Patent Grant
9486285
The invention relates generally to a skin treatment using radiation. In particular, the invention relates to a method for treating skin using a beam of radiation to cause spatially modulated thermal injury of the skin sufficient to elicit a healing response and improvement in the skin.
Ablative resurfacing of skin with lasers can be an effective treatment for skin conditions such as wrinkles. However, ablative resurfacing can have undesirable post-treatment side effects. For example, crusting, oozing, erythema can last up to 5 weeks. Furthermore, permanent scarring is a possible long-term side effect of ablative resurfacing. Such side effects can be a deterrent to individuals who otherwise desire treatment.
Improved treatments with reduced side effects include forming sub-surface thermal damage of skin, while leaving the top layer intact by combining heating and surface cooling. However, the results of sub-surface methods can be less dramatic than those achieved by ablative resurfacing. Other improvements include fractional resurfacing techniques, that treat skin in discrete spots and leave the skin between the spots untreated.
Fractional resurfacing technologies can have advantages including lower incidences of side-effects and expedited healing. These advantages can result from the undamaged regions providing blood and nutrients to the adjacent damaged regions and accelerating the healing process. Ablative resurfacing and technologies that include inducing uniform damage corresponding to coverage of an entire region can include higher efficacy at the cost of increased side effects.
The invention, in various embodiments, combines many of the advantages of ablative resurfacing with those of fractional methods. Skin can be treated by delivering a beam of radiation to a target region to cause a zone of thermal injury. The zone can include a lateral pattern of varying depths of thermal injury distributed along the target region. The lateral pattern can include at least one first sub-zone of a first depth of thermal injury laterally adjacent to at least one second sub-zone of a second depth of thermal injury. The at least one first sub-zone of the first depth and the at least one second sub-zone of the second depth can extend from a surface of the target region of the skin to form a substantially continuous surface thermal injury.
A beam of radiation can have a modulated spatial profile such that the fluence, the intensity, and/or the wavelength delivered to the skin can be varied. The spatial profile determines the depth of thermal injury to the skin. A beam of radiation can be delivered to a region of skin to cause modulated spatial profile of temperature, such that the depth of damage to the skin is varied. An advantage of the invention is that a large target region can be formed with damaged regions adjacent to substantially undamaged regions within the target region, together with a substantially continuous surface thermal injury. The substantially undamaged regions can be undamaged or less damaged than the damaged regions. Other advantages include: improved treatment efficacy initiating from zones corresponding to deeper first damage zones, high coverage of a treatment region corresponding to deeper first damage zones and less deep second damage zones, improved efficacy relating to forming a substantially continuous surface thermal injury, and improved post-treatment healing initiating from zones corresponding to less deep second damage zones.
In one embodiment, the treatment can be used to treat wrinkles or for skin rejuvenation. However, the treatment is not limited to treating wrinkles or skin rejuvenation. A beam of radiation can be delivered non-invasively to affect the skin.
In one aspect, the invention features a method for treating skin including delivering a beam of radiation to a target region of the skin, to cause a zone of thermal injury including a lateral pattern of varying depths of thermal injury distributed along the target region. The lateral pattern includes at least one first sub-zone of a first depth of thermal injury laterally adjacent to at least one second sub-zone of a second depth of thermal injury. The first depth is greater than the second depth. The at least one first sub-zone of the first depth and the at least one second sub-zone of the second depth extend from a surface of the target region of the skin to form a substantially continuous surface thermal injury. Both the at least one first sub-zone of the first depth and the at least one second sub-zone of the second depth are substantially heated to at least a critical temperature to cause the thermal injury.
In another aspect, the invention features a method for treating skin including delivering a beam of radiation to a first portion of a target region of the skin, to heat the first portion to at least a critical temperature to cause a first thermal injury. The method also includes translating the beam of radiation to a second portion of the target region. Additionally, the method includes delivering the beam of radiation to the second portion of the target region, to heat the second portion to at least the critical temperature to cause a second thermal injury. The first thermal injury and the second thermal injury extend from a surface of the target region of the skin to form a substantially continuous surface thermal injury and form a lateral pattern of varying depths of thermal injury distributed along the target region.
In yet another aspect, the invention features an apparatus for treating skin including a source of a beam of radiation and a modulator. The modulator receives the beam of radiation and forms a modulated spatial profile of the beam including a first plurality of first regions at a first fluence and a second plurality of second regions at a second fluence. The first fluence is greater than the second fluence, and each first region is spaced from an adjacent first region by a respective second region. The apparatus also includes a device for delivering the beam of radiation to a target region of skin to cause a zone of thermal injury including a lateral pattern of varying depths of thermal injury distributed along the target region. The lateral pattern includes at least one first sub-zone of a first depth of thermal injury laterally adjacent to at least one second sub-zone of a second depth of thermal injury. The first depth is greater than the second depth. The at least one first sub-zone of the first depth and the at least one second sub-zone of the second depth extend from a surface of the target region of the skin to form a substantially continuous surface thermal injury. The at least one first sub-zone of the first depth and the at least one second sub-zone of the second depth are substantially heated to at least a critical temperature to cause the thermal injury.
In other examples, any of the aspects above, or any apparatus or method described herein, can include one or more of the following features.
In various embodiments, the lateral pattern has a substantially sinusoidal cross sectional injury profile. The method can include delivering the beam of radiation to the target region to form a one-dimensional lateral pattern of varying depths of thermal injury. The method can include delivering the beam of radiation to the target region to form a two-dimensional lateral pattern of varying depths of thermal injury. The first depth and the second depth can be between about 2 mm and about 0.02 mm. The first depth can be about 1.5 mm and the second depth can be about 0.05 mm.
In some embodiments, the critical temperature is below about 100° C., 95° C., 90° C., 85° C., 80° C., 75° C., 70° C., 65° C., 60° C., 55° C., or 50° C. The thermal injury can include at least one of ablation, coagulation, necrosis, and acute thermal injury of skin. The method can include heating the at least one first sub-zone and the at least one second sub-zone to substantially the same temperature.
In certain embodiments, the method includes cooling the surface of the skin, to control the surface thermal injury. The method can include cooling the surface of the skin, to prevent unwanted surface thermal injury. The method can include cooling the target region of skin to produce at least one first region at a first temperature and at least one second region at a second temperature, the first temperature being greater than the second temperature, the at least one first region corresponding to the at least one first sub-zone, and the at least one second region corresponding to the at least one second sub-zone. The method can include cooling the target region of skin to produce at least one first region cooled to a first depth and at least one second region cooled to a second depth, the first depth being less than the second depth, the at least one first region corresponding to the at least one first sub-zone, and the at least one second region corresponding to the at least one second sub-zone.
In various embodiments, the method includes delivering a beam of radiation having a first wavelength to the at least one first sub-zone to cause the first depth of thermal injury and a beam of radiation having a second wavelength to the at least one second sub-zone to cause the second depth of thermal injury. The method can include delivering a beam of radiation having a first fluence to the at least one first sub-zone to cause the first depth of thermal injury and a beam of radiation having a second fluence to the at least one second sub-zone to cause the second depth of thermal injury. The method can include delivering a beam of radiation having a first pulse duration to the at least one first sub-zone to cause the first depth of thermal injury and a beam of radiation having a pulse duration to the at least one second sub-zone to cause the second depth of thermal injury.
In some embodiments, the at least two first sub zones of the first depth are separated by a center to center distance of about 0.05 mm to about 20 mm. The at least one first sub-zone of the first depth can have an aspect ratio of diameter:depth up to about 0.1:10. The at least one second sub-zone of the second depth can have an aspect ratio of diameter:depth up to about 0.1:10.
In certain embodiments, the apparatus includes a cooling system for controllably cooling at least a portion of the target region of skin, to control the thermal injury within the target region. The apparatus can include a cooling system for cooling the target region of skin to produce at least one first region at a first temperature and at least one second region at a second temperature, the first temperature being greater than the second temperature, the at least one first region corresponding to the at least one first sub-zone, and the at least one second region corresponding to the at least one second sub-zone. In one embodiment, the apparatus includes a cooling system for cooling the target region of skin to produce at least one first region cooled to a first depth and at least one second region cooled to a second depth, the first depth being less than the second depth, the at least one first region corresponding to the at least one first sub-zone, and the at least one second region corresponding to the at least one second sub-zone.
Other aspects and advantages of the invention can become apparent from the following drawings and description, all of which illustrate the principles of the invention, by way of example only.
The advantages of the invention described above, together with further advantages, may be better understood by referring to the following description taken in conjunction with the accompanying drawings. The drawings are not necessarily to scale, emphasis instead generally being placed upon illustrating the principles of the invention.
A therapeutic injury can be induced with electromagnetic radiation in the visible to infrared spectral region. A wavelength of light that penetrates into at least a portion of skin can be used. Chromophores can include blood (e.g., oxyhemoglobin and deoxyhemoglobin), collagen, melanin, fatty tissue, and water. Light sources can include lasers, light emitting diodes, or an incoherent source, and can be either pulsed or continuous. In one embodiment, a light source can be coupled to a flexible optical fiber or light guide, which can be introduced proximally to a target region skin. The light source can operate at a wavelength with depth of penetration into skin that is less than the thickness of the target region of skin.
In various embodiments, skin in a target region is heated to a critical temperature to cause thermal injury. In certain embodiments, the critical temperature is below about 100° C. In other embodiments, the critical temperature is below about 95° C., 90° C., 85° C., 80° C., 75° C., 70° C., 65° C., 60° C., 55° C., or 50° C. In one embodiment, the critical temperature is the temperature associated with ablation, coagulation, necrosis, and/or acute thermal injury of skin.
In various embodiments, the energy source 12 can be an incoherent light source, a coherent light source (e.g., a laser), a solid state laser, a diode laser, a fiber coupled diode laser array, an optically combined diode laser array, and/or a high power semiconductor laser. In some embodiments, two or more sources can be used together to effect a treatment. For example, an incoherent source can be used to provide a first beam of radiation while a coherent source provides a second beam of radiation. The first and second beams of radiation can share a common wavelength or can have different wavelengths. In an embodiment using an incoherent light source or a coherent light source, the beam of radiation can be a pulsed beam, a scanned beam, or a gated continuous wave (CW) beam.
In various embodiments, the source of electromagnetic radiation can include a fluorescent pulsed light (FPL) or an intense pulsed light (IPL) system. For example, the system can be a LIGHTSTATION™ (by Candela Corporation of Wayland, Mass.), or an OMNILIGHT™, NOVALIGHT™, or PLASMALITE™ system (by American Medical Bio Care of Newport Beach, Calif.). However, the source of electromagnetic radiation can also include a laser, a diode, a coherent light source, an incoherent light source, or any other source of electromagnetic radiation. FPL technologies can utilize laser-dye impregnated polymer filters to convert unwanted energy from a xenon flashlamp into wavelengths that enhance the effectiveness of the intended applications. FPL technologies can be more energy efficient and can generate significantly less heat than comparative IPL systems. A FPL system can be adapted to operate as a multi-purpose treatment system by changing filters or handpieces to perform different procedures. For example, separate handpieces allow a practitioner to perform tattoo removal and other vascular treatments. An exemplary FPL system is described in U.S. Pat. No. 5,320,618, the disclosure of which is herein incorporated by reference in its entirety.
In various embodiments, the beam of radiation can have a wavelength between about 380 nm and about 2600 nm. In certain embodiments, the beam of radiation can have a wavelength between about 1,200 nm and about 2,600 nm, between about 1,200 nm and about 1,800 nm, or between about 1,300 nm and about 1,600 nm. In one embodiment, the beam of radiation has a wavelength of about 1,500 nm. In other embodiments, the beam of radiation has a wavelength up to about 2,100 nm or up to about 2,200 nm.
In various embodiments, the beam of radiation can have a fluence of about 1 J/cm2 to about 500 J/cm2. For a given wavelength of radiation, a range of effective fluences can be approximated. Because radiation of wavelength between about 380 nm and about 2600 nm is absorbed by water, and because skin is about 70% water, the absorption coefficient of skin can be approximated as 70% of the absorption coefficient of water. Because the absorption coefficient of water is a function of the wavelength of radiation, the desired fluence depends on the chosen wavelength of radiation. The fluence necessary to produce a desired damage depth can be approximated as the fluence that will raise the temperature to the critical temperature at the desired penetration depth, calculated as:
┌3*μa*(μa+μs(1−g))−0.5
where μa, μs, and g are absorption coefficient, scattering coefficient, and the anisotropy factor of skin, respectively.
In various embodiments, the fluence used to produce a second sub-zone of damage is less than the fluence used to produce a first sub-zone of damage. In certain embodiments, the fluence used to produce a second sub-zone of damage is about 10% of the fluence used to produce a first sub-zone of damage.
In various embodiments, a desired penetration depth of light into the skin (and a corresponding depth of thermal injury) can be targeted by selecting a wavelength of a beam of radiation. For example, a water absorption coefficient can be taken from G. M. Hale and M. R. Querry, “Optical constants of water in the 200 nm to 200 μm wavelength region,” Appl. Opt., 12, 555-563, (1973) and an Optical Penetration Depth (OPD) can be calculated using a diffusion approximation. As described above, μa of skin is taken as μa of water multiplied by 0.7. The product of scattering coefficient and (1-anisotropy factor) is taken as 12 cm−1.
The at least one first sub-zone 30 of the first depth of thermal injury and the at least one second sub-zone 32 of the second depth of thermal injury extend from the surface 22 of the target region to form a substantially continuous surface thermal injury. The at least one first sub-zone 30 of the first depth and the at least one second sub-zone 32 of the second depth are substantially heated to at least a critical temperature to cause the thermal injury. In one embodiment, the temperature within the at least one first sub-zone 30 of the first depth and the at least one second sub-zone 32 can vary at or above the critical temperature and, accordingly, the degree of thermal injury can also vary at or above a pre-determined amount. In another embodiment, the temperature within the at least one first sub-zone 30 of the first depth and the at least one second sub-zone 32 can be substantially the same and, accordingly, the degree of thermal injury can also be substantially the same.
A first sub-zone of a first depth of thermal injury can improve the efficacy of treatment by including an acute thermal injury. A substantially continuous surface thermal injury can improve the efficacy of treatment by including surface ablation and/or inducing a surface peel. A second sub-zone of a second depth of thermal injury can improve post-treatment healing of skin. A second sub-zone of a second depth of thermal injury can improve post-treatment healing of an adjacent first sub-zone of a first depth of thermal injury. In various embodiments, treatment efficacy can be improved by forming first sub-zones of thermal injury adjacent to second sub-zones of thermal injury. In some embodiments, treatment efficacy can be improved by forming first sub-zones of thermal injury underlying a substantially continuous surface thermal injury. In certain embodiments, post-procedure healing can be improved by improved flow of blood and nutrients provided by a second sub-zone.
In various embodiments, a sub-zone of thermal damage can include a three-dimensional region of epidermis and/or a region of dermis. For example, in certain embodiments, a first sub-zone can include three-dimensional regions of epidermis and dermis, while a second sub-zone can include three-dimensional regions of epidermis.
In various embodiments, the pattern of thermal injury can be a continuously varying pattern (e.g., a sinusoidal-like or wave-like pattern when viewed in two-dimensions or an “egg carton” like pattern when viewed in three-dimensions). In some embodiments, the pattern of thermal injury can be a continuous surface injury with periodic or irregular regions of deeper thermal injury (e.g., a step-function like pattern when viewed in two dimensions). However, the pattern of thermal injury is not limited to any specific design. Contiguous regions in skin of subsurface injury without surface injury can be overlaid by discrete regions of added surface injury. In certain embodiments, contiguous regions of superficial injury can be overlaid by discrete regions of superficial tissue ablation.
In some embodiments, a three-dimensional pattern of varying depths and/or varying severity of thermal injury within skin can be formed. Regions of more deeply and/or severely injured skin can be contiguous with regions of less deeply and/or severely damaged skin. In certain embodiments, first regions of skin with sub-surface injury and without surface injury are formed. Such first regions can be contiguous with second regions of skin without sub-surface injury and with surface injury. In various embodiments, wounds in the skin that require long recovery periods are avoided. For example, effective treatment of skin can be provided without forming large or contiguous areas of acute injury or necrosis.
As a beam or radiation penetrates skin, the fluence (J/cm2) decreases in an approximately exponential fashion. The rate of decrease in fluence is dependent upon the absorption and scattering properties of skin. A local temperature increase due to absorbed radiation within the skin is a product of the local absorption coefficient and a local fluence divided by the volumetric specific heat. Since absorption and volumetric specific heat can be considered approximately constant within a region of skin, the local temperature rise can be considered proportional to the fluence.
Thermal damage to skin forms at temperatures at, or exceeding, a critical temperature (Tc). Little or no thermal damage to skin forms at temperatures below Tc. Therefore, depth of thermal damage to skin is approximately equal to the depth of skin that is exposed to a temperature of, or exceeding, Tc.
To form deeper sub-zones of thermal injury, more penetrating wavelengths of radiation can be used. More penetrating wavelengths can be combined with longer pulse durations to increase thermal damage. In certain embodiments, more penetrating wavelengths can be combined with surface cooling to spare overlying tissue.
To form shallower sub-zones of thermal injury, less penetrating wavelengths can be used. Less penetrating wavelengths can be combined with shorter pulse durations. Less penetrating wavelengths can be used without surface cooling or with moderate cooling. Less penetrating wavelengths can also be used with surface cooling to maintain a temperature about a Tc (e.g., allow formation of thermal injury, but prevent necrosis or acute thermal injury).
In various embodiments a beam of radiation with spatially varying intensity; a beam of radiation with spatially varying exposure time or pulse duration; a beam of radiation with spatially varying wavelengths wherein certain regions of the beam include a more penetrating wavelength and other parts include a less penetrating wavelength; and/or a beam of radiation with spatially varying wavelengths with preferential absorption in different skin structures (e.g., a beam including wavelengths with strong water absorption interspersed with wavelengths with strong blood absorption) can be delivered to a target region of the skin to cause a zone of thermal injury including a lateral pattern of varying depths.
In various embodiments, a pulse duration can be between about 1 ms and about 1 min. Shorter pulse durations can be between about 1 ms and about 100 ms. Longer pulse durations can be between about 100 ms and about 1 min.
In various embodiments, a depth of thermal injury in a deeper sub-zone can be up to about 2 mm. In certain embodiments, a depth of thermal injury in a shallower sub-zone can be up to about 50 μm. In one embodiment, deeper sub-zones having a depth of about 400-800 μm are adjacent to shallower sub-zones having a depth of about 50 μm. In another embodiment, deeper sub-zones having a depth of about 400-800 μm are adjacent to shallower sub-zones having a depth of about 25 μm. In still another embodiment, deeper sub-zones having a depth of about 1.5 mm are adjacent to shallower sub-zones having a depth of about 50 μm
In various embodiments, adjacent sub-zones of thermal damage distributed contiguously along the surface of the target region can correspond to about 100% coverage of the surface of the target region (e.g., a substantially continuous surface injury). In certain embodiments, adjacent sub-zones of thermal damage distributed contiguously along the surface of the target region can correspond to less than 100% coverage of the surface of the target region.
In various embodiments, the target region includes about 0.5% to about 99% sub-zones of greater depth. In one embodiment, the target region includes about 5% to about 50% sub-zones of greater depth. In one embodiment, the target region includes about 15% to about 30% sub-zones of greater depth.
In various embodiments, a diameter of a deeper sub-zone of thermal damage can be between about 20 μm and about 2 mm. In some embodiments, a diameter of a shallower sub-zone of thermal damage can be between about 100 μm and about 1000 μm. In various embodiments, spacing between deeper sub-zones can be between about 2 to about 5 times the diameter of the deeper sub-zone. In various embodiments, spacing between shallower sub-zones is the sum of the diameters of the deeper and the shallower sub-zones. In certain embodiments, a sub-zone of thermal damage can have an aspect ratio of diameter:depth greater than 1:2. In one embodiment, a sub-zone of thermal damage has an aspect ratio greater than 1:4. In another embodiment, a sub-zone of thermal damage can have an aspect ratio up to about 0.1:10.
In various embodiments, an optical fiber can be scanned over a surface of skin to deliver a spatially modulated beam of radiation to a target region of skin. In various embodiments, an optical fiber bundle can be used to deliver a plurality of beams of radiation. In certain embodiments, the optical fiber bundle can operate in a scanning mode over a surface of skin. In certain embodiments, the optical fiber bundle can operate in a stamping mode over a surface of skin. The diameter of a region of a surface of skin treated in each stamp can range from about 1 mm to about 50 mm. An optical fiber can be a fiber laser.
By varying the fluence, the intensity, or the wavelength of the beam 56, the depth of injury can be controlled. Increasing the intensity of the beam 56 delivered to skin 50 can form a deeper zone of injury, e.g., a first sub-zone 57. Decreasing the intensity of the beam 56 delivered to skin 50 can form a shallow zone of injury, e.g., a second sub-zone 58. Varying the fluence or the intensity of the beam 56 can form a modulated spatial pattern 59 of thermal injury in skin.
By varying the rate of translation along the skin, the depth of thermal injury can be controlled. Decreasing the rate over skin 50 can increase the total fluence delivered to a particular region, forming a deeper zone of injury, e.g., a first sub-zone 57. Increasing the rate over skin 50 can decrease the total fluence delivered to a particular region, forming a shallow zone of injury, e.g., a second sub-zone 57. Varying the rate of translation along the skin, can form a modulated spatial pattern 59 of thermal injury in skin.
In some embodiments, methods can include sequentially applying different combinations of radiation wavelength, intensity, or cooling such that a pattern of thermal injury achieved in a given pass is different than that achieved in a subsequent pass.
A cooling system can be used to modulate the temperature in a region of skin and/or minimize unwanted thermal injury to untargeted skin. For example, the delivery system 13 shown in
A spray cooling device can use cryogen, water, or air as a coolant. In one embodiment, a dynamic cooling device (e.g., a DCD available from Candela Corporation) can be used to cool the skin. For example, the delivery system 13 shown in
By cooling only a portion of the target region or by cooling different portions of the target region to different extents, the degree of thermal injury of individual portions of the target region can be controlled. By cooling with spatially varying duration and/or by cooling with spatially varying temperature, the degree of thermal injury of individual portions of the target region can also be controlled.
The cooling plate 62 can be applied to the skin surface 61 prior to or during delivery of the beam of radiation 64. In some embodiments, the cooling plate 62 can have at least one open region, corresponding to the region 63 of skin not in contact with the cooling plate 62.
The cooling plate 62 can cool different regions of the target region to different extents thus modulating a spatial profile of temperature in the skin 60. For example, skin underlying the region 63 not in contact with the cooling plate 62 can be cooled to a first temperature, and skin underlying the cooling plate 62 can be cooled to a second temperature. The first temperature is greater than the second temperature.
In some embodiments, the cooling plate 62 can be continuous (e.g., not have open regions), but have regions of varying thickness. Thicker regions of the cooling plate can extract more heat from the skin than thinner regions, thus a deeper zone of thermal injury can be formed under the thinner regions.
In
The screen 74 can modulate a spatial profile of temperature in skin by preventing the cryogen spray 71 from reaching at least a region of the surface 73. In certain embodiments, the screen 74 is not used and the cryogen spray 71 is applied to the skin surface 73 in pools of varying depth. A deeper pool can extract more heat from the skin surface 73, thus forming a region of shallow injury when radiation is delivered.
In
Sub-zones of thermal damage can form different geometries. In various embodiments, sub-zone geometries can include cylinders, cones, cuboids, spheroids, ellipsoids, and ovoids. Any of these sub-zone geometries can be overlaid with, or combined with, a substantially continuous surface thermal injury.
In another embodiment, a plurality of sub-zones of a first depth of thermal injury adjacent to a plurality of sub-zones of a second depth of thermal injury can form a one-dimensional array (e.g., a curvilinear pattern). Such a pattern can, for example, trace the contour of a wrinkle, vein, scar, or skin defect. In certain embodiments, methods can include varying a pattern over different parts of the skin to achieve different desired effects (e.g., to produce a pattern of surface injury in an area with surface wrinkles, while producing a pattern of sub-surface injury in an area for skin tightening with less surface injury).
While the invention has been particularly shown and described with reference to specific embodiments, it should be understood by those skilled in the art that various changes in form and detail may be made therein without departing from the spirit and scope of the invention as defined by the appended claims.
This application is a divisional application of U.S. patent application Ser. No. 11,763,111 filed Jun. 14, 2007, now U.S. Pat. No. 8,246,611, which claims the benefit of and priority to U.S. Provisional Application Ser. No. 60/813,729 filed Jun. 14, 2006, both of which are owned by the assignee of the instant application and the disclosures of which are incorporated herein by reference in their entireties.
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| Number | Date | Country | |
|---|---|---|---|
| 20120310235 A1 | Dec 2012 | US |
| Number | Date | Country | |
|---|---|---|---|
| 60813729 | Jun 2006 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 11763111 | Jun 2007 | US |
| Child | 13584440 | US |
