1. Technical Field
The present invention relates to a simulated biological organ.
2. Related Art
In recent years, it has become common to improve surgical operating skills by practicing on simulated organs of the human body. An example of a simulated organ is found in JP-A-2012-203153, which proposes a simulated human organ surrounding simulated human blood vessels. The proposed simulated human organ consists of an initial simulated human muscle layer, a simulated parenchyma tissue layer overlying the simulated muscle layer, and a simulated skin layer on the simulated parenchyma tissue. In the proposed simulated human organ, the hardness relationship of the layers is defined after stacking the simulated muscle layer, the simulated parenchyma layer, and the simulated skin layer so as to simulate a human body part surrounding blood vessels.
An operation technique, or procedure, suitable for practice on a simulated organ includes using an injection needle to puncture from the surface of a simulated skin layer down to a simulated blood vessel in the simulated organ, but operating procedures suitable for practice on simulated organs are not limited to injections. Other operation techniques suitable for practice on simulated organs include incision cutting into flesh) or excision (removal of flesh), particularly when the procedure is performed close to (e.g. along the periphery of) a simulated blood vessel. Of particular interest are operating procedures conducted with the use of a water jet scalpel. In this type of operation procedure (when the incision or the excision is performed on a simulated parenchyma along the periphery of a simulated blood vessel by using a pulse jet from a water jet scalpel), it is desirable that the simulated blood vessel not be damaged. It is therefore desirable that the simulated organ be able to indicate whether any damage would have been done to a human blood vessel by the operating procedure being practiced.
Although the simulated organ disclosed in JP-A-2012-203153 is suitable for practicing the purposeful puncturing of a the blood vessel by use of an injection needed (e.g. application of a point-puncturing force), effects to a blood vessel due to a non-injection operation procedure conducted along its periphery is not taken into consideration. For example, when an incision, excision or other non-injection operating procedure is performed along the periphery of a human blood vessel, an extending force (or stretching force or pressure) can sometimes be applied to the blood vessel, which may cause damage to the blood vessel.
It is therefore an object of the present invention to provide a simulated organ that more closely mimics the behavior of human tissue and thus capable of indicating damage to a simulated blood vessel resulting from such an extending force, or from other forces resulting from an operating procedure conducted along the periphery of a simulated blood vessel.
An advantage of some aspects of the invention is to provide a simulated organ which is suitable for operation practice on the assumption that incision or excision is performed on a simulated parenchyma in a simulated blood vessel periphery.
The invention can be implemented as the following forms.
(1) An aspect of the invention provides a simulated organ. The simulated organ includes a simulated blood vessel that simulates a human blood vessel, and a simulated parenchyma that simulates a human parenchyma cell. The simulated blood vessel is embedded in the simulated parenchyma. The simulated blood vessel has pressing pin breaking strength that is not less than three times that of the simulated parenchyma. In the present simulated organ, even if a force sufficient for breaking the simulated parenchyma is applied to the simulated parenchyma along the periphery of the simulated blood vessel such that the force is also applied to the simulated blood vessel, the simulated blood vessel will not be damaged. Therefore, according to the present simulated organ, an operation status can be provided on the assumption that incision or excision is performed on the simulated parenchyma in the simulated blood vessel periphery.
(2) Preferably, the pressing pin breaking strength per unit area of the simulated parenchyma is 0.01 MPa to 0.07 MPa, and the pressing pin breaking strength per unit area of the simulated blood vessel is 0.1 MPa to 0.3 MPa. With this configuration, an operation status can be provided in which a relationship of breaking strength with regard to a human cerebral parenchyma and a human cerebral blood vessel embedded therein is reflected.
The invention can be implemented in various forms in addition to the above-described configurations. For example, the invention can be implemented as a manufacturing method of the simulated organ.
The invention will be described with reference to the accompanying drawings, wherein like numbers reference like elements.
The liquid ejecting apparatus 20 includes a control unit (i.e. controller) 30, an actuator cable 31, a pump cable 32, a foot switch 35, a suction device (e.g. vacuum) 40, a suction tube 41, a liquid supply device (i.e. liquid supply, or liquid supplier, or liquid reservoir) 50, and a handpiece 100.
The liquid supply device 50 includes a water supply bag 51, a spike needle 52, a plurality of connectors (preferably first to fifth connectors 53a to 53e), a plurality of water supply tubes (preferably first to fourth water supply tubes 54a to 54d), a pump tube 55, a clogging detection mechanism (i.e. clog detector) 56, and a filter 57. The handpiece 100 includes a nozzle unit (i.e. nozzle) 200 and an actuator unit (i.e. actuator) 300. The nozzle unit 200 includes an ejecting tube 205 and a suction pipe 400.
The water supply bag 51 is preferably made of a transparent synthetic resin, and the inside thereof is filled with a liquid (preferably, a physiological saline solution). In the present application, the water supply bag is called a “water supply bag” 51 even if it is filled with liquids other than water. The spike needle 52 is connected to the first water supply tube 54a via the first connector 53a. If the spike needle 52 is stuck into the water supply bag 51, the liquid filling the water supply bag 51 is in a state where the liquid can be supplied to the first water supply tube 54a.
The first water supply tube 54a is connected to the pump tube 55 via the second connector 53b. The pump tube 55 is connected to the second water supply tube 54b via the third connector 53c. The tube pump 60 pinches the pump tube 55. The tube pump 60 feeds (i.e. pumps) the liquid from the first water supply tube 54a side to the second water supply tube 54b side through the pump tube 55.
The clogging detection mechanism 56 detects clogging inside the first to fourth water supply tubes 54a to 54d by measuring pressure inside the second water supply tube 54b.
The second water supply tube 54b is connected to the third water supply tube 54c via the fourth connector 53d. The filter 57 is connected to the third water supply tube 54. The filter 57 collects foreign substances contained in the liquid.
The third water supply tube 54c is connected to the fourth water supply tube 54d via the fifth connector 53e. The fourth water supply tube 54d is connected to the nozzle unit 200. The liquid supplied through the fourth water supply tube 54d is intermittently ejected from a distal end of the ejecting tube 205 by driving the actuator unit 300. The liquid is intermittently ejected in this way. Accordingly, it is possible to ensure excision capability using a small flow rate.
The ejecting tube 205 and the suction pipe 400 configure a double tube in which the ejecting tube 205 serves as an inner tube and the suction pipe 400 serves as an outer tube. The suction tube 41 is connected to the nozzle unit 200. The suction device 40 applies suction to the inside of the suction pipe 400 through the suction tube 41. The suction is applied to the liquid or excised fragments in the vicinity of the distal end of the suction pipe 400.
The control unit 30 controls the tube pump 60 and the actuator unit 300. Specifically, while the foot switch 35 is stepped on (i.e. actuated or switched on), the control unit 30 transmits a drive signal via the actuator cable 31 and the pump cable 32. The drive signal transmitted via the actuator cable 31 drives a piezoelectric element (not illustrated) included (i.e. housed) in the actuator unit 300. The drive signal transmitted via the pump cable 32 drives the tube pump 60. Accordingly, while a user steps on the foot switch 35, the liquid is intermittently ejected. While the user does not step on the foot switch 35, no drive signal is transmitted and liquid ejection is stopped.
Hereinafter, a simulated organ will be described. The simulated organ is also called a phantom, and is an artificial product of which a portion is excised by the liquid ejecting apparatus 20 in the present embodiment. The simulated organ according to the present embodiment is used in performing a simulated operation, such as for the purpose of a performance evaluation of the liquid ejecting apparatus 20, practicing manipulation of the liquid ejecting apparatus 20, and the like.
With reference to
The first case member 641 and the case second member 642 are manufactured by using a material having sufficient rigidity for supporting the flexible member 620 and the simulated blood vessel 630 (iron, aluminum, a hard resin, or the like). In order to have the above-described sufficient rigidity, the first case member 641 and the second case member 642 are formed of a material having a sufficiently higher elastic modulus compared to the flexible member 620. Preferably, the elastic modules of the first case member 641 and the second case member 642 are at least 2 times greater than that of the flexible member 620.
In the present preferred embodiment, the case 640 is constructed of a transparent resin material. Since the case 640 is preferably transparent, the flexible member 620 is visible from a side surface of the case 640.
The flexible member 620 is arranged inside a cylindrical recess formed in a central portion of the case 640. The flexible member 620 is formed of two sub-members such that a first flexible sub-member 621 and a second flexible sub-member 622 are stacked on each other. The flexible member 620 has a recessed region so that the simulated parenchyma 610 can be held therein, and has a cylindrical cup shape (i.e. an open cylinder with a sealed base). The flexible member 620 is formed of a material which is softer than that of the case 640 and harder than that of the simulated parenchyma 610. The flexible member 620 according to the present embodiment is formed of a material whose pressing pin (e.g. point-puncturing) breaking strength is five times that of the simulated parenchyma 610, and whose elastic modulus is also five times that of the simulated parenchyma 610.
The simulated parenchyma 610 is an artificial product that simulates a parenchyma (parenchyma cell(s)) which is a cell (or tissue) having a fundamental (or characteristic) physiological function of a human body organ (for example, a human brain, liver, or the like). According to the present embodiment, the simulated parenchyma 610 simulates a cerebral parenchyma cell of a human body, and is arranged in the cylindrical recess formed in the central portion of the flexible member 620. The simulated parenchyma 610 is a target portion of incision and excision using the liquid ejecting apparatus 20.
The simulated blood vessel 630 is an artificial product that simulates a cerebral blood vessel of the human body. The simulated blood vessel 630 is held by the case 640, and is embedded in the simulated parenchyma 610. The simulated blood vessel 630 preferably penetrates the simulated parenchyma 610, the flexible member 620, and the case 640. As stated above, the simulated blood vessel 630 may collectively represent multiple blood vessels. In the present case, simulated blood vessel 630 preferably represents three separate blood vessels: the first simulated blood vessel 631, the second simulated blood vessel 632, and the third simulated blood vessel 633, all of which are preferably arranged substantially horizontal.
The first simulated blood vessel 631 and the second simulated blood vessel 632 are arranged so each crosses the third simulated blood vessel 633 at a distinct, respective “interception point”. The first simulated blood vessel 631 and the second simulated blood vessel 632 are preferably arranged parallel to each other, and thus do not cross (or “intercept”) each other. The term “intersection point” is used herein to describe a crossing point where the first simulated blood vessel 631 and the second simulated blood vessel 632 respectively cross the third simulated blood vessel 633 on separate plains. That is, the term intercepting point is used herein to loosely refer to what would be a true interception point of two simulated blood vessels on separate plains if the simulated blood vessels were projected onto a common surface (i.e. plain) S (
According to the embodiment, the first to third simulated blood vessels are arranged so that the three are not parallel to each other. The first simulated blood vessel 631 and the second simulated blood vessel 632 are arranged parallel to each other. The third simulated blood vessel 633 is preferably arranged so that it crosses the first simulated blood vessel 631 and second simulated blood vessel 632 at an angle of 45° on a horizontal plane. The third simulated blood vessel 633 is preferably on a higher plain than the first 631 and second 632 simulated blood vessels so that the third simulated blood vessel 633 crosses the first simulated blood vessel 631 and the second simulated blood vessel 632 in an overhead crossing manner. At any given crossing point, the third simulated blood vessel 633 is located over the first simulated blood vessel 631 or the second simulated blood vessel 632 (refer to
Hereinafter, physical properties of the simulated parenchyma 610 and the simulated blood vessel 630 will be described. The simulated blood vessel 630 is preferably manufactured as a hollow member by using polyvinyl alcohol (PVA). As is known, the strength of the PVA can be changed by changing manufacturing conditions thereof. According to the present embodiment, the manufacturing conditions of the PVA are defined so that the pressing pin breaking strength of the simulated blood vessel 630 becomes 0.2 MPa, and the strength of the blood vessel is determined as follows.
It is known that pig cerebral tissues and a pig cerebral blood vessel, specifically a cerebral parenchyma having the blood vessel embedded therein, have strength characteristics that are substantially the same as those of a human. Therefore, as a substitute for testing on human brains, various attributes of the simulated parenchyma 610 are based on pig cerebral tissues and pig cerebral blood vessels. For example, a target strength (pressing pin breaking strength per unit area: 0.2 MPa) of the simulated blood vessel 630 is determined by using the pig cerebral tissue as a reference. In addition, the diameter of the blood vessel is set to 00.2 mm to 0.8 mm which simulates the cerebral blood vessel of a human body. A strength measuring machine (such as the Table-top Material Tester EZ-S manufactured by Shimadzu Corporation) may be used to measure the strength, as is described later.
The strength of the simulated parenchyma 610 can be changed by changing the manufacturing conditions of the PVA. According to the preferred embodiment, the pressing pin breaking strength per unit area (hereinafter, simply referred to as pressing pin breaking strength) of the simulated parenchyma 610 is set not greater than one third that of the simulated blood vessel 630. In other words, the simulated blood vessel 630 has breaking strength which is approximately three times (or more) greater than that of the simulated parenchyma 610. As described previously, according to the present embodiment, the pressing pin breaking strength of the simulated blood vessel 630 is preferably defined as 0.2 MPa. Accordingly, the strength of the simulated parenchyma 610 is adjusted by changing the manufacturing conditions of the PVA so as to obtain a pressing pin breaking strength in a range of 0.01 MPa to 0.07 MPa.
Both test samples of the simulated parenchyma test sample 610S and the simulated blood vessel test sample 630S are respectively and separately placed on a test table (not illustrated) of the above-described strength measuring machine 800, and are individually subjected to the strength test. The strength measuring machine 800 applies a pressing force of the load cell 810 to the simulated parenchyma test sample 610S or to the simulated blood vessel test sample 630S being subjected to the strength test, via the pin 820. In the strength test, the pin 820 is pressed and deformed until the simulated parenchyma test sample 610S or the simulated blood vessel test sample 630S breaks. The pressing force of the pin 820 during this deformation process is measured from the load cell 810 on a real time basis. The pin 820 used in measuring the pressing pin breaking strength of the simulated blood vessel test sample 630S which is the test sample of the simulated blood vessel 630 has a preferred pin diameter of 0.5 mm, and is pressed onto the test samples at a preferred pressing speed of 1 mm/s. The pin 820 used in measuring the pressing pin breaking strength of the test sample 610S which is the test sample of the simulated parenchyma 610 has a preferred pin diameter of 1.0 mm. The pin 820 is pressed into the test samples at a preferred pressing speed of 1 mm/s.
As illustrated in
F=2R{E/(1−ν2)}δ (1)
In Equation (1), F represents the pressing force, R represents the radius of the pin tip of the pin 820, E represents an elastic modulus, ν represents Poisson's ratio, and δ represents the pressing depth. It is preferable to set the depth δ1 to a value having such a degree that the value approximates the gradient of the data in a linear region of the data. On the other hand, the Hertz Sneddon equation is effective in a case where the depth δ is sufficiently smaller than the radius R of the pin tip (R=0.25 mm or 0.5 mm, depending on which pin is currently being used, which in turn depends on which of the simulated blood vessel test sample 630S or simulated parenchyma test sample 610S is being tested). Accordingly, it is preferable to set the depth δ1 so as to be sufficiently smaller than the radius R of the pin tip. If Equation (1) is modified, Equation (2) is obtained as follows.
E={(1−ν2)/2R}(F/δ) (2)
In Equation (2), F/δ represents the data gradient. The Poisson's ratio ν can employ 0.49 as an estimate value, based on the fact that the simulated parenchyma test sample 610S and the simulated blood vessel test sample 630S are both substantially incompressible. The radius R of the pin tip is known as described above. The simulated parenchyma test sample 610S and the simulated blood vessel test sample 630S are tested using different pins having different radii R. Accordingly, it is possible to calculate a pressing pin elastic modulus E of the simulated parenchyma test sample 610S or the simulated blood vessel test sample 630S by measuring the data gradient.
As illustrated in
P=Fmax/(πR2) (3)
Through the above-described test, the manufacturing conditions of the simulated blood vessel 630 are adjusted in a manufacturing process (to be described later) so as to obtain a strength which is close to the above-described preferred pressing pin breaking strength (0.2 MPa) for the simulated blood vessel 630. The simulated blood vessel 630 is manufactured by using a material prepared in this way. In addition, various adjustments of the PVA are performed on the simulated parenchyma 610 in the manufacturing process (to be described later) so as to obtain the above-described preferred pressing pin breaking strength (0.01 MPa to 0.07 MPa) for the simulated parenchyma 610.
Next, the first flexible sub-member 621 is inserted into the recess of the first case member 641, see
Next, the simulated blood vessel 630 is manufactured (Step S730). As a material for the simulated blood vessel 630, the embodiment employs polyvinyl alcohol (PVA). If desired in the present embodiment, the simulated blood vessel 630 may be a hollow member, and thus, the following manufacturing method can be employed. According to the method, an outer periphery of an extra fine wire is coated with the PVA prior to curing, and the extra fine wire is pulled out after the PVA is cured. The outer diameter of the extra fine wire is aligned with the inner diameter of the blood vessel. The extra fine wire is made of metal, and may be formed of a piano wire, for example. In manufacturing the simulated blood vessel 630 by using the PVA, as described previously, the manufacturing conditions of the PVA are adjusted so as to obtain a pressing pin breaking strength of 0.2 MPa. The simulated blood vessel 630 is formed by using the PVA whose manufacturing conditions have been adjusted, and by using an extra fine wire, such as a piano wire. In a case where the first simulated blood vessel 631, the second simulated blood vessel 632, and the third simulated blood vessel 633 are set to be different simulated blood vessels, extra fine wires of different diameters may be used.
Next, the simulated blood vessel 630 is arranged (Step S740).
A gap G, i.e. separation, between the first simulated blood vessel 631 and the second simulated blood vessel 632 is preferably set to a distance a little larger than the diameter of the suction pipe 400 (for example 1.25 to 2.5 times larger) (refer to
Next, the second case member 642 is fixed to the first case member 641 (Step S750). Specifically, as illustrated in a lower section in
Next, the second flexible sub-member 622 is manufactured (Step S760). The manufacturing method is the same as the manufacturing method (Step S710) of the first flexible sub-member 621. However, the second flexible sub-member 622 has a shape different from that of the first flexible sub-member 621. It has a ring shape. Accordingly, step S760 uses a die different from that used in Step S710.
Once constructed, the second flexible sub-member 622 is inserted into a hole (i.e. the opening formed within the perimeter) of the second case member 642 (Step S770).
Next, the simulated parenchyma 610 is manufactured and arranged (Step S780) (e.g. poured into the opening defined by the inner perimeter of flexible member 620 so as to engulf the simulated blood vessel 630).
Immediately before the simulated organ 600 is used after Step S780 is completed, the simulated parenchyma 610 and an upper portion of the flexible member 620 are excised, i.e. removed, (Step S790) preferably so as to be substantially flush with the upper surface of case second member 642. In this manner, the simulated organ 600 illustrated in
An excision test of the simulated parenchyma 610 is performed on the obtained simulated organ 600. This excision test may be performed in order to evaluate the performance of the liquid ejecting apparatus 20 illustrated in
The simulated organ 600 according to the above-described embodiment is configured so that the pressing pin breaking strength of the simulated blood vessel 630 is equal to or greater than three times that of the simulated parenchyma 610. Accordingly, when practicing incision and excision skills on the simulated parenchyma 610 illustrated in
The simulated organ 600 according to the above-described embodiment is configured so that the pressing pin breaking strength of the simulated parenchyma 610 is 0.01 MPa to 0.07 MPa, and the pressing pin breaking strength of the simulated blood vessel 630 is 0.2 MPa, which is approximately equal to, or greater than, three times that of the simulated parenchyma 610. If the pressing pin breaking strength is set in this way, the simulated parenchyma 610 has a physical property of strength that is substantially the same as that of the cerebral parenchyma cell in the brain of a human body. The simulated blood vessel 630 also has the physical property of strength that is substantially the same as that of a human cerebral blood vessel embedded in a human cerebral parenchyma. Therefore, according to the simulated organ 600 in the embodiment, an operation status can be provided in which a relationship of the breaking strength with regard to the cerebral parenchyma cell in the brain of the human body and the cerebral blood vessel embedded therein is reflected.
Without being limited to the embodiment, the example, and the modification example which are described herein, the invention can be implemented according to various configurations within the scope of the invention without departing from the present invention. For example, technical features (details) in the embodiment (s) and modification example (s) that correspond to technical features according to aspects of the invention can be appropriately replaced or combined with each other in order to partially or entirely solve the previously described problem or in order to partially or entirely achieve the previously described advantageous effects. If any one of the technical features is not described herein as essential, it may be possible for the technical feature to be omitted. For example, the following configurations can be adopted as an alternative.
In the above described simulated organ 600, the simulated blood vessel 630 is embedded in a simulated parenchyma 610, and the pressing pin breaking strength of the simulated blood vessel 630 is 0.2 MPa, which is approximately equal to, or greater than, three times that of the simulated parenchyma 610. However, the pressing pin breaking strength may be a value other than 0.2 MPa. For example, it may be 0.1 MPa to 0.3 MPa. In this case, the pressing pin breaking strength of the simulated parenchyma 610 may also need to be adjusted.
In the above described simulated organ 600, the simulated blood vessel 630 is embedded in a simulated parenchyma 610 that together simulate human brain tissue (i.e. a human cerebral parenchyma and a human cerebral blood vessel). However, organs other than human brain tissue can be simulated. In this case, the pressing pin breaking strength of the simulated blood vessel 630 may be adjusted to reflect those of the other tissue being simulated. Alternatively, the pressing pin breaking strength of the simulated blood vessel 630 may be set to value that just high enough to avoid damage during a practiced surgical procedure.
If the strength can be measured in a form of the simulated blood vessel 630 by using measurement specifications in the strength measuring machine, the pressing pin breaking strength of the simulated blood vessel 630 may be directly measured. In this case, the pressing pin breaking strength measured in both test samples described above may be supplemented by a ratio between the sheet thickness and the thickness of the simulated blood vessel 630.
An excise procedure may be applied to the simulated organ 600 using a surgical tool other than the intermittently ejected liquid. For example, the simulated organ 600 may be excised by using a continuously ejected liquid, or may be excised by using a liquid provided with excision capability using an ultrasound. Alternatively, the simulated organ 600 may be excised by using a metal scalpel.
The number of simulated blood vessels 630 may be one, two, four, or more. A configuration may be adopted in which at least one simulated blood vessel 630 is embedded in the simulated parenchyma 610.
In addition, in the above-described embodiments, the simulated blood vessel 630 is hollow, but the simulated blood vessel may alternatively be made solid.
The construction material (s) of the simulated blood vessel 630 is not limited to that in the above-described example. For example, a synthetic resin other than PVA (for example, urethane) may also be used, or a natural resin may also be used.
The material of the simulated parenchyma 610 is not limited to that in the above-described example. For example, a synthetic resin other than PVA (for example, urethane or a rubber-based material) may also be used.
The simulated blood vessel 630 may be manufactured by using injection deposition (3D printing using an ink jet method).
The simulated parenchyma 610 may be manufactured by using 3D printing.
The simulated blood vessel 630 and the simulated parenchyma 610 may be collectively manufactured by using 3D printing. When 3D printing is performed in this way, an ink may be adjusted in advance so that the above-described strength relationship between the simulated parenchyma 610 and the simulated blood vessel 630 is realized after the ink is dried.
The preferred embodiment adopts a configuration in which a piezoelectric element is used as a actuator. However, the embodiment may adopt a configuration in which liquid is ejected by using an optical maser, a configuration in which the liquid is ejected by a heater generating air bubbles in a liquid, and/or a configuration in which liquid is ejected by a pump pressurizing liquid. According to the configuration in which the liquid is ejected by using the optical maser, the optical maser emits radiation at the liquid so as to generate the air bubbles in the liquid, and using the resultant increased liquid pressure.
According to the embodiment, the second case member 642 is fixed onto the first case member 641, thereby configuring the case 640, but the configuration is not limited thereto. Any configuration that fixes the first case member 641 to the second case member 642 so as to prevent unwanted movement relative to each other may be adopted. Alternatively, a configuration may also be adopted in which two members are connected to each other using frictional force generated by the two case members coming into contact with each other, or a configuration may also be adopted in which the two members are attachable to and detachable from each other.
The embodiment adopts a configuration in which the simulated blood vessel 630 is embedded in the simulated parenchyma 610 traversing the simulated parenchyma 610, the flexible member 620, and the case 640, but the configuration is not limited thereto. A configuration may also be adopted in which the simulated blood vessel 630 traverses at least one of the simulated parenchyma 610, the flexible member 620, and the case 640, or a configuration may also be adopted in which none of the members is traversed. Any configuration may be adopted in which at least a portion of the simulated blood vessel 630 is embedded in the simulated parenchyma. In addition, the embodiment adopts a configuration in which the simulated blood vessel is fixed to the case 640, but the configuration is not limited thereto. A configuration may also be adopted in which the simulated blood vessel is less likely to move by coming into close contact with the simulated parenchyma without being fixed to the case 640.
Number | Date | Country | Kind |
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2015-150669 | Jul 2015 | JP | national |