[Machine Learning Methods in Assessing the Risks of Target Organ Damage in Masked Hypertension].

Aim To develop models for predicting the risk of target organs damage (TOD) in different phenotypes of "masked" arterial hypertension (MAH) based on methods of machine learning (ML).Material and methods A retrospective cohort analysis was performed for 284 clinical records of patients (261 males, 23 females; median age, 38 years). Group 1 included 125 patients with grade 1-2 arterial hypertension (AH) and low or moderate risk; group 2 included 159 subjects with normal "office" blood pressure (BP) exposed to chronic professional stress. The 24-h BP monitoring (24-h BPM) and ultrasound examination of the heart and carotid arteries were performed; glomerular filtration rate (GFR) was estimated using the СКD-EPI formula. MAH was phenotyped by clustering 24-h BPM data, and the risk of TOD was predicted by analysis of odd ratios (OR) and with the ML methods, random forest (RF) and artificial neural networks (ANN). Data were analyzed using the R language in the RStudio environment.Results According to results of the 24-h BPM and cluster analysis, 121 (76.1 %) subjects of group 2 had MAH. The MAH phenotypes were identified as follows: systolic-diastolic (SDMAH) (43.8 %); isolated systolic (ISMAH) (35.5 %), and isolated diastolic (IDMAH) (20.7%). As compared to stable AH, subjects with different MAH phenotypes showed both increases and decreases in individual 24-h BPM indexes. Thus, in subjects with IDMAH, mean 24-h values of systolic and diastolic BP were significantly lower than with AH while in SDMAH, they were considerably higher. The OR analysis demonstrated that odds of differently located TOD were associated with definite MAH phenotypes. With that, ISMAH was associated with the highest risk of glomerular hyperfiltration; IDMAH was associated with reduced GFR and vascular remodeling; and SDMAH was associated with left ventricular myocardial hypertrophy. The developed models for predicting the risk of TOD based on the RF and ANN methods showed a high accuracy, which was provided by multistep procedures of selecting the predictors and cross-validation.Conclusion Modern ML technologies enhance the risk stratification of patients with different clinical variants of AH.

[The Distinguish Method of Severe Aortic Stenosis Treatment Geriatric High Mortality Risk Patients].

Aim To improve quality of treatment for senile patients with pronounced aortic stenosis (AS).Material and methods Aortic valve stenosis (AS) is the most common valve pathology in cardiosurgical patients. Surgical correction of aortic valve (AV) stenosis accounts for 10 to 22 % of open-heart operations. 125 patients with pronounced AS were treated in the N. N. Burdenko Main Military Clinical Hospital between 2010 and 2017. This study was based on the implementation of new, minimally invasive methods in our clinic in 2013: balloon aortic valvuloplasty (BAVP) of the aortic valve and transcatheter aortic valve prosthesis (TCAVP).Results In the group of patients receiving the drug therapy alone, the in-hospital mortality was 2 %. At the time of maximum follow-up duration (3 years), the survival rate was 50.5 %. In the group of patients who underwent the AV replacement with extracorporeal circulation, the 3 year postoperative mortality was 16.6 %. There was no 3 year mortality in the group of patients who underwent TCAVP. The short-term beneficial effect of BAVP was confirmed.Conclusion An algorithm was developed for medical care of patients older than 75 with pronounced AS; the place of BAVP in the step-by-step management of these patients was determined. Using the developed approach in the management of these patients provided a 32 % (p<0.05) increase in the number of cases of radical surgical care.

[Experience with the use of viadril anesthesia]. / Opyt primeneniia viadrilovogo narkoza

Based on experimental and clinical findings the authors concluded that a combination of viadril with neuroleptanalgesics shows a number of advantages over purely viadril anesthesia or its combination with other drugs for inhalation and intravenous anesthesia. The technic of thalmonal-viadril anesthesia is reported.