Options for overcoming implantation failures in infertility of uterine genesis due to chronic endometritis. A review

Chronic endometritis remains one of the most controversial issues of modern gynecology. The high relevance of research in this area is confirmed not only by the high prevalence but also by the extremely negative impact of this disease on the reproductive potential of patients. The complexity of the pathogenesis mechanism of the chronic inflammatory process of the endometrium stimulates the genuine interest of the world gynecological community to study the main patterns of endometrial receptor disorder, including implantation status and repeated reproductive failures. In this regard, it is essential to summarize the accumulated results of worldwide research to find the most optimal and effective diagnostic and therapeutic approaches

A review of international and national clinical guidelines for the management of patients with endometrial polyps

Endometrial polyp (EP) is a common disease of the uterine mucosa in reproductive age, peri- and post-menopause. Hysteroscopy is the primary method of diagnosing EP, and polypectomy is the method of choice for treatment. Despite many years of research on EP, there are still gaps in the understanding of its pathogenesis; approaches to the diagnosis and therapy of EP are not standardized, which makes it difficult for gynecologists to make informed decisions about the management of patients with this disease. It determined the focus of our work. We reviewed clinical guidelines for EP diagnosis and treatment from the American Society of Gynecological Endoscopy, the Norwegian Society for Gynecology and Obstetrics, the draft clinical guidelines "Endometrial polyps" from the Russian Society for Obstetrics and Gynecology (as of July 28, 2022, not approved by the Russian Ministry of Health); as well as the Royal College of Obstetricians and Gynecologists guideline on the management of women with endometrial hyperplasia. The review has led to the conclusion that the recommendations in the current clinical guidelines for the management of women with EP are inconsistent and the diagnostic algorithm for suspected EP is not well-established; the indications for the wait-and-see, surgical treatment of EP are not defined; criteria of high oncological risk requiring surgical treatment of EP are not formulated. Clarifying these issues will help gynecologists make informed decisions about treatment options

Патогенез опущения влагалища с формированием ректоцеле

To carry out a systematic analysis of the data available in the modern literature on the pathogenesis of the formation of vaginal prolapse with the formation of rectocele rectum. The failure of the pelvic floor, namely its posterior compartment with the formation of a rectocele against the background of the lowering of the posterior vaginal wall, continues to be one of the most common gynecological diseases. This article presents an analysis of current literature data on the pathogenesis of pelvic organ prolapse with the formation of rectocele. Analyzing the above-mentioned data, it can be noted that the research data of recent years have significantly expanded the understanding of the etiology and pathogenesis of pelvic organ prolapse in its posterior compartment. However, the issues of etiology and pathogenesis of genital prolapse in patients of reproductive age, the role of individual risk factors and their combinations, pathogenetic mechanisms of development are still far from being resolved. Unfortunately, none of the above theories fully explains all the reasons for the formation of pelvic organ prolapse in its posterior compartment.Проведен систематический анализ данных, имеющихся в современной литературе, относительно патогенеза формирования опущения влагалища с формиро- ванием ректоцеле. Несостоятельность тазового дна, а именно заднего компартмента с формированием ректоцеле на фоне опущения задней стенки влагалища, продолжает оставаться одним из наиболее распространенных гинекологических заболеваний. В статье представлен анализ современных данных литературы о патогенезе пролапса тазовых органов (ПТО) с формированием ректоцеле. Исследования последних лет заметно расширили представления об этиологии и пато- генезе ПТО в его заднем компартменте. Однако вопросы этиологии и патогенеза генитального пролапса у пациенток репродуктивного возраста, роли отдельных факторов риска и их сочетаний, патогенетические механизмы развития все еще далеки от окончательного решения. К сожалению, ни одна из существующих теорий полностью не объясняет все причины формирования ПТО в его заднем компартменте

Efficacy of laser remodeling in the genitourinary syndrome of menopause: A review

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice. Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause

Vulvovaginal atrophy in the peri- and post-menopause: relevance and impact on quality of life

Vulvovaginal atrophy (VVA) is detected in more than 50% of postmenopausal women, and at 4049 years of age, 15-19% of women have relevant signs. Atrophic changes in the female urogenital system are associated with hypoestrogenism, which results in the defective synthesis of collagen and elastin due to reduced functional activity of fibroblasts. Although the symptoms of genitourinary syndrome of menopause significantly impair the quality of life, women rarely seek medical help for urogenital symptoms, considering them a normal condition for the period of aging. We searched Cochrane Library, PubMed, Science Direct, and ELibrary databases for the keywords vulvovaginal atrophy, genitourinary syndrome of menopause, quality of life, epidemiology, and postmenopausal age for 20122022. The literature review suggests that the prevalence of VVA is extremely high but underestimated due to the infrequent seeking of medical care by female patients with relevant symptoms. The genitourinary syndrome of menopause dramatically impacts patients' quality of life, but not all women eligible for treatment receive it. One of the reasons for refusing hormonal treatment is patients' fear of the systemic effects of hormonal drugs. There is an unmet need for alternative non-hormonal therapies. The objective is to analyze and systematize the scientific data accumulated over the past ten years on the epidemiology of VVA, its impact on patients' quality of life, and the challenges in diagnosing and treating the disease

Risk factors for in vitro fertilization failures in women with adenomyosis-associated infertility

Aim. To identify risk factors for in vitro fertilization (IVF) failures in women with adenomyosis-associated infertility. Materials and methods. The study included 83 patients of reproductive age with adenomyosis. Women were divided into two groups: the main group (n=53) included patients with adenomyosis and a history of 1 or more unsuccessful attempts at embryo transfer, and the comparison group (n=30) included women with adenomyosis without impaired fertile function. The mean age of the patients was 364.0 years. Results. Gynecological conditions such as cervical dysplasia, noninflammatory vaginal diseases, and a history of sexually transmitted infections (STIs) were significantly (5-fold) more common in patients with a history of IVF failures (p0.05). A high prevalence of endocrine and digestive system disorders (27.7 and 7.7 times, respectively) was found in infertile women with adenomyosis (p0.05). Coagulation disorders were identified 4.8 times more often in women with adenomyosis-associated infertility and IVF failures. Inflammatory and proliferative endometrial diseases (hyperplasia, intrauterine synechia, and chronic endometritis) were significantly more common in patients in the main group than in patients with adenomyosis without impaired fertility (p0.05). Conclusion. Risk factors for IVF failure in women with adenomyosis-associated infertility are other specified coagulation defects [D68.8] (antiphospholipid syndrome), odds ratio (OR) 4.8, 95% confidence interval (CI) 1.120.9; dysplasia of cervix uteri, unspecified [N87.9] (OR 10.2, 95% CI 1.292.4), other noninflammatory disorders of vagina [N89.7] (OR 10.2, 95% CI 1.292.4), STIs (OR 12.7, 95% CI 1.4112.5), endocrine system disorders (OR 27.7, 95% CI 1.5516.5), and digestive system disorders (OR 7.8, 95% CI 2.227.8)

Патогистологические изменения в легких в отдаленные сроки после COVID-19

World literature is paying increasing attention to the long-term course of COVID-19 and symptoms that appear after the acute coronavirus infection. The symptoms, functional state of the lungs, and the X-ray changes are assessed. Nevertheless, post-COVID lung histology has not been described yet.The aim of this article is to study the long-term pathological changes in the lungs after acute COVID-19. Methods. We analyzed autopsy lung material from 19 deceased who had COVID-19. The average age of the deceased was 68.82 ± 14.6 years. All patients were found to have IgG to SARS-CoV-2. The median time to death following viral interstitial pneumonia was 72 days. Results. The causes of death and thrombotic complications (infarctions of various organs and venous thrombosis) were analyzed. Histological examination revealed thrombosis of small pulmonary arteries and capillaries of interalveolar septa, microinfarctions, hemorrhages, foci of organizing pneumonia, and nonspecific interstitial pneumonia.Conclusion. The first assessment of histological changes in human lungs showed that the most common post-COVID pathologic changes are microcirculation disorders combined with small areas of acute lung damage. The obtained data are essential for understanding the pathogenesis of post-COVID syndrome, necessitate diagnostic of microvasculature disorders using laboratory tests, scintigraphy, and CT imaging, as well as search for the therapeutic strategies.В мировой медицинской литературе все большее внимание уделяется проблеме длительного течения COVID-19 и появлению симптомов у лиц, перенесших коронавирусную инфекцию (КИ). Проводится оценка симптомов, функционального состояния легких, а также динамики рентгенологических изменений. Тем не менее работ по исследованию гистологических изменений в легких в доступной литературе не обнаружено.Целью данного исследования явилось изучение патогистологических изменений в легких в отдаленные сроки после перенесенной КИ.Материалы и методы. Выполнен анализ аутопсийного материала легких, полученного от умерших больных (n = 19; средний возраст – 68,82 ± 14,6 года), ранее перенесших КИ. Во всех случаях обнаружены иммуноглобулины G к SARSCoV-2. Медиана времени до момента смерти после перенесенной вирусной интерстициальной пневмонии составила 72 дня.Результаты. По результатам анализа причин смерти выявлены осложнения после перенесенного COVID-19 в виде инфарктов разных органов и тромбозов венозной системы. При патогистологическом исследовании отмечены выявлены тромбоз мелких ветвей легочных артерий и капилляров межальвеолярных перегородок, микроинфаркты, кровоизлияния, очаги организующейся и неспецифической интерстициальной пневмоний.Заключение. Впервые по результатам оценки гистологических изменений в легких показано, что наиболее часто в отдаленные сроки после перенесенного COVID-19 выявляются нарушения микроциркуляции, сочетающиеся с мелкими участками острого повреждения легких. Полученные данные важны для понимания патогенеза постковидного синдрома и диктуют необходимость диагностики прижизненных нарушений в микроциркуляторном русле с использованием лабораторных методов, сцинтиграфии и методов компьютерной визуализации, а также поиска терапевтических стратегий

The Role of Altered Mitochondrial Metabolism in Thyroid Cancer Development and Mitochondria-Targeted Thyroid Cancer Treatment

Thyroid cancer (TC) is the most common type of endocrine malignancy. Tumour formation, progression, and metastasis greatly depend on the efficacy of mitochondria—primarily, the regulation of mitochondria-mediated apoptosis, Ca2+ homeostasis, dynamics, energy production, and associated reactive oxygen species generation. Recent studies have successfully confirmed the mitochondrial aetiology of thyroid carcinogenesis. In this review, we focus on the recent progress in understanding the molecular mechanisms of thyroid cancer relating to altered mitochondrial metabolism. We also discuss the repurposing of known drugs and the induction of mitochondria-mediated apoptosis as a new trend in the development of anti-TC therapy

Novel Models of Crohn’s Disease Pathogenesis Associated with the Occurrence of Mitochondrial Dysfunction in Intestinal Cells

Crohn’s disease remains one of the challenging problems of modern medicine, and the development of new and effective and safer treatments against it is a dynamic field of research. To make such developments possible, it is important to understand the pathologic processes underlying the onset and progression of Crohn’s disease at the molecular and cellular levels. During the recent years, the involvement of mitochondrial dysfunction and associated chronic inflammation in these processes became evident. In this review, we discuss the published works on pathogenetic models of Crohn’s disease. These models make studying the role of mitochondrial dysfunction in the disease pathogenesis possible and advances the development of novel therapies

Long Non-Coding RNAs in Colorectal Cancer: Navigating the Intersections of Immunity, Intercellular Communication, and Therapeutic Potential

This comprehensive review elucidates the intricate roles of long non-coding RNAs (lncRNAs) within the colorectal cancer (CRC) microenvironment, intersecting the domains of immunity, intercellular communication, and therapeutic potential. lncRNAs, which are significantly involved in the pathogenesis of CRC, immune evasion, and the treatment response to CRC, have crucial implications in inflammation and serve as promising candidates for novel therapeutic strategies and biomarkers. This review scrutinizes the interaction of lncRNAs with the Consensus Molecular Subtypes (CMSs) of CRC, their complex interplay with the tumor stroma affecting immunity and inflammation, and their conveyance via extracellular vesicles, particularly exosomes. Furthermore, we delve into the intricate relationship between lncRNAs and other non-coding RNAs, including microRNAs and circular RNAs, in mediating cell-to-cell communication within the CRC microenvironment. Lastly, we propose potential strategies to manipulate lncRNAs to enhance anti-tumor immunity, thereby underlining the significance of lncRNAs in devising innovative therapeutic interventions in CRC