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A Life in the Lab: Four decades of working with Jerry Lutty
I met Jerry in the fall of 1974 when I joined Bernie Hochheimer’s lab at the Johns Hopkins Applied Physics Lab (APL) as a photographer in an NEI-funded study to examine dyes for possible use in clinical ocular angiography. Bernie, who was a brilliant physicist in optical systems, and subsequently worked on the repair of the Hubble Telescope mirror, co-developed ICG angiography in the early 70’s with Bob Flower who I would later go on to work with. Prior to joining Bernie’s lab, I had been a cinematographers assistant at APL, working on a documentary film about the life of Dr. R.E. Gibson. He was, at that time, Director Emeritus of the Johns Hopkins Applied Physics Lab and and Professor of biomedical engineering of The Johns Hopkins University School of Medicine. One day after filming wrapped, he invited me to join him for lunch in his office at APL. Dr. Gibson suggested that I would be better served if I pursued a career in science, even though I had no formal training in that field. He asked me to meet with Bernie to discuss working in his research lab at APL and Wilmer. Needless to say, when Dr. Gibson spoke, I listened.
I met with Bernie shortly thereafter, and was offered the position which I promptly accepted. Bernie was such a good man and someone who made a tremendous contribution to the field of ophthalmology. In addition to ICG angiography, he helped develop, (in collaboration with Dr. Arnall Patz), laser photocoagulation as a method for treating diabetic retinopathy. I reported to work the following week and was introduced to Jerry who was, at that time, conducting the toxicological aspect of the dye study. I later found out that Jerry also had a connection to Dr. Gibson who steered me to Bernie’s lab. His father-in-law, Dr. Alfred J. Zmuda (A.J.), was a specialist at APL in geomagnetism, ionospheric physics and space physics, and an expert on the Aurora Borealis. I had to admire Bernie for hiring two guys who looked like they could have been at a political protest or an Earth Day celebration on the National Mall the day before. We both had hair well below our shoulders and Jerry had a big beard which he wore for the remainder of the subsequent 40+ years we worked together. We hit it off immediately and would take walks around APL’s campus at lunch time discussing art, music, politics and photography. I looked up to Jerry as I found him to be a kind and gentle soul, with a passion for knowledge and a temperament for teaching.
Following the completion of the dye study in the 70’s, Jerry and I worked in different labs on the same floor of the Woods Research Building at Wilmer. Jerry became involved in ocular angiogenesis research under Dr. Arnall Patz (who was director of the Wilmer Eye Institute at the time) and I worked with Bob Flower to further develop ICG angiography for clinical use. Later, in the early 80’s, Jerry and I collaborated on studies of Retinopathy of Prematurity under Patz and Flower. Dr. Patz had received the Lasker Award in 1956 for his research showing that giving high levels of oxygen to premature infants was causing an epidemic of blindness in those babies. We felt that a key to understanding the vasculopathy of ROP was a better understanding of normal retinal vascular development. Jerry and I worked closely on the project for the next several years and developed a new technique for visualization of the retinal vasculature. In the 80’s, the number of NIH biomedical research grants to be funded was slashed by 23%. Even though we kept the project going for the following several years, primarily through the generosity of donors to Wilmer, I eventually was forced to return to APL for several years until the biomedical research funding situation improved. While Jerry was fortunate to remain at Wilmer, we did manage to collaborate part-time on several projects during that period.
In the early 90’s Jerry received an NIH grant to study sickle cell retinopathy, and an RPB grant to study diabetic retinopathy. I returned to Wilmer again on a full time basis. I was incredibly lucky to have worked with both Jerry and Dr. Morton Goldberg on the sickle cell project. Dr. Goldberg was Wilmer’s Director at the time and an expert on sickle cell retinopathy. We were very productive during that period and gained valuable insights into vaso-occlusive processes in both diabetic and sickle cell retinopathy. We identified growth factors in sickle cell retina and showed that arteriovenous crossings were a preferred site of seafan formation. Seafan was the term coined for the neovascularization that formed at the interface between perfused and nonperfused peripheral retina which resembled the marine invertebrate Gorgonia flabellum.
In diabetic retina, we showed increased levels of the cell adhesion molecule ICAM-1 in retinal vessels. This protein could contribute to the retinal microangiopathy observed in diabetics by enhancing leukocyte adhesion to endothelium and consequently the incidence of capillary obstruction. Our study and subsequent work demonstrated ICAM-1 and its binding partners are operative in diabetic retinopathy and may serve as potential targets for therapeutic interventions. The publication of that work, in The American Journal of Pathology, has been one one of our most cited papers.
In addition to our work in diabetic and sickle cell retinopathy, Jerry also received NIH funding to continue our work on Retinopathy of Prematurity during the late 90’s and early 2000’s. We demonstrated the anti-VEGF (Vascular Endothelial Growth Factor) therapy was effective in reducing neovacularization in animal models of ROP, but that therapeutic doses should be carefully considered clinically so that retinal revascularization wasn’t inhibited.
The 2000’s brought continued success and renewed interest in normal fetal development of retinal and choroidal vasculatures. The discovery that the fetal choriocapillaris formed by a process of hemovasculogenesis, a process in which vasculogenesis and hematopoiesis occur simultaneously, was intriguing. Our work in fetal choroid led us to begin studying the choroidal vasculature in disease states, particularly, in Age-Related Macular Degeneration (ARMD). We showed that choriocapillaris dropout occurs in eyes of ARMD prior to clinical manifestations of disease. Additionally, we found that mast cells in choroid may contribute to the dry form of ARMD. These studies are still ongoing by Dr.’s Malia Edwards and Imran Bhutto at Wilmer.
I officially retired from Wilmer in 2018, however, I continued working with Jerry on a part-time basis to finish up some papers for publication. I had known and worked with him for over 45 years. He had been a mentor, a collaborator and one of my dearest friends during that time. He was a remarkable human being and I consider myself extremely lucky to have been a part of his lab and his life. He mentored countless high school students, undergrads, medical students and postdocs during his career. His teaching style, patience and desire to inspire future generations in science was an attribute to his impeccable character. I was deeply saddened by his passing as many in his circle were. We lost a a giant in science, a kind human being, dear friend and a devoted family man!
(It's a tree. Covered in lights. At the Lincoln Park Zoo.)
Nine months ago, on March 18th, I tore my left anterior cruciate ligament while skiing. I didn't even know it happened, just that I twisted my knee, felt a pop, and while skiing down, my knee sometimes slipped laterally when I pushed off of it. Seventeen days later, I had surgery. They had numbed my entire left leg by injecting lidocaine near my femoral and sciatic nerves. The entire limb was limp and flaccid, a bulky slab of flesh. In three hours, my surgeon, JML3, sliced my knee open, extracted the middle third of my patellar tendon and bone as a graft, drilled through my tibia and femur, threaded the graft through, screwed some plastic in there…Twenty hours later, my leg awoke from its sedated, zombie state. The subsequent journey was nothing I had planned, anticipated nor ever conceived--a journey of mental, intellectual, emotional, physical anguish, confusion, amusement and curiosity. Some of it I documented and described previously. Gross feelings, revelations on knee surgery, molecular basis of healing, the unknowns, the inevitable morbidity, why's, how's, what to do about it all took residence in my brain. I have since endeavored to figure all these things out. I learned you cannot find anything meaningful by querying "gimp" or "gimpy" in the NCBI PubMed literature search.
Thus, a list of ten memorable knee things I read:
1. Mechanisms of Anterior Cruciate Ligament Injury in World Cup Alpine Skiing
See, I'm not crazy. There's a technical term describing how I tore my ACL. It's called the "slip-catch mechanism." Yeah, that's right, I'm a World Cup alpine skier. Not.
2. The "Ligamentization" Process in Anterior Cruciate Ligament Reconstruction
Published two weeks after my surgery, this literature review describes the healing process of the ACL graft as observed in numerous animal models and biopsied samples from humans. I read it and freaked out when I came upon the part where they described the graft becoming necrotic about four weeks post-surgery. Necrosis = cell death, in an unnatural, destructive manner. The thing in my knee was dying. Rotting. Zombifying. Gag.
A 26-year old man, 18-months post-ACL surgery, died. They took his knee, cut it apart and looked at it. It was mostly healed and the graft had integrated in such a way that looked normal. The bone plugs of the graft were indeed necrotic (acellular) at the core, but the periphery had viable cells and had fused to the femoral and tibial tunnels. The tendonous portion of the graft, also necrotic at the core, had otherwise revascularized and was re-colonized by fibroblasts. Until this study, observations of the stages of healing and graft incorporation were based on animal studies; healing in humans were based on superficial biopsies.
4. Potential of Skin Fibroblasts for Application to Anterior Cruciate Ligament Tissue Engineering
They synthesized an ACL graft in vitro and put it into a goat! Two bone scaffolds from a pig, a string between the two bone plugs, some goat ACL fibroblasts, artificial growth media, exogenous collagen, one week in an incubator, and voila! De novo synthesis of a graft. After being put into a goat, the graft became vascularized and innervated and colonized by cells. It got remodeled in the goat's knees, as would the usual other grafts. But it was weak, only 36% of the strength of the native ACL after 13 months. Nevertheless, impressive!
Forty days post-surgery, I finally hit the wall and became impatiently frustrated by the gross feelings in my knee and adjacent part of my lower leg. It made it very hard to focus on the tasks at hand. Then, I realized my skin, lateral and inferior to my scar/incision site was numb to both touch and temperature. Epidermal insensitivity. This was the first article I found that helped me make sense of this. Damage to the dermatome--in particular, the infrapatellar nerve, a branch of the saphenous nerve, which runs down the inside of your leg. This article also made me aware of the long-term post-surgical knee morbidity that I would come to experience. Not everything would be honky-dory after all. At the time, I only cared about the feeling in my skin, since I could quantify it. They reported the numbness would persist, probably forever. I followed the changes weekly. I still exhibit 22.7 square centimeters of numbness to touch.
On my second day of physical therapy, 18 days post-surgery, I rode on a stationary bicycle. At the time, I was still wearing my brace locked in full extension. I only ever took the brace off to shower and do my physical therapy exercises and had yet to bear weight on my left leg without the brace (that's right, I had to sleep with the thing on--it sucked). The muscles were functionally retarded and unable to coordinate my weight when my knee was bent. I recall asking my physical therapist, "How do I get on the bike with only one leg?" Looking unconcerned, she said, "You'll figure it out." Man, tough crowd. I hopped over and managed to mount the thing. Afterwards, when it was time to get off, I didn't even bother asking how I should best do this, and just pushed off the seat and hopped down onto my right leg. At that moment, my physical therapist, in a serious tone, said, "Careful! You don't want to tear your other ACL." Me, horrified, baffled, whimpered, "What?! That can happen?" Yeah, that can happen. I found this paper and it was ghastly. Of 33 female athletes that had undergone ACL reconstruction, 10 of them tore their ACL a second time. 76% of the time, it happened in the other leg! I showed this paper to my physical therapist and she said to me, "You shouldn't be reading this type of material. It's best to focus on recovery and prevention." I justified to myself that this fits under prevention. PREDICTORS of secondary tears, hence, things I need to work on.
7. Gluteus Medius: Applied Anatomy, Dysfunction, Assessment, and Progressive Strengthening
Physical therapy? What is that? I was walking fine before surgery, why can't I do it after? Two months post-surgery and the pieces were still not yet falling into place in my head, and many things I was experiencing I still had not found a decent explanation for. I just didn't get it. In addition, I wanted to know why I was doing bizarre exercises in physical therapy. My physical therapist, who treated me for four months from the time after surgery, humored my curiosity and inquiries. She gave me this review. It became a gateway article to my queries into understanding the biomechanics of one's lower extremities, how strengthening the gluteal muscles subsequently aid to stabilize your knees, ankles, everything. I followed the key words that led to my realization that rupturing of the ACL results in loss of neuromuscular signaling of the knee to brain about joint position, gait abnormalities, increased internal rotation of the tibia, confused and weakened the quadriceps and hamstrings…consequences that at this time I had assumed only to affect my balance and coordination.
8. ACL Surgery: How to Get It Right the First Time and What to Do If It Fails
This is a really informative textbook. It has almost everything you need to know about anatomy, diagnosis, biological mechanisms that lead to the failure of the graft to heal itself, types of grafts, fixation devices, pros/cons and technical specifications of these hardware, the technicalities and variations of the surgery (it's crazy complex!), a generalized gist of the molecular healing process, plus what to expect post-surgery in terms of rehabilitation and muscle weakness and inflammation and answers to many of those "why" questions I had (that I had eventually found in circuitous searches through the scientific literature), minus the experimental details. You would be surprised how most mechanical graft failures are attributed to technical errs of the surgery (i.e. graft installed at a bad angle, poor screw fixation, missed/improper diagnoses, etc).
It would have been nice to read this before surgery, though I might have been grossed out by the gory surgical photos of splayed open knees. I went into the surgery entirely naive about what to expect afterward and why. The extent of my knowledge was "Brace locked in full extension for four weeks, in brace unlocked to flex to 90 degrees until six weeks, walking unfettered afterwards, running at 3-4 months, cutting/pivoting at 5 months, back to sports at 6 months. Increased rate of osteoarthritis. Some discomfort at the scar when kneeling." Sounded easy--perhaps this was for the best?
9. Knee Function and Prevalence of Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction
The first scientific article I came upon of many on this topic. Ultimately (as gleaned from other papers), osteoarthritis (OA) appears to be a direct consequence of the ACL rupture. The twisting of the knee, tearing other things, and banging of the bones (bone and cartilage bruising) may contribute, but simply snipping (transection of) the ligament alone is sufficient to immediately induce the cellular signals that precipitate the joint and cartilage degeneration. Severing of the ligament physically destroys neuromuscular transmission between the ligament to adjacent muscles and the brain. An intra-articular blood vessel is usually ruptured, resulting in joint effusion, inhibition of quadricep function, and unfavorable changes to the articular environment: plasmin dismantling of the fibrin clot that forms as a healing scaffold on the torn ligament; upregulation of matrix metalloproteases that destroy the cartilage and matrix proteins in the joint that serve as lubrication; inflammatory cytokine signaling that affect chondrocyte (the cartilage producing cells) metabolism and viability; reduction of proteoglycan IV (aka lubricin), a "lubricating" joint matrix protein that buffers the cartilage and stimulates chondrocyte activity. The altered neuromuscular signaling also leads to muscular weakness, gait changes, force loading on different parts of the cartilage in the joint, increased friction and wearing of the cartilage, factors of which are not entirely restored by surgery or rehabilitation… Regardless of reconstruction, ACL tears have been reported to lead to osteoarthritis in 20-80% of the population 10-12 years post-injury, 90% OA by 15 years, 45% total knee arthroplasty (replacement) by 35 years. A pretty grim and sobering outlook.
I am not a fan of having a statistically sealed fate and I am thus holding out a small sliver of hope that I can be the anomaly that defies these near-inevitable odds.
10. Phys Ed: Can Running Actually Help Your Knees? (New York Times Article)
There's a lot of interesting reading in the Wellness blog section of the NYTimes. Anyway, there's no defined protocol on how to avoid OA, nor what differentiates those 10% of people that don't get it in 15 years from the 90% that do. However, numerous correlative studies have found that physical activity keeps the joints lubed up and healthier. They advocate low-impact activities, but without consistent and definitive empirical justification. This article, and many others, discuss observations on how in runners, chondrocytes in the knees continually produce cartilage and maintain cartilage volume; this is in contrast to sedentary folks, where cartilage thinning is observed. The consequences are not clearly defined for previously injured knees, but assuming aberrant cartilage loading due to neuromuscular imbalances, repetitive impact would accelerate joint degeneration. On the other hand, exercise increases and maintains muscular strength, and weight-bearing exercises have, in some cases, been observed to increase cartilage surface area and/or thickness.... I'm going to figure out an experiment to do that involves running. It will span a decade. We will see what happens to me. At worst, I will get OA and require a knee replacement, which at this rate, will occur with a 45% likelihood.
Another reason to run? "Runner's high" is actually from increased production of endocannabinoids, not endorphins. Endocannabinoids are fat-soluble signaling molecules, the same class of molecules acquired from use of marijuana. The lipid quality of these molecules allow them to readily cross the membranous blood-brain barrier and stimulate the brain to feel "high." Endorphins are proteinaceous, and thus do not readily diffuse through lipid membranes. Anyway, so running may be beneficial, if not for my left knee, then for my brain. I can feel it in my vastus medialis.
Ozier Muhammad/The New York Times
Dr. John J. Ricotta works with another surgeon at Stony Brook University Hospital on Long Island. Dr. Ricotta sought training in stenting, to give patients more options.
November 29, 2005
Stent vs. Scalpel
By BARNABY J. FEDER
After Linda Packer, a 64-year-old social worker in Manhattan, fell twice over the Memorial Day weekend and felt vaguely unwell, a series of tests revealed a serious problem: one of the two main arteries carrying blood to her brain was more than 80 percent blocked by plaque.
Hers was a fairly advanced case of a condition, known as carotid artery disease, that becomes increasingly common with age and has been linked to 25 percent of the 700,000 strokes in this country each year. It also leads to millions of cases of mini-stroke, memory loss and other brain impairments that interfere with daily life.
Doctors told Ms. Packer her condition was severe enough to justify cutting open the artery to clear out the plaque. Some 150,000 Americans annually undergo such surgery, whose risks include strokes, heart attacks and infections. Until recently, the only alternative was a combination of blood-thinning drugs and blood-pressure medications, and watchful waiting.
But Ms. Packer sought a relatively new, less-invasive alternative called carotid stenting, which has been used on more than 10,000 patients since regulators approved it last year. The technique widens arteries from the inside by threading a catheter through the circulatory system, pressing the plaque into the wall and inserting a metal mesh stent to prop open the artery.
Despite some complications, Ms. Packer is pleased with the results of her procedure. "When it comes to carving up my neck and leaving a big scar I could avoid," she said, "then my vanity comes into play."
But the procedure's seeming ease and its growing popularity have some experts worrying that too many doctors and patients, spurred on by medical device makers, may embrace it without fully understanding that it is generally as risky as surgery - and potentially riskier in some cases.
It is also expensive. Analysts estimate that sales of carotid stents, which cost around $3,000 each, have not yet topped $100 million. But some envision a $1 billion market for the devices within a decade - not counting doctors' fees.
This country now spends about $2 billion annually on surgical treatment of carotid blockages. Both the surgery and carotid stenting procedures cost $10,000 to $15,000. Prominent skeptics include Dr. Mark J. Alberts, a professor of neurology at Northwestern University Medical School. He cites clinical data showing stroke and death rates of more than 10 percent within one year among those getting stents - not much different from the results in the same study for surgery.
Dr. Alberts and some other doctors say that both procedures are done too often and that the advent of carotid stenting seems to be making the problem of over-treatment worse. "There may be a few niche groups of patients that need a carotid stent, but we're already seeing more carotid stents being put in than is justified," said Dr. Alberts, who practices at Northwestern Memorial Hospital, a major stroke treatment center for the Chicago region.
Everyone agrees that clinical evidence about the relative risks in different types of patients is only beginning to emerge. But some clinical studies have found lower complications for both procedures than those cited by Dr. Alberts, with some results seeming to favor stenting and others leaning toward surgery.
And advocates of the technology say that more recent data show that stenting success rates are climbing, now that the systems use temporarily implanted filters to catch bits of life-threatening plaque knocked loose during the procedure. By contrast, they say, carotid surgery - called endarterectomy - has no significant room for improvement.
"We are beginning to see results that make us believers that carotid stents will replace endarterectomy, and that it's only a matter of time," Dr. L. Nelson Hopkins, a professor of neurosurgery and radiology at the State University at Buffalo School of Medicine, said last month at a symposium in Washington.
The trickiest cases involve elderly patients for whom surgery is risky but stenting might be even riskier. Patients older than 80 are more likely to have calcified blockages that are hard to push aside with a stent, and they are more likely to have twisted arteries in which it is harder to implant the stent. Even stenting proponents worry about overuse of the technology in challenging cases.
"There is too much focus on who is a high surgical risk and not enough on who is at high risk for stenting," Dr. Sriram S. Iyer, chief of endovascular interventions at Lenox Hill Hospital in Manhattan, said at the same Washington symposium where Dr. Hopkins spoke. (Ms. Packer's procedure was conducted at Lenox Hill, one of the nation's busiest stenting centers.)
The Washington symposium was sponsored by Boston Scientific, a leader in stents used in cardiac cases, which hopes to receive Food and Drug Administration approval for a carotid stenting system by the end of the year. So far, only Guidant and Abbott Laboratories are cleared to sell carotid stents and related equipment in this country.
The F.D.A. has also tentatively approved a stent system from the Cordis division of Johnson & Johnson. Clearance is being delayed until Cordis convinces the government it has dealt with unrelated manufacturing and record-keeping problems. Medtronic, the largest company making only medical devices, could receive F.D.A. approval late next year.
Registries in which doctors track the outcomes of patients who receive carotid stents are providing a growing body of data about their performance. But doctors and insurers place far more weight on randomized clinical trials that compare the various makes and models of stents with one another or with other therapies.
By far the most important such trial under way is the Carotid Revascularization Endarterectomy Versus Stenting Trial, commonly known as Crest. A government- and industry-sponsored test comparing surgery with Guidant's stent system, the trial started in 2000 after three years of planning. But with less than a third of the enrollment goal of 2,500 patients completed, doctors will have a long wait for esults.
Meanwhile, patient demand for stents is growing. Dr. Michael R. Jaff, the director of the vascular diagnostic laboratory at Massachusetts General Hospital in Boston, told doctors and analysts at the Washington symposium that patients were showing up with "reams of paperwork" from Web sites that have convinced them stenting is the right procedure for them.
Specialists known as interventional cardiologists are poised to grab a majority of the carotid stent business. They make up the largest medical group in stenting, with as many as 15,000 practitioners, and are usually the first to spot carotid disease, which often develops along with heart disease.
But those doctors face stiff competition from the nation's 2,800 vascular surgeons who, on average, receive about 30 percent of their revenue from endarterectomies. They say that their ability to do either procedure makes them the most unbiased source of information for carotid disease patients.
Dr. John J. Ricotta, the chairman of surgery at Stony Brook University Hospital, on Long Island, sought training in the stenting procedure last April, to be able to give patients more options. "There's going to be a lot of pressure to do these cases," he said of stenting. But Dr. Ricotta said that in most cases he would still probably prefer surgery, for which he has had a low complication rate.
Then there are the interventional radiologists, who have extensive experience with stenting in arteries not near the heart, and neurologists, who specialize in treating brain diseases. The neurologists moving into carotid stenting emphasize that they have superior training in recognizing and dealing with brain damage that carotid stenting can cause.
"All the specialties involved have the sense that they have as much or more to offer than the others," said Dr. Barry F. Uretsky, an interventional cardiologist at the University of Texas Medical Branch in Galveston.
Doctors say the single biggest brake on expansion of carotid stenting is the government's reimbursement policy. Medicare restricts coverage to patients who have a blockage of at least 70 percent of an artery, who have already had a stroke or displayed some other clear symptom of carotid disease and who have conditions that make surgery highly risky. That covers fewer than 10 percent of the patients who currently undergo carotid surgery, which is routinely covered by Medicare and commercial insurance plans.
Meanwhile, Ms. Packer - whose insurer, Guardian Health Net, agreed to pay for the procedure - says she is happy she got the stent, despite some side effects. Those included swollen lymph glands and scattering bits of plaque that led to painful swelling in her foot and a serious infection in her thigh and groin, which required a two-week course of antibiotics.
Not only does she believe her risk of stroke has been reduced, Ms. Packer is also convinced the procedure has other benefits that device companies have not yet even asked regulators to consider.
"My memory and energy levels are better now," she said.
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Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Dr. Ephraim Church, a neurosurgeon, looks at a monitor as Dr. Varun Padmanaban prepares a patient for direct revascularization procedure to treat for Moyamoya Disease, where a scalp artery (superficial temporal artery) is connected directly to the middle brain (cerebral) artery in order to increase blood flow to the brain.
Paras Hospitals | Paras aspatal gurugram | Paras Hospital
Let's know about the services of Cardiology department of Paras Hospitals, Gurgaon by Dr. Mahesh Wadhwani, Chief of Cardiac Surgery & HOD, Department of Paediatric and Adult Cardiac Surgery.
To consult Dr. Mahesh Wadhwani, click here- ow.ly/Mi9k50ufVmJ
Profile- Dr. Wadhwani is an exemplary surgeon, credited to be part of more than 6000 major heart surgeries over the last 11 years. He trained at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, which is the most premier institute in the field of Cardiothoracic and Vascular Surgery in India. He also has the experience of being the founding member of three major corporate hospitals in North India, namely Narayana Hrudayalaya, Jaipur, FMRI Gurgaon, and Max Hospital Gurgaon. He specializes in pediatric cardiac surgery, Beating Heart CABG, Total arterial Revascularization (TAROPCAB), Valve Replacement/ Valve Repair, Congenital Surgery/Congenital Defects, Atrial Septal Defect(ASD), Ventricular Septal Defect(VSD), Tetralogy of Fallot in Children (TOF), Patent Ductus Arteriosus (PDA), to list a few.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Health care professionals at Penn State Health St. Joseph Medical Center perform their second Transcarotid Artery Revascularization (TCAR) on Wednesday, April 27. The procedure is a non-invasive method for treating carotid stenosis, a blockage of an artery in the neck that can lead to stroke.
Find more updates on #Cardiology: cardiologyinsights.euroscicon.com
SYNTAX Score Should Not Guide #Revascularization Strategy in Patients
In diabetic patients with multivessel CAD, the SYNTAX score was not an independent predictor of hard clinical events in those receiving #CABG
Guide: Sibia Medical Centre - First visit: How to reach, What to expect & Facilities (Hindi).
There is always anxiety when visiting any doctor. Here Dr S. S. Sibia, Director of Sibia Medical Centre informs how to reach Ludhiana in Punjab (India) from within India or abroad and what to expect. How you should prepare to come for the first visit, what all you should bring with you and how you will be received at the centre, the procedure followed and a summary of the treatments available at Sibia Medical Centre. Sibia Medical Centre is known the world over as pioneer for non-invasive, non-surgical tests and treatments. Dr Sibia informs about the Cardiovascular Cartography (CCG) pre-angiogram heart flow mapping, External Counter Pulsation (ECP / EECP), Extracorporeal Shockwave Myocardial Revascularization (ESMR) and Artery Chelation / Clearance Therapy (ACT) for heart disease, ESWL Lithotripsy to remove kidney stones with rays without surgery, Cartilage regeneration with Cytotron Regenerative Tissue Engineering for Knee and other joint arthritis pain, no side effect Cancer tumour rehabilitation with Cytotron / RFQMR Degenerative Tissue Engineering, Bio-oxidative Ozone Therapy, Anti-aging, Detoxification, Nutrition Medicine, etc.
MEET THE SPEAKERS:
Dr Sanjoy Nagaraja
Consultant Interventional Neuro Radiologist
Lead Clinician Neuro Radiology
University Hospital
Coventry
United Kingdom
Lectures on:
Endovascular Treatment for Intra Cranial Aneurysms
Stents & Pipe Lines
Endovascular Revascularization Techniques
Neurosurgery Update Course
7-15th September 2013
University Hospital
Coventry
United Kingdom
Nine day Course
10 hours of daily lectures
200 course lecture topics
100 National & International Speakers
30 participating hospitals
Video sessions of operative procedures
Interactive lectures
Group discussion
1000 page course syllabus
5000 images presented
Certificate of Attendance
Throwback Thursday: Dr. Jonathan Russin (left), a Keck neurosurgeon, stands at the finish line of the 2016 Los Angeles Marathon with former patient Kathy Nguyen and her husband, Robby. Russin saved Nguyen's life after she suffered a brain aneurysm in 2015. As a way to celebrate her return to full health, Nguyen invited Russin and others affiliated with the USC Neuro Revascularization Center to run with her in 2016 marathon, and they've been running together ever since. This past Sunday, March 20, marks the sixth time they've run the L.A. Marathon together. (Photo/Mary Dacuma)
Dr. Ephraim Church, a neurosurgeon, performs a direct revascularization procedure, where a scalp artery (superficial temporal artery) is connected directly to the middle brain (cerebral) artery in order to increase blood flow to the brain. The procedure is performed as a surgical treatment for Moyamoya Disease.
Dr. Ephraim Church, a neruosurgeon, performs a direct revascularization procedure, where a scalp artery (superficial temporal artery) is connected directly to the middle brain (cerebral) artery in order to increase blood flow to the brain. The procedure is performed as a surgical treatment for Moyamoya Disease.
Patient Satnam Singh from Birmingham, UK was advised bypass operation but he wanted to explore no-surgery treatments. He had Extracorporeal Shockwave Myocardial Revascularization (ESMR) treatment at Sibia Medical Centre. Dr. Sibia, Director of Sibia Medical Centre, Ludhiana explains this world’s latest German technology to treat heart patients with soundwaves.
Satnam Singh is a happy man as he finds relief with this novel therapy.
Sibia Medical Centre is a pioneer in Cardiovascular Cartography non-invasive heart flow mapping, External Counter Pulsation (ECP / EECP), Extracorporeal Shockwave Myocardial Revascularization (ESMR), Chelation Therapy, Ozone Therapy, Lifestyle Management, and Optimum Medication. For details visit www.smconline.in, email to drsibia@gmail.com or call, text SMS or WhatsApp to +91 9814034818.
www.zyloxtb.com/healthcare-professionals/thrombite-clot-r...
More efficient choice of recanalization
HELICAL OPEN-SIDE STRUCTURE
HIGHER ACUTE RECANALIZATION RATE
The Thrombite™ Clot Retriever Device, featuring S-shaped helical open-side structure, is designed for more efficient clot removal and optimum revascularization in a wide range of vessels.
Thrombite™ Clot Retriever Device
PRODUCT FEATURES
HELICAL OPEN-SIDE STRUCTURE
enables Thrombite™ retriever to efficiently entwine and clamp the clot
assures clot retention for confident removal and revascularization
OVERLAPPED STENT AT THE HELICAL OPEN-SIDE STRUCTURE
increases contact surface with thrombus and maximizes clot integration
EXCELLENT FLEXIBILITY AND VESSEL WALL APPOSITION
optimizes clot retention during smooth navigation through the tortuous anatomies
Radiopaque markers on the distal end of the device increase device visibility
3 markers for the sizes with 3.0 and 4.0mm diameter
4 markers for the sizes with 5.0 and 6.0mm diameter
Advanced stent surface treatment process
RADIAL FORCE
High radial force is designed for clot integration at the initial stage of stent expansion
Low radial force at nominal stent diameter ensures atraumatic retrieval
RADIAL FORCE
How a Stent Retriever Procedure Is Performed
Stent retriever procedure is generally performed in patients with the indications of acute cerebral infarction within six hours. After femoral artery puncture, the catheter is inserted after sheath puncture, and DSA is performed along the catheter to the brain to find the position of blocked vascular. Make the stent retriever reached the position and passing through the clot. Then release to capture the clot. After that, the stent retriever will be extracted along with the clot and finally leave your body.
ORDERING INFORMATION OF CLOT RETRIEVAL DEVICE
STENT RETRIEVAL DEVICE STRUCTURE
European Journal & Dr Mandeep report improvement in refractory Angina, heart's blood flow with ESMR.
A study published in the European Heart Journal reports a rising incidence of refractory angina patients for whom medical therapy is limited and prognosis poor.
The study was to assess the efficacy of Extracorporeal Shockwave Myocardial Revascularization (ESMR) in improvement of myocardial perfusion and symptoms.
151 patients were enrolled in the study.
Dr. Atul Kasliwal is a renowned Heart Specialist in Jaipur, providing customized treatment plans for each patient. He offers balloon angioplasty and stenting services, as well as minimally invasive endovascular procedures such as laser revascularization or shunt surgery. With vast experience in treating heart failure, Dr. Kasliwal is a reliable source for newer interventions like balloon angioplasty and stenting. He also provides free consultations to local physicians, making him a great option for those in need of a heart specialist in Jaipur.
Southern VIP & Foot Rescue Surgery Center Fulton KY
Southern VIP & Foot Rescue Surgery Center, located at 221 Main Street, Fulton, KY 42041, provides Foot Rescue procedures. Foot Rescue is a minimally invasive treatment for Peripheral Artery Disease (PAD) that uses tiny wires and other microtools to remove arterial blockages in the lower legs and feet, restoring blood flow all the way to the toes. Dr. Thomas Hodgkiss, a board-certified interventional radiologist who specializes in interventional oncology and PAD arterial revascularizations, performs the procedures.
Address: 221 Main St, Fulton, KY 42041, USA
Phone: 270-295-1250
Website: southernvip.com/
OsseoShop ExoGraft Plus Powder is a 3D Allograft with rapid revascularization, excellent biocompatibility, and powerful osteoinductive and osteoconductive properties.
"Rediscovering revascularization in damaged human tissue is well explained by the instructions etched in the DNA, but it is still a subject where nanobiotechnology and microfluidics and valve logic will have great technological insights." Edilson Gomes de Lima - from its book Nanobiotechnology.
Cerebral Revascularization: Techniques in Extracranial-to-Intracranial Bypass Surgery: Expert Consult – Online and Print0
"The Mxenes without giving them material intelligence such as microfluidics, revascularization technologies, valve logic and IC architecture in these materials, through the bottom-up manufacturing process, will remain as amorphous materials." Edilson Gomes de Lima
beta secretase inhibitors is a group of secreted cytokines that play an important role in revascularization, embryonic vascular, and cancer.
Heart failure is the most common heart disease and it can be difficult to diagnose in its early stages. Atul Kasliwal is one of the Best Cardiologist in Rajasthan who examines patients suffering from this disease and provides customized treatment plans. He can help you with balloon angioplasty and stenting procedures, while minimally invasive endovascular treatments such as laser revascularization may also be beneficial. To learn more about Dr. Atul's care for patients with heart failure, connect with him today!
Stem Cell Therapy for "eye related disorder" provides some major advantages are as follow:-
These all are the techniques which have discussed above useful only for small cartilage defect and not suitable for major cartilage defect because they form fibrocartilge which is not rigid to support complete weight
1. Neuroprotection and Neuroregeneration
2. Regenerate Retinal Pigment Epithelial cells
3. Regenerate of photoreceptor cells
4. Provides revascularization
Embrace the rhythm of progress in cardiovascular care with our ESMR treatment. It offers a ray of optimism for cardiac health, stimulating blood vessel growth to enhance myocardial revascularization.
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Heart failure is a serious condition that can be difficult to diagnose in its early stages. Angioplasty in Jaipur
Dr. Atul Kasliwal examines patients suffering from this disease and provides personalized treatment plans to help you live a better life. He can help with balloon angioplasty and stenting procedures, while minimally invasive endovascular treatments such as laser revascularization may also be beneficial.
Are you looking for an experienced and reliable Heart Specialist in Jaipur? Look no further than Dr. Atul Kasliwal, a renowned heart specialist who offers comprehensive heart care services. He offers customized treatment plans that include balloon angioplasty and stenting, as well as minimally invasive endovascular procedures such as laser revascularization. Dr. Kasliwal also provides free consultations on demand and looks after several local physicians.
Best cardiologist in jaipur
Dr. Atul Kasliwal is a board-certified and fellowship-trained Best cardiologist in jaipur who treats patients suffering from heart disease with a customized treatment plan for each patient, depending on how severe their problems are. This approach helps Dr. Atul Kasliwal to provide the most effective treatment plan possible for his patients' needs. As an expert in endovascular care, Dr. Atul Kasliwal offers laser revascularization and stenting services as well as balloon angioplasty and stenting to help his patients live healthy lives again.
Southern VIP & Foot Rescue Surgery Center Fulton KY
Southern VIP & Foot Rescue Surgery Center, located at 221 Main Street, Fulton, KY 42041, provides Foot Rescue procedures. Foot Rescue is a minimally invasive treatment for Peripheral Artery Disease (PAD) that uses tiny wires and other microtools to remove arterial blockages in the lower legs and feet, restoring blood flow all the way to the toes. Dr. Thomas Hodgkiss, a board-certified interventional radiologist who specializes in interventional oncology and PAD arterial revascularizations, performs the procedures.
Address: 221 Main St, Fulton, KY 42041, USA
Phone: 270-295-1250
Website: southernvip.com/