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    • 2. 发明申请
    • Electrically efficient neurally-excitable stimulation technical field
    • 电动高效神经兴奋刺激技术领域
    • US20050038479A1
    • 2005-02-17
    • US10638855
    • 2003-08-11
    • D. DenoDavid EulerLawrence MulliganEdwin DuffinDavid Igel
    • D. DenoDavid EulerLawrence MulliganEdwin DuffinDavid Igel
    • A61N1/362A61N1/365A61N1/368
    • A61N1/36514A61N1/3627A61N1/36564A61N1/368
    • A medical device, e.g., an implantable medical device, delivers one or more neurally-excitable stimulation pulses to myocardial tissue during a period when the tissue is refractory. The width of the pulses is less than or equal to approximately one half millisecond. In some embodiments, the current amplitude of the pulses is less than or equal to approximately twenty milliamps. In exemplary embodiments, the medical device delivers a pulse train of six or fewer pulses separated from each other by an interval that is greater than or equal to approximately ten milliseconds. In some embodiments, the medical device delivers pulses according to a schedule stored in a memory, or as a function of a monitored physiological parameter of a patient, such as an intracardiac pressure. In some embodiments, the medical device suspends or withholds delivery of neurally-excitable based on detection of cardiac ischemia.
    • 医疗装置,例如可植入的医疗装置,在组织难治的时期期间,向心肌组织递送一个或多个神经可兴奋的刺激脉冲。 脉冲的宽度小于或等于大约一个半毫秒。 在一些实施例中,脉冲的电流幅度小于或等于大约二十毫安。 在示例性实施例中,医疗设备递送彼此间隔大于或等于大约十毫秒的六个或更少个脉冲的脉冲串。 在一些实施例中,医疗装置根据存储在存储器中的计划或者作为患者的被监测的生理参数(例如心脏内压力)递送脉冲。 在一些实施方案中,基于心脏缺血的检测,医疗装置暂停或禁止神经可兴奋的递送。
    • 3. 发明申请
    • Method and apparatus for optimization and assessment of response to extra-systolic stimulation (ESS) therapy
    • 用于优化和评估对收缩期刺激(ESS)治疗的反应的方法和装置
    • US20050075675A1
    • 2005-04-07
    • US10680494
    • 2003-10-07
    • Lawrence MulliganD. DenoJohn BurnesNirav Sheth
    • Lawrence MulliganD. DenoJohn BurnesNirav Sheth
    • A61N1/362A61N1/365
    • A61N1/3627A61N1/36514A61N1/36578
    • A method and apparatus for optimizing and assessing the response to extra-systolic stimulation (ESS) are provided. An optimization/monitoring parameter is calculated as a function of potentiation ratio, PR, and recirculation fraction, RF, derived from measurements of myocardial contractile function during and after ESS. PR may be computed as the ratio of the contractile function on post-extra-systolic beats during ESS to baseline contractile function. RF may be computed as the slope of a linear regression performed on a plot of the contractile function for a post-extra-systolic beat versus the contractile function for the previous post-extra-systolic beat after ESS is ceased. The ESI resulting in a maximum optimization/monitoring parameter, preferably computed as the product of PR and RF, is determined as the optimal ESI. The operating ESI may be automatically adjusted, and/or PR and RF data may be stored for monitoring purposes.
    • 提供了一种用于优化和评估对收缩期刺激(ESS)的反应的方法和装置。 根据ESS期间和之后的心肌收缩功能测量得出,优化/监测参数作为增强比PR和再循环分数RF的函数计算。 PR可以计算为ESS期间收缩功能对收缩后收缩期与基线收缩功能的比值。 RF可以被计算为在ESS停止之后针对收缩后收缩压的收缩功能图与先前的收缩后节拍后的收缩功能的曲线进行的线性回归的斜率。 产生最大优化/监测参数的ESI,优选地计算为PR和RF的乘积,被确定为最佳ESI。 可以自动调整操作ESI,并且可以存储和/或PR和RF数据用于监视目的。
    • 4. 发明申请
    • System for enhanced cardiac function with combined PESP/NES
    • 使用PESP / NES组合增强心脏功能的系统
    • US20060247699A1
    • 2006-11-02
    • US11116941
    • 2005-04-28
    • John BurnesLawrence MulliganRandall Knoll
    • John BurnesLawrence MulliganRandall Knoll
    • A61N1/36
    • A61N1/3627A61N1/36114A61N1/36564
    • In some embodiments, a method of applying stimulation pulse therapy to excitable tissue may include one or more of the following steps: (a) delivering a PESP stimulation therapy to the excitable tissue for a cardiac cycle, (b) delivering a NES stimulation therapy to the excitable tissue during certain cardiac cycles, (c) determining physiologic demand of the patient based on at least one physiologic measurement, (d) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and ceasing the delivery of the NES and PESP stimulation therapy when physiologic demand returns to a base level, and (e) determining physiologic demand being placed on a heart based on at least one physiologic measurement, and modulating the ratio of the number of cardiac cycles in which the NES stimulation therapy is delivered to the number of cardiac cycles in which the PESP stimulation therapy is delivered based on physiologic demand.
    • 在一些实施方案中,将刺激脉冲治疗应用于可兴奋组织的方法可以包括以下步骤中的一个或多个:(a)将PESP刺激疗法递送至心脏周期的可兴奋组织,(b)将NES刺激疗法递送至 (c)基于至少一个生理测量来确定患者的生理需求,(d)基于至少一个生理测量来确定置于心脏上的生理需求,并且停止递送 NES和PESP刺激治疗,当生理需求恢复到基础水平时,以及(e)基于至少一个生理测量来确定置于心脏上的生理需求,以及调节NES刺激疗法的心脏周期数 基于生理需求被传递到其中递送PESP刺激疗法的心脏周期数。
    • 7. 发明申请
    • Implantable medical device for monitoring cardiac blood pressure and chamber dimension
    • 用于监测心脏血压和腔室尺寸的植入式医疗装置
    • US20050027323A1
    • 2005-02-03
    • US10000973
    • 2001-10-30
    • Lawrence MulliganMichael Hill
    • Lawrence MulliganMichael Hill
    • A61B5/0215A61N1/362A61N1/365A61N1/368
    • A61N1/3627A61N1/36528A61N1/36564A61N1/3684
    • Implantable medical devices (IMDs) for monitoring signs of acute or chronic cardiac heart failure by measuring cardiac blood pressure and mechanical dimensions of the heart and providing multi-chamber pacing optimized as a function of measured blood pressure and dimensions are disclosed. The dimension sensor or sensors comprise at least a first sonomicrometer piezoelectric crystal mounted to a first lead body implanted into or in relation to one heart chamber that operates as an ultrasound transmitter when a drive signal is applied to it and at least one second sonomicrometer crystal mounted to a second lead body implanted into or in relation to a second heart chamber that operates as an ultrasound receiver. The ultrasound receiver converts impinging ultrasound energy transmitted from the ultrasound transmitter through blood and heart tissue into an electrical signal. The time delay between the generation of the transmitted ultrasound signal and the reception of the ultrasound wave varies as a function of distance between the ultrasound transmitter and receiver which in turn varies with contraction and expansion of a heart chamber between the first and second sonomicrometer crystals. One or more additional sonomicrometer piezoelectric crystal can be mounted to additional lead bodies such that the distances between the three or more sonomicrometer crystals can be determined. In each case, the sonomicrometer crystals are distributed about a heart chamber such that the distance between the separated ultrasound transmitter and receiver crystal pairs changes with contraction and relaxation of the heart chamber walls.
    • 公开了通过测量心脏的心脏血压和机械尺寸并提供作为测量血压和尺寸的函数优化的多室起搏的用于监测急性或慢性心脏心力衰竭迹象的可植入医疗装置(IMD)。 尺寸传感器或传感器至少包括安装到第一引线体的第一经济学压电晶体体,该第一引线体被植入或与一个心室相关联,该心室在作用于其上的驱动信号时作为超声波发射器工作,并且至少一个第二经济测量仪晶体安装 植入到作为超声波接收器操作的第二心室的第二引线体中。 超声波接收器将从超声波发射器传输的冲击超声能量通过血液和心脏组织转换为电信号。 发射超声波信号的产生与超声波的接收之间的时间延迟随着超声发射器和接收器之间的距离的函数而变化,而超声发射器与接收器之间随着第一和第二经济计量晶体之间心室的收缩和膨胀而变化。 一个或多个附加的经济测量压电晶体可以安装到另外的引线体上,使得可以确定三个或更多个经济测量晶体之间的距离。 在每种情况下,经济测量仪晶体分布在心室周围,使得分离的超声波发射器和接收器晶体对之间的距离随着心室壁的收缩和松弛而改变。