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A heart valve prosthesis and method of implanting the prosthesis are disclosed. A valve is mounted within a support apparatus that is deformable between a first condition and a second condition. The prosthesis has a cross-sectional dimension in the second condition that is less than a cross-sectional dimension of the supported valve when in first condition. The prosthesis can be implanted into a patient's heart, such as during a direct vision procedure through a tubular implantation apparatus that maintains the prosthesis in its second condition until discharged from the tubular apparatus.
1. An implantation system, comprising:
an elongated cylindrical member having spaced apart ends, at least one of the ends providing an opening;
a body portion from which the cylindrical member extends to terminate in the opening that is spaced longitudinally apart from the body portion, the body portion having a greater outer diameter than the cylindrical member, the cylindrical member having an inner diameter in a range from about 5 mm to about 15 mm, the cylindrical member and body portion being substantially coaxial along a linear axis extending through the cylindrical member and the body portion;
a heart valve prosthesis including a generally cylindrical support having axially spaced apart ends, a valve mounted within the support at a fixed axial position between the spaced apart ends of the support, the prosthesis being deformable to a first condition in which the prosthesis has a reduced cross-sectional dimension, the support being biased to expand the prosthesis radially outwardly from the first condition to a second condition in which the prosthesis has a cross-sectional dimension that is greater than the reduced cross-sectional dimension, the prosthesis being mounted within the cylindrical member in the first condition; and
a plunger operative to traverse at least part of the cylindrical member and urge the prosthesis from the cylindrical member through the opening.
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12. An implantation system, comprising:
an implanter comprising:
an elongated cylindrical member having spaced apart ends and a lumen extending through the cylindrical member, at least one of the ends providing an opening into the lumen;
a body portion having a greater outer diameter than the cylindrical member, the cylindrical member extending from the body portion to terminate in the opening spaced longitudinally apart from the body portion, the cylindrical member and body portion being substantially coaxial along a linear axis that extends through the implanter;
a plunger operative to traverse at least part of the lumen along the linear axis; and
a heart valve prosthesis comprising:
a generally cylindrical support having axially spaced apart ends, and
a valve mounted within the support, the prosthesis being deformable to a first condition in which the prosthesis has a reduced cross-sectional dimension and being expandable from the first condition to a second condition in which the prosthesis has a cross-sectional dimension that is greater than the reduced cross-sectional dimension, the prosthesis being mounted within the cylindrical member in the first condition, such that the plunger is operative to traverse at least part of the cylindrical member and urge the prosthesis from the cylindrical member through the opening.
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This application is a continuation-in-part of U.S. patent application Ser. No. 09/659,882, which was filed on Sep. 12, 2000 now abandoned and entitled VALVULAR PROSTHESIS AND METHOD OF USING SAME, which is incorporated herein by reference.
The present invention relates to an implantable prosthetic device and, more particularly, to a heart valve prosthesis and to a method of implanting the prosthesis.
It is well known to utilize mechanical heart valves, such as the ball check valve, and natural tissue cardiac valves to replace defective aortic and mitral valves in human patients. One type of natural tissue heart valve typically employs a porcine valve for implantation in a human, as they are very similar to human valves of appropriate size and generally are easy to procure. Typically, the porcine valve is fixed by chemically treating it, such as with an appropriate glutaraldehyde solution. The treated porcine valve further may be mounted into a stent to support the valve at a fixed position.
A stent typically is formed of a resilient material, such as a plastic (e.g., DELRIN). Examples of various stent structures are disclosed in U.S. Pat. No. 3,983,581, U.S. Pat. No. 4,035,849. The stent usually is covered with a fabric material, such as DACRON or a suitable textile material. The fabric material provides structure for securing the valve relative to the stent. The stented heart valve prosthesis may be implanted into a patient for a heart valve replacement.
In order to surgically implant a heart valve into a patient, the patient typically is placed on cardiopulmonary bypass during a complicated, but common, open chest procedure. In certain situations, an individual requiring a heart valve replacement may be sufficiently ill, such that placing the individual on cardiopulmonary bypass may pose too great of risk. Such individuals may correspond to a class of patients who may have a non-functioning pulmonary valve or severe aortic valve insufficiency. In particular, many older patients having a deficient aortic or pulmonic valve may be too ill to survive conventional open-heart surgery.
Patients exhibiting these and other conditions would benefit from an improved heart valve prosthesis that may be implanted by a less invasive and/or more efficient implantation procedure.
The following presents a simplified summary of the invention in order to provide a basic understanding of some aspects of the invention. This summary is not an extensive overview of the invention. It is intended to neither identify key or critical elements of the invention nor delineate the scope of the invention. Its sole purpose is to present some concepts of the invention in a simplified form as a prelude to the more detailed description that is presented later.
One aspect of the present invention provides a heart valve prosthesis. The prosthesis includes a generally cylindrical support having a plurality of support features that extend generally axially between opposed ends of the support. For example, the support features can be formed of elongated, thin resilient wire or rods. Adjacent support features further can be connected together by biasing elements (e.g., springs) that urge interconnected support features apart from each other so as to bias the support radially outwardly. The biasing elements can be arranged in a circular array at each of the opposed ends of the support, such as to provide a cage-like cylindrical support. A valve, such as a treated natural tissue valve, is mounted within the support to define a supported valve. The supported valve can be deformed between reduced and expanded cross-sectional conditions to facilitate implantation of the prosthesis, while also providing desired functionality and coaptation of the valve when it is implanted.
Another aspect of the present invention provides a method for implanting a heart valve prosthesis. The heart valve prosthesis can be of the type described in the preceding paragraph, although other types of valves also could be implanted according to such method. The heart valve prosthesis is inserted into a generally cylindrical and elongated enclosure, such that the prosthesis has a reduced cross-sectional dimension generally corresponding to an internal dimension of the cylindrical enclosure. An opening is formed in a blood vessel and the portion of the enclosure holding the prosthesis is inserted through the opening. The cylindrical enclosure is positioned at a desired position and the prosthesis is discharged from the enclosure. As a result, the discharged heart valve prosthesis expands from the reduced cross-sectional dimension to an expanded cross-sectional dimension, such that an exterior portion of the heart valve prosthesis engages adjacent tissue to mitigate axial movement of the prosthesis relative to the adjacent tissue. The method can be performed without cardiopulmonary bypass as well as without opening the patient's heart.
To the accomplishment of the foregoing and related ends, certain illustrative aspects of the invention are described herein in connection with the following description and the annexed drawings. These aspects are indicative, however, of but a few of the various ways in which the principles of the invention may be employed and the present invention is intended to include all such aspects and their equivalents. Other advantages and novel features of the invention will become apparent from the following detailed description of the invention when considered in conjunction with the drawings, in which:
The valve portion 12 includes inflow and outflow ends 16 and 18 spaced apart from each other by a length of a generally cylindrical sidewall portion 20. While the inflow and outflow ends 16 and 18 are illustrated as being annular in
The valve portion 12 also includes one or more leaflets 22, 24, and 26 that are attached to and extend from an interior of the sidewall portion 20. In the example illustrated in
The valve portion 12 may be formed of any substantially biocompatible valve apparatus. By way of example, the valve portion 12 may include an animal heart valve (e.g., pulmonic or aortic), a manufactured valve device (e.g., a valve as shown and described in U.S. Pat. No. 4,759,758 or U.S. Pat. No. 5,935,163) a venous valve (e.g., a bovine or equine jugular venous valve). Those skilled in the art will understand and appreciate that the foregoing list is not intended to be exhaustive but, instead, is intended illustrate a few examples of the types of valves that may be utilized in a valvular prosthesis 10 in accordance with an aspect of the present invention.
If the valve portion 12 is formed of a natural tissue material, such as an animal heart valve, a venous valve, or a composite valve manufactured of natural tissue, the valve should be chemically fixed, such as in a suitable solution of glutaraldehyde in a closed condition (as is known in the art). The fixation process facilitates closure of the valve 12 under application of back flow pressure, while remaining open during normal forward blood flow through the valve 12. By way of example, the natural tissue valve may be cross-linked with glutaraldehyde and undergo a detoxification process with heparin bonding, such as according to a NO-REACT� treatment process from Shelhigh, Inc. of Millburn, N.J. The NO-REACT� treatment improves biocompatibility of the valve apparatus 12 and mitigates calcification and thrombus formation.
In accordance with an aspect of the present invention, the valve portion 12 exhibits structural memory. That is, if the valve apparatus 12 is compressed, such as to a reduced diameter at the time of being implanted, it will return substantially to its original shape and configuration upon removal of radially inward forces. As a result, the valve apparatus 12 is able to maintain coaptation of the leaflets 22, 24, and 26 even after being deformed. The memory feature of the valve is further improved by mounting it within the stent portion 14.
Turning now to the stent portion 14, such as shown in
According to an aspect of the present invention, the stent 14 may deformable between first and second conditions, in which the first condition has a reduced cross-sectional dimension relative to the second condition.
By way of example, the mesh may be formed of a shape memory alloy material, such as may be formed of a nitinol (nickel-titanium alloy) wire. Shape memory (or thermal memory) is a characteristic in which a deformed part remembers and recovers to a pre-deformed shape upon heating. By forming the stent 14 of a shape memory alloy, the stent is inelastically deformable to new shape, such as a reduced cross-sectional dimension, when in its low-temperature (martensitic) form. For example, the stented valve (
When the stent 14 is heated to its transformation temperature, which may vary according to the alloy composition, it quickly reverts to its high-temperature (austenitic) form. The stented valve may retain the compressed condition by keeping it cooled. Alternatively, the stent and valve may be retained in the compressed position, such as with sutures circumscribing the structure, a cylindrical enclosure around the structure, etc. The prosthesis 10 will then return toward its high-temperature (or original) position upon removal of the retaining element.
It is to be appreciated that, alternatively, the stent 14, in accordance with an aspect of the present invention, could be inelastically deformable so as to require an intervening force to return the deformed stent substantially to a desired configuration. For example, a balloon catheter or spring mechanism could be employed to urge the stent and the valve located therein generally radially outward so that, after being implanted to a desired position, the stent will engage the surrounding tissue in a manner to inhibit movement relative to the surrounding tissue.
Referring back to
As mentioned above, the stent portion 14 may be formed of a shape memory alloy. In this way, the valvular prosthesis 10 may be compressed to a reduced cross-sectional dimension about the axis A and maintained at the reduced dimension while being implanted. Once the valvular prosthesis 10 is at a desired implantation position, the prosthesis may be permitted to return toward its original cross-sectional dimension so as to engage a valve wall or other surrounding tissue at the desired position. The engagement between the stented valvular prosthesis 10 and the surrounding tissue inhibits axial movement of the prosthesis relative to the tissue. In accordance with an aspect of the present invention, lateral extensions or spikes (see, e.g.,
The stent portion 54 in this example is formed of a deformable mesh, which may be substantially identical to that described above with respect to
In accordance with an aspect of the present invention, each of the stent posts 84, 86, 88 may extend radially outwardly an angle T relative to the axis A. By way of example, the angle T may range from about 10 to about 60 degrees relative to a line drawn through the juncture of each post and the base 82 parallel to the central axis A. The outwardly extending posts 84, 86, and 88 facilitate engagement between each respective post and surrounding tissue when implanted, as the posts (being resilient) tend to urge radially outwardly and into engagement with such tissue.
The stent 80 also includes a plurality of spikes 90 and 92 that extend radially outwardly from the stent. In particular, some outwardly extending spikes 90 are curved generally toward an outflow end of the stent and others 92 are curved generally toward an inflow end of the stent. In addition, a row of spikes 90 may extend outwardly relative to the stent 80 at the inflow end thereof, which spikes also are curved generally toward the outflow end. The varying contour of the spikes 90 and 92 mitigates axial movement of the stent 80 (in both axial directions) relative to tissue engaged thereby, such as after being implanted. It is to be understood and appreciated that, while a single row of spikes is illustrated near the inflow end of the stent in
In accordance with an aspect of the present invention, the prosthesis 100 of
An implantation flange (or sewing ring) 132 may be formed at the inflow end of the prosthesis 100. The implantation flange 132 may be formed of substantially the same material as the outer sheath 140, such as formed from the outer sheath 130 or by attaching a separate flange by other methods. The outer sheath 130 may be attached to the valve 98 and/or to the stent 80 by applying sutures 134 and 136 at the respective inflow and outflow ends of the prosthesis 100. Some of the spikes 90, 92 may extend through the outer sheath 130 so as to mitigate axial movement of the prosthesis 100 relative to surrounding tissue when the prosthesis is implanted. Sutures 134 and 136 may be applied respectively at the inflow and outflow ends to secure the outer sheath relative to the stent 80 and the valve 100. The outer sheath 130 may include an outflow end that conforms to the contour of the outflow end 104 of the valve 100.
With reference to
The valvular prosthesis 202 is illustrated within the enclosure 208 in a compressed condition, such as described above. That is, the valvular prosthesis 202 within the enclosure 208 has a cross-sectional dimension that is less than its normal cross-sectional dimension, being maintained in such position by the enclosure. Those skilled in the art will appreciate that the orientation of the valvular prosthesis 202 will vary depending upon the direction in which blood is to flow through the valve when implanted.
By way of example, the external stent of the valvular prosthesis 202 may be formed of a deformable material, such as a shape memory alloy material (e.g., nitinol), which maintains its shape when cooled. Accordingly, the prosthesis 202 may be cooled (e.g., within a suitable fluid), compressed to a desired reduced cross-sectional dimension so as to fit within the enclosure 208, and then inserted within the enclosure. The prosthesis 202, after the stent being heated (e.g. to an ambient temperature), may desire to expand to its original dimension and configuration. However, the enclosure 208 or another retaining mechanism, such as a suture or other tubular member around the prosthesis, may be used to restrict its expansion. The compression of the valvular prosthesis 202 may be performed just prior to surgery to mitigate undesired permanent deformation of the valvular prosthesis 202. The plunger mechanism may be urged in the direction of arrow 220, such as by activating the trigger 206. Movement of the plunger 210, in turn, causes the prosthesis 202 to also be moved in the direction of the arrow 220. As the prosthesis 202 is urged through the opening 214 and discharged therefrom, the prosthesis may expand. Accordingly, the opening 214 should be positioned at the location where the prosthesis 202 is to be implanted prior to discharge. When the prosthesis 202 expands toward its original condition, the sidewall of the stent and/or spikes associated with the stent may engage and/or be urged into surrounding tissue so as to mitigate axial movement of the prosthesis relative to the surrounding tissue. As a result, the prosthesis may be implanted without sutures to provide an operable valve, such as a heart valve or a venous valve. When a valvular prosthesis is being employed as a heart valve, in accordance with present invention, it will be appreciated that the prosthesis may be implanted either as part of an open chest procedure or the patient's chest may be closed. Additionally, other expandable stent structures also could be utilized in accordance with an aspect of the present invention.
The valvular prosthesis 300 may be implanted in a compressed condition. It is to be appreciated that the valvular prosthesis 300 may be implanted in the aortic position during a conventional open chest procedure or during a closed chest procedure. The valvular prosthesis 300 may be implanted by using a catheter (or other structure) to retain the prosthesis in a compressed condition. The catheter may then be used to position the valve at a desired position, such as by utilizing a suitable imaging technology (e.g., x-ray, ultrasound, or other tomography device) or a direct line of sight. Once at the desired position, the prosthesis 300 may be discharged from its retaining mechanism (e.g., an enclosure) so that it expands toward its original expanded configuration at the desired position within the aorta 306.
It is to be understood and appreciated, though, if the patient has a calcified aortic valve, the patient typically must be put on cardiopulmonary bypass to remove the calcium and implant the valve. Advantageously, a valvular prosthesis 300 in accordance with the present invention may be implanted more efficiently so as to mitigate morbidity and mortality of the patient. In addition, the prosthesis may be implanted without sutures or, alternatively, some sutures may be utilized. For example, sutures may be applied at the inflow end 304 (e.g., at a sewing ring) and/or at the outflow end 308, such as when the prosthesis is configured to have axially extending lobes (see
As mentioned above, the prosthesis 350 is mounted within the enclosure 353 in a compressed condition prior to implantation. The enclosure 353 and the prosthesis 350, for example, may be introduced into the inferior vena cava through the patient's right femoral vein. The prosthesis 350 and enclosure 353 may traverse the vascular system to the inferior vena cava 354 with the assistance of suitable imaging equipment such as x-ray, ultrasound, or other imaging devices. The imaging equipment is utilized to navigate the enclosure 353 and the prosthesis 350 to the desired position. Once at the desired position, such as at the opening to the pulmonary artery 360, the prosthesis 350 may be discharged through a distal opening of the enclosure 353. The valvular prosthesis 350 then expands from its compressed condition to an expanded condition, as illustrated in
Advantageously, the valvular prosthesis 350 may be implanted in the patient without cardiopulmonary bypass. As a result, a significant amount of time may be saved with less stress on the patient, thereby mitigating the risks of morbidity and mortality associated with conventional open-heart surgery typically employed to implant a heart valve prosthesis. Those skilled in the art will understand and appreciate that this process also may be utilized to implant a valvular prosthesis for a venous valve, such as in a patient's lower limb.
The support 400 also includes one or more retaining elements 410 that inhibit radial expansion of the support beyond a certain desired amount. For example, the retaining element 410 can be in the form of one or more flexible cords (e.g., sutures) that limit circumferential expansion of the features 406 caused by the biasing elements 408. In the example in
The support 420 also includes retaining features 432 that limit the circumferential expansion of the support to a desired amount. The retaining feature 432 is in the form of a pair of cords (e.g., sutures) having ends connected together to form a loop that is connected at each end 424 and 426 of the support. Each loop 432 is flexible to permit the support to be deformed into a reduced cross-sectional dimension. The loops 432 also inhibit expansion at each of the ends 424 and 426 according to the dimensions of the respective loops. For example, one end 426 (e.g., the inflow end) can have a larger maximum diameter than the other end 424 (e.g., the outflow end) of the intermediate portion 422.
The support 420 further includes members 440 and 442 that extend axially and radially outwardly from the respective ends 424 and 426 of the support. In this example, each of the members 440 and 442 includes a plurality of triangular projections 444. Each projection 444 includes a pair of legs 446 that are connected to the respective ends 440 and 442. The legs 446 extend radially axially and radially outwardly from the respective ends 440 and 442 and terminate in an apex 448 spaced apart from the intermediate portion 422.
In the example in
The valve 472 includes an inflow end 474 and an outflow end 476 at axially opposed ends of the valve, with a sidewall portion 478 extending between the ends thereof. The inflow end 474 of the valve 472 is positioned near an inflow end 426 of the support 420. The sidewall portion 478 can be a tubular valve wall. A plurality of leaflets 480 extend radially inward from the valve wall 478 and coapt along their side edges to provide for substantially unidirectional flow of blood through the valve 472. The outflow end 476 of the valve 472, which is located near the outflow end 424, has a generally sinusoidal contour. The peaks are aligned with commissures between adjacent leaflets 480, with sinuses located between the commissures. The valve 472 can be connected within the support 420 via sutures 124 or other connecting means.
By way of illustration, when the prosthesis is to be implanted at the pulmonary position, the valve 472 can be a treated porcine pulmonic valve. When it is to be implanted at an aortic position, the valve 472 can be a porcine aortic valve. For example, the valve can be of the type shown and described in U.S. Pat. Nos. 5,935,163, 5861,028 or 5,855,602. It is to be understood and appreciated that other valve configurations of could be used in accordance with an aspect of the present invention. For example, one or more leaflets of the valve 472 could be mounted within a length of tubular valve wall or other generally cylindrical biocompatible material and operate in a known manner to provide for the unidirectional flow of fluid through the valve from the inflow to outflow ends.
In accordance with an aspect of the present invention, the prosthesis 470 also includes an outer sheath 482 of a substantially biocompatible material. The outer sheath 474 covers at least a substantial amount of exposed portions of the support 420 (including the ends 424 and 426) so as to mitigate contact between the blood and the support when the prosthesis is implanted. In the example of
The support 500 includes a plurality of generally axially extending features 512 (e.g., resilient rods or wires) that are biased to urge adjacent interconnected features circumferentially apart from each other. Because a plurality of such features are interconnected in a cylindrical arrangement, the biasing of the features apart from each other results in radially outward expansion of the cylindrical support 500 according to the dimensions of the retaining cords 506, 508, and 510. In one aspect, biasing elements 514, which can be springs, connect each adjacent pairs of features 512 together at each end of each respective support portion 502 and 504. Each of the cords 506, 508, 510 further interconnect a respective set of biasing elements at a corresponding axial location, with the cord 506 interconnecting biasing elements of both support portions at the intermediate axial location. While substantially identical biasing elements 514 are illustrating throughout the support 500, it is to be understood and appreciated that different types of biasing elements could be used at different locations of the support. Additionally, a separate length of a flexible cord can be used to interconnect adjacent support features, instead of the single loop inserted through an aperture of the respective biasing elements shown and described herein.
In view of the arrangement described above, it is to be appreciated that a length of the cord 506, 508 or 510 that extends between adjacent biasing elements 514 of each support portion 502, 504 and the pair of interconnected adjacent features 512 define a generally triangular structure. A plurality of such triangular structures are interconnected in a circumferential arrangement to define the generally cylindrical sidewalls of the respective support portions 502 and 504. The features 512 of each such triangular structure are urged apart from each other by the interconnecting biasing element 514. The juncture of the support portions 502 and 504 are connected by the connecting element 506 so as to provide radial expansion combined from both of the support portions. As a result, about twice the amount of radial expansive force is provided along the length of the cord 506.
The resulting support 500 thus provides a cage-like structure in which a valve can be mounted in accordance with an aspect of the present invention. The support 500 can be deformed to a reduced cross-sectional dimension, such as by applying a radially inward force to the sidewall portion thereof. Upon removal of the radially inward force, the support will expand to its expanded cross-sectional configuration due to the radial expansion provided by the arrangement of biasing elements 514 and interconnected axially extending features 512.
In accordance with an aspect of the present invention,
The valve 542 illustrated in
By way of illustration, when the prosthesis 540 is to be implanted at the pulmonary position, the valve 542 could be a treated porcine pulmonic valve and a porcine aortic valve when it is to be implanted at an aortic position. For example, the valve can be of the type shown and described in U.S. Pat. Nos. 5,935,163, 5861,028 or 5,855,602. Of course, other types and valve configurations also could be used in combination with the support 500 to form the prosthesis 540 in accordance with an aspect of the present invention.
The prosthesis 540 further includes an outer sheath 550 of a flexible biocompatible material, such as treated and detoxified animal pericardium, as described herein. The outer sheath 550 covers at least some of the exposed support 500, such as the interior of the prosthesis and the ends 552 and 554. The outer sheath 550 can be formed of one or more sheets of the biocompatible material, which are attached to the prosthesis 540 to reduce exposure of the support to blood when implanted in its expanded condition. The outer sheath 550 is sufficiently flexible and resilient so as to facilitate deforming the prosthesis 540 to a reduced cross-sectional dimension and its subsequent expansion to its expanded cross-sectional dimension, as shown in
The sidewall portion of the valve 542 is attached (e.g., by sutures) to the support 500, such as to features and/or biasing elements, so that when the support expands, the valve also expands to its desired expanded configuration. Also, because the valve 542 has been fixed (e.g., in a suitable glutaraldehyde solution) to a desired shape and configuration, the valve maintains its desired shape and coaptation between leaflets when the prosthesis 540 is in its expanded condition.
Prior to implanting the 540, such as by a direct implantation procedure through a blood vessel that provides a generally linear path to the desired implantation site, one or more sutures 554 can be attached to the proximal end 552 of the prosthesis. For example, the suture 554 is applied through loops that form generally diametrically opposed biasing elements 514 at the proximal end 552. The sutures 554 can be used to adjust the relative position of the prosthesis 540 after positioned in the heart in its expanded condition. Additionally or alternatively, the prosthesis 540 could be adjusted to a desired position manually by a surgeon by applying external force to the prosthesis through the heart. Advantageously, the prosthesis 540 can be directly implanted without cardiopulmonary bypass, such as in the pulmonary position or with minimal bypass to the aortic position in accordance with an aspect of the present invention.
Each of the cylindrical portions 572 and 574 includes a plurality of generally axially extending support features 578, such as thin rods, bands, or wire of a substantially resilient material. The features 578, for example, are arranged as a plurality of interconnected triangles in which the features define elongated legs that extend between the intermediate connecting element 576 and additional connecting elements 580 and 582 located at the opposite ends 584 and 586 of the associated cylindrical portions 572 and 574. The connecting element 582 at the inflow end of the valve also can have a greater diameter than the connecting element 580 at the outflow end. The features 578 in each cylindrical portion 572 and 574 are connected by biasing elements 588 that urge each adjacent pair of interconnected features circumferentially apart from each other. Because the features 578 are connected in a circumferential array, the collective forces of the biasing elements result in radially outward expansion of the prosthesis 570 up to a maximum dimension defined by the respective connecting elements 576, 580 and 582.
The prosthesis 570 further includes a heart valve 590 mounted within the support. The valve 590 has an inflow end 592 and an outflow end 594, which are positioned on axially opposed sides of the intermediate cord 576. In particular, the intermediate connecting element 576 and associated biasing elements 588 substantially circumscribe an annular base portion near the inflow end 592 of the valve 590. Because the valve 590 is attached (e.g., by sutures) to the support formed of the cylindrical portions 572 and 574, the radial outward forces provided by the support help maintain the base of valve in a desired annular shape when the prosthesis 570 is in its expanded condition shown in
By way of example, when the prosthesis 570 is to be implanted at the pulmonary position, the valve 590 could be a treated porcine pulmonic valve. A porcine aortic valve can be used for the aortic position. Those skilled in the art will understand and appreciate other types and valve configurations also could be used in the prosthesis 570 in accordance with an aspect of the present invention.
The prosthesis 570 further includes an arrangement of members 598 and 600 that extend axially and radially outwardly from the respective ends 584 and 586 of the prosthesis 570. The members 598 and 600 are operative to help secure the prosthesis 570 to surrounding tissue when it is implanted. The members 598 and 600 include a plurality of triangular projections 602 that extend axially and radially outwardly from the ends. While six substantially symmetrical projections are shown at each end, those skilled in the art will understand and appreciate that any number could be used (e.g., 4, 6, 9, 12, 18, etc.).
Each triangular projection 602 includes a pair of legs 604 that are connected together by an interconnecting biasing element 606. The biasing elements form apices of the triangular projection 602 spaced from the respective ends 584, 586. Adjacent triangular projections 602 also are coupled together and to respective ends 584 and 586 by additional biasing elements 608 located at the ends of the prosthesis 570. The biasing elements 588, 606, and 608 bias the support portion of the prosthesis 570 and valve 590 attached thereto in a radially outward direction toward its fully expanded condition. Additionally, the triangular projections 602 can further engage surrounding tissue when the prosthesis is implanted to help hold the prosthesis at a desired position relative to the surrounding tissue.
The prosthesis 570 also can include an outer sheath 610 of biocompatible material (e.g., animal pericardium) that covers most (or all) of the support structure that would be exposed to blood when implanted. The covering further could be an expansion of the valve wall the contains the leaflets of the heart valve 590. In this example, the outer sheath 610 covers the support between the ends 584 and 586 of the cylindrical portions 572 and 574 and the support features 578 in the interior of the prosthesis 570. The triangular projections 602 are left uncovered, which may facilitate their insertion and integration into surrounding tissue. It is to be understood and appreciated, however, that the projections 602 also could be covered with biocompatible material, similar to the example of
The prosthesis 570 is well suited for direct implantation without cardiopulmonary bypass, such as in the pulmonary position, or direct implantation with minimal bypass to the aortic position in accordance with an aspect of the present invention. Direct implantation with the prosthesis also can be sutureless, although one or more sutures can be applied to further fix the prosthesis at a desired position.
In view of the various arrangements of heart valve prostheses described herein, a simplified and efficient method of using such prosthesis is described below with respect to
For example, the inner diameter of the barrel 704 can range from about 5 mm to about 15 mm, whereas the outer diameter of the heart valve prosthesis 702 (in its expanded condition) typically ranges from about 15 mm to about 35 mm. Thus, the barrel can accommodate a prosthesis 702, which has been deformed to reduced cross-sectional dimension, without compromising the durability and operation of the valve. The exterior of the barrel further can include indicia (e.g., ruler markings) 710 that can help indicate the distance the barrel is inserted into a patient.
The implanter 700 also includes a handle 712 that extends outwardly from a proximal end 714 of the body portion 706. The handle 712, which may be gripped by a surgeon, facilitates manipulating the barrel 704 along a desired path. A plunger 716 has a distal end 718 that can be urged into engagement with the prosthesis 702 to push the prosthesis from the opening 708 of the barrel 704. The plunger 716 includes an elongated portion that extends from its distal end 718 and terminates in a proximal end portion 718. The proximal end portion 718 operates as a trigger that can be grasped by a surgeon to move the plunger through the barrel 704. Other means to discharge the heart valve also could be utilized in accordance with an aspect of the present invention. Fluid, such as saline, also can be introduced into the barrel 704, such as through an opening (not shown) in the plunger 716, to facilitate the discharge of the prosthesis 702 from the barrel.
In the examples of
For example, the implanter 700 could be introduced into a blood vessel (e.g., the pulmonary artery) that provides a substantially direct and linear path to the desired implantation position. Further, the procedure can be implemented without cardiopulmonary bypass, such as when the prosthesis is implanted through the pulmonary artery. Alternatively, cardiopulmonary bypass can be used, but for a generally short period of time, such as when the prosthesis is implanted at the aortic position. Bypass generally is required when implanting at the aortic position due to the relatively high blood pressure as well as to facilitate decalcification of the patient's existing heart valve, as needed.
The implanter 700 further can include an aperture 724 (or interconnected apertures) that extend longitudinally through the plunger 716 and the end 718. The aperture 724 provides a passage through which one or more sutures 726 connected to a proximal end 728 of the prosthesis 702 can extend. For example, prior to loading the prosthesis 702 into the barrel 704, the suture 726 can be applied to the end 728 of the prosthesis, such as through generally diametrically opposed biasing elements (e.g., coil springs) at the respective end. Part of the suture 726 extends between the opposed sides of the prosthesis 702. The remaining lengths of the suture 726, which extends from one or both sides of the prosthesis, can be fed through the barrel and aperture 724 to a location external to the implanter 700, such as shown in
The surgeon can then insert the barrel 734 through the opening in the vessel wall 732. Two lengths 738 of the purse string 730 suture extend from the vessel 732 through an elongated cylindrical guide 740 of a generally rigid material, such as rubber, plastic, or metal material. One end 742 of the cylinder 740 engages the vessel wall 732 and/or the barrel 734, and the two lengths 738 of suture extend through the other end 744. By fixing the length of suture relative to the cylinder 740, such as by clamping the sutures to the cylinder by a clamp 745, the vessel wall surrounding the barrel 734 can be kept relatively tight around the barrel so as to mitigate blood loss through the incision. As a result, cardiopulmonary bypass is not required. However, it is to be understood that in certain situations, such as when implanting the prosthesis at the aortic position, some bypass may be necessary, although usually for a much shorter period of time than with conventional procedures.
After the distal end 746 of the barrel 734 has been inserted a desired length into the vessel 732, such as indicated by indicia printed on the barrel, the heart valve prosthesis 748 located in the barrel can be discharged. For example, a plunger 750 positioned for axial movement relative to the barrel 734 can be moved toward the distal end 746 of the barrel and into engagement with the prosthesis 748. The heart valve prosthesis 748 is configured to expand toward its fully expanded condition when it is discharged from the barrel 734 because radial inward forces that maintain the prosthesis at a reduced cross-sectional dimension are removed. In particular, the prosthesis 748 includes a self-expanding support 752 in which an associated heart valve 754 is mounted. In the example of
One or more sutures 762 can be attached to a proximal end 764 of the prosthesis 748 so as to pass through an aperture 766 that extends through at least a substantial portion of the implanter 736. For example, the suture 762 can be applied through the centers of generally opposed circular biasing elements located at the proximal end 764. After the prosthesis 748 is discharged into the patient's heart, a surgeon can grasp the sutures to adjust the position of the prosthesis, such as by urging both ends of the suture in the direction 768, shown in
In view of the foregoing example, those skilled in the art will understand and appreciated that the prosthesis 748 can be implanted without opening the heart and without cardiopulmonary bypass. When the patient's existing valve needs to be removed and or calcium deposits cleaned, such cleaning can be performed through the pulmonary artery or other connecting vessels prior to implanting the prosthesis 748, such as through a trocar and/or by endoscopic means.
What has been described above includes examples of the present invention. It is, of course, not possible to describe every conceivable combination of components or methodologies for purposes of describing the present invention, but one of ordinary skill in the art will recognize that many further combinations and permutations of the present invention are possible. Accordingly, the present invention is intended to embrace all such alterations, modifications and variations that fall within the spirit and scope of the appended claims. Furthermore, to the extent that the term "includes" and variants thereof or the term "having" and variants thereof are used in either the detailed description or the claims, each such term is intended to be inclusive in a manner similar to the term "comprising."
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United to partner with Bohemians; friendly slated for June 5
D.C. United announced a development partnership with the Baltimore Bohemians of the United Soccer Leagues' Premier Development League. A friendly between United's under-23 squad and the Bohemians has been scheduled for June 5 at Bel Air's Cedar Lane Park, the Bohemians' home field. As part of the agreement, the Bohemians will provide United with prospective players who might have the potential to play in Major League Soccer.

subset: commoncrawl


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Henry the kitten blinked a little while curled up in a pink blanket in the recovery room Tuesday morning at the Edmonton Humane Society. The society's "warrior cat" was sleepy after having his leg amputated. "It went really well," society volunteer co-ordinator Kolbi Kukurba said that afternoon. "He's just waking up."
My wife was hoping for Brad Pitt to be on the bed when we opened the door to our room at the just-opened Palladian Hotel.
When I tell people that we counted 27 cowboy hats during 10 days in Texas, the usual response is, "Is that all?"
The idea of following one's dream pervades California culture.
Even if we don't particularly look like models, we feel like models.


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Eliminate Discrimination from BC Hydro and Lower Corporate Costs
The British Columbia Hydro is causing great and undue hardships for people from every single income level, and its
The British Columbia Hydro is causing great and undue hardships for people from every single income level, and its
POUR LA LIBERTÉ DES FEMMES Sahraouis dans les territoires occupés du Sahara Occidental. Les pratiques actuelles de
"Many people somewhere are watching the most terrifying moments of my life and taking grotesque pleasure in them," said
Build a advanced Culture of Compassion and Empathy for Humans,Nonhumans,Earth and
Please express support and sympathy for the families who lost loved ones in the Sandy Hook shooting, and those injured.
Wisconsin DNR Proposes Allowing Packs of Dogs to "Train" On Wolves During March Denning and Birthing Season. THIS
Cowichan people live in over-crowded conditions, some homes have four generations living under one roof. Allow our
Force Facebook to remove the page, Wolf Butchering, cooking, and recipes, and all its variations. These pages are
Its important to remove hatred and propaganda in a Democratic State that brags and defines the country as being
For over six decades Tibetans have suffered such atrocities and worse as a result of China's illegal occupation of
Indigenous Lands, Waters, and Resources. No more abuse by Harper! Get your companies, corporations, and Provincial State
The killing of Yellowstone's monitored wolves is the last straw in the wave of wolf slaughtering going on in America.
WHY SHOULD YOU SIGN...well watch and then see
This page advocates the slaughter, and consumption of a religious icon.
I hope that people will stand with me to fight against this change!! We need to protect our Navigable Waters, our once
Stop Bullying: Canada, let's be the change to inspire the world, is a group where we come together to provide resources,
South Africa has the highest rape statistics in the world. Every 46 seconds a woman in South Africa is raped. Another
Why You Eat Should Organic Whenever Possible
Many of the cosmetics, personal-care products, and household products that we use every day are tested on animals.
Bear baiting (also called bear baying) pits a declawed and defanged bear which is chained to a stake against hunting
ITS FALLING APART SLOWLY, ESPECIALLY MEDICAL, LETS ALL TAKE A STAND NOW! We need to stand as one nation, First Nations


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Celebrity Central / Top 25 Celebs
Jenny McCarthy
Jenny McCarthy: One Last Thing
The TV personality, 40, hosts a new VH1 late-night talk show, The Jenny McCarthy Show
Jenny McCarthy Gets a New Tattoo During Super Bowl Blackout
Wearing high heels the day after proves painful, the new VH1 star says
Jenny McCarthy's Super Bowl Plans: 'Have Fun' with Boys
The single starlet tells PEOPLE she wants to enjoy the time with "someone who isn't a slime ball"
Jenny McCarthy Ready for a Crazy New Year's Eve with Ryan Seacrest
"I've got the drunk guy with no shirt on next to a 10-year-old from Nebraska," she says of the gig
Jenny McCarthy Is a 'Cougar,' But Feels Like a Teenager
The former Playboy cover girl turns 40 Thursday, but tells PEOPLE, "I don't feel that old"
5 Things You Missed This Weekend: Taylor Swift's in Love, Prince William Saves a Life, Jenny McCarthy Hits Sin City & More!
Jenny McCarthy Hits Vegas Post-Breakup
"I'm good," the model and actress tells PEOPLE after splitting with Brian Urlacher earlier in the week
Jenny McCarthy & Brian Urlacher Split Up
"Brian and I have decided to turn our romance into an amazing friendship," she says
Lollapalooza Lures Jenny McCarthy, Joe Manganiello & More to the Windy City
Jenny McCarthy Sizzles with Old-Style Hollywood Glamour in Playboy
Get a sneak peek of a (strategically cropped) picture from the TV personality's nude spread
Kendra Wilkinson Approves of Jenny McCarthy's Playboy Cover
Jenny McCarthy Is Comfortable Posing Nude as a Mom
The star and her son "will have that conversation someday" about her Playboy images
Jenny McCarthy's Sexy-at-39 Playboy Cover: Sneak Peek
The Love in the Wild host tells PEOPLE she didn't diet for her nude shots, but did "tone up"
Jenny McCarthy Enjoys a Colada Cocktail Poolside: See Photo & Get the Recipe!
Get the recipe for a Colada Cocktail in time for summer solstice


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actually metal is non of the chinese elements, but part of the earth element *G* just trolling... err... saying
i suggest any interested in this game to read the book first to get a grasp on the idea!
Even if you aren't interested in this game, read the books. They're incredible.
None of them seemed to know what the game was about lol.
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The shape is classic and it's oh-so-cozy, what's not to love about this lounger? This recliner is upholstered in brown faux leather and features a pop-up footrest for kicking back.
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|4 posts found
Warning RE donating money to Fallen Sword
General Discussion « Fallen Sword
Originally posted by BigglesVII
It's still worse than ever. They have admitted the game is slow because the code they use is poor, and say they are trying to fix it, but the new interface they tested was even slower than the old one. New servers do not help if the delay is because the code is aweful.
Truth about FS
General Discussion « Fallen Sword
Originally posted by OmHideoshi
Hunted Cow announced it in the Sigma Storm forums.
Sigmastorm, Fallenswords other game
General Discussion « Fallen Sword
SigmaStorm has been officially dropped by Hunted Cow.
FallenSword is in a decline and has fewer players every day.
Hunted Cow Studios just does not seem to know how to keep people playing their games long-term, and the game design makes it impossible for any but the spendiest new players to compete against the few long-term players that stick arund, many of whom seem to do so just so they can kick the snot out of newbies. Plus many established players cheat a lot, using scripts and illegal multiple accounts.
They are not really free games, you need to pay to enjoy them because you start out with a character so lame that you spend all your time banging your head against the tiny stamina and backpack space you start with. Think hard before you throw yourself in as fresh meat for the grinder. Read the complaints int he FS forums that have not been deleted by Hunted Cow, and then imagine what the complaintrs that they did delete were like!
Truth about FS
General Discussion « Fallen Sword
Fallen Sword is dieing. Every day, there are fewer and fewer players online. Many players with years spent playing the game are quitting, and among the few hundred people who are "online," many just have their browsers set to reload the page when they are not there (for a variety of reasons, like buffing people automatically) or are illegal "multi" accounts. HC never deletes inactive players or dead guilds, so the numbers they give are wildly inflated. They may do that to please their investors or advertisors.
The game is tedious and full of sadists who enjoy driving other people out of the game. The forums are dominated by these sadists and bullies, and the staff at Hunted Cow seem to favor them over all others. For a new player this is especially bad, because new players have no chance at all against the established players. Hunted Cow implemented a two-week Pvp-free time for new players because newbies were being gang-assaulted by organized PvP mobs and were quitting almost immediately. Now they just quit after the two-week period of deception is over. Customer support is run by some young woman with no clue who is easily manipulated into banning people from the game by the organized gangs that think they rule the game. She is the most widely disliked person in the game, but she runs customer support - what does that tell you?
The interface is poorly designed and as a result if you play via smartphone or other pay-per-bit service you will pay a fortune. And you will never be a competitive player without high-speed internet, even though it is just a lame grid-based browser game with no animations except a few animated GIFs. It is a text-based game in a graphic interface, completely outdated. Hunted Cow released a anew interface but it is just new artwork over the same obsolete structure, and where they did try to improve the underlying code they introduced a lot of bugs.
Hunted Cows recently announced that their other "big" game, SigmaStorm2, was no longer supported. Fallen Sword is headed down the same road. Read the Fallen Sword forums, much of this can be seen there if you read between the lines and figure out what was in the posts that are missing (you can see them in other people's posts as quotes some times and there are a LOT of missing posts!)
Invest your time and money elsewhere.


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A Jewish Chicago police officer was awarded a $540,000 judgment against a former superior who allegedly taunted him for years with anti-Semitic and racist remarks.
On Monday, a federal jury found in favor of Detlef Sommerfield, a German-Jewish immigrant who had accused retired Chicago Police Sgt. Lawrence Knasiak of calling him a "f*cking Jew boy," waving a swastika at him, and engaging in other harassing behavior while Knasiak was Sommerfield's superior between 2000 and 2007, according to a report by the Chicago Sun-Times.
A spokesman for Chicago's legal department told the Sun-Times that the city had been dismissed from the suit in 2009. That would leave Knasiak solely responsible for the judgment.
Previously, in 2012, a separate federal jury had awarded Sommerfield $30,000 in a discrimination case against the city of Chicago over the same incidents. According to a report by the Chicago Tribune, Sommerfield first complained about the harassment in 2004, but the Chicago Police Department did not investigate his claim until 2007. Sommerfield filed his lawsuits against Knasiak and the city in 2008, according to the Sun-Times.
Sommerfield was born in Germany in 1961, according to the Tribune, and one of his aunts was killed during the Holocaust.
Sommerfield's lawyer, Joseph Longo, told the Sun-Times that Knasiak "was able to yell these remarks out in roll call with other sergeants and lieutenants and captains standing next to him." He added, "Not just once or twice, but regularly, and nobody tells him to stop. I don't understand that. It's baffling."
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text: https://www.alexandria.unisg.ch University of St.Gallen en new publications - Melaniekatharina Oschlies Alexandria::new publications Balanced Growth Binswanger, H. C., Sunde, U., Vischer, T., Kienzler, D., Kreutzer, M., Oschlies, M., Nazarkina, L., Rüdisser, M. F., Dwertmann, D. J. G., Kunz, J. J., Roy, F. ., Komba, X. K., Meissner, F., Pieper, C., Rubel, H., & Schädler, J., Mennillo, G. (Ed.), Schlenzig, T. (Ed.), & Friedrich, E. (Ed.) (2012). Balanced Growth: finding strategies for sustainable development. Berlin: Springer, DOI:10.1007/978-3-642-24653-1. - ISBN 978-3-642-24652-4. --- What is balanced growth? This book shows that the definitions and implications of the concept of balanced growth vary significantly among the different disciplines in economic science, but are not exclusive at all. Terms such as sustainability or balanced growth have become buzzwords. In practice, they are often a desirable vision rather than an achievable objective. Why? Doubts may arise about ... https://www.alexandria.unisg.ch/publications/207934 2011-12-16 Value of Business Model Adaptivity for Growth and Performance of Firms in Emerging Industries Oschlies, M., & Loock, M. (2011). Value of Business Model Adaptivity for Growth and Performance of Firms in Emerging Industries. In Strategies for a Multi-Polar World. Chicago: SMS Strategic Management Society. --- It is often stated that a business model should be characterized by a high internal fit of its components and that a stronger fit results in higher firm performance and growth. However, for emerging industries, like the renewable energy industry, we also find arguments that point to negative aspects of too much internal fit. Thus, we argue for business model adaptivity which we assume to benefit ... https://www.alexandria.unisg.ch/publications/99661 2011-04-18


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Getty Images photo by Karen Bleier
March 31, 2009
Pistachio nuts are displayed on Tuesday in Washington, D.C. U.S. federal food safety officials said a California plant was recalling at least one million pounds of pistachio products following fears of salmonella contamination. The announcement came in the wake of a devastating salmonella outbreak linked to peanut products that has left nine people dead and nearly 700 sick since late last year.The Food and Drug Administration (FDA) cautioned consumers to avoid eating pistachios until it had determined the full scope of the contamination and said it was conducting genetic testing of pistachio samples. The food safety agency said it was investigating pistachio products sold by Setton Pistachio of Terra Bella Inc, California, the second-largest pistachio processor in the United States.
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01:01 05-07-2015
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This meal is quick, easy and excellent for entertaining.
YIELD: 4 servings
Ingredients1 cup plain yogurt
1 package cream cheese
1 jar marinated artichoke hearts, undrained
1 pound shrimp
1 tablespoon chopped fresh chives or 1 teaspoon dried.
1 tub fresh mushrooms, sliced.
1/2 teaspoon garlic salt
1 teaspoon finely shredded lemon peel.
PreparationCook pasta as directed but add juice of one lemon to water.
1. Mix yogurt, cream cheese, lemon zest, salt, mushrooms, shrimp, artichoke hearts and chives in large saucepan.
2. Cook over low heat until cream cheese has melted and mixture is hot.
3. Toss with pasta and sprinkle more chives on top.
4. Serve immediately.


text:
Vans Authentic Lo Pro Carmine Rose Red HB Print Shoes
Item # 219540
Buy1 Get1 Free
Stash Points: 2,997
What is this?This is the number of points you get in The Zumiez Stash for purchasing this item. Stash points are redeemable for exclusive rewards only available to Zumiez Stash members. To redeem your points check out the rewards catalog on thestash.zumiez.com.
Add some texture and timeless style to your look in the Vans Authentic Lo Pro HB Print girls shoe.
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You would do well to remember today that even an Aquarius has limits. It may feel as if you can take on the world and win, and maybe you can, but there is sure to be a downside, especially if you come on strong when you don't have to.
or email firstname.lastname@example.com
March 3, 2014 | 12:01am
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black suede jewel covered t strap sandals
designer's notes
Standout designs are what Giuseppe Zanotti does best. So why not add a little extra style to your step with these bombastic sandals?
color: Black Sued upper with allover jewel studding Rounded open toe Jewel studded t-strap and anklestrap Leather loop at toe Back zip closure with suede pulltab Leather lining Leather sole Suede; Italy; style# 333319801


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★HUDSON SATURDAYS★ Print Ticket & Bring With You or Show from phone. DRESS CODE ENFORCED (2506 Robinhood) FOR TABLES, CABANA or INFO: 713.259.5725
- Music
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Essential Oils 101 & Diaper Bag Makeover WORKSHOP!
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Contact Us
The First Year Inquiry Program offers General Education courses featuring
active learning opportunities exclusively to first-year students. Why take a mega-class when you can be one of 19 students in a special seminar?
FYI students show
measurable academic improvement after taking
a single FYI course. What are you waiting for?
FYI Fall 2015 Courses [PDF]...
Please plan your schedule using the information above. You will not actually be able to register for FYI courses until your orientation session. We do this so that students with early registration privileges do not have unfair access to FYI classes. Also note restrictions in the lefthand column. Some sections are limited to certain student populations.
Hear what an NC State first-year student has to say about working on critical & creative thinking [1 min. video]
FYI Advantages for Students
FYI offers many advantages to faculty and departments as well. See Faculty Info or contact program director Rich Slatta for details.
Core Teaching Principles & Best Practices
Your first year is the time to begin developing skills to apply for and obtain fellowships. Start with the Fellowship Advising Office Website. It's also a good time to begin planning to study abroad. Check the Gilman Scholarship Website.
Gilman Scholarships provide funding for students receiving a Pell Grant
to study abroad for the semester, summer or academic year. For a summer
program, the deadline is usually the first week of March. Programs must
be at least 4 weeks in length to qualify. Average award for the summer
is $3000. Maximum award is $5000. Tiffany L. Kershner, Ph.D., at the
Fellowship Advising Office, can assist you with these and other
fellowship opportunities.


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June 15, 2015
Great wellies with a wide fitting for bigger calves.
May 12, 2014
Good product. bought on sale so was great value. would not pay full price for this product though as the quality is not great.
November 07, 2013
These wellies are fantastic if you want extra room around the calf area, but they are also wider round the foot and therefore would suggest you purchase a size smaller than you normally take.
lovely bright design which will keep you smiling even on the dullest of days
November 03, 2013
Great wellingtons, my son loves the design & says that they are the most comfortable wellies he's had.
October 24, 2013
Great boot
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Originally written on NFL Trade Rumors | Last updated 1/26/13
NEW ORLEANS, LA - OCTOBER 31: Defensive coordinator Gregg Williams of the New Orleans Saints looks on prior to the game against the Pittsburgh Steelers at the Louisiana Superdome on October 31, 2010 in New Orleans, Louisiana. (Photo by Matthew Sharpe/Getty Images)
ESPN's Adam Schefter reports that former Saints defensive coordinator Gregg Williams is on the "verge" of becoming the assistant head coach of the Tennessee Titans pending Williams' reinstatement to the league from his Bountygate suspension. Filed to ESPN: Suspended former Saints DC Gregg Williams already has met with Titans and is on verge of becoming Tennessee's assistant HC. — Adam Schefter (@AdamSchefter) January 26, 2013 CBS's Jason LaCanfora writes that Williams, and the NFL commissioner Roger Goodell are expected to meet sometime next week to discuss Williams's reinstatement. The Rams recently fired Williams, who was hired prior the 2012 season, after missing all of the season because of the Bountygate suspension. Williams is very familiar in the Titans organization, as he worked for them from 1997 to 2000 as their defensive coordinator. The post Report: Titans Close To Hire Gregg Williams As Their Assistant Head Coach appeared first on NFL Trade Rumors -.
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With the Cork Board, for use with the Crates storage system, you can pin up notes, photos, or Justin Bieber posters to your heart's content. Or position it on top of your Crate and use it as a grippy-textured tabletop.
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This car is an absolutely beauty! This car features a beautiful white exterior with a well kept black leather interior. This 4Matic model is... More
1992 Mercedes Benz 400E 400 E 198,664 MILES PREMIUM PACKAGE / 4 Speed Automaticl/ Leather SEATS /No ACCIDENT CAR / GREAT RUBBER / 6... More
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REDUCEDSuper clean never damaged easy to ride has cool tinted windshield and available saddlebags, excellent tires/paint/stripes and chrome.loaned it to a Bro in Laws girlfriend... More


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When it comes to eating sustainably and inexpensively, you can have your cake and eat it too. Costco, the bulk-buying mecca, announced this week its Kirkland brand of ...On September 4, 2014 / By Cassady Sharp
This amazing planet of ours has so many special places of great natural beauty, especially those enmeshed within a web of ecological relationships. I have been privileged to ...On April 23, 2013 / By Eduardo Sousa
Greenpeace is an independent organization that does not take money from corporations or government. We rely on individual donations from people just like you.Donate


text: Publications Search Results Users may wish to consult What's Included in the Bibliography. Results 1 - 1 Results per page: 25 50 100 Sort by: Pub Date (newest) Title Recent Additions Author Clear All Pub. Year Citation 1993 Cattan, Peter . The diversity of Hispanics in the U.S. work force. Monthly Labor Review. 116, (8), 3-15. Full Text Options: PDF Worldcat Google Scholar Export Options: RIS EndNote XML [1]


text:
Need to know: CV cliches Why you can`t find a jobHF interviews
China's Sichuan Hanlong Group is facing more than just a blow to its pride after an offer worth 1.18 billion Australian dollars (US$1.23 billion) to acquire full control of Africa-focused iron ore miner Sundance Resources collapsed.
It's also staring at hefty paper losses on its 14.2% stake in Sundance.
Hanlong paid 44 cents for each of the 443.79 million Sundance shares it acquired from the trustees of the Talbot Group in March 2011, valuing the total transaction at A$190.9 million. Investments made by the Talbot Group were being liquidated after founder Ken Talbot died along with much of the Sundance board in a plane crash when visiting its West African operations in June 2010.
Skeptics unconvinced China's Hanlong Mining will complete its 1.38 billion Australian dollar (US$1.4 billion) acquisition of West Africa-focused Sundance Resources Ltd. may soon have a reason to change their mind.
Hanlong needs to make the first of three A$5 million payments tied to a convertible note facility by the end of this week. A person close to the transaction told Deal Journal Australia the fund transfer could be made as early as Tuesday.
If Hanlong fails to deposit the cash into an Australian trust account on time, Sundance has the right to terminate its right to acquire the company, the Perth-based miner said Feb. 8.
The board of Sundance Resources is likely to recommend a 12% lower offer from China's Hanlong Mining, which would value the Africa-based miner at around 1.5 billion Australian dollars (US$1.57 billion), a person familiar with the matter said Wednesday.
The new bid will be at A$0.50 a share, the person said, adding that the lower price to be offered reflected a change in market conditions.
It's a sweetened takeover bid that could turn sour in the eyes of some Australian hedge fund managers.
In October, China's Hanlong Mining increased its offer for iron ore developer Sundance Resources to 57 Australian cents a share from an initial offer 50 cents a share.
But emerging from a trading halt Friday, the stock is sitting rather unhappily at 39.5 cents a share, valuing the company at 1.1 billion Australian dollars (US$1.08 billion), a 44% discount to Hanlong's bid.
The sell-off is due to Friday's announcement that Hanlong has not received a "Highly Confident Letter" of guarantee from China Development Bank due today. Although the Sundance board decided to waive it as a requirement for Phase One of the Scheme Implementation Agreement, the market sees it more as waving a red flag.
Looking at the deteriorating iron ore price, some fund managers believe Sundance appears desperate to get the deal through while Hanlong could have been seeking a way out.
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The ABCs of Battling Bioterrorism
Why scientists are busily developing new vaccines-and why they are years away from stockpiling what we may need.
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I know it is early but a 12-19 record isn't what Reds fans or owners envisioned for what was supposed to be a promising season with a season veteran manager onboard.
And what we have seen so far is what we have seen the past two years. Only difference is an improved starting rotation with the young arms and a much improved bullpen. But the offense still can't manufacture runs and Dunn's inablility to hit with runners in scoring position is enough to drive even mild manner Reds fans nuts.
Things won't change unless there is new blood. Time to bring up Bruce and Bailey. Time to send Junior packing back to Seattle where he can wrap up a Hall of Fame career. Get a couple of prospects and move on. Keep Dunn till the midseason trading deadline. Then get the best deal you can and put the money saved towards a free agent or two for the 2009 season.
While it might seem like I'm throwing in the towel, the reality is what you're seeing now is what you have been watching the past two years. And no matter how many GMs and managers you fire, the product on the field won't improved until you make changes.
Hopefully the Reds can change their fortunes but if they keep the same motley crew, expect another brutal season.


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Just the job for walking the dogs
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During cell division, whether hematopoietic stem cells (HSCs) will develop into new stem cells (self-renewal) or differentiate into other blood cells depends on a chemical process called DNA methylation. These were the findings of researchers at the laboratory of Dr. Frank Rosenbauer of the Max Delbrck Center for Molecular Medicine (MDC) Berlin-Buch in cooperation with the laboratory of Professor Sten Eirik W. Jacobsen (Lund University, Sweden and the University of Oxford, England). Furthermore, the researchers showed that DNA methylation also plays a crucial role for cancer stem cells (Nature Genetics, online, doi: doi:10.1038/ng.463)*.
A group of three enzymes, the DNA methyltransferases (Dnmt) regulates the addition of methyl groups to the DNA (DNA methylation). One of these enzymes Dnmt1 is responsible for the maintenance of the marks with the methyl groups, the DNA methylation pattern, because the distribution of the methyl groups on the DNA decides which genes are transcribed and which are blocked. Researchers speak in this context of epigenetic information, in contrast to genetic information.
However, it was unclear until now whether DNA methylation plays a special role in the control of hematopoietic stem cell characteristics. From the HSCs all of the blood cells of the body are formed. Since blood cells have only a limited lifetime, the body must form new blood cells over and over again. The pool for this is generated by the HSCs.
In order to discover what function DNA methylation has for HSCs, the two doctoral students Ann-Marie Brske and Lena Vockentanz of the MDC research laboratory of Dr. Rosenbauer switched off the enzyme Dnmt1 in the mice. As a result, the animals were not viable because the hematopoietic stem cell function was completely disturbed.
By contrast, when the two researchers arranged that the HSCs formed just a little Dnmt1, the animals survived, but the HSCs lost their potential for
|Contact: Barbara Bachtler
Helmholtz Association of German Research Centres


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OKLAHOMA CITY — UCLA senior Lisa Longaker pitched a three-hitter and Yvonne Gutierrez hit a two-run home run in the first inning Wednesday as the Bruins defeated Kent State, 4-0, in the opening game of softball's College World Series.
On Friday, UCLA (58-6) will face Cal State Long Beach (48-17), which defeated Nevada Las Vegas, 2-0, in the second game of the double-elimination tournament.
Longaker struck out nine, walked none and retired the first 10 batters as she improved her record to 20-1. It was her 13th shutout of the season. Kent State fell to 43-8.
For Long Beach, freshman Mary Letourneau scattered six singles and sophomore shortstop Kim Kostyk had two hits and scored both runs. Letourneau is 21-9 with 15 shutouts.


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Moody wraps up berth in regional semis
MERCEDES -- Moodys ace pitcher Brittany Johnson also carried a big stick with her Friday night in the Trojans history-making performance at Mercedes High School.
Johnson threw a complete game three-hitter and drove in five runs from the plate in helping Moody clinch its first regional semifinal berth with an 8-2 victory over the Tigers in Game 2 of a best-of-3 Region IV-4A quarterfinal softball playoff series. Behind Johnsons two-hit shutout Thursday, the Trojans won Game 1, 3-0 at Cabaniss Field to sweep the series.
District 30-4A champion Moody (28-6 overall) advances to play either District 25-4A runner-up Dripping Springs or District 27-4A runner-up Boerne in next weeks Region IV-4A semifinals at a date, time and location to be determined.
This is a great feeling -- weve worked so hard for this and this is a big accomplishment for us, said Trojans coach Paula Rodriguez, whose team was making its fourth regional quarterfinal appearance since 2001 and its second in the past three seasons. We didnt want the series to go to a third game because you never know what will happen. We wanted to close it out tonight in Game 2 and thats what we did. Hopefully well get past this next round as well.
Mercedes coach Betty Morrell gave a lot of credit to the Trojans defense for ending the Tigers season.
Moody just has a very salty team, said Morrell, whose District 32-4A champion Tigers finished the season at 27-8. We hit the ball well -- its just their third baseman (Jackie Valderaz) and their shortstop (Audrey Gonzalez) kept making great plays on defense. Their defense really helped them win this series.
As did Johnson, who yielded just one earned run in the entire series.
Johnson (25-5) pitched seven innings of three-hit ball Friday, she allowed two runs -- one earned -- on three hits, walked six and struck out seven.
Johnson also had the big day from the plate, as she had two hits and 5 RBI, which included a key two-run triple during a three-run second inning by the Trojans and a two-run, fifth-inning single. Johnson also plated Crystal Lucio with a sacrifice fly in the fourth inning to extend Moodys lead to 5-1.
Olivia Mendezs RBI grounder for Moody scored Gonzalez, who singled, to push the Trojans lead to 6-1 in the fifth inning, before Johnson delivered her two-out single to right field to score Mendez and Michelle Hernandez.
Samantha Jeter scored the first run of the game for the Trojans in the first inning, as she reached on a Mercedes error, stole second and scored on another fielding error by the Tigers. Kaylee Villarreal drove in Moodys other run with an infield single in the second inning.
Mercedes pitcher yielded Alyssa Martinez (8-2) didnt receive a lot of help from the Tigers defense, which made four errors. Martinez allowed five hits in seven innings and struck out five.
game 2
Moody 130 130 0--8 5 2
Mercedes 001 000 1--2 3 4
WP -- Brittany Johnson (25-5). LP -- Alyssa Martinez (8-2). 3B -- Moody: Brittany Johnson. HIGHLIGHTS -- Mercedes: Martinez: 7 IP, 5 H, 5 Ks; Alyssa Posades 1-4, RBI. Moody: Johnson 7 IP, 3 H, 7 Ks and 2-3, 3B, R, 5 RBI; Kaylee Villarreal 1-2, RBI; Audrey Gonzalez 1-2, R; Michelle Hernandez 1-2, 2 R; Olivia Mendez R, SB, RBI.
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Arizona: They took care of business.
USC: Well, at least they won.
Arizona St: They needed a win, and they didn't get it.
Washington St: Even worse than their usual effort.
Washington: They needed a win, and they didn't get it.
Cal: Another ugly loss for the Bears.
Oregon: Their national title dreams are officially over, and their Rose Bowl dreams just took a big hit.
@ Stanford , Oregon (-7)
my pick: Oregon 31, @ Stanford 21
What to take from this:
If you're Oregon:
A huge loss for the Ducks. Any chance of somehow sneaking into the national title game discussion is over, and now they're out of margin for error. Unless they sweep Arizona and Oregon St, they'll need help to make the Rose Bowl. The dream is still alive, but it's starting to look ill.
If you're Stanford:
This was a huge win for the Cardinal. Barring a truly wacky series of events, they're finally back in a bowl game for the first time since 2001, and they made a huge national splash while doing it. That said, the defense sucked again. Half of this team (offense) is fantastic, but the other half (defense) remains a disaster.
Oregon St (-7) 31, @ Cal 14
my pick: @ Cal 35, Oregon St 31
What to take from this:
If you're Oregon St:
This was an extremely impressive effort by the Beavers. This is only the third Pac-10 road win anyone's had over a decent to good team (USC at Cal and Arizona at Oregon St were the others). Moreover, they played a complete game in dominating the Bears. The defense has been a big issue for most of the year, but it played great here. They need plenty of help, but don't sleep on this team's Rose Bowl chances. They've got two easy games, and if they can pull an upset at Autzen, this could well be the 2009 Pac-10 champ.
If you're Cal:
Cal has done well against mediocre to lousy teams, but once they play teams with a pulse, they play dead. With Arizona and Stanford still to come, this could easily be the start of a losing streak, especially now that their best player is done for who knows how long. This team is in major trouble.
@ UCLA (-5) 24, Washington 23
my pick: @ UCLA 27, Washington 17
What to take from this:
If you're Washington:
This team is far better than it was last year. They've won some games, and they've competed against pretty much everyone. That said, this game helped make it clear that there is still a lot of work left to do. Barring a miracle run, they're home for the holidays yet again.
If you're UCLA:
It was ugly, and it was too close for comfort, but they finally won. Now all they have to do is avoid screwing up at Pullman and hold serve at home against ASU, and they're back to the postseason. There's plenty of work to be do, and they need to up their level of play, but after finally breaking the losing streak there's good reason to believe they can find a way to get it done.
USC (-10) 14, @ Arizona St 9
my pick: USC 31, @ Arizona St 14
What to take from this:
If you're USC:
Once again, the Trojans make it clear that they just aren't all that good. They were great at Cal, and strong at Ohio St, but other than that, they just haven't been a great team. Good, sure. Very good, maybe. But definitely not great. All the rest of their games are in the Coliseum, so they have a shot at running the table, but this almost certainly won't be a Rose Bowl team, and unless they really show something special over the next few weeks you have to wonder whether they really deserve a Fiesta Bowl or Sugar Bowl berth. Yes, they'll get one if they win out (and it might be on the table even if they drop one more, though that'd be much tougher), but this is no longer the sort of team you automatically trust to win it. Next year should be back to usual, but it's becoming more and more clear that this year is simply different.
If you're Arizona St:
Once again, they had a game they really needed to have, and once again they couldn't get it done. They competed against USC, just like they competed against Cal, just like they competed against Georgia, but at some point they actually have to win. Now, a bowl berth is a long shot. That great 2007 season is becoming more and more of a distant memory.
@ Arizona (-32) 48, Washington St 7
my pick: @ Arizona 42, Washington St 7
What to take from this:
If you're Washington St:
Another ass-kicking by a team way better than them. Not much to say at this point.
If you're Arizona:
The Wildcats played really well in this game, but it's hard to say how meaningful it was, given how bad Wazzu is. Still, this was a nice confidence booster.
Pac-10 Games Record:
This Week: 3-2 SU, 2-3 ATS
Season: 44-15 SU, 22-31-2 ATS
National Games of the Week:
@ Alabama (-7.5) 24, LSU15
my pick: @ Bama 28, LSU 14
Ohio St 24, @ Penn St (-5) 7
my pick: @ Penn St 24, Ohio St 21
@ Nebraska 10, Oklahoma (-4.5) 3
my pick: Oklahoma 28, @ Nebraska 21
National Games Record:
This Week: 1-2 SU, 2-1 ATS
Season: 15-15 SU, 14-15-1 ATS
Bad Lines
Iowa -15.5 vs Northwestern
Missed by 22.5 points and outright upset
Duke +10 @ UNC
Missed by 3 points.
Idaho +7.5 vs Fresno
Missed by 2.5 points
SMU -17.5 vs Rice
Missed by 14.5 points
Georgia Tech -14 vs Wake
Missed by 11 points.
Bad Lines Record:
This Week: 0-5
Season: 30-24-1
Mr Pac-10's 2009 Blog
Questions, comments or suggestions? Email me at firstname.lastname@example.com


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Sour Cream Potato Salad
28 Sep 2009
|7 Medium, cooked in jacket, peeled and sliced
|French dressing/Italian dressing
|1⁄3 Cup (5.33 tbs) (Clear)
|Sliced celery
|3⁄4 Cup (12 tbs)
|Sliced green onions and tops
|1⁄3 Cup (5.33 tbs)
|Hard cooked eggs
|1 Cup (16 tbs)
|Dairy sour cream
|1⁄2 Cup (8 tbs)
|Prepared horseradish
|1 1⁄2 Teaspoon
|Celery seed
|To Taste
|Diced pared cucumber
|1⁄3 Cup (5.33 tbs)
|To Taste
While potatoes are warm, pour dressing over and then chill for 2 hours.
Add celery and onion.
Chop egg whites; add.
Sieve yolks; reserve some for garnish.
Combine remaining sieved yolk with mayonnaise, sour cream, and horseradish mustard.
Fold into salad.
Add salt and celery seed to taste.
Chill salad for 2 hours.
Add diced cucumber; mix.
To trim, sprinkle reserved sieved yolk and sliced onion tops over top.
Rate It
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Sour Cream Potato Salad Recipe


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Interview with Nigel Eccles of FanDuel - June 30
FanDuel Book Preview - Subscribers Only - May 28
Cracking FanDuel: Week 18 - January 3
Playoff Top 130 (Performance) - December 30
Footballguys Postseason Subscriber Contest Rules - December 30
Playoff Top 130 (PPR) - December 30
Cracking FanDuel: Week 17 - December 27
Game Predictor: Week 17 - December 25
Cracking FanDuel: Week 16 - December 20
Game Predictor - Week 16 - December 17


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The Waitlist on IMLeagues serves as a holding zone for teams that don't currently have a division that they can play in. Teams are able to enter the Waitlist and start creating their team by adding new members. If a spot in a division or a whole new division open up, teams are able to move themselves from the Waitlist into that division.
Not exactly sure how to register your team for Intramurals?
Visit this page for easy instructions on how to register for IMLeagues.
Detailed instructions are included for previous athleague users and new users.
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