Los mejores ortopedistas del tratamiento de Coxartrosis — TOP-139 médicos

HOMO HOMINI MEDICUS. Eclectic surgeon, specialist in orthopedics and traumatology, pioneer of endoscopic surgery, radio-guided and minimally invasive robotics of the spine and small and large joints (knee, hip, foot, shoulder, elbow and wrist). He combines surgery with regenerative medicine, which he was the first to launch in Italy and Europe, with the use of FSV cells (Stromal Vascular Fraction, particularly rich in stem cells). Adolfo Panfili boasts a prestigious scientific and sporting curriculum of international importance, as well as being an expert in homeopathy, homotoxicology, phytotherapy, acupuncture and BEST chiropractic. Expressly commissioned by his teacher, Prof. Linus Pauling (multiple Nobel Prize winner), inventor of Orthomolecular medicine, he founded AIMO, (International Association of Orthomolecular Medicine), revisiting this science and merging it with other super-specialist branches, including regenerative medicine , aimed at restoring and repairing cartilage, bone and joint structures, vertebral discs, ligaments, tendons, etc.

Prof Adolfo Panfili, orthopedic surgeon with a very long CV of international standing. He is president of AIMO, the International Association of Orthomolecular Medicine of which he is the founder. He was a student of the double Nobel Prize winner Linus Pauling, inventor of Orthomolecular medicine. Prof Panfili has revisited and expanded this science by merging it with other sciences and techniques including the use of Stromal Vascular Fraction.

– He is Deputy Rector for International Relations as well as Dean of the Master's Faculty of Orthomolecular Sciences at the Popolare University of Milan;

– He is the first to have carried out minimally invasive robotic surgery in orthopedics in Italy with the Mazor system;

– He is Trainer and Proctor of Dtrax, a minimally invasive posterior cervical fusion and distraction system;

– He is the Director of various High Technology Minimally Invasive Spinal Surgery Centers accredited with the NHS and otherwise;

– He is the founder and director of the first Italian Center for Minimally Invasive Robotic Spine Surgery and one of the most eminent members of robotic surgery at the “International Academy for Robotic Spine Surgery”;

Prof. Panfili has been treating vertebrae, posture and nutrition in close synergy since the beginning of his thirty-year professional activity, both from a surgical and manipulative point of view, being among other things the first orthopedist in Europe to graduate in Best Chiropractic with Prof. Ted Morter, one of the best chiropractors in the world, of whom he was the best European student.

– He is currently a pioneer in the use and application of the Stromal Vascular Fraction in the field of well-being, anti-aging and longevity, with particular reference to orthopaedics, the spine and cervical, the aspect of cartilage damage for prevention of degenerative diseases of the hips, knees and intervertebral discs.

Dr. Aranda received his degree in Medicine and Surgery from the Universidad de Málaga in 1983. He specialized in traumatology and orthopedics at the Department of Traumatology and Surgical Orthopedics of the Instituto Dexeus, Barcelona between 1988 and 1993. under the direction of Dr. Villarrubias.

Throughout his medical practice, Dr.Aranda has worked in leading hospitals in Spain, participated in the medical support of the 1992 Olympics in Barcelona and was a traumatologist in the Federación Española de Motociclismo in the European and World Championships in the period 1982 - 1992.

Dr. Aranda currently concentrates his medical practice on the treatment of pathologies of the hip and foot at Hospital Quironsalud Marbella and is a traumatologist at the Sociedad Sportclinic Marbella, a member of the Spanish Society for Hip Surgery Secca.

Assoc. Prof. Ozgur Cicekli

Education :

Bachelor's Degree: 1998-2005 - School Of Medicine (english), Hacettepe University
Residency Education Ankara Atatürk Educatıon And Research Hospital
2005 – 2010 - Orthopedıcs And Traumatology Clınıc
Title Of Associate Professor: 2019 Sakarya Unıversıty Educatıon And Research Hospıtal

Biography :

2005 – 2010 - Resıdency, Atatürk Teaching And Research Hospital, Ankara
2011-2012 – Mılıtary Servıce, Samsun Mılıtary Hospıtal
2012 – 2015 – Conscrıptıon, Şanlıurfa Mehmet Akif Inan Educatıon And Research Hospıtal
2015-2020 Ministry Of Health Sakarya University Training And Research Hospital
2020 – Adatip Sakarya Hospital

Area of Specialty :

Areas Of Focus
Sports Injuries And Surgeries
Joint Preserving Surgery
Arthroplasty
Orthopedic Traumatology

Memberships :

1. 2018, Member, Turkish Society Of Sports Injuries, Arthroscopy And Knee Surgery
2. 2014, Memberi Turkish Orthopedics And Traumatology Training Council (totek)
3. 2012, Member, Federation Of Turkish Society Of Orthopedics And Traumatology (totbid)

Congress :

Letters/articles/publications
A. Articles Published In International Peer-review Journals:
A.1 Çiçekli Özgür, Dogan Metin (2018). Evaluation Of Surgical Outcome In Advanced Age Patients With Developmental Hip Dysplasia. International Journal Of Surgery, 52, 44-49., Doi:
10.1016/j.ijsu.2015.02.020, (control No: 4920803)
A.2 Çiçekli Özgür,topçu Hüseyin Nevzat,kochai Alauddin,sükür Erhan,türker Mehmet
(2019). Comparison Of Suprapatellar And Infrapatellar Tibial Nailing: More Anatomic Entry Point And
Fracturereduction Via The Suprapatellar Approach. International Journal Of Clinical And Experimental
Medicine, 12(1), 804-811., Doi: Ijcem0082501, (control No: 4840087)
A.3 Çiçekli Özgür,özdemir Güzelali,uysal Mustafa,biçici Vedat,bingöl Izzet (2016).
Percutaneous Cannulated Screw Fixation For Pediatric Epiphyseal Ankle Fractures. Springerplus,
5, (1) Doi: 10.1186/s40064-016-3623-1, (control No: 4920888)
A.4 Çiçekli Özgür,kochai Alauddin,sükür Erhan,basak Ali Murat,kurtoglu Alper,türkermehmet (2019). Suprapatellar Approach For Fractures Of The Tibia: Does The Fracture Level Matter?.
Joint Diseases And Related Surgery, 30(1), 10-16., Doi:
10.5606/ehc.2019.63487, (control No: 4919692)
A.5 Çiçekli Özgür, Bingöl Izzet,tepe Nermin,akgül Turgut,çiçekli Esen, Atbinici
Hasan,arslan Arslan Kagan (2016). Neuromuscular Functional Changes Of The Quadriceps After Acl Reconstruction. West Indian Medical Journal, Doi: 10.7727/wimj.2015.558,
(control No: 4892448)
A.6 Özdemir Güzelali, Çiçekli Özgür, Akgül Turgut, Zehir Sinan, Ferit Yücel, Eskin Deniz
(2014). The Results Of Autologous Bone Graft And Titanium Headless Cannulated Compression Screw For Treatment Of Scaphoid Nonunion. Turkish Journal Of Trauma And Emergency Surgery, 20(3),
199-204., Doi: 10.5505/tjtes.2014.92255, (control No: 4866486)
A.7 Özdemir Güzelali, Akgül Turgut, Çiçekli Özgür, Yilmaz Baris, Atbinici Hasan, Yücel Ferit (2017). Lunatum Excision And Scaphocapitate Arthrodesis In Kienböck's Disease. Journal Of Orthopaedic Surgery, 25(1), Doi: 10.1177/2309499017692704, (control No: 4866032)
A.8 Kochai Alauddin, Türker Mehmet, Çiçekli Özgür, Özdemir Ugur, Bayam
Levent, Erkorkmaz Ünal, Sükür Erhan (2018). A Comparative Study Of Three Commonly Used Fixation Techniques For Isolated Medial Malleolus Fracture. Joint Diseases And Related Surgery,
29(2), 104-109., Doi: 10.5606/ehc.2018.61449, (control No: 4866101)
A.9 Sükür Erhan, Akar Abdülhalim, Topçu Hüseyin Nevzat, Çiçekli Özgür, Kochai
Alauddin, Türker Mehmet (2018). The Effect Of N-acetylcysteine On Mechanical Fatigue Resistance Of Antibiotic-loaded Bone Cement. Journal Of Orthopaedic Surgery And Research, 13,
Doi: 10.1186/s13018-018-0843-9, (control No: 4866136)
A.10 Akgül Turgut, Zehir Sinan, Özdemir Güzelali, Yücel Ferit, Türk Abdulkadir, Çiçekli
Özgür (2014). The Results Of Low Profile Locking Anatomical Plate Application For The Treatment Of Edinburg Type 2 Clavicle Diaphysis Fractures. Turkish Journal Of Trauma And Emergency Surgery, 20(4), 286-290., Doi: 10.5505/tjtes.2014.88303, (control No: 4866478)
A.11 Sükür Erhan, Akar Abdülhalim, Uyar Ahmet Çagri, Çiçekli Özgür, Kochai
Alauddin, Türker Mehmet, Topçu Hüseyin Nevzat (2018). Vacuum-assisted Closure Versus Moist Dressings In The Treatment Of Diabetic Wound Ulcers After Partial Foot Amputation: A
Retrospective Analysis In 65 Patients. Journal Of Orthopaedic Surgery, 26(3), Doi:
10.1177/2309499018799769, (control No: 4866083)
A.12 Yalçin Muhammed Nadir, Bektaser Süleyman Bülent, Çiçekli Özgür, Dogan Metin
(2009). Bucket-handle Tear Of A Discoid Lateral Meniscus In A 6-year-old Girl. Acta Orthopaedica Et
Traumatologica Turcica, 43(6), 528-531., Doi: 10.3944/aott.2009.528, (control No: 4866457)
A.13 Yalçin Muhammed Nadir, Bektaser Süleyman Bülent, Çiçekli Özgür, Ugras
Serdar, Dogan Metin (2010). An Unusual Cause Of Recurrent Joint Effusions: Nonhemophilic
Hemosiderotic Synovitis Of The Knee. Acta Orthopaedica Et Traumatologica Turcica, 44(2), 162-
165, Doi: 10.3944/aott.2010.2240, (control No: 4866450)
B. Articles Published At Local Peer-review Journals:

B.1 Çiçekli Özgür (2019). Does Sleep Disturbance And Quality Of Life Improve After Arthroscopic Rotator Cuff Repair?. Annals Of Medical Research, 26(4), 664-669., Doi:
10.5455/annalsmedres.2019.01.049, (control No: 4892204)
B.2 Sükür Erhan, Uyar Ahmet Çagri, Özdemir Ugur, Gökçen Hüseyin Bahadir, Çiçekli
Özgür, Topçu Hüseyin Nevzat (2018). Assessment Of Concordance Between Age Group And Etiology, Level And Revisions Of Amputations. Medeniyet Medical Journal, 33(1), 10-16., Doi:10.5222/mmj.2018.35002,

Certificate
Turkish Society Of Orthopedics And Traumatology-turksih Council Of Orthopedics And Traumatology Educaiton Board Test, Orthopedics And Traumatology Qualification Test, 2014, Ankara, Certificate,
14.09.2014 -26.10.2014 (national)

Course
Nice Shoulder Course, Shoulder Course, Covering Arthroscopic And Prosthetic Surgery. The Program Includes Lectures By Leading Shoulder Surgeons, Round Table Discussions, A Live Surgery Session And Workshops With Cadavers And Plastic Models., Nice, Course, 02.06.2016 -04.06.2016 (international)
2.
Ao Trauma Course- Advanced Principles Of Fracture Management, Ao Trauma Course- Advanced
Principles Of Fracture Management, Ankara, Course, 17.01.2015 -20.01.2015 (national)
3.
Ao Trauma Courses- Foot Ankle, Ao Trauma Courses- Foot Ankle Surgery, Graz, Kurs, 17.09.2014 -
19.09.2014 (international)
4.
Epos-bat Advanced Course, Current Concepts In The Management Of Pediatric Hip Disorders., Izmir,
Course, 06.09.2013 -07.09.2013 (international)
5.
Gazi Shoulder Arthroscopy Course, Shouler Arthroscopy Course, Ankara, Gazi University Hospital, Course
04.01.2013 05.01.2013 (national)
6.
Fracture Management During The Growth, Fracture Management During The Growth, Ao Trauma Courses, Graz, Course, 12.09.2010 -12.09.2010 (international)
7.
Ao Trauma Course Approach And Osteosynthesis, Ao Trauma Course Approach And Osteosynthesis (with Cadaver Dissections), Graz, Course, 08.09.2010 -12.09.2010 (international)
8.
Introductory Course With Cadaver Dissections, Introductory Course With Cadaver Dissections For Ao Travma-course Approaches And Osteosynthesis, Graz, Course, 07.09.2010 -07.09.2010 (international)
9.
Ao Trauma Course-principles In Operative Fracture Management, Ao Trauma Course-principles In Operative Fracture Management, Ankara, Course, 15.01.2010 -19.01.2010 (national)
10.
Ao Pediatric Trauma Course, Ao Pediatric Trauma Course, Izmir, Course, 18.04.2009 -19.04.2009 (national)
11.
2. Intramedular Nailing Course, Intramedular Nailing Course, 2009, İzmir, Course, 15.01.2009
18.01.2009 (national)
12.
Basic Sciences And Research School, Turkish Society Of Orthopedics And Traumatology-turksih Council Of Orthopedics And Traumatology Educaiton Orthopedics And Traumatology Basic Sciences And Research School, Turkish Society Of Orthopedics And Traumatology-turksih Council Of Orthopedics And Traumatology Educaiton Erzurum, Course, 27.02.2008-01.03.2008 (national)

SUB-SPECIALISTS 

• *Trauma Surgery 
• *Joint Prosthesis Surgery
• *Knee Surgery 
• *Arthroscopic Surgery 
• *Spine Surgery 
• *Deformity Surgery 

TECHNOLOGIES 

• *Robotic Joint Replacement Systems 
• *Kinematic Approach of Knee Replacement Surgery 
• *Journey II Knee Prosthesis System

EDUCATIONAL INFORMATION 

1. *Eskişehir Osmangazi University Faculty of Medicine (Bachelor’s Degree, 2005-2011) 
2. *Health Sciences University Ankara Education and Research Hospital (Specilization Education, 2012-2017) 
3. His international published article is named as ‘’Mahmuti, A., Güler, U.O., Haberal, B., Şimşek, E.K., Yüksel, S., Temiz, A., Tuncay, I.C. Biomechanical Comparison of Polymethylmethacrylate Augmentation Methods in Failed Pedical Screw Revision. Turk Neurosurg. 2021; 31 (5): 788-794. DOI: 10.5137/1019-5149.JTN.34653-21.2. PMID: 34374983’’. 

COURSES INFORMATION

1. *11th TOTBID School of Basic Sciences and Research, Malatya. 
2. *1-3 March 2013. AO Basic Trauma Course (Principles in Operative Fracture Management), İstanbul 2013. 
3. *10th Basic Orthopedic Trauma Education Meeting, Ankara. 13-14 September 2013. 
4. *6th Intramedullary Nailing Course, İzmir 2013. 
5. *Instrumentation Course in Arthroscopic Surgery, İstanbul 2013. 
6. *6th Minimally Invasive, Locked Plate Osteosynthesis and Advanced Trauma Education Meeting. 5-6 December 2014. 
7. *TOTBID GKD-PEV Course, Konya 2015.
8. *AO Advanced Trauma Course (Principles in Operative Fracture Management), Ankara 2017. 
9. *Stryker Mako Certification Lab., Amsterdam. June 2019.

CONGRESS INFORMATION

1. *23rd National Turkish Orthopedics and Traumatology Congress. 29 October – 3 November 2013. 
2. *5th Orthopedics and Traumatology İstanbul Meeting. 10-12 April 2015. 
3. *Spine Intervention Society 2019 European Congress, Munich. May 2019. 

CAREER INFORMATION

1. *Şırnak İdil State Hospital (General Practitioner, 2017-2019) 
2. *Ankara Education and Research Hospital (Specialization Education, 2012-2017) 
3. *Şırnak State Hospital (Specialist Doctor, 2017-2019) 
4. *Turan Turan Health Group (OM Spine Surgery Center – Robotic TT Orthopedics Robotic Surgery Center) (Specialist Doctor, 2019-now) 
5. *Başkent University Faculty of Medicine Orthopedics and Traumatology Department Adana Dr. Turgut NOYAN Application and Research Center (Specialist Doctor, 2020-2021)

El Dr. M. Kerem Canbora es un experto cirujano ortopédico y de reemplazo de rodilla con más de 20 años de experiencia. Es especialista en artroscopia de hombro, reemplazo de rodilla, reemplazo de cadera y cirugía de codo y está afiliado a la Sociedad Turca de Cirugía de Hombro y Codo y a la Sociedad Europea de Cirugía de Hombro y Codo. Completó su formación en el Hospital de Formación e Investigación del Hospital Haydarpaşa Numune y en la Facultad de Medicina de Harvard.

surgeon. Dr. Serdar Karaman graduated from İnönü University Faculty of Medicine. Subsequently, he completed his specialist training in Orthopedics and Traumatology at İnönü University. His previous experiences include Elbistan State Hospital and İnönü University. 

Areas of particular interest: Hand surgery, sports surgery, arthroplasty, cartilage injuries, pediatric orthopedics, foot and ankle surgery, arthroscopic surgeries, lengthening surgeries and pelvic fractures.



Scientific Publications

Articles Published in International Refereed Journals: 1. Which is more dangerous, earthquake, or the panic? Evaluation of the 24 January 2020 Elazig/Türkiye earthquake related musculoskeletal injuries. E Ergen, O Kaya, Ö Yılmaz, HU Özdeş, ÖC Batur, S Karaman, İ Güzel, .Ulus Travma Emergency Surgery Derg 28 (9), 1335-1339 2. The Clinical Results of Tendon Transfers in Patients with Ulnar Palsy. S Karaman, S Ekrem, K Ertem. Journal of Medical Case Reports and Reviews 5 (6), 1144- 1152 3. Clinical results of endoprosthetic reconstructions in metastatic and primary bone tumors. R Sevimli, S Karaman. Medicine Science 11 (1), 199-203 4. A Case of Glomus Tumor in an Unusual Localization of Hand. S Ekrem, S Karaman, K Ertem, H Köse. Clin Case Rep Int. 2020; 4 1198 5. Spontaneous extensor pollicis longus (EPL) tendon rupture after ironing. S Karaman, M Köroğlu, ZM Özdemir, K Ertem. Oral Presentations Presented at Annals of Clinical and Analytical Medicine 2020 National and International Congresses: 1. Medium and Long-Term Results of Patients to whom We Performed Microfracture for Knee Joint Cartilage Damage. Karaman S, Ergen E, Aslantürk O, Kılınç Ö. 30th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 9-14 November 2021. 2. Medium and Short-Term Results in Our Patients Treated with Reconstruction with Endoprosthesis After Resection for Malignant Bone Tumors. Sevimli R., Karaman S. Bone Joint 2021 Online Congress, Ankara, Turkey, 1 - 04 April 2021, p.82 3. Mid-Term Clinical Results of Surgical Treatment of Thumb Metacarpophalangeal Joint and Collateral Ligament Injuries. Karaman S., Ekrem S., Ertem K. 17th National Turkish Hand and Upper Extremity Surgery Congress, Turkey, 16 - 20 November 2020 4. Mid-Term Results of Surgical Treatment of Thumb Metacarpophalangeal Joint Collateral Ligament Injuries. Karaman S., Ekrem S., Ertem K., Aslantürk O. 17th National Turkish Hand and Upper Extremity Surgery Congress (ONLINE), Turkey, 16 - 20 November 2020 5. Evaluation of Mid-Term Functional Results of Our Patients Who Had Arthroscopic Rotator Cuff Repair. Kilinç Ö., Ertem K., Ergen E., Karaman S. 17th National Turkish Hand and Upper Extremity Surgery Congress, Turkey, 16 - 20 November 2020 6. Retrospective Examination of Patients Treated Surgically Due to Carpal Bone Cyst. Karaman S., Ekrem S., Ertem K. 29th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 22 - 27 October 2019, vol.53, p.47 7. Streptococus Pneumonia in the Proximal Humerus in a Baby Presenting with Brachial Plexus Disorder Clinic Case Report of Osteomyelitis Due to Disease. Karaman S., Özdeş H. U., Gündüz E. 29th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 22 - 27 October 2019, vol.53, pp.152 8. Retrospective Examination of Mid-Term Results of Surgical Treatment of ThumbMmetacarpophalangeal JointCollateral Ligament Injuries. Karaman S., Ekrem S., Ertem K. 29th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 22 - 27 October 2019, vol.53, pp.139-140 9. Retrospective Examination of Patients Who Had Tendon Transfers Due to Ulnar Nerve Paralysis. Karaman S., Ekrem S., Ertem K. 29th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 22 - 27 October 2019, vol.53, p.139 10. Case Report of Radial Nerve Interference Between the Fracture Line in Supracondylar Humerus Fracture . Karaman S., Sağir A., Çoban İ., Sevimli R. 29th National Turkish Orthopedics and Traumatology Congress, Antalya, Turkey, 22 - 27 October 2019, vol.53, pp.147-148 11. Should We Have A Controlling Hip X-Ray In A Child Whom His Hip Ultrasonography Reported As Normal Previously? Ceylan M. F., Karaman S., Karakaplan M. 17th International Eastern Mediterranean Family Medicine Congress, Adana, Turkey 10 - 13 May 2018 12. Medico-Legal Examination Of Patients With Developmental Dysplasia Of Hip Treated Surgically Due To Late Diagnosis. Ceylan M. F., Karakaplan M., Karaman S. 17. 17th International Eastern Mediterranean Family Medicine Congress, Adana, Turkey, 10 - 13 May 2018 13. Does The Implemented "Developmental Dysplasia Early Screening Program" Reduced The Need For Surgical Treatment? Ceylan M. F., Karakaplan M., Karaman S., Kaya R. 17th international eastern mediterranean family medicine congress, Adana, Turkey, 10 - 13 May 2018 14. Shoulder Septic Arthritis Occurring In Newborn With Brachial Plexus Paralysis Clinic; Case Report Presentation. Yıldırım E, Karaman S. 16th National Congress of the Turkish Society for Surgery of the Hand and Upper Extremity and 5th National Congress of the Hand Therapist Society Abstract Supplement. May 6-9 2018, Pamukkale, Denizli, Turkey. Hand Microsurg 2018;7: Suppl1. P.47

Ortopedista-Traumatólogo, Especialista en tratamiento de rodilla, tendones y ligamentos

I am a graduate of the Faculty of Medicine of the Medical University in Warsaw. Since 2015, I have been a senior assistant at the Orthopedics and RheumoOrthopedics Clinic of the CMKP Hospital named after Prof. A. Gruca in Otwock, and since 2018 – a research assistant at the Medical Center for Postgraduate Education in Warsaw. I gained professional experience in domestic and foreign centers. I did internships and participated in numerous courses in Finland, the Netherlands, Germany, Italy and Great Britain. I speak Polish and English.

Main areas of my interest include mainly knee and hip replacements, complications after endoprostheses, periprosthetic infections, reconstructive procedures within the knee joint, including arthroscopic procedures and corrective osteotomies of the tibia (e.g. HTO, tibial tuberosity osteotomies), as well as surgical treatment of neuropathies: carpal tunnel syndrome, ulnar nerve syndrome. I am the author and co-author of numerous publications.

El Dr. Aviram Gold es un cirujano ortopédico altamente experimentado, cirujano de reemplazo de cadera y rodilla con más de 20 años de experiencia. Es médico de la Universidad Hebrea de Jerusalén, Escuela de Medicina Hadassah y tiene una Maestría en Administración de la Salud de la Universidad Ben-Gurion en el Negev, Escuela de Administración, Departamento de Administración de Sistemas de Salud. Está certificado por la junta de cirugía general y ortopédica de Israel, certificado en medicina aeronáutica, y ha asistido al Curso Avanzado de AO: Avances en el tratamiento de fracturas, Leeds y curso de Instructor de Soporte Vital Avanzado en Trauma. Ofrece tratamientos para una variedad de afecciones musculoesqueléticas, con procedimientos populares que incluyen reparación del tendón del hombro-manguito rotador, artroscopia de rodilla, cirugía de fusión de tobillo, reemplazo total de rodilla B/L, reemplazo total de cadera B/L, cirugía de rejuvenecimiento de cadera, ligamento cruzado anterior ( LCA) Reconstrucción, Reparación de meniscos, Liberación del túnel carpiano y Artroscopia de hombro. Horario de atención: lunes a sábado de 8 am a 4 pm.