Role of cytokines in pathogenesis, diagnosis and efficiency evaluation of immunotherapy in various variants of sclerotic lichen in women

Our aim was to evaluate diagnostic and pathogenetic significance of plasma cytokines (IL-20, IL-23, IL-10, TNFα, IFNγ) in the patients with various clinical and histological variants of sclerotic lichen and to assess opportunity for their use as effectiveness criteria of immunotherapy for this disease using a drug based on eukaryotic deoxyribonucleic acid (Derinat). The prospective cohort study included assessment of the clinical manifestations (itching and dyspareunia) and measurement of blood cytokine contents (IL-20, IL-23, IL-10, TNFα, IFNγ) in women (n = 114) with various clinical variants of sclerotic lichen (atrophic, sclerotic and sclerotic-atrophic) before and after immunotherapy with a nucleic acid-based drug (Derinat). Derinat was chosen due to the fact of being an agonist of Toll-like receptors, and a number of immunoregulatory effects, including the ability to modulate cytokine production and to exert a positive influence upon regeneration processes. In addition, based on visual inspection, vulvoscopy and morphohistochemical examination results (evaluation criteria: skin thickness, number of collagen fibers, severity of fibrosis and sclerosis, etc.), the corresponding subgroups were classified within the II group, i.e., 2.1 (minimal sclerotic signs, n = 14), and 2.2 (pronounced sclerotic signs, n = 20). The control group consisted of conditionally healthy women, without history or presence of vulvar pathology (n = 30), with an age ranging from 20 to 50 years. Along with cytokine assessment by enzyme immunoassay, the study used the data of clinical examination (anamnesis collection, examination, palpation, vulvoscopy), as well as complex morphohistochemical evaluation of vulvar tissues. In atrophic variant, we have observed an increase in plasma IL-23 content, along with decreased TNFα; in lichen sclerosis, a maximal increase in IL-20, IL-23, and IFNγ was revealed; in sclerotic form of sclerotic lichen variant with severe sclerotic features, maximally enhanced IL-20, IL-23, TNFα, IFNγ, along with minimal levels of IL-10 was registered, as compared with other groups. Immunotherapy using Derinate resulted into significant reduction in the clinical manifestations in sclerotic lichen, i.e., itching of the vulva and dyspareunia, as well as normalization of cytokine indexes. Our studies have demonstrated an opportunity of using plasma concentrations of IL-20, IL-23, IL-10, TNFα, IFNγ as biomarkers of sclerotic lichen variants, and as laboratory criteria for efficiency of immunotherapy

PARAMETERS OF CARDIORESPIRATORY SYNCHRONISM AND THEIR DERIVATIVES IN THE ASSESSMENT OF THE FUNCTIONAL STATE WHEN RESTORING ERECTILE FUNCTION IN MEN AFTER PROSTATE CANCER TREATMENT METHOD HIFU

Aim. To assess the functional state in the recovery of erectile function in men after the treatment of cancer by HIFU, the parameters of cardiopulmonary synchronism and their derivatives.Materials and methods. Observations were performed on 24 patients aged 45-56 years, who were referred to the increase in the level of the prostatic specific antigen for inpatient treatment in the urological department. At their inspection the cancer of a prostate of I-II stage has been diagnosed. Patients underwent a cardiac-respiratory synchronism test and determined the regulatory-adaptive status index and regulatory-adaptive capabilities by its parameters. After diagnosis, patients were assigned tumor destruction by transrectal high-intensity focused ultrasound ablation. After the operation, the patients were discharged from the hospital the next day and further follow-up was conducted in an outpatient setting with a visit to the hospital at 1, 3, 6, 12 months. After 6 months, the sample of the cardiopulmonary synchronism was repeated. According to questionnaires subjective assessment of the international index of erectile function ICEF-5, the QOL index assessment of quality of life. Statistical analysis of the results of the study was carried out using the programs: "STATISTIKA 6.0 for Windows". After establishing the normal distribution of the variant, significant differences were used in comparing the mean values in paired comparisons, taking the t-test of Student for p <0,05.Results. Before treatment in a group of 24 patients, regulatory-adaptive capabilities were assessed as satisfactory. After treatment of prostate cancer with the method of transrectal high-intensity focused ultrasound ablation, the level of the prostatic specific antigen was sharply reduced from 6,81±0,32 to 0,70±0,01 ng/ml (p<0,001), the tumor volume from 39,8±0,4 to 8,5±0,3 cm3 (p<0,001). Six months after the treatment of prostate cancer, the synchronization range increased by 22,5%. The duration of synchronization development decreased by 39,1%. This led to an increase in the regulatory-adaptive status index by 100,6%. Regulatory adaptive capabilities varied from "satisfactory" to "good". Six months after the treatment of prostate cancer in patients, part of the prostate gland was preserved and ejaculation was possible. Erectile function resumed 6 months after surgery, when regulatory and adaptive capacities were restored. And in 16 people, whose index of regulatory-adaptive status was 77,9±0,4, the international index of erectile function was 23,8±0,1 points. This indicates that the state of erection is normal. The index of quality of life assessment QOL they had 0,9±0,1 points, which corresponds to a good quality of life. In 8 patients with a regulatory-adaptive status index of 44,6±0,4, the international index of erectile function was 18,2±0,3, indicating mild erectile dysfunction. The index of QOL quality of life was 2,1±0,2 points, which corresponds to a satisfactory quality of life.Conclusion. The positive dynamics of the range of cardiopulmonary synchronism, a decrease in the duration of synchronization at the minimal border, an increase in the index of regulatory-adaptive status and regulatory-adaptive capabilities integrally reflect the consequences of effective treatment of prostate cancer and, consequently, the preservation of erectile function

STUDY OF MULTIPLE FACTORS INFLUENCING THE DEVELOPMENT OF ANOMALIES OF LABOR ACTIVITY

Goal. To determine multiple factors influencing the development of anomalies of labor activity to optimize the examination of pregnant women after 37th week of gestation.Materials and methods. 308 pregnancies that resulted in delivery of term fetuses complicated by various anomalies of labor activity have been monitored. 154 patients have been selected and divided into 4 clinical groups: group 1. 27 pregnant women (17,54%) with pathological preliminary period; group 2. 39 pregnant women (25,32%) with rapid birth; group 3. 41 pregnant women (26,62%) with uterine inertia and group 4. 47 pregnant women (30,52%) with discoordination of labor activity Results. Rank correlation, characterizing the redistribution of muscle mass of the anterior wall of the uterus during childbirth has been identified. The change in the level of energy consumed for birth labor in patients with anomalies occurs on the background of low level of stress tolerance and changing IRAS.Correlation analysis allows us to determine the level of glucose, which correlates with interleukin levels, and pH levels which also correlate with levels of interleukin. Both glucose, and pH correlate with the anomalies of labor activity. A strong correlation has been identified between the thickness of the anterior wall of the uterus and the level of interleukins.Conclusion. After 37th week of pregnancy, while defining the level of stress tolerance in the groups of pregnant women, threatened by the development of anomalies of labor activity, the calculation of the IRAS on the background of the laboratory determination of glucose, blood pH and thickness of the anterior wall of the uterus, will allow forming an individual plan of delivery and reducing obstetric and fetal injurie

Breast-feeding efficacy prognosis by digestive enzymes activity in newborns

Aim of investigation. To present to the new data on initial digestive potential of the full-term and premature newborns according to the level of digestive enzymes in serum of the puerperant woman and her child, stomach content of latter and amniotic waters. Material and methods. Material was received from 76 puerpera and their newborns at the full-term and premature pregnancies. Content of hydrolases: amylase, lipase, pepsinogens-I and II was assessed in blood serum of umbilical cord, venous blood of the mother, amniotic fluid and newborn stomach content. Enzymes were detected by Roche diagnostic kit, pepsinogens - Abbott immunoassay test. Results. Fetal development of different enzyme systems digestive potential develops in different terms, and is significantly lower in the newborn, then in the mother, in premature children it is lower, than in those born often normal gestation term. Pepsinogen II concentration is higher than that of pepsinogen I both in stomach content and amniotic fluid. Conclusions. Newborn digestive potential at the end of gestation is determined by his/her digestive glands and can be characterized by hydrolases activity in amniotic fluid, umbilical cord blood and stomach content. This potential acts as is gastroenterological criterion for breast-feeding readiness

PROBLEMS OF DIAGNOSIS AND TREATMENT OF PATIENTS WITH BACKGROUND PROCESSES AND TUMOR PATHOLOGY OF THE VULVA

Aim. The study was designed for the optimization of the approaches to the diagnosis and management of women with background diseases and tumor pathology of the vulva.Materials and methods. The study involved more than a thousand and a half patients from different regions of Russia and CIS countries with precancerous and tumor pathology of the external genitals. A variety of methods were used in the primary diagnosis and monitoring in the treatment and observation, ranging from the banal examination, palpation, laboratory studies and ending with modern morphological studies, CT, MRI and PET diagnostics.Results. The characteristic differences in the background processes of the vulva were revealed, which allowed us to divide them into two groups: the first group – the pathological process occurs against the background of dystrophic changes in the tissues of the external genitals; the second group – the dermis and subcutaneous fat are not changed. Clear morphological criteria of two variants of changes are accompanied by a significantly different clinical picture. Conservative measures had low efficiency in the pathology of the vulva with a neurodystrophic process. Carrying out a photodynamic therapy and laser vaporization is justified only in young and middle-aged women with precancer. It was found that the high efficiency of surgical treatment is combined with a large number of early and late postoperative complications, which in itself causes discomfort, pain, dysuric phenomena, and dyspareunia. It is possible to reduce the frequency of postoperative complications and improve the functional and cosmetic results of the treatment only with the use of reconstructive plastic surgery. We have developed and widely implemented the methods of closing wound defects in everyday practice and evaluated their effectiveness. Conclusion. Over the past 20 years, a lot of work has been done to address the topical issues related to the diagnosis and treatment of background processes, precancer and vulva cancer. However, at present, there is no center where theoretical issues are studied at a serious level, conservative and invasive methods of treatment are developed, and educational and methodical work with doctors is carried out. Without proper attention to these issues, this problem is unlikely to be solved in the near future, both from theoretical and practical points of view

IMPLEMENTATION OF INTERNATIONAL ISO 9001 STANDARD AS AN INSTRUMENT OF MEDICAL SERVICES QUALITY IMPROVEMENT

In this research are presented the modern approaches to the management improvement in a medical institution for providing high  quality medical services. Here are also presented the main stages and  results of the international ISO 9001 standard implementation. The  purposeful and systematic efforts for maintaining and improving the  quality system management processes allow us to use ISO 9001 as a highly effective instrument for the constant improvement of medical care quality

COC’s application for decreasing cardiovascular risks

Nowadays application of combined oral contraceptives with folates is considered not only as effective contraception, but also as  treatment of hyperandrogenic dermopathy and prophylaxis of cardiovascular diseases

Evaluation of regulatory-adaptive status of pregnant women with type ii diabetes at 38-40 weeks of gestation

Observations were performed on 20 healthy pregnant women and 84 women with diabetes on 38-40 weeks of gestation. All pregnant conducted obstetric examination, determined the glycemic profile, urinalysis, glucose, ketone bodies, acetone. The regulatory-adaptive status was evaluated on a sample of cardio-respiratory synchronism. Registration of uterine activity, along with the movements of the fetus and the fetal heart rate was monitored by external cardiotocography. To determine the functional state of the fetus were used ultrasound. It was found that among 34 pregnant women 9 of them had incorrect diagnosis compensated diabetes, which had been disproved by values of regulatory-adaptive status indicated decompensated diabetes. Later the diagnosis had been proved. Thus, the question of delivery of pregnant women with diabetes should not only be on the level of blood glucose, glycated hemoglobin, fetal biophysical profile data, but also on the regulatory-adaptive status which is determined by the parameters of the sample cardiorespiratory synchronism

ADVANTAGES OF CONSERVING SURGERY WITH EXCISION OF MUCO-MUSCULAR CERVICAL FLAP BY USING TRANSVAGINAL MORTSELLYATOR IN THE TREATMENT OF BENIGN COMBINED PATHOLOGY OF THE CERVIX AND UTERINE BODY

On the basis of a comprehensive study of the clinical and laboratory parameters of a comparative assessment of the effectiveness of operations subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator and total hysterectomy about benign combined pathology of the cervix and uterine body. Depending on the extent of surgical treatment 2 groups of women were formed, who have had total hysterectomy and subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator. As a result of further examination revealed the benefits of subtotal hysterectomy with excision of muco-muscular cervical flap: the duration of the operation, blood loss, and drop in hemoglobin levels after surgery. Preserving the anatomical relationship of the pelvic organ, saving ligament apparatus and cervical innervations save vaginal integrity, reduce the risk of complications in the form of descent and prolapse of the vaginal walls in the late postoperative period, which will undoubtedly improve the quality of life of women