Обоснование эффективности антибактериальной терапии в лечении хронической воспалительной болезни матки

A review of studies on chronic endometritis enables the authors to conclude that bacterially contaminated endometrium is the reason causing reduced fertility in case of confirmed subclinical inflammation. Chronic subclinical inflammation of the endometrium is often associated with genital endometriosis, which apparently leads to abnormal uterine bleedings. The identification of a microbial agent in case of endometritis in the routine outpatient practice is not mandatory because global experience including high-level evidence-based studies confirms the expediency of an empirical therapy based on minimum clinical criteria; otherwise, there may be irreversible consequences for the reproductive system. A preventive antibacterial therapy during the pre-conception period in infertile patients suffering from recurrent miscarriages is an efficient method to prevent reproductive losses.Обзор научных исследований, посвященных хроническому эндометриту, позволяет сделать вывод, что контаминированный микроорганизмами эндометрий при наличии подтвержденного субклинического воспаления является причиной, приводящей к снижению фертильности. Хроническое субклиническое воспаление эндометрия нередко ассоциировано с генитальным эндометриозом, что, вероятнее всего, является причиной аномальных маточных кровотечений. Обнаружение того или иного микробного агента при эндометрите в рутинной амбулаторной практике не является обязательным, так как мировой опыт, включающий научные исследования с высоким уровнем доказательности, свидетельствует о целесообразности эмпирической терапии, основанной на минимальных клинических критериях, ибо в противном случае последствия для репродуктивной системы могут быть непоправимы. Превентивная антибактериальная терапия в преконцепции у пациенток с бесплодием, привычным невынашиванием беременности является эффективным способом профилактики репродуктивных потерь

Подходы к ведению беременных и кормящихженщин с опоясывающим герпесом

The article describes the epidemiology, classification, clinical manifestations and treatment of herpes zoster. Basic approaches to treating of herpes zoster in pregnancy are outlined.Обсуждаются клинические проявления и осложнения опоясывающего герпеса. Риск развития осложнений выше в группе пациентов с иммунодефицитом. В связи с тем, что беременные женщины относятся к группе иммунокомпромитированных пациентов, предлагаются показания для проведения системной терапии опоясывающего герпеса этиотропными противовирусными препаратами у беременных и кормящих женщин

Pharmacological treatment of uterine myoma in the period of the menopausal transition

Pharmacological treatment of uterine myoma in the period of the menopausal transition Tapilskaya N.I.1, Glushakov R.I.2 1 National Medical Research Center Of Obstetrics, Gynecology And Perinatology named after V.I. Kulakov, Moscow 2 St. Petersburg State Pediatric Medical University Uterine myoma is one of the most common gynecological diseases, which is associated with a high risk of abnormal uterine bleeding, dysmenorrhoea, and now there are no markers that allow to assess the degree of response to treatment and the risks of recurrence of the disease, which ultimately limits the possibilities of the personalized treatment choice. Aim: to evaluate the efficacy and safety of a prolonged use of mifepristone as a drug therapy of uterine myoma in patients during the menopausal transition (Stage 2 of STRAW 10 at the time of treatment). Patients and Methods: the prospective study involved 141 patients with uterine myoma who received mifepristone (Gynestril®) 50 mg every other day for 12 months. After the end of the therapy, the dynamics of the course of uterine myoma was monitored 1 time in 6 months before the onset of menopause (median follow-up of 41 months). Before and after the end of the treatment, all patients underwent an endometrial pipelle biopsy followed by a histological examination. Results: by the end of the 3-d month of treatment medical amenorrhea was registered in 97.8% of patients, by the end of the 6-th month of treatment — in 100% of patients. By the end of 12 months of treatment, the thickness of the endometrium was more than 10 mm in 63% of patients, with an average thickness of 13.8±2.9 mm. According to the results of a histological study of the endometrial biopsy, all the samples had no signs of hyperplastic processes or neoplasms. For 36 months after the end of treatment, the total relapse rate was 21.7%, while in 90% of 10 cases progression was subsequently replaced by stabilization and / or regression. Within 3 years the subsequent regression of uterine myoma was registered in 30.4% of patients. Conclusions: the results of this study demonstrated that the prolonged use of mifepristone (Gynestril®) is characterized by high effectiveness and safety profile. Key words: uterine myoma, bleeding, uterine bleeding, treatment of uterine myoma, mifepristone, Gynestril®. For citation: Tapilskaya N.I., Glushakov R.I. Pharmacological treatment of uterine myoma in the period of the menopausal transition // RMJ. 2018. № 5(I). P. 10–15.<br

The use of autologous mesenchymal stem cells for endometrial repair in patients with lower fertility

Objective: Evaluation of the effectiveness of mesenchymal stem cells (MSC) in patients with lower fertility associated with Asherman’s syndrome and an extremely thin endometrium. Patients and methods: A pilot study was conducted with participation of 11 women aged 25-43 years. The endometrium was evaluated by dynamic transvaginal ultrasound (US) with Doppler imaging, outpatient hysteroscopy on the 7-9th day of the menstrual cycle (m.c.). Autologous MSC were collected from adipose tissue or menstrual blood. Intravenous and intrauterine injection of autologous MSC was performed on the 3-4th m.c. The effect of therapy was assessed by the occurrence of pregnancy and also by echographic characteristics of the endometrium. Results: The use of MSC was attended by a significant (р < 0.003) increase of endometrial thickness according to US findings and a decrease of the resistivity index of basal arteries in all patients, restoration of normal endometrial thickness and structure in 8 patients. Control outpatient hysteroscopy did not reveal any recurrence of intrauterine synechiae. Clinical pregnancy was recorded in 6 cases. Conclusion: The use of autologous MSC is a promising method of overcoming infertility in patients with Asherman’s syndrome and an extremely thin endometrium not responding to standard therapy. © 2019, Dynasty Publishing House. All rights reserved

Analysis of 19.9 million publications from the PubMed/MEDLINE database using artificial intelligence methods: Approaches to the generalizations of accumulated data and the phenomenon of “fake news” [Анализ 19,9 млн публикаций базы данных PubMed/MEDLINE методами искусственного интеллекта: подходы к обобщению накопленных данных и феномен “fake news”]

Introduction. The English-language databases PubMed/MEDLINE and Embase are valuable information resources for finding original publications in basic and clinical medicine. Currently, there are no artificial intelligence systems to evaluate the quality of these publications. Aim. Development and testing of a system for sentiment analysis (i.e. analysis of emotional modality) of biomedical publications. Materials and methods. The technique of analysis of the “Big data” of biomedical publications was formulated on the basis of the topological theory of sentiment analysis. Algorithms have been developed that allow for the classification of texts from 16 sentiment classes with 90% accuracy (manipulative speech, research without positive results, propaganda, falsification of results, negative personal attitude, aggressive text, negative emotional background, etc.). Based on the algorithms, a scale for assessing the sentiment quality of research (β-score) is proposed. Results. Abstracts of 19.9 million publications registered in PubMed/MEDLINE over the past 50 years (1970–2019) were analyzed. It was shown that publications with low sentiment quality (the value of the β-score of the text is less than zero, which corresponds to the prevalence of manipulative and negative sentiments in the text) comprise only 18.5% (3.68 out of 19.9 million). The greatest values of the β-score were characterized by publications on sports medicine, systems biology, nutrition, on the use of applied mathematics and data mining in medicine. The rubrication of the entire array of publications by 27,840 headings (MESH-system of PubMed/MEDLINE) indicated an increase in the β-score by years (i.e., the positive dynamics of sentiment quality of the texts of publications) for 27,090 of the studied headings. The most intense positive dynamics was found for research in genetics, physiology, pharmacology, and gerontology. 249 headings with sharply negative dynamics of sentiment quality and with a pronounced increase in the manipulative sentiments characteristic of the tabloid press were highlighted. Separate assessments of international experts are presented that confirm the patterns identified. Conclusion. The proposed artificial intelligence system allows a researcher to make an effective assessment of the sentiment quality of biomedical research papers, filtering out potentially inappropriate publications disguised as “evidence-based”. Copyright © 2020, Farmakoekonomika. All rights reserved