Sutureless device and method for closing a tissue opening

Abstract

A sutureless device and methods for closing a tissue opening that minimizes the labor, cost, and skill typically required is disclosed. The apparatus comprises two anchors that attach to either side of an open tissue wound. The two anchors are connected together by a tie strip; the tie strip has a plurality of teeth and a rack. As the wound edges and anchors are brought together the ratchet system on the tie strip prevents the anchors and tissue wound from reopening. To control the distance between the two anchors, a rack and pinion system and a key or a lever system is utilized. The rack is located on the tie strip and the pinion is located on the key.

Claims

1. A tissue closing device comprising: a receiving base having a receiving adhesive and a receiving body; a first hair coupler comprising a first adhesive configured to adhere to the receiving adhesive of the receiving base; an anchor base having an anchor adhesive and a tie strip comprising a rack and a plurality of teeth, the tie strip receivable within the receiving body; a second hair coupler comprising a second adhesive configured to adhere to the anchor adhesive of the anchor base; a key comprising a pinion configured to engage the rack; the receiving body comprising a slide port and a pawl extending into the slide port; wherein the plurality of teeth and the pawl maintains the distance between the anchor base and receiving base; wherein on a first side of a wound, the first adhesive of the first hair coupler and the receiving adhesive on the receiving base are adapted to receive a patient's hair therebetween, thereby securing the patient's hair; wherein on a second, opposite side of the wound, the second adhesive of the second hair coupler and the anchor adhesive of the anchor base are adapted to receive a patient's hair therebetween, thereby securing the patient's hair.

2. A method of closing a tissue wound on the scalp using a tissue closing device, the method comprising: removing a first adhesive cover from a first hair coupler, exposing a first adhesive; removing a receiving cover from a receiving base, exposing a receiving adhesive; interposing a patient's hair between the first hair coupler and the receiving base near a tissue wound, securing the hair therebetween; removing a second adhesive cover from a second hair coupler, exposing a second adhesive; on a side of the tissue wound opposite the receiving base, removing an anchor cover from an anchor base, exposing an anchor adhesive; interposing the patient's hair between the second hair coupler and anchor base; inserting a closure mechanism coupled to the anchor base into a receiving body of the receiving base; decreasing the distance between the receiving base and the anchor base until the patient's tissue wound is closed.

3. The method of claim 2, wherein the closure mechanism is a tie strip with a plurality of teeth.

4. The method of claim 2, wherein the receiving body comprises a slide port and a pawl.

Description

DESCRIPTION OF THE DRAWINGS

(1) The invention may take form in certain parts and arrangement of parts, and preferred embodiment of which will be described in detail in the specification and illustrated in the accompanying drawing, which for a part hereof:

(2) FIG. 1 shows an elevated side plan view of the tissue closing device of the invention;

(3) FIG. 2 shows an array of the tissue closing device, illustrating how each tissue closing device is connected to the other tissue closing devices; in addition, shows a key releasably connected to one of the tissue closing devices in the array;

(4) FIG. 3 shows a side view of the tissue closing device that shows the device attached to a user's skin and a tie strip bridging over an open tissue wound;

(5) FIG. 4 shows a side view of the tissue closing device that shows the device attached to a user's skin and a tie strip bridging over the tissue wound with the tissue wound closed and the wound's edges properly aligned; in addition, shows a badged covering the device and the tissue wound;

(6) FIG. 5 shows a bottom view of an array of the tissue closing device; showing the locations of the adhesive pads and an adhesive cover;

(7) FIG. 6 shows a top view of an array of tissue closing devices, illustrating how the location of each tissue closing device may vary based upon the type and location of the tissue wound;

(8) FIG. 7 shows a side view of the tissue closing device with an open wound showing how the tissue closing device bridges over an open wound, also illustrating how a key is position onto receiving base;

(9) FIG. 8. shows a cross section view of the tissue closing device, showing how the teeth located on a tie strip interacts with a latch and a pawl;

(10) FIG. 9. shows a top view of the device with the key placed on the receiving anchor;

(11) FIG. 10 shows an elevated side view of an array of tissue closing devices and the key; illustrating variable number of tissue closing devices that may be combined in the array;

(12) FIG. 11 shows an elevated side view of an array of the receiving anchors, illustrating the connection between each device is flexible and the array may be adjustable for jagged wounds or adjust to the contour of the body;

(13) FIG. 12 shows a bottom view of the key;

(14) FIG. 13 shows an array of the tissue closing devices, illustrating how a user may utilize a cutting device such as scissors to separate the tissue closing devices;

(15) FIG. 14 shows an elevated side view of an array of the devices, illustrating the connection between each device is flexible and the array may be adjustable for arced tissue wounds or adjust to the contour of the body;

(16) FIG. 15 illustrates an elevated side view of the device that includes a lock that prevents movement of the tie strip;

(17) FIG. 16 shows a top view of the device with the lock that prevents movement of the tie strip;

(18) FIG. 17 shows a side view of the device with the lock in a closed position, therefore would prevent movement of the tie strip;

(19) FIG. 18 shows a side view of the device with the lock in an open position, therefore allowing movement of the tie strip;

(20) FIG. 19 shows a side view of the device with a lever; the lever being integrally formed with the receiving base;

(21) FIG. 20 shows an elevated side view of the device with a lever that is integrally formed with receiving base;

(22) FIG. 21 shows an elevated side view of the device with a removable lever;

(23) FIG. 22 shows an elevated side view of the device that is formed in a shape arc to match the contours of the body, such as a finger;

(24) FIG. 23 shows a top perspective view of a tissue closing device with a hair securement mechanism;

(25) FIG. 24 shows a top perspective view of a decoupled tissue closing device with a hair securement mechanism;

(26) FIG. 25 shows a bottom perspective view of a tissue closing device with a hair securement mechanism; and

(27) FIG. 26 shows a cross-sectional view of a tissue closing device with a hair securement mechanism.

DRAWING REFERENCE NUMBERS

(28) 2 Tissue closing device 30 Slide port

(29) 4 Anchor base 32 Cross member

(30) 6 Receiving base 34 Side

(31) 8 Tie strip 36 Coupler

(32) 9 Array 38 Scissors

(33) 10 Receiving body 50 Key

(34) 12 boss 52 Handle

(35) 14 Latch 54 Pinion

(36) 15 Pawl 56 Orifice

(37) 16 Teeth 58 Shaft

(38) 18 Rack 60 Lock

(39) 20 starting end 62 Lock hook

(40) 22 Anchor buttress 64 Catch

(41) 24 Tip 70 Lever

(42) 25 Recess 72 pivot point

(43) 26 pad 74 Lever clasp

(44) 27 Adhesive cover 76 Lever mortise

(45) 28 Adhesive 100 Tissue wound

(46) 29 Cover tab 102 Skin

(47) 104 Bandage 238 First cover

(48) 200 Tissue closing device 240 First tab

(49) 202 Anchor base 242 Second adhesive

(50) 204 Receiving base 244 Second cover

(51) 206 Closure mechanism 246 Second tab

(52) 208A Securement mechanism

(53) 208B Securement mechanism

(54) 210 Plurality of teeth

(55) 212 Receiving body

(56) 214 Boss

(57) 216 Latch

(58) 218 Pawl

(59) 220 Anchor adhesive

(60) 222 Receiving adhesive

(61) 224 Anchor cover

(62) 226 Anchor tab

(63) 228 Receiving cover

(64) 230 Receiving tab

(65) 232 First hair coupler

(66) 234 Second hair coupler

(67) 236 First adhesive

DESCRIPTION

(68) The following discussion describes embodiments of the invention and several variations of these embodiments. This discussion should not be construed, however, as limiting the invention to these particular embodiments. Practitioners skilled in the art will recognize numerous other embodiments as well. It is not necessary that the device have all the features described below with regard to the specific embodiment of the invention shown in the figures.

(69) In the following description of the invention, certain terminology is used for the purpose of reference only and is not intended to be limiting. Terms such as “upper,” “lower,” “above,” and “below” refer to directions in the drawings to which reference is made. Terms such as “inward” and “outward” refer to directions toward and away from, respectively, the geometric center of the component described. Terms such as “side,” “top,” “bottom,” “horizontal,” and “vertical” describe the orientation of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology includes words specifically mentioned above, derivatives thereof, and words of similar import.

(70) Referring generally to FIGS. 1 through 22, a tissue closing device 2 comprising of an anchor base 4, a receiving base 6, and a tie strip 8 for closing a tissue wound 100. As shown in FIGS. 3, 7, 9, and 10, a key 50 comprising of a handle 52 and pinion 54. Another embodiment of the invention is shown in FIGS. 17, 18, 19 and 20 comprising the use of a lever 70. Each item will be discussed in detail below.

(71) As illustrated in FIGS. 3 and 4, the anchor base 4 and the receiving base 6 attach to a patient's skin 102. The anchor base 4 is attached near the edge of a tissue wound 100. The receiving base 6 is attached on the opposite side near the edge of the tissue wound 100. The anchor base 4 and the receiving base 6 is preferably composed of a semi-rigid material such as nylon or plastic; however, flexible materials, metals or any semi-rigid materials are suitable for use in the present invention. The width and length of the anchor base 4 and the receiving base 6 vary based upon the size of the tissue wound 100. Larger tissue wounds 100 will require a larger sized anchor base 4 and receiving base 6. In application, a user would have a variety of different sizes available, and the user would select the appropriate size tissue closing device 2 determined by the size of the tissue wound 100. In addition, as shown in FIG. 22, the tissue closing device 2 may be curved or arced to conform with the shape of the body, such as a finger or chin. The specific shape of the anchor base 4 and the receiving base 6 may also vary.

(72) Located on the bottom of the anchor base 4 and the receiving base 6 is an adhesive 28. The adhesive 28 is for attaching the anchor base 4 and the receiving base 6 to the patient's skin 102. The adhesive 28 is generally any hydrophilic adhesive or medical adhesive agent such as a hydrocolloid, a hydrogel, or an acrylic polymer. However, many different types of adhesives 28 may work and are well known in the profession. As one skilled in the art will recognize, if the size of the anchor base 4 and the receiving base 6 increases, the surface area of the adhesive 28 increases, thus increasing the strength of the connection between the skin 102 and the anchor base 4 or receiving base 6.

(73) To increase the comfort of the patient, a pad 26 may be placed between the adhesive 28 and the bottom of the anchor base 4 or the receiving base 6. The pad 26 may be installed in a recess 25 located on the base of the anchor base 4 and the receiving base 6. The shape and depth of the recess 25 is similar to the pad 26. The pad 26 will typically be flexible and more elastic than the anchor base 4 and the receiving base 6. The flexibility of the pad 26 will help maintain adhesion, minimize blister, and reduce irritation as well as adapts to irregularities of the surface of the skin 102.

(74) As seen in FIG. 5, an adhesive cover 27 protects the adhesive 28. In addition, the adhesive cover 27 helps keep the adhesive 28 free of bacteria or viruses. The adhesive cover 27 is a protective layer that may be peeled away immediately prior to use. Generally, the adhesive cover 27 is coated paper but may be made of plastic or any other suitable material. The adhesive cover 27 must be easily removable by the user. In application, many users will use protective gloves to assist them in obtaining a stronger grip on the adhesive cover 27. A tab 29 is located on the edge of the adhesive cover 27. The tab 29 is generally made of the same material as the adhesive cover 27.

(75) As illustrated in FIGS. 3 and 4, the tie strip 8 connects the receiving base 6 and the anchor base 4 by bridging over the tissue wound 100. The tie strip 8 comprises a starting end 20, a tip 24, a rack 18, and a plurality of teeth 16. Generally, the tie strip 8 is comprised of the same material as the anchor base 4 and the receiving base 6. The starting end 20 is attached to the anchor base 4. To increase the strength of the connection between the starting end 20 and the anchor base 4, additional anchor buttresses 22 may be added. In the preferred embodiment, the tie strip 8, anchor buttress 22, and the anchor base 4 are integrally formed from the same material. Located at the opposite end of the longitudinal axis of the tie strip 8 is the tip 24. The tip 24 has a spearhead shape to allow the user to easily insert the tie strip 8 into a receiving body 10. The tie strip 8 length, width and thickness vary based upon the size of the tissue wound 100 and the actual need. However, the size of the tie strip 8 must be able to withstand a tension force to prevent the tissue wound 100 from reopening.

(76) Located on the top of the tie strip 8 are the teeth 16. The teeth 16 are axially spaced along the longitudinal axis of the tie strip 8 for engaging with a pawl 15, which is described below. Located on the side of the tie strip 8 is the rack 18. The rack 18 is essentially an axially spaced gear bar that engages with the pinion 54 or lever 70 as illustrated in FIG. 15 or any other mechanical device which will incrementally close the distance between receiving base 6 and anchor base 4. located on the key 50. As one skilled in the art will recognize, the location of the rack 18 and the teeth 16 may be located on any side of the tie strip 8.

(77) FIG. 8 is an illustration of the receiving body 10 that is located on the receiving base 6. The receiving body 10 includes a slide port 30, a cross member 32, two slides 34, and a latch 14. The slide port 30 is an opening for reception of the tie strip 8. The size of the slide port 30 is slightly larger than the size of the tie strip 8, such that the tie strip 8 will easily glide into the slide port 30 but small enough to prevent the tie strip 8 from freely moving. Generally, the receiving body 10 is integrally formed on the receiving base 6.

(78) As shown in FIG. 8, a latch 14 is pivotally connected to the receiving body 10. However, the connection only allows the latch 14 to move when a force is applied to it. The latch 14 includes the pawl 15 that extends from the latch 14 into the slide port 30. As the tie strip 8 is passed through the slide port 30, the slope of the teeth 16 push the pawl 15 away from the tie strip 8, allowing the tie strip 8 to slide further into the receiving body 10. When tension is applied to the tie strip 8 to withdraw it from the receiving body 10, the latch 14 acts to position the pawl 15 so that the pawl 15 firmly grips one of the teeth 16. Thus, the pawl 15 only allows the tie strip 8 to move in one direction. If the user wishes to withdraw the strap 8 from the receiving body 10, the user must intentionally lift the latch 14 so that the pawl 15 is raised above the teeth 16.

(79) As illustrated in FIGS. 15 and 16, a lock 60 is located on the latch 14. The lock 60 prevents the movement of the tie strip 8 in any direction. The lock 60 extends down from the latch 14 parallel to the sides 34. Located at the end of the lock 60 is a lock hook 62. Located on the sides 34 is a catch 64. To prevent movement of the tie strip 8, the user pushes the latch 14 towards the receiving base 6. The movement of the latch 14 lowers the pawl 15 towards the teeth 16 so that the pawl 15 creates an interference fit with one of the teeth 16 and prevents movement of the tie strip 8. To prevent the latch 14 from returning to it normal location, the lock hook 62 engages with the catch 64 as shown in FIG. 17.

(80) As described above and shown in FIGS. 3 and 12, the key 50 is releasably connected to the anchor base 4. The key 50 comprises the handle 52 and the pinion 54. The handle 52 is of a size that allows the user to easily grip it and apply a rotational force to the key 50. The handle 52 may have several different shapes and sizes. Located at the base of the key 50 is the pinion 54. The pinion 54 generally has a gear-like shape and corresponds with the rack 18 located on the tie strip 8. A shaft 58 is positioned between the pinion 54 and the handle 52 to raise the handle 52 above the receiving base 6. The key 50 is made of any semi-rigid or rigid materials such as nylon, plastic or metal. However, other suitable materials may also be utilized such as metals.

(81) Located at the base of the key 50 and in the center of the pinion 54 is an orifice 56. Located on the receiving base 6 is a boss 12. Generally, the boss 12 has a circular shape. The orifice 56 has a size and shape slightly larger than the boss 12, such that the user may place the orifice 56 over the boss 12, creating a tight fit, yet allow the user to freely turn the key 50. One skilled in the art will acknowledge that there are several embodiments for releasably connecting the key 50 to the receiving base 6. One such embodiment is the receiving base 6 have a recessed well in order to receive the key 50.

(82) One embodiment of the invention is illustrated in FIGS. 19 and 20, which utilizes a lever 70. The lever 70 releasably connects to and engages receiving body 10. Located at the base of the lever 70 is a lever clasp 74. The lever clasp 74 extends towards the tie strip 8 and the teeth 16. The lever 70 acts as a ratchet, advancing the tie strip 8 forward with precise control. When the users actuates the lever 70, the lever 70 pivots at the pivot point 72 and causes the lever clasp 74 to move. The lever clasp 74 engages with one of the teeth 16 and pushes the tie strip 8 and the anchor base 4 towards the receiving base 6. When the tissue wound 100 is closed, the lever 70 is removed or positioned parallel to the body of the tie strip 8 to prevent interference with a bandage 104. FIG. 19 and 20 shows the lever 70 integrally formed with the receiving base 6. However, FIG. 21 shows an alternative way for the lever 70 attaching to the receiving base 6 by utilizing a Lever mortise 76. One who is skilled in the art would recognize that there are several methods of creating pivot point 72 and creating a method for advancing tie strip 8.

(83) As illustrated in FIGS. 3, 4, and 10, a coupler 36 may connect several tissue closing devices 2 together in an array 9. The coupler 36 may connect to either or both the anchor base 4 and the receiving base 6. While FIGS. 3, 4, and 10 show four couplers 36 connecting each tissue closing device 2, different multiples of couplers 36 may be utilized. The coupler 36 may be made from any flexible or semi-flexible material such as nylon. The flexibility, compressibility or expandability of the coupler 36 allows the user to adjust the location of each tissue closing device 2. As illustrated in FIG. 6., the coupler 36 is easily severed. However, in some embodiments, the coupler 36 is rigid and resilient.

(84) In practice, an array 9 of tissue closing devices 2 are supplied to the user. The user determines the number of tissue closing devices 2 required to properly close the tissue wound 100 and removes the excess tissue closing devices 2 from the array 9. FIG. 4 shows a pair of scissors 38 or other cutting devices needed to separate the tissue closing device 2. If the tissue wound 100 is extremely jagged or located on a curved or rounded portion of the body, the user may separate all the tissue closing devices 2. Preferably, the longitudinal axis of each tissue closing device 2 is perpendicular to the longitudinal axis of the tissue wound 100 at a particular point on the tissue wound.

(85) As shown in FIG. 4, a thin film bandage 104 is position over the entire device 2 and wound 100. Typically, the bandage 104 is a transparent film, but could be opaque and of various different materials. The bandage 104 is to protect the wound 100 from bacteria and debris. In addition, the bandage 104 prevents the device 2 from being snagged on outside objects. Furthermore, the bandage 104 keeps the adhesive 28 more securely fastened to the skin 102. This may in turn be covered by a bulkier protective covering of various materials.

(86) The method to operate the tissue wound device 2, the user removes the adhesive cover 27 from the back of the anchor base 4 and the receiving base 6. The adhesive 28 connects the anchor base 4 and the receiving base 6 to the skin 102. Specifically, the anchor base 4 is placed next to the edge of the tissue wound 100. The receiving base 6 is placed on the opposing side of the tissue wound 100. The tip 24 is inserted into the slide port 30 located on the receiving base 6. However, the tip 24 may be inserted during the manufacturing process.

(87) The key 50 is then inserted onto the boss 12 located on the receiving base 6. As the user turns the key 50, rotational motion of the pinion 54 is converted into a linear motion of the tie strip 8 and the anchor base 4 in such a way that the distance between the anchor base 4 and the receiving base 6 decreases. An alternative to the key 50, is the utilization of the lever 70.

(88) As the space between the anchor base 4 and the receiving base 6 decreases, the skin 102 is pulled together and closes the tissue wound 100. The teeth 16 and the pawl 15 maintain the distance between the anchor base 4 and the receiving base 6. This system allows the user to carefully make incremental movements of the skin 102. Once the wound is appropriately closed, the lock 60 may be utilized to prevent any movement.

(89) Many individuals do not want sutures or staples due to their invasive nature. In addition, it may, at times, be difficult to apply or remove sutures or staples and the process may cause a lot of discomfort. The tissue closing device 200 is a non-invasive approach to closing a wound where hair is located and can be easily removed after the wound has healed. For example, when using the tissue closing device 200 with hair securement mechanisms, a strong adhesive may be used to connect the tissue closing device 200 to a patient's hair. This connection allows a patient's hair, including the wound, to be pulled together, allowing the wound to heal. To remove the tissue closing device 200, it is as simple as adding a solution to the adhesive that will break its bond and allow for painless removal. This is in contrast to using sutures or staples where discomforts may be present during removal. It should be noted that other securement mechanisms may be used, such as tape, compressible rings, clips, etc.

(90) In one embodiment, as shown in FIGS. 23-26, a tissue closing device 200 comprises an anchor base 202, a receiving base 204, a closure mechanism (e.g., a tie strip) 206, and hair securement mechanism 208A, 208B. The securement mechanisms 208A, 208B may comprise first hair coupler 232 which comprises a first adhesive 236, a first adhesive cover 238, and a first hair tab 240. The first hair coupler 232 is used to attach to the receiving base 204 and hair of the patient. While the first hair coupler 232 is used with the receiving base 204, a second hair coupler 234 attaches to the anchor base 202 and hair of the patient. The second hair coupler 234 comprises a second adhesive 242, a second adhesive cover 244, and a second hair tab 246. The first and second adhesives 236, 242 can be any medical grade adhesive, such as an acrylic adhesive. Further, the first and second adhesive covers 238, 244 protect the adhesive material on the first and second hair couplers 232, 234, while the first and second tabs 240, 246 allow a medical provider to remove the first and second adhesive covers 236, 244.

(91) To apply the tissue closing device, a user places the tissue closing device 200, with the first and second hair couplers 232, 234, over a wound on the scalp. Specifically, the user grasps the tabs and removes the first and second adhesive covers 238, 244 and the anchor and receiving covers 224, 228, exposing the adhesive. The first and second hair couplers 232, 234 are positioned on opposite sides of a wound. The hair is then interposed between the first hair coupler 232 and the receiving base 204 and then between the second hair coupler 234 and the anchor base 202 near the scalp, allowing the tissue closing device 200 to be secured to the hair. The user then pushes the receiving base and the anchor base 202, 204 together, with the tie strip 206 inserted into the receiving base 204, pulling the hair and scalp, until the wound is closed. It should be noted that other closure mechanisms maybe used, such as a key and pinion, a rack, a lever, a simple push in tie strip without a rack, or any other closure mechanism known in the art to close an open wound.

(92) In one embodiment, the anchor base 202 may comprise the tie strip 206 having a plurality of teeth 210. The receiving base 204 may comprise a receiving body 212, a boss 214, latch 216, and pawl 218 (shown in FIG. 26), similar to previous embodiments, that assist in coupling to the anchor base 202. The anchor base 202 and the receiving base 204 are preferably composed of a semi-rigid material, such as nylon or plastic; however, flexible materials, metals, or any semi-rigid or rigid materials are suitable for use. The width and length of the anchor base 202 and the receiving base 204 may vary based upon the size of the tissue wound. A bottom of the anchor base 202 comprises an anchor adhesive 220 and the receiving base 204 comprises a receiving adhesive 222. Located on the bottom of the anchor base 202 is an anchor cover 224 with an anchor tab 226, while the bottom of the receiving base 204 comprises a receiving cover 228 with a receiving tab 230. The anchor cover 224 and receiving cover 228 adhere to the anchor adhesive 220 and receiving adhesive 222 to prevent the adhesive from prematurely adhering to an object. The adhesive is for attaching the anchor base 202 and the receiving base 204 to the patient's hair, near the scalp, and to the hair securement mechanism 208A, 208B.

(93) It will be appreciated that the hair securement mechanisms 208A, 208B are not limited to the first and second couplers 232, 234. There may be other ways to couple the anchor base 202 and the receiving base 204 to a patient's hair. For example, the anchor and receiving base 202, 204 could use other securement mechanisms such as: (1) tape that directly adheres to the patient's hair without the first and second hair couplers 232, 234; (2) a set of hair clips/clamps that couple to the hair on each side of the wound; or (3) compressible rings that secure to a patient's hair. Further, in order to secure compressible rings into the hair, a medical provider would insert the hair into a ring, coupled to an anchor base, until the ring is near the scalp. Hair would also be inserted through a ring on the receiving base in a similar manner, but on the opposite side of a tissue wound. To secure the compressible rings, a medical provider would crimp or compress the ring onto the hair. The medical provider can then pull the wound together via a closure mechanism, such as the tie strip 206. The tissue closing device 200 with the first and second hair couplers 232, 234, or other securement mechanisms discussed above, are not limited to humans and could be used by a veterinarian on numerous animals.

(94) While a preferred embodiment of the invention of the device has been shown and described herein, it should, however, be understood that the description above contains many specifics that should not be construed as limiting the scope of the invention. Thus, the scope of the embodiment should be determined by the appended claims and their legal equivalents thereof, rather than by the examples given.