In order to determine ADC, a region of interest (ROI) was established on the ADC map above the required area (prostatic neoplasm, lymph node or normal tissue) with the lowest ADC value identified as the zone with the largest hypo-intensity of MR signal. Taking into consideration that DWIs are morpho-functional images with limited morphological information, in order to improve the accuracy of anatomical comparisons of suspicious areas, we additionally performed mutual overlap of axial T2-WIs and DWIs using RadiAnt DICOM Viewer 2020.2.3 software package, obtaining a color map, where color intensities corresponded to the degrees of diffusion restriction, allowing for accurate spotting of the abnormal lesions detected on DWIs. To obtain the precise ROI position above the area of the lymph node analyzed on ADC maps, we copied the ROI from the respective slice of axial T1-WIs or T2-WIs, which have served as a precise anatomical landmark. In addition to that, to ensure more precise identification of lymph nodes, we proposed a DWIbased method of pelvic lymph node mapping using a maximum intensity projection algorithm, which facilitated spatial identification of lymph nodes and preoperative preparation (Fig. 1). No significant differences were observed when comparing mean sizes of N+ and N– pelvic lymph nodes (p > 0.05). At the same time, when comparing  mean ADC values for N+ and N– pelvic lymph nodes, we did observe a  tatistically significant difference: in metastatic lymph node involvement, this value was 0.74 ± 0.09 × 10-3 mm2/s, while in lymph nodes without  metastatic involvement this value was 1.05 ± 0.23 • 10-3 mm2/s (p < 0.001). Such findings reflect diffusion restriction of hydrogen molecules in N+ lymph nodes due to the increased cellular density in their tissues, which is the case in the development of malignant tumors (Fig. 2). The ROC-analysis using the ADC of DWI MRI for differentiation of N+ and N– pelvic lymph nodes in PCa has shown that in a threshold cut-off value of 0.87 •
10-3 mm2/s, the sensitivity and specificity were 87% and 75%, respectively, with a high accuracy of the method, area under the curve = 0.933; 95% confidence interval (CI) = 0.852–1.0; p < 0.001 (Fig. 3) 

 It can be argued that the apparent diffusion coefficient of diffusion-weighted images of MRI can be used as potential imaging marker for the  iagnosis of local recurrence of RCC, provided it is localized in the renal parenchyma. However, further investigations with more cases are required. 

 To summarize, being an attractive research topic, the radiogenomics of PCa currently is not a comprehensively investigated area of oncourology. According to preliminary research findings conducted in this field, the combination of genomics and radiomics (and presumably metabolomics, proteomics, and transcriptomics) as integrative parts of precision medicine in the future has the potential to become the foundation for a personalized approach to the management of PCa. However, there are a number of hindrances to achieving this goal, such as relatively small numbers of patients included in current studies, a lack of available large randomized controlled trials, the need to use complex integrated methods of big data analysis, the comparatively high cost of genomic profiling and imaging methods, and the question of whether, before we include any potential genomic or transcriptomic marker into radiogenomic analysis, it should first be validated in order to prove its separate clinical value. If so, it greatly and significantly shifts the horizon of the actual use of radiogenomics in clinical practice, owing to the need for a huge body of future research. 

Abstract

The research aims at improving the quality assessment of clinical audit results in Ukraine using the complex of statistical methods and studying statistical methods in foreign reports of the clinical audit and personal experience.

Materials and Methods. The research was performed by analyzing the reports of clinical audit (n=62), held during 2021 by the Healthcare Quality Improvement Partnership. The spectrum of statistical methods was extended by the analysis of the example of a sociological survey of patients (n=405) regarding the quality assessment of medical care. The methods applied in the current study included systemic approach and analysis, structural and logical analysis, correlation and regressive analysis, calculation of relative values.

Results and Discussion. All 100% clinical audit reports, carried out by the Healthcare Quality Improvement Partnership were based on the results of the statistical calculations. The most common method of processing results is the epidemiological statistics (93.5%), ratio of chances/risks (30.6%), probability assessment by Х² Pearson's method (21.0%). It is noteworthy that for pointing the central tendency almost in half of the cases (46.8 %) the median and the Interquartile Range were used. Complex mathematical methods such as the survival assessment by Kaplan- Meier and method multiple regression were used in 6.5 % та 4.8 % reports, accordingly.

Conclusions. Based on our own experience, we suggested implementation of standardization methods, a detailed correlation and regressive analysis, neuro networks and power analysis into the methodology (technique) of the clinical audit. Implementation of spectrum of evidentially substantiated methods of statistical analysis will allow to increase the evidence level and to deepen the statistical analysis of databases when conducting the clinical audit, аnd therefore, the quality assessment of clinical audit results will increase.

SARS-CoV-2 and side effects of SARS-CoV-2 vaccination show tropism to nervous system structures. Neurological side effects from the central and peripheral nervous systems have been observed quite rarely after vaccination against COVID-19 compared to a large number of vaccinated individuals. The article presents a clinical case of simultaneous damage to the central and peripheral nervous systems in the form of acute autoimmune inflammatory encephalomyelopolyradiculoneuropathy, which occurred after receiving the first dose of the BNT162b2 mRNA vaccine. The severe course of encephalomyelopolyradiculoneuropathy with peripheral tetraplegia, sensory disturbances, bulbar syndrome, and dysautonomia, followed by the occurrence of pneumonia, secondary bacterial meningoencephalitis, the need for longterm mechanical ventilation led to the occurrence of pneumothorax and multiple organ failure, which caused the patient’s death after one and a half months of intensive therapy. Thus, the acute autoimmune inflammatory encephalomyelopolyradiculoneuropathy can be considered as a probable rare neurological complication of SARS-CoV-2 vaccination with mRNA-based vaccines. Encephalomyelopolyradiculoneuropathy can have a severe course, accompanied by multiple complications and leading to death. Establishing of the causal relationships of the occurrence of rare neurological pathological conditions close in time to vaccination against SARS-CoV-2 with mRNA-based vaccines requires additional further researches.