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No 2 (2015)
- Year: 2015
- Articles: 19
- URL: https://journals.eco-vector.com/0300-9092/issue/view/6369
Articles
THE NOTCH SIGNALING PATHWAY IN THE HUMAN PLACENTA DURING PHYSIOLOGICAL AND COMPLICATED PREGNANCY
Abstract
The literature review gives data on the history of the discovery of the Notch signaling pathway, its molecular structure, cell localization, and functions of its major components, as well as those on the canonical and noncanonical pathways of their interaction, by specifying the basic steps in activating the structural components of the pathway. Particular emphasis is placed on the specific features of Notch signaling pathway functioning in the human placenta during physiological pregnancy; the specific features of the temporary and spatial expression of receptors and ligands in the placental Notch system, as well as its role in the course of placentation are described. The functions of the Notch signaling system in the structures of villous and extravillous trophoblasts are detailed; data on its role in the processes of trophoblast invasion, proliferation, and differentiation, as well as placental vasculogenesis and angiogenesis are given. The specific features of Notch system functioning in some pregnancy complications, mainly in preeclampsia, are depicted and the possible mechanisms by which the components of this system are involved in the development of pregnancy complications are also given.
Obstetrics and Gynecology. 2015;(2):5-11
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THE SPECIFIC FEATURES OF PLACENTAL APOPTOSIS AND CELL PROLIFERATION IN PREECLAMPSIA
Abstract
Objective. To evaluate the activity of the processes of placental apoptosis and cell proliferation in preeclampsia. Subjects and methods. A case-control study enrolled 11 women without preeclampsia, 14 with moderate preeclampsia and 14 with severe preeclampsia. The specific features of the course of pregnancy and labor, the placental expression of markers for cell proliferation (Ki-67), antiapoptosis (Bcl-2), and proapoptosis (p53) were analyzed. Results. In preeclampsia, in severe one in particular, the capillary endothelium and stromal macrophages showed the activated processes of cell proliferation and antiapoptosis; the symplastotrophoblast displayed those of cell proliferation and proapoptosis; the activity of antiapoptosis was drastically reduced. The correlations of the immunohistochemical parameters of cell proliferation, placental pro- and antiapoptosis with obstetric complications (sub- and decompensated placental insufficiency, severe preeclampsia, neonatal hypotrophy and asphyxia) suggest that there are similar mechanisms of their development. Conclusion. The processes of placental apoptosis and cell proliferation play a definite role in the pathogenesis of preeclampsia; however, the significance of cell renewal programs in the development of this syndrome calls for further investigation.
Obstetrics and Gynecology. 2015;(2):12-19
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PREGNANCY OUTCOMES IN GESTATIONAL HYPERTENSIVE DISORDERS
Abstract
Objective. to study pregnant outcomes and delivery modes in relation to the degree of hypertensive disorders and gestational ages. Subjects and methods. One hundred and fifty women with hypertensive states caused by current pregnancy at above 20 week’s gestation (a study group) and 50 women with normal pregnancy without hypertensive disorders in the same gestational periods (a control group) were examined. The outcomes of pregnancy, the time and methods of delivery were studied in relation to the severity of hypertensive disorders. Pearson’s x 2test was used to assess the relationship between qualitative indicators. Results. In gestational hypertensive disorders, pregnancy ends in term, preterm, and immature births in 26.7, 54.7, and 18.6% of the examinees, respectively. Reproductive losses in hypertensive disorders are 22.7%. Hypertensive disorders are characterized by a high rate of operative deliveries (70.7%). Gestational age affects the rate of a delivery mode - operative deliveries prevail over vaginal ones before 34 weeks’ gestation; the reverse is observed after 34 weeks. The rate of cesarean delivery in hypertension depended on the degree of the disease and considerably increased (8.6-fold) in its severe forms. Conclusion. Pregnancy-induced hypertensive disorders every so often give rise to poor outcomes for both the mother and fetus. The treatment of this disease, its severe forms in particular, is ineffective. The only correct and effective way to overcome this problem is timely delivery and prevention of the severe forms of the disease.
Obstetrics and Gynecology. 2015;(2):20-26
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SOLUBLE INTERCELLULAR ADHESION MOLECULE-1 AND ENDOTHELIN ARE NONSPECIFIC MARKERS OF ENDOTHELIAL DYSFUNCTION IN GESTOSIS
Abstract
Objective. To study a relationship between the levels of endothelin and soluble intercellular adhesion molecule-1 (sICAM-1) and the severity of clinical manifestations of gestosis. Subjects and methods. One hundred and thirteen pregnant women, including 30 with physiological pregnancy, 30 with mild gestosis, 32 with moderate gestosis, and 21 with severity gestosis, were examined. The peripheral blood levels of endothelin and sICAM-1 were determined using the commercial test systems Endotheln (1-21) (Biomedica, Austria) and Human sICAM-1 (Bender MadSystem GmbH (Austria). Results. There was an interrelated increase in the serum concentration of sICAM-1 and endothelin during gestosis-complicated versus physiological pregnancy. The levels of sCAM-1 and endothelin were found to be related to the severity of clinical manifestations of gestosis. Conclusion. The determination of sICAM-1 and endothelin concentrations may be used to clarify the severity of gestosis.
Obstetrics and Gynecology. 2015;(2):27-32
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FREE EMBRYONIC DNA LEVELS IN THREATENED RECURRENT MISCARRIAGE AND UNCOMPLICATED PREGNANCY AT LESS THAN 22 WEEKS' GESTATION
Abstract
Objective. To make a comparative analysis of the peripheral blood levels of free embryonic DNA (fe-DNA) in women with threatened recurrent miscarriage and healthy pregnant women at 6 to 22 weeks’ gestation. Subjects and methods. A prospective cohort study was conducted in 57 pregnant women, including 33 women with recurrent miscarriage and 24 with an uncompromised obstetric and gynecological history. Regardless of fetal gender, fe-DNA was determined by a real-time polymerase chain reaction assay at a 2-week interval. Results. The clinical manifestations of threatened and incipient abortion were found to be related to high fe-DNA levels without regard to a patient’s history. In the women with recurrent miscarriage and an uncomplicated course of the first half of pregnancy, the levels of fe-DNA were established to be significantly higher than those in healthy pregnant women, which may predispose to placenta-related gestational complications. Conclusion. This data should be further analyzed to clarify the role of these changes in the implementation of the later gestational complications and possibilities of their use in clinical practice.
Obstetrics and Gynecology. 2015;(2):33-38
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INNATE IMMUNITY SIGNALING RECEPTORS IN THE INDUCTION OF APOPTOSIS IN EARLY MISCARRIAGE
Abstract
Objective. To study the specific features of expression of toll-like receptor (TLR) 1-10 mRNA and the major apoptotic enzyme caspase-3a in patients with recurrent miscarriage at 6-10 weeks’ gestation. Subject and methods. The decidual tissue obtained when curetting the uterine in 57patients with spontaneous miscarriage at 6-10 weeks’ gestation (a study group) and in 57patients who had undergone medical abortion in the same gestational period (a control group) were examined. The expression of TLR 1-10 mRNA and caspase-3a in the endometrium was investigated using a quantitative polymerase chain reaction (PCR). Results. The patients with early miscarriage of infectious and inflammatory genesis showed an increased endometrial expression of TLR3, the ligand of which was viral double-stranded RNA. Those with spontaneous miscarriage were noted to have a decrease in TLR6 expression, which was strongly correlated with the endometrial activation of caspase-3a that is a major enzyme of irreversible apoptosis. There was no correlation between the expression of caspase and other TLRs. The expression of TLR6 had a positive moderate correlation with the number of births (R = 0.32; p = 0.03) and a weak negative correlation with the number of spontaneous miscarriages (R = -0.29; p = 0.002) in the history. Conclusion. Thus, the normal expression of TLR6 may play a protective role in the endometrium, interfering with miscarriages due to the prevention of apoptosis.
Obstetrics and Gynecology. 2015;(2):39-43
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IMPAIRED EXPRESSION OF THE PROTEINS MGMT AND EZRIN IN ENDOMETRIAL HYPERPLASIA, ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA, AND LOW-GRADE ENDOMETRIOID ADENOCARCINOMA IN PERIMENOPAUSAL WOMEN
Abstract
Objective. To study the impaired expression of the proteins 0-6-methylguanine-DNA methyltransferase (MGMT) and ezrin in different forms of endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and low-grade endometrioid adenocarcinoma (EAC) in perimenopausal women. Subjects and methods. Thirty-five perimenopausal patients, including 12 with simple EH (SHE) without atypia (Group 1), 9 with complex EH (CEH) without atypia (Group 2), 5 with CEH with atypia (CEHA) (Group 3), 5 with EIN (Group 4), and 4 with low-grade EAC (Group 5), which were histologically and immunohistochemically verified using Ki67 and PTEN, were examined. Nine removed uteri and 22 endometrial scrapes were explored. The results of an immunohistochemical examination of ezrin expression and data on the level of MGMT protein expression in endometrial tissues were presented. Results. The level of MGMTprotein expression increases in SHE and CEH, peaks at the stages of CEHA and EIN, and decreases in EAC. The specific features of ezrin expression are associated with that, as the disease progresses from simple HE to EAC, there is a loss of its apical specific localization, as well as free cell cytoplasmic accumulation. Conclusion. The obtained results of clinicoanamnestic, diagnostic, and immunohistochemical studies in the above patient groups can substantiate a differentiated approach to choosing a treatment policy for patients with different forms of EH.
Obstetrics and Gynecology. 2015;(2):44-48
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ANTIANEMIC DRUGS IN THE COMBINATION TREATMENT OF SMALL PELVIC INFLAMMATORY DISEASES
Abstract
Objective. To provide a pathogenetic rationale for the use of the iron preparation sorbifer durules to treat small pelvic inflammatory diseases (SPID) in relation to the processes of free radical oxidation. Subjects and methods. Reproductive-aged women who formed a control group of donors and a study group of patients with SPID were examined. Serum iron levels were colorimetrically determined using a Cobas Integra automated biochemical analyzer. Transferrin and ferritin concentrations were immunoturbidimetrically estimated with the same analyzer. A RANDOX test system was applied to determine the plasma total antioxidant status. Hemoglobin levels were measured using a Sysmex KX-21N hematological analyzer. IL-4, IL-8, TNF-a, INF-a, INF-y, and neopterin were analyzed by a competitive enzyme immunoassay employing a Multiskan Ascent semiautomated vertical photometer (Thermo Electron). Results. The significant decrease in the levels of serum iron, hemoglobin, and transferrin as the manifestations of endogenous intoxication syndrome become severe and blood loss is absent confirms that this cohort of patients develops anemia of inflammation. Conclusion. The findings suggest that there is a reduction in the level of serum iron and its depot concentration in SPID, which calls for correction with sorbifer durules.
Obstetrics and Gynecology. 2015;(2):49-52
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ASSOCIATION OF TNF AND TGFB1 GENE POLYMORPHISMS WITH A PREDISPOSITION TO VAGINITIS IN REPRODUCTIVE-AGED WOMEN
Abstract
Objective. To establish the distribution of allelic variants of the immune response genes associated with a predisposition to vaginitis in reproductive-aged women. Subjects and methods. A polymerase chain reaction (PCR) assay was used to investigate 22 allelic variants of the immune response genes in 96 women with vaginitis. A comparison group consisted of 60 apparently healthy women without signs of genital tract inflammatory diseases. Peripheral blood samples were examined. Results. The distribution of 22 allelic alleles of the immune response genes was established in the apparently healthy women and in the patients with vaginitis. The allelic variants of TNF (rs361525) and TGFB1 (rs1800469) polymorphisms, which were associated with the development of vaginitis, were ascertained. Both allelic variants result in the decreased TNF and TGFB1 mRNA expression, they are more common in the population, which can also cause the high prevalence of this gynecological disease. Conclusion. There was a positive association of the C allele of the TGFB1-509 C>T locus (OR =1.8; CI: 1.12.9) and a negative association of the A allele of the TNF-238 G>A locus (OR = 0.21; CI: 0.07-0.68) with a predisposition to inflammatory diseases of the lower female genital tract.
Obstetrics and Gynecology. 2015;(2):53-59
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GENE POLYMORPHISM FOR CATECHOLAMINE METABOLIC ENZYMES AND DNA EXCISION REPAIR AS A PREDICTOR OF REPRODUCTIVE LOSSES
Abstract
Despite the development of modern science and medicine, the problem of miscarriage does not lose its relevance. In parallel with the long studied causes of pregnancy loss, a great deal of recent attention has been paid to its genetic ones. The elaboration of catecholamines, whose physiological concentrations are maintained owing to the generation of the genetically determined enzyme catechol- O-methyltransferase (COMT), is one of the most significant adaptive body systems. The maintenance of the primary structure of DNA, which is required for normal body homeostasis, is accomplished by the coordinated work of a cascade of reactions in the DNA repair system, one of the main components of which is the enzyme 8-oxoguanine DNA glycosylase, which ensures the mechan ism of excision repair. Our investigation included 274 women to examine for the alleles of the COMT gene polymorphism rs4680 and the OGG1 gene polymorphism rs1052133. The findings suggest that the COMT rs5680 A/A and GA genotypes and the OGG1 rs1052133 G/G and C/G genotypes enhance the risk of pregnancy loss in patients with a history of miscarriage.
Obstetrics and Gynecology. 2015;(2):60-65
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LAPAROSCOPY IN THE SURGICAL TREATMENT OF GYNECOLOGICAL CANCER PATIENTS
Abstract
Subjects and methods. The paper presents treatment results in 59 gynecological cancer patients, 24 of them were laparoscopically operated on. Results. During laparoscopy, no significant differences were found in the volume of removed tissues and in the number of lymph nodes, but blood loss and hospital stay length considerably reduced. Conclusion. The development and use of operative laparoscopy is a promising area in gynecological oncology; the technique may be used as a surgical stage for the treatment of cancers of the female reproductive system.
Obstetrics and Gynecology. 2015;(2):66-71
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TOPICAL ISSUES OF DRUG SAFETY MONITORING IN THE RUSSIAN FEDERATION
Abstract
The paper deals with the topical issues of pharmacoviligance development worldwide and in the Russian Federation. Particular attention is given to spontaneous communications, a method used to detect adverse reactions in daily medical practice. The role of practitioners in revealing drug safety problems is considered. The practical aspects of how to organize pharmacoviligance in therapeutic-and-prophylactic institutions are detailed.
Obstetrics and Gynecology. 2015;(2):72-80
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IMPACT OF AUTOIMMUNE THYROIDITIS IN PREGNANT WOMEN ON THEIR BABIES' HEALTH STATUS
Abstract
Objective. To study the impact of autoimmune thyroiditis (AIT) in pregnant women on their infants’ health indicators in the early neonatal period and within the first year of life. Subjects and methods. A group of 72 pregnant women with AIT was examined. The investigators studied pregnancy outcomes and their babies’ health indicators: anthropometric data, neonatality features, perinatal central nervous system (CNS) lesion, intrauterine infection and somatic diseases, the incidence of acute diseases during the first year of life, and thyroid ultrasound findings in infants aged 1 year. Results. The significant rate of hypotrophic intrauterine growth restriction (IUGR) was noted in full-term neonatal babies born to mothers with AIT, which correlated with antithyroid antibodies and the presence of hypothyroidism during pregnancy. There was a high prevalence of intrauterine infection among the babies of mothers with AIT. Comparison of groups of AIT patients who had undergone early and late iodine prevention established the higher rate of thyroid structural changes in the infants whose mothers had received late iodine prevention during pregnancy. Conclusion. AIT in pregnant women has no significant impact on the anthropometric parameters of neonates, the rate of perinatal CNS lesion and somatic diseases in babies when hypothyroidism is adequately corrected during pregnancy. The high level of maternal blood antithyroid antibodies is a risk factor for hypotrophic IUGR. The babies born to mothers with AIT are a group at high risk for intrauterine infection and belong to a category of frequently ill children. Inadequate iodine prevention in pregnant women with AIT negatively affects the thyroid in their children, which is shown by the heterogeneous echostructure and enhanced vascularization of the thyroid parenchyma at echographic study.
Obstetrics and Gynecology. 2015;(2):81-86
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SYNTHETIC GENISTEIN IN ACTIVE FORM FOR THE THERAPY OF MENOPAUSAL SYNDROME
Abstract
Phytoestrogens are used to treat menopausal symptoms in women who cannot or do not want to use hormone therapy. As of now, soya isoflavones have been most studied and genistein has been recognized to have the strongest effect on estrogen receptors. Soybean extracts have been gained widespread acceptance as dietary supplements, but the use of synthetic genistein has a relatively recent history. Objective. To evaluate the efficacy and safety of synthetic genistein in the treatment of menopausal symptoms in peri- and postmenopausal women. Subjects and methods. The investigation enrolled 23 women with menopausal syndrome whose severity was evaluated in accordance with the modified menopausal index (MMI). All the patients received synthetic genistein in a daily dose of 60 mg for 6 months. Its efficacy was evaluated from the changes in MMI, autonomic dysfunction, and quality of life; its safety was assessed from physical examination results, biochemical markers of liver function, and small pelvic, abdominal, and breast ultrasound findings. Results. Genistein showed a high efficacy in correcting mild and moderate menopausal disorders. After 6 months of therapy, there was a statistically significant (p < 0.005) decrease in MMI from 37.39±0.99 (pretreatment) to 6.96±0.67 (posttreatment). At the same time, there was a reduction in the mean index of autonomic dysfunction from 41.39±2.13 to 9.65±0.47 (p < 0.005) and positive health changes, as shown by the MOS SF-36 questionnaire. No adverse events or refusals to participate in the investigation during treatment were recorded. Conclusion. Synthetic genistein may be considered as the drug of choice in treating the neuroautonomic manifestations of mild and moderate menopausal syndrome.
Obstetrics and Gynecology. 2015;(2):87-93
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ROLE OF BIOCHEMICAL MARKERS AND CERVICOMETRY IN THE DIAGNOSIS OF THREATENED PRETERM BIRTH
Abstract
Objective. To assess the PartoSure test and cervicometry used to define the risk of preterm birth. Subjects and methods. A test for PAMG-1 and cervicometry were performed in 49 patients with threatened preterm birth. Time to delivery (TTD) intervals was estimated if labor occurred. Results. The test was positive (+) in 100% of cases if the cervical canal length (L) was 4 1.5 cm (6% of the patients); at the same time, preterm births occurred in 75% (TTD=18 and 44 hours). When L was 1.5 to 3 cm, the positive (+) test was seen in only 1 case (85%) (TTD=140 hours). The relationship between the results of the test and cervicometry, their diagnostic sensitivity, specificity, the prognostic value of positive and negative results were determined. Conclusion. The PartoSure test in conjunction with cervicometry is a technique to determine whether threatened preterm birth may be managed in an outpatient setting.
Obstetrics and Gynecology. 2015;(2):94-98
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PREMATURE DELIVERY: ARE THERE PROMISES?
Abstract
Objective. To evaluate the efficiency and safety of different types of tocolysis during imminent premature delivery. Subject and methods. Women with premature pregnancy and recorded regular uterine contractility at 24-33 weeks’ gestation were divided into 2 groups. Tocolysis was performed using tractocile (atosiban) in Group 1 (n = 35) and gynipral in Group 2 (n = 23). Results. Pregnancy could be prolonged by on an average of 16.9 days in Group 1 and by 10.9 days in Group 2. Tractocil could postpone labor for more than 7 days in 27 pregnant women, which constituted 77% and gynipral could in 11 pregnant women, which was 47.8%. Moreover, the higher frequency of additional administration of tocolytic agents was found in the gynipral group. Conclusion. The use of tractocile is associated with the longer period of preterm pregnancy. And the safety of the agent makes its possible use just in outpatient and first-level inpatient settings, and while transporting to the third-level inpatient settings
Obstetrics and Gynecology. 2015;(2):99-103
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UTERINE ARTERIOVENOUS MALFORMATION: A CLINICAL CASE
Abstract
Objective. To analyze a case of uterine arteriovenous malformation, a rare abnormality of small pelvic organs, in a 29-year-oldprimiparous multigravida at 23-24 weeks’ gestation. Subjects and methods. A 29-year-old primiparous multigravida at 2324 weeks’ gestation diagnosed with cervical varices was examined at the Department of Ultrasound Diagnosis, Chelyabinsk Regional Perinatal Center. Ultrasonography was performed using a Voluson E6 apparatus (General Electric, USA) having transabdominal and transvaginal transducers with color Doppler flow mapping and pulsed wave Doppler. Results. Ultrasonography showed that the fetal size corresponded to a gestational age of 23-24 weeks; no fetal anomalies were detected; the placenta was located at the anterior uterine wall, failed to block the internal uterine mouth area, it was thickened up to 52 mm; there was expansion of intervillous spaces with slow blood circulation and subamniotic cysts of up to 37 mm, oligohydramnios, and small pelvic varices. The anterior wall of the uterus mainly in its lower third displayed myometrial varices of up to 10-12 mm and a cystic structural focus of up to 28 mm; local hypervascularization with mosaic staining; the parametrial veins were dilated up to 17 mm. The uterine cervix was enlarged, 94 x 90 x 95 mm in size, had a barrel-like shape with well-defined even contours, a heterogeneous wide-meshed structure with multiple anechogenic inclusions. Conclusion. Objectively, there were vascular changes: uniform cervical hypervascularization with the mosaic staining characteristic of turbulent blood flow. Pulsed wave Doppler revealed a high hyporesistant vascular blood flow velocity of up to 25-40 cm/sec, wh ich depended on the diameter of vessels; the resistance index was 0.42.
Obstetrics and Gynecology. 2015;(2):104-107
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Eduard K. Aylamazyan
Obstetrics and Gynecology. 2015;(2):108-108
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PRAVILA DLYa AVTOROV
Obstetrics and Gynecology. 2015;(2):110-112
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