22 research outputs found
Optimization of electron beam parameters of LIA-10M accelerator
A numerical simulation of the LIA-10M accelerator was carried out. It is shown that at the existing configuration
of the diode unit and maximal for LIA-10M injection parameters (3 MeV, 50 kA) significant (up to 40%) beam losses
in the accelerating channel are possible. As a result of calculations the injector cathode geometry was optimized
what permitted to avoid beam electron leakage onto the walls of accelerating channel and to improve significantly
output parameters of the LIA-10M accelerator.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠΈΡΠ»Π΅Π½Π½ΠΎΠ΅ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠΊΠΎΡΠΈΡΠ΅Π»Ρ ΠΠΠ£-10Π. ΠΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ ΠΏΡΠΈ ΡΡΡΠ΅ΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΊΠΎΠ½ΡΠΈΠ³ΡΡΠ°ΡΠΈΠΈ Π΄ΠΈΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ·Π»Π° ΠΈ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ
Π΄Π»Ρ ΠΠΠ£-10Π ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ°Ρ
ΠΈΠ½ΠΆΠ΅ΠΊΡΠΈΠΈ (3 ΠΡΠ, 50 ΠΊΠ) Π²ΠΎΠ·ΠΌΠΎΠΆΠ½Ρ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ (Π΄ΠΎ 40%) ΠΏΠΎΡΠ΅ΡΠΈ ΠΏΡΡΠΊΠ° Π² ΡΡΠΊΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ ΡΡΠ°ΠΊΡΠ΅. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΡΠ°ΡΡΠ΅ΡΠΎΠ² ΠΎΠΏΡΠΈΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π° Π³Π΅ΠΎΠΌΠ΅ΡΡΠΈΡ ΠΊΠ°ΡΠΎΠ΄Π° ΠΈΠ½ΠΆΠ΅ΠΊΡΠΎΡΠ°, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ ΡΡΠ΅ΡΠΊΠΈ ΡΠ»Π΅ΠΊΡΡΠΎΠ½ΠΎΠ² ΠΏΡΡΠΊΠ° Π½Π° ΡΡΠ΅Π½ΠΊΠΈ ΡΡΠΊΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ° ΠΈ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΡΠ»ΡΡΡΠΈΡΡ Π²ΡΡ
ΠΎΠ΄Π½ΡΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΡΡΠΊΠΎΡΠΈΡΠ΅Π»Ρ.ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠΈΡΠ΅Π»ΡΠ½Π΅ ΠΌΠΎΠ΄Π΅Π»ΡΠ²Π°Π½Π½Ρ ΠΏΡΠΈΡΠΊΠΎΡΡΠ²Π°ΡΠ° ΠΠΠ-10Π. ΠΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΠΎ ΠΏΡΠΈ ΡΡΠ½ΡΡΡΡΠΉ ΠΊΠΎΠ½ΡΡΠ³ΡΡΠ°ΡΡΡ Π΄ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ Π²ΡΠ·Π»Π° Ρ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΈΡ
Π΄Π»Ρ ΠΠΠ-10Π ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠ°Ρ
ΡΠ½ΠΆΠ΅ΠΊΡΡΡ (3 ΠΠ΅Π, 50 ΠΊΠ) ΠΌΠΎΠΆΠ»ΠΈΠ²Ρ Π·Π½Π°ΡyΡ (Π΄ΠΎ 40%) Π²ΡΡΠ°ΡΠΈ ΠΏΡΡΠΊΠ° Π² ΠΏΡΠΈΡΠΊΠΎΡΡΡΡΠΎΠΌΡ ΡΡΠ°ΠΊΡΡ. Π£ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠΎΠ·ΡΠ°Ρ
ΡΠ½ΠΊΡΠ² ΠΎΠΏΡΠΈΠΌΡΠ·ΠΎΠ²Π°Π½Π° Π³Π΅ΠΎΠΌΠ΅ΡΡΡΡ ΠΊΠ°ΡΠΎΠ΄Π° ΡΠ½ΠΆΠ΅ΠΊΡΠΎΡΠ°, ΡΠΎ Π΄ΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΡΠ½ΠΈΠΊΠ½ΡΡΠΈ Π²ΠΈΡΠΎΠΊΡ Π΅Π»Π΅ΠΊΡΡΠΎΠ½ΡΠ² ΠΏΡΡΠΊΠ° Π½Π° ΡΡΡΠ½ΠΊΠΈ ΠΏΡΠΈΡΠΊΠΎΡΡΡΡΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΡ Ρ ΡΡΡΡΡΠ²ΠΎ ΠΏΠΎΠ»ΡΠΏΡΠΈΡΠΈ Π²ΠΈΡ
ΡΠ΄Π½Ρ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΏΡΠΈΡΠΊΠΎΡΡΠ²Π°ΡΠ°
Results of LIA-10M accelerator investigations
There are presented basic results of experiments on the LIA-10M accelerator since its putting into operation (1994) till today. There were investigated various modes of accelerator operation and its output characteristics depending on the parameters of injected electron beam, number of connected accelerator modules, time program of inductors switch-in etc. There was obtained a large scope of experimental data that are of interest for LIA-10M accelerator practical use and for the development of new facilities of this type. The investigations that have been performed recently make it possible to considerably (half as much again) increase the output dose parameters of the accelerator as compared to the level achieved before: maximal dose (Si) and dose rate on the output flange constitute 400 Gy and 2.5.1010 Gy/s, while at a 1 meter distance from the target they are equal to 7.5 Gy and 5.108 Gy/s, respectively
Sports training in parts of the active army in the period of the Caucasian war
The article deals with the sports training in units of the Russian army during the Caucasian war. The attention is paid to the specifics of military operations in the coastal, flatland, foothill and mountain areas. The materials included the documents from the archival department of the Sochi city administration (Sochi, Russian Federation), scientific publications, as well as orders of the military department, which reflected the studying issues. The methodology of the article is based on the traditional principles of historicism, objectivity, analytical, probabilistic and statistical, typological and comparative methods. The method of historicism made it possible to see, on the basis of dissimilar facts, obtained in the course of practical work with the documents, the important phenomena and processes related to the organization of sports training in the Russian army and in particular among the troops in the Caucasus. In conclusion, the authors stated that the system of sports exercises covered all muscle groups and developed skills of the combatant in the Caucasus to overcome any difficulties in the implementation of combat missions. The system of sports training for all units was not the same and could be different. So, for example, the teams of the Azov barges were less trained on sports equipment, and paid more attention to the exercises on the development of the arms and shoulder girdle. The reasons for this were the impossibility of using barges in other climatic zones, except for the coastal. Copyright Β© 2017 by Academic Publishing House Researcher s.r.o. Copyright Β© 2017 by Sochi State University
Sports training in parts of the active army in the period of the Caucasian war
The article deals with the sports training in units of the Russian army during the Caucasian war. The attention is paid to the specifics of military operations in the coastal, flatland, foothill and mountain areas. The materials included the documents from the archival department of the Sochi city administration (Sochi, Russian Federation), scientific publications, as well as orders of the military department, which reflected the studying issues. The methodology of the article is based on the traditional principles of historicism, objectivity, analytical, probabilistic and statistical, typological and comparative methods. The method of historicism made it possible to see, on the basis of dissimilar facts, obtained in the course of practical work with the documents, the important phenomena and processes related to the organization of sports training in the Russian army and in particular among the troops in the Caucasus. In conclusion, the authors stated that the system of sports exercises covered all muscle groups and developed skills of the combatant in the Caucasus to overcome any difficulties in the implementation of combat missions. The system of sports training for all units was not the same and could be different. So, for example, the teams of the Azov barges were less trained on sports equipment, and paid more attention to the exercises on the development of the arms and shoulder girdle. The reasons for this were the impossibility of using barges in other climatic zones, except for the coastal. Copyright Β© 2017 by Academic Publishing House Researcher s.r.o. Copyright Β© 2017 by Sochi State University
Studying the physiological effects of a new model of septoplasty in rats
Physiological responses to the proposed rat septoplasty model under general anesthesia were investigated. We studied the motor activity of rats and heart rate variability before experiment, one day and two days after surgery. After surgical intervention, motor activity decreased, the time of fading and grooming increased, the value of HF decreased, and VLF increased. Surgical trauma of the nasal septum mucous membrane in rats in the early postoperative stage contributes to a powerful stress response in the form of a shift in the balance of the autonomic nervous system towards the sympathetic nervous system, causes mobilization of central regulation mechanisms, reduces research activity, and provokes an anxious, depressive-like state and anxiety in rats. Β© 2020 All-Russian Federation of the Specialists in Head and Neck Diseases. All rights reserved
Π‘ΠΏΠΎΡΠΎΠ± ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΌΠ΅ΠΆΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ ΠΏΠ΅ΡΠ΅Π³ΠΎΡΠΎΠ΄ΠΊΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ. ΠΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅
Background: At present, there are no methods for intraoperative monitoring of the interventricular septum (IVS) thickness in a stopped and empty heart. This might be an obvious reason for unsatisfactory results after a number of septal myectomies.Aim: To provide an experimental background for the method to control the IVS thickness (that we had proposed) during septal myectomy.Materials and methods: The proposed technique is based on the transillumination method. The experimental models were cadaveric porcine hearts, as well as fragments of the human myocardium removed during septal myectomies. The thickness of the translucent myocardium was estimated depending on the local illumination value at the entrance to the myocardium and the external illumination of the surgical field. We compared the results of 67 septal myectomies performed in the clinic of the Almazov National Medical Research Centre with the results of 35 similar experimental procedures with cadaveric porcine hearts using the proposed way of measurement.Results: A graph of the illumination at the entrance to the myocardium against the thickness of the translucent myocardium was constructed. After conventionally performed septal myectomies the median variation of the myocardial thickness was 4 [3; 6] mm. In the experiment using the proposed control method, the median variation was 1 [1; 2] mm, i.e. significantly less than with the conventional approach (p = 3 x 10-10).Conclusion: The method to control the IVS thickness when performing septal myectomy makes it possible to achieve the required myocardial thickness the resection area with much greater accuracy than with the conventional one.ΠΠ±ΠΎΡΠ½ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ Π½Π΅ ΡΡΡΠ΅ΡΡΠ²ΡΠ΅Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΈΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΌΠ΅ΠΆΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ ΠΏΠ΅ΡΠ΅Π³ΠΎΡΠΎΠ΄ΠΊΠΈ (ΠΠΠ) Π½Π° ΠΎΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΠΎΠΌ ΠΈ ΡΠ°Π·Π³ΡΡΠΆΠ΅Π½Π½ΠΎΠΌ ΡΠ΅ΡΠ΄ΡΠ΅. ΠΡΠΈΠΌ, ΠΏΠΎ Π²ΡΠ΅ΠΉ Π²ΠΈΠ΄ΠΈΠΌΠΎΡΡΠΈ, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Ρ Π½Π΅ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΡΠ΄Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ.Π¦Π΅Π»Ρ - ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°ΡΡ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΡΠΉ Π°Π²ΡΠΎΡΠ°ΠΌΠΈ ΡΠΏΠΎΡΠΎΠ± ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΠΠ ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΎΡΠ½ΠΎΠ²Ρ ΡΠΏΠΎΡΠΎΠ±Π° ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ ΠΌΠ΅ΡΠΎΠ΄ ΡΡΠ°Π½ΡΠΈΠ»Π»ΡΠΌΠΈΠ½Π°ΡΠΈΠΈ. ΠΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΠΌΠΈ ΠΌΠΎΠ΄Π΅Π»ΡΠΌΠΈ ΡΠ»ΡΠΆΠΈΠ»ΠΈ ΡΡΡΠΏΠ½ΡΠ΅ ΡΠ²ΠΈΠ½ΡΠ΅ ΡΠ΅ΡΠ΄ΡΠ°, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΡΠ°Π³ΠΌΠ΅Π½ΡΡ ΡΠ΅Π»ΠΎΠ²Π΅ΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, ΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΠΏΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΡ
ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ. ΠΡΠ΅Π½ΠΈΠ²Π°Π»Π°ΡΡ ΡΠΎΠ»ΡΠΈΠ½Π° ΠΏΡΠΎΡΠ²Π΅ΡΠΈΠ²Π°Π΅ΠΌΠΎΠ³ΠΎ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ Π»ΠΎΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΎΡΠ²Π΅ΡΠ΅Π½Π½ΠΎΡΡΠΈ Π½Π° Π²Ρ
ΠΎΠ΄Π΅ Π² ΠΌΠΈΠΎΠΊΠ°ΡΠ΄ ΠΈ Π²Π½Π΅ΡΠ½Π΅ΠΉ ΠΎΡΠ²Π΅ΡΠ΅Π½Π½ΠΎΡΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠ»Ρ. Π‘ΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ 67 ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ, Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΡΡ
Π² ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ΅ Π€ΠΠΠ£ Β«ΠΠΠΠ¦ ΠΈΠΌ. Π.Π. ΠΠ»ΠΌΠ°Π·ΠΎΠ²Π°Β» ΠΠΈΠ½Π·Π΄ΡΠ°Π²Π° Π ΠΎΡΡΠΈΠΈ, ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ 35 Π°Π½Π°Π»ΠΎΠ³ΠΈΡΠ½ΡΡ
ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΡ
Π½Π° ΡΡΡΠΏΠ½ΡΡ
ΡΠ²ΠΈΠ½ΡΡ
ΡΠ΅ΡΠ΄ΡΠ°Ρ
Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΠΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΡΡΡΠΎΠ΅Π½ Π³ΡΠ°ΡΠΈΠΊ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡΠ²Π΅ΡΠ΅Π½Π½ΠΎΡΡΠΈ Π½Π° Π²Ρ
ΠΎΠ΄Π΅ Π² ΠΌΠΈΠΎΠΊΠ°ΡΠ΄ ΠΈ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΏΡΠΎΡΠ²Π΅ΡΠΈΠ²Π°Π΅ΠΌΠΎΠ³ΠΎ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°. ΠΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ, Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΡΡ
ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΠΌ ΡΠΏΠΎΡΠΎΠ±ΠΎΠΌ, ΠΌΠ΅Π΄ΠΈΠ°Π½Π° ΡΠ°Π·Π±ΡΠΎΡΠ° Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 4 [3; 6] ΠΌΠΌ, Π° Π² ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΠΠ - 1 [1; 2] ΠΌΠΌ (Ρ = 3 Ρ
10-10).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π‘ΠΏΠΎΡΠΎΠ± ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΠΠ ΠΏΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΠ΅ΠΏΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠΈΡΠΊΡΠΎΠΌΠΈΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π΄ΠΎΠ±ΠΈΡΡΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΡΠΎΠ»ΡΠΈΠ½Ρ ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π° Π² Π·ΠΎΠ½Π΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΡΠΎ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ Π±ΠΎΠ»ΡΡΠ΅ΠΉ ΡΠΎΡΠ½ΠΎΡΡΡΡ, ΡΠ΅ΠΌ ΠΏΡΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΌ Π²Π°ΡΠΈΠ°Π½ΡΠ΅ ΠΈΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ
Π Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΡ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΠΎΡΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠΈ Ρ ΠΊΠ°Π½Π΄ΠΈΠ΄Π°ΡΠΎΠ² Π½Π° ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΡΠ΅ΡΠ΄ΡΠ°
Background: Fixed pulmonary hypertension (PH) in heart transplant candidates is a risk factor for right ventricular failure in the postoperative period and early mortality. Patients with fixed PH are not included in the waiting list. Thus, the correct assessment of the pulmonary circulation before the operation affects both clinical management and prognosis. Aim: To reduce the risk of incorrect patient non-inclusion to the waiting list by reduction of false negative test results for PH reversibility.Materials and methods: Fourteen heart transplant candidates were included in this retrospective cohort single center study. Fixed PH with pulmonary vascular resistance (PVR) exceeding 3.5 Wood's units was found in all these patients using right heart catheterization and pulmonary vasoreactivity tests. Initially, these patients had not been put into the waiting list. Pulmonary catheterization was performed in the intensive care unit with a Swan-Ganz catheterΒ and pre-pulmonary thermodilution technique. To perform pulmonary vasoreactivity tests, inhaled iloprost (n = 12) or nitric oxide (n = 2) were used. Subsequently all patients received levosimendan infusion at a dose of 12.5 (0.05β0.2) mg/kg/min, with repeated pulmonary artery catheterization and pulmonary vasoreactivity tests at 72 hours after the infusion. Pulmonary vasoreactivity tests results allowed 13 patients to be included into the waiting list. Heart transplantation was performed in 8 recipients, with postoperative assessment of their hemodynamic and clinical parameters. Data are presented as median [25th percentile; 75th percentile].Results: After the levosimendan infusion, there was a decrease in the pulmonary artery mean pressure from 45 [36; 47] to 29.5 [23; 37] mm Hg (p 0.01), and in PVR from 6.9 [4.9; 8.9] to 3.6 [2.9; 5.9] Wood's units (p 0.01). In 7 patients, PVR decreased to less than 3.5 Wood's units: the rest of the patients underwent pulmonary vasoreactivity tests. As a result, 13 of 14 patients showed reversible PH and were included into the waiting list. By the date of the manuscript submission, heart transplantation has been performed in 8 patients. Their PVR 6 hours after surgery was 2.2 [2; 3.1] Wood's units; there were no cases of fixed PH and right heart failure. There was a single death associated to a hemorrhagic stroke at day 6 after heart transplantation. The sensitivity of pre-operative pulmonary vasoreactivity tests with the use of levosimendan was 87.5%.Conclusion: Levosimendan infusion may increase the sensitivity of the pulmonary vasoreactivity tests before patients' inclusion into the waiting list for heart transplantation.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠ°Ρ Π»Π΅Π³ΠΎΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ (ΠΠ) Ρ ΠΊΠ°Π½Π΄ΠΈΠ΄Π°ΡΠΎΠ² Π½Π° ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡΒ ΡΠ΅ΡΠ΄ΡΠ° β ΡΠ°ΠΊΡΠΎΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΏΡΠ°Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΈ ΡΠ°Π½Π½Π΅ΠΉ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²Β Ρ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΠΉ ΠΠ Π½Π΅ Π²ΠΊΠ»ΡΡΠ°ΡΡ Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡΒ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΠ΅ΡΠ΄ΡΠ°. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΠΊΠΎΡΡΠ΅ΠΊΡΠ½ΠΎΡΡΡ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΌΠ°Π»ΠΎΠ³ΠΎ ΠΊΡΡΠ³Π° ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π²Π»ΠΈΡΠ΅Ρ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π½Π°Β ΡΠ°ΠΊΡΠΈΠΊΡ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π½ΠΎ ΠΈ Π½Π° ΠΏΡΠΎΠ³Π½ΠΎΠ·.Π¦Π΅Π»Ρ β ΡΠ½ΠΈΠ·ΠΈΡΡ ΡΠΈΡΠΊ ΠΎΡΠΈΠ±ΠΎΡΠ½ΠΎΠ³ΠΎ Π½Π΅Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²Β Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΠ΅ΡΠ΄ΡΠ° ΠΏΡΡΠ΅ΠΌΒ ΡΠΎΠΊΡΠ°ΡΠ΅Π½ΠΈΡ ΡΠΈΡΠ»Π° Π»ΠΎΠΆΠ½ΠΎΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠ΅ΡΡΠΎΠ² Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Β ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΊΠΎΠ³ΠΎΡΡΠ½ΠΎΠ΅ ΠΎΠΏΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 14 ΠΊΠ°Π½Π΄ΠΈΠ΄Π°ΡΠΎΠ² Π½Π° ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΡΠ΅ΡΠ΄ΡΠ°,Β Ρ ΠΊΠΎΡΠΎΡΡΡ
ΠΏΡΠΈ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (ΠΠ) ΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠΈ ΡΠ΅ΡΡΠ° Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠΒ Π±ΡΠ»Π° ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠ°Ρ ΠΠ Ρ Π»Π΅Π³ΠΎΡΠ½ΡΠΌΒ ΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΡΠΎΠΏΡΠΎΡΠΈΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ (ΠΠ‘Π‘), ΠΏΡΠ΅Π²ΡΡΠ°ΡΡΠΈΠΌ 3,5 Π΅Π΄. ΠΡΠ΄Π°. ΠΠ΅ΡΠ²ΠΎΠ½Π°ΡΠ°Π»ΡΠ½ΠΎ ΡΡΠΈΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ Π±ΡΠ»ΠΎ ΠΎΡΠΊΠ°Π·Π°Π½ΠΎ Π²ΠΎ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠΈ Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΠ΅ΡΠ΄ΡΠ°. ΠΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ ΠΠΒ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈΒ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ° Swan-Ganz ΠΈ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΏΡΠ΅ΠΏΡΠ»ΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉΒ ΡΠ΅ΡΠΌΠΎΠ΄ΠΈΠ»ΡΡΠΈΠΈ. ΠΠ»Ρ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΡΠ΅ΡΡΠ° Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ ΠΈΠ½Π³Π°Π»ΡΡΠΈΡ ΠΈΠ»ΠΎΠΏΡΠΎΡΡΠ°Β (Ρ 12 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ) ΠΈΠ»ΠΈ ΠΎΠΊΡΠΈΠ΄Π° Π°Π·ΠΎΡΠ° (Ρ 2). Π Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅ΠΌ Π²ΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π±ΡΠ»Π° Π½Π°Π·Π½Π°ΡΠ΅Π½Π° ΠΈΠ½ΡΡΠ·ΠΈΡΒ Π»Π΅Π²ΠΎΡΠΈΠΌΠ΅Π½Π΄Π°Π½Π° Π² Π΄ΠΎΠ·Π΅ 12,5 ΠΌΠ³ ΡΠΎ ΡΠΊΠΎΡΠΎΡΡΡΡΒ 0,05β0,2 ΠΌΠΊΠ³/ΠΊΠ³/ΠΌΠΈΠ½, ΡΠ΅ΡΠ΅Π· 72 ΡΠ°ΡΠ° ΠΏΠΎΡΠ»Π΅ ΠΊΠΎΡΠΎΡΠΎΠΉ ΠΏΡΠΎΠ²Π΅Π»ΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ ΠΠΒ ΠΈ ΡΠ΅ΡΡΡ Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠ. ΠΠΎ ΠΈΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌΒ 13 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ.Β Π’ΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΡΠ΅ΡΠ΄ΡΠ° Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° 8 ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠ°ΠΌ, Π² ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅Β ΠΎΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ. ΠΠ°Π½Π½ΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΠΊΠ°ΠΊ ΠΌΠ΅Π΄ΠΈΠ°Π½Π° [25-ΠΉ; 75-ΠΉ ΠΏΡΠΎΡΠ΅Π½ΡΠΈΠ»ΠΈ].Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎΡΠ»Π΅ ΠΈΠ½ΡΡΠ·ΠΈΠΈ Π»Π΅Π²ΠΎΡΠΈΠΌΠ΅Π½Π΄Π°Π½Π°Β ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΠΠΒ Ρ 45 [36; 47] Π΄ΠΎ 29,5 [23; 37] ΠΌΠΌ ΡΡ. ΡΡ. (p 0,01),Β ΠΠ‘Π‘ ΡΠΌΠ΅Π½ΡΡΠΈΠ»ΠΎΡΡ Ρ 6,9 [4,9; 8,9] Π΄ΠΎ 3,6 [2,9; 5,9]Β Π΅Π΄. ΠΡΠ΄Π° (p 0,01). Π£ 7 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΠ‘Π‘ ΡΠ½ΠΈΠ·ΠΈΠ»ΠΎΡΡΒ Π΄ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΌΠ΅Π½Π΅Π΅ 3,5 Π΅Π΄. ΠΡΠ΄Π°, ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌΒ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π±ΡΠ» Π²ΡΠΏΠΎΠ»Π½Π΅Π½ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΠΉ ΡΠ΅ΡΡ Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠ. Π ΠΈΡΠΎΠ³Π΅ 13 ΠΈΠ· 14 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΎΠ±ΡΠ°ΡΠΈΠΌΡΠΉ Ρ
Π°ΡΠ°ΠΊΡΠ΅Ρ ΠΠ ΠΈ Π±ΡΠ»ΠΈΒ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈΒ ΡΠ΅ΡΠ΄ΡΠ°. ΠΠ° ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠΎΠ΄Π³ΠΎΡΠΎΠ²ΠΊΠΈ ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΈΒ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΡΠ΅ΡΠ΄ΡΠ° Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° 8 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ. ΠΠ‘Π‘ ΡΠ΅ΡΠ΅Π· 6 Ρ ΠΏΠΎΡΠ»Π΅ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈΒ ΡΠ΅ΡΠ΄ΡΠ° ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 2,2 [2; 3,1] Π΅Π΄. ΠΡΠ΄Π°, ΡΠ»ΡΡΠ°Π΅Π²Β Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΠΉ ΠΠ ΠΈ ΠΏΡΠ°Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½Π΅ Π±ΡΠ»ΠΎ. ΠΠ΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΡΠΉΒ Π»Π΅ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈΡΡ
ΠΎΠ΄ Π±ΡΠ» ΡΠ²ΡΠ·Π°Π½ Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ Π³Π΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ° Π½Π° 6-Π΅ ΡΡΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅Β ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. Π§ΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉΒ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΠΈ ΠΠ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈΒ Π»Π΅Π²ΠΎΡΠΈΠΌΠ΅Π½Π΄Π°Π½Π° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 87,5%.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅.Β ΠΠ½ΡΡΠ·ΠΈΡ Π»Π΅Π²ΠΎΡΠΈΠΌΠ΅Π½Π΄Π°Π½Π° ΠΌΠΎΠΆΠ΅Ρ ΠΏΠΎΠ²ΡΡΠΈΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΡΠ΅ΡΡΠ° Π½Π° ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΡΡΡ ΠΠ ΠΏΠ΅ΡΠ΅Π΄Β Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π² Π»ΠΈΡΡ ΠΎΠΆΠΈΠ΄Π°Π½ΠΈΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΠ΅ΡΠ΄ΡΠ°