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1 » :,,,
2 : :,,, -,,,»,,,,..»,,, 2- : : ,.,, 83, -mail: uchsovet@bsmu.by, ,..
3 1, [T. M. Marthaler, 2004; U. Schiffner t al., 2009;.., 2011]., 25%., [N. B. Pitts, 2005; J. M. Armfield, 2008; R. A. Bagramian, 2009; B. A. Dye, 2015]. 1 3,,. ( ), ( ) 71 (Early Childhood Caries) [T. F. Drury, 1999].,, [..., 2011;.., 2011;..., 2010;.., 2010;.. Dye, 2007;. Alm, 2012].,. 25% 72%. Borutta et al., 2003;.. El-Yazeed, 2011; A.. Kramer, 2014]. 36%.., 2013], 34% [.., 2012], 50%. Slabšinskien et al., 2010] ,,, [P. E. Petersen, 2010].,
4 2..,,,.,,, , 1990] 2002 [.., 2002].,,. 6 36,,., - «,» ( , ), «,» ( , ).
5 3 :,. : ,. 4.,. 5., : ; , 25, 25 ; ,, ,.,, (n=767); 66 ; 57 ; 205 ; mutans streptococci Lactobacilli. :,, (,, ),.
6 4,,,. - 3, ( ). -,,,.,,.. ( ).,,.., , 1-4, 6,7% 63,5%. (58,5%) 13 18,,. 3 1,2%. 2.,,
7 ,,. mutans streptococci 45,8%,. MS. 4.,,,, -,,,, ,7%. 500 ppmf -, 0,16 0,25 ( »). 6., : mutans streptococci 69,2%, 26%, 5,94±0,08 6,64±0, , 62,0%.,, 59,1%,, (45,0%). ( ),,,, 53,4 72,5%
8 6...,,,,,,,,,. «15»., «3».,, (800 ). [21, 22, 42, 50]. (345 ) (205 ) [11, 12, 14, 25, 26, 40, 53, 54, 58, 59].» [10, 15, 17, 32, 49, 57, 62].,,,. 90%, [64] 90%; [62, 63] 70%. : (30, 2008.,, ); » (29, 2008., );
9 7 (28, 2010., ); XVIII (24 26, 2010., ); 9- (28, 2010., ); (27, 2011., ); 7- (16, 2011., ); 16- EADPH (22 24, 2011., );, 90- (27, 2011., );, 90- ( 27, 2011., ); 11- EAPD ( , ); VI (26, 2012., ); 8-» XI» (23, 2012., ); 17- EADPH (15 17, 2012., ); ( , ); XII XX «-2013» (28, 2013., ); - «2013» (5, 2013., ); 1- ( , ); 18- EADPH (, , ); (, 4, 2014., ); 2014» (10 11, 2014., ); 3- (15 16, 2014., ); 5- (17 18, 2014., ); X ( , ); 2- ( , ); (, 27, 2015., ); ( , ); 6- (16 17, 2015., ); 20- EADPH (17 19, 2015., ); XI - (20, 2015., ); 3- ( , ), 13- «.
10 8.» ( , ); «2016» (5 6, 2016., ). «3-»., «1-».,, «23-»., «25-».,,, ;,,. : 1, 21 (12,9 ), 3, 11 (5,8 ); ,,,,, 4,,,., 65, , , «3-». ( ), «15-». ( ), ( ) ( ).
11 9 (n) : n = 92N 0,16, N. 0,95 5% ,.,, : «15-». 60, «3-». 317, 195.,, , ).,, 3 : (129 ); 2- (5% NaF) 2 (123 ); 3- (5% NaF) 4 (124 ) ,,,., mutans streptococci (MS), 4-5- : 4- «Cervite» (Ivoclar Vivadent) 4 (52 ), 5-2 «Cervite» (Ivoclar Vivadent) 2 (5% NaF) (51 ). 7- SM 8- (31 ).,,,.
12 10 1.,, 6- (125 ). 500 ppm 2, - 1 1, (5% NaF) (40 ), 6.2 (42 ) 0,05% ( )
13 (mutans streptococci Lactobacilli) ,,. 147 (49,8%) 148 (50,2%). 15,2 (4,87), 14,0 [12,0/18,0]., 66, 57. ( ) 49.,, 205. «Marusya+7» ( ) , ,.. / (436 ) (185 )... (,,,,, ), (,,,, ), (,, )
14 12 (,,,,,,,, ).,, ( ),.. (1990).. (2006)..,.. (2000),. Ribeiro. (1999) ( ) (..,.., 2015) [64]. mutans streptococci Lactobacilli «CRT bacteria» (Ivoclar Vivadent / ). 2.,.,,,, GC Plaque Indicator Kit (GC, ) : =5,5, =6,0, =6,5 =7,0...,..,.., 2014) [63].
15 13 «Marusya+7» (, ) 100 (1 ) 14. Silness-Low (1964), «CRT bacteria» (Ivoclar Vivadent, ). [P. Weinstein, 2006]..,,,,,, 1.., ( ), (160 ) (20 ),.,, 74,.,,..
16 14 Excel for Windows ( ), Statistic ( ) (SD), ( ), [LQ/UQ],.. [2,5% 97,5%].,.. : U-,. ( ),» ( ) [95% ]. (p),, 95% ( <0,05).., ,7 (6,00), 13,0 [10,0/18,0]. 383 (47,9%) 417 (52,1%). 41 (5,1%) ,8 (5,62), Me=8,0 [6,0/16,0] ,1%. 5,2 (2,82) ,0 (2,88) (32,8±1,70%). 6,7±1,29 %, 47,6±3,30 % 13 18, 57,3±4,14% ,5±6,68 %
17 ( 2 =0,01, p=0,90) ,70 (2,87), 1-4 2,72 (5,27). 114 (15,0%). (28,0%) , 5,5% 16,9±2,37%,. ( =0,59, <0,001). 1-4 : 1,64 (2,78), 0,0 [0,00/4,00], 0,02 (0,28) 0,04 (0,36). ( 1 ) 0,42 (1,17), ( 2 ) 0,33 (1,02), ( 3 ) 0,85 (1,92). 10 (1,3%) 28 ( 4 =0,04 (0,34)). 7 (0,9%) 20, 10 (1,3%) 28., 2,,. ( =1,18%). 1,63 (2,86), 0,00 [0,00/3,20]. (n=551, 68,9%), (n=241, 30,1%). 73,0±2,86% 3-4-,.., 20% 80%. ( 2). (33,6% 37,6% ). (29,3%) (20,5%).
18 ( 2 =161,84, p<0,001). 12 ( =0,41, <0,01) ( =0,38, <0,01) ,10 ( =0,14) 0,35 (p<0,001), ,35 (p<0,001) 0,37 (p<0,001). 45,9±1,76%. 3,18 (1,92). (33,1%). (20,5%), (15,3%) (17,8%). 41%. 524 (65,5%), 495 (65,2±1,73%) ,9 (1,70), 3,0 [2,0/4,0].,,
19 17,,. 1-4 ( =0,42, <0,001), 1-4 ( =0,43, <0,001) =0,41, <0,001) ,13 (p<0,001) ( =0,57, p<0,001 =0,55, p<0,001) ( =0,35, p<0,001 =0,40, p<0,001) ( =0,14, p=0,04 =0,16, p=0,40).,, ( 2 =123,35 p<0,001)., : (56,3±7,16%), (61,5±13,50%) (67,4±6,91%).,, 40,6±2,70% 37,5±8,56%. 338 (44,5%), 165 (48,8±2,72%).,, 19,9±1,95% ( 2 =70,85, p<0,001).,, 3,2,,.,, 2,3, 2,4. (p<0,001). : ( 2 =31,5, =0,002). ( 2 =136,9, =0,03), ( 2 =32,14, <0,001). n=332 (46%), 187 (26%), 210 (28%).
20 18,, ( =0,43, p<0,001), =0,21, p<0,001). (V =0,48, <0,0001 V =0,44, <0,0001 ). ( =0,09, =0,01). Ribeiro 1,44 (1,67), 1,00 [0,00/3,00]. 472 (62,2%) (0 1 ), 163 (21,5%) (2 3 ) 124 (16,3%) (4 5 )., ( 2 =249,63, <0,001). ( ) 20,3%,. 505 (66,5%), 57 (7,5%) 197 (26,0%).,, 313 (79%): 193 (49%) (30%) 2. 2 =112,32, <0,001). ( 2 =82,68, <0,001)., (57%), (81%), (86%), (100%), 81%.. 89,4%. 76,5%.,, 55,. 88%, 80%.
21 19, 447 (55,9%) ( 1). ( 2 =5,50, =0,09)., 299 (66,9±2,23%), 172 (38,5±2,30%), 116 (26,0±2,08%) 44 (9,8±1,41%). 1. n , n (%) 217 (48,5) 32 (9,1) 154 (51,5) 95 (19,0) 97 (56,4) 152 (24,2) 50 (43,1) 199 (29,1) 12 (27,3) 756 (31,3) «*» (p<0,05). V 0,42 0,000* 0,34 0,000* 0,28 0,000* 0,10 0,003* 0,02 0,57,, ( <0,0001). 295 mutans streptococci 135 (45,8±2,90%): 59 (20,0%) 1 (10 4 ) ; 65 (22,0%) 2 (10 5 ) 11 (3,8%) (3, 10 6 ). 160 (54,2%) mutans streptococci.. MS 0 66 (41,3%), MS 1 47 (79,7%), MS 2 58 (89,2%) MS 3 10 (90,9%),,, (V =0,36, p<0,0001; V =0,47, p<0,0001; V =0,22, p=0,005 ). 1,9%, MS 100% MS.
22 20 <0,0001), MS 2 MS 3 (V =0,04, =0,12). MS =0,77, <0,0001). MS ( =0,50, <0,0001), ( =0,76, <0,0001).. ( =0,68)., (p<0,0001), ( =0,009) ( =0,04). ( =0,38, =0,001). 1,6:10., ( = 0,27, =0,03). Na/K 0,02 1,48. 2:10. Na/K ( =0,61), ( =0,99). 6,09 (0,45), 6,00 [6,00/6,50]. (n=84) 6,11 (0,45), 6,0 [6,0/6,5], (n=121) 6,07 (0,45) 6,0 [5,5/6,5], ( =0,58). ( = 0,51, <0,0001).,, 6,45 (0,47), 6,5 [6,0/7,0]., 1-4, 5,99 (0,36), 6,0 [5,5/6,0]. U- ( <0,0001).,. 1-4 ( = 0,54, p<0,0001)..,
23 21 (n=56), 6,33 (0,48),, (n=149), 5,99 (0,41) <0,0001).,,,, ( <0,001)., 12,. (123 ) 54,5%, 2,27 (2,70).,, 96,7%, 5,38 (2,88). ( <0,001).. «Marusya+7» (1- ) (2- ), 1-10,5% 5,94±0,08 6,64±0,06 76% ( <0,001). 2-2,1% 6,06±0,10 6,19±0,08 33% ( =0,06). MS 92% 1-8% MS 69,2% <0,001), 2-4,0% ( =0,16). MS 88% 1-28% 2-. Lactobacilli 1-36%, 36% 12%. Lactobacilli 26% ( =0,03). 2- Lactobacilli 3,5% =0,32).. 0,23 (0,16), Me=0,18 [0,10/0,33],». 0,05
24 22 0,72. 9 (26,5%), 0,07 (0,02), 0,07 [0,06/0,07]. 13 (38,2%), 0,17 (0,03), 0,17 [0,15/0,19]. 12 (35,3%) (1 ), 0,41 (0,13), 0,35 [0,32/0,48] ,63 (0,34), =0,61 [0,40/0,71] (p<0,0001). 0,22 1,35. 4 (17,4%), 0,24 (0,01), M =0,24 [0,23/0,25]. 6 (26,1%), (0,38 0,54 ), 0,45 (0,06), 0,44 [0,40/0,49]. (13 (56,5%)), 0,60 1,58. 0,84 (0,32), 0,69 [0,63/0,95]., 0,08 (0,07), 60,7% (95% 52,8 68,5). 11,0 94%, 50,8-78,7%. 80% 94% 7 (20,6±6,94%).,, 0,03 (0,01), 63,5%.,, 0,06 (0,05), 59,1% (95% 44,5 73,8). 1 0,13 (0,08), 60,2% (95% 44,7 76,7)., 1 3, 0,30, 0,60, 0,66 1,31 (. Marthaler,1992).,,
25 23 (500 ppmf - ), 1. 0,12 (0,07) F -, 40% (95% 33,6 46,4). 13,2% 70,0%, 34,6% 51,5%.,, 0,05 (0,01), =0,045 [0,04/0,05]. 38,0% (95% 25,2 50,6). 0,10 (0,04), =0,11 [0,08/0,13]. 46,4% (95% 27,0 65,7).,, 0,15 (0,07) F -, =0,15 [0,12/0,19] F -. 37,7% (95% 28,7 46,6). 0,002 (0,001)», 0,006 (0,002) ½ 0,008 (0,004).,, ( =0,68 =0,75, p<0,001)., 500 ppm 18,2 37,5%, 36,4 75,0% ,0 20,0% 20,0 40,0%.,,, 1 ( 2 =1,2; >0,05),, 2 ( 2 =7,70; =0,001)., 1,, 2 ( 2 =18,47; =0,009)., 2,, ( =0,01),
26 24 1 ( <0,001)., 2,, ( =0,003), 1 ( =0,49). ( ),,, 4, 2 ( =4,23, 95% 1,41 12,75),, 1 2 =2,26, 95% 1,55 3,39)., 27,2% =0,19), 62,0% <0,00001), 78,4% ( <0,00001), ( =0,21),. MS, 59,1% ( =0,001) 45,0% ( =0,13). 3 53,4%, =2,95 (95% 1,39 6,29). 3 68,1% ( <0,001), =3,58 (95% 0,90 14,26). 3 75,2% ( <0,0001). 0,11, 2,1; =19,95 (95% 5,47 71,48). 0,05%
27 25 1,7 - ( =0,02), =2,25 (95% 1,11 4,57).,,, 31,9% ( =0,28), 0,05% 52,1% ( =0,03).. 2,5 3. ( 3). 3.
28 26 1.,,, 32,8% 1-4 =1,70. 9, ,18%. 30,1%. (33,6% 37,6%) [1, 5, 21, 23, 26, 42]. 46,8%, [1, 20, 28, 29, 32, 36, 43, 44, 51, 63]. 2. :,,, 12.,, 6,2 ( =6,19; 95% 4,07 9,41),,.,,,.,, 3,8, [2,15, 25, 28, 41, 42, 43, 46, 61].,. 80% [19, 41, 48, 49]. 3., :,, ;
29 27,, [3, 4, 5, 8, 15, 20, 37, 55]., [9, 12, 28, 52]., 55,9%, 45,8%. mutans streptococci, Lactobacilli ( =0,77 =0,47 ) [24, 27, 43, 53, 54, 57]. 4.,,,, [46, 47].,, ( =5,93 5,84 ) [15, 20, 24]. 63,2%, - 43,2% [21]. 5.,,,. 35,3%,,,, 60,7% (95% 52,8 68,5) ;.,,, 500 ppm, 18,2 37,5%, 20,0 40,0% [9, 10, 14, 30, 56]. (500 ppm) 2 4 =4,23 (95% 1,41 12,75) [17, 22]. 6.,, mutans streptococci 92%
30 28 36% Lactobacilli, : 5,94±0,08 6,64±0,06 [7, 11, 13, 16, 40, 58, 59]. 7.,. 27,2%;, 62,0% 78,4%. MS (59,1%) [22, 31, 38, 39]. 53,4% 68,1%. 75,2%., 0,05%. 0,05%, 31,9% 52,1% [21, 50].. 46,0% (n=278). 6 96,2% (n=126), 12 90,8% (n=119), 2 57,3% (n=75) [21, 34]..
31 29 46,0% (n = 278). 6 96,2% (n = 126), 12 90,8% (n = 119), 2 57,3% (n = 75) [21, 34]. 1.,., [22, 27, 33, 35, 37]. 2., 12,,,. [3, 46, 49, 60]. 3., 500 ppm. 500 ppmf -., ( ) [62]. (, ). 4. ( ) [45, 63]. 5.,.,
32 30.,, 0,05% Cervitec 2,. [21, 22, 64]. 6.,. ) ( ) [21].
33 31 1.,.. : /..,... :., /..,.,..,. // /..,.,..,. // Biologische und soziale Determinanten im Bedingungsgefuege der fruehkindlichen Karies / S. Kneist, E. Maslak, R. Care, S. Berzina, S. Scrivele, T. Tserekhava, N. Shakavets, M. Wagner,V. de Moura-Sieber, R. de Moura, A. Borutta // Quintessenz Vol. 4, /.,.,.,.,.,.,.,.,.,. // ,.. /..,..,.. // ,.. /..,.. // , : /.,.,.,.,.,.,.,.,.,.,. // ,.. /.. // ,.. /..,.. // , ,.. «Marusya+7» /..,.. // ,
34 32 12.,.., /..,.. // ,.. /..,..,.. // ,.. /..,.. // Caries and its risk factors in young children in five different countries / S. Skrivele, R. Care, S. Barcina, S. Kneist, V. de Maure-Sieber, R. de Moura, A. Borutta, E. Maslak, T. Tserekhova, N. Shakovets, M. Wagner // J. Stomatologija. Baltic Dental and Maxillofacial Vol. 15, 2. P Shakovetz, N. Veränderungen des Plaque-pH-Wertesbei Vorschulkindern nach Konsum eines probiotischen Trinkjoghurts / N. Shakovetz, A. Borutta, S. Kneist // Oralprophylaxe & Kinderzahnheilkunde Vol. 35. P ,.. /..,.. // Dental Forum ,.. /..,.. // ,.. /..,.. // , ,.. /..,.. // ,.. /.. // ,.. /.. // , , 23.,.. /.. //, : V. ;....,
35 33 24.,.. /.. // 6-»..:, ,.. /..,.. // -, 5-..., : 18- /..,..,..,.. //,, :.., /...., ,.. /.. // : «2010»,., /.:..,..,..., /..,.,.,.,.,.,. // :. VII.-...,,, /.:..,...., ,.. /.. // : ( ) /... ;...., ,.. /.. //, : «2011»,., /.:.. [.]., ,.. /..,.. // XXI : ,
36 34..,...,., , ,.. /.. // :.. /.:.. [.]., ,.. / /.. // Consilium med , ,.. «Grandio So» /..,..,.. // : «2012»,., /.:.. [.]., ,.. /.. // : , ,., /....., ,.. /..,..,.. // : VI,., /... ;.:. [.]., ,.. /..,.. // : «2012»,., /.:.. [.]., /..,..,..,.. // XXI. :.. V.-...,., , /..,..,..,.. // :
37 [..] ,.. /..,.. // PRO ,.. /.. // :.. II...,., /.:. - [.]., ,.. /.. // : «2014»,., , /.:...]., Shakovets, N. Dental status and risk factors of ECC in young children in Belarus / N. Shakovets // 3rd International Congress USSI EDI, Novi Sad, Novi Sad, S Shakovets, N. Zubni status I faktori rizika od karijesa ranog detinjstva kod male dece u Belorusiji / N. Shakovets // 5 Kongres Stomatologa Voj-vodine, Novi Sad, Novi Sad, S ,.. /..,.. // :.. III..,., /.:. [.]., ,.. /..,.. // IV, ,., /...,...., ,.. /.. // :.. III..,., /.:. [.].,
38 Shakovets, N. Rani decji karijes kod dece sa razlicitim faktorima rizika / N. Shakovets, T. Tserakhava // 6 Kongres Stomatologa Vojvodine. Zbornik Radova, Novi Sad, Serbija, Maj Novi Sad, P ,.. /.. // - :..... «2016»,., 5 6, /.:...]., Shakavets, N. Caries preventive effect of the fissure sealing in children up to 3 years old / N. Shakavets // 7 Kongres Stomatologa Vojvodine. Zbornik Radova, Novi Sad, Serbija, Maj Novi Sad, P Tserekhava, T. Zur Mundgesundheit bei belorussischen Kleikindern /. Tserekhava, N. Shakovets // 11. Jahrestagung Deutsche Gesellschaft fur Kinderzahnheilkunde, Mainz, Mainz, S Tserakhava, T. Ernährungsverhalten und Mundgesundheit von Kleinkindern im Alter von zwölf Monaten / T. Tserakhava, N. Shakovets,. Borutta // 15 Jahrestagung der Deutschen Gesellschaft fur Kinderzahnheilkunde, Oralprophylaxe & Kinderzahnheilkunde A20 A Tserakhava, T. Occurrence of cariogenic microflora in infants and their mothers / T. Tserakhava, N. Shakovets // 22nd Congress of IAPD, International Journal of Paediatric Dentistry. Munich, Vol. 19, 1. P Tserakhava, T. The level of cariogenic microflora in infants from the families and children s home / T. Tserakhava, N. Shakovets // Symposium Fruhkindlicher Karies, Oral prophylaxes & Kinderzahnheilkunde. Köln, Biological and Social Determinants of Early Childhood Caries / S. Scrivele, S. Berzina, R. Care, E. Maslak, T. Tserakhava, N. Shakovets, R. de Moura-Sieber, V.de Moura, M. Wagner, S. Kneist, A. Borutta // 58th Annual ORCA Congress, Caries Research. Kaunas, P Shakavets, N. Fluoride intake from fluoride dentifrices by children and adults / N. Shakavets,. Tserakhava // 16th Meeting of EADPH, Rome, Supplement to Annali di Stomatologia Vol. 2, suppl Shakovets, N. Bacterial and behavioral factors associated with early childhood caries in children aged 9-18 months / N. Shakovets,. Tserakhava // 58th Annual ORCA Congress, Caries Research. Kaunas, P Shakavets, N. Caries preventive effect of probiotic drink in preschool children / N. Shakavets, T. Tserakhava // Addressing Common Challenges in Europe:
39 37 Pan European Working in Support of Oral Health. 17th Annual Congress of the European Association of Dental Public Health in a Joint Meeting of BASC and EADPH, London, November London, P Shakavets, N. Short-term effect of biodrink Marusya+7 on Salivary Microbiota / N. Shakavets, T. Tserakhava // 11th Congress of the European Academy of Paediatric Dentistry, Strasbourg, ay : abstract book. Strasbourg, P A fluoride vanish program for early childhood caries prevention / N. Shak vets, T. Tserakhava, L. Belik, E. Melnikova // 18th Annual Congress of the European Assosiation of Dental Public Health in a Joint Meeting with Council of European Chief Dental Officers, Malta, November, Malta, Absrt P Shak vets, N. Feeding practice in young children as risk factor of ECC / N. Shak vets, T. Tserakhava // 20th European Association of Dental Public Health Conference, Istanbul, Turkey, September Istanbul, Abstr ,,,, : : G01N 31/16 /..,..,.. ;.: : : 61 10/00, 61 1/24 /..,.. ;.: : : , /..,... :,
40 38 :,,, :,,,,,,,,. :,. i : : 66 ; 57 ; 205 ; mutans streptococci Lactobacilli.,,,. :,. 3,..... :. :.
41 39 :,,, :,,,,,,,,. :,. : : 66 ; 57 ; 205 ; mutans streptococci Lactobacilli.,,,. :,. 3,..... :. :.
42 40 SUMMARY Shakovets Natalia Vyacheslavovna Early Childhood Caries: etiology, prediction, prevention, treatment Key words: dental caries, young children, the prevalence, intensity, microorganisms, probiotic drink, fluoridated toothpaste, varnish, fissure sealing. The aim of the research: to improve the efficiency of the provision of dental care in young children by developing methods of prediction, prevention and treatment of dental caries. Materials and Methods: epidemiological study of 800 children aged 6 36 months. Mineral composition and bactericidal activity of saliva samples in 66 children; 57 wash samples after toothbrushing with fluoride toothpaste; 205 samples of dental plaque; 80 saliva samples of mothers and 295 children to determine the level of colonies of mutans streptococci and Lactobacilli. Laboratory, clinical-laboratory, clinical, statistical methods were used. The results and their scientific novelty: complex clinical and statistical investigation of oral health of young children living in a major industrial center was carried out. The influence of biological, medical and social factors on the development of dental caries in children aged up to 3 years was determined. On this base a mathematical model and the scale prediction of dental caries were developed. New index to assess the oral hygiene in young children was developed and proposed. The data of reducing the level of cariogenic microorganisms in the oral cavity of children and raising the ph of plaque after probiotic drink consumption were obtained. It was determined the safety amount of fluoridated toothpaste for toothbrushing in children up to 3 years old. The effectiveness of the proposed schemes of the differentiated comprehensive prevention and treatment of early childhood caries was assessed. Recommendations for use: use in the pediatric departments of health care institutions and dental profile in the educational process of higher medical and graduate education. The field of application: pediatric dentistry.
43 /16... «Times».... 2, , :».,, 1/ , 6, ,.
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