Abstract: A treatment method is disclosed, which includes preparing a catheter assembly by inserting an inner catheter into an outer catheter and screwing a protrusion of the outer catheter into a helical groove of the inner catheter; introducing the catheter assembly into the radial artery along a guide wire; pushing the catheter assembly along the guide wire to a target site in front of a stenosis of a blood vessel; releasing the screwing between the helical groove of the inner catheter and the protrusion of the outer catheter after a distal end of the catheter assembly reaches the target site; and causing the outer catheter to abut on at least a part of wall surfaces of a thoracic aorta and an abdominal aorta while drawing a helix and causing the treatment device to protrude from a distal end of the outer catheter at the stenosis.

Abstract: The disclosure discloses a universal robot for interventional angiographic surgery and interventional therapeutic surgery. The robot meets the needs of both angiographic surgery and therapeutic surgery, which facilitates the clinical use. The robot is universal for both angiographic surgery and interventional therapeutic surgery, with advantages of simple structure, good stability, modular structure design, and so on, which is suitable for operation environment. By measuring the push and pull force of the micro force sensor at the driving end, the change of the axial friction force of the guide wire is judged, which gives the doctor timely reminder and protects the safety of patients. According to the feedback value of the high precision load cell at the driven end, the clamping degree of the guide wire is adjusted at any time to ensure there is no slipping phenomenon, which meets the needs of vascular interventional surgery.

Abstract: A catheter has a distal assembly with at least one loop with ring electrodes. A single continuous puller wire for bidirectional deflection is pre-bent into two long portions and a U-shape bend therebetween. The U-shape bend is anchored at a distal end of a deflectable section which is reinforced by at least one washer having at least two holes, each hole axially aligned with a respective lumen in the deflectable section. Each hole is centered with a lumen so that each puller wire portion therethrough is straight and subjected to tensile force only. A proximal end of the support member is flattened and serrated to provide a better bonding to the distal end of the deflectable section.

Abstract: A method of delivering a prosthetic heart valve to the aortic valve annulus while a patient's heart is beating is disclosed. The method includes accessing the left ventricle through an intercostal incision and forming a puncture in the left ventricle. A guidewire is advanced into the left ventricle and through the native aortic valve. An introducer is passed over the guidewire and into the left ventricle. A valve delivery device is advanced over the guidewire and through the introducer until a prosthetic heart valve positioned thereon is located within the native aortic valve. The prosthetic heart valve is then radially expanded within the aortic valve annulus for replacing the function of the native aortic valve.

Abstract: Methods for treating a patient using therapeutic renal neuromodulation and associated devices, systems, and methods are disclosed herein. One aspect of the present technology, for example, is directed to a catheter apparatus including an elongated shaft defined by a braid embedded within a polymer. The braid can include one or more thermocouple assemblies intertwined with a braiding element. The thermocouple assemblies can be coupled to one or more electrodes at a distal portion of the shaft.

Abstract: An interface structure for detachably interfacing a surgical robot arm to a surgical instrument, the interface structure comprising a main body; and a drive transfer element comprising a first portion and a second portion, the first portion being releasably engageable with a portion of the surgical robot arm and the second portion being releasably engageable with a portion of the surgical instrument; the drive transfer element being movable relative to the main body so as to enable transfer of drive between the surgical robot arm and the surgical instrument.

Abstract: A catheter manufacturing method includes the step of providing a hollow cylindrical part of a catheter, having a longitudinal axis, to be bonded to a given part along respective edge surfaces of the hollow cylindrical and the given parts. One or more undercut structures that are disposed circumferentially with respect to the longitudinal axis and also generally parallel to the longitudinal axis, the undercut structures having a radial orientation with respect to the longitudinal axis, are formed at least in the edge surface of the hollow cylindrical part. The hollow cylindrical part and the given part are connected using the undercut structures.

Abstract: An endoscope with a folding mechanism for foldably or bendably holding an endoscopy head at the distal end of the endoscope, preferably an endoscope shaft, having a number of axially successive segments that are adjustable via an actuating element. The segments define at least one channel for the passage of minimally invasive surgical instruments, flushing media, supply lines and the like. The segments are in the form of wedge-shaped cylinder sections having end faces oriented relative to each other in a wedge-shaped manner. Each cylinder section receives a cylinder jacket portion having a minimum axial length and an opposite cylinder jacket portion having a maximum axial length. Two directly adjacent segments are mutually oriented such that they are axially supported on or axially abut the relevant cylinder jacket portions of maximum axial length, which results in hinge- or joint-contact occurring on the support or placement point.

Abstract: An imaging catheter assembly is provided. In one embodiment, the imaging catheter assembly includes a flexible elongate member including a distal portion and a proximal portion; a crown element coupled to the distal portion, wherein the crown element includes an annular ring, a first post and, a second post, and wherein the first post and the second post extend from the annular ring; a first pullwire anchored to the annular ring at the first post and extending along the flexible elongate member from the crown element to the proximal portion of the flexible elongate member; a second pullwire anchored to the annular ring at the first post and extending along the flexible elongate member from the crown element to the proximal portion of the flexible elongate member; and an imaging component coupled to the distal portion.

Abstract: Catheter-based delivery systems for delivery and retrieval of a leadless pacemaker include features to facilitate improved manipulation of the catheter and improved capture and docking functionality of leadless pacemakers. Such functionality includes mechanisms directed to deflecting and locking a deflectable catheter, maintaining tension on a retrieval feature, protection from anti-rotation, and improved docking cap and drive gear assemblies.

Abstract: A device for providing a magnetic treatment by evoking muscle contraction by a time-varying magnetic field and providing a RF treatment by heating biological structure. The device may provide a pressure treatment. The device includes an applicator having an RF electrode and a magnetic field generating device. The device may also include a main unit, a human machine interface, and a control unit. The control unit adjusts a signal provided to the RF electrode and creates an RF circuit, and also adjusts the signal provided to the magnetic field generating device and creates a magnetic circuit electrically insulated from the RF circuit. The RF circuit may include a power source and a power amplifier, and the magnetic circuit may include an energy storage to supply the magnetic field generating device with electric current.

Abstract: Vascular filters and deflectors and methods for filtering bodily fluids. A blood filtering assembly can capture embolic material dislodged or generated during an endovascular procedure to inhibit or prevent the material from entering the cerebral vasculature. A blood deflecting assembly can deflect embolic material dislodged or generated during an endovascular procedure to inhibit or prevent the material from entering the cerebral vasculature.

Abstract: A catheter device includes a shaft having a steerable distal portion and a plurality of layers including a braided layer. A first pull-wire lumen is disposed at least partially within the braided layer, and a second pull-wire lumen is disposed at least partially within the braided layer. The first pull-wire lumen and the second pull-wire lumen are circumferentially spaced apart from each other in the steerable distal portion of the shaft.

Abstract: A system for manipulating a guide catheter within a patient's nasal passages or sinus cavities includes a guide catheter formed from an elongate flexible member having a lumen passing there through. A wire guide is slidably disposed within the lumen of the guide catheter. The system further includes a steering member fixedly secured to a proximal end of the wire guide and a proximal hub secured to a proximal end of the guide catheter. The system further includes a recessed handle having a first recess for fixedly receiving the proximal hub of the guide catheter and a second recess for receiving the steering member, the second recess being dimensioned to permit axial and rotational movement of the steering member while disposed in the second recess.

Abstract: A medical device that includes a handle, a shaft extending distally from the handle, an end effector extending distally from the shaft, a first actuator movably coupled to the handle, and a second actuator movably coupled to the handle. The first actuator is configured to (1) articulate the shaft in response to translating the first actuator in a first direction relative to the handle and the second actuator, and (2) actuate the end effector in response to translating the first actuator in a second direction relative to the handle and the second actuator. The second actuator is configured to (1) articulate the shaft in response to translating the second actuator in the first direction relative to the handle and the first actuator, and (2) actuate the end effector in response to translating the second actuator in the second direction relative to the handle and the first actuator.

Abstract: A bi-directional steerable catheter adapted for delivery into a patient's vasculature. The pull wires which are used to tension the deflectable segment of the steerable catheter are wound in parallel around the axis of the steerable catheter on opposite sides of the steerable catheter.

Abstract: A device for positioning a coronary stent within coronary arteries is described. The device has a housing having a cylindrical front part and an internally-threaded cylindrical rear part connected to each other by a slot allowing the cylindrical rear part to rotate around an axis. The cylindrical front part of the housing is provided with recesses for fixing a coronary guide. A runner is provided with projections for engaging an internal thread of the cylindrical rear part of the housing. The device includes a structure for clamping disposed in a threaded runner cap. The runner is disposed inside a retainer with ears projecting into side holes on both sides of the housing. Clamping is operable by rotation of the rear part of the device housing. A method for positioning a coronary stent within coronary arteries is also described.

Abstract: An electrophysiology catheter includes an elongated support member with shape-memory as a first composite component and an elongated outer tubing as a second composite component, the support member defining a longitudinal axis of the catheter, the support member including a distal portion with a plurality of single-axis sensors, and the elongated outer tubing generally coextensive with the elongated support member, the tubing including a side wall surrounding a lumen through which the support member extends and joins with the outer tubing to form a catheter, the tubing including conductive wires embedded in the side wall and ring electrodes on an outer surface of the side wall, each ring electrode in conductive contact with a respective conductive wire.

Abstract: A spacer member is provided that is configured to be implanted adjacent an anatomical structure. The spacer member defines a curved bore, a first opening in a side wall of the spacer member and a second opening in one of a top wall and a bottom wall of the spacer member. Each of the first opening and the second opening are in fluid communication with the curved bore. A flexible anchoring member is configured to be inserted through the side opening and through the curved bore of the spacer member such that a distal end portion of the flexible anchoring member extends out of the second opening at an angle relative to the one of the top wall and the bottom wall of the spacer member.

Abstract: A medical device including a catheter body, a first elongate body, and a service loop ring. The catheter body has a catheter shaft. The first elongate body extends through at least part of the catheter shaft and is configured to move longitudinally in the catheter shaft. The first elongate body is looped through the service loop ring to form a service loop configured to expand and contract as the first elongate body moves longitudinally in the catheter shaft.

Abstract: A suturing instrument includes a handle, an elongate shaft, and a suturing head. One or more pull wires extend from the handle into the elongate shaft for controllably deflecting a deflectable portion of the elongate shaft in one or more directions and/or planes for improved maneuverability within the body of a patient during an endoscopic or laparoscopic surgical procedure and for changing the positioning of the suturing head.

Abstract: A torque cable that comprises an inner layer and an outer layer. The inner layer includes a plurality of wires that form a braiding pattern. A first set of wires of the inner layer is directed in a proximal direction and a second set of wires of the inner layer is directed in a distal direction. The outer layer includes a plurality of wires that form a braiding pattern. A first set of wires of the outer layer is directed in a proximal direction and a second set of wires of the outer layer is directed in a distal direction.

Abstract: Devices used to treat tissue, including treatment of vertebral bone fractures, are disclosed. The devices may be configured to displace bone tissue using an expandable member, such as a balloon. The devices may further include a handle having a rotatable grip configured to apply a tension force to a plurality of pull wires to articulate a distal portion of the devices.

Abstract: An apparatus includes a handle assembly, a shaft assembly, and an end effector. The handle assembly includes a body and an actuator. The actuator includes a rotary member that is configured to be driven by a finger of a hand that grasps the handle body. The shaft assembly includes an external sheath that is fixed to the handle body and an inner shaft that is coupled to the actuator. The inner shaft is configured to slide longitudinally relative to the external sheath in response to rotation of the first rotary member relative to the handle body. The end effector is configured to encompass a bodily lumen and includes a flexible member extending distally from the inner shaft. A first coupling element is fixed to the distal tip of the flexible member. A second coupling element is fixed to the external sheath. The flexible member defines an adjustable loop.

Abstract: Embodiments of delivery systems, devices and methods for delivering a prosthetic heart valve device to a heart chamber for expanded implementation are disclosed. More specifically, methods, systems and devices are disclosed for delivering a self-expanding prosthetic mitral valve device to the left atrium, with no engagement of the left ventricle, the native mitral valve leaflets or the annular tissue downstream of the upper annular surface during delivery, and in some embodiments with no engagement of the ventricle, mitral valve leaflets and/or annular tissue located downstream of the upper annular surface by the delivered, positioned and expanded prosthetic mitral valve device.

Abstract: A medical system includes a plurality of tubes configured to be arranged about a periphery of an insertion device. A lumen of each of the plurality of tubes is configured to receive a medical device. Each of the tubes is configured to be coupled to the periphery of the insertion device and is moveable from a collapsed configuration adjacent the periphery of the insertion device to an expanded configuration further radially outward of the periphery of the insertion device as compared to the collapsed configuration.

Abstract: A medical device that includes a handle, a sheath extending from the handle, and a tool within the sheath and movable relative to the sheath. The handle includes an inner body and an outer body disposed over the inner body. The outer body is movable relative to the inner body. The handle includes a first actuator secured to the tool. The first actuator has an actuated state permitting movement of the tool relative to the sheath in response to moving the outer body relative to the inner body. The handle includes a second actuator secured to the sheath. The second actuator has an actuated state permitting movement of the sheath relative to the tool in response to moving the second actuator relative to the outer body. An unactuated state of the first actuator and an unactuated state of the second actuator prevents movement of the tool relative to the sheath.

Abstract: A deflectable catheter shaft with compression resistance coils configured to create different curve shapes when the catheter is steered or deflected in different directions. One or more compression resistance coils may include an elongated-pitch section. The compression resistance coils may be pull wire compression coils or body compression coils.

Abstract: Catheters, sheaths, or other tubular devices are provided that include a proximal end, a distal end sized for introduction into a patient's body, and a steerable distal portion. The tubular device includes a primary lumen extending between the proximal and distal ends; an auxiliary lumen adjacent the primary lumen; and one or more reinforcement members including windings extending helically along at least the distal portion, at least some of the windings passing between the primary and steering element lumens and at least some of the windings surrounding both the primary and steering element lumens. In one embodiment, a steering element is slidably disposed within the auxiliary lumen. Apparatus and methods for making such tubular devices are also provided.

Abstract: A vascular access wire is disclosed. The vascular access wire includes an elongated core member and a distal tip. The Distal tip comprising a crank configured with a crank distal surface and a crank center of rotation. The crank is configured to rotate about the crank center of rotation when the core member is sufficiently loaded axially and when the crank distal surface is pressed against a wall of a target blood vessel, for triggering or affecting a deflecting and/or a deforming of the core member proximally to the crank.

Abstract: A medical device has a distal member with a configuration that can be changed by means of a control handle with a control assembly employing a rotational cam, a shaft, and a pulley, where the rotational cam is rotationally mounted on a portion of the control handle for rotation by a user. The rotational cam operates on the shaft to move it proximally or distally depending on the direction of rotation which in turn rotates the pulley to draw or release a puller wire to change the configuration of the distal member of the medical device. The shaft is oriented along a diameter of the control handle. The shaft has two ends which extends through two axial guide slots in the portion of the control handle to sit two opposing helical tracks formed on inner surface of the rotational cam. The guide slots are parallel with the longitudinal axis of the control handle and therefore maintain the shaft's diametrical orientation as the rotational cam is rotated to move the shaft proximally or distally.

Abstract: A catheter includes a handle and an elongate member extending from the handle. The catheter may also include steering system coupled to the handle. The steering system may be configured to deflect at least a portion of the elongate member in at least one direction. The catheter may also include a locking mechanism configured to lock the portion of the elongate member in a deflected configuration, and a lever coupled to the handle. The lever may be configured to move from a first position to a second position to engage the locking mechanism. The lever may also be configured to be separably retained at least at one of the first position or the second position to prevent movement therebetween.

Abstract: A work channel arrangement of an endoscope for guiding medical tools and/or for the through-flow of media. The work channel arrangement has a work channel which is flexible at least in part and extensible relative to the endoscope and which can be moved from a first position, in which the work channel outlet is oriented in the axial direction of the endoscope head, to a second position in which it is extended in the distal direction relative to the first position and in which the work channel outlet is or can be deflected, by means of a guide mechanism, to a predetermined lateral or rearward direction.

Abstract: A scope device includes a shaft, a deflectable portion, and a handle portion. The shaft is inserted through a body lumen to a target area within a body. The shaft defines first and second lumens extending along a proximal portion thereof. The first and second lumens are merged to form a common lumen along a distal portion thereof via a fitting having a structure which, when connected to the first and second lumens, converge the first and second lumens toward the common lumen. The deflectable portion is connected to the distal end of the shaft and includes a channel aligned with and in communication with the common lumen. The handle portion includes a connector having a first hub including a first channel open to and in communication with the first lumen and a second hub including a second channel open to and in communication with the second lumen.

Abstract: A motion feedthrough for a surgical drape, the motion feedthrough comprising a drive transfer element comprising a first portion and a second portion, the first portion being releasably engageable with a portion of a robot arm and the second portion being releasably engageable with a portion of an instrument, the drive transfer element being movable relative to a bulk portion of the drape so as to transfer drive between the robot arm and the instrument.

Abstract: A deflectable vascular catheter includes a proximal handle assembly, an elongated sheath extending distally from the proximal handle assembly and including a deflectable distal end portion, an actuation mechanism operatively associated within an interior cavity of the proximal handle assembly for deflecting the distal end portion of the sheath, an anchor ring located at a distal end of the deflectable distal end portion of the sheath, and a pull wire extending from the actuation mechanism to the anchor ring. The pull wire has a non-circular cross-section and is laser welded to an exterior surface of the anchoring ring.

Abstract: A catheter system including a wire, a translatable catheter, and first and second tethers is introduced into a body of a subject. The translatable catheter has a curved portion proximate a distal end of the translatable catheter. The first tether is coupled to the wire, and passes proximally through the translatable catheter. The second tether is attached to the curved portion. The catheter system is positioned such that the wire is disposed at a first location in the body. While the wire remains at the first location, the translatable catheter is translated away from the wire by manipulating the first tether and the second tether. Other embodiments are also described.

Abstract: Devices, systems and methods are described herein to provide improved steerability for delivering a prosthesis to a body location, for example, for delivering a replacement mitral valve to a native mitral valve location. The steerable delivery system can contain a steerable rail configured for multi-plane bending to direct a distal end of the delivery system.

Abstract: A handle shaft is disposed at a proximal end of a catheter. A wire extends from a distal part of the catheter, proximally through the catheter to the handle shaft. A knob is disposed outside of the handle shaft. A threaded mechanism provides operative coupling between the knob and the handle shaft such that (i) rotation of the knob with respect to the handle shaft alters tension in the wire via the threaded mechanism functioning as a linear actuator; and (ii) non-rotational axial movement of the knob with respect to the handle shaft alters tension in the wire without the threaded mechanism functioning as a linear actuator. Other embodiments are also described.

Abstract: A medical probe includes a shaft, an expandable membrane and a probe maneuvering assembly (PMA). The shaft is configured for insertion into a cavity of an organ of a patient. The PMA is located inside the expandable membrane and includes a first elastic element, which is fitted along a longitudinal axis of the PMA and is configured to expand the membrane by shortening the PMA, and to collapse the membrane by elongating the PMA. The PMA further includes a second elastic element, which surrounds at least a portion of the first elastic element and is configured to deflect the membrane relative to the longitudinal axis.

Abstract: Disclosed herein are a catheter assembly and method of applying a catheter assembly. In an example, the catheter assembly can include a catheter body and frame member extending between proximal and distal portions, the frame member having a first mechanical characteristic, and a floating sleeve coupled around the frame member and extending between the proximal and distal portions, the floating sleeve having a second mechanical characteristic different than the first mechanical characteristic. The floating sleeve can include at least one floating segment and one or more anchor segments along the catheter body. The at least one floating segment of the floating sleeve can be moveable relative to the frame member, and the one or more anchor segments of the floating sleeve can be interconnected with the frame member.

Abstract: A device for removing a clot from a vessel can have dual layers where an inner expandable body runs within an outer expandable body. The device can have a collapsed delivery configuration, an expanded deployed configuration, and a clot pinching configuration. The inner and outer bodies can be a plurality of cells formed by a network of struts. The openings of the cells align when the device is deployed within the clot, where the radial force from the expanding bodies urges portions of the clot through the openings. The inner and outer bodies can be configured to be selectively translatable relative to each other, so that the portions of the clot in the cell openings can be compressed and gripped when the translation transitions the device to the clot pinching configuration. The translation can be maintained to pinch the clot as it is retrieved from the patient.

Abstract: The present disclosure relates to devices, systems and methods for endoscopic suturing or stitching through an access tube or the like. An endoscopic stitching device is provided and includes a handle assembly; an elongate shaft supported by and extending from the handle assembly; and an end effector supported on a distal end of the elongate shaft. The end effector includes a neck assembly configured and adapted for articulation in one direction between a substantially linear configuration and an off-axis configuration, and a pair of juxtaposed jaws pivotally associated with one another. Each jaw defines a suture needle receiving recess formed in a tissue contacting surface thereof.

Abstract: A medical device comprises a control system, processing modules, and a wire bundle connecting the control system to the processing modules, the wire bundle comprising control lines and data lines. Each processing module is coupled to a respective set of sensors arranged to interface with a biological tissue site, the sensors being configured to capture analog physiological signals generated from the biological tissue site. The control system is configured to generate a control signal on the control lines to initiate a data collection cycle by the processing modules. In response to the control signal, each processing module is configured to perform a respective data collection process which comprises (i) capturing and processing an analog physiological signal on each enabled sensor to generate a data sample for each analog physiological signal captured on each enabled sensor, and (ii) outputting data samples to the control system on the data lines.

Abstract: Surgical instruments with rotation stop devices and related methods are disclosed herein, e.g., for providing limited rotation between first and second components of the surgical instrument in a range greater than 360 degrees. Exemplary rotation stop devices can have a low profile and can include various features to facilitate packaging of the device within a larger instrument.

Abstract: Described are methods, systems, devices for facilitation of intraluminal medical procedures within the neurovasculature. A catheter advancement device includes a flexible elongate body having a proximal end, a distal end, and a single lumen extending therebetween. The flexible elongate body has a proximal segment, an intermediate segment, and a tip segment. The proximal segment includes a hypotube coated with a polymer. The intermediate segment includes an unreinforced polymer having a durometer of no more than 72D. The tip segment is formed of a polymer different from the intermediate segment and has a durometer of no more than about 35D and a length of at least 5 cm. The tip segment has a tapered portion that tapers distally from a first outer diameter to a second outer diameter over a length of between 1 and 3 cm.

Abstract: A system of needles having rudders or keels is provided having perforations, such as kerfs, to allow the needles to be bent by the manipulations of wires imbedded within the needle body. The pulling or pushing of the embedded wires, or stylets, causes the needle tip to be bent, while within the body, to allow the needle to be steered past impediments towards the target necessitating treatment. Wires can be pulled or pushed and in some instances both a push and pull wire are provided to give the needle precision steerability. The needles are provided with a keel or rudder, or can be shaped such as with a teardrop cross-section, to give a degree of stabilization to the course the needle, and attendant tubing, takes within the patient. The kerf cut section of the needle, which can be on one side, two sides or all about the circumference of the needle, allows the needle to be bent one way and then, as needed, another way to allow the needle to be steered within the body.

Abstract: An embodiment of the present invention provides for an elongated medical device with a hypotube backbone running through the device, and a spiral lumen spiraled around the backbone along the length of the backbone. The backbone may be formed from a nitinol alloy for increased bendability without compromising axial stiffness. The device may also incorporate a jacket around the hypotube and spiral lumen formed using either melting, molding, bonding, or casting. The spiral lumen may be configured to accommodate a variety of uses, including actuation members (e.g., pull wires), tools, and means for aspiration, irrigation, image capture, and illumination. Additionally, the present invention provides a method for constructing an elongated medical device with a hypotube backbone running through the device, and a spiral lumen spiraled around the backbone along the length of the backbone.

Abstract: A steerable catheter having a hub with a control feature includes a semi-rigid catheter with the hub attached at the proximal end. The distal end of the catheter includes a distal tip and a flexible portion adjacent the distal tip. The catheter includes a working channel, and further includes a channel through which a tension member or wire extends to the distal tip. Tension in the wire causes the distal tip to deflect and be steered. The hub includes a fixed member attached to the catheter, an inner member that moves axially relative to the fixed member, and an outer member that rotates relative to the inner member and the fixed member. Rotation of the outer member results in translation of the inner member, which is attached to the tension member and provides for controlled steering of the distal tip.

Abstract: A catheter, more particularly an endovascular catheter, with a catheter shaft including a first lumen and a shaft opening, a deflection element and a controlling element. The first lumen and the shaft opening communicate with each other. The deflection element is rotatably arranged inside the catheter shaft, and configured to deflect a guidewire through the shaft opening. The controlling element is operably connected with the deflection element and configured to rotate the deflection element in a first rotating direction . Furthermore, the present invention refers to a catheter assembly with such a catheter and a guidewire.