The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention

BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013.All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 vs.grade 0–1)or Rentrop(grade 3 vs.grade 0–2)grading system.The primary endpoint was 5-year cardiac death.RESULTS Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade 3.According to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading system.CONCLUSIONS In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death.Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.

Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Structural jump-diffusion model for pricing collateralized debt obligations tranches

This paper considers the pricing problem of collateralized debt obligations tranches under a structural jump-diffusion model, where the asset value of each reference entity is generated by a geometric Brownian motion and jump with an asymmetric double exponential distribution. Conditioned on the common factor of individual entity, this paper gets the conditional distribution, and further obtains the loss distribution of the whole reference portfolio. Based on the semi-analytic approach, the fair spreads of collateralized debt obligations tranches, i.e., the prices of collateralized debt obligations tranches, are derived.

Promotion effect of TGF-β-Zfp423-ApoD pathway on lip sensory recovery after nerve sacrifice caused by nerve collateral compensation

Resection of oral and maxillofacial tumors is often accompanied by the inferior alveolar nerve neurectomy,resulting in abnormal sensation in lower lip.It is generally believed that spontaneous sensory recovery in this nerve injury is difficult.However,during our follow-up,patients with inferior alveolar nerve sacrifice showed different degrees of lower lip sensory recovery.In this study,a prospective cohort study was conducted to demonstrate this phenomenon and analyze the factors influencing sensory recovery.

Advances in Research of Treatment of Angina Pectoris in Coronary Heart Disease from the Method of Dredging Collaterals with Pungent

The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis is obstruction of the heart collaterals,and treatment mainly adopts dredging collaterals and relieving pain.Based on the treatment principles of dredging collaterals with pungent,aiming at the etiology,pathogenesis and disease characteristics of angina pectoris in coronary heart disease,this article systematically analyzes the Method of Dredging Collaterals with Pungent including the methods of dredging collaterals with pungent moisture,dredging collaterals with pungent warm,dredging collaterals with pungent aroma,and dredging collaterals with insect type drugs,to provide ideas for the treatment of angina pectoris in coronary heart disease.

Isolated Major Aortopulmonary Collateral Artery Causing Heart Failure: Transcatheter Occlusion of Mapcas Using Amplatzer Vascular Plugs and Amplatzer Piccolo Occluders

Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels that arise from the aorta or its first-order branches and are distally connected to the pulmonary arterial vasculature, thereby providing pulmonary blood flow. MAPCAs are often associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Isolated MAPCAs are rare in patients without congenital heart disease with structurally normal hearts. Sometimes, isolated congenital MAPCAs can occur without any lung disease. Isolated MAPCAs represent the occurrence of collaterals in the absence of underlying heart disease, which commonly presents as heart failure, recurrent respiratory tract infection, and pulmonary artery hypertension. We report a rare case of congestive heart failure in a 6-year-old patient with dual arterial supply to an otherwise normal right lung, with a normal bronchial tree, and a structurally normal heart. The patient was successfully managed by the closure of collaterals by Amplatzer vascular plugs II (AVPII) and Amplatzer Piccolo Occluders.

Obligation-based Theory vs.Right-based Theory:Confrontation of Ideas Between Warrender and Strauss

There is a transition from the objective laws or moral orders that precede human will in classical natural law to the subjective demands or rights emanating from human will in modern natural law,and it represents a historical debate on the shift from an obligation-based theory to a right-based theory.Strauss,within the context of this transition across time,assesses Thomas Hobbes's philosophy of law and recognizes him as the founder of modern natural rights theory.Using Wesley Newcomb Hohfeld's analysis of jurisprudence,Howard Warrender assesses the privilege nature of Hobbes's concept of natural rights and concludes that,since Hohfeld's privilege is the opposite of obligation and related to no-right,obligations cannot be derived from natural rights.Therefore,Warrender argues that Strauss's assertion requires correction.However,Warrender places excessive emphasis on Hohfeld's static separation of the concept of privilege within his theoretical system,overlooking the dynamic transformation from privilege to claim rights.In this regard,Hobbesian scholar Carlan's criticism of Warrender is valid.Meanwhile,Warrender's research holds theoretical significance in that he,under the premise of being a part of Hobbes'natural law tradition,transforms Hohfeld's flat,two-party legal rights relationships into a three-party legal rights structure,which could represent a potential innovation in the 20^(th)century legal philosophy.

基于毒邪与络病学说探讨免疫炎症在慢性心力衰竭中作用

慢性心力衰竭(以下简称心衰),是各种心脏疾病的终末期阶段,其发病机制与免疫炎症密切相关。免疫细胞激活后,产生大量炎症因子,损伤心肌细胞,导致心肌纤维化、心室重构等病理改变。“毒损心络”是心衰发生、发展的主要病机,贯穿心衰发展的始终,以不同的形式影响心衰的发展及预后。该文通过查阅相关文献,基于毒邪与络病学说,从免疫炎症与心衰的关系及中药防治进行系统梳理,提出心衰早期,以心气虚为主,兼心气阴虚,尚未化毒、入络;心衰中期,心气亏虚为本,痰浊、瘀血、水饮留滞络脉,有化毒、入络趋势;心衰晚期,痰、瘀、水蕴结成毒,损伤心络。中药以复方治疗为主,多具有益气温阳、化瘀利水、解毒通络之功效,通过恢复M1/M2、Th1/Th2及Th17/Treg细胞之间的动态平衡,调节促炎/抗炎因子,从根本上祛除或缓解因毒邪产生的病理状态,减轻炎症,调整心之气血阴阳,达到扶正祛邪、保护心功能的作用,为临床防治心衰提供指导。

On the Principle of Consistency of Rights and Obligations in the Constitution of PRC

“The Fundamental Rights and obligations of Citizens”, the title of Chapter II of the current Constitution of PRC, and the stipulation that citizens must fulfill certain obligations while enjoying rights have triggered many debates. Considering the historical origin, constitutional philosophy, and the text and structure of the Constitution, the special provisions of the current Constitution are influenced by the principle of consistency of rights and obligations. The principle of consistency of rights and obligations in the Constitution is of complex connotation. Therefore, although the principle of consistency of rights and obligations effectively connects the public and private spheres, it ignores the diversity and differences of the interests and elements contained in the Constitution, the asymmetry of the normative status of fundamental rights and fundamental obligations,and the right of citizens to self-determination of personal interests.The principle of consistency of rights and obligations should be purposefully narrowed and concretized: In the context of public-private integration and risk society prevention, the principle of consistency of rights and obligations can be used as a supplement to the functional system of the Constitution;in the field of fundamental political obligations, the principle of consistency of rights and obligations should be in line with the requirements of the state to respect and protect human rights;in the field of fundamental social obligations, the exercise of fundamental rights by individuals is protected by the Constitution as long as they comply with the law and do not infringe upon the interests of the social community. The principle of the consistency of rights and obligations is only used as the negative constituents of the determination of rights and the basis for the effect against a third party of fundamental rights.

Discussion on reprogramming of tumor energy metabolism and intervention of traditional Chinese medicine based on the theory of“collateral Q i stagnation”

The theory of stagnation of collateral Qi(Chinese medicine refers to the most fundamental and subtle substances thatconstitute the human body and maintain life activities,and also has the meaning of physiological functions)originates from the theory of collateral disease,which refers to the deficiency of Qi in the body’s collaterals,the loss of Qi and blood,and the failure of stagnation of collateral Qi,which leads to the loss of Qi,blood and body fluid,and the formation of pathological products such as deficiency,depression,phlegm,blood stasis in the local area,and ultimately damage the pathological process of collaterals.Based on the in-depth study of the pathogenesis of collateral Qi stagnation and the previous study of meridian channels,we believe that the key pathogenesis of the formation,evolution and spread of malignant tumors is“collateral Qi deficiency stagnation,collateral Qi stagnation and collateral Qi decay”.As an important energy resonance channel of the body,meridians play a key role in the process of material transformation and energy metabolism.It is believed that the small focus caused by the pathogenesis of stagnation is the cause of malignant transformation of tumor,the reprogramming of energy metabolism induced by the lesion of collateral Qi is the basis of the progress of tumor pathogenesis,and the formation of tumor microenvironment regulated by the tumor toxin vena is the root of alienation of tumor development.Guided by this theory,focusing on the correlation between collateral Qi and tumor energy metabolism,using Professor Hua Baojin's treatment method of“Regulating Qi and detoxifying”to prescribe drugs can adjust collateral Qi function,achieve the relative balance of internal environment,and then inhibit the progress of tumor.Based on the above understanding,this study tries to enlighten new diagnosis and treatment ideas under the guidance of“stagnation of collateral Qi”in traditional Chinese medicine,in order to provide some theoretical support for the intervention of traditional Chinese medicine in the process of tumor development.

“肺虚络瘀”病机观与氧化应激在慢性阻塞性肺疾病发病过程中相关性探讨

将“肺虚络瘀”病机观为作为慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)发病的核心理论指导以探讨其与氧化应激的相关性,结合对COPD机制的现代临床调查与实验研究,对COPD病理改变过程中出现的氧化应激进行分析与探讨,认为氧化应激是COPD的重要病机之一;从肺虚对机体氧化-抗氧化平衡调节失调,提出COPD氧化-抗氧化失衡是肺虚的微观病理表现基础;氧化应激及其产生的病理改变与“肺虚络瘀”具有相同的病机改变表现;通补肺络法通过调节机体的氧化-抗氧化水平,减轻氧化应激,延缓COPD进程,从这3个方面深入探究COPD的“肺虚络瘀”病机制论与氧化应激的相关性,全面阐释COPD“肺虚络瘀”病机观的科学内涵,并从分子机制水平上诠释从肺络论治COPD的作用机制与靶点,为COPD的中医药治疗与其治疗机制研究提供新的思路及科学依据。

CT血管成像对ACI患者颈动脉狭窄程度及侧支循环的价值研究

目的分析、探究CT血管成像技术在ACI患者颈动脉狭窄、侧支循环等病情诊断方面的成效。方法对我院2021.3-2022.3月期间收治的100例急性脑梗死(ACI)患者一般病理资料进行回顾性分析,以数字减影血管造影(DSA)结果为诊断金标准,对CT血管成像技术(CTA)的诊断价值进行分析,以临床出具的数字减影血管造影(DSA)结果为金标准,分析CT血管成像技术(CTA)在临床上的诊断价值,评估此技术在临床诊断中的效能。结果与临床金标准相比,CTA诊断技术具有较高的临床评估价值[Kappa>0.8~1.0,曲线下面积(AUC)>0.9,P<0.01];CTA诊断技术在评估颈动脉狭窄程度等方面与临床金标准具有一定的一致性[Kappa>0.6~0.8,曲线下面积(AUC)>0.7~0.9,P<0.01];而在评估侧支循环临床诊断中,CTA诊断技术与临床金标准具有一致性,具有较高的评估价值[Kappa>0.8~1.0,曲线下面积(AUC)>0.9,P<0.01]。结论以临床“金标准”的诊断结果为依据分析,CTA诊断技术能够对ACI患者出现病变的血管形态及侧支循环状态等进行全面的评估,CTA诊断结果可为治疗工作提供准确性相对较高且客观的医学依据,确实是评估ACI患者颈动脉狭窄程度、侧支循环状态的可靠办法;而与DSA技术相比,CTA与之具有较高的一致性,说明在病情发作早期为ACI患者实施CTA检查可获悉颈动脉的狭窄及侧支循环状态,有利于改善患者群体的预后。

批准生效合同责任承担的体系构造——《民法典合同编通则解释》第12条评释

《民法典合同编通则解释》第12条仅涉及法律、行政法规这一层级法源设立的直接影响债权合同生效的报批手续,属于法律规定的特别生效要件。合同已成立未生效时产生形式拘束力,包括不得擅自变更或解除的消极义务以及履行报批义务等积极义务。法定报批义务以及围绕报批义务的约定独立生效,属于依据诚实信用原则产生的附随义务,相对方有权采取请求继续履行报批义务的救济方式。第12条第1款在第一阶段新创设了一种法定解除权,“违反报批义务的赔偿责任”应仅限于固有利益的直接损失,而不应参照违反预约合同的赔偿范围。第2款在第二阶段的解除权符合《民法典》第563条要件,赔偿范围参照违约责任时需考察通过批准的难易度、报批义务人拒不报批的主观恶性程度以及整个交易的完成度和成熟度。第4款在第三阶段批准机关决定不予批准时无须规定解除权,报批义务人承担过错责任,依据《民法典》第157条考虑适用财产返还和折价补偿制度的替代效果。

生成式人工智能防沉迷立法问题研究

既有防沉迷规范的适用范围有限并且没有指出相关主体的具体义务,其难以应对生成式人工智能令人沉迷的风险。从原因视角分析,生成式人工智能令人沉迷的原因在于其生成的虚拟世界更具有吸引力、精准推送产生舒适性、虚拟人物使人产生情感依赖。从后果视角分析,人们对生成式人工智能的沉迷容易造成创新能力退化、道德标准僵化与价值导向机械化、审美形式化等问题。基于此,生成式人工智能提供者和开发者首先需要履行审批和披露义务。其次应设置防沉迷层面的算法,包括根据用户的年龄等因素设置相应的防沉迷策略,设置用户偏好推送的限度,履行适当的披露义务并拒绝提供情感慰藉;应当对生成式人工智能在思维认知领域“作为思想生成、创新工具”加以限制;设置道德过滤机制;在特定情形中限制“直接提供成品”的使用频次。再次,定期进行算法检查。最后,生成式人工智能提供者和开发者违反防沉迷、防止依赖义务应当承担行政责任。

论注册商标使用义务规范的体系化构建——兼评商标法修订草案征求意见稿相关条款

2023年1月13日,国家知识产权局公布《中华人民共和国商标法修订草案(征求意见稿)》,强调“强化商标使用义务,引导商标注册回归制度本源”是本次修法主要内容之一。目前,我国注册商标使用义务制度存在概念模糊、注册审查程序中使用意图与承诺使用的取舍不定、核准注册后权利人违背使用义务的法律责任不明等问题。在明晰注册商标专用权人商标使用概念的基础上,以“注册审查—权利维持—权利处分—权利救济”为轴,全过程设定注册商标使用义务,可以有效提高商标使用的法律地位,引导商标注册制回归“商标的生命在于使用”的制度本源。

作为反垄断救济措施的数字平台互操作义务

作为反垄断救济措施的数字平台互操作义务,是解决当前数字平台封禁行为的重要方式,既能维持现有符合市场特征的市场结构,又能将数字平台内部的网络效应外部化,允许市场竞争者公平共享网络效应产生的效率。通过降低市场进入壁垒恢复市场的有效竞争,避免用户、数据等价值要素聚集于少数数字平台。不论是作为反垄断事前监管措施,还是作为反垄断事后救济措施,数字平台互操作义务都有较好的适用基础和空间。结合我国目前肯定性调整方法规定不足的现实情况,数字平台互操作义务可能适用的情形也比较清晰,主要是针对数字平台既有反竞争性的互操作安排。实施时应当明确以基线标准作为实施的限度,严格秉持依法、审慎、积极和协同的理念。以公平原则、比例原则为义务设计的基本原则,对互操作义务的范围、标准以及监管等各方面内容予以科学设定。

ChatGPT类生成式人工智能产品提供者之刑事责任

ChatGPT类生成式人工智能产品数据处理不可控,提供者刑事责任不明确,将会引发刑事治理难题。在产品投入流通时,如果ChatGPT类生成式人工智能产品符合国家标准、行业标准,并不存在当前科学技术水平能够发现的缺陷,一般不宜追究产品提供者的刑事责任;在产品投入流通后,产品提供者应承担适度的安全管理义务。违反安全管理义务,有可能承担刑事责任。有限度追究产品提供者的刑事责任,既符合网络领域积极主义刑法观的趋势,也有利于实现鼓励科技创新和防范产品风险之间的平衡,还符合社会公众的期待。提倡“全面性考察”方案,用以限制产品提供者成立帮助信息网络犯罪活动罪的范围。在具体贯彻“全面性考察”方案时,可以“超过半数规则”作为产品提供者主观“明知”的认定标准。

合同履行绿色义务的性质与效力——《民法典》第509条第3款释论

《民法典》第509条第3款规定的合同履行中的绿色义务,引起了巨大理论争议,也带来了司法实践难题。将该条款解释为倡导性条款,还是解释为有约束力的法定义务条款,其意义完全不同。为推进生态文明建设,结合民法绿色原则和立法体系进行分析,应当明确该条款的法定义务属性,通过对合同自由的适当限制,实现对当事人行为的环保约束。具体来说,合同履行的绿色义务具有附随义务属性,违反该义务可能导致损害赔偿、强制履行等责任,债权人也可能因而享有合同解除权;同时,该义务具有不真正义务属性,虽不能强制执行,但可能导致对方当事人减少价款请求权。上述两种定性虽有区别但并非相互排斥,应当由法官在司法裁判中结合案情决定采用不同的解释路径,以确定合同履行绿色义务的具体内容和边界,并依据社会共同价值、参酌习惯等,认定违反该义务的法律效果,体现绿色义务对合同当事人的现实约束力。

CT灌注成像参数对急性脑梗死侧支循环的评估价值及与术后近期预后的相关性

目的探讨CT灌注成像(CTPI)参数对急性脑梗死(ACI)侧支循环的评估价值及与术后近期预后的相关性。方法选取我院2022年1月-2023年2月收治的106例ACI患者,以数字血管造影(DSA)作为诊断“金标准”,将其分有侧支循环组(46例)与无侧支循环组(60例)。两组患者均进行CTPI检查,对比两组受试者CTPI参数[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)],采用受试者工作特征(ROC)曲线分析CTPI参数对ACI侧支循环的预测价值;比较CTPI参数评估急性缺血性脑梗死侧支循环与DSA检查的一致性;采用Pearson相关性分析ACI患者的CTPI参数与美国国立卫生研究院卒中量表(NIHSS)、改良Ranking量表(mRS)评分的相关性。结果有侧支循环组CBV、CBF均高于无侧支循环组(P<0.05),MTT、TTP均低于无侧支循环组(P<0.05)。ROC曲线分析显示,CBV、CBF、MTT、TTP及联合检测对ACI侧支循环均有预测效能(P<0.05),其AUC分别为0.793、0.705、0.841、0.669、0.879,单独检测中MTT效能最高,但仍低于联合检测效能。CTPI参数联合检查对ACI侧支循环的诊断灵敏性为84.78%、特异性为90.00%、准确率为87.74%、阳性预测值为86.67%、阴性预测值为88.52%、Kappa值为0.750。有侧支循环组NIHSS、mRS评分均低于无侧支循环组(P<0.05);Pearson相关分析发现,CBV、CBF与NIHSS、mRS评分呈负相关(P<0.05),MTT、TTP与NIHSS、mRS评分呈正相关(P<0.05)。结论ACI有侧支循环患者的CBV、CBF均较无侧支循环患者高,MTT、TTP均较无侧支循环患者低,CTPI参数用于评估ACI侧支循环具有较高的诊断效能,且有侧支循环患者近期预后较好,同时CBV、CBF、MTT、TTP与ACI患者近期预后均存在相关性,可通过检测CBV、CBF、MTT、TTP预测患者近期预后。

论减轻损失规则

减轻损失规则的重要内容是减轻损失义务,包含两方面的意思:第一,原告有义务采取积极措施(positive steps)将被告违约所致损失降至最低范围;第二,在被告适当履行合同的情况下,原告实施某些行为是适当的,但在被告已经违约的场合,原告倘若再实施这些行为,就会不公正地扩大违约造成的损失(unjustifiably augment the loss)。减轻损失义务大多源自法律的规定,也有基于当事人的约定产生的情形。减轻损失的措施可以类型化为停止履行、替代安排、守约方与违约方再协商、继续履行。守约方应当采取什么样减轻损失的措施,要取决于周围情事。其措施是否适当,宜以一个理性人、经济人的认识作为判断标准比较合理,并且对这种适当的要求不宜太高。在程序方面,要根据双方当事人提供的证据做出事实的认定。是否需要将选择措施之事预先通知违约方,主流观点主张,虽然通知并非“坏事”,但这充其量只是看整个行为是否合理的其中一个因素,而且不一定是重要因素。守约方采取减轻损失的措施支出的合理费用,应由违约方负责赔偿。守约方违反减轻损失的义务,不向违约方就此承担违约责任,但由此扩大的损失无权请求违约方予以赔偿。