text:
|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|18 Mar 1997
|Fecha de presentación
|7 Jun 1995
|Fecha de prioridad
|5 Feb 1993
|También publicado como
|Número de publicación
|Matthew O'Boyle
|Cesionario original
|The Joe W. & Dorothy Dorsett Brown Foundation
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (1), Citada por (96), Clasificaciones (21), Eventos legales (5)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
This a division, of application Ser. No. 08/014,021, filed Feb. 5, 1993, now abandoned.
The invention broadly relates to a catheter and a method for its use in opening a stenosis in a coronary artery or any other vascular vessel. In particular, the invention relates to an inflatable balloon catheter wherein the balloon also serves as a piezoelectric generator of ultrasonic energy for breaking up the stenosis.
Percutaneous transluminal angioplasty (PTA) is presently the primary therapy for certain forms of atherosclerotic artery disease. The major application of the procedure is in the coronary arteries, but the procedure can also be used in peripheral arteries or any vascular vessel. Atherosclerosis results in the restriction and blockage of blood flow in arteries by an accumulation in the blood vessel of a variety of biological materials. Such restriction or blockage results in oxygen deprivation of the tissue supported by the blood supply. This deprivation and its effect, angina, is referred to as "ischemia". If the blood supply through the coronary artery is almost completely or completely blocked for more than two or three minutes, permanent damage to the myocardia or infarction and death may result. The biological matter causing arterial blockage (stenosis) may be plaque, or thrombotic, calcific or fibrous matter or any combination thereof.
Several methods are known in the art to dilate an existing path through a stenosis and restore blood flow. Balloon angioplasty requires the insertion into the blood vessel and through the stenosis of a deflated balloon, which is hydraulically inflated to stretch and compact the stenosis material against the wall of the artery. This procedure is somewhat effective; however, the incidence of re-stenosis is high, and in many cases bypass surgery must be undertaken. A confirmed attendant risk associated with this procedure is subsequent downstream embolism or clogging, which can be essentially as serious as the most serious stenosis which the procedure is designed to remedy.
In order that the smallest possible stenosed aperture may be crossed, conventional balloon catheter designs call for a balloon having minimal profile diameter in the deflated state. As a result, the balloon wall thickness must be minimized, reducing the burst pressure of the balloon. At the same time, however, there is a growing demand for higher balloon burst pressures to overcome the high resistance of some biological materials in stenoses that are somewhat or completely calcified.
The need for a minimal profile diameter in the deflated state also requires a minimization of the catheter shaft tip to as small a diameter as can accommodate a given guide wire. However, this impairs the pushability of the catheter across the stenosis, since a thinner shaft is also a weaker shaft.
Most balloons are made of either polyethylene, polyethylene terephthalate (PET), or a polyolefin copolymer. A conventional balloon catheter comprises a balloon-over-a-wire design, however this invention anticipates on-the-wire piezoelectric catheters where the guide wire occupies a central lumen of the catheter.
A recent development in treatment of stenosis is the use of ultrasonic energy to break up the biological material comprising stenosis in peripheral blood vessels. The mechanisms of ultrasound treatment are primarily direct mechanical effects and cavitation. Generally, the ultrasonic energy is generated in vitro and delivered, for example, via a titanium wire of 0.5 millimeter diameter to the 2 millimeter spherical tip of the catheter at the site of stenosis. Frequencies in the range of 10-20 kHz are typically used with a power output of up to 20-25 W/cm2. Such a device is described in R. J. Siegel et al., "Percutaneous Ultrasonic Angioplasty: Initial Clinical Experience", Lancet, pp 772-774, Sept. 30, 1989.
The spherical tip must be large enough to create a pathway through the stenosis through which a subsequent angioplasty balloon catheter may pass. Unfortunately, though the spherical tip breaks open a lumen of approximately 2 millimeter diameter through the stenosis, it does not remove the annulus of biological material which surrounds the 2 mm aperture. Instead the annulus must be crushed against the vessel wall by the subsequent angioplasty balloon in order to achieve a larger aperture.
Another problem with the conventional catheters used to mechanically deliver ultrasonic energy is that the titanium wire which is generally used for this purpose is relatively stiff and therefore cannot be effectively steered into a coronary artery. A thinner, more flexible wire, such as stainless steel, is not able to transmit effectively the amount of ultrasonic energy required by the procedure. Titanium is thus the material of choice in the mechanical transmission of the ultrasonic energy. Consequently, this method of delivering ultrasonic energy for ablation of the stenosis cannot be applied to the coronary arteries.
Diagnostic catheters are known in the art which have in vivo piezoelectric transducers at their tips. These piezoelectric transducers are used for ultrasonic imaging of the vessel in which the catheter is inserted. Often, such transducers are used in combination with an angioplasty balloon catheter. In such a combination, the transducer provides imaging of the stenosis for which the balloon is used to dilate. The transducer may also be used to measure the flow in an autoperfusion catheter, in which a conduit is incorporated in the catheter to allow blood to flow by the inflated balloon. Such a catheter is disclosed in U.S. Pat. No. 5,046,503 to Schneidermann. The piezoelectric transducer is a piezoelectric crystal placed adjacent the autoperfusion conduit inside the balloon.
A different kind of piezoelectric element can be found in the intravascular, ultrasonic imaging catheter of U.S. Pat. No. 5,109,861 to Walinsky et al. Thin layers of flexible plastic material, such as polyvinylidene diflouride (PVDF), are utilized which can be spot polarized in active regions to exhibit piezoelectric characteristics. This kind of imaging catheter may be used in conjunction with balloon catheters to assist in locating the portion of the vessel wall to be treated. However, the low amplitude, high frequency piezoelectric transduction of ultrasonic energy cannot, and is not intended to, ablate the stenosis under observation.
U.S. Pat. No. 5,135,001 discloses a piezoelectric element in the form of a PVDF layer sandwiched between an inner cylindrical electrode and a plurality of outer electrode strips running axially along the length of the catheter, for use in imaging the inside surface of the blood vessel. In one embodiment, the piezoelectric element is contained within an inflatable balloon. After the catheter is positioned at the desired location, the balloon may be inflated with liquid until it contacts the vessel walls. This assures more efficient transmission and echo reception of ultrasound energy than would be possible if there were gaps between the catheter sheath and the vessel walls. In alternative embodiments, the outer electrode strips are located on the outer surface of the balloon, while the balloon still contains the inner cylindrical electrode and the piezoelectric layer. The electrode strips may also be attached to the inside of the inflatable balloon.
While it has been demonstrated that ultrasonic energy can be used to image the inside surfaces of blood vessels, and ultrasonic energy has been delivered over titanium wires to stenoses in peripheral vessels to open up a nominal aperture, no effective means of delivering ultrasonic energy to substantially ablate stenosis material in a coronary artery as provided by the present invention is presently available. There is a need for a catheter which can deliver ultrasonic energy to the location of stenosis, to substantially open the blockage without the need to use balloon pressure to crush the stenosis open. There is a further need to avoid the high risk of re-stenosis which accompanies balloon angioplasty, and to ablate the stenosis material in particle sizes sufficiently small to reduce the risk of downstream embolism.
It is an object of the present invention to provide an angioplasty balloon catheter, and a method for its use, which has a piezoelectric balloon capable of delivering sufficient in vivo ultrasonic energy for ablating biological material comprising a stenosis of coronary arteries or other blood vessels in the human body. It is a further object of the present invention to provide a catheter wherein the piezoelectric balloon may be excited to deliver ultrasonic energy in either the deflated or inflated state, or any state of partial inflation with a contrast fluid.
The catheter has a lumen through which a guide wire may be passed for guiding the catheter to the site of stenosis. The catheter further has at its distal end a balloon preferably comprising a polyvinylidene diflouride (PVDF) homopolymer or crosslinked with a polyolefin copolymer, which has been poled by corona discharge such that it exhibits piezoelectric properties. The balloon may be inflated via other lumens in the catheter with a contrast fluid which is electrically conductive. The outer shaft of the catheter, as well as the outer surface of the balloon, are metalized to provide a conductive path on the outside of the catheter. An ultrasonic frequency signal may be applied between the outer metalized surface and the conductive contrast fluid to excite the piezoelectric balloon into ultrasonic vibratory states.
According to the method of the invention, the catheter is guided to the site of arterial stenosis by means of a guide wire. If the stenosis is complete, such that the catheter cannot be pushed across the stenosis, an excitation signal may be applied to the balloon in its deflated state, which causes a longitudinal vibratory motion, in effect hammering the tip of the catheter through the biological material of the stenosis.
When the catheter has crossed the stenosis, the balloon may be inflated while the excitation signal is maintained. The inflation of the balloon causes the vibrating surface of the balloon to remain in mechanical contact with the stenosis material, and the stenosis is further ablated. The inflation of the balloon does not predominantly cause a crushing of the material of the stenosis against the vessel wall, but rather maintains intimate contact between the material and the vibrating surface, thereby maximizing delivery of ultrasonic energy to the material, and causing its complete ablation. Repeated inflations and deflations of the balloon allow for flushing of the ablated material by perfusion of blood.
The guide wire may be chosen to have a flexibility such that the catheter and guide wire may be steered into and used in coronary arteries.
FIG. 1 is a long-sectional view of the distal end of the preferred embodiment of the catheter of the present invention.
FIG. 2 is a long-sectional view of the proximal end of the preferred embodiment of the catheter of the present invention.
FIG. 3 is a cross-sectional view of an alternative multi-lumen embodiment of the catheter of the present invention.
FIG. 4 is a cross-sectional view of another alternative multi-lumen embodiment of the catheter of the present invention.
FIG. 5 is a sectional view of a blood vessel stenosis showing the catheter of the present invention in the process of ablating a path across the stenosis.
FIG. 6 is a sectional view of a blood vessel stenosis showing the catheter of the present invention after crossing the stenosis and in the process of further ablating the stenosis.
Generally, the catheter of the present invention comprises an tubular extrusion having at least two lumen. A first lumen is used to accommodate a flexible guide wire. A second lumen forms a fluid path for a conductive contrast fluid which both serves to inflate a balloon located at the distal end of the catheter, and to conduct an ultrasonic electrical signal. The outer surface of the catheter is metalized along its length, as is the outer surface of the balloon at its distal end, to form a second conductive path for the application of an ultrasonic electrical signal. The balloon is formed of polymeric material having piezoelectric properties. The outer metalized surface forms one conductive path to the outer surface of the balloon, while the conductive contrast fluid forms a second conductive path to the inner surface of the balloon, such that an ultrasonic signal across the two conductive paths creates a signal potential across the material thickness of the balloon. By virtue of its piezoelectric properties, the balloon will mechanically deform in response to the changing potential. At the proximal end of the catheter, an appropriate hub or connector facilitates connection to a source of contrast fluid and to a source of ultrasonic electrical signal.
Turning to FIG. 1, the distal end 10 of a catheter according to the present invention has an angioplasty balloon 12 which also acts as a transducer when excited by a.c. or d.c. frequencies of up to 1 GHz. One end of the balloon is connected to an inner tube 14 of the catheter, which tube serves as the through-hole for the guide wire 16. At its other end, the balloon is connected to the outer tube 18 of the catheter. The space between the inner tube 14 and the outer tube 18 defines a fluid path 20 into which a conductive contrast fluid may be pumped to provide an inflation pressure for the balloon, and additionally to provide a conductive path for the application of an excitation signal to the piezoelectric balloon. A second conductive path takes the form of a layer 22 of metalization which covers the outer surface of the balloon and the outer surface of the outer tube 18. The metalization layer 22 preferably does not contact any portion of the inner tube 14.
The balloon may comprise a flexible, expandable polymeric material possessing piezoelectric properties. Many well-known materials are suitable, such as a copolymer synthesized from polyvinylidene difluoride (PVDF)/trifluoroethylene crosslinked with a polyolefin polymer. Such a balloon may be readily fabricated as is known in the art from extruded tubing, with inflated dimensions preferably approximately in the range of 2 mm to 4 mm in diameter, and a length approximately in the range of 20 mm to 25 mm, depending upon the desired application. The wall thickness preferably should be approximately in the range of 9 microns to 56 microns, however, for a given balloon size, the capacitance will vary with the wall thickness, and may need to be taken into consideration.
The tensile strength of piezoelectric homopolymers, copolymers and compounds is only approximately half that of polyethylene terephthalate (PET), which is commonly used for fabrication of conventional angioplasty balloons. However, high inflation pressures typically required of conventional angioplasty balloons are not required in the present invention, because the inflation of the balloon according to the present invention is not primarily for the purpose of crushing the stenosis material against the vessel wall, but rather primarily for merely maintaining contact between the balloon surface and the stenosis material as the stenosis is ablated.
The extrusion of such balloons is known in the art, such as in U.S. Pat. No. 4,490,421 to Levy, the teachings of which are incorporated by reference. The method in Levy describes the formation of balloons from polyethylene terephthalate, but can be used identically in the formation of balloons from piezoelectric homopolymers, copolymers and compounds which can be bi-axially oriented, i.e., which can be blown after extrusion. Alternatively, custom fabricated balloons are commercially available from such companies as Advanced Polymers, Inc., of Salem, N.H.
Piezoelectric copolymers are typically long-chain semicrystalline polymers containing repeating units of CH2 --CF2. By way of example, PVDF may be compounded with PET in a ratio of 30% to 70% by dry weight to produce a piezoelectric material which can be bi-axially oriented. Such a compound may be prepared by extruding the 70 parts-by-weight of 5-micron granulated PVDF, then pelletizing the extrusion, and mixing with the 30 parts-by-weight of granulated PET, and extruding, stretching and blowing the mixture to form a balloon from the resulting compound, which can be subsequently treated to create piezoelectric properties, as outlined below.
Alternatively, PET may be compounded with the copolymer PVDF/trifluoroethylene, which has a piezoconstant approximately twice that of PVDF alone. Yet another alternative is the compound of PET and the copolymer PVDF/tetrafluoroethylene. PET may also be compounded with polyvinylidene cyanide, which exhibits piezoelectric properties similar to those of PVDF. In each case, PET may be replaced by any suitable polyolefin copolymer, such as polyethylene/ethyl vinyl alcohol. A variety of piezoelectric materials may be used for the balloon, comprising one of any number of compounded and/or crosslinked combinations of at least one of the set of piezoelectric copolymers such as PVDF, polyvinylidene fluoride, PVDF/tri- and PVDF/tetrafluoroethylene, and polyvinylidene cyanide, and at least one of the set of polyolefin copolymers like PET or polyethylene/ethyl vinyl alcohol.
According to the preferred embodiment of the invention, the piezoelectric balloon comprises a copolymer that is synthesized from PVDF/trifluoroethylene crosslinked and/or compounded with a suitable polyolefin copolymer, in a ratio that provides maximum piezoelectric response with the ability to be bi-axially oriented.
After extrusion and blowing, the balloon must be treated so that it exhibits piezoelectric properties. What is called the "alpha phase" of the material occurs when the polymer is cooled from a molten state. This phase is not piezoelectric. Typically, the exemplary piezoelectric material polyvinylidene diflouride (PVDF) may be converted to its potentially piezoelectric beta phase by a three-step treatment comprising physical stretching, electrical poling and electroding. In the present invention, stretching is achieved during production of the balloon according to the method described in Levy. Alternatively, stretching of the tubular balloon as it is extruded, or inflation at high pressure of the balloon after extrusion, will also suffice to convert it to the beta phase. In the beta phase, the carbon chains are aligned in parallel strips and planes.
Subsequent poling of the beta-phase PVDF material by corona discharge or field poling yields alignment of hydrogen and fluorine atoms to form aligned dipoles in the material and resultant piezoelectric properties. One method of poling comprises passing the balloon between two electrodes which create a corona discharge. However, the piezoelectric nature of the resultant balloon will not be uniform around its circumference. In a preferred method of poling, a thin, cylindrical first electrode is placed inside the tubular balloon, while a second cylindrical electrode is placed around the outside of the balloon, and a corona discharge is initiated and maintained for a period of time across the thickness of the balloon. The electrical and ambient parameters required for poling by corona discharge are known in the art, and are detailed in C. F. Liaw et al., "Poling of Multiple PVDF Films by Moving Corona Discharge", Ferroelectrics, Vol. 99, pp. 127-132 (1989), the teachings of which are incorporated by reference.
The guide wire 16 may be made of a suitable material such as stainless steel. Any number of conventionally available guide wires may be chosen for insertion into the guide wire lumen.
Turning now to FIG. 2, the proximal end 30 of the catheter according the present invention is shown having a catheter hub 32. A circular channel 33 through the length of the hub has three sections of differing diameters. A first section 34 has a channel diameter which can snugly accommodate adhesive bonding of inner tube 14 to its inner surface 35. A second section 36 has a channel diameter substantially greater than the outer diameter of inner tube 14, but smaller than the outer diameter of outer tube 18, to create a space around inner tube 14 for the flow of conductive fluid up the channel and into fluid pathway 20. A third section 38 has a channel diameter which can snugly accommodate adhesive bonding of outer tube 18 to its inner surface 37, as shown in FIG. 2. A bore hole 40 forms a pathway to the space of section 34 for the infusion of the conductive contrast fluid. The bore hole may have a winding 41 for the screw-like attachment or some other means of securing the attachment of a hose or pressure gauge or other device for delivering fluid to the fluid pathway 20 and sealing the fluid therein at a certain pressure. The hose or gauge may in turn connect to a mechanically or electrically controlled source of fluid pressure.
The hub 32 may be formed of polycarbonate, or any other polymeric material having approximately the same resilience, non-conductivity, and thermal and tensile qualities.
To provide for the application of an ultrasonic excitation signal to the piezoelectric balloon at the distal end of the catheter, a first electrically conductive lead 42 is embedded in hub 32 as shown in FIG. 2, such that one end protrudes from the hub to facilitate connection to a source of an ultrasonic electrical signal, and the other end protrudes into the fluid path between the hub channel diameter and the inner tube 14 outer diameter, such that it is in conductive contact with the fluid. The lead 42 is preferably a silver conductor. Furthermore, the lead 42 need not be limited to the short protrusion into the fluid path shown in FIG. 2, but may extend along the length of fluid pathway 20, all the way to the distal end of the catheter, entering the balloon void, thus reducing the impedance of the fluid path.
A second lead takes the form of a silver wire winding 44 wound around and in intimate conductive contact with the metalized surface of the outer tube 18, as shown in FIG. 2. A tail 46 of the wire winding facilitates electrical connection to a source of an ultrasonic electrical signal. The winding 44 is embedded in and surrounded by a bead 48 of conductive epoxy resin. A suitable conductive epoxy resin for this purpose, by way of example, is Tracon Tra-Duct 2922, available from Tracon, Inc., of Medford, Mass.
Importantly, the metalization layer 22 on the outer surface of outer tube 18 does not reach the catheter hub 32.
The inner tube 14 and outer tube 18 of the catheter can be extruded from any thermoplastic that meets friction, stiffness, flexibility and other criteria employed in the design of commercially available percutaneous transluminal angioplasty catheters as known in the art. Preferably, the tubes are extruded from high density polyethylene such as Petrothene 6800-00, which may be obtained from Quantum Chemical Co. of Cincinnati, Ohio. The length of the catheter should be approximately 135 cm, as is typical for conventional percutaneous transluminal coronary angioplasty catheters. The catheter may be marked at a regular interval, 10 cm by way of example, with a radio-opaque marker, as is typically done with conventional catheters known in the art.
The inner tube 14 should have an outer diameter slightly less than that of the distal shoulder 24 of the balloon to facilitate adhesive bonding to the balloon. The internal diameter of the inner tube 14 should preferably be about 0.020 inches to facilitate free passage of a typical guide wire having a diameter of between 0.014 and 0.018 inches. The wall thickness of inner tube 14 should be sufficient to withstand the pressure of the conductive fluid applied in the fluid pathway 20 for balloon inflation, which will typically be less than of four atmospheres. If the inner tube cannot withstand such pressures and collapses, it will bind the guide wire.
Similarly, the outer tube 18 should have an outer diameter slightly less than that of the proximal shoulder 26 of the balloon to facilitate adhesive bonding of the balloon. Balloon and outer tube dimensions should be selected such that the outer diameter of the outer tube 18 is less than 0.050 inches to facilitate steering the catheter through 180° turns in three planes in close proximity without exerting undue transverse pressure on the guide wire which would result in resistance to advancement of the balloon toward the stenosis site. Such flexibility is required to access certain coronary arteries.
Referring again to FIG. 1, the balloon is attached at its distal shoulder 24 to the outer surface of the inner tube 14, and similarly at its proximal shoulder 26 to the outer surface of outer tube 18, by adhesive bonding. Similarly, referring to FIG. 2, the inner tube 14 is attached by adhesive bonding to the inner surface 35 of the channel section 34 of the catheter hub 32. The outer tube 18 is attached by adhesive bonding to the inner surface 37 of the channel section 38 of the catheter hub. The polymeric materials of these surfaces which are bonded together preferably are treated to enhance bonding according to a method which does not change the inherent properties of the materials.
One such way of facilitating high strength bonding of these polymer surfaces is with exposure of the surfaces to activated inert gas, such as activated helium, for a short interval prior to application of an epoxy adhesive. Corona discharge is the preferred form of activation of the inert species for this purpose. The exposure causes a crosslinking of the polymer molecules on the surface of the material exposed, creating high cohesive strength ideal for adhesive bonding. Preferably, only those surfaces meant to be bonded together are exposed. This treatment is known in the art and is detailed in H. Schonhorn, "Surface Treatment of Polymers for Adhesive Bonding", J. Applied Polymer Science, Vol. 11, pp. 1461-1474 (1967), the teachings of which are incorporated by reference.
While the catheter 10 may take the form of two independent tubes, the inner tube 14 and the outer tube 18, one inside the other, such an arrangement need only be a model for the distal and proximal ends of an otherwise multi-lumen extrusion. Turning to FIG. 3, a cross-sectional view of the distal end of the catheter 10 taken along the line 3 in FIG. 1 shows one such possible arrangement of the lumen in a multi-lumen version of the catheter 10. Inner tube 14 and outer tube 18 actually comprise a single solid extrusion having bridging sections 52 and 54 between them. Fluid path 20 now comprises two lumen, one above the bridge and one below the bridge. Epoxy adhesive layer 56, balloon 12, and metalization layer 22 are also shown, but not to scale. Inside inner tube 14 can be seen the guide wire 16.
In an alternative embodiment, the catheter 10 can be formed as a multi-lumen extrusion having a cross-section as shown in FIG. 4, as it would be seen along line bisection the catheter at its mid-point. Here the inner tube 14 and the outer tube 18 have been substantially merged into a single solid multi-lumen extrusion. Furthermore, inner tube 14 and outer tube 18 are no longer concentrically arranged. It is to be understood that this multi-lumen version of the catheter 10 can be so shaped at its distal and proximal ends as to provide the protruding inner tube as shown in FIGS. 1 and 2, and that the catheter hub and balloon can be easily adapted to the non-concentricity of the catheter shaft without any technical difficulty. Also shown are the fluid pathways 20 and the guide wire 16. The metalization layer 22 is shown to scale and therefore appears in the figure to have no thickness.
The catheter should be assembled in the following manner. The extrusion and poling of the balloon, and the extrusion of the multi-lumen shaft of the catheter may first be carried out separately. The catheter hub may be formed and bored according to specifications. The areas of these parts which are to be joined by adhesive are then treated to increase their bondability according to the description above. Subsequently the balloon is bonded with such as epoxy adhesive or the like to the distal end of the catheter. The catheter hub may be bonded to the proximal end of the catheter prior to metalization of the outer surface of the catheter, or may by bonded thereto only after the outer surface has been metalized, since in any case, the catheter hub is not meant to be metalized. Conductive lead 42 may be emplaced in the catheter hub at any time.
Metalization of the outer surface of the catheter, including the outer surface of the balloon, may be achieved by evaporated metal or plasma sputtering techniques, as are commonly known in the art. Such metalizing services are readily available on a commercial basis. It is preferable to inflate the balloon before metalization so that substantially all of its inflated surface area is metalized. Of course, the metalization may also be limited to just the region around the balloon, with a wire embedded in the catheter shaft extrusion connected thereto to provide a conductive path back to the catheter hub. A layer of nickel, copper, gold, silver, or other appropriate conductive metal may be deposited to a thickness in the range of approximately 50 Angstroms to approximately 800 Angstroms. Silver is preferred as the metal layer due to its low resistivity of approximately 1,586 μohm/cm.
After metalization, a conductive wire winding 44 of preferably silver wire may be wrapped around the catheter shaft in intimate conductive contact with the metalized surface. A tail 46 of the winding 44 may be used for connection to an ultrasonic signal source. Thereafter, the winding may be embedded in a coating bead of conductive epoxy resin 48.
Finally, in order to insulate the outer metalized conductive path from contact with the organic tissues of the human body, a conformal coating of Parylene Polymer less than about one micron thick may be applied to the catheter, again with the balloon in the inflated condition. This service is available from Nova Tran Corp., of Clear Lake, Wis.
The balloon transducer of the catheter of the present invention may be powered with an ultrasonic excitation electrical signal source connected to the conductive leads 42 and 46 with the fluid path filled, either nominally or at an increased pressure, with conductive contrast fluid. While the balloon will respond to signals up to 1 GHz, it is preferable to use frequencies in the range of about 10 kHz to about 40 kHz. In clinical use, the power output of the balloon should not exceed 25 watts, otherwise necrosis of the smooth muscle cells may occur. The signal generator used should have a fixed output frequency and a maximum amplitude setting to avoid misuse or inadvertent injury to the patient. The balloon may be driven, by way of example, with a 20 kHz signal with a 500-volt RMS amplitude on a 50% duty cycle of 30 milliseconds at 60 second intervals. In other words, such a drive would deliver 600 cycles of 500 RMS volts for 30 milliseconds, then rest for 30 milliseconds, and this can be done 1000 times for every 60 second interval, after which the drive may be stopped to evaluate progress. The balloon may be driven by any waveform, such as a square wave or a sinusoidal wave, or by pulsed d.c.
In order to excite the piezoelectric balloon, the fluid path 20 is evacuated and then back filled with conductive contrast fluid. The balloon can be excited in either the deflated or inflated state. Silver conductive lead 42 is then in conductive contact with the fluid. A potential applied across the two conductive leads 42 and 46 causes a potential across the thickness of the balloon 12. The potential across the balloon in turn causes dimensional changes in all three planes of the piezoelectric film of the balloon to varying degrees for each plane. As the voltage increases, the magnitude of the deformation increases and if the voltage applied is cyclical, the frequency of the deformation will match the frequency of the applied signal.
Since no conductive fluid is in contact with the distal and proximal shoulders of the balloon where epoxy adhesive bonds the balloon to the inner tube 14 and the outer tube 18, no deformation of the balloon at the bond sites will occur, and these bonds will not be jeopardized by deformation.
The conductive contrast fluid may be provided by a controlled source able to monitor and adjust the fluid pressure applied to the fluid path of the catheter. Preferably, the source is also able to provide an oscillating or periodic pressure to the fluid, for repeated inflation and deflation of the balloon at regular intervals of about 10 milliseconds to about 100 milliseconds, by way of example. Such a device facilitates the cycle of inflation and deflation of the balloon according to the method described below, where deflation allows for flushing of the ablated stenosis material. The device may preferably be a computerized or programmable electronic device with pneumatic control over the applied pressure of the contrast fluid.
Turning now to FIG. 5, the angioplasty balloon catheter 10 of the present invention is shown in use in ablating a substantially completely stenosed artery. The arterial wall 60 a buildup 62 of biological material forming the stenosis. The guide wire 16 typically may be pushed through such a stenosis without difficulty because guide wires are very small, very stiff and easy to push. The catheter 10, however, has a much greater profile diameter, and lacks the stiffness of a guide wire so that it cannot be pushed across the stenosis.
When the distal tip of the catheter comes into contact with the stenosis, the balloon, which is in the deflated state, is excited according to the invention with an ultrasonic signal. The balloon material deforms accordingly, with the major axis of deformation being along the axis of the catheter. The amplitude of deformation is small, however the frequency is high, matching the frequency of the ultrasonic signal. This results in a hammering of the tip of the catheter against the stenosis, ablating the biological material thereof. Predominantly, the mechanical impact loosens and breaks up the material, however, ultrasonic energy is also secondarily transmitted to the stenosis via waves in the surrounding blood plasma, which assists in the ablation of the biological material forming the stenosis. The ultrasonic energy is particularly useful in causing the biological material to break up into sufficiently small particle sizes to minimize the risk of downstream embolism or clotting.
As shown in FIG. 5, the vibration of the balloon, in conjunction with the application of an axial load by the operator, causes the ablation of the stenosis material 64. As a result, the catheter hammers open a path for itself through the stenosis. After the catheter has crossed the stenosis, the pressure of the conductive contrast fluid is increased, preferably by means of a controlled source, to inflate the balloon, as shown in FIG. 6. As the balloon 12 is inflated, the ultrasonic excitation signal is maintained, so that the balloon continues to vibrate. It is contemplated that the balloon may be inflated slowly, by slowly increasing the fluid pressure, or rapidly with an inflation pressure of about four atmospheres, depending on the diameter of the artery, the stenosis material and stenosis size. In either case, the frequency of the excitation signal realizes substantially quicker motion in the form of deformation than the motion of inflation, such that even with rapid inflation, the stenosis material 64 is ablated by ultrasonic vibrations rather than crushed against the arterial wall 60.
A cycle of frequent inflation and deflation during ablation of the stenosis may optimally be employed according to the method of the invention. Apparatus for supplying the inflation pressure should be programmed or otherwise controlled to successively inflate and deflate the balloon in the excited state at a peak pressure of about 4 atmospheres, at a periodicity in the range of about 10 milliseconds to about 100 milliseconds. This periodicity is substantially slower than the frequency of the ultrasonic vibration, allowing for approximately 200 to 2000 vibrations per inflation at an ultrasonic frequency of 20 kHz, for example. At such a periodicity, the periods of balloon deflation permit the ablated stenosis material to be flushed by the flow of blood, and also permit perfusion of blood for downstream supply of oxygen, thereby avoiding ischemia. The perfusion also serves to return the balloon to normal temperature from the anticipated 1° C. or 2° C. anticipated rise in temperature.
The performance of the ultrasonic ablation may be monitored in real-time by means of a fluoroscope, as is commonly practiced in the art in conventional balloon angioplasty. The ablation of the material by repeated inflations of the excited balloon transducer may be performed until substantially all of the stenosis is ablated.
The catheter of the present invention provides a novel means of ablating a stenosis of a coronary artery or any other vessel in the human body. The catheter and the method for using the catheter can be applied to any small profile or even totally occluded stenosis to produce an aperture or completely ablate the stenosis. Ablation has the advantage of reducing the subsequent risk of re-stenosis. Also, the use of ultrasonic energy has the advantage of pulverizing the stenosis into particles too small to create a risk of downstream embolism.
While the invention has been described with reference to a preferred embodiment, it is to be clearly understood by those skilled in the art that the invention is not limited thereto. Accordingly, the scope of the invention is to be interpreted only in conjunction with the appended claims.
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|14 Abr 2000
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|Methods for in vivo magnetic resonance imaging
|19 May 1998
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|24 Mar 2000
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|Magnetic resonance imaging guidewire probe
|2 Abr 2001
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|Systems and methods for evaluating the urethra and the periurethral tissues
|11 Jun 2002
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|Catheter balloon with ultrasonic microscalpel blades
|24 Abr 2002
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|24 May 2005
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|9 Feb 2004
|14 Sep 2010
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|11 Abr 2002
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|Intravascular filter device with piezoelectric transducer
|24 Abr 2009
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|Ablative ultrasonic-cryogenic apparatus
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|Method of manufacturing an ultrasound transmission member for use in an ultrasound catheter device
|7 Nov 2006
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|Flowcardia, Inc.
|Vibrational catheter devices and methods for making same
|12 Jun 2009
|24 Jul 2012
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|18 Jul 2008
|21 Ago 2012
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|Ultrasound catheter having improved distal end
|13 Nov 2012
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|Intrabody HIFU applicator
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|11 Oct 2002
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|Sahatjian Ronald A.
|Catheter Lesion diagnostics
|11 Jun 2002
|11 Dic 2003
|Miller Paul James
|Catheter balloon with ultrasonic microscalpel blades
|20 Jun 2003
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|14 May 2004
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|Apparatus and method for an ultrasonic medical device with a non-compliant balloon
|2 Mar 2004
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|Occlusion balloon catheter with external inflation lumen
|24 May 2005
|8 Jun 2006
|Surgi-Vision, Inc.
|Evaluating the urethra and the periurethral Tissues
|23 Ago 2006
|25 Ene 2007
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|Ultrasound catheter for disrupting blood vessel obstructions
|12 Jun 2007
|11 Oct 2007
|Johns Hopkins University
|Biopsy and Sampling Needle Antennas for Magnetic Resonance Imaging-Guided Biopsies
|5 Abr 2006
|11 Oct 2007
|Henry Nita
|Therapeutic ultrasound system
|16 Jul 2007
|8 Nov 2007
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|Pre-shaped therapeutic catheter
|7 Sep 2007
|13 Mar 2008
|Spence Paul A
|Ultrasonic implant, systems and methods related to diverting material in blood flow away from the head
|21 Dic 2007
|8 May 2008
|Henry Nita
|Ultrasound catheter having protective feature against breakage
|28 Ene 2008
|10 Jul 2008
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|Steerable ultrasound catheter
|22 May 2008
|18 Sep 2008
|Flowcardia, Inc.
|Therapeutic ultrasound system
|18 Jul 2008
|20 Nov 2008
|Henry Nita
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|17 Dic 2008
|23 Abr 2009
|Boston Scientific Scimed, Inc.
|Occlusion balloon catheter with external inflation lumen
|30 Oct 2007
|30 Abr 2009
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|24 Abr 2009
|20 Ago 2009
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|Ablative ultrasonic-cryogenic apparatus
|22 Abr 2009
|27 Ago 2009
|Flowcardia, Inc.
|Ultrasound catheter devices and methods
|14 May 2009
|3 Sep 2009
|Bacoustics, Llc
|Ablative ultrasonic-cryogenic methods
|7 Ago 2009
|28 Ene 2010
|Flowcardia, Inc.
|Ultrasound catheter and methods for making and using same
|7 Ago 2009
|28 Ene 2010
|Flowcardia, Inc.
|Ultrasound catheter and methods for making and using same
|16 Dic 2010
|Henry Nita
|Device and method for vascular re-entry
|26 May 2011
|Flowcardia, Inc.
|Ultrasound catheter devices and methods
|30 Jun 2011
|Ross Tsukashima
|Angioplasty Balloon Catheter with Active Delivery Medicament(s) Using Ultrasonic Means
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|Spence Paul A
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|Intrabody hifu applicator
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|10 Sep 1999
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|14 May 2004
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|Catheter for treatment of total occlusions and methods for manufacture and use of the catheter
|Clasificación de EE.UU.
|606/169, 606/170, 128/898, 604/22, 606/171, 606/191, 606/194
|Clasificación internacional
|Clasificación cooperativa
|Clasificación europea
|10 Abr 2000
|Fee payment
Year of fee payment: 4
|17 Sep 2004
|Fee payment
Year of fee payment: 8
|22 Sep 2008
|Maintenance fee reminder mailed
|18 Mar 2009
|Lapse for failure to pay maintenance fees
|5 May 2009
|Expired due to failure to pay maintenance fee
Effective date: 20090318


text:
3) Early 19th-century nationalism directly opposed the principle
upheld at the Congress of Vienna
A) legitimate monarchies or dynasties, rather than ethnicity, provide the basis for political unity.
B) A set of common ideals should provide the basis for political unity.
C) ethnicity, rather than monarchies or dynasties, provide the basis for political unity.
D) military strength, rather than ethnicity, provides the basis for political unity.
E) common language should provide the basis for political unity.
4) A significant difficulty for nationalism was, and is: 4)
A) transitioning from monarchies to republicanism and peaceful elections.
B) determining which ethnic groups could be considered nations, with claims to territory and
political autonomy.
C) deciding which religion should be accepted as the formal religion of the state.
D) finding enough support among the mass of the population.
E) settling on which national customs should be formally adopted by the state and schools.
5) Nineteenth-century liberals derived some of their political ideas from the: 5)
A) biblical passages within the doctrine of the Holy Roman Church.
B) the writings of Thomas Hobbes.
C) ancient writings of the Romans.
D) writers of the Enlightenment.
E) philosophers of the American Revolution.
6) Which of the following is not a region of nationalistic pressure during the 19th century? 6)
A) Austrian rule in Hungary
B) Italian unification on the peninsula
C) French rule in Belgium
D) Polish rulers seeking to drive out Russian rulers
E) English rule in Ireland
7) The political goals of nineteenth-century liberals included all of the following except: 7)
A) religious toleration.
B) distribution of land.
C) limited government regulation of business.
D) legal equality.
E) freedom of the press.
8) All of the following are consistent with the goals of nineteenth-century liberals except: 8)
A) the removal of international tariffs and internal barriers to trade.
B) the desire to maintain the economic restraints associated with mercantilism or the regulated
economies of enlightened absolutists.
C) the desire for an economic structure in which people were free to use whatever talents and
property they possessed to enrich themselves.
D) the opposition to the old paternalistic legislation that established wages and labor practices by
government regulation or by guild privileges.
E) support for efforts to reform agricultural policies and techniques.
9) Which of the following correctly identifies the major pillars of 19th-century conservatism? 9)
A) established churches, solid military, and legitimate monarchies
B) landed aristocracies, established churches, and solid military
C) solid military, established churches, and legitimate monarchies
D) land, labor, and law
E) legitimate monarchies, landed aristocracies, and established churches
10) In December 1816, an unruly mass meeting took place near London. As a result of this disturbance 10)
A) temporarily suspended habeas corpus.
B) extended existing laws against seditious gatherings.
C) executed nearly 500 people.
D) outlawed workers' organizations or unions.
E) both A and B
11) The Charter provided for a(n): 11)
A) appointed legislature and hereditary monarchy.
B) suffrage for women and minorities.
C) bicameral legislature and elected monarchy.
D) elected monarchy and appointed legislature.
E) hereditary monarchy and a bicameral legislature.
12) Although their provisions were limited in scope, these three German states granted constitutions 12)
after 1815:
A) Hamburg, Bremen, and Brandenburg.
B) Wu¨rttemberg, Hessen, and Bremen.
C) Baden, Bavaria, and Wu¨rttemberg.
D) Bremen, Prussia,and Saxony.
E) Hessen, Bavaria, and Baden.
13) The major powers at the Congress of Vienna included: 13)
A) Russia, France, Italy, and Great Britain.
B) Prussia, Austria, France, and Italy.
C) Prussia, France, Austria, and Great Britain.
D) Russia, Austria, Prussia, and Great Britain.
E) Russia, Prussia, Italy, and Great Britain.
14) The Six Acts attempted to: 14)
A) raise public revenue through taxes and prohibit illegal search and seizures.
B) give the monarchy new powers and begin military expansion.
C) prevent radical leaders from agitating and to give the authorities new powers.
D) prevent Catholics from exercising their civil rights.
E) both A and B
15) The Concert of Europe refers to the: 15)
A) new informal arrangement for resolving mutual foreign policy issues.
B) the combined effort to defeat Napoleon.
C) new Russian, Austrian, Prussian, and British quadruple alliance.
D) 1814 restoration of the French monarchy.
E) January 1820 outbreak of the Spanish revolution.
16) The Treaty of London, signed in 1827, demanded: 16)
A) that Russia resign Romania as an independent state.
B) Turkish recognition of Greek independence.
C) that the Turks allow Britain, France, and Russia to decide the future of Greece.
D) both B and C.
E) both A and C.
17) Louis XVIII agreed to become a(n): 17)
A) socialist monarch.
B) constitutional monarch.
C) elected president.
D) absolute monarch.
E) parliamentary monarch.
18) This event sparked movements for independence from European domination throughout Latin 18)
A) the American Revolution from Great Britain.
B) the Crimean War.
C) the wars of the French Revolution, particularly those of Napoleon.
D) the French and Indian War.
E) the War of 1812.
19) Between 1791 and 1804 this French colony achieved independence: 19)
A) Haiti.
B) French Indochina.
C) the Dominican Republic.
D) Cuba.
E) Guiana.
20) By 1830: 20)
A) Bolivia and Chile had achieved independence.
B) Colombia and Bolivia had achieved independence.
C) Argentina and Brazil had achieved independence.
D) Uruguay had achieved independence.
E) most of Latin America had achieved independence.
21) He was placed on the Spanish throne after Napoleon's downfall and although he promised to 21)
govern according to a written constitution, he ignored his pledge:
A) Charles X.
B) Alexander I.
C) Ferdinand VII.
D) Louis XVIII.
E) Estaban VII.
22) Which of the following events illustrated to Russian soldiers how backward and politically stifled 22)
their own nation remained?
A) visits by foreign army officers
B) Russian and Austrian commercial exchange
C) Russian battles with the Prussians
D) Russian occupation of France
E) the imposition of new taxes on the merchant class
23) He supported the American Monroe Doctrine in 1823 and is credited with the successful conclusion 23)
of the War of Jenkins's Ear:
A) William Pitt the Younger.
B) Klemens von Metternich.
C) George Canning.
D) Thomas Babington Macaulay.
E) William Jenkins.
24) Although this revolt failed completely, it was the first rebellion in modern Russian history whose 24)
instigators had specific political goals:
A) Senate Square Revolt.
B) Revolt of 1825.
C) Revolt of Saint Petersburg.
D) October Revolt.
E) Decemberist Revolt.
25) The Russian Tsar was king of this country and frequently infringed on the constitution and 25)
quarreled with its diet:
A) Prussia. B) Serbia. C) Poland. D) Finland. E) Estonia.
26) Great Britain supported independence in Latin America because it: 26)
A) hoped to secure commercial interests on the continent.
B) thought this would harm the United States.
C) was sympathetic to the plights of the Latin American slaves.
D) hoped to provoke a war with the United States.
E) wanted to colonize Latin America itself.
27) He imposed an authoritarian constitution on Haiti and made himself Governor-General for life, 27)
but he preserved formal ties with France:
A) San Marti´n.
B) Toussaint L'Ouverture.
C) Miguel Hidalgo y Costilla.
D) Simo´n Bol´ivar.
E) King Miguel II.
28) Independence in Brazil: 28)
A) was bloodless.
B) was accompanied by the freeing of all the slaves.
C) was won at the cost of thousands of Creole lives.
D) was won at the cost of thousands of slaves' lives.
E) left Brazil a monarchy for another 67 years.
29) Tsar Alexander I turned away from reform and at home and abroad took the lead in suppressing: 29)
A) nationalism and communism.
B) communism and socialism.
C) feminism and Catholicism.
D) liberalism and nationalism.
E) socialism and liberalism.
30) This officer advocated representative government and the abolition of serfdom: 30)
A) Pestel. B) Trotsky. C) Paul. D) Putin. E) Molotov.
31) This secret society was more moderate and favored constitutional monarchy and the abolition of 31)
serfdom, but wanted to protect the interests of the aristocracy:
A) Southern Society.
B) Compass Society.
C) Northern Society.
D) Eastern Society.
E) Western Society.
32) Who succeeded Tsar Alexander I after his unexpected death in November 1825? 32)
A) Constantine
B) Paul
C) Nicholas
D) Michael I
E) Alexander II
33) Who stated "there is no doubt that serfdom, in its present form, is a flagrant evil which everyone 33)
realizes, yet to attempt to remedy it now would be, of course, an evil more disastrous"?
A) Alexander I
B) Voltaire
C) Paul I
D) Constantine I
E) Nicholas I
34) 34)
´ ´
He lowered interest rates on government bonds in order to create a fund to pay an annual sum to
the survivors of the emigres who forfeited land, restored the rule of primogeniture, and enacted a
law that punished sacrilege with imprisonment or death:
A) Alexander I.
B) Louis XVIII.
C) Napoleon III.
D) Charles X.
E) Louis Philippe.
35) Which of the following is not true of the Four Ordinances? 35)
A) They eliminated any further elections.
B) They called for new elections.
C) They dissolved the recently elected Chamber of Deputies.
D) They restricted freedom of the press.
E) They limited the franchise to the wealthiest people in the country.
3) Early 19th-century nationalism directly opposed the principle
upheld at the Congress of Vienna

subset: commoncrawl


text:
Katusha's Rodriguez emerged from a battle with several top riders to cross the finish line, situated on the Green Mountain climb, in first place.
"It was a spectacular win ," said the Spaniard. "I'm very happy with this performance: my rivals are great riders, so the fact I managed to take this stage makes this victory even more important. Obviously they're not in top shape, but neither am I. I'm in good condition for February though.
"I knew this climb very well, because it is the third year I have taken part in the Tour of Oman. It is really demanding, but I knew where to start my sprint and this helped me a lot."
Froome finished in second - and with incumbent general classification leader Sagan (Cannondale) falling behind the front-runners, the Team Sky rider moved into the overall lead.
Cadel Evans (BMC Racing) finished third which puts the Australian second on GC, 24 seconds behind Froome. Alberto Contador's fourth-placed finish leaves him in third overall, an additional second behind Evans. Sagan's Cannondale stablemate Vincenzo Nibali came in fifth.
After 16km of the 144km stage Brent Bookwalter (BMC), Gregory Rast (RadioShack-Leopard), Gatis Smukulis (Katusha), Paul Voss (NetApp-Endura) and Matthias Friedman (Team Champion System) escaped.
They built up a lead of 4:10 as they crossed three gentle ascents but Saxo-Tinkoff, Astana and Katusha headed the peloton and the lead was less than two minutes with 14km remaining.
And they were caught early on the steep summit finish on Jabal Al Akhdhar, or "Green Mountain", which tops out at 1235m where Purito beat a small but select group which did not include Tour de France winner Bradley Wiggins who was dropped on the lower slopes.
The Tour of Oman continues on Friday with the penultimate stage, a 144km trek from Al Alam Palace to the Ministry of Housing in Boshar - a stage which takes in three ascents of the brisk Bousher Alamrat climb.
- Sports & Recreation


text:
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text:
In This Section
Journal Forum
A Meta-Analysis of High Resolution Audio Perceptual Evaluation - June 2016
2 comments
Synthetic Reverberator - January 1960
3 comments
Sound Board: High-Resolution Audio - October 2015
4 comments
AES E-Library
Radiation of Enclosed Loudspeaker in Baffle: Simulation Model and Results
A theoretical investigation of the conventional speaker, placed into a rigid wall, has been presented at AES 116 [1]. The quasi-dynamic approach to the loading force and pressure was introduced there. The speaker diaphragm was regarded as a number of concentric rings. The acoustic pressure and surface velocity is predicted using the first two approximations in [1]. These simulations show the difference between the real measurements and the analytical models, used with some standard assumptions from the classic theory of plates. The results suggest that the modelling process needs to become more specified. Hence, to simulate the behaviour of a standard suspension, the outer, clamped ring was given the characteristics of rubber, with non-linear deformations. The 4th approximation of the problem is formulated in this paper.
Click to purchase paper as a non-member or login as an AES member. If your company or school subscribes to the E-Library then switch to the institutional version. If you are not an AES member and would like to subscribe to the E-Library then Join the AES!
This paper costs $33 for non-members and is temporarily free for AES members.
Learn more about the AES E-Library
Start a discussion about this paper!


text:
Possible Duplicate:
Encryption of a movie file.
I have downloaded an avi movie and I have been asked to look for the video codec in u website
I have downloaded an avi movie and I have been asked to look for the video codec in u website
marked as duplicate by ChrisF, Bobby, Sathya♦ Mar 8 '11 at 12:20
This question has been asked before and already has an answer. If those answers do not fully address your question, please ask a new question.
Try using VLC Media PLayer
It is capable of playing (almost?) any video file, and should definitely be able to play your video.
If you didn't want to try a different player, and you are on:
Windows: you should be able to use The Combined Community Codec Pack to play the video in your player of choice.
I have heard of some "films" simply being videos directing you to go a random website on the internet and download a codec from there and install it, whereby they can potentially install a virus and other malicious software onto your computer. While this may not be the case for you it is a possibility.
I'd go with Azz and try playing it with VLC, if that can't figure out what the file is and play at least some of it then more likely than not the file is bogus.


text:
Live Prices Not Available
To show you the most accurate prices, TTPM only displays our pricing tool on products which we've reviewed in the past three years.
The MEGA Bloks Chuggington Jet Pack Adventure building set comes with 103 pieces that let kids build and rebuild the clock tower and train depot in four different configurations. Build the tracks through the buildings and ride the rails up to four levels high. Attach Wilson's jet pack to the buildable skyrail and send Wilson "flying" down. The set also includes Action Chugger. Both train engines have moveable mouths when a button on their heads is pressed. A four-part buildable Vee is also included.
Chuggington fans will enjoy building a familiar scene from the TV show and interacting with toy versions of the characters they like to watch on TV. Kids will like the different actions of each train engine and creating new adventures for Action Chugger and Wilson.
The MEGA Bloks Chuggington Jet Pack Adventure set is for Chuggington fans ages 3 and up.
Young kids will need help from parents to put this set together. It took us about 30 minutes to assemble.
Sometimes the jet pack comes off the track.
The assembly booklet only shows you how to build one configuration of this set. There are pictures of the other three configurations to use as a guide if you build those. Instructions can be found online at http://chuggington.megabloks.com/en/videos/10/Jet-Pack-Adventure.
Farmhouse Friends
from MEGA Bloks
MEGA Bloks Food Truck Kitchen
from Fisher-Price
Swing & Slide Safari
from MEGA Bloks
MEGA Bloks Fisher-Price Build 'n Go Table
from Mattel
First Builders Peter Police Car
from MEGA Bloks
Teenage Mutant Ninja Turtles Half Shell Heroes Raph Shell Cycle
from MEGA Bloks
Little Architect - Girls
from Crocodile Creek
Little Architect - Boys
from Crocodile Creek
Blaze and the Monster Machines Jungle Ramp Rush
from MEGA Bloks
LEGO Duplo Around the World
from LEGO


text:
Léon: The Professional (French: Léon; also known as The Professional) is a 1994 English-language French crime thriller film written and directed by Luc Besson. It stars Jean Reno and Gary Oldman, and features the motion picture debut of Natalie Portman. In the film Leon (Reno), a professional hitman, reluctantly takes in 12-year-old girl Mathilda (Portman), after her family is murdered by corrupt Drug Enforcement Administration agent Norman Stansfield (Oldman). Léon and Mathilda form an unusual relationship, as she becomes his protégée and learns the hitman's trade. Wikipedia
Malky: Hey Stan, Stan! What are doing? He's dead!
Stansfield: But he ruined my suit.
|10 points
|2 points
|1 point
|1 point
|1 point


text:
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In this paper, an indirect noninvasive method for measuring input impedance and the variations in the assembly of the interconnect and packaging between antenna and the integrated circuit (IC) effects of passive radio frequency identification (RFID) transponder (tags) antennas is presented. The analysis of different RFID tags is presented together with the experimental data.
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text:
Thegrideon Asterisk Password Recovery$29.95
Quick Specs
Total Downloads:2,382
Date Added:May 07, 2012
Price:Free to try (Password length is limited ); $29.95 to buy
File Size:971.52KB
Downloads Last Week:33
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From Thegrideon Software: Asterisk Password allows you to read passwords hidden behind the asterisks in dialog's password fields. Asterisk Password uncovers hidden passwords from password dialog boxes, web pages and ActiveX controls. Another great feature of this program is the ability to display Protected Storage contents. Protected Storage is widely used by a range of Windows programs and Web services to store confidential information as well as passwords.
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iTunes streaming
Apple's Streaming Preview Of Daft Punk's New Album Leads To Free Download
Just because you can pirate an unreleased album, doesn't mean you should.
Lory Gil
| May 17
Pandora Could Be Toast As Apple Gets Ready To Launch Streaming Music Service
Apple is set to launch their own streaming music service.
Bryan M. Wolfe
| September 7
Apple Now Streaming Red Hot Chili Peppers' Upcoming Album In iTunes - First Sign Of More To Come?
In a special promotion, Apple is now allowing users to an upcoming album free of charge right in iTunes.
Alexander Vaughn
| August 23


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Northern Edge Elite Hockey School
178 Chesterfield Industrial Blvd
Chesterfield, MO 63005
Visit website
Is this your business?
Promote your business through our innovative Marketplace system! It's free to sign up!
Sign up to update your information for free! See options to post blog articles, photos and promote your listing!Log in & claim
Business ID: 26105344 | Universal ID: 401d59d0-e23c-5c6e-869b-59f7f9eae2fd


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Five-Spice Pork Spareribs
Total Time
Prep 10 mins
Cook 30 mins
First cooked in the oven and then on the BBQ.
Ingredients Nutrition
- 1⁄2 cup soy sauce
- 1⁄4 cup fish sauce
- 1 teaspoon five-spice powder
- 1 tablespoon sesame oil
- 1⁄2 cup palm sugar
- 6 garlic cloves, finely chopped
- 1⁄4 cup coriander root, and stem
- 2 tablespoons rice wine
- 1 1⁄2 kg pork spareribs, cut into 5cm pieces
- Combine all the marinade ingredients in a bowl. Add the spareribs, coat well and leave to marinate overnight.
- Preheat oven to 180C and bake spareribs for 20 minutes.
- Barbecue over medium heat until golden brown, about 10 minutes.
Most Helpful
Went for the oven cook and after 20 minutes took them out and put on a baking tray and cranked up to 200 (fan forced) for 10 minutes and they were just oh so good. If doing the oven cook method take them out of the marinade and cook on baking tray, I think then that the 20 minutes would be accurate but then I would simmer the sauce in a small sauce pan to spoon over the ribs, rice and veg. A little too salty for personal taste but expected being soy sauce based but the DM absolutely devoured them. Will like to try again with pork loin chops and on the barbie (with DH cooking). Thank you Jewelies, made for Edition 5 - Make My Recipe - a game of tag.
These were extremely tasty!! I finished them in the oven, too...total cook time was...45 minutes - 1 hr? Nice easy prep...a great recipe! Thanks, Jewelies! Made for the Aussie Swap 6/08.


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North Tryon Commandos For Christ Inc
Rating: 5 stars 1 1 review 252
2923 Shenandoah Ave % Mary J Waters Charlotte NC 28205 USA
Filter Reviews by Role
Promote This Nonprofit
GreatNonprofits badges allow you to raise awareness of your favorite nonprofits on your own web sites!
Reviews for North Tryon Commandos For Christ Inc
We can all assume or may know how our homeless brothers and sisters are fed and clothed....but a better question is "how are they shown love and compassion?" It is certainly through the works of North Tryon Commandos for Christ lead by Pastor Mary. Have you ever looked someone in the eyes, given him or her a big hug and said "God loves you, I love you"? i admit that it is difficult for me as i am sure it is for most others. Well, The Commandos team does it everyday year round. They have not forgotten that feeding the heart and soul is just as important as the body. Help is needed in so many ways...learn more about they do. My review is unsolicited but I felt obligated to tell others about Commandos for Christ.
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Assistance League of Charlotte
Writer wrote:
The Assistance League of Charlotte is an incredible volunteer organization helping children at risk in Mecklenburg County. ... more »
Jacobs Ladder Job Center, Inc.
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My job ended as a result of moving out of Charlotte in 2009 for a family situation. I was not able to find work when I got to... more »
Goodwill Industries of the Southern Piedmont, Inc.
Jenn Jackson wrote:
When people think of Goodwill, they often think of a great place to shop for inexpensive treasures or the perfect place to donate... more »
Center for Sustainable Change
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I have been involved with this beautiful organization since it's inception in 2004. The work before that date was known as Health... more »
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I have donated to this charity for years and did some volunteer computer work for them this year. I personally visited the mission... more »


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Pipra Mishra is a
small Village/hamlet
in Deoria Tehsil
in Deoria District of Uttar Pradesh State, India.
It comes under Pipra Mishra Panchayath.
It belongs to Gorakhpur Division .
It is located 1 KM towards East from District head quarters Deoria.
333 KM from State capital Lucknow
Pipra Mishra Pin code is 0 and postal head office is .
Pipra Mishra is surrounded by
Baitalpur Tehsil towards North ,
Rampur Karkhana Tehsil towards North ,
Bhaluani Tehsil towards South ,
Pathar Dewa Tehsil towards East
Deoria ,
Rudrapur ,
Lar ,
are the nearby Cities to Pipra Mishra.


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NEW YORK (June 21, 2013)--The stock market closed out a wild week Friday with modest gains, as the Dow Jones industrial average rose 41 points, or 0.3 percent, to end at 14,799.
The Dow plunged 560 points Wednesday through Thursday after the Federal Reserve said it expected to end its bond-buying program by the middle of next year if the economy continues to improve.
The Standard & Poor's 500 index rose four points, or 0.3 percent, to close at 1,592 points.
Technology stocks fell after business software maker Oracle disappointed investors late Thursday with flat revenue.
The Nasdaq composite fell seven points, or 0.2 percent, to end at 3,357.
Slightly more stocks rose than fell on the New York Stock Exchange where volume was very heavy at 5.5 billion shares.


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Abbott Sues Watson Over Niaspan Cholesterol Drug Patents
Abbott Laboratories sued Watson Pharmaceuticals Inc. in Wilmington, Delaware, federal court for allegedly infringing two patents for its Niaspan cholesterol drug.
Abbott, based in Abbott Park, Illinois, contends Parsippany, New Jersey-based Watson is planning to market generic versions of the medicine before the patents expire, according to a complaint filed March 16.
Watson's effort to sell the generic tablets "has led to foreseeable harm and injury to Abbott," according to the lawsuit, which seeks a ruling of infringement and an order to stop Watson's premature sale of the drug.
Abbott logged about $1.2 billion in U.S. sales of Niaspan in the 12 months ended Jan. 31, Watson said in a statement citing IMS Health data. Watson confirmed in the statement that it has filed an application with the U.S. Food and Drug Administration for approval to sell its version of the extended-release tablets.
The case is Abbott Laboratories v. Watson Pharmaceuticals Inc., 12-CV-324, U.S. District Court, District of Delaware (Wilmington).
To see the patents, click: 6,080,428 and 6,469,035.


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"Save Mono Lake!" Top 5 Page for this destination Lee Vining by SteveOSF
Lee Vining Travel Guide: 116 reviews and 312 photos
Lee Vining clings to Highway 395 on the edge of Mono Lake. This small town is located at a high elevation of 6780 feet. Staying at Lee Vining is your best bet for seeing Mono Lake or visiting the nearby ghost town of Bodie. Lee Vining offers lodging, restaurants, gasoline and other services. It makes a great base camp for visiting the nearby attractions.
Some of you may remember the slogan ?Save Mono Lake?. In 1941, water began being diverted from Mono Lake?s tributaries to squelch the growing thirst of the Los Angeles area to the south. The culprit was the Los Angeles Department of Water and Power. Ecological havoc raked upon Mono Lake as a result of drastically lowered the water levels. By being deprived of its freshwater sources, the volume of Mono Lake was cut in halve, while its salinity doubled.
In the late 1970s activists began to organize and lobby lawmakers, policy makers, and the public at large. The message was heard and compromises introduced. Eventually in the late 1990s the water diversions were reduced and Mono Lake could begin the slow process of recovery. However, before the reduction in diversion occurred, the water level in the lake had already dropped 40 feet!
Because water will continue to be diverted to Los Angeles, Mono Lake will never be completely restored. The lake will always be at least 25 feet or more lower than its pre-diversion level. But the lake and its ecosystem have been granted a reprieve from certain tragic death.
- Pros:Very scenic area
- Cons:It is a bit out of the way
- In a nutshell:On the shore of a beautiful lake
Reviews (17)
This is a historic lodge located just across Highway 395 from Mono Lake, and is just outside of Lee Vining. It has a... more travel advice
Lee Vining is a relatively remote community located east of the Sierra Nevada Mountains in California. As a small... more travel advice
When arriving from the east along Highway 120, stunning views can be seen. Beautiful mountain scenery can be enjoyed... more travel advice
As the sun sets over the mountains and not over the lake, the sunsets are not as spectacular as the sunrises.... more travel advice
Comments (8)
Lee Vining is a great place to explore the northern Sierra from. Next time go later in the Summer - say like now - and enjoy the view from the top of Dana Peak, hiked directly east from Tioga Pass.
Mono lake is a very sad story! It is too bad that such a wonderful landscape is little by little destroyed. I hope that will end. I remember that we camped near Tioga pass, in the forest.
You've just opened my world to these less known destinations. Mono Lake & Lee Vining look appealing for a future trip. Cheers!
Very thorough page on this interesting spot. ~Joe
Excellent, interesting tips acompanied by beautifu photos.
This is an area I haven't been to in years. Hope to make it back!
Nice photos and writing for Mono Lake!
Beautiful lakes & mountain scenery around here = like a breath of fresh air
SteveOSF's Related Pages
Lee Vining Travel Guide
Member Travel Pages
- "~Lee Vining ~"
- "Save Mono Lake!"
- "Mono Lake, a recovering endangered ecosystem!"
- "Mono Lake"
- "Base Camp for Eastern Yosemite and Mono Lake"
- "Lee Vining, California."
- "Mono Lake (near the town of Lee Vining)"
- See All...
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- See All...
"Just beyond the edge of the world is a new horizon."
- Member Rank:
- 0 0 3 6 9
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- 493 Reviews
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- 38 Photos
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Have you been to Lee Vining?Share Your Travels
Latest Activity in Lee Vining
- updated a Lee Vining Travel Page "Save Mono Lake!"
- Posted in Miscellaneous Forum "Re: Member Pages"
- Commented on one of Beach_dog's Lee Vining travel pages
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- Uploaded a Photo to "Historic Lodge at Mono Lake"
Photos in Lee ViningSee All Photos (38)
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text:
Q & Q Directory » Reference » Environment and Nature
Links Sort by: Hits | Alphabetical
|How to prune - http://www.wctreeservice.com/
Tree trimming is the act of pruning or How to prune? Our Tree Care experts and Tree Company should be consulted before you start Tree Cutting. -
|Green Business Directory - http://ourgreendirectory.com/
|A Resource for eco friendly products Information - http://www.allecofriendly.info
Find information and various resources related to eco friendly products at AllEcoFriendly.info. -
|ECA Application Ontario - http://gpmenvironmental.com/
Environmental consultants will help you obtain your Environmental Compliance Approvals (ECA) from Ontario's Ministry of Environment as quickly as possible.ECA Application Ontario. -
|Cleantech - http://www.cleantekmarket.com
Cleantech Market is an online clean technology platform, connecting technologies with organizations and finance. Join our Cleantech Marketplace. -


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TweakTown NewsRefine News by Category:
TweakTown Posts - Page 2
Introducing Tweakipedia, our new home to all things tweaking at TweakTown
Today we are very excited to be announcing a new part of our website called Tweakipedia. Tweakipedia will be an amusement park of technology, filled with guides from how to overclock your computer to installing Windows from a USB drive. Not only that, but we will be taking in reader submissions on tweaks and guides.
This means that if you have a tweak recommendation, then you can submit it to us and we'll get it into Tweakipedia. We'll also love to hear suggestions on what you'd love to see next, so if you are itching to see how a certain GPU (or three) performs in a particular game, then you can request that. If you didn't know how to do a particular task - for example, building a system with Corsair's Obsidian 900D case - then we would secure that part and write a how-to build guide on it.
The idea is that the reader is heavily involved in Tweakipedia. We want you to submit ideas, requests, your own guides and tweaks - everything. This way, you're directly contributing to Tweakipedia and seeing it slowly morph into a gigantic source of great tech information. That is the next point - Tweakipedia will be a source we can continue to come back on in future reviews, articles and more.
Continue reading 'Introducing Tweakipedia, our new home to all things tweaking at TweakTown' (full post)
TweakTown iPhone App version 1.4 - adds iPhone 5 support, design improvements
Yesterday Apple approved version 1.4 of the TweakTown iPhone app to the App Store.
In our latest version we have made improvements to better support iOS 6 as well as provide a full viewing experience for those using an iPhone 5. In addition to that we've also made some design improvements. We have removed the Daily Deals section, but Ask The Experts has been added.
Upgrade the app now, or head on over to the App Store and get it installed people!
Important Notice - Please update your TweakTown RSS feed links!
Rumor has it that popular RSS feed service FeedBurner could be shut down soon by Google.
As that is the case, we have moved away from the FeedBurner service and reverted back to our own in-house RSS feeds. In 30 days your current TweakTown RSS feed links will no longer work.
Please visit our RSS feed page and update your links!
We're hiring a US East Coast TweakTown News Editor!
We are hiring a news editor based on the US East Coast!
You will be required to post daily news and attend tech events on the East coast. You need to own a digital camera. You need to be addicted to technology and have a passion to write about it. It would be a bonus if you have previous online experience, too.
If you feel you are the right person for the job, please email your CV and other relevant information to jobs at tweaktown dot com.
Just to be very clear, this is a paid position.
Hello, Internet - we're back... finally!
What a few days it has been!
We changed from our older servers over to a new host with a single high-powered dual Xeon server with all the trimmings such as RAID 10 Intel SSDs, 48GB of RAM and more. We thought it would be a fairly simple process to move all of our files and databases over to the new server and get online in a few hours. The new server is running a different server control panel with some other different configurations that we weren't familiar with. It really did a good job of confusing us all, but finally we are back online. Things are not 100% perfect yet, but we're close. Apache redirects... grrrrr!
We are working as fast as we can to bring the site back to 100% working order, it won't be long now. The good news is that we are now on a very powerful server that is going to be able to hold up when we get hit with a lot of traffic, and it will also be a great server for us to grow into as we continue to grow. It's been an expensive and stressful event, but we've learnt a lot.
I would like to single out Dave from WiredTree (and the rest of the support team, too) for helping us migrate from our older servers. Thanks for your help guys and dealing with our constant questions and pestering. It has been a testing few days for sure, but we're almost at the end.
We're on the move to a new web server!
We are currently moving all data from our old servers over to a single new high-end web server located in Los Angeles with a different host.
At the moment our forums are down and we aren't adding any new content to the site. We have plenty of hot tech content lined up for you as soon as we're on the new site and the DNS is switched over.
It's going to be worth the wait. As TweakTown grows, we required a better solution for our hosting needs, and we think we've got a server that is going to last us for a good while and result in faster performance and less downtime. Our new host also offers stock performance tuning and security hardening, and we're excited to see the performance ourselves of this new investment once it goes online.
CPU: Dual Intel Xeon E5620 2.4GHz
RAM: 48GB DDR3 ECC Registered
Storage: 4 x 180GB Intel 520 SSDs in RAID 10 on Adaptec 6405 RAID controller
Software: LiteSpeed Web Server
LAN: 1Gbps
We'll post another update once we're live on the new server!
We're hiring a NYC or nearby based TweakTown News Editor!
We are hiring a news editor based in New York city or in the nearby area!
You will be required to post daily news and attend tech events in NYC and the surrounding area. You need to own a digital camera. You need to be addicted to technology and have a passion to write about it. It would be a bonus if you have previous online experience, too.
If you feel you are the right person for the job, please email your CV and other relevant information to jobs at tweaktown dot com.
Introducing TweakTown's Ask the Experts - ask us tech questions, we answer!
Today we are introducing (or re-introducing if you've known TweakTown long enough) our newest section, Ask the Experts.
As the name implies, it gives you our readers the ability to submit tech questions and we'll do our best to try and help you solve them. Or it may not be actual problems you are facing, buy having trouble deciding on what product to buy. We are here to help and offer our advice and opinion. Hey, you even get your name and country up on the site as well!
Anthony Garreffa is manning our Ask the Experts section and is all set to receive your questions right now. He'll do his best to answer them. Sadly we won't be able to post and answer all questions, only the best ones will be selected. From time to time, we may also run a giveaway for the best questions - so, stay tuned.
Starting asking us your questions, right now!
E3 Day 2 in brief: Babes, games, and stay the course
The title enticed you to read this article, didn't it? No? Well, a promise is a promise, so let's do a top three booth babes countdown. Gree's costumed beauty gets third place. Sorry for the slightly bad picture.
Nyko babe gets second place, simply because of the costume she was in. Not bad looking either.
I have to give the gold to Trion's babe as she is the best costumed.
There are a few honorable mentions that I will be putting on Facebook later today. I didn't just check out the babes, though, as this is a gaming show. I got the grand tour of several indie games and was impressed. While these games may not have had the fit and finish of the major game studio games, they featured innovative game play ideas. Often these games were created by one or two people, and sometimes in a short period of time.
Borderlands 2 was on display, but I didn't get a chance to go hands-on. Just like Crysis, they were also not allowing photos or video to be taken of the game. ZombiU appears to be better than expected and not just some over-hyped game that ends up flopping once people get their hands on it.
Nothing interesting has come out of Microsoft or Sony at this E3, but that is often how it is. Next year will be massive, if the rumors are true, when Microsoft and Sony launch their next-gen consoles. For now, they are pushing the PS3 and 360.
Continue reading 'E3 Day 2 in brief: Babes, games, and stay the course' (full post)
Poll Results - Your thoughts on TweakTown version 2012 (i.e. our new design!)
Our latest poll had almost 1,300 people who answered, Your thoughts on TweakTown version 2012 (i.e. our new design!)
Overall TweakTown readers were vastly impressed with our new design with 74% on the positive side and 26% on the negative side.
More specifically 28% voted that our new design is epic, while 46% said not bad. We're happy, you are all happy with it. On the negative side 14% said they preferred the old design, while 13% said they don't like it. Well, we're sorry about that.
For the actual numbers, go here. In our latest poll, we ask you about... What do you want more? (NVIDIA GeForce GTX 680 or AMD Radeon HD 7970) Let us know! Go here to vote!


text:
U.S. Open: Serena Williams Dominates for Spot in Semifinals
Williams Looks Poised to Win Sixth U.S. Open Title
There were about 10 minutes Wednesday night when it looked like Serena Williams might be in trouble once again at a grand slam this year.
Down 3-0 and two breaks to Flavia Pennetta of Italy, the two-time defending champion looked to be in for a long night. And then, just like that, she wasn't. Williams rattled of six straight games and 12 of the next 14 to nab the last semifinal spot at the U.S. Open, beating Pennetta 6-3, 6-2.
When she is at her best, as she was for stretches Wednesday night, Williams suffocates opponents, pinning them back behind the baseline and feasting on balls that land in the service boxes. After Pennetta's early heat, Williams settled in and was as good as she's been at this tournament, despite a sore foot that forced her to seek medical attention at the end of a doubles match Tuesday.
Pennetta landed just 59% of her first serves, and with Williams winning 14 of 23 points on Pennetta's second serve, that meant the Italian was basically dead if she didn't get her first serve in the box. Knotted at 2-2 in the second set, Pennetta lost four straight points on her serve as Williams ripped three consecutive forehand winners to seal the break, then never looked back.
Williams has had an ugly year at the Grand Slams. She went out in the fourth round in Australia, the second round at the French, and the third round at Wimbledon. She fell to Ana Ivanovic, Alizé Cornet and Garbine Muguruza—not exactly Steffi Graf, Martina Navratilova, and Kim Clijsters.
"I've had a tough year and gone down to some great players who aren't in the top 10," she said after the match. "You can't underestimate anyone."
She has won this title five times though, and appears determined to win a sixth. She faces Ekaterina Makarova in the semifinals Friday. Makarova is playing in her first Grand Slam semifinal at the age of 26. At 5-foot-11, she has a big serve and plays a power game similar to Williams. One problem—usually, she doesn't do it nearly as well.
Write to Matthew Futterman at firstname.lastname@example.com
- 13


text:
Party in Muy Muy
Maura's house is somewhere up in those hills
The real Senorita Dora the Explora
The panorama from the Hotel Panorama, Esteli
On the road again. At least it's a good road.
Writing a letter to her sponsor in the USA
Mary Ann (her good side, not the shiner) and friend
Osacar Gamez barrio in Esteli
Barbed wire clothesline
Fully equipped gas kitchen
Detached half-bath
Cozy bedroom with mood lighting
La Garnacha organic farm
Rock wedged in between the tires. No AAA
The choir
Scrounging in the dump
Carvings for sale
Dance contest
CFCA staffers
The CFCA parade
Barbecue pit, made of leaf springs
The edge of Bluefields. There's a 7 hour boat ride to the community up the river. We didn't visit.
Maura in the English scarf we brought her


text:
Copyright © 2015 FunnelBrain LLC. All rights reserved. *AP and Advanced Placement Program are registered trademarks of the College Board, which was not involved in the production of, and does not endorse, this product
|a) planning, controlling, monitoring, releasing a project
|b) planning. controlling, monitoring, reviewing a process
operations management
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