Abstract: The system and device ensure a smooth and shockless effect of changeover of the first and second jaws from the diverged position to the clamped position with the control option of the impact force upon closing. The left atrial appendage isolation system incorporates a clip device between the first and second jaws, a clamping device and a control device. The clip has a connecting device, the clamping element is configured to contain the first hinge. The connecting device comprises the second hinge, the first and second hinges being connected to the corresponding ends of the first jaw and are designed to rotate the specified first jaw relative to the second jaw made fixed, at an angle ranging from 0° to 180°. The first hinge is made controllable, the control device comprises the first hinge actuator adapted to couple detachably with tension to fit with the said first hinge.

Abstract: A surgical instrument including a system for stopping a beam of the surgical instrument from impacting a distal pin when reversing a knife is disclosed. A knife assembly of the surgical instrument comprises the knife, the beam, and a firing nut. A firing lead screw can drive the firing nut distally and proximally. A firing screw compression spring extends along the firing lead screw and applies a load proximally on the firing nut when the firing nut is driven toward a distal end of the firing lead screw.

Abstract: A surgical clip may include: a first leg member having an inner surface, an outer surface, and first and second side surfaces, the inner surface of the first leg member having a concave curvature; a second leg member having an inner surface, an outer surface, and first and second side surfaces, the inner surface of the second leg member having a convex curvature; at least one first tooth extending from a first lateral side of the inner surface of the second leg member; and a first channel defined between the first side surface and the inner surface of the first leg member. The first and second leg members may be configured to move between an open configuration and a closed configuration, and in the closed configuration, the at least one first tooth is received in the first channel.

Abstract: A clamp for a medical procedure includes a first clamp member, a second clamp member, a hinge, a biasing member, a shaft, and an actuator. The hinge couples the first ends of the first and second clamp members such that the first clamp member is pivotable relative to the second clamp member. The biasing member couples the second ends of the first and second clamp members and is configured to apply a clamping force. The distal end of the shaft and the biasing member are fixedly coupled with at least one of the first clamp member or the second clamp member for a duration of the medical procedure. The actuator is operatively coupled with the biasing member such that the actuator selectively tensions the biasing member to provide the clamping force.

Abstract: Apparatus for performing an ocular surgery, the apparatus comprising: a support housing having a bottom configured to be positioned on the sclera of an eye during performance of an ocular surgery; a muscle hook holder connected to the support housing and configured to hold an ocular muscle hook so that the ocular muscle hook is translatable to elevate an ocular muscle away from the eye during performance of the surgery; and a set of graduation markings on the support housing useable to determine a distance that the ocular muscle hook is translated to elevate the ocular muscle.

Abstract: Certain aspects relate to systems and techniques for articulating medical instruments. In one aspect, the instrument includes a wrist having at least one degree of freedom of movement, and an end effector coupled to the wrist. The end effector can include a cartridge for delivering a plurality of clips to tissue. The wrist may include one or more cables capable of moving an actuator with one degree of freedom of movement within the end effector to advance one or more clips through the end effector.

Abstract: Medical devices, systems and methods for occluding a left atrial appendage of a heart are provided. In one embodiment, the medical device includes an occluder portion and an anchor portion that are pivotably coupled to each other with hinge components. The hinge components each include a base with arms extending from the base such that the arms of each one of the hinge components extend through and capture a first eyelet of the occluder portion and a second eyelet of the anchor portion to facilitate pivotably coupling the anchor portion to the occluder portion.

Abstract: A recapturable external LAA exclusion clip system includes a clip comprising first and second clip struts, at least one of the struts having a connector interface comprising a first portion of a lock, and a delivery device comprising a handle and an end effector. The handle comprises jaw and lock controls. The end effector is connected to the handle and comprises a clevis and first and second jaws. The jaws are connected to the clevis and operatively connected to the jaw control to actively articulate at least one of the jaws with respect to the other. At least one of the jaws has a connector comprising a second portion of the lock operatively connected to the lock control to removably lock with the first portion of the lock. The first and second portions of the lock have a locked state and are configured to unlock the locked state upon actuation of the lock control.

Abstract: Unitary endoscopic vessel harvesting devices are disclosed. In some embodiments, such devices may comprise an elongated body having a proximal end and a distal end. A conical tip may be disposed at the distal end of the elongated body. In addition, the surgical instrument may include one or more surgical instruments moveable in a longitudinal direction along an axis substantially parallel to a central longitudinal axis of the cannula from a retracted position proximally of a distal end of the tip to an advanced position toward the distal end of the tip to seal and cut a blood vessel.

Abstract: A minimally invasive occlusion device is disclosed. The minimally invasive occlusion device includes a first link having a first end and a second end, a second link having a first end and a second end; the first end of the second link connected to the first end of the first link by a compensating coupler. Another minimally invasive occlusion device may include a delivery frame or a shaft having an articulating cradle coupled to the shaft. A method of occluding tissue is also disclosed. The method of occluding tissue includes placing a first link of an occlusion device laterally at a base of tissue, placing a second link of an occlusion device on an opposing side of the base of tissue, substantially parallel with the first link, and securing the first link and the second link to fully occlude the base of tissue.

Abstract: An LAA exclusion system includes a clip comprising first and second separate clip struts, and a bias device comprising spring portions, and a delivery device having clip-contacting ends. The first clip strut has a first proximal end. The second clip strut has a second proximal end adjacent the first proximal end. The clip struts together define a first exterior surface and an opposing second exterior surface. The first spring portion connects the first clip strut to the second clip strut along the first exterior surface and the second spring portion connects the first clip strut to the second clip strut along the second exterior surface. The spring portions define therebetween a strut-securing area at the first and second proximal ends. The clip-contacting ends are configured to removably connect to the proximal ends of the clip struts through the strut-securing area.

Abstract: The invention provides an implantable system for managing urinary incontinence. The system includes a sling with an elongate body member having a proximal portion, a distal portion and an intermediate portion. The intermediate portion is configured to be positioned underneath urethra of a subject for providing an adequate support to prevent leakage of urine during a stress event. The system may include a pressure sensor communicatively coupled with the elongated body member and configured to be positioned in an abdominal cavity and adapted to sense an increase in intra-abdominal pressure. The pressure sensor generates a first signal that is indicative of a change in the intra-abdominal pressure upon occurrence of the stress event. The system includes a processing circuit to process the first signal sensed by the pressure sensor.

Abstract: A nasal dilator includes a first leg and a second leg insertable into a pair of respective nasal openings. The first leg and the second leg are separated by a clearance. A connecting member extends between the first leg and the second leg and an adjustment mechanism is operably coupled to both the first leg and the second leg. The adjustment mechanism includes a tension shaft that is rotatable about an axis to vary the clearance.

Abstract: Apparatus and methods for occluding hollow body structures, such as blood vessels, and for attaching tissue layers together by providing implantable elements on opposite sides of the structure or tissue layers and drawing the implants together to occlude the body structure and/or bring the tissue layers together. The implants are deliverable in a low-profile configuration and self-expand to an enlarged configuration. The implantable elements are delivered by transfixing the body structure, then releasing the implants on opposite sides of the body structure and drawing the implants together to effect an occlusion or attachment. The implants are configured to apply oppositely directed forces to opposite surfaces of the tissue layers at alternate, circumferentially spaced locations and may constrain the tissue in a serpentine pattern or in a direct clamping pattern. The implants grip the tissue in a manner that defines a pressure zone about the transfixion aperture that prevents leakage from the aperture.

Abstract: A clip applier assembly may include a surgical clip and a clip applier. The surgical clip may include first and second leg members configured to ligate tissue. The first leg member may include a first proximal portion, a first distal portion, a first inner surface, and a first outer surface. The first outer surface may have a convex curvature. The second leg member may include a second proximal portion, a second distal portion, a second inner surface, and a second outer surface. The second leg member may further include an inner portion and an outer portion separated by a channel. The second outer surface may be formed on the outer portion and have a convex curvature. The clip applier may have a first jaw member configured to engage the first outer surface and a second jaw member configured to engage the second outer surface.

Abstract: A medical device has an artificial contractile structure including at least one contractile element adapted to contract a hollow body organ in such a way that said contractile element is adapted to be in a resting position or in an activated position, the activated position being defined with the contractile element constricting the hollow body organ and the resting position being defined with the contractile element not constricting the hollow body organ. The medical device further includes a tensioning device adapted to apply a force so as to tighten the contractile element around the hollow body organ. The contractile element further includes a closure for forming the contractile element into a closed loop around said hollow body organ, the closure having a plurality of lips arranged to engage the contractile element.

Abstract: Apparatus and methods are provided for occluding blood vessels and other anatomical structures. Occlusion devices are delivered percutaneously and extraluminally through a small gauge needle and include expandable elements that are deployable on opposite sides of a target vessel to be occluded. When positioned about the vessel the elements are expanded and brought together to compress and occlude the vessel. Embodiments include those adapted for temporary as well as permanent use.

Abstract: A nasal compressive device for preventing post-operative swelling following a rhinoplasty or other procedure performed on a user's nose or nasal cavity and prevent possible poly-beak deformities. The nasal compressive device includes nasal plugs and a nasal bridge disposed on a selectively actuated clip with a resilient spring portion. The user actuates the clip to open the nasal compressive device and then inserts the nasal plugs into their nostrils. The user then relaxes or closes the nasal compressive device which brings the nasal plugs into contact with an inner surface of their nasal cavity while also forcing the nasal bridge down on top of the user's dorsum. Once placed in the user's nose, the nasal compressive device also applies an upward force to the tip of the user's nose while also simultaneously providing a compression force over the user's dorsum, thereby reducing the amount of unwanted swelling and further shaping the nose.

Abstract: The present disclosure provides methods and devices for wound closure. In some exemplary embodiments, a tissue approximation device is provided. In some embodiments, the tissue approximation device includes a first scissors arm having a proximal end and a distal end and a second scissors arm having a proximal end and a distal end. In some embodiments, the second scissors arm is connected to the first scissors arm at a pivot point. In some embodiments, the tissue approximation device further includes a first rake member connected to the distal end of the first scissors arm via a first articulating joint. In some embodiments, the first rake member includes a plurality of hooks configured to grip tissue.

Abstract: An occlusive device includes a frame element having a distal end and a proximal end, and a delivery configuration and a deployed configuration. The occlusive device also includes an occlusive face having a peripheral edge, where the occlusive face positioned toward the proximal end of the frame element. The occlusive device also includes at least one anchor positioned at the peripheral edge of the occlusive face, where the at least one anchor extends at an acute angle to the peripheral edge of the occlusive face.

Abstract: An implantable medical device for sealing and repairing defects in a body tissue or for creating an anastomosis includes a frame and a covering material. In some embodiments, the frame includes a single continuously wound wire that defines an apposition portion, a defect-occupying portion, and a sealing portion. In some embodiments, the tissue-sealing and anastomosis devices provided herein are well-suited for use in the GI tract including the small bowel and colon. In some embodiments, a two-part frame construct facilitates independent tailoring of apposition forces and radial forces exerted on tissues by the two-part frame.

Abstract: A temporary aortic occlusion device is disclosed, having an expandable locator portion and an expandable occlusion portion. The expandable locator portion assists a user in determining whether the distal end of the device has been advanced within a patient's aorta, and the occlusion portion is expanded to occlude the patient's aorta, preferably below the renal arteries.

Abstract: A medical device system may include an elongate shaft having a lumen extending from a proximal end to a distal end, a release wire disposed within the lumen of the elongate shaft configured to releasably attach a medical device to the distal end of the elongate shaft, and a securement member releasably coupled to the proximal end of the elongate shaft and fixedly attached to a proximal end of the release wire. A proximal portion of the securement member may be configured to translate proximally away from the proximal end of the elongate shaft upon application of a proximally-directed force to the proximal portion of the securement member and radially inward directed force to the distal portion of the securement member while the elongate shaft is maintained in a fixed position.

Abstract: A surgical fastener and a related deployment device as well as their methods of use are disclosed. In one embodiment, the deployment device includes one or more surgical fasteners including a head and a distally extending coil body attached to the head. The head includes a through hole with an internal thread. The deployment device also includes a mandrel including a threaded portion located at a distal end of the mandrel. The threaded portion is engaged with the internal thread of the one or more surgical fasteners. A rotator is associated with the one or more surgical fasteners such that the rotator can selectively rotate the one or more surgical fasteners relative to the mandrel to displace the one or more surgical fasteners in a distal direction.

Abstract: This tool is for treating an excised end of a body organ and is provided with: a long and thin, flexible first band section having a distal end and a proximal end that are made of a biodegradable-absorptive polymer; a long and thin, flexible second band section having a distal end and a proximal end that are made of a biodegradable-absorptive polymer; and a first locking section having a first ratchet claw made of a biodegradable-absorptive polymer, wherein the first locking section is formed at the distal end of the second band section, the distal end of the first band section and the proximal end of the second band section are joined together, at least one ratchet tooth that is capable of meshing with the first ratchet claw is formed on the external surface of the first band section, and the engagement of the ratchet tooth with the first ratchet claw forms a flattened ring which is used to bind a body organ so as to ligate a tube or cavity that opens at an excised end of the body organ.

Abstract: The invention relates to a fastening device for implant device, the fastening device comprising at least two fastening sections, where a first fastening section is arranged with a through hole, a second fastening section is arranged with a protruding part, and where said protruding part is in place in said through hole in a fastening device locking state, where the protruding part on the second fastening section is arranged with a through channel having an inlet and an outlet, said through channel being arranged to receive an implant device feed member, said inlet and outlet being accessible from the exterior of the fastening device in said fastening device locking state, wherein the first fastening section is securely locked to the second fastening section when, in said fastening device locking state, said implant device feed member is in place in the through channel and protrudes from both the inlet and the outlet of said through channel.

Abstract: A vessel occlusion device is provided for use during a coronary artery bypass procedure. The vessel occlusion device may include a clamp including at least one rigid portion sized to be disposed around an outer surface of a vessel such as the aorta. The clamp defines a clamp lumen sized to receive the vessel. The clamp has a sidewall with an opening extending therethrough, and an inflatable balloon disposed within the clamp lumen and positioned proximal of the opening in the sidewall.

Abstract: An elongate resilient tube of a mesh of shape memory alloy is used to therapeutically occlude an opening in body tissue. The tube is compressible so that it can be delivered to the opening in the body within a catheter. The tube self-expands as it is released from the catheter to contiguously form, sequentially, the following shapes: an outer bell-shaped structure; an inner bell-shaped structure disposed within the outer bell-shaped structure to conformingly engage an inner side of the outer bell-shaped structure; a tubular connector having a diameter substantially smaller than the inner bell-shaped structure, the tubular connector extending away from an apex of the inner bell-shaped structure; an inner plate-shaped structure; an outer plate-shaped structure; and a releasable connector. The bell shape is placed on one side of the opening, and the plate shape is placed on the other side of the opening, the connector passing through the opening.

Abstract: A disposable hemostatic clip is provided, the clip includes two degradable clip-arms, a pulling bracket, a hook handle and a degradable sleeve. The degradable clip-arms are respectively arranged on two front portions of the pulling bracket; a lower part of the pulling bracket hooks with the hook handle; and the pulling bracket and the hook handle are assembled in the degradable sleeve. The degradable clip-arms and the degradable sleeve are made by using a degradable material, so that all the parts of the hemostatic clip retained in the body are degradable. At the same time, the disposable hemostatic clip also provides a metal part used in combination with a degradable part, thereby achieving separation and retention of a degradable clip portion.

Abstract: A heart valve anchor has a body that includes a distal portion, a distal end, a proximal portion, and a proximal end. The distal end and the proximal end define a longitudinal axis. The body has an expandable portion that includes a first radially expandable portion at the distal portion of the body, a second radially expandable portion at the proximal portion of the body, and a root portion disposed between the first and second radially expandable portions. The body has a first configuration adapted to be housed at least partially within a tissue penetrating device, and a second configuration in which the first and second radially expandable portions are partially or fully expanded such that the anchor engages tissue in a region between the first and second radially expandable portions.

Abstract: A method is provided for making an appendage of a soft surgical tool, including: receiving a set of mechanical constraints for a surgical procedure; calculating a set of articulation states based on the set of mechanical constraints; generating a plurality of print commands for printing an appendage configured to form the set of articulation states based on the calculation; and printing an appendage based on the plurality of print commands. Multiple printed appendages can be formed into an orienting assembly.

Abstract: Implant deployment systems can generally can include a braided implant that can be detachably attached to a delivery tube by an expansion ring that can be positioned within a notch on an outer surface of the delivery tube near a distal end of the delivery tube. The implant can be positioned within a lumen of the delivery tube and remain attached to the delivery tube as the assembly is fed through a microcatheter to a treatment site. Once the braided implant is implanted, the expansion ring can move from a collapsed configuration that is engaged with the notch of the delivery tube to a deployed configuration that releases the delivery tube, thereby releasing the braided implant from the delivery tube.

Abstract: Described herein are compositions composed of micronized placental components and pharmaceutical compositions thereof. The compositions have numerous medical applications. Methods for making and using the micronized compositions are also described herein.

Abstract: A partly resorbable tissue clip for stapling tissue includes at least one gripping tooth that grips the tissue, at least one force deflecting element that is equipped with at least one gripping tooth, and at least one spring element that is connected to the at least one force deflecting element. The at least one gripping tooth or a portion of the at least one force deflecting element or of at least one of the force deflecting elements is made of bioresorbable material.

Abstract: A device for treating tissue includes a capsule defining a channel extending therethrough and clip arms. Each of the arms includes a proximal part releasably coupled to a distal part, a proximal portion of the distal part configured to be received within the channel of the capsule so that the arms move proximally and distally relative to the capsule between a tissue receiving configuration, in which distal ends of the arms are separated from one another, and a tissue clipping configuration, in which distal ends of the arms are moved toward one another. The proximal portion of each of the arms is configured to release from the corresponding distal part to lock the distal part of each of the arms over a portion of target tissue to be clipped while the proximal parts of the alms are removed from the body.

Abstract: A surgical ligation clip capable of remote deployment through a cannula to engage an anatomical structure.

Abstract: A grasping tool (20) for removing a stent from the body of a patient. The grasping tool has a grasping head (38) forming two jaws connected to each other and configured to be shifted between an open state and a closed state. Each jaw includes three portions having different thicknesses. The grasping tool is configured to obtain sufficient holding force between the jaws while requiring reduced operating force of the tool. A method for removing a stent from a patient is also disclosed.

Abstract: An occluder includes a first occluder disc, a second occluder disc, a waist portion connecting the first occluder disc and the second occluder disc, and at least one soft and fibrous strand bundle structure. The strand bundle structure is disposed on at least one of a disc surface of the first occluder disc and a disc surface of the second occluder disc, the two disc surfaces faces each other, and the strand bundle structure is disposed near the waist portion. By disposing the strand bundle structure to be immediately adjacent to the waist portion, a defect opening can be occluded after implantation, thereby effectively blocking blood from flowing from one side of the defect to the other side thereof, and preventing a shunt from being formed.

Abstract: An occlusive medical device system may include an elongate shaft having a lumen extending longitudinally through a tubular body portion and a plurality of retaining arms extending distally from the tubular body portion. An occlusive medical device may include a proximal tubular mounting portion fixed to an expandable occlusive element. A release wire may be axially translatable between a distal engagement position and a proximal released position, the release wire having a distal engagement portion and a distal retention portion distal of the distal engagement portion. The distal engagement portion may be configured to engage the plurality of retaining arms in the distal engagement position, thereby urging the plurality of retaining arms into releasable engagement with the proximal tubular mounting portion, wherein when the release wire is in the proximal released position, the plurality of retaining arms is deflectable radially inward to disengage from the proximal tubular mounting portion.

Abstract: Embodiments include a clamp for a medical procedure, the clamp having a first clamp member having a first end and a second end, a second clamp member having a first end and a second end, a hinge, the hinge coupling the first ends of the first and second clamp members, a biasing member, the biasing member coupling the second ends of the first and second clamp members, the biasing member being configured to apply a first clamping force in a first stage, and a second clamping force in a second stage, where the second clamping force is greater than the first clamping force.

Abstract: The adjustable uterine compression apparatus for postpartum hemorrhage includes at least one belt adapted for encircling the uterus transversely, the belt having keeper loops so that the belt can be cinched to continuously adjust the degree of compression applied to the uterine arteries. The belt may also be shortened and used to apply compression to the ovarian arteries. Preferably, a plurality of belts are applied spaced apart axially along the body and cervix of the uterus. The belts may be applied separately and independently, or may be embedded or incorporated into a sheet or vest that may be applied posteriorly behind the uterus and further secured by straps extending over the fundus that are cinched to at least one of the transverse belts to apply axial compression, in addition to transverse compression of the uterus. The belt(s) and vest may be made of polyglactin mesh, so that they are bioabsorbable.

Abstract: An volume filling device for treatment of obesity is placed outside the stomach wall of the patient to reduce the inner volume of the stomach, thereby affecting the patient's appetite. By providing the volume filling device outside the stomach wall, contact with stomach acids is avoided, thereby increasing the life of the device.

Abstract: Devices and methods for treatment of a patient's vasculature are described. The device includes a self-expanding resilient permeable shell having a radially constrained state and an expanded state with a globular, axially shortened configuration. The permeable shell may be a single layer of braided elongate filaments having first and second ends that are secured at the proximal end of the permeable shell. The devices may also include permeable shells made of woven braided mesh having a variable mesh density, i.e., the average size of pores in one region are a different than the average size of pores in another region. Methods of using the device to treat a cerebral aneurysm are also described. Methods of forming a tubular braid are also described. Methods of forming a tubular braid with variable braid densities are described. Methods of forming a tubular braid using a castellated mandrel are also described.

Abstract: A clamp installation tool is provided. The tool may include a longitudinal main body, a selectable retention mechanism, and a tip manipulation member. The longitudinal main body may have an elongate member with a longitudinal support platform to support a clamp. The selectable retention mechanism may have a plurality of bosses to be received into corresponding apertures of the clamp, and the tip manipulation member may be coupled to a distal end of the longitudinal main body and arcuately articulable relative to the longitudinal main body. The tool may be operable to install a clamp inside a body cavity.

Abstract: A recapturable external LAA exclusion clip system includes a clip comprising first and second clip struts, at least one of the struts having a connector interface comprising a first portion of a lock, and a delivery device comprising a handle and an end effector. The handle comprises jaw and lock controls. The end effector is connected to the handle and comprises a clevis and first and second jaws. The jaws are connected to the clevis and operatively connected to the jaw control to actively articulate at least one of the jaws with respect to the other. At least one of the jaws has a connector comprising a second portion of the lock operatively connected to the lock control to removably lock with the first portion of the lock. The first and second portions of the lock have a locked state and are configured to unlock the locked state upon actuation of the lock control.

Abstract: The disclosure is directed to clamping and cutting device for flexible, wet tubes. Specifically, the disclosure is directed to devices, kits and methods for selectably clamping an umbilical cord and only then cutting the cord, without the necessity of defining a mother side and/or baby side.

Abstract: A device for treating an aneurysm with a braided implant can include a delivery tube having a spiral groove on an outer surface of the delivery tube and a braided implant having a spiral segment. The spiral segment can engage the spiral groove as the braided implant is delivered to an aneurysm treatment site. At the treatment site, the braided implant can be implanted, and the delivery tube can be rotated to disengage the spiral segment from the spiral groove. Once released, the spiral segment can reshape to occlude the neck of the aneurysm.

Abstract: An end effector for a suturing and grasping device includes a stationary jaw member, a suturing jaw member, and a grasping jaw member. The suturing jaw member is selectively movable relative to the stationary jaw member to drive a suturing needle between the suturing jaw member and the stationary jaw member. The grasping jaw member is selectively movable relative to the stationary jaw member to grasp tissue between the stationary jaw member and the grasping jaw member.

Abstract: The present disclosure provides a surgical clip for ligating a blood vessel or tissue structure. The surgical clip includes a first leg member including a first inner surface and a first plurality of protrusions disposed on the first inner surfaces. The surgical clip also includes a second leg member including a second inner surface and a second plurality of protrusions disposed on the second inner surface. The surgical clip further includes a hinge member joining the first leg member and the second leg member. The at least one of the first and second plurality of protrusions includes a gable structure that extends along a longitudinal direction of the first or second inner surface. The orientation and the geometric shape of the protrusions of the surgical clip allow for increased resistance to the migration or sliding of the clip along a longitudinal direction of the blood vessel or tissue structure, while providing a balanced closure force.

Abstract: The present invention relates to a device for intermittently obstructing a bodily opening, such as a gastric opening, and includes a proximal member connected to a distal member by a tether. The proximal member is formable from an elongated and narrower configuration to a contracted or expanded but wider configuration. When employed in the stomach, the device may be arranged transluminally with the distal member disposed in the duodenum and the proximal member disposed against the pyloric valve, intermittently occluding the pyloric valve and preventing or delaying the flow of gastric contents through the pyloric valve.