The present disclosure relates generally to systems, devices and methods for dispensing therapeutic fluids (e.g., insulin) to a patient. In particular, the present disclosure relates to portable infusion devices/systems that can be attached to a body of the patient and have a reusable part and a disposable part.
Medical treatment of some illnesses requires continuous drug infusion into various body compartments, such as subcutaneous and intra-venous injections. Diabetes mellitus patients, for example, require administration of varying amounts of insulin throughout the day to control their blood glucose levels. In recent years, ambulatory portable insulin infusion pumps have emerged as a superior alternative to multiple daily syringe injections of insulin. These pumps, which deliver insulin at a continuous basal rate as well as in bolus volumes, were developed to liberate patients from repeated self-administered injections, and enable them to maintain a near-normal daily routine. Both basal and bolus volumes generally have to be delivered in relatively precise doses, according to an individual prescription, since an overdose or under-dose of insulin could be fatal.
Several ambulatory insulin infusion devices are currently available on the market. Mostly, these devices comprise a housing containing a driving mechanism, a power source, a controller, electronics and other minor components. Such devices generally include a disposable reservoir, configured as a conventional syringe containing insulin, which is received within the housing, and which is replaced every 2-3 days of operation. A disposable infusion set, which includes a distally located needle/cannula assembly including a cannula and a penetrating member, is connected to the reservoir at its proximal end via a fluid communication tube. Usually, the patient fills the syringe with insulin, attaches the infusion set to an exit port of the syringe, and then inserts the syringe into the pump. After purging air out of the syringe and infusion set, the patient subcutaneously inserts the penetrating member and cannula, at a selected location on the body, and withdraws the penetrating member. To avoid irritation and infection, the subcutaneously inserted cannula must be replaced and discarded after 2-3 days, together with the empty syringe. The syringe plunger is driven by a driving mechanism which includes a threaded-rod (also referred to as a “threaded plunger rod” or “threaded piston rod”), a motor, and controller/electronics. Examples of first generation syringe-type dispensing mechanism are described, for example, in U.S. Pat. No. 3,631,847 to Hobbs, U.S. Pat. No. 3,771,694 to Kaminski, U.S. Pat. No. 4,657,486 to Stempfle, and U.S. Pat. No. 4,544,369 to Skakoon, the contents of all of which are hereby incorporated by reference in their entireties. Other dispensing mechanisms have been also discussed, including peristaltic positive displacement pumps, as described, for example, in U.S. Pat. No. 4,498,843 to Schneider and U.S. Pat. No. 4,715,786 to Wolff, the contents of all of which are hereby incorporated by reference in their entireties.
Although these devices represent an improvement over multiple daily injections, they nevertheless all suffer from several drawbacks. One drawback is the large size and weight of the devices, caused by the configuration and the relatively large size of the driving mechanism and syringe. These relatively bulky devices have to be regularly carried in a patient's pocket or attached to his/her belt. Consequently, the fluid delivery tube of the infusion set is very long, usually greater than 60 cm, in order to enable needle/cannula insertion at remote sites of the body. These uncomfortable, bulky devices and long infusion sets are disfavored by the majority of diabetic insulin users, since they disturb regular activities, such as sleeping and swimming. Furthermore, the effect of the image projected on the teenagers' body is unacceptable. In addition, the use of a delivery tube excludes some standard remote insertion sites, like buttocks, arms and legs.
To avoid the noted consequences of a long delivery tube of the infusion set, a new concept of second generation pumps was proposed. This concept included a remote controlled skin securable (e.g., adherable) device with a housing having a bottom surface adapted to contact patient's skin, a reservoir disposed within the housing, and an injection needle adapted to communicate with the reservoir. These skin adherable devices are disposed of every 2-3 days (similarly to other available pump infusion sets). These devices are described, for example, in U.S. Pat. No. 5,957,895 to Sage, U.S. Pat. No. 6,589,229 to Connelly, and U.S. Pat. No. 6,740,059 to Flaherty, the contents of all of which are hereby incorporated by reference in their entireties. Additional configurations of skin securable pumps are described in U.S. Pat. No. 6,723,072 to Flaherty and U.S. Pat. No. 6,485,461 to Mason, the contents of all of which are hereby incorporated by reference in their entireties.
Second generation skin adherable infusion devices suffer from major drawbacks which include, inter alia, the following:
To mitigate the costs issues associated with second-generation devices, and to improve patient's customization of the configuration, functionality and features of their devices, a third generation of skin securable (e.g., adherable) dispensing device was proposed and developed. An example of such a device is described in co-pending/co-owned U.S. patent application Ser. No. 11/397,115 and International Patent Application No. PCT/IL06/001276, the contents of which are hereby incorporated by reference in their entireties. In a third generation device, a dispensing unit is employed, which is composed of two parts: a reusable part, that includes a driving mechanism, electronics, and other relatively expensive components, and a disposable part that includes relatively inexpensive components, such as, for example, a reservoir, a power source (which may form part of the reusable and/or the disposable part, or may be a separate component), etc.
A third generation device provides a more cost-effective solution and enables diverse use of the device. An improvement to a third generation skin securable pump that includes two parts (e.g., a reusable part and a disposable part) is described, for example, in co-pending/co-owned U.S. patent application Ser. No. 12/004,837 and International Patent Application No. PCT/IL07/001578, the contents of which are hereby incorporated by reference in their entireties. These disclosures include embodiments directed to a device and a method for connection and disconnection of a skin adherable dispensing unit. In some such embodiments, the device includes a cradle unit which is initially adhered to the skin. A cannula is then inserted through the cradle unit into the body of the user. Insertion can be done automatically by a designated inserter, or may be done manually. The dispensing unit of the device can also be connected and disconnected to and from the skin-adhered cradle at the patient's discretion. This concept enables versatile operational modes that include manual and automatic cannula insertion, use of cannulae with various lengths, and also enables cannula insertion at various insertion angles. The cradle is disposable and relatively inexpensive, and may be discarded every 2-3 days. Unlike second generation infusion pumps, in the event of site misplacement of the cannula (due to scarred tissue, bleeding, cannula kinking, etc.) only the cradle and cannula need to be disposed of and replaced, rather than the whole device. Consequently, under those circumstances, the reservoir, still containing unused insulin, can be used when the infusion device is connected to a new cradle/cannula arrangement.
Currently available third generation devices nevertheless have a few drawbacks, including:
Embodiments of the present disclosure address one or more of the concerns noted above with respect to prior devices.
In some embodiments of the present disclosure, a therapeutic fluid dispensing device/system includes a skin securable (e.g., adherable) dispensing unit that is small, thin, simple, relatively inexpensive, removably connectable to a cradle unit and capable of remote or manual control.
In some embodiments, a therapeutic fluid dispensing device/system is provided that enables reservoir filling to any desired volume, does not require additional syringe for filling, and contains mechanisms to monitor reservoir volume and alert the patient when remaining fluid volume in the reservoir is low.
In some embodiments, a therapeutic fluid dispensing device/system is provided which can be repeatedly connected and disconnected to and from the body in a safe, reliable, and user friendly manner. Disconnections and reconnections do not affect the dispensing unit components and/or operation, nor harm the surrounding body tissues.
In some embodiments, a therapeutic fluid dispensing device/system is provided which delivers fluid into the body via a soft cannula which is inserted into the body of a user either manually or automatically by a dedicated inserter.
In some embodiments, a therapeutic fluid dispensing device/system is provided which delivers fluid into the body by a soft cannula that can be inserted at any desired angle. The cannula length may be tailored to patients' need.
In some embodiments, a therapeutic fluid dispensing device/system is provided that delivers fluid into the body, where the dispensing device is composed of two parts: a disposable part and a reusable part. The disposable part includes the reservoir and the reusable part includes at least a portion of the driving mechanism and other relatively expensive components. The disposable part may be composed of fewer parts, which are easy to manufacture and assembly and which are relatively inexpensive.
In some embodiments, the disposable part may include a piston-plunger type reservoir system, which is configured as a relatively flat container having a thin profile (e.g., oval-shaped, a profile having 4-arches, etc.). Such a reservoir may serve for drawing fluid from a glass bottle (e.g., insulin vial), and may be filled with various amounts of fluid upon user/patient discretion. Reservoir volume can be monitored and the user alerted to a low volume condition.
In some embodiments, a therapeutic fluid dispensing device/system having a disposable part and a reusable part, where the sealing between the two parts after connection is reliable and does not affect the device's function, is provided.
In some embodiments, a therapeutic fluid dispensing device/system is provided which includes an occlusion sensor to monitor occlusion in the insulin delivery path.
In some embodiments, a device/system that delivers therapeutic fluid into the body is provided which may include a dispensing unit composed of two parts (e.g., a reusable part and a disposable part), a skin securable (e.g., adherable) cradle unit, a cannula cartridge unit, and a remote control unit. The dispensing unit can be connected to and disconnected from the skin securable cradle unit. Fluid delivery programming can be performed by buttons/switches disposed on the dispensing unit or by a remote control unit which communicates with the dispensing unit and enables communication of additional user inputs, data acquisition functionality, and data downloading/transfer operations.
In some embodiments, the device can further include a cannula cartridge unit that can be loaded into a dedicated inserter. The cartridge may include a subcutaneously insertable cannula having a cannula hub at its proximal end, a penetrating member which pierces the skin and is withdrawn after cannula insertion, and a protective case (a “protector”) that contains the cannula and the penetrating member to maintain cannula sterility and to avoid unintentional self-piercing. The cannula cartridge unit is configured to be fitted within a “well” of the cradle unit which, in some embodiments, is a protrusion encircling a passageway enabling the insertion and placement of the cannula in a subcutaneous compartment of the patient's body and rigidly connecting the cannula hub to the cradle. The cannula can be inserted in various angles in relation to the skin surface. The cannula can be configured in various lengths to be tailored to a patient's need.
In some embodiments, the cannula hub proximal end includes a self sealable rubber septum that can be pierced by a connecting lumen that emerges from the outlet port of the dispensing unit for maintaining fluid communication between the reservoir and the subcutaneously placed cannula.
In some embodiments, the cradle unit and/or cannula cartridge unit can be placed manually or by a dedicated insertion device referred-to as “inserter”. Withdrawal of the penetrating member after the subcutaneous insertion of the cannula can be performed manually or automatically by the inserter.
In some embodiments, the dispensing device/unit includes a reusable part including at least a portion of a driving mechanism to drive a plunger or piston, electronics, and other relatively expensive components, and the disposable part includes the relatively inexpensive components such as a reservoir, a fluid connecting tube, an outlet port, a connecting lumen, a piston, and a power source configured to supply power to the dispensing unit. The piston is adapted to be received within the reservoir and is configured to force (displace) therapeutic fluid from the reservoir into a connecting tube. The piston and reservoir are configured to have an oval shape with a thin profile. The disposable part can further include a portion of the driving mechanism.
In some embodiments, the driving mechanism is shared by both parts of the dispensing unit and includes, for example:
In some embodiments, the tip (or “juice extractor”) is configured to fit within the sleeve upon attachment of the reusable and disposable parts. The engagement member is configured to function in two modes: a first mode enabling free movement of the piston rod, and a second mode enabling a controlled movement of the piston rod.
In some embodiment, the first mode of the engagement member enables filling of the reservoir, and the second mode of the engagement member enables linear displacement of the piston received within the reservoir to cause delivery of therapeutic fluid into the patient's body.
In some embodiments, each one of the parts of the dispensing device/unit has a separate housing. The housing of the reusable part may contain a reusable chassis to accommodate various components (e.g., electronics) and the housing of the disposable part may contain a disposable chassis to accommodate the disposable components (e.g., a connecting tube).
In some embodiments, the reservoir and housing(s) of the dispensing device are configured to have a non-circular cross-section (e.g. ellipse, oval, 4 curves, 8 curves) so that the dispensing unit has relatively small dimensions and/or a thin profile.
In some embodiments, the reservoir is an integral part of the housing of the disposable part of the dispensing device.
In some embodiments, the two-part dispensing unit including the driving mechanism with the engagements member, a juice extractor and a sleeve enables the user to fill the reservoir with any desired volume of therapeutic fluid. The reservoir can be filled without use of an auxiliary syringe and may require a dedicated adapter.
In some embodiments, the dispensing unit includes a sensor to monitor the amount of fluid contained within the reservoir. In particular, the sensor can alert the patient when the volume of the fluid contained within the reservoir is low.
In some embodiments, the dispensing unit includes a sensor to monitor occlusion in the connecting tube and/or the cannula. In particular, the sensor can comprise two parts: a reusable sensor portion located in the reusable part and a disposable sensor portion located in the disposable part of the dispensing device.
In some embodiments, the reusable part of a dispensing unit includes connectors to enable electrical connection between a power source located in the disposable part and various energy consuming components, such as electronics, which are located in the reusable part.
In some embodiments, the housing of the dispensing unit includes a vent port/aperture (which may be located in the reusable part) to enable air passage between the internal cavity of the dispensing unit and the surrounding. Such a vent port/aperture may be sealed by a selective membrane to enable air passage while preventing liquids ingression into the internal cavity of the dispensing unit.
In some embodiments, the two part dispensing unit is waterproof after connection of the reusable part and disposable part. Sealing can be achieved by at least one seal/gasket (e.g., a rubber O-ring/gasket) located in the disposable and/or reusable parts.
In some embodiments, the device includes a notifier (i.e., notification mechanism such as one or more types of user output interfaces) to notify/alert the user. The notifier can be, for example, visual (e.g., a display), audible (e.g., a buzzer) or vibratory (e.g., a vibrator), or a combination thereof, and can be located in the dispensing unit, the remote control unit or both.
In some embodiments, the device can further comprise a sensing apparatus (e.g., sensor) to sense and monitor bodily analyte(s), e.g., glucose. The analyte(s) sensing can be performed using electrodes disposed on the cannula. Embodiments which comprise both dispensing apparatus and sensing apparatus can be referred-to as “system” and if fluid is dispensed according to sensed analyte levels, the system can then be referred to as a “closed loop system”.
In some embodiments of the present disclosure, a method to control delivery of fluid to the body of a patient using the above mentioned device/system is described.
In one aspect, a portable therapeutic fluid dispensing device is disclosed. The fluid dispensing device includes a reusable part comprising a reusable part housing including at least a controller and a first portion of a driving mechanism, and a disposable part comprising a disposable part housing including at least a reservoir to retain therapeutic fluid, an outlet port to which the therapeutic fluid is dispensed, a fluid conduit providing fluid communication between the reservoir and the outlet port, and a second portion of the driving mechanism. At least a portion of the disposable part housing defines at least a portion of the reservoir. Also, the second portion of the driving mechanism is mechanically couplable to the first portion of the driving mechanism upon connection of the disposable part to the reusable part.
Embodiments of the fluid dispensing device may include one or more of the following features.
The device may be skin-adherable.
The disposable part housing may include a skin-adherable base configured to receive the reusable part housing.
At least one of the reusable part and/or the disposable part may include at least one chassis configured to be received in the respective one of the reusable part housing and the disposable part housing and provide structural support for one or more components of the respective one of the reusable part and the disposable part.
At least one of a reusable part chassis, the reusable part housing, a disposable part chassis and/or the disposable part housing may include at least one gasket to establish device-sealing condition upon connection of the reusable part and the disposable part.
At least one of a reusable part chassis and/or the reusable part housing may include one or more latches configured to mate with corresponding one or more recesses defined on at least one of a disposable part chassis and/or the disposable part housing such that the reusable part is connectable to the disposable part.
At least one of a reusable part chassis and/or the reusable part housing may include one or more recesses configured to receive corresponding one or more latches included with at least one of a disposable part chassis and/or the disposable part housing such that the reusable part is connectable to the disposable part.
The first portion of the driving mechanism may include at least one of, for example, a motor, one or more cogwheels actuated by the motor and/or a drive sleeve in mechanical connection with the one or more cogwheels such that rotational force transferred by the one or more cogwheels causes rotational movement of the drive sleeve. The one or more cogwheels may form part of a planetary gear system, where the planetary gear system may further include a housing having an interior which is at least partially threaded to house the one or more cogwheels. The drive sleeve may include a hollow cylinder, at least a portion of the hollow cylinder having a plurality of teeth defined along a circumference of the at least the portion of the hollow cylinder, the plurality of teeth configured to mechanically interact with the one or more cogwheels of the first part of the driving mechanism.
The fluid dispensing device may further include one or more monitoring mechanisms to monitor operation of the at least one of, for example, the motor, the one or more cogwheels and/or the drive sleeve. The one or more monitoring mechanisms may include at least one of, for example, a radiation source emitting radiation traveling in a direction substantially perpendicular to the longitudinal axis of a shaft of the motor, a flag wheel including at least one rotatable portion of a disc coupled to the shaft of the motor at a position where, upon rotation of the shaft and the at least one portion of the disc, the flag wheel periodically blocks the emitted radiation from propagating in the direction of radiation and/or a radiation detector positioned to intercept at least some of the radiation emitted by the radiation source when the emitted radiation is not blocked by the at least one portion of the disc. The radiation detector may further be configured to generate a signal in response to detection of the at least some of the radiation and transmit the signal to a processor of the controller to process the signal.
The second portion of the driving mechanism may include at least One of, for example, a piston, a piston rod mechanically coupled at a first end of the piston rod to the piston, a driving tip mechanically coupled to the piston rod at a second end of the piston rod, the driving tip configured to mechanically interact with the first portion of the driving mechanism upon connection of the reusable part and the disposable part, and/or an engagement member coupled to the piston rod, the engagement member configured to selectively enable controlled displacement of the piston rod and substantially unrestricted displacement of the piston rod within at least the reservoir of the disposable part.
The piston rod may include a threaded rod. The piston may further include at least one gasket disposed on the exterior of the piston adapted for at least one of, for example, preventing fluid leakage from the reservoir and/or stabilizing the piston within the reservoir. The at least one gasket disposed on the exterior of the piston may include at least one lubricated gasket to reduce friction with walls of the reservoir. The piston may include a cavity to receive the first end of the piston rod. The cavity of the piston may be connectable to the first end of the piston rod to enable at least one of, for example, pushing of the piston using the piston rod and/or pulling of the piston using the piston rod and/or unrestricted rotation of the first end of the piston rod within the piston cavity. The cavity of the piston may be connectable to the first end of the piston rod such that when connected the cavity and the first end form a snap-fit.
The driving tip may be selected from the group consisting of, for example, a driving tip integrally coupled to the piston rod and/or a modular driving tip manufactured separately from the piston rod and configured to be assembled to the piston rod.
The driving tip may include a plurality of ridges spaced apart from one another along the circumference of the tip, the driving tip being receivable within a drive sleeve of the first portion of the driving mechanism mechanically coupled to a motor through one or more cogwheels. The drive sleeve may include a plurality of grooves within the sleeve, the grooves being spaced apart from one another to correspond to the spacing of the plurality of ridges of the driving tip. The grooves within the drive sleeve may be substantially parallel to the longitudinal axis of the drive sleeve.
The engagement member may be configured for threaded engagement with the piston rod. The engagement member may be further configured to be disengaged from the piston rod to provide substantially unrestricted movement of the piston rod when disengaged from the engagement member. The engagement member may include a first opening and a second opening, at least a portion of the second opening may be threaded. When the engagement member is positioned in a first position, a threaded piston rod may be placed in the first opening and be configured to linearly move substantially unrestricted. When the engagement member is positioned in a second position, the threaded piston rod may be placed in the second opening and be configured to linearly move upon rotation of the threaded piston rod. The engagement member may be displaceable from the first position to the second position by one of, for example, automatic displacement upon connection of the reusable part and the disposable part and/or manual displacement.
The engagement member may further include an extension extending from the engagement member that, when actuated, causes the engagement member to move from the first position to the second position. The extension piece may be actuated by an actuator, resulting from connection of the reusable part and the disposable part. The actuator may include a planetary gear system having one or more cogwheels of the first portion of the driving mechanism.
At least a portion of the disposable part housing may include one or more reinforcing ribs.
At least a portion of the disposable part housing may be transparent. The at least the portion that is transparent may include at least a part of the reservoir.
The at least the portion of the disposable part housing defining the at least a portion of the reservoir may include at least one scale of graduations.
The at least a portion of the reservoir may be lubricated to reduce friction between a piston and walls of the reservoir.
The reservoir may include cross-sectional configuration selected from the group consisting of, for example, a round configuration, an oval configuration, an elliptical configuration, a multi-curved configuration and/or a substantially rectangular configuration.
The piston may include a cross-sectional configuration selected from the group consisting of, for example, a round configuration, an oval configuration, an elliptical configuration, a multi-curved configuration and/or a substantially rectangular configuration.
The fluid conduit may include a channel defined within the disposable part housing.
The fluid conduit may include at least one elastic region. The at least one elastic region may include a tube accommodated in a chassis of the disposable part, where an end of the tube may include a nipple connectable to the disposable part housing to establish fluid communication between the reservoir and the tube upon assembly of the chassis of the disposable part into the disposable part housing.
The reusable part housing may include an aperture defined on an external surface of the reusable part housing, the aperture leading into an internal cavity defined in the reusable part housing to enable air passage into the internal cavity.
The reusable part may further include one or more user-actuated buttons actuatable by a user to specify control instructions for a processor of the controller, the control instructions being related to operation of the fluid dispensing device.
The reusable part may further include a Printed Circuit Board having at least one rigid portion and at least one flexible portion.
The reusable part may further include at least one notifier to generate notifications to a user based on signals transmitted by the controller.
The reusable part may further include a transceiver to perform at least one of, for example, transmitting to a remote control unit and/or receiving transmissions from the remote control unit.
At least one of the reusable part and the disposable part may further include a power source. The reusable part may include a capacitor electrically coupled to the power source, the capacitor configured to store energy provided by the power source.
The disposable part may include the power source, and the reusable part may include electrical connectors electrically coupled to the power source of the disposable part, and at least one electronic component in electrical communication with the power source through the electrical connectors. Each of the electrical connectors may include a first connecting end electrically coupled to the at least one electronic component, and a second connecting end electrically coupled to the power source of the disposable part. The second connecting end of the each of the electrical connectors may include a resilient connecting end configured as a spring. One or more of the reusable part housing and a reusable part chassis configured to be received in the reusable part housing may include a rigid extension accommodating the electrical connectors, the rigid extension configured to provide one or more of, for example, structural support to the electrical connectors and/or protection of the electrical connectors.
The reusable part may further include a mechanism to monitor fluid levels inside the reservoir, the mechanism including at least one energy source, at least one energy detector to detect energy emitted by the at least one energy source and to generate a signal to be processed by a processor, and a regulator to regulate the level of energy received by the at least one energy detector based, at least in part, on the fluid level in the reservoir.
The regulator may include a piston rod displaceable within an inner channel defined in a drive sleeve of the first portion of the driving mechanism. The at least one energy source and the at least one energy detector may be positioned opposite each other and on opposite sides the drive sleeve, and the drive sleeve may have at least one opening establishing an optical path between the at least one energy source and the at least one energy detector when the piston rod does not block the at least one opening.
The at least one energy detector may be configured to detect the emitted energy when the piston rod is linearly displaced within the drive sleeve to a position where the piston rod does not block the at least one opening to enable passage of the emitted energy in the optical path between the at least one energy source and the at least one energy detector.
The mechanism to monitor fluid level may be configured to enable detection of several positions of the piston rod corresponding to several levels of fluid inside the reservoir. The mechanism may include a plurality of energy sources, and a plurality of energy detectors, the drive sleeve including a plurality of sets of opposite openings, and each of the plurality of energy sources may be configured to emit radiation to pass through a corresponding set of the plurality of sets of opposite openings. When not blocked by the piston rod, the emitted radiation may be detected by a corresponding one of the plurality of the energy detectors.
The signal generated by the at least one energy detector may be indicative that the fluid level inside the reservoir reached a predetermined threshold. The processor may be configured to determine, at least in part based on the signal generated by the at least one energy detector, a level of the fluid inside the reservoir, and provide a notification to a user via one or more of, for example, a notification component in the reusable part and a remote control.
The regulator may include a piston rod displaceable within an inner channel defined in a drive sleeve of the first portion of the driving mechanism, the at least one energy source and the at least one energy detector may be disposed on the same side of the drive sleeve. The at least one energy detector may be configured to receive and detect, in accordance with positions of the piston rod, at least some of the energy emitted by the at least one energy source and reflected by surfaces of the piston rod through an opening in the drive sleeve.
The reusable part may further include a mechanism to monitor fluid levels inside the reservoir, the mechanism including a magnetic coil surrounding at least a portion of a drive sleeve of the first portion of the driving mechanism, the drive sleeve configured to receive a piston rod, the piston rod being displaceable within an inner channel defined in the sleeve. At least a portion of the piston rod may include metallic material. Displacement of the piston rod within the drive sleeve may cause a change in the inductance level of the magnetic coil corresponding to a position of the piston rod within the drive sleeve, the position of the piston rod within the drive sleeve corresponding to a respective fluid level in the reservoir.
The fluid dispensing device may further include an occlusion sensor to detect occlusion in a fluid path from the reservoir to a body of a user. The occlusion sensor may include a first portion disposed within the reusable part, the first portion including at least a sensing element and a spring biased platform, and a second portion disposed within the disposable part, the second portion including at least a track formed in a disposable part chassis received within the disposable part housing, the track configured to accommodate at least a portion of a flexible fluid delivery tube of the fluid conduit. The sensing element may be configured to be pressed against the delivery tube upon connection of the reusable and disposable parts such that an increase in the pressure within the delivery tube causes an increase in the forces exerted on the sensing element. The sensing element may further be configured to generate a signal transmitted to a processor of the controller corresponding to the level of sensed forces exerted on the sensing element. When the level of sensed forces exerted on the sensing element exceeds a predetermined threshold, the signal may be indicative that an occlusion state has been reached.
The controller may be configured to provide a notification to a user, in response to receipt of the signal indicative that the state of occlusion has been reached, via one or more of, for example, a notification component in the reusable part and/or a remote control. The controller may be configured to automatically suspend operation of the fluid dispensing device in response to receipt of the signal indicative that the state of occlusion has been reached.
The fluid dispensing device may further include a handle having a first end removeably connectable to the driving tip coupled to the piston rod, and a second end configured to be gripped by a user. The handle may be configured to facilitate pushing and pulling the piston rod into and away from the reservoir.
The fluid dispensing device may further include an analyte sensor to monitor analyte concentration levels in a body of a patient. The fluid dispensing device may be configured to operate in one or more of, for example, a closed-loop mode wherein therapeutic fluid dispensing is based, at least in part, on the monitored analyte concentration levels, a semi-closed loop mode wherein the therapeutic fluid dispensing is based, at least in part, on the monitored analyte concentration levels and input from the patient and/or an open loop mode wherein the therapeutic fluid dispensing is independent of the monitored analyte concentration levels. The fluid dispensing device may further include a subcutaneously insertable cannula configured to deliver the dispensed therapeutic fluid into the body of the patient. The subcutaneously insertable cannula may include the analyte sensor.
In another aspect, a fluid dispensing system is disclosed. The system includes the portable fluid device described above, a remote control unit to control operation of at least the portable fluid dispensing device, and a skin-adherable cradle connectable to the fluid dispensing device such that the fluid dispensing device can be removably connected to the skin-adhereable cradle.
Embodiments of the system may include any one or more of the features described above in relation to the fluid dispensing device, as well as one or more of the following features.
The fluid dispensing system may further include a cannula cartridge unit including a cannula hub having an opening sealed at one end by a self-sealable septum, a cannula having an inner channel, the cannula coupled to the cannula hub at the opening, and a removable penetrating member fitted within the inner channel of the cannula, the removable penetrating member configured to be removed from the cannula upon subcutaneous insertion of the cannula.
The remote control unit may include at least one of, for example, a display and/or operating buttons. The display of the remote control unit may include a touch-sensitive display.
The remote control unit may be adapted to perform at least one of, for example, provide operating instructions to the fluid dispensing device and/or receive from the fluid dispensing device one or more of alerts and/or status indications.
The remote control unit may be implemented using a device selected from a group consisting of, for example, a personal computer, a laptop, a music or multimedia player, a PDA, a cellular phone, a watch and/or a remote control.
The remote control unit may be configured to communicate with the fluid dispensing device using a mode of communication selected from a group consisting of, for example, wireless communication, wired communication, wire line communication, RF communication, IR communication and/or induction-based communication.
The remote control unit may further include an analyte sensor to determine analyte concentration levels in a body of a user. The analyte may include glucose.
The remote control unit may further include a port to receive a test strip containing a blood sample of the user, the analyte sensor being configured to determine the analyte concentration level in the blood of the user.
In a further aspect, a method for dispensing therapeutic fluid is disclosed. The method includes connecting a fluid dispensing device reusable part including a first portion driving mechanism to a disposable part of the fluid dispensing device, the disposable part including a second portion of the driving mechanism. The method also includes controllably actuating the first portion of the driving mechanism to cause the second portion of the driving mechanism to dispense therapeutic fluid contained in a reservoir in the disposable part through an outlet port of the disposable part, the therapeutic fluid delivered to the outlet port through a fluid conduit in the disposable part connecting the reservoir to the outlet port.
Embodiments of the method may include any one or more of the features described above in relation to the fluid dispensing device and the fluid dispensing system.
In another aspect, a method for monitoring fluid levels in a reservoir of a fluid dispensing device having at least a reservoir to retain fluid, a driving mechanism for displacing the fluid from the reservoir, a controller and a mechanism for monitoring fluid levels is disclosed. The method includes activating the driving mechanism and the mechanism for monitoring fluid levels in the reservoir, monitoring the position of a displaceable piston rod of the driving mechanism, generating a signal for processing by a processor of the controller, and determining the level of fluid in the reservoir based, at least in part, on the received signal.
Embodiments of the method may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the above-described methods, as well as one or more of the following features.
The method may further include generating a notification to a user upon determining the level of fluid in the reservoir.
The mechanism for monitoring fluid levels in the reservoir may include at least one component selected from a group consisting of, for example, an energy source, an energy detector, a magnetic coil and/or a “Hall effect sensor”.
In a further aspect, a method for detecting occlusion in a fluid path from a reservoir of a fluid dispensing device to a body of a user is disclosed. The method includes providing a fluid dispensing device comprising at least one reservoir for retaining therapeutic fluid and a flexible fluid delivery tube to deliver the therapeutic fluid, providing an occlusion sensor comprising at least a sensing element pressed against the delivery tube, generating a signal representative of a level of force exerted on the sensing element by the delivery tube as a result of an increase in pressure in the delivery tube, and determining, based on the signal representative of the level of force, if a state of occlusion has been reached.
Embodiments of the method may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the above-described methods, as well as one or more of the following features.
The method may further include generating a notification to the user upon determining that the state of occlusion has been reached.
The method may further include suspending the operation of the fluid dispensing device upon determining that a state of occlusion has been reached.
The occlusion sensor may further include a first portion including at least the sensing element, and a second portion including at least a structure to support the delivery tube. The method for detecting occlusion may further include coupling the first portion to the second portion prior to generating the signal.
In an additional aspect, an adapter to enable transfer of therapeutic fluid to the reservoir of the fluid dispensing device described above is disclosed. The adapter includes a first connecting end for releasable attachment to a container of the therapeutic fluid, and a second connecting end for releasable attachment to the disposable part of the fluid dispensing device.
Embodiments of the adapter may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the above-described methods, as well as one or more of the following features.
The first connecting end may include a needle to pierce a sealing cover of the therapeutic fluid container and establish fluid communication between the container and the adapter. The first connecting end may further include a circular wall defining a depression to receive a circular neck of the therapeutic fluid container.
The second connecting end may include an opening to be fitted into the outlet port of the disposable part. The opening of the second connecting end may be sealed by a self-sealable septum configured to be pierced by a connecting lumen of the disposable part upon connection of the adapter to the disposable part. The opening of the second connecting end may be in fluid communication with a needle in the first connecting end, the needle being configured to pierce a sealing cover of the therapeutic fluid container and establish fluid communication between the container and the adapter.
The second connecting end may further include a wall configured to match contours of the disposable part and to support the adapter against the disposable part housing after connection of the adapter to the disposable part.
In a further aspect, a method for filling a reservoir disposed within a fluid dispensing device with therapeutic fluid is disclosed. The dispensing device has at least a disposable part comprising a housing including a reservoir to retain therapeutic fluid, an outlet port, and a portion of a driving mechanism, the disposable part being connectable to a reusable part having another portion of the driving mechanism. At least a portion of the housing defines at least a portion of the reservoir. The method includes providing the disposable part of the fluid dispensing device, providing an adapter having a first connecting end for releasable attachment to a container of the therapeutic fluid, and a second connecting end for releasable attachment to the outlet port of the fluid dispensing device, and attaching the first connecting end of the adapter to the container of the therapeutic fluid such that a needle of the first connecting end of the adapter pierces a sealing cover of the container and establishes fluid communication between the container and the adapter. The method further includes attaching the second connecting end of the adapter to the outlet port of the disposable part such that a connecting lumen of the outlet port pierces a septum of the second connecting end of the adapter and establishes fluid communication between the adapter and the outlet port. The method also includes pulling a piston rod of the portion of the driving mechanism included in the disposable part to cause at least some of the therapeutic fluid in the container to flow through the adapter and into the reservoir via the outlet port.
Embodiments of the method may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the adapter, the above-described methods, as well as one or more of the following features.
The method may further include pushing the piston rod to remove air from the reservoir.
The method may further include detaching the second connecting end of the adapter from the outlet port of the disposable part.
The method may further include using a handle attached to the piston rod for at least one of, for example, pulling the piston rod and/or pushing the piston rod.
In a further aspect, a fluid level sensor to measure fluid level in a container containing fluid displaced by movement of a driving mechanism is disclosed. The fluid level sensor may include at least one energy source, at least one energy detector to detect energy emitted by the at least one energy source and to generate a signal to be processed by a processor, and a regulator to regulate the level of energy received by the at least one energy detector based, at least in part, on the fluid level in the container.
Embodiments of the fluid level sensor may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the adapter, the above-described methods, as well as one or more of the following features.
The regulator may include a piston rod of the driving mechanism, the piston being displaceable within an inner channel defined in a drive sleeve coupled to a motor of the driving mechanism, the at least one energy source and the at least one energy detector being positioned opposite each other and on opposite sides the drive sleeve, and the drive sleeve having at least one opening establishing an optical path between the at least one energy source and the at least one energy detector when the piston rod does not block the at least one opening.
The at least one energy detector may be configured to detect the emitted energy when the piston rod is linearly displaced within the drive sleeve to a position where the piston rod does not block the at least one opening to enable passage of the emitted energy in the optical path between the at least one energy source and the at least one energy detector.
In another aspect, a fluid level sensor for monitoring fluid levels inside a reservoir containing fluid displaced by movement of a driving mechanism is disclosed. The fluid level sensor includes a magnetic coil surrounding at least a portion of a drive sleeve coupled to a motor of the driving mechanism, the drive sleeve configured to receive a piston rod of the driving mechanism, the piston rod being displaceable within an inner channel defined in the sleeve. At least a portion of the piston rod includes metallic material. Displacement of the piston rod within the drive sleeve causes a change in the inductance level of the magnetic coil corresponding to a position of the piston rod within the drive sleeve, the position of the piston rod within the drive sleeve corresponding to a respective fluid level in the reservoir.
Embodiments of the fluid level sensor may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the adapter, the first described fluid level sensor and the above-described methods.
In yet an additional aspect, an occlusion sensor to sense a state of occlusion occurring within a fluid path including at least a fluid delivery tube is disclosed. The occlusion sensor includes a sensing element configured to be pressed against the fluid delivery tube, the sensing element further configured to generate a signal representative of a level of force exerted on the sensing element by the delivery tube as a result of an increase in pressure in the delivery tube.
Embodiments of the occlusion sensor may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the adapter, the fluid level sensors, the above-described methods, as well as one or more of the following features.
The occlusion sensor may further include a controller to determine if the state of occlusion has been reached based on the signal generated by the sensing element that is representative of the level of force exerted on the sensing element, the controller being further configured to perform, upon determining that the state of occlusion has been reached, one or more of, for example, provide a notification to a user that the state of occlusion has been reached and/or automatically suspend fluid delivery operations.
In another aspect, an adapter to facilitate transfer of fluid from a first container containing the fluid to a second container disposed in a housing is disclosed. The adapter includes a first connecting end for releasable attachment to the first container of the fluid, the adapter including a needle to pierce a sealing cover of the fluid container and establish fluid communication between the first container and the adapter. The adapter also includes a second connecting end for releasable attachment to a port on the housing.
Embodiments of the adapter may include any one or more of the features described above in relation to the fluid dispensing device, the fluid dispensing system, the first adapter described above, the fluid level sensors, the occlusion sensor, the above-described methods, as well as the following feature.
The second connecting end may include an opening to be fitted into the port of the housing, the opening of the second connecting end being sealed by a self-sealable septum configured to be pierced by a connecting lumen of the housing to establish fluid communication between the adapter and the second container disposed in the housing.
Throughout the entirety of the present disclosure, use of the terms “comprising”, “including,” “containing,” and any other similar synonymous terms, is inclusive or open-ended and does not exclude additional, non-recited or non-described elements or operations.
Throughout the entirety of the present disclosure, use of particular terminology is not intended to restrict or narrow in anyway whatsoever the descriptions and embodiments of the present disclosure. Rather, embodiments and descriptions that could have been described using synonymous and/or equivalent terminology are also contemplated as coming within the scope the present disclosure and/or the claims.
Details of one or more implementations are set forth in the accompanying drawings and in the description below. Further features, aspects, and advantages will become apparent from the description, the drawings, and the claims.
Embodiments of the present disclosure are described with reference to the accompanying drawings. In the drawings, like reference numbers indicate identical or functionally similar elements.
a-2c are schematic diagrams of a fluid delivery system including a dispensing device that can be composed of one part (2a) or two-parts (2b), and can further include a cradle unit and cannula cartridge unit (2c).
a-3d are views and diagrams of a fluid dispensing device/unit that can be composed of two parts and can be secured to the skin of a patient.
a-4c are views and diagrams of a skin adherable cradle unit and a dispensing unit connected to the cradle unit.
a-5c are views and diagrams of a fluid dispensing device and facilitating operation of the dispensing device via a remote control unit (5a) and via buttons located on the dispensing device (
a-6c are schematic cross-sectional diagrams of an arrangement of a skin adherable cradle unit and cannula cartridge unit and the insertion/placement of the cannula through the cradle and into the body.
a-7b are views and diagrams of a skin adherable cradle unit.
a-8b are views and diagrams of a cannula cartridge unit.
a-10b are views and diagrams of an insertion device.
a-11b are schematic diagrams of a dispensing unit composed of a single part (11a) or two parts (11b), employing a plunger/piston pumping mechanism.
a-12e are schematic diagrams of a two-part dispensing device (or unit) composed of a reusable part and disposable part, that is connectable to a skin adherable cradle unit.
a-14b are views and diagrams of a disposable part composed of a housing and a chassis.
a-15c are views and diagrams of a housing of a disposable part.
a-16b are diagrams of a four (4) curves shaped reservoir.
a-17b are diagrams of an oval-like shaped reservoir.
a-18b are diagrams of an elliptic shaped reservoir.
a-19b are diagrams of a round shaped reservoir.
a-20d are views of a disposable part, including an exploded view of a disposable part chassis and disposable components (20a) and the disposable part housing (20b) with views (20c-20d) that depict the fluid flow path.
a-21c are views and diagram of a piston.
a-23b are views and diagrams of a connected piston and piston rod.
a-24c are views and diagrams of an engagement member and a piston rod.
a-25f are diagrams depicting a procedure of drug drawing and reservoir filling using an adapter, and performing a subsequent flow path priming.
a-26f are diagrams depicting a procedure of drug drawing and reservoir filling using an adapter.
a-27c are views and diagrams of an adapter.
a-28c are views and diagrams of disposable parts having various transparent windows and graduations scales for fluid level monitoring.
a-30b are views and diagrams of a reusable part that includes a housing and chassis.
a-33b are views and diagrams of a rigid-flex PCB in its folded (33a) and spread (33b) configurations.
a-35b are views and diagrams of a planetary gear.
a-37c are views of a drive-sleeve that include a perspective view (37a), a cross sectional view (37b) and a cross-sectional view of a tip (“juice extractor”).
a-40b are views and diagrams of a two-part dispensing device before connection, and an automatic engagement mechanism.
a-41b are views and diagrams of a two-part dispensing device after connection, and an automatic engagement mechanism.
a-42b are views of the automatic engagement mechanism before and after connection of a disposable part and a reusable part.
a-43f are diagrams and views of a dispensing unit electrical circuit and the electrical coupling between a power source of the disposable part and electronics of the reusable part.
a-44c are views and diagrams of a reservoir level indicator operating according to relative movement of a piston rod and a sleeve employing an optical sensor (
a-45b are diagrams of a reservoir level indicator operating according to the relative movement of a piston rod and a sleeve employing magnetic induction sensor.
a-46e are diagrams of an occlusion sensor deployed in a two-part dispensing unit.
a-48b are views of a disconnected dispensing unit and sealing gaskets on a disposable part housing (shown in
a-49c are diagrams of a remote control unit of the fluid delivery system, including a screen with GUI (
The present disclosure generally relates to delivery of therapeutic fluid(s) to patients and in particular, to portable therapeutic fluid dispensing/delivery/infusion devices (as used herein, the terms dispensing, delivery and infusion are interchangeable), systems and methods for delivery of a therapeutic fluid (e.g., insulin) to a patient. In some embodiments, a fluid delivery device comprises a fluid dispensing unit which includes a reusable part and a disposable part, and may also include a remote control unit. The reusable part generally contains the relatively expensive components, such as electronics, at least a portion of driving mechanisms (and in some embodiments, all the components of driving mechanisms), sensors, motors and various other components. The disposable part is configured to include a reservoir for retaining therapeutic fluid (e.g., insulin), a connecting tube for delivery of the therapeutic fluid, a piston/plunger structure (the terms piston and plunger may be used herein interchangeably) for pumping fluid from the reservoir to the body, and, in some embodiments, a power source to provide power to at least one of the reusable part and the disposable part of the fluid delivery device. The disposable part can also be configured to include a portion of the driving mechanism, so that the driving mechanism is being shared by both parts (disposable and reusable).
In some embodiments, the power source can be located in the reusable part. In some embodiments, a power source can be located in both parts. An example of a fluid dispensing unit composed of two parts is described in co-pending/co-owned U.S. patent application Ser. No. 11/397,115 and International Patent Application No. PCT/IL08/001057, the contents of which are hereby incorporated by references in their entireties. An example of a fluid dispensing unit having a rechargeable power source located in the reusable part is disclosed in co-pending/co-owned International Patent Application No. PCT/IL09/000266, the content of which is hereby incorporated by reference in its entirety.
The disposable part and/or at least some of its components are generally replaced after a relatively short pre-determined period of time (e.g., after two-three days, one week, or any other suitable time), or after delivery of a pre-determined amount of therapeutic fluid.
In contrast, the reusable part and/or at least some of its components are generally replaced after a longer period of time than the disposable part (and/or its components), for example, after three months, six months or any other suitable time. In some embodiments, any component of the fluid delivery device may be replaced whenever it is malfunctioning.
In some embodiments, a fluid delivery system is provided which, in addition to including a fluid dispensing unit, further comprises a skin securable (e.g., adherable) cradle unit and a remote control unit. The dispensing unit can be connected to and disconnected from the skin securable cradle unit. The remote control unit communicates with the dispensing unit to communicate programming commands and instructions, user inputs, notifications and acquired data.
The fluid delivery system may further include a cannula cartridge unit which comprises a cannula, a penetrating member including a sharp instrument (i.e. needle) to pierce the skin and which is withdrawn after cannula insertion, and a cannula hub. The cannula cartridge unit is configured to be fitted within a “well” of the cradle unit which includes a protrusion that encircles a passageway to facilitate the insertion and placement of the cannula in a subcutaneous compartment of the patient's body and rigidly anchor the cannula hub to cradle. In some embodiments, the cannula can be inserted in various angles with relation to the skin surface. The cannula may be further configured in various lengths to be tailored to a patient's need.
The cradle unit, cannula cartridge unit, and the disposable part of the dispensing unit may be disposable (e.g., may be discarded after 2-3 days). The remote control is generally a durable unit and may be replaced, if necessary, every five years, ten years, or any other relatively long period of time.
In some embodiments, a fluid delivery device/system is provided which comprises a dispensing apparatus for fluid delivery (e.g., insulin) and a sensing apparatus (sensor) to sense body analytes (e.g., glucose). In some embodiments, a subcutaneously insertable element comprises a cannula for fluid delivery and/or a probe for analyte sensing. The subcutaneously insertable element can be used for both dispensing and sensing functionalities. Thus, under such circumstances, the modules/components configured to perform dispensing and sensing operations are implemented using a single device requiring only a single insertion site.
Referring to
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Referring to
The cannula cartridge unit 400 includes a cannula 404 and a penetrating member 406. The cannula 404, configured, in some embodiments, as a soft cannula made of, for example Teflon®, may be adapted to be coupled to an opening of a cannula hub 403 having a self-sealing rubber septum 402 through which the penetrating member 406 is inserted. The penetrating member 406 (as further shown in detail in
b illustrates the cannula cartridge unit 400 after insertion. The cannula hub 403 is placed within the well 30 so that the penetrating member 406 is piercing the skin 5 and the cannula 404 is inserted in the body. The cannula hub 403 is snap-fitted within the well 30 by operation of the latches 32, 34.
c illustrates the cradle unit 20 adhered to the skin 5, with the penetrating member 406 removed. The cannula 404 is placed within the subcutaneous tissue and secured to the cradle unit 20, and a penetrating member 406 which includes a dagger 407 having the sharp tip 410, and the grip 408 is extracted from the cannula cartridge unit 400 to leave the cannula 404 subcutaneously inserted in the body.
Referring to
The cradle unit 20 can further include a frame 39 (as shown in
In some embodiments, the cradle base 37 may comprise apertures/cavities to, for example, improve the adherence/attachment of the cradle unit 20 to the skin 5 surface, prevent moisture confinement between the cradle unit 20 and skin 5, and to enable access to the skin (to relieve any skin irritation by, for example, scratching).
The cradle base 37 can be made of, for example, plastic materials such as polyethylene, polycarbonate or any other suitable material. The material may be, at least in part, transparent to enable the user to see the skin 5 under the base 37 after adherence of the cradle unit 20 to the skin 5. Use of at least partially transparent materials may be important in situations where the cannula 404 has been improperly inserted and locally injured the tissue, for example, when the penetrating member 406 accidentally punctures a blood vessel during cannula 404 insertion, causing hematoma. The user may then remove the cradle unit 20, discard it, and secure another, unused cradle unit, in another insertion site. By discarding only the cradle unit (that is configured to enable connection and disconnection of a dispensing device), a costly discarding of skin adherable insulin pumps (which include the insulin contained therein) may be avoided.
Referring to
In some embodiments, the cannula cartridge unit 400 further comprises a protector 450, as illustrated in
Adherence of the cradle unit 20, insertion of the cannula cartridge unit 400 and subcutaneous placement of the cannula 404 can be performed either manually or by a dedicated insertion device 500, referred-to as “inserter”, shown in
Alleviation of pain and discomfort during skin piercing may be achieved by using pain reduction mechanism (not shown), as described, for example, in co-pending/co-owned International Patent Application No. PCT/IL08/000861, the content of which is hereby incorporated by reference in its entirety.
Referring to
a depicts a single-part dispensing device 10. The fluid is delivered from a reservoir 220 to the outlet port 210. Received within the reservoir 220 is a piston 110 which urges the reservoir's fluid towards the outlet port 210. The reservoir 220 is in fluid communication with the outlet port 210 via a connecting tube 230. Actuation of the piston 110 (and thus displacement of the fluid in the reservoir 220) is performed by a driving mechanism 120 which includes a motor (e.g. a stepper motor, a DC motor, an SMA actuator or the like), and gears for driving the piston 110. The driving mechanism further includes a piston rod 112 which is mechanically coupled to a piston 110. The driving mechanism 120 can be controlled by various electronic modules, including controller/processor (e.g., CPU, MCU) and transceiver, collectively designated using common reference numeral 130. A suitable power source 240 is also provided, and can include one or more batteries, a capacitor to store electrical energy, etc. In some embodiments, the power source 240 may be rechargeable. Infusion programming and control can be performed, for example, by a remote control unit 900 (not shown in
b illustrates a two-part dispensing device 10 (when the two parts are disconnected) comprising a reusable part 100 and a disposable part 200. The two-part dispensing unit 10 is implemented using a plunger/piston pumping mechanism.
The reusable part 100 may comprise at least a portion of the driving mechanism 120 (e.g., motor and gears), electronic components/modules collectively designated as common reference numeral 130, one or more buttons 15, and may further include other relatively expensive components such as sensors.
The disposable part 200 may comprise the relatively inexpensive components, including, for example, a reservoir 220, provided with a piston 110 which is coupled to a piston rod 112, a power source 240, an outlet port 210, a connecting lumen 250 (not shown in
Infusion programming can be performed by a remote control unit 900 (not shown in
Referring to
e illustrates the disconnection of the dispensing device 10 from the cradle unit 20. Details regarding various configurations of connection/disconnection mechanisms to connect/disconnect a dispensing unit to a cradle unit are provided, for example, in co-pending/co-owned U.S. patent application Ser. No. 12/004,837 and International Patent Application No. PCT/IL07/001578, the contents of which are hereby incorporated by reference in their entireties.
Referring to
The disposable part 200 is provided with an outlet port 210 having a connecting lumen 250 (not shown in
The disposable part 200 may further include a power source 240 (e.g., a battery) which supplies electrical voltage/current to at least the reusable part (not shown in
Referring to
In some embodiments, the disposable chassis is assembled as a module ready for easy and convenient assembly with the disposable housing by inserting the chassis into the housing. The easy assembly approach may be used with either one or both of the disposable housing and its housed components and the reusable housing its housed components.
Referring to
The perimeter of the housing 202 may be asymmetrical and have two corners (204 and 201) and may include different curvatures. For example, the corner 204 may have an approximated sharper angle at the side of the reservoir 220, and the corner 201 may have a curve defining a smaller angle on its other side. Such an arrangement enables optimization of the volume of the reservoir 220 and the fitting of a piston within it. At least a portion of the reservoir may include one or more reinforcing ribs, which may be integral with the housing 202, but which may also be supplied as a separate reinforcing structure either within the reservoir 220 or external thereto. Such an embodiment is illustrated in
With reference again to
In some embodiments, the housing 202 may include a supporting structure to protect the recessed portion 203 of the housing 202 from external pressure that might cause undesired and uncontrolled fluid delivery to the patient's body, as shown in
In some embodiments, the housing 202 is constructed from plastic material such as polyethylene, and may be, at least partly, transparent (see
In some embodiments, the cross-section of the disposable part 200 may define a multi-curve shape. Such curved structures, when used to in defining the structure of the reservoir section within the housing, improve sealing and/or overall operability of the piston pump. Such curved sections create a rigid structure that provides adequate support and protection to the components disposed inside the disposable part 200. Such a curved structure is illustrated in
Specifically, in some embodiments, the reservoir 220 may have a cross section defined by a four-curved geometry, as shown in
In some embodiments, the reservoir 220 has either oval-shaped, ellipse-shaped or multi-curved cross section.
Referring to
In some embodiments, a dispensing device 10 fitted with such multi-curved, oval or elliptical reservoirs will generally have a thin profile, to thus provide a patient with a miniature, comfortable and discreet pump. Such thin profiles have, in some embodiments, thicknesses of less than 12 mm.
Referring to
a-19b show some examples of reservoir/housing/piston arrangements. In some embodiments, the dispensing unit 10 may employ one or more reservoirs 220, configured in various shapes, designs and dimensions.
Referring to
b depicts the connection of the tube nipple 234 with the opening of a fluid channel/tunnel 232 disposed inside the walls of the housing 202. The channel 232 may be provided with two openings: one opening 232a to connect with the tube nipple 234 and another opening 232b (not shown in
Referring to
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As illustrated in
The small opening 290 is configured to friction fit the threaded piston rod 112 in order to lock the rod 112 relative to member 286 and prevent free movement thereof. In some embodiments, the small opening 290 may include a plurality of threads (shown in
Referring to
In some embodiments, an adapter 8 is used to connect the container 6 to the outlet port 210, as shown in
During the filling procedure, the patient draws back the piston rod 112 to pump the therapeutic fluid from the container 6 to the reservoir (as shown in
In some embodiments, the patient may be required to push air from the reservoir into the sealed container 6 prior to drawing therapeutic fluid, to pressurize the container 6 and facilitate an easy and low-resistant drawing of therapeutic fluid from the container 6 into the reservoir 220.
In some embodiments, the patient can grip the tip 288 to pull the piston rod 112. In some embodiments, during the filling procedure, pulling the piston rod 112 can be performed by a dedicated auxiliary handle 18, as shown in
Once the filling procedure is completed, as illustrated in
As illustrated in
Referring to
As illustrated in
Referring to
c is a cross-section view of the adapter 90 illustrating how the fluid flows within the adapter 90 from the adapting needle 966 to the opening 92, thus establishing fluid path between the container and the connecting lumen of the disposable part. The sharp end 966b of the adapting needle 966 resides within the inlet port of the adapter 96 and is positioned such that it can pierce the septum of the fluid container. A distal end 966a of the adapting needle 966 is associated with the opening 92 in the female end of the adapter 90 to enable fluid to flow from the adapting needle 966 to the opening 92, and vice versa. As mentioned above, the opening 92 is provided with a septum 94 that can be pierced by the connecting lumen of the disposable part. The sharp end 966b of the adapting needle 966 is, in some embodiments, fully concealed within the depression defined by the border wall and is therefore, under those circumstances, not readily accessible by the user. Concealment of the sharp end 966b can thus prevent inadvertent puncture of the user. Further examples of adapters such as adapter 90 are described, for example, in co-pending/co-owned U.S. patent application Ser. No. 11/989,680, the content of which is hereby incorporated by reference in its entirety. It is to be noted that an adapter such as the adapters described herein (including the adapter 90) may be used in conjunctions with other types of fluid dispensing devices. Furthermore, adapters such as those described herein, may be used in conjunctions with other types of devices/systems (e.g., devices/systems where it may be necessary or desirable to transfer fluid from one container to another container/housing) and not just with fluid dispensing devices.
To enable a user to view the amount of fluid within the reservoir (e.g., during filling of the reservoir), at least a portion of the reservoir walls may be transparent. At least one scale of graduations 206 can be marked/printed along the reservoir 220 in various locations, as shown in
c illustrate the reusable part and its components. Referring to
In some embodiments, the sleeve 186 is configured to receive the piston rod 112 of the disposable part 200 upon connection of the reusable part 100 and the disposable part 200, and to transfer rotational movement to the tip 288 of the piston rod 112 and the piston rod 112. The reusable part 100 may further includes electronics, designated with the reference numeral 130, and may comprise one or more of, for example, a controller, a processor, a transceiver, an antenna, etc.
In some embodiments, the reusable part 100 may include connectors to establish electrical communication between a power source 240 (e.g., a battery) located, for example, in the disposable part, and the reusable part's electronics 130 (as illustrated in
In some embodiments, the reusable part 100 may also include sensors, including sensors to determine the amount of therapeutic fluid in the reservoir (shown in greater detail in
In some embodiments, the reusable part 100 may comprise further a notification mechanism (e.g., visual/audible/vibrational notifiers), as shown in greater detail in
In some embodiments, the reusable part 100 may include seals/gaskets to prevent seepage of liquid and/or contaminants into the dispensing unit 10 when the reusable part 100 and the disposable part 200 are connected and operable. This is described in greater detail in
Referring to
In some embodiments, the reusable chassis 181 is assembled as a module that is ready for easy and convenient assembly with the reusable housing 102 by inserting the chassis 181 into the housing 102. Similar modular assembly may also be implemented for disposable housings and their components.
Referring to
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As further shown in
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As noted, in some embodiments, various parts/components of the driving mechanism may be coupled to one or more monitoring mechanisms to monitor operation of, for example, the motor, the cogwheels and/or the drive sleeve. Referring to
Various configurations of a monitoring mechanism are also described in co-pending/co-owned International Patent Application No. PCT/IL08/000642, the content of which is hereby incorporated by reference in its entirety.
a-37c illustrate a sleeve 186 structured as a hollow cylinder having inner teeth 85 along the interior of the cylinder and an outer rim 84 having gear teeth. The inner teeth 85 may be structured to form grooves disposed along the sleeve. The grooves are generally uniformly configured throughout the length of the sleeve to enable proper linear movement of the tip of the piston rod within the sleeve. As shown, these grooves may substantially traverse the length of the sleeve 186, and one or more grooves (and in some embodiment, all the grooves) may be arranged parallel to the longitudinal axis of the sleeve 186.
The inner teeth 85 of the sleeve (a cross-sectional view of which is shown in
An outer rim 84 of the sleeve 186 may include gear teeth configured to interact with teeth of other rotary gears such as the gear 182c of the planetary gear 182 (shown in
Referring to
Referring to
In some embodiments, engagement of the engagement member 2861 can be performed automatically (rather than manually as described above).
Upon connection of the disposable part 200 and reusable part 100, as shown in
a-42b further depict the engagement member 2861 and its engagement functionality. The actuating component (or “actuator”) which presses the leaf 2910 may be the planetary gear 182 which is located in the reusable part 100.
Referring to
c illustrates an assembled dispensing unit 10 when the reusable part 100 is connected to the disposable part 200. As shown, when connected, the distal ends 243a and 243b of the connectors 242a and 242b come in contact with the electrical contacts of the power source 240 to enable current flow between the disposable part 200 and the reusable part 100.
In some embodiments, the connectors 242a and 242b can be located in the disposable part 200. Generally, however, connectors such as the connectors 242a and 242b are included within the reusable part 100 to reduce manufacturing costs of the disposable part 200.
In some embodiments, the connectors 242a and 242b may be mechanically durable and be resistant to mechanical fatigue resulting from recurrent connection and disconnection of the connectors 242a and 242b to the power source 240. For example, if a reusable part 100 is replaced every three months, and a disposable part 200 is discarded every three days, the connectors 242a and 242b will be connected and disconnected with the power source 240 at least thirty times. The protruded connectors 242a and 242b may also be exposed to unintentional mechanical wear and tear when the two parts of the dispensing unit 10 are disconnected (as illustrated in
Referring to
The connectors 242a and 242b are, in some embodiments, manufactured from a flexible material. The connectors, or at least their distal ends, may be structured to be resilient (e.g., may be configured as springs) so as to be able to connect and disconnect to and from the power source 240 without harming the power source's structure and operability, and to ensure establishment of proper mechanical contact between the connectors 242a and 242b and the electrical contacts of the power source 240 within a pre-determined range of possible varying spatial locations of the components. For example, a difference in the dimensions of a battery-based power source may be inherent to the power source's production process (e.g., two batteries from the same production line may slightly differ in their dimensions, for example, in their width dimension). In another example, differences in battery dimensions may be a result of chemical processes which occur inside the power source during its lifetime (i.e., the same battery may increase in its width dimension during its lifetime due to chemical processes, such as oxidation-reduction in fuel cells). The connectors 242a and 242b can be manufactured from thin metal strips, for example, stainless steel. In some embodiments, the distal ends of the metal strips are aligned with the edge of the rigid extension 102a, and the spring is formed either by folding the distal end of the strip or, as illustrated in
In some embodiments, the connectors 242a, 242b may be configured (through selection of, for example, materials with appropriate chemical properties) to prevent corrosion, etching, etc., which can harm their electrical functionality of transferring current/voltage therethrough. Construction of the connectors may include using different coatings, applying appropriate surface treatment procedures, etc.
a-44c illustrate a sensor 160 that can be used to determine fluid levels in a reservoir 220. The sensor 160 can alert/notify the user (either by displaying an alert/a notification on the dispensing unit 10 and/or a remote control unit 900, and/or by any other notification mechanisms) that it is time to replace the disposable part 200 and/or the reservoir 220. Such an alert and/or a notification may be generated when the reservoir fluid level has reached a certain pre-determined threshold level. The sensor 160 can also alert/notify the user as to how many units of therapeutic fluid are left in the reservoir 220 as shown, for example, in
With continued reference to
In some embodiments, the sleeve 186 can be configured to have a plurality of aligned and opposite apertures (not shown), e.g., four (4) aligned pairs of apertures, similar to the apertures 66, 666. This plurality of apertures may be associated with corresponding light sources and detectors (similar to the source 55 and detector 555) to enable monitoring of several positions of the piston rod 112. This arrangement can thus be used to frequently monitor the amount of therapeutic fluid contained within the reservoir 220. In some embodiments, an array of sources and a corresponding array of detectors can be positioned along the sleeve 186. The sleeve can be structured to include a corresponding arrays of apertures, or include a longitudinal slit (not shown) to facilitate light passage.
In some embodiments (not shown in the figures), the sensor 160 can include a light source and a detector that can be positioned on the same side of the sleeve 186. Longitudinal slit(s)/aperture(s) provided in the sleeve 186 enable passage of emitted light into the interior of the sleeve 186. Thus, for example, if the piston rod 112 is located inside the sleeve 186 (i.e., the reservoir has some therapeutic fluid), the light is reflected from the piston rod and is detected by the detector. If the piston rod 112 is retracted from a portion of the sleeve (i.e., the reservoir fluid level has reached the predetermined threshold), the light emitted by the source passes through the slit/apertures and is not detected by the detector. Once light is no longer detected by the detector, the detector may send a signal to a controller/processor of the dispensing unit. The processor controller/processes this signal and may communicate an alert to the patient to replace the disposable part/reservoir (or otherwise advise the patient of how much of the therapeutic fluid remains in the reservoir), either by displaying a message on the remote control unit's display, and/or generating an audio signal and/or a vibrational signal, and/or alerting the patient in any other way. Alternatively and/or additionally, the tip 288 of the piston rod can be used to reflect light, for example, by virtue of white coloring of tip 288.
Referring to
In some embodiments, other detection mechanism methodologies and techniques may be implemented to determine the reservoir fluid level based on, for example, magnetic signals (e.g., the Hall Effect), capacitance differentiation, mechanical detection, etc.
Referring to
In some embodiments, the occlusion sensor 140 can be located in the reusable part 100 of a two-part dispensing device or may be shared between both parts (100, 200).
a illustrates a dispensing device/unit 10 comprising two parts: a reusable part 100 having at least a portion of the occlusion sensor 140, and a disposable part 200 having a portion of the occlusion sensor 140 and a connecting tube 230. The reusable part 100 includes a sensing element 142 and a spring biased slider 144 coupled to the sensing element 142. The sensing element 142 is electrically coupled to the electronics 130, (e.g., a processor-based device). The connecting tube 230 of the disposable part 200 is disposed at least in part within a track 246 of the sensory mechanism. The track 246 can be an integral portion of the disposable chassis 281.
b-46e illustrate the occlusion sensor 140 when the disposable part 200 is disconnected from the reusable part 100 (as shown in
Referring to
When an occlusion occurs, the pressure within the tube 230 increases, thus causing the resilient and flexible tube 230 to inflate resulting in an increase in the forces exerted on the sensing element 142. The force (pressure) is measured by the sensing element 142, which transmits to the processor/controller a signal corresponding to the measured force, and when a pre-determined threshold value is exceeded, the processor/controller (e.g., of the electronics 130) determines that an occlusion occurred. The processor/controller then causes a notification signal to be generated that is used to notify the user that an occlusion has occurred and that the cannula, the cradle and/or the disposable part 200 has to be replaced. The controller may automatically halt/suspend the operation of the dispensing unit 10 in response to receipt of a signal indicative of an occlusion state in the fluid path from the reservoir 220 to the user/patient. The user may disconnect the operating dispensing unit and inspect the unit to eliminate the possibility of an occlusion in the portion of the fluid path residing within the disposable part 200. Appearance of drops at the tip of the connecting lumen of an operating dispensing unit may indicate that a distal occlusion exists, and that consequently, only the cannula and cradle need to be replaced. Notification can be visual, audible, vibrational, etc., and can be made via the dispensing unit 10, the remote control unit 900 or both.
In some embodiments, the sensing element 142 can be configured as a tactile/force/pressure sensor. Further descriptions of occlusion sensors in fluid delivery devices are provided, for example, in co-pending/co-owned U.S. patent application Ser. No. 11/810,854, the content of which is hereby incorporated by reference in its entirety.
Unlike conventional occlusion sensors for infusion pumps which monitor the driving mechanism, a occlusion sensing mechanism that is predicated on the behavior of a connecting tube in a device employing a plunger/piston-like pumping mechanism facilitates quick and sensitive occlusion detection. Detection of an occlusion according to the present disclosure can occur within minutes to a couple of hours after the occlusion condition has occurred. In contrast, in conventional sensory mechanisms, occlusion is typically detected twelve (12) or more hours after the occurrence of an occlusion.
In some embodiments, the sensor 140 requires that the connecting tube 230 have certain mechanical, physical and chemical characteristics (e.g. diameter, resiliency, bio-compatibility) to enable occlusion detection using the connecting tube 230, as described in co-pending/co-owned International Patent Application No. PCT/IL08/000864, the content of which is hereby incorporated by reference in its entirety.
In some embodiments, the fluid delivery device/system can communicate with the user to notify the user of alerts, alarms, errors, status, etc. Notification can be performed in various ways such as visual, audible, vibrational and/or the like.
Visual notification can be made by employing the display/screen 906, such as a Liquid Crystal Display (“LCD”) of the remote control unit 900, as shown for example in
In some embodiments, visual notification can be further provided in the dispensing device's display, for example, a display located in the reusable part 100 in a two-part dispensing device, as described for example in co-pending/co-owned International Patent Application No. PCT/IL08/001057, the content of which is hereby incorporated by reference in its entirety.
Audible notification can be employed in the remote control unit 900, and may be configured as a “beep” sound or as a tailored ringtone associated with a specific function/notification/message. Audible notifications can be further employed in the dispensing unit 10. A buzzer can be located on the housing of the dispensing unit 10. In a two-part dispensing unit 10, the buzzer is preferably located in the reusable part 100. The buzzer can be coupled either to the external side or to the internal side of the housing.
As illustrated in
In some embodiments, the aperture/port 199, which enables air flow into the internal cavity of the dispensing device 10, is also required to facilitate operation of a power source, such as a power source comprising one or more Zinc-air batteries, and also facilitate achieving pressure equilibration, and enhancing buzzer sound, as described in co-pending/co-owned International Patent Application No. PCT/IL08/000999, the content of which is hereby incorporated by reference in its entirety.
In some embodiments, the dispensing device 10 is sealed and waterproof (to eliminate the ingression of liquids, e.g., water). The extent of sealing may conform, for example, to IPX8 performance standard, and may be determined based on the dispensing unit's requirements to operate in different conditions, such as rain conditions, operating in a bath, etc. Thus, the aperture/port 199 is, in some embodiments, sealable. This can be done by providing the aperture/port 199 with a selective membrane (e.g. Gore-Tex®) which enables air/gas passage but prevents liquids ingression. A sealable aperture/port of a dispensing unit is described in co-pending/co-owned International Patent Application No. PCT/IL08/001000, the content of which is hereby incorporated by reference in its entirety.
In some embodiments, the two-part dispensing unit 10 may further require sealing between the disposable part 200 and the reusable part 100 to prevent ingression of liquids into the internal cavity of the dispensing unit 10 (which may, for example, harm the electronic components and cause irreversible damage to the dispensing unit).
a-48b illustrate the sealing and the secure connection of the two parts (100 and 200).
b illustrates a reusable part 100 provided with a peripheral protrusion 2222 which is coupled to the seal/gasket 222 of the disposable part 200 upon connection of the reusable part 100 and the disposable part 200 to seal the dispensing unit. The reusable part 100 can be also provided with a seal/gasket 223 which supports the reusable chassis 181 within the housing 102 of the reusable part and seals the interface therebetween. The seal/gasket 223 can be disposed either on the housing 102 or the chassis 181 of the reusable part 100. Thus, at least one of the reusable part housing, the chassis of the reusable part, the disposable part housing and/or the chassis of the disposable part may include a seal or a gasket such that upon connection of the reusable part to the disposable part, a device sealing condition is established.
As illustrated in
In some embodiments, a securable connection between the two parts (100 and 200) is implemented using a snap-fit arrangement that includes one or more latches 261 and 262 provided at the disposable chassis and/or the housing of the disposable part, as shown in
In some embodiments, the extension 102a of the reusable part 100 can provide further support for the alignment and connection of the two parts (100 and 200) upon connection and disconnection.
In some embodiments, further supporting and/or strengthening of the sealing and/or connection of the two parts (100 and 200) may be performed by adhesion, ultrasonic soldering, laser welding, etc., of the various components of the dispensing device/unit (as well as the cradle and/or cannula cartridge units).
Referring to
Referring to
The remote control unit 900 can communicate operating/control instructions (e.g., basal and/or bolus fluid dispensing commands) to a controller (e.g., the processor comprising part of electronics 130) of the dispensing unit 10 and/or receive messages (e.g., alerts and warnings) from the processor (e.g., such messages including low battery warning, low volume of fluid in reservoir warning, etc.). The remote control unit 900 can also display such instructions, warnings, and alerts, as well as display current state of the device (e.g., dispensing bolus dose of insulin). For example, the remote control unit 900 can indicate basal dosage rates of insulin dispensing (e.g., 1.6 U/hr). As described above, such dispensing rates (whether bolus or basal) may be dispensed by the linear movement of the piston rod 112. The display of the remote control unit 900 can also indicate progress of dispensing of the bolus, as well as, enable the user to stop dispensing of insulin (see
The remote control unit 900 can communicate with the dispensing unit 10 via wireless communication as well as by any other suitable communication methodologies, for example induction, RF transmission, IR transmission, etc., as well as by wired communication. Communication between the remote control unit 900 and dispensing unit 10 can be unidirectional (i.e., one-way communication) or bi-directional (i.e., two-way communication).
In some embodiments, the remote control unit 900 may be implemented using a PC, a laptop, a watch, a cellular phone, a music or multimedia player (e.g., an iPod), a Personal Digital Assistant (“PDA”) or any other suitable remote commander/controller.
In some embodiments, the remote control unit 900 may include a glucose sensor which is coupled to the remote control unit 900, as illustrated in
In some embodiments, the remote control unit 900 can further include dedicated software elements (computer program products) to cause a processor to of the remote control unit to perform such operations as bolus selection procedures, as described, for example, in U.S. patent application Ser. No. 12/051,400, the content of which is hereby incorporated by references in its entirety, and Carbohydrate-to Insulin Ratio (“CIR”) estimation as described, for example, in co-pending/co-owned International Patent Applications Nos. PCT/US08/07703 and PCT/IB08/003,185, the contents of which are hereby incorporated by references in their entireties.
In some embodiments, the fluid delivery device/system can further comprise a sensing apparatus to monitor bodily analyte(s) e.g., monitoring of concentration levels of glucose in the interstitial fluid (“ISF”). The sensing apparatus may comprise sensing elements, dedicated processing elements, delivery modules and components, etc. Sensing of the analyte(s) can be performed within the body (“in vivo”) or outside the body, and may be performed by various techniques such as optical techniques, electrochemical techniques, etc. The sensing apparatus can measure analyte concentration at measurement rates (or frequencies) that are either continuous, semi-continuous, periodic or discrete.
A sensing apparatus may include at least two electrodes to sense the concentration level of glucose in the ISF, and are disposed proximate to the distal end of the cannula so that when the cannula is subcutaneously inserted, the electrodes are also subcutaneously inserted. The electrodes generate electrical signal representative of the glucose level which is electrically transferred (by wires and/or disposed conductors) to a processing element located in the dispensing unit (e.g., in an electronics module, such as any of the electronics 130 described herein, in the reusable part of a two-part dispensing unit). Such a sensing apparatus is described in detail in co-pending/co-owned U.S. patent application Ser. No. 11/963,481, the content of which is hereby incorporated by reference in its entirety.
In some embodiments, a dispensing apparatus and sensing apparatus (constituting a “system”) is configured to operate in one or more of a closed loop, an open loop, or a semi-open loop mode. In a closed loop mode, an analyte concentration is sensed by a sensor and determined by a processor, and based on the determined concentration, the processor generates commands to cause a dispensing apparatus to dispense one or more therapeutic fluids to the human body. In an open loop mode, the sensing and dispensing functions are not linked. A device/system which operates in this mode could indicate a value for the determined analyte concentration, but no feedback control is exercised over the rate of dispensing. A user interface, or other ways by which a user can communicate commands to the device, enables the user to dispense the therapeutic fluid. In the semi-closed mode, the sensing occurs as described above for the closed loop mode. However, the device/system can wait for confirmation from a user, or alternatively can request such confirmation, possibly via a user interface, before dispensing the therapeutic fluid in the amounts that might be needed based on the determined analyte concentration.
Example embodiments of the methods and components of the present disclosure have been described herein. As noted elsewhere, these example embodiments have been described for illustrative purposes only, and are not limiting. Other embodiments are possible and are covered by the disclosure. Such embodiments will be apparent based on the teachings contained herein. It is also understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other embodiments are within the scope of the following claims.
The present application is a 35 U.S.C. §371 national stage entry of PCT/IL2009/000388, which has an international filing date of Apr. 7, 2009 and claims priority to U.S. Provisional Patent Application No. 61/123,509, filed in the U.S. Patent & Trademark Office on Apr. 9, 2008. The present application incorporates herein by reference the disclosure of each of the above-referenced applications in its entirety.
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PCT/IL2009/000388 | 4/7/2009 | WO | 00 | 2/25/2011 |
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WO2009/125398 | 10/15/2009 | WO | A |
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