For processing the treatment system of fierce dangerous placenta previa clinical acute disease
Technical field
The present invention relates to a kind for the treatment of system for processing fierce dangerous placenta previa clinical acute disease.
Background technology
For tackling China human mortality aging, promote population balanced development, China has implemented in full a couple in 2016 can
The policy of two children of fertility.Due to the relieving of two tire policies and the rising of previous cesarean section rate, uterine cicatrix again gestation with
Increase.Once Placenta Hominiss implantation is at the cicatrix of uterus, that is, define fierce dangerous placenta previa.Fierce dangerous placenta previa produces to be sent out often
Raw unmanageable massive hemorrhage, easily causes the severe complications such as disseminated inravascular coagulation, shock, not only hysterectomy rate
Height, and maternal mortality rate is high, is obstetrics' urgency, danger, serious symptom.
Research with regard to fierce dangerous placenta previa treatment is a lot of both at home and abroad.Research is pointed out to treat the side of fierce dangerous placenta previa
Method has a lot, including conventional Cesarean operation, lower uterine segment tourniquet strapping, Intra-arterial infusions, the resistance of ventral aorta sacculus
Break.Conventional Cesarean operation is previously to implement Cesarean esction under not having any auxiliary equipment to help, often because going out greatly in art
Blood and row uterectomy, patient therefore loses organ, loses permanent fertility.And lower uterine segment tourniquet is tied up
Method can only select after delivery of baby, limited in terms of uterus amount of bleeding in reducing art.
In recent years, gradually ripe with intervention operation, some strong large hospitals spend high cost both at home and abroad
Set up hybridization operating room, intervention operating room etc., balloon position is positioned by x line, intervention blocks internal iliac artery or ventral aorta
To reduce intraoperative hemorrhage.But bilateral internal iliac blocks due to bilateral to be blocked, operation technique is more complicated, the time is long, in art
Application dsa, makes anemia of pregnant woman and fetus be exposed to for a long time under x beta radiation, in the case of there is metrecotpia tremulous pulse blood supply, such as
Ovarian artery and (or) external iliac artery participate in blood supply, simple block bilateral internal iliac it is impossible to effective control intraoperative hemorrhage.Although
Intervention blocks ventral aorta and achieves good result for fierce dangerous caesarean section with placenta previa in recent years, but, it is also to be situated between in x line
Lead down, need dsa to assist, piercing process wears method for blind, easily causes femoral nerve injury, stock arteriovenous fistula.Moreover build hybridization
Operating room/intervention operating room cost is high, and general hospital is difficult to bear, and patient spends also expensive.
Content of the invention
The present invention provides clinical for processing fierce dangerous placenta previa for overcoming technical problem present in prior art
The treatment system of emergency case, this treatment system is so that process the operation of fierce dangerous placenta previa clinical acute disease in general operating room
Can complete, and can avoid medical personnel and female tire is exposed to radiating of being subject under x-ray.
A kind for the treatment of system for processing fierce dangerous placenta previa clinical acute disease, including ultrasonic scanner and inaccessible ball
Capsule, ultrasonic scanner is used for detecting the situation for the treatment of site, and ultrasonic scanner is also electrically connected with ultrasound wave display device.
For adopting ultrasonic scanner to detect internal situation, it is to avoid detected using x-ray in prior art
When it is not necessary to the protection of x line, dsa equipment etc., this project can be carried out after general hospital is trained, entirely perform the operation in general surgery
Room can be carried out and completes, and can substantially reduce medical insurance spending, save medical insurance, reduce patient's economy and psychological burden.With
Localization by ultrasonic can be more accurate with guided puncture femoral artery, it is to avoid wear by mistake, and this is not available for x line.
Ultrasonic mediation mediates compared to x line, can avoid medical personnel and female tire is exposed to radiating of being subject under x-ray,
Even if far below the fetal well-being x beta radiation dosage of 150mgy, the operating time also can be significantly restrained.And in ultrasonic guidance mistake
Cheng Zhong, did not both radiate, and did not also have a time restriction, more without contrast agent, reduce the interference to surgical for the extrinsic factor.
Preferably technical scheme, its supplementary features is: occlusion balloon includes metallic framework, is provided with capsule outside metallic framework
Body, utricule is elastomer, and metallic framework comprises a metal braid, and it has the profile of default extension, in this default extension
Each of profile proximally and distally comprises a groove, and each proximally and distally has a connection terminal, and it is used for being fixedly attached to
Every one end in metal braid, this connection terminal is contained in inside grooves, and metal braid has memory characteristic so that working as
During to proximally and distally all not applying the first state constraining, the shape of metallic framework can support utricule sealing blood vessels, when right
When near-end applies to apply the thrust away from near-end away from the pulling force of far-end or to far-end, metallic framework is in the second state,
The cross section of the second state is less than the cross section under first state in order to can be pumped through the blood vessel in human body.
Form the metallic framework of utricule by metal braid, Main Load can be undertaken with the basic configuration of component utricule,
So as to block on the whole, block up tight blood vessel.And the sectional area size by utricule, with force-bearing situation phase knot proximally and distally
Close, thus easily realizing the switching of big small cross-sectional area.
Further preferred technical scheme, its supplementary features is: near-end is hollow, and far-end is connected with first connecting rod,
First connecting rod proximally in pass through.
By by control the first connecting rod of far-end proximally in pass through, near-end and far-end can be controlled from one side, convenient
One hands control the operation at two ends simultaneously.
Technical scheme still further preferably, its supplementary features is: is additionally provided with reactant bag in utricule, reaction bag chamber sets
Put the lateral surface in first connecting rod, during the energising of reactant in reactant bag, reactant occurs chemical reaction, for by capsule
Cubical expansion is opened.
Setting reactant bag, and make to produce a large amount of gases in the reactant short time, thus utricule is strutted, so that capsule
Body tightly can be fitted with blood vessel, is fully contacted, thus ensureing blood vessel constriction uniformly and sealing.
Further preferred technical scheme, its supplementary features is: occlusion balloon also includes the first loop, the first loop
On be connected with first switch, be connected with first resistor in the first loop, first resistor is arranged in the reactant of reactant bag.
By electrically-fired mode it is achieved that by the extraneous reaction controlling reactant whether, thus realizing to reactant
Automatically control.
Further preferred technical scheme, its supplementary features is: utricule is provided with barrier film, and barrier film is arranged on utricule
Side, barrier film is used for stopping that the gas in utricule escapes from utricule.
By arranging barrier film, completely cut off the effusion of the gas in utricule, improve the lasting seals in intra-operative blood vessel
Property.
Further preferred technical scheme, its supplementary features is: barrier film is provided with second resistance, and second resistance connects
In the second loop, it is provided with second switch and the 3rd switch in second servo loop, second switch includes the first contact and second and touches
Point, the first contact is fixedly connected to a little less with the first drawstring, and the first drawstring is driven by the first button, and the first button is pressed
When, the first drawstring moves away from the direction of far-end, and the first contact and the second contact, and closes when the 3rd switch is in
During conjunction state, to burn to break barrier film, the gas in utricule is escaped so that second resistance is conductive.
Setting second servo loop, to be controlled to second resistance, it is possible to achieve the aerofluxuss in utricule are contracted with metal braid
The synchronization of small bore.And by arranging the 3rd switch again, realize controlling metal braid deformation extent and the aerofluxuss of utricule
Separate, it is to avoid when independent adjustment metal braid section, cause the misoperation of air bags.
Preferably technical scheme, its supplementary features is: the step processing fierce dangerous placenta previa clinical acute disease includes:
S1. Preoperative ultrasound detects ventral aorta;
S2. Preoperative ultrasound accurately measures ventral aorta internal diameter, at positioning renal artery opening at abdominal aortic bifurcation, and surveys
Measure its distance, select sizeable sacculus to instruct;
S3. ultrasonic guidance femoral artery puncture, through right common femoral artery Puncture approach, foley's tube is inserted ventral aorta, and
Guiding sacculus enters at renal artery opening and between abdominal aortic bifurcation, and fixing indwelling is standby;
S4. ultrasonic reaffirm balloon position, now sacculus be blocked state;Ultrasonic guidance precise positioning balloon position,
To avoid blocking the important organs such as kidney, sacculus upper end is made to be close at renal artery opening;
S5. preoperative pre- blocking-up, is changed with renal artery anastomosis stenosis blood flow and is confirmed whether to block completely;
S6. balloon occlusion timing blocks before delivery of baby;Enjoin Invasive Technology Department doctor before cutting myometrium
Dilating sacculus block blood supply, and ultrasonic monitoring blood flow is dynamic simultaneously.
Ventral aorta internal diameter can be accurately measured by preoperative while detecting ventral aorta, select suitable ball to instruct
Capsule diameter;Because sacculus and ventral aorta internal diameter can coincide, accurate blocking-up can be reached during dilating sacculus, thus avoiding sacculus excessive
Fill and lead to injury of abdominal aorta, or sacculus underfilling leads to Abdominal aortic crossclamping complete, intraoperative hemorrhage etc..
The above-mentioned method repeatedly blocking, can block ventral aorta according to Suture hemostasis situation in art, during avoiding long repeatedly
Between blood vessel blocking blood injury blacked-out areas internal organs;
With with the change of dynamic monitoring blood flow and being confirmed whether to block completely in localization by ultrasonic art, and can find early to have or not
The complication such as thrombosis and artery dissection, this is also not available for x line.
Further preferred technical scheme, its supplementary features is: also include digital image processing apparatus and controller and
Start button,
Digital image processing apparatus, for receiving the image that ultrasonic scanner is obtained, and are converted into digital picture, and
In identification digital picture, gray value is less than the region of preset value, and the length in a first direction in this region is more than in second party
3 times of length upwards, are defined as angiosomeses;And confirmed as at renal artery opening according to the infall of multiple angiosomeses and
At abdominal aortic bifurcation;
Controller, for control robot arm to be moved at abdominal aortic bifurcation by utricule and renal artery opening between,
When the position of utricule is identified by digital image processing apparatus, and after confirming as tram, triggering first switch is so that utricule
Expand to block blood vessel;And after operation terminates triggering the 3rd switch and second switch, by the reduced cross-sectional of utricule, by sacculus from
Remove in blood vessel;
Start button, the recognizer and controller for starting digital image processing apparatus controls the journey of sacculus action
Sequence.
Further preferred technical scheme, its supplementary features is: also includes digital image processing apparatus and controller, surpasses
Sound wave display device is touch screen,
Digital image processing apparatus, for receiving the image that ultrasonic scanner is obtained, and are converted into digital picture, and
In identification digital picture, gray value is less than the region of preset value, and the length in a first direction in this region is more than in second party
3 times of length upwards, are defined as angiosomeses;And confirmed as at renal artery opening according to the infall of multiple angiosomeses and
At abdominal aortic bifurcation;
Controller, for control robot arm to be moved at abdominal aortic bifurcation by utricule and renal artery opening between,
When the position of utricule is identified by digital image processing apparatus, and after confirming as tram, triggering first switch is so that utricule
Expand to block blood vessel;And after operation terminates triggering the 3rd switch and second switch, by the reduced cross-sectional of utricule, by sacculus from
Remove in blood vessel;
Arrange on touch screen multiple for selection operation step or control first switch, second switch, the 3rd switch choosing
Select key.
Brief description
Fig. 1 is the structure chart of the embodiment of the present invention 1;
Fig. 2 is the schematic diagram in balloon inflation for the occlusion balloon of the embodiment of the present invention 1;
Fig. 3 is the schematic diagram when utricule shrinks for the occlusion balloon of the embodiment of the present invention 1.
Fig. 4 is the schematic diagram that ultrasonic scanner carries out that Preoperative ultrasound detects ventral aorta.
Fig. 5 is the schematic diagram that ultrasonic scanner carries out Preoperative ultrasound detection.
Fig. 6 is the schematic diagram of ultrasonic guidance femoral artery puncture.
Fig. 7 is the schematic diagram that ultrasonic scanner carries out ultrasonic guidance sacculus positioning.
Fig. 8 is that ultrasonic scanner carries out the dynamic schematic diagram of ultrasonic monitoring blood flow.
Fig. 9 is the structural representation of the embodiment of the present invention 2.
Figure 10 is the structural representation of the embodiment of the present invention 3.
Specific embodiment
For content of the invention, feature and effect of the present invention can be further appreciated that, hereby enumerate following examples, and describe in detail
As follows:
Embodiment 1:
Fig. 1 is the structure chart of the embodiment of the present invention 1;Fig. 2 is the occlusion balloon of the embodiment of the present invention 1 in balloon inflation
Schematic diagram;Fig. 3 is the schematic diagram when utricule shrinks for the occlusion balloon of the embodiment of the present invention 1;In figure, represented by reference
Implication is as follows:
1st, ultrasonic scanner;2nd, ultrasound wave display device;3rd, occlusion balloon;31st, metal braid;32nd, utricule;33、
Groove;34th, near-end;35th, far-end;36th, first connecting rod;37th, reactant bag;38th, barrier film;39th, second resistance;40th, the first drawstring;
41st, the first button;42nd, the 3rd switch.
A kind for the treatment of system for processing fierce dangerous placenta previa clinical acute disease, including ultrasonic scanner 1 and obturation
Sacculus 3, ultrasonic scanner 1 is used for detecting the situation for the treatment of site.Ultrasonic scanner 1 is also electric with ultrasound wave display device 2
Connect.
For adopting ultrasonic scanner 1 to detect internal situation, it is to avoid detected using x-ray in prior art
When it is not necessary to the protection of x line, dsa equipment etc., this project can be carried out after general hospital is trained, entirely perform the operation in general surgery
Room can be carried out and completes, and can substantially reduce medical insurance spending, save medical insurance, reduce patient's economy and psychological burden.With
Localization by ultrasonic can be more accurate with guided puncture femoral artery, it is to avoid wear by mistake, and this is not available for x line.
Ultrasonic mediation can avoid medical personnel and female tire to expose the radiation of x-ray compared to the mediation of x line, even if being far below
The fetal well-being x beta radiation dosage of 150mgy, the operating time also can be significantly restrained.And during ultrasonic guidance, both do not had
There is radiation, also there is no time restriction, more without contrast agent, reduce the interference to surgical for the extrinsic factor.
It is further preferred that occlusion balloon 3 includes metallic framework, outside metallic framework, it is provided with utricule 32, utricule 32 is bullet
Gonosome, metallic framework comprises a metal braid 31, and it has the profile of default extension, presets each of the profile of extension at this
Near-end 34 and far-end 35 comprise a groove 33, and each near-end 34 and far-end 35 have a connection terminal, and it is used for being fixedly attached to
Every one end in metal braid 31, this connection terminal is contained in inside groove 33, and metal braid 31 has memory characteristic,
So that when all not applying the first state constraining to near-end 34 and far-end 35, the shape of metallic framework can support utricule 32 envelope
Close blood vessel, when near-end 34 is applied apply away from the pulling force of far-end 35 or to far-end 35 with the thrust away from near-end 34, gold
Belong to skeleton and be in the second state, the cross section of the second state is less than cross section under first state in order to can be pumped through people
Internal blood vessel.
Form the metallic framework of utricule 32 by metal braid 31, master can be undertaken with the basic configuration of component utricule 32
Want load such that it is able to blocking on the whole, blocking up tight blood vessel.And the sectional area size by utricule 32, with near-end 34 and far-end 35
Force-bearing situation combine, thus easily realizing the switching of big small cross-sectional area.
Still further preferably, near-end 34 is hollow, and far-end 35 is connected with first connecting rod 36, and first connecting rod 36 is proximally
Pass through in 34.
Proximally passed through in 34 by the first connecting rod 36 of far-end 35 will be controlled, can from one side to control near-end 34 with remote
End 35, facilitates the operation that handss control two ends simultaneously.
Still more preferably, it is additionally provided with reactant bag 37 in utricule 32, reaction bag chamber is arranged on the outer of first connecting rod 36
Side, during reactant energising in reactant bag 37, there is chemical reaction in reactant, for by utricule 32 distending.Inaccessible
Sacculus 3 also includes the first loop, the first loop being connected with first switch, is connected with first resistor in the first loop, the first electricity
Resistance is arranged in the reactant of reactant bag 37.Although this part-structure does not have on the diagram to illustrate, those skilled in the art
Be completely can according to existing knowledge component out related circuit.
Setting reactant bag 37, and make to produce a large amount of gases in the reactant short time, thus utricule 32 is strutted, so that
Obtain utricule 32 tightly to fit with blood vessel, be fully contacted, thus ensureing blood vessel constriction uniformly and sealing.By electric ignition
Mode it is achieved that by the extraneous reaction controlling reactant whether, thus realizing reactant is automatically controlled.
Further preferred, utricule 32 is provided with barrier film 38, and barrier film 38 is arranged on the side of utricule 32, and barrier film 38 is used for
Stop that the gas in utricule 32 escapes from utricule 32.By arranging barrier film 38, completely cut off the effusion of the gas in utricule 32, carried
The high lasting seals in intra-operative blood vessel.
Further preferred, barrier film 38 is provided with second resistance 39, and second resistance 39 connects in the second loop, and second
It is provided with second switch and the 3rd switch 42, second switch includes the first contact and the second contact, the first contact and use in loop
It is fixedly connected to a little less in the first drawstring 40 controlling near-end 34, the first drawstring 40 is driven by the first button 41, the first button
41 when being pressed, and the first drawstring 40 moves away from the direction of far-end 35, and the first contact and the second contact, and when the
When three switches 42 are in closure state, so that second resistance 39 conduction makes the gas in utricule 32 escape to burn brokenly barrier film 38
Go out.Setting second servo loop, to be controlled to second resistance 39, it is possible to achieve the aerofluxuss in utricule 32 are contracted with metal braid 31
The synchronization of small bore.And by arranging the 3rd switch 42 again, realize controlling metal braid 31 deformation extent and utricule 32
The separation of aerofluxuss, it is to avoid cause the misoperation of air bags when independent adjustment metal braid 31 section.
The concrete principle of above-mentioned sacculus is:
When sacculus is positioned, by promoting first connecting rod 36, far-end 35 is sent into forward the appropriate location in blood vessel, and
Press the first button 41 so that the second near-end 34 is in the state away from far-end 35 as far as possible, thus metal knitted product are pulled open, with
Metal knitted product are made to be in less second state in section.After feeding puts in place, unclamp the first button 41, due to metal knitted
Product have memory effect, outward expansion that can be spontaneous when not being subject to external force, thus utricule 32 is strutted.And, now will
First switch closes, and the reactant in reactant bag 37 occurs chemical reaction, generates gas, for example, can allow ammonium nitrate in heating
Water, oxygen and nitrogen is generated under state.Or allow Hydrazoic acid,sodium salt generate sodium and nitrogen.Utricule 32 is strutted, now due to there being barrier film
38 stop, so gas will not be revealed from utricule 32.
When needing to make sacculus shrink, press the button, pull near-end 34 with respect to first even not only through the first drawstring 40
Bar 36 moves on the right side of in figure, and the first contact is electrically connected with the second contact, press simultaneously the 3rd switch 42, second time
Road turns on, the local of resistance heating barrier film 38, and barrier film 38 ruptures, and gas sprays from utricule 32, simultaneously near-end 34 and far-end 35
Away from also making metal braid 31 be elongated, corresponding sectional area also reduces, take sacculus from blood vessel thus convenient
Go out.
Preferably, the step processing fierce dangerous placenta previa clinical acute disease includes:
1. as shown in figure 4, Preoperative ultrasound detects ventral aorta, and measure related data.Right side arrow is used for showing abdomen master
Distance between at aortic bifurcation and at renal artery opening, left color arrow is ventral aorta internal diameter.
2., as shown in figure 5, Preoperative ultrasound accurately measures ventral aorta internal diameter, divide away from ventral aorta at positioning renal artery opening
At fork, and measure its distance, instruct to select sizeable sacculus model, thus reaching accurate blocking-up.Left arrow is
At abdominal aortic bifurcation, right side arrow is at renal artery opening.
3. as shown in fig. 6, ultrasonic guidance femoral artery puncture, through right common femoral artery Puncture approach.In Fig. 6, arrow indication is
The position of femoral artery puncture pin.Foley's tube is inserted ventral aorta, and guides sacculus to enter at renal artery opening and abdomen master
Between aortic bifurcation, fixing indwelling is standby, now as shown in Figure 7.In Fig. 7, arrow indication is sacculus, divides positioned at ventral aorta
At fork and between renal artery opening
4. ultrasonic reaffirm balloon position, now sacculus be blocked state.Ultrasonic guidance precise positioning balloon position, with
Avoid blocking the important organs such as kidney.Below horizontal in renal artery due to blocking plane, very not quick to ischemia under this plane
The internal organs of sense, therefore guiding sacculus enters at renal artery opening and between abdominal aortic bifurcation, makes sacculus upper end be close to kidney
At arterial ostium.
5. preoperative pre- blocking-up, is changed with renal artery anastomosis stenosis blood flow and is confirmed whether to block completely.
6. as shown in figure 8, balloon occlusion timing blocks before delivery of baby.Enjoin before cutting myometrium and be situated between
Enter section's doctor's dilating sacculus and block blood supply, ultrasonic monitoring blood flow is dynamic simultaneously.In Fig. 8, in many lines area defined not
See blood flow signal.
7. delivery of baby seraglio body injection oxytocin, row manual removal Placenta Hominiss.Row blunt separation during Placenta acrreta.Then 1
Number absorbable suture repeatedly placental separation face at " 8 " word suture lower uterine segment and cervix uteri internal orifice.After suture, closure sacculus is observed and is had
No active bleeding.
8. balloon occlusion can repeatability operation.If any active hemorrhage, can block again, until wound surface no bleeding.Repair
Cut lower edge on uterine incision, suture.
Ventral aorta internal diameter can be accurately measured by preoperative while detecting ventral aorta, select suitable ball to instruct
Capsule diameter;Because sacculus and ventral aorta internal diameter can coincide, accurate blocking-up can be reached during dilating sacculus, thus avoiding sacculus excessive
Fill and lead to injury of abdominal aorta, or sacculus underfilling leads to Abdominal aortic crossclamping complete, intraoperative hemorrhage etc..
The above-mentioned method repeatedly blocking, can block ventral aorta according to Suture hemostasis situation in art, during avoiding long repeatedly
Between blood vessel blocking blood injury blacked-out areas internal organs;
With with the change of dynamic monitoring blood flow and being confirmed whether to block completely in localization by ultrasonic art, and can find early to have or not
The complication such as thrombosis and artery dissection, this is also not available for x line.
Embodiment 2:
The present embodiment is with the difference of above-described embodiment, and in the present embodiment, operation is real not by manual mode
Existing, but realized by automated manner, specific corresponding system also includes digital image processing apparatus and controller and opens
Dynamic button,
Digital image processing apparatus, for receiving the image that ultrasonic scanner is obtained, and are converted into digital picture, and
In identification digital picture, gray value is less than the region of preset value, and the length in a first direction in this region is more than in second party
3 times of length upwards, are defined as angiosomeses;And confirmed as at renal artery opening according to the infall of multiple angiosomeses and
At abdominal aortic bifurcation;
Controller, for control robot arm to be moved at abdominal aortic bifurcation by utricule and renal artery opening between,
When the position of utricule is identified by digital image processing apparatus, and after confirming as tram, triggering first switch is so that utricule
Expand to block blood vessel;And after operation terminates triggering the 3rd switch and second switch, by the reduced cross-sectional of utricule, by sacculus from
Remove in blood vessel;
Start button, the recognizer and controller for starting digital image processing apparatus controls the journey of sacculus action
Sequence.
Embodiment 3:
The present embodiment is with the difference of above-described embodiment, and specific corresponding system also includes Digital Image Processing dress
Put and controller, ultrasound wave display device is touch screen,
Digital image processing apparatus, for receiving the image that ultrasonic scanner is obtained, and are converted into digital picture, and
In identification digital picture, gray value is less than the region of preset value, and the length in a first direction in this region is more than in second party
3 times of length upwards, are defined as angiosomeses;And confirmed as at renal artery opening according to the infall of multiple angiosomeses and
At abdominal aortic bifurcation;
Controller, for control robot arm to be moved at abdominal aortic bifurcation by utricule and renal artery opening between,
When the position of utricule is identified by digital image processing apparatus, and after confirming as tram, triggering first switch is so that utricule
Expand to block blood vessel;And after operation terminates triggering the 3rd switch and second switch, by the reduced cross-sectional of utricule, by sacculus from
Remove in blood vessel;
Arrange on touch screen multiple for selection operation step or control first switch, second switch, the 3rd switch choosing
Select key.
Although being described to the preferred embodiments of the present invention above in conjunction with accompanying drawing, the invention is not limited in
The specific embodiment stated, above-mentioned specific embodiment is only schematically, is not restricted, this area common
Technical staff, under the enlightenment of the present invention, in the case of without departing from present inventive concept and scope of the claimed protection, also may be used
To make a lot of forms.These belong within protection scope of the present invention.