162 research outputs found

    ЀотодинамичСская тСрапия больной с впч–ассоциированной lsil шСйки ΠΌΠ°Ρ‚ΠΊΠΈ (клиничСскоС наблюдСниС)

    Get PDF
    The article describes a clinical example of timely, safe and effective photodynamic therapy (PDT) in a patient diagnosed with human papillomavirus (HPV) CIN I-associated cervical cancer after ineffective vaccination with 4-valent Gardasil vaccine. Clinical case demonstrates the low effectiveness of HPV vaccination in patients with established HPV infection. In this patient, the lack of adequate treatment for about 1.5 years led to the development of HPV associated CIN I of the cervix. Center for Laser and Photodynamic Diagnostics and Therapy of Tumors and MRI P.A. Herzen, the patient underwent a course of antiviral PDT with the achievement of complete regression of dysplasia and complete eradication of HPV viruses. The patient tolerated the treatment well, without complications. The period of relapse-free follow-up is 19 months.Π’ ΡΡ‚Π°Ρ‚ΡŒΠ΅ описываСтся клиничСский ΠΏΡ€ΠΈΠΌΠ΅Ρ€ провСдСния своСврСмСнной, бСзопасной ΠΈ эффСктивной фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (Π€Π”Π’) Ρƒ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠΈ с Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ассоциированной с вирусом ΠΏΠ°ΠΏΠΈΠ»Π»ΠΎΠΌΡ‹ Ρ‡Π΅Π»ΠΎΠ²Π΅ΠΊΠ° (Π’ΠŸΠ§) Π‘IN I шСйки ΠΌΠ°Ρ‚ΠΊΠΈ послС нСэффСктивной Π²Π°ΠΊΡ†ΠΈΠ½Π°Ρ†ΠΈΠΈ 4-Π²Π°Π»Π΅Π½Ρ‚Π½ΠΎΠΉ Π²Π°ΠΊΡ†ΠΈΠ½ΠΎΠΉ гардасил. ΠšΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΠΎΠ΅ наблюдСниС дСмонстрируСт Π½ΠΈΠ·ΠΊΡƒΡŽ ΡΡ„Ρ„Π΅ΠΊΡ‚ΠΈΠ²Π½ΠΎΡΡ‚ΡŒ Π²Π°ΠΊΡ†ΠΈΠ½Π°Ρ†ΠΈΠΈ ΠΏΡ€ΠΎΡ‚ΠΈΠ² Π’ΠŸΠ§ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с установлСнной Π’ΠŸΠ§ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠ΅ΠΉ. Π£ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠΈ отсутствиС Π°Π΄Π΅ΠΊΠ²Π°Ρ‚Π½ΠΎΠ³ΠΎ лСчСния Π½Π° протяТСнии ΠΎΠΊΠΎΠ»ΠΎ 1,5 Π»Π΅Ρ‚ ΠΏΡ€ΠΈΠ²Π΅Π»ΠΎ ΠΊ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΡŽ Π’ΠŸΠ§ ассоциированной CIN I шСйки ΠΌΠ°Ρ‚ΠΊΠΈ. Π’ Π¦Π΅Π½Ρ‚Ρ€Π΅ Π»Π°Π·Π΅Ρ€Π½ΠΎΠΉ ΠΈ фотодинамичСской диагностики ΠΈ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ ΠΎΠΏΡƒΡ…ΠΎΠ»Π΅ΠΉ ΠΈ МР МНИОИ ΠΈΠΌ. П.А. Π“Π΅Ρ€Ρ†Π΅Π½Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠ΅ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ курс противовирусной Π€Π”Π’ с достиТСниСм ΠΏΠΎΠ»Π½ΠΎΠΉ рСгрСссии дисплазии ΠΈ ΠΏΠΎΠ»Π½ΠΎΠΉ эрадикации вирусов Π’ΠŸΠ§. Π›Π΅Ρ‡Π΅Π½ΠΈΠ΅ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠ° пСрСнСсла Ρ…ΠΎΡ€ΠΎΡˆΠΎ, Π±Π΅Π· ослоТнСний. Π‘Ρ€ΠΎΠΊ Π±Π΅Π·Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²Π½ΠΎΠ³ΠΎ наблюдСния – 19 мСс

    ЀотодинамичСская тСрапия больного Π±Π°Π·Π°Π»ΡŒΠ½ΠΎΠΊΠ»Π΅Ρ‚ΠΎΡ‡Π½Ρ‹ΠΌ Ρ€Π°ΠΊΠΎΠΌ ΠΊΠΎΠΆΠΈ ΡƒΡˆΠ½ΠΎΠΉ Ρ€Π°ΠΊΠΎΠ²ΠΈΠ½Ρ‹ стадии T3N0M0 (клиничСскоС наблюдСниС)

    Get PDF
    The article presents a clinical observation. The patient, 72 years old, applied to the MNII them. P.A. Herzen with complaints about the presence of an ulcerated tumor of the left ear. After further examination, a diagnosis was made - basal cell carcinoma of the ear skin with spread to the skin of the parotid region T3N0M0. On July 9, 2021, the patient underwent a course of photodynamic therapy (PDT) using a photosensitizer based on chlorin e6 and a diode laser with a wavelength of 662 nm. After one course of PDT, complete regression of the tumor was recorded.Π’ ΡΡ‚Π°Ρ‚ΡŒΠ΅ прСдставлСно клиничСскоС наблюдСниС. Π‘ΠΎΠ»ΡŒΠ½ΠΎΠΉ, 72 Π»Π΅Ρ‚, обратился Π² МНИОИ ΠΈΠΌ. П.А. Π“Π΅Ρ€Ρ†Π΅Π½Π° с ΠΆΠ°Π»ΠΎΠ±Π°ΠΌΠΈ Π½Π° Π½Π°Π»ΠΈΡ‡ΠΈΠ΅ изъязвлСнной ΠΎΠΏΡƒΡ…ΠΎΠ»ΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΡƒΡ…Π°. ПослС дообслСдования поставлСн Π΄ΠΈΠ°Π³Π½ΠΎΠ· – Π±Π°Π·Π°Π»ΡŒΠ½ΠΎΠΊΠ»Π΅Ρ‚ΠΎΡ‡Π½Ρ‹ΠΉ Ρ€Π°ΠΊ ΠΊΠΎΠΆΠΈ ΡƒΡ…Π° с распространСниСм Π½Π° ΠΊΠΎΠΆΡƒ ΠΎΠΊΠΎΠ»ΠΎΡƒΡˆΠ½ΠΎΠΉ области T3N0M0. Π‘ΠΎΠ»ΡŒΠ½ΠΎΠΌΡƒ 09.07.2021 Π±Ρ‹Π» Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½ курс фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (Π€Π”Π’) с использованиСм фотосСнсибилизатора Π½Π° основС Ρ…Π»ΠΎΡ€ΠΈΠ½Π° Π΅6 ΠΈ Π΄ΠΈΠΎΠ΄Π½ΠΎΠ³ΠΎ Π»Π°Π·Π΅Ρ€Π° с Π΄Π»ΠΈΠ½ΠΎΠΉ Π²ΠΎΠ»Π½Ρ‹ 662 Π½ΠΌ. ПослС провСдСния ΠΎΠ΄Π½ΠΎΠ³ΠΎ курса Π€Π”Π’ Π±Ρ‹Π»Π° зарСгистрирована полная рСгрСссия ΠΎΠΏΡƒΡ…ΠΎΠ»ΠΈ

    Identification and quantification of anthocyanins in honeysuckle under the conditions of Tomsk Province

    Get PDF
    Background. Honeysuckle is a promising berry crop for food and medical uses, which has recently become increasingly popular. Searching for sources with high content of bioactive substances to obtain new fruit cultivars with improved chemical composition continues to be relevant. Anthocyanin content and composition in honeysuckle cultivars depend on many factors, including plant reproduction conditions (temperature and humidity). Studying chemical composition of Siberian honeysuckle cultivars grown under the conditions of Western Siberia will make it possible to identify sources of high BAS content for various uses.Materials and methods. The target materials of the study were fruits of 21 honeysuckle cultivars grown in Western Siberia before and after freezing. The qualitative and quantitative composition of anthocyanins was assessed in ethanol extracts of honeysuckle fruits using HPLC technique.Results. The content of anthocyanins was higher in the fruits of honeysuckle grown in Western Siberia compared with the published data for the same cultivars reproduced in Belgorod Province (Central Black Earth Region). After freezing, the anthocyanin level in honeysuckle fruits remained the same and in some cases even increased.Conclusions. The obtained data helped to ascertain that honeysuckle fruits reproduced in Western Siberia are valuable sources of such bioactive compounds as anthocyanins

    ΠšΠΎΠΌΠ±ΠΈΠ½ΠΈΡ€ΠΎΠ²Π°Π½Π½ΠΎΠ΅ эндоскопичСскоС Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ больного Π½Π΅ΠΎΠΏΠ΅Ρ€Π°Π±Π΅Π»ΡŒΠ½Ρ‹ΠΌ Ρ€Π°ΠΊΠΎΠΌ срСднСй Ρ‚Ρ€Π΅Ρ‚ΠΈ ΠΏΠΈΡ‰Π΅Π²ΠΎΠ΄Π° (4-Π»Π΅Ρ‚Π½Π΅Π΅ клиничСскоС наблюдСниС)

    Get PDF
    The results of 4-year clinical follow-up in the patient with obstructive inoperable retropericardial esophageal cancer are represented. According to cardiac co-morbidity (myocardial infarction, postinfarction cardiosclerosis) the palliative care for patient was managed. To preserve patency of esophagus multiple courses of endoscopic photodynamic therapy by means of the approach developed in P.A. Herzen MCRI were performed. From 2011 to 2014 thirteen courses of photodynamic therapy with photosens were conducted. The patient was under follow-up for 4 years and 3 months to his death in 2015. For follow-up period the patient had oral feeding with no signs of dysphagia, not significant weight loss and with good quality of life.Β ΠŸΡ€ΠΈΠ²Π΅Π΄Π΅Π½Ρ‹ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ 4-Π»Π΅Ρ‚Π½Π΅Π³ΠΎ клиничСского наблюдСния Π·Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠΌ со ΡΡ‚Π΅Π½ΠΎΠ·ΠΈΡ€ΡƒΡŽΡ‰ΠΈΠΌ Π½Π΅ΠΎΠΏΠ΅Ρ€Π°Π±Π΅Π»ΡŒΠ½Ρ‹ΠΌ Ρ€Π°ΠΊΠΎΠΌ ΠΏΠΈΡ‰Π΅Π²ΠΎΠ΄Π° Π² Ρ€Π΅Ρ‚Ρ€ΠΎΠΏΠ΅Ρ€ΠΈΠΊΠ°Ρ€Π΄ΠΈΠ°Π»ΡŒΠ½ΠΎΠΌ сСгмСнтС. Π‘ ΡƒΡ‡Π΅Ρ‚ΠΎΠΌ ΡΠΎΠΏΡƒΡ‚ΡΡ‚Π²ΡƒΡŽΡ‰Π΅ΠΉ ΠΊΠ°Ρ€Π΄ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΏΠ°Ρ‚ΠΎΠ»ΠΎΠ³ΠΈΠΈ (ΠΈΠ½Ρ„Π°Ρ€ΠΊΡ‚ ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π°, постинфарктный кардиосклСроз) Π±Ρ‹Π» Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½ ΠΏΠ»Π°Π½ ΠΏΠ°Π»Π»ΠΈΠ°Ρ‚ΠΈΠ²Π½ΠΎΠ³ΠΎ лСчСния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°. Π‘ Ρ†Π΅Π»ΡŒΡŽ сохранСния проходимости ΠΏΠΈΡ‰Π΅Π²ΠΎΠ΄Π° Π±Ρ‹Π»Π° Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½Π° многокурсовая эндоскопичСская фотодинамичСская тСрапия ΠΏΠΎ Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½Π½ΠΎΠΉ Π² МНИОИ ΠΈΠΌ. П.А. Π“Π΅Ρ€Ρ†Π΅Π½Π° ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ΅. Π‘ 2011 ΠΏΠΎ 2014 Π³Π³. ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΎ 13 курсов фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ с ΠΏΡ€Π΅ΠΏΠ°Ρ€Π°Ρ‚ΠΎΠΌ фотосСнс. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚ находился ΠΏΠΎΠ΄ динамичСским наблюдСниСм 4 Π³ΠΎΠ΄Π° 3 мСс Π΄ΠΎ смСрти Π² 2015 Π³. Π’Π΅ΡΡŒ срок наблюдСния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ питался Ρ‡Π΅Ρ€Π΅Π· Ρ€ΠΎΡ‚, Π±Π΅Π· ΠΏΡ€ΠΈΠ·Π½Π°ΠΊΠΎΠ² дисфагии, Π±Π΅Π· Π²Ρ‹Ρ€Π°ΠΆΠ΅Π½Π½ΠΎΠΉ ΠΏΠΎΡ‚Π΅Ρ€ΠΈ вСса, с Ρ…ΠΎΡ€ΠΎΡˆΠΈΠΌ качСством ΠΆΠΈΠ·Π½ΠΈ.

    ЀотодинамичСская тСрапия Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π²Π½ΡƒΡ‚Ρ€ΠΈΠΊΠΎΠΆΠ½Ρ‹ΠΌΠΈ мСтастазами ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ‹

    Get PDF
    Results of treating 114 skin metastases of melanoma in 21 patients are represented. Melanoma progression with cutaneous metastases after previous treatment was diagnosed in all patients. The method of prolonged photodynamic therapy developed by authors with fotosens administrated intravenously at dose of 0.4 mg/kg of body weight was used in the study. First session of tumor irradiation was performed 2 h after injection of photosensitizer. Patients underwent superfi cial or contact irradiation depending on topography and type of growth of metastatic foci. Course of treatment accounted for 7–10 sessions of photodynamic therapy with 24 h interval, light dose delivered to tumor for one session – 350 J/cm2. Signifi cant clinical effect (complete and partial tumor regression) was obtained in 89% of cases for developed method.Β ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²Π»Π΅Π½Ρ‹ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ лСчСния 114 мСтастатичСских ΠΎΡ‡Π°Π³ΠΎΠ² ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ‹ Π² ΠΊΠΎΠΆΡƒ Ρƒ 21 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°. Π£ всСх Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π±Ρ‹Π»ΠΎ диагностировано прогрСссированиС ΠΌΠ΅Π»Π°Π½ΠΎΠΌΡ‹ с мСтастазированиСм Π² ΠΊΠΎΠΆΡƒ послС ΠΏΡ€Π΅Π΄ΡˆΠ΅ΡΡ‚Π²ΡƒΡŽΡ‰Π΅Π³ΠΎ ΠΏΡ€ΠΎΡ‚ΠΈΠ²ΠΎΠΎΠΏΡƒΡ…ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ лСчСния. Π’ исслСдовании использована разработанная Π°Π²Ρ‚ΠΎΡ€Π°ΠΌΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ° ΠΏΡ€ΠΎΠ»ΠΎΠ½Π³ΠΈΡ€ΠΎΠ²Π°Π½Π½ΠΎΠΉ фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ с ΠΏΡ€Π΅ΠΏΠ°Ρ€Π°Ρ‚ΠΎΠΌ фотосСнс, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΉ Π²Π²ΠΎΠ΄ΠΈΠ»ΠΈ Π²Π½ΡƒΡ‚Ρ€ΠΈΠ²Π΅Π½Π½ΠΎ Π² Π΄ΠΎΠ·Π΅ 0,4 ΠΌΠ³/ΠΊΠ³ массы Ρ‚Π΅Π»Π° больного. ΠŸΠ΅Ρ€Π²Ρ‹ΠΉ сСанс облучСния ΠΎΠΏΡƒΡ…ΠΎΠ»Π΅Π²Ρ‹Ρ… ΠΎΡ‡Π°Π³ΠΎΠ² ΠΏΡ€ΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Ρ‡Π΅Ρ€Π΅Π· 2 Ρ‡ послС ввСдСния фотосСнсибилизатора. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°ΠΌ выполняли повСрхностноС ΠΈΠ»ΠΈ ΠΊΠΎΠ½Ρ‚Π°ΠΊΡ‚Π½ΠΎΠ΅ ΠΎΠ±Π»ΡƒΡ‡Π΅Π½ΠΈΠ΅ Π² зависимости ΠΎΡ‚ Ρ‚ΠΎΠΏΠΎΠ³Ρ€Π°Ρ„ΠΈΠΈ ΠΈ Ρ…Π°Ρ€Π°ΠΊΡ‚Π΅Ρ€Π° роста мСтастатичСского ΡƒΠ·Π»Π°. ΠšΡƒΡ€Ρ лСчСния – 7–10 сСансов фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ с ΠΈΠ½Ρ‚Π΅Ρ€Π²Π°Π»ΠΎΠΌ Π² 24 Ρ‡, ΠΏΠ»ΠΎΡ‚Π½ΠΎΡΡ‚ΡŒ энСргии Π»Π°Π·Π΅Ρ€Π½ΠΎΠ³ΠΎ излучСния, ΠΏΠΎΠ΄Π²ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΠΊ ΠΎΠΏΡƒΡ…ΠΎΠ»ΠΈ Π·Π° ΠΎΠ΄ΠΈΠ½ сСанс – 350 Π”ΠΆ/см2. ΠŸΡ€ΠΈ ΠΏΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½Π½ΠΎΠΉ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠΈ ΠΏΠΎΠ»ΡƒΡ‡Π΅Π½ ΠΎΠ±ΡŠΠ΅ΠΊΡ‚ΠΈΠ²Π½Ρ‹ΠΉ клиничСский эффСкт (полная ΠΈ частичная рСгрСссия ΠΎΠΏΡƒΡ…ΠΎΠ»ΠΈ) Π² 89% наблюдСний.

    Peptide Detection of Fungal Functional Amyloids in Infected Tissue

    Get PDF
    Many fungal cell adhesion proteins form functional amyloid patches on the surface of adhering cells. The Candida albicans Agglutinin-like sequence (Als) adhesins are exemplars for this phenomenon, and have amyloid forming sequences that are conserved between family members. The Als5p amyloid sequence mediates amyloid fibril formation and is critical for cell adhesion and biofilm formation, and is also present in the related adhesins Als1p and Als3p. We have developed a fluorescent peptide probe containing the conserved Als amyloid-forming sequence. This peptide bound specifically to yeast expressing Als5p, but not to cells lacking the adhesin. The probe bound to both yeast and hyphal forms of C. albicans. Ξ”als1/Ξ”als3 single and double deletion strains exhibited reduced fluorescence, indicating that probe binding required expression of these proteins. Additionally, the Als peptide specifically stained fungal cells in abscesses in autopsy sections. Counterstaining with calcofluor white showed colocalization with the amyloid peptide. In addition, fungi in autopsy sections derived from the gastrointestinal tract showed colocalization of the amyloid-specific dye thioflavin T and the fluorescent peptide. Collectively, our data demonstrate that we can exploit amyloid sequence specificity for detection of functional amyloids in situ

    Growth, structure analysis and anisotropic superconducting properties of MgB2 single crystals

    Full text link
    Here we report the growth of sub-millimeter MgB2 single crystals of various shapes under high pressure in Mg-B-N system. Structure refinement using a single-crystal X-ray diffraction analysis gives lattice parameters a=3.0851(5) A and c=3.5201(5) A with small reliability factors (Rw =0.025, R=0.018), which enables us to analyze the Fourier and Fourier difference maps. The maps clearly show the B sp2 orbitals and covalency of the B-B bonds. The sharp superconducting transitions at Tc =38.1-38.3K were obtained in both magnetization (DTc =0.6K) and resistivity (DTc <0.3K) measurements. Resistivity measurements with magnetic fields applied parallel and perpendicular to the Mg and B sheets reveal the anisotropic nature of this compound, with upper critical field anisotropy ratio of about 2.7.Comment: 9 pages, 5 figures and 1 tabl

    Π˜ΠΠ’Π ΠΠžΠŸΠ•Π ΠΠ¦Π˜ΠžΠΠΠΠ― Π€ΠžΠ’ΠžΠ”Π˜ΠΠΠœΠ˜Π§Π•Π‘ΠšΠΠ― Π’Π•Π ΠΠŸΠ˜Π― Π‘ΠžΠ›Π¬ΠΠ«Π₯ РАКОМ Π–Π•Π›Π£Π”ΠšΠ

    Get PDF
    Results of intraoperative photodynamic therapy (IOPDT) in patients with gastric cancer are represented in the article. The study included 240Β patients with gastric cancer stage II-IV (Π’3-4N0-3M0-1) withΒ  evident or suspected peritoneal dissemination who underwentΒ  examination andΒ treatment in P.Herzen Moscow Oncology ResearchΒ  Institute. The group 1, the study group, included 140 patients whoΒ  underwent nominallyΒ curative or palliative surgery for locallyΒ  advanced and disseminated gastric cancer with IOPDT as additionalΒ  intraoperative intervention forΒ antiblastics and cancer treatment. The group 2, the control group, included 100 patients who alsoΒ  underwent nominally curative or palliativeΒ surgery (equal to extentΒ  of surgery in patients from the study group) for locally advanced and disseminated gastric cancer and no intraoperativeΒ implication of physical or chemical treatment methods. IOPDT did not worsen a course of early post-operative period, did not impact onΒ severity ofΒ  post-operative complications and was not associated with increase of post-operative mortality. IOPDT allowed for improvement ofΒ 1-yearΒ  and 3-year disease-specifi c survival rates: by 16.1% and 16.7%,Β  respectively. For nominally curative resections, median survival, 1- yearΒ and 3-year disease-specifi c survival rates were improved by 14 months, 17.8% and 31.3%, respectively. For R1, R2 resections,Β  IOPDT improvedΒ 1-year disease-specifi c survival rates by 16.4%. Additionally, for nominally curative resections IOPDT did not increase the recurrence rate andΒ improved median recurrence-free survival,Β  1-year and 3-year recurrence-free survival rates by 16 months,Β  27.2% and 25.4%, respectively.Β Π’ ΡΡ‚Π°Ρ‚ΡŒΠ΅ прСдставлСны Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ примСнСния ΠΈΠ½Ρ‚Ρ€Π°ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΎΠ½Π½ΠΎΠΉ фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (Π˜ΠžΠ€Π”Π’) Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Ρ€Π°ΠΊΠΎΠΌΒ ΠΆΠ΅Π»ΡƒΠ΄ΠΊΠ°. Π’ исслСдованиС Π²ΠΊΠ»ΡŽΡ‡Π΅Π½Ρ‹ 240 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ²Β  Ρ€Π°ΠΊΠΎΠΌ ΠΆΠ΅Π»ΡƒΠ΄ΠΊΠ° II-IV стадии (Π’3-4N0-3M0-1) с Π½Π°Π»ΠΈΡ‡ΠΈΠ΅ΠΌ ΠΈΠ»ΠΈ ΠΏΠΎΠ΄ΠΎΠ·Ρ€Π΅Π½ΠΈΠ΅ΠΌΒ Π½Π°Β  ΠΏΠ΅Ρ€ΠΈΡ‚ΠΎΠ½Π΅Π°Π»ΡŒΠ½ΡƒΡŽ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½Π°Ρ†ΠΈΡŽ, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΌ Π² МНИОИ ΠΈΠΌ. П.А. Π“Π΅Ρ€Ρ†Π΅Π½Π° Π±Ρ‹Π»ΠΈ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½Ρ‹Β  обслСдованиС ΠΈ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅. Π’ ΠΏΠ΅Ρ€Π²ΡƒΡŽ,Β ΠΎΡΠ½ΠΎΠ²Π½ΡƒΡŽ Π³Ρ€ΡƒΠΏΠΏΡƒ Π²ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΎ 140 Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ…, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΌΒ  Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½Ρ‹ условно-Ρ€Π°Π΄ΠΈΠΊΠ°Π»ΡŒΠ½Ρ‹Π΅ ΠΈΠ»ΠΈ ΠΏΠ°Π»Π»ΠΈΠ°Ρ‚ΠΈΠ²Π½Ρ‹Π΅ ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΈ ΠΏΠΎ поводу мСстно- распространСнного ΠΈ диссСминированного Ρ€Π°ΠΊΠ° ΠΆΠ΅Π»ΡƒΠ΄ΠΊΠ° с ΠΏΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Π² качСствС ΠΌΠ΅Ρ‚ΠΎΠ΄Π°Β  Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΠ³ΠΎΒ ΠΈΠ½Ρ‚Ρ€Π°ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ воздСйствия с Ρ†Π΅Π»ΡŒΡŽ ΠΈΠ½Ρ‚Ρ€Π°ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΎΠ½Π½ΠΎΠΉΒ  антибластики ΠΈ ΠΏΡ€ΠΎΡ‚ΠΈΠ²ΠΎΠΎΠΏΡƒΡ…ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ воздСйствия – Π˜ΠžΠ€Π”Π’. Π’Ρ‚ΠΎΡ€ΡƒΡŽ,Β ΠΊΠΎΠ½Ρ‚Ρ€ΠΎΠ»ΡŒΠ½ΡƒΡŽ Π³Ρ€ΡƒΠΏΠΏΡƒΒ  составили 100 Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ…, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΌ Π±Ρ‹Π»ΠΈ Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½Ρ‹ Ρ‚Π°ΠΊΠΆΠ΅ условно-Ρ€Π°Π΄ΠΈΠΊΠ°Π»ΡŒΠ½Ρ‹Π΅ ΠΈΒ  ΠΏΠ°Π»Π»ΠΈΠ°Ρ‚ΠΈΠ²Π½Ρ‹Π΅ ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΈΒ (ΠΏΠΎ ΠΎΠ±ΡŠΠ΅ΠΌΡƒ ΡΠΎΠΎΡ‚Π²Π΅Ρ‚ΡΡ‚Π²ΡƒΡŽΡ‰ΠΈΠ΅ хирургичСским Π²ΠΌΠ΅ΡˆΠ°Ρ‚Π΅Π»ΡŒΡΡ‚Π²Π°ΠΌ ΡƒΒ  Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… основной Π³Ρ€ΡƒΠΏΠΏΡ‹) ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρƒ мСстно-распространСнного и диссСминированного Ρ€Π°ΠΊΠ° ΠΆΠ΅Π»ΡƒΠ΄ΠΊΠ° Π±Π΅Π· ΠΈΠ½Ρ‚Ρ€Π°ΠΎΠΏΠ΅Ρ€Π°Ρ†ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ примСнСния физичСских ΠΈΠ»ΠΈ химичСских ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΎΠ²Β  воздСйствия.Β Π˜ΠžΠ€Π”Π’ Π½Π΅ ΡƒΡ…ΡƒΠ΄ΡˆΠΈΠ»Π° Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ Ρ€Π°Π½Π½Π΅Π³ΠΎ послСопСрационного ΠΏΠ΅Ρ€ΠΈΠΎΠ΄Π°, Π½Π΅ влияла Π½Π° Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒ послСопСрационных ослоТнСний ΠΈ нС ассоциирована с ΡƒΠ²Π΅Π»ΠΈΡ‡Π΅Π½ΠΈΠ΅ΠΌΒ  послСопСрационной Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π˜ΠžΠ€Π”Π’ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΡƒΠ»ΡƒΡ‡ΡˆΠΈΡ‚ΡŒ ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ 1- Π»Π΅Ρ‚Π½Π΅ΠΉΒ ΠΈ 3-Π»Π΅Ρ‚Π½Π΅ΠΉ ΠΎΠ±Ρ‰Π΅ΠΉ спСцифичСской выТиваСмости: Π½Π° 16,1% ΠΈ 16,7%, соотвСтствСнно. ΠŸΡ€ΠΈ условно-Ρ€Π°Π΄ΠΈΠΊΠ°Π»ΡŒΠ½Ρ‹Ρ… опСрациях – мСдиану выТиваСмости Π½Π° 14 мСс, ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ 1- Π»Π΅Ρ‚Π½Π΅ΠΉ ΠΈ 3-Π»Π΅Ρ‚Π½Π΅ΠΉ ΠΎΠ±Ρ‰Π΅ΠΉ спСцифичСской выТиваСмости – Π½Π° 17,8% ΠΈ 31,3%, соотвСтствСнно. ΠŸΡ€ΠΈ опСрациях Π² объСмС R1, R2 ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π˜ΠžΠ€Π”Π’ ΡƒΠ»ΡƒΡ‡ΡˆΠΈΠ»ΠΎ 1- Π»Π΅Ρ‚Π½ΡŽΡŽ ΠΎΠ±Ρ‰ΡƒΡŽ ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ Π²Ρ‹ΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡ‚ΡŒΒ Π½Π° 16,4%. ΠšΡ€ΠΎΠΌΠ΅ Ρ‚ΠΎΠ³ΠΎ, ΠΏΡ€ΠΈ условно- Ρ€Π°Π΄ΠΈΠΊΠ°Π»ΡŒΠ½Ρ‹Ρ… опСрациях ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π˜ΠžΠ€Π”Π’ Π½Π΅ ΡƒΠ²Π΅Π»ΠΈΡ‡ΠΈΠ»ΠΎ частоту Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²ΠΎΠ² ΠΈ ΡƒΠ»ΡƒΡ‡ΡˆΠΈΠ»ΠΎ ΠΌΠ΅Π΄ΠΈΠ°Π½Ρƒ Π±Π΅Π·Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ выТиваСмости Π½Π° 16 мСс, ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ 1-Π»Π΅Ρ‚Π½Π΅ΠΉ ΠΈ 3-Π»Π΅Ρ‚Π½Π΅ΠΉ Π±Π΅Π·Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ выТиваСмости – Π½Π° 27,2% ΠΈ 25,4%, соотвСтствСнно

    ЀотодинамичСская тСрапия ΠΏΡ€ΠΈ Ρ€Π°ΠΊΠ΅ ΠΊΠΎΠΆΠΈ Π»ΠΈΡ†Π°, Ρ€Π°Π·Π²ΠΈΠ²ΡˆΠ΅Π³ΠΎΡΡ Π² Π·ΠΎΠ½Π΅ ΠΏΡ€Π΅Π΄ΡˆΠ΅ΡΡ‚Π²ΡƒΡŽΡ‰Π΅ΠΉ Π»ΡƒΡ‡Π΅Π²ΠΎΠΉ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (клиничСскоС наблюдСниС)

    Get PDF
    The results of a 13-year clinical observation of a patient after treatment for basal cell carcinoma of the skin of the right cheek Ist cT1N0M0 are presented. The history of the course of the disease is associated with the fact that the patient underwent radiation therapy in early childhood for hemangioma of the lower eyelid of the right eye and right cheek. In 2008, against the background of post-radiation changes in the area of the right cheek, basal cell carcinoma was diagnosed at the Moscow Oncological Research Institute. P.A. Herzen. At the Center for Laser and Photodynamic Diagnostics and Tumor Therapy, the patient underwent organ-preserving PDT treatment. A course of photodynamic therapy (PDT) with 5-aminolevulic acid was carried out. Subsequently, the patient was followed up until 2021 without relapse in the PDT area. In 2016, the patient was diagnosed with a relapse of the disease in the form of a new focus of basal cell carcinoma of the upper eyelid skin on the right Iast cT1N0M0. The patient underwent a course of PDT with a chlorin e6-based photosensitizer. Complete regression of the tumor was achieved, the period of relapse-free follow-up was 5 years.ΠŸΡ€ΠΈΠ²Π΅Π΄Π΅Π½Ρ‹ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ 13-Π»Π΅Ρ‚Π½Π΅Π³ΠΎ клиничСского наблюдСния ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠΈ послС лСчСния Π±Π°Π·Π°Π»ΡŒΠ½ΠΎΠΊΠ»Π΅Ρ‚ΠΎΡ‡Π½ΠΎΠ³ΠΎ Ρ€Π°ΠΊΠ° ΠΊΠΎΠΆΠΈ ΠΏΡ€Π°Π²ΠΎΠΉ Ρ‰Π΅ΠΊΠΈ I ст сВ2N0M0. АнамнСз заболСвания связан с Ρ‚Π΅ΠΌ, Ρ‡Ρ‚ΠΎ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠ΅ Π² Ρ€Π°Π½Π½Π΅ΠΌ дСтствС ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρƒ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΠΌΡ‹ Π½ΠΈΠΆΠ½Π΅Π³ΠΎ Π²Π΅ΠΊΠ° ΠΏΡ€Π°Π²ΠΎΠ³ΠΎ Π³Π»Π°Π·Π° ΠΈ ΠΏΡ€Π°Π²ΠΎΠΉ Ρ‰Π΅ΠΊΠΈ Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½Π° лучСвая тСрапия. Π’ 2008 Π³., Π½Π° Ρ„ΠΎΠ½Π΅ постлучСвых ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π² области ΠΏΡ€Π°Π²ΠΎΠΉ Ρ‰Π΅ΠΊΠΈ, диагностирован Π±Π°Π·Π°Π»ΡŒΠ½ΠΎΠΊΠ»Π΅Ρ‚ΠΎΡ‡Π½Ρ‹ΠΉ Ρ€Π°ΠΊ Π² МНИОИ ΠΈΠΌ. П.А. Π“Π΅Ρ€Ρ†Π΅Π½Π°. Π’ Π¦Π΅Π½Ρ‚Ρ€Π΅ Π»Π°Π·Π΅Ρ€Π½ΠΎΠΉ ΠΈ фотодинамичСской диагностики ΠΈ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ ΠΎΠΏΡƒΡ…ΠΎΠ»Π΅ΠΉ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠ΅ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΡ€Π³Π°Π½ΠΎΡΠΎΡ…Ρ€Π°Π½ΡΡŽΡ‰Π΅Π΅ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΎΠΌ Π€Π”Π’. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½ курс фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (Π€Π”Π’) с 5-Π°ΠΌΠΈΠ½ΠΎΠ»Π΅Π²ΡƒΠ»ΡŒΠ½ΠΎΠ²ΠΎΠΉ кислотой. Π’ ΠΏΠΎΡΠ»Π΅Π΄ΡƒΡŽΡ‰Π΅ΠΌ больная наблюдалась 13 Π»Π΅Ρ‚ Π±Π΅Π· Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²Π° Π² Π·ΠΎΠ½Π΅ Π€Π”Π’. Π’ 2016 Π³ Ρƒ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠΈ диагностирован Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ² заболСвания Π² Π²ΠΈΠ΄Π΅ Π½ΠΎΠ²ΠΎΠ³ΠΎ ΠΎΡ‡Π°Π³Π° Π±Π°Π·Π°Π»ΡŒΠ½ΠΎΠΊΠ»Π΅Ρ‚ΠΎΡ‡Π½ΠΎΠ³ΠΎ Ρ€Π°ΠΊΠ° ΠΊΠΎΠΆΠΈ Π²Π΅Ρ€Ρ…Π½Π΅Π³ΠΎ Π²Π΅ΠΊΠ° справа IА ст сВ1N0M0. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΊΠ΅ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ курс Π€Π”Π’ с фотосСнсибилизатором Π½Π° основС Ρ…Π»ΠΎΡ€ΠΈΠ½Π° Π΅6. Достигнута полная рСгрСссия ΠΎΠΏΡƒΡ…ΠΎΠ»ΠΈ, срок Π±Π΅Π·Ρ€Π΅Ρ†ΠΈΠ΄ΠΈΠ²Π½ΠΎΠ³ΠΎ наблюдСния – 5 Π»Π΅Ρ‚

    ЀотодинамичСская тСрапия Π² Π»Π΅Ρ‡Π΅Π½ΠΈΠΈ ΠΈΠ½Ρ‚Ρ€Π°ΡΠΏΠΈΡ‚Π΅Π»ΠΈΠ°Π»ΡŒΠ½Ρ‹Ρ… Π½Π΅ΠΎΠΏΠ»Π°Π·ΠΈΠΉ шСйки ΠΌΠ°Ρ‚ΠΊΠΈ, Π²ΡƒΠ»ΡŒΠ²Ρ‹ ΠΈ Π²Π»Π°Π³Π°Π»ΠΈΡ‰Π°

    Get PDF
    In the present review the authors analyzed the effectiveness of treatment of intraepithelial neoplasia I-II-III of the cervix (CIN), vulva (VIN) and vagina (VaIN) using photodynamic therapy (PDT). PDT is a method based on exposure to light after preliminary introduction of a photosensitizer into the body with the formation of singlet oxygen, which has a cytotoxic effect. The results of research on the use of PDT with various photosensitizers in the complex of therapeutic measures in patients with CIN, VIN, VaIN are presented. These data on the effectiveness and safety of PDT, ease of use allow this medical technology to be attributed to one of the most promising areas in the treatment of pathological intraepithelial changes of the cervix, vulva and vagina. The presented information allows focusing the attention on the PDT method and informing doctors and researchers about the broad prospects for applying this treatment method in clinical practice.Π’ ΠΎΠ±Π·ΠΎΡ€Π΅ Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹ прСдставлСн Π°Π½Π°Π»ΠΈΠ· эффСктивности лСчСния ΠΈΠ½Ρ‚Ρ€Π°ΡΠΏΠΈΡ‚Π΅Π»ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ Π½Π΅ΠΎΠΏΠ»Π°Π·ΠΈΠΈ I-II-III стСпСни шСйки ΠΌΠ°Ρ‚ΠΊΠΈ (CIN), Π²ΡƒΠ»ΡŒΠ²Ρ‹ (VIN) ΠΈ Π²Π»Π°Π³Π°Π»ΠΈΡ‰Π° (VaIN) с использованиСм фотодинамичСской Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (Π€Π”Π’). Π€Π”Π’ – ΠΌΠ΅Ρ‚ΠΎΠ΄, основанный Π½Π° воздСйствии свСтом послС ΠΏΡ€Π΅Π΄Π²Π°Ρ€ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΠ³ΠΎ ввСдСния Π² ΠΎΡ€Π³Π°Π½ΠΈΠ·ΠΌ фотосСнсибилизатора с ΠΎΠ±Ρ€Π°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ синглСтного кислорода, ΠΎΠΊΠ°Π·Ρ‹Π²Π°ΡŽΡ‰Π΅Π³ΠΎ цитотоксичСский эффСкт. ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²Π»Π΅Π½Ρ‹ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ исслСдований ΠΏΠΎ использованию Π€Π”Π’ с Ρ€Π°Π·Π»ΠΈΡ‡Π½Ρ‹ΠΌΠΈ фотосСнсибилизаторами Π² комплСксС Π»Π΅Ρ‡Π΅Π±Π½Ρ‹Ρ… мСроприятий Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с CIN, VIN, VaIN. ΠŸΡ€ΠΈΠ²Π΅Π΄Π΅Π½Π½Ρ‹Π΅ Π΄Π°Π½Π½Ρ‹Π΅ ΠΎΠ± эффСктивности ΠΈ бСзопасности Π€Π”Π’, простота примСнСния ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡŽΡ‚ Π΄Π°Π½Π½ΡƒΡŽ ΠΌΠ΅Π΄ΠΈΡ†ΠΈΠ½ΡΠΊΡƒΡŽ Ρ‚Π΅Ρ…Π½ΠΎΠ»ΠΎΠ³ΠΈΡŽ отнСсти ΠΊ числу Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ пСрспСктивных Π½Π°ΠΏΡ€Π°Π²Π»Π΅Π½ΠΈΠΈΜ† Π² Π»Π΅Ρ‡Π΅Π½ΠΈΠΈ Ρ€Π°Π·Π»ΠΈΡ‡Π½ΠΎΠΉ стСпСни выраТСнности ΠΈΠ½Ρ‚Ρ€Π°ΡΠΏΠΈΡ‚Π΅Π»ΠΈΠ°Π»ΡŒΠ½Ρ‹Ρ… ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ шСйки ΠΌΠ°Ρ‚ΠΊΠΈ, Π²ΡƒΠ»ΡŒΠ²Ρ‹ ΠΈ Π²Π»Π°Π³Π°Π»ΠΈΡ‰Π°. ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²Π»Π΅Π½Π½Π°Ρ информация ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ‚ Π°ΠΊΡ†Π΅Π½Ρ‚ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π½Π° Π€Π”Π’ ΠΈ ΠΈΠ½Ρ„ΠΎΡ€ΠΌΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Π²Ρ€Π°Ρ‡Π΅ΠΈΜ† ΠΈ Π½Π°ΡƒΡ‡Π½Ρ‹Ρ… сотрудников ΠΎ ΡˆΠΈΡ€ΠΎΠΊΠΈΡ… пСрспСктивах примСнСния Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅Ρ‚ΠΎΠ΄Π° Π² клиничСской ΠΏΡ€Π°ΠΊΡ‚ΠΈΠΊΠ΅
    • …
    corecore