Background: Survival in cervical cancer largely depends on the presence of morphological risk factors, among which lymphovascular space invasion (LVSI) plays a key role in the spread of tumor cells through the circulatory and/or lymphatic system. Dysfunction of the p53 tumor suppressor may be considered a determining factor in the development of LVSI during tumor progression. Studies have shown an association of the TP53 Pro72Arg polymorphism with cervical cancer risk. However, the association of Pro72Arg with LVSI formation has not been investigated. Aim: To determine the association of the TР53 Pro72Arg (rs1042522) polymorphism with LVSI and survival in cancer depending on the type of adjuvant radiotherapy. Methods: We retrospectively evaluated 5-year overall survival (OS) and progression-free survival (PFS) in patients with stage I–II cervical cancer who underwent radical Wertheim hysterectomy followed by adjuvant radiotherapy or adjuvant chemoradiotherapy between 2014 and 2020. Radiotherapy was initiated 3–4 weeks after surgery and included external beam radiotherapy to the primary tumor bed and regional lymph nodes (single fraction dose 2 Gy, total dose 40–45 Gy) and intracavitary gamma-therapy using brachytherapy devices (vaginal stump irradiation at a single fraction dose of 5 Gy twice weekly to a total dose of 20–25 Gy) in 2–4 sessions; chemoradiotherapy included polychemotherapy 3 weeks after surgery followed by external beam radiotherapy and brachytherapy. Polychemotherapy was administered in 2–3 cycles according to the following regimen: paclitaxel 175 mg/m2 intravenously on day 1 + cisplatin 75 mg/m2 intravenously on day 1 every 3 weeks. The TP53 Pro72Arg (rs1042522) polymorphism was determined by polymerase chain reaction in all patients. The presence of tumor emboli in lymphatic/blood vessels (LVSI status) was assessed histologically in tumor and/or peritumoral tissues. Results. The study included 90 patients treated for stage I–II cervical cancer (median age 49 (47; 64) years) with LVSI (LVSI+ group, n = 60) and without LVSI (LVSI- group, n = 30). In the LVSI+ group, 30 patients received adjuvant radiotherapy (follow-up period 39.89 ± 14.81 months), and 30 patients received adjuvant chemoradiotherapy (follow-up period 51 ± 9.59 months); all patients in the LVSI- group (n = 30) received adjuvant radiotherapy (follow-up period 48.72 ± 10.16 months). No differences were found between patient groups depending on the therapy received (adjuvant radiotherapy vs chemoradiotherapy in LVSI+ status), as well as depending on the presence of LVSI (LVSI+ vs LVSI- on adjuvant radiotherapy) for age (p = 0.792 and p = 1.00), TNM stage (p = 0.605 and p = 0.796), histological type (p = 0.488 and p = 0.739), tumor grade (p = 0.811 and p = 0.481), or number of surviving and deceased patients (p = 0.085 and p = 0.228). In LVSI+ patients, chemoradiotherapy compared with radiotherapy was associated with a reduction in the number of recurrences: 3.33% (1/30) vs 23.33% (7/30), p = 0.023. Radiotherapy in LVSI+ vs LVSI- did not affect the recurrence rate: 23.33% (7/30) vs 6.67% (2/30), p = 0.071. Five-year OS did not differ significantly depending on LVSI status (among patients receiving radiotherapy, 5-year OS was 83.33% in LVSI+ and 93.33% in LVSI-, p = 0.161), nor depending on therapy type (in LVSI+ patients, 5-year OS was 83.33% with radiotherapy and 96.67% with chemoradiotherapy, p = 0.063). However, 5-year PFS was statistically significant – 76.67% vs 93.33% (p = 0.048) and 76.67% vs 96.67% (p = 0.016), respectively. An association of LVSI in cervical cancer with the TP53 Pro72Arg (rs1042522) genetic variant was established in multiplicative (χ2 = 5.18; p = 0.024) and dominant (χ2 = 4.36; p = 0.038) models. In Cox regression analysis in a univariate model, the minor Arg/Arg (G/G) genotype of the Pro72Arg variant was a significant risk factor associated with worse 5-year OS (hazard ratio 8.425; 95% confidence interval 1.05–67.43; p = 0.045) and 5-year PFS (hazard ratio 8.46; 95% confidence interval 1.058–67.67; p = 0.044). Conclusion. An association of the TP53 Pro72Arg (rs1042522) polymorphism with LVSI in cervical cancer was identified. Carriage of the minor Arg/Arg (G/G) genotype of the Pro72Arg polymorphism is associated with an unfavorable prognosis during radiotherapy and chemoradiotherapy, representing a risk factor for reduced survival.
Background: Quantitative assessment of abdominal subcutaneous adipose tissue (SAT) thickness is in demand for patient phenotyping, including abdominal and sarcopenic obesity. However, the comparability of results between different ultrasound scanners and measurement modes remains insufficiently determined. Aim: To analyze the inter-device and inter-mode agreement of abdominal SAT thickness measurements using the BodyMetrix BX2000 and SonoStar UProbe C5PL ultrasound scanners. Methods: A single-center cross-sectional comparative methodological study was conducted. From March to June 2025, seventy-four patients of a multidisciplinary hospital (41 women, 33 men) aged 19 to 82 years were examined. During a single visit, each patient underwent sequential measurements with the BodyMetrix BX2000 and SonoStar UProbe C5PL scanners; the interval between measurements did not exceed 5 minutes. All ultrasound examinations were performed by a single ultrasound diagnostician with 8 years of experience, who was trained on both scanners. Measurements were taken with the patient standing, to the right of the umbilical ring, at a 90° angle without compression. Three subcutaneous adipose tissue thickness parameters were compared: BodyMetrix SFL (A-mode, 2.5 MHz, automatic detection), BodyMetrix SAT thickness (B-mode, 2.5 MHz, low resolution, manual measurement), and SonoStar SAT thickness (B-mode, 10 MHz, high resolution, manual measurement). The paired t-test with Holm correction, Pearson correlation, Bland–Altman analysis, Hedges’ g effect size, Lin’s concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) were used. Results: No statistically significant differences were found between BodyMetrix SFL and SonoStar SAT thickness: p = 0.894, Hedges’ g = -0.009 (95% CI: -0.239; 0.220). For this pair, the Pearson correlation coefficient was r = 0.861 (p 0.001), CCC = 0.84 (95% CI: 0.76; 0.90), ICC = 0.85 (95% CI: 0.77; 0.90). The mean difference by Bland–Altman was -0.1 mm (95% CI: -1.8; 1.6), limits of agreement ranged from -14.3 to 14.1 mm, and agreement range = 28.4 mm. For the pair BodyMetrix SFL – BodyMetrix SAT thickness, statistically significant differences were obtained: p 0.001, Hedges’ g = 1.319 (95% CI: 1.002; 1.631), r = 0.504 (p 0.001), CCC = 0.20 (95% CI: 0.11; 0.28), ICC = 0.20 (95% CI: -0.09; 0.47), mean difference = 14.6 mm (95% CI: 12.1; 17.1), limits of agreement from -6.1 to 35.3 mm, and agreement range = 41.4 mm. For the pair SonoStar SAT thickness – BodyMetrix SAT thickness, statistically significant differences were also obtained: p 0.001, Hedges’ g = 1.475 (95% CI: 1.140; 1.805), r = 0.484 (p 0.001), CCC = 0.19 (95% CI: 0.10; 0.27), ICC = 0.19 (95% CI: -0.09; 0.47), mean difference = 14.7 mm 95% CI: 12.4; 17.0), limits of agreement from -4.4 to 33.8 mm, and agreement range = 38.3 mm. Conclusion: At the group level, the closest estimates of abdominal SAT thickness were obtained using BodyMetrix A-mode and SonoStar B-mode, suggesting that these approaches are the most comparable for group analysis. For individual longitudinal monitoring, direct comparison of results obtained with different devices and modes is limited due to differences in agreement limits; therefore, it is preferable to use the same scanner, a single measurement mode and a standardized examination protocol.
Background: In patients with inflammatory bowel diseases (IBD), skeletal muscle involvement includes not only reduced muscle mass but also decreased muscle strength (dynapenia). Previous studies in IBD have mainly focused on quantitative assessment of muscle area by computed tomography (CT), while reduced muscle strength has been studied separately from CT characteristics. It remains unclear whether dynapenia in IBD patients is primarily associated with decreased skeletal muscle area or with changes in muscle quality, including reduced muscle density and myosteatosis. Aim: To evaluate the association between handgrip strength and CT-derived skeletal muscle parameters in patients with IBD. Methods: A single-center cross-sectional study was conducted, including patients with IBD aged 18–75 years hospitalized from January to April 2026 at the Department of Gastroenterology of University Clinical Hospital No. 1 of I. M. Sechenov First Moscow State Medical University. All participants underwent abdominal CT during hospitalization. Muscle strength was assessed by handgrip dynamometry; dynapenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle area, skeletal muscle index (SMI), and CT-derived muscle density were calculated from abdominal CT images using a convolutional neural network-based artificial intelligence algorithm Comp2Comp. Association analysis was performed using multivariable linear regression adjusted for sex, age, and body mass index. Results: The study included 53 IBD patients, of whom 32 (60%) were male; median age was 38 [28; 51] years. Crohn’s disease was diagnosed in 24 (45%) patients, ulcerative colitis in 29 (55%). Dynapenia was identified in 7 (13%) of 53 patients. In multivariable regression analysis, no statistically significant association was found between handgrip strength and SMI (β = 0.29 kg per 1 cm²/m²; p = 0.182). At the same time, a positive association was observed between handgrip strength and CT-derived muscle density (β = 0.44 kg per 1 HU; 95% confidence interval 0.002–0.87; p = 0.048). Conclusion: In IBD patients, dynapenia is associated with lower muscle density and is not related to SMI. These findings demonstrate the potential of using CT-derived qualitative skeletal muscle characteristics in IBD to identify patients with reduced functional muscle properties.
Background: The combination of chronic obstructive pulmonary disease (COPD) and tuberculosis forms a specific clinical and pathogenetic phenotype. Studying the cytokine profile in comorbid pathology is necessary to understand the mechanisms of mutual aggravation of disease course. Aim: To assess the strength of association between serum levels of key cytokines and clinically significant manifestations of comorbid COPD and tuberculosis, with a primary focus on the presence of bacterial shedding. Methods: A single-center observational comparative cross-sectional study was conducted. From December 2024 to March 2026, clinical and laboratory parameters, serum cytokine levels, and the presence of Mycobacterium tuberculosis in sputum were evaluated in men aged 45 years and older followed up in pulmonology and phthisiology departments for COPD, pulmonary tuberculosis, or their combination, as well as in healthy volunteers in the control group. Serum levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. Mycobacterium tuberculosis (MTB) isolation was assessed by sputum smear microscopy, fluorescent microscopy and/or sputum culture. Patients with a positive result were classified as MTB+, while those without confirmed bacterial shedding were classified as MTB-. Results: Data from 209 men were analyzed: 42 healthy volunteers (control group); 63 patients with COPD without active tuberculosis (COPD group); 51 patients with active pulmonary tuberculosis without comorbid COPD (TB group); and 53 patients with both COPD and active pulmonary tuberculosis (COPD + TB group). Median age across groups ranged from 64 to 69 years (p = 0.137). The groups differed significantly in smoking history, forced expiratory volume in 1 second (FEV1), oxygen saturation (SpO2), and markers of systemic inflammation. The comorbid group (COPD + TB) had the highest smoking history (median 31 pack-years), lowest FEV1 (41.3% of predicted), highest C-reactive protein (32.7 mg/L), and lowest SpO2 (90%) (all p 0.001). Levels of all five cytokines increased from the control group to the comorbid group (COPD + TB): median IL-6 from 6.3 to 51.7 pg/mL, IL-1β from 3.1 to 27.1 pg/mL, IL-8 from 18.4 to 66.0 pg/mL (all p 0.001). In bacterial shedders (MTB+, n = 59), cytokine levels were higher than in patients without bacterial shedding (MTB-, n = 45): IL-1β, 32.9 vs 13.2 pg/mL; IL-10, 29.1 vs 13.4 pg/mL; TNF-α, 30.0 vs 15.3 pg/mL (all p 0.001). The best discriminative ability for bacterial shedding was shown by IL-10 (AUC = 0.924) and TNF-α (AUC = 0.923). A multivariate logistic model including IL-1β, IL-6, TNF-α and the IL-6/IL-10 ratio demonstrated an in-sample AUC of 0.991 (95% confidence interval 0.979–1.000), and 0.974 (SD 0.009) after cross-validation. Conclusion: Serum cytokine levels are strongly associated with bacterial shedding. The cytokine profile may be considered as a research tool for stratifying the inflammatory phenotype in combined COPD and pulmonary tuberculosis.
Background: Currently, dopamine agonists are the established first-line therapy for prolactin-secreting pituitary adenomas. However, long-term treatment may be associated with the development of fibrotic changes within the adenoma tissue, which correlates with resistance to medical therapy and technical difficulties during transnasal surgery. Despite extensive experience with dopamine agonists in prolactinomas, cut-off points for dose and treatment duration that predispose to fibrotic transformation of the adenoma remain unclear. Aim: To determine the cabergoline dose and treatment duration at which the degree of prolactinoma fibrosis increases. Methods: This single-center, observational, retrospective, cohort, uncontrolled, non-interventional study included 31 patients with prolactin-secreting pituitary adenomas who underwent endonasal endoscopic transsphenoidal adenomectomy between 2007 and 2025. Twenty-one patients received preoperative cabergoline therapy, while 10 patients did not receive dopamine agonists before surgery. Cabergoline resistance was the indication for surgery in 16 of the 21 treated patients; the remaining 5 underwent surgery for other reasons. In all resected prolactinomas, the degree of tumor fibrosis was assessed histologically using van Gieson staining, followed by quantitative measurement of collagen area using morphometric analysis in ImageJ software. For ROC analysis, the binary outcome was defined as the presence of fibrotic transformation with collagen content ≥ 5% of the tumor tissue area. Results: Preoperatively, cabergoline was administered at a dose of 2.89 ± 1.44 mg/week for a duration of 4.39 ± 2.12 years. The median percentage of fibrosis (percentage collagen content, PCC) in resected prolactinomas from the cabergoline-treated group (n = 21) was 21% [8.5; 35], compared with 7% [3; 7] in patients who did not receive dopamine agonists before surgery (n = 10) (p = 0.049). Spearman correlation analysis at a cabergoline dose ≥ 1.5 mg/week revealed a direct monotonic relationship between fibrosis area and treatment duration: r = 0.48; p = 0.006. ROC analysis showed moderate predictive ability for cabergoline treatment duration (cut-off 2.5 years, AUC = 0.81 (95% confidence interval 0.650–0.980), sensitivity 75%, specificity 73%) and good predictive ability for cabergoline dose (cut-off 1.5 mg/week, AUC = 0.85 (95% confidence interval 0.710–0.990), sensitivity 70%, specificity 82%) in determining the risk of prolactinoma fibrosis. Conclusion: A cabergoline dose ≥ 1.5 mg/week and treatment duration 2.5 years are associated with an increased likelihood of fibrotic transformation of prolactinomas. These findings should be considered when determining the optimal timing (before tumor fibrosis develops) for surgical treatment of cabergoline-resistant prolactinomas.
Background: Liver fibrosis is a manifestation of chronic liver diseases (CLD) and a key prognostic factor for their progression. The development of non-invasive quantitative magnetic resonance imaging (MRI) techniques that are robust to the influence of liver tissue composition is important for fibrosis stage stratification. The extracellular volume fraction (ECV) reflects the volume of the extracellular matrix and can be considered a specific quantitative marker of fibrotic changes. Aim: To evaluate the diagnostic performance of liver and spleen ECV for stratifying liver fibrosis stages and to analyze the effect of steatosis on the robustness of the diagnostic characteristics of the technique. Methods: This single-center, observational, retrospective, two-sample, comparative study included 427 patients with CLD and 111 patients without CLD examined in inpatient and outpatient settings between November 2024 and July 2025. Fibrosis staging was performed using the Metavir scale (F0–F4). Liver and spleen ECV were calculated based on T1 mapping using the MOLLI 5(3)3 protocol before and 10 minutes after intravenous contrast injection according to the formula: ECV = (1 - Hct) × (ΔR1organ / ΔR1aorta). Steatosis stratification was performed based on the proton density fat fraction, forming subgroups of patients without steatosis and with steatosis. ROC analysis was performed to assess diagnostic performance when discriminating ≥ F2, ≥ F3, and F4. Results: The study cohort comprised 538 patients (276 women and 262 men, mean age 47.2 ± 14.2 years). Distribution by fibrosis stage: F0 – 228 (of which 111 had no CLD), F1 – 126, F2 – 79, F3 – 40, F4 – 65. No steatosis was found in 287 patients, while 251 had steatosis. Liver and spleen ECV values progressively increased with advancing fibrosis from F0 to F4. Pairwise differences between adjacent stages remained statistically significant (FDR 0.05). For detecting clinically significant fibrosis (≥ F2), the AUC for liver ECV was 0.865 in patients without steatosis and 0.872 in those with steatosis; for ≥ F3, 0.939 and 0.977; and for F4, 0.976 and 1.000, respectively. For spleen ECV, when detecting stage ≥ F2, the AUC was 0.779 and 0.866; for ≥ F3, 0.882 and 0.911; and for F4, 0.940 and 1.000, without and with steatosis, respectively. Conclusion: Liver ECV is a highly informative quantitative biomarker of liver fibrotic changes in CLD. The diagnostic performance of the technique increases at later fibrosis stages and remains robust in the presence of steatosis. Spleen ECV provides additional diagnostic value, mainly for assessing severe fibrosis and liver cirrhosis.
Niemann-Pick disease type C (NP-C) is a rare, progressive, autosomal recessive neurodegenerative disorder with onset at various ages, caused by pathogenic variants in the NPC1 or NPC2 genes. In the late-infantile form of NP-C, the development of psychotic symptoms at onset or during the course of the disease in preschool children has not been described in the literature. We report a clinical case of a 6-year-old female patient who, from the first days of life, had prolonged jaundice, hepatosplenomegaly and haemorrhagic episodes. Early development was age-appropriate, but from the age of 4 years speech regression began, and from the age of 5 years progressive behavioral disturbances appeared. The key feature was the development of rare and severe psychotic symptoms at preschool age in the late-infantile form of NP-C: inappropriate laughing without reason, talking to a mirror, night wandering around the house, aggressive jealousy of a younger brother, grabbing a kitchen knife, self-aggression (scratching until bleeding), insomnia and withdrawal. Simultaneously, daytime enuresis, ataxia and upward gaze palsy – a pathognomonic sign of NP-C – appeared. Video-electroencephalography monitoring revealed epileptic encephalopathy with continuous spike-and-wave activity during sleep with a pharmacoresistant course. Whole-exome sequencing identified compound heterozygous mutations c.3019CG + c.3742_3745delCTCA in NPC1, and blood oxysterol levels were markedly elevated. Subsequently, pathogenetic therapy with miglustat was initiated. Psychotic manifestations in NP-C can mimic childhood schizophrenia or psychotic disorder, but their combination with hepatosplenomegaly, ataxia and supranuclear gaze palsy should immediately direct the physician towards biochemical and genetic testing for NP-C.
Background: The incidence of cancer in acromegaly varies substantially, ranging from 6.8% to 21.3%. Population-based studies have revealed differences both in the tumor types and in the risk factors for cancer development in acromegaly. Aim: To assess the frequency and structure of malignancies in patients with acromegaly from a single region of the Russian Federation and to identify possible clinical and biochemical predictors of cancer risk in these patients. Methods: A retrospective observational single-cohort study was performed. Data from the acromegaly registry of the Moscow Region as of December 1, 2025, were analyzed. The frequency and structure of malignancies were studied in the cohort of acromegaly patients. Clinical and biochemical characteristics, features of acromegaly course, prevalence of comorbidities, and treatment modalities were compared between acromegaly patients with and without cancer. Results: Among 423 patients with acromegaly included in the Moscow Region registry, 75 (17.7%) had malignancies, and 7 of them had multiple primary cancers. A total of 82 malignant tumors were recorded, 4 of which were diagnosed before the onset of acromegaly symptoms. The most commonly affected sites were the thyroid (18/82, 22.0%), colon (16/82, 19.5%), breast (13/82, 15.9%), and uterus (11/82, 13.4%). Patients with cancer were older at the time of acromegaly diagnosis (mean ± SD, median [LQ; UQ]: 51.5 ± 13.9, 54 [41; 62] vs 48.0 ± 13.5, 49 [38; 58] years, p = 0.036) and at the last visit (66.7 ± 12.5, 69 [61; 75] vs 60.1 ± 13.5, 61.5 [50; 70] years, p = 0.004), and had a significantly longer time to remission of acromegaly (8.9 ± 9.2, 5 [3; 12] vs 5.6 ± 5.6, 4 [2; 7] years, p = 0.021). Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels at both acromegaly diagnosis and the last visit did not differ between groups. In the cancer group, the frequency of primary hyperparathyroidism (10.7% vs 3.9%, p = 0.009; odds ratio (OR) 3.303, 95% confidence interval (CI) 1.300–8.392) and glucose metabolism disorders (68.9% vs 54.1%, p = 0.021; OR 1.879, 95% CI 1.097–3.219) was significantly higher. Moreover, patients with cancer had significantly higher prolactin levels at acromegaly diagnosis (6080 ± 13045, 1767 [1060; 2500] vs 2098 ± 4183, 1138 [724; 1939] mIU/L, p = 0.022), although the frequency of hyperprolactinemia did not differ (24.2% vs 22.1%, p = 0.700). Conclusion: In the Moscow Region, the most frequent cancers in acromegaly patients were those of the thyroid, colon, breast, and uterus. Risk factors for cancer in acromegaly included longer duration of active acromegaly (but not the degree of GH or IGF-1 elevation), as well as the presence of glucose metabolism disorders and primary hyperparathyroidism.
Helicobacter pylori infection remains a key risk factor for chronic gastritis, peptic ulcer disease, and gastric adenocarcinoma. However, the efficacy of standard eradication regimens is substantially declining due to rising antibiotic resistance and frequent therapy-related adverse effects. In this context, interest in adjuvant strategies is growing, including the use of probiotics and postbiotics / metabiotics capable of increasing eradication rates and improving treatment tolerability through strain-specific mechanisms of action and modulation of the gastrointestinal microbiota. This review focuses on the postbiotic / metabiotic Limosilactobacillus reuteri DSM 17648, which has demonstrated anti-H. pylori activity that persists after inactivation and is independent of H. pylori antibiotic resistance. The article discusses the main mechanisms of action of L. reuteri DSM 17648, including strain-specific coaggregation with H. pylori, competitive blocking of pathogen adhesion to gastric epithelium, inhibition of H. pylori virulence factors, masking of its adhesins, as well as the production of antimicrobial and anti-inflammatory metabolites (organic acids, reuterin, exopolysaccharides, etc.) that contribute to reduced expression of urease, vacA, and cagA genes and attenuation of the inflammatory response in the gastric mucosa. A review of major clinical studies in adults and children is provided, including randomized placebo-controlled trials in Europe and Asia, which have shown that adding L. reuteri DSM 17648 to standard triple therapy increases H. pylori eradication rates by an average of 10–20%, reduces bacterial load (as assessed by urea breath test), alleviates dyspeptic symptoms, and decreases the frequency of gastrointestinal adverse effects by 20–40% compared to eradication therapy alone. Data from pediatric studies are separately examined, confirming the efficacy and favorable safety profile of the metabiotic during courses of up to 56 days, as well as the absence of serious adverse events in patients across different age groups. Based on cumulative experimental and clinical evidence, practical aspects of L. reuteri DSM 17648 use are discussed, including its incorporation into standard H. pylori eradication regimens and as monotherapy (in infected individuals without immediate eradication indications, between antibiotic courses, and in special patient populations), its place in current guidelines (Maastricht VI, Russian clinical guidelines), and future perspectives for use in combined and alternative therapeutic regimens, including the potential to reduce gastric cancer risk in infected individuals through its multifaceted impact on bacterial load, H. pylori virulence factors, inflammation, and gastric mucosal barrier function.
Background: Risk stratification for adverse cardiovascular outcomes is a key challenge in clinical cardiology. In addition to traditional risk scores, various other markers, including circulating microRNAs, have been actively investigated in recent years as a potential tool for personalized prognosis. Aim: To assess the prognostic value of baseline microRNA levels in patients with asymptomatic coronary atherosclerosis detected by multislice computed tomography (MSCT) during long-term follow-up. Methods: The retrospective analysis included data from 30 patients with asymptomatic coronary atherosclerosis confirmed by MSCT. At baseline, plasma levels of 15 circulating microRNAs were measured in all patients using NucleoSpin miRNA Plasma kits (MACHEREY-NAGEL, Germany): miR-195p, miR-126-3p, miR-205-5p, miR-126-5p, miR-21-5p, miR-143-3p, miR-223-3p, miR-145-5p, miR-29b-3p, miR-146a-5p, miR-92a-3p, miR-150-5p, miR-23a-3p, miR-181b-5p, miR-451a. Information on clinical outcomes within 5 years after enrollment was obtained from the Unified State Health Information System (USHIS, Russia). Endpoints were acute myocardial infarction (AMI), stroke, all-cause mortality, and a composite endpoint (AMI / stroke / mortality). Results: Among the 30 patients with asymptomatic atherosclerosis on MSCT (mean age 70 ± 9.8 years, 11 men), adverse outcomes were recorded in 7 patients during the 5-year follow-up, while 23 patients remained event-free. In univariate Cox analysis, only two microRNAs showed a statistically significant association with the outcome (AMI, stroke, and all-cause mortality): for miR-143-3p, the hazard ratio (HR) was 0.724 (95% confidence interval [CI] 0.539–0.972; p = 0.032); for miR-451a, HR was 27.872 (95% CI 1.125–690.637; p = 0.042). ROC analysis revealed borderline significance in predicting adverse events for miR-143-3p (sensitivity 71.4%, specificity 73.9%; p = 0.059) and for miR-451a (sensitivity 71.4%, specificity 87.0%; p = 0.066). In multivariable Cox regression adjusted for the Framingham risk score, a higher miR-143-3p level was independently associated with a reduced risk of all-cause death (HR 0.71; 95% CI 0.52–0.96). After adjustment for the Multi-Ethnic Study of Atherosclerosis (MESA) risk score, the high-risk category of miR-143-3p was associated with an increased risk of reaching the composite endpoint (HR 607.997; 95% CI 4.606–8024.582). Conclusion: Among the 15 microRNAs studied, miR-143-3p and miR-451a demonstrated an association with the development of adverse outcomes in patients with asymptomatic coronary atherosclerosis. These findings point to the potential prognostic value of these microRNAs, but require confirmation in studies with larger patient samples.
Background: 5-Aminosalicylates (5-ASA) are first-line therapy for patients with ulcerative colitis (UC). Although the 2022 ECCO Consensus considers 5-ASA to be low-risk, data on their use during pregnancy remain conflicting. Aim: To investigate the course and outcomes of pregnancy in women with UC, as well as the disease activity during gestation, according to adherence to prescribed 5-ASA therapy. Methods: Data from the registries of seven inflammatory bowel disease centers in Russia were analyzed. The analysis included women with UC (International Classification of Diseases, 10th edition code K51) who received 5-ASA therapy alone and for whom medical records contained information on pregnancy course and outcome. Disease and pregnancy courses were compared between two groups: those adherent and those non adherent to prescribed 5-ASA therapy. Adherence was defined as starting 5-ASA at least 3 months before conception and continuing a stable dose admission throughout pregnancy; non adherence was defined as self-discontinuation of therapy upon becoming pregnant. Results: The study included 73 women with UC (48 aged 30 years, 25 aged 30–40 years). Of these, 58.9% received oral 5-ASA only (41 women mesalamine, 2 sulfasalazine), and 41.1% (n = 30) received combination therapy with rectal 5-ASA. In 8.2% (n = 6) of cases, patients switched from oral to combination therapy during pregnancy. The majority (82.2%, n = 60) continued prescribed 5-ASA therapy throughout pregnancy, while 17.8% (n = 13) discontinued it on their own upon becoming pregnant. The overall rate of UC relapse during pregnancy was 39.7% (29/73). UC recurrence was more frequent in the discontinuation group than in the fully adherent group: 92.3% (12/13) and 28.3% (17/60) respectively (p 0.001). Threatened miscarriage was also higher in the discontinuation group: 38.5% (5/13) and 13.3% (8/60) (p = 0.047) respectively. The composite rate of pregnancy complications (threatened miscarriage, preterm birth, early pregnancy termination) was 76.9% (10/13; 95% confidence interval [CI] 49.7–91.8) in non adherent patients vs. 21.7% (13/60; 95% CI 13.1–33.6) in adherent patients (p 0.001). Newborns in the maintenance 5-ASA therapy group more frequently had normal birth weight and Apgar scores (90.5%, n = 48) compared to those born to mothers who discontinued 5-ASA (42.8%, n = 3) (p = 0.007). No adverse events in women or congenital malformations in newborns were registered during 5-ASA treatment before conception and throughout pregnancy. Conclusion: Adherence to maintenance 5-ASA therapy in women with UC is associated with a more favorable pregnancy course and outcomes compared to discontinuation of therapy upon conception.
Background: Non-muscle-invasive bladder cancer (NMIBC) is characterized by high prevalence and a high recurrence rate. Data on the association of type 2 diabetes mellitus (T2DM) with the risk and prognosis of bladder cancer are conflicting. Understanding the effect of comorbid T2DM on the insulin signaling system in NMIBC patients may improve the diagnostic work-up and optimize antitumor treatment. Aim: To identify differences in the levels of insulin-like growth factors 1 and 2 (IGF-1 and IGF-2) in blood, urine and tumor tissue between patients with NMIBC and T2DM, patients with NMIBC without T2DM, patients with T2DM without cancer, and healthy controls (donors). Methods: This pilot single-center cross-sectional comparative study included 20 newly diagnosed NMIBC patients with comorbid T2DM (middle-aged and elderly) hospitalized from September 2022 to May 2024. IGF-1 and IGF-2 levels were measured by enzyme-linked immunosorbent assay in serum and urine samples collected before surgery, and in tumor tissue homogenates. The results were compared with those from 20 NMIBC patients without T2DM, 12 outpatients with T2DM without cancer, and 10 healthy donors examined during the same period. Blood glucose and glycated hemoglobin (HbA1c) levels were determined in all subjects. Results: In NMIBC patients with T2DM, the blood IGF-1 level did not exceed the median value of the donor group (589 ng/mL) in 18 out of 20 cases and was on average two-fold lower than in T2DM patients without cancer (p 0.001). In 25% (5/20) of NMIBC patients and 50% (6/12) of T2DM patients, the blood IGF-1 level exceeded the maximum donor value (998 ng/mL). Blood IGF-2 levels were higher in T2DM patients than in all other groups (p 0.001), whereas the other groups did not differ from each other. The NMIBC group showed the highest variability in circulating IGF-2 (coefficient of variation 273%) and included isolated cases with levels close to those observed in T2DM patients. Urinary IGF-1 excretion in NMIBC patients with T2DM did not differ from that in donors and was on average four-fold lower than in NMIBC patients without diabetes (p = 0.003). Tumor tissue IGF levels did not differ between patients with and without diabetes. In NMIBC patients with T2DM receiving metformin, a positive correlation was found between blood IGF-1 and glucose levels (Spearman’s rank correlation coefficient +0.803, p = 0.034), and their blood IGF-1 level was on average 1.7-fold lower than in other patients of this group (p = 0.047). In normoglycemic cases on metformin, the blood IGF-1 level was the lowest, on average 3.8-fold below donor values (p = 0.007). Conclusion: In middle-aged and elderly patients of both sexes with NMIBC and comorbid T2DM, in contrast to T2DM patients without cancer and NMIBC patients without T2DM, relatively low blood and urine IGF-1 and IGF-2 levels were observed, close to those in donors, and tumor IGFs levels did not differ from control values. In NMIBC patients with T2DM receiving metformin, unlike other patients and donors, a strong positive correlation between blood IGF-1 and glucose levels was found. In normoglycemic patients on metformin, the blood IGF-1 level was the lowest among all patients and donors. This may indicate a possible mechanism of the antitumor effect of metformin, but this observation requires confirmation in larger clinical studies.
Background: Pemphigus vulgaris is an autoimmune bullous dermatosis for which high-dose glucocorticoid (GC) therapy is the first-line treatment. However, the use of supraphysiological GC doses may lead to the development of hypercortisolism symptoms. Aim: To investigate the somatic and metabolic disorders induced by supraphysiological doses of systemic GCs (prednisolone) in patients with pemphigus vulgaris in order to optimize their management. Methods: A single-center, observational, two-sample, retrospective, comparative, non-interventional study was performed. The main group consisted of patients with pemphigus vulgaris who received supraphysiological doses of prednisolone for 6 months (initial dose 60–120 mg/day; at 6 months, 20–25 mg/day; cumulative prednisolone dose ranged from 6300 to 13200 mg, median 9900 mg). The comparison group included patients with Cushing’s disease or corticosteroma. Anthropometric parameters, clinical manifestations (18 major symptoms of hypercortisolism), and laboratory/instrumental findings were assessed. Results: A total of 25 patients (median age 51 [43; 60] years) with pemphigus vulgaris, 49 patients (median age 39 [32; 45] years) with Cushing’s disease, and 41 patients (median age 43 [34; 51] years) with corticosteroma were examined. The main symptoms observed in pemphigus vulgaris patients after 6 months of high-dose prednisolone therapy were weight gain (20/25, 80%), muscle weakness (17/25, 68%), matronism (12/25, 48%), and central redistribution of subcutaneous fat (11/25, 44%). In pemphigus vulgaris patients, the frequency of such clinical manifestations as weight gain, striae, muscle weakness, increased appetite, irritability / tearfulness, insomnia, and memory impairment did not differ significantly from that in endogenous hypercortisolism, whereas the frequency of abdominal fat redistribution, hair loss, back pain, and decreased libido was similar only to the corticosteroma group. In pemphigus vulgaris patients after 6 months of prednisolone, the frequency of arterial hypertension increased from 3 (12%) to 9 (36%) cases (p = 0.031 compared with baseline); glucose metabolism disorders were newly diagnosed in 8 (32%) patients (p = 0.008), and hypokalemia also in 8 (32%) patients (p = 0.008). Waist and hip circumferences, total cholesterol, triglycerides, and potassium levels did not differ between pemphigus vulgaris patients and those with endogenous hypercortisolism. The cumulative prednisolone dose in pemphigus vulgaris patients correlated positively and significantly with the frequency of muscle weakness (r = 0.460, p = 0.020) and hypertriglyceridemia (r = 0.587, p = 0.003). Conclusion: The clinical and biochemical changes that developed in pemphigus vulgaris patients on GC therapy were more similar to the abnormalities observed in corticosteroma than to those in Cushing’s disease. In pemphigus vulgaris patients before starting prednisolone, it is advisable to assess body mass index and blood pressure, measure waist and hip circumferences, and perform measurements of total cholesterol, triglycerides, potassium, and glucose during an oral glucose tolerance test. During GC therapy, consideration may be given to the following: additional potassium supplementation at 1 g/day and the elimination of simple carbohydrates from the diet; regular monitoring of body mass index, waist and hip circumferences, blood pressure, and self-monitoring of postprandial (2-hour) glycemia; monthly laboratory measurement of serum potassium; and, if postprandial glycemia is elevated, a repeated oral glucose tolerance test.
Background: The prevalence of obesity among working-age men with high occupational stress reaches 41%, significantly exceeding the average population level (28.6%). In this cohort, obesity is recognized as one of the leading risk factors for the early development of cardiovascular and cerebrovascular diseases. Experimental evidence indicates the influence of obesity and intermittent hypoxia on the disruption of the blood-brain barrier (BBB). As a biological marker reflecting BBB dysfunction, claudin-5 is of interest, with increased serum concentrations observed in neurodegenerative, psychiatric, autoimmune diseases, and in the acute stage of ischemic stroke. Aim: To determine the association of abdominal obesity and intermittent hypoxia with serum claudin-5 levels and the severity of cerebral microangiopathy in working-age men with high occupational stress. Methods: A single-center continuous cross-sectional study was conducted with sequential enrollment of 100 men from the personnel of the Russian Ministry of Emergency Situations (EMERCOM), aged 20 to 60 years, with cardiovascular risk factors, who underwent examination and treatment at the clinic of the Nikiforov Russian Center for Emergency and Radiation Medicine, EMERCOM of Russia, from February 1, 2024, to March 1, 2025. Stress levels were assessed using the Psychological Stress Measure (PSM-25). All patients underwent ultrasound scanning of the brachiocephalic arteries with measurement of intima-media thickness (IMT) and the percentage of stenosis in the presence of atherosclerotic plaques. The severity of cerebral vascular lesions was evaluated by the number of gliosis foci and the Fazekas scale based on brain magnetic resonance imaging (MRI). Laboratory tests included determination of total cholesterol and its fractions, triglycerides, glucose, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin (HbA1c), fibrinogen, and claudin-5. For screening for obstructive sleep apnea syndrome, overnight 8-hour pulse oximetry was performed with calculation of the desaturation index (DI). Results: Abdominal obesity was detected in 76 of the 100 examined individuals. Overnight pulse oximetry was not performed in 13 patients for technical reasons. The final analysis included data from 87 patients, who were divided into 3 groups based on the presence of obesity and intermittent hypoxia: Group 1, 20 patients without abdominal obesity and significant intermittent hypoxia (waist circumference (WC) ≤ 94 cm, DI 15); Group 2, 46 patients with isolated abdominal obesity (WC 94 cm, DI 15); Group 3, 21 patients with abdominal obesity and moderate-to-severe intermittent hypoxia (WC 94 cm, DI ≥ 15). A progressive increase in the severity of hyperglycemia was observed with rising HbA1c levels (5.0 [4.8; 5.4], 5.4 [5.0; 5.7], 5.7 [5.4; 6.2] %; p = 0.0002, p1–2 = 0.072, p1–3 = 0.0001, p2–3 = 0.036) and an increase in serum claudin-5 (1.9 [1.1; 3.1], 2.9 [1.4; 7.7], 5.3 [2.0; 7.9] ng/mL; p = 0.040, p1–2 = 0.163, p1–3 = 0.041, p2–3 = 1.0) across the three groups, respectively. A significant increase in the severity of cerebral vascular lesions on MRI was noted only in the group with combined obesity and intermittent hypoxia. The prevalence of periventricular changes on the Fazekas scale in Group 1was 0 (0%), in Group 2, 2 (4%), and in Group 3, 4 (23.5%) (p = 0.015, p1–2 = 0.77, p1–3 = 0.0225, p2–3 = 0.027). Conclusion: Abdominal obesity, and especially its combination with intermittent hypoxia, is associated with increased HbA1c levels and serum claudin-5 concentrations, as well as with the development of cerebral vascular lesions diagnosed by MRI. It is hypothesized that intermittent hypoxia contributes additionally to the alteration of vascular wall proteins, leading to BBB disruption, which promotes the development of cerebrovascular diseases. Measurement of claudin-5 holds promise as a marker of BBB damage.
Background: Cerebral small vessel disease (cSVD) and Alzheimer's disease (AD) are the most common causes of cognitive impairment (CI) in older adults. In some cases, they are difficult to be differentiated due to similar clinical, MRI, and laboratory manifestations, as well as comorbidity associated with accelerated CI progression. Aim: To compare specific characteristics of cerebral atrophy and their association with the type and severity of CI in cSVD and AD patients. Methods: This was a single-center observational cross-sectional study with consecutive patient recruitment conducted from December 2020 to December 2023. It included 45 cSVD patients (48.9% women, mean age 64.6 ± 5.7 years) and 26 AD patients (61.5% women, mean age 66.1 ± 7.9 years). All participants underwent a comprehensive neuropsychological examination and brain MRI (3 Tesla) with calculation of volumetric indices (gray and white matter volumes, white matter hyperintensities, and cerebrospinal fluid), ventriculocranial coefficients for assessing internal atrophy, and surface morphometry. Results: No statistically significant sex, age, or education level differences were found between cSVD and AD patients (p 0.05); however, arterial hypertension and obesity were more prevalent in cSVD (p = 0.003). Most cSVD patients were diagnosed with cognitive dysfunction with impairment of executive function (33.3%) and of the mixed (55.6%) type, whereas in AD, an isolated amnestic type (96.3%) dominated (p 0.001). The results of neuropsychological tests showed significant between-group differences for the MoCA scale scores and memory tests (p = 0.002 and p 0.001, respectively), but not for executive functions (p 0.05). In cSVD, cognitive test results correlated with all intracranial volumetric indices and internal atrophy coefficients (r 0.25, p 0.05), while in AD, they correlated only with gray matter volume (for MoCA R = 0.436, p = 0.02). Moderate CI in AD was characterized by the temporoparietal cortex atrophy (p = 0.006 for the left middle temporal gyrus, and p = 0.051 for the right upper parietal gyrus), while in cSVD, it was associated with insular atrophy from both sides (p = 0.014 for the right and p = 0.058 for the left insula). Dementia manifested as atrophy extending beyond these regions. Binary logistic regression allowed for the differentiation between mild CI and dementia by regional atrophy thresholds: in AD, of the right parahippocampal gyrus (AUC = 0.753; 95% confidence interval 0.557 to 0.949, p = 0.033) and in cSVD, of the isthmus of the left cingulate gyrus (AUC = 0.778; 95% confidence interval 0.637 to 0.919, p = 0.001). Conclusion: cSVD and AD significantly differ by the CI and cerebral atrophy profile. Region-specific atrophy markers can be used for the differential diagnostics of the pathologies and their mixed forms, and for monitoring of CI progression.
Rationale: The differential diagnosis of focal liver lesions remains challenging, particularly in situations where the use of contrast agents in magnetic resonance imaging (MRI) is contraindicated (e. g., due to renal failure or allergy) or when the findings on T2-weighted images (T2WI) lack any pathognomonic signs. In these scenarios, an additional diagnostic tool is required to support decision-making, and a clinical-radiomic model capable of accurately classifying focal lesions based on T2WI data with accuracy and precision could be relevant. Aim: To develop and perform internal validation of a clinical-radiomic model for the differential diagnosis of focal liver lesions based on T2WI. Methods: This was a retrospective cross-sectional single-center study with an open anonymized WORC-Liver dataset, containing T2WI abdominal MRI images of patients with focal liver lesions (the original data collection performed at Erasmus Medical Center (Rotterdam, the Netherlands) between 2002 and 2018 using 1.5T Siemens, Philips, and General Electric scanners). Image processing included normalization (SimpleITK, Z-score) and interpolation to isotropic 1 × 1 × 1 mm³ voxels. Radiomic feature extraction was performed using intensity histograms and gray-level matrices (PyRadiomics). The characteristics were classified using the XGBoost algorithm with an 80:20 train-validation split. Results: From the initial dataset of 186 cases, 146 patients (72 with malignant and 74 with benign lesions) were selected for analysis. On the internal validation set (n = 30), the model showed high diagnostic performance: ROC-AUC 96% (95% confidence interval [CI]: 0.89–1.00), sensitivity 87% (95% CI: 77–97), specificity 93% (95% CI: 85–100). The analysis of variable importance revealed the largest contributions from the following ones: patient age (SHAP +0.88), manufacturer: GE (SHAP +0.35), patient sex (SHAP +0.29), and original_gldm_DependenceNonUniformity (SHAP +0.17). Conclusion: We were able to develop a high-accuracy clinical-radiomic model for the non-invasive differential diagnosis of focal liver lesions using native T2WI. The results demonstrate the model's potential for clinical application, particularly when the contrast administration is contraindicated. Its implementation would require further validation in larger and more diverse datasets.
The development of new strategies to treatment of ENT disorders makes it necessary to implement non-invasive diagnostic methods into clinical practice; these methods should be able to provide the information on the biological tissues and be applicable to the intra-operational use. The aim of this review is to summarize the data on the use of optical coherent tomography (OCT) in the otolaringology. This method gives two- and three-dimensional images of a biological tissue with resolution of 1 mcm up to the depth of 2 mm. The use of this method in the ENT practice is associated with the development of specialized OCT modifications and special probes, including those compatible with standard endoscopes and/or intraoperational microscopes. OCT diagnostics may proved unique information for the solution of the following clinical tasks: the differential diagnosis between tumours and non-tumours, including their early stages, assessment of particular pathomorphological characteristics in inflammatory disorders, monitoring of tissue response to treatment. The addition of OCT to standard diagnostic algorithms would facilitate an improvement in the differential diagnosis and optimisation of treatment choice in a number of clinically significant ENT disorders. Multi-mode OCT equipment which allow both structural and functional information, as well as machine learning methods for image interpretation is a promising area of the OCT techniques.
Background: Renal cell carcinoma (RCC) is a highly immunogenic neoplasm and a promising target for the development of new approaches to immunotherapy. Galectins can modulate immune response, actively participating in inflammation, and help the tumor cells to escape host immune reaction. Some members of the galectin family could further become promising diagnostic or prognostic markers of various malignancies. However the data obtained are not unambiguous, and in some observations are extremely contradictory. We have demonstrated previously a significant increase of soluble galectins-1, -3 and -9 levels in serum of RCC patients before the initiation of anti-tumor therapy. Aim: To analyze an association between serum galectins-1, -3, -4, -7, -9 levels and overall survival of RCC patients with various stages of the tumor process. Methods: We retrospectively analyzed the impact of baseline soluble galectins-1, -3, -4, -7, -9 levels on overall survival of 129 patients with primary RCC who had undergone examination and treatment at the N. N. Blokhin National Medical Research Center of Oncology from 2019 to 2023. Surgery had been performed in all patients, and 10 of them had systemic target treatment or immunotherapy after surgery. Serum galectins concentrations were measured before the start of specific treatment with standard enzyme immunoassay kits. Results: The patients (n = 129) were followed up for 0.3 to 64.6 months (median, 39.3 months) after surgery. During this follow-up 32 (24.8%) patients died. They survived from 0,3 to 50.8 months (median, 20.2 months) after the initiation treatment. The patient groups selected depending on the corresponding marker levels (above or below the median) were not different in their clinical and pathologic characteristics and the treatment performed. Only pre-treatment serum galectin-3 and galectin-9 levels were associated with overall survival rates. Serum concentrations of galectin-3 and galectin-9 above the median level (10.1 ng/mL and 9.2 ng/mL) significantly decreased the 5-years overall survival of RCC patients by 21.1% and 17.6% respectively. Conclusion: Measurement of serum galectin-3 and galectin-9 concentrations can be used as supplementary criteria for the assessment of overall survival prognosis in patients with RCC.
Background: Coronary artery ectasia (CAE) complicates the course of ST segment elevation myocardial infarction (STEMI) by increasing the risk of thrombotic complication, which is commonly associated with increased infarction area. The optimal choice of antihypertensives and anticoagulants may potentially improve clinical outcomes in these patients. Aim: To assess the impact of various antihypertensive and anticoagulant regimens on long-term clinical outcomes in patients with STEMI and ectasia of the index artery. Methods: This retrospective multicenter study included 80 patients with STEMI and angiographically confirmed CAE of the index artery, hospitalized from January 2014 to February 2022. All patients received standard treatment (dual antiplatelet therapy, statins, and β-blockers). Additional medications included angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), calcium channel blockers (CCB), and direct oral anticoagulants (DOAC). Clinical endpoints were followed up to December 31, 2024. Kaplan–Meier analysis was used to evaluate the primary combination endpoint, i. e. major adverse cardiovascular events (MACE), which included overall mortality, stroke, recurrent myocardial infarction, hospitalizations due to chronic heart failure (CHF), and secondary endpoints (overall mortality, stroke, recurrent myocardial infarction, recurrent revascularization of the index artery, and hospitalizations due to CHF). Results: The cohort of the patients admitted with STEMI and CAE of the index artery (n = 80) consisted mostly of men (81.3%), and the mean age was 61 years. Arterial hypertension and hyperlipidemia were present in 71.3% of the patients each; diabetes mellitus in 18.8%, and 50% of the patients were smokers. Most patients (86.3%) were admitted without signs of severe acute heart failure (Killip class I), with median SYNTAX score of 11. The median follow-up duration was 58 months. The use of ACEi did not reduce the MACE rate (35.6% vs 33.3%; p = 0.860), but was associated with a reduction in hospitalizations for CHF (6.8% vs 23.8%; p = 0.044). The use of ARB was not associated either with a reduction in the MACE rates (23.1% vs 37.3%; p = 0.790) or hospitalizations for CHF (15.4% vs 10.4%; p = 0.371). There was a non-significant trend toward a lower MACE rates (20% vs 37.1%; p = 0.11) and hospitalizations for CHF (0% vs 12.9%; p = 0.09) among patients taking CCB. The use of DOAC was not associated with a significant clinical benefit in MACE frequency (42.9% vs 34.2%; p = 0.261) or hospitalizations for CHF (0% vs 12.3%; p = 0.439). Conclusion: In patients with CAE, particularly those with STEMI, the use of ACEi as a component of antihypertensive therapy should be considered to reduce the risk of heart failure decompensation, provided there are no contraindications. The potential benefits of CCB and DOAC warrant further investigation.
Background: Psychological abnormalities are common among breast cancer (BC) survivors and may negatively impact their quality of life and outcomes. An improvement in the psychosocial well-being of cancer patients is a key objective of comprehensive cardio-oncology rehabilitation (CORE) programs. Remote CORE models could contribute to increased patient involvement in such programs. Aim: To compare the effectiveness of the off-line (Off-L) and online (On-L) CORE programs regarding their effects on the psychological status parameters in ВС survivors. Methods: This single center pilot randomized prospective study was conducted in a total of 90 BC survivors from 2021 to 2023 in a specialized cardiology clinic. The patients were randomized into three parallel groups in 1:1:1 ratio: the Off-L cardiac rehabilitation program group, the On-L cardiac rehabilitation program group, and the control group. The CORE programs included an educational component addressing cardiovascular risk factors with nutritional counseling, a supervised individualized twice weekly physical exercise program for 3 months (Off-L group), an individualized home-based physical exercise regimen with remote support for 3 months (On-L group), and psychological support with a single session with a psychologist. The control group patients were followed up in their routine clinical practice. In all patients, past history data were collected, including educational level and marital status. Baseline assessments and follow-up evaluation at 6 months included clinical characteristics, stress levels (visual analog scale, VAS), anxiety and depression scores (Hospital Anxiety and Depression Scale, HADS), sleep quality (Pittsburgh Sleep Quality Index), and cognitive function (Montreal Cognitive Assessment, MoCA). Results: The patients median age was 49 years [IQR 46; 56]. At baseline, anxiety symptoms (AS) were found in 45 (50%) patients, depressive symptoms (DS) in 16 (17.8%), high stress levels in 51 (56.7%), sleep disturbances in 80 (89%), and cognitive impairment in 11 (12.4%) patients. There were no differences at baseline between the groups in their main characteristics studied. Over the 6-month follow up, 23 patients dropped from the study. By the end of the observation period, the CORE groups showed a decrease in AS in the Off-L group (n = 20) from 8.5 [6.0; 10.0] to 6.0 [4.0; 9.5] points, with the difference in their median values of -1.5 (95% confidence interval [CI]: -3.0, -0.5, p = 0.026) and in the On-L group from 7.0 [5.0; 8.0] to 5.0 [3.0; 8.0] points (the difference in median values: -2.0, 95% CI: -3.0, 0.5, р = 0.018). No significant changes in AS were found in the control group (the difference in median values: -0.5, 95% CI: -2.0, 0.5, p = 0.181). In the patients with baseline subclinical (8 to 10 points, HADS-A) and clinically significant (≥ 11 points) anxiety, the participation in the CORE programs have led to a higher chance of its decrease either to 8 points or a change in the anxiety category from clinically overt to subclinical (odds ratio 5.667, 95% CI: 1.129, 28.455, р = 0.035). By the end of the follow up, the stress levels in the Off-L group decreased from 8.0 [5.0; 9.0] to 7.0 [4.0; 8.0] VAS points (the difference of the medians: -1.5, 95% CI: -2.0, 0.0, р = 0.050), in the On-L group from 7.0 [6.0; 8.0] to 5.0 [4.0; 6.8] points (the difference of the medians: -1.5, 95% CI: -2.5, -0.5, р = 0.003). There were no significant changes over time in the stress levels in the control group (the difference of the medians: 0.0, 95% CI: -1.0, 1.0, р = 0.974). No statistically significant changes were found in depression scores or sleep quality over the 6-month observation period in the study groups. The On-L group demonstrated a statistically significant improvement in the MoCA cognitive function scores (the difference of the medians: 0.5, 95% CI: 0.0, 1.0, р = 0.021). Conclusion: The participation of BC survivors in the CORE programs facilitates the decrease in anxiety and stress. The On-L CORE program is not inferior to the Off-L program in its impact on the patients’ psychological status. In this regard, further larger studies on the effectiveness of CORE models with various type of telemedicine support seem promising in this patient population.
