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 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.
The aim of the study is to development of an algorithm for managing pregnancy and childbirth by studying the functional state of the mother-placenta-fetus system in pregnant women who have undergone COVID-19 in different trimesters of pregnancy.
The object of the study was 105 pregnant women who, were treated at the Samarkand Regional Perinatal Center and a specialized maternity center for pregnant women with COVID-19
Тhe scientific novelty of the research consists of the followings: for the first time in pregnant women infected with COVID-19, a relationship was established between the course of pregnancy, childbirth, the postpartum period and the development of complications depending on the trimester and severity of the disease; a direct correlation has been established between the state of the vessels of the mother-placenta-fetus system (resistance and pulsation indices, Endothelin-1 indicators), disorders in the hemostasis system (D-dimer, platelet aggregation) and the clinical course of the disease in pregnant women who underwent COVID-19; it has been established for the first time that the developed scale for assessing risk factors for non-developing pregnancy in women infected with COVID-19 (age, BMI, obstetric history, gestation period, hemostasis system status, endothelial function and severity of the disease) can serve as a prognostic marker of the degree of risk of pregnancy complications; it was proved for the first time that the choice of effective therapy for restoring hemodynamics in the mother-placenta-fetus system, in women who underwent COVID-19 at different stages of pregnancy, leads to a decrease in the number of thrombophilic complications.
Implementation of the research results. The results of the scientific research were introduced into the practical activities of the Samarkand Regional Perinatal Center by Order No. 128/1 of 01.09.2022 and the Samarkand City Maternity Complex No. 1 by order No. 58/1 of 03.10.2022. In pregnant women who underwent COVID-19 at different periods of pregnancy, changes in the mother-placenta-fetus system were determined using simple and effective research methods, such as ultrasound and Dopplerography, and this saved 53,000 soums; obstetricians and gynecologists, as well as neonatologists and therapists, are needed to diagnose signs of complications in the echocartin, that is, it has been proven that there is no need for other highly qualified specialists for this, due to the lack of need to train new personnel, state budget funds have been saved. With early detection of disorders in the hemostasis system in pregnant women with COVID-19: the period of stay of patients in the hospital was reduced from 10.5 days to 7.5 days and the number of hospital bed days was reduced; due to the reduction of the period of stay in the hospital for several days, the number of necessary drugs was reduced (on average, drugs are used for 1 day in the amount of 130,000 soums). Examination of pregnant women infected with viral diseases using simple and effective research methods such as ultrasound and Dopplerography served to save 85,000 soums: in the early stages up to 16 (10-11 weeks. - fetometry), 19-21, 32-34, 38-40 weeks of pregnancy; due to the absence of the need to use other research methods, it was possible to reduce costs by 23.5%; early detection of changes in the hemostasis system and endothelial dysfunction using fast, budgetary and effective research methods, contributed to the prevention of possible pregnancy complications, as well as the absence of the need to use long-term and expensive research methods, and this saved 106 000 soums: the coagulogram was checked in 105 (100%) patients, time was saved and efficiency was increased; endothelin-1 was also determined in 105 (100%) patients, efficiency was increased by 78.6%.
Improving the functionality of blood circulation in the uteroplacental and fetal-placental systems, a comprehensive analysis of possible complications during pregnancy and childbirth in women who have had viral infections, improving diagnostic, preventive and prognostic measures for managing pregnancy and childbirth contributed to the birth of live, full-term and healthy newborns in women who experienced COVID-19 during pregnancy, as well as a decrease in maternal mortality and perinatal mortality, 43% of women underwent rehabilitation in the postpartum period, 23.8% of women who underwent severe COVID-19 improved their quality of life.
To introduce scientific novelty on the topic “The impact of COVID-19 on the state of hemodynamics in the mother-placenta-fetus system in pregnant women”, a letter was sent to the Ministry of Health from Samarkand State Medical University on November 9, 2022 under No. 4295 (Conclusion of the Ministry of Health No. 8 n-z / 679 of December 15, 2022).
The structure and volume of the dissertation. The content of the dissertation consists of an introduction, five chapters, conclusion, list of used references. The volume of the dissertation consists of 113 pages.
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.
ВВЕДЕНИЕ 3
ГЛАВА I. ТЕОРЕТИЧЕСКИЕ ОСНОВЫ ОБУЧЕНИЯ
ПОСЛЕДОВАТЕЛЬНОЙ ПЕРЕВОДЧЕСКОЙ
ДЕЯТЕЛЬНОСТИ СТУДЕНТОВ ЯЗЫКОВЫХ ВУЗОВ 11
1.1. Различные подходы к трактовке перевода и особенности устного перевода 11
1.2. Лингвистические особенности текстов для обучения последовательной переводческой деятельности 26
1.3. Лингводидактические особенности развития компетенций последова-тельного переводчика и психолингвистические особенности последовате-льного перевода 38
Выводы по первой главе 55
ГЛАВА II. СОВРЕМЕННОЕ СОСТОЯНИЕ ОБУЧЕНИЯ
ПОСЛЕДОВАТЕЛЬНОЙ ПЕРЕВОДЧЕСКОЙ ДЕЯТЕЛЬНОСТИ СТУДЕНТОВ ЯЗЫКОВЫХ ВУЗОВ В РЕСПУБЛИКЕ УЗБЕКИСТАН..58
2.1. Анализ Государственного образовательного стандарта, учебных программ и учебников в плане исследуемой проблемы 58
2.2. Изучение, обобщение опыта обучения последовательному переводу студентов языковых вузов 66
2.3. Уровень владения навыками последовательного перевода студентами языковых вузов 71
2.4. Использование информационно-коммуникационных технологий в обучении последовательному переводу студентов языковых вузов и в совершенствовании комплекса упражнений для обучения последовательному переводу 85
Выводы по второй главе 117
ГЛАВА III. МЕТОДИКА ОБУЧЕНИЯ ПОСЛЕДОВАТЕЛЬНОМУ
ПЕРЕВОДУ СТУДЕНТОВ ЯЗЫКОВЫХ ВУЗОВ 119
3.1. Цель, задачи, организация и проведение экспериментального обучения 119
3.2. Качественный и количественный анализ результатов экспериментального обучения 128
3.3. Методические рекомендации по обучению последовательному переводу студентов языковых вузов с учетом критериев отбора текстов 137
Выводы по третьей главе 148
ЗАКЛЮЧЕНИЕ 149
СПИСОК ИСПОЛЬЗОВАННОЙ ЛИТЕРАТУРЫ 151
ПРИЛОЖЕНИЯ 167
ВВЕДЕНИЕ
Актуальность и востребованность темы диссертации. Потребность в практическом переводе растет в мире по мере углубления процесса глобализации и расширения межэтнических отношений. Понимание межъязыковой и межкультурной коммуникации в профессиональной подготовке переводчиков, анализ переводческой практики, разграничение жанровых особенностей, формирование и развитие переводческих способностей, расширение терминологии, анализ переводческих вмешательств, развитие профессиональных качеств, справка и комментарии к зарубежной специализированной литературе по переводу важно провести исследования для улучшения стандарта обучения.
В мире особое внимание уделяется углублению научных исследований на основе таких задач, как повышение качества перевода, развитие профессиональной этики, обучение за счет психофизиологических навыков, грамотное решение задач межкультурного общения, улучшение подготовки переводчиков в реальных ситуациях. В связи с этим формирование рефлексивных, коммуникативных, профессиональных, лингвистических, прагматических и межкультурных коммуникативных компетенций переводчиков при последовательномпереводе, анализ переводческой практики, расширение терминологии, выявление лексических, технических, психологических трудностей, а также двуязычия, многоязычия, коннотации, Приоритет отдается исследованиям трансформации, интерференции, эквивалентности, конвергенции, анализа (воображение) и синтеза (речь), формирования межъязыковой и межкультурной коммуникации, а также совершенствования жанровых и психолингвистических особенностей.
В нашей стране в результате реформ, основанных на развитии международных отношений, коренное реформирование системы образования, организация образовательного процесса в соответствии с общемировыми образовательными стандартами и национальными ценностями усиливает потребность в переводчиках. В Послании Президента Республики Олий Мажлису подчеркнуто: «Мы и в дальнейшем будем придавать приоритетное значение глубокому изучению английского и других иностранных языков. Вместе с тем наладим широкомасштабную работу по подготовке и повышению квалификации кадров по востребованным в нашей стране специальностям» [1]. При этом имеют важное значение лингводидактические особенности обучения последовательному переводу, составные и обоснованные характеристики компетенции переводчика относительно учебного процесса, авторская модель обучения, реализация обучения и интерактивных методов обучения с использованием общих, особенных и педагогических принципов, информационных технологий.
Данное диссертационное исследование в определенной степени служит реализации задач, обозначенных в Указе Президента Республики Узбекистан №УП-4947 от 7 февраля 2017 года «О Стратегии действий по дальнейшему развитию Республики Узбекистан» [2], в Указах Президента Республики Узбекистан №УП-5847 от 8 октября 2019 года «Об утверждении Концепции развития системы высшего образования Республики Узбекистан до 2030 года» [3], №УП-5763 от 11 июля 2019 года «О мерах по реформированию управления в сфере высшего и среднего специального образования» [4], в Постановлениях Президента Республики Узбекистан №ПП-2909 от 20 апреля 2017 года «О мерах по дальнейшему развитию системы высшего образования» [5], №ПП-3775 от 5 июня 2018 года “О дополнительных мерах по повышению качества образования в высших образовательных учреждениях и обеспечению их активного участия в осуществляемых в стране широкомасштабных реформах” [6], №УП-4391 от 11 июля 2019 года “О мерах по внедрению новых принципов управления в систему высшего и среднего специального образования” [7], в Постановлениях Кабинета Министров Республики Узбекистан №174 от 24 мая 2016 года "О мерах по закупке зарубежной учебной и научной литературы для системы высшего образования" [8], №816 от 10 октября 2018 год “Об обеспечении высших образовательных учреждений учебной литературой»[9], а также других нормативно-правовых актах, касающихся данной деятельности.
Соответствие исследования с приоритетными направлениями развития науки и технологий республики. Диссертация выполнена в рамках приоритетного направления развития науки и технологий Республики I.« Духовно-нравственное и культурное развитие демократического и правового общества, формирование инновационной экономики».
Степень изученности проблемы. Проблемами изучения перевода и преподавания перевода в Узбекистане занимались И.Гафуров, Ж.Шарипов, Н.Камбаров, Г.Саломов, О.Муминов, Э.Муратова, К.Мусаев, И.Тухтасинов, У.Йулдашев, Г.Ирмухамедова и другие ученые [92, 156, 110, 142, 46, 48, 134, 148, 108, 35].
Г.Бакиева, Л.Ахмедова, М.Джусупов, Д.Джуманова, Д.Хашимова, М.Ирискулов, Э.Эркаев, М.Назарова, Ф.Абдуллаева, Н.Бабаниязова [12, 80, 97, 96, 150, 107, 159, 50, 74, 82] и другие ученые проводили исследования в области методики обучения иностранным языкам.
Вопросы подготовки будущих переводчиков в странах СНГ изучали такие ученые, как Е.Аликина, Н.Гавриленко, А.Гребенщикова, Л.Бархударов, В.Сафонова, О.Максютина, И.Алексеева, С.Гураль, Б.Комиссаров [77, 90, 94, 84, 143, 124, 76, 95, 112].
Дж.Кэтфорд, Э.Найда, Дж.Ричардс, К.Бринклекс, С.Колина, Д.Жиль [19, 49, 58, 17, 22, 29] занимались обучением методам последовательного перевода в европейских странах.
Связь диссертационного исследования с планами научно-исследовательских работ высшего образовательного или научно-исследовательского учреждения, где выполнена диссертация. Исследование диссертации проводилось в рамках исследовательского проекта Узбекского государственного университета мировых языков «Исследования, научная и творческая работа среди докторантов, независимых исследователей и студентов».
Цель исследования состоит в выявлении лингводидактических особенностей обучения последовательному переводу студентов языковых вузов, а также разработка предложений и рекомендаций по совершенствованию методики обучения последовательному переводу с родного языка на английский и с английского на родной.
Задачи исследования:
изучить подходы к переводческому процессу и сравнить особенности последовательного и синхронного перевода через уровни процесса перевода;
определить лингводидактические особенности обучения последовательному переводу посредством изучения компетенций последовательного переводчика;
выявить психолингвистические особенности последовательного перевода и определить необходимые психофизиологические навыки студентов;
выявить и уточнить трудности, испытываемые переводчиком на каждом этапе процесса последовательного перевода;
определить критерии отбора текстов с учетом их лингвистических особенностей в обучении последовательному переводу;
организовать педагогические опытно-экспериментальные работы, провести их, разработать рекомендации по результатам исследования и усовершенствовать методику обучения последовательному переводу студентов языковых вузов.
В качестве объекта исследования обозначен процесс обучения последовательному переводу студентов языковых вузов, к опытно-экспериментальным работам привлечено 222 студента по направлению «Теория и практика перевода» Узбекского государственного университета мировых языков, Каракалпакского государственного университета им. Бердаха, Самаркандского государственного института иностранных языков.
Предмет исследования: лингводидактическое содержание, формы, средства обучения последовательному переводу студентов языковых вузов.
Методы исследования. В диссертации применен комплекс методов, направленных на обеспечение эффективного изучения: теоретические (аналитико-статистический, сравнительно-сопоставительный, аналогия, моделирование), диагностические (опросы, беседа, анкета, наблюдение, проектирующие методики), прогностические (экспертное оценивание, обобщение самостоятельных оценок), педагогический эксперимент и математические методы (статистическая обработка данных, графическое изображение результатов и другие).
Научная новизна исследования заключается в следующем:
общие, отличные (классификация, временной интервал, оборудование, переводческая деятельность, действия, коммуникация) и схожие (форма, усвоение, сопоставление, реальная коммуникация, общность навыков) особенности синхронного и последовательного перевода определены через уровни оценки качества перевода (микро-, мезо- и макроуровень);
своеобразные лингводидактические особенности обучения последовательному переводу (прагматические, лексико-семантические, коммуникативные, психофизиологические, социокультурные, технические) выявлены через развитие психофизиологических данных(громкость и четкость речи, устойчивость к стрессовым ситуациям, удерживание в оперативной памяти основного содержания фразы и др.) студентов;
лингвистические, психологические и технические трудности речевых навыков уточнены по ситуационным факторам через этапы последовательного перевода (начальный, ключевой, переходный, этап синтеза, итоговый);
на основе методики отбора целевых специальных текстов и ситуационного анализа усовершенствована методика обучения двустороннему последовательному переводу с родного языка на английский язык и с английского языка на родной язык.
Практические результаты исследования состоят из нижеследующего:
на основе психофизиологических особенностей последовательного переводчика усовершенствован комплекс упражнений с содержанием, ориентированным на последовательный перевод, а также критерии отбора специальных текстов;
разработан план тренинговых занятий для переводчиков с содержанием, ориентированным на последовательный перевод;
разработано методическое обеспечение обучения последовательному переводу гидов-переводчиков.
Достоверность результатов исследования определяется использованием результатов отечественных и зарубежных ученых и практиков в сфере педагогического образования и методологии теории познания; применением источников, соответствующих задачам исследования, взаимно дополняющих друг друга методов исследования; анализом опытно-экспериментальных работ и качественному и количественному обеспечению результатов исследования.
Научная и практическая значимость результатов исследования. Научная значимость результатов исследования состоит в описании психолингвистических особенностей последовательной переводческой деятельности и подходов к процессу перевода, критериев отбора текстов с учетом их лингвистических особенностей при обучении последовательному переводу, а также в изучении компетенций последовательного переводчика.
Практическая значимость исследования определяется тем, что при разработке учебников, учебных пособий, учебных программ в высших образовательных учреждениях можно использовать план тренинговых занятий для переводчиков с содержанием последовательного перевода, методическое обеспечение и комплекс упражнений по обучению последовательному переводу гидов-переводчиков.
Внедрение результатов исследования. На основе методических и практических предложений, разработанных по лингводидактическим особенностям обучения последовательному переводу студентов языковых вузов:
научные новшества, касающиеся общих, различных и аналогичных функций синхронного и последовательного перевода, были использованы при подготовке специальных материалов для обучения последовательному переводу гидов-переводчиков музея Олимпийской Славы (справка № 02-07-08-1926 Министерства физической культуры и спорта от 6 июля 2020 года). В результате разработана разработка тренингов по содержанию последовательного перевода для переводчиков, которая дает возможность более точно оценить качество перевода на микро-, мезо- и макроуровне и повысить качество последовательного перевода;
своеобразные лингводидактические особенности обучения последовательному переводу, выявленных на основе развития психофизиологических данных студентов использованы в практическом проекте А-1-209 «Создание учебников и учебных пособий на английском языке по теоретическим дисциплинам в магистратуре (английский язык) с точки зрения межкультурно-коммуникативного подхода и создание узбекско-англо-русского словаря лингвистических терминов» (справка № 89-03-4459 Министерства высшего и среднего специального образования от18 ноября 2019года). В результате возможности повышения качества перевода и его оценки были расширены за счет улучшения этапов процесса последовательного перевода;
ситуационные факторы лингвистических, психологических и технических трудностей речевых навыков, выявленные на этапах последовательного перевода 6.1. Совершенствование модуля современных тенденций в переводе и обучении (справка № 10-05/65 Республиканского научно-практического центра развития инновационных методик обучения иностранным языкам при Узбекском государственном университете мировых языков от 8 июня 2020 года). В результате, было обогащено содержание учебных курсов для учителей;
при подготовке материалов для методического обеспечения гидов- переводчиков и экскурсоводов использованы рекомендации по методике обучения двустороннему последовательному переводу с родного языка на английский и с английского на родной язык, усовершенствованные на основе методики выделения целевых специальных текстов и ситуационного анализа (справка № 02-22/7465 Государственного комитета Республики Узбекистан по развитию туризма от 11 октября 2019 года). В результате обогащено методическое обеспечение обучения гидов-переводчиков последовательному переводу, появилась возможность повысить профессиональную активность гидов-переводчиков и экскурсоводов.
Апробация результатов исследования. Результаты настоящего исследования обсуждались на 7 международных и 8 республиканских научно-практических конференциях.
Опубликованность результатов исследования. По теме диссертации всего опубликовано 23 научные работы, из них 8 статей в научных изданиях, рекомендованных Высшей аттестационной комиссией Республики Узбекистан для публикации основных научных достижений диссертации, из которых издано 7 - в республиканских, 1 - в зарубежных журналах.
Структура и объём диссертации. Диссертация состоит из введения, трёх глав, заключения, списка использованной литературы и приложений. Основной текст (объём) диссертации составляет 150 страниц.
ЗАКЛЮЧЕНИЕ
В результате исследований, проведённых по диссертации доктора философии (PhD) по педагогическим наукам на тему «Лингводидактические особенности обучения последовательному переводу студентов языковых вузов» представлены следующие выводы:
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.
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.
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.
The aim of the study is to improving the quality of treatment of ventral hernias in patients with morbid obesity by improving the tactical and technical aspects and optimizing the choice of hernioplasty method.
The object of the study were 121 patients with ventral hernias and morbid obesity who were hospitalized in the surgical department of the 1st clinic of the Samarkand State Medical University in the period from 2012 to 2021.
The scientific novelty of the study is as follows: a method was developed for preoperative preparation of patients with ventral hernia and morbid obesity using a modified pneumatic belt-bandage to adapt the cardiovascular and respiratory systems to intra-abdominal hypertension after hernioplasty; improved technical aspects of the reconstruction of the anterior abdominal wall in patients with morbid obesity; the surgical instrument "retractor" has been improved for technical optimization of the stage of suturing the anterior abdominal wall for fixing the prosthesis in patients with concomitant obesity and abdominal ptosis; clarified clinical and instrumental criteria for the specific unification of the scale for assessing the quality of life of patients after hernioplasty and abdominoplasty for ventral hernias and morbid obesity with differentiation of the value of physical, mental and social daily activity. The practical results of the study are as follows: According to the results of a scientific study to improve the diagnosis and surgical treatment of patients with ventral hernias and morbid obesity: improved "retractor". The use of the proposed tool made it possible to level the technical difficulties in fixing the prosthesis against the background of severe overweight with a reduction in the operation time; developed guidelines "Technical aspects of hernioplasty for ventral hernias in patients with morbid obesity" (certificate of the Ministry of Health 8n-r / 905 dated October 12, 2021), "Criteria for the choice of surgical treatment of patients with ventral hernias and obesity" (certificate of the Ministry of Health 8n-r /906 dated October 12, 2021). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and morbid obesity; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and morbid obesity have been introduced into the practice of health care, in particular, in the departments of surgery of the 1st clinic of the Samarkand State Medical Institute, the Jizzakh Regional Multidisciplinary Medical Center and the Sh. Rashidov District Medical Association of the Jizzakh region (certificate of the Ministry of Health 8n-z / 368 dated October 22, 2021). The implementation of research results by improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and morbid obesity made it possible to reduce the overall incidence of postoperative complications from 14.8% to 8.9%, including wound complications from 11.1% to 4.5% and extra-abdominal from 7.4% to 4.5%, as well as significantly reduce the duration of surgical treatment and rehabilitation periods after various types of hernioplasty and abdominoplasty. The structure and scope of the dissertation. The dissertation consists of an introduction, five chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of the text material is 107 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.
Object of the research: the process of teaching physics
The aim of the research: The periodical law of physics and the proof of the physical education according ot the law.
Methods of the research: To analyze literature regarding the research; to observe teaching process, conversation with the teacher and a pupil, to observe professional expricnce of school teachers, to prepare questionnaires, to conduct, to work out and analyse statistically the pedagogical experiment.
Scientific novelty of the research: Considering the periodic education law as a separate subject, the periods of physical education were methodically characterised, the diffcrcnciation was analyzed, the practical outcome of physical pcriodisation was reflected and the technology of governing physical education periodically at secondary schools and learning teaching materials were thoroughly established.
Practical importance of the research: the periodic technology of teaching physics which is the result of the research - can be widely used in teaching physics at secondary schools; in creation of teaching material; in working out new forms of independent and distance learning and in teachers’ training system. It can also be used in teaching other subjects at secondary schools and in other stages of education.
Efficiency and the implementation of the project: More than 30 articles, brochures and a monography were published on this dissertation. The results of the research were discussed and analyzed in the scientific conferences in foreign and local teachers and professors conferences and meetings at Bukhara State University and in another educational establishments. (Bukhara - 2000, 2001,
2002, 2003; Karshi city - 2003, 2004; Guliston city 2002, 2005; Samarkand -
2003, 2004, Tashkent city 2003, 2005; Termez city 2003, 2004; Namangan city 2005, Ferghana city 2002, 2004). The efficiency of the research at secondary schools has reached 20.8% at average.
The degree of implementation: The results of the research can be used in teaching physics at secondary schools, in teachers training system, in the creation of text-books and other teaching materials and in condiction research works connected to this matter.
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.
Today, Uzbekistan is opening up to the whole world. One of the factors in the development of any state is that it has its place in the world community within the framework of important organizations. Uzbekistan has introduced various diplomatic mechanisms to accelerate the process of active interaction and mutually beneficial cooperation with the region and the world. One of the most important organizations in our country is the Shanghai Cooperation Organization. The rich history and close cultural ties between the SCO member states predetermine wide cultural and humanitarian cooperation within the organization. In this sense, it is worth noting that a hundred years ago the space of the SCO countries was connected by the ancient routes of the Silk Road. It is also deeply symbolic that by the 21st century, the countries of Eurasia are ready to develop new economic, cultural and humanitarian ties, reviving ancient traditions in the context of globalization. Some political and economic changes in the world require that only interstate cooperation be adapted to the principles of public diplomacy. Cultural and humanitarian cooperation has a growing tendency to develop mutual understanding, mutual enrichment and integration of cultures, creating a solid social basis for disseminating information and knowledge about the traditions and customs of peoples in the SCO space. Uzbekistan has long been associated with the people of the SCO space through ethnic, linguistic, religious and other ties. It was the land of Uzbek that served as a bridge connecting these links. Therefore, the most important direction of Uzbekistan’s foreign policy is cooperation with the SCO membe countries. Therefore, the possibility of further strengthening the role of Uzbekistan in all areas is an urgent problem. This article describes the cultural and humanitarian cooperation between Uzbekistan and the SCO, multilateral diplomacy in this area and the contribution of Uzbekistan to the development of this sector within the organization
Subject of research: 128 patients with acute, subacute, secondary-chronic and primary-chronic types of Rock fever.
Aim of research: early diagnosis of audio and vestibular disturbances on patients undergo Rock fever and against background of usage of ototoxic medicines by applying of modem complex tools of audio research and impcdanccmctry.
Tools of research: general clinical research, special inquiries: examination of otolaryngologic organs, acoumctcring, tone threshold audiomctcring, voice audiometery, impcdanccmctry, detection of audio sensitivity to ultrasound under methodology of В. M. Sagalovich, vestibulometery, clcctronistagmography, reenccphalography.
Results received and their novelty: different types of audio disturbances were first time discovered from patients with Rock fever infection during a complex inquiry of audio and vestibular organs status: in acute and subacute types of Rock fever there dominate the audio disturbances on sound conductivity, in chronic type - the mixed or advantageously ncurosensoric character. There was applied an impcdanccmetry to define a character and level of injury of audio organ.
A scheme of complex conservative therapy included the mounts that influence on hemodynamics; adjuvants; the mounts that influence on tissue interchange; antyhypoxantincs that improve microcirculation of internal car; enzyme mounts that eliminate cicatrical and soldering processes in medium ear.
Practical value of dissertation: a qualified method of diagnosis of different types audio disturbances was proposed to practical public health. The methods of early diagnosis allow asserting a necessity of usage of early complex inquiries of audio and vestibular analyzers to make a prevention and development of further abnormalities (hard hearing and surdity).
A level of introduction: received results were introduced to the work of Otolaryngologic department of Second Tashkent State Medical Institute and clinical infectious hospital of Scientific Research Institute of Epidemiology, Microbiology of Infection Diseases of Republic of Uzbekistan.
Fields of applying: otolaryngology, infection diseases.
Subject of the inquiry: 298 patients with finn deformations of the larynx and trachea
Aim of the inquiry: early rehabilitation of patients with firm deformations of the larynx and trachea path optimization and creating clinical and pathogenic methods of complex treatment.
Methods of the inquiry: clinical examination, special examination: LOR-examination, endoscopy of air ways, X-ray, CT, MRI of larynx, trachea and bronchus, bacterial examination of larynx and trachea wounds; morphological examination, biochemical methods of examination: lipid peroxidation, antioxidant enzymes, activity of hepatic monooxygenase system (MOS); biophysical methods of examination: исследование electric damage of erythrocytes’ membrane (EDEM), blood viscosity (BV) and blood shift velocity (BSV); cytological examination.
The results achieved and their novelty: In patients with firm deformations of the larynx and trachea, firstly basing on complex investigation clinical and structural-functional parameters revealed pathomorphological changes in neck tissues as chronic inflammation with productive component. Despite, revealed disrupt balance of process lipid peroxidation and antioxidant system, hydroxylic function of liver, decrease of electoral penetrability of erythrocytes’ membrane and aggravate of hemorheology. With this, level of expression of changes depends on clinic form and load disease, correlate with stage of wound healing and after restore of functions of the larynx and trachea gradually becoming normal. Presented classification of the firm deformations of the larynx and trachea, permitting complexly counting etiologic factor and morphological variant of the damage of laryngotracheal tract. In scheme of the pathogenic complex conservative therapy before and after reconstructive operations included medicine, influencing on Hemodynamic, with ability membranotrope action, systemic enzymotherapy, immunostimulators, and correction of the tissue metabolism by laser. Created private and modified methods of reconstructive laryngotracheoplasty in case of cicatricle stenosis of glottic and subglottic parts, bilateral paralyses of the larynx, cicatricle deformations of pharyngolarynx, combination deformations and defects of the larynx and trachea, permitting single stage restore laryngotracheal ways.
Practical value: The investigation of pathogenic mechanism of developing of the firm deformations of the larynx and trachea on data of changes of main functional and metabolic processes will permit not only activating and improving of pathogenic therapy, and forecasting variant of development and course of postoperative period after reconstructive operations.
Use of proposed methods of complex conservative and surgical treatment of the firm deformations of the larynx and trachea allowed to provide whole volume of restoring means in more short time and with less quantity of stage operations, preoperative preparing till 3 days, hospital stay till 14-20 days, surgical operations in 1.9 time.
Degree of embed and economical effectivity: The results of investigation intruded in treatment practice of the First and Second Tashkent Medical Institutes, LOR-clinics of Samarqand territorial children hospital, territorial hospital of Karshi. Materials of the investigation using in study process of LOR - cathedra First Tashkent Medical Institutes during lectures and practice tutorials with students, magistracies, and clinic ordinators. Determined main economic effect in use of proposed complex therapy in connection with reduce of term of treatment and hospital stay (on an average 10 days) and taking off or decreased disability on 67% patients.
Sphere of usage: otorhinolaryngology, surgery, reanimation
Object of research: The object of the thesis is the aspect of standard speech in the languages of mass media.
Subject of research: is the normative, communicative and ethic aspects of the speech standard of the language of mass media.
Methods of research: The following methods have been used in the thesis: the method of linguistic classification, methods of semantic and stylistic and componcntial analysis, comparative method, analysis of uttered speech on the radio and TV, and social poll.
The obtained and their novelty: The normative, communicative and ethic aspects of speech standard of mass media (newspaper, television and radio) were analysed for the first time as a monographic research; the principles of the problems of the language of the mass media and speech standard in linguistics were defined; modern concept of the speech standard have been covered and specific features of using speech standards in the language of the mass media have been pointed out; the language peculiarities of the language of the mass media have been analysed; national specific feature of the language of newspaper was covered; socio and psycholinguistic and functional and communicative peculiarities have been studied; expressiveness of the newspaper language and its speech and speech standard evaluation have been defined; the specific language features of newspaper, television and radio have been pointed out; speech the language of newspaper, television and radio have been analysed from speech standard point of view; the use of language in mass media have been analysed from standpoint of speech standard and normative aspect; speech standard of mass media have been analysed from communicative aspect; standard of speech was analysed from ethic aspect; interrelation between the aspects of speech standard in the language of mass media have been revealed
Practical value: The results of the research can be applied to doing scientific work in General Linguistics, Uzbek Linguistics, Speech Standard, Stylistics, Rhetoric and Journalism; it can used in conducting lectures and having seminars in the philology and journalism faculties in speech standard, stylistics, the language of Mass Media, and Rhetoric.
Degree of embed and economic efficiency: The basic content of the work reflected in a monograph, in scientific articles published in foreign journals, scientific and theoretical conferences, and in more than 60 articles and abstracts.
Sphere of usage: The materials of the research can be used in writing textbooks in Speech Standard, Stylistics, Linguoculturology, the Language of Mass Media, and Psycholinguistics.
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).
В современной абдоминальной хирургии одним из актуальных направлений для исследований продолжает оставаться совершенствование различных вариантов пластики послеоперационных грыж. В мире ежегодно выполняется более 2100000 операций по поводу вентральной грыжи и 42% из них -послеоперационные грыжи. В последние годы наблюдается явная тенденция к расширенному применению при гсрниопластикс различных вариантов биологических сеток. «Объединенный анализ семи исследований PCSTAR для послеоперационных грыж с использованием ретромускулярной сетки показал, что частота рецидивов грыжи составляет 5,7%». Применение стандартных оперативных вмешательств по типу аллопластики в положении onlay не решает проблему ранних послеоперационных осложнений: отхождение сером, миграция сетки, спаечпая болезнь, высокая частота рецидива грыж и др. В то же время пластика грыж местными тканями создает проблему повышения вну-трибрюшного давления, и поздним осложнениям в виде рецидивов грыж. «Рост послеоперационного внутрибрюшного давления приводит к полиорган-ной недостаточности, затем абдоминальному компартмент синдрому, и даже смерти». В настоящее время не существует консенсуса о хирургическом подходе при гигантских послеоперационных грыжах брюшной стенки, в связи с чем необходимость продолжения разработки новых технологий и совершенствования тактики не вызывает никаких сомнений.
В мировой практике в настоящее время наиболее актуальными продолжают оставаться исследования, направленные на изучение морфологических и функциональных аспектов рецидивных послеоперационных вентральных грыж, электронная микроскопия выявляет ультраструктурные деструктивные изменения клеток кожи, апоневроза и мышц, что свидетельствует о морфофункциональной недостаточности тканей брюшной стенки,обсуждаются вопросы клеточной инженерии новых инновационных материалов, проводятся шментальные исследования на животных с испытанием биотехнических свойств, текстуры и эластичности новых полимеров, проводятся исследования открытых доступов с разделением заднего компонента с выпуском поперечной мышцы живота и ретроградной сеткой, начаты роботизированные операции.
Современные аспекты развития отечественного здравоохранения включают множество мер, направленных на улучшение результатов лечения больных с послсопсрациоными вентральными грыжами и связанными с ними патологическими состояниями за счет внедрения современных принципов интенсивной терапии и хирургической тактики. В стратегию развития Нового Узбекистана на 2022-2026 годы по семи приоритетным направлениям включены задачи по повышению качества оказания населению квалифицированных медицинских услуг. Реализация данных задач, в том числе, путем оптимизации тактико-технических подходов к выбору метода герниопластики, а также разработка методов профилактики гнойно-воспалительных осложнений в области аллопластического матераиала, является одним из актуальных направлений абдоминальной хирургии и медицины в целом, ввиду высокой медико-социальной значимости данной патологии.
В результате исследований, проведённых в мире, по повышению эффективности аллопластики при послеоперационных вентральных грыжах и снижению риска осложнений в послеоперационном периоде получен ряд научных результатов, в том числе: определено, что пациенты, перенесшие реконструкцию брюшной стенки, имеют повышенный риск послеоперационной дыхательной недостаточности, понимание эпидемиологии этого осложнения может улучшить профилактику; доказано, что чем крупнее грыжа, тем выше риск ранних хирургических осложнений, в том числе таких как дыхательная декомпенсация, поскольку грыжи со временем часто увеличиваются в размерах, откладывание операции может привести к увеличению размеров грыжи и, следовательно, к большему риску осложнений; показано, что отношение объема грыжи к объему брюшной полости <20% является независимым фактором при закрытии без натяжения, что обосновывает интерес к предоперационной во-люметрии для адаптации тактики хирургической помощи; определено, что у пациентов, перенесших плановую лапароскопическую гсрниопластику, предикторами смертности являются более старший возраст и некоторые сопутствующие заболевания: застойная сердечная недостаточность, нарушения легочного кровообращения, коагулопатия, заболевания печени, метастатический рак, неврологические расстройства и паралич; установлено, что пожилой возраст, асцит, предоперационная почечная и легочная недостаточности являются независимыми предикторами 30-дневной смертности, при наличии этих факторов риска следует серьезно рассмотреть консервативное лечение; доказано, что универсальный калькулятор хирургического риска Американского колледжа хирургов (ACS) точно предсказывает тридцатидневные исходы, включающие серьезные осложнения: венозную тромбоэмболию, соматическую заболеваемость, инфекцию области хирургического вмешательства, незапланированную повторную операцию, смертность и продолжительность пребывания в стационаре.
В настоящий период в мире наиболее актуальными исследованиями в хирургии продолжают оставаться разработка новых методов герниопластики при больших и гигантских вентральных грыжах, каждый из которых имеет свои плюсы и минусы в зависимости от сложности выполнения, риска развития послеоперационных осложнений и рецидива, проводятся крупные рандомизированные клинические исследования, сравнивающие существующие методы традиционной герниопластики с лапароскопическим доступом и роботизированной хирургией, все более распространяющейся в последние 10 лет, проводится поиск новых синтетических и биологических материалов, разрабатываемых для производства и использования композитных сеток, обладающих необходимой прочностью и способностью предотвращать фатальные местные осложнения в условиях контаминированной среды. Однако, несмотря на технические достижения в этой области, ни один современный метод герниопластики и протезы не отвечают всем требованиям. Одна из ключевых проблем заключается в том, что существующие синтетические эндопротезы не имеют достаточной эластичности, устойчивости к инфицированию, высокой механической прочности и целостности в течение длительного времени. Дальнейшие исследования этих клинических аспектов несомненно улучшат современное представление о возможностях биосовместимых эндопротезов и позволят разработать оптимальный метод их расположения при аллогсрниопластикс.
Подход к пациентам с послеоперационными грыжами значительно изменился за последние 20 лет благодаря как достижениям в технологии создания сетки, так и хирургическим подходам. Ключевые факторы успешного исхода включают изменение факторов риска до операции, таких как отказ от курения и снижение веса, выбор сетки, соответствующей типу грыжи и запланированному расположению сетки, а также широкое перекрытие сетки за пределами грыжевого дефекта. У этих пациентов все чаще используются новые методы, такие как высвобождение трансабдоминальной мышцы и разделение компонентов с установкой ретроградной сетки и роботизированные подходы к грыже брюшной стенки. В последние годы наблюдается увеличение количества биологических сеток, доступных для герниопластики брюшной стенки. Биологические сетки обычно состоят из материалов, полученных от человека, свиньи или крупного рогатого скота. Обоснование использования биологических сеток заключается в том, что они могут действовать как каркас для прорастания естественных тканей. Кроме того, существуют рассасывающиеся синтетические сетки, которые обладают свойствами, аналогичными свойствам биологических сеток, но с теоретически меньшим риском, поскольку они не получены из животного или человеческого материала. Выбор сетки для вентральной грыжи зависит от множества факторов, которые включают в себя как свойства сетки, так и се расположение, например, внутрибрюшинно, предбрю-шинно или ретроректусно ее размещать. Кроме того, тип грыжевого дефекта является еще одним фактором риска, например, является ли рана чистой или грязной, и выполняется ли пластика мостовидным протезом или с опорой. Следует избегать легких или биологических сеток для перекрытия дефекта из-за повышенного количества рецидивов. Проведенный анализ литературы, касающейся теоретических аспектов и клинического опыта применения технологий совершенствования современных синтетических и биологических протезов, способных обеспечить более лучший пластический эффект, а также методов профилактики рецидивов вентральных грыж свидетельствует о том, что это является одним из приоритетных направлений в современной абдоминальной хирургии. Нерешенным вопросом остается выбор оптимального эндопротеза, обладающего высокой эффективностью и соответствующего международным стандартам, предъявляемым к таким свойствам как биологическая инертность и механическая прочность, а также метода расположения сетки по отношению к слоям брюшной стенки. Учитывая, что многие применяемые на сегодняшний день методы аллогерниопластики не лишены недостатков, актуальным направлением является разработка новых методов пластики при гигантских вентральных грыжах и способов профилактики послсопсрацитонных осложнений в условиях контаминированной раны, с обоснованием их эффективности в клинико-экспериментальном исследовании.
The aim of investigation in the perfection of the methodical system of the development of the technical style of thinking at the pupils of academic lyccums of the technical directions by means of profile differentiation of the mathematic training.
The object of investigation is the process of differential mathematic training in academic lyccums of technical direction.
The methods of investigation. This is critical analysis of the native and foreign pedagogical experiments, working out teaching and methodic materials for teachers- experimenters and the model- practical controf of their efficiency, and also mathematic- static treatment of receiving results.
The receiving results and their novelty arc contained to the carrying out of the criteria of selection of the content of the mathematic education, of the variant of content and methods of mathematic training in the academic lyceums taking into consideration methodic peculiarities, connected with technical directions of the education.
The practical significance is contained in the possibility of using the formulated criteria of selection of the content of mathematic education for the preparation of the training programmers and training- methodical appliances by mathematic.
The degree of introduction and economic significance. Not only in the technical but also in the natural- scientific directions can be guidebook in the working out of training - methodic complex by educational profiles.
The field of application: academic lyccums of the technical direction of Ministry of Higher and Secondary-Specialized Education of the Republic of Uzbekistan.
Purpose of reseach: to optimize outcomes of therapy of the patients SD, purulent - septic complicated of lower extremities (PSCLE), by monitoring, duly revealing of character disturbans of function of the liver and purposeful correction them in complex therapy of the specified pathological condition.
Methods of research: clinical-biochemical researches, ECG, ultrasonic research of the liver, ultrasonic dopplerography, percutaneus definition a pressure (voltage) of oxygen, angiography, radionuclide researches, psichometric tests.
The results achieved and their novelty: the carried researches have shown, that the liver is not one of the basic organs - targets at SD (at the expense of features it blood circulation), at decompenciation SD, complicated PSCLE, there is an essential infringement liver blood circulation in system lever artery, to the subsequent disturbance of its numerous functions. The inclusion in complex therapy hepatoprotectory, antioxygents and preparations blocking ALT activity is pathogenic proved and promotes optimization of outcomes such of complication SD, as PSCLE.
Practical significance: the elaborated and offered complex therapy of the patients provides of optimization of outcomes, is an effective method of treatment and preventive maintenance of complications.
Degree of introduction and economic efficiency: the results of research have been introduced into practice of branches intensive therapy and reanimation 2-clinic TMA and Republican Centre of Purulent Surgery and Surgical Complication of Sugar Diabetes
Area of application: reanimation and intensive therapy, surgery.