Quality of life is one of the most important parameters of infant vital functions. Its evaluation allows planning rehabilitation of infants with perinatal CNS lesions more precisely on various age levels. The research has been carried in the Center of perinatology Ministry of healthcare Khabarovsk Region. It included 1000 infants. 1000 parents and physicians that were following these infants up were interviewed. Quality of life was evaluated with the use of Russian version of international questionnaire QUALIN (QualitedevieduNourisson). It has been shown that quality of life of infants with CNS lesion consequences is lower than that of healthy infants. Their quality of life was improving with age, though it still remained lower than that of healthy infants. During the 1st year rehabilitation of infants with CNS lesions should be aimed at optimization of their physical and neuropsychic development and family environment, and between 1st and 3rd year of life — at behavior and communication, neuropsychic and physical development and family environment.

Key words: quality of life, infants, consequences of perinatal lesions of central neurvous system, QUALIN questionnaire.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 7–13.)

Outpatient help to underage population is leading priority for the general healthcare system. The main task of a child policlinic is prevention and early detection of pathologies, and decreasing of rates of illness and child mortality. Complex rehabilitation of children helps improve basic health indexes in underage population. The article displays effectiveness of complex program of medical and social rehabilitation of children with health deviations on the outpatient basis.

Key words: medical and social rehabilitation, reflex therapy, child, sickness rate.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 14–19.)

Complex medico-sociological survey included demographic analysis and morbidity among children of first year of life in the Chechen Republic and Republic of Ingushetia (2005–2009), data from interviews with mothers upon popularity and duration of breast feeding, as well as analysis of medico-social factors that affect these parameters. Results of the survey allowed to make a sketch of concrete measures work optimization of medico-prophylactic institutions, that aim at popularity boost of breast feeding.

Key words: chechens and ingushs, medico-demographic parameters, morbidity and mortality of children of first year of life, duration and popularity of breast feeding, obstetrical and pediatric medical prophylactic institutions.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 20–25.)

Study objective — to evaluate etarnecept influence on quality of life of idiopathic juvenile arthritis patients’ quality of life. 25 patients with poly- and oligoarthritides aged 8 (6; 11) years. Before etarnecept use quality of life of all patients was significantly lower that that of healthy children judging upon children’s own opinion and that of their parents. No longer that after 1 month since the beginning of etarnecept treatment 92% of patients claimed significant increase in their quality of life (according to patients’ opinion, total score increase from 53 to 59, from 49 to 60, according to parents (p < 0,001). After 12 months of treatment 68 % of patients had quality of life similar to the one of healthy children.

Key words: juvenile idiopathic arthritis, etarnecept, methotrexate, quality of life, efficacy, safety.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 26–34.)

This article covers peculiarities of renin and aldosterone production in children with hydronephrosis with relation to the severity of non-differentiated connective tissue dysplasia (NDCTD) and time of urinal obstruction elimination. The grounds for this study are: the notion about hydronephrosis being an internal phenotypic indication of NDCTD, presence of NDCTD of various severity in all children with hydronephrosis, correlation between presence of moderate to severe NDCTD and nephrosclerosis formation, type and time of progression of different forms of renal pathology; modern conception of rennin and aldosterone participation not only in electrolyte balance regulation and vasomotion, but in fibrogenesis stimulation as well. Study objective — to evaluate renin and aldosterone production in children with hydronephrosis with relation to the severity of NDCTD and time of urinal obstruction elimination. 39 patients with hydronephrosis participated in the study. Groups were designed with relation to the severity of NDCTD and duration of the obstruction. The relation between rennin production and severity of NDCTD has been shown for the first time. Moderate to severe forms of NDCTD were accompanied with hyperreninaemia regardless the time of obstruction duration and are characterized by early nephrosclerosis formation, relapses of secondary pyelonephritis and renal failure progression. Hyperaldosteronism mostly reflects time of obstruction duration, also adds to srterisl hypertension formation, but is not clearly related to the severity of NDCTD.

Key words: non-differentiated connective tissue dysplasia, renin, aldosterone.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 35–40.)

Article contains study results of clinical efficacy of ribomunil in complex treatment and rehabilitation program in 30 children, recovered from acute Epstein–Barr viral infection, with disbiosis of nasal, oropharyngeal and colon mucosa. It has been shown that application of ribosomal complex over 1 to 6 months allows successful sanitization of main body loci, it also promotes normalization of blood parametres, decrease general sensitization of the body and thus prevent Epstein–Barr viral infection from becoming chronic and decrease the amount of intercurrent diseases in children.

Key words: Epstein–Barr viral infection, disbiosis of main body loci, ribomunil, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 41–47.)

Biennial program of controlled tooth brushing performed econdary school among junior schoolchildren from Minsk secondary school № 166 proved to be highly effective. Decrease in caries increment has been shown on the average up to 50%. No credible differences between remineralising defluorinated toothpastes or pastes enriched with aminofluoride (F = 500 ppm) and sodium fluoride  (F = 1000 ppm) efficacy were found in this study. Credibility of the results was determined by comparison with similar study conducted on a bigger population of children. Though anti-caries effect of the same tooth-pastes in a bigger-scale study was lower — within 30%. Such difference can be explained by a different level of motivation and discipline of participants.

Key words: schoolchildren, dental caries prevention, toothpastes.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 48–51)

Study objective — to study clinical and immunopathologic characteristics of early neonatal sepsis in infants of different gestational age and to perform clinical and economical evaluation of immunosupportive therapy with Pentaglobin efficacy in complex treatment of this disease. 79 infants diagnosed with neonatal sepsis were included into prospective study. These patients were divided into 3 subgroups in order to evaluate clinical and economical efficacy of immunosupportive therapy: subgroup A (n = 38) — patients receiving. Pentaglobin as part of basic complex treatment from 3–6 days of life; subgroup B (n = 27) — from 7–10 days of life; subgroup C  (n = 27) — patients treated without Pentaglobin. Proven high clinical and economical efficacy of immunoglobulin preparations as a part of complex treatment of neonatal sepsis allows to recommend this type of therapy for a wide application in neonatology as a part of neonatal sepsis treatment.

Key words: early neonatal sepsis, prematurity, extremely low body mass, immunosupportive therapy, intravenous immunoglobines, clinical and economical analysis, neonatal sepsis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 52–61)

Mucolytics are widely used in pediatric respiratory pathology treatment. This review contains information about main groups of mucolytics. Special attention is given to acetylcystein. It also includes substantiation report of mucolytics in complex treatment of acute and chronic bronchopulmonary disorders in children.

Key words: acetylcystein, mucocillary clearence, acute respiratory viral infection, bronchoobstructive syndrome, respiratory function.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 62–66)

Craniopharyngoma is a rare embriogenic tumor of sellar or parasellar region with low malignization rates and quite high incidence of relapses. High variability of anatomic localizations makes surgical treatment quite complicated. Regardless satisfactory treatment results and positive outcomes, post-surgical complications may dramatically lower patient’s quality of life. Also anatomical localization of craniopharyngomas stipulates high incidence of endocrine disorders. This review contains main diagnostic and treatment principles, complications linked to either tumor growth or to treatment. The authors discuss interpherone α use as a potential treatment method.

Key words: craniopharyngioma, hypothalamic obesity, panhypopituitarism.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 67–70.)

Nowadays infectious-inflammatory diseases of ENT-organs take one of the leading positions among pediatric acute pathology including that of infants. Despite abundant information upon etiology and pathogenesis of these diseases there are still questions regarding the most effective therapeutic schemes. This article contains information about peculiarities of pediatric ENT inflammatory diseases treatment. Special attention is paid to the problem of topical treatment of pediatric infectious-inflammatory ENT-diseases. It also includes discussion of benefits and drawbacks of various treatment options and medications used in this field.

Key words: pharyngitis, tonsillitis, topical treatment, lozenges.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 72–76.)

Antibiotic therapy is common cause of intestinal dysbiosis in children. Indigenous intestinal microflora disbalance negatively affects different host’s system and organs. That is why dysbiosis prevention one of the most important part of rationale antibacterial treatment.  The article contains basic information about contents and function of symbiont microflora, etiology, pathogenesis clinical presentation and main principles of antibiotic-associated diarrhea treatment.

Key words: microbiocoenosis, antibiotic-associated diarrhea, ecoantibiotics, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 77–82)

The article is dedicated to study of efficacy and safety of ibandronic acid administered intravenously to 25 patients suffering from juvenile arthritis and system osteoporosis. It was concluded that administration of 3 mg of ibandronate every 3 months during 76 weeks increase  CTX, which indicates improvement of bone metabolism. During the treatment no subsequent vertebrae fractures have been registered. Increase in bone mass during the ibandronate therapy has been sufficient to allow endoprosthetic hip replacement in 7 patients.

Key words: child, juvenile arthritis, osteoporosis, treatment, biophosphates, ibandronic acid.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 83–88)

Urinary syndrome is an invariable and often the only manifestation of renal and urinary tract injury. Modern laboratory diagnostics prioritize prompt tests such as «dry chemistry» urine analysis using deep-stick tests. Study objective: to evaluate diagnostic accuracy of deep-stick tests in urinary syndrome verification in pediatric urinary tract infections (UTI). Methods: examination of a urinary sample using standard methods and prompt analysis with urine biochemical composition analyser among 66 children aging from 2 months to 16 years. From this group: 28 children had UTI and 38 other somatic diseases. Results: it has been shown that nitrite test-sticks have low diagnostic sensitivity — 69%, high prognostic value of a positive result (90%) and high specificity (94%). Diagnostic sensitivity of leucocytic esterase is 73%, its’ prognostic value of a positive result — 92% and diagnostic specificity — 94%. Erythrocyteuria test had diagnostic sensitivity of 80% and specificity of 95%. Protein test had diagnostic sensitivity of 61% and prognostic value of 64% and 81% specificity. Conclusion: deep-stick test implementation with regard to specifications of this method will allow a more differential approach to it’s use in labs of medicoprophylactic facilities, also reduce the amount of time required for lab urine examinations, as well as to increase reliability of diagnostic information.

Key words: children, urinary tract infections, stick-tests, «dry chemistry», diagnostic accuracy, method, urinalysis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 89–95)

The article contains results of retrospective observational study of adalimumab safety and efficacy in 67 juvenile arthritis and juvenile arthritis with eye involvement patients refractory to classical immunosuppressive treatment. It also contains a description of a recombinant biological medication — adalimumab: already on the 4th week of treatment acute inflammatory changes in the affected joints were relieved, joint motion range fully recovered; by the week 8 — full remission of the uveitis was reported in 45% of affected eyes (27/61), normalized disease activity lab parameters such as ESR, serum C-reactive protein.

Key words: children, juvenile rheumatoid arthritis, rheumatoid uveitis, adalimumab.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 96–102)

The article contains provisional data from epidemiologic study of pneumococcal opaquecommunity-acquired pneumoniae and acute otitidis mediae among children from 0 to 7 years, admitted to one of St. Petersburg children’s hospitals. Etiology definition was carried out via blood and phlegm sampling. Neither bacteriological blood nor sputum analysis proved pneumococcal etiology of the disease in none of 168 admitted patients. However, PCR proved invasive form of pneumococcal pneumonia: pneumococcus was found in 2 (9%) from 22 patients. Streptococcus pneumoniae was found in 23,5% of patients aged 0–3 years and in 21,8% of those aged 4–7 years. Nevertheless PCR has proven pneumococcal etiology in 62,8 and 41.1% of cases respectfully. On the ground of this data following indices were calculated: average prevalence of non-invasive pneumococcal pneumoniae — 58,5:100 000, severe forms of pneumococcal otitidis media that require admittance to hospital — 122,1 for children 0–3 years old, 97,4 per 100 000 — 4–7 years old. Acquired data is much higher than prevalence indices of many controllable infections in the country. Pneumococcal serotyping has shown the following: on 75,9% corresponded to 7-valent and on 95,1% it corresponded to 13-valent conjugated pneumococcal vaccines, registered in the Russian Federation. Thereby antipneumococcal immunization has been proved reasonable against pneumoniae and acute otitides mediae among infants. Inclusion of this vaccination into the national calendar has also been proved reasonable.

Key words: pneumococcal pneumonia, otitis, vaccination, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 103–107)

The article is dedicated to functional disorders of colon motility in children. Various reasons of constipation are discussed in this article as well as the possibility of a Dufalac use as a laxative in children with conditioned reflex constipation, in order to overcome painful defecation induced negativism.

Key words: constipation, children, treatment, prebiotics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 108–110)

The article contains analysis of prevalence and primary disease rates data of inflammatory diseases of the joints in children of Rostov region. It has been shown that just epidemiologic study allows more precise evaluation of parameters under study. Judging by epidemiologic study results prevalence of juvenile arthritis among children in 2006 and 2010 was 61,9 and 85,0 per 100 000 accordingly. Official data, however, were almost twice lower: 30,7 and 38,4 per 100 000 children, accordingly. It has been proved that in overall structure of inflammatory diseases the leading position takes juvenile arthritis (51%), second place is occupied by reactive arthropathies (49%). First place is taken by Reiter syndrome (31%), second — by juvenile oligoarthritis (18%), third — by an ankylosing spondillitis (15%),fourth — postenterocolitic arthropathy (caused by Yersinia) (10%) and seronegative juvenile polyarthritis (10%).

Key words: children, chronic joint diseases, juvenile arthritis, reactive arthritis, prevalence, clinical peculiarities.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 111–115)

Presented results of treatment efficacy research for topical fusafungin in patient with acute rhinosinusitis. 70 patients with acute rhinosinusitis aged 3 to 17 years were included into the study. All patients had been treated with fusafungin aerozole for 10 days. The results show that fusafungin is effective as a part of complex therapeutic schemes for treating subchronic rhinorhinosinusitis after adenotomy as well as in patients with rhinosinusitis and 1–2 stage adenoids. Patients with rhinosinusitis against the background of chronic adenoiditis had positive dynamics later on probably due to protracted inflammation and failure of a normal nasal drainage.

Key words: rhinosinutitides, fusafungin, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 116–118)

Use of specialized products is one of the ways of improving pregnant women nutrition. Efficacy evaluation is done by unification method,  that is based on product tolerance study, their influence progress and outcome of the pregnancy, foetus and women’s nutritive status.  This article contains guidelines of clinical physiological evaluation of efficacy of specialized products for pregnant women. Inclusion and exclusion criteria as well as efficacy variables are also included in the article.

Key words: pregnant women, specialized products.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 119–121.)

Atopic dermatitis remains an important medico-social problem due to its high spread in the population and development of complications. External non-steroid therapy remains first line treatment. This article presents treatment results of 40 patients aged 1 to 17 years old with moderate to severe atopic dermatitis with Zinocap cream (pirition zinc). Clinical efficacy of the treatment was assessed using SCORAD index and DLQI questionnaire at a first visit and on days 8, 15 and 22 of treatment.

Key words: atopic dermatitis, zinc pirition, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 122–127)

«National program of infantile feeding optimization in the Russian Federation» contains modern approaches to feeding up introduction to the infants. However, till present day, one cannot find a single opinion upon when it is suitable to prescribe first feeding up, as well as upon right sequence of products. This article contains results of the first stage of the study which objective is to lay Scientific grounds for feeding up introduction scheme, described in the «National program…». All the participants of this controlled study were divided into two groups — one receiving breast feeding, another one on artificial feeding. Each group was divided into three subgroups depending on the age of feeding up introduction — at4, at — 5 or at 6 months. Feeding up was introduced with different sequence of products.  The results prove that body mass increase was significantly higher in the group of children that were already receiving feeding up, in comparison to the group of infants that were still formula fed. It has also been shown that body mass increase was higher in the group where porridges were introduced as the first feeding up product, even though the volume remained the same.

Key words: infants, supplemental feeding.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (6): 128–136)

Pain and fever are one of the most frequent conditions in pediatric practice. Frequent occurrence of fever accompanied by a pain syndrome stipulates combined antipyretic and analgesic medications. This article contains information upon ibuprofen use («Nurofen for children») in pediatric patients as an antipyretic and analgesic medication to be used as part of complex treatment of acute respiratory infections.

Key words: fewer, children, ibuprofen.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 137–140)

Acute intestinal infections are quite common among children. Their clinical presentations include intoxication syndrome (drowsiness, low appetite, fever etc), infectious toxic syndrome (toxicosis with exicosis, neurotoxicosi, hypovolemic or infectious-toxic shock)and diarrhea syndrome. Sometimes intestinal infections can be quite severe and even lethal. However disease duration and outcome depend on timelines and adequacy of prescribed treatment. Main guidelines of intestinal infections treatment include probiotics. That is why the right choice of probiotics is important for a pediatrician. The article contains basic information upon etiopathogenesis, classification, diagnostic criteria and acute pediatric intestinal infections treatment guidelines.

Key words: acute intestinal infections, etiopathogenesis, diagnostic criteria, treatment, probiotics, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 141–147)

Pediatric bronchial asthma is one of the most spread allergic diseases. There is a recent tendency of pediatric asthma morbidity increase, also among infants, as well as increase in its severity. That is why specialists all over the world are working upon new diagnostic methods and design of optimal therapeutic guidelines. This review contains main concepts of asthma treatment taking into account patient’s age and level of disease control. Optimal combinations of medications for basic treatment are also considered in this article as well as most promising asthma treating strategies.

Key words: bronchial asthma, children, pharmaceutical treatment, inhaled glucocorticosteroids.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 148–156)

Rhinosinusitis is a common term that means inflammation of the mucosa of paranasal and nasal cavities. In the last 10 years there was a three-fold increase in rhinosinusitis’ morbidity rates and annual increase of hospital admissions on the average of 1,5–2%. The prevalence of various forms of rhinosinusitidis among adult population is 5 to 15% and 5% among children. Such ubiquitous spreading is one of the leading factors that stipulate socio-economic burden of the disease. According to various studies, rhinosinusitidis dramatically decrease quality of life: these patients show more inferior results in tests upon pain sensitivity and social activity in comparison with patients with coronary heart disease and COPD; in approximately 26% of patients rhinosinusitidis are followed by development or progression of depression. Rhinosinusitis treatment is one of the hottest issues in modern otorhinolaryngology, that demand more financial support with every year. Achievments in immunology have become grounds for immunocorrection as part of complex treatment of such patients. Bacterial lysates are used as preventive medications.

Key words: rhinosinusitidis, immunomodulators, bacterial lysates.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 157–161)

This survey contains efficacy analysis and substantiation of treatment of allergic children with respiratory infections with modern immune modulators. Evolution of immunomodulates is followed up on the example of pidotimod as well as its efficacy based on its influence on immunoregulation system and mucosal immunity. The authors underline the necessity of reasonable prescription of medications with immunostimulating activity to children with various forms of respiratory infections.

Key words: children, acute respiratory infections, allergic diseases, immunomodulators, pidotimod.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 166–169)

Chronic tonsillitis remains a current problem in pediatric health due to the risk of nonspecific systemic heart, renal and joint diseases. High social significance and prevalence among children call for effective preventive and treatment measures against this disease. Topical bacterial lysates recently have become popular among physicians as safe and effective component of tonsillitis treatment.

Key words: chronical tonsillitis, childhood, bacterial lysates.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 176–178)

Nutrient deficiency in children’s food leads to delay in physical and neuropsychic development, increase risk of various diseases. Longstanding deficit of several nutrients in a diet can lead to permanent changes in child’s body. This is vitally important especially in childhood and adolescence — time of most extensive growth and development. The review covers physiological role of vitamins and minerals, especially vitamin-mineral metabolism in children and main reasons of possible deficit of these micronutrients in their diet. Recommendations upon prevention and correction of vitamin-mineral deficit with the use of individually prescribed vitamin-mineral complexes are given in the article.

Key words: children, health, micronutrients, vitamin & mineral complexes.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 179–185)

Coughing is one of the most common reasons why parents seek for a pediatrician’s advice. The most frequent cause of cough in children are acute respiratory infections, but it can also appear against the background of non-infectious nature as well as drug side effect or due to alien object aspiration. Thorough examination and differentiation diagnosis are the cornerstones of making anticough treatment choice allowing to achieve maximum results in short terms, avoiding unnecessary use of medications. This review contains descriptions of main cough reasons as well cough treatment pediatric guidelines.

Key words: coughing, children, herbal medications.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (6): 186–190)

The article presents main strategies of breast feeding of prematurely born infants support, such as use of Philips AVENT breast pumpfor lactation formation and feeding of the infant with native breast milk.

Key words: premature infants, nursing mother, breast feeding support, modern accessories for breast feeding support.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (6): 170–175)

This article presents clinical case of early manifestation of juvenile oligoarthritis with rapid contracture and destructive joint changes formation. Methotrexate was administered IM 15 mg/m2 once a week. After 3 months of treatment — acute inflammatory changes in the joint were relieved as well as arthralgias, morning stiffness and there was a decrease in laboratory markers of the disease. After 6 months full motion range of the joint was achieved and contracture relieved. Remission is maintained for the last 12 months.

Key words: children, juvenile arthritis, methotrexate.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 191–197)

Clinical case of bladder extrophy in an 11-years old girl. The presentation covers main pathogenic mechanisms of the disease, diagnostic algorithm and treatment approaches.

Key words: Bladder extrophy, children.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 198–203)

This article contains results of a study dedicated to dosage of electropulse high tone therapy using an express analysis of live cells mobility in alternating current field of children with spastic forms of cerebral palsy.

Key words: cerebral palsy, electropulse high tone therapy, dose — effect, cell, electrophoretic mobility of red blood cells, zetapotential.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 204–207)

On the eve of the 300th anniversary of Mikhail Lomonosov this article covers the early of Lomonosov’s life, his childhood and adolescence.

Key words: Lomonosov, education, St. Petersburg academy of sciences.
(Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6): 208–212)