The aim of the research consists in development of offers and recommendations about further improvement of criminal-legal and criminological measures of fight against crimes in the sphere of information technologies and safety.
The object of the research work is the system of the public relations regulating criminal-legal, criminological and organizational measures for counteraction to crimes in the sphere of information technologies and safety.
The scientific novelty of the research consists of the following:
the expediency of establishment of administrative responsibility for violation of personal privacy at compliance with the law about protection of private life, ensuring protection of the rights of citizens and also completion of legal gaps is proved;
need of establishment of responsibility for infringement of personal privacy in article 1411 Criminal Code of the Republic of Uzbekistan when ensuring criminal legal protection of personal privacy and inevitability of responsibility is proved;
for ensuring the principles of justice and humanity in the criminal legislation the expediency of awarding punishment in the form of restriction of freedom on the persons who have committed crimes in the sphere of information technologies is proved;
high degree of public danger of some crimes (illegal activities for attraction of money and (or) other property (article 1881 of CK), production, storage, distribution or demonstration of the materials containing threat of public safety and to public order (article 2441 of CK)) committed with use of networks of telecommunications and the Internet is explained;
establishment of responsibility for bringing to suicide and inducement to suicide with use of networks of telecommunications and the Internet is proved;
need of introduction of responsibility of the blogger for placement of public negative information of a certain look for the Internet is proved;
inadmissibility of use of personal data of the participants at implementation of electronic commerce for who aren't provided by the contract, need of nondisclosure of the specified data are proved;
establishment of the ban on distribution among children of the information justifying illegal behavior and promoting commission of offense, calling for promotion of the destructive ideas in society and also responsibility for the specified acts is offered;
expediency of application of a method of «confidential dialogue» concerning the persons who have committed information crimes, need of implementation of inquiry, the investigation and preventive measures proceeding from their psychological state are specified;
need of recognition of the actions exerting negative impact to life, health and morality of the personality, made with use of means of information technologies as socially dangerous act is offered.
Implementation of research results. The results of the study are used:
the proposal on establishment of administrative responsibility for violation of personal privacy has found the reflection in article 461 of the Code of the Republic of Uzbekistan about the administrative liability entered by the Law of the Republic of Uzbekistan of September 23, 2016 No. ZRU-411 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from September 28, 2016, No. 06/1-05/1148-vkh). This change provides compliance with the law about personal privacy, protection of the rights of citizens and also completion of a legal gap in the legislation;
the proposal on establishment of criminal liability for violation of personal privacy has found the reflection in article 1411 of the Criminal code of the Republic of Uzbekistan entered by the Law of the Republic of Uzbekistan of September 23, 2016 No. ZRU-411 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from September 28, 2016, No. 06/1-05/1148-vkh). Establishment of criminal liability for commission of the act breaking personal privacy provides criminal legal protection of private life of the person and inevitability of responsibility;
offers on expediency of awarding punishments in the form of restriction of freedom concerning the persons who have committed crimes in the sphere of information technologies, have found the reflection in articles 2781-2786 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan from August 10, 2015 No. ZRU-389 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). This offer serves purpose of alternative punishment for crimes in the sphere of information technologies;
high degree of public danger of commission of some types of crimes with use of networks of telecommunications and the Internet has found reflection in article 1881, the «g» point of third part of article 2441 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan of April 25, 2016 No. ZRU-405 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). According to this offer criminal liability for use of information technologies in criminal intents has been established;
responsibility for bringing to suicide, the inducement to suicide made with use of networks of telecommunications and the Internet have been established in article 103 and 1031 Criminal Code of the Republic of Uzbekistan according to the Law of the Republic of Uzbekistan of June 13, 2017 No. ZRU-436 (the act of Committee on the legislation and the judicial-legal matters of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 06/1-05). This offer has served establishment of criminal liability for the information attacks encroaching on human life;
regulations on responsibility of the blogger for dissemination of public negative information of some look on the Internet are introduced in articles 3 and 121 of the Law of the Republic of Uzbekistan from December 11, 2003 No. 560-II «About informatization» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer serves prevention of various crimes committed with use of the Internet;
offers on inadmissibility of use of personal data of the participants at implementation of electronic commerce for who aren't provided by the contract need of nondisclosure of the specified data have found the reflection in article 18 of the Law of the Republic of Uzbekistan of May 22, 2018 No. ZRU-385 «About electronic commerce» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer became a basis for the ban illegal use of personal data from participants of electronic commerce;
offers on establishment of the ban on distribution among children of the information justifying illegal behavior and promoting commission of offense, calling for promotion of the destructive ideas in society and also responsibility for the specified acts are introduced in article 16 of the Law of the Republic of Uzbekistan of September 8, 2017 No. ZRU-444 «About protection of children from information doing harm to their health» (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer has served recognition of dissemination of information among children of information doing harm to their health as illegal behavior;
offers on improvement of criminal liability for crimes in the sphere of information technologies and safety have been used by preparation of analytical notes within the Concept of improvement of the criminal and criminal procedure legislation approved by the resolution of the President of the Republic of Uzbekistan of May 14, 2018 No. PP-3723 (the act of Committee on questions of innovative development, information policy and information technologies of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan from July 2, 2018, No. 05/2-01-71). This offer serves a proving of inevitability of responsibility for crimes in the sphere of information technologies and information security;
offers on expediency of application of a method of «confidential dialogue» concerning the persons who have committed information crimes, need of implementation of inquiry, the investigation and preventive measures proceeding from their psychological state have been introduced in activity of the relevant structural divisions of the Ministry of Internal Affairs of the Republic of Uzbekistan (the act of the Ministry of Internal Affairs of the Republic of Uzbekistan from July 2, 2018 No. 33/1985). This offer has served increase in efficiency of prevention of crimes in the sphere of information technologies and information security;
offers on need of definition of external influence, level of competence and practical skills of employees, motives of offense when studying the reasons of crimes in the sphere of information technologies and information security and also conducting monitoring of social networks have been introduced in activity of the relevant structural divisions of the Ministry of Internal Affairs of the Republic of Uzbekistan (the act of the Ministry of Internal Affairs of the Republic of Uzbekistan from July 2, 2018 No. 33/1985). This offer has served definition of the reasons and early warning of crimes in the sphere of information technologies and information security;
offers that the information security is object of criminal legal protection taking into account its direct connection with the state interests have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has served protection of information security as object of criminal legal protection;
offers on need of implementation of complex measures from law enforcement agencies for ensuring information security at information security have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has provided orientation of activity of law enforcement agencies on information security;
offer that threats of information security exert essential harm to the interests of the personality, society and state information have found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03- 07-02/124). This offer has allowed to estimate high degree of public danger of information threats as a factor of commission of information crimes;
the rule about protection of the personality against illegal information influence taking into account that impact on consciousness of the personality with use of means of information technologies exerts negative impact on life, health and morality of the personality, has found the reflection in the Law of the Republic of Uzbekistan «About modification and additions in the Law of the Republic of Uzbekistan «About the principles and guarantees of freedom of information» (the act of the Center of information security and assistance in ensuring public order at the Ministry of information technology development and communications of the Republic of Uzbekistan from November 13, 2017 No. 03-07-02/124). This offer has served recognition of the specified actions as socially dangerous act.
Structure and volume of the dissertation. The thesis consists of an introduction, four chapters, a conclusion, a list of used literature and applications. The volume of the thesis is 260 pages.
Laurocerasus officinalis (a synonym for the name Prúnus laurocérasus according to the old classification) - medicinal laurel has bactericidal properties, that is, it releases a wide variety of volatile substances, including phytoncides, which cleanse the environment from microbes and bacteria, and improve the microclimate. Due to these properties, this plant has high sanitary and hygienic properties. Based on this, cherry laurel is recommended for wide target cultivation. And for this it is necessary to develop the most effective methods for propagating this tree. The method of microclonal propagation of the apical meristem part of shoots in vitro is proposed for use
Одно из первых мест в структуре заболеваемости новорожденных занимает анемия, приводящая к нарушению адаптации, усугублению гипоксического повреждения органов и тканей, ухудшению течения сопутствующих заболеваний. Этиология анемии непосредственно связана с метаболизмом железа, и в значительной степени определяется физиологическими и биохимическими особенностями эритропоэза, а также его регуляцией. Уточнение механизмов развития анемии новорожденных и ее терапия являются одной из актуальных проблем современной неонатологии.
This article discusses the provisions of the current legislation of the Republic of Kazakhstan and the Republic of Uzbekistan, regulating the field of electronic document management. The article considered the regulatory legal acts of the Republic of Kazakhstan and the Republic of Uzbekistan, regulating the issues of drawing up an electronic document and implementing electronic document management, such as: the Law of the Republic of Kazakhstan "On electronic documents and electronic digital signature" dated January 7, 2003; The Law of the Republic of Uzbekistan "On Electronic Document Management"; Law of the Republic of Kazakhstan "On Informatization" dated November 24, 2015 No. 418; Law of the Republic of Uzbekistan "On informatization" dated December 11, 2003 No. 560; Law of the Republic of Kazakhstan dated July 26, 2016 No. 11"On payments and payment systems"; Law of the Republic of Uzbekistan dated November 1, 2019 No. 578 "On payments and payment systems". When considering the issue of drawing up an electronic document in electronic document management systems, it is clear that the issue of certifying an electronic document with a seal in the necessary cases has not been settled. For a document to be considered signed and certified with a seal, it is necessary that such a signature and seal be included in the electronic document. Today there is a formal obstacle to the electronic document flow of documents, the creation of which is carried out on special paper forms with coats of arms or emblems. This requirement applies to certain types of statutory, financial documents, notarized documents, etc. In connection with the widespread use of information communications, the problem of information security, the existing systems for storing, transferring and processing information, becomes very important for society. Currently, the prevailing epidemiological situation in the country and in the world has significantly accelerated the exchange of data in electronic form in all spheres of society. Almost all activities of the society have switched to the electronic format of information exchange, including entrepreneurship. We hope that in the Republic of Kazakhstan and in the Republic of
In this article, the methods of construction of minarets of Khiva, architectural composition, building materials, history of construction, devices of aboveground and underground parts, which are of special importance in the ancient Khorezm architecture, are described in scientific sequence and in-depth analysis for the first time. Much of this information is being inserted into scientific circulation for the first time.
Recently, Republic of Korea and Republic of Uzbekistan have been buoyed up by expectations for new leadership. Under the new governments and new policies, the relationship between the two countries has entered a new phase. The new Korean government led by Moon Jae-in sees the new domestic and foreign policy initiatives led by the Mirziyoyev government as highly encouraging and shows great interest in establishing mutually beneficial partnership with the new government in Uzbekistan.
In this article trade and economic cooperation between the Republic of Uzbekistan and the Republic of Korea was considered. In particular, foreign trade turnover of the Republic of Uzbekistan with South Korea, the main exported, imported goods and investment cooperation were separately studied in this direction.
At the same time, in the article were analyzed promising directions of the Republic of Uzbekistan with the Republic of Korea and corresponding proposals were given in its final part.
The article examines the experience of Uzbekistan in preventing corruption in the private sector. It is determined that the negative factors of the spread of corruption among companies leads to a decrease in the competitiveness of the national economy, the quality of public administration, undermines the foundations of free competition, creates threats to the political stability and security of the country.
With the spread of corruption, the business climate and the quality of corporate governance deteriorate, the reputation of companies is undermined, and their investment attractiveness decreases.
In the markets of goods, works, services, negative selection is taking place, monopoly and protectionism are increasing. It was revealed that corruption in the private sector devalues democratic values, contributes to the spread of legal nihilism, permissiveness, money-grubbing, impunity, etc., causing significant harm to the interests of both society and the state, and the rights of citizens.
The thesis is substantiated that the most effective means of preventing corruption in the private sector is the introduction of anti-corruption compliance systems and the corresponding methods of their certification into its subjects. Based on the methods of a comparative study, measures have been identified to introduce anti-corruption compliance in business structures, as well as business entities with state participation.
It is determined that international universal, regional and special standards (UN, OECD, GRECO, ISO, etc.) have a significant impact on the development of national legislation and practice of law enforcement in this area. The thesis about the need to improve the legal foundations of the anti-corruption compliance system, the need to introduce institutions of responsibility of legal entities in Uzbekistan, prevent illegal lobbying activities, etc.
SUMMARY
The article examines the experience of Uzbekistan in preventing corruption in the private sector. It is determined that the negative factors of the spread of corruption among companies leads to a decrease in the competitiveness of the national economy, the quality of public administration, undermines the foundations of free competition, creates threats to the political stability and security of the country.
With the spread of corruption, the business climate and the quality of corporate governance deteriorate, the reputation of companies is undermined, and their investment attractiveness decreases. In the markets for goods, works, services, negative selection is taking place, monopoly and protectionism are increasing.
It was revealed that corruption in the private sector devalues democratic values, contributes to the spread of legal nihilism, permissiveness, money-grubbing, impunity, etc., causing significant harm to the interests of both society and the state, and the rights of citizens.
In order to eradicate corruption in all spheres of society, Uzbekistan is improving the appropriate legal, institutional and organizational measures. The Law "On Combating Corruption" adopted on the initiative of the President of Uzbekistan dated 03.01.2017. In addition to measures to prevent corruption in the field of public administration, he identified as measures to prevent corruption in the field of socio-economic development and entrepreneurship:
elimination of administrative and bureaucratic barriers, simplification and increase in the efficiency of registration, permitting and licensing procedures;
optimization of the control and supervisory functions of state bodies, improvement of the system of inspections of the activities of business entities, prevention of illegal interference in their activities;
widespread introduction of remote forms of relationships between government bodies and business entities;
creating equal conditions for doing business and preventing unfair competition;
introduction of effective legal mechanisms for public procurement, ensuring publicity, transparency and maintaining a competitive environment in the placement of public procurement;
creation of fair conditions and equal opportunities for the population in the field of education, health care, social security, public services and other areas of social and economic development, prevention of corruption offenses;
introduction of effective anti-corruption mechanisms in non-governmental organizations, etc.
The thesis is substantiated that the most effective means of preventing corruption in the private sector is the introduction of anti-corruption compliance systems and the corresponding methods of their certification into its subjects.
On the basis of comparative research methods, measures have been identified to introduce anti-corruption compliance in business structures, as well as business entities with state participation.
In order to improve the efficiency of the anti-corruption system, create the most favorable business climate, promote a positive image of the country in the international arena, by the Decree of the President of the Republic of Uzbekistan “On measures to further improve the anti-corruption system in the Republic of Uzbekistan” No. UP-5729 dated 05/27/2019. the State Anti-Corruption Program for 2019-2020 was approved, which provided for strengthening anti-corruption measures in organizations with a state share in the authorized capital by: introducing a system of anti-corruption “compliance control” and monitoring its effectiveness, еnsuring internal order in accordance with the relevant anti-corruption standard (ISO 37001), as well as introducing special anti-corruption measures in the private sector, ensuring strict measures and control procedures, ensuring strict ethical rules when participating in public procurement, encouraging collective anti-corruption actions of businesses.
In order to improve the investment attractiveness and strengthen the image of our country in the international arena, introduce new mechanisms for working with ratings and indices in state bodies and organizations, by the Decree of the President of the Republic of Uzbekistan “On improving the position of the Republic of Uzbekistan in international ratings and indices, as well as introducing a new mechanism of systematic work with them in government agencies and organizations ”No. UP-6003 dated 02.06.2020. the Republican Council for work with international ratings and indices was created.
Republican Council for improving the position of the Republic of Uzbekistan in socio-economic, political and legal international ratings and indices 06/13/2020 the program of measures to improve the position of the Republic of Uzbekistan in the socio-economic, political and legal international ratings and indices was approved.
In order to increase the effectiveness of state policy aimed at preventing and combating corruption in all spheres of society and the state 29.06. In 2020, the Decree of the President of the Republic of Uzbekistan “On additional measures to improve the anti-corruption system in the Republic of Uzbekistan” No. UP-6013 was adopted
In accordance with the Decree, the Anti-Corruption Agency of the Republic of Uzbekistan and the National Council of the Republic of Uzbekistan for Combating Corruption were created.
It is determined that international universal, regional and special standards (UN, OECD, GRECO, ISO, etc.) have a significant impact on the development of national legislation and practice of law enforcement in this area. The thesis about the need to improve the legal foundations of the anti-corruption compliance system, the need to introduce institutions of responsibility of legal entities in Uzbekistan, prevent illegal lobbying activities, etc.
Since the establishment of diplomatic relations between Korea and Uzbekistan in 1992, the two countries, based on mutually beneficial cooperation and trust, have been developing friendly relations in various fields every year. In particular, the rise of Korea and Uzbekistan to the level of "Special Strategic Partnership" in 2019 was an important event in relations between the two countries. These achievements have not been achieved overnight, but are the result of the two countries ’trust, cooperation and efforts to support each other over the past 30 years. 2021 will mark the 30th anniversary of diplomatic relations between Korea and Uzbekistan. Since the establishment of diplomatic relations in 1992, diplomatic relations between the two countries have been growing in quantity and quality. Today, the presidents of Korea and Uzbekistan sometimes call each other "Aka-Uka" and sometimes describe each other as "true friends." Korea and Uzbekistan have become true brothers. Accordingly, Korea and Uzbekistan, which are actively developing diplomatic, economic, social, as well as health, cultural and labor exchanges as strategic partners for each other, will be a great synergy if they expand cooperation in the future and meet each other's needs and develop together. effect is expected to occur.
The article analyzes the essence of the institution of citizenship, the main principles of this institution, clarification of the constitutional bases, their types, scope and importance in the system of legal status of the citizenship of the Republic of Uzbekistan on the basis of comparative analysis of the sources of constitutional law and legislation of foreign countries, and exploration of the study of international law and universally recognized standards. It identifies legal gaps and contradictions in the field of legal regulation of citizenship of the Republic of Uzbekistan on the basis of comparison of the legislation of the CIS and the Baltic states, and provides scientifically based proposals and recommendations for their elimination. Moreover, the need and benefits of the implementation into national legislation, including the Constitution of the Republic of Uzbekistan based on the results of the research of the level of compliance of the legislation on citizenship of the Republic of Uzbekistan with the universally recognized rules and principles of international law. In addition to, the article emphasizes the significance of the application of universally recognized legal norms in internal law, which improves the “image” of the Republic of Uzbekistan in the international arena and show clear position on the right to citizenship (or change it).
The article presents the world forecast for the development of the heat and power industry for the production of heat and electricity. It is noted that the increase in the production of types of energy is associated not only with an increase in the consumption of fossil fuels, but also with the deterioration of the environmental situation. Taking into account the foreign experience of using solar installations producing thermal energy and favorable climatic conditions of the Republic of Uzbekistan, the prospects of using solar air heaters for heating existing residential buildings were discussed. providing residential buildings and drying plants with heat energy without expensive constructive and technological solutions, as well as carrying out rapid heating of premises. Such a collector, despite the fact that the air has a lower heat capacity, can provide an even distribution of heat, it is well regulated both in temperature and in the amount of air supplied. In addition, collectors operating under natural convection conditions can be successfully combined with a traditional heating system.
At the same time, the article also shows a positive experience of using air heaters in drying technology. In particular, an industrial prototype of a solar air heater was used to dry the windings of transformers used in pumping stations of irrigation systems for the water sector of the Republic. It is shown that the use of air heaters allows saving not only significant fuel, energy and monetary resources, but also strengthening the energy security of the Republic of Uzbekistan.
SUMMARY
On the article "The role of solar heaters in the thermal energy industry and the prospects for their development in the Republic of Uzbekistan"
The article discusses the use of solar heaters in the conditions of the Republic of Uzbekistan during the heating season to support traditional heating systems.
As is well known, solar energy is the most prepared form of all existing alternative energy sources, which can be used, partial and in some cases completely, as a replacement to the heating system in the residential or public buildings. More acceptable devices that provide this heating can be considered solar air heaters.
Such a collector, despite air’s low heat capacity, can provide an even distribution of heat, well-regulated both by temperature and by the amount of air supplied. The Republic of Uzbekistan is in a favorable geographical area for such collector because solar energy in the country can be practically used for 10 months of the year, of course, considering the variable nature of solar insolation.
The author of the article shows that with the volume of housing stock of Uzbekistan at 507,5 million m2 (private housing fund is 504,1 million m2 as of January 1, 2018), 4 months’ heating cost during the heating season can make up 4,6 trillion soums.
Preliminary calculations show that the use of solar air heaters in buildings heating systems, at least as an auxiliary source of thermal energy, provides significant savings in natural gas.
For example, during the coldest months in the country – December and January- the savings can comprise 0,26 to 0,23 trillion soums. The article presents an experimental sample of the solar air heater, as well as describes the positive results of using solar air heaters for drying transformer windings.
Поскольку почвенная экологическая среда сложна, внесение удобрений, и дальнейшее их быстрое растворение, а также распространение в пахотном слое может привести к изменениям в устойчивых почвенных микроценозах.
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.
In chronic experiments in laboratory animals, studied toxicological perspective new antiarrhythmic effect of N-deacetyllappaconitine for the treatment of arrhythmic states, an original herbal preparation based on Aconitum leucostonum, Ac.Septentrionale was created. During 2,5 months of intragastric administration in animals exposed to all doses of N-deacetyllappaconitine, no deviations in the parameters of the functioning of the nervous system were found, therefore, this value is the lowest effective (threshold) dose in a chronic experiment.