BILIARY SYSTEM - ΟΜΙΛΙΑ ΚΟΥΡΟΥΣΗ 2Ο ΜΕΡΟς ΕΒΙΤΑ

8/8/2019 BILIARY SYSTEM - 2

1/60

&RPSXWHG 7RPRJUDSKLF &7 &KRODQJLRJUDSK\&RPSXWHG 7RPRJUDSKLF &7 &KRODQJLRJUDSK\ 7KH,9 DJHQWV VXFK DV VRGLXP LRWUR[DWH ZHUH XVHG IRUFRQYHQWLRQDO ,9 FKRODQJLRJUDSK\ XVLQJ SODQDU

WRPRJUDSK\ $GHTXDWH FRQWUDVW H[FUHWLRQ UHOLHV RQQHDUQRUPDO KHSDWRF\WH IXQFWLRQ VR WKH WHFKQLTXHXVXDOO\ IDLOV LI ELOLUXELQ OHYHOV DUH PRUH WKDQ WZR WRWKUHH WLPHV QRUPDO 7KLV WHFKQLTXH LQYROYHV WKH ,9LQIXVLRQRIDQDJHQWZLWKKHOLFDO&7SHUIRUPHGDERXW PLQ ODWHU 0XOWLVOLFH KHOLFDO &7 DOORZV KLJKUHVROXWLRQ VFDQQLQJ DQG PXOWLSODQDU UHIRUPDWWLQJ


2/60

&RPSXWHG 7RPRJUDSKLF &7 &KRODQJLRJUDSK\&RPSXWHG 7RPRJUDSKLF &7 &KRODQJLRJUDSK\

0DJQHWLF UHVRQDQFH FKRODQJLRSDQFUHDWRJUDSK\>05&3@0DJQHWLF UHVRQDQFH FKRODQJLRSDQFUHDWRJUDSK\>05&3@0DJQHWLFUHVRQDQFHFKRODQJLRSDQFUHDWRJUDSK\05&3LVQRQLQYDVLYHDQGKDV UHSODFHG 37& DQG(5&3 ,W UHOLHV


3/60

RQKHDYLO\7ZHLJKWHGVHTXHQFHV WKDWGLVSOD\ VWDWLRQDU\

ZDWHU DV KLJK VLJQDO 0XOWLSODQDU WKLQ DQG WKLFN VHFWLRQDFTXLVLWLRQVDUHREWDLQHGXVLQJIDVWVSLQHFKRWHFKQLTXHV6LQFH FRQYHQWLRQDO 05&3 LV QRW UHOLDQW RQ FRQWUDVWH[FUHWLRQ LW LV VXLWDEOH IRU MDXQGLFHG SDWLHQWV ZKLFK LV DPDMRU DGYDQWDJH FRPSDUHG ZLWK &7,9& 0DJQHWLF UHVRQDQFH

FKRODQJLRSDQFUHDWRJUDSK\>05&3@ 0DJQHWLFUHVRQDQFH FKRODQJLRSDQFUHDWRJUDSK\>05&3@ 0RUHUHFHQWO\ 05 KDV EHHQ FRPELQHG ZLWK KHSDWRELOLDU\FRQWUDVW DJHQWV 7KHVH DJHQWV ZKLFK LQFOXGHJDGREHQDWH GLPHJOXPLQH DQG JDGR[HWLF DFLGGLVRGLXP 'LDJQRVWLF SLWIDOOV ZLWK 05&3 LQFOXGHORFDOL]HG VLJQDO YRLGV FDXVHG E\ VXUJLFDO FOLSV DQG


4/60

LQWUDGXFWDO JDV RU EORRG %LOH IORZ YRLGVPD\PLPLFVPDOO VWRQHV EXW WKH IRUPHU DUH FHQWUDOO\ SODFHG DQGKDYH OHVV ZHOOGHILQHG PDUJLQV WKDQ WKH ODWWHU

0DJQHWLF UHVRQDQFHFKRODQJLRSDQFUHDWRJUDSK\>05&3@ 0DJQHWLFUHVRQDQFHFKRODQJLRSDQFUHDWRJUDSK\>05&3@


5/60

(QGRVFRSLF UHWURJUDGH FKRODQJLRSDQFUHDWRJUDSK\>(5&3@ (QGRVFRSLF UHWURJUDGHFKRODQJLRSDQFUHDWRJUDSK\>(5&3@ $GYDQWDJHV RI (5&3

DUHWKDWERWKWKHELOLDU\DQGSDQFUHDWLFGXFWVDUHVWXGLHG,WDOORZVYLVXDODVVHVVPHQWRIWKHGXRGHQXPDQGDPSXOODRI9DWHUDQGSURYLGHVDQRSWLRQIRUELRSV\DQGEUXVKLQJVDVZHOODVLQWHUYHQWLRQDOSURFHGXUHV&RPSOLFDWLRQUDWHVYDU\

GHSHQGLQJ RQ WKH LQGLFDWLRQ IRU WKH SURFHGXUH WKHSUHVHQFHRIFRH[LVWLQJGLVHDVHDQGWKHH[SHULHQFHRIWKHHQGRVFRSLVW7KHPDLQGLDJQRVWLFSLWIDOOZLWK(5&3LVWKHXQGHUILOOLQJ RI GXFWV DERYH D VWULFWXUH

(QGRVFRSLF UHWURJUDGH FKRODQJLRSDQFUHDWRJUDSK\>(5&3@ (QGRVFRSLF UHWURJUDGH


6/60

FKRODQJLRSDQFUHDWRJUDSK\>(5&3@ (5&3 WHFKQLTXH$HQGRVFRSLFLQMHFWLRQRIFRQWUDVWPHGLXPLQWRELOLDU\GXFWV % FKRODQJLRJUDP (5&3 LPDJH RI D QRUPDOELOLDU\ WUHH

3HUFXWDQHRXV WUDQVKHSDWLF FKRODQJLRJUDSK\>37&@

3HUFXWDQHRXV WUDQVKHSDWLF FKRODQJLRJUDSK\>37&@'LUHFWSXQFWXUHRIWKHLQWUDKHSDWLFGXFWVXVLQJDILQHJDXJH &KLED QHHGOH DOORZV GHPRQVWUDWLRQ RI WKHELOLDU\ WUHH 7HFKQLFDO VXFFHVV LV UHGXFHG ZLWK


7/60

XQGLODWHGGXFWV\VWHPVDQGLQOHVVH[SHULHQFHGKDQGV

6SHFLILFLQGLFDWLRQV6SHFLILFLQGLFDWLRQV7RGHILQHWKH OHYHO DQG FDXVH RI REVWUXFWLRQ LQ SDWLHQWV ZLWKGLODWHG ELOH GXFWV RQ XOWUDVRXQG LQ WKH SUHVHQFH RIMDXQGLFH3UHYLRXVVXUJHU\ZLWKGLVFRQQHFWLRQRIWKHELOH GXFW ZLWK GUDLQDJH WKURXJK D 5RX[ ORRS ,Q

GHILQLQJELOLDU\HQWHULFRUELOLDU\FXWDQHRXVILVWXODV,Q GHILQLQJ WKH OHYHO RI D ELOH OHDN 7R PDS WKHELOLDU\WUHHDVDSUHOLPLQDU\WRHVWDEOLVKLQJH[WHUQDORU


8/60

LQWHUQDO ELOLDU\ GUDLQDJH ZLWK VWHQW UHSODFHPHQW +HSDWRELOLDU\ VFLQWLJUDSK\ >+,'$ VFDQ@ +HSDWRELOLDU\

VFLQWLJUDSK\>+,'$VFDQ@+HSDWRELOLDU\LPLQRGLDFHWLFDFLG+,'$ VFLQWLJUDSK\ XVHV D GHULYDWLYH RI LPLQRGLDFHWLFDFLG D ELOLUXELQ DQDORJXH ODEHOOHG ZLWK P7F ,W LVLQMHFWHG LQWUDYHQRXVO\ DQG VHULDO JDPPD FDPHUD LPDJHV

DUHREWDLQHGRYHUK,WUHOLHVRQQHDUQRUPDOELOLUXELQOHYHOV DOWKRXJK VRPH DJHQWV FDQ EH H[FUHWHG ZLWKPRGHUDWHHOHYDWLRQVRIELOLUXELQ6HULDOLPDJHDFTXLVLWLRQVVKRZDFFXPXODWLRQ RI WKH LVRWRSH LQ WKH OLYHU ELOH GXFWV

GXRGHQXP VPDOO ERZHO DQG JDOOEODGGHU SURYLGLQJ LW LVSUHVHQW DQG WKH F\VWLF GXFW LV SDWHQW


9/60

7HFKQLTXH7HFKQLTXH%HWZHHQDQGP&LRI7F

+,'$ LV DGPLQLVWHUHG LQWUDYHQRXVO\DIWHU DKU IDVW,PDJHV DUH DFTXLUHG RYHU WKH QH[W KRXU DW PLQLQWHUYDOV 7KH QRUPDO 7F+,'$ VFDQ SURYLGHV

IXQFWLRQDO DQG PRUSKRORJLFDO LQIRUPDWLRQ DERXWKHSDWLF SDUHQFK\PD LQ WKH ILUVW PLQ H[WUDKHSDWLFELOLDU\WUHHE\PLQDQGH[FUHWLRQLQWRWKHERZHOE\K


10/60

'LVRUGHUV RI WKH JDOOEODGGHU 'LVRUGHUV RI WKH

JDOOEODGGHU

'LVRUGHUV RI WKH JDOOEODGGHU 'LVRUGHUV RI WKHJDOOEODGGHU *DOOEODGGHU VWRQHV 6OXGJH 0LON RIFDOFLXP ELOH &KROHF\VWLWLV *DOOEODGGHU ILVWXODH3RUFHODLQ JDOOEODGGHU $GHQRP\RPDWRXV


11/60

K\SHUSODVLD *DOOEODGGHU SRO\SV *DOOEODGGHU

FDUFLQRPD

*DOO 6WRQHV *DOO 6WRQHV 86 LV WKHPRVW DFFXUDWHPRGDOLW\ IRU WKHGLDJQRVLVRI JDOOEODGGHU VWRQHV*DOOVWRQHV DSSHDU DV HFKRJHQLF IRFL SURGXFLQJ DFRXVWLF

VKDGRZV6WRQHPRELOLW\LVIUHTXHQWO\LGHQWLILDEOH6PDOOVWRQHV DUH GLIIHUHQWLDWHG IURP VPDOO SRO\SV E\ WKHGHPRQVWUDWLRQ RI PRELOLW\ RU WKH SUHVHQFH RI DQ


12/60

DFRXVWLF VKDGRZ

6OXGJH 6OXGJH 6OXGJH RQ 86 DSSHDUV DV ILQH

QRQVKDGRZLQJ GHSHQGHQW HFKRHV ,W LV FRPSRVHG RIFDOFLXPELOLUXELQDWHJUDQXOHVFKROHVWHUROFU\VWDOVDQGJO\FRSURWHLQV ,W LV PRUH FRPPRQO\ VHHQ LQ FKURQLF

IDVWLQJVWDWHV6OXGJHUHVROYHVVSRQWDQHRXVO\LQSHUFHQW RI SDWLHQWV DQG JDOOVWRQHV ZLOO GHYHORS LQ SHU FHQW


13/60

0LON RI FDOFLXP 0LON RI FDOFLXP *DOOEODGGHU ELOH

EHFRPHVYHU\YLVFRXVSUREDEO\DVDUHVXOWRIVWDVLVDQG FRQWDLQV D KLJK FRQFHQWUDWLRQ RI FDOFLXPELOLUXELQDWH2Q86LWFDXVHVGLIIXVHHFKRHVVLPLODUWRVOXGJHEXWLVPRUHHFKRJHQLFZLWKDWHQGHQF\WROD\HU

RXW DQG SURGXFH DQ DFRXVWLF VKDGRZ


14/60


15/60

3HULFKROHF\VWLF IOXLG *%:DOO WKLFNHQLQJ VWULDWLRQV

DQG 2FFDVLRQDOO\ *% ZDOO K\SHUDHPLD RQ 'RSSOHUH[DPLQDWLRQ

$FXWH&KROHF\VWLWLV&7$FXWH&KROHF\VWLWLV&7&7LV OHVV DFFXUDWH WKDQ86 IRU DFXWH FKROHF\VWLWLV 7KH

&7 ILQGLQJV LQ DFXWH FKROHF\VWLWLV LQFOXGH *% ZDOOWKLFNHQLQJVXEVHURVDORHGHPDJDOOEODGGHUGLVWHQVLRQKLJKGHQVLW\ ELOH SHULFKROHF\VWLF IOXLG DQG


16/60

LQIODPPDWRU\ VWUDQGLQJ LQ WKH SHULFKROHF\VWLF IDW

*DOOVWRQHV*DOOEODGGHUZDOOHQKDQFHPHQW

+HSDWRELOLDU\ VFLQWLJUDSK\ LQ $FXWH FKROHF\VWLWLV

+HSDWRELOLDU\ VFLQWLJUDSK\ LQ $FXWH FKROHF\VWLWLV+HSDWRELOLDU\ VFLQWLJUDSK\ KDV D KLJK GLDJQRVWLFDFFXUDF\ IRU DFXWH FKROHF\VWLWLV $ SRVLWLYH UHVXOW LV

QRQYLVXDOL]DWLRQRIWKHJDOOEODGGHUZKLFKUHVXOWVIURPF\VWLFGXFWREVWUXFWLRQ:KLOVWLWVDFFXUDF\LVVLPLODUWR86 ,W LV PRUH WLPH FRQVXPLQJ DQG GRHV QRW DOORZ


17/60

DVVHVVPHQW RI UHODWHG RUJDQV

(PSK\VHPDWRXV &KROHF\VWLWLV (PSK\VHPDWRXV&KROHF\VWLWLV 7KLV FRQGLWLRQ KDV D UHODWLYHO\ KLJKPRUWDOLW\UDWH,WLVPRUHFRPPRQLQPHQ$ERXW

DUHGLDEHWLFVDQGVWRQHVDUHSUHVHQWLQOHVVWKDQ7KH GLDJQRVLV RQ SODLQ UDGLRJUDSKV DQG &7 ZKLFKVKRZV LQWUDPXUDO DQGRU LQWUDOXPLQDO JDV FDXVHG E\

JDVIRUPLQJ RUJDQLVPV 2Q 86 UHFRJQLWLRQ RI WKHJDOOEODGGHUGLIILFXOWDQGOHDGWRDIDOVHQHJDWLYHUHVXOW6PDOO IRFL RI LQWUDPXUDO JDV PD\ FDXVH ULQJGRZQ


18/60

DUWHIDFW DQG PLPLF DGHQRP\RPDWRVLV

&KURQLF$FDOFXORXVFKROHF\VWLWLV&KURQLF$FDOFXORXVFKROHF\VWLWLV 86 PD\ VKRZ FRQWUDFWHG JDOOEODGGHU

*% ZDOO WKLFNHQLQJ QR VWRQHV $Q HMHFWLRQ IUDFWLRQPRUH WKDQ SHU FHQW RQ &&.FKROHVFLQWLJUDSK\ LVJHQHUDOO\ WDNHQ WR EH DQ LQGLFDWRU RI JDOOEODGGHUG\VIXQFWLRQ )LJ $ &KURQLF FKROHF\VWLWLV


19/60

;DQWKRJUDQXORPDWRXV FKROHF\VWLWLV

;DQWKRJUDQXORPDWRXV FKROHF\VWLWLV 7KLV FRQGLWLRQ LVFKDUDFWHULVHG KLVWRORJLFDOO\ E\ D GHVWUXFWLYHLQIODPPDWRU\ SURFHVV ZLWK YDU\LQJ SURSRUWLRQV RI

ILEURXV WLVVXH LQIODPPDWRU\ FHOOV DQG OLSLGODGHQPDFURSKDJHV7KHSUHVHQFHRIJDOOVWRQHV LVYDULDEOH,WV ORFDOO\ LQYDVLYH QDWXUH

*% 3RO\SV *% 3RO\SV 7KH PDMRULW\ RI SRO\SV DUHFKROHVWHURO DQG OHVV RIWHQ DGHQRPDWRXV &KROHVWHUROSRO\SV DUH XVXDOO\ PP LQ VL]H ZKHUHDVDGHQRPDV FDQ EHXS WR FP 7KH\ DSSHDU DV VPDOO


20/60

HFKRJHQLF QRQVKDGRZLQJ IRFL DGKHUHQW WR WKH

JDOOEODGGHU ZDOO /DFN RI PRELOLW\ IDYRXUV D SRO\SUDWKHUWKDQDVWRQH'RSSOHUIORZZLWKLQDQHFKRJHQLFOHVLRQ GLIIHUHQWLDWHV LW IURP WXPHIDFWLYH VOXGJH *%

SRO\S 6ROLWDU\ QRQGHSHQGHQW DQG QRQVKDGRZLQJSRO\S

$GHQRP\RPDWRVLV FKROHF\VWLWLV JODQGXODULV SUROLIHUDQV$GHQRP\RPDWRVLV FKROHF\VWLWLV JODQGXODULV SUROLIHUDQV7KLVFRQGLWLRQRIXQNQRZQDHWLRORJ\KDVGLVWLQFWSDWKRORJLFDOIHDWXUHVZLWKURXQGFHOOLQILOWUDWLRQPXVFOHK\SHUWURSK\DQG

IRUPDWLRQRIHSLWKHOLDOPXFRVDOVLQXVHV5RNLWDQVN\$VFKRIIVLQXVHV,WRFFXUVLQWKUHHGLVWLQFWW\SHVRQ2&*$IXQGDOQRGXODU ILOOLQJ GHIHFW 6WULFWXUHV ZKLFK RFFXU DW DQ\ VLWHZLWKLQ WKH JDOOEODGGHU DQGZKLFK EHFRPHDFFHQWXDWHG DIWHU


21/60

JDOOEODGGHUFRQWUDFWLRQ(SLWKHOLDOVLQXVHVZKLFKPD\RQO\

EHFRPH DSSDUHQW IROORZLQJ FRQWUDFWLRQZLWK FRQWUDVWZLWKLQVPDOO PXUDO GLYHUWLFXOD

*% $GHQRP\RPDWRVLV *% $GHQRP\RPDWRVLV7KHDIIHFWHGVHJPHQWRIWHQFRQWDLQVEULJKWHFKRHVDULVLQJIURPWKHF\VWLFVSDFHVRUIURPVPDOOVWRQHVRUFU\VWDOVZLWKLQ WKHP RIWHQ DVVRFLDWHG ZLWK FRPHWWDLO ULQJ

GRZQ DUWHIDFWV


22/60

*DOOEODGGHU FDUFLQRPD *DOOEODGGHU FDUFLQRPD$GHQRFDUFLQRPD RI WKH JDOOEODGGHU LV DVVRFLDWHG ZLWKVWRQHVLQRYHURISDWLHQWV7KHUHLVDIHPDOHWRPDOHUDWLR RI 3RUFHODLQ JDOOEODGGHU DQG VFOHURVLQJFKRODQJLWLVDUHSUHGLVSRVLQJIDFWRUV&KDUDFWHULVWLFDOO\WKHWXPRXUVDUHVFLUUKRXVDQGORFDOO\LQILOWUDWLYHLQYROYLQJWKHLQWUDKHSDWLF ELOLDU\ WUHH DQG FRPPRQ GXFW ZLWK UHVXOWLQJ

REVWUXFWLRQDQGMDXQGLFHDVDFRPPRQSUHVHQWLQJIHDWXUH,QYROYHPHQW RI WKH KHSDWLF DUWHU\ DQG SRUWDO YHLQ DW WKHSRUWDDUH WKHPDLQ UHDVRQVZK\FXUDWLYH VXUJHU\ LV RIWHQQRW SRVVLEOH DQG WUHDWPHQW LV SDOOLDWLYH

*DOOEODGGHUFDUFLQRPD*DOOEODGGHUFDUFLQRPD,WPD\EH VHHQ RQ LPDJLQJ DV IRFDO RU GLIIXVH LUUHJXODU


23/60

WKLFNHQLQJRIWKHJDOOEODGGHUZDOORUDVDODUJHUPDVV

LQ WKH JDOOEODGGHU IRVVD *DOOEODGGHU VWRQHV DUHSUHVHQWLQWKHPDMRULW\DQGPD\DSSHDUWREHEXULHGLQ WKH PDVV 7KH GLVHDVH WHQGV WR VSUHDG WR O\PSK

QRGHV DURXQG WKH SRUWDO YHLQ UHODWLYHO\ HDUO\ LQ LWVFRXUVH,WDOVRVSUHDGVWRWKHDGMDFHQWOLYHUVHJPHQWV DQG

*%FDUFLQRPD*%FDUFLQRPD3RO\SRLGDOJURZWKZLWK

EUHDFKRIFRQWLQXLW\RIWKHXQGHUO\LQJZDOODUURZ%$GYDQFHG FDUFLQRPD H[WHQGLQJ RXWVLGH WKH IXQGXVZLWK D QRGDO PHWDVWDVLV SRVWHULRU WR WKH SDQFUHDWLF


24/60

KHDG DUURZ

&KROHVWHURVLV&KROHVWHURVLV,QWKLVFRQGLWLRQWKHUHLVGLIIXVH GHSRVLWLRQ RI FKROHVWHURO RQ WKH JDOOEODGGHUPXFRVD'HSRVLWVDUHRIWKHRUGHURIPPPXOWLSOH

DQGIL[HGRQVFDQQLQJ'LIIHUHQWLDWLRQIURPDSRO\SLVQRWSRVVLEOH7KHFRQGLWLRQLVJHQHUDOO\DV\PSWRPDWLFWKH PDMRULW\ RI SDWLHQWV GHYHORS FKROHVWHURO VWRQHV&KROHVWHURVLVVKRZLQJIL[HGPXUDOGHIHFWV


25/60

0LUUL]]LV\QGURPH0LUUL]]LV\QGURPH7KLVV\QGURPHRFFXUV ZKHQ DQ LPSDFWHG FDOFXOXV ZLWKLQ WKH F\VWLFGXFWFDXVHVDFXWHFKROHF\VWLWLV([WHQVLRQRIWKHORFDOLQIODPPDWRU\SURFHVVLQYROYHVWKHFRPPRQKHSDWLFRU

FRPPRQELOHGXFW7KLVFRPSUHVVLYHHIIHFWPD\UHVXOWLQ ELOLDU\ REVWUXFWLRQ DQG MDXQGLFH &KROHF\VWHFWRP\DORQH RIWHQ UHVXOWV LQ WKH UHHVWDEOLVKLQJ RI ELOLDU\

GUDLQDJH DQG UHOLHI RI MDXQGLFH


26/60

%LOH GXFW SDWKRORJLHV %LOH GXFW SDWKRORJLHV


27/60

%LOH GXFW SDWKRORJLHV %LOH GXFW SDWKRORJLHV

&KROHGRFKROLWKLDVLV +HSDWROLWKLDVLV &KROHGRFKDOF\VW %LOLDU\ F\VWLF GLVHDVH %LOLDU\ DWUHVLD %LOLDU\VWULFWXUHV3DUDVLWLFLQIHFWLRQV%LOLDU\OHDNVDQGELOH

GXFW LQMXULHV &KRODQJLRFDUFLQRPD 3DQFUHDWLF DQGDPSXOODU\ WXPRXUV

&KROHGRFKROLWKLDVLV &KROHGRFKROLWKLDVLV $W OHDVW SHU FHQWRI ELOH GXFW VWRQHV DUH VWRQHV WKDW KDYH SDVVHG IURP WKHJDOOEODGGHU VRFDOOHG VHFRQGDU\ VWRQHV 3ULPDU\ VWRQHV DUHWKRVHWKDWDULVHLQWKHELOHGXFWDQGWKHVHDUHSLJPHQWVWRQHV86*'XFWGLODWDWLRQDQGDFRXVWLFVKDGRZLQJDUHHDFKDEVHQWLQDERXWSHUFHQWRIFDVHV3RVLWLYHVWRQHGLDJQRVLVGHSHQGVRQWKHGHPRQVWUDWLRQRIDQLQWUDGXFWDOHFKRJHQLFIRFXVLQERWK


28/60


29/60

&KROHGRFKROLWKLDVLV&KROHGRFKROLWKLDVLV(5&3KDVDKLJKDFFXUDF\IRUWKHGLDJQRVLVRIFKROHGRFKROLWKLDVLV

,WGRHVQRWKRZHYHUGHWHFWDOOVWRQHVDQGLQRQHVWXG\LWV VHQVLWLYLW\ ZDV SHU FHQW 05&3 KDV D KLJKUHSRUWHG DFFXUDF\ LQ WKH GLDJQRVLV RI FKROHGRFKROLWKLDVLV7KHVHQVLWLYLWLHVRISHUFHQWDQG

SHU FHQW DQG D VSHFLILFLW\ RI SHU FHQW

+HSDWROLWKLDVLV+HSDWROLWKLDVLV7KHJUHDWPDMRULW\RIGXFW VWRQHV DUH H[WUD KHSDWLF ,QWUDKHSDWLF VWRQHV


30/60


31/60

MDXQGLFH IURP REVWUXFWLRQ DQG FKRODQJLWLV GXFW

GLODWDWLRQ RIWHQ LQ SDWLHQWV ZLWK QRQVSHFLILFDEGRPLQDOV\PSWRPV5DUHO\VXFKF\VWVDUHVRODUJHWKDW WKHLU UHODWLRQVKLS WR WKH ELOLDU\ WUHH FDQ RQO\ EH

GHWHUPLQHG 6OLGH&KROHGRFKDOF\VWVFODVVLILHGLQWRILYHW\SHV

%


32/60

7\SH , 7\SH , 7\SH , F\VWLF RU IXVLIRUP GLODWDWLRQ RIH[WUDKHSDWLF ELOH GXFW $SS ,QFLGHQFH 7\SH,, 7\SH,, 7\SH ,, GLYHUWLFXOXP $SS ,QFLGHQFH 7\SH,,, 7\SH,,, 7\SH ,O,FKROHGRFKRFHOH RI LQWUDGXRGHQDOFRPPRQ ELOH GXFW GLODWDWLRQ $SS ,QFLGHQFH 7\SH,9 7\SH,97\SH ,9H[WUD DQG LQWUDKHSDWLF F\VWV $SS,QFLGHQFH 7\SH97\SH97\SH9LQWUDKHSDWLFGLODWDWLRQ>&DUROLV


33/60

'LVHDVH@ $SS ,QFLGHQFH 7\SH 9

%LOLDU\$WUHVLD%LOLDU\$WUHVLD%LOLDU\DWUHVLD%$LVDUDUH GLVHDVH FKDUDFWHUL]HG E\ D ELOLDU\ REVWUXFWLRQ RIXQNQRZQ RULJLQ WKDW SUHVHQWV LQ WKH QHRQDWDO SHULRG8QWUHDWHG WKLV FRQGLWLRQ OHDGV WR FLUUKRVLVDQGGHDWKZLWKLQ WKH ILUVW \HDUV RI OLIH


34/60

%LOLDU\ $WUHVLD %LOLDU\ $WUHVLD 6XUJLFDO WUHDWPHQW

XVXDOO\LQYROYHVDQLQLWLDODWWHPSWWRUHVWRUHELOHIORZWKH .DVDL SRUWRHQWHURVWRP\ %$ UHPDLQV WKHFRPPRQHVW LQGLFDWLRQ IRU SDHGLDWULF OLYHU

WUDQVSODQWDWLRQ WKURXJKRXW WKH ZRUOG

%LOLDU\$WUHVLD%LOLDU\$WUHVLD7ZRGLIIHUHQWIRUPVRI%$ DUH LGHQWLILHG 6\QGURPLF%$ a LQZKLFKELOLDU\ DWUHVLD LV DVVRFLDWHG ZLWK YDULRXV FRQJHQLWDO


35/60

DQRPDOLHV VXFK DV SRO\VSOHQLD DVSOHQLD FDUGLDF RU

LQWUD DEGRPLQDO DEQRUPDOLWLHV 1RQV\QGURPLF %$aLQZKLFKELOLDU\DWUHVLDLVDQLVRODWHGDQRPDO\

%LOLDU\ $WUHVLD %LOLDU\ $WUHVLD 8OWUDVRQRJUDSK\8OWUDVRQRJUDSK\ RI WKH OLYHU LV SHUIRUPHG DIWHU D

KRXUVIDVWZLWKDQ,9IOXLGLQIXVLRQ%$LVVXVSHFWHGLI WKH JDOOEODGGHU LV VKUXQNHQ GHVSLWH IDVWLQJ LI WKHOLYHU KLOXP DSSHDUV K\SHUHFKRJHQLF WULDQJXODU FRUGVLJQ RU LI WKHUH LV D F\VW DW WKH OLYHU KLOXP 7KHUH


36/60

VKRXOG EH QR HYLGHQFH RI ELOH GXFW GLODWDWLRQ

%LOLDU\ $WUHVLD %LOLDU\ $WUHVLD &KRODQJLRJUDSK\&KRODQJLRJUDSK\LVQHHGHGWRDVVHVVWKHPRUSKRORJ\DQG SDWHQF\ RI WKH ELOLDU\ WUHH 2WKHUV %LRFKHPLFDO

OLYHU IXQFWLRQ WHVWV VKRZ FKROHVWDVLV


37/60

%LOLDU\ $WUHVLD %LOLDU\ $WUHVLD +HSDWRELOLDU\VFLQWLJUDSK\HJ+,'$VFDQVGHPRQVWUDWHVDIDLOXUH

RI H[FUHWLRQ RI WKH UDGLRLVRWRSH LQWR WKH LQWHVWLQH9LVXDOLVDWLRQ RI VPDOO ERZHO XVLQJ WKH LVRWRSH 7F',6,'$ GLLVRSURS\OLPLQRGLDFHWLF DFLG H[FOXGHVELOLDU\ DWUHVLD


38/60

7ULDQJXODU FRUG VLJQ 7ULDQJXODU FRUG VLJQ 7KH

WULDQJXODU FRUG VLJQ LV D WHUP XVHG WR GHVFULEH WKHILEURWLF REOLWHUDWHG FRPPRQ ELOH GXFW LQ LQIDQWV ZLWKELOLDU\ DWUHVLD 86* UHYHDOV WXEXODU HFKRJHQLF FRUG

DUURZV

%LOLDU\ VWULFWXUHV %LOLDU\ VWULFWXUHV %LOLDU\ VWULFWXUHVPD\ EH EHQLJQ DQG PDOLJQDQW %HQLJQ ELOLDU\VWULFWXUHV 3RVWVXUJLFDO VWULFWXUHV 3ULPDU\ VFOHURVLQJ


39/60

&KRODQJLWLV >36&@ &KURQLF SDQFUHDWLWLV %DFWHULDO

FKRODQJLWLV +,9 FKRODQJLRSDWK\

3RVWVXUJLFDO VWULFWXUHV 3RVWVXUJLFDO VWULFWXUHV

3RVWRSHUDWLYH VWULFWXUHV PRVW RIWHQ UHVXOW IURPFKROHF\VWHFWRP\ 7KH\ WHQG WR EH RQO\ PP LQOHQJWK 7KH\ RIWHQ LQYROYH WKH FRPPRQ GXFW 'XFWVWRQHVPD\GHYHORSSUR[LPDOWRDVWULFWXUH05&3KDV


40/60

WKH DGYDQWDJH RYHU (5&3 RI GHPRQVWUDWLQJ GXFWV

DERYH D FRPSOHWH VWULFWXUH

6OLGH (5&3 VKRZV D SRVWFKROHF\VWHFWRP\VWULFWXUHDUURZZKLFKFKDUDFWHULVWLFDOO\LVYHU\VKRUW


41/60

3ULPDU\ VFOHURVLQJ &KRODQJLWLV >36&@ 3ULPDU\VFOHURVLQJ &KRODQJLWLV >36&@ 7KLV LV D GLVHDVH RIXQNQRZQDHWLRORJ\FKDUDFWHULVHGE\DQ LQIODPPDWRU\SURFHVV DIIHFWLQJ WKH LQWUD DQG H[WUDKHSDWLF GXFWV

7KH FRQGLWLRQ FRPPRQO\ SUHVHQWV LQ HDUO\ FKLOGKRRGZLWK IHDWXUHV RI FKROHVWDVLV


42/60

3ULPDU\ VFOHURVLQJ &KRODQJLWLV >36&@ 3ULPDU\

VFOHURVLQJ&KRODQJLWLV>36&@7KLVLVFKDUDFWHUL]HGRQFKRODQJLRJUDSK\ E\ PXOWLSOH VHJPHQWV RI VWULFWXULQJLQYROYLQJ LQWUDKHSDWLF DQGRU H[WUDKHSDWLF GXFWV

$QRWKHUIHDWXUHLQWKHFRPPRQELOHGXFWLVGLYHUWLFXODOLNHRXWSRXFKLQJV:HOOHVWDEOLVKHG36&LVDVVRFLDWHGZLWKDUHDVRIDWURSK\DQGK\SHUWURSK\ZLWKLQWKHOLYHUEHVW VHHQ ZLWK &7 RU 05,

3ULPDU\ VFOHURVLQJ &KRODQJLWLV >36&@ 3ULPDU\VFOHURVLQJ&KRODQJLWLV>36&@5HFRJQLVHGDVVRFLDWLRQV


43/60

LV ,QIODPPDWRU\ ERZHO GLVHDVH 6HYHULW\ RI

H[WUDKHSDWLFLQYROYHPHQWPD\FDUU\DZRUVHSURJQRVLV&KRODQJLRFDUFLQRPD RFFXUV LQ DERXW SHU FHQW RIDIIHFWHG SDWLHQWV GLIILFXOW WR GLDJQRVH HDUO\

3ULPDU\ VFOHURVLQJ &KRODQJLWLV >36&@ 3ULPDU\VFOHURVLQJ &KRODQJLWLV >36&@


44/60

3ULPDU\ VFOHURVLQJ FKRODQJLWLV &7,9& VKRZVPXOWLSOH LQWUDKHSDWLF DQG H[WUDKHSDWLF VHJPHQWV RIVWULFWXULQJ 3ULPDU\ VFOHURVLQJ FKRODQJLWLV


45/60

%LOLDU\ 6WULFWXUH &KURQLF SDQFUHDWLWLV %LOLDU\6WULFWXUH&KURQLFSDQFUHDWLWLV3DQFUHDWLWLVERWKDFXWHDQGFKURQLFFDQSURGXFHELOLDU\VWULFWXULQJFDXVHGE\ILEURVLV DQGRU DQ LQIODPPDWRU\ PDVV&KRODQJLRJUDSKLFDOO\ WKH VWULFWXUHV DUH W\SLFDOO\VPRRWK DQG WDSHUHG DQG WHQG WR H[WHQG RYHU D IHZFHQWLPHWHUV

%DFWHULDO &KRODQJLWLV %DFWHULDO &KRODQJLWLV $FXWHEDFWHULDOFKRODQJLWLVLVDOPRVWDOZD\VDVVRFLDWHGZLWK


46/60

DW OHDVW SDUWLDO ELOH GXFW REVWUXFWLRQ PRVW RIWHQ

FKROHGRFKROLWKLDVLV3DWLHQWV SUHVHQWZLWK VRPHRUDOOIHDWXUHV RI&KDUFRWV WULDG QDPHO\ IHYHU ULJKW XSSHUTXDGUDQW SDLQ DQG MDXQGLFH ,PDJLQJ VKRXOG LQFOXGH86 DQG VRPHWLPHV&705&3PD\ EH XVHG WR KHOSLGHQWLI\ REVWUXFWLQJ SDWKRORJ\ 86 PD\ VKRZ GXFWVWRQHVRURWKHUXQGHUO\LQJREVWUXFWLQJSDWKRORJ\DQGPD\ VKRZ ELOH GXFW ZDOO WKLFNHQLQJ

6OLGH5HFXUUHQW S\RJHQLFFKRODQJLWLV 53& DOVRUHIHUUHG WR DV RULHQWDO FKRODQJLRKHSDWLWLV RFFXUVPDLQO\ LQ 6RXWK(DVW $VLD RU LWV HPLJUDQWV ,W LVFKDUDFWHUL]HGE\UHFXUUHQWHSLVRGHVRIFKRODQJLWLVELOHGXFWVWRQHVELOLDU\GLODWDWLRQDQGVWULFWXUHV$OWKRXJKSDUDVLWHVLQSDUWLFXODU&ORQRUFKLVVLQHQVLVPD\SOD\D


47/60

SDUWLDO UROH

1HRSODVWLF ELOH GXFW SDWKRORJ\ 1HRSODVWLF ELOH GXFWSDWKRORJ\


48/60

1HRSODVWLF ELOH GXFW SDWKRORJ\ 1HRSODVWLF ELOH GXFWSDWKRORJ\ &KRODQJLRFDUFLQRPD 0DOLJQDQW ELOLDU\VWULFWXUH0HWDVWDVHVDQG O\PSKRPD3DQFUHDWLFDQGDPSXOODU\ WXPRXUV %LOLDU\ F\VWDGHQRPD

F\VWDGHQRFDUFLQRPD


49/60

&KRODQJLRFDUFLQRPD &KRODQJLRFDUFLQRPD&KRODQJLRFDUFLQRPD DULVHV IURP WKH ELOH GXFWHSLWKHOLXP DQG WHQGV WR VSUHDG E\ ORFDO LQILOWUDWLRQ$SSUR[LPDWHO\ SHULKLODU UHJLRQ .ODWVNLQWXPRXUV OHVV WKDQ LQ WKHGLVWDO FRPPRQGXFWOHVVWKDQDUHGLIIXVHRUPXOWLIRFDO$SSUR[LPDWHO\SHUFHQWDUHFODVVLILHGDVSHULSKHUDODULVLQJZLWKLQ

WKH OLYHU DQG SUHVHQWLQJ DV DQ KHSDWLF PDVV


50/60

&KRODQJLRFDUFLQRPD &KRODQJLRFDUFLQRPD 7KHLU

DSSHDUDQFH RQ LPDJLQJ YDULHV ZLWK VL]H DQGSDWKRORJLFDO W\SH0RVW RI WKHH[RSK\WLF WXPRXUVDUHOHVVWKDQFPDQGWKHLQILOWUDWLQJVWHQRWLFWXPRUVDUHXVXDOO\ OHVV WKDQ FP

&KRODQJLRFDUFLQRPD&KRODQJLRFDUFLQRPD2Q86WKHWXPRXUV DSSHDU DV QRGXOHV RU IRFDO ELOH GXFW ZDOOWKLFNHQLQJ2Q&7WKHQRGXOHVDUHXVXDOO\LVRGHQVHRUVOLJKWO\ K\SRGHQVH PRUH HDVLO\ VHHQ RQ FRQWUDVW


51/60

HQKDQFHG LPDJLQJ

6OLGH2Q05,WKHWXPRXUVDUHK\SRLQWHQVHRQ7

DQG K\SHULQWHQVH RQ 7 DQG VKRZ VRPH SURJUHVVLYHHQKDQFHPHQW RQ G\QDPLF LPDJLQJ 7KH SUR[LPDOH[WHQW RI WKH VWULFWXULQJ ZKLFK FULWLFDOO\ DIIHFWVWUHDWPHQW RSWLRQV LV ZHOO VKRZQ ZLWK 05&3


52/60


53/60

0HWDVWDVHV DQG O\PSKRPD 0HWDVWDVHV DQGO\PSKRPD 0HWDVWDVHV DQG O\PSKRPD PD\ UHVXOW LQKLODU RU PLGORZ ELOLDU\ REVWUXFWLRQ&KRODQJLRJUDSKLFDOO\ WKH\ PLPLF RWKHU PDOLJQDQWFDXVHV RI REVWUXFWLRQ

0HWDVWDVHV DQG O\PSKRPD 0HWDVWDVHV DQGO\PSKRPD7KHVWULFWXUHVFDQEHORQJDQGPD\KDYHD


54/60


55/60


56/60

%LOLDU\ F\VWDGHQRPD F\VWDGHQRFDUFLQRPD %LOLDU\F\VWDGHQRPD F\VWDGHQRFDUFLQRPD 7KHVH UDUHWXPRXUV RI WKH ELOLDU\ HSLWKHOLXP 3UHVHQW DVFRPSOH[RIWHQF\VWLFPDVVHVZLWKLQ OLYHU SDUHQFK\PDZKLFK PD\ LQILOWUDWH VHJPHQWDO ELOH GXFWV +LVWRORJLFDOO\ D EHWWHU SURJQRVWLF JURXS FRQWDLQLQJ

RYDULDQ VWURPD 7KHUH LV QR UDGLRORJLFDO FULWHULRQ E\ZKLFK WKHVH PD\ EH GLVWLQJXLVKHG

0DOLJQDQW ELOLDU\ VWULFWXUH 0DOLJQDQW ELOLDU\ VWULFWXUH


57/60

0DOLJQDQWELOLDU\VWULFWXUH 0DOLJQDQWELOLDU\VWULFWXUH

0DOLJQDQW %LOLDU\ 6WULFWXUHV &DXVHV 3DQFUHDWLFFDUFLQRPD &KRODQJLRFDUFLQRPD $PSXOODU\FDUFLQRPD ([WULQVLF FRPSUHVVLRQ O\PSKDGHQRSDWK\ 3ULPDU\ KHSDWLF WXPRUV RUVHFRQGDU\ GHSRVLWV

0DOLJQDQWELOLDU\VWULFWXUH 0DOLJQDQWELOLDU\VWULFWXUH,Q PDOLJQDQW KLODU REVWUXFWLRQ HYDOXDWLRQ VKRXOGLQFOXGH 3UR[LPDO H[WHQW RI VWULFWXULQJ 3UHVHQFH RI

OREDU DWURSK\ 3DWHQF\ RI WKH SRUWDO YHLQV DQG


58/60

OREDU DWURSK\ 3DWHQF\ RI WKH SRUWDO YHLQV DQG

3UHVHQFH RI DQ\ LQWUDKHSDWLF RU ORFDO H[WUDKHSDWLFPHWDVWDVHV

0DOLJQDQWELOLDU\VWULFWXUH 0DOLJQDQWELOLDU\VWULFWXUH,QPDOLJQDQWORZREVWUXFWLRQXVXDOO\GXHWRSDQFUHDWLFFDUFLQRPD WKH PDLQ IDFWRUV WR DVVHVV DUH 7XPRXUVL]H 9DVFXODU LQYROYHPHQW SRUWDO YHLQ VXSHULRUPHVHQWHULF YHLQ DQG VXSHULRU PHVHQWHULF DUWHU\

/\PSK QRGH PHWDVWDVHV DQG +HSDWLF PHWDVWDVHV


59/60

/\PSK QRGH PHWDVWDVHV DQG +HSDWLF PHWDVWDVHV

6OLGH 7KH SUR[LPDO H[WHQW RI VWULFWXULQJ LV

FODVVLILHG DFFRUGLQJ WR WKH PRGLILHG %LVPXWKFODVVLILFDWLRQ LQ WR IRXU W\SHV)LJXUH0RGLILHG%LVPXWK FODVVLILFDWLRQ RI PDOLJQDQW KLODU ELOLDU\REVWUXFWLRQ EDVHG RQ SUR[LPDO H[WHQW RI WXPRXU


60/60

,17(59(17,21$/7(&+1,48(6,17(59(17,21$/ 7(&+1,48(63HUFXWDQHRXV FKROHF\VWRVWRP\ 3HUFXWDQHRXVWUDQVKHSDWLF (QGRVFRSLF ELOLDU\FDWKHWHUL]DWLRQVWHQWLQJ %LRSV\

BILIARY SYSTEM - ΟΜΙΛΙΑ ΚΟΥΡΟΥΣΗ 2Ο ΜΕΡΟς ΕΒΙΤΑ

Documents

Transcript of BILIARY SYSTEM - ΟΜΙΛΙΑ ΚΟΥΡΟΥΣΗ 2Ο ΜΕΡΟς ΕΒΙΤΑ