Study objective. Evaluation of the immediate results of Ross procedure in a patient with aortic valve pathology.
Material and methods
This article describes the results of surgical treatment of 1 patient (11 years old) who underwent Ross procedure for aortic valve defect. The results of surgical treatment during the hospital period are analyzed.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
The aim of this research is to study child population morbidity in Azerbaijan by results of obligatory medical examinations for 2014-2019yy. In recent years, Azerbaijan has made progress in improving the quality of medical services. In order to improve the health status of the child population and provide it with high-quality medical care, the Law “On compulsory clinical examination of children” was approved in 2013. In pursuance of this law, the material and technical base of children's outpatient clinics providing medical services to children has been strengthened, their provision of medicines and medical equipment has been improved, preventive medical examinations are carried out, the quality of clinical observations and new forms of medical and rehabilitation measures are worked out. Despite this, it is necessary to understand the feasibility of an integrated, systematic approach to the implementation of tasks to preserve, strengthen and improve the health status of the child population based on the study of child health indicators, the most important of which is morbidity.
This article discusses the main goal is to socialize the child, that is, the parents instill in the child the values and behaviors that are appropriate for a member of society. If the child resists attempts to change the behavior of the parents, this process of socialization often leads to conflicts, which is a fact of conflict between parents and children. First of all, disagreement between parent and child is an inevitable reality.
The mitral valve is a complex, complex anatomical structure that consists of 4 main components: FCMC, the valve leaflets themselves, tendinous chords and papillary muscles. Accordingly, the normal operation of the valve depends on the correct operation of each individual component, and the dysfunction of one of the structures can lead to disruption of the valve and the further development of insufficiency.
The study of the issue of child socialization is one of the current problems of ethnology. Because through the upbringing of children, one can learn a lot about the lifestyle, spiritual outlook, psychological image and socio-economic history of the people. This article aims to study the features of child socialization in a modern Uzbek village on the example of a village. The information in the article was collected during the author's expeditions to the village of Mindon in 2012-2014.
Research methods: direct observation, in-depth interview-based interviews and questionnaires. Theoretically, it was based on T. Parsons' structural functional theory on the study of socialization [26, p.58.]. In this theory, the family is shown as the first major stage of socialization.
The study shows that the traditional method of upbringing in the family depends on the lifestyle of the people and is based on the experience of the people in child psychology, taking into account the mental and physical aspects of the mother from pregnancy to childbirth and adulthood.
The data presented in the study can be used to study the culture, ethnography, spiritual and moral characteristics of the Uzbek people and to theoretically enrich such areas as ethnopsychology, ethnopedagogy, gender socialization, sociology of education.
The article analyzes tasks of simplified proceedings. The forms of simplified proceedings are considered as "summary proceedings" (England), "plea bargaining" (USA), "conditional refusal to initiate criminal prosecution", "criminal order" (France), "expedited proceedings"(Germany). The ways of implementation in domestic legislation have been developed and proposed based on the results of studying models of simplified legal proceedings.
SUMMARY
One of serious problems for each state is to ensure the promptness of criminal proceedings regardless of legal system in which it operates. Attention has recently been drawn to the need of introduction of simplified procedure among the ways to increase efficiency.
Discussion at the XII UN Congress on Crime Prevention and Criminal Justice (El Salvador, Brazil, April 12-19, 2010) about the concept of simplified (accelerated) criminal justice showed that improving the fight against crime in modern conditions requires taking into account a wide range of factors. Issues negatively affecting its condition included ineffective and protracted investigations, limited use of pretrial detention clauses, ineffective case management, limited resources from prosecutors and judiciary and their insufficient use.
According to the UN, summary proceedings are simplified procedure that expedites court proceedings in order to make criminal justice system more efficient and minimize costs. In general, summary judgment is used in lower courts, usually for less serious criminal offenses, and is an expedited procedure in which certain formal procedures are not required or simplified.
The purpose of the study is to analyze the grounds for terminating a criminal case due to the non-appearance of a private prosecutor without good reason at a court session in criminal cases of private prosecution (both provided for by the Code of Criminal Procedure of the Russian Federation and arising from the Resolution of the Constitutional Court of the Russian Federation dated April 13, 2021). The mechanism proposed by the Constitutional Court of the Russian Federation for exercising the right of the defendant to effective judicial protection did not remove the problem of applying Part 3 of Art. 249 of the Code of Criminal Procedure of the Russian Federation, and the legislator, who did not accept the position of the Constitutional Court of the Russian Federation, returned to the basis for terminating the criminal. cases of private prosecution when the private prosecutor fails to appear without good reason at the court session, provided for by the Code of Criminal Procedure of the RSFSR.
This article discusses the specifics of foreign experience in raising children in preschool education. In Japan, Korea, the United States, Germany, the United Kingdom, and Russia, the preschool education system has its own peculiarities of child rearing. There are also specific recommendations on the correct choice of educational tools in preschool education. It was also noted that an analytical approach is needed in the use of best practices abroad. The specifics of the entire national education system are also highlighted, and the main tasks of pre-school education and upbringing in Uzbekistan are outlined.
Conceptual Field tests were attempted on sandy soils with three trimming frameworks at India for a very long time during 2011-2013. The trials were executed in split plot plan by relegating h2o dissolvable phosphorus composts in primary plot and suggest ed portion of phosphorus in sub-plot with three replications. The most extreme practical yield of rice, child corn and Chickpea were recorded with the utilization of . The most extreme efficient yield of progressive harvests - wheat, mustard and groundnut were recorded with the application of treatment. Practically comparable patterns were seen as far as side-reaction yield, supplement take-up and leftover soil richness status. Every one of the degrees of in compound manures were discovered to be similarly successful for grain yield, straw yield, supplement take-up, and leftover soil richness.
The article examines national and foreign experience in judicial protection of exclusive rights to intellectual property. The role and specificity of judicial protection, the legal framework regulating this sphere, the effectiveness of national legislation, relevance to the judiciary, judicial statistics in this matter, case law and the experience of foreign countries are analyzed in order to come up with the methods of protection of exclusive rights to intellectual property.
The socio-economic and legal consequences of the settlement of intellectual property disputes are presented as one of the most pressing issues in the work of the courts in the light of the fact that the issue of intellectual property rights is becoming a serious social problem in Uzbekistan and all around the world.
Based on in-depth analysis of the world experience on how the issue of jurisdiction of intellectual property cases is resolved, it is concluded that the establishment of separate courts specializing specifically in intellectual property disputes will result in resolving disputes without delay in a fair and reasonable manner.
The article differentiates between two categories of problems in the consideration of intellectual property issues in court practice. The first type of problems is related to subjective factors, while the second is demonstrated to comprise objective difficulties. Subjective problems comprise of the courts lacking the experience to resolve all disputes involving intellectual property rights. Alternatively, the objective factors are stated to entail the lack of clear legal framework or underdevelopment of single court practice regulating this category of cases.
Therefore, it is concluded that the establishment of specialized courts in Uzbekistan specifically dealing with intellectual property disputes is justified by the development of social relations based on a market economy and the growing importance of intellectual property in the life of the state and society. In this regard, it is argued that the process of formation of a panel of judges in the Supreme Court of the Republic of Uzbekistan should entail a system of retraining and advanced training of judges in the field of intellectual property rights in cooperation with the World Intellectual Property Organisation and the Intellectual Property Agency.
Taking comparative research methods as a basis, it is suggested that the Civil Procedural Code of the Republic of Uzbekistan, the Economic Procedural Code of the Republic of Uzbekistan, the Code of the Republic of Uzbekistan on Administrative offences should include a chapter devoted to reflection of the specifics of litigation of intellectual property rights, claims, lawsuits, deadlines for appeals and other procedural deadlines, norms that cover all aspects of such disputes differentiating them from other types of cases, as well as, the issue of developing the norms regulating the administrative liability for offences in the field of intellectual property rights and the criminal liability for illegal use of intellectual property rights is also justified
In the context of an increasingly complex system of international relations, powerful states areи paying close attention to the factor of cultural diplomacy. After all, this factor becomes a solid criterion for mutually beneficial cooperation and stability. Cultural diplomacy not only contributes to the development and development of international relations, but also enhances trust and promising relations not only between states, but also between nations. In particular, countries such as Russia and China are trying to effectively use cultural diplomacy, taking into account historical experience. The cultural diplomacy of these countries in international affairs is aimed at restoring historical cultural ties with neighboring countries. It should be noted that the cultural diplomacy of Russia and China is carried out differently in each region or country and has a number of similar features. In this regard, cultural diplomacy between Russia and China with the Central Asian region, including Uzbekistan, is an important element of the soft power policy, but also plays a special role in the development of cultural cooperation between peoples. For the Republic of Uzbekistan, the experience of not only leading developed countries, but also Russia and China, the largest countries of the Eurasian region, is important for the Republic of Uzbekistan with a rich history of diplomacy, including cultural diplomacy. If they do not take into account their geopolitical position, their military-economic power, as well as their common history (with Russia) and their interests, Uzbekistan will not be able to build a foreign policy strategy with them in the geo-economic space. Countries such as Russia and China have long used cultural diplomacy as an important foreign policy mechanism, and this process continues today. Therefore, it is important to study the features and experience of the cultural diplomacy policy of the two countries. This article analyzes the diplomatic experience of China and Russia in international relations, in particular the similarities and differences between cultural diplomacy.
Abstract: In this research, the results of the effects of vincamine hydrochloride and pyrozalin iodide alkaloids on the relaxation of aortic smooth muscle cells in the presence of Ca2+ L-channels have been reported. The isometric contraction activity of the aortic blood vessel smooth muscle derived from rabbits was studied using mechanography. The results, under in vitro conditions, demonstrated that the contraction activity of the rabbit aortic blood vessel smooth muscle preparation induced by 50 mM KCl was dependent on the potential of the plasma membrane, associated with the activity of the Ca2*L-channels. It was found that vincamine and pyrozalin iodide alkaloids affected the blockage of the Ca2+i-channels and a reduction in [Ca2*] concentration. The obtained results suggest that the relaxing effect of vincamine hydrochloride and pyrozalin iodide alkaloids is based on the blockage of the L-type Ca2+ channels, and they also affect the receptor-operated Ca2+ channels. In conclusion, the results indicate that in providing the relaxing effect of vincamine and pyrozalin iodide alkaloids, the blockage of potential-dependent L-type Ca2t channels, along with the blockage of receptor-operated Ca2+ channels plays an important role.
To study the immediate and long-term results after thoracic endovascular aortic repair (TEVAR).