CN101502454A - 对可植入医疗装置进行消毒的系统和方法 - Google Patents

对可植入医疗装置进行消毒的系统和方法 Download PDF

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CN101502454A
CN101502454A CNA2009100071449A CN200910007144A CN101502454A CN 101502454 A CN101502454 A CN 101502454A CN A2009100071449 A CNA2009100071449 A CN A2009100071449A CN 200910007144 A CN200910007144 A CN 200910007144A CN 101502454 A CN101502454 A CN 101502454A
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CN101502454B (zh
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D·F·小德卢戈斯
M·S·奥尔蒂斯
D·N·普莱西亚
M·勒恩伯格
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2/00Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
    • A61L2/02Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
    • A61L2/08Radiation
    • A61L2/081Gamma radiation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/0003Apparatus for the treatment of obesity; Anti-eating devices
    • A61F5/0013Implantable devices or invasive measures
    • A61F5/005Gastric bands
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2/00Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
    • A61L2/02Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
    • A61L2/08Radiation
    • A61L2/082X-rays
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2/00Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
    • A61L2/02Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
    • A61L2/08Radiation
    • A61L2/087Particle radiation, e.g. electron-beam, alpha or beta radiation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2202/00Aspects relating to methods or apparatus for disinfecting or sterilising materials or objects
    • A61L2202/20Targets to be treated
    • A61L2202/24Medical instruments, e.g. endoscopes, catheters, sharps

Abstract

本发明涉及对可植入医疗装置进行消毒的装置和方法。提供了一种具有被构造成耐受预定的消毒辐射量的内部电路的可植入医疗系统。通常,所述医疗系统包括与可植入医疗装置电通信的内部控制模块。所述内部控制模块可包括任何数目的集成电路(例如专用集成电路)和/或被构造成耐受辐射的电路板,其中所述电路或所述电路的至少某个部分被制造成耐受某一辐射量。例如,电路的某个部分可利用辐射顺应性材料、绝缘硅技术和/或砷化镓技术制造。另外,电路可包括固有地耐受这样的辐射的各种元件(例如利用基于磁场的技术制造的元件、表面声波装置等)。本发明还提供了一种通过辐射对可植入医疗装置进行消毒的方法。

Description

对可植入医疗装置进行消毒的系统和方法
技术领域
本发明涉及可植入医疗装置和系统,具体地涉及一种具有能够耐受某一预定的消毒辐射量的内部电路的可植入医疗装置。
背景技术
特别是在美国,随着肥胖人数持续增加,并且所知道的肥胖对健康的负面影响越来越多,肥胖变得越来越受到关注。人的体重超过理想体重100磅或者更多的病理性肥胖尤其引起严重健康问题的极大风险。因此,大量的注意力被聚焦到治疗肥胖患者上。治疗病理性肥胖的一种方法是围绕胃的上部设置限制装置,诸如细长的束带。胃束带典型地包括具有固定端点的填充有流体的弹性囊,该囊紧邻食道-胃结合部的下部围绕胃,以便在束带上方形成小的胃袋并在胃中形成减小的人造口。当流体注入囊中时,束带抵靠胃膨胀,从而在胃中形成食物摄取限制部分或者人造口。为了减少这种限制,将流体从束带中去除。束带的作用是减小可利用的胃的容积,并由此在变得“饱胀”之前减少可被消耗掉的食物量。
食物限制装置还包括类似地围绕胃上部的以机械方式调节的胃束带。这些胃束带包括任意数量的弹性材料或者传动装置以及驱动装置,以便调节胃束带。另外,胃束带已经被发展为包括液压和机械驱动元件。这样的可调节胃束带的例子在2000年5月30日公告的题为“Mechanical Food Intake Restriction Device”的美国专利No.6067991中公开,该文献的内容通过引用而包含在本申请中。还已知的是,通过将可膨胀的弹性囊植入到胃腔本身中来限制胃腔中可用的食物容积。囊填充有流体以便抵靠胃壁膨胀,并且由此减少胃内可用的食物容积。
使用上述食物限制装置的每一种进行安全有效的处理都要求所述装置被有规律地监测并调节以改变施加到胃上的限制程度。使用束带装置,在最初植入之后束带上方的胃袋的尺寸显著增加。因此,胃中的人造口最初必须被形成得大到足以使患者能够接收充足养分,同时胃能够适应束带装置。随着胃袋尺寸增加,束带可被调节以改变人造口的尺寸。另外,需要改变人造口的尺寸以便适应患者身体或者治疗状况的变化,或者在更紧急的情况下,减轻梗阻或者严重食管扩张。传统地,调节液压胃束带要求定期看医生,在看医生期间用休伯针和注射器穿刺患者皮肤并经注射端口将流体加入到囊中或者从囊中除去。最近,已经开发了能够以非侵入方式调节束带的可植入泵。外部程序装置使用遥测技术与植入的泵通信,以便对泵进行控制。在定期看医生期间,医生将程序装置的手持部分放置在胃植入物附近并将功率信号和命令信号传送给植入物。植入物又调节束带中的流体水平并将响应命令传送给程序装置。
如上所述的植入物包括数据存储电子装置、数据传输电子装置、功率电子装置等等。例如,这样的装置可以由电池或电容器在内部供能,而其它装置可通过外部连接的功率源或无源遥测系统供能。通常,这样的内部电路在接受外部能源时可能受到不利影响。例如,施加消毒辐射可能对电路产生不利影响,甚至最终导致系统故障。因为消毒辐射在经济、环境以及性能方面都是希望的,所以一直需要能够耐受在消毒程序中提供的辐射的系统和方法。
发明内容
本发明提供了具有被构造成耐受预定辐射量(包括在消毒程序中受到的辐射量)的内部电路的可植入医疗装置和医疗系统。通常,所述医疗系统包括与可植入医疗装置电通信的内部控制模块,可植入医疗装置被构造成设置在患者的腹膜腔内。例如,医疗装置可以是被构造成用于在通道中形成限制的可植入限制装置。内部控制模块可包括电路板、若干单个元件和/或任何数目的集成电路(例如专用集成电路),其中电路或电路的至少某个部分被制造成耐受某一辐射量。例如,电路的某个部分可利用辐射顺应性材料(radiationcompliance material)(例如陶瓷材料、钛、金、银、钽、铂、钯、铑等)制成。另外,电路可(至少部分地)由砷化镓制成。同样,电路的至少某个部分可利用绝缘硅(“SOI”)技术制造。此外,电路可包括固有地耐受这种辐射的各种元件(例如磁阻随机存取存储器)。
本发明提供了具有能够耐受预定辐射量的内部电路的可植入医疗装置和医疗系统的各个方面。在一个方面中,医疗系统包括被构造成设置在患者的腹膜腔内的可植入医疗装置。例如,该可植入医疗装置可以是被构造成在通道中形成限制的可植入限制装置。另外,医疗系统包括与可植入医疗装置和外部装置中的至少一个电通信的内部控制模块,其中,该控制模块可包括耐受一定辐射量的电路元件(例如,在可植入医疗装置的消毒过程中经受的辐射量)。电路元件可以以各种方法制造成耐受这样的辐射(即在暴露在诸如用于消毒目的的辐射后仍能工作),电路元件可以是存在于传感器、微处理器、微控制器、信号调节电路、栅极阵列、专用集成电路、存储装置、磁性随机存取存储器、磁性控制电路、声波装置、电路板等中的任意一者中。例如,电路元件的至少一个可至少部分地由辐射顺应性材料制成。这样的材料可包括陶瓷材料、钛、金、银、钽、铂、钯、铑等。另外,在一些实施方式中,电路元件的至少一个可至少部分地由砷化镓制成。在一种实施方式中,电路元件的至少一个可利用绝缘硅技术制造。例如,电路元件可包括具有顶面和底面的至少一个硅层,并且电路元件还可包括设置在所述硅层的至少一个面上的至少一个绝缘层。绝缘层可包括各种材料。例如,绝缘层可包括蓝宝石、二氧化硅等。
系统的元件可耐受各种类型和/或剂量的辐射。在一种示例性的实施方式中,电路元件可耐受在伽马辐射过程中经受的辐射量。单次剂量的消毒辐射可以是最大达到大约50千戈瑞(kGy)的任何量(例如在大约25kGy至大约50kGy的范围中)。另外,元件也可以被构造成耐受大约25kGy至大约50kGy的额外剂量,总计最高达到大约100kGy或在需要时更高的剂量。当制造环境条件高度受控时,可以使用较低的辐射剂量(例如低于25kGy)。正如所指出的那样,也可以使用各种类型的辐射。例如,所述辐射可以是伽马辐射、x射线辐射、电子束辐射等。
在另一方面中,提供了一种可植入医疗系统,其包括可植入的控制模块和被构造成设置在患者的腹膜腔内的可植入医疗装置,所述可植入的控制模块具有被构造成耐受预定的辐射(例如伽马辐射、x射线辐射、电子束辐射)剂量的多个电子元件(例如表面声波装置)。在一种示例性的实施方式中,预定剂量的辐射是能够对可植入医疗装置进行消毒的伽马辐射。虽然各种的辐射剂量都落在本发明的主旨和范围内,但是在一种示例性的实施方式中预定的辐射剂量是最高达到大约50kGy的任何量。另外,元件还可被构造成耐受大约25kGy至大约50kGy的额外剂量,总计最高达到大约100kGy或在需要时更高的剂量。电子元件可以以各种方式被制造成耐受辐射。例如,电子元件的至少一个可利用绝缘硅技术制造。利用这样的技术,电子元件可包括具有顶面和底面的至少一个硅层,并且电子元件还可包括设置在硅层的至少一个面上的至少一个绝缘层。同样,电子元件还可至少部分地由辐射顺应性材料制成。
另外,本发明提供了一种用于对可植入医疗装置进行消毒的方法的各个方面。在一个这样的方面中,所述方法包括提供被构造成设置在患者腹膜腔内的可植入医疗装置。例如,可植入医疗装置可以是被构造成在通道中形成限制的可植入限制装置。可植入医疗装置包括内部控制模块,该内部控制模块具有被构造成耐受预定的辐射剂量的任何数目的电子元件。另外,该方法包括将预定的辐射剂量传送给可植入医疗装置。电子元件可以以各种方式被构造成和/或制造成具有这样的耐辐射性。例如,电子元件可利用绝缘硅技术制成,至少部分地由辐射顺应性材料制成、至少部分地由砷化镓制成等。
预定的辐射剂量可包括能够提供期望效果(例如对可植入医疗装置进行消毒)的任何辐射类型和/或任何辐射量。例如,辐射可以是伽马辐射、x射线辐射、电子束辐射等。此外,辐射可以以各种量被传送。例如,辐射可以以最高达到大约50kGy的量传送。另外,该方法可包括传送预定辐射量的至少一次额外剂量。例如,该方法可包括施加大约25kGy至大约50kGy的额外剂量,总计最高达到大约100kGy或在需要时更高的剂量。
本发明具体地包括以下内容:
(1).一种可植入医疗系统,包括:
可植入医疗装置,其被构造成设置在患者的腹膜腔内;以及
内部控制模块,其与所述可植入医疗装置和外部装置中的至少一个电通信并且还包括耐受一辐射类型的一定辐射量的电路元件。
(2).根据第(1)项所述的系统,其中,所述电路元件耐受在所述可植入医疗装置的消毒过程中经受的辐射量。
(3).根据第(1)项所述的系统,其中,所述可植入医疗装置是被构造成在通道中形成限制的限制装置。
(4).根据第(1)项所述的系统,其中,所述电路元件的至少一个是至少部分地由辐射顺应性材料制成的。
(5).根据第(4)项所述的系统,其中,所述辐射顺应性材料选自包括陶瓷材料、钛、金、银、钽、铂、钯和铑的组。
(6).根据第(1所述的系统,其中,所述内部控制模块包括至少部分地由辐射顺应性材料制成的电路板。
(7).根据第(1)项所述的系统,其中,所述内部控制模块包括从由磁性随机存取存储元件、表面声波装置以及利用基于磁场的技术制造的元件组成的组中选出的抗辐射元件。
(8).根据第(1)项所述的系统,其中,所述电路元件存在于传感器、微处理器、微控制器、栅极阵列、专用集成电路、存储装置和信号调节电路的至少一个中。
(9).根据第(1)项所述的系统,其中,所述电路元件的至少一个是至少部分地由砷化镓制成的。
(10).根据第(1)项所述的系统,其中,所述电路元件的至少一个是利用绝缘硅技术制造的。
(11).根据第(10)项所述的系统,其中,所述电路元件的至少一个元件包括具有顶面和底面的至少一个硅层,并且所述电路元件还包括设置在所述硅层的至少一个面上的至少一个绝缘层。
(12).根据第(11)项所述的系统,其中,所述绝缘层选自包括蓝宝石和二氧化硅的组。
(13).根据第(1)项所述的系统,其中,所述辐射类型选自包括伽马辐射、x射线辐射和电子束辐射的组。
(14).根据第(13)项所述的系统,其中,所述辐射量是最高达到大约100kGy的任何量。
(15).一种可植入医疗系统,包括:
可植入医疗装置,其被构造成设置在患者的腹膜腔内;以及
可植入的控制模块,其具有被构造成耐受预定辐射剂量的任何数目的电子元件。
(16).根据第(15)项所述的系统,其中,所述可植入医疗装置是被构造成在通道中形成限制的限制装置。
(17).根据第(15)项所述的系统,其中,所述预定辐射剂量能够对所述可植入医疗装置进行消毒。
(18).根据第(17)项所述的系统,其中,所述辐射选自包括伽马辐射、x射线辐射和电子束辐射的组。
(19).根据第(17)项所述的系统,其中,所述预定辐射剂量是最高达到大约100kGy的任何量。
(20).根据第(15)项所述的系统,其中,所述电子元件的至少一个是利用绝缘硅技术制造的。
(21).根据第(15)项所述的系统,其中,所述电子元件的至少一个是表面声波装置。
(22).根据第(15)项所述的系统,其中,所述电子元件的至少一个是利用砷化镓技术制造的。
(23).根据第(15)项所述的系统,其中,所述电子元件的至少一个是利用基于磁场的技术制造的。
(24).一种用于对可植入医疗装置进行消毒的方法,包括:
提供被构造成用于设置在患者的腹膜腔内的可植入医疗装置,所述可植入医疗装置与内部控制模块电通信,所述内部控制模块具有被构造成耐受预定辐射剂量的任何数目的电子元件;以及
将预定辐射剂量传送给所述可植入医疗装置。
(25).根据第(24)项所述的方法,其中,所述可植入医疗装置是被构造成在通道中形成限制的限制装置。
(26).根据第(24)项所述的方法,其中,所述电子元件的至少一个是利用绝缘硅技术制造的。
(27).根据第(24)项所述的方法,其中,所述辐射选自包括伽马辐射、x射线辐射和电子束辐射的组。
(28).根据第(24)项所述的方法,其中,所述预定辐射剂量是最高达到大约100kGy的任何量。
(29).根据第(24)项所述的方法,还包括传送预定辐射剂量的至少一次额外剂量。
附图说明
通过下列结合附图的详细描述将更全面地理解本发明,其中:
图1A是食物摄入限制系统的一种实施方式的透视图;
图1B是限制系统的一种实施方式的透视图;
图2A是图1B中显示的限制系统的胃束带的透视图;
图2B是当应用到患者的胃-食道结合部时的图2A中所示胃束带的透视图;
图3是图1B中显示的限制系统的流体注射端口的透视图;
图4是限制系统的另一种实施方式的透视图;
图5是图1A中显示的传感器外壳的透视图;
图6是用于图5的压力传感器的可变阻抗电路的一种实施方式的示意图;
图7是与图4中显示的限制装置结合使用的压力管理系统的一种实施方式的框图;
图8A是利用绝缘硅技术制造的集成电路的示意图;
图8B是图8A的集成电路的剖视图;
图8C是图8A的集成电路的另一剖视图;
图9A是利用绝缘硅技术制造的集成电路的另一种实施方式的剖视图;
图9B是利用绝缘硅技术制造的集成电路的又一种实施方式的剖视图;
图10A是包括磁性随机存取存储器(“MRAM”)的内部电路的示意图;以及
图10B是结合在集成电路中的MRAM元件的剖视图。
具体实施方式
现在将描述一些示例性实施方式以提供对本文中公开的装置、系统和方法的结构、功能、制造以及用途的原理的全面理解。这些实施方式的一个或多个例子在附图中示出。本领域技术人员将会理解,在本文中具体描述并在附图中示出的装置和方法都是非限制性的示例性实施方式,本发明的范围仅仅由权利要求书来限定。结合一种示例性实施方式示出或描述的特征可与其他实施方式的特征组合。这样的修改和变化也都包含在本发明的范围内。
提供了具有被构造成耐受预定辐射量的内部电路的可植入医疗装置和医疗系统。辐射量可以是提供期望的治疗效果(例如消毒)所需的任何量、任何类型(例如伽马辐射、x射线辐射、电子束辐射)和/或任何剂量。例如,内部电路可具有耐受最高达到大约100千戈瑞(“kGy”)的辐射量(包括在大约25kGy至大约50kGy范围中的单次剂量)的能力。如将要描述的那样,内部电路可以以各种方式构造成耐受这样的期望辐射量。例如,电路的某个部分(例如电路板、集成电路、单独元件等)可至少部分地使用各式各样的辐射顺应性材料(例如陶瓷材料、钛、金、银、钽、铂、钯和铑)制成。另外,电路可使用砷化镓制成。此外,电路的某个部分可利用绝缘硅(“SOI”)技术制造,绝缘硅技术例如允许通过在典型的硅基片上沉积的绝缘材料(例如蓝宝石)使集成电路的各种元件彼此电绝缘。另外,电路可包括固有地耐受某一辐射程度的元件。例如,这样的元件可包括磁阻随机存取存储器(“MRAM”),表面声波装置等。因此,这样的抗辐射加固给可植入系统提供了相对于期望的消毒程序的有效耐辐射性。
本领域技术人员应当理解,可植入医疗装置和系统的各种实施方式都落在本发明的主旨和范围内。在一种示例性的实施方式中,可植入系统包括被构造成设置在患者腹膜腔内的可植入医疗装置。例如,可植入医疗装置可以是被构造成在通道中形成限制的可植入限制装置。图1A示出了食物摄入限制系统10的一种示例性实施方式。如图所示,系统10一般包括可植入部分10a和外部部分10b。图1B示出了位于患者体外的可植入部分10a。如图所示,可植入部分10a包括被构造成围绕患者的胃40的上部而设置的可调节胃束带20和例如经过导管50与可调节胃束带20流体连接的注射端口30。注射端口30可被构造成允许流体被引入到胃束带20中以及从胃束带20中除去,从而调节胃束带20的尺寸并由此调节施加到胃40上的压力。因此,注射端口30可被植入到体内可通过组织接触的位置中。典型地,注射端口被设置在患者腹部的皮肤和脂肪组织层下的侧肋下区域中。医生还典型地将注射端口植入到患者胸骨上。
内部部分10a还可包括与可植入部分10a中的封闭流路流体连通的感测或测量装置。在一种实施方式中,感测装置为被构造成测量封闭流路的流体压力的压力感测装置。虽然压力测量装置可具有各种构造并可设置在沿着内部部分10a的任何地方,包括在注射端口30中,在图示的实施方式中压力测量装置为压力传感器的形式,该压力传感器被设置在与注射端口30相邻设置的传感器外壳60内。导管50可包括连接在胃束带20与压力传感器外壳60之间的第一部分和连接在压力传感器外壳60与注射端口30之间的第二部分。虽然能够理解,感测装置可被构造成获得与一个或多个相关参数有关的数据,但是总体上其可在本文中被描述为压力感测装置。
如在图1A中进一步显示的那样,外部部分10b一般包括数据读取装置70,该数据读取装置70被构造成设置在压力传感器外壳60(其可植入厚的组织下面,例如超过10cm厚)上方的皮肤表面上,以便以非侵入方式与压力传感器外壳60通信并由此获得压力测量值。可选地,数据读取装置70可与控制箱90(以无线方式或者有线方式,如在该实施方式中经过电缆组件80)电联接,该控制箱90可显示压力测量结果,得自数据读取装置70的其他数据和/或数据警报。虽然在该例子中控制箱90显示为相对于患者处于本地,但控制箱90可相对于患者处于本地或者远程位置处。
图2A更详细地显示了胃束带20。虽然胃束带20可具有各种构造,并且本领域目前已知的各种胃束带都可被用于本发明,但是在图示的实施方式中胃束带20具有大致细长的形状,并带有具有相对的第一和第二端部20a、20b的支撑结构22,该支撑结构22可形成为一个环,使端部彼此连接。各种配合技术可被用于将端部20a、20b彼此连接起来。在图示的实施方式中,端部20a、20b为配合在一起的带子的形式,并且一个叠置于另一个之上。在图示的另一种实施方式中,例如在图1B和2B中,在胃束带20一端上的支撑结构可包括开口,胃束带20的另一个端部可穿过该开口,从而将两个端部彼此连接。胃束带20还可包括可变容积元件,诸如可膨胀囊24,该囊设置在支撑结构22一侧上或形成在支撑结构22一侧上,并被构造成与组织邻近设置。囊24可相对于胃的外壁膨胀或者收缩,从而形成可调节的人造口,以便可控制地限制食物摄入到胃中。
本领域技术人员将会理解,胃束带可具有各种其他构造。此外,在本文中公开的各种方法和装置都可同样适用于其他类型的可植入束带。例如,束带可被用于治疗大便失禁,如在美国专利No.6461292中描述的那样,该文献的内容通过引用而包含在本申请中。束带还可被用于治疗小便失禁,如在美国专利申请公开No.2003/0105385中描述的那样,该文献的内容通过引用而包含在本申请中。束带还可被用于治疗胃灼热和/或返酸,如在美国专利No.6470892中公开的那样,该文献的内容通过引用而包含在本申请中。束带还可被用于治疗阳痿,如在美国专利申请公开No.2003/0114729中描述的那样,该文献的内容通过引用而包含在本申请中。
图2B显示了围绕患者的胃食管结合部应用的可调节胃束带20。如图所示,胃束带20至少大体上围绕胃40的靠近与患者食管42的结合部的上部。优选以胃束带20中含有少量或者不含流体的收缩构型将胃束带20植入后,胃束带20可例如使用生理盐水被膨胀,以缩小人造口开口的尺寸。本领域技术人员将会理解,多种技术,包括机械技术和电技术,都可被用于调节胃束带20。图2B还示出了感测装置41的替代位置,该感测装置41设置在胃束带20的带扣43中。
流体注射端口30也可具有各种构造。在图3中显示的实施方式中,注射端口30具有大致圆柱形外壳,该圆柱形外壳具有远侧面或底面以及从底面向近侧延伸并限定了近侧开口32的周壁。近侧开口32可包括针穿刺隔膜34,该针穿刺隔膜延伸横跨该开口并提供在外壳中形成的流体容器(在图3中不可见)的入口。隔膜34优选设置在足够靠近近侧的位置,使容器的深度足以暴露针(诸如休伯针)的开口尖端,使流体输送可发生。隔膜34优选被设置成使其在被针穿刺并且针退出后自密封。如图3中进一步显示的那样,注射端口30可还包括导管连接件36,该导管连接件36与容器流体连通并被构造成与导管(例如导管50)联接。本领域技术人员将会理解,外壳可由任意数目的材料制成,包括不锈钢、钛或者聚合物材料,并且隔膜34同样可由任意数目的材料制成,包括硅树脂。
读取装置70还可具有各种构造,一种示例性的压力读取装置在共同拥有的美国专利申请公开No.2006/0189888和No.2006/0199997中更详细地公开,该文献的内容通过引用而包含于本申请中。一般说来,读取装置70可以非侵入方式测量在被植入部分10a中的流体压力,即便在压力感测装置被植入到厚(至少超过10cm)的皮下脂肪组织之下时也是如此。医生可保持读取装置70靠在传感器外壳60的位置和/或其他压力感测装置的位置附近的患者皮肤上,得到感测的压力数据以及在这里讨论的其他可能信息,并观察控制箱90上的显示器上的压力读数(和/或其他数据)。数据读取装置70还可以例如在延长的检查过程中使用带子、粘合剂和其他公知方法可拆卸地连接到患者(将在下面进一步讨论)。数据读取装置70可透过传统的布质或纸质手术单工作,并且还可以包括对于每个患者可更换的一次性的罩(未显示)。
如上所述,系统10还可包括用于监测胃限制系统10工作的一个或多个传感器。传感器可被构造成测量系统10的各种工作参数,包括但不限于:系统内的压力,系统内的温度,蠕动脉冲事件或者频率,蠕动脉冲宽度,蠕动脉冲持续时间,以及蠕动脉冲振幅。在一种示例性实施方式中,系统可包括压力测量装置形式的传感器,该传感器与封闭流路连通并被构造成测量系统内与由可调节胃束带施加到患者的胃部的限制大小对应的流体压力。在使用中,测量系统的流体压力或者任何其他控制参数可使医生能够评估限制系统的性能。如图4中所示,在图示的实施方式中,压力测量装置为设置在传感器外壳60内的压力传感器62的形式。但是,压力测量装置可设置在可植入部分的封闭液压回路内的任何地方,并且各种示例性位置和构造在共同拥有的美国专利申请公开No.2006/0211913中更详细地公开,该文献于2006年3月7日提交、题为“Non-InvasivePressure Measurement In A Fluid Adjustable Restrictive Device”,该文献通过引用而包含在本申请中。一般说来,图示的传感器外壳60包括与可植入部分10a中的流体流体连通的进口60a和出口60b。已经植入的导管50可与传感器外壳60一起翻新改进,诸如通过切断导管50并将带倒刺的连接器(或者任何其他连接器,诸如夹钳、夹片、粘合剂、焊接等)插入到导管50的被切断的端部。传感器62可设置在外壳60内并被构造成响应于液压回路内的流体压力变化并将压力变化转化成可使用形式的数据。
本领域已知的各种压力传感器均可被用作压力传感器62,例如由美国乔治亚州亚特兰大的CardioMEMS公司提供的无线压力传感器,但合适的微机电(MEMS)压力传感器也可得自任何其他来源,包括但不限于:美国密歇根州伊普西兰蒂的Integrated SensingSystems公司(ISSYS)和美国马萨诸塞州沃尔瑟姆的Remon MedicalTechnologies公司。一种示例性的MEMS压力传感器在美国专利No.6855115中描述,该文献的内容通过引用而包含在本申请中,仅用于说明的目的。本领域技术人员还能理解,合适的压力传感器可包括但不限于电容式传感器、压阻式传感器、硅应变仪式传感器或者超声(声学)压力传感器,以及能够测量压力的各种其他装置。
具有设置在其内的传感器62的传感器外壳60的构造的一种实施方式在图5中显示。在该实施例中传感器外壳60包括母板,母板可用作气密容器以防止流体与设置在传感器外壳60内的任何元件接触,除了针对传感器62所讨论的之外。传感器外壳60可由适于在体内使用的任何生物相容性材料制成,诸如聚合物、生物相容性金属以及其他相似类型的材料。此外,传感器外壳60可由任何一种或多种透明(如图5所示)、不透明、半透明和不透射线的材料制成。除其他元件以外还包括微控制器65(例如处理器)的电路板64还可设置在外壳60内,以帮助处理并传递由传感器62收集的压力测量结果以及可能是与胃束带20有关的其他数据。如同在下面进一步讨论的那样,电路板64还可包括经皮能量传输(TET)/遥测线圈和电容器。可选地,温度传感器可被集成到电路板64中。微控制器65、TET/遥测线圈、电容器和/或温度传感器可通过电路板64或者经任何其他合适的元件通信。如下所述,TET/遥测线圈和电容器可一起形成用于从外部部分10b接收功率并将压力测量结果传递到压力读取装置(例如读取装置70)的调谐振荡电路。此外,如果在没有一些辅助手段的条件下,与压力传感器62相关联的遥测元件不能到达置于患者体外的遥测装置,则可通过任何合适数目的继电器(未显示)或其他装置来提供这样的辅助手段。
在使用中,流体可通过设置在外壳表面(这里指底面)上的任何位置的开口66进入传感器外壳60并与传感器62的压力感测表面68接触。传感器62典型地相对于母板密封,使进入开口66的流体不能渗透并影响传感器62的工作,除了在压力感测表面68处之外。当流体流进和流出开口66时,传感器62可测量与压力感测表面68接触的流体的压力。例如,压力感测表面68可包括具有可变形表面的膜片,使得当流体流过开口66时,流体冲击膜片的表面,引起该表面发生机械位移。膜片的机械位移可通过包括一对可变电阻、硅应变仪的可变电阻电路转化成电信号。一个应变仪可与膜片的中央部分连接以测量膜片的位移,而匹配的第二应变仪可连接在膜片的外边缘附近。应变仪可使用粘合剂与膜片连接或者可扩散(diffuse)到膜片结构中。当胃束带20中的流体压力发生波动时,膜片表面可上下变形,从而在中央应变仪中产生阻抗变化。
用于传感器62的可变电阻电路的一种实施方式在图6中显示。所述电路包括第一应变仪96和第二应变仪98,它们形成半补偿惠斯通电桥电路100的两个上部电阻元件。当第一应变仪96对传感器的膜片的机械位移作出反应时,第一应变仪96的变化阻抗改变了通过电桥电路100的上部的电势。第二应变仪98与第一应变仪96匹配并使惠斯通电桥电路100隔热(athermalize)。第一差分放大器102和第二差分放大器104与电桥电路100连接以测量由于可变电阻应变仪96、98而引起的电桥电路100中的电势变化。特别是,第一差分放大器102测量通过整个电桥电路100的电压,而第二差分放大器104测量通过电桥电路100的应变仪半桥的差分电压。对于通过电桥的固定电压而言,应变仪电压之间的差越大,压差越大。来自差分放大器102、104的输出信号可被施加给集成到电路板64中的微控制器65,并且微控制器65可将测得的压力数据传递到置于患者体外的装置。如果需要,也可使用全补偿惠斯通电桥电路以提高压力传感器62的灵敏性和精确性。在全补偿电桥电路中,四个应变仪而不是仅仅两个应变仪与膜片表面连接。
图7示出了包括在内部部分10a和外部部分10b中的元件的一种实施方式。如图7中所示,外部部分10b包括用于将功率信号132传递到内部部分10a的初级TET线圈130。遥测线圈144也被包括用于将数据信号传递到内部部分10a。初级TET线圈130和遥测线圈144组合形成外部天线,例如读取装置70。例如设置在控制箱90中的外部部分10b可包括用于控制施加到初级TET线圈130的功率的TET驱动电路134。TET驱动电路134由具有相关联的存储器138的微处理器136控制。图形用户界面140与微处理器136连接以便输入患者信息、显示数据和医生指示、和/或打印数据和医生指示。通过用户界面140,用户(诸如患者或者临床医生)可将调节请求传送给医生并且还可输入该请求的原因。另外,用户界面140可使患者能够读取并响应来自医生的指示和/或压力测量警报。
外部部分10b还可包括初级遥测收发器142,用于将询问指令传送到植入的微控制器65并从微控制器65接收响应数据(包括感测到的压力数据)。初级收发器142与微处理器136电连接以便输入并接收指令和数据信号。初级收发器142驱动遥测线圈144,从而以选定的RF通信频率谐振。谐振电路可生成将指令数据传递到微控制器65的下行交变磁场146。作为替代,收发器142可接收从内部部分10a中的次级TET/遥测线圈156(“内部天线”)传递的遥测信号。接收的数据可被存储在与微处理器136相关联的存储器138中。功率源150可为控制箱90提供能量以便为内部部分10a中的元件提供功率。环境压力传感器152与微处理器136连接。微处理器136可使用来自环境压力传感器152的信号来针对大气压力的变化(例如由于气压条件或者高度的变化)调整接收的压力测量结果,以便提高压力测量结果的精确性。
图7还示出了内部部分10a的元件,在该实施方式中这些元件被包括在传感器外壳60中(例如在电路板64上)。如图7中所示,次级TET/遥测线圈114接收来自外部天线的功率/通信信号132。次级线圈114形成调谐振荡电路,该振荡电路与初级TET线圈130感应耦合以向植入物提供功率,或者与初级遥测线圈144感应耦合以接收和传递数据。遥测收发器158控制与次级线圈114的数据交换。另外,内部部分10a包括整流器/功率调节器160、微控制器65、与微控制器65相关联的存储器62、温度传感器112、压力传感器62和信号调节电路164。植入的元件可将压力测量结果(由于温度等引起而带有或不带有调整部分)从传感器62经天线(初级TET线圈130和遥测线圈144)输送到控制箱90。压力测量结果可被存储在存储器138中并被针对环境压力进行调整、在控制箱90的显示器上被显示和/或可能实时地被传送到远离患者的位置处的远程监测站。
如上所述,内部电路或者内部电路的至少某个部分可被制造和/或设计成经过抗辐射加固以免受到辐射效应的影响。抗辐射加固是对电子元件和电子系统进行设计和测试以使它们耐受由高能亚原子粒子和电磁辐射引起的损坏或故障的方法。如本领域技术人员所知,辐射可具有各式各样的对电路不利的效应。这样的效应可以是辐射的多次施加的累加(即总的电离剂量)或者这样的效应可由这样的能量的一次性施加产生(即单粒子效应)。在任一种情况下,这样的效应可破坏内部电路,导致低效的数据处理和/或系统故障。如目前所提供,内部电路可以是经过抗辐射加固以免受到为了提供期望的治疗效果(例如装置的消毒)而施加在装置上的某一预定剂量、某一类型和/或某一量的辐射效应的影响。在示例性的实施方式中,内部电路可被制造和/或设计成使得电路进而装置本身的功能可耐受在最高达到大约100kGy的范围中的辐射量(包括在大约25kGy至大约50kGy范围中的单次剂量)。在一些实施方式中,内部电路可被制造成耐受在大约25kGy至50kGy范围中的多次辐射剂量(最高达到大约100kGy或在需要时更高)。可被制造、构造和/或加工成耐受这样的辐射的内部电路的例子包括电路板、集成电路(例如专用集成电路)、栅极阵列、表面声波(“SAW”)装置、磁控制电路、传感器、微处理器、微控制器、存储装置、信号调节电路等。
内部电路可以以各种方式进行抗辐射加固。例如,电路可至少部分地由大量辐射顺应性材料中的任一种制成。这样的材料的例子包括陶瓷材料、钛、金、银、钽、铂、钯、铑等。本领域技术人员可想到各种其它这样的材料。在示例性的实施方式中,内部电路或者内部电路的至少某个部分可利用绝缘硅(“SOI”)技术制造。SOI技术指的是在半导体制造(尤其是微电子技术)中使用分层的硅-绝缘体-硅基片替代传统的硅基片,以减少装置的寄生电容并且由此提高性能。基于SOI的装置与传统的硅制(silicon-built)装置的不同之处在于,硅接合处在电绝缘体(通常为蓝宝石或二氧化硅)上面。绝缘体的选取主要取决于预期应用,其中蓝宝石用于对辐射敏感的应用中,二氧化硅通常用于提高性能以及减少微电子装置中的短通道效应。绝缘层和最上面的硅层的精确厚度也可随着应用而广泛变化。如本领域技术人员应当理解的那样。
图8A-8C提供了通过SOI技术制造的集成电路的例子。图8A是示意性地示出了传统的SOI晶体管的平面俯视图。同样,图8B是沿着图8A的线I-I’截取的剖视图,而图8C是沿着图8A的线II-II’截取的剖视图。如图所示,SOI结构通常包括支承基片1、处于支承基片1上的嵌入式绝缘层3以及处于嵌入式绝缘层3上的第一电导类型的半导体层5。半导体层5可被蚀刻形成具有深度小于半导体层5的厚度的局部沟道区。因此,半导体残留层存在于局部沟道区下面。局部沟道区限定了晶体管作用区5b和与晶体管作用区5b间隔开的身体接触作用区5a。局部沟道区随后被填充绝缘层7。绝缘的栅极图案11横跨晶体管作用区5b。绝缘的栅极图案11通过栅极电介质层9与晶体管作用区5b电绝缘。第二电导类型的源区/漏区16形成在晶体管作用区5b上,晶体管作用区5b位于绝缘的栅极图案11的两侧。每个源区/漏区16可具有稍微掺杂的漏极(LDD)结构。该LDD结构包括稍微掺杂区12和严重掺杂区15并且可使用形成于绝缘的栅极图案11侧壁上的间隔件13实现。在此,源区/漏区16被构造成使得它们与嵌入式绝缘层3接触,以减少寄生电容。第一电导类型的杂质被植入身体接触作用区5a中,由此在身体接触作用区5a上形成良好的接触区17。
图9A和9B提供了这样的SOI抗辐射电路的替代实施方式。例如,图9A示出了具有设置在蓝宝石基片101上的薄硅层107的集成电路的剖视图。另外,该电路包括栅极元件,该栅极元件包括金属103和位于下面的氧化物105。替代地,图9B示出了由绝缘体层109形成的集成电路,该绝缘体层109由例如设置在硅基片111上的二氧化硅制成。此外,与图9A相似,电路还包括被设置在绝缘体层109上的薄硅层107。本领域技术人员应当理解,每层的特征和/或厚度可专门设计,以提供期望的功能和/或抗辐射加固。
SOI提供了很多能够减轻或消除电离总剂量效应和单粒子效应的固有优点。例如,SOI固有地消除了闩锁效应。闩锁效应是电子元件的电源轨之间的低阻抗路径的意外产物(其可由消毒辐射的引入而产生),该产物引起了寄生结构,该寄生结构随后作为短路,干扰部件的正常功能,甚至可能由于过载电流导致部件毁坏。SOI设计通过围绕例如N沟道金属氧化物半导体(“NMOS”)晶体管和P沟道金属氧化物半导体(“PMOS”)晶体管设置的绝缘氧化物层(称为“沟道”)消除了出现闩锁效应的可能性。这破坏了这些晶体管之间的寄生结构。
另外,内部电路可利用砷化镓(“GaAs”)技术。已知GaAs在半导体性能方面具有优于硅的各种特性(例如,抗辐射能力)。因此,GaAs技术例如可被用于诸如存储装置、太阳能装置、太阳能电池和场效应晶体管(“FET”)这样的元件中。如所指出的那样,GaAs具有优于硅的一些电子特性。例如,GaAs具有较高的饱和电子速度和较高的电子迁移率,这允许由GaAs制成的晶体管以超过大约250GHz的频率工作。同样,与硅装置相比,GaAs装置在高频率运行时产生的噪声较小。GaAs装置还可以以比等同的硅装置更高的功率水平运行,因为GaAs装置具有较高的击穿电压。
除了将内部电路的不同部分制造成耐受预定的消毒辐射剂量外,内部电路可包括固有地耐受辐射的任何数目和/或类型的元件。例如,内部电路可利用能耐受期望的辐射量的基于磁场的技术。这样的基于磁场的技术的各种实施方式都落在本发明的主旨和范围内。这样的实施方式可包括使用磁阻随机存取存储器(“MRAM”)、利用磁场来打开和关闭开关的磁簧开关、霍耳效应装置、以及包括电磁线圈、整流器和功率调节电路的感应耦合电源电路。
再次参照磁阻随机存取存储器,MRAM是非易失性计算机存储器(NVRAM)技术,该技术已知固有地具有耐辐射性。与传统的RAM芯片技术不同,数据在MRAM中不是作为电荷或电流存储,而是通过磁性存储元件存储。如图10A所示,所述元件由两块铁磁片117、121形成,每块铁磁片可保持一磁场并且通过薄绝缘层119分开。两块铁磁片中的一块是设置成特定极性的永磁体121,另一块铁磁片117的磁场会变化以便与外部磁场匹配。存储装置由这样的“单元”栅格构造。
通过对单元的电阻进行测量来完成读取。(通常)通过给相关晶体管供能来选定特定单元,相关晶体管通过所述单元将电流从电源线换接到接地。由于磁隧道效应,单元的电阻由于两块铁磁片117、121中磁场的方向而变化。通过测量引起的电流,任何特定单元内部的电阻可被确定,由此能确定可写入的铁磁片的极性。典型地,如果两块铁磁片具有相同的极性,就被认为表示“0”,而如果两块铁磁片具有相反的磁性,电阻将较大,这表示“1”。
数据通过使用各种方式写入单元中。例如,在一种实施方式中,每个单元处于以彼此成直角的方式设置在该单元上方和下方的一对写入线115、125之间。当电流通过写入线115、125时,在可写入的铁磁片获得的接合部处形成感应磁场。图10B提供了结合入硅基片(或SOI基片)127中的MRAM电路的例子。此外,本领域技术人员应当理解,这些示意图仅仅是例子并且电路可包括能够耐受期望的消毒程序的各式各样的体系结构和/或元件。
抗辐射装置的另一个例子是诸如射频识别(“RFID”)标签的表面声波(“SAW”)装置。SAW装置固有地耐受升高的工作温度、高能x射线和/或伽马杀菌辐射。在示例性的实施方式中,SAW RFID标签(从德克萨斯州理查森的RF SAW公司可买到)通过压电效应工作并且通过发出声波脉冲从装置传送预编程数据,声波脉冲被反射回读数装置。SAW装置还常用作电波脉冲,该电波脉冲被反射回读数装置。另外,SAW装置由于其缓慢的传播时间而可被用作电噪声过滤器。例如,SAW装置可以是带通滤波器以及本领域技术人员想到的其他类型的RF滤波器。
除了上述系统和装置外,提供了一种用于对可植入医疗装置进行消毒的方法。与以上相同,各种类型的可植入医疗装置可与本发明方法一起使用。例如,可植入装置可被构造成设置在患者的腹膜腔内。在示例性的实施方式中,该方法包括提供被构造成在通道中形成限制的可植入限制装置。与以上相似,可植入医疗装置可包括内部控制模块,该内部控制模块具有被构造成耐受预定辐射剂量的电子元件。可以以这种方式进行制造、构造和/或加工的电子元件的例子包括电路板、集成电路(例如专用集成电路)、栅极阵列、表面声波装置、磁控制电路、传感器、微处理器、微控制器、存储装置、信号调节电路等。该方法还可包括将预定的辐射剂量传送给可植入医疗装置。
内部元件可以以能够提供期望的耐辐射性的任何方式构造。例如,一个或多个电子元件可至少部分地由辐射顺应性材料(例如陶瓷、钛、金、银、钽、铂、钯、铑等)制成。另外,电子元件可至少部分地利用砷化镓技术制造。同样,内部电路的至少某个部分可利用SOI技术制造。另外,内部电路可包括固有地耐辐射的各种元件。与以上相同,这样的元件可包括SAW装置和/或利用基于磁场的技术制造的各种装置(例如MRAM)。
内部电路可被制造和/或设计成耐受对提供期望的消毒所需的任何辐射程度、任何辐射剂量、任何辐射类型和/或任何辐射量。例如,辐射可以是伽马辐射、x射线辐射、电子束辐射等。同样,辐射剂量(单次剂量或累积剂量)可以是为了提供期望的消毒所需的任何量。例如,在示例性实施方式中,总剂量可最高达到大约100kGy(包括在大约25kGy至大约50kGy的范围中的单次剂量)。在一些实施方式中,消毒方法可包括传送预定辐射量的至少一次额外剂量。本领域技术人员应当理解,作为单次剂量或多次剂量传送的任何消毒辐射量都落在本发明方法的主旨和范围内。
这里所公开的装置可以是一次性使用的,也可以设计成多次使用。然而,在每种情况下,在至少一次使用之后,该装置可被修复以重新使用。修复可包括装置的拆卸、接着清洗或更换特定部件和随后的重新组装这些步骤的任意组合。特别地,该装置可以被拆卸,任何数量的特定部件或零件可以有选择地以任意组合被更换或去除。在清洗和/或替换特定部件之后,该装置可在修复设备中或在即将进行手术程序之前由手术队进行重新组装以便以后使用。本领域技术人员将会理解对该装置的修复可利用用于拆卸、清洗/替换、和重新组装的各种技术。这些技术的使用以及产生的修复好的装置也全都在本申请的保护范围内。
在上述实施方式的基础上,本领域技术人员将会理解本发明的进一步的特征和有点。因此,除非由权利要求书特别指明,本发明不由特别显示和描述的那些内容来限定。在本文中引用的所有出版物和参考文献通过全文引用而明确包含在本申请中。

Claims (10)

1.一种可植入医疗系统,包括:
可植入医疗装置,其被构造成设置在患者的腹膜腔内;以及
内部控制模块,其与所述可植入医疗装置和外部装置中的至少一个电通信并且还包括耐受一辐射类型的一定辐射量的电路元件。
2.根据权利要求1所述的系统,其中,所述电路元件耐受在所述可植入医疗装置的消毒过程中经受的辐射量。
3.根据权利要求1所述的系统,其中,所述可植入医疗装置是被构造成在通道中形成限制的限制装置。
4.根据权利要求1所述的系统,其中,所述电路元件的至少一个是至少部分地由辐射顺应性材料制成的。
5.根据权利要求4所述的系统,其中,所述辐射顺应性材料选自包括陶瓷材料、钛、金、银、钽、铂、钯和铑的组。
6.根据权利要求1所述的系统,其中,所述内部控制模块包括至少部分地由辐射顺应性材料制成的电路板。
7.根据权利要求1所述的系统,其中,所述内部控制模块包括从由磁性随机存取存储元件、表面声波装置以及利用基于磁场的技术制造的元件组成的组中选出的抗辐射元件。
8.根据权利要求1所述的系统,其中,所述电路元件存在于传感器、微处理器、微控制器、栅极阵列、专用集成电路、存储装置和信号调节电路的至少一个中。
9.根据权利要求1所述的系统,其中,所述电路元件的至少一个是至少部分地由砷化镓制成的。
10.根据权利要求1所述的系统,其中,所述电路元件的至少一个是利用绝缘硅技术制造的。
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PL2087913T3 (pl) 2016-12-30
BRPI0900510A2 (pt) 2009-09-29
US20090202387A1 (en) 2009-08-13
JP2009183714A (ja) 2009-08-20
EP2087913B1 (en) 2016-06-22
EP2087913A1 (en) 2009-08-12
CN101502454B (zh) 2013-08-21
RU2497483C2 (ru) 2013-11-10
US8114345B2 (en) 2012-02-14

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