Bugungi kunda raqamli platformalar eng ko‘p muhokama qilinadigan mavzularning tepasida. Ularning voqelikni o‘zgartirishdagi asosiy rolini iqtisodchilar va siyosatchilar, IT-mutaxassislari va ishlab chiqarish vakillari, fan va madaniyat, ta’lim va tibbiyot vakillari aytadi. Hayotimizning barcha jabhalarida raqamli muhitni yaratish bo‘yicha maqsadli, rejali ishlarni boshlash vaqti kelganiga hamma ham rozi. Asosiy e’tibor, birinchi navbatda, blokcheyn, sun’iy intellekt, katta ma’lumotlarni tahlil qilish kabi istiqbolli innovatsion texnologiyalarga qaratilgan. Lekin, afsuski, raqamli kelajak haqidagi munozaralarda fundamental texnologiyalar muhokamasiga asossiz ravishda kam e’tibor qaratilmoqda.
In modern abdominal surgery, one of the current areas for research continues to be the improvement of various options for plastic surgery of postoperative hernias. More than 2,100,000 operations for ventral hernia are performed annually in the world, and 42% of them are postoperative hernias. In recent years, there has been a clear trend toward the expanded use of various types of biological meshes in hernioplasty. “A pooled analysis of seven PCSTAR studies for incisional hernias using retromuscular mesh showed a hernia recurrence rate of 5.7%”[1]. The use of standard surgical interventions such as alloplasty in the onlay position does not solve the problem of early postoperative complications: seroma discharge, mesh migration, adhesive disease, high frequency of hernia recurrence, etc. At the same time, hernia repair with local tissue creates the problem of increased intra-abdominal pressure and late complications in the form of recurrent hernias. “An increase in postoperative intra-abdominal pressure leads to multiple organ failure, then abdominal compartment syndrome, and even death.” [2]. Currently, there is no consensus on the surgical approach for giant postoperative abdominal wall hernias, and therefore the need to continue to develop new technologies and improve There is no doubt about the tactics. In world practice, at present, the most relevant studies continue to be studies aimed at studying the morphological and functional aspects of recurrent postoperative ventral hernias; electron microscopy reveals ultrastructural destructive changes in skin cells, aponeurosis and muscles, which indicates morphofunctional insufficiency of abdominal wall tissues; issues of cell engineering are discussed new innovative materials, experimental studies are being carried out on animals testing the biotechnical properties, texture and elasticity of new polymers, research is being conducted on open approaches with division of the posterior component with the release of the transverse abdominis muscle and a retrograde mesh, robotic operations have begun. Modern aspects of the development of domestic healthcare include many measures aimed at improving the results of treatment of patients with postoperative ventral hernias and associated pathological conditions through the introduction of modern principles of intensive care and surgical tactics. The development strategy of New Uzbekistan for 2022-2026 in seven priority areas includes tasks to improve the quality of provision of qualified medical services to the population[3]. The implementation of these tasks, including by optimizing tactical and technical approaches to the choice of hernioplasty method, as well as the development of methods for the prevention of purulent-inflammatory complications in the field of alloplastic material, is one of the current areas of abdominal surgery and medicine in general, due to the high medical and social the significance of this pathology.
This dissertation research to a certain extent serves to fulfill the tasks approved by the Decree of the President of the Republic of Uzbekistan “On comprehensive measures to radically improve the healthcare system of the Republic of Uzbekistan” No. UP-5590 dated December 17, 2018, the Resolutions of the President of the Republic of Uzbekistan “On measures to transform the surgical service, improving the quality and expanding the scale of surgical operations in the regions" for No. PP-5254 dated October 4, 2021 and "On additional measures to ensure public health by further increasing the efficiency of medical prevention work" for No. PP-4891 dated November 12, 2020, and as well as other regulatory documents adopted in this area. Compliance of the research with the priority directions of development of science and technology of the republic. The dissertation research was carried out in accordance with the priority direction of development of science and technology of the VI Republic “Medicine and Pharmacology”. Review of foreign scientific research on the topic of the dissertation.[4] Research work aimed at improving the quality of therapeutic and preventive care for patients with ventral hernias, carried out by many leading scientific centers and higher educational institutions in the world, including the Department of Surgical and Perioperative Sciences, Umeå University, Umeå (Sweden), Department of Surgery, Kingston General Hospital, 76 Stuart Street, Kingston (Sweden). nada), Department of Surgery, Helsinki University Hospital, Helsinki ( Finland), Service de chirurgie digestive et oncologique, CHU d'Amiens (France), Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa (USA), Department of Surgery, Howard University College of Medicine, Washington (USA) , Yong Loo Lin School of Medicine, National University of Singapore (Singapore), Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; University of Calgary, Calgary (Canada), Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia (USA), Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston (USA) , Department of Surgical Sciences, Uppsala University Hospital, Uppsala (Sweden), Department of Surgery, University of Texas Health Sciences Center at Houston, Houston (USA), Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands), Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka (Japan), National Medical Research Center for Surgery named after A.V. Vishnevsky" (Russia), Republican Scientific Center for Emergency Medical Care (Uzbekistan), Tashkent Medical Academy (Uzbekistan), Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov (Uzbekistan).
As a result of studies conducted around the world to increase the effectiveness of alloplasty for postoperative ventral hernias and reduce the risk of complications in the postoperative period, a number of scientific results were obtained, including: it was determined that patients who underwent reconstruction of the abdominal wall have an increased risk of postoperative respiratory failure, understanding the epidemiology of this complication can improve prevention (the Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, USA); It has been proven that the larger the hernia, the higher the risk of early surgical complications, including such as respiratory decompensation, since hernias often increase in size over time, delaying surgery can lead to an increase in the size of the hernia and, therefore, a greater risk of complications (CentreforDigestiveDiseases, KarolinskaUniversityHospital, Stockholm, Sweden); it has been shown that the ratio of the hernia volume to the volume of the abdominal cavity <20% is an independent factor in tension-free closure, which justifies the interest in preoperative volumetry to adapt the tactics of surgical care (Servicedechirurgiegénérale, digestiveetendocrinienne, CHU LyonSud, HospicescivilsdeLyon, France); It has been determined that in patients undergoing elective laparoscopic hernia repair, predictors of mortality are older age and certain concomitant diseases: congestive heart failure, pulmonary circulatory disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders and paralysis (Department of Surgery, College of Medicine, University of Oklahoma, Tulsa , USA); Older age, ascites, preoperative renal and pulmonary insufficiency have been found to be independent predictors of 30-day mortality, and in the presence of these risk factors, conservative treatment should be seriously considered (Department of Surgery, University of Kentucky College of Medicine, Lexington, USA); The American College of Surgeons (ACS) Universal Surgical Risk Calculator has been shown to accurately predict thirty-day outcomes, including major complications: venous thromboembolism, medical morbidity, surgical site infection, unplanned reoperation, mortality, and length of hospital stay (Department of Plastic Surgery, Brown University and Rhode Island Hospital, Providence, USA). At the present time in the world, the most relevant research in surgery continues to be the development of new methods of hernioplasty for large and giant ventral hernias, each of which has its own pros and cons depending on the complexity of implementation, the risk of postoperative complications and relapse, large randomized clinical trials are being conducted, comparing existing methods of traditional hernioplasty with laparoscopic access and robotic surgery, which has become increasingly widespread in the last 10 years, a search is being made for new synthetic and biological materials developed for the production and use of composite meshes that have the necessary strength and the ability to prevent fatal local complications in a contaminated environment. However, despite technical advances in this field, no modern hernia repair method or prosthesis meets all the requirements. One of the key problems is that existing synthetic endoprostheses do not have sufficient elasticity, resistance to infection, high mechanical strength and integrity over a long period of time. Further research into these clinical aspects will undoubtedly improve the current understanding of the capabilities of biocompatible endoprostheses and will make it possible to develop an optimal method for their placement during allohernioplasty. The degree of knowledge of the problem. The current period of development of abdominal surgery is characterized by an emphasis on the problems of the effectiveness of introducing new installation methods and techniques for attaching bioprostheses, options for various suture materials to determine the most promising directions for the development of these technologies [5]. Researchers led by BittnerR.[6] (2019) state that a giant postoperative abdominal wall hernia, the maximum diameter of which exceeds 12 cm or the ratio of the volume of the hernial sac to the abdominal cavity more than 20%, is difficult to treat, with a high recurrence rate and a large number of complications. One of the most challenging problems is that after the hernia contents return to the abdominal cavity, postoperative intra-abdominal pressure will increase, leading to multiple organ failure, then abdominal compartment syndrome (ACS), and even death. There is currently no agreement on the surgical approach for these giant incisional abdominal wall hernias. To prevent recurrences, some articles recommend placing the hernia mesh in the sublayer position and or linings (KirkpatrickAW.)[7]. According to CornetteB.[8], to prevent recurrence, it is recommended to place the hernia mesh in a sublayer or underlay position, and to achieve better mesh expansion, a component separation technique (CST) may be a suitable solution, but with a significant risk of complications and recurrence. JensenKK, et al. believe that truly successful giant hernia repair requires effective bridging or augmentation that will prevent recurrence with an acceptable risk of complications[9]. Another pressing issue in abdominal surgery is that patients with incisional hernias are extremely difficult to treat due to a number of factors including obesity, previous hernia repair, previous mesh placement, domain loss, and other variables.
The approach to patients with incisional hernias has changed significantly over the past 20 years due to both advances in mesh technology and surgical approaches. Key factors for successful outcome include modification of risk factors preoperatively, such as smoking cessation and weight loss, selection of mesh appropriate for the type of hernia and planned mesh location, and wide mesh coverage beyond the hernia defect. New techniques such as transabdominal muscle release and component separation with retrograde mesh placement and robotic approaches to abdominal wall hernia are increasingly being used in these patients[10]. Recent years have seen an increase in the number of biological meshes available for abdominal wall hernia repair. Biological meshes typically consist of materials obtained from humans, pigs, or cattle. The rationale for using biological meshes is that they can act as a scaffold for the growth of natural tissues. In addition, there are absorbable synthetic meshes that have properties similar to those of biological meshes, but with theoretically less risk because they are not derived from animal or human material. The choice of mesh for a ventral hernia depends on many factors, which include both the properties of the mesh and its location, for example, whether it should be placed intraperitoneally, preperitoneally, or retrorectus. BaierKF[11](2021) believes that the guiding principle should be to avoid placing uncoated polypropylene mesh in an intraperitoneal location where it may be in direct contact with internal organs. In addition, the type of hernia defect is another risk factor, such as whether the wound is clean or dirty, and whether the repair is performed with a bridge or abutment. Lightweight or biologic meshes to bridge the defect should be avoided due to increased recurrence rates. Holihan JL [12] (2016), Hodgkinson JD [13] (2018) believe that the principle of anatomical restoration to achieve a reliable, tension-free repair with reinforced mesh reduces the incidence of early postoperative complications and late recurrence of hernia compared with bridging mesh. The analysis of the literature concerning the theoretical aspects and clinical experience of using technologies for improving modern synthetic and biological prostheses that can provide a better plastic effect, as well as methods for preventing recurrence of ventral hernias, indicates that this is one of the priority areas in modern abdominal surgery. An unresolved issue remains the choice of the optimal endoprosthesis, which is highly effective and meets international standards for such properties as biological inertness and mechanical strength, as well as the method of positioning the mesh in relation to the layers of the abdominal wall. Considering that many of the allohernioplasty methods used today are not without drawbacks, the current direction is the development of new methods of repair for giant ventral hernias and methods for the prevention of postoperative complications in conditions of a contaminated wound, with justification of their effectiveness in a clinical experimental study. The connection between the dissertation research and the research plans of the research institution where the dissertation was completed. The dissertation research was carried out within the framework of the research work plan of the State Institution “RSNPMCH named after. acad. V. Vakhidov" under the project AL-422105574 "Development of new biocompatible mesh implants made of composite materials for reconstructive surgery of abdominal and diaphragmatic hernias" (2022-2024).
The purpose of the study is to improve the results of surgical treatment of large and giant postoperative ventral hernias by introducing new laser technologies and improving the tactical and technical aspects of surgical treatment. Objectives of the study: to study the structure of immediate complications after various types of prosthetic plastic surgery; to clarify the influence of obesity factors, primary or repeat hernioplasty on the incidence of immediate and long-term complications; to evaluate the role of the immediate complicated course of the postoperative period in the incidence of long-term complications of hernioplasty; to improve the technical aspects of alloplasty for large and giant postoperative ventral hernias (POVH); to improve the technique of photodynamic therapy (PDT) of the wound surface after prosthetic plastic surgery; to study in an experiment the effectiveness of using the proposed technique of alloplasty and PDT; evaluate the morphological features of the condition of tissues during prosthetic plastic surgery using the proposed method; in a comparative aspect, evaluate the clinical effectiveness of the proposed alloplasty options in the immediate and long-term periods. The object of the study was the results of allohernioplasty in 448 patients with extensive (large) and giant POVH, who were operated on at the surgical department of the 1st clinic of the Samarkand State Medical Institute in the period from 2012 to 2021, as well as experimental animals on which the effectiveness was assessed developed a technique for prosthetic repair of postoperative ventral hernias and applied the technique of photodynamic therapy.
The subject of the study is to analyze the effectiveness of the developed alloplasty of postoperative ventral hernias and intraoperative photodynamic therapy in abdominal surgery in experiments and in the clinic. Research methods. To achieve the goal of the study and solve the assigned problems, general clinical, instrumental, biotechnological, experimental, histomorphological, microbiological and statistical research methods were used. The scientific novelty of the study is as follows: it was established that the need for extensive tissue mobilization and, as a consequence, the intersection of lymphatic capillaries during implantation of the prosthesis in the onlay position, as well as the lack of sufficient resorption function of the hernial sac in the inlay position causes a high risk of the formation of clinically significant seromas; It was determined that with prosthetic hernioplasty, along with the volume of the defect, the type of plastic surgery and the degree of obesity, the most significant predictor of the risk of developing immediate complications is the factor of re-intervention in case of recurrent hernia with the presence of a “dormant infection” hidden in the remaining ligature granulomas or scar tissue; the structure and clinical features of the course of long-term complications of hernioplasty for giant and extensive hernias were clarified, taking into account the results of the immediate postoperative period, as well as the option of fixing the prosthesis, primary or repeated hernioplasty and the degree of obesity; the method of surgery for large hernias of the anterior abdominal wall has been improved, characterized by a combination of factors such as the formation of tension-free prosthetic repair, preservation of local resorptive function to prevent the development of fluid accumulations and reducing the risk of infection; the method of preventing the development or progression of wound infection during alloplasty of ventral hernias has been improved, aimed at enhancing the antibacterial effect and stimulating reparative activity through the photosensitizing and photodynamic effect of low-energy laser radiation; It was determined in an experimental model of prosthetic plastic surgery that the proposed method of fixing the prosthesis in combination with the use of the effect of photodynamic therapy through laser radiation helps to enhance reparative processes with a reduced risk of wound complications; It has been proven that all methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic plastic surgery enhance preventive measures against the development of local infection, but are ineffective in the case of an already developed purulent-inflammatory process against the background of the use of alloplastic material. The practical results of the study are as follows: it has been determined that the implantation of synthetic materials for giant and extensive hernias is accompanied by a significant number of wound complications caused by both the surgical technique itself and the reaction of surrounding tissues to a foreign body, requiring improvement of tactical and technical approaches when performing hernioplasty; it was clarified that scar-degenerative changes in the tissues of the aponeurosis in giant and extensive hernias are a predisposing factor to the occurrence of post-prosthetic hernias, especially when implanting the prosthesis in the “inlay” position and, accordingly, require increasing the efficiency of their fixation and engraftment, as well as reducing the risk of developing local complications; it was determined based on the data of an experimental study that the proposed method of alloplasty for large ventral hernias makes it possible to achieve adequate reconstruction of the anterior abdominal wall, reduce the incidence of infection in the wound, and also use a smaller size of prosthetic material; it was determined that the proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant allows maintaining physiology, reducing the number of complications, shortening treatment time and reducing the risk of hernia recurrence; It has been determined that the proposed method for preventing the development or progression of wound infection during alloplasty of ventral hernias can reduce the frequency of suppuration, shorten the treatment time and the likelihood of relapse; It has been proven that the use of the proposed tactical and technical aspects of prosthetic repair for postoperative ventral hernias can reduce the incidence of specific complications, reduce rehabilitation time and the risk of hernia recurrence. Reliability of the research results. The reliability of the results is justified by the use of objective criteria for assessing the condition of patients, modern methods of diagnosis and treatment, the correct application of methodological approaches and sets of statistical analysis, methods for solving the problems discussed in the dissertation are based on modern scientific and practical concepts and approaches to the diagnosis and surgical treatment of patients with giant postoperative hernias. Scientific and practical significance of the research results. The results obtained make a significant contribution to the expansion of irradiation of existing ideas about the structure and clinical features of complications of hernioplasty for giant and extensive ventral hernias by identifying the morphological features of the development of a purulent-inflammatory process against the background of the use of alloplastic material, studying predictors of the risk of developing immediate complications, mechanisms for enhancing reparative processes through the use of an improved method of fixing the prosthesis in together using the effect of photodynamic therapy through laser radiation, which made it possible to enhance the antibacterial effect and improve the wound healing process. The practical significance of the study is that, based on the results obtained, the tactical and technical aspects of prosthetic hernioplasty have been optimized, the features of methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic repair have been revealed, enhancing preventive measures for the development of local infection, and the method of surgery for large anterior abdominal hernias has been improved walls, characterized by a combination of factors such as the formation of tension-free prosthetic plasty, preservation of local resorptive function to prevent the development of fluid accumulations, thereby reducing the risk of developing postoperative complications, reducing the frequency of unsatisfactory results, length of hospitalization and the likelihood of relapse. Implementation of research results. According to the results of a scientific study to optimize the tactical and technical aspects of surgical treatment of large and giant postoperative ventral hernias: the “method for plastic surgery of giant hernias of the anterior abdominal wall” has been improved (invention patent No. IAP 2022 0148 dated April 18, 2022). The proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant made it possible to reduce the number of complications, shorten the treatment time and reduce the risk of hernia recurrence; the “method for preventing the progression of infection during alloplasty of infected hernias” has been improved (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). The proposed method made it possible to reduce the frequency of wound purulent-inflammatory complications and shorten the period of rehabilitation of patients after allohernioplasty; methodological recommendations “Tactical and technical aspects of prosthetic repair for large and giant postoperative ventral hernias” have been developed (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022) . The developed recommendations made it possible to optimize the tactical and technical aspects of allohernioplasty in patients with large and giant postoperative ventral hernias; The scientific results obtained were introduced into the practical activities of healthcare, in particular, in the departments of surgery of the Khorezm and Andijan regional multidisciplinary medical centers, the clinic of the Samarkand State Medical University (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). Improving the tactical and technical aspects of prosthetic repair for postoperative ventral hernias has made it possible to reduce the incidence of specific immediate complications from 40.9% to 15.6%, to reduce rehabilitation time from 8.6±2.7 to 7.1±1.5 days, and also reduce the likelihood of long-term complications from 11.7% to 3.1%. Approbation of research results. The results of this study were discussed at 8 scientific and practical conferences, including 5 international and 3 republican ones. Publication of research results. 26 scientific works have been published on the topic of the dissertation, including 9 journal articles, 4 of which in republican and 5 in foreign journals recommended by the Higher Attestation Commission of the Republic of Uzbekistan for publication of the main scientific results of doctoral dissertations. Structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of work is 200 pages.
The aim of the study to improve the results of surgical treatment of patients with ventral hernias and concomitant abdominal pathology by optimizing the tactical and technical aspects of the simultaneous performance of simultaneous operations with the priority use of endovideosurgical technologies and tension-free plasty methods.
The object of the study were 331 patients with ventral hernias and concomitant simultaneous pathology of the abdominal organs, who were hospitalized in the surgical departments of the clinic of the Samarkand State Medical University for a period from 2012 to 2021.
The scientific novelty of the research is as follows: laparoscopic technologies were applied at certain stages of surgical intervention, which justified itself, since at the same time it allows to eliminate the hernia of the abdominal wall and the simultaneous pathology of the abdominal organs and correct it in a minimally invasive way; it was found that more than ½ (52.8%) of patients with ventral hernias have concomitant abdominal pathology that requires a one-time surgical correction, since the performance in a subsequent repeated operation levels out the results of hernioplasty; justified the use of laparoscopic technologies at certain stages of the operation, which allows correcting the simultaneous pathology of the abdominal cavity in a minimally invasive way with a significant removal of it from the hernial defect of the abdominal wall; the effectiveness of endovideosurgical technology for performing alloplasty in W1 and W2 hernias has been proven; the high information content of CT-hernioabdominometry has been proven, which makes it possible to identify defects in the topography of the anterior abdominal wall before surgery, determine the relative volume of the hernia to the volume of the abdominal cavity and choose the optimal method of hernioalloplasty; improved technical and tactical aspects of non-tension methods of hernioplasty for ventral hernias W3 and W4; the study of the dynamics of stress hormones proved that the implementation of the simultaneous stage of the operation does not significantly affect the degree of surgical aggression and thus justifies the expediency of a one-time correction of the combined pathology of the anterior abdominal wall and abdominal organs; optimization of tactical and technical aspects of one-time surgical correction of ventral hernia and combined abdominal pathology with the priority use of endovideosurgical technologies and tension-free alloplasty methods significantly improved the results of treatment.
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 concomitant abdominal pathology: a methodological recommendation “Surgery of abdominal hernias and combined pathology of the anterior abdominal wall” was developed (certificate of the Ministry of Health 8н-р / 1080 dated October 7, 2022); a methodological recommendation "Surgical correction of combined abdominal pathology in ventral hernias" was developed (certificate of the Ministry of Health 8н-р / 1086 dated October 7, 2022). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and concomitant surgical diseases of the abdominal organs; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs have been introduced into the practice of healthcare, in particular, in the departments of surgery of the Samarkand city medical association, the Samarkand regional multidisciplinary medical center, the multidisciplinary clinic of Samara State Medical University, Shakhrisabz city medical association, Surkhandarya regional diversified medical center, Jizzakh regional diversified medical center (certificate of the Ministry of Health 8н-д / 570 dated October 24, 2022). The introduction of the results of research on improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs substantiated the possibility of simultaneous performance of simultaneous operations in the combined pathology of the abdominal organs and the anterior abdominal wall, avoiding repeated operations after hernia alloplasty.
The structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, and a list of references. The volume of the main material is 153 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.
Although books on the history of Central Asian petroglyphs have been widely published, no scientific research has been carried out in this regard to date.
Of course, there are specific reasons for this situation, first of all, the rise of ideas that the people of Central Asia were backward and illiterate in the period before the October coup d'état of 1917, attempts to falsify knowledge about historical periods that educate the population in the spirit of patriotism and freedom, the study of lithographic books about history hindered in a way. Also, the focus on handwritten books in the coverage of historical processes has led to the exclusion of historical lithographic books. However, lithographic books were important not only from a source point of view, but also from a social point of view. It should be noted that the wider spread of manuscript books, as well as the social factor of lithographic books, allowed for the wide distribution of important historical sources among the population. Taking into account the fact that the work “History of Mullozoda” was published several times in lithographs, it is possible to know how widespread it was among the population [1].
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.
This article was written on the basis of a Decree of Republic of Uzbekistan PF-4850 on “Measures to strengthen further reforms of the judicial system and ensure the protection of the rights and freedoms of citizens” on 21 st of October, 2016. It includes one of the priority directions of further reforming of the judicial system to ensure the protection of the rights and freedoms of citizens, current conditions of removing state condemnation, international experience in this area and some recommendations related to legislation system.
In developing countries, capacity-building among judges, lawyers, policymakers, and other stakeholders will be an important means of maintaining sustainable diversity in international commercial arbitration (ICA). In remarks delivered at a Hong Kong University conference on arbitration reform in the Asia-Pacific, which took place on 27 October 2015, Judge Renaud Sorieul, then UNCITRAL Secretary, observed that the Model Law was not intended to set up identical systems of ICA law globally. While the adoption of the Model Law can ensure a degree of uniformity and harmonization among ICA regimes, there can still be significant differences between one Model Law state and another.
A cross sectional study was embraced to evaluate the seroprevalence of irresistible bronchitis
infection (IBI) in chickens raised under both concentrated and semi-searching frameworks in
Bangladesh. Endeavors were likewise made to segregate the infection from these two
chicken populaces. Chickens being raised under escalated framework at an Administration
poultry ranch and the semiscavenging framework at Smallholder Animals Advancement
Undertaking 2 (SLDP-2) territories, which is being worked in 5 southern locale of
Bangladesh, were serologically researched. The review was led during the period from
October 2017 to Walk 2018. Serum tests were aimlessly from 184 chickens: 104 (Fayoumi
and Rhode Island Red [RIR] breeds) from PZPF and 80 (Fayoumi, Sonali and indigenous)
from the SLDP-2 zones. To seclude the IBI, organ tests were additionally gathered from 100
dead chickens, 74 from PZPF and 26 from the SLDP-2 zones. Seroprevalence of the IBI in
chickens was resolved utilizing Abdominal muscle ELISA test. Virological inocula arranged
from the pooled organ tests of dead flying creatures as per the standard method were
immunized through allantoic sac course (@ 0.2 ml inoculum/undeveloped organism) of 10-11
days' old creating chicken incipient organisms.
In this article, the transition periods of phenological phases and yield indicators in lemon varieties and hybrids are studied. During research, the beginning of bud opening of lemon varieties was observed from February 23 (Meyer). Flowering in the varieties began on March 11, in the first-fruits of Uzbekistan and the yielding variety of Uzbekistan. Average duration of flowering in varieties was 41 days. The second growth period of shoots (16/V-30/V) began, the duration of which was 26-36 days. The beginning of fruit ripening in varieties and hybrids of lemon was determined on October 14 in the first variety of Uzbekistan and hybrid No. 34-85. For the first time, full ripening of fruits was found in hybrid No. 34-85 (4/X1).
The article highlights the benefits of Japan's development model among the global community. The standard of living of the population has grown significantly. Building, Japan is currently a leader in the automotive industry, new manufacturing technologies, scientific and technical research and computer, electrical equipment, not only in the region, but throughout the world. Today, Japan had the opportunity to pursue a relatively free policy in US foreign policy outside the influence of the United States. In the 1980s, a period of revival of Japanese foreign policy began. The main reason for the new aspirations was the growth of economic ties with the PRC, the end of the Cold War and the desire of the Japanese leadership to coordinate the political path with economic power. Japan began to participate in UN-led peacekeeping operations, and in October 1992, for the first time in a UN peacekeeping operation, launched its country's engineering battalion in Cambodia and launched several political initiatives to resolve the Cambodian conflict. Three pillars of Japanese foreign policy: a) promoting stability and world peace; b) developing countries; (c) the welfare of every citizen of the world community. Taking advantage of the economic power of Japan and its active participation in the United Nations, it can raise the issue of its membership in the UN Security Council. Another reason Japan aspires to become a member of the UN Security Council is that, if it had the opportunity, to positively consider the issue of its militaristic past.
Ensuring the right of citizens to favorable natural environment depends, first of all, on compliance with environmental standards in usage of land, water, subsoil and other natural resources in the areas of habitat - cities and other settlements, greening construction processes and rational zoning. Issues of legal protection of urban environment were considered at the UN Stockholm Conference on Human Environment (1972), the UN Habitat III Conference on Housing and Sustainable Urban Development (October 17-20, 2016, Kyoto, Ecuador). A new urban planning program was adopted as part of the Habitat-III conference [1]. This study considers main environmental problems in cities were in connection with construction processes. At the same time, we also studied organizational legal measures and scientific-theoretical bases of construction activities. In addition, legal assessment and review of zoning issues, greening of construction processes, benefits of developing “green economy”, introduction of waste-free technologies, as well as construction of energy-efficient buildings and housing was carried out. In the context of achieving goals set by the Concept of the Republic of Uzbekistan on environmental protection till 2030, introduction of environmentally friendly innovative technologies, prevention and reduction of negative impact on the environment, ensuring growth of environmentally oriented economy, “green” standards in construction sphere as well as application of scientific principles are considered essential.