48 results about "Pancreatic duct" patented technology

The invention provides application of lactic acid modified histone H3 in preparation of drugs and / or diagnostic kits for preventing and / or treating pancreatic ductal adenocarcinoma, and belongs to the technical field of disease diagnosis and / or treatment. The invention provides application of a lactic acid modified histone H3 as a target spot in preparation of a pancreatic ductal adenocarcinoma diagnostic kit or a medicine for preventing and / or treating pancreatic ductal adenocarcinoma. The site of lactic acid modification is 23-site lysine. The expression of H3K23la detected in clinical sample tissues in pancreatic ductal adenocarcinoma tumor tissues is obviously higher than that in para-carcinoma normal tissues, overexpression and non-expression of H3K23la in cells are regulated and controlled through in-vitro experiments in combination with overexpression and knock-down technologies, and results show that proliferation, invasion and migration capacities of pancreatic ductal adenocarcinoma cells are remarkably inhibited, so that the pancreatic ductal adenocarcinoma cells are remarkably inhibited. Therefore, the H3K23la can be used as a target spot for diagnosis and treatment of the pancreatic duct adenocarcinoma, and has wide application in diagnosis or treatment of the pancreatic duct adenocarcinoma.

The invention discloses a self-breaking outer drainage tube, and relates to the technical field of medical instruments, the self-breaking outer drainage tube comprises a tube body, and the tube body comprises a drainage part, a breaking part, a leading-out part and a puncture part; the drainage part and the fracture part are both made of degradable materials; the hole wall thickness of the circulation hole at the fracture part is smaller than the hole wall thickness of the circulation hole at the drainage part; during surgical operation, the degradable inner drainage part is placed in the pancreatic duct, the fracture part crosses the anastomotic stoma by 7-8 cm and crosses the biliary-intestinal anastomotic stoma, and the leading-out part walks in the enteric cavity to a proper position, penetrates out of the intestinal wall and is led out of the body through the abdominal wall. Cutting the puncture part to expose the outlet of the circulation hole, and discharging the body fluid through the circulation hole; after a certain period of time after the operation, the fracture part is automatically fractured under the action of pancreatic juice, the leading-out part is pulled out, the degradable drainage part continues to be degraded in the body and maintains the drainage function, and finally the drainage part is absorbed by the body or discharged out of the body without being taken out through the operation.

The utility model discloses a culture device for inducing differentiation of pancreatic duct stem cells, and relates to the technical field of culture devices. The culture device for inducing pancreatic duct stem cell differentiation comprises a culture box main body, the culture box main body is internally provided with a culture device, the culture device comprises a culture solution adding unit and an observation unit, the culture solution adding unit comprises a placing disc, a culture dish is arranged on the placing disc, and a movable track is arranged on the placing disc; embedded seats are symmetrically arranged in the movable track, a communicating plate is arranged at the embedded groove in each embedded seat, and a U-shaped pipe is arranged on each communicating plate. According to the utility model, on the basis that the placing disc does not rotate, the embedding seat in the movable track does circular motion to finish adding, so that the placing disc is not subjected to direct driving force, the culture dishes on the placing disc are not subjected to centrifugal force and the like, and the culture solution in the culture dishes is promoted to be stable; and the limiting grooves formed in the placement disc further ensure stable placement of the culture dishes.

A medical image processing apparatus according to an embodiment includes processing circuitry. The processing circuitry is configured to obtain a medical image related to the pancreas. The processing circuitry is configured to extract a pancreas region included in the medical image. The processing circuitry is configured to extract at least one tubular structure region from the inside of the pancreas region. The processing circuitry is configured to identify a first end part and a second end part related to the pancreas on the basis of the pancreas region. The processing circuitry is configured to estimate a primary pancreatic duct centerline of the pancreas on the basis of the tubular structure region, the first end part, and the second end part.

Medical devices and systems for treating a stricture, for example along the biliary and / or pancreatic tract, are disclosed. An example system may include a guidewire having a distal end and defining a lumen. A stiffening rod may be slidably disposed within the lumen. The stiffening rod may have a distal end and a distal end region disposed adjacent to the distal end. The stiffening rod may be configured to shift between a first position where the distal end of the stiffening rod is disposed proximally of the distal end of the guidewire and a second position where the distal end of the stiffening rod is disposed distally of the distal end of the guidewire.

The invention provides a double-guide-wire nipple sphincter incision knife which comprises an outer sheath tube, a handle, a first guide wire, a second guide wire and a metal wire, and the first guide wire is inserted into the outer sheath tube through the tube wall of the outer sheath tube and penetrates out of the tube wall of the outer sheath tube; the handle is connected with the tail end of the outer sheath tube, and the second guide wire is inserted into the outer sheath tube through the handle and penetrates out of the head end of the outer sheath tube. One end of the metal wire is fixedly connected to the tube wall of the outer sheath tube, and the other end of the metal wire is inserted into the outer sheath tube and connected with the handle. During use, an assistant can implement the guide wire to assist the nipple sphincter incision knife in intubation into the pancreatic duct, an operator can operate the second guide wire to enter the common bile duct through intubation on the side wall of the duct wall on the basis that the duct diameter of the nipple incision knife is not increased, double-person multi-angle intubation is achieved, and the bile duct intubation success rate is increased.

To provide a device for an endoscope improved in insertability when inserting a treatment instrument into a biliopancreatic duct.SOLUTION: An endoscopic device includes a sheath extending in a longitudinal direction, a treatment tool opening portion communicating with a treatment tool lumen through which the sheath is inserted in the longitudinal direction and configured to allow a treatment tool inserted through the treatment tool lumen to protrude and retract to and from a distal end side of the sheath in the longitudinal direction, and a suction opening portion communicating with a suction lumen through which the sheath is inserted in the longitudinal direction.SELECTED DRAWING: Figure 3

The utility model belongs to the technical field of drainage tubes, and particularly relates to a pancreatic duct supporting drainage tube for pancreatic surgery, which comprises a drainage main tube and a sleeve, one end of the drainage main tube is detachably connected with the sleeve through a first connecting component, a supporting component is arranged in the drainage main tube, a fixing component is arranged on the sleeve, and the fixing component is detachably connected with the sleeve through a second connecting component. The fixing assembly and the supporting assembly are detachably connected together through the second connecting assembly. The first connecting assembly comprises a first annular plate, the first annular plate is fixedly installed at one end of the drainage main pipe, and a first annular groove is formed in the left side of the sleeve. The supporting assembly is arranged in the drainage main pipe, and the fixing assembly is arranged on the sleeve, so that when the pancreas surgery is carried out, the drainage main pipe can be prevented from being flattened, the position of the sleeve can be fixed, and the situation that the drainage main pipe is blocked due to extrusion can be avoided.

The invention belongs to the field of biomedical materials, and particularly relates to an inner drainage end-by-end reducer tube based on the electrostatic spinning technology and a preparation method thereof.The inner drainage end-by-end reducer tube comprises an end-by-end reducing drainage tube, the whole drainage tube is of a hollow conical tubular structure, and the surface of the drainage tube is provided with regularly-arranged thread structures; the invention further provides a preparation method of the inner drainage end-by-end reducer pipe. The defects of existing internal drainage are overcome, and the natural anatomical form of the pancreatic duct is complied with by means of the drainage tube with the diameter changed end by end; the drainage tube is provided with a surface thread structure, and by matching with the swelling characteristic of a biodegradable material, the friction force between the drainage tube and the pancreatic duct wall is increased, and the probability of displacement of the drainage tube due to intestinal tract movement or pancreatic juice scouring is reduced.

This invention provides a single-operated duodenal sphincter cutter, comprising: an outer sheath, a guidewire, a metal wire, and a handle. The guidewire is inserted into the interior of the outer sheath through its wall and exits from its tip. The handle is connected to the tail of the outer sheath. One end of the metal wire is fixedly connected to the front of the outer sheath, and the other end is inserted into the interior of the outer sheath and connected to the handle. This invention features a dual-channel tube, with the guidewire entering the guidewire channel through the side wall. Its outer diameter is thinner than that of a conventional three-channel tube. The guidewire is led out through the side wall of the tube. With the outer sheath fixed in place, the operator can insert the guidewire into the common bile duct or pancreatic duct without the assistance of an assistant, increasing the success rate of cannulation.

Biomarkers, systems, and methods for predicting a prognostic outcome of pancreatic duct adenocarcinoma (PDAC) and responsiveness of a cancer patient to a PARP inhibitor are provided. The metabolites biomarkers are used to predicting a prognostic outcome of PDAC, and includes one or more of LysoPC (14: 0), LysoPC (18: 2), LysoPC (18: 1), Androsterone sulfate, alpha-CEHC, Glycodeoxycholic acid sulfate, LysoPC (20: 5), LysoPE (22: 5), and LysoPE (16: 1). The gene biomarkers are used to identify cancer patients responsive to a PARP inhibitor, and includes one or more of CTNND1, THRAP3, BRAF, STAT5B, and EXT2.

The invention discloses a conical endoscope, and belongs to the technical field of medical instruments. Comprising an endoscope body, an incision knife assembly, a guide wire assembly and an expandable assembly, the endoscope body is of a conical design, the endoscope body is made of a polyurethane material, the length of the endoscope body is 2200 mm, and the diameter of the endoscope body is 8 mm; according to the conical endoscope, by means of the targeted structural design, the adaptability and operation convenience of clinical operations are remarkably improved. The endoscope has the core advantages that the combined design of the conical endoscope body and the inclined axis is adopted, and the frustum-shaped structure at the front end of the endoscope is matched with the 45-degree or 60-degree adjustable central axis, so that the endoscope can accurately adapt to the anatomical trend of narrow cavities such as human biliopancreatic ducts and the like, and compared with a traditional straight-tube endoscope, the endoscope can enter a target part more easily and smoothly, and mechanical damage to mucous membranes of the cavities is reduced. The adaptive capacity is further enhanced through the modular design of the expandable assembly, and the diameter adjustment of the four or more evenly-distributed annular protrusions is achieved through the expansion control device.

[Problem] To provide: a cannula that can be easily inserted into a common bile duct or a pancreatic duct via a major duodenal papilla; and an endoscopic system provided with such a cannula. [Solution] A second camera 30 of a cannula 12 captures an image of the entrance of a common bile duct or a pancreatic duct in a state where the second camera 30 is inserted from the opening of a major duodenal papilla. A transparent shield 124 provides a cavity around the second camera 30 and ensures a field of view Vf of the second camera 30 in a state where the transparent shield 124 is inserted from the opening. The shield 124 has a convex surface 124c around the central axis CA of the field of view Vf of the second camera 30. The portion having the convex surface 124c has a uniform thickness. A guide wire 15 is configured to advance within the field of view Vf of the second camera 30.

The utility model provides a double-channel biliopancreatic pressure measuring catheter which comprises a catheter section I, a catheter section II, a catheter section III and a catheter section IV, a first guide wire channel is arranged in the catheter section I, the catheter section I is connected with the catheter section II, and a second guide wire channel and a first data transmission line channel are arranged in the catheter section II; the front end of the catheter section II is wrapped with a metal tube, the metal tube is provided with an open groove, and a pressure sensor is arranged in the open groove; the catheter section III and the catheter section IV are connected with the catheter section II, and a second data transmission line channel and a third guide wire channel are arranged in the catheter section III and the catheter section IV respectively; the tail of the catheter section III is provided with a pressure sensor connector, and the tail of the catheter section IV is provided with a guide wire connector. The pressure measuring device can be placed into duodenal papilla sphincter, common bile duct and pancreatic duct through a duodenoscope and a gastroscope forceps channel under the guide of a guide wire to measure the pressure in the duodenal papilla sphincter, the common bile duct and the pancreatic duct.

The present invention relates to a visualization catheter for minimally invasive interventional surgery of the pancreatic and bile ducts, comprising a catheter body and a traction wire as an incision knife, wherein the distal end of the catheter body can be bent, turned and rotated under the action of the traction wire to change the insertion direction and angle, and the catheter body is provided with a visual lumen and a working lumen, wherein the visual lumen is provided with a micro video image sensor and an illumination element at the distal end of the catheter body, and the distal end of the catheter body is also provided with a transparent cap for ensuring the field of view and increasing the field of view angle of the camera module. The present invention, through the support of the micro video image sensor and the transparent cap, is helpful for finding the lumen and determining its running direction, accurately guiding intubation and related diagnosis and treatment, can perform intubation under direct vision, can distinguish the pancreatic duct and the bile duct by observing the image, reduces or avoids the time of exposure of the operating physician and the patient to radiation, can improve the success rate of selective intubation, and reduces the occurrence of complications.

The invention belongs to the field of pancreatic duct adenocarcinoma prediction, and provides a pancreatic duct adenocarcinoma prediction method and system based on oral flora. The pancreatic ductal adenocarcinoma prediction method based on oral flora comprises the following steps: acquiring relative abundance information of each biomarker in a potential biomarker set for diagnosing pancreatic ductal adenocarcinoma of a to-be-detected person; using the relative abundance information of each biomarker in the biomarker set and a pre-trained multivariate statistical model to obtain a probability value of suffering from pancreatic ductal adenocarcinoma; the method comprises the following steps: performing microbiome difference analysis on saliva, duodenal juice and pancreatic tissue samples of a pancreatic ductal adenocarcinoma patient group and a pancreatic benign disease patient group, and taking an intersection of differential bacteria in the samples to obtain a potential biomarker set for diagnosing the pancreatic ductal adenocarcinoma.

The utility model belongs to the field of lithotripsy devices, and particularly relates to a device for removing bile and pancreatic duct lithotripsy under an endoscope, which comprises a catheter and a handle, a support tube is fixedly connected inside the catheter, and a capillary tube is fixedly connected at one end of the support tube outside the catheter. A driving ring is fixedly connected to the end, away from the supporting tube, of the capillary tube, a guide wire is slidably connected to the interior of the supporting tube, an ultrasonic vibration head is fixedly connected to the end, away from the driving ring, of the guide wire, and a frame is fixedly connected to the upper end of the handle. The guide wire, the ultrasonic vibration head, the capillary tube and other structures are additionally arranged on the catheter, when calculus in the bile duct needs to be removed, the calculus in the bile duct can be shattered and refined through the ultrasonic vibration head, then the capillary tube is inserted into the rear portion of the calculus, and the calculus in the bile duct can be removed. And then the calculus is taken out from the interior of the bile duct through the deformed and expanded capillary tube, so that the calculus can be taken out more conveniently.

Medical devices and method for making and using the same are disclosed. An example medical device may include implantable medical device for use along the biliary and / or pancreatic tract. The implantable medical device may include a tubular member having a first end configured to be disposed within the duodenum of a patient and a second end configured to be disposed adjacent to a pancreatic duct and / or bile duct. The tubular member may have a body including one or more wire filaments that are woven together. The tubular member may also have an outer surface with a longitudinal channel formed therein.

The invention discloses an application of miR-100 sponge in preparation of a medicine for treating type 2 diabetes mellitus. The miR-100 sponge can inhibit miR-100 in a targeted manner and close the expression of miR-100 in beta cells. The nucleic acid construct is further prepared from the nucleic acid construct, AAV8-mmu-miR-100 Sponge (AAV-Sponge) is injected into pancreatic ducts of obese diabetes mellitus mice, after treatment is conducted for 4 weeks, it is found that the sugar tolerance of the mice in a treatment group is improved, the GSIS function of beta cells is improved, and the nucleic acid construct is expected to be further applied to preparation of the medicine for treating the type 2 diabetes mellitus. The problems that current treatment methods for type 2 diabetes mellitus are deficient and the treatment cost is high are solved.

Systems and methods for treating, for example, strictures along a biliary tract and / or pancreatic duct are disclosed. An example system can include a handle (14) having a base, a first carriage (26) translatable relative to the base, and a second carriage (24) translatable relative to the base. A sheath (16) can be coupled to the first carriage. The system can also include a catheter shaft (12) having a proximal region and a steerable distal region. The proximal region can be coupled to the second carriage. A needle can be releasably coupled to the handle. The needle can be configured to pass through tissue to a location along a biliary tract and / or pancreatic duct. The system can also include a steering member (44) having a first end coupled to the steerable distal region of the catheter shaft and a second end disposed adjacent the handle.

The invention relates to the technical field of medical instruments, in particular to a liver, gall, pancreas and spleen catheter fixing device which comprises a base, a plurality of containing cavities are formed in the side portion of the base, a plurality of external flaring openings corresponding to the containing cavities are fixed to the top of the base, a clamp is arranged on the upper side of the base, and the base and the clamp are connected through a telescopic rod. An interlayer is arranged between each containing cavity and the outer flaring, a set of fixing mechanism and a self-locking mechanism are arranged in each interlayer, the fixing mechanisms are used for fixing the tail ends of the catheters, and a guide mechanism is arranged on the telescopic rod; movement and compression of the drainage tube in the body of a patient are reduced, discomfort of the patient is reduced, orderly connection of the catheters is ensured, mutual interference of the catheters is reduced, blockage caused by excessive bending of the catheters is prevented, smooth flowing of liquid in the catheters is ensured, and the treatment effect is guaranteed.

The utility model relates to medical instrument technical field especially, and it is a kind of covered stent and implantation system.This covered stent includes support framework and film, wherein: support framework is the hollowed out cylinder structure of peripheral surface, it can be radially compressed and expand;Film is coated on part support framework, and drainage mesh is formed at the region of support framework not being coated by film.Due to film being coated on part support framework, drainage mesh is formed at the region of support framework not being coated by film, bile of gallbladder, bile in common hepatic duct and pancreatic juice in pancreatic duct can enter the inside of covered stent through drainage mesh and reach duodenal papilla, thereby avoiding the phenomenon that bile and pancreatic juice cannot flow out from common bile duct and reach duodenal papilla due to common bile duct being pressed by stent, and simultaneously, a plastic stent does not need to be additionally implanted in common bile duct to help common bile duct drainage, to achieve the purpose of reducing operation cost and operation complexity.

The utility model provides a kind of wire guide calculus extraction net basket, including net basket, guide wire, net basket cap, outer sheath and handle, tail end of guide wire is connected with the head end of net basket cap, net basket cap is placed in the head end outside of outer sheath, net basket is inserted to the inside of outer sheath through the tail end of outer sheath, one end of net basket is connected with the tail end of net basket cap, other end is connected with handle;Handle is located in the tail end outside of outer sheath.The utility model can be inserted through papilla incision knife, SpyGlass or insight pancreatic duct imaging system channel etc.Various instrument channels, realize the calculus extraction treatment of multiple scenes;During the release of net basket, soft guide wire head end crosses stone more easily into the distal bile duct, more conducive to the release of net basket, and net basket can be taken out of stone by pulling back.

The utility model provides a bendable zebra guide wire which is composed of a core wire, a wrapping layer and a hydrophilic coating, the core wire is a metal wire, the wrapping layer wraps the core wire, and the hydrophilic coating is coated on the outer surface of the wrapping layer. The zebra guide wire is divided into an insertion part and an operation part which are connected with each other, the core wire is composed of a first core wire body in the insertion part and a second core wire body in the operation part, the first core wire body is spiral, the middle section of the first core wire body is a long spiral line, and the two ends of the first core wire body are short spiral lines; the second core wire is in a long strip shape. The insertion part can be bent into a return guide wire when encountering resistance, so that the guide wire can enter a thicker bile duct or pancreatic duct more easily and is prevented from entering a branch bile duct or pancreatic duct, and the probability that the guide wire is perforated is reduced.

An amplifying method of pancreatic cells is provided. The amplifying method includes performing digestion, resuspension, discontinuous density gradient centrifugation treatment and amplifying treatment sequentially. The mammalian pancreatic duct is used as the source of pancreatic precursor-like cells in the amplifying method, and islet cells and acinar cells in the cell clusters obtained by the discontinuous density gradient centrifugation treatment are removed. It is beneficial to improve the yield of the pancreatic precursor-like cells availably, and avoid the ethical restrictions and possible carcinogenic risks caused by using the embryonic stem cells. The amplifying medium used comprises a reprogramming substance composed of several small molecule compounds. It can avoid the risks of non-specific and off-target deletion that are easily caused by the use of the gene-editing methods to change the gene sequence. Also provided is a differentiation method and an application of the pancreatic precursor-like cells obtained by the amplifying method.

The utility model discloses a pancreas-intestine drainage system which comprises an intestine section tube and a pancreas section tube. The rear part of the intestine section tube is a drainage intestine inner section, and the front part is a drainage pancreatic inner section; an elastic body is formed on the outer wall of the front part of the drainage intrapancreatic section; a flexible gasket is coaxially mounted and fixed outside the pipe wall of the middle part of the intestine section pipe; a plurality of drainage holes are formed in the tube wall of the pancreatic section tube; the front portion of the drainage intra-pancreatic section on the front portion of the intestine section tube is inserted into the rear portion of the pancreatic section tube, and the elastic body on the outer wall of the front portion of the drainage intra-pancreatic section is pressed and deformed, so that the intestine section tube and the pancreatic section tube are installed, fixed and communicated together. According to the pancreatic and intestinal drainage system, the adaptability and flexibility of the system are enhanced through split type arrangement, the installation and fixing process is simple and convenient, the pancreatic duct and the intestinal duct are connected more tightly, connection and healing of the intestinal duct and the pancreatic duct are facilitated, and it is ensured that pancreatic and intestinal drainage liquid is discharged smoothly.

The invention relates to the technical field of magnetic resonance imaging, and discloses a thin-layer oblique coronal focusing view diffusion weighted imaging method of a magnetic resonance system, which comprises the following steps of: extracting a three-dimensional space walking path of a target bile duct based on magnetic resonance pancreaticobiliary duct water imaging and a cross section T2 weighted image, performing optimal plane fitting, and determining a personalized oblique coronal scanning plane; in the plane, diffusion weighted imaging is carried out by adopting a small visual field set according to bile duct projection, a layer thickness not higher than 3.0 mm and a low b value not higher than 100 seconds / square millimeters and a high b value not lower than 800 seconds / square millimeters, and echo time is set to a minimum value allowed by a system. Through cooperation of personalized plane positioning, thin-layer high-b-value imaging and intelligent quality control, the problems that conventional magnetic resonance imaging is incomplete in display of an extrahepatic cholangiocarcinoma lesion anatomical structure, low in signal-to-noise ratio, multiple in motion artifacts and difficult to accurately evaluate the longitudinal infiltration range of a tumor are solved.

The invention relates to the technical field of biological medicines, in particular to application of a reagent for inhibiting expression of miR-758-3p in preparation of a medicine for treating pancreatic ductal adenocarcinoma. The reagent is a micro RNA (miRNA) inhibitor, a small interfering RNA (siRNA), an antisense oligonucleotide (ASO) or a combination of the micro RNA inhibitor, the small interfering RNA (siRNA) and the antisense oligonucleotide (ASO) which can down-regulate the expression of the miR-758-3p. The invention also relates to a medicine for treating pancreatic ductal adenocarcinoma, which comprises an effective amount of the reagent and a pharmaceutically acceptable carrier. The medicine is used for inhibiting proliferation, migration and / or invasion of pancreatic duct adenocarcinoma cells. The invention provides a new biomarker and a treatment intervention target for pancreatic ductal adenocarcinoma. And the feasibility of targeted therapy is defined. And the method has a definite conversion prospect.

The double-cavity catheter comprises an operating handle and a catheter, the operating handle is provided with a guide wire guiding channel, a confocal probe guiding channel and a catheter containing cavity, the rear end of the catheter is arranged in the catheter containing cavity, and the interior of the catheter is divided into a guide wire cavity channel and a confocal probe cavity channel. The guide wire cavity channel and the guide wire guiding channel are communicated through a leading-in opening formed in the catheter to form an obtuse angle; a guide block is further arranged on the side, close to the rear end of the catheter, of the leading-in opening. The guide wire is steered through the guide block so as to adapt to the guide wire guide channel and the guide wire cavity channel, the control convenience of the guide wire is improved, and the guide block is integrally arranged in the catheter or the operation handle, so that the whole device is more compact in structure and more convenient to use in the assembling process. The utility model further provides a confocal probe assembly, the confocal probe assembly comprises the double-cavity catheter, a confocal probe, a guide wire and a confocal handle, the confocal probe and the guide wire are inserted into the double-cavity catheter at the same time, convenience of biliopancreatic duct imaging is improved, and operation risks are reduced.

The invention discloses a bile and pancreatic juice diversion catheter set which comprises guide wires (1), a diversion catheter (2), a pushing catheter (3) and an outer sheath tube (4), the diversion catheter (2) is installed at the head end in the outer sheath tube (4), one end of the pushing catheter (3) is inserted from the tail end of the outer sheath tube (4), the number of the guide wires (1) is two, and the number of the guide wires (1) is two. And the two guide wires penetrate through the shunting catheter (2) and the pushing catheter (3). The device can be arranged in the bile duct and the pancreatic duct, can block pancreatic-bile reflux, does not affect the normal physiological structure and function of the human body, and is suitable for all patients.