DTx(デジタル療法)設計・開発・申請における留意点

【製薬企業がクスリを売らなくなる日】
2018年、日経デジタルヘルスの連載で、アーサー・ディ・リトル・ジャパン社の増井 慶太氏が「製薬企業がクスリを売らなくなる日 ~Beyond the Pill~」というタイトルで記事を投稿している。
医薬品を取り巻く昨今の外部環境や企業内部の状況の変化から、製薬産業において大きなパラダイムシフトが起きているのだ。
“Beyond the Pills”(医薬品を越えて)の掛け声のもと、製薬企業が医薬品の創出・販売を越えた新たな事業モデルの構築や技術領域への投資を進めているという。
従前のように10数年、数百億円以上をかけて新薬を開発し、特許が切れる前にまた新薬を開発するといったビジネスモデルは、もはや成り立たなくなりつつある。これまでのやり方に固執している製薬企業は淘汰されかねないのである。
製薬業界では、競争の激化に加えて、医療財政悪化に伴う薬価の切り下げ、創薬ターゲット(タネ)の枯渇、収益性の悪化などにより、経営戦略を方針変換せざるを得ないのである。

【DTx(デジタル療法)】
近年、ソフトウェアが単体で医療機器として機能する「プログラム医療機器」(SaMD:Software as a Medical Device)が注目を集めている。いわゆるDTx(Digital Therapeutics:デジタル療法)としても知られている。
医療機器企業のみではなく、医薬品企業においてもDTxの分野に進出する動きがある。 DTxではスマートフォンのアプリなどを使用して、高血圧、糖尿病、精神神経疾患、不眠症、禁煙などへの治療介入に活用する。
2010年には、米国のWellDoc社が「Bluestar」という2型糖尿病患者向けの治療補助アプリで米国のFDAの認証を得た。
さらには人工知能(AI:artificial intelligence)や機械学習(ML:machine learning)が搭載されたプログラム医療機器の開発も進められている。
AI/MLを搭載したプログラム医療機器は、ユーザや患者が継続的に使用する間、データを収集・分析し、その結果をアップデートして機能に反映するというものである。
米国では、過去にSaMDの定義やクラス分類に関して二転三転した経緯がある。しかしながら、現在では積極的に産業界を支援し、早期に承認する制度(規制緩和)や体制を整えつつある。
FDAは2017年7 月に“Digital Health Innovation Action Plan” を発表し、世界に先駆けて新しい医療分野であるデジタルヘルスに対して積極的にコミットしていくことを表明した。
それに比べ、日本のプログラム医療機器に関する審査体制の確立や、規制要件の発出はかなり遅れていると言わざるを得ない。

【プログラム医療機器に関する規制】
DTxの研究開発においては、多額の資金調達や、臨床試験(治験)における有効性の証明など課題が多い。
加えて、プログラム医療機器は、医療機器承認(または認証)、販売、安全性監視などに関して規制がかかっている。
まず、プログラム医療機器を設計(ソフトウェアには製造工程はない)するためには、医療機器製造業の登録が必要だ。
また自社ブランドで国内市場に流通させるためには、医療機器製造販売業許可を受ける必要がある。医療機器製造販売業許可を受けるためには、体制省令やGVP省令に沿った人材要件を満たし、組織を構築し、手順書等を整備しておかなければならない。
さらにプログラム医療機器を販売(インターネット経由、メディア)する場合には販売業の許可または登録が必要である。
国内における医療機器ソフトウェアの承認(認証)申請においては、当該ソフトウェアがIEC-62304(JIS T 2304)に沿って設計・開発が実施されたことを証明しなければならない。
多くの場合、規制要件や国際規格を遵守した設計・開発が実施されておらず、仕様書等が適切に文書化されていないケースが多い。仕様書よりも先にプログラムが作成されている事案にしばしば遭遇する。
設計・開発と医療機器承認(認証)申請は、密接に関連している。医療機器ソフトウェアの設計・開発においては、申請書を作成することを前提に文書化を進める必要がある。
また、医療機器ソフトウェアが承認(認証)されるためには、その有効性と安全性が証明されなければならない。
医療機器には何らかのリスクが存在する。それらのリスクを回避するためには、ISO-14971などに沿ったリスクマネジメントが必要だ。 医療機器ソフトウェアに参入する多くの企業(スタートアップ、製薬企業など)は、有効性を追求することがもっぱらで、安全性に関しては疎いことが多い。

【MRJの失敗に学ぶ】
MRJ(三菱リージョナルジェット)は、2008年に事業化され、半世紀ぶりの国産旅客機の製造に挑戦したが、5回もの納入延期に追い込まれた。
当初、2013年に1号機をANAへ引き渡し予定であったが、未だに納入されていない。しかも、開発経費は当初の1500億円から4000億~5000億円へと膨れ上がってしまった。
現在では、生産拠点を日本から米国へ移し、名称もMRJからスペースジェットと変更された。(名称から三菱の名前が消えた。)
筆者は失敗の原因は、以下のとおりであると考えている。
1.旅客機開発の経験・ノウハウの乏しさ 旅客機部品の製造経験はあるものの、完成品の製造経験がなかった。 初期設計段階で必要な事項を十分検討、設計に反映できていなかった。
2.規制要件に関する知見の不足 規制当局からの「型式証明」を得るために必要な試験に関する開発陣の知見不足により、設計プロセスが振出しに戻った。 国交省による規制について、具体的に何をどうすればクリアできるのかをきちんと認識できていなかった。
3.人材不足 上記を回避するための経験・ノウハウ・知見・知識を有する人材が不足していた。
医療機器開発(プログラム医療機器を含む)においても同様のことが言える。経営者は新規ビジネスとして安易に医療機器に進出しようとする。
しかしながら、民生用の製品しか設計・製造した経験がない企業や、規制要件を理解していない企業が医療機器を開発した場合、そう容易いことではない。
ユーザ/患者の意図した利用に対して、適切に設計されていなければならない。
医療機器の事故は、ユーザの意図した利用と設計者の設計思想のギャップによって起きると言われている。
有効で安全な医療機器を設計開発するために、ISO、IECなどの国際規格や規制要件が存在する。 いわば、国際規格や規制要件は医療機器製品の品質を担保し、安全性を確保するためのベストプラクティスである。
それらを無視した設計開発では、承認が得られなかったり、査察で指摘を受けたり、市場で事故を起こしかねない。

お役立ち動画

関連商品

[blogcard url=”https://ecompliance.co.jp/SHOP/L_MDSW.html” title=”医療機器ソフトウェア規制(IEC-62304)への具体的な対応方法” content=”本邦において、2017年11月より、IEC 62304(医療機器ソフトウェア ‐ ソフトウェアライフサイクルプロセス)が実質的な規制要件となりました。
IEC 62304は、2006年5月に発行され、日本では2012年にJIS化(JIS T 2304)されました。2014年11月に施行された医薬品医療機器法第12条第2項において参照される「最新のライフサイクルモデル」です。
米国FDAにおいても2008年7月にRecognized Consensus Standardと認定されています。

IEC 62304は「医療機器ソフトウェア」の開発と保守に関するプロセスを規定しています。
日本以外でも欧州・北米・中国などにおいて医療機器申請時にIEC 62304に基づくソフトウェア開発の証拠が必要です。
つまりIEC 62304に従って「医療機器ソフトウェア」を開発しなければ、国内外においてソフトウェアを搭載した医療機器(単体プログラムを含む)を販売することができません。

しかしながら、IEC 62304は非常に難解です。具体的にどのような対応をとればよいのでしょうか。一般にプロセス規格は各社によってまちまちの解釈が行われ、手順書の内容が大きく異なってしまいます。
・IEC 62304を読んでも対応すべき内容や方法が分からない。
・IEC 62304を読んでもどこまでやるべきなのかの範囲が分からない。
・IEC 62304の詳細の内容が不明なまま文書構築を行っている。
などといった疑問点が多く寄せられます。

本セミナーでは、難解なIEC 62304を分かりやすく解説します。
またIEC 62304に準拠したSOPを配布し、皆様の企業内における手順書作成をご支援いたします。

【特典】
IEC 62304対応SOPのサンプルを電子ファイル(MS-Word)で配布します。

【対象者】
医療機器ソフトウェア設計者
医療機器ソフトウェア業界へ新規参入する企業担当者
医療機器製造業者へソフトウェアを供給するサプライヤ
認証機関担当者”]

[blogcard url=”https://ecompliance.co.jp/SHOP/O016.html” title=”DTx(デジタル医療)の最新の技術動向と知財戦略の新たな視点” content=”近年、デジタル・ネットワーク技術と医療技術との融合・連携による「デジタル医療」が注目されており、画期的な技術が次々に生まれています。第四次医療革命「Medicine 4.0」が進展する中、例えば、飲めるセンサーを内蔵した医薬品が開発され、手術空間をサイバー化した「スマート治療室」などが開発されています。また、アプリで病気の治療を支援する「治療用アプリ」も積極的に開発されています。人工知能を利用したAI創薬も急速に進展しています。
 このような新たな技術の開発に伴い、現在、特許出願も顕著に増加する傾向にあります。特許出願は、研究成果に基づいて利益を得るために必要不可欠であり、そのための特許戦略は、企業の将来性を左右する重要な課題です。とくに、広くて強い特許を取得することが重要であり、その結果、研究成果を事業活動に最大限に活かすことができます。
 本講演では、このような観点から、「デジタル医療」に関する最新の技術動向と特許戦略の新たな視点について説明し、今後の課題と対応策について解説します。”]

[blogcard url=”https://ecompliance.co.jp/SHOP/EL-010.html” title=”【セミナービデオ】医療機器ソフトウェア規制(IEC-62304)への具体的な対応方法セミナー” content=”本邦において、2017年11月より、IEC 62304(医療機器ソフトウェア ‐ ソフトウェアライフサイクルプロセス)が実質的な規制要件となりました。
IEC 62304は、2006年5月に発行され、日本では2012年にJIS化(JIS T 2304)されました。2014年11月に施行された医薬品医療機器法第12条第2項において参照される「最新のライフサイクルモデル」です。
米国FDAにおいても2008年7月にRecognized Consensus Standardと認定されています。

IEC 62304は「医療機器ソフトウェア」の開発と保守に関するプロセスを規定しています。
日本以外でも欧州・北米・中国などにおいて医療機器申請時にIEC 62304に基づくソフトウェア開発の証拠が必要です。
つまりIEC 62304に従って「医療機器ソフトウェア」を開発しなければ、国内外においてソフトウェアを搭載した医療機器(単体プログラムを含む)を販売することができません。

しかしながら、IEC 62304は非常に難解です。具体的にどのような対応をとればよいのでしょうか。一般にプロセス規格は各社によってまちまちの解釈が行われ、手順書の内容が大きく異なってしまいます。
・IEC 62304を読んでも対応すべき内容や方法が分からない。
・IEC 62304を読んでもどこまでやるべきなのかの範囲が分からない。
・IEC 62304の詳細の内容が不明なまま文書構築を行っている。
などといった疑問点が多く寄せられます。

本セミナーでは、難解なIEC 62304を分かりやすく解説します。
またIEC 62304に準拠したSOPを配布し、皆様の企業内における手順書作成をご支援いたします。

【特典】
IEC 62304対応SOPのサンプルを電子ファイル(MS-Word)で配布します。

【対象者】
医療機器ソフトウェア設計者
医療機器ソフトウェア業界へ新規参入する企業担当者
医療機器製造業者へソフトウェアを供給するサプライヤ
認証機関担当者”]

[blogcard url=”https://ecompliance.co.jp/SHOP/MD-QMS-149.html” title=”【IEC-62304対応】ソフトウェア開発規程・手順書ひな形” content=”本邦において、2017年11月より、IEC 62304(医療機器ソフトウェア ‐ ソフトウェアライフサイクルプロセス)が、実質的な規制要件となりました。
IEC 62304は、2006年5月に発行され、日本では2012年にJIS化(JIS T 2304)されました。
2014年11月に施行された医薬品医療機器法第12条第2項において参照される「最新のライフサイクルモデル」です。
米国FDAにおいても、2008年7月にRecognized Consensus Standardと認定されています。

IEC 62304は「医療機器ソフトウェア」の開発と保守に関するプロセスを規定しています。
日本以外でも、欧州・北米・中国などにおいて、医療機器申請時にIEC 62304に基づくソフトウェア開発の証拠が必要です。
つまり、IEC 62304に従って、「医療機器ソフトウェア」を開発しなければ、国内外においてソフトウェアを搭載した
医療機器(単体プログラムを含む)を販売することができません。 しかしながら、 IEC 62304は非常に難解です。具体的に、どのような対応をとればよいのでしょうか。

一般にIEC 62304のようなプロセス規格は各社によってまちまちの解釈が行われ、手順書の
内容が大きく異なってしまいます。
・IEC 62304を読んでも、対応すべき内容や方法が分からない。
・IEC 62304を読んでも、どこまでやるべきなのかの範囲が分からない。
・IEC 62304の詳細の内容が、不明なまま文書構築を行っている。
などといった疑問点が多く寄せられます。

本「IEC 62304対応規程・手順書ひな形」を導入いただくことによってIEC 62304に準拠したQMSを効率的・効果的に作成することができます。”]

[blogcard url=https://xn--2lwu4a.jp/qms-md/ title=”QMS(手順書)ひな形 医療機器関連” ]


Related post

Comment

  1. Today, while I was at work, my cousin stole my iphone and tested to see if it can survive a 40 foot drop, just so she can be a youtube sensation. My apple ipad is now
    destroyed and she has 83 views. I know this is completely
    off topic but I had to share it with someone!

  2. Wonderful blog! I found it while searching on Yahoo News.
    Do you have any suggestions on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get there!
    Thank you

    Also visit my site – where to buy boostaro

  3. Hi! Do you know if they make any plugins to assist with Search Engine
    Optimization? I’m trying to get my website to
    rank for some targeted keywords but I’m not seeing very good results.
    If you know of any please share. Cheers! I saw similar blog here:
    Eco bij

  4. Land cruisers will offer you full luxury and safety.

  5. sugar defender ingredients For several years,
    I’ve fought uncertain blood glucose swings that left me feeling drained and sluggish.
    However given that integrating Sugar Defender into my routine,
    I have actually noticed a considerable renovation in my overall energy and security.

    The feared mid-day distant memory, and I appreciate that
    this natural treatment accomplishes these outcomes without any unpleasant or negative reactions.
    honestly been a transformative discovery for me.

  6. A fascinating discussion is definitely worth comment. I think that you should publish more about this issue, it may not be a taboo subject but generally people don’t talk about these topics. To the next! Best wishes.

  7. Spot on with this write-up, I really think this amazing site needs much more attention. I’ll probably be returning to read more, thanks for the info!

  8. Howdy! I could have sworn I’ve been to your blog before but after browsing through a few of the articles I realized it’s new to me. Regardless, I’m definitely pleased I discovered it and I’ll be bookmarking it and checking back regularly.

  9. Pretty! This was an extremely wonderful article. Many thanks for supplying this information.

  10. This is a topic that’s close to my heart… Take care! Exactly where can I find the contact details for questions?

  11. However earlier than you plan for your first-time expertise on a cruise line, ensure that you’ve got assembled all the things.

  12. Aw, this was an incredibly nice post. Taking the time and actual effort to generate a really good article… but what can I say… I hesitate a lot and never seem to get anything done.

  13. In towns that couldn’t afford to feed prisoners, the prisoners have been put to work to feed themselves.

  14. Anand gained some benefit in the middlegame when Carlsen needed to retreat his queen to h1 and grew to become quick on time.

  15. You could require in-flight extras, car hire, particular services at the convention, enterprise dinners or specific accommodation requirements it will possibly all be arranged to suit your needs.

  16. Oh my goodness! Impressive article dude! Thank you, However I am encountering troubles with your RSS. I don’t know why I can’t join it. Is there anyone else having the same RSS issues? Anyone who knows the answer will you kindly respond? Thanks!

  17. You need to take part in a contest for one of the most useful websites on the web. I am going to recommend this web site!

  18. I would like to thank you for the efforts you’ve put in penning this website. I really hope to check out the same high-grade content from you in the future as well. In truth, your creative writing abilities has encouraged me to get my very own blog now 😉

  19. May I simply just say what a relief to uncover someone that genuinely knows what they are discussing online. You definitely understand how to bring a problem to light and make it important. More and more people ought to look at this and understand this side of the story. I can’t believe you aren’t more popular since you most certainly have the gift.

  20. This is a very good tip particularly to those new to the blogosphere. Brief but very accurate info… Appreciate your sharing this one. A must read article.

  21. Spot on with this write-up, I seriously think this amazing site needs far more attention. I’ll probably be returning to read more, thanks for the advice.

  22. I couldn’t resist commenting. Well written!

  23. I absolutely love your site.. Very nice colors & theme. Did you make this website yourself? Please reply back as I’m planning to create my own website and would love to learn where you got this from or exactly what the theme is named. Thank you!

  24. I’m amazed, I must say. Rarely do I encounter a blog that’s equally educative and entertaining, and let me tell you, you have hit the nail on the head. The problem is something not enough people are speaking intelligently about. I am very happy that I found this in my hunt for something regarding this.

  25. I could not refrain from commenting. Perfectly written.

  26. After going over a handful of the articles on your blog, I really appreciate your way of blogging. I book marked it to my bookmark website list and will be checking back soon. Please visit my web site as well and tell me your opinion.

  27. Everything is very open with a precise explanation of the challenges. It was truly informative. Your website is extremely helpful. Thank you for sharing.

  28. Hi there! This blog post couldn’t be written any better! Looking through this article reminds me of my previous roommate! He constantly kept talking about this. I most certainly will send this article to him. Fairly certain he’ll have a good read. Many thanks for sharing!

  29. All of our recreation systems had been implemented (not hacked) as initially documented.

  30. Your style is very unique in comparison to other folks I’ve read stuff from. Thank you for posting when you’ve got the opportunity, Guess I’ll just book mark this blog.

  31. Northern Lebanon High school teacher, created Little one Improvement Playgroup.

  32. bookmarked!!, I really like your web site!

  33. Aw, this was an exceptionally good post. Spending some time and actual effort to generate a really good article… but what can I say… I put things off a lot and don’t seem to get anything done.

  34. For checklist that include caps, clean indicates performed in the match but did not rating a objective.

  35. Oh my goodness! Incredible article dude! Thank you so much, However I am experiencing problems with your RSS. I don’t know the reason why I am unable to subscribe to it. Is there anyone else having the same RSS issues? Anyone who knows the answer can you kindly respond? Thanks!

  36. Kathryn Hooker of Houston, Tex.

  37. Your style is really unique in comparison to other folks I’ve read stuff from. Thank you for posting when you have the opportunity, Guess I will just book mark this page.

  38. This is a great tip especially to those new to the blogosphere. Short but very accurate information… Many thanks for sharing this one. A must read post.

  39. The work was covered in John Harries ebook, Discovering Stained Glass, which highlighted how she painted the lettering and her detailed figures.

  40. I really love your blog.. Excellent colors & theme. Did you make this website yourself? Please reply back as I’m hoping to create my own personal site and would like to learn where you got this from or exactly what the theme is called. Thanks.

  41. Nice post. I learn something totally new and challenging on websites I stumbleupon every day. It’s always interesting to read through articles from other writers and practice something from other sites.

  42. Beginning with Operation Catapult on 3 July 1940, the British pre-emptively seized French vessels.

  43. I absolutely love your site.. Excellent colors & theme. Did you make this website yourself? Please reply back as I’m attempting to create my own blog and would love to learn where you got this from or just what the theme is called. Appreciate it.

  44. Darth Caldoth – Duros Darkish Lord of the Sith mentioned in the 2019 novel Myths & Fables.

  45. Spot on with this write-up, I seriously think this site needs a great deal more attention. I’ll probably be returning to read through more, thanks for the info.

  46. Pretty! This was a really wonderful article. Thanks for providing this information.

  47. I am so happy to read this. This is the kind of manual that needs to be given and not the random misinformation that’s at the other blogs. Appreciate your sharing this greatest doc.

  48. Way cool! Some very valid points! I appreciate you writing this article plus the rest of the website is really good.

  49. Very nice blog post. I absolutely appreciate this website. Continue the good work!

  50. I just couldn’t go away your website before suggesting that I extremely enjoyed the standard information an individual provide on your visitors? Is going to be back steadily to check up on new posts [Reply]

  51. I’m new to your blog and i really appreciate the nice posts and great layout..-”\”‘

  52. Hello there! I simply want to give you a big thumbs up for your excellent information you’ve got right here on this post. I will be coming back to your web site for more soon.

  53. Excellent post. I will be dealing with many of these issues as well..

  54. I like the valuable info you provide in your articles. I’ll bookmark your blog and check again here regularly. I am quite sure I’ll learn many new stuff right here! Best of luck for the next!

  55. There is certainly a lot to find out about this subject. I like all the points you’ve made.

  56. Nice post. I learn something totally new and challenging on blogs I stumbleupon every day. It will always be interesting to read through articles from other authors and use a little something from other websites.

  57. this december, fruit cakes are becoming more common in our local supermarket. i love fruit cakes,.

  58. i do paid online surverys and also monetize my blogs, both are good sources of passive income*

  59. i like Californication because of the pretty girls and the nice music that it imparts on the show..

  60. I’m amazed, I have to admit. Seldom do I encounter a blog that’s both equally educative and entertaining, and without a doubt, you have hit the nail on the head. The problem is something which not enough people are speaking intelligently about. I’m very happy that I found this during my search for something concerning this.

  61. I conceive you have noted some very interesting details , regards for the post.

  62. I have been exploring for a bit for any high quality articles or blog posts in this kind of space . Exploring in Yahoo I ultimately stumbled upon this web site. Studying this information So i am glad to show that I have a very excellent uncanny feeling I discovered just what I needed. I such a lot unquestionably will make sure to do not disregard this website and give it a look regularly.

  63. Hi there, have you ever previously asked yourself to create about Nintendo DSi?

  64. I like this site so much, bookmarked .

  65. Oh my goodness! Incredible article dude! Thank you, However I am going through issues with your RSS. I don’t know the reason why I am unable to subscribe to it. Is there anybody getting identical RSS issues? Anyone who knows the answer will you kindly respond? Thanx.

  66. Great post, thanks for the awesome blog post. I’m having troubles subscribing to your blogs feed. Thought I’d let you know

  67. I’m not that much of a online reader to be honest but your blogs really nice, keep it up! I’ll go ahead and bookmark your site to come back later. Cheers

  68. Judging by the way you write, you seem like a professional writer.*;”`-

  69. You should be a part of a contest for one of the highest quality sites on the internet. I am going to recommend this site!

  70. I am commenting to make you understand what a great encounter our girl encountered checking your site. She learned a wide variety of details, most notably what it is like to have a wonderful giving nature to have other folks clearly learn chosen extremely tough matters. You actually did more than readers’ desires. Many thanks for displaying such precious, trusted, revealing and as well as fun guidance on the topic to Emily.

  71. you are actually a just right webmaster. The web site loading velocity is incredible. It sort of feels that you are doing any unique trick. In addition, The contents are masterwork. you have done a magnificent job on this topic!

  72. When I originally left a comment I appear to have clicked on the -Notify me when new comments are added- checkbox and now every time a comment is added I receive 4 emails with the same comment. Is there an easy method you can remove me from that service? Cheers.

  73. An impressive share! I’ve just forwarded this onto a colleague who was doing a little research on this. And he actually ordered me dinner simply because I stumbled upon it for him… lol. So allow me to reword this…. Thanks for the meal!! But yeah, thanks for spending some time to talk about this subject here on your blog.

  74. I’m wondering if you have noticed how the media has changed? What once seemed like a never discussed issue has become more prevelant. It’s that time to chagnge our stance on this though.

  75. I really glad to find this internet site on bing, just what I was searching for : D besides saved to my bookmarks .

  76. You should take part in a contest for just one of the finest blogs online. I’ll recommend this website!

  77. Good post! We will be linking to this great content on our site. Keep up the great writing.

  78. you’ve a fantastic blog right here! would you wish to make some invite posts on my blog?

  79. Thanks for sharing this information. I found this information very useful. That’s a good blog post. I will return to read more posts.

  80. Hello there! I could have sworn I’ve been to this blog before but after reading through some of the post I realized it’s new to me. Anyhow, I’m definitely happy I found it and I’ll be book-marking and checking back frequently!

  81. There are some attention-grabbing deadlines in this article but I don’t know if I see all of them middle to heart. There is some validity but I will take hold opinion until I look into it further. Good article , thanks and we wish more! Added to FeedBurner as properly

  82. Pretty nice post. I just stumbled upon your weblog and wanted to say that I have really enjoyed browsing your blog posts. After all I’ll be subscribing to your feed and I hope you write again soon!

  83. I believe one of your advertisements caused my web browser to resize, you might want to put that on your blacklist.

  84. Great post, are you looking for real estate in Casselberry, FL? Learn where the deals are, get REO lists and find town homes for sale in Oviedo.

  85. This is ridiculous! I have gone on this site several times, trying to put the codes in, but whoever made this game is making sure no one wins.

  86. Hi. Cool article. I think other website proprietors should take this website as a model – very clean and magnificent style, in addition to the content. LaterCheers.

  87. I would like to thank you for the efforts you’ve put in penning this website. I really hope to see the same high-grade blog posts by you later on as well. In fact, your creative writing abilities has motivated me to get my very own blog now 😉

  88. Jack is a Past Chair of the Motor Autos and Premises Legal responsibility Section of AAJ, the Admiralty Section of AAJ, and the Admiralty Committee of The Florida Bar.

  89. There is another good motive for getting Indian jewellery online and that’s a big price profit.

  90. In 2011, John made a documentary film about his father’s life and work, From Coventry to Cochem, the Artwork of Patrick Reyntiens.

  91. This is a topic that is close to my heart… Best wishes! Where can I find the contact details for questions?

  92. I discovered your blog web site on the internet and appearance many of your early posts. Always maintain in the really good operate. I simply additional the Feed to my MSN News Reader. Looking for toward reading a lot more of your stuff at a later time!…

  93. I really like your writing style, superb information, appreciate it for putting up : D.

  94. I’m so happy to read this. This is the kind of manual that needs to be given and not the random misinformation that’s at the other blogs. Appreciate your sharing this best doc.

  95. Howdy! I simply want to offer you a huge thumbs up for your great info you have got right here on this post. I will be returning to your web site for more soon.

  96. You will find on our sites unique no deposit bonuses,no deposit casino , no deposit poker , no deposit bingo , no deposit forex and all the top deposit bonuses

  97. This is a great website, might you be involved in doing an interview about how you designed it? If so e-mail me!

  98. Very interesting details you have mentioned , thankyou for posting .

  99. The subtle (but hilarious) underlying lament of these characters is they all reminisce over their past lives as hardened assassins and pine just to kill one more little ol’ person.

  100. Find out these pointers read on and learn to know how to submit an application doing this that you policy your corporation today. alertpay

  101. Attractive section of content. I just stumbled upon your web site and in accession capital to assert that I acquire in fact enjoyed account your blog posts. Anyway I’ll be subscribing to your augment and even I achievement you access consistently rapidly.

  102. Tamilians have a particular nook for silk garments, and so their wedding ceremony outfits are designed accordingly.

  103. Oh my goodness! Impressive article dude! Thank you so much, However I am experiencing problems with your RSS. I don’t understand why I am unable to subscribe to it. Is there anybody having similar RSS issues? Anyone that knows the solution can you kindly respond? Thanks.

  104. I real glad to locate this great site on bing, just the thing I used to be seeking : D also saved to bookmarks .

  105. Hello there! This article could not be written much better! Looking at this article reminds me of my previous roommate! He constantly kept preaching about this. I will send this article to him. Pretty sure he will have a very good read. Thanks for sharing!

  106. I was able to find good information from your blog posts.

  107. Prior to becoming a member of Labbaik Hajj Umrah, I labored in strategic enterprise development and marketing at a number of companies.

  108. Aw, this was an incredibly good post. Taking the time and actual effort to create a really good article… but what can I say… I put things off a whole lot and don’t manage to get nearly anything done.

  109. I think it made me more aware of the world and what was occurring round me.

  110. Aw, this was a very nice post. Taking the time and actual effort to create a very good article… but what can I say… I procrastinate a whole lot and don’t manage to get anything done.

  111. Can I simply just say what a relief to uncover somebody that genuinely knows what they’re talking about online. You certainly know how to bring a problem to light and make it important. More and more people have to check this out and understand this side of the story. I was surprised you’re not more popular because you surely have the gift.

  112. we love watching Dancing with the stars, the actresses and actors that joins it are nice;

  113. It?¦s really a great and useful piece of info. I?¦m happy that you simply shared this useful information with us. Please stay us informed like this. Thanks for sharing.

  114. I’m not sure exactly how I discovered your blog because I had been researching information on Real Estate in Altamonte Springs, FL, but anyway, I have had a pleasant time reading it, keep it up!

  115. Everything is very open with a clear description of the challenges. It was truly informative. Your site is very helpful. Many thanks for sharing!

  116. Hi, I just ran across your web site via Bing. Your viewpoint is truly pertinent to my life currently, and I’m really pleased I discovered your website.

  117. The when I just read a weblog, I really hope who’s doesnt disappoint me about that one. After all, I know it was my option to read, but I personally thought youd have some thing interesting to state. All I hear is often a lot of whining about something you could fix if you ever werent too busy looking for attention.

  118. I’d must seek advice from you here. Which isn’t some thing It’s my job to do! I spend time reading an article that will make people think. Also, thank you allowing me to comment!

  119. I absolutely love your site.. Great colors & theme. Did you develop this web site yourself? Please reply back as I’m looking to create my own blog and want to know where you got this from or just what the theme is named. Appreciate it!

  120. Next time I read a blog, Hopefully it won’t fail me as much as this particular one. After all, I know it was my choice to read, nonetheless I really thought you’d have something helpful to say. All I hear is a bunch of complaining about something that you could fix if you weren’t too busy looking for attention.

  121. I must thank you for the efforts you have put in penning this blog. I really hope to check out the same high-grade content by you later on as well. In truth, your creative writing abilities has inspired me to get my own, personal site now 😉

  122. Spot on with this write-up, I honestly believe this amazing site needs much more attention. I’ll probably be returning to see more, thanks for the advice.

  123. There’s no doubt that it is the single most vital information in my opinion. And i am glad reading your article. But should remark on few general things, The internet site style is perfect, the articles is very excellent : D. Good job, cheers

  124. This is a good tip particularly to those new to the blogosphere. Short but very accurate info… Many thanks for sharing this one. A must read post.

  125. I have read a few good stuff here. Certainly worth bookmarking for revisiting. I wonder how much effort you put to make such a fantastic informative site.

  126. Loving the info on this site, you have done great job on the blog posts.

  127. Lawrence River Valley. It moreover permits a number of punches to enable determination period analysis.

  128. This website truly has all the info I needed about this subject and didn’t know who to ask.

  129. you are actually a good webmaster. The site loading speed is incredible. It seems that you’re doing any unique trick. Also, The contents are masterwork. you have done a excellent job on this topic!

  130. You made some decent points there. I looked on the internet to learn more about the issue and found most individuals will go along with your views on this website.

  131. The fireplace within the dining room has practically invisible mortar, so the dimensions of the stones actually stand out.

  132. Excellent web site you have here.. It’s hard to find high quality writing like yours these days. I seriously appreciate people like you! Take care!!

  133. Oh my goodness! Amazing article dude! Thank you, However I am going through issues with your RSS. I don’t know the reason why I am unable to subscribe to it. Is there anybody else getting identical RSS problems? Anyone who knows the answer will you kindly respond? Thanx!!

  134. Everyone knows that conferences are an integral half of companies.

  135. Great web site you’ve got here.. It’s hard to find high-quality writing like yours nowadays. I honestly appreciate people like you! Take care!!

TOP