ESTTA Tracking number:
`
`ESTTA1363502
`
`Filing date:
`
`06/06/2024
`
`IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
`BEFORE THE TRADEMARK TRIAL AND APPEAL BOARD
`
`Ex Parte Appeal -
`Serial No.
`
`97172345
`
`Appellant
`
`Imperative Care, Inc.
`
`Applied for mark
`
`Z
`
`Correspondence
`address
`
`STEVEN J. NATAUPSKY
`KNOBBE, MARTENS, OLSON & BEAR, LLP
`2040 MAIN STREET, 14TH FLOOR
`IRVINE, CA 92614
`UNITED STATES
`Primary email: efiling@knobbe.com
`949-760-0404
`
`Submission
`
`Attachments
`
`Filer's name
`
`Filer's email
`
`Signature
`
`Date
`
`Reply brief
`
`Reply Brief.pdf(266536 bytes )
`Exhibits-.pdf(3926156 bytes )
`
`Zoe Vikstrom
`
`efiling@knobbe.com
`
`/Zoe Vikstrom/
`
`06/06/2024
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
`
`BEFORE THE TRADEMARK TRIAL AND APPEAL BOARD
`
`
`
`
`
`
`
`Applicant :
`
`Serial No.
`
`Filed
`
`Mark
`
`
`:
`
`:
`
`:
`
`Imperative Care, Inc.
`
`
`
`97/172345
`
`December 14, 2021
`
`Z
`
`APPLICANT’S REPLY BRIEF
`
`Commissioner for Trademarks
`P.O. Box 1451
`Alexandria, VA 22313-1451
`
`Dear Sir or Madam:
`
`
`
`Applicant submits that this Reply Brief is timely filed as Applicant submitted a Motion to
`
`Extend Its Reply Brief Deadline (“Motion to Extend”) by 30 days on May 7, 2024. A true and
`
`correct copy of the Motion to Extend as filed, along with the confirmation receipt, is attached as
`
`Exhibit A.
`
`I.
`
`The Examining Attorney Incorrectly States that Applicant Did Not Provide
`
`Evidence that Applicant’s Goods are Limited to Brain Surgery
`
`
`
`The Examining Attorney states in the Appeal Brief that Applicant did not provide evidence
`
`that Applicant’s Goods are limited to use during “brain surgery,” and that “Applicant did not cite
`
`to any evidence in the record to support its assertion that vascular catheters cannot serve
`
`neurovascular, cardiovascular, and/or endovascular applications.” See Examining Attorney’s
`
`Appeal Brief, p. 9. This is simply incorrect. See Applicant’s Appeal Brief, pp. 9-10. Moreover,
`
`the term “neurovascular” must be analyzed in the context of Applicant’s entire identification of
`
`goods. Here, Applicant’s applied-for goods are “Medical catheters for use in the neurovascular
`
`
`
`-1-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`system; Access catheters for the introduction of medical devices in the neurovascular system;
`
`Aspiration catheters for use in the neurovascular system; Medical pumps for use in the
`
`neurovascular system, namely, vacuum pumps and aspiration pumps; Medical filters for use in the
`
`neurovascular system, namely, filters for capturing debris and clots in the bloodstream; All of the
`
`foregoing for use by medical healthcare professionals in the neurovascular field” in Class 10
`
`(emphasis added). See Applicant’s Appeal Brief, p. 1. As shown in Applicant’s recitation of goods,
`
`the term “neurovascular” is used to modify the term “system,” and a “neurovascular system” is a
`
`structural unit of the brain. See Molecular Neurobiology Volume 57 (July 28, 2020) (defining
`
`“neurovascular system” as “a functional and structural unit of the brain”). See Exhibit B.
`
`Moreover, the Collins Dictionary defines “neuro” as “of a nerve, nerves, or the nervous system.”
`
`See Exhibit C. The Board may take judicial notice of dictionary definitions that (1) are available
`
`in a printed format, (2) are the electronic equivalent of a print reference work, or (3) have regular
`
`fixed editions. See TBMP §1208.04; TMEP §710.01(c); see also Fed. R. Evid. 201; 37 C.F.R.
`
`§2.122(a). Thus, Applicant has provided evidence that its goods, neurovascular catheters, are
`
`limited to use with the brain.
`
`By contrast, the goods identified in the Cited Marks Z2, Z-TRAK, and Z-TRAK PLUS do
`
`not have neurovascular system applications and none of the recitations of goods for these
`
`registrations include the wording “neurovascular”. Instead, the goods identified in the Cited Mark
`
`Z2 are limited to coronary guiding catheters. Coronary is defined by the Merriam Webster
`
`Dictionary as “of or relating to the heart.” See Exhibit D. In addition, the catheters identified in
`
`the Cited Marks Z-TRAK and Z-TRAK PLUS are limited to use with “endovascular grafts.”
`
`“Graft” is defined by Taber’s Medical Dictionary as “Tissue transplanted or implanted in a part of
`
`the body to repair a defect” and is defined by Merriam Webster Dictionary as “to implant (living
`
`
`
`-2-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`tissue) surgically.” See Exhibit E. The Board may take judicial notice of these dictionary
`
`definitions. See TBMP §1208.04; TMEP §710.01(c); see also Fed. R. Evid. 201; 37 C.F.R.
`
`§2.122(a).
`
`Surgeons using coronary guiding catheters and catheters for endovascular grafts are using
`
`these sophisticated medical devices to perform different procedures on entirely different parts of
`
`the body than neurosurgeons using neurovascular catheters during procedures involving the
`
`neurovascular system. Given these considerable differences between these medical devices, their
`
`intended uses, and the types of highly skilled and technically trained physicians using such medical
`
`devices, such physicians and medical device purchasing agents are not likely to be confused as to
`
`the source of such medical devices. This is further demonstrated by the co-existence of the Cited
`
`Marks with numerous other Z marks on the register for medical goods. See Applicant’s Brief,
`
`pp.20-24. Moreover, the peaceful co-existence of the cited registration for Z2 (owned by
`
`Medtronic, Inc.) with Z-TRAK and Z-TRAK PLUS (owned by Cook Medical Technologies LLC),
`
`shows that these highly sophisticated and discerning consumers can readily distinguish between
`
`the marks and the respective medical devices, even where these goods can be broadly categorized
`
`as “catheters”.
`
`II.
`
`The Evidence of Record Does Not Demonstrate
`
`that Applicant’s
`
`Neurovascular System Catheters are Related to the Surgical Instruments Identified
`
`in the Cited Mark
`
`Owned by Zimmer, Inc.
`
`The Examining Attorney asserts that Applicant’s neurovascular system catheters are
`
`directly overlapping with the surgical instruments and apparatuses identified in Registration No.
`
`
`
`-3-
`
`

`

`TSP.145T
`97/172345
`Z
`
` Trademark Trial and Appeal Board
`
`2478454 for the Cited Mark
`
`because Applicant’s Goods are used during surgical
`
`procedures in the medical field. See Examining Attorney’s Appeal Brief, p.6. However, the
`
`Principles of Neurological Surgery (Fourth Edition 2018) defines “surgical instruments” as “tools
`
`that allow surgeons to open the soft tissue, remove the bone, dissect and isolate the lesion, and
`
`remove or obliterate the abnormal structures of the treatment.” See Exhibit F. By contrast,
`
`neurovascular catheters are defined by the Merriam Webster Dictionary as “a tubular medical
`
`device[s] for insertion into canals, vessels, passageways, or body cavities usually to permit
`
`injection or withdrawal of fluids or to keep a passage open.” (emphasis added). See Exhibit G.
`
`The Board may take judicial notice of these dictionary definitions. See TBMP §1208.04; TMEP
`
`§710.01(c); see also Fed. R. Evid. 201; 37 C.F.R. §2.122(a).
`
`Catheters cannot and do not function to lacerate and remove tissue, bones, lesions, or other
`
`abnormal structures within the human body, and therefore, do not fall within the definition of
`
`“surgical instruments.” Indeed, the file history of the
`
`registration does not identify
`
`catheters in its line of surgical instruments. See Applicant’s Response to Office Action, Exhibit
`
`B.
`
`Accordingly, the Examining Attorney does not provide proper weight to the very
`
`significant differences between Applicant’s neurovascular system catheters used during brain
`
`procedures by neurosurgeons and Registrant’s general surgical instruments used by general
`
`surgeons to cut tissue or bone. The evidence of record establishes that Applicant’s Goods and
`
`those in the cited registrations are unrelated such that the relevant consumers, who are highly
`
`-4-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`sophisticated and highly trained physicians and/or medical purchasing agents, are unlikely to be
`
`confused.
`
`III. The Examining Attorney’s Internet Evidence Fails to Establish that the Goods
`
`in the Cited Marks and Applicant’s Goods are Related
`
`The Examining Attorney asserts that the evidence of record shows “a wide swath of these
`
`[surgical] instruments are provided by the same brand” and that Applicant’s Goods are
`
`“encompassed by the broad identifications in the cited registrations such as ‘a full line of surgical
`
`instruments and apparatuses.’” See Examining Attorney’s Appeal Brief, p.8. This contention is
`
`flawed for two reasons. First, as established above, Applicant’s Goods are not “surgical
`
`instruments” and do not overlap with the other types of catheters offered under the cited
`
`registrations. Second, the Examining Attorney’s contention is unsupported by case law. Goods
`
`are not deemed related for purposes of a likelihood of confusion analysis simply because they both
`
`appear on a company’s website. Instead, to support a conclusion that the respective marks are
`
`confusingly similar, the goods specified in the application must be related to the goods listed in
`
`the cited marks such that consumers would be confused about the source of origin. See T.M.E.P.
`
`§ 1207.01(a)(i). If the goods are not related or marketed in such a way that they would not be
`
`encountered by the same people in situations that would create the incorrect assumption that they
`
`originate from the same source, then there is no likelihood of confusion, even if the marks are
`
`identical. See id.
`
`Here, the Examining Attorney submitted webpage printouts of the brand MicroVention
`
`(see Final Office Action, p. 25-26), which includes a wide variety of products, including a balloon
`
`catheter and an aspiration pump:
`
`
`
`-5-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`.
`
`The fact that these two goods are offered by the same large medical device company does
`
`not show that they are similar or related in any way. These devices serve completely different
`
`purposes and are fundamentally different from one another, particularly amongst the highly trained
`
`medical professionals who use these medical products. Similarly, Applicant’s neurovascular
`
`catheters are not related to general surgical instruments simply because they each appear on a
`
`single company’s website. Therefore, the Examining Attorney’s examples of “large swaths” of
`
`products being offered under the same marks discounts a fundamental step in the likelihood of
`
`confusion analysis—comparing the similarity of the goods and whether they are marketed in such
`
`a way that they would not be encountered by the same consumers in situations that would create
`
`the false assumption that the products originate from the same source. Because surgical
`
`instruments for cutting tissue or bone are fundamendtally different from neurovascular catheters
`
`used during brain surgery, and highly trained and specialized neurosurgeons are fundamentally
`
`different from other types of surgeons, these goods are not related or marketed to the same
`
`consumers. Indeed, neurosurgeons are one of the most highly specialized medical practitioners in
`
`any medical system, and as such, they do not also perform general surgery. Similarly,
`
`cardiovascular surgeons are also highly trained physicians that cannot and do not perform
`
`
`
`-6-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`neurosurgery. As such, these highly trained physicians would not be using the same types of
`
`instruments to perform these fundamentally different surgical procedures on completely different
`
`parts of the body.
`
`IV.
`
`It Is Unreasonable to Assume, and There is No Evidence Supporting the
`
`Proposition, that Surgeons in the Same School or Hospital Would Discuss Applicant’s
`
`Mark and the Cited Marks and Be Confused as to the Source of Applicant’s Goods
`
`The Examining Attorney states that “in the absence of evidence to the contrary, it is
`
`reasonable to believe that surgeons at the same school or hospital do have a working relationship
`
`and may discuss their work and their tools with one another, and to assume that one surgeon’s “Z”
`
`brand of tools is the same “Z” brand used by their colleagues.” See Examining Attorney’s Appeal
`
`Brief, pp. 10-11. Applicant respectfully disagrees. First, Applicant has provided evidence to the
`
`contrary in its Appeal Brief (see Applicant’s Appeal Brief, pp. 6-10), including that neurosurgeons
`
`using neurovascular system catheters in brain surgery undergo different training and specialties as
`
`compared to surgeons using general surgery instruments, endovascular catheters for endovascular
`
`grafts, and coronary guiding catheters. Second, it is the Examining Attorney’s burden to prove a
`
`likelihood of confusion, and there is simply no evidence that these conversations occur. In
`
`addition, a hypothetical possibility of confusion does not create a likelihood of confusion. The
`
`Federal Circuit has specifically held: “[w]e are not concerned with mere theoretical possibilities
`
`of confusion, deception, or mistake or with de minimus situations but with the practicalities of the
`
`commercial world, with which the trademark laws deal.” Elec. Design & Sales, Inc. v. Elec. Data
`
`Sys. Corp., 954 F.2d 713, 719, 21 U.S.P.Q.2d (BNA) 1388, 1393 (Fed. Cir. 1992) (citing Witco
`
`Chem., 418 F.2d at 1405). Likelihood of confusion “is synonymous with ‘probable’ confusion—
`
`it is not sufficient if confusion is merely ‘possible.’” 4 McCarthy on Trademarks and Unfair
`
`
`
`-7-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`Competition § 23:3 (5th ed.) (quoting Am. Steel Foundries v. Robertson, 269 U.S. 372, 383 (1926));
`
`see also Mtd Prods. Inc. v. Universal Tire Corp., 193 U.S.P.Q. (BNA) ¶ 56 (T.T.A.B. Oct. 18,
`
`1976) (“A possibility of such confusion always exists, but what may be possible may not at all be
`
`probable and, if not probable, it is not likely.”).
`
`Moreover, the mere remote possibility that two surgeons working at the same school or
`
`hospital could discuss their respective medical devices with each other does not demonstrate that
`
`such highly sophisticated consumers would be likely to be confused as to the source of these goods.
`
`Indeed, the standard is not a possibility of confusion, but a likelihood or probability of confusion.
`
`See id. Indeed, the marketplace has already demonstrated that the
`
`registrations and the
`
`Z2, Z-TRAK, and Z-TRAK PLUS registrations can peacefully co-existence. Given the
`
`sophistication and high degree of purchasing care of the relevant consumers, the very different
`
`nature of the goods and the procedures under which they are used, and the differences in the
`
`appearance and/or spelling of the marks, confusion is simply not probable.
`
`As described above, the purpose and the nature of Applicant’s Goods (neurovascular
`
`system catheters used in neurosurgery) and the goods in connection with the Cited Marks (general
`
`surgery instruments, endovascular catheters, and coronary guiding catheters) are completely
`
`distinct and used by exceedingly sophisticated surgeons who are trained in completely different
`
`types of surgical procedures on distinct parts of the body. Therefore, these specialized surgeons
`
`and highly sophisticated medical device purchasing agents are acutely aware of the differences
`
`between these respective goods, and it simply is implausible that the relevant consumers are likely
`
`to be confused as to the source of these medical products after having a brief conversation with a
`
`colleague.
`
`
`
`-8-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`V.
`
`The Examining Attorney Mischaracterizes the Scope of Protection of
`
`Applicant’s Mark
`
`The Examining Attorney mischaracterizes the scope of protection of Applicant’s Mark
`
`when stating Applicant’s Mark is legally identical to the registrations for the mark
`
`. See
`
`Examining Attorney’s Appeal Brief, p. 4. Indeed, the rights associated with a mark presented in
`
`standard characters pertain only to “font style, size, or color” and do not apply to any additional
`
`shapes or design elements. See In re Viterra Inc., 671 F.3d 1358, 1364-65, 101 USPQ2d 1905,
`
`1910 (Fed. Cir. 2012); Citigroup Inc. v. Cap. City Bank Grp., Inc., 637 F.3d 1344, 1353, 98
`
`USPQ2d 1253, 1259 (Fed. Cir. 2011); In re Aquitaine Wine USA, LLC, 126 USPQ2d at 1187 ("We
`
`hold that when we are comparing a standard character mark to a word + design mark for Section
`
`2(d) purposes, we will consider variations of the depictions of the standard character mark only
`
`with regard to ‘font style, size, or color’ of the ‘words, letters, numbers, or any combination
`
`thereof.’"). Given that the
`
`registrations include a circle design, whereas Applicant’s
`
`Mark does not, the marks are not legally identical as Applicant’s plain block letter filing does not
`
`provide any claim to additional shapes or designs. In addition, the
`
`registrations are not
`
`entitled to a broad scope of protection in view of the peaceful co-existence of these marks with
`
`other standalone “Z” marks in Class 10 for medical goods. See Applicant’s Appeal Brief, pp. 20-
`
`24. Thus, consumers will readily perceive even very subtle differences between the marks and/or
`
`the underlying goods, particularly as Applicant’s neurovascular catheters serve very different
`
`purposes from registrant’s general surgical instruments, as discussed above. In view of the
`
`significant differences in the respective goods, the high degree of purchasing care exercised by the
`
`
`
`-9-
`
`

`

`TSP.145T
`97/172345
`Z
`
`
`
` Trademark Trial and Appeal Board
`
`relevant consumers, the narrow scope of protection for these registrations, and the difference
`
`between the appearances of the respective marks, confusion is not likely.
`
`VI. Conclusion
`
`Applicant respectfully requests that the likelihood of confusion refusal be reversed and that
`
`Applicant’s Mark be approved for publication.
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Respectfully submitted,
`
`KNOBBE, MARTENS, OLSON, & BEAR LLP
`
`By:
`
`/Zoe Vikstrom/
`
`
`
`
`
`
`
`
`
`Steven J. Nataupsky
`Jonathan Menkes
`Zoe Vikstrom
`2040 Main Street, 14th Floor
`Irvine, CA 92614
`(949) 760-0404
`efiling@knobbe.com
`
`-10-
`
`

`

`
`
`
`
`
`
`
`
`
`
`Exhibit A
`Exhibit A
`
`

`

`    ÿ

ÿ
`#$#$%#%&
` ÿ! "
`'(ÿ)ÿ*('+ÿ ÿ, (ÿ (+ÿ- +. -/ÿ0'1
`20-ÿ)ÿ- +. -/ÿ-' 3ÿ (+ÿ ,, 3ÿ20 -+
`4ÿ678
` 79ÿ:ÿ 8 79
`>?@?ABCD
`;<=
` 997E
`'FG"

H"ÿ1

"Iÿ'
`9 JÿK<8
`N
`L78M
`Q(ÿRÿ(  *,/S
`/(022Iÿ. -(Iÿ030(ÿTÿ2 -Iÿ33,
`AUCUÿ. '(ÿ-Iÿ@C)ÿ300-
`O<88 P<EJ E
`'-Q'(Iÿ1 ÿ>AV@C
`7JJ8 PP
`*('+ÿ 
`,

F

Wÿ"F  ÿ"X YZZ"F
`>C>[?VU[UCUC
`\]L PP <E
`ÿX "ÿ ÿ

"G WÿZ

"X
`7^L EPD[?[ACÿ ,,3'1 (ÿ.0'0(ÿ0-ÿ_('0(ÿ0ÿ'.ÿ0ÿ'3
`-,0(ÿ2-'ÿG!X`?AC>>ÿZW"aÿb
`c 9 8dPÿE7L N"ÿQa

F
`c 9 8dPÿ L7 9e"Ha

FYZZ"FIÿ"X YZZ"F
` fE7\8
`gN"ÿQa

Fg
`h7
`UDgU?gAUAC
` \8Eÿ<ÿÿ^<L ÿ7f ÿi^Pj$$ P7=\P<=f<k$lÿÿÿ78ÿ7E<^ 8
`ÿK 9 Efÿi^Pj$$ P7=\P<=f<k$K 9 Ef:m =nPl
`opqqrstuuvvvwxsrqywzy{u|
`}~€‚ÿ}„ÿ…†‡ˆ
`
`

`

`
`
`
`
`
`
`IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
`
`BEFORE THE TRADEMARK TRIAL AND APPEAL BOARD
`
`Applicant :
`
`Serial No.
`
`Filed
`
`Mark
`
`
`:
`
`:
`
`:
`
`
`
`Imperative Care, Inc.
`
`
`
`97/172345
`
`December 14, 2021
`
`Z
`
`APPLICANT’S MOTION FOR EXTENSION OF TIME TO FILE RESPONSE BRIEF
`
`Pursuant to T.B.M.P. §1203.02(d) and 1203.02(c), Applicant respectfully requests a 30-
`
`
`
`day extension of time within which to file its Reply Brief. Applicant submits that good cause
`
`exists for this extension request.
`
`Applicant respectfully requests that the Board grant Applicant a short extension request as
`
`Applicant needs additional time to confer with its counsel. As the short extension request will not
`
`cause any prejudice to the USPTO, Applicant respectfully requests that the extension request be
`
`granted.
`
`
`
`
`
`
`
`
`
`
`
` Respectfully submitted,
`
`
`
`
`
`
`
`Dated: May 7, 2024
`
`
`
`
`
`
`
`KNOBBE, MARTENS, OLSON & BEAR, LLP
`
`
`/Zoe Vikstrom/
`
`By:
`
`Steven J. Nataupsky
`
`Zoe Vikstrom
`
`Attorneys for Applicant
`2040 Main Street, 14th Floor
`
`
`Irvine, CA 92614
`
`(949) 760-0404
`
`
`
`
`
`

`

`
`
`
`
`
`
`
`
`
`
`Exhibit B
`Exhibit B
`
`

`

`Advertisement
`
`nature
`>
`~<& ww
`Life and Biological Sciences
`communications
`a
`a
`Browse our TOP 25 most read articles published in 2023
`Se
`(cid:8212)(cid:8212)
`
`
`
`
`
`
`
`(cid:8212)
`ae
`
`:
`
`Learn more
`
`SPRINGER LINK
`
`Findajournal
`
`Publishwithus
`
`Trackyourresearch
`
`Q Search
`
`Home > Molecular Neurobiology > Article
`
`The Role of Neurovascular System in
`Neurodegenerative Diseases
`
`Published: 28 July 2020
`
`Volume 57, pages 4373-4393, (2020)
`
`Cite this article
`
`Login
`
`D Cart
`
`Molecular Neurobiology
`
`Aims and scope >
`
`Submit manuscript >
`
`Ajmal Ahmad, Vanisha Patel, Jianfeng Xiao & Mohammad Moshahid Khan 4 Access this article
`
`S) 2947 Accesses fy 49 Citations &) 13 Altmetric
`
`S11 Mention
`
`Exploreallmetrics >
`
`Abstract
`
`Loginviaaninstitution >
`
`
`|
`(
`Buy article PDF USD 39.95
`)
`
`
`The neurovascular system (NVS), which consisted of neurons, glia, and vascular cells, isa
`
`Price excludes VAT (USA)
`
`functional and structural unit of the brain. The NVS regulates blood-brain barrier (BBB)
`
`Tax calculation will be finalised during checkout.
`
`permeability and cerebral blood flow (CBF), thereby maintaining the brain(cid:8217)s
`
`Instant access to the full article PDF.
`
`microenvironment for normal functioning, neuronal survival, and information processing.
`;
`-o,
`oo
`,
`Recent studies have highlighted the role of vascular dysfunction in several
`
`So
`Rent this article via DeepDyve (2
`
`neurodegenerative diseases. This is not unexpected since both nervous and vascular
`
`systems are functionally interdependent and show close anatomical apposition, as well as
`
`similar molecular pathways. However, despite extensive research, the precise mechanism
`
`by which neurovascular dysfunction contributes to neurodegeneration remains
`
`incomplete. Therefore, understanding the mechanisms of neurovascular dysfunction in
`
`disease conditions may allow us to develop potent and effective therapies for prevention
`
`and treatment of neurodegenerative diseases. This review article summarizes the current
`.
`.
`.
`.
`.
`.
`research in the context of neurovascular signaling associated with neurodegenerative
`
`.
`i,
`Institutional subscriptions >
`
`Figures
`
`References
`
`Sections
`
`Abstract
`
`References
`
`OO
`Fundin
`ess
`
`diseases, such as Alzheimer(cid:8217)s disease (AD), Parkinson(cid:8217)s disease (PD), amyotrophic lateral
`
`Author information
`
`sclerosis (ALS), and Huntington(cid:8217)s disease (HD). We also discuss the potential implication of
`
`Ethics declarations
`
`neurovascular factor as a novel therapeutic target and prognostic marker in patients with
`
`neurodegenerative conditions.
`
`.
`;
`wo
`Additional information
`_
`Rights and permissions
`
`About this article
`
`
`
`Endothelial
`
`cell
`
`Tight junction
`(Cjaudins, Occludins.
`
`~~
`
`«
`
`a alernAnnentain
`
`Basement
`
`membrane
`
`Advertisement
`
`Document title: The Role of Neurovascular System in Neurodegenerative Diseases | Molecular Neurobiology
`Capture URL: https://link.springer.com/article/10.1007/s12035-020-02023-z
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:12:57 GMT
`
`
`
`Page 1 of 45
`
`

`

`LICULUVdSCUldl LACLUL dd d LIUVE!L LIICLGVCULIC Ld LPOCL GLIIU PLUBPLIUSLIC INId KEL LI PdaLlleLils WILL
`
`neurodegenerative conditions.
`
`Endothelial
`
`Tight junction
`Basement
`(Claudins, Occludins,
`membrane
`p-glycoprotein
`ZO- 1)
`cell
`
`
`
`
`Endfoot
`Process
`
`Astrocyte
`
`Microglia
`
`
`
`Normal CBF with appropriate
`neurovascular coupling
`* No cognitive deficits
`* No dementia
`* Normal motor function
`¢ Low risk of AD/PD
`* Decreased neurotoxins
`* No abnormal protein aggregation
`* Low risk of ALS/HD
`
`CBF Shortfalls with
`neurovascular uncoupling
`* Neurovascular dysfunction
`* Cognitive deficit and Dementia
`* Motor dysfunction
`¢ High risk of AD/PD
`¢ Increased neurotoxins
`¢ Abnormal protein aggregation
`¢ High risk of ALS/HD
`
`
`
`
`
`
`
`@ This is a preview of subscription content, log in via an institution [4 to check access.
`
`Similar content being viewed by others
`So
`
`Srrocth masse cutls
`
`WNeceee
`
`Serooth reacts ons
`
`&
`
`P| oe (cid:8212)_
`§ | Emer
`
`m=
`fy
`Lew
`
`& | Serenay
`BR] Gu
`a
`
`-
`
`(cid:8212)
`
`Arter
`
`he
`
`/ Wevten
`The
`
`/
`
`_(cid:8212)(cid:8212)(cid:8212) eae
`Ses
`
`-
`
`_
`(cid:8212)
`Captary
`
`==.
`
`(cid:8212)
`
`Verse
`
`
`
`bam»
`
`Actn®
`
`=
`
`<=
`
`The role of brainvasculature
`
`in neurodegenerative
`
`disorders
`
`| Amyloid Beta(cid:8212)Mediated
`Neurovascular Toxicity in
`Alzheimer(cid:8217)s Disease
`
`
`
`Vascular Dysfunction and
`Neurodegenerative Disease
`
`
`
`
`
`Article
`
`24September 2018
`
`Chapter
`
`©2024
`
`Chapter
`
`©2020
`
`References
`
`1. Begley DJ, Brightman MW (2003) Structural and functional aspects of the blood-brain
`
`Document title: The Role of Neurovascular System in Neurodegenerative Diseases | Molecular Neurobiology
`Capture URL: https://link.springer.com/article/10.1007/s12035-020-02023-z
`
`
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:12:57 GMT
`
`
`
`
`
`
`Access this article
`
`
`
`C
`
`Buy article PDF USD 39.95
`
`+)
`
`
`
`
`
`Price excludes VAT (USA)
`
`Tax calculation will be finalised during checkout.
`
`Instant access to the full article PDF.
`
`Rent this article via DeepDyve [4
`
`Institutional subscriptions >
`
`
`
`Sections
`
`Figures
`
`References
`
`Abstract
`
`References
`
`Funding
`
`Author information
`
`Ethics declarations
`
`Additional information
`
`Rights and permissions
`
`About this article
`
`Advertisement
`
`Page 2 of 45
`
`

`

`
`
`
`
`
`
`
`
`
`
`Exhibit C
`Exhibit C
`
`

`

`LANGUAGE
`
`TRANSLATOR
`
`GAMES
`
`SCHOOLS
`
`BLOG
`
`More v
`
`= Collins ve.
`
`o
`4 &
`
`x Q
`
`| Morey
`Portuguese
`|
`Spanish
`|
`Italian
`| German |
`French
`
`
`Your team
`deserves
`better
`
`monday.om
`
`Team projects
`
`a fe)
`
`ie
`
`eas
`
`deserves
`better
`
`Team projects
`
`
`
`
`
`Monday.om
`
`Definition of 'neuro-'
`
`You may also like
`vs
`
`English Quiz
`Confusables
`
`neuro-
`
`in American English
`
`((cid:8216)nurow *); (cid:8216)njurow 4); 'nura 4); 'njora @))
`
`of a nerve, nerves, or the nervous system
`
`neuropathy
`
`Pronunciation
`
`>
`
`
`
`C &w) Wordle Helper
`
`)
`
`
`
`oO
`=(cid:8212)o
`
`
`Language Lover's
`Blog
`
`Quick Word Challenge
`
`Question: 1
`(cid:8212) Score:0 /5
`pedal or peddle?
`
`Which version is correct?
`=F
`He attempted to
`
`peddle his paintings
`around small London
`
`e
`
`galleries.
`\
`(cid:8212)
`TTT
`He attempted to
`pedal his paintings
`
`around small London
`galleries.
`
`
`
`J
`
`
`
`Webster's New World College Dictionary, 4th Edition. Copyright © 2010 by Houghton Mifflin
`
`Harcourt. All rights reserved.
`
`Word origin
`
`< Gr neuron, nerve
`
`neuro-
`
`in American English
`
`COMBINING FORM
`
`neurology
`
`Also (esp. before a vowel): neur-
`
`Most material © 2005, 1997, 1991 by Penguin Random House LLC. Modified entries © 2019 by
`
`Penguin Random House LLC and HarperCollins Publishers Ltd
`
`©
`
`A
`
`\EA OC
`
`©
`
`
`
`Document title: NEURO- definition in American English | Collins English Dictionary
`Capture URL: https://www.collinsdictionary.com/us/dictionary/english/neuro
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:14:05 GMT
`
`Page 1 of 3
`
`

`

`LANGUAGE
`
`TRANSLATOR
`
`GAMES
`
`SCHOOLS
`
`BLOG
`
`More v
`
`= Collins ve.
`
`o
`4 &
`
`x Q
`
`French
`
`| German |
`
`Italian
`
`|
`
`Spanish
`
`|
`
`Portuguese
`
`| Morey
`
`Y
`
`Word origin
`
`Definitions
`
`Pronunciation
`
`>
`
`team
`-
`
`eserves
`better
`
`
`
`monday.on
`
`[< Gk neuro-, comb. form of netiron, akin to L nervus]
`
`neuro-
`in British English
`
`or before a vowel heur-
`
`COMBINING FORM
`
`indicating a nerve or the nervous system
`neuroblast
`
`neurology
`
`Collins English Dictionary. Copyright © HarperCollins Publishers
`
`Word origin
`
`from Greek neuron nerve; related to Latin nervus
`
`Browse alphabetically
`
`neuro-
`
`Related terms of
`
`neuro-
`
`neuristor
`neurite
`
`neuritis
`neuro-
`
`neuro-linguistic programming
`
`New collocations
`added to dictionary
`
`Collocations are words that are
`often used together and are
`brilliant at providing natural
`sounding language for your
`speech and writing.
`
`FEBRUARY 13, 2020
`READ MORE
`
`@o0o000000000
`
`e New from Collins e
`
`Quick Word Challenge
`
`Question: 1
`
`- Score: 0 /5
`
`BIRDS
`
`What is this an image of?
`
`a
`
`Jun 04, 2024
`
`Document title: NEURO- definition in American English | Collins English Dictionary
`Capture URL: https://www.collinsdictionary.com/us/dictionary/english/neuro
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:14:05 GMT
`Page 2 of 3
`
`
`
`
`

`

`LANGUAGE
`
`TRANSLATOR
`
`GAMES
`
`SCHOOLS
`
`BLOG
`
`More v
`
`o
`4 &
`
`= Collins ve.
`
`| Morey
`Portuguese
`|
`Spanish
`|
`Italian
`| German |
`French
`
`Definitions
`Pronunciation
`>
`
`x Q
`
`greenwash
`
`Greenwash is an attempt by
`
`businesses to seem
`
`environmentally friendly without
`
`actually doing anything serious
`
`Your
`team
`deserves
`better
`
`Team projects
`
`into a business.
`
`to protect the environment.
`
`SEE PREVIOUS WORDS
`
`SEE FULL DEFINITION
`
`
`
`Grow your
`side hustle
`
`Collins
`
`Elevate your vocabulary
`Sign up to our newsletter to receive our latest news,
`i
`exclusive content and offers.
`
`Sign up now
`
`Collins Dictionaries
`
`About Collins
`
`Useful Links
`
`Browse all official
`
`About Us
`
`Collins dictionaries
`
`Contact Us
`
`FAQs
`
`Advertise with us
`
`B2B Partnerships
`
`Collins COBUILD
`
`Cookies Settings
`
`Collins ELT
`
`Terms & Conditions
`
`Dictionary API
`
`Privacy Policy
`
`HarperCollins Publishers
`
`California Privacy Rights
`
`Word Banks
`
`Do Not Sell My Personal
`Information
`
`Security
`
`© Collins 2024
`
`X
`
`f OH
`
`Document title: NEURO- definition in American English | Collins English Dictionary
`Capture URL: https://www.collinsdictionary.com/us/dictionary/english/neuro
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:14:05 GMT
`
`Page 3 of 3
`
`

`

`
`
`
`
`
`
`
`
`
`
`Exhibit D
`Exhibit D
`
`

`

`Soe Birla
`
`coronary
`
`
`
`Games & Quizzes
`
`WordoftheDay
`
`Grammar
`
`Wordplay
`
`WordFinder
`
`More
`
`
`
`Merriam-
`Webster
`
`
`
`
`
`Dae ay
`
`Definition
`
`COPrONALY 102 adjective
`
`cor-o-nary ( (cid:8216)kOr-a-,ner-64) ) (cid:8216)kar-,
`
`-,ne-ré
`
`noun
`
`
`
`
`
`Example Sentences
`
`Word History
`
`Phrases Containing
`
`1
`
`2
`
`:of, relating to, resembling, or being a crown or coronal
`
` :of, relating to, or being the coronary arteries or veins of the heart
`
`broadly : of or relating to the heart
`
`COronaly
`
`2.2 noun
`
`Noite] (cid:8364) 10 Waa
`
`adatom re] 6
`
`- Show More v
`
`plural coronaries
`
`1
`
`a: CORONARY ARTERY
`
`b
`
`: CORONARY VEIN
`
`Save Word
`
`2
`
`: CORONARY THROMBOSIS
`
`broadly : HEART ATTACK
`
`
`
`
`
` Quordle
`W
`r>o
`
`O
`
`L
`
`O
`
`ne
`
`(e!
`
`D
`
`L
`AW)
`¥)|S
`a |hlC ee
`Can you solve 4 words at
`once?
`
`
`
`Play
`
`
`
`SHEBA® What Cats Want(cid:8482)
`
`a
`
`1o anyt
`
`for that
`
`zie,
`
`they
`
`Sheba
`
`Shop Now
`
`
`
`
`
`
`
`
`
`> Examples of coronary in a Sentence
`
`Noun
`
`| almost had a coronary when | heard the news.
`
`Recent Examples on the Web
`
`Adjective
`
`But for people with a higher likelihood of heart problems, the risk of
`/
`-
`/
`atrial fibrillation is counterbalanced by the potential anti-inflammatory,
`-
`.
`_
`anti-clotting, and triglyceride-lowering benefits of omega-3 fats, which
`
`Merriam:
`
`WORD OF THE DAY
`
`meliorism@®
`
`See Definitions and Examples »
`
`
`Get Word of the Day daily email!
`
`Your email address
`
`
`
`Document title: Coronary Definition &amp; Meaning - Merriam-Webster
`Capture URL: https://www.merriam-webster.com/dictionary/coronary#:~:text=of%202%20adjective-,cor%C2%B7%E2%80%8Bo%C2%B7%E2%80%8Bnary%20%CB…
`
`
`Capture timestamp (UTC): Tue, 04 Jun 2024 17:15:22 GMT
`Page 1 of 7
`
`
`
`

`

`Merriam) oe Burra)
`
`coronary
`
`
`
`Games & Quizzes
`
`WordoftheDay
`
`Grammar
`
`Wordplay(cid:8217)
`
`Word Finder
`
`
`
`Webster
`
`e
`
`oe
`
`Dictionary
`
`
`
`But for peo