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BackgroundAmong several treatment options for BRAF-mutant metastatic melanoma, a combination of BRAF inhibitor, MEK inhibitor, and anti-PDL1 antibody seems to be a new emergent approach recently registered in the Russian Federation. It is still not clear which patient population benefits more from this simultaneous use of three drugs instead of its sequencing.AimThis study aimed to evaluate patients’ characteristics treated in real practice in 14 Russian regions by triple combination and to analyze their outcomes depending on biomarkers (PD-L1 expression).MethodsThis was a part (cohort A1) of a prospective non-interventional study of clinical outcomes and biomarkers in patients with skin melanoma. Patients were included in cohort A1 if combination treatment with vemurafenib (vem) + cobimetinib (cobi) + atezolizumab (atezo) was initiated no earlier than 12 weeks (84 days) prior to written informed consent to participate in this study. The index event was the initiation of therapy with all three drugs vem + cobi + atezo (i.e., triple combination). The primary efficacy endpoint of the study was the 24-month overall survival (OS), defined as the time from the index date to the date of death from any cause. If the patient did not experience an event, the OS will be censored at the date of the last contact. Objective response rate (ORR), duration of response (DoR), and progression-free survival (PFS) in the Intention to treat (ITT) population, in biomarker positive population, and in population with brain metastases were also evaluated. Quality of life questionnaires were pre-planned by protocol if it was a part of routine practice. Adverse events were also collected.ResultsBetween March 2021 and May 2023, 59 patients were enrolled in 19 centers from 14 regions of Russia. Thirty-one of 59 (52.4%) patients had central nervous system metastases, and 18 of 31 (58.4%) were symptomatic. Forty of 59 patients (68%) received the triple combination as the first-line treatment. The median follow-up period was 16.83 [95% confidence interval (CI) 13.8–19.8] months. The mean duration of therapy with this regimen was 9.95 months (95% CI 7.48–13.8). ORR was 55.1%; progression as the best outcome was seen in 16.3%. The median DoR was 12.95 months (95% CI 11.0–14.8 months), with a median of 20.3 months (95% CI 9.1–31.5 months) when triple therapy was administered in the first-line treatment. In patients with brain metastases (N = 31), ORR was 45.1%; the median DoR was 12.95 (95% CI 11.0–14.8 months). The median PFS in the entire population was 13.6 months (95% CI 8.6–18.6); the 24-month PFS was 22%. The estimated median OS in the entire population was 15.8 months (95% CI NA); 24-month OS was 45% (95% CI 0.32–0.64). In multivariate Cox regression model, biomarkers of interest [lactate dehydrogenase, Programmed cell death ligand-1 (PD-L1)] did not have statistically significant impact on PFS, OS, or DoR probably due to high data missing rate. No unexpected adverse events were reported. Grades 3–4 AEs were seen in 23 of 59 patients (38%) with most common were skin and liver toxicity.ConclusionTriple combination of atezolizumab, vemurafenib, and cobimetinib had proven its efficacy and tolerability in real settings. No impact of potential predictive biomarkers was seen (NCT05402059).

Background. At present, the Russian state, medical and educational communities are concerned about the health of the younger generation. In this regard, at the stage of training pediatricians in residency, there is a very acute issue related to the search for approaches, means and methods of training that contribute to the formation of the readiness of such specialists to carry out psychological and pedagogical activities and solve pedagogical problems, in the process of professional medical activity, one of which is the education of the value attitude of children to their own health. From 2022 to 2023 academic year, an experimental study was conducted at the Faculty of Retraining and Continuing Professional Education at the St. Petersburg State Pediatric Medical University, aimed at to studying evaluate the pediatrician's level of psychological and pedagogical knowledge formation and pedagogical skills which are related to their readiness to the psychological and pedagogical type of activity and the solution of pedagogical problems in medical practice. Purpose. To identify changes in the state of psychological and pedagogical knowledge and the motivational orientation of pediatricians to the formation of the value attitude of patients to health during the experimental work, conditioned by the contextual approach to the study of the discipline "Pedagogy". Materials and methods. The study involved 300 first-year pediatricians with an average age of 25.48±2.03 years, including 233 women and 67 men. All respondents were divided into two groups (150 people each) – the main group and the control group – according to the criterion of participation in the experimental work, which involved the use of a contextual approach in the process of studying the discipline of the Pedagogy curriculum. Residents agreed to conduct research procedures. In advance, the authors of the article received permission from the Local Ethics Committee of the St. Petersburg State Pediatric Medical University to organize an experimental study. The methodology of the study consisted of adapted questionnaires and questionnaires. The followingstatistical methods were used: Wilcoxon T-test (for related samples); the analysis of correlations between the studied parameters was carried out using the C. Spearman criterion. The calculation of the results was carried out using the application package of the program "IBM SPSS Statistics 27". Results. Experimental research work has revealed changes in the level of formation of psychological and pedagogical knowledge and pedagogical skills that ensure the readiness of pediatricians to carry out psychological and pedagogical activities in the process of medical practice and to solve the pedagogical problem aimed at educating the value attitude of patients to their own health. Conclusions. The results of the experimental study indicate the need to use a contextual approach in the process of training pediatricians for psychological and pedagogical activities, and as a didactic means of teaching - medical and pedagogical situations recreated or modeled by specialists.

Background. Prior to the introduction of new agents — immune checkpoint inhibitors — for inoperable and/or metastatic melanoma (IMM), chemotherapy outcomes were generally poor. The median (Me) overall survival (OS) in IMM was no more than 6-9 months, and the Me of progression-free survival (PFS) was about 2 months. The introduction of immune checkpoint inhibitors and targeted therapy changed the prognosis for the life of IMM patients dramatically. The development, studies, and approval of a new original PD-1 inhibitor, prolgolimab, in Russia in 2020 prompted the professional community to conduct a prospective observational study in the Russian Federation to assess its real-world efficacy and safety. Aim To evaluate the real-world efficacy and safety of prolgolimab in patients with IMM. Materials and methods. From October 2020 to October 2022, 700 patients with IMM receiving prolgolimab in real clinical settings in oncological institutions of various levels in the Russian Federation were included in the study. The main inclusion criteria were: pathology-confirmed diagnosis of melanoma; metastatic and/or inoperable type; use of prolgolimab outside of clinical trials; and signed informed consent. Objective response rate in the general population and the Intention-to-treat and Per Protocol populations was considered the main criterion for evaluating the efficacy of therapy, and the safety criterion was the incidence of grade 3-4 adverse events (AEs). PFS and OS rates were also assessed. Statistical analysis was performed using the SPSS 25.0 software package. Results. The objective response rate for the Per Protocol population (with radiographic assessment available) was 42% (n=235/559). Disease progression was reported in 26.7% (n=149) of patients, stabilization in 31.3% (n=175), and disease control in 73.3% of patients with IMM, regardless of the line of therapy. At the follow-up Me of 12 months (0-36), PFS for all patients regardless of the line of therapy was 8 months (95% confidence interval [Cl] 6.537-9.463), 6-month PFS was 55%, and 12-month PFS was 41%. OS Me for all included patients was 32 months, 6-month OS was 82%, and 12-month OS was 69%. Depending on the line of therapy, the OS Me was: line 1 - not reached, line 2-30 months (95% Cl 16.007-43.993), line 3 and subsequent- 22 months (95% Cl 14.264-29.736); p=0.736. According to the CTCAE 5.0 general terminology criteria for AEs, a total of 136/693 (19.6%) AEs of varying degrees were reported, in particular: grade 1-2 - 105/693 (15.2%), grade 3-4 - 25/693 (3.6%), unknown grade - 5/693 (0.7%), as well as one fatal case (0.1%) due to thromboembolism in the vascular center with an unclear (according to the investigator's assessment) relation with prolgolimab. Conclusion The results obtained at 12 months of follow-up confirm the high efficacy and satisfactory tolerability of prolgolimab in patients with IMM in real-world practice, regardless of the line of therapy and other characteristics.

Aim. To assess the efficacy and safety of lenvatinib and pembrolizumab for the treatment of mismatch repair-proficient endometrial cancer (EC) in routine clinical practice in Russia.Materials and methods. This multicenter, retrospective, cohort study included patients with recurrent and metastatic EC from 37 cancer centers in Russia treated between May 2020 and April 2023. Patients with histologically verified EC without microsatellite instability who received ≥1 course of pembrolizumab/lenvatinib therapy were included in the study. The primary endpoint was progression-free survival; the clinical characteristics of the patients were additionally analyzed, the objective response rate and the toxicity profile of therapy were assessed.Results. The study included 100 patients. Median age was 65 (30–83) years. The most common histologic tumor subtype was endometrioid adenocarcinoma (68 %); serous adenocarcinoma was diagnosed in 22 % of cases, other types of tumor – 10 % of cases. All patients had pMMR/microsatellite-stable tumors. The median progression-free survival was 7.75 months (95 % confidence interval 0.7–33.8), and a partial response to therapy was observed in 24 % of patients. Almost half of the patients (44 %) required dose reduction due to adverse events. The most common adverse events included fatigue (n = 26; 26 %), hypertension (n = 20; 20 %), and hypothyroidism (n = 14; 14 %).Conclusion. This study confirms the clinical efficacy of lenvatinib and pembrolizumab in patients with recurrent and metastatic EC without mismatch repair system deficiency (pMMR-tumors) in routine clinical practice.

Abstract Background The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates. Methods A complex intervention will be implemented and evaluated in 1057 GPs’ practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses. Discussion In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients’ vaccine-related health literacy and knowledge, and patients’ intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention’s effectiveness. Trial registration Trial registration number: DRKS00027252 (retrospectively registered).

У статті проаналізовано методологічні засади концепції формування системи інтегрованих маркетингових комунікацій, внутрішню логіку їх еволюційного розвитку та доцільність використання у світовій практиці суб’єктів туристичного ринку. Виявлено вектор та домінанти сучасного розвитку системи інтегрованих маркетингових комунікацій як стратегічно значущі орієнтири їхньої еволюції. Розкрито зміст економічної природи маркетингових комунікацій в координатах загальної теорії маркетингу в межах системно-функціонального аналізу, що забезпечує дослідження генезису системи інтегрованих маркетингових комунікацій в туристичних фірмах. Зазначено, що становлення системи сучасних маркетингових комунікацій в умовах різноманітних взаємодій сучасних туристичних компаній зі споживачами, клієнтами, партнерами і конкурентами досягається через створення стійких конкурентних переваг за рахунок цілеорієнтованих маркетингових комунікацій при домінуванні тенденцій інтеграції. Підкреслено, що ефективні маркетингові рішення при просуванні туристського продукту на ринок базуються на економічному змісті природи маркетингових комунікацій у туризмі. Показано, що основним результатом створення інтегрованих маркетингових комунікацій є синергетичний ефект, що визначає взаємодію суб'єктів туристичного ринку, які включаються в комунікації, активізуючи потенціал їхньої дії. Зазначено, що немаловажливими в умовах динамічної ринкової конкуренції є принципи оперативності та персоналізації, швидкого реагування на вимоги туристичного ринку. Підтверджено, що маркетинговий механізм стратегічного управління комунікативною політикою просування туристського продукту дозволить проводити активне стимулювання споживачів до збільшення обсягів та частоти споживання туристських послуг та переконувати потенційних споживачів підтримувати безперервний комунікативний зв'язок через запропонований інструментарій комплексу інтегрованих маркетингових комунікацій.

Background. In the modern educational conditions of Russian reality, the pedagogical community of medical universities at the stage of postgraduate education pays great attention to the readiness of doctors for professional activities, which determines the conduct of research involving the study of the relationship between meaning-life orientations and educational and professional motivation of residents with different levels of professional experience. In the 2021-2022 academic year, a study illustrating the stated problems was conducted at the St. Petersburg State Pediatric Medical University at the Faculty of Clinical Psychology. Purpose. To study the relationship between meaningful life orientations and educational and professional motivation of residents with different levels of professional experience. Materials and methods. The present study involved 65 residents of 2 years of training in various clinical specialties, their average age is 25.5 years. The entire sample of study participants was divided into two subgroups according to the parameter of involvement in professional activities. This parameter was considered necessary for studying the relationship between meaning-life orientation and educational and professional motivation of residents. Of the total number of respondents, 69% combined residency training with work in their specialty, 31% mastered the specialty at the stage of postgraduate education. Permission was obtained from the Ethics Committee of the St. Petersburg State Pediatric Medical University to organize the study. Respondents agreed to participate in the study. To evaluate the results, descriptive statistical methods, a comparative analysis using the U-Mann-Whitney criterion for explanatory variables and the Wilcoxon T-test for dependent variables, a correlation analysis of the relationships of indicators using the Spearman criterion, calculated using the STATISTICA 12.0 application package, were used. Outcomes. The study allowed to form an idea of the relationship between meaning-life orientations and educational and professional motivation of residents with different levels of professional experience. Conclusions. The results of the study will serve as the basis for rethinking the approaches to the organization of the educational process of students at the stage of residency, the search for ways of education and training that ensured the development of their educational and professional motivation and affect the formation of a system of meaning-life orientations.

Abstract Objective Due to communication barriers, people without natural speech who use augmentative and alternative communication (AAC) are rarely interviewed about their healthcare needs, expectations, and experiences. This qualitative interview study aims to investigate how AAC users evaluate a new service delivery (nSD) in AAC care in Germany. Results We conducted 8 semi-structured qualitative interviews with 8 AAC users. The results of the performed qualitative content analysis show a positive evaluation of the nSD among AAC users. Contextual factors were identified that seem to hinder the achievement of the intervention goals. These include caregivers' prejudice and inexperience with AAC and an unfavourable environment in which AAC is used.

Background. Novel agents immune checkpoint inhibitors fundamentally changed the prognosis for life in patients with metastatic and/or inoperable melanoma. The development, studies, and approval of a new original PD1 inhibitor in Russia in 2020 prompted the professional community to conduct a prospective observational study in the Russian Federation to assess the real-world efficacy and safety of prolgolimab, as real-world patients differ from the refined population in clinical trials. Aim. To evaluate the real-world efficacy and safety of prolgolimab in patients with metastatic and/or inoperable melanoma. Materials and methods. From October 2020 to October 2022, the study enrolled 700 patients with metastatic and/or inoperable melanoma receiving prolgolimab in real clinical settings in oncological institutions of various levels in the Russian Federation. The main inclusion criteria were: pathology-confirmed diagnosis of melanoma, metastatic and/or inoperable type, use of prolgolimab outside of clinical trials, and signed informed consent by the patient. Objective response rate (ORR) was considered the main criterion for evaluating the efficacy of therapy, and the safety criterion was the incidence of grade 34 adverse events. Statistical analysis was performed using the SPSS 20.0 software package. Results. The ORR for patients with skin melanoma treated with prolgolimab in the first line therapy (n= 207/337) was 48.3% (n=100), the disease stabilization was reported in 30.4% (n=63), and progression in 21.3% (n=44) of patients. There were no significant differences in response to therapy between patients with/withoutBRAFmutation, although ORR was higher in patients withBRAFmutation: the ORR for patients withBRAFmutation was 57.9% (n=33), and forBRAFnon-mutated patients, 44.4% (n=52;p=0.222). At a median follow-up of 5 months, the median PFS was 10 months (95% confidence interval 7.3512.64). The incidence of grade 34 treatment-related adverse events according to CTCAE 5.0 was 2% (n=12), and 12% (n=82) for grade 12 adverse events. Conclusion. The results confirm the high efficacy and satisfactory tolerability of prolgolimab in patients with metastatic and/or inoperable melanoma in real-world settings. There were no significant differences in ORR between patients with or withoutBRAFmutation.

The article considers the computational methods and features of the construction of a complex functional block for the implementation of the discrete wavelet transform (DWT) Dobeshie 9/7 in digital image signal processing systems based on FPGA. We proposed a mathematical model and algorithms for the implementation of parallel and series-convector methods of signal processing to calculate the coefficients of a discrete bi-orthogonal Dobeshie wavelet 9/7 taking into account the architecture of used FPGA. The model is based on wavelet transform factorization methods using lifting schemes. In contrast to conventional lifting schemes, the proposed method and algorithms can increase the speed of FPGA calculations with simplified hardware implementation. CAD Quartus II and ModelSim are used as a development environment. The behavioral model is written in Verilog HDL. Altera Cyclone® IV 4CE115 was used as FPGA. On the basis of the obtained behavioral model the testing module was developed and the simulation of digital circuit in the ModelSim environment was carried out. The formula for estimating the number of clock cycles of the forward and reverse DWT has been proposed; on its basis the estimate of the number of parallel computations depending on the number of input elements and the characteristics of the FPGA was obtained. As a result of experiments the dependences of the number of cycles for DWT computation depending on the size of the side of a square image with different variants of the number of parallel processing blocks were obtained. It is shown that parallel work of several independent modules gives a possibility to conduct concurrent processing of several input columns (rows) from input 2D array, and unification of the multiplier-summing module allows to increase efficiency of calculations and to reduce volume of occupied hardware resources. Conveyor based DWT structure is characterized by less hardware costs in terms of implementation of the calculator unit and memory allocation. As a result of testing the digital circuit, it was found that the developed block structure can significantly increase the DWT speed as well as reduce the cost of the system on a chip. The proposed realization of the block of two-dimensional forward and reverse wavelet transform for the Dobeshi 9/7 filter bank forms a complete module and can be used as a ready-made complex functional block for further development of high quality image transmission systems in real time.

The article describes features of digital processing of image signals in the process of coding based on discrete cosine (DCT) and wavelet transforms (DWT) that are used in the JPEG and JPEG2000 compression standards. To compare DCT and DWT, a digital model of the system has been developed that implements the same stages of signal processing, except for the stages of the proper discrete transforms. A method for analyzing the efficiency of the transformations based on objective assessments of image quality depending on the compression ratio is proposed. The peculiarities include the fact that, in contrast to the popular PSNR and SSIM metrics, it is proposed that the quality be assessed using the reduction factor for the RAW image format, the calculation of which is associated with the contrast sensitivity of vision. As a result of the research, quantitative estimates of the compression efficiency are obtained for the given quality parameters, depending on the type of conversion and the detail of the RAW images. Recommendations are made regarding the development of methods for increasing the efficiency of image compression based on DWT or DCT.

Background. The article presents the evolution of massage in Russia - one of the directions of manual medicine. The study of such an evolutionary process is due to the need to comprehend the mental, historical and methodological foundations of massage, allowing to assess the importance of this direction for the treatment of patients. The content of the article shows the attitude of people to massage in Ancient Russia, illustrates its progressive development from the beginning of the XVI to the end of the XVIII centuries, describes the milestones of the development of massage as an independent method of treatment in the XIX–XX centuries. Purpose. Studying the evolution of massage as one of the directions of manual medicine in Russia, interconnected with the mentality of our people and traditions that are rooted in the long past. Materials and methods. The study was carried out through a theoretical method – the analysis of scientific literature on the history of massage, the history of medicine and, to some extent, the history of medical education. The authors in their theoretical study relied on historical and cultural approaches that allow us to consider the evolution of massage in Russian medicine. Results. Theoretical analysis of scientific literature made it possible to visualize in a scientific text the evolution of massage as one of the directions of manual medicine in Russia. Conclusions. The results of the theoretical research contribute to the history of medicine and medical education, are a source that allows us to rethink the contribution of Russian scientists to the development of massage as one of the directions of manual medicine in Russia.

Abstract Background People with disabilities and without natural speech often rely on care provided by informal caregivers. The caregiving situation of these informal caregivers has been poorly researched. The objectives of the study are 1) to identify stressors, resources, and coping strategies among informal caregivers of people without natural speech and 2) to examine whether a complex intervention in augmentative and alternative communication (AAC) that is not primarily tailored to the needs of informal caregivers can reduce care-related burden. Methods The main components of the AAC intervention were (1) initial counselling session, (2) 4 AAC training sessions, (3) 20 AAC therapy sessions and (4) accompanying case management. The control group received only the initial counselling session. Within a quasi-experimental intervention study, survey data on self-perceived burden (Burden Scale for Family Caregivers, BSFC-s) from n = 154 informal caregivers of people without natural speech were collected at three time points between June 2018 and April 2021 from a postal survey. Qualitative interviews with n = 16 informal caregivers were conducted. Results Caregivers reported various stressors such as limited communication with the cared-for person and concerns about the living situation in adulthood. Diverse resources and effective coping strategies, which the caregivers refer to when dealing with stressors, could also be identified. Burden was significantly reduced in the intervention group compared to the control group. According to the results of the qualitative study, AAC use led to better communication skills and a reduction in behavioural problems and thus a decreased burden. Conclusions The AAC intervention seems to have a positive impact on self-perceived burden. Linkages between intervention components and burden reduction as well as stressors and coping strategies could be identified and provide an evidence-based foundation for developing future holistic interventions for families with individuals without natural speech. Trial registration German Clinical Trials Register (DRKS); ID: DRKS00013628 (registered on 05/02/2018).

Sarah AK Uthoff,1 Anna Zinkevich,1 Jens Boenisch,2 Stefanie K Sachse,2 Tobias Bernasconi,2 Anna L Brütt,1 Lena Ansmann1 1Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany; 2Department of Special Education and Rehabilitation, University of Cologne, Cologne, GermanyCorrespondence: Sarah AK Uthoff, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, Tel\Fax +494417984167, Email sarah.uthoff@uni-oldenburg.dePurpose: Many care settings are characterized by collaboration between a variety of stakeholders. People without natural speech who rely on augmentative and alternative communication (AAC) are often strongly dependent on the involved stakeholders and collaboration among them. Since collaboration can be challenged by many barriers, this study examines the impact of a complex intervention on collaboration in AAC care.Methods: In a quasi-experimental mixed methods intervention study which include AAC training, AAC therapy and case management, caregivers of AAC users were surveyed at 3 time points to assess collaboration and case management in the intervention versus comparison group. In addition, semi-structured focus group interviews were conducted with caregivers in the intervention group. Quantitative data were analyzed descriptively and by comparison of means. Qualitative data were analyzed using qualitative content analysis.Results: The Mann–Whitney U-test showed significantly better collaboration in the intervention group with stakeholders that are more actively involved in AAC care, such as schools (p=0.026) and residential or social facilities (p=0.010), but not with passive stakeholders such as health insurance companies. Most aspects of case management were rated significantly better in the intervention group (p< 0.001). The focus group results show mainly positive changes in collaboration with the active stakeholders, such as more commitment and openness toward AAC.Conclusion: The results show a positive impact of the intervention on the collaboration between stakeholders involved in AAC care – especially with active stakeholders. In particular, the organization of care and the accompanying case management by the AAC consultation centers seem to positively affect collaboration.Keywords: stakeholders, teamwork, mixed methods, focus groups, complex care

The history of Russian medical education indicates the importance of developing the clinical thinking of a future doctor. Today, the problem has become even more acute due to the peculiarities of the educational situation caused by the COVID-19 pandemic, when the training of future doctors was carried out online. Considering the difficulties of forming the clinical thinking of future doctors, in 2019-2022 a study was conducted at St. Petersburg State Pediatric Medical University to identify specific cognitive skills of medical university teachers who train prospective doctors. Purpose. To study specific cognitive skills that determine the specifics of the intellectual activity of teachers of clinical and theoretical departments of medical universities that train prospective doctors. Methodology. The research is based on activity-based and cognitive approaches that allow studying personality as a subject of professional activity. The diagnostic procedure was carried out using the R. Amthauer test. The structure of intelligence was determined by the factor analysis and the principal component method followed by varimax rotation with Kaiser normalization. The Statistica 10.0 program was used to process the obtained empirical results. Results. The research materials served as a source of forming ideas about the features of cognitive skills underlying the clinical thinking of doctors – teachers of clinical and theoretical departments, contributing to the development of cognitive skills of prospective doctors and determining the success of their intellectual activity. Conclusions. The obtained results can be used in the field of higher medical education.

Background: Among several treatment options for BRAF-mutant metastatic melanoma, a combination of BRAF inhibitor, MEK inhibitor, and anti-PDL1 antibody seems to be a new emergent approach recently registered in the Russian Federation. It is still not clear which patient population benefits more from this simultaneous use of three drugs instead of its sequencing. Aim: This study aimed to evaluate patients' characteristics treated in real practice in 14 Russian regions by triple combination and to analyze their outcomes depending on biomarkers (PD-L1 expression). Methods: This was a part (cohort A1) of a prospective non-interventional study of clinical outcomes and biomarkers in patients with skin melanoma. Patients were included in cohort A1 if combination treatment with vemurafenib (vem) + cobimetinib (cobi) + atezolizumab (atezo) was initiated no earlier than 12 weeks (84 days) prior to written informed consent to participate in this study. The index event was the initiation of therapy with all three drugs vem + cobi + atezo (i.e., triple combination). The primary efficacy endpoint of the study was the 24-month overall survival (OS), defined as the time from the index date to the date of death from any cause. If the patient did not experience an event, the OS will be censored at the date of the last contact. Objective response rate (ORR), duration of response (DoR), and progression-free survival (PFS) in the Intention to treat (ITT) population, in biomarker positive population, and in population with brain metastases were also evaluated. Quality of life questionnaires were pre-planned by protocol if it was a part of routine practice. Adverse events were also collected. Results: Between March 2021 and May 2023, 59 patients were enrolled in 19 centers from 14 regions of Russia. Thirty-one of 59 (52.4%) patients had central nervous system metastases, and 18 of 31 (58.4%) were symptomatic. Forty of 59 patients (68%) received the triple combination as the first-line treatment. The median follow-up period was 16.83 [95% confidence interval (CI) 13.8-19.8] months. The mean duration of therapy with this regimen was 9.95 months (95% CI 7.48-13.8). ORR was 55.1%; progression as the best outcome was seen in 16.3%. The median DoR was 12.95 months (95% CI 11.0-14.8 months), with a median of 20.3 months (95% CI 9.1-31.5 months) when triple therapy was administered in the first-line treatment. In patients with brain metastases (N = 31), ORR was 45.1%; the median DoR was 12.95 (95% CI 11.0-14.8 months). The median PFS in the entire population was 13.6 months (95% CI 8.6-18.6); the 24-month PFS was 22%. The estimated median OS in the entire population was 15.8 months (95% CI NA); 24-month OS was 45% (95% CI 0.32-0.64). In multivariate Cox regression model, biomarkers of interest [lactate dehydrogenase, Programmed cell death ligand-1 (PD-L1)] did not have statistically significant impact on PFS, OS, or DoR probably due to high data missing rate. No unexpected adverse events were reported. Grades 3-4 AEs were seen in 23 of 59 patients (38%) with most common were skin and liver toxicity. Conclusion: Triple combination of atezolizumab, vemurafenib, and cobimetinib had proven its efficacy and tolerability in real settings. No impact of potential predictive biomarkers was seen (NCT05402059). [ABSTRACT FROM AUTHOR]

Цель. Статья посвящена частным вопросам педагогической рефлексии, предполагающей аналитическую работу, иллюстрирующую отношение студентов 1 курса к организации и содержанию образовательного процесса в рамках изучения учебного предмета «Физика. Математика» в медицинском педиатрическом университете. Цель исследования сводилась к изучению удовлетворенности первокурсников образовательным процессом в университете. Метод или методология проведения работы. Основой исследования стали личностно ориентированный и гуманистический подходы, образовательные традиции, обеспечивающие развитие критического мышления будущих врачей, ценностное отношение профессорско-преподавательского состава к смыслам педагогической деятельности, понимание необходимости педагогической рефлексии. Педагогические и математико-статистические методы позволили реализовать цель исследования. Результаты. Обнаружены факторы, определяющие удовлетворенность первокурсников организацией и содержанием образовательного процесса в рамках изучения учебного предмета «Физика. Математика» в медицинском университете, средикоторых: форма обучения в вузе, гендерная принадлежность обучающихся и их суммарный балл единого государственного экзамена. Область применения результатов. Данные, полученные в процессе исследования, обусловливают необходимость учета гендерных особенностей обучающихся в образовательном процессе, осознания преподавателями существующей зависимости между удовлетворенностью субъектов образовательным процессом и такими факторами как форма обучения, суммарный балл единого государственного экзамена. В настоящее время учреждения образования отнесены к сфере услуг, потребители которых могут предъявлять повышенные требования к качеству своего образования, за которое платят.

The paper aims to present the results of the experiment in applying the online writing assistant Grammarly.com to evaluate ESP students’ essay writing skills. One hundred master students’ papers were processed by the application to identify persisting errors at a master’s level. Quantitative and qualitative methods enabled the researchers to analyze the essays by setting five parameters: audience, formality, domain, tone, and intent. At the other end, the application broke down the outcome by five measurable factors: correctness, clarity, delivery, engagement, and style issues. The representative number of the essays fed into Grammarly.com provided a vivid and reliable picture of which lexis, grammar, structure, or style issues still need addressing. The most common mistakes detected by Grammarly.com were punctuation, wordy sentences, redundancy, and the abundance of personal pronouns in a formal style. They show that the gaps in students’ academic writing need a remedial course. Another objective of the research was to explore the potential of the online writing tool for students’ self-study. Grammarly.com cannot do work for students: it cannot think for them, neither can it write for them, but it can help learners identify the reoccurring writing problems, eliminate them, and monitor the progress. The application could be particularly useful for advanced students. The functionality of the Grammarly premium version allows for a choice of styles, type of addressee, tone of writing, and many other nuances, which could be beneficial not only for studies but in future professional life. Nonetheless, despite Grammarly’s advanced features, it only suggests a better variant, sometimes it errs, and in no way is it a substitute for a teacher.

Обоснование. Современная российская социальная ситуация характеризуется выраженным вниманием к человеку, что вызывает необходимость своевременного изучения особенностей ценностных ориентаций ординаторов, выступающих основой их деонтологической культуры. В 2019-2020 гг. в Санкт-Петербургском государственном педиатрическом медицинском университете на факультете послевузовского и дополнительного профессионального образования состоялось исследование, посвященное изучению заявленной проблемы. Цель исследования. Изучение иерархии ценностных ориентаций специалистов, осваивающих образовательную программу в ординатуре. Материалы и методы. В исследовании участвовали 155 ординаторов первого курса, из них: 60 мужчин и 95 женщин. Средний возраст респондентов – 25 лет. Продолжительность исследования, включая подготовку, организацию тестирования, анализ данных, составила полгода. Исследование осуществлялось с разрешения этического комитета ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет». Каждый участник подписывал стандартную форму согласия на участие в тестировании с использованием методики М. Рокича. Оценка полученных результатов осуществлялась посредством факторного анализа (метод главных компонент с вращением Varimax). Результаты. По завершению исследования удалось сформировать представление об иерархии ценностных ориентаций врачей, обучающихся в ординатуре. Заключение. Полученные результаты послужили источником переосмысления дидактических подходов к организации образовательного процесса, усиления в нем аксиологической составляющей, способствующей формированию ценностных ориентаций, становлению деонтологической культуры специалистов в области здравоохранения.

Damage to the meninges in combination with the presence of a defect in the bone structures of the base of the skull and the formation of communication with the nasal cavity or paranasal sinuses are necessary conditions for nasal liquorrhea. There are a number of complications of nasal liquorrhea of various origins: infectious (meningitis, brain abscess), pneumocephalus, aspiration pneumonitis and gastritis. A review of the literature related to aspiration pneumonitis in nasal liquorrhea has been carried out. 4 articles were selected with descriptions of 9 cases. The analysis of demographic indicators of patients, clinical data, treatment characteristics was carried out. Based on the analysis of the literature, aspiration pneumonitis is a rare complication of nasal liquorrhea. For differential diagnosis with other types of pneumonitis, it is necessary to rely on additional clinical data, such as unilateral discharge of clear fluid from the nose when tilting the head, worsening of the condition and intensification of symptoms in a horizontal position, absence of systemic inflammatory response syndrome, ineffectiveness of antibiotic therapy, recurrent the nature of the flow. Antibiotic therapy does not cure the patient from pneumonitis. For the treatment of this pathology, it is first of all necessary to eliminate the cause of aspiration — to perform plastic surgery of the skull base defect in the absence of contraindications from the side of anesthetic aid.

Цель. Статья поднимает актуальную проблему современного высшего медицинского образования, связанную с педагогической деятельностью профессорско-преподавательского состава клинических кафедр. Целью исследования является изучение отношения преподавателей клинических дисциплин к педагогической деятельности, имеющей свою специфику, обусловленную ее интеграцией в процесс лечебно-профилактической работы. Метод или методология проведения работы. В основу исследования положены гуманистический и культурологический подходы, традиции медицинского образования России, значимые для формирования личности будущего врача, понимание особенностей педагогической деятельности, интегрированной в процесс лечебной и профилактической работы. В ходе исследования использовались психологические и математико-статистические методы. Результаты. Установлено, что среди факторов, определяющих отношение представителей профессорско-преподавательского состава клинических кафедр к педагогической деятельности, ведущими являются профессионально-педагогическая подготовка и профессиональная мотивация, от которых зависят ее качество и характер. Область применения результатов. Полученные результаты могут выступить основанием для внедрения в работу с профессорско-преподавательским составом тренингов, направленных на развитие их способности к рефлексии своей педагогической деятельности, профилактику возможного профессионального выгорания.

The mobile application "RELASCOPE+" was developed and tested in order to automate and expedite the determination of the stand density index in the forest to make decisions on the purpose of a series of forestry activities. To determine the need for sanitary felling on the basis of measurements on relascopic sample plots was the main problem. The fundamental difference between the operation of the mobile application, unlike the foreign counterparts, was not the simple calculation of basal area of trees on sample plots, but with the simultaneous distribution of accounting trees by species and sanitary conditions categories. Therefore, it was decided to use the smartphone directly as a counter. To clarify the correctness of the determination of the composition, stand density index and volume, 4 sample plots of rectangular shape were specially laid, where a complete enumeration was made and measurements were additionally made on 16 relascopic sections. In addition, a complete enumeration of trees with sanitary conditions categories was carried out on one site, after which measurements were made on relascopic sample plots using the "RELASCOPE+" application. It was possible to complete the field works almost five times faster without any camera work, when determining the basal area by the method of relascope measurement, using relascope coefficient (BAF) = 1 and the mobile application "RELASCOPE+". A certain decrease of the stand density index was observed in comparison with the complete enumeration method from 4 to 20 %, when applying the method of relascope measurement. The express method demonstrated satisfactory accuracy in determining the sanitary condition. We believe that this express method should be further introduced into production as an alternative way of determining needs for the appointment of an appropriate type of sanitary felling, considering that the use of the proposed method of determining the of basal area and volume per 1 ha in the categories of tree sanitary condition, is capable of reducing labor and time consumption. In the process of carrying out by relascope measurement using a smartphone, it was decided to refine the model of relascope by changing the method of attachment and distance to the eyes. A prospect for further studies is to justify the use of the relascope coefficient, depending on the mean diameter and the stand density index.

The article gives a description of a new culture for the southeast of Western Siberia, which can become one of the valuable sources of obtaining high-quality feed. The nutritional and energy value, biochemical composition in terms of the content of organic substances and mineral elements (calcium and phosphorus) of the dry mass are considered. The yield of green mass, the elements of its structure are shown. The research results indicate that Trigonella foenum-graecum grown in the conditions of the southeast of Western Siberia has a high nutritional and energy value of green mass. Reliable differences in the yield of green mass were revealed on average depending on the seeding rates. The maximum crop yield was obtained when sowing at a rate of 2 million/ha. The seeding rate of 3 million/ha ensured the maximum nutritional value of the dry matter.