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Frank J. P. M. Huygen - One of the best experts on this subject based on the ideXlab platform.
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dexmedetomidine vs propofol as sedation for implantation of Neurostimulators a single center single blinded randomized controlled trial
Acta Anaesthesiologica Scandinavica, 2019Co-Authors: Feline F J A Ter Bruggen, Charlotte Ceuppens, Leo Leliveld, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background: During the lead implantation of most spinal cord Neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation. Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P <.01), procedural recall (median 95.8 vs 83.3, P =.03), and sedation side effects (median 90.0 vs 83.3, P =.01). Fewer changes in the dexmedetomidine titration were necessary to maintain arousable sedation. Over time, mean arterial pressure and heart rate were significantly lower in the dexmedetomidine group. Hemodynamic side effects were comparable across groups. Conclusions: Dexmedetomidine sedation resulted in higher patient satisfaction and allowed for better arousable sedation than sedation with propofol. Although differences in hemodynamic parameters were found between the groups, these differences were not regarded as clinically relevant.
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Dexmedetomidine vs propofol as sedation for implantation of Neurostimulators: A single-center single-blinded randomized controlled trial.
Acta anaesthesiologica Scandinavica, 2019Co-Authors: Feline F. J. A. Ter Bruggen, Charlotte Ceuppens, Leo Leliveld, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background: During the lead implantation of most spinal cord Neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation. Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P
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Survey on sedation-analgesia regimens, in particular the use of dexmedetomidine, among Dutch implanters of spinal cord Neurostimulators.
Scandinavian journal of pain, 2019Co-Authors: Feline F. J. A. Ter Bruggen, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background and aims During implantation of most spinal cord Neurostimulators, patients need to be cooperative to give feedback during lead placement, and also be comfortable. Sedation and analgesia can support these conditions. This survey aimed to provide an overview of the sedation-analgesia regimens currently used among Dutch pain specialists. The survey focused on the sedative agent “dexmedetomidine” due to its attractive pharmacological profile and its promising results during awake procedures. Methods A 27-item survey was sent to the 65 pain specialists involved in neurostimulation in the Netherlands. The survey consisted of questions related to different aspects of sedation and analgesia during neurostimulation, e.g. the current regimen, the opinion on and experience with dexmedetomidine as a sedative agent, and preferences regarding different aspects of sedation (i.e. production of arousable sedation, pain management, quality of patient’s feedback and overall preference). Results Of 65 pain specialists, 45 (69%) completed the survey. Most commonly used sedative was propofol (91%) and most common used analgesic was remifentanil (78%). Of the 45 respondents, 21 (47%) considered the use of dexmedetomidine, whereas 13 (29%) had experience with dexmedetomidine during neurostimulation. The most frequently mentioned positive property of dexmedetomidine was the easy production of arousable sedation. Most respondents who used dexmedetomidine preferred dexmedetomidine sedation over propofol sedation regarding all aspects of sedation. Conclusions The most commonly used sedation-analgesia regimen is the combination of propofol-remifentanil during the implantation of a neurostimulator among Dutch pain specialists. Only a small percentage of respondents had experience with the use of dexmedetomidine, despite its reported advantages. Implications When implanting a spinal cord neurostimulator, dexmedetomidine could be considered as a sedative, given its allowance for and preservation of a state of easy arousable sedation.
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stimulation of dorsal root ganglia for the management of complex regional pain syndrome a prospective case series
Pain Practice, 2015Co-Authors: Jeanpierre Van Buyten, Iris Smet, Liong Liem, Marc Russo, Frank J. P. M. HuygenAbstract:Background Complex regional pain syndrome (CRPS) is a chronic and progressive pain condition usually involving the extremities and characterized by sensorimotor, vascular, and trophic changes. Spinal cord stimulation (SCS) is an effective intervention for this condition, but is hampered by the technical challenges associated with precisely directing stimulation to distal extremities. Dorsal root ganglia (DRG) may be more effective as a physiological target for electrical modulation due to recruitment of the primary sensory neurons that innervate the painful distal anatomical regions. Methods Eleven subjects diagnosed with uni- or bilateral lower-extremity CRPS were recruited as part of a larger study involving chronic pain of heterogeneous etiologies. Quadripolar epidural leads of a newly developed neurostimulation system were placed near lumbar DRGs using conventional percutaneous techniques. The Neurostimulators were trialed; 8 were successful and permanently implanted and programed to achieve optimal pain–paresthesia overlap. Results All 8 subjects experienced some degree of pain relief and subjective improvement in function, as measured by multiple metrics. One month after implantation of the neurostimulator, there was significant reduction in average self-reported pain to 62% relative to baseline values. Pain relief persisted through 12 months in most subjects. In some subjects, edema and trophic skin changes associated with CRPS were also mitigated and function improved. Neuromodulation of the DRG was able to provide excellent pain–paresthesia concordance in locations that are typically hard to target with traditional SCS, and the stimulation reduced the area of pain distributions. Conclusions Neuromodulation of the DRG appears to be a promising option for relieving chronic pain and other symptoms associated with CRPS. The capture of discrete painful areas such as the feet, combined with stable paresthesia intensities independent of body position, suggests this stimulation modality may allow more selective and consistent targeting of painful areas than traditional SCS.
Roman Genov - One of the best experts on this subject based on the ideXlab platform.
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closed loop Neurostimulators a survey and a seizure predicting design example for intractable epilepsy treatment
IEEE Transactions on Biomedical Circuits and Systems, 2017Co-Authors: Hossein Kassiri, Sana Tonekaboni, Tariqus M Salam, Nima Soltani, Karim Abdelhalim, Jose Luis Perez Velazquez, Roman GenovAbstract:First, existing commercially available open-loop and closed-loop implantable Neurostimulators are reviewed and compared in terms of their targeted application, physical size, system-level features, and performance as a medical device. Next, signal processing algorithms as the primary strength point of the closed-loop Neurostimulators are reviewed, and various design and implementation requirements and trade-offs are discussed in details along with quantitative examples. The review results in a set of guidelines for algorithm selection and evaluation. Second, the implementation of an inductively-powered seizure-predicting microsystem for monitoring and treatment of intractable epilepsy is presented. The miniaturized system is comprised of two miniboards and a power receiver coil. The first board hosts a 24-channel neurostimulator system on chip [15] fabricated in a $0.13\;\mu \text{m}$ CMOS technology and performs neural recording, on-chip digital signal processing, and electrical stimulation. The second board communicates recorded brain signals as well as signal processing results wirelessly. The multilayer flexible coil receives inductively-transmitted power. The system is sized at 2 $\times$ 2 $\times$ 0.7 $\text{cm}^3$ and weighs 6 g. The approach is validated in the control of chronic seizures in vivo in freely moving rats.
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ISCAS - Battery-less modular responsive neurostimulator for prediction and abortion of epileptic seizures
2016 IEEE International Symposium on Circuits and Systems (ISCAS), 2016Co-Authors: Hossein Kassiri, Nima Soltani, Jose Luis Perez Velazquez, M. Tariqus Salam, Roman GenovAbstract:An inductively-powered implantable microsystem for monitoring and treatment of intractable epilepsy is presented. The miniaturized system is comprised of two mini-boards and a power receiver coil. The first board hosts a 24-channel neurostimulator SoC developed in a 0.13μm CMOS technology and performs neural recording, electrical stimulation and on-chip digit l signal processing. The second board communicates recorded brain signals as well as signal processing results wirelessly, and generates different supply and bias voltages for the neurostimulator SoC and other external components. The multi-layer flexible coil receives inductively-transmitted power and sends it to the second board for power management. The system is sized at 2 × 2 × 0.7 cm3, weighs 6 grams, and is validated in control of chronic seizures in vivo in freely-moving rats.
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ESSCIRC - An impedance-tracking battery-less arbitrary-waveform neurostimulator with load-adaptive 20V voltage compliance
ESSCIRC Conference 2016: 42nd European Solid-State Circuits Conference, 2016Co-Authors: Hossein Kassiri, Nima Soltani, Gairik Dutta, Chang Liu, Roman GenovAbstract:A 4-channel wireless and battery-less neurostimulator with impedance-tracking power-adaptive voltage compliance is presented. The device houses a 10 mm2 0.35µm HV-CMOS SoC (system on a chip) that performs current-mode arbitrary-waveform stimulation with voltage compliance of up to 20 V. An on-chip mixed-signal controller together with a 3-bit charge-pump maintain supply voltage at its minimum required value, resulting in up to 68.5% saving in power. An 8-bit current DAC is implemented in each channel, which together with adjustable supply voltage yield a current range from 23 µA to 95 mA (100Ω load). The device receives both power and configuration commands wirelessly using a near-field inductive link. The neurostimulator SoC is wire-bonded on a 2×2 cm2 PCB. Additional rigid and flexible PCBs of the same size provide wireless command and power interface. The 3-board 2×2×0.7 cm3 stacked system weighs 6 grams.
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Massively-Parallel Neuromonitoring and Neurostimulation Rodent Headset With Nanotextured Flexible Microelectrodes
IEEE transactions on biomedical circuits and systems, 2013Co-Authors: Arezu Bagheri, S. R. I. Gabran, Muhammad Tariqus Salam, J. L. Perez Velazquez, Raafat R. Mansour, Magdy M. A. Salama, Roman GenovAbstract:We present a compact wireless headset for simultaneous multi-site neuromonitoring and neurostimulation in the rodent brain. The system comprises flexible-shaft microelectrodes, neural amplifiers, Neurostimulators, a digital time-division multiplexer (TDM), a micro-controller and a ZigBee wireless transceiver. The system is built by parallelizing up to four 0.35 μm CMOS integrated circuits (each having 256 neural amplifiers and 64 Neurostimulators) to provide a total maximum of 1024 neural amplifiers and 256 Neurostimulators. Each bipolar neural amplifier features 54 dB-72 dB adjustable gain, 1 Hz-5 kHz adjustable bandwidth with an input-referred noise of 7.99 μVrms and dissipates 12.9 μW. Each current-mode bipolar neurostimulator generates programmable arbitrary-waveform biphasic current in the range of 20-250 μA and dissipates 2.6 μW in the stand-by mode. Reconfigurability is provided by stacking a set of dedicated mini-PCBs that share a common signaling bus within as small as 22×30×15 mm3 volume. The system features flexible polyimide-based microelectrode array design that is not brittle and increases pad packing density. Pad nanotexturing by electrodeposition reduces the electrode-tissue interface impedance from an average of 2 MΩ to 30 kΩ at 100 Hz. The rodent headset and the microelectrode array have been experimentally validated in vivo in freely moving rats for two months. We demonstrate 92.8 percent seizure rate reduction by responsive neurostimulation in an acute epilepsy rat model.
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1024-channel-scalable wireless neuromonitoring and neurostimulation rodent headset with nanotextured flexible microelectrodes
2012 IEEE Biomedical Circuits and Systems Conference (BioCAS), 2012Co-Authors: Arezu Bagheri, S. R. I. Gabran, Muhammad Tariqus Salam, J. L. Perez Velazquez, Raafat R. Mansour, Magdy M. A. Salama, Roman GenovAbstract:We present a compact wireless headset system for simultaneous multi-site neural recording and neurostimulation in the rodent brain. The system comprises flexible-shaft microelectrodes, neural amplifiers, Neurostimulators, a digital time-division multiplexer (TDM), a micro-controller and a ZigBee wireless transceiver. The system is built by parallelizing up to four 0.35μm CMOS integrated circuits (each having 256 neural amplifiers and 64 Neurostimulators) to provide a total maximum of 1024 neural amplifiers and 256 Neurostimulators. Each bipolar neural amplifier features 54dB-72dB adjustable gain, 1Hz-5KHz adjustable bandwidth with an input-referred RMS noise of 7.99μV and dissipates 12.9μW. Each current-mode bipolar neurostimulator generates arbitrary waveform programmable biphasic currents in the range of 20-250μA and dissipates 2.6μW in the standby mode. Reconfigurability is enabled by stacking a set of dedicated mini-PCBs that share a common signaling bus within as small as 22×30×15mm3 volume. The system features flexible polyimide-based microelectrode array design that maximizes pad packing density. Electrodeposition pad nanotexturing reduces the electrode-tissue interface impedance from an average of 2MΩ to 30K at 100Hz. The system has been validated in vivo in Sprague-Dawley rats.
Timothy Denison - One of the best experts on this subject based on the ideXlab platform.
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A micropower support vector machine based seizure detection architecture for embedded medical devices
2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2009Co-Authors: Ali Shoeb, Eric Panken, Dave Carlson, Timothy DenisonAbstract:Implantable Neurostimulators for the treatment of epilepsy that are capable of sensing seizures can enable novel therapeutic applications. However, detecting seizures is challenging due to significant intracranial EEG signal variability across patients. In this paper, we illustrate how a machine-learning based, patient-specific seizure detector provides better performance and lower power consumption than a patient non-specific detector using the same seizure library. The machine-learning based architecture was fully implemented in the micropower domain, demonstrating feasibility for an embedded detector in implantable systems.
Jennifer L. Dewolfe - One of the best experts on this subject based on the ideXlab platform.
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Sleep, Circadian Rhythms, and Epilepsy
Current Treatment Options in Neurology, 2018Co-Authors: Joseph T. Daley, Jennifer L. DewolfeAbstract:Purpose of review There is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy. Recent findings CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere. Intracranial video EEG monitoring and EEG from implanted responsive neurostimulator devices confirm scalp video EEG findings of a nocturnal peak for interictal epileptiform discharges. Successful epilepsy surgery may improve sleep macrostructure and quality. Summary Sleep outcomes in people with epilepsy undergoing epilepsy surgery and neurostimulator implantation may provide innovative understandings into the associations between sleep and epilepsy. These associations may then provide novel therapeutic options targeting sleep and circadian pathways to improve seizure control and improve the quality of life for patients with this debilitating disorder.
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Sleep, Circadian Rhythms, and Epilepsy
Current Treatment Options in Neurology, 2018Co-Authors: Joseph T. Daley, Jennifer L. DewolfeAbstract:Purpose of review There is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy. Recent findings CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere. Intracranial video EEG monitoring and EEG from implanted responsive neurostimulator devices confirm scalp video EEG findings of a nocturnal peak for interictal epileptiform discharges. Successful epilepsy surgery may improve sleep macrostructure and quality. Summary Sleep outcomes in people with epilepsy undergoing epilepsy surgery and neurostimulator implantation may provide innovative understandings into the associations between sleep and epilepsy. These associations may then provide novel therapeutic options targeting sleep and circadian pathways to improve seizure control and improve the quality of life for patients with this debilitating disorder.
Dirk L. Stronks - One of the best experts on this subject based on the ideXlab platform.
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dexmedetomidine vs propofol as sedation for implantation of Neurostimulators a single center single blinded randomized controlled trial
Acta Anaesthesiologica Scandinavica, 2019Co-Authors: Feline F J A Ter Bruggen, Charlotte Ceuppens, Leo Leliveld, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background: During the lead implantation of most spinal cord Neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation. Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P <.01), procedural recall (median 95.8 vs 83.3, P =.03), and sedation side effects (median 90.0 vs 83.3, P =.01). Fewer changes in the dexmedetomidine titration were necessary to maintain arousable sedation. Over time, mean arterial pressure and heart rate were significantly lower in the dexmedetomidine group. Hemodynamic side effects were comparable across groups. Conclusions: Dexmedetomidine sedation resulted in higher patient satisfaction and allowed for better arousable sedation than sedation with propofol. Although differences in hemodynamic parameters were found between the groups, these differences were not regarded as clinically relevant.
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Dexmedetomidine vs propofol as sedation for implantation of Neurostimulators: A single-center single-blinded randomized controlled trial.
Acta anaesthesiologica Scandinavica, 2019Co-Authors: Feline F. J. A. Ter Bruggen, Charlotte Ceuppens, Leo Leliveld, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background: During the lead implantation of most spinal cord Neurostimulators, the patient has to be comfortable and without pain. However, the patient is expected to provide feedback during electrical mapping. Titrating sedatives and analgesics for this double goal can be challenging. In comparison with our standard sedative agent propofol, the pharmacological profile of dexmedetomidine is more conducive to produce arousable sedation. The latter, however, is associated with hemodynamic side effects. We investigated whether dexmedetomidine is preferable over propofol during neurostimulator implantation. Methods: This single-center single-blinded randomized controlled trial included 72 patients with an indication for a neurostimulator, randomized to sedation with either propofol (0.5 mg/kg for 10 minutes, followed by 2.0 mg/kg/h) or dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.6 μg/kg/h). The primary outcome was patient satisfaction with the sedation. The secondary outcomes were patient's and operator's comfort, number of titration adjustments, standard intraoperative hemodynamic and respiratory parameters and side effects. Results: Data of 69 patients (dexmedetomidine n = 35; propofol n = 34) were analyzed. Those receiving dexmedetomidine were more satisfied with the sedation than those receiving propofol; i.e. with sedation delivery (median 100.0 vs 83.3, P
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Survey on sedation-analgesia regimens, in particular the use of dexmedetomidine, among Dutch implanters of spinal cord Neurostimulators.
Scandinavian journal of pain, 2019Co-Authors: Feline F. J. A. Ter Bruggen, Dirk L. Stronks, Frank J. P. M. HuygenAbstract:Background and aims During implantation of most spinal cord Neurostimulators, patients need to be cooperative to give feedback during lead placement, and also be comfortable. Sedation and analgesia can support these conditions. This survey aimed to provide an overview of the sedation-analgesia regimens currently used among Dutch pain specialists. The survey focused on the sedative agent “dexmedetomidine” due to its attractive pharmacological profile and its promising results during awake procedures. Methods A 27-item survey was sent to the 65 pain specialists involved in neurostimulation in the Netherlands. The survey consisted of questions related to different aspects of sedation and analgesia during neurostimulation, e.g. the current regimen, the opinion on and experience with dexmedetomidine as a sedative agent, and preferences regarding different aspects of sedation (i.e. production of arousable sedation, pain management, quality of patient’s feedback and overall preference). Results Of 65 pain specialists, 45 (69%) completed the survey. Most commonly used sedative was propofol (91%) and most common used analgesic was remifentanil (78%). Of the 45 respondents, 21 (47%) considered the use of dexmedetomidine, whereas 13 (29%) had experience with dexmedetomidine during neurostimulation. The most frequently mentioned positive property of dexmedetomidine was the easy production of arousable sedation. Most respondents who used dexmedetomidine preferred dexmedetomidine sedation over propofol sedation regarding all aspects of sedation. Conclusions The most commonly used sedation-analgesia regimen is the combination of propofol-remifentanil during the implantation of a neurostimulator among Dutch pain specialists. Only a small percentage of respondents had experience with the use of dexmedetomidine, despite its reported advantages. Implications When implanting a spinal cord neurostimulator, dexmedetomidine could be considered as a sedative, given its allowance for and preservation of a state of easy arousable sedation.