The present disclosure relates generally to a reconstitution assembly. More specifically, the present disclosure relates to a drug reconstitution assembly for reconstituting a lyophilized drug.
Certain drugs are supplied in lyophilized form. The lyophilized drug must be mixed with water to reconstitute the drug into a form suitable for injection into a patient. In particular, all of the components that contact the drugs must be sterile to avoid the chance of infection.
The reconstitution process presents difficulties for many people which are in need of injecting themselves or another family member in a home environment. The general process requires the exact, sequential manipulation of the drug vial, the diluent container and the transfer syringes which must utilize needles to penetrate the vial stoppers. This process should be done with good aseptic practices.
In addition, many lyophilized drugs are provided in vials having the interior at a negative pressure relative to the atmosphere. This negative pressure facilitates reconstitution as it compensates for the volume of diluents which is injected into the vial for reconstitution. If air is allowed to enter into the interior of the vial prior to the injection of the diluents, this may make the reconstitution process much more difficult for the patient or health care provider.
Thus, reconstitution presents challenges in ensuring sterility of the product and providing ease of use to the patient or caregiver. The lyophilized drugs are often very expensive, making the minimization of the mechanical and user error of the utmost importance to avoid product waste. In particular, it is desirable to maintain user interaction with the reconstitution assembly to a minimum and to minimize the number of steps in the reconstitution process. In addition it is desirable to prevent unintentional or intentional tampering with the diluent or drug container and reuse of the reconstitution assembly. Moreover, it is desirable to minimize or eliminate the ability of the user to negatively impact the reconstitution process during user interaction.
The present disclosure provides a reconstitution assembly that is especially useful for reconstituting a lyophilized drug for use by a patient.
In one embodiment, a reconstitution assembly includes a housing including an upper sleeve and lower sleeve. The housing defines a generally tubular passageway and has an outer surface defining a user friendly configuration. A transfer set assembly is disposed within the housing between the lower sleeve and the upper sleeve. The transfer set assembly includes a pair of opposing spikes forming a portion of a fluid flow path having upper and lower ends.
A first container, typically including a diluent, is disposed inside the upper sleeve, within the passageway and adjacent the upper end of the flow path. The first container includes a first seal cap providing a sterile barrier to contents of the first container. The first container is disposed with the first seal cap facing downward. A second container is disposed inside the lower sleeve within the passageway and adjacent the lower end of the flow path. The second container includes a second seal cap providing a sterile barrier to the contents of the second container. In an embodiment, the contents of the second container contains are sealed by the second seal cap under a vacuum. The second container is disposed with the second seal cap facing upward toward the first seal cap. The upper sleeve is configured to engage the first container to prevent removal of the first container from the assembly.
A triggering mechanism sits adjacent to and is engaged to the second container and disposed within the lower sleeve of the housing and within the passageway. The triggering mechanism is situated within the housing to place the second container in a resting position and prevent the movement of the second container relative to the transfer set assembly until fluid communication is established between the interior of the first container and the upper end of the flow path. The trigger mechanism is also configured to prevent removal of the second container from the assembly.
In an embodiment, the spike at the upper end of the flow path pierces the first seal cap upon application of a first predetermined force to the first container. The first predetermined force may be applied to the end of the first container opposite the first seal cap. The force may be applied by the user grasping the housing in a vertical orientation, contacting the lower end of the second container against a surface and pushing the first container downward. Subsequent to the spike at the upper end of the flow path piercing the first seal cap of the first container, the periphery of a rim of the first container, which accepts the first seal cap, is configured to engage the triggering mechanism.
The engaged triggering mechanism is configured to allow the second container to then move axially relative to the transfer set assembly. The spike at the lower end of the flow path pierces the second seal cap upon application of a second predetermined force and the engagement of the triggering mechanism by the first container. When the second seal cap is pierced, the vacuum of the second container is accessed. The second predetermined force may be applied by maintaining the contact between the bottom of the second vial and the surface and continuing to apply a downward force to the first container.
In an embodiment, the first container encloses a liquid and the second container encloses a lyophilized product. Once the first cap of the first container is pierced with the spike at the upper end of the flow path and the second seal cap of the second container is thereafter pierced with the spike at the lower end of the flow path, the first and second containers are in fluid communication through the flow path of the transfer set assembly. Due to the vacuum of the second container, the liquid of the first container is aspirated through the fluid pathway into the second container after the first and second containers are placed into fluid communication with one another.
Thus the liquid from the first container is drawn into the second container to allow mixture with the medication in that container and requires no complicated interaction by the user other than placing the assembly in a vertical orientation on a surface and then pushing on the top of the assembly. The reconstitution assembly may then be gently agitated to mix the lyophilized product of the second container with the liquid from the first container to form a reconstituted product.
The transfer set assembly housing includes a port and forms an access path to provide fluid communication between the port and a portion of the second spike that is exposed to the interior of the second container when the second spike pierces the second seal cap. The port is disposed on the transfer set housing and extends substantially perpendicular to the flow path through the housing to the exterior of the housing. In one embodiment, the port is separated from the access path with a valve or a port seal. After the reconstituted product is formed, a patient or caregiver accesses the liquid through the port by opening the valve or removing the port seal and withdrawing the reconstituted product through the access path into a syringe without the use of a needle.
Additional features and advantages are described herein, and will be apparent from the following Detailed Description and the figures.
The present disclosure provides reconstitution assemblies that are especially useful for reconstituting a lyophilized drug. Although the assemblies are described primarily herein with respect to reconstituting a lyophilized drug, it will be apparent that the assemblies may be used to reconstitute other materials as well.
Referring now to the drawings and in particular to
A transfer set assembly 40 (
Sleeves 20 and 30 are made of a suitable moldable and sterilizable plastic such as ABS, PC or acrylic. The containers 70, 80 may be made of any suitable medical grade material for holding a substance, such as glass or plastic, and an elastomeric stopper. In one embodiment, container 70 contains sterilized water and container 80 contains a lyophilized drug. Assembly 10 provides a two-stage reconstitution method for adding the water 73 to the lyophilized drug 81 to reconstitute the drug and withdrawal of the reconstituted drug into a syringe. Assembly 10 provides a sterile mechanism for accomplishing the reconstitution goal, minimizes the chance of user mistakes and reduces the possibility of wasting lyophilized drug 81.
It should be appreciated that each of sleeves 20 and 30 include a plurality of windows spaced radially around the sleeves 20, 30. It should be appreciated that, by including a plurality of windows, the sterilization of internal parts and components is made easier. As discussed in more detail below, in various embodiments, the various components are sterilized with hydrogen peroxide vapor although other gaseous sterilants such as ethylene oxide are also contemplated.
Referring additionally to
As seen in
First container 70 is held in place in part by the wall of the second sleeve 30. An elastomeric gasket 72 or in a further embodiment, a semi-rigid thermoplastic washer (not shown) fits between first container 70 and upper sleeve 30. The first container 70 includes a seal cap 76, which may be a standard rubber vial stopper. Seal cap 76 is pierceable by the end or tip of upper spike 52. In a further embodiment, gasket 72 is formed as an elastomeric o-ring, which provides frictional contact between first container 70 and upper sleeve 30. In an embodiment, the o-ring or gasket 72 is coated with a lubricating coating to allow the first container 70 to move relative to upper sleeve 30 with reduced friction resistance. The gasket 72 provides optimal and consistent friction resistance across a broad range of vial diameters, which typically vary within a 1 mm range.
A second container 80 is disposed near lower boot 64 and the lower end of spike 62, and at least partially within the portion of the passageway 11 formed by the lower sleeve 20. A lower surface 81 is disposed below a lower rim 21 of the lower sleeve at a distance selected to provide for movement of the container 80 relative to the sleeve 20 sufficient to provide for engagement of the container with the lower spike 62 as described below while still keeping the lower surface 81 level or slightly below the rim 21.
Second container 80 is partially held in place by an elastomeric gasket 82. Second container 80 includes a seal cap 86 which can be a rubber stopper, and is capable of being pierced by the end of lower spike 62. Seal cap 86 provides a seal with container to maintain a vacuum within the container and assist in the reconstitution of the drug as described below. In a further embodiment, gasket 82 is an o-ring, which provides frictional contact between second container 80 and lower sleeve 20. In an embodiment, o-ring or gasket 82 is coated with a lubricating coating to allow second container 80 to move relative to lower sleeve 20 with reduced friction resistance. The gasket 82 provides optimal and consistent friction resistance across a broad range of vial diameters, which typically vary within a 1 mm range.
The reconstitution assembly 10 includes fluid pathways or channels to provide fluid communication from first container 70 to second container 80 and from the second container 80 to a withdrawal port 66 (
Referring now to
Referring specifically to
Prior to activation the user grips the assembly 10 and places the assembly in a vertically oriented position with the lower surface 81 of the second container 80 resting on a flat surface. Referring specifically to
Transfer set assembly 40 is engaged to and held stationary relative to the second sleeve 30 and first sleeve 20. As first container 70 is moving downward towards second container 80, the seal cap 76 comes into contact with the transfer set assembly 40 at the upper boot 54. The upper spike end of the upper spike 52 of the upper spike housing pierces the upper boot 54 and the seal cap 76 of the first container 70. Once the upper end 42a of the flow path 42 formed by the upper spike 52 penetrates through the seal cap 76 of the first container 70, the contents of the first container 70, e.g., sterilized water, are in fluid communication with the flow path 42 and transfer set assembly 40. When the upper spike 52 fully penetrates the seal cap 76 the upper surface 71 of container 70 should be approximately level or extend slightly above the rim 31.
It should be appreciated that in various embodiments, a small amount of a lubricant is applied to the tip of the upper end of spike 52 and the lower end of spike 62 prior to boots 54 and 64 being installed over the spikes. By including a small amount of lubricant on the tip of the spikes, the spikes more easily pass through the caps of the first and second containers 70, 80 with relatively low amount of effort required and with relatively low and consistent deflection of elastomeric vial caps 76 and 86. It should be appreciated that, at the point of this second configuration of
As discussed in more detail below, when first container 70 is shifted fully downward onto the transfer set assembly 40, and the seal cap 76 has been fully penetrated, the first container engages and activates triggering mechanism 100 shown in more detail in
Referring now to
At the point when the lower boot 64 and the seal cap 86 are pierced to expose the lower end 42b of the flow path 42 to the interior of the second container 80, flow path 42 provides fluid communication between the first container 70 and second container 80 and fluid 73 from first container 70 flows through the flow path 42 and comes into contact with the drug 83 of second container 80.
Typically, second container 80 is configured to enclose its contents under a vacuum, and therefore, when the second seal cap 86 and the lower boot 64 are penetrated fully, the vacuum in the second container 80 is opened to the contents of first container 70. After the seal cap has been penetrated by the lower spike 62, the negative pressure of the vacuum within the second container 80 causes the contents of the first container 70 to be aspirated through the flowpath 42 defined by transfer set assembly 40 and into the second container 80. During fluid transfer from first container 70 to second container 80, the seal 69 at the withdrawal port 66 prevents ingress of air, which would relieve the vacuum and delay or prevent transfer. Similarly, lower spike 62 creates a seal where it penetrates lower seal cap 86. Atmospheric air is allowed enter the first container 70 through vent path 404 and hydrophobic filter 408, as shown in
It should be understood that vacuum in the second container may be created or re-created at any time using a syringe connected to the withdrawal port. This allows users to recover from errors that result in vacuum loss without transfer of fluid. Such errors include removal of the withdrawal port seal before activating the device or activating the device upside down.
Referring now to
Triggering mechanism 100 includes a circular base 110, with a radial flange 112 and a wall section 114, which in the illustrated embodiment is substantially frusto-conical in shape. Wall section 114 depends from top flange 112 of the circular base 110 and forms a bottom edge 116 of the circular base 110. Three trigger fingers 102, 104 and 106 (see
In one embodiment, the three trigger fingers 102, 104 and 106 include identical features. The features described for trigger finger 106 apply equally for fingers 104 and 102 accordingly. The top of trigger finger 106 includes a shoulder portion 118. Shoulder portion 118 includes shoulders 118a and 118b and a protruding tapered flange 120, which extends upwardly between shoulder 118a and shoulder 118b. The surface of shoulder 118 extends radially inwardly from the outer shoulder wall 119 (
In an unactivated state, the surface of the shoulder 118 resides at least substantially parallel to flange 112 of the circular base 110 of the triggering mechanism 100. Flange 120 includes a base 121, which begins below the surface of shoulder 118 and between shoulder 118a and shoulder 118b, as shown for example in
Referring to
Second sleeve 30 includes three tab members 230, 232 and 234 attached to inner wall 32 above floor 210 and cylindrical section 212. The three tab members 230, 232 and 234 are likewise spaced evenly about the inner wall 32 of the upper sleeve 30 and are separated by one-hundred twenty degrees. Other numbers and positioning of tabs around the inner wall 31 are also envisioned. The three tab members 230, 232 and 234 (only 230 and 232 are illustrated) are each radially offset from the three flanges 220, 222 and 224 by forty-five degrees and are attached to the inner wall 32 of the second sleeve 30 near its top end, and extend downwardly towards floor 210 and radially inwardly towards the center axis of second sleeve 30.
Referring now generally to
Prior to activation, and during shipping, first container 70 is held statically in place in first sleeve 30 via tab members 230, 232 and 234 and by washer 72. As discussed above, tab members 230, 232 and 234 are attached to the inner wall 32 of second sleeve 30, and flare downward towards floor 210 of first sleeve 30.
Upon application of a radially outwardly applied force, the tabs flex slightly radially outwardly. First container 70 includes a neck portion 77, which extends from a main body 73 of the first container 70 to a shoulder 74 of the first container. Shoulder 74 includes a rim 75, which defines an opening into which the first seal cap 76 is secured. During assembly when the first container is inserted into the second sleeve 30, rim 75 first contacts tab members 230, 232 and 234 and flex the lower ends of the tabs outwardly to allow the rim 75 to pass over the tabs. The flexing causes the tab members 230, 232 and 234 to be biased radially inward. After the rim 75 has cleared the tab members 230, 232 and 234, the smaller diameter neck portion 77 provides the space to allow the lower portion of the tab members 230, 232 and 234 to spring radially inward towards neck 77. Upon springing radially inward, the unique inward sloping configuration of the tab engages the sloping surface of the container to collectively resist the further downward movement of first container 70. In addition the lower free edge of the tab members 230, 232 and 234 become wedged in between neck 77 and the rim 75 thereby locking first container 70 from upward movement and removal of the container 70 from the sleeve 30 and passageway 11.
First container 70 is now suspended within the sleeve 30 in the resting or unactivated position and pinned by each of the three tab members 230, 232 and 234, such that container 70 is not allowed to shift in the vertical or axial direction absent an applied deliberate downward force.
As shipped, the triggering mechanism 100 of assembly 10 is engaged with lower floor 210 of second sleeve 30. The circular base 110 of triggering mechanism 100 surrounds rim 85 of second container 80. The second container 80 is held against downward movement relative to the trigger mechanism 100 by a series of tabs 115, 117 forming a portion of the upper sleeve as shown in
Three pairs of tapered fins, 87a and 87b, 88a and 88b, and 89a and 89b are integrated into second sleeve 30 and spaced radially one-hundred twenty degrees apart. During activation, each of the three trigger fingers 102, 104 and 106 of the trigger mechanism 100 fit in between one of the three pairs of tapered fins, 88a and 88b, 89a and 89b, and 87a, 87b respectively. It should be appreciated that in
As discussed above, triggering mechanism 100 braces and prevents second container 80 from shifting relative to the housing 12 and subsequently making accidental or premature contact with the lower spike 62 of the lower spike housing of transfer set assembly 40. As assembled within the housing, trigger fingers 102, 104 and 106 of triggering mechanism 100 surround transfer set assembly 40 and extend upwardly and into floor 210 of upper sleeve 30. Each of the three flanges 220, 222 and 224 of floor 210 define an opening 219, 223 and 225, respectively, as seen in
The trigger fingers 102, 104 and 106 as seen in
Referring now generally to
As seen in
As can be seen more clearly in
As seen in
As illustrated in
After the upper spike end of the upper spike 52 has fully penetrated the seal cap 76 of the first container 70, the first container 70 is enabled to continue to move axially downward towards transfer set assembly 40. The continued downward force and movement of the first container 70 following the penetration of the seal cap 76 starts the activation of the triggering mechanism 100. As described above, in the unactivated position, the shoulders 118a and 118b of the trigger fingers 102, 104 and 106 of the triggering mechanism 100 are braced against the lower face of the flange 220, and the tapered flange 120 of trigger fingers 102, 104 and 106 extend through opening in the floor 210. When first container 70 is forced axially downwardly, rim 75 of seal cap 76 contacts the inner surfaces 128 of the tapered flanges 120 on trigger fingers 102 to 106, which are protruding through the floor 210 of the second sleeve 30 as seen at
Due to the tapered profile of the flange 120, the further the first container moves axially downward relative to second sleeve 30, the more force will be exerted in a radially outward direction against the top of each of the three trigger fingers 102, 104 and 106. The resultant radially outward force applied on the tapered flange 120 by the downward shifting first container 70 causes each of the trigger fingers 102, 104, 106 to flex in a radially outward direction as seen in
As a result of the trigger fingers 102, 104, 106 each being simultaneously flexed outward and toward the inner wall 32 of second sleeve 30, the shoulder 118 moves away from the lower surface of the floor 210. Once the shoulder 118 is forced radially outward, the shoulders 118a and 118b lose contact with the lower surface, and shift into the opening in the floor 210. As described above, prior to engagement of the rim 75 and tapered flanges 120, the triggering mechanism 100 is braced from movement relative to the first sleeve 30 by contact between the shoulders 118a, 118b, and shoulders 219a and 219b of the lower surface of the floor 220. Because shoulders 118 have now been disengaged from this braced position, the triggering mechanism 100 is now free to shift axially relative to the housing 12. It should be appreciated that the rim 75 is not configured to activate the triggering mechanism 100 or make contact with any of the tapered flanges 120 of the trigger fingers 102, 104, 106 until after the upper spike end of the upper spike 52 has penetrated the first seal 76 and put the flow path 42 of the transfer set assembly 40 into fluid communication with the fluid contents of the first container 70.
As downward force is continually applied on the first container 70, the container continues to move axially downward toward the transfer set assembly 40 until the rim 75 contacts the floor 210 of the upper sleeve 30. At the point when the rim 75 of the first container 70 sits flush against the top surface of floor 210, each of the three trigger fingers 102, 104, 106 have been flexed radially outward, as discussed above, and the first container 70 is prevented from shifting any further relative to the housing 12. It should be appreciated that, at this point in the reconstitution process, the transfer set assembly 40 and the first container 70 are in fluid connection with one another. Lower boot 64 maintains fluid within the first container 70 and the transfer set assembly 40 as seen in
Referring to
As the housing 12, first container 70, and transfer set assembly 40 move together axially downward relative to the second container and the trigger mechanism 100, the transfer set assembly 40 comes into contact with the second seal cap 86 of the second container. More specifically, first the lower boot 64 contacts the second seal cap 86 of the second container 80. As the force of the downwardly shifting transfer set assembly 40 increases against the second seal cap 86 of the second container 80, the resistance of the lower boot 64 and the second seal cap 86 give way to the lower tip of the lower spike 62. The lower tip of the lower spike 62 pierces the lower boot 64, and then continue to pierce the second seal cap 86 to put interior of the second container 80 in fluid communication with the lower end 42b of the flow path 42 and thereby in fluid communication with the interior of first container 70 via the flow path 42 of the transfer set 40 as seen in
It should be appreciated that in one embodiment, as the housing 12, first container 70 and the transfer set assembly move downward relative to the second container 80 and the triggering assembly 100, the trigger fingers 102, 104 and 106 will naturally move radially inwardly back to their natural inward biased configuration after the rim 75 of the first container 70 has passed the tapered flange 120 of each trigger finger. The tapered flange 120 will then move into the volume around the neck 77 of the container. The lower surface 121 will then wedge against the upper surface of the shoulder 74 to prevent relative separation movement of the container 70 and the container 80. The first container 70 and second container 80 are thereby clamped together and to the transfer assembly by the trigger assembly 100 thereby retaining the containers within the passageway 11 and housing 12.
As seen in
It should be appreciated that in various embodiments, the product labels 79, 89 are made of a plastic film which is more impervious to hydrogen peroxide and other sterilization chemicals than paper labels. Additionally, it should be appreciated that the plastic labels afford better friction for the labels 79, 89 to pass easily through the gaskets 72, 82 respectively. In various embodiments, the product labels 79, 89 do not wrap completely around the first and second containers 70, 80, and the label does not overlap upon itself in any location. In one embodiment, the label covers about 350 degrees of the respective container. It should be appreciated that any overlap of the label could unduly increase the force required to activate the assembly.
In reference to
As seen in
It should be appreciated that, in various embodiments, different sized containers are usable with the same housing 12. For example, in various embodiments, the first container 70 and second container 80 are swapped out for a larger first container and a larger second container, which correspond with a different drug, reconstitution or treatment. One would appreciate that using the same housing for multiple different types of drugs and treatments provides valuable flexibility and versatility. It should be appreciated that, regardless of the diameter dimensions of the containers being used, the neck of all containers is standardized according to ISO or another standardization convention, and is predictable in the industry. Therefore, when a larger-sized container is swapped with the container 70 or 80 discussed above, the trigger fingers, locking mechanism and transfer set assembly will all still interface consistently. In various such embodiments, the only parts that need be modified are the gaskets 72, 82 and the ribs 87a, 88a, 89a used to center the container. It should be appreciated that in various embodiments, the upper sleeve 30 and lower sleeve 20 includes a plurality of ribs, similar to ribs 87a, 87b and 87c in a first position and a plurality of ribs in a second position, depending upon the diameter of the containers being used. In various embodiments, it should be appreciated that the modified gaskets replacing gaskets 72, 82 when swapped out for a larger-diameter container, are color coordinated to easily notify the user which type of drug or container is to be used.
As discussed above, the contents of the second container 80 are vacuum-sealed. Therefore, when the lower end 42b of the flow path 42 is placed in fluid communication with the interior of the second container, the sealed vacuum is exposed to the flow path 42. The negative pressure level inside the second container is then equalized by pulling fluid 73 from the first container 70 through the flow path 42 facilitated by the transfer set 40 into the second container 80. When the fluid 73 has been fully transferred from the first container 70 through the transfer set assembly 40 and into the second container 80, the solid contents 83 of the second container 80 are mixed with the liquid contents 73 from the first container 70 to form a reconstituted drug. In one embodiment, the patient or caregiver gently agitates the entire reconstitution assembly 10 to mix the liquid contents 73 and the solid contents 83 adequately to form a homogeneous mixture for use as an, e.g., injectable drug. It should be appreciated that due to the penetration of the upper spike and lower spike into the interior of the first container and lower container the fluid path after activation has completed is limited to the first container 70, the transfer set assembly 40, and the second container 80. Post-agitation, the reconstituted drug will not escape this sealed boundary.
Referring now to
After the drug has been fully reconstituted, the patient or caregiver accesses the reconstituted drug through the withdrawal port 66 of the lower spike housing of the transfer set assembly 40. To facilitate complete emptying of the second container 80, the user will typically flip the assembly 10 so that the second container is now at the top of the assembly. Withdrawal port 66 is configured as a female luer connector and extends radially outward from the lower spike housing. In an embodiment the port 66 includes a series of threads 67 to provide a sealed connection with a male luer tip having an annular locking flange. Port seal 69 is configured to engage or overwrap threads 69 and sealingly enclose the withdrawal port 66. Disposed inside of withdrawal port 66 is product filter 402 in one embodiment, which is configured to prevent any unmixed solid particulate 83 from the reconstituted drug from being withdrawn.
As seen in
Access pathway 400 provides fluid communication between port 66 and the interior of second container 80 (which contains the reconstituted drug). The user is then enabled to draw the reconstituted drug out of the second container 80 through the access pathway 400, and port 66, and into a medical syringe or other suitable medical apparatus without the use of needles. In an embodiment including a check valve (not illustrated) along the access pathway 400 the fluid will be able to pass through the check valve.
It should be noted that while the user is gripping the housing and applying a force to the first container 70 to cause initial movement of the first container relative to the housing 12 followed by movement of the second container relative to the housing, the external configuration of the housing remains static or fixed. This is important because the gripping force applied by the user is directed radially inward. If the reconstitution process required radially outward flexing or distortion of the housing the gripping force applied by the user may actually interfere with the movement of the containers or other aspects of the reconstitution process.
It should be understood that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present invention and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.
This application claims priority to and the benefit of U.S. Provisional Patent Application No. 61/376,912, filed on Aug. 25, 2010, the entire contents of which is incorporated by reference herein.
Number | Date | Country | |
---|---|---|---|
61376912 | Aug 2010 | US |