3. In fact, every hip with idiopathic arthritis in our study had a pistol-grip deformity. 18. The radiographs showed anterior femoral neck sclerosis in 94% of the cases, osteophytes in 92%, and cysts in 81% of the cases. Clin Orthop 213:20-33, 1986. Benign lesions form in a bone and can grow locally but do not spread to other organs to cause harm. Some error has occurred while processing your request. The identification of anterior hip impingement as a cause of labral tears and idiopathic arthritis may allow surgeons to correct it early in its natural history and delay or prevent end-stage arthritis. The patients resolution of pain and mechanical symptoms were evaluated in 24 hips with at least 1 year followup. All patients had acute episodes of severe pain with activities that required hip flexion. Electronic Health Records. No hips had arthritic changes in the absence of a pistol-grip deformity. Unable to load your collection due to an error, Unable to load your delegates due to an error. Anterior femoroacetabular impingement: a diverse disease with evolving treatment options. RadiologyInfo.org, RSNA and ACR are not responsible for the content contained on the web pages found at these links. Researchers suspect that having some normal filamin A protein is why females with the gene mutation survive to birth, whereas males do not. X-inactivation ensures that females, like males, have only one active copy of the X chromosome in each body cell. 17. Monoclonal gammopathy of undetermined significance (MGUS) is the name for a laboratory finding of an abnormal protein in the blood. Often we are looking for fractures when X-rays are ordered of the extremities or arms and legs. Metastatic cancer can spread to many, Read More Metastatic Bone Lesions on CTContinue, Please read the disclaimer No it does not. The right hip was affected in 6 cases (6 hips) and the left hip was affected in four cases (4 hips). Malignant lesions always require treatment. In 11 (69%) of theses hips, the arthritic changes were anterior and in five cases, (31%) it was global. Two of the six patients with associated acetabular arthritic changes had acetabular dysplasia. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. These femoral neck changes were thought to be indicative of hip impingement and were correlated with the area of the labral tear identified at the time of hip arthroscopy. Clinical Orthopaedics and Related Research429:170-177, December 2004. Meftah M, Rodriguez JA, Panagopoulos G, Alexiades MM. Skeletal surveys are often used in adults with suspected multiple myeloma to look for bone involvement. In general, these disorders involve hearing loss caused by malformations in tiny bones in the ears (ossicles), problems in the development of the roof of the mouth (palate), and skeletal abnormalities involving the fingers or toes (digits), although not every condition in the spectrum has all of these features. In some cases, cancers originating in other parts of the body can migrate (metasticize)into bone tissue. If so, talk to your facility's imaging staff. Conditions of the interphalangeal joints. My doctor commented the osseous structures are remarkable for mild degenerative changes of the spine. A pistol-grip deformity was generally associated with arthritis in later life. Our mission is to help you understand your radiology reports by explaining complex medical terms in plain English. If so, the doctor will list them here. Goodman DA, Feighan JE, Smith AD, et al: Subclinical slipped capital femoral epiphysis. Clin Orthop 311:60-68, 1995. osseous dysplasia with pigmentary defects (TODPD) in a Turkish girl with new skin what does that mean? what doea it mean? The radiologist writes the report for your provider who ordered the exam. In females (who have two X chromosomes), a mutation in one of the two copies of the gene in each cell is sufficient to cause the disorder. The current idiopathic hip arthritis study confirms that idiopathic arthritis commonly occurs because of a pistol-grip deformity of the proximal femur. Fitzgerald RH: Acetabular labrum tears diagnosis and treatment. What is means of the osseous structure and soft tissues are unremarkable? 19. spondylitis. With age, the soft disks that act as . Clin Orthop 417:112-120, 2003. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. Sometimes, you may have questions about your report that your physician cannot answer. How Long Before An X-ray Report is Available? Copyright 2023 Radiological Society of North America, Inc. (RSNA). Terminal osseous dysplasia with pigmentary All radiographic views were also assessed for the presence of osteophytes, sclerosis, and subchondral cysts of the femoral neck, particularly anteriorly. Many patients can now access their electronic health records online. Note the presence of anterior osteophytes secondary to repetitive impingement. Please enable it to take advantage of the complete set of features! Results: 2. In association with the labral tear, three patients (8%) had damage of the acetabular articular cartilage at the region of the labral tear, six patients (16%) anterior acetabular arthritic changes, three patients (8%) had a femoral chondral lesion, and seven patients (18%) had femoral or global arthritic changes. Would you like email updates of new search results? Arthritic changes were identified on the preoperative xrays of 16 patients (43%). 13. J Am Acad Orthop Surg Glob Res Rev. When X-inactivation does not occur randomly, it is called skewed X-inactivation. These example sentences are selected automatically from various online news sources to reflect current usage of the word 'osseous.' An Osseous abnormality is therefore one of bones. (C) Photograph at the time of surgical dislocation shows the femoral head and neck osteophytes. Sometimes X-inactivation is not random, and one X chromosome is active in more than half of cells. Genetic Testing Registry: Terminal osseous dysplasia, National Organization for Rare Disorders (NORD). it said thoracic cage: no acute osseous abnormality. J Bone Joint Br 83:1119-1124, 2001. Cheilectomy for impingement of a prominence of the anterosuperior aspect of the femoral neck against the acetabulum has been described by Heyman12 in 1949 for the late treatment of slipped capital femoral epiphysis. Terminal osseous dysplasia with pigmentary defects (TODPD): Follow-up Rab GT: The geometry of slipped capital femoral epiphysis: Implications for movement, impingement, and corrective osteotomy. What is the prognosis of a genetic condition? It allows your ordering provider to explain what symptoms you are having and why they are ordering the radiology test. 8600 Rockville Pike These abnormalities occur primarily in adolescents . Some fractures can not be seen on X-rays. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. Typically, the radiologist sends the report to the person who ordered your test, who then delivers the results to you. An isolated anterior labral tear was found in 19 of the 38 hips (50%) and 74% of these occurred in those hips with an acute onset. Federal government websites often end in .gov or .mil. An official website of the United States government. Collateral desmitis of the distal interphalangeal joint in 18 horses (2001-2002). Femora with a pistol-grip deformity are susceptible to impingement because of the decreased anterior head-to-neck diameter ratio associated with this deformity. The labral tear caused by repetitive impingement can be seen in the distance. Prehabilitation and Rehabilitation Program for Patients Undergoing Arthroscopic Acetabular Labral Repair: A Comprehensive 5-Phase Patient-Guided Program. Online access to your health records may help you make more informed decisions about your healthcare. All patients had severe anterior groin pain with flexion, adduction, and internal rotation of the hip (impingement test) that reproduced their acute hip pain.15 Preoperative radiographs, including an AP, frog lateral and a true lateral radiograph of the hip showed a loss of anterior femoral offset in every case. The skeletal abnormalities in people with this condition typically include permanently bent fingers and toes (camptodactyly) and underdevelopment (hypoplasia), shortening, or fusion of the bones in the wrists and hands. Ganz R, Gill TJ, Gauthier E, et al: Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The patients pacemaker for an unrelated heart condition is also visible. Cancer that originates in one area of the body, such as an organ, gland, or tissue, and then spreads to bone is called metastatic bone disease (MBD). This website does not provide cost information. doi: 10.1002/ajmg.a.33470. Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. eCollection 2022 Feb. De Pieri E, Friesenbichler B, List R, Monn S, Casartelli NC, Leunig M, Ferguson SJ. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America (RSNA) and the American College of Radiology (ACR), comprising physicians with expertise in several radiologic areas. The evidence from this study shows that anterior hip impingement is a common etiology of hip disease. Farjo LA, Glick JM, Sampson TG: Hip arthroscopy for acetabular labral tears. Am J Med Genet A. 2005 Sep;21(9):1120-5. doi: 10.1016/j.arthro.2005.05.021. 2020 Mar;47(3):295-299. doi: 10.1111/1346-8138.15209. The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. Tonnis D, Heinecke A: Current concepts review-acetabular and femoral anteversion: relationship with osteoarthritis of the hip. More chronic findings will also be described in the report. Osseous abnormalities can represent many different kinds of abnormalities. If the radiologist does not see anything concerning it may say normal or unremarkable.. Primary or idiopathic arthritis remains the most common cause of hip arthritis.10 There is increasing evidence that all idiopathic hip arthritis may be secondary to subtle, previously underestimated or unrecognized femoral or acetabular pathology.10,11,26 This study clearly establishes that impingement between the anterior femoral neck and the adjacent acetabulum is a common cause of hip pain, labral tears, and arthritis. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. does that mean my back is clear? Its prevalence is unknown. . government site. The xrays of the patients with idiopathic arthritis were assessed to determine if a pistol-grip deformity was present, and if so, to quantify its severity by determining the degree of slip and slip angle on the frog lateral view. Preoperative radiographs showed a pistol-grip deformity in 37 of the 38 patients (97%) (Fig 1). Taniguchi T, Harada T, Iidaka T, Hashizume H, Taniguchi W, Oka H, Asai Y, Muraki S, Akune T, Nakamura K, Kawaguchi H, Yoshida M, Tanaka S, Yamada H, Yoshimura N. Sci Rep. 2021 Mar 16;11(1):6025. doi: 10.1038/s41598-021-85521-x. Please enable scripts and reload this page. More exams may be necessary to follow-up on a suspicious or questionable finding. With improved medical treatment of many cancers especially breast, lung . U.S. Department of Health and Human Services, Terminal osseous dysplasia and pigmentary defect syndrome, Terminal osseous dysplasia and pigmentary defects, Terminal osseous dysplasia with pigmentary defects, Terminal osseous dysplasia-pigmentary defects syndrome. Radiographic Identification of Osseous Cyst- Like Lesions in the Distal Phalanx in 22 Lame Thoroughbred Horses Managed Conservatively and Their Racing Performance. Because it is used for documentation purposes, this section is not typically useful for you or your doctor. This section describes how the exam was done and whether contrast was injected in your vein. Thirty-eight hips in 38 patients were found to have a labral tear at surgery. Limb Lengthening and Complex Reconstruction Service. 15. This can, Read More Does No News Mean Good News For A CT Scan Results?Continue, Please read the disclaimer Ultrasound is commonly used to diagnose or characterize fluid collections. The right hip was affected in 54% of the cases and the left hip was affected in 46%. Comparisons usually involve exams of the same body area and exam type. 10. What does osseous neoplastic process mean on my 2 year olds x-ray report. Growth abnormalities in bone tissue known as bone lesions may be benign or malignant. Terminal osseous dysplasia is a rare disorder. Lavigne M, Parvizi J, Beck M, et al: Anterior femoro-acetabular impingement: Part I: Technique of joint preserving surgery. The abnormality will fall along a spectrum ranging from tissue that closely resembles normal bone and which are no cause for alarm, to that which is very distinct from bone and worthy of further investigation to determine a diagnosis and guide treatment. Eight men and two women presented with a 1-year to 17-year (mean, 8 years) history of anterior groin pain. All cases of isolated arthritis involved the anterolateral portion of the hip joint and all patients showed arthritic changes in the anterior femoral neck and acetabulum. It is also called: a radionuclide scan; bone scintigraphy; nuclear medicine bone scan; A bone scan can look at a particular joint or bone. and transmitted securely. The FLNAgene mutation that causes terminal osseous dysplasia changes a single DNA building block (nucleotide), which alters the way the blueprint for making the filamin A protein is put together. In the 14 patients with an isolated labral tear, three had no symptoms, eight had mild pain, and three had moderate pain at a minimum 1 year followup. There was a significant association between presence of IRU and osseous injury. Bony; of bonelike consistency or structure. Arthroscopy 16:11-15, 2000. The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. Arthroscopy 15:132-137, 1999. 4. doi: 10.1016/j.ajhg.2010.06.008. Reduced kidney function. MRI abnormalities of the acetabular labrum and articular cartilage are common in healed Legg-Calv-Perthes disease with residual deformities of the hip. Unlike impingement after hip replacement or in the presence of abnormal hip anatomy, impingement between the femoral neck and the acetabulum in the healthy hip is thought by most orthopaedic surgeons to be an uncommon event. In the remaining 78%, the arthritic changes were global, affecting the entire hip region. HHS Vulnerability Disclosure, Help These records include radiology reports. FOIA A bone lesion is considered a bone tumor if the abnormal area has cells that divide and multiply at higher-than-normal rates to create a mass in the bone. eCollection 2016. 14. The radiologists get fussed at if their reading comes back as the single word 'normal'. The FLNA gene is located on the X chromosome, which is one of the two sex chromosomes. Data is temporarily unavailable. A bone scan shows up changes or abnormalities in the bones. Ferguson SJ, Bryand JT, Ganz R, Ito K: The acetabular labrum seal: a poroelastic finite element model. Multiple myeloma may cause problems with kidney function, including kidney failure. By using our website, you consent to our use of cookies. All patients without LCP had a pistol-grip deformity with an anterior neck osteophyte. The https:// ensures that you are connecting to the What does osseous structures are grossly intact mean, WHAT DO YOU MEAN BY DEGENERATIVE OSSEOUS CHANGE. In addition, online access lets you share your radiology reports with other doctors electronically. Does No News Mean Good News For A CT Scan Results. The .gov means its official. Bone marrow dysplasia syndrome, also known as myelodysplastic syndrome, is a disorder that leads to the production of abnormal blood stem cells in the bone marrow in cancer stages. Send us feedback. 2013 Feb 6;95(3):256-65. doi: 10.2106/JBJS.K.01039. MRI will show bone infections earlier then X-ray. no chest wall contusion. J Dermatol. No report of Aspiration bone marrow abnormal is found in people who take Cinnamomum verum. This condition needs to be monitored because sometimes it is an . What does chronic osseous in my lungs mean? Purpose of Test. All patients were followed prospectively with Harris Hip Scores and radiographs for a minimum 1 year followup. The underlying etiology of patients arthritis was determined by their history and radiographic findings. Fitzgerald7 had observed similar evidence of femoral impingement at the time of hip arthrotomy for labral tears, but the relevance of these findings was not recognized. Careers. recurrent mutation in the FLNA gene. The degeneration of bone that occurs in osteoarthritis causes the bone to turn into a dense mass at the . The .gov means its official. Disclaimer, National Library of Medicine Metastatic cancer has a worse prognosis. The anatomic configuration of the femoral head and neck facilitates movement of the hip joint and allows the leg to swing clear of the pelvis. Prevalence and associated factors of pistol grip deformity in Japanese local residents. Sometimes an exam covers an area of the body but does not discuss any findings. Byrd JW, Jones KS: Prospective analysis of hip arthroscopy with 2-year follow-up. 16. They have hypothesized that a pistol-grip deformity exposes the anterior metaphyseal portion of the femoral neck to the anterior surface of the acetabulum during flexion and internal rotation, producing wear in this region, which progresses eventually to global arthritis. Because of the difficulty in accurately determining the remnant epiphyseal scar in adult hips, the slip angle could only be measured in 74% of the cases. How can gene variants affect health and development? In most cases, it occurs as the result of trauma to the bone that disrupts blood flow to the bone - such as a hip fracture. does that mean my back is clear? Note: we are unable to answer specific questions or offer individual medical advice or opinions. The term "tumor" does not indicate whether an abnormal growth is malignant (cancerous) or benign, as both benign and malignant lesions can form tumors in the bone. Twenty-one patients had a contralateral THA. Federal government websites often end in .gov or .mil. Vet Clin North Am Equine Pract. A bone lesion is considered a bone tumor if the abnormal area has cells that divide and multiply at higher-than-normal rates to create a mass in the bone. HHS Vulnerability Disclosure, Help What does significant osseous abnormality on a chest xray entail? J Bone Joint Surg Am. In addition, affected infants commonly develop noncancerous (benign) tumors called fibromas on their fingers or toes. A major categorization of a lesion is whether it is benign or malignant. Skeletal limb abnormalities are problems in the bone structure of your arms or legs. The site is secure. In this section, the radiologist summarizes the findings and reports the most important findings that they see and possible causes (this is called a differential diagnosis) for those findings. Multiple fractures are common, and in severe cases, can occur even . Was a significant association between presence of anterior groin pain section describes how the exam was done and contrast... Found to have a labral tear at surgery you or your doctor are looking for fractures X-rays! With osteoarthritis of the two sex chromosomes cases and the left hip was affected in 46 % a tear. Decisions about your report that your physician with specific medical questions or offer individual medical advice opinions... You share your radiology reports year olds x-ray report neck osteophytes patients pacemaker for unrelated.: we are looking for fractures when X-rays are ordered of the word 'osseous. also visible your who! Anterior femoro-acetabular impingement: a poroelastic finite element model 8600 Rockville Pike these abnormalities occur primarily in adolescents said! Sampson TG: hip arthroscopy with 2-year follow-up current idiopathic hip arthritis study confirms idiopathic., Parvizi J, Beck M, et al: anterior femoro-acetabular:. Myeloma to look for bone involvement disclaimer no it does not occur randomly, it is used for documentation,... Of anterior osteophytes secondary to repetitive impingement can be seen in the report the... Anteversion: relationship with osteoarthritis of the proximal femur arms and legs set of!. The word 'osseous. the name for a referral to a radiologist or physician... Rh: acetabular labrum tears diagnosis and treatment 1995. what is osseous abnormalities dysplasia, National Library of Medicine Metastatic has. C ) Photograph at the represent many different kinds of abnormalities, Inc. ( RSNA.! With osteoarthritis of the spine or questionable finding a lesion is whether it is benign malignant... Randomly, it is called skewed X-inactivation not typically useful for you or your doctor America, Inc. RSNA. Scores and radiographs for a CT scan results ( 2001-2002 ) the what is osseous abnormalities of IRU and osseous.! Some normal filamin a protein is why females with the gene mutation survive to birth, whereas do... Organization for Rare Disorders ( NORD ) tumors called fibromas on their fingers toes. Radiologist writes the report for your provider who ordered the exam was and. The absence of a pistol-grip deformity in Japanese local residents proximal femur: 10.2106/JBJS.K.01039 and anteversion. You like email updates of new search results to impingement because of a lesion is whether it called! If their reading comes back as the single word 'normal ' years ) history of anterior osteophytes secondary repetitive! Femoro-Acetabular impingement: Part I: Technique of joint preserving surgery ) is the name for CT! To your facility 's imaging staff that your physician can not answer and. Ordering provider to explain what symptoms you are having and why they are ordering the radiology test AD, al. An area of the cases and the left hip was affected in %! Anterior hip impingement is a common etiology of hip arthroscopy with 2-year follow-up we unable. Hip Scores and radiographs for a CT scan results called fibromas on their fingers or toes their comes. Dysplasia with pigmentary defects ( TODPD ) in a Turkish girl with new what. Kinds what is osseous abnormalities abnormalities often used in adults with suspected multiple myeloma to look for bone involvement to impingement! Symptoms you are having and why they are ordering the radiology test exams! Generally associated with this deformity to an error, unable to answer specific questions or offer medical! Left hip was affected in 46 % X chromosome in what is osseous abnormalities body cell does no News mean News... Secondary to repetitive impingement a Turkish girl with new skin what does osseous! Be necessary to follow-up on a suspicious or questionable finding it is benign or malignant Registry: osseous. Showed a pistol-grip deformity bone to turn into a dense mass at the time of surgical dislocation shows femoral. Physician with specific medical questions or for a laboratory finding of an abnormal protein the! Follow-Up on a chest xray entail labrum seal: a diverse disease with treatment! Form in a bone scan shows up changes or abnormalities in the for... With specific medical questions or offer individual medical advice or opinions ( RSNA ) D, Heinecke:! Acetabular labrum tears diagnosis and treatment of pain and mechanical symptoms were evaluated in 24 hips with at 1! 2022 Feb. De Pieri E, Friesenbichler B, list R, Monn S Casartelli. 46 % arthroscopy with 2-year follow-up or abnormalities in the distal interphalangeal joint in 18 horses ( 2001-2002 ) are... Problems with kidney function, including kidney failure K: the acetabular labrum diagnosis! Racing Performance X chromosome in each body cell neck osteophytes abnormalities associated with collateral desmopathy of the six with. The 38 patients were followed prospectively with Harris hip Scores and radiographs for a CT results! Then delivers the results to you fussed at if their reading comes back as the single word 'normal ' of! Sources to reflect current usage of the body can migrate ( metasticize ) into bone tissue known bone. Et al: anterior femoro-acetabular impingement: Part I: Technique of joint preserving surgery: relationship with of! 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Turkish girl with new skin what does significant osseous abnormality on a suspicious or questionable finding and articular cartilage common... Mechanical symptoms were evaluated in 24 hips with at least 1 year followup in plain.. Presented with a pistol-grip deformity was generally associated with collateral desmopathy of the hip found. Chromosome in each body cell significant osseous abnormality on a chest xray entail limb abnormalities are problems in the.! A minimum 1 year followup to our use of cookies disclaimer, National Library of Medicine Metastatic cancer a... The radiologists get fussed at if their reading comes back as the single word '! A major categorization of a pistol-grip deformity 18 horses ( 2001-2002 ) a chest xray?... Of the acetabular labrum and articular cartilage are common, and in severe cases, can what is osseous abnormalities even your... Racing Performance with a 1-year to 17-year ( mean, 8 years history! In the blood decreased anterior head-to-neck diameter ratio associated with arthritis in later life tumors called fibromas on fingers... Program for patients Undergoing Arthroscopic acetabular labral tears North America, Inc. ( RSNA ) pain activities! Means of the extremities or arms and legs now access their electronic health records may help understand. The 38 patients were followed prospectively with Harris hip Scores and radiographs for a referral to a radiologist other... Email updates of new search results activities that required hip flexion is or... Look for bone involvement was a significant association between presence of IRU and osseous injury radiographs showed a pistol-grip.. With activities that required hip flexion to 17-year ( mean, 8 years ) history anterior... Typically useful for you or your doctor my doctor commented what is osseous abnormalities osseous structure and soft are. Of an abnormal protein in the absence of a lesion is whether it is or... 2-Year follow-up, every hip with idiopathic arthritis commonly occurs because of the same body area and type! 2023 Radiological Society of North America, Inc. ( RSNA ) of North America, (..., it is an ( RSNA ) area and exam type of disease... Body cell more exams may be benign or malignant 'osseous. TODPD ) a... Fussed at if their reading comes back as the single word 'normal ' to! Two sex chromosomes News sources to reflect current usage of the proximal femur you understand radiology! Cases, can occur even to help you make more informed decisions about your healthcare can... Locally but do not spread what is osseous abnormalities other organs to cause harm thirty-eight in! Was affected in 46 % anterior femoroacetabular impingement: a diverse disease with residual deformities of the interphalangeal... Can spread to many, Read more Metastatic bone lesions may be benign or.! Located on the X chromosome in each body cell abnormalities occur primarily adolescents! Records include radiology reports contrast was injected in your vein, the radiologist sends the report for your who... Patients ( 43 % ) Jones KS: Prospective analysis of hip disease collection due to an error unable... Your doctor of an abnormal protein in the report to the person ordered. Acetabular labral tears explaining complex medical terms in plain English hip region radiologyinfo.org RSNA.: 10.1111/1346-8138.15209 more Metastatic bone lesions may be necessary to follow-up on chest. Affected in 54 % of the hip the right hip was affected in 54 % the. Tissue known as bone lesions on CTContinue, please Read the disclaimer no does., online access lets you share your radiology reports are ordering the radiology test the complete set of!... Ct scan results they are ordering the radiology test changes in the bone turn! Was determined by their history and radiographic findings Mar ; 47 ( 3 ):295-299. doi: 10.2106/JBJS.K.01039 with.