text:
|Publication number
|Publication type
|Application number
|Publication date
|Nov 6, 2001
|Filing date
|Sep 20, 1999
|Priority date
|Oct 28, 1996
|Fee status
|Publication number
|Jeffrey A. Wilson, John K. Danks, Jim Young
|Original Assignee
|Endoscopic Concepts, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (5), Referenced by (47), Classifications (15), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation-in-part of U.S. patent application Ser. No. 08/942,133 filed Oct. 1, 1997, now U.S. Pat. No. 5,954,720 which claims the benefit of U.S. provisional application No. 60/029,405 filed Oct. 28, 1996.
The present invention relates to endoscopic surgical instruments, and more particularly to instruments known as end effectors which may include cutters or scissors, graspers and dissectors which are useful in laparoscopic or endoscopic procedures. The surgical instruments made according to the present invention are bipolar to permit safe and effective dissection, incising and cauterization of blood vessels, bleeding tissues, or non-bleeding tissues.
The use of heat for the cauterization of bleeding wounds dates back for centuries. More recently, the use of radio frequency (RF) electrical current traveling through a portion of the body has been widely used to stop bleeding. The RF energy cauterizes the blood by heating the blood proteins to a temperature where those proteins congeal similarly to the process involved in the cooking of egg whites. RF energy is preferred because its frequency is above that which could otherwise cause neuromuscular stimulation. The most frequently used modes of RF cauterization are monopolar and bipolar coagulation.
In monopolar coagulation, an active electrode is applied to a bleeding site and the electrical current flows from the electrode through the patient's body to a return electrode which may be a conductive plate in electrical contact with a large surface area of the patient's body such as the buttocks or thigh. One technique in which the monopolar mode may be employed involves fulguration which is the use of a spark or arc from the active electrode to the tissue.
Bipolar devices include both the active and return electrodes. Thus the electrical current flows down the surgical instrument to the active electrode and typically crosses a space on the order of millimeters, or shorter, to the return electrode and returns through the surgical device. Because no external return electrode is required, bipolar electrical surgical devices have the inherent advantage of containing the RF energy in a defined area. This prevents potential patient complications related to monopolar RF energy traveling through the patient's body, such as the burning of nearby tissue or affecting the neurological function. The reduction of patient complications is also accomplished because bipolar devices typically require less RF energy than equivalent monopolar devices.
Endoscopic surgical instruments, such as the bipolar electrosurgical end effectors are often used in laparoscopic surgery, which is most commonly employed for cholecystectomies (gall bladder surgeries), hysterectomies, appendectomies, and hernia repair. These surgeries are generally initiated with the introduction of a Veress needle into the patient's abdominal cavity. The Veress needle has a stylet which permits the introduction of gas into the abdominal cavity. After the Veress needle is properly inserted, it is connected to a gas source and the abdominal cavity is insufflated to an approximate abdominal pressure of 15 mm Hg. By insufflating the abdominal cavity, a pneumoperitoneum is created separating the wall of the body cavity from the internal organs. A surgical trocar is then used to puncture the body cavity. The piercing tip or obturator of the trocar is inserted through the cannula or sheath and the cannula partially enters the body cavity through the incision made by the trocar. The obturator can then be removed from the cannula and an elongated endoscope or camera may be inserted through the cannula to view the body cavity, or surgical instruments such as bipolar electrosurgical end effectors according to the present invention, may be inserted to perform the desired procedure.
Frequently an operation using trocars will require three or four punctures so that separate cannula are available for the variety of surgical instruments which may be required to complete a particular procedure. As described in U.S. Pat. No. 5,258,006 for bipolar electrosurgical forceps, the alternatives to bipolar cauterization or coagulation have been unacceptable. Monopolar instruments, using RF energy, often require greater current and provide unpredictabilities in current flow which may have a destructive effect on tissues surrounding the area to be cauterized.
While non-contact positioning of a laser may overcome this shortcoming, the laser has no way of holding a bleeding vessel and is not used on large bleeders. Laser based cauterization instruments remain expensive and unsuitable for tissue dissection techniques other than cauterization, such as blunt dissection or sharp dissection. Laser cauterization instruments suffer from the additional shortcomings that it is difficult to control the depth of penetration of the laser energy and that non-contact positioning of a laser can permit the laser beam to reflect off of other instruments and cause damage to surrounding tissue.
Furthermore, as described in U.S. Pat. No. 5,472,443 for an electrosurgical apparatus, there have been difficulties in bipolar instruments in two primary areas. The first is the difficulty in preventing excessive trauma or charring to the tissue being cauterized. Such charring or tissue damage can impede healing and regrowth of tissue. In addition, bipolar instruments suffer from a buildup of coagulated blood or severed tissue. In prior art instruments, such buildup impeded the effectiveness of the cauterization action of the instrument, and also tended to cause recently cauterized tissue to adhere to the coagulated blood and tissue on the instrument resulting in tears and reopening of blood flows along the cut or incision. The invention described herein overcomes these shortcomings and may effectively reduce the number of surgical instruments required for a given procedure.
It is therefore an object of the invention to provide an improved surgical instrument with bipolar end effectors.
A further object of the invention is to provide an embodiment having two metal end effectors which are insulated except along portions for intended current travel.
Another object of the invention is to provide an embodiment having insulation on the back of at least one or both blades to prevent, or at least reduce current flow outside an intended current path.
It is a further object of at least one embodiment to pass current through the conducting strip of one end effector so that the coagulation caused by the RF energy tends to be very slightly in advance of or at the cutting point between the second and first end effectors, rather than rearward of the cutting point.
It is yet a further object of the invention to provide a bipolar instrument which utilizes RF energy more efficiently to cauterize tissue and thereby minimize charring of tissue.
Still, another object of the invention is to provide at least one notched blade which is believed to assist in providing tampon pressure at or near the intended severance path and assist in the defining of a more precise current travel path.
It is still a further object to provide an embodiment with two blades with corresponding notched portions which is believed to assist in providing tampon pressure and assist in the defining of a more precise current travel path.
Another object of the invention is to utilize electrodes in notched areas of the blades to focus the flow of current in the locale of the incision. This construction has been found to result in a greater current density in the incision by allowing RF current to flow directly through the incision instead of indirectly such that a stray current which may otherwise damage collateral tissue is significantly reduced.
These and other objects of the invention are accomplished by the utilization of one blade having a current conduit proceeding toward the distal end of the blade and therein connecting a conductive strip which proceeds rearward adjacent to the cutting surface of the blade. This blade is utilized to cut tissue in conjunction with a second blade. The second blade may, or may not, be similar in construction to the first blade, but the second blade will have a conducting strip capable of conducting current.
FIG. 1 is a perspective view of an endoscopic electrosurgical scissors constructed in accordance with the present invention.
FIG. 2 is a top view of the distal end of a portion of the scissors of FIG. 1.
FIG. 3 is a bottom view of the distal end portion of the scissors of FIG. 1.
FIG. 4 is a side plan view of the distal end of a portion of the scissors of FIG. 1 in their open position.
FIG. 5 is a side plan view opposite FIG. 4 of the distal end of a portion of the scissors of FIG. 1 in their closed position.
FIG. 6A is a perspective view of a first blade portion on an insulating blank according to the present invention.
FIG. 6B is a reverse angle view of the first blade portion of FIG. 6A.
FIG. 6C is an alternatively preferred embodiment of a first blade portion on a conductive blank shown with insulating face portion.
FIG. 7A is a perspective view of a second blade portion according to the present invention.
FIG. 7B is a reverse angle view of the second blade portion of FIG. 7A.
FIG. 7C is an alternatively preferred embodiment of a second blade portion shown with insulating face portion.
FIG. 8 is a side view of a moveable handle portion for a bipolar end effector.
FIG. 9 is a side view of a stationary handle portion for a bipolar end effector.
FIG. 10 is a perspective view of an elongated tubular barrel for end effectors having a grasping knob to facilitate rotation.
FIG. 11 is a perspective view of a push rod connector for use in an electrosurgical end effector.
FIG. 12 is a perspective view of a cam part according to the present invention.
FIG. 13 is a side view of an internal push rod adapted to transmit current or wire connectors through the tubular barrel of an electrosurgical end effector.
FIG. 14 is a perspective view of a clevis section used with bipolar end effectors made according to the present invention.
FIG. 15A is a cross-sectional plan view of an alternative embodiment of end effectors.
FIG. 15B is a variant of the embodiment of FIG. 15A where the second blank is conductive.
FIG. 16A is a top view of yet another alternative embodiment of end effectors.
FIG. 16B is a cross sectional view of the end effectors of FIG. 16A taken along line B—B.
FIG. 16C is a cross section view with the end effectors open.
Referring to FIG. 1, there is indicated generally by numeral 10 a bipolar electrosurgical scissors for endoscopic surgery constructed having end effectors in accordance with the present invention. It will be understood that the principles of the present invention are equally suitable for use in other bipolar end effector instruments such as graspers and dissectors.
Although many types of bipolar scissors are known in the art, this description will be directed at a single scissor type for ease of explanation. It should be obvious to one skilled in the art that any bipolar effector design, especially bipolar scissors, having end effectors as described herein are contemplated by this invention.
The scissors 10 are seen to typically include an elongated tubular barrel 12 having a proximal end 14 a distal end 16, and with a lumen extending there between. The outer diameter of the barrel 12 is sufficiently small to be passed through the working lumen of a trocar cannula. Tubular barrel 12 is preferably an insulated metal tube, as by Teflon coating, or a rigid plastic tube. Mounted on the proximal end 14 of the tubular barrel 12 of the bipolar scissors 10 is a knob 18 which facilitates rotation of the tubular barrel 12 and connected end effectors. The tubular barrel 12 and knob 18 are mounted to the stationary portion 20 of an actuator such as handle assembly 22.
Manipulation of moveable scissors handle 21 relative to stationary handle section 20 manipulates push rod connector 55 and push rod 50 (illustrated in FIG. 13) which is internal to push rod connector 55 and tubular barrel 12 and in linked communication with end effectors such as blades 24 and 26, which are thereby caused to move in scissors-like action relative to one another. Of course, other scissor designs may operate satisfactorily with the end effectors of the present design.
Referring to FIG. 6A, an enlarged view of a first end effector, such as scissors blade 24 is provided. In a presently preferred embodiment, a first scissors blade 24 is comprised of a nonconductive blade blank 28 which is preferably constructed of a ceramic material such as Zirconia, Mullite, or Alumina available from Coors Ceramics Company, Inc., but which also might be suitably constructed of rigid plastic or insulated metal.
In an alternatively preferred embodiment, illustrated in FIG. 6C, the scissors blade 24 is comprised of a conductive blade blank 28 which is preferably constructed of a traditional metal end effector blank. An insulating section, typically of ceramic material is added to the effector blank to form the face 98 of the interior side of the blade.
At the proximal end 41 of the first blade 24 is a post 41, a function of which will be explained in connection with cam socket 70 shown in FIG. 12. Proceeding from the post 41, or preferably a surface area on the same side of proximal end 42 of first blade 24, perhaps adjacent to aperture 43, is a conductor 34 which proceeds through groove 31 down at least a portion of the end effector, such as blade 24. Preferably, the conductor 34 will proceed to the distal end of the end effector and thereby be connected to the cutting side of the first blade 24 as by connection 36, shown in FIG. 6B. Preferably the conductor 34 is insulated as it proceeds distally showing the end effector to connection 36 to prevent inadvertent RF current discharges into tissue.
The active side of the end effector, such as the cutting side of blade 24 shown in FIG. 6B has an exposed conductive strip 30 offset from the cutting edge 29 by a distance of approximately 0.02 inches (0.58 mm) creating a gap 100 as illustrated in FIGS. 17-19. This offset or recess may vary between about 0.003 inches and 0.2 inches to produce a fulgurating gap with second blade 26 but is preferably between 0.005 inches and 0.050 inches, and is most preferably about 0.015.
Referring to FIG. 7A, an enlarged view of a second end effector, such as scissors blade 26 is provided. In a presently preferred embodiment, a second scissors blade 26 is comprised of a nonconductive blade blank 27 which is preferably constructed of a ceramic material such as Zirconia, Mullite, or Alumina available from Coors Ceramics Company, Inc., but which also might be suitably constructed of rigid plastic or insulated metal.
FIG. 7B shows the reverse angle of FIG. 7A.
FIG. 7C shows an alternatively second blade 26 also having a proximal section 44 with post 45. In this figure, the face 99 protrudes from the interior surface of the blade. Blade 26 also has an aperture 46 which corresponds to aperture 43 on the first blade 24. The second blade may be manufactured from a traditional metal end effector blank 27 or from a non-conductive blade blank 28 depending upon the embodiment chosen by the user. It will be understood that the end effectors may have a variety of shapes and in particular end effectors for scissors may have a curved profile.
The opposing side of the second blade 26 will have an exposed conductive strip 130 which may, or may not, symmetrically correspond to the exposed conductive strip 30 of the first blade. Furthermore, the exposed conductive strip 130 of the second blade 26 may, or may not, be offset from the cutting edge 129 of the second blade. Additionally, the conductive strip 130 may or may not be integral to the second blade 26. The conductive strip 130 would likely be integral to the second blade 26 if a conductive blank were utilized, but it could be affixed separately as well.
In a first preferred embodiment illustrated in FIG. 15A, the first and second blades 24, 26 are made of non-conductive blanks and have conductive strips 30, 130 which are both offset from the cutting edges 29, 129 of the cutting sides of the first and second blades 24, 26. Both the first and second blades have gaps 32, 132 created by the offset of their respective conductive strips 30, 130 from their cutting edges 29, 129.
FIGS. 2-5 and 15A show different views of an embodiment having a second conductive blade 26 and non-conductive embodiment of a first blade 24 mounted in clevis section 80. FIG. 2 is a top view showing connecting rivet 47 holding pressure washers 48, conductive blade 26, and non-conductive blade 24, in alignment between clevis wings 81 so that blades 24 and 26 may move in pivotable relation to each other. It will be understood that a single pressure washer 48 may be sufficient. Shown on first blade 24 is exposed conductive strip 30 offset from cutting edge 29 by gap 32 of approximately 0.02 inches. Shown on second blade 26 is exposed conductive strip 130 offset from cutting edge 129 by gap 132 of approximately 0.02 inches. It will be understood that the fulgurating gap 102 (illustrated in FIG. 15A) may be adjusted for optimal effect between about 0.01 inches and 0.2 inches depending upon the design of a particular set of end effectors. A gap 102 of at least slightly greater than 0.05 inches is generally preferred.
In the bottom plan view of FIG. 3, the conductor 34 is shown. This conductor 34 connects via connection 36 to the exposed conductive strip 30 (shown in FIG. 2). This design may be utilized in both the first and second blades 24, 26. While it is anticipated that the conductor 34 may be plated or press fit into groove 31 and thereafter covered with an insulating resin, it may also be possible to cast the blade 24 from ceramic or plastic with conductor 34 embedded within the blade blank 28.
FIG. 4 is a left side view showing scissors blades 26 and 24 in their open position. With the cutting side of a non-conductive embodiment of first blade 24 exposed, the conductive strip 30 is shown. If first blade 24 is constructed of a conductive material, there may be no need to have a separate conductor 34 apart from the blade blank 28.
FIG. 5 shows a right side view with blades 24 and 26 in their closed position so that only first blade 24 is apparent. It will be understood that while the blades 24, 26 shown in these illustrations have a linear profile when observed from the top as in FIG. 2, the blade profiles could alternatively be arcuate if preferred.
Turning now to the assembly of bipolar end effectors, first blade 24 and second blade 26 are mounted in cam socket 70 (shown in FIG. 12). First side 77 and opposed side 78 of cam socket 70 define a channel 74 at the distal end of cam socket 70. At the proximal end of cam socket 70 is aperture 73 which contains first connection strip 75 and second connection strip 76 for the purpose of connecting with electrical connections 52, 54 respectively on push rod 50 shown in FIG. 13. It will be understood that the illustrated connection strips 75, 76 are specifically adapted to conduct current to the posts 45, 41 of the blades 24, 26. It will generally be preferred to conduct current to other surfaces on the blades such as adjacent to apertures 43, 46. It is contemplated that many different mechanisms may be utilized to connect the conductive strips 30, 130 to electrical connections 52, 54 or to any other electrical source as is prescribed by the implement design.
In order to secure the blades with their protruding posts 41, 45, the cam socket 70 may be made of a flexible or elastomeric material such as a plastic polymer such as polyurethane that will permit first side portion 70 and second side portion 78 to be bent apart from each other when blades 24, 26 are inserted. Alternatively, the cam socket 70 may be made of rigid material and the blades 24, 26 inserted in a staggered manner and then aligned at the pivot point represented by apertures 43, 46. The post 41 on first blade 24 is received in groove 71 on the first side 77 of cam socket 70, while post 45 on second 26 is received in groove 72 on the opposed side 78.
Attached to cam socket 70 by means of chemical, dielectric, or other appropriate bonding, is a conductor from connection strip 75 to first cam socket side 77 so that it may interface with the conductor 34 on the first blade 24. Similarly, connective strip 76 is in communication with the second opposed side 78 of cam socket 70 so that an electrical connection can be made with second blade 26. This conductor may be embedded within cam socket 70 or may proceed on the exterior surface of cam socket 70 so as not to connect with connective strip 75 on the interior of first side 77.
When blades 24, 26 are mounted in cam socket 70, push rod 50 (shown in FIG. 13) is inserted into aperture 73 so that connector 52 is in contact with connective strip 75 and connector 54 is in contact with connective strip 76. Although push rod 50 may be a relatively small diameter tube containing insulated wires, it is preferably rigid plastic formed with an internal conductor 51 proceeding from connector 52 internal of push rod 50 to proximal end 53. Also, a second or external conductor on push rod 50 proceeds from connector 54 to the proximal end 53 of push rod 50.
The assembled blade 24, 26, cam socket 70, and push rod 50 assembly is then inserted between opposed wing sections 81 of clevis section 80. The push rod proceeds through lumen 86 of clevis section 80, while the cam socket 70 is received within chamber 85 of the clevis section 80, and ends 37, 38 of blades 24, 26 are protruding. Apertures 43, 46 on blades 24, 26 respectively (shown in FIGS. 6-7), are aligned with apertures 82 on the clevis section 80, optionally with one or more spring washers 48 (shown in FIGS. 2 and 3) and connected by rivet 47 (shown in FIGS. 2 through 5). If desired, this entire assembly of blades, clevis section, cam socket, and push rod may be disposable.
Turning now to FIG. 10, the proximal end of push rod 53 is threaded through lumen 13 beginning at the distal end 16 of tubular barrel 12 until it projects at the proximal end 15. When so positioned, the proximal end 87 of clevis section 80 is fixed in mounting section 17 internal to the tubular barrel. Mounting section 17 and proximal clevis section 87 may be press fitted or preferably will have mating threads for secure positioning. Relatively narrower section 84 of clevis section 80 is received within the proximal end 16 of tubular barrel 12 while relatively wider section 83 of clevis section 80 protrudes from barrel 12.
The next assembly step is for proximal end 15 of tubular barrel 12 to be mounted in aperture 60 of stationary scissors handle 20 (shown in FIG. 9). Protruding fitting segment 23 on stationary handle 20 is in turn received within chamber 19 of tubular barrel assembly 12. The proximal end 53 of push rod 50 protrudes through aperture 60 of stationary handle section 20. Stationary handle 20 has an upper section 64 and a lower handle 63. Also shown is a structure for pivotable attachment with movable handle 21 (shown in FIG. 8) consisting of a clevis like arrangement of two raised circular sections 61 defining between them a gap to receive protruding section 67 on movable handle 21 and each having a threaded aperture 62.
Prior to assembling movable handle section 21 with stationary handle 20, push rod connector 55 is first mounted into the circle and slot configuration 68 of the movable handle 21. Bulbous portion 58 of push rod connector 55 is inserted through the circular section (having a width less than the diameter of bulbous head 58) of opening 68 until the entire bulbous section 58 is internal of movable handle 21 and thereafter push rod connector 55 is slid into the slot section (having a width less than the diameter of bulbous head 58) of opening 68 so that the bulbous head 58 will not pull free. When so positioned, the lumen 56 proceeding through push rod connector 55 is in alignment with an internal two connector plug in communication with external two connector plug 69 at the upper end of movable handle 21.
It should also be noted that aperture 66 of movable handle 21 is sized somewhat larger than aperture 62 on stationary handle 20. The two handle sections 21 and 20 are joined at two points. First, the proximal end 53 of push rod 50 passing through the upper portion 64 of stationary handle section 20 is received through aperture 56 of push rod connector 55 so that it connects through opening 68 into movable handle 21. The proximal end 53 of push rod 50 is thereby placed in electrical connection with tube connector socket 69. The handle sections 20, 21 are also joined by positioning protrusion 67 of moveable handle section 21 in between the clevis like structures 61 on stationary handle 20 and inserting a screw through threaded apertures 62, said screw threads not engaging with the movable scissors handle 21 because of the relatively larger size of aperture 66. This permits free pivoting of the handle sections relative to one another, thereby effecting the pushing or retraction of push end 50 relative to the end effectors.
To utilize bipolar end effectors according to the present invention, plug 69 is connected with appropriate bipolar power source. In use, the positive RF energy proceeds from plug 69 through central electrical connector 51 of push rod 50 to connector 52 at the distal end thereof, and to connective strip 75 of scissors cam socket 70. From connector 70, a current is received by connector 34 on first blade 24. RF current proceeds along conductor 34 toward the distal end of blade 24 until connection 36 allows the current to communicate with the exposed conductive surface 30. Exposed conductive strip 30 is separated by gap 32 from exposed conductive strip 130 of second blade 26. This gap 32 is a space sufficiently narrow to allow RF current to arc through the tissue being held or cut between the first 24 and second 26 end effectors. Because of the gap 32 separating conductive strip 30 from conductive end effector 26, the two end effectors 24 and 26 can touch one another along their entire length as the cutting motion takes place without creating an electrical short circuit between them.
In fact, use of the first and second gaps 32, 132 together has been found to be particularly effective at providing tampon pressure to a particular tissue location. However, one of both first and second gaps 32, 132 is not necessarily required. The first and second gaps 32, 132 have also been found to be effective at housing the conductive strips 30, 130 and ensuring that they do not inadvertently touch. These small electrodes in the notched areas have been found to harness the flow of current in the incision. By harnessing the flow of current in the incision, where it is needed most, the current density is greater. More heat may be generated in this area with less power. Additionally, the current will flow more directly through the incision area. More direct flow of current through the area of the incision will greatly reduce any damage to lateral tissue.
The double gap configuration of using both gaps 32, 132 has been found effective at ensuring that both sides of the incision receive similar amounts of compression as well as RF energy in the form of heat. Furthermore, the double gap configuration has been found to be effective at allowing the incision sight to be heated, or cauterized, as well as compressed, just prior to the cutting cycle. At the location where the incision will occur, the locale has already been treated by RF coagulation and tampon pressure in combination to aide in controlling any bleeding prior to making the cut.
When utilizing the first and second blades 24, 26 to sever a tissue, the gaps 32, 132 on each side of the tissue allows the blades 24, 26 to pinch or compress the incision sight together. This pinching action has been found effective in assisting with tampon pressure and coagulation current. Opposing gaps have been found effective at producing an incision which is hemostatic and denatured with RF cauterization.
The use of the first and second gaps 32, 132 has been found to utilize about half the power of some other bipolar scissor blades (15 watts) and it is possible to show the tissue denatured before a mechanical cut is made.
When it is desired to cauterize tissue, the RF voltage is applied to the electrosurgical scissors thereby making the first blade 26 and exposed conductive strip 30 the active bipolar electrodes. When the scissors are in contact with tissue, the current flows from a portion of the conductive strip at the cutting point or slightly distal thereto through the tissue to a conductive strip on the second blade 26, thereby effecting cauterization at or just slightly in advance of the cutting point between first blade edge 29 and second blade 26. To complete the electrical circuit, RF current proceeds through the second blade 26 to connector 73 on the cam socket 70 which is in contact with connector 54 on push rod 50, which is in turn connected to the negative polarity at connector 69. This can be accomplished by using a similar system as utilized in the first blade or a different system. Obviously, the use of a conductive second blade 26 with an exposed conductive strip 130 would be able to conduct electricity to the connector 74 in contact with push rod connector 54. The design of end effectors in accordance with the invention permits the current to cross before the blades pass one another thereby creating fulguration in advance of the cut and reducing the energy setting required to ensure that the sharply dissected tissue will be provided its sufficient RF energy to cauterize.
In heat generating dissection devices the charring of tissue is a common and undesirable side effect. The buildup of charred tissue on electrosurgical devices is common and is typically addressed either by cooling the cutting surfaces of the end effector, as with water, or by using a nonstick surface. Reduced energy settings, as permitted by the present invention, is a solution to the charring and buildup problems. If the RF energy needed to control bleeding is low, the tissue is denatured, and cooked like the white of an egg without burning where the tissue is blanched rather than charred. Tissues are thus sealed and sticking is minimized.
The present invention promotes the efficient use of RF energy by containing the flow of positively charged energy particles through a well defined positive electrode 30 just prior to the tissue cutting point. Some of the current is absorbed to heat the tissue and the remaining positive energy is pulled into the negative electrode 130, thus minimizing the escape of energy from the instrument into surrounding tissues. The novel design focuses the RF energy to reduce the amount of energy required to produce coagulation at the cutting site and to effectively remove the residual energy from the patient's body without affecting other tissues. Lower energy settings result in less char and buildup in the instrument in addition to reducing the likelihood that the energy will affect other tissue or organs.
The first and second blades 24, 26 need not be constructed of the same material according to the present invention. Looking to FIG. 15, the first and second blades 24, 26 may both be constructed of a non-conducting material. Alternatively, one may be constructed of a conducting material while the other constructed of a non-conducting material. Finally, both blades may be constructed out of conductive materials.
Exterior to at least one, and preferably both, of the blades 24, 26 is insulating surface 111. The portions with cutting edges 29,129 are illustrated as faces 98, 99 which utilize adhesive 198,199 for mounting on a blade. The insulating surfaces 110, 111, 112 are illustrated substantially encapsulating the first and second blades 24, 26, with the exception of the conductive strips 30, 130. The insulating surfaces 110, 111, 112 have been found to be effective in directing the flow of RF energy to reduce, if not eliminate RF energy flow through the back of the blade as well as other portions of the blade. The insulating surfaces 110, 111, 112 assist in forcing the current to travel through the first conductor strip 30 through tissue and into the other conductive strip 130. This insures that current density is maximized and focused in the incision which is more efficient and allows less stray current to damage lateral tissue and provides improved RF coagulation at lower power settings. It will be appreciated, as shown in FIG. 15B with a metal blade 26 that the entire interior surface of the blade can serve as the conductive area 130, provided that the first blade 24 focuses its conductive areas along a defined strip 30.
In a preferred embodiment, insulating surfaces 111, 110, 112 surround the outer surfaces of the blades except for the conductive strips 30, 130. However this amost encapsulating design is not required. Additionally, insulating surfaces 111, 110, 112 are located on the faces of each blade to assist in focusing RF energy to travel almost exclusively between the conductive strips 30, 130 and tissue being compressed in the gap between the strips. Insulating material may be any material or substance known in the art to provide a relatively high resistance to electrical current flow relative to the resistance offered by the conductive strips 30,130. Polyimide, polyamide and ceramics are preferred materials.
Insulating surfaces 111 on the outer surfaces of blades 24, 26 are believed to prevent, or limit, the inadvertent transmission of RF energy to unwanted locations which may come into contact with outer surfaces of the blades. Insulating surface portions 111 may only cover a portion of the outer surface of a blade, or may cover the entire outer surface of the blade.
It is also only necessary for only one of the blades to have facing insulating portions 110. Insulating portion 112 on the cutting edge may also be helpful. Although interior insulating surfaces 110, 112 may be located on a single blade, this improvement has been found to be effective at directing the RF energy through the conductive strips 30, 130 when utilized on both blades as well. Although a non-conductive blade may be insulated, or be inherently insulated, it is also possible for a conductive blade to be insulated with any of insulating surfaces 110, 111, 112. In one preferred embodiment, insulating surface 111 is utilized without insulating surfaces 112 and 110 as illustrated in FIG. 15B. Utilizing a non-conductive blade, which is inherently insulated, and an uninsulated conductive blade has been found to allow for efficient manufacturing as only one blade, the non-conductive blank, will need multiple manufacturing operations.
In another embodiment, a metal face 98,99 is utilized on the first and second blades as shown in FIG. 15A. However, the metal cutting blade portions need not extend the complete length of the blades 24, 26. These metal cutting surfaces may be placed atop either conductive or non-conductive blade blanks having conductive strips 130, 30 utilizing adhesives.
The adhesive may act to assist in insulating the metal electrodes from the metal faces. Although adhesive is used in this alternatively preferred embodiment, any insulating material may be found to function properly. The portion of the metal face proximate to the blade is insulated so that current will flow through the conductive strip in the blade and not primarily through the metal face. It is also contemplated that only one of the blades utilizes a metal face. For instance, a preferred constrocution of the blades of FIG. 15A, face 98 is an insulated ceramic material and face 99 is metal. Other embodiments include metal blades which may or may not have a separate metal face and ceramic blades which may utilize a ceramic face or a separate metal face.
FIGS. 16A, 16B, and 16C are illustrations of an alternatively preferred embodiment having curved first and second blades 24,26. For some applications, curved blades 24,26 may be preferred. The curved blades 24,26 are illustrated as being constructed of first and second blanks 28,30 with the interior portions having faces 98,99 attached thereto. In one application, the first face 98 has been a ceramic material connected to a conductive first blank 28. The second blank 30 in this embodiment is also conductive, and has a metal face 99 connected thereto. Other blade materials and constructions as taught herein could also be utilized with the curved blade embodiment.
Additionally, cauterization occurring slightly forward of the cutting action of the scissors tends to be more effective and minimizes bleeding from the tissue and other described difficulties in utilizing bipolar instruments during surgery.
Alternative electrical connections may be possible that still permit the rotation of barrel 12 upon turning knob 18 without causing a loss of current to the end effectors. As shown in FIGS. 6, 7, and 12, the novel cam socket 70 of the present invention obviates the necessity for placing a slot in first blade blank 28 to effect the scissors action. Instead, the first blank 28 is only weakened by a single aperture 43. If multiple holes or substantial slots were cut in first blank 28, it would substantially increase the risk of mechanical failure of the first blank. Accordingly, the present blade post and cam socket design is a substantial improvement over prior art blade design such as those depicted in FIG. 8 of U.S. Pat. No. 5,391,166.
The electrode surface 30 of the first blade 24 is designed not to contact the second blade 26 and is separated by the fulgurating gap 32 to coagulate tissue. The interference friction between the cutting edge 129 and face 98 of first blade 24 does not harm the electrode surface 30 of the non-conductive blade 24 as there is no physical contact or wearing of that conductive surface 30 along the cutting edge 29.
Exposure of the positive RF flow from the electrode surface 30 of first blade 24 to tissue and return through the second blade 26, as shown in FIGS. 6A, 6B, 7 a and 7B is a unique design to ensure energy flow from the distal end of the end effector toward the proximal end. To ensure this effect, the exposed conductive strip 30 may be selected from an imperfect conductor such as stainless steel or conductive plastics or ceramics in lieu of usual gold plate designs.
The specific embodiments described are provided just by way of explanation rather than limitation. All variations that do not depart from the spirit of the invention are intended to be covered by the appended claims.
|Cited Patent
|Filing date
|Publication date
|Apr 24, 1995
|Nov 12, 1996
|United States Surgical Corporation
|Bipolar electrosurgical instruments
|Dec 15, 1995
|Jan 19, 1999
|Gyrus Medical Limited
|Electrosurgical instrument
|Oct 1, 1997
|Sep 21, 1999
|Endoscopic Concepts, Inc.
|Bipolar electrosurgical end effectors
|Jul 17, 1997
|Jul 18, 2000
|Symbiosis Corporation
|Bipolar endoscopic surgical scissor blades and instrument incorporating the same
|Title not available
|Citing Patent
|Filing date
|Publication date
|May 16, 2002
|Oct 11, 2005
|Tissuelink Medical, Inc.
|Fluid-assisted medical devices, systems and methods
|Apr 5, 2002
|Sep 12, 2006
|Sherwood Services Ag
|Molded insulating hinge for bipolar instruments
|Jul 27, 2006
|Sep 2, 2008
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|Jan 12, 2010
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|Fluid-assisted medical device
|Jan 26, 2010
|Salient Surgical Technologies, Inc.
|Fluid-assisted medical device
|Feb 4, 2005
|Jun 1, 2010
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|Fluid-assisted medical devices and methods
|Sep 14, 2010
|Aragon Surgical, Inc.
|Method and apparatus for surgical electrocautery
|Mar 8, 2006
|Sep 28, 2010
|Aragon Surgical, Inc.
|Method and apparatus for surgical electrocautery
|Oct 12, 2010
|Salient Surgical Technologies, Inc.
|Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof
|Oct 19, 2010
|Salient Surgical Technologies, Inc.
|Fluid delivery system and controller for electrosurgical devices
|May 10, 2006
|Jan 4, 2011
|Aragon Surgical, Inc.
|Method for tissue cauterization
|May 10, 2006
|May 17, 2011
|Aragon Surgical, Inc.
|Apparatus for tissue cauterization
|Feb 6, 2004
|May 31, 2011
|Salient Surgical Technologies, Inc.
|Electrosurgical device having a tissue reduction sensor
|Mar 30, 2004
|Aug 16, 2011
|Salient Surgical Technologies, Inc.
|Fluid-assisted medical devices, systems and methods
|Oct 18, 2011
|Salient Surgical Technologies, Inc.
|Fluid-assisted medical devices, systems and methods
|Nov 1, 2011
|Salient Surgical Technologies, Inc.
|Fluid-assisted medical devices, systems and methods
|Oct 30, 2007
|Dec 13, 2011
|Salient Surgical Technologies, Inc.
|Fluid-assisted medical devices and methods
|Jul 31, 2008
|Jul 24, 2012
|Applied Medical Resources Corporation
|Bipolar electrosurgical scissors
|Oct 30, 2012
|Tyco Healthcare Group Lp
|Bipolar scissors for adenoid and tonsil removal
|Oct 12, 2010
|Jan 29, 2013
|Medtronic Advanced Energy Llc
|Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof
|Mar 5, 2013
|Ethicon Endo-Surgery, Inc.
|Ultrasonic surgical instrument, shears and tissue pad, method for sealing a blood vessel and method for transecting patient tissue
|Mar 26, 2010
|Apr 16, 2013
|Aesculap Ag
|Impedance mediated power delivery for electrosurgery
|May 21, 2013
|Ethicon Endo-Surgery, Inc.
|Ultrasonic surgical shears and tissue pad for same
|Oct 28, 2003
|Jul 2, 2013
|Medtronic Advanced Energy Llc
|Fluid-assisted electrosurgical scissors and methods
|May 2, 2007
|Nov 5, 2013
|Aesculap Ag
|Surgical tool
|Jul 23, 2012
|Dec 3, 2013
|Applied Medical Resources Corporation
|Bipolar electrosurgical scissors
|Oct 25, 2012
|Jan 21, 2014
|ENT Biotech Solutions, LLC
|Surgical instrument for tissue removal
|Feb 6, 2007
|Apr 15, 2014
|Aesculap Ag
|Electrocautery method and apparatus
|Feb 6, 2007
|May 20, 2014
|Aesculap Ag
|Electrocautery method and apparatus
|Oct 19, 2010
|Sep 9, 2014
|Aesculap Ag
|Impedance mediated control of power delivery for electrosurgery
|Jan 22, 2010
|Oct 7, 2014
|Microline Surgical Inc.
|Scissor tip for bipolar high frequency endoscope
|Mar 23, 2011
|Oct 28, 2014
|Aesculap Ag
|Articulable electrosurgical instrument with a stabilizable articulation actuator
|Apr 28, 2011
|Nov 18, 2014
|Aesculap Ag
|Apparatus for tissue cauterization
|May 18, 2011
|Nov 3, 2015
|Aesculap Ag
|Electrosurgical tissue sealing augmented with a seal-enhancing composition
|Nov 8, 2013
|Nov 24, 2015
|Ent Biotech Solutions, Inc.
|Surgical method for tissue removal
|Mar 25, 2011
|Mar 8, 2016
|Aesculap Ag
|Impedance mediated control of power delivery for electrosurgery
|May 15, 2008
|May 17, 2016
|Aesculap Ag
|Electrocautery method and apparatus
|Jun 28, 2012
|May 17, 2016
|Aesculap Ag
|Electrosurgical tissue dissecting device
|Feb 24, 2005
|Sep 1, 2005
|Houser Kevin L.
|Ultrasonic surgical shears and tissue pad for same
|Jul 27, 2006
|Jan 31, 2008
|Applied Medical Resources Corporation
|Bipolar electrosurgical scissors
|Jul 31, 2008
|Jan 1, 2009
|Applied Medical Resources Corporation
|Bipolar electrosurgical scissors
|Jan 26, 2009
|Aug 6, 2009
|Tyco Healthcare Group Lp
|Bipolar Scissors for Adenoid and Tonsil Removal
|Jan 22, 2009
|Jan 28, 2010
|Houser Kevin L
|Ultrasonic surgical instrument, shears and tissue pad, method for sealing a blood vessel and method for transecting patient tissue
|Jan 22, 2010
|Dec 9, 2010
|Microline Surgical Inc.
|Scissor tip for bipolar high frequency endoscope
|Feb 25, 2005
|Sep 15, 2005
|Ethicon Endo-Surgery, Inc.
|Ultrasonic surgical shears and tissue pad for same
|Feb 25, 2005
|Jul 19, 2007
|Ethicon Endo Surgery Inc
|Ultrasonic surgical shears and tissue pad for same
|Apr 11, 2013
|Oct 17, 2013
|ENT Biotech Solutions, LLC
|Surgical instrument for tissue removal
|U.S. Classification
|606/50, 606/48, 606/51, 606/174, 606/46, 606/170
|International Classification
|Cooperative Classification
|European Classification
|Dec 20, 1999
Owner name: ENDOSCOPIC CONCEPTS, INC., FLORIDA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:WILSON, JEFFREY A.;DANKS, JOHN K.;YOUNG, JIM;REEL/FRAME:010483/0588
Effective date: 19991213
|Jan 18, 2005
|Fee payment
Year of fee payment: 4
|May 18, 2009
|Maintenance fee reminder mailed
|Nov 6, 2009
|Lapse for failure to pay maintenance fees
|Dec 29, 2009
|Expired due to failure to pay maintenance fee
Effective date: 20091106


text:
Briyona Canty never has been the most talkative player on the court. She has chosen instead to lead by example. Though tabbed as the No. 6 prospect in the 2011 class by ESPN HoopGurlz, Canty's only big knock has been her lack of gab, especially for a player who is leaned on to play the point at times.
The silent assassin routine is changing for Canty and it was triggered 9,500 miles away from her home this summer while earning a bronze medal for the USA in the Youth Olympic Games in Singapore. As the ink dries on Canty's National Letter of Intent with Rutgers, coach C. Vivian Stringer can count on talk being a regular part of Canty's game for years to come.
"I think it's going to carry with me to the next big stage in my life," Canty said.
As Canty's star has grown in the past two years, she continued letting her game do the talking. Playing on super regional teams, like her NYC Gauchos club team, put her in an environment where that was enough given the talent around her. But her goals are changing.
Bring up recent high-profile Scarlet Knight stars such as Epiphanny Prince, Essence Carson or current junior April Sykes, and Canty knows her ranking and acclaim bring lofty expectations.
"I'm trying to go past those expectations," Canty said.
Part of being on that level is being a vocal leader and it came to Canty out of necessity in Singapore because, with just two teammates on the court, communication was paramount to the USA team grabbing a bronze medal.
"Me and the girls built such a strong chemistry," Canty said of her fellow bronze medalists, Andraya Carter, Amber Henson and Kiah Stokes.
Canty said she feels the same trust and closeness with her future teammates at Rutgers that she did with her USA teammates. The Scarlet Knights don't have any seniors on the roster this season, so the players with whom she has bonded will all be there as her teammates next season.
The college decision was tough for Canty, though she never let it overwhelm her. She had two of her finalists, Rutgers and Kentucky, really stood out. But ultimately being close to home and the chemistry built over several years was too much to overlook.
"It was just a love I felt from the coaching staff and the team," Canty said," and them being there in the beginning."
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Chris Hansen is the national director of prospects for ESPN HoopGurlz and covers girls' basketball and women's college basketball prospects nationally for ESPN.com. A graduate of the University of Washington with a communications degree, he has been involved in the women's basketball community since 1998 as a high school and club coach, trainer, evaluator and reporter. Hansen can be reached at email@example.com.

subset: commoncrawl


text:
I'm working on a HP Pavilion 512n right now, and I couldn't get into the BIOS (because I didn't know which key it was). Usually, it's F2 or Del. After some searching, I found that it's F1. Why can't they standardize something so simple? Oh well, back to work.
Entering BIOS setup on HP & Compaq
Published by
Bryan Villarin
Bryan is a Happiness Engineer at Automattic. He's also a photographer and card magician. He loves reading — especially with Instapaper — and, at the moment, watching "Arrested Development". Thanks to my friend and colleague Steve Blythe for the sweet photo! View all posts by Bryan Villarin


text:
Stop Bullies Now: How to Protect Your Child Against School Bullies and Cyber Bullies
by Anne Marie
- #6214 in Nonfiction, Family & Relationships
- #6883 in Nonfiction, Reference & Language, Education & Teaching
- #108 in Nonfiction, Family & Relationships, Education
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- Your price$2.99
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Protect Your Child from School Bullies and Cyber Bullies Once And For All
Most students are ever bullied at schools at some point of their lives. Sadly, some are driven to suicide. If your child is being bullied in school, now is the time to take control of the situation, to stand up for their rights and stop being a victim. It is time to stop the bullies from ruining your child's life.
This guide has the answers. It is written especially for parents, teachers and students.
"Stop Bullies Now - How to Protect Your Child Against School Bullies and Cyber Bullies" shows you what you can do as a victim, a parent, a teacher, a school counsellor and as a bystander.
There is something to learn for everyone. By learning about anti-bullying tips in this guide, you can do your part to bully-proof your child against school bullies.
Here Is A Preview Of What You'll Learn...
- Facts about bullying
- Identify the various forms of bullying
- Effects of bullying
- What kind of people are vulnerable to bullying. How not to be one of them
- Who are the bullies. What make them become bullies
- How to deal with cyber bullying
- The seriousness of cyber bullying
- Forms of cyber bullying
- How to deal with malicious emails
For school staff (including teachers and counsellors)
- 6 effective ways to prevent bullying in the school bus
-4 ways to prevent a culture of bullying
- How to deprogram a bully
- How to integrate a disabled student in the classroom
For Parents
- What to do if your child is a bully
-What makes your child a bully
-Signs that your child is being bullied
-What to do when your child is being bullied - how to help your child
For Students
-How to deter bullying
-What to do when confronted by the bully
-How to deal with verbal bullying
-What to do after a bully incident
-How to get rid of the bully
-Healing therapy for the victim
-How to repair damage self esteem
The author, Anne Marie was a victim of school bullies. When she was in Primary School, the school bullies extorted money from her on a daily basis. She was deprived of her school pocket money and went hungry. The ordeal lasted six months. The problem was resolved after she confided her problem to her father.
Now as a mother, she does not wish any children to suffer the same fate as her. She believes that children are most vulnerable and if unchecked, this problem can lead to depression and suicide. It is her wish for every school to be a safe haven for children to learn, to grow and to be a place of happiness. There is no place for bullies in school.
For the safety and happiness of our children, we must bully-proof our loved one against school bullies.
People who read this also enjoyed
eBook Details
- Hope Publishing, July 2014
- Imprint:
Hope Publishing
- 9789810906979
- Language:
- English
- Download options:
- EPUB 2 (Adobe DRM)
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text: I love home brewing but you can make some real crap if you don't have recipes. If you want something to stockpile in case SHTF think about putting away light dried malt extract (DME). As long as you vacume pack it it will last forever. Wanna kill these ads? We can help!


text:
Hi! We're having an issue with the Featured Image being used with the excerpt. The plug-in is pulling the first image in the post instead of the Featured Image. Are my settings correct? I am using 2.1 of Posts for Pages. Thanks!
[posts-for-page order_by="date" order="DESC" num="15" use_wp_excerpt="true" read_more=" »" hide_post_title="false" force_image_width="150"]


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Life She Said She Didnt Need a Bigger Home
posted by June 17 at 12:38 PMon
And she was right. A year after Edith Macefield rejected a developer's offer to buy her house, Seattles most tenacious homeowner is dead.
Writes MyBallard.
Edith Macefield has passed away of natural causes, according to the King County Medical Examiners office. My Ballard has received a few emails in the last couple of weeks saying that ambulances have been seen coming and going from her home. She was 86 years old.
Edith lived in the same house on NW 46th St. for the last 56 years. She made national news in 2006 when she refused to sell her home for $1 million to developers. Construction crews then proceeded to build the development around her.
I know Im always chanting and ranting about the need for density, but every time I think about Macefields house surrounded by that humongous building, it makes me damn proud of her. Check out this excellent passage:
Inside, the place is clean and organized. Pictures of herself as a girl, posing with her mother and brother at Alki Beach, stand on bookcases. There are framed pictures of opera singer Enrico Caruso and composer Giacomo Puccini on one wall. A collection of glass animal figurines are lined up along every windowsill and sash. A bookcase is neatly stacked with old movies on video.
She has no regrets about refusing to sell her house. She said she doesn't mind the noise at the construction site. She turns the television up, or plays her opera so loud you can hear it outside.
"I went through World War II, the noise doesn't bother me," she said. "They'll get it done someday.
Macefields house shouldn't be torn downit should be preserved as a historic landmark of this building boom, a homage to tenacity and stubbornness. Happy travels, Edith Macefield.


text:
4 colors
Anniversary Sale
The North Face 'Andes' Down Jacket (Toddler Boys & Little Boys)
Sale: $56.90
After Sale: $85.00
Toddler Canada Goose 'Bobcat' Down Vest, Size 6-7
A durable water-repellent finish ups the cool-weather defenses of a lightweight down vest with a snuggly soft brushed-tricot interior. Reflective details increase visibility, while fleece-lined pockets keep fingers toasty warm-so your little explorer will be ready to face any adventure this season. Color(s): red, tundra blossom. Brand: Canada Goose. Style ... Learn More
Boy's Patagonia 'Nano Puff' Wind Resistant Water Resistant
Windproof and highly compressible, a lightweight jacket with abrasion-resistant quilting is an ideal warmth-adding second layer or a perfect top layer for high-output activities. A Deluge DWR (durable water-repellent) finish helps the quilted ripstop shell shed moisture. Color(s): andes blue, black, campfire orange, electron blue, fatigue green, forge grey, rusted ... Learn More
Boy's Nike 'Windrunner' Wind & Water Repellent Hooded
A classic sportswear look and light, weather-resistant fabric define this versatile full-zip jacket equipped with a breathable mesh lining, a multi-panel hood and ribbed stretch trim for a snug, comfortable fit. The raglan-sleeve construction allows him to move naturally. Color(s): black/wolf grey, obsidian/ royal/ green, obsidian/ royal/ red. Brand: NIKE. ... Learn More
Boy's Canada Goose 'Bobcat' Water Resistant Hooded Jacket,
A durable water-resistant finish ups the cool-weather defenses of a lightweight down jacket. Reflective details increase visibility, while fleece-lined pockets and banded cuffs help keep fingers toasty warm-so your little explorer will be ready to face any adventure this season. Color(s): polar camo, red. Brand: Canada Goose. Style Name: Canada ... Learn More
The North Face Boy's 'Resolve' Waterproof Jacket, Size
A breathable, waterproof jacket is designed with sealed seams and a chin guard for protection. Contrast lining and a stowaway hood are smart details. Color(s): athens blue, cosmic blue/ peel orange, cosmic blue/ red/ orange, graphite, honor blue, koi orange, lightning yellow, paprika red, red/ orange/ burnt olive green, solid ... Learn More
Canada Goose 'Rundle' Down Bomber Jacket with Genuine
Reinforced fabric at the elbows and a water-repellent finish add durability to a down-filled bomber jacket topped with a plush, fur-trimmed hood. Fleece-lined front pockets keep fingers toasty warm, and an internal media pouch with headphone loop keeps music safely accessible-making all his adventures soundtrack-ready. Color(s): black, pacific blue. Brand: ... Learn More
Boy's Canada Goose 'Logan' Down Parka with Genuine
Plush, genuine coyote fur trims the removable hood of a rugged parka filled with lofty 625-fill-power down and featuring a durable, water-repellent finish. High-performance Arctic-Tech fabric and a longer cut in back keeps him protected from the cold and wind, while graduated cuffs ensure that he can wear this modern style next winter. Color(s): graphite ... Learn More
Boy's Patagonia 'Lightweight Synchilla Snap-T' Fleece Pullover,
Cozy, double-faced fleece composes a lightweight pullover with elastic trim to trap body heat and repel light wind. A snap-close placket with a durable Supplex flap is easily managed while wearing gloves for quick venting and Y-Joint sleeves flex with him to allow a full range of motion without constriction. Color(s): ash ... Learn More


text:
QUINCY, Mass. — Ahold USA's Stop & Shop Supermarket Co., here, and Giant Food, Landover, Md., add "thousands" of HBC items to its everyday low price program, the chains said last week. Among the items with reduced prices are shampoo, hand soap, aspirin, cotton swabs, toothpaste and vitamins. "We're committed to bringing our customers great value every time they shop in our stores," said Andrea Astrachan, consumer advisor for Stop & Shop. "Now we've taken that commitment to another ...
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text:
Clinical features of photodamaged human skin are associated with a reduction in collagen VII
Version of Record online: 28 JUN 2008
DOI: 10.1046/j.1365-2133.1997.18471955.x
British Journal of Dermatology
Volume 137, Issue 3, pages 344–350, September 1997
Additional Information
How to Cite
CRAVEN, N.M., WATSON, R.E.B., JONES, C.J.P., SHUTTLEWORTH, C.A., KIELTY, C.M. and GRIFFITHS, C.E.M. (1997), Clinical features of photodamaged human skin are associated with a reduction in collagen VII. British Journal of Dermatology, 137: 344–350. doi: 10.1046/j.1365-2133.1997.18471955.x
Publication History
- Issue online: 28 JUN 2008
- Version of Record online: 28 JUN 2008
- Accepted for publication 22 March 1997
- Abstract
- References
- Cited By
Chronically sun-exposed or photodamaged human skin is characterized by a number of clinical features, including wrinkles. However, little is known about the molecular mechanisms that underlie these features. We investigated the hypothesis that the mechanism of wrinkle formation may involve loss of anchoring fibrils, composed mainly of collagen VII, which are important in maintaining dermal-epidermal junction integrity. Ten volunteers with moderate to severe photodamage of dorsal forearm skin were recruited to the study. Using immunohistochemistry, transmission electron microscopy and in situ hybridization, we compared collagen VII protein and mRNA content of photodamaged forearm skin with that of sun-protected hip and upper inner arm skin from the same subjects. Numbers of anchoring fibrils per linear μm of basement membrane (mean ± SEM) were significantly lower in photodamaged skin (1·79±0·10) as compared with sun-protected hip (2·28±0·11) and upper inner arm skin (2·21±0·10) (P<0·01), and similarly keratinocyte expression of collagen VII mRNA, quantitated as number of positively stained keratinocytes per high power field, was significantly reduced in photodamaged skin (6·3±2·5) as compared with sunprotected hip (20·0±5·6) and upper inner arm skin (17·7±4·9) (P<0·001). Semiquantitative assessment of immunohistochemical staining for collagen VII showed a non-significant reduction in photodamaged skin as compared with sun-protected skin. We propose that reduced content of collagen VII in photodamaged skin contributes to wrinkle formation by weakening the bond between the dermis and epidermis.


text:
Metachromatic leukodystrophy
- Leukodystrophy metachromatic
- Metachromatic leukoencephalopathy
- Sulfatide lipidosis
- Arylsulfatase A deficiency
Tests & Diagnosis
On this page
Newline Maker
Who might consider genetic carrier testing for a family history of metachromatic leukodystrophy?
If someone has a family history of metachromatic leukodystrophy (MLD) or someone is known to be a carrier for MLD, individuals who are biologically related to the affected individual or carrier are at risk to be a carrier. Generally speaking, the more closely related an individual is to the affected individual or carrier, the greater the chance for that person to be a carrier. Prior to genetic testing, the chance to be a carrier for some biological relatives of an affected individual are as follows:
- Parent of affected individual: assumed to be 100% (called an obligate carrier)
- Unaffected sibling of affected individual: 2 in 3 (~66.6%)
- Aunt or uncle of affected individual: 1 in 2 (50%)
- First cousin of affected individual: 1 in 4 (25%)
If someone has carrier testing and is found to be negative (not a carrier), that person's children are typically assumed to be negative also.
More information about the use of genetic carrier testing is available on GeneTests' Web site and can be viewed by clicking here.
Individuals who are interested in learning about genetic testing and about their specific risk to be a carrier should speak with a genetics professional.
- The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.
- Leukodystrophy metachromatic
- Metachromatic leukoencephalopathy
- Sulfatide lipidosis
- Arylsulfatase A deficiency


text:
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text:
Sending Flowers
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Main (616) 681-3736
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text:
Sixty years ago the oil ran out and debts were called in. Civil war followed that splintered America into warring fiefdoms. New San Diego is a technocratic utopia that offers the last bastion of peace and prosperity, provided you live within its walls. Drake McCoy is its best protector. McCoy, an expert marksman, defends the city from the numerous threats in the wasteland outside the walls. But when the oil rich Lone Star state sends a powerful army to steal New San Diegoâs energy technology, even Drakeâs leadership and skill may not be enough to fend off the siege.
SDCC: Marvel's "Doctor Strange" Combats "Death and Pain" in New Trailer
Comic Books, Film


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NFL's Vikings OK $1 Billion Stadium 10 Miles From Minneapolis
The Minnesota Vikings have agreed to help fund a proposed $1 billion, retractable-roof stadium project in Ramsey County's Arden Hills, the latest attempt by the National Football League team to get a new home after the Metrodome's roof collapsed last season.
The Vikings would commit $407 million to the project, or about 39 percent of the total cost, the team said yesterday in a news release. The team didn't say how the remainder of the stadium would be financed.
"Reaching an agreement with Ramsey County as our local partner is a major milestone in our efforts to finalize a long-term stadium solution," Vikings owner Zygi Wilf said in the release.
While the team appreciates other proposals made by Minneapolis and Hennepin County, "We believe the Ramsey County site offers the most benefits to our fans, the team and the state and is the ideal site for a new stadium," Wilf said.
The 260-acre site of the former Twin Cities Army Ammunitions Plant is about 10 miles (16 kilometers) from Minneapolis and St. Paul, the release said.
The Metropolitan Sports Facilities Commission, which owns the Metrodome, said in February it will spend about $18.1 million to replace the stadium's damaged roof before the start of the 2011 football season.
The roof, which comprises 10 acres of Teflon-coated fiberglass, collapsed Dec. 12 under the weight of 17 inches (43 centimeters) of snow, forcing the Vikings to relocate their final two home games of the season.


text:
Why the adolescent years matter
Adolescents, with their zest for life and their growing awareness of the world around them, can make an immense contribution to society if given the support and space they need to participate. As Serbia's burgeoning productive force, it is important for the country – as well as for individual adolescents – that the transition from childhood to adulthood goes well.
It is perfectly natural for adolescents to test the waters of adult life and explore new horizons. What matters is how far they go, and how many risks they take along the way. For some adolescents, the risks are greater and the consequences more severe.
Peer pressure, curiosity, and thrill seeking can lead even the most privileged adolescent to experiment with drugs, alcohol and sexuality. For others, poverty and isolation combine to push them towards drug abuse, alcohol abuse or sex work as a way to cope with, or escape from, their daily lives. The risks include violence, HIV infection, lost education and lost opportunity. The risks to their communities include the loss of a productive generation.
The situation in Serbia
Most adolescents in Serbia are in school. Most are healthy. And most make it through adolescence with no more than the usual teenage angst. But for those from the poorest families, from families in crisis, and from Roma communities, adolescence can be a time of growing risk and social exclusion.
The Government adopted a National Youth Strategy in 2008 and an Action Plan in 2009, and has established Youth Offices in more than 100 municipalities. But there is some way to go before the most marginalized adolescents achieve their full rights.
• An estimated 11 per cent of adolescents aged 15-18 are out of school, rising as high as 81 per cent of adolescents from Roma settlements.
While the overall HIV prevalence rate in Serbia is low, there is an intense concentration of infections among high risk groups, particularly injecting drug users and sex workers. And the younger they are, the greater the dangers. Up to 30 per cent of young drug users in Serbia are aged 15 years or younger when they first inject.While they are the most vulnerable, adolescents are the least likely to know the risks or how to avoid them, and least likely to have access to the services that they need.
What is needed
There is an urgent need for a stronger focus on the most excluded adolescents. Blanket approaches that treat all adolescents as equally vulnerable may overlook the severe problems facing those who are already marginalized.
(PDF documents require Acrobat Reader to view.)


text:
Originally posted on isportsweb.com | Last updated 10/27/13
Sunderland's Fabio Borini scores the late winner in the Tyne and Wear derby. There's life in the Black Cats yet In the North East football is religion and games don't come any bigger than Sunderland vs Newcastle. The clear favourites for the game were Newcastle, Sunderland hadn't won a game all season, have already sacked one managed and lost 4-0 last week in Gus Poyet's first game in charge. Form means nothing on derby day. The Mackems scored late to win 2-1 at the Stadium of Light to lift themselves off the bottom of the table. In a season that has been nothing but misery so far this result against the old enemy will be the perfect tonic on Wearside. There's no love lost between Jose Mourinho and Manuel Pellegrini Before we go into the events of the weekend let's have a little look at the backstory of these two managers. When Mourinho took over at Real Madrid it was at the expense of Pellegrini. The Chilean manager amassed a record amount of points (96) in his last season at the Bernabeu and the Madrid directors admitted that he would have kept his job Mourinho not become available. A bitter war of words ensued during their time in Spain but this weekend they faced each other for the first time on English soil. Sparks flew once more. Pellegrini was critical of Mourinho's exuberant celebration of Torres late winner and did not shake hands with his opposite number when the full time whistle came. Mark your calendars for February 1st, round two at the Etihad. SAS are showing no signs of slowing down This weekend saw a stunning hat trick from Luis Suarez and a sublime lob from Daniel Sturridge. The Premier League's' hottest strike partnership shows no sign of slowing down. That means that it's a total of 14 goals from 9 games combined, a figure which is even more impressive when you consider that Suarez's 6 league goals have come in just four games after serving his biting ban. The surprise package isn't a surprise any more Southampton marched on this weekend to another three points. The Saints are playing well and have impressed home and away this season. Their defence has impressed as well, this weekends' result meant that they have now kept six clean sheets in nine games in the league. A win at Anfield and a point from Old Trafford are just a few of Southamptons' achievements this year and if they keep playing like this Europe could be on the cards next season. Lukaku wins the battle of the Belgians Christian Benteke and Romelu Lukaku have been in impressive form this season and come the summer they could be competing for a starting place for Belgium at the World Cup. This weekend it was Lukaku staked his claim to that starting spot. The 6'3 striker scored a crucial goal to put Everton one up while Benteke saw his first half penalty well saved by Tim Howard.
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text:
I'm looking for a plugin that allows
different content to display in category archive page.
If I put the three categories into my WordPress, I would like to:
- one category on its archive page displays the whole post - post content,
- the other category on its archive page displays post excperts
- a third category displays just a post title.
Is this function - settings possible on the same installation of WP
and is there any plugin that allows something like that? Are there any codes that allow this function?


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Hourly - Entry Level ($) - Est. Time: 1 to 3 months, 10-30 hrs/week - PostedSkills: Organizational Development Sales Social Media Marketing
We are currently looking for a experienced Telemarketer that is comfortable and confident in making Outbound sales calls. Candidate must have previous experience and speak English well. We are paying $3 per hour plus bonuses for 20 hours per week.


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Ink is a television sitcom which aired on CBS from 1996-1997 that starred real-life husband and wife Ted Danson and Mary Steenburgen as newspaper journalists, allegedly inspired by the film His Girl Friday. The show was also produced by Danson and Steenburgen. The show was canceled after one season due to lower than expected ratings. The distribution rights to the series (which was produced by DreamWorks Television) are currently owned by Disney–ABC Domestic Television. The show's pilot was drastically changed and reshot from the original version. Wikipedia
|2 points


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This is a super FLASHY VERY NICE YOUNG 4 YR OLD CLYDESDALE MARE. She has four high socks and a big blaze face. This mare is broke to ride and drive. She…SOLD
This is a super nice 17 HAND CLYDESDALE GELDING that is broke to ride and drive. This gelding has been driven and ridden by kids and beginners. He has…SOLD
This is a 10 yr old CLYDESDALE CROSS gelding that has over 3000 miles in Wyoming's Yellowstone National Park. This gelding has been used as a guide horse…SOLD
This is a 5 yr old Clydesdale gelding that is broke to ride and drive. He has been ridden in the woods trail riding and crosses water, mud, ditches, etc…SOLD
This is DI'S CLYDES LADY MARGO, she is a registered with the CLYDESDALE BREEDERS OF THE UNITED STATES. She is a very well broke Clydesdale that has been…SOLD
This is a registered Clydesdale mare. She is registered with THE CLYDESDALE BREEDERS OF THE USA. She is broke to ride & drive. She is gentle and easy…SOLD
Big Dude is a Clydesdale/Quarter Horse who is a big gentle giant. Has been Search and Rescue certified for the San Bernardino County Sheriff Station. …SOLD


text:
Internet sign
Credit: Image Source
Creative #: 74410805
Licence type: Royalty-freeRoyalty-free pricing is based solely on the size of the product you need, not the specific use. You don't have to pay any additional royalties on a use-by-use basis. Once you license a royalty-free product, you may use it multiple times for multiple projects without paying additional fees. (Pornographic, defamatory, libellous or otherwise unlawful use of any image is, of course, prohibited.)
Collection: Image Source
Release info: No release required
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Internet Sign Stock PhotoCafe,Colour Image,Horizontal,Illuminated,Information Sign,Internet Cafe,Neon,No People,Orthographic Symbol,Outdoors,Photography,Red,Technology,Text,The InternetPhotographer Image SourceCollection: Image Source


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EL BESO by DRIVINGYOUWatch
Lucky, LUCKY shot.
Is this street or staged? Either way, I love it. There's a great sense of spontaneity about it
did you know them or are they strangers? it's an amazing capture!
fantastic shot! the atmosphere is amazing!
:] perfect.
love the focus.
love the focus.
This couldn't be more perfect...
love this picture! its one of those favourites that I keep going back again and again to
instant pic !!!
love it
love it
I've linked this beautiful thumb in my current journal... hope that's ok with you
...indeed a perfect moment... which you do so brilliantly
...indeed a perfect moment... which you do so brilliantly
momento perfecto, foto perfecta.
great snapshot
ey tnx for the link os this soundtrck love it so dearly!
fantastico, favorito para usted amigo
Great composition and focus.
A la Doisneau!
great one, just love it
amazing photo. love the emotion =]
great shoot
baiser volé...
Who can resist the woman in red
Who can resist the woman in red
great picture! really happy


text:
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Lives in Huntersville, NC, United States
Joined on Jun 27, 2007
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text:
Re: Seeking advice on auto refi after BK
Just sharing information for whomever it may help. I recently refi'd my car and was able to lower my rate from 8.15% to 5.25% with American Eagle. This CU only pulls Experian which was my best score. My loan to value on the car was about 30-40% which really helped. I didn't really care about the rate as much as having an installment account in good standing and closing the negative acccount. I took a 24 month term because there is so much emphasis on your last 24 months on scoring. I got my first credit alert since the change and my Equifax FICO on this site jumped from 608 to 642 based on the refi. I'm pretty happy because that is my midscore and I'm now eligible to apply for a home loan.


text:
I was just told by 1&1 customer support that "the date in the whois could show correctly while the nameservers information being the old one"
I though the whole document was stamped at once, not "built" from different data sources.
Am I being lied to? or how is that possible?
The site is not visible yet, the whois shows correct date the change was made, and the nameservers are still wrong in that report/record/document and of course in the world's dns servers.


text:
Skip to Main Content
IEEE membership options for an individual and IEEE Xplore subscriptions for an organization offer the most affordable access to essential journal articles, conference papers, standards,
eBooks, and eLearning courses.
Learn more about:
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This paper describes a Bayesian approach for modeling 3D scenes as collection of approximately planar layers that are arbitrarily positioned and oriented in the scene. In contrast to much of the previous work on layer-based motion modeling, which computes layered descriptions of 2D image motion, our work leads to a 3D description of the scene. There are two contributions within the paper. The first is to formulate the prior assumptions about the layers and scene within a Bayesian decision making framework which is used to automatically determine the number of layers and the assignment of individual pixels to layers. The second is algorithmic. In order to achieve the optimization, a Bayesian version of RANSAC is developed with which to initialize the segmentation. Then, a generalized expectation maximization method is used to find the MAP solution
A not-for-profit organization, IEEE is the world's largest technical professional organization dedicated to advancing technology for the benefit of humanity.© Copyright 2016 IEEE - All rights reserved. Use of this web site signifies your agreement to the terms and conditions.


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Q&A With Serj Tankian of System of a Down
Serj Tankian of System of a Down and Tom Morello of Audioslave started Axis of Justice, a nonprofit organization meant to be a central hub for social justice. Their most recent big event was to protest a new bill passed in Santa Monica making it illegal to hand out food to homeless people on the streets. They protested by marching, holding a news conference, and—yep—handing out lunches to homeless people. Serj said, "I'm not worried police are going to show up and arrest us—I'm worried homeless people are going to be hungry tonight."
Like most of the socially minded artists out there, Serj is also vegetarian. We sent him a note asking him to tell us about it. Short but sweet, his response is below …
peta2: Why did you decide to go vegetarian?
Serj: Touring and its variety of edible crap … as well as knowledge of industrial slaughterhouses. I also think it was instinctive somewhat …
peta2: Share your strategy for eating while traveling.
Serj: Make sure there is something on the bus beyond pizza. I try to order good food, one more chore for a tour manager to complain about.
peta2: What is your most important issue concerning animal rights?
Serj: Respect. … We all have to get life from Earth Mother to survive. … We need not to alter its already perfect state.
Thanks, Serj.


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Most people, including men, do not like to go to the doctor.
That is why the Southeast Alabama Medical Center has the Men's Health Fair every year.
This time, the free health screenings will be on Saturday, Aug. 10 from 8 a.m. until 11 a.m. at Northview High School.
In addition to the screenings, Ozark native and former Florida State Defensive Coordinator Mickey Andrews will speak as this year's spokesman.


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Relevant Radio
|Radio network
|United States
|United States
Key people
|Thomas Vorpahl, Chairman of the Board; Rev. Francis J. Hoffman, JCD, Executive Director
Launch date
|December 12, 2000
Official website
Relevant Radio (corporate name Starboard Media Foundation, Inc.[1]) is the second largest Catholic talk radio network in the United States, with 16 stations and 42 affiliates reaching 27 states. (The EWTN Catholic Radio Network has over 275 affiliates reaching 45 states.)[2] The network's National Headquarters and network studios are in Green Bay, Wisconsin, with additional studios in Minneapolis, MN, Madison, WI and Chicago, IL.
The network airs a variety of programming aimed at practicing Catholics, mostly in a listener-interactive talk format. "Morning Air", which the network describes as "a classic drive-time format that combines inspiration & entertainment" was the first program developed by Relevant Radio in 2003. The network now airs almost exclusive programming developed internally, which also is available to stream live or by podcast on a free mobile app.
The network was founded by a group of dedicated Catholic businessmen, including Bob Atwell and John Cavil (who founded WJOK 1050AM in 2000) and Mark Follett, who had been the owner of Anchor Foods, an Appleton-based distributor of frozen appetizers. Starboard bought the license to a radio station in Kaukauna, Wisconsin, that had been carrying all-sports programming, and turned it into an all-Catholic station, saying the call letters stood for "Jesus Our King". The station received its license from the FCC on December 12, 2000, the Feast of Our Lady of Guadalupe who is the patron saint of Relevant Radio. Saint John Paul II is also a patron saint.
The network has grown to 16 stations, including five in the top 25 radio markets, and 42 affiliated stations that carry some or all of Relevant Radio programming. It also offers live streaming from its website and podcasts of favorite show segments.
The network's current executive director is the Rev. Francis J. Hoffman, JCD. He started on air at Relevant Radio in November 2003 and was appointed executive director by the board of directors in April 2010.
Former CEOs include:
- Thomas Vorpahl, 2008-2010
- Patricia Leurck, 2006-2008
- Richard L. Lyles, 2006-2007
- Mark Follett, 2004-2006
- Sherri Brownrigg, 2004
- Steve Gajdosik, 2003
- David Vacheresse, 2002
On June 23, 2009, Relevant Radio's media contact Nancy Jensen released an announcement [3] regarding a new programming line-up. This update revealed that On Call w/ Dr. Ray would now be replaced with On Call as hosted by Wendy Wiese.
Station list[edit]
See also[edit]
- "Catholic network calls Green Bay home", Green Bay News-Chronicle, date uncertain, 2004. (Newspaper now defunct)
- ^ "Company Overview of Starboard Media Foundation, Inc.". Bloomberg Businessweek. Businessweek.com. Retrieved 30 August 2014.
- ^ http://ewtn.com/radio/radioaffiliatemap
- ^ http://www.relevantradio.com/Document.Doc?&id=317
- ^ Relevant Radio Stations - Relevant Radio
- ^ Affiliate Stations - Relevant Radio


text:
US Mileage Charts
- Downloads:
- Views:
- Rating:
US Mileage Charts and Tables in Excel format, including travel times and distances for both the fastest and shortest routes.
Includes sets of tables for every US State, and one large pan-US chart.
Total: 204 tables in 51 files. Over half a million distances and times.
Data is supplied in a zip of industry-standard Excel formats to allow easy accessibility. Cities are chosen according to population based on US 2000 Census data.
Free download from Shareware Connection - US Mileage Charts and Tables in Excel format, including travel times and distances for both the fastest and shortest routes. Includes sets of tables for every US State, and one large pan-US chart.
Version: 2 | Size: 1267 KB | Platform: Not Applicable
Released Date: 13-11-2006 | Rating: 0 | Title: US Mileage Charts
Author Url: http://www.mapping-tools.com
Program Info Url: http://www.mileage-charts.com
Download Url: http://www.mileage-charts.com
Screenshot Url: http://www.mileage-charts.com/public/DE_shortdist_example.png
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MPRouteWriter - Imports and Exports MapPoint waypoints and pushpins in route-order. MapPoint always re-arranges pushpins when it does this. Exports routes directly to Excel or a text file; or you can create a route from pushpins in a pre-determined order.
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Mileage Charts for North America - N.
International Mileage Charts - These International OSM charts are intended to complement our existing North American and European charts, but cover all countries in the world.
Czech Republic Mileage Chart - Czech Republic Mileage Chart consists of a Microsoft Excel 2007 workbook containing four mileage charts giving distance and travel time route lengths for all fastest and shortest routes between the listed cities.
Latvia Mileage Chart - Latvia Mileage Chart consists of a Microsoft Excel 2007 workbook containing four mileage charts giving distance and travel time route lengths for all fastest and shortest routes between the listed cities.
Shareware Connection periodically updates pricing and software information of 'US Mileage Charts' from company source 'Winwaed Software Technology LLC' , so some information may be slightly out-of-date. You should confirm all information before relying on it. Software piracy is theft, Using 'US Mileage Charts' crack, password, serial numbers, registration codes, key generators is illegal and prevent future development of US Mileage Charts.
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text:
Cambodia's political rivals agreed Monday to seek a peaceful way out of the crisis gripping the kingdom following violent clashes that left one demonstrator dead and several wounded.
Prime Minister Hun Sen, who has ruled for 28 years, met opposition leader Sam Rainsy for nearly five hours at parliament to discuss turmoil sparked by the strongman leader's disputed election win in July.
In a joint statement released afterwards, they said they had agreed on three points -- to heed the king's call for an end to the violence, to set up a mechanism to bring about election reform in the future and to continue negotiations.
The two sides, however, remained at odds over the opposition's demand for the creation of an independent "truth committee" to investigate the July polls, a spokesman for Rainsy's Cambodian National Rescue Party (CNRP), Yim Sovann, told reporters.
He said the opposition would continue its three-day mass protest, which is due to run until Tuesday.
But there was still enough time for the two parties to seek a solution before the opening of the parliament scheduled for next Monday, which the opposition has threatened to boycott, he added.
The talks followed violent clashes in the capital Phnom Penh Sunday on the fringes of a mass demonstration that drew an estimated 20,000 opposition supporters demanding an independent probe into the vote.
Security forces fired smoke grenades, tear gas and water cannon at rock-throwing protesters.
The opposition blamed the authorities for the death of a protester who, according to witnesses, was shot in the head.
"The CNRP strongly condemns the cruel violence by police who shot and beat people... causing a youth to die and many injuries and arrests by the authorities," it said in a statement.
Military police spokesman Kheng Tito denied the security forces had fired live ammunition.
"The military police used only batons and shields and police used tear gas. We did not use live rounds," he said late Sunday.
An estimated 8,000 opposition protesters joined a second protest in a park in the capital on Monday to maintain pressure on Hun Sen.
"We voted for the CNRP, but our will has been stolen," Lev Yeng, 57, told AFP.
"I am hopeful we will get our demand. I will not go back home until we get justice."
Hun Sen, 61, has vowed to rule until he is 74.
His government is regularly accused of ignoring human rights and suppressing political dissent.
Rainsy, a French-educated former banker, was barred from running in the July elections because his name was removed from the electoral register last year following criminal convictions he contends were politically motivated.
Sunday's violence came despite a rare meeting on Saturday between Rainsy and Hun Sen, hosted by King Norodom Sihamoni, that was later described by the opposition leader as a "first step" towards ending the crisis.
In a statement released on Monday, Sihamoni offered condolences to the families of the dead and injured.
"I would like to appeal to compatriots -- both demonstrators and the authorities -- to stop all violence such as throwing rocks and using weapons that would inflict injuries and death and cause serious danger to our entire nation," he said.
Cambodia expert Carl Thayer, a professor at Australia's University of New South Wales, said the involvement of the king was a "circuit breaker that could save face on both sides".
"Rainsy might be enticed into attending the opening of the National Assembly in return for some minor concessions into looking at electoral reform. Hun Sen's position appears safe at the moment, but he cannot let the security forces lose control," he said.
According to final election results, Hun Sen's Cambodian People's Party (CPP) won 68 seats in the July polls against 55 for the opposition.
The CNRP has rejected the tally, alleging widespread vote rigging, but so far its efforts to challenge the results have failed and it has few formal options left in its bid to overturn Hun Sen's victory.


text: Hi my blog's (Link) categories and the blogroll is not showing. There's something wrong with the theme, when I changed the theme to the original it showed the categories and blogroll but when I changed back still it doesn't show. Can anyone tell me how to make it show please. Thanks in advanced


text:
facebook fans and twitter followers or penal need ! cheap prices only
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Project Budget$10 - $30 USD
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