Malignant class." The "Yes" response rate for the ResNet_Malignant category was 0.56; for ViT_Malignant, it was 1.0. Conclusion. Interpretability experiments were conducted with two different architectures: the ResNet18 convolutional network and the ViT-B-16 attention-enhanced network. The results of the trained models were visualized using the GradCAM and Attention Rollout methods, respectively. First, experiments were conducted on a simple-to-interpret dataset to ensure they were used correctly. The methods are then applied to the set of histological images. In easy-to-understand images (cat images), the convolutional network is more consistent with human perception; on the contrary, in histological images of breast cancer, ViT-B-16 provided results much more similar to the expert's perception.
{"title":"Neural network interpretation techniques for analysis of histological images of breast abnormalities","authors":"A. Fomina, A. Borbat, E. Karpulevich, Anton Yu. Naumov","doi":"10.26442/20795696.2022.6.201990","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201990","url":null,"abstract":"Background. Neural networks are actively used in digital pathology to analyze histological images and support medical decision-making. A common approach is to solve the classification problem, where only class labels are the only model responses. However, one should understand which areas of the image have the most significant impact on the model's response. Machine learning interpretation techniques help solve this problem. \u0000Aim. To study the consistency of different methods of neural network interpretation when classifying histological images of the breast and to obtain an expert assessment of the results of the evaluated methods. \u0000Materials and methods. We performed a preliminary analysis and pre-processing of the existing data set used to train pre-selected neural network models. The existing methods of visualizing the areas of attention of trained models on easy-to-understand data were applied, followed by verification of their correct use. The same neural network models were trained on histological data, and the selected interpretation methods were used to systematize histological images, followed by the evaluation of the results consistency and an expert assessment of the results. \u0000Results. In this paper, several methods of interpreting machine learning are studied using two different neural network architectures and a set of histological images of breast abnormalities. Results of ResNet18 and ViT-B-16 models training on a set of histological images on the test sample: accuracy metric 0.89 and 0.89, ROC_AUC metric 0.99 and 0.96, respectively. The results were also evaluated by an expert using the Label Studio tool. For each pair of images, the expert was asked to select the most appropriate answer (\"Yes\" or \"No\") to the question: \"The highlighted areas generally correspond to the Malignant class.\" The \"Yes\" response rate for the ResNet_Malignant category was 0.56; for ViT_Malignant, it was 1.0. \u0000Conclusion. Interpretability experiments were conducted with two different architectures: the ResNet18 convolutional network and the ViT-B-16 attention-enhanced network. The results of the trained models were visualized using the GradCAM and Attention Rollout methods, respectively. First, experiments were conducted on a simple-to-interpret dataset to ensure they were used correctly. The methods are then applied to the set of histological images. In easy-to-understand images (cat images), the convolutional network is more consistent with human perception; on the contrary, in histological images of breast cancer, ViT-B-16 provided results much more similar to the expert's perception.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"09 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86170427","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.202027
Irina A. Лапина, A. Tyan, Yulia Е. Dobrokhotovа, Valeriia M. Gomzikova, Y. Sorokin, V. Taranov, A. Malakhova, T. G. Chirvon, Viktoria А. Gudebsckaia, Svetlana V. Firstova, Anastasia А. Zateeva
The article addresses the treatment of uterine fibroids, which is still relevant. According to numerous studies, about 70% of females under 50 have uterine fibroids, the most common condition among perimenopausal women. The prevalence of giant forms is not high and accounts for less than 5% of all cases, especially at early diagnosis. The surgical strategy in such cases is individual and depends on many factors: size, location of nodes, and women's reproduction plans. In these clinical cases, the management of patients with giant uterine fibroids is presented according to the multimodal principles of fast-track surgery in a modern gynecological hospital. We described the main approaches in diagnosis, preoperative preparation, surgery features, and subsequent recovery to reduce the complication rate, the duration of inpatient treatment, and postoperative rehabilitation in the treatment of giant uterine fibroids.
{"title":"Principles of fast-track surgery in the treatment of giant uterine fibroids: а clinical case","authors":"Irina A. Лапина, A. Tyan, Yulia Е. Dobrokhotovа, Valeriia M. Gomzikova, Y. Sorokin, V. Taranov, A. Malakhova, T. G. Chirvon, Viktoria А. Gudebsckaia, Svetlana V. Firstova, Anastasia А. Zateeva","doi":"10.26442/20795696.2022.6.202027","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.202027","url":null,"abstract":"The article addresses the treatment of uterine fibroids, which is still relevant. According to numerous studies, about 70% of females under 50 have uterine fibroids, the most common condition among perimenopausal women. The prevalence of giant forms is not high and accounts for less than 5% of all cases, especially at early diagnosis. The surgical strategy in such cases is individual and depends on many factors: size, location of nodes, and women's reproduction plans. In these clinical cases, the management of patients with giant uterine fibroids is presented according to the multimodal principles of fast-track surgery in a modern gynecological hospital. We described the main approaches in diagnosis, preoperative preparation, surgery features, and subsequent recovery to reduce the complication rate, the duration of inpatient treatment, and postoperative rehabilitation in the treatment of giant uterine fibroids.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"161 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75978107","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}
Pub Date : 2023-01-20DOI: 10.26442/20795696.2022.6.202028
D. I. Burchakov
Physiological changes during pregnancy often disrupt women's sleep. If these changes are combined with other factors (obesity, iron or magnesium deficiency, anxiety, etc.), the pregnant woman may develop sleep disorders: obstructive sleep apnoea syndrome, restless legs syndrome, leg cramps, and insomnia. These disorders increase the risk of pregnancy complications, reduce the quality of a woman's life, and form the basis for somatic and mental disorders in the postpartum period. Therefore, the obstetrician has to be familiar with the phenomenology, diagnosis, and treatment of sleep disorders in pregnant women to treat them promptly or to refer a woman to a neurologist or psychiatrist. This review briefly describes the common sleep disorders occurring in pregnant women, especially the various types of insomnia. The main groups of sedative agents are characterized, of which only doxylamine is acceptable for use in routine practice because of its proven efficacy and safety during pregnancy.
{"title":"Sleep disturbances in pregnancy: features of diagnosis and therapy: A review","authors":"D. I. Burchakov","doi":"10.26442/20795696.2022.6.202028","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.202028","url":null,"abstract":"Physiological changes during pregnancy often disrupt women's sleep. If these changes are combined with other factors (obesity, iron or magnesium deficiency, anxiety, etc.), the pregnant woman may develop sleep disorders: obstructive sleep apnoea syndrome, restless legs syndrome, leg cramps, and insomnia. These disorders increase the risk of pregnancy complications, reduce the quality of a woman's life, and form the basis for somatic and mental disorders in the postpartum period. Therefore, the obstetrician has to be familiar with the phenomenology, diagnosis, and treatment of sleep disorders in pregnant women to treat them promptly or to refer a woman to a neurologist or psychiatrist. This review briefly describes the common sleep disorders occurring in pregnant women, especially the various types of insomnia. The main groups of sedative agents are characterized, of which only doxylamine is acceptable for use in routine practice because of its proven efficacy and safety during pregnancy.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75410693","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}
Pub Date : 2022-12-20DOI: 10.26442/20795696.2022.6.201539
T. V. Rachenkova, Y. Dudareva
The main objective of this paper was to review the current studies that consider changes in concentrations of various biologically active substances at the local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. Many biological markers, such as proinflammatory cytokines (interleukins [IL-2, IL-6, IL-10, IL-1] and tumor necrosis factor ), are considered prognostic markers. Changes in their concentrations in various biological media (serum, cervical mucus, amniotic fluid) may indicate a cellular immunological imbalance in the "motherplacentafetus" system, which is often the main pathogenesis link of late spontaneous miscarriage. Changes in concentrations of fetoplacental complex hormones such as progesterone, estradiol, and human chorionic gonadotropin have also been described. The concentrations of hypoxia-induced factor HIF1a in amniotic fluid and exosomal HIF1a in patients with cervical incompetence as one of the most common causes of late spontaneous miscarriage are presented as markers. Thus, the review shows the role of changes in concentrations of various biologically active substances at local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. The following methodology was used during work on the article: selection of publications using modern information databases, analysis of the obtained information, systematization of materials, and presentation of conclusions. An electronic search was conducted using publications identified in the following databases: eLIBRARY.RU, Google Scholar, and PubMed.
本文的主要目的是回顾目前的研究，这些研究认为局部和全身水平(宫颈粘液/羊水和血清)各种生物活性物质浓度的变化是晚期自然流产的预测因素。许多生物标志物，如促炎细胞因子(白介素[IL-2, IL-6, IL-10, IL-1]和肿瘤坏死因子)被认为是预后标志物。它们在各种生物介质(血清、宫颈粘液、羊水)中浓度的变化可能表明“母体-胎盘-胎儿”系统的细胞免疫失衡，这通常是晚期自然流产的主要发病机制。胎儿胎盘复合激素如黄体酮、雌二醇和人绒毛膜促性腺激素浓度的变化也有报道。羊水中缺氧诱导因子HIF1a的浓度和宫颈功能不全患者的外泌体HIF1a作为晚期自发性流产的最常见原因之一被提出作为标志物。因此，该综述显示了各种生物活性物质在局部和全身水平(宫颈粘液/羊水和血清)浓度变化作为晚期自然流产的预测因子的作用。在编写这篇文章的过程中使用了下列方法:利用现代信息数据库选择出版物，分析所获得的信息，将材料系统化，并提出结论。利用下列数据库中确定的出版物进行了电子检索:RU, Google Scholar和PubMed。
{"title":"Predictors of late spontaneous miscarriage: current aspects of a known problem (literature review)","authors":"T. V. Rachenkova, Y. Dudareva","doi":"10.26442/20795696.2022.6.201539","DOIUrl":"https://doi.org/10.26442/20795696.2022.6.201539","url":null,"abstract":"The main objective of this paper was to review the current studies that consider changes in concentrations of various biologically active substances at the local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. Many biological markers, such as proinflammatory cytokines (interleukins [IL-2, IL-6, IL-10, IL-1] and tumor necrosis factor ), are considered prognostic markers. Changes in their concentrations in various biological media (serum, cervical mucus, amniotic fluid) may indicate a cellular immunological imbalance in the \"motherplacentafetus\" system, which is often the main pathogenesis link of late spontaneous miscarriage. Changes in concentrations of fetoplacental complex hormones such as progesterone, estradiol, and human chorionic gonadotropin have also been described. The concentrations of hypoxia-induced factor HIF1a in amniotic fluid and exosomal HIF1a in patients with cervical incompetence as one of the most common causes of late spontaneous miscarriage are presented as markers. Thus, the review shows the role of changes in concentrations of various biologically active substances at local and systemic levels (cervical mucus/amniotic fluid and serum) as predictors of late spontaneous miscarriage. The following methodology was used during work on the article: selection of publications using modern information databases, analysis of the obtained information, systematization of materials, and presentation of conclusions. An electronic search was conducted using publications identified in the following databases: eLIBRARY.RU, Google Scholar, and PubMed.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78465381","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}
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