Background. The incidence of endometrial polyps has reached 25–35% making them the most common intrauterine pathology. Polyps account for every fourth hysteroscopy due to their association with abnormal uterine bleeding, infertility and malignancy risks. Absolute or relative hyperestrogenism are important factors in the development of endometrial polyp. Infectious and immune mechanisms have recently acquired special attention with the polyp pathogenesis.

Objectives. Management optimisation of infertile patients with endometrial polyp through differentiated choice of postoperative therapy.

Methods. We examined 90 patients of reproductive age (36.07 ± 6.14 years) with endometrial polyp and infertility conducting a comprehensive history analysis, assessment of reproductive function, extragenital and gynaecological pathology. Laboratory analyses comprised clinical and biochemical blood tests including vitamin and ferrum. Immunohistochemical endometrial estimators were CD16⁺, CD56⁺, HLA–DR(II)⁺.

Results. Patients with endometrial polyp and infertility had frequent bacterial vaginosis (90.0%), pelvic inflammations and vaginitises (78.89% each); endometrial polyp relapse was 10.4-fold more frequent in patients with infertility I compared to infertility II. Killer cell (CD16⁺ and CD56⁺) and HLA-DR(II)⁺ counts grow in chronic endometrial inflammation. Chronic autoimmune endometritis exacerbated in 53.33%, chronic exacerbated endometritis or acute endometritis were observed in 46.67%. Therapy differentiated by immunohistochemistry allowed successful pregnancy in natural cycles in 60.9% of patients with infertility I and in 85.7% — with infertility II.

Conclusion. The success rate of natural cycle pregnancy in patients of reproductive age with endometrial polyp after polypectomy is directly related to type of endometrial inflammation: chronic autoimmune, chronic exacerbated or acute endometritis. Immunohistochemical estimators can be used for differentiating therapy, which allowed a 70.3% pregnancy success rate.

Background. Imbalances of vagina microbiota in pregnant women entail the development of bacterial vaginosis and candidal vulvovaginitis. Lactobacterial strains modulate pro-inflammatory epithelium responses to enhance resistance, which renders lactobacteria promising agents in pregnant women with elevated pH.

Objectives. Assessment of the lactobacterial impact on vaginal microbiota and the course of gestation and labour.

Methods. A total of 261 pregnant women were examined and separated by cohorts according to pH of vaginal fluid: ≥4.5 in cohort 1 (n = 147), <4.5 in cohort 2 (n = 114). Cohort 1 had age 29.9 (4.6) years, cohort 2 — 29.0 (4.6) years, p = 0.55. Screening: at weeks 11–14, 18–21, 30–34 and 36–41 of gestation we performed vaginal pH-metry, cervicometry, determined opportunistic pathogens and lactobacteria with mass spectrometry. Cohort 1 received lactobacteria. Statistical analyses were performed with Statistica 10.

Results. In cohort 1 receiving lactobacteria, the number of women devoid of opportunistic flora increased from 31.29 to 43.53%. In cohort 2 not receiving lactobacteria, this number decreased from 53.51 to 35.09%. In cohort 1, L. jensenii (correlates with bacterial vaginosis rate) was primarily isolated in 9.52% women, and in 14.91% — in cohort 2. The rate of L. jensenii increased to 14.96% in cohort 1 (receiving lactobacteria) and decreased to 3.51% in cohort 2 (not receiving lactobacteria). A higher L. jensenii rate correlated with absent growth of opportunistic pathogens. Increasing the rate of L. crispatus (suppresses opportunistic pathogens) to 14.96% in cohort 1 lead to a 1.9-fold diminishing of active opportunistic flora. An increase of L. crispatus from 7.02 to 30.7% in cohort 2 supressed active opportunistic growth 3.9-fold at a normal baseline pH. Cervicometry values were invariant between the cohorts. Pregnancy complications were not observed under abundant lactobacterial growth. The risk of gestation loss occurred in 1.4% of women in cohort 1 and in 10.5% — in cohort 2. Abnormal labour and premature rupture of foetal membranes were more frequent in cohort 2.

Conclusion. With a less favourable premorbid condition in cohort 1, vaginal changes with background lactobacterial therapy facilitate gestational health in pregnancy. Many “sterile” niches, especially the maternal generative passages, represent active low biomass environments inhabited by unique typical maternal microflora. Most remarkable is the correlation between health of vaginal microbiota and abnormal labour.

Background. The only radical curative treatment for rectal fistulae is surgery. The choice of surgery requires precise characterisation of the fistulous tract. The most common instrumental methods for rectal fistula diagnosis are transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI).

Objectives. Comparative assessment of the diagnostic power of 3D TRUS and MRI techniques in revealing cryptogenic anal fistulae with respect to intraoperative examination.

Methods. The study enrolled 92 patients with rectal fistulae aged 27 to 66 years. Fistulous opening was external in 47 (51.1%) and obliterated in 45 (48.9%) patients. The average patient age was 42.7 ± 15.9 years. Surgery for acute paraproctitis 14 to 32 days prior to examination was in history of 58 (63.1%) patients. All patients had preoperative subsequent 3D TRUS and MRI compared with intraoperative examination results.

Results. The rate of correct fistulous tract type diagnosis verified with intraoperative revision was 96.7% (89/92) with 3D TRUS and 82.6% (76/92) with MRI (p = 0.0027). The error rate of 3D TRUS estimation of external sphincter involvement was 1.1% (1/92), sensitivity 96.6%, specificity 93.5%, overall accuracy 94.5%. The MRI error rate was 21.7% (20/92), with a statistically significant difference for sensitivity and overall accuracy (p < 0.0001). The rate of correct estimation of internal fistulous localisation in “anorectal clock” was 97.8% (90/92) with 3D TRUS and 90% (81/90) with MRI (p = 0.0342). Internal fistula was not detected with MRI in 2/92 (2.2%) cases, which explains the deviation. Intraoperative revision identified total 113 abscesses. The rate or correct abscess estimation was 97.3% (110/113) with 3D TRUS and 74.7% (71/95) with MRI. MRI failed to detect abscess in 18/113 (15.9%) cases (p < 0.0001).

Conclusion. 3D transrectal ultrasonography is statistically superior over magnetic resonance imaging in estimating internal fistula localisation in “anorectal clock”, fistulous type, as well as the fistulous tract location relative to external sphincteric tissue in patients with transsphincteric anal fistulae. Estimation of pararectal and intramural abscesses was also significantly different.

Background. The adverse impact of chronic hyperglycaemia on vascular wall in diabetes mellitus includes endothelial dysfunction with subsequent development of diabetic microangiopathy. Microangiopathy can be corrected via adequate glycaemic control for establishing a target level of glycated haemoglobin. Considering a multiplex nature of metabolic and vascular regulation, a comprehensive approach is required for simultaneous correction of rheological disorders, hypercoagulation and endothelial dysfunction.

Objectives. Estimation of vascular factors (von Willebrand factor, desquamated endothelium, antithrombin III, protein C, VEGF) and capillaroscopic patterns in therapy for type 1 diabetes with methylethylpyridinol in comparison with sulodexide.

Methods. A total of 89 patients with type 1 diabetes were examined and separated by two cohorts: 42 patients receiving sulodexide (cohort 1) and 47 patients receiving methylethylpyridinol (cohort 2). Therapy duration was 14 days. Both cohorts were estimated pre- and post-treatment endothelial conditions (activity of von Willebrand factor, VEGF, desquamated endothelial cell count), anticoagulant indicators (activity of antithrombin III, protein C) and had capillaroscopy with functional test and oximetry.

Results. Diabetes patients in pre-treatment exhibited signs of endothelial dysfunction, reduced blood anticoagulant protection and capillary constriction. Both cohorts in post-treatment showed the significantly reduced von Willebrand factor, VEGF activity and desquamated endothelial cell count. The anticoagulant system revealed positive dynamics; capillaroscopy reported limiting of the capillary transition zonal diameter and a certain improvement in functional performance.

Conclusion. Patients with type 1 diabetes were revealed with endothelial dysfunction and an increased blood procoagulant activity. Both sulodexide and methylethylpyridinol treatments improved endothelial dysfunction and anticoagulant blood protection. Both preparations can be used for complex microangiopathy correction in patients with <10-years history of type 1 diabetes mellitus.

Background. According to modern knowledge, macrophages and platelets support the growth and development of endometrioid heterotopia, thereby maintaining its survival under unsuitable conditions.

Objectives. To carry out a comparative analysis of blood tests with a particular focus on platelet and monocyte count in patients suffering from various forms of endometriosis and those with functional ovarian cysts before and after radical surgical treatment.

Methods. Retrospective data on platelet and monocyte count were retrieved from the medical histories of patients included in the study. Blood test results obtained before and after radical surgery were analysed. The presence of concomitant gynaecological pathologies was taken into account. Statistical data were processed using the Kruskal-Wallis test (H), Mann—Whitney criterion (U), Spearman rank correlation criterion (R) and Chi-square criterion.

Results. The research and control groups comprised 115 patients with endometrioid heterotopias of various localities and 28 patients with yellow body and follicular cysts, respectively. In both groups, the platelet count did not exceed the upper limit of normal values. In the control group, the platelet count below normal values was more common in patients both before (Chi square =10.35 (df = 1); p < 0.05) and after operation (Chi square =12.01; (df = 1); p < 0.05). A comparison of blood test parameters in patients with endometrioid heterotopias of different localities showed ovarian endometriosis to be characterised by the largest platelet count, with this value successively decreasing in patients with adenomyosis, pelvic peritoneal endometriosis and scar endometriosis. Monocyte count was significantly higher (U = 110, p < 0.05) in endometriosis associated with concomitant gynaecological pathologies, while platelet count did not depend on their presence (U = 824, p > 0.05). A comparison of platelet count values in the control group and the group of ovarian endometrioid cysts showed their significantly higher values in the latter group (U = 800.5, p < 0.05). After radical surgery, the number of platelets in both groups did not significantly differ (U = 833.5, p > 0.05). In addition, a moderate positive correlation was found between platelet count and monocyte count in patients with endometriosis before surgery (R = 0.42; p < 0.05).

Conclusion. The obtained results indicate quantitative changes in the system of mononuclear phagocytes and platelets in patients with endometriosis. These pathogenetically justified changes are specific to endometriosis, which make them a useful criterion for clarifying the genesis of ovarian cysts at the preoperative stage.

Background. Recent decades have witnessed a leap in understanding the molecular genetic bases of spinal muscular atrophy for a considerable improvement in diagnosis and treatment of this disease and development of innovative therapies for correcting genetic deficiencies. Given scarcity of etiotropic therapies for spinal muscular atrophy, traditional effective approaches remain relevant to target pathophysiological mechanisms of the disease progression and demand further development and improvement.

Objectives. Efficacy assessment of proactive therapy to spinal muscular atrophy based on electromyographic techniques using verifiable patient-specific functional scales.

Methods. The study is designed as a prospective cohort study conducted at the Republican Clinical Centre for Neurorehabilitation. We used a 15-year monitoring data on 95 children (66 boys and 29 girls) with genetically confirmed proximal spinal muscular atrophy. Patients were divided in two cohorts. The main cohort (65 children) received personalised therapy based on a proactive comprehensive stepwise approach to isolate a stem pathological pattern with clinical and electromyographic data. The comparison cohort (30 children) received conventional symptomatic therapy, including neurometabolic, cholinotropic drugs, classical massage and physiotherapy. In the study design, functional capacities and electromyographic data were estimated in a standardised time scheme with reference points («baseline», «1 year», «3 years», «5 years»).

Results. The proposed methodology for clinical and electromyographic data sampling at different points of the disease progression has yielded results. We registered a weaker pathological progression in the main cohort reflected by less pronounced motor deficiency and electromyographic pathology compared to the comparison group receiving conventional symptomatic therapy.

Conclusion. Dynamic monitoring of clinical and neurological disorders using modern assessment scales and extended electromyography of morbid motor markers enables a personalised proactive clinically justified treatment to suppress complications and manifestation of pathology.

Background. Tuberculosis is an infectious socially significant disease. Apart from individual traits of the disease pathology, drug sensitivity and the availability of effective medicine and prevention, an important factor of its control is the patient’s social status. Social patient profiling in various locations across the country is vital for developing and deploying a high-quality and feasible tuberculosis care programme.

Objectives. Social profiling of tuberculosis in St. Petersburg as an example of large urban area. Methods. We developed a questionnaire to assess 40 social parameters of a patient with tuberculosis. The study sample was representative and surveyed 666 (63.4%) and 704 (65.7%) patients with primary diagnosis in 2017 and 2018, respectively.

Results. The survey showed almost no impact of external migration on tuberculosis epidemiology in St. Petersburg. Internal migrants counted 76 (11.4%) in 2017 and 96 (13.4%) in 2018, thus suggesting the majority of primary tuberculosis patients being permanent residents of St. Petersburg. The contribution of individuals with no fixed abode to the incidence rate was also insignificant, 2.4% and 1.9%. Most patients were unemployed people of working age, 236 (35.4%) in 2017, 261 (37.1%) in 2018. Incidence among students as a younger population was lowest, 2.1% and 2.8%. Smokers accounted for half of total patients, 370 (55.6%) and 368 (52.3%). One in five patients carried HIV infection, with half of them not receiving antiretroviral therapy. Patients with unfinished secondary education and residing in collective dwellings were significantly more frequent, whilst the proportion of persons with high income decreased. Over half of the patients had no family at primary diagnosis, and over a third had never been married.

Conclusion. The social profile of primary tuberculosis in an urban area is as follows: single man, near 40 years old, permanent resident, unemployed, working-age, smoker, resides in private abode, has secondary or secondary vocational education, low to average income.

Background. Mental and physical health of students is directly linked to the emotional safety of educational environment and its recent transformation. Adoption of distance learning and IT innovations in educational practice influences students’ psycho-emotional state.

Objectives. Assessment of the psycho-emotional state of junior (9–11 years old) and older (12–17 years old) schoolchildren in Krasnodar at distance learning with respect to type of the educational institution (gymnasium, general secondary school), gender and age.

Methods. The study surveyed a total of 341 students of secondary school and 429 students of gymnasium belonging to the junior (9–11 years) and middle (12–17 years) age cohorts in Krasnodar. The Spielberg-Khanin State-Trait Anxiety Inventory (STAI) and WHO-5 well-being index questionnaire were used to assess the psycho-emotional status. A specialised questionnaire (SQ) for demographic and social assessment was used to identify the link between psycho-emotional disorders and socio-demographic factors. The questionnaires were self-filled twice, during personal school attendance and two months after the distance learning period.

Results. Moderate and high personal anxiety with low STAI alert prevailed in 83.9% of gymnasium and 85.3% of secondary school students. The anxiety level and WHO-5 well-being index were almost independent of school type and age but associated with gender: moderate personal anxiety prevailed in boys, and high anxiety — in girls. All students were shown to spend longer time on a computer or smartphone screen during distance learning.

Conclusion. We revealed no negative impact of short-term distance learning on psycho-emotional state in schoolchildren in Krasnodar. This observation may relate to a lower emotional stress at home-based distance learning due to a greater ability for time management in more comfortable environment. A negative prognosis on mental, cognitive and social skill development in schoolchildren is premature.

Background. Arterial hypertension poses a relevant problem and roots in early childhood. Today, arterial hypertension in children and adolescents is considered rather common and should be controlled and prevented as early as possible, which warrants further research into its pathogenesis and effective correction.

Objectives. To generalize current knowledge of microbiota in the development of arterial hypertension in children.

Methods. National and foreign published sources were surveyed in the eLibrary, Web of Science and PubMed databases. Keyword queries were: gut microbiota, arterial hypertension [артериальная гипертензия], children [дети], chronic systemic inflammation [хроническое системное воспаление], probiotics [пробиотики]. All sources have a publication depth of 7 years. The study used content analysis and descriptive analytics.

Results. Arterial hypertension remains a problem of high economic, medical and social importance as a major cause of brain disorders and coronary heart disease. Hypertension is shown to emerge early in childhood and adolescence during the regulatory network formation. Manifold evidence is accumulated on the involvement of human microbiota in pathogenesis of arterial hypertension. Infant microbiota is more unstable than in adults. Its taxonomic profile is viewed important for sustaining health, with imbalances in intestinal microbiota potentially entailing serious consequences. The impact of microbiota on chronic systemic inflammation, lipid metabolism, development and progression of atherosclerosis has been reported. Certain bacterial strains are known to exert benign effect on arterial hypertension and blood cholesterol. Selected mechanisms of the microbiota-mediated regulation of blood pressure have been identified. Improved methods for microbial community correction are being developed and include diet, antibiotic, prebiotic and probiotic regimens, faecal microbiota transplant.

Conclusion. Current achievements promise the emergence of novel approaches for arterial hypertension control early in childhood to avoid incorrigible adult complications.

Background. Gonadotropin-releasing hormone agonist as an ovulation trigger effectively reduces the ovarian hyperstimulation risk in in vitro fertilisation protocols, at the same time requiring an effective luteal phase support in embryo transfer cycles.

Objectives. A review of modern approaches to luteal support after the ovulation trigger switch in in vitro fertilisation/intracytoplasmic sperm injection protocols; assessment of feasibility and safety of gonadotropin-releasing hormone agonist in the post-transfer period.

Methods. Literature sources were mined in the PubMed, eLibrary, Web of Science, Cochrane Library, Cyberleninka databases at a depth of 10 years. The query keywords were: gonadotropin-releasing hormone agonist, luteal phase support, ovulation trigger, in vitro fertilisation, ovarian hyperstimulation syndrome.

Results. The review included 35 records selected from the 96 analysed total. The analysis reveals a sensible efficiency of gonadotropin-releasing hormone agonist for the luteal phase support, improved success of in vitro fertilisation/intracytoplasmic sperm injection and embryo transfer strategies, improved pregnancy outcomes. Microdosing of chorionic gonadotropin to supplement standard progesterone luteal support also improves the pregnancy outcome rate in assisted reproduction, however, at the risk of late ovarian hyperstimulation syndrome and should be applied with caution.

Conclusion. Administration of gonadotropin-releasing hormone agonist for luteal support may improve pregnancy outcomes in in vitro fertilisation/intracytoplasmic sperm injection protocols in patients with the ovarian hyperstimulation risk after the ovulation trigger switch. Nevertheless, further research is necessary into the efficacy and safety of gonadotropin-releasing hormone agonist for luteal support in embryo transfer cycles.

Background. Endometrial infertility is a frequent cause of failure in assisted reproduction. Causes of endometrial infertility are manifold and require comprehensive assessment for a successful choice of treatment strategy.

Objectives. A review of infertility concepts accounting for endometrial infertility in women of late reproductive age.

Methods. Bibliographic analysis: sources for review were mined in the PubMed, MedLine, eLibrary and Cyberleninka databases at a depth of 10 years. Keyword queries were: endometrial factors of infertility, uterine infertility [маточные факторы бесплодия], causes of infertility. Selected articles related to female infertility and, particularly, endometrial factors of infertility. Low-informative articles were not considered.

Results. A total of 51 sources were analysed, with 36 selected in the review. The reviewed evidence suggests that endometrial female infertility in late reproductive age is associated with cumulative gynaecological pathology and age-related change adversely impacting endometrial receptivity and synchrony with embryo maturation in assisted reproductive protocols.

Conclusion. Determining the functional status of endometrium is prerequisite for the outcome prognosis in assisted reproduction due to feasible failures to conceive with a vital embryo but reduced endometrial receptivity. This observation warrants a timely diagnosis and treatment of endometrial disorders prior to having assisted reproductive interventions. Woman’s age is the main predictor of successful pregnancy in IVF/ICSI protocols. Among the main markers of successful implantation is endometrial thickness. Uterine infertility may relate to impaired local immunity and autoimmune responses in uterine cavity. The most common mechanisms of uterine infertility are associated uterine myoma, endometriosis and endometritis. Women with uterine infertility attempting IVF/ICSI procedures often exhibit asynchronous endometrial development relative to the embryo maturity for implantation.

Background. Cardiovascular diseases, especially in association with arrhythmias, remain a prevailing cause of death worldwide. Arrhythmia related to imbalanced Ca²⁺ homeostasis is triggered by aberrant spontaneous diastolic Ca²⁺ leak from sarcoplasmic reticulum through cardiac ryanodine receptor-Ca²⁺ release channel (RyR2). Voltage-dependent anion channel 2 (VDAC2) is the only mammalian specific isoform also carrying a specific cardiac function.

Objectives. Description of VDAC2-mediated regulation of Ca²⁺ concentration in cardiomyocytes. Methods. Literature sources were mined in the MedLine/PubMed and eLibrary databases with keywords “heart AND calcium”, “heart AND VDAC2”, with a subsequent analysis.

Results. From 36 English-language sources, 5 were included in the review. We summarise that potentiated VDAC2 promotes mitochondrial transport of Ca²⁺ ions, and suppression of the channel leads to Ca²⁺ imbalances. Efsevin renders the channel more cation-selective and downregulates Ca²⁺ concentration in diastole.

Conclusion. VDAC2 comprises a potential drug target in therapy for severe arrhythmias. Efsevin is a promising agent for correcting abnormal Ca²⁺ transport in cardiomyocytes as an accelerator of mitochondrial Ca²⁺ uptake.

Background. Colorectal obturation is a fairly rare complication in patients with colorectal polyposis. Case descriptions of colonic obturation with underlying familial adenomatous colorectal polyposis have not been reported to date in national and foreign literature.

Clinical Case Description. Patient G., female, 31 yo, was emergently admitted to a surgical unit with a preliminary diagnosis: acute intestinal obstruction, complaints of abdominal pain, nausea, vomiting, stool and gas outlet blockage, marked general weakness. Clinical and biochemical blood tests without peculiarities. Signs of intestinal obstruction in abdominal ultrasonic and X-ray examination. Obstructive right hemicolectomy performed as emergent surgery. Diagnosis: transverse colonic C-r T3NoMo, stage II, clinical group 2. Patient had routine fibrocolonoscopy in six months; polyps were revealed in all operated colon portions. APC genetic test was positive, total colectomy was decided with single-barrel ileostomy excretion on anterior abdominal wall. Definitive diagnosis: transverse colonic C-r T3NoMo, stage II, developed with underlying familial adenomatous colorectal polyposis, clinical group 2.

Conclusion. Diagnosis of familial adenomatous colorectal polyposis with acute intestinal obturation is challenging due to forced urgent surgical intervention and lack of time for a detailed deeper examination in avoidance of baleful consequences. The case reported demonstrates that clinical manifestations of familial adenomatous colorectal polyposis extend beyond the routine complaints of abdominal bloating, stool blockage and rectal bleeding towards a formidable complication of acute colonic obturation of polypoid genesis.