61 research outputs found

    Mitochondrial Electron Transport Chain in Heavy Metal-Induced Neurotoxicity: Effects of Cadmium, Mercury, and Copper

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    To clarify the role of mitochondrial electron transport chain (mtETC) in heavy-metal-induced neurotoxicity, we studied action of Cd2+, Hg2+, and Cu2+ on cell viability, intracellular reactive oxygen species formation, respiratory function, and mitochondrial membrane potential of rat cell line PC12. As found, the metals produced, although in a different way, dose- and time-dependent changes of all these parameters. Importantly, Cd2+ beginning from 10 [mu]M and already at short incubation time (3 h) significantly inhibited the FCCP-uncoupled cell respiration; besides, practically the complete inhibition of the respiration was reached after 3 h incubation with 50 [mu]M Hg2+ or 500 [mu]M Cd2+, whereas even after 48 h exposure with 500 [mu]M Cu2+, only a 50% inhibition of the respiration occurred. Against the Cd2+-induced cell injury, not only different antioxidants and mitochondrial permeability transition pore inhibitors were protective but also such mtETC effectors as FCCP and stigmatellin (complex III inhibitor). However, all mtETC effectors used did not protect against the Hg2+- or Cu2+-induced cell damage. Notably, stigmatellin was shown to be one of the strongest protectors against the Cd2+-induced cell damage, producing a 15–20% increase in the cell viability. The mechanisms of the mtETC involvement in the heavy-metal-induced mitochondrial membrane permeabilization and cell death are discussed

    Research on the Effectiveness of Students’ Communicative Competence Formation

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    The formation of communicative competence among university students is becoming especially relevant in the uncertain and changeable world. In the study, competencies of a general nature are called invariant by the theory of the structure of the content of education, developed by Academician V. S. Lednev. The paper focuses on the effectiveness of the formation of students’ invariant communicative competence in a nontraditional form of education - joint training of Russian and international students. The results of the study show that co-education of Russian and foreign students contributes to the development of their invariant communicative competencies better than traditional education. The novelty of the research is the formation of students’ invariant communicative competence occurs in conditions different from traditional teaching. Namely, it occurs in the process of joint training of Russian students with foreign citizens. Research materials can be used in the work of higher educational institutions

    A new endemic species of Sesuvium (Aizoaceae: Sesuvioideae) from the Caribbean Basin, with further notes on the genus composition in the West Indies

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    A distinctive new species, Sesuvium curassavicum Sukhor. (Aizoaceae: Sesuvioideae), restricted to the Caribbean Basin (Kingdom of the Netherlands: Curacao and Bonaire Islands, North Colombia: La Guajira Department, and North Venezuela: Falcon State), is described and illustrated. It differs from all other perennial species growing in the West Indies by its papillate stems and wrinkled seeds. Based on the molecular phylogenetic analysis of nrDNA (ITS) and three plastid regions (rps16 gene intron, atpB-rbcL and trnL-trnF intergenic spacers), S. curassavicum is included in the 'American' clade, but its relationships are not fully resolved. The samples of the plants known as S. microphyllum fall within the 'Sesuvium portulacastrum' clade, and for that reason this species is considered here as a synonym of S. portulacastrum being an ecological form of the latter species. Sesuvium revolutifolium, S. ortegae and S. revolutum, described from cultivated plants are established as earlier synonyms of S. verrucosum, for which S. revolutifolium has priority and is proposed here as the correct name. These three species names seem to share the same provenance which cannot be Cuba, as stated in the protologue for S. revolutifolium, but rather Mexico. The name Sesuvium sessile is discussed and merged with S. portulacastrum. A new diagnostic key to the Sesuvium species in the West Indies is provided. In total, we accept for the West Indies the following species: S. curassavicum, S. humifusum, S. maritimum, S. portulacastrum and S. rubriflorum. The origins of collections of the neotype of Radiana petiolata and the holotypes of Sesuvium microphyllum and S. spathulatum are clarified.Peer reviewe

    Paucity and preferential suppression of transgenes in late replication domains of the D. melanogaster genome

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    <p>Abstract</p> <p>Background</p> <p>Eukaryotic genomes are organized in extended domains with distinct features intimately linking genome structure, replication pattern and chromatin state. Recently we identified a set of long late replicating euchromatic regions that are underreplicated in salivary gland polytene chromosomes of <it>D. melanogaster</it>.</p> <p>Results</p> <p>Here we demonstrate that these underreplicated regions (URs) have a low density of <it>P</it>-<it>element </it>and <it>piggyBac </it>insertions compared to the genome average or neighboring regions. In contrast, <it>Minos</it>-based transposons show no paucity in URs but have a strong bias to testis-specific genes. We estimated the suppression level in 2,852 stocks carrying a single <it>P</it>-<it>element </it>by analysis of eye color determined by the mini-<it>white </it>marker gene and demonstrate that the proportion of suppressed transgenes in URs is more than three times higher than in the flanking regions or the genomic average. The suppressed transgenes reside in intergenic, genic or promoter regions of the annotated genes. We speculate that the low insertion frequency of <it>P-elemen</it>ts and <it>piggyBac</it>s in URs partially results from suppression of transgenes that potentially could prevent identification of transgenes due to complete suppression of the marker gene. In a similar manner, the proportion of suppressed transgenes is higher in loci replicating late or very late in Kc cells and these loci have a lower density of <it>P-elements </it>and <it>piggyBac </it>insertions. In transgenes with two marker genes suppression of mini-<it>white </it>gene in eye coincides with suppression of <it>yellow </it>gene in bristles.</p> <p>Conclusions</p> <p>Our results suggest that the late replication domains have a high inactivation potential apparently linked to the silenced or closed chromatin state in these regions, and that such inactivation potential is largely maintained in different tissues.</p

    ΠžΡΡ‚Ρ€Ρ‹Π΅ рСспираторныС ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ, ΠΏΠ΅Ρ€Π΅Π½Π΅ΡΡˆΠΈΡ… Π² Π½Π΅ΠΎΠ½Π°Ρ‚Π°Π»ΡŒΠ½ΠΎΠΌ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π΅ критичСскиС состояния с Ρ€Π°Π·Π½ΠΎΠΉ Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒΡŽ ΠΎΡ€Π³Π°Π½Π½Ρ‹Ρ… дисфункций: рСтроспСктивноС ΠΊΠΎΠ³ΠΎΡ€Ρ‚Π½ΠΎΠ΅ исслСдованиС

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    Background: It is assumed that the severity of the multiple organ dysfunctions syndrome (MODS) in children who have experiencedΒ critical conditions in the neonatal period is a risk factor for the development of acute respiratory infections (ARI). Objective.The AimΒ was to study the relationship between the severities ofΒ  organ dysfunctions in children who had undergone critical conditionsΒ  in theΒ neonatal period, with an ARI frequency at preschool age.Methods: The study included children with MODS, the severity of which wasΒ assessed on the NEOMOD scale (moderate dysfunction 4Β  points, severe 5 points). An infectious index (II) was calculated sinceΒ the discharge from the hospital till the age of 7: the ratio ofΒ  the number of cases ARI during the past year to the age of the childΒ  thatΒ year, and the proportion of often ill children (OIC) β€” theΒ  number of ARI 4, 6 and 5 cases per year at the age of 1, 1–3 and 4– 5Β years respectively. Data on cases of ARI are obtained from the history of child development (form β„– 112/y).Results: The studyΒ included 198 children, 100 of them with severeΒ  manifestations of MODS and 98 with moderate manifestations ofΒ  MODS. The groupsΒ were comparable by sex, age, social factors (ageΒ  and level of education of parents), place of residence (city / village).Β  II (median andΒ 95% confidence interval) in children with severe andΒ  moderate manifestations of MODS under 1 year were 2 (2; 3) andΒ  1.5 (1; 2)Β respectively (p=0.006); 1–2 years β€” 1.5 (1–2) and 1 (1– 1.5) (p=0.008); 2–3 years β€” 1 (0.7–1.2) and 0.7 (0.5–1)Β  (p=0.006); 3–4Β years old β€” 1,1 (0,8–1,3) and 0,8 (0,6–0,8)Β  (Ρ€=0.003); 4–5 years β€” 0,6 (0.6–0,7) and 0,4 (0.4–0,5) (Ρ€=0.001); 5–6 years β€” 0.5Β (0.3–0.5) and 0.3 (0.2–0.3) (p=0.001); 6–7 yearsΒ  β€” 0.3 (0.3–0.3) and 0.1 (0.1–0.3) (p=0.025). The OIC in the groups for the entireΒ follow-up period was 60 (60%) and 42 (43%) respectively (p=0.011).Π‘onclusion: Severe manifestations of MODS in the neonatalΒ period are associated with a higher susceptibility of children to ARI.ΠŸΡ€Π΅Π΄ΠΏΠΎΠ»Π°Π³Π°Π΅Ρ‚ΡΡ, Ρ‡Ρ‚ΠΎ Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒ синдрома ΠΏΠΎΠ»ΠΈΠΎΡ€Π³Π°Π½Π½ΠΎΠΉ нСдостаточности (БПОН) Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ, ΠΏΠ΅Ρ€Π΅Π½Π΅ΡΡˆΠΈΡ… критичСскиС состояния Π² Π½Π΅ΠΎΠ½Π°Ρ‚Π°Π»ΡŒΠ½ΠΎΠΌ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π΅, являСтся Ρ„Π°ΠΊΡ‚ΠΎΡ€ΠΎΠΌ высокого  риска развития острых рСспираторных инфСкций (ОРИ).ЦСль исслСдования β€” ΠΈΠ·ΡƒΡ‡ΠΈΡ‚ΡŒ связь тяТСсти ΠΎΡ€Π³Π°Π½Π½Ρ‹Ρ… дисфункций Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ, ΠΏΠ΅Ρ€Π΅Π½Π΅ΡΡˆΠΈΡ…Β Π² Π½Π΅ΠΎΠ½Π°Ρ‚Π°Π»ΡŒΠ½ΠΎΠΌ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π΅ критичСскиС состояния, с частотой ОРИ Π² Π³Ρ€ΡƒΠ΄Π½ΠΎΠΌ, Ρ€Π°Π½Π½Π΅ΠΌ ΠΈΒ  дошкольном возрастС.ΠœΠ΅Ρ‚ΠΎΠ΄Ρ‹. Π’ исслСдованиС Π²ΠΊΠ»ΡŽΡ‡Π°Π»ΠΈ Π΄Π΅Ρ‚Π΅ΠΉ со БПОН, Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒ ΠΊΠΎΡ‚ΠΎΡ€ΠΎΠ³ΠΎ ΠΎΡ†Π΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ шкалС NEOMOD (умСрСнная дисфункция β€” 4 Π±Π°Π»Π»ΠΎΠ², тяТСлая β€” 5 Π±Π°Π»Π»ΠΎΠ²). Для ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π° послС  выписки ΠΈΠ· стационара ΠΈ Π΄ΠΎ сСмилСтнСго возраста рассчитывали ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΉ индСкс β€”Β  ΠΎΡ‚Π½ΠΎΡˆΠ΅Π½ΠΈΠ΅ числа случаСв ОРИ Π·Π° ΠΏΡ€ΠΎΡˆΠ΅Π΄ΡˆΠΈΠΉ Π³ΠΎΠ΄ ΠΊ возрасту рСбСнка Π² этот Π³ΠΎΠ΄, Π° Ρ‚Π°ΠΊΠΆΠ΅Β  опрСдСляли долю часто Π±ΠΎΠ»Π΅ΡŽΡ‰ΠΈΡ… Π΄Π΅Ρ‚Π΅ΠΉ (Π§Π‘Π”) β€” число ОРИ 4, 6 ΠΈ 5 случаСв Π² Π³ΠΎΠ΄Β Π²Β  возрастС Π΄ΠΎ 1, 1–3 ΠΈ 4–5 Π»Π΅Ρ‚ соотвСтствСнно. Π”Π°Π½Π½Ρ‹Π΅ ΠΎ случаях ОРИ ΠΏΠΎΠ»ΡƒΡ‡Π΅Π½Ρ‹ ΠΈΠ· истории  развития Ρ€Π΅Π±Π΅Π½ΠΊΠ°Β (Ρ„ΠΎΡ€ΠΌΠ° β„– 112/Ρƒ).Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹. Π’ исслСдованиС Π²ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΎ 198 Π΄Π΅Ρ‚Π΅ΠΉ, ΠΈΠ· Π½ΠΈΡ… 100 с тяТСлыми, 98 β€” с ΡƒΠΌΠ΅Ρ€Π΅Π½Π½Ρ‹ΠΌΠΈ проявлСниями БПОН. Π“Ρ€ΡƒΠΏΠΏΡ‹ Π±Ρ‹Π»ΠΈ сопоставимы ΠΏΠΎ ΠΏΠΎΠ»Ρƒ, возрасту, ΡΠΎΡ†ΠΈΠ°Π»ΡŒΠ½Ρ‹ΠΌ Ρ„Π°ΠΊΡ‚ΠΎΡ€Π°ΠΌ (возраст ΠΈ ΡƒΡ€ΠΎΠ²Π΅Π½ΡŒΒ ΠΎΠ±Ρ€Π°Π·ΠΎΠ²Π°Π½ΠΈΡ Ρ€ΠΎΠ΄ΠΈΡ‚Π΅Π»Π΅ΠΉ), мСсту проТивания (Π³ΠΎΡ€ΠΎΠ΄/сСло).Β  Π˜Π½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΉ индСкс (ΠΌΠ΅Π΄ΠΈΠ°Π½Π° ΠΈ 95% Π΄ΠΎΠ²Π΅Ρ€ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹ΠΉΒ ΠΈΠ½Ρ‚Π΅Ρ€Π²Π°Π») Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ с тяТСлыми ΠΈΒ  ΡƒΠΌΠ΅Ρ€Π΅Π½Π½Ρ‹ΠΌΠΈ проявлСниями БПОН Π² возрастС Π΄ΠΎ 1 Π³ΠΎΠ΄Π° составил соотвСтствСнно 2 (2; 3) ΠΈΒ  1,5 (1; 2) (Ρ€=0,006); 1–2 Π»Π΅Ρ‚ β€” 1,5 (1–2) ΠΈ 1 (1–1,5) (Ρ€=0,008); 2–3 Π»Π΅Ρ‚ β€” 1 (0,7–1,2) ΠΈ 0,7Β  (0,5–1)Β (Ρ€=0,006); 3–4 Π»Π΅Ρ‚ β€” 1,1 (0,8–1,3) ΠΈ 0,8 (0,6–0,8) (Ρ€=0,003); 4–5 Π»Π΅Ρ‚ β€” 0,6 (0,6– 0,7) ΠΈ 0,4 (0,4–0,5) (Ρ€=0,001);Β 5–6 Π»Π΅Ρ‚ β€” 0,5 (0,3–0,5) ΠΈ 0,3 (0,2–0,3) (Ρ€=0,001); 6–7 Π»Π΅Ρ‚ β€”Β  0,3 (0,3–0,3) ΠΈ 0,1 (0,1–0,3) (Ρ€=0,025). Π§Π‘Π” Π² Π³Ρ€ΡƒΠΏΠΏΠ°Ρ…Β Π·Π° вСсь ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ наблюдСния Π±Ρ‹Π»ΠΎ соотвСтствСнно 60 (60%) ΠΈ 42 (43%) (Ρ€=0,011).Π—Π°ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΈΠ΅. ВяТСлыС проявлСния БПОН Π² Π½Π΅ΠΎΠ½Π°Ρ‚Π°Π»ΡŒΠ½ΠΎΠΌ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π΅ Π°ΡΡΠΎΡ†ΠΈΠΈΡ€ΡƒΡŽΡ‚ΡΡ с Π±ΠΎΠ»Π΅Π΅Β  высокой Π²ΠΎΡΠΏΡ€ΠΈΠΈΠΌΡ‡ΠΈΠ²ΠΎΡΡ‚ΡŒΡŽ Π΄Π΅Ρ‚Π΅ΠΉ Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ, Ρ€Π°Π½Π½Π΅Π³ΠΎΒ ΠΈ дошкольного возраста ΠΊ ОРИ.ΠšΠΎΠ½Ρ„Π»ΠΈΠΊΡ‚ интСрСсов.И.А. БСляСва β€” Ρ‡Ρ‚Π΅Π½ΠΈΠ΅ Π»Π΅ΠΊΡ†ΠΈΠΉ для ΠΊΠΎΠΌΠΏΠ°Π½ΠΈΠΈΒ Β«ΠŸΡ„Π°ΠΉΠ·Π΅Ρ€ Π˜Π½Π½ΠΎΠ²Π°Ρ†ΠΈΠΈ

    ЦитомСгаловирусная инфСкция Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ ΠΏΠ΅Ρ€Π²Ρ‹Ρ… мСсяцСв ΠΆΠΈΠ·Π½ΠΈ: Π²Π°Ρ€ΠΈΠ°Π½Ρ‚Ρ‹ тСчСния, соврСмСнныС ΠΏΠΎΠ΄Ρ…ΠΎΠ΄Ρ‹ ΠΊ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (клиничСскиС случаи)

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    Cytomegalovirus infection (CMVI) in newborns and infants can occur in various clinical forms requiring a differentiated therapy. We present the peculiarities of two different variants of CMVI course generalized with a manifest clinical picture and characteristic shifts in laboratory analyzes in a child aged 2.5 months with a combined genetic pathology, and latent intrauterine in a child aged 5 days leading to the development of neurosensory hearing loss. The difficulties in diagnosing a suppressed (latent) form of the disease and choosing a therapeutic approach have been highlighted. A successful result of etiopathogenetic therapy with ganciclovir in a child with postnatal generalized CMVI has been presented. The therapeutic efficacy and safety of off-label ganciclovir preparations and anti-cytomegalovirus immunoglobulin have been confirmed. The advisability of including ganciclovir in the management protocol of children with latent forms of CMVI is discussed.ЦитомСгаловирусная инфСкция (Π¦ΠœΠ’Π˜) Ρƒ Π½ΠΎΠ²ΠΎΡ€ΠΎΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… ΠΈ Π΄Π΅Ρ‚Π΅ΠΉ ΠΏΠ΅Ρ€Π²Ρ‹Ρ… мСсяцСв ΠΆΠΈΠ·Π½ΠΈ ΠΌΠΎΠΆΠ΅Ρ‚ ΠΏΡ€ΠΎΡ‚Π΅ΠΊΠ°Ρ‚ΡŒ Π² Ρ€Π°Π·Π»ΠΈΡ‡Π½Ρ‹Ρ… клиничСских Ρ„ΠΎΡ€ΠΌΠ°Ρ…, Ρ‚Ρ€Π΅Π±ΡƒΡŽΡ‰ΠΈΡ… Π΄ΠΈΡ„Ρ„Π΅Ρ€Π΅Π½Ρ†ΠΈΡ€ΠΎΠ²Π°Π½Π½ΠΎΠΉ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ. ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²Π»Π΅Π½Ρ‹ особСнности Π΄Π²ΡƒΡ… Ρ€Π°Π·Π»ΠΈΡ‡Π½Ρ‹Ρ… Π²Π°Ρ€ΠΈΠ°Π½Ρ‚ΠΎΠ² тСчСния Π¦ΠœΠ’Π˜ β€” Π³Π΅Π½Π΅Ρ€Π°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ с манифСстной клиничСской ΠΊΠ°Ρ€Ρ‚ΠΈΠ½ΠΎΠΉ ΠΈ Ρ…Π°Ρ€Π°ΠΊΡ‚Π΅Ρ€Π½Ρ‹ΠΌΠΈ сдвигами Π² Π»Π°Π±ΠΎΡ€Π°Ρ‚ΠΎΡ€Π½Ρ‹Ρ… Π°Π½Π°Π»ΠΈΠ·Π°Ρ… Ρƒ Ρ€Π΅Π±Π΅Π½ΠΊΠ° Π² возрастС 2,5 мСс с сочСтанной гСнСтичСской ΠΏΠ°Ρ‚ΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΈ Π»Π°Ρ‚Π΅Π½Ρ‚Π½ΠΎΠΉ Π²Π½ΡƒΡ‚Ρ€ΠΈ- ΡƒΡ‚Ρ€ΠΎΠ±Π½ΠΎΠΉ Ρƒ Ρ€Π΅Π±Π΅Π½ΠΊΠ° Π² возрастС 5 Π΄Π½Π΅ΠΉ, ΠΏΡ€ΠΈΠ²Π΅Π΄ΡˆΠ΅ΠΉ ΠΊ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΡŽ нСйросСнсорной тугоухости. ΠžΡΠ²Π΅Ρ‰Π΅Π½Ρ‹ трудности диагностики стСртой (Π»Π°Ρ‚Π΅Π½Ρ‚Π½ΠΎΠΉ) Ρ„ΠΎΡ€ΠΌΡ‹ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΈ Π²Ρ‹Π±ΠΎΡ€Π° Ρ‚Π°ΠΊΡ‚ΠΈΠΊΠΈ лСчСния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°. ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²Π»Π΅Π½ ΡƒΡΠΏΠ΅ΡˆΠ½Ρ‹ΠΉ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚ этиопатогСнСтичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ ΠΏΡ€Π΅ΠΏΠ°Ρ€Π°Ρ‚ΠΎΠΌ Π³Π°Π½Ρ†ΠΈΠΊΠ»ΠΎΠ²ΠΈΡ€Π° Ρƒ Ρ€Π΅Π±Π΅Π½ΠΊΠ° с ΠΏΠΎΡΡ‚Π½Π°Ρ‚Π°Π»ΡŒΠ½ΠΎΠΉ Π³Π΅Π½Π΅Ρ€Π°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½ΠΎΠΉ Π¦ΠœΠ’Π˜. ΠŸΠΎΠ΄Ρ‚Π²Π΅Ρ€ΠΆΠ΄Π΅Π½Ρ‹ тСрапСвтичСская ΡΡ„Ρ„Π΅ΠΊΡ‚ΠΈΠ²Π½ΠΎΡΡ‚ΡŒ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡ‚ΡŒ off-label ΠΏΡ€Π΅ΠΏΠ°Ρ€Π°Ρ‚ΠΎΠ² Π³Π°Π½Ρ†ΠΈΠΊΠ»ΠΎΠ²ΠΈΡ€Π° ΠΈ противоцитомСгаловирусного ΠΈΠΌΠΌΡƒΠ½ΠΎΠ³Π»ΠΎΠ±ΡƒΠ»ΠΈΠ½Π°. ΠžΠ±ΡΡƒΠΆΠ΄Π°Π΅Ρ‚ΡΡ Ρ†Π΅Π»Π΅ΡΠΎΠΎΠ±Ρ€Π°Π·Π½ΠΎΡΡ‚ΡŒ Π²ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΈΡ Π³Π°Π½Ρ†ΠΈΠΊΠ»ΠΎΠ²ΠΈΡ€Π° Π² ΠΏΡ€ΠΎΡ‚ΠΎΠΊΠΎΠ» вСдСния Π΄Π΅Ρ‚Π΅ΠΉ с Π»Π°Ρ‚Π΅Π½Ρ‚Π½Ρ‹ΠΌΠΈ Ρ„ΠΎΡ€ΠΌΠ°ΠΌΠΈ Π¦ΠœΠ’Π˜.ИБВОЧНИК Π€Π˜ΠΠΠΠ‘Π˜Π ΠžΠ’ΠΠΠ˜Π― НС ΡƒΠΊΠ°Π·Π°Π½.ΠšΠžΠΠ€Π›Π˜ΠšΠ’ Π˜ΠΠ’Π•Π Π•Π‘ΠžΠ’ Авторы заявили ΠΎΠ± отсутствии ΠΊΠΎΠ½Ρ„Π»ΠΈΠΊΡ‚Π° интСрСсов, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΉ Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΠΎ ΠΎΠ±Π½Π°Ρ€ΠΎΠ΄ΠΎΠ²Π°Ρ‚ΡŒ

    ΠžΡ€Π³Π°Π½ΠΈΠ·Π°Ρ†ΠΈΡ Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ вскармливания Π² отдСлСниях Ρ€Π΅Π°Π½ΠΈΠΌΠ°Ρ†ΠΈΠΈ ΠΈ интСнсивной Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Ρ… Π΄Π΅Ρ‚Π΅ΠΉ: дискуссионныС вопросы

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    The priority of breastfeeding in the care of premature infants is not in doubt. For preterm babies, breastfeeding provides a dual effect, reducing the risk of both immediate and long-term effects associated with prematurity. In this regard, extraordinary efforts are being made at the international level to promote and support breast-feeding of newborns, including in intensive care units. Mother’s own milk is the first choice for feeding a premature baby. In recent years, the problems of quality and safety of expressed breast milk β€” both pasteurized and fresh β€” for newborn patients of intensive care units are discussed. The authors point out that the treatment procedures and storage conditions of expressed breast milk differ significantly; there are no common criteria for its microbiological safety, which limits the use of this unique product, especially in premature infants. In addition to the risk of bacterial infection, the risk of infection with cytomegalovirus (CMV) when using fresh milk from a CMV β€” seropositive mother is discussed for premature infants. The review examines the criteria for the risk of CMV infection in children and indications for selective treatment of breast milk for inactivation of a probable pathogen.ΠŸΡ€ΠΈΠΎΡ€ΠΈΡ‚Π΅Ρ‚Π½ΠΎΡΡ‚ΡŒ обСспСчСния Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ вскармливания ΠΏΡ€ΠΈ Π²Ρ‹Ρ…Π°ΠΆΠΈΠ²Π°Π½ΠΈΠΈ Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Ρ… ΠΌΠ»Π°Π΄Π΅Π½Ρ†Π΅Π² Π½Π΅ подвСргаСтся сомнСнию. Для Π΄Π΅Ρ‚Π΅ΠΉ, Ρ€ΠΎΠ΄ΠΈΠ²ΡˆΠΈΡ…ΡΡ ΠΏΡ€Π΅ΠΆΠ΄Π΅Π²Ρ€Π΅ΠΌΠ΅Π½Π½ΠΎ, вскармливаниС Π³Ρ€ΡƒΠ΄Π½Ρ‹ΠΌ ΠΌΠΎΠ»ΠΎΠΊΠΎΠΌ обСспСчиваСт Π΄Π²ΠΎΠΉΠ½ΠΎΠΉ эффСкт, сниТая риск ΠΊΠ°ΠΊ Π±Π»ΠΈΠΆΠ°ΠΉΡˆΠΈΡ…, Ρ‚Π°ΠΊ ΠΈ ΠΎΡ‚Π΄Π°Π»Π΅Π½Π½Ρ‹Ρ… послСдствий, связанных с Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½ΠΎΡΡ‚ΡŒΡŽ. Π’ этой связи Π½Π° ΠΌΠ΅ΠΆΠ΄ΡƒΠ½Π°Ρ€ΠΎΠ΄Π½ΠΎΠΌ ΡƒΡ€ΠΎΠ²Π½Π΅ ΠΏΡ€Π΅Π΄ΠΏΡ€ΠΈΠ½ΠΈΠΌΠ°ΡŽΡ‚ΡΡ Ρ‡Ρ€Π΅Π·Π²Ρ‹Ρ‡Π°ΠΉΠ½Ρ‹Π΅ шаги ΠΏΠΎ ΠΏΠΎΠΎΡ‰Ρ€Π΅Π½ΠΈΡŽ ΠΈ ΠΏΠΎΠ΄Π΄Π΅Ρ€ΠΆΠΊΠ΅ вскармливания Π½ΠΎΠ²ΠΎΡ€ΠΎΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… Π³Ρ€ΡƒΠ΄Π½Ρ‹ΠΌ ΠΌΠΎΠ»ΠΎΠΊΠΎΠΌ, Π² Ρ‚ΠΎΠΌ числС Π² отдСлСниях интСнсивной Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ. БобствСнноС ΠΌΠΎΠ»ΠΎΠΊΠΎ ΠΌΠ°Ρ‚Π΅Ρ€ΠΈ являСтся ΠΏΠ΅Ρ€Π²Ρ‹ΠΌ Π²Ρ‹Π±ΠΎΡ€ΠΎΠΌ для кормлСния нСдоношСнного Ρ€Π΅Π±Π΅Π½ΠΊΠ°. Π’ послСдниС Π³ΠΎΠ΄Ρ‹ ΠΎΠ±ΡΡƒΠΆΠ΄Π°ΡŽΡ‚ΡΡ ΠΏΡ€ΠΎΠ±Π»Π΅ΠΌΡ‹ качСства ΠΈ бСзопасности сцСТСнного Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ»ΠΎΠΊΠ° β€” ΠΊΠ°ΠΊ пастСризованного, Ρ‚Π°ΠΊ ΠΈ свСТСго β€” для Π½ΠΎΠ²ΠΎΡ€ΠΎΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² ΠΎΡ‚Π΄Π΅Π»Π΅Π½ΠΈΠΉ Ρ€Π΅Π°Π½ΠΈΠΌΠ°Ρ†ΠΈΠΉ ΠΈ интСнсивной Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ. Авторы ΡƒΠΊΠ°Π·Ρ‹Π²Π°ΡŽΡ‚, Ρ‡Ρ‚ΠΎ ΠΏΡ€ΠΎΡ†Π΅Π΄ΡƒΡ€Ρ‹ ΠΎΠ±Ρ€Π°Π±ΠΎΡ‚ΠΊΠΈ ΠΈ условия хранСния сцСТСнного Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ»ΠΎΠΊΠ° сущСствСнно Ρ€Π°Π·Π»ΠΈΡ‡Π°ΡŽΡ‚ΡΡ, ΠΎΡ‚ΡΡƒΡ‚ΡΡ‚Π²ΡƒΡŽΡ‚ Π΅Π΄ΠΈΠ½Ρ‹Π΅ ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΠΈ Π΅Π³ΠΎ микробиологичСской бСзопасности. ВсС это ΠΎΠ³Ρ€Π°Π½ΠΈΡ‡ΠΈΠ²Π°Π΅Ρ‚ использованиС сцСТСнного Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ»ΠΎΠΊΠ°, ΠΏΡ€Π΅ΠΆΠ΄Π΅ всСго Ρƒ Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Ρ… Π½ΠΎΠ²ΠΎΡ€ΠΎΠΆΠ΄Π΅Π½Π½Ρ‹Ρ…. Помимо опасности Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ°Π»ΡŒΠ½ΠΎΠ³ΠΎ инфицирования, Π² ΠΎΡ‚Π½ΠΎΡˆΠ΅Π½ΠΈΠΈ Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Ρ… ΠΌΠ»Π°Π΄Π΅Π½Ρ†Π΅Π² обсуТдаСтся риск зараТСния цитомСгаловирусом (Π¦ΠœΠ’) ΠΏΡ€ΠΈ использовании свСТСго ΠΌΠΎΠ»ΠΎΠΊΠ° Π¦ΠœΠ’-сСропозитивной ΠΌΠ°Ρ‚Π΅Ρ€ΠΈ. Π’ ΠΎΠ±Π·ΠΎΡ€Π΅ Ρ€Π°ΡΡΠΌΠ°Ρ‚Ρ€ΠΈΠ²Π°ΡŽΡ‚ΡΡ ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΠΈ риска инфицирования Π΄Π΅Ρ‚Π΅ΠΉ Π¦ΠœΠ’ ΠΈ показания ΠΊ ΠΈΠ·Π±ΠΈΡ€Π°Ρ‚Π΅Π»ΡŒΠ½ΠΎΠΉ ΠΎΠ±Ρ€Π°Π±ΠΎΡ‚ΠΊΠ΅ Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ»ΠΎΠΊΠ° для ΠΈΠ½Π°ΠΊΡ‚ΠΈΠ²Π°Ρ†ΠΈΠΈ вСроятного ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π°

    Π”ΠΈΠ·ΠΎΠ½Ρ‚ΠΎΠ³Π΅Π½ΠΈΠΈ ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ ΠΊΠΈΡˆΠ΅Ρ‡Π½ΠΈΠΊΠ° Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ ΠΏΠ΅Ρ€Π²Ρ‹Ρ… мСсяцСв ΠΆΠΈΠ·Π½ΠΈ ΠΊΠ°ΠΊ Ρ„Π°ΠΊΡ‚ΠΎΡ€ формирования Π°Ρ‚ΠΎΠΏΠΈΠΈ

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    The article describes the modern views on the relationship between altered development of gut microbiota in infants and the risk of developing atopic diseases (atopic dermatitis and bronchial asthma). The studies of genetic susceptibility to atopy and the influence of epigenetic mechanisms involved in the regulation of gene expression responsible for the hyperproduction of immunoglobulin E are discussed. The characteristics of the microbiota of infants with already developed atopic diseases and children at risk of atopy are analyzed. In infants who subsequently developed atopy, the composition of gut microbiota at the birth is characterized by a reduced abundance of bifidobacteriaΒ  and high content of potentially pathogenic microorganisms.Β  The triggering role of active metabolites of altered microbiota on the differentiation of T-regulatoryΒ  cells has been established.Β  A preventive effect of optimal breastfeeding has been confirmed: meta-analyzes of recent studies indicate a link between the duration of breastfeedingΒ  and a decrease in the frequency of bronchial asthma. The microbiota of breast milk contributes to the proper development of the infant’s microbiota, determines its diversity and immunomodulating action. On the basis of the conducted research, methods of targeted correction of the intestinal microbiota in children with risk of atopy can be developed.Π’ ΡΡ‚Π°Ρ‚ΡŒΠ΅ ΠΎΡ‚Ρ€Π°ΠΆΠ΅Π½Ρ‹Β  соврСмСнныС взгляды  Π½Π° связь формирования  ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ ΠΊΠΈΡˆΠ΅Ρ‡Π½ΠΈΠΊΠ° Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ ΠΏΠ΅Ρ€Π²ΠΎΠ³ΠΎΒ  Π³ΠΎΠ΄Π° ΠΆΠΈΠ·Π½ΠΈ с риском развития атопичСских Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ (атопичСского Π΄Π΅Ρ€ΠΌΠ°Ρ‚ΠΈΡ‚Π° ΠΈ Π±Ρ€ΠΎΠ½Ρ…ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ астмы). ΠžΠ±ΡΡƒΠΆΠ΄Π°ΡŽΡ‚ΡΡ исслСдования  гСнСтичСской  прСдрасполоТСнности ΠΊ Π°Ρ‚ΠΎΠΏΠΈΠΈ ΠΈ влияния эпигСнСтичСских  Ρ„Π°ΠΊΡ‚ΠΎΡ€ΠΎΠ²Β  Π½Π° Ρ€Π΅Π³ΡƒΠ»ΡΡ†ΠΈΡŽ экспрСссии Π³Π΅Π½ΠΎΠ², отвСтствСнных Π·Π° Π³ΠΈΠΏΠ΅Ρ€ΠΏΡ€ΠΎΠ΄ΡƒΠΊΡ†ΠΈΡŽ ΠΈΠΌΠΌΡƒΠ½ΠΎΠ³Π»ΠΎΠ±ΡƒΠ»ΠΈΠ½ΠΎΠ²Β  класса Π•. ΠŸΡ€ΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡ€ΠΎΠ²Π°Π½Ρ‹Β  характСристики ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ ΠΌΠ»Π°Π΄Π΅Π½Ρ†Π΅Π² с ΡƒΠΆΠ΅ Ρ€Π°Π·Π²ΠΈΠ²ΡˆΠΈΠΌΠΈΡΡ атопичСскими заболСваниями ΠΈ Π΄Π΅Ρ‚Π΅ΠΉ ΠΈΠ· Π³Ρ€ΡƒΠΏΠΏΡ‹ риска ΠΏΠΎ Π°Ρ‚ΠΎΠΏΠΈΠΈ. Π£ Π΄Π΅Ρ‚Π΅ΠΉ, впослСдствии  ΡΡ„ΠΎΡ€ΠΌΠΈΡ€ΠΎΠ²Π°Π²ΡˆΠΈΡ… Π°Ρ‚ΠΎΠΏΠΈΡŽ, состав ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ ΠΊΠΈΡˆΠ΅Ρ‡Π½ΠΈΠΊΠ° ΠΏΡ€ΠΈ Ρ€ΠΎΠΆΠ΄Π΅Π½ΠΈΠΈΒ  характСризуСтся сниТСнным содСрТаниСм Π±ΠΈΡ„ΠΈΠ΄ΠΎΠ±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠΉ ΠΈ высоким β€” условно-ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π½Ρ‹Ρ… ΠΌΠΈΠΊΡ€ΠΎΠΎΡ€Π³Π°Π½ΠΈΠ·ΠΌΠΎΠ². УстановлСна триггСрная Ρ€ΠΎΠ»ΡŒ Π°ΠΊΡ‚ΠΈΠ²Π½Ρ‹Ρ… ΠΌΠ΅Ρ‚Π°Π±ΠΎΠ»ΠΈΡ‚ΠΎΠ² ΠΈΠ·ΠΌΠ΅Π½Π΅Π½Π½ΠΎΠΉ ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ Π² трансформации Π’-рСгуляторных ΠΊΠ»Π΅Ρ‚ΠΎΠΊ. ΠŸΠΎΠ΄Ρ‚Π²Π΅Ρ€ΠΆΠ΄Π΅Π½Π° прСвСнтивная  Ρ€ΠΎΠ»ΡŒΒ  Π°Π΄Π΅ΠΊΠ²Π°Ρ‚Π½ΠΎΠ³ΠΎΒ  Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎΒ  вскармливания:Β  ΠΌΠ΅Ρ‚Π°Π°Π½Π°Π»ΠΈΠ·Ρ‹Β  исслСдований  послСдних Π»Π΅Ρ‚Β  ΡΠ²ΠΈΠ΄Π΅Ρ‚Π΅Π»ΡŒΡΡ‚Π²ΡƒΡŽΡ‚Β  ΠΎ связи ΠΏΡ€ΠΎΠ΄ΠΎΠ»ΠΆΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎΒ  вскармливания  со сниТСниСм  частоты Π±Ρ€ΠΎΠ½Ρ…ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ астмы. ΠœΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Π° Π³Ρ€ΡƒΠ΄Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ»ΠΎΠΊΠ° способствуСт Π°Π΄Π΅ΠΊΠ²Π°Ρ‚Π½ΠΎΠΌΡƒ Ρ„ΠΎΡ€ΠΌΠΈΡ€ΠΎΠ²Π°Π½ΠΈΡŽ ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ ΠΌΠ»Π°Π΄Π΅Π½Ρ†Π°, опрСдСляСт Π΅Π΅ Ρ€Π°Π·Π½ΠΎΠΎΠ±Ρ€Π°Π·ΠΈΠ΅ ΠΈ ΠΈΠΌΠΌΡƒΠ½ΠΎΠΌΠΎΠ΄ΡƒΠ»ΠΈΡ€ΡƒΡŽΡ‰Π΅Π΅ дСйствиС. На основС ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½Π½Ρ‹Ρ… исслСдований ΠΌΠΎΠ³ΡƒΡ‚ Π±Ρ‹Ρ‚ΡŒ Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½Ρ‹ ΠΌΠ΅Ρ‚ΠΎΠ΄Ρ‹ Π½Π°ΠΏΡ€Π°Π²Π»Π΅Π½Π½ΠΎΠΉ ΠΊΠΎΡ€Ρ€Π΅ΠΊΡ†ΠΈΠΈ ΠΊΠΈΡˆΠ΅Ρ‡Π½ΠΎΠΉ ΠΌΠΈΠΊΡ€ΠΎΠ±ΠΈΠΎΡ‚Ρ‹ Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ Π³Ρ€ΡƒΠΏΠΏΡ‹ риска ΠΏΠΎ Π°Ρ‚ΠΎΠΏΠΈΠΈ

    Π˜ΠΌΠΌΡƒΠ½ΠΎΠΏΡ€ΠΎΡ„ΠΈΠ»Π°ΠΊΡ‚ΠΈΠΊΠ° ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹Ρ… Π±ΠΎΠ»Π΅Π·Π½Π΅ΠΉ Ρƒ Π½Π΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Ρ… Π΄Π΅Ρ‚Π΅ΠΉ

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    Premature infants are especially in need of timely and effective specific immunoprophylaxis due to their vulnerability to infectious diseases. The article describes the basic principles for vaccination of premature infants used in healthcare by the leading countries of the world. Based on the results of clinical trials, the peculiarities of the vaccination schedule for certain infections have been determined, the specific features of the course of the post-vaccinal period have been described. The operating procedures for active immunoprophylaxis of various types of infections have been explained in detail depending on the pathology and the therapy being performed. The article uses the key points of the recommended practices for prevention of the main controlled types of infections developed by the professional association of pediatricians β€˜Union of Pediatricians of Russia’ and approved by the Ministry of Healthcare of the Russian Federation.ΠΠ΅Π΄ΠΎΠ½ΠΎΡˆΠ΅Π½Π½Ρ‹Π΅ ΠΌΠ»Π°Π΄Π΅Π½Ρ†Ρ‹ вслСдствиС уязвимости ΠΊ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΌ заболСваниям особо Π½ΡƒΠΆΠ΄Π°ΡŽΡ‚ΡΡ Π² своСврСмСнной ΠΈ эффСктивной спСцифичСской ΠΈΠΌΠΌΡƒΠ½ΠΎΠΏΡ€ΠΎΡ„ΠΈΠ»Π°ΠΊΡ‚ΠΈΠΊΠ΅. Π’ ΡΡ‚Π°Ρ‚ΡŒΠ΅ ΠΏΡ€ΠΈΠ²Π΅Π΄Π΅Π½Ρ‹ ΠΎΡΠ½ΠΎΠ²ΠΎΠΏΠΎΠ»Π°Π³Π°ΡŽΡ‰ΠΈΠ΅ ΠΏΡ€ΠΈΠ½Ρ†ΠΈΠΏΡ‹ провСдСния Π²Π°ΠΊΡ†ΠΈΠ½Π°Ρ†ΠΈΠΈ Π΄Π΅Ρ‚Π΅ΠΉ, Ρ€ΠΎΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… Ρ€Π°Π½ΡŒΡˆΠ΅ срока, примСняСмыС Π² ΠΏΡ€Π°ΠΊΡ‚ΠΈΠΊΠ΅ здравоохранСния Π²Π΅Π΄ΡƒΡ‰ΠΈΡ… стран ΠΌΠΈΡ€Π°. На основании Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚ΠΎΠ² клиничСских исслСдований ΠΎΠΏΡ€Π΅Π΄Π΅Π»Π΅Π½Ρ‹ особСнности схСмы Π²Π°ΠΊΡ†ΠΈΠ½Π°Ρ†ΠΈΠΈ ΠΏΡ€ΠΎΡ‚ΠΈΠ² ΠΎΡ‚Π΄Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΉ, описаны Ρ…Π°Ρ€Π°ΠΊΡ‚Π΅Ρ€Π½Ρ‹Π΅ ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΈ тСчСния ΠΏΠΎΡΡ‚Π²Π°ΠΊΡ†ΠΈΠ½Π°Π»ΡŒΠ½ΠΎΠ³ΠΎ ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π°. ΠŸΠΎΠ΄Ρ€ΠΎΠ±Π½ΠΎ Ρ€Π°Π·ΡŠΡΡΠ½Π΅Π½ Π°Π»Π³ΠΎΡ€ΠΈΡ‚ΠΌ дСйствий ΠΏΡ€ΠΈ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ Π°ΠΊΡ‚ΠΈΠ²Π½ΠΎΠΉ ΠΈΠΌΠΌΡƒΠ½ΠΎΠΏΡ€ΠΎΡ„ΠΈΠ»Π°ΠΊΡ‚ΠΈΠΊΠΈ Ρ€Π°Π·Π»ΠΈΡ‡Π½ΠΎΠ³ΠΎ Π²ΠΈΠ΄Π° ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΉ Π² зависимости ΠΎΡ‚ ΠΈΠΌΠ΅ΡŽΡ‰Π΅ΠΉ мСсто ΠΏΠ°Ρ‚ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΈ ΠΏΡ€ΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠΉ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ. Π’ ΠΏΡƒΠ±Π»ΠΈΠΊΠ°Ρ†ΠΈΠΈ ΠΈΡΠΏΠΎΠ»ΡŒΠ·ΠΎΠ²Π°Π½Ρ‹ ΠΊΠ»ΡŽΡ‡Π΅Π²Ρ‹Π΅ ΠΏΠΎΠ·ΠΈΡ†ΠΈΠΈ мСтодичСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉ ΠΏΠΎ Π²Π°ΠΊΡ†ΠΈΠ½ΠΎΠΏΡ€ΠΎΡ„ΠΈΠ»Π°ΠΊΡ‚ΠΈΠΊΠ΅ основных управляСмых Π²ΠΈΠ΄ΠΎΠ² ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΉ, Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½Π½Ρ‹Ρ… ΠΏΡ€ΠΎΡ„Π΅ΡΡΠΈΠΎΠ½Π°Π»ΡŒΠ½ΠΎΠΉ ассоциациСй дСтских Π²Ρ€Π°Ρ‡Π΅ΠΉ «Боюз ΠΏΠ΅Π΄ΠΈΠ°Ρ‚Ρ€ΠΎΠ² России» ΠΈ ΡƒΡ‚Π²Π΅Ρ€ΠΆΠ΄Π΅Π½Π½Ρ‹Ρ… ΠœΠΈΠ½ΠΈΡΡ‚Π΅Ρ€ΡΡ‚Π²ΠΎΠΌ здравоохранСния Π Π€
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