Background. Cervical cancer (CC) has become a common malignancy, significantly contributing to the rising mortality rate among women worldwide. The vaginal microenvironment plays a key role in the development of the human papillomavirus (HPV) infection, thereby contributing to the development of CC. Objective. To characterize the main indicators of vaginal microecology in HPV-associated cervical dysplasia. Material and methods. The study involved 102 women of reproductive age (18-49 years). The study material consisted of posterior vaginal fornix swabs and cervicovaginal secretion samples. Vaginal swabs were cultured. The vaginal microbiome was assessed based on the number of microorganisms grown. All lactobacillus isolates were assessed for their functional activity, including their ability to produce hydrogen peroxide, form biofilm, and exhibit antagonistic activity against test strains of opportunistic microorganisms. Results. In HPV-associated dysplasia, there was a significant increase in the pH of the vaginal discharge (p<0.034) and a significantly higher incidence of vaginal dysbiosis (80%), with severe dysbiosis detected in 73.3% of patients. Antagonistic activity and hydrogen peroxide production in lactobacilli of the compared groups did not differ. Biofilmforming capacity was significantly reduced in lactobacilli isolated in the cervical dysplasia group. Thus, the ability to form the main substance was low in all lactobacilli isolates in this group (p=0.02), and the ability to form biomass was absent in 60% of isolates (p=0.003). The study of the parameters characterizing local vaginal immunity did not reveal significant differences between the groups. However, a trend towards an increase in proinflammatory cytokines, regulatory IL-2 and a decrease in sIgA was noted in the group with cervical dysplasia. Conclusion. We detected significant changes in several vaginal microecological parameters in a group of women with HPV-associated cervical dysplasia. It was found that dysplasia was associated with vaginal dysbiosis, and vaginal pH was elevated. Changes in the properties of the resident vaginal microbiota were also observed, including decreased antagonistic activity and the ability to form a physiological biofilm on the vaginal mucosa, leading to decreased colonization resistance of the vaginal biotope. These parameters may indicate a progressive course of HPV-associated dysplasia and can be used as additional markers in assessing the risk of developing precancerous pathology and cervical cancer.
Background. Current clinical practice lacks a single strategy for selecting the method of surgical intervention in primary hyperparathyroidism. This shifts the focus toward personalized surgery, where an intervention method is selected considering not only radicality, low invasiveness, complications, and disease recurrence but also individual clinical features of the patient. This article defines the most effective surgical approaches based on the patient’s physical status to improve treatment outcomes in primary hyperparathyroidism.Objective. To present a new surgical decision-making algorithm for patients with primary hyperparathyroidism factoring in their physical status under the American Society of Anesthesiologists classification.Methods. This prospective, non-randomized, comparative study, conducted from 2013 to 2018, included 394 patients. The participants were divided into four groups: Group 1 (n = 97) underwent parathyroidectomy via a central mini-incision with bilateral parathyroid gland exploration combined with confocal laser microscopy; Group 2 (n = 150), via a mini-incision with unilateral exploration; Group 3 (n = 72), via a mini-incision under local anesthesia without ipsilateral exploration; and Group 4 (n = 75), via a standard Kocher incision. The study analyzed physical status classes (American Society of Anesthesiologists), operative time, length of stay in the intensive care unit, pain intensity on a visual analog scale, recurrence rates of primary hyperparathyroidism, and total length of hospital stay. Statistical analysis was performed using Statistica 6.1 software (StatSoft Inc., USA; serial number: GS-35F-589). Given the group sizes (n1 = 97, n2 = 150, n3 = 72, and n4 = 75) and the observed effect sizes, the achieved statistical power exceeded 85 % for all primary endpoints. For all hypothesis testing procedures, the significance level was set at p < 0.05.Results. Group 1 demonstrated a significantly reduced operative time of 15–50 min compared to Group 4 (50–230 min), with 81.4 % of patients not requiring intensive care. Postoperative pain was reported as minimal (10.3 %), mild (23.7 %), or moderate (54.6 %) on the visual analog scale. Furthermore, the recurrence rate of primary hyperparathyroidism decreased to 1.3 % in Group 1 (down from 10.7 % and 13.9 % in Groups 2 and 3, respectively). A surgical decision-making algorithm was developed to factor in the patient’s physical status: parathyroidectomy under general anesthesia via a central mini-incision combined with confocal laser microscopy is indicated for Classes 1 and 2, whereas a lateral mini-incision under regional anesthesia without parathyroid gland exploration — or staged surgery in cases of multi-glandular involvement or primary hyperparathyroidism recurrence — is reserved for Classes 3 and 4.Conclusion. The proposed algorithm enables a personalized approach to the surgical management of primary hyperparathyroidism by guiding decision-making based on the patient’s clinical features. Furthermore, this study provides a rationale confirming the efficacy and safety of the developed treatment strategy for this disease involving a mini-incision and intraoperative navigation with confocal laser microscopy.
The article provides an overview of domestic and foreign literature, including studies data on immune and endocrine interactions with a special focus on pathological deviations in thyroid hormones levels and the impact of thyroid status disorders on the development of complications during pregnancy and childbirth in women, the health of the newborn and children in the postnatal period. Endocrine disorders of the thyroid gland are considered – hypothyroidism, thyrotoxicosis, autoimmune thyroiditis, as well as iodine deficiency as one of the causes of these disorders. The article presents interdisciplinary research in the field of immunology and endocrinology. The analysis of domestic and foreign literature on the topic of publication is carried out. The databases Pubmed, Elibrary, Scholar.google, Cyberleninka.ru were used.
Objective : to evaluate clinical and laboratory parameters in order to identify markers that reflect the pharmaco-kinetics of tacrolimus (Tac). Materials and methods . The study included 35 kidney transplant (KT) recipients, comprising 13 women (37.1%) and 22 men (62.9%), with a median age of 48 years [37–57]. All patients received induction immunosuppressive therapy with monoclonal anti-CD25 antibodies, followed by a maintenance regimen consisting of the calcineurin inhibitor Tac in combination with antiproliferative agents (mycophenolate or azathioprine) and corticosteroids. Tac levels were measured on postoperative days 3, 7, 14, and 30. Complete blood count and biochemical parameters, including creatinine, urea, ferritin, transferrin, C-reactive protein (CRP), sodium, potassium, chloride, calcium, total protein, and total bilirubin, were assessed preoperatively and on days 1, 3, 7, 14, and 30 following KT. Results . A statistically significant positive correlation was observed between Tac trough (C₀) levels on postoperative days 3 and 7 and total bilirubin levels on day 1 (R = 0.49, p = 0.007; R = 0.48, p = 0.009, respectively). In addition, Tac C₀ level on day 3 showed a positive correlation with total bilirubin levels measured on the same day (R = 0.52, p = 0.006). Conversely, total calcium levels on day 3 were negatively correlated with Tac C₀ levels on days 7 and 14 (R = –0.60, p = 0.031; R = –0.56, p = 0.046, respectively). Conclusion . Total bilirubin levels on postoperative day 1 are directly associated with Tac levels on days 3 and 7 following KT. Additionally, lower total calcium levels on day 3 are associated with higher Tac concentrations on days 7 and 14.
