The article focuses on the study of hemodynamics of children during the period of induction into anesthesia. The analysis of the study results has been carried out – 80 children aged 3 to 14 years undergone medical procedures on diseases of abdominal cavity and anorectal area. The study results have shown that the combination of sevoflurane and ketamine in small doses has caused an effective analgesic effect with a significant vegetative stabilizing effect providing a stable course of the following stages of anesthesia and postanesthetic period.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
In this article, the eighth exhibition hall of the Termez Archaeological Museum is dedicated to the culture of Termez and Chaganiyan during the period of Amir Temur and the Timurids. In this exhibition hall, there are models of Kyrgyz, Kokildar ota, Sultan Saodat complex, glazed household items, map of Amir Temur's state, copper coins, chess pieces and military equipment are being demonstrated. The material resources displayed in exhibitions of this hall, covering the period from 1370 to the beginning of the 16th century, show that the applied art of Termez and Chaganiyan developed in harmony with the culture of other central cities of Amir Temur's state.
The present article seeks to explain the impact of the processes globalization on national cultures and the response of ethnic cultures to such processes from the viewpoint of alternate progress theories. The immanent connection between globalization and ethno-cultural diversity, proximity and national-cultural models of alternative development are the object of our research.In the current period, the communicative function of culture has expanded dramatically, transformation processes are taking place in it in accordance with global changes. In particular, forms of indirect communication (mobile phone, Internet) are making radical changes in this function. Now there is rapid rapprochement of cultures, exchange of experience and mutual enrichment. At the same time, it is necessary that the communicative function does not harm the diversity of ethno-cultures, does not interfere with intercultural communication in accordance with national interests, and especially does not focus on the decision-making of Western popular culture. No matter how much international dialogue and integration help to establish universal values and norms, they should not serve to make a culture in a mood of expansion become a dominant force.During the period of democratic reforms, scientific and practical research was started on the restoration of Uzbek ethnic culture, the use of its historical, educational and artistic-aesthetic possibilities. The state is leading the development of many types of folk creativity and art. However, comprehensive research of Uzbek ethnic culture, its genesis, sociological and axeological foundations, integration relations with the culture of sister nations, and comparison with other ethnic cultures in the system of these relations is one of the tasks before us. Philosophical studies conducted today are mainly empirical in nature, philosophical generalizations are rare in them. Therefore, there is a scientific-theoretical need to study cooperation, communication and integration between ethnic cultures under the influence of globalization from a philosophical point of view, without forgetting the allogenesis and ideogenesis of ethnic culture. It should focus not only on making philosophical generalizations, but also on finding ways to effectively use artistic-aesthetic possibilities, tools, and artifacts.
The article examines the problems of sustainable development of industrial enterprises, analyzes the factors affecting the sustainability of enterprise development, gives a definition of various types of economic sustainability during a pandemic, and highlights the internal and external factors of the sustainability of enterprises. It is shown that of the most
important factors affecting the sustainability of the development of industrial enterprises, first of all, economic stability stands out. The factors in the conditions of a deteriorating economic situation are investigated and identified, which are advisable to take into account when solving the problem of sustainable development of industrial enterprises. When conducting the study, the main sources of data were the materials of state statistics committee of the Republic of Uzbekistan. The methodological developments are based on comparative methods of analysis. Proposals have been developed to ensure economic sustainable development of industrial enterprises during a pandemic.
As presented in the content of documents of state importance, primary education is an important component of continuing education in the country, and its effective organization can be an important guarantee of success in the next stages of education. Indeed, there is an opportunity to further enrich and strengthen the skills of learning activities and spiritual and moral qualities acquired by students in primary schools, while studying in basic schools, academic lyceums, vocational colleges and higher education institutions. In this regard, it is advisable to focus on fostering a sense of responsibility from the time of primary education. The qualities formed in the student’s behavior during this period are strengthened in the later stages of the system of continuing education. This article explains the essence of the concept of «responsibility», content of educating responsibility sense of pupils of primary schools and role of academic disciplines and spiritual-educational activities in fostering a sense of responsibility in primary school students.
Были собраны и оцифрованы разнотипные и разновременные материалы о деятельности Шарафа Рашидова и той эпохи. Показан его вклад в развитие Узбекистана в период с 1950 по 1983 года. Нами была разработана “форма” для наполнения её контентом о деятельности Шарафа Рашидова. Были получены предварителные данные о том, что за период деятельности Шарафа Рашидова было создано 3 области, 37 новых районов, 77 поселков городского типа получили статус города, было построено с нуля 9 городов. Разработана визуализация цифровой документальной базы данных коллективной памяти о деятельности Шарафа Рашидова. На веб-графической основе. Она позволяет оперативно обновлять материалы, обмениваться ими, проводить научные исследования, а также использоваться в качестве наглядного пособия на лекциях по новой истории и экономике Узбекистана
В настоящее время по данным литературных источников, согласно которым женщины в период беременности подвержены повышенному риску развития нервно-психических расстройств. Согласно зарубежным исследованиям депрессивные расстройства считаются самыми частыми нервно-психическими расстройствами у женщин в послеродовом периоде.
This article analyzes the political life of the Ferghana Valley, the eastern region of the Bukhara Khanate, during the reign of Nadrmuhammad Khan (1642-1645) through sources and scientific literature