54 research outputs found
Profiling of polishing circles for the shaped cutters with a sloping tooth
Π ΠΎΠ·Π³Π»ΡΠ½ΡΡΠΎ ΠΎΡΠΎΠ±Π»ΠΈΠ²ΠΎΡΡΡ ΠΏΡΠΎΡΡΠ»ΡΠ²Π°Π½Π½Ρ Π°Π±ΡΠ°Π·ΠΈΠ²Π½ΠΈΡ
ΡΠ»ΡΡΡΠ²Π°Π»ΡΠ½ΠΈΡ
ΠΊΡΡΠ³ΡΠ² Π΄Π»Ρ ΡΠΎΡΠΌΠΎΡΡΠ²ΠΎΡΠ΅Π½Π½Ρ Π·Π°Π΄Π½ΡΠΎΡ ΠΏΠΎΠ²Π΅ΡΡ
Π½Ρ Π΄ΠΈΡΠΊΠΎΠ²ΠΈΡ
ΡΠ°ΡΠΎΠ½Π½ΠΈΡ
ΡΡΠ΅Π· Π· ΠΏΠΎΡ
ΠΈΠ»ΠΈΠΌ Π·ΡΠ±ΠΎΠΌ. ΠΡΡΠΈΠΌΠ°Π½ΠΎ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ½Ρ Π·Π°Π»Π΅ΠΆΠ½ΠΎΡΡΡ, ΡΠΊΡ ΠΎΠΏΠΈΡΡΡΡΡ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½Π½Ρ ΡΡΠΆΡΡΠΎΡ ΠΊΡΠΎΠΌΠΊΠΈ Π² ΠΏΡΠΎΡΡΠΎΡΡ Π΄Π»Ρ ΡΡΠ΅Π·, ΡΠΊΡ ΠΎΠ΄Π½ΠΎΡΠ°ΡΠ½ΠΎ ΠΌΠ°ΡΡΡ ΡΠΊ ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½ΠΈΠΉ ΠΏΠ΅ΡΠ΅Π΄Π½ΡΠΉ ΠΊΡΡ, ΡΠ°ΠΊ Ρ ΠΏΠΎΡ
ΠΈΠ»Ρ ΡΡΡΡΠΆΠΊΠΎΠ²Ρ ΠΊΠ°Π½Π°Π²ΠΊΡ. Π ΠΎΠ·Π³Π»ΡΠ½ΡΡΠΎ Π·Π°Π³Π°Π»ΡΠ½ΠΈΠΉ Π°Π½Π°Π»ΡΡΠΈΡΠ½ΠΈΠΉ ΠΌΠ΅ΡΠΎΠ΄ Π²ΠΈΠ·Π½Π°ΡΠ΅Π½Π½Ρ ΠΏΡΠΎΡΡΠ»Ρ ΡΠ»ΡΡΡΠ²Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΡΡΠ³Π°, ΡΠΊΠΈΠΉ ΡΡΠ²ΠΎΡΡΡ Π·Π°Π΄Π½Ρ ΡΠ°ΡΠΎΠ½Π½Ρ ΠΏΠΎΠ²Π΅ΡΡ
Π½Ρ ΡΡΠ΅Π·ΠΈ. ΠΠ°ΠΏΡΠΎΠΏΠΎΠ½ΠΎΠ²Π°Π½ΠΎ Π΄Π²Π° ΡΠΏΠΎΡΠΎΠ±ΠΈ ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ Π²ΠΈΠ·Π½Π°ΡΠ΅Π½Π½Ρ ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ ΠΉΠΎΠ³ΠΎ ΡΠ°Π΄ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ΅ΡΠΈΠ½Ρ. Π‘ΠΏΠΎΡΡΠ± Π²ΠΈΠ·Π½Π°ΡΠ΅Π½Π½Ρ ΡΡΠΊΠ°Π½ΠΈΡ
ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΠΎΡΠ»ΡΠ΄ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΏΠΎΡΡΠ²Π½ΡΠ½Π½Ρ ΡΠΎΠ·ΡΠ°Ρ
ΡΠ½ΠΊΠΎΠ²ΠΈΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡΠ². Π ΡΠΏΠΎΡΡΠ± Π±Π΅Π·ΠΏΠΎΡΠ΅ΡΠ΅Π΄Π½ΡΠΎΠ³ΠΎ ΡΠΎΠ·ΡΠ°Ρ
ΡΠ½ΠΊΡ ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ, Π·Π°ΡΠ½ΠΎΠ²Π°Π½ΠΈΠΉ Π½Π° ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΡΡΡΠΎΠ½Π°, ΡΠΊΠΈΠΉ Π·Π°ΡΡΠΎΡΠΎΠ²ΡΡΡΡ ΠΏΡΠΈ Π²ΠΈΡΡΡΠ΅Π½Π½Ρ ΡΡΠ°Π½ΡΡΠ΅Π½Π΄Π΅Π½ΡΠ½ΠΈΡ
ΡΡΠ²Π½ΡΠ½Ρ. ΠΡΡΠΈΠΌΠ°Π½ΠΎ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ½Ρ Π·Π°Π»Π΅ΠΆΠ½ΠΎΡΡΡ Π΄Π»Ρ Π·Π°ΠΌΡΠ½ΠΈ ΠΊΡΠΈΠ²ΠΎΠ»ΡΠ½ΡΠΉΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΠ»Ρ ΡΠ°ΡΡΠΈΠ½ΠΎΡ ΠΊΠΎΠ»Π°.Purpose. Creating a method of profiling tools, which forms the rear surface shaped cutters. Analysis of the established methods. The study of the error in determining the profile of the tool.
Design / methodology / approach. The back surface of the shaped cutter produces abrasive tools. To determine the profile of abrasive tools using the kinematic method. The surfaces of the tool and parts have a common perpendicular. The tool moves along its trektorii. The point where the common perpendicular intersects with the trajectory is the center of the abrasive tool. There are two methods for determining the position of this point. The method of constructing the table. The center of the abrasive wheel is determined by the tables. The table can make before you start. The table is suitable for any instrument. Using the table you can define any profile. For each point shaped profile cutters always have two answers. The method of solution of the transcendental equation. The center of the abrasive tool is determined by Newton's method. You can calculate the coordinates of each point of the profile shapes of abrasive tools. These points are treated with a ribbon, which is located on the tooth cutters. Calculations can be done with a given accuracy. Findingsa. Created by two methods for determining the profile of abrasive tool that handles the back surface of the contoured mills. Found the equations for determining the parameters of the circle that replaces the curved line Originality/value. These results allow us to determine the profile instrument for the formation of the back of the cutter to the desired accuracy.Π Π°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΏΡΠΎΡΠΈΠ»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π°Π±ΡΠ°Π·ΠΈΠ²Π½ΡΡ
ΡΠ»ΠΈΡΠΎΠ²Π°Π»ΡΠ½ΡΡ
ΠΊΡΡΠ³ΠΎΠ² Π΄Π»Ρ ΡΠΎΡΠΌΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ Π·Π°Π΄Π½Π΅ΠΉ ΠΏΠΎΠ²Π΅ΡΡ
Π½ΠΎΡΡΠΈ Π΄ΠΈΡΠΊΠΎΠ²ΡΡ
ΡΠ°ΡΠΎΠ½Π½ΡΡ
ΡΡΠ΅Π· Ρ Π½Π°ΠΊΠ»ΠΎΠ½Π½ΡΠΌ Π·ΡΠ±ΠΎΠΌ. ΠΠΎΠ»ΡΡΠ΅Π½Ρ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΎΠΏΠΈΡΡΠ²Π°ΡΡ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ ΡΠ΅ΠΆΡΡΠ΅ΠΉ ΠΊΡΠΎΠΌΠΊΠΈ Π² ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅ Π΄Π»Ρ ΡΡΠ΅Π·, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΠΈΠΌΠ΅ΡΡ ΠΊΠ°ΠΊ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΠΏΠ΅ΡΠ΅Π΄Π½ΠΈΠΉ ΡΠ³ΠΎΠ», ΡΠ°ΠΊ ΠΈ Π½Π°ΠΊΠ»ΠΎΠ½Π½ΡΡ ΡΡΡΡΠΆΠ΅ΡΠ½ΡΡ ΠΊΠ°Π½Π°Π²ΠΊΡ. Π Π°ΡΡΠΌΠΎΡΡΠ΅Π½ ΠΎΠ±ΡΠΈΠΉ Π°Π½Π°Π»ΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΌΠ΅ΡΠΎΠ΄ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΏΡΠΎΡΠΈΠ»Ρ ΡΠ»ΠΈΡΠΎΠ²Π°Π»ΡΠ½ΠΎΠ³ΠΎ
ΠΊΡΡΠ³Π°, ΠΊΠΎΡΠΎΡΡΠΉ ΠΎΠ±ΡΠ°Π·ΡΠ΅Ρ Π·Π°Π΄Π½ΠΈΠ΅ ΡΠ°ΡΠΎΠ½Π½ΡΠ΅ ΠΏΠΎΠ²Π΅ΡΡ
Π½ΠΎΡΡΠΈ ΡΡΠ΅Π·Ρ. ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Ρ Π΄Π²Π° ΡΠΏΠΎΡΠΎΠ±Π° ΡΠΈΡΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ Π΅Π³ΠΎ ΡΠ°Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ. Π‘ΠΏΠΎΡΠΎΠ± ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΈΡΠΊΠΎΠΌΡΡ
ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ ΡΠ°ΡΡΠ΅ΡΠ½ΡΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΏΠΎΡΠΎΠ± Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ°ΡΡΠ΅ΡΠ° ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°Ρ, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΠΉ Π½Π° ΠΌΠ΅ΡΠΎΠ΄Π΅ ΠΡΡΡΠΎΠ½Π°, ΠΊΠΎΡΠΎΡΡΠΉ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡ ΠΏΡΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΠΈ ΡΡΠ°Π½ΡΡΠ΅Π½Π΄Π΅Π½ΡΠ½ΡΡ
ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΉ. ΠΡΠ²Π΅Π΄Π΅Π½Ρ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ Π΄Π»Ρ Π·Π°ΠΌΠ΅Π½Ρ ΠΊΡΠΈΠ²ΠΎΠΉ ΡΠ°ΡΡΡΡ ΠΎΠΊΡΡΠΆΠ½ΠΎΡΡΠΈ
Research of MPLS-based virtual private networks. βManuscript.
ΠΠΈΠΏΠ»ΠΎΠΌΠ½Ρ ΡΠΎΠ±ΠΎΡΡ ΠΌΠ°Π³ΡΡΡΡΠ° ΠΏΡΠΈΡΠ²ΡΡΠ΅Π½ΠΎ Π°Π½Π°Π»ΡΠ·Ρ ΡΠ° ΠΏΡΠΎΠ΅ΠΊΡΡΠ²Π°Π½Π½Ρ Π²ΡΡΡΡΠ°Π»ΡΠ½ΠΈΡ
ΠΏΡΠΈΠ²Π°ΡΠ½ΠΈΡ
ΠΌΠ΅ΡΠ΅ΠΆ Π½Π° Π±Π°Π·Ρ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΡΡ MPLS.
ΠΡΠΎΠ±Π»Π΅Π½ΠΎ Π·Π°Π³Π°Π»ΡΠ½ΠΈΠΉ ΠΎΠ³Π»ΡΠ΄ ΠΏΡΠΈΠ½ΡΠΈΠΏΡΠ² ΠΏΠΎΠ±ΡΠ΄ΠΎΠ²ΠΈ ΡΡΡΠ°ΡΠ½ΠΈΡ
Π³Π»ΠΎΠ±Π°Π»ΡΠ½ΠΈΡ
ΠΌΠ΅ΡΠ΅ΠΆ Π·Π²βΡΠ·ΠΊΡ, ΡΠΎ Π·Π°ΡΡΠΎΡΠΎΠ²ΡΡΡΡΡΡ Π΄Π»Ρ ΠΎΡΠ³Π°Π½ΡΠ·Π°ΡΡΡ VPN-ΠΌΠ΅ΡΠ΅ΠΆ Π· Π²ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ ΡΠ° Π±Π΅Π· Π²ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½Ρ Π·βΡΠ΄Π½Π°Π½Π½Ρ. ΠΠ΅ΡΠ°Π»ΡΠ½ΠΎ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½ΠΎ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΡΡ MPLS VPN ΡΠ° ΡΡ ΠΏΡΠΈΠ½ΡΠΈΠΏΠΈ ΡΠΎΠ±ΠΎΡΠΈ. ΠΠ΄ΡΠΉΡΠ½Π΅Π½ΠΎ ΠΏΠΎΡΡΠ²Π½ΡΠ½Π½Ρ Π· ΡΠ½ΡΠΈΠΌΠΈ VPN-ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΡΡΠΌΠΈ, Π²ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ ΠΏΠ΅ΡΠ΅Π²Π°Π³ΠΈ.
Π‘ΠΏΡΠΎΠ΅ΠΊΡΠΎΠ²Π°Π½ΠΎ ΠΌΠΎΠ΄Π΅Π»Ρ ΠΌΠ΅ΡΠ΅ΠΆΡ Π΄Π»Ρ ΠΌΡΠΆΠΎΠ±Π»Π°ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠ²Π°ΠΉΠ΄Π΅ΡΠ° Π½Π° Π±Π°Π·Ρ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΡΡ IP/MPLS, ΡΠΊΠ° ΠΏΡΠ΄ΡΡΠΈΠΌΡΡ Π²ΡΡΡΡΠ°Π»ΡΠ½Ρ ΠΏΡΠΈΠ²Π°ΡΠ½Ρ ΠΌΠ΅ΡΠ΅ΠΆΡ, Π° ΡΠ°ΠΊΠΎΠΆ Π·Π°Π±Π΅Π·ΠΏΠ΅ΡΡΡ ΡΡΠ½ΠΊΡΡΡ ΡΠΊΠΎΡΡΡ ΠΎΠ±ΡΠ»ΡΠ³ΠΎΠ²ΡΠ²Π°Π½Π½Ρ. ΠΠ΄ΡΠΉΡΠ½Π΅Π½ΠΎ ΠΊΠΎΠ½ΡΡΠ³ΡΡΡΠ²Π°Π½Π½Ρ ΡΠΏΡΠΎΠ΅ΠΊΡΠΎΠ²Π°Π½ΠΎΡ ΠΌΠ΅ΡΠ΅ΠΆΡ. ΠΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½ΠΎ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ ΡΠΎΠ±ΠΎΡΠΈ ΠΏΠΎΠ±ΡΠ΄ΠΎΠ²Π°Π½ΠΎΡ ΠΌΠΎΠ΄Π΅Π»Ρ VPN-ΠΌΠ΅ΡΠ΅ΠΆΡ.Masterβs Thesis is dedicated to the analysis and designing of virtual private networks based on MPLS technology.
A general overview of principles of modern global communication networks construction were made. They are used for the organization of VPNs with connection establishment and without it. Analysis of MPLS VPN technology and its principles were examined. A comparison with other VPN technology was performed and the benefits were established.
An IP/MPLS-based interregional providerβs network model was designed. It supports virtual private networks and provides Quality of Service features. Configuration of designed network was carried out. The characteristics of constructed VPN model were investigated
ARRANGEMENT OF HIGH-TECH CARE FOR PATIENTS WITH MALIGNANT NEOPLASMS OF THE ORGAN OF VISION AT THE EXAMPLE OF CHELYABINSK REGION
The articles raises the issues that occur in the course of diagnostics of malignant neoplasms of the organ of vision. Description of structural units and personnel of the formed oncological ophthalmology center is provided. Research, therapeutic, and diagnostic activities of each structural unit of the center is described. Characteristics of the ultrasonic and computed tomography method of examination are provided. Peculiarities of the ultrasonic and computed tomography examination results are described regarding patients with malignant neoplasms of the organ of vision of the periorbital, intraocular, and orbital localization. Results of reorganization of the oncological ophthalmology service are assessed (detailed description of management of patients with malignant neoplasms of the organ of vision at different stages before and after formation of the specialized oncological ophthalmology center is provided with illustrative diagrams that demostrate the need for integration of ophthalmic services in oncology, scientifically grounded and statistically proven results of quality of specialized care at the prehospital and the hospital stage, as well as changes in the structure of stages of patients with malignant neoplasms of the organ of vision). The feasibility of creation of specialized oncological ophthalmology centers is justified on the basis of the results received
MOLECULAR-GENETIC CHARACTERISTICS OF PRIMARY TUMOR AND METASTATIC LYMPHATIC NODES IN BREAST CANCER
The purpose of systemic treatment in patients with breast cancer is based largely on the molecular characteristics ofΒ the primary tumor, but many clinical recommendations suggest also the study of metastatic nodes with an assessmentΒ of their receptor status (estrogen receptor ER, progesterone receptor RP, human epidermal growth factor receptorΒ 2 Her2/neu). This is due to the fact that according to numerous studies, the discrepancy between the status of the primaryΒ tumor and the secondary nodes can reach high rates: 3β54 % for ER, 5β78 % for RP, and 0β34 % for Her2/neu. At theΒ same time, more and more data actively demonstrate the imperfection of immunohistochemical analysis and the need toΒ study additional parameters to improve the quality of diagnosis of patients with breast cancer. Material and methods.Β A morphological and immunohistochemical study of the tumor tissue of the primary node and axillary lymph nodesΒ was performed in 199 patients with breast cancer (T1-3N0-3M0) using standard methods, and RT-PCR was also studiedΒ with the expression of 24 genes. Results. The incidence of differences between the molecular phenotypes of the mainΒ tumor and metastatic axillary lymph nodes was 26 (26 %) of 99 cases. Most often, differences were noted in cases ofΒ breast cancer with luminal A type β 13 cases (50 %). According to the results of a comparative PCR analysis of tissueΒ samples from the primary tumor and metastatic regional lymph nodes, only the expression of the CD68, ERSR1, GRB7Β and MMD11 receptors was statistically significant. Conclusion. The results indicate the need for an integrated approachΒ and additional methods for the diagnosis of breast cancer, which will undoubtedly improve the quality of planning andΒ the effectiveness of systemic treatment in patients with breast cancer
ΠΡΠ»ΡΡΠΈΡΠΏΠΈΡΠ°Π»ΡΠ½Π°Ρ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½Π°Ρ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ Π² ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ, Π²ΡΠ·Π²Π°Π½Π½ΠΎΠΉ SARS-CoV-2
The high informative value of chest computed tomography in the diagnosis of pneumonia caused by SARS-CoV-2 is generally recognized, but there is no enough data on the diagnostic capabilities of this method within 5 first days of the clinical manifestations of the disease. The paper presents the results of chest multispiral (multislice) computed tomography (MSCT) of 56 patients with COVID-19 pneumonia in the early days of the disease. The aim of the study was to analyze the semiotics of pathological changes in the lungs in the first days of the onset of clinical symptoms of COVID-19 and to clarify the methodology for conducting MSCT. Methods. The data of chest MSCT of 56 patients with clinical symptoms of a new coronavirus infection SARS-CoV-2 were analyzed. MSCT was carried out in the first 4 β 5 days of the disease. Results. Five variants for the development of the disease were revealed, including atypical, characterized by the prevalence and CT semiotics of lung damage and apparently due to the different response of the patients to SARS-CoV-2 infection. The leading signs of COVID-19 pneumonia in the early stages of the disease were foci of ground glass opacification (GGO), multifocal lesions of the lungs, edema of the interalveolar pulmonary interstitium, which distinguishes it from pneumonia of another etiology. Conclusion. Comparison of MSCT data and the clinical picture of the disease during the first 5 days suggests with high confidence the pneumonia associated with COVID-19. A prerequisite for conducting MSCT in case of suspicion of this type of pneumonia is the implementation of thin 0.5 β 1.5 mm sections, MSCT performance at suspended full inspiration, post-processing of unenhanced tomogram data in MinIP mode.ΠΡΡΠΎΠΊΠ°Ρ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ (ΠΠ’) ΠΎΡΠ³Π°Π½ΠΎΠ² Π³ΡΡΠ΄Π½ΠΎΠΉ ΠΊΠ»Π΅ΡΠΊΠΈ (ΠΠΠ) Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ COVID-19-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΎΠ±ΡΠ΅ΠΏΡΠΈΠ·Π½Π°Π½Π½Π°, ΠΎΠ΄Π½Π°ΠΊΠΎ Π΄Π°Π½Π½ΡΠ΅ ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡΡ
ΠΈ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ
Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΡΡΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄Π° Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 5 ΡΡΡΠΎΠΊ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΎΡΡΡΡΡΡΠ²ΡΡΡ. Π ΡΠ°Π±ΠΎΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΌΡΠ»ΡΡΠΈΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΠ’ (ΠΠ‘ΠΠ’) ΠΠΠ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (n = 56) Ρ COVID-19-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 4β5 ΡΡΡΠΎΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² Π±ΠΎΠ»Π΅Π·Π½ΠΈ. Π¦Π΅Π»ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ²ΠΈΠ»ΠΎΡΡ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΡΠ΅ΠΌΠΈΠΎΡΠΈΠΊΠΈ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π² Π»Π΅Π³ΠΊΠΈΡ
Π² ΠΏΠ΅ΡΠ²ΡΠ΅ Π΄Π½ΠΈ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² COVID-19 ΠΈ ΠΎΠΏΠΈΡΠ°Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΠ‘ΠΠ’. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΠ‘ΠΠ’ ΠΠΠ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΎΠΉ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ SARS-CoV-2. ΠΠ‘ΠΠ’ Π²ΡΠΏΠΎΠ»Π½ΡΠ»Π°ΡΡ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ 4β5 ΡΡΡΠΎΠΊ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΡΠ²Π»Π΅Π½ΠΎ 5 Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² ΡΠ°Π·Π²ΠΈΡΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π²ΠΊΠ»ΡΡΠ°Ρ Π°ΡΠΈΠΏΠΈΡΠ½ΡΠΉ, ΡΠ°Π·Π»ΠΈΡΠ°Π²ΡΠΈΡ
ΡΡ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡΡ ΠΈ ΠΠ’-ΡΠ΅ΠΌΠΈΠΎΡΠΈΠΊΠΎΠΉ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
ΠΈ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π½ΡΡ
, ΠΏΠΎ-Π²ΠΈΠ΄ΠΈΠΌΠΎΠΌΡ, ΡΠ°Π·Π»ΠΈΡΠ½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠ΅ΠΉ ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ SARS-CoV-2. ΠΠ΅Π΄ΡΡΠΈΠΌΠΈ ΠΏΡΠΈΠ·Π½Π°ΠΊΠ°ΠΌΠΈ COVID-19-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Π² ΡΠ°Π½Π½ΠΈΠ΅ ΡΡΠΎΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ»ΠΈΡΡ ΠΎΡΠ°Π³ΠΈ Β«ΠΌΠ°ΡΠΎΠ²ΠΎΠ³ΠΎ ΡΡΠ΅ΠΊΠ»Π°Β», ΠΌΡΠ»ΡΡΠΈΡΠΎΠΊΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
, ΠΎΡΠ΅ΠΊ ΠΌΠ΅ΠΆΠ°Π»ΡΠ²Π΅ΠΎΠ»ΡΡΠ½ΠΎΠ³ΠΎ Π»Π΅Π³ΠΎΡΠ½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠ΅ΡΡΡΠΈΡΠΈΡ, Π² ΡΠ΅ΠΌ ΠΈ ΡΠΎΡΡΠΎΡΠ»ΠΈ ΠΎΡΠ»ΠΈΡΠΈΡ COVID-19-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΎΡ ΡΠ°ΠΊΠΎΠ²ΠΎΠΉ Π΄ΡΡΠ³ΠΎΠΉ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π‘ΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ Π΄Π°Π½Π½ΡΡ
ΠΠ‘ΠΠ’ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Ρ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ΅ΡΠ²ΡΡ
5 ΡΡΡΠΎΠΊ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΡΡΡΡ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»ΠΎΠΆΠΈΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ, Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Ρ COVID-19. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΡΠΌ ΡΡΠ»ΠΎΠ²ΠΈΠ΅ΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΠ‘ΠΠ’ ΠΏΡΠΈ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠΈ Π½Π° ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΡΠΈΠΏΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΡΠΎΠ½ΠΊΠΈΡ
(0,5β1,5 ΠΌΠΌ) ΡΡΠ΅Π·ΠΎΠ², ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π·Π° ΠΏΠΎΠ»Π½ΠΎΡΠΎΠΉ Π²Π΄ΠΎΡ
Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, ΠΏΠΎΡΡΠΏΡΠΎΡΠ΅ΡΡΠΈΠ½Π³ΠΎΠ²Π°Ρ ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠ° Π΄Π°Π½Π½ΡΡ
Π½Π°ΡΠΈΠ²Π½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΠΌΠΌΡ Π² MinIP-ΡΠ΅ΠΆΠΈΠΌΠ΅
ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ Ρ Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ Π»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ Ρ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΈ Π»ΡΡΠ΅Π²ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ Π ΠΠ’
Objective. Comparison of the magnitude of the change in the density of lung tissue and the volume of these changes after radiation therapy over time based on the data obtained using the new method of quantitative analysis developed by us and with the usual visual assessment of the CT data.Materials and methods. We used the data of dynamic observation of 90 patients who underwent RT for the tumors of thoracic localization during the period from 2014 to 2021 at the Federal Institution βRussian Scientific Center of Roentgenoradiologyβ. These patients had CT examinations performed before and after RT. Control CT studies were performed 1β237 days after RT (mean control interval 96 Β± 64.3 days). A total of 238 CT studies of these patients were analyzed, with an average number of RCT studies per patient of 2.6. Among the selected patients, there were 36 (40%) men and 54 (60%) women aged 23 to 86 years (the average age was 51.9 Β± 15.6 years).Results. Radiation damage in the lungs using the method of quantitative analysis of CT data is detected starting from the value of ΞHU = 20 and volume from 3.2% for the early period (15β35 days) after the end of treatment. Starting from 15β25 to 50 days after the end of RT, quantitative analysis reveals primary changes in the lung tissue, incl. and undetectable visually (from 20 to 80 HU), and to suggest further dynamics of these changes depending on the characteristics of the performed RT. From 50 to 80 days β reveals the real volume of radiation pulmonitis by taking into account the changes invisible during visual analysis in the lung tissue irradiated at a dose of 20 Gy to 30 Gy. From 80 to 120 days β allows you to assess the presence and dynamics of changes in the lung tissue with the threshold radiation dose in the lung tissue 30β35 Gy. From 120 onwards, quantitative analysis of CT data, as well as visual assessment, reveals damage in areas of the lungs with the dose of more than 30β35 Gy, which is caused by post-radiation pneumofibrosis. On the basis of the obtained quantitative data on radiation lung damage, the mathematical regularities of the development of this process were calculated, taking into account the time and dose factors.Conclusions. Quantitative assessment of changes in lung density according to CT data in dynamics, carried out using the technique developed by us, is a radiomic indicator of their radiation damage during therapeutic irradiation in cancer patients, which, in combination with the presented mathematical model, can be used for diagnostic purposes to quantify the severity and predicting the dynamics of radiation damage to the lungs in general, as well as identifying individual radiosensitivity.The results obtained can be presented not only in the form of graphs, but also in the form of color maps with preservation of anatomical landmarks, which is convenient for use in clinical practice to support medical decision-making on patient management.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: ΡΠΎΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ ΠΈ ΠΎΠ±ΡΠ΅ΠΌΠΎΠ² ΡΡΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΏΠΎΡΠ»Π΅ Π»ΡΡΠ΅Π²ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ’) Ρ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π°Π½Π½ΡΡ
, ΠΏΠΎΠ»ΡΡΠ°Π΅ΠΌΡΡ
Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΠΎΠΉ Π½Π°ΠΌΠΈ Π½ΠΎΠ²ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° ΠΈ ΠΏΡΠΈ ΠΎΠ±ΡΡΠ½ΠΎΠΉ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠ΅ Π΄Π°Π½Π½ΡΡ
Π ΠΠ’.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈΡΡ Π΄Π°Π½Π½ΡΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 90 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π±ΡΠ»Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΠ’ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΡΠΎΡΠ°ΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2014 ΠΏΠΎ 2021 Π³. Π² Π€ΠΠΠ£ βΠ ΠΎΡΡΠΈΠΉΡΠΊΠΈΠΉ Π½Π°ΡΡΠ½ΡΠΉ ΡΠ΅Π½ΡΡ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΡΠ°Π΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈβ. Π£ Π²ΡΠ΅Ρ
ΡΡΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅Π»ΠΈΡΡ Π ΠΠ’-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΡΠ΅ Π΄ΠΎ ΠΈ ΠΏΠΎΡΠ»Π΅ ΠΠ’. ΠΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈΡΡ ΡΠ΅ΡΠ΅Π· 1β237 ΡΡΡ ΠΏΠΎΡΠ»Π΅ ΠΠ’ (ΡΡΠ΅Π΄Π½ΠΈΠΉ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π» ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ 96 Β± 64,3 ΡΡΡ). ΠΡΠ΅Π³ΠΎ Π±ΡΠ»ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ΠΎ 238 Π ΠΠ’-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΡΠΎ ΡΡΠ΅Π΄Π½ΠΈΠΌ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ Π ΠΠ’-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ Π½Π° ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° 2,6. Π‘ΡΠ΅Π΄ΠΈ ΠΎΡΠΎΠ±ΡΠ°Π½Π½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±ΡΠ»ΠΎ 36 (40,0%) ΠΌΡΠΆΡΠΈΠ½ ΠΈ 54 (60,0%) ΠΆΠ΅Π½ΡΠΈΠ½Ρ Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ ΠΎΡ 23 Π΄ΠΎ 86 Π»Π΅Ρ (ΡΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ 51,9 Β± 15,6 Π³ΠΎΠ΄Π°).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠ΅Π΄Π»Π°Π³Π°Π΅ΠΌΠ°Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° Π΄Π°Π½Π½ΡΡ
Π ΠΠ’ Π²ΡΡΠ²Π»ΡΠ΅Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ ΠΎΠ±Π»ΡΡΠ΅Π½Π½ΡΡ
ΡΡΠ°ΡΡΠΊΠΎΠ² Π»Π΅Π³ΠΊΠΎΠ³ΠΎ Π½Π°ΡΠΈΠ½Π°Ρ Ρ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ ΠΎΡ 20 HU ΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΎΡ 3,2% Π΄Π»Ρ ΡΠ°Π½Π½Π΅Π³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° (15β35 ΡΡΡ) ΠΏΠΎΡΠ»Π΅ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΡ ΠΠ’. ΠΠ°ΡΠΈΠ½Π°Ρ Ρ 25-Ρ
ΠΏΠΎ 50-Π΅ ΡΡΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΡ ΠΠ’ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π²ΡΡΠ²ΠΈΡΡ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΈ Π½Π΅ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΠΌΡΠ΅ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΡΡ ΠΎΡ 20 Π΄ΠΎ 80 HU, ΠΈ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»ΠΎΠΆΠΈΡΡ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΡΡ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΡΡΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠΉ ΠΠ’. Π‘ 50-Ρ
ΠΏΠΎ 80-Π΅ ΡΡΡΠΊΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π²ΡΡΠ²Π»ΡΠ΅Ρ ΡΠ΅Π°Π»ΡΠ½ΡΠΉ ΠΎΠ±ΡΠ΅ΠΌ Π»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΡΠ»ΡΠΌΠΎΠ½ΠΈΡΠ° Π·Π° ΡΡΠ΅Ρ ΡΡΠ΅ΡΠ° Π½Π΅Π²ΠΈΠ΄ΠΈΠΌΡΡ
ΠΏΡΠΈ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½ΠΎΠΌ Π°Π½Π°Π»ΠΈΠ·Π΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, ΠΎΠ±Π»ΡΡΠ΅Π½Π½ΠΎΠΉ Π² Π΄ΠΎΠ·Π΅ ΠΎΡ 20 Π΄ΠΎ 30 ΠΡ. Π‘ 80-Ρ
ΠΏΠΎ 120-Π΅ ΡΡΡΠΊΠΈ β ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΎΡΠ΅Π½ΠΈΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΈ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π² Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ, ΠΎΠ±Π»ΡΡΠ΅Π½Π½ΠΎΠΉ Π² Π΄ΠΎΠ·Π΅ Π±ΠΎΠ»Π΅Π΅ 30β35 ΠΡ. ΠΠ°ΡΠΈΠ½Π°Ρ ΡΠΎ 120-Ρ
ΡΡΡΠΎΠΊ ΠΈ Π΄Π°Π»Π΅Π΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π ΠΠ’ Π΄Π°Π½Π½ΡΡ
, ΠΊΠ°ΠΊ ΠΈ Π²ΠΈΠ·ΡΠ°Π»ΡΠ½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ°, Π²ΡΡΠ²Π»ΡΠ΅Ρ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠΎΠΉΠΊΠΎΠ³ΠΎ ΠΏΠΎΡΡΠ»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΠ½Π΅Π²ΠΌΠΎΡΠΈΠ±ΡΠΎΠ·Π° Π² ΡΡΠ°ΡΡΠΊΠ°Ρ
Π»Π΅Π³ΠΊΠΈΡ
, ΠΎΠ±Π»ΡΡΠ΅Π½Π½ΡΡ
Π² Π΄ΠΎΠ·Π΅ Π±ΠΎΠ»Π΅Π΅ 30β35 ΠΡ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
Π΄Π°Π½Π½ΡΡ
ΠΎ Π»ΡΡΠ΅Π²ΠΎΠΌ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΈ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ Π±ΡΠ»Π° ΡΠ°ΡΡΡΠΈΡΠ°Π½Π° ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π·Π°ΠΊΠΎΠ½ΠΎΠΌΠ΅ΡΠ½ΠΎΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΡΠΎΠ³ΠΎ ΠΏΡΠΎΡΠ΅ΡΡΠ° Ρ ΡΡΠ΅ΡΠΎΠΌ Π²ΡΠ΅ΠΌΠ΅Π½Π½FΠΎΠ³ΠΎ ΠΈ Π΄ΠΎΠ·ΠΎΠ²ΡΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ².ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ Π»Π΅Π³ΠΊΠΈΡ
ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ Π ΠΠ’ Π² Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ΅ ΠΏΠΎ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΠΎΠΉ Π½Π°ΠΌΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°Π΄ΠΈΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΌ ΠΈΡ
Π»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΎΠ±Π»ΡΡΠ΅Π½ΠΈΠΈ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΉ Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ ΠΌΠ°ΡΠ΅ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΡΡ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅Π»ΡΡ
Π΄Π»Ρ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΡΠΆΠ΅ΡΡΠΈ ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π»ΡΡΠ΅Π²ΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
Π² ΡΠ΅Π»ΠΎΠΌ, Π° ΡΠ°ΠΊΠΆΠ΅ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠ°Π΄ΠΈΠΎΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ.ΠΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π² Π²ΠΈΠ΄Π΅ Π³ΡΠ°ΡΠΈΠΊΠΎΠ², Π½ΠΎ ΠΈ Π² Π²ΠΈΠ΄Π΅ ΡΠ²Π΅ΡΠΎΠ²ΡΡ
ΠΊΠ°ΡΡ Ρ ΡΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠ΅ΠΌ Π°Π½Π°ΡΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠΈΠ΅Π½ΡΠΈΡΠΎΠ², ΡΡΠΎ ΡΠ΄ΠΎΠ±Π½ΠΎ Π΄Π»Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ Ρ ΡΠ΅Π»ΡΡ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΏΡΠΈΠ½ΡΡΠΈΡ Π²ΡΠ°ΡΠ΅Π±Π½ΡΡ
ΡΠ΅ΡΠ΅Π½ΠΈΠΉ ΠΏΠΎ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²
Π‘Π’ΠΠΠΠΠ Π’Π« ΠΠΠΠΠΠΠ ΠΠΠ’ΠΠ‘Π’ΠΠ’ΠΠ§ΠΠ‘ΠΠΠΠ ΠΠΠ ΠΠΠΠΠΠ― ΠΠΠ‘Π’ΠΠ«Π₯ Π‘Π’Π Π£ΠΠ’Π£Π ΠΠ ΠΠΠΠΠ«Π Π‘ΠΠΠ ΠΠΠΠΠΠ«Π₯ ΠΠΠ’ΠΠΠΠ ΠΠ£Π§ΠΠΠΠ ΠΠΠΠΠΠΠ‘Π’ΠΠΠ
The purpose of the study was an attempt to create universal criteria for the diagnostic imaging of bone metastases allowing biopsy to be avoided.Material and methods. Scans from 90 patients with verified primary malignant tumors and focal bone lesions in the (n=278) were analyzed. The minimal size of the focal bone lesion was 1 cm. All patients underwent multiparameter magnetic resonance imaging with a modified scanning protocol and single-photon emission computed tomography combined with computed tomography. Diagnostic evaluation was performed before starting treatment, 1 month after starting therapy, then every 3 months for 1 year.Results. The original Β«principle of 8 diagnostic elementsΒ» had been created, allowing the assessment of the main pathological conditions and processes occurring in bone structures. Based on the analysis and statistic processing of 236 foci of metastatic lesion, the diagnostic informative value of each of the imaging modalities and the algorithm as a whole were assessed, and the reference values were determined. This approach allowed the accuracy of early diagnosis to be improved due to a more reliable evaluation of bone metastases at an early stage, thus reducing or completely avoiding additional biopsies.Π¦Π΅Π»ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ²ΠΈΠ»Π°ΡΡ ΠΏΠΎΠΏΡΡΠΊΠ° ΡΠΎΠ·Π΄Π°Π½ΠΈΡ ΡΠ½ΠΈΠ²Π΅ΡΡΠ°Π»ΡΠ½ΡΡ
ΠΊΡΠΈΡΠ΅ΡΠΈΠ΅Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΊΠΎΡΡΠ΅ΠΉ ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ Π²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΡ
ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ Π±ΠΈΠΎΠΏΡΠΈΠΈ. ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 90 Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΌΠΈ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ Ρ ΠΎΡΠ°Π³ΠΎΠ²ΡΠΌΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌΠΈ Π² ΠΊΠΎΡΡΡΡ
(n=278), ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΡΠΉ ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΡΠ°Π³Π° ΡΠΎΡΡΠ°Π²Π»ΡΠ» 1 ΡΠΌ.ΠΠ΅ΡΠΎΠ΄Π°ΠΌΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ»ΠΈΡΡ ΠΌΡΠ»ΡΡΠΈΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½Π°Ρ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠΎΠ»Π° ΡΠΊΠ°Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΠΎΠ΄Π½ΠΎΡΠΎΡΠΎΠ½Π½ΠΎ-ΡΠΌΠΈΡΡΠΈΠΎΠ½Π½Π°Ρ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½Π°Ρ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ, ΡΠΎΠ²ΠΌΠ΅ΡΡΠ½Π½Π°Ρ Ρ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠ΅ΠΉ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈΡΡ ΠΏΠ΅ΡΠ΅Π΄ Π½Π°ΡΠ°Π»ΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΡΠ΅ΡΠ΅Π· 1 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ Π½Π°ΡΠ°Π»Π° ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π΄Π°Π»Π΅Π΅ ΡΠ΅ΡΠ΅Π· ΠΊΠ°ΠΆΠ΄ΡΠ΅ 3 ΠΌΠ΅Ρ ΡΡΠΎΠΊΠΎΠΌ Π΄ΠΎ 1 Π³ΠΎΠ΄Π°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠΎΡΠΌΡΠ»ΠΈΡΠΎΠ²Π°Π½ ΠΎΡΠΈΠ³ΠΈΠ½Π°Π»ΡΠ½ΡΠΉ Β«ΠΏΡΠΈΠ½ΡΠΈΠΏ 8 Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ»Π΅ΠΌΠ΅Π½ΡΠΎΠ²Β», ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΠΉ ΠΎΡΠ΅Π½ΠΈΠ²Π°ΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΈ ΠΏΡΠΎΡΠ΅ΡΡΡ, ΠΏΡΠΎΠΈΡΡ
ΠΎΠ΄ΡΡΠΈΠ΅ Π² ΠΊΠΎΡΡΠ½ΡΡ
ΡΡΡΡΠΊΡΡΡΠ°Ρ
. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π°Π½Π°Π»ΠΈΠ·Π° ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠΈ 236 ΠΎΡΠ°Π³ΠΎΠ² ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΡΠ°ΡΡΡΠΈΡΠ°Π½Π° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΈ Π°Π»Π³ΠΎΡΠΈΡΠΌΠ° Π² ΡΠ΅Π»ΠΎΠΌ, ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΡΠ΅ΡΠ΅ΡΠ΅Π½ΡΠ½ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ. ΠΠ°Π½Π½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΏΠΎΠ²ΡΡΠΈΡΡ ΡΠΎΡΠ½ΠΎΡΡΡ ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π·Π° ΡΡΠ΅Ρ Π±ΠΎΠ»Π΅Π΅ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΊΠΎΡΡΠ½ΡΡ
ΠΌΠ΅ΡΠ°ΡΡΠ°Π·ΠΎΠ² Π½Π° ΡΠ°Π½Π½Π΅ΠΉ ΡΡΠ°Π΄ΠΈΠΈ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ½ΠΈΠ·ΠΈΡΡ ΠΈΠ»ΠΈ ΠΏΠΎΠ»Π½ΠΎΡΡΡΡ ΠΈΠ·Π±Π΅ΠΆΠ°ΡΡ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π±ΠΈΠΎΠΏΡΠΈΠΉ
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