La construction des garanties réelles dans le Code monétaire et financier s'est faite sans approche coordonnée. Le législateur s'est limité à produire des réponses pragmatiques aux besoins des praticiens, dotant ces garanties d'une souplesse et d'une sécurité renforcées. Or, seul le caractère dérogatoire des mesures qui visent à renforcer la sécurité, face aux procédures collectives notamment, caractérise ce que nous identifions comme des garanties réelles dérogatoires tant des garanties réelles de droit commun que des autres garanties sur actifs financiers. Il convient alors d'en tirer les conséquences pour proposer une construction rationnelle d'une garantie réelle financière unique mais protéiforme. C'est l'entrée en vigueur de la directive 2002/47/CE et sa transposition en droit français qui invitent à envisager un remodelage des garanties sur actifs financiers. Une approche commune et unitaire inspirée par cette directive paraît inévitable pour la cohérence de la matière.

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We prospectively evaluated 30 consecutive patients with echo-enhanced transcranial color-coded duplexsonography (TCCD) and correlative transfemoral digital subtraction angiography to assess the diagnostic efficacy of echo-enhanced TCCD for evaluation of collateral pathways through the circle of Willis in patients with limited acoustic bone windows and critical symptomatic carotid disease. Echo-enhanced TCCD detected collateral blood flow through the anterior communicating artery in 16 of 18 patients (sensitivity 89%, 95% CI 65–99%) and was false positive in one out of 12 patients without collateral flow (specificity 92%, 95% CI 59–100%). For the posterior communicating artery, sensitivity was 11/14 (79%, 95% CI 49–95%) and specificity was 15/16 (94%, 95% CI 70–100%). Echo-enhanced TCCD enables to study collateral blood flow through the communicating arteries of the circle of Willis with high sensitivity and specificity in patients with obstructions of the internal carotid artery and limited acoustic bone windows. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Ziel der Studie war es zu analysieren, welchen Einfluss eine angiographisch sichtbare Kollateralisierung vor Revaskularisation bei Patienten mit einem akuten ST-Elevations-Myokardinfarkt (STEMI) und primärer perkutaner Koronarintervention (PCI) auf verschiedene in der kardialen Magnetresonanztomographie messbare Parameter und auf die klinische Prognose hat. Es wurden 235 Patienten mit STEMI und einem Symptombeginn <12 Stunden in die Analyse eingeschlossen. Alle Patienten wiesen einen funktionell insuffizienten antegraden Fluss in der Infarktarterie auf. Die Patienten wurden in zwei Gruppen unterteilt: Gruppe A mit fehlender oder nur geringer Kollateralversorgung (n=166) und Gruppe B mit einer signifikanten Kollateralisierung (n=69). Es wurden Infarktgröße, mikrovaskuläre Obstruktion und linksventrikuläre Funktion mittels Magnetresonanztomographie im Median 3 Tage nach dem Infarktereignis bestimmt sowie die Patienten über einen Zeitraum von >2 Jahren nachbeobachtet. Das Ausmaß der frühen mikrovaskulären Obstruktion war in Gruppe B signifikant geringer (3,3% gegenüber 2,1% der linksventrikuläre Masse, p = 0,009). Die mittels maximaler Kreatinkinase-MB-Ausschüttung gemessene Infarktgröße war in Gruppe B kleiner (p=0,02). Bei 227 Patienten (97%) wurde nach im Median 2,2 Jahren eine klinische Verlaufskontrolle durchgeführt. Insgesamt starben während des Kontrollzeitraums 25 Patienten: 22 Patienten (13,8%) der Gruppe A mit fehlender oder nur schwacher Kollateralisierung und 3 Patienten (4,4%) der Gruppe B mit signifikanter Kollateralversorgung vor Behandlungsbeginn (p=0,04). In Gruppe A traten 12 (7,5%) nicht-tödliche Reinfarkte auf im Vergleich zu 2 (2,9%) in Gruppe B (p=0,18). Ein kombinierter Endpunkt aus Tod oder nicht-tödlichem Reinfarkt trat in Gruppe B signifikant seltener auf als in Gruppe A (p=0,02). Zusammenfassend lässt sich formulieren, dass gut ausgebildete Kollateralgefäße vor einer Revaskularisation mittels PCI bei Patienten mit akuten STEMI mit einer schützenden Wirkung auf die koronare Mikrozirkulation und einem besseren Langzeit-Überleben assoziiert sind.

Ziel der Studie war es zu analysieren, welchen Einfluss eine angiographisch sichtbare Kollateralisierung vor Revaskularisation bei Patienten mit einem akuten ST-Elevations-Myokardinfarkt (STEMI) und primärer perkutaner Koronarintervention (PCI) auf verschiedene in der kardialen Magnetresonanztomographie messbare Parameter und auf die klinische Prognose hat. Es wurden 235 Patienten mit STEMI und einem Symptombeginn <12 Stunden in die Analyse eingeschlossen. Alle Patienten wiesen einen funktionell insuffizienten antegraden Fluss in der Infarktarterie auf. Die Patienten wurden in zwei Gruppen unterteilt: Gruppe A mit fehlender oder nur geringer Kollateralversorgung (n=166) und Gruppe B mit einer signifikanten Kollateralisierung (n=69). Es wurden Infarktgröße, mikrovaskuläre Obstruktion und linksventrikuläre Funktion mittels Magnetresonanztomographie im Median 3 Tage nach dem Infarktereignis bestimmt sowie die Patienten über einen Zeitraum von >2 Jahren nachbeobachtet. Das Ausmaß der frühen mikrovaskulären Obstruktion war in Gruppe B signifikant geringer (3,3% gegenüber 2,1% der linksventrikuläre Masse, p = 0,009). Die mittels maximaler Kreatinkinase-MB-Ausschüttung gemessene Infarktgröße war in Gruppe B kleiner (p=0,02). Bei 227 Patienten (97%) wurde nach im Median 2,2 Jahren eine klinische Verlaufskontrolle durchgeführt. Insgesamt starben während des Kontrollzeitraums 25 Patienten: 22 Patienten (13,8%) der Gruppe A mit fehlender oder nur schwacher Kollateralisierung und 3 Patienten (4,4%) der Gruppe B mit signifikanter Kollateralversorgung vor Behandlungsbeginn (p=0,04). In Gruppe A traten 12 (7,5%) nicht-tödliche Reinfarkte auf im Vergleich zu 2 (2,9%) in Gruppe B (p=0,18). Ein kombinierter Endpunkt aus Tod oder nicht-tödlichem Reinfarkt trat in Gruppe B signifikant seltener auf als in Gruppe A (p=0,02). Zusammenfassend lässt sich formulieren, dass gut ausgebildete Kollateralgefäße vor einer Revaskularisation mittels PCI bei Patienten mit akuten STEMI mit einer schützenden Wirkung auf die koronare Mikrozirkulation und einem besseren Langzeit-Überleben assoziiert sind.

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation.

銀行在面對借款人以不動產申請抵押貸款時，產生對住宅擔保品估價之需求，以為債權之確保。然銀行的估價過程與一般估價最大不同，肇因於其估價前，擔保品本身已先產生一組買賣契約價格。過去研究指出，估價會嘗試以某些較易取得的價格資訊作為定錨點(anchor)，藉以調整並成為最後的價格。而我國不動產交易價格資訊不透明，契約價格往往由借款人提供的情況下，銀行內部估價人員可能因資訊不易取得、定錨效果，在擔保品的鑑估結果上受到契約價格影響，倘有心人士欲藉此獲得高額貸款、牟取不法利益，將損及銀行債權，即使採用自動估價系統降低人為影響因素，因資料來源不佳，只會產生所謂「garbage in garbage out」的結果。據此，如何分辨契約價格是否具有參考力變成為關鍵，亦為本文欲補足的研究缺口。 本文採用國內某銀行臺北市不動產擔保品8,348筆估價資料為樣本，建立以挑選契約價格是否具有參考力的機率預測模型，尋求影響能判定契約價格是否具有參考力的主要因素，並研究在最適的機率界限下，篩選出具有參考力的契約價格樣本。而研究結果所建立的模型，其預測並篩選出的契約價格樣本均較未經模型篩選者，對擔保品價格之估計有顯著提升。因此本研究所建立的契約價格篩選模型確能提升銀行估價準確性，使不動產擔保品鑑估價格的形成過程中，獲得更多可靠的參考資訊，降低人為操縱的空間，並在成交價格資訊不足的情況下，提升估價人員對契約價格的辨識能力。 / In the face of the borrower to apply for a mortgage of real estate, financial institutions have estimated the price of the collateral requirements to protect the debt claim. However, the biggest difference with the general valuation and that of financial institutions, valuation of its causes before the collateral itself has produced a first sale contract price. In the past research that one attempts to estimate the price of some greater access to information act to anchor in order to adjust and become the final price. Because financial institutions are not easy to obtain price information on real estate transactions in Taiwan, price information is often provided by the borrower. A small number of loans borrower deliberate fraud to forgery or false irrigation Contract price sale and purchase agreement in order to obtain high credit. Even with the automatic valuation system to reduce the human impact factor, due to poor data sources, it will only produce so-called "garbage in garbage out" of the results. Accordingly, how to tell whether the contract price to a reference force becomes critical, and also in this article want to complement the research gap. We adopt 8,348 estate collateral valuation data in Taipei City of a domestic bank for the sample to establish a binary logistic regression model. And we try to seek the main factors that determine whether the contract price of the reference force, and find out the optimal cutoff point, filter out of a sample of the contract price of the reference force. The results confirm the model in this paper. The selected samples of the contract price is estimated that the price of collateral significantly improved compared with those without filtering. Therefore, the model established in this study can really improve the accuracy of bank valuation. Enhance the recognition ability of the bank's internal appraisers on the contract price in the lack of transaction price information.

Il presente lavoro di tesi analizza da un punto di vista teorico i contratti di debito con collaterale e la scelta di specializzazione degli asset produttivi. Le imprese soggette a vincoli finanziari danno in pegno i loro asset come collaterale per migliorare l’accesso al credito. Tuttavia, i prenditori di fondi trovano spesso difficoltà nel finanziare progetti con asset eccessivamente specializzati perché il loro valore di liquidazione è basso (asset troppo specializzati hanno un valore di riutilizzo limitato) anche quando i progetti hanno un rendimento atteso elevato. In questo contesto, questa tesi vuole rispondere alle seguenti domande di ricerca: in quale modo la scelta di specializzare un asset produttivo influisce sui contratti finanziari? Quali sono gli effetti delle diverse scelte di specificità su quantità e condizioni del credito? E sulla competizione nel mercato del prodotto? La tesi tratta sia temi di finanza aziendale che temi di organizzazione industriale, e, utilizzando un nuovo approccio teorico, analizza congiuntamente il grado di specificità degli asset e il loro valore di liquidazione. La specializzazione degli asset aumenta il ritorno dei progetti ma diminuisce il valore di liquidazione degli asset stessi. Quando le imprese devono impegnare gli asset come collaterale, questo implica un aumento del costo del debito. Analizzando questo “specificity trade-off”, la tesi dimostra che: nel mercato secondario il valore di liquidazione di un asset dipende dal grado di specificità, dai costi di riutilizzo e dalla presenza di potenziali acquirenti; imprese che devono ricorrere a finanziamenti investono meno in specializzazione degli asset rispetto a imprese che riescono ad auto-finanziarsi; la struttura del mercato e il grado di specializzazione scelto sono influenzati dalle condizioni finanziarie; quando il grado di specificità degli asset produttivi influisce sul grado di differenziazione dei prodotti, il trade-off implica che le imprese che devono finanziarsi attraverso il mercato dei capitali investono meno in specializzazione e, di conseguenza, sono esposte ad un grado di concorrenza maggiore nel mercato del prodotto. / My dissertation is about collateral debt contracts and the choice of specializing productive assets, from a theoretical perspective. Financially constrained firms pledge their productive assets as collateral in order to enhance their access to credit. However, firms may find it difficult to finance projects when their collateralized productive assets are too specialized since their liquidation value is low (as a matter of fact redeployability of those assets to alternative uses is scarce) even when their projects have large expected returns. In this context, my dissertation aims to answer the following research questions: how does the choice of asset specialization affect financial contracts? Which are the implications of different degree of asset specificity for the amount of credit and product market competition? This dissertation is at a cross road between industrial organization and corporate finance and uses a novel approach where the choice of asset specialization and the liquidation value of a productive asset are analyzed together. Asset specialization increases firms' project returns, but decreases the liquidation value of productive assets. When firms are credit constrained this implies a higher cost of debt. By examining this specialization trade-off, I am able to prove the following results: in the secondary market the resale value of a productive asset is determined by its degree of asset specificity, redeployability costs and the presence of firms willing to acquire the it; financially constrained firms invest less in asset specialization compared to self-financing firms; market structure and the degree of asset specialization may be influenced by financial choices; when asset specificity affects product market differentiation, the specialization trade-off implies that financially constrained firms invest less in product differentiation, and, as a consequence, face tougher competition compared to non-financially constrained firms.

Ischaemic stroke is a major cause of death and disability worldwide. Cerebral autoregulation, which can be impaired during acute stroke, and collateral flow to brain tissue through the circle of Willis, both play a role in preventing tissue infarction. The configuration of the arterial circle varies between individuals. Thus, personalised modelling of the cerebral arterial network, to determine the potential for collateral flow, can be of significant value in the clinical context of stroke. The interaction between autoregulation and collateral flow remains poorly understood. In this study, steady-state physiological models of the cerebral arterial network, including several common variants of the circle of Willis, were coupled to a spatially variable mathematical representation of cerebral autoregulation. The resulting model was used to simulate various arterial occlusions, as well as bilateral and unilateral impairment of autoregulation, in each structural variant. The work identified few circle of Willis variants that present either particularly high-risk or particularly low-risk of cerebral ischaemia. Instead it was found that most variants are dependent upon the bilateral function of autoregulation to facilitate collateral flow and preserve cerebral blood flows. When autoregulation was impaired unilaterally, downstream of an occlusion, blood flows in the contralateral hemisphere were preserved at the expense of the ipsilateral tissue at risk. Arterial network models have in the past been personalised using structural, rather than functional, angiography measurements. This thesis presents a novel model-based method for absolute blood volume flow rate quantification in short arterial segments using dynamic magnetic resonance angiography data. The work also investigated the additional information that can be obtained from such functional angiography. The flow quantification technique was found to accurately estimate flows in shorter arterial segments than an existing technique. However, improvements to noise performance, and strategies for rejection of contaminating signals from overlapping vessels within the imaging plane, are required before the technique can be applied to personalised cerebral arterial network modelling.

O sistema cardiovascular está estrutural e funcionalmente disposto de modo “circular”. Situações de obstrução do fluxo sanguíneo determinam o aparecimento de mecanismos que visam suplantar tais interrupções e manter a circularidade íntegra. À nível molecular, o principal elemento envolvido nestes mecanismos é o Vascular Endothelial Growth Factor (VEGF). A expressão do VEGF quando há oclusão arterial está bem documentada, faltando elementos com relação à oclusão venosa. Neste estudo objetivamos verificar se a oclusão à nível arterial determina uma expressão do VEGF diferente daquela que ocorre se a oclusão acontecer à nível venoso. Para isso randomizamos dois grupos de ratos de experimentação. Em um grupo realizamos a oclusão da aorta infra-renal e em outro a oclusão da veia cava infra-renal. Posteriormente medimos a expressão do VEGF através da contagem do número de células marcadas imunoistoquimicamente no omento destes ratos. O resultado demonstrou que a expressão do VEGF, quando analisada pelo método proposto foi igual no grupo da oclusão venosa e no grupo da oclusão arterial. / The cardiovascular system is structurally and functionally circular. Situations in which there is obstruction to blood flow trigger mechanisms to bypass these blockages and maintenance the integrity of the circularity. At the molecular level the main factor involved is the Vascular Endothelial Growth Factor (VEGF). The VEGF expression associated with arterial occlusion is well documented but is lacking evidence when venous occlusion occurs. This study aimed to verify if the expression of VEGF when an occlusion occurs at venous level is the same or different from that caused at the arterial level. Two groups of rats were randomized by infra-renal aortic occlusion or inferior vena cava occlusion. VEGF was measured by counting the immunohistochemistry method marked cells at the omentum level. It was demonstrated that the VEGF expression is the same in the venous group obstruction as the arterial obstruction group.