There is a great worldwide trend in the incidence of obesity, which is increasing with each passing year among all populations, including women of reproductive age. Given the impressive list of diseases associated with obesity, as well as the negative inverse correlation of the severity of obesity with fertility, this problem is global not only in the social sphere, but it also becomes demographically significant.Along with other pathogenetic mechanisms leading to persistent anovulation, an imbalance in adipokine production by adipose tissue can also serve as one of the important links in the development of reproductive dysfunction. Despite apparent interest in this topic, a large number of previously discovered adipokines are still not studied. Among adipokines, the effects of adiponectin and leptin on reproductive function are best known. Alterations in adiponectin and leptin levels can affect hypothalamic-pituitary-gonadal signaling, folliculogenesis, oogenesis and steroidogenesis. In addition, leptin is involved in the initiation of puberty, regulation of the menstrual cycle, and changes the balance between proliferation and apoptosis in ovarian cells. The leading causes of reduced fertility, infertility, and IVF failure in obese patients are mechanisms that promote the formation of chronic anovulation, delay the maturation of oocytes, reduce their quality, and/or lead to changes in endometrial susceptibility. These effects can be caused by an imbalance in the concentrations of leptin and adiponectin (leptin excess and adiponectin deficiency), lead to endometrial dysfunction, disruption of implantation and early embryogenesis. These changes, in turn, can affect just as the likelihood of spontaneous conception, so the effectiveness of assisted reproductive technologies and subsequent gestation.Thus, the study of potential pathogenetic pathways of fertility regulation in obesity, one of which is the subject of this review, is an important area for further study.
In the article, the authors examine the dependence of the degree of student satisfaction with the quality of education on the availability of tutor support for the work of project groups of first-year students of Yaroslavthe-Wise Novgorod State University. The influence of tutor support on the formation of subjectivity among students is analyzed within the framework of the management model at the university. In the course of the study, it was determined that mastering the tools for determining individual educational trajectories and reflecting them potentially affects the awareness of the value of the education received, and, as a result, the growth of satisfaction with education at the university. This process is seen as a way to solve the problem of applicants choosing specialties in which they do not intend to find employment in the future. The methodological basis of the study was the competency-based and subject-object approaches in education. The following methods were used in the study: analysis of the literature on the research problems; experiment; one-way analysis of variance, testing of hypotheses by the Fisher criterion, survey (questionnaire), methodology for assessing the stages of formation of subjectivity. Changes in the subjectivity of students accompanied by a tutor as part of project teams in the first year of study at the university have been quantitatively and statistically proven. The principal result of the study is the establishment of the fact that if university students have or increase tutor support: awareness of educational processes at the university, craving for self-education, motivation to determine educational and career trajectories, expert significance, motivation to create a personal brand. Positive changes were noted in the assessment of the usefulness of the knowledge gained by students after three months of regular classes. This fact ultimately increases satisfaction with the quality of education.
Spontaneous ovarian hyperstimulation syndrome is an extremely rare complication that develops during or after a spontaneous pregnancy and requires timely diagnosis and appropriate intensive care. This article presents a rare clinical case of spontaneous ovarian hyperstimulation syndrome with the development of its severe clinical picture in the postpartum period. The article focuses on the fact of the difficult diagnosis of this syndrome in the postpartum period and the difficulties of differential diagnosis with systemic inflammatory response syndrome associated with current infection process. The correct diagnosis changed the treatment landscape, when the administration of the right therapeutic doses of low molecular weight heparin provided positive changes in the disease course with a benign outcome.
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