Este documento identifica y describe varios insumos y herramientas utilizados para el mantenimiento preventivo de equipos electrónicos. Identifica un solvente de limpieza a base de alcohol y destilado de petróleo para limpiar equipos eléctricos de forma segura. También describe pasta térmica utilizada para mejorar la disipación de calor, lubricante para lubricar partes metálicas y remover óxido, desengrasante para quitar pinturas y grasa, y polvo de soldadura usado con flux para realizar soldaduras en placas de
This strategic operations leader has over 20 years of experience leading multi-million dollar budgets with over 200 reports. They have consistently delivered strong performance through promotions to higher leadership positions and driving organizational growth. They are a respected change agent known for their integrity, vision, and ability to implement strategic plans to manage growth and maintain a competitive edge through mentoring others and analyzing financial statements to implement cost-effective changes.
The Evolution of Meeting Rooms: 5 Secrets to a Dongle-Free ExistenceReadyTalk
Meeting rooms are constantly evolving. Companies are having to adjust to the competitive pressures and pace of change in the market, while employing new workers with different expectations on how they want to work.
This document provides instructions for students to watch a video clip, answer a question about how editing and cinematography represent gender in the clip, and publish a blog post response by a certain due date. Students are asked to write a 30-minute response analyzing how micro elements like editing represent gender, using terminology from a previous lesson on cinematography. Their self-assessed response should contain three points with evidence and examples, linking editing specifically to gender representation to achieve a higher level response.
Trên thị trường sàn gỗ Việt Nam hiện nay có rất nhiều loại sàn gỗ công nghiệp giá rẻ lót sàn nhà và được sản xuất theo tiêu chuẩn công nghệ Đức và Malaysia với nhiều tiêu chí nhằm phục vụ nhu cầu trang trí nội thất của người tiêu dùng ngày nay.
http://manhtri.vn/san-go-duc-gia-re/31922
Este documento identifica y describe varios insumos y herramientas utilizados para el mantenimiento preventivo de equipos electrónicos. Identifica un solvente de limpieza a base de alcohol y destilado de petróleo para limpiar equipos eléctricos de forma segura. También describe pasta térmica utilizada para mejorar la disipación de calor, lubricante para lubricar partes metálicas y remover óxido, desengrasante para quitar pinturas y grasa, y polvo de soldadura usado con flux para realizar soldaduras en placas de
This strategic operations leader has over 20 years of experience leading multi-million dollar budgets with over 200 reports. They have consistently delivered strong performance through promotions to higher leadership positions and driving organizational growth. They are a respected change agent known for their integrity, vision, and ability to implement strategic plans to manage growth and maintain a competitive edge through mentoring others and analyzing financial statements to implement cost-effective changes.
The Evolution of Meeting Rooms: 5 Secrets to a Dongle-Free ExistenceReadyTalk
Meeting rooms are constantly evolving. Companies are having to adjust to the competitive pressures and pace of change in the market, while employing new workers with different expectations on how they want to work.
This document provides instructions for students to watch a video clip, answer a question about how editing and cinematography represent gender in the clip, and publish a blog post response by a certain due date. Students are asked to write a 30-minute response analyzing how micro elements like editing represent gender, using terminology from a previous lesson on cinematography. Their self-assessed response should contain three points with evidence and examples, linking editing specifically to gender representation to achieve a higher level response.
Trên thị trường sàn gỗ Việt Nam hiện nay có rất nhiều loại sàn gỗ công nghiệp giá rẻ lót sàn nhà và được sản xuất theo tiêu chuẩn công nghệ Đức và Malaysia với nhiều tiêu chí nhằm phục vụ nhu cầu trang trí nội thất của người tiêu dùng ngày nay.
http://manhtri.vn/san-go-duc-gia-re/31922
Crossroads_Gender and Efficacy of ECT for MDDNatasha Bowman
This study examined whether the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder differs between males and females. The researcher reviewed charts of 157 patients who received ECT, including 100 females and 57 males. Statistical analyses found no significant differences between males and females in the number of ECT sessions needed or response to treatment. However, the researcher notes there are many potential confounding variables like age, previous medication failures, comorbidities, and use of maintenance drug therapy after ECT that require further investigation.
EULAR2017 LONG-TERM OUTCOME OF IGURATIMOD, CONVENTIONAL SYNTHETIC DISEASE-MOD...Yuji Hirano
This study investigated the long-term outcomes of iguratimod (IGU), a conventional synthetic DMARD developed in Japan, in 120 Japanese patients with rheumatoid arthritis in a real-world clinical setting. The results showed that IGU was effective for patients who were intolerant of methotrexate dose escalation or biologic DMARDs. While drug continuation rates decreased over time, some patients achieved remission after 2 years on IGU. IGU may provide a cost-effective treatment option for RA patients with financial limitations.
This study investigated the efficacy of iguratimod (IGU) in treating rheumatoid arthritis (RA) patients based on their disease activity at the start of IGU treatment. 78 RA patients taking IGU were divided into two groups based on their DAS28-CRP scores - a high disease activity group (HG) and a moderate/low disease activity group (MLG). Patients in the HG had higher tender joint counts, swollen joints counts, patient and physician global assessments, CRP levels and HAQ scores at baseline compared to the MLG. Over 24 weeks of treatment, both groups saw reductions in disease activity measures, but the HG saw significantly greater improvements in joint counts, assessments and lab markers compared to the
This study investigated the efficacy of iguratimod (IGU) in treating rheumatoid arthritis (RA) patients based on their disease activity at the start of IGU treatment. 78 RA patients were divided into two groups based on their DAS28-CRP scores: a high disease activity group (HG) and a moderate/low disease activity group (MLG). Patients in the HG had significantly higher disease activity scores and worse symptoms at baseline compared to the MLG. While both groups saw improvements in their disease activity scores over 24 weeks of IGU treatment, the HG saw significantly greater decreases in their scores and percentages of improvement compared to the MLG. The results suggest that IGU can be an effective treatment for RA
Crossroads_Gender and Efficacy of ECT for MDDNatasha Bowman
This study examined whether the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder differs between males and females. The researcher reviewed charts of 157 patients who received ECT, including 100 females and 57 males. Statistical analyses found no significant differences between males and females in the number of ECT sessions needed or response to treatment. However, the researcher notes there are many potential confounding variables like age, previous medication failures, comorbidities, and use of maintenance drug therapy after ECT that require further investigation.
EULAR2017 LONG-TERM OUTCOME OF IGURATIMOD, CONVENTIONAL SYNTHETIC DISEASE-MOD...Yuji Hirano
This study investigated the long-term outcomes of iguratimod (IGU), a conventional synthetic DMARD developed in Japan, in 120 Japanese patients with rheumatoid arthritis in a real-world clinical setting. The results showed that IGU was effective for patients who were intolerant of methotrexate dose escalation or biologic DMARDs. While drug continuation rates decreased over time, some patients achieved remission after 2 years on IGU. IGU may provide a cost-effective treatment option for RA patients with financial limitations.
This study investigated the efficacy of iguratimod (IGU) in treating rheumatoid arthritis (RA) patients based on their disease activity at the start of IGU treatment. 78 RA patients taking IGU were divided into two groups based on their DAS28-CRP scores - a high disease activity group (HG) and a moderate/low disease activity group (MLG). Patients in the HG had higher tender joint counts, swollen joints counts, patient and physician global assessments, CRP levels and HAQ scores at baseline compared to the MLG. Over 24 weeks of treatment, both groups saw reductions in disease activity measures, but the HG saw significantly greater improvements in joint counts, assessments and lab markers compared to the
This study investigated the efficacy of iguratimod (IGU) in treating rheumatoid arthritis (RA) patients based on their disease activity at the start of IGU treatment. 78 RA patients were divided into two groups based on their DAS28-CRP scores: a high disease activity group (HG) and a moderate/low disease activity group (MLG). Patients in the HG had significantly higher disease activity scores and worse symptoms at baseline compared to the MLG. While both groups saw improvements in their disease activity scores over 24 weeks of IGU treatment, the HG saw significantly greater decreases in their scores and percentages of improvement compared to the MLG. The results suggest that IGU can be an effective treatment for RA
![高齢者RAの治療
佐鯨 アバタセプトは点滴静注製剤(IV)
発売から既に4年近くを経過し､全例調査
も終了したことで日本の日常診療下におけ
る有効性および安全性が明らかになって
きました｡また､皮下注製剤(SC)も発売
されてもうすぐ1年となります｡そこで今回
は､アバタセプトの本邦での位置付けにつ
いて､ご施設での経験も含めて討議してい
きます｡近年､関節リウマチ(RA)でも患
者の高齢化が進んでおり､安全性にも一層
の配慮が必要となってきていますが､平野
先生には高齢発症のRAに関しての検討
結果を紹介いただきたいと思います｡
平野 当科ではRAの診療レベル向上を
目的として､私が赴任した2009年4月から
RA患者の臨床データを記録しています｡
我々はこのデータベースを基に､ 60歳以上
で発症した高齢発症RA (Elderly-onset
RA: EORA)､ 16-59歳で発症した成人
発症RA (Adult-onset RA: AORA)とで
層別解析を行い､ EORAの特徴について
検討しました｡ 2012年度に当科に通院
していた818例のうち､ 282例(34.5%)が
EORAでした｡ AORAとの患者背景の比
較では､ EORAは男性の比率が高くなって
いました(女性比率: 82.3% vs. 66.7%)0
AORAのほうが雁病期間が長い(16.0
年vs. 7.6年)ことを反映し､病期につい
てはAORAのほうがStageⅢおよびⅣの
比率が高いのですが(75.2% vs. 52.5%) ､
機能障害度は年齢を反映してかEORA
のほうがClass 3および4の比率が高い
(28.0% vs. 43.4%)という結果となってい
ました｡また､EORAは抗CCP抗体陰
性の割合がAORAよりも高く(23.7% vs.
14.5%､ p-0.0016) ､ RFも含めた血清反応
陰性の割合も高くなっていました(19.3%
vs. ll.4%､ p-0.0016)｡合併症について
は､呼吸器合併症や糖尿病はEORAで
多く､これらを反映してか､メトトレキサー
ト(MTX)の投与率や投与例での平均投
与量はEORAで低いという結果でした｡
EORAではMTXの代わりにサラゾスル
フアピリジンが使用され⊂いる患者の割合
が高く､ステロイド投与例の割合と投与量
も高くなっていました｡生物学的製剤の
投与歴のある患者の割合は､ AORAでは
33.2%､ EORAでは24.4%でした｡疾患
活動性については､ DAS28-ESRの寛解
率はEORAよりもAORAのほうが高いも
のの(28.8% vs. 39.2%､ p-0.0042)､低疾
患活動性以下の割合に差はありませんで
した(25.4%+28.8% vs. 39.2%+19.7%､
p-0.2038) 0
さて､ EORAを含め､増加する高齢者の
RAの治療ではどのような病態があり､ど
のような治療が必要とされるのでしょうか｡
オランダのBootsらは､最近の総説の中で
これらの点について解説しています(Boots
AMH, et al. Nat Rev Rheumato1 2013; 9:
604-613.) ｡まず､加齢が免疫系に与える影
響については､ immunosenescence (免疫
老化)と呼ばnる現象が生じることを紹介
しています｡例えば獲得免疫ではNaive
T細胞が徐々に減少する一方でMemory
T細胞が増加し､ T細胞受容体の多様性
が減少していくことなどが知られています｡
このような免疫機能の変化は炎症性疾患
や自己免疫疾患､感染症や悪性腫癌のリ
スクを上げるものと考えらjtていますが､
Bootsらは､高齢者では､合併症や身体の
虚弱性ないし脆弱性(frailty)などのリスク
∴ ~. / L:.I.(,-_∴･十l_- ･ El=.-
佐藤正夫 先生
国子の状況に応じて治療強度を層別化す
る必要性を指摘しています｡これは`go'､
go-slow'. `n0-go'の3つに層別化するも
ので､例えば80歳のRA患者で､ RA以外
の合併症がなく､生活も独立しており､社
会活動にも参加している患者であればgo
approachとして若年者と同様の治療を行
います｡しかし､同じ80歳のRA患者で
あっても､ unsuccessful agingとされるよ
うな合併症や脆弱性を有しており､社会活
動への参加も最小限の場合には､ go-slow
approachとして､ DMARDsや生物学的製
剤の安全性を考慮すること､さらに合併症
の強い場合には､ DMARDsや生物学的
製剤による治療は行わず､痔痛軽減を中心
とした治療を行うn0-go approachにする
というものです｡
さて､アバタセプトについては､全例調査
の結果から､重篤な副作用のリスク因子､
腎障害(ありvs.なし)
肝韓書(ありvs.なし)
呼吸器合併症既往歴(ありvs.なし)
オッズ比l 95%Cl ■ p億
2.055 1.0294103 0.041
1.988 1.115-3.545 l o.020
1.790 17142_表示 To111
投与前リンJ昭数(<1,000/mm3vs･≧1,000/mm3) 1 1･759 聖_212･竺LI O･01
副腎皮質ステロイ憎の併R]･(>5mg′日vs･0または≦5mg/日) 1･627 l 11009-2･623 1 01046
c一ass(3&4vs. 1&2) 1 1･626 1･038-2･547 ; 0･034
･アハタセプト投与中に1回でも副腎皮質ステロイド薬を授与された症例の投与量をプレにゾロン(PSL)換貸して1日土を32出o
アバタセプト全例調査適正使用情報Vol 5
_∴二 : .~ __ ミ･∴_≡- .:I:庁
体重(<40kg vs. ≧40kg)
呼吸器合併症既往歴(ありvs.なし)
オッズ比 95%Cl l p値
3.081 1.309-7.255 : 0･010
2.443 115to-_4.52111~~ 0.004
副腎皮貿ステロイド藁の俳が(>5mg/日vs･0または≦5mg/日) 2･169 ≡ 1･1494･095 0･017
･7,ハタセプト投与中に1回でも副腎皮質ステロイド菜を授与された症例の投与tをプレドニソロン(PSL)換32して1日量を許出o
アバクセプト全例調査適正使用情幸三Vo1 5
-,ー≡ こ【JIL=SF巧ぎょ二∫｣,r_;こ三の｢)"の｢｣別L｢,I-I
堅甲甲______
感染症
重篤副作用
重篤感染症
65歳未満
(∩=2,1 70)
314 (14.5%)
105 (4.8%)
40 (1.8%)
18 (0.8%)
65歳以上
(n=1,712)
294 (17.2%)
123 (7.2%)
58 (3.4%)
22 (1.3%)
p値
l (XZ検定)
0.021
0. 002
0.∝〉2
N.S.
アパタセプト全i;｣i萄査道三.三軍′書き≡Vo1 5
2](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)