scholarly journals The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement

2018 ◽  
Vol 20 (4) ◽  
pp. 106-112
Author(s):  
I M Samokhvalov ◽  
K P Golovko ◽  
A V Denisov ◽  
S Yu Telitsky ◽  
N A Zhirnova ◽  
...  
Keyword(s):  
Blood Volume ◽  
Medical Devices ◽  
Limited Liability ◽  
Traumatic Shock ◽  
Infusion Therapy ◽  
Volume Resuscitation ◽  
Limited Liability Company ◽  
Circulating Blood Volume ◽  
Medical Evacuation ◽  
Intraosseous Infusion

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

scholarly journals BLOOD VOLUME AND HEMODYNAMIC CHANGES IN PREGNANTS, PARTURIENTS AND PUERPERAE

2018 ◽  
Vol 5 (1) ◽  
pp. 4-8
Author(s):  
Aleksandr M. Ronenson ◽  
E. M Shifman ◽  
A. V Kulikov
Keyword(s):  
Blood Loss ◽  
Cardiovascular System ◽  
Blood Volume ◽  
Postpartum Period ◽  
Structural Changes ◽  
Volume Status ◽  
Infusion Therapy ◽  
Circulating Blood Volume ◽  
Functional Changes

In the article, there are considered questions of physiological changes of the blood volume status during pregnancy, parturition and in the postpartum period, features of functional and structural changes of the cardiovascular system. The determination of the circulating blood volume is still a stumbling block for obstetrician-gynecologists and anesthesiologists-resuscitators. Our view of the normal blood volume status during pregnancy is important in light of the assessment of the blood loss in the development of massive obstetric hemorrhage. The doctor needs to know what changes in the cardiovascular system are physiological and which are pathological in case of blood loss, with taking into account the functional changes in the heart that occur during pregnancy, parturition and in the earliest postpartum period. A deeper understanding of this problem will help the doctor avoid aggressive infusion therapy, which can lead to complications.

scholarly journals Infusion therapy in the internal diseases’ propaedeutics

2020 ◽  
pp. 306-308
Author(s):  
V.I. Chernii
Keyword(s):  
Blood Plasma ◽  
Blood Volume ◽  
Isotonic Saline ◽  
Clinical Manifestations ◽  
Tissue Perfusion ◽  
Coagulation System ◽  
Infusion Therapy ◽  
Electrolyte Balance ◽  
Circulating Blood Volume ◽  
Plasma Substitutes

Background. Infusion therapy (IT) is one of the main methods of drug therapy optimization. The essence of IT is to correct homeostasis disorders in order to detoxify, to restore the disrupted microcirculation and tissue perfusion, to eliminate the disorders of rheological and coagulation blood properties, to eliminate metabolic disorders, to improve drug delivery to the pathological focus, to restore circulating blood volume, to normalize fluid and electrolyte and acid-base balance. Objective. To describe modern IT. Materials and methods. Analysis of the literature sources on this topic. Results and discussion. Requirements for modern plasma substitutes include safety, sufficient and long-lasting volemic effect, rapid renal excretion, lack of accumulation and effect on the coagulation system, maximum similarity to blood plasma, and availability. There are several classes of plasma substitutes, and each of them has its own indications. For example, crystalloids are prescribed for dehydration, and colloids – for hypovolemia. The infusion volume is calculated based on the physiological needs of the organism, taking into account pathological fluid loss (fever, shortness of breath, postoperative wound drainage, vomiting, polyuria). Endogenous intoxication (EI) – a pathological condition that occurs as a result of exposure to toxic substances of exogenous or endogenous nature, which cause dysfunction and the development of extreme conditions – is an important field of IT application. EI can accompany chronic heart failure, peripheral vessels atherosclerosis, autoimmune and allergic diseases. Toxins have a direct (direct destruction of proteins and lipids, blocking of synthetic and oxidative processes in the cell) and indirect (microcirculation system and vascular tone disorders, changes of blood rheological properties) adverse effects. Clinical manifestations of EI include fever, malaise, and the dysfunction of various internal organs. As EI depletes the natural mechanisms of detoxification, worsens the clinical course of the disease, reduces drug sensitivity, suppresses immunity, it is an indication to detoxification via infusion. The tasks of the latter are to improve tissue perfusion, to provide hemodilution with a decrease in the toxins’ concentration, to stimulate diuresis, to eliminate acidosis, and to maintain the functional state of hepatocytes. For this purpose, solutions of polyatomic alcohols (Reosorbilact, Xylate, “Yuria-Pharm”) can be used. Reosorbilact increases the circulating blood volume, improves microcirculation and rheological blood properties, increases tissue perfusion, promotes “wash-out” of toxins, corrects acidosis and fluid and electrolyte balance, normalizes hepatocyte function, improving the own detoxification mechanisms. In case of microcirculation disturbances, it is reasonable to use the combined IT with the inclusion of Reosorbilact, Latren and Tivortin (“Yuria-Pharm”). Latren increases the elasticity of erythrocytes, reduces the aggregation of erythrocytes and platelets, normalizes the electrolyte composition of blood plasma, and Tivortin acts as a substrate for the formation of nitric oxide – the main signaling molecule of the endothelium. In addition to EI, IT usage is often prescribed for diabetic ketoacidosis. In such cases, it is advisable to use Xylate (“Yuria-Pharm”), which has antiketogenic properties, improves hemodynamics, corrects acidosis, and does not increase blood glucose levels. Xylate is recommended to be used only after preliminary rehydration with the help of isotonic saline solutions. Conclusions. 1. IT is an important method of treating a number of diseases. 2. EI accompanies not only diseases that involve intoxication syndrome, but also almost all internal diseases. 3. Reosorbilact and Xylate are the optimal solutions for detoxification. 4. It is reasonable to use combined IT, for example, the combination of Reosorbilact with Latren and Tivortin.

scholarly journals Rheo-STAT project. New options of the intoxication syndrome therapy from the point of view of the evidence: accent on pneumonia

2020 ◽  
pp. 82-83
Author(s):  
Dinh Thi Hoa ◽  
S. Beridze
Keyword(s):  
Heart Rate ◽  
Body Temperature ◽  
Blood Volume ◽  
Baseline Level ◽  
Combined Treatment ◽  
Volume Overload ◽  
Controlled Study ◽  
Infusion Therapy ◽  
Electrolyte Balance ◽  
Circulating Blood Volume

Background. Pneumonia is a widespread disease and an often cause of hospitalizations both in Vietnam and Georgia. The supportive treatment of pneumonias includes the respiratory support, the support of fluid and electrolyte balance, parenteral nutrition and some additional drugs (analgesics, corticosteroids, inotropes). Rheo-STAT study is an interventional open-label randomized controlled study of Reosorbilact (“Yuria-Pharm”) effectiveness in pneumonia treatment. The study was held in 7 countries (Ukraine, Moldova, Georgia, Vietnam, Kazakhstan, Kyrgyzstan, Uzbekistan). Objective. To assess Reosorbilact effectiveness in the elimination of the intoxication syndrome. Materials and methods. 628 adult patients with sepsis, peritonitis, pneumonias and burns took part in this study. The pneumonia subgroup included 150 people (62 % males, mean age – 41.3 years, 33 % had some concomitant diseases). Inclusion criteria were the following: age – 18-60 years, community-acquired pneumonia and antibiotic therapy, administered not later than after 48 hours after the disease beginning, at least IV class according to PSI/PORT index, the presence of informed consent, baseline level of SOFA points ≥2. The assessment according to the SOFA scale on the 3rd day of treatment in comparison to the baseline level was the primary endpoint. Secondary endpoints included the change of mean result according to other scales (APACHE II, SAPS II, MODS, PSI/PORT, CURB-65) and changes of biochemical, immunological and integral markers of endogenous intoxication. Results and discussion. Infusion therapy with the help of Reosorbilact (200-400 ml per day) led to the increase of circulating blood volume and to the decrease of total infusion volume without any risk of volume overload. Lactate – one of the Reosorbilact components – did not increase the endogenous lactate level, which testifies a high safety. Inclusion of Reosorbilact into the combined treatment in 3 days led to the body temperature decrease from 39.37 to 36.77 °С, heart rate decrease from 105.27 to 77.81 bpm, leucocytes amount – from 9.38 to 6.64×109/L. Blood oxygenation also increased at the 3rd day of treatment, and PSI/PORT index decreased from 101.47 to 49.07. Pulmonary edema or pleural effusion were not revealed in any patients. Conclusions. 1. Pneumonia is a widespread disease, which often requires hospitalization. 2. Infusion therapy with the help of Reosorbilact increases the circulating blood volume without a risk of volume overload. 3. Inclusion of Reosorbilact into the combined treatment of pneumonia in 3 days leads to the decrease of body temperature, heart rate, leucocyte amount and to the increase of blood oxigenation.

Effectiveness of clauses restricting equity transfer in articles of association of limited liability companies using fuzzy AHP: A data analysis of related cases in China from 2010 to 20191

2021 ◽  
pp. 1-12
Author(s):  
Peng Chen ◽  
Yingzhi Nie
Keyword(s):  
Fuzzy Ahp ◽  
Limited Liability ◽  
Limited Liability Company ◽  
Analytic Hierarchy ◽  
Legal Norms ◽  
The Past ◽  
Analytic Hierarchical Process ◽  
Closed Characteristics ◽  
A Company ◽  
External Equity

Based on the company cases published in China over the past ten years, both theoretical methods and Artificial intelligence technologies were applied to analysis cases data on the effectiveness of clauses restricting equity transfer in articles of association of limited liability companies (LLCs). With its unique characters based on shareholders and strong vitality, limited liability company (LLC), as the “evergreen tree” among the market players, is a company form adopted by many investors. Nevertheless, due to its prominent closed characteristics, equity transfer has become a bottleneck for the development of LLCs. According to this paper, it is necessary to distinguish between the effectiveness of clauses restricting internal and external equity transfer in articles of association of LLCs. Fuzzy Analytic Hierarchical Process (AHP) is utilized for which involves process of analytic hierarchy modelled with utilizing theory of fuzzy logic. Moreover, instead of being confined to the existing legal norms, the judgment standard of clauses restricting equity transfer in articles of association of LLCs should be comprehensively measured by the golden rules, i.e. “fairness”, “autonomy” and “operability”.

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