Abstract: A method and devices that endoscopically create an anastomosis between two sections of the digestive tract, thereby allowing at least some chyme to bypass a section of the digestive tract while, optionally, the remaining chyme passes through the entire tract.

Abstract: A device for temporarily sealing an opening in a blood vessel is provided. The device comprises a cutting mechanism for creating an opening in a blood vessel and a seal for sealing the opening in the blood vessel. The seal is delivered through an inner lumen of a tool body coupled to the cutting mechanism. Methods for using the device to construct an anastomosis between two vessels are also provided.

Abstract: A method and devices that endoscopically create an anastomosis between two sections of the digestive tract, thereby allowing at least some chyme to bypass a section of the digestive tract while, optionally, the remaining chyme passes through the entire tract.

Abstract: Fragmentable compression device for the anastomosis of hollow organs consisting of a pot-shaped body composed of two elements (1, 2), inserted one into the other and consisting of a plurality of composable sectors (5, 6), a third ring-shaped or hollow cylinder-shaped element (3) intended to be inserted into said pot-shaped body to clamp the edges of the organs to be anastomized, and a fourth element (4) also ring-shaped or hollow cylinder-shaped which is pressure-inserted into element (3) to compress said edges. Also elements (3, 4) consist of a plurality of composable sectors (7, 8). The axial dimension of the device is notably short so that, when it is applied in the vicinity of the anal canal of the patient, tenesmus is considerably reduced.

Abstract: Devices and methods for tissue acquisition and fixation, or gastroplasty, are described. Generally, the devices of the system may be advanced in a minimally invasive manner within a patient's body to create one or more plications within the hollow body organ. A tissue treatment device attached to a distal end of a flexible elongated member and has a cartridge member opposite an anvil member. The cartridge member and the anvil member are movable between a closed position and an open position, and a moveable barrier is disposed between the cartridge and anvil members to help acquire a dual fold of tissue. The tissue treatment device can be repositioned to form multiple plications within the organ.

Abstract: Apparatus and methods for rapid deployment of tissue anchors are described herein. A tissue manipulation assembly is pivotably coupled to the distal end of a tubular member and has a lower jaw member and an upper jaw member pivotably coupled to the lower jaw member. A reconfigurable launch tube is pivotably coupled to the upper jaw member and is used to urge the jaw members from a low-profile configuration to an open configuration. A needle assembly can be advanced through the launch tube across tissue received between the jaw members of the tissue manipulation assembly. Tissue anchors can be advanced through the needle assembly for securing received tissue. The tissue anchors can be positioned within a reloadable chamber of a control handle disposed outside the patient, then advanced through the needle assembly.

Abstract: A system for performing anastomosis includes a plurality of staples, an annular staple support having structure for holding the staples, and a staple closing device for closing the staples to secure the canal ends together. A method for performing anastomosis and staples for performing anastomosis are also disclosed.

Abstract: An endoscopic tissue anchor deployment device includes a handle, an elongated shaft defining an internal lumen, and an end effector attached to the distal end of the elongated shaft. A tissue anchor catheter is removably inserted through the lumen of the elongated shaft, the catheter having a tissue anchor assembly that is deployable from its distal end. In some embodiments, the handle includes a pin and track assembly that define a series of handle actuation steps corresponding to deployment steps for the deployment device end effector and the tissue anchor catheter. In some embodiments, the handle includes a catheter stop member that prevents movement of the tissue anchor catheter under certain circumstances, and a handle stop member that prevents actuation of the handle under certain circumstances.

Abstract: Apparatus and methods for endoscopic colectomy are described herein. A colectomy device having a first and a second tissue approximation device is mounted on a colonoscope separated from one another. During deployment of the colectomy device, a diseased portion of the colon is positioned inbetween the tissue approximation devices. The tissue approximation devices are radially expanded such that they contact and grasp the colon wall at two sites adjacent to the diseased portion of the colon. The diseased portion is separated from the omentum and is transected using a laparoscope or is drawn into the colonoscope for later removal. The tissue approximation devices are then urged towards one another over the colonoscope to approximate the two free edges of the colon into contact together where they are fastened to one another using the tissue approximation device as a surgical stapler to create an end-to-end anastomosis.

Abstract: The present invention relates to devices and methods for creating and securing a tissue fold during an endoluminal medical procedure. The devices and methods may be used for folding and securing, for example, a fundus wall onto an esophagus wall. An aspect of the invention includes a two-piece tissue clip configured to be installed through an endoluminal device to secure a tissue fold. The clip includes a female member and a male member configured to engage one another to secure the tissue fold. Another aspect of the invention includes a clipping device comprising a tissue clip magazine. The magazine is configured to hold a plurality of tissue clips and install the plurality of tissue clips in a single actuation of the magazine. A method for using the clipping device together with the tissue clips of the present invention to create and secure a fold of tissue during an endoluminal procedure also is disclosed.

Abstract: An anastomosis system includes a base, two rings, and a blood vessel-leading unit. A first blood vessel can be inserted in and attached to the first ring by the blood vessel-leading unit. A second blood vessel can be inserted in and attached to the second ring by the blood vessel-leading unit. The first ring is placed on a ring-guiding base in a specific manner. The second ring is placed on the ring-guiding base in a movable and rotatable manner to assure the alignment of the blood vessels in both axial and angular directions. The two rings are interconnected by at least one snap-on mechanism or buckle so that the interconnection of the rings is efficient.

Abstract: A stent and a method for implanting a stent for decompression and anastomosis formation are provided. The stent includes a non-expandable, generally tubular body having a proximal portion and a distal portion, a lumen extending through at least a portion of the body, a distal opening in the distal portion in fluid communication with the lumen and a proximal opening in the proximal portion in fluid communication with the lumen. The stent further includes a first magnetic element positioned on the distal portion of the tubular body and a second magnetic element movably positionable on the proximal portion of the tubular body. The second magnetic element is configured to surround and move over the proximal portion of the tubular body towards the first magnetic element.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: Apparatus is provided for use in a stomach of a subject. The apparatus includes a gastric balloon and an anchor coupled to the gastric balloon. The anchor includes a flexible tube, which, when in a relaxed position, is shaped so as to define a portion that prevents the anchor from passing into a duodenum of the subject. The anchor also includes one or more shape-controlling elements coupled to the portion and configured to control a shape of the portion. Other embodiments are also described.

Abstract: Apparatus (90) is provided for use in a stomach of a subject. The apparatus includes a balloon (92), adapted for placement in the stomach, and all anchor (102), coupled to the balloon. The anchor is adapted to prevent the balloon from passing into a duodenum of the subject. The apparatus further includes an inflation tube (96), coupled to the balloon to permit inflation of the balloon, and is adapted to stretch from the stomach to a mouth of the subject to facilitate inflation of the balloon. Other embodiments are also described.

Abstract: A surgical tool including an elongated body having a proximal end and a distal end, first and second sets of tissue approximating structures having deployed and retracted positions relative to the elongated body, an actuating mechanism at the proximal end of the elongated body for independently deploying and retracting each of the first and second sets of tissue approximating structures, and a drainage lumen extending from a drainage aperture at the distal end of the elongated body to the proximal end. The tool further includes a main balloon adjacent to the distal end of the elongated body, and a second balloon spaced from the main balloon toward the proximal end of the elongated body, wherein the second balloon has an expanded condition in which it diverts one of the set of tissue approximating structures away from the main balloon.

Abstract: A device is provided for endoscopy or endosonography- guided transluminal interventions whereby two luminal structures in the body may be drawn toward each other and a fluid conduit formed in between. The device may have a penetrating member and a hollow central member to which is coupled a distal retention member and in one embodiment a proximal retention member. The retention members may each be positioned inside one of the luminal structures and expanded from a first condition to an expanded second condition having an increased radius. The length of the central member may be shortened and its diameter expanded to approximate the two retention members and thereby the luminal structures.

Abstract: The present invention relates to a balloon catheter system for sealing puncture points or openings in body cavities, hollow organs or in percutaneous drainage operations in mammals, consisting of a filling catheter on the distal end of which a first balloon can be filled with the filling medium is arranged with a further balloon arranged proximally spaced apart therefrom. The balloons close the puncture point or the opening on the two sides in the filled state of the balloon. A hollow needle open at the shaft or the shaft end can be guided in the lumen of the filling catheter for filling the two balloons with the filling medium, wherein the shells of the two balloons enclose the shaft of the filling catheter. The filling catheter in each case has an opening arranged in the balloon lumen to fill the two balloons.

Abstract: Method and device for cutting a blood vessel using a cutting tool from within the blood vessel. A first cut portion of the blood vessel is fused to a second blood vessel to provide a flow channel therebetween.

Abstract: Various obesity treatment tools and methods are described herein, as well as treatments for other gastric-related diseases, e.g., GERD. Treatment includes reducing the size of the stomach pouch to limit the caloric intake as well as to provide an earlier feeling of satiety. This may be done by creating a smaller gastric pouch within the stomach directly from the interior of the stomach itself. The smaller pouches may be made through the use of individual anchoring devices, rotating probes, or volume reduction devices. A pyloroplasty procedure may also be performed to render the pyloric sphincter incompetent. A gastric bypass procedure may additionally be performed using atraumatic magnetic anastomoses devices so that sugars and fats are passed directly to the bowel while bypassing the stomach. Many of these procedures may be done in a variety of combinations. Treatment may create enforced behavioral modifications by discouraging the ingestion of high-caloric foods.

Abstract: A magnetic vascular clamp for vascular repair is described. There is a vascular sleeve forming a flexible cylindrical bellows that cylindrically encloses a section of vascular tissue to allow freely movement of the enclosed vascular tissue within the vascular sleeve. A pair of sleeve anchor rings are at each end of the vascular sleeve and they form a fixed seal with underlying vascular tissue to minimize fluid leakage from within the vascular clamp.

Abstract: The invention provides an applicator for forming a hole in a wall of a hollow organ and for connecting a hemostatic connection assembly to the hollow organ, wherein, when the hole is formed in the wall of the hollow organ, a first fluid seal exists between the hemostatic connection assembly and the wall of the hollow organ and a second fluid seal exists between the hemostatic connection assembly and the applicator, thereby minimizing fluid loss from the hollow organ.

Abstract: An endoscopic surgical instrument includes a flexible tube, a grasping and fastening end effector coupled to the distal end of the tube, and a manual actuator coupled to the proximal end of the tube. The manual actuator is coupled to the end effector by a plurality of flexible cables which extend through the tube. The tube contains a lumen for receiving a manipulable endoscope and the end effector includes a passage for the distal end of the endoscope. The end effector has a store for a plurality of male fastener parts, a store for a plurality of female fastener parts, a rotatable grasper, a rotatable fastener head for aligning a female fastener part and a male fastener part with tissues therebetween, and a firing member for pressing a male fastener part through tissues grasped by the grasper and into a female fastener part.

Abstract: Tissue management methods can include inserting a clamping device into a vessel and clamping a vessel wall via the clamping device. Tissue can be dilated about the clamping device and an anastomotic device provided to the vessel.

Abstract: A graft tube is percutaneously placed inside the lumen of a vessel and attached to the lumen wall by loops of suture material. The plurality of short sutures are made in the shape of a loop with a sharp and a blunt end then forced into a plurality of first tunnels located in sections of circular cuffs that are attached to graft tube ends. The short sutures are pushed out the first tunnel by push rods and curve back to their original shape through the adjacent lumen wall and into a plurality of second tunnels where the short sutures are lodged.

Abstract: A method for performing a surgical procedure is disclosed which uses an anvil delivery system including an anvil assembly, a flexible tube having a first end portion and a second end portion, and a fitting to deliver the anvil assembly to a desired site. The method includes the steps of cutting a second end portion of the flexible tube, attaching a fitting to the second end portion of the flexible tube which has been cut, inserting the insertion tip into tissue, advancing the insertion tip along with the flexible tube and anvil assembly to the desired site within a patient's body, and removing the flexible tube from the anvil assembly and from the desired site leaving the anvil assembly in a patient's body at the desired site.

Abstract: A surgical method for treating a tissue structure having a wall and a lumen may include providing a substantially rigid anvil and a flexible tip affixed to and extending from the distal end of that anvil; making an incision in the wall of the tissue structure; inserting the flexible tip and at least a portion of the rigid anvil through the incision into the lumen of the tissue structure; and deforming at least one connector, introduced from outside the wall of the tissue structure, against the portion of the rigid anvil located within the lumen of the tissue structure.

Abstract: A tissue displacing and fastening device is provided for manipulating and fastening tissue together. The device includes a tissue displacing elements, which displaces tissue. A fold is formed from the displaced tissue and the tissue is fastened together to secure the fold.

Abstract: Surgical connection apparatus comprises a support structure, a plurality of clips, which can be self-closing clips, each clip being releasably coupled to the support structure, and a plurality of barbs, each barb being coupled to the support structure, the barbs being separate from the clips, which are ejectable from the support structure independently of the barbs.

Abstract: A connector for fluidly coupling proximal and distal tubular segments of a fluid conduit is provided. In one embodiment, the connector can include a connector body having an outer surface defining a first outer perimeter and an inner surface defining a lumen. The connector can also include a connecting device having an open configuration and a plurality of closed configurations. The connecting device can include first and second members configured to engage each other to secure the fluid conduit to the connector. The connecting device can also include a plurality of closed configurations for securing fluid conduits of different sizes.

Abstract: A surgical cannula system. The surgical cannula system includes a cannula having a proximal end, a distal end, and a lumen extending therebetween. A tissue attachment ring, being configured to be coupled to a biological tissue, includes a lumen extending therethrough. A locking mechanism has a first locking state, in which the cannula is configured to move with respect to the tissue attachment ring, and a second locking state, in which movement of the cannula with respect to the tissue attachment ring is resisted.

Abstract: A combination tissue apposition and suture capturing device (100) for performing endoscopic procedures typically in the gastro-esophageal tract. The device (100) is particularly adapted for forming multiple plications used in a gastroplasty procedure devised to cure or ameliorate gastro-esophageal reflux disease. The device include a tissue sewing capsule (102) attached to the distal end of an endoscope having a needle (120) that is deposited in a capsule (102) distal tip cavity following the suturing of a tissue fold and retrieved to enable the suturing of a subsequent tissue fold without the need for multiple intubations. A suture clip delivery device (200) is also disclosed that is adapted to fit within the capsule to enable suture capture without the need for multiple intubations. The combination device eliminates the need for an overtube and maximizes the speed efficiency of the gastroplasty procedure. A method for using the combination device is also disclosed.

Abstract: A device for connecting abutting ends (1) of two blood vessels (2) that will be continuous after being mutually connected (anastomosis), the device primarily and substantially including a supporting part (3) that can be inserted in the two ends (1) of the blood vessel (2) to be connected, made, for example, of plastic or metal, particularly in the form of a mesh, grid, or cage. The supporting part (3) can be inserted into the blood vessels (1) far enough that the faces (4) of the blood vessel ends (1) can be brought into contact with each other and are in contact with each other in the usage position.

Abstract: The invention relates to a device for producing an ETS anastomosis connection and/or a STS anastomosis connection, comprising a ring (10) with two pins (11). Each pin has a free end (12) and a fixed end (13) which is secured to the ring; the pins extending, viewed from the fixed end toward the free end, next to and set apart from each other in the same direction. The pins each have a clamping section where the pin extends, in a first position, parallel to and along said ring from a first side of the ring to a second side of the ring that is situated diametrically opposite said first side in order to be able to clamp tissue of the wall of the receiving vessel between the ring and the clamping sections. The clamping sections of the pins are, in a second position, at an angle with respect to the plane defined by the ring in order to form, together with the ring, a jaw which widens, viewed in the direction from the fixed ends toward the free ends.

Abstract: Methods and devices for a coupler adapted and configured for use with a device insertable within a mammalian body are disclosed. The coupler also can be used as a temporary holding device for indwelling catheters, cannula, introducers or other devices. The coupler may be used to hold a catheter or other, at a fixed or movable length from the outside of a patient. The catheter or other may be inserted through the center of the coupler, with the tissue contacting ridge attached to the skin using an adhesive, suture(s), combination or other. The inside of the coupler may have a valve, ring, gasket or other, that provides fluid sealing as well as mechanical interference fit between the inside of the coupler and the outside of the catheter or other device.

Abstract: Devices, systems and methods are disclosed for the formation of an arteriovenous fistula in the limb of the patient. Embodiments include an apparatus for the creation, modification and maintenance of a fistula, including the modification of an existing dialysis fistula; and a method of supplying oxygenated blood to the venous circulation of a patient. A kit of anastomotic implants is described which supports a broad base of patient anatomies and fistula locations. The devices, systems and methods can be used to treat patients with one or more numerous ailments including chronic obstructive pulmonary disease, congestive heart failure, hypertension, hypotension, respiratory failure, pulmonary arterial hypertension, lung fibrosis and adult respiratory distress syndrome.

Abstract: A magnetic vascular clamp for vascular repair is described. There are two clamp pieces, where each clamp piece forms a partial cylindrical section of an annular cylinder. Each clamp piece has an outer surface and an inner surface, structural ribs arranged across the inner surface from one sectional end to the other, and a pair of magnetic sectional end surfaces connecting the outer surface and the inner surface and having a characteristic magnetic field arrangement. The sectional end surfaces and magnetic field arrangements of each clamp piece cooperate with the sectional end surfaces and magnetic field arrangements of the other clamp piece to form a complete annular cylinder held together by the magnetic field arrangements and enclosing an inner cylinder so as to structurally support damaged vascular tissue therein with minimal fluid leakage.

Abstract: A system and method of use for effecting the bypass or other anastomosis, connection, or port in a portion of a native blood vessel, duct, lumen or other tubular organ within the body of a living being. The system includes a connector assembly and a deployment instrument for carrying the device to the desired position within the vessel, duct, lumen or tubular organ. The system includes a piercer-dilator instrument to form an opening in the wall of the vessel, duct, lumen or tubular organ into which a connector assembly may be deployed by the deployment instrument. The connector assembly may be at least partially formed of a resorbable material and includes movable members for securing it to the tissue of the vessel, duct, lumen or tubular organ contiguous with the opening. Other components may be included in the device for expediting the procedure, with or without the use of sutures.

Abstract: In some aspects, a surgical procedure for the removal of a prostate gland is provided. The procedure comprises: (a) positioning an implant material within the urethra, (b) removing the prostate, thereby creating a urethral stump and a bladder neck, wherein the implant material occupies the urethral stump, the bladder neck, or both, and (c) securing the bladder neck to the urethral stump in an anastomosis procedure to establish a path of urine flow from the bladder to an external urethral opening (e.g., the meatus). Subsequently, the implant material is removed from the urethra, for example, by natural urine voiding or by flowing a removal fluid through and/or around the implant material in the urethra. In other aspects, a medical kit is provided.

Abstract: A seal element for sealing between tissue lumens includes a first material for allowing tissue ingrowth and a second sealant material.

Abstract: A vascular stent comprising a drug-eluting outer layer of a porous sputtered columnar metal having each column capped with a biocompatible carbon-containing material is described. This is done by placing the stent over a close-fitting mandrel and rotating the assembly in a sputter flux. The result is a coating that is evenly distributed over the outward-facing side of the stent's wire mesh while preventing the sputtered columnar coating from reaching the inward facing side where a smooth hemocompatible surface is required. The stent is then removed from the mandrel, exposing all surfaces, and finally coated with a layer of carbon such as amorphous carbon or diamond-like carbon. The carbonaceous coating enhances biocompatibility without preventing elutriation of a therapeutic drug provided in the porosity formed between the columnar structures. The result is a stent that is adapted to both the hemodynamic and the immune response requirements of its vascular environment.

Abstract: The present invention relates to an assembly comprising: a ring having anchoring elements for attaching the ring in a passage surrounded by body tissue, in particular blood vessel tissue. An applicator for fitting the ring in the passage; in which the anchoring elements have an anchoring position in which they protrude with respect to the ring, and in which the anchoring elements comprise a memory material, such as a memory metal or memory polymer, and are designed so that they can be bent from an anchoring position counter to a spring force into a fitting position and can be frozen in this fitting position by a temperature treatment in order to bend the anchoring elements back from the fitting position by the effect of this spring force into the anchoring position when a predetermined threshold temperature is exceeded, and in which the applicator is provided distally with a carrier for carrying the ring.

Abstract: Apparatus is provided for applying one or more patches to a tubular structure in a body of a patient. The apparatus includes an applicator, which is configured to removably hold the one or more patches, and to place the one or more patches at least partially around the tubular structure. The applicator includes one or more patch supports. Each of the patch supports includes a yielding pad, which is removably coupleable to one of the patches; and a stiff back support structure, to which the yielding pad is fixed. Each of the patch supports is shaped so as to define at least one chamber that itself has a volume of at least 0.5 ml when the patch supports are in respective resting states. Other embodiments are also described.

Abstract: A method and system are provided for percutaneously gaining access to oxygenated blood with an anastomosis device and pumping such oxygenated blood to other arterial regions of the vascular system. In one embodiment, a system may include an anastomosis device extending through an opening of the atrial septum. A filament may be coupled to the anastomosis device. A snare access the right atrium through the superior vena cave, grasp the filament, and withdraw the filament through the superior vena cave. The filament may then he used as a guide to direct a catheter, a conduit or some other structure into the right atrium of the heart via the superior vena cava. A flow path may be defined between the anastomosis device and an arterial location, such as in the aorta, such that at least some oxygenated blood may by-pass the left ventricle and he discharged into the aorta.

Abstract: The present invention relates to devices and methods for creating and securing a tissue fold during an endoluminal medical procedure. The devices and methods may be used for folding and securing, for example, a fundus wall onto an esophagus wall. An aspect of the invention includes a two-piece tissue clip configured to be installed through an endoluminal device to secure a tissue fold. The clip includes a female member and a male member configured to engage one another to secure the tissue fold. Another aspect of the invention includes a clipping device comprising a tissue clip magazine. The magazine is configured to hold a plurality of tissue clips and install the plurality of tissue clips in a single actuation of the magazine. A method for using the clipping device together with the tissue clips of the present invention to create and secure a fold of tissue during an endoluminal procedure also is disclosed.

Abstract: A side-to-end vascular anastomosis device comprising a diversion conduit coupled to a lower flange which is inserted into the vessel and an upper flange located on the outside of the vessel designed to clamp together to seal the incision into which the lower flange of the device is inserted.

Abstract: A cannula connects an organ with a perfusion system that monitors, treats, sustains and/or restores the viability of the organ and/or that transports and/or stores the organ. At least part of a cannula may be made of a soft elastomer to help avoid damage to the organ. In embodiments, the cannula includes a top portion, a bottom portion, a sealing ring and two compression straps. In embodiments, the cannula includes a top portion and a flexible bottom portion that may be attached to the top portion. In embodiments, part of the cannula is inserted directly into an artery and a suture is used to tie the artery in place. Also, the cannula may include an attachment feature that can be used to connect the cannula to an organ platform or chair. Various features of the cannula may allow a visual check for and venting of air bubbles in the cannula.

Abstract: Apparatus and methods for endoscopic colectomy are described herein. A colectomy device having a first and a second tissue approximation device is mounted on a colonoscope separated from one another. During deployment of the colectomy device, a diseased portion of the colon is positioned inbetween the tissue approximation devices. The tissue approximation devices are radially expanded such that they contact and grasp the colon wall at two sites adjacent to the diseased portion of the colon. The diseased portion is separated from the omentum and is transected using a laparoscope or is drawn into the colonoscope for later removal. The tissue approximation devices are then urged towards one another over the colonoscope to approximate the two free edges of the colon into contact together where they are fastened to one another using the tissue approximation device as a surgical stapler to create an end-to-end anastomosis.

Abstract: An apparatus and method for using an anastomosis device to repair severed tissues resulting from a surgical medical procedure such as a radical prostatectomy, ilio-orthotopic neobladder construction, cystoprostatectomy, cystectomy, urethral anastomosis, or ureteral anastomosis.

Abstract: A heart valve can be replaced using minimally invasive methods which include a sutureless sewing cuff that and a fastener delivery tool that holds the cuff against the patient's tissue while delivering fasteners to attach the cuff to the tissue from the inside out. The tool stores a plurality of fasteners and is self-contained whereby a fastener is delivered and placed all from inside a vessel. The fasteners are self-forming whereby they do not need an anvil to be formed. Anchor elements are operated from outside the patient's body to cinch a prosthesis to an anchoring cuff of the valve body. The cuff is releasably mounted on the tool and the tool holds the cuff against tissue and drives the fastener through the cuff and the tissue before folding over the legs of the fastener whereby secure securement between the cuff and the tissue is assured. Fasteners are placed and formed whereby fasteners are located continuously throughout the entire circumference of the cuff.