Background. Vulvovaginal infections are the most common, studied, and still causing many questions. It has been established that the disturbance of the ratio of the vaginal microbiota components does not always lead to a disorder since the development and outcome of the disorder largely depend on the state of the macroorganism, including the state of its immune system. To date, the only method for assessing the state of local immunity is smear microscopy with counting leukocytes. An alternative to leukocyte counting is the assessment of immunological parameters (e.g., the transcriptional profile of cytokine genes). An integrated approach to assessing the state of microbiocenosis (the ratio of lactobacilli and opportunistic pathogens) and local mucosal immunity, considering the individual genetic characteristics of patients and microorganisms, makes it possible to optimize treatment methods for vaginitis. One of the ways to increase the effectiveness of treatment and prevention of the recurrence of infectious and inflammatory diseases in gynecology is systemic enzyme therapy based on the complex effect of a specially selected combination of plant and animal origin enzymes on key physiological and pathophysiological processes in the body.

Aim. To study the clinical effect and the effect of combined therapy with an antibiotic and a medicinal product, including a complex of enzymes of plant and animal origin (Wobenzym) on the state of the vaginal microbiota, the expression of cytokine genes, and the recurrence rate in patients with bacterial vulvovaginitis.

Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 88 patients according to inclusion criteria. After randomization of patients into 2 groups, the main group received combination therapy (clindamycin vaginal cream 2% and Wobenzym), and patients of the comparison group received standard therapy only (clindamycin vaginal cream 2%). Short-term and long-term endpoints were defined. The primary endpoints included the assessment of symptoms, the change over time of the number of leukocytes in Gram-stained smears, and the recurrence rate; the secondary endpoints were the study of the change over time of the inflammation index, the results of the assessment of the state of the vaginal microbiota by real-time quantitative polymerase chain reaction using the Femoflor 16 reagent kit and a microbiological study.

Results. When used in combination, Wobenzym potentiates the antibacterial properties of clindamycin, reduces the inflammation index, promotes the growth of the normal microbiota of the vagina (Lactobacillus spp.), prevents the growth of opportunistic microorganisms and, as a result, prevents the recurrence of vulvovaginitis.

Conclusion. The results support the use of combination therapy (antibiotic + Wobenzym) to improve the effectiveness of therapy and maintain normocenosis.

Aim. To evaluate comprehensively the quality of life (QoL) of patients with pelvic organ prolapse (POP) who have indications for reconstructive surgery (RS) and determine the optimal tools for QoL assessment as part of preoperative screening.

Materials and methods. The study included 860 patients hospitalized for RS at the Saint-Petersburg State University Hospital. The following validated questionnaires were used to assess QoL: the RAND SF-36 (general QoL questionnaire and specialized questionnaires), in particular the P-QoL (QoL Pelvic Organ Dysfunction Questionnaire in POP), the PFDI-20 (Pelvic Organ Dysfunction Questionnaire), the ICIQ-SF (Stress Incontinence Questionnaire), the PISQ-12 (PTD Sexual Dysfunction Questionnaire), the HADS (Hospital Anxiety and Depression Scale). Lower abdominal and lower back pain was assessed using a Visual Analog Scale.

Results. Significant QoL reduction was found in most patients, including in physical and psycho-emotional aspects. Among the patients, there were no women with a high level of physical and mental health components. The indicators of vitality, general health, role-physical, and emotional functioning were more significantly reduced. More than 1/3 of women had borderline or increased levels of anxiety, and 1/4 had high levels of depression. Notably, the P-QoL questionnaire was used for the first time in the russian population of patients with POP. It identifies general health perceptions, the impact of prolapse on life, role, physical, social and personal limitations, emotions, sleep/energy, and symptom severity. Based on the study, optimal tools for preoperative screening and monitoring the state of patients after surgery are proposed.

Conclusion. The population of women with POP with indications for RS is heterogeneous in terms of the severity of physical and psychosocial functioning impairment and the degree of impact of pelvic organ prolapse symptoms. The following questionnaires can be considered as optimal tools for assessing QoL and symptom burden in patients with POP as part of preoperative screening: P-QoL to assess the decrease of various QoL aspects, PFDI-20 to determine the severity of specific pelvic organ dysfunction symptoms, HADS to identify the level of anxiety and depression.

Background. The high mortality rate from ovarian cancer is largely due to the asymptomatic course of the disease. The signs of malignant and borderline ovarian tumors are similar to the manifestations of benign lesions, which determines the relevance of developing additional examination procedures and searching for new cancer markers that will distinguish benign and malignant processes.

Aim. To build stable blood lipid panels for differentiation of healthy women, patients with benign (BOT) and malignant (MOT) ovarian tumors.

Materials and methods. The search for markers for clustering of molecular profiles of blood samples of patients of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology with BOT (cystadenoma – n=30, endometrioid cyst – n=56, teratoma – n=21), with MOT (borderline tumor – n=28, ovarian cancer of low malignancy – n=16, ovarian cancer of high malignancy – n=59) and volunteers of the group control (n=19) using discriminant analysis of orthogonal projections to hidden structures with an established threshold of importance of the variable VIP>1 (OPLS) and the method of projections to hidden structures (PLS-PLS – it is a technology of multidimensional statistical analysis used to reduce the dimension of the feature space with minimal loss of useful information; VIP importance threshold >1) and other statistical tools. Samples’ molecular profile was complete by species, which were identificated by nuclear magnetic resonance and high-perfomance liquid chromatography-mass spectrometry. The analysis of the involvement of compounds that are potential markers of malignant processes in metabolic pathways was carried out.

Results. Based on the OPLS and PLS methods, as a result of pairwise and multiclass comparisons, respectively, sets of lipids were identified that can be considered as markers of malignant and benign neoplasms. The overlap of the obtained panels with databases of metabolic pathways was studied, in particular, it was shown that all markers (except glucose) obtained by PLS for differentiation of healthy patients, patients with BOT or with MOT are involved in the transport of small molecules, glucose and lactate are involved in the “TCA Cycle” pathway “Nutrient Utilization and Invasiveness of Ovarian Cancer”. Triglycerides TG 16:0_16:0_18:1, TG 16:0_18:0_18:1, TG 16:0_18:1_18:1, TG 18:0_18:1_18:1, TG 18:0_18:1_18:2 and lactate are involved in the “HIF1A and PPARG regulation of glycolysis” pathway, and The HIF1A and PPARG genes are associated with the development of tumors. Metabolites CE 20:4, TG 16:0_16:0_18:1, TG 16:0_18:0_18:1, TG 16:0_18:1_18:1, TG 18:0_18:1_18:1, TG 18:0_18:1_18:2 are included in the pathways of energy metabolism, and LPC 16:0, PC 16:0_20:3, PC 16:0_20:4 is involved in the path of “Choline metabolism in cancer”. Graphs of the correlation interaction of markers that allow solving classification problems with an unambiguous interpretation of the results are constructed, which makes it possible to assert the prospects of using these panels for further creation of classification models.

Conclusion. It is shown that lipids from the developed panels are involved in metabolic pathways associated with the development of tumor diseases and can be used for further validation of diagnostic models based on advanced machine learning methods. The introduction of the achievements of postgenomic research has the potential to increase the diagnostic value of the applied methods of differentiation of benign and malignant proliferative processes, as well as to supplement the available data on the processes of carcinogenesis in the ovaries. Thus, the analysis of the molecular profile of blood by mass spectrometry is a minimally invasive potentially effective diagnostic method.

Background. Breast cysts are a relatively common benign condition, accounting for 26.4% of all benign mammary dysplasias (BMD). Due to scientific and technological progress, in many cases, it is possible to achieve improvement from non-surgical and complex therapy, including minimally invasive technologies such as image-guided air injections with non-surgical treatment.

Aim. To determine the optimal approach for the management of benign breast cysts and to provide a rationale for the combined use of air injections with phytotherapy.

Materials and methods. The study included women aged 25 to 45 years (mean age was 37.7±5.6 years) taking combined oral contraceptives (COCs) for at least 3 years with benign breast cysts. Patients were randomized into two groups: Group 1 (n=26) included patients with a cystic form of BMD who received a fine-needle puncture followed by air mixture injections into the cyst cavity in combination with non-surgical therapy with the herbal medicinal product Mastopol®; Group 2 (n=19) included patients with a cystic form of BMD who received only air injections into the cyst cavity. The dosing regimen of Mastopol® in patients of Group 1: 1 tablet sublingually 3 times a day 20 minutes before meals. The non-surgical therapy was initiated on the day of the air injection. The duration of treatment with Mastopol® was 3 months.

Results. A pain decrease was reported in 18 patients (69.2%) of Group 1; in Group 2, only 2 (10.5%) patients reported a pain decrease. Almost all patients of Group 2 (n=17; 89.5%) required repeated air injections for complete cyst reduction, while in Group 1, only 31% (n=8) of patients received repeated air injections. Comparative analysis showed a significant difference between the groups: φ*=1.7; p≤0.04. One month after treatment and air injections, mastalgia of varying intensity in Group 1 persisted in 31% (n=8) of patients and 89.5% (n=17) of patients in Group 2.

Conclusion. While taking COCs, women may experience pain and tension in the breast, as well as an increase in the echo density of the breast and thickening of the glandular tissue and the wall of the cysts. These adverse effects of COCs must be reduced. The results of the study demonstrated the effectiveness of the antiproliferative herbal drug Mastopol®, prescribed in combination with an adequate, effective, and safe method such as air injection into the cyst cavity.

Disruption of the structure and function of the vulvovaginal epithelium in women of reproductive age is accompanied by impaired sexual function and a decrease in the quality of life. This review analyses research on the use of hyaluronic acid (HA) for women of reproductive age with conditions and diseases manifesting as vulvovaginal atrophy. HA is involved in various physiological processes, including tissue regeneration, cell migration and proliferation during inflammation, and helps maintain water balance and tissue integrity. Local therapy with HA is effective in treating the symptoms of vulvovaginal atrophy in women of reproductive age associated with hypoestrogenism, both as a monotherapy and in combination with other treatments. It improves sexual function and quality of life, helping women to improve their sexual lives and living standards.

The basis for the prevention of cancer is the correction of initial epigenetic disorders in the cell, i.e. implementation of pathological genome reversion. Convincing evidence has accumulated to support the potential antitumor activity of compounds derived from cruciferous vegetables of the genus Brassicaceae. Indole-3-carbinol and 3,3'-diindolylmethane (DIM) have been investigated for their use as chemopreventive agents. DIM is formed in the acidic environment of the stomach as a result of dimerization of indole-3-carbinol monomers. Currently, it is impossible to identify a specific vector of influence of DIM at the molecular level. In this review, we summarize the pleiotropic effects of DIM aimed at correcting reversible epigenetic changes in tumor cells. Emphasis will be placed on the major cellular and molecular events that are effectively modulated by DIM. The main profile of DIM competencies concerns the management of intracellular signal transmission and correction of initial molecular genetic changes at the level of key participants in signaling pathways (NF-κB/Wnt/Akt/mTOR) leading to the development of cancer. The ability of DIM to differentially modulate tumor cell apoptosis has been observed in preclinical studies. It has been suggested that using DIM it is possible to increase the effectiveness of chemotherapeutic compounds with different molecular targets, thereby increasing chemosensitization. DIM has entered phase III clinical trials, with preliminary results confirming its promise both as a stand-alone drug and in combination with other components of anticancer therapy. Establishing the range of epigenetic control of DIM molecular and genetic changes in various cancers will allow optimization of therapeutic epigenetics approaches.

Over the past few decades, the attention of gynecologists and reproductive specialists has been drawn to the key causes of female infertility, among which chronic endometritis (CE) dominates. The aim of the paper is to inform gynecologists about the need for a comprehensive approach (considering comorbidities) to diagnose and treat CE using medical and physiotherapeutic treatment methods. The article presents a prospective review of pregravid preparation, considering the features of the examination, verification of the diagnosis, and treatment of two patients with a history of reproductive losses due to CE. The presented clinical cases demonstrate the importance of multidirectional diagnosis of CE, the mandatory morphological examination to verify the diagnosis, as well as the feasibility of prescribing complex therapy using both drug (antimicrobial therapy, immunomodulatory, hormonal, and combined broad-spectrum agents) and physiotherapeutic methods of treatment.

Gestational trophoblastic disease is uncommon in practice. Usually a hydatidiform mole, an invasive mole and a choriocarcinoma are known among gynecologists. The practitioners have much less information about diseases associated with the intermediate trophoblast. These rare forms of trophoblastic disease are almost impossible to diagnose clinically. The morphological differential diagnosis is also quite difficult. Just careful attention to details, methodical study of the material, starting with routine staining methods, ending with immunohistochemical analysis, the use of molecular and cytogenetic typing, make it possible to establish the correct diagnosis and choose an effective therapeutic strategy. The article describes a rare clinical case of a placental site trophoblastic disease which was manifested by an ordinary abnormal uterine bleeding and then successfully diagnosed only by pathology experts.