41 research outputs found
Effect of cerebrolysin on motor function restoration during medical rehabilitation
Ischemic stroke (IS) is characterized by high prevalence, mortality, and disability rates. Therapy aimed to correct one biochemical or molecular stage of ischemic cell injury fails to treat stroke, suggesting that it is necessary to study multimodality therapy affecting several related pathophysiological components.The paper gives the January 2016 results of the randomized placebo-controlled multicenter study CARS that demonstrates the positive effect of cerebrolysin versus placebo according to the primary efficiency criterion, the Action Research Arm Test (ARAT) scale, and total outcome 90 days after disease onset. The investigation enrolled mainly patients with moderate or severe IS (the mean National Institutes of Health Stroke Scale score was 9 at baseline).The specific features of the CARS study versus those of other clinical trials of neuroprotectors were the initial planning of narrower end criteria of efficiency (arm motor function recovery whereas the major goal of many investigations was to reduce mortality rates), as well as a standardized rehabilitation program in both treatment groups. Such investigations did not previously take into account the nature and volume of rehabilitation measures although the latter may have a substantial impact on the outcome of stroke.The CARS study is the first among the previously conducted clinical trials of neuroprotectors, which has attained the primary objective (to restore motor function), which opens up fresh opportunities for the medical support of rehabilitation measures in patients with IS
Problems of Selecting an Anticoagulant for Secondary Stroke Prevention in Patients with Atrial Fibrillation
The article describes the urgent problem of ischemic stroke prevention in patients with atrial fibrillation. It is proved that ischemic stroke in combination with AF is the most severe in terms of developing stable motor and speech disorders and disability. The frail older patients, as well as patients with swallowing disorders and reduced medical adherence present a special problem from this point of view. The most famous clinical studies on secondary prevention of cardioembolic stroke are RE-LY, ROCKET-AF, and ARISTOTLE. Based on subanalyses of randomized controlled trials, direct oral anticoagulants demonstrated a favorable efficacy profile in patients with atrial fibrillation and stroke/ transient ischemic attack, but the level of knowledge on each of them remained different. A number of advantages of rivaroxaban for primary and secondary prevention of stroke in patients with atrial fibrillation, including the elderly and patients with cognitive impairments and swallowing disorders, have been demonstrated. Β© 2021 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.Relationships and Activities. This publication was supported by AO Bayer (PPM_RIVRU00581)
ΠΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΊΠ°ΠΊ ΡΠ°ΠΊΡΠΎΡ ΡΠΈΡΠΊΠ° ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°
Background. Acute cerebrovascular accidents in general, and ischemic stroke (IS) in particular, are multifactorial diseases with extremely heterogeneous and numerous risk factors. Currently, despite the development of diagnostic technologies, in approximately 25% of patients with IS, it is not possible to establish the causes and mechanism of its development (the so-called cryptogenic stroke (CS)). As a result, the optimal antithrombotic therapy as a secondary prevention in this group of patients remains unclear. It was found that in 10β20% of patients with CS, a detailed examination reveals oncological disease (OD). It is highly likely that the prevalence of OD-related IS will increase. The US National Cancer Registry has shown a decrease in mortality in patients with the most common forms of OD (lung, breast and prostate cancer). Active OD is a proven risk factor for both IS and other thrombotic events. Nevertheless, about 50% of IS in patients with OD are classified as cryptogenic, which significantly exceeds this indicator in patients without OD. This is associated with the difficulties of intravital diagnosis of the pathogenetic mechanism of IS in patients with OD.Aim of study. Raising the awareness of neurologists about the causes, pathogenetic mechanisms of development and methods of diagnosing IS in patients with OD.Materials and methods. To achieve this goal, the results of scientific research on OD as a risk factor for CS were analyzed. The literature search was carried out in electronic search engines Scopus, eLibrary, PubMed by keywords: ischemic stroke, cryptogenic stroke, cancer, pathogenesis of ischemic stroke. Scientific articles published between 1856 and 2021 were selected for analysis, 45% of the analyzed papers on the topic of CS were published not earlier than 5 years ago.Conclusion. The cause of the development of ischemic stroke can be both the oncological process itself and the means and methods of treating it. Despite the fact that in 10β20% of patients with cryptogenic stroke OD is diagnosed, the question remains whether patients with cryptogenic ischemic stroke should be screened for latent oncological pathology, and if so, how full should the screening be. Typical radiological patterns of ischemic stroke in patients with OD are multiple foci of acute cerebral ischemia in different vascular areas, which may indicate a cardioembolic nature and, in particular, non-bacterial thrombotic endocarditis. Lifetime diagnosis of the causes of cryptogenic stroke in patients with OD is extremely difficult. Since nonbacterial thrombotic endocarditis is one of the leading causes of cryptogenic stroke in the setting of cancer, it is advisable to perform transesophageal echocardiography due to the low sensitivity of transthoracic echocardiography.Β ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΡΡΡΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΌΠΎΠ·Π³ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π² ΡΠ΅Π»ΠΎΠΌ, ΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ (ΠΠ) Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ, ΡΠ²Π»ΡΡΡΡΡ ΠΌΡΠ»ΡΡΠΈΡΠ°ΠΊΡΠΎΡΠΈΠ°Π»ΡΠ½ΡΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ Ρ ΡΡΠ΅Π·Π²ΡΡΠ°ΠΉΠ½ΠΎ Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΡΠΌΠΈ ΠΈ ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΡΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠΈΡΠΊΠ°. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ, Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΉ, ΠΏΡΠΈΠ±Π»ΠΈΠ·ΠΈΡΠ΅Π»ΡΠ½ΠΎ Ρ 25% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ Π½Π΅ ΡΠ΄Π°Π΅ΡΡΡ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΈ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ°ΠΊΠΎΠ²ΠΎΠ³ΠΎ (ΡΠ°ΠΊ Π½Π°Π·ΡΠ²Π°Π΅ΠΌΡΠΉ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΉ ΠΈΠ½ΡΡΠ»ΡΡ (ΠΠ)), Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΡΠ΅Π³ΠΎ ΠΎΡΡΠ°Π΅ΡΡΡ Π½Π΅ΡΡΠ½ΠΎΠΉ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½Π°Ρ Π°Π½ΡΠΈΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Π² ΡΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ Ρ 10β20% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΏΡΠΈ Π΄Π΅ΡΠ°Π»ΡΠ½ΠΎΠΌ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Π²ΡΡΠ²Π»ΡΡΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ (ΠΠ). ΠΠ΅ΡΡΠΌΠ° Π²Π΅ΡΠΎΡΡΠ½ΠΎ, ΡΡΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ ΠΠ, ΡΠ²ΡΠ·Π°Π½Π½ΠΎΠ³ΠΎ Ρ ΠΠ, Π±ΡΠ΄Π΅Ρ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°ΡΡΡΡ. ΠΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ΅Π³ΠΈΡΡΡ Π‘Π¨Π ΠΏΠΎΠΊΠ°Π·Π°Π» ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ ΠΠ (ΡΠ°ΠΊ Π»Π΅Π³ΠΊΠΈΡ
, Π³ΡΡΠ΄ΠΈ ΠΈ ΠΏΡΠΎΡΡΠ°ΡΡ). ΠΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΠ ΡΠ²Π»ΡΠ΅ΡΡΡ Π΄ΠΎΠΊΠ°Π·Π°Π½Π½ΡΠΌ ΡΠ°ΠΊΡΠΎΡΠΎΠΌ ΡΠΈΡΠΊΠ° ΠΊΠ°ΠΊ ΠΠ, ΡΠ°ΠΊ ΠΈ Π΄ΡΡΠ³ΠΈΡ
ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΠ±ΡΡΠΈΠΉ. Π’Π΅ΠΌ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ ΠΎΠΊΠΎΠ»ΠΎ 50% ΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΠΊΠ»Π°ΡΡΠΈΡΠΈΡΠΈΡΡΡΡ ΠΊΠ°ΠΊ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠ΅, ΡΡΠΎ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΡΠ΅Π²ΡΡΠ°Π΅Ρ Π΄Π°Π½Π½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΡΠΎ ΡΠ²ΡΠ·Π°Π½ΠΎ ΡΠΎ ΡΠ»ΠΎΠΆΠ½ΠΎΡΡΡΠΌΠΈ ΠΏΡΠΈΠΆΠΈΠ·Π½Π΅Π½Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠ° ΠΠ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΠ.Π¦Π΅Π»Ρ ΡΠ°Π±ΠΎΡΡ. ΠΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΡΡΠΈ Π²ΡΠ°ΡΠ΅ΠΉ-Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΎΠ² ΠΎ ΠΏΡΠΈΡΠΈΠ½Π°Ρ
, ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠ°Ρ
ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Π°Ρ
Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ»Ρ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΠΏΠΎΡΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ ΡΠ΅Π»ΠΈ Π±ΡΠ»ΠΈ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π½Π°ΡΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΡ
ΠΠ ΠΊΠ°ΠΊ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΠΠ. ΠΠΎΠΈΡΠΊ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Π² ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π½ΡΡ
ΠΏΠΎΠΈΡΠΊΠΎΠ²ΡΡ
ΡΠΈΡΡΠ΅ΠΌΠ°Ρ
Scopus, eLibrary, PubMed ΠΏΠΎ ΠΊΠ»ΡΡΠ΅Π²ΡΠΌ ΡΠ»ΠΎΠ²Π°ΠΌ: ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ, ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΉ ΠΈΠ½ΡΡΠ»ΡΡ, ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π· ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°. ΠΠ»Ρ Π°Π½Π°Π»ΠΈΠ·Π° Π±ΡΠ»ΠΈ ΠΎΡΠΎΠ±ΡΠ°Π½Ρ Π½Π°ΡΡΠ½ΡΠ΅ ΡΡΠ°ΡΡΠΈ, ΠΎΠΏΡΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½Π½ΡΠ΅ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 1856 ΠΏΠΎ 2021 Π³ΠΎΠ΄. 45% ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΡΠ°Π±ΠΎΡ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΡ
ΡΠ΅ΠΌΠ΅ ΠΠ, ΠΎΠΏΡΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½Ρ Π½Π΅ Π±ΠΎΠ»Π΅Π΅ 5 Π»Π΅Ρ Π½Π°Π·Π°Π΄.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΡΠΈΠ½ΠΎΠΉ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΊΠ°ΠΊ ΡΠ°ΠΌ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΎΡΠ΅ΡΡ, ΡΠ°ΠΊ ΠΈ ΡΡΠ΅Π΄ΡΡΠ²Π° ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°ΠΊΠΎΠ²ΠΎΠ³ΠΎ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΠΎ ΡΡΠΎ Ρ 10β20% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠΌ Π²ΡΡΠ²Π»ΡΡΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΎΡΡΠ°Π΅ΡΡΡ ΠΎΡΠΊΡΡΡΡΠΌ Π²ΠΎΠΏΡΠΎΡ, Π΄ΠΎΠ»ΠΆΠ½Ρ Π»ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΌ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠΌ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΡΡ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ Π½Π° ΡΠΊΡΡΡΡΡ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡ, ΠΈ Π΅ΡΠ»ΠΈ Π΄Π°, ΡΠΎ Π² ΠΊΠ°ΠΊΠΎΠΌ ΠΎΠ±ΡΠ΅ΠΌΠ΅. Π’ΠΈΠΏΠΈΡΠ½ΡΠΌΠΈ ΡΠ°Π΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΠ°ΡΡΠ΅ΡΠ½Π°ΠΌΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΠΌΠΈ ΡΠ²Π»ΡΡΡΡΡ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΎΡΠ°Π³ΠΈ ΠΎΡΡΡΠΎΠΉ ΡΠ΅ΡΠ΅Π±ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ Π² ΡΠ°Π·Π½ΡΡ
ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
Π±Π°ΡΡΠ΅ΠΉΠ½Π°Ρ
, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΌΠΎΠ³ΡΡ ΡΠΊΠ°Π·ΡΠ²Π°ΡΡ Π½Π° ΠΊΠ°ΡΠ΄ΠΈΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠΈΡΠΎΠ΄Ρ ΠΈ Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ Π½Π΅Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ. ΠΡΠΈΠΆΠΈΠ·Π½Π΅Π½Π½Π°Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° ΠΏΡΠΈΡΠΈΠ½ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΠ»ΠΎΠΆΠ½Π°. Π’Π°ΠΊ ΠΊΠ°ΠΊ ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· Π²Π΅Π΄ΡΡΠΈΡ
ΠΏΡΠΈΡΠΈΠ½ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° Π½Π° ΡΠΎΠ½Π΅ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ, ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΡΡΠ΅ΡΠΏΠΈΡΠ΅Π²ΠΎΠ΄Π½ΠΎΠΉ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ Π² ΡΠ²ΡΠ·ΠΈ Ρ Π½ΠΈΠ·ΠΊΠΎΠΉ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡΡ ΡΡΠ°Π½ΡΡΠΎΡΠ°ΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ.
The role of smoking in the development of strokes at a young age
Stroke in young patients is a disease based on a number of known specific non-modifiable factors (extracranial artery dissection, thrombophilia, open oval hole, etc.) and modifiable factors (alcohol abuse, drug use, smoking, etc.), in combination leading to the development of pathology. Smoking is a generally recognized modifiable risk factor for stroke, which is directly proportional to the number of tobacco-containing products smoked. Quitting smoking is the basis of prevention, an integral part of the treatment and rehabilitation of stroke patients. If it is impossible to completely give up smoking combustible cigarettes, it is advisable to switch to alternative smokeless products. This article presents the results of current studies on the comparative assessment of the risk of stroke in young people when using combustible cigarettes and smokeless analogues
Evaluation of Synthetic Conditions for H3PO4 Chemically Activated Rice Husk and Preparation of Honeycomb Monoliths
Activated carbons in this work were prepared from rice husk by phosphoric acid activation followed by alkaline desilication. Pseudo-random selection of 16 rice husk samples was subjected to carbonization at the
following conditions: 0.5 to 2 h of activation time, 300-600 ΒΊΠ‘ and Π3Π Π4/precursor (wt/wt) impregnation ratio of 0.5 to 2. Concentration of NaOH desilication solution varied from 0.5 to 2M. It was found that out of the four factors impregnation ratio is clearly the strongest and at the impregnation ratio of 2 for 1 h at 500 Β°C N2 BET-surface area reaches 1690 m2/g (SBET (Ar)=2492 m2/g) while pore volume becomes 1.95 cm3/g. Elemental analysis showed highest carbon content for this sample (87.96%). All samples have insignificant amount of Si and traces of metals, but considerable amount of phosphorus. Blocks of honeycomb structure prepared from Ca-montmorillonite and desilicated carbonized rice husk (impregnation ratio is 1.5, 1 h at 600 ΒΊC) have BET-surface area obtained by thermal desorption of argon up to 856 m2/g
Problems of selecting an anticoagulant for secondary stroke prevention in patients with atrial fibrillation
Unsolved Issues of Atherosclerosis Prevention and of Adequate Lipid-lowering Therapy in Patients with Acute Ischemic Cerebrovascular Accident
The existing system of medical care for patients with acute cerebrovascular accident of atherothrombotic genesis, namely lipid metabolism disorders, the modern evidence base for lipid-lowering therapy in this category of patients and the feasibility of interdisciplinary interaction of cardiologists and neurologists were discussed at a meeting of the expert council of cardiologists and neurologists in Moscow on 2021 July 7
ΠΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°
Ischemic stroke is a heterogeneous syndrome with a plurality of potential etiological factors. The routine diagnosis does not always allow the cause of acute cerebrovascular accident to be found, in such cases we talk about cryptogenic ischemic stroke, which incidence is 20-40%. The category of patients with cryptogenic stroke was first characterized and assigned to a separate group in the database of the National Institute of Neurological Diseases and Stroke in the USA, and later in the TOAST study. The diagnosis of cryptogenic stroke is usually based on the exclusion of well-known causes of acute cerebrovascular accidents, such as atherosclerosis, cardiac arrhythmias, arterial hypertension. Due to the considerable variability of concepts for cryptogenic stroke, the term ESUS (Embolic Stroke of Undetermined Source) appeared in 2014 and formulated criteria which accurately characterized these patients: non-lacunar cerebral infarction by CT and/or MRI, no atherosclerotic lesion stenosing a stroke-associated artery of more than 50%, no sources of high-risk cardioembolism, no other causes of stroke such as dissection of the artery supplying the area of infarction in the brain, migraine, arteritis. Among the potential causes and sources of cerebral embolism in patients with cryptogenic stroke are heart, veins of lower extremities and pelvis, nonstenosing atherosclerosis of brachiocephalic artery, atheroma of aortic arch, paradoxical embolism non-atherosclerotic vasculopathy, monogenic diseases, hypercoagulable states, and others. We should note that there is a lot of studies on the possible causes of cryptogenic stroke in the available literature, but no common approach to classification of etiologic factors and examination algorythms were developed. The high incidence of cryptogenic stroke, the significant heterogeneity of its etiopathogenetic mechanisms and the need for differentiated approaches to the secondary prevention of this type of acute cerebrovascular accident determine the relevance of further studies in this field.ΠΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ ΡΠ²Π»ΡΠ΅ΡΡΡ Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΡΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ Ρ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎΠΌ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΡ
ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ². Π ΡΡΠΈΠ½Π½Π°Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° Π½Π΅ Π²ΡΠ΅Π³Π΄Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΏΡΠΈΡΠΈΠ½Ρ ΠΎΡΡΡΠΎΠ³ΠΎ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΌΠΎΠ·Π³ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ (ΠΠΠΠ), Π² ΡΠ°ΠΊΠΈΡ
ΡΠ»ΡΡΠ°ΡΡ
ΠΏΡΠΈΠ½ΡΡΠΎ Π³ΠΎΠ²ΠΎΡΠΈΡΡ ΠΎ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠΌ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠ΅, ΡΠ°ΡΡΠΎΡΠ° ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ 20β40%. ΠΠ°ΡΠ΅Π³ΠΎΡΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠΌ Π²ΠΏΠ΅ΡΠ²ΡΠ΅ Π±ΡΠ»Π° ΠΎΡ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΎΠ²Π°Π½Π° ΠΈ Π²ΡΠ΄Π΅Π»Π΅Π½Π° Π² ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ Π³ΡΡΠΏΠΏΡ Π² Π±Π°Π·Π΅ Π΄Π°Π½Π½ΡΡ
ΠΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠΈΡΡΡΠ° Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΈ ΠΈΠ½ΡΡΠ»ΡΡΠ° Π‘Π¨Π, Π° Π²ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠΈ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ TOAST. ΠΠΈΠ°Π³Π½ΠΎΠ· ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°, ΠΊΠ°ΠΊ ΠΏΡΠ°Π²ΠΈΠ»ΠΎ, Π±Π°Π·ΠΈΡΡΠ΅ΡΡΡ Π½Π° ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ Ρ
ΠΎΡΠΎΡΠΎ ΠΈΠ·Π²Π΅ΡΡΠ½ΡΡ
ΠΏΡΠΈΡΠΈΠ½ ΠΠΠΠ, ΡΠ°ΠΊΠΈΡ
ΠΊΠ°ΠΊ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·, Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΠΈΡΠΌΠ° ΡΠ΅ΡΠ΄ΡΠ°, Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ. Π ΡΠ²ΡΠ·ΠΈ ΡΠΎ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΡΡ ΠΏΠΎΠ½ΡΡΠΈΡ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° Π² 2014 Π³. Π±ΡΠ» Π²Π²Π΅Π΄Π΅Π½ ΡΠ΅ΡΠΌΠΈΠ½ ESUS (Embolic Stroke of Undetermined Source β ΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ Ρ Π½Π΅ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠΌ) ΠΈ ΡΡΠΎΡΠΌΡΠ»ΠΈΡΠΎΠ²Π°Π½Ρ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ, ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠ΅ΡΠΊΠΎ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²: Π½Π΅Π»Π°ΠΊΡΠ½Π°ΡΠ½ΡΠΉ ΠΈΠ½ΡΠ°ΡΠΊΡ ΠΌΠΎΠ·Π³Π° ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΉ ΠΈ/ΠΈΠ»ΠΈ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ, ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ, ΡΡΠ΅Π½ΠΎΠ·ΠΈΡΡΡΡΠ΅Π³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΡΠ²ΡΠ·Π°Π½Π½ΡΡ Π°ΡΡΠ΅ΡΠΈΡ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅ΠΌ Π½Π° 50%, ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠ² ΠΊΠ°ΡΠ΄ΠΈΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ°, ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ Π΄ΡΡΠ³ΠΈΡ
ΠΏΡΠΈΡΠΈΠ½ ΠΈΠ½ΡΡΠ»ΡΡΠ°, ΡΠ°ΠΊΠΈΡ
ΠΊΠ°ΠΊ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΡ Π°ΡΡΠ΅ΡΠΈΠΈ, ΠΏΠΈΡΠ°ΡΡΠ΅ΠΉ ΠΎΠ±Π»Π°ΡΡΡ ΠΈΠ½ΡΠ°ΡΠΊΡΠ° ΠΌΠΎΠ·Π³Π°, ΠΌΠΈΠ³ΡΠ΅Π½Ρ, Π°ΡΡΠ΅ΡΠΈΠΈΡ. Π‘ΡΠ΅Π΄ΠΈ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΡΠΈΡΠΈΠ½ ΠΈ ΠΈΡΡΠΎΡΠ½ΠΈΠΊΠΎΠ² ΡΠ΅ΡΠ΅Π±ΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΡΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠΌ Π΄ΠΎΠ»ΠΆΠ½Ρ Π±ΡΡΡ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΡΠ΅ΡΠ΄ΡΠ΅, Π²Π΅Π½Ρ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ ΠΈ ΡΠ°Π·Π°, Π½Π΅ΡΡΠ΅Π½ΠΎΠ·ΠΈΡΡΡΡΠΈΠΉ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ· Π±ΡΠ°Ρ
ΠΈΠΎΡΠ΅ΡΠ°Π»ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ, Π°ΡΠ΅ΡΠΎΠΌΡ Π΄ΡΠ³ΠΈ Π°ΠΎΡΡΡ, ΠΏΠ°ΡΠ°Π΄ΠΎΠΊΡΠ°Π»ΡΠ½Π°Ρ ΡΠΌΠ±ΠΎΠ»ΠΈΡ, Π½Π΅Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π²Π°ΡΠΊΡΠ»ΠΎΠΏΠ°ΡΠΈΡ, ΠΌΠΎΠ½ΠΎΠ³Π΅Π½Π½ΡΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π³ΠΈΠΏΠ΅ΡΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΈ Π΄Ρ. Π‘Π»Π΅Π΄ΡΠ΅Ρ ΠΎΡΠΌΠ΅ΡΠΈΡΡ, ΡΡΠΎ Π² Π΄ΠΎΡΡΡΠΏΠ½ΠΎΠΉ Π½Π°ΠΌ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ ΠΈΠΌΠ΅Π΅ΡΡΡ Π±ΠΎΠ»ΡΡΠΎΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΡ
ΠΎΠΏΠΈΡΠ°Π½ΠΈΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΡ
ΠΏΡΠΈΡΠΈΠ½ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°, ΠΎΠ΄Π½Π°ΠΊΠΎ Π΅Π΄ΠΈΠ½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ ΡΠΈΡΡΠ΅ΠΌΠ°ΡΠΈΠ·Π°ΡΠΈΠΈ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΈ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Π° ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΡΡΡΡΡΡΠ²ΡΡΡ. ΠΡΡΠΎΠΊΠ°Ρ ΡΠ°ΡΡΠΎΡΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°, Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎΡΡΡ Π΅Π³ΠΎ ΡΡΠΈΠΎΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ², Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΎΠ² ΠΊΠΎ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΡΠΈΠΏΠ° ΠΠΠΠ ΠΎΠ±ΡΡΠ»Π°Π²Π»ΠΈΠ²Π°ΡΡ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΏΡΠΈ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ