患者平均年齢は、67±９歳、 男性 94％
平均4ヶ月後SGRQ-TS（ St. George’s Respiratory Questionnaire (SGRQ) 総数）に群間差なし (2.3 units, P=0.14)
介入群でのSGRQ-TSの単位以上改善比率は対照より大きく、MCIDを凌駕 (53% versus 39% 、P=0.05)
ドメインスコア比較で、介入群では、対照に比べ 小さく、HRQLの良好さを反映し、、症状で4.6単位、 インパクトで3.3単位良好 (P=0.046 、P=0.049)
2群比較で、Activityスコアは有意差無し
4ヶ月後、対照に比較し、介入群では歩数779歩/日多い
| 血圧目標 | 条件 | エビデンスレベル |
|---|---|---|
| <150> | 80歳超 | IIa/B |
| <140> | CAD | I/A |
| ACS | IIa/C | |
| HF | IIa/B | |
| <130> | CAD | IIb/C |
| 心筋梗塞後 | IIb/C | |
| 卒中/TIA | ||
| 冠動脈疾患 | ||
| PAD,AAA |
The decreased heart rate increases diastolic filling time for coronary perfusion. β -Blockers also inhibit renin release from the juxtaglomerular apparatus.
Cardioselective ( β 1) agents without intrinsic sympathomimetic activity are used most frequently. Relative contraindications to their use include significant sinus or atrioventricular node dysfunction, hypotension, decompensated HF, and severe bronchospastic lung disease.
PAD is rarely made symptomatically worse by the use of these agents, and mild bronchospastic disease is not an absolute contraindication. Caution is needed when brittle diabetic patients with a history of hypoglycemic events are treated because β -blockers may mask the symptoms of hypoglycemia.
Recently, there has been considerable controversy concerning the appropriateness of using β -blockers as first-line therapy in hypertension in those patients who do not have a compelling indication; however, their use in patients with angina, prior MI, or HF has a solid basis of positive data. β -Blockers should be prescribed as initial therapy for the relief of symptoms in patients with stable angina. β -Blockers may be considered as long-term therapy for all other patients with coronary or other vascular disease. Recent ACC Foundation/AHA guidelines 169,170 have recommended β -blocker therapy in patients with normal LV function after MI or ACS (Class I; Level of Evidence B), specifically carvedilol, metoprolol succinate, or bisoprolol, in all patients with LV systolic dysfunction (ejec tion fraction ≤ 40%) or with HF or prior MI unless contrain - dicated (Class I; Level of Evidence A). β -Blockers should be started and continued for 3 years in all patients with normal LV function after MI or ACS (Class I; Level of Evidence B). 168–17
With this test, a sample of the woman's blood is taken after 10 weeks of pregnancy. The test measures the relative amount of free fetal DNA in the mother's blood. The test determines the chance that the fetus has Down syndrome, Edward syndrome or Patau syndrome based on the relative amount of DNA from chromosomes 21, 18 and 13.
http://www.ucsfhealth.org/education/cell-free_fetal_dna_testing/
18,955 名の女性を登録、15,841 名の結果を検討。 平均結婚年齢 30.7歳、平均妊娠期間 12.5週。 トリソミー21のcfDNA検査のAUCは 0.999 、標準検査では 0.958 (P=0.001)。 トリソミー 21 を、cfDNA検査 38/38 検出(100%; 95% 信頼区間[CI], 90.7 〜 100)、対して 標準検査では 30 / 38 (78.9%; 95% CI, 62.7 〜 90.4) (P=0.008)
偽陽性率は cfDNA 検査 0.06% (95% CI, 0.03 〜 0.11) 、標準検査 5.4% (95% CI, 5.1 〜 5.8)
The diagnosis of IgG4-related disease (IgG4-RD) requires biopsy confirmation and should not be based on the simple finding of an elevated serum concentration of the IgG4 antibody, according to an international consensus statement.http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/50768
自己免疫性膵炎とMikulicz病をともにIgG4に関連する疾患と捕らえられたことより、IgG4を中心とした疾患範囲は大きく広がり、涙腺、唾液腺、甲状腺、リンパ節、髄膜、大動脈、肺、心膜、胆管、腎臓、前立腺、皮膚など殆どすべての臓器に生じうる疾患と考えられるようになった。
http://www.med.osaka-u.ac.jp/pub/imed3/lab_2/page4/igg4rd.html
