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.
Objects of research: educational process in the Institute of Pedagogy in the conditions of innovation changes in teaching based on the person-oriented paradigm.
Subject of research: pedagogical monitorinr of the students’ training as a complex of knowledge, conditions, and methods for realization of technology of the person-oriented education in the Pedagogical Institution.
Objective of the work: comprehensive theoretical and practical study of the pedagogical monitoring as a scientific event and development of the system for its implementation in the paradigm of the person-oriented education in the Pedagogical Institution.
Methods of research: study and analysis of the literature on the problem; questionnaire design and ranking, testing, pedagogical experiment, methods of mathematical statistics.
Obtained results and their novelty: has been developed and introduced: pedagogical monitorinr of the students’ training in the Pedagogical Institution; designed organizational model of the pedagogical monitorinr system; phenomenon of the pedagogical monitorinr has been considered in the context of the person-oriented educational process paradigm.
Practical significance: have been developed methodical guidelines for pedagogical monitorinr; individual curriculums, diagnostic methodic, and lesson scenarios; have been demonstrated ways, forms and methods of introduction of the pedagogical monitoring during person-oriented educational process in the Pedagogical Institution.
Degree of introduction: research findings have been reflected in 12 publications; basic conclusions and provisions have been discussed at the International, Republican and Inter institutional conferences.
Sphere of application: secondary school of general education, secondary specialized school, vocational schools (colleges and academic lyceums), and higher school.
The article is about a creative approach to the organization of professional activity, self-discipline, the desire to enrich their professional knowledge and improve their pedagogical skills, to establish a respectful and demanding relationship with students and their parents, a positive solution to complex pedagogical conflicts mastering the skills of making.
The article is about a creative approach to the organization of professional activity, self-discipline, the desire to enrich their professional knowledge and improve their pedagogical skills, to establish a respectful and demanding relationship with students and their parents, a positive solution to complex pedagogical conflicts. mastering the skills of making.
Topicality and demand of the theme of dissertation. In world practice of informatization, systems of electronic document interchange (EDIS) arc considered and introduced last years not only as systems for automation of manage processes but also as high-grade platforms for creation of uniform information field, so borders of their use, certainly, expands and scientists of the world raises interest to them. In researches of leading scientists of infocommunication technologies the demand of problems of authentic gathering, transfer, analysis, coding of information during formation of office-work documents is allocated for getting of effective technologies raising mobility and productivity of EDIS.
Complex measures undertaken by the Government of Republic of Uzbekistan on development of systems of region-territorial automated management and to creation of uniform information field arc directed on wide introduction of information systems, EDIS, databases (DB) on the basis of modern information-communication technologies. In this connection, working out of new methods to intelligent processing of information resources used for improvement of data transfer quality, allowing effectively to find out and correct errors in structure of electronic document interchange with least material and time expenses, differs a special urgency and, at the same time, remains the unresolved theoretical and applied problem having important economic value.
Requirements to information resources and streams of data transmission as the important factor of efficiency and quality of EDIS functioning arc expressed in providing of stability, integrity, safety and authenticity of the information. One of important among factors is the criterion of authenticity of the information, caused by distortion of transferred messages in infocommunication networks because of failures and refusals of means, any handicaps in communication channels, errors of operators, scanning and recognition systems.
Hence, construction of effective systems to control of information authenticity during transfer and processing represents special scientific interest as priority technology of data processing, characteristic for conditions of automated management and electronic document interchange at the enterprises and organizations.
For existing methods, despite of providing the high level of information transfer authenticity, some unsolved questions is typical, and as basic of them it is possible to allocate the following: at development technologies of electronic documents interchange in structure of modern data transfer packages the significant volume of resource is spent for headings, at the same time the most part of information in headings remains constant from package to package during stream of transfer of the whole frame (redundancy of the information arising at it and mechanisms to provide reliability of deliveries consisting, basically, in sending the appropriate message and repeated transfer of packages, - result to additional time and material expenses while errors detection and elimination); code and hardware methods of information transfer control arc focused, mainly, on elimination the transposition mistakes in managing fields of packages; however, at data transfer there arc also distortions in information fields, which frequently reveal as multiple text mistakes.
In this relation, the decision of tasks for providing of information transfer authenticity is reasonable to consider in two aspects.
Solutions of the first type tasks should taken into account errors of the man-operator, scanning and other devices intended for input of the information. These kinds of mistakes make greatest volume of distortions in text and arise at Applied and Representation levels of OSI model (Open System Interconnection reference model).
Solutions of second type tasks, devoted to control of the information reliability, take into consideration the probability of distortions which occur at stages of Transport, Network, Physical and Line of model OSI.
Demand of the dissertation is characterized by the fact that introduction of a wide range of IP-enabled technologies in electronic document interchange is connected to requiring close attention tasks of detection and correction of errors during preparation and processing of documents.
This research work is focused on providing realization of laws of the Republic of Uzbekistan «On informatization», «On electronic digital signature», «On electronic document», «On electronic commerce», «On electronic payments», Decree of the Cabinet of Ministers of the Republic of Uzbekistan № 126 on 05.04.2011 «About measures on installation and use of a single secured e-mail and system of electronic document interchange in the executive office of cabinet of ministers, bodies of government and economic governance, local government».
Following that, the solution of listed tasks requires carrying out the special researches and development connected to creation of methods and algorithms, capable to control the information authenticity in structure of data transfer packages at the expense of use the enclosed redundancy, and able to function in transport environment, eliminating existing lacks. This fact causes necessity of allocation of a special class algorithms for providing of information authenticity on the basis of new type of PR-rcdundancy (property redundancy), defined by depending on properties of processed object.
Purpose of research is development ol constructive methods, models, algorithms and systems of information authenticity control during transfer and processing of the data on the basis of mechanisms used PR-rcdundancy of various nature, and software and algorithmic realization of results for developing technologies of electronic document interchange.
Scientific novelty of disscrtational research consists in the following:
concept, methodology and software and algorithmic bases to construction methods, models and algorithms for the information authenticity control in systems of electronic document interchange arc developed, classes of objects characterized by PR-rcdundancy, applied to provide accuracy, integrity, efficiency, compression, availability of information resources in EDIS arc allocated;
methods and algorithms arc offered for control of information reliability at the expense of use the artificial redundancy on the basis of linear, modular, plane summing mechanisms and definition of belonging to the coded subsets;
methods and software complexes arc developed for control of information reliability at the expense of use the natural redundancy on the basis of algorithms in which procedures of statistical, arithmetic, parsing coding, n-gram structured description, statistical pattern recognition and hashing of text elements arc realized;
for control and correction of spelling mistakes in texts on Uzbek language methods and algorithms arc offered on the basis of models of multilevel morphological analysis and n-grams Grammatik description;
on the basis of enclosed logic criteria, database and knowledgebase in structure of the built-in expert systems methods and algorithms arc developed for the control of information authenticity at the expense of use the structural-technological PR-rcdundancy;
methods arc offered to synthesis algorithms of text information reliability control in interactive system of errors detection and correction for developing technologies of electronic document interchange.
Conclusion
1. Developed in the dissertation constructive methods, models, software and algorithms complexes to control of information authenticity by principles of using of PR-rcdundancy on the basis of concepts of system analysis, control and information processing allow to increase efficiency and productivity of EDIS.
2. The estimation of current state of the theory and practice of code, hardware and program methods of control of authenticity information transfer had shown insufficiency of existing types of redundancy for providing qualitative functioning of EDIS. Principles of use of PR-rcdundancy at electronic documents for working out applied methods, software and algorithmic complexes to providing of information transfer authenticity have allowed to design toolkit of development of existing technologies.
3. Methods of: linear, plane and modular summation; codings by rules of Haffman, Lempcl-Ziv-Velch, Barrousc-Willcr, arithmetic coding, statistical recognition, logic control form methodical bases of use of PR-rcdundancy for expansion possibilities of algorithms and software complexes to providing of the information authenticity during drawing up, transfer and processing of electronic documents texts.
4. Efficiency of developed algorithms is shown and solutions arc got for tasks of control the information authenticity on the basis of criterion of mistakes undctccting probabilities. It is established, that they find up to 92 % of all kinds of mistakes, capable to correct single, double and adjacent transpositional mistakes, in comparison with existing methods reduce labour content and cost of control in 2-3 times if probability of mistakes is accepted as P«4-10-3, and also raise the information authenticity up to three orders.
5. To solving tasks of control and correction of spelling mistakes in Uzbek texts methods, algorithms and systems arc developed included morphological and n-gram structured models. The developed technique of getting frequency characteristics of n-gram on the basis of distortions probability parameters statistics arc applied during systematization hash-codes for parsing coding.
6. Interpolation and extrapolation methods of construction the logic and arithmetic function of statistical recognition arc used for working out algorithms to control of text elements images authenticity. Methods arc developed to control authenticity of alarm characteristics of text elements images in ncuronctworking system to information processing which includes parts of automatic recognition and control of images signals. Methods and algorithms arc realized in the structure system to control of information authenticity for eases when information in EDIS is represented as metatext on the basis of belonging attributes and classification of metatext on fuzzy semantic hypcrnct.
7. Methods and algorithms of the control of the information authenticity, based on methods of dictionary, statistical and hash-codings provide effective applying of the hardware-software environment of parallel computations NVIDIA with use of standard libraries of numerical analysis, optimized data exchange between CPU and GPU for optimization.
8. It is determined that at realization of the system to control of spelling on the basis of developed ways of description and identification of the software shell, treelike representation of n-gramm grammar and architecture of framework Sfinks-4 focused on various language models used PR-rcdundancy, the number of undetected errors and cost of realization considerably decreases, and labour content in comparison with the spelling control system on the basis of morphological analysis decreases twice.
9. Developed simulating algorithms, complexes of software and systems to control of information authenticity on the basis of using PR-rcdundancy have found practical application in systems of: automated organization of educational environment in high schools; adapted data transfer, processing and analysis in infocommunication networks; EDIS of enterprises.
10. The developed software complexes to control the information authenticity in structure of EDIS and computer system of adapted transfer, handling and data analysis arc implemented in real working conditions in the Samarkand branch «UzTelecom» of the State committee or communication, for informatization and telecommunication technologies of the Republic of Uzbekistan and in Joint Venture «Tasty-Fuit». Appropriate certificates confirm cost of economical efficiency of dissertation results.
In the development of the Republic of Uzbekistan, the need to create and implement an excellent educational system based on the rich spiritual potential of the people and universal human values and the latest achievements of modern economy, science, technology and technology, as well as the theoretical and methodological foundations of national pedagogy and modern pedagogical technologies, and their implementation in practice is competitive. it is planned to pay special attention to the task of training specialties. Therefore, the article presents some problems in the use of modern pedagogical technologies.
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.
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