За последние 60-70 лет отчетливо прослеживается эволюция возбудителей, вызывающих инфекционные за-болевания женских половых органов. Так, до применения сульфаниламидных препаратов (до 30-х годов XX столе-тия) основным возбудителем послеродовых, послеаборт-ных и хирургических инфекций являлся стрептококк. По-явление стрептоцида и других сульфаниламидов способ- Цель исследования -оценка эффективности, безопасности и комплаентности применения вагинального геля и жидкого мыла «Вагилак» для профилактики дисбиоза вагинального биотопа после рассечения промежности в родах. Материал и методы. В исследование были включены 23 пациентки, перенесшие рассечение промежности в родах, обратившиеся с жалобами на выделения из влагалища за амбулаторной помощью через 60 дней после родов. Эффективность терапии интимными средствами «Вагилак» оценивали на основании динамики субъективной оценки выраженности признаков дис-биоза влагалищного биотопа по 5-балльной системе. Результаты. В результате проведенного исследования установлено, что при применении средств интимной гигиены «Вагилак» происходит снижение выраженности субъективных признаков дисбиоза влагалища у пациенток, перенесших рассечение промежности в родах, в 2 раза. Заключение. Использование средств интимной гигиены, приготовленных на основе молочной кислоты, -вагинального геля и жидкого мыла «Вагилак» -позволяет восстанавливать оптимальные значения pH влагалищной среды, способствует подавлению роста анаэробных бактерий и созданию оптимальных условий для роста собственной лактофлоры, обеспечивая колонизационную резистент-ность вагинального биотопа и повышая общую эффективность лечения.Авторы информируют об отсутствии конфликта интересов. Ключевые слова: рассечение промежности в родах, дисбиоз влагалищного биотопа, вагинальный гель «Вагилак», жидкое мыло «Вагилак».Objective -to evaluate the efficiency and safety of and compliance with Vagilac vaginal gel and Vagilac liquid soap for the prevention of vaginal biotope dysbiosis after episiotomy during delivery. Subjects and methods. The investigation enrolled 23 patients who had undergone episiotomy during delivery and sought outpatient care because of complaints of vaginal discharge 60 days postpartum. The efficiency of Vagilac therapy was evaluated from changes in the subjective estimates as to the degree of signs of vaginal biotope dysbiosis by a 5-scoring system. Results. The investigation ascertained that the use of the Vagilac intimate hygiene products showed a 2-fold reduction in the magnitude of subjective vaginal dysbiosis signs in the patients who had undergone episiotomy during delivery. Conclusion. The application of the lactic acid-based intimate hygiene products Vagilac vaginal gel and Vagilac liquid soap makes it possible to restore the optimal vaginal pH values and promotes the suppressed growth of anaerobic bacteria and the creation of optimal conditions for the growth of intrinsic lactoflora, by ensuring the colonization resistance of a vaginal biotope and enhancing the total efficiency of treatment. The authors de...
Objective. To study the immune patterns of the endometrium in women with infertility of uterine genesis in the phase of "implantation window". Materials and methods. Forty-two infertile women of reproductive age were prospectively examined. At the first stage, the contingent of women was divided into groups in accordance with the causes of infertility diagnosed before the current treatment: with chronic endometritis (CE) (n = 10); with tubal peritoneal infertility (TPI) (n = 32). A comprehensive examination of women included sonography of pelvic organs, hysteroscopy, examination of endometrial material in the period of the "implantation window" (morphological, immunohistochemical, real time (RT) PCR study,). The resulting for distinguishing molecular phenotypes of chronic inflammation (n = 30) and "normal" endometrium (n = 12) were the data of immunohistochemical studies of the immune profile (in the glandular epithelium and stromal cells (TNF-, IL-10, NRF2, GM-CSF and CXCL16), in the glandular epithelium BCA1, in the stroma TGF-) compared with the indicators of healthy fertile women (control group, n = 10). CE was verified based on pathomorphological and immunohistochemical studies (CD 138+). Results. Structural features of the endometrium in women with CE in the phase of the "implantation window" corresponded to the average stage of secretion in 36.4 %; variants of "out-of-phase" were identified in 63.6 % (late stage of the proliferation phase (16.7 %), dissociated development (13.3 %), early stage of the secretion phase (43.3 %)). Molecular characteristics of the immunologically tolerant endometrium, favorable for implantation, are determined by the balanced production of pro-and anti-inflammatory cytokines, growth factors and chemokines. Aggressive "microenvironment" in the endometrium of women with the phenotype of chronic inflammation was determined by the dominant of proinflammatory cytokines of the Th1/Th17 profile (an increase in comparison with the control of the expression level of TNF- and GM-CSF by 1.1 times and 1.2 times, in the glandular epithelium of chemokines CXCL16 and BCA1 by 1.2 times, CXCL16 in the stroma in 1.2 times) on the background of reduced production of protective factors (TGF- (1 point), IL-10 (in the glandular epithelium by 2 times, in the stroma by 1.8 times), NRF2. Conclusions. Different molecular characteristics of the endometrium in women with TPI and CE determine the heterogeneity of potencies for blastocyst implantation.
The cause of 75% of all implantation failures is impaired endometrial receptivity. Most of the implantation window markers studied are regulated by estradiol and progestrone. Steroid hormones are involved in the binding of molecular makers to specific nuclear receptors and any disturbance in steroid receptor expression can lead to impaired endometrial morphofunctional properties and receptivity. There are three levels of receptivity: genetic, proteomic, and morphological. According to genetic studies, during the implantation window period, there is a 10-fold increase in the expression of about 395 genes in parallel with a decrease in the expression of other 186 genes, various proteases, cell adhesion molecules and matrix proteins. Proteomic markers that affect endometrial receptivity include various growth factors, cytokines, cell adhesion molecules, and integrins. One of the main markers of the morphological level of receptivity is the pinopodia. Over the past 20 years, a large number of molecular markers of endometrial receptivity have been studied and the understanding of implantation mechanisms has expanded. But, despite this, no ideal marker for the assessment of endometrial receptivity in impaired fertility has been found. For the most accurate and effective diagnosis and to reduce the incidence of early reproductive loss, it is necessary to investigate all three levels of endometrial receptivity.
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