Peculiarities of course of pragnancy, labors, condtiotion of a fetus and a newborn in pregnant women–displaced ones (Retrospective analysis)

2018 ◽  
pp. 83-88
Author(s):  
I.A. Zhabchenko ◽  
◽  
N.G. Korniets ◽  
S.V. Tertychna-Telyuk ◽  
◽  
...  
Keyword(s):  
Pregnant Women ◽  
Inflammatory Diseases ◽  
Stress Hormones ◽  
Negative Influence ◽  
Main Group ◽  
High Rate ◽  
Control Group ◽  
Average Weight ◽  
Psychological Condition ◽  
The Military

The less investigated problem of modern obstetrics is psychological condition of women during pregnancy and labors, who were affected by negative influence of nowadays, especially the military aggression, because precisely stress hormones determine the failure of adaptation, metabolic disorders and, as a result, an activation of infectious and chronic diseases, which determined the direction, the aim and the task of the work. The objective: to investigate peculiarities of course of pregnancy and labors, condition of a fetus and a newborn in pregnant women – displaced ones (IDP) in order to develop the improved methods of obstetric and perinatal complication prophylaxis in such women. Materials and methods. In order to achieve the object view, retrospective clinic and statistic analysis of 225 case histories of pregnancies and labors of IDP (the main group) and 51 pregnant women (control group), who continuously has been living in the territories controlled by Ukraine and did not stay in the military actions area during the process of investigation, were conducted. Pregnant women from the main and control groups were giving birth in the Delivery Departments of Central Cities Multyfield Hospitals of Belokurakino and Rubizhne of Luhansk Region in 2014–2017 years. Results. Pregnancy in IDP women is coursing under the maximal psycho emotional tension and stress, which promote complications development during gestation and labors. The risk factors which affects of the manifestation of pregnancy complications are: violations in psycho emotional condition of pregnant women, high infectious morbidity during puberty period, presents of chronic somatic pathology and high rate of inflammatory diseases of the female reproductive organs. Develop of placental-associated complications of pregnancy are typical in majority of IDP pregnant women: threatening of early and late spontaneous abortions, preterm labors, early gestosis, placental dysfunction and asiderotic anemia. Violations of labor act complications such as preterm and early rupture of amniotic membranes, weakness of labor activity and traumas of maternal ways, which lead to increase of specific gravity of complicated labors up to 20.3% and operative deliveries by the means of the Caesarian Section up to 23.6%, are most common for the main group of pregnant women. Newborns of the IDP women had an average weight less than 217 grams after delivery, in the asphyxia of different degrees one in eleven children was born. 34.8% of IDP women newborns had a pathological course of neonatal period which caused the further supervision on the 2nd level of neonatal care and was the reason of extra charges from the side of the parents. Conclusion. It is desirable to provide a full-fledged psychological support and routine treatment of chronic extragenital diseases at the periconceptional stage in IDP women. The preventive measures during pregnancy must foresee the violation of psychological condition correction and development of placental-associated complications. Key words: pregnancy, labors, complication, psychological violations, forced displaced people.

Optimization of the treatment-diagnostic approach to manual vacuum-aspiration at post-partum pyo-inflammatory diseases

2018 ◽  
pp. 40-45
Author(s):  
O.V. Bulavenko ◽  
◽  
L.R. Ostapiuk ◽  
V.O. Rud ◽  
A.S. Voloshinovskii ◽  
...  
Keyword(s):  
Fluorescence Spectroscopy ◽  
Inflammatory Diseases ◽  
Post Partum ◽  
Uterine Cavity ◽  
Short Wave ◽  
Main Group ◽  
Optimal Time ◽  
Control Group ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration

The problem of postpartum pyo-inflammatory diseases requires the introduction of new approaches to its solution and optimization of diagnostic and therapeutic developments. The objective: was to determine the optimal time for manual vacuum aspiration of the uterus in postpartum endometritis, correction of therapeutic tactics and control of patients in the framework of the method of fluorescence spectroscopy. Materials and methods. The main group – 170 women with postpartum pyo-inflammatory diseases, control group – 40 women with uncomplicated course of the postpartum period. Their blood serum was examined using the method of fluorescence spectroscopy, in particular after manual vacuum aspiration of the uterus. Results. Fluorescence spectra were studied for 40 women of control group and 170 women of the main group, among them in 44 (25.8%) – in the dynamics during the treatment after manual vacuum aspiration of the uterine cavity. In 93.2% of the patients in the main group after it an increase in fluorescence intensity and max displacement in the short-wave region were recorded, which was a reliable sign of improving the condition of the patients. Conclusion. The use of the method of fluorescence spectroscopy in postpartum endometritis after manual vacuum aspiration of the uterus significantly helps to improve the monitoring of the process of treatment and, if necessary, to correct it in order to recover the patients in time. Key words: endometritis, manual vacuum aspiration of the uterus, the method of fluorescence spectroscopy.

scholarly journals Modern view on the problem of optimization of therapy in pregnant women with functional cervical insufficiency

2018 ◽  
Vol 22 (1) ◽  
pp. 173-177
Author(s):  
V. F. Oleshko
Keyword(s):  
Blood Serum ◽  
Pregnant Women ◽  
Main Group ◽  
Control Group ◽  
Cervical Insufficiency ◽  
Progesterone Concentration ◽  
Therapeutic Dosage ◽  
Hormonal Balance ◽  
Magnesium Orotate ◽  
Micronized Progesterone

A functional cervical insufficiency plays an important role in the etiology of miscarriage and premature birth. The aim of research was to estimate the hormonal balance indexes during the course of pregnancy in pregnant women with functional cervical insufficiency and to correct the revealed violations in order to prevent obstetric complications. 101 pregnant women with confirmed diagnosis of a functional cervical insufficiency in term of gestation 22–32 weeks of pregnancy (the main group) and 34 pregnant women and women in labor with physiological condition of the cervix (the control group) were examined. The content of estradiol, progesterone, cortisol and prolactin was examined in the blood serum. On the second stage of examination 63 pregnant women obtained general basic therapy (I main group) and 38 pregnant women (II main group) received a developed treatment complex which included progesterone support by the micronized progesterone 200–400 mg twice a day up to 34–35 weeks of pregnancy, magnesium support by the magnesium orotate dehydrate in the therapeutic dosage and arginine glutamate in the therapeutic dosage. The correction of cervical insufficiency was performed with the help of a cervical pessary (according to indications). The examination of hormonal balance revealed an accurate decease of progesterone concentration on the background of high concentration of estradiol and increased levels of stress-associated hormones. Propitious influence of the developed therapy is proved by increase of progesterone concentration in the blood serum, normalization in stress-associated hormones balance according to gestational age. All this provideded the decrease of specific weight of threatened preterm labors, placental dysfunction, vaginitis, bacterial vaginosis and delay the labors up to 38–39 weeks of gestation in 97,4% of pregnant women (82,5% in the I main group). Prescription of micronized progesterone, magnesium orotate dehydrate, arginine glutamate to pregnant women with a cervical insufficiency is reasonable and effective one comparing with general and traditional therapy.

scholarly journals Clinical and cytological characteristic of a condition of the oral cavity at pregnant women with various types of a diabetes mellitus

2016 ◽  
Vol 65 (6) ◽  
pp. 45-51 ◽  
Author(s):  
Ludmila Yu Orekhova ◽  
Anna A Aleksandrova ◽  
Ludmila A Aleksandrova ◽  
Ramila S Musaeva ◽  
Gulrukhsor Kh Tolibova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Oral Cavity ◽  
Pregnant Women ◽  
Inflammatory Diseases ◽  
Type I Diabetes ◽  
Periodontal Diseases ◽  
Diabetes Mellitus Type 1 ◽  
Control Group ◽  
Type I ◽  
Liquid Based Cytology

Introduction. More and more researches dedicated to the communication of diseases of the oral cavity of pregnant women with diabetes. It is proved that the intensity of caries and inflammatory periodontal diseases (gingivitis and periodontitis) increase significantly during pregnancy, while the presence of comorbidities, such as diabetes, increase these indexes.Aim. The aim of the work was to study the dental status of pregnant women with diabetes.Materials and methods. The study compared women with gestational diabetes mellitus, type 1 diabetes, and type 2 diabetes, to a control group of pregnant women without diabetes. In addition to clinical research methods, liquid-based cytology of the contents of the gingival sulcus was performed.Results. The results of clinical and laboratory studies have shown that inflammatory diseases of periodontium and teeth within pregnant women with diabetes are more common than within the pregnant women without this disease. It should be noted that the frequency of occurrence and severity of these diseases in the pregnant women with type I diabetes is higher than in the other groups.Conclusion. Pregnant women with diabetes are at risk for dental disease and require more attention from dentists, endocrinologists and obstetricians. The use of liquid-based cytology method helps in the diagnosis of inflammatory periodontal diseases.

scholarly journals ПОРУШЕННЯ ВАРІАБЕЛЬНОСТІ СЕРЦЕВОГО РИТМУ ЯК МЕТОД ОЦІНЮВАННЯ АДАПТАЦІЙНИХ РЕАКЦІЙ ОРГАНІЗМУ ВАГІТНИХ ПРИ НАЯВНОСТІ ШКІДЛИВИХ ЗВИЧОК

2018 ◽  
Author(s):  
V. H. Korniienko ◽  
A. S. Fitkalo
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Pregnant Women ◽  
Cardiac Rhythm ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Cardiac Rhythm Variability ◽  
Adaptive Reactions

According to modern data, the cardiovascular system is a kind of indicator of the organism's adaptive activity, and the structure of the heart rhythm carries information about the development of adaptive reactions in response to irritating factors of the external and internal environment.The aim of the study – to investigate the functional state of the autonomic nervous system in pregnant women who have harmful habits by evaluating and analyzing the parameters of heart rate variability in order to prevent complications of non-delivery of gestational process.Materials and Methods. The study involved 73 pregnant women, 53 of them were pregnant (the main group) who had malignant habits in history. Before studying adaptive reactions in pregnant women, a study of cardiac rhythm variability was performed in practically healthy non-pregnant women of reproductive age (25.3±2.2) years). The control group consisted of 20 pregnant women without any harmful habits. Determination of heart rate variability was performed on the basis of peripheral heart rate recording, which included measuring the sequence of RR intervals for 5 minutes, followed by mathematical analysis using the PlsMntr software product.Results and Discussion. It was established that in the main group, in the complicated failure to pass the gestational process, violations of cardiac rhythm variability were detected in 59.7 % of cases. There is an increase in the frequency of very low frequency (VL F) waves (43.5 % relative to control, p<0.05), indicating a predominance of humoral and metabolic rate of regulation of the cardiac rhythm. At the threat of premature births, a decrease in the particle (LF) is observed at 36.6 %, a decrease in the share of high-frequency waves (НF) by 30.8 %. Taking into account the results of the study, one can speak of a decrease in the tone of the sympathetic and parasympathetic nervous system, reducing the influence of the reflexive vegetative level of regulation, which, in turn, indicates the depletion of regulatory mechanisms and the lack of an adaptive protective effect of n.vagus on the heart.Conclusions. Our innovative low-invasive method of evaluating the adaptive reactions of the organism through the determination and analysis of indicators of cardiac rhythm variability in pregnant women with the existing harmful habits offers us the opportunity to observe manifestations of functional stress of regulatory systems of pregnant women, preceding the development of complication of non-delivery of gestational process.

scholarly journals DISTURBANCE OF 20α-HYDROXYSTEROID DEHYDROGENASE ACTIVITY IN VILLOUS CHORION SYNCIOTHYTHROPHOBLAST AT REACTIVATION OF CYTOMEGALOVIRUS INFECTION DURING PREGNANCY

2017 ◽  
Vol 1 (65) ◽  
pp. 50-53
Author(s):  
Инна Довжикова ◽  
Inna Dovzhikova ◽  
Михаил Луценко ◽  
Mikhail Lutsenko ◽  
Ксения Петрова ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Dehydrogenase Activity ◽  
Cytomegalovirus Infection ◽  
Hydroxysteroid Dehydrogenase ◽  
First Trimester ◽  
Main Group ◽  
Control Group ◽  
Reaction Products ◽  
Igg Antibody ◽  
Antibody Titers

The aim of the work is to assess the effects of cytomegalovirus infection on the 20α-hydroxysteroid dehydrogenase activity in the villous chorion syncytiotrophoblast in the first trimester of pregnancy. The materials for the study included 48 villous chorions samples taken during spontaneous abortions at 8th–10th weeks of gestation from women with reactivation of cytomegalovirus infection (the main group). The control group included 35 villous chorions samples from pregnant women with chronic cytomegalovirus infection in the latent stage taken at medical abortions at the same stage of gestation. The results of women’s examination were studied taken into account the activity of cytomegalovirus infection by immunoassay by detection of IgM antibodies or by 4 times and more increase of IgG antibody titers in the paired serums in dynamics in 10 days. The activity of 20α-hydroxysteroid dehydrogenase was assessed by the histochemical method. Quantitative evaluation of the reaction products was carried out on sections under the microscope MT (Japan) connected to software-hardware complex «SCION Corporation» (USA). At histochemical specimen of villous chorion of pregnant women who had a reactivation of cytomegalovirus infection during pregnancy (main group), there was a decrease of cytophotometric parameter of 20α-hydroxysteroid dehydrogenase activity till 30.1±2.12 pixels/μm2 (p<0.001) compared with the control group. The decrease in the reaction activity in syncytiotrophoblast indicated a decrease in the contents of 20α-dihydroprogesterone in placenta, which contributed, in our opinion, to spontaneous abortion.

scholarly journals Clinical significance of expression of the marker of adaptation to hypoxia HIF-1α in pregnant women with initial forms of venous disease

2020 ◽  
Author(s):  
E. Iu. Iupatov ◽  
L. I. Maltseva ◽  
T. P. Zefirova ◽  
R. S. Zamaleeva ◽  
I. M. Ignatiev ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Pregnant Women ◽  
Hypoxia Inducible Factor ◽  
Perinatal Outcomes ◽  
Main Group ◽  
Control Group ◽  
Adaptation To Hypoxia ◽  
Venous Disease ◽  
Healthy Children ◽  
Venous Valves

Aim: to study the activity of the hypoxia marker HIF-1α (hypoxia-inducible factor-1α) in pregnant women with phlebopathy.Materials and Methods. We examined 70 women with phlebopathy in the dynamics of pregnancy. The main group consisted of 30 patients whose newborns had signs of hypoxia; the control group consisted of 40 women with healthy children. All women underwent ultrasound examinations of the veins of the lower extremities and pelvis with an assessment of vascular patency, the condition of the venous valves, and the phenomenon of platelet sludge. The expression of the HIF-1α transcription factor at 18–20 and 36 weeks was performed by real-time PCR.Results. Disorder of veins functional state was found in all pregnant women of the main group, which was accompanied by the formation of platelet sludge of varying degrees in the area of the venous valves in the majority, signs of endothelial dysfunction and venous hypoxia – an increase in the expression of the hypoxia gene HIF1-α by 2.18 times. In the women of the control group the indicators were not violated.Conclusion. The transcription factor HIF1-α can be considered a marker of unfavorable perinatal outcomes in pregnant women with signs of phlebopathy.

scholarly journals Influence of osteopathic correction on the psychoemotional state and quality of life of pregnant women with concomitant pathology of the urinary system

2020 ◽  
pp. 66-74
Author(s):  
E. N. Nenashkina
Keyword(s):  
Drug Therapy ◽  
Pregnant Women ◽  
Emotional State ◽  
Life Quality ◽  
Pain Syndrome ◽  
Main Group ◽  
Chronic Pyelonephritis ◽  
Control Group ◽  
Psychoemotional State ◽  
Traditional Drug

Introduction. The presence of somatic diseases during pregnancy leaves a serious imprint on the emotional state of a woman, significantly worsens the quality life indicators and affects the clinical characteristics of pregnancy. One of these diseases is chronic pyelonephritis. There are a fairly large number of recommendations for the treatment of this pathology. However the focus is mainly on drug therapy. At the same time the existing restrictions on the number of drugs using during pregnancy, the problem of polypragmasia, and the increase in the number of allergic complications of drugs using dictate the need to search alternative methods of treatment, primarily non-drug ones. Moreover, the problems of pregnant women life quality with chronic pyelonephritis during complex drug therapy are often not given due attention.The goal of research — to assess the impact of osteopathic correction on the psycho-emotional state and life quality of pregnant women with concomitant pathology of the urinary system.Materials and methods. A prospective controlled randomized study was conducted in the period 03.2016– 01.2018 on the basis of medical clinics of LLC «Mokhov Institute of osteopathy» and LLC «Vasileostrovskaya clinic of reproduction and genetics». There were observed work 48 pregnant women with chronic pyelonephritis aged 25–45 years, with a gestation period 13–27 weeks. During the processing of the clinical material, 8 patients were eliminated. As a result of the selection process, a group of 40 people was formed. All pregnant women with chronic kidney disease, depending on the used treatment method, were divided into two groups using a simple randomization method with a random number generator. There was formed the main group (20 people), and the control group (20 people). Patients of the main group received medication and osteopathic correction (3 procedures with an interval of 7–10 days). Patients in the control group received only traditional drug therapy. All pregnant women with chronic pyelonephritis had an osteopathic examination before and after treatment with forming an osteopathic conclusion, and the assessment of the pain syndrome severity by a visual analog scale (VAS), the general psycho-emotional state (the method of rapid assessment of health, activity and mood — HAM), and the level of life quality (Questionnaire Medical Outcomes Study — Short Form).Results. Pregnant women with chronic pyelonephritis were characterized by a weak pain syndrome, a psychoemotional state violations in the categories «well-being» and «activity», and a decrease in both the physical and mental components of life quality. After the complex treatment including the additional to traditional drug therapy osteopathic correction methods, the statistically significant decrease of the pain severity degree (p=0,001), increase of psychoemotional state rates in the category of «activity» (p=0,05) and the increase of physical and mental components of life quality (p=0,02) were observed in the main group compared with the control.Conclusion. Chronic pathology of the kidneys during pregnancy affects the emotional state of a woman, significantly worsens life quality indicators. The use of osteopathic correction as a part of the complex therapy of pregnant women with chronic pyelonephritis can improve the emotional state and life quality; reduce the pain severity, and so can be used to improve medical care for this population category. 

scholarly journals Correction of genital tract dysbiotic states of pregnant women with miscarriages using two-step approach to treatment

2014 ◽  
Vol 18 (2 (70)) ◽  
Author(s):  
N. V. Shchuruk
Keyword(s):  
Pregnant Women ◽  
Genital Tract ◽  
Main Group ◽  
Control Group ◽  
Second Stage

The article presents some data of effectiveness of two-step approach to genital tract treatment of pregnant women with miscarrages. According to the obtained data, the vaginal dysbiosis of pregnant women with the risk of miscarrages was trated by means of probiotic – bioenteroseptic “Enterogermina” on the the second stage of treatment. It resulted in recovery of vaginal microbiocenosis in 28 (87,5 %) out of 32 patiens of the main group, while in the control group this index was 37,5 %. It is recommended to use the proposed way of treatment in the obstetric and gynecologic facilities, as the most effective method.

scholarly journals Peculiarities of the course of pregnancy in women with common helminth infestations

2020 ◽  
pp. 52-55
Author(s):  
Babashova Fidan Mahmud kizi ◽  
Keyword(s):  
Pregnant Women ◽  
Visual Detection ◽  
Study Groups ◽  
Main Group ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Rare Form ◽  
Helminth Eggs ◽  
Acute Yellow Atrophy ◽  
Symptom Complex

The objective: peculiarities of pregnancy in women with common worm infestations in Baku. Materials and methods. During the period from 2015 to 2017, 152 women with common worm infestations were examined, in the gestation period from 16 to 40 weeks in the age group from 18 to 38 years. Depending on the nature of the infestation, 2 main groups were formed: the 1st main group included 84 women who had monoinvasia of helminths, and the 2nd main group included 68 women who had mixed helminth infestation. The control group consisted of 42 women who were pregnant without helminthiasis. All women were examined at 16–22, 23–29, 30–36 and 37–40 weeks of pregnancy. Helminthosis diagnostics was performed by detecting helminth eggs in faecal smears, pinworm eggs in scraping from perianal folds, and visual detection of helminth eggs or pinworms in faeces and vomit. Results. Common symptoms of early toxicosis are nausea, hypersalivation, and vomiting. A rare form of morning sickness treat dermatosis pregnant women, pregnant bronchial asthma, tetany, acute yellow atrophy of the liver, osteomalacia. Symptoms of toxicosis were evaluated in 152 pregnant women. The main symptoms of early toxicosis–nausea, hypersalivation and vomiting–were more common in pregnant women with helminthiasis than in women of the control group. In women with helminthiasis, a symptom complex similar to the manifestations of early toxicosis may persist throughout pregnancy, despite ongoing toxicosis therapy. Since persistent nausea and vomiting can be etiologically caused by helminthic-protozoic intoxication, the frequency of nausea and vomiting in different groups in the second and third trimesters was compared. In the second half of pregnancy, women with complaints of nausea and vomiting were present in all study groups, but they were more common in pregnant women with helminthiasis than in women in the control group. Conclusions. The data obtained on the more frequent manifestation of early toxicosis in pregnant women with helminthiasis and its demonstrated resistance throughout pregnancy prove that helminth infestations negatively affect the course of pregnancy. Key words: helminth-protozoal invasion, placental insufficiency, pregnancy.

scholarly journals Features of laboratory markers in pregnant women with antiphospholipid syndrome and retrochorial hematoma

2021 ◽  
pp. 12-19
Author(s):  
Oleh Tomniuk
Keyword(s):  
Platelet Aggregation ◽  
T Lymphocytes ◽  
Pregnant Women ◽  
Nk Cells ◽  
Antiphospholipid Syndrome ◽  
Annexin V ◽  
Main Group ◽  
Control Group ◽  
Antiphospholipid Antibody ◽  
Willebrand Factor

The aim. Study of hemostasis, antiphospholipid antibody levels and immunological parameters in pregnant women with antiphospholipid syndrome (APS), in particular with retrochorial hematoma (RCH). Materials and methods. 90 women were selected and divided into two groups: the control group – 30 pregnant women with a normal pregnancy (without APS) and the main group – 60 pregnant women with APS. Women in the main group were diagnosed with APS before pregnancy. In turn, the main group was divided into two subgroups: 1 subgroup – 41 pregnant women without RCH and 2 subgroup – 19 pregnant women with RCH. The main indicators of hemostasis were determined in all pregnant women, namely: the degree and rate of platelet aggregation, Willebrand factor, D-dimers. In addition, the level of antiphospholipid antibodies (APLA), antibodies to β2-glycoprotein, to annexin V, to prothrombin was examined, and the level of annexin V was also determined. The absolute and relative content of Treg, CD3+, T-lymphocytes, CD4+ (T-helpers), CD8+ (cytotoxic T-lymphocytes), CD19+ (B-lymphocytes), CD16+CD56+ (NK cells), CD16+CD56+CD107a+ (activated NK cells). Results. The obtained results showed that in pregnant women with APS compared to pregnant women without APS there are statistically significantly higher values of the degree and rate of platelet aggregation (90.6±6.3% and 106.3±6.7% vs. 65.3±5.3 % and 73.4±5.6%, respectively). There were also higher values ​​of Willebrand factor and D-dimers (2.5±0.3 IU/ml and 378.1±34.3 ng/ml against 1.7±0.2 IU/ml and 268.1±27, 3 ng/ml, respectively). APLAs were significantly higher in pregnant women with APS compared with pregnant women in the control group, namely: 16.1±1.5 vs. 3.8±0.4 U/ml. With regard to antibodies to β2-glycoprotein, to annexin V, to prothrombin and to the level of annexin V, their values were also statistically significantly higher in the group of pregnant women with APS. In addition, the results of the study showed that pregnant women with APS showed changes in subpopulations of immunocompetent cells. However, examining the difference in hemostasis, antibody content, and level of lymphocyte subpopulations between pregnant women with APS with and without RCH, it was found that their shifts in pregnant women with RCH were more pronounced than in women without RCH. Conclusions. Pregnant women with APS are characterized by significantly more significant changes in hemostasis, manifested by activation of intravascular thrombosis. In addition, such pregnant women had a significantly higher concentration of autoantibodies. There are also changes in the immune system, in particular, a decrease in Treg-cells, which have the ability to reduce the specific proliferation and effector functions of lymphocytes, thereby participating in the pathogenesis of APS.

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