Israel: Mennen Medical Ltd. 4 Ha-Yarden Street, Yavne, P.O. Box 102, Rehovot 76100, Israel Phone: +972-8-9323333 Fax: +972-8-9328510

United States: Mennen Medical Corp. 950 Industrial Blvd. Southampton, PA 18966-4070, USA Phone: +215 259-1020 Fax: +215 675-6212

United Kingdom: Mennen Medical UK Unit 18 Avant Business Center 21 Denbigh Road Milton Keynes MK1 1DT, UK Phone: +44 1908 646070 Fax: +44 1908 646030

Abstracts from Scientific Articles 1. New Circulating-Water Devices Warm More Quickly than Forced-Air in Volunteers Wadhwa A, Komatsu R, Orhan-Sungur M, Barnes P, In J, Sessler DI, Lenhardt R . Outcomes Research Institute, University of Louisville, Louisville, Kentucky, USA Anesth Analg. 2007 Dec; 105(6):1681-7

Abstract BACKGROUND: Newer circulating-water systems supply more heat than forced-air, mainly because the heat capacity of water is much greater than for that of dry warm air and, in part, because they provide posterior as well as anterior heating. Several heating systems are available, but three major ones have yet to be compared directly. We therefore compared two circulating-water systems with a forced-air system during simulation of upper abdominal or chest surgery in volunteers . METHODS: Seven healthy volunteers participated on three separate study days. Each day, they were anesthetized and cooled to a core temperature near 34°C, which was maintained for 45–60 min. They were then rewarmed with one of three warming systems until distal esophageal core temperature reached 36°C or anesthesia had lasted 8 h. The warming systems were 1) energy transfer pads (two split torso pads and two universal pads ;Kimberly Clark, Roswell, GA); 2) circulating-water garment (Allon MTRE 3365 for cardiac surgery, Akiva, Israel ;(and 3) lower body forced-air warming (Bair Hugger #525, #750 blower, Eden Prairie, MN). Data are presented as mean sd; P 0.05 was statistically significant . RESULTS: The rate of increase of core temperature from 34°C to 36°C was 1.2°C 0.2°C/h with the Kimberly Clark system, 0.9°C 0.2°C/h with the Allon system, and 0.6°C 0.1°C/h with the Bair Hugger (P 0.002) CONCLUSIONS: The warming rate with the Kimberly Clark system was 25% faster than with the Allon system and twice as fast as with the Bair Hugger. Both circulating-water systems thus warmed hypothermic volunteers in significantly less time than the forced-air system . 2. Effects of a Circulating-water Garment and Forced-air Warming on Body Heat Content and Core Temperature Taguchi A, Ratnaraj J, Kabon B, Sharma N, Lenhardt R, Sessler DI, Kurz A . Department of Anesthesiology, Washington University, St. Louis, Missouri, USA . Anesthesiology. 2004 May;100(5):1058-64 .

Abstract Background: Forced-air warming is sometimes unable to maintain preoperative Normothermia. Therefore, the authors compared heat transfer, regional heat distribution, and core rewarming of forced-air warming with a novel circulating-water garment . METHODS: Nine volunteers were each evaluated on two randomly ordered study days. They were anesthetized and cooled to a core temperature near 34°C. The volunteers were subsequently warmed for 2.5 h with either a circulating-water garment * or a forced-air cover. Overall, heat balance was determined from the difference between coetaneous heat loss (thermal flux transducers) and metabolic heat production (oxygen consumption). Average arm and leg (peripheral) tissue temperatures were determined from 18 intramuscular needle thermocouples, 15 skin thermal flux transducers, and “deep” hand and foot thermometers . RESULTS: Heat production (approximately 60 kcal/h) and loss (approximately 45 kcal/h) were similar with each treatment before warming. The increases in heat transfer across anterior portions of the skin surface were similar with each warming system (approximately 65 kcal/h). Forced-air warming had no effect on posterior heat transfer, whereas circulating-water transferred 21 ± 9 kcal/h through the posterior skin surface after a half hour of warming. Over 2.5 h, circulating water thus increased body heat content 56% more than forced air. Core temperatures thus increased faster than with circulating water than forced air, especially during the

first hour ,with the result that core temperature was 1.1° ± 0.7°C greater after 2.5 h (P < 0.001). Peripheral tissue heat content increased twice as much as core heat content with each device, but the core-to-peripheral tissue temperature gradient remained positive throughout the study . CONCLUSIONS: The circulating-water system transferred more heat than forced air, with the difference resulting largely from posterior heating. Circulating water rewarmed patients 0.4°C/h faster than forced air. A substantial peripheral-to-core tissue temperature gradient with each device indicated that peripheral tissues insulated the core, thus slowing heat transfer . *The Garment used for the research was the Allon, Medical Thermoregulation Equipment [MTRE], Or Akiva, Israel ,as mentioned in the full article. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1409744/?tool=pubmed

3. A New Thermoregulation System for Maintaining Perioperative Normothermia and Attenuating Myocardial Injury in Off-Pump Coronary Artery Bypass Surgery Nesher N, Insler SR, Sheinberg N, Bolotin G, Kramer A, Sharony R, Paz Y, Pevni D, Loberman D, Uretzky G . Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street , Tel-Aviv 64239, Israel . Heart Surg Forum. 2002;5(4):373-80 .

Abstract Background: Most patients undergoing coronary artery bypass surgery demonstrate perioperative mildto-moderate hypothermia (