7 research outputs found
Domain structure and electrical properties of Gd- and Tm-doped lithium niobate single crystals
We have grown lithium niobate single crystals doped with rare-earth elements (Gd and Tm) and have examined etch patterns on their surfaces by atomic force microscopy. The thermal stability of their regular domain structure has been assessed, and their anomalous electrical properties have been studied in the temperature range 300-380 K
Features of the Postgrowth Thermal and Electrothermal Treatment of Nominally Pure and Heavily Doped LithiumβNiobate Crystals
Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis
Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and men over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to -2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4-L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1). Copyright Β© 2017 by the MediaSphere
Effect of charge mixture preparation technology on the physicochemical and optical properties of LiNbO3:Mg crystals
Π§Π°ΡΡΠΎΡΠ°, ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ°, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π±ΡΠΎΠ½Ρ ΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π°ΡΡΠΌΡ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ Π±ΡΠΎΠ½Ρ ΠΎΠ»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΠ΅ΠΉ ΠΈ Π²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²
Bronchopulmonary dysplasia (BPD) and bronchial asthma (BA) are the most common chronic lung diseases in children, but the relationship between these diseases has not been fully defined. The incidence of atopic diseases (atopic dermatitis, allergic rhinitis, and BA) in children with BPD are significantly different according to national and international studies. There is not enough data on risk factors for the development, clinical and laboratory features of the course and treatment of BA in children with BPD. Material and methods. The case histories of 1104 patients (2004-2017) with BPD criteria were analyzed at the Department of Pediatrics at the RUDN University. On the basis of clinical and anamnestic data, allergological examination, and study of respiratory function, the frequency of asthma was determined. The comparative study was conducted in patients with isolated diseases - BPD (without BA) and BA (without BPD) - to determine the risk factors and characteristics of BA in children with BPD. Results and discussion. The frequency of BA was 7%, atopic dermatitis - 3.8% and allergic rhinitis - 3.6%. The risk factors for the development of BA in children with BPD were determined for low birth weight (LBW) (p=0.0037), late prematurity (p=0.0007), family history of allergy through asthma (p=0.0334), concomitant atopic dermatitis (p=0.0018) and allergic rhinitis (p=0.0022). Severe BPD (p=0.0002), episodes of bronchial obstruction in the first 3 years of life (p=0.0272). It was found that BA in children with BPD, compared with children without BPD is statistically significant. It characterized by an earlier onset (p=0.0168), a mild intermittent course (p=0.0003), a rarer need for inhaled bronchodilators (p=0.0034) and more frequent administration of inhaled corticosteroids as basic therapy (p=0.0399). Conclusion. We suggested that BA in children could be a respiratory consequence of BPD and a comorbid disease with a separate phenotype. The management of children suffering from BA and BPD should include the registration and evaluation of epidemiology, risk factors, clinical and laboratory features. It would be necessary to implement the clinical and allergological examination and the development of an individualized management program for patients.ΠΡΠΎΠ½Ρ
ΠΎΠ»Π΅Π³ΠΎΡΠ½Π°Ρ Π΄ΠΈΡΠΏΠ»Π°Π·ΠΈΡ (ΠΠΠ) ΠΈ Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½Π°Ρ Π°ΡΡΠΌΠ° (ΠΠ) ΡΠ²Π»ΡΡΡΡΡ ΡΠ°ΠΌΡΠΌΠΈ ΡΠ°ΡΡΡΠΌΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ Π»Π΅Π³ΠΊΠΈΡ
Ρ Π΄Π΅ΡΠ΅ΠΉ, ΠΎΠ΄Π½Π°ΠΊΠΎ ΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ Π΄Π°Π½Π½ΡΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ Π΄ΠΎ ΠΊΠΎΠ½ΡΠ° Π½Π΅ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π°. Π§Π°ΡΡΠΎΡΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ Π°ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ (Π°ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄Π΅ΡΠΌΠ°ΡΠΈΡΠ°, Π°Π»Π»Π΅ΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΈΠ½ΠΈΡΠ° ΠΈ ΠΠ) Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΠΎΡΠ»ΠΈΡΠ°Π΅ΡΡΡ; ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈ Π·Π°ΡΡΠ±Π΅ΠΆΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Π½Π΅ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΎ ΡΠ°ΠΊΡΠΎΡΠ°Ρ
ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ, ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ
ΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠ»ΠΈ ΠΈΠ·ΡΡΠ΅Π½Ρ ΠΈΡΡΠΎΡΠΈΠΈ Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ ΠΈ ΠΠΠ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅, Π½Π°Π±Π»ΡΠ΄Π°Π²ΡΠΈΡ
ΡΡ Π½Π° ΠΊΠ°ΡΠ΅Π΄ΡΠ΅ ΠΏΠ΅Π΄ΠΈΠ°ΡΡΠΈΠΈ Π€ΠΠΠΠ£ ΠΠ Β«Π ΠΎΡΡΠΈΠΉΡΠΊΠΈΠΉ ΡΠ½ΠΈΠ²Π΅ΡΡΠΈΡΠ΅Ρ Π΄ΡΡΠΆΠ±Ρ Π½Π°ΡΠΎΠ΄ΠΎΠ²Β» (ΠΠΎΡΠΊΠ²Π°) Π½Π° Π±Π°Π·Π΅ ΠΊΠΎΠ½ΡΡΠ»ΡΡΠ°ΡΠΈΠ²Π½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ Ρ Π΄Π½Π΅Π²Π½ΡΠΌ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠΎΠΌ ΠΠΠ£Π Β«ΠΠ΅ΡΡΠΊΠ°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½Π°Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ Π±ΠΎΠ»ΡΠ½ΠΈΡΠ° β 6Β» ΠΠ΅ΠΏΠ°ΡΡΠ°ΠΌΠ΅Π½ΡΠ° Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ Π³. ΠΠΎΡΠΊΠ²Ρ Ρ 2004 ΠΏΠΎ 2017 Π³. Π‘ΡΠ΅Π΄ΠΈ ΡΡΠΈΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π°Π½Π°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π΄Π°Π½Π½ΡΡ
, Π°Π»Π»Π΅ΡΠ³ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΈ Π²Π½Π΅ΡΠ½Π΅Π³ΠΎ Π΄ΡΡ
Π°Π½ΠΈΡ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π° ΡΠ°ΡΡΠΎΡΠ° ΠΠ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Ρ ΠΈΠ·ΠΎΠ»ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ: ΠΠΠ (Π±Π΅Π· ΠΠ) ΠΈ ΠΠ (Π±Π΅Π· ΠΠΠ) Π΄Π»Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° ΠΈ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 1104 ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΠΊΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΡΡΡΠΈΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° ΠΠΠ, ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π° ΡΠ°ΡΡΠΎΡΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ Ρ Π½ΠΈΡ
Π°ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ. Π§Π°ΡΡΠΎΡΠ° ΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 7%, Π°ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄Π΅ΡΠΌΠ°ΡΠΈΡΠ° - 3,8%, Π°Π»Π»Π΅ΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΈΠ½ΠΈΡΠ° - 3,6%. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠ: Π½ΠΈΠ·ΠΊΠ°Ρ ΠΌΠ°ΡΡΠ° ΡΠ΅Π»Π° ΠΏΡΠΈ ΡΠΎΠΆΠ΄Π΅Π½ΠΈΠΈ (Ρ=0,0037), ΠΏΠΎΠ·Π΄Π½ΡΡ Π½Π΅Π΄ΠΎΠ½ΠΎΡΠ΅Π½Π½ΠΎΡΡΡ (Ρ=0,0007), ΠΎΡΡΠ³ΠΎΡΠ΅Π½Π½ΡΠΉ ΡΠ΅ΠΌΠ΅ΠΉΠ½ΡΠΉ Π°Π»Π»Π΅ΡΠ³ΠΎΠ°Π½Π°ΠΌΠ½Π΅Π· ΠΏΠΎ ΠΠ (Ρ=0,0334), ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΠ΅ Π°ΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΠΉ Π΄Π΅ΡΠΌΠ°ΡΠΈΡ (Ρ=0,0018) ΠΈ Π°Π»Π»Π΅ΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΈΠ½ΠΈΡ (Ρ=0,0022), ΡΡΠΆΠ΅Π»Π°Ρ ΠΠΠ (Ρ=0,0002), ΡΠΏΠΈΠ·ΠΎΠ΄Ρ Π±ΡΠΎΠ½Ρ
ΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠΈ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 3 Π³ΠΎΠ΄Π° ΠΆΠΈΠ·Π½ΠΈ (Ρ=0,0272). Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π΄Π΅ΡΡΠΌΠΈ Π±Π΅Π· Π΄Π°Π½Π½ΠΎΠ³ΠΎ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
Π½ΠΎΠ²ΠΎΡΠΎΠΆΠ΄Π΅Π½Π½ΡΡ
ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΡΠ°ΡΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ Π±ΠΎΠ»Π΅Π΅ ΡΠ°Π½Π½ΠΈΠΌ Π½Π°ΡΠ°Π»ΠΎΠΌ (Ρ=0,0168), Π»Π΅Π³ΠΊΠΈΠΌ ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΡΠΈΡΡΡΡΠΈΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ (Ρ=0,0003), Π±ΠΎΠ»Π΅Π΅ ΡΠ΅Π΄ΠΊΠΎΠΉ ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΡΡ Π² ΠΈΠ½Π³Π°Π»ΡΡΠΈΠΎΠ½Π½ΡΡ
Π±ΡΠΎΠ½Ρ
ΠΎΠ»ΠΈΡΠΈΠΊΠ°Ρ
(Ρ=0,0034) ΠΈ Π±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΡΠΌ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΈΠ½Π³Π°Π»ΡΡΠΈΠΎΠ½Π½ΡΡ
Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄ΠΎΠ² Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π±Π°Π·ΠΈΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (Ρ=0,0399). ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠΌ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅ΠΌ ΠΠΠ, ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΡΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ΠΌ Ρ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΠΌ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΎΠΌ. ΠΠΊΠ°Π·Π°Π½ΠΈΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π΄Π΅ΡΡΠΌ, ΡΡΡΠ°Π΄Π°ΡΡΠΈΠΌ ΠΠ ΠΈ ΠΠΠ, Π΄ΠΎΠ»ΠΆΠ½ΠΎ ΠΏΡΠ΅Π΄ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡ ΡΡΠ΅Ρ ΠΈ ΠΎΡΠ΅Π½ΠΊΡ ΡΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ, ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ, ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ Ρ ΡΠ΅Π°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ ΡΡΠ°ΠΏΠ½ΠΎΠ³ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈ Π°Π»Π»Π΅ΡΠ³ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΈ Π²ΡΡΠ°Π±ΠΎΡΠΊΠΎΠΉ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²
Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis [Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΏΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅, Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°]
Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mΠ΅n over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to -2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4-L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1). Copyright Β© 2017 by the MediaSpher
Π€Π΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΏΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅, Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°
Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and men over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to -2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4-L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1). Copyright Β© 2017 by the MediaSphere.Π‘ΠΊΡΠΈΠ½ΠΈΠ½Π³ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ Π³ΡΡΠΏΠΏ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π°Π»Π³ΠΎΡΠΈΡΠΌΠ° FRAX ΡΡΠ΅Π΄ΠΈ Π²ΡΠ΅Ρ
ΠΆΠ΅Π½ΡΠΈΠ½ Π² ΠΏΠΎΡΡΠΌΠ΅Π½ΠΎΠΏΠ°ΡΠ·Π΅ ΠΈ ΠΌΡΠΆΡΠΈΠ½ ΡΡΠ°ΡΡΠ΅ 50 Π»Π΅Ρ (A1). Π Π΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ ΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°ΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΠΈ Π½Π°Π·Π½Π°ΡΠ°ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π° Π»ΠΈΡΠ°ΠΌ Ρ Π½ΠΈΠ·ΠΊΠΎΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠΌ ΠΊΡΡΠΏΠ½ΡΡ
ΠΊΠΎΡΡΠ΅ΠΉ ΡΠΊΠ΅Π»Π΅ΡΠ°, ΠΈ/ΠΈΠ»ΠΈ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΡ
Π½ΠΈΠ·ΠΊΠΎΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² (FRAX), ΠΈ/ΠΈΠ»ΠΈ ΠΏΡΠΈ Π²ΡΡΠ²Π»Π΅Π½Π½ΠΎΠΌ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠΈ ΠΠΠ Π΄ΠΎ -2,5 SD ΠΏΠΎ Π’-ΠΊΡΠΈΡΠ΅ΡΠΈΡ Π² ΡΠ΅ΠΉΠΊΠ΅ Π±Π΅Π΄ΡΠ° ΠΈ/ΠΈΠ»ΠΈ ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΡΡ
ΠΏΠΎΠ·Π²ΠΎΠ½ΠΊΠ°Ρ
(Π1). ΠΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ Π±ΠΎΠ»Π΅Π²ΡΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ Π² ΡΠΏΠΈΠ½Π΅, ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΡΠΎΡΡΠ° Π½Π° 4 ΡΠΌ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΆΠΈΠ·Π½ΠΈ ΠΈΠ»ΠΈ Π½Π° 2 ΡΠΌ ΠΏΡΠΈ ΡΠ΅Π³ΡΠ»ΡΡΠ½ΠΎΠΌ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅, ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΠΌ Π³Π»ΡΠΊΠΎΠΊΠΎΡΡΠΈΠΊΠΎΠΈΠ΄Ρ, Π±ΠΎΠ»ΡΠ½ΡΠΌ Ρ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π½Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΡΠ°Ρ
Π°ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ 2-Π³ΠΎ ΡΠΈΠΏΠ° ΠΈΠ»ΠΈ Π½Π° ΠΈΠ½ΡΡΠ»ΠΈΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ c Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌΠΈ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ°ΠΌΠΈ Π΄ΡΡΠ³ΠΎΠΉ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠΎΠ·Π²ΠΎΠ½ΠΎΡΠ½ΠΈΠΊΠ° (Th4-L5) Π² Π±ΠΎΠΊΠΎΠ²ΠΎΠΉ ΠΏΡΠΎΠ΅ΠΊΡΠΈΠΈ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² ΡΠ΅Π» ΠΏΠΎΠ·Π²ΠΎΠ½ΠΊΠΎΠ² (B1). ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π΄Π²ΡΡ
ΡΠ½Π΅ΡΠ³Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²ΡΠΊΠΎΠΉ Π΄Π΅Π½ΡΠΈΡΠΎΠΌΠ΅ΡΡΠΈΠΈ (DXA) ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½ΠΎ Π»ΠΈΡΠ°ΠΌ Ρ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠΉ 10-Π»Π΅ΡΠ½Π΅ΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² (FRAX) Π² ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»Π΅ ΠΌΠ΅ΠΆΠ΄Ρ Π½ΠΈΠ·ΠΊΠΎΠΉ ΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² (B1). Π Π΅Π·ΡΠ»ΡΡΠ°Ρ ΡΡΠ°Π±Π΅ΠΊΡΠ»ΡΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½Π΄Π΅ΠΊΡΠ° (Π’ΠΠ), ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠΉ Π² Ρ
ΠΎΠ΄Π΅ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΉ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²ΡΠΊΠΎΠΉ Π΄Π΅Π½ΡΠΈΡΠΎΠΌΠ΅ΡΡΠΈΠΈ, ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ Π²ΠΊΠ»ΡΡΠ°ΡΡ Π² Π°Π»Π³ΠΎΡΠΈΡΠΌ FRAX Ρ ΡΠ΅Π»ΡΡ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΌΠ΅ΡΠΎΠ΄Π° (B1). ΠΠ°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡ Π²ΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Ρ Π²ΠΏΠ΅ΡΠ²ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΡΠΈ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ°Π½Π΅Π΅ Π½Π°Π·Π½Π°ΡΠ΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΡΠ΅Π»ΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ ΠΏΡΠΈΡΠΈΠ½Π°ΠΌΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ Ρ
ΡΡΠΏΠΊΠΎΡΡΠΈ ΡΠΊΠ΅Π»Π΅ΡΠ° (B1). ΠΠ»Ρ ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ Π½ΠΈΠ·ΠΊΠΎΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² ΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΠΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·ΠΎΠΌ Π² ΡΠ°Π²Π½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Ρ Π±ΠΈΡΡΠΎΡΡΠΎΠ½Π°ΡΡ (ΠΠ€), ΠΈΠ»ΠΈ Π°Π½ΡΠΈΡΠ΅Π»Π° ΠΊ Π»ΠΈΠ³Π°Π½Π΄Ρ ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠ°-Π°ΠΊΡΠΈΠ²Π°ΡΠΎΡΠ° ΡΠ΄Π΅ΡΠ½ΠΎΠ³ΠΎ ΡΠ°ΠΊΡΠΎΡΠ° ΠΊΠ°ΠΏΠΏΠ°-Π±Π΅ΡΠ° (Π΄Π΅Π½ΠΎΡΡΠΌΠ°Π±), ΠΈΠ»ΠΈ Π°Π½Π°Π»ΠΎΠ³ΠΈ ΠΏΠ°ΡΠ°ΡΠ³ΠΎΡΠΌΠΎΠ½Π° (ΡΠ΅ΡΠΈΠΏΠ°ΡΠ°ΡΠΈΠ΄) (A1). ΠΠ΅Π½ΠΎΡΡΠΌΠ°Π± ΡΠ°ΠΊΠΆΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½ Π΄Π»Ρ ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΏΠΎΡΠ΅ΡΠΈ ΠΊΠΎΡΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΡ ΠΈ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ² ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΊΠΎΡΡΠ½ΡΡ
ΠΌΠ΅ΡΠ°ΡΡΠ°Π·ΠΎΠ² Ρ ΠΆΠ΅Π½ΡΠΈΠ½, ΠΏΠΎΠ»ΡΡΠ°ΡΡΠΈΡ
ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠ°ΠΌΠΈ Π°ΡΠΎΠΌΠ°ΡΠ°Π·Ρ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ°ΠΊΠ° ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, ΠΈ Ρ ΠΌΡΠΆΡΠΈΠ½ Ρ ΡΠ°ΠΊΠΎΠΌ ΠΏΡΠ΅Π΄ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ, ΠΏΠΎΠ»ΡΡΠ°ΡΡΠΈΡ
Π³ΠΎΡΠΌΠΎΠ½-Π΄Π΅ΠΏΡΠΈΠ²Π°ΡΠΈΠΎΠ½Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ (A1). ΠΠ²ΠΈΠ΄Ρ Π°Π½Π°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ° ΡΠ΅ΡΠΈΠΏΠ°ΡΠ°ΡΠΈΠ΄Π° ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ Π΅Π³ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠ΅ΡΠ²ΠΎΠΉ Π»ΠΈΠ½ΠΈΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·ΠΎΠΌ, Ρ ΡΠΆΠ΅ ΠΈΠΌΠ΅ΡΡΠΈΠΌΠΈΡΡ ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠ°ΠΌΠΈ ΡΠ΅Π» ΠΏΠΎΠ·Π²ΠΎΠ½ΠΊΠΎΠ² Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅, Ρ Π»ΠΈΡ Ρ ΠΊΡΠ°ΠΉΠ½Π΅ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ Π½ΠΈΠ·ΠΊΠΎΡΡΠ°Π²ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ΅ΡΠ΅Π»ΠΎΠΌΠΎΠ², ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²ΡΡΡΠ΅ΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π΅ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΡΡ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ (B1). ΠΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Π΄Π»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΡΠ΅ΠΎΠΏΠΎΡΠΎΠ·Π° ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ Π½Π°Π·Π½Π°ΡΠ°ΡΡ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ ΠΊΠ°Π»ΡΡΠΈΡ ΠΈ Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° D (A1)