text:
A unit of China's People's Liberation Army has been tied to a location believed to be the source of "an overwhelming percentage of the attacks on American corporations, organizations and government agencies," according to a report in the New York Times on Tuesday.
"An unusually detailed 60-page study, to be released Tuesday by Mandiant, an American computer security firm, tracks for the first time individual members of the most sophisticated of the Chinese hacking groups – known to many of its victims in the United States as 'Comment Crew' or 'Shanghai Group' – to the doorstep of the military unit's headquarters," the report says. "The firm was not able to place the hackers inside the 12-story building, but makes a case there is no other plausible explanation for why so many attacks come out of one comparatively small area."
Over the past year, Global Public Square contributors have looked at a range of cyber issues, from the potential threat posed by Chinese firms to what the U.S. can do to improve its cyber defenses.
"Weak cybersecurity renders America less secure on a global strategic level," wrote Katrina Timlin, a research assistant at the Center for Strategic and International Studies, on GPS last February. "Around seventy countries are building cyber capabilities for their military or national defense infrastructure. Among the most capable countries are Russia and China, historical competitors with America."
More from CNN: U.S. firm links China with hacking
"Although they are unlikely to launch a spontaneous cyber attack, it is understandable they are probing our vulnerabilities and testing the limits of cyber espionage. America's competitors have clear incentives to seek economic and military advantage through these 'illicit' means, and America's inability to properly defend its cyber infrastructure is only facilitating this nefarious behavior."
How should the U.S. respond?
According to A. Greer Meisels and Mihoko Matsubara, the United States and its allies need to coordinate their response to these threats. "As countries pursue interoperability for the sake of military efficiency, they also face an increase in shared vulnerabilities. Washington should take advantage of its pre-existing alliance network and serve as a hub to synchronize such efforts," the authors wrote in October. "This requires developing robust, actionable intelligence capabilities that can provide real-time information to decision-makers in the United States, to private companies, and to its allies."
More from CNN: Have courage to deal with cyber war
But Jennifer Stisa Granick, director of civil liberties at the Stanford Law School Center for Internet and Society, suggested that in the push to find solutions in the U.S., it's worth asking whether more legislation is the answer.
"Bringing federal agencies up to par won't…require new laws. President Obama could implement much of the Cybersecurity Act via executive order," Granick wrote in August. "Further, government may be able to raise standards for critical infrastructure networks through regulation rather than legislation. In most critical industries, electricity, nuclear power, chemical plants and water safety are already heavily regulated by the government. So why, for example, did NASDAQ get hacked in 2011? When we, or Congress, understand this, we can apply the tool that would improve the situation, whether it's Securities and Exchange Commission regulation or new laws."
What is the point of this article? Who gives two hoots if China gets the secret ingredient to the coca-cola recipe or learns that we have a gps satellite where it shouldn't be. This still doesn't give a large news corporation the right to stir up American support for a anti-Chinese political action.
Don't just write an article to hear yourself, give it some solid meaning.
I think you missed the point. US companies & US investors do care if the Chinese Govt is spying on them. The PRC also spies on the US Govt and that endangers US national security. I am sure you would not want the Chinese Govt hacking into your computer, would you?
The U.S. is the most armed country in the world, with 90 guns to every 100 people. This statistic represents those with gun permits–it does not include those with guns that are not licensed. As of 2-21-2013, there are 315,366,068 people in the US. Do the math. Look at how advanced our country is. Now, do believe that China has a Chinese chance in Hell of invading the US? They may give it the ole college try so to say, but succeed? In their dreams. I am a woman who owns a Colt AR15. Am I a dead shot with it? Yes. Would I step up to defend my country? You better believe that I will–in a heartbeat.
Very John Wayne, and just as antiquated. What are you going to do when a cyber attack deletes all records of your bank account? Shoot the ATM machine?
How big it is? en I think it is as big as ONE foot long subway~or maybe tast even as well as subway~~
Come on boy~who will attack the others, at their own home and using a stupid static IP address? it is way too stupid~~I cann't believe the report comes from a professional group of internet security~~it sounds like a military report , which is ask more budgets~~that's it
So what will our "Dear Leader" do about it? NOTHING....
The PRC has been engaged in cyberespionage against the US for over decade. The US Govt had warnings but ignored them for the most part. Now we are slowly waking up to the cyber threat from the PRC. The PRC also engages in hacking & cyber warfare against Tibetan, Uighur, and Chinese dissidents. The PRC is a major threat to US national interests. It is hegemonistic and imperialistic. It wants to the new Middle Kingomd and dominate Asia. Asian nations must unite to stand up to the PRC.
Much of this is industrial espionage. China doesn't want a military confrontation with us, they prefer to win on the economic battlefield. They want the Citizens Against Government Waste ad "Now they work for us" to become a reality.
Gives us an opportunity to see their capabilities.
We are no different. Do you really think that we have no cyber soldiers out there? Do you think that your web experience is not controlled by the government? Try to register the domain newrevolution and see what happens.
First of all when we hack into their systems all we get back is what the chinese stole from everyone else. Do you really think that the chinese can innovate on their own under such restricted conditions! Besides where would china be if it weren't for American technology. They would all still be using rickshaws for transportation. If I've said it once, I've said it a thousand times "NEVER TRUST A G00K!".
Consider this. Most of the computers here are made with parts from China. Do we know if these components only do what we bought them to do, or do they provide a "back door" to those who designed the circuit firmware? Who checks whether these cards and boards have exploits built in?
"How big is China's cyber threat?"
China is a massive threat to the rest of the world. Period. If you've every been to China you know that if they ever did take the world over that humankind might as well hang it up and let some other species take over. The quality of life there is very poor for most people and any attempt to protest most likely puts you in prison. The communist elite steal whatever land they want from everyone else, and send those that complain to black prisons that are not even part of the official legal machinery there.
Like the US is any better? Let see no real health care, crazies with guns, lobbyist in control of your congress, a useless congress and the media which keeps the masses i.e. sheep ignorant and hateful like yourself..... And that's just the beginning... 16 TRILLION+ national debt and more to come!
China is the next war.
We are all being "played" by the media, left and right. There really are no "truths", just "positions" and "interests". Not so long, historically speaking, after the old Soviet was put to bed, we look to our next "boogy-man" so we can all be herded into following our masters wishes.
USA has the largest and most advanced hacking organization in the whole entire universe, Period. Agree? Every once in awhile, we just have to bring up this bad dude, which's CHINA in the neighborhood, so everyone will scare of him and not do business with him, instead do business with USA.
China will deny it until they are blue in the face, but they are doing it. In fact, about two years ago, it was in the news that they hacked into something really important, and before Chinese officials could get to them, their Cyber Geeks boasted that they were able to hack into any computer system in the world. i.e. they tipped their hand. Their geeks stated that there was literally no system in the world that could defend against their hacks. Immediately after that, there was complete silence from their side, as would be expected. The Geeks were obviously told to shut-up. After that, there have been several reports pointing the finger at them, but they deny it every time. Seriously, would anyone really expect them to admit to it ??? This is obviously of the utmost importance at this time. We should spare no resources to address the issue.
OK so you have traced the problem to one single 12 storey buidling in China. If the PLA was really spying on US using this location they would immediately shut it down and shift their attacks to anohter adress.
If this does not happen, then this is a decoy and they want to be caught.
I really don't think they are stupid enough to be tracebale – it is much more plasuible that they have several levels of decoys and outsource the job to somepne else:
Meantime, the Scare Mongers have their day.
Just because the brutal Chinese Communist Party is helping a few rich, greedy Americans get richer, don't imagine that they like Westerners or are not brainwashing their people about how evil Americans are. Even though on the outside, they smile and shake our hands, and they try to dress and be like us, one would be quite surprised if he or she could read Chinese schoolbooks and learn exactly what the evil Party teaches its children about us. Americans have been mislead by their Government and media into trading with the enemy, and I mean the enemy. The cruel Party has murdered one hundred million of its own people since 1949, imagine what it would do to us given half a chance. This is just my understanding, thank you.
jeff forsythe, the Chinese do not consider you evil at all. They just think you are a typical kwok zucking kwok zucker who loves zucking lama's kwok.
Countries are all doing it to each other. Don't be naive.


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As the "Leafs Suck! Leafs Suck!" chant reverberated through MTS Centre on New Year's Eve, the Winnipeg Jets did exactly what they had to do.
Thanks to goals by Zach Bogosian (pictured: the Jets all-star calibre defenseman), Andrew Ladd and Blake Wheeler (with the eventual winner at 10:50 of the second period on the power play), the Jets beat the Toronto Maple Leafs 3-2 and completed the task set out by the coaching staff, management, the players themselves and most Jets fans — get at least 20 points in the month of December.
Reality sets in for the Jets now. They head out to face the Canadiens in Montreal on Wednesday, the Leafs in Toronto on Thursday, then go to Buffalo next Saturday and Boston next Tuesday. It will be the first four road games in a month in which they play nine of 13 games away from home.
Then, for the first 16 days of February, the young Jets play six of eight on the road. In total, that's 15 of their next 21 away from "the seventh man," at MTS Centre and it will, no doubt, be a real test for a team that is 5-8-4 on the road this season.
And that's why Saturday night's win over Toronto was so important. With the victory, the Jets finished 10-3-1 in December — that's 21 of a possible 28 points. They were 9-2-1 at home — 19 of a possible 24 points. They started the month 9-11-4 and in 12th place in the East. They finished at 19-14-5, tied for sixth in the East. In mid-November, the Jets trailed Toronto by 12 points. Saturday night, they moved two points ahead of the Leafs.
In a nutshell, the Jets picked up the ground they needed to pick up with 15 of the next 21 games on the road.
Now that's not to say that the Jets won't finish above .500 during the next 47 days. They certainly could rise to a difficult occasion and surprise everybody by keeping the streak alive. They have, after all, won three straight and one of those games, a 4-1 win in Colorado, was earned away from the thunderous din of MTS Centre.
"The first two periods (Saturday night), I thought we were just awesome," said veteran Jets defenseman Ron Hainsey, as the Jets outshot the Leafs 28-12 through the first 40 minutes. "They brought some real pressure in the third period but we held on.
"We now have to get our road record up, we know that. We know our road record needs work, but we got a big win in Colorado, so we need to find a way to do that a lot more often going forward. That was a nice game.
"When you're on the road, your only focus is to get out with a win. Look, it's easy to play in this building. It's not hard to get challenged and be ready to play here. These fans are amazing. They just want you to perform, so if you can't get fired up here, you really have to look at yourself in the mirror. It's different on the road. We have to find a way to challenge ourselves and stay focused on winning."
Saturday night, the Jets beat a struggling team that played a tough game, especially in the third period. The Leafs gave it everything they had in the final 20 minutes. but Ondrej Pavelec (pictured) shut them down while the defense in front of him was outstanding — a defence that has won three straight and allowed only three goals without an injured Dustin Byfuglien in the lineup.
The best of the bunch on Saturday was Bogosian, who played 23 minutes and 14 seconds and not only scored a goal but blocked a shot and had six hits.
Meanwhile, forward Blake Wheeler was solid, as well. He played 22:33 and had the winning goal and an assist.
"It was big win, we're feeling pretty good about it," said Wheeler, who has a five-game points streak and 22 points in the last 20 games. "This month was huge. We dug ourselves a bit of a hole in the first month and a half. We knew we had to play well this month in order to put ourselves in a good position heading into a real tough part of our schedule. We've done that and we'll enjoy it for a day or two. but we'll have to be ready on Wednesday heading into Montreal."
The Jets indeed got the job done in December. They have every right to feel good about themselves.
Now comes six weeks of truth. If they survive 15 of the next 21 on the road, it's going to be a fun spring in Winnipeg.


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Spine distraction implant
A spine distraction implant alleviates pain associated with spinal stenosis and facet arthropathy by expanding the volume in the spine canal and/or neural foramen. The implant provides a spinal extension stop while allowing freedom of spinal flexion.
Latest Patents:
This application is a division of, and claims priority to, U.S. patent application Ser. No. 09/842,756, filed Apr. 26, 2001, which is a continuation of U.S. patent application Ser. No. 09/474,038, filed Dec. 28, 1999, now U.S. Pat. No. 6,332,882, which is a division of U.S. patent application Ser. No. 09/474,037, filed Dec. 28,1999, now U.S. Pat. No.6,190,387, which is a continuation of U.S. patent application Ser. No. 09/175,645, filed Oct. 20, 1998, now U.S. Pat. No. 6,068,630, which is a continuation-in-part of U.S. Pat. No. 08/958,281, filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. Pat. No. 08/778,093, filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948, all of which are incorporated by reference in their entireties.
As the present society ages, it is anticipated that there will be an increase in adverse spinal conditions which are characteristic of older people. By way of example, with aging comes increases in spinal stenosis (including but not limited to central canal and lateral stenosis), the thickening of the bones which make up the spinal column and facet arthropathy. Spinal stenosis is characterized by a reduction in the available space for the passage of blood vessels and nerves. Pain associated with such stenosis can be relieved by medication and/or surgery. Of course, it is desirable to eliminate the need for major surgery for all individuals and in particular for the elderly.
Accordingly, there needs to be developed procedures and implants for alleviating such condition which are minimally invasive, can be tolerated by the elderly and can be performed preferably on an outpatient basis.
The present invention is directed to providing a minimally invasive implant and method for alleviating discomfort associated with the spinal column.
The present invention provides for apparatus and method for relieving pain by relieving the pressure and restrictions on the aforementioned blood vessels and nerves. Such alleviation of pressure is accomplished in the present invention through the use of an implant and method which distract the spinous process of adjacent vertebra in order to alleviate the problems caused by spinal stenosis and facet arthropathy and the like. While the implant and method particularly address the needs of the elderly, the invention can be used with individuals of all ages and sizes where distraction of the spinous process would be beneficial.
In one aspect of the invention, an implant is provided for relieving pain comprising a device positioned between a first spinous process and a second spinous process. The device includes a spinal column extension stop and a spinal column flexion non-inhibitor.
In another aspect of the invention, the implant is positioned between the first spinous process and the second spinous process and includes a distraction wedge that can distract the first and second spinous processes as the implant is positioned between the spinous processes.
In yet another aspect of the present invention, the implant includes a device which is adapted to increasing the volume of the spinal canal and/or the neural foramen as the device is positioned between adjacent spinous processes.
In yet a further aspect of the present invention, a method is presented for relieving pain due to the development of, by way of example only, spinal stenosis and facet arthropathy. The method is comprised of the steps of accessing adjacent first and second spinal processes of the spinal column and distracting the processes a sufficient amount in order to increase the volume of the spinal canal in order to relieve pain. The method further includes implanting a device in order to maintain the amount of distraction required to relieve such pain.
In yet a further aspect of the invention, the method includes implanting a device in order to achieve the desired distraction and to maintain that distraction.
In yet a further aspect of the invention, the implant includes a first portion and a second portion. The portions are urged together in order to achieve the desired distraction.
In still a further aspect of the invention, the implant includes a distracting unit and a retaining unit. The distracting unit includes a body which can be urged between adjacent spinous processes. The body includes a slot. After the distracting unit is positioned, the retaining unit can fit into the slot of the retaining unit and be secured thereto.
In yet a further aspect of the invention, the implant includes a first unit with a central body. A sleeve is provided over the central body and is at least partially spaced from the central body in order to allow for deflection toward the central body.
In a further aspect of the invention, the implant includes a first unit having a central body with a guide and a first wing, with the first wing located at first end of the body. The guide extends from a second end of the body located distally from the first wing. The implant further includes a sleeve provided over said central body. The sleeve is at least partially spaced from the central body in order to allow for deflection of the sleeve toward the central body. The implant further includes a second wing and a device for securing the second wing to the first unit, wherein the sleeve is located between the first and second wings.
In yet another aspect of the invention, an implant system includes a cylindrical sleeve which is inwardly deflectable. The system further includes an insertion tool which includes an insertion guide, a central body, a stop and a handle. The guide and the stop extend from opposite sides of the central body and the handle extends from the stop. A sleeve fits over the guide and against the stop preparatory to being positioned between the two adjacent vertebrae with the insertion tool.
In yet a further aspect of the invention, the implant includes central body and first and second wings and a means for selectively positioning one of the first and second wings relative to the other in order to accommodate spinous processes of different sizes.
Other implants and methods within the spirit and scope of the invention can be used to increase the volume of the spinal canal thereby alleviating restrictions on vessels and nerves associated therewith, and pain.
For simplicity in description, identical components are labeled by the same numerals in this application.
Embodiment of FIGS. 1-5a, 5b
A first embodiment of the invention is shown in
The second forked end 24 (
For purposes of implantation between adjacent first and second spinous processes of the spinal column, the implant 20 is configured as shown in
It is noted that this implant as well as the several other implants described herein act as an extension stop. That means that as the back is bent backwardly and thereby placed in extension the spacing between adjacent spinous processes cannot be reduced to a distance less than the distance between the lowest point of saddle 26 and the lowest point of saddle 28. This implant, however, does not inhibit or in any way limit the flexion of the spinal column, wherein the spinal column is bent forward.
Preferably, such a device provides for distraction in the range of about 5 mm to about 15 mm. However, devices which can distract up to and above 22 mm may be used depending on the characteristics of the individual patient.
With all the ligaments (such as the superspinous ligament) and tissues associated with the spinous processes left intact, the implant 20 can be implanted essentially floating in position in order to gain the benefits of the aforementioned extension stop and flexion non-inhibitor. If desired, one of the saddles 26 can be laterally pinned with pin 29 to one of the spinous processes and the other saddle can be loosely associated with the other spinous processes by using a tether 31 which either pierces or surrounds the other spinous process and then is attached to the saddle in order to position the saddle relative to the spinous process. Alternatively, both saddles can be loosely tethered to the adjacent spinous process in order to allow the saddles to move relative to the spinous processes.
The shape of the saddles, being concave, gives the advantage of distributing the forces between the saddle and the respective spinous process. This ensures that the bone is not resorbed due to the placement of the implant 20 and that the structural integrity of the bone is maintained.
The implant 20 in this embodiment can be made of a number of materials, including but not limited to, stainless steel, titanium, ceramics, plastics, elastics, composite materials or any combination of the above. In addition, the modulus of elasticity of the implant can be matched to that of bone, so that the implant 20 is not too rigid. The flexibility of the implant can further be enhanced by providing additional apertures or perforations throughout the implant in addition to the holes 40 which also have the above stated purpose of allowing the interbody piece 30 to be rotated in order to expand the distance between the saddle 26, 28.
In the present embodiment, it is understood that the spinous processes can be accessed and distracted initially using appropriate instrumentation, and that the implant 20 can be inserted and adjusted in order to maintain and achieve the desired distraction. Alternatively, the spinous process can be accessed and the implant 20 appropriately positioned. Once positioned, the length of the implant can be adjusted in order to distract the spinous processes or extend the distraction of already distracted spinous processes. Thus, the implant can be used to create a distraction or to maintain a distraction which has already been created.
The placement of implants such as implant 20 relative to the spinous process will be discussed hereinbelow with other embodiments. However, it is to be noted that ideally, the implant 20 would be placed close to the instantaneous axis of rotation of the spinal column so that the forces placed on the implant 20 and the forces that the implant 20 places on the spinal column are minimized.
Further, it is noted that during the actual process of installing or implanting the implant 20, that the method uses the approach of extending the length of the implant 20 a first amount and then allowing the spine to creep or adjust to this distraction. Thereafter, implant 20 would be lengthened another amount, followed by a period where the spine is allowed to creep or adjust to this new level of distraction. This process could be repeated until the desired amount of distraction has been accomplished. This same method can be used with insertion tools prior to the installation of an implant. The tools can be used to obtain the desired distraction using a series of spinal distraction and spine creep periods before an implant is installed.
Embodiment of FIGS. 6, 7, 8, 9 and 10
The embodiment of the invention shown in the above
Embodiment of FIGS. 11, 12 and 13
Another embodiment of the apparatus and method of the invention is shown in
Embodiments of FIGS. 14, 15, 16, 16a, and 17
An alternative embodiment of the implant can be seen in
The embodiment of implant 130 is not circular in overall outside appearance, as is the embodiment 110 of
If it is desired, and in order to assure that the first member 132 and the second member 134 are aligned, key 148 and key way 150 are designed to mate in a particular manner. Key 148 includes at least one flattened surface, such as flattened surface 152, which mates to an appropriately flattened surface 154 of the keyway 150. In this manner, the first member is appropriately mated to the second member in order to form appropriate upper and lower saddles holding the implant 130 relative to the upper and lower spinous processes.
Embodiment of FIGS. 18, 19 and 20
The implant 330 as shown in
The first or second wedges 332, 334 have a mating arrangement which includes a channel 344 and a projection of 346 which can be urged into the channel in order to lock the wedges 332, 334 together. The channel 334 is undercut in order to keep the projection from separating therefrom. Further, as in other devices described herein, a detent can be located in one of the channel and the projection, with a complimentary recess in the other of the channel and the projection. Once these two snap together, the wedges are prevented from sliding relative to the other in the channel 344.
While the above embodiment was described with respect to wedges, the wedges could also have been designed substantially as cones with all the same features and advantages.
Embodiments of FIGS. 21 and 22
The implant 370 is comprised of first and second distraction cone 372, 374. These cones are made of a flexible material. The cones are positioned on either side of the spinous processes 376, 378 as shown in
Embodiments of FIGS. 23, 24 and 25
Implant 170 can be made of a deformable material so that it can be urged into place and so that it can somewhat conform to the shape of the upper and lower spinous processes. This deformable material would be preferably an elastic material. The advantage of such a material would be that the load forces between the implant and the spinous processes would be distributed over a much broader surface area. Further, the implant would mold itself to an irregular spinous process shape in order to locate the implant relative to spinous processes.
With respect to
Embodiment of FIGS. 26, 27 and 28
The embodiment shown in
The distraction tool 190 can be inserted through a small incision in the back in order to spread apart the spinous processes. Through the same incision which has been slightly enlarged laterally, an upper end 202 of ring 200 can be initially inserted followed by the remainder of the ring 200. Once the ring is inserted, the ring can be rotated slightly by moving handle 198 downwardly in order to further wedge the spinous processes apart. Once this has been accomplished, an implant such as implant 204 can be inserted through the ring and properly positioned using implant handle 206. Thereafter, the implant handle 206 and the insertion tool 196 can be removed.
Embodiments of FIGS. 29, 30, 31, 32 and 33
As can be seen in
As can be seen in
As can be seen in
Embodiment of FIGS. 34 and 35
Another embodiment of the invention is shown in
Embodiments of FIGS. 36, 37 and 38
The embodiments of
The implant 230 is inserted laterally throughout the opening between upper and lower spinous processes. The first body 238 causes the initial distraction. Each successive conical body distracts the spinous processes a further incremental amount. When the desired distraction has been reached, the spinous processes are locked into position by steps 236. At this point, if desired, the initial nose body 238 of the implant and other bodies 240 can be broken, snapped or sawed off if desired in order to minimize the size of the implant 230. In order for a portion of the implant 230 to be broken or snapped off, the intersection between bodies such as body 238 and 240, which is intersection line 242, would be somewhat weakened with the appropriate removal of material. It is noted that only the intersection lines of the initial conical bodies need to be so weakened. Thus, intersection line 244 between the bodies which remain between the spinous processes would not need to be weaker, as there would be no intention that the implant would be broken off at this point.
Turning to
Embodiment of FIGS. 39 and 40
In the embodiment of
Further, a plurality of cannula can be used instead of one, with each cannula being slightly bigger than one before. In the method of the invention, the first smaller cannula would be inserted followed by successively larger cannula being placed over the previous smaller cannula. The smaller cannula would then be withdrawn from the center of the larger cannula. Once the largest cannula is in place, and the opening of the skin accordingly expanded, the implant, which is accommodated by only the larger cannula, is inserted through the larger cannula and into position.
Embodiments of FIGS. 41, 42 and 43
The precurved implant 270 in
Although only two break lines 280, 282 are depicted, multiplebreak lines can be provided on implant 270 so that the implant can continue to be fed over the guide wire 278 until the appropriate width of the implant 270 creates the desired amount of distraction. As described hereinabove, the break lines can be created by perforating or otherwise weakening the implant 270 so that the appropriate portions can be snapped or sawed off.
With respect to the precurved implant 272, this implant is similar in design to the implant 230 shown in
Embodiment of FIG. 44
A further embodiment of the invention is shown in
Embodiment of FIG. 45
Embodiment of FIGS. 46 and 47
Implant 310 of
Embodiments of FIGS. 48, 49, 50 and 51
As can be seen in
Alternatively, the insertion tool 326 can be used to insert multiple implants 320, 321 into the space between the spinous processes 322, 324 (
Embodiment of FIGS. 52, 53, 54, 55a and 55b
The embodiment of
A variety of materials can be used to make the implant and the fluid which is forced into the implant. By way of example only, viscoelastic substances such as methylcellulose, or hyaluronic acid can be used to fill the implant. Further, materials which are initially a fluid, but later solidify, can be inserted in order to cause the necessary distraction. As the materials solidify, they mold into a custom shape about the spinous processes and accordingly are held in position at least with respect to one of two adjacent spinous processes. Thus, it can be appreciated that using this embodiment and appropriate insertion tools the implant can be formed about one spinous process in such a manner that the implant stays positioned with respect to that spinous process (
It is to be understood that many of the other implants disclosed herein can be modified so that they receive a fluid in order to establish and maintain a desired distraction much in the manner as implant 350 receives a fluid.
Embodiment of FIGS. 56, 57 and 58
The implant 360 as shown in
Embodiments of FIGS. 59 and 60
In this embodiment, the implant 380 is comprised of a plurality of interlocking leaves 382. Initially, a first leaf is positioned between opposed spinous processes 384, 386. Then subsequently, leafs 382 are interposed between the spinous processes until the desired distraction has been built up. The leaves are somewhat spring-like in order to absorb the shock and can somewhat conform to the spinous processes.
Embodiment of FIG. 61
The implant 390 of
Embodiment of FIGS. 62 and 63
Implant 410 of
As shown in
Embodiment of FIGS. 64, 65 and 66
The embodiments of
In the embodiment of
The embodiment of
Embodiments of FIGS. 67, 68
The implant 550 is Z-shaped and includes a central body 552 and first and second arms 554, 556, extending in opposite directions therefrom. The central body 552 of the implant 550 includes first and second saddles 558 and 560. The first and second saddles 558 and 560 would receive upper and lower spinous processes 562, 568. The arms 554, 556 are accordingly located adjacent the distal end 566 (
Embodiment of FIGS. 69, 70, 71 and 71a
The second arm 590, projecting from second saddle 586, is located somewhat rearward of the distal end 600, and extends partially along the length of the central body 582. The second arm 590 projects at a compound angle from the central body 582. As can be seen in
In a preferred embodiment, the first and second arms 588,590 have a length which is about the same as the width of the central body 582. Preferably, the length of each arm is about 10 mm and the width of the central body is about 10 mm. However, the bodies with the widths of 24 mm and greater are within the spirit and scope of the invention, along with first and second arms ranging from about 10 mm to greater than about 24 mm. Further, it is contemplated that the embodiment could include a central body having a width of about or greater than 24 mm with arms being at about 10 mm.
It is to be understood that the embodiment of
The embodiment of
The implant 610 of
Embodiment of FIGS. 72, 73
Implant 630 is also designed so that it can be inserted from one side of adjacent spinous processes. This insert 630 includes a central body 632 with the first and second arms 634, 636 extending on either side thereof. As can be seen in
For purposes of positioning the implant 630 between adjacent spinous processes, the plunger 638 is pulled outwardly as shown in
Plunger 638 can be spring biased to the position as shown in
Embodiments of FIGS. 74, 75, 76, 77, and 78
Other embodiments of the invention are shown in
Implant 700 includes first and second saddle 706, 708 which are used to receive and spread the load from the upper and lower spinous processes. The saddle 706 is defined by first and second arms 710 and 712. The second saddle 708 is defined by third and fourth arms 714 and 716. As can be seen in
First arm 710 is in addition designed to accommodate the shape of the vertebra. As can be seen in
The second arm 712 is small so that it is easy to insert between the spinous processes, yet still define the saddle 706. The fourth arm 716 is larger than the third arm 714, both of which are smaller than the first arm 710. The third and fourth arms are designed so that they define the saddle 706, guide the spinous processes relative to the implant 700 during movement of the spinal column, and yet are of a size which makes the implant easy to position between the spinous processes.
The procedure, by way of example only, for implanting the implant 700 can be to make an incision laterally between two spinous processes and then initially insert first arm 710 between the spinous processes. The implant and/or appropriate tools would be used to distract the spinous processes allowing the third leg 714 and the central body 702 to fit through the space between the spinous processes. The third leg 714 would then come to rest adjacent the lower spinous processes on the opposite side with the spinous processes resting in the first and second saddle 706, 708. The longer fourth leg 716 would then assist in the positioning of the implant 700.
The implant 760 as shown in
Embodiment of FIGS. 79, 80, 80a, 81, 82, 83, 83a, 84, 85, 86 and 87
Another embodiment of the invention is shown in
The threaded bore 820 in this embodiment slopes at approximately 45° angle and intersects the slot 806. With the second wing 824 in position, the set screw 822 when it is positioned in the threaded bore 820 can engage and hold the second wing 824 in position in the slot 806.
Turning to
As can be seen in
The implant 800 includes, as assembled, an upper saddle 844 and the lower saddle 846. The upper saddle 844 has an upper width identified by the dimension "UW". The lower saddle 846 has a lower width identified by the dimension "LW". In a preferred embodiment, the upper width is greater than the lower width. In other embodiments, the "UW" can be smaller than the "LW" depending on the anatomical requirements. The height between the upper and lower saddles 844, 846 is identified by the letter "h". These dimensions are carried over into
For the above table, all dimensions are given in millimeters.
For purposes of surgical implantation of the implant 800 into a patient, the patient is preferably positioned on his side (arrow 841 points up from an operating table) and placed in a flexed (tucked) position in order to distract the upper and lower vertebrae.
In a preferred procedure, a small incision is made on the midline of the spinous processes. The spinous processes are spread apart or distracted with a spreader. The incision is spread downwardly toward the table, and the distracting unit 802 is preferably inserted upwardly between the spinous processes 840 and 842 in a manner that maintains the distraction of spinous processes. The distracting unit 802 is urged upwardly until the distracting or bulbous end 808 and the slot 806 are visible on the other side of the spinous process. Once this is visible, the incision is spread upwardly away from the table and the retaining unit or second wing 824 is inserted into the slot 806 and the screw 822 is used to secure the second wing in position. After this has occurred, the incisions can be closed.
An alternative surgical approach requires that small incisions be made on either side of the space located between the spinous processes. The spinous processes are spread apart or distracted using a spreader placed through the upper incision. From the lower incision, the distracting unit 802 is preferably inserted upwardly between the spinous processes 840 and 842 in a manner that urges the spinous processes apart. The distracting unit 802 is urged upwardly until the distracting or bulbous end 808 and the slot 806 are visible through the second small incision in the patient's back. Once this is visible, the retaining unit or second wing 824 is inserted into the slot 806 and the screw 822 is used to secure the second wing in position. After this has occurred, the incisions can be closed.
The advantage of either of the above present surgical procedures is that a surgeon is able to observe the entire operation, where he can look directly down onto the spinous processes as opposed to having to view the procedure from positions which are to the right and to the left of the spinous processes. Generally, the incision is as small as possible and the surgeon is working in a bloody and slippery environment. Thus, an implant that can be positioned directly in front of a surgeon is easier to insert and assemble than an implant which requires the surgeon to shift from side to side. Accordingly, a top-down approach, as an approach along a position to anterior line is preferred so that all aspects of the implantation procedure are fully visible to the surgeon at all times. This aides in the efficient location of (i) the distracting unit between the spinous processes, (ii) the retaining unit in the distracting unit, and (iii) finally the set screw in the distracting unit.
Embodiment of FIGS. 88, 89, 90 and 91
Another embodiment of the invention is shown in
The end 908 of implant 900 is different in that it is more pointed, having sides 909 and 911 which are provided at about 45° angles (other angles, such as by way of example only, from about 30° to about 60° are within the spirit of the invention), with a small flat tip 913 so that the body 904 can be more easily urged between the spinous processes.
The distracting unit 902 further includes a tongue-shaped recess 919 which extends from the slot 906. Located in the tongue-shaped recess is a threaded bore 920.
As can be seen in
Embodiment of FIGS. 92, 92a, 92b, 93, 93a, 93b, 93c, 93d, 94, 94a, 94b, 95, 95a, and 96
Still a further embodiment of the invention is depicted in
Alternatively, the first wing can be secured to the central body with a press fit and detent arrangement as seen in
In yet another alternative embodiment, the first wing can be designed as shown in
Positioned at the other end of the central body 1002 is a guide 1010. In this particular embodiment, guide 1010 is essentially triangularly-shaped so as to be a pointed and arrow-shaped guide. Alternatively, guide 1010 could be in the shape of a cone with lateral truncated sides along the longitudinal axis 1008. Guide 1010 includes a recess 1012 having a threaded bore 1014. Recess 1012 is for receiving a second wing 1032 as will be described hereinbelow.
Additionally, it is also to be understood that the guide 1010 can be bulbous, cone-shaped, pointed, arrow-shaped, and the like, in order to assist in the insertion of the implant 1000 between adjacent spinous processes. It is advantageous that the insertion technique disturb as little of the bone and surrounding tissue or ligaments as possible in order to (1) reduce trauma to the site and facilitate early healing, and (2) not destabilize the normal anatomy. It is to be noted that with the present embodiment, there is no requirement to remove any of the bone of the spinous processes and depending on the anatomy of the patient, there may be no requirement to remove or sever ligaments and tissues immediately associated with the spinous processes.
The implant 1000 further includes a sleeve 1016 which fits around and is at least partially spaced from the central body 1002. As will be explained in greater detail below, while the implant may be comprised of a bio-compatible material such as titanium, the sleeve is comprised preferably of a super-elastic material which is by way of example only, a nickel titanium material (NiTi), which has properties which allow it to withstand repeated deflection without fatigue, while returning to its original shape. The sleeve could be made of other materials, such as for example titanium, but these materials do not have the advantages of a super-elastic material.
In this particular embodiment, the central body 1002 includes elongated grooves 1018, along axis 1008, which receives elongated spokes 1020 extending from the internal surface of the cylinder 1016.
In a preferred embodiment, both the cross-section of the central body and the sleeve have a major dimension along axis 1022 and a minor dimensional along axis 1024 (
Alternatively as can be seen in
In other embodiments, the sleeve can have minor and major dimensions as follows:
In one preferred embodiment, said sleeve has a cross-section with a major dimension and a minor dimension and said major dimension is greater than said minor dimension and less than about two times said minor dimension. In said embodiment, said guide has a cross-section which is adjacent to said sleeve with a guide major dimension about equal to said sleeve major dimension and a guide minor dimension about equal to said sleeve minor dimension. Further in said embodiment, said guide extends from said central body with a cross-section which reduces in size in a direction away from said central body.
In another preferred embodiment, said guide is cone-shaped with a base located adjacent to said sleeve. Further, said guide has a base cross-section about the same as the oval cross-section of said sleeve.
Thus, from the above, it is evident that preferably a major dimension of the sleeve correspond with a major dimension of the central body and a minor dimension of the sleeve corresponds with a minor dimension of the central body. Additionally, it is evident that the major dimension of the sleeve 1016 is substantially perpendicular to a major dimension of the first wing 1004 along longitudinal axis 1030 (
As indicated above, the preferred material for the sleeve 1016 is a super-elastic material and more preferably one comprised of an alloy of nickel and titanium. Such materials are available under the trademark Nitinol. Other super-elastic materials can be used as long as they are bio-compatible and have the same general characteristics of super-elastic materials. In this particular embodiment, a preferred super-elastic material is made up of the following composition of nickel, titanium, carbon, and other materials as follows:
In particular, this composition of materials is able to absorb about 8% recoverable strain. Of course, other materials which can absorb greater and less than 8% can come within the spirit and scope of the invention. This material can be repeatably deflected toward the central body and returned to about its original shape without fatigue. Preferably and additionally, this material can withstand the threshold stress with only a small amount of initial deforming strain and above the threshold stress exhibit substantial and about instantaneous deformation strain which is many times the small amount of initial deforming strain. Such a characteristic is demonstrated in
Preferably, the above super-elastic material is selected to allow deformation of up to about, by way of example only, 8%, at about 20 lbs. to 50 lbs. force applied between a spinous processes. This would cause a sleeve to deflect toward the central body absorbing a substantial amount of the force of the spinous processes in extension. Ideally, the sleeves are designed to absorb 20 lbs. to 100 lbs. before exhibiting the super-elastic effect (threshold stress level) described above. Further, it is possible, depending on the application of the sleeve and the anatomy of the spinal column and the pairs of spinous processes for a particular individual, that the sleeve can be designed for a preferable range of 20 lbs. to 500 lbs. of force before the threshold stress level is reached. Experimental results indicate that with spinous processes of an older individual, that at about 400 pounds force, the spinous process may fracture. Further, such experimental results also indicate that with at least 100 pounds force, the spinous process may experience some compression. Accordingly, ideally the super-elastic material is designed to deform or flex at less than 100 pounds force.
In a preferred embodiment, the wall thickness of the sleeve is about 1 mm or 40/1000 of an inch (0.040 in.). Preferably the sleeve is designed to experience a combined 1 mm deflection. The combined 1 mm deflection means that there is ½ mm of deflection at the top of the minor dimension and a ½ mm deflection at the bottom of the minor dimension. Both deflections are toward the central body.
In a particular embodiment where the sleeve is more circular in cross-section, with an outer dimension of 0.622 in. and a wall thickness of 0.034 in., a 20 lb. load causes a 0.005 in. deflection and a 60 lb. load causes a 0.020 in. deflection (approximately ½ mm). A 100 lb. load would cause a deflection of about 0.04 in. or approximately 1 mm.
Thus in summary, the above preferred super-elastic material means that the sleeve can be repeatedly deflected and returned to about its original shape without showing fatigue. The sleeve can withstand a threshold stress with a small amount of deforming strain and at about said threshold stress exhibit about substantially instantaneous deformation strain which is many times the small amount of the forming strain. In other words, such super-elastic qualities mean that the material experiences a plateau stress where the material supports a constant force (stress) over very large strain range as exhibited in
It is to be understood that for this particular embodiment, bar stock of the super-elastic material is machined into the appropriate form and then heat treated to a final temperature to set the shape of the material by increasing the temperature of the material to 932° Fahrenheit and holding that temperature for five (5) minutes and then quickly quenching the sleeve in water. It is also to be understood that preferably the present nickel titanium super-elastic alloy is selected to have a transition temperature Af of about 59° Fahrenheit (15° C.). Generally for such devices the transition temperature can be between 15° C. to 65° C. (59° F. to 149° F.), and more preferably 10° C. to 40° C. (50° F. to 104° F). Preferably, the material is maintained in the body above the transition temperature in order to exhibit optimal elasticity qualities.
Alternatively, and preferably, the sleeve can be fabricated by wire Electrical Discharge Machining (EDM) rather than machined. Additionally, the sleeve can be finished using a shot blast technique in order to increase the surface strength and elasticity of the sleeve.
Top and side views of the second wing 1032 are shown in
An alternative configuration of the second wing 1032 is depicted in
With respect to the alternative second wing 1032 depicted in
Embodiment of FIG. 97
Implant 1050 of
Embodiment of FIG. 98
Implant 1060 is depicted in
Embodiment of FIGS. 99 and 100
Embodiment of FIGS. 101, 102, 102a, 103, 104, 105, 106, and 107
Another embodiment of the invention can be seen in
As with implant 1000, implant 1100 includes a central body 1002 (
In this particular embodiment, the sleeve 1016 is preferably oval or elliptical in shape as can be seen in
It is to be understood that the sleeve in this embodiment has all the characteristics and advantages described hereinabove with respect to the above-referenced super-elastic sleeves.
The second wing as discussed above, can come in a variety of shapes in order to provide for variations in the anatomical form of the spinous processes. Such shapes are depicted in
Alternative embodiments of second wings, as shown in
It is to be understood that in this embodiment, if desired, the second wing may not have to be used, depending on the anatomy of the spinal column of the body, and this embodiment still has the significant advantages attributable to the guide 1010 and the functionality of the sleeve 1016.
Embodiment of FIGS. 108, 109, and 110
The implant 1120 as shown in
Embodiment of FIGS. 111, 112, 113, 114, 115, 116, and 117
An additional embodiment of the implant 1150 is shown in
Implant 1150 includes a central body 1152 with a first wing 1154, where central body 1152 includes elongated groove 1156 which extends to the guide 1158. A screw 1160 is received in a threaded bore located in the elongated groove 1156.
The second wing 1162 includes a central body 1164 which is substantially perpendicular to the second wing 1162.
The central body 1164 includes a plurality of bores 1166 provided therein. These bores are formed adjacent to each other in order to define a plurality of scallops, each scallop capable of retaining bolt 1160 therein. As can be seen in
It is to be understood that preferably during the surgical process, the central body 1152 is urged between spinous processes. After this has occurred, the second wing is guided by the other sides of the spinous processes from a path which causes the plane of the second wing to move substantially parallel to the plane of the first wing until the central body 1164 associated with the second wing 1162 is received in the groove of 1156 of the central body 1152 associated with the first wing 1154. After this has occurred, the bolt 1160 is positioned through aligned bores associated with the second wing 1162 and the central body 1152 in order to secure the second wing to the central body.
While embodiment 1150 does not depict a sleeve such as sleeve 1016, such a sleeve 1016 could be placed over body 1152 and be within the spirit of the invention.
Industrial Applicability
From the above, it is evident that the present invention can be used to relieve pain caused by spinal stenosis in the form of, by way of example only, central canal stenosis or foraminal (lateral) stenosis. These implants have the ability to flatten the natural curvature of the spine and open the neural foramen and the spacing between adjacent vertebra to relieve problems associated with the above-mentioned lateral and central stenosis. Additionally, the invention can be used to relieve pain associated with facet arthropathy. The present invention is minimally invasive and can be used on an outpatient basis.
Additional aspects, objects and advantages of the invention can be obtained through a review of the appendant claims and figures.
It is to be understood that other embodiments can be fabricated and come within the spirit and scope of the claims.
1. An implant for relieving pain associated with the spinal column which is positionable between adjacent spinous processes of the spinal column, comprising:
- a first unit including a body, a distraction guide extending from said body in order to assist in the positioning of said body between and distraction of said adjacent spinous processes, and a first wing;
- a second wing;
- said body including a second wing receiver that can receive said second wing, said body adapted for positioning between the adjacent spinous processes, with the first wing adapted to be positionable along first sides of the adjacent spinous processes and the second wing adapted to be positionable along second sides of the spinous processes; and
- wherein once said body is positioned between adjacent spinous processes, said distraction guide can be removed from said body.
2. An implant for relieving pain associated with the spinal column which is positionable between adjacent spinous processes of the spinal column, comprising:
- a first unit including a body, a distraction guide extending from said body in order to assist in the positioning of said body between and distraction of said adjacent spinous processes, and a first wing; and
- a second wing removably connectable with said body; and
- wherein said guide is removable from said body.
3. An implant positionable between adjacent spinous processes of the spinal column, comprising:
- a distracting body;
- a bulbous distraction end removably connected with said distracting body for positioning said distracting body between adjacent spinous processes;
- a first wing connected with said distracting body at an end of said distracting body opposite said bulbous distraction end;
- a second wing removably connectable with said distracting body;
- wherein once said distracting body is positioned between adjacent spinous processes, said bulbous distraction end can be removed from said distracting body.
4. An implant positionable between adjacent spinous processes of the spinal column, comprising:
- a distracting body having a proximal end and a distal end, the distracting body including: a bulbous distraction guide removably connected with said proximal end in order to assist in the positioning of said distracting body between and the distraction of adjacent spinous processes; a first wing connected with said distal end; and a means for receiving;
- a second wing removably connectable with said means for receiving; and
- wherein once said distracting body is positioned between adjacent spinous processes, said bulbous distraction guide can be removed from said proximal end.
5. The implant of claim 4, wherein said second wing is removably connected with said means for receiving by one of a screw, a bolt and a pin.
6. The implant of claim 4, wherein said first and second wing are each shaped to approximate a contour of adjacent lamina.
Patent History
Type: Application
Filed: Dec 10, 2003
Publication Date: May 12, 2005
Inventors: James Zucherman (San Francisco, CA), Ken Hsu (San Francisco, CA), Charles Winslow (Walnut Creek, CA), Henry Klyce (Piedmont, CA)
Application Number: 10/732,589


text:
to Stronghold on Sugarloaf Mountain
Stronghold, Incorporated is a non-profit corporation,
organized in 1946 by the late Gordon Strong. It owns and operates
the mountain property for the public's "enjoyment and education
in an appreciation of natural beauty."
Sugarloaf Mountain has been designated a Registered Natural Landmark
because of its geological interest and striking beauty. Stronghold
agreed to maintain its natural state, and your help in this regard
will be a most welcome contribution.
Funds for maintenance and improvement do not come from federal,
state, or municipal sources. They come from a modest trust fund,
from membership dues, and from gifts and bequests of folks like
you, who are interested in preserving this priceless heritage.
We wish you a pleasant stay and venture the thought that as you
stand and look out upon the lovely Monocacy Valley and the mountains
beyond, you will experience a moral and spiritual uplift. Gordon
Strong believed that "... those who appreciate natural beauty
will be better people, people who treat each other better."


text:
Date: 1 April 2007
* From this date forward, no major KDE subsystem can be committed to kdelibs. * The location of all classes are fixed within kdelibs * Trunk is expected to contain KDE4 code only now. This effectively means that all scripts processing translations for KDE3 in trunk will cease. * Extragear applications that want to release based on KDE3 are expected to move to /branches/stable and work from there. * The buildsystem requirements are fixed; i.e, must not require a version of cmake greater than 2.4.5.
Date: 1 May 2007
* Qt 4.3 is required from here until release. * The kdelibs API is frozen. This means that the classes and interfaces are not allowed to change, except with permission of the core developers. * To make an API change, post a kdelibs API exception request to the kde-core-devel mailinglist with an explanation and the code. If there are no objections after a week, the change can be committed. NOTE: all affected modules must continue to compile and work as expected.
Date: 1 June 2007
* The KDE main modules are frozen for new features. * No new features are allowed, the focus is on stabilizing the applications and fixing all bugs. * The main module maintainers must indicate if they will follow the release schedule or will divert and not be released together with KDE 4.0.
Start: 25 June 2007 End: 24 September 2007 Duration: 3 months (estimated)
* From this date forward, a Beta Version will be published every month until most grave bugs are resolved. * The kdelibs API is now frozen solid. * Translations are included starting with the second Beta, thus beginning a string freeze. Exceptions can be requested on the kde-i18n mailinglist.
Start: 25 September 2007 End: 22 October 2007 Duration: 4 weeks (estimated)
* From this date forward, a Release Candidate will be released every two weeks until *all* grave bugs are resolved. * After the first Release Candidate there is a total release freeze. This means only regressions (breakage caused due to the KDE4 port) or grave bugs can be fixed, but nothing else. * With the first Release Candidate, a list of languages which will be included with the KDE 4.0 release will be made available, based on the usual rules.
Date: 23 October 2007
* This date is based on an estimated 3 Beta's and 2 Release Candidates.


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This charming logo features pretty watercolor overlays that will help you professionally brand your business at an affordable price. Simply include your business information during checkout and I will customize it for your business by changing colors, text, and layout as needed.
You will receive the following digital files for your logo. All files are high resolution and are 300 dpi.
• 1 JPG file with a white background
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When purchasing the listing, please include the following in the 'Note to Seller' section at checkout:
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If you forget to do this, don't panic! I will contact you. 🙂
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Acupuncture, a 5,000-year-old Chinese medical practice, is proving to be one way for some asthma patients to manage their symptoms without over-paying. In a study conducted by the University Hospital of Vienna, over 70 percent of patients with long-standing asthma reported a significant improvement in their symptoms after 10 weeks of acupuncture treatment.
Bronchospasms associated with asthma result from over-stimulation of the parasympathetic nervous system. Stimulation of acupuncture points can relieve both physical and emotional stress because they trigger the release of endorphins in the brain. Asthma sufferers can therefore experience both a physical release from bronchial constriction, and also an emotional or psychological release from the fear of constriction and suffocation.
Acupuncture is also more cost-effective than many Western drug therapies. In 1990, costs related to asthma were estimated at $6.2 billion. According to the American Lung Association, the average cost for one hospital stay for a child with asthma is $4,000. Acupuncture, by contrast, costs an average of $85 per session and can eliminate the need for emergency hospital visits and Western drugs. An estimated 70 to 80 percent of the nation's insurers covered acupuncture treatments in 1996, making it an even more viable option for those with asthma.
For more information on how acupuncture can help manage the symptoms of asthma, please call 800-729-0941.


text:
ICD-10 Code S66.912A
Strain of unspecified muscle, fascia and tendon at wrist and hand level, left hand, initial encounter
|Short Description:
|Strain of unsp musc/fasc/tend at wrs/hnd lv, left hand, init
|Long Description:
|Strain of unspecified muscle, fascia and tendon at wrist and hand level, left hand, initial encounter
Valid for Submission
ICD-10 S66.912A is a billable code used to specify a medical diagnosis of strain of unspecified muscle, fascia and tendon at wrist and hand level, left hand, initial encounter. The code is valid for the year 2019 for the submission of HIPAA-covered transactions.
Code Classification
- Injury, poisoning and certain other consequences of external causes (S00–T98)
Information for Medical Professionals
Convert S66.912A to ICD-9
The following crosswalk between ICD-10 to ICD-9 is based based on the General Equivalence Mappings (GEMS) information:
The following clinical terms are approximate synonyms:
- Injury of left wrist
- Repetitive strain injury of left hand
- Strain of muscle of left wrist
- Strain of muscle of wrist
- Strain of tendon of left wrist
- Strain of tendon of wrist
Information for Patients
Hand Injuries and Disorders
No matter how old you are or what you do for a living, you are always using your hands. When there is something wrong with them, you may not be able to do your regular activities.
Hand problems include
- Carpal tunnel syndrome - compression of a nerve as it goes through the wrist, often making your fingers feel numb
- Injuries that result in fractures, ruptured ligaments and dislocations
- Osteoarthritis - wear-and-tear arthritis, which can also cause deformity
- Tendinitis - irritation of the tendons
- Disorders and injuries of your fingers and thumb
- Brachial plexopathy (Medical Encyclopedia)
- Claw hand (Medical Encyclopedia)
- Dupuytrens contracture (Medical Encyclopedia)
- Hand fracture - aftercare (Medical Encyclopedia)
- Hand or foot spasms (Medical Encyclopedia)
- Hand x-ray (Medical Encyclopedia)
- Radial nerve dysfunction (Medical Encyclopedia)
- Ulnar nerve dysfunction (Medical Encyclopedia)
[Read More]
Sprains and Strains
A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move your joint. You might feel a pop or tear when the injury happens.
A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle.
At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Ankle sprain - aftercare (Medical Encyclopedia)
- Elbow sprain -- aftercare (Medical Encyclopedia)
- Foot sprain - aftercare (Medical Encyclopedia)
- Hamstring strain - aftercare (Medical Encyclopedia)
- Hip flexor strain -- aftercare (Medical Encyclopedia)
- Sprains (Medical Encyclopedia)
- Strains (Medical Encyclopedia)
- Tendon repair (Medical Encyclopedia)
- Wrist sprain - aftercare (Medical Encyclopedia)
[Read More]
Wrist Injuries and Disorders
Your wrist is made up of eight small bones known as carpals. They support a tube that runs through your wrist. That tube, called the carpal tunnel, has tendons and a nerve inside. It is covered by a ligament, which holds it in place.
Wrist pain is common. Repetitive motion can damage your wrist. Everyday activities like typing, racquet sports or sewing can cause pain, or even carpal tunnel syndrome. Wrist pain with bruising and swelling can be a sign of injury. The signs of a possible fracture include misshapen joints and inability to move your wrist. Some wrist fractures are a result of osteoporosis.
Other common causes of pain are
- Sprains and strains
- Tendinitis
- Arthritis
- Gout and pseudogout
- Colles wrist fracture - aftercare (Medical Encyclopedia)
- De Quervain tendinitis (Medical Encyclopedia)
- Wrist arthroscopy (Medical Encyclopedia)
- Wrist pain (Medical Encyclopedia)
- Wrist sprain - aftercare (Medical Encyclopedia)
[Read More]
ICD-10 Footnotes
General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.


text:
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Meet your fellow owners in our Owners Clubs
It's Time to Play "WHO AM I"?
1. Give your mystery car a mystery name so that we can run 2-3 contests at once and we know which mystery we are referring to. e.g. "the unloved one".
2. Must be a CAR or a CAR-PERSON.
3. Get "real" when you do this. Not many people are going to know much about the 1910 American Moosejaw or Henry Ford's tailor.
4. Do it up like an autobiography. Have fun. e.g. "I was born in the time of the Great Depression, of humble origins, but ended up racing at Indianapolis." (and more if you wish to clarify if you are a car or a person).
5. Make it difficult, but not impossible.
I'll start off with what i hope is a fairly easy one.
I am one of the most maligned cars in U.S. history, but not necessarily the most famous one that everyone laughs at. I don't understand why. I was attractive, technically interesting and fun to drive. Had someone shown more interest in me, I might have developed over time into a unique American creation.
Even today, I'm not worth very much. Sadly I may never be rehabilitated.
Who Am I?
You can ask for more hints if you wish, but I have the right to decline to give them. :shades:0
My first guess would be a 1960 Chevy Corvair?0
very close. Try another year.0
1965 Corvair then, first year of the 2nd-gen? Didn't GM actually put a lot of effort into that one, compared to the '60-64, to clean up its handling act?0
Yes '65 Corvair. Well they put STYLING effort but kept many of the same maladies (of course). The tail-happiness was corrected in 1964 actually, before the new body style. The '65 Corvair coulda been a contendah for the "American Porsche" or perhaps the Miata. One of GM's most regrettable errors, but then they kept the Corvette, which they were planning to kill in 1955.0
OK, I'll play. Here goes:
While my model name was produced both before and after this year, one of my most popular hardtop iterations is referred to by a two-word nickname - of which, this first year I was produced tends to be more synonymous with this term. I shared my body style with other corporate cousins, but I'm generally regarded as the most sought after by collectors.
What year and make/model am I??? And, what's my two-word nickname?0
I'd guess "The Goat," but I'm not sure to which Pontiac GTO year(s) you'd be referring, assuming that's even the one you're describing.0
Nope, not a GTO. Think rear roofline.0
Nope, not a GTO. Think rear roofline . . . . . . sort of.0
texases Posts: 8,846How about '61 Chevy Impala "Bubble Top"? (ignoring the other "Bubbletop" name )0
DING! DING! DING! We have a winner!!!
Actually, I thought the '61 model was the only year for the bubble top, but in the "minutes" of exhaustive research I did before posting the question, I came to find that the term "bubble top" also referred to some 1962 models.
BTW, the "pop" in the title was a hint (albeit an obsure one) aimed at the whole bubble top thing. :P0
pretty good effort parm. Thanks!
PS: Your mystery car doesn't have to be OLD!0
I'm a Corvette that deserves better. My hard-headed older brother gets all the glory, and a lot of it, too--- even though we're very close in age. It's not fair! I look almost the same, and I can do anything he can do! In fact, if I have to say so myself, I'm really an improvement in subtle ways.
Worse yet, even my *younger* brother gets more respect, even though he's barely younger. All he's got is a bit better athletic ability. He can go fast and stop on a dime. I take a bit longer to do that.
If you saw all three of us coming towards you, you'd think we were triplets. But get close, and suddenly I am unfairly judged.
Who am I?0
The C5 Z06, the older brother being the ZR-1.0
Nope, but a good guess. Remember this is a year, not a model, and it is bracketed by two siblings.0
Okay, I'll let a Corvette expert take a whack at it.0
Sounds like we're talking about a fairly modern car here. I must admit, if it's newer than 1972 (perhaps 1974 for a Vette), my interest tends to fade pretty quick. Mainly because major changes to the Corvette's styling occurred so seldom between the mid 1970's and 1997 resulting in a homogenized product for many years in a row. Heck, there haven't been that many changes since '97. Tough to get excited when the same warmed over car is trotted out year after year. And, some of the Vette's styling cues in the 1980's were absolutely horrid. I'm sure a true Corvette enthusiast would see it differently. But, to me, they've become somewhat of a dependable appliance (albeit a sporty one) that few can afford – compound that if you're talking about a ZR-1 which is absolutely a great car and I'd love to have one. But, how often does one really need to hustle from 0-100 in less than 13 seconds and stop on a dime when stopping on a quarter is more than adequate? Sorry, didn't mean to be such a buzz kill. I'm sure somebody out there will know the answer. It just ain't me! :confuse:0
Nope not a modern Vette.
Hint: We are talking about C2s0
I'll take a crack at this. I will say the 1964 Corvette, maybe the convertible to fit the reference to "hard-headed older brother", which would be the '63 split window. In 1965 the "younger brother" had the 425 hours 396, the first year of the big block.
2009 BMW 335i, 2003 Corvette cnv. (RIP 2001 Jaguar XK8 cnv and 1985 MB 380SE [the best of the lot])0
And a GOLD STAR to bhill.
That is correct. The '64 Corvette coupe, whilst at the very least a well-sorted out version of the '63, merely doesn't have that split back glass, thereby relegating it to secondary status in value and prestige to its nearly-identical older brother.
To further add insult to injury, the 4-wheel disk brakes of the '65 are much prized (actually a good thing in a Corvette, which, prior to this time, could only seriously race in a straight line, to be taunted in the curves by cheeky little Mini Coopers).
So the unfortunate '64 coupe, while certainly not CHEAP to buy, is always in the back row of the C2 beauty pageants.0
I was heralded as the second coming of the brand I worked for because of my "European roots", and indeed I was that brand's first new model in much too long.
Despite that, I sold badly and my brand is now defunct. :-(
You can call me the "Round One"; I didn't have a hard corner on me anywhere.
2014 Mini Cooper (stick shift of course), 2016 Camry hybrid, 2009 Outback Sport 5-spd (keeping the stick alive)0
Saturn LS?
Caddy Catera?Nope.0
Dang, you're good! Yup, Saturn LS, in fact I believe it was actually the "L-series", there were 100s, 200s, and even 300s at some point.
2014 Mini Cooper (stick shift of course), 2016 Camry hybrid, 2009 Outback Sport 5-spd (keeping the stick alive)0
Oh ya, the "LS" was the sedan whereas the "LW" was the wagon. I think there was an "LC" coupe concept at one point as well.0
But it was the first thing I could think of...
I was once proclaimed by a well known magazine as "Like a Rat in Reeboks" when it came to my zippy handling, nimble nature and racing roots.0
I thank you for the gold star, sir, and for not pointing out that I misspelled 'horse' (fingers faster than brain). Anyway, I will take a crack at the other side of this one:
Although I do not represent the first time a manufacturer put the engine out of a larger bodied car into a smaller body, I am the first one where the manufacturer took the engine out of one of their full sized car and put it in one of their intermediates to get a performance sedan. The operative word is sedan; I am a 4-door. As a result, I could out-accelerate any other car that year with the single exception of the fuel-injected Corvette; I could stay with the carbureted ones.
2009 BMW 335i, 2003 Corvette cnv. (RIP 2001 Jaguar XK8 cnv and 1985 MB 380SE [the best of the lot])0
Way to go bhill2! Nicely played. I kept having the 1968 Vette on the brain because it had its problems, but it didn't fit the other criteria - mainly that you'd never confuse a 1968 Corvette with its one year older version - the 1967 (which was actually supposed to be the first year for the Mako Shark design).
That whole Saturn thing hurt my head thinking about it. You guys are good.0
bhill2 - any chance you're a Mopar product from the 1950's?0
I'm also conjuring up dog dish hubcaps on something from the 1960's. A real sleeper. Am I even remotely near the ballpark??? . . . . you know, like two bus tranfers and a train ride away? :P0


text: High-street style for discerning women everywhere, Nine West began its journey in the fashion industry as a footwear brand, plying the image conscious around the world with fabulous shoes. Now a globally recognised label, you can choose anything from outerwear to accessories. Over the years the brand has taken the world by storm to become a household name known for offering affordable style. Nine West has gone from strength to strength since it began in 1983, meaning you can confidently choose women's Nine West dresses for ready-to-wear elegance every day.


text:
Thanks everyone for your sincere responses to yesterday's "grace" post. It's one of the posts I'm most proud of and it didn't even have a photograph. Hmmm…maybe I really have to work on this writing thing a bit more.
Anyway, to bring this discussion full circle, I received this email from my 11 year old yesterday written in giant pink letters.
"hi its me, izzy. u told me 2 send u an email asking u 2 send me pics so cool. yea…
love you…
*i did the big font just 4 u! "
Well, my kids might need help with "please" and "thank you" but they're on the right track for gracefulness.


text:
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YES! Recommends: Global Oneness Project
Resilience is that steely strength, that net that catches us, those arms that support us when our world falls apart. It is that will or spirit that encourages us to carry on.
From the unfazed to the deeply concerned, how do we help build resilience in our students? One way is to show them that they are not alone.
YES! recommends the Global Oneness Project for their inspiring and richly produced resources that explore how the radically simple notion of interconnectedness can be lived in our increasingly complex world. Through Global Oneness lesson plans, written stories, and film, your students will meet people from all over the globe—Tibetan nuns, Ecuadorian shamans, Ethiopian aid workers—and explore themes, such as real nourishment and having more with less. By showing the diverse ways oneness is expressed, your students will be inspired to create solutions to their own and their community's challenges.
We are thrilled to be one of the first organizations to share Global Oneness Project's education resources, including two free DVDs of its greatest film shorts.
What does "oneness" have to do with your students' lives and the world?
The 11 lessons and 200 exercises from Living Oneness: Restoring Wholeness in a Fragmented World will inspire your students to better understand the importance of oneness in their own lives, community, and the world. In action, oneness is about service and stewardship.
The study guide may be downloaded in its entirety or by chapter, using the links below. For high school and university students.
Download Complete Study Guide in PDF format.
Chapter 9: Oneness Now: More than just seeing holistically
Oneness is more than just seeing holistically; it's seeing the big picture and what's hidden. The consciousness of oneness reminds us how to live with ourselves and each other.
- Our Future As A Multiracial Society
A racially just, inclusive, and even loving society is still possible, says a YES! Magazine panel of visionaries.
Chapter 10: Service: Shifting the emphasis from getting to giving
When we start to wonder what we can offer life, rather than focusing on what we need to get from it, we begin working with the forces that are already working for the whole. We begin living oneness.
- Anthropology 101: How to Change the World
Professor Tom Murphy's students work beside farmers, fisherman, wastewater technicians, and Native American leaders through an award-winning service learning program.
Chapter 11: Living Oneness: Synchronizing head, heart, and hands
When we align our hearts with our minds and our actions, we open a door for these living qualities not only to support our relationships, but to sanctify everything we do.
These aren't just people in paintings looking at you. They are people imploring you to listen and act.
Personal Resilience - Identity, Worldview, and Service
Jayesh Patel, founder of the Indian NGO Manav Sadhna, shows us how the Gandhian principles inspiring the organization are put into practice in the vast slums of Ahmedabad.
- Barefoot College Photo Essay
The Barefoot College of Tilonia India began in 1972 with the conviction that solutions to rural problems lie within the community.
Seva Cafe: Love All, Serve All
Seva, or service, is the selfless giving of oneself for the betterment of others and the world around. At Seva Cafe, the concept of service takes the form of a "pay it forward" restaurant, where every meal is cooked and served with love.
- The Power of Food
Providing food for people in need—regardless of whether they are "deserving" is a central part of Sara Miles' spiritual journey.
Community Resilience - Social Justice, Community Building
Youth worker Nelsa Libertad Curbelo Cora describes the inspiration behind Barrio de Paz (Peace Town), a non-violent youth movement in Guayaquil, Ecuador. Barrio de Paz brings together street gangs and provides services to this struggling community.
- Healing Power of Prison Poetry
Writers help teens in jail learn to express difficult truths by putting pencil to paper.
In the inner city of Johannesburg, The GreenHouse Project is turning one urban park into a seedbed for sustainable communities. The program takes a holistic approach to the city's challenges, integrating green building and design, efficient and renewable energy, recycling, organic farming, and nutrition.
- Living Building 2.0 Aims for a Green, Just Built Environment
What if buildings, communities, and infrastructure projects were designed to be beautiful, socially just, and as gentle on the environment as plants are?
Place-based Resilience - Sustainability, Relocalization
Knowing How to Nurture Ourselves
Stephan Fayon, director of an international seed bank in Auroville, India, explains how preserving the diversity of seeds ensures against the breakdown of large-scale industrial agriculture.
- Haitian Farmers Refuse Monsanto Hybrid Seeds
A coalition of peasant farmers is standing up for food sovereignty.
Anshu Gupta is the founder of Goonj, a volunteer-run recycling center in New Delhi that recycles garments to provide clothes, schoolbags, sanitary napkins, and other amenities for India's poor. Anshu offers a heartfelt appeal to be mindful of the unused clothing taking space in your closet right now, and what a treasure it could be for someone in need.
- Share Your Stuff
From socks to cars to skills, how sharing and swapping gives you more.
Special note on free DVDs:
Film Library Volumes I and II on DVD, plus their accompanying discussion and action guides, are available for free download at Global Oneness Project Education. The DVDs are comprised of short films hand picked by Global Oneness staff. DVDs can also be ordered from Global Oneness Project's Organize a Screening.
Global Oneness Project theme pages are a feast of everything you wanted to know about a certain something, delivered on a silver platter. These "something's" are subjects worthy of discussion, such as our relationship to the land, material greed, our diets, and expressions of generosity. Anchored by short essays, these pages burst with enticing extras of photography, video, quotes and related articles.
Film Library DVDs are free and include question and action guides. Engage your community! Global Oneness has put together a selection of its short films on two DVDs and will send one to you for free anywhere in the world if you agree to gather 10 or more people for your film screening.
[See right side of page]
VISIT: [See right side of page]
DO: Organize a film screening
is devoted to exploring how the radically simple notion of interconnectedness can be lived in our increasingly complex world. Since 2006, the project has traveled the globe finding inspiring stories of oneness practiced by everyday people devoted to taking care of our shared world. These powerful narratives are conveyed through the brilliance of film and essays.
Photos courtesy of Global Oneness Project.


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Project LEAD cultivates leaders in health care
Five employees from various Sentara locations in Southern Virginia were recently recognized as they completed the 2015 Project LEAD program. Now in its eleventh year, Project LEAD is a leadership program created by and conducted through Sentara Halifax Regional Hospital and is designed to identify and foster rising leaders at the hospital and its associated facilities.
Participants in this year's class included:
- Kimberley Hudson, RN, labor and delivery nurse IV at Sentara Halifax Regional Hospital
- Joni Long, RN, restorative nurse supervisor/ICN/employee health nurse at Sentara MeadowView Terrace
- Kelly Powell, RN, BSN, CHPN, hospice nurse at Sentara Halifax Hospice and Palliative Care
- Stephanie Waller, CCS-P, CPC, audit appeal coordinator at Sentara Halifax Regional Hospital
- Michelle Weddle, LPC, clinical coordinator at Sentara Behavioral Health Services.
The program is facilitated by Vance Midgett, MDiv, manager of guest services and pastoral care at Sentara Halifax Regional Hospital.
"The Project LEAD program is challenging and rigorous, and it focuses on the development of leadership skills," Midgett states. "We offer a thorough overview of leadership, governance, financial perspective, human resources, external relations and community service. We want participants to experience new perspectives and learn about the organization outside their normal area of work."
The goal of the six-month program is to equip management with improved skills and a cohesive mission focus, based on a well-rounded knowledge of Sentara Halifax Regional Hospital and all its related locations. The program was developed by Sentara Halifax Regional Hospital President Chris A. Lumsden and Chief Nursing Officer Patricia Thomas.
"Like so many things in life, you get out of this program what you put into it," Midgett says. "When applications are reviewed and interviews are held, we seek out individuals who are energized by the prospect of participating in this program and who want to be better and contribute as both an employee and a leader. We have so many employees with the potential to do great things, and this program brings out new ideas that can help us be better and serve Southern Virginia in greater ways."
Participants are required to attend weekly in-services beginning in January and ending in June. The in-services are led by key members of management. Participants are expected to be engaged in weekly sessions and take part in discussions in order to further their understanding.
The group travels to Richmond in February to meet with several of the region's leaders and legislators. The Project LEAD group also travels to Washington, D.C. for a look at healthcare-related issues on the national level. Members of Project LEAD also take time to shadow managers and senior managers of their choice during the course of the program.
Finally, a significant component of the Project LEAD program is the case study, in which participants choose a topic related to improving services or one that addresses a legislative issue. The topic is carefully explored and addressed and concludes with a presentation to senior management.
"An organization performs only as well as its leaders," says Lumsden. "Project LEAD gives each participant an opportunity to become more educated and involved and to know that their opinion counts."