标签归档 南京新茶外卖论坛

　　In recent years, with the intensification of international technological competition, Germany, the United States, Thailand, South Korea, Japan and other countries have successively set up national-level IPR appeal hearing mechanisms to protect their own scientific and technological innovations and ensure the unity and certainty of IPR adjudication. By tracing the recent work of foreign intellectual property courts, this paper introduces the progress and related work measures of foreign intellectual property courts in recent years in court establishment, case trial, response to epidemic situation, diversified dispute resolution mechanism, information work, judicial openness and international exchange, with a view to enlightening.

　　I. Basic information on the establishment of overseas intellectual property courts

　　The establishment of early intellectual property courts

　　Before 2020, the specialized intellectual property courts (courts) established around the world mainly include: the German Federal Patent Court established in 1961, the British High Court Patent Court established in 1977, the Korean Patent Court established in 1998, the Singapore Intellectual Property Court established in 2002, the Japanese Intellectual Property High Court established in 2005, the Malaysian Intellectual Property Court established in 2007 and the British Intellectual Property Enterprise established in 2013.

　　In addition, although the scope of the US Court of Appeals for the Federal Circuit established in 1982 is not limited to intellectual property cases, patent civil and administrative cases and the "337 investigation" appeal case of the US Federal Trade Commission are all under its exclusive jurisdiction and constitute the main types of cases it actually accepts.

　　The Thai Intellectual Property and International Trade Court, established in 1997, is not limited to intellectual property cases, but all first-instance intellectual property cases, including civil cases and criminal cases, are under its exclusive jurisdiction.

　　Although the scope of accepting cases by the Finnish Market Court established in 2013 is not limited to intellectual property cases, all intellectual property cases except criminal cases are under its exclusive jurisdiction.

　　Recent establishment of intellectual property courts

　　On July 1, 2020, in order to ensure the uniformity and certainty of the adjudication of intellectual property cases, Poland established a number of specialized intellectual property courts, including four intellectual property courts of first instance and two intellectual property appeal courts, among which technical intellectual property cases were under the exclusive jurisdiction of the Warsaw District Intellectual Property Court.

　　In addition, the establishment of the European unified patent court is progressing closely, and will begin to accept cases after the entry into force of the Agreement on the Unified Patent Court. The entry into force condition of the Agreement on Unified Patent Courts is that the domestic legislatures of at least 13 member countries (including Germany, France and Italy, which hold the most valid patents) approve the Agreement, and the entry into force date is the first day of the fourth month after the last country that meets the entry into force conditions deposits its instrument of ratification.

　　In August, 2021, Germany, as the last country to achieve the conditions for entry into force, ratified the Unified Patent Court Agreement, which will take effect on the first day of the fourth month after Germany deposited its instrument of ratification. It is noteworthy that in order to ensure the smooth transition to the operation stage of the unified patent court after the entry into force of the unified patent court agreement, the provisional application agreement of the unified patent court agreement agreed in part of the unified patent court agreement came into effect on January 19, 2022, and the eight-month provisional application period of the unified patent court agreement has officially started.

　　The European unified patent court has started the final preparatory stage, and its administrative Committee has adopted the rules of European patent litigation qualification regulations, European unified patent court service and personnel regulations, financial regulations and so on; The Advisory Committee responsible for the recruitment of judges in the Unified Patent Court has been established, and the registration of judges has been closed, and about 1,000 applications have been received. Almost all patent judges in Germany and France have signed up for this recruitment activity, and the selection work is currently underway. It is expected that the European Unified Patent Court will be officially put into operation in September 2022 or early 2023.

　　Second, the main work of the recent extraterritorial intellectual property courts

　　In the trial of cases

　　1. The trial of the case

　　The U.S. Court of Appeals for the Federal Circuit accepted 1,511 appeals, 1,456 appeals and 1,582 appeals in 2019, 2020 and 2021 (from September 30 of the previous year to September 30 of that year); 1602 cases, 1568 cases and 1370 cases were concluded respectively. Intellectual property cases accounted for 67% (about 1012 cases), 61% (about 888 cases) and 53% (about 838 cases) respectively. Among them, the patent examination cases from the US Patent and Trademark Office accounted for 43% (about 650 cases), 38% (about 553 cases) and 35% (about 553 cases) respectively; The patent cases from the U.S. federal district court accounted for 22% (about 332 cases), 21% (about 306 cases) and 16% (about 253 cases) respectively. Trademark cases accounted for 2% of the total number of cases received in three years, about 30, about 29 and about 32 respectively.

　　In 2019 and 2020, Japan’s Intellectual Property High Court accepted 259 cases of intellectual property rights (174 cases of first instance and 85 cases of civil appeal) and 221 cases (152 cases of first instance and 69 cases of civil appeal); 254 cases (166 cases of first instance requesting to cancel the ruling and 88 cases of civil appeal) and 224 cases (159 cases of first instance requesting to cancel the ruling and 65 cases of civil appeal) were concluded respectively. In 2019, the average trial period of first-instance cases requesting revocation of the ruling was 8.6 months, and the average trial period of civil appeal cases was 7 months. 9.6 months and 9 months respectively in 2020.

　　In 2019 and 2020, the Korean Patent Court accepted 949 cases of intellectual property rights (836 cases requesting cancellation of administrative rulings and 113 cases of civil appeals) and 797 cases (671 cases requesting cancellation of administrative rulings and 126 cases of civil appeals); 930 cases (801 cases requesting cancellation of administrative ruling and 129 cases of civil appeal) and 877 cases (758 cases requesting cancellation of administrative ruling and 119 cases of civil appeal) were concluded respectively. In 2019, the average trial period of administrative cases was 237 days, and the average trial period of civil appeal cases was 308 days. 251 days and 320 days in 2020 respectively.

　　The German Federal Patent Court accepted 1,548 and 1,505 intellectual property cases in 2019 and 2020 respectively; 1838 cases and 1632 cases were concluded respectively. The average trial period of each court in the German Federal Patent Court is different, among which the average trial period of the invalid court is 27.8 months in 2019 and 32.8 months in 2020; The average trial period of the Technical Appeals Tribunal is 28.5 months in 2019 and 27.9 months in 2020; The average trial period of the court of appeal for utility model patents is 22.9 months in 2019 and 20.9 months in 2020; The average trial period of the Trademark and Design Patent Appeal Court is 22.1 months in 2019 and 21.8 months in 2020; The average trial period of the Legal Appeal Court is 10.4 months in 2019 and 8.4 months in 2020.

　　In 2019, 2020 and 2021, the Intellectual Property and International Trade Court of Thailand accepted 2,838 cases (207 civil cases and 2,631 criminal cases), 2,073 cases (211 civil cases and 1,862 criminal cases) and 554 cases (64 civil cases and 490 criminal cases) respectively; 2,957 cases (217 civil cases and 2,740 criminal cases), 2,078 cases (186 civil cases and 1,892 criminal cases) and 467 cases (53 civil cases and 414 criminal cases) were concluded respectively.

　　2. Relevant important referees in recent years

　　On compensation for damages in patent civil infringement cases.

　　In February, 2020, the Japanese Intellectual Property High Court used the calculation method of damages based on loss of profits in the case of "MTG v. Five Stars" involving the patent infringement dispute of beauty instruments, arguing that the contribution of patents was not considered when calculating damages, and finally the amount of damages was 440.06 million yen.

　　In November 2020, in the case of "Vectura v GlaxoSmithKline" patent infringement dispute, the US Court of Appeals for the Federal Circuit upheld the judgment of the court of first instance that the infringer’s sales of nearly $3 billion was multiplied by the license fee of 3%, and that the infringer compensated the patentee for a total of more than $89 million.

　　In September, 2021, the U.S. Court of Appeals for the Federal Circuit partially revoked the district court’s judgment in the case of SRI and Cisco, and decided that Cisco Company constituted intentional infringement, bearing twice the punitive damages, and maintaining the district court’s judgment on fully supporting the lawyer’s fees.

　　In September of the same year, the U.S. Court of Appeals for the Federal Circuit overturned the judgment of the district court in the case of Lubby Holdings and Henry Chung, arguing that Article 287 of the U.S. Patent Law requires that the patentee must inform the infringer of what acts are suspected of infringement and which patent is infringed by the alleged infringing product. At the same time, The infringer is required to stop the infringement or seek a patent license. Because the patentee in this case failed to provide evidence to meet these requirements, the U.S. Court of Appeals for the Federal Circuit overturned the judgment of the district court on the tort compensation caused by the infringer’s infringement before being sued, and sent the case back to the district court for retrial and decided on the tort compensation caused by the infringement after the prosecution.

　　On patentability in patent administrative cases.

　　In February, 2021, in the case of Trustees of Columbia University v. Illumina, the U.S. Court of Appeals for the Federal Circuit pointed out that it was obvious to use the known literature to identify the patent unless it was clearly stated that the method of disclosure was not feasible or should not be adopted.

　　On the intersection of patent civil infringement and administrative invalidation procedure.

　　In January, 2021, in the case of ABS and Cytonome, the U.S. Court of Appeals for the Federal Circuit dismissed the appeal filed by the accused infringer ABS Company for reconsideration procedure on the grounds that the judgment that the accused infringer did not constitute infringement in both civil cases had become the final judgment and the accused infringer had no interest in the patent invalidation reexamination decision.

　　On the identification of evidence of patent infringement.

　　In April, 2021, the U.S. Court of Appeals for the Federal Circuit upheld the district court’s judgment that Sharp Company did not constitute patent infringement against Wi-LAN Company, and held that the printed source code of a third-party chip manufacturer did not constitute a business record, and the attached employee statement was prepared in response to the lawsuit, and was not kept during the regular activities, so it could not be used as evidence to prove the infringement.

　　On the protection of pharmaceutical patents.

　　On September 30, 2021, the Korean Patent Court overturned the ruling made by the Korean Intellectual Property Hearing and Appeal Committee, and decided that PEGylated drugs belonged to the new drugs in the drug patent extension system under the Korean patent law system, which expanded the scope of new drugs considered by the Korean Intellectual Property Office, thus being more coordinated and consistent with the scope of new drugs in the drug patent extension system in the United States and the European Union.

　　On October 9, 2020, the German Federal Patent Court decided that the combination of ezetimibe and simvastatin was not innovative drugs in the case of invalid patent supplementary protection certificate for ezetimibe /simvastatin, and revoked the issued EU supplementary protection certificate.

　　On the identification of artificial intelligence inventors.

　　Since 2018, steven tyler, an American scientist, has submitted patent applications to many countries or regions as the inventor of his artificial intelligence system. Law enforcement and judicial organs in various countries are faced with the legal issue of whether the artificial intelligence system is the inventor of the patent. In this regard, different judicial organs present different views.

　　The German Federal Patent Court ruled in November 2021 that although the artificial intelligence system cannot be an inventor of a patent alone, it can be added as an inventor and written in the patent application.

　　In September 2021, the British Court of Appeal also rejected steven tyler’s request to list artificial intelligence as a patent application of a separate inventor. At present, the case has been appealed to the British Supreme Court; In September 2021, the U.S. Federal District Court for the Eastern District of Virginia ruled that the artificial intelligence system could not be an inventor under the U.S. patent law.

　　On the contrary, the Australian Federal Court of Appeal ruled in July 2021 that artificial intelligence can be used as a patent inventor according to Australian patent law.

　　In addition, in Japan, South Korea and other countries, the patent issue of the DABUS case is still under review.

　　With the development of artificial intelligence, artificial intelligence has challenged the patent laws and judicial organs of various countries, and whether artificial intelligence can become a patent inventor is gradually being explored and clarified in various countries.

　　Work initiatives

　　1. Work measures to deal with the epidemic situation

　　Affected by the outbreak of the COVID-19 epidemic in 2020, overseas intellectual property courts took timely measures to deal with the epidemic, mainly including the following aspects:

　　The first is to start using remote trial. Japan’s Intellectual Property High Court, Germany’s Federal Patent Court, Thailand’s Intellectual Property and International Trade Court and the UK’s Patent Court all use Microsoft Teams software or the commercial version of Skype software to conduct trials by remote video conference.

　　The U.S. Court of Appeals for the Federal Circuit issued an announcement in official website at the beginning of the outbreak to suspend off-line court sessions, and changed the cases that really needed to be heard to be held by teleconference, and provided real-time audio live broadcast to the public on official website.

　　The second is to limit the number of courts. The German Federal Patent Court adopts a combination of online and offline trial, that is, the judge and the lawyer of one party are in court, and all other litigants participate in the trial through remote video conference. At the same time, the German Federal Patent Court also issued regulations to limit the number of courts, limiting the number of standard courts with 30 people to 9 and the number of large courts with 90 people to 30.

　　The third is to encourage parties to submit case materials online. Thailand’s Intellectual Property and International Trade Court encourages parties to use the electronic document system and the court’s comprehensive online service system to follow up the status of cases and pay legal fees and other expenses without going to court.

　　The fourth is to amend the rules of civil procedure. In July, 2020, the U.S. Court of Appeals for the Federal Circuit promulgated the newly revised Rules of Procedure for the Federal Circuit, including the relevant provisions on the submission of documents by electronic means, and the provisions on the delay of the limitation of action when neither electronic nor on-site paper submission can be made.

　　In addition, the Thai Intellectual Property and International Trade Court announced the new rules of remote trial during the epidemic in time, allowing all civil cases to be litigated online.

　　The fifth is to focus on dealing with the backlog of cases. In order to cope with the backlog of cases caused by the epidemic, the British courts have established courts (also known as "Nightingale Courts") that have been converted from hotels, concert halls or theaters, and hired part-time judges and retired judges to hear cases that have been backlogged due to the epidemic. In an interview, the judge of the British High Court said that except for the early ban due to the epidemic, the patent court almost did not postpone hearing any cases.

　　Sixth, strengthen the protection of trial data and information. In order to cope with the backlog of cases during the epidemic and the fact that judges often take case materials home for processing, the trial data protection team of the British courts published a guide to the protection of trial case data information in April 2020, which stipulated specific norms for the preservation of case materials to prevent the disclosure of trial data.

　　During 2021, some foreign intellectual property courts adjusted epidemic prevention measures. For example, since September of that year, the United States Court of Appeals for the Federal Circuit began to resume on-site trials of some cases, but made requirements for the number of people participating in the trial, wearing masks, and nucleic acid testing certificates.

　　2. Diversified dispute resolution mechanism

　　On May 25th, 2020, Korea Patent Court signed a memorandum of cooperation with Korea Commercial Arbitration Commission. According to the memorandum of cooperation, the Korean patent court can refer some arbitration cases related to intellectual property rights to the Korean Commercial Arbitration Commission for handling, so as to promote the diversified dispute resolution of intellectual property cases.

　　3. Informatization work

　　The German Federal Patent Court has long joined its own information cooperation project. According to the requirements of related information work, it will realize the electronization of all documents by January 1, 2026 at the latest. This requires the German Federal Patent Court to replace its visualization system that has been used for many years and switch to the visualization trial system agreed in the cooperation project. At present, the German Federal Patent Court is focusing on transferring trial case files to a visual trial system. According to statistics, there are 5,500 directories and 450,000 files to be transferred.

　　4. Judicial openness

　　On August 10, 2020, the Korean Patent Court signed a memorandum of cooperation with the World Intellectual Property Organization, which will provide WIPO with the English version of the intellectual property judicial judgment of the country, thus facilitating foreign parties to obtain the judgment of the Korean Patent Court and improving the influence of the intellectual property trial in the country.

　　Both the Japanese Intellectual Property High Court and the Korean Patent Court have formulated and published the 2020 edition of the court introduction manual and the 2021 edition of the court introduction manual in official website in time, which contains the historical evolution, organizational structure, litigation procedures, research and exchange, case trials and other contents of the court.

　　International exchange

　　On September 17, 2020, the library jointly established by Thailand Intellectual Property and International Trade Court and the World Intellectual Property Organization was officially put into use, and all books and materials were open to judges, lawyers, government agencies and the public. The establishment of the library is one of the important contents of the Cooperation Statement signed by the Thai Intellectual Property and International Trade Court and the World Intellectual Property Organization in 2018.

　　On November 11-12, 2020, the Korean Patent Court held the 6th Global Intellectual Property Court Conference with the theme of "Court, Intellectual Property and Globalization". A total of 500 intellectual property judges, lawyers and scholars from the United States, Britain, Belgium, Australia, Japan and other countries attended the meeting. The topics exchanged in this meeting cover biotechnology patents and software patents, design patent litigation, transnational patent litigation, standard essential patents and other fields.

　　From November 10th to 11th, 2021, the Korean Patent Court continued to hold the 7th Global Intellectual Property Court Conference with the theme of "Court, Intellectual Property and Harmonization" by combining online and offline. The topics exchanged at the meeting covered the latest hot topics such as compulsory patent licensing, the challenge of artificial intelligence to patent law, the protection of computer software copyright, and how to balance the interests of units and employees in job invention-creation cases.

　　In January, 2021, Japan Intellectual Property High Court held the 2020 annual intellectual property judicial seminar online. Judges and lawyers from the United States, Britain, Germany and Japan participated in the discussion and exchange of two themes: "the status quo of equivalent infringement in patent infringement litigation" and "court litigation activities under epidemic situation".

　　In October, 2021, Japan Intellectual Property High Court continued to hold the 2021 judicial seminar on intellectual property, and judges and lawyers from various countries discussed and exchanged two themes: "International comparison of indirect patent infringement" and "using expert knowledge in civil litigation".

　　otherwise

　　In response to the professionalism and complexity of the current trial of technical intellectual property cases, the Korean Patent Court set up a technical consultation expert recommendation committee on July 17, 2020, appointed nine experts from different research institutions as members of the committee, and revised the relevant domestic trial rules. According to the latest trial rules, in the process of hearing technical cases, if the presiding judge needs the support of experts in related technical fields, he can make a request to the Technical Advisory Expert Recommendation Committee, and the Committee will provide experts in related fields according to the request to help the judges hear related technical cases.

　　Third, analysis and enlightenment

　　It has become an international trend to establish an appeal mechanism for intellectual property cases at the national level.

　　Germany, the United States, Thailand, South Korea, Japan and other countries have successively set up national-level IPR appeal trial mechanisms, and have formed a relatively mature IPR trial operation mechanism.

　　Poland also established a centralized trial system for intellectual property cases in July 2020.

　　The European unified patent court, which was established beyond the national level, officially entered the final preparatory stage on January 19, 2022, and it is expected to start its official operation in September 2022 at the earliest.

　　In recent years, the globalization trend of intellectual property litigation around standard essential patents, pharmaceutical patents, artificial intelligence and other fields has become increasingly prominent. The competition among countries for and safeguarding their own jurisdiction, excluding and restricting the jurisdiction of other countries has intensified, and the trend of centralized trial of intellectual property cases has become increasingly obvious. It has become an international trend to establish a unified national or even supranational regional appeal trial mechanism for intellectual property cases.

　　The internationalization trend of intellectual property disputes is becoming more and more obvious.

　　In recent years, in the fields of standard essential patents, medicine, artificial intelligence, etc., many countries are facing the same legal problems at the same time, parallel lawsuits occur from time to time, and the internationalization trend of intellectual property disputes is becoming increasingly obvious. On the one hand, we should continue to pay attention to the extraterritorial dynamics, learn from the useful experience of extraterritorial courts, and broaden our international horizons; On the other hand, it is also necessary to thoroughly investigate the actual situation of scientific and technological enterprises, especially multinational enterprises, and respond to the judicial needs of scientific and technological innovation subjects. It is necessary to strengthen the research on difficult and complicated problems in new fields and new formats of intellectual property, sum up the rules of adjudication in a timely manner in combination with the trial practice inside and outside the region, and timely study the coping strategies of intellectual property problems in new fields and new formats, so as to provide judicial wisdom support for the emerging new and complex problems. In addition, in view of the new problems, new situations and the improvement of intellectual property trial mechanism faced by all countries, it is necessary to increase judicial exchanges and discussions with overseas intellectual property courts, deeply participate in global intellectual property governance under the framework of the World Intellectual Property Organization, and promote the improvement of the international intellectual property governance system.

　　(Author: the Supreme People’s Court)

　　Li yonglei

　　For "edema", most people will recognize it. The simplest way is to press the affected area with your hand. If the skin sags into a small pit and cannot recover immediately, it is "swollen". After living at home for more than two months, many middle-aged and elderly people have similar edema. What needs to be vigilant is that the causes of edema are not only the obvious reduction of exercise and the high age of the family, but also some pathological reasons may be hidden.

　　Clinically, "edema" generally refers to edema of lower limbs, mainly manifested as swelling of limbs, which starts at the ankle and then spreads to the whole lower limbs, and sometimes occurs in the limbs, but edema of lower limbs is the most common.

　　Why does kidney disease cause edema?

　　Mr. Ma has always felt weak waist recently, and his urine is dark and frothy. When he took off his socks, he found obvious indentation on his calf. After seeing a doctor, he was diagnosed with hematuria, proteinuria, moderate hypertension and other problems, and was later diagnosed as acute glomerulonephritis. The edema in the patient’s leg is the secondary edema caused by renal disease.

　　Edema can be caused by many reasons, and different edema has different characteristics. Edema caused by kidney diseases is called nephrogenic edema. Nephrogenic edema is the most common cause of edema in clinic, and it is also one of the common symptoms of kidney diseases. Why can kidney problems lead to edema? There are two main reasons: first, the filtration function of glomerulus to water and sodium decreases, while the renal tubule reabsorbs water and sodium well, which leads to the retention of water and sodium, which is often accompanied by the increase of capillary permeability in the whole body, so the water in the interstitial space is retained; Second, a large amount of proteinuria in the body leads to low plasma protein.

　　Nephrogenic edema first occurs in loose tissues, such as ankles, eyelids or face, which is most obvious in the morning and can spread to lower limbs and the whole body in severe cases. It is characterized by being soft and easy to move, showing concave edema in clinic, that is, depression can occur when pressing local skin with fingers.

　　Clinically, nephrogenic edema is mainly divided into nephrotic edema and nephritis edema.

　　Nephrotic edema mainly refers to nephrotic syndrome. In addition to systemic edema, patients also have a lot of proteinuria, hypoproteinemia and hyperlipidemia. All causes of nephrotic syndrome, including primary causes (minimal change nephropathy, mesangial proliferative glomerulonephritis, mesangial capillary glomerulonephritis, membranous nephropathy, focal segmental glomerulosclerosis) and secondary causes (allergic purpura, systemic lupus erythematosus, hepatitis B virus-associated nephritis, diabetic nephropathy, renal amyloidosis, myeloma nephropathy) can cause nephrotic edema.

　　Nephritis edema mostly starts from eyelid and face, mainly seen in patients with acute glomerulonephritis. In addition to edema and hypertension, the patient’s clinical manifestations are also urine changes, such as hematuria, proteinuria, red blood cell cast, oliguria, etc. After the acute phase, the edema can subside.

　　For such patients, early treatment is the key, and the overall treatment principles are as follows:

　　1. Restrict sodium salt intake: Both nephrotic edema and nephritis edema have sodium and water retention, so sodium salt intake must be restricted, but it should be appropriate to avoid hyponatremia;

　　2, diuresis: when necessary, using diuretics while limiting sodium can promote sodium and water discharge to relieve edema, and can relieve hypertension and reduce heart load;

　　3, control proteinuria: proteinuria must be controlled for nephrotic edema, and immunosuppressive drugs (dexamethasone, prednisone, etc.) can be used to restore the normal permeability of glomerulus;

　　4, under the guidance of a doctor, supplement plasma protein.

　　Some edema comes from heart disease.

　　Ms. Liu, 75, has a history of hypertension for many years, but she believes that she is in good health and does not take medicine regularly. After catching a cold two weeks ago, I felt weak, palpitation, obvious swelling of my feet, and it was difficult to wear shoes. After coming to the hospital, he was diagnosed as hypertension, coronary heart disease and heart failure by the Department of Cardiology.

　　Ms. Liu, a patient with hypertension, suffered from heart disease and heart failure after catching a cold. It is due to the edema of lung congestion tissue, the increase of airway resistance and the decrease of alveolar elasticity, resulting in dyspnea, which is to say that breathing is fast and shallow. In fact, clinically, most hypertension will be combined with various types of heart disease, and at the same time, different stages of heart disease may be accompanied by different degrees of hypertension. Poor long-term control of hypertension can cause changes in heart structure and function, which is called hypertensive heart disease. Studies have shown that 70% of heart failure is caused by hypertension, and there may be related cardiac complications such as coronary heart disease and atrial fibrillation. In the early days, patients are prone to fatigue dyspnea, such as when going upstairs, carrying loads, buying food, and even when looking after children. Some people will have paroxysmal dyspnea at night, which usually occurs 1-2 hours after falling asleep. Patients wake up because of tightness and shortness of breath, and may have cough and foam-like sputum. Those with mild symptoms can relieve themselves and live as usual during the day, while those with severe symptoms can continue to attack and cough pink foam-like sputum.

　　Then, how is edema related to high blood pressure and heart disease?

　　Recently, many patients who came to the hospital due to edema of lower limbs were admitted to the clinic, and some of them were diagnosed as cardiogenic edema. Cardiogenic edema is the body edema caused by cardiac dysfunction. The disease can present systemic or localized edema, which first manifests as decreased urine volume, heavy limbs and increased weight, and then gradually appears edema of lower limbs and whole body. Under normal circumstances, the patient’s ankle first appears sunken edema, which gradually develops into systemic edema. Accompanied by right heart failure, patients will also have other symptoms and signs, such as palpitation, asthma, jugular vein distension, hepatomegaly, and even pleural effusion and ascites. The principles of treating cardiogenic edema are cardiotonic, diuretic and heart protection.

　　In heart diseases, heart failure is the most common cause of limb edema. Due to the different concentrations of protein and salt in blood and surrounding tissues, when blood circulation is blocked, the surrounding tissues can easily absorb the liquid in blood excessively, resulting in edema. However, leg swelling caused by heart disease develops relatively slowly, and many elderly people only notice the abnormality because their feet are swollen and they can’t wear shoes. Cardiogenic edema of lower limbs does not need deliberate treatment, and the heart function is restored, and the symptoms of edema can naturally be significantly improved.

　　Mosquito bites can also cause edema of lower limbs.

　　Recently, Mr. Wang was bitten by a bug when he went out for an outing. After scratching his calf wound, he developed redness and edema. He was diagnosed with erysipelas after seeing a doctor.

　　Erysipelas is an infection involving superficial lymphatic vessels of dermis, and the main pathogenic bacteria are group A β Streptococcus hemolyticus Any inflammation of the skin, especially the inflammation with chapped or ulcerated skin, can be a way for pathogenic bacteria to invade the human body. Mild abrasions or scratches, injuries outside the head, unclean umbilical cord ligation and chronic leg ulcers may all lead to this disease.

　　Infected with erysipelas, why does the lymphatic system have edema?

　　Lymphatic system is a resource recovery and antivirus system of human body, which is widely distributed in human body. Lymphogenic edema mainly refers to the proliferation of subcutaneous fibrous connective tissue after repeated infection of soft tissue fluid on the body surface caused by the obstruction of lymph reflux in some parts of the body. If limbs are involved, it will be thickened, and the skin will be thickened, rough and tough like elephant skin in the later stage, also known as "elephant skin swelling".

　　Lymphatic dysplasia or infection can cause swelling of tissues in the corresponding area. There are also some people who have slight abnormalities in the development of blood vessels in their lower limbs and are more prone to edema symptoms. We usually analyze the condition of patients’ lymphatic system by puncturing subcutaneous edema tissue fluid. The protein content of lymphedema fluid is usually very high, ranging from 1.0 to 5.5g/dl, while the protein content of edema tissue fluid with simple venous stasis, heart failure or hypoproteinemia is 0.1 to 0.9g/dl. However, this method can’t understand the lesion site and function of lymphatic vessels, and it is necessary to determine the development or obstruction of lymphatic vessels by lymphangiography.

　　Thromboedema of cardiac vein in patients with low back pain

　　Mr. Liu is obese, has irregular meals and stays up late for a long time. He is a lover of carbonated drinks and has a history of lumbar muscle strain and lumbar disc herniation. In recent days, he suffered from swelling and pain in his unilateral calf, which was obvious after sitting and standing, but did not relieve obviously after lying in bed. After examination by a doctor, deep venous thrombosis has formed in his lower limbs.

　　Seeing the doctor’s diagnosis, Mr. Liu was puzzled and felt that the thrombus came suddenly. Actually, it is not. He is obese, does little exercise, stays up late, and has an unreasonable diet. These factors will easily lead to an increase in blood viscosity. In addition, he suffers from waist disease, and will stay in bed and take medicine when the pain attacks. Staying in bed for a long time will make the blood flow slow, the muscles will not pump enough blood, and it is easy to form a thrombus. At the same time, although taking medicine relieved waist inflammation, it also concealed other symptoms, thus delaying the opportunity to see a doctor. Therefore, we remind patients with lumbar diseases to pay attention to the phenomenon of edema in limbs.

　　Venous thromboedema is common after surgery, trauma, long-term bed rest and long-term desk workers. The vast majority of venous thrombosis of lower limbs is painful first and then swollen, and the more swollen it is, the more painful it is. The most common harm of this disease to human body is pulmonary embolism caused by blood clots falling off, which leads to death. Some blood clots may also cause cerebral thrombosis, renal thrombosis and intestinal thrombosis. The degree of harm mainly depends on the proportion of blood vessel blockage and the shape of thrombus. After regular anticoagulation and anti-inflammatory treatment, a considerable number of patients’ conditions can be stable, and regular medication can be taken later. For those with serious blood vessel blockage and the risk of thrombus falling off, timely surgery is needed. At present, the implantation of inferior vena cava filter is the main method to prevent fatal pulmonary embolism caused by thrombus shedding in acute stage, and it is a minimally invasive operation by interventional method. If thrombus is ablated after anticoagulant therapy, surgery can be avoided; If the patient has persistent high fever, sepsis, uncontrollable infection and irreversible necrosis of lower limbs, it may be necessary to consider amputation.

　　Generally speaking, there are many reasons for edema of lower limbs, which cannot be enumerated here. For healthy people, we suggest that you do the following three things in your daily life to avoid edema as much as possible. First, exercise moderately, avoid sitting and lying for a long time, and pay attention to moving the lower limbs when flying for a long time; The second is to supplement water properly and eat fruits and vegetables reasonably to avoid blood viscosity; Third, those who suffer from physical injuries due to diseases or various reasons, and need to use anti-inflammatory and anticoagulant drugs for prevention under the guidance of professional doctors, should follow the doctor’s advice and take drugs correctly.

　　(Author: Beijing Longfu Hospital)

Original Xu Chao, I’m Chaoski.

Now that the flu is in an epidemic period, many people around me have confessed. I don’t know what the situation is like there.

According to the monitoring data of the National Influenza Center, the percentage of influenza-like cases in the total number of outpatient and emergency cases in southern and northern provinces increased compared with the previous week, which was also significantly higher than the same period last year.

Further analysis shows that the current wave of influenza viruses in the south and north are mainly influenza A virus H3N2 subtype.

Today, I will talk to you seriously about the related problems of swine flu. I hope you can do a good job of protection and avoid being recruited.

Influenza A (A) virus is a kind of influenza virus. According to the two proteins on the surface of influenza A virus, namely hemagglutinin (HA/H) and neuraminidase (Na/N), it can be divided into different subtypes. Among them, there are 18 H subtypes (H1-H18) and 11 N subtypes (N1-N11).

Three major H subtypes (H1, H2 and H3) and two N subtypes (N1 and N2) have been reported in humans. Influenza A virus subtypes commonly prevalent in humans include influenza A H1N1 and influenza A H3N2. Influenza A is the only influenza virus known to cause a global influenza pandemic.

Seasonal influenza is mainly caused by influenza A (H1N1), H3N2 and influenza B virus infection.

It is mainly transmitted by droplets of respiratory secretions, direct or indirect contact and fine particles. The incubation period after infection is usually 1-3 days.

The typical clinical features after infection are acute onset, high fever, headache, muscle aches, fatigue and mild respiratory symptoms.

Body temperature often reaches its peak in several hours to 24 hours, reaching 39-40℃, even higher or accompanied by cold, and may also be accompanied by respiratory symptoms such as dry cough, stuffy nose and runny nose.

Some patients may be accompanied by conjunctival congestion, retrosternal discomfort and gastrointestinal symptoms such as vomiting, abdominal pain, diarrhea or constipation.

If there are no complications, the course of the disease is mostly self-limited. After 3-4 days, the body temperature will gradually subside and the general symptoms will improve, but it may take 1-2 weeks for cough and fatigue to recover.

If it is severe influenza, the disease progresses rapidly, mainly manifested as pneumonia, acute respiratory distress syndrome, acute kidney injury, septic shock and multiple organ dysfunction syndrome.

Among them, pneumonia is the most common complication of influenza, which can be divided into influenza virus pneumonia, secondary bacterial pneumonia or mixed pneumonia. It usually appears after 2-4 days, or the condition improves briefly after treatment, and symptoms such as fever, cough, cough with thick phlegm, and difficulty breathing reappear.

We used to hear family members in media reports say, "Isn’t it just a cold? When people came, they were fine. How could they die?" Yes, the flu is also possible.

For patients with chronic underlying diseases (such as heart failure, myocardial infarction, stroke, diabetes, chronic obstructive pulmonary disease, asthma, liver and kidney dysfunction), the situation may be more dangerous. Some data show that compared with healthy people of the same age, patients with chronic basic diseases are more seriously ill after being infected with influenza virus, and the risk of death is 11.3 times that of healthy people.

There are two kinds of drugs commonly used in influenza. One is antipyretics, such as ibuprofen and acetaminophen. The other is anti-influenza drugs.

At present, the antiviral treatment of influenza is relatively mature, including neuraminidase inhibitors (such as oseltamivir), hemagglutinin inhibitors (such as Abidor) and RNA polymerase inhibitors (such as mabaloxavir). For emergency patients with non-severe influenza, antiviral treatment should be carried out in time after etiological diagnosis. For emergency patients with severe and critical influenza, antiviral treatment should be started within 48 hours of onset, without waiting for the result of etiological diagnosis.

Most cases of infection with H1N1 are mild. Besides the antipyretic and antiviral treatment mentioned above, symptomatic treatment can also be carried out:

1. If there is an acute cough related to influenza, antihistamines (such as diphenhydramine) and expectorants (such as acetylcysteine and carbomestane) can be added to relieve the cough;

2. If there is acute diarrhea related to influenza, you can use oral rehydration salts, fully rehydrate, supplement intestinal probiotics, and use montmorillonite powder;

3. If there is an acute sore throat related to influenza, you can use some buccal tablets and atomized inhalation. Many people have experienced "blade throat" before, and I believe they should have some experience.

Another point is the flu vaccine. I remind everyone to get the flu vaccine almost every autumn and winter, especially children, the elderly, patients with chronic diseases and other people with high risk of flu, and pay more attention to daily protection.

Generally speaking, after 2-4 weeks of influenza vaccination, the human body will produce antibodies with protective level. Some people may ask, is it too late to get vaccinated now? How to say, as long as you can get the flu vaccine, it is recommended to get it as soon as possible to prevent subsequent infections.

Ok ~ today’s issue is more serious. Thank you for seeing the friends here. I hope everyone can protect themselves and their families and be healthy ~

Reference: The consensus of emergency experts on the diagnosis and treatment of adult influenza (2022 edition)

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