GUIDE WIRES
20220296860 · 2022-09-22
Assignee
Inventors
Cpc classification
A61M2025/09175
HUMAN NECESSITIES
A61M2025/09133
HUMAN NECESSITIES
A61M2025/09141
HUMAN NECESSITIES
International classification
Abstract
A guide wire in which a distal end portion of the guide wire can be easily bent in a specific plane direction in shaping, is provided. A guide wire includes a core shaft having a maximum diameter in a cross section orthogonal to an axial direction of the core shaft and an orthogonal diameter in a direction orthogonal to a direction of the maximum diameter, the core shaft includes a first specific portion located on a distal end side of the core shaft and having an oblateness between 7% and 35%, where oblateness is defined as the difference between the maximum diameter and the orthogonal diameter divided by the maximum diameter. The first specific portion of the core shaft can be 5 mm or more in the axial direction.
Claims
1. A guide wire comprising: a core shaft having a maximum diameter in a cross section orthogonal to an axial direction of the core shaft and an orthogonal diameter in a direction orthogonal to a direction of the maximum diameter in the cross section, the core shaft including a first specific portion located on a distal portion of the core shaft and having an oblateness of between 7% and 35%, wherein: the first specific portion extends 5 mm or more in the axial direction; and oblateness is equal to a difference between the maximum diameter and the orthogonal diameter divided by the maximum diameter.
2. The guide wire according to claim 1, wherein the first specific portion is formed of a material containing stainless steel.
3. The guide wire according to claim 1, wherein the core shaft includes a second specific portion located closer to a distal end of the core shaft than the first specific portion, the second specific portion having the oblateness of 40% or more.
4. The guide wire according to claim 3, wherein a direction of the maximum diameter of the first specific portion and a direction of the maximum diameter of the second specific portion are parallel to each other.
5. The guide wire according to claim 3, wherein the second specific portion is formed of a material containing stainless steel.
6. The guide wire according to claim 1, wherein the core shaft includes a superelastic portion located closer to a proximal end of the guide wire than the first specific portion; and the superelastic portion includes a superelastic alloy.
Description
BRIEF DESCRIPTION OF DRAWINGS
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DETAILED DESCRIPTION OF EMBODIMENTS
[0041]
[0042] Guide wire 100 is a medical device configured to be inserted into a blood vessel or the like in order to guide a catheter (not illustrated) to a lesion (e.g., a constricted part or occluded part) in the blood vessel or the like. As illustrated in
[0043] Core shaft 10 is a rod-shaped member having a relatively small diameter at a distal end side and a relatively large diameter at a proximal end side. The core shaft 10 includes a first core shaft part 11, which includes the distal end of the core shaft 10, and a second core shaft part 12 located nearer the proximal end side of the core shaft 10 with respect to the first core shaft part 11. The first core shaft part 11 will be described in detail later.
[0044] The second core shaft part 12 includes a small diameter portion 120, a large diameter portion 121, and a tapered portion 122. In
[0045] The small diameter portion 120 of the second core shaft part 12 is a portion including the distal end of the second core shaft part 12. The small diameter portion 120 has a rod shape having a circular transverse cross-section (e.g., XY cross section) taken orthogonal to the axial direction (e.g., Z-axis direction) of the core shaft 10. As shown in
[0046] The large diameter portion 121 of the second core shaft part 12 is located nearer the proximal end side of the core shaft 10A with respect to the small diameter portion 120. In some embodiments, the large diameter portion 121 has a circular rod shape having a larger outer diameter than the small diameter portion 120 in a transverse cross-section.
[0047] The tapered portion 122 of the second core shaft part 12 is disposed between the small diameter portion 120 and the large diameter portion 121. The outer diameter of the tapered portion 122 gradually increases from a boundary position with the small diameter portion 120 to a boundary position with the large diameter portion 121.
[0048] It is noted that the shape of the transverse cross-section of each portion of the second core shaft part 12 is not limited to a circular cross-section, and may be shaped in any suitable manner and can include a polygonal cross-section, such as, for example, a triangle or a rectangle.
[0049] The second core shaft part 12 can include any suitable material for performing the functions described herein. For example, the second core shaft part 12 can include metal materials, and more specifically, stainless steel (e.g., SUS302, SUS304, SUS316, or the like), superelastic alloys such as Ni—Ti alloys, piano wires, nickel-chromium alloys, cobalt alloys, tungsten, and the like. In the present embodiment, the second core shaft part 12 is formed of a material containing a superelastic alloy such as a Ni—Ti alloy. In some configurations, the second core shaft part 12 formed of a material containing a superelastic alloy, so that a performance (sometimes called “restorability”) in which the shape of the second core shaft part 12 returns, after deformation, to the original shape can be exhibited, even when the guide wire 100 advances in a bent blood vessel or the like, thereby making it possible to maintain the operability and vascular selectivity of the guide wire 100.
[0050] The coil body 20 is a coil-shaped member and, in some embodiments, can be formed into a hollow cylindrical shape by spirally winding one wire. The coil body 20 is arranged so as to surround the outer periphery of the distal end part of the core shaft 10. For example, coil body 20 may surround the first core shaft part 11 and the small diameter portion 120, the tapered portion 122, and a part of the large diameter portion 121 of the second core shaft part 12.
[0051] The coil body 20 can include, for example, a metal material. To elaborate, the metal material can include a radiolucent metal material such as stainless steel (e.g., SUS302, SUS304, SUS316, or the like), a superelastic alloy such as a Ni—Ti alloy, a piano wire, as a nickel-chromium alloy or a cobalt alloy, or a radiopaque metal material such as gold, platinum, tungsten, or an alloy containing these elements, such as, a platinum-nickel alloy. In embodiments in which at least a part of the coil body 20 is a radiopaque material, an operator can identify the position of the coil body 20 in a radiolucent image.
[0052] The distal end-side joint part 30 couples the distal end of the core shaft 10 to the distal end of the coil body 20. The distal end of the core shaft 10 and the distal end of the coil body 20 can be fixed to, or be embedded in, the distal end-side joint part 30. The outer peripheral surface on the distal end side of the distal end-side joint part 30 can be a smooth surface, such as, for example, a substantially hemispherical surface. The distal end-side joint part 30 can be formed of a metal solder (e.g., silver solder, gold solder, zinc, Sn—Ag alloy, and Au—Sn alloy) or a bonding agent such as an epoxy adhesive. By arranging the distal end-side joint part 30 on the distal end side with respect to the core shaft 10, it is possible to prevent the core shaft 10 from contacting a blood vessel wall or the like. In this way and others, guide wire 10 can prevent the core shaft 10 from being damaged.
[0053] The proximal end-side joint part 40 couples a proximal end side of the core shaft 10 to a proximal end side of the coil body 20. The proximal end-side joint part 40 can be formed of the same material as the distal end-side joint part 30, described above. It is noted that the position of the proximal end-side joint part 40 is not limited to the proximal end side of the coil body 20, and may be located at any suitable position along the coil body 20.
[0054]
[0055] The first core shaft part 11 can be a rod-shaped member. In the embodiment shown, the first core shaft part 11 includes a material containing stainless steel (e.g., SUS302, SUS304, SUS316, or the like). The first core shaft part 11 is sometimes referred to as “ribbon” or “shaping ribbon”. The first core shaft part 11 can be connected to the distal end of (the small diameter portion 120 of) the second core shaft part 12. For example, in some embodiments first core shaft part 11 is bonded with small diameter portion by a metal solder such as silver solder, gold solder, zinc, a Sn—Ag alloy, or an Au—Sn alloy, or by an adhesive such as an epoxy adhesive.
[0056] As illustrated in
[0057] In the following, the longest diameter in a transverse cross-section, such as the XY cross-section, orthogonal to the axial direction of the core shaft 10 (e.g., Z-axis direction) is referred to as “maximum diameter.” The diameter in a direction orthogonal to a direction of the maximum diameter in the transverse cross-section is referred to as “orthogonal diameter,” and a value (%) obtained by dividing the difference between the maximum diameter and the orthogonal diameter by the maximum diameter is referred to as “oblateness.”
[0058] The strongly oblate part 110 of the first core shaft part 11 includes the distal end of the first core shaft part 11.
[0059] As illustrated in
[0060] The strongly oblate part 110 of the first core shaft part 11 may have an oblateness of 40% or more in the transverse cross-section. To illustrate, first core shaft part 11 may be formed from a rod-shaped member, such as a wire, that is flattened (e.g., by press working or the like). As a specific example, for a wire diameter of a rod-shaped member before flattening of 40 μm, the maximum diameter D11 is 57 μm, the orthogonal diameter D12 is 24 μm, and the oblateness is 57.9% in the strongly oblate part 110. However, the oblateness of the strongly oblate part 110 of the first core shaft part 11 in the transverse cross-section may be any other value of 40% or more (the same applying to a third embodiment described below).
[0061] As illustrated in
[0062] As illustrated in
[0063] The oblateness of the slightly oblate part 112 of the first core shaft part 11 can be between 7% and 35%. As a specific example, for an unflattened wire diameter of 40 μm, when the oblateness is 30.0%, the maximum diameter D21 is 46 μm and the orthogonal diameter D22 is 32 μm in the slightly oblate part 112. For the same wire, when the oblateness is 7.3%, the maximum diameter D21 is 41 μm and the orthogonal diameter D22 is 38 μm. For an unflattened wire diameter of 75 μm, when the oblateness is 31.0%, the maximum diameter D21 is 87 μm and the orthogonal diameter D22 is 60 μm, and when the oblateness is 7.8%, the maximum diameter D21 is 77 μm and the orthogonal diameter D22 is 71 μm.
[0064] As illustrated in
[0065] The first core shaft part 11 having a transverse cross-section with an oblate shape (a substantially rectangular or substantially elliptical shape) described above can include, for example, a material containing stainless steel, and can be manufactured by flattening a rod-shaped member having a circular transverse cross-section in a suitable manner, such as via press working.
[0066] As described above, the guide wire 100 of the first embodiment includes the core shaft 10. The core shaft 10 includes the slightly oblate part 112 (of the first core shaft part 11) that is located on the distal end side of the core shaft 10 and has an oblateness between 7% and 35%. The length of the slightly oblate part 112 of the first core shaft part 11 in the axial direction of the core shaft 10 (e.g., Z-axis direction) can be 5 mm or more.
[0067] Contrary to traditional guidewires with circular cross-sections, the guide wire 100 includes the slightly oblate part 112 of the first core shaft part 11 having an oblateness of 7% or more, as described above. In some embodiments, the length of the slightly oblate part 112 of the first core shaft part 11 in the axial direction of the core shaft 10 is 5 mm or more. Thus, in the guide wire 100, as compared with the configuration in which the slightly oblate part 112 of the first core shaft part 11 has a circular transverse cross-section (in other words, an oblateness of 0%), the bending direction of the slightly oblate part 112 can be biased to the specific plane direction (e.g., a direction along the YZ plane along the axial direction of the core shaft 10 and along the direction of the orthogonal diameter D22) in the shaping. Thus, for the guide wire 100, the slightly oblate part 112 of the first core shaft part 11 can be easily bent in the specific plane direction (or a direction close to the specific plane direction) in the shaping.
[0068] Configurations where the slightly oblate part 112 of the first core shaft part 11 has an oblateness of 40% or more may result in “whipping” which may reduce the rotation performance (operability) of the guide wire 100. During whipping, when the guide wire 100 is rotated within a blood vessel, the distal end part of the guide wire 100 bounces and escapes in any direction like a whip.
[0069] On the other hand, in the guide wire 100, the oblateness of the slightly oblate part 112 of the first core shaft part 11 can be less than or equal to 35%. In this way and others, in the guide wire 100, the occurrence of whipping is prevented when the guide wire 100 is rotated within a blood vessel, and therefore the rotation performance of the guide wire 100 is not impacted due to the whipping. Thus, the rotation performance of the guide wire 100 can be maintained, even when the slightly oblate part 112 of the first core shaft part 11 can be easily bent in the specific plane direction in the shaping process.
[0070] In a configuration in which the length of the slightly oblate part 112 of the first core shaft part 11 in the axial direction of the core shaft 10 is less than 5 mm, it can be difficult to shape the distal end part. In the present embodiments, the length of the slightly oblate part 112 of the first core shaft part 11 in the axial direction of the core shaft 10 can be 5 mm or more, and thus, it is easy to shape the distal end part. However, if the length of the slightly oblate part 112 is excessively long, whipping may occur. Therefore, the length of the slightly oblate part 112 of the first core shaft part 11 in the axial direction of the core shaft 10 is preferably, for example, 15 mm or less.
[0071] In the guide wire 100, the wire diameter of the slightly oblate part 112 of the first core shaft part 11 can be 40 μm or more. In configurations in which the wire diameter is less than 40 μm, the directionality of shaping is unlikely to be limited to the specific plane direction, regardless of the oblateness. Thus, in the present embodiment in which the wire diameter of the slightly oblate part 112 of the first core shaft part 11 is 40 μm or more, the directionality of shaping tends to be limited to the specific plane direction, as compared with the configuration in which the wire diameter is less than 40 μm. In this way and others, the rotation performance of the guide wire 100 can be better controlled.
[0072] In the guide wire 100, the slightly oblate part 112 of the first core shaft part 11 can include a material containing stainless steel. Stainless steel can be plastically deformed more easily than some other materials, and thus, the deformation from the shaping tends to be retained without the guide wire 100 returning to its original shape, so that the slightly oblate part 112 can easily be shaped.
[0073] The strongly oblate part 110 of the first core shaft part 11, which is located closer to the distal end of the core shaft 10 than the slightly oblate part 112 of the first core shaft part 11, can have an oblateness of 40% or more. The bending angle from the shaping of the strongly oblate part 110 is likely to be larger than the bending angle from the shaping of the slightly oblate part 112 of the first core shaft part 11. Therefore, the guide wire 100 can be suitable in a case where the guide wire 100 is used in a state where the slightly oblate part 112 of the first core shaft part 11 is bent to have a relatively small curvature and the strongly oblate part 110 is bent to have a relatively large curvature.
[0074] In the guide wire 100, the direction of the maximum diameter D21 of the slightly oblate part 112 of the first core shaft part 11 and the direction of the maximum diameter D11 of the strongly oblate part 110 of the first core shaft part 11 can be parallel to each other. Bending directions from the shaping of the slightly oblate part 112 and the strongly oblate part 110 of the first core shaft part 11 tend to be along the orthogonal diameters D12 and D22 rather than the directions of the maximum diameters D11 and D21, and thus, the bending directions can be substantially the same plane direction. In this way and others, it is possible to prevent the occurrence of three-dimensional shaping between the slightly oblate part 112 and the strongly oblate part 110 of the first core shaft part 11, so that the directionality of deformation of the guide wire 100 from the shaping can be limited to the specific plane direction (or a direction close to the specific plane direction).
[0075] In the guide wire 100, the strongly oblate part 110 of the first core shaft part 11 can be formed of a material comprising stainless steel. Stainless steel can be plastically deformed more easily than other materials, and thus, the deformation from the shaping tends to be retained without the guide wire 100 returning to its original shape, so that the strongly oblate part 110 can be easily shaped.
[0076] The second core shaft part 12 can be formed of a material containing a superelastic alloy. In some such configurations, the restorability of the second core shaft part 12 can be improved, thereby providing the desired operability and vascular selectivity in the guide wire 100. In this way and others, guide wire 100 can have sufficient operability and vascular selectivity, even when the slightly oblate part 112 of the first core shaft part 11 can be easily bent in the specific plane direction in the shaping process.
[0077]
[0078] As shown in
[0079] The thirty samples differ from one another in at least any one of the wire diameter (the longest diameter in the transverse cross-section (XY cross section)) and the oblateness. As shown, samples 1 to 6 have a wire diameter of 80 μm, samples 7 to 12 have a wire diameter of 70 μm, samples 13 to 18 have a wire diameter of 55 μm, samples 19 to 24 have a wire diameter of 40 μm, and samples 25 to 30 have a wire diameter of 30 μm.
[0080] As shown in
[0081] The maximum diameter and the orthogonal diameter (and therefore the oblateness) in each sample can be adjusted by changing the pressing amount of a press used when manufacturing the first core shaft part from a wire having a circular transverse cross-section. Specifically, when the pressing amount of the press is increased, the oblateness can be increased, with the maximum diameter being increased and the orthogonal diameter being decreased.
[0082] The maximum diameter and the orthogonal diameter in each sample shown in
[0083]
[0084] As illustrated in
[0085] In samples 25 to 30, the evaluation results of the directionality of shaping were “poor.” On the other hand, as described above, in samples 20 to 24, the evaluation results of the directionality of shaping were “good.” This shows that, when the wire diameter is less than 40 μm, the directionality of shaping is unlikely to be limited to the specific plane direction, regardless of the oblateness.
[0086]
[0087] The rotation performance was evaluated using the following process. The proximal end part of the guide wire is rotated (in the circumferential direction of the axis of the guide wire), and it is evaluated whether t the distal end part (e.g., the first core shaft part) of the guide wire rotates, before the proximal end part of the guide wire is rotated by 180°.
[0088]
[0089] When it is determined that the distal end part of the guide wire 100 rotates before the proximal end part rotates by 180°, the sample was judged as “good” (“0” in the Judgment column of
[0090] As shown in
[0091]
[0092] In samples 7 to 30, the evaluation results of the rotation performance were “good.” This means that, in a wire diameter of less than 80 μm, rotation performance is less impacted by oblateness, and the problem with rotation performance as described above is likely to occur in a wire diameter of 80 μm or more.
[0093] The results of the performance evaluation (both directionality of shaping and the rotation performance) in other embodiments and modifications of the present guidewires, which will be described later, are similar to the results of the performance evaluation in the guide wire 100.
[0094]
[0095] As illustrated in
[0096] As illustrated in
[0097] As illustrated in
[0098] The first core shaft part 11A is a rod-shaped member. The oblateness in the first core shaft part 11A can be between 7% and 35%. As a specific example, for a wire diameter of 40 μm of the first core shaft part 11A, when the oblateness is 30.0%, the maximum diameter D31 is 46 μm and the orthogonal diameter D32 is 32 μm. When the oblateness is 7.3%, the maximum diameter D31 is 41 μm and the orthogonal diameter D32 is 38 μm. However, the oblateness in the first core shaft part 11A may be any other value between 7% and 35%. When the wire diameter is changed, the maximum diameter D31 and the orthogonal diameter D32 are similar to those described in guide wire 100. The first core shaft part 11A can include or correspond to the first specific portion.
[0099] The shape of the transverse cross-section of the first core shaft part 11A may be uniform over the entire length of the first core shaft part 11A in the axial direction (e.g., Z-axis direction).
[0100] As described above, the guide wire 100A includes the core shaft 10A. The core shaft 10A includes the first core shaft part 11A, which is located on the distal end side of the core shaft 10A and has an oblateness between 7% and 35%. The length of the first core shaft part 11A in the axial direction of the core shaft 10A (e.g., Z-axis direction) may be 5 mm or more.
[0101] In the guide wire 100A, the bending direction of the first core shaft part 11A tends to be limited to the specific plane direction (e.g., a direction along the YZ plane along the axial direction of the core shaft 10A and along the direction of the orthogonal diameter D32) in the shaping process. Thus, the first core shaft part 11A can be easily bent in the specific plane direction (or a direction close to the specific plane direction) in the shaping process. In addition, in the guide wire 100A of the second embodiment, the oblateness of the first core shaft part 11A can be less than 35%. Thus, according to this guide wire 100A of the second embodiment, for the same reason as in the case of the guide wire 100, the rotation performance of the guide wire 100A can be maintained, even when the guide wire 100A has the configuration in which the first core shaft part 11A can be easily bent in the specific plane direction in the shaping as described above.
[0102] In a configuration in which the length of the first core shaft part 11A in the axial direction of the core shaft 10A is less than 5 mm, it can be difficult to shape the distal end part. In the present embodiments, the length of the first core shaft part 11A in the axial direction of the core shaft 10A can be 5 mm or more, and thus, it is easy to shape the distal end part. However, the length of the first core shaft part 11A in the axial direction of the core shaft 10A is preferably 15 mm or less, to avoid whipping, as described above.
[0103] In the guide wire 100A, the first core shaft part 11A can be formed of a material containing stainless steel. Stainless steel can be plastically deformed more easily than other materials, and thus, the deformation from the shaping tends to be retained without the guide wire 100A returning to its original shape, so that the first core shaft part 11A can be easily shaped.
[0104] In the guide wire 100A, the core shaft 10A includes the second core shaft part 12, which can be formed of a material containing a superelastic alloy. Thus, for the same reason as in the case of the guide wire 100, the operability and vascular selectivity of the guide wire 100A can be maintained, even when the first core shaft part 11A can be easily bent in the specific plane direction in the shaping as described above.
[0105]
[0106] As illustrated in
[0107] As illustrated in
[0108] The guide wire 100B includes the core shaft 10B. The core shaft 10B includes the slightly oblate part 112B (of the first core shaft part 11B), which is located on the distal end side of the core shaft 10B and has an oblateness of between 7% and 35%. The length of the slightly oblate part 112B of the first core shaft part 11B in the axial direction of the core shaft 10B (e.g., Z-axis direction) can be 5 mm or more.
[0109] Thus, for the same reason as in the case of the guide wire 100, the rotation performance of the guide wire 100B can be maintained, even when the slightly oblate part 112B of the first core shaft part 11B can be easily bent in the specific plane direction in the shaping.
[0110] In the guide wire 100B, the wire diameter of the slightly oblate part 112B of the first core shaft part 11B can be 40 μm or more. In this way and others, the rotation performance of the guide wire 100B can be more better controlled for the same reason as in the case of the guide wire 100.
[0111] In the guide wire 100B, a maximum diameter D51 (or wire diameter) of the slightly oblate part 112B of the first core shaft part 11B can be 80 μm or more.
[0112] In the guide wire 100B, the slightly oblate part 112B of the first core shaft part 11B may be formed of a material containing stainless steel. Stainless steel can be plastically deformed more easily than other materials, and thus, the deformation from the shaping tends to be retained without the guide wire 100B returning to its original shape, so that the shaping can be easily performed.
[0113] In the guide wire 100B, the strongly oblate part 110B, which is located closer to the distal end of the core shaft 10B than the slightly oblate part 112B of the first core shaft part 11B, can have an oblateness of 40% or more. Thus, for the same reason as guide wire 100, the guide wire 100B is suitable to be used in a state where the slightly oblate part 112B of the first core shaft part 11B is bent to have a relatively small curvature and the strongly oblate part 110B is bent to have a relatively large curvature.
[0114] In the guide wire 100B, the direction of the maximum diameter D51 of the slightly oblate part 112B of the first core shaft part 11B and the direction of the maximum diameter D51 of the strongly oblate part 110B of the first core shaft part 11B can be parallel to each other. Thus, for the same reason as guide wire 100, the directionality of deformation of the guide wire 100B from the shaping can be limited to the specific plane direction (or a direction close to the specific plane direction).
[0115] In the guide wire 100B, the strongly oblate part 110B of the first core shaft part 11B can be formed of a material containing stainless steel and the deformation from the shaping tends to be retained without the guide wire 100B returning to its original shape, so that the guide wire 100B can be easily shaped, as described herein.
[0116]
[0117] As illustrated in
[0118] As illustrated in
[0119] The guide wire 100C includes the core shaft 10C. The core shaft 10C includes the first core shaft part 11C, which is located on the distal end side of the core shaft 10C, and can have an oblateness between 7% and 35%. The length of the first core shaft part 11C in the axial direction of the core shaft 10C (e.g., Z-axis direction) can be 5 mm or more.
[0120] In the guide wire 100C, the oblateness of the first core shaft part 11C can be between 7% and 35%, as described above. Thus, as described herein, the rotation performance of the guide wire 100C can be maintained, even when the first core shaft part 11C can be easily bent in the specific plane direction in the shaping.
[0121] In the guide wire 100C, the first core shaft part 11C may be formed of a material containing stainless steel and the deformation from the shaping tends to be retained without the guide wire 100C returning to its original shape, so that the guide wire 100C can be easily shaped, as described herein.
[0122] The techniques disclosed herein are not limited to the above-described embodiments, and may be modified into various modes without departing from the spirit of the above-described embodiments. For example, the following modifications can be applied.
[0123] The configurations of the guide wires 100 and 100A in the embodiments described above are merely examples and various modifications can be applied.
[0124] For example, the first embodiment described above may have a configuration in which the direction of the maximum diameter D21 of the slightly oblate part 112 of the first core shaft part 11 and the direction of the maximum diameter D11 of the strongly oblate part 110 of the first core shaft part 11 are not parallel to each other.
[0125] In the embodiments described above, the distal end-side joint part 30 may not be provided in the guide wires 100, 100A, 100B, and 100C.
[0126] Further, the materials of the members constituting the guide wires 100, 100A, 100B, and 100C of the embodiments described above are merely examples and various modifications are possible. These examples are not inclusive and a skilled person would understand that other modifications can be made without departing from the scope of the described embodiments.