2 research outputs found
Sensitivity of human lymphocytes to genotoxic effect of N-methyl-N-nitrosourea: possible relation to gynecological cancers
The aim of this work is to study responses of PHA-stimulated and resting lymphocytes to methylating agent N-methyl-N-nitrosourea (MNU) and to compare sensitivity to this agent of healthy donor lymphocytes and lymphocytes from patients with gynecological cancers. Methods: Cytotoxicity of MNU, apoptotic death of lymphocytes, was evaluated using two common tests β annexin V-FITC detection assay and live/dead double staining assay (nuclear morphological changes). Genotoxic effect of the agent was determined as delayed (secondary) DNA double strand breaks (DSBs) using neutral comet assay both conventional variant and modified for detection of bromodeoxyuridine-labelled comets, produced by proliferating lymphocytes only. Results: Unstimulated lymphocytes were tolerant to geno- and cytotoxic effects of MNU. In contrast to resting cells, proliferating lymphocytes showed significant genotoxicity (p = 0.0054) of MNU followed by increased apoptotic death of cells (p < 0.05). Average number of secondary DSBs induced by MNU in lymphocytes from patients with gynecological cancers was about 4-fold less than that of lymphocytes of healthy donors. While lymphocytes from cancer patients did not change proliferative index in response to MNU, the agent decreased 2-fold proliferative indices of stimulated lymphocytes from healthy donors. Conclusion: There is a reverse association between geno- and cytotoxicity of MNU in stimulated lymphocytes and the presence of tumor. The relationship appears to be based on MMR-insufficiency in lymphocytes of the cancer patients.Π¦Π΅Π»Ρ: ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΡΠ΅ΠΊΡΠ° ΠΌΠ΅ΡΠΈΠ»Π½ΠΈΡΡΠΎΠ·ΠΎΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ (ΠΠΠ) Π½Π° Π€ΠΠ-ΡΡΠΈΠΌΡΠ»ΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ Π»ΠΈΠΌΡΠΎΡΠΈΡΡ ΠΈ Π² ΡΠΎΡΡΠΎΡΠ½ΠΈΠΈ
ΠΏΠΎΠΊΠΎΡ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ½ΠΎΡΠΎΠ² ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΆΠ΅Π½ΡΠΊΠΎΠΉ ΠΏΠΎΠ»ΠΎΠ²ΠΎΠΉ ΡΡΠ΅ΡΡ. ΠΠ΅ΡΠΎΠ΄Ρ: ΡΠΈΡΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡ ΠΠΠ
(Π°ΠΏΠΎΠΏΡΠΎΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π³ΠΈΠ±Π΅Π»Ρ Π»ΠΈΠΌΡΠΎΡΠΈΡΠΎΠ²) ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎ Π΄Π²ΡΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌ β Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡ ΠΊΠ»Π΅ΡΠΎΠΊ Ρ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠΎΠΌ annexin
V-FITC ΠΈ ΠΏΠΎ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ ΡΠ΄ΡΠ° ΠΊΠ»Π΅ΡΠΎΠΊ ΠΏΠΎΡΠ»Π΅ ΠΈΡ
ΠΎΠΊΡΠ°ΡΠΈΠ²Π°Π½ΠΈΡ ΡΠΌΠ΅ΡΡΡ 2 ΠΠΠ-ΡΡΠΎΠΏΠ½ΡΡ
ΠΊΡΠ°ΡΠΈΡΠ΅Π»Π΅ΠΉ.
ΠΠ΅Π½ΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡ ΠΠΠ, Π²ΡΠΎΡΠΈΡΠ½ΡΠ΅ Π΄Π²ΡΠ½ΠΈΡΠ΅Π²ΡΠ΅ ΡΠ°Π·ΡΡΠ²Ρ ΠΠΠ (ΠΠ ) ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΌΠ΅ΡΠΎΠ΄Π° Π½Π΅ΠΉΡΡΠ°Π»ΡΠ½ΡΡ
ΠΠΠ-ΠΊΠΎΠΌΠ΅Ρ. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΡΠΉ Π²Π°ΡΠΈΠ°Π½Ρ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΈ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π΄Π»Ρ ΠΏΠΎΠ΄ΡΡΠ΅ΡΠ° ΠΊΠΎΠΌΠ΅Ρ, ΡΠΎΡΠΌΠΈΡΡΠ΅ΠΌΡΡ
ΡΠΎΠ»ΡΠΊΠΎ
Π΄Π΅Π»ΡΡΠΈΠΌΠΈΡΡ Π»ΠΈΠΌΡΠΎΡΠΈΡΠ°ΠΌΠΈ, ΠΌΠ΅ΡΠ΅Π½Π½ΡΠΌΠΈ BrUdr. ΠΠΎΠ»Ρ ΡΠ°ΠΊΠΈΡ
ΠΊΠΎΠΌΠ΅Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ»ΠΈ ΠΊΠ°ΠΊ ΠΈΠ½Π΄Π΅ΠΊΡ ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠ°ΡΠΈΠΈ ΠΊΠ»Π΅ΡΠΎΠΊ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ:
Π»ΠΈΠΌΡΠΎΡΠΈΡΡ Π² ΡΠΎΡΡΠΎΡΠ½ΠΈΠΈ ΠΏΠΎΠΊΠΎΡ ΡΡΡΠΎΠΉΡΠΈΠ²Ρ ΠΊ Π³Π΅Π½ΠΎ- ΠΈ ΡΠΈΡΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΌΡ ΡΡΡΠ΅ΠΊΡΠ°ΠΌ ΠΠΠ. Π ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠΈΡΡΡΡΠΈΡ
ΠΊΠ»Π΅ΡΠΊΠ°Ρ
Π² ΠΎΡΠ²Π΅Ρ
Π½Π° Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΠΠ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π»ΠΈΡΡ Π²ΡΠΎΡΠΈΡΠ½ΡΠ΅ ΡΠ°Π·ΡΡΠ²Ρ ΠΠΠ (Ρ < 0,01) ΠΈ Π²ΠΎΠ·ΡΠ°ΡΡΠ°Π»Π° ΡΠ°ΡΡΠΎΡΠ° ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π°ΠΏΠΎΠΏΡΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΊΠ»Π΅ΡΠΎΠΊ (Ρ < 0,05). ΠΠ΅Π½ΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡ ΠΠΠ Π½Π° ΡΡΠΈΠΌΡΠ»ΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ Π»ΠΈΠΌΡΠΎΡΠΈΡΡ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΈΠ»Ρ Π²
4 ΡΠ°Π·Π° Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Π½Π° Π»ΠΈΠΌΡΠΎΡΠΈΡΠ°Ρ
Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ½ΠΎΡΠΎΠ². ΠΠΈΠΌΡΠΎΡΠΈΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Π½Π΅ ΠΈΠ·ΠΌΠ΅Π½ΡΠ»ΠΈ ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠ°ΡΠΈΠ²Π½ΡΠΉ ΠΈΠ½Π΄Π΅ΠΊΡ Π² ΠΎΡΠ²Π΅Ρ Π½Π°
Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΠΠ; Π² Π»ΠΈΠΌΡΠΎΡΠΈΡΠ°Ρ
Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π΄ΠΎΠ½ΠΎΡΠΎΠ² Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΠΠ Π²ΡΠ·ΡΠ²Π°Π»ΠΎ 2-ΠΊΡΠ°ΡΠ½ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΈΠ½Π΄Π΅ΠΊΡΠ°.
ΠΡΠ²ΠΎΠ΄Ρ: ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π° ΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ Π³Π΅Π½ΠΎ- ΠΈ ΡΠΈΡΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΎΡΠ²Π΅ΡΠΎΠΌ Π»ΠΈΠΌΡΠΎΡΠΈΡΠΎΠ² Π½Π° Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΠΠ ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ΠΌ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ.
ΠΡΠ΅Π΄ΠΏΠΎΠ»Π°Π³Π°Π΅ΡΡΡ, ΡΡΠΎ Π³Π΅Π½ΠΎΡΠΎΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡ ΠΠΠ ΡΠ²ΡΠ·Π°Π½ Ρ ΠΏΡΠΎΡΠ΅ΡΡΠΎΠΌ ΠΏΠΎΡΡΡΠ΅ΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠ²Π½ΠΎΠΉ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΠΏΠ°ΡΠ°ΡΠΈΠΈ
ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π°Π½Π°Π»ΠΈΠ·Π° ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ Π΄Π»Ρ ΡΡΠ°Π½ΡΠ°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Ρ ΠΈΠΌΠΈΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΠΈ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎ Π½Π°ΡΡΡΠ°Π΅ΠΌΡΠΌΠΈ ΠΌΠΈΠΊΡΠΎΡΡΠ΅ΡΠ°ΠΌΠΈ Π² ΠΎΠ½ΠΊΠΎΠ³ΠΈΠ½Π΅ΠΊΠΎΠ»ΠΎΠ³ΠΈΠΈ
Background: Magnetic resonance imaging (MRI) is used for the staging and assessment of treatment results of female pelvic tumors. The inclusion of transarterial chemoembolization (TACE) with drug-saturated microspheres into the treatment regimen puts a question to the radiologist: what TACE characteristics should be taken into account for the correct interpretation of the treatment results?
Aim: To determine the main MRI parameters that characterize the results of TACE in the treatment of women with primary and recurrent pelvic tumors.
Materials and methods: We performed a retrospective observational study of 80 patients with primary tumors (group 1) and 20 patients with recurrent tumors (group 2) of the small pelvis, complicated by tumor bleeding, who underwent 121 TACE procedures from 01.09.2015 to 01.12.2021 and were followed up to May 31, 2022. The study inclusion criteria were as follows: compliance with the approved protocol and time points for pelvic MRI. TACE results were evaluated according to RECIST 1.1.
Results: In 100% of the cases in the groups 1 and 2, bleeding was controlled within 24 hours. In group 1, partial response was achieved in 48% (n = 38), complete response in 15% (n = 12), stabilization in 37% (n = 30), without any progression in all patients. In group 2, partial response was achieved in 27% (n = 5), complete response in 11% (n = 2), stabilization in 62% (n = 13), without any progression, as well. When comparing the mass volumes, recurrent tumors were significantly more responsive to TACE. The type of tumor growth was infiltrative (n = 25), expansive (n = 55), and mixed (n = 20). No significant differences in volume changes depending on the type of tumor growth were found. Eight women had undergone non-targeted ovarian embolization related to the type of blood supply. There were no cases of non-targeted embolization of the abdominal organs and the bladder, even with existing abnormal collateral vasculature.
Conclusion: According to this data, the results of TACE for primary and recurrent pelvic tumors are characterized with the following MRI parameters: 1) hemostatic and cytostatic effects of TACE are manifested independently of each other; 2) tumor volume reflects changes after TACE to a greater extent than changes in linear dimensions; 3) there are cases of non-targeted ovarian embolization.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ»Ρ ΡΡΠ°Π΄ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΠΌΠ°Π»ΠΎΠ³ΠΎ ΡΠ°Π·Π° Ρ ΠΆΠ΅Π½ΡΠΈΠ½ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½Π°Ρ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ (ΠΠ Π’). ΠΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ Π² ΡΡ
Π΅ΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π½ΡΠ°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Ρ
ΠΈΠΌΠΈΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΠΈ (Π’ΠΠ₯Π) Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎ Π½Π°ΡΡΡΠ°Π΅ΠΌΡΠΌΠΈ ΠΌΠΈΠΊΡΠΎΡΡΠ΅ΡΠ°ΠΌΠΈ ΡΡΠ°Π²ΠΈΡ ΠΏΠ΅ΡΠ΅Π΄ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΎΠΌ Π²ΠΎΠΏΡΠΎΡ: ΠΊΠ°ΠΊΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π’ΠΠ₯Π Π½Π°Π΄ΠΎ ΡΡΠ΅ΡΡΡ Π΄Π»Ρ ΠΊΠΎΡΡΠ΅ΠΊΡΠ½ΠΎΠΉ ΡΡΠ°ΠΊΡΠΎΠ²ΠΊΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ?
Π¦Π΅Π»Ρ Π²ΡΠ΄Π΅Π»ΠΈΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΠΠ Π’, ΠΊΠΎΡΠΎΡΡΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π’ΠΠ₯Π Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌΠΈ ΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΌΠ°Π»ΠΎΠ³ΠΎ ΡΠ°Π·Π°.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ 80 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ (1-Ρ Π³ΡΡΠΏΠΏΠ°) ΠΈ 20 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ (2-Ρ Π³ΡΡΠΏΠΏΠ°) ΠΌΠ°Π»ΠΎΠ³ΠΎ ΡΠ°Π·Π°, ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΡΠΌ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° 121 Π’ΠΠ₯Π Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎ Π½Π°ΡΡΡΠ°Π΅ΠΌΡΠΌΠΈ ΠΌΠΈΠΊΡΠΎΡΡΠ΅ΡΠ°ΠΌΠΈ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 01.09.2015 ΠΏΠΎ 01.12.2021 ΠΈ ΠΎΡΡΠ»Π΅ΠΆΠ΅Π½Π° Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° Π½Π° 31.05.2022. ΠΡΠΈΡΠ΅ΡΠΈΠ΅ΠΌ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ Π±ΡΠ»ΠΎ ΡΠΎΠ±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΡΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Π° ΠΈ ΡΡΠΎΠΊΠΎΠ² ΠΠ Π’-ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΌΠ°Π»ΠΎΠ³ΠΎ ΡΠ°Π·Π°. ΠΡΠ΅Π½ΠΊΠ° ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π’ΠΠ₯Π Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ ΠΏΠΎ RECIST 1.1.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅ΠΌΠΎΡΡΠ°Π· Π² 1-ΠΉ ΠΈ 2-ΠΉ Π³ΡΡΠΏΠΏΠ°Ρ
Π±ΡΠ» Π΄ΠΎΡΡΠΈΠ³Π½ΡΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΡΡΡΠΎΠΊ Π² 100% ΡΠ»ΡΡΠ°Π΅Π². Π 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΡΠ°ΡΡΠΈΡΠ½ΡΠΉ ΠΎΡΠ²Π΅Ρ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ Π² 48% (n = 38), ΠΏΠΎΠ»Π½ΡΠΉ ΠΎΡΠ²Π΅Ρ Π² 15% (n = 12), ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·Π°ΡΠΈΡ Π² 37% (n = 30), ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π½Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΎΡΡ. ΠΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΡΠ°ΡΡΠΈΡΠ½ΡΠΉ ΠΎΡΠ²Π΅Ρ ΠΎΡΠΌΠ΅ΡΠ΅Π½ Π² 27% (n = 5), ΠΏΠΎΠ»Π½ΡΠΉ ΠΎΡΠ²Π΅Ρ Π² 11% (n = 2), ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·Π°ΡΠΈΡ Π² 62% (n = 13), ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ°ΠΊ ΠΆΠ΅ Π½Π΅ Π±ΡΠ»ΠΎ. ΠΡΠΈ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ° Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ Π·Π°ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΎ, ΡΡΠΎ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΠ΅ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΡΠ°ΡΠ΅ Π² Π±ΠΎΠ»ΡΡΠ΅ΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΎΡΠ²Π΅ΡΠ°Π»ΠΈ Π½Π° Π’ΠΠ₯Π. Π’ΠΈΠΏ ΡΠΎΡΡΠ° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π±ΡΠ» ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠ²Π½ΡΠΌ (n = 25), ΡΠΊΡΠΏΠ°Π½ΡΠΈΠ²Π½ΡΠΌ (n = 55), ΡΠΌΠ΅ΡΠ°Π½Π½ΡΠΌ (n = 20). ΠΡΠΈ ΡΡΠΎΠΌ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ Π² ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΠΈΠΏΠ° Π΅Π΅ ΡΠΎΡΡΠ° Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ. Π£ 8 ΠΆΠ΅Π½ΡΠΈΠ½ Π±ΡΠ»Π° Π½Π΅ΡΠ΅Π»Π΅Π²Π°Ρ ΡΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΡ ΡΠΈΡΠ½ΠΈΠΊΠΎΠ², ΡΠ²ΡΠ·Π°Π½Π½Π°Ρ Ρ ΠΊΡΠΎΠ²ΠΎΡΠ½Π°Π±ΠΆΠ΅Π½ΠΈΠ΅ΠΌ. Π‘Π»ΡΡΠ°Π΅Π² Π½Π΅ΡΠ΅Π»Π΅Π²ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΠΈ ΠΎΡΠ³Π°Π½ΠΎΠ² Π±ΡΡΡΠ½ΠΎΠΉ ΠΏΠΎΠ»ΠΎΡΡΠΈ ΠΈ ΠΌΠΎΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ, Π΄Π°ΠΆΠ΅ ΠΏΡΠΈ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΊΠΎΠ»Π»Π°ΡΠ΅ΡΠ°Π»ΡΡ
.
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠΎ Π½Π°ΡΠΈΠΌ Π΄Π°Π½Π½ΡΠΌ, ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π’ΠΠ₯Π ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
ΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ
ΠΌΠ°Π»ΠΎΠ³ΠΎ ΡΠ°Π·Π° Ρ ΠΆΠ΅Π½ΡΠΈΠ½ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡ ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅ ΠΠ Π’-ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ: 1) Π³Π΅ΠΌΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈ ΡΠΈΡΠΎΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΡΠ΅ΠΊΡΡ Π’ΠΠ₯Π ΠΏΡΠΎΡΠ²Π»ΡΡΡΡΡ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΠΎ Π΄ΡΡΠ³ ΠΎΡ Π΄ΡΡΠ³Π°; 2) ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠΎΡΠ»Π΅ Π’ΠΠ₯Π Π² Π±ΠΎΠ»ΡΡΠ΅ΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΎΡΡΠ°ΠΆΠ°Π΅Ρ ΠΎΠ±ΡΠ΅ΠΌ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, ΡΠ΅ΠΌ Π»ΠΈΠ½Π΅ΠΉΠ½ΡΠ΅ ΡΠ°Π·ΠΌΠ΅ΡΡ; 3) ΠΈΠΌΠ΅ΡΡΡΡ ΡΠ»ΡΡΠ°ΠΈ Π½Π΅ΡΠ΅Π»Π΅Π²ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΠΈ ΡΠΈΡΠ½ΠΈΠΊΠΎΠ²