The present disclosure relates generally to a wound dressing. The present disclosure relates more particularly to a wound dressing having an absorbent structure for the maintenance of a suitable moisture level at the surface of wounds and a reduction of odor.
Maintaining a moist wound environment can promote the healing of wounds, especially burns and chronic wounds such as ulcers. However, excessive moisture or pooling of wound exudate on the wound can cause maceration of skin adjacent to the wound and other difficulties. Furthermore, liquid exudate can leak from the wound site and contaminate clothes or bedding. It can be difficult to maintain the desired moisture level at the wound site because the rate of wound fluid production varies from wound to wound, and over time for any single wound. This can necessitate frequent dressing changes and a variety of dressing types to treat different wounds.
Some wound dressings are designed to promote moisture vapor transmission through the wound dressing while maintaining a moist wound environment. It is often desirable to use a wound dressing with an odor-absorbing layer. However, the moisture vapor transmission rate (MVTR) provided by a wound dressing typically decreases if additional layers are added to the wound dressing and/or if existing layers of the wound dressing are made thicker. This is because additional layers and/or thicker layers are known to obstruct moisture vapor transmission through the wound dressing and therefore have the effect of decreasing MVTR. It would be desirable to provide a wound dressing that overcomes these and other limitations of conventional wound dressings.
One implementation of the present disclosure is a wound dressing including a superabsorbent layer, a backing layer, and a charcoal layer. The superabsorbent layer is configured to absorb wound fluid and has a first side and a second, wound-facing side. The backing layer also has a first side and a second, wound-facing side. The backing layer is substantially impermeable to liquid and substantially permeable to vapor. The charcoal layer is positioned between the first side of the superabsorbent layer and the second, wound-facing side of the backing layer. The charcoal layer is configured to increase a moisture vapor transmission rate of the wound dressing.
Another implementation of the present disclosure is a wound dressing including a superabsorbent layer, a backing layer, and an intermediate layer. The superabsorbent layer is configured to absorb wound fluid and has a first side and a second, wound-facing side. The backing layer also has a first side and a second, wound-facing side. The backing layer is substantially impermeable to liquid and substantially permeable to vapor. The intermediate layer is positioned between the first side of the superabsorbent layer and the second, wound-facing side of the backing layer. The intermediate layer is configured to increase a moisture vapor transmission rate of the wound dressing.
Another implementation of the present disclosure is a wound dressing including a superabsorbent layer, a backing layer, and a charcoal layer. The superabsorbent layer is configured to absorb wound fluid and has a first side and a second, wound-facing side. The backing layer also has a first side and a second, wound-facing side. The backing layer is substantially impermeable to liquid and substantially permeable to vapor. The charcoal layer is configured to increase a moisture vapor transmission rate of the wound dressing. The charcoal layer includes a first side positioned adjacent to and abutting the second, wound-facing side of the backing layer. The charcoal layer also includes a second, wound-facing side positioned adjacent to and abutting the first side of the superabsorbent layer.
Another implementation of the present disclosure is a wound dressing including a superabsorbent layer, a backing layer, and an intermediate layer. The superabsorbent layer is configured to absorb wound fluid and has a first side and a second, wound-facing side. The backing layer also has a first side and a second, wound-facing side. The backing layer is substantially impermeable to liquid and substantially permeable to vapor. The intermediate layer is configured to increase a moisture vapor transmission rate of the wound dressing. The intermediate layer includes a first side positioned adjacent to and abutting the second, wound-facing side of the backing layer. The intermediate layer also includes a second, wound-facing side positioned adjacent to and abutting the first side of the superabsorbent layer.
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, inventive features, and advantages of the devices and/or processes described herein, as defined solely by the claims, will become apparent in the detailed description set forth herein and taken in conjunction with the accompanying drawings.
Referring generally to the FIGURES, a wound dressing with odor absorption and increased moisture vapor transmission is shown, according to an exemplary embodiment. The wound dressing has multiple layers including a backing layer, a charcoal layer, and a superabsorbent layer laminated to a hydrophilic foam layer. In some embodiments, the superabsorbent layer and the hydrophilic foam layer are bonded to each other (e.g., laminated together using a fusible fiber) or otherwise combined to form an island.
Advantageously, the charcoal layer increases the moisture vapor transmission rate (MVTR), the absorbency, the total fluid handling capacity (TFHC) of the wound dressing relative to similar wound dressings without the charcoal layer. Such an increase in MVTR is unexpected given that adding another layer typically decreases MVTR. However, the unique arrangement and composition of layers included in the wound dressing has been shown to increase MVTR, absorbency, and TFHC.
In some embodiments, the charcoal layer includes activated charcoal (e.g., an activated charcoal cloth) having a plurality of small, low-volume pores within the internal volume of charcoal layer 104. The pores increase the internal surface area of the charcoal layer available for adsorption of the wound fluid. It is believed that the pores within the charcoal layer contribute to the unexpected increase in MVTR.
Another advantage provided by the charcoal layer is odor absorption. The charcoal layer may have odor-absorbent properties and may function to reduce wound odor. The odor-absorbent properties of the charcoal layer may result from the charcoal layer trapping odor within the plurality of small, low-volume pores. The odor-absorbent properties of the charcoal layer, in combination with the increase in MVTR, absorbency, and TFHC, provide a multifunctional wound dressing that both manages wound exudate and reduces wound odor without requiring multiple wound dressings. Additional features and advantages of the wound dressing are described in detail below.
Referring now
In various embodiments, wound dressing 100 can be formed as a substantially flat sheet for topical application to wounds or contoured for application to body surfaces having high curvature. The size of wound dressing 100 can vary depending on the size of the wound to be dressed. For example, it is contemplated that the size of wound dressing 100 can range from 1 cm2 to 200 cm2, and more preferably from 4 cm2 to 100 cm2. However, other shapes and sizes of wound dressing 100 are also possible depending on the intended use.
Wound dressing 100 is shown to include a backing layer 102, a charcoal layer 104, a superabsorbent layer 106, and a hydrophilic foam layer 108. In some embodiments, superabsorbent layer 106 and hydrophilic foam layer 108 are bonded to each other (e.g., laminated together using a fusible fiber) or otherwise combined to form an island 107. Charcoal layer 104 may be positioned between backing layer 102 and island 107. In some embodiments, wound dressing 100 includes a removable cover sheet 103 to cover island 107 before use.
Backing layer 102 is shown to include a first side 110 and a second, wound-facing side 112 opposite first side 110. When wound dressing 100 is applied to a wound, first side 110 faces away from the wound whereas second side 112 faces toward the wound. Backing layer 102 supports charcoal layer 104 and island 107 and provides a barrier to passage of microorganisms through wound dressing 100. In some embodiments, backing layer 102 is a thin layer of polyurethane film. One example of a suitable material for backing layer 102 is the polyurethane film known as ESTANE 5714F. Other suitable polymers for forming backing layer 102 include poly alkoxyalkyl acrylates and methacrylates, such as those described in Great Britain Patent Application No. 1280631A filed Nov. 22, 2002, the entire disclosure of which is incorporated by reference herein. In some embodiments, backing layer 102 includes a continuous layer of a high-density blocked polyurethane foam that is predominantly closed-cell. Backing layer 102 may have a thickness in the range of 10 μm to 100 μm, preferably in the range of 50 μm to 70 μm. In some embodiments, backing layer 102 has a thickness of approximately 60 μm.
Backing layer 102 may be substantially impermeable to liquid and substantially permeable to moisture vapor. In other words, backing layer 102 may be permeable to water vapor, but not permeable to liquid water or wound exudate. This increases the total fluid handling capacity (TFHC) of wound dressing 100 while promoting a moist wound environment. In some embodiments, backing layer 102 is also impermeable to bacteria and other microorganisms. Backing layer 102 may have a moisture vapor transmission rate (MVTR) of approximately
preferably 500 to
° C. at 100% to 10% relative humidity difference. In some embodiments, backing layer 102 is configured to wick moisture from charcoal layer 104 and distribute the moisture across first side 110.
Side 112 of backing layer 102 may be coated with an acrylic or other adhesive. The adhesive applied to side 112 ensures that wound dressing 100 adheres to surface 126 and that wound dressing 100 remains in place throughout the wear time. In some embodiments, the perimeter of backing layer 102 extends beyond (e.g., circumscribes) the perimeters of charcoal layer 104 and island 107 to provide an adhesive-coated margin for adhering wound dressing 100 to the skin of a patient adjacent to the wound being treated, shown in
In some embodiments, side 112 of backing layer 102 contacts side 114 of charcoal layer 104. Side 112 of backing layer 102 may be adhered to side 114 of charcoal layer 104 or may simply contact side 114 without the use of an adhesive. The perimeter of superabsorbent layer 106 may extend beyond (i.e., circumscribe) the perimeter of charcoal layer 104 to provide a margin around the perimeter of charcoal layer 104. Side 112 of backing layer 102 may extend beyond the perimeter of charcoal layer 104 to contact side 118 of superabsorbent layer 106. Side 112 of backing layer 102 may adhere to side 118 of superabsorbent layer 106 along the margin that extends beyond charcoal layer 104. In this way, backing layer 102 and superabsorbent layer 106 may form a closed pocket, sealing charcoal layer 104 between backing layer 102 and superabsorbent layer 106.
In some embodiments, the adhesive applied to side 112 of backing layer 102 is moisture vapor transmitting and/or patterned to allow passage of water vapor therethrough. The adhesive may include a continuous moisture vapor transmitting, pressure-sensitive adhesive layer of the type, conventionally used for island-type wound dressings (e.g., a polyurethane-based pressure sensitive adhesive). One example of an adhesive which can be used is a pressure sensitive adhesive based on acrylate ester copolymers, polyvinyl ethyl ether and polyurethane, as described in Great Britain Patent Application No. 1280631A. The basis weight of the adhesive may be 20 to 250 g/m2, and more preferably 50 to 150 g/m2.
Charcoal layer 104 is shown to include a first side 114 and a second, wound-facing side 116 opposite first side 114. When wound dressing 100 is applied to a wound, first side 114 faces away from the wound whereas second side 116 faces toward the wound. In some embodiments, first side 114 of charcoal layer 104 contacts second side 112 of backing layer 102. Similarly, second side 116 of charcoal layer 104 may contact first side 118 of superabsorbent layer 106. Charcoal layer 104 may be adhered to backing layer 102 and superabsorbent layer 106 along surfaces 112, 114, 116, and/or 118. Alternatively, charcoal layer 104 may be sealed in a closed pocket between backing layer 102 and superabsorbent layer 106 such that adhesive is not required to fix charcoal layer 104 to backing layer 102 and/or superabsorbent layer 106.
Advantageously, charcoal layer 104 may increase the MVTR, absorbency, and total fluid handling capacity (TFHC) of wound dressing 100 relative to similar wound dressings without charcoal layer 104. The increase in MVTR provided by charcoal layer 104 is unexpected given that adding another layer typically decreases MVTR. However, the unique combination of layers included in wound dressing 100 increases these properties while providing other benefits such as odor absorption. Several tables and graphs illustrating the results of testing performed to demonstrate this increase in MVTR, absorbency, and TFHC are shown in
Charcoal layer 104 may include activated charcoal (e.g., an activated charcoal cloth) having a plurality of small, low-volume pores within the internal volume of charcoal layer 104. The pores increase the internal surface area of charcoal layer 104 available for adsorption of the wound fluid. It is believed that the pores within charcoal layer 104 contribute to the increase in MVTR, absorbency, and TFHC. Small pores can be used to achieve a large internal surface area available for adsorption of the wound fluid, whereas larger pores may result in less surface area available for adsorption. Accordingly, it may be desirable to use relatively smaller pores to increase MVTR, absorbency, and TFHC. In some embodiments, charcoal layer 104 has a surface area available for adsorption in the range of 500 to 1500 m2/g (i.e., per gram of the activated charcoal) and a pore volume in the range of 0.3 to 0.8 cm3/g (i.e., per gram of the activated charcoal). However, it is contemplated that other surface areas and pore volumes can also be used to achieve a similar effect.
Another advantage provided by charcoal layer 104 is odor absorption. Charcoal layer 104 may have odor-absorbent properties and may function to reduce wound odor. The odor-absorbent properties of charcoal layer 104 may result from charcoal layer 104 trapping odor within the plurality of small, low-volume pores. The odor-absorbent properties of charcoal layer 104, in combination with the increase in MVTR, absorbency, and TFHC, provide a multifunctional wound dressing 100 that both manages wound exudate and reduces wound odor without requiring multiple wound dressings.
In some embodiments, charcoal layer 104 includes one or more therapeutic or antimicrobial agents. Therapeutic agents can include, for example, growth factors, analgesics, local anaesthetics and steroids. Antimicrobial agents can include antiseptics such as silver compounds (e.g. silver sulfadiazine) and chlorhexidine, and antibiotics. Several examples of therapeutic and antimicrobial agents which can be added to charcoal layer 104 are described in detail in U.S. Pat. No. 8,962,908 issued Feb. 24, 2015, U.S. Pat. No. 8,858,987 issued Oct. 14, 2014, and U.S. Pat. No. 8,124,826 issued Feb. 28, 2012. The entire disclosure of each of these patents is incorporated by reference herein.
Adding an antimicrobial agent to charcoal layer 104 may be desirable for several reasons. For example, combining the antimicrobial agent with charcoal layer 104 eliminates the need for a separate antimicrobial agent or layer, which simplifies manufacturing as well as wound treatment. Additionally, separating the antimicrobial agent from the wound may prevent unnecessary exposure to the antimicrobial when it is not needed, which can maintain the moisture level of the wound within a desirable range (e.g., drier wounds). In the presence of higher exudate, higher levels of the antimicrobial will be released as charcoal layer 104 becomes wet. This may cause the antimicrobial agent to migrate against the antimicrobial concentration gradient into the wound.
In some embodiments, charcoal layer 104 may be replaced with another intermediate layer between backing layer 102 and superabsorbent layer 106. The intermediate layer may include an activated charcoal cloth, an antimicrobial alginate cloth, a gauze, or a knitted yarn. These types of materials may also increase the MVTR, absorbency, and TFHC of wound dressing 100 relative to similar wound dressings without these additional layers.
In some embodiments, wound dressing 100 includes one or more liquid-permeable layers. A liquid-permeable layer may be located between charcoal layer 104 and backing layer 102 and/or between charcoal layer 104 and superabsorbent layer 106. For embodiments in which charcoal layer 104 is replaced with another intermediate layer, the liquid-permeable layers may be located between the intermediate layer and backing layer 102 and/or between the intermediate layer and superabsorbent layer 106. In some embodiments, wound dressing 100 includes a pair of liquid-permeable layers that envelop charcoal layer 104 or the intermediate layer (i.e., located on both sides of charcoal layer 104 or the intermediate layer).
In some embodiments, the liquid-permeable layers function to contain charcoal layer 104 and/or the intermediate layer. For example, charcoal layer 104 and/or the intermediate layer may be susceptible to breaking into several smaller pieces when wet. The liquid-permeable layers can be placed on opposite sides of charcoal layer 104 and/or the intermediate layer in order to reduce movement of the broken pieces within charcoal layer 104 and/or the intermediate layer.
In some embodiments, the liquid-permeable layers are made of a liquid-permeable fabric such as nylon. For example, the liquid-permeable layers may be made of a nylon fabric having a mass density of approximately 50 grams per square meter (GSM) of the fabric. The nylon fabric may be similar to or the same as the nylon fabric used in the ACTISORB brand wound dressing produced by Acelity. In some embodiments, the nylon fabric is spun-bonded and/or non-woven. The nylon fabric can be configured to allow liquid to permeate the fabric while keeping charcoal layer 104 and/or the intermediate layer contained between layers of the nylon fabric.
A benefit of using nylon non-woven fabric is that the fabric can be heated to bond to itself. For example, the layers of nylon fabric may be sized such that the perimeters of the nylon fabric layers extend beyond (e.g., circumscribe) the perimeter of charcoal layer 104 and/or the intermediate layer. The perimeters of the nylon fabric can be bonded to each other by applying heat to form a sealed pocket containing charcoal layer 104 and/or the intermediate layer between layers of the nylon fabric.
Superabsorbent layer 106 is shown to include a first side 118 and a second, wound-facing side 120 opposite first side 118. When wound dressing 100 is applied to a wound, first side 118 faces away from the wound whereas second side 120 faces toward the wound. In some embodiments, first side 118 of superabsorbent layer 106 contacts second side 116 of charcoal layer 104. Similarly, second side 120 of superabsorbent layer 106 may contact first side 122 of hydrophilic foam layer 108. In some embodiments, superabsorbent layer 106 is laminated to hydrophilic foam layer 108 using a fusible fiber positioned between superabsorbent layer 106 and hydrophilic foam layer 108. In some embodiments, superabsorbent layer 106 is configured to wick moisture from hydrophilic foam layer 108 and distribute the moisture across first side 118.
In some embodiments, superabsorbent layer 106 includes a hydrogel or hydrogel composition. Several examples of hydrogels and hydrogel compositions which can be used to form superabsorbent layer 106 are described in detail in U.S. Pat. No. 8,097,272 issued Jan. 17, 2012, U.S. Pat. No. 8,664,464 issued Mar. 4, 2014, and U.S. Pat. No. 8,058,499 issued Nov. 15, 2011. The entire disclosure of each of these patents is incorporated by reference herein.
The expressions “hydrogel” and “hydrogel compositions” used herein are not to be considered as limited to gels which contain water, but extend generally to all hydrophilic gels and gel compositions, including those containing organic non-polymeric components in the absence of water. For example, superabsorbent layer 106 may be formed from a polyurethane that entraps water to form a gel. In some embodiments, superabsorbent layer 106 is substantially continuous and/or substantially non-porous or non-foamed. Superabsorbent layer may include a flexible plasticized hydrophilic polymer matrix having a substantially continuous internal structure. The density of superabsorbent layer 106 may be greater than 0.5 g/cm3, more preferably greater than 0.8 g/cm3, and most preferably from 0.9 to 1.1 g/cm3. In some embodiments, the thickness of superabsorbent layer 106 is from 1 mm to 10 mm, more preferably from 2 mm to 5 mm.
In some embodiments, superabsorbent layer 106 is cross-linked and preferably it is substantially insoluble in water at ambient temperature. However, the structure of superabsorbent layer 106 absorbs and entraps liquid to provide a highly hydrated gel structure in contrast to the porous foam structure of hydrophilic foam layer 108. Preferably, the gel can absorb 1 to 10 g/g of physiological saline at 20°, more preferably 2 to 5 g/g.
In some embodiments, the dry weight of superabsorbent layer 106 is from 1000 to 5000 g/m2, more preferably from 2000 to 4000 g/m2. In some embodiments, superabsorbent layer 106 includes from 1% to 30% of water, more preferably from 10% to 20% by weight of water before use. In some embodiments, superabsorbent layer 106 contains from 1% to 40%, more preferably from 5 to 15%, by weight of one or more humectants, preferably selected from the group consisting of glycerol, propylene glycol, sorbitol, mannitol, polydextrose, sodium pyrrolidine carboxylic acid (NaPCA), hyaluronic acid, aloe, jojoba, lactic acid, urea, gelatin, lecithin and mixtures thereof. The entrapped water and optional humectants give the hydrogel a soft, moist wound-friendly surface for contacting the wound.
Hydrophilic foam layer 108 is shown to include a first side 122 and a second, wound-facing side 124 opposite first side 122. When wound dressing 100 is applied to a wound, first side 122 faces away from the wound whereas second side 124 faces toward the wound. In some embodiments, first side 122 of hydrophilic foam layer 108 contacts second side 120 of superabsorbent layer 106.
In some embodiments, hydrophilic foam layer 108 is laminated to superabsorbent layer 106 using a fusible fiber positioned between superabsorbent layer 106 and hydrophilic foam layer 108. For example, superabsorbent layer 106 may be applied to first side 122 of hydrophilic foam layer 108 and may at least partially cover first side 122. Superabsorbent layer 106 can be bonded to hydrophilic foam layer 108, for example by an adhesive or by radiation cross-linking. In some embodiments, superabsorbent layer 106 is bonded to the hydrophilic foam layer 108 by urethane or urea linkages. This can be achieved by applying hydrophilic foam layer 108 to superabsorbent layer 106 (substantially without mixing) before polyurethane curing is complete.
Hydrophilic foam layer 108 may include a polyurethane foam coupled to side 120 of superabsorbent layer 106. In some embodiments, hydrophilic foam layer 108 includes a flexible plasticized hydrophilic polymer matrix having an internal cellular structure. Several examples of hydrophilic foams which can be used to form hydrophilic foam layer 108 are described in detail in U.S. Pat. No. 8,097,272 issued Jan. 17, 2012, U.S. Pat. No. 8,664,464 issued Mar. 4, 2014, and U.S. Pat. No. 8,058,499 issued Nov. 15, 2011. The entire disclosure of each of these patents is incorporated by reference herein.
Advantageously, hydrophilic foam layer 108 provides enhanced absorbency for liquid exudate. This is because the initial substantially anhydrous condition and porous structure of hydrophilic foam layer 108 enables it to absorb a larger amount of water by both chemical and physical absorption that is the case for the corresponding hydrogel material. Furthermore, the porous structure of the foam provides for rapid uptake of liquid exudate, in contrast to pure hydrogel dressings.
In some embodiments, hydrophilic foam layer 108 has a thickness of from 1 to 20 mm, more preferably from 1.5 to 5 mm. In some embodiments, hydrophilic foam layer 108 has a density of from 0.28 g/cm3 to 0.5 g/cm3, and more preferably from 0.32 g/cm3 to 0.48 g/cm3. Preferably, hydrophilic foam layer 108 has an elongation to break of at least 150%, more preferably from 500% to 1000%. The foam that forms layer 108 may be hydrophilic and can absorb aqueous fluids such as wound exudate with swelling. Hydrophilic foam layer 108 may be highly cross-linked and substantially insoluble in water.
In some embodiments, hydrophilic foam layer 108 has an absorbency of at least 3 grams of saline per gram of foam, and preferably a swellability in water of at least 200%. In some embodiments, hydrophilic foam layer 108 is constructed using the foam as described in European Patent No. 0541391 issued Jun. 10, 1998, the entire disclosure of which is incorporated by reference herein. In some embodiments, hydrophilic foam layer 108 includes less than 10% water prior to use as an absorbent, more preferably less than 5% water, and even more preferably it contains less than 2% of water before use.
Referring now to
The TFHC is defined as the sum of MVTR and absorbency (i.e., MVTR+absorbency=TFHC).
a mean absorbency of
and a mean TFHC of
a mean absorbency of
and a mean TFHC of
which is over 23% of the MVTR value without charcoal layer 104. The addition of charcoal layer 104 also increased absorbency by
which is over 20% of the absorbency value without charcoal layer 104. Consequently, the addition of charcoal layer 104 increased TFHC by
which is over 21% or the TFHC value without charcoal layer 104.
A statistical hypothesis test (e.g., a t-test) was performed on these test results to determine whether the increases in MVTR, absorbency, and TFHC are statistically significant. The statistical hypothesis test showed that the samples of wound dressing 100 with charcoal layer 104 have a significantly higher MVTR, absorbency, and TFHC relative to the samples without charcoal layer 104. This indicates that the samples of wound dressing 100 with charcoal layer 104 are significantly better than the samples without charcoal layer 104 at absorbing and transmitting moisture from the wound.
It is contemplated that charcoal layer 104 could be used to increase the MVTR of a sample with a thick backing layer 102. As the thickness of a backing layer 102 increases, the MVTR decreases. If a higher MVTR was desired but the thickness of backing layer 102 could not be altered; the addition of charcoal layer 102 could be beneficial. As well as increasing MVTR, absorbency, and TFHC compared to the non-charcoal samples, charcoal layer 104 can also act as an odor absorber. This would be beneficial to patients' quality of life. An antimicrobial compound (e.g., silver) can be added to charcoal layer 104 to combat bacteria in wounds.
The construction and arrangement of the systems and methods as shown in the various exemplary embodiments are illustrative only. Although only a few embodiments have been described in detail in this disclosure, many modifications are possible (e.g., variations in sizes, dimensions, structures, shapes and proportions of the various elements, values of parameters, mounting arrangements, use of materials, colors, orientations, etc.). For example, the position of elements can be reversed or otherwise varied and the nature or number of discrete elements or positions can be altered or varied. Accordingly, all such modifications are intended to be included within the scope of the present disclosure. The order or sequence of any process or method steps can be varied or re-sequenced according to alternative embodiments. Other substitutions, modifications, changes, and omissions can be made in the design, operating conditions and arrangement of the exemplary embodiments without departing from the scope of the present disclosure.
This application claims the benefit of priority to U.S. Provisional Application No. 62/516,289, filed on Jun. 7, 2017, which is incorporated herein by reference in its entirety.
Filing Document | Filing Date | Country | Kind |
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PCT/US2018/035873 | 6/4/2018 | WO | 00 |
Number | Date | Country | |
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62516289 | Jun 2017 | US |