Moscow Center Research Articles

Values in the doctor-patient interaction: understanding and cooperation

Introduction. Cooperation between a medical professional and a patient is the main value in the work of a medical institution rganization and the key to improving the quality of specialists. The purpose of the study. Development and testing of the “secret patient” method, which allows assessing the quality of medical care in accordance with the Moscow clinics’ values from the patient’s point of view; identifying factors influencing patients’ opinions regarding the quality of medical care. Materials and methods. The study was conducted in 2024 at two medical centers in Moscow. The following methods are: focus group, content analysis, “secret patient”, participant observation. Results. The assessment tools include the possibility and convenience of making an appointment with a doctor on the website of a medical institution; features of communication with medical workers; characteristics of the medical institution; information about the medical institution and communications in the medical institution; additional information. All medical care’ elements correlate with the values: patient-centeredness, friendliness, teamwork, trust and mutual respect. Research limitations. The study is limited by the absence of disease in the investigators conducting the participant observation. Conclusion. The developed methodology for receiving feedback from the head of a medical organization from patients corresponds to the core values of Moscow clinics and can be taken into the operational activities of medical organizations. Doctors provide consultations in accordance with the clinic’ values. Mutual respect and trust must be reinforced by the adoption of appropriate values by patients. The main shortcomings present in isolated cases are associated with unequal treatment of patients and incorrect communication by nursing staff.

Об актуальности наследия Вл.С. Соловьева

The general characteristics of the materials of the International “Round table” “Relevance of V.S. Solovyov's legacy: philosophy, philology, cultural studies (modernity calls and possible answers)” devoted to the discussion of the problems of V.S. Solovyov's legacy research are presented. The initiator and organizer of the scientific event was the editorial board of the journal “Solovyov studies”. The discussion was attended by Russian and foreign specialists – philosophers, philologists, cultural scientists from the largest universities and academic centers in Moscow, St. Petersburg, Ivanovo, Nizhny Novgorod, Kaliningrad, Kostroma, Saransk, Astrakhan. Foreign participants are researchers of V.S. Solovyov's legacy from Italy, Spain, and France. It is noted that the discussion participants focused on the problems of historiography and source studies of Russian philosophy in general and the legacy of V.S. Solovyov. The relevance of the ethical vector of his historiosophical ideas is pointed out to the philosophical unreasonableness and politicization of modern attacks on Solovyov's legacy, the lack of a fundamental scientific and philosophical research program. Attention is drawn to the need for further research into the historical and philosophical context of the formation of V.S. Solovyov's philosophical views and their influence on the subsequent development of culture, on the prospects of the projects “logic of unity” and “philosophy of neo-unity” being developed. The relevance of the idea of Christian unity by V.S. Solovyov is noted. Promising directions for further philological study of his work are revealed. The role of the journal “Solovyov Studies” in the development of Russian and foreign Solovyov studies is determined.

Multiple recurrences of adnexal torsion in a 9-year-old girl: a case report

Most girls with abdominal pain syndrome caused by gynecological pathology are admitted to pediatric surgery departments. When adnexal torsion is detected, detorsion is performed. There is no single protocol for ovariopexy. A 9-year-old girl was admitted to the surgical hospital of the Regional Children’s Clinical Hospital No. 2 in Voronezh for the first time because of nagging pain in the lower abdomen. Vomiting was noted at the height of the pain syndrome. Ultrasound of the pelvic organs revealed torsion of the right uterine appendages. Laparoscopy showed that the right ovary was purple and enlarged in size and torsion of the uterine appendages by 720°. Detorsion of the right adnexal torsion was conducted, and blood supply was restored after 10 minutes. The child was discharged on hospitalization day 9. Five months later, the patient was admitted with repeated right adnexal torsion. Laparoscopic detorsion was performed: blood flow was restored, and the ovary was found to be viable. The patient was recommended to be hospitalized at the Federal Medical Center in Moscow for laparoscopic ovariopexy; however, her patients refused further treatment. The girl was discharged from the hospital on postoperative day 9. After 11 days, recurrent torsion of the right uterine appendages by 720° occurred, and laparoscopic detorsion was performed. Ten days after consulting a gynecologist, laparoscopic fixation of the right uterine appendages was planned. Ovariopexy was performed by suturing the ovary to the broad ligament of the uterus with an interrupted suture. The patient was discharged from the hospital in a satisfactory condition. Four months following ovariopexy, the child had no complaints, and ultrasound showed no pathological changes in the ovaries.

Targeted Radionuclide Therapy for the Treatment of Metastatic Bone Disease: A Retrospective Analysis in Moscow, Russia

Introduction: Metastatic bone disease (MBD) is a common complication of advanced cancer, causing significant morbidity and negatively impacting patients' quality of life. Targeted radionuclide therapy (TRT) has emerged as a promising treatment modality for MBD, offering targeted delivery of therapeutic radiation to bone metastases while minimizing damage to healthy tissues. Methods: A retrospective cohort study was conducted at leading oncology centers in Moscow, Russia, between 2018 and 2023. Patients with MBD who received TRT with either Strontium-89 or Samarium-153 were included. Data on patient demographics, primary tumor type, number of bone metastases, pre-treatment pain scores, performance status, and survival outcomes were collected. Results: A total of 150 patients were included in the study (mean age 62 years, 55% female). The most common primary tumor types were prostate (35%), breast (25%), and lung (15%). The median number of bone metastases was 5 (range 1-20). Pre-treatment pain scores were high (median 7 on a 0-10 scale). A significant reduction in pain scores was observed post-TRT (median 3, p<0.001). Overall survival at 1 year was 75%, with a median survival of 18 months. Favorable prognostic factors included a lower number of bone metastases, good performance status, and absence of visceral metastases. Conclusion: TRT is a safe and effective treatment option for patients with MBD in Moscow, Russia, offering significant pain palliation and improved quality of life.

Первый храм в Челябинской крепости в контексте сакрализации пространства в ходе русской колонизации Урала и Сибири

The first temple in the Chelyabinsk fortress in the context of the sacralization of space during the Russian colonization of the Urals and Siberia.The article, on the basis of the sources involved, deals in general terms with the main problems of temple building in the frontier zone in the process of Russian colonization of the Urals and Siberia from the late XVI to the 1730s. Sources are acts of record documentation: decrees, orders, reports. The purpose of the article is to analyze the relationship between state and church structures in temple building. The work is done within the framework of cultural history.The main institutions of the colonization process were the structures of the state and the church, the direct actors were peasants, merchants and servicemen of various categories, and the Posad population. The consolidation of Russia in new territories was carried out through the sacralization of space. The starting point in this process was the construction of the first Orthodox church. Initially, the question of building a temple was raised by both the secular authorities and parishioners, depending on the specific situation. Then the functions of establishing the ecclesiastical and administrative structure were delegated by the center to the field.If earlier the chain looked like this: Orthodox first settlers - the center in Moscow - the royal decree in place of the voivode - implementation, execution of the decision on the spot; then a new link appears at the diocesan level in the person of the bishop. This was caused, first of all, by the increasing scale of colonization, the complication of the secular and ecclesiastical-administrative structure. In the record correspondence, the idea of the impossibility of the existence of an Orthodox person without a temple can be traced.To find out the initiators of the nomination of the first temple in the Chelyabinsk fortress, an analysis of the names of the bishops of the Siberian Metropolis, in charge of which the fortress was located, was undertaken; monks of the Assumption Dalmatian Monastery in 1735, whose archimandrite was instructed to lay the church; the heads of the families of the fortress, recorded in the census of 1739 – 1740. From this it was concluded that the "symphony" of the initiative "from above" and the initiative "from below" was made.

Exploring intra-urban thermal stress vulnerability within 15-minute city concept: Example of heat waves 2021 in Moscow

Heat vulnerability in big cities is important because of the increase in heat wave frequency and thermal stress that is identified by Urban Heat Island. Our study investigated intra-urban heat vulnerability in Moscow, which strongly influenced by historic context in urban planning, with a focus on local disparities. We considered the vulnerability framework in terms of “exposure,” “sensitivity,” and “adaptive capacity,” and adopted the concept of a 15-minute city to evaluate spatial patterns on example of 2021 heat waves. We used high-resolution meteorological data from the regional meteorological model COSMOCLM and calculated the Physiologically Equivalent Temperature (PET) to assess thermal stress and define exposure. The data from OSM and other open sources were used to assess sensitivity and adaptive capacity through the proximity of green spaces, cooling centers, healthcare, and premium service facilities. The PET varied from 25.3 °C in the outskirts to 30.2 °C in Moscow centre; however, variations in thermal stress did not have adverse effects on the spatial patterns of vulnerability. The vulnerability indicator in the east was six times higher than in more prosperous areas of the center, north and southwest, due to historical development, mainly the transformation from former industrial areas into residential areas.

Воспитательный потенциал церковнославянского памятника «Святогорская повесть»

The article describes the experience of using the Church Slavonic monument " Svyatogorskaya Tale" in the context of patriotic education and expanding the scientific horizons of the younger generation obtained by the author during classes with schoolchildren and students of military-patriotic camps in the period from 2007 to 2020 and pilgims.The presentations of the material and features of its use in the classroom are given.The immersion into the historical context of the events described in the story allows us to draw the attention of listeners to edifying moments in the history of North-West Russia in the second half of the 16th century. An important aspect of the use of " Svyatogorskaya Tale" for educational purposes is that of the presence of a theological component and a significant role of the personality of the hero of the story - Blessed Timofey Svyatogorsky describing his high moral qualities. A special significant moment in the entire history of the appearances of the Svyatogorsky icons in 1563 and 1569 underlines the blessing of Russian statehood with its center in Moscow and the conditions for the prosperity of the people and the state. The importance of immersing the listeners into the environment of moral, theological and socio-political problems having been raised in the text of an ancient monument cannot be overestimated. The presented issues of the national importance and mastering them is current for representatives of all regions of modern Russia.

The efficacy of immune checkpoint inhibitors in patients with cancer with pseudoprogression.

2620 Background: Pseudoprogression (PsP) is quite a common phenomenon in cancer patients undergoing therapy with immune checkpoint inhibitors (ICI). It could be defined as temporary increase of tumor volume or the number of tumor lesions after beginning of ICI treatment (immune unconfirmed progressive disease - iUPD) followed by clinical response. However, many specialists in real clinical practice are hesitant to continue ICI therapy in patients with iUPD because of medical or financial constraints. We aimed to evaluate the efficacy of ICI in patients with clinical evidence of PsP. Methods: We retrospectively analyzed 1001 cases of ICI treatment (male 58,4%, age 28-90 years) in patients with various solid malignancies: melanoma – 316, lung – 280, kidney – 247, GI cancer – 96, cervix of the uteri – 62. The patients were treated in 2 regional referral centers in Moscow and Moscow Region between June 2018 and Dec. 2022. Unconfirmed progressive disease (iUPD) according to iRECIST criteria was diagnosed in 316 patients at the first imaging control after the beginning of ICI treatment (31,6%). Results: Among 316 patients with iUPD the presence of progression (immune confirmed progressive disease – iCPD) was verified in 105 (33,2%): melanoma – 109 (34,5%), lung – 86 (30,7%), kidney – 75 (30,4%), GI cancer – 42 (43,8%), cervix of the uteri – 4 (6,5%). Stable disease was found in 144 (45,6%), partial response in 50 (15,8% - iPR), complete response in 17 patients (5,4% - iCR). Altogether, PsP was diagnosed in 211 of 1001 patients (21,1%). Overall objective response rate in 316 patients with iUPD reached 21,2%, control over disease was achieved in 66,8% of cases. Severe immune-mediated adverse events (3-4 st. according to CTC AE 5.0) were diagnosed in 9 patients (2,8%). Median overall survival in patients with iUPD and ORR was 60,65 mon (95%CI 57,54-63,76), in patients without iUPD and ORR – 147,56 mon (95%CI 137,2-157,93). Conclusions: PsP was diagnosed in 21,1% of patients getting ICI treatment in real clinical practice with median survival in PsP patients with objective response of about 60 months. Only 10,5% of patients had iCPD after their second follow-up. We feel that close adherence to iRECIST criteria to verify true progression is mandatory in patients under ICI treatment to exclude unnecessary cessation of treatment.

Interchangeability of anti-PD1 antibodies in patients (pts) with metastatic NSCLC.

e20553 Background: PD-(L)1 inhibitors are approved immunotherapy agents in treatment for mNSCLC, however, limited data exists about switching between different anti-PD1 antibodies. Our study aimed to evaluate the safety and efficacy of the interchangeability of nivolumab, pembrolizumab, and atezolizumab in patients (pts) with mNSCLC in the 2nd and 3rd line. Methods: We retrospectively evaluated data of pts with mNSCLC treated in four oncology centers in Moscow and SaintPetersburg (Russia). Inclusion criteria were as follows: histologically confirmed mNSCLC with no driver mutations, performance status ECOG 0-2, monotherapy of anti-PD(L)1 antibody, and switching to another PD(L)1 inhibitor for any reason except progression disease or toxicity after initiating of immunotherapy. The primary end-point was progression-free survival (PFS), and secondary end-points were the rate of all grades and grade 3-4 adverse events (CTC AE 5.0). A sample size of 83 achieves 80% power to detect an equivalence difference of 15% in 3-months PFS after the change of anti-PD1 antibody with a one-sided significance level of 0,05. Results: A total of 103 patients (27% female) were included with a mean age of 66 years (33-93). 0-1, 2, and ≥3 organs with metastases have 70 (68%), 17 (17%), and 16 (16%) pts, respectively. Performance status ECOG 0, 1, and 2 was in 16 (16%), 70 (68%), and 17 (17%) pts, respectively. 50 (48%) patients received pembrolizumab, 40 (39%) pts received nivolumab, and 13 (13%) pts – atezolizumab. 48 (47%) pts were switched to atezolizumab, 28 (27%) pts were switched to nivolumab, 26 (25%) pts – to pembrolizumab. The median duration of treatment with the first anti-PD(L)1 antibody was 6 months (1-53 months), with the second PD(L)1-inhibitor was 3 months (1-41 months). Within 3 months after 1 replacement of the drug, there were 77 (74,7%) pts without progression. With the median follow-up of 8 months (1-41), the estimated 3-month PFS was 79,3%. The efficacy of switching was not associated with the agent (HR 0,97, 95CI 0,68-1,38, p = 0,9). There were 2 cases of AEs of 3-4 grades when switching to the second drug. Conclusions: Switching from one anti-PD(L)1 antibody to another in pts with mNSCLC is possible in case of limited access to PD(L)1 inhibitors.

Efficacy of immunotherapy in advanced gastric cancer: preliminary results of a multicenter observational study

Background: Due to the low efficacy of PD-L1 antibodies in second and subsequent lines of metastatic gastric cancer (mGC), the optimal treatment strategy of such patients and appropriate choice of predictive biomarkers remain challenging. The aim of our study is to assess the efficacy of immune checkpoint inhibitors monotherapy in patients with mGC in routine clinical practice, especially in heavily-pretreated patients. Materials and methods: We retrospectively analyzed data of patients treated in five oncology centers in Moscow between 2018 and 2023, who received nivolumab or pembrolizumab for advanced gastric cancer. Primary end-point of our study was 6-months PFS. Secondary end-points were overall survival (OS), objective respons e rate (ORR), and disease control rate (DCR). Toxicity was assessed using CTC AE v5.0 scale. Results: 122 patients with mGC who received immune checkpoint inhibitors were included between 1 January 2018 and 28 February 2023. 6-months PFS rate was 31,6 %. The median OS was 7 months (95 % CI: 2–20), the median PFS was 3 months (95 % CI: 1,5–9,5). A statistically significant difference in OS was detected in patients with MSI compared to MSS (25 months vs 6 months; 95 % CI: 0,21–0,86; HR: 0,43). A trend towards higher PFS was observed as well (10 months in MSI vs 3 months in MSS; 95 % CI:0,26–1,01; HR: 0,51). No statistical significance in PFS and OS according to PD-L1 CPS was found among patients with MSS. ORR and DCR were 36,6 % and 10,6 %, respectively. No cases of pseudoprogression or fatal immune-related AEs were observed. Conclusion: Our real-world data is consistent with published literature and the results from clinical trials. Further studies are needed to determine prognostic factors and to establish prognostic model of patients receiving ICIs for optimal treatment strategy of mGC.

Ways to overcome the screenwriting crisis in Ukrainian cinematography of the second half of the 1920s

The relevance of the article. The history of Ukrainian cinematography of the 1920s is generally well studied. The relevance of this work lies in the fact that there are almost no works in Ukrainian film studies that examine the state of screenwriting in Ukraine during its birth and formation.
 Problem statement. After the end of the Soviet-Ukrainian (“civil”) war, which led to the Bolshevik occupation of Ukraine, there was an urgent need to reorganize the work of the entire cinematographic industry. With the organization in 1922 on the basis of the All-Ukrainian Film Committee of the All-Ukrainian Photocinema Administration (VUFKU), the heads of the new film department began to establish sustainable film production, but encountered the problem of a chronic shortage of film scripts.
 At this time, the “new” Ukrainian cinematography, for completely external reasons, experienced an acute shortage of screenwriters who had experience in cinematography. Film production, which was growing rapidly and unwaveringly, constantly lacked scripts that would be acceptable from an artistic point of view and at the same time be acceptable to the party bodies from an ideological perspective. Let’s note that there were essentially too many scripts, and film factories were literally “drowning” in the so-called “script flow”. But in this “flow” only a small part turned out to be suitable for implementing from an ideological point of view. Therefore, from the second half of the 1920s, it became increasingly common to talk about a “script crisis”, which was more ideological than creative.
 When the VUFKU began its work, “Soviet film dramaturgy” actually did not exist yet. Therefore, the directors turned to an old, time-tested source — literature. On the basis of literary works, they sought to make films more or less close to the spiritual and social trends of the time.
 At the beginning of the 1930s, the controversy surrounding the “screenwriting crisis” in Ukraine stopped. It was then that the management system of the film industry in the USSR was finally transformed. A clear vertical of soviet management with the film center in Moscow is being formed. Ukrainian cinema finally loses its autonomy and Ukrainian film factories start working with scripts approved in Moscow.

THE ISSUE OF PERSONAL EXCHANGE IN RELATIONS BETWEEN THE BSSR AND POLAND IN 1921-1939

The article focuses on the issue of personal exchange in the relations between the BSSR and Poland in 1921-1939. It is emphasized that after the conclusion of the Riga Peace Treaty, the issues of bilateral population exchange were dealt with by a specially created Joint Commission for Repatriation with centers in Warsaw and Moscow. In August 1924, the issue of personal became part of diplomatic relations between Poland and the USSR. In particular the Ministry of Internal Affairs of Poland and Bureau under the Central Committee of the RCP (b)-Central Committee of the All-Russian Communist Party (b) began to deal with the problems of repatriation. Attempts were also made to effect an exchange of prisoners through the military authorities. It is indicated that according to the “Treaty on personal exchange between Poland, Russia (Belarus) and Ukraine” concluded in march 1923, the implementation of the largest number of persons subject to personal exchange between the parties was envisaged.

Real world effectiveness of regorafenib in heavily pretreated patients with metastatic colorectal cancer.

141 Background: Metastatic colorectal cancer (mCRC) remains a challenge with a significant impact on patient survival and quality of life. Over the past decade, targeted therapies have emerged as promising treatment options for mCRC, including regorafenib. While clinical trials have established efficacy and safety of regorafenib in mCRC, based on the CORRECT and ReDos trials, the real-world utilization and outcomes associated with this therapy have gained increasing importance. This abstract presents a real-world data analysis focused on the use of regorafenib in patients with metastatic colorectal cancer in a community based comprehensive cancer center in Moscow, Russia. The data were collected from 2 outpatient medical oncology departments from 2018-2022 and we evaluated the real world patterns of use, effectiveness and safety. Methods: We evaluated all patients who were issued Regorafenib at a medical pharmacy of our cancer center. We evaluated all Regorafenib issued from 2018-2022 in our center – 348 patients received Regorafenib and 311 of them were patients with metastatic colorectal cancer and identified patterns of use, toxicity and outcomes in this patient population. Results: The median age was 61.2 and 49.5% were female (50.5 – were male%) Primary tumor was right sided in 20.9% of all patients, left sided – 49.1% and rectum in 29.9% De novo metastatic colorectal cancer was in 208 patients and 103 patients were those who progressed after initial treatment. Mutation status was identified in 91% of all patients. 46% had KRAS mutation, 3.8% were BRAF mutated and 4.2% were NRAS mutated. MSI status was known for 71% of the patients and it was negative. We understand the selection bias, because most of MSI-h patients would have gone on to receive immunotherapy rather than a TKI. The patients identified in our practice were more heavily pretreated (93.5% of them received more than 3 lines of prior therapy) and 1/3 of all patients were ECOG 2-3 performance status. Toxicity data were available only in 61% of the patients which reveals data caveats when using real world data outside of a clinical trial. Any grade toxicity was noted in 53% of all patients. Using Kaplan Myer Survival Analysis, the median PFS was 2 months and median OS was 5.3 months in the evaluated population. Conclusions: The real world data analysis shows that while Regorafenib is another treatment option, and our data confirm the results of clinical trial, its utilization and use provides only modest clinical benefit for patients.[Table: see text]

Sustainable urban development: Environmental improvement of Moscow

The article deals with the ecological situation of Moscow on the example of Zamoskvorechye. The neighbourhood includes an island, the official name of which has not been established so far. Reconstruction of the median Sadovnicheskaya Street with the formation of new green spaces and public and cultural spaces is proposed. The psychophysiological features of human perception and related psycho-emotional states that determine the influx of citizens into the reconstructed zones have been taken into account. Models of comfortable and safe space for people in the centre of Moscow are proposed.

Field studies of the Chulym-Turkic language: history and 2023 field trips

The article discusses the fieldwork studies of the Chulym-Turkic language, a moribund idiom in the Tomsk Region and the Krasnoyarsk Territory in Russia. The systemic research was started by Professor A. P. Dulzon in the mid-1940s and initially focused on the Lower Chulym dialect, with note-taking serving the main form of language documentation till the 1970s. In the 21st century audio recordings were made from its last speaker whose passing in 2011 marked the extinction of the whole dialect. Since the 1970s, the focus shifted to the Middle Chulym dialect. Scholars from various institutions, including the Tomsk Linguistic School, as well as scholars from other scientific and educational centers of Moscow, Russia, Korea and the USA have been involved in the study. The Middle Chulym subdialects have been documented, with the data stored in platforms such as the Endangered Languages Archive and the “LingvoDoc” linguistic platform. The article reports the types and volume of the recorded materials, provides information on archive data, and discusses the published Chulym-Turkic language samples available on the internet. It also shares preliminary observation results from the latest fieldwork, including the identification of an ‘intermediary’ Middle Chulym subdialect. Finally, the article reflects on the current state of the Chulym-Turkic language and the proficiency of its native speakers, as well as projects aimed at raising awareness and supporting the language.

Urban aerosol, its radiative and temperature response in comparison with urban canopy effects in megacity based on COSMO-ART modeling

The study of urban aerosol and its influence on radiation and meteorological regime is important due to the climate effect. Using COSMO-ART model with TERRA_URB parameterization, we estimated aerosols and their radiative and temperature response at different emission levels in Moscow. Mean urban aerosol optical depth (AOD) was about 0.029 comprising 20–30% of the total AOD. Urban black carbon mass concentration and urban PM10 accounted for 86% and 74% of their total amount, respectively. The urban AOD provided negative shortwave effective radiative forcing (ERF) of −0.9 W m−2 at the top of the atmosphere (TOA) for weakly absorbing aerosol and positive ERF for highly absorbing aerosol. Urban canopy effects decreased surface albedo from 19.1% to 16.9%, which resulted in positive shortwave ERF at TOA, while for longwave irradiance negative ERF was observed due to additional emitting of urban heat. Air temperature at 2 m decreased independently on the ERF sign, partially compensating (up to 0.5 °C) for urban heat island effect (1.5 °C) during daytime. Mean radiative atmospheric absorption over the Moscow center in clear sky conditions reaches 4 W m−2 due to urban AOD. The study highlights the role of urban aerosol and its radiative and temperature effects.

Conditionally Background Level of Aerosol Pollution of Near-Surface Air in Moscow and One of Its Suburbs: Seasonal Variations

The data of continuous observations of aerosol composition in the near-surface atmosphere in Moscow (in the city center) and in Moscow region (near Zvenigorod, Moscow region) for three years, from autumn 2019 to the end of 2022, are analyzed. The obtained data were compared with the results of observations on the Moscow network stations “Mosecomonitoring”. The concept of conditionally background aerosol pollution of the atmosphere in Moscow is introduced for those days when the average daily concentration of PM10 is less than the MPC value (60 µg/m3). Previously, the authors found that all episodes of increased aerosol pollution in Moscow with daily average PM10 concentration higher than the MPC value, are associated either with the presence of a close local source in the city itself, or with the long-range transport of fire aerosols and/or dust from other territories to the Moscow region. The average daily PM2.5 concentration in the city and the suburb is lower than the MPC (35 µg/m3) all year round. The days corresponding to the introduced conditional background make up more than 91% over three years in the center of Moscow. Such a conditional background is formed by both natural and anthropogenic sources of aerosols, and not only of local, but also of remote origin. It implicitly takes into account the influence of meteorological conditions on sources and sinks of aerosols, as well as advective air mass transport of aerosol to and from the city. Seasonal variations in mass concentration of PM10, PM2.5 particles and individual chemical elements, as well as in the distribution of chemical elements by the size of aerosol particles in near-surface atmosphere under conditionally background pollution are analyzed. The emphasis is placed on the similarity and difference in the conditionally background near-surface aerosol for the city and the suburb in different seasons.

"BIG SVERDLOVSK" IN THE HISTORICAL AND ARCHITECTURAL DIMENSION OF THE 1920S - 1930S

The paper analyzes the processes of urban planning and architectural shaping that took place in the administrative center of the Ural (since 1934 - Sverdlovsk) region, the city of Sverdlovsk in the 1920s - 1930s. The paper notes that the new architectural and spatial structure of one of the largest cities in the Urals, which arose during the implementation of the general plan «Big Sverdlovsk», was based mainly on the ideas of the architectural avant-garde, the main creative trend of which was constructivism. The paper also indicates that Sverdlovsk constructivism, which led to the creation of a large number of unique structures, was formed and developed under the influence of famous architects representing the avant-garde centers of Moscow, Leningrad and Tomsk, as well as the German Bauhaus school, which was considered the founder of this style. The paper draws attention to the fact that the practical implementation of the plan of architectural and urban development of Sverdlovsk led to the creation of a polycentric urban system within which, along with the reconstruction of the central core of the city, on the basis of large factories, surrounding industrial and residential areas («socialist cities»), regulated by systems of consumer services, transport and landscaping, arose. The paper concludes that these architectural and construction processes of the 1920s - 1930s, which took place in Sverdlovsk within the constructivist avant-garde, and then evolved towards decorative constructivism and neoclassicism, allowed the city to take a serious step in the development of urban planning, led to the creation of an architectural aura that formed its unique image.

Pharmacokinetic and Pharmacogenetic Predictors of Major Bleeding Events in Patients with an Acute Coronary Syndrome and Atrial Fibrillation Receiving Combined Antithrombotic Therapy.

Objective: This study's objective was to evaluate the effects of pharmacokinetic and pharmacogenetic factors on major bleeding in patients with ACS and non-valvular AF receiving combined antithrombotic therapy consisting of rivaroxaban, clopidogrel, and aspirin as part of dual or triple therapy. Methods: A prospective observational study was conducted in two PCI centers in Moscow, the Russian Federation, from 2017 to 2018. One hundred patients with ACS and AF were enrolled. Prospective follow-ups continued for 12 months. Results: A total of 36 patients experienced bleeding events, with 10 experiencing major bleeding based on the BARC scale and 17 experiencing major bleeding based on the ISTH scale. The following predictors associated with an increased number of major bleeding events were identified: for the ISTH scale, a Css min. of rivaroxaban of >137 pg/mL (5.94 OR, (95% CI, 3.13-12.99; p < 0.004)) and carriage of the T allelic variant polymorphism ABCB1 rs4148738 (8.97 OR (95% CI, 1.48-14.49; p < 0.017)), as well as for the BARC scale (5.76 OR (95% CI, 2.36-9.87; p < 0.018)). Conclusions: Measuring residual steady-state rivaroxaban concentrations and determining the carriage of the T allelic variant polymorphism ABCB1 rs4148738 may be applicable to high-risk patients for subsequent antithrombotic therapy modification.

Identification predictors of risk of dental implant rejection in the early postoperative period

BACKGROUND: The modern model of healthcare requires a paradigm shift in the thinking of healthcare managers, doctors, and patients. A personalized approach, identification of possible causes of diseases, and prevention of pathologies are the components of successful and quality healthcare delivery in our country. Dentistry is a field in which preventive, prophylactic, and personalized medicine is an integral part of patient care. One of the important tasks of modern digital dentistry is to find indicators that allow for predicting dental implant complications. The solution to this problem could be the creation of a medical decision support system that allows predicting outcomes before implant surgery. AIMS: To reliably identify predictors of early (up to 6 months) risk of dental implant rejection by applying hierarchical Bayesian survival analysis models. METHODS: Data collected retrospectively for patients who underwent dental implant placement between 2013 and 2022 were considered information bases. Data were generated from multicenter surveys conducted in dental implant centers in Stavropol, Moscow, and Penza. The total number of observed cases was 1472. A group of defined factors was considered candidate risk predictors, and the Bayesian hierarchical Cox model (Gsslasso Cox) was used to identify risk predictors. RESULTS: After retrospective analysis of the collected data and screening out incomplete and poor-quality information, the database included a total of 39 variables (factors) for 1472 observations (implants). The multivariate analysis yielded the following predictors of risk of early dental implant rejection: male sex (hazard ratio [HR] 2.388, 95% confidence interval [CI] 1.345; 4.240, p=0.003), age at implantation (years; HR1.034, 95% CI 1.0081.041, p=0.011), oral hygiene (SilnesLow index; HR 2.439, 95% CI 1.2054.701, p=0.051), osteoporosis (HR 5.512, 95% CI 3.6848.248, p 0.001), bone width (mm; HR 0.823, 95% CI 0.7160.944, p=0.006), anesthetic type (local; HR 0.469, 95% CI 0.2340.944, p=0.034), localized periodontitis (HR 2.024, 95% CI 1.4522.821, p=0.039), and low-festooned, thick gingiva (HR=0.485; 95% CI: 0.358-0.658; p=0.0104). CONCLUSIONS: This study shows that predictors of risk of dental implant rejection can be identified separately in the early postoperative period (up to 6 months) by using hierarchical Bayesian survival analysis models, and risk predictors different from those in the longer term are identified in this period.