Печень является одним из жизненно важных органов в организме человека. Важнейшими функциями печени являются- пищеварительная, метаболическая, барьерная, дезинтоксикационная, экскреторная, функция депо крови, гликогена и жирорастворимых витаминов. Печень играет основную роль в поддержании уровня гликемии. Нарушение обмена веществ печени сопровождается снижением се белковосинтетической функции из-за дефицита энергии в гепатоцитах и нарушения деятельности рибосом. Последствиями нарушения синтеза белков могут быть: гипопротеинемия, кровоточивость и другие заболевания
В этом статье рассматривается воспитание в начальных
классах его методы, роль, цели, формы и другие. И особенности каждого личности в цели воспитания
it is presented about the main function of cytokinesis under physiological and pathological current to
pregnancy. It is Shown adjusting role cytokinesis in estimation of the directivities immune answer. It is installed that change
immune homeostasis is leading factor in structure gestational complications, in determination degree to gravity' of the
complications to pregnancy, forecast of its current and upshot for full- grown and fruit
One of the important directions in digitizing economic processes is the need to introduce modern information technologies and e-commerce systems into the public procurement system. The aim of the study is to analyse the stages of digitalization of the public procurement system. The commodity exchange plays an important role in the effective functioning of the public procurement system. The study determined the role of the trading platform, its organizational and legal forms and functions in public procurement through the commodity exchange. The article describes in detail the process of
placing an order at the stage of public procurement, as well as the process of fulfilling a contract by a supplier. The article describes the procedure for organizing tenders, the conditions and procedure for participation in tenders. The article provides some suggestions for further improving the public procurement system: development and implementation of a national classification of goods (services) in the public procurement system that meets international and national standards; an increase in the number of operators working in the public procurement information portal system, and, consequently,
an increase in the competitive environment, etc.
This article examines the place and role of analysis in the road safety system, from the point of view of the basis for making management decisions. The types of analysis of road traffic accidents are highlighted, and indicators of accidents are analyzed, their advantages and disadvantages are revealed. It is noted that the comparison method is used as the main method for analyzing accidents, for the use of which it is necessary to clearly understand which objects, processes, factors should be compared with each other, according to what characteristics, properties, indicators a comparison should be made, what specific calculation procedure should be put into basis of comparison. Special attention should be paid to the study and comparison of the dynamics of change in accident rate indicators, which is the most common method of analysis, both absolute indicators and any specific and relative indicators. There are several main methods for studying and comparing the dynamics of changes in the state of accidents, which can be effectively used to assess the results of activities to ensure road safety, identify unfavorable trends, and also serve as the basis for further analysis aimed at clarifying the reasons for these unfavorable changes in order to necessary preventive measures. A method for analyzing road traffic situations is considered, which makes it possible to form the ability to predict the development of events on the roads, as well as designed to prevent road traffic accidents.
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.
Relationships between nations of Central Asia and China of Tang era in the Chinese source "Jiu Tang Shu" of the period Wu-dai (the old history of Tang) and “Xin Tang Shu” (the new history of Tang) were researched in the article. The dynasty chronicle "Jiu Tang Shu" contains 200 juans (chapters) and step by step tells the events with missing some details. “Xin Tang shu” consists of 225 juans and perfectly complements those missing details. Also, the article discusses the reasons for the active foreign policy of the Chinese emperors in relation to the state of Central Asia. In addition to information about the works, there is also information about the author and editors who, due to political circumstances, were able to implement these historical projects. In the source "Jiu Tang Shu" more attention was paid to the information about the relationship of the Tang state with the Yenisei Kyrgyz and Uighurs. However, there is information about other peoples, but they are smaller in volume. These relationships are mostly trade-embassy, religious and cultural. Historico-geographical data on various regions of Central Asia and China have also found their place in the work. As stated above, "Xin Tang Shu" is a new and revised version of the old book. Every pubescent detail has been illuminated and supplemented. Dates and terms deserve special attention because of their precise definitions and translations. Unlike the previous book, "Xin Tang Shu" is divided into clear sections, in which the events of the mowing dynasty are systematically told. Information about relationships can be found in two chapters, which are also divided into internal blocks. In addition to information about the Yenisei Kyrgyz, Uyghurs and other Turkic peoples, there is also information about the Sisi and Shiwei people who also played a huge role in shaping China's foreign policy with the peoples of Central Asia.
Small business is one of the most important areas of self-reliance and raising the standard of living
of the population. It is necessary to study the various experiences of the advanced countries of the world at the aim of developing small business widely and broadly. The greatest experience of China deserves to learn it in this direction.
The issues of support and financing of small business and private entrepreneurship are covered in the works of many scientists in scientific and economic literature. The place and role of small business in the economic development of China is the object of study of many scientific works of our time. Nowadays, there is no clear methodology for assessing the system of economic relations, taking into account the social component in the process of its transformation. The state in every possible way supports small business realizing that the increase in employment of the population has a beneficial effect on the standard of living and relieves social tensions in society. The article carefully examines the economic category of Huaqiao as a social phenomenon between relatives, but gives a powerful impetus to business development in the end. An important feature of East Asian entrepreneurship, and Chinese methods in
particular way are the most nepotism of business, as well as, the transfer of control by inheritance, as a rule, from father to son, and at all levels, from small business to major corporations. Economic efficiency of business contacts of the Chinese is very high. In many ways, production of many types of products was established, market management methods were mastered, and lifestyles changed in China. Close mutually beneficial cooperation, played a huge role in
the entry of the PRC into the global and regional market.
This article provides a comprehensive theoretical analysis of aspects of speech culture, modern speech culture, which are always in the focus of the linguists. It is impossible to imagine the unity of the people living in a developed country without three important concepts: homeland, language and culture. World linguistics has shown that the study of language should be studied not as a closed system, but as a system in motion that is, in relation to such areas as society, thought, culture, politics, ideology, religion and etc. The connection of the science of language with various fields opens up a wide range of possibilities in the discovery of its new features, since the doctrine of speech culture is developed in connection with the creation of views on literary and non-literary forms of language, static and dynamic state and its functional types. The modern concept in speech culture - normative, communicative, moral principle and rhetorical canon are the main features of cultural speech, all of which play a very important role development. In order to present speech in a cultural way, it is necessary to develop the skills of choosing and using the necessary language tools, to form a conscious attitude towards them and to follow the established norms.