text:
|Publication number
|Publication type
|Application number
|Publication date
|23 Sep 2004
|Filing date
|16 Dec 2003
|Priority date
|31 Aug 2002
|Also published as
|Publication number
|Eckhard Alt
|Original Assignee
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (30), Referenced by (62), Classifications (27)
|External Links: USPTO, USPTO Assignment, Espacenet
[0001] This application is a continuation-in-part of co-pending patent application Ser. No. 10/232,774, filed Aug. 31, 2002 ("the '774 application"), which is a CIP of U.S. Pat. No. 6,478,815, issued Nov. 12, 2002 ("the '815 patent.
[0002] The present invention relates generally to stents that are implantable or deployable in a vessel or duct within the body of a patient to maintain the lumen of the duct or vessel open, and more particularly to improvements in stent structures.
[0003] When inserted and deployed in a vessel, duct or tract of the body, for example a coronary artery after dilatation of the artery by balloon angioplasty, a stent acts as a prosthesis to maintain the vessel, duct or tract (generally referred to as a vessel for convenience herein) open. The stent has the form of an open-ended tubular element with openings through its sidewall to enable its expansion from a first outside diameter which is sufficiently small to allow it to be navigated through the vessel to a target site where it is to be deployed, to a deployed second outside diameter sufficiently large to engage the inner lining of the vessel for retention at the target site.
[0004] An occluded coronary artery, for example, is typically attributable to a buildup of fatty deposits or plaque on the inner lining of the vessel. A balloon angioplasty procedure is the treatment of choice to compress the deposits against the inner lining of the vessel to open the lumen. Alternatively, removal of plaque may be achieved by laser angioplasty, or by rotationally cutting the material into finely divided particles which are dispersed in the blood stream. For a large segment of patients undergoing the procedure, traditional angioplasty has resulted in new blockage of the treated vessel only a relatively short time thereafter, attributable to trauma to the blood vessel wall from the original procedure. The mechanism responsible for this restenosis or re-occlusion of the vessel lumen is intimal hyperplasia, a rapid proliferation of smooth muscle cells in the affected region of the wall.
[0005] To maintain the vessel open, it has become customary to install one or more stents at the trauma site at the time of or shortly after the angioplasty procedure is performed. The stenting procedure is recommended for virtually all patients, since those who are predisposed to restenosis are not readily identifiable at the outset. Typically, deployment of the stent is performed by radial expansion under outwardly directed radial pressure exerted, for example, by inflating the balloon of a catheter on which the stent is mounted for implanting in the patient. The expansion is such that the stent engages the inner lining or inwardly facing surface of the vessel wall. The structural characteristics of the stent give it sufficient resilience to allow some contraction from its expanded diameter after the balloon is deflated and the catheter removed from the body, but also adequate stiffness to largely resist the natural recoil of the vessel wall.
[0006] Unfortunately, the very presence of the stent in the vessel tends to promote thrombus formation as blood flows through the vessel, which results in an acute blockage. At the outward facing surface of the stent in contact or engagement with the inner lining of the vessel, tissue irritation can exacerbate restenosis attributable to hyperplasia. With current techniques, thrombosis, clotting, and restenosis attributable to installation of the device are reduced or even eliminated by use of drug-eluting stents, and to a somewhat lesser extent, by appropriate choice of the surface characteristics of the stent.
[0007] Selection of the material or materials of which the stent is composed is also affected by a patient's allergic reaction. A statistically significant percentage of the patient population who are candidates for stents suffer may severe allergic reaction to common stent materials, including chromium, nickel, and even medical grade 316L stainless steel, which contains about 16% nickel. Implanting a stent composed of these materials in such patients is contra-indicated.
[0008] Another consideration in material selection is the need for stent fluoroscopic visibility during the implant procedure, to allow the implanting physician to avoid binding while the stent is navigated on its catheter through the vessel, and to deploy the stent when the desired target site is reached, as well as to permit it to be viewed in periodic examinations of the patient. Thickness of the stent wall is governed not only to enable the stent to withstand vessel wall recoil following deployment, but to assure adequate visibility with fluoroscopy. Nevertheless, the composition and thickness of the stent wall must also take into account sufficient flexibility to allow the stent to be maneuvered through narrow vessels without binding, and to be deployed under balloon pressurization that will not unduly risk the possibility of rupture.
[0009] It follows that a suitable stent for successful interventional placement should possess features of good radiopacity and freedom from distortion during magnetic resonance imaging (MRI), flexibility with suitable elasticity to be plastically deformable, resistance to vessel recoil, sufficient thinness to minimize obstruction to flow of blood (or other fluid or material in vessels other than the cardiovascular system), biocompatibility to avoid vessel re-occlusion, and avoidance of allergic reaction. As noted above, stent structural design and material selection play a critical role in influencing these features.
[0010] Aside from vascular usage, other ducts or tracts of the human body in which a stent may be installed to maintain an open lumen include the tracheo-bronchial system, the biliary hepatic system, the esophageal bowel system, and the urinary tract. Many of the same requirements are found in these other endoluminal usages of stents.
[0011] It is quite apparent that technological innovation has yielded considerable progress in the field of interventional cardiology in recent years, such as the successful solution to one of the major problems of restenosis with the advent of drug-eluting stents. Recent clinical trials and usage following regulatory approvals have identified at least two or three different drugs that, when present in a coating on the implanted stent, are locally released from the coating and display a marked capability to inhibit restenosis. Still, bare metal stents remain in use and are implanted and continue to be implanted in large numbers of patients, with resulting restenosis and need for re-intervention that varies between 15% to 40% of patients, depending on vessel size, length (in size) of the stenosis, presence or absence of diabetes, and number and location of stents deployed in the patient. Recent clinical trials have demonstrated that less than 10% of patients receiving implants of drug-eluting stents suffered restenosis during the reporting period, even in patients with small vessels, diabetes, or long (large) stenoses.
[0012] A prerequisite of such improved patient response, however, is a need to maintain close contact of the surface of the implanted stent with the vessel wall. The delivery of the drug(s) from the stent coating is a local rather than systemic phenomenon, in which the stent coating releases a highly lipophilic (hydrophobic) drug that diffuses into the vessel wall in the locale, or immediate vicinity, of the stent implant. It is therefore mandatory that a multitude of small cells, not further away from each other than about 0.5 to 1.0 mm, provide this coverage of the vessel area. If a single stent is implanted, the coverage of the vessel wall and its impregnation by the drug is sufficient, as common trials have shown.
[0013] Unfortunately, however, much of the vascular stenosis found in patients involves not merely one vessel, but several sites. Classically, one of the sites for development of restenosis or of an arteriosclerosis is the bifurcation, shown schematically in FIG. 1A, where a vessel branches off and divides into either two vessels or a main vessel 10 and a side branch 11. Arteriosclerotic masses or stenoses 8 are present in both vessel 10 and side branch 11 at the bifurcation. Side branches in the coronary arteries very rarely undergo a 90-degree angulation at take off, but rather, much closer to a 45-degree branching angulation from the main vessel, as shown, by way of example, as angle θ in FIG. 1A.
[0014] This Figure illustrates the principle dilemma encountered for side branch stenting. The distribution of arteriosclerotic masses 8 in side branch 11 are shown as they normally develop. A mass 8 is present in the main vessel 10, but other masses 8 are present as well, include the branching off of side branch at 11 at its origin and its proximal and distal sites. To increase the diameter of the main vessel, a balloon catheter is inserted and/or a stent is implanted, to squeeze these masses into he wall of the vessel. The vessel is over-expanded at the site where the stent is implanted, and this provides excellent mechanical scaffolding, which resists reduction in diameter of the vessel from naturally-occurring vessel recoil. But correction of the condition in the side branch is more complex.
[0015]FIGS. 1B-1G are schematic diagrams useful in illustrating some of the different techniques attempted in the past to treat stenoses at the branching of a vessel into two vessels or into a main vessel and side branch.
[0016]FIGS. 1B and 1C represent the first two steps common to a sequence of steps that ends with a step illustrated in respective ones of the remaining four parts of FIG. 1.
[0017] In FIG. 1B, a stent 12 is implanted to cover the lesion (stenosis or arteriosclerotic mass, e.g., already subjected to an angioplasty procedure) in the main vessel 10 only, such that the stent also covers the opening of the side branch 11 by a so-called bridging at 14.
[0018] In FIG. 1C, a tiny guide wire 15 is advanced through an opening between the struts of the stent 12 in the main vessel 10, so that the guide wire penetrates into the side branch 11, and a balloon dilatation is performed by running a balloon catheter over the guide wire into the side branch 11 followed by an angioplasty procedure at target site 16.
[0019] In FIG. 1D, a stent 17 mounted on a balloon catheter (not shown), which could be the same balloon catheter used for the angioplasty procedure in FIG. 1C, is guided (over the guide wire 15, not shown in FIG. 1D to reduce unnecessary cluffer) between struts of stent 12 in the main vessel 10 into side branch 11 and deployed in the side branch, in the form of a T-like implant.
[0020] In FIG. 1E, an alternative arrangement to that of FIG. 1D is illustrated, to implant stent 12 in the main vessel 10 and stent 17 in the side branch 11 such that each stent starts (i.e., has its proximal end) at the place 19 where the bifurcation into the two vessels begins.
[0021] In another alternative arrangement, shown in FIG. 1F, stent 12 is implanted in the main vessel 10 as in FIG. 1C, and stent 17 is implanted through stent 12 in such a way that each stent covers the main vessel 10 in its respective proximal part, with stent 12 overlying stent 17. The mesh of stent 12 through which stent 17 is installed is opened by inflating the deployment balloon (not shown) through the opening from the main vessel 10 to the side branch 11, so as to enable blood to flow from the main vessel into and through the side branch.
[0022] A similar alternative, shown in FIG. 1G, involves a crush technique. Here, stent 12 implanted in the main vessel 10 is completely squeezed to the side by stent 17 implanted into the side branch 11, but an adequate opening exists in the main vessel at the point of the crushed stent 12 to allow blood to flow through that path as well as through the side branch.
[0023] None of these techniques has been shown to have long-term merit, whether with stainless steel (bare metal) stents or with drug coated (drug-eluting) stents. The side branch 11 usually has a diameter about 25-75% of the diameter of the main vessel 10.
[0024] The long-term results of treating bifurcated lesions including a side branch have not been satisfactory. Either an uncovered area is left at the proximal triangle 20 of the side branch 11 (e.g., FIG. 1D, and also FIGS. 1C, 1E, regarding a similar problem), the size of which depends on the angulation of the side branch bifurcation, which leaves lesions 8 ready to proliferate again; or too much metal is present in the vessel. In the former case, implanting a stent at the distal origin of the side branch, as shown in FIG. 1D, is inadequate to fully cover the inner wall of the side branch in that vicinity because of its geometry. And in the latter case, such as where two stents are implanted so as to overlap each other for full coverage, as in FIGS. 1F and 1G, the resulting large amount of metal in the vessel has yielded very poor results clinically. Even drug coated stents have their limitation in application involving bifurcated lesions.
[0025] This inadequacy has two consequences. First, the masses that are squeezed by the stent into the side wall of the artery tend to protrude at any unprotected and uncovered site, making the results of stenting unsatisfactory, not only on an acute basis but also long term. Initial results with drug coated stents also show that restenosis actually develops exactly at this uncovered area. This is attributable to the fact that the restenosis-hindering drug is delivered (eluted) from the stent coating and its distribution into the vessel wall is confined to the immediate vicinity of the stent struts. Accordingly, the uncovered triangle 20 lacks receipt of adequate medication to inhibit proliferation of smooth muscle cells, and restenosis occurs at this location.
[0026] Another problem encountered in the past has been that stents are made of stainless steel, which has a rather low radiopacity. Therefore, the stainless steel stent wall diameter must be in a range from 90 to 140 micrometers, which, although this is sufficiently thin and flexible to be advanced through a small artery, in principle, a stent strut thickness of 80 or of even 50 μm would better serve the purpose with greater flexibility and adequate mechanical strength to withstand vessel recoil. But stainless steel stents of such thinness are barely visible, if at all, under fluoroscopy.
[0027] Recent developments in stent composition and materials have led to stents that provide a better image than experienced with the bare stainless steel variety in the fluoroscopic catheterization laboratory setting, as well as reduced wall thickness and concomitant greater flexibility, without sacrificing mechanical strength in the radial direction. These advances are achieved, for example, by either a stainless steel stent with a thin layer of appropriate material of greater radiopacity, such as gold, tantalum, or platinum, which allows the stainless steel base material wall to be made considerably thinner without sacrificing fluoroscopic visibility, as disclosed in patent U.S. Pat. No. 6,099,561 to the applicant herein. Alternatively, use of materials of higher density, such as niobium with a small amount of zirconium as disclosed in the '815 patent, or of multiple sandwich layers of materials having greater radiopacity, which allows the stent to be fabricated with smaller diameter and thinner wall dimension. Other materials that serve this purpose include new alloys of steel and platinum or of cobalt alloyed with chrome, nickel, and molybdenum, or noble metal coatings such as disclosed in U.S. Pat. No. 6,099,561, issued Aug. 8, 2000, also to the applicant herein. The increased visibility of the stent with these new compositions and techniques applies not only to the stent as a whole, but even to its individual struts.
[0028] It is therefore a principal aim of the present invention to describe a system that overcomes the current limitations of side branch stenting.
[0029] A presently preferred embodiment of the invention resides in a cooperative stent adapted to be implanted in a patient's body into an acutely angled side branch at a junction of bifurcation from a main vessel, duct or tract. The cooperative stent has an acutely angled end adapted to reside against a portion of a separate main stent implanted in the main vessel, duct or tract bridging the bifurcation junction, such that the cooperative stent when implanted fully covers the inner wall surface of the side branch at the bifurcation junction, with negligible gaps. The stent may be termed "cooperative" in the sense that it cooperates with the main stent to fully cover the lesion present in the main vessel, duct or tract and the side branch at the bifurcation thereof.
[0030] The acute angle of the acutely angled end is approximately 45°. And the end of the cooperative stent opposite the acutely angled end is at a different angle from the acute angle, preferably a right angle, relative to the longitudinal axis of the stent. Thus, the acutely angled end of the stent has a short side and a long side connected via an imaginary plane that cuts through the wall of the stent at that end. At least one of the short side and the long side may have an identifying radiopaque parameter or enhanced visibility characteristic to enable viewing and properly orienting the cooperative stent during implant thereof in the side branch. Indeed, the entire stent may be fabricated from material having enhanced radiopacity without sacrificing thinness, such as observed in the aforementioned '774 application
[0031] Preferably also, the outer surface of the cooperative stent has a coating that includes a drug selected to inhibit restenosis, for elution of the drug from the stent when it is implanted in the side branch. Additionally, the acutely angled end of the cooperative stent is adapted to reside against the main stent at an opening along the portion thereof that bridges the bifurcation, to allow a portion of fluid carried by the main vessel, duct or tract, such as blood in the case of coronary artery, to flow relatively unobstructed through the bifurcation junction into the side branch.
[0032] In essence, the preferred embodiment may be characterized as a stent having a single straight tubular wall patterned with a plurality of interconnected struts having voids therebetween, and a pair of openings at opposite ends of the wall, the ends being skewed relative to one another. One of the skewed ends has either a fluoroscopically visible marker for properly orienting the stent during implantation, or enhanced visibility as a whole.
[0033] Alternatively, the stent may be characterized as a single tube with a multiplicity of through-holes in its side, and one of its two open ends skewed relative to its side, whereby to enable the stent to be implanted in mating relation to the geometry of a side branch similarly skewed relative to a main blood vessel at a bifurcation thereof. And the one skewed end is fluoroscopically identifiable to enable proper orientation of the stent during implantation in the side branch.
[0034] According to another aspect of the invention, the stent adapted to be implanted in a side branch at the skewed bifurcation from a main blood vessel in a patient's body, is mounted on a stent delivery system, preferably a balloon catheter, for navigation through the main vessel and deployment of the stent in the side branch at the bifurcation. One of the stent's open ends is angled to match the skew of the bifurcation of the side branch; and the stent is mounted on the balloon catheter with its matching angled end positioned proximally on the catheter. At least one of the stent or the balloon catheter has a fluoroscopically visible characteristic or marker at the matching angled end of the mounted stent for properly orienting the stent during its deployment in the side branch. Alternatively, at least one of the stent and the balloon catheter has fluoroscopically identifiable markers at the shorter and longer sides of the matching angled end of the mounted stent to facilitate rotation of the catheter and proper orientation of the stent for deployment in the side branch. A radiopaque characteristic or marker may also be present at the opposite end (the right-angled end) of the stent, either on the stent itself or on the balloon or catheter immediately adjacent that end of the stent.
[0035] Yet another aspect of the invention resides in a method of implanting a stent in a side branch at a skewed bifurcation from a main blood vessel in a patient's body. A first step of the method involves navigating a balloon catheter through the main vessel to the bifurcation. A stent is mounted on the catheter with the stent's matching angled end to the skew of the side branch bifurcation positioned proximally on the catheter. The navigation of the catheter continues until the stent is positioned in the side branch at the bifurcation. Next, the catheter is rotated to an extent necessary to orient the stent's matching angled end for substantially complete coverage of the inner wall of the side branch at the bifurcation. Finally, the stent is deployed against the inner wall of the side branch to effect that coverage by inflating the balloon of the catheter, and the balloon is then deflated and the catheter is withdrawn, leaving the stent in place.
[0036] Still another aspect of the invention pertains to the manufacture of a stent specifically adapted for implantation in a side branch at the origin of the bifurcation thereof from a main vessel, wherein the manufacture or fabrication of the side branch stent is preferably carried out by starting with a single metal tube of appropriate length, diameter and wall thickness and having at least one of its open ends angled at 90° (or approximately so) relative to the longitudinal axis of the tube. The sidewall of the tube is then patterned with a multiplicity of through holes either before or after the other open end of the tube is cut at an acute angle chosen to match the skew angle of the side branch bifurcation from the main vessel, nominally 450. The through-hole pattern is produced such that the tube diameter may be expanded from its starting dimension, which is sufficiently small to allow the tube to be inserted (by means of a stent delivery system) into a vessel, duct or tract of the patient's body designated to undergo a stenting procedure, to a diameter of adequate dimension when deployed to hold the side branch lumen open for fluid (e.g., blood) flow therethrough. The final stent may be coated with a know drug or carrier of a drug suitable for elution from the stent when in place in the side branch to inhibit stenosis or restenosis of the side branch inner wall. The acute skew-matching angle of what is to be the proximal end of the stent when implanted, is preferable formed at an angle of 45°, since that angle serves to match the large majority of skews of bifurcations from a main vessel, and will allow an inventory of the side branch stents to be maintained at the place where stenting procedures are to be performed, without a need for custom fabrication or maintaining inventories of such stents with various acute angled ends. However, different angulations other than 45° are feasible and beneficial as well.
[0037] Therefore, it is a principal aim of the present invention to provide a stent that is designed to give full coverage of the inner wall of a side branch at the skewed bifurcation of the side branch from a main vessel, with no or only negligible gap relative to a stent bridging the bifurcation in the main vessel.
[0038] Another aim is to provide a stent with one its open ends angled to match the skew of the bifurcation of a side branch in which the stent is to be implanted from a main vessel.
[0039] Still another aim of the invention is to provide a stent mounted on a balloon catheter with an end of the stent, angled to match the bifurcation skew of a side branch at which the stent is to be deployed, positioned proximally on the catheter.
[0040] Yet another aim is to provide a method of implanting a stent in a skewed bifurcation from a main vessel for substantially full coverage of the side branch wall at the bifurcation against which the stent is deployed, regardless of the angle of the skew.
[0041] It is noteworthy that the technical problems associated with side branch stenting have been studied extensively, and many proposed solutions have been advanced in the prior art, but none of these proposals rises to the level of the solution advanced by applicant herein. Examples of the prior art proposals are set forth below.
[0042] US patent application 2003/0187494 of Loaldi, titled "Endoluminal Device for Delivering and Deploying an Endoluminal Expandable Prosthesis," published Oct. 2, 2003, describes a device that has enhanced delivery capacity. FIG. 55 of this patent application shows two stents implanted next to each other to fit the shape of a bifurcation and to cover two branches, but not the main vessel. The application discusses device operation with two wires, and the practicality of deploying into two different sites.
[0043] US patent application 2003/0181972 of Re, published Sep. 25, 2003, describes an MRI and x-ray compatible stent material of tungsten-rhenium that provides increased stent visibility, but no side branch stenting by special means.
[0044] US patent application 2003/0097169 of Brucker et al., titled "Bifurcated Stent and Delivery System," published May 22, 2003, discloses how bifurcation into one main stent integrates the side branch stent.
[0045] US patent application US 2003/0009209 of Hojeibane, titled "Bifurcated Axially Flexible Stent," published Jan. 9, 2003, describes in FIG. 11 a stent with asymmetric ends having two different angulations.
[0046] US application US2002/0095208 of Gregorich et al., titled "Stent," published Jul. 18, 2002, describes a stent that allow side branch access, but has angular ends on both its sides.
[0047] Various bifurcated stent designs are described, for example, in patents U.S. Pat. No. 6,086,611; U.S. Pat. No. 6,129,738; U.S. Pat. No. 6,602,225; and U.S. Pat. No. 6,540,779B2. In U.S. Pat. No. 6,514,281 a single Y member is used to cover a bifurcation by means of a single stent that extends into both vessels. U.S. Pat. No. 6,080,191 to Summers also discloses a two-legged stent, as do U.S. Pat. No. 4,994,071; U.S. Pat. No. 5,749,825; and U.S. Pat. No. 5,755,771.
[0048] U.S. Pat. No. 6,540,777 evaluates and suggests a locker mechanism for stents.
[0049] Generally, these suggestions configure the acute technical implantation outcome, but fail to consider the long-term consequences of stenting a side branch for local smooth muscle cell growth, the shifting of plaque material, or the requirements of drug-coated stents. Moreover, none of the prior art designs of which the applicant herein is aware, with the possible exception of the radiopaque tungsten material of US patent application 2003/0181972, discuss a need or desire for increased visibility. Additionally, use of a marker to identify more closely the location and position of an endovascular graft supported by a stent, as described in U.S. Pat. No. 6,361,557 is only to address a concern for graft placement.
[0050] The above and still further aims, objectives, features, aspects and attendant advantages of the present invention will be better understood from a consideration of the following detailed description of a best mode presently contemplated of practicing the invention, by reference to certain preferred embodiments and methods of fabrication and thereof, taken in conjunction with the accompanying drawings, in which:
[0051]FIGS. 1A-1G are schematic diagrams, discussed in terms of prior art proposed solutions in the Background section above, namely:
[0052]FIG. 1A illustrates the multiple sites of vascular stenosis or arteriosclerotic masses at or in the vicinity of a bifurcation from a main vessel into a side branch in the patient's body.
[0053]FIGS. 1B and 1C are schematic diagrams of initial steps typically employed in the prior art in a sequence that leads to respective ones of the solutions illustrated in the remaining four parts of FIG. 1.
[0054]FIG. 1D is a schematic diagram of a proposed prior art solution in which separate stents are implanted in the main vessel and a bifurcated side branch.
[0055]FIG. 1E is a schematic diagram of an alternative prior art proposed solution to that of FIG. 1D in which V-type stenting is performed, with a stent implanted in the main vessel and a cooperative stent implanted in the side branch, the two abutting each other at the point where the bifurcation commences.
[0056]FIG. 1F is a schematic diagram of another alternative prior art solution, in which a stent is implanted in the main vessel, followed by implanting a second stent in the side branch through the main stent.
[0057]FIG. 1G is a schematic diagram of yet another prior art alternative solution, in which a crush technique is used to implant the stent into the side branch through the stent in the main vessel by completely squeezing the latter to the side.
[0058]FIG. 2A is a schematic diagram of the side view of a side branch stent according to the present invention.
[0059]FIG. 2B is a schematic diagram of the side branch stent of FIG. 2A implanted in relation to a main stent.
[0060]FIG. 3A is a schematic diagram of the side branch stent of FIG. 2 properly mounted on a balloon catheter.
[0061]FIG. 3B is a schematic diagram of identifying markers used in conjunction with the side branch stent of FIG. 3B mounted on a balloon catheter, for aiding rotation and proper orientation of the side branch stent during deployment.
[0062] According to a principal aspect of the invention, a single stent 37 (FIGS. 2A and 2B) is fabricated to exhibit different angulations at its proximal end 39 and distal end 40, the angulation at its proximal end (relative to the locus of its implantation on a balloon catheter) being arranged to match the angulation of a side branch 31 (in which stent 37 is intended to be implanted) at its bifurcation (junction) 34 from a main vessel 30. In particular, the stent 37 is adapted to be implanted in the side branch 31 at a skewed bifurcation from main vessel 30 in a patient's body, by means of a stent delivery system (described more fully below) including a balloon catheter on which the stent is mounted for navigation through the main vessel and deployment of the stent in the side branch at the bifurcation. The stent 37 has one of its open ends 39 angled to match the skew of the bifurcation of the side branch, and when the stent is mounted on the balloon catheter so that its matching angled end is positioned proximally thereon.
[0063] The angulation is such that the side branch stent 37, when properly implanted, lies with that angled end 39 positioned directly against a portion 35 of the side of a stent 32 in the main vessel that bridges the bifurcation junction 34, with only a virtually negligible gap 36, if any, between the two stents 32 and 37. The distal end 40 of the side branch stent has a 90-degree angulation relative to its longitudinal axis 41, whereas the proximal end 39 of the side branch (or cooperative) stent 37, which is intended to reside at the origin (i.e., the bifurcation junction 34) of the side branch 31 stemming from the main vessel 30, has an angulation α that deviates from this rectangular configuration. The stent 37 thus has a side of 50 of relatively short length, and a side 51 of relatively longer length.
[0064] The applicant herein has determined that the most suitable and appropriate angle α for the proximal end 39 of the side branch stent 37 is a 45-degree angulation, which covers the majority of the angles of the branching off of a side branch from a main vessel. This angulation determines the extent of coverage of the inner vessel wall of the side branch 31 can be achieved by stent 37 at the origin of the side branch. As shown in FIG. 2B, the optimum coverage is full or complete coverage, in which the proximal end 39 of side branch stent 37 abuts directly against the main stent 30 bridging portion 35 of bifurcation 34. With this optimum coverage the gap 36 is effectively zero. In practice, however, unless the angulation α of proximal end 39 exactly matches that of the bifurcation of the side branch 31 from main vessel 30, some gap 36, albeit relatively negligible, will exist when the stent 37 is implanted. But even if the proximal end 39 protrudes slightly (not shown) into the main vessel 30 at the bifurcation 34 when stent 37 is implanted, that slightly protruding portion can be squeezed against the side of the inner wall of the main vessel (and the side branch) by inflating the balloon of a balloon catheter (shown and discussed with regard to FIGS. 3A and 3B, below) during deployment.
[0065] It is most important, especially with drug-coated (drug-eluting) stents, that as much as practicable, full coverage of the inner wall of side branch 31 be achieved at and adjacent the bifurcation junction 34. Otherwise, any substantial uncovered portion of the inner wall would have a tendency toward restenosis, attributable to limited drug concentration (which is highly localized to the extent of the stenting) and to a lack of mechanical scaffolding in the uncovered area. While it is possible to fabricate and tailor the angle of the proximal end 39 of the side branch stent 37 to match a particular angulation of the bifurcation in of each side branch 31—in practice for example, by creating an inventory of stents having one angled end within the range of angles most likely to be encountered in stenting—it is preferred for the sake of convenience, that the side branch stent 37 be manufactured, by conventional techniques, with a proximal end angled at 45° from the longitudinal axis 41 of the sten, according to the angulation of side branches most prevalent in the body, and particularly in the coronary arteries.
[0066] The distal end 40 of side branch stent 37 is preferably angled at 90° relative to the longitudinal axis 41 of the stent, so as to avoid problems of binding and perhaps even penetrating the vessel wall when advancing the stent through the vascular system to the target site at which the stent is to be deployed. Furthermore, no particular need exists to deviate with the distal end from the angle of the conventional stent end.
[0067] As shown in FIGS. 3A and 3B, for purposes of implanting the side branch stent 37, it is mounted on the balloon 43 adjacent the distal end 44 of a balloon catheter 45, in the usual manner. In the case of the present invention, however, the optimally angled end 39 of the stent 37 is to be positioned at the proximal end of the balloon 43 of catheter 45. Of course, this is done to assure that the stent will be properly oriented for implantation in the side branch. During navigation of the catheter 45 through the vascular system and into the main vessel and beyond, the balloon 43 is maintained in an evacuated or deflated state, as opposed to the partially or fully inflated state shown in FIGS. 3A and 3B, for ease of advancement to the target site. The catheter 45 has an open lumen to allow it to be navigated in over-the-wire fashion on a guide wire 47 previously inserted into the main vessel 10 and ultimately into the side branch 31 in which the side branch stent 37 is to be deployed. Stent 37 may be deployed before or after main vessel stent 32 is implanted, but if deployed afterward it must either be navigated through the mesh sidewall of the main vessel stent at the bifurcation, or the main vessel stent must have its sidewall opened at the bridging portion 34 of the bifurcation junction, as by an earlier opening with a balloon catheter.
[0068] Once the side branch stent 37 is in place at the origin 34 (FIG. 2B) of the side branch 31, it becomes necessary to assure that stent 37 is oriented with the longest length 51 of its sidewall arranged to match the inner wall angle of the most proximal point of branching of the bifurcation. To that end, unless the stent 37 is fortuitously oriented in that way, it must be rotated to achieve that orientation by appropriately rotating the catheter 45. Once that is done, the side branch stent 37 may be deployed by inflating the balloon 43 of catheter 45 until the stent sidewall is pressed firmly against the inner wall of the side branch 31 at its origin. The pressurizing agent within the balloon 43 may then be evacuated, and the catheter 45 withdrawn from the body, leaving stent 37 implanted in place at the origin of the bifurcation.
[0069] This leads to the description of a second feature of the side branch stent and methodology of the present invention, namely visibility. Depending on the rotation, the longer part 51 of the stent 37 can be placed either in direction of the proximal origin of a side branch as shown in FIG. 2B, or toward a distal origin (not shown). To allow a correct placement, the stent is preferably composed of a material that allows identification of the asymmetric ends 39 and 40 defined by different side lengths 50 and 51, as shown in FIGS. 2A and 2B. Suitable materials or coatings having the radiopacity and other characteristics necessary to enable such identification under fluoroscopy as the stent-mounted catheter is navigated into position in the patient's vascular system are described in the applicant's aforementioned '561 application and '815 patent, for example.
[0070] Another means suitable for identification of the two ends of the side branch stent and to facilitate its rotation and proper orientation for implantation involves the use of radiopaque markers at one or both ends of the catheter 45 shaft immediately adjacent the respective ends of balloon 43 (FIG. 3B). The marker or markers, for example of gold, platinum, or other noble metal, such as at point 56 on the distal end and/or at point 57 for the shorter side 50 and/or at points 58 for the longer side of the stent 37, serve to identify a critical point or points of the stent so as to allow the stent to be rotated into proper position for deployment and implantation with optimum coverage of the inner wall of the side branch 31 at the locus of the bifurcation origin. The markers may be placed either inside or outside the stent in its mounting location on the balloon 43 of the stent delivery system.
[0071] If an unequal number of markers is used, for example two or three markers used at one end to identify the longer side, and a single marker used on the opposite end to identify the shorter side of the stent, rotation of the shaft and balloon of the stent delivery system can separate the two sets of markers. For example, if the catheter is rotated in the anterior posterior position both markers will overlap if they are at the same latitude or length of a stent and, thus, are not identifiable individually. This presents a warning to the implanting physician that the stent is not properly positioned for deployment at the bifurcation origin. In contrast, maximum separation of the two sets of markers would identify the stent as being rotated into the proper position and orientation for deployment. Preferably, however, the entire stent is composed or marked with radiopaque material. Alternatively, the thickness of the stent wall at each of its ends is greater to render those asymmetric ends more radiopaque, for aiding implantation of the stent in the proper orientation and position.
[0072] The final side branch stent to be implanted in the patient may be coated with a known drugs or drugs, or a carrier incorporating a drug or drugs, which are adapted to be eluted from the stent when deployed in the side branch to inhibit stenosis or restenosis of the side branch inner wall, and as well to inhibit clotting (thrombosis) within the lumen of the side branch.
[0073] Although a best mode of practicing the invention has been disclosed by reference to a preferred method and embodiment, it will be apparent to those skilled in the art from a consideration of the foregoing description that variations and modifications may be made without departing from the spirit and scope of the invention. Accordingly, it is intended that the invention be limited only by the appended claims and the rules and principles of applicable law.
|Cited Patent
|Filing date
|Publication date
|22 May 1989
|19 Feb 1991
|Cordis Corporation
|Bifurcating stent apparatus and method
|18 Sep 1996
|12 May 1998
|Isostent, Inc.
|Means method for treatment of stenosed arterial bifurcations
|3 Nov 1995
|26 May 1998
|Divysio Solutions Ulc
|Expandable stent and method of delivery of same
|5 Apr 1996
|20 Oct 1998
|Medtronic, Inc.
|Endoluminal prostheses having position indicating markers
|14 Oct 1997
|13 Apr 1999
|Iowa-India Investments Company Limited
|Stent for positioning at junction of bifurcated blood vessel and method of making
|14 Jan 1997
|27 Jun 2000
|American Biomed, Inc.
|Method for making a stent
|25 Sep 1997
|11 Jul 2000
|Ave Connaught
|Bifurcated stent
|5 Mar 1998
|8 Aug 2000
|Scimed Life Systems, Inc.
|Dilatation and stent delivery system for bifurcation lesions
|8 May 1998
|8 Aug 2000
|Divysio Solutions Ltd.
|Expandable bifurcated stent and method for delivery of same
|27 Mar 1998
|12 Sep 2000
|Medinol Ltd.
|Bifurcated stent and method of making same
|20 Jun 1998
|10 Oct 2000
|Medtronic Ave, Inc.
|Method and apparatus for treating stenoses at bifurcated regions
|18 Jun 1999
|13 Nov 2001
|Medinol Ltd.
|Multilayered metal stent
|3 Feb 2000
|26 Mar 2002
|Medtronic Ave, Inc.
|Staplebutton radiopaque marker
|31 Jan 2000
|4 Jun 2002
|Scimed Life Systems, Inc.
|Braided branching stent, method for treating a lumen therewith, and process for manufacture therefor
|23 May 2000
|27 Aug 2002
|Medinol, Ltd.
|Bifurcated stent with improved side branch aperture and method of making same
|4 Sep 1998
|4 Feb 2003
|Scimed Life Systems, Inc.
|System for delivering bifurcation stents
|15 Feb 2001
|1 Apr 2003
|Scimed Life Systems, Inc.
|Locking stent
|26 Jun 2001
|1 Apr 2003
|Medinol Ltd.
|Bifurcated stent with improved side branch aperture and method of making same
|28 Feb 2001
|5 Aug 2003
|Scimed Life Systems, Inc
|Substantially circular catheter assembly
|3 Oct 2000
|23 Sep 2003
|Scimed Life Systems, Inc.
|Process for manufacturing a braided bifurcated stent
|16 Oct 2002
|6 Sep 2005
|Wei-Jan Chen
|Prevention of atherosclerosis and restenosis
|13 Sep 2001
|7 Aug 2007
|Cordis Corporation
|Stent with angulated struts
|6 Apr 2001
|1 Nov 2001
|Vardi Gil M.
|Extendible stent apparatus
|23 Apr 2001
|6 Dec 2001
|Jacob Richter
|Bifurcated stent with improved side branch aperture and method of making same
|28 Mar 2002
|18 Jul 2002
|Scimed Life Systems, Inc.
|22 Aug 2002
|20 Mar 2003
|Gumm Darrell C.
|Rotating stent delivery system for side branch access and protection and method of using same
|26 Feb 2002
|22 May 2003
|Brucker Gregory G.
|Bifurcated stent and delivery system
|7 Jan 2002
|10 Jul 2003
|Martin Eric C.
|Bifurcated stent for percutaneous arterialization of the coronary sinus and retrograde perfusion of the myocardium
|22 Mar 2002
|25 Sep 2003
|Scimed Life Systems, Inc.
|MRI and x-ray compatible stent material
|19 Dec 2000
|2 Oct 2003
|Alessandro Loaldi
|Endolumenal device for delivering and deploying an endolumenal expandable prosthesis
|Citing Patent
|Filing date
|Publication date
|12 Oct 2004
|17 Feb 2009
|Scimed Life Systems, Inc.
|One-branch stent-graft for bifurcated lumens
|4 Aug 2004
|16 Mar 2010
|Boston Scientific Scimed, Inc.
|Extendible stent apparatus
|8 Sep 2005
|8 Jun 2010
|Boston Scientific Scimed, Inc.
|Inflatable bifurcation stent
|20 Jul 2010
|Boston Scientific Scimed, Inc.
|Bifurcated stent and delivery system
|19 Oct 2010
|Boston Scientific Scimed, Inc.
|Stent with protruding branch portion for bifurcated vessels
|6 Jul 2006
|2 Nov 2010
|Robert Kipperman
|Method for placement of a stent assembly in a bifurcated vessel
|6 Mar 2006
|16 Nov 2010
|Boston Scientific Scimed, Inc.
|Bifurcated stent
|28 Nov 2007
|16 Nov 2010
|Boston Scientific Scimed, Inc.
|Bifurcated stent with drug wells for specific ostial, carina, and side branch treatment
|27 Nov 2006
|30 Nov 2010
|Boston Scientific Scimed, Inc.
|Stent with spiral side-branch
|30 Aug 2007
|30 Nov 2010
|Boston Scientific Scimed, Inc.
|Bifurcated stent
|15 Jun 2006
|14 Dec 2010
|Boston Scientific Scimed, Inc.
|Extendible stent apparatus
|26 May 2009
|22 Feb 2011
|Boston Scientific Scimed, Inc.
|Extendible stent apparatus
|20 Jun 2007
|12 Apr 2011
|Boston Scientific Scimed, Inc.
|Nesting twisting hinge points in a bifurcated petal geometry
|5 Sep 2007
|31 May 2011
|Boston Scientific Scimed, Inc.
|Bifurcated stent with entire circumferential petal
|25 Aug 2009
|31 May 2011
|Boston Scientific Scimed, Inc.
|Stent with protruding branch portion for bifurcated vessels
|16 Jan 2007
|14 Jun 2011
|Boston Scientific Scimed, Inc.
|Bifurcated stent
|12 Sep 2007
|14 Jun 2011
|Boston Scientific Scimed, Inc.
|Bifurcated stent with open ended side branch support
|23 May 2007
|30 Aug 2011
|Boston Scientific Scimed, Inc.
|Bifurcated stent
|1 Jun 2009
|13 Sep 2011
|Boston Scientific Scimed, Inc.
|Bifurcation stent pattern
|8 Sep 2005
|18 Oct 2011
|Boston Scientific Scimed, Inc.
|Crown stent assembly
|8 Sep 2005
|25 Oct 2011
|Boston Scientific Scimed, Inc.
|Overlapping stent
|8 Jan 2009
|29 Nov 2011
|Robert Kipperman
|Specialized catheter and method for placement in a bifurcated vessel
|4 Oct 2006
|6 Dec 2011
|Gurbel Paul A
|Detection of restenosis risk in patients receiving a stent by measuring the characteristics of blood clotting including the measurement of maximum thrombin-induced clot strength
|28 Mar 2007
|21 Feb 2012
|Boston Scientific Scimed, Inc.
|Bifurcation stent and balloon assemblies
|2 Nov 2006
|26 Jun 2012
|Boston Scientific Scimed, Inc.
|Adjustable bifurcation catheter incorporating electroactive polymer and methods of making and using the same
|12 Sep 2006
|10 Jul 2012
|Boston Scientific Scimed, Inc.
|Multilayer balloon for bifurcated stent delivery and methods of making and using the same
|3 Feb 2011
|14 Aug 2012
|Boston Scientific Scimed, Inc.
|Extendible stent apparatus
|4 Dec 2006
|4 Sep 2012
|Boston Scientific Scimed, Inc.
|Stent with protruding branch portion for bifurcated vessels
|21 Dec 2007
|2 Oct 2012
|Boston Scientific Scimed, Inc.
|Bi-stable bifurcated stent petal geometry
|7 Mar 2006
|30 Oct 2012
|Boston Scientific Scimed, Inc.
|Bifurcated stent with improvement securement
|14 Dec 2004
|30 Oct 2012
|Boston Scientific Scimed, Inc.
|Stent with protruding branch portion for bifurcated vessels
|26 May 2005
|27 Nov 2012
|Boston Scientific Scimed, Inc.
|Crimpable and expandable side branch cell
|14 Dec 2005
|1 Jan 2013
|Boston Scientific Scimed, Inc.
|Connectors for bifurcated stent
|23 Oct 2007
|23 Apr 2013
|Cook Medical Technologies Llc
|Thoracic arch stent graft and method of delivery
|31 May 2011
|23 Apr 2013
|Boston Scientific Scimed, Inc.
|Stent with protruding branch portion for bifurcated vessels
|14 Dec 2005
|7 May 2013
|Boston Scientific Scimed, Inc.
|Telescoping bifurcated stent
|23 Sep 2011
|25 Jun 2013
|Robert Kipperman
|Balloon for use in placing stents in bifurcated vessels
|26 May 2005
|9 Jul 2013
|Boston Scientific Scimed, Inc.
|Stent side branch deployment initiation geometry
|22 Jun 2012
|15 Oct 2013
|Boston Scientific Scimed, Inc.
|Adjustable bifurcation catheter incorporating electroactive polymer and methods of makings and using the same
|30 Mar 2007
|11 Feb 2014
|Boston Scientific Scimed, Inc.
|Balloon fold design for deployment of bifurcated stent petal architecture
|31 Dec 2008
|10 Jun 2014
|Boston Scientific Scimed, Inc.
|Bifurcation stent delivery system and methods
|25 Oct 2010
|21 Oct 2014
|Veniti, Inc.
|Bi-directional stent delivery system
|9 Dec 2005
|21 Oct 2014
|Cook Medical Technologies Llc
|Stented side branch graft
|29 May 2008
|13 Jan 2015
|Boston Scientific Scimed, Inc.
|Bifurcated stent and delivery system
|17 Mar 2004
|30 Dec 2004
|Davidson Charles J.
|Stent with protruding branch portion for bifurcated vessels
|12 Oct 2004
|3 Mar 2005
|Patrice Nazzaro
|One-branch stent-graft for bifurcated lumens
|6 Jun 2005
|16 Feb 2006
|Advanced Stent Technologies, Inc.
|Stent with protruding branch portion for bifurcated vessels
|9 Dec 2005
|22 Jun 2006
|William A. Cook Australia Pty. Ltd.
|Stented side branch graft
|15 Jun 2006
|26 Oct 2006
|Advanced Stent Technologies, Inc.
|Extendible stent apparatus
|10 Oct 2006
|8 Feb 2007
|Advanced Stent Technologies, Inc.
|Extendible stent apparatus
|29 Aug 2005
|1 Mar 2007
|Boston Scientific Scimed, Inc.
|Stent with expanding side branch geometry
|8 Sep 2005
|8 Mar 2007
|Boston Scientific Scimed, Inc.
|Inflatable bifurcation stent
|15 Sep 2006
|19 Apr 2007
|Cappella, Inc.
|Intraluminal device with asymmetric cap portion
|22 Apr 2009
|28 Oct 2010
|Ricky Chow
|Aneurysm treatment system, device and method
|19 Apr 2011
|14 Feb 2013
|Shanghai Microport Medical (Group) Co., Ltd.
|Stent for bifurcated vessel
|6 Dec 2007
|10 Jun 2009
|Joline Gmbh & Co. Kg
|Implantierbare Gefäßstütze
|28 Nov 2008
|14 Sep 2011
|Translumina GmbH
|Implantable vessel support
|4 Oct 2006
|19 Apr 2007
|Paul A Gurbel
|The detection of restenosis risk in patients receiving a stent
|12 Sep 2008
|18 Mar 2010
|Alexandr Grigorievich Viller
|Dubble-balloon delivery system for an implantable eccentric stent
|3 Nov 2009
|18 Nov 2010
|Industry-Academic Cooperation Foundation, Yonsei University
|H-side branch stent
|8 Jun 2010
|16 Dec 2010
|Trireme Medical, Inc.
|Side branch balloon
|13 Mar 2014
|5 Mar 2015
|Thomas Ischinger
|Oblique stent
|U.S. Classification
|623/1.35, 623/1.43
|International Classification
|Cooperative Classification
|European Classification


text:
Induction Recordings
Vocal Group Hall of Fame
Inductions Now Available
on iTunes and Amazon!
[Photo Gallery]a
October 1, 1958 Little Anthony & The Imperials recorded Neil Sedakas The Diary along with their street corner classic, Traveling Stranger.
Top Single: Reach Out
The Four Tops #7 1966
Birthday: Barbara Parritt (The Toys) 1944 Herbert Tubo Rhoad (The Persuasions) 1944
Howard Hewett (Shalamar) 1959
October 2, 1954
The Spaniels Lets Make Up was released.
1961 Phil Spector launched his successful label Philles (with partner Lester Still) with the release of The Crystals first single, Theres No Other.
Top Single: Who Put The Bomp Barry Mann & The Edsels #11 1961
Play That Funky Music #1 1976
Birthday: David Sommerville
(The Diamonds) 1933
Claude McKnight (Take 6) 1962
October 3, 1955
Elvis Presley made his first public performance at 10 in a dairy show talent contest. He sang Old Shep and won $5, finishing 2nd.
1981 The Tokens reunited for one Concert at New Yorks Radio City Music Hall after more than a decade apart.
Top Single: Oh Pretty Woman
Roy Orbison #1 1964 Candida Dawn #3 1970
October 4, 1958
George Goldner (End Records President) signed The Flamingos.
1962 Bob Dylan showcased at New Yorks Carnegie Hall Annex. Fifty three people showed up.
Top Single: Hurt So Bad
The Lettermen
#18 1969 -
Another One Bites The Dust
Queen #1 1980
Birthday: Arlene Smith (The Chantels) 1941 Patti LaBelle (The Bluebelles) 1944
October 5, 1968
Cream The 3 ½ year old Supergroup led by Eric Clapton began its farewell tour. All three of their LPs were million sellers.
Top Single: Mack The Knife
Bobby Darin #1 1959
October 6, 1958
The Elegants follow-up to their #1 Little Star, Please Believe Me was issued. They recorded 12 more 45s but never charted again.
1978 After living together for 9 years, ABBA members Anni-Frid Lyngstad and Benny Anderson finally married.
Top Single: Glory of Love
The Five Keys #1 R&B 1951 Sherry The 4 Seasons #1 1962
October 7, 1957
The Crests first single My Juanita was released. The record reached #86 Pop and the group members each earned $17.50.
1967 The Mamas & The Papas British tour and TV appearances were canceled when Mama Cass Elliot was jailed for a night, accused of stealing items from a hotel.
Top Single: The Letter The Box Tops #1 1967
Everybody Plays The Fool The Main Ingredient #4 1972
Birthday: Tony Sylvester
(The Main Ingredient 1941
October 8, 1977
The Emotions Dont Ask My Neighbors (#44 Pop, #7 R&B) charted as the follow up to their mega-hit Best Of My Love (#1 Pop & R&B). It was their 17th of 30 R&B hits between 1969 and 1984.
Top Single: Last Train To Clarksville The Monkees #6 1966
Birthday: Fred Cash
(The Impressions)
October 9, 1954
Shirley Gunter and The Queens, a Los Angeles female quartet, hit the R&B singles survey with Oop Shoop (#*). By the time Oop Shoop was released Shirley (sister of Coasters member Cornel Gunter was legally blind.
1958 Eddie Cochran recorded Cmon Everybody.
Top Single: Bristol Stomp
The Dovells #5 1961 Hit The Road Jack Ray Charles #1 1961
October 10, 1958
The Dells opened a weeks engagement headlining at New Yorks Apollo Theater.
1978 Aerosmith members Joe Perry and Steven Tyler were injured when an over zealous fan launched a Cherry Bomb on to the stage in Philadelphia.
Top Single: Dancing In The Streets Martha & The Vandellas
#3 1964.
Mr. Custer Larry Verne #1 1960
Birthday: Cyril Neville (The Neville Brothers) 1948
October 11, 1969
The Cowsills last of seven Top 100 entries, Silver Threads (MGM #74) charted.
1962 - Love Me Do become the first Beatles 45 to chart when it debuted at #49 on the British hit list.
Top Single: Dance With Me The Orleans #7 1975
When I Think Of You Janet Jackson #1 1986
October 12, 1956
Johnnie Rays Just Walkin In The Rain entered the U.K. charts. The million selling American hit was co-written by Johnny Bragg & Robert Riley, two inmates at the Tennessee State Prison.
Top Single: Sugar Shack
Jimmy Gilmer & The Fireballs #1 1963
October 13, 1956
The Heartbeats classic, A Thousand Miles Away (#53 Pop, #5 R&B) was released. The groups lead singer, James Sheppard, wrote the standard while lounging in his bath tub.
1963 The term Beatlemania coined after a near riot at a TV show, Sunday Night at The London Palladium, where the Mop Tops appeared.
Top Single: Tears On My Pillow Little Anthony & The Imperials #4 1958
Its All In The Game Tommy Edwards #1 1958
Birthday: Marie Osmond (The Osmonds) 1959
October 14, 1957
The Rays timeless tune Silhouettes charted en route to #3.
1955 19 year old Buddy Holly and his friend Bob Montgomery were opening act (as Buddy & Bob) in their hometown of Lubbock, TX for visiting rock start Bill Haley & The Comets. The next day they opened for Elvis Presley.
Top Single: Happy, Happy Birthday Baby The Tune Weavers #4 R&B 1957
Kiss You All Over Exile #1 1978
October 15, 1960
Danny & The Juniors, hit artists of the era-defining At The Hop left ABC Records and signed with Swan Records of Philadelphia.
Top Single: Ive Got You Under My Skin The 4 Seasons #9 1966.
Birthday: Marv Johnson (The Seranaders) 1938 Tito Jackson (The Jacksons) 1953
"Truth In Music"
Law in 34 US States
ABC 20/20 Piece on Truth In Music
Must seeclick
"Truth In Music"
Fake Doo Wop
Support the Vocal Group Hall of Fame
a 501(c)3 Non-profit Foundations
By downloading one of a kind recordings of the Hit Songs recorded at Inductions
The Vocal Group
Hall of Fame
501(c)3 Non-profit Foundation
The Columbia Theatre
82 West
State St.
Sharon, Pa. 16146
Fall - 2015
Please support
Vocal Group
Hall of Fame
by Downloading
at Inductions
Preview 150
Induction Recordings
Vocal Group
Hall of Fame
StarVista Entertainment, Time Life
Present "Legendary Voices"
Hosted by The Lettermen
The Lettermen Hits Medley Performance Recorded in Nashville, Tennessee
November 6, 2013
The Lettermen Interview Recorded in
Nashville, Tennessee -
November 6, 2013

subset: commoncrawl


text:
ADA Info
Learning new things is not just for school kids! You can learn basic computer skills at the library. We offer free computer classes every Tuesday and Thursday at 3 pm. Come check them out and learn something new this fall!
Crosby Book Club invites interested Earthlings to our next meeting, at 2 pm on Friday, August 15. We will be discussing Science Fiction. Do you enjoy this genre? Why or why not? Let's engage!
Jina Faith from the Eddie V. Gray Wetlands Center will be here on Tuesday, August 12th at 10:30 am. She will talk about wetland animals and bring some live animals to see up close. You might even get to see a baby alligator!
In addition to the fun programming and reading incentives, this summer the Crosby Branch Library has a weekly drawing. Stop by and see what prize we are offering this week. Be sure to stop by regularly--each week's drawing is meant to appeal to different groups that use the library. Here are some of our winners so far:
The Crosby Branch Book Club will meet Friday, June 27, at 2:00 pm.
Harris County Texas
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Locations & Hours
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text:
Latest Videos
Throwback Thursday: Golic & Colo Browns LegendsPosted Oct 8, 2015
Bob Golic and Don Colo talk about getting together with teammates during alumni weekend and being inducted into the Cleveland Browns Legends program.
Inside: Pruitt "These Fans Hold On To You Forever"Posted Apr 22, 2015
Browns Running Back from 1973-1981, Greg Pruitt, talks about his experiences moving to Cleveland as a player, his thoughts on the new uniforms, and also about the fans passion for the Browns.
Uniform Reveal: Browns History and HeritagePosted Apr 14, 2015
Take a look back at the history and heritage that played a role in the new Browns Uniforms
Jim Brown: "The Uniforms Are Fantastic"Posted Apr 14, 2015
Jim Brown comments on the Browns Uniform Reveal Event.
Inside: Cockroft "I Got To Finish As A Brown"Posted Apr 14, 2015
Don Cockroft, Placekicker/Punter from 1968-1980 and a member of the "Kardiac Kids", talks about his twelve year career with the Browns and his book "The 1980 Kardiac Kids - Our Untold Stories".
Inside: Draft Retrospective - Brian SipePosted Apr 13, 2015
We take a look back at the 1972 Draft where the Browns selected Quarterback Brian Sipe.
NFL Legends: Jim Brown Career HighlightsPosted Mar 5, 2015
Running back Jim Brown left the game at his peak and still sits atop the record books. Making his mark on and off the field, he is a true legend.
Thank You Dawg Pound!Posted Jan 6, 2015
A special "Thank You" message for the Dawg Pound.
Honoring Jim BrownPosted Oct 2, 2013
The Browns will honor Jim Brown at halftime of the Browns-Bills game on 10/3
Alumni Spotlight: Jim BrownPosted Sep 28, 2013
Browns.com traveled to Hollywood, California to bring you this exclusive one-on-one interview with Browns Hall of Fame running back Jim Brown.
Jimmy Haslam and Jim Brown Press Conference - 5/29Posted May 29, 2013
Jimmy Haslam and Jim Brown speak to the media at FirstEnergy Stadium, after announcing that Brown was named a Special Advisor to the organization.
This Day in Browns History - March 16Posted Mar 16, 2013
On this day in Browns history in 1951, offensive lineman Joe DeLamielleure was born and on the same day in 1956 TE Ozzie Newsome was born


text:
Item No. » AA-LMIS
Sorry, this item is Out of Stock. You can still order it and we will ship it to you as soon as it comes in.
Get your rear in gear and move it move it. This sock is soft and comfortable thanks to Lin's Coolmax fibers woven in and it will be durable thanks to a nylon outer shell to protect the soft yarns underneath.


text:
The South Florida law offices of Steinger, Iscoe & Greene are taking a proactive stance in helping potential victims of bodily fluid transfer due to the negligence of a veteran nurse at Broward General Medical Center, as stated in the Sun-Sentinel October 7, 2009. Health officials admit the nurse reused the same saline bag amongst 1,851 patients in administering Gadolinium MRA contrast dye for cardiac chemical stress tests. The patients are expected to receive a letter from Broward General early this week urging them to seek physician administered screening for Hepatitis B and C and HIV/AIDS.
Fort Lauderdale, FL (PRWEB) October 7, 2009 -- Last night's NBC 6 Miami 7pm news broadcast broke the story "Broward (General) health officials have confirmed that a veteran nurse may have used IV bags contaminated with other patients' fluids while administering saline solution to patients who came to the hospital for cardiac chemical stress tests. …the nurse routinely used the same bag on different patients. As many as 1,851 patients may have been impacted."
Over the weekend Broward General Hospital sent 1,851 certified letters to the potential victims of this bodily fluid backflow scare asking that the patients contact a physician immediately to administer Hepatitis B and C and HIV/AIDS screening.
Managing Partner of the Fort Lauderdale law office of Steinger, Iscoe & Greene, William McAfee notes, &quo
|Source: PRWeb
Copyright©2009 Vocus, Inc.
All rights reserved


text:
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In August of 2010, My Boys (my wonderful Guides/Angels) woke me up & told me that they wanted me to write a book. It was to be called "Answers". They said someone would ask me a series... More > of questions and They would answer. I said "Ok" & told few family & friends & forgot about it. In October, at one of my Live events, I met Angie Felske. I read for Angie for over an hour, privately. She had lost 2 sons violently & both came through for her with intimate details. In January of 2011, Angie emailed me saying that the Boys kept waking her up at night telling her they wanted her to write a book with Jamie. They gave her a comprehensive list of questions & she attached them to the email. I wrote back telling her I knew. That the book was called Answers & let's get started. In the pages of this book you will find information you may have never heard before. A unique perspective perhaps. It was not designed to be perfect and is far from it. It was created to give you a catalyst to find your own Answers.< Less
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Chia Recipes
Chia Seed Puddings
Prep time
5 - 10 minutes
Total Time
2 hour refrigerate
A group
These healthy treats are great when you desire something sweet and delicious. They take very little time to prepare and are great in the mornings for a quick and yummy addition to your breakfast. Serve with fresh fruit, eggs and veggies for a nutritious start to your day.
1 cup coconut milk or almond milk
¼ cup chia seeds
¼ cup honey, maple syrup or coconut sugar (or to taste)
½ tsp vanilla extract (optional)
Possible flavouring options:
2 tbsp cocao powder
¼ cup raspberries puree (or other fruit purees)
¼ cup lemon juice
In a medium size bowl, mix all ingredients and add your choice of flavouring. Mix well to combine. Transfer pudding into shot glasses. Refrigerate the pudding for at least 2 hours.


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An acute elevation of blood pressure, or acute hypertension, is a life-threatening condition that can cause permanent damage to the brain, heart, kidneys and blood vessels. It occurs in nearly 50 percent of patients presenting to the hospital with acute heart failure and is a common occurrence for patients with renal dysfunction. It is critical to rapidly manage and maintain optimal blood pressure to minimize risk of death and damage to vital organs. Of the over 35 million people in the United States with hypertension, over one million people each year will have one or more acute episodes of high blood pressure, requiring treatment in an acute care setting.
About Congestive Heart Failure (CHF)
Currently in the U.S., CHF affects nearly 5 million people with 550,000 new cases of CHF diagnosed each year. Despite the treatment of CHF with multiple drugs, almost all CHF patients will experience at least one episode of acute CHF that requires treatment with intravenous medications in the hospital. There were over 1,100,000 hospitalizations for CHF in 2004. Congestive heart failure has tremendous human and financial costs. Estimated direct costs in the U.S. for CHF were $29.6 billion in 2006.
About Palatin Technologies, Inc.
Palatin Technologies, Inc. is a biopharmaceutical company primarily
focused on discovering and developing targeted, receptor-specific peptide
and small molecule therapeutics, including melanocortin ("MC")-based
therapeutics. Therapeutics affecting the activity of the MC family of
receptors may have the potential to treat a variety of conditions and
diseases, including sexual dysfunction, obesity and related disorders,
cachexia, hemorrhagic shock and inflammation-related diseases. The Company
is exploring other receptor-specific therapeutics, including natriuretic
peptide receptor A ("NPRA") agonist compounds for use in treatment of acute
systemic hypertension, congestive heart failure and other d
|SOURCE Palatin Technologies, Inc.
Copyright©2008 PR Newswire.
All rights reserved


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Knight Rider - 1x13: Exit Light, Enter Knight - Discussion and Spoiler
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January 28 2009, 02:22 PM
Pumpkin Spice Bacon
Location: Kansas City
Knight Rider - 1x13: Exit Light, Enter Knight - Discussion and Spoiler
From TV.com:
When Mike tries to stop a bank robbery things go badly and he ends up being a hostage himself. Mike figures out that the robbers have more on their mind than grab the money and run. They are overly interested in one of the hostages and her husband's safety deposit box. Mike is unable to communicate with KITT and works on enlisting the hostages to help capture the robbers.
Ok, I think they're begining to strain the "Knight" in episode titles thing.
Just because it's futuristic doesn't mean it's practical.
Pumpkin Spice Bacon
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The leader of the Nation of Islam told a crowd of approximately 1 million people to become more active in solving their own problems instead of relying on others.
Its a normal Thursday morning in the Hillside High dance studio.
The Durham A-Z: H is for Hayti exhibit opens at the Museum of Durham History on Friday.
N.C. A&Ts strong defense helped head coach Rod Broadway earn his 100th career coaching victory, making him only the 26th active FCS coach with 100 wins.
Gerrymandering districts in North Carolina is old hat.
Democrats gerrymandered districts for years to ensure they kept majorities in the state House and Senate and
The political story of the year by far is the sudden resignation of House Speaker John Boehner. His announcement last month sent shock waves throughout the body
Durham Parks & Recreation will host a grand
Author Zelda Lockhart will read from her new
The Apple Gold Group, a franchisee of


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Mon., April 9, 2012 1:10pm
Plant Scherer Under Review
Potential health effects of emissions from Plant Scherer near Macon are under a new review by the state. It comes after high levels of radioactive uranium reportedly surfaced in nearby wells.
Full Story
©Copyright 2015, Georgia Public Broadcasting. All Rights Reserved
Georgia Public Radio®


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With Windows Server 2012 Hyper-V we've taken performance to the next level.
For example:
Windows Server 2012 Hyper-V provides Single-Root Input/Output (SR-IOV) Networking.
To learn more, I want to point you to this outstanding 8 part blog series written by John Howard. John makes a small joke that this is a feature the team has been working on for many years and it merely appears in the UI as a few checkboxes.(!) While the UI impact may appear minimal, the development and test behind SR-IOV requires deep engineering prowess which will become evident as you read this blog. I've included brief descriptions of each part with links below, but I highly recommend the entire series.
I also want to highlight one very important point about Windows Server 2012 Hyper-V and SR-IOV. Our awesome team didn't take any shortcuts. Specifically, using SR-IOV with Hyper-V 2012 works with Live Migration. I know that everyone has come to expect that all our new Hyper-V features work with Live Migration, but this feature is very different because:
>> the virtual machine is actually communicating with physical hardware <<
Yes, think about that for a second.
When you go into Device Manager of the guest OS running within a VM configured with SR-IOV, you'll actually see the real NIC. Here's a screenshot. This is Device Manager on a virtual machine with Windows Server 2012 as guest and SR-IOV enabled using a Broadcom NIC:
It's one thing to Live Migrate a virtual machine where the VM and all of its devices are virtualized, it's another to Live Migrate a virtual machine where the VM is communicating with hardware.
Windows Server 2012 Hyper-V and SR-IOV support with Live Migration is a really, really big deal and another area where VMware is attempting to catch up with us. (No, vSphere 5.1 can't vMotion VMs with SR-IOV…).
One more thing, SR-IOV also applies to Microsoft Hyper-V Server 2012, available at no cost.
"Everything You Wanted to Know about SR-IOV in Hyper-V" by John Howard
Part 1: http://blogs.technet.com/b/jhoward/archive/2012/03/12/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-1.aspx
Part 1 discusses emulated versus software devices, the pros and cons and constraints of each and why Microsoft is investing in SR-IOV.
Part 2: http://blogs.technet.com/b/jhoward/archive/2012/03/13/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-2.aspx
Part 2 discusses the SR-IOV standard, physical functions (PFs) virtual functions (VFs) and the hardware requirements to make SR-IOV even possible.
Part 3: http://blogs.technet.com/b/jhoward/archive/2012/03/14/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-3.aspx
Part 3 discusses device drivers and how they function in an SR-IOV environment as well as screenshots of an SR-IOV NIC within a Hyper-V VM.
Part 4: http://blogs.technet.com/b/jhoward/archive/2012/03/15/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-4.aspx
Part 4 discusses some of the low level necessary firmware and motherboard changes to make SR-IOV function and provides a pointer to an interesting presentation given 4 years ago at WinHEC 2008 by Jake Oshins that provides further insight into SR-IOV.
Part 5: http://blogs.technet.com/b/jhoward/archive/2012/03/16/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-5.aspx
Part 5 explains the IO path with SR-IOV enabled, covers SR-IOV configuration via the UI and a deeper dive into PowerShell.
Part 6: http://blogs.technet.com/b/jhoward/archive/2012/03/19/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-6.aspx
Part 6 discusses SR-IOV and Live Migration in detail. It covers the engineering challenge of making SR-IOV work with Live Migration (not trivial folks) and even includes a video that demonstrates a virtual machine with an SR-IOV NIC under load being Live Migrated. There's even a link to a WinHEC 2006 presentation (told you we've been looking at this technology a while…)
Part 7: http://blogs.technet.com/b/jhoward/archive/2012/03/20/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-7.aspx
Part 7 discusses SR-IOV and how it works with the new inbox Windows Server 2012 NIC Teaming. Yes folks, you can team SR-IOV NICs in the guest.
Part 8: http://blogs.technet.com/b/jhoward/archive/2012/03/21/everything-you-wanted-to-know-about-sr-iov-in-hyper-v-part-8.aspx
Part 8 discusses debugging SR-IOV and includes examples in PowerShell and covers troubleshooting through the Event Viewer.
Any Microsoft Plans for GPU pass-through so that we can one day run AutoCAD in Virtual machines without a problem ?
This can also be done on kvm with fail over bonding at the VM. Upon migration the sr-iov device is detached and then reattached on the other side. I don't think its as big a deal as you say it is, because MS is basically doing the same thing with hyper-v migration except it is better hidden from the user. SR-IOV doesn't support pcie device state migration so all implementations are going to use this 'trick'. I agree however VMware has fallen behind severely in the last 2 years.


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|NOVALERT, INC Patent applications
|Patent application number
|METHOD AND APPARATUS FOR MINIMALLY INVASIVE IMPLANTS - The present invention involves a device and method capable of providing minimally invasive insertion of implants with saline, aqueous or other fluid fillers while preventing deflation and/or migration, as well as monitoring for leakage from, or leakage into, implants (such as breast implants, pacemakers, implantable cardioverter defibrillators, other inflatable devices and other related devices). The device described herein has the ability to be inserted minimally invasively and to sense and communicate the occurrence of loss of integrity in the shell of virtually any implant.
|EXTERNAL SENSING FOR IMPLANT RUPTURE - The present invention relates to a system and a method for sensing for the rupture of an implant (such as a breast implant) that has been implanted in body tissues or in an organ of a patient. In one embodiment, a system according to the present invention includes, among other possible things, a sensor coupled to an outer surface of the implant and configured to measure a property at the outer surface of the implant, for example, electrical conduction, chemical composition, or an optical property that is indicative of whether an implant rupture has occurred. The sensor is also configured to transmit a wireless signal to a device external to the body, which alerts the patient or a healthcare provider whether the measured property indicates that the implant rupture may have occurred.


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Monday October 05, 2015 Last updated 14:18PM
Robyn Hata Gage | Te Tarata Commemorations
Cavalry coming to Whakatohea commemoration. Whakatohea is this weekend marking the 150th anniversary of the Battle of Te Tarata. The Opotiki-based tribe still hasn't settled its historical treaty claims, after rejecting a $40 million offer almost 20 years ago, and spokesperson Robyn Hata-Gage says the sense of grievance over the confiscation of 450,000 acres of its land still burns.
Kiritahi Firmin | Suicide prevention hui at Ratana Pa
Suicide does not discrimnate at all. All of us who have been affected by suicide are over it. We need to find a community based, indigneous based, simplistic process a rongoa to help save the lives of our people and we've got to do it now
Koha Alpass Waru | Stoptober - Time to give up cigarettes
Fromer Radi oWaatea host has joined the Stopober kaupapa to qit smoking. She talks with Dale about the first day of her journey
Jane Kelsey | Helen Clark needs to heed her own UN advisers on TPPA
In standing beside National Prime Minister John Key and appearing to endorse the Trans-Pacific Partnership Agreement (TPPA) Helen Clark has forgotten the most vulnerable New Zealanders who will bear the brunt of the governments concessions to US demands, especially on medicines, and the rights of New Zealanders to decide our own future, says University of Auckland law professor and TPPA critic Jane Kelsey
Dynamics of Whanaungatanga participants
Dale Husband is joined by some of the participants of the Dynamics of Whanaungatanga Course. Listen to their stories
Kia Korero Mai - Naida Glavish - Who does Anne Tolley think she is ?
In 1988 the groundbreaking report, Puao Te Ata Tu into the Institutional racism of the the Social welfare Department. At the heart of the issue is a profound misunderstanding or ignorance of the place of the child in Maori society and its relationship with whanau, hapu, iwi structures.� This was in response to the deprivation that Maori whanau face and the mass removal of our children from whanau into the care of the state . Twenty seven years later Anne Tolley the Minister for Social Development wants to find a way of stopping the most at-risk beneficiaries from having more children.Naida Glavish discusses this kaupapa with Eruera Morgan
Kia Korero Mai - Tumatakuru O'Connell - TPPA ISIS
The UN had/are there general assembly this week to vote on major global strategies for topical issues. Two of the main kaupapa that were discussed there was the TPPA and ISIS. What does that mean for Maori? Te Tumatakuru O'Connell shares his view: Obama offers 'ideas' to fight ISIS, Putin sends guns Putin told the General Assembly on Monday, Today, we provide military and technical assistance both to Iraq and Syria and many other countries of the region who are fighting terrorist groups.� Rebuking Obama's campaign of limited airstrikes against ISIS, Putin said, We should finally acknowledge that no one but President Assads armed forces and Kurdish militias is truly fighting the Islamic State and other terrorist organizations in Syria�
Dame Tariana Turia - Why she supports Chris Brown coming to Aotearoa
Dame Tariana Turia talks with Dale Husband about why she is in support of Hip Hop artist Chris Brown visiting Aotearoa
Maori Women Leadership Support Chris Brown
WILLIE JACKSON: I was extremely proud last week when some of Maoridoms top women leaders came out in a press conference held at my Marae Nga Whare Waatea to express their support for the singer Chris Brown.
Our flip flop Prime Minister.
WILLIE JACKSON:I used to call my mate John Tamihere a flip flop. If I said it was black, he'd say it was white, even after calling it black himself. If I said it was up, he'd say it was down. If I said it was Labour, he'd counter by saying it was National.
How is removing Maori children from whanau & sterilising the poor appropriate
I find it difficult to respond to the latest idea from National on our most vulnerable Mokopuna. CYFS is to undergo another rebuild, this is the 15th time since the department was created.


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Early in the season, when the Bills were winning five of their first seven games and their offense was among the league leaders in points and yards and Ryan Fitzpatrick was the AFC's offensive player of the month for September, it looked as if Buffalo had finally turned the corner after 11 consecutive non-playoff seasons.
As the Bills continue sinking back to their requisite spot near the bottom of the NFL standings with seven consecutive losses, it looks as if around that corner was a brick wall, and they have crashed into it and gone splat. The Bills are now 5-9, and they have a real good chance of finishing 5-11 with a home game against Denver and a road finale at New England remaining. Buffalo also will have some big-time concerns heading into the offseason, and those start with Fitzpatrick.
"It's hard for me to go out there and turn the ball over three times and struggle like I did and have people angry and upset, and you hear the boos, you hear all that," said Fitzpatrick, who was booed off the field a few times during the Bills' 30-23 loss to Miami. "But I'm a guy that's never going to stop playing, never going to stop fighting. I just have to figure it out and get better. We haven't played very well, and that starts with me."
In the last week of October, when the Bills were about to get to 5-2 with a dominating 23-0 win over Washington, Fitzpatrick signed a contract extension for six years worth a potential $59 million, about $24 million of that guaranteed. Since the ink dried, the Bills won that game in Toronto over the Redskins, and they have lost their next seven, and Fitzpatrick has been simply horrific.
Following the Miami loss, coach Chan Gailey was asked if he had lost confidence in his quarterback and he predictably said, "Zero. I've lost zero confidence." That statement was only slightly hard to believe.
Over the first seven games, Fitzpatrick completed 67.7 percent of his passes for 1,739 yards with 14 touchdowns and seven interceptions, and he was averaging 7.59 yards per attempt. During the seven-game losing streak, his percentage is 57.7 percent, with eight TDs and 12 picks, and his yards per attempt is a sickly 5.96 yards.
As Fitzpatrick was throwing three interceptions by midway through the third quarter against the Dolphins, Gailey said he never considered benching Fitzpatrick in favor of Tyler Thigpen.
"We are not at a point yet where we can't get better and we can't continue to try to improve as a football team," Gailey said. "I don't know who's going to be here next year. He's got to work with everybody."
Fitzpatrick caught lightning in a bottle early in the year, though that storm started brewing in 2010. After an 0-2 start under Trent Edwards last season, Gailey cut Edwards and turned the offense over to Fitzpatrick, who was in his second year with the Bills after starting his career with stints in St. Louis and Cincinnati. Fitzpatrick could not direct a victory in any of his first six starts as Buffalo dipped to 0-8, but then he started to play better, he developed some chemistry with Stevie Johnson, and the Bills split their final eight games.
During the NFL lockout, Fitzpatrick was a pillar of team unity. He hosted several teammates at his home in Arizona for a week of workouts, and then was one of the leaders when the team gathered in Buffalo in May to conduct its own minicamp. When he got off to the hot start, the Bills felt the need to lock him up to a new deal because he was going to be an unrestricted free agent come March 2012.
It now appears the Bills, known for botching personnel decisions, may have made another. Fitzpatrick looks nothing like a franchise quarterback, and in fact, looks exactly like what he has been most of his career, a backup.
Last week, Gailey was asked if the Bills would consider picking a quarterback in the first round of the 2012 draft, and he said he didn't think that was on the table. It seems hard to believe it wouldn't be, especially if the Bills -- who seem headed for a top-10 slot -- have a shot at someone like Heisman Trophy winner Robert Griffin III from Baylor or USC's Matt Barkley, if either declares for the draft and is sitting there when Buffalo picks.
Copyright (C) 2011 The Sports Xchange. All Rights Reserved.


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Former Rep. Ron Paul said Thursday that he believes the government is "over-exaggerating" the Ebola outbreak, possibly to make a profit off less effective, more expensive organic phosphate medicine.
"Governments deceive us, and sometimes they hype things. I don't think we are going to see in the next year a horrendous breakout of Ebola in this country," the former GOP presidential candidate said in a video on his website, Voices of Liberty.
Mr. Paul said there was never "absolute proof" that the chemical DDT, which was previously used to treat malaria, would be dangerous as a treatment to Ebola. However, instead of using DDT, doctors use "very expensive organic phosphates" that he says kill patients.
"Could there be a possibility in this that making the organic phosphates, maybe there's a profit in this?" he said. "Maybe that is the reason that we end up doing this."


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Rome, Italy: A new, effective, non-surgical treatment for uterine fibroids can help women with this condition maintain their fertility, an American scientist told the 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome today (Wednesday). Dr. Alicia Armstrong, Chief, Gynecologic Services, National Institutes of Health (NIH) Programme in Reproductive and Adult Endocrinology, Bethesda, Maryland, said that the outcome of two Phase II clinical trials of ulipristal acetate (UPA) had significant implications for both infertility and general gynaecology patients.
UPA belongs to a relatively new class of drug, the selective progesterone receptor modulators or SPRMs. It is currently used for emergency contraception, and acts by blocking the progesterone receptor and hence ovulation (release of the egg). Recent research has shown that progesterone also plays a role in the development of uterine fibroids, which affect 24 million women in Europe and can lead to a range of symptoms such as abdominal pain and discomfort and heavy and irregular menstrual bleeding. Fibroids are the major indication for hysterectomy in Europe and the US, and they also contribute to infertility by interfering with the ability of the embryo to implant in the womb and causing miscarriage.
"Both the fibroids and the surgical interventions commonly used to treat them can cause significant fertility problems," said Dr. Armstrong, "and we wanted to see whether fibroids could shrink and surgery could be avoided by using an SPRM."
Results from two Phase II randomised, placebo-controlled, double-blinded studies performed at NIH were pooled and analysed. In the trials, women aged from 25-50 years with symptomatic uterine fibroids were randomised to receive UPA or placebo once a day for three menstrual cycles. The researchers found that, out of the 57 patients who it was possible to evaluate for efficacy, 18 received placebo, 20 10mg of UPA
|Contact: Mary Rice
European Society of Human Reproduction and Embryology


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Ingredients1 package fresh cheese tortellini
1 cup halved cherry tomatoes
1 cup fresh spinach leaves, coarsely chopped
1/2 cup chopped pepperoncini peppers
6 tablespoons (1.5 ounces) shredded fresh Parmesan cheese
1 tbsp capers
1/4 cup chopped fresh basil
1 (8-ounce) can great northern beans
1 tbsp fresh lemon juice
1 1/2 tablespoons extra-virgin olive oil
PreparationCook the pasta according to package directions.
Meanwhile, combine the tomatoes, spinach, peppers, cheese, capers, basil, and beans in a large bowl.
Drain pasta; rinse with cold water.
Add pasta, lemon juice, and oil to the tomato mixture. Toss gently. Serve immediately.


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About 90 percent of ALS cases are sporadic and 10 percent run in families. Mutations in the superoxide dismutase1 (SOD1) gene are found in about one-fifth of people with familial ALS, and for decades, experts have theorized that the gene holds clues to sporadic ALS. Laboratory mice carrying human SOD1 mutations develop signs of ALS as they age, and have been widely used to investigate the causes and potential treatments for the disease.
Recent NIH-funded studies showed that astrocytes derived from these SOD1 mice are toxic to motor neurons. Astrocytes lesser known than neurons and usually described as playing a supportive role became prime suspects for killing neurons in ALS.
At the same time, however, researchers have questioned whether SOD1 mice are useful and whether SOD1 itself is relevant for understanding sporadic ALS. Although dozens of potential therapies have shown promise in the mice, so far only riluzole has proven to help patients in clinical trials. Those results raised concerns that SOD1 might not be a factor in the majority of ALS cases after all.
"The Ohio team has developed a useful model for addressing these issues," said Amelie Gubitz, Ph.D., a program director at NINDS. "Their analysis of the cells adds to mounting evidence that astrocytes and particularly SOD1 function in those cells contribute to both sporadic and familial ALS."
The investigators obtained post-mortem spinal tissue from ALS patients through the National Disease Research Interchange (NDRI). This is a nonprofit organization supported by NIH, voluntary health organizations and corporate and individual sponsors that enables people to donate their tissues for use in research after death, and then delivers specific tissues to research labs. NDRI performed the autopsies in the ALS patients' local communities and used couriers to fly the tissue samples to Columbus. By working through weekends and ofte
|Contact: Daniel Stimson
NIH/National Institute of Neurological Disorders and Stroke