JP6608924B2 - 多極同時肺動脈高周波アブレーションカテーテル - Google Patents

多極同時肺動脈高周波アブレーションカテーテル Download PDF

Info

Publication number
JP6608924B2
JP6608924B2 JP2017522463A JP2017522463A JP6608924B2 JP 6608924 B2 JP6608924 B2 JP 6608924B2 JP 2017522463 A JP2017522463 A JP 2017522463A JP 2017522463 A JP2017522463 A JP 2017522463A JP 6608924 B2 JP6608924 B2 JP 6608924B2
Authority
JP
Japan
Prior art keywords
electrode
ablation
pulmonary artery
annular ring
length
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.)
Active
Application number
JP2017522463A
Other languages
English (en)
Japanese (ja)
Other versions
JP2017521214A (ja
JP2017521214A5 (OSRAM
Inventor
シャオリャン チェン
Original Assignee
プルノヴォ メディカル （ウーシー） カンパニー リミテッド
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
Priority claimed from US14/666,214 external-priority patent/US9827036B2/en
Application filed by プルノヴォ メディカル （ウーシー） カンパニー リミテッド filed Critical プルノヴォ メディカル （ウーシー） カンパニー リミテッド
Publication of JP2017521214A publication Critical patent/JP2017521214A/ja
Publication of JP2017521214A5 publication Critical patent/JP2017521214A5/ja
Application granted granted Critical
Publication of JP6608924B2 publication Critical patent/JP6608924B2/ja
Active legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00541—Lung or bronchi
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1226—Generators therefor powered by a battery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Otolaryngology (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Cardiology (AREA)
  • Surgical Instruments (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
JP2017522463A 2014-07-11 2015-07-10 多極同時肺動脈高周波アブレーションカテーテル Active JP6608924B2 (ja)

Applications Claiming Priority (11)

Application Number Priority Date Filing Date Title
US201462023781P 2014-07-11 2014-07-11
US62/023,781 2014-07-11
US14/666,214 2015-03-23
US14/666,214 US9827036B2 (en) 2012-11-13 2015-03-23 Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US14/672,013 US9918776B2 (en) 2012-11-13 2015-03-27 Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US14/672,021 2015-03-27
US14/672,010 2015-03-27
US14/672,010 US9820800B2 (en) 2012-11-13 2015-03-27 Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US14/672,021 US9872720B2 (en) 2012-11-13 2015-03-27 Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US14/672,013 2015-03-27
PCT/US2015/039930 WO2016007851A1 (en) 2014-07-11 2015-07-10 Multi-pole synchronous pulmonary artery radiofrequency ablation catheter

Related Child Applications (1)

Application Number Title Priority Date Filing Date
JP2019193400A Division JP2020044338A (ja) 2014-07-11 2019-10-24 多極同時肺動脈高周波アブレーションカテーテル

Publications (3)

Publication Number Publication Date
JP2017521214A JP2017521214A (ja) 2017-08-03
JP2017521214A5 JP2017521214A5 (OSRAM) 2018-06-28
JP6608924B2 true JP6608924B2 (ja) 2019-11-20

Family

ID=55064957

Family Applications (4)

Application Number Title Priority Date Filing Date
JP2017522463A Active JP6608924B2 (ja) 2014-07-11 2015-07-10 多極同時肺動脈高周波アブレーションカテーテル
JP2019193400A Pending JP2020044338A (ja) 2014-07-11 2019-10-24 多極同時肺動脈高周波アブレーションカテーテル
JP2021192988A Active JP7653346B2 (ja) 2014-07-11 2021-11-29 多極同時肺動脈高周波アブレーションカテーテル
JP2024209230A Pending JP2025027101A (ja) 2014-07-11 2024-12-02 多極同時肺動脈高周波アブレーションカテーテル

Family Applications After (3)

Application Number Title Priority Date Filing Date
JP2019193400A Pending JP2020044338A (ja) 2014-07-11 2019-10-24 多極同時肺動脈高周波アブレーションカテーテル
JP2021192988A Active JP7653346B2 (ja) 2014-07-11 2021-11-29 多極同時肺動脈高周波アブレーションカテーテル
JP2024209230A Pending JP2025027101A (ja) 2014-07-11 2024-12-02 多極同時肺動脈高周波アブレーションカテーテル

Country Status (10)

Country Link
EP (3) EP4647111A2 (OSRAM)
JP (4) JP6608924B2 (OSRAM)
KR (4) KR102513522B1 (OSRAM)
CN (2) CN107072707B (OSRAM)
AU (5) AU2015287691B2 (OSRAM)
BR (1) BR112017000610B1 (OSRAM)
CA (2) CA2954897A1 (OSRAM)
RU (1) RU2692219C2 (OSRAM)
SG (2) SG10201800251YA (OSRAM)
WO (1) WO2016007851A1 (OSRAM)

Families Citing this family (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120095371A1 (en) 2010-10-18 2012-04-19 CardioSonic Ltd. Ultrasound transducer and cooling thereof
JP6441679B2 (ja) 2011-12-09 2018-12-19 メタベンション インコーポレイテッド 肝臓系の治療的な神経調節
WO2013134543A1 (en) 2012-03-08 2013-09-12 Medtronic Ardian Luxembourg Sarl Immune system neuromodulation and associated systems and methods
US11357447B2 (en) 2012-05-31 2022-06-14 Sonivie Ltd. Method and/or apparatus for measuring renal denervation effectiveness
US12082868B2 (en) 2012-11-13 2024-09-10 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US11241267B2 (en) 2012-11-13 2022-02-08 Pulnovo Medical (Wuxi) Co., Ltd Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
CN102908191A (zh) 2012-11-13 2013-02-06 陈绍良 多极同步肺动脉射频消融导管
US9827036B2 (en) 2012-11-13 2017-11-28 Pulnovo Medical (Wuxi) Co., Ltd. Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
WO2016090175A1 (en) 2014-12-03 2016-06-09 Metavention, Inc. Systems and methods for modulating nerves or other tissue
US11350987B2 (en) 2015-01-28 2022-06-07 St. Jude Medical, Cardiology Division, Inc. Thermal mapping catheter
US10524859B2 (en) 2016-06-07 2020-01-07 Metavention, Inc. Therapeutic tissue modulation devices and methods
RU2694583C1 (ru) * 2016-12-13 2019-07-16 Федеральное государственное бюджетное научное учреждение "Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний" (НИИ КПССЗ) Способ лечения резистивной артериальной легочной гипертензии
WO2018173047A1 (en) * 2017-03-20 2018-09-27 Sonivie Ltd. Method for treating heart failure by improving ejection fraction of a patient
EP4115936B1 (en) 2017-11-28 2024-03-06 St. Jude Medical, Cardiology Division, Inc. Lumen management catheter
WO2019226640A1 (en) 2018-05-21 2019-11-28 St. Jude Medical, Cardiology Division, Inc. Radio-frequency ablation and direct current electroporation catheters
EP3893755A4 (en) * 2018-12-13 2023-01-25 NXT Biomedical, LLC METHODS AND DEVICES FOR BLOOD OXYGENATION TREATMENT
CN110897710B (zh) * 2019-11-30 2021-08-31 杭州堃博生物科技有限公司 肺部神经消融系统的控制方法、系统以及计算机介质
US20220047326A1 (en) * 2020-08-13 2022-02-17 Biosense Webster (Israel) Ltd. Applying Bipolar Ablation Energy Between Shorted Electrode Groups
WO2022038546A1 (en) 2020-08-18 2022-02-24 St. Jude Medical, Cardiology Division, Inc. High-density electrode catheters with magnetic position tracking
US12082877B2 (en) * 2021-01-22 2024-09-10 CRC EP, Inc. Ablation catheter and operation method of same
JP7688153B2 (ja) 2021-04-07 2025-06-03 ビーティーエル メディカル デベロップメント エー．エス． パルス場アブレーション装置および方法
EP4108197A1 (en) 2021-06-24 2022-12-28 Gradient Denervation Technologies Systems for treating tissue
ES3039137T3 (en) 2021-07-06 2025-10-17 Btl Medical Dev A S Pulsed field ablation device
CR20250188A (es) 2022-10-05 2025-08-22 Btl Medical Dev A S Dispositivo y método de ablación de campo pulsado
WO2025227077A1 (en) * 2024-04-25 2025-10-30 Board Of Supervisors Of Louisiana State University And Agricultural And Mechanical College Radiofrequency ablation device

Family Cites Families (29)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0728029B1 (en) * 1993-11-10 1999-06-16 Medtronic Cardiorhythm Electrode array catheter
US5797905A (en) * 1994-08-08 1998-08-25 E. P. Technologies Inc. Flexible tissue ablation elements for making long lesions
US6575969B1 (en) * 1995-05-04 2003-06-10 Sherwood Services Ag Cool-tip radiofrequency thermosurgery electrode system for tumor ablation
US5755760A (en) * 1996-03-11 1998-05-26 Medtronic, Inc. Deflectable catheter
US20050010095A1 (en) * 1999-04-05 2005-01-13 Medtronic, Inc. Multi-purpose catheter apparatus and method of use
US9694121B2 (en) * 1999-08-09 2017-07-04 Cardiokinetix, Inc. Systems and methods for improving cardiac function
EP1233716B1 (en) * 1999-11-22 2014-07-30 Boston Scientific Limited Loop structures for supporting diagnostic and therapeutic elements in contact with body tissue
JP3895531B2 (ja) * 2000-09-01 2007-03-22 オリンパス株式会社 電気手術装置
US6866662B2 (en) * 2002-07-23 2005-03-15 Biosense Webster, Inc. Ablation catheter having stabilizing array
US20060241366A1 (en) * 2002-10-31 2006-10-26 Gary Falwell Electrophysiology loop catheter
US7235070B2 (en) * 2003-07-02 2007-06-26 St. Jude Medical, Atrial Fibrillation Division, Inc. Ablation fluid manifold for ablation catheter
US8657814B2 (en) * 2005-08-22 2014-02-25 Medtronic Ablation Frontiers Llc User interface for tissue ablation system
WO2008008796A2 (en) * 2006-07-10 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
JP4027411B1 (ja) * 2007-03-29 2007-12-26 日本ライフライン株式会社 電極カテーテル
US8712550B2 (en) * 2008-12-30 2014-04-29 Biosense Webster, Inc. Catheter with multiple electrode assemblies for use at or near tubular regions of the heart
US8540662B2 (en) * 2009-03-24 2013-09-24 St. Jude Medical, Atrial Fibrillation Division, Inc. Medical devices having an atraumatic distal tip segment
AU2010319477A1 (en) * 2009-11-11 2012-05-24 Holaira, Inc. Systems, apparatuses, and methods for treating tissue and controlling stenosis
US9907607B2 (en) * 2009-12-30 2018-03-06 St. Jude Medical, Atrial Fibrillation Division, Inc. Guide and flexible sleeve for use with catheters
US8369923B2 (en) * 2010-04-14 2013-02-05 St. Jude Medical, Atrial Fibrillation Division, Inc. Dual-deflecting electrophysiology catheter
US9943363B2 (en) 2010-04-28 2018-04-17 Biosense Webster, Inc. Irrigated ablation catheter with improved fluid flow
US8956352B2 (en) * 2010-10-25 2015-02-17 Medtronic Ardian Luxembourg S.A.R.L. Catheter apparatuses having multi-electrode arrays for renal neuromodulation and associated systems and methods
US8792962B2 (en) * 2010-12-30 2014-07-29 Biosense Webster, Inc. Catheter with single axial sensors
CN202637103U (zh) * 2011-08-26 2013-01-02 王捷 具有肾神经标测功能的导管
ES2767093T3 (es) * 2011-11-07 2020-06-16 Medtronic Ardian Luxembourg Dispositivos endovasculares de monitorización nerviosa y sistemas asociados
CN104066395B (zh) * 2011-12-15 2017-09-05 里兰斯坦福初级大学理事会 用于治疗肺动脉高血压的设备和方法
CN202982207U (zh) * 2012-11-13 2013-06-12 陈绍良 治疗肺动脉高压的多极同步射频消融导管
CN102908191A (zh) * 2012-11-13 2013-02-06 陈绍良 多极同步肺动脉射频消融导管
CN103908334A (zh) * 2012-12-31 2014-07-09 上海微创电生理医疗科技有限公司 多电极消融导管
US9050010B2 (en) * 2012-12-31 2015-06-09 Biosense Webster (Israel) Ltd. Double loop lasso with single puller wire for bi-directional actuation

Also Published As

Publication number Publication date
JP7653346B2 (ja) 2025-03-28
AU2023286013A1 (en) 2024-01-25
CN107072707A (zh) 2017-08-18
EP3166524A4 (en) 2018-04-11
AU2020250197A1 (en) 2020-11-05
SG11201700223PA (en) 2017-02-27
AU2022202710A1 (en) 2022-05-19
WO2016007851A8 (en) 2017-02-16
KR20240042155A (ko) 2024-04-01
KR20210021093A (ko) 2021-02-24
CN112704559B (zh) 2023-03-28
JP2020044338A (ja) 2020-03-26
RU2017101338A (ru) 2018-08-14
AU2015287691A2 (en) 2017-03-02
AU2022202710B2 (en) 2023-09-28
JP2022028883A (ja) 2022-02-16
EP4014908A1 (en) 2022-06-22
RU2692219C2 (ru) 2019-06-21
RU2017101338A3 (OSRAM) 2018-11-28
AU2015287691A1 (en) 2017-02-02
KR102650430B1 (ko) 2024-03-25
AU2019204804B2 (en) 2020-07-09
KR20230042403A (ko) 2023-03-28
AU2023286013B2 (en) 2025-12-18
CN107072707B (zh) 2020-09-04
KR20170034397A (ko) 2017-03-28
KR102513522B1 (ko) 2023-03-23
EP4647111A2 (en) 2025-11-12
AU2019204804A1 (en) 2019-07-25
KR102766112B1 (ko) 2025-02-12
AU2020250197B2 (en) 2022-02-03
EP4014908B1 (en) 2025-11-05
EP3166524B1 (en) 2023-01-04
CA2954897A1 (en) 2016-01-14
WO2016007851A1 (en) 2016-01-14
AU2015287691B2 (en) 2019-04-11
EP4014908C0 (en) 2025-11-05
CA3201993A1 (en) 2016-01-14
BR112017000610A2 (pt) 2018-01-23
SG10201800251YA (en) 2018-02-27
JP2017521214A (ja) 2017-08-03
BR112017000610B1 (pt) 2022-09-27
KR102219632B1 (ko) 2021-02-25
JP2025027101A (ja) 2025-02-26
EP3166524A1 (en) 2017-05-17
CN112704559A (zh) 2021-04-27

Similar Documents

Publication Publication Date Title
JP7653346B2 (ja) 多極同時肺動脈高周波アブレーションカテーテル
US12458427B2 (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
US11241267B2 (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
HK40051288A (zh) 多极同步肺动脉射频消融导管
HK40051288B (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
HK1234978B (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
HK1234978A1 (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
HK1235654A1 (en) Multi-pole synchronous pulmonary artery radiofrequency ablation catheter
HK1235654B (zh) 多极同步肺动脉射频消融导管

Legal Events

Date Code Title Description
A521 Request for written amendment filed

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20180517

A621 Written request for application examination

Free format text: JAPANESE INTERMEDIATE CODE: A621

Effective date: 20180517

A131 Notification of reasons for refusal

Free format text: JAPANESE INTERMEDIATE CODE: A131

Effective date: 20190304

A521 Request for written amendment filed

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20190516

TRDD Decision of grant or rejection written
A01 Written decision to grant a patent or to grant a registration (utility model)

Free format text: JAPANESE INTERMEDIATE CODE: A01

Effective date: 20190924

A61 First payment of annual fees (during grant procedure)

Free format text: JAPANESE INTERMEDIATE CODE: A61

Effective date: 20191024

R150 Certificate of patent or registration of utility model

Ref document number: 6608924

Country of ref document: JP

Free format text: JAPANESE INTERMEDIATE CODE: R150

R250 Receipt of annual fees

Free format text: JAPANESE INTERMEDIATE CODE: R250

R250 Receipt of annual fees

Free format text: JAPANESE INTERMEDIATE CODE: R250

R250 Receipt of annual fees

Free format text: JAPANESE INTERMEDIATE CODE: R250

R250 Receipt of annual fees

Free format text: JAPANESE INTERMEDIATE CODE: R250