Volume 02 Issue 09-2022
22
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The creation of new medical technologies allows doctors to perform simultaneous surgical procedures in the upper
respiratory tract. Joint operative procedures are often performed in ENT organs, but this problem remains poorly
studied and insufficiently illuminated in the practice of otorhinolaryngology. There are not many works of local authors
devoted to simultaneous operations in rhinology. It should be noted that, despite the possibilities of modern
conservative therapy, the number of simultaneous operations in diseases of the nose, intranasal structures, and
paranasal cavities is not decreasing.
KEYWORDS
Nasal cavity, simultaneous operations, paranasal sinuses.
Research Article
EFFECTIVENESS USING OF SILICON SPLINTS IN SURGICAL PROCEDURES
ON THE MUCOUS MEMBRANE OF THE CAVITY OF THE NOSE
Submission Date:
September 10, 2022,
Accepted Date:
September 20, 2022,
Published Date:
September 30, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue09-06
U.S. Khasanov
Researcher, Tashkent Medical Academy, Uzbekistan
A.A. Rakhimov,
Researcher, Tashkent Medical Academy, Uzbekistan
J.A. Djuraev
Researcher, Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 09-2022
23
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
INTRODUCTION
Among the diseases of the larynx, deviation of the
septum of the nose occupies the main place. The
deviation of the septum of the nose causes the
occurrence of other pathological processes in the nasal
cavity. The deviation of the septum of the nose causes
hypertrophy of the lateral wall of the nasal cavity,
which in turn causes joint diseases in the cavity.
Simultaneous operations ("simultaneous" in English -
at the same time) are complex operative practices
aimed at the simultaneous surgical correction of two or
more diseases of different organs in one or more
anatomical areas. It is especially important to perform
simultaneous operations in cases where there is a
pathogenetic connection between two surgical
diseases. If the existing joint pathology is not surgically
corrected at the same time, the disease may worsen in
the postoperative period. It should be noted that
simultaneous
surgical
correction
by
an
otorhinolaryngologist is cost-effective compared to
separate operations, in which the cost of place-day is
reduced by 2 or more times, the time spent on
examinations, pre- and post-operative treatment,
anesthesiological drugs costs are reduced.
The creation of new medical technologies allows
doctors to perform simultaneous surgical operations in
the field of upper respiratory tract less invasively. Joint
operative procedures are often performed in ENT
organs, but this problem remains poorly studied and
insufficiently
covered
in
the
practice
of
otorhinolaryngology. There are not many works of
local authors devoted to simultaneous operations in
rhinology [5,17,3,7,16]. It should be noted that despite
the possibilities of modern conservative therapy, the
number of simultaneous operations in diseases of the
nose, nasopharyngeal structures and paranasal
cavities is not decreasing [3,9,10,21,1,17].
Purpose of the research work was
- studying the
morpho-functional features of the nasal mucosa after
joint simultaneous surgical operations in cavity of the
nose.
THE RESULTS AND DISCUSSION
Research materials and methods In 2021-2022, 60
patients with diseases of the nose and paranasal
cavities were comprehensively examined and treated
at the otorhinolaryngology department of the
multidisciplinary clinic of the Tashkent Medical
Academy. Combined surgical procedures were
performed in these patients, and morpho-functional
studies were conducted on the effectiveness of
hemostatic agents. Symptoms such as difficulty
breathing through the nose, constant and occasional
runny nose, impaired sense of smell were observed in
the patients. These symptoms have been associated
with impaired olfactory function in some cases. During
the clinical examination, the symptoms of headache
and forehead pain were often noted in the patients
(table 1).
Volume 02 Issue 09-2022
24
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Table 1
The frequency of the main clinical symptoms in patients with joint disease of the nasal cavity
Complaints
Number of patients (n=120), %
abs.
%
Difficulty breathing through the nose
60
100.0
Impaired sense of smell
14
23.0
Nasopharyngeal discomfort
22
36.6
Sneezing
18
45.0
Discharge from the nose (of different nature - mucous, mucous-purulent,
etc.)
30
50.0
Constant runny nose
20
33.3
Occasional runny nose
10
16.6
Occasional headaches
10
16.6
p>0.05
During the study hydrogen ion concentration activity
was also studied during the investigation nasal
separation, suction, mucociliary transport and nasal
cavity in patients (table 2).
Table 2.
Results of functional testing methods of the mucous membrane of the nasal cavity
Indicators
Group 1
n=20
2nd group,
n=20
Group 3
n=20
Indicators in the
norm
Mucociliary clearance
(min)
31.7±0.67***
29.83±0.4***
30.83±0.4***
20.4±0.82**
11.5±1.4
28.5±0.72*
26.4±0.82**
Hydrogen ion
concentration indicator
(pH)
7.36±0.01***
7.37±0.01***
7.37±0.01***
7.2±0.01
7.0±0.01
7.3±0.01
7.2±0.01
Suction function (pupil
reaction time (number))
81±2.65***
82.3±1.41***
82.3±1.41***
69.8±0.72**
68.2±0.6
74.5±0.42**
73.8±0.72**
57.3±0.48***
56.5±0.52***
56.5±0.52***
41.25±0.08
Volume 02 Issue 09-2022
25
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Separation function
(cotton weight (mlgr))
51.1±0.16
49.3±0.26*
44.3±0.26*
*-Differences compared to normal valuesweak reliable,(p>0.05)
**-Differences compared to normal valuesmoderately strong reliable,(p>0.05)
***-Differences compared to normal valuesstrong reliable,(p>0.05)
As can be seen from Table 2, there was almost no
difference in pH indicators in the 3 groups of patients.
However, in the mucociliary transport examination,
31.7 minutes before and 28.5 minutes after surgical
interventions in 1 group of patients (with a gauze
swab), this indicator was 29.83 before and 26 minutes
after medical procedures in 2 groups of patients
(hemostatic sponge). ,4 minutes, in 3 groups of
patients (splint) it was 30.83 minutes before
treatment, and then it was 20.4 minutes. Sucking task
(pupillary reaction time (number)) of group 3 patients
was observed to be significantly changed compared to
the rest of group 1 and 2 patients, namely 82.3 seconds
before treatment and 69.8 seconds after
treatment. The separation function (cotton weight
(mlgr)) results show that
According to obtained results, it can be concluded that
the tools used after surgical interventions in the nasal
cavity have a significant effect on the mucous
membrane of the nasal cavity, which was confirmed in
the above data. Among the compared methods, the
results of the use of the Splint tool we offer after
surgical interventions show that the effect on the
mucous membrane of the nasal cavity is almost
minimal.
In order to investigate nasal breathing or nasal
ventilation, we studied rhinopneumometry indicators
(table 3).
Table 3
Rhinopneumometry test results (before treatment procedures)
Group
Right
Left
SOP, sm3/s
SS, Pa/ sm3/s
SOP, sm3/s
SS, Pa/ sm3/s
І
311.01±9.65
(46%
↓
)
1.64±0.11 (43%
↑
)
314.01±9.65
(46%
↓
)
1.79±0.11
(43%
↑
)
ІІ
324.23±10.07 (59%
↓
)
1.45±0.09 (96%
↑
)
323.23±10.07
(59%
↓
)
1.65±0.09
(96%
↑
)
ІІІ
301.01±9.65
(46%
↓
)
1.31±0.11 (43%
↑
)
325.01±9.65
(46%
↓
)
1.46±0.11
(43%
↑
)
Volume 02 Issue 09-2022
26
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
p>0.05
As can be seen from the table, rhinopneumometry
parameters (before surgery): volume flow value in
group 1 patients, right - 291sm3/s, left - 274 sm3/s,
resistance, right - 1.84 PA/sm3 /s, left - 0.59 PA/ sm3/s,
UHO - 340 sm3/s, UQ - 0.54 PA/ sm3/s. Value of volume
flow in 2 groups of patients, right - 291 sm3/s, left - 274
sm3/s, resistance, right - 1.84 PA/ sm3/s, left - 0.59 PA/
sm3/s, UHO - 340 sm3/s, UQ - 0.54 PA/ sm3/s. Volume
flow value in 3 groups of patients, right - 291 sm3/s, left
- 274 sm3/s, resistance, right - 1.84 PA/ sm3/s, left - 0.59
PA/ sm3/s, UHO - 340 sm3/s, UQ - 0.54 PA/ sm3/s. The
results of the examination showed that the indicators
of nasal ventilation were almost the same in all 3
groups of patients before treatment.
Table 4
Rhinopneumometry test results (after treatment procedures)
Group
Right
Left
SOP, sm3/s
SS, Pa/ sm3/s
SOP, sm3/s
SS, Pa/ sm3/s
І
411.01±9.65
(66%
↓
)
0.84±0.11 (73%
↑
)
414.01±9.65
(76%
↓
)
0.99±0.11
(68%
↑
)
ІІ
584.23±10.07 (79%
↓
)
0.65±0.09 (86%
↑
)
564.23±10.07
(84%
↓
)
0.89±0.09
(89%
↑
)
ІІІ
671.01±9.65
(90%
↓
)
0.44±0.11 (93%
↑
)
684.01±9.65
(92%
↓
)
0.51±0.11
(95%
↑
)
p>0.05
After treatment procedures (table 4): volume flow
value in group 1 patients, right - 204 sm3/s, left - 360
sm3/s, resistance, right - 0.74 PA/ sm3/s, left - 0.42 PA/
sm3/s, UHO- 564 sm3/s, UQ - 0.27 PA/ sm3/s. Value of
volumetric flow in 2 groups of patients, right - 204
sm3/s, left - 360 sm3/s, resistance, right - 0.74 PA/
sm3/s, left - 0.42 PA/ sm3/s, UHO - 564 sm3/s, UQ - 0.27
PA/ sm3/s. Value of volumetric flow in 3 groups of
patients, right - 204 sm3/s, left - 360 sm3/s, resistance,
right - 0.74 PA/ sm3/s, left - 0.42 PA/ sm3/s, UHO - 564
sm3/s, UQ - 0.27 PA/ sm3/s.
The obtained data indicate that the ventilatory
function of the nasal cavity was significantly improved
in 3 groups of patients (this was manifested due to the
absence of means of resistance to the airflow in the
nasal cavity).
Patients have a nose a microbiological study was
carried out in order to study the significance of the
microflora of the mucous membrane in the effect of
the means on the functions of the nasal cavity after the
medical procedures carried out in the nasal cavity.
In this, in the 1st group when examining the condition
of smears taken from the nasal mucosa of patients
who underwent nasal septum surgery and used gauze
tampons 7-14 days after the operation, staphylococcus
aureus, Haemophilus influenzae, Streptococcus
pneumonia, Escherichia coli were found in the
Volume 02 Issue 09-2022
27
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
microbiological landscape of 7-14 days in 46 patients. .
In the remaining 4 patients, the recovery of the
condition of the nasal mucosa in the postoperative
period lasted for 1 month. When examining the
condition of the smears taken from the nasal mucosa
on the 7-14 days after the operation, 47 Staphylococcus
aureus and Escherichia coli were detected in the
microbiological landscape of the patient on the 7th
day. Staphylococcus aureus was detected on the 14th
day.
In order to determine the degree of influence of the
tools used in the nasal cavity on the nasal mucosa after
nasal cavity surgical procedures, a cytological study
was conducted in patients (table 5).
Table 5
In rhinopathologies, the state of the mucous membrane of the nasal cavity is on a rhinocytogram
Signs
1 group (n=)
2 groups (n=)
3 groups (n=)
breath
papillary cellular
structures
derived from the
epithelium of the
airways
Bef
o
re the o
pe
ra
tio
n
Da
y 7
af
te
r
su
rg
ery
Da
y 14
af
ter
su
rg
er
y
Bef
o
re the o
pe
ra
tio
n
Da
y 7
af
te
r
su
rg
ery
Da
y 14 af
ter
su
rg
er
y
Bef
o
re the o
pe
ra
tio
n
Da
y 7
af
te
r
su
rg
ery
Da
y 14 af
ter
su
rg
er
y
Basal cells
+
+
+
+
+
+
+
+
+
Scattered cells of
the respiratory
epithelium
-
-
-
-
-
+
+
+
+
Signs of
hypersecretion in
respiratory
epithelial cells
-
-
+
-
+
+
+
+
+
Volume 02 Issue 09-2022
28
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Degenerative-
destructive signs
in respiratory
epithelial cells
-
+
+
-
-
+
-
-
-
Metaplasia of
squamous cell
elements
-
-
+
-
-
+
-
-
+
Treatment
pathomorphosis
-
-
-
-
-
+
+
+
+
Cornification
-
-
+
-
+
+
-
+
+
Fibroblasts
-
+
+
-
+
+
+
+
+
segmented
neutrophils
-
-
+
-
-
+
-
+
+
Eosinophils
+
-
+
+
-
+
+
-
+
Lymphocytes
+
+
+
+
+
+
+
+
+
Histiocytes
-
-
+
-
+
+
+
+
+
Phagocytosis
-
-
+
-
-
+
+
+
+
Bacterial flora
+
+
+
+
+
+
+
-
-
Volume 02 Issue 09-2022
29
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
As can be seen from the table data, the state of the
nasal mucosa was recorded in patients of each group
in the cytological material obtained from the mucous
membrane of the nasal cavity after the operation.
Thus, in patients who used gauze tamponade of the
nasal cavity (the first group), clear signs of
inflammatory infiltration and dystrophic changes were
detected. in the second group of patients, a
hemostatic sponge was used after surgery, and in this
group, in addition to the symptoms in the above group,
therapeutic pathomorphism was determined. Patients
in the third group (only the splint was used) were
distinguished by the reduction of inflammatory signs
and the presence of regenerative process signs, as can
be seen from the rhinocytogram of the mucous
membrane.
Thus, the cytological examination of smears taken
from the mucous membrane of the nasal cavity taken
from patients with various rhinopathologies in the
postoperative period showed that nitric oxide leads to
the disruption of intercellular connections in the
structure of polypous tissue and slplint after surgery in
group 3 patients with the help of it led to the
strengthening of the regenerative processes of the
mucous membrane of the nasal cavity. The results of
cytological studies have once again confirmed the
effectiveness of using the splint in the practice of
otorhinolaryngologists.
CONCLUSION
The use of the silicon "Splint" as an alternative to
tamponade of the nasal cavity in joint surgical
procedures in the nasal cavity, due to the reduction of
the volume of complications during and after the
operation in patients, strong trophic changes of the
mucous membrane and pain reduction improved
treatment results.
REFERENCES
1.
Baranov, Konstantin Konstantinovich, etal.
"Osobennosti
diagnostici
i
lecheniya
sochetannoy
patologii
nosa
i
slezootvodyashchikh putey u detey." Practical
Medicine 16.5 (2018).
2.
Kalinin, P. L., etal. "Otsrochennye nosovye
krovotecheniya posle endoscopicheskogo
transsphenoidalnogo
udaleniya
adenoma
hypophysis" Rossiyskaya rinologiya 25.4 (2017):
28-36.
3.
Arabyan, Jirayr Migranovich. Objektivnaya
otsenka
i
obsnovanie
hirurgicheskogo
meshetelstva
pri
sochetannoy
adenotonzillarnoy i rhinogennoy respiratory
chronic. Obstruktsii u detey. Diss. Yerevan
State Medical University named after M.
Geratsy, 2017.
4.
Kochergin, G. A., V. V. Dvoryanchikov, and F. A.
Syroezhkin. "Rehabilitation of patients with
vestibular disturbances posle simultannyx
rinootoxirurgicheskix vmeshatelstv." Russian
Rhinology 23.4 (2015): 29-33.
5.
Ermakova, M. V., K. O. Kurganova, and A. B.
Knyazev.
"Tselesoobraznost
simultannyx
operatsiy v rinologii." Bulletin of medical
internet conference. Vol. 5. No. 5. Obshchestvo
s ogranichennoy otvetstvennostyu "Nauka i
innovatsii", 2015.
6.
Palchun V. T., Magomedov M. M., Dibirova T. A.
USTROYSTVO DLYa OSTANOVKI NOSOVOGO
KROVOTECHENIya. - 2011.
7.
Boyko, N. V., A. S. Bachurina, and A. I. Zhdanov.
"Prophylaxis
of
postoperatsionnykh
krovotechenii
pri
adenotomii."
Russian
rhinology 23.2 (2015): 26-30.
8.
Boyko, N. V., and Yu. V. Shatokin.
"Pathogenesis of nosovykh krovotechenii and
Volume 02 Issue 09-2022
30
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
bolnykh s arterialnoy hypertension." Journal of
Otorhinolaryngology 80.5 (2015): 41-45.
9.
Tarkova AR, Chernyavsky AM, Morozov SV,
Grigorev IA, Tkacheva NI, Rodionov VI.
Hemostatic material of local activity and the
basis of oxidized cellulose. SibNauchMedy
Journ. 2015;35(2):11-15.
10.
Zabirov
R.
A.
i
dr.
MASSIVNYE
RETсIDIVIVIRUYushchIE
NOSOVYE
KROVOTEChENIya
U
BEREMENNOY
JENshchchINY
//RUSSIAN
OTORHINOLARYNGOLOGY
Meditsinskiy
nauchno prakticheskiy zurnal. - 2011. - S. 144.
11.
Kraynyukov P. E. i dr. Ostanovka profuznogo
nosovogo
krovotecheniya
(prnk)
with
ispolzovaniem
roentgenendovaskulyarnykh
methodical //Glavnyy vrach Yuga Rossii. – 2013.
– no. 1 (32).
12.
Konstantinova YuE, Abrosimova NV, Sotnikov
KA,
Lipatov
VA.
Pokaseteli
krovoostanavlivayushchey activity foam na
osnove carboxymethylcellulose. Zdorove i
Obrazovanie v XXI veke. 2016;18(1): 142-44.
13.
Sharipova, M. A., G. A. Nurkasimova, and J. S.
Isabaeva.
"Metody
uskoreniya
srokov
reabilitatsii posleoperatsionnogo perioda v
rhinohirurgii." Journal of Surgery Kazakhstan 2
(38) (2014).
14.
Gyusan, A. O. "Vozmojnosti simultaneous
surgery
and
rhinology."
Journal
of
Otorhinolaryngology 3 (2014): 48-50.
15.
Leontev, A. F., etal. "Simultannoe lechenie
hirurgicheskoy i otorinolaringologicheskoy
patologii u detey mlashe vozrasta." Kremlin
medicine. Clinical Journal 1 (2014): 37-38.
16.
Morozov, Aleksandr Dmitrievich, and Milana
MuzarinovnaKumysheva. "Opredelenie taktiki
perioperatsionnogo lecheniya zabolevaniy
polosti
nosa.
RussianotorhinolaryngologyMeditsinskiy
nauchno-prakticheskiy zurnal (2014): 153.
17.
Khushvakova N. J., Khamrakulova N. O.,
Abdusamatov F. S. PRIMENENIE PREPARATA
TAXOKOMBA
PRI
NOSOVYX
KROVOTECHENIYAX
U
BOLNYX
S
CHRONICHESKIM
LEUKOZOM
//Novye
tekhnologii v otorinolaringologii. - 2014. - S. 287-
291.
18.
Konoshkov
A.
S.,
Letyagin
K.
V.
DIAGNOSTIChESKAYa I LEChEBNAYa TAKTIKA
PRI
POSTTRAUMATIChESKIX
NOSOVYX
KROVOTEChENIYAX
//RUSSIAN
OTORHINOLARYNGOLOGY
Meditsinskiy
nauchno-prakticheskiy zurnal. - 2012. - S. 99.
19.
Jurova O. N., Podpalov V. P., Kunitsky V. S.
Obshchaya vrachebnaya praktika: tactic of a
doctor in arterial hypertension, oslojnennoy
nosovym
krovotecheniem
//Uvajaemye
kollegye!. - 2012.
20.
Bejin A.I., Maystrenko A.N., Lipatov V.A.,
Chizhikov G.M., and Zhukovsky V. A..
"Hemostatic activity of new application means
and basis of carboxymethyl cellulose" Vestnik
new medical technology, vol. XVIII, no. 3, 2011,
pp. 152-154.
21.
Tarkova A. R., Chernyavsky A.M., Morozov S.V.,
Grigorev I.A., Tkacheva N.I., and Rodionov V.I.
"Hemostatic material of local activity and the
basis of oxidized cellulose" Sibirskii nauchnyi
meditsinskii zurnal, vol. 35, no. 2, 2015, pp. 11-15.
22.
Lipatov V.A., Ershov M.P., Sotnikov K.A.,
Ushanov A.A., Novikova N.V., Konstantinova
Yu.E. "Sovremennye tendentsii primenenia
lokalnykh
apliktsionnykh
krovoostanovlivayuschikh sredstv" Innova, no.
2 (3), 2016, pp. 64-69.
23.
Lipatov V.A., Lazarenko S.V., Sotnikov K.A.,
Severinov D.A., & Ershov M.P. (2018). K
Volume 02 Issue 09-2022
31
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
22-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
voprosu
o
metodologii
sravnitelnogo
izucheniya stepi hemostaticheskoy activitie
applicatsionnyx
