This document describes a novel transcatheter device to treat hypertrophic obstructive cardiomyopathy (HOCM) using non-thermal irreversible electroporation (NTIRE). HOCM is a common genetic heart condition that can cause sudden death. Current treatments have limitations. The proposed device uses NTIRE, which damages cell membranes without heat, to ablate thickened heart muscle in seconds via a minimally invasive approach. Preclinical studies show NTIRE safely and effectively ablates cardiac tissue. The team aims to develop an endovascular NTIRE device for HOCM and pursue FDA approval based on existing use in cancer. They expect the addressable market to be large with an opportunity to develop additional cardiac applications
A presentation regarding a analysis of the marketplace for stents and also how Abbott could enter the market with their new stent technology in order to acquire the most amount of customers.
Life is extremely precious and no one is guaranteed anything. Injuries, neurological disorders, and autoimmune disorders can make life extremely difficult. If a person has any of these conditions, he or she can be put on a transplant list to be given a second chance.
Stem cells are found in the umbilical cord of a newborn baby and they have been used to treat over 80 diseases. Banking your cord blood is vital because it will give your baby a perfect match for transplant if something should happen later. Your baby’s cord blood could be a possible match for you and for the rest of your family, too.
Our new eBook, the Latest Clinical Update for Stem Cell Therapies, is designed to show you how umbilical cord blood can treat nearly 20 different diseases and disorders. This is just a small insight into the importance of cord blood and why banking can save a family member’s life. With each informed person, more lives are saved.
Absent Internal Carotid Artery in Circle of Willisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A presentation regarding a analysis of the marketplace for stents and also how Abbott could enter the market with their new stent technology in order to acquire the most amount of customers.
Life is extremely precious and no one is guaranteed anything. Injuries, neurological disorders, and autoimmune disorders can make life extremely difficult. If a person has any of these conditions, he or she can be put on a transplant list to be given a second chance.
Stem cells are found in the umbilical cord of a newborn baby and they have been used to treat over 80 diseases. Banking your cord blood is vital because it will give your baby a perfect match for transplant if something should happen later. Your baby’s cord blood could be a possible match for you and for the rest of your family, too.
Our new eBook, the Latest Clinical Update for Stem Cell Therapies, is designed to show you how umbilical cord blood can treat nearly 20 different diseases and disorders. This is just a small insight into the importance of cord blood and why banking can save a family member’s life. With each informed person, more lives are saved.
Absent Internal Carotid Artery in Circle of Willisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
Monocytes and macrophages are innate immune cells that reside and accumulate in atherosclerotic lesions but also in the healthy and injured heart and brain. The cells and their subsets pursue distinct functions in steady state and disease, and their tenure may range between hours to months. Some subsets are highly inflammatory, while others support tissue repair.
Dr. Matthias Nahrendorf discusses current concepts of cell supply by the hematopoietic system, lineage relationships and systems’ cross talk, highlights open questions, and describes imaging tools for studying monocytes, macrophages and their progenitors.
Key Topics Include:
- Resident versus bone marrow derived macrophages
- Roles and phenotypes of heart leukocytes
- Hematopoiesis and the bone marrow in cardiovascular disease
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
Monocytes and macrophages are innate immune cells that reside and accumulate in atherosclerotic lesions but also in the healthy and injured heart and brain. The cells and their subsets pursue distinct functions in steady state and disease, and their tenure may range between hours to months. Some subsets are highly inflammatory, while others support tissue repair.
Dr. Matthias Nahrendorf discusses current concepts of cell supply by the hematopoietic system, lineage relationships and systems’ cross talk, highlights open questions, and describes imaging tools for studying monocytes, macrophages and their progenitors.
Key Topics Include:
- Resident versus bone marrow derived macrophages
- Roles and phenotypes of heart leukocytes
- Hematopoiesis and the bone marrow in cardiovascular disease
Com uma concepção de "affordable luxury", o Canvas oferecerá surpreendente requintes de luxo com um dos menores preços de toda a região, e areas de lazer funcionais que definem um estilo de vida refinado.
Localizado no Distrito de Artes e Entretenimento, entre South Beach, Brickell, Design District e Midtown e a curta distancia do Metro Mover, serão residencias com preços a partir de US$ 280.000 a US$ 607,000:
1 quarto+1 wc, varanda, 74,32m2
1 quarto+anexo+1 wc e lavabo, varanda, 84,54m2
2 quartos+2 wc, varanda, 87,32m2
2 quartos+2 wc, varanda, 103,10m2
Informações: Sergio@bergenglobal.com
Nriaegis is the best company in Delhi NCR which provides all types of Property Management, Business Support, Event Management, Travel Support, Medical Support and many more services for Indians and Non-Resident Indian at the lowest cost. We’ve international experience of over 25 years. Our services are appreciated by our clients due to our efforts and the best quality.
وهي شرط مهم جداً في عملية زراعة الشعر ومن دون منطقة مانحة ذو كثافة جيدة لا يمكن إجراء عملية زراعة الشعر . و المنطقة المانحة هي المناطق التي توفرالشعر وجذور الشعر التي سيتم زراعتها في مناطق الصلع لدى المريض
المنطقة المانحة للشعر
الجزء الخلفي من الرأس والجانبين لا يتأثر بهرمون الأندروجين المسبب للصلع الذكوري والشعر في تلك المناطق لا يتساقط بل ينمو بشكل دائم . لذا حين يتم زراعة الشعر المأخوذ من تلك المناطق فإنه يتابع نموه بشكل طبيعي ودائم في موقعه الجديد
A talk about the future of cardiology (also medicine in general) given on the 28th april 2014 in the Medical University of Silesia in Poland to doctors and students. It shows the trends of medicine and medical technology development with the biggest potential.
Innovations in Percutaneous Intervention, 1977-2007. Slides created by Simon H. Stertzer, MD, FACC, FAHA, Professor Emeritus, Stanford University School of Medicine.
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerve...InsideScientific
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerventions
Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Email (Opens in new window)
ON DEMAND
Experts discuss how PET/CT imaging can be used to enable image-guided neurointerventions and to study targeted delivery and clearance of therapeutic agents.
WATCH WEBINAR
Mice are by far the most frequently used animal for modeling disease and developing therapeutic strategies including neurointerventions. However, due to its anatomical and physiological barriers, the brain is a difficult target for delivery of therapeutic agents. Systemic administration is plagued with marginal brain accumulation and high risk of off-target side effects.
In this webinar sponsored by Scintica Instrumentation, Dr. Piotr Walczak, Dr. Mirosław Janowski and Dr. Wojciech Lesniak address this challenge and discuss why advanced imaging is essential to perform image-guided neurointerventions.
First, Dr. Janowski provides rationale as to how imaging can be used to better understand how therapeutic agents are delivered to the brain and subsequently cleared. Next, Dr. Walczak reviews methodological and technological advances for improving precision and reproducibility of brain targeting in mice based on MRI and two-photon microscopy. Finally, Dr. Lesniak presents recently-published results using ARGUS PET/CT to quantify intra-artrial delivery of antibodies, nanobodies and poly(amidoamine) dendrimers.
Key Learning Objectives Include:
- Why advanced imaging is essential to perform image-guided neurointerventions
- Why we need to visualize not only penetration of therapeutic agents to the brain, but also their clearance
- How image-guided procedures can be used to visualize and optimize delivery of therapeutic agents to the brain
a presentation on experimental study design for CVD models, will help you in selecting the case to study and pick a right one. as Cardiovascular plays a important role.
1. Novel Transcatheter
Device to Treat
Hypertrophic Obstructive
Cardiomyopathy
Elad Maor MD PHD
Zachi Berger PhD MBA
Sheba Medical Center, Israel
2016
2. The clinical need:
Hypertrophic Obstructive
Cardiomyopathy
Dynamic left ventricular outflow tract obstruction
The most common cardiac genetic disorder
Prevalence 1:500 adults (600,000 in the US)
A major cause of sudden death and heart failure in young
people
3. HCM Can Cause
Outflow Track Obstruction
Characterized by a thickened but nondilated left ventricle
Cause increased intraventricular pressures that may be
detrimental to LV function
Increased myocardial wall stress and oxygen demand
In histopathology specimens of HCM, cardiac muscle cells
(myocytes) in both ventricular septum and left ventricle (LV)
free wall show increased transverse diameter and bizarre
shapes
Clinical diagnosis of HCM is usually made with two-
dimensional echocardiography
A 14 years old boy with sudden death and
septal thickness of 65 mm. Ao - aorta, LVFW
– left ventricular free wall, VS – ventricular
septum
4. Clinical Course and
Medical Treatment 1
HCM can lead to sudden cardiac death or progressive heart failure with
exertional dyspnea and functional limitation
Current medical treatments: Myectomy Surgery, Alcohol Ablation,
Anticoagulation Drugs
Surgical septal reduction therapy - Myectomy - is the gold standard as the
results for, are unmatched for early, long term benefit
However, Myectomy has generally been confined to selected major centers
having substantial experience with this procedure and is not suitable for all
patients
5. Clinical Course and
Medical Treatment 2, 3
Percutaneous alcohol septal ablation, is alternative to Myectomy only in
selected patients and is a sub-optimal solution
The use of Beta Blockers, Calcium Channel Blockers and anticoagulation in
patients who develop atrial fibrillation with a lot of side effects
There is clinical need for novel minimally invasive
non-surgical approach
6. Our Device and Method:
Non Thermal Irreversible
Electroporation - NTIRE
Our novel transcatheter endovascular device and method will be
able to attenuate left ventricular obstruction and heart failure in
patients with HCM, without the need for open heart surgery
Our approach is based on a novel non thermal ablation approach
that can damage only cellular components within seconds and with
no damage to the extra cellular components
8. Medical Use of Irreversible
Electroporation
It can induce significant ablation of biological tissue, and is
currently under evaluation in clinical trials for the treatment
of solid tumors utilizing 1,500V
Irreversible electroporation with voltages of up to 3,000V is
CE and FDA approved for solid tumors. It is being used
clinically all over the world
There are currently more than 90 clinical trials running but
not in Cardiology
9. Summary of NTIRE Preclinical
Studies
Non-thermal Irreversible Electroporation (NTIRE) is an
emerging cell ablation approach
NTIRE induces cell death by creating pores in cell membranes
In contrast to all other available ablation modalities, it induces
ablation within microseconds and with no heat generation
Due to its non-thermal nature, NTIRE does not damage extra
cellular components
Our preliminary in vivo results show that endovascular NTIRE
has the potential to ablate hypertrophic myocardium, without
the need for open heart surgery
Our results demonstrate the efficacy and safety of in-vivo non
thermal ablation of cellular components in the beating heart
10. Preliminary Animal Model
In vivo IRE is achieved using two needle
electrodes inserted into the anterior
myocardium of SD rat through the 4th
inter-costal space
Ablation effect due to different NTIRE protocols
on vascular smooth muscle cells (VSMC). The
figure summarizes and compares NTIRE
ablation efficiency of eight different
electroporation protocols. Ablation effect is
shown as the percentage of vascular smooth
muscle cells in the treated carotid artery
compared with the right carotid artery of the
same animal. The reduction in five of the groups
was statistically significant (P<0.001, bars)
marked with an asterisk)
17. Endovascular NTIRE Prototype:
Disposable Flexible Nitinol Cage
Real picture of the prototype in its
inflated state. The four legs are 2
cm in length. (Assembled by Jim
Mitchell, Angiodynamics Inc.,
Queensbury , NY - subcontractor)
Electric field distribution (∆V = 600 Volts) -.
Color-Scale is in units of V/cm. This potential
difference electric field is relatively uniform and
high enough throughout the vessel wall
18. Scientific and Medical
Recognition
Peer Reviewed Journal Articles:
Maor E, Ivorra A, Leor J, Rubinsky B. The Effect of Irreversible Electroporation on Blood Vessels. Technol
Cancer Res Treat. 2007 Aug; 6(4): 307-312. Cited in PubMed; PMID: 17668938.
Maor E, Ivorra A, Leor J, Rubinsky B. Irreversible Electroporation Attenuates Neointimal Formation after
Angioplasty. IEEE transactions on bio-medical engineering. IEEE Trans Biomed Eng. 2008 Sep;55(9):2268-
74. Cited in PubMed; PMID: 18713696
Maor E, Ivorra A, Rubinsky B. Non Thermal Irreversible Electroporation - Novel Technology For Vascular
Smooth Muscle Cells Ablation. PLoS One. 2009;4(3):e4757. Epub 2009 Mar 9. Cited in PubMed; PMID:
19270746.
Granot Y, Ivorra A, Maor E, Rubinsky B. In vivo imaging of irreversible electroporation by means of electrical
impedance tomography. Phys Med Biol. 2009 Aug 21;54(16):4927-43. Epub 2009 Jul 30. PMID: 19641242
Maor E, Rubinsky B. Endovascular Nonthermal Irreversible Electroporation: A Finite Element Analysis.
Journal of Biomechanical Engineering 2010;132(3): 031008. Cited in PubMed; PMID: 20459196.
Maor E, Ivorra A, Mitchell JJ, Rubinsky B. Vascular smooth muscle cells ablation with endovascular
nonthermal irreversible electroporation. J Vasc Interv Radiol. 2010. 21(11):1708-15.
Phillips M, Maor E, Rubinsky B. Nonthermal irreversible electroporation for tissue decellularization. J
Biomech Eng. 2010. 132(9):091003.
Peer Reviewed Book Chapter
Maor E, Nagler A, Leor J (November 2008). Umbilical Cord Blood Cells for Cardiac Repair. In Ioannis
Dimarakis (Ed.), Handbook of Cardiac Stem Cell Therapy (chapter 4). London, United Kingdom. Imperial
College Press. ISBN: 9781848162563
19. Summary of Results
NTIRE damages cell membrane only
NTIRE has a non thermal nature
Treatment duration of less than 10 sec !
Efficient and precise
Sparing of extra cellular components
20. IP
PCT/IL2014/050219
MYOCARDIAL ABLATION BY IRREVERSIBLE
ELECTROPORATION
BY TEL HASHOMER MEDICAL RESEARCH
INFRASTRUCTURE AND SERVICES LTD
INVENTOR – ELAD MAOR
PRIORITY DATE 05/06/2013
22. Market potential
Business model – selling disposables
Prevalence of HCM within the general population is ~0.5%
2.5 Million individual worldwide with HCM
10% will benefit intervention
Estimated price target 5K-10K USD
1-2 B USD potential market
23. Future Clinical Applications
Septal ablation for HOCM
Tissue scaffolding
Cardiac arrhythmias
Endovascular drug delivery
24. 2 years Development Plan
Activity Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8
1 Design of possible endovascular prototypes X X
2
Finish element simulation of the heat transfer
problem
X X
3 Assembly of the selected endovascular prototype X X
4 In Vivo experiments – Safety X X
5 In Vivo experiments – Efficacy X X
6 Analysis of histopathology specimens X
25. The Team
Elad Maor, MD – Inventor and Consultant
Zachi Berger, Ph.D. MBA – CEO/Founder
Clinical development – Sheba Medical Center
26. Summary
Large market with limited medical solutions
Novel minimally invasive procedure
IP in PCT stage
Regulation will be based on other procedures
Short development time
Leading team and Medical Center