Модель прогнозирования и управления преждевременными родами

Background: It seems relevant to study the contribution of socio-demographic, somatic and obstetric-gynecological factors in the implementation of preterm birth. Aims: Assessment of the prognostic significance of socio-demographic, obstetric-gynecological and somatic factors in the prediction of preterm birth and associated adverse pregnancy outcomes with subsequent validation of the prognostic model. Materials and methods: Cohort study with a mixed cohort. A retrospective assessment of socio-demographic factors, harmful habits, obstetric and gynecological pathology, somatic diseases, course and outcomes of pregnancy was carried out with the assessment of the status of newborns in 1246 women with subsequent construction of a predictive model of preterm birth and adverse outcomes of pregnancy using Regression with Optimal Scaling and its prospective validation in 100 women. Results: The most significant predictors, that increase the chance of preterm birth and adverse pregnancy outcomes, were history of premature birth, irregular monitoring during pregnancy, history of pelvic inflammatory disease, smoking, obesity, the onset of sexual activity up to 16 years, cardiovascular and endocrine diseases. Intellectual job reduced the chance of preterm birth and adverse pregnancy outcomes This multivariate predictive model has a diagnostic value. The score of risk factors 25 points had a sensitivity of 73%, a specificity of 71%, the area under the ROC curve (AUC) 0.76 (good quality), p0.001. After stratification of high-risk groups by maternal and perinatal pathology the following list of diagnostic and therapeutic measures is introduced and actively implemented in antenatal clinics. To stratificate this model, we prospectively analyze the course and pregnancy outcomes of 100 women divided into 2 groups: group 1 ― 50 women with preterm delivery, group 2 ― 50 women with term delivery. A total score of 25 and above had 44% of women in group 1 and only 10% of women in group 2 (sensitivity 81.4%, specificity 61.6%, positive predictive value 44%, negative predictive value 90%, positive likelihood ratio 2.2 [1.53.0], negative likelihood ratio 0.3 [0.130.68]). Conclusions: We have proposed a model for predicting preterm birth and delivery and perinatal losses using the available characteristics of pregnant women from early pregnancy with moderate indicators of diagnostic value. Further validation of the model in the general population of pregnant women is required.Обоснование. Представляется актуальным изучение вклада социально-демографических, соматических и акушерско-гинекологических факторов в реализацию преждевременных родов. Цель исследования ― оценка значимости социально-демографических, акушерско-гинекологических и соматических факторов в прогнозировании преждевременных родов и ассоциированных с ними неблагоприятных исходов беременности с последующей валидизацией прогностической модели. Методы. Когортное исследование со смешанными группами участников. Проводилась ретроспективная оценка социально-демографических факторов, вредных привычек, соматических заболеваний, гинекологической патологии, течения и исходов беременности для новорожденных у 1246 женщин с целью построения модели прогнозирования преждевременных родов и неблагоприятных исходов беременности при помощи регрессионного анализа с оптимальным шкалированием и валидизацией модели у 100 женщин. Результаты. Наиболее значимыми предикторами, увеличивающими риск преждевременных родов и неблагоприятных исходов беременности, оказались преждевременные роды в анамнезе, нерегулярное наблюдение во время беременности, воспалительные заболевания органов малого таза в анамнезе, курение, ожирение, начало половой жизни до 16 лет, сердечно-сосудистые и эндокринные заболевания. Принадлежность к интеллектуальной работе, наоборот, уменьшала риск преждевременных родов и ассоциированных с ними неблагоприятных исходов. Данная прогностическая модель продемонстрировала диагностическую ценность. При подсчете 25 и более баллов модель имела чувствительность 73%, специфичность 71%, площадь под ROC-кривой (AUC) 0,76 (качество хорошее), р0,001. После стратификации групп высокого риска по материнской и перинатальной патологии в условиях женской консультации внедрен и активно проводится определенный перечень диагностических и лечебно-профилактических мероприятий. С целью стратификации модели проспективно проанализированы течение и исходы беременности у 100 женщин, разделенных на 2 группы по 50 человек, чья беременность закончилась преждевременными или своевременными родами. В группе 1 суммарный балл 25 имели 44% женщин, в группе 2 ― только 10% женщин (чувствительность 81,4%, специфичность 61,6%, положительная прогностическая значимость 44%, отрицательная прогностическая значимость 90%, положительное отношение правдоподобия 2,2 [1,53,0], отрицательное отношение правдоподобия 0,3 [0,130,68]). Заключение. Нами предложена модель прогнозирования преждевременных родов и перинатальных потерь с использованием доступных характеристик беременных женщин с ранних сроков беременности с умеренными показателями диагностической значимости. Требуется дальнейшая валидизация модели на большей популяции беременных женщин

Gender characteristics of the pathogenesis, prevention and treatment of metabolic syndrome [Гендерные особенности патогенеза, профилактики и лечения метаболического синдрома]

Metabolic syndrome (MS) is widespread which explains high relevance of the topic. The MS development depends on various factors (age, race, social and economic status, level of physical activity, cultural development, diet, genetic background and educational level). Traditionally, the MS assessment and cardiovascular risk stratification includes measurement of total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, as well as glucose and insulin levels. Some other factors are being investigated and might serve as the surrogate endpoints for the effectiveness of treatment and prevention strategies in addition to insulin resistance indices (HOMA-IR, Caro). These include some systemic biomarkers such as highly sensitive C-reactive protein, leptin and adiponectin, which mediate the link between inflammation and obesity, as well as potentially prognostic markers of cardiovascular diseases. The paper considers the gender specificity of the MS and main components of the MS, such as hypertension, insulin resistance, obesity, and dyslipidemia. We review different approaches of international guidelines and specific regional and national characteristics and analyze gender-related peculiarities of each component of the MS in order to justify an individualized choice of management approach. © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved

Analysis of approaches to treating seasonal allergic rhinitis in pregnant women

Approximately 20-30% of reproductive-aged women suffer from seasonal allergic rhinitis, the uncontrolled course of which during pregnancy can not only worsen the quality of life and the course of comorbidities, but also give rise to maternal and fetal hypoxia. Objective. To analyze approaches to treating seasonal allergic rhinitis in pregnant women. Subjects and methods. An anonymous questionnaire survey of physicians (332 therapists and 734 obstetricians/ gynecologists) was conducted within the study “Epidemiology of Medication Use in Pregnant Women” (Stage 2); the clinical guidelines of foreign and Russian professional societies for this problem were analyzed. Results. The physicians rarely indicated topical steroids (8.4%); first-generation antihistamines were the leaders (29.7%); the physicians less often indicated second-generation drugs, such as loratadine (13.8%) and cetirizine (10.7%). Conclusion. In accordance with the guidelines, the approach to treating allergic rhinitis in pregnant women should be the same as applied to other patients; an important part is assigned to nondrug therapies. By taking into account the high prevalence of this disease, it is appropriate to do educational work on this problem among physicians. © Bionika Media Ltd

Analysis of approaches to treating seasonal allergic rhinitis in pregnant women

Approximately 20-30% of reproductive-aged women suffer from seasonal allergic rhinitis, the uncontrolled course of which during pregnancy can not only worsen the quality of life and the course of comorbidities, but also give rise to maternal and fetal hypoxia. Objective. To analyze approaches to treating seasonal allergic rhinitis in pregnant women. Subjects and methods. An anonymous questionnaire survey of physicians (332 therapists and 734 obstetricians/ gynecologists) was conducted within the study “Epidemiology of Medication Use in Pregnant Women” (Stage 2); the clinical guidelines of foreign and Russian professional societies for this problem were analyzed. Results. The physicians rarely indicated topical steroids (8.4%); first-generation antihistamines were the leaders (29.7%); the physicians less often indicated second-generation drugs, such as loratadine (13.8%) and cetirizine (10.7%). Conclusion. In accordance with the guidelines, the approach to treating allergic rhinitis in pregnant women should be the same as applied to other patients; an important part is assigned to nondrug therapies. By taking into account the high prevalence of this disease, it is appropriate to do educational work on this problem among physicians. © Bionika Media Ltd

Structural and electronic properties of Na/Cu(111) at different coverages by first principles

Nanostructures are presently enjoying an increasing interest in the field of materials science. In particular, importance is given to ordered monolayers prepared by deposition of atoms on a crystalline surface. The growth of these superlattices can be controlled so as to obtain an ordered structure by means of the lateral interaction of adatoms lying on the metal surface. The objective of our study is to investigate the structural and electronic properties using DFT total-energy calculations; we employ a jellium-like model to describe the substrate but we also take into account the presence of discrete surface states that are known to affect the lateral interaction. Our treatment of the substrate is based on the model proposed by E.V. Chulkov et al. [Surf. Sci. 437, 330 (1999)]; in this model one constructs a mono-dimensional potential so as to reproduce some important electronic properties of the metal surface, such as i) the energy gap in the projected bulk band-structure and ii) the energy position of surface states. We put into practice Chulkov potential implementing into an existing plane-waves code (ABINIT, URL http://www.abinit.or