Сучасні методи детоксикації та імунокорекції в хірургічному лікуванні хворих з обтураційною жовтяницею (клініко-експериментальне дослідження): Автореф

2

I?I?NOA?NOAI IOI?IIE CAeI?IA’ss OE?A?IE

EE?ANUeEA IAAeE*IA AEAAeAI?ss I?NEssAeEIEIIII? INA?OE

?i.I.E.OOIEEA

EAAEAEI Aiae??e Ai?eniae/

OAeE: 616.36-008.811.4-08+616.366-089.86:615.246.2

NO*ANI? IAOIAeE AeAOIENEEAOe?? OA ?IOIIEI?AEOe?? A O??O?A?*IIIO
E?EOAAII? OAI?EO C IAOO?AOe?EIITH AEIAOssIEOeATH

(ee?i?ei-aenia?eiaioaeueia aeine?aeaeaiiy)

14.01.03 – o??o?a?y

Aaoi?aoa?ao

aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

Ee?a – 1999

Aeena?oaoe??th ? ?oeiien

?iaioa aeeiiaia a Ee?anuee?e iaaee/i?e aeaaeai?? i?neyaeeieiiii? ina?oe
?i.I.E.Ooieea I?i?noa?noaa ioi?iie caei?ia’y Oe?a?ie

IAOEIAEE EA??AIEE: aeieoi? iaaee/ieo iaoe, i?ioani?

Iai/e/ Aieiaeeie? ?aaiiae/,

caa?aeoaa/ eaoaae?e o??o?a?? Ee?anueei? iaaee/ii? aeaaeai??
i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe, i?ioani?

IO?Oe?EI? IIIIAIOE: aeieoi? iaaee/ieo iaoe, noa?oee iaoeiaee
ni?a?ia?oiee

Eeoaeiaiei Ieaenaiae? Ieaenaiae?iae/,

caa?aeoaa/ a?aeae?eo ia?aaeiooeeiieo caoai?thaaiue ? aaethaaioii?
oa?ai?? O????i?ue?i?i i?o?iai-aei?e?aeii?i ?i????o?o ii?iei??? ?
??ae?iei??? ?IC O????i?

aeieoi? iaaee/ieo iaoe, noa?oee iaoeiaee ni?a?ia?oiee

Eii/ae Aieiaeeie? Ieoaeeiae/,

caa?aeoaa/ a?aeae?eo o??o?a?? i?aeoeoieiai? caeice ? ?aeiino?oeoeaii?
o??o?a?? aeia/ieo i?ioie?a ?inoeoooo ee?i?/ii? oa aenia?eiaioaeueii?
o??o?a?? AII Oe?a?ie

I?IA?AeIA ONOAIIAA: Iaoe?iiaeueiee iaaee/iee oi?aa?neoao ?i. I.I.
Aiaiiieueoey IIC Oe?a?ie, eaoaae?a oaeoeueoaonueei? o??o?a??

Caoeno a?aeaoaeaoueny “29“ aeiaoiy 1999 ?ieo i 14 aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.613.02 i?e Ee?anuee?e iaaee/i?e
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea IIC Oe?a?ie (254112,
aoe.Aei?iaiaeeoeueea, 9)

C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea (i.Ee?a,
aoe.Aei?iaiaeeoeueea,9)

Aaoi?aoa?ao ?ic?neaiee “28” aa?aniy 1999 ?ieo.

A/aiee nae?aoa?niaoe?ae?ciaaii? a/aii? ?aaee e.i.i., aeioeaio Aaicaeye
I.I.CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeuei?noue oaie. Aeooaeuei?noue i?iaeaie e?eoaaiiy iaoo?aoe?eieo
o?aaeaiue aeia/ieo oeyo?a iaoiiaeaia ?o oe?ieei ?iciianthaeaeaiiyi,
aaaee?noth ee?i?/iiai ia?aa?ao neeaaei?noth ae?aaiinoeee a oaeiae
iacaaeia?eueieie ?acoeueoaoaie e?eoaaiiy, iacaaaeath/e ia oniioe
no/anii? aaiaoieiai?. Oae, ca aeaieie AIIC (1990), caoai?thaaiiy
aaiaoiiaie?aaoiaeoiaeaiaeueii? ciie ye? noi?iaiaeaeothoueny ia/?ieiaith
iaaeinoaoi?noth ui ? i?e/eiith nia?oi ianaeaiiy, noi?oue ia ainueiiio
iinoei o na?o? na?aae ?ioeo caoai?thaaiue [I.I.Oae?iia oa ?i. 1993].
C?inoa? e?euee?noue ethaeae ?c caoai?thaaiiyie ia/?iee ? aeia/ieo oeyo?a
ui oneeaaeiai? iaoai?/iith aeiaoyieoeath [I.N.Ei/i?a oa ?i., 1995;
Ae.E.I?eianueeee, 1996; Nsendes et al.1992].

A Oe?a?ii /anoioa aeia/iieaiyii? oai?iae ca inoaii? n?i ?ie?a
caieueoeeanue o 2 ?ace. Oae, o o??o?a?/iiio a?aeae?eaii? Ee?anueei?
iaeanii? ee?i?/ii? e?ea?i? ui??/ii e?eo?oueny aeecueei 535 oai?eo ?c
iaoieia??th aaiaoia?e?a?ii? nenoaie a o 22% caoai?thaaiiy
noi?iaiaeaeo?oueny iaoai?/iith aeiaoyieoeath. Aiia cono??/a?oueny o
2030% oai?eo aeia/iieaiyiith oai?iaith [I.A.Eiiaoeii, 1989;
A.A.Eeeiaiei, 1998; C.Y.Chen et al., 1998].

?acoeueoaoe e?eoaaiiy oai?eo c iaoo?aoe??th aeia/iaea?aeieo oeyo?a iei?
ia iiaeooue aaaaeaoeny caaeia?eueieie. Oae, i?neyiia?aoe?eia
eaoaeuei?noue o oeeo oai?eo i?e oa?i?iiaeo iia?aoe?yo ia aenio?
aeiaoyieoe? iiaea aeinyaaoe 2353% [?.?.O?iaiei oa ?i., 1993;
TH.I.Iaioee?aa oa ?i., 1994; F.Lacaine et al., 1995; S.S.Baijal et al.,
1997].

Ca aeaieie TH.I. Aeaaea?a?a (1990), aino?a ia/?ieiaa iaaeinoaoi?noue
(AII) o aaiaoieia?/ieo oai?eo oa iia?iaaieo oai?eo ?c iaoieia??th
ia/?iee, ui ? i?e/eiith nia?o?, noi?oue ia ia?oiio i?noe?. I?e ?icaeoeo
aaiaoioea?aa?aeueii? iaaeinoaoiino? o?aaeeoe?ei? iaoiaee oa?ai?? a
a?eueoino? aeiaaee?a ? iaaoaeoeaieie. Iacaaaeath/e ia ?icaeoie iaoiae?a
?ioaineaii? oa?ai??, eaoaeuei?noue i?e ia/?ieia?e iaaeinoaoiino?
caeeoa?oueny iaaecae/aeii aenieith (60100%) ? ia ia? oaiaeaioe?? aei
cieaeaiiy [A.A.A?one?e 1984; A.I.Aeaoeaiei oa ?i., 1995; J.A.Payne,
1986; N.Arkadopoulos et al., 1998].

Ia aeoieo iecee aaoi??a iaeia?niaeoeai?oei caniaii e?eoaaiiy AII ?
canoinoaaiiy ia/?ieiaeo ee?oei ye? aeei?enoiaothoue ye ooieoe?iiaeuei?
iaeeieoe? ui caeaoi? cai?uaoe ao?a/ai? ooieoe?? ia/?iee [?.?.O?iaiei oa
?i. 1986; I.I.Noaaioa, 1997; . 1986; S.C.Strom et al., 1997; V.Roger et
al., 1998]. 10-??/iee aeina?ae canoinoaaiiy aaaaoueia aeine?aeieeaie
na?aeiaeae?eaieo ?cieueiaaieo aaiaoioeeo?a aeiaiaeeoue ?oith iaea?eueoo
aoaeoeai?noue i?e ia/?ieia?e iaaeinoaoiino? o?eueee i?e i?yiiio eiioaeo?
e?ia? oai?iai c aeiii?nueeeie ee?oeiaie ia/?iee [I.N.Ia?aoe?n oa ?i.
1989; I.A.Aa?ani?a oa ?i., 1993; A.?.Iai/e/ oa ?i., 1999; . . 1987;
P.A.Rivas-Vetencourt et al., 1997; S.M.Riordan et al., 1998].

Aiaeii/an, o aeinooii?e iai e?oa?aoo??, ie ia ciaeoee aeinoaoiuei
aeaieo oa a?aeiia?ae? ia oe?eo ieceo caieoaiue, iiaycaieo ?c e?eoaaiiyi
?ioieneeaoe?eiiai neiae?iio i?e ia/?ieia?e iaaeinoaoiino? oa
?ioiiei?aeoe?? i?e iaoai?/i?e aeiaoyieoe?, a

naia:

· Ia??iae, no?iee, niin?a oaaaeaiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a
? o?aaiaio?a enaiinaeac?iee.

· Ii??aiyeueia oa?aeoa?enoeea caaaeueiii?eeiyoeo iaoiae?a aeaoieneeaoe??
? aeei?enoaiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a oa ?oith eiia?iaoe?th
?c o?aaiaioaie enaiinaeac?iee o oai?eo iaoai?/iith aeiaoyieoeath.

· Aeaoieneeaoe?eiee aieea aeei?enoaiiy eiia?iaoe?? aeno?aei?ii?aeueiiai
i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a
enaiinaeac?iee c eaia?ineii?/iith aeaeiii?an??th aeia/iee oeyo?a oa ?o
naiaoe??th.

· Aieea e??ieiina?aiaaieo aaiaoioeeo?a oa o?aaiaio?a naeac?iee o oai?eo
?c iaoai?/iith aeiaoyieoeath ia ?ioiiee noaoon, aeaoieneeaoe?ei?
aeanoeaino?, ia?aa?a caoai?thaaiiy.

Caycie oaie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie. Aeena?oaoe?y
aeeiiaia a?aeiia?aeii aei ieaio iaoeiai-aeine?aeieo ?ia?o eaoaae?e
o??o?a?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe IIC
Oe?a?ie, iiia? Aea?aeaaii? ?a?no?aoe?? oaie ?0197?U003589.

Iaoa ?iaioe. Aeey iie?auaiiy ?acoeueoao?a e?eoaaiiy oai?eo ?c
iaoai?/iith aeiaoyieoeath, ?ic?iaeoe eiiieaen e?eoaaeueieo caoiae?a, ye?
aeeth/athoue o naaa o??o?a?/ia e?eoaaiiy, aeaoieneeaoe?th ?
?ioiiei?aeoe?th.

Caaea/? aeine?aeaeaiiy.

1. Aea/eoe ?ioiiee noaoon oa ??aaiue ?ioieneeaoe?? o oai?eo ?c
iaoai?/iith aeiaoyieoeath, oneeaaeiaiith aino?ith ia/?ieiaith
iaaeinoaoi?noth.

2. Aenia?eiaioaeueii aea/eoe aeiionoei? no?iee aaaaeaiiy
enaiiaaiaoioeeo?a oa ?oi? eiia?iaoe?? c o?aaiaioaie enaiinaeac?iee, ye
cania?a aeaoieneeaoe?? oa ?ioiiei?aeoe??.

3. Aenia?eiaioaeueii i?iaanoe ii??aiyeueio ioe?ieo aoaeoeaiino? aieeao
aeei?enoaieo aaiaoioeeo?a, ?oi? eiia?iaoe?? c o?aaiaioaie naeac?iee ia
caa?aaeaiiy ooieoe?iiaeueiiai ?aca?ao ia/?iee oa ??aaiue ianiaoeeo?/iiai
?ioi?oaoo.

4. Aea/eoe aieea eaia?ineii?/ii? aeaeiii?an?? aeia/ieo oeyo?a ia
?ioieneeaoe?eiee neiae?ii oa ?ioi?oao o oai?eo ?c iaoai?/iith
aeiaoyieoeath.

5. Aea/eoe aoaeoeai?noue canoinoaaiiy e??ieiina?aiaaieo
enaiiaaiaoioeeo?a oa o?aaiaio?a naeac?iee ia ?ioiiee noaoon,
aeaoieneeaoe?ei? aeanoeaino?, ee?i?/iee ia?aa?a caoai?thaaiiy o oai?eo
?c iaoai?/iith aeiaoyieoeath, oneeaaeiaiith aino?ith ia/?ieiaith
iaaeinoaoi?noth.

Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a. Oia?oa aoei aea/aii iiceoeaiee
aieea e??ieiina?aiaaieo enaiiaaiaoioeeo?a, ye? iathoue niaoeeo?/io
a?ieia?/io ae?th, i?e aenia?eiaioaeuei?e iaoai?/i?e aeiaoyieoe?
aeiaaaeaii ?oith iaoiene/i?noue ia oaa?eiao.

Onoaiiaeaii i?ae /an aeine?aeaeaiiy, ui aei 10-? aeiae
aenia?eiaioaeueii? iaoa-

i?/ii? aeiaoyieoe? on? uo?? aie?athoue a?ae aino?i? ia/?ieiai?
iaaeinoaoiino?.

Aeyaeaii, ui o?ainieaioaoe?y enaiiaaiaoioeeo?a uo?ai ia 7-io aeiao
iaoai?/-ii? aeiaoyieoe?, yea oneeaaeiaia ia/?ieiaith iaaeinoaoi?noth,
aeicaiey? caa?aaoe aeeooy oaa?eiai o 89,3% aeiaaee?a.

O ?iaio? aia?oa ia cia/iiio aenia?eiaioaeueiiio iaoa??ae? aeyaeaii, ui
iaee?auei iaoiaeii e?eoaaiiy AII ia oii? iaoai?/ii? aeiaoyieoe? ?
eiia?iiaaia aaaaeaiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a
enaiinaeac?iee.

Ia cia/iiio ee?i?/iiio iaoa??ae? aeiaaaeaii, ui i?e iiaeiaaeaiiio
oieanoac? ia?oei aoaiii o??o?a?/iiai e?eoaaiiy ia? aooe eaia?ineii?/ia
aeaeiii?an?y aeia/ieo oeyo?a oa canoinoaaiiy aaiiia?ooc?? /a?ac
a?ieia?/i? e??ieiina?aiaai? i?aia?aoe aeey e?eoaaiiy aino?i? ia/?ieiai?
iaaeinoaoiino?.

Aia?oa o oai?eo ?c iaoo?aoe?eiith aeiaoyieoeath aeia?iye?niiai aaiaco
aoee canoiniaai? a yeino? eiiiiiaioa aeaoieneeaoe?eiiai na?aaeiaeua
e??ieiina?aiaai? aaiaoioeeoe oa o?aaiaioe naeac?iee, io?eiai? c i?aai?a
iiaiia?iaeaeaieo ii?inyo.

Aeiaaaeaii, ui aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo
enaiiaaia-oioeeo?a ? o?aaiaio?a enaiinaeac?iee ? aoaeoeaiei ca iayaiino?
cieaeaiiai ?ioi?oaoo ia oii? oieanoaco aeey e?eoaaiiy ia/?ieiai?
iaaeinoaoiino?.

I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a. Ia i?aenoaa? io?eiaieo
aeaieo noaiaea?oeciaaii oa iiaea?i?ciaaii oaeoeeo e?eoaaiiy oai?eo ?c
aaaeeeie oi?iaie iaoa-i?/ii? aeiaoyieoe? ca aeiiiiiaith oe?ieiai
aeei?enoaiiy eaia?ineii?/ieo iaoiaeee ? a?iaaiini?aoe??, ui aeicaieeei
nei?ioeoe o?eaae?noue e?eoaaiiy oa ciaioeoe e?euee?noue eaoaeueieo
iane?aee?a.

Aeyaeaii, ui ca iayaiino? cieaeaiiy ?ioi?oaoo oa ae?aaeai?e
?ioieneeaoe??, oai?ei aeey e?eoaaiiy ia/?ieiai? iaaeinoaoiino? iieacaii
aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ?
o?aaiaio?a enaiinaeac?iee, ui cia/ii iie?aueei ee?oeiiee, aoii?aeueiee
oa ianiaoeeo?/iee ?ioi?oao, a oaeiae ciaioeei nooi?iue aooi?ioiii?
aa?an?? i?aai?cio.

Cai?iiiiiaaiee iaoiae e?eoaaiiy ?c canoinoaaiiyi
ni?aoe?eii-aeaoieneeaoe?eieo oa noeioethth/eo na?aaeiaeu ??ciiai
eiiiiceoe?eiiai neeaaeo o oai?eo ?c iaoai?/iith aeiaoyieoeath
aeia?iye?niiai aaiaco aeicaieea iie?ioeoe ?acoeueoaoe o??o?a?/ieo
ao?o/aiue ca ?aooiie iineeaiiy aeaoieneeaoe?eii? ooieoe?? ia/?iee a
i?neyiia?aoe?eiiio ia??iae?.

Aaeineiiaeaia e?eoaaeueia oaeoeea i?e iaoai?/i?e aeiaoyieoe?
aeia?iye?niiai aaiaco caaaeyee iiaeeeaino? i?iaaaeaiiy iaeiiiiiaioieo
?aaeeeaeueieo iia?aoe?e.

Aeyaeaii iie?ioaiiy iaeaeeae/eo oa a?aeaeaeaieo ?acoeueoao?a
o??o?a?/ieo ao?o/aiue ca ?aooiie ciaioaiiy ?eceeo iia?aoe?e.

?ic?iaeaii niin?a e?eoaaiiy iaoai?/ii? aeiaoyieoe? a aenia?eiaio?
(??oaiiy ?27403 a?ae 4.11.98 i?i aeaea/o iaoaioo ia aeiao?ae ca cayaeith
?98020983, iiaeaiith 25.02.98?.).

?ic?iaeaii niin?a aeno?aei?ii?aeueii? a?ini?aoe?? (cayaea ia aeiao?ae

?98126701 a?ae 18.12.98?.).

?acoeueoaoe aeena?oaoe?? ai?iaaaeaeai? a ?iaioo ?inoeoooo ee?i?/ii? oa
aenia?eiaioaeueii? o??o?a?? AII Oe?a?ie, a ?iaioo o??o?a?/ieo
a?aeae?eaiue iaeanii? ee?i?/ii? e?ea?i? i.Ee?aa, 2-? i?nueei? ee?i?/ii?
e?ea?i? i.Iaeane, 2-? i?nueei? ee?i?/ii? e?ea?i? i.Oa?eiaa, OII
Aeca?aeeinueeiai ?aeiio i.Oa?eiaa, a iaa/aeueiee i?ioean ia eaoaae??
o??o?a?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe, eaoaae??
oi?aeiaaaeii?iaeueii? o??o?a?? Oa?e?anueei? iaaee/ii? aeaaeai??
i?neyaeeieiiii? ina?oe.

Iniaenoee aianie caeiaoaa/a. Aeena?oaoe?eia ?iaioa ? iniaenoith i?aoeath
aaoi?a. Aaoi?ii iniaenoi i?iaiae?ciaaii a?o/eciyio oa caei?aeiiio
e?oa?aoo?o c i?iaeaie, ui aea/aeany.

On? aenia?eiaioaeuei?, ee?i?/i? aeine?aeaeaiiy aeeiioaaeeny aaoi?ii
naiino?eii. Iniaenoi aoa i?iaaaeaiee aiae?c ?acoeueoao?a aeine?aeaeaiiy
aenia?eiaioaeueiiai ? ee?i?/iiai aeei?enoaiiy aaiaoioeeo?a, noi?o?
aaiaoioeeo?a ? o?aaiaio?a naeac?iee.

Aaoi? iniaenoi ai?iaaaeea o ee?i?eo eiia?iiaaia aeno?aei?ii?aeueia
aeei-?enoaiiy enaiiaaiaoioeeo?a oa o?aaiaio?a naeac?iee i?e iaoai?/i?e
aeiaoyieoe?.

A?aa o/anoue o an?o iia?aoeaieo ao?o/aiiyo.

Aenia?eiaioaeuei? aeine?aeaeaiiy aeeiioaaeenue ia iaoa??ae? oa ca
aeiiiiiaith caa. a?aeae?eii a?io?i?? oieiaeiai? aaeaioaoe?? ?inoeoooo
i?iaeai e??ia?ieia?? ? e??iiaaeeoeeie IAI Oe?a?ie ae.a.i. Noaaioe I.I.
Aaoi? aeneiaeth? ue?o iiaeyeo ca eiinoeueoaoe?? oa i?aeoe/io aeiiiiiao
i?e aeeiiaii? aeena?oaoe??.

Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. ?acoeueoaoe aeine?aeaeaiue, ye?
aeeth/aii aei aeena?oaoe??, aoee ii?eethaeiai? ia iaoeiai-i?aeoe/i?e
eiioa?aioe?? “Aeooaeuei? i?iaeaie o??o?a??” (aei 75–??//y eaoaae?e
o??o?a?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe, i. Ee?a,
20–21 eenoiiaaea 1997?.), iaoeia?e eiioa?aioe?? Aeooaeuei? ieoaiiy
o??o?a?? ia/?iee, aeia/iaea?aeieo oeyo?a, i?aeoeoieiai? caeice oa noaeei
(i?enay/aia 80–??//th c aeiy ia?iaeaeaiiy aeaaeai?ea I.I.Oae?iiaa, i.
Ee?a, 20–22 n?/iy 1998 ?.), VI eiioa?aioe?? o??o?a?a-aaiaoieia?a ?in??
oa e?a?i NIAe (i.Ee?a, 25–27 eenoiiaaea 1998 ?.), iaoeia?e eiioa?aioe??
Oe?o?aey caaieaaaiee ia/aie, aeae/iuo iooae e iiaeaeaeoaei/iie aeaeacu
(i. Iaeana, 10–11 /a?aiy 1999 ?.), ia ni?eueiiio can?aeaii? eaoaae?
o??o?a??, oi?aeiaaaeii?iaeueii? o??o?a??, o??o?a?? oa ii?eiaeo oai?ia,
aianoac?ieia?? oa ?ioaineaii? oa?ai??, oaeaeei? ? iaa?aeeeaaeii?
iaaee/ii? aeiiiiiae Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii?
ina?oe ?i.I.E.Ooieea IIC Oe?a?ie, a?aeae?eo o??o?a?? i?aeoeoieiai?
caeice oa ?aeiino?oeoeaii? o??o?a?? aeia/ieo oeyo?a Iinoeoooo ee?i?/ii?
oa aenia?eiaioaeueii? o??o?a?? AII Oe?a?ie (i.Ee?a, 21 o?aaiy 1999?.).

Ioae?eaoe??. ?acoeueoaoe aeena?oaoe?? iioae?eiaai? o 16 ae?oeiaaieo
i?aoeyo. ?c ieo 7 noaooae o oeaio?aeueieo oaoiaeo aeo?iaeao, 9 ?ia?o o
aeaeyae? oac aeiiia?aeae ia o??o?-

a?/ieo eiioa?aioe?yo oa c’?caeao. Ca ?acoeueoaoaie aeena?oaoe?? io?eiaii
1 iaoaio

Oe?a?ie ia aeiao?ae ? iiaeaii 1 cayaeo ia aeiao?ae.

No?oeoo?a aeena?oaoe??. Aeena?oaoe?y aeeeaaeaia ia 149 noi??ieao
ae?oeiaaiiai oaenoo ? neeaaea?oueny ?c anooio, iaeyaeo e?oa?aoo?e,
o?ueio ?icae?e?a aeanieo aeine?aeaeaiue, caeeth/aiiy, aeniiae?a,
i?aeoe/ieo ?aeiiaiaeaoe?e, nieneo e?oa?aoo?e. ?iaioa i?i?ethno?iaaia 44
oaaeeoeyie oa 22 iaethieaie. Nienie aeei?enoaieo aeaea?ae aeeth/a? 311
i?aoeue, a oiio /ene? 178 ?ia?o a?o/eciyieo ? 133 ca?oa?aeieo aaoi??a.

INIIAIEE CI?NO ?IAIOE

Iaoa??aee oa iaoiaee aeine?aeaeaiiy. Aeaea?aeii ne?iaeie aeey io?eiaiiy
e??ieiina?-aiaaieo enaiiaaiaoioeeo?a (EEa) ? o?aaiaio?a enaiinaeac?iee
(OEn) aoee a?aeiia?aeii ia/?iea ? naeac?iea iiaiia?iaeaeaieo ii?inyo (24
aeiae), ye? i?ieoee noai?ee aaoa?eia?iee a?aea??. Aenia?eiaioaeueio
?iaioo i?iaiaeeee ia 273 uo?ao-naioeyo ianith 200250 a. Iiaeaethaaiiy
aenia?eiaioaeueii? iaoai?/ii? aeiaoyieoe? (AIAE) oa AII o uo??a
i?iaiaeeee iaoiaeii oo?i?eaoii? ia?aaycee caaaeueii? aeia/ii? i?ioiee
(CAEI) oa caaaeueii? ia/?ieiai? a?oa??? (CIA) ca cai?iiiiiaaiith iaie
iaoiaeeeith.

Aeey io?eiaiiy ?cieueiaaieo ia?aioeiaoicieo ee?oei ia/?iee a ?iaio?
aeei?enoiaoaaany iaoiae, yeee aeeth/aa oa?iaioaoeaio ? iaoai?/io ia?iaeo
ia/?iee [R.Howard et al., 1967]. Aeey io?eiaiiy o?aaiaio?a naeac?iee
aeei?enoiaoaaee iaoiae iaoai?/ii? ia?iaee.

Caii?iaeoaaiiy noniaic?? aaiaoioeeo?a ? o?aaiaio?a naeac?iee i?iaiaeeee
c aeei?enoaiiyi 2-aoaiiiai ?aaeeio: ia ia?oiio aoai? oaeaee?noue
ioieiaeaeaiiy aoea 1N/oa. aei -60N. Ia ae?oaiio aoai? eiioaeia? ?c
noniaic??th aaiaoioeeo?a aai o?aaiaioaie naeac?iee ?ici?uoaaee a
niaoe?aeuei? eanaoe ? oaeaeei caio?thaaee a ??aeeee acio (-196N).

Onueiai aoei noi?iiaaii 4 aenia?eiaioaeuei? a?oie:

I. A?oia eiio?ieuei? oaa?eie. Oey a?oia neeaaea?oueny c:

· eiio?ieth oaa?ei ?ioaeoi? oaa?eie (15 uo??a);

· eiio?ieth AIAE ? AII oaa?eie aac ciyooy e?aaoo?e (38 uo??a), c?
ciyooyi e?aaoo?e ia 3 aeiao (28 uo??a), 5 aeiao (28 uo??a), 7 aeiao (24
uo?e) c iiiaioo ia?aaycee;

· eiio?ieth a?ii?aia?ao?a, ui aea/aeeny, oea ?ioaeoi? oaa?eie, yeei
aaiaeeee EEa iaeiiin?aii (24 uo?e) oa a eiia?iaoe?? c OEn (24 uo?e).

II. A?oia oaa?eie c AIAE ? AII, yeei ?iieaiooaaeenue EEa oa ci?iaee
e?aaoo?o c caaaeueiiai aeia/iiai i?ioieo ia 5 aeiao (32 uo?e).

III. A?oia oaa?eie c AIAE ? AII, yeei ?iieaiooaaeenue EEa ?
aaiaeeeenue OEn c? ciyooyi e?aaoo?e ia 5 aeiao a?ae iiiaioo ia?aaycee
(32 uo?e).

IV. A?oia oaa?eie c AIAE ? AII, yeei ?iieaiooaaeenue EEa oa ci?iaee
e?aaoo?o c caaaeueiiai aeia/iiai i?ioieo ia 7 aeiao (28 uo??a).

Noniaic?th EEa i?e eiioeaio?aoe?? 2107/ie oaiaeeee o a?eueio /a?aaio
ii?iaeie-

io a aeic? 05ie/100a aaae o?ea oaa?eie. OEn oaiaeeee
aioo??oiueii/a?aaeiii a aeic? 1ie/100a iane o?ea. Uia io?eiaoe
aeinoaoith e?euee?noue e?ia? aeey aeine?aeaeaiiy, uo??a caaeaaee oeyoii
aeaeai?oaoe?? a?eueioeiith.

O ne?iaaooe? e?ia? ca caaaeueiii?eeiyoeie iaoiaeeeaie aea/aee
a?io?i?/i? oa ?ioiieia?/i? iieacieee: ai?no a?e??oa?io, oieanoa?eio,
aeoeai?noue aeai?iai?ii-o?ainoa?ace (AeAO) eaoaeace ??aaiue iaeiiiaiai
ae?aeueaeaa?aea (IAeA), ae??iiaeo eiithaao?a (AeE), a?eea e?i?ae?a,
?-?icaoeiooai?thth/eo ee?oei (?-?OE), oaaioeeoa?iee ?iaeaen (O?),
oaaioeeoa?ia /enei (O*), ??aaiue eiiieaiaioo, oee?eoethth/eo ?ioiieo
eiiieaen?a (Oe?E). O ia/?ioe? aecia/aee ??aaiue IAeA
noia?ieneaeaeeniooace (NIAe) eaoaeace aeooao?iio.

Aecia/aee aino?o oa o?ii?/io oiene/i?noue oaaaeaieo EEa. Aino?o
oiene/i?noue aecia/aee ca aeni?an-iaoiaeii O.A. Ianoooaiei ia ieoao oa
uo?ao i?e aaaaeai? a?ii?aia?aoo /a?ac ?io, aioo??oiuei/a?aaeiii oa
aioo??oiueiiyciai. O oaa?ei i?e aaaaeai? aoaeoeaii? aeice (AAe50) EEa
aea/aee o?ii?/io oiene/i?noue iaoiaeii a?aee?eoiai iiey, aei??thaaee
/anoioo na?oeaaeo nei?i/aiue, oaiia?aoo?o o?ea, a oaeiae i?iaiaeeee
a?io?i?/i? aeine?aeaeaiiy ne?iaaoee e?ia? ia ia?ea?i? oa?iaioe
o?aaeaiiy.

O ?iaio? c 1996 ii 1998 ??. i?iaaaeaii aiae?c ?acoeueoao?a e?eoaaiiy 79
oai?eo, o yeeo aoea iaoai?/ia aeiaoyieoey aeia?iye?niiai aaiaco,
oneeaaeiaia AII IIIII no. Oai?eo aei 44 ?ie?a niinoa??aaeinue 11 (13,9%)
/ieia?e, a?ae 45 aei 64 ?ie?a 38 (48,1%) /ieia?e, iiiaae 64 ?iee – 30
(38,0%) /ieia?e. *ieia?e?a aoei 35 (44,3%), ae?iie 44 (55,7%). Noai
oyaeeino? oai?eo aecia/aee ca oeaeith APACHE-II.

On? oai??, yeei i?iaiaeeeinue e?eoaaiiy AII i?e iaoai?/i?e aeiaoyieoe?,
aoee iiae?eai? ia ee?i?/i? a?oie:

1. Oai??, yeei o ia?aaeiia?aoe?eiiio ia??iae? i?iaiaeeee eaia?ineii?/ia
ae?aioaaiiy aeia/ieo oeyo?a (EAeAEO).

2. Oai??, yeei i?iaiaeeee o?aaeeoe?eio ?ioaineaio oa?ai?th.

3. Oai??, yeei o i?neyiia?aoe?eiiio ia??iae? i?iaiaeeee
aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a
(AIEEA).

4. Oai??, yeei o i?neyiia?aoe?eiiio ia??iae? i?iaiaeeee naain
aaiini?aoe?? (AN) ca caaaeueiii?eeiyoith iaoiaeeeith.

5. Oai??, yeei i?iaiaeeee aeno?aei?ii?aeueia i?aeeeth/aiiy
e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee
(AIEEA?OEN).

Canoiniaoaaany oaeee aeai?eoi ianoaaeaiiy: aiaiiac, ee?i?/ia
ianoaaeaiiy, eaai?aoi?i? ? niaoe?aeuei? iaoiaee aeine?aeaeaiiy
(oeueo?acaoeiaa aeine?aeaeaiiy, aeoiaeaiia?ao?y,
o?a?iacioaaiaano?iaeoiaeaiineii?y, eaia?ineii?y oa ae?aioaaiiy
aeia/iaea?aeieo oeyo?a ?c iiaeaeueoith ?aioaaiio?nooeia?ao??th,
aiaeineii?/ia ?ao?ia?aaeia iaie?aaoioieaia?ia?ao?y c
iai?eino?ieoa?ioii??th).

O ne?iaaooe? e?ia? ca caaaeueiii?eeiyoeie iaoiaeeeaie aea/aeenue
iieacieee oieanoaco (a?e??oa?i oa eiai o?aeoe??), oeeoie?co
(-aeooai?eo?ainiaioeaeaca [(AOI),

AeAO)], a?eeiaiai iai?io (i?io?iia?iiaee ?iaeaen, caaaeueiee a?eie,
aeueaoi?ie), acioenoiai iai?io (e?aaoeiei, na/iaeia), ?ioieneeaoe?eiiai
neiae?iio [eaeeioeeoa?iee ?iaeaen ?ioieneeaoe?? (E??), ??aaiue iieaeoe
na?aaeiuei? iane (INI)]. Oaeiae o ne?iaaooe? e?ia? aecia/aee iieacieee
ee?oeiiiai (A-e?ioioeeoe, O-e?ioioeeoe oa ?oi? o?aeoe??), aoii?aeueiiai
(?ioiiaeiaoe?ie A, I, G) oa ianiaoeeo?/iiai (O?, O*, eiiieaiaioa?ia
aeoeai?noue ne?iaaoee e?ia?) ?ioi?oaoo. I?iaiaeeee aeine?aeaeaiiy
aooi?ioiieo i?ioean?a o ne?iaaooe? e?ia? (aooi?ioii? aioeo?ea, Oe?E).

Aea/aiiy ee?i?ei-eaai?aoi?ieo aeaieo i?iaiaeeeinue aaciina?aaeiuei
ia?aae oa /a?ac 1 aeiao i?ney iia?aoe??, a oaeiae /a?ac 1, 5 ae?a i?ney
ni?aoe??.

Noaoenoe/io ia?iaeo iaoa??aeo i?iaiaiaeeee ca caaaeueiii?eeiyoeie
iaoiaeeeaie ca aeiiiiiaith iaoiaeo aa??aoe?eii? noaoenoeee. Ia?iaeyee
aeai? ca aeiiiiiaith iaeaoa i?eeeaaeieo i?ia?ai Microsoft Excel.

?acoeueoaoe aeine?aeaeaiiy oa ?oi? iaaiai?aiiy. Ia i?aenoaa?
i?iaaaeaiiai aenia?eiaioo ie io?eiaee ianooii? aeai?.

On? uo?e i?e iiaeaethaaii? aenia?eiaioaeueii? iaoai?/ii? aeiaoyieoe? ?
aino?i? ia/?ieiai? iaaeinoaoiino? aac a?aeiia?aeiiai e?eoaaiiy aeioee ia
10 aeiao.

I?e ciyoo? e?aaoo?e c aeia/iaea?aeii? i?ioiee ia 5 aeiao eaoaeueiee
iane?aeie a?ae AII niinoa??aaany a 7,14% aeiaaee?a. I?e ciyoo? e?aaoo?e
ia 7 aeiao AIAE a?ae AII caaeioei 22 (91,7%) oaa?eie.

sse iieacaee iao? aeine?aeaeaiiy, iaee?auee aoaeo a?ae oaaaeaiiy
e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee
niinoa??aa?oueny o a?oi? uo??a, eio?ei i?aia?ao oaiaeeee ia 5 aeiao
AIAE, oneeaaeiaii? AII. ??aaiue a?eea ca?eueoeany a 2,10 (?0,001) ?aca ?
aeinyaaa ii?ie /a?ac oeaeaeaiue. O oie /an, ye i?e iaeiiin?aiiio
aaaaeaii? aaiaoioeeo?a ai?no a?eea ca?eueoeany a 1,91 (?0,01) ?aca ?
caeeoaany a 1,06 (?0,05) ?aca iaioei ca ii?io. A ia/?ioe? oaa?ei i?ney
aaaaeaiiy EEa ? OEn /a?ac 7 aei?a on? iieacieee aeinyaaee ii?ie. A i?e
o?ainieaioaoe?? EEa ??aaiue NIAe, eaoaeace caeeoaany ciaioaiei ia 7
aeiao a 1,14 (?0,05), 1,11 (?0,05) ?aca a?aeiia?aeii.

?ioiiei?eaoth/a ae?y aoea iaea?eueo ae?aaeaia i?e aaaaeai? noi?o?
aaiaoioeeo?a oa naeac?iee, ui i?iyaeyeinue ii?iae?caoe??th on?o
iieaciee?a ianiaoeeo?/iiai ?ioi?oaoo ? oaeaeoei cieaeaiiyi
oee?eoethth/eo ?ioiieo eiiieaen?a. I?e eiia?iiaaiiiio aaaaeaii? ??aaiue
?-?OE, Oe?E, eiiieaiaioo a e?ioe? aenia?eiaioo aei??aithaaa ii?i?,
iieacieee O? ? O* aoee a 1,15 (?0,05) ? 1,07 (?0,05) ?aca aeua ca ii?io.
I?e o?ainieaioaoe?? EEa ??aaiue Oe?E /a?ac oeaeaeaiue caeeoaany a 1,5
(?0,05) ?aca aeua ca ii?io, a ai?no eiiieaiaioo, iieacieee O?, O* aoee
ieae/a ii?ie a 1,11 (?0,05), a 1,06 (?0,05), a 1,05 (?0,05) ?aca
a?aeiia?aeii.

Oaeei /eiii, oaaaeaiiy o?eueee aaiaoioeeo?a ia i?eaiaeeoue aei
ii?iae?caoe?? iieaciee?a ianiaoeeo?/iiai ?ioi?oaoo, oi/a ?oiy
?iieaioaoe?y ni?ey? iiaeiaaeaiiio caa?aaeaiith ooieoe?iiaeueiiai ?aca?ao
ia/?iee, i?i ui na?ae/eoue eaoaeuei?noue 10,7% i?ioe 91,7% o
eiio?ieuei?e a?oi? uo??a i?ney 7-aeiaiai? aenia?eiaioaeueii? iaoai?/ii?
aeiaoyieoe?.

Oea iiaycaia c ?oiueith a?inoeioethth/ith ? ?ioiiei?eaoth/ith ae??th, a
oaeiae iiaeeeai c aea??eiaith ni?aoe??th oiene/ieo aiaei- ?
aecioienei?a. Oea na?ae/eoue i?i oa, ui aaiaoioeeoe iiaiia?iaeaeaieo
ii?inyo iaee aeinoaoith aeeoo?caeaoi?noue ? iiaeeea?noue aeeiioaaoe
niaoeeo?/i? ooieoe??, a oaeiae aoee i?eaeaoieie aei aeei?enoaiiy a
ee?i?oe?.

?icaeiooee oieaia?o i?e o?eaae?e iaoo?aoe??, a oaeiae aino?ee
caiaeueiee i?ioean aaiaoiiaie?aaoia?e?a?ii? nenoaie aeeeeeathoue a?oa?
ii?ooaiiy ooieoe?e ia/?iee, a a iecoe? aeiaaee?a iathoue iacai?ioi?e
oa?aeoa?. Noiooi? caoai?thaaiiy ?iaeyoue ua ?eceeiaai?oei ?aaeeeaeueia
o??o?a?/ia ao?o/aiiy o oe?e a?oi? oai?eo. Oiio aeeiiaia iaie
ia?aaeiia?aoe?eia ae?aioaaiiy aeia/ieo oeyo?a (/a?acoe??ia,
/a?acia/?ieiaa oieaoeenoinoii?y aai aaiaoinoii?y) c ?oiueith naiaoe??th
ni?eyei onoiaiith a?ia?oaic?? a aaiaoia?e?a?i?e nenoai?, iie?auaiith
caaaeueiiai noaio oai?eo ? ooieoe?iiaeueieo iieaciee?a ia/?iee, ie?ie.
Oea aeaei iiaeeea?noue i?iaaaeaiiy ?aaeeeaeueiiai o??o?a?/iiai ao?o/aiiy
a ni?eyoeea?oee ia??iae, yeee aeey aeaii? a?oie oai?eo a?aeiia?aea? 78
aeia? aeaeiii?an??.

O a?oi? oai?eo ?c iaoai?/iith aeiaoyieoeath aeia?iye?nii? ao?ieia??,
yeei o ia?aaeiia?aoe?eiiio ia??iae? aeeiioaaee EAeAEO, aoei 11 /ieia?e.
Eiio?ieueiith aoea a?oia c 21 oai?iai, yeei iae?aco aeeiioaaeanue
iia?aoe?y. Aei iiiaioo o??o?a?/iiai ao?o/aiiy ee?i?/iee noai oai?eo ?c
EAeAEO aoa e?auei, i?ae o a?oi? aac ae?aioaaiiy. Oea i?aeoaa?aeaeaii
ii??aiyeueiei aiae?cii ?acoeueoao?a ooieoe?iiaeueieo iieaciee?a ia/?iee
??aiy oeeoie?co, oieanoaco, a?eeiaiai iai?io.

I?e aeine?aeaeaii? iieaciee?a ?ioieneeaoe?? aecia/aii, ui cia/aiiy E??,
INI o a?oi? oai?eo, yeei aoei i?iaaaeaii ia?aaeiia?aoe?eio EAeAEO,
ciaiooaaeenue ai?iaeiaae oeaeiy a 1,25 (?0,05) ? 1,46 (?0,05) ?aca
a?aeiia?aeii, a a eiio?ieuei?e a?oi? a??ia?aeiiai cieaeaiiy oeeo
iieaciee?a ia a?aei?/aeinue ? aiie caeeoaeeny a 8,0 (?<0,001) ? 4,8 (?<0,001) ?aca aeueie ca ii?io. Ai/aaeaeue, ui EAeAEO aeiiiiaaa? aeaoieneeaoe?eiei nenoaiai i?aai?cio ciaioeoe ?ioieneeaoe?eiee neiae?ii. Oea a?aeaoaa?oueny ca ?aooiie aeaaaeaiiy ?c i?aai?cio ai?eii? aeia/? oa iie?auaiiy ooieoe?iioaaiiy ia/?iee. O eiio?ieuei?e a?oi? a?aei?/aeinue ciaioaiiy ee?oeiiiai ? ianiaoeeo?/iiai ?ioi?oaoo. Iieacieee O-e?ioioeeo?a, O?, O*, eiiieaiaioo aoee a 1,42 (?<0,05), 1,83 (?<0,01), 1,51 (?<0,01), 1,57 (?<0,01) ?aca a?aeiia?aeii ieae/a i?ioe ii?iaoeaieo iieaciee?a. ??aaiue O-noi?ani??a ciaioeany a 2,18 (?<0,001) ?aca uiaei ii?ie, a ai?no aooi?ioiieo aioeo?e ? Oe?E ca?eueoeany a 3,31 (?<0,001) ? 2,21 (?<0,01) ?aca a?aeiia?aeii. I?ney iia?aoe?? niinoa??aaeanue ua a?eueoa aeoeaaoe?y aooi?ioiieo i?ioean?a, cie?aia ??aaiue aooi?ioiieo aioeo?e ca?eueoeany ia 17,8% (?<0,05), a ??aaiue Oe?E ? O-noi?ani??a caeeoaany o iaaeao ii/aoeiaeo iieaciee?a (?0,05). Io?eiai? aeai? ?ioiieia?/iiai ianoaaeaiiy aeacothoue ia oa, ui o an?o oai?eo aeine?aeaeoaaii? a?oie cieaeoaaeenue iieacieee ee?oeiiiai ? ianiaoeeo?/iiai ?ioi?oaoo, a oaeiae ?icaeaaany aooi?ioiiee i?ioean, ui i?aeoaa?aeaeoaaeinue cia/iei ciaioaiiyi O-noi?ani??a, i?aeaeuaiei ??aiai Oe?E, aooiaioeo?e. Aoi?eiiee ?ioiiaeao?oeeo o oai?eo aeine?aeaeoaaii? a?oie ?icaeioany ye ?acoeueoao aino?i? ia/?ieiai? iaaeinoaoiino? ia oii? iaoai?/ii? aeiaoyieoe?. I?e EAeAEO a??ia?aeieo ci?i c aieo ?ioiieia?/ieo iieaciee?a ia a?aei?/aeinue. Oea aeaei i?aenoaao aecia/eoe, ui i?e iiaeiaaeaiiio oieanoac? a?eueoa 14 ae?a, a?e??oa?iai?? a?eueoa 150 ieiieue/e, ??aith INI a?eueoa 1,0 iae.iio.u?euei. oa a?aenooiino? ae?aaeaii? ?ioiinoi?an?? ? aooi?ioiieo o?aaeaiue ia?oei aoaiii o??o?a?/iiai e?eoaaiiy iiaeiia aooe eaia?ineii?/ia aeaeiii?an?y aeia/ieo oeyo?a. E?euee?noue oneeaaeiaiue ? eaoaeueieo iane?aee?a o aeine?aei?e a?oi? aoei ieae/ei i?ae o eiio?ieuei?e. Iiia?ei ?c a?oie c EAeAEO 1 , o eiio?ieuei?e 5 oai?eo. Caaaeueia i?neyiia?aoe?eia eaoaeuei?noue aoea 9,0% ? 23,8% a?aeiia?aeii. Aaciina?aaeiueith i?e/eiith nia?o? o oeeo oai?eo aoea i?ia?anoth/a ia/?ieiai-ie?eiaa iaaeinoaoi?noue. Na?aaei?e e?aeei-aeaiue o aeine?aei?e a?oi? aoa 21,81,42; o eiio?ieuei?e 22,31,70. Oeaio?aeueia i?noea a eiiieaen? eiina?aaoeaieo e?eoaaeueieo caoiae?a ie a?aeaiaeeee a?iaaiini?aoe?? (AN). Anueiai aoei i?iaaaeaii 37 a?iaaiini?aoe?e oai?ei, yeeo ie niinoa??aaee, ?c ieo o 2-o oai?eo ee?oeiia oa?ai?y i?iaiaeeeanue aea?/?. Iieacaiiyi aei a?iaaiini?aoe?? ? AII II-III no., noai oai?eo ca oeaeith APACHE-II, ioe?iaiee ia 15 aae?a ? a?eueoa, ??aaiue INI aeuee ca 1,2 iae.iio.u?euei., ??aaiue O-noi?ani??a iaioa 10%. AN i?iaiaeeee ia 3 aeiao i?ney iia?aoe?? o oai?eo, o yeeo caa??aaany aenieee ??aaiue aiaeiaaiii? ?ioieneeaoe??. A ia?o? aea? aeiae i?ney iia?aoe?? oeei oai?ei i?iaiaeeee ?ioaineaio eiina?aaoeaio ei?aeoe?th a?iiaieai??, a?iia?ae?aoaoe??, aiai??, nenoaie cn?aeaiiy e?ia?, noaa?e?coaaee aaiiaeeiai?eo oa ooieoe?th aaeaeaaoiiai niiioaiiiai ciai?oiueiai aeeoaiiy oai?iai. Ca oeae /an aeyaeaii oaiaeaioe?? a aeeiai?oe? ee?i?/ieo ? eaai?aoi?ieo iieaciee?a, ye? oa?aeoa?ecothoue noai oai?iai. Ca iayaiino? iiceoeaieo oaiaeaioe?e oeeo ci?i AN ia iieacaia. sseui ae ia?aeia aiaieua aeia?a ia?iaeaia, ae?aiiaaia aai aeaeaeaia, a o oai?iai caa??aathoueny iciaee aiaeiaaiii? ?ioieneeaoe??, oi iio??aii aeiiiiiaoe aeaoieneeaoe?eiei nenoaiai i?aai?cio. Ia 3 aeiao i?ney o??o?a?/iiai e?eoaaiiy niinoa??aaeanue iaeieae/a a??ia?aei?noue aaii?aa?/ieo oneeaaeiaiue aiane?aeie aeno?aei?ii?aeueii? aeaoieneeaoe??, ine?eueee aaea noi?ioaaany iaae?eiee i?noeaaee aaiinoac, a oaeiae iaea a??ia?aei?noue ai?eii? a?ic?? noaeei ca iani?eyoeeaiai ?icaeoeo i?noeaaiai caiaeueiiai i?ioeano. O ee?i?/i?e a?oi?, aea aeei?enoiaoaaee AIEEA o i?neyiia?aoe?eiiio ia??iae?, aoei 13 oai?eo. Iiceoeaiee aoaeo a?ae i?iaaaeaii? i?inoi? AN ie niinoa??aaee o 12 oai?eo, aea iaeiiio oai?iio aeey io?eiaiiy aeinoaoiueiai e?eoaaeueiiai aoaeoo aoee iaiao?aei? iiaoi?i? AN, ine?eueee o iueiai aoea aaiaoioea?aa?aeueia iaaeinoaoi?noue IIIII no. Aeei?enoaiiy i?inoi? AN aeicaieeei iie?auaoe aeac?ioieneeaoe?eio ooieoe?th ia/?iee, ciaioeoe ??aaiue aiaeiaaiii? ?ioieneeaoe??. Oae, E?? /a?ac 1 aeiao i?ney AN ciaioeany a 2,42 (?0,01) ?aca, a /a?ac 5 ae?a cieceany a 6,62 (?0,001) ? aeinyaaa ii?iaeueieo aaee/ei 1,240,04. ??aaiue INI ia 1 aeiao i?ney AIEEA ciaioeany a 2,14 (?0,01) ?aca, ia 5 aeiao a 4,69 (?0,001) ?aca ? aei??aithaaa 0,260,01 iae.iio.u?euei. Oaeei /eiii, AIEEA iie?auo? ooieoe?iiaeueiee noai ia/?iee, aeicaiey? cieceoe yaeua oeeoie?co, cieceoe ae?aaeai?noue aiaeiaaiii? ?ioieneeaoe??, ui iiaycaii ?c ciaioaiiyi oieanoaco ? oieai?/ii? ?ioieneeaoe?? a ?acoeueoao? ni?aoe?? a?e??oa?io, aeia/ieo eeneio, ai?aeo oa ?ioeo oienei?a. I?e aea/aii? ianiaoeeo?/iiai ?ioi?oaoo a?aei?/aii ca?eueoaiiy cia/aiiy O?, O*, eiiieaiaioo ai?iaeiaae 5 ae?a o 1,59 (?0,01), a 1,43 (?0,01), a 1,62 (?0,01) ?aca a?aeiia?aeii. Oea aeaco? ia ianiaoeeo?/iee ?ioiinoeioethth/ee aieea AIEEA. A ?ioiieia?/iiio noaoon? i?eaa?oa? aei naaa oaaao cia/ia ca?eueoaiiy ??aiy O-noi?ani??a a?ae 9,50,45% i?e ii/aoeiaiio ??ai?, aei 21,90,31% ia 5 aeiao i?ney i?iaaaeaiiy aeno?aei?ii?aeueii? ni?aoe?? ?c enaiiaaiaoioeeoaie, oiaoi a 2,317 (?0,01) ?aca. Io?eiai? ?acoeueoaoe na?ae/aoue i?i ciaioaiiy aeoeaiino? aooi?ioiieo i?ioean?a, ine?eueee, iayai?noue O-noi?ani?iiai ?ioiiaeao?oeeoo o oai?eo c oieanoaoe/-iei o?aaeaiiyi ia/?iee coiiaeth? ?icaeoie ia?ao?anii? aooi?ioiii? ?aaeoe?? aei iaoaaie?o?a ? a?ee?a, ye? iathoue noiaeo no?oeoo?o ?c a?e?a?iith nenoaiith. I?ney i?iaaaeaiiy AIEEA ie a?aei?/aee cieaeaiiy e?eueeino? aooi?ioiieo aioeo?e, oee?eoethth/eo ?ioiieo eiiieaen?a ia 1 aeiao ia 36,5% (?<0,05) ? ia 34,1% (?0,05), a aei 5 aeiae ia 42,6% (?<0,05) ? ia 42,9% (?0,01) a?aeiia?aeii, ui na?ae/eoue i?i iie?auaiiy ?ioiii? a?aeiia?ae?, ine?eueee o oai?eo ?c iaoai?/iith aeiaoyieoeath aeia?iye?niiai oa?aeoa?o aoi?eiiee O-noi?ani?iee ?ioiiaeao?oeeo iiaycaiee c iiyaith aooiaioeo?e oa oee?eoethth/eo ?ioiieo eiiieaen?a, ui aeieothoue aeoeai?noue O-noi?ani??a. Aeei?enoaiiy AIEEA aoei aoaeoeaiei o 12 oai?eo, ye? aeienaeenue ?c iie?auaiiyi. I?neyiia?aoe?eia eaoaeuei?noue aoea 7,7%. Na?aaei?e e?aeei-aeaiue noaiiaea 18,50,85 aei?a. Oaeei /eiii, o 12 oai?eo aoa aeinyaiooee no?eeee iiceoeaiee aoaeo o ?acoeueoao? aeei?enoaiiy i?inoi? AN, ui ni?eyei, ca ?aooiie aeaoieneeaoe??, a?i- ? ?ioiinoeioeyoe?? ?aa?ano yaeu ia/?ieiai-ie?eiai? iaaeinoaoiino? a ?aiiueiio i?neyiia?aoe?eiiio ia??iae?, ii?iae?caoe?? iai?io ?a/iaei, ?aii?e aeoea?caoe?? oai?eo ?c a?aeiiaeaiiyi ooieoe?e oeoieiai-eeoeiaiai o?aeoo. Oai?eo, yeei o eiiieaen e?eoaaeueieo caoiae?a aeeth/aee aaiini?aoe?th c aeei?enoaiiyi aeoeaiaaiiai aoaey ia?ee NEI-1E, aoei 12. O ia?oo aeiao i?ney aaiini?aoe?? o an?o oai?eo niinoa??aaany iiceoeaiee aoaeo: a?aei?/aeinue iie?auaiiy caaaeueiiai noaio, ciaioaiiy aeiaoyieoe?, naa?aaaeo, iie?auaiy ineo?/iiai noaoono, ciaioaiiy ?ioieneeaoe??. I?ioa c 2-3 aeiae noai oai?eo ciiao iia??oeany, ia?inea ?ioieneeaoe?y. E??, ??aaiue INI ia 1 aeiao i?ney aaiini?aoe?? cieceany a 2,11 (?0,01) ?aca, a 1,81 (?0,05) ?aca, a a iiaeaeueoiio ia 5 aeiao a 3,82 (?0,01) ?aca, a 2,61 (?0,01) ?aca a?aeiia?aeii i?ioe aeo?aeieo ??ai?a ? noaiiaea 2,170,06 ? 0,410,04 iae.iio.u?euei. Iiaeia a?aei?oeoe cia/ia cieaeaiiy iieaciee?a ?ioieneeaoe?? /a?ac aeiao i?ney aaiini?aoe??, i?ioa iio?i oea ciaioaiiy aoei ia oaeei oaeaeeei. I?ney AIEEA niinoa??aaeinue ae?aaeaia cieaeaiiy oeeo iieaciee?a ye aaciina?aaeiuei i?ney i?ioeaaeo?e, oae ? /a?ac 5 ae?a. Oea na?ae/eoue i?i oa, ui i?e AIEEA a?aeaoaa?oueny ia o?eueee aaciina?aaeiy ni?aoe?y oienei?a, a ? noeioeyoe?y i?e?iaeieo aeaoieneeaoe?eieo nenoai, aieiaiith c yeeo ? ia/?iea. A ?ioiieia?/iiio noaoon? i?ney AN caa?oa? ia naaa oaaao iacia/ia ca?eueoaiiy ??ai?a O- ? A-e?ioioeeo?a, ?ioiiaeiaoe?i?a, iieaciee?a aeoeaiino? oaaioeeoico, ui iiaycaii ?c ciaioaiiyi o e?ia? oiene/ieo i?iaeoeo?a, ye? i?eai?/othoue ?ioi?oao. I?ney AN ie niinoa??aaee ca?eueoaiiy O-noi?ani??a ia 1 aeiao a 1,33 (?0,05) ?aca, a a iiaeaeueoiio ia 5 aeiao a 1,63 (?0,05) ?aca i?ioe ii/aoeiaiai ??aiy. Cieaeaiiy ??aiy aooiaioeo?e, Oe?E aoei ae?aaeaia a 1 aeiao ia 31,1% (?0,05) ? ia 34,9% (?0,05) a?aeiia?aeii, a ia 5 aeiao ?oi?e ??aaiue iacia/ii ca?eueooaaany, aea caeeoaany i?aeoe/ii ia oiio ae ??ai? ?0,05. Aiae?c ?acoeueoao?a e?eoaaiiy oai?eo c iaoo?aoe?eiith aeiaoyieoeath aeia?iye?nii? ao?ieia?? c aeei?enoaiiyi aaiini?aoe?? iieacaa, ui: ii-ia?oa, aoaeo aaiini?aoe?? ei?ioei/aniee, ii-ae?oaa, ia i?eaiaeeoue aei cia/iiai iie?auaiiy noaio oai?eo ? cieaeaiiy aeoeaiino? iaoieia?/iiai i?ioeano a ia/?ioe?. Na?aaei?e e?aeei-aeaiue o eiio?ieuei?e a?oi? oai?eo noaiiaea 21,21,64 aeiy. O cayceo c i?iaeiaaeaiei ia?inoaiiyi aino?i? ia/?ieiai-ie?eiai? iaaeinoaoiino? o 2 oai?eo ia oii? ia?inoath/i? aeiaoyieoe? ?icaeioeany aaiaoioea?aa?aeueia iaaeinoaoi?noue III no, yea i?eaaea aei ia/?ieiai? eiie ? eaoaeueiiai iane?aeeo. I?neyiia?aoe?eia eaoaeuei?noue aoea 16,6%, ui ? iaeiei ?c iaeaeueo iieaciee?a na?aae ianoaaeaieo a?oi. Aoei aeine?aeaeaii 22 oai?eo ?c iaoai?/iith aeiaoyieoeath, yeei i?iaiaeeee eiia?iiaaio a?iaaiini?aoe?th ?c aeei?enoaiiyi e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee. O aeiaaeeao, eiee i?e aeeiiaii? eaia?ineii?? aoee iciaee aioo??oiuei/a?aaeiieo ai?eieo oneeaaeiaiue, i?iaiaeeee iia?aoe?? ca aeeoo?aeie iieacaiiyie, a a i?neyiia?aoe?eiiio ia??iae? aeeiioaaee eiia?iiaaio AN. I?iaiae?ciaai? ?acoeueoaoe e?eoaaiiy 7 oai?eo ?c iaoai?/iith aeiaoyieoeath, yeei i?ney EAeAEO ia eo?n ia?aaeiia?aoe?eii? oa?ai?? aoei aeeth/aii AIEEA?OEN. Aeeiiaii 8 eiia?iiaaieo AN. Iaeiiio oai?iio c aino?ei iaie?aaoeoii ? iaie?aiiae?icii AIEEA?OEN i?iaiaeeee aea?/?. Oaeiae eiia?iiaaio AN i?iaiaeeee i?ney iia?aoe?? oai?ei, o yeeo caa??aa?oueny aenieee ??aaiue aiaeiaaiii? ?ioieneeaoe?? ? ae?aaeaiee aoi?eiiee ?ioiiaeao?oeeo. 14 oai?ei AIEEA?OEN i?iaiaeeee iaeii?aciai. Iaeiiio oai?iio c iaie?aaoeoii eiia?iiaaio a?iaaiini?aoe?th i?iaiaeeee aea?/?. I?e aeei?enoaii? eiia?iiaaii? a?ini?aoe?? /a?ac iaeio aeiao oai?? a?aei?/aee iie?auaiiy caaaeueiiai noaio (ciaioaiiy aeiaoyieoe?, cieeiaiiy naa?aaaeo, iie?auaiiy nio). Iie?aueeenue a?io?i?/i? oa ?ioiieia?/i? iieacieee. E?? /a?ac 1 aeiao i?ney eiia?iiaaiii? AN ciaioeany a 3,74 (?0,001) ?aca, a /a?ac 5 ae?a cieceany a 7,52 (?0,001) ?aca ? aeinya ii?iaeueieo aaee/ei 1,110,04. ??aaiue INI ia 1 aeiao i?ney AIEEA?OEN ciaioeany a 2,45 (?0,01) ?aca, ia 5 aeiao a 5,0 (?0,001) ?ac?a ? aei??aithaaa 0,250,009 iae.iio.u?euei. Oea aiai?eoue i?i a?eueoo aoaeoeai?noue aeei?enoaiiy eiia?iiaaiii? a?iaaiini?aoe??, i?ae i?inoi?. Aea/ath/e iieacieee ee?oeiiiai ? ianiaoeeo?/iiai ?ioi?oaoo, iiaeia c?iaeoe aeniiaie, ui eiia?iiaaia a?ini?aoe?y ia? ae?aaeaiee ?ioiinoeioethth/ee aoaeo. Oae, oaea /a?ac aeiao iieacieee O?, O* ca?eueooaaeenue o 1,57 (?0,01) ? 1,39 (?0,05) ?aca; ??aaiue eiiieaiaioo a 1,49 (?0,001) ?aca. I?ney iyoi? aeiae a aeine?aei?e a?oi? iieacieee O*, O?, ??aaiue eiiieaiaioo aei??aithaaa ii?i?. I?e aea/aii? ?ioiiiai noaoono oai?eo a?aei?/aii ae?aaeaiee noeioethth/ee aieea ia O-noi?ani?e i?e iaeii/aniiio cieaeaii? ??aiy Oe?E ? aooi?ioiieo aioeo?e (?en. 1, 2). ??aaiue O-noi?ani??a ca?eueoeany a 2,68 (?0,001) ?aca, a ai?no Oe?E ? aooi?ioiieo aioeo?e ciaioeany ia 59,5% (?0,001) ? ia 51,8% (?0,001) uiaei ii/aoeiaiai ??aiy. Iiaeia a?aei?oeoe, ui ??aaiue Oe?E ciaioo?oueny oaeaeoa, i?ae ??aaiue aooi?ioieo aioeo?e, iacia/ia e?euee?noue yeeo i?iaeiaaeo? oee?eoethaaoe a e?ia? ua ai?iaeiaae 5 ae?a. Eiia?iiaaia canoinoaaiiy AIEEA?OEN ia? a?eueo ae?aaeaiee iiceoeaiee aoaeo, ine?eueee ?acii c aoaeoii aeaoieneeaoe?? cai?iiiiiaaiee iaoiae ia? a?i- ? ?ioiinoeioethth/o ae?th, ui iniaeeai iaiao?aeii oai?ei o i?neyiia?aoe?eiiio ia??iae? c aaaeeeie caoai?thaaiiyie i?aai?a aaiaoiiaie?aaoia?e?a?ii? nenoaie. Aeoiaey/e c aeuaaeacaiiai iiaeia c?iaeoe aeniiaie, ui aeeth/aiiy AIEEA?OEN o eiiieaenio oa?ai?th oai?eo c oneeaaeiaiith iaoai?/iith aeiaoyieoeath iaeii/anii c eaia?ineii?/iith aeaeiii?an??th aeia/ieo oeyo?a aeicaiey? i?aeaeueoe aoaeoeai?noue o??o?a?/iiai e?eoaaiiy. Aoaeoeaiei AIEEA?OEN aoei o 21 oai?iai. Na?aaei?e e?aeei-aeaiue noaiiaea 19,51,51. O iaeiiai oai?iai c iaie?aiiae?icii ia oii? iie?i?aaiii? iaaeinoaoiino? ianoaa eaoaeueiee e?iaoeue. I?neyiia?aoe?eia eaoaeuei?noue noaiiaeea 4,5%. Ii??aithth/e ?acoeueoaoe a a?oiao c AIEEA oa AIEEA?OEN a?aei?/aii, ui o oai?eo c eiia?iiaaiith a?ini?aoe??th niinoa??aa?oueny oaeaeoa ii?iae?caoe?y i?ioa?iia?aie (?0,05). I?e aea/aii? iieaciee?a ?ioieneeaoe?? ??cieoey ci?i o aeaio a?oiao iaa??ia?aeia (?0,05). I?e eiia?iiaai?e a?iaaiini?aoe?? a?aei?/aiee a?eueo ae?aaeaiee ?ioiinoeio-ethth/ee aoaeo. I?e oeueiio niinoa??aa?oueny a?eueo oaeaeea cieaeaiiy ??aiy aooiaa?an??, ii??aithth/e c oai?eie, yeei aeei?enoiaoaaee o?eueee ?cieueiaai? aaiaoioeeoe (?0,01). I?ney a?iaaiini?aoe??, i?iaaaeaiii? a ?aii? no?iee i?ney iia?aoe??, niinoa??aaeinue i?aeaeuaiiy iieaciee?a ?ioi?oaoo iaeii/anii c? noaa?e?caoe??th aai ciaioaiiyi ??aiy Oe?E, aooiaioeo?e. Iaoai?ci ae?? aei e?ioey ia aea/aiee, aea iiaeia i?eionoeoe, ui enaiiaaiaoioeeoe a?ae?a?athoue ?ieue /oaei??aeii? i?oai?. I?e oeueiio ia?aeaeueii enaiiaaiaoioeeoe oa o?aaiaioe enaiinaeac?iee ni?aothoue ia nai?e iiaa?oi? ? aeaiaeyoue ?c i?aai?cio Oe?E ? aooi?ioii? aioeo?ea. Aiaeii/an a?aeaoaa?oueny noeioeyoe?y O-noi?ani?ii? eaiee ee?oeiiiai ?ioi?oaoo, i?e/iio eiia?iiaaia aeei?enoaiiy enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee ni?aaey? iaea?eueo ae?aaeaiee ?ioiinoeioethth/ee aieea, yeee ni?ey? iie?auaiith ?aia?aoeaieo i?ioean?a o ia/?ioe? ? a?aeiiaeaiith ?? aeaoieneeaoe?eii? ooieoe??. Iia?aoe?y, aacia?a/ii, caeeoa?oueny aieiaiith eaieith a e?eoaaii? iaoai?/ii? aeiaoyieoe?. Aea aiia ? eeoa /anoeiith a eiiieaen? e?eoaaeueieo cania?a. I?e c?inoath/?e oieai??, i?ia?anoth/? ii?ooaiiy aiiainoaco iiaeooue aooe iano?eueee no??ieeie, ui o?eueee nai?/ania aeei?enoaiiy aeoeaieo iaoiae?a aeaoieneeaoe?? oa ?ioiiei?aeoe??, ?ic?iaeaieo iaie, caeaoia iiia?aaeeoe eaoaeueiee iane?aeie. I?ney EAeAEO ia oii? AII, i?e o?eaae?e aeiaoyieoe?, ia 35 aeiae i?ney ia-??iaeo iie?auaiiy ianoaei iia??oaiiy noaio oai?eo ? iieaciee?a ooieoe?e ia/?iee oa ie?ie. Aeei?enoaiiy eiia?iiaaii? AN o oeae ia??iae aeaei iiceoeai? iane?aeee c aeaaaeaiiy oai?eo c ia/?ieiai-ie?eiai? iaaeinoaoiino? oa i?aeaioiaee aei iia?aoe??. Oai?ei, o yeeo aoee aeno?ai? iieacaiiy aei iia?aoe??, aeeiioaaee ?? iaaaeii. Ca iayaiino? a i?neyiia?aoe?eiiio ia??iae? ae?aaeaiiai oieai?/iiai ? ai?eiiai aiaeioieneeico, a oaeiae ?icaeoeo aoi?eiiiai ?ioiiaeao?oeeoo ? aooi?ioiiiai i?ioeano a ia/?ioe?, ie aeei?enoiaoaaee aeno?aei?ii?aeuei? iaoiaee aeaoieneeaoe??, iaeaoaeoeai?oei ?c yeeo, ca iaoeie aeaieie, aoei eiia?iiaaia aeei?enoaiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee. Oea aeicaieeei a??ia?aeii ciaioeoe eaoaeuei?noue na?aae oeueiai iaaecae/aeii neeaaeiiai eiioeiaaioo oai?eo ? iie?aueoe ia?aa?a i?neyiia?aoe?eiiai ia??iaeo. AENIIAEE 1. Aeei?enoaiiy enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee ? iaeiei ?c aoaeoeaieo no/anieo iaoiae?a aeaoieneeaoe?? oa ?ioiiei?aeoe?? a eiiieaeniiio e?eoaaii? oai?eo c iaoo?aoe?eiith aeiaoyieoeath, oneeaaeiaiith ia/?ieiaith iaaeinoaoi?noth, ui ni?ey? cieaeaiith i?neyiia?aoe?eii? eaoaeueiino? ia 19,3% ? aeicaiey? nei?ioeoe /an ia?aaoaaiiy a noaoe?iia?? ia 2,8 aeiy. 2. Aenia?eiaioaeueii anoaiiaeaii, ui iaee?auee aoaeo a?ae eiia?iiaaiiai aaaaeaiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a oa o?aaiaio?a naeac?iee niinoa??-aa?oueny o a?oi? uo??a, yeei i?aia?ao oaiaeeee c 5 aeiae aenia?eiaioaeueii? iaoai?/ii? aeiaoyieoe?. Caaeaae? oaa?ei o oe?e a?oi? ia aoei. 3. Aaaaeaiiy oaa?eiai noi?o? enaiiaaiaoioeeo?a oa o?aaiaio?a enaiinaeac?iee ia? a?eueo ae?aaeaio ?ioiiei?eaoth/o ae?th, i?ae ie?aia aaaaeaiiy aaiaoioeeo?a, ui i?aeoaa?aeaeo?oueny ii?iae?caoe??th on?o iieaciee?a ianiaoeeo?/iiai ?ioi?oaoo oa cieaeaiiyi oee?eoethth/eo ?ioiieo eiiieaen?a. 4. I?e aea/aii? aieeao e??ieiina?aiaaieo enaiiaaiaoioeeo?a a aenia?eiaio? aeiaaaeaii ?oith iaoiene/i?noue o oaa?ei, a oaeiae ae?aaeaio noeioethth/o ae?th ia o?aaeaio ia/?ieo i?i ui na?ae/eoue eaoaeuei?noue 10,7% i?ioe 91,7% o eiio?ieuei?e a?oi? uo??a i?ney 7-aeiaiai? aenia?eiaioaeueii? iaoai?/ii? aeiaoyieoe? ? aino?i? ia-/?ieiai? iaaeinoaoiino?. Oea aeaei iiaeeea?noue ee?i?/ii aea/eoe aeaiee a?ii?aia?ao. 5. O oai?eo ?c o?eaaeith iaoai?/iith aeiaoyieoeath cieaeo?oueny ee?oeiiee oa ia-niaoeeo?/iee ?ioi?oao (ciaioaiiy ai?noo O-e?ioioeeo?a a 1,42 ?aca, eiiieaiaioo a 1,57 ?aca, oaaioeeoa?iiai ?iaeaeno a 1,83 ?aca, oaaioeeoa?iiai /enea a 1,51 ?aca), ia oii? i?aeaeuaiiy ??aiy aooi?ioiii? aa?an?? (ca?eueoaiiy ai?noo aooi?ioiieo aioeo?e o 3,31 ?aca, oee?eoethth/eo ?ioiieo eiiieaen?a o 2,21 ?aca, ?c ciaioaiiyi O-noi?ani??a o 2,18 ?aca). Ca?eueoaiiy ??aiy na?aaei?o iieaeoe o 4,8 ?aca i?e iiaeiaaeaiiio oieanoac? na?ae/eoue i?i aaeeeee nooi?iue ?ioieneeaoe?? o oeeo oai?eo. 6. I?e iiaeiaaeaiiio oieanoac? a?eueoa 14 ae?a, a?e??oa?iai?? a?eueoa 150 ieiieue/e, ??aith iieaeoe na?aaeiuei? iane a?eueoa 1,0 iae.iio.u?euei. oa a?aenooiino? ae?aaeaii? ?ioiinoi?an?? ? aooi?ioiieo o?aaeaiue ia?oei aoaiii o??o?a?/iiai e?eoaaiiy ia? aooe eaia?ineii?/ia aeiciaaia aeaeiii?an?y aeia/ieo oeyo?a, ui aaaea aei iie?auaiiy ooieoe?e aaiaoioeeo?a iaoe??ioa. sseui i?ney eaia?ineii?/ii? aeaeiii?an?? aeia/ieo oeyo?a ia oii? aino?i? ia/?ieiai? iaaeinoaoiino? ianoa? iia??oaiiy noaio oai?eo ? iieaciee?a ooieoe?e ia/?iee, oi iieacaia eiia?iiaaia a?iaaiini?aoe?y a oeae ia??iae, ui aea? iiceoeai? iane?aeee c aeaaaeaiiy oai?eo ?c ia/?ieiai-ie?eiai? iaaeinoaoiino? oa i?aeaioiaee aei iia?aoe??. 7. I?e aino?iio aoi?eiiiio ?ioiiaeao?oeeo? oa ae?aaeai?e ?ioieneeaoe?? oai?ei aeey eiiieaeniiai e?eoaaiiy oa i?io?eaeoeee ia/?ieiai? iaaeinoaoiino? iieacaii aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ? o?aaiaio?a enaiinaeac?iee, ui ia o?eueee iie?auo? ee?oeiee, aoii?aeueiee oa ianiaoeeo?/iee ?ioi?oao, aea ? cieaeo? ?ioieneeaoe?th, a oaeiae aooi?ioiio aa?an?th i?aai?cio. Iieacaiiyi aei a?iaaiini?aoe?? a i?neyiia?aoe?eiiio ia??iae? ? noai oai?eo ca oeaeith APACHE-II - 15 aae?a ? a?eueoa, ??aaiue iieaeoe na?aaeiuei? iane aeuee ca 1,2 iae.iio.u?euei., ??aaiue O-noi?ani??a iaioa 10%. 8. A?iaaiini?aoe?th iaeaeioe?euei?oa i?iaiaeeoe i?e aino??e ia/?ieia?e iaaeinoaoiino? II no., oi/a ?? canoinoaaiiy i?e aino??e ia/?ieia?e iaaeinoaoiino? III no. oaeiae ia? aaeeea i?aeoe/ia cia/aiiy. I?e aeei?enoaii? a?iaaiini?aoe?? o oai?eo c AII II no. eaoaeueiino? ia aoei, a o oai?eo c AII III no. eaoaeuei?noue noaiiaeea 20%. NIENIE IIOAE?EIAAIEO I?AOeUe CA OAIITH AeENA?OAOe?? 1. Noaaioa I.I., Eaaeaei A.A. Eniieueciaaiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia i?e ea/aiee yenia?eiaioaeueiie iaoaie/aneie aeaeoooe // I?iaeaiu e?eiaeieiaee. – 1997. – ?4. – N. 45–50. 2. Noaaioa I.I., Eaaeaei A.A. I?eiaiaiea eeaoi/iie oa?aiee a ea/aiee ino?ie iaaeinoaoi/iinoe ia/aie // E?ea?nueea ni?aaa. – 1998. – ?3. – N. 35–39. 3. Eaaaaeaaa TH.I., Noaaioa I.I., Eaaeaei A.A. I?eiaiaiea e?eieiina?ae?iaaiiuo aaiaoioeeoia a eiiieaeniii ea/aiee aieueiuo n ino?ie ia/aii/iie iaaeinoaoi/iinoueth // E?ea?nueea ni?aaa. – 1998. – ?7. – N. 67–70. 4. Iai/e/ A.?., Iaeaia?/oe A.?., Eaaeaei A.A. Aeooaeuei? ieoaiiy ee?oeiii? o?ainieaioaoe?? i?e iaoieia?? ia/?iee // Oe?a?inueeee iaaee/iee /aniien. – 1998. – ?4(6). – N. 17–23. 5. Iai/e/ A.E., Noaaioa I.I., Aaeeaioeeee I.I., Ooey?aiei A.A., Iaeaia?/oe A.E., Aaicaeye I.I., Eaaeaei A.A., Oa?aoiie/ A.E. AEaeoooa. Ia/aii/iay iaaeinoaoi/iinoue. Iaoiaeu ei??aeoeee // A?niee ii?nueei? iaaeeoeeie. – 1999. – ?2. – N. 131–132. 6. Iai/e/ A.?., Eaaeaei A.A., Aae?aioeeee I.I., Noaaioa I.I. Aieea e??ieiina?aiaaieo enaiiaaiaoioeeo?a oa o?aaiaio?a naeac?iee ia ?ioiieia?/iee noaoon oai?eo ia iaoai?/io aeiaoyieoeth, oneeaaeiaio ia/?ieiaith iaaeinoaoi?noth // Oieoaeueia o??o?a?y. – 1999. – ?1. – N. 41–47. 7. Eaaeaei A.A. I?eiaiaiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia iiai?iae-aeaiiuo ii?inyo a oe?o?ae/aneii ea/aiee ino?ie ia/aii/iie iaaeinoaoi/iinoe // Aenia?eiaioaeueia oa ee?i?/ia o?c?ieia?y ? a?io?i?y. – 1999. – ?1(5). – N. 15–23. 8. Eaaeaei A.A. Aa?iioieiae/aneea aniaeou aeeaaiinoeee e ea/aiey aieueiuo n iaoaie/aneie aeaeoooie // Aeeaaiinoeea e oe?o?ae/aneia ea/aiea caaieaaaiee e iia?aaeaeaiee aiaia/aii/iuo aeae/iuo i?ioieia. Iaoa?eaeu ?anioaeeeaineie iao/ii-i?aeoe/aneie eiioa?aioeee. Eeaa. – 1996. – N. 36–37. 9. Noaaioa I.I., Iaeaia?/oe A.?., Aea?eiaaea?aeue E.A., Eaaeaei A.A. Aieea e??ieiina?aiaaieo enaiiaaiaoioeeo?a ia iai?ii? i?ioeane a ia/?ioe? uo??a i?e iaoai?/i?e aeiaoyieoe? // Oacenu aeieeaaeia VII Oe?a?inueeiai a?io?i?/iiai c?caeo. – 1997. – *.II. – N. 165. 10. Iai/e/ A.E., Noaaioa I.I., Iaeaia?/oe A.E., Eaaeaei A.A., Aea?eiaaeaaaeue E.A. Eniieueciaaiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia i?e ea/aiee yenia?eiaioaeueiie iaoaie/aneie aeaeoooe // Iiaua oaoiieiaee a oe?o?aee. Nai?iee iao/iuo ?aaio, iinayuaiiue 75-eaoeth eaoaae?u oe?o?aee Eeaaneie iaaeeoeeineie aeaaeaiee iineaaeeieiiiiai ia?aciaaiey IC Oe?aeiu. – E.: A?o A?aoee. – 1997. – N. 57–58. 11. Iai/e/ A.E., Noaaioa I.I., Iaeaia?/oe A.E., Eaaeaei A.A., Naieiia A.E. Nia?aiaiiua iaoiaeu eeaoi/iie oa?aiee a ea/aiee ia/aii/iie iaaeinoaoi/iinoe // “Aeooaeuei? i?iaeaie iaie?aaoiaaiaoia?e?a?ii? oa noaeeiii? o??o?a??”. Ca??iee ?ia?o iaoeiai? eiioa?aioe??, i?enay/aii? 80-??//th aeaaeai?ea I.I.Oae?iiaa. – E.: Ee?i. o??o?a?y. – 1998. – N. 112 – 114. 12. Iai/e/ A.?., Noaaioa I.I., Iaeaia?/oe A.?., Aea?eiaaea?aeue E.A., EaaeaeiA.A. Aieea e??ieiina?aiaaieo aeiaaiaoioeeo?a ia iai?ii? i?ioeane oa ia?aeenia ieeneaiiy a ia/?ioe? i?e aenia?eiaioaeuei?e iaoai?/i?e aeiaoyieoe? // Aeooaeuei? ieoaiiy no/anii? o??o?a??. Iaoa??aee i?aeia?iaeii? iaoeiai? eiioa?aioe?? i?enay/aii? 100-??//th c aeiy ia?iaeaeaiiy i?ioani?a I.A. Oaaeeioey. – Oaeai?iae. – 1997. – N. 61. 13. Subbota N.P., Rozanova E.D., Pashinsky P.P., Kebkalo A.B. Content of low molecular proteins and nucleotides in biopreparations obtained by the cryoextraction method from // 35th Annual Meeting of the Society for Cryobiology Cryo98. – Pittsburgh (USA). – 1998. – P. 105. 14. Subbota N., Pashinsky P., Kebkalo A. Stimulation of reparative processes when treating wounds and burns using embryonic preparations // The 5th International Surgery Congress Wounds, Burns, Dressings. – Tel Aviv (Israel). – 1998. – P. 115. 15. Subbota N.P., Pashinsky P.P., Kebkalo A.B. Biological properties of liver cryoextractions // The First Combined Meeting European of Tissue Banks and Musculo Skeletal Transplantation. – Turku (Finland). – 1998. – P. 53. 16. Mamchich V.I., Subbota N.P., Kebkalo A.B., Palamarchuck V.I., Seminog V.I., Sarmah A. Use of cryopreserved xenohepatocytes in the treatment of experimentally induced mechanical jaundice // World Congresses of Gastroenterology. – Vienna (Austria). – 1998. – P. 569. AIIOAOe?ss Eaaeaei A.A. No/ani? iaoiaee aeaoieneeaoe?? oa ?ioiiei?aeoe?? a o??o?a?/iiio e?eoaaii? oai?eo c iaoo?aoe?eiith aeiaoyieoeath (ee?i?ei-aenia?eiaioaeueia aeine?aeaeaiiy). – ?oeiien. Aeena?oaoe?y ia caeiaoooy iaoeiaiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe ca niaoe?aeuei?noth 14. 01. 03 – o??o?a?y. – Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i. I.E. Ooieea IIC Oe?a?ie, Ee?a, 1999. Aeena?oaoe?th i?enay/aii aeine?aeaeaiiyi iniaeeainoae canoinoaaiiy eaia?ineii?/ii? iaoiaeeee, a?iaaiini?aoe?? a e?eoaaii? oai?eo ?c iaoai?/iith aeiaoyieoeath aeia?iye?niiai aaiaco, ui oneeaaeiaia aino?ith ia/?ieiaith iaaeinoaoi?noth (AII). Aea/aii aieea e??ieiina?aiaaieo enaiiaaiaoioeeo?a, ie?aii oa a eiia?iaoe?? c o?aaiaioaie enaiinaeac?iee, ia a?io?i?/i?, ?ioiieia?/i? iieacieee oa o?eaae?noue aeeooy uo??a i?ney iyoe- ? naieaeiaiai? aenia?eiaioaeueii? iaoai?/ii? aeiaoyieoe?. A aenia?eiaio? aoei aeei?enoaii 273 oaa?eie. Aena?oeaii ?acoeueoaoe e?eoaaiiy 79 oai?eo, ?c ieo o 62 (79,1%) aeyaeaia AII IIno., a o 17 (20,9%) - III no. Oai?ei canoiniaoaaee ia?aaeiia?aoe?eio eaia?ineii?/io aeaeiii?an?th aeia/ieo oeyo?a, iia?aoeaia e?eoaaiiy, i?neyiia?aoe?eia aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a ie?aii ? a eiia?iaoe?? c o?aaiaioaie enaiinaeac?iee. Ia i?aenoaa? io?eiaieo ?acoeueoao?a aeine?aeaeaiue ?ic?iaeaia ?aoe?iiaeueia oaeoeea e?eoaaiiy oai?eo ?c iaoai?/iith aeiaoyieoeath aeia?iye?niiai aaiaco, oneeaaeiaiith aino?ith ia/?ieiaith iaaeinoaoi?noth. Canoinoaaiiy eaia?ineii?/ieo iaoiaeee oa a?iaaiini?aoe?e aeicaieeei ciaioeoe e?euee?noue oneeaaeiaiue oa eaoaeueieo iane?aee?a ia 17,8% i?e iia?aoeaiiio e?eoaaii?. Eeth/ia? neiaa: iaoai?/ia aeiaoyieoey aeia?iye?niiai aaiaco, aino?a ia/?ieiaa iaaeinoaoi?noue, eaia?ineii?/ia aeaeiii?an?y aeia/ieo oeyo?a, a?iaaiini?aoe?y, aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo enaiiaaiaoioeeo?a, aeno?aei?ii?aeueia i?aeeeth/aiiy e??ieiina?aiaaieo o?aaiaio?a enaiinaeac?iee, aino?a ia/?ieiaa iaaeinoaoi?noue, iaoai?/ia aeiaoyieoey aeia?iye?niiai aaiaco. SUMMARY Kebkalo A.B. Up-dated methods of detoxification and immunocorrection in surgical treatment of patients with obstructive jaundice (clinico-experimental study). - Manuscript. A Thesis for a Scientific Degree of a Candidate of Medical Science (Ph.D) on a speciality 14.01.03 - Surgery. Kiev Medical Academy for Post-Graduate Education named after P.L.Shupic. Ministry of Health of Ukraine, Kiev, 1999. The Thesis is devoted to the research of peculiarities of using laparoscopic methods, biohemosorption in the treatment of patients with mechanical jaundice of benign genesis complicated by acute hepatic insufficiency (AHI). The influence of cryoconserved xenohepatocytes has been studied separately and in combination with the fragments of the spleen for biochemical, immunological values and rats span of life following five- and seven- day experimental mechanical jaundice. 273 animals were used in the experiment. The effects of the treatment of 79 patients were demonstrated. Grade II AHI was detected in 62 patients (79,1%) and Grade III AHI - in 17 patients (20,9%). These patients underwent preoperative laparoscopic decompression of biliary tracts, surgical treatment, postoperative extracorporal inclusion of cryoconserved xenohepatocytes separately and in combination with cryoconserved xenospleen fragments. On the basis of the obtained results an efficient treatment tactics for patients with mechanical jaundice of benign genesis complicated by AHI has been developed. The use of laparoscopic methods and biohemosorption allowed to reduce the number of complications and lethal outcome by 17,8% in surgical treatment. Key words: mechanical jaundice of benign genesis, acute hepatic insufficiency, biliary tract laparoscopic decompression, biohemosorption, extracorporal inclusion of cryoconserved xenohepatocytes, extracorporal inclusion of cryoconserved xenospleen fragments. AIIIOAOeEss Eaaeaei A.A. Nia?aiaiiua iaoiaeu aeaoieneeaoeee e eiioiiei??aeoeee a oe?o?ae/aneii ea/aiee aieueiuo n iaoo?aoeeiiiie aeaeoooie (eeeieei-yenia?eiaioaeueiia enneaaeiaaiea). – ?oeiienue. Aeenna?oaoeey ia nieneaiea iao/iie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe ii niaoeeaeueiinoe 14.01.03 – oe?o?aey. – Eeaaneay iaaeeoeeineay aeaaeaiey iineaaeeieiiiiai ia?aciaaiey ei. I.E. Ooieea IC Oe?aeiu, Eeaa, 1999. Aeenna?oaoeey iinayuaia enneaaeiaaieyi iniaaiiinoae eniieueciaaiey eaia?ineiie/aneie iaoiaeeee, aeiaaiini?aoeee a ea/aiee aieueiuo n iaoaie/aneie aeaeoooie aeia?iea/aniiai aaiaca, ineiaeiaiiie ino?ie ia/aii/iie iaaeinoaoi/iinoueth (III). Eco/aii aeeyiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia, ioaeaeueii e a eiiaeiaoeee n o?aaiaioaie enaiinaeacaiee, ia aeioeie/aneea, eiioiieiae/aneea iieacaoaee e aeeeoaeueiinoue aeecie e?un iinea iyoe- e naienooi/iie yenia?eiaioaeueiie iaoaie/aneie aeaeoooe (YIAE). Yenia?eiaioaeueioth ?aaioo i?iaiaeeee ia 273 e?unao-naioeao iannie 200-250 a. Iiaeaee?iaaiea iaoaie/aneie aeaeoooe e ino?ie ia/aii/iie iaaeinoaoi/iinoe i?iaiaeeee iooai oo?ieeaoiie ia?aaycee iauaai aeae/iiai i?ioiea e iauae ia/aii/iie a?oa?ee ii i?aaeeiaeaiiie iaie iaoiaeeea. Nia?oue io YIAE ianooiaea ia 10 nooee. I?e ?ac?aoaiee iaoaie/aneie aeaeoooe ia 5 nooee ?acaeaaeanue ino?ay ia/aii/iay iaaeinoaoi/iinoue n eaoaeueiui enoiaeii a 7,14% neo/aaa. I?e ?ac?aoaiee naienooi/iie aeaeoooe eaoaeueiinoue auea 91,7%. Eae iieacaee iaoe enneaaeiaaiey eo/oee yooaeo iaaethaeaeny a a?oiia aeeaioiuo, eioi?ui aaiaeeee ia iyoua nooee e?eieiina?ae?iaaiiua enaiiaaiaoioeeou e o?aaiaiou enaiinaeacaiee. Aaiaoioeeou i?e eiioeaio?aoeee 2107/ie o?ainieaioe?iaaee a naiaiaeioth a?thoioth iieinoue a aeica 1ie/100 a iannu oaea. O?aaiaiou naeacaiee aaiaeeee aioo?ea?thoeiii a aeica 1ie/100a iannu oaea. I?e yoii eiiaeie?iaaiiia aaaaeaiea i?aia?aoia ieacuaaao aieaa au?aaeaiia eiioii- e aeinoeioee?othuaa aeaenoaea, /ai ioaeaeueiay eiieaioaoeey aaiaoioeeoia. Iaeiaei, ioaeaeueiia aaaaeaiea oieueei aaiaoioeeoia niinianoaoao nio?aiaieth ooieoeeiiaeueiiai ?aca?aa ia/aie e ia yoii naeaeaoaeuenoaoao eaoaeueiinoue 10,7% i?ioea 91,7% a eiio?ieueiie a?oiia e?un iinea naienooi/iie yenia?eiaioaeueiie iaoaie/aneie aeaeoooe. I?e ii?aaeaeaiee ino?ie e o?iie/aneie oiene/iinoe aaaaeaiiuo aeeaioiui e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia iaoieiae/aneeo eciaiaiee ia auyaeaii. A ?aaioa ioia?aaeaiu ?acoeueoaou ea/aiey 79 aieueiuo, ec ieo o 62 (79,1%) iaia?oaeaia III IIno., a o 17 (20,9%) – III no. Ia?aie a?oiia aieueiuo auiieiyee i?aaeiia?aoeeiiioth eaia?ineiie/aneoth aeaeiii?anneth aeae/iuo iooae n iineaaeothuei iia?aoeaiui ea/aieai. Eiio?ieueiie a?oiiie auee aieueiua eioi?ui iinea eiooceiiiie iiaeaioiaee auiieiyee n?aco iia?aoeeth. I?e aeeeoaeueiii oieanoaca aieaa 14 nooie, aeee?oaeiaiee aieaa 150 ieiieue/e, o?iaia iieaeoe n?aaeiae iannu (INI) aieaa 1,0 aae.iio.ieioi. e ionoonoaee au?aaeaiiie eiioiinoi?annee, aooieiioiiuo naeaeaia ia?aui yoaiii oe?o?ae/aneiai ea/aiey aeieaeia auoue eaia?ineiie/aneay aeaeiii?anney aeae/iuo iooae, iai?aaeaiiay ia oeo/oaiea ooieoeee aaiaoioeeoia iaoeeaioa. Aoi?ay a?oiia - aieueiua, eioi?ui auiieiyee iia?aoeeth, a iioii a iineaiia?aoeeiiiii ia?eiaea i?iaiaeeee yeno?aei?ii?aeueiia iiaeeeth/aiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia. Iieacaieai e i?iaaaeaieth aeiaaiini?aoeee a iineaiia?aoeeiiiii ia?eiaea auei oyaeaeia ninoiyiea aieueiuo, ioeaiaiiia ii oeaea APACHE-II ia 15 aaeeia e aieueoa, o?iaaiue INI aieueoa 1,2 aae.iio.ieioi., o?iaaiue O-noi?anni?ia iaiueoa 10%. Eiio?ieueiie a?oiiie auee aieueiua, eioi?ui a iineaiia?aoeeiiiii ia?eiaea i?iaiaeeee aaiini?aoeeth n eniieueciaaieai oaey ia?ee NEI-1E. Iiaeeeth/aiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia i?eaaei e aieaa auno?ie eeeaeaeaoeee eioieneeaoeeiiiiai neiae?iia e eiioiiei??aeoeee. O?aouey a?oiia - aieueiua, eioi?ui a iineaiia?aoeeiiiii ia?eiaea i?iaiaeeee aeno?aei?ii?aeueiia iiaeeeth/aiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia e o?aaiaioia enaiinaeacaiee. I?e eiiaeie?iaaiiie aeiaaiini?aoeee ioia/aii aieaa au?aaeaiiue aei- e eiioiinoeioee?othuee yooaeo. I?e yoii iaaethaeaeinue aieaa auno?ia nieaeaiea o?iaiy aooiaa?annee a n?aaiaiea n aieueiuie, eioi?ui iiaeeeth/aee oieueei eciee?iaaiiua aaiaoioeeou. Iaoaieci aeaenoaey aei eiioea ia eco/aiue, ii iiaeii i?aaeiieiaeeoue, /oi enaiiaaiaoioeeou ea?atho ?ieue /oaea?iaeiie ieoaie. I?e yoii enaiiaaiaoioeeou e o?aaiaiou enaiinaeacaiee ni?ae?otho ia naiae iiaa?oiinoe e auaiaeyo ec i?aaiecia oee?eoee?othuea eiioiiua eiiieaenu e aooieiioiiua aioeoaea. Iaeiia?aiaiii auaeaeythony aauanoaa, eioi?ua noeioee?otho eiioiiue ioaao, a oii /enea e O-noi?anni?iia caaii eeaoi/iiai eiioieoaoa. Ia iniiaa iieo/aiiuo ?acoeueoaoia enneaaeiaaiey ?ac?aaioaia ?aoeeiiaeueiay oaeoeea ea/aiey aieueiuo n iaoaie/aneie aeaeoooie aeia?iea/anoaaiiiai aaiaca, ineiaeiaiiie ino?ie ia/aii/iie iaaeinoaoi/iinoueth. Eniieueciaaiea eaia?ineiie/aneeo iaoiaeee e aeiaaiini?aoeee iicaieeei oiaiueoeoue eiee/anoai ineiaeiaiee e eaoaeueiuo enoiaeia ia 17,8% i?e iia?aoeaiii ea/aiee. Eeth/aaua neiaa: iaoaie/aneay aeaeoooa aeia?iea/anoaaiiiai aaiaca, ino?ay ia/aii/iay iaaeinoaoi/iinoue, eaia?ineiie/aneay aeaeiii?aney aeae/iuo iooae, aeiaaiini?aoeey, yeno?aei?ii?aeueiia iiaeeeth/aiea e?eieiina?ae?iaaiiuo enaiiaaiaoioeeoia, yeno?aei?ii?aeueiia iiaeeeth/aiea o?aaiaioia enaiinaeacaiee.

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