Abstract: Intramedullary systems, expandable intramedullary nails, expandable anchors, and methods of using the same. The intramedullary system may include an expandable intramedullary nail configured to extend into an intramedullary canal of a long bone and/or one or more expandable anchors configured to extend at an angle transverse to the intramedullary nail. The intramedullary nails and/or anchors may include one or more integrated expansion mechanisms that allow for insertion in a contracted configuration and expansion into a deployed configuration to lock the relative position and prevent axial rotation and translation of the system.

Abstract: Intramedullary systems, expandable intramedullary nails, expandable anchors, and methods of using the same. The intramedullary system may include an expandable intramedullary nail configured to extend into an intramedullary canal of a long bone and/or one or more expandable anchors configured to extend at an angle transverse to the intramedullary nail. The intramedullary nails and/or anchors may include one or more integrated expansion mechanisms that allow for insertion in a contracted configuration and expansion into a deployed configuration to lock the relative position and prevent axial rotation and translation of the system.

Abstract: A bone fixation system, device and method are provided herein. A system may include a bone plate. The bone plate is adapted to be affixed to a bone surface, and comprises a bioactive porous portion. The porous portion is adapted to include bone healing-promoting substances, such as hollow microparticles containing the bone healing-promoting substances embedded in the porous portion. The bone plate further includes at least one attachment portion. In some embodiments, the attachment portion includes a face, which defines indentations, such as dimples, to retain an amount of adhesive.

Abstract: A fixing device for bone fractures having at least two tensioning elements, at least two fastening elements and at least two sleeve elements. Each of the tensioning elements has a contoured body and has, at ends mutually spaced apart in the longitudinal direction, receivers which enclose sleeve elements and/or fastening elements, so that by linking a plurality of tensioning elements, sleeve elements and/or fastening elements they can be arranged into a chain. Each tensioning element is formed with mirror-symmetry with respect to the longitudinal direction, wherein the receivers extend, starting from an imaginary center line of each tensioning element in longitudinal direction, upwards or downwards to the outer edge of the contoured body of the tensioning element in the height direction and have a toothing system on their contact surface facing the imaginary center line.

Abstract: A bone plate system for securing a plurality of bones is provided including a plate member, a locking device of the bone plate, and a surgical cable having a trailing end for being connected to the bone plate and a leading end for being advanced around the bones and into the locking device. The surgical cable may be tensioned to approximate the bones, urge the bones together, and seat the bone plate against the bones. The locking device may be reconfigured to a locked configuration to fix the bone plate to the surgical cable. The bone plate further includes a plurality of throughbores for receiving bone anchors that rigidly fix the bone plate to the bones. The bone plate system utilizes the tensile strength of the surgical cable and the rigid fixation between the bone anchors and the bone plate to resist relative movement of the bones.

Abstract: A fixing pin for orthopedic surgery is provided. The fixing pin for orthopedic surgery includes: an inner fixing pin inserted from one-side cortex of a bone to the opposite-side cortex thereof; an outer fixing pin including a first hole and a first screw portion formed to protrude from a front end thereof, the first hole being penetrated by the inner fixing pin so that front and rear ends of the inner fixing pin protrude, the outer fixing pin being inserted into only one-side cortex of the bone, and the inner fixing pin being fixed to the outer fixing pin; and a sleeve including a second hole and fixed to the outer fixing pin, the second hole being penetrated by the outer fixing pin so that front and rear ends of the outer fixing pin protrude. Therefore, according to the present disclosure, it is possible to perform internal fixation even after reposition of bone fracture has been performed using a fixing pin.

Abstract: Unicortical path detection for a measurement system for monitoring a depth of penetration of a working portion of an instrument in a bone of a patient. The unicortical detection may compare an average cortex thickness in a bicortical path to an actual measured depth of penetration. If the actual depth of penetration exceeds the average thickness, a unicortical path may be detected. Upon detection of a unicortical path, an alert may be provided and/or the instrument may be arrested upon subsequent breaching of the cortex.

Abstract: A cartridge for mixing and injecting bone cement includes a body including a cylindrical member, a first coupler and a second coupler at a first open end and a second open end of the cylindrical member, respectively, a first opening/closing member detachably coupled with the first coupler, a second opening/closing member detachably coupled with the second coupler, and a mixing ball in an internal space of the body. A bone cement mixing and transferring system includes the cartridge having powder and liquid components of bone cement inserted and mixing the powder and liquid components, an injection tube coupled with the cartridge after removing the first opening/closing member from the cartridge, and a cement gun mounted to a rear side of the second opening/closing member, the cement gun applying pressure for injecting bone cement mixed in the cartridge into an area to be treated via the injection tube.

Abstract: A torsional-mode ultrasonic vibration generator is manufactured with longitudinal slots extending along its horn which damp unwanted vibrational modes and allow it to be made significantly smaller than previous apparatus. The torsional-mode ultrasonic generator is operable with a suite of surgical tools, to perform portions of an orthopaedic arthroplasty revision procedure. Three of the tools are for removing bone cement from within a bone cavity on a prosthesis cemented into the bone cavity. Three other tools are for separating an uncemented prosthesis from ingrown bone by cutting the bone between the prosthesis and walls of the bone cavity. The seventh tool is provided with sensors to determine a separation between a bone-cutting tool head and a metal prosthesis, feedback from the sensors being used to control servo motors of an articulated mounting for the seventh tool, to maintain the separation at a desirable value.

Abstract: An ultrasonic vibrator and an ultrasonic treatment device which can adjust a resonant frequency while maintaining driving force are provided. An ultrasonic vibrator 1 includes two metal blocks 2, a driving unit 3 that is arranged between the metal blocks 2 and produces a piezoelectric effect to vibrate by application of an alternating voltage, and at least one adjustment unit 4 that is arranged between the metal blocks 2 and the driving unit 3 in an insulated state and changes Young's modulus.

Abstract: A method of treating bowel diseases includes introducing a fluid into a portion of a patient's colon and applying energy thereto from an external energy source such that the fluid and the energy cooperate to treat tissue of the portion of the patient's colon in contact with the fluid. Another method of treating inflammatory bowel diseases includes sealing a portion of a patient's colon, introducing an electrically-conductive fluid thereto, and energizing an electrode disposed therein to treat tissue of the portion of the patient's colon in contact with the electrically-conductive fluid. Another method of treating inflammatory bowel diseases includes sealing a portion of a patient's colon and introducing a heated fluid at a temperature equal to or above 60° C. to treat tissue of the portion of the patient's colon in contact with the heated fluid.

Abstract: Electrosurgical procedures. At least some of the example methods for detecting that an electrosurgical wand is effected by a blockage, including supplying a high frequency energy to an active electrode of an electrosurgical wand; drawing an electrically conductive fluid from the vicinity of the active electrode; sensing a temperature signal indicative of a temperature of the electrically conductive fluid drawn from the vicinity of the active electrode; and cycling the high frequency energy supplied upon the temperature of the electrically conductive fluid drawn from the vicinity of the active electrode exceeding a first threshold temperature.

Abstract: A method for the selective elevation and separation of tissues comprised of multiple layers and a surgical instrument for performing the method. The method may be performed without the requirement of a solid mechanical device insertion or transection through the mucosal layer. In particular, the method and surgical instrument may be used for the selected separation and/or resection of selected portions of benign or malignant tissues (e.g. defining tissue planes, polyp elevation and removal, submucosal tissue tunnelling, endoscopic mucosa resection, etc).

Abstract: A surgical instrument includes a flexible tube defining a proximal end and a distal end. An end effector, disposed at the distal end of the flexible tube, is configured for insertion into and advancement through a body cavity to a treatment target. The end effector is adapted to connect to a source of energy. The end effector includes an expandable member which can expand from an un-expanded state to an expanded state in order to circumferentially contact a bodily treatment target. The end effector further includes at least one heating member that may hear the expandable member such that the expandable member may thermally treat tissue that the expandable member contacts.

Abstract: An electrosurgical apparatus comprising an electrosurgical instrument for delivering RF energy and/or microwave frequency energy into biological tissue, an interference cable for conveying radiofrequency (RF) and/or microwave frequency energy between an electrosurgical generator and the electrosurgical instrument, wherein a sterile barrier sheath surrounds a connection interface between the instrument and interface cable. The sterile barrier sheath and instrument may be a sterilisable unit suitable for repeated use.

Abstract: An apparatus for treating inflammatory bowel diseases is provided. The apparatus includes a body and an elongate spring coil extending distally from the body and configured to be positioned within a patient's colon. The elongate spring coil defines a spiral configuration and is configured to be selectively moved relative to the body. The apparatus also includes at least one electrode disposed on the elongate spring coil and configured to emit energy. The at least one electrode is moved along a spiral path in response to movement of the elongate spring coil relative to the body. A method of use for treating inflammatory bowel diseases is also provided.

Abstract: Devices, systems and methods for cutting and sealing of tissue such as bone and soft tissue. Devices, systems and methods include delivery of energy including bipolar radiofrequency energy for sealing tissue which may be concurrent with delivery of fluid to a targeted tissue site. Devices include debridement devices which may include a fluid source. Devices include inner and outer shafts coaxially maintained and having cutters for debridement of tissue. An inner shaft may include electrodes apart from the cutter to minimize trauma to tissue during sealing or hemostasis. Devices may include a single, thin liner or sheath for electrically isolating the inner and outer shafts.

Abstract: A system includes an energy source and a surgical device. The energy source has a receptacle configured to delivery energy to the surgical device through a receptacle. The surgical device is configured to deliver the energy to tissue. The surgical device includes a plug selectively engagable to the receptacle to couple the surgical device to the energy source. The plug includes a prong configured to mechanically transition from a condition permitting engagement of the plug and the receptacle to another condition inhibiting engagement of the plug with the receptacle upon reaching a predetermined usage threshold.

Abstract: Surgical devices and methods for cutting tissue are provided having a cutting element that is biased to facilitate tissue cutting. For example, a surgical device is provided with a handle that has an elongate shaft assembly with first and second jaws for engaging tissue. The surgical device includes a cutting element that is moveable through a slot formed in at least the second jaw for cutting tissue engaged between the first and second jaws. In an exemplary embodiment, the cutting element is biased toward the second jaw such that the cutting element remains within the slot in the second jaw when thick tissue is engaged.

Abstract: The present disclosure relates to methods, devices, kits and systems for enhancing the efficacy and longevity of denervation procedures.

Abstract: A system for treating uterine tissue having a seal assembly configured for positioning in a patient's cervical canal and uterine cavity; an expandable distal balloon portion; an expandable elongate medial balloon portion configured for movement between a first transversely expanded shape for engaging a cervical canal and a second transversely non-expanded shape for trans-cervical insertion; and a fluid source in communication with distal balloon portion and medial balloon portion for expansion of said balloon portions.

Abstract: Ablation apparatus is provided. The apparatus includes an ablation electrode shaped to define a cavity thereof, and comprising a metallic distal face that is shaped to define a plurality of apertures. A fluid-delivery channel is configured to deliver fluid to the apertures. At least one ultrasound transducer is disposed within the cavity of the ablation electrode, the transducer being configured to transmit an ultrasound wave through the apertures. Other embodiments are also described.

Abstract: Systems and methods are disclosed for providing and using an ablation catheter. The catheter may include a ring electrode having a contact force sensor that provides signals to a system controller to indicate whether the ablation electrode is in contact with the tissue to be ablated as well as how much of the ablation electrode is in contact with the tissue.

Abstract: Provided are a method and apparatus for performing medical catheterization using electrical power circuitry disposed outside a medical catheter and remote internal circuitry disposed within the medical catheter. At least one of the power circuitry and the internal circuitry is isolated from electrical ground. Exactly two wires connect the power circuitry to the internal circuitry and a signal generator is provided for generating an alternating carrier that is communicated from the power circuitry to the internal circuitry via the wires. Decoders are disposed in the power circuitry and the internal circuitry, and a transceiver performs half-duplex data communication between the power circuitry and the internal circuitry by alternately modulating the carrier voltage amplitude in one of the power circuitry and the internal circuitry and decoding the modulated carrier voltage amplitude in another of the power circuitry and the internal circuitry.

Abstract: Electrode assemblies include segmented electrodes disposed on a catheter. The segmented electrodes can be constructed at the tip of the catheter. Tip electrodes can be constructed from an electrically insulative substrate comprising an inner lumen, an external tip surface, and a plurality of channels extending from the inner lumen to the external tip surface, a plurality of segmented electrodes, and a plurality of spot electrodes. Each of the plurality of segmented electrodes and each of the plurality of spot electrodes can be laterally separated from each other by an electrically non-conductive substrate portion and each of the spot electrodes and each of the segmented electrodes can be electrically coupled to at least one wire or conductor trace.

Abstract: A catheter system includes a catheter comprising a tip assembly, the tip assembly having a plurality of electrodes and the plurality of electrodes are configured to measure electrical signals. The system also includes a processing unit configured to: receive a first electrical signal sensed by a first electrode of the plurality of electrodes and a second electrical signal sensed by a second electrode of the plurality of electrodes. A first vector is determined based on the first electrical signal that corresponds to the first electrode. A second vector is determined based on the second electrical signal that corresponds to the second electrode. A resultant vector is determined by summing at least the first vector and the second vector, wherein the resultant vector is indicative of the orientation of the tip assembly.

Abstract: A catheter adapted to measure a contact force. The catheter includes a proximal segment, a distal segment, and a spring segment. The spring segment extends from the proximal segment to the distal segment. The spring segment is configured to permit relative movement between the distal segment and the proximal segment in response to an application of the force on the distal segment. The spring segment includes a slotted tube having a longitudinal axis and a plurality of sensing elements. The sensing elements are disposed on surfaces of the slotted tube. The sensing elements are configured to output a plurality of signals indicative of the relative movement between the proximal segment and the distal segment.

Abstract: The present invention pertains to multiple piece irrigated ablation electrode assemblies wherein the irrigation channels are insulated or separated from at least one temperature sensing mechanism within the distal portion of the electrode assembly. The present invention further pertains to methods for improved assembly and accurate measurement and control of the electrode temperatures while effectively irrigating the device and target areas.

Abstract: A catheter enables real-time light measurements, for example, without limitation, diffuse reflectance, fluorescence, etc., from biological materials, such as tissue (including blood), while performing RF ablation. The catheter tip design isolates illumination and collection paths within the tip electrode such that light for illuminating the tissue of interest (e.g., cardiac tissue or blood) is isolated within the tip electrode from light that returns from the tissue to the catheter tip, and vice versa. Such a design advantageously avoids saturation of the optical detector, and ensures diffusion of the illumination light within the medium of interest. The catheter has a catheter body and a tip electrode with a shell wall and a hollow cavity. The shell wall has at least an illumination opening and a collection opening.

Abstract: An embodiment of a system for ablating tissue comprises an electrode configured for use to deliver RF power to ablate the tissue, and a heat flow sensor configured to provide a measurement of heat flow from the electrode to blood or irrigation fluid. According to some embodiments, the system further comprises an RF source configured to generate RF power connected to the electrode (PE) to ablate tissue, and a controller configured to control a level of RF power and a duration for an ablation procedure. The controller is programmed to implement a process to estimate RF power dissipated in tissue (PT), including calculating power loss due to convective heat flow (PCONV) from the tissue through the electrode to the blood or the irrigation fluid to cool the electrode, and calculating the RF power dissipated in tissue (PT) by subtracting PCONV from PE.

Abstract: A catheter is adapted to ablate tissue and provide lesion qualitative information on a real time basis, having an ablation tip section with a generally omni-directional light diffusion chamber with one openings to allow light energy in the chamber to radiate the tissue and return to the chamber. The chamber is irrigated at a positive pressure differential to continuously flush the opening with fluid. The light energy returning to the chamber from the tissue conveys a tissue parameter, including without limitation, lesion formation, depth of penetration of lesion, cross-sectional area of lesion, formation of char during ablation, recognition of char during ablation, recognition of char from non-charred tissue, formation of coagulum around the ablation site, differentiation of coagulated from non-coagulated blood, differentiation of ablated from healthy tissue, tissue proximity, and recognition of steam formation in the tissue for prevention of steam pop.

Abstract: Systems, assemblies, and methods to treat pulmonary diseases are used to decrease nervous system input to distal regions of the bronchial tree within the lungs. Treatment systems damage nerve tissue to temporarily or permanently decrease nervous system input. The treatment systems are capable of heating nerve tissue, cooling the nerve tissue, delivering a flowable substance that cause trauma to the nerve tissue, puncturing the nerve tissue, tearing the nerve tissue, cutting the nerve tissue, applying pressure to the nerve tissue, applying ultrasound to the nerve tissue, applying ionizing radiation to the nerve tissue, disrupting cell membranes of nerve tissue with electrical energy, or delivering long acting nerve blocking chemicals to the nerve tissue.

Abstract: According to one aspect, a medical system may include a laser source for providing laser energy. The medical system may also include a fluid source containing a fluid for absorbing the laser energy to generate heat. The medical system may further include a medical device operatively coupled to the laser source and the fluid source. The medical device may include a shaft having a distal end, and a cap at the distal end of the shaft. The cap may include a lens and a reflector for deflecting the laser energy toward the lens. The lens may be configured to emit the laser energy from the cap toward a target.

Abstract: A method and system of ablating melanin are provided. Stepwise multi-photon fluorescence is induced in melanin within a region of tissue. The fluorescence is detected, and at least a portion of the melanin from which the fluorescence is detected is ablated. The system and method can use a continuous wave laser in the near infrared range for the inducement and ablation of melanin, providing high resolution at low cost.

Abstract: Laser ablation catheters and methods of using same for efficient tissue ablation are disclosed. In some cases, laser ablation catheter embodiments may include expanded distal tips that allow for beam energy expansion and reduce dead space at the distal cutting surface of the laser ablation catheter.

Abstract: In one embodiment, a method is disclosed for a robotic arm. The method includes pitching a linkage assembly having a plurality of links coupled in series together to constrain movement of a tool along an insertion axis; and enabling movement of the linkage assembly about a pitch axis with a strap drive-train coupled thereto using an electro-mechanical strap stack routed between a first link and a second link. The electro-mechanical strap stack includes a drive strap coupled to the linkage. The drive strap moves the linkage assembly.

Abstract: A method is provided for correcting a curvature or deformity in a patient's spine based on the digitized locations of implanted screws. The method is implemented by a control unit through a GUI to digitize screw locations, accept one or more correction outputs, and generate one or more rod solution outputs shaped to fit at locations distinct from the implanted screw locations.

Abstract: Systems and methods are disclosed for assessing organ and/or tissue transplantation by estimating blood flow through a virtual transplant model by receiving a patient-specific anatomical model of the intended transplant recipient; receiving a patient-specific anatomical model of the intended transplant donor, the model including the vasculature of the organ or tissue that is intended to be transplanted to the recipient; constructing a unified model of the connected system post transplantation, the connected system including the transplanted organ or tissue from the intended transplant donor and the vascular system of the intended transplant recipient; receiving one or more blood flow characteristics of the connected system; assessing the suitability for an actual organ or tissue transplantation using the received blood flow characteristics; and outputting the assessment into an electronic storage medium or display.

Abstract: Systems and methods for displaying a predicted outcome of a lung volume reduction procedure for a patient including a user interface, a processor, and programing operable on the processor for displaying a predicted outcome of the bronchoscopic lung volume reduction procedure on the user interface, wherein displaying the predicted outcome of the lung volume reduction procedure includes receiving patient data comprising volumetric images of the patient, analyzing the volumetric images to identify one or more features correlated to treatment outcome prediction, predicting an outcome for a treatment modality or treatment device using the one or more identified features, and displaying the predicted outcome on the user interface.

Abstract: A medical navigation system is provided, comprising a computing device having a processor coupled to a memory, a tracking camera for tracking medical devices, and a display for displaying an image; an automated arm assembly electrically coupled to be computing device and controlled by a signal provided by the computing device, the automated arm assembly including a multi-joint arm having a distal end connectable to an effector that supports a surgical camera electrically coupled to the computing device; and a medical device having a tracking marker attachable to the medical device.

Abstract: Methods and systems for performing trackerless image guided soft tissue surgery. For a patient in need of brain surgery, pre-operative preparation for a patient is performed by generating a three-dimensional textured point cloud (TPC) for the patient's scalp surface, and registering the first three-dimensional TPC to a magnetic resonance (MR) model of the brain. During the surgery, an intra-operative cortical surface registration to the MR model is performed for the MR-to-cortical surface alignment. Then shift measurement and compensation to the MR model is performed by: performing absolute deformation measurement of the brain based on the MR model with the cortical surface registration, and obtaining shift correction to the MR model using the absolute deformation measurements. The shift correction may be used for adjusting an image guidance system (IGS) in the brain surgery.

Abstract: A surgical hardware and software monitoring system and method allows for surgical planning while the patient is available for surgery, for example while the patient is being prepared for surgery so that the system may model the surgical site. In one embodiment, the model may be used to track contemplated surgical procedures and warn the physician regarding possible boundary violations that would indicate an inappropriate location in a surgical procedure. In another embodiment, the monitoring system may track the movement of instruments during the procedure and in reference to the model to enhance observation of the procedure. In a further embodiment the monitoring system can be used to model and track the changes in the surgical site itself.

Abstract: Systems and methods for establishing and tracking virtual boundaries. The virtual boundaries can delineate zones in which an instrument is not permitted during a surgical procedure. The virtual boundaries can also delineate zones in which the surgical instrument is permitted during the surgical procedure. The virtual boundaries can also identify objects or structures to be treated by the instrument or to be avoided by the instrument during the surgical procedure.

Abstract: Systems, methods and devices are disclosed for use in electronic guidance systems for surgical navigation to determine the relationship between the three-dimensional coordinates of an anatomy of a patient and those of medical image data. These coordinates are required to assist in the determination of the surgical measurements with respect to which components, such as, an acetabular prosthesis, are inserted into a body of the patient, hi one example, during hip replacement surgery, a surgeon receives guidance of how to place an acetabular prosthesis in the body of the patient specifically in the pelvis with respect to medical image data.

Abstract: Disclosed are an automated hair transplant device for transplanting a selected hair into a hair loss area, and the transplanting method comprising selecting a hair of which the root is healthy, making the selected hair have a predetermined length without harming the follicle thereof, putting the hair of a predetermined length in a hair transplant needle, inserting the hair transplant needle into the scalp into which the hair is transplanted, and then separating the hair transplant needle from the scalp while leaving the hair therein.

Abstract: A locator of a surgical port of a surgical robot system, the surgical robot system comprising an instrument attached to a robot arm, the instrument having an instrument shaft able to pass through the surgical port to a surgical site, the locator comprising: an interface configured to couple to the surgical port; a mechanism configured to permit relative linear and/or rotational motion of the interface and the instrument shaft; and a controller comprising a processor operable to estimate the position of a part of the robot arm, the controller configured to control the mechanism in dependence on the estimated position of the part of the robot arm such that as the robot arm retracts the instrument from the patient, the locator moves the port away from the robot arm and provides a reaction force to keep the port in place.

Abstract: A surgical robot system includes a support structure for positioning relative to a patient. The support structure includes a plurality of mounting structures. One or more robotic tool cassettes that are configured to interchangeably connect with any of the mounting structures. Each tool cassette includes a concentric tube manipulator and a transmission for operating the concentric tube manipulator. The support structure also includes a tube collector including a tube assembly associated with each of the mounting structures. The tube assemblies are configured to receive the concentric tube manipulators and guide the manipulators to extend along predetermined trajectories relative to each other.

Abstract: Methods, apparatus, and systems for operating a surgical system. In accordance with a method, a position of a surgical instrument is measured, the surgical instrument being included in a mechanical assembly having a plurality of joints and a first number of degrees of freedom, the position of the surgical instrument being measured for each of a second number of degrees of freedom of the surgical instrument. The method further includes estimating a position of each of the joints, where estimating the position of each joint includes applying the position measurements to at least one kinematic model of the mechanical assembly, the kinematic model having a third number of degrees of freedom greater than the first number of degrees of freedom. The method further includes controlling the mechanical assembly based on the estimated. position of the joints.

Abstract: The manipulator system includes a control unit that is configured such that when a current passing as a result of connection of a first electrically conductive portion to a second electrically conductive portion is sensed by a mount sensor unit while a drive unit is driven, there is deactivation of a driving member for driving a second driving force transmission member of the plurality of second driving force transmission members, which member has the sensed second electrically conductive portion.

Abstract: A prophylactic kit apparatus configured to be used with only a single patient includes a plurality of sealed modules and a housing configured to contain those sealed modules such that only one of the plurality of sealed modules can be removed from the housing at a time. This kit may include a physically-discrete informational patient aid disposed within the housing and having information disposed thereon. By one approach these physically-discrete informational patient aids can have a bookmark form factor. So configured, a medical services provider can readily provide the physically-discrete informational patient aid to a patient to thereby facilitate the patient becoming informed regarding the corresponding prophylactic service with little or no burden on the service provider.