Analysis of factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in case of suspected prosthetic valve infective endocarditis

Aim. To analyze the factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) in case of suspected prosthetic valve endocarditis (PVE).Material and methods. The results of PET/CT performed in 66 patients after heart valve replacement were analyzed: 55 patients with suspected PVE (≥3 months after surgery) and 11 comparison groups without PVE (2 months after surgery). In the group with suspected PVE (n=55) at the time of the study, 27% (15/55) had a normal body temperature, 85% (47/55) — no leukocytosis. In 16% (9/55), the examination was performed from 3 to 6 months after surgery and in 67% (37/55)  — against the background of long-term antibiotic therapy (ABT). The final diagnosis of PVE was made on the basis of clinical (including 6±3 followup), laboratory, instrumental, and intraoperative (n=40) data: confirmed  — in 37 patients; ruled out — in 29 patients. In order to determine the influence of factors on obtaining false PET/CT results, the odds ratio was calculated.Results. In the group with suspected PVE (n=55), the PET/CT results made it possible to establish and rule out PVE in 92% (34/37) and 67% (12/18) of patients, respectively. In 16% (9/55) of patients, false positive (n=6) and false negative (n=3) results. Thus, the sensitivity, specificity and diagnostic accuracy of PET/CT in the diagnosis of PVE were 92%, 67% and 84%, respectively; positive and negative predictive values — 85% and 80%. The analysis of the odds ratio did not reveal the relationship of low inflammatory activity, the interval between surgery and PET/CT from 3 to 6 months, and long-term ABT before PET/CT with false PET/CT results (p>0,05). In the comparison group without PVE (n=11), 91% (10/11) received false positive PET/CT results, and one patient received a true negative result.Conclusion. The data obtained indicate the high informative value of PET/CT in the diagnosis of PVE. Interval >2 months between surgery and PET/CT significantly reduces the accuracy of PET/CT results. Other factors analyzed in the presented group did not affect the accuracy of PET/CT results

Высокие значения исходных объемных ПЭТ-биомаркеров как предикторы неблагоприятного прогноза классической лимфомы Ходжкина

Purpose: To analyse the prognostic value of the initial volumetric PET biomarkers – the total metabolic tumor volume (MTV) and the total lesion glycolysis (TLG) – in classic Hodgkin's lymphoma (cHL) and determine their optimal threshold values for prognosis.Material and methods. This retrospective study included 62 cHL patients with different stages who underwent staging with 18F-FGD PET/CT. The follow-up period was from 6 to 61 months after the baseline PET/CT, 41 patients remained in remission, 10 patients had refractory course, 11 relapsed. The examinations were processed with automatic (multi-foci segmentation – MFS) method to obtain MTV and TLG using two fixed absolute thresholds (SUVmax ≥ 2.5 and SUVmax ≥ 4.0) and one relative threshold (41% of SUVmax).Results. In subgroups with disease remission (n = 41) and refractory course or relapse (n = 21), statistically significant differences between MTV and TLG with the two thresholds were found – SUVmax ≥ 2.5 and 41% of SUVmax (p < 0.05). When using threshold of SUVmax ≥ 4.0 statistically differences between the mean of MTV and TLG were no detected.Univariate analysis revealed correlation between progression-free survival and volumetric PET biomarkers (MTV and TLG) with three thresholds (SUVmax ≥ 2.5, SUVmax ≥ 4.0, and 41% of SUVmax).Conclusion. In cHL high values of initial volumetric PET biomarkers – MTV and TLG – calculated with three thresholds (SUVmax ≥ 2.5, SUVmax ≥ 4.0, and 41% of SUVmax) are associated with unfavourable prognosis – a high probability of refractory disease course or relapse.The optimal prognostic thresholds values of MTV and TLG in the analysed group were determined respectively: SUVmax ≥ 2.5 – 204 cm3 and 961, at 41% of SUVmax – 105 cm3 and 620.Цель исследования: анализ прогностического значения исходных объемных ПЭТ-биомаркеров – общего метаболического объема опухоли (MTV) и общего уровня гликолиза (TLG) – при классической лимфоме Ходжкина (кЛХ) и определение их оптимальных пороговых прогностических значений.Материал и методы. Ретроспективно проанализированы результаты ПЭТ/КТ-исследований 62 пациентов с впервые выявленной кЛХ. Период наблюдения составил от 6 до 61 мес после исходного ПЭТ/ КТ-исследования. В течение указанного периода у 41 (66%) пациента сохранялась ремиссия заболевания, у 10 (16%) пациентов диагностировано рефрактерное течение, у 11 (18%) – рецидив. Показатели MTV и TLG рассчитывались автоматическим методом с использованием для каждого трех значений отсечки фона: двух абсолютных – SUVmax ≥ 2,5 и SUVmax ≥ 4,0 и одного относительного – 41% от SUVmax.Результаты. Для расчета пороговых прогностических значений MTV и TLG группа была разделена на две подгруппы: 1-я – с ремиссией заболевания в течение периода наблюдения (n = 41); 2-я – с рефрактерным или рецидивирующим течением (n = 21). В указанных подгруппах были выявлены статистически значимые различия между показателями MTV и TLG при двух используемых значениях отсечки фона – SUVmax ≥ 2,5 и 41% от SUVmax (р < 0,05). При использовании отсечки фона – SUVmax ≥ 4,0 – значимых различий между указанными показателями в подгруппах получено не было.При однофакторном анализе параметры MTV и TLG с использованием трех пороговых значений отсечки фона (SUVmax ≥ 2,5, SUVmax ≥ 4,0 и 41% от SUVmax) коррелировали с выживаемостью без прогрессирования.Заключение. При кЛХ высокие значения исходных объемных ПЭТ-биомаркеров MTV и TLG, рассчитанные с использованием различных порогов отсечки фона (SUVmax ≥ 2,5, SUVmax ≥ 4,0 и 41% от SUVmax), ассоциируются с неблагоприятным прогнозом – высокой вероятностью рефрактерного течения заболевания или возникновения рецидива.Оптимальные прогностические пороговые значения MTV и TLG в анализируемой группе составили: при SUVmax ≥ 2,5 – 204 см3 и 961, при 41% от SUVmax – 105 см3 и 620 соответственно

Current status of nuclear cardiology in the Russian Federation

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described

Analysis of the restoration of cardiology diagnostics scope in the Russian Federation during the COVID-19 pandemic: results of the Russian segment of the INCAPS COVID 2 study under the auspices of the International Atomic Energy Agency

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers

науково-практичний коментар

Науково-практичний коментар Кодексу України про адміністративні правопорушення : станом на 5 верес. 2017 р. / за заг. ред. С.В. Пєткова. – Київ: Центр учб. літ., 2017. – 544 с. – ISBN 978-611-01-0880-5.У даному науково-практичному коментарі подано постатейний аналіз чинної редакції Кодексу України про адміністративні правопорушення з урахуванням останніх змін і доповнень станом на 5 вересня 2017 року.This scientific and practical commentary provides an article-by-article analysis of the current version of the Code of Ukraine on Administrative Offenses, taking into account the latest changes and additions as of September 5, 2017.В данном научно-практическом комментарии дан постатейный анализ действующей редакции Кодекса Украины об административных правонарушениях с учетом последних изменений и дополнений по состоянию на 5 сентября 2017

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Algorithm for solving multicriteria problem of appointments on the networks

To describe complex projects or various jobs that make up a set of interrelated activities, use the network schedule. Several variants of network models are used. 1. For practical use, the Gantt chart is the most widely used - it is a graphical representation of consecutive intervals of time and the use of resources. 2. The network graph is represented as a graph, where the vertices are an event (or its state at a certain point in time), and the connecting arcs (or edges) are works. The graph model is used in the work. In this case, the events (the fact of the completion or the beginning of the work) correspond to the vertices of the graph, and the work to the arcs, the orientation of which corresponds to the technology of this process. An important role in the project management model is played by the optimal assignment of performers to the existing list of works. With this formulation of the problem, the total implementation time or the length of the critical path on the graph can be used as a criterion. In this case, the criterion is imposed a restriction on the deadline for the execution of work (or the project as a whole). Thus, the total time spent on the project and the length of the critical path are represented by equally important characteristics of the project implementation, and they should be considered as two equivalent criteria for the multicriteria project management task. We have proposed an algorithm, in general, an approximate determination of the set of Pareto-optimal solutions of a given problem

18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN CANCER PATIENTS: A WHOLE-BODY EXAMINATION PROCEDURE

Positron emission tomography (PET) is one of the current techniques of molecular radionuclide imaging, which provides a qualitative and quantitative assessment of biochemical processes occurring in a living organism. The paper contains information on how to per- form 18F-fluorodeoxyglucose PET for whole-body examination. It analyzes factors that influence the accuracy of obtained results, methods for PET image analysis, and reasons for possible diagnostic errors