Abstract: In order to provide an implant for fixing adjacent bone plates, in particular cranial bone plates, which has an inner abutment element by means of which a separation gap between the bone plates can be overlapped at a bone plate inner side and has an outer abutment element for overlapping the separation gap at a bone plate outer side lying opposite the bone plate inner side and which is easy for a surgeon to use and by means of which the bone plates may be securely fixed, it is proposed that at least one tension band is guided displaceably through the outer abutment element, by means of which, when a tensile stress is exerted, the inner abutment element and the outer abutment element are mutually braceable, and that the at least one tension band is fixable on the outer abutment element.

Abstract: A stent, or device for repair and reconstruction of the spinal disc wall, or annulus fibrosus, after surgical incision or pathologic rupture, which is inserted through an aperture into the subannular space. The stent has radial extensions which are caused or allowed to expand into an expanded configuration to bridge the aperture. The stent thereby occludes the defective region from the inside of the vertebral disc and prevents the migration of nucleus pulposus therethrough, while also providing a scaffold for tissue growth.

Abstract: A two-sheet fascial expander prosthesis for temporary use and method of using it to treat abdominal hypertension and associated organ system function impairment, in which each flat sheet is attached to the fascia only at opposite sides of an incision. One side of each sheet is armed with mating fastening elements that bond when united to bring about high tensile shear strength and low tensile peeling-off resistance permitting easy separation for diagnostic and therapeutic abdominal entry. The invention is useful because it expands the fascia and adds compliance to the envelope of the abdominal cavity by bridging the gap between free borders of the incised fascia containing intra-abdominal organs without strangulating their blood supply and retaining some tension on the fascia to prevent retraction and bringing the edges closer together as healing progresses, and permitting final removal of the patch and fascia-to-fascia closure.

Abstract: In a device for stretching the skin, particularly for closing a wound, anchoring elements are anchored in the skin. The anchoring elements are movable on a guide device. First anchoring elements are anchored in the skin of the edge of the wound.

Abstract: An integrated wound dressing system and method including a bandage and a self-contained receptacle that stores treatment material for the care and treatment of wounds. The treatment material is easily accessible and can be removed from the receptacle through an exit. The treatment material can then be used to control bleeding and/or clean the wound before dressing. The bandage may include a layer of plastic that acts as an occlusion barrier to reduce heat loss and maintain moisture levels at the wound site. The occlusion barrier also acts to prevent the passage of air into or out of the wound site. The bandage also includes fasteners that act to prevent unintentional unraveling and to secure the bandage during final packaging. These fasteners help facilitate the wrapping of amputations, stumps, and extremities. The integrated wound dressing system provides an all-in-one system for treating and dressing wounds and reduces the time required to do so.

Abstract: A surgical device is disclosed along with methods of using the same. The surgical device may comprise an outer sheath and a collar assembly. The collar assembly may be coupled to the outer sheath and may comprise a first arm coupled to the outer sheath at a first hinge; a second arm coupled to the first arm at a second hinge; and a collar coupled to the second arm. The collar assembly may be movable from an un-deployed position where the first arm and the second arm extend the collar distally from the outer sheath to a deployed position where the collar is aligned with the first channel of the outer sheath. Also, the first arm, the second arm, and the collar may be positioned substantially within a cross-sectional area of a distal end of the outer sheath when the collar assembly is in the un-deployed position.

Abstract: A reduced-pressure system for treating tissue, such as damaged subcutaneous tissue, includes a shaped dressing bolster for placing on the patient's epidermis and substantially sized to overlay the damaged subcutaneous tissue. The system further includes a sealing subsystem for providing a fluid seal over the shaped dressing bolster and a portion of the patient's epidermis, and a reduced-pressure subsystem for delivering a reduced pressure to the sealing subsystem. The reduced-pressure system may develop a force, which may include a vertical force that is realized at tissue site deeper than the epidermis or a closing force directed towards the incision. The shaped dressing bolster is shaped to evenly distribute the force. Other methods and systems are included.

Abstract: A reinforced closure anchor includes a fabric layer having an adhesive side, an opposite non-adhesive side, and an outer edge. An anchor member layer having a reinforcing structure, an adhesive side, and an opposite non-adhesive side is disposed on the fabric layer. The anchor member non-adhesive side is adhered to the fabric layer adhesive side. The anchor member is disposed within the outer edge of the fabric layer.

Abstract: A medical apparatus positionable in a cavity of a bodily organ (e.g., a heart) may constrict a bodily orifice (e.g., a mitral valve). The medical apparatus may include tissue anchors that are implanted in the annulus of the orifice. The tissue anchors may be guided into position by an intravascularly or percutaneously deployed anchor guiding frame. Constriction of the orifice may be accomplished by cinching a flexible cable attached to implanted tissue anchors. The medical device may be used to approximate the septal and lateral (clinically referred to as anterior and posterior) annulus of the mitral valve in order to move the posterior leaflet anteriorly and the anterior leaflet posteriorly and thereby improve leaflet coaptation and eliminate mitral regurgitation.

Abstract: The present invention provides methods and devices for treating the annulus of an intervertebral disc. The methods and devices can employ an expandable treatment device which is deployed at least partially in the subannular space. Fixation devices and methods are also disclosed, which help to secure the treatment device in place.

Abstract: A surgical stapling device for deploying staples connected with suture to tissue includes a handle having a staple actuator mechanism, a tubular support shaft having a longitudinal axis and extending from the handle, and a staple cartridge mounted on the support shaft and connected to the staple actuator mechanism for applying one or more staples to the tissue. The cartridge has a cartridge housing adapted to receive a plurality of staples in a row for longitudinal movement therethrough and an anvil mounted on the housing. The cartridge further includes a mechanism for advancing the forwardmost staple in the row into engagement with the anvil, and a suture guide supporting a length of suture that extends in a loop for attachment to the staples as they are secured to the tissue.

Abstract: The present embodiments provide apparatus and methods suitable for coupling a graft member to tissue, closing a bodily opening, and the like. At least one proximal deployable member and at least one distal deployable member are provided, each having a contracted state suitable for delivery and further comprising an expanded state. In the expanded state, the proximal and distal deployable members are configured to secure the graft member to the tissue. Optionally, a loop member may be provided for receiving a suture for further securing the graft member to the tissue.

Abstract: The methods, devices, and systems are provided for performing endovascular repair of atrioventricular and other cardiac valves in the heart. Regurgitation of an atrioventricular valve, particularly a mitral valve, can be repaired by modifying a tissue structure selected from the valve leaflets, the valve annulus, the valve chordae, and the papillary muscles. These structures may be modified by suturing, stapling, snaring, or shortening, using interventional tools which are introduced to a heart chamber. Preferably, the tissue structures will be temporarily modified prior to permanent modification. For example, opposed valve leaflets may be temporarily grasped and held into position prior to permanent attachment.

Abstract: A device and method for closing a percutaneous vascular puncture with anchors at the distal ends of wires temporarily implanted in extravascular tissue adjacent the puncture. The wires are tensioned to draw the tissue together to approximate the edges of the puncture. The wires are retained in that position while the blood in the region of the arteriotomy clots. When hemostasis has been achieved, the anchoring wires then can be removed.

Abstract: A hemostatic device includes a hemostatic head that includes a peripheral end surface formed at a distal end of the hemostatic head, the peripheral end surface extending along an outer edge region of the distal end in a circumferential direction of the hemostatic head and having suction ports formed on the peripheral end surface, a recess that is open at the distal end and that is surrounded by the peripheral end surface, a plurality of suction channels that are formed inside the hemostatic head, the suction channels communicating with the respective suction ports. The device also includes a suction device for applying suction pressure to the suction ports via the suction channels, the suction device being coupled to the suction channels.

Abstract: Incision and closure surgical device designed to assist in operative surgery as a means of effecting and repairing skin wounds. A slide fastener is fitted to a self-adhesive sheet that is attached to the skin surface. The slider of the slide fastener contains a contact electrode for electrocoagulation fitted with a cutting edge. As the slide fastener is opened, the slider simultaneously effects the incision by means of the cutting edge of the electrode, severing both the flexible sheet and the skin beneath. For closing the incision, the stringer tapes of the slide fastener interlock by the action of the slider, thereby bringing both the edges of the flexible sheet and the wound beneath into apposition.

Abstract: An engagement mechanism for a sternal clamp, the mechanism allowing for an open status where the clamp may be lengthened or shortened, a closing status where the clamp may only be shortened, and a locked status where the clamp cannot be lengthened or shortened, and wherein the device can be disposed in the locked status in differing overall lengths.

Abstract: A band-aid includes at least one piece which includes a first adhesive portion and a second adhesive portion defined in two ends of an inner surface thereof. A lifting portion is located between the first and second adhesive portions. The first and second adhesive portions are adhered to two edges of a wound and the pulled toward each other by lifting the lifting portion. The two edges of the wound are rebuilt to reduce any possible scar by using the band-aid.

Abstract: In a sternum closure device for fixing two sternum portions to be connected to one another, comprising an inner contact element for abutment on the inner surface of the sternum, at least one clamping element fixed to this contact element and projecting transversely from it and at least one outer contact element for abutment on the outer side of the sternum which can be clamped against the inner contact element by means of the clamping element guided through the intermediate space between the sternum portions, it is suggested in order to hinder the separation of the sternum as little as possible during any renewed operation that the inner contact element consist of two parts which are separate from one another and each of which is designed to abut on one of the two sternum portions and that connecting means be provided for the releasable connection of the two parts arranged next to one another.

Abstract: Devices and methods for closing an arteriotomy include a percutaneously placeable central tube deployable about the arteriotomy by which an array of radially expandable fingers having suction ports can be engaged with the surface of tissue about the arteriotomy enabling the fingers to grip the tissue without piercing it. A delivery tube can advance a closure element along the outside surface of the central tube, thereby radially contracting the fingers and puckering the gripped tissue to approximate the edges of the arteriotomy. The closure element is further advanced until it is forced off of the distal tips of the fingers such that the closure element surrounds the puckered tissue and secures permanent closure of the arteriotomy.

Abstract: Devices for attaching a first mass and a second mass and methods of making and using the same are disclosed. The devices can be made from an resilient, elastic or deformable materials. The devices can be used to attach a heart valve ring to a biological annulus. The devices can also be used for wound closure or a variety of other procedures such as anchoring a prosthesis to surrounding tissue or another prosthesis, tissue repair, such as in the closure of congenital defects such as septal heart defects, tissue or vessel anastomosis, fixation of tissue with or without a reinforcing mesh for hernia repair, orthopedic anchoring such as in bone fusing or tendon or muscle repair, ophthalmic indications, laparoscopic or endoscopic tissue repair or placement of prostheses, or use by robotic devices for procedures such as those above performed remotely.

Abstract: Herein disclosed is a simple, passive splinting system for sternotomy patients designed to provide a continuous yet readily adjustable, compressive tangential stabilizing force to the ribcage so as to promote healing of a median sternotomy incision while minimizing patient pain.

Abstract: A mechanical system for sequentially securing skin tissue preferably utilizes a tissue manipulator apparatus to approximate a portion of an interior surface of each of two pieces of living dermis tissue along a vertical interface below an exterior surface such that discrete target tissue zones are defined within the two pieces of living dermis tissue. An applicator apparatus includes a driving head portion positioned in the vertical interface and at least partially below the exterior surface and a handle portion positioned at least partially above the exterior surface. The applicator apparatus unilaterally drives a fastener through a first side of the living dermis tissue and then sequentially drives the fastener through a second side of the living dermis such that the fastener is positioned below the exterior surface and a portion of the fastener is positioned generally transverse to the vertical interface.

Abstract: A surgical device to stanch the flow of blood is disclosed. The surgical device can place an implantable adhesive over or around varices or other bleeders. The surgical device has a vacuum system for capturing tissue and an adhesive system to apply adhesive to the captured tissue. A vacuum chamber is used to contact tissue and contains a chamber therein for the reception of tissue. An adhesive applicator is provided within the vacuum chamber and moves longitudinally therein to apply adhesive to tissue. The surgical device can apply an adhesive patch to tissue or inject adhesive into tissue. Alternately, an adhesive actuator and a chemical agent can be dispensed to tissue within the vacuum chamber.

Abstract: The present disclosure is directed to a medical device comprising a dispenser adapted to dispense a tissue sealant or one or more precursor compounds, the dispenser being operably coupled to a grasper. Furthermore, the medical device comprises a dispenser adapted to dispense a tissue sealant or one or more precursor compounds thereof, the dispenser being operably coupled to a surgical cutter. Additionally or alternatively the medical device can include an actuation mechanism, whereby the dispenser dispenses the tissue sealant or one or more precursor compounds at a surgical cutting site or in a proximity thereof.

Abstract: An apparatus for closure of a patent foramen ovale of a patient comprises a frame member defining respective first, second and third frame segments, and a growth and/or clot promoting material positioned on at least one of the segments. The frame member is alignable in a generally elongated first position for deployment via a delivery catheter, and is elastically movable therefrom to a compressed second position when the frame member is deployed across the foramen ovale. The frame segments are structured and arranged such that upon deployment of the apparatus across the foramen ovale, the first frame segment is disposed distal of the atrial septum, the second frame segment is disposed intermediate the atrial septum and the tissue flap, and the third frame segment is disposed proximal of the tissue flap.

Abstract: A device for closing the left atrial appendage of a patient comprising a retention member composed of a shape memory material and a mesh material supported by the retention member. The retention member has a first elongated configuration for delivery and a second expanded configuration for placement within the left atrial appendage. The mesh is configured to block blot clot migration from the appendage. In the second configuration the retention member moves toward a shape memory position. The retention member has a plurality of appendage wall engagement members to secure the retention member to the appendage.

Abstract: An epidermal positioning mechanism for use with an application to a predetermined epidermal surface. The epidermal positioning mechanism comprises a strip of material having a first end portion of a predetermined shape, a second end portion of a predetermined shape, and middle portion coupling the first end portion to the second end portion. The first end portion and the second end portion each may include a side including an adhesive layer. An overlaying, non-adhesive barrier layer may be located between a portion of the adhesive layer and an end portion.

Abstract: An apparatus and method for treating a fracture of a bone is provided. A bone suture assembly includes a first bone plate positioned proximate to the bone. A suture is positioned through the first bone plate and across the fracture of the bone to thereby stabilize the fracture. A method of treating a fracture of a bone includes positioning at least one suture anchor proximate to the bone and positioning at least one bone plate between at least one suture anchor and the bone. The method also includes moving at least one suture across the fracture of the bone and through at least one bone plate, attaching at least one suture to at least one suture anchor, and tensioning at least one suture to stabilize the fracture of the bone.

Abstract: A barbed suture for connecting tissue, and a combination surgical needle with a barbed suture. The suture includes an elongated body and a plurality of barbs projecting from the body. Each barb causes the suture to resist movement in an opposite direction from which the barb faces. The disposition of the barbs on the body may be staggered, twist cut multiple spiral, overlapping, or random. Also, the configuration of the barbs may be a certain spirality angle ?, barb cut angle ?, barb cut depth, barb cut length, barb cut distance, corrugated barb underside, arcuate barb base, or varying barb size.

Abstract: A wound closure system and a method of closing a wound are disclosed. The wound closure system includes a plurality of skin anchors mechanically attached to external skin tissue around a periphery of a wound, a line extending between the skin anchors, the line slidably engaged with each skin anchor, and a biasing member that provides tension on the line to draw all of the skin anchors toward the wound. The method of closing a wound includes the steps of attaching a plurality of skin anchors to external skin around a periphery of a wound, extending a line between the skin anchors around substantially the entire periphery of the wound, and providing tension to the line to draw the skin anchors toward the wound.

Abstract: A wound closure system and a method of closing a wound are disclosed. The wound closure system includes a plurality of skin anchors mechanically attached to external skin tissue around a periphery of a wound, a line extending between the skin anchors, the line slidably engaged with each skin anchor, and a biasing member that provides tension on the line to draw all of the skin anchors toward the wound. The method of closing a wound includes the steps of attaching a plurality of skin anchors to external skin around a periphery of a wound, extending a line between the skin anchors around substantially the entire periphery of the wound, and providing tension to the line to draw the skin anchors toward the wound.

Abstract: A system and method of moving and stretching plastic tissue using dynamic force. An elastomeric driver is adjustably attachable to one or more anchors for securing the elastomer to the plastic tissue, providing a self adjusting system that is capable of exerting relatively constant tension over a certain distance.

Abstract: An epidermal positioning mechanism for use with an application to a predetermined epidermal surface. The epidermal positioning mechanism comprises a strip of material having a first end portion of a predetermined shape, a second end portion of a predetermined shape, and middle portion coupling the first end portion to the second end portion. The first end portion and the second end portion each may include a side including an adhesive layer. An overlaying, non-adhesive barrier layer may be located between a portion of the adhesive layer and an end portion.

Abstract: A wound closure system and a method of closing a wound are disclosed. The wound closure system includes a plurality of skin anchors mechanically attached to external skin tissue around a periphery of a wound, a line extending between the skin anchors, the line slidably engaged with each skin anchor, and a biasing member that provides tension on the line to draw all of the skin anchors toward the wound. The method of closing a wound includes the steps of attaching a plurality of skin anchors to external skin around a periphery of a wound, extending a line between the skin anchors around substantially the entire periphery of the wound, and providing tension to the line to draw the skin anchors toward the wound.

Abstract: Embodiments of the invention may be directed to apparatuses for securing and sealing apertures in tissue and related methods of use.

Abstract: A surgical stapler comprises a hollow shaft 10 and a tube 92 slidable axially within the shaft between a forward position wherein one end 96 of the tube projects beyond a free end of the shaft to enter a puncture site in a blood vessel and a rearward position wherein the end of the locator tube is retracted within the shaft. A surgical staple 40 straddles the tube 92 and is slidable thereon forwardly towards an anvil 24 against which the staple may be deformed to staple together the opposite edges of the puncture site. A cam mechanism drives the staple forwardly along the tube 92 into deforming engagement with the anvil and at the same time retracts the tube into the shaft in time to allow the legs of the staple to close onto the puncture site.

Abstract: A surgical stapler comprises a hollow shaft 10 and a tube 92 slidable axially within the shaft between a forward position wherein one end 96 of the tube projects beyond a free end of the shaft to enter a puncture site in a blood vessel and a rearward position wherein the end of the locator tube is retracted within the shaft. A surgical staple 40 straddles the tube 92 and is slidable thereon forwardly towards an anvil 24 against which the staple may be deformed to staple together the opposite edges of the puncture site. A cam mechanism drives the staple forwardly along the tube 92 into deforming engagement with the anvil and at the same time retracts the tube into the shaft in time to allow the legs of the staple to close onto the puncture site.

Abstract: Tissue is approximated by adhering anchors to opposing sides of a wound and coupling the anchors together.

Abstract: Methods and apparatus directed to tissue capture, presentation and retention using a surgical apparatus. One or more tissue capture arms can include surface features that engage captured tissue and provide omni-directional support during capture and retention of the tissue. The tissue clamping arm can include improved centering features for positioning captured tissue relative to a penetrator that is advance into the capture tissue. Through improved tissue handling and tissue retention relative to the penetrator, captured tissue can be consistently pierced regardless of external forces and techniques. The tissue clamping arm can include gripping members arranged along an interface surface to improve tissue grip and presentation.

Abstract: The present invention provides a device for occluding an anatomical aperture, such as a septal defect or patent foramen ovale (PFO). The occluder includes two sides connected by an intermediate joint. Each of the sides includes at least one elongate element, which is arranged to form non-overlapping loops. Each loop has at least one radially-extending segment that is adjacent to a radially-extending segment of another loop. In at least some embodiments, at least one pair of adjacent radially-extending segments is connected. The loops of the device may be of various shapes, sizes, and configurations, and, in at least some embodiments, the loops have rounded peripheries. In some embodiments, at least one of the sides includes a tissue scaffold.

Abstract: A system and method of moving and stretching plastic tissue using dynamic force. An elastomeric driver is adjustably attachable to one or more anchors for securing the elastomer to the plastic tissue, providing a self adjusting system that is capable of exerting relatively constant tension over a certain distance.

Abstract: A medical closure screen device for a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed.

Abstract: A medical closure screen device for a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed.

Abstract: To close a translumenal hole made in the stomach (or colon, etc.) pursuant to natural orifice surgical treatment of tissue in the peritoneal cavity, one or more guides are engaged with the hole, and the guides can be pulled to purse together tissue on opposite sides of the hole. A closure device is then advanced along the guides over the pursed tissue to adhere the tissue together using heat, staples, sutures, etc.

Abstract: A barbed bodily tissue connector for insertion into tissue comprises an elongated body having a substantially polygonal periphery in cross-section including at least three sides. Each side meets an adjacent side at an edge of the elongated body. A plurality of barbs project from the edges of the body. The barbs are configured such that they are yieldable in a direction toward the body and resist retraction from tissue in an opposite direction.

Abstract: A device for attaching, relocating or reinforcing tissue includes a first tissue anchoring portion having a support plate and a plurality of barbs extending from the support plate for engaging tissue at a first location, a second tissue anchoring portion having a support plate and a plurality of barbs extending from the support plate for engaging tissue at a second location which is different from the first location, and a connection element, such as a suture or a mesh structure, interposed between and interconnecting the first tissue anchoring portion and the second tissue anchoring portion. The support plate of at least one of the first tissue anchoring portion and the second tissue anchoring portion may have longitudinally axially formed therethrough a bore for receiving the connecting element so that the surgeon may pull on the end of the connecting element to adjust the distance between the first tissue anchoring portion and the second tissue anchoring portion.

Abstract: Disclosed is a two-component device for closing a laceration or incision. The device includes a first component comprising a first adhesive-backed anchoring member and one or more first connecting members extending from one edge thereof in a first direction. Also included is a second component comprising a second adhesive-backed anchoring member and one or more second connecting members extending from one edge thereof in a second direction generally opposite to the first direction. Means for attaching the one or more first connecting members to the second anchoring member and means for attaching the one or more second connecting members to the first anchoring member is also provided. The attachment of the connecting members to the anchoring members forms attached and bridging portions of the one or more connecting members, the attached portions being attached to an anchoring member, and the bridging portions spanning the over-laceration area between the first and second anchoring members.

Abstract: A flexible medical closure screen for closing a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed.

Abstract: A medical closure screen device for a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed.