Real Practice Research Articles

Features of management of patients with pah associated with systemic connective tissue diseases in real clinical practice

The article deals with the problem of diagnosis of pulmonary arterial hypertension (PAH) in systemic connective tissue diseases. PAH is characterized by a progressive increase in pulmonary vascular resistance, which leads to the development of right ventricular heart failure and premature death of patients. The features of the management of patients with PAH associated with systemic connective tissue diseases in real clinical practice are presented. A clinical case is presented. The importance of early diagnosis, careful differential diagnosis and its verification using invasive methods for assessing central hemodynamics is noted. Early initiation of the initial pathogenetic combination therapy based on a comprehensive assessment of the risk of mortality and disease progression can improve not only clinical symptoms, exercise tolerance, indicators of biochemical markers, but also slow down the progression of the disease, is the key to improving the prognosis in patients with PAH. Comprehensive management of patients by a team of cardiologist and rheumatologist allows improving the volume and quality of medical care, taking into account the individual characteristics of the patient, and applying a personalized approach to therapy.

Phenotype-associated efficacy of regression of post-stroke hand paresis immediately after a course of adjuvant repetitive transcranial magnetic stimulation in real clinical practice

Phenotype-associated efficacy of regression of post-stroke hand paresis immediately after a course of adjuvant repetitive transcranial magnetic stimulation in real clinical practice

Association of Blood Glucose Data With Physiological and Nutritional Data From Dietary Surveys and Wearable Devices: Database Analysis

Background Wearable devices can simultaneously collect data on multiple items in real time and are used for disease detection, prediction, diagnosis, and treatment decision-making. Several factors, such as diet and exercise, influence blood glucose levels; however, the relationship between blood glucose and these factors has yet to be evaluated in real practice. Objective This study aims to investigate the association of blood glucose data with various physiological index and nutritional values using wearable devices and dietary survey data from PhysioNet, a public database. Methods Three analytical methods were used. First, the correlation of each physiological index was calculated and examined to determine whether their mean values or SDs affected the mean value or SD of blood glucose. To investigate the impact of each physiological indicator on blood glucose before and after the time of collection of blood glucose data, lag data were collected, and the correlation coefficient between blood glucose and each physiological indicator was calculated for each physiological index. Second, to examine the relationship between postprandial blood glucose rise and fall and physiological and dietary nutritional assessment indices, multiple regression analysis was performed on the relationship between the slope before and after the peak in postprandial glucose over time and physiological and dietary nutritional indices. Finally, as a supplementary analysis to the multiple regression analysis, a 1-way ANOVA was performed to compare the relationship between the upward and downward slopes of blood glucose and the groups above and below the median for each indicator. Results The analysis revealed several indicators of interest: First, the correlation analysis of blood glucose and physiological indices indicated meaningful relationships: acceleration SD (r=–0.190 for lag data at –15-minute values), heart rate SD (r=–0.121 for lag data at –15-minute values), skin temperature SD (r=–0.121), and electrodermal activity SD (r=–0.237) for lag data at –15-minute values. Second, in multiple regression analysis, physiological indices (temperature mean: t=2.52, P=.01; acceleration SD: t=–2.06, P=.04; heart rate_30 SD: t=–2.12, P=.04; electrodermal activity_90 SD: t=1.97, P=.049) and nutritional indices (mean carbohydrate: t=6.53, P<.001; mean dietary fiber: t=–2.51, P=.01; mean sugar: t=–3.72, P<.001) were significant predictors. Finally, the results of the 1-way ANOVA corroborated the findings from the multiple regression analysis. Conclusions Similar results were obtained from the 3 analyses, consistent with previous findings, and the relationship between blood glucose, diet, and physiological indices in the real world was examined. Data sharing facilitates the accessibility of wearable data and enables statistical analyses from various angles. This type of research is expected to be more common in the future.

Stress test protocols applied without treadmill and bicycle ergometer: procedures and interpretation

The article highlights the possibility of application of exercise tests without special equipment. The methodological features of conducting tests and their interpreting options are shown. Changed body position tests have been updated. The definitions of stress tests and exercise tests have been clarified. A classification of ergometers and indicators of monitored parameters has been worked out. Examples of medical reports are given. The application possibilities of stress tests were considered in real clinical practice at the stages of treatment and rehabilitation of patients with a wide range of nosologies. Tables for independently determining the exercise test results are presented. The methods can be used in pediatric practice. The article is addressed to a wide range of practitioners and functional diagnostics specialists.

Didáctica del género discursivo oral para la educación inicial

The study of the oral discursive genre has traditionally occupied a relevant place in teaching orality as a mechanistic expressive ability that does not do justice to the complexity of the real practices of oral interaction in the fields of use. Therefore, this text aims to seek new meanings of the theoretical and pedagogical understandings of oral interaction within the framework of Emergency Remote Teaching (ERE) and to propose didactics of the oral discursive genre for Initial Education from the reflexivity of teachers organized in mixed research communities. The methodological perspective adheres to the principles of action research, in which the production of collective knowledge is promoted. The findings suggest the symbiosis of time-space in the online classroom as a constituent scenario of the participants that configures a framework of dialogic relationships from three chronotopes: intention, meaning, and appropriation, which enable significant forms of communication where the oraldiscursive genre is considered as a way of organizing different pedagogical proposals by venturing into six itineraries of reflection in order to make it visible in the school curriculum.

Early intravenous beta-blockers injection in patients with acute STEMI: the results of the Russian registry REGION-IM

Aim. To study the features of the appointment of beta-blockers (BB) therapy in the early stages of acute myocardial infarction without ST segment elevation (nonSTEMI) in real clinical practice in the Russian Federation according to the REGION registry, to analyze the frequency and use cases of Intravenous forms (IVF).Material and methods. REGION-IM is a multicenter prospective Russian registry of acute myocardial infarction (AMI). The database records demographic, anamnestic, clinical characteristics of patients, results of laboratory and instrumental examinations. The patient’s recruitment was carried out from 01.11.2020 to 30.06.2023. Overall, 10,884 patients with AMI were included in the MI REGION, of which 3252 patients with non-STEMI and 7631 — with acute myocardial infarction with ST segment elevation (STEMI), information on the appointment or refusal of IV therapy on the first day of hospitalization is present for 7597 patients with STEMI.Results. On the first day after hospitalization, 1.2% (n=91) of patients with STEMI received IVF therapy. In all cases, metoprolol was used at an average daily dose of 4.43 mg. The majority of patients (61.5%, n=56) were transferred to oral administration of BB on the first day, another 33% of patients (n=30) — the next day, 4.4% (n=4) received only intravenous BB, one (1.1%) information is missing due to the transfer to another hospital. The most common relative and absolute contraindications to the appointment of BB — acute heart failure (AHF), including Killip II, and systolic blood pressure less than 120 mmHg. They were observed in less than 20% of all patients with STEMI and in 13% and 12% of patients who received IVF. 74% of patients received oral medications on the first day. Oral forms of BB were used to initiate therapy 61 times more often than IVF of BAB (p<0.0001). Hospital mortality among all patients with STEMI was 4.3% (n=328). Of these, 3.3% (n=249) — cardiac death, 0.7% (n=58) — non-cardiac cause of death, 0.3% (n=21) — the cause of death is not specified. In the group of patients who received IVF, 2.2% died (n=2, of which 1 was a cardiac cause, 1 was not indicated), 4.3% did not receive it (n=326, 76% was a cardiac cause). There was no statistically significant difference in hospital mortality in patients treated with IVF and those who did not receive IVF.Conclusion. The results of the REGION-IM registry demonstrate an unreasonably rare frequency of IVF use in the early stages of the disease in patients with STEMI. Intravenous administration of metoprolol at an average total dose of about 4-5 mg on the first day of hospitalization with further transition to oral administration of BAB was safe. There was no significant difference in the frequency of deaths in the hospital, cases of AHF, cardiogenic shock, severe conduction disorders in the form of grade II-III AV block between the groups of patients who received and did not receive IVF.

Fighting the Standardized Norm: Combating Linguistic Deficit Ideologies

ABSTRACT Standardized forms are those used by the upper-middle class, and the promotion of them is a way to benefit the institutions of power. Therefore, the ideal curriculum should promote critical language awareness (CLA) to use linguistic ideologies to the benefit of US Latinx students, and Spanish programs should work towards de-foreignizing the curriculum by making space for US Spanish. This article proposes revisiting the goals of Spanish programs considering the real linguistic practices of US Latinx, and situating them in the history of colonization of Latinx in the US. Students could use oral histories and cultural projects to promote the use of Spanglish and dismantle language ideologies to transform the perception of US Spanish.

EPOCH-CHF As A Mirror of the Current Problems in Cardiovascular Diseases Treatment in Real Clinical Practice

Aim To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.Material and methods Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.Results The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.Conclusion The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.

Cumulative Incidence and Prognostic Value of Readmissions in Patients With Heart Failure: Data From a Large Cohort Study of Real Clinical Practice in St. Petersburg.

Aim To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P<0.001 was considered significant.Results The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p<0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.

Patient With Chronic Heart Failure as a Participant in the Treatment Process: the Role of Structured Training And Outpatient Observation (on the Anniversary of the Study Chance).

Aim The article presents the principal results and conclusions of the study "SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)", organized by the Society of Experts in Heart Failure.Material and methods CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition.Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p<0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p<0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 ± 16.3 in the IG (p<0.001) and 6.2 ± 15.3 in the CG (p<0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation of patients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p<0.0001), to a greater extent in women.Conclusion The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up of patients in real clinical practice and serves as a vivid example of the importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.

Action observation with motor simulation of reactive stepping: A randomized study in older adults with a history of falls

BackgroundPerturbation-based training improves reactive stepping responses to prevent falling following a loss-of-balance. As there is currently no safe and feasible method for home-based practice, this randomized study investigated whether action observation with motor simulation (AOMS) of balance recovery improves reactive stepping in older adults with a history of falls. Additionally, we evaluated whether effects differ between AOMS of a human actor in the same experimental context or of an avatar in a virtual world. MethodsSeventy participants with a history of falls (68.3 ± 5.2y/o;52f) were subjected to 20 balance perturbations eliciting backward reactive steps. The AOMS group was tested after simulation of 20 reactive steps demonstrated by either a human actor (HumanAOMS) or a virtual avatar (AvatarAOMS). The control group was tested without prior observation. The primary outcome was reactive step quality, quantified as the leg angle at stepping-foot contact. ResultsDifferences between groups in the first perturbation trial were not significant. Upon repeated trials, both AOMS groups improved reactive step quality substantially faster than the control group. AOMS participants required on average five repetitions to achieve a reactive step quality that was no longer different from final performance in the last trial, whereas the control group needed ten. Both HumanAOMS and AvatarAOMS yielded similar gains. ConclusionsThe lack of effect in the first trial suggests that AOMS alone may not be sufficient for preventing real-life falls in this population. A next step would be to investigate whether this could be achieved by combining brief real perturbation practice with AOMS.

The influence of real and accrual earnings management on idiosyncratic risk with good corporate governance as a moderating variable

This study investigates the impact of real and accrual earnings management on idiosyncratic risk, with a focus on the moderating role of good corporate governance, proxied by managerial ownership, in manufacturing firms listed on the Indonesia Stock Exchange from 2020 to 2022. Using moderated regression analysis, the findings reveal that both real and accrual earnings management practices negatively affect idiosyncratic risk, suggesting that earnings management may serve as a risk mitigation tool under efficient contracting perspectives. However, managerial ownership exhibits divergent effects: while it strengthens the risk-reducing impact of real earnings management, it unexpectedly amplifies the idiosyncratic risk associated with accrual earnings management, potentially due to managerial motivations to meet financial targets. These results highlight the complex role of corporate governance in earnings management, as it may act as both a stabilizing and risk-amplifying factor depending on the type of earnings management practiced. The study underscores the need for stakeholders to critically evaluate earnings management and corporate governance practices, while encouraging future research to include additional variables to further explain idiosyncratic risk determinants. The study's Adjusted R Square value of 8.1% indicates that other significant factors affecting idiosyncratic risk were not captured in this analysis.

Role of the Russian Heart Failure Society in Defining Views on Assessing the Severity and Implementing Optimal Methods of Treating CHF in the Russian Federation Over 25 years. Review of Registries and Multicenter Clinical Trials

An important objective of the creation of the Society of Experts in Heart Failure (SEHF) was to assess the level of diagnostics and approaches to the treatment of chronic heart failure (CHF) in the Russian Federation (RF), without which it was impossible to bring clinical practice to the optimal level and in consistency with the existing clinical guidelines. Thus, along with the development of Guidelines for the diagnosis and treatment of CHF, a series of registries and multicenter clinical trials (MCTs) was conducted to bring the indexes of real practice closer to the developed Guidelines. Numerous MCTs organized during the 25 years of the SEHF existence have significantly improved the substantiated and recommended therapy for CHF administered by practicing physicians in the Russian Federation. This article overviews the most important registries and MCTs that were conducted during the 25 years of the SEHF work and their effect on CHF diagnostics and treatment in the clinical practice in the RF.

Retina and optic nerve diffusion restriction in acute central retinal artery occlusion: A case-control study.

To determine the frequency and accuracy of diffusion restriction (DR) of the retina and/or optic nerve (ON) detection on standard brain magnetic resonance diffusion-weighted imaging (DWI-MRI) in patients presenting with acute non-arteritic central retinal artery occlusion (CRAO). This is a retrospective case-control study that includes all consecutive patients presenting to our tertiary academic center from 2013-2021 with acute non-arteritic CRAO (cases) or acute ischemic stroke syndrome (controls, age and gender-matched) that had brain MRI performed within 14 days from symptom onset. Two neurology residents (junior and senior), a vascular neurologist, and two neuroradiologists, blinded to the site of CRAO, independently reviewed the brain MRIs to assess for the presence of retina and ON DR. The consensus agreement between the two neuroradiologists was used to perform sensitivity and specificity analyses and calculate inter-rater reliability (prevalence-adjusted bias-adjusted kappa coefficient). A total of 128 patients with acute non-arteritic CRAO (mean (SD) age 69 (14) years; 50% female; median time from CRAO to DW-MRI 2 days (IQR 1-5)) and 128 age and gender-matched controls with acute cerebral ischemia were included. After the neuroradiologist consensus, DR was correctly identified in the retina or ON in 51/128 (39.8%) CRAO cases, retina alone 27.3%, ON alone 24.2%, and both retina and ON 11.7%, with almost perfect neuroradiologists' inter-rater reliability for retina (K = 0.91) and ON (K = 0.83). Among controls, the retina DR was identified in 1/128 (0.8%) and ON DR in 5/128 (3.9%). The sensitivity, specificity, positive predictive value, and negative predictive value were 28.1%, 99.2%, 97.3%, and 58.0% for retina DR, and 27.3%, 96.1%, 87.5%, and 56.9% for ON DR. Though experienced neuroradiologists identified retina and ON DR with excellent inter-rater reliability, these are infrequent findings in real world CRAO practice, with excellent specificity but limited sensitivity. Prospective studies with larger cohort of patients, optimization of standardized orbit DWI-MRI protocols are needed to facilitate a more accurate and reliable identification of retina and ON DR in acute CRAO.

Traditional Game Lato-Lato: Physics Learning Media to Improve Students’ Conceptual Mastery of Collision and Momentum Materials

<p>Physics is a science that studies natural phenomena, but students' interest in this subject is often low because it is considered abstract and difficult. The traditional approach to physics learning, which often focuses on theory, is less appealing to many students. One effective way to increase students' understanding and interest is through experimentation and the use of adequate teaching aids. In this context, the traditional game of Lato-Lato shows great potential as an innovative learning medium. This research aims to find out the concept of physics through the lato-lato game. This article reviews Lato-Lato's role in teaching physics concepts, especially in collision and momentum matter. This study uses a literature review method to evaluate the existing literature related to the use of Lato-Lato in physics education. The review process involves identifying, selecting, and critically evaluating literature from various academic databases. The results of the study indicate that Lato-Lato can be an effective learning tool by integrating physics theory with real practice in an interactive and fun way. This game not only helps students understand difficult physics concepts through hands-on experience, but also increases their motivation and interest in learning physics. The integration of Lato-Lato in physics learning can enrich teaching methods by providing a more contextual and practical approach.</p>

Penerapan Undang-Undang Nomor 35 Tahun 2009 Tentang Narkotika Terhadap Anak Pengedar Narkotika di Kota Medan

Implementation of Law no. 35 of 2009 concerning Narcotics in Medan City is an important issue in the context of legal protection for children involved as narcotics dealers. This research aims to analyze how the narcotics law is applied in cases involving children, as well as things that are considered in the law enforcement process and how criminal proceedings are carried out in the juvenile criminal justice system. This research provides an in-depth understanding of the application of special regulations, namely Law no. 35 of 2009 concerning Narcotics, while still considering Law no. 11 of 2012 which regulates the Juvenile Criminal Justice System. This approach aims to ensure legal protection for children involved in narcotics crimes, so that the law can be applied fairly and protect children's rights. This research utilizes empirical juridical legal methods, where the main data is obtained through direct interviews with judges serving at the Special Class IA Medan District Court, thus enabling researchers to obtain relevant and in-depth perspectives regarding the application of this law in real practice in the judicial environment.

Islamic Religious Education Learning Methods

Problems that are often experienced in the learning process include learning difficulties, varying levels of creativity between teachers and students, inappropriate application of teaching methods, limitations in the use of learning media. This research aims to investigate and analyze religious learning methods that fall into categories centered on students studying Islamic religious education. This research uses the library research research method, by taking a descriptive-analytical approach with this type of literature review. The results of this research are that Islamic religious learning methods that are student-centered, including the Inquiry-Based Learning (IBL) Method, promote students' critical and analytical thinking skills in finding answers to the problems they face. The Group Discussion Method, with an interactive approach, is able to increase students' enthusiasm for learning through sharing ideas and debating relevant topics. Practice Methods provide opportunities for students to conduct experiments and real practice, helping them find answers to problems through hands-on experience. The Active Learning method encourages students to think critically and creatively, contextualizing learning materials with everyday life situations. The Peer Tutor method utilizes the role of peers as tutors, increasing understanding through closer communication and interaction. Overall, these methods, with their various innovations, have proven effective in improving the quality of Islamic religious learning, helping students develop critical thinking skills, problem solving, and a deeper understanding of Islamic teachings.

Problems of adherence to therapy in patients with gout in real clinical practice

Problems of adherence to therapy in patients with gout in real clinical practice

Results of treatment of patients 75 years or older with non-metastatic prostate cancer in real clinical practice

Aim. To evaluate the results of radical surgical treatment and radiotherapy in patients with non-metastatic prostate cancer at age ≥75 years.Materials and methods. The retrospective study included data from 151 patients ≥75 years with verified non-metastatic prostate cancer who underwent radical prostatectomy (RP) or external beam radiotherapy (EBRT). Median age was 81.0 (75.0–97.0) years. Median Charlson comorbidity index was 7 (4–12). Median baseline prostate specific antigen (PSA) level was 11.0 (1.8–172.0) ng/mL. Prostatic adenocarcinoma was verified (ISUP grade 4–5 – 30 (19.9 %)) in all patients. сТ category was сТ3–4 in 37 (24.5 %), cN1 category was diagnosed in 10 (6.6 %) patients. The groups of unfavorable intermediate, high and very high risk included 93 (61.6 %) patients. Radical treatmentwas performed in all cases: RP in 38 (25.2 %), EBRT in 113 (74.8 %) patients (109 (72.2 %) men completed EBRT). Adjuvant treatment was administered in 8 (21.1 %) patients who underwent surgery. In the EBRT group neoadjuvant androgen-deprivation therapy (ADT) was administered in 74 (65.5 %), adjuvant ADT in 79 (70.0 %) cases. Treatment groups were matched by the main characteristics (р >0.05 for all) excluding lower baseline PSA in the RP group (р = 0.013). Median follow-up was 46.2 (1.5–234.2) months for all patients.Results. RP complications were registered in 3 (7.8 %), EBRT complications – in 7 (6.2 %) patients. No serious or lethal adverse event was observed. Recurrences were diagnosed in 9 (23.7 %) patients after surgery and in 26 (23.9 %) of 109 patients who completed EBRT. In the total study population, 4-year recurrence-free, cancer-specific, overall, and cardiac-specific survival rates were 74.5; 96.3; 91.2 and 90.8 %, respectively. The only factor significantly decreasing overall survival was Charlson comorbidity index ³8 (р = 0.05). Significant decrease of recurrence-free survival was observed in the surgery group compared to the EBRT group (р = 0.032). It did not translate into decreased cancerspecific and overall survival (р >0.05 for all). There was no significant difference in cardiac-specific survival between the groups (р = 0.626). Significant unfavorable prognostic factors of recurrence-free survival in the EBRT group included сN1 category (р = 0.045), very high risk (р = 0.049), and EBRT dose.Conclusion. RP and EBRT in elderly patients with non-metastatic prostate cancer receiving treatment in real clinical practice have acceptable safety profile and provide effectiveness comparable to the historical data on patients not sampled by age. The optimal candidates for radical treatment are men with Charlson comorbidity index <8.

Prognosis of patients with Hodgkin lymphoma and indeterminate response to PD-1 inhibitor therapy: considerations for application of LYRIC criteria in real clinical practice.

PD-1 inhibitors have shown unconventional response patterns in classic Hodgkin lymphoma (cHL). These include the phenomenon of pseudoprogression, highlighting the need for specialized response criteria such as the LyRIC, which stringened definitions for disease progression with introduction of indeterminate response category. Despite their potential utility, these provisional criteria are currently underutilized and require further refinement through clinical practice data collection. In this retrospective study LyRIC criteria were systematically used for response assessments in 180 patients with refractory cHL treated with nivolumab. Median follow-up was 60months. Indeterminate response (IR) was a frequent phenomenon in study population: at 3months of therapy 63 (35%) patients had an indeterminate response (IR1 7%, IR2 23%, IR3 6%). Among them 18 (29%) achieved an objective response with continued monotherapy. There were no differences in OS or TTNT depending on the type of IR. IR was the best achieved response in 45 (25%) patients. Patients with IR had favorable prognosis with no difference in OS, PFS and TTNT comparing to patients with PR when subsequent therapy was initiated due to disease progression. Patients with IR may achieve prolonged disease control or a deeper response upon continuing treatment. These findings support the broader implementation and adjustment of LyRIC criteria in clinical practice to enhance decision-making in cHL patients treated with immunotherapy.