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US 7543589 B2 Abstract A method and apparatus for transmural ablation using an instrument containing two electrodes or cryogenic probes. A clamping force is exerted on the two electrodes or probes such that the tissue of the hollow organ is clamped therebetween. Bipolar RF energy is then applied between the two electrodes, or the probes are cryogenically cooled, thus ablating the tissue therebetween. The method provides for ablating cardiac tissue of a patient utilizing a sub-xyphoid approach and identifying cardiac tissue prior to ablation.
Claims(22) 1. A method for creating an electrically isolated line of ablated tissue in cardiac tissue comprising:
a) clamping cardiac tissue between a pair of jaws each of which carries a conductive member;
b) passing sufficient bi-polar electrical current between the conductive members through the cardiac tissue to form a line of ablation in the cardiac tissue;
c) gauging the completeness of tissue ablation; and
d) indicating to the user when tissue ablation is complete.
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13. A method for creating an electrically isolated line of ablated tissue in cardiac tissue comprising:
a) clamping cardiac tissue between a pair of jaws each of which carries a conductive member;
b) passing sufficient bi-polar electrical current between the conductive members through the cardiac tissue to form a line of ablation in the cardiac tissue;
c) gauging the completeness of tissue ablation by monitoring one or more of tissue temperature and at least one electrical characteristic relating to ablation; and
d) indicating to the user when tissue ablation is complete.
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18. A method for creating an electrically isolated line of ablated tissue in cardiac tissue comprising:
a) clamping cardiac tissue between a pair of jaws each of which carries a conductive member;
b) passing sufficient bi-polar electrical current between the conductive members through the cardiac tissue to form a line of ablation in the cardiac tissue;
c) gauging the completeness of tissue ablation by monitoring transmission of an electrical signal across the line of ablation; and
d) indicating to the user when tissue ablation is complete.
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Description This application is a continuation of application Ser. No. 10/927,746 filed Aug. 27, 2004, now issued as U.S. Pat. No. 7,487,780, which is a continuation of application Ser. No. 10/015,476, filed on Dec. 13, 2001, now issued as U.S. Pat. No. 6,889,694, which is a division of application Ser. No. 10/038,506, filed Nov. 9, 2001, which is a continuation-in-part of application Ser. No. 10/032,378, filed Oct. 26, 2001, now issued as U.S. Pat. No. 6,932,811, which is a continuation-in-part of application Ser. No. 09/844,225 filed Apr. 27, 2001, now issued as U.S. Pat. No. 6,517,536, which is a continuation-in-part of application Ser. No. 09/747,609 Dec. 22, 2000, now issued as U.S. Pat. No. 6,546,935 which claims the benefit of provisional application Ser. No. 60/200,072, filed Apr. 27, 2000. Each of the above applications is hereby incorporated by reference. Atrial fibrillation is the most common heart arrhythmia in the world, affecting over 2.5 million people in the United States alone. Ablation of cardiac tissue, in order to create scar tissue that poses an interruption in the path of the errant electrical impulses in the heart tissue, is a commonly performed procedure to treat cardiac arrhythmias. Such ablation may range from the ablation of a small area of heart tissue to a series of ablations forming a strategic placement of incisions in both atria to stop the conduction and formation of errant impulses. Ablation has been achieved or suggested using a variety of techniques, such as freezing via cryogenic probe, heating via RF energy, surgical cutting and other techniques. As used here, �ablation� means the removal or destruction of the function of a body part, such as cardiac tissue, regardless of the apparatus or process used to carry out the ablation. Also, as used herein, �transmural� means through the wall or thickness, such as through the wall or thickness of a hollow organ or vessel. Ablation of cardiac tissue may be carried out in an open surgical procedure, where the breastbone is divided and the surgeon has direct access to the heart, or through a minimally invasive route, such as between the ribs or via catheter that is introduced through a vein, and into the heart. Prior to any ablation, the heart typically is electronically mapped to locate the point or points of tissue which are causing the arrhythmia. With minimally invasive procedures such as via a catheter, the catheter is directed to the aberrant tissue, and an electrode or cryogenic probe is placed in contact with the endocardial tissue RF energy is delivered from the electrode to the tissue to heat and ablate the tissue (or the tissue may be frozen by the cryogenic probe), thus eliminating the source of the arrhythmia. Common problems encountered in this procedure are difficulty in precisely locating the aberrant tissue, and complications related to the ablation of the tissue. Locating the area of tissue causing the arrhythmia often involves several hours of electrically �mapping� the inner surface of the heart using a variety of mapping catheters, and once the aberrant tissue is located, it is often difficult to position the catheter and the associated electrode or probe so that it is in contact with the desired tissue. The application of either RF energy or ultra-low temperature freezing to the inside of the heart chamber also carries several risks and difficulties. It is very difficult to determine how much of the catheter electrode or cryogenic probe surface is in contact with the tissue since catheter electrodes and probes are cylindrical and the heart tissue cannot be visualized clearly with existing fluoroscopic technology. Further, because of the cylindrical shape, some of the exposed electrode or probe area will almost always be in contact with blood circulating in the heart, giving rise to a risk of clot formation. Clot formation is almost always associated with RF energy or cryogenic delivery inside the heart because it is difficult to prevent the blood from being exposed to the electrode or probe surface. Some of the RF current flows through the blood between the electrode and the heart tissue and this blood is coagulated, or frozen when a cryogenic probe is used, possibly resulting in clot formation. When RF energy is applied, the temperature of the electrode is typically monitored so as to not exceed a preset level, but temperatures necessary to achieve tissue ablation almost always result in blood coagulum forming on the electrode. Overheating or overcooling of tissue is also a major complication, because the temperature monitoring only gives the temperature of the electrode or probe, which is, respectively, being cooled or warmed on the outside by blood flow. The actual temperature of the tissue being ablated by the electrode or probe is usually considerably higher or lower than the electrode or probe temperature, and this can result in overheating, or even charring, of the tissue in the case of an RF electrode, or freezing of too much tissue by a cryogenic probe. Overheated or charred tissue can act as a locus for thrombus and clot formation, and over freezing can destroy more tissue than necessary. It is also very difficult to achieve ablation of tissue deep within the heart wall. A recent study reported that to achieve a depth of ablation of 5 mm, it was necessary to ablate an area almost 8 mm wide in the endocardium. See, �Mechanism, Localization, and Cure of Atrial Arrhythmias Occurring After a New Intraoperative Endocardial Radiofrequency Ablation Procedure for Atrial Fibrillation,� Thomas, et., J. Am. Coll. Cardiology, Vol. 35, No. 2, 2000. As the depth of penetration increases, the time, power, and temperature requirements increase, thus increasing the risk of thrombus formation. In certain applications, it is desired to obtain a continuous line of ablated tissue in the endocardium. Using a discrete or point electrode or probe, the catheter must be �dragged� from point to point to create a line, and frequently the line is not continuous. Multielectrode catheters have been developed which can be left in place, but continuity can still be difficult to achieve, and the lesions created can be quite wide. Because of the risks of char and thrombus formation, RF energy, or any form of endocardial ablation, is rarely used on the left side of the heart, where a clot could cause a serious problem (e.g., stroke). Because of the physiology of the heart, it is also difficult to access certain areas of the left atrium via an endocardial, catheter-based approach. Recently, epicardial ablation devices have been developed which apply RF energy to the outer wall of the heart to ablate tissue. These devices do not have the same risks concerning thrombus formation. However, it is still difficult to create long, continuous lesions, and it is difficult to achieve good depth of penetration without creating a large area of ablated tissue As noted above, other forms of energy have been used in ablation procedures, including ultrasound, cryogenic ablation, and microwave technology. When used from an endocardial approach, the limitations of all energy-based ablation technologies to date are the difficulty in achieving continuous transmural lesions, and minimizing unnecessary damage to endocardial tissue. Ultrasonic and RF energy endocardial balloon technology has been developed to create circumferential lesions around the individual pulmonary veins. See e.g., U.S. Pat. No. 6,024,740 to Lesh et al. and U.S. Pat. Nos. 5,938,660 and 5,814,028 to Swartz et al. However, this technology creates rather wide (greater than 5 mm) lesions which could lead to stenosis (narrowing) of the pulmonary veins. See, �Pulmonary Vein Stenosis after Catheter Ablation of Atrial Fibrillation,� Robbins, et al., Circulation, Vol. 98, pages 1769-1775, 1998. The large lesion area can also act as a locus point for thrombus formation. Additionally, there is no feedback to determine when full transmural ablation has been achieved. Cryogenic ablation has been attempted both endocardially and epicardially (see e.g., U.S. Pat. No. 5,733,280 to Avitall, U.S. Pat. No. 5,147,355 to Friedman et al., and U.S. Pat. No. 5,423,807 to Milder, and WO 98/17187, the latter disclosing an angled cryogenic probe, one arm of which is inserted into the interior of the heart through an opening in the heart wall that is hemostatically sealed around the arm by means of a suture or staples), but because of the time required to freeze tissue, and the delivery systems used, it is difficult to create a continuous line, and uniform transmurality is difficult to verify. Published PCT applications WO 99/56644 and WO 99/56648 disclose an endocardial ablation catheter with a reference plate located on the epicardium to act as an indifferent electrode or backplate that is maintained at the reference level of the generator. Current flows either between the electrodes located on the catheter, or between the electrodes and the reference plate. It is important to note that this reference plate is essentially a monopolar reference pad. Consequently, there is no energy delivered at the backplate/tissue interface intended to ablate tissue. Instead, the energy is delivered at the electrode/tissue interface within the endocardium, and travels through the heart tissue either to another endocardial electrode, or to the backplate. Tissue ablation proceeds from the electrodes in contact with the endocardium outward to the epicardium. Other references disclose epicardial multielectrode devices that deliver either monopolar or bipolar energy to the outside surface of the heart. It is important to note that all endocardial ablation devices that attempt to ablate tissue through the full thickness of the cardiac wall have a risk associated with damaging structures within or on the outer surface of the cardiac wall. As an example, if a catheter is delivering energy from the inside of the atrium to the outside, and a coronary artery, the esophagus, or other critical structure is in contact with the atrial wall, the structure can be damaged by the transfer of energy from within the heart to the structure. The coronary arteries, esophagus, aorta, pulmonary veins, and pulmonary artery are all structures that are in contact with the outer wall of the atrium, and could be damaged by energy transmitted through the atrial wall. Accordingly, it is the object of the present invention to provide an improved method and apparatus for making transmural ablations to heart tissue. It is a related object to provide a method and apparatus for making transmural ablation in heart tissue that minimizes unnecessary damage to the heart tissue. It is a further object to provide a method and apparatus for making transmural ablation in heart tissue that creates continuous lesions in a single step. It is still a further object to provide a method and apparatus for ablating cardiac tissue which utilizes a sub-xyphoid approach. It is also an object to provide a method and apparatus for identifying a selected cardiac location prior to ablation. It is another object to provide a method and apparatus for introducing fluid to the selected cardiac location for enhanced viewing of the selected cardiac location. It is yet another object to provide a method and apparatus for creating a positive pressure within an intrapericardial space. It is an additional object to provide a method and apparatus for ablating and identifying the selected cardiac location wherein ablation and identification are performed by a single integrated apparatus. These objects and others will become apparent upon reference to the following detailed description and attached drawings for use in treating cardiac arrhythmia. A method for ablating cardiac tissue of a patient employs sub-xyphoid access. The method includes the steps of making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage and providing the ablation instrument which includes at least a pair of distal electrodes adapted to be connected to opposite terminals of an RF energy generator. The electrodes are disposed to engage cardiac tissue at a selected cardiac location to ablate tissue therebetween. Furthermore, the method includes the steps of inserting the ablation instrument through the instrument receiving passage to a sub-xyphoid region, advancing the ablation instrument through the sub-xyphoid region to the selected cardiac location, and ablating the cardiac tissue at the selected location by energizing the electrodes. A method for identifying cardiac tissue prior to ablation first includes the steps of making a percutaneous incision proximal to the xiphoid to define an instrument receiving passage and providing a locating instrument for identifying a selected cardiac location. The locating instrument includes an elongated body and a distal end. The method for identifying cardiac tissue further includes the steps of inserting the locating instrument through the instrument receiving passage to a sub-xyphoid region, advancing the locating instrument through the sub-xyphoid region to position the distal end within an intrapericardial space, and creating a positive pressure within the intrapericardial space by injecting a substantially clear fluid from the distal end into the intrapericardial space. Then follows the step of identifying the selected cardiac location prior to ablation. The present invention further provides a method which combines the steps for identifying cardiac tissue and the steps for ablating cardiac tissue. With reference to the present invention, the compression of the atrial tissue is important because it insures that the exposed electrode surface or cryogenic probe is not in contact with any tissue or blood except the clamped tissue to be ablated. Specifically, the clamping of the tissue between the electrodes or cryogenic probes insures that the conductive or cooled area is only in contact with the clamped tissue. The compressed tissue acts to isolate the electrically active or cryogenically cooled surface, and prevents inadvertent energy delivery to other parts of the heart or blood. The outside temperature of the electrode can easily be monitored to insure that the temperature of the insulation in contact with blood remains below a critical temperature (40� C., for example). In one form of the invention, transmural ablation using RF energy is accomplished by providing an atrial ablation device having a lower �j� clamp/electrode element and placing it on the atrial tissue below the pulmonary veins. Once the pulmonary veins have been isolated, an upper clamp/electrode element is introduced, and the clamp assembly �J� is worked back onto the epicardial atrial tissue. Once the jaws are positioned below the ostia of the pulmonary veins, the tissue is partially clamped, allowing continued flow from the pulmonary veins to the left atrium. Once the clamps are safely away from the pulmonary vein tissue, and onto atrial tissue, the clamps are closed together to compress the tissue. Once the tissue is compressed, bipolar RF energy is used to ablate the clamped atrial tissue. The clamps are then removed, the lesion having been created. Lesions may also be created by inserting one clamp/electrode element through an incision in the heart so as to permit contact with endocardial tissue. This incision may be created with a separate instrument. Alternatively, the tip of one of the jaws may have a piercing structure associated therewith for making the entry incision. Once the clamps are properly located, the tissue is compressed and RF energy is applied. Turning now to the figures of the drawings, a method embodying the present invention is shown schematically in The wider zone of clamped tissue serves several purposes. When the clamping members are closed onto tissue, any blood in the clamped zone is squeezed or expressed out. Further, the distance between the electrodes is minimized, so that the ablation zone remains narrow. It is important to isolate the blood from the ablation zone to avoid creating thrombus. Accordingly, a clamped zone that isolates the ablation zone from the blood minimizes the temperature at the periphery of the ablation zone and will reduce the likelihood of the formation of thrombus by the blood in contact with the clamped zone. Once tissue has been fully ablated with the clamp in the position shown in This �clamping� method and device for creating transmural lesions has a number of advantages. First, using a two step method as shown allows for clamping and ablation of atrial tissue without stopping the blood flow from the pulmonary vein. Secondly, by clamping both walls together, and delivering energy through the clamped tissue, the atrial tissue is not penetrated. Because the atrial tissue is not penetrated, a larger jaw can be used, and the clamping force can be much higher because of the increased stiffness of the jaw. Also, there is no concern of bleeding from an atrial puncture. Another advantage of this method and device is that ablation of tissue within the pulmonary veins is avoided, as recent articles have shown that ablation of tissue within the pulmonary veins can cause pulmonary hypertension and stenosis. Specifically referring to Turning to The grasper is made of a rigid material, such as stainless steel, and is substantially encased in a durable insulating material, such as ABS plastic. With reference to In keeping with the invention, the grasper jaws have raised or convex, opposed tissue clamping surfaces, 90, 92, respectively, with each clamping surface, 90, 92 centrally supporting an electrode 94, 96, respectively, of opposite polarity. The spacing between the jaws is substantially uniform or constant when in the closed or clamped position. RF energy of opposite polarity is supplied to the electrodes 94, 96 through conductors 98, 100, which are connected to an RF generator. As with the previously-described jaw members, this electrode/clamp configuration provides a clamped zone of tissue that is significantly wider than the zone of ablated tissue created by the opposed electrodes. This causes for any blood in the clamp zone to be squeezed or expressed out of the ablation zone, thus reducing the likelihood of thrombus formation, as well as minimizing the distance between the electrodes, so that the ablation zone remains narrow. The clamping also eliminates the cooling effect of circulating blood. With reference to In keeping with a further aspect of the invention, the graspers may provide feedback that permits the user to gauge the completeness (i.e., degree of transmurality) of the ablation. Specifically, a transmural lesion blocks electrical signals because it is non-conductive scar tissue. Because impedance is simply the inverse of conductivity, the ability of the lesion to block electrical signals is accurately indicated by its impedance, which can be measured simultaneously with the creation of the lesion. During RF energy application to the tissue to be ablated, the current and voltage applied to the tissue are measured, and the impedance calculated and stored. Based upon a function of the impedance (e.g., its value, the change in value, or the rate of change in value)) it is determined whether ablation is complete and transmural. See e.g., U.S. Pat. No. 5,403,312, which is incorporated by reference herein. Indicator lights or other types of signals (e.g., audible) may be associated with the grasper to correspond to the degree of ablation determined by the impedance feedback system. For example once the impedance reaches a certain level for a certain period of time, a red light may be activated to signal that ablation is complete. In keeping with another aspect of the invention, a feedback system for determining the temperature of the ablated tissue is also provided. To this end, the jaws include a series of thermocouples 102 that are supported in the insulating member 84 remote from the associated electrode 94 near the edge of the jaw 78 The thermocouples 102 protrude slightly through the surface of the insulating member 84 so as to engage any tissue clamped between the jaws 72, 74. Wires 104 are attached to the thermocouples 102 to transmit the information received to a remote location. Again, a visual or other indicator may be provided to alert the user that a certain pre-determined critical temperature (erg., 40� C.) has been reached, thus permitting the user to avoid undesired thermal spread. Turning to The drive jaw assembly 118 comprises a drive electrode 126, a drive insulator 128, and a drive jaw cap 130. The drive electrode 126 provides a second electrical pathway adjacent the tissue to be ablated and is located on the inside of the drive jaw assembly 118 (�inside� being defined as the side contacting the tissue to be ablated). The drive insulator 128 surrounds the drive electrode 126 and forms the inside of the drive jaw assembly 118. The drive jaw cap 130 forms the backside of the drive jaw assembly 118 (�backside� being defined as the surface opposite the drive electrode 126). Each of the electrodes 120, 126 is attached to an electrically conductive means, such as a wire, that runs the length of the extension shaft and through the conductor cord 112 for coupling to the RE generator 114. Each jaw assembly 116, 118 is supported by a two piece extension shaft comprising a right fixed member 132 and left fixed member 134 (for the fixed jaw) and a right drive member 136 and left drive member 138 (for the drive jaw 118). A shaft cap 139 covers the coextensive portions of the fixed members 132, 134 and the drive members 136, 138 (when the jaws are in the open position as seen in The handle 140 comprises two mating halves 140 a, 140 b for encapsulating the actuation and force control mechanisms for the grasper, as well as providing for grounding of the shaft components by means of a conductive shaft pin 141. In order to move the drive jaw assembly 118 between its open and closed positions, the handle 140 includes a lever comprising a pair of lever plates 146 and a lever shroud 148. The lever is pivotally mounted on a support member 150 extending between the two halves 140 a, 140 b of the handle 140, with a lever spring 151 biasing the lever to its open position ( The carriage 154 includes a lost motion assembly comprising a carriage spring 156 for controlling the minimum and maximum loads that can be applied to tissues that are to be captured between the jaw assemblies 116, 118. As can be readily appreciated, the thicker the tissue that is grasped between the jaws, the greater the compression of the spring 156, and the greater the compression force exerted by the jaws on the tissue. (The range of tissue thickness is expected to be between about 1-15 mm.) In other words, the force exerted by the jaws on the tissue held therebetween increases as the distance between the jaws increases. Adjustment of the compression force is accomplished by pre-loading the carriage spring 156 with a load adjustment screw 158. The lost motion assembly also includes a thumb latch 160 for releasing the clamping pressure and for providing a mechanical stop for the spring-loaded carriage 154. The thumb latch 160 is pivotally mounted on a latch pin 162 to secure the thumb latch to the handle 140. Additionally, a latch spring 164 is provided for biasing the thumb latch 160 to its locked position. A latching step on the carriage 154 interfaces with the tip of the thumb latch 160 to provide for the mechanical stop. When the lever is pivoted with respect to the handle 140, the drive jaw assembly 118 and its drive members 136, 138 slide along the longitudinal direction of the shaft to bring the two jaw assemblies 116, 118 into contact with the tissue intended to be grasped. In order to ablate a narrow, long region of biological tissue with the instrument 110, the tissue is first placed between the open instrument jaws 116, 118. The user then grasps the actuation lever comprising the lever plates 146 and lever shroud 148 to apply the force required to drive the drive members 136, 138 and drive jaw assembly 118 distally, thus compressing the tissue and automatically engaging the thumb latch 160. The thumb latch 160 locks the position of the drive members 136, 138 and the drive jaw assembly 118 with respect to the handle 140 and the fixed jaw assembly 116. The amount of jaw force on the tissue is controlled by the lost motion assembly between the lever and the drive members 136, 138. With the jaws closed on the tissue, the operator activates the RF generator 114. RF energy passes through the tissue between the electrodes 120, 126, thus ablating the tissue between these electrodes. After completion of the ablation cycle, the operator releases the clamping of the tissue by depressing the thumb latch 160, thus releasing the carriage 154. With the carriage 154 released, the lever spring 151 drives the drive members 136, 138 and the drive jaw assembly 118 proximally to their open positions. The actuation lever, since it is directly coupled to the carriage 154, also returns to the open position. Turning to With reference to With reference to With reference to With reference to With reference to With reference to With reference to With reference to 81 With reference to A further embodiment of a grasper according to the present invention is shown in The jaws 252, 254 also include a lost motion connection including a spring to bias the jaws toward the closed position. With reference again to With reference to In order to be sure that lesions 1 and 2 are fully transmural and completely encircle the RPV's and LPV's so as to effectively electrically isolate the RPVs and LPVs from the atrium, one of the jaw members of the grasper may be provided with an EKG sensor intermediate the ends of the jaw. The EKG sensor is located on the jaw so that, when the grasper jaws are closed on the tissue intended to be ablated, the EKG sensor contacts the tissue outside of the ablation line on the pulmonary vein side of the line of ablation. Thus, by monitoring the EKG of the atrial tissue adjacent the pulmonary vein, the surgeon can determine simultaneously with the creation of the ablation line whether the pulmonary veins have been electrically isolated from the atrium. In addition, the grasper jaw may include pacing electrodes intermediate its ends. The pacing electrodes are located on the opposite side of the ablation electrode from the EKG sensor, again outside the line of ablation. Thus, a pacing pulse can be transmitted by the pacing electrodes which will be sensed by the EKG sensors when the jaws of the grasper are closed on the tissue. The pacing and sensing continues as the ablation electrodes are activated to create the lesion. When the lesion is complete, the EKG sensors will no longer be able to detect the pacing signal. When a pacing electrode is paired with the EKG sensor, the EKG sensors may be on either side of the jaw, i.e., on either the pulmonary vein side or the atrial side of the ablation line created by the ablation electrodes. The EKG electrodes and pacing electrodes are best seen in Lesion 4 connects the lesion 1, which surrounds the right pulmonary veins, to the mitral valve annulus (MVA). It may be made through the same incision and purse-string suture used for making lesion 3. With reference again to When making lesion 4, care must be exercised in locating the grasper jaws so that the electrodes, when RF energy is applied, do not damage the mitral valve leaflets. It is known that the electrical signals generated by atrial tissue differ from the electrical signals generated by ventricular tissue. Consequently, the distal tip of one of the jaw members of the grasper includes an EKG sensor so that the EKG of the tissue contacted by the tip of the grasper can be monitored. As best seen in It may also be desirable to make a lesion between the superior vena cava (SVC) and the inferior (IVC). This may be created in two steps, in which lesions 5 and 6 are made. With reference to A lesion 8 is made between the right atrial appendage and the tricuspid valve annulus (TVA) utilizing an incision and purse-string suture made in the RAA, as illustrated in A final lesion 11 is illustrated that connects lesion 10 circumscribing the left atrial appendage with lesion 2 that circumscribes the left pulmonary veins. As illustrated, the lesion 11 is made utilizing an incision and purse string suture through which the grasper jaw is introduced, the incision being located in the left atrial appendage beyond the lesion 10. In a further embodiment, the present device consists of two long, linear, wire-type electrodes, which are in parallel relationship to each other, each approximately 1 mm in diameter, and 50 mm long. The electrodes are insulated along their entire surface with a thin layer of high dielectric material such as polyamide, except for a thin strip of electrically conductive material that runs along the length of each electrode, in face-to-face relationship with each other. The electrodes are comprised of a high modulus material, such as tungsten or carbon fiber. One of the electrodes is designed to be introduced into the interior of a hollow organ through a small puncture wound in the wall of the organ. The second electrode is introduced on the opposite side of the hollow organ wall. The device incorporates a mechanism for advancing each electrode individually, or both simultaneously, in parallel relation with each other. The device also includes a clamping mechanism that brings the two electrodes together so that their exposed conductive surfaces are in face-to-face relation and the electrodes exert sufficient pressure to clamp the tissue. Once both electrodes have been advanced to their desired positions, the clamping mechanism is activated which brings the two wires together, and clamps the tissue between the two exposed electrode surfaces. RF energy is then applied between the two electrodes, and the tissue is ablated in a long, continuous, transmural line. A monitoring device measures the voltage, current, impedance, and/or temperature between the two electrodes, and an algorithm determines whether the tissue is fully ablated. This device provides a way to achieve and verify a fully transmural and continuous line of tissue ablation by locating the atrial tissue between two bipolar wire electrodes, and clamping the tissue. The forceps consist of two electrode pads of opposite polarity designed to grasp and clamp tissue. A well-known method of determining the status of the tissue between the electrode pads is to monitor the current, voltage, and impedance of the tissue, as done using the Richard Wolf generator for bipolar forceps. It is well known in the art that the ablative status of tissue clamped between two bipolar electrodes can easily be determined by monitoring the increase in tissue impedance as the tissue desiccates. This device is to be used with an RF generator that monitors current, voltage, and impedance to determine the state of tissue ablation of the tissue compressed between the inner and outer electrodes. The RF generator will be equipped with an indicator which informs the user of the status of the clamped tissue, and when ablation is complete (i.e., transmural along the entire length of the electrodes). This device provides the capability of creating long, transmural lesions through atrial wall tissue of varying thickness because it employs an active bipolar electrode on each side of the atrial wall, and the ablation proceeds from both the inside and outside of the atrial wall. The device is also unique in that the electrodes are used to compress the tissue to be ablated. This compression is critical because the inside and outside surfaces of the atrium can have irregularities, and a high clamping pressure insures that both electrodes are making good contact with tissue along the full length of each electrode. Clamping the tissue also reduces the distance between the electrodes, and makes the ablation more efficient because the electrical energy is more concentrated. Because of this higher concentration of energy, lower powers and temperatures can be used to achieve complete ablation, and the process is considerably faster As an example, to fully ablate a 5 mm deep lesion, 30 cm long can take several minutes with an endocardial catheter electrode array, and the temperatures can be as high as 80 to 90 degrees centigrade at the tissue surface with the generator power as high as 40 to 50 watts. In benchtop testing of the present invention in animal hearts, a fully transmural 30 mm line through 5 mm of tissue was achieved in 5 seconds at 20 watts. With reference to The operation of the device begins by advancing the inner electrode wire 201 by advancing the slider button 203. Once the inner electrode 201 is advanced to the desired length, the outer electrode 202 is advanced by advancing slider button 204. Note that further advancement of slider button 204 also advances slider button 203, so that both electrodes 201 and 202 advance simultaneously. Because of the bend 202 a in the electrode wire 202, and the notch 205 a in the slider tube assembly 205, the slider tube advances along with the outer electrode 202. Once both electrodes are advanced to the desired length, the slider tube 205 is advanced so that the end 205 b of the slider tube 205 contacts the arcuate wire segment 202 b of electrode wire 202. Further advancement of slider tube 205 acts to compress the electrode wires 201 and 202 together along the entire effective length L. The compression of the tissue is important because it insures that the exposed electrode surface is not in contact with any tissue or blood except the clamped tissue to be ablated. Referring to In another embodiment of the invention, a penetrating compressive/tensile electrode is used. Once the jaws are positioned below the ostia of the pulmonary veins, the tissue is partially clamped, allowing continued flow from the pulmonary veins to the left atrium. An electrode needle is introduced which enters the left side of the atrial tissue and exits on the right side into a tip securing point on the lower jaw. This point will prevent the tip from moving axially when a needle is pushed. The lower atrial tissue can be compressed by �pushing� on the needle with a force that compresses tissue between the needle electrode and the lower jaw electrode. Bipolar RF energy is then applied between the needle and lower jaw electrodes to ablate a line of tissue from the needle entry to exit point. Once the lower atrial tissue has been ablated, the upper jaw is moved down to contact the tip of the lower jaw. Note that this still provides an open lumen for blood flow from the pulmonary veins to the left atrium. The needle is rotated 180 degrees on its axis so that the electrode surface faces up. The needle is then �pulled� to create tension, and exert a compressive force that compresses tissue between the needle electrode and the upper jaw. Bipolar RF energy is then applied between the needle electrode and upper jaw to ablate the tissue. Note that the partial closing of the upper jaw to contact the tip of the lower jaw could be done prior to compressing the lower atrial tissue. With reference to A further aspect of this invention provides three methods which may be used to gain access to ablate cardiac tissue. The first method gains access to the heart by opening the patient's chest or thoracic region. The second method gains access to the heart by intercostal incisions whereby access to the heart is achieved between the ribs. Finally, the third method utilizes a sub-xyphoid approach. In any event, each method is adapted to place the ablations at previously identified locations that require ablation. The first method is illustrated in Locating and identifying the ablation locations may be performed by one of several different instruments such as a bullet dissector 306, which is best shown in The continuous flow of saline from the bullet dissector 306 allows the saline to flush blood and other body debris from the transparent head 308 and endoscope viewing lens so as to provide a clear viewing space. As saline flows out of the head, the flow of saline pushes against the adjacent tissue and aids in dissection by, for example, separating the pericardium from the heart. The continuous flow of saline creates a working space between the dissector and the surrounding tissue and ensures that this space is positively pressurized. In addition, the head 308 of the bullet dissector also may be designed to allow easy dissection around the pulmonary veins or other cardiac tissues. The head 308 is bullet shaped. It has a rounded distal tip 309 which gently separates or dissects tissue. The diameter of the head 307 may be equal to or larger than the body 310. Once the thoracic cavity is accessible, the bullet dissector 306 is inserted into the patient's chest cavity adjacent the heart, as shown in After the ablation locations are located and identified, the ablation or clamping device is then introduced into the patient's chest and positioned in contact with the location. The ablation device which is generally used for the open heart procedure is the grasper shown and described in In Once the intercostal penetration is made, the bullet dissector is introduced through the incision, as shown in Using the intercostal method, transmural ablations may be performed on other cardiac tissue using RF energy, as previously described herein. Ablation is repeated until all ablation locations have been treated. Ablation devices may be inserted into different access locations 336 depending on which directional approach is preferred for the cardiac tissue which requires ablation. Different ablation devices may be inserted depending on which cardiac tissue requires treatment. Once all areas are treated on the right side in In the sub-xyphoid method, the initial incision is made beneath the rib cage R, preferably between the xyphoid XP and the adjacent costal cartilage C. In Using the sub-xyphoid approach, it also may be possible to perform ablation on both pairs of pulmonary veins at the same time either through the same incision or through separate incisions. In For example, as shown in Once dissection is completed, an ablation device 384 may be inserted through the sub-xyphoid access location 380. The ablation device may be inserted into the intrapericardial space alongside the bullet dissector 306 either by enlarging the pericardial incision using a suitable cutting device or by causing the pericardial incision to stretch or widen to accommodate the ablation device. It is also possible to remove the bullet dissector 306 and then insert the ablation device, although use of the bullet dissector in combination with the ablation device is preferred. The ablation device is advanced to the cardiac tissue to be treated such as, for example, the confluence of the atrium and the pulmonary veins. With the aid of the bullet dissector and endoscope, the tissue to be treated is identified. Within the working space created by the bullet dissector, one jaw of the ablation device is positioned below the pulmonary veins and the other jaw is positioned above the pulmonary veins. The ablation device is properly positioned around the tissue to be treated and then clamped. Verification may be performed to ensure that the clamped tissue between the jaws of the ablation device is the location which requires ablation. The bullet dissector may help visualize and confirm that the appropriate cardiac tissue is being treated. The curved jaw members of the ablation device should be oriented such that the concave portion faces the pulmonary veins and the convex portion faces the atrium. Ablation of the cardiac tissue is performed by using RF energy to create an ablation lesion, as previously described. The sub-xyphoid approach may be used to create ablations as shown in The sub-xyphoid method can be repeated as necessary to create additional ablations. For example, a second circumferential ablation may be created around the right pulmonary veins. When using an ablation device similar to the grasper shown in During ablation drainage of excess fluid may be performed by inserting a drainage tube through the sub-xyphoid access location 380. Once all ablation locations are treated, the ablation device and bullet dissector are withdrawn and the sub-xyphoid access location 380 is closed using well-known techniques. It is not necessary to suture the pericardium incision. Importantly, each method may be performed with a beating heart or with the heart stopped. Where the heart is stopped, it is understood that the patient must be connected to a cardio-bypass machine. The methods may be performed either with the lungs inflated or deflated. If the lung is deflated, then the patient must be connected to a respirator. It is realized that where both the heart is stopped and the lung deflated, then the patient will be connected to a cardiopulmonary bypass system. Where the lung is deflated, it may be preferred to deflate only one lung at a time before proceeding to deflate the other lung. For example, where cardiac tissue adjacent each pair of right and left pulmonary veins requires treatment, either the right lung or the left lung may be deflated, but not both. After all cardiac tissue requiring ablation is treated on the deflated side, the lung is re-inflated and the process is repeated for the other side of the heart. Each method may be used to create transmural ablation as previously described herein for epicardial or endocardial surfaces. For epicardial ablations, an incision is usually made into the pericardium to access the epicardial surface. Although it is possible to perform ablations without penetrating the pericardium, penetration into the intrapericardial space, the space within the pericardial cavity between the pericardium and the epicardium, may allow for better positioning of the ablation device for ablation of the identified cardiac tissue. Where the ablation device is inserted into the intrapericardial space, it is advanced to the location which has been identified as requiring ablation. The ablation device directly contacts the epicardial surface of the heart relating to this location and the location is ablated. Methods of epicardial ablation for creating lesions around the pulmonary veins are disclosed in U.S. Pat. No. 6,161,543, which is incorporated herein by reference. For endocardial ablation, an incision is made in the heart wall by a blade on the tip of the ablation device or by other suitable instrument. The incision in the heart wall may be treated with an appropriate suture such as a purse string suture 327 shown in FIG. 76. Then the dissector and endoscope can locate and identify the location to be ablated. Once the location is identified, one of the jaws of the ablation device or grasper is inserted into the heart to directly contact the endocardial surface which requires ablation. After ablation, the jaw of the ablation device, is withdrawn back through the incision. The process is repeated until all locations are treated. Thus, it can be seen that a transmural ablation device and method have been provided that overcome the limitations of the prior art. First, current technology involves ablation devices deliver ablation energy to either the inside (endocardium) or outside (epicardium) of the heart. Using these techniques, the tissue ablation proceeds from one wall of the heart through the tissue to the opposite wall. To date, there has been no reliable way to consistently achieve lesions that penetrate the full thickness of the atrial wall (transmural lesions), and there has been no way to determine either continuity or transmurality of these lesions. If the lesion does not penetrate through enough of the atrial wall, conduction can still occur, and the lesion does not fully block the electrical signals that are causing the arrhythmia. Using an endocardial approach, if the lesion penetrates too far through the wall, critical structures such as coronary arteries, veins, or the esophagus can be damaged on the outside of the heart. Using an epicardial approach, if the lesion penetrates too far, blood can be coagulated, or critical structures such as valves, nodes, or connective tissue can be damaged on the inside of the heart. There has also been no reliable and consistent way to safely achieve fully continuous, long (greater than 1 cm) lesions in the atrial wall without a high risk of thrombus, damage to critical structures, or extensive damage to the atrial tissue. The present invention overcomes these shortcomings because the conductive area of each electrode is very narrow compared to the width of the clamped area. As a result, the thermal damage to the tissue is minimal. In contrast, current technology uses catheter electrodes which are typically 1 or 2 mm diameter requiring a lesion width of almost 8 mm to achieve a depth of 5 mm. Using the present invention, a lesion depth of 5 mm with a width of less than 2 mm can be achieved. This aspect of the invention allows for longer linear lesions with less power delivery because less tissue is being heated. There is, therefore, considerably less damage to healthy atrial tissue for a lesion of a given depth and length. Recent efforts in creating linear lesions using endocardial electrodes resulted in ablation of over 20% of the atrial endocardium, and a commensurate decrease in atrial contractility. Another advantage of this device is that ablation can be done on a beating heart. Using a high modulus material such as tungsten or carbon fiber would allow a minimum diameter, and a maximum clamping pressure for a given clamping length. Once the device is clamped onto the atrial wall, the position of the electrodes can be verified by visually inspecting the position of the outer electrode before delivery of RF energy. If the clamping pressure is higher than the atrial pressure, then clamping over a coronary artery would cut off blood flow, and the resulting change in the EKG would act as a warning to the user prior to applying RF energy. The clamping will prevent any movement of the electrodes relative to the heart wall, and RF energy can be applied with confidence that the ablated tissue will be contained completely between the two electrodes. Another important feature of this device is that the energy transfer is limited to the tissue clamped between the two electrodes. The insulated electrodes protect structures on the outside of the heart from being exposed to RF energy. Because of this limitation of current flow, damage to critical structures can be avoided. Another advantage of this device is that it can easily be adapted to a minimally invasive thoracoscopic approach. The device shown has been reduced to a 5 mm diameter device, and can probably be reduced to 3 mm or less. Using video thoracoscopy, the device could be introduced through a small intracostal incision, and used to create fully transmural linear lesions on a beating heart, possibly under local anesthesia on an anesthetized patient. Accordingly, a device and method for performing transmural ablation has been provided that meets all the objects of the present invention. While the invention has been described in terms of certain preferred embodiments, there is no intent to limit the invention to the same. Instead it is to be defined by the scope of the appended claims. Patent Citations
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text:
A Tribute to Mad Skill (10 player)
In the Trial of the Grand Crusader, reach a Tribute Chest with at least 45 attempts remaining in 10-player mode.
Quick Facts | ||||||||
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The Wowhead Client is a little application we use to keep our database up to date, and to provide you with some nifty extra functionality on the website!
It serves 2 main purposes:
You can also use it to keep track of your completed quests, recipes, mounts, companion pets, and titles!
So, what are you waiting for? Download the client and get started.

subset: commoncrawl


text:
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Our favourite version of the i30. A great car, especially at this money.


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Reports to help you estimate the value of property...
Postcode ReportPrices paid over the past 24 months, median price trends and forecasts
Property ReportGet an estimate of the value of a property using the same methodology that APM provides to Australia's leading financial organisations.
Street ReportFind out what the neighbours paid.
Note: Where the demographics are shown as a ranking (rather than the actual demographic) the number indicates the ranking from most common to less common. The rank in the Comparison Region indicates where the demographic of the Target Region ranks in the Comparison Region.
The demographics are compiled from a variety of sources including the Australian Bureau of Statistics and research by Australian Property Monitors. Copyright in ABS Data resides with Commonwealth of Australia. Used with permission. (www.abs.gov.au)
An educational booklet to help you find out everything you must know about investment fees.
Sponsored Links


text:
Norris, Hendricks set for duel in middle game
O's righty, Cubs rookie both in the midst of excellent stretches
It might not be all that surprising if the Orioles-Cubs matinee on Saturday at Wrigley Field turns into a pitchers' duel. Baltimore righty Bud Norris, fresh off one of his best starts of the season, will get the ball opposite Chicago rookie Kyle Hendricks, who has turned in six straight quality starts.
The game will carry greater big-picture significance for the O's, who had their four-game win streak snapped by a 4-1 Chicago win on Friday. Baltimore will look to further pad its American League East cushion toward double-digit territory as they face the cellar-dwelling Cubs all weekend.
Norris is charged with that task on Saturday. He, like most of the Baltimore rotation, has been rolling of late, earning a 2.87 ERA and 1.21 WHIP over his last 10 starts.
On Monday, Norris beat the White Sox, allowing two runs over seven innings to outduel Chris Sale before the Orioles' offense broke it open late. Norris allowed just one baserunner through the first six innings and issued no walks for the first time since his first start of the season.
Hendricks, meanwhile, has been a recent bright spot for the Cubs, as he's ventured into waters uncharted by a first-year Cubs pitcher since a young Kerry Wood tossed seven straight quality starts (twice) in 1998.
During Hendricks' streak, not only has he met the requirements for a quality start -- at least six innings, no more than three earned runs -- but he's cruised past them. The 24-year-old righty has lasted a minimum of seven innings in five of those six games and allowed no more than one earned run in all six, posting a 0.84 ERA and 0.89 WHIP in that span.
Nearly two-thirds of all of Hendricks' pitches this month have been sinkers, according to brooksbaseball.net, and it's worked out just fine for him. Opposing batters are hitting .224 with a .293 slugging percentage against the sinker.
Hendricks' most recent gem came Monday against the Mets when he allowed one run in seven innings for his fourth consecutive win. A Lucas Duda homer was the lone blemish on his ledger.
"I know it's a short snippet, and [Hendricks has] been very, very good, but he is [Greg] Maddux-like in his execution and approach," Cubs manager Rick Renteria said afterward, referencing the former Cubs pitcher and recent Hall of Fame inductee.
Orioles: Machado likely done for season
Manny Machado is eligible to return from the 15-day disabled list Wednesday. He won't.
In fact, his season is likely over. The 22-year-old is expected to undergo right knee surgery by Dr. Neal ElAttrache within the next week, MLB.com confirmed on Friday.
Machado, diagnosed with a right knee ligament sprain earlier this month, has been traveling with the team, but information about his injury has been closely guarded. The team never released which ligament was injured or the grade of the sprain, and manager Buck Showalter said before Friday's 4-1 loss to the Cubs that he was hoping to be able to give reporters a more concrete answer on Machado's timetable this weekend.
It will be the second consecutive season-ending knee procedure for the young All-Star, who suffered a season-ending left knee injury last September at Tropicana Field and missed the first month of this season recovering. ElAttrache also performed Machado's left knee surgery.
Cubs: Myriad of strikeouts part of growing process, Renteria says
The Cubs strike out -- a lot. They entered play Friday second in the Majors with 1,127 punchouts, trailing only the Marlins (1,129). They also tied Miami with a 23.4 percent strikeout rate that's tops in the big leagues.
According to Renteria, though, it can at least in part be chalked up to the Cubs' many young position players still finding their way at the Major League level. Arismendy Alcantara and Javier Baez, for example, had struck out in 27. 3 percent and 40.5 percent of their plate appearances, respectively, and although they are only relatively recent callups, the since-optioned Mike Olt (39.6 percent) and Junior Lake (33.4 percent) also did their fair share of swinging and missing.
"For some of the young guys who just arrived, it's still a learning process, it's still trying to get comfortable at the Major League level," Renteria said. "It's also getting comfortable understanding there's a lot of information out there, and the opposition can dissect every single thing about a particular batter's approach and attack it and use anything they can against that particular hitter. They're in a learning curve and trying to understand both sides of it.
"You have to break down young men having the at-bats and see what their thought process was during the at-bat. By the same token, you still want guys to have the aggressiveness they have."
Worth noting
• Baltimore center fielder Adam Jones said Friday he isn't sure whether he will go with the team of MLB players headed to Japan for a five-game exhibition series in November. Jones was one of four players selected to the team earlier this week.
• Righty Jacob Turner pronounced himself ready should the Cubs opt to give him the start Tuesday against the Reds in place of the injured Edwin Jackson. Turner threw 34 pitches in two innings of relief Thursday, and he last started -- for the Marlins, also against the Reds -- on Aug. 3.
• In a combined 61 plate appearances against Norris, the Cubs own a .167/.246/.278 slash line. The Orioles have never faced the rookie Hendricks.
Tim Healey is an associate reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


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Intraductal papilloma is a small, noncancerous (benign) tumor that grows in a milk duct of the breast.
Intraductal papilloma occurs most often in women ages 35 - 55. The causes and risk factors are unknown.
The health care provider might feel a small lump under the nipple, but this lump cannot always be felt. There may be discharge from the breast.
A mammogram often does not show papillomas. Ultrasound may be helpful.
Other tests include:
The involved duct is removed with surgery and the cells are checked for cancer (biopsy).
There may be support groups for women with breast disease in your area. Ask your doctor or other health care provider for a recommendation.
The outcome is excellent for people with one tumor. People with many tumors, or who get them at an early age may have an increased risk of developing cancer, particularly if they have a family history of cancer or there are abnormal cells in the biopsy.
Complications of surgery can include bleeding, infection, and anesthesia risks. If the biopsy shows cancer, you may need further surgery.
Call your health care provider if you notice any breast discharge or a breast lump.
There is no known way to prevent intraductal papilloma.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch) The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
This page was last updated: May 20, 2014


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Denver Broncos Gear
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Product ID: 1685946
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Celebrate your Denver Broncos fandom in top-notch style with this Platinum performance T-shirt from Nike. You always like to look your best when you represent your Denver Broncos no matter what the occasion is. With this tee, you'll be able to do just that, featuring a printed team logo and "Denver Broncos" lettering in an eye-popping platinum color. Add in Nike's Dri-FIT technology to keep you cool and comfortable, and you'll never be more excited to proclaim yourself as the #1 Denver Broncos fan!
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Customized items can be personalized with options such as your name, your favorite
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Green/White Stripe Quilted Hammock
- $ 199 98 199.98
- Shipping
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About this item
This quilted fabric hammock offers a traditional look for your backyard and reverses to a solid color. The spreader bar are sanded and varnished for water repellence and better look. The grommets are made of brass and installed at every 2 inches for strength and higher weight capacity. The fabric is a solution dyed acrylic padded with polyfiber fill that dries out quickly. The rope is a soft spun polyester rope that will provide durability to the hammocks. The hanging hardware is zinc plated for rust resistance and better look. The rings are part of the macrame; clew and come with chains, s-hooks and a special tree-hook for ease of hanging on trees or stand.
- Weather-resistant outdoor fabric
- Top layer green/white stripe, reverses to solid
- Polished hardwood spreaders
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- Stand not included
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Say my name and his in the same breath, I dare you to say they taste they same.
What Arsenal fans think about RVP moving to UTD: Originally Posted by akbar There is a difference between playing shit and being shit. You said I think RVP is shit, where I'm saying he'll play shit... His ability will still be there but it just won't have a bug effect on UTD. Oh akbar....
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National Wildlife Federation's new Mascot Madness: How Climate Change is Hurting School Spirit report details how the climate crisis is hurting the real-life species that are mascots for many of America's college basketball teams.
Read NWF's Mascot Madness >>
Jobs for the Future and National Wildlife Federation are partners in The Greenforce Initiative, an effort to strengthen the capacity of community colleges to green the skills of our modern workforce. Learn more about The Greenforce Initiative >>
Start a project, connect with other students, and earn recognition for your leadership skills and positive impact on wildlife and the environment. Learn more >>


text:
01 Jun 2014 20:00 Etihad Airways today confirmed that it will forward a letter detailing the conditions precedent and the criteria for a proposed equity investment by Etihad Airways that have been negotiated with Alitalia and its stakeholders over the past months. The Italian Government appreciates the strategic importance of this transaction and looks favourably at the Etihad Airways - Alitalia partnership.Upon confirmation by the Board of Alitalia and its stakeholders of their acceptance of these terms, the airlines will proceed to final documentation in order to complete the proposed transaction, in line with EU and other regulatory requirements.President and Chief Executive Officer of Etihad Airways, James Hogan, said: "We are delighted to be able to move forward with this process and look forward to the successful conclusion of the proposed transaction with Alitalia."An equity investment in Alitalia will be beneficial not only for the both airlines, but, more importantly, it will give more choice and broader travel opportunities to business and leisure travellers into and out of Italy."Gabriele Del Torchio, Chief Executive Officer of Alitalia, said: "This is an excellent outcome for Alitalia. This investment will provide financial stability and confirms Alitalia's key strategic role as an infrastructure player in the travel and tourism industry in Italy for long-term growth." Roberto Colaninno, President of Alitalia, said: "We are delighted to move forward with Etihad Airways providing Alitalia with an ideal strategic partner enhancing the Company's long term growth perspectives." Contact Us As a truly international airline, we have a genuinely global presence. Find out how to contact your nearest Etihad office. View contact details Feedback Should you wish to send us a comment, compliment, or complaint, or simply ask a question, please click here Like Us Visit our page on Facebook! Watch Us Visit our channel on YouTube! Follow Us Etihad Airways | Etihad Deals | Etihad Help | Etihad Rewards
Flight schedule: Flight # Departs Departure Arrives Arrival Frequency Duration EY 171 Abu Dhabi (AUH) 8:50am Los Angeles (LAX) 2:20pm Daily 16hr 30 min EY 170 Los Angeles (LAX) 4:50pm Abu Dhabi (AUH) 8:10pm 1 Daily 16hr 20 min


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The Kansas Association of Senior Corps Directors announced Sen. Jerry Moran has been selected as one of four recipients of the Distinguished Service Award through Voices for National Service.
"The beginning of wisdom is to call things by their proper name." — Confucius
The suburbs have had it rough in the last few years. The 2008-2009 economic collapse led to waves of foreclosures in suburbia, as home prices plummeted. More recently, census data suggest that Americans are actually shifting back closer to city...
In 2014, we said goodbye to some legendary entertainers and influential performers. From unexpected deaths to the passing of Hollywood A-list celebrities, here�s a look at some of the stars who are gone but not forgotten.
As if we needed another reason to envy her,�Jennifer Lawrence�has been named the top-grossing...
Last spring G told me on his way to bed that I should watch "The Goldbergs," the very TV show's ad I was laughing at as he made his way up the stairs. And even though I occasionally laughed at the promos, I never...
North Korea is comparing�President Barack Obama�to a "monkey" for urging Sony to release�The...
Now that Christmas is over and people begin taking down the decorations and packing them away for next year, there is the Christmas tree with which to get rid of.
Jakob Provo, of El Dorado, spent his last semester serving as an intern in Washington, D.C., with Sen. Jerry Moran.
President Obama's unilateral executive action on immigration will make hundreds of thousands, perhaps more than a million, illegal immigrants eligible for federal transfer payments.
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This bug day will take place on Sunday, August 1st 2010, but feel free to start early. The aim of this bug day is to get as many Dolphin-related bugs done as possible. Our target for triage is bugs listed in bugs.kde.org under the product Dolphin.
Warning |
Always make a note on the bug of what the status is in the version you are testing with (be explicit as to what version of 4 you are using, mentioning whether it is a source build and which distro the packages come from). |
Prioritizing is good. If a major application doesn't work, this should be taken care of.
Keep an eye on what the "Version:" fields say in Bugzilla. If it says "unspecified", change the version field to match what the report says, i.e. to match version the bug was first reported in. Do not change the version number if it is currently set as a number! (ex. from 4.0 to 4.2)
As requested by the Dolphin maintainter, just leave it to the version where the user has reported it, not to the version where it could be reproduced.
After adding triaged bugs on this page, you should keep an eye on their bugzilla status. Add yourself on the CC field in bugzilla to be informed about updates. When a bug is closed on bugzilla, it should be updated on this page.
You can do this with the tag <s>...</s>
Please select a period of bugs from the Division of Labour section below and mark your name next to it and mark it with your irc nickname to show that you are working on it. When you have completed all the bugs in that section, please mark it as complete.
For each bug, try and reproduce it as described in the report. Then list it in the appropriate section below. If you wish to close or mark as duplicate a bug, please list it here even if you have the bugzilla permissions to do so, in order to get a second opinion from another triager. This will help to reduce the number of incorrect actions taken on bugs.
Tell developers what you are testing with. (If you expect to upgrade between now and Bug Day, put what version you are using now next to the bugs/comments that you put on this page.)
Please give distro/version or SVN branch/trunk with revision below:
IRC Nickname | KDE version used for testing | |
Lemma | KDE SC 4 svn trunk r1157840 | |
jtamate | KDE SC 4 svn trunk rev. 1156755 | |
stephdg | KDE 4.3.0 with Fedora 10 |
Tip |
Please be sure to sign every bug or comment you add to this page with your irc nickname. You can use the wiki markup ~~~ to insert your wiki username automatically (but only do this if it is the same as your IRC nickname, otherwise write your IRC nickname in by hand). |
Please choose a batch that is not already taken and then query bugs.kde.org for all bugs in that batch. Please mark you irc nickname in the table below to show which batches bugs you are working on to avoid duplication of effort.
The bugzilla query to use for this triage day can be found here.
Batch | No of bugs | IRC Nickname | Status | Query |
1 | 5 | Jtamate | done except 214765 | Query |
2 | 5 | Lemma | starting | Query |
3 | 5 | stephdg | 3 left, 225280 & 225682 done | Query |
4 | 5 | Query | ||
5 | 5 | Query | ||
6 | 5 | Query | ||
7 | 5 | Query | ||
8 | 5 | Query | ||
9 | 5 | Query | ||
10 | 5 | Jtamate | done | Query |
11 | 5 | Query | ||
12 | 5 | Query | ||
13 | 5 | Query | ||
14 | 5 | Query | ||
15 | 5 | Query | ||
16 | 5 | Query | ||
17 | 5 | Query | ||
18 | 5 | Query | ||
19 | 5 | Query | ||
20 | 5 | Jtamate | done | Query |
21 | 5 | Query | ||
22 | 5 | Query | ||
23 | 5 | Query | ||
24 | 5 | Query | ||
25 | 5 | Query | ||
26 | 5 | Query | ||
27 | 5 | Query | ||
28 | 5 | Query | ||
29 | 5 | Query | ||
30 | 2 | Query |
(Total bugs 147)
Below lists the various sections for completed bugs. This aids everyone in double checking each other's work. In addition this allows those of us that don't have bugzilla permissions to list bugs so that the folks with the permissions can follow up.
Please note that this is an experimental layout designed to reduce the number of edit conflicts on this page. Each section is its own subpage. The best way to work with this is to enable section editing by going to "My preferences" > "editing" > "Enable section editing via [edit] links". When you click edit you will automatically edit the subpage.
If you don't have bugzilla permissions yet, you can't change version fields. Put what needs changing here and someone else will go through and do it for you. Don't worry, you'll have permissions soon enough...
If it is a deterministic bug, put it here. Make sure it has instructions. You should be able to verify it. (Write that you did on bugzilla and include your version information.)
- ppenz reproduced it :-( http://bugs.kde.org/show_bug.cgi?id=226442#c10 FiNeX
If the bug doesn't exist anymore, it goes here. WORKSFORME!
Put suspected duplicates here.
A bug is INVALID if it describes desired behavior, or something that isn't a bug.
If a bug was previously UNCONFIRMED and you can reproduce it, put it here.
If anything is in doubt, put it here, and give a description of why you think a developer should look at it.
If a bug sounds valid but can't really be reproduced and needs more information from the reporter, put it here.
If a bug needs for example special hardware, network servers or locales installed, put it here.
If it is a valid bug, but not a dolphin bug, it might have been assigned the wrong product on Bugzilla. Put it here so it can be reassigned to the proper component.
In this section put the bugs that you think the primary cause of the bug are nepomuk or strigi.
If there are bugs you can't test for whatever reason (apart from the ones needing a particular setup which have their own section), fill those in here.


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What about 3D support for R500+?..
Is it in this git, or there is another "experimental" branch?
Phoronix: xf86-video-ati 6.9.0 RC2 Driver Released
Twelve days after the first xf86-video-ati 6.9.0 Release Candidate, the second RC release is now available for testing. Since xf86-video-ati 6.9.0-rc1, the man page has been updated, a ShadowFB R600 fix, PLL tweaks, a possible fix for VGA on ATI IGP chipsets, warning fixes, cleanups, and other work...
What about 3D support for R500+?..
Is it in this git, or there is another "experimental" branch?
Well what surprises me is that it already runs Compiz better than fglrx (there's nearly no flickering and I can move video players *with* the video that is being played) for me...
This is a bit off-topic, but can we please get some coverage (and 2nd opinion ) on VIA's latest source patch on linux.via.com.tw ? It seems to be something about support for *chrome in DRM or whatever...
Isn't MESA contains software rendering implementation?..
(and I had problems some time ago, when glxinfo reported "Mesa", that meant I didn't have DRI with fgrlx).
Where can I read more about it?
Another question: what uses Compiz in the article author's system? I heard there isn't AIGLX support yet, in the open-source drivers.
( http://phoronix.com/forums/showpost....02&postcount=1 )
, at least with "stable" xserver..
P.S.: it would be really helpful for me to read an article, explaining all this MESA/AIGLX/DRI stuff for dumbs ;-) Has anybody a link?
the radeon driver (part of xf86-video-ati) has had AIGLX for ages according to wikipedia (which also has other answers for you):
edit: Mesa link was to the disamiguation page... d'oh!
Mityukov, if you want to actually see and touch the 3d drivers :
- go to http://gitweb.freedesktop.org
- scroll down a bit to mesa/mesa and click on it. That will give you a "Summary" page showing recent changes, recent tags (eg this point is release 6 RC2) and recently used branches
- click on "tree" - this will show you the actual source code, about 1.1 million lines IIRC
- navigate down to the HW drivers by clicking on src, then mesa, then drivers, then dri, then r300 (code for R3xx, 4xx, 5xx)
For drm, go back to gitweb.freedesktop.org, scroll down to mesa/drm, click on "tree", then "shared core" and you will see driver files for all the different supported asics.
"Ask Phoronix members to give you a "link for dumbs" and they'll send you to GitWeb!" ;-)
10x anyway, I'm not as skilled in C but I think I will be able to read at least .h files..
btw, it's now clear for me that Mesa has both software (basically for referencing) and HW implementations.
Another point, that I got, is that Mesa acts as a "core" for opensource DRI drivers.
Do I have any progress? %)
> xf86-video-ati is the DDX driver.
DDX -- means basically 2D?
.. what then about these recent articles:
* Open-Source ATI Driver Achieves 3D Success
* Gaming With The Open-Source R500 Driver
Why they refer to Driver (not to HW branch of Mesa)?
Not a hardware implementation but the following
DDX refers to the X driver, not the mesa or kernel component
It has 2D and 2D acceleration, and initializes DRM and DRI
#1, it's simpler and shorter, do you think they'll say something like: R600 3D in users/somedev/my-reaaaaaaaaally-long-branh-name
#2, there are 2 r500/600 drivers at the moment, radeon and radeonhd, radeon has better support for 3D, and more support for more cards


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