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Неинвазивная диагностика и консервативная терапия эндометриоза
Подзолкова Н.М., Фадеев И.Е., Масс Е.Е., Полетова Т.Н., Сумятина Л.В., Денисова Т.В. Неинвазивная диагностика и консервативная терапия эндометриоза. Гинекология. 2022;24(3):167–173.
DOI: 10.26442/20795696.2022.3.201508
DOI: 10.26442/20795696.2022.3.201508
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Podzolkova NM, Fadeev IE, Mass EE, Poletova TN, Sumyatina LV, Denisova TV. Non-invasive diagnosis and non-surgical treatment of endometriosis: A review. Gynecology. 2022;24(3):167–173.
DOI: 10.26442/20795696.2022.3.201508
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Аннотация
Эндометриоз – крайне разнообразное по локализации, клиническому течению и исходам гормонозависимое заболевание женщин преимущественно репродуктивного возраста. Необходимость органосберегающего лечения для сохранения и/или восстановления фертильности, негативные последствия радикальных хирургических вмешательств по поводу эндометриоза для овариального резерва и результативности применения вспомогательных репродуктивных технологий, а также доброкачественный характер заболевания, склонного к самоограничению после достижения менопаузы, неизбежно приводят к поиску эффективных методов консервативной терапии и необходимой для этого неинвазивной диагностики эндометриоза. В статье представлены современные принципы консервативного ведения пациенток с эндометриозом.
Ключевые слова: эндометриоз, неинвазивная диагностика, гормональная терапия, диеногест
Ключевые слова: эндометриоз, неинвазивная диагностика, гормональная терапия, диеногест
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Endometriosis is a hormone-dependent condition occurring in women of predominantly reproductive age. It has an extremely diverse localization, clinical course and outcomes. The need for organ-sparing treatment to preserve and/or restore fertility, the negative effects of radical surgery for endometriosis on ovarian reserve and the effectiveness of assisted reproductive technologies, and the benign nature of the disease, which tends to self-limitation after menopause, lead to the search for effective methods of non-surgical treatment and the need for noninvasive diagnosis of endometriosis. The article presents the current principles of non-surgical management of patients with endometriosis.
Keywords: endometriosis, noninvasive diagnosis, hormonal therapy, dienogest
Полный текст
Список литературы
1. Santulli P, Tran C, Gayet V, et al. Oligo-anovulation is not a rarer feature in women with documented endometriosis. Fertil Steril. 2018;110(5):941-8. DOI:10.1016/j.fertnstert.2018.06.012
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3. National Institute for Health and Clinical Excellence. Endometriosis: diagnosis and management. 2017. Available at: https://www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-183763254.... Accessed: 13.04.2022.
4. Dunselman GAJ, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. DOI:10.1093/humrep/det457
5. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007;57(539):470-6.
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10. Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. DOI:10.1093/humupd/dmz049
11. Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol. 2018;51:16-24. DOI:10.1016/j.bpobgyn.2018.01.013
12. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018;38(5):1576-89. DOI:10.1148/rg.2018180080
13. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-32. DOI:10.1002/uog.15955
14. Tong A, VanBuren WM, Chamié L, et al. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol. 2020;45(6):1569-86. DOI:10.1007/s00261-020-02483-w
15. Saraswat L, Ayansina D, Cooper K, et al. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG. 2018;125(1):64-72. DOI:10.1111/1471-0528.14793
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18. Winkel CA, Scialli AR. Medical and Surgical Therapies for Pain Associated with Endometriosis. J Womens Health Gend Based Med. 2001;10(2):137-62. DOI:10.1089/152460901300039485
19. Rafique S, Decherney AH. Medical Management of Endometriosis. Clin Obstet Gynecol. 2017;60(3):485-96. DOI:10.1097/GRF.0000000000000292
20. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009;(2):CD004753. DOI:10.1002/14651858.CD004753.pub3
21. WHO. Medical eligibility criteria for contraceptive use. Fifth edition, 2015. Available at: https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf?sequence=9. Accessed: 13.04/2022.
22. Bedaiwy MA, Allaire C, Alfaraj S. Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril. 2017;107(3):537-48. DOI:10.1016/j.fertnstert.2016.12.024
23. Georgiou EX, Melo P, Baker PE, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019;2019(11). DOI:10.1002/14651858.CD013240.pub2
24. Likes CE, Cooper LJ, Efird J, et al. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet. 2019;36(3):483-90. DOI:10.1007/s10815-018-1388-x
25. Mönckedieck V, Sannecke C, Husen B, et al. Progestins inhibit expression of MMPs and of angiogenic factors in human ectopic endometrial lesions in a mouse model. Mol Hum Reprod. 2009;15(10):633-43. DOI:10.1093/molehr/gap063
26. Murji A, Biberoğlu K, Leng J, et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020;36(5):895-907. DOI:10.1080/03007995.2020.1744120
27. Caruso S, Iraci M, Cianci S, et al. Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain. J Pain Res. 2019;12:2371-8. DOI:10.2147/JPR.S207599
28. Strowitzki T, Faustmann T, Gerlinger C, et al. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health. 2015;7:393. DOI:10.2147/IJWH.S77202
29. Seo J-W, Lee D-Y, Yoon B-K, Choi D. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. Eur J Obstet Gynecol Reprod Biol. 2017;212:9-12. DOI:10.1016/j.ejogrb.2017.03.011
30. Kim SA, Um MJ, Kim HK, et al. Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis. Obstet Gynecol Sci. 2016;59(6):506. DOI:10.5468/ogs.2016.59.6.506
31. Liang B, Wu L, Xu H, et al. Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: a comparison study in mice. Reprod Biol Endocrinol. 2018;16(1):32. DOI:10.1186/s12958-018-0347-9
32. Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med. 2020;47(1):1-11. DOI:10.5653/cerm.2019.02971
33. ASRM 2018. Scientific Abstracts to be presented at the 74th Scientific Congress of the American Society for Reproductive Medicine, October 6–10, 2018, Denver, Colorado. e90.
2. Эндометриоз. Клинические рекомендации Минздрава РФ. 2020 [Endometriosis. Clinical guidelines of the Ministry of Health of the Russian Federation. 2020 (in Russian)].
3. National Institute for Health and Clinical Excellence. Endometriosis: diagnosis and management. 2017. Available at: https://www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-183763254.... Accessed: 13.04.2022.
4. Dunselman GAJ, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. DOI:10.1093/humrep/det457
5. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007;57(539):470-6.
6. Culley L, Law C, Hudson N, et al. A qualitative study of the impact of endometriosis on male partners. Hum Reprod. 2017;32(8):1667-73. DOI:10.1093/humrep/dex221
7. Bernuit D, Ebert AD, Halis G, et al. Female Perspectives on Endometriosis: Findings from the Uterine Bleeding and Pain Women’S Research Study. J Endometr. 2011;3(2):73-85. DOI:10.5301/JE.2011.8525
8. Эл-Джефут М., Артымук Н.В. Новое о теориях патогенеза эндометриоза. Фундаментальная и клиническая медицина. 2019;4(3):77-82 [Al-Jefout M, Artymuk NV. Causes and mechanisms of endometriosis: an update. Fundamental and Clinical Medicine. 2019;4(3):77-82 (in Russian)]. DOI:10.23946/2500-0764-2019-4-3-77-82
9. ETIC Endometriosis Treatment Italian Club. When more is not better: 10 “don’ts” in endometriosis management. An ETIC* position statement. Hum Reprod Open. 2019;2019(3):hoz009. DOI:10.1093/hropen/hoz009
10. Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. DOI:10.1093/humupd/dmz049
11. Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol. 2018;51:16-24. DOI:10.1016/j.bpobgyn.2018.01.013
12. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018;38(5):1576-89. DOI:10.1148/rg.2018180080
13. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-32. DOI:10.1002/uog.15955
14. Tong A, VanBuren WM, Chamié L, et al. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol. 2020;45(6):1569-86. DOI:10.1007/s00261-020-02483-w
15. Saraswat L, Ayansina D, Cooper K, et al. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG. 2018;125(1):64-72. DOI:10.1111/1471-0528.14793
16. Sagsveen M, Farmer JE, Prentice A, et al. Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003;2003(4):CD001297. DOI:10.1002/14651858.CD001297
17. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019. DOI:10.1002/14651858.CD001019
18. Winkel CA, Scialli AR. Medical and Surgical Therapies for Pain Associated with Endometriosis. J Womens Health Gend Based Med. 2001;10(2):137-62. DOI:10.1089/152460901300039485
19. Rafique S, Decherney AH. Medical Management of Endometriosis. Clin Obstet Gynecol. 2017;60(3):485-96. DOI:10.1097/GRF.0000000000000292
20. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009;(2):CD004753. DOI:10.1002/14651858.CD004753.pub3
21. WHO. Medical eligibility criteria for contraceptive use. Fifth edition, 2015. Available at: https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf?sequence=9. Accessed: 13.04/2022.
22. Bedaiwy MA, Allaire C, Alfaraj S. Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril. 2017;107(3):537-48. DOI:10.1016/j.fertnstert.2016.12.024
23. Georgiou EX, Melo P, Baker PE, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019;2019(11). DOI:10.1002/14651858.CD013240.pub2
24. Likes CE, Cooper LJ, Efird J, et al. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet. 2019;36(3):483-90. DOI:10.1007/s10815-018-1388-x
25. Mönckedieck V, Sannecke C, Husen B, et al. Progestins inhibit expression of MMPs and of angiogenic factors in human ectopic endometrial lesions in a mouse model. Mol Hum Reprod. 2009;15(10):633-43. DOI:10.1093/molehr/gap063
26. Murji A, Biberoğlu K, Leng J, et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020;36(5):895-907. DOI:10.1080/03007995.2020.1744120
27. Caruso S, Iraci M, Cianci S, et al. Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain. J Pain Res. 2019;12:2371-8. DOI:10.2147/JPR.S207599
28. Strowitzki T, Faustmann T, Gerlinger C, et al. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health. 2015;7:393. DOI:10.2147/IJWH.S77202
29. Seo J-W, Lee D-Y, Yoon B-K, Choi D. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. Eur J Obstet Gynecol Reprod Biol. 2017;212:9-12. DOI:10.1016/j.ejogrb.2017.03.011
30. Kim SA, Um MJ, Kim HK, et al. Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis. Obstet Gynecol Sci. 2016;59(6):506. DOI:10.5468/ogs.2016.59.6.506
31. Liang B, Wu L, Xu H, et al. Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: a comparison study in mice. Reprod Biol Endocrinol. 2018;16(1):32. DOI:10.1186/s12958-018-0347-9
32. Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med. 2020;47(1):1-11. DOI:10.5653/cerm.2019.02971
33. ASRM 2018. Scientific Abstracts to be presented at the 74th Scientific Congress of the American Society for Reproductive Medicine, October 6–10, 2018, Denver, Colorado. e90.
________________________________________________
1. Santulli P, Tran C, Gayet V, et al. Oligo-anovulation is not a rarer feature in women with documented endometriosis. Fertil Steril. 2018;110(5):941-8. DOI:10.1016/j.fertnstert.2018.06.012
2. Endometriosis. Clinical guidelines of the Ministry of Health of the Russian Federation. 2020 (in Russian).
3. National Institute for Health and Clinical Excellence. Endometriosis: diagnosis and management. 2017. Available at: https://www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-183763254.... Accessed: 13.04.2022.
4. Dunselman GAJ, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. DOI:10.1093/humrep/det457
5. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007;57(539):470-6.
6. Culley L, Law C, Hudson N, et al. A qualitative study of the impact of endometriosis on male partners. Hum Reprod. 2017;32(8):1667-73. DOI:10.1093/humrep/dex221
7. Bernuit D, Ebert AD, Halis G, et al. Female Perspectives on Endometriosis: Findings from the Uterine Bleeding and Pain Women’S Research Study. J Endometr. 2011;3(2):73-85. DOI:10.5301/JE.2011.8525
8. Al-Jefout M, Artymuk NV. Causes and mechanisms of endometriosis: an update. Fundamental and Clinical Medicine. 2019;4(3):77-82 (in Russian).
DOI:10.23946/2500-0764-2019-4-3-77-82
9. ETIC Endometriosis Treatment Italian Club. When more is not better: 10 “don’ts” in endometriosis management. An ETIC* position statement. Hum Reprod Open. 2019;2019(3):hoz009. DOI:10.1093/hropen/hoz009
10. Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. DOI:10.1093/humupd/dmz049
11. Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol. 2018;51:16-24. DOI:10.1016/j.bpobgyn.2018.01.013
12. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018;38(5):1576-89. DOI:10.1148/rg.2018180080
13. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-32. DOI:10.1002/uog.15955
14. Tong A, VanBuren WM, Chamié L, et al. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol. 2020;45(6):1569-86. DOI:10.1007/s00261-020-02483-w
15. Saraswat L, Ayansina D, Cooper K, et al. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG. 2018;125(1):64-72. DOI:10.1111/1471-0528.14793
16. Sagsveen M, Farmer JE, Prentice A, et al. Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003;2003(4):CD001297. DOI:10.1002/14651858.CD001297
17. Brown J, Crawford TJ, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019. DOI:10.1002/14651858.CD001019
18. Winkel CA, Scialli AR. Medical and Surgical Therapies for Pain Associated with Endometriosis. J Womens Health Gend Based Med. 2001;10(2):137-62. DOI:10.1089/152460901300039485
19. Rafique S, Decherney AH. Medical Management of Endometriosis. Clin Obstet Gynecol. 2017;60(3):485-96. DOI:10.1097/GRF.0000000000000292
20. Allen C, Hopewell S, Prentice A, Gregory D. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2009;(2):CD004753. DOI:10.1002/14651858.CD004753.pub3
21. WHO. Medical eligibility criteria for contraceptive use. Fifth edition, 2015. Available at: https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf?sequence=9. Accessed: 13.04/2022.
22. Bedaiwy MA, Allaire C, Alfaraj S. Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril. 2017;107(3):537-48. DOI:10.1016/j.fertnstert.2016.12.024
23. Georgiou EX, Melo P, Baker PE, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019;2019(11). DOI:10.1002/14651858.CD013240.pub2
24. Likes CE, Cooper LJ, Efird J, et al. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet. 2019;36(3):483-90. DOI:10.1007/s10815-018-1388-x
25. Mönckedieck V, Sannecke C, Husen B, et al. Progestins inhibit expression of MMPs and of angiogenic factors in human ectopic endometrial lesions in a mouse model. Mol Hum Reprod. 2009;15(10):633-43. DOI:10.1093/molehr/gap063
26. Murji A, Biberoğlu K, Leng J, et al. Use of dienogest in endometriosis: a narrative literature review and expert commentary. Curr Med Res Opin. 2020;36(5):895-907. DOI:10.1080/03007995.2020.1744120
27. Caruso S, Iraci M, Cianci S, et al. Effects of long-term treatment with Dienogest on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain. J Pain Res. 2019;12:2371-8. DOI:10.2147/JPR.S207599
28. Strowitzki T, Faustmann T, Gerlinger C, et al. Safety and tolerability of dienogest in endometriosis: pooled analysis from the European clinical study program. Int J Womens Health. 2015;7:393. DOI:10.2147/IJWH.S77202
29. Seo J-W, Lee D-Y, Yoon B-K, Choi D. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. Eur J Obstet Gynecol Reprod Biol. 2017;212:9-12. DOI:10.1016/j.ejogrb.2017.03.011
30. Kim SA, Um MJ, Kim HK, et al. Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis. Obstet Gynecol Sci. 2016;59(6):506. DOI:10.5468/ogs.2016.59.6.506
31. Liang B, Wu L, Xu H, et al. Efficacy, safety and recurrence of new progestins and selective progesterone receptor modulator for the treatment of endometriosis: a comparison study in mice. Reprod Biol Endocrinol. 2018;16(1):32. DOI:10.1186/s12958-018-0347-9
32. Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med. 2020;47(1):1-11. DOI:10.5653/cerm.2019.02971
33. ASRM 2018. Scientific Abstracts to be presented at the 74th Scientific Congress of the American Society for Reproductive Medicine, October 6–10, 2018, Denver, Colorado. e90.
Авторы
Н.М. Подзолкова1, И.Е. Фадеев*1,2, Е.Е. Масс1, Т.Н. Полетова1, Л.В. Сумятина1, Т.В. Денисова1
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы, Москва, Россия
*iefadeev@mail.ru
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы, Москва, Россия
*iefadeev@mail.ru
________________________________________________
Natalia M. Podzolkova1, Igor E. Fadeev*1,2, Elizaveta E. Mass1, Tatiana N. Poletova1, Liliana V. Sumyatina1, Tatyana V. Denisova1
1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 Davydovsky City Clinical Hospital, Moscow, Russia
*iefadeev@mail.ru
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