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Patent application title: SUPPORTIVE BALLOON CATHETER
Inventors: David Christian Lentz (Bloomington, IN, US) Anders Bro (Malmo, SE) Katrine Birch Rasmussen (Bloomington, IN, US)
IPC8 Class: AA61M2510FI
Class name: Internal pressure applicator (e.g., dilator) inflatable or expandible by fluid inserted in vascular system
A supportive balloon catheter which may be used to assist a wire guide in advancing across a lesion which partially or totally occludes an intraluminal passage. The supportive balloon catheter is advanced over the wire guide, close to the location of the lesion. The supportive balloon catheter is then inflated, securing the position of the wire guide in the intraluminal passage. A braid on the catheter may provide additional structural support. The secured catheter restricts the movement of the wire guide advancing across the lesion, preventing kinking or deflection off the surface of the lesion. Once the wire guide has advanced across the lesion, the supportive balloon catheter or a different angioplasty may be used to clear the lesion from the intraluminal passage.
1. A support balloon catheter, comprising: a body having a proximal end and a distal end; a plurality of lumens within the body, including a first lumen for a wire guide, and at least one inflation lumen; an inflatable member located near the distal end of the body having a proximal side, a distal side, and an outer surface which defines an interior region which communicates with an opening in the at least one inflation lumen; and a braid extending proximally along the body from the proximal side of the inflatable member and distally from the opening of the inflation lumen.
2. The support balloon catheter of claim 1, wherein the braid extends distally along the body from the interior region of the inflatable member.
3. The support balloon catheter of claim 1, wherein the braid extends to the proximal end of the body.
4. The support balloon catheter of claim 1, comprising a single inflation lumen within the body, wherein the inflation lumen encircles the first lumen.
5. The support balloon catheter of claim 1, comprising two inflation lumens within the body.
6. The support balloon catheter of claim 1, wherein the braid encircles only the first lumen and extends to the distal end of the body.
7. The support balloon catheter of claim 1, wherein the body has a first portion comprising the plurality of lumens and a second portion comprising the first lumen, and wherein the braid encircles the plurality of lumens over the first portion of the body and encircles only the first lumen over the second portion of the body.
8. The support balloon catheter of claim 1, further comprising additional braids so that each of the plurality of lumens is encircled by at least one braid.
9. The support balloon catheter of claim 1, wherein the plurality of lumens extend to the distal end of the body, and wherein a side opening extending through the body forms the opening of the at least one inflation lumen.
10. The support balloon catheter of claim 1, wherein the distal end of the first lumen is angularly offset from a longitudinal axis defined by the body.
11. The support balloon catheter of claim 1, wherein each of the plurality of lumens is defined by a liner.
12. A method of advancing a wire guide across a lesion, comprising: advancing a wire guide to a lesion within an intraluminal passage; advancing a support balloon catheter over the wire guide to the lesion, wherein the support balloon catheter comprises a body having proximal and distal ends, a plurality of lumens including a first lumen for the wire guide and at least one inflation lumen, a braid extending proximally from the distal end of the body, and an inflatable member located near the distal end of the body having an outer surface which defines an interior region which communicates with an opening in the at least one inflation lumen; inflating the inflatable member against a wall of the intraluminal passage; thereby restricting movement of the support balloon catheter within the intraluminal passage; and advancing the wire guide at least partially across the lesion.
13. The method of claim 12, further comprising: deflating the inflatable member after the wire guide has advanced at least partially across the lesion; advancing the support balloon catheter at least partially across the lesion after deflating the inflatable member; and inflating the inflatable member after the support balloon catheter has advanced at least partially across the lesion.
14. The method of claim 12, further comprising: deflating the inflatable member after the wire guide has advanced at least partially across the lesion; retracting the support balloon catheter from the intraluminal passage over the wire guide; advancing an angioplasty balloon catheter comprising a second inflatable member through at least a portion of the lesion; and inflating the second inflatable member after a distal portion of the angioplasty balloon catheter has advanced at least partially across the lesion.
15. The method of claim 14, wherein the angioplasty balloon catheter is advanced from an opposing side of the lesion from where the support balloon catheter was advanced, and wherein the wire guide is received into a lumen of the angioplasty balloon catheter after advancing at least partially across the lesion.
16. The method of claim 15, wherein the wire guide is received into the lumen of the angioplasty balloon catheter by use of a snare.
17. The method of claim 12, wherein the braid extends proximally along the support balloon catheter through the interior region of the inflatable member.
18. The method of claim 12, wherein the support balloon catheter has a first portion comprising the plurality of lumens and a second portion comprising the first lumen, and wherein the braid encircles the plurality of lumens over the first portion of the support balloon catheter and encircles only the first lumen over the second portion of the support balloon catheter.
19. The method of claim 12, further comprising additional braids so that each of the plurality of lumens is encircled by at least one braid.
20. The method of claim 12, wherein the plurality of lumens extend to the distal end of the support balloon catheter, and wherein a side opening extending through the support balloon catheter forms the opening of the at least one inflation lumen.
[0001] The present disclosure is related to and claims all benefit pursuant to 35 U.S.C. §119 of U.S. Provisional Application Ser. No. 62/028,960, filed Jul. 25, 2014, which is incorporated by reference in its entirety.
[0002] The field of the present invention relates to supportive catheters for use in advancing wire guides across a lesion.
[0003] Wire guides are commonly used during angioplasties to pass through narrow passages in the body so that larger catheters and other devices may be advanced through an intraluminal passage along an already established path. Specifically, during an angioplasty, the wire guide is used to cross the portion of the intraluminal passage which is partially or completely occluded by a lesion. However, when the open passage through the lesion is extremely small or completely occluded, it can be difficult for the wire guide to cross the lesion. Furthermore, because wire guides are typically flexible to accommodate curvatures in the vasculature, they often fail to cross the lesion due to the tip of the wire guide being deflected away from the lesion or due to the body of the wire guide kinking in response to longitudinal force being exerted on the wire guide by the operator. To prevent this, support catheters are commonly used to brace the wire guide within the intraluminal passage. The support catheter is advanced over the wire guide as close as possible to the lesion. The wire guide is then advanced in an attempt to cross the lesion. However, although the support catheter prevents kinking of the wire guide, the body of the support catheter frequently bends, flexes, or kinks in response to the force being exerted by the wire guide. This movement of the support catheter makes it more likely that the wire guide will deflect off the lesion or miss a narrow opening which might exist to cross the lesion. It is desirable that a support catheter provide additional support to the wire guide to prevent the tendency of the support catheter, when under stress, to bend, flex, or kink.
[0004] The process of attempting to cross a difficult lesion as described above can become time consuming. Because angioplasties are performed under fluoroscopy, it is desirable to conduct the procedure as quickly as possible to minimize the amount of radiation to which the patient is exposed. Additionally, if the wire guide cannot be advanced across the lesion, the angioplasty cannot be performed, and more invasive alternative procedures must be used instead. More invasive procedures pose greater risk of harm to the patient and require longer recovery times.
[0005] A supportive balloon catheter may be used to allow a wire guide to advance across a lesion which partially or completely occludes an intraluminal passage. Once the wire guide has advanced across the lesion, the balloon may then be deflated and re-inflated within the lesion, or different catheters may be advanced over the wire guide to treat the lesion.
[0006] In view of this, the supportive balloon catheter system includes a catheter having an inflation lumen and a wire guide lumen. The balloon catheter is advanced over the wire guide to an area close to the lesion, where an inflatable member on the catheter is inflated through the inflation lumen. The inflated balloon catheter presses against the wall of the intraluminal passage, providing support to the wire guide in advancing across the lesion. The catheter may also be braided to provide additional structural support to the wire guide.
[0007] The supportive balloon catheter may be used in conjunction with an angioplasty balloon catheter. Once the wire guide has advanced across the lesion, an angioplasty balloon may be advanced over the wire guide and inflated to clear the intraluminal passage. This angioplasty balloon may be advanced from the same side of the lesion as the supportive balloon catheter, or may be advanced from the opposing side of the lesion.
BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS
[0008] The invention may be more fully understood by reading the following description in conjunction with the drawings, in which:
[0009] FIGS. 1A-1D are side plan views of a support balloon catheter system within an intraluminal passage, showing a wire guide, and a support balloon catheter in the vicinity of a lesion.
[0010] FIGS. 2A-2D are side plan views of a support balloon catheter system within an intraluminal passage, showing a support balloon catheter and an angioplasty balloon catheter arranged on opposing sides of a lesion.
[0011] FIG. 3A is a cross-sectional side view of a support balloon catheter system, showing the configuration of the braid of the support balloon catheter.
[0012] FIG. 3B is a cross-sectional axial view of the support balloon catheter system shown in FIG. 3A.
[0013] FIG. 4A is a cross-sectional side view of a support balloon catheter system, showing another possible configuration of the braid of the support balloon catheter.
[0017] FIG. 6A is a side plan view of a support balloon catheter system showing a support balloon catheter, a wire guide, and side holes along the support balloon catheter's body.
[0019] FIG. 7A is cross-sectional side view of a support balloon catheter system, showing an alternative co-axial configuration of the lumens.
[0021] Referring now to the drawings, and particularly to FIGS. 1A-1D, a wire guide 101 is shown in an intraluminal passage 100 in the vicinity of a lesion 102. The lesion 102 shown in FIG. 1A may have completely occluded the intraluminal passage 101, or a very narrow channel 110 may be open to the passage of blood. In order for the angioplasty procedure to continue, the wire guide 101 must be advanced at least partially into the lesion 102. However, the narrowness or lack of a channel 110 may prevent the wire guide 101 from being able to easily advance into the lesion 102. If the wire guide 101 is of an insufficient stiffness, it may kink or bend in response to the force exerted on it, instead of advancing through the lesion 102.
[0022] If the wire guide 101 is unable to advance into the lesion 102, a support balloon catheter 104 may be advanced over the wire guide 101 to the lesion 102. As shown in FIG. 1B, it may be advantageous to advance the support balloon catheter 104 as close to the lesion 102 as possible, to give optimal support to the wire guide 101. The wire guide 101 may then be advanced again in an attempt to advance through the lesion 102. During this second attempt, the wire guide lumen 107 of the support balloon catheter 104 may provide support for the wire guide 101, preventing kinking or deflection by constraining the movement of the wire guide 101 within the wire guide lumen 107. It is possible, however, that even with this added support, the support balloon catheter 104 may bend or flex within the intraluminal passage 100, preventing the wire guide 101 from advancing at least partially through the lesion 102.
[0023] If the uninflated support balloon catheter 104 is unable to support the wire guide 101 to advance through the lesion 102, then the inflatable member 103 of the support balloon catheter 104 may then inflated to bring the outer surface of the inflatable member 103 into contact with the wall 108 of the intraluminal passage 100, as shown in FIG. 1C. This inflation should occur as near as possible to the lesion 102. It may be desirable to inflate the inflatable member 103 to a sufficient pressure to effectively anchor the position of the support balloon catheter 104 within the intraluminal passage 100. The inflatable member 103 may also be inflated in such a way to expand the wall 108 of the intraluminal passage 100 in the vicinity of, but proximal to the lesion 102, potentially creating or enlarging any channel 110 that might exist through the lesion 102.
[0024] Once the support balloon catheter 104 has been secured by inflation of the inflatable member 103, the movement of the support balloon catheter 104 within the intraluminal passage 100 will be restricted. The wire guide 101 may then be advanced again at least partially through the lesion 102, as shown in FIG. 1 D. The wire guide lumen 107 of the support balloon catheter 104 prevents the wire guide 101 from kinking or bending, while the inflation of the inflatable member 103 against the wall 108 of the intraluminal passage 100 prevents the support balloon catheter 104 from bending or flexing.
[0025] Once the wire guide 101 has been advanced partially into the lesion 102, the inflatable member 103, if inflated, may be deflated. The support balloon catheter 104 may then be at least partially advanced into the lesion 102. Once the support balloon catheter 104 has advanced, the inflatable member 103 may be inflated to push the lesion 102 against the wall 108 of the intraluminal passage 100, expanding the wall 108 of the intraluminal passage 100 to create a larger channel 110 for blood flow.
[0026] Once at least a portion of the lesion 102 has been expanded, the inflatable member 103 may be deflated. If the lesion 102 has been completely expanded, clearing the intraluminal passage 100, the support balloon catheter 104 may be withdrawn over the wire guide 101. If, however, the inflatable member 103 was only able to expand a portion of the lesion 102, then the support balloon catheter 104 may be advanced further through the lesion 102 and reinflated to expand another portion of the lesion 102. The process of inflating, deflating, and advancing may be repeated until the entire lesion 102 has been expanded and the intraluminal passage 100 is clear of any blockages.
[0027] The wire guide 101 shown in FIGS. 1A-1D must have a tip with sufficient rigidity to pass through the lesion 102 without deforming. Furthermore, it may be desirable for the wire guide 101 to have a radiopaque tip 306, to allow the operator to observe the movement of the wire guide 101 through the lesion 102 through radioscopy.
[0028] The support balloon catheter 104 shown in FIGS. 1A-1D comprises a plurality of lumens, including a wire guide lumen 107 and at least one lumen for inflation fluid 105. The wire guide lumen 107 may end with an opening at the distal end of the balloon catheter 104. The inflation lumen 105 may terminate at several locations along the length of the support balloon catheter, but must have at least an opening to communicate with the interior region 109 of the inflatable member 103.
[0029] The inflatable member 103 is arranged on the distal portion of the balloon catheter 104 and may take the form of a balloon, as shown in FIGS. 1A-1D. The inflatable member 103 has an outer surface which defines an interior region 109. The inflatable member 103 may also be pleated with preformed folds to allow for controlled inflation from a tightly wrapped uninflated state. Pleats allow the inflatable member 103 to return to a smaller, uniform shape after deflation, ensuring that the support balloon catheter 104 may be advanced and reinflated.
[0030] The length of the inflatable member 103 along the support balloon catheter 104 may differ depending on the intended purpose of the support balloon catheter 104. If the support balloon catheter 104 is intended only to facilitate the advancement of the wire guide 101 across the lesion 102, the inflatable member 103 need only be as long as necessary to adequately secure the support balloon catheter 104 against the wall 108 of the intraluminal passage, which may be relatively short. Alternatively, if the support balloon catheter 104 is intended to both facilitate the advancement of the wire guide 101, and then expand the lesion 102, the length of the inflatable member 103 may be considerably longer, depending on the length of the lesion 102 which is being cleared.
[0031] Additionally, the support balloon catheter 104 may have other features such as radiopaque markers 106 on the body of the support balloon catheter 104 to indicate the position of the inflatable member 103 within the intraluminal passage 100. Using the radiopaque markers 106, operators may ensure that the support balloon catheter 104 is deployed as close to the lesion 102 as possible, giving the maximum possible support to the wire guide 101 in attempting to advance through the lesion 102. Additionally, the support balloon catheter 104 and inflatable member 103 may have a hydrophilic coating on the distal portion to increase the pushability and trackability of the support balloon catheter 104 as it advances over the wire guide 101.
[0032] FIGS. 2A-2D show an alternative embodiment of the support balloon catheter system. In some situations, a different wire guide 201 and an angioplasty balloon catheter 204 may first be advanced to clear the lesion 102. However, if the lesion 102 mostly or totally occludes the intraluminal passage 100, the different wire guide 201 may be unable to advance through the lesion 102. This may be particularly true since the angioplasty balloon catheter 204 may not be a support balloon catheter with a braid up to the distal end to prevent the different wire guide 201 from flexing or deflecting off the lesion 102. In such a situation, it may be more expedient to advance the wire guide 101 of the support balloon catheter 104 to the opposing side of the lesion 102 and cross the lesion 102 using the support balloon catheter 104 and the method described above and demonstrated in FIGS. 1A-1D.
[0033] Once the wire guide 101 of the support balloon catheter 104 has crossed the lesion 102, it may be received into a lumen 207 of the angioplasty balloon catheter 204. To facilitate this, the different wire guide 201, if used previously, may need to be retracted. As an alternative, the different wire guide 201 may be substituted with a snare 200 on the distal end of an elongated member. After crossing the lesion 102, the wire guide 101 of the support balloon catheter 104 may be advanced into a loop of the snare 200 as shown in FIG. 2A. The snare 200 then closes around the wire guide 101, and is retracted back into the lumen 207 of the angioplasty balloon catheter 204, as shown in FIG. 2B. Once received inside, the wire guide 101 may be advanced through the lumen 207 of the angioplasty balloon catheter 204. It may be desirable to advance the wire guide 101 to the proximal end of the angioplasty balloon catheter 204 to better control the movement of the angioplasty balloon catheter 204 over the wire guide 101. Concurrently, the original support balloon catheter 104 may be deflated as shown in FIG. 2B and retracted from the body over the wire guide 101.
[0034] The angioplasty balloon catheter 204 is then advanced over the wire guide 101 at least partially across the lesion 102, as shown in FIG. 2C. Because it lacks a braid, the angioplasty balloon catheter 204 may be more likely to flex and advance easily through the channel 210 crossed by the wire guide 101. Furthermore, the angioplasty balloon catheter may be sized so that the inflatable member 203 is at least as long as the length of the lesion 102. Once the angioplasty balloon catheter 204 has advanced, the inflatable member 203 may be inflated to push the lesion 102 against the wall 108 of the intraluminal passage 100, expanding the wall 108 of the intraluminal passage 100 to create a larger channel 210 for blood flow.
[0035] The snare 200 used in the above procedure may comprise at least one loop. It may be desirable that the loop is large enough within the intraluminal passage 100 that little precision is needed to advance the wire guide 101 of the support balloon catheter 104 through the loop of the snare. Additionally, it may be desirable that the loop of the snare 200 be made of a radiopaque material to aid the operator in directing the original wire guide 101 into the loop. Furthermore, it may be necessary to exert the minimum amount of force possible in closing the snare 200 on the wire guide 101. If the snare 200 is closed too tightly, it may kink or divert the distal tip of the wire guide 101, making it more difficult to be received in the lumen 207 of the angioplasty balloon catheter 204.
[0036] The angioplasty balloon catheter 204 may comprise a plurality of lumens. The first lumen 207 is used to extend the snare and receive the original wire guide 101, while at least one lumen opens into the interior region 209 of the inflatable member 203 of the angioplasty balloon catheter 204 to inflate the inflatable member 203 using inflation fluid. Additionally, the configuration of the inflatable member 203 on the angioplasty balloon catheter 204 may be different from the inflatable member 103 of the support balloon catheter 104. The inflatable member 103 of the support balloon catheter 104 is primarily configured to press against the wall 108 of the intraluminal passage 100 and may therefore be somewhat shorter in length, but may be capable of being expanded to a diameter at least as large as the intraluminal passage. Comparatively, the inflatable member 203 of the angioplasty balloon catheter 204 should be configured to have a length at least as long as the target lesion 102 which it is being deployed to clear. The result is that the inflatable member 203 of the angioplasty balloon catheter 204 may be substantially longer than the inflatable member 103 of the support balloon catheter 104, but may not need to be inflated to as large a diameter.
[0037] The support balloon catheter 104 may be configured in a variety of ways. FIGS. 3A and 3B show one possible embodiment of the support balloon catheter 304. FIG. 3A shows a support balloon catheter 304 with two portions having different diameters. The first portion encompasses the wire guide lumen 307, and two inflation lumens 305. The second portion comprises only the wire guide lumen 307. An inflatable member 303 may be attached to the second portion on its distal end, but may be attached to the first portion on its proximal end. The interior region 309 of the inflatable member 303 communicates with the opening of the inflation lumens 305 to allow for inflation.
[0038] The support balloon catheter shown in FIGS. 3A and 3B also shows the configuration of a braid 302, 308, 311 which increases the rigidity of the support balloon catheter 304. To provide support to the wire guide 301, it may be desirable for the braid 302, 308, 311 to extend proximally along the body of the support balloon catheter 304 from the proximal side of the inflatable member 303, and distally from the opening of the inflation lumens 305. To accomplish this, the braid 302, 308, 311 will extend along the body of the support balloon catheter 304 through at least a portion of the interior region 309. The braid 302, 308, 311 may extend distally from the interior region 309 of the inflatable member 303 and may extend to as far as the distal end of the body of the support balloon catheter 304. Additionally, the braid 302, 308, 311 may also extend to the proximal end of the body of the support balloon catheter 304.
[0039] The support balloon catheter may be comprised of two portions. In the first portion of the support balloon catheter 304, the braid 302 encircles the plurality of lumens 305, 307 of the support balloon catheter 304. In the second portion, the diameter of the braid 308 is reduced, encircling only the remaining wire guide lumen 307. Between these two portions, there may be a transition portion of the braid 311 between the diameters of the first portion and the second portion. For each portion, the braid 302, 308 may be embedded in the material 312 of the support balloon catheter 304. However, the transition portion of the braid 311 may have openings defined by the areas between the filaments of the braid which allow the inflation lumens 305 to communicate with the interior region 309 of the inflatable member 303. Preferably, the braid 308 extends at least to the second portion and may extend to the distal end of the support balloon catheter 304. Additionally, the braid may extend proximally to the proximal end of that support balloon catheter 304.
[0040] Various components of the support balloon catheter 304 may be made from a number of different materials. For example, the wire guide lumen 307 and the inflation lumens 305 may be defined by liners 313, 314 made from materials such as polyimide or PTFE. Lumens formed by liners 313, 314 would provide the advantages of isolating the lumens, preventing cross-communication between the inflation lumens 305 and the wire guide lumen 307. The braid 302, 308, 311 may be made of a rigid material such as nitinol and encircles the liners 313, 314. The catheter material 312 is formed around these liners 313, 314 and the braid 302, 308 and may be made from materials such as a thermoplastic polyamide. The inflatable member 303 is applied on the second stage of the support balloon catheter 304 material and may be composed of a material such as polyamide. The interior region 309 may be inflated using a liquid such as saline or contrast fluid.
[0041] FIGS. 3A and 3B also disclose other possible features of the support balloon catheter 304. For increased steerability of the wire guide 301, it may be desirable to include a tip 310 on the end of the support balloon catheter 304 which is angularly offset from the longitudinal axis defined by the body of the support balloon catheter 304. The angular tip may be useful in directing the wire guide 301 into a channel 110 through the lesion 102, which is off-center within the intraluminal passage 100. Additionally, it may be desirable to include a radiopaque tip 306 on the wire guide 301 to allow the operator to track the progress of the wire guide 301 through the lesion 102 through radioscopy.
[0042] Another possible embodiment of the support balloon catheter 404 and wire guide 401 may be seen in FIGS. 4A and 4B. The support balloon catheter 404 shown also comprises two inflation lumens 405 and one wire guide lumen 407, each defined by separate liners 413, 414. The two inflation lumens 405 extend and open into the interior region 409 of an inflatable member 403 to allow for communication of inflation fluid. Other features may also be included such as a tip 410 which is angularly offset from the longitudinal axis defined by the body of the support balloon catheter 404.
[0043] It may be desirable for the braid 402 to be encased in the catheter material 412, encircling the wire guide lumen 407 for at least a portion of the support balloon catheter's length. A braid 402 encircling the wire guide lumen 407 only would still provide support to the wire guide 401 in attempting to cross the lesion 102, and may also be easier to manufacture than the catheter 304 shown in FIGS. 3A and 3B, as a three staged braid 302, 308, 311 having different diameters would not be needed.
[0044] Another possible embodiment of the support balloon catheter 504 and wire guide 501 may be seen in FIGS. 5A and 5B. The balloon catheter 504 shown also comprises two inflation lumens 505 and one wire guide lumen 507, each defined by separate liners 513, 514. In some circumstances, however, a single lumen for inflation fluid may be sufficient to inflate the inflatable member. The two inflation lumens 505 extend and open into the interior region 509 of an inflatable member 503 to allow for communication of inflation fluid. Other features may also be included such as a tip 510 which is angularly offset from the longitudinal axis defined by the body of the support balloon catheter 504.
[0045] It may be desirable for the support balloon catheter 504 to have additional braids. In the embodiment of FIGS. 5A and 5B, three braids 502, 508 are shown so that each of the plurality of lumens 505, 507 is encircled by at least one braid 502, 508 for at least a portion of the support balloon catheter 504. The braids 502, 508 are encased in the catheter material 512. Such a configuration would provide support to the wire guide 501 in attempting to cross the lesion 102 and provide additional support to the support balloon catheter 504 as a whole, and may also be easier to manufacture than the catheter 304, 404 shown in FIGS. 3A and 3B as a three staged braid 302, 308, 311 having different diameters would not be needed.
[0046] Another possible embodiment of the support balloon catheter 604 and wire guide 601 is shown in FIGS. 6A and 6B. In the embodiment shown, the catheter comprises of a wire guide lumen 607 and at least one inflation lumen having side openings 605 that communicate with the interior region 609 of the inflatable member 603. For simplicity of construction, it may be desirable to construct the support balloon catheter 604 having a single diameter to the distal end. To facilitate this, it may be necessary to preform side openings 605 in the inflation lumen during the manufacturing of the support balloon catheter 604. The side openings 605 must be large enough and numerous enough to permit efficient communication of inflation fluid to the interior region 609 of the inflatable member 603 depending on what inflation fluid is used. For example, if a low viscosity liquid such as saline is used to inflate the inflatable member 603, more side openings 605 may be preferable to larger diameter side openings 605 to efficiently inflate the inflatable member 603. However, if the a more viscous fluid such as contrast fluid is used to inflate the support balloon catheter 604, larger side openings 605 may be needed to efficiently allow communication of the fluid between the inflation lumen and the interior region 609 of the inflatable member 603. If, as shown in FIG. 6B, the braid 602 encircles the plurality of the lumens, the side openings 605 must be arranged between the gaps in the braid 602 to allow for free communication between the interior region 609 and the inflation lumens.
[0047] Another possible embodiment of the support balloon catheter 704 and the wire guide 701 is shown in FIGS. 7A and 7B. In this embodiment, a co-axial arrangement of the lumens 705, 707 is shown, wherein the body of the support balloon catheter has only a single outer inflation lumen 705, and where that lumen 705 encircles an inner wire guide lumen 707. The outer inflation lumen 705 terminates at some point in the interior region 709 of the inflatable member 703 forming an opening through which inflation fluid may be used to inflate the inflatable member 703, while the inner wire guide lumen 707 continues through to the distal end of the support balloon catheter 704.
[0048] The co-axial configuration of the lumens 705, 707 is likely simpler and less costly to manufacture, but may provide less stability to the wire guide 701 which is attempting to cross the lesion 102, because the inner wire guide lumen 707 may not be fixed to the outer inflation lumen 605, but instead float freely within. This might be averted by providing at least one support member which connects the body of the outer inflation lumen 705 to the liner 713 of the inner wire guide lumen 707. Alternatively, the wire guide lumen 707 may be stabilized by including a braid 702 embedded in the liner 713 of the wire guide lumen 707. However, it may be preferable to embed the braid 702 in the body of the outer inflation lumen 705 for the first portion of the support balloon catheter 704, and transition the braid 702 to be embedded in the liner 713 of the wire guide lumen 707 distally from the opening of the outer inflation lumen 705, in a manner similar to that shown in FIGS. 3A and 3B.
[0049] Accordingly, it is now apparent that there are many advantages of the invention provided herein. In addition to the advantages that have been described, it is also possible that there are still other advantages that are not currently recognized but which may become apparent at a later time.
[0050] While preferred embodiments of the invention have been described, it should be understood that the invention is not so limited, and modifications may be made without departing from the invention. The scope of the invention is defined by the appended claims, and all devices that come within the meaning of the claims, either literally or by equivalence, are intended to embrace them.
Patent applications by David Christian Lentz, Bloomington, IN US
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"We and our partners take compliance seriously, and after the partner informed us that one of their millions of betting markets was left open after the European soccer game concluded, RSI self-reported to the NJDGE and agreed to pay the $1,000 penalty," spokesperson Lisa Johnson said.
As for Kambi, they have since made it mandatory that all of their trading team members retrain in quality assurance, while they must also have secondary approval from their team supervisors when manually entering sports data on their feed to prevent a repeat occurrence.
About Dean Carr
Dean is a sports betting writer specialising in match previews and betting strategy for football and UK horse racing. Dean has a wide range of expertise, including betting previews, recommendations, tactics, and betting psychology.

redpajama_set_name: RedPajamaCommonCrawl


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Sudhesh Kumar
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Highly Influential Citations
Oxidative stress and genotoxic effect of zinc oxide nanoparticles in freshwater snail Lymnaea luteola L.
Daoud Ali, S Alarifi, Sudhesh Kumar, Maqusood Ahamed, Mohammed Afzal Ali Siddiqui
Aquatic toxicology
Understanding the toxic effects of nanoparticles on aquatic organism is the biggest obstacle to the safe development of nanotechnology. However, little is known about the toxic mechanisms of zinc… (More)
Zinc oxide nanoparticles selectively induce apoptosis in human cancer cells through reactive oxygen species
Mohd Javed Akhtar, M. S. Sami Ahamed, Sudhesh Kumar, M. Salman Khan, Javed Ahmad, Salman A. H. Alrokayan
International journal of nanomedicine
BACKGROUND Zinc oxide nanoparticles (ZnO NPs) have received much attention for their implications in cancer therapy. It has been reported that ZnO NPs induce selective killing of cancer cells.… (More)
Kaempferol has osteogenic effect in ovariectomized adult Sprague–Dawley rats
Ritu Trivedi, Sudhesh Kumar, Avinash Kumar, Jawed Akhtar Siddiqui, N. Chattopadhyay
Molecular and Cellular Endocrinology
Kaempferol (K), a flavonol, is known to have anti-osteoclastogenic effect. We here show that K, from 0.2 to 5.0 microM, increased mineralized nodules in rat primary osteoblasts. K also significantly… (More)
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Contamination levels and spatial distribution of organochlorine pesticides in soils from India.
Kumkum Mishra, Ramesh C. Sharma, Sudhesh Kumar
Ecotoxicology and environmental safety
Organochlorine pesticides, dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH), are potential chemical pollutants extensively used for agriculture and vector control purposes due to… (More)
Liver-specific deletion of augmenter of liver regeneration accelerates development of steatohepatitis and hepatocellular carcinoma in mice.
Chandrashekhar R Gandhi, John Richard Chaillet, +12 authors Thomas E. Starzl
BACKGROUND & AIMS Augmenter of liver regeneration (ALR, encoded by GFER) is a widely distributed pleiotropic protein originally identified as a hepatic growth factor. However, little is known about… (More)
Genotoxicity assessment of acute exposure of chlorpyrifos to freshwater fish Channa punctatus (Bloch) using micronucleus assay and alkaline single-cell gel electrophoresis.
Daoud Ali, Naresh Sahebrao Nagpure, Sudhesh Kumar, Ravindra Kumar, Basdeo Kushwaha
Chemosphere
Chlorpyrifos (O,O-diethyl O-3,5,6-trichloro-2-pyridylphosphorothioate) is one of the organophosphate pesticides widely used in agricultural practices throughout world and irreversible inhibitor of… (More)
Nanotoxicity of pure silica mediated through oxidant generation rather than glutathione depletion in human lung epithelial cells.
Mohd Javed Akhtar, M. S. Sami Ahamed, +4 authors Iqbal Ahmad
Though, oxidative stress has been implicated in silica nanoparticles induced toxicity both in vitro and in vivo, but no similarities exist regarding dose-response relationship. This discrepancy may,… (More)
Effects of Egb 761 on bone mineral density, bone microstructure, and osteoblast function: Possible roles of quercetin and kaempferol
Ritu Trivedi, Avinash Kumar, Varsha Gupta, Sudhesh Kumar, N. Chattopadhyay
The effects of standardized and concentrated extract of Ginkgo biloba, Egb 761, were studied on estrogen deficiency-induced bone loss in ovariectomized (OVx) rats rendered osteopenic. Upon osteopenia… (More)
Assessment of genotoxic and mutagenic effects of chlorpyrifos in freshwater fish Channa punctatus (Bloch) using micronucleus assay and alkaline single-cell gel electrophoresis.
Daoud Ali, Naresh Sahebrao Nagpure, Sudhesh Kumar, Ravindra Kumar, Basdeo Kushwaha, Wazir Singh Lakra
Food and chemical toxicology : an international…
Chlorpyrifos (CPF) is the single largest selling agrochemical that has been widely detected in surface waters in India. The studies on long-term genotoxic effects of CPF in different tissues of fish… (More)
Snake venom: a potent anticancer agent.
Deepika Jain, Sudhesh Kumar
Asian Pacific journal of cancer prevention…
Since cancer is one of the leading causes of death worldwide, and there is an urgent need to find better treatment. In recent years remarkable progress has been made towards the understanding of… (More)


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The Giving Tree helping residents receive needed items
By Brian Sherrod |
Posted: Tue 5:55 PM, Dec 04, 2018
TORRINGTON, Wyo. Your throw aways are our treasure or can be someone else's treasures. That is the motto for students at Torrington High School for their second annual Giving Tree.
With their holiday cheers of its better to give than it is to receive, these 24 students are collecting clothes, canned goods and even Christmas trees for residents of Torrington to give to their loved ones or anyone in need. For one student, she says this will impact the community in a big way.
"The community needs more help than you ever noticed," said Tayte Rodriguez, Giving Tree Member. "Being able to see kids come in and get stuff for their parents and vice versa kind of makes you feel happy just knowing that they don't have to stress about a present or something."
Student Council and Spanish National Honor Society will be collecting these items until December 18th.
You can donate them at the front office or in Mrs. Racine's room. The items will be displayed for pickup on the same night during their band concert.
"I think it's a great way to bring everyone together and it's really fun," said Maryssa Lira, Giving Tree Member.
With these students making a difference in their community, they are happy to give in return what the community already does for them.
"It's really cool because we see people bring in donations and it's great to see the community step up," explained Sandra Vanatta, Giving Tree Member. "They are a huge part of everything we do."
Tips to Help Keep Your Spirits Up Over The Holidays
NORAD tracking Santa's journey around the world
Collecting children's drawings to give to local veterans
Singers spread the love on Valentine's Day


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Mysterious 'Fast Radio Burst' Pinpointed for First Time
Powerful transient radio flashes in the universe pop off randomly and appear to defy explanation, but astronomers have made a breakthrough in pinpointing the exact source of one of these fast radio bursts.
By Ian O'Neill
Powerful transient radio flashes in the universe pop off randomly and appear to defy explanation, but astronomers have made a breakthrough in pinpointing the exact source of one of these fast radio bursts, known simply as "FRBs."
Top 10 Astronomical Discoveries Of All Time
Only a handful of FRBs have ever been positively identified by looking back through the data archives of radio telescopes. They may be extremely short lived, but they are so powerful that, for the briefest of moments, come from a phenomenon that can generate more energy than our sun can pump out for 10,000 years.
As dazzling as these events are, their apparently random nature (they seem to be generated well beyond our galaxy and appear anywhere in the sky) and extremely short (millisecond) burst makes follow-up observations nigh-on impossible. However, on Wednesday, astronomers using the Commonwealth Scientific and Industrial Research Organisation (CSIRO) radio telescopes in eastern Australia and the National Astronomical Observatory of Japan's Subaru telescope in Hawaii, announced a breakthrough.
Usually, FRBs are found months or even years after they've been detected by radio telescopes. By analyzing radio archives, the FRB signals can be teased out. Unfortunately, this method leaves no room for follow-up observations of the region of sky the signal was detected, leaving their origin a mystery. To rectify this, the international team set up an early warning system so that as soon as a signal is received, other observatories are alerted and are able to quickly zoom in on the region of sky where the FRB was detected.
ANALYSIS: Mystery Cosmic Radio Pulse Leaves Magnetic Clue
(This system is akin to the alert system between NASA's Swift space telescope that detects gamma-ray bursts, or GRBs, and ground-based observatories so rapid follow-up observations can zoom in on the energetic explosion.)
So, on April 18, 2015, the Australian 64-meter Parkes Radio Telescope detected an FRB flash and immediately notified the collaboration. Within 2 hours, the CSIRO Compact Array telescope, located 400 kilometers (250 miles) north of Parkes, slewed in the direction of where the pulse was spotted and was able to detect a radio emission from the blast site which lasted for 6 days before fading. Already astronomers had done something unprecedented; they had identified the location of a FRB and measured its radio afterglow.
Meanwhile, atop Mauna Kea in Hawaii, the Subaru telescope was able to begin its observing run, identifying the precise source of the FRB and radio afterglow. As the location of the April 18 FRB was known to a precision of 1,000 times better than previously discovered FRBs, Subaru made the groundbreaking discovery that this FRB originated inside a galaxy 6 billion light-years away.
What is particularly interesting is that, after further observations of this random galaxy, the researcher found it to be an old elliptical galaxy - the kind of galaxy where you wouldn't expect to see much in the way of star formation. This is the first indication that FRBs probably aren't generated by star formation processes.
ANALYSIS: The Glitchy Gamma-Ray Burst
"This is not what we expected," said Simon Johnston, Head of Astrophysics at CSIRO and a member of the research team. "It might mean that the FRB resulted from, say, two neutron stars colliding rather than anything to do with recent star birth."
What's more, this observation was used as a tool to identify how much material the radio emission from the FRB traveled through, eventually reaching Earth 6 billion years later. And for this one event, it seems to exactly match our theoretical models as to the distribution of matter, including dark matter, in the universe.
"The good news is our observations and the model match - we have found the missing matter," said Evan Keane from the SKA Organisation, and lead author of the study published in the journal Nature. "It's the first time a fast radio burst has been used to conduct a cosmological measurement."
ANALYSIS: A Gamma Ray Burst From the Primeval Universe
It is hoped that, now a system is in place to make rapid and precise observations of FRBs, more FRBs can be used out to further refine cosmological models.
As for what generated this particular FRB, some production mechanisms have been ruled out and others have become more likely, but at least we know where it came from and what kind of galaxy produced it. But even better, astronomers estimate the universe sparkles with 10,000 FRBs throughout the entire sky every day - we just need more radio telescopes looking for them.
An artist's impression of a fast radio bursts and the CSIRO Parkes radio telescope in Australia.
March 13, 2013, marks 20 years since the W. M. Keck Observatory began taking observations of the cosmos. Located in arguably one of the most extreme and beautiful places on the planet -- atop Mauna Kea, Hawai'i, 13,803 ft (4,207 m) above sea level -- the twin Keck domes have observed everything from asteroids, planets, exoplanets to dying stars, distant galaxies and nebulae. Seen in this photograph, the Keck I and Keck II telescopes dazzle the skies with their adaptive optics lasers -- a system that helps cancel out the turbulence of the Earth's atmosphere, bringing science some of the clearest views attainable by a ground-based observatory.
To celebrate the last two decades of incredible science, Discovery News has assembled some of the most impressive imagery to come from Keck.
Starting very close to home, the Keck II captured this infrared image of asteroid 2005 YU55 as it flew past Earth on Nov. 8, 2011.
Deeper into the solar system, the Keck NIRC2 near-infrared camera captured this beautiful observation of the oddball Uranus on July 11-12, 2004. The planet's north pole is at 4 o'clock.
This is a mosaic false-color image of thermal heat emission from Saturn and its rings on Feb. 4, 2004, captured by the Keck I telescope at 17.65 micron wavelengths.
A nice image of Saturn with Keck I telescope with the near infrared camera (NIRC) on Nov. 6, 1998. This is a composite of images taken in Z and J bands (1.05 and 1.3 microns), with the color scaling adjusted so it looks like Saturn is supposed to look to the naked eye.
This is Saturn's giant moon Titan -- a composite of three infrared bands captured by the Near Infrared Camera-2 on the 10-meter Keck II telescope. It was taken by astronomer Antonin Bouchez on June 7, 2011.
Another multicolored look at Titan -- a near-infrared color composite image taken with the Keck II adaptive optics system. Titan's surface appears red, while haze layers at progressively higher altitudes in the atmosphere appear green and blue.
This image of Neptune and its largest Tritan was captured by Caltech astronomer Mike Brown in September 2011. It shows the wind-whipped clouds, thought to exceed 1,200 miles per hour along the equator.
A color composite image of Jupiter in the near infrared and its moon Io. The callout at right shows a closeup of the two red spots through a filter which looks deep in the cloud layer to see thermal radiation.
HR 8799: Three exoplanets orbiting a young star 140 light years away are captured using Keck Observatory's near-infrared adaptive optics. This was the first direct observation by a ground-based observatory of worlds orbiting another star (2008).
Now to the extremes -- an image of Stephan's Quintet, a small compact group of galaxies.
The Egg Nebula: This Protoplanetary nebula is reflecting light from a dying star that is shedding its outer layers in the final stages of its life.
This is WR 104, a dying star. Known as a Wolf Rayet star, this massive stellar object will end its life in the most dramatic way -- possibly as a gamma-ray burst. The spiral is caused by gases blasting from the star as it orbits with another massive star.
Narrow-field image of the center of the Milky Way. The arrow marks the location of radio source Sge A*, a supermassive black hole at the center of our galaxy.
A high resolution mid-infrared picture taken of the center of our Milky Way reveals details about dust swirling into the black hole that dominates the region.
A false-color image of a spiral galaxy in the constellation Camelopardalis.
A scintillating square-shaped nebula nestled in the vast sea of stars. Combining infrared data from the Hale Telescope at Palomar Observatory and the Keck II telescope, researchers characterized the remarkably symmetrical "Red Square" nebula.
Galaxy cluster Abell 2218 is acting as a powerful lens, magnifying all galaxies lying behind the cluster's core. The lensed galaxies are all stretched along the shear direction, and some of them are multiply imaged.
The central starburst region of the dwarf galaxy IC 10. In this composite color image, near infrared images obtained with the Keck II telescope have been combined with visible-light images taken with NASA's Hubble Space Telescope.
Keck I (right) and Keck II (left) domes at Mauna Kea.
Keck I and Keck II aim their adaptive optics lasers at the galactic center.


At least 30 mutations in the LYST gene have been identified in people with Chediak-Higashi Syndrome.
Summary of LYST gene : this gene seems to code for a protein involved in intracellular traffic regulation from and towards lysosomes.
Protein Lyst expression in whole organism: Blood Plasma , Blood Mononuclear , Platelet , Kidney , Liver .
Gene LYST includes some genetic information indispensable for the coding of a protein known as the Lysosomial Trafficking Regulator. It seems that this protein plays an important role in the transport of materials into cellular structures called lysosomes . Mutations in LYST cause a rare autosomal recessive disorder that is Chèdiak-Higashi syndrome. Lysosomes are cytoplasmatic organules act as recycling center within cells. They use digestive enzymes (acid hydrolases) to break down toxic substances , digest bacteria that invade the cell , and recycle worn-out cell components. They are also able to degrade every biologic polymer including lipids, proteins , nucleic acids ,polysaccharides .
Chèdiak Higashi syndrome (CHS) is a condition that affects many parts of the body , particularly the immune system. This condition in inherited in an autosomal recessive pattern , which means both copies of the gene in each cell have mutations . The parents of an individual affected each carry one copy of the mutated gene. As mentioned above the mutation that causes the CHS involves chromosome 1 which carry LYST gene.
•	EPHIDEMIOLOGY : Although its exact incidence is unknown , fewer than 200 people with the condition have been reported worldwide.
Chediak-Higashi syndrome (CHS) is characterized by Oculocutaneus Albinism, immunodeficiency, and a mild bleeding tendency. Approximately 85% of affected individuals develop the accelerated phase, a lymphoproliferative infiltration of the bone marrow and reticuloendothelial system.
Melanocytes contain lysosomial structures specialized called melanosomes , in CHS these organules are enlarged . As a result melanin is trapped within the giant melanosomes and is unable to contribute to skin,hair and eye pigmentation , this is why people with CHS have OCULOCUTANEUS ALBINISM. Pigment dilution is highly variable, but can involve hair, skin, and eyes. In classic forms of CHS, the hair has a "silvery" or metallic appearance. Skin pigment dilution may not be appreciated unless compared to that of more darkly pigmented family members. Reduced iris pigmentation is associated with decreased retinal pigmentation and nystagmus.
Enlarged lysosomes in certain immune system cells prevent these cells from responding appropriately to bacteria and other foreign invaders . As a result , the malfunctioning immune system cannot protect the body from severe and recurrent infections. Bacterial infections are most common, with Staphylococcus and Streptococcus species predominating; viral and fungal infections can also occur [Introne et al 1999].
These abnormally large lysosomes can also invalidate coagulation and nervous central system ; inside platelets they prevent normal activation with thrombocytopenia. Clinical manifestations are generally mild and include epistaxis, gum/mucosal bleeding, and easy bruising.
Most children with CHS ultimately reach a stage of the disorder known as "accelerated phase" .This severe phase is thought to be triggered by viral infections. Especially EBV infection is thought to hasten development of the accelerated phase, although this relationship has never been proven. Absence of NK cell function is also believed to contribute to development of the accelerated phase. Clinical manifestations include fever, lymphadenopathy, hepatosplenomegaly, anemia, neutropenia, and sometimes thrombocytopenia. Originally, it was thought oto be a disease similar to a lymphoma, but it was later discovered that it is actually a non-malignant hemophagocytic and lymphohistiocitic infiltration in multiple organs. The accelerated phase and its complications are the most common cause of mortality in individuals with CHS [Eapen et al 2007].
There seems to be an apparent genotypical-phenotypical correlation in this disease: recently new forms of CHS that present clinical manifestations which differ slightly from the ones described in literature. The studies conducted on this forms shows patients with milder disease that also has a later onset and describes three classes: childhood, adolescent, and adult disease. [Karim et al 2012]. The milder form of CHS usually manifests itself in adolescence and is extremely rare. Some studies show how 10-15% of patients that presents milder phenotypical aspects of the disease survives into adulthood, but developes a progressive and often fatal neurological dysfunction. An ever lesser percentage of patients manifests an intermediate disease phenotype which becomes evident during adolescence. It is characterized by severe infections during childhood but a slow progress during adolescence without presenting the accelerated phase. The genotype-phenotype correlation derives from the fact that in patients with the childhood disease have only a functional mutation in the LYST gene, with total loss of protein activity. In patients with the adolescent and adult forms of the disease the mutations found were missense which codified with a protein that still maintained partial function. [Tchernev et al 2002] This has been confirmed lately in 2013 in recent studies regarding three patients presenting a new mutation in homozygosis of the LYST gene: a deletion (deletion of nucleotides 3073 and 3074 in coding domain). During transcription this mutation brings loss of residues of Arg and Tre [Weisfled Adams JD e all 2013]. These three patients clinically manifested a mild form of the disease with progressive neurodegenerative disease in adult age, cognitive decline, parkinsonisms, signs of spino-cerebellar degeneration, peripherical neuropathy, slight alterations in pigmentation, and subclinic immune dysfunction. It has been shown also that the clinical severity of the disease also correlates with the cellular phenotype. Detailed studies of fibroblasts and melanocytes from individuals with CHS with different clinical phenotypes illustrated the range of enlargement of intracellular granule abnormalities in different CHS cell types [Westbroek et al 2007].
4.	Progressive neurologic symphtoms that can include intellectual disabilities, peripheral neuropathy, balance abnormalities, and tremor.
PATIENT RISK FACTORS : CHS is a rare disease , risk factors sre not accerted . Some riks factors may unclude ionizing radiations and toxic substances during pregnancy that can provoke genatic mutations.
The only treatment that cures the hematologic and immunologic defects is allogenic HSCT. The most favorable outcome is achieved when HSCT is performed prior to development of the accelerated phase.
Correction of refractive errors may improve visual acuity.Sunglasses should be used to protect sensitive eyes from UV light.
Neurologic abnormalities. Because of the progressive nature of the neurologic symptoms, older patients should engage rehabilitation specialists early in the course of the disease.
•	Eapen M, DeLaat CA, Baker KS, Cairo MS, Cowan MJ, Kurtzberg J, Steward CG, Veys PA, Filipovich AH. Hematopoietic cell transplantation for Chediak-Higashi syndrome. Bone Marrow Transplantation. 2007;39:411–5.
•	Karim et All . Apparent genotype-phenotype correlation in childhood, adolescent , and adult Chediak-Higashi Syndrome . AmJ Med Genet.2002 Feb 15; 108 (1):16-22.
•	Westbroek et All. Cellular defects in Chediak-higashi syndrome correlate with the molecular genotype and clinical phenotype. J Invest Dermatol. 2007 Nov; 127(11): 2674-7.
•	Filipovich AH. Hemophagocytic lymphohistiocytosis and related disorders. Curr Opin Allergy Clin Immunol. 2006;6:410–15.
Shiflett SL , Kaplan J, Ward DM . Chediak-Higashi Syndrome: a rare disorders of lysosomes and lysosome related organelles . Pigment cell Res. 2002 Aug ; 15 (4) : 251-7 . Review.
Ward DM , Shiflett SL, Kaplan J. Chediak-Higashi : a clinical e molecular view of a rare lysosomial storage disorder. Curr Mol Med .2002 Aug; 2 (5): 469-77. Review.


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CHAT

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South Africa launches notes, coins for 100th anniversary of Mandela's birth
South Africa on Friday launched a set of limited edition bank notes and gold coins to mark the 100th anniversary on July 18 of the birth of Nelson Mandela.
The South African Reserve Bank said the notes depict Mandela's life including his upbringing in rural Eastern Cape as the son of a chief, his 27-year incarceration and the end of apartheid in 1994 when he became president. Mandela died in 2013 aged 95.
The launch forms part of events across the world, culminating locally in an annual Mandela Day lecture by former US president Barack Obama next week.
READ ALSO: Asaba 2018: Delta hopes to spend N4bn on logistics — Gov. Okowa
The etching on the one-ounce gold coin of a smiling middle-aged Mandela with his hair parted down the middle was designed by Zimbabwe-born Sindiso Nyoni, whose work includes stinging rebukes of former Zimbabwean leader Robert Mugabe.
"Growing up and living most of my life under a dictatorship, we were not able to experience this feeling of democracy that South Africans have," Nyoni said.
Mandela's face already graces all South Africa's banknotes.
(Reuters/NAN)
South Africa's Ramaphosa recovers from COVID-19, resumes work
Court orders ex-South Africa president Zuma back to jail
Rwanda records six Omicron cases, tightens COVID-19 protocols
Omicron: Severe cases remain low in South Africa – WHO
United Kingdom's impertinent restriction on Nigerian travellers
Despite surge, South Africa sees mild symptoms in Omicron patients


Kabul (Reuters): A series of explosions hit an area near the Marshal Fahim military academy in the Afghan capital, Kabul, early on Monday, a witness said.
Kabul resident Mohammad Ehsan said the explosions began at around 5 a.m. and lasted for at least an hour. Smaller blasts at less frequent intervals could still be heard, he said.


I am using GE865 with rev. 10.00.003.
Testing multisockets with UDP protocol.
Sending data from modem to UDP echo server using AT#SSENDEXT.
for each echo and I can read the echo using AT#SRECV.
situation is reached when I don't receive SRINGs anymore.
has received the echo using AT#SI, but I dont receive SRINGs anymore.


Hair and Make Up Group Deals - Discover how you can treat yourself and your friends to an amazing pamper day in Mansfield!
It's always better to pamper yourself with friends!
It doesn't matter the occasion, from weddings to proms or stag dos to christmas nights out, it's always a nice treat to go out with your friends and be pampered. Here at New Shades Salon we offer a range of group deals, Gold, Silver or Bronze.
Receive makeup and a photoshoot, minimum 6 people, £72.
Receive hair, makeup and photoshoot, minimum 6 people, £120.
Receive hair, makeup and a limo ride to the photoshoot, minimum 6 people, £180.
Don't hesitate to give us a call if you have something else in mind though, whether it's 6 of you, or 600, we're always happy to do what we can to make your day that little bit extra special.


Trevor reached out to Paparazzi Proposals to capture his Clearwater engagement proposal photography session.
We coordinated for our sneaky photographer to set up a blanket with 24 red roses and a bottle of champagne for their arrival. moment the beautiful sun setting, Trevor used it as the picture-perfect moment to get down on one knee. Our photographer was discreetly capturing everything.
Found the one and bought the ring? Submit your request now for a $50 discount!
Give us a call now at call 1 (888) 287-5120 for a free consultation. Let's start planning your once-in-a-lifetime moment.
We had a chance to speak with newly-engaged couple, and they shared with us how they met, and, inevitably, fell in love.
We met February 2017 after Trevor came home from an Iraq deployment. Mutual friends introduced us as we are from the same suburb of Chicago.
What was the first thing that attracted you to one another?
Trevor: Her personality; she was easy to talk to and so upbeat.
Kari: His politeness and genuine interest in the things I talked about.
When did you know that they were the one?
Trevor: We took a trip to San Diego. We had a horrible time upon our arrival trying to get into our hotel and she just kept trying to make the best of it.
Kari: I was in the car with the radio on and they were telling stories about grooms crying when they saw their bride. I thought to myself "Trevor will definitely cry whether it's me or someone else" and it physically ached to think about him marrying someone other than me.
Why did you choose to propose where you did?
I always knew I wanted to do it somewhere warm to make it somewhere special outside of our norm. Somewhere that felt like paradise. I love the ocean and the sunset and especially them combined, so the beach while on vacation in Florida was perfect.
Where did you purchase the ring?
The ring is from Brilliant Earth. Kari is obsessed with rose gold and they have the best colored rose gold jewelry. It was also really important to Kari that the diamond be one that was responsibly mined. Brilliant Earth not only mines responsibly, but they also reinvest some of the proceeds back into the mining communities. Our diamond helps continue funding for schooling in a village in the Democratic Republic of the Congo!


Former National MP Jami-Lee Ross will today make his first public outing since receiving mental health care last month.
Ross told Stuff he would be attending the opening of the Taiaho Mai building at Middlemore Hospital.
"That's the Counties Manukau DHB's mental health facility that I was admitted to last month," Ross told Stuff.
He would be attending as a local MP – he remains the MP for Botany – and as someone who has received care at the hospital.
In October, Ross was taken into care at Middlemore's mental health unit for two days.
Ross told Stuff he did not intend to speak at the event – "I'll just be there quietly applauding the exceptional people that work in mental health, and thank them for what they do supporting patients during some very difficult times".
"I hope to see some of the doctors and nurses that were so kind to me while I was in their care."
Health Minister David Clark is due to give a speech at Middlemore at midday.
A spokesman for the minister said he was not aware that Ross would be attending the event until it was reported in the media today.
Ross' appearance today comes after a turbulent few weeks for the MP.
In early October, National Leader Simon Bridges said Ross would be absent from Parliament for a few months while he dealt with personal health issues.
A few weeks later, Bridges said the PwC investigation into the leak of National Party travel expenses concluded that on the "balance of probabilities the evidence establishes that Jami-Lee Ross was the person who leaked the expenses and the sender of the text message".
The next day, in an hour-long media stand up, Ross launched a scathing attack on Bridges over claims of electoral fraud – claims that Bridges denied – Ross resigned as a National MP, but said he would stay on as the local MP for Botany.
He then proceeded to leak secretly record phone conversations between himself and Bridges to media.
Ross was taken into care at the mental health unit of Middlemore later that week.
He has not made a public appearance since he was discharged on October 23.


meteral, materaisl, mateiral, meaterial, matherial, nateral, marterial, materia, matierak, materila, mterial, meterial, materals, materil, matirial, materal, materail, matrial, matterial, matiral, meterials, matierial, materieal, matireal, materical, maerial, metarial, materails, matreials, matieral, marerial, materian, matrerial, matreal, materisl, matarial, amterial, materiral, metrial, matreial, materiasl, mateial, matereal, materiall, meteryal, mateal, matiriol, mattrial, meatrial, metiral, mutereal.
The substance of which anything is made.
Anything composed of matter; that of which anything is made.
Consisting of matter; not spiritual; corporeal; important; essential; not merely formal.


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Pro Nautas Group acquires Buss Data to provide enhanced digital services to maritime customers
January 17, 2018 News
Connectivity and navigation solutions provider Pro Nautas has acquired maritime technology company Buss Data. Buss Data offers IT solutions for cargo shipping, river cruises and port operations, essential for efficiency on board and ashore. The acquisition of Buss Data enables Pro Nautas to expand its range of products and services, alongside enhanced customer support. Together, the companies will focus on growing the digital platform and providing their customers with intelligent data services, powerful insights and analytics.
Buss Data brings technological know-how, expertise and a strong market position. The company's solutions are used by leading shipping companies and have been installed on more than 1,500 vessels since the company was founded. The wide range of state-of-the-art STAR Applications covers all operational processes of a shipping company, including purchasing, crewing, maintenance, vessel performance, chartering, document management and other software applications. All information is synchronised between ship and shore via a client-server or cloud solutions.
The strategic acquisition of Buss Data strengthens Pro Nautas' technological capabilities in the rapidly evolving maritime industry. By integrating Buss Data applications with Pro Nautas' connectivity, navigation & smart maintenance solutions, the company will create a software intelligence platform where operational, technical and commercial data is securely shared in real time among all stakeholders for decision support and operational transparency.
The acquisition brings together two companies whose cultures are based on a customer-first approach. It also reaffirms its commitment to providing clients with faster access to new solutions and technologies and to support them in the process of digital transformation.
About Pro Nautas
Pro Nautas provides solutions for marine connectivity, Ship's IT, navigation and Smart Maintenance with a primary focus on optimising operations on board and ashore, enhancing crew welfare and increasing safety.
About Buss Data
Buss Data, founded in 2002, is a maritime technology company offering a software platform to enable efficient operations on board and ashore. The company's STAR Applications are designed for ship owners, ship managers & port operators and provide access to all information related to the vessel's management and operations.
Pro Nautas to supply full Connectivity, IT and Dual ECDIS Solution to Zeaborn Group
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If you wish to purchase wine but live in a state not listed above, let us notify you when regulations allow shipment.
Out-of-state standard shipping is $19.95 for 6 bottles and $34.95 for 12 bottles. Express shipping is available. See available options at checkout.
A person at least 21 years of age must be present to sign for wine shipments. FedEx cannot leave wine without this signature. Some customers choose to use a work address for wine deliveries.
Wine Club wines are delivered monthly depending on the delivery options you have selected. We sometimes postpone a shipment due to extremely hot or cold weather, and will notify you if that's necessary.


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Homepage Losses and Aviation SafetyRussian Su-35 pilot who shot down Russian Su-30 will be charge in court with criminal conduct
Russian Su-35 pilot who shot down Russian Su-30 will be charge in court with criminal conduct
Major Vasily Savelyev, the Russian Air and Space Force (RuASF) Sukhoi Su-35 pilot who shot down a RuASF Su-30 on Sep. 22, 2020 will face military trial.
According to Russian newspaper Kommersant in fact, on Oct. 21, 2021 his case was transferred to Tver garrison's military court. The day of the trial has not yet been assigned.
Savelyev can face up to seven years in jail since because, in accordance with the Aricle no. 351 of the Russian Criminal Code, he is accused of violating the rules of operation and combat use of a military aircraft.
The incident took place in the Tver region, approximately 300 kilometers (190 miles) northeast of Moscow, during a routine training flight where two Su-35S and one Su-30M2 fighter jets were practicing combat maneuvers at high and medium altitudes.
The exercise involved Su-35s being attacked by the Su-30, followed by a counterattack, Kommersant reported.
The aircraft featured gun cameras that the pilots could activate by engaging the same button of the real gun. The cameras could capture the mock kills scored during the drill.
As explained by Aerotime, during the exercise, one of the Su-35s flown by flight leader Savelyev, fired a burst of 30 mm rounds from its GSh-30-1 cannon.
After five shells heavily damaged its right wing, the Su-30 became uncontrollable. Both the crew members were forced to eject.
The Main Military Investigation Directorate of the Investigative Committee of the Russian Federation found Savelyev guilty.
According to protocol the entire weapons control system has to be deactivated: the Su-35 has to be prepared for the exercise by disengaging the gun and engaging the gun camera. Moreover, the pilot has to fire his gun in a safe direction before starting combat maneuvers.
Savelyev violated the rules of operation because he did not perform the check, the Committee reported.
Savelyev appealed the decision, stating that the ground crew had to disengage the weapons system, as well as physically remove the belt with the rounds from the autocannon. He also said that the exercise was intended to be as close to the real engagement as possible, which ruled out performing any additional checks.
Noteworthy this was not the first time that a Russian fighter erroneously shot down another Russian Aircraft.
On Apr. 26, 2017 in fact a MiG-31 from Russia's Eastern Military District crashed during a training flight near the Telemba proving ground, the Republic of Buryatia.
At that time, the Russian Ministry of Defense did not explain why the aircraft crashed.
Both crew members reportedly ejected and a search and rescue helicopter was dispatched to the site of the incident.
In 2019 emerged that the twin-engine fighter was brought down by another MiG-31 which fired an R-33 air-to-air missile mistakenly.
A report appeared on Baza claimed that "… the accident of the MiG-31 aircraft was the result of omissions in the activities of officials in the organization of the LUT (flight tactical exercises – Approx. Ed. precluding their mutual falling into the zone of permitted launches of guided missiles R-33)…"
The report continued: "… the accident of the MiG-31 aircraft as a result of the crew's violation of safety measures and missions for flight, expressed in the premature activation of the aircraft's on-board radar station by the navigator and the unauthorized launch of the R-33 guided missiles by the commander of the MiG-31 fighter aircraft…"
In short, the MiG-31 mistakenly shot down its wingman.
Photo credit: Alex Beltyukov Russianplanes.net via Wikipedia and Russian Ministry of Defence
Losses and Aviation Safety / Military Aviation
Russian Naval Aviators eject from Sukhoi Su-30SM on runway in Crimea. Ground crew injured by the blast of the rocket motor from the seat.
Russian Su-30SM fighter jet crashes in Syria killing crew
Russian Su-35 allegedly shot down Russian Su-30 during dogfight training


I so disappointed I cant go, wish you were going to be there tomorrow!
Are you coming to Madrid?
JUST MONDAY??????????/ CANT MAKE IT ON MONDAY!!!
Scott, I will send my representation to London signing.
Mi Nice is living there and she will be on time.
looking forward to seeing some london photos.
Wish I could be there (back at uni now!!) Have a fantastic time in London!
I'll be there with my new book !!!
Great. See you on Monday, then.
Fantastic!! I will definatley be there, huge huge admirer!
sad. i won't be there 'till the 22nd. love the book.
My favorite store in London!
See you and the crowd at your signing vs. wait for dishwasher delivery . . .
agggggggggh! Hope it's great, please take lots of pics!
Nothing bad can ever happen to you at Liberty.
Are you coming to Chicago? Please, please.
do pay melbourne a visit if you can!
Can't wait – will head over straight after work!
Good luck with the book signing tonight.
Such a pleasure to have been there and met you – thank you for being so gracious! And the book is gorgeous – I am so pleased to own a copy!
It was wonderful to meet you! Hope to see you in Mexico soon! Arantza.
I wonder if it's the one and only occassion in London, or will there be at least one more event at the "SartoraLUST Pop-Up Shop – London" until the 30th?
I would love to have a signed book! Are you going to the USA, Portland, OR specifically?
Mr Schuman, congratulations, Sir, on all your achievements which I am sure have come not without a lot of courage.
The obstacles you have surmounted are usually the obstacles that would keep otherwise as artistic a men from doing what they feel is right. I guess the nagging little voice inside of us all sometimes becomes too vociferous for us to remain stationary. Well done to you.
I just wanted to note the above as today, being my 42nd birthday, has been a very introspective moment for me, summarizing all that has happened so far and one of the things I wanted to do was write a book.
It sounds easy, just follow your heart, follow the little voice, do what you want to do, listen to the inner mofo, etc.
Regardless, I'm still trying to find my path less traveled.
Im so sad I missed it. Im a student studying in London and I love your stuff for GQ. Let us know when you'll be back!
Wish I could have made it as well! I interned at Liberty this summer with the Visual Merchandising team, and it is such a lovely store! It is truly a great venue for The Sartorialist! Can't wait to hear more about the pop-up shop in menswear!!
so sad to have missed it. i thought there was going to be one more occasion in the beginning of next week. such a pitty! i study in london, why did i have to arrive back to university so late?!?
Great post. Some really good points in there. Catch you later.


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PSTET Answer Key 2018 – Punjab TET September 25th Question Paper 1, 2 SET Solutions, PSTET 2018 Answer Key Download , Punjab TET Answer Key SET A, B, C, D With Solutions. SCERT Conducted Punjab State Teacher Eligibility Test 2018 on 25th Febraury 2018 (sunday) at various examination centers all over the state.
PSTET Answer Key 2018 : PSTET 2017 Exam was Conducted on February 2018 in Various Centers Across Punjab from 1st class to 8th class in Schools. Paper 1 is Primary Test for to teach Class 1 to 5 and Paper 2 Meant for to teach from Class 6 to 8. Both Test had Conducted on February 25th and Every Candidates are eagerly waiting for the Pstet answer key 2017 with solutions to check and analyze the answer sheet. Here Below we are giving answer with solved question papers from top coaching institutes early to check and after we will give pstet 2018 key officially from official website.
In accordance with the provisions of sub-section (1) of Section 23 of the RTE Act, the National Council for Teacher Education (NCTE) vide Notification dated 23rd August, 2010 laid down the minimum qualifications for a person to be eligible for appointment as a teacher for class I to VIII. It had been inter alia provided that one of the essential qualifications for a person to be eligible for appointment as a teacher in any of the schools referred to in Clause (n) of section 2 of the RTE Act is that he/she should pass the Teacher Eligibility Test (TET) which will be conducted by the appropriate Government in accordance with the Guidelines framed by the NCTE. Now State Council of Educational Research & Training, Punjab will very soon going to declare PSTET Answer Key 2018 / Punjab TET Solutions / Answer Key 2015 with complete paper solutions on it's official website at www.tetpunjab.com for written examination . This year a huge number of applicants appeared PSTET 2018 Exam .
The examination was held in two session Morning Session and Afternoon Session. Morning session was started at 10:00 AM and Afternoon Session started at 01:30 PM.This PSTET exam was held in 2 Categories Paper 1st for Primary Level and 2nd for B.Ed. applicants PSTET Answer Key 2018.
Candidates looking for the post of teacher in Punjab's government schools from Class 1 to Class 8 have to clear Teacher Eligibility Test (TET). Paper 1 is meant for teachers opting for Class 1 to Class 5 and Paper 2 for aspirants opting for Class 6 to Class 8. It is conducted by both Central government and state governments in India.
Educational qualification: Aspirants should have a graduation degree, including BA, B Sc, B Com. All B Ed graduates need to pass this exam to work as a teacher.
Exam pattern: The test will comprise of a total 150 multiple type question (MCQ) with each carrying 1 mark. The test will be divided in two parts comprising Paper I and Paper II.
PSTET Answer Key 2018 : With reference to Punjab State Teachers Eligibility Test (PSTET)-2017 conducted on 25.02.2018 by the State Council of Educationat Research & Training Punjab, the Answer Keys of Paper-1 and Paper-2 will upload on the website www.tetpunjab.com.
Negative marking : 1 mark will be deducted for each wrong answer.
Environmental studies – 30 questions.


We are pleased to invite you to Program 1: I+YOU=WE in Omaha, Nebraska, USA, which will be presented by Fr. Jarosław "Jay" Szymczak and local Coach Team on March 25-26, 2017. All details for contact are listed on the poster.
YO+TU=NOSOTROS ¡Siempre hay lugar para ser más felices y más plenos!
© 2019 Copyright Family Support Fundation.


Bring on the chunk!!! Little Miss Lo is gaining weight like a pro, at 9lbs and 14oz she is in the 15th percentile! She's in the 3rd percentile for height at 21 inches. I think we might have a budding butter ball on our hands.
I have been highly impressed with her mobility. Right before my eyes this girl rolled from her tummy to her back. She can no longer be trusted to take naps on the couch because not only has she proven that she will roll but she will also scoot to the end. Exhibit A!
She handles her hiccups much better and is cooing up a storm. She is seriously the sweetest thing and gives us all the cute we can handle.
I linked Noelle's 2 month favorites because they are definitely relevant but I'm so excited to feature this month's favorite!
Happy Baby Wrap is so stylish and comfortable and the material is out of this world soft. Lo fits securely in this wrap with no concerns at all. Though there is a lot of material I wouldn't let it discourage you. With some practice you'll be a wrapping pro. I used another wrap with Noelle and it wasn't nearly this soft or comfortable to wear. They come in a variety of prints and they have a new carrier that has just hit the market for pre-sale.
I'm also so excited to announce that I will be doing a giveaway on my instagram (mrshazleyandababy)!!!! I wanted to start sharing these favorites with you so please stayed tuned to my instagram because the giveaway contest will start today! One lucky winner will receive this amazing wrap!


Are You A Whiz At Mental Math?
How well can you deal with numbers in your head? Don't cheat – no paper and pencil or calculators allowed with this quiz!
Whoops! It seems like your mental math skills are pretty mediocre. That's okay though - mental math is one of those things that you get better at if you practice. Get some mental workouts in and come back to take this quiz again!
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You're more than just a mental math whiz - you're a magician! You answered all of these questions correctly...and probably with great ease. Congratulations on a quiz VERY well done!
Are You A Mental Math Expert?


Tilly joined M.E as an intern in the latter part of 2015 as part of AUT University's co-operative education initiative. She has since completed her undergraduate degree, majoring in Finance and Economics, and joined the team at M.E.
Tilly has a keen interest in economic modelling and has worked on several economic impact studies since joining the team. She brings with her a strong knowledge of economic theory and its practical implications. Her strong research and analytical skills contribute to the high quality of output produced by M.E.


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Vancouver, Washington, USA, March 18, 2015 - US Digital is pleased to announce our full new line of E4T's and S4T's available up to 360 CPR are available for purchase. These products are designed to replace the E4P and S4 products and deliver a marked performance increase over similar encoder models.
The E4T and S4T utilize state of the art transmissive optical sensing technology, and incorporate US Digital's own proprietary OptoASIC. Assembly of the E4T is simple and efficient and retains the previous E4P's form factor.


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Saint-Martin-de-Laye  es una población y comuna francesa, situada en la región de Aquitania, departamento de Gironda, en el distrito de Libourne y cantón de Guîtres.

Demografía

Referencias

Enlaces externos

 INSEE
 Elecciones municipales de 2008

Saint Martin Laye

redpajama_set_name: RedPajamaWikipedia


You may have been racking your brain about what to get that special someone (or special people) on your gift list and may be close to giving up and buying a tie, candle, or novelty mug.
You know that everyone wants the perfect Christmas gift and they appreciate it more with a surprising twist! But it's hard to know what that might be.


Bracelets are the perfect accessory piece.
It can be the statement or a compliment to a necklace, pair of earrings or an outfit.
There are several collections here for you to browse! From the Petite collection that is a bit more reserved and a subtle accent to the Metal collection that is home to the new large spiral beads.
There is something special there for you!


Research cited by the Obama administration as proof that it can cut wasteful healthcare spending and improve treatment at the same time proves no such thing, The New York Times reports.
The work by a group at Dartmouth College supposedly showed which hospitals charge more and give worse care than others.
But that's not the case. "The Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government's Medicare program," The Times reports.
The Dartmouth group produced color-coded maps in the Dartmouth Atlas of Health Care to show where the wasteful spending is. Brown indicated hospitals and regions that offered expensive and inadequate care, and beige showed hospitals and areas where the reverse is true.
Members of Congress using the maps demanded that the Obama administration just cut Medicare payments to hospitals and doctors in the brown zones. And White House officials said they'd indeed consider that.
Yet the Dartmouth group's research is quite limited, The Times points out.
The researchers claim that doctors in the Upper Midwest provide superior and cheaper care than those in the South and in big cities.
"But the real difference in costs between, say, Houston and Bismarck, N.D., may result less from how doctors work than from how patients live," The Times explains.
All the Obama administration's arguments may prove moot in the end, as 20 states have filed a lawsuit challenging the constitutionality of the healthcare reform law.


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Q: Embedded Java database allowing concurrent reads from different JVM instances? Is there an embedded Java RDBMS that supports multiple concurrent readers from different JVM instances?

A: You could try HyperSQL for instance, it may be deployed as a standard SQL server

A: Derby has a network mode, as do most of the embedded Java database solutions, but then it ceases to be purely embedded. You can also use JNDI in a J2EE container to share references to embedded databases like Derby amongst separate Web Apps.

redpajama_set_name: RedPajamaStackExchange