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A new version of Rdio's iPhone app is available, and if you're a fan of the music streaming service, you should download it immediately. If you haven't yet turned the corner on subscription-based streaming, this update makes it worth a look.
Some of Rdio's best tools for discovering new music were previously only available on the website, but the new app now includes these tools, vastly improving the mobile experience. It's also more stable and easier to use.
For those of you new to Rdio ("ar-dee-o"), here's the deal: It's an on-demand, cloud-based jukebox. You search for an artist, an album name or a song title, and you can click on one of the results and start listening immediately. The service has around 8 million songs available for streaming. Sure, there are some holes in Rdio's library, and other services go deeper. But no service has everything, and Rdio is deep enough for almost everyone. You can hook up with your Facebook and Twitter friends and see what they're listening to, and you can share playlists with each other.
For $5 a month, you can listen through your desktop browser. For $10 a month, you can also listen through your iPhone, BlackBerry, Android phone, Windows 7 phone, a desktop client or a Sonos system if you have one. The $10 plan also enables you sync tracks to your mobile phone for offline listening. Whether Apple's new subscription policy will change Rdio's pricing is still a question mark.
Full disclosure: I've been an Rdiohead for the last six months or so. I have the website pinned as an App Tab in my browser at the office and at home, and I log at least two or three hours of streaming per day. I also have the app installed on my old iPhone 3G, which is Velcroed to the wall in the kitchen. I stream through my Jambox while flambéing my crêpe suzette.
This level of devotion comes from the same guy who only a year ago was constantly arguing that subscription-based streaming, rental, and other cloud-based jukebox horse pucky would never, ever work. I was strictly a "if I can't download the files, I won't pay a dime" person.
I tried them all. To me, MOG is meh, though others love it. Spotify is interesting, but it's too flaky for me here in the states. Too many hoops.
Now, I give Rdio $10 a month. The things that really turned me around were Rdio's discovery tools on its website – the social aspect lets me see what my friends are listening to, the recommendations are surprisingly decent, and the New Releases tab in the web app lets me stream just about every new album the same day it hits the stores. Yes, calling up your faves instantly from the search box is a big draw, but these little darkened corners – browsing the automated recommendations and checking out new releases – are where I spend the bulk of my time on Rdio. For me, it takes all the pain out of discovery and all the risk out of buying new music.
And this is why I'm excited about the new iPhone update – Rdio has finally baked those extra features into the app.
The old iPhone app, which the company launched with, wasn't much to talk about. It was difficult to navigate and it was buggy. It did let me see what my friends were listening to, but the recommendations weren't there and the new releases were harder to dig out.
This week's update, which appeared in the iTunes Store on Wednesday, changes all that. There's a new dashboard that looks like the Facebook app's dashboard. It lets you jump into New Releases or Recommendations with a tap. There's a big search box at the top. Icons can be trashed or re-arranged. There's also a new icon to browse Top Charts, but (surprise!) the wider Rdio community has the same terrible taste in music as the general populace. I'll stick to my friends, thank you.
I was given the opportunity to test the app on my iPhone 4, and I spent the last couple of days listening to full albums both over Wi-Fi and over AT&T's 3G network in San Francisco. The sound quality on 3G is still good – a little crunchy during the delicate bits, but overall quite decent. Wi-Fi sounds stellar.
General usability is better too. The coolest new item is the persistent player widget at the bottom of the app. If you wanted to get to your current selection in the old app, you'd have to dance through the menus. Now, you just drag the player up from the bottom of the screen from anywhere within the app.
Lastly, the update is iPhone only, so if you're a Droid or a Dell Venue Pro user, you're stuck with the old code for now.
So if you're not yet an Rdio person, strike while the iron is hot. And if you're a fan – and an iPhone user – this update will make you happy.
WIRED New interface puts the best of the website's discovery tools into the app. Not nearly as buggy as the old app. Persistent player is a plus. All those jams beamed from space, instantly.
TIRED New app is iPhone only. The library is deep but don't have everything, so you'll have to be adventurous. Only works in the U.S. and Canada for now. Some think $10 a month is steep.
Photos by Jim Merithew/Wired.com
See Also:- Kazaa, Skype Founders Launch Twitter-Like Music Service Rdio


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4:00 pm Sundays during term time
5:30 pm Mondays-Fridays during term time
The Cathedral Choir (or sometimes a visiting Choir) takes the principal part in this service, in which Psalms are sung, two readings are taken from the bible, the Song of Mary (Magnificat), the Song of Simeon (Nunc dimittis) and an anthem are sung, and prayers offered.
The congregation is invited to listen and let the music lift up the heart to God.
The traditional language of the Book of Common Prayer is used.
This service lasts between 40 minutes (weekdays) to 1 hour (Sundays).

subset: commoncrawl


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How about a lesson on another zombie from the very pages of my imagination? I drew this figure live yesterday and today I an extremely excited to be submitting it to you all. I will be showing you "how to draw a zombie face" step by step. I am calling this lesson "zombie face" because that is what you will initially be doing. I know that there is half of a torso and even an arm, but unlike my other zombie tutorial that I drew back in 2007, I really tried to focus more on the upper body aspect of this hideous looking, grotesque being. One of my favorite movies that I watched a while ago is "28 Weeks Later", I mean that movie was pure rawness. This zombie human that I am going to show you how to draw is wicked cool. The body texture is so detailed that it took me hours to complete. I really didn't color in the zombie too much, but if you wanted to add your own shading that would be fine. It's all up to the artists that is drawing. Anyway I have to get outta here right now because I have a lot more lessons to submit. I will leave you with tutorial on "how to draw a zombie face" step by step. Have fun and happy drawing guys!
DragoArt members upload artwork and drawing tutorials! They are also allowed to leave comments on tutorials, profiles, etc. Many more features, as well; it's way better than just being a boring guest! Register Now!


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Season generously and fry in a very hot frying pan or wok for 2-3 mins, until nicely browned and cooked through. They'll take a little longer to cook if marinated first or sharing a crowded pan with other stir-fry ingredients.
Keep in the fridge below 5˚C. If you're not going to eat it within a day or two, freeze your meat as soon as possible and always within the use by date. Once frozen, use within a month. Use on the day of defrosting.
Organic pig farmer
Our pork comes from Helen Browning at Eastbrook Farm in Wiltshire. Helen set up her farm over 27 years ago. She's a champion of organic farming and giving animals the best quality of life – in fact, she's Chief Executive of the Soil Association and spends much of her time campaigning for better animal welfare.
Helen's organic breeding herd of 200 sows are pure British Saddlebacks - a hardy, native breed that thrive outdoors, make great mothers and produce great flavoured pork. Boars are Large Whites, a typical UK outdoor reared cross. They counter the fat levels found in pure breed Saddlebacks, but not enough to change their special flavour.
Helen's pigs live in fields outdoors in family groups with loads of space and fresh ground to rootle around in. Even in the coldest, wettest weather, the pigs seem happiest outside foraging in the grass, clover and mud looking for roots, bugs and other treasure. They also have dry, warm 'arc' houses with plenty of fresh straw when they want to be cosy. Piglets are born outside in their arcs and weaned later than in conventional (non-organic) farming, so they are robust and independent by the time they leave their mothers.
If you want to see the pigs foraging for yourself, Eastbrook Farm welcome visitors to their farm for walks or guided tours. They also run an award winning pub, The Royal Oak.
Riverford butchery
We choose traditional breeds, which we believe give better flavour. We carefully hang and butcher the meat ourselves, then mature it for extra flavour and tenderness.


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Follow RFF News on your cell phone. Text follow rff to 40404 you will receive txt messages with RFF News
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I know this is not the place for chatting but I just wanted to take a moment to thank all of you that post for your hard work. BB would hardly be worth it without you! Thanks
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Home > Bedroom Furniture > Beds > Kingsize Beds
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Free Two Person Delivery: Within 10 working daysDimensions: H100 W165 L207.5 cmAssembly Required: YesIncludes: 1 year manufacturers guaranteeColour: IvoryFor more info: See product description below
At a glance
A fantastic choice for master and guest bedrooms. The warm ivory finish combines with the shaker styling to give you a piece that will stand the test of time and many a bedroom decor change.
Constructed from solid American white oak and MDF with a strong and sturdy build.
Fits a standard UK king-size mattress.
Available as the bed frame only or with the Deluxe or Elite pocket 1000 mattresses.
Deluxe semi orthopaedic : 13.5 gauge Bonnell spring unit, rod edge supports, 900 gsm spring insulator pad, 600 gsm polyester filling. Quilted Belgium damask cover. Quilted boarder with air vents. 23 cm deep.
Elite pocket 1000: 1000 pocket sprung unit. Hand tufted. 1000 gsm spring insulator pad, 800 gsm polyester filling. Luxury damask quilted cover. Quilted boarder with air vents. 23 cm deep.
Flat packed for easy home assembly. Easy to follow instructions included.
No need to struggle, the Salerno bed frame is delivered by a two man team to a room of your choice.
If the delivery team believe that damage to the product or premises, or injury to themselves or others, may occur whilst delivering to your chosen room they will leave the goods in a safe and convenient place.
Delivered in two boxes, plus plastic wrapped mattress if purchased.
Part of our bedroom furniture collection.
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Free 2 Person Delivery Service to England and Wales
This item will be delivered using a two man delivery service, to the room of your choice. You will be contacted to agree your delivery date.
A time slot of either AM (7:00am - 12 noon) or PM (12 noon - 6:00pm) Monday to Friday (excluding Bank Holidays) will be given. Somebody will need to be available to sign for your order upon delivery.
We aim for 2 man deliveries to take place within 10 working days. Extreme weather and other factors outside our control can extend the delivery time on rare occasions.
Surcharge of £30 for deliveries to Scotland. (This is a one off charge no matter how many items you order.)
Refunds & Returns
If for whatever reason you want to return your purchase to us you have 14 days from the day of delivery no questions asked. To ensure a full refund please ensure the item is kept in its original condition, this means unused, to help you achieve this we recommend keeping the packaging and labels until you have decided to keep the item. You will find full return details in your order confirmation email.


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Mon - Sat: 9.00am - 6.00pm
Wednesday: 9.00am - 8.00pm
Sunday : 11.00am - 5.00pm
What would make a perfect holiday? Tell us who is going with you, what airport you'd like to fly from and any other details we may find useful, such as if it's a special occasion.
If we need to get in touch, when is the best time to give you a call about your holiday?


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DTSA and missing data
Mplus Discussion
Categorical Data Modeling
posted on Thursday, July 21, 2005 - 9:45 am
I'm setting up a DTSA in mplus. A few people in my dataset have an intermittent missing value. For example: 0 0 . 0 0 1. Is it necessary to censor the person at the second assessment and discard the later three observed waves? Or is it appropriate to allow full information maximum likelihood to account for the missing assessment.
posted on Thursday, July 21, 2005 - 1:36 pm
Here is the opinion of Katherine Masyn:
Although there may be information lost, the easiest thing is to censor
those with intermittent missing at the last observation before the first
missing assessment. If there are only a "few" people in the data set with
this kind of missingness, that shouldn't be a problem.
It's really not appropriate to put in all the observed data and then use
FIML b/c if the missing value is "1" then that person should not be
contributing to the risk set of any subsequent times periods.
I'm looking into multiple imputation for a data set that has many missing
assessments like this. However, this will still require the appropriate
reformatting of each imputed data set before fitting the survival models.
posted on Monday, July 25, 2005 - 8:40 am
Thanks for the response. I have one follow-up question. Since type=missing is always used to specify a DTSA, how does mplus know to treat the periods of time after an event or after censoring as "no longer at risk" rather than using FIML to estimate those values?
posted on Monday, July 25, 2005 - 5:36 pm
FIML doesn't estimate the missing values. I think it is easier to think of FIML as disregarding the missing values - not including them in the likelihood computations. FIML under MAR is just a principle for using all non-missing values.
posted on Friday, August 07, 2009 - 8:57 pm
Dear Dr. Muthens:
I am new to Mplus. I have a question about how to get the HRs and their confidence intervals from the DTSA model.
1. Is there any existing command that directly procoduces HRs?
2. If not, can I use the constraint command to generate another parameter indicating the exponential of the coefficients? (I tried the constraint command, but found that the CIs for the new parameters were not the same as the CIs of the HRs calculated by hand based on the coefficients)
3. Any other convenient ways?
Thank you very much for your help in advance!
Tihomir Asparouhov
posted on Monday, August 10, 2009 - 9:28 am
1. No
2. Yes - that's the way to do it. The confidence limits are not the same because Mplus does a delta method to estimate Exp(beta) asymptotic distribution and based on that it produces CI. Your method and the Mplus method are asymptotically the same and it is not known in general which method is better for finite sample size. One could conduct simulations to figure out which method is better.
3. No
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Sejusa And Omara-Otunnu At London Launch of Uganda's Freedom and Unity Platform (FUF)
Gen. Sejusa and Prof. Omara-Otunnu
[Op-Ed: Announcement By FUF]
London Launch of Uganda's Freedom and Unity Platform (FUF): An inclusive political organization working for a new democratic, united, tolerant and progressive Uganda.
Dear Ugandans, Friends of Uganda, and Global Media Fraternity, You are cordially invited to attend the historic launch of FUF - the Freedom and Unity Platform, which is fronting the global campaign to transform Uganda into a nation of peace and sustainable development based on the ethical values of democracy, respect for human rights, and the rule of law. The organization is committed to play a constructive role in international affairs, to work to end the culture of impunity and to promote accountability.
The launch event, which will include the unveiling of the FUF Manifesto and the official communication about the leadership of the organization, will take place: On Saturday 14, December 2013.
From 12.00pm to 16.00pm. At the London School of Economics (LSE). Alumni Theatre Hall.
Address: Lower-ground floor of the New Academic Building, 54 Lincoln's Inn Fields, WC2A 3LJ. Nearest Tube – Holborn (turn left and walk down Kingsway, and make any of the left turns off Kingsway towards the small green park called – the Lincoln's Inn Fields.)
Due to the limited space at the venue, attendance is by invitation only, and all those invited are advised to confirm their attendance with the FUF press department.
Among the Keynote Speakers will be the following: Prof. Amii Omara-Otunnu (FUF Chairman), General David Sejusa (FUF founder member, and former Head of Uganda's Security Services) and others.
Please reply to Dr. Vincent Magombe, FUF Press Secretary, firstname.lastname@example.com
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- Ann GarrisonFebruary 22,2018 @ 08:03 PM
I think you have "Filtered HTML" turned on here. If you switch to "Full HTML," it will probably...
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I haven't written a blog about what happened at Sandy Hook Elementary on Friday, December 14, 2012 for a couple of reasons.
First, my life at school has been busy. Extremely busy.
I'm always swamped this time of year, but this tragedy made things even busier (I'm not complaining).
Parents, students, and staff were more shaken about this event than anything I've ever experienced.
During Columbine, I was a snot-nosed young teacher, so I'm sure I didn't realize the impact it had on my administrators and school at the time.
Secondly and most importantly, an event like this doesn't lend itself to snarky sarcastic blog writing (this is my go to move).
So, I've taken some time off from blogging.
And I'm glad I did.
I think the most important thing we can do at times like this is be reflective.
The best reaction is not to overreact. This can be hard to do when everyone around you wants you to "Do something!"
In the face of tragedy, we all want to immediately implement rules or procedures to fix our own situation.
And often times, that's the worst thing we can do.
Time will give us many of the answers we are searching for.
Lessons will be learned from what happened in Connecticut.
Schools will become safer. Politicians will eventually do the right thing (I hope). Administrators and teachers will be better trained.
Students who are already safe will be even safer in the future.
These things will take time, but they will happen.
This of course, will never fix what happened, but we have to understand we can't fix it.
We can only make things better from this point forward.
This can sound cold and uncaring, but it's not. It is why I didn't write a blog the next day.
As a side note… Why does the news media put children and families who were directly involved in a tragedy on TV, but won't show a drunk fan who runs on the field during a professional baseball or football game because they don't want to "glorify" their actions?


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Water is the foundation of life: we're unable to survive without it. But the problem is that water is scarce, and this country is running out of it.
More than 98% of South Africa's water has already been allocated, and this country is facing a severe water crisis in the coming decade. We're going to face skyrocketing water prices, droughts due to climate change and increasing competition over water – possibly leading to conflict. Already a lack of access to water is leading to service delivery protests around the country. This means that water is a critical constraint to development.
Today Greenpeace Africa launches our latest report 'Water hungry coal: Burning South Africa's water to produce electricity', which paints an ugly picture of how Eskom's coal addiction and this country's water shortages are linked. In this kind of context, the choices being made are crucial. But Eskom and the South African government are making a clear (but very risky) energy choice in favour of coal expansion, at the expense of access to scarce water resources, people's health and affordable electricity.
Water insecurity is already a present reality and not a fiction of the future to come. If Eskom and the South African government continue to bet on coal, we will run out of water even more quickly than previously thought.
So, where is the water for Eskom's new mega coal-fired power stations (Medupi and Kusile) going to come from? The utility's reckless water-hungry coal expansion is a major threat to the country's already stressed water resources, and further compromises water access for the poor.
The figures back up the severity of the situation: in one second Eskom uses the same amount of water as a single person would use within one year, based on access to the minimum 25 litres of water per day. What is scary is that as Eskom burns South Africa's water to produce electricity, nearly a million households still don't even have access to the minimum 25 litres of water per day, never mind the 600 000 litres Eskom uses every minute.
One doesn't have to look hard to find out why Eskom is so water-intensive: 93% of South Africa's electricity comes from coal. In fact, it is very likely that building more coal-fired power stations like Medupi and Kusile, and increasing coal mining to supply them, will essentially send South Africa into a water deficit, putting all South Africans at risk.
The coal mining and electricity industry obtain priority access to water, but every step in the coal chain requires direct use of substantial amounts of water, both using and polluting this scarce resource.
Unfortunately, there are more questions than answers when it comes to water. The people of South Africa have a right to know how water is allocated in this country, how it is managed and who is polluting it.
Currently, critical information on water allocation, management and pollution is classified as confidential, and decisions around it are not transparent. How can half the mines which supply Eskom with coal operate without valid water licences? How can Kusile get the go-ahead without a serious assessment of its water use? How can we know for sure that South Africa´s water resources have not already been over-allocated?
Water is not just an environmental issue. Water is key for future development, and it is a fundamental issue at the heart of justice, economics and human rights. Eskom and the South African government can no longer ignore this.
It is still possible to pull back from the brink of crisis. The alternative is already here: renewable energy. The South African government and Eskom must embrace this alternative, since there is simply no substitute for water.
It is time to end the era of coal in South Africa. There is no other alternative, and our ability to deal with a changing climate and future water crisis depends on it.
(Unregistered) Kitnicks
From the title, I thought this was going to be an article about a crackpot method of electricity generation, not about water wastage. I understand the...
From the title, I thought this was going to be an article about a crackpot method of electricity generation, not about water wastage. I understand the temptation to wax poetic, but please pick a clearer title next time.
19 October, 2012 at 18:56
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You can't burn water. Water is already an oxide of hydrogen. What does my statement have to do with your article? Not much, but then agian, nei...
You can't burn water. Water is already an oxide of hydrogen. What does my statement have to do with your article? Not much, but then agian, neither does the title.
20 October, 2012 at 17:23
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Formed in place fixation system with thermal acceleration
A subcutaneously formed in place orthopedic fixation device is provided, such as for fixation of the spine or other bone or bones. The device comprises an inflatable member, such as a tubular balloon. A heat source is provided in thermal communication with the interior of the balloon. The balloon is positioned at a treatment site while in a flexible, low crossing profile configuration. The balloon is thereafter inflated with a hardenable media, and heated to accelerate hardening of the media. Methods and delivery structures are also disclosed.
This is a continuation-in-part of U.S. patent application Ser. No. 09/976,459, filed on Oct. 10, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/943,636, filed on Aug. 29, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/747,066, filed on Dec. 21, 2000, which claims priority to U.S. Provisional Patent Application 60/213,385, filed Jun. 23, 2000, entitled "Percutaneous Interbody Fusion Device," the contents of each of which are incorporated in their entirety into this disclosure by reference.BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to medical devices and, more particularly, to systems for forming orthopedic fixation or stabilization implants in place within the body, such as by infusing a formable media into a cavity. In one application, the present invention relates to minimally invasive procedures and devices for forming a spinal stabilization rod in situ.
2. Description of the Related Art
The human vertebrae and associated connective elements are subject to a variety of diseases and conditions which cause pain and disability. Among these diseases and conditions are spondylosis, spondylolisthesis, vertebral instability, spinal stenosis and degenerated, herniated, or degenerated and herniated intervertebral discs. Additionally, the vertebrae and associated connective elements are subject to injuries, including fractures and torn ligaments and surgical manipulations, including laminectomies.
The pain and disability related to these diseases, conditions, injuries and manipulations often result from the displacement of all or part of a vertebra from the remainder of the vertebral column. A variety of methods have been developed to restore the displaced vertebrae or portions of displaced vertebrae to their normal position and to fix them within the vertebral column. For example, open reduction with screw fixation is one currently used method. The surgical procedure of attaching two or more parts of a bone with pins, screws, rods and plates requires an incision into the tissue surrounding the bone and the drilling of one or more holes through the bone parts to be joined. Due to the significant variation in bone size, configuration, and load requirements, a wide variety of bone fixation devices have been developed in the prior art. In general, the current standard of care relies upon a variety of metal wires, screws, rods, plates and clamps to stabilize the bone fragments during the healing or fusing process. These methods, however, are associated with a variety of disadvantages, such as morbidity, high costs, lengthy in-patient hospital stays and the pain associated with open procedures.
Therefore, devices and methods are needed for repositioning and fixing displaced vertebrae or portions of displaced vertebrae which cause less pain and potential complications. Preferably, the devices are implantable through a minimally invasive procedure.SUMMARY OF THE INVENTION
There is provided in accordance with one aspect of the present invention, an in situ formable orthopedic fixation rod. The rod comprises an elongate tubular body, having an interior chamber therein. The body is inflatable from a first, insertion profile to a second, enlarged profile by introducing a curable media into the chamber. An accelerator, for accelerating the curing of the curable media is also provided.
In one embodiment, the accelerator comprises a heat source. The heat source may comprise a resistance heating element, a conductive coil, a plurality of carbon fibers, or other heat sources known in the art. A heat sensor may additionally be carried by the chamber.
Preferably, the heat source is capable of heating at least a portion of the media to at least about 43° C. For some applications, the heat source is capable of heating at least a portion of the media to at least about 60° C.
In accordance with another aspect of the present invention, there is provided an orthopedic fixation device. The fixation device comprises an elongate flexible tubular body, having a distal end and a proximal end, and a central lumen extending therethrough. A manifold is provided at the proximal end of the body, comprising at least one port. An inflatable member having a proximal end, a distal end and an interior is removably attached to the distal end of the tubular body. A heat source is provided in thermal communication with the interior of the inflatable member. A valve, for resisting the escape of inflation media, is provided on the inflatable member. The heat source may comprise a resistive heating element, a circulating loop for circulating heated media, an RF antenna, an ultrasound transducer, a microwave antenna or a waveguide.
In accordance with another aspect of the present invention, there is provided a method of stabilizing an orthopedic fracture or joint between adjacent bones. The method comprises inserting at least two anchors having ports, into one or more bones. An orthopedic device is delivered to a position extending between the two ports. The orthopedic device is inflated with a hardenable media, and the media is heated above body temperature to accelerate hardening.
In accordance with another aspect of the present invention, there is provided a method of forming an orthopedic fixation device at a treatment site within the body of a patient. The method comprises the steps of positioning an outer wall at the treatment site within the patient, the outer wall defining a chamber therein. A hardenable media is introduced into the chamber, and the hardenable media is heated to accelerate hardening, to form the orthopedic device. In one application, the positioning step comprises positioning the outer wall between two bone anchors. The bone anchors may be positioned in adjacent fragments of a bone, separated by a bone fracture. Alternatively, the bone anchors may be positioned in vertebral bodies of the spine, such that the outer wall spans across an intervertebral disc or disc space. The treatment site may also be the interior of a bone, such as in the cancellous bone space of a long bone such as the femur.
In accordance with a further aspect of the present invention, there is provided a deployment catheter for deploying an implantable orthopedic device. The catheter comprises an elongate flexible tubular body, having a proximal end and a distal end. An inflatable device is removably carried by the distal end. An energy source is connected to the proximal end, and a heating element is provided in thermal communication with the inflatable device.
Further features and advantages of the present invention will become apparent to those of skill in the art in view of the detailed description of preferred embodiments which follows, when considered together with the attached claims and drawings.BRIEF DESCRIPTION OF THE DRAWINGS
Although the application of the present invention will be disclosed primarily in connection with a spinal fixation procedure, the methods and devices disclosed herein are intended for use in any of a wide variety of medical applications where formation of an attachment, bulking, support, fixation or other element in situ may be desirable.
One advantage of the in situ prosthesis formation in accordance with the present invention is the ability to obtain access to a treatment site through a minimally invasive access pathway, while enabling the formation of a relatively larger implant at the treatment site. This allows procedure morbidity to be minimized, since open surgical cutdowns or other invasive access procedures may be avoided. In addition, the in situ formation in accordance with the present invention allows the formation of an implant having any of a wide variety of customized or predetermined shapes, due to the ability of the infusible hardenable media to assume the shape of the cavity or flexible container into which it is infused.
The methods and devices of the present invention additionally enable access to a treatment site within the body along a curved and even tortuous pathway, through which a preformed prosthesis would not fit or would not be navigable. The detachable inflatable prosthesis of the present invention, removably coupled to the distal end of an elongate flexible tubular catheter body, can be dimensioned for percutaneous, surgical or transluminal advancement and deployment of an inflatable or otherwise curable in place prosthesis in any of a wide variety of orthopedic applications, such as the spine as disclosed in greater detail below, as well as long bones, short bones, and associated ligaments and tendons. In addition, the deployment catheter and prosthesis can be dimensioned for transluminal navigation throughout the cardiovascular system, the gastrointestinal tract, the biliary tract, the genitourinary tract, or the respiratory tract (e.g. the tracheobronchial tree). The device may thus be advanced through artificial access pathways as well as naturally occurring lumens and hollow organs. Additional applications of the in situ device formation technology of the present invention will become apparent to those of skill in the art in view of the disclosure herein.
In connection with spinal fixation applications, the present invention involves inserting one or two or more bone anchors having a connector such as a portal into at least a first and a second adjacent or nonadjacent vertebra. An implantable, inflatable orthopedic device is inserted through the portals and inflated to lock to the bone anchors and stabilize the bone components. A deployment system, comprising a delivery catheter removably carrying the implantable device, is provided, such that the procedure may be conducted in a percutaneous or minimally invasive manner to minimize procedure trauma to the patient.
The deployment system shown in
The overall length and cross sectional dimensions of the delivery catheter 100 may be varied, depending upon the intended clinical application. In a device intended for percutaneous or minimally invasive fusion of lumbar and/or sacral vertebrae, for example, the tubular body 104 will generally have a length within the range of from about 15 cm to about 50 cm, and a diameter within the range of from about 2 mm to about 6 mm.
Percutaneous insertion of the delivery catheter 100 may be facilitated by the provision of a removable elongate stiffening wire 122, extending through a lumen such as inflation lumen 130 (see
The deployment device 100 further comprises a manifold 124, located at the proximal end 106 of the elongate tubular body 104. The catheter manifold 124 provides a maneuvering handle for the health care professional, and supports an inflation port 126 and a vent port 128. Either or both the inflation port 126 or the vent port 128 may be provided with a coupling, such as a luer-lock fitting for connection to associated devices as is known in the art. For example, a luer or other connector on the inflation port 126 facilitates connection to a source of pressurized inflation media in a conventional manner. The vent port 128 may be connected to a syringe or other device to draw a vacuum, to evacuate air from the balloon prior to infusion of the hardenable media.
The manifold 124 may also include an injection port for allowing injection of radiopaque contrast fluid to enable visualization of the delivery device on a fluoroscope. The proximal manifold 124 may be machined or injection molded of any of a variety of known suitable materials such as PTFE, ABS, nylon, polyethylene, polycarbonate, or others known in the art. A precision gasket may also be provided, which seals securely around the inner sleeve 110, prohibiting fluid loss.
Catheter manufacturing techniques are generally known in the art, including extrusion and coextrusion, coating, adhesives, and molding. The catheter of the present invention is preferably made in a conventional manner. The elongate shaft of the catheter may be extruded, using polymers such as Nylon, PEBAX, PEEK, PTFE, PE or others known in the catheter arts, the stiffness of which may be selected as appropriate. Material selection varies based on the desired characteristics. The joints are preferably bonded. Biocompatible adhesives or heat bonding may be used to bond the joints. The balloon and stent are also made in a conventional manner.
The deployment system 100 further comprises an implantable inflatable orthopedic device 102, which may function, in a spinal fusion application, as an inflatable or formed in place fixation plate or rod. Implantable device 102 is removably carried by the distal end of the tubular body 104, such that inflation lumen 130 is in communication with the interior cavity 146 of the inflatable device 102. The inflation media may thus be infused through inflation port 126 (or opening 127) located at manifold 124 to fill the cavity 146.
The implantable device 102, which may be a balloon 114, includes a proximal end 116, a distal end 118, and a flexible wall 148. The balloon 114 may be formed from any of a variety of polymeric materials which are known in the balloon angioplasty arts. These include, for example, complaint materials such as polyethylene, polyethylene blends or nylon, and substantially noncompliant materials such as polyethylene terephthalate. Any of a wide variety of other biocompatible polymers may be utilized, as will be apparent to those of skill in the art in view of the disclosure herein.
The balloon 114 may comprise a single or multiple layers, depending upon the desired physical properties. In one embodiment, the balloon comprises two layers, having a reinforcing structure such as a stent or a plurality of axially extending support strips sandwiched therebetween. In an alternate embodiment, the balloon 114 comprises a first, inner layer which restrains the hardenable media. A second, outer layer is coaxially disposed about the first layer, and is provided with a plurality of apertures or a microporous structure. An infusion lumen is provided in the elongate tubular body, for providing communication between a proximal infusion port and the space in between the inner and outer balloon layers. In this manner, fluids, which may contain any of a variety of medications, can be infused into the tissue surrounding the treatment site. Suitable structures and manufacturing considerations are disclosed in U.S. Pat. No. 5,295,962 to Crocker et al., the disclosure of which is incorporated in its entirety herein by reference.
Although a cylindrical configuration for balloon 114 is illustrated herein, any of a variety of alternative cross sectional configurations may be utilized. The overall length, diameter and wall thickness of the implantable inflatable orthopedic device 102 may be varied, depending on the particular treatment and access site. In one embodiment, device 102 has an inflated length between about 2 and 12 cm, and often between about 5 cm and about 8 cm for adjacent vertebrae fixation. The device 102 has an inflated diameter of generally between about 0.5 and 2 cm.
The length of the balloon 114 is based upon the anticipated distance between the first and second anchors, or, in an embodiment having more than two anchors, between the anchors having the greatest axial separation. For example, in a fusion application in which two adjacent lumbar vertebrae (e.g. L4-L5) are to be fused in an adult, the first and second anchors will generally be spaced apart by a distance within the range of from about 5 cm to about 8 cm. Preferably, the axial length of the balloon 114 is sufficiently longer than the inter anchor spacing to permit a portion of the balloon to expand on the "far" side of the anchor aperture as is illustrated, for example, in
For use in an application where a first vertebrae is attached to a second vertebrae, and the second vertebrae is separated from the first vertebrae by at least a third vertebrae, for example in the lumbar spine, the inter anchor distance will generally be within the range of from about 10 cm to about 20 cm. As will be appreciated by those of skill in the art, in a three or more vertebrae fixation, the intermediate vertebrae or vertebraes will normally but need not necessarily be connected to the inflatable balloon 114. Thus, in one application, the balloon 114 connects a first attachment point at a first bone and a second attachment point at a second bone, with one or more intermediate bones unconnected to the balloon 114. In another application, at least a third anchor is provided in between the first and second anchors, and the balloon 114 is threaded through an aperture on each of the first, second and third anchors. The desirability of attaching or leaving unattached intervening vertebrae or other bones or structures between two attachment points is a matter of clinical judgement, in view of the particular circumstances of the patient.
The primary function of the balloon 114 is to influence or control the shape of the hardenable media, following injection therein. The implantable balloon 114 is not normally required to restrain pressure over an extended period of time. Thus, a greater design flexibility may be permitted, compared to conventional angioplasty or other dilatation balloons. For example, the balloon 114 may be porous, either for drug delivery as has been discussed, or to permit osteoincorporation and/or soft tissue ingrowth.
Certain hardenable media which may be utilized in connection with the present invention, such as PMMA, have a significantly greater viscosity in the precured form, compared to conventional angioplasty balloon inflation media. In addition, since the balloon 114 is not intended to contain significant pressure, conventional high strength materials such as for high pressure angioplasty may not be necessary. This allows the balloon 114 to be constructed in any of a variety of ways, including techniques utilized for balloon angioplasty applications. In addition, the balloon 114 (or balloon-like structure) may be made out of any of a wide variety of woven or nonwoven fibers, fabrics, metal mesh such as woven or braided wires, and carbon. Biocompatible fabrics or sheet material such as ePTFE and Dacron® may also be used.
The hardenable media is preferably a rapid setting, liquid polymer or polymer precursor, such as polymethyl methacrylate. However, any of a variety of other materials which provide the required stiffening or setting characteristics may be used, including any of a variety of epoxies, polyurethane or blends of polyurethane-silicone.
In the context of a rod shaped inflatable container, for use in spinal fixation procedures, the physical requirements of the hardenable media will depend upon the length and diameter of the rod as well as the physical requirements imposed by the implantation site. For certain embodiments, polymethyl methacrylate, epoxy, polyurethane or other particular material may or may not exhibit sufficient physical properties. Physical properties of hardenable materials can be modified through the addition of any of a variety of additives, such as carbon fibers, Kevlar or Titanium Rods, woven or laser etched metallic tubular stents, or other strength enhancers as will be understood in the art. The selection of a particular hardenable media, as well as the desirability of adding strength, flexibility, or other physical property enhancers, can be optimized for any particular implantation system through routine experimentation by those of skill in the art in view of the disclosure herein.
Certain composite materials, such as carbon fibers embedded in a bonding agent such as a two part epoxy, or two part polyurethane have been found particularly useful in forming the implant of the present invention. For example, graphite (carbon fibers) having a diameter within the range of from about 0.003 to about 0.007 inches are provided in bundles (tows) composed of from about 3,000 to about 12,000 fibers. One typical fiber useful for this purpose is manufactured by Hexcel Carbon Fibers, Salt Lake City, Utah, Part No. HS/CP-5000/IM7-GP 12K. Preferably, the Tow tensile strength is in the range of from about 5,000 to about 7,000 Mpa. Tow tensile modulus is within the range of from about 250 to about 350 Gpa.
In general, the composite rods in accordance with the present invention will exhibit a static compression bending values (per ASTM F1717) within the range of from about 100 to about 200 lbs., and, preferably greater than about 150 lbs. The composite rods will exhibit a static torsion (per ASTM F1717) within the range of from about 300 to about 500 inch pounds, and, generally in excess of about 400 inch pounds. The rods will preferably reach at least about 5 million cycles, at 5 Hz. Each of these parameters may be measured in accordance with the protocols described in the American Society for Testing and Materials (ASTM) designation F 1717-96, a copy of which is attached hereto as Appendix A, and which is incorporated in its entirety herein by reference.
Within the range of from about 30 to about 60 bundles of the carbon fiber described above is packed in a deflated balloon, optionally along with a Ni—Ti stent having an 8 mm diameter and 8 cm length. Although any of a variety of stents may be utilized, one useful structure is similar to the Smart Stent (Cordis), and it helps keep the structure intact and also adds structural strength to the implanted structure.
A one or a two part epoxy having a viscosity in the range of from about 100 to about 500 cps is then injected into the balloon under pressure such as by using a pump and pressure within the range of from about 4 ATM to about 10 ATM or more depending upon viscosity, balloon strength and other design considerations. The pump is run for a sufficient duration and under a sufficient pressure to ensure that the epoxy wets all of the fibers. This may range from about 10 minutes or more to about an hour, and, in one application where the pump was run at about 5 ATM pressure, requires at least about ½ hour. Specific method parameters may be optimized depending upon the viscosity of the epoxy, infusion pressure, infusion flow rate, density of the packed carbon fibers, and other variables as will be apparent to those of skill in the art in view of the disclosure herein.
In an alternate embodiment, carbon fibers having within the range of from about 15 to about 45 degrees of braids are utilized. The braid may be in the form of a plain weave, and may be obtained, for example, from Composite Structures Technology (Tehachapi, Calif.). A 0.5 inch diameter of 45 degrees braided carbon fiber sleeve is positioned within the center of the balloon. This braided sleeve conforms dimensionally to the inside diameter of the balloon. A 0.3 inch diameter braided carbon sleeve (again 45°×45° plain weave) may also be positioned concentrically within the balloon, within the outer braided carbon fiber sleeve. Unidirectional fibers are thereafter introduced inside of the ID of the inner braided carbon sleeve. Unidirectional fibers are also introduced into the annular gap between the two braided sleeves. The volume of the fiber per volume of balloon is generally within the range of from about 40% to about 55%. After placement of the foregoing structure within the portals of the screws, the epoxy mix having a viscosity within the range of from about 100 to about 500 cps is injected under 10 atmospheres pressure into the balloon.
Although the foregoing composite structure was described using a carbon fiber example, any of a variety of fibers may be positioned within the balloon to enhance the physical properties of the finished product. For example, Kevlar fibers, PEEK, and any of a variety of alternatives may be used. In general, the fibers will preferably provide a very high tensile strength and high modulus, having a low diameter to enhance deliverability of the device.
The use of braided sleeves will produce higher structural resistance to sheer stress as a result of torsional loads, plus the ability to distribute unidirectional fibers in a homogenous manner within the balloon at all times. This appears to improve the performance of the implant.
One construction of a composite formable rod in accordance with the present invention is illustrated in
An inner support tube 123 is spaced radially inwardly from the outer support tube 121. Inner support tube 123, in one embodiment, comprises a 0.3″ diameter braided carbon fiber sleeve having characteristics described above. A first plurality of unidirectional fibers 125 is axially oriented within the annular space between the outer support tube 121 and inner support tube 123. A second plurality of unidirectional carbon fibers 127 is positioned within the inner support tube 123.
Any of a variety of alternate constructions can be readily utilized, in accordance with the teachings herein. For example, three or more tubular support tubes may be utilized. The layering sequence of the various components may be changed, and other features added or deleted depending upon the desired performance of the finished device. In addition, although the balloon 114 in one embodiment comprises a nylon single layer balloon, other materials may be utilized. In addition, multiple layer balloons may be utilized, with or without support structures such as stents, wires, or woven tubular support structures sandwiched therebetween.
Marker bands made of materials such as gold, platinum or tantalum may also be positioned on the balloon, to facilitate fluoroscopic visualization. Alternatively, a radio opaque material, such as tantalum powder, may be sprinkled among the carbon fibers prior to infusion of the epoxy or other hardenable media, to allow visualization during placement.
The epoxy or the polyurethane material preferably has a relatively fast cure rate at 37° C. A low viscosity (no greater than from about 100 to about 1000 CPS) facilitates rapid transluminal introduction through the delivery catheter and wetting of the relatively small interstitial spaces between adjacent carbon fibers. In addition, the polymer is preferably radiopaque. The polymerization is preferably minimally exothermic, to minimize or prevent thermal damage to the surrounding tissue. One epoxy which may be useful in the present invention is Epotek 301 available from Epoxy Technologies. This epoxy reaches 50 to 60% of its strength within about three to four hours following deployment, at 37° C. Using a bonding agent having these approximate characteristics, the patient can be restrained from rolling for an initial cure period of approximately three or four hours to achieve a partial cure (e.g., at least about 50% and preferably 60% or more), and be maintained in bed for a secondary cure period such as approximately the next eight to twelve hours or more to accommodate a full cure. Other formulations of two part epoxies or polyurethanes with faster cure times (preferably no more than about one hour full cure) can be formulated by changing the ratios of components and formulations for the catalysts. Cure time can also be accelerated through the use of accelerators, such as catalysts or the application of heat as is discussed in detail below.
Terms such as "hardenable" or "curable" media are used interchangeably herein, and are intended to include any material which can be transluminally introduced through the catheter body into the cavity 146 while in a first, flowable form, and transitionable into a second, hardened form. These terms are intended to cover materials regardless of the mechanism of hardening. As will be understood by those of skill in the art, a variety of hardening mechanisms may exist, depending upon media selection, including UV, other wavelength of electromagnetic energy, or catalyst initiated polymerization, thermally initiated polymerization, solvent volatilization, and the like. While the media selection may affect catheter design in manners well understood by those of skill in the art, such as to accommodate outgasing of byproducts, application of heat, catalysts, or other initiating or accelerating influences, these variations do not depart from the concept of the invention of introducing a flowable media into a shape and subsequently curing the media to the shape. Two part medias, such as a two part epoxy or polyurethane, or a monomer and an initiator may be introduced into the cavity 146 through separate lumen extending throughout the tubular body. Expandable media may also be provided, such as a material which is implantable in a first, reduced volume, and which is subsequently enlargeable to a second, enlarged volume such as by the application of water or heat, or the removal of a restraint.
Various safety features to minimize the risk of rupture or leakage of the hardenable media may be utilized, depending upon design preferences. For example, a two-layer or three-layer or more balloon may be utilized to reduce the risk of rupture. In addition, the material of the single or multiple layers of the balloon may be selected to minimize escape of volatile components from the curable media. In one embodiment, a double balloon is provided having a nylon inside layer and a PET outside layer.
In addition, the inflation pressure of the curable media may be affected by the nature of the balloon. For example, a polyethylene balloon having a wall thickness of about 0.001″ may have a burst pressure of about 7 to 8 atmospheres. In that embodiment, an inflation pressure of no more than about 4 to 5 atmospheres may be desired. A slightly higher inflation pressure, such as on the order of from about 5 to about 6 atmospheres, may be utilized with a nylon balloon. Relatively noncompliant materials such as PET have much higher burst pressures (range of 10-20 atmospheres), as is well understood in the balloon angioplasty arts.
In addition, the balloon contains a proximal valve as will be discussed in additional detail below. Multiple valves may be utilized, in series along the flow path, to reduce the risk of failure and escape of hardenable media. As a further safety feature, the deployment catheter may be provided with an outer spill sheath in the form of an elongate flexible tubular body which surrounds the deployment catheter and at least a proximal portion of the balloon. This spill sheath provides an additional removable barrier between the junction of the catheter and the balloon, and the patient. If a spill occurs during the filling process, the spill sheath will retain any escaped hardenable media, and the entire assembly can be proximally retracted from the patient. Following a successful filling of the balloon, the spill sheath and deployment catheter can be proximally retracted from the patient, leaving the inflated formable orthopedic fixation structure in place.
The reinforcing element 120 may be exposed to the interior cavity 146 formed by the flexible wall 148, providing additional structural integrity. See, e.g.,
The reinforcement element 120 may include an expandable tubular stent. A stent of any suitable type or configuration may be provided with the delivery device, such as the Cordis artery stent ("smart stent"). Various kinds and types of stents are available in the market (Sulzer/Medica "Trotege" stent and Bard "Memotherm" stent), and many different currently available stents are acceptable for use in the present invention, as well as new stents which may be developed in the future.
Referring to
The balloon 114 may be removably attached to the tubular body 104 by a slip or friction fit on the distal end 108 of the outer sleeve 112 or on the inner sleeve 110. A variety of alternative releasable attachments may be used between the outer sleeve 112 and/or inner sleeve 110 and the proximal end 103 of the balloon 114, such as threaded engagement, bayonet mounts, quick twist engagements like a luer lock connector, and others known in the art. In each of these embodiments, a first retention surface or structure on the outer sleeve 112 and/or inner sleeve 110 releasably engages a complimentary surface or retention structure on the proximal end 103 of the balloon 114 as will be apparent to those of skill in the art.
The balloon 114 comprises a self-sealing valve 160 which prevents the hardenable media from leaking once the delivery catheter 100 is detached from the balloon 114. Valve 160 is provided for closing the pathway between inflation lumen 130 and inner cavity 146. Valve 160 may be located at the proximal end 116 of inflatable device 102. A variety of different valves may be used as will be recognized by those of skill in the art, such as a slit valve, check valve, duck-billed or flap valve. Alternatively, a stopper may be provided which can be placed within the pathway to prevent leakage.
Referring to
An alternate valve is illustrated in
The valve 160 may be connected to or formed with the inflatable device in any of a variety of manners, as will be appreciated in view of the disclosure herein. In the illustrated embodiment, the balloon 114 is provided with a proximally extending neck 115 which carries the valve 160 therein. The tubular body 165 having the cap 167 thereon is positioned concentrically within the proximal neck 115, as illustrated in
Additional details of one detachable connection between the delivery system and the implantable device is illustrated in
The tube 161 extends into a sliding fit with a tubular support structure 163 which may be positioned in a proximal neck portion of the balloon. When positioned as illustrated, the tube 161 ensures that the valve 160 is open, so that the inner sleeve 110 may extend axially therethrough into the balloon.
In addition, the inside diameter of the tube 161 is preferably sufficiently larger than the outside diameter of the inner sleeve 110 to provide an annular passageway in communication with the vent lumen 132. This structure ensures that the interior of the balloon remains in communication with the proximal vent port by way of a vent lumen 132 extending throughout the length of the assembly. In the illustrated embodiment, the outside diameter of the inner sleeve 110 is about 0.082″ to about 0.084″, and the inside diameter of the tube 161 is about 0.085″ to about 0.086″. Following infusion of the curable media into the balloon, the inner tube 110 and tubular body 161 are both proximally retracted from the balloon, thereby enabling the valve 160 to close as is described elsewhere herein.
When fully inflated, as shown in
Referring to
The bone anchors of
Bone anchor 10 comprises a proximal portion 12 having a proximal end 14 and a distal portion 16 having a distal end 18. Proximal portion 12 typically comprises a head 20 and a portal 22. In a preferred embodiment, head 20 comprises a proximal portion 24 configured to mate with the tip of a screwdriver. Head 20 may comprise a standard or Phillips slot for mating with the screwdriver. A variety of slot configurations are also suitable; such as hexagonal, Torx, rectangular, triangular, curved, or any other suitable shape. The bone anchor of
Portal 22 of bone anchor 10 may extend through head 20 and is generally between about 4 mm and 8 mm in diameter, preferably about 6 mm to about 8 mm in diameter. Portal 22 may be of any shape suitable for receiving inflatable, implantable orthopedic device 102; however, portal 22 is preferably round.
Distal portion 16 of bone anchor 10 typically comprises threads 26 and a sharp tip 28. Bone anchor 10 also preferably comprises a central lumen 30 extending coaxially completely through bone anchor 10 from proximal end 14 to distal end 18 and configured to receive a guidewire. Bone anchor 10 may also include at least one perforation 32, as shown in
Distal portion 46 comprises a shaft 52 having a tip 54 configured to interface with proximal portion of bone anchor 10. Screwdriver 40 may also comprise a central lumen 55 extending coaxially from proximal end 44 to distal end 48 configured to receive a guidewire.
A directing sheath 180, as shown in
Directing sheath 180 is preferably formed from a biocompatible polymer. Directing sheath 180 may also include a radiopaque filament 194 passing around each opening in central portion 186 or the entire length of sheath 180. Filament 194 aids in localizing directing sheath 180 after percutaneous placement.
The accelerator is not necessary a part of the delivery catheter 100.
In order to accomplish the objective of accelerating polymerization of the epoxy or other hardenable media, the heating element preferably elevates the temperature of the epoxy to a point above normal body temperature. Temperatures at the heating element of at least about 43°, preferably at least about 50°, and, under certain circumstances as high as 60° C. or more are desirable to produce an optimal cure rate. However, the outside of the implant is preferably not heated to the extent that it causes localized tissue necrosis. Tissue necrosis occurs at approximately 45° C. Thus, the heat source preferably sets up a temperature differential between the surface of the implant and the interior of the implant. This may be accomplished in several ways, such as, for example, selecting materials and thickness of the outer flexible wall 148 to provide thermal insulation of the adjacent tissue from heat generated by the heating element. As an alternative or in addition, heat sink structures may be provided at or near the outer surface of the orthopedic device 102. A flow path such as an annular space formed within a double walled balloon may be utilized to circulate a coolant such as saline or other circulating cooling fluid. Such measures preferably permit the heating element to be heated as high as 50° C. or higher, while maintaining the outside surface of the device 102 at a temperature of no more than about 45° C., and, preferably no more than about 43° C.
Excessive temperature can also be reached transiently, such as at the beginning of a heating cycle when the temperature may temporarily overshoot the 45° C. desired maximum. The present inventors have determined that the initial temperature overshoot can be eliminated or reduced by appropriately driving the power to the heating element as is discussed in detail below. The driver circuitry preferably brings the heating element up to operating temperature rapidly, while minimizing the risk of thermal overshoot beyond a predetermined maximum. All of the foregoing measures preferably allow a sufficient curing of the hardenable media to limit the required period of immobility to no more than about 2 hours, preferably no more than about 1 hour and, optimally no more than about 45 minutes post implantation. Although a complete cure is not required within this time window, a sufficient cure is desirable that the patient need not be immobilized beyond the initial cure. Thereafter, the hardenable media will continue to harden, such as over the next few hours or even days, but with little or no restriction on the patient's activities.
The resistive heating element, whether the heating coil 300, the reinforcement element 120, or other structure, may be made from material with either a positive or negative temperature coefficient of resistance, e.g., electrical resistance either directly or indirectly proportionate to temperature, respectively. The temperature may be monitored by measuring the DC voltage across the resistive heating element, for the voltage is directly proportional to resistance for a given current, and the temperature coefficient of resistance is known. Alternatively, by measuring the voltage, current and phase of the drive system, the resistance of the heating element and thus its temperature can be calculated by a microprocessor or dedicated circuitry.
Alternatively a thermistor 314 may be used to monitor the temperature of the inflatable orthopedic device 102. Thermistors are well known in the art. Using one or more separate thermistors 314 would entail more electrical contacts (not shown) as another electrical loop in addition to the one running the heating element may be necessary. Other methods of measuring the temperature include the use of an optical fiber in conjunction with a thermally reactive material, a coaxial plunger in conjunction with a thermal bulb, or a semiconductor temperature sensor or junction (such as a diode) carried by the orthopedic implant. A bimetallic heating element may function similarly to a circuit breaker and self-regulate.
The illustrated embodiment of the control panel 316 has a cycle button 600 with which to select the heating cycle, and a cycle window 602 to display the cycle selected. The control panel 316 is also provided with a pause switch 604 to pause the heating cycle, and LED's 606 and 608 respectively to indicate whether the cycle is running or paused. A time window 610 indicates the time elapsed in the heating cycle. An optional toggle switch (not shown) may be used to toggle the time window 610 to display the time remaining in the heating cycle. A power switch 612 turns the control panel on and off while a power LED 614 displays its power status. A heating LED 616 indicates whether the heating cycle is in a heating phase. Warning LED's 618 indicate whether there is a fault in the circuitry or connection with the heating element 300. Battery LED's indicate the charge status of the battery.
Low-pass filters 332 isolate the high frequency power generator 326 from a precision current source 334 and an amplifier 336. The precision current source 334 feeds a low precise DC current through the heating element 330. The resulting DC voltage across the heating element 330 is amplified by the amplifier 336 and compared against a reference voltage generated by a reference module 338. The comparison is done by a level comparator 340. As voltage is directly proportionate to resistance at a given current, the resistance across the heating element 330 can thus be measured. With the temperature coefficient of resistance of the heating element 330, the temperature of the heating element 330 can thus be calculated. The control block 324 acts on feedback from the comparator 340 to enable or disable the high frequency power generator 326, and thus regulate the temperature of the heating element 330 according to the heating profile. In one embodiment a clinical practitioner may have the option of overriding the heating profile by inputting the desired temperature into the control block 324 directly.
While a resistive heat source has been described in some of the above embodiments, other energy sources to accelerate the curing of the curable media may be used. These include, but are not limited to, adding a polymerizing agent, radio frequency, ultrasound, microwave and lasers. Also, the complete curing of the curable media by the described apparatus and methods is not always required to occur before discontinuing the heat source or other initiator step in these embodiments. When the curable media has been partially cured to a certain level of structural integrity, the patient does not have to be retrained for the remaining cure time necessary to achieve a complete cure. Thus the period of patient immobilization is minimized using the curing accelerators of the present invention.
Another specific embodiment is described in connection with
The inner electrical connector tube 438 is coaxially carried by the exterior perimeter of the suction tube 434. The outer electrical connector tube 440 is coaxially arranged around the exterior perimeter of the inner electrical connector tube 438. A layer of electrical insulation is provided between the two electrical connector tubes 438 and 440. This can be accomplished by coating the inner surface of the outer electrical connector tube 440 or the outer surface of a proximal portion of the inner electrical connector tube 438 with an electrically insulating material, such as polyurethane or PTFE. Both electrical connector tubes 438 and 440 may be slotted to ease connection, as discussed below. A wire connects each electrical connector tube to the drive circuit of the heating element 408. Each electrical connector tube may have an additional wire connected to it, which may be used together as a dedicated feedback loop to more accurately measure the electrical resistance of the heating element 408. A spacer tube 442 is provided with a notch 443 which provides an annular seat for the proximal end of the outer electrical connector 440, to hold the outer electrical connector tube 440 in place.
A lock tube 444 is coaxially arranged around the exterior perimeter of the spacer tube 442. The lock tube 444 is provided with one or two or more axially extending slits 445 and provided with a radially inwardly extending projection 446 for releasable engagement with a corresponding annular recess on the proximal end of the balloon 400, as discussed below. The inner tube 448 holds the suction tube 434 and the injection tube 430, as all three extend all the way proximally into the catheter handle. The outer tube 450 terminates proximally at a luer lock at the distal end of the catheter handle.
Referring to
When the catheter is attached to the balloon 400, the inner electrical connector tube 438 contacts the inner electrical connector ring 422, and the outer electrical connector tube 440 contacts the outer electrical connector ring 424. As described above, both electrical connector tubes are slotted to ease their insertion into the respective electrical connector rings. These two contacts complete the electric circuit between the heating element 408 and its drive circuitry.
The lock tube 444 holds the balloon 400 in place at the end of the catheter. A seal 426 at the proximal end 416 of the balloon 400 seals against the interior surface of the lock tube 444. As described above, the lock tube 444 is slit to ease its insertion over the proximal end 416 of the balloon 400. One or more radially inwardly extending projections 446 provided on the interior surface of the lock tube 444 complements the bottleneck 428 in the proximal end 416 of the balloon 400 to provide an interference engagement which is maintained by the outer tube 450. The outer tube 450 may be released via the luer lock 506, allowing it to slide distally over the lock tube 444 to restrain the projection 446 of the lock tube 444 within the bottleneck 428 of the balloon 400.
Any of a variety of releasable connectors may be utilized, between the catheter and the implant. For example, threaded connections, twist locks, interference fit and friction fit structures are well known in the art. In general, a releasable connection which will withstand sufficient tension and compression during the positioning process is preferred. Such structures will generally include an interference fit. In the illustrated embodiment, a radially inwardly extending annular ridge which is provided with two or more axially extending slots to allow lateral movement cooperates with a radially inwardly extending annular recess on the proximal end of the implant as has been discussed. The radially inwardly extending ridge provides an interference surface, which may also be carried by one or more lever arms or other support structures. The relationship may alternatively be reversed between the deployment catheter and the implant, such that one or more radially outwardly extending projections on the implant engage a radially outwardly extending recess on the interior wall of the deployment catheter. In general, a positive interference fit can be readily accomplished by a first locking surface on the catheter which is removably engaged with a second, complementary locking structure on the implant. Preferably, one of the first and second locking structures is laterally moveable to engage and disengage the implant, and a lock is provided for releasably locking the first and second engagement surfaces to releasably retain the implant on the catheter.
The deployment and release of the inflatable orthopedic balloon 400 is now described. A guide wire may be inserted into the injection lumen 432 to stiffen the entire catheter to facilitate insertion of the balloon 400. This guide wire may be inserted via the injection port 502. Ideally this guide wire extends all the way to the distal end 402 of the balloon, and has a diameter that permits axial movement within the inner diameter of the injection tube 430. The insertion of the balloon 400 may be visualized by fluoroscopy of the distal marker 404 and the proximal marker 418. The guide wire is removed prior to the injection of curable medium into the balloon 400 via the injection lumen 432.
The injection port 502 is then connected to a pump, which pumps curable medium into the balloon 400 through the injection tube 430. As the injection tube 430 in the illustrated embodiment extends through the inner tubing 406 into or close to the distal end 402 of the balloon 400, the balloon is filled from the distal end 402 first. A vacuum is connected to suction port 504. As described above, the suction tube 434 extends through the valve assembly 420 of the balloon 400 to a point just distal of the proximal marker 418, and the inner tubing 406 of the balloon 400 is porous. This suction thus contributes to the filling of the balloon 400 with curable medium.
After the space 412 (as defined by the volume between the inner tubing 406 and the outer wall 414 of the balloon 400) is filled with curable medium, the luer lock 510 may be disengaged to allow the removal of the injection tube 430 and the suction tube 434. Any space remaining in the inner tubing 406 is filled with curable medium as the injection tube 430 is slowly pulled out. The valve assembly 420 of the balloon 400 prevents any curable medium from leaking.
A high frequency current is passed through the heating element 408 to accelerate the curing of the curable medium in the balloon 400, as has been discussed above in
After the completion of the heating cycle, the catheter is removed from the balloon 400 by first sliding outer tube 450 proximally, exposing the lock tube 444. As described above, the lock tube 444 is slit. Without the outer tube 450 around it, the rounded proximal surface of projection 446 of the lock tube 444 will slide over and off the bottleneck 428 of the balloon 400 as the catheter handle 500 is pulled proximally. This action will also disengage the inner electrical connector tube 438 from the inner electrical connector ring 422 and the outer electrical connector tube 440 from the outer electrical connector ring 424. The balloon 400 is thus left in place after the removal of the catheter.
Although the application of the present invention will be disclosed in connection with connecting two adjacent vertebrae, the methods and structures disclosed herein are intended for various other applications such as to connect three or more vertebrae, as will be apparent to those of skill in the art in view of the disclosure herein. In addition, the method may be used to stabilize the L5 vertebrae, using the cranial-ward portion of the sacrum as the vertebrae with which L5 is anchored. Furthermore, although the method is disclosed and depicted as applied on the left side of the vertebral column, the method can also be applied on the right side of the vertebral column, or both sides of the vertebral column sequentially or simultaneously.
The method of the present invention involves percutaneously inserting one or more fusion devices into two or more than two adjacent vertebrae, either unilaterally or, preferably bilaterally, where a portion or all of at least one of the vertebrae is unstable, separated or displaced. The fusion devices reposition or fix the displaced vertebra or portion of the displaced vertebra to a position within the vertebral column which is more stable or which causes less morbidity.
Referring now to
The method will now be disclosed and depicted with reference to only two vertebrae, one which is either unstable, separated or displaced and one of which is neither unstable, separated nor displaced. However, the method can also be applied to three or more vertebrae simultaneously, as will be understood by those with skill in the art with reference to this disclosure. Additionally, the method can be used to stabilize the L5 vertebrae, using the cranial-ward portion of the sacrum as the "vertebrae" with which L5 is anchored. Further, though the method is disclosed and depicted as applied on the left side of the vertebral column, the method can also be applied on the right side of the vertebral column or, preferably, can be applied on both sides of the vertebral column, as will be understood by those with skill in the art with reference to this disclosure.
First, the present method comprises identifying a patient who is a suitable candidate for undergoing the method. In connection with a spinal application, a suitable candidate has one or more unstable vertebrae, one or more portions of one or more vertebrae at least partly separated from the remainder of the vertebrae, one or more portions of one or more vertebrae at least partly separated from the remainder of the vertebrae with potential or complete separation, or has one or more vertebrae or a portion of one or more vertebrae displaced from its normal position relative to the vertebral column, or has one or more portions of one or more vertebrae at least partly separated from the remainder of the vertebrae and displaced from its normal position relative to the vertebral column. Further, the suitable candidate will normally have either pain, loss of function or real or potential instability which is likely due to the separation or displacement, or separation and displacement. If only a portion of the vertebra is unstable, separated or displaced, the portion of the vertebra that is unstable, separated or displaced will generally include at least part of the vertebral body and adjoining pedicle. However, other unstable, separated or displaced portions of a vertebra can be repositioned or fixed using the present method, as will be understood by those with skill in the art with reference to this disclosure. For example, a suitable patient can have a disease or condition such as spondylosis, spondylolisthesis, vertebral instability, spinal stenosis and degenerated, herniated, or degenerated and herniated intervertebral discs, though actual indications require the expertise of one of skill in the art as will be understood by those with skill in the art with reference to this disclosure.
Next, the present method comprises making a stab incision in the patient's skin overlying the patient's vertebral column at or near the level of the vertebrae or portion of vertebrae to be repositioned or fixed. In one embodiment, the incision is made at or near the level of the pedicle of the vertebra or portion of vertebra to be repositioned or fixed. The pedicle level is located preferably by identifying the pedicle shadow using fluoroscopy. In a preferred embodiment, the stab incision is made using a #11 scalpel blade.
Then, as shown in
Then, as shown in
The biopsy needle 202 is then removed and the tract from the skin surface to the nicked periosteal surface is enlarged by using a high-pressure fascial dilator balloon (not shown) over the needle-tipped guidewire. Then, the balloon is removed and a working sheath 206 is introduced into the dilated tract. Alternately, a hard plastic or metallic sheath with a central dilator is advanced over the guidewire from the skin surface to the periosteal surface. Next, a pilot hole may be drilled using an over-the-wire drill bit driven by a hand held drill.
Next, as shown in
The stages discussed above are repeated for at least one additional vertebra 212 until each vertebra that is to be repositioned or fixed has a bone screw 208 applied, and additionally for at least one vertebra which is neither unstable, separated nor displaced and which lies adjacent the cranial-most or caudal-most vertebra that is being repositioned or fixed. The bone screw 208 placed into the vertebra 212 which is neither unstable, separated nor displaced is used as the anchor to reposition or fix each vertebra 200 which is unstable, separated or displaced as follows. As will be understood by those with skill in the art with reference to this disclosure, the bone screws can be placed into the vertebrae in a different order to that described above.
After a bone screw is positioned in each vertebra, the portals are connected using an inflatable connection rod according to the present invention where the rod is inserted between the portals of the bone screws and inflated to create a rigid structure with the bone screws, thereby repositioning and fixing the one or more than one previously unstable, separated or displaced vertebra, or one or more previously unstable, separated or displaced portions of one or more vertebrae with the vertebra that is neither unstable, separated nor displaced. Connection of the bone screws with the inflatable rod is accomplished as follows.
Referring now to
Then, as shown in
In one embodiment, as further shown in
In another embodiment, as further shown in
In another embodiment, the needle-tipped, semi-rigid guidewire 216 comprises an outer helical, flat wire sheath and an inner retractable sharp tip stylet. Once the needle-tipped, semi-rigid guidewire is placed, the stylet can be removed to allow for easier capture by the capture device with less trauma to the surrounding tissue.
Then, as shown in
Next, as shown in
Then, as shown in
Finally, as shown in
Referring now to
In another embodiment of the present method, a directing sheath 180 according to the present invention is advanced over a guidewire until the openings in the directing sheath 180 overlie the position in each vertebra which will receive a bone screw 208. The bone screws 208 are then placed as disclosed in this disclosure, but through the openings in the directing sheath 180, which aligns the lumen in the directing sheath with the portals of the bone screw 208. Then (not shown), a guidewire is inserted into the lumen of the directing sheath at the proximal end of the directing sheath and advanced until the guidewire passes through each portal of the bone screws and exits the body through the lumen of the directing sheath at the distal end. The directing sheath is then removed by peeling the sheath apart along the scored lines and pulling the two halves out from the body. The guidewire that was in the lumen of the directing sheath remains in place to guide the placement of the uninflated, inflatable connection rod. Alternately, the uninflated, connection rod can be inserted directly into the lumen of the directing sheath at the proximal end and advanced until the uninflated, inflatable connection rod is properly positioned between the portals of the bone screws. Referring now to
In one embodiment, there is provided a kit for performing methods of the present invention. The kit comprises a plurality of bone screws according to the present invention. The kit can also comprise other components of the system of the present invention, such as a guidewire directing device, an inflatable connection rod, the components of the polymer system to be mixed and injected and a directing sheath. In another preferred embodiment, the kit also comprises a screwdriver according to the present invention. A control with electronic driving circuitry can also be provided, for thermal acceleration of the hardenable media.
Referring to
Cross-linking may be accomplished in any of a variety of configurations, as will be apparent to those of skill in the art in view of the disclosure herein. For example, a pair of laterally opposing pedicle screws 208 may be connected to each other by an inflatable crossbar or solid crossbar as will be apparent from the disclosure herein. Alternatively, the body of the two opposing inflatable connection rods 222a and 222b can also be connected by a crossbar. Although the present discussion will focus primarily upon the latter construction, it is to be understood that the present invention contemplates any cross connection between a left and right connection rod, preferably through a procedure in which each of the connection rods or crossbars is installed in a less invasive or minimally invasive procedure.
Referring to
A cross tie support 248 is axially movably positioned within the access sheath 232. Cross tie support 248 is connected at a distal end 249 through a releasable connector 246 to a cross tie 234. Cross tie 234 facilitates connection of a crossbar with a primary inflatable connection rod, to achieve cross linking of the orthopedic fixation system.
Although a variety of structures for cross tie 234 can be utilized, one convenient construction is illustrated in
The cross tie 234 additionally comprises a second connector 240, such as a second aperture 242. The second aperture 242 is adapted to receive a crossbar 222c, as illustrated in
The cross tie 234 is held in place during the procedure by a cross tie support 248 through a releasable connector 246. The releasable connector 246 facilitates the positioning of the cross tie 234 during the deployment step, but enables decoupling following proper positioning of at least an inflatable connection rod 222a and possibly also the crossbar 222c. Any of a variety of releasable connection structures may be utilized, such as a threaded distal end on the cross tie support 248, which threadably engages an aperture on the cross tie 234.
As illustrated in
Referring to
Preferably, the first aperture 238 is dimensioned with respect to the connection rod 222a such that a secure fit is provided between the inflatable connection rod 222a and cross tie 234 following complete curing of the curable media. If shrinkage of the curable media is contemplated, the first aperture 238 may be defined within an annular ring on the frame 244 which has an expansion break extending therethrough. In this manner, inflation of the inflatable connection rod 222a can be accomplished such that the expansion break allows a slight enlargement of the diameter of the first aperture 238. Upon transverse shrinkage of the inflatable connection rod 222a during the curing process, the natural bias imparted by the frame 244 allows the first aperture 238 to shrink, thereby retaining a tight fit with the inflatable connection rod 222a throughout a range of diameters. This construction may also be applied to the apertures extending through the bone screws 208, as well as the second apertures 242.
The cross tie support 248 is illustrated in
The final construction is illustrated in
Although only a single crossbar 222c is illustrated, two or three or four or more crossbars 222c may alternatively be used, depending upon the axial lengths of the inflatable connection rods 222a and 222b, and the desired structural integrity of the finished assembly. In addition, although the crossbar 222c is illustrated as extending generally perpendicular to the longitudinal axis of each of the inflatable connection rods 222a and 222b, the crossbar 222c may cross each of the inflatable connection rods 222 at any of a variety of angles ranging from approximately +45° to −45° with respect to the illustrated position. Thus, the crossbar 222c may be implanted at a diagonal if the desired structural integrity can be thus achieved.
The crossbar 222c may comprise any of a variety of forms. For example, the crossbar illustrated in
In an alternate application of the cross-linking technology of the present invention, the crossbar is constructed in a manner which enables elimination of the separate cross tie 234. Referring to
The 21 French dilator 260 is advanced over a stiff 0.038″ guidewire, with an 8 French catheter. A 24 French pusher sheath 262 is positioned proximally of the tubular body 254.
Using this deployment system, the tubular body 254 may be positioned relative to two pairs of bone screws 208 as illustrated schematically in
The tubular body 254 may by itself provide sufficient cross-linking strength for the intended purpose. Alternatively, the tubular body 254 may be filled with a curable media 266 to enhance the structural integrity of the resulting assembly. For example, as illustrated in
The embodiment of
Although the present invention has been described in terms of certain preferred embodiments, other embodiments of the invention including variations in dimensions, configuration and materials will be apparent to those of skill in the art in view of the disclosure herein. In addition, all features discussed in connection with any one embodiment herein can be readily adapted for use in other embodiments herein. The use of different terms or reference numerals for similar features in different embodiments does not imply differences other than those which may be expressly set forth. Accordingly, the present invention is intended to be described solely by reference to the appended claims, and not limited to the preferred embodiments disclosed herein.
1-29. (canceled)
30. A formed in place orthopedic device, comprising:
- an outer wall, defining a cavity therein;
- a plurality of reinforcing fibers in the cavity;
- a hardenable media for bonding with the reinforcing fibers to form the orthopedic device; and
- a heating element for heating the hardenable media;
- wherein the hardenable media is hardened while the device is positioned within the body of a patient to create the formed in place orthopedic device.
31. A formed in place orthopedic device as in claim 30, wherein the hardenable media comprises an epoxy.
32. A formed in place orthopedic device as in claim 30, wherein the hardenable media comprises polyurethane.
33. A formed in place orthopedic device as in claim 30, wherein the reinforcing fibers comprise carbon fibers.
34. A formed in place orthopedic device as in claim 30, wherein the reinforcing fibers comprise graphite fibers having a diameter within the range of from about 0.003 inches to about 0.007 inches.
35. A formed in place orthopedic device as in claim 30, wherein the reinforcing fibers are provided in at least one bundle having within the range of from about 3,000 to about 12,000 fibers.
36. A formed in place orthopedic device as in claim 35, comprising from about 30 to about 60 bundles of fibers.
37. A formed in place orthopedic device as in claim 30, wherein the reinforcing fibers have a Tow tensile strength within the range of from about 5,000 Mpa to about 7,000 Mpa.
38. A formed in place orthopedic device as in claim 30, wherein the reinforcing fibers have a Tow tensile modulus within the range of from about 250 Gpa to about 350 Gpa.
39. A formed in place orthopedic device as in claim 30, further comprising at least one reinforcing sleeve within the cavity.
40. A formed in place orthopedic device as in claim 30, wherein the reinforcing sleeve comprises a braided carbon fiber wall.
41-67. (canceled)
Type: Application
Filed: Jun 14, 2005
Publication Date: Oct 20, 2005
Patent Grant number: 7780705
Inventors: Samuel Shaolian (Newport Beach, CA), George Teitelbaum (Santa Monica, CA), To Pham (Trabuco Canyon, CA), Thanh Nguyen (Irvine, CA), James Dabney (Irvine, CA)
Application Number: 11/151,785


text:
11 people showed up for our first meeting of the new year. Thanks to Iovation for providing a comfortable space with pizza.
We will be having another PRP soon, as well as a YAMS hackathon. We may combine the two into one event. Watch this space for details.
Here are Tim's slides from his Database Trending talk last night. I can't wait to try this at home!
I converted his .odp slides to .ppt so's I could a) upload them to WP (no .odp allowed!) and b) include his notes.


text:
Jobs related to "Leasing Agent"
Job Title: Leasing Agent
Leasing Agent Position Description:
The Leasing Agent works as part of a team under the direction of the Property Manager, to lease units and provide customer assistance to the clients. The Leasing Agent must relate well to people, exercise good judgment and discretion in dealing with residents, vendors, and co-workers.
Responsibilities of the Leasing Agent:
- Showing Apartments
- Taking telephone inquiries
- Greeting Prospects
- Taking applications, deposits and verifying all information to be true and correct
- Follow up of prospects and current residents needs
- Posting and monitoring ads
- Assisting the Property Manager in maintaining all aspects of property operations
- Ensures the efficient operation of the property
- Evictions of delinquent residents
Qualifications for the Leasing Agent:
- At least one year experience working in residential property management as a Leasing Agent, and the following skills are preferred:
- Accounting
- Sales
- Customer service
- Strong computer literacy with MS Word, Excel, E-mail and Internet
- AMSI, YARDI or Rent Roll software is strongly preferred
- Exceptional organization and time management skills required
- Work well under pressure
- Computer literacy, if applicable
- Strong interpersonal skills; ability to communicate effectively with a diversity of individuals at all organizational levels
- Criminal background check required
Renoir Staffing, LLC is committed to a drug-free workplace!
Since 1985, Renoir Staffing, LLC has been meeting the needs of apartment communities, property management companies, and commercial real estate offices. Headquartered in Alameda, Renoir Staffing has branch offices in San Jose, Folsom, Culver City, and Garden Grove, CA, employing more than 600 people with over $10 million in sales. The company has repeatedly been listed as one of the largest staffing agencies in the Bay Area. Please visit our website at www.renoirstaffing.com
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text:
The sun is shining, which means the roads are clogged with one-season cyclers. Now's their opportunity to recharge their cellphones the eco-friendly way—well, if they've got a Nokia phone, that is.
The bicycle charger kit includes the actual charger, plus the holder to affix to the handlebars. Cycling at 6km an hour is enough to start charging the phone, but if you can increase your speeds to 12km an hour it charges just as fast as a conventional wall-plug charger. It works with any Nokia cellphone with the 2mm pin-jack, though be careful you remember to remove your phone when you lock up your bike. [Nokia]


text:
Item No.:
Product Name:
Tempered Glass Module 18Watt, 2000mA & 9Volt
For charging 6V rechargeable battery and applications
- Power (maximum): 18W
- Current (maximum) Isc: 2000mA
- Voltage voc: 9V
Frame size: 641x290x25mm
We have over 100 solar modules with output ranging from 60mA to 9000mA for 3V, 6V, 12V and 24V
Built with all weather and durable special high quality water-white low iron tempered glass
Made by USA most advanced and high technology equipment for perfect quality
Use best grade USA made high efficiency solar cells and components
New improvement coating material and adhesive material
UV protection, all weather protection, moisture protection and corrosive protection
A blocking diode is built in the circuit with the connecting cable wire to protect the battery against discharge at night time
All solar modules are provided with battery clips for immediate and easy to use
Applications: Tvs, recreational vehicles, radios, water pumps, car battery boosters, home systems, car chargers, ventilators, street lights and hi-way call boxes (phone box) etc.
[Please click here to go back]
To make enquiry on this product, go back to product list and check the box.


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Hey Tom, I have class on Monday nights off and on (which is why I wasn't at PC tonight). Is there a way to pick up my winnings (from the night of April 29th) throughout the week or how is it best to collect? Just wondering, thanks.Perry Martin


text:
Endorsed by Curators:
Play for promos, play for prizes, play for the love of the game!
HobbyTown Lincoln offers four different events every Friday, so you can choose your favorite format each week:
5pm registration, 6pm start. Free entry, Standard format. Four Swiss rounds, promo foils to Top 2 and 2 random players based on standings after Round 4.
5pm registration, 6pm start.$5 entry, Modern format. Every player receives 1 booster pack for entering, plus HobbyTown gift cards to the Top 4 players FNM Promo foils to Top 2 plus 2 random players after Round 4.
Come sign in to play Commander in casual groupings from 6pm-9pm at HobbyTown Lincoln! Entry is free, and 4 random players will each receive an FNM promo!
5pm registration, 6pm draft start.$10 entry, Quick Draft format.20-minute Swiss rounds, single-game matches, "free" first mulligan each game. Promo foils to Top 2 plus 2 random players based on standings after final round.