WO2006118884A2 - Drug delivery devices and related components, systems and methods - Google Patents
Drug delivery devices and related components, systems and methods Download PDFInfo
- Publication number
- WO2006118884A2 WO2006118884A2 PCT/US2006/015709 US2006015709W WO2006118884A2 WO 2006118884 A2 WO2006118884 A2 WO 2006118884A2 US 2006015709 W US2006015709 W US 2006015709W WO 2006118884 A2 WO2006118884 A2 WO 2006118884A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- drug delivery
- delivery device
- mixing chamber
- manifold
- agitator
- Prior art date
Links
Classifications
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F31/00—Mixers with shaking, oscillating, or vibrating mechanisms
- B01F31/40—Mixers with shaking, oscillating, or vibrating mechanisms with an axially oscillating rotary stirrer
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F31/00—Mixers with shaking, oscillating, or vibrating mechanisms
- B01F31/44—Mixers with shaking, oscillating, or vibrating mechanisms with stirrers performing an oscillatory, vibratory or shaking movement
- B01F31/441—Mixers with shaking, oscillating, or vibrating mechanisms with stirrers performing an oscillatory, vibratory or shaking movement performing a rectilinear reciprocating movement
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F33/00—Other mixers; Mixing plants; Combinations of mixers
- B01F33/50—Movable or transportable mixing devices or plants
- B01F33/501—Movable mixing devices, i.e. readily shifted or displaced from one place to another, e.g. portable during use
- B01F33/5011—Movable mixing devices, i.e. readily shifted or displaced from one place to another, e.g. portable during use portable during use, e.g. hand-held
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F33/00—Other mixers; Mixing plants; Combinations of mixers
- B01F33/50—Movable or transportable mixing devices or plants
- B01F33/501—Movable mixing devices, i.e. readily shifted or displaced from one place to another, e.g. portable during use
- B01F33/5011—Movable mixing devices, i.e. readily shifted or displaced from one place to another, e.g. portable during use portable during use, e.g. hand-held
- B01F33/50112—Movable mixing devices, i.e. readily shifted or displaced from one place to another, e.g. portable during use portable during use, e.g. hand-held of the syringe or cartridge type
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/75—Discharge mechanisms
- B01F35/752—Discharge mechanisms with arrangements for converting the mechanism from mixing to discharging, e.g. by either guiding a mixture back into a receptacle or discharging it
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/75—Discharge mechanisms
- B01F35/754—Discharge mechanisms characterised by the means for discharging the components from the mixer
- B01F35/75425—Discharge mechanisms characterised by the means for discharging the components from the mixer using pistons or plungers
Definitions
- This description relates to drug delivery devices, as well as related components, systems and methods.
- Calcium phosphate-based cement is commonly used in many orthopedic and anaplastic surgical procedures.
- Various devices have been developed to prepare and/or deliver bone cement in such procedures.
- This description relates to drug delivery devices, as well as related components, systems and methods.
- the drug delivery devices, systems and methods can offer a reliable, repeatable, and/or consistent delivery of a predetermined volume of a liquid containing a therapeutic agent, such as an osteogenic agent.
- a therapeutic agent such as an osteogenic agent.
- the therapeutic agent Prior to dissolution in the liquid, the therapeutic agent can be provided (stored) in the delivery device, for example, in solid (e.g., powder) form.
- therapeutic agents include proteins, such as a member of the transforming growth factor beta (TGF- ⁇ ) family, at least one protein from the bone morphogenetic protein (BMP) family of proteins, or at least one protein from the growth/differentiation factor (GDF) family of proteins.
- TGF- ⁇ transforming growth factor beta
- BMP bone morphogenetic protein
- GDF growth/differentiation factor
- the therapeutic agent includes combinations of proteins, for example, combinations of any of the foregoing proteins.
- the compound can be secured in the device until reconstituted and administered to a patient to help control (e.g., prohibit) unintended usage.
- the components for reconstituting, mixing and agitating and delivery the admixture can be aseptically contained within a unitary system, thereby minimizing or eliminating contamination.
- the delivery device can also provide force enhancement to mix and prepare for injection reconstituted compounds which exhibit substantially viscous properties.
- a drug delivery system features a drug delivery device including a main body including a proximal end, a distal end, and a mixing chamber positioned between both ends, a rotary driver disposed at the proximal end of the main body, a main piston operably linked to the rotary driver, an agitator disposed with the mixing chamber and affixed to an agitator shaft, the agitator shaft operably linked to the main piston such that rotating the rotary drive imparts axial movement to agitator, and a piston end operably linked to the main piston.
- a drug delivery system features a delivery device, a reconstitution manifold and an air pump.
- the reconstitution manifold includes a first vial to contain a first substance, a second vial, in fluid communication with the first vial, to contain a second substance.
- the air pump is in fluid communication with the first and second vials and configured to operate in at least a first and second mode. While operating in the first mode, at least part of the first substance is combined with the second substance to form a resulting admixture. While operating in the second mode, the admixture is transferred from either the first or second vials to the delivery device.
- a method for preparing calcium phosphate-based cement includes reconstituting a BMP powder to form a BMP admixture in manifold, delivering the BMP admixture from the manifold to a delivery device releasably attached to the manifold, mixing the admixture with a CPM (calcium phosphate matrix) contained within the delivery device to form a third substance, and displacing a piston slidably disposed within the delivery device to eject the third substance from the delivery device.
- CPM calcium phosphate matrix
- FIGs. IA and IB are perspective and side views of an embodiment of a drug delivery device, respectively.
- FIG. 3 is a partial sectional perspective view of the device of FIGs. IA and IB.
- FIG. 4 is an exploded and partial sectional view of the device of FIGs. IA and IB.
- FIG. 8A is a cross-sectional view of the device of FIGs. IA and IB.
- FIG. 9 is a cross-section of view of the device of FIGs. 2 A and 2B.
- FIG. 10 is a graphical depiction of the axial and rotation movement of components of the devices of FIGs. IA through 2B.
- FIG. 12 is a schematic view of a drug delivery system including the drug delivery device of FIGs. IA and IB and a reconstitution manifold.
- FIG. 13 is a perspective view of a drug delivery system.
- FIG. 15 is a perspective view of the internal components of the reconstitution manifold of FIG. 13.
- FIG. 16 is a cross-sectional view of internal components of the reconstitution manifold of FIG. 13.
- a drug delivery system reconstitutes a first substance, mixes and agitates the reconstituted first substance with a second substance to form a third substance and delivers, by injection, the third substance to a patient.
- the first substance is a therapeutic agent, such as an ' osteogenic agent.
- a therapeutic agent can be provided, for example, in solid (e.g., powder) form.
- therapeutic agents include proteins, such as members of the TGF- ⁇ family (e.g., one or more members of the BMP family of proteins, one or more members of the GDF family of proteins).
- osteogenic agents are disclosed, for example in U.S. Pat. Nos. 6,719,968, 6,027,919, 5,658,882, 5,618,924 and 5,013,649, which are hereby incorporated by reference.
- the osteogenic agent is BMP-2, BMP-12 or MP52.
- multiple therapeutic (e.g., osteogenic) agents can be used.
- the second substance is a CPM powder.
- the first substance is reconstituted and transferred to a delivery device containing the second substance wherein the reconstituted BMP powder and CPM are mixed to form a third substance.
- the third substance is then ejected from the delivery device and administered to a patient by injection, for example.
- the drug delivered system is configured for preparing a homogeneous third substance, which includes the first and second substances, and has physical properties such as viscosity, density and specific gravity well suited for delivery to a patient by injection, for example.
- the device is configured for use with BMP-2.
- FIGs. IA and IB show a delivery device 100 having a proximal end 102 and a distal end 104 and including a main body front 105 joined to an axially extending main body rear 110.
- the delivery device can be dimensioned to administer a suitable quantity, such as 5-ml or 1-ml of a material, such as a bone cement, to a patient.
- a rotary drive 115 is threadably attached at the proximal end 102 of the main body rear 110 and an outer front 120 is threadably attached to the main body front 105.
- the outer front 120 includes a luer connection 123 configured to receive a needle or reconstitution manifold (described below).
- the main body front 105 includes a window 125 to display the position of the interior components of the device 100 and the contents therein, hi some embodiments, the main body rear 115 includes laterally extending fins 130.
- the delivery device 100 can include a piston end 132 extending along a concentric bore in the rotary drive 115 and protrudes beyond a proximal end 133 of the drive 115.
- FIGs. 3 through 9 show the internal components of the delivery device 100 including a syringe barrel 135 disposed within the main body front 105.
- a piston shaft 140 extends axially along the length of the device between the proximal and distal ends 102, 104.
- An agitator shaft 145 concentrically receives a portion of the piston shaft 140.
- the syringe barrel 135 includes a frustoconical wall 147 (FIGs. 8A and 8B) to define a mixing chamber 150 through which the piston shaft 140 extends.
- the syringe barrel 135 can include a circumferentially extending vent (not shown) to allow evolved gases within the barrel to escape while the mixing chamber 150 is filled and/or during the mixing and/or ejection of the contents contained therein (described below).
- the vent can be formed from a sintered material wrapped with a high density polyethylene, such as polytetrafluoroethylene (PTFE), for example.
- PTFE polytetrafluoroethylene
- the piston shaft 140 includes a piston head 151 and an axial central bore 152 extending along the piston shaft 140 from a port 153 located at a distal end of the piston head 151, toward the mixing chamber 150, when the piston shaft 140 is in a fully distal position.
- the central bore 152 can includes transverse ports 154, such that when the piston head 151 is in a fully distal position, the luer connection 123 is in fluid communication with the mixing chamber 150.
- the outer front 120 can include a substantially cylindrical ejection chamber 155 which receives a front seal 157.
- the ejection chamber 155 and front seal 157 are sized to receive the piston head 151 of the piston shaft 140.
- An agitator 158 and an agitator seal 160 which seated proximally to the agitator 158 and can be frustoconical, for example, are contained within the mixing chamber 150 and are attached to the piston shaft 140.
- a piston end 132 (FIGs. 8Aand 8B) is attached to a proximal end of the piston shaft 140 with a fastener 134.
- an agitator and an agitator seal integrally form an agitator assembly 163.
- the agitator assembly 163 engages the frustoconical wall 147 of the syringe barrel 135 to form a seal therewith.
- the proximal end 164 of the piston shaft 140 extends and connects with the fastener 134.
- a piston end spring 165a and main piston spring 165b bias the piston shaft 140 distally to improve contact between the piston head 151 with the front seal 157 during mixing.
- Acam track 173 extends around the agitator shaft 145 and receives a cam follower 175 mounted to an inner surface of the syringe barrel 135.
- the rotary drive 115 is keyed directly to the main piston 166 proximate the piston end 132 (FIGs. 8A and 8B). Accordingly, rotation of rotary drive 115 rotates the main piston 166.
- the main piston 166 is keyed to the agitator shaft 145, such that as the main piston 166 rotates, engagement of the cam follower 175 with the cam track 173 imparts axial movement of the agitator shaft 145 and the attached agitator 158 within the mixing chamber 150.
- the cam track 173 can describe a helical path, for example, about the agitator shaft 145.
- a retainer ring 177, a drive runner 180, and a drive runner stop ring 185 are concentrically arranged along the drive outer 172 between the main body rear 110 and the rotary drive 115.
- the agitator shaft 145 and attached agitator 158 follow a reciprocating motion within the mixing chamber 150 to mix the paste.
- one prescribed motion includes 120-degrees rotation of the rotary drive 150; a 240-degrees helical motion with 30-mm axial movement towards the distal end 104; a 120-degrees rotation; and 240-degrees helical motion with 30 mm axial movement towards the proximal end 102.
- the agitator 158 thus returns to its starting point every two revolutions of the rotary drive 115.
- the agitator 158 includes a plurality of blades 186 extended substantially radially from the agitator shaft 145.
- the blades 186 can be made from a variety of material including, for example, polycarbonate, Santoprene ® (Monsanto Corporation, Delaware), polyester elastomer, polypropylene, or polyethylene.
- the blades 186 can be formed from a flexible material and configured to mix and agitate the contents of the mixing chamber 150 to form a homogeneous paste.
- the blades 186 can be configured to deform when the agitator shaft 145 is moved rotationally and remain radially extended when the agitator shaft 145 is moved axially.
- the rotary drive 115 is keyed to a drive runner 180, which engages threads 187 on the main body rear 110. As the rotary drive 115 is turned, the drive runner 180 moves along the main body rear until it contacts the drive runner stop ring 185.
- the retainer ring 177 includes two tabs 188 configured to engage slots 189 disposed in the main body rear 110 proximal to the fins 130, to prevent the rotary drive 115 from moving axially relative to the main rear body 110.
- the drive runner stop ring 185 is pinned to the main body rear 110 and secured in place.
- the drive runner stop ring 185 includes circumferentially located bosses 190 sized and configured to engage circumferentially located recesses 193 on the drive runner 180.
- the drive runner 180 advances axially along threads 187 a predetermined distance until the drive runner is proximate the drive runner stop ring 185.
- the bosses 190 along the drive runner stop ring 185 engage the recesses 193 along the drive runner 180 locking the drive runner 180 against further rotation.
- the drive runner 180 is locked to the drive runner stop ring 185.
- the drive inner 170 is configured to rotate and be fixed axially by an radially extending flange 194 disposed between the main body front 105 and the rotary drive 115.
- the drive inner 170 connects to the main piston 166 by a two start 120-mm pitch thread, and therefore rotates by 90-degrees counterclockwise as the main piston 166 moves back.
- the drive outer 172 carries a set of ratchet arms 195 (FIG. 4) that permit only clockwise rotation within the main body front 105 and is threaded to the drive inner 170 via a single start 3-mm pitch thread. Therefore, as the drive inner 170 rotates counterclockwise, the drive outer 172 is forced to rotate 90-degrees relative to the drive inner 170, and is pushed 0.75 mm towards the distal end of the device.
- the piston end 132 After the piston end 132 is depressed a full stroke by the user (in the distal direction), the piston end 132 then moves back toward its original position (in the proximal direction) to complete a return stroke under the action of the a spring (not shown) located in an annular region between piston end 132 and the rotary drive 115.
- the drive outer 172 bears directly on the syringe barrel 135 such that the syringe barrel 135 is forced 0.75-mm towards the distal end 104 of the device.
- the operator can use the laterally extending fins 130 (FIGs. IA through 2B) for improved leverage in depressing the piston end 132.
- a full return stroke of the piston end 132 in the proximal direction, 30-mm translates into an axial movement of the syringe barrel 135 of only 0.75-mm, while increasing the transmitted axial force by a factor of 40 (30 / 0.75-mm).
- Such force enhancement decreases the static and dynamic force requirements for mixing and displacing the contents of the syringe barrel. This is particularly advantageous when the syringe barrel 135 contains a substantially viscous fluid.
- the force enhancement and corresponding axial advancement of the syringe barrel 135 can be modified to suit various operator force requirements and fluid viscosities.
- the syringe barrel 135 remains stationary relative to the main body front 105 during the forward stroke of the main piston 166, and the front of the main piston 166 moves into a reduced diameter section of the outer front 120, which serves as a small diameter paste dispensing syringe.
- the volume occupied by mixed paste contained within the mixing chamber 150 is less than that occupied by the CPM powder, so there is a void within the mixing chamber at the end of the mixing process.
- the first 10 to 15 strokes of the piston end 132 and the main piston 166 serve to take up the void space.
- the reducing volume of the mixing chamber 150 causes the contents of the mixing chamber 150, such as a paste for example, to flow into the reduced diameter bore in the outer front seal 157, as the main piston 166 is withdrawn.
- this paste is forced out of the luer connection 123 on the front of the outer front 120, and into an injection needle attached to the luer connection 123.
- the volume of paste ejected from the device is from about 0.1 ml to about 0.3ml per stroke of the main piston 166.
- FIG. 13 depicts a unitary system 300 including components of the drug delivery system 200.
- the drug delivery device 100 and/or the syringe 210 can be releasably attached to the reconstitution manifold 205 during varying stages of use of the drug delivery system 200.
- the cover 230 can include vial guides 232, 234 (FIG. 15) to center the vials 215, 220 on the concentric needles 235.
- the manifold 205 can include a manifold assembly 305 to support the vials 215, 220 as the cover 230 is moved to the lowered position.
- the delivery device 100 is attached to the manifold 205 at a device connector 310 (FIGSs. 14A and 14B).
- the syringe 210 is attached to the manifold 205 at an air pump connector 315.
- all components of the manifold 205, including the vials 215, 220 are self-contained by an external housing 320 which can be configured to be tamper-evident or tamper-proof.
- a connection shutter 325 is slideably disposed proximate the device connector 310 and configured to be normally held open against the bias of a spring (not shown) by the luer connection 123 when the delivery device 100 engages the manifold 205.
- the connection shutter 325 springs closed and passes into a groove (not shown) configured such that the shutter 325 can not subsequently be reopened. This configuration minimizes the possibility of extraction of the contents of the vials 215, 220 from the manifold 205 by premature removal of the delivery device 100.
- the concentric needles 235 can include a core needle 330 substantially surrounded by an outer sheath 335 to define annular space between the core needle 330 and the sheath 335 for passage of the contents of the vials to the manifold 205.
- the core needle 330 is open at a needle tip 340 and connected to an air conduit 345 to provide for passage of air and between the vial 215 and the air pump 210 and between the vial 220 and the vent 225.
- Transverse ports 340 extend from the sheath 335 to provide fluid communication between the vials 210, 215 and the manifold 205.
- an operator pushes the cover 230 of the manifold 205 downward thereby penetrating the vials 215, 220 with concentric needles 235.
- the syringe 210 is first pulled out to draw the WFI from the vial 215 through a first one-way valve 227 and into the concentrate vial 220, facilitated by the vent 225.
- the manifold 205 is then gently agitated to reconstitute the contents of the concentrate vial 220.
- the syringe 210 is then pushed in to force the reconstituted mixture from the concentrate vial 220 through a second one-way valve 229 and into the delivery device 100.
- the delivery device 100 can be removed from the manifold 205 by rotating the delivery device 100, for example, and detaching the luer connection 123 from the device connector 310.
- the connection shutter 325 closes to limit access to the remaining contents of the concentrate vial 220.
- Both of the return valves 227, 229 and the luer connection 123 can be contained with a valve manifold 350.
- a delivery needle (not shown), such as a Tuohy needle with an obdurator, for example, is connected to the luer connection 123 of the delivery device 100.
- the delivery needle can be positioned within a patient before or after connection with the delivery device 100, using a fluoroscope, for example, and directed at a treatment site, such as a wrist or hip, for delivery of the contents of the mixing chamber 150 of the delivery device 100.
- the rotary driver 115 or the piston end 132 protruding from the rotary drive 115 (FIGs. 8 A, 8B, and 9) is rotated clockwise (as viewed from the proximal end 102) 15 to 20-degrees, for example, to release the bayonet and force the piston end 132 in a proximal direction under the bias of the springs 165a and 165b (FIGs. 7, and 9).
- the piston end 132 rotates independently of the rotary drive 115.
- the delivery device 100 is configured for onetime usage.
- the devices and systems can be used in any desired application.
- the devices and systems can be used in tissue (e.g., bone, cartilage, tendon, meniscus, ligament) treatment and/or repair.
- the devices and systems can be used in bone-to-bone repair.
- the devices and systems can be used in cartilage regeneration.
- the devices and systems can be used in bone fracture repair.
- the devices and systems can be used in implant treatment and/or repair.
- the devices and systems can be used to grout one or more implants.
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- Chemical & Material Sciences (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Infusion, Injection, And Reservoir Apparatuses (AREA)
- Prostheses (AREA)
- Medicinal Preparation (AREA)
Abstract
Description
Claims
Priority Applications (7)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/912,003 US20090043282A1 (en) | 2005-04-29 | 2006-04-26 | Drug Delivery Devices and Related Components, Systems and Methods |
MX2007013209A MX2007013209A (en) | 2005-04-29 | 2006-04-26 | Drug delivery devices and related components, systems and methods. |
AU2006242640A AU2006242640A1 (en) | 2005-04-29 | 2006-04-26 | Drug delivery devices and related components, systems and methods |
BRPI0609902-5A BRPI0609902A2 (en) | 2005-04-29 | 2006-04-26 | drug delivery devices and related components, system and methods |
CA002603033A CA2603033A1 (en) | 2005-04-29 | 2006-04-26 | Drug delivery devices and related components, systems and methods |
EP06751416A EP1874238A2 (en) | 2005-04-29 | 2006-04-26 | Drug delivery devices and related components, systems and methods |
JP2008509061A JP2008539026A (en) | 2005-04-29 | 2006-04-26 | Drug delivery device and related components, systems, and methods |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US67599505P | 2005-04-29 | 2005-04-29 | |
US60/675,995 | 2005-04-29 |
Publications (2)
Publication Number | Publication Date |
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WO2006118884A2 true WO2006118884A2 (en) | 2006-11-09 |
WO2006118884A3 WO2006118884A3 (en) | 2007-03-01 |
Family
ID=37308478
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2006/015709 WO2006118884A2 (en) | 2005-04-29 | 2006-04-26 | Drug delivery devices and related components, systems and methods |
Country Status (9)
Country | Link |
---|---|
US (1) | US20090043282A1 (en) |
EP (1) | EP1874238A2 (en) |
JP (1) | JP2008539026A (en) |
CN (1) | CN101166487A (en) |
AU (1) | AU2006242640A1 (en) |
BR (1) | BRPI0609902A2 (en) |
CA (1) | CA2603033A1 (en) |
MX (1) | MX2007013209A (en) |
WO (1) | WO2006118884A2 (en) |
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WO2011010128A1 (en) * | 2009-07-23 | 2011-01-27 | Orthogem Limited | Tripore delivery device |
WO2011083357A1 (en) * | 2010-01-08 | 2011-07-14 | Vexim Sas | Devices, methods and systems for mixing and dispensing flowable material |
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US9139952B2 (en) * | 2012-03-08 | 2015-09-22 | James Hangley | Applicator for applying resin to a precreased piece of fabric and method of the same |
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WO2011083357A1 (en) * | 2010-01-08 | 2011-07-14 | Vexim Sas | Devices, methods and systems for mixing and dispensing flowable material |
Also Published As
Publication number | Publication date |
---|---|
MX2007013209A (en) | 2008-11-04 |
CA2603033A1 (en) | 2006-11-09 |
BRPI0609902A2 (en) | 2010-05-11 |
EP1874238A2 (en) | 2008-01-09 |
JP2008539026A (en) | 2008-11-13 |
AU2006242640A1 (en) | 2006-11-09 |
US20090043282A1 (en) | 2009-02-12 |
CN101166487A (en) | 2008-04-23 |
WO2006118884A3 (en) | 2007-03-01 |
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