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La relation entre centration sur la personne et centration sur l’experience immediate interieure, ou « experiencing », est historiquement complexe et la tendance la plus frequente est de mettre les deux en concurrence. Cependant, chacune existe et a sa pleine place dans la pratique therapeutique centree sur la personne. Une pratique tenant compte exclusivement d’une seule de ces deux dimensions serait desequilibree. Leur interrelation est de ce fait a repenser de maniere a parvenir a ne plus les considerer comme separees. La personne est l’auteure de son experiencing, elle entre en relation avec, dans une dynamique et non de maniere figee. Le processus therapeutique, pour etre complet, se doit d’integrer ces deux poles que sont la personne et l’experiencing dans une seule et meme dimension globale.

The purpose of the investigation was to study the nootropic effects of rhythmic transcranial magnetic stimulation (rTMS) using low-intensity magnetic field with the induction rate of 45 mT, base frequency of 50 Hz, modulation frequency of 10 Hz in combination with standard medical and psychological therapy in the rehabilitation of patients with post-stroke cognitive impairment (PSCI). Materials and methods. The rehabilitation outcomes in 98 patients with PSCI syndrome were studied. The patients were subdivided into 2 groups: 53 patients of the control group were treated with the standard nootropic medications and neuropsychological procedures; 45 patients of the main group were additionally treated with rTMS by the low-intensive running pulsed magnetic field of 10 Hz modulation frequency. The dynamics of the score increase according to Rivermid, Karnovsky, Roshina, MMSE, mRS, HDRS, SF-36 scales were analyzed. Conclusion. Application of rTMS with low-intensive running pulsed magnetic field of 10 Hz modulation frequency in combination with a standard program of cognitive rehabilitation contributes to a significant improvement in the recovery of mental calculation function in ischemic stroke patients, as well as normalization in mood swings in the patients who had suffered a hemorrhagic stroke and post-stroke depression. This variant of rTMS can be safely used in patients with PSCI syndrome in the early recovery period, 3 weeks after the onset of stroke.

This review is devoted to current approaches to the combined use of BMP-2 with other protein factors to increase osteoinductivity of recently developed materials. The current trend is to create materials with a low BMP-2 concentration that are efficient in osteoinduction and provide continuous protein release. A number of medications have been developed in Russia and South Korea on the basis of BMP-2 synthesized in E. coli cells. The first experience of their use in orthopedics, traumatology, spinal surgery, and dental implantology showed promising results. Also, the possibility of the recombinant BMP-2 use in ophthalmology, and oncology, as well as osteoarthritis treatment, was studied. The databases of PubMed Central (U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM)), PubMed (NLM National Center for Biotechnology Information (NCBI)), and e-library (Science Electronic Library) were used to analyze published results.

We have fabricated a series of potassium-doped (K-doped) perovskite solar cells (PSCs). Structural investigations of the developed PSCs have shown that alkai doping affects the perovskite layer structure and morphology with the increase of the crystallite size and surface uniformity. K-doped samples exhibite higher photovoltaic (PV) performance and improved operational stability compared to the control series of undoped PSCs, due to retarded recombination processes.

Background. Daratumumab is IgG1-K humanized anti-CD38 monoclonal antibody. It has a direct impact on tumor and immunomodulatory effect. Aim. To assess the efficacy of daratumumab monotherapy in patients with progressive, and relapsed/refractory multiple myeloma (MM), as well as to find out the degree of toxicity and safety of this drug. Materials & Methods. The trial included 10 MM patients (3 men and 7 women) aged 51-74 years (median 57 years). Stage 3 (according to Durie-Salmon system) was determined in all patients, in 2 of them stage 3B with creatinine clearance < 30 mL/min was reported. According to ISS (International Staging System) criteria, stage 2 and stage 3 were identified in 6 and 4 patients, respectively. All the patients had been previously treated with bortezomib and lenalido-mide with further double refractoriness in 4 out of 10 patients. Bendamustine and carfilzomib were administered to one patient each, both in combined regimens. The number of previous therapy lines was 3-6 (median 5). Results. Overall response was 50 % including 2 (20 %) patients with very good partial remission. In 1 (10 %) patient complete remission was achieved. During the follow-up of 6-32 months (median 15 months) median overall survival was not achieved. Median progression-free survival was 17.8 months. Daratumumab is characterized by favorable safety profile. In 20 % of patients infusion-induced reactions with severity grades 1-2 were observed. Among other adverse events the following should be pointed out: weakness (30 %), nausea (10 %), headache (10 %), anorexia (10 %), thrombocytopenia (20 %), and neutropenia (30 %). No serious complications were reported. Conclusion. Daratumumab treatment is a safe and effective method of anticancer drug therapy in relapsed/refractory MM.

Here, we give an overview of purification of the recombinant BMP-2 produced in Escherichia coli and its efficacy in bone tissue regeneration as a constituent of different osteoplastic materials. Protein production in this heterologous system and its subsequent purification and refolding resulting in the active protein are described. The efficacy of BMP-2 originated from prokaryotic cells in osteogenesis induction, which is similar to the efficacy of that produced in eukaryotic cells, has been demonstrated in many studies with the variety of carriers and animal models. In this review, the databases PubMed Central (United States National Institutes of Health’s National Library of Medicine, NIH/NLM), PubMed (NLM National Center for Biotechnology Information, NCBI), and e-library (Scientific Electronic Library) were used.

This article is devoted to a comparative legal analysis of the concept and legal regulation of telemedicine in Russia, Europe (on the example of the EU), and the USA. Telemedicine, the problems of using telemedicine technologies in the provision of medical care are relevant objects of scientific research and discussion both for medicine and law (medical law, civil law). Telemedicine issues have become especially significant in connection with the introduction of Federal Law No. 242-FZ of July 29, 2017 “On Amending Certain Legislative Acts of the Russian Federation on the Use of Information Technologies in the Field of Health Protection”, which legalized the use of telemedicine in Russia. In the framework of this comparative study of the concept of "telemedicine", the article analyzes the definitions of this term, enshrined in the laws of these countries, as well as the definitions available in science and practice. Attention is also being paid to the definition of “telemedicine” given by the World Health Organization. The analysis of the legal regulation of telemedicine considers the relevant sources of legal regulation in Russia, the EU, and the USA, and allows drawing conclusions about the existing problems of legal regulation and gaps in the legislation.

Osteoplastic materials PLA/PCL/HA and PHB/HA and scaffolds with a highly porous structure based on them with potential applications in regenerative medicine have been obtained by solvent casting with thermopressing and salt leaching for PLA-based samples and solid-state mixing with subsequent thermopressing and salt leaching for PHB-based samples. The scaffolds were characterized by SEM-EDX, DSC, FTIR spectroscopy, mechanical tests in compression, measurement of the contact angle, in vitro studies, including loading by recombinant BMP-2 and EPO and their release kinetics, and in vivo studies on a model of regeneration of critical-sized cranial defects in mice. Biomimetic scaffolds with micropores sizes ranged from 300 to 500 μm and volume porosity of 70% imitate trabecular bone's structure and have increased hydrophilicity to achieve osteoconductive properties. Mechanical characteristics correspond to native trabecular bone. Elastic modulus - key mechanical characteristics of bone implants - showed the values of 0.15 ± 0.04 and 0.18 ± 0.08 GPa for PLA/PCL/HA and PHB/HA scaffolds, respectively. Both materials have high biocompatibility and can be used together with recombinant proteins BMP-2 and EPO. Introduction of BMP-2 leads to induction of new bone formation, introduction of EPO results in increased angiogenesis in the implantation area. The obtained scaffolds with recombinant proteins can be used as bone implants for reconstruction of defects of lightly or non-loaded bones.

Synthetic materials based on Ultra-High Molecular Weight PolyEthylene (UHMWPE), PolyEtherEtherKetone (PEEK) and PolyLActide (PLA) with the addition of recombinant bone growth factor BMP-2 and erythropoietin have been developed, which have high biocompatibility and osteoinductive properties.

New recombinant carriers-modular nanotransporters (MNTs)-with N-terminal ligand module to the epidermal growth factor receptor (EGFR) were developed and characterized. Human epidermal growth factor (hEGF) and antibody-like protein Z1907 were used as a ligand module. We demonstrated that MNTs are able to internalize in a receptor-specific manner into the target cancer cells and to accumulate in the target cell nuclei. Conjugation of MNTs with the Auger electron emitter 111In significantly enhanced the cytotoxic effect of 111In on the target cells. It was found that the transfer of EGF from the C-terminus to the N-terminus of the MNT enhanced the proliferation of target cells, whereas the use of Z1907 did not have a similar effect.

A method for investigating the integration of implants on a model of critical-size cranial defects using push-out method has been developed.

ZrO2–Y2O3 nanostructured systems with different yttria content (Y2O3 = 0, 3 and 10 mol.%) were synthesized under hydrothermal conditions and their structural, optical and electronic properties were investigated. Using ZrO2–Y2O3 systems the electron-conductive thin-film photoelectrodes were fabricated and used to develop the perovskite solar cells (PSCs) with the device configuration glass/FTO/ZrO2-Y2O3/CH3NH3PbI3/spiro-MeOTAD/ Au. The comparative studies of the PSCs photovoltaic parameters revealed that under 1000 W/m2 (AM1.5G) illumination solar cells with ZrO2–Y2O3 photoelectrodes demonstrated considerably higher power conversion efficiency in comparison with PSCs based on the undoped ZrO2 photoelectrodes.

Background. In multiple myeloma (MM) treatment a single autologous hematopoietic stem cell transplantation (auto-HSCT) is preceded by conditioning regimens aimed at intensifying cytoreductive effect. In the course of ongoing search for combined conditioning regimens an attractive option proved to be thiotepa/melphalan combination. Aim. Data analysis of a pilot study of the efficacy of conditioning regimens including administration of two alkylating agents (thiotepa and melphalan) with subsequent auto-HSCT. Materials & Methods. 9 patients received 10 auto-HSCTs with conditioning regimen including administration of 250 mg/m2 of thiotepa on Day -5 and 140 mg/m2 of melphalan on Day -2. After auto-HSCT pegylated filgrastim was administered in 8 patients. Engraftment period was calculated on the basis of absolute neutrophil count ≥ 0,5 x 109/L and thrombocyte level ≥ 20 x 109/L. Regimen toxicity was assessed according to CTCAE v5.0. Survival rates were estimated by Kaplan-Meier curves. Results. The use of thiotepa did not require administration of any additional drugs. The incidence of mucositis and enteropathy of grade 1-2 was 100 % and 70 %, respectively. Pyrexia was reported in 7 auto-HSCTs. Pneumonia occurred in 1 patient. The infusion of 1-3 doses of platelet concentrate (median of 2 doses) was required in all patients except for one. Donor erythrocytes were transfused to 3 patients. Engraftment was reported in all patients within the period of 10-14 days. Median hospitalization duration from Day 0 to hospital discharge was 16 patient-days. After auto-HSCT the quality of response improved in 6 out of 9 patients. MM progression was reported in one patient with complex karyotype. Further follow-up showed progression in 2 patients. By December 2018 median follow-up of 9 patients from the date of auto-HSCT was 9 months (range 3-20 months), me dian progression-free survival was 17 months, median overall survival was not reached. Conclusion. Acceptable toxicity, improvement of response quality, and maintenance of it for up to 20 months allow to consider combined conditioning regimen Thio/Mel to be a possible alternative to the standard Mel200 regimen.

Summary Anagrelide is an established treatment option for essential thrombocythaemia (ET). A prolonged release formulation was developed with the aim of reducing dosing frequency and improving tolerability, without diminishing efficacy. This multicentre, randomized, double blind, active‐controlled, non‐inferiority trial investigated the efficacy, safety and tolerability of anagrelide prolonged release (A‐PR) over a reference product in high‐risk ET patients, either anagrelide‐naïve or ‐experienced. In a 6 to 12‐week titration period the individual dose for the consecutive 4‐week maintenance period was identified. The primary endpoint was the mean platelet count during the maintenance period (3 consecutive measurements, day 0, 14, 28). Of 112 included patients 106 were randomized. The mean screening platelet counts were 822 × 109/l (95% confidence interval (CI) 707–936 × 109/l) and 797 × 109/l (95% CI 708–883 × 109/l) for A‐PR and the reference product, respectively. Both treatments effectively reduced platelet counts, to mean 281 × 109/l for A‐PR (95% CI 254–311) and 305 × 109/l (95% CI 276–337) for the reference product (P

Electrical conduction and oxygen diffusion mobility in the bixbyite ( Ia3) and rhombohedral ( R3) polymorphs of the Ln6MoO12-Δ (Ln = Er, Tm, Yb; Δ = δ, δ1, δ2; δ1 > δ2) heavy lanthanide molybdates, belonging to new, previously unexplored classes of potential mixed (ionic-electronic) conductors, have been studied in the range of 200-900 °C. The oxygen self-diffusion coefficient in bixbyite ( Ia3) Yb6MoO12-δ phase estimated by the temperature-programmed heteroexchange with C18O2 was shown to be much higher than that for rhombohedral ( R3) RI (with large oxygen deficiency) and ( R3) RII (with small oxygen deficiency) Ln6MoO12-Δ (Ln = Tm, Yb; Δ = δ1; δ1 > δ2) oxides. According to the activation energy for total conduction in ambient air, 0.99, 0.93, and 1.01 eV in Er6MoO12-δ, Tm6MoO12-δ, and Yb6MoO12-δ bixbyites, respectively, oxygen ion conductivity prevails in the range ∼200-500 °C. Oxygen mobility data for the rhombohedral Ln6MoO12-Δ (Ln = Er, Tm, Yb; Δ = δ1, δ2) phases RI and RII indicate that the oxygen in these phases exhibits mobility at much higher temperatures, such as those above 600-700 °C. Accordingly, below 600-700 °C they have predominantly electronic conductivity. As shown by total conductivity study of Ln6MoO12-δ (Ln = Er, Tm, Yb) bixbyites ( Ia3) and rhombohedral phases Ln6MoO12-Δ (Ln = Er, Tm, Yb; Δ = δ1, δ2) ( R3) in dry and wet air, the proton conductivity contribution exists only in Ln6MoO12-δ (Ln = Er, Tm, Yb) bixbyites up to 450-600 °C and decreases with a decreasing of the lanthanide ionic radius. The obtained data on the mobility of oxygen and the presence of proton contribution in bixbyites in the 300-600 °C temperature range make it possible to confirm unequivocally that Ln6MoO12-δ (Ln = Er, Tm, Yb) bixbyites are mixed electron-proton conductors at these temperatures.

Detection of FLT3 gene mutations in acute myeloid leukemia is now recognized as an unfavorable factor that affects the disease course, emerging the risk of relapses and overall survival shortening and disease-free survival of patients. The aim of the study was to determine the frequency of mutations of the gene FLT3 and to assess their impact on clinical indicators, overall survival and disease-free survival in patients with acute myeloid leukemia. We compared complete blood count parameters, karyotype, duration of overall survival and disease-free survival in 199 patients with acute myeloid leukemia depending on the presence or absence of mutations of the FLT3 gene. Significant differences across these groups were discovered only in WBC and blasts between the group of patients with acute myeloid leukemia (FLT3+) and without mutations in the FLT3 gene (FLT3-). The differences between two groups were also identified in patients chromosomal aberrations. Significant differences (p=0,00024) in the duration of overall survival between groups of patients with acute myeloid leukemia with mutations of FLT3-ITD+, FLT3-TKD+ and FLT3- were demonstrated. Median overall survival was: 1 6 months for patients with mutation FLT3-ITD+ and 17 months for FLT3-TKD+ patients and not achieved for FLT3- patients. The use of modern molecular genetic methods of research in acute myeloid leukemia allows to improve the diagnosis of the disease, as well as to carry out risk stratification and individualize therapy. The use of targeted therapy for FLT3-positive patients who are not candidates for hematopoietic stem cell transplantation will increase the effectiveness of the treatment and improve the performance of overall survival and disease-free survival.

The article analyses F.Ye. Vasilyuk’s contribution to the development of psychological counseling/ psychotherapy practices in Russia and to the formation of counseling psychology as a scientific discipline. Basing on his works on the ‘situational-historical analysis’ of the development of Russian psychology from the 1990s to the present, the article outlines the stages in the development of psychological research and practice and the corresponding tasks that were in the focus of F.Ye. Vasilyuk’s attention. The status of counseling/psychotherapy practice and its key characteristics in relation to fundamental and applied psy¬chology are analyzed in detail. The essential characteristic of counseling practice and psychology according to F.E. Vasilyuk is ‘keeping in mind’ the holistic image of an individual as both an epistemological and axi¬ological, ethical ideal. The psychotechnical implementation of such vision is illustrated by the example of the psychotherapeutic system of co-experiencing psychotherapy. In the final part the article discusses the formation of psychological counseling/psychotherapy as an anthropological practice and the problem of ‘general’ therapeutic knowledge.

Background. Secondary hemophagocytic syndrome (SHPS) and sepsis, although very similar in their clinical manifestations and laboratory parameters, essentially differ in terms of methods of their treatment. SHPS therapy is aimed at immunosuppression, whereas in sepsis anti-infectious treatment is required. To choose the correct therapy a rapid differential diagnosis is necessary. Aim. Search and analysis of criteria of differential diagnosis between SHPS and sepsis. Materials & Methods. The data of 102 patients were analyzed: 55 SHPS patients (median age 60 and range 18-81 years) and 47 sepsis patients (median age 60 and range 18-89 years). SHPS was diagnosed on the basis of HLH-2004 and H-Score criteria. Sepsis was confirmed by documented inflammatory lesions and systemic inflammatory reactions. Microbiologically confirmed sepsis was reported in 10 (21 %) patients. In all sepsis patients multiple organ failure was identified. Results. The study of SHPS and sepsis groups revealed significant differences (p < 0.05) in the levels of C-reactive protein, procalcitonin, creatinine, albumin, and sodium. It was also found out that splenomegaly rate and the levels of triglycerides, ferritin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in SHPS were significantly higher than in sepsis, but the levels of glycosylated ferritin (%GF), fibrinogen, leukocytes, neutrophils, and thrombocytes were lower. The following medians (quartiles 1-3) were reported in SHPS and sepsis, respectively: triglycerides (mmol/L) were 3.1 (2.3-3.8) and 1.5 (0.8-2.7), total ferritin (ng/mL) was 7,170 (3,159.2-12,551.0) and 1,274 (559.0-3,041.5), %GF was 26.5 (16.7-37.3) and 54.5 (37.7-71.8), fibrinogen (g/L) was 2.8 (1.4-4.4) and 5.3 (2.8-6.8), ALT (IU/L) was 50 (20-102) and 30 (15.3-55.5), AST (IU/L) was 66 (40.0-105.6) and 36 (24.678.0), leukocytes (x109/L) were 3.7 (2.1-5.5) and 8.9 (6.5-14.5), thrombocytes (X109/L) were 56 (25.2-93.5) and 157 (97-308). According to ROC analysis the areas under the curve were as follows: 0.88 for neutrophil level, 0.85 for total ferritin, %GF, leukocytes, and thrombocytes, 0.74 for triglycerides, 0.71 for fibrinogen, 0.65 for sodium, and 0.61 for ALT and AST. Conclusion. In differential diagnosis between SHPS and sepsis most important are the levels of total ferritin, its glycosylated fraction, and triglycerides; less important are fibrinogen, neutrophils, thrombocytes and spleen size. As diagnosis and differential diagnosis between SHPS and sepsis are based on the sum total of clinical and laboratory markers, none of the specified characteristics can serve as a reliable parameter if taken separately.

Aim. To analyze the effect on prognosis of mutations that are typical of acute myeloid leukemia (AML) patients. Materials & Methods. The study included 620 AML patients surveyed at Hematology Clinics of Saint Petersburg (Russia) and Charite Clinic (Berlin, Germany). G-banding of chromosomes was employed for cytogenetic testing. Aberration screening in DNMT3A, IDH1/2 genes was based on real-time polymerase chain reaction (PCR) with subsequent analysis of melting and sequencing profiles. Mutations in FLT3, NPM1 genes were revealed by PCR. Results. Mutations were identified in 343 (55.3 %) out of 620 patients. Significantly more often mutations were discovered in patients with normal karyotype (NK) (p = 0.001). FLT3-ITD mutation was associated with reduced medians of overall survival (OS) and disease-free (DFS) survival: 11.3 vs. 15.8 months with FLT3-ITD- (p = 0.005) and 10.0 vs. 13.3 months with FLT3-ITD+ (p = 0.009), respectively. The relation of FLT3-ITD allele burden to OS duration was also assessed. In the ITDlow/ITD- group the OS median was considerably longer than in the ITDhigh group (p = 0.028). In the group of patients with 1 mutation in NPM1 gene OS and DFS were much better in comparison with other patients (medians of 27.4 and 13.9 months, respectively, p = 0.040; 19.3 and 12.0 months, p = 0.049). Negative impact of mutations in DNM-T3A gene was noticed while assessing OS median: 12 (DN-MT3A+) and 15 months (DNMT3A-), respectively (p = 0.112). Mutations in IDH1 gene correlated with a better OS than in the group without mutations (p = 0.092). The rs11554137 polymorphism in IDH1 gene was associated with worse OS in the group of patients with NK (p = 0.186). In 144 patients various mutation combinations (from 2 to 5) were identified. It was demonstrated that mutations in FLT3 (FLT3-ITD), NPM1, DNMT3A, and IDH2 were identified significantly more often in combinations with other mutations (p = 0.001): NPM1+/ FLT3-ITD+ (20.8 %), NPM1+/FLT3-ITD+/DNMT3A+ (8.3 %), and FLT3-ITD+/DNMT3A+ (8.3 %). Patients with 1 mutation had a noticeably longer OS median compared with patients with 2 mutations (18.1 and 12.2 months; p = 0.003). In patients with NPM1+ according to their OS the most unfavorable additional mutation was FLT3-ITD (median 27.4 vs. 9.2 months; p = 0.019) and the combination of NPM1+/FLT3-ITD+/DNM-T3A+ (median 27.4 vs. 14.6 months; p = 0.141). OS of patients with DNMT3A+ showed a downward trend if FLT3-ITD additional mutation was identified (17.3 vs. 7.1 months; p = 0.074). Conclusion. Mutations in FLT3, DNMT3A, IDH1/2, NPM1 genes frequently occur in AML intermediate-risk patients, i.e. they determine the intermediate prognosis group in AML. The studied mutations considerably impact prognosis. It is important to take into consideration mutation type, its allele burden, and the presence of additional mutations. A patient with 2 mutations has a considerably worse OS compared with a patient with 1 mutation. The studied group of patients with the combination of NPM1+/FLT3-ITD+, NPM1+/ FLT3-ITD+/DNMT3A+, DNMT3A+/FLT3-ITD+ mutations has the poorest prognosis. Comprehensive analysis of genetic damages in AML patients allows to most accurately predict the course and prognosis of the disease and to plan targeted therapy.

The present study is devoted to the significance of personal experience for the psychotherapist’s empathy in the context of her/his professional activity. As a result of processing interviews (N=14) using the grounded theory methodology, we reveal and describe the phenomenon of the empathic involvement of the therapist that occurs in the intersection of his/her own traumatic experience and the client’s experience. The structure of the phenomenon, contextual conditions and causal reasons for its occurrence, the psychotherapist’s action/interaction strategies with the phenomenon of empathic involvement and the consequences of these strategies are analyzed. Various forms of empathic involvement are identified: when the client’s experience is similar to the experience of the therapist’s trauma and when the client provokes a response as, rather, the source of the trauma. The analysis of the interviews shows that empathic involvement places the therapist not only in a situation of sympathetic understanding of the client but also in the area of his/her own traumarelated experiences, including the process of giving the meaning and significance to the professional activity.

We present a report on the results of the International Conference on Counseling Psychology and Psychotherapy in the memory of Fyodor E. Vasilyuk (November 1—3, 2018, Moscow).

A distinctive feature of the social spheres functioning is acute cash shortages among consumers and the social demand presence; this makes it impossible to use “classical” methods of multi-criteria analysis and underlines the importance of an effective and objective apparatus creating for evaluating enterprises in these areas. The TOPSIS method was chosen as the basis for the creation of such a toolkit, a modified version of which allows the needs and capabilities of consumers to be taken into account as accurately as possible and the criteria apparatus to be flexibly adjusted to a specific request. However, due to the fact that the alternatives assessment is carried out by experts, it is important to provide a mechanism for its results objectivity increasing through the experts’ competence assessment.