Topicality and demand of the subject of dissertation. Researches of human population genomic variety and scenarios of its genetic pool formation arc one of perspective directions of modem genetics. Prompt progress in this field has allowed defining the basic routes of continents settlement. However the information about Central Asian (CA) populations even on «classical» genetic markers has accidental, fragmentary character, and requires additional large-scale investigations. Besides, according to historical, archeological, paleontological and some anthropogenetic studies, given region was playing certain role in ancient moving of modem human ancestors throughout Eurasian continent. Therefore it is extremely important to summarize and perform complex assessment of new and collected data on Central Asian populations as practically there arc no multivariate analyses studies of given region as a complex population system.
In studies of human population genetic structure arc usually used various approaches allowing understanding concept of populations subdivision and character of genetic relationships between them. Among these techniques the prominent place belongs to approaches based on an assessment of genetic distances between populations with their subsequent analysis by multivariate statistics methods. For even more compelling picture of the relationships between the populations on tree diagram we composed «the genetic landscape» of area, where the description of population genetic structure is presented by equally spaced figures consistently consolidating populations according to their genetic distances from each other and thus creating a genetic landscape. This approach is not only a tool for elementary population boundary detection, but also can be effectively used for identification of borders and sizes of population as naturalistic unit.
Multigcnctic landscape is a collection of different genetic systems which arc specific to the region and ethnic groups, which have their geographical areas, their geographical, historical and cultural boundaries. Gene flows arc run through these conventional boundaries, but they arc less intense than in the limits of area. These limits arc ambiguous and fluid, but it is real. You can identify them by studying, for example, the structure of marriage migration. Therefore anthropogenesis of different populations will inevitably differ from each other. Ethnogenetic composition tends to change over time, from generation to generation, and hence there is a need to understand the structure of the genepool, not only at a given time, but also in the study of genetic processes that form and reform the gcncpooL In this regard, the studying of multigcnctic landscapes is in close contact with the demographics, medical and genetic ecology, anthropology, ethnology, archeology and history of the peoples, that is, with a range of areas, not only natural, but also the humanities knowleges.
Study of genomic diversity is important not only to address questions of origin and genetic history of different ethnic groups, but is also the basis for molecular epidemiology of hereditary and multifactor diseases. Each region is characterized by a specific set of common genetically determined diseases. To understand the causes of the prevalence of disease in different regions, and to develop approaches to their early DNA diagnosis and effective prevention, initially it is necessary to conduct population-based studies, which determine the development of the disease.
Purpose of research is to implement a comprehensive description of the structure of indigenous Central Asian populations genetic pool, examine demographic, phylogenetic and evolutionary features of Central Asian populations through the analysis of genetic variety of mtDNA, Y-chromosomal (NRY), autosomal, X-chromosomal microsatcllites and immunogcnetic variants of Helicobacter pylori (H.pylori) and hepatitis В virus (HB V).
To achieve this goal the following tasks of research is solved:
specification of immunogcnetic variants of H.pylori and HBV, allocated at the patients in Central Asian region, with the subsequent comparative phylogenetic analysis of H.pylori and HBV regional versions with those in other regions of the world;
examination of genetic variety and degree of genetic differentiation of Central Asian populations according to classical population-genetic objects -polymorphisms of mtDNA, Y-chromosomal, autosomal and X- chromosomal STRs;
assessment of the Western and East-Eurasian lines of population inheritance contribution to Central Asian populations’ genetic pool at regional, ethnic, sub-cthnic levels and in a level of elementary populations;
reviewing of character of regional populations relationships by genetic variety of mtDNA, autosomal, X-chromosomal, Y-chromosomal STRs markers in view of ethnographic, social and linguistic data;
evaluation of sex-specific genetic structure and the social organization according to polymorphisms of mtDNA, autosomal, X-chromosomal, Y-chromosomal markers in the region;
determination of ancient ways of migrations and scripts of formation of Central Asian populations according to mtDNA, autosomal, X-chromosomal, Y-chromosomal STRs markers and immunogcnetic variants of H.pylori and HBV',
evaluation of ethnogenetic position of studied Central Asian populations in the system of genetic pools of Eurasia and the world in general through comparative analysis of all studied population-genetic parameters.
Scientific novelty of dissertational research consists in the following:
for the first time was performed a study of genetic pool structure of 26 Central Asian populations from 6 ethnic groups as complete population systems using a wide range of genetic objects;
for the first time was made an assessment of informativeness of each type of genetic subjects. For the first time was received detailed characteristic of genetic pool structure of indigenous Central Asian population on the basis of variability lines of the spectrum of genetical objects;
for the first time was defined the ratio of Westem-and the East-Eurasian lines in a genepool of Central Asian population and were made an assessments of genetic variety level and genetic differentiation degree of regional populations as a whole;
for the first time phylogenetic analysis of major haplogroups of investigated genetic subjects was conducted;
for the first time the position of Central Asian population in population genetic pool system of surrounding regions and Eurasia in the whole was studied;
for the first time the evolutionary-adaptable mechanisms, necessary in the forecast of formations of multigenic pathologies in region were studied at 6 ethnoses of Central Asian.
CONCLUSION
1. H.pylori from Central Asian territory is similar to Western Europe isolates, and shaped by two ancestral populations genotype Ancestral Europe 1 (dominant) and Ancestral Europe2 and for AE1-genotype Central Asian region probably is the source. H.pylori from the territory of Central Asia form a separate cluster group: close relationship of Tadjik, Uzbek strains and Iranian isolates from the north of Iran is established. Kirghiz isolates were found to be closer to populations from territory of Siberia.
2. High diversity of HBV genotypes in Central Asia was found -4 genotypes (A, C, D, and G). Phylogenetic analysis of Central Asian genotype HBV-with options for other regions of the world showed a close relationship between the dominant genotype D (0,78), the D1-subtype with variants of the virus in Europe, the Middle East and Africa.
3. The rates of genetic affinity for STR-NRY in Kazakhs, Turkmens, Karakalpaks Turtkul at the level of the same lineage were high: 0,58 (p<0,001); 0,34 (p<0,01) and 0,77 (p<0,001), respectively. The coefficients of relationship at the level of clan for Kazakhs, Turkmens, Uzbeks and Karakalpaks from Kungrad and Turtkul were lower: 0,30 (r<0,01); 0,21 (p<0,001) and 0,40 (r<0,001); 0,07 (p<0,05) and 0,09 (p<0,05), respectively. At the level of the tribe, the indicators were negative for all Turkic populations: -0,02 (r<0,05);-0,04 (r<0,001);-0,07 (p<0,01); -0,0011 (r<0,1) and -0,10 (r<0,01), respectively.
4. The analysis of mtDNA HVS-1 showed that total rate of differentiation level for all populations was low: FST=0,013; p<0,0001. Level of diversity between groups was 0,6% (p<0,001) of the total variability. Parameter of genetic differences between Turkic and Indo-Iranian populations made 0,55% (p<0,0283) of the total genetic variability. The rate of genetic differentiation on a sub-ethnic level was significantly expressed in Indo-Iranian group (FST=0,0197;r<0,001) than among the Turkic-speaking (0,3%; p=0,10). In all populations, in general, wasn‟t detected the correlation between genetic and geographic distances at the global level on mtDNA HVS-1: r=0,00682; p=0,502.
5. Analysis of STR-NRY showed that the level of the genetic differentiation between ethnic groups was 5,6% (p<0,02); general differentiation between populations made RST=0,186 (p<0,001). Combined analysis, taking into account the language and way of life of Turkic and Indo Iranian populations, showed the general differences between the two groups – 9,1% Value of genetic differentiation when comparing the ethnos-ethnos was slightly lower than the level within ethnos: 5,6% among ethnic groups, 18,6%, and 13,7%-between populations within the ethnic group.
6. Analysis of heterozygosity (H) and the average number of pairwise differences (p) of mtDNA, were high in nomadic populations (av.H=0,99; av.p=5,29) and farmer populations (av.H=0,99; av.p=5,32). Heterozygosity (H) on Y- chromosome was lower in nomadic groups than in the agrarian – 0,86 and 0,99,respectively (p<0,01). Nomadic populations exhibit a higher level of population differentiation (RST) in comparison with farmers - 0,19 and 0,06, respectively (p<0,01). Indicators of population growth (r) were lower in nomadic populations compared with farmers - 1,004 and 1,008, respectively (p=0,056).
7. The level of genetic differentiation in all ethnic groups was higher on the Y chromosome in comparison with mtDNA. The farming populations showed no significant difference in the genetic differentiation FST (Y)=0,069 and FST (mtDNA)=0,034, while among patrilineal nomadic population the level of genetic diversity was higher in the male line of inheritance - FST(Y)=0,177 and FST (mtDNA)=0,010. Genetic diversity of population structure in patrilineal nomads on autosomal and X-linked markers were: FST (A)=0,008 (0,006-0,010) and FST (X)=0,011 (0,001-0,004) (H0: FST(A)=FST(X); H1: FST(A)>FST(X); p=0,02). In bilinear farmer populations the differences of autosomal and X-chromosomal markers were insignificant: FST (A)=0,014 (0,012-0,016) and FST (X)=0,013 (0,008-0,018 at p=0,36).
8. Analysis of mtDNA indicated that the age of expansion on the territory of Eurasia (τw) declined significantly from East to West (r=0,72; p<0,001). The age of expansion had a pronounced tendency to decrease from 30 thousand years in China to 17 thousand years in Western Europe. Age of expansion in Central Asia amounted to 26 thousand years. Results of expansion analysis on NRY also show a decrease in genetic diversity from the East to the West of Eurasia (r=0,49; p<0,001). In Central Asia this age was 16 thousand yrs. According STRs-NRYBatwing analysis of the minimal age of Uzbek population origin was 1232,71 yrs old (Ne=14088 (6765-23942); α=0,0108 (0,0065-0,0155)).
9. The apportionment of multilocus genetic variations among ethnic and linguistic groups of Central Asian populations showed that more than 98% of all variations were within the population (p<0,0001). Evaluation of the ethnic and linguistic affiliations in the observed variations showed reliable conformity - FST=0,007; p<0,0001 and FST=0,011; p<0,0001, respectively. We didn‟t find evidence of geographical isolation within each of the Turkic and Indo Iranian groups of populations (p=0,363 and p=0,772, respectively).
10. Analysis of multilocus allelic diversity (AR) and heterozygosity (He) showed differences among the Central Asian and other populations in allelic variety (χ2 =105,29; d.f.=25; p<0,0001) and heterozygosity (χ2=67,98; d.f.=25; p<0,0001). Population differentiation at multilocus analysis at populations of Central Asia is more pronounced than in the other regions of Eurasia: in European and Middle Eastern groups pairwise estimation of FST ranged from 0,011 to 0,015 and -0,008-0,021, respectively; in East-Asian groups from -0,011 to 0,046; and finally, in Central Asia these rates ranged from -0,004 to 0,056. Heterozygosity was significantly higher in the group of the Indo-Iranian populations than among Turkic-speaking (He=0,818 and He=0,787, respectively; Z=-4, 55; p<0,0001). According to multilocus analysis all 26 Central Asian populations slightly but significantly differed (FST=0,015; CI99%=0,011-0,018; p<0,01).
The age is common risk factor for cardiovascular diseases (CVD). One of the main risk factors for ageing is biologic age of vessels or vessel ageing. Main mechanisms of vessel ageing are oxidative stress, chronic inflammation, endothelial disfunction, apoptosis of endothelial cells, demage of endothelial EPCs progenitory cells functions, replication ageing of endothelial cells, disregulation of circadian system, arterial stiffness. Understanding of the mechanisms that lead to ageing pathophyziological changes in vessels is important and necessary of for novel methods of patogenetic treatment
Острый аппендицит (ОА) - одно из самых распространенных хирургических заболеваний органов брюшной полости. Преимущественно им болеют в возрасте от 15 до 40 лет, что по новой возрастной классификации ВОЗ относят к молодому возрасту (от 25 до 44 лет), 44—60 лет — это средний возраст, 60—75 лет — пожилой возраст, 75—90 лет — это старческий возраст, а после 90 — это долгожители. Другими словами, ОА - заболевание людей молодого работоспособного возраста, что имеет свою практическую значимость. Внедрение в клиническую практику современных методов обследования позволило улучшить диагностику ОА и значительно оптимизировать результаты его лечения, но в старших возрастных группах повсеместного качественного улучшения диагностики не произошло, причем это касается как гиподиагностики, так и гипердиагностики.
This work is to study the effectiveness of topical glucocorticosteroids in the treatment of adenoid vegetations in preschool children. The study included 50 children (mean age 4.25 ± 0.24 years) with adenoid vegetations. The patients were divided into 2 groups. Group 1 included 25 children (mean age 4.0 ± 0.22 years) who received irrigation therapy with fluticasone furoate, 1 injection of 55 μg into each half of the nose once a day for at least 1 month. Group 2 - 25 children (average age 4.5 ± 0.5 years), who were prescribed irrigation therapy with saline solution, 3-5 ml in each half of the nose 3 times a day for at least 1 month. Intranasal use in patients with adenoid vegetations of fluticasone furoate for a month led to a decrease in the size of the hypertrophied pharyngeal tonsil and an improvement in nasal breathing, thereby improving the quality of life of a sick child.
The purpose of this study was to compare the onset of the eruption of the first milk tooth in premature infants of different body weights for teething. 146 infants were examined - 77 premature and 69 fullterm children aged 5 to 36 months, both sexes. The results were analyzed taking into account the biological age and the age after conception, or adjusted age, which is the gestational age plus the chronological age of the baby in the month of eruption of the first milk tooth.It was revealed that, taking into account the chronological age, teething in premature newborns and children with very low birth weight is significantly delayed.
Синдром преждевременного старения рассматривается как взаимодействие двух основных процессор старения, как разрушительного процесса, и витуакта (vita-жизнь и auctum-увеличивает) т.е. процесса стабилизирующего жизнеспособность организма и увеличивающего продолжительность жизни. Продолжительность жизни зависит от сочетанного участия в старении биологических (генетических) и социальных факторов т.е. условий жизни. У каждого вида существует свой предел жизни. Существует также границы старения. Пожилой возраст 60-74 года, старческий возраст 75-90 лет, более-90 лет - долгожители. Также следует отметить у человека видовая продолжительность жизни составляет 90 лет.
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.
Patients with unstable variants of angina pectoris have risk factors that contribute to the early development and progression of coronary artery atherosclerosis. According to a number of studies, a large contribution to the development of unstable variants of angina pectoris is made by the main behavioral risk factors (smoking, excessive alcohol consumption, improper and unhealthy diet, reduced physical activity, fatigue), which naturally leads to the development of obesity, dyslipidemia and diabetes mellitus
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.
Улучшение качества анестезии путём комбинированного применения малых доз опиоида фентанила при артропластике тазобедренного сустава у детей.В проспективное исследование включены 43пациента(3-12 лет, средний возраст5,7±0,63) с врожденным вывихом бедра, оперированные в клинике ТашПМИ.Объективный статус больных по ASA соответствовал II-III классу. Критерии включения в исследуемую группу:возраст пациентов от 3 до 12 лет; наличие информированного согласия на оперативное вмешательство; врождённый вывих бедра. Критерии исключения: патологический вывих бедра; пациенты, страдающие тяжелыми системными заболеваниями.
Thermal injury is a serious medical, social and economic problem. The development of the heavy and chemical industries, as well as the widespread use of electricity in everyday life and industry, will contribute to a significant increase in burn injuries. Purpose. In case of burn injuries, the burn consists in the study of disorders in the hemostasis system in the shock phase. The object of the study was patients admitted to the department of combustiology of the Samarkand branch of the Republican Scientific Center for Emergency Medical Aid in the period from 2017 to 2020. In the phase of burn shock with deep burns from 10 to 35% of the body surface 95 (out of 112 main groups). The age of the patients ranged from 18 to 75 years, the average age was 54.3 ± 0.7. There were 142 (65.43%) men and 75 (34.56%) women. There was a poorly developed increase in the coagulation system (tolerance to heparin 253.4 ± 21.3 seconds, thrombotest - 4.06 ± 0.2 degrees), PTI decreased to 87.6 ± 3.1% (R <0.05). there was a constant decrease in fibrinolytic activity. However, a sharp decrease in fibrinolytic activity was observed, amounting to 6.58 ± 0.69% (P <0.05). Conclusions. When all patients are hospitalized, comprehensive anti-shock measures should be taken to improve the water-salt balance, acid-base balance and disruption of homeostasis.
Невротическая депрессия является одной из самых распространненых психоневрологических расстройств в практике детского медицинского психолога. Несмотря на большую распространенность и очевидные проблемы, с которой сталкивается как сам ребенок так и его семья, на существующий момент в обозреваемой литературе крайне мало данных об особенностях психопатологического профиля у этой группы больных. Изучение особенностей невротической депрессии у детей позволит с большей точностью и своевременностью диагностировать этот тяжелый симптомокомпслекс.