218 research outputs found
An innovative technique to improve safety of volatile anesthetics suction from the cardiopulmonary bypass circuit
Context: Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB) is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB. Aims: The aim of this study is to improve the safe administration of volatile anesthesia during CPB. Settings and Design: Tertiary teaching hospital. Subjects and Methods: We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit. Results: We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase. Conclusions: Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety
Differential Reinforcement of Alternative Behavior Increases Resistance to Extinction: Clinical Demonstration, Animal Modeling, and Clinical Test of One Solution
Basic research with pigeons on behavioral momentum suggests that differential reinforcement of alternative behavior (DRA) can increase the resistance of target behavior to change. This finding suggests that clinical applications of DRA may inadvertently increase the persistence of target behavior even as it decreases its frequency. We conducted three coordinated experiments to test whether DRA has persistence-strengthening effects on clinically significant target behavior and then tested the effectiveness of a possible solution to this problem in both a nonhuman and clinical study. Experiment 1 compared resistance to extinction following baseline rates of reinforcement versus higher DRA rates of reinforcement in a clinical study. Resistance to extinction was substantially greater following DRA. Experiment 2 tested a rat model of a possible solution to this problem. Training an alternative response in a context without reinforcement of the target response circumvented the persistence-strengthening effects of DRA. Experiment 3 translated the rat model into a novel clinical application of DRA. Training an alternative response with DRA in a separate context resulted in lower resistance to extinction than employing DRA in the context correlated with reinforcement of target behavior. The value of coordinated bidirectional translational research is discusse
Analysis of influenza vaccination coverage among the elderly in Genoa (Italy) based on a deprivation index, 2009-2013
Introduction. The elderly suffer the most influenza-related complications, and 90%of deaths due to influenza occur in older subjects. Consequently, the elderly are among the main targets of influenza vaccination campaigns. The use of deprivation indexes can help to identify subgroups with lower vaccination uptake. This study analyzed influenza vaccination coverage in elderly persons living in Genoa (Italy) in relation to a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify population subgroups needing specific intervention to improve vaccination coverage. Methods. The study targeted subjects aged 65 65 years living in Genoa in the period 2009-2013. Information on vaccination coverage was provided by general practitioners and Local Health Units. A combination of linear regression, factor analysis and cluster analysis was used to construct the SEHDI at Census Tract (CT) level, on the basis of data from the 2011 Italian census. Results. In 2011, people aged 65 65 years accounted for the 27.7%of the population of Genoa. Most elderly subjects were assigned to either the medium (45.3%) or medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6%high deprivation; 1.3%low deprivation). Significant, nonlinear (p < 0.05 NL) relationships were observed in both sexes with regard to mortality due to all respiratory diseases (RD) and chronic obstructive pulmonary disease (COPD), with the highest Standardized Mortality Ratio (SMR) values in women in the high deprivation group of women (1.81, p < 0.05 RD; 1.79, p < 0.05 COPD). The SMRs for influenza and pneumonia showed a positive linear trend in women (p < 0.05) with the highest value in the high deprivation group (1.97, p < 0.05), while in men the trend was NL (p < 0.05). A positive linear trend (p < 0.05) was found with regard to vaccination coverage, which grew weakly as deprivation increased, up to the medium-high deprived group (from 34.6%to 44.4%). However, the high deprivation group showed the lowest value (33.3%). Conclusions. The results revealed a relationship between deprivation and influenza vaccination coverage in the elderly. This finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated intervention in each local area
Why the anti-meningococcal b vaccination during adolescence should be implemented in italy: An overview of available evidence
Although meningococcal disease has a low incidence in Italy, it is a public health concern owing to its high lethality rate and high frequency of transitory and/or permanent sequelae among survivors. The highest incidence rates are recorded in infants, children and adolescents, and most of the cases are due to Neisseria meningitidis B. In Italy, anti-meningococcal B (anti-MenB) vaccination is free for infants but, despite the considerable disease burden in adolescents, no national recommendation to vaccinate in this age-group is currently available. The aim of this study was to assess the main available scientific evidence to support the Italian health authorities in implementing a program of free anti-MenB vaccination for adolescents. We conducted an overview of the scientific literature on epidemiology, disease burden, immunogenicity and safety of available vaccines, and economic evaluations of vaccination strategies. Each case of invasive meningococcal disease generates a considerable health burden (lethality rate: 9%; up to 60% of patients experience at least one sequela) in terms of impaired quality of life for survivors and high direct and indirect costs (the mean overall cost of acute phase for a single case amounts to about EUR 13,952; the costs for post-acute and the long-term phases may vary widely depending of the type of sequela, reaching an annual cost of about EUR 100,000 in cases of severe neurological damage). Furthermore, vaccination against meningococcus B in adolescence proved cost-effective. The study highlights the need to actively offer the anti-MenB vaccination during adolescence at a national level. This would make it possible to avoid premature deaths and reduce the high costs borne by the National Health Service and by society of supporting survivors who suffer temporary and/or permanent sequelae
Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection : a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO
Introduction: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.Methods: CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods.Results: From 1,196 initial citations, 8 studies were selected, including 1,357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I2= 64%).Conclusions: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death
Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study
This study aims to ascertain whether (1) an educational program is sufficient to achieve adequate Diaphragm Ultrasound (DUS) assessments on healthy volunteers and (2) combining a video tutorial with a practical session is more effective in making learners capable to obtain accurate DUS measurements, as opposed to sole video tutorial
ΠΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠ΅ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΠΏΠΎΡΠ»Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΠΎΠ±ΡΠ΅ΡΠ²Π°ΡΠΈΠΎΠ½Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅)
Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support.ΠΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΈΠ· ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΌΠΎΠΆΠ΅Ρ ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΡΡ Β«ΡΠΈΠ½Π΄ΡΠΎΠΌ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠΉ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈΒ», Π²ΠΊΠ»ΡΡΠ°ΡΡΠΈΠΉ Π΄ΠΎΠ»Π³ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅, ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ. ΠΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π²ΠΊΠ»Π°Π΄ Π΄Π°Π½Π½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π² Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΠΎΠ΅ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅ ΠΈΠ·ΡΡΠ΅Π½.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΡΠΈΠΏ ΠΈ ΡΡΠ΅ΠΏΠ΅Π½Ρ ΡΡΠΆΠ΅ΡΡΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
ΡΠ°ΡΡΡΡΠΎΠΉΡΡΠ² ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅ ΠΈΠ· ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ ΠΠ’) ΠΈ Π½Π° ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΡ
6 ΠΌΠ΅ΡΡΡΠ΅Π².ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 218 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’ ΡΠ½ΠΈΠ²Π΅ΡΡΠΈΡΠ΅ΡΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΌΠ΅ΠΆΠ΄Ρ Π°ΠΏΡΠ΅Π»Π΅ΠΌ 2016 ΠΈ ΠΈΡΠ»Π΅ΠΌ 2017 Π³Π³. ΠΡΠΈΡΠ΅ΡΠΈΠΈ ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΡ: Π²ΠΎΠ·ΡΠ°ΡΡ ΠΌΠ»Π°Π΄ΡΠ΅ 18 Π»Π΅Ρ, ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΈΠ»ΠΈ ΡΠΏΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΠ°Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΆΠΈΠ·Π½ΠΈ ΠΌΠ΅Π½Π΅Π΅ 90 Π΄Π½Π΅ΠΉ, ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π² ΠΠ ΠΠ’ ΠΌΠ΅Π½Π΅Π΅ 12 ΡΠ°ΡΠΎΠ². ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠΈ SF-36 (ΠΊΡΠ°ΡΠΊΠ°Ρ ΡΠΎΡΠΌΠ° ΠΎΡΠ΅Π½ΠΊΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΡ) ΠΈ 5-ΡΡΠΎΠ²Π½Π΅Π²ΡΠΉ EQ-5D-5L (ΠΠ²ΡΠΎΠΏΠ΅ΠΉΡΠΊΠΈΠΉ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° Π² 5 ΠΎΠ±Π»Π°ΡΡΡΡ
), ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π·Π°ΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅ ΠΈ ΡΠ΅ΡΠ΅Π· 30, 90 ΠΈ 180 Π΄Π½Π΅ΠΉ ΠΏΠΎΡΠ»Π΅ Π½Π΅Π΅. ΠΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ ΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ ΠΊΡΠ°ΡΠΊΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ΅ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΠ΅ Π² ΠΠ ΠΠ’ (Π³ΡΡΠΏΠΏΠ° ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ, n=109), ΠΈ ΡΠ΅Ρ
, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠΎΡΠ»ΠΈ ΠΊΡΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΠΠ ΠΠ’ (Π³ΡΡΠΏΠΏΠ° ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, n=109).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π§Π΅ΡΠ΅Π· 180 Π΄Π½Π΅ΠΉ Π²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠΎΠ² SF-36 ΠΈ EQ-5D-5L ΠΏΠΎΠ²ΡΡΠΈΠ»ΠΈΡΡ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΌΠΎΠΌΠ΅Π½ΡΠΎΠΌ Π²ΡΠΏΠΈΡΠΊΠΈ, Π·Π° ΠΈΡΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΏΡΠΈΡ
ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π·Π΄ΠΎΡΠΎΠ²ΡΡ SF-36 (p=0,08). Π Π³ΡΡΠΏΠΏΠ΅ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ»ΡΡΡΠΈΠ»ΠΈΡΡ Π²ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ EQ-5D-5L, Π² ΡΠΎ Π²ΡΠ΅ΠΌΡ ΠΊΠ°ΠΊ Π² Π³ΡΡΠΏΠΏΠ΅ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΡΠ»ΡΡΡΠΈΠ»ΠΈΡΡ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎ-Π°Π½Π°Π»ΠΎΠ³ΠΎΠ²ΠΎΠΉ ΡΠΊΠ°Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΠΎΡΠ½ΠΈΠΊΠ°.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’, Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠ΅ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΡ. ΠΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΈΠ· ΠΠ ΠΠ’ ΡΠ½ΠΈΠΆΠ°Π΅ΡΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ. ΠΠ°ΡΡΡΠ΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠΈΡ
ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΈ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΡ ΡΡΠ΅ΡΡ, Π±ΡΠ»ΠΈ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌ, ΡΠ΅ΠΌ Ρ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². Π‘ΠΈΡΡΠ°ΡΠΈΡ ΠΏΠΎΠΌΠΎΠΆΠ΅Ρ ΠΈΡΠΏΡΠ°Π²ΠΈΡΡ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΡΠΏΠΈΡΠ°Π½Π½ΡΡ
ΠΈΠ· ΠΠ ΠΠ’, Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΠΎΡΡΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ°Ρ
Ρ ΡΠΏΠΎΡΠΎΠΌ Π½Π° Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΠΏΡΠΈΡ
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