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Patent application title: LASER BEAM DERMATALOGICAL HEAT TREATMENT DEVICE
Alain Cornil (Aix En Provence, FR)
Alban Gosse (Mimet, FR)
Patrick Peronne (Paris, FR)
IPC8 Class: AA61B1820FI
USPC Class:
606 9
Class name: Instruments light application dermatological
Publication date: 2010-12-02
Patent application number: 20100305554
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A device for dermatological treatment, includes an energy source, the
energy source generating a quasi-Gaussian laser beam, characterised in
that it includes an element for shaping the beam between the energy
source and a source to be treated, the shaping element being adapted for
converting the beam into a beam having a power distributed homogenously
on a given surface, and in that the device further includes a removable
and replaceable optical unit.
1. A dermatological treatment device comprising an energy source, the
energy source emitting a quasi-Gaussian laser beam, characterised by the
fact that it includes a means of shaping the beam between the energy
source and the zone to be treated, the means of shaping being suitable
for converting the beam into a beam, the power of which is distributed
homogeneously over a given area, and by the fact that in addition the
device includes a detachable and interchangeable optical unit.
2. Treatment device as claimed in claim 1, characterized by the fact that the means used to shape the laser beam (61) is suitable for converting the beam into a beam with a flat-top profile (510).
3. Treatment device as claimed in claim 1, characterized in that the means used to shape the laser beam (61) includes at least one lens array (64) and one cylindrical lens (66).
4. Treatment device as claimed in claim 1, characterised in that it includes an optical fibre (63) placed in front of the energy source (62) in order to reduce the divergence of the energy source (62) fast axis.
5. Treatment device as claimed in claim 1, characterised in that it includes a means of pyrometry (712).
6. Treatment device as claimed in claim 1, characterised in that it includes a user interface including at least one of the following components: an LCD screen (75), an emergency stop button (76), a on/off button (77), a double button system (88), an indicator light (89) and a buzzer (717).
7. Treatment device as claimed in claim 1, characterised in that the energy source is a diode (62) the wavelength of which is between 800 nm and 1800 nm, and preferably between 810 nm and 910 nm.
8. Treatment device as claimed in claim 1, characterised in that it includes a battery system (71) for autonomous operation.
9. Treatment device as claimed in claim 1, characterised in that it includes an RFID reader (711) in order to ensure the device can be safely used.
10. Treatment device as claimed in claim 9, characterised in that the range of the RFID reader is less than 5 mm.
11. Dermatological treatment device as claimed in claim 1, characterised in that it includes a microcontroller (111) for managing the energy source.
12. Dermatological treatment device as claimed in claim 1, characterised in that it includes a recess (83), positioned downstream of the laser beam shaper output in order to ensure there is a distance between the shaper output and the treatment zone.
13. Treatment apparatus containing a device as claimed in claim 1, characterised in that it additionally includes a sterilisation sleeve (80).
14. Treatment apparatus as claimed in claim 13, characterised in that it includes an RFID component (151) included in the sterilisation sleeve (80).
15. Dermatological treatment device including a device as claimed in claim 1 and an RFID component, characterised by the fact that the RFID component (92) is designed to transmit information about the treatment zone to the device.
16. Dermatological treatment equipment as claimed in claim 15, characterised in that the device includes a microcontroller (112) for managing reading of the RFID component (92).
17. Dermatological treatment equipment as claimed in claim 15, characterised in that the RFID component (92) interacts with the energy source by means of a contact.
18. Dermatological treatment equipment as claimed in claim 15, characterised in that the energy source operating settings are memorised in the RFID component (92) and communicated to the energy source control device.
19. Dermatological treatment equipment as claimed in claim 15, characterised in that the RFID component (92) operates at a frequency of between 13 and 14 MHz.
20. Dermatological treatment equipment as claimed in claim 15 characterised by the fact that the RFID component (92) includes a means of storing information characterising a status of the area to be treated, the information corresponding to one of the following statuses:the area to be treated has not been treated.the area to be treated is in the course of treatment.treatment of the area to be treated has finished.
21. Dermatological treatment equipment as claimed in claim 15, characterised in that the device, upon receiving information about the status of the zone to be treated, includes the means of preventing reuse of any adhesive attachment element containing an RFID component (92) which has already been used once to treat the treatment zone.
22. Dermatological treatment equipment as claimed in claim 15, characterised in that the RFID (92) component is contained in an adhesive element (90), the adhesive element (90) being positioned close to the area to be treated.
23. Dermatological treatment equipment as claimed in claim 22, characterised in that the RFID component (92) includes means to prevent reuse of any adhesive attachment element (90) which has already been used to treat a treatment zone.
24. Treatment unit, characterised by the fact that it includes an apparatus as defined in claim 13 and the treatment device includes an RFID reader (711).
25. A process for using the treatment unit according to claim 24 comprising the following stages:Querying by the RFID reader (711) of the treatment device of the sterilising sleeve's (150) RFID component (151) in order to obtain information characterising the sleeve's state of sterilisation and/or the sleeve's last date of sterilisation.A decision on the basis of this information whether the sleeve can be used or not.According to the decision taken in the previous stage, authorise the device to fire or not.
26. Process according to claim 25, characterised by the fact that in addition it comprises the following stages:once use of the device finishes, the RFID reader (711) changes the information in the sleeve's RFID component so as to prevent the sleeve being used again without sterilisation.
[0001]This invention relates to the treatment of a patient's skin wounds
with a laser beam, and more specifically a device for such treatment.
[0002]Various solutions for promoting wound healing by using an external energy source are known in the current state of the art. They consist of treating the tissue with light energy emitted by a laser source in order to selectively heat specific parts of the skin, during a very short laser firing time (less than one second). The selective nature of the treatment means temperature increases in the irradiated tissue areas are restricted.
[0003]The wavelength of the laser beams is chosen according to the area to be treated. In laser hair removal, the wavelength corresponds to the absorption peaks of melanin, the main constituent of the hair bulb.
[0004]The laser acts by producing a laser light pulse that is selectively absorbed by the lesion to be treated, on the basis of its colour, without damaging the surrounding tissue.
[0005]European patent application EP265470 also describes a device which is used for uniting the lips of a wound comprising a laser the emission wavelength of which is chosen such that it can perform tissue bonding and unite the lips of the wound, and a holding piece suitable for being secured to the tissue around the wound so as to hold the lips of said wound in contact, at least while the wound is exposed to said laser radiation.
[0006]The key idea is to unite both skin and vessels, by using sufficient laser energy to achieve an increase in tissue temperature beyond 60° C., suitable for denaturing and achieving interdigitation of the collagen fibres. This temperature is currently acknowledged to be the level above which irreversible heat damage is caused if tissue is heated for longer than one second, leading to tissue coagulation and necrosis through burning which slows and reduces the quality of the healing process.
[0007]In general, the prior art aims to apply electromagnetic energy emitted by a laser or radio frequency (RF) source to the tissue such as to selectively heat specific parts of the skin, with a variety of different approaches: [0008]For techniques targeting small structures, the irradiation times are very short, less than the thermal relaxation time in the targeted zone. This is the case for hair removal systems and the treatment of vascular lesions. In both cases, the laser beam wavelength is selected according to the area to be treated. In laser hair removal, the wavelength corresponds to the absorption peaks of melanin, which is the main constituent of the hair bulb (documents U.S. Pat. Nos. 5,595,568 and 5,735,844). Vascular laser treatment involves a wavelength selected for maximum absorption by the haemoglobin. [0009]For deep structures (the dermis for example): the principle of selectivity is achieved by combining the RF or laser source with a surface cooling system that reverses the temperature gradient, thus preserving the surface structures. This is the case in RF (document U.S. Pat. No. 5,755,753) or laser remodelling techniques. [0010]A third approach to selectivity combines both solutions and can also be used in conjunction with pressure that is applied to reduce the quantity of blood and hence of haemoglobin, which could interfere with the treatment, in the skin (document U.S. Pat. No. 5,630,811).
[0011]To conclude, in the prior art, the use of a laser beam, which generally has a conventional Gaussian profile, has a major disadvantage. The energy distribution is similar to that of a Gaussian function, with the direct consequence of heating the skin surface in a non-uniform and selective manner, with a major temperature peak in the centre of the irradiated zone, which would cause a temperature gradient that is too great with respect to the precision of the temperature range in which it is desirable to operate.
[0012]One aim of the present invention is to seek to improve the prior art in order to solve the aforementioned problem.
[0013]To this end the invention embodies a dermatological treatment device comprising an energy source, the energy source emitting a quasi-Gaussian laser beam, characterised by the fact that it includes a means of shaping the beam between the energy source and the zone to be treated, the means of shaping being suitable for converting the beam into a beam, the power of which is distributed homogeneously over a given area, and by the fact that in addition the device includes a detachable and interchangeable optical unit.
[0014]This homogeneous distribution of power is used to achieve selective yet overall and homogeneous heating across the tissue area to be treated, in order to activate tissue healing processes.
[0015]Advantageously but optionally, the invention includes at least one of the following features: [0016]the means used to shape the laser beam are suitable for converting the beam into a beam with a flat-top profile. [0017]the means used to shape the laser beam include at least one lens array and one cylindrical lens. [0018]the device includes an optical fibre placed in front of the energy source in order to reduce the divergence of the energy source fast axis. [0019]the device includes a means of pyrometry. [0020]the device includes a user interface including at least one of the following components: an LCD screen, an emergency stop button, a on/off button, a double button system, an indicator light and a buzzer. [0021]the energy source is a diode, the wavelength of which is between 800 and 1,800 nm, and preferably between 810 nm and 910 nm. [0022]the device includes a means of energy storage (battery) for autonomous operation. [0023]the device includes an RFID (Radio Frequency Identification) reader in order to ensure the device can be safely used. [0024]the range of the RFID reader is less than 5 mm. [0025]the device includes a microcontroller for managing the energy source. [0026]the device includes a recess, positioned downstream of the output from the laser beam shaper in order to ensure there is a distance between the shaping device output and the treatment zone.The invention also relates to a treatment kit comprising a device as claimed in the invention, and which additionally includes a sterilisation sleeve.
[0027]The invention also relates to a sterilisation sleeve.
[0028]The invention also relates to a dermatological treatment device and a dermatological treatment process whereby: [0029]the dermatological treatment device includes a device as claimed in the invention and an RFID component, the RFID component being designed to transmit information about the treatment zone to the device. [0030]the device includes a microcontroller for managing the process by which the RFID component is read. [0031]the RFID component interacts with the energy source by means of a contact. [0032]the operating settings of the energy source are memorised in the RFID component and communicated to the energy source control device. [0033]the RFID component includes a means of storing information characterising a status of the area to be treated, the information corresponding to one of the following statuses: [0034]the area to be treated has not been treated. [0035]the area to be treated is in the course of treatment. [0036]treatment of the area to be treated has finished. [0037]the RFID component operates at frequency of between 13 and 14 MHz. [0038]the device, receiving information about the status of the zone to be treated, has a means of preventing the reuse of the adhesive element containing an RFID component when this has already been used once to treat the treatment zone. [0039]the RFID (92) component is contained in an adhesive element (90), the adhesive element (92) being positioned close to the area to be treated. [0040]the RFID component includes a means of preventing the reuse of the adhesive element if this has already been used to treat a treatment area. [0041]the RFID (92) component being included in the sterilising sleeve. [0042]the RFID (92) component being included in a portable element.
[0043]the portable element is chosen from the following group: nametag, telephone, bleeper, id card.
[0044]The invention also relates to a dermatological treatment process, whereby: [0045]the process is preferably suitable for biochemical activation of the healing of a patient's skin wounds, using a treatment device as claimed in the invention, and whereby the process includes a stage in which a laser beam is applied to an area of the said patient's skin, and whereby the power of the said beam is distributed homogeneously across the whole area. [0046]in addition, the process includes the following prior step: the treatment device is placed in a sterilising sleeve. [0047]in addition, the process includes the following steps: [0048]affixing an adhesive element in the vicinity of the zone to be treated. [0049]selecting an optical unit for the device. [0050]bringing the device close to the wound so that the RFID reader can read information from the RFID component. [0051]applying the laser beam to the area to be treated.
[0052]Further characteristics, aims and advantages of this invention will become clear through reading the detailed description below and referring to the drawings appended hereto, given by way of non-exhaustive examples and wherein:
[0053]FIG. 1 is a graph illustrating a logarithmic relationship between exposure time and temperature for inducing a heat shock response.
[0054]FIG. 2 is a graph illustrating the different phases of healing of a cutaneous wound.
[0055]FIG. 3 is a graph illustrating the different absorption coefficients of the main chromophores as a function of the wavelengths of the laser source emitted.
[0056]FIG. 4 is a graph illustrating the skin penetration (as a percentage) of a laser beam as a function of its wavelength.
[0057]FIG. 5 is a graph illustrating a conventional laser beam profile and a laser beam profile as claimed in the invention.
[0058]FIG. 6 gives a schematic illustration of a laser beam conversion device as claimed in the invention.
[0059]FIGS. 7 and 8 are diagrams illustrating a dermatological treatment device as claimed in the invention.
[0060]FIG. 9 is a simplified diagram of a skin closure strip as claimed in the invention.
[0061]FIG. 10 illustrates the design that could be printed on a skin closure strip as claimed in the invention.
[0062]FIG. 11 is a schematic representation of the communications between an RFID component and the two microcontrollers in a device as claimed in the invention.
[0063]FIGS. 12a to 12c are graphs illustrating various temperature increase scenarios on the surface of an area of treated tissue.
[0064]FIGS. 13 and 14 are logic flowcharts showing the processes at work in the microcontrollers in a device as claimed in the invention.
[0065]FIG. 15 represents a device and a sleeve as claimed in a particular embodiment of the invention.
[0066]FIG. 16 represents a device and portable elements as claimed in a particular embodiment of the invention.
[0067]The invention is based on moderate heating to provide heat treatment to a limited volume of cutaneous tissue surrounding and including a present or future cutaneous lesion (a future lesion, for instance, in the case of surgical incisions). As stated above, it is not a matter of selectively heating one or more skin constituents, but effectively heating the whole of an area located throughout the thickness of the skin (epidermis, dermis, upper layer of the subcutaneous tissue) to generate a biological response to the heat stress or thermal conditioning throughout the tissue. The choice of beam and all related parameters is therefore based on these specifications.
[0068]FIG. 1 illustrates a logarithmic relationship between exposure time on the y-axis (units in seconds) and the temperature for inducing a heat shock response along the x-axis (units in degrees Celsius). Heat shock response is a cellular mechanism used to maintain stability when a shock (e.g. heat shock) is undergone. The heat shock response often involves the production of heat shock proteins (HSP), a protein group that can help accelerate the healing process.
[0069]The invention does not aim to alter the cell structure, but to influence the healing process by inducing HSP production. Indeed, uncontrolled hyperthermia can quickly lead to tissue damage and consequently to tissue denaturing and destruction. Using thermal conditioning, the invention provides for induction of a localised fever, the maximum temperature of which is controlled to avoid the appearance of tissue damage.
[0070]By directing a source of electromagnetic energy such as a laser at the wounded tissue zone, thermal conditioning is induced such as to alter the inflammatory process. The link between a controlled temperature increase (moderate hyperthermia), HSP production and the inflammation process has already been established in the prior art.
[0071]As shown in FIG. 2, the healing process can be broken down into three phases following the initial thrombosis:
[0072]inflammation (21),
[0073]proliferation (22) and,
[0074]remodelling (23).
[0075]The x-axis of this graph shows the time since the start of healing and the y-axis shows a given heat shock response level and hence a level of HSP production.
[0076]The process of treating a patient's skin wounds using a laser beam consists of directing light energy onto the tissue with the aim of generating moderate and controlled hyperthermia as early as possible in the healing process in order to prevent scarring and accelerate tissue regeneration, rather than correcting this scarring once the scar itself has appeared. The time at which the wound is treated must therefore be selected carefully with respect to the inflammation phase.
[0077]An optimum treatment window should be defined, to ensure that the peak of HSP production coincides with the inflammation phase. Since the HSP production peak may occur up to 24 hours after heat stress has been undergone, the conditioning treatment may take place up to 24 hours before the lesion appears.
[0078]Beam Selection:
[0079]The choice of beam and all related parameters is based on precise specifications. A digital simulation model was used, based on the finite element method, taking into account interactions between the light and the main chromophores in the treatment region, in order to confirm the theoretical choices.
[0080]Wavelength Selection:
[0081]FIG. 3 is a graph with three curves showing the energy absorption coefficient (y-axis) as a function of the energy wavelength (x-axis) for the following skin constituents:
[0082]melanin, shown as curve 301,
[0083]haemoglobin, shown as curve 302,
[0084]water, shown as curve 303.
[0085]FIG. 4 is a graph showing the rate of absorption of each skin layer for each wavelength.
[0086]Referring to these figures, we can see that light absorption by the various chromophores can vary considerably according to the wavelength.
[0087]Since the melanocytes are located in the basal layer of the epidermis, the wavelength must be greater than 800 nm in order to pass through this layer without being fully absorbed. At wavelengths of less than 590 nm, haemoglobin is the predominant chromophore and is therefore highly absorbent. However, at red and near-infrared wavelengths (between 600 nm and 1000 nm), there is relatively little absorption since neither water nor blood absorb energy at these wavelengths. Finally, for wavelengths greater than 1800 nm, absorption of water is extremely high and this absorption becomes the predominant factor.
[0088]The range of wavelengths to be used must therefore be between 800 nm and 1800 nm. In a preferred embodiment, the wavelength will be 810 nm or 910 nm. Advantageously, wavelengths of 1,200 nm would minimise absorption by melanin, but current technology does not provide a sufficiently powerful beam from a laser diode source at this wavelength.
[0089]Spot Shape Selection:
[0090]The shape of the laser spot must also be designed in order to provide deep heating and stimulate all tissues involved in the skin wound healing process: the hypodermis, dermis, and epidermis. Since depth is near-proportional to the laser spot diameter, a diameter greater than or equal to 3 mm will be preferred in the case of a round spot. Ideally, the spot shape could also be tailored to the geometry of the area to be treated, to enable the most homogeneous distribution possible of light energy within the target tissue. In a preferred embodiment, a rectangular spot shape whose width is at least 3 mm and whose length may be several centimetres could be used to treat linear wounds.
[0091]Temperature Precision in the Heated Volume and Laser Beam Profile:
[0092]The invention additionally relates to the temperature precision achieved within the heated volume. The digital model developed can be used to optimise all parameters and achieve a minimum temperature of 45° C. (temperature required to induce heat stress) and a maximum temperature of 55° C. As described in the prior art, temperatures in excess of 60° C. can induce protein denaturing and therefore counteract the desired effect. The maximum temperature of 55° C. means that this threshold value will not be exceeded.
[0093]For these reasons, and as shown in FIG. 5, which illustrates both a conventional Gaussian beam profile (curve 512) and the beam profile of a device as claimed in a possible embodiment of the invention (curve 510), a conventional Gaussian beam profile is not the most suitable profile. Indeed, as the name suggests, the energy distribution is similar to a Gaussian function, which has the direct effect of heating the skin surface in a non-uniform manner, with a major temperature peak in the centre of the irradiated zone. The temperature gradient will therefore be too great as compared with the precision of the temperature range in which it is desirable to operate.
[0094]A flat-top (or top-hat) profile (510) is consequently to be preferred to a Gaussian profile in order to ensure the skin surface temperature is homogenised, and therefore the temperature in the volume heated.
[0095]This flat-top power profile, shown as curve 510, gives a more homogeneous heating effect throughout the heated area, rather than a selective heating action. This profile is defined by two components: [0096]the ratio of wavefront width (515) to full-width half-maximum (FWHM) (514). [0097]the rate of variation (516) along the wavefront width (515). [0098]and nominal power (518) which is the mean power along the wavefront width (515).
[0099]One feature of a flat-top profile is a minimal rate of variation (516) along the wavefront width, with a maximal wavefront width-to-FWHM ratio. Advantageously, a flat-top profile will have a rate of variation of less than 5% and a ratio of wavefront width-to-FWHM of greater than 90%.
[0100]The spot shape will depend on the medical indication. In a preferred embodiment and in a configuration chosen for treating incisions, the spot dimensions will be 20 mm by 4 mm, and the rate of variation less than +/-20% of nominal power (518).
[0101]In order to achieve this particular profile, the invention provides a means for shaping the laser beam emitted by the diode (since the laser beam has a Gaussian profile on output from the diode). The system in question is shown in FIG. 6.
[0102]In one possible embodiment of the invention therefore, the means of shaping the laser beam (61) is positioned downstream of a laser diode (62), advantageously characterised in that its emission width is 200 μm by 5 μm and its divergence is 8×35°. An optical fibre (63) positioned in front of the diode acts as a cylindrical lens to reduce divergence of the diode's fast axis advantageously to approximately 5°. The laser beam then passes through the laser beam shaper (61), which comprises a system of two lens arrays (64) and a cylindrical lens (66), which splits the original beam into as many beams as there are lenses in the lens array (64). Each sub-beam is focused at the desired distance and all these beams are then superimposed to achieve a flat-top profile.
[0103]The beam's focal distance depends chiefly on the focal length of the cylindrical lens. The homogeneous nature of the profile depends however both on the focal length of the cylindrical lens and on the focal lengths of the two lens arrays. Furthermore, to achieve the most homogeneous flat-top beam possible, the input beam must strike as many lenses in the array as possible (the greater the number of sub-beams formed, the more the sub-beams tend to a flat-top profile when combined). There is, therefore, a balance to be struck between the distance between the diode and the first lens array and the angle of divergence, in order to maximise the homogeneity of the flat-top profile, whilst reducing the length of the final system.
[0104]In order to make the technique as accessible to as many users as possible, the device is designed to be easy and safe to use under all circumstances and in all locations in which it may be used, from a general practitioner's surgery to the sterile environment of an operating theatre. Since users of the device may need to travel or make regular visits, the size and portability of the device is also a key factor. In addition, as described above, the invention provides for the light source to be applied as early as possible in the healing process in order to prevent the appearance of scarring, rather than correcting this once the scar has appeared. For this purpose, users need a medical device that can enable early intervention, i.e. directly in the operating theatre in a sterile environment.
[0105]The medical device should therefore be designed to be small, portable, easy to use with one hand and autonomous (wireless) and further designed to avoid jeopardising the cleanliness or sterility of the environment in which it is used.
[0106]One embodiment of a device as claimed in the invention will now be described, referring to FIGS. 7 and 8.
[0107]A dermatological treatment device (70) as claimed in the invention, which comprises a closed optical unit (722), including at least one laser system (72) comprising a power laser diode whose wavelength is between 750 nm and 1400 nm and whose power is greater than 1 W and less than 25 W, and a conversion means (74) consisting of a lens array or a phase array. The laser system (72) and conversion means (74) are designed to emit a laser beam with the aforementioned advantageous characteristics. The optical unit (722) may also include a sighting laser (73), whose power is less than 1 mW for instance, in order for said sighting laser to provide comfort in use and not generate any biological response. In order to ensure this sighting laser (73) is visible, its wavelength may for instance be between 480 nm and 650 nm (red colour).
[0108]The invention provides for the optical unit (722) to be removable and interchangeable in order to facilitate maintenance of the treatment device (70) and ensure its flexibility (ability to change diode type according to the desired treatment type). The invention therefore provides the device user (e.g. medical practitioner) with a panel of optical units, each of which will have different configurations while at the same time complying with safety-related constraints (the user cannot change the settings him/herself).
[0109]The treatment device (70) also comprises a battery element (71) so that the device can be fully independent from the point of view of its energy supply. This battery may be interchangeable.
[0110]The treatment device (70) includes one or more electronic circuits (710) whose function is to manage the general power supply to the device and to the various components included in the device.
[0111]The treatment device includes an RFID reader (711) (e.g. RFID antenna), used to make the device safe by ensuring that the laser only fires when it is in the vicinity of an RFID component (tag) affixed close to the treatment area, thus preventing any risk of harm for the user, patient and other nearby persons. This system also enhances treatment safety by reading pre-recorded settings from the tag, meaning that the practitioner cannot accidentally change any parameter that is potentially dangerous to the patient (chiefly laser power and firing time). The laser firing settings are controlled on the basis of information transmitted by the RFID component, which contains parameters that can be used to adjust the firing power, firing time and number of pulses, according to the user's choices.
[0112]The user will select the component according to the nature of the treatment to be performed, and the tag selected will transmit a signal or information to the receiver which will control the laser emissions. The component consists for instance of a patch formed by a piece of adhesive fabric that includes a radio frequency identification (RFID) tag, consisting of an antenna design that enables inductive coupling for powering a high frequency component and transmission of a high frequency signal emitted by this component.
[0113]The component must be placed close to the treatment zone such that the treatment device (70) is within interaction range of the tag throughout the duration of treatment.
[0114]These RFID components are widely described in the prior art. However, the invention envisages that the RFID component also plays a role in automating the process. In fact, the RFID component has an identifier which refers to a settings table in the laser software. This table contains preset values for firing power and firing time and also the type of patient to be treated (for a safety check by the practitioner). When using the device, the user simply selects the safety strip (containing the RFID components) based on the patient's skin phototype and indication (wound, acne treatment, skin remodelling etc.). Unlike other laser systems on the market, the user cannot adjust the operating settings. Treatment parameters are therefore based solely on the choice of strip containing the treatment identifier.
[0115]Advantageously, the distance between the RFID component and the treatment device (70) is between one and fifteen centimetres. This distance is assessed by the limited range of the means of interaction between the component and treatment device (70) or by a range-finder, for instance an ultrasound range-finder integrated into the device.
[0116]The treatment device also includes a pyrometer (712), used to monitor the temperature increase that can cause superficial burning (temperature greater than 60° C.). The pyrometer (712) is used to set up a closed loop on the laser beam. The pyrometer (712) is in fact a safety component that monitors skin surface temperature. It operates to "lock down" or deactivate laser firing if the temperature reaches a preset threshold value. The pyrometer (712) can also be used in a more advanced way within a closed control loop in order to readjust the laser settings.
[0117]In general, the temperature at the surface and deeper in the epidermis will depend on a variety of parameters such as:
[0118]1--wavelength, which is a key factor in the absorption and scattering of light by the various chromophores (water, haemoglobin, melanin).
[0119]2--laser power, causing heating to a greater or lesser depth.
[0120]3--spot shape and size, which influences the heat distribution at depth.
[0121]4--beam profile, which has a direct input on the temperature gradient across a beam cross-section (Gaussian profile, flat-top profile).
[0122]5--firing time which, associated with a given power, if it is long promotes a heat diffusion heating system.
[0123]6--finally, parameters directly related to the patient, the most significant of which is likely to be the skin phototype.
[0124]There may not therefore be a general correlation between the surface temperature of the epidermis and the temperature of lower layers. On the other hand, if all laser-related parameters (points 1 to 5) are fixed, it is possible to "predict" the temperature increase in the tissue on the basis of a human factor, and therefore from the phototype.
[0125]In addition there is provision for a transparent optical window (713) in the wavelength range between 480 nm and 1.4 μm. In a preferred embodiment, potassium bromide that is transparent to wavelengths from 450 nm to 10 μm could be chosen.
[0126]A standby system could be also added to the device, to operate when the device is not used for a preset length of time. Standby mode is interrupted as soon as the user presses either of the firing buttons. This type of system saves battery power, on the one hand, but in particular prevents the sighting laser (even a low power laser) from causing eye damage.
[0127]In addition, the treatment device could include a cooling system comprising an internal radiator (714) connected directly or via a heat pipe to the laser diode. Furthermore, one possible embodiment of the invention provides for a natural and/or forced ventilation device to evacuate heat generated by the laser diode from the device in a sterile manner in order to avoid jeopardising the sterility of the operating area above which the treatment device (70) is used.
[0128]Advantageously, the device could be fitted with a user interface to provide the user with information on the operating parameters (wavelength, settings contained in the RFID component and read by the RFID treatment device, temperature measured by the pyrometer).
[0129]We will give details of a treatment device's user interface as claimed in the invention. Advantageously, the treatment device's user interface as claimed in the invention includes the following items: [0130]an LCD screen (75), used for feeding back information to the user on device operating settings and parameters (the LCD screen may be a touch-screen). [0131]an emergency stop button (76), which the user can activate to stop the device quickly in a emergency. [0132]an on/off button (77) to switch the device on or off. [0133]a double button system (88) to trigger and secure the laser: the double button system (two buttons, one on either side) makes the firing operation safe in that the laser can only fire when both buttons are held down by the user. As soon as the user releases either button, the laser immediately stops firing. Consequently, if the handpiece were to be inopportunely placed on a work surface and one of the buttons was resting on an item on the work surface, the laser could not fire. [0134]an indicator light (89) to show the user that the device is operating, [0135]a buzzer (717) to warn the user of a problem (battery problem, too high temperature measured by the pyrometer).
[0136]Advantageously, a possible embodiment of the invention provides for a removable sterile sleeve (80) designed to contain the device and isolate it from the outside surroundings. This sleeve can be understood as a sterile casing in which the device is placed in order to ensure that the area in which the device is used remains sterile. Advantageously, the removable sleeve (80) is designed not to interfere with the laser beam. For this purpose the device is provided with a window that is transparent to the preset wavelengths, in order to allow a beam whose wavelength is within the range of preset wavelengths to pass through. The removable sleeve (80) is also designed not to interfere with the operation of the pyrometer (712). The removable sleeve (80) also allows heat removal without having a detrimental effect on the sterile environment in which the treatment device (70) is used. Using this sleeve, the laser can be fired without altering the sterility of the sleeve's outside surfaces.
[0137]The sleeve must obviously be sealed and have a sealed closure system, so as to create a microbial barrier between the device and its surroundings. Nevertheless, this sterile barrier must not hinder the removal of heat generated by the device. The sleeve therefore contains at least one air filter and preferably at least two air filters (an air inlet and air outlet filter) to allow air circulation inside the sleeve.
[0138]Moreover, the sleeve must not hinder access to the device controls (firing buttons, switch, emergency stop button), it must not prevent information from being read (LCD screen, indicator lights) or the device from being gripped. In a preferred embodiment, the sleeve should therefore comprise a rigid section at the bottom of the device for correct positioning and a flexible transparent upper section covering the rest of the device.
[0139]Since surfaces 81 and 82 of the sleeve are in contact with the patient particularly when treating an incision, the risk that the sleeve could come into contact with blood should not be ignored. In fact, if the sleeve is in contact with blood, blood may accumulate on it as it is moved across the rest of the incision; the laser beam passing through the sleeve could be absorbed by these traces and consequently lose part of the treatment energy in this zone. In a preferred embodiment, the treatment device (70) and the lower rigid part (87) of the sleeve (80) in contact with the treatment area both include a recess (83) opposite the laser beam output, ensuring there is no direct contact with the patient and therefore no fouling or contamination and ensuring a distance between the beam shaper output and the tissue zone to be treated.
[0140]The sleeve therefore comprises one rigid section and one flexible section (for operation of the buttons and ease of holding). It is intended that both sections should be made of PVC, with a thickness for example of between 2 and 3 tenths of a millimetre for the flexible section and a few millimetres for the rigid section.
RFID Component
[0141]As shown in FIG. 9, and as described above, treatment is made safe and controlled by means of a safety strip (90) containing an RFID chip which transmits the various operating settings to the laser device, on the basis of the medical indication and skin phototype of the patient to be treated. This safety strip (90), which may be produced in several different lengths (e.g. 4, 10 and 20 cm), is affixed approximately 5 mm away from the zone to be treated.
[0142]The safety strip comprises two adhesive elements: one double-sided adhesive element (91) and another single-sided adhesive element (93). These two elements sandwich the RFID components (92), which are arranged every 2 cm. The safety strip may, for instance, be 2 cm wide.
[0143]The lower adhesive element (91) is in contact with the patient's skin. It must therefore be biocompatible and offer appropriate adhesion to the skin during use. The lower adhesive element (91) must stick to the patient's skin and also bond with both the RFID component and the upper adhesive element (93). The lower adhesive element is therefore a double-sided adhesive.
[0144]A sterilisation stage is included in the manufacturing process used to produce the safety strips.
[0145]The upper adhesive element (93) must be a single-sided adhesive element in order to permit assembly with the RFID component (92) and lower adhesive element (91). As shown in FIG. 10, there is provision for printing information on the upper section (93), such as the skin phototype, the company name, a scale to help the practitioner gauge progress of the treatment, along with the product reference.
[0146]The upper adhesive element (93) is designed not to interfere with RFID communication between the device's RFID reader (711) (see FIG. 7) and the RFID components (92).
[0147]The RFID components must comply with ISO standard 15693-3. There is also provision for the mandatory and optional sections, as defined by this standard, to be implemented as well. Since RFID transmission range is critical, the RFID components (92) as claimed in the invention are such that this value can be set once the "RFID component--RFID reader" pair has been selected. The size of these RFID components may for instance be 14 mm×14 mm and their thickness less than 1 mm. The EEPROM storage capacity of the RFID component shall be at least 1024 bytes. In addition there is provision for a sterilisation process using ethylene oxide.
Communication Process Between the RFID Component and the Device
[0148]As shown in FIG. 11, the device is composed of two microcontrollers (111 and 112). One (microcontroller 111) is responsible for managing the laser, the energy, the heat control and the UI; the other (microcontroller 112) for managing the safety strips (90). As for management of firing, this is shared by the two controllers (111 and 112). Firing may be stopped due to a too high temperature (managed by microcontroller 111) or due to activation of the emergency stop (microcontroller 111). Resumption of treatment is constrained by these two conditions that cause the device to stop.
[0149]Referring to FIGS. 12a, 12b and 12c, the pyrometer (712) (see FIG. 7) stops the laser if the skin temperature exceeds a critical temperature, for instance 60° C. (managed by microcontroller 111). These figures are graphs which show temperature curves 120, 121 and 122 (temperature in degrees Celsius on the Y-axis) as a function of heating time TC (on the X-axis); TC1, TC2 and TC3 represent the time at which laser firing is stopped. If the laser has been stopped by the pyrometer (712), firing can be authorised once more a single time only, after a safety delay (e.g. 5 seconds) if during the first laser emission, the firing time was less than or equal to half the preset firing time (as managed by microcontroller 112). This is the case in FIG. 12c. The figures therefore illustrate the following scenarios: [0150]FIG. 12a illustrates a scenario in which the laser is stopped (TC1) after 50% of the preset firing time has elapsed; in this case the laser treatment cannot be resumed. [0151]FIG. 12b illustrates a scenario in which the laser is not stopped before the end of the preset firing time (TC2). [0152]FIG. 12c illustrates a scenario in which the laser is stopped (TC3) before 50% of the preset firing time has elapsed; in this case the laser treatment may be resumed.
[0153]If the pyrometer (712) trips after 50% or more of the normal firing time has elapsed (FIG. 12a), the end of normal firing should be indicated with a beep (microcontroller 111). If the pyrometer (712) trips before 50% of the time has elapsed, a display on the user interface will indicate to the user that laser treatment may be resumed.
[0154]If the user stops the laser voluntarily or otherwise and the elapsed time is less than or equal to 75% of the preset firing time, the laser treatment may be allowed to resume once, after a 5 second delay. This re-authorisation is valid for a 60 minute period.
[0155]If the emergency stop system trips (FIG. 7, button 76), a checking procedure could be provided.
[0156]The presence of an RFID component (92) is indicated by the TTL pin (113) on the microcontroller (112). The presence of an RFID component (92) gives no information regarding its status. To find out the status of the RFID component (92), a "read settings" message must be sent to the microcontroller (112). This command lets you find out information on the treatment status of the RFID component (92) which is in the range of the RFID reader (711). The status of an RFID component (92) may be one of the following: [0157]Treated. [0158]OK (Not Treated). [0159]Immediate resumption (identical to not treated). [0160]Wait then resume (5 seconds).Microcontroller 111 Recognises Five Messages from Microcontroller 112: [0161]INIT: Initialisation of the clock and device identification. [0162]PARAM: Retrieve information on RFID component (92) status, firing power and firing time (firing only allowed if status is OK). [0163]START: Start of firing. [0164]STOP: End of firing. [0165]PAUSE: Stop firing prematurely.
[0166]When the device starts, microcontroller 111 initialises the clock in microcontroller 112 with the INIT message. Both clocks are synchronised. At the pulse edge of the TTL pin (113) of microcontroller 112, microcontroller 111 requests the firing settings via the PARAM message. Depending on the response from microcontroller 112 the user interface is updated and firing is authorised. During firing, microcontroller 111 indicates firing progress to microcontroller 112 with the messages START, STOP and PAUSE. Microcontroller 112 updates RFID component (92) information according to these messages. The device's clock is managed by the microcontroller 111. It does not contain the exact date and time, but timing information relating to the device start-up. It operates as a timer. The device clock may be reinitialised following extended battery power loss. In this case, if an RFID component (92) has been treated, its treatment start date is later than the current date. Even if treatment is not finished, the RFID component (92) is considered as treated.
[0167]FIG. 13 illustrates a logic flowchart for microcontroller 111. Thus box 1301 shows detection of the presence or otherwise of an RIFD component; if not detected, the user interface indicates that no RFID component was found (box 1302). If an RFID component is detected, the parameters are read (box 1303) in order to diagnose RFID component status (box 1304). If the status is OK, the device indicates via its user interface that it is "ready" (box 1305), and if the firing button is activated (box 1306), then microcontroller 111 sends microcontroller 112 the START message (box 1307) to indicate that laser emission should be started. Finally, the laser is switched on (box 1308). If the message is WAIT, the device indicates that it is on "standby" (box 1309) and returns to the start of the flowchart. If the message is TRT OK (treated), the device indicates that the zone has been treated (box 1310) and returns to the start of the flowchart.
[0168]If firing is initiated (box A), temperature measurement (box 1311) is performed. If this temperature is greater than 60° C., a time measurement (box 1312) is also performed. If this time value is less than 50% of the preset firing time, a PAUSE message (box 1313) is sent to microcontroller 112 and the laser is switched off (box 1314).
[0169]If the temperature measured in 1311 is less than 60° C., a time measurement (box 1315) is also performed. If this time value is less than 75% of the preset firing time, a further temperature measurement (box 1311) is performed. If, on the other hand, the time value is greater than 75% of the preset firing time TC, a STOP message (box 1316) is sent to microcontroller 112. A temperature measurement is then performed (box 1317), and if the temperature is less than 60° C., the firing time is checked (box 1318); if the actual firing time is less than the preset firing time TC (meaning that the laser treatment has not yet finished), a further temperature check is performed (back to box 1317). This loop continues until the temperature exceeds 60° C. or the firing time reaches or exceeds TC. In either case, the laser is turned off (box 1320), a beep is sounded (box 1321) (or any other user interface signal) to advise the user that treatment of this zone has finished, and an end of treatment message is displayed (box 1322). Coming back to box 1312, if the actual firing time is greater than 50% of TC, a STOP message is sent to the microcontroller (box 1319) and the laser is turned off (box 1320). If the actual firing time is less than or equal to 50% of TC, a STOP message is sent to the microcontroller (box 1319) and the laser is turned off.
[0170]As shown in FIG. 14, a firing authorisation management logic flowchart for microcontroller 112 will now be described. If an RFID tag is detected (box 1401), microcontroller 111 waits for a message (box 1402). When a message (box 1403) is received, it is analysed. If the message is START, and the laser was last fired less than 5 seconds ago (box 1405), microcontroller 111 sends the WAIT message (box 1406). If, on the other hand, the laser was last fired more than 5 seconds ago, the total_start variable (indicating the number of times the laser has fired) is increased by one increment (box 1407) and the last_start variable (indicating the time at which the laser last fired) is updated (box 1408). Finally an OK message is sent (box 1409).
[0171]If the message received is STOP, the total_start variable is set to a predetermined maximum (box 1410) and the OK message is sent (box 1411).
[0172]If the message received is PAUSE, the end of firing time is recorded (box 1413).
[0173]Finally, if the message received is PARAM, the total_start variable (box 1414) is analysed. If this variable is lower than the specified maximum, the TREATED message is sent (box 1415). If not, the last_start variable (box 1416) is analysed. If this variable is lower/greater than 60 minutes, the TREATED message is sent (box 1415). If not, a check is performed to see whether the laser was last fired more than 5 seconds ago (box 1417). If this is not the case, the WAIT message is sent (box 1418). If, on the other hand, the laser was last fired more than 5 seconds ago, the OK message is sent and the settings are read (box 1419). The information in the RFID component may be selected from the following options: unique RFID component identifier, manufacturing date, expiry date, device settings identifier based on skin type and the safety strip manufacturing batch number.
[0174]Obviously, all the numerical values in this description (e.g. percentages, temperature etc.) are given simply for reference in order to guide production of the invention. Other numerical values could therefore be used for instance as determined by experimentation, whilst still remaining within the scope of the invention.
[0175]In a possible embodiment of the invention, there is provision for the adhesive attachment element to have a threefold safety role: [0176]making the device safe by immediately stopping the device from operating when the RFID component (92) in the adhesive attachment element (90) is no longer within range of the RFID reader (711) in the device. [0177]defining the treatment settings. The user selects the adhesive attachment element according to the indication and patient's skin type, and the pre-programmed RFID components (92) within the adhesive attachment element (90) directly transmit the appropriate parameters to the device. [0178]protecting integrity (single use). When in use, the device records information about treatment status on the RFID components (92) in the adhesive attachment element. Treatment status may be as follows: zone to be treated has not been treated, zone to be treated is being treated, and treatment of the zone to be treated has finished. Once treatment is completed, the device, upon receiving information about the status of the zone to be treated, has a means of preventing reuse of the adhesive attachment element (90) provided with a means of identification when this has already been used once for treating a treatment zone. This RFID component locking principle ensures that each adhesive attachment element can only be used once. The direct benefit of this system is that it prevents: [0179]a second treatment in the same place (elimination of the risk of overdose). [0180]reuse of a used adhesive attachment element which was sterile when delivered.
[0181]There is provision for the means of preventing reuse of the adhesive attachment element (90) to be included in the RFID component itself directly.
Scenarios of Surfaces to be Treated
[0182]In certain medical or dermatological applications, treatment must be applied to surfaces and not to "linear" zones as is the case with an incision for example.
[0183]The device must therefore be moved over the whole surface to be treated, something that makes it difficult or impossible to attach a safety strip along the zone to be treated as described previously. In fact, when the zone to be treated is "linear", the strip may be easily fixed beside and along this zone to be treated. This is not the case when the treatment zone is a surface. There are also other reasons why such a safety strip cannot be applied beside the treatment zone: for example depending on the position of the treatment zone on the body, applying such a safety strip may be difficult (joints, locations) or depending on the nature of the skin in the area to be treated, applying such a strip may present specific problems (allergy, applying to the mucosa, etc.).
[0184]As shown in FIG. 15, and in order to resolve any difficulties linked to the application of a safety strip, there is the option of providing the safety sleeve (150) (identical to sterilisation sleeve 80) with an RFID component (151) the same as the one described within the safety strip, that is to say the sterilisation sleeve (150) could comprise an RFID component, itself comprising storage space intended in particular for recording information regarding firing and/or firing authorisation parameters as described previously.
[0185]The practitioner therefore chooses the sleeve according to the patient to be treated and/or the type of treatment to be given. When the sleeve is positioned correctly on the treatment device, the device's RFID reader reads the information and firing parameters contained in the sleeve's RFID component. Thus the device operates in combination with the sleeve (and more specifically with the sleeve's RFID component). This sleeve/treatment device treatment unit is improved by the interaction between the sleeve's RFID component and the device's RFID reader. Such a sleeve/treatment device combination ensures that the device is used properly with a sleeve and therefore ensures sterilisation during treatment: in fact if the device is used without the sleeve no firing parameters or firing authorisation are given.
[0186]The energy source's operating parameters are memorised in the sleeve's RFID component and are communicated to the device for controlling the energy source (the laser for example). Preferably the RFID component operates in the frequency band of between 13 and 14 MHz.
[0187]However, in a situation where the zone to be treated is a surface, treatment is generally longer than when the area is "linear". Thus a particular embodiment of the invention stops the sleeve's RFID component from preventing reuse and authorises as many laser firings as necessary for treating the surface.
[0188]As shown in FIG. 16, the RFID component (151) can also be included in another object such as the practitioner's identity card (160) or any other portable item (name tag (161), telephone (162), bleeper (163) . . . ).
[0189]Thus a practitioner wishing to use the device (70) must acquire this portable object (160, 161, 162 or 163) comprising the RFID element (151) in order to be able to use the treatment device (70). In this way, the device's (70) reader (711), in communication with the portable element's RFID component (151), is able to read information regarding operating parameters and/or firing authorisations. Such an embodiment of the invention means that only the person wearing this portable object comprising the RFID element would be able to use the treatment device (70).
Sterilising the Sleeve
[0190]As the sleeve is the part of the device in contact with the patient's skin and more generally with the patient's environment, a process for sterilising the sleeve is essential and indispensable so that the sleeve cannot be used without it first being sterilised.
[0191]As shown in FIG. 15, the sleeve's (150) RFID component (151) includes storage areas intended in particular for recording information regarding sterilisation of the sleeve. This information is characterised by the sleeve's sterilisation status. At the same time there is provision for a steriliser (152) intended for sterilising the sleeve (150) to contain an RFID component (154) able to read and write to the storage space in the aforementioned RFID component (151) included in the sleeve (150). It should be remembered that a medical steriliser is a medical instrument used for sterilising medical tools and accessories. Depending on its principle of operation, the steriliser comprises a tube that causes warming within the steriliser. This tube emits ultra-violet radiation; these rays strike the internal walls of the steriliser. The ultraviolet rays are transformed into ozone and sterilise the tools; these rays have a powerful germicide effect. Operation of the steriliser is in particular ensured by a door (158) (combined with walls (156)) suitable for ensuring that the steriliser's (152) enclosure (157) is hermetically sealed.
[0192]A process for sterilising the sleeve (150) comprises the following stages therefore: [0193]Place the sleeve (150) in the steriliser's (152) enclosure (157). [0194]Close the hermetically sealed door (158). [0195]Read the information contained in the RFID component (151) of the sleeve (150) to find out whether the sleeve is sterile or not (in which case the user of the steriliser can be warned that the sleeve has already been sterilised; the sterilisation process can also be started). [0196]Start the sterilisation process. [0197]At the end of the sterilisation process, using the RFID component (154), change the information written to the storage area according to which the sleeve has been sterilised as well as the date of sterilisation.A process for using the sleeve (150) comprises the following stages therefore: [0198]Place the treatment device as claimed in the invention in the sterilisation sleeve. [0199]The RFID reader (711) belonging to the device as claimed in the invention queries the sleeve's RFID component to find out whether or not the sleeve has been sterilised and the date it was last sterilised. [0200]Decide on the basis of this information whether the sleeve can be used or not. The relative question is to know whether the sleeve may be considered as sterile or not; firing authorisation for the device depends on this decision. [0201]If the sleeve should not be used (sleeve not sterile), activate a visual and/or audible alarm in order to alert the user to the fact that the sleeve must not be used. The device is also designed such that in these circumstances firing is not authorised. If the sleeve is considered as sterile then firing is authorised.
[0202]The decision according to which the sleeve is sterile or not is not taken based on information collected from the sleeve's (150) RFID chip (151). If this information shows that the sleeve is not sterile or that it was last sterilised before a certain specified date (for example 24 hours), then sterilisation is no longer guaranteed and the decision is taken that the treatment device may be used.
[0203]On the other hand, if according to this information, the sleeve has been sterilised and sterilisation was subsequent to the specified time limit, then the decision is taken according to which the device is sterile and that it can be used.
[0204]After the sleeve/treatment device pair as described previously have been used, the RFID reader (711) in the treatment device changes the information in the sterilisation sleeve's (150) RFID component (151) indicating that the sleeve has been used and is therefore no longer sterile. In addition, if the sleeve is used subsequently without prior sterilisation, the user will be warned that the sleeve is not sterile and firing is not authorised.
Double-Blind Clinical Study/Randomized Study
[0205]In a certain context, the RFID reader and safety strip unit can also be used for carrying out a so-called "double-blind" clinical study. In addition to containing the laser parameters, the strip contains information stipulating whether the laser should actually fire or simply simulate firing. The treatment device is designed so that whether it actually treats the area to be treated or not, the same behaviour is perceptible to the practitioner (emits a sound or a visual signal indicating firing). The strips are programmed during manufacture by software that randomly authorises "actual" treatment or not via parameters contained in the strip's RFID component.
[0206]This same software is able to read information concerning treatment authorisation. The practitioner therefore treats the patient using the strip without knowing whether the treatment is actually delivered by the treatment device. After using the strip, the practitioner hands the strip over to whoever is responsible for the clinical study with his/her assessment of the results of treatment. The person responsible for the study then reads the strip in order to determine whether the patient has been treated or not.
[0207]Thus, with such a process, no direct participant can know when the device provides actual treatment or when it doesn't during the clinical trial. This principle ensures that opinions with regard to the results of treatment collected are obtained with complete objectivity.
Patent applications by Alain Cornil, Aix En Provence FR
Patent applications by Alban Gosse, Mimet FR
Patent applications by Patrick Peronne, Paris FR
Patent applications by EKKYO
Patent applications in class Dermatological
Patent applications in all subclasses Dermatological
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St. Joseph's was one of eight men's basketball teams invited to compete in the 2013 Old Spice Classic, set for next Thanksgiving weekend and the following weekend at the HP Field House at the ESPN Wide World of Sports Complex in Lake Buena Vista, Fla.
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Skip to comments.Brokered GOP convention? Get ready, say political strategists
Posted on 03/15/2012 8:42:44 AM PDT by BO Stinkss
With a breakaway front-runner still yet to emerge in the GOP race, political observers and senior Republican strategists are beginning to seriously contemplate what a brokered convention in Tampa Bay might look like.
A candidate must win the support of 1,144 delegates to become the Republican nominee for president. While most commentators agree that Mitt Romney is the only candidate with a realistic shot of reaching that number before the convention in August, that outcome is by no means assured, especially after his losses in Alabama and Mississippi.
Brokered conventions in the modern era have been exceedingly rare. The last time Republican delegates arrived at the GOP convention uncertain who their nominee would be was 1976, the year Ronald Reagan nearly snagged the nomination away from President Gerald Ford.
(Excerpt) Read more at dailycaller.com ...
From your lips to God's ears!
I love the idea of a brokered convention because I seriously think that Obama has a plan to pull the federal mandate from the Obamacare legislation and to try to persuade the Supreme Court to let the legislation stand without the Federal Mandate, but with a State mandate, instead.That seems logical but if that's the case, why are the rats promoting the idea of rats voting for Santorum in the cross-over primaries?
Before Obama can make this offer, he needs to have Romney confirmed as the Republican nominee. Santorum would stop the idea dead.
"RE: I dont believe Dick Morriss assertion that it would kill Republicans chances this fall"
The Morris assertion is based on the self-interest of the political consultant-strategist businessman. People like Rove, Morris, Rollins, etc. make their living by being paid to manipulate the electoral system to ensure the political victory of the wealthy individuals and families that play the game of electory politics. If the people. through their selection of delegates actually send delegates to the convention empowered select the nominee based on their own judgement of who is best able to represent the party and the nation in the general election, the Roves. Morrisses, and Rollins have totally failed in their businss objective, which was to ensure that whoever employed their services is assured on the nomination.
Of course Morris is going to be totally against the delegates making the decision of who will be the nominee at the convention!
My guy? My guy is Mitch Daniels, and he's not running. I think the crop of GOP candidates is as bad as I can ever remember, as witnessed by the fact that Santorum is actually a serious candidate for election--let's be real; in any other year, he'd be a single digit candidate.
So you have to make the best of a bad situation, and that's to pick a terrible candidate early and unite behind him--think of this as the GOP's John Kerry. Newt is absolutely awful and is completely incapable of winning anything, so he's out. Santorum or Romney, I don't care. 6 one, half dozen the other. Let's pick one and then start running against Obama. Remember, the idea is to win in November.
Probably true. I still believe a Ryan-Rubio ticket would give us a lock on the White House for the next 16 years, but that door appears to be closed.
Some of the rats haven't got the message and the Obama administration can't very well tell them.
Stop using the term "brokered." That's the left-wing spin to make the convention look like a bunch of fat guys with cigars in back rooms.
I would suggested "contested."
Maybe just D.C.?
"Open" sounds even better!
"Maybe Sarah will be our nominee."
She did always say that if she did run that it would be an unconventional campaign.
Unconventional at the convention is certainly unconventional.
"Sure beats a MITTENS love fest..."
Unless it turns into a Jeb Bush lovefest.
Ok. That's definitely an interesting theory you've got there.
I don't know if that is the most likely. Romney has spend millions of dollars publicly assassinating the character of Santorum. Why would he choose to play second banana to Mitt when he could team up with Newt and be at the top of the ticket. I actually think they would make a formidable team. Newt could play the unlikable but vicious and competent VP role ala Dick Cheney.
WA State has been working on meeting ALL the state requirements for Obamacare since the bill was passed. Well, maybe since our state attorney general signed onto the law suit, challenging the federal mandate.
Last week, WA State legislatures were proposing the $1 abortion premium. We already have assisited suicide and the state already tried challenging the religious expemptions to abortion by trying to force pharmacists to dispense the abortion pills against their religious or conscientious objections. They lost the case in court. They need the federal government to set the precedent.
Pity the poor GOP elites! Their efforts to push Romney and other establishment candidates on us doesn't seem to be working. The nasty ill-mannered conservative base just isn't cooperating. /s
I'd be excited about that ticket. Ryan is young; he should run for governor and he'd be a really tough guy to beat in a presidential election.
A brokered convention means the dems win.
There are two reasons Rick would VP for Mitt:
1. Santorum + Gingrich < 1144
2. Santorum (despite his good points, which he has) is not really a conservative and has no real objection to Romney
Open convention. Even better.
Good call...
He has an 88.1% rating from the American Conservative Union and isn't a conservative?
I've read a lot here in FR on the subject and I have become convinced that historically he is very pro-union and that he did vote for many big-spending projects. Also, that high rating was one of his years in office, not all of his years.
Is he more conservative than Romney? Probably.
Is he an actual conservative in his thinking? I don't believe so.
I believe that it would not be a big problem for him, ideologically, to team up with Romney.
Things are much worse than in '08 then. IIRC, you wanted an astroid to be POTUS in '08 vs. slamming into earth ...
What am I missing?
How can Mitt and Paul have less than 1144 AND Santorum and Gingrich also have less than 1144?
I would suggest 'unobfuscated by rat media and RINO whores'.
He has an 88.1% rating from the American Conservative Union and isn't a conservative?
How can Mitt and Paul have less than 1144 AND Santorum and Gingrich also have less than 1144?Good question.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


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Cuisinart Dishwasher-Safe Anodized 11-Piece Cookware SetItem#: CQU-101817661 | Model#: DSA-11
Currently Out Of Stock!
DS HARD ANODIZED 11 PC. SET Product Details
- ArmorGuard hard anodized construction for superior durability and optimal cooking performance
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- Includes 1 qt. saucepan with cover, 2.5 qt. saucepan with cover, 3 qt. saute pan with cover, 8" and 10" skillets and 6 qt. saucepot with pasta insert and cover
Manufactured by: Conair
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- Conair logos are registered trademarks of Conair. All others trademarks and copyrights mentioned herein are the property of their respective owners.


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"The design was modern/contemporary, which was chosen to compliment the shower card. This thank you card reminds the guests again of the distinct personality and the nod to details that the mother-to-be possesses. The mother-to-be chose not to have her name printed on the card since she wanted to personalize it with her own hand. The paper had a high quality weight that you find in high-end printing supplies."
"These cards were perfect and matched the invitation I sent out for my son's baptism. I received them quickly and was able to get them out the day after the party!"
"I love how easy it is to personalize these and they are the perfect size for me! Just large enough for a short 'n sweet note to show my gratitude."
"I purchased these as thank yous for my bridal shower. I really like the thickness. I wrote with a super fine Sharpie and it did not bleed through. It is small, so keep that in mind. The website does say the size, but I managed to skip that important detail. I purchased the matching address labels and I spent extra on the nicer envelopes. Excellent design and quality. Highly recommend!"
"The one problem with this item is that there isn't a cream colored envelope to match the card. White doesn't go with the cream card stock. I ended up ordering gold to try to match the name printed on the card, ok but not a perfect match."
Copyright © 2004-2016 Shutterfly, Inc | Tiny Prints | Terms of Use. Designated trademarks and brands are the property of their respective owners.


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Clive Davis
Clive Davis Is 'Feeling Keenly the Loss' of Whitney Houston
Originally posted 02/08/2013 07:55AM
As the music community mourns Whitney Houston one year after her death at 48, her mentor and confidante, Clive Davis is "feeling keenly the loss" of the superstar, he told PEOPLE on Thursday at the Beverly Hilton Hotel.
Gearing up for his annual pre-Grammy gala that centered last year on Houston's memorial, Davis, 80, says at Saturday's big event, he is "going to do something to remind everybody that her talent lived among us and in so many people."
On the same night as his event, a special is airing on CBS, dedicated to the fallen diva.
Whitney Houston Remembered in Speeches and Song
Originally posted 02/18/2012 04:40PM
Whitney Houston's funeral brought the singer back to where it all began – the New Hope Baptist Church in Newark, N.J., where she performed as a child in the choir.
On Saturday, those same walls were filled with music and stories of the star who touched so many lives in her 48 years.
With tears and laughter, BeBe Winans shared memories of sitting with Houston – in her closet – preparing for her first tour. "We weren't crowded," he joked of the space. "It was as big as this church."
Bobby Brown Performing After Attending Whitney Houston Funeral
Originally posted 02/16/2012 01:40PM
Not only is Bobby Brown not banned from attending Whitney Houston's invitation-only funeral on Saturday, he is performing with New Edition a few hours later, it was just announced.
"He is not being banned. That's completely untrue," a family source tells PEOPLE.
Adds a close family friend: "Bobby will be there at the funeral to support his [and Houston's] daughter [Bobbi Kristina Brown, 18]. There was some talk ... some people were angry at him, but that's just grief. He will be there."
Kevin Costner and Clive Davis to Speak at Whitney Houston's Funeral
Originally posted 02/16/2012 11:50AM
Kevin Costner, the leading man who costarred with Whitney Houston in her greatest movie hit, The Bodyguard, is planning to speak at her funeral this weekend, a family source tells PEOPLE.
In addition, both Aretha Franklin and Stevie Wonder will sing at the service, and Houston's record producer from the very beginning of her career, Clive Davis, will also speak, Whitney's rep confirms.
According to the family source, "Whitney's family is devastated, but they're getting through it."
In addition, says the family source, "Clive has been a complete rock for her family this entire time. He's been with her since the beginning, and he's been everything to them. They're leaning on him for emotional support. He talks to them hourly, and he's a very big part in planning her funeral. Clive has been a constant presence for them. They're thanking God for Clive."
Honoring Whitney Houston: A Moment of Silence at Clive Davis Pre-Grammy Bash
Originally posted 02/12/2012 01:50AM
The death of Whitney Houston has rocked the industry on the eve of music's biggest night, but the show must go on – it's what she would have wanted, music mogul Clive Davis said Saturday night.
"Whitney was so full of life. She was so looking forward to tonight," he told those gathered Saturday night at The Recording Academy and Clive Davis's pre-Grammy gala, which she was due to attend (although she was not scheduled to perform, he said, as previously reported).
"She loved music and loved this night that celebrated music," he continued of the late singer, whose death is currently under investigation.
Whitney Houston's Death: 'A Light Has Been Dimmed' in Music Industry
Originally posted 02/11/2012 11:00PM
The loss of a legend on the eve of Sunday's Grammys has brought a message of condolence from the Recording Academy.
"Six-time Grammy winner Whitney Houston was one of the world's greatest pop singers of all time who leaves behind a robust musical soundtrack spanning the past three decades," Neil Portnow, president and CEO of The Recording Academy, which presents the annual Grammy Awards, said in a statement Saturday.
"Her powerful voice graced many memorable and award-winning songs."
Whitney Houston Back in Form for CD Launch
Originally posted 07/15/2009 02:10PM
In London to unveil her new album at a VIP party Tuesday night, Whitney Houston – looking glam in a black and white Dolce & Gabbana gown – signaled she was back.
With her mentor, music mogul Clive Davis, playing nine tracks from her upcoming album to be released in September, Houston, 45, "looked radiant," a source at the party at the Mandarin Oriental Hotel tells PEOPLE.
"She gave an amazing speech saying how much the album comes from the heart and telling of her love for Clive Davis," the source added. "She was also saying how much she loved being in London … and you could tell she was happy to be here."
Kelly Clarkson Speaks Out on Clive Davis 'Feud'
Originally posted 07/23/2007 12:35PM
Kelly Clarkson is finally speaking out to clear up rumors about her relationship with label head Clive Davis after the two had creative differences over her latest record.
The most buzzed about stars this minute!
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text: Brand: Anita Style: 5687 Sizes: 32 - 46 B, C, D, E; 32 - 42 F, G, H Fabric Content: Polyblend Anita Rosa Faia Romina Underwire Bra 5687. Adjustable straps. Underwire cups. Special supporting effect on the bottom and side of cup. Richly embroidered underwired bra with stretch embroidery band on the upper cup. The underbust band has a special anatomically shaped design, is turned and has an additional embroidery band at the front. In the large sizes the straps are covered with SilkyTouch microfiber, they become wider and the back with 3-position fastener becomes higher.


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Ever struggled to pray in the middle of winter? Rebecca Willen reflects on the season and its connections to the liturgical year.
Browsing: Advent
If you're looking for a few last minute giving ideas that are totally appropriate to give during the ongoing Christmas season (which extends through The Epiphany of the Lord!), here are two terrific recommendations from our friends at Paraclete Press. Both resources are treasures that will truly amplify joy this holiday season!
Sometimes we mistakenly assume that every secular celebration of Christmas is to be ignored or thrown out altogether. Jeannie Ewing urges readers to pause to consider the beautiful meaning in every Christmas image or song.
Stop and pause during this Advent season and listen to a brief reflection by Kelly Wahlquist, author of Created to Relate.
If you're too busy (who isn't?), use words to bring Christ's peace into your day. Sharon Rayner offers some ideas!
During Advent the O Antiphons are sung recalling the Names of Jesus. Margaret Rose Realy, Obl OSB, reminds us of the personal trust needed when sharing a name with others.
Kimberly Cook meditates on the Gospel passage in which Jesus heals the centurion's servant: faith saves the centurion and it saves our souls as well.
Are you spending Advent waiting or rushing? Deanna Bartalini suggests that we wait and expect something extraordinary to happen on Christmas morning!
Advent Is a time of waiting, but how do we wait? Do we wait as with joyful expectation or has life's disappointments left us jaded and closed to any spiritual surprises? Melanie Jean Juneau encourages readers to welcome light into their inner darkness.
What small successes are you celebrating this week? Join the fun and get some encouragement, too! Sherry Antonetti hosts this fun weekly feature.
Join Kelly Wahlquist for a video Advent Reflection to help you get the most out of this season.
Advent is upon us. This year, join CRS Fair Trade as your family, community and parish prepare for the coming of Christ. Together we'll reflect on the journey that brought Mary and Joseph to the stable in Bethlehem and on communities around the world that continue to encounter rejection on their journeys today.
Many years ago when Dave and I were raising our brood of youngsters, Advent was the season for "cleaning house"…
It is easy to allow Advent to become a season of rushed busyness rather than one of reflective contemplation and joyful liturgical traditions. Tiffany Walsh describes the small ways she strives to keep the spirit of Advent alive within her home.
On the menu for CatholicMom.com's Sunday Brunch, we have a sample of articles from the past week.


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Bucs Kicker Connor Barth Out for the Season
The 2013 season for Connor Barth was over before it even began. The Tampa Bay Buccaneers kicker tore his Achilles' tendon in a charity basketball game Friday and will be placed on the reserve/non-football injury list.
On Monday, Barth underwent surgery to repair the injury, but doctors determined he won't be able to play this year.
The team signed veteran kicker Lawrence Tynes, a 2012 Pro Bowl alternate, to replace him.
Shortly after the announcement, Barth tweeted the following message:
"I really want to say a big thanks to all my fans out there for the kind words! I will be back better than ever next year! #ItsABucsLife"
He also posted this photo:
"We are disappointed to lose a productive player like Connor, but are very fortunate to be able to sign an experienced kicker at this time of year,? said Buccaneers General Manager Mark Dominik.
?Lawrence and his agent, Ken Harris, had other standing opportunities, but we are pleased that they thought this was the right place for Lawrence to continue his career.?
This offseason, the team signed veteran kicker Nate Kaeding to create competition and limit Barth's reps, but Kaeding elected to retire due to injury.


text: 000 FXUS63 KBIS 281134 AFDBIS Area Forecast Discussion National Weather Service Bismarck ND 634 AM CDT Wed Sep 28 2016 .UPDATE... Issued at 634 AM CDT Wed Sep 28 2016 Hourly weather elements were blended to latest observations. Otherwise the forecast remains on track this morning. && .SHORT TERM...(Today and tonight) Issued at 306 AM CDT Wed Sep 28 2016 Focus in the short term is on low temperatures and cloud cover in the James river valley and Turtle mountains areas early this morning. Latest satellite shows low clouds just east of our county warning area over Valley City up to Devils Lake. Initial short range models were bringing cloud cover into the James river valley and Turtle mountains a bit earlier and where low clouds have not developed temperatures have dropped below the consensus models forecast. With that said do expect the low cloud deck stretching from Devils Lake area through Dickey county to slowly progress east and expand a bit through the early morning hours. This should bring temperatures back into the 40s in those colder spots and stop any possible frost development in most areas. Temperature gradients as of 08 UTC differ by as much as 9 degrees between Jamestown and Valley City where the cloud deck is squarely over. Otherwise a quiet and pleasant day. Skies should clear by afternoon and highs will range from around 60 east to around 70 west. .LONG TERM...(Thursday through Tuesday) Issued at 306 AM CDT Wed Sep 28 2016 A large upper level ridge will dominate North Dakota`s weather pattern into the weekend. The 00 UTC model guidance continues to show a weak disturbance moving in late Thursday into Friday. While Cape values are weak there will be a chance for a thunderstorm or two embedded in the showers. A western CONUS trough will begin to impact North Dakota weather starting Sunday as the large upper level ridge breaks down and moves east. The 00 UTC ECMWF and GFS both show chances for for showers and thunderstorms Sunday through early next week. As of the latest runs the GFS is the most progressive of the two with a closed low moving through North Dakota Tuesday and Wednesday of next week. && .AVIATION...(For the 12Z TAFS through 12Z Thursday morning) Issued at 634 AM CDT Wed Sep 28 2016 MVFR stratus and/or fog will impact KJMS through 13-15Z this morning, remaining east of KMOT and KBIS. Otherwise VFR all terminals for the 12Z period. && .BIS WATCHES/WARNINGS/ADVISORIES... NONE. && $$ UPDATE...NH SHORT TERM...MM LONG TERM...MM AVIATION...NH


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Before the season, the big talk was about Dylan Cummings of Pennsville and Tom Flacco of Eastern becoming the first quarterbacks in South Jersey history to pass for more than 6,000 yards.
That was off by only 1,000 yards.
Cummings and Flacco each have passed 7,000 career yards. Cummings likely will soar past 7,500 on Friday night.
Flacco likely will move into third place on the state's all-time list on Friday night, behind only Cummings and Butler High School's Scott Brown.
"To hit 7,000 is a pretty nice accomplishment," Flacco said. "I didn't even know I was close to it. Right now, we're just worried about winning games and continuing this run because this is what we worked so hard for."


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The Ultimate Flight Plan to Patient Safety and Quality Care"How can it be that in 2008, a checked bag on an airline flight is still exponentially safer than a patient in an American hospital? Simply put, one industry has learned the realities of what it takes to make a human system safe, and the other has not. So what does it take to dramatically improve patient safety and service quality? It takes a host of new and different (and sometimes radical)
Surprising Lessons on Living Longer, Safer, and Healthier from America's Favorite Medical ExaminerWHEN THIS DOCTOR TALKS, YOU SHOULD LISTEN.Thousands of people make an early exit each year and arrive on medical examiner Jan Garavaglia's table. What is particularly sad about this is that many of these deaths could easily have been prevented. Although Dr. Garavaglia, or Dr. G, as she's known to many, could not tell these individuals how to avoid their fates, we can benefit from her experience
Spy Secrets That Can Save Your Life Deluxe
A Former CIA Officer Reveals Safety and Survival Techniques to Keep You and Your Family ProtectedThe deluxe edition of Spy Secrets That Can Save Your Life includes 10 exclusive videos from author and former CIA officer Jason Hanson that demonstrate practical tactics everyday civilians can use to protect themselves.When Jason Hanson joined the CIA in 2003, he never imagined that the same tactics he used as a CIA officer for counter intelligence, surveillance, and protecting agency personnel
Keeping Children and Teenagers Safe (and Parents Sane)Safety skills for children outside the home Warning signs of sexual abuse How to screen baby-sitters and choose schools Strategies for keeping teenagers safe from violenceAll parents face the same challenges when it comes to their children's safety: whom to trust, whom to distrust, what to believe, what to doubt, what to fear, and what not to fear. In this empowering book, Gavin de Becker, the
The Piercing Bible Guide to Aftercare and Troubleshooting
How to Properly Care for Healing and Infected Ear, Facial, and Body PiercingsIn this compilation of chapters on healing and troubleshooting from The Piercing Bible, piercing expert Elayne Angel distills her best advice on caring for new piercings, from cleaning and hygiene to avoiding trauma and infection. It includes healing tips for every type of piercing: · Earlobe · Cartilage · Nose · Eyebrow · Tongue · Navel · Nipple · Genital Elayne has performed more than 40,000
$7.99Cuando estás en situaciones difíciles te sientes perdido, no sabes qué hacer o por dónde empezar. Lo primero que necesitas es reconocer, sin juicios, el lugar que estás ocupando en el mundo. Toma un respiro y haz conciencia de tu relación contigo mismo, con tu familia, y con tu trabajo; date unos minutos para medir cómo está tu energía, cómo se siente tu cuerpo, cómo reacciona tu mente y qué te
Protect Yourself Against BioterrorismHow does anthrax spread? Should I avoid opening my mail? Wasn't I vaccinated for smallpox years ago? What exactly is encephalitis? Is my workplace a target for bioterrorism? What precautions can I take to stay healthy and safe? PROTECT YOURSELF AGAINST BIOTERRORISM From fears of full-scale germ warfare to the spread of dangerous and deadly illnesses, we are faced with a new breed of anxiety --
SIMPLE SURVIVAL : A Family Outdoors GuideThe Simple Basics Knowing some simple basics can make the difference between life or death in an emergency survival situation, Gary Benton's SIMPLE SURVIVAL can teach you the simple skills that could save you or a loved one. If you are going into the outdoors, be it hunting, hiking, boating, camping, or any outdoor sport, you could find yourself in trouble and need to survive. No one ever plans
Injury-Avoidance Habits for First-Time Marathoners and Half-MarathonersFrom the Foreword by John Loftus, Ultra-marathoner and Safety Consultant: Why would someone write a running / walking book about SAFETY – managing the unforeseen, the training route, weather, gear, and personal security, about INJURY AVOIDANCE – minimizing hurt and pain to our body and mind and CREATING GOOD HABITS so that we do "the right thing" unconsciously? The reality is, whether at work, at
Negotiating Safety in American Society"Risk" is a capacious term used to describe the uncertainties that arise from physical, financial, political, and social activities. Practically everything we do carries some level of risk—threats to our bodies, property, and animals. How do we determine when the risk is too high? In considering this question, Arwen P. Mohun offers a thought-provoking study of danger and how people have managed it
The Prepper with the Most Toys Wins! Prepping - It's Not Just for DoomsdayThe Apocalypse, end of the world, a black swan or an extinction level event is the principle reason most survivalists prepare, and for which most books are written. Being prepared for all these disasters is a worthwhile goal, but the real reason to be prepared is already here in our daily lives. While most prepare for a Tsunami, it's a rising tide that takes the highest toll. Instead of discussing


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ROCKINGHAM, N.C. (AP) - Proving that if given good equipment he can be competitive, Kenny Wallace won the pole Friday for the Pop Secret Microwave 400 in a Chevrolet fielded by Dale Earnhardt Inc.
Wallace, in the DEI car as a fill-in driver for the injured Steve Park, ran a fast lap around North Carolina Speedway at 154.690 mph to earn his third career pole and first since 1997.
Wallace was the 18th different pole-winner this season, tying the 1997 record for most in one season of Winston Cup competition.
Ricky Craven qualified second for Sunday's race in a Ford, running a lap at 154.351. Rookie Casey Atwood, plagued by speculation that his job with Evernham Motorsports is in trouble, was third in a Dodge.
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code veronica is a completely different style of game, it's survival horror
i'm biased because the series is my favorite of all time, but it sure as hell is worth 400 points
people spend just as much if not more on mediocre at best arcade games, can't go wrong with a cheap price for a classic game
It's still a Resident Evil game at it's core. While I personally love both Code Veronica and RE4, if he didn't like 5 or 6, I don't think he's going to like the others. Resident Evil may not be the series for him.


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NALCHIK, Russia — Natai Al Sharkas' great-grandfather killed his Russian commanding officer and defected to the enemy.
The ethnic Circassian swells with pride at the thought of the century-old act.
Natives of what is now Russia's Caucasus region, Circassians fiercely resisted the Russian czarist conquest that ended in the 1860s after decades of scorched-earth warfare, mass killings or expulsions that some historians and politicians consider genocide.
The carnage forced many — like Al Sharkas' ancestors — to seek refuge in what is today Syria.
Now carnage in Syria is driving many back to their homeland.
This spring, Al Sharkas joined hundreds of Circassians fleeing war-torn Syria for this remote Russian region of soaring peaks and lush forests. In the coming months, thousands more are expected to arrive in Kabardino-Balkariya, a Caucasus province the size of Maryland with a population of less than 900,000, two-thirds of which is ethnic Circassian.
"We are planning to stay here for good," Al Sharkas, 35, said as he sat under fragrant fir trees at a Soviet-era resort hotel where many of the Circassian immigrants have sought shelter. "That's the decision we made a long time ago and it's been accelerated by the events in Syria."
Circassians were widely dispersed in the Russian expulsions. An estimated two million live in Turkey, another 100,000 in Syria and other sizeable populations are in Jordan and the United States. But their sense of ethnic unity remains strong and the pull of their homeland compelling.
Al Sharkas' great-grandfather Koushoukou, his brother and two cousins were forcibly drafted and sent to the Russian-Turkish war of the late 1870s. They had to fight Ottoman Turks — fellow Muslims whose sultans supported Circassian resistance and provided refuge for hundreds of thousands of them. After killing his officer in Bulgaria, Koushoukou joined the Turkish military and ended his life in Damascus — part of Ottoman Turkey at the time.
Al Sharkas, which means Circassian in Arabic, used a network of family connections, along with Facebook, to find relatives in Kabardino-Balkariya and other parts of Russia. He encourages his Syrian relatives to follow him to the Caucasus, although now, because of the fighting, it hardly seems possible. "They are trapped there as it is almost impossible to even leave their neighbourhoods," he said.
Assmat Yahya, a retired electrician from a Circassian village in the Syrian-controlled part of the Golan Heights, also found relatives in the Caucasus and plans to stay in Russia with his wife.