September 2006 *Ansar Medical Technologies, Inc*/vs Medical Technologies, Inc.

September 2006 *Ansar Medical Technologies, Inc*/vs Autonomic Nervous System And Respiration The Future of Medicine!

Common Questions What is the ANX 3.0 test? The ANX 3.0 tests are two independent clinical tests (or studies) designed to determine the ability of both branches of the autonomic nervous system (ANS) to respond to and relax from a challenge. The two branches that make up the ANS are the sympathetic and parasympathetic (SNS and PSNS, respectively). The challenges are: 1) deep breathing to challenge the PSNS, 2) valsalva to challenge the SNS, and 3) standing from a seated position to challenge both systems. How and why is the ANX 3.0 different from similar technologies/procedures? ANSAR is the only company with the MIT patent rights to incorporate respiratory activity analysis in with heart rate variability spectral analysis methodology. How applicable is the procedure to specific disease states? Clinical literature substantiating the efficacy of ANS testing for individuals with many chronic diseases is available, including leadership articles recommending ANS function testing. Are there any special considerations regarding the use of the device? High risk patients and patients whose pacemakers may pace during the study should be carefully considered.

ANSAR…is the ANSwer! Autonomic Nervous System Monitoring using Respiration Real-Time Non-Invasive Digital Reimbursable Respiration ANSAR Better Outcomes Better Medicine Secure Investment

ANSAR Promotes Balance Maintain Balance = Maintain Health How? With ANSAR’s autonomic nervous system monitor the ANX 3.0! Why? ANS monitoring is recommended! ANS monitoring improves outcomes! The ANX 3.0 makes it easy! The ANX 3.0 is automated! Balance What? Parasympathetics & Sympathetics

What Does ANSAR Offer? The Ability to Balance PSNS SNS Like everything in life, if you are in balance you are healthier! ANS monitoring allows you to improve your treatment protocol. Balance between the two branches of the Autonomic Nervous System

Significant Clinical Applications! Beta-Blocker Responsiveness CAN DAN Cardiomyopathies Cardiac Arrhythmias Congestive Heart Failure Syncope Hypertension Sleep Apnea Asthma COPD Peripheral Vascular Diseases Circulation Problems Pain Management Neurological Conditions Chronic Regional Pain Syndrome Anxiety/Stress Parkinson’s Disease Psychological Conditions

Chronic Disease → Autonomic Imbalance Autonomic Imbalance = Autonomic Dysfunction Autonomic Dysfunction → Peripheral Autonomic Neuropathy (PAN) PAN → (DAN* →) CAN → Death *Diabetic Autonomic Neuropathy (DAN), only if the patient is a diabetic Cardiovascular Autonomic Neuropathy (CAN): no more heart control SUMMARY: Chronic Disease → Autonomic Dysfunction → Autonomic Neuropathy SO WHAT?: Autonomic Dysfunction is Asymptomatic Autonomic Neuropathy does not happen “over night” Autonomic Neuropathy is too late SO CHRONIC DISEASE IS THE INDICATION AND JUSTIFICATION FOR TESTING

Who is Recommending ANS Testing? ANS Monitoring Recommended By: American Heart Association American Academy of Neurology American Diabetes Association American Academy of Family Physicians Juvenile Diabetes Association National Heart, Lung, and Blood Institute National Diabetes, Digestive, and Kidney Disease National Institute Of Health

September 2006 *Ansar Medical Technologies, Inc*/vs Doctor What Have You Been Using? Are you using smart technology? Are You Seeing the Whole Picture: both ANS Branches simultaneously as two specific measures? Is it time to upgrade?

Want to know the difference between these tests and ours? Cardiac Output Tilt Studies EKG Click to see Q-Sart Event Monitoring Sitting Standing Blood Pressure Thermal Studies More comfortable for your patient Simultaneously measures both branches of the ANS Uses Respiration Standard of Care Augment these tests and revenues with more specific ANS information Nerve Conduction Velocity Cardiac Output Tilt Studies Vascular Imaging EKG Holter Monitor Q-SART Event Monitoring Thermal Studies Sitting Standing Blood Pressure Stress Test

Nerve Conduction Velocity ANX 3.0 Does NOT measure Sympathetic or Parasympathetic nerves Nerve Conduction Velocity measures the larger sensory and motor (A&B) fibers Assumption: small fiber neuropathy progresses at the same rate as large fiber neuropathy Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes Neuropathy cannot be healed and leaves few therapeutic options More likely to require life-long therapy Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Measures the effects of the small C fibers or autonomic and pain fibers. Eliminates guessing, detects autonomic dysfunction before neuropathy. Chronic disease justifies autonomic function testing before end-organ changes. Detecting dysfunction before neuropathy enables more therapeutic options. Shorter-term therapy possible Back

Tilt Studies ANX 3.0 Measure both Sympathetic and Parasympathetic nerves, but uses drugs Tilt Studies indicate cardiac function, including ANS input. Tilt can detect and differentiate orthostasis and syncope and differentiate their sub- conditions. Studies are uncomfortable, time consuming, and often unrevealing of autonomic symptoms. Studies are difficult to do in the office and require significant training to interpret. Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes More likely to require life-long therapy Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously Ansar also indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction and neural from vascular dysfunction. Ansar can also detect and differentiate orthostatsis and syncope and differentiate their sub-conditions. Monitoring is comfortable, shorter, and typically revealing of autonomic symptoms. Studies are designed for the office and interpretation is automated. Chronic disease justifies autonomic function testing before end-organ changes. Shorter-term therapy possible. Back

Stress Tests ANX 3.0  Does NOT measure Sympathetic nerves independently only Parasympathetic nerves  Stress Tests indicates cardiac function, including ANS input  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar also indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia  Studies are uncomfortable and often unrevealing of autonomic symptoms  Monitoring is comfortable and typically revealing of autonomic symptoms  Symptoms must be present to test, forcing you to wait for end-organ changes  Chronic disease justifies autonomic function testing, detect dysfunction before neuropathy, more options for early intervention, before CAN  Low normal ejection fractions are difficult to justify implanted devices  Low normal ejection fractions with autonomic indications of depleted parasympathetic protection for the heart can differentiate this patient sub-population  Neuropathy (“dead nerves”) cannot be healed. Diabetic or Cardiovascular Autonomic Neuropathy (DAN or CAN) leaves few therapeutic options.  “Bruised nerves” are easier to heal. Autonomic Dysfunction precedes DAN or CAN, a time when more options are available. Back

 Does NOT measure Sympathetic nerves independently only Parasympathetic nerves  EKG indicates cardiac function, including ANS input  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia  Test is 60 seconds long at rest only  Test is 15 minutes, and includes responses to challenges  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes  Likely to require life-long therapy  Shorter-term therapy possible EKG ANX 3.0 Back

 Does NOT measure Sympathetic nerves independently only Parasympathetic nerves  Holter Monitoring indicates cardiac function over time, including ANS input  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia.  Qualitative measures of ANS  Quantitative measures of ANS  Monitoring is uncontrolled, home-based, and can be cumbersome  Monitoring is controlled, office-based, and can be performed by most in only 15 minutes.  Data not immediately available  Data immediately available  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes  Likely to require life-long therapy  Shorter-term therapy possible Holter Monitor ANX 3.0 Back

 Does NOT measure Sympathetic nerves independently only Parasympathetic nerves  Event Monitoring indicates cardiac function over time, including ANS input  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates autonomic input to the heart to help differentiate neural from cardiac dysfunction, including in arrhythmia  Monitoring is uncontrolled, home-based, and can be cumbersome  Monitoring is controlled, office-based, and can be performed by most in only 15 minutes.  Data not immediately available  Data immediately available  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes  More likely to require life-long therapy  Shorter-term therapy possible Event Monitor ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Ambulatory Blood Pressure indicates BP responses over time, including ANS input  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates autonomic input to BP control to help differentiate neural from cardiovascular dysfunction  Ansar study challenges model the different activities patients experience over time  Studies are home based and data is not immediately available  Studies are designed for the office and data is immediately available  BP affected by many factors, including baroreceptor reflex which responds to autonomic input  Autonomic function in part controls BP. By the time BP changes autonomic dysfunction may have been present for a long time  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes Hypertension is associated with many chronic diseases Ambulatory Blood Pressure ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Cardiac Output measures the output from the heart  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar measures the input to the heart  The only thing between the two measures is the heart  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases  More likely to require surgery or life- long therapy  Shorter-term therapy possible, may also avoid surgery Cardiac Output ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Vascular Imaging detects vascular valve dysfunction and vascular insufficiency  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates possible autonomic involvement  Vascular insufficiency can be due to sympathetic nerve or smooth muscle dysfunction, imaging cannot differentiate  Ansar can detect sympathetic insufficiency (withdrawal)  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases  More likely to require surgery or life-long therapy  Shorter-term therapy possible, may also avoid surgery Vascular Imaging ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Sitting-Standing Blood Pressure can indicate presence of supine hypertension and other abnormal BP changes  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates possible autonomic involvement in supine hypertension and other abnormal BP changes  Ansar study challenges model supine to standing conditions  BP affected by many factors, including baroreceptor reflex which responds to autonomic input  Autonomic function in part controls BP. By the time BP changes autonomic dysfunction may have been present for a long time.  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes. Hypertension is associated with many chronic diseases  Chronic BP disorders do not happen “over night”, Autonomic Dysfunction typically presents first Sitting-Standing Blood Pressure ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Thermal Studies use sweat patterns over the whole body to determine regional autonomic function  Measures BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar indicates systemic autonomic function  Thermal studies are difficult to perfom in the office and uncomfortable for the patient  Ansar studies are designed for the office and comfortable  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ changes  Chronic disease justifies autonomic function testing before end-organ changes Thermal Studies ANX 3.0 Back

 Does NOT measure Sympathetic or Parasympathetic nerves  Q-SART investigates sympathetic and parasympathetic innervation of sweat glands to detect peripheral autonomic neuropathy, using electricity and topical applications of drugs  Measures systemic autonomic nerves, BOTH Sympathetic and Parasympathetic nerves independently and simultaneously  Ansar investigates sympathetic and parasympathetic innervation of the heart and lungs to detect PAN, DAN, and CAN  Q-SART is difficult to perform in the office and uncomfortable for the patient  Ansar studies are designed for the office and are comfortable  Symptoms must be present to test, forcing you to wait for disease or disorder to cause end-organ change  Chronic disease justifies autonomic function testing before end-organ changes Q-SART ANX 3.0 Back

Reimbursable Under Two CPT codes FDA Clearance Standard of Care Non-invasive Digital Real time Objective Data Printable Reports Possible Therapy Options

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September 2006 *Ansar Medical Technologies, Inc*/vs Thank you for giving us your time. We hope this presentation has been informative. If you have any question concerning this demonstration or require any leasing information please contact us at