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Sulaiman MY, Wicaksono S, Dirgantara T, Mahyuddin AI, Sadputranto SA, Oli'i EM. Influence of bite force and implant elastic modulus on mandibular reconstruction with particulate-cancellous bone marrow grafts healing: An in silico investigation. J Mech Behav Biomed Mater 2024; 157:106654. [PMID: 39042972 DOI: 10.1016/j.jmbbm.2024.106654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/27/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
This study aims to investigate tissue differentiation during mandibular reconstruction with particulate cancellous bone marrow (PCBM) graft healing using biphasic mechanoregulation theory under four bite force magnitudes and four implant elastic moduli to examine its implications on healing rate, implant stress distribution, new bone elastic modulus, mandible equivalent stiffness, and load-sharing progression. The finite element model of a half Canis lupus mandible, symmetrical about the midsagittal plane, with two marginal defects filled by PCBM graft and stabilized by porous implants, was simulated for 12 weeks. Eight different scenarios, which consist of four bite force magnitudes and four implant elastic moduli, were tested. It was found that the tissue differentiation pattern corroborates the experimental findings, where the new bone propagates from the superior side and the buccal and lingual sides in contact with the native bone, starting from the outer regions and progressing inward. Faster healing and quicker development of bone graft elastic modulus and mandible equivalent stiffness were observed in the variants with lower bite force magnitude and or larger implant elastic modulus. A load-sharing condition was found as the healing progressed, with M3 (Ti6Al4V) being better than M4 (stainless steel), indicating the higher stress shielding potentials of M4 in the long term. This study has implications for a better understanding of mandibular reconstruction mechanobiology and demonstrated a novel in silico framework that can be used for post-operative planning, failure prevention, and implant design in a better way.
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Affiliation(s)
- Muhammad Yusril Sulaiman
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Satrio Wicaksono
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia.
| | - Tatacipta Dirgantara
- Mechanics of Solid and Lightweight Structures Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Andi Isra Mahyuddin
- Dynamics and Control Research Group, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
| | - Seto Adiantoro Sadputranto
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia
| | - Eka Marwansyah Oli'i
- Oral and Maxillofacial Medical Staff Group, Hasan Sadikin General Hospital, Jalan Pasteur 38, Bandung, 40161, West Java, Indonesia; Oral and Maxillofacial Department, Faculty of Dentistry, Universitas Padjajaran, Jalan Sekeloa Selatan 1, Bandung, 40132, West Java, Indonesia; Mechanical Engineering Graduate Program, Faculty of Mechanical and Aerospace Engineering, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, West Java, Indonesia
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Yan Z, Zou C, Kenmegne GR, Pan X, Ghimire N, Silva KMN, Fang Y. Newly designed plate for the treatment of posterolateral tibial plateau fractures: a finite element analysis. J Orthop Surg Res 2024; 19:201. [PMID: 38532441 DOI: 10.1186/s13018-024-04686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND This study investigated the biomechanical properties of a new plate used for the treatment of posterolateral tibial plateau fractures using finite element analysis. METHODS The study groups were as follows: group PM, model of the new plate with posteromedial tibial plateau fracture; group PL, model of the new plate with posterolateral tibial plateau fracture; and group PC, model of the new plate with posterior tibial plateau fracture. We used two loading modes: uniform loading on the entire plateau, and loading on the posterior plateau. Data such as the displacement of the fracture and distribution of stress on the new plate and screws were recorded and analyzed. RESULTS When the whole plateau was loaded, the displacement of fractures in groups PM, PL, and PC were 0.273, 0.114, and 0.265 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 118.131 MPa, 44.191 MPa, and 115.433 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 166.731, 80.330, and 164.439 MPa, respectively. When the posterior tibial plateau was loaded, the displacement of the fractures in groups PM, PL, and PC was 0.410, 0.213, and 0.390 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 194.012 MPa, 72.806 MPa, and 185.535 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 278.265, 114.839, and 266.396 MPa, respectively. CONCLUSION The results of this study revealed that titanium plates have good fixation effects in all groups; therefore, the use of the new plate for posterolateral tibial plateau fractures appears to be safe and valid.
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Affiliation(s)
- Zhaokui Yan
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuelin Pan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Nawin Ghimire
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Kuruwitage Manthi Nihara Silva
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Aftabi H, Zaraska K, Eghbal A, McGregor S, Prisman E, Hodgson A, Fels S. Computational models and their applications in biomechanical analysis of mandibular reconstruction surgery. Comput Biol Med 2024; 169:107887. [PMID: 38160502 DOI: 10.1016/j.compbiomed.2023.107887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Advanced head and neck cancers involving the mandible often require surgical removal of the diseased parts and replacement with donor bone or prosthesis to recreate the form and function of the premorbid mandible. The degree to which this reconstruction successfully replicates key geometric features of the original bone critically affects the cosmetic and functional outcomes of speaking, chewing, and breathing. With advancements in computational power, biomechanical modeling has emerged as a prevalent tool for predicting the functional outcomes of the masticatory system and evaluating the effectiveness of reconstruction procedures in patients undergoing mandibular reconstruction surgery. These models offer cost-effective and patient-specific treatment tailored to the needs of individuals. To underscore the significance of biomechanical modeling, we conducted a review of 66 studies that utilized computational models in the biomechanical analysis of mandibular reconstruction surgery. The majority of these studies employed finite element method (FEM) in their approach; therefore, a detailed investigation of FEM has also been provided. Additionally, we categorized these studies based on the main components analyzed, including bone flaps, plates/screws, and prostheses, as well as their design and material composition.
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Affiliation(s)
- Hamidreza Aftabi
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada.
| | - Katrina Zaraska
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Atabak Eghbal
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sophie McGregor
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Eitan Prisman
- Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, V5Z 1M9, BC, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
| | - Sidney Fels
- Department of ECE, University of British Columbia, Vancouver, V6T 1Z4, BC, Canada
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Hijazi KM, Dixon SJ, Armstrong JE, Rizkalla AS. Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction. MATERIALS (BASEL, SWITZERLAND) 2023; 17:140. [PMID: 38203994 PMCID: PMC10779528 DOI: 10.3390/ma17010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.
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Affiliation(s)
- Khaled M. Hijazi
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
| | - S. Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Jerrold E. Armstrong
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Amin S. Rizkalla
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
- Chemical and Biochemical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Lv Z, Li Z, Yang Q, Li J. A 3D-printed patient-specific modular implants for pelvic reconstruction of bone tumors involving the sacroiliac joint. Front Bioeng Biotechnol 2023; 11:1233960. [PMID: 37691901 PMCID: PMC10484402 DOI: 10.3389/fbioe.2023.1233960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Current reconstruction methods of the pelvic ring after extensive resection of tumors involving the sacroiliac joint have a high incidence of failure. We aimed to study the effect of 3D-printed patient-specific implant reconstruction to show that this method is stable and has a low risk of failure. Methods: Between February 2017 and November 2021, six patients with bone tumors involving the sacroiliac joint (Enneking I + IV) who received 3D-printed patient-specific implants for pelvic reconstructive surgery were retrospectively analyzed. Two female and four male patients with a mean age of 41.83 years (range 25-65 years) were included. Two were osteosarcomas, two chondrosarcomas, one malignant fibrous histiocytoma, and one giant cell tumor of bone. For each patient, preoperative osteotomy guides were designed to ensure accurate tumor resection and individualized prostheses were designed to ensure a perfect fit of the bone defect. General, oncologic, and functional outcomes, implant status, and complications were retrospectively analyzed. The Visual Analog Scale (VAS) was used to assess pain and the Musculoskeletal Tumor Society (MSTS) score was used to assess hip function. Osseointegration was assessed by CT. Results: According to the preoperative design, complete resection of the entire tumor and reconstruction with a custom 3D-printed sacroiliac joint implant was completed without perioperative severe complications or deaths. Relatively satisfactory surgical margins were achieved. The mean operative time and intraoperative blood loss were 495 min (420-600 min) and 2533.33 mL (range, 1,200-3,500 mL), respectively. The mean follow-up was 49.83 months (range, 18-75 months). At the last follow-up, all four patients were disease-free, and the two patients who developed lung metastases were alive with tumors. All patients could walk unassisted. The mean VAS was 1.33 (range, 0-2). The mean MSTS score was 25.33 (range, 24-27). CT showed complete osseointegration of the implant to the ilium and sacrum. Conclusion: The 3D-printed custom prosthesis can effectively reconstruct pelvic stability after total sacroiliac joint resection with satisfactory clinical results.
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Affiliation(s)
| | | | | | - Jianmin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Zhou Q, Su X, Wu J, Zhang X, Su R, Ma L, Sun Q, He R. Additive Manufacturing of Bioceramic Implants for Restoration Bone Engineering: Technologies, Advances, and Future Perspectives. ACS Biomater Sci Eng 2023; 9:1164-1189. [PMID: 36786214 DOI: 10.1021/acsbiomaterials.2c01164] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Treating bone defects is highly challenging because they do not heal on their own inside the patients, so implants are needed to assist in the reconstruction of the bone. Bioceramic implants based on additive manufacturing (AM) are currently emerging as promising treatment options for restoration bone engineering. On the one hand, additively manufactured bioceramic implants have excellent mechanical properties and biocompatibility, which are suitable for bone regeneration. On the other hand, the designable structure and adjustable pores of additively manufactured bioceramic implants allow them to promote suitable cell growth and tissue climbing. Herein, this review unfolds to introduce several frequently employed AM technologies for bioceramic implants. After that, advances in commonly used additively manufactured bioceramic implants, including bioinert ceramic implants, bioactive ceramic implants, and bioceramic/organic composite implants, are categorized and summarized. Finally, the future perspectives of additively manufactured bioceramic implants, in terms of mechanical performance improvement, innovative structural design, biological property enhancement, and other functionalization approaches, are proposed and forecasted. This review is believed to provide some fundamental understanding and cutting-edge knowledge for the additive manufacturing of bioceramic implants for restoration bone engineering.
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Affiliation(s)
- Qing Zhou
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaonan Su
- Beijing Scrianen Pharmaceutical Co. Ltd., Beijing 102699, China
| | - Jianqin Wu
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xueqin Zhang
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Ruyue Su
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Lili Ma
- Center of Dental Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qiang Sun
- Center of Dental Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Rujie He
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing 100081, China
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Haroun F, Benmoussa N, Bidault F, Lassau N, Moya-Plana A, Leymarie N, Honart JF, Kolb F, Qassemyar Q, Gorphe P. Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101281. [PMID: 36084893 DOI: 10.1016/j.jormas.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction. METHODS The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation. RESULTS Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation. CONCLUSION The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.
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Affiliation(s)
- Fabienne Haroun
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France; BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - François Bidault
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nathalie Lassau
- BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Nicolas Leymarie
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Fréderic Kolb
- Plastic and Reconstructive Surgery, UC San Diego, University of California, CA, United States
| | | | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France.
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Ngomi N, Khayeka-Wandabwa C, Egondi T, Marinda PA, Haregu TN. Determinants of inequality in health care seeking for childhood illnesses: insights from Nairobi informal settlements. GLOBAL HEALTH JOURNAL 2022. [DOI: 10.1016/j.glohj.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Javaid M, Haleem A, Singh RP, Suman R. 3D printing applications for healthcare research and development. GLOBAL HEALTH JOURNAL 2022. [DOI: 10.1016/j.glohj.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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