Current views on the possibility of cervical insufficiency correction

The main role in spontaneous abortion in 2nd and 3d trimesters is assigned to cervical insufficiency. According to a number of researchers, bed rest, elevated lower limbs, restriction of physical activity, tocolysis, antibacterial therapy do not affect the prolongation of pregnancy and are ineffective for preventing premature spontaneous labor. Correction of cervical insufficiency can be carried out by a vaginal form of progesterone, cerclage, pessary. The use of vaginal progesterone is justified in women with recurrent miscarriage, a history of premature birth, and shortening of the cervix to less than 25 mm. Indications for surgical correction are limited to patients with habitual loss of pregnancy due to cervical weakness or a history of premature birth. In the absence of significant obstetric history, cerclage has no advantages over the use of progesterone. The optimal time for cerclage is up to 20 weeks of pregnancy. Unlike progesterone cerclage has complications, the frequency and severity of which are attributable to the timing and indications for correction. Transabdominal cerclage is performed only when there is a technical impossibility of vaginal access due to the absence of a vaginal part of the cervix or after unsuccessful attempts of vaginal cerclages. Most often, the use of a pessary is associated with the diagnosis of a short cervix in terms of more than 24 weeks of gestation in the absence of an aggravated history. The combined use of gestagens, pessary and cerclage does not increase the efficiency of carrying a singleton pregnancy. Methods for the prevention of preterm delivery in multiple pregnancy, such as the introduction of a specialized outpatient service, bed rest, antibacterial therapy, progesterone, preventive cerclage or the insertion of a pessary do not change the incidence and mortality of newborns

Simulating the Antarctic ice sheet in the late-Pliocene warm period: PLISMIP-ANT, an ice-sheet model intercomparison project

In the context of future climate change, understanding the nature and behaviour of ice sheets during warm intervals in Earth history is of fundamental importance. The late Pliocene warm period (also known as the PRISM interval: 3.264 to 3.025 million years before present) can serve as a potential analogue for projected future climates. Although Pliocene ice locations and extents are still poorly constrained, a significant contribution to sea-level rise should be expected from both the Greenland ice sheet and the West and East Antarctic ice sheets based on palaeo sea-level reconstructions. Here, we present results from simulations of the Antarctic ice sheet by means of an international Pliocene Ice Sheet Modeling Intercomparison Project (PLISMIP-ANT). For the experiments, ice-sheet models including the shallow ice and shelf approximations have been used to simulate the complete Antarctic domain (including grounded and floating ice). We compare the performance of six existing numerical ice-sheet models in simulating modern control and Pliocene ice sheets by a suite of five sensitivity experiments. We include an overview of the different ice-sheet models used and how specific model configurations influence the resulting Pliocene Antarctic ice sheet. The six ice-sheet models simulate a comparable present-day ice sheet, considering the models are set up with their own parameter settings. For the Pliocene, the results demonstrate the difficulty of all six models used here to simulate a significant retreat or re-advance of the East Antarctic ice grounding line, which is thought to have happened during the Pliocene for the Wilkes and Aurora basins. The specific sea-level contribution of the Antarctic ice sheet at this point cannot be conclusively determined, whereas improved grounding line physics could be essential for a correct representation of the migration of the grounding-line of the Antarctic ice sheet during the Pliocene

PLISMIP-ANT, an ice-sheet model intercomparison project

In the context of future climate change, understanding the nature and behaviour of ice sheets during warm intervals in Earth history is of fundamental importance. The late Pliocene warm period (also known as the PRISM interval: 3.264 to 3.025 million years before present) can serve as a potential analogue for projected future climates. Although Pliocene ice locations and extents are still poorly constrained, a significant contribution to sea-level rise should be expected from both the Greenland ice sheet and the West and East Antarctic ice sheets based on palaeo sea-level reconstructions. Here, we present results from simulations of the Antarctic ice sheet by means of an international Pliocene Ice Sheet Modeling Intercomparison Project (PLISMIP-ANT). For the experiments, ice-sheet models including the shallow ice and shelf approximations have been used to simulate the complete Antarctic domain (including grounded and floating ice). We compare the performance of six existing numerical ice-sheet models in simulating modern control and Pliocene ice sheets by a suite of five sensitivity experiments. We include an overview of the different ice-sheet models used and how specific model configurations influence the resulting Pliocene Antarctic ice sheet. The six ice-sheet models simulate a comparable present-day ice sheet, considering the models are set up with their own parameter settings. For the Pliocene, the results demonstrate the difficulty of all six models used here to simulate a significant retreat or re-advance of the East Antarctic ice grounding line, which is thought to have happened during the Pliocene for the Wilkes and Aurora basins. The specific sea-level contribution of the Antarctic ice sheet at this point cannot be conclusively determined, whereas improved grounding line physics could be essential for a correct representation of the migration of the grounding-line of the Antarctic ice sheet during the Pliocene

Ice surface changes during recent glacial cycles along the Jutulstraumen and Penck Trough ice streams in western Dronning Maud Land, East Antarctica

Reconstructing past ice-sheet surface changes is key to testing and improving ice-sheet models. Data constraining the past behaviour of the East Antarctic Ice Sheet are sparse, limiting our understanding of its response to past, present and future climate change. Here, we report the first cosmogenic multi-nuclide (10Be, 26Al, 36Cl) data from bedrock and erratics on nunataks along the Jutulstraumen and Penck Trough ice streams in western Dronning Maud Land, East Antarctica. Spanning elevations between 741 and 2394 m above sea level, the samples have apparent exposure ages between 2 ka and 5 Ma. The highest-elevation bedrock sample indicates (near-) continuous minimum exposure since the Pliocene, with a low apparent erosion rate of 0.15 ± 0.03 m Ma−1, which is similar to results from eastern Dronning Maud Land. In contrast to studies in eastern Dronning Maud Land, however, our data show clear indications of a thicker-than-present ice sheet within the last glacial cycle, with a thinning of ∼35–120 m during the Holocene (∼2–11 ka). Difficulties in separating suitable amounts of quartz from the often quartz-poor rock-types in the area, and cosmogenic nuclides inherited from exposure prior to the last deglaciation, prevented robust thinning estimates from elevational profiles. Nevertheless, the results clearly demonstrate ice-surface fluctuations of several hundred meters between the current grounding line and the edge of the polar plateau for the last glacial cycle, a constraint that should be considered in future ice-sheet model simulations

PATHOGENETIC VALIDATION OF ADDITIONAL OBJECTIVE CRITERIA FOR POSSIBLE EFFECTIVE PREGNANCY PROLONGATION AFTER PREMATURE MEMBRANE RUPTURE

The goal of present study was a search for pathogenetical reasoning of an opportunity for prolongation of pregnancy complicated by premature rupture of membranes at a gestational term of 22-34 weeks. The patients were subject to due observation and expectant treatable of pregnancy with prevention of possible infectious and inflammatory complications, as well as monitoring of systemic inflammatory response markers, immune state, and cytokine profile of blood in pregnant women with this disorder. We conducted a comprehensive clinical and laboratory examination of fifty pregnant women, whose pregnancy was complicated by premature membrane rupture at 22-34 weeks of gestation. A control group consisted of 40 women with normal pregnancy. For assessment of cellular composition of the blood, a BC3000+ hematological analyzer was used. Distinct subsets of peripheral blood lymphocytes were studied by flow cytometry using monoclonal antibodies («FACS Calibur» «Becton Dickinson», USA). Blood levels of cytokines (IL-2, IL-6, IL-8, TNFα, IL-4, IL-10) were determined by ELISA using test systems (ZAO “VectorBest”, Novosibirsk, Russia). Stereoultrastructural study of membranes was performed with a scanning electron microscope «Hitachi S-450”. The findings suggest that the failure of membranes emerging du to systemic metabolic disorders and changes in peripheral blood cells (leukocytosis, lymphopenia due to CD19+ B lymphocytes). Moreover, one could observe reduced counts of CD16+CD56+ T cells (natural killer cells) that showed certain parallelism with increased levels of proinflammatory cytokines (IL-6, IL-8, TNFα) in blood from pregnant PROM, as well as a decrease in IL-10 and IL-4 contents antagonized their proinflammatory effects to certain extent. An opportunity of incomplete pregnancy prolongation for patients with premature rupture of membranes was based on thorough assessment of their somatic and obstetric status and general condition of the fetus, when adequate and comprehensive therapy was applied. In the course of pregnancy prolongation, we found a progressive increase in pro-inflammatory cytokine levels (IL-2, IL-6, IL-8, TNFα), a steady decrease in CD19+ B cell counts, CD3+СD4+ helpers, natural killer cells, increased levels of cytotoxic CD3+CD8+ T cells .The pathogenesis-based criteria for necessary termination of the pregnancy for women with PROM are identified, including an increase in acute-phase proteins levels in blood, development of neutrophilic leukocytosis, lymphopenia, increase of pro-inflammatory cytokine levels in blood (IL-1β, IL-6, IL-8, TNFα), along with progressive reduction of CD3+СD4+ lymphocytes, CD16+CD56+ and CD19+ В lymphocytes

Development of certified reference material (CRM) of uranium mass fraction in metallic uranium

Metallic uranium certified reference material (CRM) has been developed and certified as State certified reference material and Russian 1 class certified material (according to the RF State Standard 8609-2004) within the State system of accounting and control of nuclear materials. The certified parameter is mass fraction of uranium

АКУШЕРСКИЕ ПРОБЛЕМЫ У ВИЧ-ИНФИЦИРОВАННЫХ ЖЕНЩИН

Objective: to study the features of the course of pregnancy and childbirth in HIV-infected women in the Saratov region according to a retrospective analysis of case histories for 2013–2018. Materials and methods. A retrospective clinical and statistical analysis of the course of pregnancy, childbirth and the postnatal period was carried out according to medical records of 282 HIV-infected pregnant women who were treated at the State Agrarian Medical Center (Engels, Saratov Region, Russia) in 2013–2018. (main group). The comparison group consisted of patients who were not infected with HIV who were treated at the SAUS EOC in 2013–2018. To assess the statistical significance of differences, the standard statistical analysis software package STATISTICA 10,0 was used. Results. Compared to 2013, in 2018, the age of HIV-infected pregnant women has decreased (p&lt;0,05). HIV-infected people are less likely to go to a maternity clinic before the 12th week of pregnancy (p&lt;0,05). A high frequency of co-infection of HIV-infected women with urinary infection (p&lt;0,05) and genital tract (p&lt;0,05), hepatitis C viruses (p&lt;0,05) and B (p&lt;0,05), and syphilis was found anamnesis (p&lt;0,05). A high susceptibility of these women to viral infections was noted: acute respiratory viral infection (p&lt;0,05), genital herpes virus (p&lt;0,05), cytomegalovirus infection (p&lt;0,05). The incidence of sexually transmitted infections is high: urogenital chlamydia (p &lt;0,05), trichomonas colpitis (p&lt;0,05). HIV-infected pregnant women have an increased incidence of anemia (p&lt;0,05), chronic pyelonephritis (p&lt;0,05), and skin diseases (p&lt;0,05), and body mass deficiency is more common (p&lt;0,05). In case of HIV infection, the frequency of operative delivery (p&lt;0,05), premature birth (p&lt;0,05), the frequency of formation of a low-weight fetus at a time of gestation (p&lt;0,05), as well as perinatal mortality (p&lt;0,05). The reserve for reducing perinatal mortality for newborns from HIV-infected mothers is in the pregravid period, testing for HIV, hepatitis C virus, correction of the patient’s weight, elimination of the iron deficiency condition, detection and rehabilitation of urogenital foci. When taking to a dispensary account, control and correction of anemia, chronic infectious diseases, monitoring of the state of the vaginal biocenosis are necessary, in the second half of pregnancy — control of fetal growth.Цель: изучить особенности течения беременности и родов у ВИЧ-инфицированных женщин Саратовской области по данным ретроспективного анализа историй болезни за 2013–2018 годы. Материалы и методы. Проведен ретроспективный клинико — статистический анализ течения беременности, родов и послеродового периода по данным медицинской документации 282 ВИЧ-инфицированных беременных, находившихся на лечении в ГАУЗ ЭПЦ (г. Энгельс, Саратовская область, Россия) в 2013–2018 годах (основная группа). Группу сравнения составили пациентки, не инфицированные ВИЧ, находившиеся на лечении в ГАУЗ ЭПЦ в 2013–2018 годах. Для оценки статистической значимости различий использован стандартный пакет программ статистического анализа STATISTICA 10.0. Результаты. По сравнению с 2013 годом в 2018 году возраст ВИЧ-инфицированных беременных уменьшился (p&lt;0,05). ВИЧ-инфицированные реже обращаются в женскую консультацию до 12 недели беременности (p&lt;0,05). Установлена высокая частота коинфицирования ВИЧ-инфицированных женщин инфекцией мочевых (р&lt;0,05) и половых путей (р&lt;0,05), вирусами гепатитов С (р&lt;0,05) и В (р&lt;0,05), сифилисом в анамнезе (р&lt;0,05). Отмечена высокая поражаемость этих женщин вирусными инфекциями: острой респираторной вирусной инфекцией (р&lt;0,05), вирусом генитального герпеса (р&lt;0,05), цитомегаловирусной инфекцией (р&lt;0,05). Высока частота встречаемости инфекций, передающихся половым путем: урогенитального хламидиоза (р&lt;0,05), трихомонадного кольпита (р&lt;0,05). У ВИЧ-инфицированных беременных отмечается повышенная заболеваемость анемией (р&lt;0,05), хроническим пиелонефритом (р&lt;0,05), кожными заболеваниями (р&lt;0,05), чаще встречается дефицит массы тела (р&lt;0,05). При ВИЧ-инфицировании увеличивается частота оперативного родоразрешения (p&lt;0,05), преждевременных родов (p&lt;0,05), частота формирования маловесного к сроку гестации плода (p&lt;0,05), а также перинатальной смертности (p&lt;0,05). Резервом для снижения перинатальной смертности для новорожденных от ВИЧ-инфицированных матерей являются в прегравидарном периоде тестирование на ВИЧ, вирус гепатита С, коррекция веса пациентки, исключение железодефицитного состояния, выявление и санация очагов мочеполовой инфекции. При взятии на диспансерный учет необходим контроль и коррекция анемии, хронических инфекционных заболеваний, мониторирование состояния биоценоза влагалища, во второй половине беременности — контроль роста плода. </p