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NeoGraft Peer Review at Orlando Live Surgery ISHRS WorkShop

D

desirehair

Valued member
BigMac
I am affiliated with NeoGraft.
There is so much speculation and distortion about what happens with the NeoGraft hair transplant procedure that we continue to feel an obligation to let your readers know the real facts about NeoGraft so that they can make the best choice for themselves. There is no science behind your comments and I quote: €œ Suction is a force €¦to make the object move €¦this will have the effect of changing the structure of the "object" in this case the FUE graft/skin tissue. The tissue will alter its structure, the cells distort due to the force of the suction on them, As the cells are distorted they will strecth back and forth against the normal cultutre they live in creating if you like, "micro bruising" or simply they are then damaged. €


Perhaps I did not explain it well in my prior post that follicles are least damaged by NeoGraft, compared to other methods, so I will try again. I am not expert at physics but let €™s take an analogy. Gas is a €œforce € to make your car move and the car incurs intense air pressure resistance as it moves. We all know how delicate the frame of a car is, because if you put some pressure with your hand on the frame you can dent it without too much effort. Yet cars go through this ordeal of driving every day and do not become €œdistorted € due to the forces of air, the material does not €œstretch back and forth € and cars do not get micro bruised or damaged. Neither do follicles or airplanes for that matter. That is what technology is about- expanding the limits of human potential by understanding physics. Here is the real story. NeoGraft €™s process is the most gentle process up to date for follicles. Far more damage is done to follicles with the STRIP method and with the manual[/b] FUE method. With the STRIP method hundreds of follicles may be transected (damaged) as the doctor €™s knife excises (cuts out ) the strip of scalp from the patients head since he/she is cutting blind and cannot see the follicles he/she is cutting through. That Strip of scalp is then cut into smaller strips. Each time the strip of scalp is cut there are more chances to transect follicles. These smaller strips are then given to technicians who separate their strips into individual follicles. Follicles do not grow in a row so there is always a risk of follicles being transected again. How much transaction occurs depends on the skill of the technician. No doctors or forums ever speak of this, but this is what happens.


During this process the strip is exposed to the hot lights of a microscope, which is very drying. It is left to the discretion of the technician how much the follicles are sprayed so that they stay moist. It amazes me how much speculation there is about NeoGraft drying follicles when we have done live cases all over the country to show that with NeoGraft technology the harvested follicles are moist and robust and there is no damage or drying. There is a greater chance of follicles drying out with the Strip method than with NeoGraft . Furthermore, with the STRIP method there is also a risk of damaging the follicles during the implanting process. Tweezers are used to push and shove the follicles into slits that are not the same size as the follicles. Because each follicle is cut by hand and by different technicians they will all be different sizes. The technicians sometimes have to use force (here is a real force issue, as opposed to gentle negative air pressure) to push in the follicles into slits that do not match in size, which may damage the follicles. With thinner follicles, there is too much space around the follicle and it is loose, so may fall out. During the implanting process, some follicles might be pushed in too deep and become buried as the technician tries to push the follicle into the slit. This can cause complications. With NeoGraft all the follicles are the same size and that size matches the slits. No tweezers are used, so there is no pinching of the follicles as they are pushed and shoved into the slits with tweezers which can damage them as I have mentioned before. Many times grafts pop out while implanting with tweezers and these have to be pushed back into the slit site. Implanting follicles during a manual[/b] FUE process is the same procedure as used with the SLIT method. Tweezers are used in manual[/b] FUE also for implanting with the same potential for damaging the follicles.


These problems do not occur with the NeoGraft FUE implanting device. NeoGraft uses very gentle negative pressure to place the follicles into receptor sites that are the same size as the follicles so the follicles have a good fit and there is less chance of them popping out or falling out. The doctor will not experience buried follicles, nor will follicles be damaged by tweezers because none are used. I think we could mention here also that with the STRIP procedure there is a risk of cutting nerves and arteries, which sometimes causes persistent pain, whereas with an FUE procedure there is not this risk. Another problem is that for some patients, after the strip is sutured, depending on the laxity of the skin, they may feel a tightness at the back of their head which is very unpleasant to live with. This does not occur with FUE. The STRIP procedure is much more invasive than an FUE procedure and many patients experience extensive pain after the STRIP procedure, which requires strong medication, whereas an FUE procedure is not as invasive or as painful. Most patients only feel some feel a mild discomfort. The down time for an FUE procedure is much less than for STRIP and the patient can do physical activites quite soon after an FUE procedure, but not with STRIP. Extensive long scars are a possibility with the Strip procedure whereas with FUE scarring is minimal and consists of tiny almost microscopic scars, barely visible allowing hair to be worn short. It is obvious there are benefits to the patient in having an FUE procedure but manual[/b] FUE has problems.
A manual[/b] FUE procedure, one that does not use NeoGraft, has a major problem because the doctor has to use tweezers to extract the follicles as they are not harvested from a strip of scalp. Using tweezers to extract follicles causes a high transaction rate (damaged follicles), in the neighbourhood of 10 to 30 percent depending on the characteristics of the follicles and the skill of the doctor. The doctor has to squeeze the follicle, and yank and pull it out and this exposes the follicle to damage. Scoring the follicle causes many transections also because it is difficult for the doctor to hold his hand at the angle of hair growth. Also the doctor €™s hand becomes very tired after a few hours, causing more risk for transections and a large transplant might take two or more days to do. Because of the high transaction rate most doctors do not offer FUE hair transplants. Curly hair is especially difficult to extract, as the follicles splay, and there are some other types of follicles which are challenging to extract. The majority of doctors would never attempt to do a manual FUE with these patients because of the difficulties the hair presents. So most doctors stick with the STRIP method, even though FUE is more beneficial for the patient as pointed out above.


The high transaction rate of a manual FUE negates some of the benefits of a manual FUE. That has changed now with NeoGraft. Now patients can reap the benefits of an FUE hair transplant and not be exposed to a high transaction rate regardless of the type of hair they have. NeoGraft has done African American hair transplants, live, one of the most difficult types of hair, with a low transaction rate. Doctors who have a large number of African American patients have bought NeoGraft. NeoGraft, simplifies the transplant process and the procedure does not depend on the skill of the surgeon as much as a manual FUE. Of course the doctor has to be trained on NeoGraft and skillful in using the NeoGraft tool, but with NeoGraft,,the tool guides the doctor and as a result we are seeing low transaction rates with NeoGraft. There are other technical reasons for the low transaction rate but these are too complicated to explain. NeoGraft also speeds up the transplant process by more than two times so that a transplant of 3,500 hairs that might take 2-3 days with manual FUE can be done in one day now with NeoGraft.


Sparky, your comment: so it [NeoGraft] after it cuts the flesh around the graft in an fue fashion, the suction then rips it from its base and up the tube, you couldnt pay me enough to undergo this € should not be a comment written about NeoGraft but about manual [/b]FUE procedures. As I mentioned, with manual FUE you can have transections as high as 10-30 percent because of the squeezing, yanking and pulling, or ripping as you call it, especially if the patient has grafts that are strongly anchored. (Everyone is different). NeoGraft avoids these problems. With NeoGraft €™s technology, the grafts are gently harvested with suction that can be adjusted to each patient €™s personal profile, depending on how deeply or strongly the grafts are anchored. Each graft is scored with a depth adjusted to the patients unique characteristics and then the grafts are gently suctioned out. With NeoGraft €™s system, we have shown an extremely low transaction rate (damage rate) for follicles, as mentioned, even with difficult, splayed African American hair, which we have shown at our demonstrations.

At the Live Surgery Workshop our transaction rate was between 1-2 percent. The FUE instrument that demonstrated before NeoGraft at the Live Surgery Show had a transaction rate about 5 times higher!! All the instruments shown at the show were to harvest the same amount of follicles, but NeoGraft harvested close to double the amount of follicles than the other instruments did at the show because doctors asked us to keep going. By pulling more grafts than the other demonstrators we were exposing ourselves to more transections but this did not happen. We still had the lowest count. Sparky, your comment that €œthere is nothing wrong with standard non motorised fue, therefore no reason to try to better it € might be your personal view, but I do not think that once a patient understands how NeoGraft works there will be anyone who agrees with you. You might think it is okay to choose a €œmanual non motorized € procedure that has a 10 to 30 percent transaction rate as opposed to a 2 percent or less with NeoGraft but for most balding patients every follicle is precious and they do not want to lose any more than necessary. You can choose to believe that if NeoGraft €œfeels no need to post pictures, we feel no need to believe that neograft is any good. € How €œgood € NeoGraft is does not depend on yours or anyone €™s belief but on facts. Patients are not interested in beliefs and this is not fair reporting to them, it is misleading. You can also advise patients (based on your beliefs, not evidence) to steer away from NeoGraft, and that is your right, but if you do so you are doing an injustice to those patients who come to your site. I doubt they will pay you any heed once they understand the benefits of a NeoGraft procedure.

I think it is time to accept that NeoGraft is an improvement over what is available today. Why fight technology so hard, especially when we are so transparent with the excellent results of NeoGraft. The facts are out there so why keep writing such speculative and incorrect information for your readers? Why would we do live demonstrations that to use BigMac €™s words: €œchanges structure of tissue, distorts cells, and causes microbruising, or damage € to follicles. More importantly, the doctors who are acquiring NeoGraft would have to be dumb to purchase such a device. Most doctors spend months or more than a year investigating the NeoGraft device before purchasing NeoGraft They often come to several shows, follow up on results, ask lots of questions etc. When a reader questions you about NeoGraft, it would be more fair and honest to the reader to not go into negative criticisms based on a lack of knowledge about the technology of NeoGraft but to honestly tell the reader that you do not have answers for their questions because you do not know how NeoGraft works nor have you seen NeoGraft procedures (because if you had you would not write such false information). You might advise your readers to search further and do their due diligence.

Finally BigMac you ask €œmaybe you could take the NeoGraft machine to these doctors clinics and perform FUE. We can then get feedback from them. € This is what we are doing BigMac. We are going all over the U.S. scheduling live demonstrations with doctors who are hair restoration doctors, some of which do FUE, and those who would like to do hair restoration. The feedback is that doctors are purchasing NeoGraft so they must see the value of this device. But what about the Live Surgery Workshop? So many doctors were there why not speak with them yourself. As for your other request, we do not ask doctors to write in to forums for us, as there are many forums I have contacted, who were writing false information. We follow our business plan and that is to demonstrate for doctors the NeoGraft device. As for your last request: €œCan you direct at least 5/10 patients to this forum to share their experience with documented pictures. € The NeoGraft group does not do transplants and patient information is confidential. So it would have to be the doctors themselves, with consent from the patients who can direct patients to you. We are however, building a new web site and are in the process of working with the doctors to give us before and after pictures so that these will hopefully be available soon, along with videos of the work NeoGraft does.


 
Bigmac

Bigmac

Administrator
Staff member
Hi Desirehair.

Thanks for the reply as its good to debate in an honest and open manner which is what my patient driven community is all about.

One aspect i would like to address straight away is a car is made rigid because of the different forces,also the material used are made to withsatnd the pressures it is put under, for example a soft top is heavier than a hard top for this exact reason, comparing living tissue to a piece of metal is a very weak argument and does not stand.Compare apples with apples.

The hair follicle sits in the skin,it doesn't assume it will be sucked up a tube in later life,so has nothing in place to withstand the pressures it is put under as the cells are distorted.Sorry but this piece of your arguement doesn't withstand the pressure imo.I will address the other aspects of your post later as i need to attend to my son.

Thanks bm.

ps,could you provide me with a list of doctors/contact details who have purchased the Neograft so i can contact them and ask them to show examples on here.
 
Bigmac

Bigmac

Administrator
Staff member
Hi Desirehair.

I`m back and re read your post again.

What you fail to appreciate is readers on the forum want to know about new technology but proof is also what they want,you can write long posts all you like but prove your claims and pubish them.No one said they are against new technology but to blindly accept it as better by definition because it is new is ignorant.Ask many of the repair patients around,they took on "new" technology and see where they are today.

You have a product that you wish to present to people as you have sold it to doctors and now need to get it well known,no problem but do not expect people to just except it without asking questions and to turn and say "There are other technical reasons for the low transaction rate but these are too complicated to explain." is an insult to people,just explain without trying to bash existing methods of extraction, you may be surprised people are not stupid and can read between the lines and understand technical data.

If you want to promote the vitrues of this machine give fact not rhetoric,how big is the punch you use,how do you keep transection low,how do you counter the change and distortion of the skin cells from the pressure of the suction.It's not necessary to tell us about other methods and then just say yours is better,you need to prove it.


Thanks bm.

 
Sparky

Sparky

Valued member
Fue in the wrong hands may yeild badly, but we knoew good surgeons who know what they are doing with fue. If your not willing to show good hi def pics, then we can assume your ashamed of what you have made, stop with the long speeches, they are boring, we like pictures.
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
desirehair wrote:
Furthermore, follicles harvested with NeoGraft are gently suctioned out after the scalp is scored,
Are you real?! I really feel you are a marketing guy with no knowledge of medicine. "Gently suctioned out" by negative pressure?
 
Dr. A s Clinic

Dr. A s Clinic

Valued member
desirehair wrote:
These problems do not occur with the NeoGraft FUE implanting device. NeoGraft uses very gentle negative pressure to place the follicles into receptor sites that are the same size as the follicles so the follicles have a good fit and there is less chance of them popping out or falling out.
Let me begin 1 at a time.
How can you implant with negative pressure. Were you not saying negative pressure is nneded to suck out the graft.
So, you need positive pressure to force the graft into a slit. Right? Now how do you force a graft into a slit at positive pressure without any collateral damage. The tweezer that safely places the graft into the slit does much less damage and results/pictures prove that.
I look fwd to hearing your thoughts.
 
Bigmac

Bigmac

Administrator
Staff member
Hi Desirehair,will you be addressing the questions posed by myself and V.

Thanks bm.
 
Sparky

Sparky

Valued member
They know that thier product is toilet, but they have to try to sell it to make money.'''h;h;;h
 
D

desirehair

Valued member
V,
You are correct about the mix up of the positive and negative pressure terms. I was posting late at night and made a mistake. I have visited your site many times and find it informative. Great Pictures and videos too.
To clarify the two terms:
Positive Pressure - condition that exists when more air is supplied to a space than is exhausted, so the air pressure within the space is greater than that in surrounding areas; air flows out of positively pressurized spaces into negatively pressurized spaces
Negative Pressure - condition that exists when less air is supplied to a space than is exhausted from the space, so the air pressure within that space is less than that in surrounding areas; air flows into negatively pressurized spaces form positively pressurized areas

This site has been asking for pictures. Here are links to two videos and a link for before and after pictures of NeoGraft hair transplants . The first video shows harvesting and implanting using NeoGraft. The second video is a SLOW MOTION video of harvesting with negative pressure. You can see the grafts being removed, no tweezers are used. I have included a link to pictures. The grafts in the picture were harvested by Dr. Peter Malouf using NeoGraft. Dr. Malouf is in Texas and the picture was taken about two months ago. As you know from the posts I have written on this forum and on other forums, NeoGraft was at the Live Surgery Workshop in Orlando in April 2010 and did a live hair transplant procedure. Our transaction rate was very low, only between 1-2 percent. Often we have a lower transaction rate than that. NeoGraft harvested twice as many grafts as the other demonstrators because the doctors asked us to keep going and harvest more follicles. Other instruments which were used on other patients at the Live Surgery Show transected at a much higher rate than NeoGraft about 8-9 times as many transections. Many doctors examined the NeoGraft follicles under a microscope and found them to be robust, with good tissue surrounding the grafts and moist.

As for tweezers being the best instrument for a transplant, we have not found this to be so. During the harvesting process, grafts are often pulled, yanked, and twisted, with the need to squeeze the follicle while doing so. With implanting follicles have to be squeezed again by the tweezers to insert them and then pushed and prodded into the slit opening. The situation is worse with a STRIP procedure where the follicles are different sizes and do not exactly match up with the slits. Grafts can be damaged during this process. The air pressure we use is adjusted for each patient and procedure. It is so mild, but just enough to 'pop' in the graft during implanting. There seems to be a wrong assumption when we speak of air pressure that there is some great force applied to a follicle by NeoGraft. This is not so. Research and Development has established the optimum air pressure to be used which is very gentle to the follicle during the extraction and implanting process. THERE IS MORE PRESSURE AND FORCE ON A FOLLICLE WITH A TWEEZER. With NeoGraft doctors do not have the problem of buried grafts, which can be a problem for the patient and the doctor who uses tweezers to PULL out the graft and push the graft into the slit site. We do live demonstrations 4-7 times a month so doctors can see how NeoGraft works. Everyone is welcome.

http://app.talkfusion.com/fusion2/view.asp?NDMxNjY1_2835785 This is the original video €“regular speed.
http://app.talkfusion.com/fusion2/view.asp?NTQwMTU4_2835785
The video is a slow motion video.

http://www.neograft.com/Picture_Gallery.html


 
Sparky

Sparky

Valued member
These 2 videos dont show any grown out results whatsoever, what made you think we wanted to see the neograft in action, basically you cant back this thing up. Grown out results are the only thing that matters.
 
D

desirehair

Valued member
It seems there is a problem with the picture gallery link. I am resending it. If this does not work just type in the link and it should take you to the site;

http://www.neograft.com/Picture_Gallery.html
 
Bigmac

Bigmac

Administrator
Staff member
Hi Desirehair.

The video links provided only show extractions,not results.The link to the results does not work.I had a look on the Dallas Neograft website and the picture quality of the results are very poor.I've also taken the following quote from the website of Dr. Peter Malouf -

quote:

The Center for Skin and Cosmetic Dermatology now offers the NeoGraft „¢ hair restoration and hair transplant program using the most modern Follicular Unit Extraction (FUE) technique. NeoGraft is a patented hair transplantation device that advances and refines the procedure of hair transplanting. The NeoGraft system is the product of ten years of research and development, offering the next generation in hair transplantation and achieving a more reproducible and aesthetically appealing hairline. NeoGraft is currently being used in Europe and Asia and has been recently cleared by the FDA for use in the United States. Over 18,000 hair transplants have been done with this device in the last two years with excellent results

end quote:

If 18,000 procedures have been done in the last two years there should be 1000's of results readily available.IMO this figure is exaggerated.Please post some detailed grown out results as requested.

Thanks BM
 
Bigmac

Bigmac

Administrator
Staff member
The picture link now works but i`d like to see detailed pictures of high quality from different angles etc,take a look at the results posted on here by doctors as this is what i need to see.

Thanks bm.
 
Sparky

Sparky

Valued member
The results look very poor indeed, I wouldnt undergo this for free, no way.
 
Sparky

Sparky

Valued member
This work for example, which is taken from your website, looks absolutley terrible, talk about butchering!

neograft7_front_of_head.jpg

 
D

desirehair

Valued member
We are very honest, and post real pictures of real people. This gentleman has very poor density and so his hair will never be as thick as a person who has a lot of density. This is also a 6 month picture and so his hair will still thicken considerably. Most hair people e.g. doctors, post their best pictures, of patients with very thick donor areas, and then they make everyone believe that they will look the same. We posted a fair variety of pictures of patients with different densities as we are an honest company and you only chose one of the pictures.
 

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D

desirehair

Valued member
Here is another procedure done with NeoGraft where there is good density. Everyone has these kind of good pictures, when someone has a lot of hair to transplant from the back. It is time for the hair industry to become truthful and let everyone know that for some people with less density and not a lot of hair to transplant from the back of the head, their procedure will be the best outcome that the doctor can do for that patient without totally depleting the donor area.
 

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D

desirehair

Valued member
Big Mac,
There is enough information on your site now about NeoGraft for readers to be able to make some better decisions for themselves. I wanted to address some of the comments you made and answer some of your questions, because I will be taking a break from the site after this post.

I agree with what you wrote:
"No one said they are against new technology but to blindly accept it as better by definition because it is new is ignorant. Ask many of the repair patients around,they took on "new" technology and see where they are today." As I said I totally agree with you. There are many very sad stories in the hair restoration field and in cosmetics in general where new technology did not deliver and even caused harm. I think it is very important for patients to do serious research before doing any procedures. As for my car analogy, it was an attempt to show that even powerful air pressure and resistance does not do damage to a vehicle , or plane which has been developed by those who understand the laws of physics whereas a punch to a car can dent it without too much effort because different laws are operating. Both actions are under the laws of physics but powerful air pressure/resistance does not do damage to cars, or planes and yet a mild punch to a car can cause it to dent. The same can be shown about human tissue.
Let me try this one. Just like a follicle does not assume it will be "sucked up" people were not meant to jump out of planes sky diving, or water skiing at high speeds or drive on motorcycles or bungee jump but they do and they do not get damaged or distorted from the air resistance or pressure. (They do from accidents). But you can get bruised from a mild knock. This is similar to the car analogy. I am just trying to show different actions have different results. Anyway we should not continue this line of conversation, except to say that there are people who do research and development to try and find the point at which a particular action or force is not harmful or damaging to tissue or metal of cars and planes etc. This knowledge can be applied to many things including a follicle.
A follicle can deal with the positive and negative air pressure without being damaged if the pressure is calibrated to be friendly to follicles. Damage to follicles does not occur with the calibrated minimal positive and negative air pressure used by NeoGraft. We find follicles get damaged if they are transected by the punch, when the angle of the follicle is not followed properly. Follicles also get damaged from tweezers. Many times a follicle is implanted with tweezers and it looks okay but in fact the stem cells have been destroyed by the pushing, twisting, or squeezing action, or the bulb has been damaged. That hair may be implanted but will not grow and the doctor may never know this. Often the shafts break from the force of the pulling and yanking from tweezers during extraction. As I said in my other response there is probably more pressure on a follicle from the squeezing pushing and pulling action of tweezers than the gentle air pressure we use. As for the myth of follicles drying out in the air, NeoGraft technology allows the follicles to be misted as needed. Once a follicle has been properly released from it's underlying tissue, it takes an almost negligable amount of air pressure to bring it to the surface and at the levels NeoGraft uses, there is no harm to the grafts. NeoGraft has been developed through a great deal of research and development so that the air pressure is calibrated to not damage follicles.
Big Mac, I am all for debate and healthy skepticism about a new product as you state. The problem we have encountered with many forums, such as this one, is that there have been wild conjectures about what happens to the follicles in a NeoGraft procedure. These conjectures are not based on facts or science. For example, your site, keeps referring to the work NeoGraft does as €œfollicles get distorted by air pressure €, even after I have sent so many posts explaining that in reality when doctors see the follicles, they are excellent follicles and not distorted at all. Think about it. If people openly speeding though air pressure, sky diving or water skiing, do not get distorted by air pressure or resistance, and metal does not get twisted, or distorted and many things do not then why should follicles? Also assume that a great deal of testing was done for planes, cars and for parachuting before people discovered what kind or amount of force damages and what does not. The same holds true of follicles. As I stated years of research and development was done with NeoGraft to figure out the pressure that is follicle friendly. NeoGraft uses this knowledge to harvest and implant follicles. I have said that we do many live shows a month for doctors to see a NeoGraft procedure. Do you think doctors acquire NeoGraft machines because they see "distorted follicles?"

Now, to answer some of your questions, Neograft can use small punches from 7.5mm or less to more than 1.0 mm. We have used 08,.09 and 1.0 mm. The larger the punch the less chance for transections. A 1.0 is what many FUE doctors use, and we recommend, but there are those who write they use a smaller punch and we have used a smaller punch also in some of our demonstrations. There is a trade off because there is less tissue around the follicle the smaller the punch, and also as I said, more chance for transections, although our transaction rates with a .08 and a .09 were very low and not much different than with the 1.0mm. The benefit as I said with a little bigger punch is the extra tissue. Also with curly hair or African American hair that splays it is better to use a bigger punch to ensure less transections. We have done live demonstrations with African American hair and had a low transaction rate using a 1.0 punch. The choice depends a lot on the doctors preferences.
In answer to your questions about transections, our harvesting tool is ergonomically engineered to help the doctor follow the angle of the follicle. This plus the positive and negative air pressure work to help the doctor harvest and implant the follicles without having his hand become as tired as happens with a manual FUE. I hope my information has helped answer some of your questions. As I said, I intend to take a break for a while. I am not enjoying some of the comments as they are unnecessary and do not lead to good, intelligent and respectful conversation. You can get most of the answers needed about NeoGraft from the web. More and More doctors who have acquired NeoGraft are posting on the web. Soon you will be able to see their pictures.
Here are the sites again, to the pictures and the videos, as in V €™s post
http://app.talkfusion.com/fusion2/view.asp?NDMxNjY1_2835785
http://app.talkfusion.com/fusion2/view.asp?NTQwMTU4_2835785
The above video is slow motion
http://www.neograft.com/Picture_Gallery.html






 
Sparky

Sparky

Valued member
in the result I posted, you can tell by looking at the grafts that the surgery is not refined.
 
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