Objectives To compare the performance of the PRECISE scoring system against several MRI-derived delta-radiomics models for predicting histopathological prostate cancer (PCa) progression in patients on active surveillance (AS). Methods The study included AS patients with biopsy-proven PCa with a minimum follow-up of 2 years and at least one repeat targeted biopsy. Histopathological progression was defined as grade group progression from diagnostic biopsy. The control group included patients with both radiologically and histopathologically stable disease. PRECISE scores were applied prospectively by four uro-radiologists with 5–16 years’ experience. T2WI- and ADC-derived delta-radiomics features were computed using baseline and latest available MRI scans, with the predictive modelling performed using the parenclitic networks (PN), least absolute shrinkage and selection operator (LASSO) logistic regression, and random forests (RF) algorithms. Standard measures of discrimination and areas under the ROC curve (AUCs) were calculated, with AUCs compared using DeLong’s test. Results The study included 64 patients (27 progressors and 37 non-progressors) with a median follow-up of 46 months. PRECISE scores had the highest specificity (94.7%) and positive predictive value (90.9%), whilst RF had the highest sensitivity (92.6%) and negative predictive value (92.6%) for predicting disease progression. The AUC for PRECISE (84.4%) was non-significantly higher than AUCs of 81.5%, 78.0%, and 80.9% for PN, LASSO regression, and RF, respectively (p = 0.64, 0.43, and 0.57, respectively). No significant differences were observed between AUCs of the three delta-radiomics models (p-value range 0.34–0.77). Conclusions PRECISE and delta-radiomics models achieved comparably good performance for predicting PCa progression in AS patients. Key Points • The observed high specificity and PPV of PRECISE are complemented by the high sensitivity and NPV of delta-radiomics, suggesting a possible synergy between the two image assessment approaches. • The comparable performance of delta-radiomics to PRECISE scores applied by expert readers highlights the prospective use of the former as an objective and standardisable quantitative tool for MRI-guided AS follow-up. • The marginally superior performance of parenclitic networks compared to conventional machine learning algorithms warrants its further use in radiomics research.

The availability of simple, accurate, and affordable cuffless blood pressure (BP) devices has the potential to greatly increase the compliance with measurement recommendations and the utilization of BP measurements for BP telemonitoring. The aim of this study is to evaluate the correlation between findings from routine BP measurements using a conventional sphygmomanometer with the results from a portable ECG monitor combined with photoplethysmography (PPG) for pulse wave registration in patients with arterial hypertension. Methods: The study included 500 patients aged 32–88 years (mean 64 ± 7.9 years). Mean values from three routine BP measurements by a sphygmomanometer with cuff were selected for comparison; within one minute after the last measurement, an electrocardiogram (ECG) was recorded for 3 min in the standard lead I using a smartphone-case based single-channel ECG monitor (CardioQVARK®-limited responsibility company “L-CARD”, Moscow, Russia) simultaneously with a PPG pulse wave recording. Using a combination of the heart signal with the PPG, levels of systolic and diastolic BP were determined based on machine learning using a previously developed and validated algorithm and were compared with sphygmomanometer results. Results: According to the Bland–Altman analysis, SD for systolic BP was 3.63, and bias was 0.32 for systolic BP. SD was 2.95 and bias was 0.61 for diastolic BP. The correlation between the results from the sphygmomanometer and the cuffless method was 0.89 (p = 0.001) for systolic and 0.87 (p = 0.002) for diastolic BP. Conclusion: Blood pressure measurements on a smartphone-case without a cuff are encouraging. However, further research is needed to improve the accuracy and reliability of clinical use in the majority of patients.

Aim. Estimation of social, demographic and anamnestic characteristics of patients survived cerebral stroke as well as the medical treatment received by the patients before the reference stroke in the hospital and at discharge within the framework of the stroke register LIS-2 (study of mortality among patients survived stroke in Lyubertsy district). Material and methods. All the patients (637 persons) admitted to the Lyubertsy regional hospital №2 due to stroke from 01.01.2009 to 31.12.2010 were enrolled into the study. Results. 36% were men and 64% were women with mean age of 70.99±9.6 years old. 554 (87.0%) patients had history of arterial hypertension and 155 (24.3%)-of atrial fibrillation. 147 (23.1%) patients had previous stroke. In-hospital mortality made up 21.8% (mean age of 139 deceased patients was 72.7±9.6 years old). 374 (75%) patients were prescribed ACE inhibitors, 421 (85%)-antiplatelet agents, 4 (1%)-warfarin. Statins intake was recommended to 3 (1%) patients. Conclusion. We revealed low frequency of prescription of drugs with proven positive prognostic value in patients after stroke.

Внедрение в клиническую практику новых пероральных антикоагулянтов (НОАК) является одним из главных достижений кардиологии последних лет. На протяжении более чем двух десятилетий стандартом профилактики мозгового инсульта (МИ) у больных с фибрилляцией предсердий (ФП) были антагонисты витамина К (АВК), в первую очередь-варфарин [1-3]. Применение этих препаратов спасло жизни сотням тысяч больных. Однако особенности фармакологического действия АВК, в первую очередь, нестабильность клинического эффекта, создают проблемы для врача и больного [4,5]. Вследствие этого часто происходит досрочное прекращение приема пероральных антикоагулянтов (ОАК), нередко врачи вообще отказываются от назначения ОАК из-за сложностей с подбором дозы препарата и наличием побочных эффектов [6]. Появление НОАК в клинической практике в 2012 г. значительно улучшило процесс профилактики МИ у больных с ФП: эти препараты используются в фиксированных дозах и не требуют регулярного контроля эффекта. Согласно результатам клинических исследова

The aim of this study was to evaluate efficacy and applicability of the “intermittent hypoxic-hyperoxic exposures at rest” (IHHE) protocol as an adjuvant method for metabolic syndrome (MS) cardiometabolic components. A prospective, single-center, randomized controlled clinical study was conducted on 65 patients with MS subject to optimal pharmacotherapy, who were randomly allocated to IHHE or control (CON) groups. The IHHE group completed a 3-week, 5 days/week program of IHHE, each treatment session lasting for 45 min. The CON group followed the same protocol, but was breathing room air through a facial mask instead. The data were collected 2 days before, and at day 2 after the 3-week intervention. As the primary endpoints, systolic (SBP) and diastolic (DBP) blood pressure at rest, as well as arterial stiffness and hepatic tissue elasticity parameters, were selected. After the trial, the IHHE group had a significant decrease in SBP and DBP (Cohen’s d = 1.15 and 0.7, p < 0.001), which became significantly lower (p < 0.001) than in CON. We have failed to detect any pre-post IHHE changes in the arterial stiffness parameters (judging by the Cohen’s d), but after the intervention, cardio-ankle vascular indexes (RCAVI and LCAVI) were significantly lowered in the IHHE group as compared with the CON. The IHHE group demonstrated a medium effect (0.68; 0.69 and 0.71 Cohen’s d) in pre-post decrease of Total Cholesterol (p = 0.04), LDL (p = 0.03), and Liver Steatosis (p = 0.025). In addition, the IHHE group patients demonstrated a statistically significant decrease in pre-post differences (deltas) of RCAVI, LCAVI, all antropometric indices, NTproBNP, Liver Fibrosis, and Steatosis indices, TC, LDL, ALT, and AST in comparison with CON (p = 0.001). The pre-post shifts in SBP, DBP, and HR were significantly correlated with the reduction degree in arterial stiffness (ΔRCAVI, ΔLCAVI), liver fibrosis and steatosis severity (ΔLFibr, ΔLS), anthropometric parameters, liver enzymes, and lipid metabolism in the IHHE group only. Our results suggested that IHHE is a safe, well-tolerated intervention which could be an effective adjuvant therapy in treatment and secondary prevention of atherosclerosis, obesity, and other components of MS that improve the arterial stiffness lipid profile and liver functional state in MS patients.

Aim      To evaluate the clinical picture and factors associated with unfavorable outcomes in admitted patients with COVID-19.Material and methods This study included all patients admitted to the COVID Center of the National Research Center of Cardiology of the Russian Ministry of Health Care from May 1 through May 31, 2020. Clinical demographic, laboratory, and instrumental indexes and associated factors were studied with one-way and multivariate logistic regression analysis.Results This study included 402 patients aged 18 to 95 years (mean age, 62.9±14.6 years); 43.0 % of them were older than 65 years. COVID-19 was frequently associated with chronic comorbidities, including arterial hypertension (74.4 %), obesity (41.6 %), history of ischemic heart disease (12.9 %), atrial fibrillation (18.9 %), type 2 diabetes mellitus (DM) (13.0 %), and oncological diseases (9.2 %). 13.0 % of patients were smokers; less than 10% had chronic lung diseases. 3.9% of patients had a combination of COVID-19 and acute coronary pathology, including acute myocardial infarction (MI) in 3.2 % (13) and unstable angina in 0.7 % (3). The most frequent clinical manifestation of COVID-19 were four symptoms: cough (81.1 %), weakness (80.3 %), shortness of breath (71.6 %), and fever (62.7 %). 46.5% of patients had shortage of breath and chest pain/compression, 40.3% had headache, 31.1% had myalgia, 28.8% had anosmia, and 25.5% had ageusia. Arterial oxygen saturation was <93.0 % in 55.7 % of cases. According to laboratory blood tests the patients had anemia (58.2 %), lymphopenia (34.8 %), neutropenia (19.2 %), thrombocytopenia (11.9 %), and increased levels of high-sensitivity C-reactive protein (hsCRP, 87.3 %), interleukin-6 (89.3 %), ferritin (62.1 %), and D-dimer (49.2 %). 56.2% of patients required various regimens of oxygen support. 83 (20.6%) patients were admitted to intensive care and resuscitation units; invasive artificial ventilation was performed only for 34 (8.5 %) patients. In-hospital mortality was 7.7 % (31 / 402). One-way regression analysis identified major factors associated with death during the stay in the hospital: age >55 years, NEWS scale score >4.0, oxygen saturation <92.0 %, blood glucose >5.4 mmol/l, hs-CRP >25.7 mg/l, and creatinine clearance <72.0 ml/min. Furthermore, the risk increased with increasing degree of changes in each factor. According to results of the multivariate regression analysis, three most significant predictors of the hard endpoint, all-cause death during the stay in the hospital, were more than 5-fold increases in aspartate aminotransferase and/or alanine aminotransferase compared to normal levels (relative risk (RR) 16.8 at 95 % confidence interval (CI) 5.0–56.3, р<0.001), pronounced changes in the lungs consistent with a CT-4 picture as shown by computed tomography (CT) (RR 13.4; 95 % CI 3.9–45.5, р<0.001), and MI/unstable angina during the stay in the hospital (RR 11.3; 95 % CI 1.4–90.6, р=0.023). The probability of death was also considerably increased by chronic obstructive pulmonary disease, impaired kidney function (creatinine clearance estimated by Cockcroft-Gault <60.0 ml/min), type 2 DM, oncological diseases, and dementia.Conclusion      This study established factors associated with unfavorable outcomes in admitted patients with COVID-19. This will allow identifying in advance patients with a high risk of complications that require increased attention to take more active diagnostic and therapeutic measures at prehospital and hospital stages.

Мозговой инсульт (МИ) занимает одну из ведущих позиций в структуре заболеваемости и смертности на-селения РФ [1]. По абсолютным показателям смерт-ности от МИ Российская Федерация (РФ), к сожале-нию, занимает одно из последних мест среди разви-тых стран мира [2]. Такая ситуация может быть связана с большим количеством причин, в том числе, с осо-бенностями популяции РФ, распространенностью определенных факторов риска среди населения, а так-же с лечением, первичной и вторичной профилактикой МИ. Одним из основных инструментов для изучения проблемы МИ могут стать крупномасштабные на-блюдательные исследования или регистры [3]. Счи-тается, что регистры являются одним из методов оценки заболеваемости, особенностей возникнове- Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke). Material and methods. All patients (n=960) admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study. Results. Men accounted for 37.5%, women -62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%), atrial fibrillation in 252 (26.8%) patients, 199 (20.7%) patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years). Low frequency of the antihypertensive therapy (34.5%), lipid-lowering therapy (0.7%), antiplatelet agents (5.7%), anticoagulation therapy prescription in patients with atrial fibrillation was detected. Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

247Острое нарушение мозгового кровообращения (ОНМК) занимает одно из ведущих мест в структуре за-болеваемости и смертности, в т.ч. сердечно-сосудистой, [1] и инвалидизации населения [2]. Патогенез и риск развития ОНМК тесно связаны с сердечно-сосудистыми заболеваниями (ССЗ) и факторами их риска [3], что под-разумевает единые подходы к их профилактике. Ре-зультаты крупных международных клинических ис-следований неоднократно демонстрировали, что про-гноз пациентов после перенесенного ОНМК возмож-но улучшить [4][5][6][7][8][9] Цель. На основании результатов регистра ЛИС-2 (Люберецкое исследование смертности больных, перенесших мозговой инсульт), с помощью специально разрабо-танного алгоритма, провести оценку соответствия клиническим рекомендациям профилактической терапии, назначенной пациентам в стационаре и при выписке, а также оценить влияние результатов на отдаленную смертность. Материал и методы. С помощью современных клинических рекомендаций были созданы шкалы оценки качества сердечно-сосудистой терапии по профилактике по-вторного инсульта, а также разработан индекс профилактики повторного нарушения мозгового кровообращения (иППНМК) для проведения такой оценки. Анализ те-рапии проводился у группы выживших в стационаре пациентов регистра ЛИС-2 (N=753). Оценка качества терапии проводилась с помощью иППНМК, изучено влия-ние результатов индекса на отдаленную смертность (Ме=2,3 года). Результаты. На основании результатов оценки с помощью иППНМК было продемонстрировано, что более высокое соответствие терапии клиническим рекомендациям приводило к достоверно лучшей отдаленной выживаемости. Несоответствие проводимой терапии клиническим рекомендациям обусловлено неназначением препаратов с доказанной эффективностью и нерациональным выбором проводимой профилактической терапии. Медиана оценки качества терапии составила 44,4% (22,2;44,4). Заключение. В регистре ЛИС-2 отмечается низкое соответствие проводимой профилактической терапии клиническим рекомендациям. Алгоритм оценки качества про-филактической сердечно-сосудистой терапии позволяет выявлять недостатки при профилактике повторного инсульта и может служить примером внедрения данных доказательной медицины в реальную клиническую практику. Aim. To study the conformity of preventative therapy prescribed to patients during a hospital stay and at a discharge to clinical guidelines using a special algorithm, and to assess the impact of the results on a long-term mortality based on the LIS-2 register (Lyubertsy study of mortality in patients after cerebral stroke). Material and methods. The scales to assess the quality of cardiovascular care for the prevention of recurrent stroke along with the prevention of recurrent ischemic attacks index (PRIA index) for this assessment were developed according to current clinical guidelines. Analysis of the therapy was performed using PRIA index on survived hospital patients from LIS-2 register (N=753). The impact of PRIA index results on a long-term mortality (Me=2.3 years) was studied.Results. Based upon the results of the assessment obta...