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Selama rangsangan seksual, Cialis memungkinkan seorang pria, untuk mengisi dengan darah yang cukup untuk menyebabkan ereksi. Setelah seks berakhir, ereksi hilang. Anda akan mendapatkan ereksi dengan hanya mengambil Cialis. Rangsangan seksual diperlukan untuk Cialis menjadi efektif. Dokter Anda atau ahli kesehatan selalu Anda sumber informasi terbaik ketika mengevaluasi pengobatan untuk masalah ereksi.



Hasil tes menunjukkan bahwa dari 700 peserta sekurang-kurangnya 88% dari orang mengalami perbaikan dengan ereksi



CIALIS 50mg( tadalofil) digunakan untuk mengobati dysfuncion ereksi ( Impotensi) Cialis mulai bekerja di 30minutes dan berlangsung selama sekitar 3 jam, sementara efek viagra berlangsung hingga 5 jam,



Fungsi cialis 50mg.



1.membuat penis tegak, meningkatkan kualitas hubungan seksual, membangkitkan kekuatan untuk bersetubuh yang kedua dan mengurangi kelelahan. menghilangkan ejakulasi prematur, mengaktifkan fungsi ginjal dan meningkatkan sekresi sel testis.



2.mengandung banyak faktor kekuatan yang dibutuhkan oleh laki-laki, administrasi jangka panjang dapat meningkatkan semangat, prostat dan penyakit lain yang serupa, dan dosis penggunaan: ambil satu pil 10-30 menit sebelum hubungan seksual.



CIALIS 50mg tadalafil



Obat kuat seks dalam bentuk tablet yang bagus untuk meningkatkan vitalitas pria dewasa tua maupun yang muda. di minum 1 jam sebelum main. dijamin joss dan perkasa. banyakanya produk cialis yang ada dipasaran ini merupakan yang paling bagus dan paling manjur khasiatnya, obat kuat seks dalam bentuk tablet siap minum, obat kuat seks cialis merupakan hasil formula ramuan yang sudah teruji dan terbukti secara klinis mampu meningkatkan daya tahan seks dan vitalitas pria dewasa dalam berhubungan seksual. setelah anda minum dalam waktu 15 menit saja sudah bereaksi, anda akan tahan ereksi, tahan lama dalam bersenggama selama satu jam lebih.



Produk obat kuat seks cialis ini merupakan obat kuat yang sudah melewati uji kualitas, jadi anda tidak perlu kuatir dengan efek samping yang diberikan, obat kuat seks cialis ini aman digunakan tapa efek samping ke jantung, ginjal, maupun organ lainnya. dengan dosis yang cukup tepat per tablet ramuannya, sehingga mempercepat reaksi setelah anda minum. walaupun dosisnya tinggi namun tetap aman untuk jantung anda.



Produk kuat seks tahan lama cialis ini sangat terbatas ketersediaanya jadi bila anda ingin segera pesan silahkan kontak kami akan segera di siapkan. hanya di kami produk-produk terbaik dan di jamin paling murah silahkan anda bandingkan dengan yang lain. produk yang kami display di atas adalah asli dan original yang juga akan kami kirimkan pada anda.



ATURAN PAKAI



1 tablet di minum, 30menit sebelum berhubungan.



Negara Asal : Inggris



Harga : 1 botol isi 10 tablet

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Sildenafil May Help In Liver Cirrhosis
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Liver cirrhosis patients who modernize this corollary be not eligible to put aware with liver transplantation. Although at hand be no matured use all for this complication of liver cirrhosis hence far, treatment for other form of pulmonary hypertension personal be industrialized.



Frank Reichenberger (University Giessen Lung Centre, Germany) and his troop contained by vehicle of Austria and Germany studied the effect of sildenafil (Revatio', Viagra') in a trifling solidify of patients alongside liver cirrhosis and pulmonary hypertension.



They could festival that sildenafil psychiatric therapy done one year could improve symptom, apply bulkiness and pulmonary blood peril. Furthermore, there be no report together fractious effects to the treatment.



The playwright conclude that patients with liver cirrhosis should be habitually tested for encouragement of pulmonary hypertension, by means of treatment with sildenafil here condition is helpful and safe and jangle.



The European Respiratory Journal is the peer-reviewed experimental publication of the European Respiratory Society (more than 8,000 specialist in lung disease and respiratory tablets in Europe, the United States and Australia)




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Controlled trial of sildenafil in advanced Idiopathic pulmonary fibrosis
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抄録会から。

Controlled trial of purchase cialis in advanced Idiopathic pulmonary fibrosis
NEJM2010;363:620-8


背 景
シルデナフィルは,ホスホジエステラーゼ 5を阻害することにより、NOを産生し、血管を拡張させる。シルデナフィルは特に換気良好な肺の血管を拡張し、換気血流不均等を改善する。
 シルデナフィル投与により進行性特発性肺線維症患者の歩行距離,呼吸困難,QOL が改善されるという仮説を検証した.
進行性特発性肺線維症の定義は,一酸化炭素拡散能が予測値の 35%未満であることとした.

方 法
シルデナフィルの二重盲検無作為化プラセボ対照試験を実施した.
期間は2期間に分けられた。
第 1 期は 12 週間の二重盲検試験で,患者をシルデナフィル群とプラセボ群に割り付けて比較した.
Primary endpointは 6 分間歩行距離が 20%以上延長した患者の割合とした.
Secondary endpointは,動脈血酸素化,呼吸困難の程度,QOL の変化などとした.
第 2 期は 12 週間の非盲検試験で,全例にシルデナフィルを投与し,評価を行った.

結 果
2007年から2009年まで 180 例を試験に登録した.
89人がシルデナフィル群で、プラセボ群は91人であった。
Primary endpointである、6 分間歩行距離が 20%以上改善したのは,シルデナフィル群 89 例中 9 例(10%),プラセボ群 91 例中 6 例(7%)であり、有意差は認めなかった。(P=0.39).
Secondary endpointである動脈血酸素化,一酸化炭素拡散能,呼吸困難の程度,QOL には小さいが有意な差が認められ,シルデナフィル群のほうが良好な結果を示した.
第2期では特に差は認めなかった。
12週死亡率と急性増悪に差はなかった。
重篤な有害事象も両群では同等であった。

考 察
Primaryでは優位差を認めなかったが、呼吸困難とQOLで小さな差を認めたことは臨床的には重要と考える
また、シルデナフィル群のほうがPaO2とDLCOが良好で、これは以前のデーターで認められるような、IPF患者における換気血流不均等の改善効果によるものと考えられた。

結 論
この試験では,主要転帰に関してシルデナフィルの有益性は示されなかった.一部の副次的転帰では良好な結果が得られたことから,さらなる研究が必要とされる.


抄読会での議論。

肺高血圧の評価は行っているのか→このスタディでは記載がない、心エコーはASルールアウト目的で行っている
期間が12週と短いのはなぜか?
→比較的短期間の効果を期待したからでは?
NEJMに記載されたのは→180人の二重盲検試験のためか??
シルデナフィルが繊維化を抑制するという主張ではなく、換気血流不均等の改善という観点で述べられている。→ピレスパとの違い

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