The present disclosure is directed generally to devices and methods for ablating lung tumors and more particularly the ablation treatment of lung tumors by using liquid metal as an electrode.
To date, thermal ablation is becoming an increasingly attractive choice for the treatment of unresectable tumors in the lung. Radiofrequency (RF) energy has seen the most utility for pulmonary ablation. However, there are significant technical deficiencies in the delivery of RF energy to the lung. The use of multiprong electrodes, which increase total electrode surface area, and ionic fluid infusion have been shown to decrease impedance to RF current flow in the lung. Although effective, these techniques are not without drawbacks. Fluid infusion is unpredictable and has been associated with an increased risk of complications. Multitined electrodes increase invasiveness, can be difficult to use in solid tumors situated in normal lung tissue, and have been associated with irregular zones of ablation and increased rates of occurrence of pneumothorax.
In addition, various radiofrequency ablation (RFA) has been utilized for treating peripheral lung tumors. However, there remains a need for improvement due to insufficient ablation coverage and the difficulty of endoscopically navigating the ablation electrodes to targeted tumors in the peripheral pulmonary lesions (PPL). It is desired for the ablation electrodes to be flexible and relatively soft and fit in the PPL that is small in diameter, preferably less than 2 mm, to ablate tumors that are closer to the peripheral of the lung.
Although hyperthermic treatment using radio frequency (RF) ablation is a treatment for lung tumors, the requirement of exact delivery of the rigid metal electrode into the center of the target site in the peripheral lung legion often may result in the risk of damage to the surrounding regions or suboptimal ablation.
To solve the problems of the requirement of exact delivery of the rigid metal electrode into the center of a target site, an RF ablation catheter device 100 uses a medical grade liquid metal device instead of using a solid electrode. The liquid metal device acts as an electrode through which RF ablation energy can be applied against the lung tumors. By injecting the liquid metal device into a target site, this will be conforming with the anatomical structures of the target site. Because of this conforming shape of the liquid metal device, there is less risk of damage to the surrounding regions. The liquid metal device is easily removed by aspiration suction without damaging the surrounding regions. Accordingly, the liquid metal device 150 acts an independent and flexible electrode within the target site creating larger ablation area.
The RF ablation catheter device 100 configured to ablate tumors adjacent the target site using a liquid metal device comprises a flexible shaft 110 configured to advance endobranchially into the target site. The catheter device 100 further comprises an inflatable balloon 120 mounted on the shaft 110 wherein a portion of the flexible shaft that is distal to the inflatable balloon 120 is defined as a distal segment 119. The catheter device 100 further comprises a RF conductor 115 attached to the distal segment 119 and configured to allow RF current to pass through the liquid metal device in such a way the liquid metal device delivers radio frequency (RF) energy to ablate the tumors.
According to a first aspect, the current invention provides a radio-frequency (RF) ablation catheter which comprises a flexible shaft, an inflation balloon and an RF conductor element. The flexible shaft extends between a distal end and a proximal end, the inflatable balloon is mounted on the shaft. A portion of the flexible shaft is distal to the inflatable balloon and is defined as a distal segment of the shaft. The RF conductor element is located on the distal segment and is adapted to electrically contact and to deliver RF energy to a liquid metal.
The flexible shaft can comprise an inner shaft and an outer shaft, wherein the outer shaft is arranged surrounding the inner shaft to cover at least a partial length of the inner shaft. The flexible shaft extends between the distal end to the proximal end along a shaft axis wherein the length of the shaft is defined along the shaft length axis.
The inner shaft and the outer shaft can have the same length distal to the inflatable balloon to together form the distal end of the shaft and wherein the RF conductor element is formed on the distal segment of the outer shaft.
Alternatively, the length of the inner shaft distal to the inflatable balloon can be formed shorter than the length of the outer shaft distal to the balloon to form a cavity between the distal end of the outer shaft and the distal end of the inner shaft. The cavity has a distal opening and the RF conductor element is arranged in said cavity.
The RF conductor element can be arranged in a recessed manner in the cavity to cover a partial surface area of said cavity. Alternatively, the RF conductor element can be arranged in the cavity to entirely cover the surface area of the cavity. As a further alternative, the RF conductor element can be arranged in the cavity and protrudes via the at least one opening to the outside of the cavity. The RF conductor element which extends from the inside of the cavity to the outside of the cavity can cover the entire surface area of the cavity or just a partial surface area of said cavity.
The flexible shaft can further comprise an inflation lumen defined by a space between the outer flexible shaft and the inner flexible shaft, in communication with the inflatable balloon and adapted to supply or discharge a fluid to/from the inflatable balloon. The inner shaft can further comprise a guide wire lumen adapted for insertion of a guide wire. The guide wire can be formed of an electrical conductive material.
The inflatable balloon can be mounted on the outer shaft of the inflatable balloon and can be integrally formed with the outer shaft. The distal segment of the flexible shaft comprises a cover element to partially overlay a conductive surface of the RF conductor element, wherein the cover element is made of a non-conductive material.
The distal segment can comprise a cover element which is attached to the distal segment of the shaft to form a cavity with at least one opening, wherein the conductor element is received in said cavity and wherein the cover element is made of a non-conductive element.
The cover element can be formed as a hollow cylinder to surround a partial length of the distal segment of the shaft and to form a cavity with at least an opening wherein the cavity extends from the distal end of the shaft.
The RF conductor element can be arranged in a recessed manner in the cavity to cover a partial surface area of said cavity. Alternatively, the RF conductor element can be arranged in the cavity and entirely covers the surface area of the cavity. As further alternative, it can be provided that the RF conductor element is arranged in the cavity and protrudes via the at least one opening to the outside of said cavity.
The RF conductor element can be formed by at least one electrically conductive metal element on the distal segment of the shaft. The conductive metal element is formed as a rigid metal element.
The at least one electrical conductive element can be formed as a ring-segment to cover at least one/a proportion of the circumference of the surface area of the distal segment or can be alternatively formed as an entire ring to cover the whole circumference of a partial surface area of the distal segment.
The at least one electrically conductive element can be formed pad shaped or formed by at least one conductive wire. Furthermore, according to the invention, the conductive element can be formed by an electrically conductive metal mesh.
The RF conductor element can be arranged at a proximal end of the distal segment directly neighbouring the inflatable balloon.
The flexible shaft can further comprise a fluid channel adapted to instill a liquid metal into at least one passageway, preferably at a target side in a body organ.
The catheter can further comprise an injection port in the area of the proximal end of the shaft, that is in communication with the fluid channel of the flexible shaft.
The fluid channel is adapted to instill a liquid metal supplied to the fluid channel preferably via an injection port into at least one passageway. The flexible shaft can further comprise an inflation lumen in communication with the inflatable balloon and adapted to supply or to discharge a fluid to/form the inflatable balloon.
The catheter can further comprise a temperature sensor mounted on the distal segment of the shaft. The temperature sensor can be arranged in the cavity of the cover element. The temperature sensor can be further formed as a thermocouple embedded in the distal segment of the flexible shaft, wherein a temperature sensing surface is formed as an endface of the distal end of the flexible shaft.
The temperature sensor can be formed as a thermocouple partially attached to the RF conductor element to form a temperature sensing surface in the area of the RF conductor element.
The flexible shaft can further comprise a guidewire lumen adapted to receive a guidewire. The guidewire can be made of an electrically conductive material.
The RF conductor element can be adapted to electrically be connected to an RF generator and to pass a flow of an RF current from the RF generator to the liquid metal. The catheter can further comprise an RF generator which is electrically coupled to the RF conductor element.
The RF power of the RF energy delivered to the liquid metal can be provided in the range of 40 to 180 Watts.
The RF ablation catheter can further comprise a handle portion arranged in the area of the distal end of the flexible shaft. The handle portion can comprise a guidewire port, an electrical connection and an injection port. The guidewire port can be connected to a guidewire lumen adapted for insertion of a guidewire and formed in the flexible shaft. The electrical connection can be adapted to connect the conductor element to an RF generator. The injection port can be connected to an injection lumen formed in the flexible shaft and adapted for instilling a liquid metal into a passageway. The injection port can be adapted for attachment of a syringe. Such an attachment can be formed for example by a Luer connector.
It can be provided that the liquid metal comprises gallium.
The liquid metal can be provided to be liquid at 37° C.
According to a further aspect of the current invention, an ablation catheter assembly can be provided which comprises a flexible bronchoscope comprising an instrument channel, an RF ablation catheter according to the first aspect of the current invention and adapted to travel through said instrument channel of said flexible bronchoscope.
The bronchoscope can have a diameter of less than 4.0 mm.
The bronchoscope can further comprise a fluid channel adapted to instill or suction fluid preferably into at least one passageway at a target site in a body organ.
The ablation catheter assembly can further comprise an amount of liquid metal in electrical contact with the RF conductor element.
According to a further aspect, the current invention provides a kit comprising an RF ablation catheter according to the first aspect of the current invention or the ablation catheter assembly according to the second aspect of the current invention and further comprises a container which comprises a liquid metal.
The liquid metal can comprise gallium.
The liquid metal can be provided to be liquid at 37° C.
According to a further fourth aspect, the current invention provides a liquid metal for use in the treatment of cancer, wherein the treatment comprises the steps of:
The liquid metal can be used for the treatment of cancer wherein the cancer is a lung cancer.
The liquid metal can be heated to a range of 60° C. to 80° C. by applying an RF current. The liquid metal can comprise gallium. The liquid metal can be further provided to be liquid at 37° C. According to a further aspect of the invention, a liquid metal is delivered into a passageway of the body organ through the catheter. The liquid metal used in various embodiments of the invention is liquid at a body temperature, i.e. at 37° C. Preferably, it is also liquid at room temperature, i.e. at about 25° C.
Metals are in general defined as materials that are capable of conducting electricity at a temperature of 0 Kelvin.
The liquid metal used in the invention is pharmaceutically acceptable; i.e. non-toxic during the time of use of the metal and non-reactive.
In one preferred embodiment, the liquid metal comprises gallium. Gallium has a melting point of 30° C.
In a further preferred embodiment, the liquid metal is an alloy. Preferably, it is an eutectic alloy.
In a further preferred embodiment, the liquid metal is an alloy comprising gallium, preferably at least 50% by weight of gallium.
Gallium can readily alloy with most metals. So as an ingredient, it could be used to form many low-melting alloys with other metals, such as indium (In), bismuth (Bi), tin (Sn), lead (Pb), zinc (Zn), aluminum (Al) and so on. The melting points of the alloys are different depending on the constituents and the proportions.
One embodiment is an alloy comprising 62-95% gallium, 5-22% indium, and 0-16% tin by weight.
EGaln (78.6% G& and 21.4% In by weight) and Galinstan® (68.5% Ga, 21.5% In, and 10.0% Sn by weight) are commonly and commercially available. They are eutectic mixtures. Taking EGaln as an example, it is fabricated by placing 78.6 wt % gallium and 21.4 wt % indium in a container, then heating and mixing them with a magnetic stirring apparatus or a glass pipette until thoroughly combined. Similar to gallium, bismuth could also comprise a series of low-melting alloys with Pb, Sn, Cd, Zn and In, etc.
Further information is available for example in “Liquid Metal Biomaterials” (2018) from Jing Liu and Liting Yi and references cited therein, which are incorporated herein to the extent they are not in contradiction with the teaching of the application.
To assist in understanding the invention, reference is made to the accompanying drawings to show by way of illustration specific embodiments in which the invention may be practiced. The drawings herein are not necessarily made to scale or actual proportions. For example, the lengths and widths of the components may be adjusted to accommodate the page size.
This disclosure is related to methods, devices, assemblies, and system for transbronchial ablation of a lung tumor. Aspects of the disclosure are included as follows. A radiofrequency (RF) ablation catheter which is configured to heat a passageway filled with a liquid metal, the ablation catheter comprises a flexible shaft having a proximal end and a distal end, the flexible shaft having a fluid channel configured to instill the liquid metal into the passageway. The ablation catheter further comprises an inflatable balloon mounted on the flexible shaft wherein a portion of the flexible shaft that is distal to the balloon is defined as a distal segment of the flexible shaft, the balloon configured to obstruct the passageway. The ablation catheter comprises an RF conductor located on the distal segment configured for connecting RF energy to the liquid metal thereby heating the passageway.
Throughout this disclosure, the target site or region may be referred to the bronchial trees located between the segmental bronchus (3rd-4th generations), subsegmental bronchus (5th-11th generations), bronchioles (12th-15th generations), and terminal bronchioles (16th generation). The preferred target site may further include the respiratory bronchioles (17th-19th generations). In some embodiment, the lobar bronchus (2nd generation) may be included in the target site.
Also, throughout this disclosure, the target airway or passageway is referred to bronchial airways surrounding or adjacent target tumor masses within the target site. Note that the target airway includes main bronchial airway and subbranches. Once the target airway is determined, the operator may determine one of the occlusion balloon positions (i.e., A, B, or C) located at its proximal portion of the target airway as exemplified in
In one embodiment, the ablation catheter 110 comprises the flexible shaft 110.
The flexible shaft 110 further comprises an outer shaft 110a and an inner shaft 110b which have the distal ends 110c and 110d respectively. The outer shaft 110a has a lumen for insertion of the inner shaft 110b as shown in
The inner shaft 110b comprises a guidewire lumen 111 having outer diameter of 0.4-0.5 mm and a fluid lumen or injection lumen 112 having outer diameter of 0.2-0.3 mm as shown in the cross-sectional view (c-c) of
In one embodiment, as shown in
In one embodiment, the distal portion of the inner shaft 11b may be getting thicker so as to securely attach to the inside lumen of the outer shaft 110a while the proximal portion is getting thinner to create an inflation lumen 113. The inflation lumen 113 is defined the space between the outer shaft 110a and inner shaft 110b as shown in
In one embodiment, the ablation catheter device 100 further comprises an occlusion balloon 120 mounted on the outer shaft 110a as shown in
In one embodiment, a portion of the outer shaft 110a that is distal to the occlusion balloon 120 can be defined as the distal segment 119 of the shaft. In some embodiments, the distal segment of the shaft has a length of less than 5.0-6.0 mm. The distal segment 119 of the shaft that is distal to the balloon 120 should be short to avoid direct tissue contact.
The main function of the occlusion balloon 120 is to close the entry way of the target airway which is filled with the liquid metal 150. The entry way of the target airway, for example, could be about 4-5 mm in diameter. When the ablation catheter 100 is placed at the target airway, the balloon 120 is configured to close the entry way of the target airway before instilling the liquid metal. After the completion of the intended ablation, the balloon 120 is deflated and the ablation catheter 100 is removed from the bronchoscope 170 through the working channel.
In one embodiment, the ablation catheter further comprises a RF connector or conductor 114. The main function of RF connector or conductor 114 is to connect RF energy to the liquid metal thereby heating the target airway. Various forms of the connector 115 can be used. For example, in one embodiment, a conductive wire type of the connector 115 can be used as shown in
Alternatively, as shown in
Alternatively, in some embodiments, the RF connector 115 can be attached on the surface of the distal segment 119 as shown in
In one embodiment, the ablation catheter 100 further comprises the temperature sensor 114 configured to read the temperature of the liquid metal. The temperature sensor 114 is connected to a thermocouple 117 which runs through the inner shaft 110b to the generator as shown
Under the temperature controlled mode of the generator, for example, the operator initially set the temperature at 80° C. and monitors the temperature of the activated liquid metal from the temperature sensor 114 during the pre-defined time. When the temperature sensor 114 shows 60° C. or higher of the activated liquid metal device, then the operator can maintain the ablation until the pre-defined time.
For accurate reading the temperature of the activated liquid metal 150 itself during the ablation procedure, the temperature sensor 114 should be placed away from the tissue. As shown in
In one embodiment, the ablation catheter device 100 further comprises the handle portion 130 as shown in
In another aspect, the invention is an ablation catheter assembly comprising the ablation catheter device 100 described herein. The assembly further comprises a flexible bronchoscope 170 comprising an instrument channel (sometimes also called a working channel). As shown in
To solve the problem of the requirement of exact delivery of the rigid metal electrode into the center of a target site in the peripheral lung legion, this invention uses a medical grade liquid metal device instead of using a solid electrode. The liquid metal device acts as an electrode through which RF ablation energy can be applied against the lung tumors. By injecting the liquid metal device into the target site, this will be conforming with the anatomical structures of the target site. Because of this conforming shape of the liquid metal device, there is less risk of damage to the surrounding regions. The liquid metal device is easily removed by aspiration suction without damaging the surrounding regions. Accordingly, the liquid metal 150 acts an independent and flexible electrode within the target site creating larger ablation area.
For more clearly defining herein, the liquid metal device could be stated as being a device suitable for treating cancer comprising one or more conductive metals in liquid form which conducts RF energy to target cancer masses. The preferred liquid metal is gallium based liquid metal. As a metal, it has high conductivity as high as metal, thermal conductivity high enough to be used for thermometer, excellent radio-opacity that can be used as a radio-contrast dye.
Furthermore, it has a very low melting point (15.5° C.), which keeps its liquid form at room temperature. Because of excellent radiopacity and high viscosity, the liquid metal injection into the target site of the bronchial tree is fully controllable under the fluoroscopic guidance. The injected liquid metal is gradually spreading from the proximal part to the distal without interruption according to the injected volume and pushing power. The operator is able to control the amount and extent of the liquid metal injection based on needs.
The pre-defined volume of the liquid metal 150 in the syringe may vary depending on the situation. In some embodiments, the liquid metal 150 has a volume of less than 1.0 ml; in some cases, less than 0.5 ml; and in some cases, less than 0.2 ml. In some embodiment, the syringe contains at least 0.05 ml of the liquid metal device 150. Most of the injected liquid metal is retrievable by bronchoscopic suction or natural expectoration over a few days. By means of fluoroscopic imaging analysis, about 82% of the injected liquid metal is able to be retrieved by active suction or passive expectoration. It is noteworthy that the liquidity of the liquid metal is the solution to eliminate the specific problems related with invasiveness such as puncture related problems, such as pneumothorax, arising from percutaneous approaches with rigid electrode needle, multi-tinned RF needles with poor controllability and unwanted damage coming from malposition electrode, etc.
The liquid metal 150 further comprises one or more conductive metals in liquid form. Examples of liquid metals include gallium, indium, and tin. In some embodiments, the liquid metal 150 comprises gallium. In some embodiments, liquid metal device 150 comprises indium. In some embodiments, the liquid metal 150 comprises a mixture of liquid metals, such as a combination of gallium, indium, and tin. One such example is “Galinstan”, which is an alloy of gallium, indium, and tin. Another example is “eGaln”, which is an alloy of gallium (75.5%) and indium (24.5%).
The target ablation size may depend on the diameter and length of the target airway as well as the number of the subbranches of the target airway. For example, it shows that the less diameter of the target airway, the higher temperature of the ablation.
In some embodiment, the dashed line of
The treatment method for ablating lung tumors uses an approach through the patient's airway. The approach may be referred to as a transbronchial or endobronchial approach. The airway refers to the anatomical lumens through which air passes including the trachea, bronchi, and bronchioles. The system for this method may comprises (a) the ablation catheter, (b) the liquid metal device, (c) the bronchoscope or introducer sheath, and (d) the generator.
The treatment method may comprise inserting a bronchoscope into the target site. The ablation catheter 100 device is advanced to a target airway through the bronchoscope working channel. Then, the target airway is closed by inflating the occlusion balloon. Then, the liquid metal device is instilled into the target airway. RF electric current is applied to the RF conductor element 115. This RF current is transmitted through the liquid metal device to administer tissue-ablating RF energy to the tumor. The liquid metal device is suctioned out of the target site. Suctioning of the liquid material device could be done through the bronchoscope.
As shown in
When the ablation catheter is positioned at the proximal portion of the target airway, the occlusion balloon is inflated and locked to make the target airway a closed space to confine the later injected liquid metal device within the target airway as shown in
When the target airway is closed, the operator instills the liquid metal device into the closed target airway from the syringe as shown in
When the operator makes pressurized injection of the liquid metal device, the liquid metal device is gradually spreading from the proximal part to the distal of the target airway without interruption according to the injected volume and pushing power. The operator may be able to control the amount and extent of the liquid metal device based on needs under the fluoroscopic guidance. For example,
In some embodiment, shown in
In this treatment method, the preferred liquid metal for injection is E-Galn. Since the liquid metal device (i.e., E-Galn) has adequate radiopacity, the device itself can be used as a radiocontrast agent. In addition, the liquid metal device (i.e., E-Galn) has high viscosity and a low melting point (15.5° C.) which keeps its liquid form at room temperature. Because of these attributes of E-Galn, the liquid metal device injection into the target site is fully controllable under the fluoroscopic guidance. In some embodiment, the liquid metal comprises gallium.
By injecting the liquid metal device into the target airway, this will be conforming with the anatomical structures of the target airway as shown in
When the liquid metal device is injected into the target airway, a caution for distancing at least 5-10 mm of the distal tip of the liquid metal device from the pleura or other visceral organs in the sensitive zone may be advised to avoid unnecessary injury outside target site. Our computer simulation model also supports the distancing between the tip of the liquid metal device and the sensitive zone illustrated in
In some embodiments, the liquid metal device 150 is not instilled into any alveoli of the lung to avoid damage to the alveolar sac. The volume of the liquid metal device 150 may depend on various factors, such as the size of the tumor, location of the tumor, number of branches, etc. In some embodiments, the amount of liquid metal device 150 instilled is less than 2.0 ml; in some cases, less than 1.0 ml; and in some cases, less than 0.5 ml. In some embodiments, at least three bronchiole branches of the bronchial airways are instilled with the liquid metal device 150; and in some cases, at least five bronchiole branches.
When the liquid metal device is confined in a closed space within the target site, the operator selects the temperature controlled mode of the RF generator with the desired temperature at 80° C. as ablation mode. Under this ablation mode, the RF conductor of the ablation device configured to allow RF current to pass through the injected liquid metal device in such a way the liquid metal device delivers radio frequency (RF) energy to ablate the tumors. The temperature sensor of the ablation device is configured only to read the activated liquid metal device, and create an RF ablation feedback loop.
Under the RF ablation feedback loop, the RF generator keeps delivering RF energy to the injected liquid metal through the RF connector until the injected liquid metal reaches to 60° C. which the temperature sensor directly reads from the injected liquid metal device. The effective ablation temperature may be defined as 40° C., 50° C., 60° C., 70° C., or 80° C. respectively depending on the anatomical structures.
Although a variety of ablation modes are applicable in each procedure, the temperature controlled mode (set at 80° C.) was preferably used in the procedure by virtue of consistent and effective ablation. The ablation procedure may be terminated if there is any of the following conditions: (1) impedance rises over 250Ω, (2) reaching out to the predetermined time (5, 10, 15 minutes according to the pre-defined procedure plan).
Thanks to its excellent bioavailability, Gallium-based liquid metal has been widely studied in the field of hyperthermic cancer treatment and artificial organ. For medial application, E-Galn can be used in the form of either ‘bulk material’ or ‘microdroplet’ through sonification process. Among them, microdroplet form is related with significant cytotoxicity reaction because it leads to high concentration of gallium and Indium ion release to the solution, in contrast to the bulk form of E-Galn.
In this procedure, the bulk-type E-Galn is used, and our experiments reaffirmed that serum gallium and indium concentrations can be almost negligible in pigs even with intentionally excessive amounts of E-Galn. This result is also consistent with other several studies investigating the direct inject of E-Galn into the tumor for the hyperthermic cancer treatment.
They also performed ISO guideline-directed E-Galn biocompatibility tests with the evidence that E-Galn is safe for intra-tissue injection. In our experiments, a single shot for the effective ablation usually need E-Galn of less than 1 ml. And most of them (about 70˜90%) is able to be directly retrieved by bronchoscopic suction or natural expectoration thereafter. This residual bronchial electrode (E-Galn) amount corresponds to the about hundreds of times less than the amount of E-Galn for intra-tumoral injections in those studies assuming the same body weight. In our experiments, the residual liquid metal device in the target site is not associated with any significant problems in lung either. Regarding indium toxicity, it is well-known that indium is toxic to the lungs, but this occurs only when indium is distributed in the lungs in the form of inhaled gas. This is not the case of the ablation in this procedure.
The descriptions and examples given herein are intended merely to illustrate the invention and are not intended to be limiting. Each of the disclosed aspects and embodiments of the invention may be considered individually or in combination with other aspects, embodiments, and variations of the invention. In addition, unless otherwise specified, the steps of the methods of the invention are not confined to any particular order of performance. Modifications of the disclosed embodiments incorporating the spirit and substance of the invention may occur to persons skilled in the art, and such modifications are within the scope of the invention.
Any use of the word “or” herein is intended to be inclusive and is equivalent to the expression “and/or,” unless the context clearly dictates otherwise. As such, for example, the expression “A or B” means A, or B, or both A and B. Similarly, for example, the expression “A, B, or C” means A, or B, or C, or any combination thereof.
Number | Date | Country | Kind |
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22189768.9 | Aug 2022 | EP | regional |
Filing Document | Filing Date | Country | Kind |
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PCT/IB2022/061712 | 12/2/2022 | WO |
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63285982 | Dec 2021 | US | |
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63358806 | Jul 2022 | US | |
63417600 | Oct 2022 | US |