EP3638353A1 - Instrument de ponction médical - Google Patents

Instrument de ponction médical

Info

Publication number
EP3638353A1
EP3638353A1 EP18793162.1A EP18793162A EP3638353A1 EP 3638353 A1 EP3638353 A1 EP 3638353A1 EP 18793162 A EP18793162 A EP 18793162A EP 3638353 A1 EP3638353 A1 EP 3638353A1
Authority
EP
European Patent Office
Prior art keywords
instrument according
puncturing instrument
puncturing
cannula
puncture
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP18793162.1A
Other languages
German (de)
English (en)
Inventor
Götz HÄRLE
Anton HÄRLE
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of EP3638353A1 publication Critical patent/EP3638353A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/065—Guide needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0111—Aseptic insertion devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M2025/09116—Design of handles or shafts or gripping surfaces thereof for manipulating guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/002—Packages specially adapted therefor ; catheter kit packages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0097—Catheters; Hollow probes characterised by the hub
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0113—Mechanical advancing means, e.g. catheter dispensers

Definitions

  • the present invention relates to a medical puncture instrument for
  • a first task is to provide the physician for these treatment methods, an aid that does not include the need to first remove the many components individually from the packaging container to sort them under sterile conditions and then assemble, so before his medical treatment first perform non-specialist installation work.
  • Another object of the invention is to obviate the need, which is obligatory in the state of the art, for interrupting, ie opening, the catheter into the wiring harness, which is already filled with the installation fluid, which represents a not inconsiderable bacterial contamination risk ,
  • Diameter measuring catheter into the cannula opening or the handling means with significantly reduced tactile performance because of the applied rubber gloves.
  • the cost-efficiency to be considered in the health care system it should also be taken into consideration that in a modern operating system the business administration costs per minute amount to approx. 15 €, which is particularly important in terms of the time required for the assembly of the individual components. Therefore, when laying catheters in regional anesthesia, the aim is to reduce the number of persons involved and to have all procedural steps carried out only by a person dressed in a sterile condition, namely the anesthesiologist. This is not only about the monetary time resulting from the assembly requirement, but also about the reliability of the procedure under the stress in which the patient and the doctor are in this situation, so that unwanted side effects such as catheter shifts and catheter infections are avoided as far as possible so rare. For example, a recent study on 3,491 regional anesthetic procedures has shown a complication rate of 12.1% (Anesthesiologist Vol. 60, 1014; 2011).
  • the hand guiding the ultrasound head should, as far as possible until catheter fixation at the skin entry point, ensure ultrasound monitoring of the distal end of the cannula and catheter. It would therefore be desirable that all of the procedural steps include skin puncture, placement of a local anesthetic depot on the neural structure, insertion of the catheter, complete retraction of the puncture cannula over the catheter, and fixation of the catheter at the skin entry site alone from the other hand. So one-handed can be done. If for the assembly or disassembly of the individual components, the hand holding the transducer added, the transducer must be stored.
  • Drove droplets out of the cannula port increasing the risk of bacterial contamination to the interior of the tubing string.
  • a further amount of liquid of approximately 0.1 ml is pushed out of the cannula retrograde.
  • insertion of the catheter through the puncture cannula should again be under sonographic control to ensure that the distal end of the catheter arrives at the targeted anatomical point in space as it emerges from the cannula tip.
  • the previously taken for the removal of the syringe to help hand would only need to record the ultrasound head again and visit the nervous target structure, which is not a very easy, but at least time-consuming procedure.
  • the puncture cannula should as far as possible also be retracted over the inserted catheter under ultrasound control, whereby the distal end of the catheter must not undergo any change in position. Threading the catheter out of the puncture cannula is difficult without ambidextrous insertion, with unwanted dislocations of the distal end of the catheter.
  • connection line to the pain pump is made to continuously instill the local anesthetic, the air volume in the proximal catheter section, the catheter coupling and the bacterial filter, the approx. 1.2 ml is expelled from the wiring harness into the perineural space, which is not only against the background of the
  • its shaft (1) in order to improve the visibility of the puncture aid in the ultrasound image, its shaft (1), at least in its distal part, should have an outer surface that enhances echogenicity. This can be achieved by surface structures that reflect the ultrasound disperse or by a coating that causes the same effect.
  • the next sub-task which is to relieve the physician of the assembly work in the previously used for regional anesthesia and the laying of vascular catheters cutlery with up to 10 different components, can be solved by replacing the present in a set of individual components a finished Puncture instrument in the packaging container is provided.
  • the individual components delivered so far as a set for regional anesthesia have already been assembled according to the manufacturer into an instantly usable puncture instrument, which is delivered in the packaging container while avoiding the complication risks described above.
  • the removal of the puncture instrument from the sterile packaging is now possible with one hand.
  • the various components in particular expansive and up to 50 cm long equipment in the limited anesthesia surgical area lying prone to crash, or jump out of the packaging bag during removal and possibly doing so contaminate; This also prevents incorrect assembly, eg due to incorrect sequence of the method steps.
  • a conventional cannula consists of an elongated shaft, at the distal end of a puncture tip is formed. At the other, i. proximal end of the shaft is inserted into a plastic cannula socket, this process is done by crimping or gluing. This version of the shaft then expands proximally into a cannula connection, which can be coupled with a syringe in the form of a connector or the currently still most commonly used Luer-lock connection.
  • proximal subsequent section of the cannula connection is also referred to as a handle because of its significant transformation and extension of its operation.
  • the cannula includes a cannula shaft 1 which terminates distally in a cannula tip 2. At its proximal end, the cannula shaft is embedded in a cannula socket 3.
  • Proximal can extend to the cannula socket in conjunction with the cannula connection in a handle 4 in the form of a handle body with a fully trained, square in cross-section Einmuldung to seize the puncture instrument with two or three fingers and direct targeted in the puncture can;
  • This is followed proximally by the cannula connection 5 with a connector part, which is connected to a congruent connector extension 6, which is connected to an intermediate piece 7, hereinafter referred to as a lock or catheter lock.
  • This intermediate piece 7 is shown in Fig.
  • a rubber-elastic body 9 is housed; this is penetrated by a channel 10, its inner diameter is slightly smaller than the outer diameter of the catheter 11 and dimensioned so that a sufficient, but surmountable frictional force in the manual, axial displacement of the catheter consists.
  • the catheter brake thus formed is intended to prevent unwanted change of position of the catheter in the puncturing instrument and to fix the catheter distal end 12a and 12b, respectively, at the desired position in the puncturing instrument, but to allow intentional displacement of the catheter beyond the cannula tip.
  • Friction force of the catheter brake in the range of 0.15 to 0.6 N is set.
  • the puncture instrument Before starting the puncture, the puncture instrument should be vented. This is done by injecting the instillation solution (see thick arrow) by means of the connecting hose via the connecting piece 8 into the chamber 7A of the catheter lock; As a result, first the air located here and in the cannula area (1; 3; 4; 5; 7A) is passed through the
  • a well-known in the art lip valve 13, as z. B is shown in Fig. 3 of US 4960412 A, can be used.
  • This lip valve 13 may be an isolated component, but also connected to the rubber-elastic body 9 of the catheter brake. In this configuration, the catheter tip 12a is in the predetermined position Pos.A, so proximal to the lips 13a of the lip valve 13.
  • Cannula protective sheath either at its proximal or distal end accomplished which are shown in Fig. 3 and Fig.4.
  • the lip valve should ensure a watertight seal even when the catheter tip 12b is advanced to the position. This is achieved when the slot length S of the lip valve is in a certain relationship to the diameter D of the catheter; this ratio can be calculated from the equation 5 ⁇ (3.1415 xD) / 2 for each catheter. This seal can also be accomplished by the rubber-elastic body alone or in cooperation with the lip valve.
  • the proximal portion of the lock chamber 7A is formed by a cap 21, which engages distally with a projection 22 in a groove 23a of the distal half 23, whereby the proximal and distal sections of the catheter lock are possible air-tight and waterproof coupled with each other.
  • a cap 21 of the rubber-elastic body 9 is embedded.
  • the cap 21 extends into a connector part 14, in which a congruent plug connection element 24 of the handling element 25 engages.
  • the distal portion of the catheter sheath terminates in a connector element 26, e.g. shown in the form of a thread or a plug connection with internal connection extension 6.
  • the two lock sections in the region of their connection (22, 23) can be designed to be rotatable relative to one another, with a liquid-tightness.
  • Cannula mount can also be integrally formed.
  • a further embodiment is shown in which the handle against the lock cap 14 can be rotated.
  • the handle against the lock cap 14 can be rotated.
  • This has advantages when the orientation of the needle tip is to be adjusted individually to direct the advancement of the cylindrical body in the body in the extension direction, especially in Tuohy or side hole needles.
  • the connector part 14 has a groove 14a into which a bead 24a of the plug connection element 24 engages.
  • FIGS. 3A-C are longitudinal sections through a cannula protective sheath 27 in which the puncture instrument is delivered in an in-situ manner.
  • Fig. 3A shows the distal end of a cannula protective sheath 27a; the cannula tip 2 lies freely in the distal end region of the cannula protective sheath, which conceals the sharp tip 2a of the cannula end, in order to advance during the preparation phase
  • the active anesthetist but also the to prevent easily perforable sterile cover.
  • the distal end 28 is the
  • Needle protection cover in this version water and airtight.
  • FIG. 3B shows the proximal end 27b of the cannula protective sheath which, in the delivery state, is pushed over the distal section 29 of the cannula socket 3 in a clamping manner.
  • This portion of the cannula socket 3 has a distal portion 29b, which has on its outer surface outwardly prominent axially extending webs 30, or between these grooves. If the cannula protective cover is slidably pushed over this area only, an overpressure with respect to the environment prevailing in the cannula protective cover can be compensated for pressure via the grooves extending between the webs, ie. Air or liquid can escape.
  • the cannula protective sheath is pushed over the proximal portion 29a of the clamping area of the cannula socket 3, on the other hand, a seal is produced, since this area is formed without grooves, ie has a circular clamping area.
  • the proximal, corresponding region of the cannula socket may have a proximally increasing outer diameter, as in Flg. 3 C is illustrated.
  • the configuration in the form of a conical section of the cannula socket increases the clamping action between cannula cover and cannula socket so that the former also provides sufficient overpressure for the retrograde filling of the end 12b of the catheter in lock chamber 7a with instillation solution and simultaneous displacement and expulsion of the air in the catheter withstand.
  • the cannula socket 3 and the distal section 23 of the lock 7, as well as the proximal section (lock cap) 21 and the handling element 25 may each be formed in one piece.
  • FIG. 4 A shows the closure mechanism
  • the grooves between the webs create clearances through which air and / or water can escape when inside the cannula and consequently also in the cannula Needle protective cover overpressure is built in relation to the environment. This leakage of air and / or water can be prevented when the distal portion 31b of the occluding plug having no grooves on its surface is pressed into the cylindrical lumen of the cannula protective sheath, as illustrated in Fig. 4B.
  • closure plug 31 In this positional relationship of closure plug 31 and distal end of the cannula protective sheath, the latter can be closed air-tight and watertight.
  • the closure plug 31 can also have a recess 33 at the distal end of the conical thickening 31 b, into which the distal end of the cannula protective sheath can be inserted in order to improve the seal.
  • FIG. 5 A shows a side view of a preferred embodiment of the puncturing instrument, in which the handle has been arranged proximally of the catheter lock 7 and has been modified to form a multifunctional handling element 34.
  • This handling element has a channel 35 for the catheter 11, wherein this channel is opened centrally at the top in a length of about 4 cm, and thereby the catheter in this area 36 is open. The material reduction of the handling element in this region 36 can be carried out so far that the catheter is completely free here.
  • This area 36 at the top of the handling element forms an engagement surface 37 for a finger, preferably the thumb for axial displacement of the here resting catheter (or Mandrains or Seldinger wire) 11, which are pressed with his finger against this attack surface and moved so can.
  • a handle design 38 in the form of two strap sections 38a and 38b is formed, in which two fingers of a hand can engage and thus secure the puncture instrument without thumbs and able to orient in space.
  • These strap portions 38a and 38b may be formed integrally or integrally in the region in which they are opposed. This frees the thumb for other activities. If the brackets 38a and 38b are somewhat elastic in the lower region lying between the two arrows, they can adapt to the respective size of the fingers, wherein in the delivery state they have approximately a diameter D of approximately 12 mm.
  • the handling element on the bottom instead of the two roundish strap also have only about 15 to 20 mm long biconcave handle extension 38c, which can be clamped between two fingers, as shown in Fig. 5 B. Therefore, this handle design on the underside allows using the use of two fingers of a hand punctually accurately advance the puncture instrument without the use of thumb exactly aligned with the targeted anatomical point in space.
  • the catheter channel 35 is indicated by dashed lines () in Figs. 1 and 5 for ease of understanding, while a dash-dot-dash formation (_. _.) Marks the catheter 11 in the non-visible area.
  • the handling element in a cylindrical portion 39 to which by means of a connector 40, a catheter container may be connected, the connector part 41 engages in the connector 40.
  • This catheter container should be designed so that the handling of the puncture instrument is not hindered as possible. This presupposes that it is relatively small in its spatial dimensions and measures in no plane in diameter over 6 cm. To avoid disabilities in the puncture itself, it is advantageous if the catheter container in the connector 40 can be easily brought into different rotational positions with respect to the orientation of the bracket 38 a and 38 b and on / can be found.
  • the catheter container may consist, for example, of a helix of a plurality of mutually adjacent spiral coils 42, which receive the proximal portion of the catheter, which is not inserted into the puncture instrument.
  • the total length of the container turns is based on the catheter length.
  • the catheter container has e.g. approximately the shape of an Archimedean spiral 44, here the turns lie in a plane, which allows a more compact dimensions.
  • Fig. 6A is a longitudinal sectional view through the, the connector opposite end
  • a vent hole 47 is mounted so that air and water but not the catheter can escape through it.
  • Fig. 6B is also a longitudinal sectional view through the connector 45 opposite end of the catheter container shown.
  • a core 48 in the form of a thin steel wire, which largely closes the catheter lumen, but can be pulled out of the catheter.
  • a blocking element 49 projecting beyond the catheter cross-section is designed, which is shown here as a sphere.
  • another container for the proximal catheter portion may be attached to the connector of the cylinder portion 39, e.g. be connected in the form of a foil bag or other shape.
  • the distal catheter tip 12 may already be a manufacturer advanced in the position Pos.B.
  • the maneuvers when venting the puncture instrument can be simplified. All that is required now is to expel the gases contained in the connecting hose, lock chamber and cannula area by injecting the instillation fluid; the success of this measure can be seen at the outlet of water / liquid at the distal end of the cannula cap.
  • a catheter coupling is then attached, in the proximal connector connector a bacterial filter can be inserted / connected.
  • extension 51 of the upper half of the connector element 24 On the other hand of a flexible-elastic blade 52, which starts off proximally from the attack surface 15 starting distally from this, applies to the underside of the catheter and this up against the Extension 51 presses.
  • the extension 51 and / or the tab 52 In the area of contact with the catheter, the extension 51 and / or the tab 52 have a rubber coating 51a and 52a, respectively, in order to accomplish the braking effect.
  • These contact areas can be planned and / or according to the
  • the pressing force of the blade 52 is to be designed so that a frictional force of 0.15 to 0.5 IM arises. If pressure is exerted on the latter to displace the cylindrical body 11 from above, the latter pushes the lamella downwards, thereby eliminating the contact of the cylindrical body with the rubberized portions 51a and / or 52a of the braking element.
  • the brake elements 9 and 50 may be adapted to each other so that both cooperatively largely preclude a displacement of the cylindrical body; On the other hand, each alone can produce the desired braking effect. Only one of the two can be formed in the puncture instrument.
  • the puncture instrument can be described as follows. All subcomponents of the puncture instrument are already connected by manufacturer in the sterile packaging and are immediately ready for use without any ontageer Monisse.
  • the puncture instrument also includes a braking element that holds the cylindrical body fixed at a particular location but an arbitrary one
  • Displacement allows.
  • the entire puncture instrument can be gripped by means of the Griffausformung on the underside of the handling means with one hand and the sterile packaging can be removed with a handle.
  • the sterile packaging can be removed with a handle.
  • a bacterial filter if one is used, or a syringe filled with local anesthetic directly attached.
  • local anesthetic is injected into the system until all air is expelled and fluid from the needle tip exit.
  • the anesthetist searches with one hand by means of the sterile packaged
  • the puncturing instrument according to the invention can also be used advantageously in other medical procedures with appropriate adjustments.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un instrument de ponction médical destiné à introduire des moyens d'assistance allongés dans le corps, comprenant un moyen d'assistance à la ponction présentant une tige métallique (1) qui se termine à son extrémité distale par pointe de canule (2) et à son extrémité proximale par une monture de canule (3), un moyen de manipulation (4;34) destiné à faire avancer le moyen d'assistance à la ponction, et un moyen d'assistance (11) allongé, pouvant coulisser axialement, situé à l'intérieur du moyen d'assistance à la ponction. Ces composants se présentent sous la forme d'un instrument de ponction préalablement monté. L'extrémité distale (12a ou 12b) du moyen d'assistance est placée dans une position prédéterminée dans l'instrument de ponction; le moyen de manipulation se présente sous la forme d'un corps de préhension dont la surface est conçue de manière à permettre la préhension par des doigts et est raccordé à une partie saillante de canule (5); le moyen d'assistance situé dans un canal formé par la tige et le moyen de manipulation possède une longueur supérieure à celle du canal environnant; le moyen d'assistance (11) peut coulisser par rapport à la tige (1) qui l'entoure et par rapport au moyen de manipulation (4; 34) et fait saillie de manière proximale par rapport à la zone de manipulation.
EP18793162.1A 2017-06-14 2018-06-12 Instrument de ponction médical Withdrawn EP3638353A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102017005569.6A DE102017005569A1 (de) 2017-06-14 2017-06-14 Medizinisches Punktionsinstrument
PCT/DE2018/000188 WO2018228633A1 (fr) 2017-06-14 2018-06-12 Instrument de ponction médical

Publications (1)

Publication Number Publication Date
EP3638353A1 true EP3638353A1 (fr) 2020-04-22

Family

ID=63998460

Family Applications (1)

Application Number Title Priority Date Filing Date
EP18793162.1A Withdrawn EP3638353A1 (fr) 2017-06-14 2018-06-12 Instrument de ponction médical

Country Status (6)

Country Link
US (1) US20200206462A1 (fr)
EP (1) EP3638353A1 (fr)
JP (1) JP2020523167A (fr)
DE (2) DE102017005569A1 (fr)
MX (1) MX2019014356A (fr)
WO (1) WO2018228633A1 (fr)

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102019002962A1 (de) * 2019-04-30 2020-11-05 Anton Härle Medizinisches Transfer-System
CN110420378A (zh) * 2019-09-09 2019-11-08 南京鼓楼医院 胸腔双尾纤维硅胶引流导管、穿刺引流装置及方法
WO2023095129A1 (fr) * 2021-11-29 2023-06-01 Microbot Medical Ltd. Stockage automatisé pour un outil chirurgical allongé

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA935059A (en) * 1970-02-27 1973-10-09 Jewett-Ashley Holding Corp. Catheter device
US3995628A (en) * 1975-04-25 1976-12-07 Travenol Laboratories, Inc. Catheter insertion device
US4960412A (en) 1988-04-15 1990-10-02 Universal Medical Instrument Corp. Catheter introducing system
US6929624B1 (en) * 2003-02-03 2005-08-16 Gil Del Castillo Intravenous catheter housing with retractable needle
AU2016305010B2 (en) * 2015-08-11 2019-06-20 Trice Medical, Inc. Fully integrated, disposable tissue visualization device

Also Published As

Publication number Publication date
DE102017005569A1 (de) 2018-12-20
MX2019014356A (es) 2020-07-20
DE112018003018A5 (de) 2020-08-13
WO2018228633A1 (fr) 2018-12-20
US20200206462A1 (en) 2020-07-02
JP2020523167A (ja) 2020-08-06

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