Pub Date : 2023-10-04DOI: 10.26442/20795696.2023.3.202358
Natalia V. Aganezova, Sergey S. Aganezov, Ksenia E. Gogichashvili, Anna S. Artemyeva, Anna O. Nyuganen
Aim. To evaluate the expression of FOX proteins (FOXA1 and FOXA2) in the endometrium during the implantation window in women with a history of reproductive dysfunctions with different thickness of the endometrium.
Materials and methods. The prospective cohort comparative study was conducted. The main group included patients with "thin" endometrium (7 mm according to ultrasound on preovulatory days; n=52), the comparison group consisted of women with normal endometrial thickness (7 mm according to ultrasound; n=62; women of both groups with reproductive dysfunctions of unknown reason), the control group included 16 healthy fertile women. Aspiration biopsy of the endometrium was performed on the 68 days after ovulation, as well as venipuncture to obtain a sample of peripheral blood to determine the levels of sex steroids (estradiol E2 and progesterone P). A combined histological and immunohistochemical study of endometrial biopsies was performed.
Results. All women had ovulatory values of progesterone P16.1 nmol/l (68 days after ovulation) and normoestrogenemia (E2, pmol/l) in the blood. E2/P was similar in all groups (p0, 05). A pronounced expression of FOXA1 was noted in women with thin endometrium significantly more often (p0.05) with various hormone-receptor characteristics of the endometrium (42% n=22 out of 52) compared with healthy participants (0%; n=0). Reduced FOXA2 expression in the uterine mucosa was significantly more often detected on 68 days after ovulation in women with "thin" endometrium (56% n=29 of 52) than in women with normal endometrial thickness, both in women from the comparison group and in healthy women from the control group (p0.05). In a generalized analysis of the expression of FOX proteins in the endometrium on days 68 after ovulation, it was generally found that every second (50%; n=57 out of 114) women with a history of reproductive disorders (with a reduced and normal M-echo value) expression of proteomic markers differed from healthy women. In the case of "thin" endometrium, more than two thirds of patients (71%; n=37 out of 52) showed differences in endometrial expression of FOX proteins compared with women without a burdened reproductive history.
Conclusion. In the majority of women (71%) with a thin endometrium and a history of reproductive dysfunctions, the expression of FOX proteins in the endometrium differed from the control group. Overall, endometrial expression of FOX proteins, which is likely to be different from healthy women, in patients with reproductive dysfunctions of unknown origin is a significant predictor of reproductive failure. At the same time, such an isolated indicator as M-echo value 7 mm according to ultrasound data is not an absolute prognostic marker of endometrial receptivity disorders.
{"title":"Endometrial expression of FOX proteins (FOXA1 and FOXA2) in women of reproductive age with different endometrial thickness: prospective cohort comparative study","authors":"Natalia V. Aganezova, Sergey S. Aganezov, Ksenia E. Gogichashvili, Anna S. Artemyeva, Anna O. Nyuganen","doi":"10.26442/20795696.2023.3.202358","DOIUrl":"https://doi.org/10.26442/20795696.2023.3.202358","url":null,"abstract":"Aim. To evaluate the expression of FOX proteins (FOXA1 and FOXA2) in the endometrium during the implantation window in women with a history of reproductive dysfunctions with different thickness of the endometrium.
 Materials and methods. The prospective cohort comparative study was conducted. The main group included patients with \"thin\" endometrium (7 mm according to ultrasound on preovulatory days; n=52), the comparison group consisted of women with normal endometrial thickness (7 mm according to ultrasound; n=62; women of both groups with reproductive dysfunctions of unknown reason), the control group included 16 healthy fertile women. Aspiration biopsy of the endometrium was performed on the 68 days after ovulation, as well as venipuncture to obtain a sample of peripheral blood to determine the levels of sex steroids (estradiol E2 and progesterone P). A combined histological and immunohistochemical study of endometrial biopsies was performed.
 Results. All women had ovulatory values of progesterone P16.1 nmol/l (68 days after ovulation) and normoestrogenemia (E2, pmol/l) in the blood. E2/P was similar in all groups (p0, 05). A pronounced expression of FOXA1 was noted in women with thin endometrium significantly more often (p0.05) with various hormone-receptor characteristics of the endometrium (42% n=22 out of 52) compared with healthy participants (0%; n=0). Reduced FOXA2 expression in the uterine mucosa was significantly more often detected on 68 days after ovulation in women with \"thin\" endometrium (56% n=29 of 52) than in women with normal endometrial thickness, both in women from the comparison group and in healthy women from the control group (p0.05). In a generalized analysis of the expression of FOX proteins in the endometrium on days 68 after ovulation, it was generally found that every second (50%; n=57 out of 114) women with a history of reproductive disorders (with a reduced and normal M-echo value) expression of proteomic markers differed from healthy women. In the case of \"thin\" endometrium, more than two thirds of patients (71%; n=37 out of 52) showed differences in endometrial expression of FOX proteins compared with women without a burdened reproductive history.
 Conclusion. In the majority of women (71%) with a thin endometrium and a history of reproductive dysfunctions, the expression of FOX proteins in the endometrium differed from the control group. Overall, endometrial expression of FOX proteins, which is likely to be different from healthy women, in patients with reproductive dysfunctions of unknown origin is a significant predictor of reproductive failure. At the same time, such an isolated indicator as M-echo value 7 mm according to ultrasound data is not an absolute prognostic marker of endometrial receptivity disorders.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135643956","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202178
Y. Dobrokhotova, I. Lapina, A. Tyan, V. Taranov, T. G. Chirvon, Nikita V. Glebov, Olesya V. Kaykova, Anastasiya A. Malakhova, Valeriia M. Gomzikova, Vladislava I. Klaushuk
Pelvic organ prolapse belongs to the group of multidisciplinary pathological processes, in the pathogenesis of which various etiological components are involved, leading to destabilization of ligaments and muscular-fascial system. In most cases, pelvic floor dysfunction requires surgical treatment, which allows eliminating defects and reducing clinical symptoms, also improving quality of life of patients. Performing surgeries for genital prolapse using laparoscopic approach is associated with high efficiency and low risk of unfavorable clinical outcomes. However, despite significant progress and improvement of surgical treatment options, the choice of the rational treatment in terms of a personalized approach remains relevant. This literature review analyzes classical and alternative modes of laparoscopic correction of pelvic organ prolapse.
{"title":"Accelerated recovery program for patients after laparoscopic correction of pelvic organ prolapse: A prospective study","authors":"Y. Dobrokhotova, I. Lapina, A. Tyan, V. Taranov, T. G. Chirvon, Nikita V. Glebov, Olesya V. Kaykova, Anastasiya A. Malakhova, Valeriia M. Gomzikova, Vladislava I. Klaushuk","doi":"10.26442/20795696.2023.2.202178","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202178","url":null,"abstract":"Pelvic organ prolapse belongs to the group of multidisciplinary pathological processes, in the pathogenesis of which various etiological components are involved, leading to destabilization of ligaments and muscular-fascial system. In most cases, pelvic floor dysfunction requires surgical treatment, which allows eliminating defects and reducing clinical symptoms, also improving quality of life of patients. Performing surgeries for genital prolapse using laparoscopic approach is associated with high efficiency and low risk of unfavorable clinical outcomes. However, despite significant progress and improvement of surgical treatment options, the choice of the rational treatment in terms of a personalized approach remains relevant. This literature review analyzes classical and alternative modes of laparoscopic correction of pelvic organ prolapse.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84467991","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202206
Larisa S. Sotnikova
Background. The study of the recovery and restoration of the mucous membranes of the genital tract with vaginal intimate gels is presented. Aim. To determine the clinical effectiveness of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal for restoration of the mucous membranes of the vulva and vagina. Materials and methods. Two groups of women were formed, Floragel and Vagizhenal, to analyze the clinical efficacy of cosmetic gels for intimate hygiene. Group 1 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes and the absence of normal vaginal microflora. For intimate hygiene, this group regularly used the gel for intimate hygiene Floragel for 1 month. Group 2 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes of various etiologies. For intimate hygiene, this group regularly used the gel for intimate hygiene Vagizhenal for 1 month. The gels were applied regularly, two times a day in the morning and evening, in a thin layer after hygienic procedures. Evaluation of the clinical effectiveness of special cosmetic gels for intimate hygiene Floragel and Vagizhenal included assessment of clinical efficacy, indicators of gynecological status, findings of microscopic and microbiological examination of vaginal discharge (Femoflor system), determination of the vaginal health index, and measurement of nonspecific immune protection of the vagina levels of interferon , interleukin (IL)-1, IL-6, IL-10 in the vaginal discharge using enzyme-linked immunosorbent assay. Results. As shown by the questionnaires and interviews with patients, the use of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal was associated with a significant improvement (p0.05) in clinical symptoms: an improvement of vaginal discharge, the disappearance of unpleasant odor and itching, and an improvement in the state of the vaginal mucous membranes and vulva. A special gynecological examination showed significant changes in the visual morphological and functional state characteristics of the vaginal mucosa and vulva. An improvement was reported in 90% (27) patients (p0.05) who used Floragel and in 80% (24) patients who used Vagizhenal. Conclusion. The results demonstrate Floragel and Vagizhenal gels' high efficiency in restoring normal microflora and moisturizing mucous membranes by optimizing microbiological indicators, improving the vaginal health index and local immunity factors, indicating that special gels for intimate hygiene Floragel and Vagizhenal have not only cosmetic but also therapeutic properties.
{"title":"Current methods of normalization and maintenance of mucous membranes in gynecology: A prospective study","authors":"Larisa S. Sotnikova","doi":"10.26442/20795696.2023.2.202206","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202206","url":null,"abstract":"Background. The study of the recovery and restoration of the mucous membranes of the genital tract with vaginal intimate gels is presented. \u0000Aim. To determine the clinical effectiveness of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal for restoration of the mucous membranes of the vulva and vagina. \u0000Materials and methods. Two groups of women were formed, Floragel and Vagizhenal, to analyze the clinical efficacy of cosmetic gels for intimate hygiene. Group 1 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes and the absence of normal vaginal microflora. For intimate hygiene, this group regularly used the gel for intimate hygiene Floragel for 1 month. Group 2 included 30 women aged 25 to 55 with clinical symptoms of genital tract mucosa atrophic changes of various etiologies. For intimate hygiene, this group regularly used the gel for intimate hygiene Vagizhenal for 1 month. The gels were applied regularly, two times a day in the morning and evening, in a thin layer after hygienic procedures. Evaluation of the clinical effectiveness of special cosmetic gels for intimate hygiene Floragel and Vagizhenal included assessment of clinical efficacy, indicators of gynecological status, findings of microscopic and microbiological examination of vaginal discharge (Femoflor system), determination of the vaginal health index, and measurement of nonspecific immune protection of the vagina levels of interferon , interleukin (IL)-1, IL-6, IL-10 in the vaginal discharge using enzyme-linked immunosorbent assay. \u0000Results. As shown by the questionnaires and interviews with patients, the use of special cosmetic gels for intimate hygiene, Floragel and Vagizhenal was associated with a significant improvement (p0.05) in clinical symptoms: an improvement of vaginal discharge, the disappearance of unpleasant odor and itching, and an improvement in the state of the vaginal mucous membranes and vulva. A special gynecological examination showed significant changes in the visual morphological and functional state characteristics of the vaginal mucosa and vulva. An improvement was reported in 90% (27) patients (p0.05) who used Floragel and in 80% (24) patients who used Vagizhenal. \u0000Conclusion. The results demonstrate Floragel and Vagizhenal gels' high efficiency in restoring normal microflora and moisturizing mucous membranes by optimizing microbiological indicators, improving the vaginal health index and local immunity factors, indicating that special gels for intimate hygiene Floragel and Vagizhenal have not only cosmetic but also therapeutic properties.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88057412","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202219
Lyubov T. Gadzhieva, S. M. Pronin, Stanislav V. Pavlovich, V. Kometova, L. A. Ashrafyan
Aim. To evaluate the effectiveness of the intrauterine levonorgestrel-releasing device (LNG-IUD) in the treatment of atypical hyperplasia and the use of LNG-IUD in combination with a gonadotropin-releasing hormone analog (3.6 mg goserelin depot) in the treatment of stage Ia highly differentiated endometrial adenocarcinoma in women wishing to preserve childbearing function, and to assess reproductive outcomes after treatment in these women. Materials and methods. A prospective and retrospective series of cases included all patients treated with LNG-IUD or LNG-IUD combined with goserelin 3.2 for atypical hyperplasia or early endometrial cancer (EC) treated in the Department of Innovative Oncology and Gynecology of the Institute of Oncogynecology and Mammology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology from January 2018 to March 2022. Response rates and the relationship of the response with clinical and pathological factors were calculated. Results. Fifty-six patients diagnosed with atypical hyperplasia or stage Ia highly differentiated endometrial adenocarcinoma were treated with LNG-IUD and LNG-IUD combined with 3.2 mg of goserelin. Of the 56 patients who completed a 6-month course of hormonal treatment, 42 (82%) showed a complete response: 22 (91.7%) with atypical endometrial hyperplasia (AEH) and 20 (74.1%) with EC. In 4 (7.8%) patients, a partial response was reported: 2 (8.3%) with AEH and 2 (7.4%) with EC. No response was noted in 5 (9.8%) patients in the EC group only. Childbirth was reported in 13 (23.2%) women: 8 (29.6%) with AEH and 5 (17.2%) with EC. Two (3.6%) women were in the second trimester of pregnancy, and 17 (30.4%) women had an early pregnancy loss; 7 (25.9%) of them had AEH, and 10 (34.5%) had EC. The positive response rate was 90.2% at 6 months: 24 (100%) patients with atypical hyperplasia and 22 (81.5%) with EC. Patients with EC in combination with polycystic ovary syndrome and obesity and patients with the non-obese EC phenotype had a lower therapy efficacy. Conclusion. LNG-IUD therapy for the conservative treatment of atypical hyperplasia and LNG-IUD therapy combined with goserelin 3.2 for early EC led to a morphological cure in most patients and can be considered for women planning pregnancy.
{"title":"Outcomes of organ-preserving treatment of atypical hyperplasia and early stage endometrial cancer in reproductive age: A prospective and retrospective study","authors":"Lyubov T. Gadzhieva, S. M. Pronin, Stanislav V. Pavlovich, V. Kometova, L. A. Ashrafyan","doi":"10.26442/20795696.2023.2.202219","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202219","url":null,"abstract":"Aim. To evaluate the effectiveness of the intrauterine levonorgestrel-releasing device (LNG-IUD) in the treatment of atypical hyperplasia and the use of LNG-IUD in combination with a gonadotropin-releasing hormone analog (3.6 mg goserelin depot) in the treatment of stage Ia highly differentiated endometrial adenocarcinoma in women wishing to preserve childbearing function, and to assess reproductive outcomes after treatment in these women. \u0000Materials and methods. A prospective and retrospective series of cases included all patients treated with LNG-IUD or LNG-IUD combined with goserelin 3.2 for atypical hyperplasia or early endometrial cancer (EC) treated in the Department of Innovative Oncology and Gynecology of the Institute of Oncogynecology and Mammology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology from January 2018 to March 2022. Response rates and the relationship of the response with clinical and pathological factors were calculated. \u0000Results. Fifty-six patients diagnosed with atypical hyperplasia or stage Ia highly differentiated endometrial adenocarcinoma were treated with LNG-IUD and LNG-IUD combined with 3.2 mg of goserelin. Of the 56 patients who completed a 6-month course of hormonal treatment, 42 (82%) showed a complete response: 22 (91.7%) with atypical endometrial hyperplasia (AEH) and 20 (74.1%) with EC. In 4 (7.8%) patients, a partial response was reported: 2 (8.3%) with AEH and 2 (7.4%) with EC. No response was noted in 5 (9.8%) patients in the EC group only. Childbirth was reported in 13 (23.2%) women: 8 (29.6%) with AEH and 5 (17.2%) with EC. Two (3.6%) women were in the second trimester of pregnancy, and 17 (30.4%) women had an early pregnancy loss; 7 (25.9%) of them had AEH, and 10 (34.5%) had EC. The positive response rate was 90.2% at 6 months: 24 (100%) patients with atypical hyperplasia and 22 (81.5%) with EC. Patients with EC in combination with polycystic ovary syndrome and obesity and patients with the non-obese EC phenotype had a lower therapy efficacy. \u0000Conclusion. LNG-IUD therapy for the conservative treatment of atypical hyperplasia and LNG-IUD therapy combined with goserelin 3.2 for early EC led to a morphological cure in most patients and can be considered for women planning pregnancy.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78465702","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202123
I. Medyannikova, Yuliya Ch. Kuklis, I. Saveljeva, G. B. Beznoshchenko, E. G. Galyanskaya, O. Tsygankova, E.G. Prodanchuk, E. Bukharova, N. Nosova, Pavel V. Davidov
Background. Generalized endotheliopathy in SARS-CoV-2 is associated with the release of the vasoactive peptide endothelin-1, which stimulates the activation of both the plasma and platelet clotting pathways. It is believed that endothelin-1 is one of the most potent vasopressors of the human cardiovascular system and has a strong pressor and thrombogenic effect on many vessels, including in the motherplacentafetus system. Aim. To study endothelial dysfunction in pregnant women with new coronavirus infection SARS-CoV-2. Materials and methods. An open-label prospective continuous cross-sectional study enrolled 96 patients who survived COVID-19 at various gestational ages. Depending on the severity of the underlying disease, patients were divided into groups: Group 1 (n=18) included patients with mild SARS-CoV-2 coronavirus infection, Group 2 (n=56) included women with moderate severity, Group 3 (n=22) included patients with severe COVID-19. The control group consisted of 100 pregnant women who had no COVID-19 or signs of acute respiratory viral infection. In all groups, endothelin-1 levels were determined by enzyme-linked immunosorbent assay. Results. In pregnant women with no COVID-19 and patients after mild COVID-19, the level of endothelin-1 corresponds to the reference values; in pregnant women with moderate and severe underlying disease, the level of endothelin-1 was 2.04.0 pmol/L. It reflects the increased activity of the endothelium in the uterine bloodstream and blood vessels in the motherplacentafetus system. Placental insufficiency in women after COVID-19 is caused by endothelial dysfunction that triggers vasospasm and increased vascular resistance in the uterine arteries (r=0.8; p0.01). Conclusion. The diagnosis of endothelial dysfunction in the motherplacentafetus system after COVID-19 can be helpful in the prediction and prevention of vascular complications, both placental, associated with great obstetrical syndromes (premature birth, intrauterine growth retardation, preeclampsia, antenatal fetal death), and extraplacental ones (arterial and venous thrombosis).
{"title":"Endothelial dysfunction in the mother–placenta–fetus system after a new coronavirus infection SARS-CoV-2: An open prospective cross-sectional study","authors":"I. Medyannikova, Yuliya Ch. Kuklis, I. Saveljeva, G. B. Beznoshchenko, E. G. Galyanskaya, O. Tsygankova, E.G. Prodanchuk, E. Bukharova, N. Nosova, Pavel V. Davidov","doi":"10.26442/20795696.2023.2.202123","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202123","url":null,"abstract":"Background. Generalized endotheliopathy in SARS-CoV-2 is associated with the release of the vasoactive peptide endothelin-1, which stimulates the activation of both the plasma and platelet clotting pathways. It is believed that endothelin-1 is one of the most potent vasopressors of the human cardiovascular system and has a strong pressor and thrombogenic effect on many vessels, including in the motherplacentafetus system. \u0000Aim. To study endothelial dysfunction in pregnant women with new coronavirus infection SARS-CoV-2. \u0000Materials and methods. An open-label prospective continuous cross-sectional study enrolled 96 patients who survived COVID-19 at various gestational ages. Depending on the severity of the underlying disease, patients were divided into groups: Group 1 (n=18) included patients with mild SARS-CoV-2 coronavirus infection, Group 2 (n=56) included women with moderate severity, Group 3 (n=22) included patients with severe COVID-19. The control group consisted of 100 pregnant women who had no COVID-19 or signs of acute respiratory viral infection. In all groups, endothelin-1 levels were determined by enzyme-linked immunosorbent assay. \u0000Results. In pregnant women with no COVID-19 and patients after mild COVID-19, the level of endothelin-1 corresponds to the reference values; in pregnant women with moderate and severe underlying disease, the level of endothelin-1 was 2.04.0 pmol/L. It reflects the increased activity of the endothelium in the uterine bloodstream and blood vessels in the motherplacentafetus system. Placental insufficiency in women after COVID-19 is caused by endothelial dysfunction that triggers vasospasm and increased vascular resistance in the uterine arteries (r=0.8; p0.01). \u0000Conclusion. The diagnosis of endothelial dysfunction in the motherplacentafetus system after COVID-19 can be helpful in the prediction and prevention of vascular complications, both placental, associated with great obstetrical syndromes (premature birth, intrauterine growth retardation, preeclampsia, antenatal fetal death), and extraplacental ones (arterial and venous thrombosis).","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85062610","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202101
V. Tskhay, A. A. Bakunina, Gulnar T. Mikailli
Adenomyosis is a heterogeneous gynecologic disease with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhea. This article provides an overview of current knowledge about the methods of medical therapy for adenomyosis, based on the current understanding of the pathogenesis of the disease. We searched for scientific publications in the Cochrane Library, PubMed, and eLIBRARY databases using the keywords "adenomyosis", "medical treatment", and "hormonal therapy" from 2017 to 2022. We analyzed and summarized the scientific data accumulated to date on the methods of medical treatment of adenomyosis in women of reproductive age using gonadotropin-releasing hormone agonists, aromatase inhibitors, mifepristone, a levonorgestrel-releasing intrauterine device, combined oral contraceptives, and progestins.
{"title":"Medical treatment of adenomyosis: a literature review","authors":"V. Tskhay, A. A. Bakunina, Gulnar T. Mikailli","doi":"10.26442/20795696.2023.2.202101","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202101","url":null,"abstract":"Adenomyosis is a heterogeneous gynecologic disease with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhea. This article provides an overview of current knowledge about the methods of medical therapy for adenomyosis, based on the current understanding of the pathogenesis of the disease. We searched for scientific publications in the Cochrane Library, PubMed, and eLIBRARY databases using the keywords \"adenomyosis\", \"medical treatment\", and \"hormonal therapy\" from 2017 to 2022. We analyzed and summarized the scientific data accumulated to date on the methods of medical treatment of adenomyosis in women of reproductive age using gonadotropin-releasing hormone agonists, aromatase inhibitors, mifepristone, a levonorgestrel-releasing intrauterine device, combined oral contraceptives, and progestins.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86655288","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202114
Y. Dobrokhotova, E. Kareva, I. I. Grishin, Natalia A. Kochina, E. V. Krasnoshchok, V. I. Komagorov
Background. Genital prolapse dramatically affects the quality of life of patients. Various sources show that the relapse rate after surgical treatment is 30 to 60%. Aim. To determine and compare the expression levels of collagen metabolism proteins before and after exposure to laser and radio frequency in the postoperative period in postmenopausal patients and to compare ultrasound elastography data to justify using these exposure methods as a rehabilitation program. Materials and methods. Histological specimens were collected from 54 patients with postmenopausal POP-Q grade 3 genital prolapse, and an ultrasound examination was made before surgery and after rehabilitation therapy. A real-time polymerase chain reaction method was used to assess the expression level of type I collagen, matrix metalloproteinases (MMP-2, MMP-9), and tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). Ultrasound examination was performed using the technology of compression elastography with the analysis of the color scale and the coefficient of tissue deformation. Results. Data were obtained on the increase in the expression of TIMP-1 by 7 times and TIMP-2 by 4 times in the radiofrequency therapy group compared to the group before treatment, as well as a 64-fold decrease in TIMP-2 expression in the vaginal tissue of women in the group after laser therapy compared to the group before treatment. A significant increase in the expression of TIMP-1 and TIMP-2 genes in vaginal tissue after radiofrequency exposure and a decrease in TIMP-2 after laser exposure demonstrate the compensatory effect of biological markers in response to energy therapy, as well as the remodeling effect of these methods. According to ultrasound, tissue elasticity in patients increased after laser and radiofrequency exposure. Conclusion. The results support using radiofrequency and laser therapy in the postoperative period as rehabilitation methods.
{"title":"The effect of laser and dynamic quadripolar radiofrequency therapies on the expression of collagenogenesis proteins in the vaginal epithelium and tissue elasticity in women with genital prolapse","authors":"Y. Dobrokhotova, E. Kareva, I. I. Grishin, Natalia A. Kochina, E. V. Krasnoshchok, V. I. Komagorov","doi":"10.26442/20795696.2023.2.202114","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202114","url":null,"abstract":"Background. Genital prolapse dramatically affects the quality of life of patients. Various sources show that the relapse rate after surgical treatment is 30 to 60%. \u0000Aim. To determine and compare the expression levels of collagen metabolism proteins before and after exposure to laser and radio frequency in the postoperative period in postmenopausal patients and to compare ultrasound elastography data to justify using these exposure methods as a rehabilitation program. \u0000Materials and methods. Histological specimens were collected from 54 patients with postmenopausal POP-Q grade 3 genital prolapse, and an ultrasound examination was made before surgery and after rehabilitation therapy. A real-time polymerase chain reaction method was used to assess the expression level of type I collagen, matrix metalloproteinases (MMP-2, MMP-9), and tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). Ultrasound examination was performed using the technology of compression elastography with the analysis of the color scale and the coefficient of tissue deformation. \u0000Results. Data were obtained on the increase in the expression of TIMP-1 by 7 times and TIMP-2 by 4 times in the radiofrequency therapy group compared to the group before treatment, as well as a 64-fold decrease in TIMP-2 expression in the vaginal tissue of women in the group after laser therapy compared to the group before treatment. A significant increase in the expression of TIMP-1 and TIMP-2 genes in vaginal tissue after radiofrequency exposure and a decrease in TIMP-2 after laser exposure demonstrate the compensatory effect of biological markers in response to energy therapy, as well as the remodeling effect of these methods. According to ultrasound, tissue elasticity in patients increased after laser and radiofrequency exposure. \u0000Conclusion. The results support using radiofrequency and laser therapy in the postoperative period as rehabilitation methods.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87606141","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202215
V. Radzinsky, M. R. Orazov, M. Khamoshina, R. E. Orekhov, I. S. Zhuravleva
Aim. To assess the safety and efficacy of non-hormonal agents for mild vasomotor symptoms of menopause. Materials and methods. The study included 173 females aged 4855 with mild vasomotor symptoms during the early postmenopausal period. Patients in the study cohort were stratified into two groups by the double-blind method. In group 1 (study), the patients took the homeopathic agent Neoclimsal 1 tablet 4 times a day sublingually until completely dissolved for 4 weeks (n=86). In group 2 (n=87), the patient received a placebo (30 mg of microcrystalline cellulose) in a regimen mimicking the study treatment. Twenty-three patients withdrew from the study due to protocol violation or revoked their consents for reasons not related to medication. At the end of the study, 75 patients remained in both groups. The therapeutic efficacy was assessed based on the Greene and MENQOL scores change. The SF-36 questionnaire was used to evaluate patients' quality of life, and the average rate of falling asleep was calculated to assess the change in sleep disturbance. The change of M-echo and mammography results were reviewed using the BI-RADS scale 12 months after the start of the treatment to assess the agent's safety. Study design: A prospective, double-blind, placebo-controlled study. Results. The course of Neoclimsal, sublingual tablets, reduced the severity of vasomotor symptoms by 2.3 times, the severity of depression by half (p0.001), and at the end of treatment after 12 weeks of observation, the therapeutic effect not only persisted but tended to increase (p0.001). Improvement in the quality of life of patients treated with Neoclimsal was confirmed by an improvement in the MENQOL score by 1.4 times a month after the start of therapy while maintaining the achieved result after 12 weeks of observation (p0.001). The drug's safety is confirmed by the absence of adverse side effects and allergic reactions, the absence of endometrial thickness change within 3 months after the start of treatment, and mammography results using the BI-RADS scale at 12 months. Conclusion. The results indicate the effectiveness of non-hormonal therapy in relieving vasomotor symptoms of mild postmenopause with a high safety profile. The drug has a beneficial effect on sleep disorders, reducing the severity of mental distress and improving the general quality of life.
{"title":"Efficacy and safety of non-hormonal agents for vasomotor symptoms of menopause: A prospective, double-blind, placebo-controlled study","authors":"V. Radzinsky, M. R. Orazov, M. Khamoshina, R. E. Orekhov, I. S. Zhuravleva","doi":"10.26442/20795696.2023.2.202215","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202215","url":null,"abstract":"Aim. To assess the safety and efficacy of non-hormonal agents for mild vasomotor symptoms of menopause. \u0000Materials and methods. The study included 173 females aged 4855 with mild vasomotor symptoms during the early postmenopausal period. Patients in the study cohort were stratified into two groups by the double-blind method. In group 1 (study), the patients took the homeopathic agent Neoclimsal 1 tablet 4 times a day sublingually until completely dissolved for 4 weeks (n=86). In group 2 (n=87), the patient received a placebo (30 mg of microcrystalline cellulose) in a regimen mimicking the study treatment. Twenty-three patients withdrew from the study due to protocol violation or revoked their consents for reasons not related to medication. At the end of the study, 75 patients remained in both groups. The therapeutic efficacy was assessed based on the Greene and MENQOL scores change. The SF-36 questionnaire was used to evaluate patients' quality of life, and the average rate of falling asleep was calculated to assess the change in sleep disturbance. The change of M-echo and mammography results were reviewed using the BI-RADS scale 12 months after the start of the treatment to assess the agent's safety. Study design: A prospective, double-blind, placebo-controlled study. \u0000Results. The course of Neoclimsal, sublingual tablets, reduced the severity of vasomotor symptoms by 2.3 times, the severity of depression by half (p0.001), and at the end of treatment after 12 weeks of observation, the therapeutic effect not only persisted but tended to increase (p0.001). Improvement in the quality of life of patients treated with Neoclimsal was confirmed by an improvement in the MENQOL score by 1.4 times a month after the start of therapy while maintaining the achieved result after 12 weeks of observation (p0.001). The drug's safety is confirmed by the absence of adverse side effects and allergic reactions, the absence of endometrial thickness change within 3 months after the start of treatment, and mammography results using the BI-RADS scale at 12 months. \u0000Conclusion. The results indicate the effectiveness of non-hormonal therapy in relieving vasomotor symptoms of mild postmenopause with a high safety profile. The drug has a beneficial effect on sleep disorders, reducing the severity of mental distress and improving the general quality of life.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"1150 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88332148","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202209
D. A. Malyshkina, N. Sotnikova, D. Voronin, Arina E. Kalinina, Elizaveta M. Godunova, M. Golubeva, Elizaveta V. Rumyanceva
Aim. To identify risk factors for uterine leiomyoma (ULM) in women of reproductive age based on the study of clinical and medical history features in various tumor types. Materials and methods. The study included 82 women of reproductive age with symptomatic ULM (the main group) and 47 somatically healthy women of reproductive age without proliferative gynecological diseases who underwent elective treatment at the Gorodkov Ivanovo Research Institute of Motherhood and Childhood (Director is professor AI Malyshkina, MD, Ph.D.). The study patients underwent general clinical examinations, ultrasound examination of the pelvic organs, histological examination of endometrial biopsy specimens, and myomatous nodes in women of the main group. Results. The following risk factors and clinical and history features were identified in women with uterine fibroids: late reproductive age (p=0.000), unregistered marriage (p=0.026), employment (p=0.006), history of profuse and painful menstruation (p=0.000 and p=0.000, respectively), inflammatory diseases of the respiratory system (p=0.003), pain syndrome and profuse menstruation (p=0.000 and p=0.000, respectively), endometrial hyperplasia without atypia, and chronic endometritis according to histological examination (p=0.000 and p=0.000, respectively). When comparing the subgroups "Ki67+" and "Ki67-", we obtained the following clinical and history features in women with proliferating uterine fibroids: varicose disease of the lower extremities (p=0.035); and when comparing the subgroups "with secondary changes" and "without secondary changes", we found a higher rate of pain (p=0.038) in women with secondary changes in the myomatous node, as well as a tendency to a higher rate of painful menstruation (p=0.093) and endometrial hyperplasia (p=0.093). Conclusion. Risk factors for ULM in women of reproductive age can be divided into modifiable ones, which include social disadvantage (unregistered marriage, hard physical work), inflammatory factor (inflammatory diseases of the respiratory system) and unmodifiable (late reproductive age). Clinical and history features of women with Ki67+ ULM compared to women with Ki67- ULM include more frequent use of barrier contraception, high prevalence of varicose vein disease of the lower extremities, and surgical interventions on the pelvic organs. Also, according to histological examination, women with ULM with secondary changes in the myomatous node, compared to women with ULM without secondary changes in the myomatous node, have a higher prevalence of painful menstruation, pain syndrome, and concomitant endometrial hyperplasia.
{"title":"Clinical and anamnestic risk factors for the development of uterine leiomyoma in women of reproductive age: A case control study","authors":"D. A. Malyshkina, N. Sotnikova, D. Voronin, Arina E. Kalinina, Elizaveta M. Godunova, M. Golubeva, Elizaveta V. Rumyanceva","doi":"10.26442/20795696.2023.2.202209","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202209","url":null,"abstract":"Aim. To identify risk factors for uterine leiomyoma (ULM) in women of reproductive age based on the study of clinical and medical history features in various tumor types. \u0000Materials and methods. The study included 82 women of reproductive age with symptomatic ULM (the main group) and 47 somatically healthy women of reproductive age without proliferative gynecological diseases who underwent elective treatment at the Gorodkov Ivanovo Research Institute of Motherhood and Childhood (Director is professor AI Malyshkina, MD, Ph.D.). The study patients underwent general clinical examinations, ultrasound examination of the pelvic organs, histological examination of endometrial biopsy specimens, and myomatous nodes in women of the main group. \u0000Results. The following risk factors and clinical and history features were identified in women with uterine fibroids: late reproductive age (p=0.000), unregistered marriage (p=0.026), employment (p=0.006), history of profuse and painful menstruation (p=0.000 and p=0.000, respectively), inflammatory diseases of the respiratory system (p=0.003), pain syndrome and profuse menstruation (p=0.000 and p=0.000, respectively), endometrial hyperplasia without atypia, and chronic endometritis according to histological examination (p=0.000 and p=0.000, respectively). When comparing the subgroups \"Ki67+\" and \"Ki67-\", we obtained the following clinical and history features in women with proliferating uterine fibroids: varicose disease of the lower extremities (p=0.035); and when comparing the subgroups \"with secondary changes\" and \"without secondary changes\", we found a higher rate of pain (p=0.038) in women with secondary changes in the myomatous node, as well as a tendency to a higher rate of painful menstruation (p=0.093) and endometrial hyperplasia (p=0.093). \u0000Conclusion. Risk factors for ULM in women of reproductive age can be divided into modifiable ones, which include social disadvantage (unregistered marriage, hard physical work), inflammatory factor (inflammatory diseases of the respiratory system) and unmodifiable (late reproductive age). Clinical and history features of women with Ki67+ ULM compared to women with Ki67- ULM include more frequent use of barrier contraception, high prevalence of varicose vein disease of the lower extremities, and surgical interventions on the pelvic organs. Also, according to histological examination, women with ULM with secondary changes in the myomatous node, compared to women with ULM without secondary changes in the myomatous node, have a higher prevalence of painful menstruation, pain syndrome, and concomitant endometrial hyperplasia.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79086807","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 : 2023-07-14DOI: 10.26442/20795696.2023.2.202193
V. Prilepskaya, M. V. Iurova
Papillomavirus infection is one of the most important infectious diseases of the reproductive system. The genome of human papillomavirus (HPV) transforms the cervical epithelial cells, leading to progressive changes: from cervical epithelial neoplasia to carcinoma in situ and further to invasive cancer. More than 550 000 cases of cervical cancer (CC) are reported yearly. In Russia, the incidence of CC in 2020 decreased for the first time in 20 years, and the average annual rate of increase in incidence was 1.27%. It became possible thanks to the introduction of a new system of diagnosis, treatment, and prevention of cervical cancer, in particular, the introduction of screening and a program of modern methods of diagnosis and treatment. Uniform for all countries, screening cervical diseases aims to diagnose changes in the cervical epithelium that occur due to HPV, which may be silent. Until now, the basis of screening programs was a cytological study (pap-test). Since 2018, most EU countries have switched to primary screening for HPV (HPV test) due to its greater sensitivity compared to the cytological method. No etiopathogenetic methods of HPV therapy have been developed yet. However, numerous studies have described the effective treatment of HPV-associated cervical lesions. It was shown that the most effective is a comprehensive approach involving treatment aimed at abnormal tissues and nonspecific antiviral and immunomodulatory therapy. The basis of the CC prevention strategy, of course, is primary prevention through vaccination. Studies are ongoing on the effectiveness of the new generation of vaccines based on the L2 viral protein and therapeutic vaccines against HPV.
{"title":"Current approaches in the diagnosis, treatment and prevention of HPV-associated cervical diseases: practical recommendations. A review","authors":"V. Prilepskaya, M. V. Iurova","doi":"10.26442/20795696.2023.2.202193","DOIUrl":"https://doi.org/10.26442/20795696.2023.2.202193","url":null,"abstract":"Papillomavirus infection is one of the most important infectious diseases of the reproductive system. The genome of human papillomavirus (HPV) transforms the cervical epithelial cells, leading to progressive changes: from cervical epithelial neoplasia to carcinoma in situ and further to invasive cancer. More than 550 000 cases of cervical cancer (CC) are reported yearly. In Russia, the incidence of CC in 2020 decreased for the first time in 20 years, and the average annual rate of increase in incidence was 1.27%. It became possible thanks to the introduction of a new system of diagnosis, treatment, and prevention of cervical cancer, in particular, the introduction of screening and a program of modern methods of diagnosis and treatment. Uniform for all countries, screening cervical diseases aims to diagnose changes in the cervical epithelium that occur due to HPV, which may be silent. Until now, the basis of screening programs was a cytological study (pap-test). Since 2018, most EU countries have switched to primary screening for HPV (HPV test) due to its greater sensitivity compared to the cytological method. No etiopathogenetic methods of HPV therapy have been developed yet. However, numerous studies have described the effective treatment of HPV-associated cervical lesions. It was shown that the most effective is a comprehensive approach involving treatment aimed at abnormal tissues and nonspecific antiviral and immunomodulatory therapy. The basis of the CC prevention strategy, of course, is primary prevention through vaccination. Studies are ongoing on the effectiveness of the new generation of vaccines based on the L2 viral protein and therapeutic vaccines against HPV.","PeriodicalId":36505,"journal":{"name":"Gynecology","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82193623","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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