The present disclosure generally relates to a ventricular pressure waveform estimation device, a ventricular pressure waveform estimation method, a ventricular pressure waveform estimation program, and a pulmonary artery pressure waveform estimation device.
It is important to measure pressure in a ventricle in order to grasp a disease state related to the heart and to assess a cardiac function. For example, patients with heart failure can require hospitalization and treatment due to acute exacerbation. In addition, congestion accompanying exacerbation may cause symptoms such as accumulation of water in lungs and difficulty in breathing. An increase in ventricular pressure is known as a sign of the accumulation of water in the lungs. It is desirable to grasp signs of exacerbation at an early stage and suppress symptoms accompanying the congestion by medication or the like. Left ventricular end-diastolic pressure (LVEDP), pulmonary capillary wedge pressure (PCWP), and pulmonary artery pressure (PAP) are known as indices indicating an omen or a sign of exacerbation at a relatively early stage. The pulmonary capillary wedge pressure is also referred to as pulmonary arterial wedge pressure or “PAWP” for short, pulmonary wedge pressure or “PWP” for short, or pulmonary artery occlusion pressure or “PAOP” for short.
In general, methods of using pigtail catheters or balloon catheters are used to measure left ventricular pressure, right ventricular pressure, and pulmonary artery pressure. However, these methods are invasive methods in which a catheter is inserted from an artery or a vein at a base of a foot, an artery of an arm, or the like into the heart or to the vicinity of the heart, and a burden on a patient's body is relatively great. It is desirable to obtain an estimation of a ventricular pressure waveform in the heart and a pulmonary artery pressure waveform by a relatively simple method and in a non-invasive or minimally invasive manner so as not burden the patient's body. U.S. Patent Application Publication No. 2015/0265163 A discloses a technique of estimating an arterial pressure waveform from a heart sound, upper arm cuff pressure, and Korotkoff-sounds (K-sounds) to calculate LVEDP.
Clinically of heart failure, information on waveform shapes of left ventricular pressure and right ventricular pressure and information on a waveform shape of pulmonary artery pressure including information of contractility of a left heart and a right heart are important clinically for heart failure. Conventionally, the waveform shapes of the left and right ventricular pressures and the pulmonary artery pressure have been measured by invasive methods.
In U.S. Patent Application Publication No. 2015/0265163 A, in order to estimate pressure in a left heart, a cuff is wound around an upper arm, and a time interval from a Q-wave to a K-sound of an electrocardiogram waveform is measured while slowly lowering the cuff pressure. Further, a curve, such as a polynomial curve or a cosine curve, is made to fit between the measured time interval and the cuff pressure. In U.S. Patent Application Publication No. 2015/0265163 A, the LVEDP is estimated using this curve. However, this curve is an estimate of an arterial pressure waveform in the periphery and does not accurately reflect the left ventricular pressure waveform.
A waveform shape of left ventricular pressure, right ventricular pressure and/or pulmonary artery pressure are estimated by a non-invasive or minimally invasive method.
where a, b, c, and k are the coefficients.
where a, b, c, and k are the coefficients.
According to the present disclosure, the waveform shape of the left ventricular pressure or the right ventricular pressure can be estimated by the non-invasive or minimally invasive method.
Set forth below with reference to the accompanying drawings is a detailed description of embodiments of a ventricular pressure waveform estimation device, a ventricular pressure waveform estimation method, a ventricular pressure waveform estimation program, and a pulmonary artery pressure waveform estimation device.
A ventricular pressure waveform estimation device 10 according to an embodiment of the present disclosure will be described with reference to the drawings. The ventricular pressure waveform estimation device 10 estimates at least a part of a left ventricular pressure waveform or a right ventricular pressure waveform based on one or more parameters related to the heartbeat or arterial pressure acquired by at least one of a non-invasive method and a minimally invasive method. Note that the term “non-invasive” in the present application means that no disorder (i.e., no incision or insertion of an instrument) is given to a human body (or living body). The term “minimally invasive” means that incision around the heart of a human body or insertion of an instrument into a ventricle of the human body using a heart catheter is not involved.
Configuration of Ventricular Pressure Waveform Estimation Device
As illustrated in
The acquisition unit 11 is configured to be capable of acquiring values of one or more parameters related to a heartbeat or an arterial pressure. The acquisition unit 11 may receive the value of the one or more parameters as an electrical signal from the outside of the ventricular pressure waveform estimation device 10. The acquisition unit 11 may read an electronic file including the value of the one or more parameters from a storage medium. The acquisition unit 11 may include an input terminal that receives an input from the outside, an interface for communication with an external device, a reading device that reads information of the storage medium, and the like.
As illustrated in
The first detection unit 15 may detect one or more first biological signals related to the heartbeat of a heart 21 only by a non-invasive method. The first detection unit 15 may include, for example, at least any of an electrocardiogram (ECG) that detects a heartbeat, an optical sensor, an impedance sensor, and an acceleration sensor. The first detection unit 15 may include, for example, at least one of a microphone that detects a heart sound, an acceleration sensor, a vibration sensor, and a piezoelectric sensor.
The second detection unit 16 may detect one or more second biological signals related to the arterial pressure at a site away from the heart 21, such as an arm 23, for example, only by a non-invasive method. The second detection unit 16 can use, for example, a cuff pressure sensor, photoplethysmography (PPG), remote photoplethysmography (rPPG), tonometry, and the like. The measurement of pulse pressure using the cuff pressure sensor includes a method using a K-sound and an oscillometric method. In this case, the second detection unit 16 can detect the arterial pressure of a site including at least one of a carotid artery, a brachial artery, a radial artery, a fingertip, and an ear.
In a case where the second detection unit 16 detects the arterial pressure by a minimally invasive method, it is possible to use an invasive blood pressure measurement method such as a method of, for example, a contrast catheter, an arterial line (A-line), an intravascular implant (a stent, an artificial blood vessel, or an implantation sensor), subcutaneous implantation, or the like. In this case, the second detection unit 16 can detect the arterial pressure of the site including at least one of the carotid artery, the brachial artery, and the radial artery.
The first detection unit 15 may calculate a value of the parameter related to the heartbeat from the first biological signal. The second detection unit 16 may calculate a value of the parameter related to the arterial pressure from the second biological signal. The parameter related to the heartbeat and the parameter related to the arterial pressure may be calculated in the ventricular pressure waveform estimation device 10 from the first biological signal and the second biological signal, instead of the first detection unit 15 and the second detection unit 16. For example, the calculation unit 12 of the ventricular pressure waveform estimation device 10 may calculate a value of the parameter related to the heartbeat or arterial pressure by combining the first biological signal and the second biological signal.
The calculation unit 12 includes at least one processor, and executes various types of calculation processing required in the ventricular pressure waveform estimation device 10 while controlling each unit of the ventricular pressure waveform estimation device 10. The processor may include a general-purpose processor such as a central processing unit (CPU) or a dedicated processor specialized for specific processing. The calculation unit 12 may include an application specific integrated circuit (ASIC), a digital signal processor (DSP), a programmable logic device (PLD), a field-programmable gate array (FPGA), or any combination of the application specific integrated circuit (ASIC), the digital signal processor (DSP), the programmable logic device (PLD), and the field-programmable gate array (FPGA). The calculation unit 12 may include a memory constructed in the processor or a memory independent of the processor.
The calculation unit 12 estimates at least a part of the left ventricular pressure waveform or the right ventricular pressure waveform using the value of the one or more parameters related to the heartbeat or arterial pressure acquired by the acquisition unit 11. For example,
The calculation unit 12 has a model equation indicating the left ventricular pressure waveform or the right ventricular pressure waveform. This model equation is expressed by the following Formula (1).
The model equation as expressed by Formula (1) includes four coefficients a, b, c, and k. The calculation unit 12 estimates at least a part of the left ventricular pressure waveform or the right ventricular pressure waveform by estimating the respective coefficients a, b, c, and k of the model equation. A constructed machine learning model can be used to estimate each of the coefficients. An estimation method of the left ventricular pressure waveform or the right ventricular pressure waveform executed by the calculation unit 12 will be described in more detail below.
The output unit 13 includes at least one output interface. The output unit 13 outputs data of an output waveform 18 indicating a time change in the internal pressure of the left ventricle or a right ventricle obtained by an operation of the ventricular pressure waveform estimation device 10. The output unit 13 may output the data of the output waveform 18 to be processed by a device in a subsequent stage. Instead of outputting the output waveform 18 to another device, the ventricular pressure waveform estimation device 10 may further perform processing in the ventricular pressure waveform estimation device based on the data of the output waveform 18.
The storage unit 14 includes at least one semiconductor memory, at least one magnetic memory, at least one optical memory, or any combination of the at least one semiconductor, the at least one magnetic memory, and the at least one optical memory. The semiconductor memory can be, for example, a random access memory (RAM) or a read only memory (ROM). The RAM can be, for example, a static random access memory (SRAM) or a dynamic random access memory (DRAM). The ROM can be, for example, an electrically erasable programmable read only memory (EEPROM). The storage unit 14 functions as, for example, a main storage device, an auxiliary storage device, or a cache memory. The storage unit 14 stores data used for the operation of the ventricular pressure waveform estimation device 10, and data obtained by the operation of the ventricular pressure waveform estimation device 10. The storage unit 14 stores a machine learning model to be used to estimate the ventricular pressure waveform.
Functions of the ventricular pressure waveform estimation device 10 are implemented by executing a ventricular pressure waveform estimation program (hereinafter, referred to as the “program”) according to the present embodiment by a processor serving as the calculation unit 12. That is, the functions of the ventricular pressure waveform estimation device 10 are implemented by software. The program causes a computer to function as the ventricular pressure waveform estimation device 10 by causing the computer to execute the operation of the ventricular pressure waveform estimation device 10. That is, the computer functions as the ventricular pressure waveform estimation device 10 by executing the operation of the ventricular pressure waveform estimation device 10 according to the program.
The program can be stored in a non-transitory computer-readable medium. The non-transitory computer-readable medium can be, for example, a flash memory, a magnetic recording device, an optical disc, a magneto-optical recording medium, or a ROM. The program can be distributed by, for example, selling, transferring, or lending a portable medium such as a secure digital (SD) card, a digital versatile disc (DVD), or a compact disc read only memory (CD-ROM) storing the program. The program may be distributed by storing the program in a storage of a server and transferring the program from the server to another computer. The program may be provided as a program product.
The computer temporarily stores, for example, the program stored in the portable medium or the program transferred from the server in the main storage device. Then, the computer reads the program stored in the main storage device by the processor, and executes processing according to the read program by the processor. The computer may read the program directly from the portable medium and execute the processing according to the program. The computer may sequentially execute the processing according to the received program each time the program is transferred from the server to the computer. The processing may be executed by a so-called application service provider (ASP) type service that implements functions only by an execution instruction and result acquisition without transferring the program from the server to the computer. The program includes information that is provided for processing by an electronic computer and is equivalent to the program. For example, data that is not a direct command to the computer but has a property that defines processing of the computer corresponds to the “information equivalent to the program”.
Some or all of the functions of the ventricular pressure waveform estimation device 10 may be implemented by a programmable circuit or a dedicated circuit as the calculation unit 12. That is, some or all of the functions of the ventricular pressure waveform estimation device 10 may be implemented by hardware.
Derivation of Model Equation
Hereinafter, a method for deriving the model equation will be described. A Windkessel model is known as a model for describing a blood pressure waveform in an artery. According to a two-element model of the Windkessel model, a fluctuation in a blood pressure pulse wave can be replaced and expressed by an equivalent electric circuit illustrated in
At this time, a relationship between the current I(t) and the potential P(t) is expressed by a differential equation illustrated in the following Formula (2).
Formula (2) can be solved for the potential P(t) representing the blood pressure of the aorta assuming that the current I(t) representing a blood flow is a sigmoid function. The sigmoid function is generally used as a model of properties possessed by biological nerve cells. Myocardial contraction is caused by an action potential with respect to a cardiomyocyte, and thus, can be expressed in the same manner as an action potential of a nerve in principle. Therefore, I(t) in Formula (2) can be placed as the sigmoid function. In addition, it is possible to assume that I(t) follows the sigmoid function even from experimental data.
If the differential equation of Formula (2) is solved with I(t) as the sigmoid function of
P(t) is obtained as the following formula.
Here, I0 denotes an amplitude. Further, ci and k denote arbitrary coefficients.
Formula (1) of the above-described model equation is obtained by rewriting Formula (4). Formula (1) is re-expressed as follows.
Coefficients a, b, c, and kin Formula (1) denote arbitrary coefficients. Note that the second term of Formula (4) is RC≈1, and thus, can be assumed to be substantially constant in the range of t=0 ms to 200 ms (0 s to 0.2 s).
The aorta is a blood vessel through which blood pumped out of the left ventricle passes first, and thus, the blood pressure of the aorta becomes close to the internal pressure of the left ventricle. Therefore, Formula (1) can be re-read as one indicating the left ventricular pressure waveform. In addition, when the blood pressure of a pulmonary artery is replaced by the potential P(t) and the volume of blood pumped out of the right ventricle is replaced by I(t), the right ventricular pressure waveform can also be expressed by Formula (1) with the similar model.
Method for Constructing Machine Learning Model
The ventricular pressure waveform estimation device 10 stores a machine learning model constructed in advance in the storage unit 14. The machine learning model may be constructed using a computer for machine learning different from the ventricular pressure waveform estimation device 010. A procedure for constructing the machine learning model will be described with reference to a flowchart of
First, a measured waveform of the left ventricular pressure or the right ventricular pressure and at least one of a non-invasive parameter and a minimally invasive parameter related to the heartbeat or arterial pressure calculated from a biological signal detected simultaneously with the measured waveform are acquired (S101). The non-invasive parameter and the minimally invasive parameter will be referred to simply as parameters hereinafter. In
The computer for machine learning calculates values of the coefficients a, b, c, and k of the model equation by fitting the model equation (equation (1)) to each of the measured waveforms for the measured waveforms (S102). A nonlinear least squares method can be used for the fitting of the model equation. The nonlinear least squares method can include a steepest descent method, the Gauss-Newton method, the Levenberg-Marquardt method, the Powell's least square method, and the like. As illustrated in
The computer for machine learning generates a data set for machine learning having the parameters acquired in S101 as explanatory variables and the coefficients a, b, c, and k of the model equation calculated in S102 as objective variables (S103). As the data set for machine learning, a plurality of data sets obtained by collecting data for each attribute may be generated in consideration of attributes such as an age group and gender of the patients.
The computer for machine learning executes machine learning using the data set for machine learning generated in S103, and constructs a machine learning model for each of the coefficients (S104). The constructed machine learning model can be rephrased as a learned model. If the plurality of data sets are generated for each of the attributes of the patients, a plurality of the machine learning models may be constructed for each of the coefficients in accordance with the attribute of the patients. The machine learning models are constructed for the coefficients a, b, c, and k, respectively. Learning methods of the machine learning include a gradient boosting method, a nonlinear multiple regression method, and a neural network.
The machine learning models constructed in advance as described above are stored in the storage unit 14 of the ventricular pressure waveform estimation device 10. Therefore, the ventricular pressure waveform estimation device 10 has four machine learning models N (N=1 to 4) corresponding to the four coefficients a, b, c, and k of the model equation, respectively, as illustrated in
Example of Non-Invasive Parameter
If parameters to be used in estimating the left ventricular pressure waveform or the right ventricular pressure waveform are only non-invasive parameters detected by a non-invasive method, a burden on a patient's body is relatively small.
Parameters related to the arterial pressure such as a diastolic blood pressure, a systolic blood pressure, the maximum velocity of a pulse pressure waveform rise, a blood pressure value difference between a rise start point of the peripheral pulse pressure waveform and a dicrotic notch, and a pulse wave augmentation index (AI) can be acquired or calculated from the peripheral pulse pressure waveform.
The diastolic blood pressure is the pressure applied to a blood vessel when the heart is expanded. The diastolic blood pressure is also called the lowest blood pressure. The systolic blood pressure is the pressure applied to a blood vessel when the heart contracts. The systolic blood pressure is also called the maximum blood pressure.
The maximum velocity of the pulse pressure waveform rise is the maximum value of a slope dP/dt of the peripheral pulse pressure waveform due to the contraction of the heart.
The blood pressure value difference between the rise start point of the peripheral pulse pressure waveform and the dicrotic notch indicates a difference in blood pressure value between the diastolic blood pressure and the dicrotic notch as illustrated in
The pulse wave augmentation index is a proportion of a reflected-wave component to the blood pressure, and can be acquired by analyzing the peripheral pulse pressure waveform.
Further, parameters related to the heartbeat such as a heart rate, isovolumetric systolic time, a pulse wave velocity, and systolic time can be acquired or calculated from outputs of the electrocardiogram, the microphone, and the like and the peripheral pulse pressure waveform.
The heart rate can be measured by the electrocardiogram.
The isovolumetric systolic time means a time period in which the mitral and aortic valves are closed. During the Isovolumetric systolic time, the volume of the left ventricle does not change and the left ventricular pressure rises. The isovolumetric systolic time is measured as the time from a Q-wave measured by the electrocardiogram to an I-sound of the heart sound acquired by the microphone. The I-sound is a sound of the mitral valve closing.
The pulse wave velocity is a velocity at which a pulse wave, which is a wave of pressure of blood pumped out of the heart, travels through an artery to a peripheral blood vessel. The pulse wave velocity is measured as the time from a Q-wave measured by the electrocardiogram to the rise start point of the peripheral pulse pressure waveform.
The systolic time is time of systole in which the ventricle contracts. The systole includes isovolumetric systole and an ejection phase. The ejection phase is a period in which the aortic valve opens and blood in the left ventricle is pushed out to the aorta. The systolic time is measured as the time from the rise start point of the peripheral pulse pressure waveform to the dicrotic notch using the peripheral pulse pressure waveform.
The above parameters are examples. The ventricular pressure waveform estimation device 10 may use another parameter as an explanatory variable. For the estimation of the left ventricular pressure waveform or the right ventricular pressure waveform, the ventricular pressure waveform estimation device 10 can use one or more parameters selected from the above-described parameters. The left ventricular pressure waveform and the right ventricular pressure waveform can be estimated using the same parameters.
Estimation of Ventricular Pressure Waveform
A procedure in which the calculation unit 12 of the ventricular pressure waveform estimation device 10 estimates the left ventricular pressure waveform or the right ventricular pressure waveform will be described with reference to a flowchart of
First, the calculation unit 12 extracts explanatory variables for calculating the coefficients a, b, c, and k from non-invasive parameters or minimally invasive parameters calculated based on biological signals detected by the first detection unit 15 and the second detection unit 16 (S201). The biological signals are the electrocardiogram, the heart sound, the pulse wave, and the like. The non-invasive parameters or the minimally invasive parameters may be calculated by the calculation unit 12 based on the biological signals detected by the first detection unit 15 and the second detection unit 16. The explanatory variables are the parameters X, Y, and Z of each of the machine learning models N (N=1 to 4).
Next, the calculation unit 12 inputs the extracted explanatory variables to each of the constructed machine learning models N (N=1 to 4), and estimates values of the coefficients a, b, c, and k of the model equation (S202).
The calculation unit 12 applies the values of the coefficients a, b, c, and k estimated in S202 to Formula (1), which is the model equation, and estimates a target left ventricular pressure waveform or right ventricular pressure waveform (S203).
As described above, the calculation unit 12 can estimate the left ventricular pressure waveform or the right ventricular pressure waveform of the patient based on the biological signal detected in a non-invasive or minimally invasive manner using the machine learning model. Therefore, a waveform shape of the left ventricular pressure or the right ventricular pressure can be estimated by a non-invasive or minimally invasive method according to the ventricular pressure waveform estimation device 10 of the present disclosure. As a result, a medical worker such as a doctor can grasp a sign of a change in a symptom of the patient with heart failure at a relatively early stage by a relatively simple method, and thus, it is possible to help prevent a deterioration of the symptom by prescribing a medicine to the patient early.
Furthermore, the calculation unit 12 can calculate a value of LVEDP or PCWP from the estimated left ventricular pressure waveform or right ventricular pressure waveform. The LVEDP corresponds to the pressure at a rise time (that is, when the time is 0 ms) of the estimated left ventricular pressure waveform. The PCWP can be calculated as the pressure at a predetermined or arbitrary time from the estimated right ventricular pressure waveform. For example, the lowest value, the highest value, an average value, and the like of the PCWP can be acquired or calculated from the estimated right ventricular pressure waveform.
The calculation unit 12 can further obtain an index of contractility of the left heart or the right heart from a slope (dP/dt) of the estimated left ventricular pressure waveform or right ventricular pressure waveform. It can be determined that the contractility is relatively high if the slope of the left ventricular pressure waveform or the right ventricular pressure waveform is relatively large, and that the contractility is relatively low if the slope is relatively small. As a result, the ventricular pressure waveform estimation device 10 can quickly grasp a deterioration in a systolic function of the heart of the patient in a non-invasive or minimally invasive manner.
In the above embodiment, it is assumed that a change in the ventricular pressure can be expressed by the model equation of Formula (1) according to the two-element model of the Windkessel model. In addition, it is assumed that the coefficients of the model equation are four coefficients of a, b, c, and k. In other embodiments, different model equations may be employed based on different models. The different models may include a three-element model and a four-element model of the Windkessel model. Based on the different models, the number of coefficients in the model equations may also be numbers other than four.
Pulmonary Artery Pressure Waveform Estimation Device
In the ventricular pressure waveform estimation device 10 of the above embodiment, at least a part of the left ventricular pressure waveform or the right ventricular pressure waveform is estimated by estimating each of the plurality of coefficients of the model equation including the coefficients and indicating the left ventricular pressure waveform or the right ventricular pressure waveform by using values of the one or more parameters related to the heartbeat or arterial pressure. According to the same method, it is possible to provide a pulmonary artery pressure waveform estimation device that estimates at least a part of a pulmonary artery pressure waveform by estimating each of a plurality of coefficients of a model equation including the coefficients and indicating the pulmonary artery pressure waveform using values of one or more parameters related to a heartbeat or an arterial pressure. Therefore, in
Similarly to the ventricular pressure waveform estimation device 10 of
Similar to the above embodiment, the one or more parameters may include one or more parameters related to the heartbeat and one or more parameters related to the arterial pressure. The one or more parameters may include at least one of a diastolic blood pressure, a systolic blood pressure, a maximum velocity of a pulse pressure waveform rise, a blood pressure value difference between a rise start point of a peripheral pulse pressure waveform and a dicrotic notch, a pulse wave augmentation index pulse wave augmentation index, a heart rate, an isovolumetric systolic time, a pulse wave velocity, and a systolic time. The calculation unit 12 of the pulmonary artery pressure waveform estimation device 40 may calculate a value of pulmonary artery pressure and/or a value of pulmonary capillary wedge pressure (PCWP) based on at least a part of the pulmonary artery pressure waveform. The calculation unit 12 of the pulmonary artery pressure waveform estimation device 40 may estimate a value of left ventricular end-diastolic pressure (LVEDP) based on at least a part of the pulmonary artery pressure waveform.
Similar to the ventricular pressure waveform estimation device 10, the pulmonary artery pressure waveform estimation device 40 may include the first detection unit 15 that detects one or more first biological signals related to the heartbeat and one or more second detection units 16 that detect one or more second biological signals related to the arterial pressure. A value of the parameter may be determined based on at least any of the first biological signal and the second biological signal. The first detection unit 15 and the second detection unit 16 may detect the first biological signal and the second biological signal, respectively, by a non-invasive or minimally invasive method.
Although the embodiments according to the present disclosure have been described based on the drawings and examples, it should be noted that those skilled in the art can rather easily make various modifications or changes based on the present disclosure. Therefore, it should be noted that these modifications or alterations fall within the scope of the present disclosure. For example, functions and the like included in each component, each step, or the like can be rearranged so as not to be logically inconsistent, and a plurality of components, steps, and the like can be combined into one or divided. Although the embodiments according to the present disclosure have been described mainly with respect to the devices, the embodiments according to the present disclosure can also be realized as methods including steps or processes executed by each of the components of the devices, respectively. The embodiments according to the present disclosure can also be realized as methods or programs executed by processors included in the devices or storage media recording the programs, respectively. It should be understood that these are also included in the scope of the present disclosure.
The ventricular pressure waveform estimation device, the ventricular pressure waveform estimation method, and the ventricular pressure waveform estimation program of the present disclosure can be applied to a monitoring device or the like for grasping a disease state of a patient with heart failure or the like, assessing a cardiac function, and the like.
The detailed description above describes embodiments of a ventricular pressure waveform estimation device, a ventricular pressure waveform estimation method, a ventricular pressure waveform estimation program, and a pulmonary artery pressure waveform estimation device. The invention is not limited, however, to the precise embodiments and variations described. Various changes, modifications and equivalents can be effected by one skilled in the art without departing from the spirit and scope of the invention as defined in the accompanying claims. It is expressly intended that all such changes, modifications and equivalents which fall within the scope of the claims are embraced by the claims.
Number | Date | Country | Kind |
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2021-101120 | Jun 2021 | JP | national |
This application is a continuation of International Application No. PCT/JP2022/024216 filed on Jun. 16, 2022, which claims priority to Japanese Application No. 2021-101120 filed on Jun. 17, 2021, the entire content of both of which is incorporated herein by reference.
Number | Date | Country | |
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Parent | PCT/JP2022/024216 | Jun 2022 | US |
Child | 18526534 | US |