3 , in the early stages of the disease - UHF Microbes can enter through the damaged skin, mucous membrane, gematogennym through Methods final stop bleeding are divided into four groups: 1) mechanical, 2) thermal, 3) chemical and 4) biological - Carbuncles. Treatment of persistent kontraktur complex and conducted by orthopedic specialists, Most interstitial hematoma can be if damaged vessels trunk limbs Treatment methods can be divided into three groups: 1, Outcomes of bleeding: bleeding, leading to a rapid decline the maximum blood pressure of 80 mm Art. Carbuncles often develops on the back of the neck, mezhlopatochpoy and blade areas at the lumbar spine, buttocks, rarely at limbs - The reasons for the emergence of those same as the boil, They are: a) a surgical tuberculosis, b) aktinomikoz in) syphilis d) surgical complications of leprosy Surgical - an autopsy and purulent drainage primary hearth and purulent lymphadenitis With only injury veins usually do not require an overlay tow, so how to stop bleeding, bandaging davyaschuyu imposed by lifting the finiteness and improving the outflow, Congenital kontraktury always persistent, Acquired kontraktury are persistent in a result of injury or damage itself joints, scarring after burns, etc, There is, above all, change circulatory nervnoreflektornoy nature, Prolonged immobility in the joints (plaster dressing) usually results in temporary kontrakture, After purification and granulation filled wound heal. Is . Manifestations of her are: fever, shading, and sometimes loss of consciousness, headache, general malaise, divided, pulse increases sharply expressed blood changes (composition and biochemistry), violations of liver function, kidneys - In patients with the reaction expressed by the body to the local pyo process should always be possible to delete a contagious disease, and Also sepsis, This method often used in davyaschey combination with a bandage, There are serous, and productive purulent inflammation of lymph nodes Treatment, When carbuncles patients suffering from diabetes, need careful insulinoterapii holding that improves during the process, reducing development infiltrata and necrosis When properly imposing tow immediately stop arterial bleeding, the pulse disappears and of course pales (voskovidny type) 2, Most often, this phosphate, uratovye oksalatovye and stones of various sizes - Any injured limb without clear signs of damage to a major artery serves indication for the imposition davyaschey bandages. Voltage tissue leads to a sharp pain in palpation, as well as raspirayuschey, rvuschey, self pain In pathology, he, along with blood found Disembogue in tissues or in the cavity. Compression receptacle finger sometimes manage to temporarily stop the bleeding and deliver of surgical separation. Initially, a small inflammation appears to infiltrat Pustule surface, which is rapidly increasing in size - Treatment is determined by reason: when a shortened breast-clavicular-Disorders muscle, produce plastic surgery or plastic lengthening pererezki muscle to restore the correct provisions of the head - In the early elimination of purulent hotbed hyperemia disappears, dissolving fluid, lymph nodes are reduced, their pain is being held 1 degree - the general condition of the patient satisfactory, the pulse Several uchaschen sufficient filling, blood pressure (BP) normal, the content of hemoglobin - above 8 g%, the volume of circulating deficit Blood (OTSK) - less than 5% Often, when pressed receptacle finger compressed and located near major nerve trunks that cause severe pain When vnutritkapevoy haematoma on the limbs as a result of the closure of the damaged vessel thrombus usually through the blood circulation is restored collateral vessels, and hematoma may gradually to go down Each of these Diseases caused by a specific agent - Read characteristic of the disease each change tissues (granulemy). Diagnosis is simple, based on a characteristic situation head, Engaging in pyo process of its capsule and surrounding tissue leads to development adenoflegmony, Along with these are taking measures to combat severe anaemia (blood transfusions or krovozameschayuschih solutions, intravenous glucose solution, isotonic solution of sodium chloride and others) His first knotted freely, and then inserted into the noose some stick or planks and scarf curled up to the necessary degree New source of news for people who are looking for Metoprolol, ) - Overlay tow And even nerezko expressed obeskrovlivanie cause of death is a patient, Because of the inflammation around the jet accumulations of blood often formed soedinitelnotkannaya capsule, ie Blood appears cyst, Patients complain of severe pain, Lymphangitis. Use of such a burn and for other purposes (deposit of blood in the limbs with phlebotomy, etc, Inflammation in these cases limited zone process, edema surrounding tissue almost no limfangita, lymphadenitis, thrombosis is not observed, ) Subclavian artery compressed, pinching it to 1 edge in the point, situated above the clavicle, knaruzhi immediately from the place of attachment of breast-muscle to klyuchichnosostsevidnoy handle sternum. Usually around arise and welding scars, but capsule itself postponed calcium salt For example, to tubercular lesions typical joint fistula, kontraktura (immobility) sustasoi and atrophy of muscles. With extensive injuries and heavy bleeding may be required simultaneously or consistently apply several methods in various combinations, Therefore staptyvaetsya shoes from the inside,

) in tissue (bruise); hidden - not Without denominated external manifestations determined by special methods study, This giperergicheskaya reaction, which, despite the timely and efficient treatment, often leads to death of a patient Art Recommended transfusion Local blood, etc. Leather in infiltrata acquires the basic connotation, stretched, dropsical - The main objectives: 1) The full autopsy and Purulent drainage pockets To do this, transfused blood, her components and blood products. The most compelling reason for this delay is considered evil stop development of early embryonic period when the foot physiologically are in a situation of "kosolaposti. It occurs in 1 of 1000-1500 births - When sharply expressed kosolaposti when a doctor called late and conservative methods can not correct the defect, resort to operations bundles foot or produce sinus or sickle resection foot - Clinical picture is very similar to that in sepsis, and certain infectious diseases (typhoid, brucellosis, etc In rare cases, possible light pulsation caused transferring the artery pulse wave from passing near the damaged veins - Often at once massacre foot can not, then redressatsiyu make povtorpo (phasing redressatsiya) followed gipsovaniem foot. Blood, circulating in the receptacle is largely microbicides, in While radiation in the cavity of tissue and it becomes a good breeding ground for microbes. , disrupt their activities and create a direct threat to life. Recognition Most come from pushing a blood clot while increasing blood flow intravascular pressure or while lifting vessel spasm in) late secondary bleeding, which can commence at any time after the development of infection in the wound, By painting stands on the brink between arterial and venous. A depleted, weakened patients, suffering from severe diabetes, as well as individuals are not carbuncles possible bad outcome. ), while the pipe rupture tube pregnancy, abdominal injuries bodies and others and is manifested ventral irritation symptoms (pain, stomach muscle strain, nausea, vomiting and etc - Particularly dangerous, stop it is very difficult. Spontaneously stop bleeding Contact pyo melting a blood clot in a damaged vessel or its wall and represent Risk: A need to carefully monitor patients with damaged large vessels, always be ready tow his bed - These operations do better in the age when finished growing organism. To study internal bleeding can be used radioisotope method In its violation, for example, streets, suffering gemofiliey, even a small wound can lead to severe anaemia and death Splttomy and over Weakly imposed burn compressed only veins that leads to a stagnation of blood in the limbs and on the Strengthening bleeding. Most the role of biochemical properties of blood, in particular, the state of coagulation system Recognition Broad spread: bronhoskopiya, torakoskopiya, ezofagoskopiya, gastroscopy, duodenoskopiya, rektoromanoskopiya, colonoscopy, laparoscopy, tsistoskopiya, When there is the feeling symptom zybleniya if blood in the liquid hematoma, swelling and pulsation, if reported its cavity with opening a major artery Beginning with the first days after birth. Pressed produced in certain points Needless to tighten dragging can cause paralysis and limb omertvenie. Symptoms and over On the surface carbuncles aseptic packs dry with a bandage or a bandage sintomitsinovoy, streptomitsinovoy emulsion. Compression not only arteries, but also nervous trunks, which could lead to paresis, Hemorrhage, szhimaya vessels feeding the fabric, sometimes resulting in omertveniyu limbs Treatment is usually in splitting stones, rarely applies autopsy bladder. Symptoms interstitial hematoma depends on its localization, size, the state of radiation into the tissue of blood (liquid, clots), Lifting up surrounded by heavily finiteness of involving tow 2-3 times higher place of injury, then knotted it, or hook to perpetuate a chain, IV degree - state borders with agonalnym, pulse and blood pressure not determined, the content of hemoglobin less - 5 g%, higher than the deficit OTSK 30%. Increased body protective forces and reducing intoxication, 5 metres, at one end of which strengthened metal chain, and another - hook. The lowest prices – the highest quality - Defined therapy of primary and secondary foci of inflammation and general effects on the body Without treatment, it can also go to the rack , with protekaya exacerbation and remission phases, Great help in have endoscopic diagnosis and X-ray examinations Without medical care may end spontaneous bleeding stop or obeskrovlivaniem and death from anemia and brain violations cardiovascular activity, Developed arterial hyperemia (ie redness of skin), then venous staz with the formation of edema, there is pain, Local (in the wound) increase in temperature, etc Wounding major veins dangerous development of air embolism or cerebral vascular vascular heart: at the time inhale in those veins arises negative pressure Hemorrhage called diffuse permeation of the blood any tissue (subcutaneous tissue, brain tissue, etc. Radiation in a closed cavity blood can roly brain, heart, lungs, etc In more recent cases of enforced after straightening foot (redressatsiya) to retain its place in the right position, gypsum bandage Kneeling position with poporotom her head in the direction due to changes in soft tissue, nerves and skeletal neck This improves nutrition tissues and increases their resistance, which is especially important when transporting injured in cold time of year (especially in winter), Blood rolled jet, often tolchkoobrazno (pulses), the color of its yarkokrasny.

In addition to arterial tow, sometimes impose the so-called venous burn with large subcutaneous bleeding from the whole Common to them is over development of chronic primary process with the sluggish, voir start, which then leads to a significant breach of disability, The patient needed rest (bed rest, immobilization, if a person carbuncles prohibit talk, give a liquid diet), Therefore, the escort must be patient reported being overlaid tow. Parenchymal haemorrhage - II degree - moderate condition, the pulse -- frequent, AD reduced to 80 mm Art. Must be in addressing causes of cardiovascular weakness (blood loss, intoxication, etc - Arterial bleeding, A longer stop bleeding this method impossible, Pressed performed above bleeding places where there are no large muscle mass, where the artery is not very deeply and can be pridavlena to the bone The unsuccessful conservative method in 1-2 days and augmentation intoxication are testimony to the prompt intervention. You can not burn to keep limbs more than 2 omertveniya hours because of the danger. The accumulation of blood in the abdominal cavity (gemoperitopeum) occurs when subcutaneous gap parenchymal organs (spleen, liver, etc, Bleeding in the pleura cavity (gemotoraks) accompanied by compression of light affected parties, which causes shortness of breath; there is also limiting respiratory excursions chest, weakening flicker noise and respiratory congestion on the side of blood, ). Rubber bint less traumatizes tissue than rubber tube Thus, development gnoerodnoy microflora in gemotorakse cause pyo pleurisy, with gemartroze - pyo arthritis Bladder stones - Chronic specific processes, Poor children carry blood loss early age, because they have not yet formed all the compensation mechanisms The disease is secondary, arising due to the inflammatory process in a given area of the body. When bleeding in the skull cavity develops compression symptoms of the brain. Promote the development of attrition, heavy general disease, metabolic disease (diabetes, obesity) and high virulence of the causative agent (or golden Staphylococcus stafilo-streptococcal infection, less streptokokk who enter through the hair follicle) Enabling point is on-statochpaya in urine most bubbles, as well as to accede infection. To maintain the necessary level of blood supply to vital organs organism develops complex mechanism of adaptation, which includes: 1) spasm receptacles, 2) increases cardiac and respiratory activity, 3) increase circulating blood through it from the depot and tissue fluid Cessation of circulation in tissues reduces their resistance to infection and provides a fertile ground for Development anaerobic gangrene, 3. Capillary stops bleeding quickly and independently has significance only if the decreased blood svertyvaemosti (haemophilia, liver disease, sepsis), Limfadenit occurs when microorganisms, toxins and their products with the collapse of the lymph tissue of the primary hotbed recorded in the lymph nodes - Several diseases cause bleeding in with the changing chemical composition of blood: haemophilia, jaundice, scarlet fever, sepsis, scurvy and other Bleeding may or domestic - in one direction or another body cavity (pleura, ventral, etc - When a person carbuncles sepsis, meningitis and thrombophlebitis occur more frequently than in other localizations Most are single. Koptraktura, Lack of it is that it does not stop bleeding of the major arteries and, sdavlivaya tissue, leading to disruption in blood circulation peripheral divisions limbs It happens one-and two-way. This normergicheskaya reaction to pyo infection more easily eliminated. , hemoglobin content - up to 5 grams% OTSK deficit - 30% - At the same time carry out urgent measures to stimulation of cardiovascular activity. Some local patients nagnoenie runs with poorly observed reaction (gipoergicheskoy), Given the time allocated to: a) the primary bleeding, starting immediately after damage, injuries, b) early secondary bleeding arising in the first hours and days after injury (to the development of infection in the wound) Of the complications can be: lymphangitis, limfadenit, progressive thrombophlebitis, sepsis, purulent meningitis The overall reaction of the organism to introduce microbes arose gnoerodnyh simultaneously with the local The chronic purulent processes are developing normally secondarily from acute processes, such as osteomyelitis, pleurisy, nagnoeniya wounds, etc. To reduce the adverse action recommended through the one hour burn to dissolve several minutes (if not bleeding resumes) and then to delay it again Time conducive to their development, are: a) the presence in the zone trauma breeding environment for them (hemorrhage, dead tissue), b) simultaneous coexistence of several kinds of microbes (poliinfektsiya), c) microbial penetration increased virulence, for example, pollution seats pyo separates damaged another patient, d) weakness immunobiologicheskih reactions e) violation of local and general circulation at patient KROVOTECHENIYA Limfadenit. It is recommended not to impose burn on the limb with acute surgical infection, or when lesions vessels (arteriosclerosis, thrombophlebitis, etc. Pyo limfadenit begins with kataralno-giperplasticheskogo lymphadenitis, then there pyo node infiltration and education of several small pockets, are merging, resulting krasplavleniyulimfaticheskogo hub - Diagnostic puncture chest detects presence of blood in the pleura cavity In visible holes nekrotizirovannye tissue. pal bacteria in the wound begin to exercise their livelihoods and reproduce it through an average of 6-12 hours. Images in the bladder as a result of falling into it bacteria, mucus, foreign body on urethritis or later on sand ureter and from kidney stones Therefore, when internal or interstitial accumulations there is always the chance of blood infection, The use of lymphadenitis with antibiotics sometimes achieved rapid cure In x-ray diagnosis helps study and distoskopiya It is manually Straightening foot massage and bintovanii its soft bandages in the right situation Art. Vnutrisustavnoe bleeding provides: additional joint, sharp movements and pain during palpation, restriction of mobility, a symptom fluctuations, defined in the joints, muscles are not covered - In inflammatory source accumulates a large number neytrofilnyh leukocytes

Art Chronic surgical infection. can complete a full joint immobility - anchylosis - Local reaction of tissue Collapse. Appears krivosheya acquired in connection with the pathological process spine, muscles, as a result of prolonged situation vicious head because of characteristics of professional work or restrictions of view of one eye. ), so the need takiebolnye vtschatelnom survey to identify the epicenter and purulent primary input Gates microbes. ) Zakrutka (hauling) " Treatment, Shown also pain and cordial means abundant drink, milk-plant diet - With timely and proper treatment favorable prognosis. Often develops during injury or shortly afterwards, but may observed with intoxication, acute infection, bleeding, etc At the emergence of bacterial organism responsible for local and general reactions. 2) Dezintoksikatsiya all available methods (withdrawal, destruction, adsorbitsiya toxins). Recognition Common symptoms are similar for all types of bleeding, including for Interior. When hidden bleeding in the gastrointestinal tract applies benzidinovaya sample, Siltpyumy and over, 2 - Existing methods have advantages and disadvantages and used in isolation or in combination (such as dressing and davyaschaya spirits of limbs). When dissemination of the surrounding tissue develops periadenit for characterized by inflammation of immobility knots. Called streptokokkami and other pathogenic microbes, but more often happens flora mixed - It is important to good care. Treatment Often to stop resort to internal bleeding operations (chrevosechenie, torakotomiya, trephination skull, etc. When wounding large veins vnutrivenoznym with increased pressure, more often difficulties due to the outflow, blood may flow jet, but it usually does not pulses - Certain bleeding vessels do not see blood cit as a sponge, Therefore, in old age, when heart and blood vessels are no longer possess sufficient reserves, there is the worst outcomes - Bleeding mixed with minor injury arteries, veins, capillaries Interior parenchymal orgapaov (liver, spleen, lungs, kidneys) may be very abundant and long. These include chronic purulent and specific chronic disease Usually there increasing swelling, disappearance pulse on vessels, periferichnee hematoma, or cyanosis sharp paleness of skin, which becomes cold, that is the phenomenon of ischemia, Treatment - Krivosheev - When carbuncles, isolates, on the face, as well as at large in size, general phenomenon particularly pronounced sharply, but quickly go subsided when selection begins corrupt and exclusion from the dead tissue - The temperature is raised to 40 S, there is much intoxication (nausea and vomiting, loss of appetite, severe headache, insomnia, delirium and occasionally unconscious state). Is in therapeutic gymnastics, mechanotherapy, applying fixing associations, apparatus, and if necessary, surgical treatment Implemented operational tactics and conservative treatment, gives the best effect integrated , hemoglobin content - up to 8 g% OTSK deficit reaches 15%. Profuznoe (massive) arterial bleeding leads to severe anemia so quickly that compensation mechanisms are not able to develop blood loss, More often occur in the presence of inflammation at the source obstacles to healing (sequesters, foreign body, poor wound outflow separates and others), Axillary (podmyshechnuyu) artery can be roly, her press to the head of the humerus in podmyshechnoy Gap. The rapid decline in blood pressure in connection with the sudden a decrease in vascular wall tone and cardiac weakness - Ways of infection, reaction of tissues and whole body for each of these diseases are specific, that greatly facilitates diagnosis, There are various modifications (burn with pelotom, elastic, etc. Venous bleeding. Methods temporary stop bleeding: pit of course, possible bend in the joints and roly passing vessels in that area (paltsevoe pressed, davyaschaya dressing, imposing tow, as well as clips on the bleeding receptacle in the wound), The course lymphadenitis it is acute or chronic - There are giperergicheskuyu, normergicheskuyu and gipoergicheskuyu reaction - Such obeskrovlivanie brain causes death due to oxygen starvation, violations functions of the brain and cardiovascular system, When external bleeding characterized by slow venous outflow blood. According to gravity and caused bleeding (severe anaemia) emit four degrees blood loss. Circling dragging soft tissue limb together with blood vessels carried out strings. III degree - the heavy state, the pulse -- filiforme, AD - up to 60 mm Art Capillary bleeding - In early development carbuncles (inflammation infiltrat) apply antibiotikoterapiyu -- obkalyvanie solution hotbed of antibiotics and their intramuscular injections, inside -- Extension sulfanilamidnye drugs, These pockets are easily purulent treatment (and some patients go without him) but the main condition -- if the reaction caused by a high degree of protective forces organism Patients note of pain, frequent urination to pozyvy, pain at the end urinating, blood in urine, ), so as this may facilitate the spread of the development process or embolism. Pressed artery.

Inflammatory phenomena taking fewer tissues, swelling happens a small, slight increase in temperature, changes in blood not are sharply pronounced. Preventing temporary kontraktur is timely right treatment of major diseases, the active responsibility of the patients, therapeutic gymnastics. Pyo process may be booming with the rapid spread it on okruzhaschietkani ityazhelymi extensive phenomena Educated bruise sdalivaet veins and arterial intact trunks, that sometimes leads to the development of coronary limb gangrene, if time will not be provided surgical assistance - Brachial artery pressed to the inner surface of the humerus from the inner edges biceps muscle. The tumor woody density with drastic changes skin and the formation of fistulas, emit kroshkovidny matter, usually indicates aktinomikozom defeat In a particularly virulent flora or with lowered resistance can develop pyo limfadenit There is due to spasm blood vessel and education blood clot in his views that facilitated lowering blood pressure in bleeding, Oppression microflora in the primary source and lymph nodes - the application antibiotics, sulfanilamidov, nitrofuranov etc Sclerosis, organic Violations of vices and functional cardiac activity are very adverse moments, The most important of them: inguinal bend - for artery thighs, popliteal region - for artery drumsticks, ulna joint - for ulnar artery in the shoulder bend, podmyshechnaya area and internal surface biceps muscle - for artery hands; on the neck from the internal edge Breast-clavicular muscle near her middle - for the carotid artery, her press finger to the transverse processes VI cervical vertebrae Mechanisms of blood compensation: for bleeding outcomes of great importance have the size and speed of blood, patient age, general condition organism and the cardiovascular system Local signs are different The extent of her depends on the number of bacterial toxins and tissue products, as well as resistance Changes vitamin balance in the body, the toxins can also lead to vascular permeability. Individual holes merge, forming a large defect in the skin, through which derives much matter and ottorgayutsya necrotic tissue. Acute inflammation of lymph vessels, Arterial external bleeding naiboleeznachitelnoe and quickly leads to severe anaemia: growing paleness, frequent and low pulse, a progressive reduction of blood pressure, dizziness, rubs in the eyes, nausea, vomiting, fainted - There is excitement or, conversely, a patient weakness, the decline blood pressure, stagnation in the small circle of blood circulation - Treatment Otherwise if the infection takes sluggish, but during prolonged Femoral artery easiest roly, to press its horizontal branches pubic bone at the point, rapolagayuscheysya immediately below pupartovoy ligament (in inguinal region) in the middle distance between the front upper iliac axis and symphysis (mezhdulonnymi Bone), During slow, within a few weeks, bleeding body adapts to chronic anaemia and there may be a long time with very low hemoglobin, Blood has a dark connotation, and continuous flow evenly - If then in the cavity (pleura, abdominal and others) not razovetsya pyo infection, the blood is exposed to destruction and suction, Particular virulent microbes, highlighting strengths toxins usually cause severe general reaction of the body. Shakes the entire surface of the wound because of an abundance of blood receptacles in internal organs Sometimes pyo proceeding less rapidly A long existence curve neck in a patient develops asymmetry person - When bleeding into the pericardial (gemoperikardium) growing phenomenon tamponady heart (cardiac activity drop, cyanosis, increased venous pressure, etc, To not say uschem skin, put a towel under the burn, In order to ascertain the causes of disease is important X-ray cervical spine, Acute-pyo necrotic inflammation several hair bags and sebaceous glands to form a common infiltrata and extensive necrosis skin and subcutaneous tissue. Recognition with greater reliability confirmed microscopic study separates fistulas and histological analysis of pieces of tissue, taken in biopsy. There comes as a result of violations of integrity when the vessel injuries, pyo molten, raising blood, atmospheric pressure - 5) Reduction in phases purulent current process (clearance Rapa and its regeneration - a fracture) Esmarha burn is a strong rubber tube up to 1. Characterized by sudden pallor, small and frequent pulse, low pressure, superficial and rare breathing, the advent cold sweat, Ayer limbs, low body temperature, zatormozhennostyo and sometimes darkening of consciousness, which is usually in shock save He overlaid places below damage to the receptacle with a force that causes compression only superficial veins, and for up to a hour, Persistent or temporary restriction of mobility of joints Used to temporarily stop blood bleeding in the extremities, neck, head - or fall per cent hemoglobin at 1 / 3 of baseline quantities, is extremely dangerous, as can be obeskrovlivanie develop the brain. 4) The impact on the microflora that caused process (destruction or suppression of their activities) For hemorrhage in knee joint characterized nadkolennika balloting. If you can tow a specialized otstutstvii handy to use material, for example, the scarf. Characterized by extreme supinatsii foot, with turn inside the front of her. Kosolapov innate When gnilostnoy phlegmon mouth, paradentitah, gangrenoznyh quinsy and other lymph nodes can affect gangrenoznym process gnilostnym disintegration (gnilostny limfadenit) Radionuclide introduced intravenously and normally accumulate in the liver, where retikuloendotelialnymi absorbed from the blood cells and channel disappears through 15-20 minutes, The epidermis over a hotbed of necrosis burst in several places, a few holes ( "sieve"), from which stands out thick greenish-gray matter He has a number of features to their specific gravity as a result of purulent intoxication - 3) Promote immunobiologicheskih forces patient. The diagnosis is confirmed puncture joint cavity and the receipt of blood to it, When small bleedings (internal or hidden) resorted to puncture (joint, pleura cavity, pericardial). Acute limfadenit runs differently, There znachitetnyl blood loss in severe anaemia, Most of the work to restore blood loss falls on the cardiovascular system, Inflammation lymph nodes. ) The cause of congenital defect is krivoshei development Neck Spine (such as additional sinus vertebrae) or, more often, shortening Breast-clavicular-mastoid muscle ) Disadvantages overlay tow: 1 - While raising course, you can stop the bleeding if damaged veins