Vol 71, No 5 (2022)

The development of the fetal central nervous system and the formation of its integrative functions have been studied for a long time. In the middle of the 20^th century, researchers paid attention to structural changes and in the 1980s to the sequence of formation of functional relationships in the fetal body and the possibilities of their assessment. Further development of technology (accumulation of knowledge in the field of embryology, better resolution of ultrasound diagnostic devices, introduction and improvement of magnetic resonance imaging methods) allowed for not only receiving more detailed data on structural patterns in the fetal brain during pregnancy, but also presenting new opportunities for expanding knowledge about its functional condition. The review is devoted to the generalization of knowledge about the development of the fetal central nervous system, the brain vascular network formation and the brain circulation, as well as possibilities of assessing the formation of the fetal central nervous system integrative function during the entire period of pregnancy.

This review article presents a comparative assessment of various types of energies used in the surgical treatment of cervical pathology, with their positive and negative sides. The mechanisms of action of the damaging agent, indications and contraindications, as well as results of treatment of cervical diseases and follow-up complications are presented. Attention is drawn to current promising areas in the treatment of cervix disorders. In particular, the article reviews the modern method of treatment using ultrasonic ablation, presents an idea of the methodology for conducting high-intensity focused ultrasound therapy, and discusses the possibility of conducting non-invasive this therapy. The article displays the world and domestic literature data.

BACKGROUND: The instructions for use of the suture material or coagulation tool do not describe the changes that may occur when they interact. A review of the literature found a small number of publications on changes in the physical properties of the suture material when exposed to chemical and mechanical factors. However, this is not enough to predict the effects of energy on the suture material and, as a result, on wound healing or the quality of the postoperative scar.

AIM: To determine and measure the effect of the energy used for coagulation on the strength of the suture material.

MATERIALS AND METHODS: In the experimental research, data on changes in the strength of 20 different filaments after exposure to the energy used for coagulation were analyzed in comparison with control samples.

RESULTS: Research resulted in obtaining both expected or predicted indicators of changes in the strength of threads, and vice versa, absolutely unexpected results, which only confirms the significance of the research. Most of the filaments have lost their original strength after exposure to energy. However, some threads have become, on the contrary, stronger, despite the apparent destructive effect.

CONCLUSIONS: The coagulation energy used in the ligature field changes the physical properties of the filaments. Therefore, in some cases it is worth abandoning the use of a certain type of energy and using another well-known method of hemostasis.

BACKGROUND: Immune mechanisms play a leading role in the pathogenesis of early reproductive loss. Modern methods of regulating disorders of immune homeostasis to overcome infertility and recurrent miscarriage include immune-efferent therapies such as immunocytotherapy, plasmapheresis, and intravenous administration of immunoglobulins and fat emulsions. Intralipid is the gold standard of the first generation parenteral fat emulsion that reduces the cytotoxicity of NK cells. In the literature, there are opposite data on the effectiveness of Intralipid fat emulsion in repeated implantation failure. This may be due to indications for its appointment and the choice of criteria for evaluating the effectiveness of this therapy.

AIM: The aim of this study was to evaluate the effect of Intralipid therapy on the onset of pregnancy in patients with a history of early reproductive loss.

MATERIALS AND METHODS: This prospective cohort study was conducted in Saint Petersburg, Russia in 2018–2021 and included 97 patients with a history of early reproductive loss (recurrent pregnancy loss or repeated In Vitro Fertilization failures). Patients were randomized into two study groups. The first group consisted of 41 women with Intralipid therapy, and the second group comprised 56 women without this therapy. Patients of the first group received 200 ml of Intralipid 20% (intravenous fat emulsion) once a month for three consecutive months before pregnancy. Inclusion criteria were ages 18 to 40 years, two cases of reproductive failure (pregnancy loss up to 12 weeks and / or unsuccessful In Vitro Fertilization attempts), and normal spouse karyotypes. Exclusion criteria were miscarriage due to fetal chromosomal abnormalities diagnosed by curettage and histopathological examination of products of conception from miscarriages, anatomical anomalies in the development of the genital apparatus, abnormal spouse karyotypes, and soy protein allergy. We evaluated anamnesis data and immunological parameters (functional activity of NK cells in peripheral blood before and after treatment). The efficacy of therapy was judged by the onset of pregnancy.

RESULTS: The Mann – Whitney U-test showed the difference in the levels of NKT cells before and after treatment with fat emulsions (p = 0.0076), this parameter decreasing 1.846 times compared to control. Clinical pregnancy in patients treated with Intralipid occurred twice as often compared to patients who did not receive fat emulsion therapy: 59.3% (n = 19) vs. 27.6% (n = 13), respectively (p = 0.0048).

CONCLUSIONS: Intralipid fat emulsion increases pregnancy rates by decreasing NKT cells in women with early reproductive loss.

BACKGROUND: The main method of endometrioid ovarian cyst treatment is considered surgery with further hormone therapy. However, the recurrence rate of endometriomas, even 5–7 years after combined treatment, can reach 50%.

AIM: The aim of this study was to identify risk factors for recurrence of endometrioid ovarian cysts among women of reproductive age after combined treatment.

MATERIALS AND METHODS: This study included 196 women operated on for ovarian endometriosis. We carried out a comparative analysis of the data between the study groups: the main group comprised 45 patients with a relapse of the disease; the comparison group consisted of 151 women without a relapse. Hematoxylin-eosin staining was used for morphological examination of the surgical material, and monoclonal mouse antibodies to Ki-67 and bcl-2 (DAKO, Denmark) were used for immunohistochemical examination. The construction of a statistical model for predicting the recurrence of ovarian endometriosis among women of reproductive age was carried out using multivariate binary logistic regression analysis in reverse stepwise mode. The influence of the independent variable on the likelihood of recurrence was determined using the odds ratio and its 95% confidence interval, with the sensitivity, specificity and diagnostic accuracy evaluated.

RESULTS: A set of predictors has been identified that provides the greatest contribution to recurrence of ovarian endometriosis. Immunohistochemistry study showed that the level of Ki-67 protein was higher in the group with relapsed endometriomas compared to the non-recurrent course: in the epithelial lining of the cyst, 9.08 ± 2.60 and 2.06 ± 1.16%, respectively (p = 0.043); in the cytogenic stroma, 11.67 ± 4.10 and 9.81 ± 3.40%, respectively (p = 0.48). Bcl-2 expression was reduced in the epithelial lining of the cyst capsule in the main group in comparison with the material where there was no recurrence: 0.653 ± 0.043 and 0.961 ± 0.056%, respectively (p = 0.31).

CONCLUSIONS: Of significance in predicting the risk of recurrence of ovarian endometriosis is a combination of four signs in one patient: primary infertility; pelvic organ surgery in history, unrelated to endometriosis; elevated levels of CA-125 oncoprotein and proliferative changes in cytogenic stroma cells, as well as increased expression of the Ki-67 antigen in the epithelial lining of the endometrioid cyst.

BACKGROUND: The insertion of a cervical pessary is a method for treating short cervix and preventing preterm birth. The study of the vaginal microbiota composition and the need for its routine correction after the pessary insertion remain to be investigated. To date, there are no works devoted to the assessment of changes in vaginal microbiocenosis after the cervical pessary insertion.

AIM: The aim of this study was to assess the microbiological safety of the Dr. Arabin cervical pessary in pregnant women with short cervix.

MATERIALS AND METHODS: This prospective study included 22 pregnant women with singleton or multiple pregnancies with short cervix (<25‰ L.J. Salomon scale) and threatened miscarriage in the second and third trimesters who received the Dr. Arabin cervical pessary. The obtained clinical materials included the secretion of the posterolateral vaginal fornix. We used the Femoflor 16 test (NPO DNA-Technology Ltd., Moscow, Russia) as a method of molecular biological analysis. In addition, the patients independently controlled the pH of the vaginal contents using the pH-balance express test. Vaginal microbiocenosis was assessed in a dynamic manner: before the cervical pessary insertion, then every two to four weeks after it, and on the day the pessary was removed. In all 22 pregnant women, clinical material was obtained twice: before the cervical pessary was inserted and when it was removed; in 15 women (68.18%) three times, and in nine pregnant women (40.91%) four times.

RESULTS: The analysis of vaginal microbiocenosis showed no significant changes in vaginal microbiocenosis in the examined pregnant women before and after the insertion of the cervical pessary (p > 0.05). The concentration of lactobacilli remained high (in the range of 10⁷ lg DNA copies/ml) during the entire observation period. The numbers of facultative and obligate anaerobic bacteria, as well as yeast-like fungi of the Candida genus, Ureaplasma spp., and Mycoplasma hominis were within the physiological levels. No pathogenic microorganisms such as Mycoplasma genitalium were detected in any patient. After the cervical pessary insertion against the background of normocenosis, 72.73% of pregnant women noted an increase in the amount of light and odorless discharge from their genital tract. However, we found no changes in the vaginal microbiota composition.

CONCLUSIONS: The insertion of the Dr. Arabin cervical pessary under conditions of vaginal normocenosis is a microbiologically safe way to correct short cervix and prevent preterm birth, and does not disrupt the vaginal microflora in pregnant women before delivery.

BACKGROUND: It is common a wide range of reproductive disorders in couples with structural chromosome aberration in one of the partners, such as infertility, miscarriage, unsuccessful assisted reproductive technologies attempts. In this regard, predicting the reproductive outcome in a particular couple is an extremely difficult task. To solve it, it is necessary to consider the influence of many factors, including the type of chromosome translocation and the carrier’s sex.

AIM: To evaluate the structure of reproductive disorders in couples where one of the partners was a chromosome translocation carrier, depending on its type: Robertsonian or reciprocal, and carrier’s sex.

MATERIALS AND METHODS: In this retrospective cohort study, we analyzed the clinical and anamnestic data of 100 couples where one of the partners was a chromosome translocation carrier. Couples applied to fertility centers between March 2009 and May 2019. To assess the effect of the type of chromosomal translocation and carrier’s sex, we provided intergroup comparisons.

RESULTS: Comparative analysis of somatic pathology and chronic gynecological diseases didn’t reveal significant differences between groups of female patients (Fischer’s exact test, p > 0,05). An intergroup comparison of reproductive outcomes in couples divided by the type of chromosome translocation: reciprocal or Robertsonian, and the carrier’s sex, detected significant differences. Primary infertility was significantly more often detected in couples with a male translocation carrier, secondary — with a female carrier (Fisher’s exact test, p = 0,01). Pregnancy significantly more frequent occurred and, it was also significantly more often spontaneously interrupted in couples with a female carrying of reciprocal or Robertson translocation (χ² = 13,29, df = 3, p = 0,004). Thus, a female carrying a chromosomal translocation is characterized by a greater risk of miscarriage.

CONCLUSIONS: The chromosome translocation type and the carrier’s sex have a differential effect on the nature of reproductive disorders. Female carrying a chromosomal translocation increases the likelihood of both pregnancy and its spontaneous termination. In contrast, in couples with a male translocation carrier, the probability of both pregnancy and miscarriage is lower. Thus, the type of translocation and the carrier’s sex determine the individual risks of reproductive disorders, including infertility and miscarriage, which should be considered in the planning, choosing the method of onset and management of pregnancy.