In modern abdominal surgery, one of the current areas for research continues to be the improvement of various options for plastic surgery of postoperative hernias. More than 2,100,000 operations for ventral hernia are performed annually in the world, and 42% of them are postoperative hernias. In recent years, there has been a clear trend toward the expanded use of various types of biological meshes in hernioplasty. “A pooled analysis of seven PCSTAR studies for incisional hernias using retromuscular mesh showed a hernia recurrence rate of 5.7%”[1]. The use of standard surgical interventions such as alloplasty in the onlay position does not solve the problem of early postoperative complications: seroma discharge, mesh migration, adhesive disease, high frequency of hernia recurrence, etc. At the same time, hernia repair with local tissue creates the problem of increased intra-abdominal pressure and late complications in the form of recurrent hernias. “An increase in postoperative intra-abdominal pressure leads to multiple organ failure, then abdominal compartment syndrome, and even death.” [2]. Currently, there is no consensus on the surgical approach for giant postoperative abdominal wall hernias, and therefore the need to continue to develop new technologies and improve There is no doubt about the tactics. In world practice, at present, the most relevant studies continue to be studies aimed at studying the morphological and functional aspects of recurrent postoperative ventral hernias; electron microscopy reveals ultrastructural destructive changes in skin cells, aponeurosis and muscles, which indicates morphofunctional insufficiency of abdominal wall tissues; issues of cell engineering are discussed new innovative materials, experimental studies are being carried out on animals testing the biotechnical properties, texture and elasticity of new polymers, research is being conducted on open approaches with division of the posterior component with the release of the transverse abdominis muscle and a retrograde mesh, robotic operations have begun. Modern aspects of the development of domestic healthcare include many measures aimed at improving the results of treatment of patients with postoperative ventral hernias and associated pathological conditions through the introduction of modern principles of intensive care and surgical tactics. The development strategy of New Uzbekistan for 2022-2026 in seven priority areas includes tasks to improve the quality of provision of qualified medical services to the population[3]. The implementation of these tasks, including by optimizing tactical and technical approaches to the choice of hernioplasty method, as well as the development of methods for the prevention of purulent-inflammatory complications in the field of alloplastic material, is one of the current areas of abdominal surgery and medicine in general, due to the high medical and social the significance of this pathology.
This dissertation research to a certain extent serves to fulfill the tasks approved by the Decree of the President of the Republic of Uzbekistan “On comprehensive measures to radically improve the healthcare system of the Republic of Uzbekistan” No. UP-5590 dated December 17, 2018, the Resolutions of the President of the Republic of Uzbekistan “On measures to transform the surgical service, improving the quality and expanding the scale of surgical operations in the regions" for No. PP-5254 dated October 4, 2021 and "On additional measures to ensure public health by further increasing the efficiency of medical prevention work" for No. PP-4891 dated November 12, 2020, and as well as other regulatory documents adopted in this area. Compliance of the research with the priority directions of development of science and technology of the republic. The dissertation research was carried out in accordance with the priority direction of development of science and technology of the VI Republic “Medicine and Pharmacology”. Review of foreign scientific research on the topic of the dissertation.[4] Research work aimed at improving the quality of therapeutic and preventive care for patients with ventral hernias, carried out by many leading scientific centers and higher educational institutions in the world, including the Department of Surgical and Perioperative Sciences, Umeå University, Umeå (Sweden), Department of Surgery, Kingston General Hospital, 76 Stuart Street, Kingston (Sweden). nada), Department of Surgery, Helsinki University Hospital, Helsinki ( Finland), Service de chirurgie digestive et oncologique, CHU d'Amiens (France), Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa (USA), Department of Surgery, Howard University College of Medicine, Washington (USA) , Yong Loo Lin School of Medicine, National University of Singapore (Singapore), Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; University of Calgary, Calgary (Canada), Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia (USA), Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston (USA) , Department of Surgical Sciences, Uppsala University Hospital, Uppsala (Sweden), Department of Surgery, University of Texas Health Sciences Center at Houston, Houston (USA), Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands), Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka (Japan), National Medical Research Center for Surgery named after A.V. Vishnevsky" (Russia), Republican Scientific Center for Emergency Medical Care (Uzbekistan), Tashkent Medical Academy (Uzbekistan), Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov (Uzbekistan).
As a result of studies conducted around the world to increase the effectiveness of alloplasty for postoperative ventral hernias and reduce the risk of complications in the postoperative period, a number of scientific results were obtained, including: it was determined that patients who underwent reconstruction of the abdominal wall have an increased risk of postoperative respiratory failure, understanding the epidemiology of this complication can improve prevention (the Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, USA); It has been proven that the larger the hernia, the higher the risk of early surgical complications, including such as respiratory decompensation, since hernias often increase in size over time, delaying surgery can lead to an increase in the size of the hernia and, therefore, a greater risk of complications (CentreforDigestiveDiseases, KarolinskaUniversityHospital, Stockholm, Sweden); it has been shown that the ratio of the hernia volume to the volume of the abdominal cavity <20% is an independent factor in tension-free closure, which justifies the interest in preoperative volumetry to adapt the tactics of surgical care (Servicedechirurgiegénérale, digestiveetendocrinienne, CHU LyonSud, HospicescivilsdeLyon, France); It has been determined that in patients undergoing elective laparoscopic hernia repair, predictors of mortality are older age and certain concomitant diseases: congestive heart failure, pulmonary circulatory disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders and paralysis (Department of Surgery, College of Medicine, University of Oklahoma, Tulsa , USA); Older age, ascites, preoperative renal and pulmonary insufficiency have been found to be independent predictors of 30-day mortality, and in the presence of these risk factors, conservative treatment should be seriously considered (Department of Surgery, University of Kentucky College of Medicine, Lexington, USA); The American College of Surgeons (ACS) Universal Surgical Risk Calculator has been shown to accurately predict thirty-day outcomes, including major complications: venous thromboembolism, medical morbidity, surgical site infection, unplanned reoperation, mortality, and length of hospital stay (Department of Plastic Surgery, Brown University and Rhode Island Hospital, Providence, USA). At the present time in the world, the most relevant research in surgery continues to be the development of new methods of hernioplasty for large and giant ventral hernias, each of which has its own pros and cons depending on the complexity of implementation, the risk of postoperative complications and relapse, large randomized clinical trials are being conducted, comparing existing methods of traditional hernioplasty with laparoscopic access and robotic surgery, which has become increasingly widespread in the last 10 years, a search is being made for new synthetic and biological materials developed for the production and use of composite meshes that have the necessary strength and the ability to prevent fatal local complications in a contaminated environment. However, despite technical advances in this field, no modern hernia repair method or prosthesis meets all the requirements. One of the key problems is that existing synthetic endoprostheses do not have sufficient elasticity, resistance to infection, high mechanical strength and integrity over a long period of time. Further research into these clinical aspects will undoubtedly improve the current understanding of the capabilities of biocompatible endoprostheses and will make it possible to develop an optimal method for their placement during allohernioplasty. The degree of knowledge of the problem. The current period of development of abdominal surgery is characterized by an emphasis on the problems of the effectiveness of introducing new installation methods and techniques for attaching bioprostheses, options for various suture materials to determine the most promising directions for the development of these technologies [5]. Researchers led by BittnerR.[6] (2019) state that a giant postoperative abdominal wall hernia, the maximum diameter of which exceeds 12 cm or the ratio of the volume of the hernial sac to the abdominal cavity more than 20%, is difficult to treat, with a high recurrence rate and a large number of complications. One of the most challenging problems is that after the hernia contents return to the abdominal cavity, postoperative intra-abdominal pressure will increase, leading to multiple organ failure, then abdominal compartment syndrome (ACS), and even death. There is currently no agreement on the surgical approach for these giant incisional abdominal wall hernias. To prevent recurrences, some articles recommend placing the hernia mesh in the sublayer position and or linings (KirkpatrickAW.)[7]. According to CornetteB.[8], to prevent recurrence, it is recommended to place the hernia mesh in a sublayer or underlay position, and to achieve better mesh expansion, a component separation technique (CST) may be a suitable solution, but with a significant risk of complications and recurrence. JensenKK, et al. believe that truly successful giant hernia repair requires effective bridging or augmentation that will prevent recurrence with an acceptable risk of complications[9]. Another pressing issue in abdominal surgery is that patients with incisional hernias are extremely difficult to treat due to a number of factors including obesity, previous hernia repair, previous mesh placement, domain loss, and other variables.
The approach to patients with incisional hernias has changed significantly over the past 20 years due to both advances in mesh technology and surgical approaches. Key factors for successful outcome include modification of risk factors preoperatively, such as smoking cessation and weight loss, selection of mesh appropriate for the type of hernia and planned mesh location, and wide mesh coverage beyond the hernia defect. New techniques such as transabdominal muscle release and component separation with retrograde mesh placement and robotic approaches to abdominal wall hernia are increasingly being used in these patients[10]. Recent years have seen an increase in the number of biological meshes available for abdominal wall hernia repair. Biological meshes typically consist of materials obtained from humans, pigs, or cattle. The rationale for using biological meshes is that they can act as a scaffold for the growth of natural tissues. In addition, there are absorbable synthetic meshes that have properties similar to those of biological meshes, but with theoretically less risk because they are not derived from animal or human material. The choice of mesh for a ventral hernia depends on many factors, which include both the properties of the mesh and its location, for example, whether it should be placed intraperitoneally, preperitoneally, or retrorectus. BaierKF[11](2021) believes that the guiding principle should be to avoid placing uncoated polypropylene mesh in an intraperitoneal location where it may be in direct contact with internal organs. In addition, the type of hernia defect is another risk factor, such as whether the wound is clean or dirty, and whether the repair is performed with a bridge or abutment. Lightweight or biologic meshes to bridge the defect should be avoided due to increased recurrence rates. Holihan JL [12] (2016), Hodgkinson JD [13] (2018) believe that the principle of anatomical restoration to achieve a reliable, tension-free repair with reinforced mesh reduces the incidence of early postoperative complications and late recurrence of hernia compared with bridging mesh. The analysis of the literature concerning the theoretical aspects and clinical experience of using technologies for improving modern synthetic and biological prostheses that can provide a better plastic effect, as well as methods for preventing recurrence of ventral hernias, indicates that this is one of the priority areas in modern abdominal surgery. An unresolved issue remains the choice of the optimal endoprosthesis, which is highly effective and meets international standards for such properties as biological inertness and mechanical strength, as well as the method of positioning the mesh in relation to the layers of the abdominal wall. Considering that many of the allohernioplasty methods used today are not without drawbacks, the current direction is the development of new methods of repair for giant ventral hernias and methods for the prevention of postoperative complications in conditions of a contaminated wound, with justification of their effectiveness in a clinical experimental study. The connection between the dissertation research and the research plans of the research institution where the dissertation was completed. The dissertation research was carried out within the framework of the research work plan of the State Institution “RSNPMCH named after. acad. V. Vakhidov" under the project AL-422105574 "Development of new biocompatible mesh implants made of composite materials for reconstructive surgery of abdominal and diaphragmatic hernias" (2022-2024).
The purpose of the study is to improve the results of surgical treatment of large and giant postoperative ventral hernias by introducing new laser technologies and improving the tactical and technical aspects of surgical treatment. Objectives of the study: to study the structure of immediate complications after various types of prosthetic plastic surgery; to clarify the influence of obesity factors, primary or repeat hernioplasty on the incidence of immediate and long-term complications; to evaluate the role of the immediate complicated course of the postoperative period in the incidence of long-term complications of hernioplasty; to improve the technical aspects of alloplasty for large and giant postoperative ventral hernias (POVH); to improve the technique of photodynamic therapy (PDT) of the wound surface after prosthetic plastic surgery; to study in an experiment the effectiveness of using the proposed technique of alloplasty and PDT; evaluate the morphological features of the condition of tissues during prosthetic plastic surgery using the proposed method; in a comparative aspect, evaluate the clinical effectiveness of the proposed alloplasty options in the immediate and long-term periods. The object of the study was the results of allohernioplasty in 448 patients with extensive (large) and giant POVH, who were operated on at the surgical department of the 1st clinic of the Samarkand State Medical Institute in the period from 2012 to 2021, as well as experimental animals on which the effectiveness was assessed developed a technique for prosthetic repair of postoperative ventral hernias and applied the technique of photodynamic therapy.
The subject of the study is to analyze the effectiveness of the developed alloplasty of postoperative ventral hernias and intraoperative photodynamic therapy in abdominal surgery in experiments and in the clinic. Research methods. To achieve the goal of the study and solve the assigned problems, general clinical, instrumental, biotechnological, experimental, histomorphological, microbiological and statistical research methods were used. The scientific novelty of the study is as follows: it was established that the need for extensive tissue mobilization and, as a consequence, the intersection of lymphatic capillaries during implantation of the prosthesis in the onlay position, as well as the lack of sufficient resorption function of the hernial sac in the inlay position causes a high risk of the formation of clinically significant seromas; It was determined that with prosthetic hernioplasty, along with the volume of the defect, the type of plastic surgery and the degree of obesity, the most significant predictor of the risk of developing immediate complications is the factor of re-intervention in case of recurrent hernia with the presence of a “dormant infection” hidden in the remaining ligature granulomas or scar tissue; the structure and clinical features of the course of long-term complications of hernioplasty for giant and extensive hernias were clarified, taking into account the results of the immediate postoperative period, as well as the option of fixing the prosthesis, primary or repeated hernioplasty and the degree of obesity; the method of surgery for large hernias of the anterior abdominal wall has been improved, characterized by a combination of factors such as the formation of tension-free prosthetic repair, preservation of local resorptive function to prevent the development of fluid accumulations and reducing the risk of infection; the method of preventing the development or progression of wound infection during alloplasty of ventral hernias has been improved, aimed at enhancing the antibacterial effect and stimulating reparative activity through the photosensitizing and photodynamic effect of low-energy laser radiation; It was determined in an experimental model of prosthetic plastic surgery that the proposed method of fixing the prosthesis in combination with the use of the effect of photodynamic therapy through laser radiation helps to enhance reparative processes with a reduced risk of wound complications; It has been proven that all methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic plastic surgery enhance preventive measures against the development of local infection, but are ineffective in the case of an already developed purulent-inflammatory process against the background of the use of alloplastic material. The practical results of the study are as follows: it has been determined that the implantation of synthetic materials for giant and extensive hernias is accompanied by a significant number of wound complications caused by both the surgical technique itself and the reaction of surrounding tissues to a foreign body, requiring improvement of tactical and technical approaches when performing hernioplasty; it was clarified that scar-degenerative changes in the tissues of the aponeurosis in giant and extensive hernias are a predisposing factor to the occurrence of post-prosthetic hernias, especially when implanting the prosthesis in the “inlay” position and, accordingly, require increasing the efficiency of their fixation and engraftment, as well as reducing the risk of developing local complications; it was determined based on the data of an experimental study that the proposed method of alloplasty for large ventral hernias makes it possible to achieve adequate reconstruction of the anterior abdominal wall, reduce the incidence of infection in the wound, and also use a smaller size of prosthetic material; it was determined that the proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant allows maintaining physiology, reducing the number of complications, shortening treatment time and reducing the risk of hernia recurrence; It has been determined that the proposed method for preventing the development or progression of wound infection during alloplasty of ventral hernias can reduce the frequency of suppuration, shorten the treatment time and the likelihood of relapse; It has been proven that the use of the proposed tactical and technical aspects of prosthetic repair for postoperative ventral hernias can reduce the incidence of specific complications, reduce rehabilitation time and the risk of hernia recurrence. Reliability of the research results. The reliability of the results is justified by the use of objective criteria for assessing the condition of patients, modern methods of diagnosis and treatment, the correct application of methodological approaches and sets of statistical analysis, methods for solving the problems discussed in the dissertation are based on modern scientific and practical concepts and approaches to the diagnosis and surgical treatment of patients with giant postoperative hernias. Scientific and practical significance of the research results. The results obtained make a significant contribution to the expansion of irradiation of existing ideas about the structure and clinical features of complications of hernioplasty for giant and extensive ventral hernias by identifying the morphological features of the development of a purulent-inflammatory process against the background of the use of alloplastic material, studying predictors of the risk of developing immediate complications, mechanisms for enhancing reparative processes through the use of an improved method of fixing the prosthesis in together using the effect of photodynamic therapy through laser radiation, which made it possible to enhance the antibacterial effect and improve the wound healing process. The practical significance of the study is that, based on the results obtained, the tactical and technical aspects of prosthetic hernioplasty have been optimized, the features of methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic repair have been revealed, enhancing preventive measures for the development of local infection, and the method of surgery for large anterior abdominal hernias has been improved walls, characterized by a combination of factors such as the formation of tension-free prosthetic plasty, preservation of local resorptive function to prevent the development of fluid accumulations, thereby reducing the risk of developing postoperative complications, reducing the frequency of unsatisfactory results, length of hospitalization and the likelihood of relapse. Implementation of research results. According to the results of a scientific study to optimize the tactical and technical aspects of surgical treatment of large and giant postoperative ventral hernias: the “method for plastic surgery of giant hernias of the anterior abdominal wall” has been improved (invention patent No. IAP 2022 0148 dated April 18, 2022). The proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant made it possible to reduce the number of complications, shorten the treatment time and reduce the risk of hernia recurrence; the “method for preventing the progression of infection during alloplasty of infected hernias” has been improved (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). The proposed method made it possible to reduce the frequency of wound purulent-inflammatory complications and shorten the period of rehabilitation of patients after allohernioplasty; methodological recommendations “Tactical and technical aspects of prosthetic repair for large and giant postoperative ventral hernias” have been developed (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022) . The developed recommendations made it possible to optimize the tactical and technical aspects of allohernioplasty in patients with large and giant postoperative ventral hernias; The scientific results obtained were introduced into the practical activities of healthcare, in particular, in the departments of surgery of the Khorezm and Andijan regional multidisciplinary medical centers, the clinic of the Samarkand State Medical University (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). Improving the tactical and technical aspects of prosthetic repair for postoperative ventral hernias has made it possible to reduce the incidence of specific immediate complications from 40.9% to 15.6%, to reduce rehabilitation time from 8.6±2.7 to 7.1±1.5 days, and also reduce the likelihood of long-term complications from 11.7% to 3.1%. Approbation of research results. The results of this study were discussed at 8 scientific and practical conferences, including 5 international and 3 republican ones. Publication of research results. 26 scientific works have been published on the topic of the dissertation, including 9 journal articles, 4 of which in republican and 5 in foreign journals recommended by the Higher Attestation Commission of the Republic of Uzbekistan for publication of the main scientific results of doctoral dissertations. Structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of work is 200 pages.
The aim of the research work is determination of the prospects for the use of a domestic agent for the prevention of adhesion formation in thoraco-abdominal surgery on the basis of experimental and morphological studies.
Research objectives were white outbred rats in the amount of 62 individuals, in two experimental studies on the abdominal and pleural cavities, in each series of experiments the studies were carried out in 2 comparative groups, control and main. Experiments on the formation of adhesions in the abdominal and pleural cavities were carried out on the basis of the Republican Specialized Scientific and Practical Medical Center of Surgery named after acad. V.Vakhidov in the Department of Experimental Surgery for the period from 2019 to 2020.
The scientific novelty of the research consists of the followings: it is proved according to the data of experimental research that when modeling the adhesion process in the abdominal cavity, the local application of an anti-adhesion coating made of cellulose derivatives reduces the processes of adhesiogenesis and the development of changes in architectonics, bends and narrowings of the intestinal lumen; it was found in an experimental study that when modeling the adhesion process in the chest cavity, the local use of an anti-adhesion implant provides a significant decrease in the risk of adhesiogenesis in the form of the formation of coarse adhesions or planar adhesions; it was determined that when blood serum was applied over a powder implant, the quality of adhesion and the uniformity of its distribution on the surface of the experimental defect of the peritoneum or lung did not change, but, in contrast to activation by blood (to ensure a hemostatic effect), it was not accompanied by the development of cellular inflammation due to the resorption of thrombotic masses; it was found that the formation of a gel film over the area of damage to the peritoneum in the absence of cellular elements of blood makes it possible to achieve biodegradation of the coating without a pronounced cellular-inflammatory reaction, providing cicatricial replacement of defects with a significant reduction in the risk of developing a massive adhesive process; the morphostructural features of the formation of the adhesive process when using an anti-adhesive coating, characterized by regression in the dynamics of the number of connective tissue cells of the inflammatory infiltrate with scarring of the defect zone without the development of adhesive conglomerates with the surrounding tissues, have been determined.
Introduction of the research results. According to the results of a scientific study on a comparative analysis of the use of a domestic agent for the prevention of adhesion formation in thoraco-abdominal surgery: methodological recommendations were developed: "New technologies for the prevention of adhesions in thoraco-abdominal surgery" (certificate of the Ministry of Health No. 08-09/10055 of August 12, 2021). The proposed recommendations for performing surgical interventions on the organs of the abdominal and thoracic cavities will allow for sparing local hemostasis, as well as prevent the formation of a coarse adhesive process in the abdominal cavity.
The obtained scientific results on a comparative analysis of the use of the domestic remedy for the prevention of adhesion formation in thoraco-abdominal surgery have been introduced into the practical activities of health care, including in the Republican Specialized Scientific and Practical Medical Center for Surgery named after V.I. Academician V. Vakhidov, surgical departments of the clinics of the Andijan and Samarkand State Medical Institutes (certificate of the Ministry of Health No. 08-09/10055 of August 12, 2021). Based on the proposed results of experimental studies, it was shown that the use of an anti-adhesive coating made of cellulose derivatives made it possible to reduce the risk of adhesion formation from 60% to 20%, bowel deformation without manifestations of obstruction from 33.3% to 13.3% and the possibility of acute adhesive intestinal obstruction from 6.7% to 0%.
Structure and scope of the dissertation. The dissertation consists of an introduction, four chapters, conclusions, practical recommendations and a list of cited literature. The volume of work is 113 pages.
Миопия является одним из самых распространенных глазных заболеваний в мире и наиболее частой причиной снижения остроты зрения, встречаясь в 12-30% случаев среди офтальмопатологии. Высокий интерес к данной проблеме в последние годы связан с увеличением распространения близорукости среди населения всего мира, а именно, ее высоких степеней от -6,0 дптр и выше.
За последние десятилетия отмечен рост близорукой рефракции, особенно среди учащихся и работающих с компьютером.
Частота высокой близорукости, одной из наиболее тяжёлой рефракционной патологии, по данным разных авторов, колеблется от 6-18 до 27-33,2% [1, 41, 45, 89, 97]. В последние годы привлекает все большее внимание исследователей коррекция ослабленного зрения при близорукости высокой степени, в частности врожденной. Врожденная близорукость в 55-60 % случаев бывает высокой и является одной из главных причин инвалидности по зрению [52]. За последние десятилетия число лиц с близорукостью возросло, всего в мире очки носят около 1 млрд, человек. Близорукость чаще обнаруживается у детей 7-12 лет, усиливается в подростковом возрасте, а в 18-40 лет стабилизируется. Это очень важный аспект, т.к. прогрессирование близорукости в среднем возрасте чаще всего связано с увеличением преломляющей силы оптического аппарата глаза. В последнее десятилетие число людей с миопией в странах Европы увеличилась и составляет 30% -40% всего населения.В странах Юго-Восточной Азии достигает 70% и более. Миопия высокой степени развивается у 2% населения и является одной из необратимых причин слепоты у лиц молодого и среднего возраста. В Европе 8,8% стойкой слепоты связаны с миопией высокой степени, в США она занимает второе место среди причин инвалидности.
Низкая острота зрения у близоруких нарушает их трудоспособность, ограничивает возможность выбора профессии и полноценную жизненную активность. Коррекция миопии высокой степени с целью сохранения полноценной остроты зрения актуальна, как в социальном, так и в научном плане. Лица с близорукой рефракцией нуждаются в очковой коррекции. Наблюдения показали, что, если определенный контингент постоянное ношение очков воспринимает как огромное благо, то значительная часть близоруких лиц, особенно молодые женщины нашего региона, категорически отказываются от ношения очков, обрекая себя на зрительный дискомфорт.
Коррекция ослабленного зрения при миопии - актуальнейшая проблема офтальмологии. Она обусловлена как распространенностью миопии преимущественно у молодых лиц, то есть социальноактивного контингента, так и тенденцией к повышению степени ее в связи с возрастающей зрительной и психологической нагрузкой.
Существующие традиционные методы коррекции зрения при высокой миопии не всегда устраивают пациентов в современных сложных социально-экономических условиях.
Традиционным способом коррекции аметропий является очковая. Более 80% людей с нарушением рефракции предпочитают этот вид коррекции из-за ее доступности, отсутствием серьезных осложнений при ее использовании. Однако, очковая коррекция не всегда применима. Очки трудно переносятся при анизометропии и при высоких степенях аметропий. Есть ограничения по профессиональным состояниям больных. Нередко, даже при хорошей переносимости, они не устраивают больных по косметическим соображениям. Очковые линзы до сих пор остаются самым доступным и распространённым средством коррекции миопии. Самым серьёзным и неустранимым недостатком очковых линз является их влияние на размеры ретинального изображения объекта.Второе обстоятельство, часто заставляющее пациентов обращаться к другим видам коррекции, связано с косметическими недостатками очков. Проблема очков доводит до трагедии молодежь, особенно девушек в Узбекистане, где большинство предвзято относятся к «очкарикам». Кроме того, недостатками очковой коррекции являются: сужение полей зрения, зрительный дискомфорт, вызываемый климатическими условиями, частая смена очков (1 раз в 1 -2 года).
В случаях невозможности или непереносимости очковой коррекции альтернативой является использование контактных линз. От 15% до 18% больных с нарушением рефракции используют этот вид коррекции [35, 36]. Контактные линзы свободны от присущих очковым линзам косметических дефектов и, составляя единую оптическую систему с глазом, практически не влияют на величинуретинального изображения. Тем не менее, ряд обстоятельств (как объективного, так и субъективного характера) часто заставляет пациентов отказываться от ношения контактных линз, в частности:
- так называемые манипуляционные сложности;
- необходимость ухода за контактными линзами;
- потенциальная возможность осложнений, связанных с ношением контактных линз.
Контактные линзы - хотя и являются физиологической коррекцией, но не всегда достигается удовлетворительная адаптация к ним в индивидуальных случаях высокой миопии. Негативное влияние на переносимость и возможные осложнения (кератиты, эрозия роговицы, конъюнктивиты) оказывают особенности климатических условий в регионе Средней Азии, отличающиеся повышенной запыленностью и низкой атмосферной влажностью воздуха, из-за чего контактная коррекция не может быть широко рекомендована.
От 1 до 5 % людей с нарушением рефракции не желают или не могут использовать очки и контактные линзы и решаются на хирургические виды коррекции.
Таким образом, комплексный подход к проблеме оптической коррекции миопии высокой степени в настоящее время осуществляется по следующей схеме: очковая коррекция —► коррекция контактными линзами —» хирургическая коррекция. Каждое последующее звено в этой схеме является более сложным и применяется при безуспешности или невозможности использования более простого способа коррекции. Своевременная коррекция высокой миопии необходима для полноценного развития и функционирования зрительного анализатора, что обуславливает целесообразность проведения рефракционных операций у больных с непереносимостью очковой и контактной коррекции.
В настоящее время сложились два подхода к проблеме лечения близорукости высокой миопии - это применение хирургических методик, направленных исключительно на быстрое достижение рефракционного эффекта и более серьёзное отношение к миопии как к болезни, при которой в той или степени поражаются все структуры глазного яблока [24, 73, 106, 107].
Изменить рефракцию оптических сред глаза можно тремя путями.
Первый путь - экстраокулярный, когда дополнительная оптическая система размещается перед глазным яблоком (очки) или непосредственно на нем (контактные линзы). Этот ставший традиционным путь не предусматривает изменения структуры преломляющих сред самого глаза и может рассматриваться как неинвазивный.
Второй путь - это изменение преломляющей способности роговой оболочки дозированным хирургическим воздействием с роговой оболочки дозированным хирургическим воздействием с помощью ножа или лазерного излучения.
Третий путь - интраокулярный, который предусматривает изменение рефракции глаза с помощью операций со вскрытием глазного яблока.
Обилие разработанных к настоящему времени методов воздействия на оптику глаза и конкретных оперативных вмешательств неизбежно ставит как перед пациентом, так и перед врачом проблему выбора наиболее адекватного для каждого конкретного случая метода операции.
В настоящий момент приходится констатировать, что идеального и абсолютно безопасного метода хирургической коррекции аметропий не существует, и каждый потенциальный пациент должен быть информирован об этом. Индивидуальный выбор оптимального метода зависит от существующих в стране или регионе возможностей, как в отношении технического оснащения, так и опытности хирургов в проведении данного вида операций, степени и вида аметропии, а также возраста пациента, общего состояния его здоровья и, наконец, его финансовых возможностей.
В настоящее время арсенал хирургической коррекции аномалий рефракции огромен. Как хирургам, так и пациентам предоставлена уникальная возможность, выбирать методы и способы коррекции рефракционных дефектов [2, 3, 8, 50, 64]. Рефракционные операции - понятие собирательное и включает в себя вмешательства, которые могут изменить оптические свойства и параметры различных частей оптической системы глаз (длины оси, силу роговичной и хрусталиковой линз.)
Выбор метода хирургического лечения - актуальная и жизненно важная проблема. От того, насколько точным будет выбор, зависит исход операции, а значит, и социальная, и профессиональная реабилитация пациента.
The aim of the research consists in development of offers and recommendations about further improvement of criminal-legal and criminological measures of fight against crimes in the sphere of information technologies and safety.
The object of the research work is the system of the public relations regulating criminal-legal, criminological and organizational measures for counteraction to crimes in the sphere of information technologies and safety.
The scientific novelty of the research consists of the following:
the expediency of establishment of administrative responsibility for violation of personal privacy at compliance with the law about protection of private life, ensuring protection of the rights of citizens and also completion of legal gaps is proved;
need of establishment of responsibility for infringement of personal privacy in article 1411 Criminal Code of the Republic of Uzbekistan when ensuring criminal legal protection of personal privacy and inevitability of responsibility is proved;
for ensuring the principles of justice and humanity in the criminal legislation the expediency of awarding punishment in the form of restriction of freedom on the persons who have committed crimes in the sphere of information technologies is proved;
high degree of public danger of some crimes (illegal activities for attraction of money and (or) other property (article 1881 of CK), production, storage, distribution or demonstration of the materials containing threat of public safety and to public order (article 2441 of CK)) committed with use of networks of telecommunications and the Internet is explained;
establishment of responsibility for bringing to suicide and inducement to suicide with use of networks of telecommunications and the Internet is proved;
need of introduction of responsibility of the blogger for placement of public negative information of a certain look for the Internet is proved;
inadmissibility of use of personal data of the participants at implementation of electronic commerce for who aren't provided by the contract, need of nondisclosure of the specified data are proved;
establishment of the ban on distribution among children of the information justifying illegal behavior and promoting commission of offense, calling for promotion of the destructive ideas in society and also responsibility for the specified acts is offered;
expediency of application of a method of «confidential dialogue» concerning the persons who have committed information crimes, need of implementation of inquiry, the investigation and preventive measures proceeding from their psychological state are specified;
need of recognition of the actions exerting negative impact to life, health and morality of the personality, made with use of means of information technologies as socially dangerous act is offered.
Implementation of research results. The results of the study are used:
the proposal on establishment of administrative responsibility for violation of personal privacy has found the reflection in article 461 of the Code of the Republic of Uzbekistan about the administrative liability entered by the Law of the Republic of Uzbekistan of September 23, 2016 No. ZRU-411 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from September 28, 2016, No. 06/1-05/1148-vkh). This change provides compliance with the law about personal privacy, protection of the rights of citizens and also completion of a legal gap in the legislation;
the proposal on establishment of criminal liability for violation of personal privacy has found the reflection in article 1411 of the Criminal code of the Republic of Uzbekistan entered by the Law of the Republic of Uzbekistan of September 23, 2016 No. ZRU-411 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from September 28, 2016, No. 06/1-05/1148-vkh). Establishment of criminal liability for commission of the act breaking personal privacy provides criminal legal protection of private life of the person and inevitability of responsibility;
offers on expediency of awarding punishments in the form of restriction of freedom concerning the persons who have committed crimes in the sphere of information technologies, have found the reflection in articles 2781-2786 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan from August 10, 2015 No. ZRU-389 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). This offer serves purpose of alternative punishment for crimes in the sphere of information technologies;
high degree of public danger of commission of some types of crimes with use of networks of telecommunications and the Internet has found reflection in article 1881, the «g» point of third part of article 2441 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan of April 25, 2016 No. ZRU-405 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). According to this offer criminal liability for use of information technologies in criminal intents has been established;
responsibility for bringing to suicide, the inducement to suicide made with use of networks of telecommunications and the Internet have been established in article 103 and 1031 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan of June 13, 2017 No. ZRU-436 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). This offer has served establishment of criminal liability for the information attacks encroaching on human life;
regulations on responsibility of the blogger for dissemination of public negative information of some look on the Internet are introduced in articles 3 and 121 of the Law of the Republic of Uzbekistan from December 11, 2003 No. 560-II «About informatization» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer serves prevention of various crimes committed with use of the Internet;
offers on inadmissibility of use of personal data of the participants at implementation of electronic commerce for who aren't provided by the contract need of nondisclosure of the specified data have found the reflection in article 18 of the Law of the Republic of Uzbekistan of May 22, 2018 No. ZRU-385 «About electronic commerce» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer became a basis for the ban illegal use of personal data from participants of electronic commerce;
offers on establishment of the ban on distribution among children of the information justifying illegal behavior and promoting commission of offense, calling for promotion of the destructive ideas in society and also responsibility for the specified acts are introduced in article 16 of the Law of the Republic of Uzbekistan of September 8, 2017 No. ZRU-444 «About protection of children from information doing harm to their health» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer has served recognition of dissemination of information among children of information doing harm to their health as illegal behavior;
offers on improvement of criminal liability for crimes in the sphere of information technologies and safety have been used by preparation of analytical notes within the Concept of improvement of the criminal and criminal procedure legislation approved by the resolution of the President of the Republic of Uzbekistan of May 14, 2018 No. PP-3723 (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer serves a proving of inevitability of responsibility for crimes in the sphere of information technologies and information security;
offers on expediency of application of a method of «confidential dialogue» concerning the persons who have committed information crimes, need of implementation of inquiry, the investigation and preventive measures proceeding from their psychological state have been introduced in activity of the relevant structural divisions of the Ministry of Internal Affairs of the Republic of Uzbekistan (the act of the Ministry of Internal Affairs of the Republic of Uzbekistan from July 2, 2018 No. 33/1985). This offer has served increase in efficiency of prevention of crimes in the sphere of information technologies and information security;
offers on need of definition of external influence, level of competence and practical skills of employees, motives of offense when studying the reasons of crimes in the sphere of information technologies and information security and also conducting monitoring of social networks have been introduced in activity of the relevant structural divisions of the Ministry of Internal Affairs of the Republic of Uzbekistan (the act of the Ministry of Internal Affairs of the Republic of Uzbekistan from July 2, 2018 No. 33/1985). This offer has served definition of the reasons and early warning of crimes in the sphere of information technologies and information security;
offers that the information security is object of criminal legal protection taking into account its direct connection with the state interests have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has served protection of information security as object of criminal legal protection;
offers on need of implementation of complex measures from law enforcement agencies for ensuring information security at information security have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has provided orientation of activity of law enforcement agencies on information security;
offer that threats of information security exert essential harm to the interests of the personality, society and state information have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03- 07-02/124). This offer has allowed to estimate high degree of public danger of information threats as a factor of commission of information crimes;
the rule about protection of the personality against illegal information influence taking into account that impact on consciousness of the personality with use of means of information technologies exerts negative impact on life, health and morality of the personality, has found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has served recognition of the specified actions as socially dangerous act.
Structure and volume of the dissertation. The thesis consists of an introduction, four chapters, a conclusion, a list of used literature and applications. The volume of the thesis is 260 pages.
В современной абдоминальной хирургии одним из актуальных направлений для исследований продолжает оставаться совершенствование различных вариантов пластики послеоперационных грыж. В мире ежегодно выполняется более 2100000 операций по поводу вентральной грыжи и 42% из них -послеоперационные грыжи. В последние годы наблюдается явная тенденция к расширенному применению при гсрниопластикс различных вариантов биологических сеток. «Объединенный анализ семи исследований PCSTAR для послеоперационных грыж с использованием ретромускулярной сетки показал, что частота рецидивов грыжи составляет 5,7%». Применение стандартных оперативных вмешательств по типу аллопластики в положении onlay не решает проблему ранних послеоперационных осложнений: отхождение сером, миграция сетки, спаечпая болезнь, высокая частота рецидива грыж и др. В то же время пластика грыж местными тканями создает проблему повышения вну-трибрюшного давления, и поздним осложнениям в виде рецидивов грыж. «Рост послеоперационного внутрибрюшного давления приводит к полиорган-ной недостаточности, затем абдоминальному компартмент синдрому, и даже смерти». В настоящее время не существует консенсуса о хирургическом подходе при гигантских послеоперационных грыжах брюшной стенки, в связи с чем необходимость продолжения разработки новых технологий и совершенствования тактики не вызывает никаких сомнений.
В мировой практике в настоящее время наиболее актуальными продолжают оставаться исследования, направленные на изучение морфологических и функциональных аспектов рецидивных послеоперационных вентральных грыж, электронная микроскопия выявляет ультраструктурные деструктивные изменения клеток кожи, апоневроза и мышц, что свидетельствует о морфофункциональной недостаточности тканей брюшной стенки,обсуждаются вопросы клеточной инженерии новых инновационных материалов, проводятся шментальные исследования на животных с испытанием биотехнических свойств, текстуры и эластичности новых полимеров, проводятся исследования открытых доступов с разделением заднего компонента с выпуском поперечной мышцы живота и ретроградной сеткой, начаты роботизированные операции.
Современные аспекты развития отечественного здравоохранения включают множество мер, направленных на улучшение результатов лечения больных с послсопсрациоными вентральными грыжами и связанными с ними патологическими состояниями за счет внедрения современных принципов интенсивной терапии и хирургической тактики. В стратегию развития Нового Узбекистана на 2022-2026 годы по семи приоритетным направлениям включены задачи по повышению качества оказания населению квалифицированных медицинских услуг. Реализация данных задач, в том числе, путем оптимизации тактико-технических подходов к выбору метода герниопластики, а также разработка методов профилактики гнойно-воспалительных осложнений в области аллопластического матераиала, является одним из актуальных направлений абдоминальной хирургии и медицины в целом, ввиду высокой медико-социальной значимости данной патологии.
В результате исследований, проведённых в мире, по повышению эффективности аллопластики при послеоперационных вентральных грыжах и снижению риска осложнений в послеоперационном периоде получен ряд научных результатов, в том числе: определено, что пациенты, перенесшие реконструкцию брюшной стенки, имеют повышенный риск послеоперационной дыхательной недостаточности, понимание эпидемиологии этого осложнения может улучшить профилактику; доказано, что чем крупнее грыжа, тем выше риск ранних хирургических осложнений, в том числе таких как дыхательная декомпенсация, поскольку грыжи со временем часто увеличиваются в размерах, откладывание операции может привести к увеличению размеров грыжи и, следовательно, к большему риску осложнений; показано, что отношение объема грыжи к объему брюшной полости <20% является независимым фактором при закрытии без натяжения, что обосновывает интерес к предоперационной во-люметрии для адаптации тактики хирургической помощи; определено, что у пациентов, перенесших плановую лапароскопическую гсрниопластику, предикторами смертности являются более старший возраст и некоторые сопутствующие заболевания: застойная сердечная недостаточность, нарушения легочного кровообращения, коагулопатия, заболевания печени, метастатический рак, неврологические расстройства и паралич; установлено, что пожилой возраст, асцит, предоперационная почечная и легочная недостаточности являются независимыми предикторами 30-дневной смертности, при наличии этих факторов риска следует серьезно рассмотреть консервативное лечение; доказано, что универсальный калькулятор хирургического риска Американского колледжа хирургов (ACS) точно предсказывает тридцатидневные исходы, включающие серьезные осложнения: венозную тромбоэмболию, соматическую заболеваемость, инфекцию области хирургического вмешательства, незапланированную повторную операцию, смертность и продолжительность пребывания в стационаре.
В настоящий период в мире наиболее актуальными исследованиями в хирургии продолжают оставаться разработка новых методов герниопластики при больших и гигантских вентральных грыжах, каждый из которых имеет свои плюсы и минусы в зависимости от сложности выполнения, риска развития послеоперационных осложнений и рецидива, проводятся крупные рандомизированные клинические исследования, сравнивающие существующие методы традиционной герниопластики с лапароскопическим доступом и роботизированной хирургией, все более распространяющейся в последние 10 лет, проводится поиск новых синтетических и биологических материалов, разрабатываемых для производства и использования композитных сеток, обладающих необходимой прочностью и способностью предотвращать фатальные местные осложнения в условиях контаминированной среды. Однако, несмотря на технические достижения в этой области, ни один современный метод герниопластики и протезы не отвечают всем требованиям. Одна из ключевых проблем заключается в том, что существующие синтетические эндопротезы не имеют достаточной эластичности, устойчивости к инфицированию, высокой механической прочности и целостности в течение длительного времени. Дальнейшие исследования этих клинических аспектов несомненно улучшат современное представление о возможностях биосовместимых эндопротезов и позволят разработать оптимальный метод их расположения при аллогсрниопластикс.
Подход к пациентам с послеоперационными грыжами значительно изменился за последние 20 лет благодаря как достижениям в технологии создания сетки, так и хирургическим подходам. Ключевые факторы успешного исхода включают изменение факторов риска до операции, таких как отказ от курения и снижение веса, выбор сетки, соответствующей типу грыжи и запланированному расположению сетки, а также широкое перекрытие сетки за пределами грыжевого дефекта. У этих пациентов все чаще используются новые методы, такие как высвобождение трансабдоминальной мышцы и разделение компонентов с установкой ретроградной сетки и роботизированные подходы к грыже брюшной стенки. В последние годы наблюдается увеличение количества биологических сеток, доступных для герниопластики брюшной стенки. Биологические сетки обычно состоят из материалов, полученных от человека, свиньи или крупного рогатого скота. Обоснование использования биологических сеток заключается в том, что они могут действовать как каркас для прорастания естественных тканей. Кроме того, существуют рассасывающиеся синтетические сетки, которые обладают свойствами, аналогичными свойствам биологических сеток, но с теоретически меньшим риском, поскольку они не получены из животного или человеческого материала. Выбор сетки для вентральной грыжи зависит от множества факторов, которые включают в себя как свойства сетки, так и се расположение, например, внутрибрюшинно, предбрю-шинно или ретроректусно ее размещать. Кроме того, тип грыжевого дефекта является еще одним фактором риска, например, является ли рана чистой или грязной, и выполняется ли пластика мостовидным протезом или с опорой. Следует избегать легких или биологических сеток для перекрытия дефекта из-за повышенного количества рецидивов. Проведенный анализ литературы, касающейся теоретических аспектов и клинического опыта применения технологий совершенствования современных синтетических и биологических протезов, способных обеспечить более лучший пластический эффект, а также методов профилактики рецидивов вентральных грыж свидетельствует о том, что это является одним из приоритетных направлений в современной абдоминальной хирургии. Нерешенным вопросом остается выбор оптимального эндопротеза, обладающего высокой эффективностью и соответствующего международным стандартам, предъявляемым к таким свойствам как биологическая инертность и механическая прочность, а также метода расположения сетки по отношению к слоям брюшной стенки. Учитывая, что многие применяемые на сегодняшний день методы аллогерниопластики не лишены недостатков, актуальным направлением является разработка новых методов пластики при гигантских вентральных грыжах и способов профилактики послсопсрацитонных осложнений в условиях контаминированной раны, с обоснованием их эффективности в клинико-экспериментальном исследовании.
The article considers religious tolerance as the basis for ensuring internal stability and integration of the society, keeping them from upheavals, suppressing the split of nations and states. According to Article 31 of the Constitution of the Republic of Uzbekistan, “Freedom of conscience is guaranteed for all. Everyone has the right to profess any religion or not to profess anyone. Forced imposition of religious beliefs is unacceptable”. As noted in Article 61 of the Constitution, “religious organizations and associations are separated from the state and are equal before the law. The state does not interfere in the activities of religious associations”. The article considers that religion embraces various interaction processes: communication, socialization, transference of religious experience, development of ties between individual believers, between believers and the religious community, the clergy, between religious organizations of different religions. The article discusses freedom of conscience – the guaranteed constitutional right of citizens to profess any religion or not to profess anyone. As noted in Article 3 of the Law of the Republic of Uzbekistan “On Freedom of Conscience and Religious Organizations”, any compulsion is not allowed when a citizen determines his attitude to religion, to profess or not to profess religion, to participate or not to participate in religious services, religious rites and ceremonies, in receiving religious education. The involvement of minors in religious organizations, as well as the training of their religion against their will, the will of their parents or persons replacing them, is not allowed. The exercise of freedom to practice religion or other convictions is subject only to those restrictions that are necessary to ensure national security and public order, life, health, morality, rights and freedoms of other citizens. Foreign citizens and stateless persons enjoy the right to freedom of conscience and freedom of religion on an equal basis with citizens of the Republic of Uzbekistan and bear the responsibility established by law for violation of legislation on freedom of conscience and religious organizations.
In the manuscript fund of the Institute of Oriental Studies named after Abu Rayhan Beruni of the Academy of Sciences of Uzbekistan the manuscript №2225 is stored. It presents a full comment for the composition of Jalaladdin Rumi “Masnaviyi Ma’naviy” and consists of six notebooks. This comment is named as “Sharhi Masnaviyi Mavlaviy”, author – Ayyub. Interpretations of some words from composition are given in “Comments” which also contains stories about Rumi’s life and his edifications. Some of the stories are presented by commentator himself. There are the notes of what sources they are extracted before each story and information, which are submitted by Ayyub. When commenting “Masnaviy” expositor used following compositions: “Nayname”, “Yusuf and Zuleykha”, Abdurakhman Jami’s “Nafakhotu-l-uns”, Akhmad Afloki’s “Manokibu-l-orifin”, Shaykh Abdurakhim Bikhori’s “Kashfu-l-lugot va-l islokhot”. In a number of bytes of “Masnaviy” are given the words and expressions from text or ayat in Koran. Firstly, commentator gives full text or a fragment from particular ayah then provides comments. In composition “Masnaviy” Rumi adduces sayings from Hadith and from various stories which have taken place in life of prophets. Ayyub, in turn, completely overlooks given Hadith and stories and then only adds his comments. Expositor also uses the other texts of comments, which were written for “Masnaviy”, and for some related views he expounds his own persuasions, where he doesn’t indicate the exact names of the sources from which such information was brought, but only limits to the phrase “some commentators write”. There are cases of examples as well from other parts of “Masnaviy” in “Comments”. Before writing “Comments” Ayyub explored many books about Rumi’s life and work, worked with dictionaries, improved his knowledge in the sphere of religion and tasawwuf, collected data from earlier written comments. The sources which were used while writing “Comments of Masnaviyi Mavlavi” composition are the most valuable among many others about life and work of Rumi.
Masnavi in dakhini "Layli and Majnun" was written under the pseudonym Ajiz, and the differences between the six manuscripts of Masnavi Ajiz were analyzed. It is known that among the poets who responded to the epic "Layli and Majnun" in Urdu, or rather in the ancient Urdu-Dakhini, the Masnavi of Muhammad Sharif Ajiz occupies a special place among other versions of "Layli and Majnun". "in Dakhini. Among the Dakhini poets, several poets wrote under the pseudonym Ajiz. The goal was to determine the authorship of the Masnavi Leyli and Majnun by identifying information about several poets with the same pseudonym based on gazelles, muhammas and other inscriptions stored in the museum Salorjanga During a scientific trip to Hyderabad, we studied the life and work of poets under the pseudonym Ajiz, and the results of our attempts to find out who wrote the masnavi showed that Arifiddin Khan Ajiz was a famous poet who lived during the reign of Asafjah. The second poet was Muhammad Ali Ajiz or Sayyad Mahmud Ajiz, the author of Masnavi, Queen of Egypt. The author of another Masnavi, Gul o-sanobar, was a poet who wrote under the pseudonym Ajiz, and from his linguistic features it became clear that he was a poet who lived after Vali. Author of the prose work Iblisnoma "In the ancient dakhini - also a poet with the pseudonym Ajiz. It turned out that" Layli and Majnun "did not belong to this poet. Naval Singh is a poet who wrote in during the reign of Ajiz Asafjokh. Another poet, under the pseudonym Ajiz, has a 16-verse Muhammad, whose language refers to the author of the ghazal copied by the aforementioned bayaz. The Bayaz titled "Muhammas" contains the muhammas of several poets, including the Muhammad poet named Ajiz, whose language is close to the language of the time when the wali was created, and the overall author of the muhammas included in this were poets who lived soon after Wali.
The article is dedicated to analysis of the repetitions, expressed by noun in Uzbek translation of the work "Romeo and Juliet" by W. Shakespeare. In it is considered way of talking of the repetitions in Uzbek translation of original English text is spoken about skill of the translator in process, are researched particularities of their usage. Linguistics uses several means of expression to ensure the effectiveness of speech. One of them is repetition, which serves to effectively express the speaker's speech and causes the listener to emotionally arouse in connection with a certain event or incident, as well as to highlight certain statements in speech. It is used when the speaker is under the influence of strong emotions. Repetition, as one of the most common stylistic devices, is found in a wide variety of genres, colorful works and in a wide variety of texts. As a stylistic method, the properties of repetition are associated with the feelings and moods of the reader, reinforcing and reinforcing the thinking in his mind. Therefore, in our opinion, the main stylistic function of repetition is the function of absorbing strong emotions and subtleties in the reader or listener. There are also types of repetitive stylistic means such as verbal, phonetic, lexical, syntactic, semantic repetition. Hence, it also includes multiple uses of units at a specific linguistic level or at multiple levels to improve the tone and emotionality of the text. The power of this effect is manifested not only in the repetitive units of phonetic and lexical meaning, but also in the communicative and distant repetition of repetitive linguistic units in this context. Thus, the main function of communicative repetitions is to draw the attention of the reader or listener to the emotionality and expressiveness of the expression, as well as to create the tone of the text. Duplicate words that go side by side (at the end of the first sentence and at the beginning of the second sentence) always provide new or additional information in sync with the development of the textual content. They help create vertical rhyme and enhance the expressiveness of the poetic image.
An adverb is a lexico-grammatical class of unchangeable, as a rule, words denoting a sign of an action, quality or object and acting in the syntactic function of a circumstance or definition, less often of a predicate. The adverb in all languages of the world belongs to the late parts of speech, the formation process of which continues to the present day. At the same time, words belonging to this category still retain their functions in other parts of speech from which they were formed. Another distinctive feature of the adverb is the conceptual heterogeneity of the class of words in comparison with other parts of speech. Based on the above, we can say that there are many definitions of adverbs in Afghan and Iranian studies. Previously, the works of Arab scholars served as the basis for studying the grammar of Dari and the Persian languages; today, Afghan and Iranian philologists admit that there are significant differences between Arabic and their languages, and therefore, in studying the grammar of their language, they try to take into account the grammatical features exclusively Farsi. It should be noted that there is an activity of Iranian philologists in the field of writing scientific articles and books devoted to the interpretation of a particular grammatical issue, the attention of researchers to the structure of syntax has increased. We have analyzed a number of works on the grammar of the Dari and Persian languages, which touch on the question of parts of speech and minor members of a sentence. Below is a brief description of some works on the grammar of the modern Dari and Persian languages, in which the question of our research is most fully considered. In world linguistics, the Dari language is not widely studied, like the Persian language. In Iranian studies, in the scientific description of this language, it is mainly noted that it differs from the modern Persian language. In the Dari language, as well as in the Persian language, the authors consider the adverb from a morphological and syntactic point of view. In the course of our research, we analyzed the works related to the modern Dari language, as well as unique works that are being republished for the second time in Afghanistan
This article is devoted to the study of euphemisms related to the concept of "woman" in Chinese and Uzbek linguoculture. Sometimes people encounter situations when communicating with others where they cannot say what they want directly or use phrases in their own sense, putting their interlocutors at a disadvantage. Euphemisms applied to find out solution of such complicated situations. Euphemisms are words and expressions, which are replaces forbidden, improper to say, rude lexicon that contradict moral norms in its own polite way. Euphemisms reflects the psychology, worldview, customs, traditions, myths and beliefs of a people. The article examines the euphemisms associated with the concept of "woman" in Chinese and Uzbek linguoculture in such thematic groups as "woman's age", "pregnancy", "morals" and "appearance". The general and specific aspects of euphemisms expressing the concept of "woman" in Chinese and Uzbek linguoculture are compared and their place in language and culture is shown. Changes of way of thinking and worldview of Chinese and Uzbek peoples at certain times, growth of the role of women in the socio-political life, role as mother, housewife moreover as a active member of society with equal rights with men explained through euphemisms. In both nationalities have been found cognitive traits of women such as oriental abashment, pudency, humbleness and chastity, which is reflected in euphemisms. The study of euphemisms associated with the concept of “woman” in Chinese and Uzbek linguoculture is important in solving the current issue of gender equality. The examine of euphemisms makes it possible to deeply study and understand the mentality of a people, to form a complete picture of its national culture, values, customs, traditions, moral criteria, the national character of a native speaker and the relationship between the language and culture. Along with this, knowledge of euphemisms avoids misunderstandings and difficulties arising in the process of intercultural communication, eliminates pragmatic obstacles, and ensures successful and effective communication.
The purpose of the study was to determine and evaluate the features of morphological changes in the liver parenchyma of 5-month-old white outbred rats under the influence of anti inflammatory drugs under conditions of polypharmacy.
The object of study for experimental studies was taken 250 white male rats weighing 200-250 g.
The scientific novelty of the research is as follows: polypharmacy of anti-inflammatory drugs negatively affects all parameters of liver structures. Under the influence of polypharmacy, there is a decrease in the absolute mass of the liver, volume and morphological parameters of the liver parenchyma. The decrease in morphometric parameters depends on the number of drugs in polypharmacy; under conditions of polypharmacy, the state of the hepatic capillaries and internal bile ducts, as well as biological membranes, was studied, as a result of which the structural structure of the liver, the development of destruction of the hepatic tissue were studied, and the morphofunctional foundations of this condition were shown.
Implementation of the research results. Based on the obtained scientific results, the morphofunctional characteristics of the liver of rats in the norm and under the influence of polypharmacy were determined:
Approved methodological recommendations: "Methodology for determining the morphometric parameters of the liver during polypharmacy of anti-inflammatory drugs" (Conclusion No. 8n-r / 265 dated 14.03.2022 of the Ministry of Health of the Republic of Uzbekistan) and "Methodology for determining the morphometric parameters of the liver during polypharmacy of anti-inflammatory drugs" (Uzbekistan, Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z 180 of 2022), electronic program No. DGU 1038 "Program for studying the comparative characteristics of morphological changes caused by polypharmacy in the liver."
The scientific results obtained in the study of morphological and functional properties and morphometric changes in the structure of the liver under the influence of polypharmacy have been introduced into the practice of the Samarkand branch of the Republican Specialized Oncological and Radiological Scientific and Practical Medical Center of the Samarkand City Medical Association (Order of the Ministry of Health of the Republic of Uzbekistan dated March 14, 2022, 8n-r / 265-No. and conclusion No. 8 n-z 180 of 2022). The implementation of the obtained research data allows developing methods for early diagnosis, treatment and prediction of organopathology by morphological parameters, improving the quality of life and reducing the number of complications.
The structure and scope of the dissertation. The structure of the dissertation consists of an introduction, three chapters, a conclusion and a list of references. The volume of the dissertation was 103 pages.
This article briefly describes the set of verbs in Arabic and Uzbek, its study by linguists, comparative lexical-semantic analysis of action verbs in both languages. In the study of the lexical-semantic relations of action verbs in Arabic language, special attention should be paid to aspects related to the meaning of verbs, such as synonyms and antonyms between them. Among the verbs of action in Arabic, there are many verbs that have polysemantic meanings, and sometimes they are used in their original meaning, and sometimes in other meanings as well. The meaning of these verbs also depends on the event or situation to which they are related. While the original, original meaning of the verb is mainly related to the normal state of the subject, other meanings serve to express his emotional state. During study of lexical-semantic relations related to action verbs in Arabic, special attention should be paid to which prepositions these verbs come with, because a particular action verb depends on whether the object to which the action is directed is animate or inanimate may require a different preposition. In synonymous relations, the verbs of action differ according to the extent to which the action lasted, for what purpose it was performed, or by what means it was performed. There are similarities and differences in the expression of the verb "to come" in Uzbek and in Arabic. In Uzbek, the main semantic of this action verb is quite simple, but the content is almost identical to the Arabic lexeme "to come". In Uzbek, this verb requires that the object to which it is directed come mainly in the infinitive, place-time, exit, and direction verbs, while in Arabic they are represented by a preposition giving the meaning of an infinitive or a definite conjunction. In expressing some of the meanings of the verb "to come" in the Uzbek language, it is necessary to use their Arabic alternative, and in some cases, the meanings of this verb in the Uzbek language. in Arabic it is also expressed by the verb "to come", but in this case it is necessary to choose a verb that expresses the expected meaning from the synonymous verbs that mean "to come" in Arabic.
In this chapter, the reader gets to know why everything is about computer networks. Computer networks vary in transmission media (wired or wireless), topology, size and scale. They can be classified as enabled or disabled. They can also be divided into local networks, metropolitan networks and global networks. This chapter lists common computer networking applications. A router is a device that connects two or more packet networks or subnets. It performs two main functions: it monitors traffic between these networks by routing data packets to the intended IP addresses, and allows multiple devices to use the same Internet connection
In the introductory part of the article the author
characterizes concept of taxable base. In the basic part of the article questions of taxable base under the tax to property are considered. In the conclusion the author comes to opinion, that
it is necessary to develop the national tax laws connected with the tax to property.