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Желчнокаменная болезнь: правильная тактика – залог успешного литолиза
Желчнокаменная болезнь: правильная тактика – залог успешного литолиза
Вялов С.С. Желчнокаменная болезнь: правильная тактика – залог успешного литолиза. Consilium Medicum. 2017; 19 (8.2. Гастроэнтерология): 77–82. DOI: 10.26442/2075-1753_19.8.2.77-82
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Аннотация
В статье приводится анализ данных по тактике лечения неосложненной желчнокаменной болезни с учетом особенностей диагностического поиска. Рассматриваются актуальные исследования методов медикаментозной терапии желчнокаменной болезни, в том числе отбор пациентов – кандидатов на терапию, использование урсодезоксихолевой кислоты, обсуждаются аспекты затрат на лечение. Необходимым представляется выполнение требований к диагностике и подбору пациентов для перорального литолиза, что обеспечивает успех терапии. Следует учитывать особенности препаратов, качество производства и субстанции при выборе средства терапии. В качестве иллюстрации приводится разбор клинического случая.
Ключевые слова: желчнокаменная болезнь, билиарный сладж, билиарная дисфункция, урсодезоксихолевая кислота, литолиз.
Key words: cholelithiasis, biliary sludge, biliary dysfunction, ursodeoxycholic acid, litholysis.
Ключевые слова: желчнокаменная болезнь, билиарный сладж, билиарная дисфункция, урсодезоксихолевая кислота, литолиз.
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Key words: cholelithiasis, biliary sludge, biliary dysfunction, ursodeoxycholic acid, litholysis.
Полный текст
Список литературы
1. Heaton KW, Braddon FE, Mountford RA et al. Symptomatic and silent gall stones in the community. Gut 1991; 32: 316.
2. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117: 632.
3. Petroni ML, Jazrawi RP, Pazzi P et al. Risk factors for the development of gallstone recurrence following medical dissolution. The British-Italian Gallstone Study Group. Eur J Gastroenterol Hepatol 2000; 12: 695.
4. Warttig S, Ward S, Rogers G, Guideline Development Group. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ 2014; 349: g6241.
5. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990; 89: 29.
6. Portincasa P, van de Meeberg P, van Erpecum KJ et al. An update on the pathogenesis and treatment of cholesterol gallstones. Scand J Gastroenterol (Suppl.) 1997; 223: 60.
7. Zakko SF, Guttermuth MC, Jamali H et al. A population study of gallstone composition, symptoms, and outcomes after cholecystectomy (abstract). Gastroenterology 1999; 116: A43.
8. Berger MY, van der Velden JJ, Lijmer JG et al. Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol 2000; 35: 70.
9. Sherlock S, Dooley J. Diseases of the liver and biliary system, Blackwell Science, Oxford, 2002.
10. Ko CW, Sekijima JH, Lee SP. Biliary sludge. Ann Intern Med 1999; 130: 301.
11. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
12. Caroli A, Del Favero G, Di Mario F et al. Computed tomography in predicting gall stone solubility: a prospective trial. Gut 1992; 33: 698.
13. Shea JA, Berlin JA, Escarce JJ et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154: 2573.
14. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ 2001; 323: 1170.
15. Colli A, Conte D, Valle SD et al. Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Aliment Pharmacol Ther 2012; 35: 1370.
16. Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc 2003; 17: 1723.
17. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983; 250: 2323.
18. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
19. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 1992; 127: 917.
20. Shao T, Yang YX. Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 2005; 100: 1813.
21. Tomida S, Abei M, Yamaguchi T et al. Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Hepatology 1999; 30: 6.
22. Tint GS, Salen G, Colalillo A et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 1982; 97: 351.
23. Rubin RA, Kowalski TE, Khandelwal M, Malet PF. Ursodiol for hepatobiliary disorders. Ann Intern Med 1994; 121: 207.
24. Fromm H, Malavolti M. Bile acid dissolution therapy of gallbladder stones. Baillieres Clin Gastroenterol 1992; 6: 689.
25. Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis 1975; 20: 735.
26. Guarino MP, Cong P, Cicala M et al. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut 2007; 56: 815.
27. Guarino MP, Cocca S, Altomare A et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol 2013; 19: 5029.
28. Di Ciaula A, Wang DQ, Wang HH et al. Targets for current pharmacologic therapy in cholesterol gallstone disease. Gastroenterol Clin North Am 2010; 39: 245.
29. Сарвилина И.В. Сравнительный клинико-экономический анализ применения препаратов урсодезоксихолевой кислоты у пациентов с желчнокаменной болезнью 1 стадии. Лечащий врач. 2015; 2. / Sarvilina I.V. Sravnitel'nyi kliniko-ekonomicheskii analiz primeneniia preparatov ursodezoksikholevoi kisloty u patsientov s zhelchnokamennoi bolezn'iu 1 stadii. Lechashchii vrach. 2015; 2. [in Russian]
30. Вялов С.С., Степченко А.А., Дронова Т.А., Винницкая Е.В. Выбор препарата для лекарственной терапии с учетом особенностей субстанции. Арх. внутренней медицины. 2012; 4 (6): 34–8. / Vialov S.S., Stepchenko A.A., Dronova T.A., Vinnitskaia E.V. Vybor preparata dlia lekarstvennoi terapii s uchetom osobennostei substantsii. Arkh. vnutrennei meditsiny. 2012; 4 (6): 34–8. [in Russian]
2. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117: 632.
3. Petroni ML, Jazrawi RP, Pazzi P et al. Risk factors for the development of gallstone recurrence following medical dissolution. The British-Italian Gallstone Study Group. Eur J Gastroenterol Hepatol 2000; 12: 695.
4. Warttig S, Ward S, Rogers G, Guideline Development Group. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ 2014; 349: g6241.
5. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990; 89: 29.
6. Portincasa P, van de Meeberg P, van Erpecum KJ et al. An update on the pathogenesis and treatment of cholesterol gallstones. Scand J Gastroenterol (Suppl.) 1997; 223: 60.
7. Zakko SF, Guttermuth MC, Jamali H et al. A population study of gallstone composition, symptoms, and outcomes after cholecystectomy (abstract). Gastroenterology 1999; 116: A43.
8. Berger MY, van der Velden JJ, Lijmer JG et al. Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol 2000; 35: 70.
9. Sherlock S, Dooley J. Diseases of the liver and biliary system, Blackwell Science, Oxford, 2002.
10. Ko CW, Sekijima JH, Lee SP. Biliary sludge. Ann Intern Med 1999; 130: 301.
11. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
12. Caroli A, Del Favero G, Di Mario F et al. Computed tomography in predicting gall stone solubility: a prospective trial. Gut 1992; 33: 698.
13. Shea JA, Berlin JA, Escarce JJ et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154: 2573.
14. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ 2001; 323: 1170.
15. Colli A, Conte D, Valle SD et al. Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Aliment Pharmacol Ther 2012; 35: 1370.
16. Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc 2003; 17: 1723.
17. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983; 250: 2323.
18. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
19. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 1992; 127: 917.
20. Shao T, Yang YX. Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 2005; 100: 1813.
21. Tomida S, Abei M, Yamaguchi T et al. Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Hepatology 1999; 30: 6.
22. Tint GS, Salen G, Colalillo A et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 1982; 97: 351.
23. Rubin RA, Kowalski TE, Khandelwal M, Malet PF. Ursodiol for hepatobiliary disorders. Ann Intern Med 1994; 121: 207.
24. Fromm H, Malavolti M. Bile acid dissolution therapy of gallbladder stones. Baillieres Clin Gastroenterol 1992; 6: 689.
25. Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis 1975; 20: 735.
26. Guarino MP, Cong P, Cicala M et al. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut 2007; 56: 815.
27. Guarino MP, Cocca S, Altomare A et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol 2013; 19: 5029.
28. Di Ciaula A, Wang DQ, Wang HH et al. Targets for current pharmacologic therapy in cholesterol gallstone disease. Gastroenterol Clin North Am 2010; 39: 245.
29. Sarvilina I.V. Sravnitel'nyi kliniko-ekonomicheskii analiz primeneniia preparatov ursodezoksikholevoi kisloty u patsientov s zhelchnokamennoi bolezn'iu 1 stadii. Lechashchii vrach. 2015; 2. [in Russian]
30. Vialov S.S., Stepchenko A.A., Dronova T.A., Vinnitskaia E.V. Vybor preparata dlia lekarstvennoi terapii s uchetom osobennostei substantsii. Arkh. vnutrennei meditsiny. 2012; 4 (6): 34–8. [in Russian]
2. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117: 632.
3. Petroni ML, Jazrawi RP, Pazzi P et al. Risk factors for the development of gallstone recurrence following medical dissolution. The British-Italian Gallstone Study Group. Eur J Gastroenterol Hepatol 2000; 12: 695.
4. Warttig S, Ward S, Rogers G, Guideline Development Group. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ 2014; 349: g6241.
5. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990; 89: 29.
6. Portincasa P, van de Meeberg P, van Erpecum KJ et al. An update on the pathogenesis and treatment of cholesterol gallstones. Scand J Gastroenterol (Suppl.) 1997; 223: 60.
7. Zakko SF, Guttermuth MC, Jamali H et al. A population study of gallstone composition, symptoms, and outcomes after cholecystectomy (abstract). Gastroenterology 1999; 116: A43.
8. Berger MY, van der Velden JJ, Lijmer JG et al. Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol 2000; 35: 70.
9. Sherlock S, Dooley J. Diseases of the liver and biliary system, Blackwell Science, Oxford, 2002.
10. Ko CW, Sekijima JH, Lee SP. Biliary sludge. Ann Intern Med 1999; 130: 301.
11. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
12. Caroli A, Del Favero G, Di Mario F et al. Computed tomography in predicting gall stone solubility: a prospective trial. Gut 1992; 33: 698.
13. Shea JA, Berlin JA, Escarce JJ et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154: 2573.
14. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ 2001; 323: 1170.
15. Colli A, Conte D, Valle SD et al. Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Aliment Pharmacol Ther 2012; 35: 1370.
16. Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc 2003; 17: 1723.
17. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983; 250: 2323.
18. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
19. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 1992; 127: 917.
20. Shao T, Yang YX. Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 2005; 100: 1813.
21. Tomida S, Abei M, Yamaguchi T et al. Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Hepatology 1999; 30: 6.
22. Tint GS, Salen G, Colalillo A et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 1982; 97: 351.
23. Rubin RA, Kowalski TE, Khandelwal M, Malet PF. Ursodiol for hepatobiliary disorders. Ann Intern Med 1994; 121: 207.
24. Fromm H, Malavolti M. Bile acid dissolution therapy of gallbladder stones. Baillieres Clin Gastroenterol 1992; 6: 689.
25. Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis 1975; 20: 735.
26. Guarino MP, Cong P, Cicala M et al. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut 2007; 56: 815.
27. Guarino MP, Cocca S, Altomare A et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol 2013; 19: 5029.
28. Di Ciaula A, Wang DQ, Wang HH et al. Targets for current pharmacologic therapy in cholesterol gallstone disease. Gastroenterol Clin North Am 2010; 39: 245.
29. Сарвилина И.В. Сравнительный клинико-экономический анализ применения препаратов урсодезоксихолевой кислоты у пациентов с желчнокаменной болезнью 1 стадии. Лечащий врач. 2015; 2. / Sarvilina I.V. Sravnitel'nyi kliniko-ekonomicheskii analiz primeneniia preparatov ursodezoksikholevoi kisloty u patsientov s zhelchnokamennoi bolezn'iu 1 stadii. Lechashchii vrach. 2015; 2. [in Russian]
30. Вялов С.С., Степченко А.А., Дронова Т.А., Винницкая Е.В. Выбор препарата для лекарственной терапии с учетом особенностей субстанции. Арх. внутренней медицины. 2012; 4 (6): 34–8. / Vialov S.S., Stepchenko A.A., Dronova T.A., Vinnitskaia E.V. Vybor preparata dlia lekarstvennoi terapii s uchetom osobennostei substantsii. Arkh. vnutrennei meditsiny. 2012; 4 (6): 34–8. [in Russian]
________________________________________________
2. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117: 632.
3. Petroni ML, Jazrawi RP, Pazzi P et al. Risk factors for the development of gallstone recurrence following medical dissolution. The British-Italian Gallstone Study Group. Eur J Gastroenterol Hepatol 2000; 12: 695.
4. Warttig S, Ward S, Rogers G, Guideline Development Group. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ 2014; 349: g6241.
5. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990; 89: 29.
6. Portincasa P, van de Meeberg P, van Erpecum KJ et al. An update on the pathogenesis and treatment of cholesterol gallstones. Scand J Gastroenterol (Suppl.) 1997; 223: 60.
7. Zakko SF, Guttermuth MC, Jamali H et al. A population study of gallstone composition, symptoms, and outcomes after cholecystectomy (abstract). Gastroenterology 1999; 116: A43.
8. Berger MY, van der Velden JJ, Lijmer JG et al. Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol 2000; 35: 70.
9. Sherlock S, Dooley J. Diseases of the liver and biliary system, Blackwell Science, Oxford, 2002.
10. Ko CW, Sekijima JH, Lee SP. Biliary sludge. Ann Intern Med 1999; 130: 301.
11. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
12. Caroli A, Del Favero G, Di Mario F et al. Computed tomography in predicting gall stone solubility: a prospective trial. Gut 1992; 33: 698.
13. Shea JA, Berlin JA, Escarce JJ et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994; 154: 2573.
14. Johnson CD. ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder. BMJ 2001; 323: 1170.
15. Colli A, Conte D, Valle SD et al. Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Aliment Pharmacol Ther 2012; 35: 1370.
16. Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc 2003; 17: 1723.
17. Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983; 250: 2323.
18. Festi D, Reggiani ML, Attili AF et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 2010; 25: 719.
19. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 1992; 127: 917.
20. Shao T, Yang YX. Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 2005; 100: 1813.
21. Tomida S, Abei M, Yamaguchi T et al. Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Hepatology 1999; 30: 6.
22. Tint GS, Salen G, Colalillo A et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 1982; 97: 351.
23. Rubin RA, Kowalski TE, Khandelwal M, Malet PF. Ursodiol for hepatobiliary disorders. Ann Intern Med 1994; 121: 207.
24. Fromm H, Malavolti M. Bile acid dissolution therapy of gallbladder stones. Baillieres Clin Gastroenterol 1992; 6: 689.
25. Trotman BW, Soloway RD. Pigment vs cholesterol cholelithiasis: clinical and epidemiological aspects. Am J Dig Dis 1975; 20: 735.
26. Guarino MP, Cong P, Cicala M et al. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut 2007; 56: 815.
27. Guarino MP, Cocca S, Altomare A et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol 2013; 19: 5029.
28. Di Ciaula A, Wang DQ, Wang HH et al. Targets for current pharmacologic therapy in cholesterol gallstone disease. Gastroenterol Clin North Am 2010; 39: 245.
29. Sarvilina I.V. Sravnitel'nyi kliniko-ekonomicheskii analiz primeneniia preparatov ursodezoksikholevoi kisloty u patsientov s zhelchnokamennoi bolezn'iu 1 stadii. Lechashchii vrach. 2015; 2. [in Russian]
30. Vialov S.S., Stepchenko A.A., Dronova T.A., Vinnitskaia E.V. Vybor preparata dlia lekarstvennoi terapii s uchetom osobennostei substantsii. Arkh. vnutrennei meditsiny. 2012; 4 (6): 34–8. [in Russian]
Авторы
С.С.Вялов*
1 ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6;
2 ФГБОУ ВО «Московский государственный технический университет им. Н.Э.Баумана (национальный исследовательский университет)». 105005, Россия, Москва, ул. 2-я Бауманская, д. 5, стр. 1;
3 Global Medical System clinic & hospitals. 121099, Россия, Москва, 1-й Николощеповский пер., д. 6, стр. 1
*svialov@mail.ru
1 People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaya, d. 6;
2 N.E.Bauman Moscow State Technical University. 105005, Russian Federation, Moscow, ul. 2-ia Baumanskaia, d. 5, str. 1;
3 Global Medical System clinic & hospitals. 121099, Russian Federation, Moscow, 1-i Nikoloshchepovskii per., d. 6, str. 1
*svialov@mail.ru
1 ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6;
2 ФГБОУ ВО «Московский государственный технический университет им. Н.Э.Баумана (национальный исследовательский университет)». 105005, Россия, Москва, ул. 2-я Бауманская, д. 5, стр. 1;
3 Global Medical System clinic & hospitals. 121099, Россия, Москва, 1-й Николощеповский пер., д. 6, стр. 1
*svialov@mail.ru
________________________________________________
1 People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaya, d. 6;
2 N.E.Bauman Moscow State Technical University. 105005, Russian Federation, Moscow, ul. 2-ia Baumanskaia, d. 5, str. 1;
3 Global Medical System clinic & hospitals. 121099, Russian Federation, Moscow, 1-i Nikoloshchepovskii per., d. 6, str. 1
*svialov@mail.ru
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