229 research outputs found
How should a patient with rheumatoid arthritis behave after achievement of remission?
The paper considers the very urgent problem of optimization of the management of rheumatoid arthritis (RA) patients who have achieved remission (or persistent low disease activity) during therapy using biologicals. It analyzes the results of BeSt, OPTIMA, HIT HARD, ACT-RAY, AVERT, PRESERVE, RETRO, PRIZE, DRESS, HOPEFUL-2, and HONOR studies, the data of NinJa and CORRONA registries, and the experience gained in treating psoriasis concerning practically important issues, such as whether tumor necrosis factor-Ξ± inhibitors and biologicals with other mechanisms of action can be discontinued; whether the whole anti-inflammatory therapy can be stopped; whether the dose of biologicals can be reduced as an alternative to complete discontinuation or as a step to discontinue biologicals; whether repeated or intermittent therapy with biologicals can be used; what value of the depth of suppression of inflammatory activity is in solving the problem of whether biologicals can be discontinued. The current results may lead to the conclusion that in RA the dose of biologicals may be successfully reduced and, in some cases, the latter may be completely discontinued. This possibility seems to be associated with the depth of remission. Repeated use of biologicals generally gives rise to prompt improvement in patients with a recurrent disease-activity rebound. The results of a trial of etanercept are most optimistic. Re-treatment with biologicals generally provides fast improvement in patients with a relapse of disease activity. The results of the trials of etanercept are most optimistic
Fermion conformal bootstrap in 4d
We apply numerical conformal bootstrap techniques to the four-point function
of a Weyl spinor in 4d non-supersymmetric CFTs. We find universal bounds on
operator dimensions and OPE coefficients, including bounds on operators in
mixed symmetry representations of the Lorentz group, which were inaccessible in
previous bootstrap studies. We find discontinuities in some of the bounds on
operator dimensions, and we show that they arise due to a generic yet
previously unobserved fake primary effect, which is related to the existence of
poles in conformal blocks. We show that this effect is also responsible for
similar discontinuities found in four-fermion bootstrap in 3d, as well as in
the mixed-correlator analysis of the 3d Ising CFT. As an important byproduct of
our work, we develop a practical technology for numerical approximation of
general 4d conformal blocks
Efficiency of teaching patients with early-stage rheumatoid arthritis
Education programs are an important part of the management of patients with rheumatoid arthritis (RA).Objective: to develop a unified model of an education program for RA patients and to evaluate its efficiency at the early stage of the disease.Material and methods. A group education program was worked out with the support of the All-Russian public organization of the disabled βThe Russian rheumatology organization βNadezhdaβ (Hope)β and encompassed 4 daily classes lasting 90 min. All information was presented by a multidisciplinary team of specialists (rheumatologists, a cardiologist, a psychologist, a physiotherapist, and a physical trainer). The study included 55 patients with early RA (89.1% of women aged 18 to 62 years; the duration of the disease was 2 to 22 months); of them 25 were taught using the education program (a study group); 30 received drug therapy only (a control group). Following 3 and 6 months, the number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and pain were determined applying a 100-ml VAS, DAS28, HAQ, and RAPID3. Adherence to non-drug treatments was assessed employing a special patient questionnaire.Results. Three and six months after being taught, two patient groups showed increases in adherence to joint protection methods by 13 and 10 times (p<0.01), regular physical training by 4 and 3.25 times (p<0.01), uses of orthoses for the wrist joint by 2 times and 75% (p<0.01) and knee orthoses by 33.3 and 50.0% (p<0.01), and orthopedic insoles by 71.4 and 57.1% (p<0.01), respectively. Following 6 months, there were statistically significant differences between the two groups in most parameters (p<0.05), except for ESR, CRP, and DAS28 (p>0.05). Further more, a good response to treatment was significantly more common in these periods, as shown by the EULAR response criteria (DAS28): 56.3% versus 40% in the control group (p<0.05).Conclusion. The education program decreases the intensity of pain syndrome and improves the functional status and quality of life of patients with early RA within 6 months. Patient education enhances adherence to non-drug treatments. The highest positive result was achieved just 3 months later; it slightly tailed off at 6 months. This necessitates re-education in succeeding 3β6 months
ΠΠ°ΠΊ Π²Π΅ΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ ΠΏΠΎΡΠ»Π΅ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΠ΅ΠΌΠΈΡΡΠΈΠΈ?
The paper considers the very urgent problem of optimization of the management of rheumatoid arthritis (RA) patients who have achieved remission (or persistent low disease activity) during therapy using biologicals. It analyzes the results of BeSt, OPTIMA, HIT HARD, ACT-RAY, AVERT, PRESERVE, RETRO, PRIZE, DRESS, HOPEFUL-2, and HONOR studies, the data of NinJa and CORRONA registries, and the experience gained in treating psoriasis concerning practically important issues, such as whether tumor necrosis factor-Ξ± inhibitors and biologicals with other mechanisms of action can be discontinued; whether the whole anti-inflammatory therapy can be stopped; whether the dose of biologicals can be reduced as an alternative to complete discontinuation or as a step to discontinue biologicals; whether repeated or intermittent therapy with biologicals can be used; what value of the depth of suppression of inflammatory activity is in solving the problem of whether biologicals can be discontinued. The current results may lead to the conclusion that in RA the dose of biologicals may be successfully reduced and, in some cases, the latter may be completely discontinued. This possibility seems to be associated with the depth of remission. Repeated use of biologicals generally gives rise to prompt improvement in patients with a recurrent disease-activity rebound. The results of a trial of etanercept are most optimistic. Re-treatment with biologicals generally provides fast improvement in patients with a relapse of disease activity. The results of the trials of etanercept are most optimistic.Π ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅ΡΡΡ Π²Π΅ΡΡΠΌΠ° Π°ΠΊΡΡΠ°Π»ΡΠ½Π°Ρ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ° ΠΎΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ (Π Π), Π΄ΠΎΡΡΠΈΠ³ΡΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΡΠ΅ΠΌΠΈΡΡΠΈΠΈ (ΠΈΠ»ΠΈ ΡΡΠΎΠΉΠΊΠΎ Π½ΠΈΠ·ΠΊΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ) Π½Π° ΡΠΎΠ½Π΅ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (ΠΠΠΠ). ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ BeSt, OPTIMA, HIT HARD, ACT-RAY, AVERT, PRESERVE, RETRO, PRIZE, DRESS, HOPEFUL-2, HONOR, Π΄Π°Π½Π½ΡΠ΅ ΡΠ΅Π³ΠΈΡΡΡΠΎΠ² NinJa ΠΈ CORRONA, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΠΏΡΡ, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠΉ ΠΏΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΏΡΠΎΡΠΈΠ°Π·Π°, Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΡΠ°ΠΊΠΈΡ
Π²Π°ΠΆΠ½ΡΡ
Π² ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΏΠ»Π°Π½Π΅ Π²ΠΎΠΏΡΠΎΡΠΎΠ², ΠΊΠ°ΠΊ: Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΎΡΠΌΠ΅Π½Ρ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠΎΠ² ΡΠ°ΠΊΡΠΎΡΠ° Π½Π΅ΠΊΡΠΎΠ·Π° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ξ± ΠΈ ΠΠΠΠ Ρ ΠΈΠ½ΡΠΌΠΈ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠ°ΠΌΠΈ Π΄Π΅ΠΉΡΡΠ²ΠΈΡ, Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΎΡΠΌΠ΅Π½Ρ Π²ΡΠ΅ΠΉ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π΄ΠΎΠ·Ρ ΠΠΠΠ ΠΊΠ°ΠΊ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π° ΠΏΠΎΠ»Π½ΠΎΠΉ ΠΎΡΠΌΠ΅Π½Π΅ ΠΈΠ»ΠΈ ΡΡΡΠΏΠ΅Π½Ρ Π½Π° ΠΏΡΡΠΈ ΠΊ ΠΎΡΠΌΠ΅Π½Π΅ ΠΠΠΠ, ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠ΅ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΈ Β«ΠΏΡΠ΅ΡΡΠ²ΠΈΡΡΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅Β» ΠΠΠΠ, Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π³Π»ΡΠ±ΠΈΠ½Ρ ΠΏΠΎΠ΄Π°Π²Π»Π΅Π½ΠΈΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π΄Π»Ρ ΡΠ΅ΡΠ΅Π½ΠΈΡ Π²ΠΎΠΏΡΠΎΡΠ° ΠΎ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΎΡΠΌΠ΅Π½Ρ ΠΠΠΠ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΊ Π½Π°ΡΡΠΎΡΡΠ΅ΠΌΡ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΌΠΎΠΆΠ½ΠΎ Π·Π°ΠΊΠ»ΡΡΠΈΡΡ, ΡΡΠΎ ΠΏΡΠΈ Π Π Π²Π΅ΡΠΎΡΡΠ½ΠΎ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π΄ΠΎΠ·Ρ, Π° Π² Π½Π΅ΠΊΠΎΡΠΎΡΡΡ
ΡΠ»ΡΡΠ°ΡΡ
β ΠΈ ΠΏΠΎΠ»Π½Π°Ρ ΠΎΡΠΌΠ΅Π½Π° ΠΠΠΠ. Π’Π°ΠΊΠ°Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ, ΠΏΠΎ-Π²ΠΈΠ΄ΠΈΠΌΠΎΠΌΡ, ΡΠ²ΡΠ·Π°Π½Π° Ρ Π³Π»ΡΠ±ΠΈΠ½ΠΎΠΉ ΡΠ΅ΠΌΠΈΡΡΠΈΠΈ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠΌ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠ΅ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΠΠΠ, ΠΊΠ°ΠΊ ΠΏΡΠ°Π²ΠΈΠ»ΠΎ, ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π±ΡΡΡΡΠΎΠΌΡ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΎΠΏΡΠΈΠΌΠΈΡΡΠΈΡΠ½ΡΠΌΠΈ Π²ΡΠ³Π»ΡΠ΄ΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΡΠ°Π½Π΅ΡΡΠ΅ΠΏΡΠ°
ΠΠΎΠ»ΠΈΠΌΡΠΌΠ°Π± Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ: ΡΠΎΠ»Ρ ΠΈΠΌΠΌΡΠ½ΠΎΠ³Π΅Π½Π½ΠΎΡΡΠΈ
The review considers the specific features of golimumab (GLM), a representative of a group of tumor necrosis factor-Ξ± inhibitors primarily by comparing its immunogenicity parameters with other drugs in this group (infliximab, adalimumab, certolizumab pegol, etanercept). Despite its fundamental similarity with other biologicals from a category of monoclonal antibodies, GLM is shown to be characterized by a significantly lower detection rate for antibodies to the drug and by its high serum concentration stabilities and a sustained clinical response.Π ΠΎΠ±Π·ΠΎΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π³ΠΎΠ»ΠΈΠΌΡΠΌΠ°Π±Π° (ΠΠΠ), ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΡΠ΅Π»Ρ Π³ΡΡΠΏΠΏΡ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠΎΠ² ΡΠ°ΠΊΡΠΎΡΠ° Π½Π΅ΠΊΡΠΎΠ·Π° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ξ±, Π² ΠΏΠ΅ΡΠ²ΡΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ Ρ ΡΠΎΡΠΊΠΈ Π·ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΈΠΌΠΌΡΠ½ΠΎΠ³Π΅Π½Π½ΠΎΡΡΠΈ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ ΡΡΠΎΠΉ Π³ΡΡΠΏΠΏΡ (ΠΈΠ½ΡΠ»ΠΈΠΊΡΠΈΠΌΠ°Π±, Π°Π΄Π°Π»ΠΈΠΌΡΠΌΠ°Π±, ΡΠ΅ΡΡΠΎΠ»ΠΈΠ·ΡΠΌΠ°Π±Π° ΠΏΡΠ³ΠΎΠ», ΡΡΠ°Π½Π΅ΡΡΠ΅ΠΏΡ). ΠΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ ΠΠΠ, Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΏΡΠΈΠ½ΡΠΈΠΏΠΈΠ°Π»ΡΠ½ΠΎΠ΅ ΡΡ
ΠΎΠ΄ΡΡΠ²ΠΎ Ρ Π΄ΡΡΠ³ΠΈΠΌΠΈ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΠΌΠΈ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ ΠΈΠ· ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ ΠΌΠΎΠ½ΠΎΠΊΠ»ΠΎΠ½Π°Π»ΡΠ½ΡΡ
Π°Π½ΡΠΈΡΠ΅Π», Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΌΠ΅Π½ΡΡΠ΅ΠΉ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½ΠΈΡ Π°Π½ΡΠΈΡΠ΅Π» ΠΊ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ, Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠΎΠΉΠΊΠΎΡΡΡΡ ΡΡΠ²ΠΎΡΠΎΡΠΎΡΠ½ΠΎΠΉ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ ΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡΡ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΠΎΠ³ΠΎ ΡΡΠΎΠ²Π½Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ°
ΠΡΡΡΡΠ΅ Π²ΠΎΠΏΡΠΎΡΡ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ°
The current treatment strategy for rheumatoid arthritis (RA) is based on the principles of early aggressive therapy and tight control, which are summarized in Β«Treat-to-TargetΒ» recommendations. The draft RA treatment guidelines by the Association of Rheumatologists of Russia (ARR) reflect these principles in expanded form. Twenty-four ARR recommendations contain the detailed description of current treatments for RA, which relies on the principles of evidence-based medicine. Some practical issues for the management of patients with RA require special attention. The comparison of a number of randomized trials and the authorβs experience in the REMARCA study may conclude that subcutaneous methotrexate (MTX) in an initial dose 10β15 mg/week with its fast increase up to 20Π 30 mg/week is an optimal first-line therapy for RA. To choose the period within which a decision should be made on the incorporation of biologic agents (BA) in patients with an inadequate response to MTX is a serious matter. The experience gained in a number of clinical trials, particularly in those of etanercept, shows that a 12-week follow-up is sufficient in most patients. First of all, it is important for early RA. After achieving sustained remission, the reasonable tactics is to accurately reduce the dose of a BA although there may also be complete therapy discontinuation (Β«treatment holidayΒ») in the future.Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½Π°Ρ ΡΡΡΠ°ΡΠ΅Π³ΠΈΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ Π°ΡΡΡΠΈΡΠ° (Π Π) ΠΎΡΠ½ΠΎΠ²Π°Π½Π° Π½Π° ΠΏΡΠΈΠ½ΡΠΈΠΏΠ°Ρ
ΡΠ°Π½Π½Π΅ΠΉ Π°Π³ΡΠ΅ΡΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ ΡΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ, ΠΊΠΎΡΠΎΡΡΠ΅ ΡΡΠΌΠΌΠΈΡΠΎΠ²Π°Π½Ρ Π² ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΡΡ
Β«ΠΠ΅ΡΠ΅Π½ΠΈΠ΅ Π΄ΠΎ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΠ΅Π»ΠΈΒ». ΠΡΠΈ ΠΏΡΠΈΠ½ΡΠΈΠΏΡ Π² ΡΠ°Π·Π²Π΅ΡΠ½ΡΡΠΎΠΉ ΡΠΎΡΠΌΠ΅ ΠΎΡΡΠ°ΠΆΠ΅Π½Ρ Π² ΠΏΡΠΎΠ΅ΠΊΡΠ΅ Π Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ ΠΏΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π Π ΠΡΡΠΎΡΠΈΠ°ΡΠΈΠΈ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠ»ΠΎΠ³ΠΎΠ² Π ΠΎΡΡΠΈΠΈ (ΠΠ Π ). 24 ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΠ Π ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΠΏΠΎΠ΄ΡΠΎΠ±Π½ΠΎΠ΅ ΠΈΠ·Π»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π Π, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΠΎΠ΅ Π½Π° ΠΏΡΠΈΠ½ΡΠΈΠΏΠ°Ρ
Π΄ΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½Ρ. ΠΡΠΎΠ±ΠΎΠ³ΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΡ ΡΡΠ΅Π±ΡΡΡ Π½Π΅ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π²ΠΎΠΏΡΠΎΡΡ Π²Π΅Π΄Π΅Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
Π Π. Π‘ΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ ΡΡΠ΄Π° ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΈ ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ° Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Π ΠΠΠΠ ΠΠ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ Π·Π°ΠΊΠ»ΡΡΠΈΡΡ, ΡΡΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠ΄ΠΊΠΎΠΆΠ½ΠΎΠΉ ΡΠΎΡΠΌΡ ΠΌΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°ΡΠ° (ΠΠ’) Π² Π½Π°ΡΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΎΠ·Π΅Β 10β15 ΠΌΠ³/Π½Π΅Π΄ Ρ Π±ΡΡΡΡΡΠΌ Π΅Π΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π΄ΠΎ 20β30 ΠΌΠ³/Π½Π΅Π΄ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΠ΅ΡΠ²ΠΎΠΉ Π»ΠΈΠ½ΠΈΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π Π. Π‘Π΅ΡΡΠ΅Π·Π½ΡΠΌ Π²ΠΎΠΏΡΠΎΡΠΎΠΌ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΠ±ΠΎΡ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°, Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎ ΠΏΠΎΠ΄ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² (ΠΠΠΠ) ΠΏΡΠΈ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΌ ΠΎΡΠ²Π΅ΡΠ΅ Π½Π° ΠΠ’. ΠΠΏΡΡ, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠΉ Π² ΡΡΠ΄Π΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
ΡΡΠ°Π½Π΅ΡΡΠ΅ΠΏΡΠ°, ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°Π΅Ρ, ΡΡΠΎ Π΄Π»Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ 12 Π½Π΅Π΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. Π ΠΏΠ΅ΡΠ²ΡΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ ΡΡΠΎ Π²Π°ΠΆΠ½ΠΎ ΠΏΡΠΈ ΡΠ°Π½Π½Π΅ΠΌ Π Π. ΠΠΎΡΠ»Π΅ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΡΠΎΠΉΠΊΠΎΠΉ ΡΠ΅ΠΌΠΈΡΡΠΈΠΈ ΡΠ°Π·ΡΠΌΠ½ΠΎΠΉ ΡΠ°ΠΊΡΠΈΠΊΠΎΠΉ Π±ΡΠ΄Π΅Ρ Π°ΠΊΠΊΡΡΠ°ΡΠ½ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π΄ΠΎΠ·Ρ ΠΠΠΠ, Ρ
ΠΎΡΡ Π² ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½Π° ΠΈ ΠΏΠΎΠ»Π½Π°Ρ ΠΎΡΠΌΠ΅Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (Β«treatment holidayΒ»).
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