Abstract: A force transmission mechanism for a teleoperated surgical instrument includes a drive pulley, a drive cable operably coupled with the drive pulley, a driven pulley operably coupled with the drive cable, and an actuation member operably coupled to the driven pulley. The actuation member is configured to transmit force to actuate an end effector of the surgical instrument. Rotational motion of the driven pulley causes translational movement of the actuation element to actuate the end effector. Methods relate to operating a force transmission mechanism.

Abstract: A control unit for a medical device is provided. The control unit includes a palm interface engageable by a palm of a hand, a restraint capable of elastically deforming to apply a restraining force to the dorsum of the hand and a finger interface engageable by one or more fingers of said hand.

Abstract: Provided is a sterile drape configured to cover a medical observation apparatus to keep the medical observation apparatus sterile, the medical observation apparatus including a microscope part configured to magnify and image a microfine site of an observation object, an input part configured to receive an input of an operation instruction to the microscope part, and a grip part having a bar shape and having a surface provided with at least a portion of the input part, the sterile drape including: an attaching part configured to be fixed and attached to the grip part in a state where the sterile drape covers the medical observation apparatus.

Abstract: A lid for a sterile container includes a lid component and at least one gas exchange section on the lid component. The lid also includes at least one frame for receiving a filter device on a lid inner face on the at least one gas exchange section, at least one outer cover which covers the at least one gas exchange section on a lid outer face, and at least one connection element which is inserted in the lid component to secure the outer cover to the lid outer face and secure the frame to the lid inner face. The lid can be incorporated into a sterile container and feature an outer cover.

Abstract: Apparatus and methods are described which guide a surgeon in performing a reconstructive or cosmetic procedure. The apparatus and methods utilize three dimensional presentations of the target surgical site incorporating one or more virtual surgical guides which help attain proper alignment and orientation of the post surgical outcome.

Abstract: A medical device processor includes an enclosure for holding at least one medical device, a first reservoir containing a disinfectant therein, a water source containing water therein and in fluid communication with a mixing chamber, and a liquid distribution system configured to deliver disinfectant from the first reservoir to the at least one medical device. The liquid distribution system is configured to deliver water from the water source to the mixing chamber. The liquid distribution system includes a pump and a flow sensor. The pump is operable to deliver the disinfectant from the first reservoir to an internal channel of the at least one medical device. The flow sensor is operable to monitor the disinfectant delivered by the pump to the internal channels of the at least one medical device.

Abstract: An obturator assembly includes an obturator positionable within a lumen of a device and movable within the lumen between a first position and a second position. The obturator includes a distal tip portion, wherein, with the obturator in the first position, the distal tip portion limits fluid communication through the lumen and, with the obturator in the second position, the distal tip portion provides fluid communication through the lumen.

Abstract: A retainer cooperating with a plurality of teeth and configured to stabilize the plurality of teeth, the retainer including at least one elongated arc which is shaped overall adapted to a natural curvature of a lower jaw or an upper jaw, wherein the at least one elongated arc is locally adapted individually to a surface contour of respective abutting teeth, wherein the retainer is machined from a sheet metal plate and includes two mutually parallel surfaces, wherein the sheet metal plate is made from a nickel titanium alloy, preferably a nitinol, wherein the retainer contacts a tooth surface in an installed condition of the retainer, wherein a machined surface of the retainer faces the tooth surface in the installed condition of the retainer, and wherein an upper side or a lower side of the retainer corresponds to an original surface plane of the sheet metal plate.

Abstract: The present disclosure describes devices, systems, and methods for monitoring use of an oral appliance in an oral cavity using extra-oral sensor(s). One method includes sensing one or more physical properties of an oral appliance using an extra-oral sensor, providing a compliance signal from the extra-oral sensor, the compliance signal comprising an electronic representation of the one or more physical properties of the oral appliance, identifying one or more patient compliance factors based on the compliance signal, the one or more patient compliance factors providing a basis to identify an extent of compliance of usage of the oral appliance with an orthodontic treatment plan, and providing one or more compliance indicators based on the one or more patient compliance factors, the one or more compliance indicators providing a basis to indicate the extent of compliance.

Abstract: An aesthetic, stain resistant ligature with material properties suited for prolonged maintenance of sliding mechanics. The orthodontic ligatures of the present disclosure offer a practitioner the ability to tailor the level of tension applied by the ligature without fear of disengagement or deterioration over time.

Abstract: Disclosed herein are embodiments of dental implant arrangements comprising an implant body and an attachment element, wherein the implant body is designed matching the attachment element in such a way that the attachment element is partially insertable into the implant body as far as an abutment surface on the implant body. The attachment element is connected to the implant body by a connection element and is characterized in that an attachment element abutment surface of the attachment element is held against the abutment surface by the connection element. The implant body has a first sealing surface, which is located opposite a second sealing surface of the attachment element. The first sealing surface or the second sealing surface has a sealing seat into which a sealing element is inserted by which the interior of the implant body is sealed off from the environment.

Abstract: An electric toothbrush includes a grip portion, a brush portion, and a joint arrangement for connecting the two portions. The joint arrangement has an upper cylinder portion and a lower cylinder portion, with an axis of the upper cylinder portion being inclined a predetermined angle with respect to an axis of the lower cylinder portion. The grip portion is connected to the lower cylinder portion and the brush portion is connected to the upper cylinder portion, so that the grip portion and the brush portion are inclined by the predetermined angle.

Abstract: A toothbrush comprises a handle section and a brush head. The handle section further comprises a channel having at least one outlet opening which is fluidly coupled to a toothpaste supply, wherein the toothpaste is conveyed from the toothpaste supply via the channel to the at least one outlet opening via a suction process carried out with a mouth of an user.

Abstract: A storage and dispensing system of orthodontic brackets includes a package with an orthodontic bracket. The package has a base and a cap. The base has a post on which the orthodontic bracket is secured. The cap includes a blind bore. The cap surrounds the post and the orthodontic bracket. The cap and the base are configured to form a moisture tight seal therebetween. The orthodontic bracket may be a precoated orthodontic bracket. The base or the cap includes an o-ring. The package is releasably secured to a strip and the strip includes an RFID tag. The package is releasably secured to a strip. The strip includes an RFID tag. A method of manufacturing orthodontic brackets includes placing a predetermined amount of adhesive on an orthodontic bracket, positioning the precoated orthodontic bracket on the base, and placing the cap over the precoated orthodontic bracket and into contact with the base.

Abstract: The device for recording centric jaw relation and orientation jaw relation simultaneously is disclosed that provides an accurate and precise recording of centric jaw relation as well as orientation jaw relation recording and transfer. The device includes a central bar, a centric relation recorder, a dentulous adjustable fork or an edentulous fork, a semi-circular frame, a nasion pointer and an orbital pointer. The central bar is received by a plurality of clamping assemblies that adjustably position the nasion pointer, the adjustable fork or the edentulous fork and the centric relation recorder respectively. The device can be used in case of both, dentulous as well as edentulous subjects. The device can advantageously transfer the centric relation record to any semi-adjustable articulators or non-adjustable articulators.

Abstract: An oral care mouthpiece (10) is disclosed. The mouthpiece includes a shell (15) having an arch shape corresponding to a dental arch. The shell (15) includes a wall corresponding to facial surfaces of teeth in the dental arch, and a bite plate corresponding (157) to biting surfaces of the teeth. The mouthpiece also includes a wicking layer (19) on an inner surface of the wall. The mouthpiece further includes a filament layer (23) on the wicking layer.

Abstract: Calendered surgical meshes comprising polyhydroxyalkanoate polymers have been developed. These meshes, preferably made from poly-4-hydroxybutyrate or copolymer thereof, have a thickness that is between 50 to 99% of the thickness of the mesh prior to calendering, and a burst strength that is not less than 20% of the burst strength of the mesh prior to calendering. The thinner calendered meshes are particularly suitable for surgical applications where a thinner profile mesh with high burst strength is required, and where it is advantageous to have a mesh with a smooth surface. The meshes may be partially or fully resorbable, and are particularly suitable for use in the treatment of pelvic organ prolapse.

Abstract: Provided are porous, biocompatible implant bodies and materials. These materials suitably comprise a population of randomly arranged and entangled thermoplastic constituents, with at least some of the constituents being bonded to one another The implant bodies are capable of being manipulated at room temperature from a first shape to a second shape, and of maintaining the second shape at about internal body temperature. Also provided are related methods of fabricating such implants and installing the implants into a subject.

Abstract: Disclosed is a stent for transluminal implantation in hollow organs, particularly in blood vessels, the ureter, the esophagus, the colon, the duodenum or bile ducts. The stent comprises a first section comprising a substantially tubular first body which extends along a first longitudinal axis and comprises a first lateral end and a first central end; a second section comprising a substantially tubular second body which extends along a second longitudinal axis and comprises a second lateral end and a second central end, wherein the first and second stent sections are connected to each other in the region of the central ends by means of a coupling section, the stent comprising a plurality of cells which are defined by bordering elements formed by the tubular bodies, and wherein the first central end of the first stent section is embodied in a sloping manner.

Abstract: A prosthesis for placement within an aortic root, includes a graft having a proximal end, distal end, and lumen disposed therethrough and a stent assembly disposed at that proximal end of the graft, the stent assembly comprising a first stent unit comprising a first proximal section having a first bend interconnected by a first curved strut and a second curved strut and a second bend interconnected by a third curved strut and a fourth curved strut, the first bend of the first proximal section and second bend of the first proximal section facing each other and circumferentially spaced apart; and a first distal section connected to the first proximal section.

Abstract: A soft tissue fixation system, most typically applicable to orthopedic joint repairs, such as anterior cruciate ligament (ACL) knee repair procedures, comprises an implant which is placeable in a tunnel disposed in a portion of hone, wherein the tunnel is defined by walls comprised of bone. A first member is deployable outwardly to engage the tunnel walls for anchoring the implant in place in the tunnel, and a second member is deployable outwardly to engage tissue material to be fixed within the tunnel. The second member also functions to move the tissue material outwardly into contact with the tunnel walls to promote tendon-bone fixation. Extra graft length is eliminated by compression of the tendon against the hone at the aperture of the femoral tunnel, which more closely replicates the native ACL and increases graft stiffness. The inventive device provides high fixation of tendon to bone and active tendon-bone compression.

Abstract: The present disclosure describes various embodiments of adjustable implants, particularly permanent breast implants, intended for implantation into a subject, particularly a human subject. In some embodiments, the adjustable implant comprises a shell including a resilient shell membrane, a first reservoir containing a fluid, e.g., a saline, a second reservoir including a resilient second-reservoir membrane, and a pump. The pump may include a first pump actuator, a first pump inlet, and a first pump outlet. The first reservoir and second reservoir may be disposed within the shell and be in fluid communication via the pump. Fluid may be transferred between the two reservoirs to change the profile of the implant.

Abstract: An eye-implantable electrowetting lens can be operated to control an overall optical power of an eye in which the device is implanted. A lens chamber of the electrowetting lens contains first and second fluids that are immiscible with each other and have different refractive indexes. By applying a voltage to electrodes of the lens, the optical power of the lens can be controlled by affecting the geometry of the interface between the fluids. To facilitate implantation of such an eye-implantable device, components of the device may be inserted individually and the device may be assembled in situ. In situ assembly could allow insertion of components of the device into the eye through an incision that is smaller than the assembled device, reduce a chance of failure of the device, reduce the mechanical and/or chemical seal requirements of the assembled, or allow for modular device design.

Abstract: Tubular prostheses are provided for use in airways, upper digestive, and urinary tracts. Each of these uses has its own specific sets of biological specifications, based on what it must contain and exclude and the physical and chemical pressures and stresses to which it is subjected. The prostheses may be made from allogeneic cells. Thus they can be manufactured and stored prior to an individual's personal need arising.

Abstract: An implantable prosthetic device includes a spacer member configured to be disposed between leaflets of a native heart valve that is located between a first chamber and a second chamber of the heart. The prosthetic device further includes a plurality of anchor members coupled to the spacer member and configured to capture the leaflets between respective anchor members and the spacer member such that the prosthetic device is retained between the leaflets. The spacer member is configured to provide a flow path through the prosthetic device between the first chamber and the second chamber when the leaflets are captured between the anchor members and the spacer member such that blood can flow regurgitatively from the second chamber to the first chamber through the spacer member.

Abstract: A pair of paddles are moved laterally away from one another in an exemplary method of repairing a native valve of a patient during a non-open-heart procedure. After the paddles are moved laterally away from one another, first and second gripping members are moved from an open position to a closed position to grasp valve leaflets. The paddles are then moved laterally toward one another. A cam can be used to move the paddles away from one another.

Abstract: An exemplary valve repair system for repairing a native valve of a patient during a non-open-heart procedure has a delivery device and a valve repair device. The valve repair device is configured to be delivered through a lumen of the delivery device and to attach to a native valve of a patient. The valve repair device has first and second paddles and first and second gripping members. The first and second paddles are movable between an open position and a closed position. The first gripping member is attached to the first paddle and the second gripping member is attached to the second paddle. The gripping members are configured to attach to the native valve of the patient. A gripper control mechanism is configured to separately move the first and second gripping members.

Abstract: This application relates to methods, systems, and apparatus for replacing native heart valves with prosthetic heart valves and treating valvular insufficiency. In a representative embodiment, a support frame configured to be implanted in a heart valve comprises a main body formed by formed by a plurality of inner members forming an inner clover and a plurality of outer members forming an outer clover. The support frame can include gaps located between inner members of the plurality of inner members and outer members of the plurality of outer members. The inner clover can be radially inside the outer clover, and the outer clover can have larger dimensions than the inner clover. The support frames herein can be radially expandable and collapsible.

Abstract: A prosthetic heart valve can include a frame, a valve component, and a sealing member. The frame can have an inflow end portion, an outflow end portion, an intermediate portion disposed between the inflow and outflow end portions, and a plurality of struts. The frame can be radially compressible and expandable between a radially-compressed configuration and a radially-expanded configuration. The valve component can be disposed within and coupled to the frame and have a plurality of leaflets. The sealing member can have a plurality of ribs and a plurality of drapes. The ribs can be coupled to and extend radially outwardly from the frame when the frame is in the radially-expanded configuration. The drapes can be coupled to and extend radially between the frame and the ribs. The sealing member can be configured to reduce or prevent perivalvular leakage around the prosthetic heart valve.

Abstract: A prosthetic valve having a frame, a leaflet structure having leaflets forming a primary valve mounted inside the frame, and at least one secondary valve is disclosed. The secondary valve can have a valve element with stationary portion and a detached portion, and at least one aperture in at least one leaflet. The secondary valve can be formed by a portion of at least one leaflet.

Abstract: A mitral valve prosthesis includes an expandable frame having a proximal end, a distal end, and a middle portion. A plurality of tips extend from the proximal end of the frame for attachment to a delivery catheter. A plurality of anchors are disposed along the distal end of the frame and extend toward the proximal end for engaging tissue. An outer circumferential portion extends around the middle portion of the frame and is positioned radially outwardly of the frame. The outer circumferential portion preferably increases in diameter along a distal direction. A distal end of the outer circumferential portion is located distal of free ends of the anchors when the expandable frame is deployed. A valve body is positioned within an interior of the expandable frame and includes leaflets adapted to allow flow in a first direction and prevent flow in a second direction.

Abstract: Apparatus is provided for use with a prosthetic valve for implantation at a patient's native heart valve. The apparatus includes an implant and a tool. The implant includes a plurality of metal segments coupled at a plurality of joints to define a ring having upper joints and lower joints disposed along the ring. The implant also includes a plurality of anchors coupled to the ring at the joints. The tool is couplable to the implant, and is configured to anchor the implant at the native heart valve by rotation of the tool. Other embodiments are also described.

Abstract: A valved conduit including a bioprosthetic valve, such as a heart valve, and a tubular conduit sealed with a bioresorbable material. The bioprosthetic heart valve includes prosthetic tissue that has been treated such that the tissue may be stored dry for extended periods without degradation of functionality of the valve. The bioprosthetic heart valve may have separate bovine pericardial leaflets or a whole porcine valve. The sealed conduit includes a tubular matrix impregnated with a bioresorbable medium such as gelatin or collagen. The valved conduit is stored dry in packaging in which a desiccant pouch is supplied having a capacity for absorbing moisture within the packaging limited to avoid drying the bioprosthetic tissue out beyond a point where its ability to function in the bioprosthetic heart valve is compromised. The heart valve may be sewn within the sealed conduit or coupled thereto with a snap-fit connection.

Abstract: A delivery system and method for delivering a prosthetic heart valve to the aortic valve annulus via a transaortic approach. The system includes a balloon catheter for delivering a balloon-expandable prosthetic heart valve through an introducer from an approach from outside the patient, through a minimally-invasive opening in the chest cavity through an incision in the aorta, and into the aorta and aortic annulus. The balloon catheter includes a flexible, tapered tip just distal of the balloon to facilitate positioning of the prosthetic heart valve in the proper orientation within the aortic annulus. The prosthetic heart valve may be installed over the existing calcified leaflets, and a pre-dilation valvuloplasty procedure may also be utilized.

Abstract: Medical devices and methods for making and using medical devices are disclosed. An example system medical device delivery system includes an outer shaft having a proximal end region, a distal end region and a lumen extending therein. The delivery system also includes an inner shaft having a proximal end region, a distal end region and a lumen extending therein, wherein the inner shaft extends within at least a portion of the lumen of the outer shaft. The delivery system also includes a tip member disposed the along the distal end region of the outer shaft, the tip member including a proximal end region and a distal end region; wherein the outer shaft and the inner shaft are configured to position an implantable medical device therebetween and wherein the tip member includes an annular groove positioned adjacent the proximal end region of the tip member.

Abstract: A medical device delivery system includes an outer shaft having an outer shaft lumen extending therethrough and an inner shaft that is slidingly disposable within the outer shaft lumen. A coupler assembly is secured to a distal end region of the inner shaft and includes an elongate tubular member including a proximal region and a distal region, the proximal region of the elongate tubular member secured to the distal end region of the inner shaft, a plurality of fingers extending distally from the distal region of the elongate tubular member that are adapted to releasably engage an implantable medical device and a plurality of sheathing aids extending distally from the distal region of the elongate tubular member that are adapted to guide the medical device back into the outer shaft lumen.

Abstract: Tools and methods are provided for delivering a device to a native valve of a patient's heart. A catheter can include a flexible tube, a plurality of links, and a control wire. Applying tension to the control wire pulls on the links, which causes links to bend the flexible tube.

Abstract: An anchor includes (a) an anchor head; and (b) a tissue-engaging member extending distally away from the anchor head until a distal tip of the tissue-engaging member, and configured to anchor the anchor to tissue. An anchor driver can include (a) a longitudinal shaft, having a flexible distal portion and a distal end; (b) a deployment element at the distal end of the shaft, reversibly lockable to the anchor head, and reversibly movable between (i) a locked state that retains locking between the deployment element and the anchor head, and (ii) an unlocked state that unlocks the deployment element from the anchor head; and (c) a tissue-piercing lance, reversibly movable between (i) an extended state in which the lance extends distally from the shaft past the distal tip of the anchor, and retains the deployment element in the locked state, and (ii) a retracted state in which the deployment element automatically moves into the unlocked state.

Abstract: A limb sparring system for replacing a portion of a radius, the radius being adjacent to an ulna, the system comprising a cutting guide including a cut guiding portion for guiding a saw when making a predetermined cut in the radius to excise the portion of the radius, an opposed ulnar mounting portion mountable to the ulna, and a linking portion extending therebetween; and an endoprosthesis configured for replacing the portion of the radius after the portion of the radius has been excised. When the cutting guide is operatively mounted to the radius and ulna, the cut guiding portion and the ulnar mounting portion engage respectively the radius and the ulna in a predetermined spatial relationship relative thereto.

Abstract: Mandible endoprosthesis implant and mandible endoprosthesis implant system and surgical kit comprising the same, the mandible endoprosthesis implant comprising: first end second implant elements which can be coupled in a manner so as to allow a relative pivotal movement therebetween. The present disclosure further provides methods for surgically repairing a mandible.

Abstract: A soft anchor surgical fixation device includes two soft anchoring implants. The implants have a first elongate state where the implants may slide easily through a bone hole or tunnel, and a second axially compressed state where the implants are prevented from sliding through the bone hole or tunnel. The device also includes a suture pathway extending at least partially along and through the sidewalls of the implants. Tension on the suture transitions the implants from the first elongate state to the second compressed state.

Abstract: An augment device includes a hollow sleeve surrounding a channel extending through the hollow sleeve from a top to a bottom of the hollow sleeve, the hollow sleeve comprising a wall having an inner face and an outer face. The hollow sleeve includes at least one bending joint, the bending joint being configured for compressing the channel. Thereby the hollow sleeve may be compressed under an external force, leading to a decreased circumference and width of the hollow sleeve. This leads to a gap between the perimeter of the augment device and surrounding bone material, breaking any connections. By virtue of this, a much facilitated removal of the augment device can be achieved. Further, an extraction tool includes grippers for engaging and compressing the augment device, and further instruments, particularly a jig, for achieving an effective removal.

Abstract: The present invention relates to a device and system for surgical fixation of small bones, small bone fragments, and osteotomies and more particularly to compression screw having an elongated and spiked tapered threaded leading portion which is joined to a section that is free from threads and a threaded trailing portion and more sharply tapered head which has threads that continue from the threads of the leading portion.

Abstract: Systems and methods for planning surgical procedures involving custom medical implants that can involve the selection, design and/or creation of custom medical implants and/or the selection, modification, and/or design of custom surgical procedures related to those implants. Certain embodiments allow implants to be selected, designed, created, or otherwise customized and then placed in patients using non-standard surgical techniques. The invention provides greater flexibility in implant use by allowing a surgeon to revise, create, or otherwise select surgical techniques for custom implants and, ultimately, provide better treatment in a greater variety of medical circumstances. Certain embodiments of the invention involve computer assisted surgery to provide for implant-related surgery involving non-standard surgical steps and/or implants.

Abstract: Presented are methods and systems for determining, monitoring, and displaying the relative positioning of two rigid bodies during surgery. In particular, the present disclosure relates to methods and systems for positioning a prosthesis relative to a bone during a surgery as well as to systems and methods for verifying resulting relative positioning of adjacent bones.

Abstract: Improved ankle prosthesis. The invention concerns an ankle prosthesis (100), comprising a talar component (200) which includes a talar upper face (201) defining a first articular surface (202) and which extends between a talar anterior edge (203) and an opposite talar posterior edge (204) according to a first average direction, said first articular surface (202) being curved according to said first average direction, said first articular surface (202) comprising a first curved portion (202A) and a second curved portion (202B), each extending according to said first average direction, said first curved portion (202A) having a first curvature and said second curved portion (202B) having a second curvature, said prosthesis (100) being characterized in that said first curved portion (202A) and said second curved portion (202B) define respectively an anterior portion and a posterior portion of said first articular surface (202), said first curvature being greater than said second curvature. Ankle prostheses.

Abstract: The present invention relates to a device and system for surgical fixation of small bones, small bone fragments, and osteotomies and more particularly to compression screw having a threaded leading portion which is joined to a section that is free from threads, and which includes an angle or from 12° to 25° in a plane through the longitudinal axis of the screw and a portion which is joined to a head having a configuration that is intended to provide anti-rotational stability and compression through the device.

Abstract: A system for implanting an interbody device between adjacent vertebrae comprises an interbody device having a plurality of lobes extending outwardly from a longitudinal rib, and having a relaxed shape approximating the shape of the disc being replaced. An insertion guide has a bore therein from a proximal end to a distal end thereof to accept the interbody device in an unrelaxed shape. The distal end is shaped for insertion into an intervertebral space. The insertion rod may be positioned within the bore of the insertion guide whereby the interbody device is positioned within the intervertebral space by advancing the insertion rod into the insertion guide.

Abstract: An interbody fusion device includes a base member, a top member, and an expansion mechanism for moving the top member relative to the base member. The expansion mechanism may include a connector drive rod assembly, a gear, a threaded rod, and a support means. The gear ring is coupled to the threaded rod and is rotatable. The expansion mechanism may also include at least one load head coupled to the threaded rod. An alternative interbody fusion device is also disclosed and includes a bottom member, a superior member, and an expansion mechanism for moving the superior member relative to the base member, wherein the expansion mechanism comprises at least one expansion assembly for moving an end of the superior member relative to the bottom member.

Abstract: Described here are deformable, monolithic, stabilization implants suitable for use within bone and between bones to fuse vertebral bodies, to repair herniated discs, or to repair spinal compression fractures. The implants are introduced into a chosen site at a first, smaller height and then plastically deformed to achieve a second, but unique, pre-selected, larger height. Variations of the device provide one or more specific larger heights. The devices are suitable as intervertebral spinal fusion implants for the immobilization of adjacent vertebral bodies. Methods of and instruments for deployment of the implants are also described. Also described are variations of the device suitable as sizing instruments.