No 7 (2016)

Objective. To present an update on the immunogenetic mechanisms of miscarriage. Material and methods. Literature was sought in the scientific libraries and Pubmed, Medline, and other databases. 230 sources dealing with the immunological aspects of miscarriage, 36 of which formed the basis for this review, were examined. Results. Recent investigations indicate that there is a close relationship between infection and pregnancy complications, such as miscarriage, placental insufficiency, and preterm delivery. The organism was protected against pathogens with the components of the innate and acquired immunity system. Current cellular and molecular investigations revealed a number of gene polymorphisms in the components of the immune system, which modify an immune response, predisposing to a certain spectrum of infectious agent-related diseases, such as infertility, miscarriage, premature delivery, and placental insufficiency. Conclusion. The investigations conducted in reproductive immunology disclose the molecular genetic mechanisms of miscarriage, which makes it possible to take a new look at the possible causes of miscarriage and to define prospects for prevention and treatment.

Objective. To carry out a systematic review of the data available in the modern literature on the role of different molecular genetic markers for cervical carcinogenesis along with traditional cervical cancer screening methods. Material and methods. The review included the data of foreign and Russian articles published over the past 5 years and found in the Pubmed on this topic. Results. The paper describes main methods used for cervical cancer screening, as well as new epigenetic biomarkers that enable proper management tactics to be chosen in difficult clinical situations. Conclusion. Diagnostic biomarkers (WIFI gene methylation, the expression of mir-29b in the cervical epithelium, p16 and Ki67, etc.) play a pivotal role in interpreting the final diagnosis if there are controversial and ambiguous results of cytological examination and HPV testing, which emphasizes the need for their further investigation.

The choice of wait-and-see or active tactics for prolonged and protracted pregnancy remains controversial. Objective. To compare the specif ic features of the course of labor and perinatal outcomes in women who tend to prolong pregnancy in relation to management tactics. Subjects and methods. 272 healthy primiparas at 284-285 days’ gestation were included in the study; 74 patients formed a control group; a wait-and-see tactic was used in 90 patients; labor preinduction was carried out in 108. Results. After taking mifepristone, uterine contractions occurred in 63% of the women. Preinduction was continued with dinoprostone in the others: 1 dose in 70%, 2 doses in 20%, and 3 doses in 10%. In the labor preinduction group, the rate of primary or secondary uterine inertia and dystocia was minimal, accounting for 16.6% versus 40%. In the wait-and-see tactic group, the risk of abnormal labor was 2.1 times higher than that in the control group. In the same group, the rate of oxytocin-augmented labor was significantly more common than that in the control group (30% versus 16.2%). The rate of birth to big large fetuses and babies with signs of postmaturity was seen more frequently in the wait-and-see tactic group (p < 0.05). Conclusion. Labor preinduction in women tending to prolong pregnancy at 284-285 days is a rather effective and safe method to prevent complications, allows the lower rate of birth to postmature infants, and this does not contribute to the higher rate of cesarean section and poor perinatal outcomes.

Objective. To def ine the possible role of presepsin (PSP), a new highly sensitive and highly specific marker for systemic inflammatory response and sepsis, in predicting preeclampsia (PE). Subjects and methods. The investigation enrolled 48 women. A study group included patients with hypertensive disorders: preeclampsia (early and late), preeclampsia in the presence of chronic hypertension (CH), and CH. Results. Comparison of PSP levels revealed no significant differences between the groups. What was more, the level of PSP did not correlate with the laboratory parameters of inflammation, which apparently points to the fact that the inflammatory process is inadequately pronounced in the study women. Conclusion. In patients with PE, the systemic inflammatory response has probably other developmental mechanisms unassociated with PSP. There is a need for further investigations searching for the molecular determinants with PE.

The quality of oocytes and their morphology have a great impact on the outcomes of assisted reproductive technology (ART) programs. The literature contains contradictory data on the impact of abnormal smooth endoplasmic reticulum (SER) aggregates on the parameters of embryogenesis, the occurrence of pregnancy and its course. Objective. To reveal risk factors for SER aggregates in the cytoplasm of oocytes and to evaluate their impact on the embryological characteristics and clinical outcomes of ART programs. Subjects and methods. The prospective cohort study included 162 women treated with in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) for infertility. The patients were divided into 2 groups: 1) women with 100% oocytes with SER aggregates; 2) those with 100% morphologically normal oocytes. The oocytes were assessed by light microscopy during fertilization with ICSI. Results. A history of recurrent genital herpes and Chlamydia infection increased a risk for the appearance of SER aggregates in the cytoplasm of oocytes in the patients receiving ART programs by 3.7 times. When a patient received more than 10 mature oocytes, her chances of having oocytes with SER aggregates were 3.3 times higher. Other clinical anamnestic parameters, as well as the specific features of superovulation did not affect the occurrence of this abnormality. The rate of oocyte fertilization and the quality of obtained embryos were lower in the SER aggregate group. In the women with SER aggregates, their clinical pregnancy occurred 4.1 times less frequently and the rate of early reproductive losses was 3.86 times higher than in those with morphologically normal oocytes. Conclusion. The performed study provided evidence for the substantial negative effect of SER aggregates on the outcomes of ART programs and revealed risk factors for this pathology. There is no question that this problem needs further investigation, a search for the causes and mechanisms of this oocyte dysmorphism, and determination of the optimal management tactics for patients with abnormal oocytes.

Objective. To reveal an association between prenatal exposure to benz[a]pyrene, styrene, formaldehyde, maternal genotype, and infant birth weight. Subjects and methods. The population-based cross-sectional study recruited 166 puerperas randomly selected from a population of pregnant women who had admitted to Chita maternal hospitals and given birth to a baby at more than 35 weeks’ gestation. The inclusion criteria were their age of 20 to 40 years and at least 5-year residence in Chita. Women with fetal malformations and multiple pregnancy were excluded. The levels of benz[a]pyrene and formaldehyde in serum from puerperas and in umbilical cord blood from newborns were determined using high performance liquid chromatography, the content of styrene was estimated by gas chromatography. Detoxification genotypes were defined by real-time PCR. Results. There was a significant inverse correlation between neonatal weight and the level of benz[a]pyrene, styrene, and formaldehyde in the maternal blood and that of benz[a]pyrene and styrene in the neonatal blood. The neonatal weight was higher with the lower levels of benz[a]pyrene in the maternal blood and in the neonatal umbilical cord blood provided that there was GSTP1A allele c.313 A>G, SULT1A1 G allele c. 404 G>A, CYP1A1 T allele c. 1189 T>C, and MTR A allele c. 2756A>G. Weight was also related to the content of styrene and was significantly lower in the presence of CYP1A1 C allele c. 1189 T>C, MTHFR allele T c. 677 C>T, and MRT G allele c. 2756 A>G. In case of higher formaldehyde levels, the neonatal weight was considerably lower in the presence of NAT2 C allele c. 341 T>C. Conclusion. Our findings suggest that the allelic status of the genes of the xenobiotic transformation system (GSTP1 c.313 A>G, EPHX1 c.337 T>C, NAT2c.341 T>C, SULT1A1 c.404 G>A, and CYP1A1 c.1189 T>C), antioxidant defense (GPX1 c.599 C>T), and folate metabolism (MTHFR c.677 C>Tand MTR c.2756A>G) in the development of fetal growth retardation. On entering the body, polycyclic aromatic hydrocarbons are first activated with cytochrome enzymes, CYP1A1 in particular, and then inactivated with glutathione transferases, GSTM1 and GSTP1 in particular. The combination of highly active CYP1A1 genotype with defective GST types may substantially increase the risk of birth of low birthweight babies.

Background. The present-day educational process requires drastic restructuring and alterations with consideration for the introduction of high technologies in medicine. Objective. To elaborate methodological approaches to using innovative, simulation, and virtual technologies in the educational process, by evaluating their efficiency. Material and methods. Unique training computer soft hardware complexes, a series of “2D and 3D Virtual Surgeon” surgery stimulators, a special tensometric test bench, an “Inbody Anatomy” three-dimensional human anatomy atlas, a “Pirogov” interactive anatomical table, and criteria for assessing students, interns, and residents in an open surgery simulator were developed. Results. A summative assessment of both the obtained manual skills and decision result of the proposed cases was made. A 100-point scale was used to assess the results of testing. The results were as follows: 44.1% of the 524 students tested on the stimulator received good and excellent marks. The vast majority (69.9%) of 215 students in the comparison group had satisfactory and bad marks. These results uniquely suggest that the educational process using the soft hardware complex is effective. Conclusion. Thus, the experience with data-processing studies at a higher educational medical establishment with the compulsory integration with Biomodeling and Interactive Visualization Centers may become a platform for the further formation and development of continuing professional education.

Objective. To reveal the main echographic signs of fetal airway obstructive lesions and to assess a postnatal outcome in a neonatal infant on the basis of this presented analysis of the data available in the literature and the authors’ two observations. Material and methods. Obstructive lesion of the upper airway was diagnosed in two fetuses at 19 weeks and 1 day and 20 weeks and 2 days and that of the lower airway was at 21 weeks and 6 days. The pregnancies were interrupted. Results. The major echographic sign of airway obstruction in a fetus is its significantly increased size and higher lung echogenicity. There is also a pathological evagination of the cupula of the diaphragm towards the abdomen, as well as ascites. The process is also bilateral in obstruction of the upper airway and unilateral in that of the lower airway. This pathology is noted to have a poor postnatal prognosis. Conclusion. Echography allows the intrauterine diagnosis of as rare and prognostically poor abnormality as fetal airway obstruction and the information obtained from the investigation may decide what further pregnancy management tactics should be applied in terms of subsequent neonatal prognosis.

Background. Connective tissue disease gives rise to a great number of human diseases. Pregnant women with connective tissue dysplasia are prone to scar tissue disorganization and microcirculatory bed pathology with the changes manifesting in the larger vessels too. In forensic medical practice, there have been no described cases of vascular malformations detected in the gravid uterus in the presence of undifferentiated connective tissue dysplasia with an incompetent uterine scar, which are complicated by antepartum uterine wall rupture, hemorrhagic shock, and fetal death. Case report. The authors give their own case of uterine vascular malformation in a 41-year-old woman with undifferentiated connective tissue dysplasia and uterine scar disintegration (myomectomies in 2002 and 2006), which were responsible for histopathologic uterine rupture. The investigation used clinical, morphological, and immunohistochemical examinations that revealed types I, III, and IV collagens in the rupture area. Immunohistochemical examination showed the expression mainly of type III collagen and that of type IV collagen in the wall of the described vessels. Type I collagen accumulated chiefly in the adjacent myometrium. High type III collagen expression was determined in the rupture area. Thus, it was established that there was vascular malformation in the uterine wall and undifferentiated connective tissue dysplasia with the uterine wall scar being disintegrated and with the choreal and decidual tissues penetrating deeply into the thickness of the uterine wall in the area of malformed vessels with uterine wall rupture. Conclusion. In undifferentiated connective tissue dysplasia, type III collagen (embryonic collagen) accumulates in the scar tissue, which facilitates the invasion of chorionic villi into the uterine wall in an old scar area. In addition, vascular malformations gave rise to wall ischemia, which also aggravated the processes of connective tissue disorganization and caused uterine rupture.

Moscow 117997, Ac. Oparina str. 4, Russia Background. The current concept of the pathogenesis of ovarian serous cancer and primary peritoneal serous carcinoma suggests the presence of prior serous tubal intraepithelial carcinoma (STIC). The basis for this statement is accumulated data on a concurrence of ovarian and primary peritoneal serous cancer and STIC. Furthermore, STIC is detected in women with BRCA1 and BRCA2 mutations after prophylactic adnexectomy. At the same time, there is information on STIC found in women with benign gynecologic disease. Description. The paper presents a clinical case of a 50-year-old patient whose histological examination of the material obtained during surgery for uterine myoma exhibited STIC on the left and minor serous carcinoma foci in the commissures on the surface of the right ovary. Immunohistological examination revealed the high expression of the markers Ki-67 and p53 in all tumor samples. Conclusion. Serous carcinoma foci in the commissures on the surface of the right ovary appear to be a highly aggressive primary peritoneal carcinoma, the precursor of which was STIC. Detailed histological examination of the fallopian tubes could reveal highly aggressive serous cancer at the preclinical stage in the patient with initially diagnosed benign lesion of the female reproductive system.