Medicine and Health Sciences Commons^™

Stage Of Disease And Likelihood Of Surgical Intervention In Colon Cancer Patients: An Exploratory Analysis Of The Seer Database, R. Denneny, D. Delgado, V. Nguyen, J. Subramoney, B. George, E. Mitchell, Md

Phase 1

Introduction/Objectives: Colorectal cancer (CRC) remains as the third-leading cause of cancer-related deaths amongst both men and women in the United States. However, the mortality rate from CRC continues to drop, which has been attributed to increased surgical polyp removal. This study explored the association between disease stage and the likelihood of surgical intervention as primary treatment for the disease.

Methods: Retrospective cohort study analysis using de-identified patient data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) database from 1998-2015. Inclusion criteria included patients with colon cancer, over 18 years of age, with known disease in either the proximal or …

Racial Disparities In Head And Neck Cancers In An Urban Hospital, Jessica Kraus-Lavy, Charnita Zeigler-Johnson, Scott W Keith, Frances Guiles, David Cognetti, Voichita Bar-Ad, Rita S. Axelrod, Md

Phase 1

Introduction: Head and neck cancer incidence rates are higher for white residents in Philadelphia, while related mortality rates are highest for black residents. It is unclear how risk factors like HPV and smoking contribute to these disparities. The goal of this study is to determine which factors are associated with head and neck cancers in a diverse patient population from a Philadelphia hospital.

Methods: Cancer registry data from Thomas Jefferson University was used to obtain records from 922 head and neck cancer patients. One patient of other race was excluded. Twenty in-situ cancer cases were excluded. Chi-square tests were used …

Are We Doing It For The Money? A Salary Survey Of The United States Surgical Program Directors, Alexander Hoey, Ba, Brian Hoey, Md, Stanislaw Stawicki, Md

Phase 1

Compensation packages and job responsibilities for United States surgical program directors (PD) vary considerably from one institution to the next. With limited compensation data available for PD’s, this survey reassesses and compares the salaries, benefits, duties, and contract arrangements of all allopathic U.S. surgical PDs. Questionnaires regarding these areas of interest were mailed out electronically to all of the PDs and data was compared between the individuals’ responses using Chi-Squared and Fischer Exact Tests. Fifty-five percent of the PDs responded, revealing significant variation in total compensation packages, size of the dedicated stipend for the role, and time spent on clinical …

High Density Of Tumor-Associated Macrophage Staining Correlates With Poor Clinicopathologic Markers In Head And Neck Squamous Cell Carcinoma: A Meta-Analysis, Alexander Knops, Ba, Ayan Kumar, Bs, Brian Swendseid, Md, Ubaldo E. Martinez-Outshoorn, Md, Larry Harshyne, Phd, Nancy Philp, Phd, Ulrich Rodeck, Md, Phd, Christopher Snyder, Adam Luginbuhl, Md, David Cognetti, Md, Jennifer Johnson, Md, Joseph Curry, Md

Phase 1

Background: Head and neck squamous cell carcinoma (HNSCC) develops within a complex cellular microenvironment that promotes tumor growth, but also represents many potential therapeutic targets. Macrophage presence within that environment has been implicated in the growth, aggression, and persistence of HNSCC. Current literature reports variable degrees of association between tumor-associated macrophage (TAMs) density and clinicopathologic markers of disease.Inconsistent findings may result from grouping of TAM subtypes, which include both M1 (pro-inflammatory) and M2 (immunosuppressive). Our aim is to define the prognostic significance of the phenotypes of tumor-associated macrophages in HNSCC.

Methods: We conducted a meta-analysis of the existing publications investigating …

Retrospective Chart Review Assessing Factors That Contribute To Network Leakage In Postoperative Pancreatic Cancer Patients, Nazanin Sarpoulaki, Christian Fernandez, Md, Mark Hurwitz, Md

Phase 1

Introduction: Standard of care for resectable pancreatic cancer includes surgery, chemotherapy, with consideration of radiotherapy. Thomas Jefferson University Hospital (TJUH) is a large volume institution for pancreatectomy. Rate of subsequent in-network adjuvant treatment are far less which may impact outcomes. We will elucidate variables that influence coordinated patient care.

Objective: To evaluate variables that correlate with follow up and adjuvant treatment of pancreatic cancer patients at TJUH.

Methods: Retrospective medical chart reviews will be performed with data from patients with pancreatic cancer who have undergone resection at TJUH from April 2017 to March 2018. Patient demographics, clinical, and pathologic information …

Factors Associated With Stage At Presentation Among Patients With Rare Pancreatic Tumors: An Exploratory Analysis Of The Seer Database, J. Subramoney, D. Delgado, V. Nguyen, R. Denneny, B. George, E. Mitchell, Md

Phase 1

Introduction: Rare pancreatic carcinomas (PC) account for roughly 15% of all pancreatic cancers and approximately 8,300 new cases within the US annually. Little research compares initial stage at diagnosis among rare vs. common pancreatic tumors. The aim of this study was to examine associations between tumor histology and initial stage at diagnosis among cases of rare pancreatic cancers.

Methods: Retrospective cohort study, using the NCI’s Surveillance, Epidemiology, and End Results (SEER) 1990-2015 database. We included patients diagnosed with pancreatic cancer aged 18+. Histology was classified into four categories (ductal, carcinoid, mucinous adenocarcinoma, and undetermined) and stage was dichotomized …

Management Of Retinoblastoma In Older Children (>5 Years) Using Intra-Arterial Chemotherapy: Comparison Of Outcomes To Pre-Chemotherapy And Intravenous Chemotherapy Eras, Evan Selzer, Ms, R. Joel Welch, Md, Pascal Jabbour, Md, Ann Leahey, Md, Carol L. Shields, Md

Phase 1

Introduction: Intra-arterial chemotherapy (IAC) has emerged as an effective treatment for retinoblastoma (RB), but little information exists regarding its use in older patients (>5 years). We evaluate the use of IAC (2008-2018) for RB in older patients and compare outcomes to those in the pre-chemotherapy (<1994) and intravenous chemotherapy (IVC) (1994-2007) eras.

Objective: To evaluate the hypothesis that IAC is effective in managing RB in older patients.

Methods: We performed a retrospective analysis of all patients older than 5 years who were treated with IAC for RB from 2008-2018 on the Ocular Oncology Service at the Wills Eye Hospital. Comparisons were made to historic, …

Implementation Of Psychological Interview And Testing In A Large Sperm Bank, Catherine Sham, Andrea Braverman, Robert Mora, Makenzie Perdue, Jaime Shamonki

Phase 1

Introduction: Historically, sperm donor applicants have been medically but not psychologically evaluated by mental health professionals (MHPs). As social norms and legislation shift toward non-anonymous donation, psychological assessments can provide opportunities to exclude unqualified donors and allow donors to consider the long-term implications of donating.

Objective: To determine the effectiveness of psychological screening in identifying unqualified sperm donors, and to evaluate psychological reasons for disqualification through clinical interview and testing.

Methods: A retrospective chart review of 229 potential donors who passed initial qualification at a major sperm bank from February 2017 to February 2018. All potential donors were evaluated by …

Association Of Cyp2c19*17 Allele And Choice Of P2y12 Inhibitor On Cardiovascular Outcomes Following Percutaneous Coronary Intervention, Yash Varma, Bs, Craig R. Lee, Phd, Pharmd, Joseph S. Rossi, Md, George A. Stouffer, Md

Phase 1

Introduction: The CYP2C19*17 allele variant is a gain-of-function polymorphism which increases levels of the active metabolite of clopidogrel.

Objective: *17 is associated with increased bleeding risk during clopidogrel therapy, but it is unclear whether alternative P2Y12 inhibitors, prasugrel and ticagrelor, produce better clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).

Methods: A single-center observational study was conducted in 928 PCI patients who received CYP2C19 testing and dual anti-platelet therapy (DAPT). Risk of major adverse cardiovascular or cerebrovascular events (MACCE) and clinically significant bleeding over 12 months were compared across genotype and DAPT groups by proportional hazards regression.

Results: 584 …

Identifying The Causes Of Cancer Readmissions: A Patient Centered Approach, Emily Wei, Katie Holland, Allison Zibelli, Md

Phase 1

Introduction: Readmission rates of cancer patients remain high, while the rates of many other conditions are decreasing in the United States. Cancer patients are a plurality of patients readmitted to hospitals within 30 days of discharge, and have a high rate of avoidable readmission. Therefore, it is important to understand why these readmissions happen in order to prevent their occurrence.

Objective: This study hopes to identify specific, and potentially personal, reasons that bring cancer patients back to the hospital. Patient perspective may reveal trends that are not apparent in medical record chart reviews. This information can present an opportunity to …

Sociodemographic Background Characteristics Of Patients Who Participate In A Lung Cancer Screening Program, Amber Zhang, Marcella Pimpinelli, Brooke Ruane, Russell K. Mcintire, Julie Barta, Md, Hee-Soon Juon, Bridget Jackson

Phase 1

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors.

Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP).

Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective …

Post-Operative Outcomes Of Surgical Treatment For Trigeminal Neuralgia, Daniel Tzou

Phase 1

Introduction: Trigeminal Neuralgia causes severe paroxysmal facial pain that leads to debilitating quality of life. Pharmacologic management often becomes insufficient, and the microvascular decompression (MVD) procedure is the mainstay surgical intervention. Internal neurolysis (IN) is a novel addition to the MVD procedure to treat trigeminal neuralgia, and its efficacy has not been well tested.

Objective: The objectives of the study are to understand appropriate surgical treatments for trigeminal neuralgia and to determine the efficacy of the additional IN compared to MVD.

Methods: A retrospective cohort study on patients undergoing surgical intervention for trigeminal neuralgia at TJUH was conducted. Surgical treatment …

The Accuracy Of Blood Pressure Measurement By A Smartwatch And A Portable Health Device, Vignesh Murali, Noud Van Helmond, Cecilia G. Freeman, Christina Hahnen, Nilanjan Haldar, Jacquelyn N. Hamati, Dylan M. Bard, Geno J. Merli, Jeffrey I. Joseph

Phase 1

Introduction: Hypertension is a leading cause of mortality. Proper blood pressure (BP) control can be achieved by lifestyle modification, pharmacotherapy, and frequent measurements. With the growing popularity of cuffless blood pressure monitors, it is important to independently validate their accuracy.

Objective: We evaluated two cuffless blood pressure monitors, The Everlast TR10 fitness watch and the BodiMetrics Performance Monitor, for their accuracy and precision in BP measurements.

Methods: Using a protocol derived from the ANSI/AAMI/ISO 2013 standard for evaluating automated sphygmomanometers, we measured the blood pressures of 85 patients recruited from the Thomas Jefferson University Hospital Preadmission Testing Center with two …

Acute Pancreatitis In The Emergency Department, Gregory J. Lopez, Bs, Matt Hall, Md, Matthew Babineau, Md, Darshan Kothari, Md, Ryan C. Burke, Phd, Mph, Richard E. Wolfe, Md, Sunil G. Sheth, Md, Stephen Freedman, Md, Nathan I. Shapiro, Md, Carrie Tibbles, Md

Phase 1

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition.

Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores.

Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Identifying The Causes Of Cancer Readmissions: A Patient Centered Approach, Katie Holland, Emily Wei, Allison Zibelli

Phase 1

While there are large efforts to decrease readmission rates in the United States, cancer patients represent a population that has been overlooked. Cancer patients are a vulnerable population who make up a large portion of hospital readmissions. Most of the current research on the causes of readmissions in cancer patients focuses on medical chart reviews and insurance claims. Many of these studies fail to incorporate patient input which could further the understanding of the complete burden associated with cancer readmissions. The goal of this study is to understand the personal reasons behind the decision of cancer patients to return to …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

Total Body Skin Exam And Number Needed To Screen, Audra Hugo, Michael Bui, Alexander Sherban, Shayan Waseh, Elizabeth Jones, Md

Phase 1

Introduction/Background: Skin cancer screening could impact mortality and morbidity in US adults; however, the effectiveness of widespread screening remains unclear. Further research is necessary to determine what age groups, with what risk factors, might benefit from routine total body skin exams (TBSE) in the US.

Objective: This study sought to determine, on average, the number of patients, per decade, needed to screen via TBSE to identify one person with skin cancer.

Methods: A retrospective review of Jefferson Dermatology outpatient data in Epic was conducted. All patient charts from 1/1/2017 - 1/1/2018 were reviewed if they received a TBSE. The type …

Pilot Study For Using Fitbit Activity Trackers To Monitor And Predict Onset Of Car-T Cell Immunotherapy Related Adverse Events Including Cytokine Release Syndrome, Cassra Clark, Ms, Bs, Adam Dicker, Md, Phd, Fastro, Margaret Kasner, Md, Msce, Gina Keiffer, Md, Neil Palmisiano, Md, Ms, Pierluigi Porcu, Md, Kaitlin Rancani, Crnp, Vincent Yeung, Md, Lindsay Wilde, Md

Phase 1

Introduction: Immunotherapy using T Cells with engineered chimeric antigen receptors (CAR) is a revolutionary modality for treating cancer, especially B cell malignancies. It also has specific toxicities. The most common toxicities observed are cytokine-release syndrome (CRS) and neurotoxicity. These therapy-related adverse events can range from mild to fatal. If appropriately and timely treated, they have a good prognosis. Thus, further insight into predictive biomarkers can help clinical management of patients and reduce morbidity and mortality.

Objective: One of the constitutional symptoms associated with CRS is fatigue. With the advent of activity tracking digital technology, I propose a pilot study exploring …

Clinical And Pathologic Factors In Breast Cancer Patients With Bone Metastases Undergoing Surgery For Pathologic And Impending Fractures, Emily Bochner, Kerith Wang, Benjamin Leiby, Ayako Miura, William Kevin Kelly

Phase 1

Introduction: Metastatic lesions to bone carry a poor prognosis. Bone lesions can be responsible for significant morbidity in patients, including pathologic or impending fractures that may require emergent surgical evaluation.

Objective: We evaluated the clinical and pathologic features associated with breast cancer patients with bone metastases who underwent surgery for pathologic or impending fractures.

Methods: A retrospective chart review of 20 breast cancer patients with bone metastases who underwent surgery from the Bone Biorepository Bank at Sidney Kimmel Cancer Center was performed. We evaluated their clinical and pathologic characteristics and performed Fisher’s Exact Testing to explore potential associations.

Results: 90% …

Efficacy Of Combination Of Immunotherapies In A Murine In A Murine Squamous Cell Carcinoma Model, E. Correia, C. Portocarrero, U. Rodeck

Phase 1

Introduction: Head and neck squamous cell carcinomas (HNSCCs) are a type of neoplasm found in the epithelium of the oral cavity, oropharynx, nasopharynx, larynx, or hypopharynx. Recent evidence has demonstrated that 70-90% of HNSCC are associated with Human Papillomavirus (HPV), particularly strain 16 producing oncogenic proteins E6/E7. Currently, HNSCCs are treated with surgery, chemotherapy, and radiation, however immunotherapy with immune checkpoint (PD-1) blocking agents promises to improve outcomes in HNSCC.

Objective: This study examined the therapeutic effects of dual and triple combination immunotherapies in a mouse model of HPV-associated HNSCC.

Methods: Treatment modalities included a tumor vaccine (attenuated Listeria monocytogenes …

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose …

Diagnostic Accuracy Of Home Sleep Apnea Testing (Hsat) Based On Recording Duration, Angela Alnemri, Theodora Fynn, Prakash Vasudevan, Ritu Grewa, Karl Doghramji

Phase 1

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA.

Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA.

Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) …

Sickle Cell Disease And Variation In The Par4 Receptor, Matthew Lankiewicz, Steven E. Mckenzie, Leonard Edelstein, Stephanie Renna

Phase 1

Sickle cell disease disproportionately affects African Americans in the U.S. Much can still be learned regarding determinants of frequency and severity of painful vaso-occlusive episodes in these patients. It has been reported that a variant in PAR4 (protease-activated receptor 4) has a unique distribution among African Americans. One variant (Thr120) is hyperactive, while the other (Ala120) is hypoactive. This receptor is present on platelets, vascular cells, and nociceptors. We wish ultimately to test the hypothesis that sickle cell patients with the hyperactive PAR4 receptor have greater pain severity. A genotype-phenotype correlation would have prognostic value. An adequately powered study to …

Treatment Outcomes In Gram Negative Periprosthetic Joint Infection, Irene Kalbian, Ba, Karan Goswami, Md, Carol Foltz, Phd, Nathan John, Bs, William Arnold, Md, Javad Parvizi, Md, Fcrs

Phase 1

Introduction: Outcomes associated with periprosthetic joint infection (PJI) involving Gram negative (GN) organisms are poorly understood. While prevailing beliefs indicate that GN PJI cases have poorer prognoses than Gram positive (GP) cases, the current literature is sparse and inconsistent.

Objective: The purpose of this study is to systematically compare the treatment outcomes for GN PJI versus GP PJI.

Methods: A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using an institutional PJI database. Treatment failure defined by the Delphi criteria was compared between cases with only GN organisms (n=45) and only …

Identifying Refractory Aml Patients Using Rate Of Wbc Decline In Order To Reduce Length Of Stay, Kyle Itri, Thomas Klumpp

Phase 1

Introduction: Acute Myeloid Leukemia (AML) is the most common acute leukemia in the United States. At diagnosis, these patients are admitted to begin induction chemotherapy and remain in the hospital throughout treatment. Response to therapy is assessed with bone marrow biopsy one month later. However, rate of white blood cell (WBC) and absolute blast count (ABC) decline can be useful in predicting bone marrow blast clearance and complete remission.

Objective: Therefore, our goal is to identify AML patients refractory to induction therapy using rate of WBC, ABC, and ANC decline as prognostic markers in order to reduce length of stay. …

Does Concomitant Cabg Influence The Outcomes Of Post-Myocardial Infarction Ventricular Septal Defect Repair?, Dylan P. Horan, Jae Hwan Choi, Matthew P. Weber, Elizabeth Maynes, Sinal Patel, Jothika Challapalli, Jessica G.Y. Luc, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. Over time, understanding of the pathology and its management has resulted in improved outcomes; however, controversies remain.

Objective: We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.

Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. After assessment for inclusion and exclusion criteria, 66 studies were selected for the analysis. Data were extracted and pooled for systematic review and meta-analysis.

Results: Average age was 68.7 years …

Sensory Outcomes In Digital Nerve Repair Techniques: An Updated Meta-Analysis And Systematic Review, Zachary J. Herman, Bs, Asif M. Ilyas, Md

Phase 1

Introduction: Injuries to the digital nerves are common with trauma to the hand; surgery is often required to repair injured nerves. Surgical management of digital nerve injuries includes neurorrhaphy or use of allograft, autografts, and conduits.

Objective: In light of the increasing availability and utilization of digital nerve repair constructs, an updated meta-analysis was undertaken in order to comparatively review the available evidence to determine differences in outcomes.

Methods: We reviewed the most current literature on sensory outcomes of various digital nerve repair techniques using static two-point discrimination (S2PD), moving two-point discrimination (M2PD), Semmes Weinstein–Monofilament testing (SWMF) and complication rates …