[Twin gestation with regressive partial hydatidiform mole and coexisting live fetus]. / Nerazvivayushchiisya chastichnyi puzyrnyi zanos v slitnoi dikhorial'noi platsente s normal'nym razvitiem vtorogo bliznetsa.

The case of dichorionic twin pregnancy is described, with a fused placenta, one part of which is represented by a tissue of partial hydatidiform mole (PHM) with signs of regression, the second part is a placenta of a common structure with a normal development of the second twin. The delivery took place at the term of 38 weeks with a live healthy girl weighing 3250 g. A single placental disc consisted of two fused placentas with a clear boundary between them. The placenta of a live-born girl was mature, with focal chorangiosis, the second part of the disc was represented by the PHM tissue with avascular giant bizarre villi, some of them with central cisterns, with stromal fibrosis, low proliferative activity of the villous trophoblast and a significant narrowing of the intervillous space. A genetic study was carried out on the material of paraffin blocks from two parts of the placental disc containing the tissue of the villous chorion, and the blood of the parents. Comparative analysis of DNA isolated from the paraffin block of PHM with the DNA of the parents revealed the presence of diandric dispermic triploidy. No chromosomal pathology was found in the placenta of a living girl. For hydatidiform mole in the case of multiple pregnancy, an increase in the volume of the affected placenta is characteristic compared to the normal placenta of the twin. In our observation, the presence in the placenta with PHM signs characteristic of placentas with antenatal fetal death, stromal fibrosis of the villi and low proliferative activity of the trophoblast suggests a regression of PHM.

[Effect of arterial hypertension and hyperlipidemia on remodeling of articular cartilage and the development of osteoarthritis (experimental study).]

Osteoarthritis (OA) is a degenerative-inflammatory disease of the synovial joints associated with age, cardiovascular comorbidity, and other factors, based on cartilage (AC) and subchondral bone (SCB) damage. Recent studies have shown that age-related changes, cardiovascular diseases and OA may have a number of common molecular mechanisms. At the same time, the conditions and the degree of influence of arterial hypertension (AH) and hyperlipidemia (HL) on the tissues of the joints remain unclear. The purpose of the study is to study the effect of arterial hypertension and hyperlipidemia on the processes of cellular stress, remodeling of AC and the development of OA. An experimental study was carried out on 18 adult males of purebred guinea pigs (28-30 weeks old, weight 750-900 g). The 1st group (model AH) - 6 individuals, the 2nd (model with HL) - 6 individuals, the 3rd group (control) - 6 individuals. The results of the study allowed to establish that AH and HL have a direct effect on the tissues of the joints, causing cellular stress, manifested in changes in the morphofunctional characteristics of chondrocytes. Changes in the phenotype of cells leads to degradation of AC and SCB, ectopic angioproliferation. However, cardiometabolic factors influence AC remodeling processes in different ways. Thus, with isolated hypertension, hypertrophic differentiation of chondrocytes, destruction of articular cartilage, loss of cambial cells are observed. In HL, cell death processes, pathological mineralization of articular cartilage and enhanced pathological angiogenesis are observed. The greatest changes in articular cartilage are caused by the combination of AH and HL. With a combination of cardiometabolic factors, necrotic destruction of AC and replacement of SCB with osteopod-like matrix is observed.

[Placental mesenchymal dysplasia]. / Mezenkhimal'naia displaziia platsenty.

OBJECTIVE: To carry out a clinical and morphological analysis of 6 cases of placental mesenchymal dysplasia (PMD) that is not associated with Beckwith-Wiedemann syndrome. MATERIAL AND METHODS: Medical records, placental macroscopic and microscopic changes, histochemical (MSB staining) and immunohistochemical studies of placental tissue with antibodies against p57, CD34, smooth muscle actin, desmin, and Ki-67 were analyzed. RESULTS: Vascular anomalies in the chorionic plate and stem villi, the increased size and edema of the stem villi during normal formation of the terminal branches of the villous tree, the lack of proliferation of villous trophoblast were the typical signs of PMD and were noted in all cases. Comparison of the results of ultrasonography with the morphological pattern of the disease suggested that there were ultrasound signs that were typical of PMD. The characteristics of the course and outcomes of pregnancy in PMD were given. The features of morphological changes in the presence of PMD concurrent with preeclampsia were found. Significant variability in p57 expression in PMD was shown and variants of changes given. There were no substantial features of the expression of desmin and smooth muscle actin in PMD. CONCLUSION: MDP has typical morphological and ultrasound signs. The significant variability in the levels of chorionic gonadotropin and alpha-fetoprotein and in the expression of p57 does not allow their use in the differential diagnosis of PMD. The high incidence of thrombotic events in the intervillous space and fetal vessels, as well as intrauterine growth restriction, intrauterine hypoxia, and an impaired neonatal adaptation period in PMD should be taken into account when determining the management tactics for female patients and newborns.

[The prospects for the further development of the Belokurikha spa and health resort territory in the Altai Krai (region)].

We undertook a balneological survey of the Belokurikha spa and health resort territory with the purpose of distinguishing and identifying the potential health-improvement areas most promising for the extension and optimization of the therapeutic, tourist and recreational activities. The assessment was focused on the characteristic of the landscape and climatic conditions of the territory, the possibilities for the development of the existing resources of mineral waters and therapeutic muds as well as for the discovery of the potential new ones. The recommendations are proposed to promote the development of different forms of tourism with special reference to its medical and health-improvement aspects. It is suggested that the territory of the «Belokurikha¼ resort¼, «Belokurikha-2¼ and «Belokurikha-3¼ health-improvement areas should be integrated into a single spa-and-health resort district of federal importance.

[Pregnancy in women with heart defects: outlook on the problem].

Modern approach to management of pregnancy and delivery in women with heart defects is presented in this paper. The 3-level system of observation of this contingent of patients is based on stratification of risk of development of cardiological complications which allows to form an algorithm of physicians actions, and to optimize tactics of ambulatory and hospital stages of treatment. Stratification of risk is supplemented with quantitative echocardiographic parameters which reflect hemodynamic overload of the myocardium and facilitate work of a practical physician. Special consideration is given to pregnant women subjected to palliative cardiac surgery. If contractile function is preserved these women have good prognosis relative to prolongation of pregnancy and unassisted delivery.

[The use of nitric-silica mineral water in combined rehabilitative therapy of musculotonic dorsopathy syndromes].

Nitric-silica baths had beneficial myoadaptive and analgesic effect on patients with reflex dorsopathy syndromes. Balneotherapy combined with the treatment by sinusoidal modulated currents, massage, and remedial gymnastics was efficacious in alleviating musculotonic and orthopedic problems in patients with lumbar osteochondrosis. This effect was more pronounced than with the use of gas-bubble baths due to the improvement of trophic processes in the muscular tissue of the affected back and limb regions.