No 2 (2016)

Objective. To give an update on a relationship between detoxification system gene polymorphisms and the development of preeclampsia. Materials and methods. The available literature sources published in Medline, Pubmed, and other databases, were sought. The authors found 68 sources on a relationship between detoxification gene polymorphisms and the development of preeclampsia, out of which 49 were included in this review. Results. The concept of the role of single nucleotide polymorphisms of the detoxification system in the development of oxidative stress in preeclampsia was set forth. The major detoxification system genes (GSTP1, GSTM1, GSTT1, GPX1, EPHX1, SOD-2, SOD-3, CYP1A1, MTHFR, and MTR) and their functions were given. The most significant gene polymorphisms were revealed in preeclampsia. The data found in the available literature on the relationship between the polymorphisms and the rate of preeclampsia, as well as on the placental expression of these genes in this disease were analyzed. Conclusion. The early diagnosis of preeclampsia has not been fully studied It is necessary to conduct further investigations in this area.

Objective. To assess the possibility of using echography in the diagnosis and prediction of postnatal outcome in congenital diaphragmatic hernia in a fetus. Material and methods. Forty-four publications of leading Russian and foreign investigators were analyzed. Results. The accuracy of intrauterine diagnosis of diaphragmatic hernias is 60-70%; the detection time varies from 24 to 26 weeks of pregnancy and depends on the site of the lesion and the presence of comorbidity. The echographic signs of this abnormality include cardiac compression and displacement, contralateral diaphragmatic defect, and the emergence of abdominal organs in the chest. In bilateral diaphragmatic defect, the liver is determined in the right chest and intestinal loops and stomach are in that in the left chest. Conclusion. The main prognostic signs that correlate with survival include comorbidity, the intrathoracic location of the liver, the degree of pulmonary hypoplasia, and cardiac compression index.

Objective. To study main strategies for prophylactic salpingectomy and its impact on ovarian reserve. Material and methods. The key words «salpingectomy» and “ovarian reserve» (or «FSH», or «AMH», or «AFC») were used to look for the literature in the Medline database. A total of 25 sources were analyzed. Twenty articles were selected. Results. The paper provides a scientific rationale for surgery at varying degrees of risk for serous ovarian cancer. It shows that there is a need for simultaneous salpingectomy in women during hysterectomy. The role of the technique in enhancing the efficiency of treatment for infertility is discussed. Conclusion. After salpingectomy, there is a secondary ovarian failure risk, the estrogen deficiency consequences of which may outweigh the benefit of the decreased incidence of ovarian cancer and the prevention of small pelvic inflammatory diseases. Unintended surgical aggression against small pelvic organs without direct damage to the gonads (salpingectomy) has a critical impact on ovarian reserve in patients with an initial decline in ovarian function.

Objective. To make a systematic analysis of the data available in the current literature on extraplacental trophoblast elements in the maternal body, the history of their study, properties, and the possibilities of therapeutic and diagnostic use. Material and methods. The review included the data of foreign and Russian articles published in the past 50 years and found in the retrieval systems Pubmed and Google scholar on this topic. Citation preference was given to the papers published in the past 10 years. Results. Current views on the morphology, classification, functions, and properties of extraplacental trophoblast structures are considered. There are data of in vitro and in vivo experimental studies. Attention is given to the specific features of the therapeutic and diagnostic potential of trophoblast and placental cells, which is determined by their properties (invasion, hormonal function, low immunogenicity, and a capability for immunosuppression and tolerance induction); and views on cancer risk are described. Conclusion. The study of extraplacental trophoblast functions offers prospects for the clinical diagnosis of genetic disorders and the placental status, for the understanding of tolerance forming processes during pregnancy, oncogenesis, and implantation. Mesenchymal stem cells, placental explants, and placental factors may be effectively used in cellular and tissue therapy and, on the strength of their natural trophicity for reproductive organs, are particularly effective in treating gynecological diseases: infertility, endocrine disorders, and autoimmune responses.

Objective. To study the clinical and immunological safety of influenza vaccines in pregnant women, as well as pregnancy outcome. Material and methods. A blind placebo-controlled study was conducted in 137 women in the second and third trimesters of physiological pregnancy who had received single vaccination against influenza in the season of 2010-2011. Group 1 comprised 43 women vaccinated with the Russian monovalent subunit adjuvant vaccine monogrippol plus (A/H1N1v strain 5 μg, Polyoxidonium 500 μg); Group 2 included 50 pregnant women vaccinated with the trivalent subunit adjuvant vaccine grippol plus (5 μg of each strain: A/H1N1v, H3N2, and B, 500 μg of polyoxydonium (Petrovax, Russia); Group 3 consisted of 44 pregnant women vaccinated with the commercial triple subunit vaccine agrippal containing 15 μg in each of the above 3 strains of antigens (Novartis Vaccines and Diagnostics, Italy). A control group included 41 pregnant women who had placebo (phosphate salt buffer). Clinical, biochemical, immunological, and statistical studies were used. Results. Assessment of the clinical course of the postvaccinal period showed that the asymptomatic course was recorded in 58.1% of the pregnant women in Group 1, 60.0% in Group 2, 54.5% in Group 3, and 60.9% in Group 4 (p > 0.05), which were not different from Group 5 (30 (61.3%) vaccinated nonpregnant women). Local systemic reactions were slightly marked, comparable in all the groups, and unaccompanied by deterioration in the status of pregnant women. On days 7 and 30, there were no pronounced changes in the results of biochemical blood tests in each examined group (p > 0.05), lipidograms, hormonal profile, and serum immunoglobulins. There was a difference in the short-term increase in INF-γ in the pregnant women in the second trimester of pregnancy in the use of immunologic adjuvant subunit vaccines, which was presumably associated with the involvement of Th1-mediated mechanisms in a postvaccinal immune response. As for an adjuvant-free analogue, there was an elevation of IL-4 (a sign of Th2-dependent activation), especially in the vaccinated in the third trimester of pregnancy. All the found shifts in the values recorded in different groups of the vaccinated persons were within the allowable limits. Pregnancy resulted in physiological birth in 85.4-90.7% of cases in all the groups. Conclusion. The injection of the Russian immunologic adjuvant influenza vaccine is immunologically safe and does not affect the course of pregnancy.

Objective. To investigate the specific features of blood adrenocorticotropic hormone (ACTH) level fluctuations in pregnant women with high anxiety level and in their newborns. Subjects and methods. The investigation enrolled 20 women with normal pregnancy and 25 pregnant women with a high personality and reactive anxiety level rated using the anamnestic data questionnaire and the Spielberger inventory. Blood ACTH levels were investigated in the pregnant women before birth activity and in their newborns. Blood samples were taken from the ulnar vein of a pregnant woman and the umbilical vein of a neonate infant into centrifuge tubes containing EDTA and centrifuged at 2000 rev/min for 10 min. Plasma ACTH levels were measured by enzyme immunoassay using the respective test kits from DRG Instruments GmbH (Germany). The data were statistically processed using a package of Statistica 10 programs to deduce the statistical significance Student’s t-test. Results. The pregnant women with high anxiety level and their newborns displayed significantly increased blood ACTH concentrations. The differences in the blood hormone levels in the women with normal pregnancy and their neonates with considerably higher blood ACTH levels in the pregnant women with high anxiety level and their newborns suggest that there is no correlation between the hormone levels in the mother and her fetus/neonate, on the one hand, and that the pregnant women with a high level of anxiety exhibited activated ACTH synthesis and release processes in both the mother and her fetus, as well as its transfer from mother to fetus, on the other hand. Conclusion. The findings may admit that in pregnant women with high anxiety level, ACTH-dependent disorders may develop in their fetus and posterity and that it is necessary to consider them in the clinical presentation of these conditions.

Objective. To investigate mir-29b expression levels in the cervical epithelium in cervical intraepithelial neoplasias. Subjects and methods. The investigation included 74 reproductive-aged women making up 3 groups: 1) 24 patients diagnosed with low-grade squamous intraepithelial lesions (LSIL); 2) 20 women with high-grade squamous intraepithelial lesions (HSIL); 3) a control group of 30 women without pathological changes in the cervix uteri. Cytological and histological examinations, expanded colposcopy, and a real-time polymerase chain reaction (PCR) assay for the detection of human papillomavirus were used. MicroRNA expression levels were estimated by a quantitative PCR assay using TaqMan miRNA Assays (Applied Biosystems). Results. There were 2.2- and 4.2-fold reductions in mir-29b expression levels in LSIL and HSIL (p = 0.008 and 0.0002, respectively). Estimation of mir-29b expression allows prediction of cervical intraepithelial neoplasia with a sensitivity of 70% and a specificity of 72.2%. The diagnostic efficiency was 70.3%. Conclusion. The performed investigation along with traditional studies permits consideration of mir-29b as one of the informative molecular markers to predict the degree of cervical epithelial lesion in neoplastic diseases of the cervix uteri.

Objective. To identify a group of the functional parameters of mitochondria associated with premature ovarian insufficiency (POI), by comparatively estimating the values of the mitochondrial function of peripheral blood mononuclear cells (MNCs) and subcutaneous fibroblasts in women with POI and preserved menstruation rhythms. Subjects and methods. The investigation enrolled 20 patients with POI and 12 women with a regular menstrual cycle at the age of 29 to 38 years. All the participants underwent physical and hormonal examinations, estimation of the membrane potential of the mitochondria of peripheral blood MNCs and subcutaneous fibroblasts, as well as the components of the antioxidant system, such as the level of total (tGSH), reduced (GSH) and oxidized (GSSG) glutathione, the ratio of reduced/oxidized glutathione (GSH/GSSG), the content of malondialdehyde (MDA), and the enzymatic activity of catalase. Results. Comparative analysis of biochemical and functional markers for endothelial dysfunction revealed significant differences in the amount of total cholesterol, apolipoprotein B, and glucose and in the level of endothelium-dependent vasodilation between the groups of women with POI and those with regular menstrual rhythms (p < 0.05). There was a significant increase in the proportion of cells with high-energy mitochondria in the women with POI versus the control group both for peripheral blood MNCs and subcutaneous fibroblasts (p < 0.05). Catalase activity was significantly lower in the POI group than in the control group (p = 0.03). A positive correlation was found between the content of MNCs and subcutaneous fibroblasts with high-energy mitochondria for both groups (r = 0.48; p = 0.029). There was also a direct correlation between MDA and the proportion of cells with high-energy mitochondria for MNCs in the POI group (r = 0.45; p = 0.043) while the control group shows an inverse correlation between MDA and apolipoproteins A1 and B (r = -0.76, p = 0.003 and r = -0.67, p = 0.012, respectively). A correlation was found between body mass index and the level of tGSH (r = 0.57, p = 0.042), reduced GSH (r = 0.57, p = 0.42), and GSH/ GSSG ratio (r = 0.66, p = 0.026) in the group of normalcy disappearing in the POI group. Conclusion. Where there are manifestations of POI, there is an imbalance between the pro- and antioxidant systems, which plays a role of the trigger of the abnormality. The prooxidant processes are mainly associated with the MNC fraction containing high-energy mitochondria. The detected differences in the development of compensatory processes for the normalcy and POI group, which consist in the breaking of the glutathione-dependent component of the antioxidant system in the abnormality, may suggest the importance of maintaining the adequate level of glutathione and possibly other free thiols in the plasma to prevent the development of this pathology.

Objective. To analyze the efficiency of intraoperative injection of Ambene to reduce blood loss during surgical treatment in patients with disseminated ovarian cancer after neoadjuvant chemotherapy. Subjects and methods. The investigation enrolled 36 patients with morphologically verified disseminated ovarian cancer (Stages III-IV). The patients were divided into 2 groups: a) those who had received intravenous Ambene intraoperatively (a study group) and 2) those who had undergone cytoreductive surgery without using hemostatic agents (a comparison group). Results. The Ambene-treated patients were observed to have a much lower volume of intraoperative blood loss than those who had no hemostatic therapy, which amounted to 80±12 and 550±11 ml, respectively. Conclusion. The findings are suggestive of the efficiency of single intraoperative administration of Ambene in patients with disseminated ovarian cancer after neoadjuvant chemotherapy.