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 to improve the results of treatment of patients with combined injuries of the pelvis and femur, by developing tactical and technical aspects based on the severity of the injury and the severity of the condition.
The object of the study was 130 patients with injuries of the pelvic and hip bones with concomitant trauma, treated at the Republican Scientific Center for Emergency Medical Aid and its Samarkand branch for the period 2016-2021 years.
The scientific novelty of the research work is the following: the structure and frequency of combined injuries of the pelvis and femur in the general structure of injuries, in the structure of injuries to the pelvis and femur separately were evaluated. the risk factors for the development of unsatisfactory results of treatment of concomitant injuries of the pelvis and hip, based on traditional clinical and diagnostic standards, have been determined; a direct relationship has been proven in the dynamics of the condition of the victims and the prognosis, taking into account the type and nature of segmental injuries; the device for external fixation for stable functional minimally invasive osteosynthesis has been improved and the possibility of expanding the indications for surgical treatment for combined injuries of the pelvis and hip in the early period of traumatic disease has been proved; the technical advantages of a complete set of an improved rod device for external fixation have been proved, the pelvic and femoral versions of which make it possible to use them for effective stabilization of the pelvis and hip separately during anti-shock measures, and for the final reposition of bone fragments; the direct dependence of treatment results on the proposed tactics of providing trauma care at an early hospital stage, depending on the type, nature, severity of pelvic and hip injuries, and the severity of the condition has been proved.
The introduction of research results. Based on the results of scientific research to improve the surgical aspects of providing assistance to victims with concomitant injuries of the pelvis and femur: based on the results of the development of a device for the treatment of fractures, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation "Apparatus for the treatment of combined fractures of the pelvic and hip bones" (patent No. 2749897 dated 06/18/2020). The results obtained made it possible to improve the tactics of surgical treatment of patients, to shorten the period of hospitalization and the period of postoperative rehabilitation, to ensure the possibility of patients with minimal economic costs; on the basis of the results of scientific research on the diagnosis and treatment of concomitant injuries of the pelvic and femur bones, methodological recommendations were approved "Method for the treatment of victims with concomitant injuries of the pelvis and hip, depending on the severity" (Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z / 288 dated August 31, 2021 of the year). The results obtained made it possible to improve the quality of wound diagnosis and rehabilitation of patients with injuries of the pelvic and hip bones in concomitant injury; approved methodological recommendations "Tactics of rendering assistance to victims with combined injuries of the pelvis and hip, taking into account the severity of the condition" (Conclusion of the Ministry of Health of the Republic of Uzbekistan No. 8 n-z / 288 of August 31, 2020). The results obtained made it possible to improve the tactical and technical aspects in the treatment of injuries to the pelvic and hip bones, based on the severity of the injury and the severity of the patient's condition.
Scientific results have been introduced into the practical activities of healthcare, in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, the Jizzakh Branch of the Republican Scientific Center for Emergency Medical Aid, the Samarkand branch of the Republican Scientific Center for Emergency Medical Aid (certificate of the Ministry of Health No. 08-09 / 18979 dated December 02, 2021). The proposed tactics for the treatment of combined injuries of the pelvis and femur made it possible to reduce the incidence of postoperative complications of excellent and good long-term functional results from 66.1% to 92.6%.
The structure and scope of the dissertation. The dissertation consists of an introduction, five chapters, conclusions, practical recommendations, a list of referencesand applications. The volume of the text material of the work is 111 pages.
Topicality and demand of the subject of dissertation. Various techniques of hybridization arc used in crop breeding, including cotton to produce a wide variability in agronomical valuable traits and develop new forms.
Regardless of its implementation hybridization process leads heredity decoding which allow the new plastic genotypes formation with an ability to change and adapt to the new conditions. Hybridization and selection arc considered as a main synthetic method of new varieties development and a success in this largely depends on the choice of crosses method and genotypes of initial forms. Therefore, there is given a special attention for studying the genetic basis and improving of hybridization methods. However, based on the most widely used of hybridization methods arc not always possible to develop varieties having high parameters of composite agronomical traits. Many developed varieties as a result of breeding methods arc genetically become homogeneous, which leads to a reduction of genetic variation and increasing of risk of cpiphytoty outbreaks and decreasing of total productivity (Boroycvich, 1981). Therefore, it is necessary to increase the genetic variability of crops’ agronomic traits by involving of original forms, as well as wild relatives of crops with genetic resistance to various stress factors, diseases and pests.
In increase cotton production through the creation of early maturing, high-yielding having good fiber yield and quality, resistant to various diseases, pests and stress factors, as well as with low level or toxic gossypol in cotton seeds still remain as critical problem in cotton production.
To overcome these problems there need to improving of genetic basis for assessment of existing donors and through the use of various hybridization methods to create new enriched genotypes, promoting positive recombination of polygene in hybrid’ organism for use in applied cotton breeding. Based on the above stated, the study of the genetic aspects of various methods of remote composite intraspecific and interspecific hybridization, based on the comparative evaluation of the effectiveness in order to isolate valuable recombinants and transgressive forms having new genetic variability of traits arc important both scientific and practical point of view.
The dissertation meets the objectives as set out in the Lows of Uzbekistan «On Seed Production» of December by 21, 2007 and «On Breeding achievements» by August 21, 2002 directed to developing and introduction of high-yielding cotton varieties, with a good yield and fiber quality, tolerance to various factors, as well as improving seed production.
Purpose of researches is comparative study of effectiveness of the various methods of intraspecific composite, convergent and inter-specific (3 to 5 species) hybridization revealing the nature of inheritance, form shaping and transgressive variation of traits, total and (+)-gossypol in creation of genetically enriched breeding material and for using in the applied cotton breeding.
Scientific novelty of the dissertation research is follows:
in the system of topcrosscs there used genetic evaluation for combining ability of main agronomic traits cotton varieties with different origins for further using in intraspecific composite and convergent hybridizations;
there established principally dominant inheritance and overdominance type of inheritance (with deviation toward the initial forms with the high agronomic traits) in F| at composite intra-and interspecific hybridization which genetically distinct accessions from the local and foreign selection and wide transgressive variability in F2-F3, facilitating to efficient selection of valuable recombinants;
first identified the inheritance nature and variability of total and (+)-gossypol in the cotton hybrids’ generative parts, developed by involving of American accessions with high (+)- gossypol and local varieties, as well as their correlation with some agronomical valuable traits;
first there held comparative study of economic traits at the different forms of amphidiploid G.thurheri x G.raimondii K-58 (hirsutum type) and K-59 (type harhadense) for free reproduction and after crossing the cultural forms of G.hirsutum L. species, it was established a wide range of variation of agronomic traits at mutant form of K-59 and composite hybrids, derived from it’s participation as compared to K-58 amphidiploid and it’s composite hybrids. It was found out those two types (type G.hirsutum K-58 and type G.harhadense K-59) of amphidiploid G.thurheri x G.raimondii at the free reproduction exhibits similarities with the both cultural tctraploid species; G.hirsutum L. and G.harhadense L., respectively. When they crossed with the cultivated G.hirsutum L. species these amphidiploid forms also behave as natural tctraploids;
it is revealed that, at the composite hybrids produced with the participation of the both forms of amphidiploid (K-58 and K-59) G.thurheri Tod. x G.raimondii Ulhr., as a result of transgressive variation, there is a disturbance of negative correlations between such traits as yield and fiber length, fineness and boll numbers conducive to positive recombinants emergence and increase donor opportunities of amphidiploids;
by comparative study of different methods of remote intra-and interspecific hybridization revealed the genetic nature of inheritance nature and variation degree of the main agronomic traits in composite hybrids, as well as their effectiveness in allocating recombinants having a new genetic variability of traits;
it is revealed that the possibility of breaking some negatively correlated traits by different methods of composite intra-and interspecific hybridization and selection of recombinants combining early maturity and high productivity, high fiber output with its quality and 1000 seed weight, etc.;
it is confirmed that the effectiveness of used methods such as a composite intraspecific and interspecific crosses, to increase positive transgressive variation and segregation genetically enriched recombinants having new combination of high levels of positive parameters of agronomic traits that were recommended and used to develop valuable initial material and new cotton varieties;
the obtained theoretical data on inheritance nature, hcritability and agronomic traits morphogenesis, levels of total and (+)-gossypol and their correlation with other agronomical valuable traits at developed hybrids could be successfully used in the field of fundamental research, and created unique hybrids, forms, progenies, lines and varieties could be used in applied cotton breeding.
Conclusion
1. There obtained and identified on comparative study base of intraspecific composed and converged hybrids with participation of six registered medium staple cotton cultivars in topcross system and high effects of GCA on the following traits:
«50%-cmcrgcncy-50 % flowering» Yulduz (-0.71); Tashkent-6 (-0.39) and in S-9070 (-0.38); “50% cmcrgcncy-50% maturing” S-9070 (-1.43), and in
Tashkent- 6 (-0.91); one boll weight S-6532 (+ 0.11); 1000 seeds weight S-9070 (+0.51); on productivity Tashkent-6 (+5,28), S-4911 (+4,04) and S-9070 (+2 24); fiber output S-6532 (+1,29); fiber length S-4911 (+0,70) and S-6532 (+0,48); fiber strength S-6532 (+1,57) and S-4911 (+0,91); micronairc S-6532 (+0,24) and Ak-Darya-6 (+0.24). These donors of high valuable traits were used by us for improving of the recurrent varieties by composite and convcrcgcnt hybridization. It was found that involvement of the varieties with a high GCA in convergent hybridization allows improving of the recurrent varieties and developing of a new initial material for cotton breeding:
inheritance nature and variability degree of agronomic traits at intraspecific composite and convergent cotton hybrids revealed the relative efficiency of the studied hybridization techniques during elaboration of new initial material with enriched genotypes of agronomic traits, and recommended to use in geneticselection process;
convergent hybrids F i dominated by early maturity, in terms of productivity and fiber output occurcd overall effect of overdominance, and F2-F3 appeared as positive transgressive forms;
significant effect of the genotype of the parental forms involved in hybridization on the inheritance nature of fiber quality (length, micronairc, strength) had convergent hybrids Fj, as well as their level of recombination in F2-F3 indicating the need for breeding of recombinants on these traits in early generations, taking into account genotype of initial forms;
the inheritance of the wilt tolcrancccs bccamcs not only depending on the pathogen load in soil fungus infections, but also depends on the used hybridization methods. Thus, most high resistance, i.c. negative superdominance on wilt tolerance observed in convergent hybrids F, and F2;
the direction and strength of correlation between the studied traits in intraspecific composite and convergent hybrids varied in depending on crosses type and from genotype of recurrent varieties. At present ease, the greatest number of recombinants with positive combination of high indicator traits which determining fiber quality, as well as its output, length, observed with with composite, particularly with convergent hybridization.
2. For the first time, on the basis of studies on determination the percentage of (+)- gossypol in seeds of genetically different cultivars of Uzbek cotton selection and analysis of variability, inheritance degree of total and (+)-gossypol in the environmentally and genetically remote hybrids and their correlations with economically valuable traits was proved:
the cultivars S-6524, S-6530 and S-6532 which were elaborated involving subspccic of G.ssp.punctatum had the highest level of (+)- gossypol and the «Turon» cultivar which was developed by composite hybridization has a low indicator of the current trait and relatively high level of total gossypol in seeds;
It was determined intermediate inheritance level of (+)- gossypol in the petals and seeds in F| hybrids and wide positive and negative transgressive variability in Ғ2-Ғ3. It was proved that the efficiency of plant selection with high (+)- gossypol in seeds since F2, that confirmed with segregation of constant progenies and lines on trait basis in F4 hybrids;
as a result of research the cross-correlation total and ( +)- gossypol and some agranomically valuable traits was found that between the ( +)- gossypol in the petals and seed exists a weak correlation. The data on correlations of studied traits showed an independent genetic control of (+)-gossypol in the generative organs and independent inheritance of them at cco- geographically and genetically remote hybridization.
3. For the first time, based on comparative study of agronomic traits of amphidiploid G.thurheri Tod. x G.raimondii Ulbr. two forms (hirsitum type -K-58 and harhadense type -K-59) and hybrids derived from G.hirsutum L. varieties revealed:
both studied forms of hirsutum type and harhadense type of amphidiploid G.thurheri Tod. x G.raimondii Ulbr., being functional diploids provided wide combinative variability in the progeny from the free reproduction and crossing with the cultivars of tetrapioid G.hirsutum L., and showed their similarity to G.hirsutum L. and G.harhadense L. tctraploid species, respectively;
as a result of the research a group of unique composite hybrids (F\G.thurherii Tod. x G.raimondii Ulbr.) x G.hirsutum L. confirmed unlimited transgressive variation as the basis of a new form revealing, new gene pool developing for use in applied cotton breeding. Herewith, at bud mutant K-59 observed emergence of phenotypes with higher variability for most agronomic traits compared to K-58;
it was found out that in composite hybrids which obtained by crossing of studied forms of G. thurberi Tod. x G. raimondii Ulbr. amphidiploids (2n=52) and with G.hirsutum L. cultivars were observed relatively rapid improvement on productivity and its components in comparison with freely propagated amphidiploids offspring. Herewith, composite hybrids involving K-58 on boll number in all generations was slower comparied to hybrids derived from K-59;
composite hybrids F, obtained involving two cultivars of cultivated forms on fiber output and length were observed deviation toward the parent with the best expression of the trait. It was revealed that the fiber output and length of the studied composite hybrids susceptible to less variability compared in terms productivity and its components. Relatively high variation was manifested on fiber output in F2, and on fiber length in F2-F3. In freely multiplying offspring of K-59 and its hybrids with varieties in F3 was observed the derivations of more long staple plants compared with hybrids, developed involving K- 58;
free propagating amphidiploids’ offsprings and composite hybrids selected by using of cultural forms showed the least wilt susceptibility compared with the control. Wilt resistance of barbadense type K-59 progenies from the free breeding was higher as compared than offspring of K-58, and higher in composite hybrids F2-F4, obtained involving K-59.
4. Under the general principle of correlation relationships among the studied hybrids were found that composite hybrids F2 amphidiploids’ G.thurberi Tod x G.raimondii Ulbr., both types (K-58 and K-59) with a G.hirsutum L. type Acala sj-5 cultivar showed mainly low positive and negative correlation coefficient values, which in most eases were none significant. In hybrid combination of K-58 x Andijan-60 fiber output and length correlated positively;
5. Based on comparative study of inheritance and variation of agronomic traits in developed 4 genomic [(G.thurberi Tod. X G.raimondii Ulbr.) X G.arhoreum L.] x G.hirsutum L., 5 - genome [(F|K-28 x S-6524 ) x G.harhadense L. hybrids and their backcross hybrids were proved:
the possibility of broad transgress variation and creation genetically enriched recombinants on unique traits;
efficiency of backcrosscs among the composite interspecific earlier generation hybrids for rapid improvement and stabilization of eultuvated forms of cotton;
wide transgress variability presence in 4 and 5 species composite hybrids and their backcross hybrids on productivity and its components starting with F|. In particular, it was confirmed the effectiveness of five species hybridization to increase the boll numbers per plant, boll weight and weight of 1000 seeds at 4 and 5 species and backcrosscs hybridization.
by obtaining recombinants having fiber output 43,1-45,0%, fiber length - 40 mm and above, micronairc of fiber 3.9-4.5 and wilt tolerance it was confirmed the effectiveness of introgressive and transgressive breeding at composite 4-5 species hybridization and their backcross hybrids.
6. As a result of studies of correlations in composite 4-5 species and backcrosscs hybridization of F2 hybrids it was revealed the effectiveness of used methods in interruption of such negatively correlated traits as «fiber output» and «fiber length» from medium positive (r=+0,39) up to high positive (r=+0,62), «fiber length» and «micronairc» -medium positive (r=+0,55), as well as «fiber length» and «fiber strength» -medium positive (r =+0,56 and r=+0.50).
7. Based on intraspecific composite and convergent, eco-geographically and genetically remote and 3-4-5 species and backcrosscs hybridizations were developed the following new breeding progenies, lines and varieties of upland cotton:
by composite and convergent hybridization way-L-7966, L-214/05; CC-896/05; CC-896/28; CC-991/05; CC-991/09; KC-1/05; КС-1/08; КС-1/18; KC-1/35; KC-1/51; KC-1/77, S-231-233/07, L-234-235/07, L-236-237/07, L-242-243/07, L-244-245/07, L-482-483/07, L-484-485/07, L-666-667/07, L-397-398/07, L-802-803/07, L-814-815/07, L-230/05;
cco- geographically and genetically distant hybridization - cultivar S-7300, S-7301, the progenies S-5344, S-5361. HPG-1;
composite 3 - specific hybridization -cultivar «Sulton», «Jarkurgan», S-7276, S-7277, as well as a number of lines;
8. Using the remote intra-and interspecific hybridization it was elaborated unique introgression hybrids, genetically enriched cotton recombinants, progenies, lines, and varieties «Sulton», «Jarkurgan», S-7276, S-7277, S-7300, S-7301 having positive combination of high agronomic traits. Cultivar «Sulton» was included in the State register from 2011 and for the period from 2008 up to 2014 it was sown on the area of over than 275,5 thousand hectares.
9. The following rcccomcndations were given for practize and future studies:
use of method convergent hybridization, allowing improving of agronomic valuable traits of recurrent parent and registered medium staple cotton cultivars and receiving a positive transgressive variability;
as an initial source in convergent crosses use cotton varieties with high General combination ability (GCA) on the following: on early maturity- Tashkent-6 and S-9070; boll weight - S-6532; weight of 1000 seeds S- 9070; on productivity -Tashkent-6, S-4911 and S-9070; fiber output -S-6532; fiber length - S-4911 and S-6532; fiber strength - S-6532 and S-4911; and for micronairc - S-6532 and Ak-Darya-6.
for use as an initial source in cotton genetics and breeding research such new cotton selection progenies as well as the lines: KS-1/05; K.S-1/08; K.S-1/18; KS-1/35; KS-1/51; and KS-1/77, L-7966, L-214/05, S-214/05, SS-896/05; SS-896/28; SS-991/05 and SS-991/09 with early maturity, productivity, wilt tolerance, fiber output and quality.
to use in cotton genetics and breeding researches both USA accessions BC3S,-47-8-l-17, BC3S|-l-3-6-15 with 95% of (+)-gossypol level in seeds and lines HPG-1 and others with 90% of (+)-gossypol level, as donors on this trait. Since 2012, developed and studied in the competitive variety testing of Institute the following lines: L-404-05 and L-6970 with high (+)- gossypol level were recommended for testing on ground control of the State Inspection Commission for Agriculture crops variety testing.
widespread use of various forms of synthetic tetrapioids G.thurheri Tod. x G.raimondii Ulbr., 4-5 species composite hybrids [(G. thurheri Tod. x G. raimondii Ulbr.) x G.arhoreum L.] x G.hirsutum L. and [(F t K- 28 x C-6524 ) x G.harhadense L., as well as their backcrosscs for achievement the broad transgress variation, elaboration genetically enriched recombinants on economically valuable traits and their use in practical cotton breeding;
to extend the areas in of early maturing commercialised cotton cultivar «Sulton» and perspective one «Jarkurgan» as well broad testing of such as new varieties S-7277, S-7300 and S-7301 in the republic.
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.
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.
Topicality and demand of the theme of dissertation. In world practice of informatization, systems of electronic document interchange (EDIS) arc considered and introduced last years not only as systems for automation of manage processes but also as high-grade platforms for creation of uniform information field, so borders of their use, certainly, expands and scientists of the world raises interest to them. In researches of leading scientists of infocommunication technologies the demand of problems of authentic gathering, transfer, analysis, coding of information during formation of office-work documents is allocated for getting of effective technologies raising mobility and productivity of EDIS.
Complex measures undertaken by the Government of Republic of Uzbekistan on development of systems of region-territorial automated management and to creation of uniform information field arc directed on wide introduction of information systems, EDIS, databases (DB) on the basis of modern information-communication technologies. In this connection, working out of new methods to intelligent processing of information resources used for improvement of data transfer quality, allowing effectively to find out and correct errors in structure of electronic document interchange with least material and time expenses, differs a special urgency and, at the same time, remains the unresolved theoretical and applied problem having important economic value.
Requirements to information resources and streams of data transmission as the important factor of efficiency and quality of EDIS functioning arc expressed in providing of stability, integrity, safety and authenticity of the information. One of important among factors is the criterion of authenticity of the information, caused by distortion of transferred messages in infocommunication networks because of failures and refusals of means, any handicaps in communication channels, errors of operators, scanning and recognition systems.
Hence, construction of effective systems to control of information authenticity during transfer and processing represents special scientific interest as priority technology of data processing, characteristic for conditions of automated management and electronic document interchange at the enterprises and organizations.
For existing methods, despite of providing the high level of information transfer authenticity, some unsolved questions is typical, and as basic of them it is possible to allocate the following: at development technologies of electronic documents interchange in structure of modern data transfer packages the significant volume of resource is spent for headings, at the same time the most part of information in headings remains constant from package to package during stream of transfer of the whole frame (redundancy of the information arising at it and mechanisms to provide reliability of deliveries consisting, basically, in sending the appropriate message and repeated transfer of packages, - result to additional time and material expenses while errors detection and elimination); code and hardware methods of information transfer control arc focused, mainly, on elimination the transposition mistakes in managing fields of packages; however, at data transfer there arc also distortions in information fields, which frequently reveal as multiple text mistakes.
In this relation, the decision of tasks for providing of information transfer authenticity is reasonable to consider in two aspects.
Solutions of the first type tasks should taken into account errors of the man-operator, scanning and other devices intended for input of the information. These kinds of mistakes make greatest volume of distortions in text and arise at Applied and Representation levels of OSI model (Open System Interconnection reference model).
Solutions of second type tasks, devoted to control of the information reliability, take into consideration the probability of distortions which occur at stages of Transport, Network, Physical and Line of model OSI.
Demand of the dissertation is characterized by the fact that introduction of a wide range of IP-enabled technologies in electronic document interchange is connected to requiring close attention tasks of detection and correction of errors during preparation and processing of documents.
This research work is focused on providing realization of laws of the Republic of Uzbekistan «On informatization», «On electronic digital signature», «On electronic document», «On electronic commerce», «On electronic payments», Decree of the Cabinet of Ministers of the Republic of Uzbekistan № 126 on 05.04.2011 «About measures on installation and use of a single secured e-mail and system of electronic document interchange in the executive office of cabinet of ministers, bodies of government and economic governance, local government».
Following that, the solution of listed tasks requires carrying out the special researches and development connected to creation of methods and algorithms, capable to control the information authenticity in structure of data transfer packages at the expense of use the enclosed redundancy, and able to function in transport environment, eliminating existing lacks. This fact causes necessity of allocation of a special class algorithms for providing of information authenticity on the basis of new type of PR-rcdundancy (property redundancy), defined by depending on properties of processed object.
Purpose of research is development ol constructive methods, models, algorithms and systems of information authenticity control during transfer and processing of the data on the basis of mechanisms used PR-rcdundancy of various nature, and software and algorithmic realization of results for developing technologies of electronic document interchange.
Scientific novelty of disscrtational research consists in the following:
concept, methodology and software and algorithmic bases to construction methods, models and algorithms for the information authenticity control in systems of electronic document interchange arc developed, classes of objects characterized by PR-rcdundancy, applied to provide accuracy, integrity, efficiency, compression, availability of information resources in EDIS arc allocated;
methods and algorithms arc offered for control of information reliability at the expense of use the artificial redundancy on the basis of linear, modular, plane summing mechanisms and definition of belonging to the coded subsets;
methods and software complexes arc developed for control of information reliability at the expense of use the natural redundancy on the basis of algorithms in which procedures of statistical, arithmetic, parsing coding, n-gram structured description, statistical pattern recognition and hashing of text elements arc realized;
for control and correction of spelling mistakes in texts on Uzbek language methods and algorithms arc offered on the basis of models of multilevel morphological analysis and n-grams Grammatik description;
on the basis of enclosed logic criteria, database and knowledgebase in structure of the built-in expert systems methods and algorithms arc developed for the control of information authenticity at the expense of use the structural-technological PR-rcdundancy;
methods arc offered to synthesis algorithms of text information reliability control in interactive system of errors detection and correction for developing technologies of electronic document interchange.
Conclusion
1. Developed in the dissertation constructive methods, models, software and algorithms complexes to control of information authenticity by principles of using of PR-rcdundancy on the basis of concepts of system analysis, control and information processing allow to increase efficiency and productivity of EDIS.
2. The estimation of current state of the theory and practice of code, hardware and program methods of control of authenticity information transfer had shown insufficiency of existing types of redundancy for providing qualitative functioning of EDIS. Principles of use of PR-rcdundancy at electronic documents for working out applied methods, software and algorithmic complexes to providing of information transfer authenticity have allowed to design toolkit of development of existing technologies.
3. Methods of: linear, plane and modular summation; codings by rules of Haffman, Lempcl-Ziv-Velch, Barrousc-Willcr, arithmetic coding, statistical recognition, logic control form methodical bases of use of PR-rcdundancy for expansion possibilities of algorithms and software complexes to providing of the information authenticity during drawing up, transfer and processing of electronic documents texts.
4. Efficiency of developed algorithms is shown and solutions arc got for tasks of control the information authenticity on the basis of criterion of mistakes undctccting probabilities. It is established, that they find up to 92 % of all kinds of mistakes, capable to correct single, double and adjacent transpositional mistakes, in comparison with existing methods reduce labour content and cost of control in 2-3 times if probability of mistakes is accepted as P«4-10-3, and also raise the information authenticity up to three orders.
5. To solving tasks of control and correction of spelling mistakes in Uzbek texts methods, algorithms and systems arc developed included morphological and n-gram structured models. The developed technique of getting frequency characteristics of n-gram on the basis of distortions probability parameters statistics arc applied during systematization hash-codes for parsing coding.
6. Interpolation and extrapolation methods of construction the logic and arithmetic function of statistical recognition arc used for working out algorithms to control of text elements images authenticity. Methods arc developed to control authenticity of alarm characteristics of text elements images in ncuronctworking system to information processing which includes parts of automatic recognition and control of images signals. Methods and algorithms arc realized in the structure system to control of information authenticity for eases when information in EDIS is represented as metatext on the basis of belonging attributes and classification of metatext on fuzzy semantic hypcrnct.
7. Methods and algorithms of the control of the information authenticity, based on methods of dictionary, statistical and hash-codings provide effective applying of the hardware-software environment of parallel computations NVIDIA with use of standard libraries of numerical analysis, optimized data exchange between CPU and GPU for optimization.
8. It is determined that at realization of the system to control of spelling on the basis of developed ways of description and identification of the software shell, treelike representation of n-gramm grammar and architecture of framework Sfinks-4 focused on various language models used PR-rcdundancy, the number of undetected errors and cost of realization considerably decreases, and labour content in comparison with the spelling control system on the basis of morphological analysis decreases twice.
9. Developed simulating algorithms, complexes of software and systems to control of information authenticity on the basis of using PR-rcdundancy have found practical application in systems of: automated organization of educational environment in high schools; adapted data transfer, processing and analysis in infocommunication networks; EDIS of enterprises.
10. The developed software complexes to control the information authenticity in structure of EDIS and computer system of adapted transfer, handling and data analysis arc implemented in real working conditions in the Samarkand branch «UzTelecom» of the State committee or communication, for informatization and telecommunication technologies of the Republic of Uzbekistan and in Joint Venture «Tasty-Fuit». Appropriate certificates confirm cost of economical efficiency of dissertation results.
The aim of the study is to improve the results of diagnosis and surgical treatment of victims with closed abdominal injury by developing a new approach to ultrasound assessment of the amount of hemoperitoneum, expanding and specifying indications for laparoscopy, taking into account the volume of free fluid in the abdominal cavity.
The object of the study were 160 patients with closed abdominal injury with stable hemodynamics, was hospitalized in the surgical Department of the Republican specialized scientific and practical center for emergency medicine of the Samarkand branch (clinical departments of surgical diseases № 2 and surgery postgraduate faculty of Samarkand state Medical Institute) for the period from 2010 to 2019.
The scientific novelty of the study is as follows: a fundamentally new approach to ultrasound evaluation of discrete volumes of free fluid in the abdominal cavity is proposed, based on taking into account the thickness of the fluid layer and its prevalence in the abdominal cavity zones; The expediency of using the ultrasound indicator "free fluid in the abdominal cavity < or >500 ml" in choosing the tactics of surgical treatment of patients with closed abdominal injury is substantiated; an algorithm for choosing surgical tactics for the treatment of patients with closed abdominal trauma was developed based on an ultrasound assessment of the volume of free fluid in the abdominal cavity.
Implementation of research results. Based on the results of a scientific study to improve the diagnosis and surgical treatment of patients with closed abdominal trauma:methodological recommendations "The choice of tactics for surgical treatment of closed abdominal trauma based on ultrasound assessment of the nature and severity of the injury" have been developed (certificate of the Ministry of Health No. 8n-z/1282 dated November 15, 2022). The proposed recommendations made it possible to increase the effectiveness of the diagnosis of intra-abdominal injuries in patients with abdominal trauma;
The results of scientific research on improving the diagnosis and surgical treatment of patients with closed abdominal injury have been introduced into medical practice, including the clinical practice of the Republican Scientific Center for Emergency Medical Care and its Samarkand, Surkhandarya and Navoi branches (conclusion of the Ministry of Health No. 8 n-z/699 dated December 21, 2022). The introduction of the obtained results into clinical practice allowed to improve the quality of high-tech surgical care provided to patients with isolated and combined abdominal injuries, to reduce the frequency of postoperative complications from 11.9 to 3.1% (p=0.144).
The structure and volume of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions and a list of cited literature. The volume of the text material is 107 pages.
Relevance of the problem. The difficulties of diagnostics of orbital diseases are well known. Especially difficult is intraspecies differentiation among the multitude of tumour, pseudotumour, inflammatory, vascular, endocrine and other diseases occurring here, manifested by the symptom complex of unilateral exophthalmos [Beradze I.N., 1978; Brovkina A.F., 1993].
Malignant intraocular neoplasms are the main cause of death of patients with diseases of the organ of vision, with 45-48% of patients dying from metastases in the first 5 years after enucleation [Alekseeva I.B., 1990, Barkhash S.A.1978, Brovkina A.F..1991, 1997; Keizer R.W.. Viclvoyc G.L.,1986],
Retinoblastoma is the most frequent malignant neoplasm in children. According to different authors, the frequency of its occurrence is 1 case per 14000 - 35000 newborns. [Bobrova N.F. and Vit V.V., 1993; Brovkina A.F., 1997; Provenzale J.M., et al., 1995; Skulski M., et al., 1997; Weber A.L., Mafee M.F, 1992; Wilms G., et al., 1989]. The frequency of patients with the most malignant intraocular tumour in adults - uveal melanoma has recently reached 7-9 people per 1 million population [Brovkina A.F., 1997; Kotslyansky E.O., 1989; Yushko N.A., Peskova L.I., Kalenich L.A., 1989; Peyster R.G., Augsburger J..I., Shields J.A., 1988; Romani A.. Baldeschi L., ct al 1998; Scott I.U., 1998].
The fundamental difference in treatment tactics, depending on the stage of development, size and topography of the tumour, as well as the seriousness of the prognosis in retinoblastomas and melanomas sharply increase the requirements for the accuracy of their differential diagnosis. At the same time, the number of diagnostic errors in ocular tumours continues to be 10-30% even when complex clinical and instrumental examination is applied in specialised ophthalmological centres [Ternovoy S.K., Panfilova G.V., Rogozhin V.A., 1979; Friedman F.E., Malyuta G.D., Kodzov M.V., 1995; Song G.X., 1991].
Widely used in ophthalmological practice traditional diagnostic methods (ophthalmoscopy, gonioscopy, diaphanoscopy, fluorescence angiography, laboratory tests) are insufficient to obtain comprehensive information about the localisation, nature of growth and prevalence of volumetric pathological formations of the eye and orbit. This circumstance and not quite satisfactory results of surgical treatment are the causes of high mortality of patients [Muratova T.T., Nigmanova N.H., Kozlovskaya G.M.. 1989, Naches A.I., 1980; Cheremisin V.M., Trufanov G.E., Kholin A.V., 1991]. Untimely or erroneous recognition of pathological processes of the orbit leads to a sharp deterioration of visual functions, up to blindness, and in some cases to the death of the patient [Yuzhakov A.M., Travkin A.G., Kiseleva O.A., 1991]. All this determines the importance of timely and accurate diagnosis of diseases of the orbit, on the one hand, and the difficulty of such diagnosis - on the other [Gabunia R.I., Kolesnikova E.K., Tumanov L.B., 1982].
The fact that the orbit is closed from direct inspection and palpation by bone walls and the eyeball, indicates the advantage of radial diagnostics in comparison with other methods of examination. In the arsenal of clinicians there is a great variety of methods of clinical-radial diagnostics of orbital pathology, however, at present the information in the literature about their resolving capabilities and significance in comparative aspect is incomplete and not fully studied. The priority of using one or another instrumental investigation, their sequence and expedient combination have not been determined yet. This makes it difficult to choose the optimal standardised approach for diagnosis and adequate treatment [Cheremisin V.M., Trufanov G.E., 1993, Weber A.L., Sabates N.R., 1996; Wenig V.M., Mafee M.F., 1998].
Thus, the study of these and other questions, contributing to the improvement of diagnostics and treatment of patients with neoplasms of the eye and ocular cavity, should be recognised as urgent urgent.
Purpose of the study. Comparative evaluation of magnetic resonance tomography capabilities and development of algorithms for complex radial diagnostics of volumetric formations of the visual organ. To solve this goal we set the following tasks.
1. To study the normal picture of the magnetic resonance image of the visual organ in comparison with other methods of visualisation.
2. To find out the possibilities of magnetic resonance tomography, ultrasound and computed tomography in detection and evaluation of intraocular neoplasms.
3. To determine the role and place of magnetic resonance tomography in differential diagnostics of volumetric pathological formations of the eye cavity in comparison with other radial methods of research.
4. To determine the indications and to develop an algorithm for the complex application of radiography, ultrasound, computer and magnetic resonance tomography for diagnostics of volumetric formations of the eye organ.
Scientific novelty.
The present work is the first to give a detailed and detailed description of the complex clinical and radiation examination, with generalisation and standardisation of magnetic resonance, computer and ultrasound semiotics of volumetric pathological formations of the eye and eye cavity. The conducted clinical and instrumental investigations allowed to determine the diagnostic value and resolving capabilities of each of the applied methods. The ultrasound, CT and MRI signs of volumetric formations of the eye organ were studied, clarified and supplemented taking into account the use of low-field magnetic field and general-purpose ultrasound apparatus. The developed standardised diagnostic algorithm of examination of patients with this pathology is new, thanks to which the pre-oppositional diagnosis of tumour and other diseases of the visual organ is improved and the total radiation load on the patient is reduced.
Conclusions
1. MPT will provide an opportunity to study the weight of the soft tissue and anatomical components of the ocular cavity, up to the optic nerve sheath and perineural liquor space, the orbital apex and chiasmal-sellar region, as well as to assess the condition of adjacent structures of the brain and facial skull. The method is limited in the evaluation of changes in the bony walls of the orbital cavity.
2. MRI is inferior in detecting characteristic signs of retinoblastoma (presence of calcification). The sensitivity of MRI was 66.6%, while for ultrasound and CT these values were 96.1 and 100%, respectively. But when the tumour spreads rstrobulbarly outside the eyeball (at 3-4 stages) the informativeness of MRI increases significantly. In uveal melanoma the sensitivity and specificity of MRI reaches 100%.
3. Both MRI and CT have a high detection rate (98.1% and 95.8% respectively) of benign orbital tumours of both primary and secondary origin. However, MRI is the preferred method of investigation. MRI is especially informative when a cranioorbital tumour and pseudotumour are suspected. The sensitivity of the method is 90.9% and 91.6%, respectively
4. In some cases ultrasound can be used to differentiate between encapsulated and diffuse neoplasms, which facilitates the diagnosis. However, when the pathological process is localised near the orbital apex, the diagnostic value of ultrasound decreases. In such cases it is advisable to use MRI.
5. In detection of primary and secondary malignant tumours of the orbital cavity both MRI and CT are quite informative (sensitivity 97,2% and 95,4% respectively), but the most comprehensive information about the state of bone walls will be provided by CT. When the process spreads intracranially, the value of MRI increases significantly, especially with the use of contrast enhancement.
6. The developed algorithm of complex clinical and radiation examination of patients with the use of ultrasound, CT and MRI is the most effective in the diagnosis of volumetric pathological formations of the eye and eye cavity, allowing to reduce to an adequate minimum the total radiation load on the patient and diagnostic period, excluding duplication of research techniques and choosing the most informative in each case, which in turn allows to develop appropriate treatment tactics and reduce the level of disability of the patient.
The aim of the research work is to improve the results of surgical treatment of chronic anterior-medial dislocations of the radial head in children based on the improvement of the method of surgical treatment.
The object of the study was 83 patients with chronic antero-medial dislocations of the head of the radius, treated in the department of the consequences of childhood injuries of the Samarkand branch of the RSSPMC of Traumatology and Orthopedics for the period 2017-2020. The scientific novelty of the research work is the following: it is proved by histological examination that, in case of injuries from up to 1 month ago, the anterior wall of the joint capsule is thin and elastic, which is easily stretched, and from 3 months ago, it thickens, scars and forms fibrous tissue; the possibility of using a fibrous-modified joint capsule for annular ligament plasty in the surgical treatment of chronic antero-medial dislocations of the radial head from 3 months ago was proved; the tactics of surgical treatment of chronic antero-medial dislocations of the head of the radius depending on the deformity of the bones of the forearm were determined; a direct relationship between the results of surgical treatment of chronic antero-medial dislocations of the head of the radius, depending on the duration of the injury, has been proven.
The introduction of research results. Based on the obtained scientific results on the optimization of surgical treatment of chronic antero-medial dislocations of the radial head in children:
based on the results of the development of a method for annular ligament plasty, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation “A method for the surgical treatment of chronic anterior medial dislocation of the radial head in children by capsuloplasty according” (patent № 2749870 dated 06/17/2021). The results obtained made it possible to improve the results of surgical treatment, to reduce the period of penetration in the hospital and after the surgical rehabilitation period; based on the results of scientific research on the surgical treatment of chronic anterior medial dislocations of the radial head, the guidelines “Surgical treatment of chronic dislocations of the radial head in children” were approved (Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 81 dated February 21, 2022). The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children; based on the results of scientific research on the surgical treatment of chronic antero-medial dislocations of the head of the radius, the methodological recommendations “Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 289 of August 31, 2021” were approved. The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children;
Scientific results have been introduced into the practice of healthcare (Conclusion of the Ministry of Health 08-32955 of October 24, 2022), in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center for Traumatology and Orthopedics, the Bukhara branch of the Republican Scientific Center for Emergency Medical Care, and the Samarkand Regional Children's Multidisciplinary Medical Center. The proposed method for the treatment of chronic anterior-medial dislocations of the radial head in children allowed to reduce the frequency of relapses, increase excellent and good results from 75.6% to 92.9%.
The structure and scope of the dissertation. The dissertation consists of an introduction, 5 chapters, conclusion, conclusions, practical recommendations, a list of references and applications. The volume of the dissertation is 109 pages.
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.
The purpose of the study is to determine the significance of genetic factors in the development of chronic nephritic syndrome in children and to clarify the features of the clinical course
The оbject of research were 129 children aged 4-15 years who were treated for chronic nephritis in the nephrology department of the Samarkand Regional Multidisciplinary Paediatric Medical Centre.
The scientific novelty of the study is as follows:it has been established that the severity of chronic nephritic syndrome in children is associated with clinical manifestations (gradual development, dyspepsia, abdominal pain) and an increase in the amount of Cystatin C in the blood;for the first time, it was revealed that the development of sclerotic lesions due to increased proliferation in patients with the presence of the MMP-9 (A-8202G) rs 11697325 genotypes in chronic nephritic syndrome leads to a worsening of the clinical course of the disease; established early diagnostic marker MMP-9 (A-8202G) rs 11697325 and its tissue inhibitor TIMP-2 (C536T) rs 11551797 in chronic nephritic syndrome in children in the diagnosis of the disease; for the first time, the prognostic value of the alleles of the MMP-9 (A-8202G) rs 11697325 genes and the homozygous G/G genotype in determining the risk of developing the disease in children with chronic nephritic syndrome has been proven.
Implementation of the research results. Based on scientific results of evaluation of the role of polymorphic genes of matrix metalloproteinase and its tissue inhibitors in chronic nephritic syndrome in children: methodological recommendation “The role of polymorphic genes of matrix metalloproteinase and its genetic inhibitors in the development of chronic nephritic syndrome in children” was developed and approved (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 554 of 30.02.2022).
This methodological recommendation made it possible to predict the development of chronic nephritic syndrome in children and improve preventive measures; approved and developed on the basis of scientific results of research on early diagnosis and prognosis of chronic nephritic syndrome “Dynamics of clinical and laboratory parameters in nephritic syndrome in children”, (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 555 of 30.02.2022).
This methodological recommendation made it possible to optimize the diagnosis and treatment tactics for various forms of nephritic syndrome in children;
The results obtained were implemented in the practice of health care, in particular, in the Republican Children's National Medical Center, in the 1st clinic of the Samarkand State Medical University, in the Samarkand Regional Children's Multidisciplinary Medical Center (conclusion No. 8 n-r/324 of 21.06.2022 of the Ministry of Health of Uzbekistan).
The application of the obtained results to practice has made it possible to reduce the frequency of recurrence of the disease in children, prevent complications of the disease, improve the quality of life of patients, diagnose and prevent the disease.
The structure and scope of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions, practical recommendations. The volume of the dissertation is 120 pages.
Topicality and demand of the theme of dissertation. One of the actual problems of modern physical chemistry and macromolecular chemistry is the study on the development of the fundamentals of synthesis of functional polymers with ion-exchange and complexing properties.
Anion exchange and complexing compounds based fibrous materials have a high specific surface area, which provides a high possibility of sorption and desorption processes. They arc especially effective in removing toxic substances, even at very low content of the latter from the air and water pollution. Of particular interest is the acrylic fiber "Nitron", which is produced by JSC "Navoiazot" (Uzbekistan).
In the Academy of Sciences of the Republic of Uzbekistan, Tashkent Institute of Textile and Light Industry conducted research on the development of fibrous ion exchange materials based on acrylic fiber "Nitron" but they have not been brought to its logical end. In addition, when these studies neglected the study of the physicochemical aspects of the preparation of these materials.
In developing the fundamentals of ion exchange materials obtaining a lot of attention paid to the study of physical and chemical aspects of the synthesis and properties of these high-molecular compounds. These studies due to the fact that they allow you to adjust the processes of synthesis and, therefore, necessary to obtain polymers with required composition and with complex specific properties.
As noted above, to date, no attention was paid to the study of the physicochemical foundations of anion exchangers and polycomplcxons, due to applied research conducted to date in this field of research. In this regard, the study of physical and chemical principles of bases of creation, and the properties of anion exchangers and polycomplcxons based on acrylic fiber "Nitron" arc actual both from a theoretical and practical point of view.
Demand perform of the dissertation is characterized by the fact that modern worldwide technology for extraction of non-ferrous and precious metals can not be realized without the use of ion-exchange materials. These techniques use mostly granular sorbents, while fibrous sorbents comprise just 2-3 % of the ion exchange materials used . Using technology employing ion exchange material from algae and natural brine deposits of oil and gas recovered to 90% of iodine and bromine, lodinc-containing sorbents arc used for disinfection of drinking water from microorganisms and extraction of mercury from wastewater and gas emissions. They can be used for concentrating the processing solutions and biologically active substances in the preparation of catalyst systems nanoparticles metals. It should also be noted that Uzbekistan hitherto not been established as industrial manufacture granular and fibrous sorbents, although such polymers arc widely used in industry.
The purpose of this study is to identify the physico- chemical characteristics of the formation and properties of anion exchangers polycomplcxons based on acrylic fiber " Nitron ".
Scientific novelty of disscrtational research consists in the following:
in the first time studied the kinetics of the interaction of acrylic fiber "Nitron" with nitrogen-containing bases in aqueous and organic media;
shown that due to the high surface area fibers arc modifiable , the reaction rate depends on the concentration of the nitrile groups of the polymer being in the solid surface;
proved previously identified mechanism of the catalytic action of small amounts of hydroxylaminc on the process of modifying of fiber " Nitron " with nitrogen-containing bases;
in the first lime developed a method for producing anion exchangers branched structure by sequential treatment of acrylic fiber " Nitron " with cthylcncdiaminc and dichlorocthanc;
found that the interaction of PAN - fibers with hcxamcthylcnc- and ethylene diamines formed anion exchange fibrous materials having in its composition as a weakly basic and strongly basic functional groups ;
in the first time obtained new polycomplcxons with ampholytic properties by reacting maleic anhydride with amine -modified polyacrylonitrile fiber " Nitron " or by hydrolysis of residual of the nitrile groups modified with diamines of acrylic fiber "Nitron";
established values of the thermodynamic equilibrium constants of adsorption of ions Cr (VI), Си (II), halogens, Arsenazo (III) by synthesized anion exchangers and polycomplcxons and alteration in thermodynamic functions of the process testify to high sorption capacity of these ion-exchange materials with respect to the sorption ions;
Conclusion
1. Values degree reaction of the nitrile group and a nitrogenous base, the activation energy of the process shows that the process of modifying fiber " Nitron " nitrogen-containing bases subject to the usual regularities observed in homogeneous reactions. This effect is due to a high fiber surface area to be modified, allowing the reactants to facilitate access to the nitrile groups of the polymer. (Physical chemistry, High molecular compounds).
2. Kinetic studies of the reaction of acrylic fiber " Nitron " with diamine (hexamethylene and ethylenediamine) showed that the change of physical and chemical parameters of the modification process can be controlled sorption properties, chemical resistance and the strength of the anion exchangers due to network structure of the polymer. It has been established that this modification "Nitron" produces strongly basic anion character especially in organic media. Strongly basic anion exchangers possibility of obtaining a high sorption capacity with graft polycthylcnpolyaminc chain reactions revealed in fiber modification "Nitron " ethylenediamine in the presence of dichloroethane. (High molecular compounds, Physical chemistry ).
3. IR - spectroscopic and analytical determination of the formation of intermediate amidoxime groups in the polymer chains and free hydroxylaminc after substitution reaction proved previously proposed mechanism of the catalytic action of hydroxylaminc on the process of chemical modification of acrylic fiber " Nitron " nitrogen-containing bases . ( Physical Chemistry).
4. Developed conditions of synthesis polycomplcxons reacting maleic anhydride with modified by hcxamcthylcncdiaminc acrylic fiber "Nitron" and with of hydrolysis of residual nitrile groups modified by hcxamcthylcnc- and cthylcncdiamin of acrylic fibers . (High molecular compounds, Physical Chemistry).
5. Alkalinity obtained anion exchange resins depends on the nature of their functional groups. Strongly basic anion exchangers have in their composition cyclic amidine groups and they arc formed by the reaction of polyacrylonitrile fiber with a diamine. The specific surface area obtained fibrous sorbents exceeds by two orders of known surface area granular ion exchange resins, and their crosslinking rate is up to 100 nodes per macromolecule polymer. ( Physical Chemistry )
6. Kinetics and thermodynamics of the sorption of various inorganic and organic ions obtained polycomplcxons sorbents showed that ions of Cr (VI), Arsenazo (111) can be sorbed strongly basic anion exchangers only, and the process of sorption of copper (II) with polycomplcxons occurs not only due to the ion exchange, but also due to chelation. ( Physical Chemistry ).
7. Developed the conditions obtaining bromide complexes of polymers and kinetics, thermodynamics of the sorption halogen anion in synthesized materials was studied. It is shown that the lower the stability of the ion [Bn]’ for ion [J3]'than the ability to form such molecular chlorine ions leads to the fact that almost no molecular chlorine is adsorption, and molecular bromine is absorbed to a lesser extent than the molecular iodine. (Physical Chemistry ).
8. Combined developed iodinated anion exchange materials based on acrylic fiber " Nitron " and chitosan. Insertion of the iodinc-containing chitosan materials, leads to an increase of absorbent capacity. Combined antibacterial dressings have a pronounced anti-inflammatory and antibacterial effect, arc effective for the treatment of necrotic soft tissue diseases. (High molecular compounds, Physical Chemistry).
Topicality and demand of the subject of dissertation. In the world lat days chanchcd structures of trauma, increase the number of heavy combined traumas, which resulting in more heavy nature of simultaneous injuries of three , four or more anatomical regions, which creates difficulties in determining of the order of care and surgical tactics in patients with combined traumas of the facial skeleton bones (CTFSB). The syndrome of mutual burdening injuries of various anatomical regions, variety, hcavity and speed of the development of pathological process did difficulty of diagnosis of the CTFSB. Complexity of the clinical picture, features of the progress of post-traumatic shock, the development of traumatic disease cause difficulties which arise in the course of examination of patients and put tasks to the experts to find new ways of developing diagnostic algorithms and early surgical treatment of the CTFSB.
Frequency of CTFSB ranges from 34,8 to 63,3%. Fractures of orbit has been observed with an extremely high frequency (98%) in CTFSB, injury of the orbit is accompanied by damage of the eyeball and its subsidiary bodies has been observed in 66 % of eases. Consequences of eye injuries arc becoming the leading cause of disability and in 50% of eases could cause permanent loss of vision. By reason of death combined trauma take the third part after coronary heart diseases. Frequency of disfiguring defects and deformities of face occurs in 12 and 57%, disability in CTFSB reaches up to 23%. CTFSB, combined with TBI, causes up to 60% of deaths.
The causes of unsufficient results is non-availability of a diagnostic algorithm, which includes the most informative research methods, determining the order of interaction and priority of work of doctors of various specialties in CTFSB.
In some eases, requires specified an indications, character, scope, sequence and timing of surgical interventions, depending of the objective assessment of heaviness of injuries to various anatomical regions, prognosis criteria, the nature and heaviness of life-threatening consequences of combined trauma. The research work earned out within the framework of the achievement of the set by the Decree of the President of Republic of Uzbekistan “About measures on the further deepening reform the health care system” November 28, 2011, № PD-1652, maintenance of high-quality medical aid to the population under modem requirements and standards.In this regard the need for the development of algorithms of diagnosis and early methods of surgical treatment of patients with CTFSB constitute one of the important criteria demand the theme of dissertation.
Purpose of research is improvement of the diagnostic tactics and therapeutic interventions in patients with acute combined injuries of the facial bones according to the severity and location of the injury.
Scientific novelty of disscrtational research consists in the following: revealed the structure and features provide consistent care to patients with combined injuries in Republic of Uzbekistan;
The sequence of diagnostic and therapeutic measures, depending on the patient's general condition with CTFSB first determined by using created CT program "ADIL
developed innovative methods for early reduction and fixation of bone fragments in CTFSB;
identified endogenous factors, affecting on the wound process, disclosed the mechanisms of post-traumatic complications in CTFSB;
proved, that at 2 - 3rd days after the injury occurs the depression of cell and humoral immunity in the blood. Increases the level of proinflammatory cytokines, reduced the level of anti-inflammatory cytokine (in 2,8 at patients with heavy commonl condition. Increased levels of pro - and reducing anti - inflammatory cytokines is a poor prognostic factor in the development of inflammatory complications (bone wound suppuration, osteomyelitis of the jaw bones, soft tissue abscess);
patients with CTFSB at 2 - 3rd days after the injury occurs the depression of the content of protein and micronutrients (calcium, potassium and phosphorus) in the blood, which is a prognostic factor of the development of complications;
a scheme was developed for integrated medical correction of endogenous factors affecting on the development of posttraumatic complications;
1. CTFSB in 100% of cases combined with TBI, in 27.7 % with injuries of skeleton and internal injuries. In the diagnosis and treatment of patients with CTFSB should participate resuscitator, maxillofacial surgeon, neurosurgeon, ophthalmologist, and otolaryngologist. Primary debridement of wounds, reduction and fixation of bone fragments in patients in compensated state should be done within 3 hours after injury, while at subcompensated state - during the first day, and at the decompensated state - within 3 days.
2. With the CT program "ADIL" can determine the overall condition of patients in a short time. The most informative diagnostic criteria arc the general condition of patients, level of consciousness, hemodynamic stability, shock index and temperature gradient. The severity of the general condition of patients is directly dependent on the localization of the fracture of the facial bones. Multiple fractures of the upper and middle areas of the face arc the most serious injury in patients.
3. Patients with CTFSB in compensated and subcompensated state emergency surgical aid and diagnostic procedures should be performed in full volume (maxillofacial surgery, traumatology, neurosurgery, surgery, ophthalmology and otorhinolaryngologist), including the reduction and fixation of bone fragments in the first day. To patients with CTFSB in state decompensated should be performed at least diagnostic procedures, limiting the amount of emergency surgery. Reduction and fixation of bone fragments should be done after the restoration of function of vital organs and systems.
4. The method of choice for the treatment of depressed large bone fragments of facial bones is a titanium distractor, the use of which gives a good clinical and functional outcome.
5. When depressed fracture of the zygomatic arch application of the developed device will allow us to produce reduction and fixation of bone fragments in the early stages (within one day) with a good cosmetic result.
6. At patients with CTFSB in posttraumatic period (7- 14th day.) there arc a deep depression of CD3, CD4 cell composition, humoral factors and secretory immune system, increased necrosis factor CD95, increasing the levels of proin-flammatory (IL-6 ) and a decrease - anti- inflammatory (IL -10) cytokines. On 9-10th day reduced total protein, calcium, potassium and phosphorus in the blood .
7. Reduction of cellular and humoral immunity, increased proinflammatory cytokine and tumor necrosis factor, reducing the anti-inflammatory cytokine , the protein concentration in the blood, calcium, potassium and phosphorus arc predictors of complications.
8. Application of complex drug therapy within the 1-3 days after the injury with the inclusion of immune ( immunomoduline, ribomunil ), enzyme ( Voben-zym ) drugs osteoplastic materials allows to correct the violation of homeostasis, also used to prevent complications.
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.
Topicality and demand of the subject of dissertation. Bronchial asthma (BA) is one of the most common and serious diseases, which in the world suffer from 3 to 12% of the child population of the globe. Proportion of adolescents with asthma, is one third of all children with this disease. High prevalence of asthma in the numbers of teenagers, characteristics of the disease, age-related aspects of the functioning of the endocrine and immune systems of teenagers that cause difficulties which arise in the course of the diagnostic process, highlight the need to find innovative approaches to diagnosis and treatment of this disease.
It is known that the key immune mechanisms in the pathogenesis of the vast majority of AD cases is real and indisputable fact. Currently, considerable interest to researchers involved in the pathogenesis of positions of allergic diseases, especially asthma, along with IL-4 and IL-13 causes a number of other (IL-6, IL-8, IL-10, IL-5, INF-a and INF-y) immunoregulatory cytokines.
Genetic predisposition plays an important role in the development of allergic diseases. Currently available data on the relationship with asthma and associated with disease symptoms polymorphism approximately 150 genes. Important role as the main contender for the predisposition to asthma gene is a gene encoding flchain of high affinity receptor IgE. Interaction elevated levels of antigen-specific IgE with FceRip plays a central role in the pathogenesis of allergic asthma. Particularly attractive candidate gene asthma is also one of the enzyme genes biotransformation - GSTirl, encoding glutathione S-transferase and л1 express almost exclusively in the pulmonary tissue. This gene is located at the locus 11 ql 3, for which repeatedly shown clutch with atopic symptoms. Accumulated in the literature say about the relationship of gene polymorphism FceRI, GSTnl with different allergic diseases.
From this perspective, the study of immunological and genetic mechanisms of the pathogenesis of this disease for the construction of rational treatment and prevention emphasizes the relevance of this thesis research.
From the earliest days of independence, the country has successfully implemented state programs aimed at reforming the health care system. As a result, the targeted implementation of organizational health and research activities aimed at effective diagnosis, prevention and treatment of asthma among adolescents, with some success in the treatment of this disease in the country. However, now the problem of early diagnosis and the development of effective programs for treatment and prevention among adolescents with asthma remain one of the most important issues of modern health care. This research work was carried out in the framework of the tasks set by the Resolution of the Cabinet of Ministers of the Republic of Uzbekistan "On additional measures to improve the health of women and the younger generation," dated 25.01.2002 for the №32. In this regard, the need to deepen the information received about the state of cellular and humoral immunity among adolescents, asking pathogenetic informative immunogcnctic studies in asthma arc one of the important criteria demand the dissertation topic.
Purpose of research is study the immunological and genetic mechanisms of the pathogenesis of asthma in adolescents and form the basis of this plan rational diagnostic and therapeutic measures in this pathology.
In To achieve this goal the following tasks of research is solved:
to establish the clinical course of asthma in the population of adolescents living in the Samarkand region, in the early stages of the pathological process in the bronchopulmonary system.
explore the features of the state of cellular and humoral immunity, as well as activation markers in asthma in adolescence by determining the immunophenotype of lymphocytes in the peripheral blood.
to examine the level of production of immunorcgulatory cytokine interleukin-6 and interfcron-y and install them pathogenetic informative in asthma among adolescents.
to determine the features of distribution of allele and genotype frequencies of polymorphic variants of genes and FceRip GSTnl population Uzbek people with asthma, compared with the healthy part of the population.
examine the clinical and immunological aspects effectiveness of therapies using drugs and polioksidony tsikloferon in patients with asthma in adolescence.
on the basis of studies to develop a multivariate model of formation of bronchial asthma and develop an optimal algorithm for the diagnosis, treatment, prevention in adolescents with this pathological condition.
Scientific novelty of dissertational research consists in the following:
proposed introduction to the work of doctors teen clinics layered approach testing can significantly improve the detection rate of asthma in adolescence and optimize treatment and preventive measures in high-risk groups;
first defined the peculiar characteristics of the quantitative parameters of the immune status of patients with asthma in the cohort of adolescence and the corresponding proposed regulations and guidance documents for the healthy part of the adolescent population;
for the first time presents a comprehensive assessment of the cytokine profile of blood serum in bronchial asthma in adolescents. Specific features of products immunorcgulatory cytokines IL-6 and INF-y and their pathogenetic and regulatory information content in asthma among adolescents;
first analyzed the distribution of alleles and genotypes of polymorphic gene variants and gene FceRip GSTirl among patients with different phenotypic variants of AD and healthy individuals of Uzbek nationality, which resulted in the identified markers of increased risk or, conversely, resistance to the development of asthma in adolescents Uzbek ethnicity;
algorithms for phase diagnosis, treatment and prevention of asthma in adolescence in terms of disclosure of important moments of the pathogenesis of the disease, allowing to build a rational sequence of diagnostic search, aimed at verifying the diagnosis and expedient construction of preventive measures.
Conclusion
1. Set the frequency of occurrence of the disease and the structure of "asthma" in the arid zone among teens. Said pathology is recorded in 9,6% of the population surveyed adolescents, while the disease is more common among females. In the structure of the disease prevails periodical exposure and mild persistent form.
2. Identified by clinical features of asthma among adolescents living in the arid zone, indicate a high frequency of lesions of the bronchial tree association with allergic processes in other organs and tissues: in 73,9% of the AR, 53,7% with AK. 16,6% with BA and 14% with urticaria/angiocdcma.
3. Found that in the study population of patients with asthma adolescence occur expressed disturbances of the immune status, manifested deficit indicators as cell (CD3‘, CD4+, CD8 , CD16+), and humoral immunity (CD19 , IgA, IgG, IgM) and activation markers (CD23+, CD95). The immune status of patients with asthma in young people, adolescence has distinctive features, the depth of detected violations immunoreactivity was most pronounced in the younger age group.
4. In patients with bronchial asthma in adolescence revealed distinct changes in cell-cell interactions in the immune system: a significant increase in the content of Th2-cclls secreted IL-6 is a regulator of maturation of antibodies and immunoglobulin production itself, and vice versa reducing regulator activity of Th 1-cell cytokine INF-y.
5. It was found that the contents of cytokines IL-6, INF-y and in the peripheral blood is in communication with one pathogenic disease. It is shown that the lowest level of INF-y production in the scrum is characteristic of allergic clinical pathogenic variant asthma in adolescence. Adolescents suffering from predominantly infectious form of asthma, there is a sharp trend towards increased production of IL-6 in peripheral blood.
6. Revealed that markers of increased risk of allergic forms of asthma in adolescents Uzbek ethnicity arc genotype FceRip-109T/T allele FceRip-109T, low-risk markers - FcsRip-109C/C and allele Fc£Rip-109C. A high degree of cohesion genotype FcsRip-109T/T allele and FcsRip-109T with hereditary burden of asthma in the Uzbek population.
7. Among females ethnic Uzbek Association revealed lie-105 allele and genotype Ilc-105/Ilc-105 polymorphic gene locus GSTkI at high risk for asthma. Revealed that the genotype associated with the development Ilc-105/Ilc-105 allergic form of asthma in adolescents Uzbek population.
8. Complex therapy with adolescents’ patients with asthma ciklofcron and polyoxidonium, providing immunocorrective effect, enhances the clinical efficacy of basic therapy. In the study of prophylactic efficacy of immunomodulators positive indicators prevailed in the group of patients receiving polioksidony, necessitating its inclusion in the priority scheme of integrated treatment and prevention of asthma in adolescents.
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 results of a study on the composition and rheological properties of solutions after separation of glaserite, as well as the influence of technological parameters on the process of evaporation of mother liquors in the production of potassium sulfate by conversion of flotation potassium chloride with mirabilite of the Tumryuk deposit, are presented. The most intensive process of evaporation of the mother liquor, after separation of the glaserite, proceeds at a temperature of 100°C. In this case, after 60 minutes, the volume of the solution decreases by more than 50%, while at 80 and 60°C these figures are 20 and 5%, respectively. With an increase in the volume of the evaporated liquid from 5% to 40%, the amount of precipitated sodium chloride increases from 3.1% to 22.9% of the mass of the initial mother liquor containing (wt.%): K2O-6.86; Na2O-11.67; SO4-2-3.46, CI--16.02; H2O-66.26 at 20°C. The density of the mother liquors with an increase in the volume of the evaporated solution increases from 1.250 g/cm3 to 1.358 g/cm3 at a temperature of 20°C and from 1.210 g/cm3 to 1.330 g/cm3 at 80°C, the viscosity decreases from 2.126 mPa s to 2.007 mPa s upon evaporation of 40% moisture and up to 0.914 mPa s when the temperature rises from 20°C to 80°C.
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.
Objects of research: 1st group (control) - 8 dogs, which apply traditional intensive therapy at craniocereberal trauma without hypothermia. 2 st group - 8 dogs, which apply drug treatment with external craniocerebral hypothermia. 3 st group -8 dogs, which apply drug treatment with perfusion method of hypothermia. At 286 patients with heavy craniocerebral trauma, efficiency hyperventilation on a background of various methods CCH is investigated depending on type of infringement of a cerebral blood flow.
Purpose: to optimize results of protection and reanimation of a brain at a severe craniocereberal trauma by perfection of a method craniocerebral hypothermia and the differentiated choice of a mode of artificial ventilation easy.
Methods: the cerebral blood flow parameters estimated by transcranial Dop-plcrography datas. Also was definite saturation of arterial (SataO2) and venous (SaI. vjO2) blood oxygen, cerebral blood flow (arteriovenous difference O2), a level of lactate in peripheral blood and in liquor, parameters of intensity.
Results and novelty: by complex study was proved that perfusion method of the craniocerebral hypothermia is an effective and adequate method of protection of a brain caused by hypoxia and secondary damages at severe craniocerebral trauma. It is established, that at carrying out perfusion CCH the important factor of protection of a brain from hypoxia and secondary damages to which the death of animals at severe craniocerebral trauma, is preservation on a limit of physiological norm of functioning erythrocytes owing to adaptable decrease in processes the lipid peroxidation, preservation at high enough level of activity of enzymes antioxidant system, reactions peroxide hemolysis erythrocytes and which can serve as criteria of an estimation of the forecast of efficiency of spent treatment, an outcome of disease.
Practical value: it is developed and pathogenetic efficiency of a perfusion method of the CCH is proved at severe craniocerebral trauma. The algorithm of differential use hyperventilation at patients with severe craniocerebral trauma is developed depending on type of cerebral blood supply disturbance and a degree of development intracranial hypertension.
Inclusion of a method perfusion method of the CCH increase efficiency of protection of a brain from hypoxia and secondary damages reduces frequency of lethal outcomes at severe craniocerebral trauma.
Introduction and economic efficiency: results of research are introduced in practice of the Republican science centre of neurosurgery Health Ministry of the Republic of Uzbekistan and department of anesthesiology and resuscitation of 2-clinic of the Tashkent medical academy.
Field of application: resuscitation and neurosurgery.