The present disclosure relates generally to medical fluid delivery applications, and, particularly, to fluid injection systems including a fluid injector, a syringe, and a plunger within the syringe. More particularly, the present disclosure is directed to a syringe plunger with a dynamic seal.
In many medical diagnostic and therapeutic procedures, a medical practitioner such as a physician injects a patient with a fluid. In recent years, a number of injector-actuated syringes and powered injectors for pressurized injection of fluids, such as contrast media, have been developed for use in imaging procedures such as angiography, computed tomography (CT), ultrasound, and magnetic resonance imaging. In general, these powered injectors are designed to deliver a preset amount of contrast and/or saline at a preset flow rate using one or more disposable or refillable syringes.
Automatic injection mechanisms typically include a syringe connected to a powered injector with a linear actuator. The linear actuator operates a moveable piston that is configured to engage a plunger inserted in the barrel of the syringe. The interface or engagement between the piston and plunger generally includes a reversible mechanical locking structure such as screw threads, undercuts, pins, swivels, snap fit connections, and the like for establishing and maintaining the connection between the piston and plunger.
The plunger/piston interface should be sufficiently strong to retract the plunger in a proximal direction through the barrel to draw fluid into the syringe, as well as to advance the plunger through the barrel in the distal direction to expel the fluid contained therein.
In addition to being sufficiently strong to maintain good connection between the piston and plunger during use, the interface should also be removable so that the syringe and plunger can be disposed of after use. With mechanical locking structures, to disengage the piston from the plunger, the user either orients the piston and plunger for disengagement, such as by rotating the syringe to properly align locking features on the piston and plunger, or pulls the piston away from the plunger with sufficient force to overcome the locking structure. Once the piston is disengaged from the plunger, the used syringe and plunger may be discarded.
A challenge with syringe plunger seals is insufficient sealing during injection procedures. It would be desirable to provide a syringe plunger with a dynamic seal to enhance sealing during injection procedures where compression is generated when the syringe is under injection pressure conditions. Preloading compression is not desirable because over the shelf life of the syringe the plastic components undergo deformation or creep that impairs forming an adequate seal under injection pressure conditions. Furthermore, it is desirable to limit compression due to automated assembly process where it is desirable to have low pressure during manufacturing. Accordingly, various aspects of a syringe plunger with a dynamic seal described herein overcome these deficiencies.
While automated injectors are well-known, improved fluid delivery systems which make the injection processes simpler for medical staff are always needed. With respect to the present disclosure, a syringe having a plunger with a dynamic seal is set forth. Desirably, the plunger with a dynamic seal which slides easily through the inner wall of the barrel of the syringe, but nevertheless is configured to provide a good effective seal against the inner wall of the barrel during an injection procedure to prevent leaking of the substance contained therein, is also needed.
In view of the foregoing, a need exists for a syringe having a plunger with a dynamic seal which can be used with an injector, such as a powered injector. According to one aspect of the disclosure, the plunger with dynamic seal generates compression under injection pressure conditions. Initially, under relatively low pressure conditions, the compression between the plunger and the inner wall of the barrel is low. The compression increases under injection pressure conditions of the fluid delivery system and thus increases the seal between the plunger and the inner wall of the barrel of the syringe.
In one aspect, a syringe plunger with a dynamic seal is provided. The syringe plunger with a dynamic seal comprises a support ring and a cover disposed over and coupled to the support ring, wherein an air cavity defining a predetermined volume is defined between the support ring and the cover.
In another aspect, a syringe comprising a plunger with a dynamic seal is provided. The syringe comprises a barrel defining an inner wall, and a plunger located within the inner of the barrel. The plunger comprises a support ring and a cover disposed over and coupled to the support ring, wherein an air cavity defining a predetermined volume is defined between the support ring and the cover.
In addition to the foregoing, various other method and/or system and/or program product aspects are set forth and described in the teachings, such as text (e.g., claims and/or detailed description) and/or drawings, of the present disclosure.
The various aspects of the present disclosure are also described in the following clauses.
Clause 1: A plunger, comprising: a support ring; and a cover disposed over and coupled to the support ring, wherein the support ring and the cover define an air cavity therebetween, the air cavity defining a predetermined volume.
Clause 2: The plunger of clause 1, further comprising a conical cap disposed over the cover.
Clause 3: The plunger of clause 2, wherein the conical cap comprises an overmold element disposed over thereon.
Clause 4: The plunger of any of clauses 1 to 3, wherein the cover further comprises first and second annular ribs.
Clause 5: The plunger of any of clauses 1 to 4, wherein the cover comprises: conical cap; a cylindrical sidewall having at least one annular rib; and a flange to engage the support ring.
Clause 6: The plunger of any of clauses 1 to 5, wherein the support ring comprises a conical cap that defines an included angle greater than about 90°.
Clause 7: The plunger of clause 6, wherein the conical cap of the support ring defines an included angle greater than about 90° and less than about 120°.
Clause 8: The plunger of clause 6 or 7, wherein the conical cap of the support ring and the conical cap of the cover define an angle therebetween.
Clause 9: The plunger of clause 8, wherein the angle defined between the conical cap of the support ring and the conical cap of the cover is greater than 0° and less than about 30°.
Clause 10: The plunger of any of clauses 1 to 9, wherein the support ring comprises: a shoulder; and defines an annular groove between the shoulder and the conical cap to receive a flange defined by the cover.
Clause 11: The plunger of any of clauses 1 to 10, wherein the predetermined volume is selected in a range between 0.1 mL and 10 mL.
Clause 12: A syringe, comprising: a barrel defining an inner wall; and a plunger located within the inner wall of the barrel, the plunger comprising: a support ring; and a cover disposed over and coupled to the support ring, wherein an air cavity defining a predetermined volume is defined between the support ring and the cover.
Clause 13: The syringe of clause 12, wherein the plunger comprises a conical cap disposed over the cover.
Clause 14: The syringe of clause 13, wherein the conical cap comprises an overmold element disposed thereon.
Clause 15: The syringe of any of clauses 12 to 14, wherein the cover further comprises first and second annular ribs that form a seal with the inner wall of the barrel.
Clause 16: The syringe of any of clauses 12 to 15, wherein the cover comprises: conical cap; a cylindrical sidewall having at least one annular rib; and a flange to engage the support ring.
Clause 17: The syringe of any of clauses 12 to 16, wherein the support ring comprises a conical cap that defines an included angle greater than about 90°.
Clause 18: The syringe of clause 17, wherein the conical cap of the support ring defines an included angle greater than about 90° and less than about 120°.
Clause 19: The syringe of clause 17 or 18, wherein the conical cap of the support ring and the conical cap of the cover define an angle therebetween.
Clause 20: The syringe of clause 19, wherein the angle defined between the conical cap of the support ring and the conical cap of the cover is greater than 0° and less than about 30°.
Clause 21: The syringe of any of clauses 12 to 20, wherein the support ring comprises: a shoulder; and defines an annular groove between the shoulder and the conical cap to receive a flange defined by the cover.
Clause 22: The syringe of any of clauses 12 to 21, wherein the predetermined volume is selected in a range between 0.1 mL and 10 mL.
Clause 23: A method of making a plunger, the method comprising: providing a support ring, the support ring comprising a first conical cap, a shoulder, and defines an annular groove between the shoulder and the conical cap; attaching a cover to the support ring, the cover comprising a second conical cap, a cylindrical sidewall, and a flange to engage the annular groove of the support ring; and attaching a third conical cap to the second conical cap of the cover.
Clause 24: A method of making a syringe, comprising: providing a syringe barrel; making a plunger in accordance with a method, the method comprising: providing a support ring, the support ring comprising a first conical cap, a shoulder, and defines an annular groove between the shoulder and the conical cap; attaching a cover to the support ring, the cover comprising a second conical cap, a cylindrical sidewall, and a flange to engage the annular groove of the support ring; and attaching a third conical cap to the second conical cap of the cover; and inserting the plunger in the syringe barrel.
The foregoing is a summary and thus may contain simplifications, generalizations, inclusions, and/or omissions of detail; consequently, those skilled in the art will appreciate that the summary is illustrative only and is NOT intended to be in any way limiting. Other aspects, features, and advantages of the devices and/or processes and/or other subject matter described herein will become apparent in the teachings set forth herein.
Further, it is understood that any one or more of the following-described forms, expressions of forms, examples, can be combined with any one or more of the other following-described forms, expressions of forms, and examples.
The foregoing summary is illustrative only and is not intended to be in any way limiting. In addition to the illustrative aspects, aspects, and features described above, further aspects, aspects, and features will become apparent by reference to the drawings and the following detailed description.
The novel features of the described forms are set forth with particularity in the appended claims. The described forms, however, both as to organization and methods of operation, may be best understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
Before explaining various forms of syringe plungers with dynamic seals in detail, it should be noted that the illustrative forms are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative forms may be implemented or incorporated in other forms, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative forms for the convenience of the reader and are not for the purpose of limitation thereof.
Further, it is understood that any one or more of the following-described forms, expressions of forms, examples, can be combined with any one or more of the other following-described forms, expressions of forms, and examples.
Various forms are directed to syringe plungers with dynamic seals to provide enhanced sealing during injection procedures under injection pressure conditions. With reference to
In use, the external piston is brought into contact with the mating element 20 of the syringe 10 and engages the mating element 20. In one aspect, the syringe may be disposable. Various techniques may be employed to engage the external piston with the mating element Once engagement is established, the external piston can be retracted to fill the syringe 10 with fluid or driven in the proximal direction to eject fluid contained therein. Once the fluid is ejected, a slider (not shown) is moved in the proximal direction to disengage the external piston from the mating element 20. Once disengaged, a user can dispose of the syringe 10. Additional examples of syringes can be found in commonly assigned US Publication No. 2016/0151570, filed Jul. 9, 2014, and titled VACUUM SYSTEM FOR SYRINGE INTERFACE, U.S. Pat. Nos. 9,173,995; 9,199,033; and 9,700,670, and U.S. application Ser. No. 15/451,573 the disclosures of which are incorporated herein by reference.
Referring to
The barrel 12 is adapted to contain a fluid F, such as a medicament, biological solution, saline, or contrast agent, to be injected to a patient. The barrel 12 extends longitudinally from a proximal end 21, near the injector apparatus, to a distal end 22 and is configured to expel the fluid F from the distal end 22 of the barrel 12. The distal end 22 may include an outflow port 24, such as a nozzle, needle cannula, or catheter tubing. The barrel 12 may be formed from any suitable biocompatible and medical grade material including glass, metal, ceramic, plastic, rubber, or combinations thereof.
The plunger 14 is adapted to be slidably inserted in the barrel 12, and includes a cylindrical body 26 formed of elastomeric material, a sidewall 28, and a conical cap 30. The plunger 14 has an external diameter ED that corresponds to an inner diameter ID of the barrel 12, such that a fluid seal is formed between the sidewall 28 and an inner wall 29 of the barrel 12. In certain aspects, the sidewall 28 includes one or more annular ribs 32 extending radially from the sidewall 28. The annular ribs 32 are adapted to contact and compress against the inner wall 29 to form a fluid tight seal and are adapted to slide against the inner wall 29 of the barrel 12 as the plunger 14 is advanced or retracted while maintaining the fluid tight seal. The annular ribs 32 reduce the contact surface area against the inner wall 29 of the barrel 12, which lessens the frictional forces between the barrel 12 and plunger 14 and allows the plunger 14 to slide through the barrel 12 more easily.
The plunger 14 may further include an annular shoulder 42 or ring positioned on a proximal end of the plunger 14. The annular shoulder 42 contacts a corresponding portion of the piston 18 or piston head 16 for imparting additional pushing force against the plunger 14.
The sidewall 28 is flexible and can deform outwards to increase the size of the opening and cavity defined by an inner portion of the plunger 14, to accept the piston head 16 and/or support ring 116. In certain aspects, a portion of the sidewall 28 may essentially be hollow and include an annular channel (not shown) to reduce the structural integrity of the sidewalls 28, thereby further increasing the flexibility.
In use, the piston head 16 is inserted into the cavity defined by the plunger 14 establishing a removable engagement therebetween. The engagement is sufficient to maintain the connection between the plunger 14 and piston head 16 both as the plunger 14 is advanced through and retracted from the barrel 12. As such, the engagement must be strong enough to counteract both the initial frictional breakaway force created by the contact between the sidewall 28 and/or annular ribs 32 of the plunger 14 and the inner surface of the barrel 12, as well as the dynamic frictional forces created as the plunger 14 slides through the barrel 12 and at least partial vacuum that is created as plunger 14 is retracted to draw liquid F into the syringe.
The cover 114 includes a cylindrical sidewall 108, a conical cap 160, and a flange 162 such as a projecting rim or edge for coupling the cover 114 to the support ring 116. The cover 114 includes one or more annular ribs, such as a first annular rib 120 and a second annular rib 122. The first annular rib 120 is received in a first annular slot 124 defined by the inner wall 106 of the barrel 104 and the second annular rib 122 is received in an annular slot 126 also defined by the inner wall 106 of the barrel 104.
The support ring 116 includes an annular shoulder 154, a conical cap 152, and an annular groove 118 defined therebetween to receive the flange 162 of the cover 114. The conical cap 152 of the support ring 116 defines an included angle θ1 of about 90° and an annular groove 118 to receive the cover 114 portion of the conical cap 110. The support ring 116 defines an inner volume 132 within the conical cap 160. At least one aperture 134 is defined by the support ring 116 to provide an exit path for the air between the cover 114 and the support ring 116 during injection pressurization. The air is vented through the at least one aperture 134 back outside of the barrel 104 of the syringe and away from the path of the fluid.
An air cavity 128 is defined between the tip 150 of the conical cap 152 of the support ring 116 and the conical cap 160 of the cover 114. The conical cap 160 of the cover 114 is in contact with and supported by the conical cap 152 of the support ring 116 at an interface 130. There is not a gap or air cavity defined at the interface 130.
The cover 214 includes a cylindrical sidewall 208, a conical cap 260, and a flange 262 such as a projecting rim or edge for coupling the cover 214 to the support ring 216. The cover 214 includes a first annular rib 220 and a second annular rib 222. The first annular rib 220 is received in a first annular slot 224 defined by the inner wall 206 of the syringe barrel 204 and the second annular rib 222 is received in a second annular slot 226 also defined by the inner wall 206 of the syringe barrel 204.
The support ring 216 includes an annular shoulder 254, a conical cap 252, and an annular groove 218 defined therebetween to receive the flange 262 of the cover 214. The conical cap 252 of the support ring 216 defines an included angle θ2 greater than about 90° and an annular groove 218 to receive the cover 214 portion of the conical cap 210. In the illustrated example, the included angle θ2 is 96°, although the disclosure is not limited in this context, as the included angle θ2 can be calculated to produce an optimal effect of the dynamic seal. The support ring 216 defines an inner volume 232 within the conical cap 252. At least one aperture 234 is defined by the support ring 216 to provide an exit path for the air between the cover 214 and the support ring 216 during injection pressurization. The air is vented through the at least one aperture 234 back outside of the syringe barrel 204 of the syringe and away from the path of the fluid.
The conical cap 252 of the support ring 216 and the conical cap 260 of the cover define a gap or air cavity 230 therebetween. The air cavity 230 or “gap” is defined between the support ring 216 and the cover 214 along the conical portion of the plunger 202. An angle θ3 is defined between the support ring 216 and the cover 214 and defines the air cavity 230. The angle θ3 can vary from a value greater than 0° to less than about 30°, for example, and nominally is about 6°. The air cavity 230 defines a predetermined compliance volume such that when the syringe plunger system 200 undergoes injection pressurization, the overmold element 212 and the cover 214 deform and flex into the compliance volume defined by the air cavity 230. The injection pressure applies an axial force to the overmold element 212 and the cover 214 causing them to deform and compress the air cavity 230, which applies a radial force to the first and second annular ribs 220, 222 to engage the respective first and second annular slots 224, 226 and/or against the inner wall 206 to create a dynamic seal under injection pressure conditions. The volume of the air cavity 230 increases as the included angle θ2 is increased. The volume of the air cavity 230 can be optimized by suitable selection of the included angle θ2. Thus, the compliance volume can be increased or decreased based on the included angle θ2. The included angle θ2 can vary from a value greater than about 90° to less than about 120°, for example, and nominally is about 96°. The compliance volume can vary from about 0.1 mL to 10 mL, for example. With an included angle θ2 of about 96°, as shown in
While the term “air cavity” is used herein to describe the compressible volume between the conical cap 252 of the support ring 216 and the conical cap 260 of the cover, other compressible materials may also be included in the volume between the conical cap 252 of the support ring 216 and the conical cap 260 of the cover. For example, in certain aspects, the volume between conical cap 252 and conical cap 260 may be filled with a bladder containing a compressible fluid, for example a compressible gas or other fluid. In another aspect, the volume between conical cap 252 and conical cap 260 may be filled with a compressible material, such as an elastic material with a low modulus that can deform under the pressure loads associated with an injection procedure. Non-limiting examples may include a compressible or deformable material, such as thermoplastic elastomer or a foam material, which compresses to allow for a dynamic seal under pressure loads typical of an injection procedure. In certain aspects, predictable compression and thereby, predictable control of the dynamic seal between the plunger sidewall and the inner wall of the syringe may be achieved by selecting a material having a certain strain or compression factor under a desired pressure load. In certain aspects, the compression of the material would reverse in the absence of the pressure load of the injection procedure.
In one aspect the body of the syringe barrel 204 can be made of polyethylene terephthalate commonly abbreviated PET such as Eastman MN052 PET, for example. The support ring 216 can be made of a polycarbonates (PC) thermoplastic polymer or any suitable medical grade polymer that is strong, tough, and may be optically transparent and can be easily worked, molded, and thermoformed, such as Lexan 141, for example. The cover 214 may be made of a thermoplastic elastomer (TPE), sometimes referred to as thermoplastic rubbers, or other mix of polymers such as plastic and a rubber with both thermoplastic and elastomeric properties, such as Santoprene 181-5, for example. The cover 214 may be optically transparent or translucent. Thermoplastics may be desirable due to their relatively ease of use in manufacturing and ability of being injected molded. The overmold element 212 may be made of polypropylene (PP), also known as polypropylene thermoplastic polymer, such as polypropylene P5M4K-046, for example, and may be optically transparent or translucent. The syringe barrel 204, the support ring 216, the cover 214, and the overmold element 212 are made of medical grade plastics and materials.
As shown in
Accordingly, the volume of the air cavity 230 (see
y=1.3722x2+0.2746x−0.001 (1)
While various details have been set forth in the foregoing description, it will be appreciated that the various aspects of the syringe plunger with dynamic seal may be practiced without these specific details. For example, for conciseness and clarity selected aspects have been shown in schematic form rather than in detail.
It is worthy to note that any reference to “one aspect,” “an aspect,” “one form,” or “a form” means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in one form,” or “in a form” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.
Although various forms have been described herein, many modifications, variations, substitutions, changes, and equivalents to those forms may be implemented and will occur to those skilled in the art. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications and variations as falling within the scope of the disclosed forms. The following claims are intended to cover all such modifications and variations.
All of the above-mentioned U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications, non-patent publications referred to in this specification and/or listed in any Application Data Sheet, or any other disclosure material are incorporated herein by reference, to the extent not inconsistent herewith. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
One skilled in the art will recognize that the herein described components (e.g., operations), devices, objects, and the discussion accompanying them are used as examples for the sake of conceptual clarity and that various configuration modifications are contemplated. Consequently, as used herein, the specific exemplars set forth and the accompanying discussion are intended to be representative of their more general classes. In general, use of any specific exemplar is intended to be representative of its class, and the non-inclusion of specific components (e.g., operations), devices, and objects should not be taken as limiting.
With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations are not expressly set forth herein for sake of clarity.
While particular aspects of the present subject matter described herein have been shown and described, it will be apparent to those skilled in the art that, based upon the teachings herein, changes and modifications may be made without departing from the subject matter described herein and its broader aspects and, therefore, the appended claims are to encompass within their scope all such changes and modifications as are within the true spirit and scope of the subject matter described herein. It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations.
In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.”
Although various forms have been described herein, many modifications, variations, substitutions, changes, and equivalents to those forms may be implemented and will occur to those skilled in the art. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications and variations as falling within the scope of the disclosed forms. The following claims are intended to cover all such modifications and variations.
In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more forms were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various forms and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.
This application is a continuation of U.S. application Ser. No. 16/471,300, filed 19 Jun. 2019, which is a § 371 U.S. national phase application of PCT International Application No. PCT/US2018/012284, filed 4 Jan. 2018, and claims the benefit of U.S. Provisional Patent Application No. 62/443,302, filed 6 Jan. 2017, the disclosures of which are hereby incorporated in their entirety by reference.
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20220288322 A1 | Sep 2022 | US |
Number | Date | Country | |
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Parent | 16471300 | US | |
Child | 17830604 | US |