An example vehicle electrical power system includes a battery operable to power a load of a vehicle over a direct current (DC) bus, a multiphase alternating current (AC) machine comprising a plurality of windings, and a power converter. The power converter includes a plurality of power switches and a controller. The controller is configured to, in a first mode, operate the power converter as an active rectifier that provides current to the DC bus to supply DC loads, and charge the battery from the current on the DC bus; and in a second mode, operate the power converter as a boost converter that converts a variable output voltage of the battery to a constant voltage on the DC bus. The power converter utilizes the plurality of windings when operated as an active rectifier and boost converter. A method of operating a vehicle electrical power system is also disclosed.

The present disclosure relates to electrical power systems, and more particularly to an electrical power system for a hybrid or electric vehicle.
Hybrid vehicles incorporate a rechargeable battery that is used to power one or more traction drive motors to move the vehicle at low speeds. At higher speeds and/or during certain acceleration conditions, an additional "prime mover" internal combustion engine is used to move the vehicle. The battery of a hybrid typically charges from regenerative breaking, which uses vehicle kinetic energy to generate current for charging the battery.
Similarly, range-extended electric vehicles, which are run exclusively on battery power under certain conditions, may include a prime mover engine to charge the vehicle battery once its charge is depleted.
Hybrid and electric vehicles have required a dedicated boost converter to increase the vehicle battery voltage to power a pulse load.

Electrical power system for hybrid or electric vehicle


A branching device for optical waveguides by which a component of light is coupled out of the main light path which is formed by a first and second waveguide into a subsidiary third waveguide comprises a simplified construction which reduces material costs as well as assembly costs. For this purpose, the invention provides that between two coaxially aligned optical waveguides there is arranged only one beam divider reflector which is in the form of a coating or layer and that in the region of the group of light beams which is emitted from the end surface of one of the waveguides and is reflected by the beam divider reflector there is a gradient lens which focuses the end surface of the one waveguide onto the end surface of a third waveguide.

The present invention is directed to a branching device for optical waveguides which device decouples a component of light out of a main line formed by optical waveguides into a subsidiary line which is also formed by an optical waveguide.
Branching devices or elements of the type which will branch out a component of light from the main line into a subsidiary line are disclosed by K. Kobayashi et al, "Micro-Optics Device for Branching, Coupling, Multiplexing and Demultiplexing", 1977, International Conference of Integr., Optics and Optical Fiber Communications, B11-3, FIG. 2. In this device, a fiber F1 abuts against an end surface of a gradient lens L1 whose other end surfaces are inclined at an angle of 45.degree. to the optical axis of the gradient lens. A beam divider reflector is applied in the form of a coating to this inclined end surface. A second gradient lens L2 is arranged coaxial with the gradient lens L1 and, likewise, possesses an end surface which is inclined at an angle of 45.degree. to the optical axis and which abuts against the beam divider reflector which is in the form of a coating. A second waveguide F2 abuts against the other end surface of this gradient lens L2 which, like the corresponding end surface of the gradient lens L1, is perpendicular to the optical axis. The two waveguides F1 and F2 are arranged coaxially to the common optical axis of the two gradient lenses L1 and L2. A third gradient lens L3 is arranged adjacent the beam divider reflector and is in contact with the top surface of the gradient lens L1. The third gradient lens L3 has an optical axis which is arranged at right angles to the common optical axis of the gradient lenses L1 and L2 and intersects the beam divider reflector at an angle of 45.degree.. A third optical waveguide F3 abuts against the end surface of the gradient surface L3 which faces away from the beam divider reflector. The individual gradient lenses are dimensioned so that a group of light beams emerging from one of the optical waveguides F1, F2 or F3 are directed parallel. End beam reversal principle is used and this means that the end surface of the waveguide F1 which abuts against the gradient lens L1 is focused onto the end surface of the waveguide F2 which abuts against the gradient lens L2 and vice versa. The same applies to the gradient lens L1 and L3 in which case, however, the beam divider reflector acts as an intermediate element and is a fundamental significance.
Accordingly in the known branching devices, three gradient lenses with specific dimensions are required, although not illustrated in FIG. 2 of the above mentioned publication, the optical waveguides which are coupled to the gradient lenses are provided with halves of plug connections which are used for connecting optical waveguides to one another.
Thus, the known branching device or element is constructed from three gradient lenses which must be adjusted relative to one another during the production of the element. The following fine adjustments are also required during production:
1. adjustment of the waveguide F2 to the gradient lens L2; PA1 2. adjustment of the waveguide F3 to the gradient lens L3. It should be pointed out that the adjustment of the waveguide F1 to the gradient lens L1 is not required as it is provided by the first two adjustments if the lens elements were already connected to one another; PA1 3. adjustment of one plug half to waveguide F1; PA1 4. adjustment of one plug half to the waveguide F2; and PA1 5. adjustment of one plug half to waveguide F3.
Thus, a total of five optical fine adjustments must be carried out.


A parallel gripper includes an electric motor; a threaded spindle connected to the motor to be driven thereby about a longitudinal spindle axis; a spindle nut threadedly mounted on the spindle for longitudinal travel therealong upon rotation of the spindle; a support block affixed to the nut; an arrangement for preventing a rotation of the spindle nut about the spindle axis; a mounting plate for accommodating a gripper jaw thereon; and a first, a second, a third and a fourth web coupling the mounting plate to the support block. The first and second webs are parallel to one another and are spaced in a direction parallel to the spindle axis; and also, the third and fourth webs are parallel to one another and are spaced in a direction parallel to the spindle axis. Further, strain gauges are mounted on the webs for emitting signals representing a bending deformation the webs undergo in response to a reaction force generated by a gripping force of the gripper.

This invention relates to a parallel gripper which includes two gripping jaws moved simultaneously in opposite directions toward or away from one another by an electric motor, preferably a stepping motor via a common worm wheel or separate worm wheels of a worm gear drive. The shaft of each worm wheel is extended to form a spindle on which at least one spindle nut is threadedly mounted to travel parallel to the spindle axis as the spindle is rotated. A support is affixed to the spindle nut and prevented from rotation about the spindle axis. In case two supports are provided, they move on each side of the worm wheel on the spindle in opposite directions. Each gripping jaw is carried by a respective support. Further, for each gripping jaw a force-measuring device is associated, having strain gauges for detecting deformations.
German Offenlegungsschrift (application published without examination) 36 06 874 discloses a gripper having gripping jaws which, for adjusting the gripping opening, are shifted by a motor with the intermediary of a worm screw drive including threaded spindles. The motor, particularly a stepping motor, is supported against a biasing force for displacement parallel to the length direction of the worm screw. It is a disadvantage of this arrangement that an accurate measurement of the gripping force at each gripping jaw and an indication of the gripping position are not possible.
Further, German Offenlegungsschrift 39 05 656 discloses a parallel gripper having a spindle drive and presence monitoring means in which, with the aid of a special switching device connected with the spindle nut, a switching signal is emitted if, during the gripping process, the switch is actuated by a body and by the pressure applied thereby to the jaws. The switch is coupled to the motor control which generates control signals for the motor. In this prior art construction too, a measurement and regulation of the gripping force is not possible.
It is further known, such as disclosed, for example, in German Offenlegungsschrift 39 10 801 to indirectly determine the gripping force by means of the motor current. Such a method, however, is inaccurate and also, it cannot determine the gripping force at the individual jaws.
Further, U.S. Pat. No. 4,132,318 discloses a manipulating system including a two-jaw gripper wherein each jaw is coupled with a gripping jaw drive by means of a six-component force-and-torque system. Both measuring systems are asymmetrical; forces and torques are determined with the aid of measured deformations. Such a gripper is unstable; a reliable, positive gripping cannot be effected because the jaws are pivotal in all directions. Further, no overload safety device appears to be provided or is feasible.

Parallel gripper having a force measuring arrangement


A scan type electron microscope has an electron beam generating source for generating an electron beam with which a sample is irradiated; a sample chamber, supplied with a gas for effecting a gas amplification, for housing the sample; a secondary electron detecting means, installed in the sample chamber, for detecting secondary electrons gas-amplified by the gas after being generated from the sample with the irradiation of the electron beam; and an electrode, disposed between the sample and the secondary electron detecting means, for absorbing positive ions produced when the secondary electrons are gasamplified by the gas. The electrode may be constituted by a further fine tube extended from a pressure limiting aperture to a position just above the sample and formed with a path of the electron beam. The absorption of the positive ions prevents a positive charge-up of the sample, whereby a voltage between the sample and the secondary electron detecting means can be kept at a fixed level. A scatter of the primary electron beam can also be remarkably reduced so as to eliminate scattered electrons which cause noise.

1. Field of the Invention
The present invention relates to an environment-control-oriented scan type electron microscope.
2. Related Background Art
In a typical scan type electron microscope, secondary electrons emitted from a sample (target) disposed in a vacuum are detected by luminescence of a scintillator. In contrast with this, according to an environment-control-oriented scan type electron microscope, the secondary electrons from the sample disposed in a low-pressure gas such as a water vapor are gas-amplified by the gas. The thus amplified secondary electrons are detected directly by a detection electrode. This environment-control-oriented scan type electron microscope is capable of viewing a variety of samples that could not be viewed by ordinary electron microscopes.
In an ordinary low-acceleration scan type electron microscope, however, a primary electron beam incident on the sample is substantially equivalent to a quantity of the secondary electrons emitted from the sample. Contrastingly, in the environment-control-oriented scan type electron microscope, an acceleration voltage of the electron beam is relatively large. Hence, the quantity of the secondary electrons emitted from the sample is smaller than a quantity of the primary electron beam incident on the sample. For this reason, a negative charge-up (electrification) of the sample is easy to take place in the environment-control-oriented scan type electron microscope. A mechanism for neutralizing the negative charge of the sample is therefore required.
FIG. 9 shows one example of the conventional environment-control-oriented scan type electron microscope. Referring to FIG. 9, an electron gun (unillustrated) is installed in a vacuum chamber 1 (consisting of, as a matter of fact, a plurality of subchambers partitioned by an aperture for differential exhausting). The vacuum chamber 1 is adjacent to a sample chamber 2 (its outer frame is not shown) for housing a sample 7 through a pressure limiting aperture plate 3. An objective lens composed of an electromagnetic lens is provided along the circumference of the pressure limiting aperture plate 3 through an insulator 4. The sample chamber 2 is supplied with a gas (e.g., a water vapor) for effecting a gas amplification from an unillustrated supply source. At the same time, a gas pressure in the sample chamber 2 is kept on the order of 0.1 Torr to several tens of Torr by means of an unillustrated vacuum pump. Further, the gas in the sample chamber 2 flows via the pressure limiting aperture plate 3 into the vacuum chamber 1. However, a gas pressure in the vacuum chamber 1 is kept under a smaller pressure (state of a higher degree of vacuum) on the order of 10.sup.-2 to 10.sup.-3 Torr just above, e.g., the pressure limiting aperture plate 3 than in the interior of the sample chamber 2 by means of a vacuum pump 6. In fact, as explained above, the vacuum chamber 1 is partitioned by the aperture into the plurality of subchambers. The vacuum pump is provided in each subchambers. The electron gun is installed in the subchamber exhibiting the highest degree of vacuum.
A sample 7 defined as a view target is housed in the interior of the sample chamber 2. Further, in this conventional example, the pressure limiting aperture plate 3 serves as a secondary electron detector. A positive voltage with respect to the sample 7 is applied to the pressure limiting aperture plate 3 from a variable voltage source 8. A secondary electron signal obtained from the pressure limiting aperture plate 3 is led via a preamplifier 9 to an unillustrated processor.
When viewing the sample 7, the sample 7 is irradiated with a primary electron beam emitted from the electron gun in the vacuum chamber 1 via an aperture 3a of the pressure limiting aperture plate 3. At this time, the secondary electrons emitted from the sample 7 are gas-amplified by the gas existing in the sample chamber 2 while migrating toward the pressure limiting aperture plate 3 because of an electric field of the pressure limiting aperture plate 3 serving as the secondary electron detector. Positive ions produced as a result of this fall on the sample 7, thereby neutralizing a negative charge of the sample 7 which is generated with the irradiation of the electron beam. Further, the gas-amplified secondary electrons are taken in the pressure limiting aperture plate 3 serving as the secondary electron detector. A secondary electron signal thereof is taken in an external processor via a preamplifier 9.
FIG. 10 illustrates another example of the conventional environment-control-oriented scan type electron microscope. In this conventional example, the pressure limiting aperture plate and the secondary electron detector are separately provided. Referring to FIG. 10, the portions corresponding to those in FIG. 9 are marked with the like symbols, and the detailed explanations thereof will be omitted.
Referring again to FIG. 10, a ring-like secondary electron detector 10 having a minor diameter of several mm is disposed along the circumference of the pressure limiting aperture plate 3 upwardly of the sample 7. A positive voltage is applied to the secondary electron detector 10 from a variable voltage source 11. The secondary electron signal from the secondary electron detector 10 is also taken in the unillustrated processor via a preamplifier 12. Further, the positive voltage with respect to the sample 7 is also applied to the pressure limiting aperture plate 3 from the variable voltage source 8.
In the apparatuses shown in FIGS. 9 and 10, however, a much larger amount of excessive positive ions than an amount of incidence of the primary electron beam fall on the sample 7. This results in a positive charge-up of the sample 7. As a consequence of this charge-up, a potential difference between the secondary electron detector and the sample is decreased; and a gas amplification rate of the secondary electrons is reduced. For this reason, there exist inconveniences in which a gain of the secondary electron detector declines, and an SN ratio of a view image obtained decreases.
A reduction in the potential difference between the secondary electron detector and the sample due to the charge-up of the sample 7 may be compensated by stepping up a voltage of the secondary electron detector. However, in such case, a potential difference between the secondary electron detector and a metal (e.g., lens) at an earth potential in the vicinity of this detector in turn becomes too large. A trace amount of discharge is caused therebetween. This results in noise on the view image, so that is becomes impossible to improve the SN ratio.


A speech signal is input to a microphone (10) and applied through a signal compressor (14) to a filter array (18) consisting of a high pass channel (20), a midfrequency channel (22) and a low pass channel (24). The outputs of the filter array (18) are precision rectified in rectifiers (28), (36) and (46). The rectified signals are applied to voltage controlled power drivers (54) and (56), where the output of the midfrequency channel (22) and the low frequency channel (24) are applied to the power driver (54) and the output of the high frequency channel (20) and the low frequency channel (24) are applied to the power driver (56). The power driver (54) drives vibrators (58) and (60) and the output of the power driver (56) drives a vibrator (62). To drive the vibrators (58) and (60), a random frequency signal at the output of a one shot multivibrator (38) is amplitude modulated by the output of the midfrequency channel (22). To drive the vibrator (62) the same random frequency signal is amplitude modulated by the output of the high pass channel (20).

The spectrograph is the time-honored tool for study of speech perception for visually displaying segregated frequency patterns in space. Recently, however, there is evidence to show that many differences exist between a speech spectrograph and a neural output of a cochlea. For example, the output of the cochlea is linear up to about 1,000 Hz and logarithmic above that, whereas the spectrograph is either logarithmic or linear. Thus, there is serious question whether the temporal processing of acoustical components of speech by the ear can be demonstrated by a speech spectrogram. This is not considered to be a trivial shortcoming of the speech spectrogram given that the fundamental frequency and the first formant information of speech are coded, at least to some extent, by temporal information.
Although it can now be shown that there is a basic problem with the use of the speech spectrogram for voice analysis, the primary problem appears to be that the exclusive use of the spectrograph for speech analysis confines the concept of the speech signal to a spatio-temporal display. Such a spatio-temporal display is now realized to be quite unlike the signal as it exists in space. An acoustic speech signal does have spatial property, but they are not necessarily related to the spatial separation frequencies manifested in the speech spectrogram. The acoustic speech signal is a frequency-integrated, complex waveform whose actual spatial properties are indicated by radiation and reflection, not by frequency. The acoustic world we live in is not fully represented by a speech spectrogram.
Heretofore, the reliance on the speech spectrograph as the sole source of information about the speech signal has restricted observations to an analog of the neural output of the cochlea. This has resulted in the missing of the hypothesized higher order free integration stage of perceptual analysis. It is now understood that a more complete analysis of a speech signal required a study of the speech waveform in addition to the spectrogram. The spectrogram provides the components of the signal (spatial) and the waveform shows how the components are integrated in time and space.
A feature of the present invention is to provide apparatus for analyzing the speech waveform for kinds of information not readily observable from the spectrogram. Further, by the apparatus of the present invention, information available from the speech waveform can be applied to practical problems in speech science. Specifically, by examining the speech waveform, there is developed a tactile speech reception aid for the deaf.
Further, an examination of the speech waveform has been applied to the invention described and claimed in the co-pending patent application entitled, "Voice Pitch Detector and Display", Ser. No. 48,238, filed June 13, 1979, which is a real time speaker independent pitch extractor with a voice pitch display. A voice pitch detector and display as described in applicant's co-pending application is a device which integrates the periodicities of several spectral channels to aid in the perception of pitch.
In accordance with the present invention, there is provided a tactile aid to speech reception which presents information about a speech signal to an observer through the skin by means of vibrator transducers. The tactile aid utilizes the waveform envelope to provide a single, slowly varying reference for the many rapid spectral changes in speech. This provides the perceptual system of the observer with a means of integrating information over relatively long periods of time (across syllables). The importance of this is to maintain the temporal order of the speech elements for the observer. The aid of the present invention develops a single time envelope for the integration of spectral information by means of discretely placed vibrators.
Heretofore, tactile aids utilized vocoder type transducers for the conveyance of tactile speech cues. Vocoder type aids separate spectral information into spatially arrayed areas on the skin. Such type aids encounter difficulties when ordering spectral information in time, since the vocoder type aid has as many separate time envelopes as it has spectral channels. It is believed that the vocoder type aid provides good vowel discrimination whereas the vibrator type aid of the present invention has the advantage of discriminating sentence length material.
A feature of the present invention is to provide a tactile aid to speech reception that retains an integrated amplitude envelope and enables the observer to discriminate sentence length material. Further, in accordance with the present invention, a tactile aid conveys as much spectral information to the skin as possible without sacrificing the waveform envelope.


The present disclosure discloses a method for manufacturing a display substrate, including: forming an organic thin film layer by coating a conductive organic material on a base substrate at a region which corresponds to a non-display region of a to-be-formed display substrate; forming a pixel definition layer on the base substrate; printing an organic functional layer within a pixel region defined by the pixel definition layer on the base substrate; and removing the organic functional layer at the non-display region by peeling off the organic thin film layer. The peeling off the organic thin film layer includes: connecting two ends of the organic thin film layer to two electrodes of a power supply, respectively; and breaking an interface between the organic thin film layer and the pixel definition layer with joule heat generated by the organic thin film layer when the organic thin film layer is powered.

Comparing with a liquid crystal display (LCD), an organic light emitting diode (OLED), has advantages such as fast response, wide-angle view, high brightness, bright color, thinness, and is considered to be a next generation display technology.
For OLED or a polymer light emitting diode (PLED), there are two methods for forming an organic thin film layer.
First Method: Vacuum Evaporation
The first method is suitable for forming an organic thin film layer by using organic small molecular material. The first method has characteristic such as no solvent required to form the organic thin film layer and the formed organic thin film layer having a uniform thickness. However, the vacuum evaporation has disadvantages of high equipment investment and low material utilization, and is not suitable for production of a large-size product.
Second Method: Solution Process.
The second method specifically includes an inkjet printing process, a spin-coating process, a nozzle-coating process, etc. The second method is suitable for forming an organic thin film layer by using polymeric material and soluble small molecules. The second method has advantages of low equipment investment and has outstanding advantages in large-scale production of large-size products.
A continuous printing technique, which is one of the most important techniques in the solution process, has advantages of simple device and fast printing speed. In a printing process, a nozzle moves back and forth at a fast speed. As shown in FIG. 1, one problem of the continuous printing technique is that a printed organic functional thin film 3 may appear in a non-display region.
Currently, the organic functional thin film in the non-display region is removed by means of plasma etching, laser etching, solvent cleaning, etc., but by adopting the aforementioned cleaning methods, particles are introduced, which affects display effect.

Method for manufacturing a display substrate by peeling an organic layer


An apparatus including of a mold for slush molding articles of a least two colors; a tank; a separation wall disposed in the tank and dividing the tank into two spaces; a gasket mounted on a free edge of the separation wall which faces the mold, the gasket having a plurality of rigid inserts disposed therein in a predetermined distribution; and an actuator device which expands and retracts the rigid inserts thereby correspondingly expanding and retracting the gasket. A method for slush molding utilizes the apparatus.

The method of slush molding plastisol or PVC powder or other materials is generally known and is described in the literature, of which the following examples can be cited:
1) "PLAST"--Sept. 1979 pp 175-177. PA1 2) "MODERN PLASTIC ENCYCLOPEDIA" 1977-1978 pp 340 onwards. PA1 3) BALL W., Ziebart W., Woite B. (BMW) Mannheim VDI conference "New Requirement for Car Interior Trim" pp 1-18. PA1 4) Pabst H. G., Shaper S., Schmidt H., Terveen A. (AUDI) Mannheim VDI Conference 1987--"Development and large-scale use of dashboards produced by Slush Molding PVC". PA1 5) Khue N. N., Kunpers-Martz M., Dankmeier O. (EVC) "Development of optimum powder-blend for slush molding" IVth International Conference PVC '90-24-26 April 1990, Brighton U. K., pp 31/1-31/14. PA1 a) molding a gasket which substantially reproduces as such or slightly modified the profile of the mold along a line thereof which defines on the molded article the corresponding separation line between two different colors, PA1 b) providing on the inside of the mold along the separation line at least one dividing wall to define two separated half spaces inside the mold, PA1 c) fixing the gasket onto the dividing wall in proximity to the mold to form a seal within the mold between the two half-spaces, PA1 d) slush molding a layer of a first material constituting the first of the two different colors, the layer adhering to the mold only on the walls of the first half-space defined within it, PA1 e) consolidating the layer of the first material adhering to the mold, PA1 f) removing the dividing wall and the relative gasket from the mold, PA1 g) slush molding a continuous layer of a second material constituting the second of the two or more colors, and repeating the process according to the number of colors required. PA1 In stage d) of the aforesaid method, the material is left in contact with the mold for the time required for it to adhere and partly gel or melt in the part relating to the first color. PA1 a) providing a mold having an inner surface; PA1 b) providing a gasket having a profile which is approximately the same as a profile of a corresponding region of the mold inner surface; PA1 c) providing rigid material inserts in the gasket; PA1 d) fixing the gasket to a separation wall having a chamber therein; PA1 e) inserting the gasket and the separation wall into the mold, and aligning the gasket along the corresponding region of the mold inner surface to create a seal between the mold inner surface and the separation wall and to define first and second half-spaces within the mold that are sealed from each other; PA1 f) compressing the gasket against the corresponding region of the mold utilizing a mechanical device; PA1 g) slush molding a layer of a first colored material within the first half-space, the layer of the first colored material only adhering to walls defining the first half-space; PA1 h) consolidating the layer of the first colored material; PA1 i) removing the gasket and the separation wall from the mold; PA1 j) slush molding a continuous layer of a second colored material within the mold, thereby producing the molded two-colored article which includes the layer of the first colored material, the continuous layer of the second colored material, and a separation line between the layer of the first colored material and the continuous layer of the second colored material.
FR-A-1,439,028 (Rhone Poulenc), CH-A-293,508 (J. Croning), FR-A-1,075,378 (Telegraph Construction), PA0 FR-A-1,381,850 (Gosudarstvenny), PA0 GB-A-905,546 (Plastomatic) PA0 U.S. Pa. No.-A-2,736,925 (J. S. Heisler), PA0 FR-A-1,131,153 (National Research), PA0 GB-A-1,337,962 (Aquitaine Total), PA0 GB-A-1,056,109 (Celanese), PA0 U.S. Pat. No.-A-3,039,146 (T. Hengel.), PA0 U.S. Pat. No.-A-2,915,788 (T. Hengel), PA0 GB-A-865,608 (T. Hengel), PA0 FR-A-916,055 (ICI), PA0 GB-A-1,025,493 (M. F. Smith), PA0 FR-A-1,560,675 (Goodyear Tire), PA0 DE-A-1,554,967 (Vaessen-Schemaker), PA0 IT-A-22197 A/80 (ILPEA), PA0 DE-A-3,417,727 (YMOS).
All these patents or articles describe a substantially similar process, briefly consisting of filling a preheated metal mold with polymer liquid or powder, removing the excess liquid or solid and then heating the mold to complete gelling or fusion of the material which has adhered to it. The mold is then cooled and the final molding extracted.
In the sector involving such articles, a problem has recently appeared when trying to obtain a finished product, such as simulated leather for trimming an automobile dashboard, having two or more sharply divided colors in the exposed part of the molding.

Method for slush molding articles, of two or more colors from thermoplastic, thermosetting or elastomeric resins in powder form


Transmitting and receiving apparatus, for transmitting an input video signal having 525 lines/field progressive scanning by converting the input video signal into a signal compatible with the NTSC system, and for reproducing from that NTSC-compatible signal a video signal having 525 lines/field progressive scanning. The transmitting apparatus has a first separating system for separating vertical high frequency components in a three-dimensional horizontal-vertical-temporal domain from the input video signal; a modulating system for modulating the separated components from the first separating system by .mu.-modulation; a system for filtering a modulation output from the modulating system to remove a lower sideband component from the modulation output, the filtering system having a Nyquist characteristic; and a system for multiplexing a filtered output from the filtering system to form the NTSC-compatible signal. The receiving apparatus has a second separating system for separating the multiplexed filtered output from the NTSC-compatible signal; and a system for reproducing a video signal having 525 lines/field progressive scanning in response to the filtered output from the second separating system. More particularly, the vertical high-frequency components have a vertical spatial frequency of 515/4 cph, and the filtered output from the filtering system has a frequency band of 2.2 MHz to 4.2 MHz.

1. Field of the Invention
The present invention relates to an extended definition or enhanced definition (ED) TV system and, more particularly, to an apparatus for transmitting an extended definition TV signal having a broader frequency band than conventional TV signals over a conventional TV signal transmission line while being compatible with a conventional TV signal on the same line.
2. Description of Related Art
Systems for transmitting a higher definition TV signal while preserving the compatibility thereof with conventional TV systems (e.g. the NTSC system) have recently been proposed or tested. These ED systems in general are used in order to, for example, multiplex frequency components higher than 4 MHz or to multiplex picture information of both side panels in a high definition signal having an aspect ratio of 16:9.
Generally, when a 525 lines/field progressive scanning (non-interlace) signal is transmitted as an extended definition TV signal by an interlace scanning process which is applied to the NTSC system or to a similar conventional TV system, the signal is, theoretically, in the rhombic range of the vertical-temporal frequency domain. This is indicated by a dotted line in FIG. 1, where the signal in this range can be transmitted without causing aliasing distortions, as generally accepted. It will be seen that the progressive scanning signal has a particular frequency band indicated by a solid line in FIG. 1, showing the range beyond where the vertical-temporal frequencies are too high and cannot be transmitted. Therefore, it is necessary to enlarge the frequency range by using supplemental components on the reception side. However, vertical high frequency components (indicated by the hatched areas 10 and 12 in FIG. 2 and centered around the vertical frequency of 525/2 cph) have customarily been removed by a low pass filter as components disturbing a conventional TV receiver as described in Yasuki et al. by a paper entitled "A Study of Multiplexing Technique for Greater Aspect Ratio", the Institute of Television Engineer's of Japan, Technical Report BCS89-4, pp. 19-24 (August 1989). Specifically, as shown in FIG. 3, it has been customary to remove components around 525/2 cph by motion-adaptive LPF processing. This processing is directed toward the reduction of interline flicker in still pictures and the reduction of vertical aliasing interference in motion pictures, each of which is found in the conventional TV receiver. This stems from the fact that while a signal having an extended vertical high frequency spectrum is desirable with a receiver using an up-converter (interlace scan to progressive scan conversion) from the sharpness standpoint, consideration has to be given to the reduction of interference in the conventional TV receiver which uses interlace scanning. For this reason, even the range indicated by the dotted line in FIG. 1 has heretofore not been transmitted in practice.
A system for multiplexing and transmitting supplemental components to enhance vertical resolution is taught by Ito et al. in a paper entitled "Study and Experiments of NTSC Compatible Wide Aspect Broadcasting System", the Institute of Television Engineers of Japan, Technical Report BCS 89-10, pp. 55-60 (September 1989). The system disclosed in this paper removes vertical high frequency components to display a picture having a wide aspect ratio of 16:9 on a conventional NTSC receiver, but this removal causes a lower vertical resolution. The removed vertical high frequency components are to transmitted the reception side as multiplexed supplemental components, and the original resolution is recovered by using the multiplexed components on the reception side. Although such a system basically differs from the "transmission of components which cannot be transmitted by the NTSC system" to which the present invention pertains, it is common to the present invention regarding the separation and transmission of vertical high frequency components and will therefore be outlined. The system as taught in the referenced article detects whether a picture is still or moving and, when the picture is still, transmits high frequency components from 360/2 cph to 480/2 cph in upper and lower mask portions as shown by area 14 in FIG. 4. With this system, adaptive processing based on such still motion detection is essential. Further, since signal processing on a main panel portion corresponding to an NTSC signal executes vertical time-compression after vertical low pass filter (V LPF) processing, the vertical frequency components below 360/2 cph are spread to an upper frequency of 480/2 cph. As a results, a picture appearing on the NTSC receiver suffers from noticeable interline flicker when it is still.
As stated above, it has been customary to remove vertical high frequency components above 360/2 cph as interference components on the transmitting side beforehand and to thereby lower vertical resolution on the a reception side. While an implementation for separating and transmitting vertical high frequency components has been proposed, it aggravates interline flicker on an NTSC receiver. Moreover, this prior art implementation needs complicated processing and large scale hardware due to the motion-adaptive processing, while suffering from the degradation of picture quality due to adaptive processing.

Apparatus for transmitting an extended definition TV signal having compatibility with a conventional TV system


The load support structure includes a compression member joined adjacent its ends to the end portions of a tension member. A foam plastic is disposed between said members and bonded to the juxtaposed surfaces of said members so that force applied to one of said members will be resisted by the shear and tension modulus of the foam plastic whereby the load support structure can support increased loads. The support structure may be the floor in a storage housing.

In U.S. Pat. No. 4,030,265, there is disclosed an arch beam comprised of a low modulus filler between a compression member and a tension member. Thus, the arch beam in said patent bears a superficial resemblance to the present invention. In said patent, the resistance of the compression member is increased by utilizing the compression strength of the low modulus filler. In said patent, the support points 20 and 21 are spaced apart by a distance which is smaller than the distance between the focus points. In said patent, reaction blocks 18 and 19 are utilized to distribute stress concentration from the reaction forces at the support points. The present invention is directed to a different class of structures from that disclosed in said patent.


The salt, the 2-hydroxy-3-[5-(morpholin-4-ylmethyl)pyridin-2-yl]1H-indole-5-carbonitrile citrate, a process for its preparation, pharmaceutical formulations containing it and the use of it in therapy, and particularly in the therapy of GSK3 related conditions and disorders.

2-Hydroxy-3-[5-(morpholin-4-ylmethyl)pyridin-2-yl]1H-indole-5-carbonitrile as a free base and the hydrochloride salt thereof are described in WO 03/082853. This compound is useful because it possess pharmacological activity by showing inhibiting effect on GSK3 (WO 03/082853). This compound could be used to treat Alzheimer disease, dementias, chronic and acute neurodegenerative diseases, bipolar disorders, schizophrenia, diabetes, hair loss, bone-related disorders and all the listed disorders described in WO 03/082853, which hereby are incorporated into this specification by reference.
Glycogen synthase kinase 3 (GSK3) is a serine/threonine protein kinase composed of two isoforms (α and β), which are encoded by distinct genes but are highly homologous within the catalytic domain. GSK3 is highly expressed in the central and peripheral nervous system. GSK3 phosphorylates several substrates including tau, β-catenin, glycogen synthase, pyruvate dehydrogenase and elongation initiation factor 2b (eIF2b). Insulin and growth factors activate protein kinase B, which phosphorylates GSK3 on serine 9 residue and inactivates it.
Alzheimer's Disease (AD) Dementias, and Taupathies.
AD is characterized by cognitive decline, cholinergic dysfunction and neuronal death, neurofibrillary tangles and senile plaques consisting of amyloid-β deposits. The sequence of these events in AD is unclear, but is believed to be related. Glycogen synthase kinase 3β (GSK3β) or Tau phosphorylating kinase selectively phosphorylates the microtubule associated protein Tau in neurons at sites that are hyperphosphorylated in AD brains. Hyperphosphorylated tau has lower affinity for microtubules and accumulates as paired helical filaments, which are the main components that constitute neurofibrillary tangles and neuropil threads in AD brains. This results in depolymerization of microtubules, which leads to dying back of axons and neuritic dystrophy. Neurofibrillary tangles are consistently found in diseases such as AD, amyotrophic lateral sclerosis, parkinsonism-dementia of Gaum, corticobasal degeneration, dementia pugilistica and head trauma, Down's syndrome, postencephalatic parkinsonism, progressive supranuclear palsy, Niemann-Pick's Disease and Pick's Disease. Addition of amyloid-β to primary hippocampal cultures results in hyperphosphorylation of tau and a paired helical filaments-like state via induction of GSK3β activity, followed by disruption of axonal transport and neuronal death (Imahori and Uchida., J. Biochem 121:179-188, 1997). GSK3β preferentially labels neurofibrillary tangles and has been shown to be active in pre-tangle neurons in AD brains. GSK3 protein levels are also increased by 50% in brain tissue from AD patients. Furthermore, GSK3β phosphorylates pyruvate dehydrogenase, a key enzyme in the glycolytic pathway and prevents the conversion of pyruvate to acetyl-Co-A (Hoshi et al., PNAS 93:2719-2723, 1996). Acetyl-Co-A is critical for the synthesis of acetylcholine, a neurotransmitter with cognitive functions. Accumulation of amyloid-β is an early event in AD. GSK Tg mice show increased levels of amyloid-β in brain. Also, PDAPP mice fed with Lithium show decreased amyloid-β levels in hippocampus and decreased amyloid plaque area (Su et al., Biochemistry 2004, 43:6899-6908). Thus, GSK3β inhibition may have beneficial effects in progression as well as the cognitive deficits associated with Alzheimer's disease and other above-referred to diseases.
Chronic and Acute Neurodegenerative Diseases
Growth factor mediated activation of the PI3K/Akt pathway has been shown to play a key role in neuronal survival. The activation of this pathway results in GSK3β inhibition. Recent studies (Bhat et. al., PNAS 97:11074-11079 (2000)) indicate that GSK3β activity is increased in cellular and animal models of neurodegeneration such as cerebral ischemia or after growth factor deprivation. For example, the active site phosphorylation was increased in neurons vulnerable to apoptosis, a type of cell death commonly thought to occur in chronic and acute degenerative diseases such as cognitive disorders, Alzheimer's Disease, Parkinson's Disease, amyotrophic lateral sclerosis, Huntington's Disease and HIV dementia and traumatic brain injury; and as in ischemic stroke. Lithium was neuroprotective in inhibiting apoptosis in cells and in the brain at doses that resulted in the inhibition of GSK3β. Thus GSK3β inhibitors could be useful in attenuating the course of neurodegenerative diseases.
Bipolar Disorders (BD)
Bipolar Disorders are characterised by manic episodes and depressive episodes. Lithium has been used to treat BD based on its mood stabilising effects. The disadvantage of lithium is the narrow therapeutic window and the danger of overdosing that can lead to lithium intoxication. The discovery that lithium inhibits GSK3 at therapeutic concentrations has raised the possibility that this enzyme represents a key target of lithium's action in the brain (Stambolic et al., Curr. Biol. 6:1664-1668, 1996; Klein and Melton; PNAS 93:8455-8459, 1996; Gould et al., Neuropsychopharmacology, 1:32-8, 2004). GSK3 inhibitor has been shown to reduce immobilisation time in forced swim test, a model to assess on depressive behavior (O'Brien et al., J Neurosci 2004, 24:66791-6798) GSK3 has been associated with a polymorphism found in bipolar II disorder (Szczepankiewicz et al., Neuropsychobiology. 2006;5 3(1):51-6). Inhibition of GSK3β may therefore be of therapeutic relevance in the treatment of BD as well as in AD patients that have affective disorders.
Schizophrenia
Accumulating evidence implicates abnormal activity of GSK3 in mood disorders and schizophrenia. GSK3 is involved in signal transduction cascades of multiple cellular processes, particularly during neural development. Kozlovsky et al (Am J Psychiatry 2000 May; 157(5):831-3) found that GSK3β levels were 41% lower in the schizophrenic patients than in comparison subjects. This study indicates that schizophrenia involves neurodevelopmental pathology and that abnormal GSK3 regulation could play a role in schizophrenia. Furthermore, reduced β-catenin levels have been reported in patients exhibiting schizophrenia (Cotter et al., Neuroreport 9:1379-1383 (1998)). Atypical antipsychotics such as olanzapine, clozapine, quetiapine, and ziprasidone, inhibits GSK3 by increasing ser9 phosphorylation suggesting that antipsychotics may exert their beneficial effects via GSK3 inhibition (Rosborough et al., Int J Neuropsychopharmacol, 4:1-13 2006).
Diabetes
Insulin stimulates glycogen synthesis in skeletal muscles via the dephosphorylation and thus activation of glycogen synthase. Under resting conditions, GSK3 phosphorylates and inactivates glycogen synthase via dephosphorylation. GSK3 is also over-expressed in muscles from Type II diabetic patients (Nikoulina et al., Diabetes 2000 February; 49(2):263-71). Inhibition of GSK3 increases the activity of glycogen synthase thereby decreasing glucose levels by its conversion to glycogen. In animal models of diabetes, GSK3 inhibitors lowered plasma glucose levels up to 50% (Cline et al., Diabetes, 2002, 51:2903-2910; Ring et at., Diabetes 2003, 52:588-595). GSK3 inhibition may therefore be of therapeutic relevance in the treatment of Type I and Type II diabetes and diabetic neuropathy.
Alopecia
GSK3 phosphorylates and degrades β-catenin. β-catenin is an effector of the pathway for keratonin synthesis. β-catenin stabilisation may be lead to increase hair development. Mice expressing a stabilised β-catenin by mutation of sites phosphorylated by GSK3 undergo a process resembling de novo hair morphogenesis (Gat et al., Cell 1998 Nov. 25; 95 (5):605-14)). The new follicles formed sebaceous glands and dermal papilla, normally established only in embryogenesis. Thus GSK3 inhibition may offer treatment for baldness.
Bone-Related Disorders and Conditions
GSK3 inhibitors could be used for treatment of bone-related disorders or other conditions, which involves a need for new and increased bone formation. Remodeling of the skeleton is a continuous process, controlled by systemic hormones such as parathyroid hormone (PTH), local factors (e.g. prostaglandin E2), cytokines and other biologically active substances. Two cell types are of key importance: osteoblasts (responsible for bone formation) and osteoclasts (responsible for bone resorption). Via the RANK, RANK ligand and osteoprotegerin regulatory system these two cell types interact to maintain normal bone turnover (Bell NH, Current Drug Targets—Immune, Endocrine & Metabolic Disorders, 2001, 1:93-102).
Osteoporosis is a skeletal disorder in which low bone mass and deterioration of bone microarchitecture lead to increased bone fragility and fracture risk. To treat osteoporosis, the two main strategies are to either inhibit bone resorption or to stimulate bone formation. The majority of drugs currently on the market for the treatment of osteoporosis act to increase bone mass by inhibiting osteoclastic bone resorption. It is recognized that a drug with the capacity to increase bone formation would be of great value in the treatment of osteoporosis as well as having the potential to enhance fracture healing in patients.
The use of GSK3 inhibitors in primary and secondary osteoporosis, where primary osteoporosis includes postmenaupausal osteoporosis and senile osteoporosis in both men and women, and secondary osteoporosis includes cortison induced osteoporosis, as well as any other type of induced secondary osteoporosis. In addition to this, GSK3 inhibitors may also be used in treatments of myeloma. The GSK3 inhibitors may be administered locally or systemically, in different formulation regimes, to treat these conditions.
Inflammatory Disease
The discovery that GSK3 inhibitors provide anti-inflammatory effects has raised the possibility of using GSK3 inhibitors for therapeutic intervention in inflammatory diseases. (Martin et al., Nat Immunol 2005, 6:777-784; rev. in Jope et al., Neurochem Res 2006, Aug. 30). Inflammation is a common feature of a broad range of conditions including Alzheimer's Disease and mood disorders.

Citrate salt of an indole derivative and its pharmaceutical use


An inner barrel shaft is separate from the shaft of the first rotating machine. A first bearing assembly is configured to support the inner barrel shaft. The first bearing assembly is separate from the first rotating machine. An outer barrel includes an outer barrel shaft that is separate from a shaft of a second rotating machine. The outer barrel is configured to be coupled to the shaft of the second rotating machine. The second rotating machine is configured to drive or be driven by the first rotating machine. The outer barrel is fluidically isolated from the inner barrel. The outer barrel is configured to surround the inner barrel. The outer barrel is magnetically coupled to the inner barrel to co-rotate with the inner barrel. A second bearing assembly is configured to support the outer barrel shaft. The second bearing assembly is separate from the second rotating machine.

Rotating equipment is sometimes used in hazardous environments, such as a downhole environment of oil and gas wells, which is very hostile to equipment. The downhole pressures and temperatures are usually higher than the ambient conditions. The downhole fluids can contain very corrosive species, such as H2S and CO2. In addition, there can be sand, debris, and other solids in the wellbore. The usable life of the equipment exposed to the downhole environment is often much shorter due to different failure modes caused by combining these conditions in different ways. High temperature, high strength, or corrosion-resistant materials are used to extend the life of downhole equipment in many cases. However, the presence of debris and solids can still be detrimental to downhole rotary devices at the physical contact points, for example, bearing surfaces. Therefore, the contact surfaces of the downhole rotary devices are protected by isolating the downhole environment.
Rotary devices have a shaft to transmit torque. The traditional approach to transmit torque is to use a solid shaft with shaft seals around it to isolate downhole fluids from motor, bearings, and other parts which need to be protected from downhole fluids and solids. Seals eventually fail, especially under the pressure, temperature, and corrosive downhole environments. Failure of seals leads to the ingress and exposure to downhole fluid for parts that cannot tolerate the downhole fluids. This eventually causes different failure modes of downhole rotating devices. To fundamentally eliminate all these failure modes, the shaft seal can be eliminated. To do so, a magnetic coupling can be used to transmit torques without a solid or mechanically linked shaft, instead using a magnetic field to transmit torque. When there are no shaft seals, there are no shaft seal failures.

Rotodynamically isolated magnetic coupling


An image-transmitting device connected to image-display devices through a bus cable is provided. The image-transmitting device includes a memory unit storing a set of screen data whose correspondence to each of the image-display devices and a displaying order of the screen data to be displayed on the image-display devices are predetermined; a transmission-data-generating unit selecting specific screen data from among the set of the screen data by following the correspondence and the displaying order, and generating transmission data that each of the image-display devices is to display based on the selected specific screen data; a bus interface connected to the image-display devices through the bus cable; and a transmission unit transmitting the transmission data from the bus interface through the bus cable to each of the image-display devices. The image-transmitting device transmits as the screen data, a combination of data specifying an updating area of the screen data displayed on an image-display device and data used for updating part of the screen data displayed in the updating area, to the image-display device through the bus cable, so that the image-display devices can simultaneously update the screen data displayed thereon.

1. Field of the Invention
The present invention generally relates to an image-display system. The present invention particularly relates to an image-display system that includes image-display devices for displaying a plurality of images simultaneously, and to a user interface provided in an image-display system for allocating a document that includes a plurality of pages to image-display devices included in the image-display system.
2. Description of the Related Art
An image is enlarged by being displayed on a plurality of projectors in a presentation. In addition, a part of the image displayed on each of the projectors can have a high resolution. Further, by setting a plurality of image-display devices on a table, and then displaying images on the image-display devices, more information can be displayed at once on the image-display devices than on a single image-display device. Operation systems such as Windows 98 produced by Microsoft and Mac OS produced by Apple provide a function to use a plurality of image-display devices for displaying images. However, a plurality of video cards 12 must be added to a computer 10, the video cards 12 corresponding to respective image-display devices 14 that are connected to the computer 10 as shown in FIG. 1. Alternatively, special hardware similar to a video card that can connect a plurality of the image display devices 14 must be prepared in addition to the computer 10 and the image-display devices 14.
Additionally, there is software named VNC that displays an image displayed on a monitor of a first computer onto a monitor of a second computer through a network. This VNC is freeware created by Tristan Richard, Quentin Stafford-Fraser, Kenneth R. Wood, and Andy Hooper (Tristan Richard, Quentin Stafford-Fraser, Kenneth R. Wood, Andy Hooper, "Virtual Network Computing", IEEE Internet Computing, Volume 2, Number 1, January/February 1998). The VNC enables fast update of an image displayed on the monitor of the second computer by transmitting raster data of an updated area on the monitor of the first computer and a command to replace a color of an evenly colored area on the monitor of the first computer, to the second computer.
As software installed in an image-display system that includes the computer 10 (a control device) and a plurality of the image-display devices 14, there exists a web browser such as the Internet Explorer produced by Microsoft. The image-display system including the web browser is called a hypertext-document display system, and displays a hypertext document wherein texts, still pictures, movies and sounds included in the document are linked to other related data called objects. The web browser obtains data in an HTML (HyperText Markup Language) format through a network by use of a HTTP protocol, or reads the data from a local disk. Subsequently, the web browser analyzes the obtained data, generates image data indicating contents of the obtained data, and displays the image data on a monitor. The web browser obtains new data in the HTML format from a linked address when a user clicks a mouse in a specific area that has been initially linked to other documents on a monitor, and then displays the new data as an image on the monitor. Additionally, an area called a tool bar provided on an HTML-data display screen displays two buttons, "forward" and "back". The web browser can display the previous pages that have been displayed on the monitor by a user pressing the buttons "forward" and "back".
Another image-display system is a system that uses a plurality of image-display devices. One of methods to use the image-display devices is to divide a large image into images, and then to display the images on the image-display devices. Another method, disclosed in Japanese Laid-Open Patent Application No. 9-81475, is to divide a document logically and then to display logically divided pages of the document. In this method, an LCD (Liquid Crystal Display) board is used as an image-display device. However, a CRT display and a projector may be substituted for the LCD board. Generally, a document includes a set of pages. Assuming each of the pages included in the document is displayed on one of the image-display devices, a user can switch from one page to another page intuitively by observing the pages displayed on the image-display devices simultaneously, or by changing a location of each of the image-display devices physically. A document created by use of a word processor is considered a series of pages in one dimension. The invention disclosed in Japanese Laid-Open Patent Application No. 9-81475 displays a plurality of the pages included in the document simultaneously on the image-display devices by transmitting files that include a plurality of the pages to a group of the image-display devices.
However, in hypertexts such as the HTML, each page includes links connected to other pages in addition to a link to the previous page and a link to the next page. Thus, there exist a plurality of pages connected to each page. In a case in which hypertexts that include complicated links to a plurality of pages are to be displayed on a plurality of image-display devices, a control device included in an image-display system cannot determine which page a user wants to display on each of the plurality of image-display devices only by transmitting the plurality of pages to the plurality of image-display devices. In such an environment, it is necessary to provide a user interface that relates a specific page in a document to a specific image-display device in an image-display system.

Method and apparatus for controlling image-display devices collectively


An obstruction removal system for percutaneous removal of clots or obstructions within the vascular system is disclosed. The obstruction removal system includes a multi-lumen catheter with a plurality of circulating capture devices attached to or integral with a drive belt. The circulating capture or interference devices affect removal of the clot or obstruction bit-by-bit through a series of passes. The obstruction removal system may include one or more drive mechanisms, such as a pulley system and/or a vacuum source and/or a pressurization source, on its proximal end for driving the drive belt and capture devices through the catheter in a circulating manner. The obstruction removal system may also include one or more cleaning mechanisms, such as a vacuum chamber and/or a fluid rinse chamber, for removing the captured clot pieces from the capture devices.

A number of vascular disorders, such as stroke, pulmonary embolism, peripheral thrombosis, and atherosclerosis, are characterized by formation of occlusions that prevent normal blood flow in blood vessels. For example, an ischemic stroke is a neurological dysfunction caused by a blockage of one of the major arteries of the brain. Hemodynamically significant restriction of arterial blood flow can lead to oxygen deprivation in tissue, referred to as ischemia, and can quickly lead to cell death and organ dysfunction. The brain is the organ most sensitive to ischemia, followed by the heart, the abdominal organs, and the extremities. The brain will usually not tolerate ischemia for very long without massive neuron death (stroke). When treating ischemic events in the brain, it is imperative to restore blood flow quickly and safely. The blockage can be the result of emboli or pieces of thrombotic tissue that have dislodged from other body sites (formed in the heart, carotid artery, or elsewhere) or from the cerebral vessels themselves. The emboli or pieces of thrombotic tissue may migrate downstream to occlude in the narrow cerebral arteries. The blockage may also be caused by the formation of a blood clot at the site of blockage (thrombosis) or the obliteration of the lumen of a blood vessel caused by atherosclerosis.
Stroke is the third most common cause of death in the United States and the most disabling neurologic disorder. Hemorrhagic stroke accounts for 20% of the annual stroke population. Hemorrhagic stroke often occurs due to rupture of an aneurysm or arteriovenous malformation bleeding into the brain tissue, resulting in cerebral infarction. The remaining 80% of the stroke population are ischemic strokes and are caused by occluded vessels that deprive the brain of oxygen-carrying blood.
When a patient presents with neurological deficit, a diagnostic hypothesis for the cause of stroke can be generated based on the patient's history, a review of stroke risk factors, and a neurologic examination. If an ischemic event is suspected, a clinician can tentatively assess whether the patient has a cardiogenic source of emboli, large artery extracranial or intracranial disease, small artery intraparenchymal disease, or a hematologic or other systemic disorder. A head CT scan is often performed to determine whether the patient has suffered an ischemic or hemorrhagic insult. Blood would be present on the CT scan in subarachnoid hemorrhage, intraparenchymal hematoma, or intraventricular hemorrhage.
Traditionally, emergent management of acute ischemic stroke consisted mainly of general supportive care, e.g., hydration, monitoring neurological status, blood pressure control, and/or anti-platelet or anti-coagulation therapy. In 1996, the Food and Drug Administration approved the use of Genentech Inc.'s thrombolytic drug, tissue plasminogen activator (t-PA) or ActivaseB, for treating acute stroke. However, the success rate of this approach is still very low. With this form of therapy, only 30% of patients are expected to realize a good or excellent clinical outcome several months following infusion, and patients who demonstrate signs of intracranial hemorrhage at the time of presentation (on a CT study of their heads) are not candidates for t-PA therapy. Also, intravenous t-PA therapy is associated with an almost 6% fatal intracranial hemorrhage rate.
Patients treated with t-PA were more likely to sustain a symptomatic intracerebral hemorrhage during the first 36 hours of treatment. The frequency of symptomatic hemorrhage increases when t-PA is administered beyond 3 hours from the onset of a stroke. Besides the time constraint in using t-PA in acute ischemic stroke, other contraindications include the following: if the patient has had a previous stroke or serious head trauma in the preceding 3 months, if the patient has a systolic blood pressure above 185 mm Hg or diastolic blood pressure above 110 mmHg, if the patient requires aggressive treatment to reduce the blood pressure to the specified limits, if the patient is taking anticoagulants or has a propensity to hemorrhage, and/or if the patient has had a recent invasive surgical procedure. Therefore, only a small percentage of selected stroke patients are qualified to receive t-PA.
New classes of "neuroprotectant" agents and "angiogenesis promoters" are being developed and tested. These drugs may extend the effective therapeutic window for stroke therapy and permit better long term outcomes. Their use, however, may require novel delivery systems and often require that the patient be stabilized and ischemia relieved in order to obtain a lasting clinical improvement.
Obstructive emboli have also been mechanically removed from various sites in the vasculature for years. For example, the "Fogarty catheter" or variations thereof has been used, typically in the periphery, to remove clots from arteries found in legs and in arms. These well known devices are described, for example, in U.S. Pat. No. 3,435,826 to Fogarty and in U.S. Pat. No. 4,403,612 to Fogarty, each of which is incorporated by reference herein in its entirety. In general, these patents describe a balloon catheter in which a balloon material is longitudinally stretched when deflated. In procedures for removing emboli using the Fogarty catheter or other similar catheters, it is typical, first, to locate the clot using fluoroscopy. The embolectomy catheter is then inserted and directed to the clot. The distal tip of the balloon catheter is then carefully moved through the center of the clot. Once the balloon has passed through the distal side of the clot, the balloon is inflated. The balloon catheter is then gradually proximally withdrawn. The balloon, in this way, acts to pull the clot proximally ahead of the balloon to a point where it can be retrieved. The majority of procedures using a Fogarty type catheter repeat these steps until the pertinent vessel is cleared of clot material.
A variety of alternative emboli retrieval catheters have also been developed, in which various wire corkscrews and baskets must be advanced distally through the embolic material in order to achieve capture and removal. For example, Concentric Medical, Inc. (located in Mountain View, Calif.) has created an intraluminal clot retrieval system consisting of a nitinol-(Nickel-Titanium alloy) shape memory corkscrew-like coil that is advanced into an occluding clot, such as shown in U.S. Pat. No. 6,663,650; U.S. Pat. No. 6,730,104; and U.S. Pat. No. 7,285,126, each of which is incorporated by reference herein in its entirety. The coil and its attached wire are then withdrawn from the affected vessel, retrieving the thrombus material into a balloon-tipped guiding catheter positioned in the internal carotid artery. However, removal of emboli using such catheters carries potential problems. One such problem occurs when advancing the catheter through the clot dislodges material to a more remote site where removal may become more difficult or impossible.
New devices and methods are thus needed in treating vasculature occlusions in the body, including treating patients with acute ischemic stroke and occlusive cerebrovascular disease, and treating symptomatic patients with embolization or hemodynamic compromise. There are a number of significant problems faced in designing a system which will quickly and easily, yet effectively, evacuate emboli from a treatment location within a blood vessel. First, the small size of certain vessels in which such therapy occurs is a limiting factor in the design of emboli removal systems. Vessels as small as 3 mm in diameter are quite commonly found in the cerebral arteries, coronary arteries, and even certain saphenous vein graph bypass vessels can also be as small as 3 mm or 4 mm; although some can range as high as 7 mm. Nevertheless, a successful emboli removal system must be effective within extremely small working areas and safely traverse the tortuous cerebral vasculature. The system must also be equally effective in larger vessels, those of 5 mm or more in diameter.
Another obstacle is the wide variety in emboli dimensions. Although definitive studies are not available, it is believed that emboli may have approximate diameters ranging anywhere from tens of micrometers to a few hundred micrometers and lengths over 5 cm. More specifically, emboli that are considered dangerous to the patient may have diameters as large as 200 to 300 micrometers or even larger. Often obstruction removal systems have only a single capture device on the distal end to capture and contain the entire obstruction. Such a capture device must be of a relatively large size in order to effectively remove the entire source of vascular occlusion in one pass. However, the relatively large size of the single capture device may not accommodate small vessels.
Thus, an effective emboli removal system must be able to retrieve relatively large embolic particles and clots, at the same time, fit within relatively small vessels. In order to minimize the size of the obstruction removal system, the obstruction removal system of the present invention utilizes a plurality of relatively smaller capture devices that each capture a small portion of the clot or obstruction in order to remove the source of vascular occlusion in a piecemeal or gradual fashion.


A foldable card and method of making has multiple panels connected by fold lines which are placed laterally inward from free peripheral edges of end panels such that the card can be die cut in a folded configuration around an entire periphery of the card without entirely eliminating the fold lines. In a preferred method of making the cards, card stock is folded along the fold lines prior to cutting. The fold lines of the card are spaced at intervals to define different widths of adjoining panels so that when folded in a "Z" configuration a free peripheral edge of an end panel overlaps or underlaps a fold line. There may be multiple fold line interconnected panels between end panels. The fold lines may be oriented generally vertically or generally horizontally relative to the face of the card. Abutting surfaces of two or more adjacent panels may be bonded by adhesive at areas not coincident with adjoining fold lines in which case the fold lines between such adhesively connected panels may be eliminated in the die cutting step. In an alternate embodiment, a separate tipped-on panel is applied to a face of a folding panel of the card. The peripheral edges of the tipped-on panel are die cut such that the fold lines are positioned laterally inward from peripheral edges of the tipped-on panel so that the fold lines are not eliminated in the cutting step.

Foldable greeting cards having multiple panels connected by fold lines are desirable for the large amount of graphic area provided and structural distinctiveness. Large scale manufacture of such cards is difficult in processes in which the fold lines which connect the panels are formed after the card is cut from card stock. Automated folding is difficult with cards having non-linear peripheral edges to the panels. This is why folding cards are generally rectangular and the fold lines extend the entire length of the panels.
To form multiple panel cards with panels having curved and/or intricately shaped peripheral edges, it is preferred to die cut around an entire periphery (360.degree.) of the front and back panels of the card while the card is in a folded configuration. This, however, results in cutting off the fold lines and thereby disconnecting the panels. U.S. Pat. No. 4,558,980 discloses a method of 360.degree. die cutting a multi-panel card in a folded configuration wherein the fold lines are cut off and the panels remain connected by adhesive applied proximate to common peripheral edges of adjoining panels at areas coincident with the fold lines.
It is also desirable to 360.degree. die cut cards which have a uniquely finished or textured cover panel which is adhesively attached or "tipped-on" to a folding panel of the card, whereby an entire periphery of the front panel could be intricately shaped, along with the other panels of the card. However, a similar problem arises in which the die cutting eliminates the fold line which connects the foldable panels, including the panel which supports the tipped-on panel. These constraints of prior approaches to foldable multi-panel cards increase production costs and thereby limit the number of card designs of this type available.


The chin exercise device in a first embodiment of the present invention includes an elongated handle having a top end, a bottom end, a front side, and a rear side; a pair of curved members extending outwardly from the top end of the handle; and an arm which is pivotally attached to the curved members. The arm has a foam pad for receiving a person's chin. Attached to the rear side of the elongated handle is a foam pad which is placed against a person's clavicle or chest when the device is used by a person to exercise. In order to use the device a person holds the handle and places the foam pad of the handle against his or her chest. The person then places his or her chin into or on the foam pad on the arm. The person moves his or her chin downwardly, toward his or her chest. The springs create resistance as the person brings his or her chin down, thereby exercising the muscles of the chin. The second embodiment of the present invention is similar to the first embodiment; however, the springs are replaced with flexible bands. The bands may be changed in order to increase or decrease the amount of resistance. In a third embodiment of the invention, the resistance provided in the device is created by a single flexible band. The amount of resistance may be varied by placing the band in various positions.

The present invention is directed toward a chin exercise device and more particularly, toward a device which improves muscle tone in the chin and neck areas.
As people become older their bodies start to change. One typical sign of change is sagging and flabby skin in the chin and neck areas. Such a condition is the result of underlying muscles losing their tone due to aging and/or lack of proper exercise. The muscles elongate and droop or sag. This condition also causes wrinkles.
One way of controlling this condition is cosmetic surgery commonly known as a "face-lift." This procedure is effective in tightening facial skin. However, as a result of such tightening, the skin must support the underlying muscle. If this muscle lacks tone, it is lengthened and becomes droopy. Since the skin is not adapted to support the underlying muscles, this creates an even stronger tendency for the skin to droop. While such a method is a quick fix, it is temporary. That is, the process of drooping and wrinkling gradually starts again and the surgery must be repeated. Furthermore, this surgical procedure does not strengthen or tone muscles.
Exercise is one well known way which is effective in toning and strengthening muscles in the arms and legs. The same is also effective in strengthening the muscles of the chin and neck. Besides which, exercising provides long-term results, is inexpensive, simple, and healthier than cosmetic surgery.
Several devices are known which aid a person in exercising his or her chin and neck. One such device is disclosed in U.S. Pat. No. 3,497,217 to Feather which teaches an exercising device with a base plate which rests on a person's thorax or chest with a chin rest member space above the base plate. A hinge connects the base plate and chin rest member. Springs between the members resist compression when the person moves his or her head up and down, thereby exercising the muscles of the neck. This device, however, may not be stable and can slip from its location between the person's chest and chin. Furthermore, the compression forces cannot be easily adjusted.


Systems and methods make possible the placement of one or more electrode leads in a tissue region for providing functional and/or therapeutic stimulation to tissue. The systems and methods are adapted to provide the relief of pain.

Neurostimulation, i.e., neuromuscular stimulation (the electrical excitation of nerves and/or muscle to directly elicit the contraction of muscles) and neuromodulation stimulation (the electrical excitation of nerves, often afferent nerves, to indirectly affect the stability or performance of a physiological system) and brain stimulation (the stimulation of cerebral or other central nervous system tissue) can provide functional and/or therapeutic outcomes. While existing systems and methods can provide remarkable benefits to individuals requiring neurostimulation, many quality of life issues still remain. For example, existing systems include complicated procedures to place electrodes and pulse generators, and issues remain with the migration of electrodes which eventually reduce the effectiveness of the neurostimulation. Furthermore, these systems are, by today's standards, relatively large and awkward to manipulate, transport, and adhere to the patient.
There exist both external and implantable devices for providing neurostimulation in diverse therapeutic and functional restoration indications. These neuro-stimulators are able to provide treatment and/or therapy to individual portions of the body. The operation of these devices typically includes the use of an electrode placed either on the external surface of the skin and/or a surgically implanted electrode. In the case of external neurostimulators, surface electrode(s) and/or percutaneous lead(s) having one or more electrodes may be used to deliver electrical stimulation to the select portion of the patient's body.
One example of an indication where therapeutic treatment may be provided is for the treatment of pain, such as to provide a therapy to reduce pain in individuals with amputated limbs. Amputation leads to chronic pain in almost all (95%) patients, regardless of how much time had passed since the amputation (Ephraim et al. 2005). The pain can be extremely bothersome to amputees, significantly decrease their quality of life, correlate with increased risk of depression, and negatively affect their inter-personal relationships and their ability to return to work (Kashani et al 1983; Blazer et al. 1994; Cansever et al. 2003). The present methods of treatment, which are primarily medications, are unsatisfactory in reducing amputation-related pain, have unwanted side effects, offer a low success rate, and often lead to addiction.
Most amputees have two types of pain: residual limb (stump) pain and phantom pain. Approximately 72-85% of amputees have phantom pain and 68-76% of amputees have residual limb (stump) pain (Sherman and Sherman 1983; Sherman et al. 1984; Ehde et al. 2000; Ephraim et al. 2005). Both stump pain and phantom limb pain are chronic pains experienced after an amputation, and they are easily distinguished by the perceived location of the pain. Stump pain is sensed in the portion of the limb that remains after amputation, and phantom limb pain is perceived in the portion of the limb that has been removed. Typically, amputee patients with severe stump pain also have severe phantom limb pain, but it is recommended that their responses to treatment be measured independently (Jensen et al. 1985; Kooijman et al. 2000). Stump and phantom pain can be severe and debilitating to a large proportion of persons with amputations, who will unfortunately often progress through a battery of management techniques and procedures without finding relief from their pain (Bonica 1953; Sherman et al. 1980; Ehde et al. 2000; Loeser 2001a; Ephraim et al. 2005).
An estimated 80-95% of 1.7 millions persons who currently live with amputations plus the additional 185,000 persons expected to undergo amputation each year in the United States will suffer from stump and/or phantom pain at an annual direct cost of $1.4-2.7 billion and overall associated costs of $13 billion (Sherman and Sherman 1983; Sherman et al. 1984; Ehde et al. 2000; Mekhail et al. 2004; Ephraim et al. 2005). Severe post-amputation pain often leads to further disability, reduced quality of life, and frequently interferes with the simple activities of daily life more than the amputation itself (Millstein et al. 1985; Schoppen et al. 2001; Marshall et al. 2002; Whyte and Carroll 2002; Rudy et al. 2003), and no available therapy is sufficient to manage it (Sherman et al. 1980; Jahangiri et al. 1994; Rosenquist and Haider 2008).
Many techniques have been developed to treat post-amputation pain, but all of them are ultimately insufficient (Jahangiri et al. 1994). A review in 1980 found that none of the 68 treatments available for post-amputation pain were uniformly successful (Sherman et al. 1980), and more recent reviews have found that little has changed and there remains a large need for an effective method of treating stump and phantom pain (Davis 1993; Wall et al. 1994; Loeser 2001a; Halbert et al. 2002; Rosenquist and Haider 2008). Some studies report that as few as 1% of amputees with severe phantom and stump pain receive lasting benefit from any of the available treatments (Sherman and Sherman 1983; Sherman et al. 1984). Presently, most patients are managed with medications, but approximately a third of amputees still report severe (intensity of 7-10 on a scale of 0-10) phantom and stump pain.
Non-narcotic analgesics, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDS), have relatively minor side effects and are commonly used for several types of pain. However, they are not specific to stump or phantom pain and are rarely sufficient in managing moderate to severe chronic post-amputation pain (Sherman et al. 1980; Loeser 2001a; Rosenquist and Haider 2008).
The use of narcotic analgesics, such as N-methyl-D-aspartate (NDMA) antagonists, has shown only minor success with inconsistent results. Narcotics carry the risk of addiction and side effects, such as nausea, confusion, vomiting, hallucinations, drowsiness, dizziness, headache, agitation, and insomnia. Several trials of multiple narcotic agents have failed to show statistically significant improvement in phantom pain (Stangl and Loeser 1997; Nikolajsen et al. 2000; Loeser 2001a; Maier et al. 2003; Hayes et al. 2004; Wiech et al. 2004; Rosenquist and Haider 2008).
Physical methods such as adjusting the prosthesis may be helpful, but only if the pain is due to poor prosthetic fit. Other physical treatments, including acupuncture, massage, and percussion or heating/cooling of the stump, have few complications but also have limited data to support their use and have not been well accepted clinically (Russell and Spalding 1950; Gillis 1964; Monga and Jaksic 1981; Loeser 2001a).
Psychological strategies, such as biofeedback and psychotherapy, may be used as an adjunct to other therapies but are seldom sufficient, and there are few studies demonstrating efficacy and these approaches are not specific to stump or phantom pain (Dougherty 1980; Sherman 1980). Mirror-box therapy has demonstrated mixed results and is not widely used in clinical practice (Ramachandran and Rogers-Ramachandran 1996; Brodie et al. 2007; Chan et al. 2007; Rosenquist and Haider 2008).
Many surgical procedures have been attempted, but few are successful and most are contraindicated for the majority of the amputee patients (Loeser 2001a). Because neuromas are implicated with stump and phantom pain, there have been many attempts to remove them surgically, but ultimately a new neuroma will develop each time a nerve is cut and the pain relief only lasts for the 3 weeks that it takes for a new neuroma to form (Sturm 1975; Sunderland 1978; Sherman 1980). Furthermore, neuroablative procedures carry the risk of producing deafferentation pain, and any surgical procedure has a greater chance of failure than success (Loser 2001a; Rosenquist and Haider 2008). Thus, present medical treatments of stump and phantom pain are inadequate, and most sufferers resort to living with pain that is poorly controlled with medications.
Electrical stimulation systems hold promise for relief of post-amputation pain, but widespread use of available systems is limited.
Transcutaneous electrical nerve stimulation (TENS) has been cleared by the FDA for treatment of pain and may be successful in reducing post-amputation pain. TENS systems are external neurostimulation devices that use electrodes placed on the skin surface to activate target nerves below the skin surface. TENS has a low rate of serious complications, but it also has a relatively low (i.e., less than 25%) long-term rate of success.
Application of transcutaneous electrical nerve stimulation (TENS) has been used to treat stump and phantom pain successfully, but it has low long-term patient compliance, because it may cause additional discomfort by generating cutaneous pain signals due to the electrical stimulation being applied through the skin, and the overall system is bulky, cumbersome, and not suited for long-term use (Nashold and Goldner 1975; Sherman 1980; Finsen et al. 1988).
Spinal cord stimulation (SCS) systems are FDA approved as implantable neurostimulation devices marketed in the United States for treatment of pain. Similar to TENS, when SCS evokes paresthesias that cover the region of pain, it confirms that the location of the electrode and the stimulus intensity should be sufficient to provide pain relief and pain relief can be excellent initially, but maintaining sufficient paresthesia coverage is often a problem as the lead migrates along the spinal canal (Krainick et al. 1980; Sharan et al. 2002; Buchser and Thomson 2003).
Lead migration is the most common complication for spinal cord stimulators occurring in up to 45-88% of the cases (North et al. 1991; Andersen 1997; Spincemaille et al. 2000; Sharan et al. 2002). When the lead migrates, the active contact moves farther from the target fibers and loses the ability to generate paresthesias in the target area. SCS systems attempt to address this problem by using leads with multiple contacts so that as the lead travels, the next contact in line can be selected to be the active contact.
Spinal cord stimulation is limited by the invasive procedure and the decrease in efficacy as the lead migrates. When it can produce paresthesias in the region of pain, spinal cord stimulation is typically successful initially in reducing stump and phantom pain, but over time the paresthesia coverage and pain reduction is often lost as the lead migrates away from its target (North et al. 1991; Andersen 1997; Loeser 2001a).
Brain stimulation systems are limited by the lack of patient selection criteria and the lack of studies demonstrating long-term efficacy.
Peripheral nerve stimulation may be effective in reducing post-amputation pain, but it previously required specialized surgeons to place cuff- or paddle-style leads around the nerves in a time consuming procedure.
Immediately following amputation, all patients experience short-term (postoperative) pain, but it usually resolves within a month as the wound heals. In contrast, a long-term pain often develops and persists in the stump and phantom limb after the amputated limb has healed into a healthy stump. Stump and phantom pain are thought to have a peripheral and central component, and both components may be mediated by stimulating the peripheral nerves that were transected during amputation.
Neuromas develop when a peripheral nerve is cut and the proximal portion produces new axon growth that forms a tangled mass as it fails to connect with the missing distal portion of the nerve. All amputations produce neuromas and not all neuromas are painful, but neuromas are thought to be a major source of pain after amputation (Burchiel and Russell 1987; Loeser 2001a; Rosenquist and Haider 2008). Neuromas may generate spontaneous activity (Wall and Gutnick 1974), and the level of activity in afferent fibers innervating the region of pain has been linked to the level of post-amputation pain (Nyströom and Hagbarth 1981).
As previously described, electrical stimulation has been used and shown to be effective in treating amputee pain, but present methods of implementation have practical limitations that prevent widespread use. External systems are too cumbersome, and implanted spinal cord stimulation systems often have problems of lead migration along the spinal canal, resulting in either the need for frequent reprogramming or clinical failure.
It is time that systems and methods for providing neurostimulation address not only specific prosthetic or therapeutic objections, but also address the quality of life of the individual requiring neurostimulation, including a need to treat amputee pain with minimally-invasive systems and methods that may not require reprogramming, and include lead(s) that can be inserted percutaneously near target peripheral nerve(s) and resist(s) migration.
The electrical stimulation of nerves, often afferent nerves, to indirectly affect the stability or performance of a physiological system can provide functional and/or therapeutic outcomes, and has been used for activating target nerves to provide therapeutic relief of pain.
While existing systems and methods can provide remarkable benefits to individuals requiring therapeutic relief, many issues and the need for improvements still remain.
Many techniques have been developed to treat pain, but all of them are ultimately insufficient.
Non-narcotic analgesics, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDS), have relatively minor side effects and are commonly used for several types of pain. However, they are rarely sufficient in managing moderate to severe chronic pain (Sherman et al. 1980; Loeser 2001a; Rosenquist and Haider 2008).
The use of narcotic analgesics, such as N-methyl-D-aspartate (NDMA) antagonists, has shown only minor success with inconsistent results. Narcotics carry the risk of addiction and side effects, such as nausea, confusion, vomiting, hallucinations, drowsiness, dizziness, headache, agitation, and insomnia.
Psychological strategies, such as biofeedback and psychotherapy, may be used as an adjunct to other therapies but are seldom sufficient, and there are few studies demonstrating efficacy.
Electrical stimulation systems have been used for the relief of pain, but widespread use of available systems is limited.
There exist both external and implantable devices for providing electrical stimulation to activate nerves and/or muscles to provide therapeutic relief of pain. These "neurostimulators" are able to provide treatment and/or therapy to individual portions of the body. The operation of these devices typically includes the use of an electrode placed either on the external surface of the skin and/or a surgically implanted electrode. In most cases, surface electrode(s), cuff-style electrode(s), paddle-style electrode(s), spinal column electrodes, and/or percutaneous lead(s) having one or more electrodes may be used to deliver electrical stimulation to the select portion of the patient's body.
Transcutaneous electrical nerve stimulation (TENS) has been cleared by the FDA for treatment of pain. TENS systems are external neurostimulation devices that use electrodes placed on the skin surface to activate target nerves below the skin surface. TENS has a low rate of serious complications, but it also has a relatively low (i.e., less than 25%) long-term rate of success.
Application of TENS has been used to treat pain successfully, but it has low long-term patient compliance, because it may cause additional discomfort by generating cutaneous pain signals due to the electrical stimulation being applied through the skin, and the overall system is bulky, cumbersome, and not suited for long-term use (Nashold and Goldner 1975; Sherman 1980; Finsen et al. 1988).
In addition, several clinical and technical issues associated with surface electrical stimulation have prevented it from becoming a widely accepted treatment method. First, stimulation of cutaneous pain receptors cannot be avoided resulting in stimulation-induced pain that limits patient tolerance and compliance. Second, electrical stimulation is delivered at a relatively high frequency to prevent stimulation-induced pain, which leads to early onset of muscle fatigue in turn preventing patients from properly using their arm. Third, it is difficult to stimulate deep nerves and/or muscles with surface electrodes without stimulating overlying, more superficial nerves and/or muscles resulting in unwanted stimulation. Finally, clinical skill and intensive patient training is required to place surface electrodes reliably on a daily basis and adjust stimulation parameters to provide optimal treatment. The required daily maintenance and adjustment of a surface electrical stimulation system is a major burden on both patient and caregiver.
Spinal cord stimulation (SCS) systems are FDA approved as implantable neurostimulation devices marketed in the United States for treatment of pain. Similar to TENS, when SCS evokes paresthesias that cover the region of pain, it confirms that the location of the electrode and the stimulus intensity should be sufficient to provide pain relief and pain relief can be excellent initially, but maintaining sufficient paresthesia coverage is often a problem as the lead migrates along the spinal canal (Krainick et al. 1980; Sharan et al. 2002; Buchser and Thomson 2003).
Spinal cord stimulation is limited by the invasive procedure and the decrease in efficacy as the lead migrates. When it can produce paresthesias in the region of pain, spinal cord stimulation is typically successful initially in reducing pain, but over time the paresthesia coverage and pain reduction is often lost as the lead migrates away from its target (North et al. 1991; Andersen 1997; Loeser 2001a).
Lead migration is the most common complication for spinal cord stimulators occurring in up to 45-88% of the cases (North et al. 1991; Andersen 1997; Spincemaille et al. 2000; Sharan et al. 2002). When the lead migrates, the active contact moves farther from the target fibers and loses the ability to generate paresthesias in the target area. SCS systems attempt to address this problem by using leads with multiple contacts so that as the lead travels, the next contact in line can be selected to be the active contact.
Peripheral nerve stimulation may be effective in reducing pain, but it previously required specialized surgeons to place cuff- or paddle-style leads around the nerves in a time consuming procedure.
These methods of implementation have practical limitations that prevent widespread use. External systems are too cumbersome, and implanted spinal cord stimulation systems often have problems of lead migration along the spinal canal, resulting in either the need for frequent reprogramming or clinical failure.
Percutaneous, intramuscular electrical stimulation for the treatment of post-stroke shoulder pain has been studied as an alternative to surface electrical stimulation. A feasibility study (Chae, Yu, and Walker, 2001) and a pilot study (Chae, Yu, and Walker, 2005) showed significant reduction in pain and no significant adverse events when using percutaneous, intramuscular electrical stimulation in shoulder muscles.
This form of percutaneous, intramuscular electrical stimulation can be characterized as "motor point" stimulation of muscle. To relieve pain in the target muscle, the percutaneous lead is placed in the muscle that is experiencing the pain near the point where a motor nerve enters the muscle (i.e., the motor point). In "motor point" stimulation of muscle, the muscle experiencing pain is the same muscle in which the lead is placed. In "motor point" stimulation of muscle, the pain is felt and relieved in the area where the lead is located.

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Systems and methods to place one or more leads in tissue for providing functional and/or therapeutic stimulation