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世界の先天性心疾患の専門病院が1985年から作成してきた 専門医向け専門医学データベースです。 真に、小児を救う為には、必須なデータベースです。 また、現在も、世界の専門医が改定版を作成しているものです。 |
日本だけの データベースで 足りますか |
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Pedcath 8 日本版がりリースされました。 ご要請をお待ち申し上げます |
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Pedcath7ソフトウエアのバージョンアップについて 2011年5月現在 平素のご愛顧に謹んで御礼申し上げます。 さて、当該ソフトウエアを、日本国内でご担当させて頂き、10年になります。 その間、Pedcath3から7への移行をお手伝いさせて頂きました。 さて、当該メーカのSSS社へは、過去四回訪問してきておりますが、 本年5月 題記の件でご説明を受けて参りました。 当該会社の方針は下記の通りとのことです ので、ご案内申し上げます。 1、 当バージョンアップは、年間契約の下で行われています。 その年間契約は、 別紙Aの内容で、貴学とメーカとの直接契約となっております。 そして、実施要領はすべて、email を通じて実施されます。 内容により、順番に実施するものもあり、すべてが、最新に即できるわけでは ありません。 2、日本向けの納入実績では、過去いずれも契約をされていない為、 別紙Bの内容については、 現在即にはできかねるとのことです。 従って、もし、ご希望されるならば、 別紙Bのどの部分を希望されるかにより、 個別見積もりになるとのことです。 なお、日本向けは、現在、V。7.4.3のバージョンアップです。 もし、お手元のソフトウエアが当該バージョン以前である場合には、 当該バージョンまでのバージョンアップについても個別お見積もりをするとの ことです。 3、 基本的なバージョンアップは、当該委員会で決定された内容に従って実施されて きており、 そのいきさつもあり、いちがいに、英語版と同じにできると保証はできないとの見解です。 以上、ご要望、ご指摘、ご質問がございましたら、弊社またはメーカ宛お寄せ願います。 |
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動脈硬化指標、ABPM(収縮期、拡張期、平均血圧など) ホルター機能24時間から72時間 アルテリオグラフ24 薬事認可有り、日本特許有り、 中心血圧及び関連パラメータは検証対象です、 |
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Central blood pressure: current evidence and clinical importance Carmel M. McEniery1*, John R. Cockcroft2, Mary J. Roman3, Stanley S. Franklin4, and Ian B.Wilkinson1 1Clinical Pharmacology Unit,
University of Cambridge, Addenbrooke’s Hospital, Box 110, Cambridge CB22QQ, UK;
2Department of Cardiology,Wales Heart Research Institute, Cardiff CF14 4XN, UK; 3Division of Cardiology,Weill Cornell Medical College, New York, NY
10021, USA; and 4University of California, UCI School of Medicine, Irvine, CA
92697-4101, USA Received 29 April 2013;
revised 27 November 2013; accepted 17 December 2013; online
publish-ahead-of-print 23 January 2014 and central pressure. Therefore, basing treatment decisions on
central, rather than brachial pressure, is likely to have important
implications for the future diagnosis and management of hypertension. Such a
paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above
that already provided by brachial artery pressure. Keywords Central pressure †
Blood pressure †
Anti-hypertensive treatment †
Cardiovascular risk Introduction The brachial cuff sphygmomanometer was introduced into medical practice well over 100 years ago, enabling the routine,
non-invasive, measurement of arterial blood pressure. Life insurance companies were among the first to capitalize on the information provided by cuff sphygmomanometry, by observing that blood pressure in largely asymptomatic individuals relates to future cardiovascular risk—observations that are nowsupported by a wealth of
epidemiological data.1 The most recent Global Burden of Disease report2 identified hypertension as the leading cause of death and
disability worldwide. Moreover, data from over 50 years of randomized
controlled trials clearly demonstrate that lowering brachial pressure, in hypertensive individuals, substantially reduces cardiovascular events.1,3 For these reasons, measurement of brachial blood pressure has become embedded in routine clinical assessment throughout the developed world, and is one of the most widely accepted ‘surrogate measures’ for regulatory bodies. The major driving force for the continued use of brachial blood pressure has been its ease of measurement, and the wide variety of devices available for clinical use. However, we have known for
over half a century that brachial pressure is a poor surrogate for
aortic pressure, which is invariably lower than corresponding brachial values. Recent evidence suggests that central pressure is also
more strongly related to future cardiovascular events4 – 7 than brachial pressure, and responds differently to certain drugs.8,9 Appreciating this provides an ideal framework for understanding the much
publicized inferiority of atenolol and some other beta-blockers,10 compared with other drug classes, in the management of essential hypertension. Although central pressure can now be assessed
noninvasively with the same ease as brachial pressure, clinicians are unlikely to discard the brachial cuff sphygmomanometer without robust evidence that cardiovascular risk stratification, and
monitoring response to therapy, are better when based on central rather than peripheral pressure. Central pressure assessment and accuracy will also have to be standardized, as it has been for brachial
pressure assessment with oscillometric devices. This review will discuss
our current understanding about central pressure and the evidence required to bring blood pressure measurement, and cardiovascular risk assessment into the modern era. Physiological concepts Arterial pressure varies continuously over the cardiac cycle, but
in clinical practice only systolic and diastolic pressures are
routinely reported. These are invariably measured in the brachial artery using cuff sphygmomanometry—a practice that has changed little over the last century. However, the shape of the pressure waveform * Corresponding author. Tel: +44 1223 336806, Fax: +44 1223 216893, Email: cmm41@cam.ac.uk Published on behalf of the European Society of Cardiology. All
rights reserved. &The Author 2014. For permissions please email:
journals.permissions@oup.com European Heart Journal (2014) 35, 1719–1725 doi:10.1093/eurheartj/eht565 Pressure measured with a cuff and sphygmomanometer in the brachial
artery is accepted as an important predictor of future cardiovascular
risk.However, systolic pressure varies throughout the arterial tree, such that
aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is
highly variable between individuals. Emerging evidence now suggests that
central pressure is better related to future
cardiovascular events than is brachial pressure. Moreover, anti-hypertensive
drugs can exert differential effects on brachial and
central pressure. Therefore, basing treatment decisions on central, rather than
brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a
paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above
that already provided by brachial artery pressure.As discussed earlier, a full
synthesis of the available evidence concerning central pressure and the risk of future cardiovascular events is now required. However, it will also be necessary
to determine the clinical relevance of differences
between brachial and central pressure for the individual patient, especially given the relatively high
correlation between the
two. Emerging data support the prognostic superiority
of both 24-h ambulatory blood pressure monitoring (ABPM)79 – 81 andhomemonitoring81 in comparison with office measurements. Interestingly, a recent study82 demonstrated that 24-h ambulatory cuff pressures were comparable with
office central pressure measurements in the prediction of risk, although the significance of this study awaits confirmation.83 As yet, there are no data
comparing the
predictive value ofhomemonitoring vs. central pressure in the prediction of risk. Ultimately, it will be necessary to evaluate
the prognostic value of 24-h
ambulatory central pressure.With the recent development of ambulatory central pressure systems,84,85 this is now possible and it may be reasonable to hypothesize that 24-h
central, rather than
brachial ABPM would be superior in terms of risk prediction. |
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