Disclosure of Invention
In view of this, it is necessary to provide an expansion device and a guidance system for solving the problem of how to cause a blood vessel to be tortuous or spasm in an artery, which makes it difficult for a guidance catheter to pass through the blood vessel.
In one aspect, the present application provides a dilation device comprising:
the expansion pipe comprises a supporting pipe and an expansion pipe sleeved outside the supporting pipe, an filling cavity is formed in the expansion pipe, and the expansion pipe has a contraction state and an expansion state of expanding along the radial direction after the filling cavity is filled with a medium;
the connecting pipe is connected with the expansion pipe and provided with an filling channel which is communicated with the filling cavity;
the adaptor, the adaptor be equipped with full sufficient mouth that full passageway is linked together.
The technical solution of the present application is further described below:
in one embodiment, the outer diameter of the expansion tube decreases in a direction away from the connection tube.
In one embodiment, the expansion device is provided with a guide wire channel which extends through the expansion tube, the connecting tube and the connecting piece.
In one embodiment, the peripheral side of the expansion pipe is provided with a drainage hole which is communicated with the guide wire channel.
In one embodiment, the outer peripheral side of the dilating tube, the outer peripheral side of the connecting tube and the inner wall of the guide wire channel are provided with a lubricating coating.
In one embodiment, the outer periphery of the connecting pipe is provided with threads; and/or the presence of a gas in the gas,
an annular bulge is arranged on the outer peripheral side of the connecting pipe, and the outer diameter of the annular bulge is gradually increased along the direction from the expansion pipe to the adaptor; and/or the presence of a gas in the gas,
a reticulate pattern structure is arranged on the outer peripheral side of the connecting pipe; and/or the presence of a gas in the gas,
the periphery side of the connecting pipe is provided with a medicine hole, and the medicine hole is used for bearing medicines.
In one embodiment, the connecting pipe comprises an inner pipe and an outer pipe sleeved outside the inner pipe, the filling channel is formed between the inner pipe and the outer pipe, one end of the inner pipe is connected with the supporting pipe, the other end of the inner pipe is connected with the adapter, one end of the outer pipe is connected with the expansion pipe, and the other end of the outer pipe is connected with the adapter.
In one embodiment, the connecting pipe includes an inner pipe and an outer pipe sleeved outside the inner pipe, the inner pipe and the outer pipe form the filling passage therebetween, the inner pipe is connected to the supporting pipe, the outer pipe is connected to the expansion pipe, a connecting hole is provided at one end of the filling passage away from the expansion pipe, the expansion device further includes a pushing pipe, one end of the pushing pipe penetrates through the connecting hole and penetrates into the filling passage, and the other end of the pushing pipe is communicated to the filling port.
In one embodiment, the material of the expansion pipe is a biocompatible polymer material; the material of the support tube is a biocompatible metal material.
In another aspect, the present application further provides a guiding system, which includes a guiding catheter and the above-mentioned expansion device, the expansion device is disposed through the guiding catheter, the expansion tube is disposed through one end of the guiding catheter, and the adaptor is disposed through the other end of the guiding catheter.
In another aspect, the present application further provides a guidance system, including:
the expansion pipe comprises a supporting pipe and an expansion pipe sleeved outside the supporting pipe, an inflation cavity is formed in the expansion pipe, and the expansion pipe has a contraction state and an expansion state of expanding along the radial direction after the inflation cavity is filled with a medium;
the connecting pipe is connected with the expansion pipe and provided with an filling channel, the filling channel is communicated with the filling cavity, the connecting pipe comprises a soft section, a bending section and a supporting section which are sequentially connected, the soft section is connected with the expansion pipe, and at least one bending structure which is bent relative to the supporting section or the soft section is formed in the bending section; and (c) a second step of,
the adaptor is connected with the support section and provided with a filling opening communicated with the filling channel;
wherein instrument channels for passing surgical instruments are formed in the expansion tube, the connecting tube and the connecting piece.
The expansion device and the guiding system are characterized in that the expansion pipe comprises a supporting pipe and an expansion pipe sleeved outside the supporting pipe, the supporting pipe can effectively increase the supporting strength of the expansion pipe, so that the expansion pipe can smoothly penetrate into the tortuous or spasm position of the blood vessel, and the expansion pipe is configured to have the contraction state and the expansion state, so that after the expansion pipe penetrates into the tortuous or spasm position of the blood vessel, a medium such as liquid or gas is injected into a filling cavity of the expansion pipe through a filling channel of the connecting pipe through a filling opening of the adapter, the expansion pipe is radially expanded, a tortuous blood vessel with plaque and ulcer or a tight spasm blood vessel is expanded, the resistance of the blood vessel wall is reduced, and the guiding catheter or the radiography catheter and other surgical instruments can smoothly pass through the tortuous or spasm position of the blood vessel. When encountering the problem of blood vessel tortuosity or spasm in the interventional operation, the guiding catheter and other surgical instruments can be ensured to smoothly penetrate to the pathological change position without changing the access path, the operation is simple, the operation time is saved, and the time of exposing the patient and the operator to rays is reduced.
Detailed Description
In order to make the aforementioned objects, features and advantages of the present invention comprehensible, embodiments accompanied with figures are described in detail below. In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present invention. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein.
In particular, one aspect of the present application provides an expansion device for expanding a blood vessel to assist in guiding a surgical instrument, such as a catheter, through the blood vessel. Specifically, the expanding device of an embodiment includes expansion pipe, connecting pipe and adaptor, and wherein the expansion pipe includes that stay tube and cover establish the expansion pipe outside the stay tube, is formed with sufficient chamber in the expansion pipe, and the expansion pipe has the expansion state of contraction state and following radial expansion behind the sufficient medium of sufficient chamber, and the connecting pipe is connected with the expansion pipe, and the connecting pipe is equipped with sufficient passageway, sufficient passageway and sufficient chamber intercommunication, and the adaptor is equipped with the sufficient mouth that is linked together with sufficient passageway.
In particular, the expanding device can be used together with a guide catheter or a contrast catheter when in use, when the guide catheter or the contrast catheter encounters the problem of blood vessel tortuosity or spasm and can not continuously penetrate into the blood vessel, the expansion device can be passed into the guide catheter, and the expansion tube can be passed out of the guide catheter or the contrast catheter and passed into the tortuous or spastic part of the blood vessel, the adapter can be used for connecting with a syringe, then the injector injects liquid or gas and other media into the filling cavity of the expansion pipe through the filling opening of the adapter piece, the media can cause the expansion pipe to expand radially after filling the filling cavity, thereby supporting the tortuosity or spasm position of the blood vessel, expanding the inner diameter of the blood vessel to ensure that the surgical instruments such as a guide catheter or an angiography catheter and the like smoothly pass through the tortuosity or spasm position of the blood vessel and penetrate to the lesion position, the expansion device is then withdrawn from the guide catheter or the contrast catheter, and the surgical instrument can be delivered to the lesion site through the guide catheter or the contrast catheter.
The expansion device comprises an expansion pipe and an expansion pipe, wherein the expansion pipe is sleeved outside the support pipe, the support pipe can effectively increase the support strength of the expansion pipe, so that the expansion pipe can smoothly penetrate into a tortuous or spasm position of a blood vessel, and the expansion pipe is configured to have a contraction state and an expansion state, so that after the expansion pipe penetrates into the tortuous or spasm position of the blood vessel, a medium such as liquid or gas is injected into a filling cavity of the expansion pipe through a filling channel of a connecting pipe through a filling opening of an adapter, the expansion pipe is radially expanded, a tortuous blood vessel with plaques and ulcers or a tight spasm blood vessel is expanded, the resistance of the blood vessel wall is reduced, and surgical instruments such as a guide catheter or a contrast catheter can be guaranteed to smoothly pass through the tortuous or spasm position of the blood vessel. When encountering the problem of blood vessel tortuosity or spasm in the interventional operation, the guiding catheter and other surgical instruments can be ensured to smoothly penetrate to the pathological change position without changing the access path, the operation is simple, the operation time is saved, and the time of exposing the patient and the operator to rays is reduced.
Various embodiments of the stent of the present application are further described below with reference to the accompanying drawings.
Specifically, referring to fig. 1 and 2, fig. 1 and 2 illustrate a structural schematic view of the expansion device 10 of the first embodiment, specifically, the expansion device 10 of the first embodiment includes an expansion tube 11, a connection tube 12 and an adaptor 13, wherein the expansion tube 11 includes a support tube 111 and an expansion tube 112 sleeved outside the support tube 111, an inflation cavity 113 is formed in the expansion tube 112, the expansion tube 112 has a contracted state and an expanded state radially expanded after the inflation cavity 113 is filled with a medium, one end of the connection tube 12 is connected to the expansion tube 11, the connection tube 12 is provided with an inflation channel 123, the inflation channel 123 is communicated with the inflation cavity 113, the other end of the connection tube 12 is connected to the adaptor 13, and the adaptor 13 is provided with an inflation port 131 communicated with the inflation channel.
Further, in the present embodiment, the material of the expansion tube 112 is a biocompatible polymer material, for example, a composite material formed by mixing one or more of polyethylene, polypropylene, polytetrafluoroethylene, polyurethane, polyamide, polyether block polyamide, polyester, and silicone rubber can be selected. The expansion tube 112 may be formed by injection molding, extrusion, pressing, calendering, or thermoforming, among other processes. Preferably, in the present embodiment, the expansion tube 112 is a double-layer tube, and includes an inner layer covering the outer peripheral surface of the support tube 111 and an outer layer sleeved outside the inner layer, and the filling cavity 113 is formed between the inner layer and the outer layer. In another embodiment, the expansion tube 112 may also be a single-layer tubing, with the inflation lumen 113 formed between the expansion tube 112 and the support tube 111.
Further, in the present embodiment, the material of the support tube 111 is a biocompatible metal material, for example, a composite material formed by mixing one or more of titanium, magnesium, nickel, cobalt, stainless steel, and the like is selected. Preferably, the structure of the support tube 111 is a braided mesh tube structure, so as to effectively increase the supporting rigidity of the expansion tube 11, thereby ensuring that the expansion tube 11 can penetrate into the support tube 111 to support the flexible expansion tube 112.
Referring to fig. 3, the outer diameter of the dilating tube 11 gradually decreases towards the direction away from the connecting tube 12, i.e. the dilating tube 11 is overall tapered, so as to improve the dilating performance of the dilating tube 11, ensure that the dilating tube 11 can smoothly penetrate into a narrower tortuous or spastic position in the blood vessel without damaging the blood vessel, and simultaneously combine the capability of the dilating tube 11 to be inflated, thereby effectively dilating the blood vessel.
Further, the stent 10 is provided with a guide wire channel 14, and the guide wire channel 14 penetrates the stent tube 11, the connecting tube 12 and the connecting member. Specifically, in use, a guidewire can be threaded into the guidewire channel 14 of the expansion device 10 such that the guidewire can be delivered to a designated area along the expansion device 10. Including but not limited to a guide wire, a contrast wire, a rotational milled wire, etc.
Furthermore, the outer peripheral side of the expanding tube 11 is provided with a drainage hole 114, and the drainage hole 114 is communicated with the guide wire channel 14. Therefore, after the expansion device 10 is delivered to the lesion part, the blood flow of the branch blood vessel can circulate through the drainage hole 114 and the guide wire channel 14, and the blood circulation of the branch blood vessel is ensured. Further, the drainage aperture 114 is spaced from the filling lumen 113 to prevent blood from entering the filling lumen 113 and to prevent the medium in the filling lumen 113 from leaking into the blood vessel.
Further, the outer peripheral side of the stent 11 and the outer peripheral side of the connection tube 12 are provided with a lubricant coating, so that the friction force between the blood vessel wall and the stent 10 is reduced, the smoothness of the stent 10 when it penetrates into the blood vessel is improved, and the blood vessel is prevented from being damaged. Further, the inner wall of the guide wire channel 14 is also provided with a lubricating coating, thereby improving the smoothness when the guide wire is inserted. Preferably, the lubricant coating is selected from a hydrophilic coating such as polyvinylpyrrolidone, or a hydrophobic coating such as silicone oil, polytetrafluoroethylene, or the like.
Further, referring to fig. 2, in the present embodiment, the connection tube 12 includes an inner tube 121 and an outer tube 122 sleeved outside the inner tube 121, an inflation channel 123 is formed between the inner tube 121 and the outer tube 122, one end of the inner tube 121 is connected to the support tube 111, the other end of the inner tube 121 is connected to the adaptor 13, one end of the outer tube 122 is connected to the expansion tube 112, and the other end of the outer tube 122 is connected to the adaptor 13. That is, in the present embodiment, the connection pipe 12 has a double-layer structure, and the connection pipe 12 has a double-layer structure to connect the expansion pipe 11 and the connection member, thereby improving the supporting performance and the twisting performance of the expansion device 10.
Specifically, the material of the outer tube 122 is a biocompatible polymer material, such as a composite material formed by mixing one or more of polyethylene, polypropylene, polytetrafluoroethylene, polyurethane, polyamide, polyether block polyamide, polyester, and silicone rubber. Further, the hardness of the material of the outer tube 122 is greater than that of the expansion tube 112, so that the outer tube 122 of the connection tube 12 is prevented from being expanded and deformed when the expansion tube 112 is filled with the medium.
The material of the inner tube 121 is a biocompatible metal material, for example, a composite material formed by mixing one or more of titanium, magnesium, nickel, cobalt, stainless steel, and the like. Preferably, the inner tube 121 and the support tube 111 are integrally formed, that is, the inner tube 121 is also a braided mesh tube structure, so as to effectively improve the support and torsion control of the connection tube 12.
Further, the outer circumference side of the outer tube 122 of the connection tube 12 may be provided with some texture structure, thereby improving the functionality of the connection tube 12. Specifically, referring to fig. 4, in one embodiment, the outer circumference of the connecting tube 12 is provided with a thread 124, so that when the stent 10 passes through tortuous and spastic vessels, the rotational connector drives the connecting tube 12 to rotate, and since the outer circumference of the connecting tube 12 is provided with the thread 124, the blood vessel wall and the thread 124 act to apply an axial force to the stent 10, thereby helping the stent 10 pass through tortuous and spastic vessels, and further improving the pushability, passability and controllability of the stent 10.
Referring to fig. 5, the outer periphery of the connection tube 12 may further be provided with an annular protrusion 125, and the outer diameter of the annular protrusion 125 gradually increases along the direction from the expansion tube 11 to the adaptor 13, i.e. the annular protrusion 125 has a tapered structure, and the outer diameter of the end of the annular protrusion 125 close to the expansion tube 11 is smaller, so as to be easier to penetrate into the tortuous and spasm part of the blood vessel. The annular protrusion 125 has a larger outer diameter at the end close to the dilating tube 11, so that the connecting tube 12 has a certain expandability, and when the connecting tube 12 passes through tortuous and spastic vessels, the vessel can be further dilated, thereby improving the expandability of the dilating device 10. Preferably, the outer circumferential side of the connection pipe 12 is provided with a plurality of annular protrusions 125, and the plurality of annular protrusions 125 are arranged along the axial direction of the connection pipe 12.
Referring to fig. 6, the outer periphery of the connecting tube 12 may also be provided with a texture 126, and preferably, the texture 126 may be a metal texture, which may improve the rigidity of the connecting tube 12, thereby improving the supporting performance and the twisting performance of the supporting tube 111.
Referring to fig. 7, the outer periphery of the connecting tube 12 may also be provided with a drug hole 127, and the drug hole 127 is used for carrying drugs, wherein the drugs include but are not limited to drugs for treating vasospasm, so that the vasospasm can be treated while the blood vessel is dilated. Preferably, the plurality of medicine holes 127 are provided, and the plurality of medicine holes 127 are spaced apart on the outer circumferential side of the connection pipe 12.
Referring to fig. 8 to 10, fig. 8 to 10 illustrate a structural schematic view of the expansion device 20 of the second embodiment, and specifically, unlike the first embodiment, the expansion device 20 of the second embodiment further includes a push pipe 24, and the push pipe 24 is used for connecting the connecting pipe 22 and the adaptor 23. Specifically, in the second embodiment, the connecting tube 22 includes an inner tube 221 and an outer tube 222 sleeved outside the inner tube 221, a filling passage 223 is formed between the inner tube 221 and the outer tube 222, the inner tube 221 is connected to the support tube, the outer tube 222 is connected to the expansion tube, one end of the filling passage 223, which is far away from the expansion tube 21, is provided with a connecting hole 2231 communicated with the filling passage 223, the other part of one end of the filling passage 223, which is far away from the expansion tube 21, except for the connecting hole 2231 is a closed structure, one end of the pushing tube 24 penetrates through the connecting hole 2231 and penetrates into the filling passage 223, and the other end of the pushing tube 24 is communicated to the filling port 231.
Specifically, the push tube 24 is a hollow tubular structure with two open ends, and the diameter of the push tube 24 is smaller than the radial dimension of the filling passage 223, so as to ensure that one end of the push tube 24 penetrates into the filling passage 223 to communicate the filling passage 223 with the filling port 231 through the push tube 24, and ensure that when a liquid or gas medium is injected into the filling port 231, the medium can enter the filling cavity 213 and make the dilating tube 21 enter the dilating state to dilate the blood vessel. And because the diameter of the push tube 24 is small, the push tube occupies a small space in the blood vessel, so that other surgical instruments can not be influenced to pass through the blood vessel, and the push tube is beneficial to assisting in delivering other interventional instruments.
Further, the material of the pushing pipe 24 is a biocompatible metal material, for example, a composite material formed by mixing one or more of titanium, magnesium, nickel, cobalt, stainless steel, and the like is selected, so that the support property and the torsion control property of the pushing pipe 24 are improved. Further, the cross section of the pushing rod may be circular, oval, rectangular, etc., without limitation.
It is understood that, in the case that there is no contradiction between the technical features, other technical features of the expanding tube 21, the connecting tube 22 and the adaptor 23 of the second embodiment may be the same as those of the first embodiment, and will not be described herein.
The present application further provides a guiding system, and in particular, the guiding system of an embodiment includes a guiding catheter and the expansion device of any of the above embodiments, the expansion device is disposed through the guiding catheter, the expansion tube is disposed through one end of the guiding catheter, and the adaptor is disposed through the other end of the guiding catheter.
Specifically, when the guiding catheter is used, the guiding catheter can be firstly passed through a blood vessel, when the guiding catheter encounters the problem of blood vessel tortuosity or spasm and cannot be continuously passed through the blood vessel, the expansion device can be passed through the guiding catheter, the expansion tube passes through the distal end of the guiding catheter, the adaptor is left at the proximal end of the guiding catheter and is used for being connected with the injector, then gas or liquid medium is injected into a filling port of the adaptor through the injector, the medium can enter a filling cavity of the expansion tube through a filling channel, so that the expansion tube is radially expanded and supports the tortuosity or spasm part of the blood vessel, the inner diameter of the blood vessel is expanded, at the moment, the guiding catheter can smoothly pass through the tortuosity or spasm position of the blood vessel and is passed to the lesion position, and then the expansion device is withdrawn from the guiding catheter to convey a surgical instrument to the lesion position through the guiding catheter or the contrast catheter.
The aforementioned dilation devices generally need to be used in conjunction with a guiding catheter to achieve the function of dilating the vessel and delivering the device. In another embodiment of the present invention, a guiding system 30 having functions of expanding a blood vessel and guiding an instrument is provided, and specifically, referring to fig. 11, the guiding system 30 of an embodiment includes an expanding tube 31, a connecting tube 32 and an adaptor 33, wherein the expanding tube 31 includes a supporting tube and an expanding tube sleeved outside the supporting tube, an inflation cavity is formed in the expanding tube, the expanding tube has a contraction state and an expansion state expanded along a radial direction after the inflation cavity is filled with a medium, one end of the connecting tube 32 is connected to the expanding tube 31, the connecting tube 32 is provided with an inflation channel, the inflation channel is communicated with the inflation cavity, the other end of the connecting tube 32 is connected to the adaptor 33, and the adaptor 33 is provided with an inflation port 331 communicated with the inflation channel.
Further, in this embodiment, the connection tube 32 includes a flexible section 321, a bending section 322 and a supporting section 323 connected in sequence, the flexible section 321 is connected to the dilation tube 31, the bending section 322 is formed with at least one bending structure bending relative to the supporting section 323 or the flexible section 321, and a bending angle of the bending structure can be adjusted according to a physiological structure (such as a coronary artery opening position, an inclination angle, etc.) of the patient and an operation path (such as a left coronary artery or a right coronary artery), so that the connection tube 32 can smoothly hang the coronary artery opening after entering the aorta.
Further, the guiding system 30 is provided with an instrument channel, which penetrates the dilating tube 31, the connecting tube 32 and the connecting member 33, so that a surgical instrument such as a guide wire, a balloon, a stent, etc. can be delivered to the lesion site through the instrument channel.
It should be understood that, in the case that there is no contradiction in the combination of the technical features, other technical features of the expanding tube 31, the connecting tube 32 and the adaptor 33 of the guiding system 30 of the present embodiment may be the same as the technical features of the expanding tube 31, the connecting tube 32 and the adaptor 33 of the expanding device of the first embodiment, and are not described herein again.
The guiding system 30 is provided at one end of the connecting tube 32, the expanding tube 31 is configured to include a supporting tube and an expanding tube sleeved outside the supporting tube, the supporting tube can effectively increase the supporting strength of the expanding tube 31, so that the expanding tube 31 can smoothly penetrate into the tortuous or spasm position of the blood vessel, and the expanding tube is configured to have a contracted state and an expanded state, so that after the expanding tube 31 penetrates into the tortuous or spasm position of the blood vessel, a medium such as liquid or gas is injected into the filling cavity of the expanding tube 31 through the filling channel of the connecting tube 32 through the filling opening 331 of the adaptor 33, so that the expanding tube radially expands, thereby expanding the tortuous blood vessel with plaque and ulcer or the tight spasm blood vessel, reducing the resistance of the blood vessel wall, ensuring that the guiding system 30 smoothly passes through the tortuous or spasm position of the blood vessel and enters the lesion site, and simultaneously, by providing an instrument channel in the guiding system 30, so that the guiding system 30 can assist the guide wire, balloon, stent and other instruments to smoothly pass through the tortuous or spastic position of the blood vessel and reach the diseased region.
The technical features of the embodiments described above may be arbitrarily combined, and for the sake of brevity, all possible combinations of the technical features in the embodiments described above are not described, but should be considered as being within the scope of the present specification as long as there is no contradiction between the combinations of the technical features.
The above-mentioned embodiments only express several embodiments of the present invention, and the description thereof is specific and detailed, but not to be understood as limiting the scope of the invention. It should be noted that, for a person skilled in the art, several variations and modifications can be made without departing from the inventive concept, which falls within the scope of the present invention. Therefore, the protection scope of the present patent shall be subject to the appended claims.
In the description of the present invention, it is to be understood that the terms "central," "longitudinal," "lateral," "length," "width," "thickness," "upper," "lower," "front," "rear," "left," "right," "vertical," "horizontal," "top," "bottom," "inner," "outer," "clockwise," "counterclockwise," "axial," "radial," "circumferential," and the like are used in the orientations and positional relationships indicated in the drawings for convenience in describing the invention and to simplify the description, and are not intended to indicate or imply that the referenced device or element must have a particular orientation, be constructed and operated in a particular orientation, and are not to be considered limiting of the invention.
Furthermore, the terms "first", "second" and "first" are used for descriptive purposes only and are not to be construed as indicating or implying relative importance or implicitly indicating the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include at least one of the feature. In the description of the present invention, "a plurality" means at least two, e.g., two, three, etc., unless specifically limited otherwise.
In the present invention, unless otherwise expressly stated or limited, the terms "mounted," "connected," "secured," and the like are to be construed broadly and can, for example, be fixedly connected, detachably connected, or integrally formed; can be mechanically or electrically connected; they may be directly connected or indirectly connected through intervening media, or they may be connected internally or in any other suitable relationship, unless expressly stated otherwise. The specific meanings of the above terms in the present invention can be understood by those skilled in the art according to specific situations.
In the present invention, unless otherwise expressly stated or limited, the first feature "on" or "under" the second feature may be directly contacting the first and second features or indirectly contacting the first and second features through an intermediate. Also, a first feature "on," "over," and "above" a second feature may be directly or diagonally above the second feature, or may simply indicate that the first feature is at a higher level than the second feature. A first feature being "under," "below," and "beneath" a second feature may be directly under or obliquely under the first feature, or may simply mean that the first feature is at a lesser elevation than the second feature.
It will be understood that when an element is referred to as being "secured to" or "disposed on" another element, it can be directly on the other element or intervening elements may also be present. When an element is referred to as being "connected" to another element, it can be directly connected to the other element or intervening elements may also be present. As used herein, the terms "vertical," "horizontal," "upper," "lower," "left," "right," and the like are for purposes of illustration only and do not denote a single embodiment.