№ 9 (2016)

Objective. To carry out a systematic analysis of the data available in the literature on new possibilities of organized screening for cancer of the cervix uteri (CCU), by applying biological self-sampling for high-risk HPV testing. Materials and methods. The review included the data of foreign and Russian papers published in the electronic databases Medline, PubMed, and Cochrane Library in the past 10 years. Results. The paper describes the results of self-sampling of vaginal discharge for testing, followed by its test for HPV using a PCR assay in different countries of the word as screening for CCU, as well as a comparison of this technique with cytological screening. It shows the efficiency of the test in identifying high-risk HPV types, which determines a possibility for its use in CCU screening programs in Russia. Conclusion. The increase in the incidence of CCU necessitates for a more effective approach to the early diagnosis of this disease. Self-sampling for HPV testing is acceptable for large-scale screening for CCU. The method reduces the cost of the screening, increases its coverage of the population, and has a high sensitivity and specificity. There is a need for further investigations in this area.

Objective. To carry out a systematic analysis of the data available in the current literature on the pathogenetic features of the interaction of the hemostatic system during tumor growth. Materials and methods. The review included the data of foreign and Russian papers published in the past 15 years and found in e-Library and Pubmed on this topic. Results. The paper describes the pathogenetic mechanisms responsible for the involvement of tissue factor in the process of tumor growth as the most significant tumor procoagulant. A separate section is devoted to the pathophysiology of tumor neoangiogenesis. The role of endothelial activation in the process of tumor growth is revealed in detail. Conclusion. The pathophysiological features of tumor growth make cancer perhaps the best example of acquired thrombophilia. A better understanding of the pathophysiology of thrombophilia in cancer should provide clinicians with a more accurate rationale for more aggressive and certain antithrombotic treatment strategies in patients with malignant tumors.

Objective. To carry out a systematic analysis of the data available in the current literature on the impact of maternal diabetes mellitus on neonatal health. Materials and methods. The review included the data of foreign and Russian papers published in the past 10 years and found in PubMed on this topic. Results. There is scientific evidence pointing to the great sociomedical importance of gestational diabetes mellitus that is frequently responsible for the high rate of poor pregnancy outcomes for both the mother and her newborn infant. There is also an update of international investigations of the features of health adaptation in babies born to diabetic women. Conclusion. There is a need for further investigations of the complex metabolic mechanisms influencing both the development of diabetic fetopathy and health in this group of children in the future.

Objective. To identify risk factors for original placenta previa, its preservation by the time of delivery, and poor outcomes for mother and fetus. Subjects and methods. Clinical and paraclinical characteristics were comparatively analyzed in 70 patients with placenta previa by the time of labor, in 150 parturients with a positive migration in second-trimester placenta previa, and in 100parturients with physiological placentation. In addition to compulsory examinations provided by guidance documents, all the patients in the comparison groups underwent molecular genetic testing of the alleles of the hemostatic genes, the participants of hemostatic reactions, and the folate metabolic genes by a PCR assay. Parametric and nonparametric statistical methods were used for the statistical processing of the findings. Results. The history of hormone-dependent gynecological diseases (p < 0.001), infertility (p < 0.001), intrauterine contraceptive devices (p < 0.05), and hypertensive syndrome (p < 0.001), as well as the associations between defective alleles of the genes of hemostasis and folate metabolism (p < 0.01), hepatitis B and C viruses (p < 0.001), and autoimmune processes (p < 0.001) are risk factors for fully preserving the placental previa for delivery.

Objective. To evaluate the efficiency of laser ovarian drilling in women with polycystic ovary syndrome (PCOS) in an assisted reproductive technology program. Subjects and methods. A cross-sectional prospective study was conducted. A study group comprised 30 patients aged 27.7±4.2 years with PCOS; a comparison consisted of 30patients (mean age, 31.6±2.5 years) without PCOS. The patients underwent hormonal, ultrasound, and complete clinical and laboratory studies. Results. The criteria for PCOS are anovulation, menstrual irregularities, hirsutism, insulin resistance, prolonged infertility, failed IVF attempts, and ultrasound criteria for polycystic ovaries. These criteria were an absolute indication for laparoscopic ovarian drilling by holmium laser in the patients of the study group. Conclusion. Laparoscopic laser drilling is a surgical technique to trigger ovulation and does not reduce the ovarian reserve, enhancing a woman’s chances of getting pregnant in the ART program.

Objective. To investigate the efficiency and safety of two dosage regimens of lactic acid in combination with metronidazole versus a conventional two-stage regimen consisting of metronidazole + a probiotic. Subjects and methods. 140patients with bacterial vaginosis (BV) were randomized into 3 groups: 1) 40patients received vaginally metronidazole and lactic acid at an interval of 12 hours for 10 days; 2) the patients took sequentially metronidazole (for 10 days) and lactic acid (for 10 days) (the treatment cycle was 20 days); 3) those who had a 20-day total sequential therapy involving metronidazole for 10 days and then a probiotic for 10 days. Therapeutic effectiveness was evaluated using the Amsel criteria and real-time PCR results. The data were statistically processed using Statistica 10.0. Results. There were statistically significant differences in the basic criteria: a reduction in leucorrhoea, amine odor, and key cell counts and vaginal pH restoration in favor of the patients treated with lactic acid versus those used the probiotic. There were also significant better results in reducing the titer of BV-associated microorganisms and the growth of lactobacilli in the lactic acid groups. Conclusion. The parallel or sequential use of a combination of metronidazole and lactic acid as vaginal suppositories is a more effective treatment for BV than that of a combination of metronidazole and the probiotic.

Objective. To create an approach to analyzing differences in the molecular composition of the eutopic and ectopic endometrium at various sites, by using direct mass spectrometry. Subjects and methods. The case-control study included 30 patients with ovarian endometrioid cysts and peritoneal endometriosis (Grades III-IVendometriosis according to the classification of the American Fertility Society). The diagnosis of external genital endometriosis was verified during clinical and instrumental examination, including diagnostic and therapeutic laparoscopy, and ultimately confirmed by histology. The endometrium was sampled in all the patients during hysteroscopy. Each sample was divided into two parts: for pathological studies and for direct mass spectrometry (EESI-based procedures, liquid extraction of low molecular weight substances from tissue with simultaneous ionization). The characteristic high- and low-resolution mass spectra of lipid tissue were obtained. Results. The ectopic endometrium, unlike the eutopic one, showed significantly varying levels of 5 different lipid classes: phosphatidylcholines (PC 32:1, PC 0-36:3, PC 38:7, PC 38:6, PC 40:7, PC 40:6, PC O-42:1), phosphoethanolamine (PE O-20:0), sphingomyelin (SM 34:1), diglyceride (DG 44:9), and triglycerides (TG 41:2, TG 49:4, TG 52:3). Phosphatidylcholines and sphingomyelin may be proposed as possible biomarkers for endometriosis since these lipids are closely linked to apoptotic suppression, oxidative stress, and cell malignancy. Conclusion. Lipidomic analysis of endometrioid tissues allows the identification of new molecular processes that cause the enhanced cell growth characteristic for the aggressive form of endometriosis. Not only new diagnostic approaches, but also potential therapeutic targets and novel treatments aimed at pathophysiological mechanisms may be proposed as a result of validation.

Objective. To estimate the incidence of vulvar malignancies (VM) in the Republic of Kazakhstan. Material and methods. The investigation material included statistical data on 852 patients registered for VM for the first time across the Republic of Kazakhstan in 2003 to 2012. The source of information was data (death notices and certificates, and autopsy reports) obtained from the specialized and nonspecialized institutions of the country, as well as information from registry offices. Conventional methods of descriptive epidemiology and statistics were applied. Results. A total of 852 patients with newly diagnosed VM were notified during the study period. The largest number of patients with VM (n = 425 (49.9%)) were registered in the oldest age group (70years and older). In the republic, the rough or intense rate of VM incidence was recorded to be 1.0±0.1 (95% CI, 0.9-1.2). Over 10years, the growth rate was 12.6%. There was a geographical variability in the prevalence of VM. Relatively high intense VM incidence rates were recorded in the Northern Central Region (1.4) whereas these in the South Region were equal to 0.9per 100,000 respective population. Over time, the growth rate of VM was 3.9% in the South Region and 6.2% in the Northern Central Region of the Republic of Kazakhstan. Conclusion. Thus, 852 patients with VM were registered in the Republic of Kazakhstan over 10 years. Elderly patients (aged 70 years and older) accounted for half of all the registered. Vulvar cancer showed age-related and geographical variabilities. There were relatively high rates of VM incidence in old age groups and in the Northern Central regions of the country. These results call for further investigations using the analytical epidemiology methods that can explain the geographical variability and identify certain risk factors in the genesis of this relatively rare malignant tumor in women.

Objective. To carry out a systematic analysis of the data available in modern literature on different perinatal complications caused by vitamin and trace element deficiencies in women and on the possibilities of preventing these conditions. Materials and methods. The paper analyzes 33 literature sources from 1989 to 2015, which discuss disorders occurring in the mother-placenta-fetus system due to vitamin and trace element deficiencies, and considers the ways of their solution Results. Abnormalities might develop in the mother-placenta-fetus system during gestation in micronutrient deficiency; methods for their prevention were considered. Conclusion. Taking into account difficulties in predicting perinatal complications in women with vitamin and mineral deficiencies, to minimize a risk for their development requires their prevention even during pregravid preparation, by taking vitamin-mineral complexes, which should be continued during pregnancy and lactation.