So, good morning everybody, or indeed good afternoon, evening, wherever you're watching in the world if you're not er UK based, or indeed if you're watching on demand later, whatever time you're watching us. Thank you for joining us on today's webinar which is about advances in veterinary dermatology, specifically around the use of CO2-based precision cryotherapy and cryosurgery and transdermal exosome delivery. So a very exciting topic, I'm looking forward to hearing more.
A big, big thank you to our sponsor today, Vette, which is a device that's brought to you by Reasons Medical. It's due to their kind sponsorship that allows us all to learn about this exciting topic and innovative technology, er, today that you can hopefully use in your practise to benefit your patients. So our speaker today is Doctor Tundey.
Hi, hi Tunde. Hello, how are you? So, er, Doctor Tunday is a UK based vet er with over 20 years of experience in small animal practise.
She currently serves as clinical director at vet care centres in Guernsey. Er she was previously previously their lead vet there and she has been clinical and regional director in some of the major UK veterinary companies. So er Dunda holds a postgrad certificate also in veterinary Business Management from, from the University of Liverpool, and she combines her extensive clinical experience with strong leadership in veterinary practise management, and her professional interests include small animal dentistry, surgery and dermatology, so very applicable for today's talk, er, also clinical excellence, team development and veterinary business leadership.
So, throughout the talk, if you've got any questions for today, please pop them, pop them in the Q&A box, if you hover over your screen that should pop up. So any questions, please pop there. The talk should be around 30 to 35 minutes, so we'll have plenty of time to go through your questions at the end, and cover off as as many of those as possible.
If you've got any other technical issues, queries, anything like that, then there's another chat box, so pop those in there and our webinar bet team will, will get to those and, and answer you back, but for the Q&A stuff, pop them in the Q&A box. So all that is left for me to do is to say thank you very much to Tunde for being here. Er good luck and sit back and enjoy, so take it away Tunde.
Thank you very much, yeah, today I would like to present you a new concept that's been developed to take the struggle out of skin management and bring, The wonder of Korean skincare into the veterinary sector supporting us in the constant battle of antibiotic stewardship and reshape essentially how we think about wound management in general. I believe we all agree that dermatological conditions are amongst the most frequently encountered challenges in small animal general practise. Chronic, recurrent, and treatment resistant cases can be particularly frustrating for both us as clinicians and owners.
We could say the same about wound management. Who can say hand on heart that it's really seeing a surgical wound breakdown to an infection or just to. Due to the client taking the boss collar home as an optional accessory that serves only as a physical barrier for passing smoothly through the doorway and gets often removed way too early.
How many of us struggle with the management of the chronic changes caused by atopic dermatitis, those that we can never quite get it right despite a decent itch control. Somehow this effort still seems subliminal. So we're gonna go a few slides here.
And I would like to say that Recent Medical, being the first company to adapt and develop a medical device that has achieved commercial success in human aesthetic dermatology markets called Target Co. This gadget built upon precision cooling and transdermal delivery technology. Was adapted later into Betty's.
A medical device specifically designed for veterinary applications, making this revolutionary treatment option available for all our patients in day to day practise. But let's get introduced properly. What is that is.
That is, is an innovative veterinary device that utilises medical grade CO2 technology to deliver precise temperature controlled treatment for inflammation. And Any other conditions, inflammatory conditions in animals. That device itself, it's a 3 in one device designed for non-invasive, non-contact cryogen treatment applications.
So let's start with the first mode, the eye mode mode, which achieves continuous cooling for large surface areas, allowing delivery of certain pharmaceutical or non-pharmaceutical molecules through the derm by transforming them into microscopic ice particles that penetrates the skin. This, delivering the treatment intradermally significant to an injection but without the use of a physical needle. This ensures that the, the treatment is pain-free and extremely well tolerated by our patients.
CX mode is defined by rapid precision temperature control, which sets and maintains a target temperature throughout the treatment, offering a precise landing temperature between -5 and 5 degrees. As well known, inflammatory biomarkers respond to specific temperatures applied for specific durations. This is how the CX mode delivers its anti-inflammatory effect.
This Frequently reduces the risk of unexpected incidents such as pigmentation or frostbite at treatment sites. It can, it can be used for effectively reducing inflammation such as post-operative, suling, interdigital cyst, blepharitis, also to achieve local anaesthesia or analgesia for minor interventions as phlebotomy or fine needle aspiration. FX mode or freeze mode is for cryosurgical application.
Practically doing the same as a a cryoon would do. It is ideal for small wart pendulous lumps removal without or with anaesthesia, obviously depending on. These locations.
It achieves temperatures up to -79 degrees and it can be applied very specifically to the warts usually or or lumps we're gonna use it for. Let's go further. So do we have, just a.
Resume of what we can do with this device in different modes, and here's gonna be a short demonstration of how this device works in atopic dermatitis and wound lesion cases . Here we go. Nice.
As we know, in atopic dermatitis cases, the chronic inflammation and dryness impair the skin barrier. Leading to recurrent superficial lesions, lichanization, erythema, and pruritis, consequently exposing the patient to secondary fungal or bacterial infections. The application of Vexohel with Pattis helps reinforce restoration.
And enhances hydration and reduces surface inflammation by suppressing local mast cell production. In wound cases, the trauma disrupts the epidermis and dermis, causing tissue loss and bleeding with increased risk of infection. In these cases, application of Vexo heel allows the exosome solution to penetrate deeper through the damaged skin surface, actively promoting new tissue formation and regenerative processes by promoting angiogenesis, collagen, elastin, and fibroblast production.
Also promoting hair growth, this all without the necessity of using systemic or topical antibiotics. Treatment application is really easy. I'm gonna show one of our three patients receiving treatment in clinic.
It's really pain-free and, and. Non-stressful for both us and the animals. So we already mentioned exosome and vexo hill.
But let's touch a bit more on what is vexoheel for a deeper understanding. Vexohyl or Vexohyl P is a plant-derived exosome-based solution. It presents in a liophysite powder which at the time of use needs to be reconstructed with a solvent, in this case.
It's gonna be hyaluronic acid. Exosomes are 30 to 150 nano size extracellular vesicles that mediate intracellular communication and promote tissue repair. They act like tiny bubbles packed with proteins, fats, and genetic material like DNA and RNA, their main role being within cell communication.
Exosomes are produced by all cells in the body and majorly carry the information or the cargo of the cells of their origin. The exosomes in vexo heel originates from stem cells, and their main therapeutic effects include fibroblast activation and migration, enhanced keratinocytes, proliferation and re ethicalization. Increased collagen synthesis, angiogenesis, and immunomodulation.
As a cell-free therapy compared to stem cell therapy, exosome offer advantages including high biocompatibility. Reduced immunogenicity, reduced risk of tumorogenesis, and considerably improved safety profile compared to cell-based therapies. So this device all together with Taxo hereel offers a great versatile versatility in, in, our practise.
So let's give the boring theory and see the exciting practical clinical cases where vettes and or Vxo Hill played a major role in patient treatment success. Meet Milo. Five year old male bulldog presented with post-operative bone breakdown following history of cyto excision surgery attributed to non-compliance with protective collar use.
Treatment consisted of applying 1 mL of fexo heel over 60 seconds, repeated at regular intervals of 3 to 4 days apart. The outcome of the treatment was progressive improvement in wound healing observed over a twelve-day treatment period, although. It could have been sooner if the owner wouldn't decide to remove the buster car away too early.
Inflammation reduced and The tissue restored completely afterwards. This is Vinnie. It was the first patient I actually treated with VexoHel.
Vinnie presented with chronic dermatitis accompanied by otitis externa identified by cultural staphs, Corina bacteria and malahesia. She presented extensive licaive lesions with alopecia and chronic hyperpigmentation of the neck and the chest. The treatment consisted of chlorhexidine.
4% topical applying applied topically. Lucky that map for pruriis control, Daxo Hill applied the Avati's eyeing mode for 1 minute each time repeated for 4 consecutive occasions and of course targeted oral therapy based on culture and sensitivity. Achieving full skin regeneration and full fur growth after the 4th treatment only.
The last image, it's only a couple of weeks after the finish the treatment. This is Rollo, a 3 year old male old bulldog. And presented with an acute interdigital swelling, very common occurrence in these breeds.
Of 3 days' duration, treatment consisted of application of Taxol heel 3 days apart, 0.25 mLs over 10 to 15 seconds, no anti-inflammatory or antimicrobial treatment was used whatsoever, achieving complete resolution before the fourth session. And here's Moshe, an 1115 year old male domestic short cat who is still certainly enjoys flexing his muscles in the neighbourhood.
Hence, he's been presented with a cat bite abscess previously treated unsuccessfully with antibiotics, showing a persistent open wound over his neck. Treatment consisted of Vexo heel. Applied over 60 seconds, 0.5 mil without resuming further antibiotic therapy.
Moshe, after one treatment, didn't require further sessions, mainly because his wound considerably healed over within less than seven days. Secondary because he decided as well not to turn up for his second appointment on his own accord. This is Izzy, a lovely 12 year old female by mariner presented with an acute unilateral upper eyelid brapharitis of unknown origin.
We treated as if that is CX mode at the precise landing temperature of 0 °C for 10 seconds, repeated twice at the same session. Resolution of the swelling was achieved by day one, with no further additional treatment needed. And this is Bella, a 4 year old female cocker spaniel.
She'd been attacked by a kind of torso, leaving a large open wound over the side of her neck, which was surgically debrided but way too large for surgical closure. She'd been treated with potentiated amoxicillin with clavulanic acid, pain management, and paracetamol. And meloxicam, regular bandages postoperatively to start with.
At her second bandage change, we decided to stop antibiotics altogether and leave her on pain relief and initiate Vexo heel treatment at regular intervals of 2 to 3 days apart, coinciding with her bandaging regimen using renal foam and a soft dressing. We use 1 mil of Vexo heel. Applied over 1 minute on every occasion, full scarring achieved by day 26 with no further antibiotic treatment necessarily.
Or Over all this treatment period. This is Honey, an 11 year old Labrador presented with an infected necrotic wound pressure sore over her right hock. Swab was taken for culture and sensitivity from the wound, which was consistent with profuse growth of staphs and mixed anaerobes.
Honey's wound was only treated with Vxohill after removing the crotic tissue and flushed with sterile saline solution. No bandage was used. Or any antibiotics, Honey was already on long-term anesthes for degenerative joint disease.
She was treated with PaxoHel 1 meal per minute and had a total of 4 sessions of treatment. I would like to emphasise that during all her treatment period, Honey didn't receive any kind of antimicrobial. Or antibiotic treatment.
Which proves Wexel Hill's efficiency infected in infected wound management. Meat bare, a little stuffy, who presented with multiple dogfights, wounds. Large areas of skin discontinuation and tissue trauma.
No systemic antibiotics being used during her treatment either. Treatment consisted once again from Vexo heel applied 1 meal over 60 seconds twice, twice a week. And obviously pain relief.
She had a total of 6 treatments. The outcome of the treatment was a progressive wound improvement with healthy granulation, fully scarred, with full hair regrowth by the 2nd week. And this is Tess, a cheeky Norfolk terrier with a history of chronic progressive alopecia.
Test was borderline hypothyroid although non-responsive to thyroid supplementation for over a year. Clinic clinical signs consisted with. Alopecia X.
We decided to start Vexo heal treatment with. Applying 2 mLs over 2 minutes over all affected area, initially starting twice weekly and then increasing intervals between 7 to 10 days. The outcome was gradual consistent f growth achieved within less than 3 months of treatment.
She's still growing her hair as we speak. This is a case, that proves. That, that he's.
Use in, in, cryosurgery. We see a small wart removal which needed two treatments. And you can see treatment.
Achieved like successfully wart reduction within 2 weeks post treatment, so. Here we go, and Then last but not least, here is a young maqueque treated in Thailand who presented with extensive burn scaling injury over the pope. She'd been treated with Vexo heel over 1 mil over 60 seconds applied.
1 meal for 6 treatment sessions. The result was a progressive improvement in wound appearance, reduction in inflammation and pain. Healthy granulation and epitalization.
Strong regenerative response despite the severity of, of the thermal injury. This case demonstrates FexoHel's efficiency in burn and scold wound management. Oops, what have I done?
So. The summary of the clinical outcomes is we observed a faster bone closure using Vexo heel, reduce inflammation and pain. It's incredibly well tolerated by by our patients.
And as a recap, that is, is a non-invasive, non-painful, practical, and above all supports antibiotic stewardship. It is extremely well tolerated. By our patients as you could see, and comes with a high client satisfaction.
So these are just a few cases to prove that he's efficiency and versatility in a clinic, a first opinion clinical practise. So here we go. Just to prove how easy it is to apply on a very compliant patient.
I truly feel that. This kind of revolution is how we think about skin and wound management in the future. I believe this this product and and device, it's, it's there to help us in, in, in many ways and I've been told before that.
It does look very futuristic and I do agree because I believe this is a future of skin and wound management in veterinary practise. So thank you all for listening and bearing with me. And if you have any questions, please do ask.
Thanks again. Great, thanks Tunde, that was really interesting. Er I didn't know whether you wanted to show us the device.
I know you've got one there just so we can close up how er how it looks . So the device itself, let me see if I see myself as well because it would be easier to see what you can see. So this is the device that is device, so it comes with a little cylinder which is a.
One. This cylinder contains the CO medical grade CO2, which attaches to the end of the device. It has 22 heads, designed for different applications.
So this would be the ones we use for ice needling techniques. So to, to, use the Vxo heel for those kinds of treatment and. They come with a little, little chamber that you could apply on the end and in which end you would put your solution.
OK, here we go. These are the solutions. I'm not sure if you can see them.
Would you put the whole vial in there? You, if you mix them up, so one, it contains the powder, one is the, the hyaluronic acid, you mix them up before the treatment. And then, depending on how big is the surface area you would like to treat, you draw up, mostly drawn up it's 2 mils for, for our, alopecia x cases, but usually between 2, 0.25 to 1 mil.
1 mil probably is the most, commonly used, amount we, we, we have used. . It gives, if you mix them up, it gives you a free meal solution.
You can safely store it in the fridge up to 3 months. Which never lasts 3 months, to be honest, . And then you, it is a little hole we can introduce the, the, the solution in the chamber and then when we set the device up it will say and it's in iron mode, which is ice needling mode and we'll click and then when it's ready we just pray so it plays.
That's Spray cool air, obviously, or, or, or the. Solution actually what we put in for the other. Types of treatment, what we can do so for the .
The CX mode, we would change the the heads to a different head. That comes with the device, it's very easy to put it on, very self-explanatory, and you would have a little guard for it so you don't make too close contact to skin. And again when we .
Put the device on, the device actually recognises what head is on the device. So this is FX mode, so that would be the freeze mode, so you can use it as a cryo pen. For cryo pen applications we do have a little .
Guard as well so we can be precise and not burn anything around, yes, so you could put it around your little, wound or not wound, like lump or wart and then just, press it against it and it will freeze instantly to -79 degrees because it's a freezing mode, it will ask you, I think twice if you're sure about it and, and you're aware of that. Also you can, yeah, then choose, there are little arrows. You can choose your CX modes, so the cooling or local anaesthesia modes, and you can set your temperatures between -5 and 5 degrees anytime or anywhere you, you'd like to, to use it for treatment.
Yeah, and you say the cooling mode, local anaesthesia mode, is that for dogs and cats maybe that are sensitive to injections and things like that it's absolutely worth like, you know, the freeze sprays they use, it, it works in the same way, so it just like cool it down. I, I, . Successfully used it also in inflammatory cases, so cysts like interdigital cysts as well without the vexo heal or postoperative like inflammation or when they get very hot around the wound, it's really nice.
Also, obviously the ones that are very sensitive for needles and jumpy and like or a fine needle less spray. Yeah, yeah, that's a good idea actually, yeah, and I, and I suppose my, my question was because you demoed it there, but it, it sounded quite loud, but I think that was because it was quite microphone, because I've seen it in action before and it, it didn't seem that loud, so I was like, are you going to swap one problem for another? Do you have any cats, for instance, that are sensitive to sound and how do they manage?
We had . I use it on cats and I think it really depends on the area you're using, actually the device, I do believe you can get like little hand, handcuffs for animals, but I never use them. If it's an area around the face like we had that, that blepharitis, usually nurses just, just rub their ears and, and just fuss about the head and, and it just gets tolerated.
The first hiss I think it just. Kind of puts them off, but then it's so soothing for, for these cases, they just ease in it and it's just like, yeah, they, they just, and it's not a long, not a long treatment, is it? So how many seconds do you generally most, most treatments lasts 60 seconds, .
So, but it can be lasting from like 20 seconds to 2 minutes if, if, if it's a large area, I would probably use, use it over 2 minutes. Also the liquid, I would say it would cover a 2025 centimetre area. So.
Depends, but yeah, so, on, on that poodle I showed initially we use one meal for the whole neck and, and chest area. Yeah, you had a question about that actually. How do you calculate, so it, I guess it depends on third area I think what you want to cover if it's a large area, I would say if it's over.
At 2025 centimetre per 25, I would use probably more than a metre. But you can see it because the the skin starts glistening with the the solution. You can't wipe it off, but you can see how it actually lands on, on the skin and penetrates the skin.
So when you see the skin getting dry, then you probably need more or, or you have less dry areas on the skin. Right, so it's a bit case dependent then. Yes, I would say one meal for.
I would say in the area of like 25 by 25 centimetre it it should be plenty. And we have the, the, the eye case, so we had a question about the cornea. So is there any danger if this gets on the cornea or could it be beneficial to cornea I don't know.
Good question. I wouldn't, well, I would avoid to land on the cornea. So what we've done, we cut the eyelids shut, as much as we could, because we use zero °C, it wouldn't have probably caused any, any problems to the cornea.
It's my, my main worry is the speed of, of the, the. That it lands the cool air on, on them. Yeah, but you wouldn't use the, so you wouldn't use the cryo on an eyelid.
Yeah, you, well, I would, you can use it as a cryo on the eyelid, but I would definitely use it on an anaesthetized patient. Yeah, I wouldn't. We used it, for wart removals on non-anesthetized person, patients, persons, not persons, but patients, but, .
We, we successfully, they tolerate it so well depending again where is the area, but er it's, you can use it on limbs without any anaesthetics. OK, good, and you mentioned people that has it, has this ever been used in people, Is this a technology that's used on human skin or? Absolutely, it derives from a technology that's been used in aesthetic aesthetics in.
Korea. And also, so I, I do believe they are using the target cool device in all these aesthetic surgery places and Aesthetic places in even in the UK. Yeah, OK, cool.
And then going beyond dogs and cats, I mean you showed the little poor little monkey with his little hand there that looked very small. Does it, is it used in other exotics, livestock, could it be used on human skin, that kind of thing? This device being used, .
On poetry, I believe in birds, exotics, we used it in rabbits before, so when we had . Fly strike like lesions that a lot of dead skin, absolutely we use it on over necrotic skin and achieve like full skin regeneration, which is amazing. So yeah, we, we use it on all.
I, I think, because it's so safe, I think it's, it's no species you can't use it practically. I suppose you know the the effect against the the antibacterial effect is indiscriminate, isn't it? So if you've got concerns about that, you know, I suppose you really hit the nail on the head with the whole AMR piece as well.
It's really good to see that it can help to reduce antibiotics, so. Absolutely, I think that's one of my passion. I think we, we still use a lot of antibiotics when we shouldn't, and I think, it's time for, for opening our eyes to, to different, .
Options Options and opportunities because. I can't tell how, how, . How great it is when you definitely know this is something you would have reached for antibiotics for those 2 cases of 3 of them I presented, we knew and proved that they had bad bacteria and we never reached for antibiotics on the whole course.
It was great to have the owners trusting us to try the device on this and yeah and raise awareness that yeah we can deal with things without using antibiotics in a safe way. Yeah, and are you using I suppose you're using less in your clinic then, are you finding that yes with some patients you use antibiotics alongside for a bit, but then it allows you to shorten the course or are you just being bold enough now to say that a lot of patients we'll just go straight to. We started, as you've seen in the second dog, dog bite wound, .
You would reach for antibiotics. It was so many open wounds on that that dog, and they all deep. You can actually see in the vexel here when we applied it, it just floated under the skin like blew, blew the dog up kind of, and you would say, oh, this is.
Really needing antibiotics, but we said, we just let's do a couple of sessions without and see, just monitor it closely, and we haven't reached for any during the treatment, and I think, the owners are really impressed with that because it wasn't the first time it happened and, and they've usually been packed with antibiotics and yeah. Yeah, that's good. Yeah, no, I think a lot of owners are now kind of they are being educated and they are moving more away cos we do more options now, which is really good, good to see, so we've got a few more questions, so this is a, this is another one.
So regardless of the wound severity, from minor to major skin condition, non-contaminated to contaminated wound. Deep, superficial, how many sessions would you use to of the vettes? Is it like a once daily thing for a few days, or is it like once a week?
Like how, how long would you use it for? Can you give us some examples? Yes, depends, for wounds, I do like to use them at least twice a week, so maybe 4 days apart, 5 days, so depends where it falls.
And then depends on the graduate healing and we'll assess it after. It's really interesting how the wounds are healing as well with that is because it's visible, really visible from one session to another, and it just contracts and, and the fur grows at the same time, which is really nice. To say because your scarring, it's, it's, it's minimal after the, the, OK, so you, you kind of base your decision based on the progression of, yes, absolutely.
I would say a wound management usually requires 4 to 6 sessions, depends on, on how big and, and how many areas or how deep they are. OK, fabulous. I've got a dentistry question for you actually, which is I love it.
You're interested in dentry as well. Er can we use it to treat gum hyperplasia? Yes you can, and you can actually, I'm, I'm sorry I didn't put it on my slides, but they were very successful treatments of .
Feline, gingivitis, viral gingivitis, I know it would require to kind of immobilise them for the treatment, so probably a, a, a sedation, maybe some, . Alakistan alongside just to apply because it wouldn't be more than 30 to 60 seconds to apply it around the mouth, but, severe gingivitis, gingivar hyperplasia, yes, you can use it safely and with, with great results, and I suppose you could kind of use it. Post like, dental surgery, you know, if you've got like a infected tooth socket that you're worried about, you know, you can.
I haven't used it, but I'm sure you can. Yeah, OK. Cool.
I suppose that answers the question which we've had also is, is there any harm if the patient licks the treated area, so I suppose if you use it not. Yeah, I know, and to be honest, after treatment is nothing to lick off because it does penetrate deeper in the skin, so it, it's, yeah, it's safe and it's, it's kind of, I describe it, to owners, it's like an invisible liquid bandage on, on, on the skin. So yeah, it is safe.
That's good. And compare comparison to laser therapy and and other skin treatment modalities, could you discuss that a little bit more? Can you use them together or would you use one or the other?
Yeah, they, they are, . Laser therapy, it's, it's great. I've been using it a lot.
This device started to take over it though er because I find it, the duration of treatment is shorter. And also that the results are much more visible like you, they are, are quicker for me. But yeah, it, it's I think it's preferences, what, what you used to do, but .
As for wound management, definitely I would choose this one. Like post-operative, laser therapy, yes, yeah, I would still think that's a good option, but, for, for wound management or wound breakdown, I would definitely choose vaccine here. And in and in terms of interactions, I mean you've mentioned it's, it's very safe.
Is there any concern if you're using particular drugs or are there modalities, no, you'd use it no, because it's not a drug, it's not a physical drug, it's not a pharmaceutical, . Yeah, it's, it's, it's the safest thing I think we, we ever used in, in practise. Good.
And then I suppose final question, er, where is it available? Can we get it? Oh, good question.
I think . At the moment there are no distributors in the UK, but hopefully we're gonna get some distributors. I think whoever wants it, I'm just gonna pop it back on, it is, an email address, there, and if you want to get in contact, just, just write directly to that contact.
There and they will pick it up and arrange delivery if, if somebody would like to try it. I think, I can't recommend it more than I, I, I truly believe this, this really changes how, how we look at . Wound and skin in general because the amount of skin we find like skin disorders we find in, in nowadays in practise, it, it's just overwhelming I think and it's just it's a daily thing isn't nothing quite cuts it and it's a, a good thing to have it around so I.
Yeah. Fabulous. So yeah, I mean I know there is a website as well, so I'm I'm assuming everyone can find that if you just type it back on, yeah.
Into Google, there will be more information there as well, so that's that's great. So yeah, I think that's all, all the questions for now. The webinar will be online within the next 24 or so hours, so if you want to go over any of that again.
Any of you that were listening, then please, check that out. Your CPD certificates will also be available within the next 24 hours as well for those that, that want them. So yeah, thank you for watching.
Thanks, Tunde, that was excellent. It's really cool Debari. Thank you very much.
And, yeah, if any more questions pop up, do, do not hesitate to, to put them on and I'll answer them. Yeah, fabulous, will do. And thanks to our sponsors, which was, was Betty's today, so.
Everybody have a good rest of your day or evening wherever you are, and hopefully we'll see you next time. Thank you, thank you.
