105 research outputs found
Technology "Debate" as a tool for communicative competence development
The task of a modern university is to produce a highly qualified and competent specialist, ready for independent implementation of professional activities. Communicative competence is one of the fundamental in such preparation. The purpose of the article is to review the experience of implementing the Debate technology as an effective means of developing communicative competence of future vocational training teachers. The article focuses on the specifics of their future activities, its features and conditions, as well as their role in the field of professional education. The teacher of vocational training carries out pedagogical, educational-production and organizational-methodological activities in students training in secondary vocational schools. The basis for the implementation of his professional activity is the construction of effective interaction in the classroom between the teacher and students. For this, future teachers of vocational training must master communicative competence which is one of the main components of their future activities success. The article reveals features of the "Debate" and their capabilities in studentsβ training. The study allowed us to check the level of communicative competence development in dynamics, as well as to identify the level of students' motivation before using the Debate technology and after. Based on the data obtained, we can talk about the effectiveness of technology implementation. "Debate" provides ample opportunities for students to develop interaction skills, conduct constructive dialogue, select arguments, effective interaction strategies, the ability to balance emotional stress during the discussion, the ability to speak in public and other skills that contribute to the development of communicative competence and provide highly qualified specialist training
Average time scale for Dome Fuji ice core, East Antarctica
Three different approaches to ice-core age dating are employed to develop a depth-age relationship at Dome F: (1) correlation of the ice-core isotope record to the geophysical metronome(Milankovich surface temperature cycle) inferred from the deep borehole temperature profile at Vostok,(2) importing a known chronology from another(Devils Hole) paleoclimatic signal, and(3) direct ice sheet flow modeling. Inverse Monte Carlo sampling is used to constrain the accumulation rate reconstruction and ice flow simulations in order to find the best-fit glaciological time scale matched with the two other chronologies. General uncertainty of the different age estimates varies from 2 to 6kyr on average and reaches 6-14kyr at maximum. Whatever the causes of this discrepancy might be, they are thought to be of different origins, and the age errors are assumed to be independent. Thus, the average time scale for the Dome F ice core down to a depth of 2500m(ice age of 335kyr) is deduced consistently with all three age-depth relationships within the standard deviation limits of Β±3.3kyr, and its accuracy is estimated as 1.4kyr on average. The constrained ice-sheet flow model allows extrapolation of the ice age-depth curve further to the glacier bottom and predicts the ages at depths of 2800, 3000, and 3050m to be 615Β±70, 1560Β±531, and 2985Β±1568kyr, respectively
Vostok (Antarctica) ice-core time-scale from datings of different origins
Three different approaches to ice-core age dating are employed to develop a depth-age relationship at Vostok, Antarctica: (1) correlating the ice-core isotope record to the geophysical metronome (Milankovich surface temperature cycles) inferred from the borehole temperature profile, (2) importing a known chronology from another (Devils Hole, Nevada, USA) paleoclimatic signal, and (3) direct ice-sheet flow modeling. Inverse Monte Carlo sampling is used to constrain the accumulation-rate reconstruction and ice-flow simulations in order to find the best-fit glaciological time-scale matched with the two other chronologies. The general uncertainty of the different age estimates varies from 2 to 6 kyr on average and reaches 6-15 kyr at maximum. Whatever the causes of this discrepancy might be, they are thought to be of different origins, and the age errors are assumed statistically independent. Thus, the average time-scale for the Vostok ice core down to 3350 m depth is deduced consistent with all three dating procedures within the standard deviation limits of Β± 3.6kyr, and its accuracy is estimated as 2.2 kyr on average. The constrained ice-sheet flow model allows, at least theoretically, extrapolation of the ice age-depth curve further to the boundary with the accreted lake ice where (at 3530 m depth) the glacier-ice age may reach βΌ2000 kyr
Socio-gaming technology in the development of studentsβ personality
In response to modern needs of the labor market in highly qualified specialists capable of independent and creative activities, higher education institutions are developing professional competence of students using various innovative technologies that contribute to enhancing students' cognitive position. The implementation of modern educational technologies in the system of vocational education is a necessity dictated by the conditions of a competency-based educational paradigm. The peculiarity of educational technology as an effective means of forming professional competence is to ensure the guaranteed achievement of goals. In preparing a student for professional activity, technologies that allow a student to be immersed in conditions as close as possible to professional ones are of particular relevance. The advantage of socio-gaming technologies implementation consists both in revealing a studentβs capabilities, his potential, including each of them in the educational process, and in shaping students' ability to master the norms and rules of behavior in society. The purpose of the article is to review the experience of implementing socio-gaming technologies in the training of students of higher educational institutions. Communicative competence is one of the most significant elements of preparing students for both professional activities and life in society. The article presents a study to verify the level of formation of communicative competence. The level was established according to certain criteria related to inclusion in the learning process, building effective interaction with other students. Statistical analysis showed the effectiveness of the technology under consideration. An additional survey of students made it possible to establish that the game contributes to their active involvement in educational process and construction of effective communication with classmates
ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Ρ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² Helianthus annuus L. ΠΈ Rosmarinus officinalis L. Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΡΠΈΡΡΡΠ½ΠΎΠ³ΠΎ ΠΆΠΈΡΠ°
The aim of this study was to study the oxidation resistance and functional properties of oleogels based on high oleic oil and wax from Helianthus annuus L. with the addition of a natural complex antioxidant β an extract from Rosmarinus officinalis L. and lecithin from Helianthus annuus L. β when used as a frying medium for French-fries. High oleic sunflower oil was structured into an oleogel with sunflower wax at a dosage of 5%. Studies were carried out to determine the possibility of replacing the synthetic antioxidant tert-butylhydroquinone at a dosage of 200 mg/kg with a natural antioxidant based on rosemary extract and sunflower lecithin in an oleogel with a defoamer. It was determined that the introduction of sunflower wax increased the induction period of high-oleic sunflower oil by 1.6 times, and the additional introduction of defoamer and antioxidants increased this figure by 1.8β2 times. The rate of accumulation of oxidation products in oil, which is characterized by the level of total polar materials, decreased when wax and antioxidants were added. The degree of thermal oxidation most quickly reached the limit value in oil without additives; in oleogels, it significantly decreased. The introduction of sunflower wax into oil contributed to a noticeable decrease in the absorption of oil by potatoes: fried in oleogel, it absorbed 34β38% less oil than fried in oil without additives. The addition of 0.07% rosemary extract with sunflower lecithin to the oleogel increased the operating time of frying oil by at least 2 times, approximately the same as that of the oleogel with tert-butylhydroquinone. This makes it possible to replace the synthetic antioxidant in deepfrying oleogel with natural rosemary extract with sunflower lecithin. The developed oleogel is a frying oil that has a longer service life and allows you to get fried products with a lower amount of fat.Π¦Π΅Π»ΡΡ Π½Π°ΡΡΠΎΡΡΠ΅Π³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ»ΠΎΡΡ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΡΠΈ ΠΊ ΠΎΠΊΠΈΡΠ»Π΅Π½ΠΈΡ ΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
ΡΠ²ΠΎΠΉΡΡΠ² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Π΅ΠΉ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π²ΡΡΠΎΠΊΠΎΠΎΠ»Π΅ΠΈΠ½ΠΎΠ²ΠΎΠ³ΠΎ ΠΌΠ°ΡΠ»Π° ΠΈ Π²ΠΎΡΠΊΠ° ΠΈΠ· Helianthus annuus L. Ρ Π²Π²ΠΎΠ΄ΠΎΠΌ Π½Π°ΡΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ³ΠΎ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Ρ β ΡΠΊΡΡΡΠ°ΠΊΡΠ° ΠΈΠ· Rosmarinus officinalis L. ΠΈ Π»Π΅ΡΠΈΡΠΈΠ½Π° ΠΈΠ· Helianthus annuus L. β ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΠΈΡ
Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΆΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΡΠ΅Π΄Ρ Π΄Π»Ρ ΠΊΠ°ΡΡΠΎΡΠ΅Π»Ρ-ΡΡΠΈ. ΠΡΡΠΎΠΊΠΎΠΎΠ»Π΅ΠΈΠ½ΠΎΠ²ΠΎΠ΅ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΠΎΠ΅ ΠΌΠ°ΡΠ»ΠΎ Π±ΡΠ»ΠΎ ΡΡΡΡΠΊΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Ρ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΡΠΌ Π²ΠΎΡΠΊΠΎΠΌ Π² Π΄ΠΎΠ·ΠΈΡΠΎΠ²ΠΊΠ΅ 5%. ΠΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π·Π°ΠΌΠ΅Π½Ρ ΡΠΈΠ½ΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Ρ ΡΡΠ΅Ρ-Π±ΡΡΠΈΠ»Π³ΠΈΠ΄ΡΠΎΡ
ΠΈΠ½ΠΎΠ½Π° Π² Π΄ΠΎΠ·ΠΈΡΠΎΠ²ΠΊΠ΅ 200 ΠΌΠ³/ΠΊΠ³ Π½Π° Π½Π°ΡΡΡΠ°Π»ΡΠ½ΡΠΉ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Ρ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΡΠΊΡΡΡΠ°ΠΊΡΠ° ΡΠΎΠ·ΠΌΠ°ΡΠΈΠ½Π° ΠΈ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠΈΡΠΈΠ½Π° Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Π΅ Ρ ΠΏΠ΅Π½ΠΎΠ³Π°ΡΠΈΡΠ΅Π»Π΅ΠΌ. ΠΡΠ»ΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΎ, ΡΡΠΎ Π²Π½Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΊΠ° ΡΠ²Π΅Π»ΠΈΡΠΈΠ»ΠΎ ΠΈΠ½Π΄ΡΠΊΡΠΈΠΎΠ½Π½ΡΠΉ ΠΏΠ΅ΡΠΈΠΎΠ΄ Π²ΡΡΠΎΠΊΠΎΠΎΠ»Π΅ΠΈΠ½ΠΎΠ²ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΠΎΠ³ΠΎ ΠΌΠ°ΡΠ»Π° Π² 1.6 ΡΠ°Π·Π°, Π° Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π²Π²ΠΎΠ΄ ΠΏΠ΅Π½ΠΎΠ³Π°ΡΠΈΡΠ΅Π»Ρ ΠΈ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Π΅ΠΉ ΡΠ²Π΅Π»ΠΈΡΠΈΠ» Π΄Π°Π½Π½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΡΠΆΠ΅ Π² 1.8β2 ΡΠ°Π·Π°. Π‘ΠΊΠΎΡΠΎΡΡΡ Π½Π°ΠΊΠΎΠΏΠ»Π΅Π½ΠΈΡ ΠΏΡΠΎΠ΄ΡΠΊΡΠΎΠ² ΠΎΠΊΠΈΡΠ»Π΅Π½ΠΈΡ Π² ΠΌΠ°ΡΠ»Π΅, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠ°ΡΡΡ ΡΡΠΎΠ²Π½Π΅ΠΌ ΠΎΠ±ΡΠΈΡ
ΠΏΠΎΠ»ΡΡΠ½ΡΡ
Π²Π΅ΡΠ΅ΡΡΠ², ΠΏΡΠΈ Π²Π½Π΅ΡΠ΅Π½ΠΈΠΈ Π²ΠΎΡΠΊΠ° ΠΈ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Π΅ΠΉ ΡΠ½ΠΈΠΆΠ°Π»Π°ΡΡ. Π‘ΡΠ΅ΠΏΠ΅Π½Ρ ΡΠ΅ΡΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠΊΠΈΡΠ»Π΅Π½ΠΈΡ Π±ΡΡΡΡΠ΅Π΅ Π²ΡΠ΅Ρ
Π΄ΠΎΡΡΠΈΠ³Π»Π° ΠΏΡΠ΅Π΄Π΅Π»ΡΠ½ΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Π² ΠΌΠ°ΡΠ»Π΅ Π±Π΅Π· Π΄ΠΎΠ±Π°Π²ΠΎΠΊ, Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»ΡΡ
ΠΎΠ½Π° Π·Π°ΠΌΠ΅ΡΠ½ΠΎ ΡΠ½ΠΈΠΆΠ°Π»Π°ΡΡ. ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π² ΠΌΠ°ΡΠ»ΠΎ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΊΠ° ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°Π»ΠΎ Π·Π°ΠΌΠ΅ΡΠ½ΠΎΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π²ΠΏΠΈΡΡΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΌΠ°ΡΠ»Π° ΠΊΠ°ΡΡΠΎΡΠ΅Π»Π΅ΠΌ: ΠΎΠ±ΠΆΠ°ΡΠ΅Π½Π½ΡΠΉ Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Π΅, ΠΎΠ½ Π²ΠΏΠΈΡΡΠ²Π°Π» Π½Π° 34β38% ΠΌΠ΅Π½ΡΡΠ΅ ΠΌΠ°ΡΠ»Π°, ΡΠ΅ΠΌ ΠΎΠ±ΠΆΠ°ΡΠ΅Π½Π½ΡΠΉ Π² ΠΌΠ°ΡΠ»Π΅ Π±Π΅Π· Π΄ΠΎΠ±Π°Π²ΠΎΠΊ. ΠΠ½Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Ρ 0.07% ΡΠΊΡΡΡΠ°ΠΊΡΠ° ΡΠΎΠ·ΠΌΠ°ΡΠΈΠ½Π° Ρ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΡΠΌ Π»Π΅ΡΠΈΡΠΈΠ½ΠΎΠΌ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π»ΠΎ Π²ΡΠ΅ΠΌΡ ΡΠΊΡΠΏΠ»ΡΠ°ΡΠ°ΡΠΈΠΈ ΡΡΠΈΡΡΡΠ½ΠΎΠ³ΠΎ ΠΆΠΈΡΠ° Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ ΡΠ΅ΠΌ Π² 2 ΡΠ°Π·Π° ΠΏΡΠΈΠΌΠ΅ΡΠ½ΠΎ ΡΠ°ΠΊΠΆΠ΅, ΠΊΠ°ΠΊ ΠΈ Ρ ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Ρ Ρ ΡΡΠ΅Ρ-Π±ΡΡΠΈΠ»Π³ΠΈΠ΄ΡΠΎΡ
ΠΈΠ½ΠΎΠ½ΠΎΠΌ. ΠΡΠΎ Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΏΡΠΎΠΈΠ·Π²Π΅ΡΡΠΈ Π·Π°ΠΌΠ΅Π½Ρ ΡΠΈΠ½ΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠΎΠΊΠΈΡΠ»ΠΈΡΠ΅Π»Ρ Π² ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Π΅ Π΄Π»Ρ ΡΡΠΈΡΡΡΠ° Π½Π° Π½Π°ΡΡΡΠ°Π»ΡΠ½ΡΠΉ ΡΠΊΡΡΡΠ°ΠΊΡ ΡΠΎΠ·ΠΌΠ°ΡΠΈΠ½Π° Ρ ΠΏΠΎΠ΄ΡΠΎΠ»Π½Π΅ΡΠ½ΡΠΌ Π»Π΅ΡΠΈΡΠΈΠ½ΠΎΠΌ. Π Π°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΡΠΉ ΠΎΠ»Π΅ΠΎΠ³Π΅Π»Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠΈΡΡΡΠ½ΡΠΌ ΠΆΠΈΡΠΎΠΌ, ΠΈΠΌΠ΅ΡΡΠΈΠΌ Π±ΠΎΠ»Π΅Π΅ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΡΠΎΠΊ ΡΠΊΡΠΏΠ»ΡΠ°ΡΠ°ΡΠΈΠΈ ΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΠΌ ΠΏΠΎΠ»ΡΡΠ°ΡΡ ΠΎΠ±ΠΆΠ°ΡΠ΅Π½Π½ΡΠ΅ ΠΏΡΠΎΠ΄ΡΠΊΡΡ Ρ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΈΠΌ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ ΠΆΠΈΡΠ°
Wastewater treatment electroplating plants from ions of copper by coagulation
In the article the urgent problems of purification of wastewater. The physicochemical method of wastewater treatment of electroplating plants was studied. The main types of coagulants are considered.Π ΡΠ°Π±ΠΎΡΠ΅ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ Π°ΠΊΡΡΠ°Π»ΡΠ½ΡΠ΅ ΠΏΡΠΎΠ±Π»Π΅ΠΌΡ ΠΎΡΠΈΡΡΠΊΠΈ ΡΡΠΎΡΠ½ΡΡ
Π²ΠΎΠ΄. ΠΠ·ΡΡΠ΅Π½ ΡΠΈΠ·ΠΈΠΊΠΎ-Ρ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΏΠΎΡΠΎΠ± ΠΎΡΠΈΡΡΠΊΠΈ ΡΡΠΎΡΠ½ΡΡ
Π²ΠΎΠ΄ Π³Π°Π»ΡΠ²Π°Π½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΡΡΠ². Π Π°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΡΠΈΠΏΡ ΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠΎΠ²
Special Economic Zones in Russia: Practice of Application of Tax Incentives and Assessment of Efficiency
The article considers the features of the application of fiscal instruments in the special economic zones of Russia in the context of the effectiveness of tax incentives and preferential tax treatment. The purpose of the article is to formulate proposals on improving the methodology of assessment of the efficiency of the special economic zones of the Russia. The basic methods of research were analyses, synthesis and comparative analysis. The study was based on the results of the operation of nine Russian special economic zones of various types launched at least seven years ago. As special economic zones are an instrument for future economic development and growth, assessing the efficiency of such zones is difficult. In the article, the authors analyzed the methods for assessing the effectiveness of special economic zones applied at different times, identified their main similarities and differences. The article analyses imperfections of the methodology for estimating special economic zones based on projected values of indicators: the number of residents, the number of jobs created in the zone, the amount of attracted investments, etc. This approach does not always allow for an effective assessment of a special economic zone because the target values of the indicators may initially be incorrect. The concept of the effectiveness of a special economic zone is proposed to be considered from the point of view the budgetary costs and benefits, as well as in the context of the socio-economic development of the region that hosts the zone. Analysis of the development of special economic zones can become more objective when the existing methodology for assessing the effectiveness is complemented with indicators that reflect the impact of special economic zones on the level of social and economic development of the region.Π‘ΡΠ°ΡΡΡ ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π° Π²ΠΎΠΏΡΠΎΡΠ°ΠΌ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠΈΡΠΊΠ°Π»ΡΠ½ΡΡ
ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½ΡΠΎΠ² Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΡΡ
ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½ Π ΠΎΡΡΠΈΠΈ Ρ ΡΠΎΡΠΊΠΈ Π·ΡΠ΅Π½ΠΈΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»ΡΠ΅ΠΌΡΡ
Π»ΡΠ³ΠΎΡ ΠΈ ΠΏΡΠ΅ΡΠ΅ΡΠ΅Π½ΡΠΈΠΉ. Π¦Π΅Π»Ρ ΡΡΠ°ΡΡΠΈ β ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ΠΈΠΉ ΠΎ ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΠΌΠΎΠΉ Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½ Π ΠΎΡΡΠΈΠΈ. ΠΠ°Π·ΠΎΠ²ΡΠΌΠΈ ΠΌΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ»ΠΈΡΡ Π°Π½Π°Π»ΠΈΠ·, ΡΠΈΠ½ΡΠ΅Π· ΠΈ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ·. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π»ΠΎΡΡ Π½Π° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°Ρ
Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π΄Π΅Π²ΡΡΠΈ ΡΠΎΡΡΠΈΠΉΡΠΊΠΈΡ
ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΠΈΠΏΠΎΠ² ΡΠΎ ΡΡΠΎΠΊΠΎΠΌ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π±ΠΎΠ»Π΅Π΅ 7 Π»Π΅Ρ. ΠΠΎΡΠΊΠΎΠ»ΡΠΊΡ ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ Ρ ΠΎΡΠΎΠ±ΡΠΌ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΡΠ°ΡΡΡΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΡΡ ΡΠΎΠ±ΠΎΠΉ ΠΈΠ½ΡΡΡΡΠΌΠ΅Π½Ρ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°Π·Π²ΠΈΡΠΈΡ, ΠΎΡΠΈΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π½Π° ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Ρ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΎΡΠ΅Π½ΠΊΠΈ Π΅Π³ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π²ΡΠ·ΡΠ²Π°Π΅Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π½ΡΠ΅ ΡΡΡΠ΄Π½ΠΎΡΡΠΈ. Π ΡΡΠ°ΡΡΠ΅ Π°Π²ΡΠΎΡΠ°ΠΌΠΈ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½, ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΠΌΡΠ΅ Π² ΡΠ°Π·Π½ΡΠ΅ ΠΏΠ΅ΡΠΈΠΎΠ΄Ρ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ, ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΠΈΡ
ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΡΡ
ΠΎΠ΄ΡΡΠ²Π° ΠΈ ΡΠ°Π·Π»ΠΈΡΠΈΡ. ΠΡΠΈΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ Π½Π΅ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²Π° ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π½Π° Π°Π½Π°Π»ΠΈΠ·Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΏΠ»Π°Π½ΠΎΠ²ΡΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ: ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΡΠ΅Π·ΠΈΠ΄Π΅Π½ΡΠΎΠ², ΡΠΈΡΠ»Π° ΡΠΎΠ·Π΄Π°Π½Π½ΡΡ
ΠΈΠΌΠΈ ΡΠ°Π±ΠΎΡΠΈΡ
ΠΌΠ΅ΡΡ, ΠΎΠ±ΡΠ΅ΠΌΠΎΠ² ΠΏΡΠΈΠ²Π»Π΅ΡΠ΅Π½Π½ΡΡ
ΠΈΠ½Π²Π΅ΡΡΠΈΡΠΈΠΉ ΠΈ Ρ. ΠΏ. ΠΠ°Π½Π½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ Π½Π΅ Π²ΡΠ΅Π³Π΄Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΎΡΠ΅Π½ΠΈΡΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΡΡ Π·ΠΎΠ½Ρ, ΠΏΠΎΡΠΊΠΎΠ»ΡΠΊΡ ΠΏΠ»Π°Π½ΠΎΠ²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΠΈΠ·Π½Π°ΡΠ°Π»ΡΠ½ΠΎ Π½Π΅ΠΊΠΎΡΡΠ΅ΠΊΡΠ½Ρ. ΠΠΎΠ½ΡΡΠΈΠ΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΎΡΠΎΠ±ΠΎΠΉ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π·ΠΎΠ½Ρ ΠΏΡΠ΅Π΄Π»Π°Π³Π°Π΅ΡΡΡ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡ Ρ ΡΠΎΡΠΊΠΈ Π·ΡΠ΅Π½ΠΈΡ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π±ΡΠ΄ΠΆΠ΅ΡΠ½ΡΡ
Π·Π°ΡΡΠ°Ρ ΠΈ Π²ΡΠ³ΠΎΠ΄, Π½ΠΎ ΠΈ Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΈ ΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅Π³ΠΈΠΎΠ½Π°, Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΡΠ΅Ρ ΠΎΡΠΎΠ±Π°Ρ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π·ΠΎΠ½Π°. ΠΠ½Π°Π»ΠΈΠ· ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½ ΠΌΠΎΠΆΠ΅Ρ ΡΡΠ°ΡΡ Π΄Π΅ΠΉΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΎΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΈ ΡΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌ ΠΏΡΠΈ Π΄ΠΎΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΡΡΠ΅ΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ, ΠΎΡΡΠ°ΠΆΠ°ΡΡΠΈΠΌΠΈ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΠΎΡΠΎΠ±ΡΡ
ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
Π·ΠΎΠ½ Π½Π° ΡΡΠΎΠ²Π΅Π½Ρ ΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎ-ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅Π³ΠΈΠΎΠ½Π°
ΠΠ΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ ΠΏΠ΅ΡΠ΅Π½ΠΈ: ΠΎΠΏΡΡ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ
The purpose of the study was to evaluate the outcomes of a series of liver resections performed in a single regional specialized cancer center. Material and Methods. Eighty-nine patients underwent liver and/ or extrahepatic bile duct resections in the Penza Regional Oncology Hospital over the 8-year study period. Malignancies were observed in 81 patients. Extended liver resections (4 segments or more) were performed in 58 (65.2 %) cases. Results. Postsurgical morbidity and mortality rates were 31.5 % (28 of 89) and 6.7 % (6 of 89), respectively. Six of 10 patients with primary liver carcinomas were alive without evidence of disease progression at a follow-up time ranged from 1.0 to 76.7 months. Adjuvant chemotherapy (ACT) was the only predictor (HR=0.40; 95 % CI 0.16-0.98) of overall survival in patients with metastatic colorectal cancer (mCRC). The median survival time after liver resections for mCRC with or without ACT was 54.5 (95 % CI: 14.5-94.5) vs 21.8 months (95 % CI: 14.2-29.4), respectively. In mCRC patients with ACT, the 5-year overall survival rate was 44.8 Β± 12.9 %. Conclusion. Primary hepatobiliary carcinomas and colorectal cancer liver metastases are the most common reasons for liver resections. A series of liver resections in a low-volume hospital is feasible with the achievement of good outcomes.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ - ΠΎΡΠ΅Π½ΠΊΠ° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ΅ΡΠΈΠΉΠ½ΠΎΠ³ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ ΠΏΠ΅ΡΠ΅Π½ΠΈ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΠ΅Π½Π·Π΅Π½ΡΠΊΠΎΠΌ ΠΎΠ±Π»Π°ΡΡΠ½ΠΎΠΌ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π΄ΠΈΡΠΏΠ°Π½ΡΠ΅ΡΠ΅ Π·Π° 8 Π»Π΅Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΈ/ΠΈΠ»ΠΈ Π²Π½Π΅ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ² Π²ΡΠΏΠΎΠ»Π½Π΅Π½Ρ 89 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ. ΠΠ»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π±ΡΠ»ΠΈ Ρ 81 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°. ΠΠ±ΡΠΈΡΠ½ΡΠ΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ (4 ΠΈ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠΎΠ²) ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Ρ Π² 58 (65,2 %) Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡΡ
. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½Ρ Ρ 28 (31,5 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ΅ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈΡΡ
ΠΎΠ΄ Π½Π°ΡΡΡΠΏΠΈΠ» Ρ 6 (6,7 %) ΠΈΠ· 89 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ. Π Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΈΠ· 10 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΅ΡΡΠ΅ΡΠΎ ΠΆΠΈΠ²Ρ Π² ΡΡΠΎΠΊΠΈ ΠΎΡ 1 Π΄ΠΎ 76,7 ΠΌΠ΅Ρ. ΠΠ΄ΡΡΠ²Π°Π½ΡΠ½Π°Ρ Ρ
ΠΈΠΌΠΈΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ (ΠΠ₯Π’) Π±ΡΠ»Π° Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΡΠΌ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠΌ (HR=0,4; 95 % ΠΠ 0,16-0,98) ΠΎΠ±ΡΠ΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Π² Π³ΡΡΠΏΠΏΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΌΠ΅ΡΠ°ΡΡΠ°Π·Π°ΠΌΠΈ ΠΊΠΎΠ»ΠΎΡΠ΅ΠΊΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ°ΠΊΠ° (ΠΌΠΠ Π ). ΠΠ΅Π΄ΠΈΠ°Π½Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ Ρ/Π±Π΅Π· ΠΠ₯Π’ ΠΏΠΎΡΠ»Π΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΌΠΠ Π ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 54,5 (95 % ΠΠ 14,5-94,5) vs 21,8 ΠΌΠ΅Ρ (95 % ΠΠ 14,2-29,4) ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. 5-Π»Π΅ΡΠ½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΠ₯Π’ - 44,8 Β± 12,9 %. ΠΡΠ²ΠΎΠ΄Ρ. Π ΡΡΡΡΠΊΡΡΡΠ΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΏΡΠ΅Π²Π°Π»ΠΈΡΡΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
Π³Π΅ΠΏΠ°ΡΠΎ-Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°Π·ΠΎΠ² ΠΊΠΎΠ»ΠΎΡΠ΅ΠΊΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ°ΠΊΠ°. Π‘Π΅ΡΠΈΠΉΠ½ΠΎΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ ΠΏΠ΅ΡΠ΅Π½ΠΈ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ 3-Π³ΠΎ ΡΡΠΎΠ²Π½Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ Ρ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΠ³ΠΎ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°
Π€Π΅Π½ΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΠ»Π°ΡΡΠΈΡΠ½ΠΎΡΡΡ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΈΜ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ
Introduction. Metastatic melanoma is characterized by clinical and morphological heterogeneity and plasticity. Rare cases of metastatic melanoma are known, that have no visual expression of melanocytic markers. Contradictory histology of such melanomas requires a differential diagnosis from morphologically similar non- melanocytic tumors, sarcoma or lymphoma. objective is to describe the extraordinary cases of metastatic melanomas with low expression of differentiation markers. material and methods. 15 melanoma cases with unusual clinical and morphological characteristics were included in the study. These tumors were examined by pathologist and cytologist, by immunohistochemical and FISH analyses, mutations in BRAF, NRAS and KIT genes were detected by PCR. results. Some primary tumors were amelanotic, therefore, they were difficult for differential tumor diagnosis. Most frequently, primary tumors were located on the back, shin or head. In 4 patients the primary focuses were not detected. Metastatic lesions were as large nodular tumors in soft tissues of the back or lower limb. Most tumors belong to mixed or spindle-cell histological types. Spindle-shaped cells were also revealed by cytological analysis. BRAF gene mutations were identified by genetic analysis in 27 % of tumors, NRAS and KIT gene mutations were not detected. In 4 cases FISH analysis was performed to detect EWSR1 gene rearrangements, but it did not confirm the diagnosis of sarcoma. conclusion. The results indicate the presence of a heterogeneous group of melanoma cases, which have a number of morphological and molecular features that bring them closer to sarcomas.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΠ° ΠΎΡΠ»ΠΈΡΠ°Π΅ΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΈΜ Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎΡΡΡΡ ΠΈ ΠΏΠ»Π°ΡΡΠΈΡΠ½ΠΎΡΡΡΡ. ΠΡΡΡΠ΅ΡΠ°ΡΡΡΡ ΡΠ΅Π΄ΠΊΠΈΠ΅ ΡΠ»ΡΡΠ°ΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΈΜ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΡΡΡΡ ΠΌΠ΅Π»Π°Π½ΠΎΡΠΈΡΠ°ΡΠ½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ². ΠΠΈcΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈ ΡΠ°ΠΊΠΈΠ΅ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ ΡΡΠ΅Π±ΡΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΈΜ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΎΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈ ΡΡ
ΠΎΠ΄Π½ΡΡ
Π½Π΅ΠΌΠ΅Π»Π°Π½ΠΎΡΠΈΡΠ°ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΈΜ, ΡΠ°ΡΠΊΠΎΠΌΡ ΠΈΠ»ΠΈ Π»ΠΈΠΌΡΠΎΠΌΡ. Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π½Π΅ΠΎΡΠ΄ΠΈΠ½Π°ΡΠ½ΡΡ
ΡΠ»ΡΡΠ°Π΅Π² ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΈΜ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ Ρ Π½ΠΈΠ·ΠΊΠΎΠΈΜ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΠ΅ΠΈΜ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²ΠΎΡΠ½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ². ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠΏΠΈΡΠ°Π½Ρ 15 ΡΠ»ΡΡΠ°Π΅Π² ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ Ρ Π½Π΅ΠΎΠ±ΡΡΠ½ΡΠΌΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ°ΠΌΠΈ. ΠΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΠ΄Π²Π΅ΡΠ³Π»ΠΈΡΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌΡ, ΡΠΈΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΠΈΠΌΠΌΡΠ½ΠΎΠ³ΠΈΡΡΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΎΠΌΡ ΠΈ FISH-Π°Π½Π°Π»ΠΈΠ·Ρ, Π±ΡΠ»ΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΠΌΡΡΠ°ΡΠΈΠΈ Π² Π³Π΅Π½Π°Ρ
BRAF, NRAS ΠΈ KIT. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅ΡΠ²ΠΈΡΠ½ΡΠ΅ ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ ΡΠ°ΡΡΠΎ Π½Π΅ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π»ΠΈ ΠΏΠΈΠ³ΠΌΠ΅Π½ΡΠ°, ΡΡΠΎ Π·Π°ΡΡΡΠ΄Π½ΡΠ»ΠΎ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ. ΠΠΏΡΡ
ΠΎΠ»ΠΈ ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°Π»ΠΈΡΡ ΡΠ°ΡΠ΅ Π²ΡΠ΅Π³ΠΎ Π½Π° ΡΠΏΠΈΠ½Π΅, Π³ΠΎΠ»Π΅Π½ΠΈ ΠΈΠ»ΠΈ Π³ΠΎΠ»ΠΎΠ²Π΅, Ρ 4 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠ΅ ΠΎΡΠ°Π³ΠΈ Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½Ρ. ΠΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ»ΠΈ ΡΠΎΠ±ΠΎΠΈΜ ΠΊΡΡΠΏΠ½ΡΠ΅ ΡΠ·Π»ΠΎΠ²ΡΠ΅ Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ Π² ΠΌΡΠ³ΠΊΠΈΡ
ΡΠΊΠ°Π½ΡΡ
Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΡΠΏΠΈΠ½Ρ Π»ΠΈΠ±ΠΎ Π½ΠΈΠΆΠ½Π΅ΠΈΜ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠΈ. ΠΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²ΠΎ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΈΜ ΠΎΡΠ½ΠΎΡΠΈΠ»ΠΈΡΡ ΠΊ ΡΠΌΠ΅ΡΠ°Π½Π½ΠΎΠΌΡ ΠΈΠ»ΠΈ Π²Π΅ΡΠ΅ΡΠ΅Π½ΠΎΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠΌΡ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠΈΠΏΠ°ΠΌ. ΠΠ΅ΡΠ΅ΡΠ΅Π½ΠΎΠΎΠ±ΡΠ°Π·Π½ΡΠ΅ ΠΊΠ»Π΅ΡΠΊΠΈ ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ ΠΈ ΠΏΡΠΈ ΡΠΈΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
. ΠΡΠΈ Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΌΡΡΠ°ΡΠΈΠΈ Π² Π³Π΅Π½Π΅ BRAF Π²ΡΡΠ²Π»Π΅Π½Ρ Π² 27 % ΠΌΠ΅Π»Π°Π½ΠΎΠΌ, ΠΌΡΡΠ°ΡΠΈΠΈ Π² Π³Π΅Π½Π°Ρ
NRAS ΠΈ KIT Π½Π΅ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Ρ. Π 4 ΡΠ»ΡΡΠ°ΡΡ
Ρ ΠΏΠΎΠΌΠΎΡΡΡ FISH ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· Π½Π° Π½Π°Π»ΠΈΡΠΈΠ΅ ΡΠ΅Π°ΡΠ°Π½ΠΆΠΈΡΠΎΠ²ΠΊΠΈ Π³Π΅Π½Π° EWSR1, ΠΏΡΠΈ ΡΡΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΡΠ°ΡΠΊΠΎΠΌΡ Π½Π΅ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠ΄ΠΈΠ»ΡΡ. ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠΊΠ°Π·ΡΠ²Π°ΡΡ Π½Π° Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΡ Π½Π΅ΠΎΠ΄Π½ΠΎΡΠΎΠ΄Π½ΠΎΡΡΡ ΠΈ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΡΡ ΠΏΠ»Π°ΡΡΠΈΡΠ½ΠΎΡΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
ΠΌΠ΅Π»Π°Π½ΠΎΠΌ. Π ΡΠ΄ Π²ΡΡΠ²Π»Π΅Π½Π½ΡΡ
ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΈΜ ΡΠ±Π»ΠΈΠΆΠ°Π΅Ρ ΡΡΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ρ ΡΠ°ΡΠΊΠΎΠΌΠ°ΠΌΠΈ
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