The topic of this presentation is on complications from closure devices. Current FDA approved closure devices for five to seven French sheaths include variety of devices that are listed here. There are unique characteristics for each of the devices as mentioned here. ProStar XL is one of the oldest devices that has been used since 1994. It has a braided suture and it's a 10 French device. ProGlide is a newer version of a closure device which is suture mediated similar to ProStar. The only difference is it has a mono filament suture rather than braided suture and both of them are from Abbott vascular. Another Abbott vascular device is Star-Close SE that uses nightingale clip and this device is not as frequently used as ProStar. Cordyce and Cardinal Health have several devices. ExoSeal Minx Grip and the newest comer is Minx Control. This device uses Extravascular PGA plug and Extravascular PGA PG sealant. Another one is by Cardiva Medical that started with Boomerang and then Catalyst 1, 2, and 3 and the latest one is Vascade. It uses Kaolin and Chitocin and Protamine in earlier generation devices and more recently it uses Collagen for controlling the bleeding. Fish by Morris Innovative devices rarely used. It uses SIS arterial plug and finally Turumo has several devices. Angioseal VIP and more recently Angioseal Evolution that uses Collagen plug and bioabsorable anchor. Now a variety of vascular closure devices have been tried and they all have their idiosyncrasies and complexities and complications related to the use of those devices. As far as vascular closure devices are concerned and incidence of complications the most common one is bleeding that is seen in roughly about 70% of patients that are referred to surgery. Infection is the second most common type of complication that is roughly occurring in about 39% of cases and finally ischemia occurs in about 28% of cases of patients that are referred to surgery. Pseudoaneurism is present in about 20% of patients that are referred for surgery. Manual compression also has obviously complications related to this particular technique and the most common complication is occurrence of pseudoaneurism that occurs in about 71% of cases that are referred to surgery. Hemorrhage is the second most common one and occurs in about 32% of patients and finally AV fistula in about 15% of patients. When we look at the meta-analysis and studies in more than 10,000 of patients related to incidence of complications with the use of vascular closure devices versus manual compression we can see that the incidence of vascular complications with vascular closure devices occurs somewhere between 1.1% to 2.5%. What we can see is that in most of the studies when compared to vascular closure devices and manual compression the risk of complication is somewhat higher with vascular closure devices than with manual compression. So vascular closure devices in general do not decrease the incidence of vascular complications they only save time as far as length of being bedridden after the procedure. Here is one of the studies so-called respect perspective randomized clinical trial that compared manual compression to a variety of devices including angiocele, perclose, proglide, starclose, minx, exocele and what we can see here is that one of the lowest incidence of vascular complications as far as major complications are concerned occurs with manual compression. All the other ones have a significantly higher incidence of vascular complications than manual compression except for exocele and vascate. We can see that certain devices have low incidence of minor vascular complications and certain ones such as exocele has a significantly higher incidence of vascular complications which are qualified as minor which probably relates in most of the occasion to bleeding and occurrence of hematoma. One of the most important factors as far as complications are concerned related to the use of vascular closure devices is operator experience. As we can see here there is a significant learning curve for most of the vascular closure devices and really the incidence of vascular complications drops significantly after the operator gains experience in over 250 to 350 cases and after that we achieve a certain plateau and significantly lower incidence of vascular complications than in the first 25 or 75 or 100 cases. Variety of vascular complications can occur with the use of vascular closure devices and here is one of the examples in the relatively young individual that had a procedure done. This was a diagnostic procedure with the use of collagen-based closure device. We can see thrombosis occlusion of the left iliac artery. In this particular patient intervention was performed with thrombolysis and mechanical thrombectomy to re-establish the flow to the left lower extremity. Another relatively common complication particularly for those that are not using vascular ultrasound to gain access at the common femoral artery is the stick that is too high and bleeding in the retroperineum as shown here. So retroperineal bleeding can carry significant consequences and it should be avoided by all means because this is probably one of the most traumatic and serious complication that can occur due to suboptimal imaging and suboptimal access when using vascular closure devices. Now what about large bore vascular closure devices which are devices for accesses larger than 10 French and all the way up to 25 French. In the United States at the present time we have three devices that are approved for clinical use. The oldest one is ProStar XL. It's a 10 French braided suture medium vascular closure device that has been approved in the European Union for large bore femoral artery closure all the way up to 24 French but not in the United States. This device has a prolonged learning curve, has over 30 steps to be able to deploy the device safely and for that particular reason is not very extensively used. Another device is ProGlide which is a six French suture mediated monofilament vascular closure device that is approved in the United States for large bore closure all the way from 12 French to 21 French OD. This device is very commonly used for diagnostic and also interventional procedures. It has a significantly shorter learning curve than ProStar and therefore it offers to the operators great results with a relatively short experience and short learning curve. One of the disadvantages of this device is that frequently it will require the use of two devices for large bore access and occasionally if you have a failure of hemostasis three devices might be used for large bore access such as 21 French or all the way to 24 French which is not uncommon for T-VAR procedures and also for TAVR procedures. More recently we have a Manta device that has been approved for clinical use for large bore access and there are two devices 14 French device and 18 French device. Those devices are approved in United States and also abroad in European Union for large bore access repair all the way to 25 French OD. This device has a shorter learning curve and what is also very important this device can be used after the intervention so it means at the end of the procedure which is advantageous in certain scenarios such as emergency cases, ruptured abdominal and ruptured thoracic aortic aneurysms. What is very important is that such immediate closure devices such as ProGlide and ProStar can be only used in a pre-closed fashion it means at the end of the procedure we cannot use those devices they have to be used at the beginning of the procedure with which adds extra time. Manta on the other hand has advantages because it can be used at the end of the procedure and it saves time. Some of the complications related to large bore closure devices are for instance ProStar has complexities as we have mentioned as far as deployment is concerned but also it cannot be used in certain scenarios or has a significantly higher incidence of complications when we deal with calcifications, excessive fibrosis or scarring, post-surgery or the use of previous closure devices and also lack of operator experience or inexperience with this particular device. Very rarely we can encounter faulty device but that probably is very rare. As far as per-close ProGlide is concerned this device is commonly used and the advantages are that it can be used over the wire and in case if we have a failure of closure another device can be used to prevent complications such as shown here with hematoma, bleeding, retroperitone, hematoma and so on. Occasionally if this device is not properly used or if we have significantly diseased arteries with atheroma we can encounter dissection as it is shown in the lower picture on the right hand side and then this particular complication can lead to thrombosis embolization and occlusion of the access site artery. Here is another example of a patient that had the procedure done via left femoral approach for TAVR with large bore sheath all the way up to 24 french sheath. We can see before TAVR the access site was accessed with the micro puncture needle. We can see the artery was normal in size without any evidence of significant obstruction and at the end of the procedure after deployment of a collagen-based large bore closure device we can see occlusion of the access site and thrombosis at the access site. So one has to take images from the contralateral approach or use the ultrasound to make sure that the access site is patent after the use of collagen-based large bore closure devices to prevent serious complications like it occurred in this particular patient that needed an intervention to resolve this problem. So in comparison between Manta and other closure devices primarily Sucha media closure devices and surgery here we have this bar graph related to major complications and minor complications and in a table above we can see the results from the european c mark trial with the use of Manta device we can see also the results from the us id pivotal trial with Manta and also european union post market registry with the use of Manta device. What is very important is that obviously in clinical trial we expect better results than in a registry because in registry there is less rigorous analysis and limitations as far as inclusion and exclusion criteria are concerned. We can see that the vark2 major vascular complications occurred in those three studies somewhere in the range between 1.9 to 4.2 percent and as far as minor vascular complications are concerned they occurred from zero to 2.7 percent. Now in the bar graphs if we compare the results from the Manta clinical trials and registries we can see the incidence of major and minor vascular complications are significantly lower than with pro star proglide and also with the surgical access and repair and also as far as composite information is concerned for major and minor vascular complications. So obviously the newer generation devices are addressing this problem in a positive way as far as avoiding major and minor vascular complications are concerned. So why do large bore access site complications persist? There are numerous factors that play a significant role in this particular problem and complication. Some of them are as listed here patient related, vessel diameter matters, the smaller the vessel, the larger the incidence of complications particularly when you have severe vessel calcifications and stenosis and also tortuosity. Multiple procedures also play a significant role as far as complications are concerned because there is more manipulation in the device and the chances that the device might not perform well. Patients with morbid obesity have significantly higher incidence of complications and not all devices are designed to work perfectly in morbidly obese patients. Gender also plays a role not necessarily for any other reason than that females in general have smaller axis vessels and when using large sheets trauma can occur at the axis site and also females that develop vascular disease have in general more extensive disease and more atherosclerotic disease of not only axis vessels but also of the iliac arteries and the aorta as well. Vessel tortuosity plays a significant role and certain devices should not be used with extremely tortuous axis site vessels. Presence of peripheral arterial disease of the lower extremities plays also significant role as well emergency cases that are required to be done on emergency basis and there might not be adequate time to appropriately evaluate the axis site such as the use of CT and ultrasound to achieve proper access. There are also numerous physician related complications that occur and probably the most important one is experience whether with a suture media closure device or with collagen-based closure device that is currently or that are currently available. Presence of a multi-specialty team is also very important which means that a surgical backup is of great benefit and presence of a surgeon during procedure particularly when using large bore sheets is of importance to prevent or efficiently address and resolve the problem. The use of ultrasound to gain access is extremely important particularly for the use of large bore sheets in being able to assess the axis site and decide whether proper access has been obtained. Also aggressive manipulation of devices and sheets during the procedure can add to complexity and complications related to the procedure. Inaccurate measurements or lack of measurements such as CT imaging or ultrasound imaging that is not done or is not properly done can be a problem. Prolong procedures also add to complications particularly related to thrombosis and ischemia of the lower extremities and then finally complications can occur due to different use of devices. For instance EVAR, T-VAR and TAVR procedures require the use of large bore devices and not all devices are created equal and some of them might perform better in one scenario and might not perform better in another scenario. So the interventionist has to become familiar with each device that he or she might be using and to determine the idiosyncrasies advantages and disadvantages of each device in each particular scenario. Now some of the procedures have devices that are sheath based and those might be beneficial as far as avoiding complications because there is less manipulation rather than using a device percutaneously and then placing the sheath after that that can potentially traumatize the axis site. Delivery profile matters to a significant degree and that has been clearly documented in literature and clinical trials. The larger the profile the higher the incidence of complications and finally the use of closure device and familiarity with closure device plays a significant role. So in conclusions proper patient selection and adequate imaging are essential to avoid major axis site complications. This is particularly true when using large bore axis site devices. One should gain experience with axis site closure devices to be able to use them judiciously. When having difficulty in advancing large profile sheets or devices through iliac artery one should anticipate possible complications such as spasm, rupture, laceration, or evulsion and then complications related to such as retroperneal bleed and severe hypotension. To avoid those type of problems and to be able to address them in a judicious and exponential way one should make sure to maintain wire access until hemostasis is achieved. The contralateral femoral artery axis is also very important to prevent or stop retroperneal bleeding by inflating a compliant balloon in abdominal aorta or ipsilateral iliac artery. We should also make sure that we are able to identify the site and type of bleeding and on the basis of this information we'll be able to decide what is the most appropriate procedure to resolve any particular problem. This is particularly true in scenarios of severe iliac artery damage such as dissection, laceration, or evulsion to decide whether the intramational procedure is beneficial or possible or maybe is surgical acts as the only reasonable way to address and resolve this problem. One should also have appropriate size endographed available and this is particularly true for problems related to retroperneal bleeding and trauma to the iliac vessel and that should be available to the operator on a routine basis without any significant delay. Also whenever using large bore devices such as for EVAR, TEVAR, and TAVR, blood transfusion should be available and should be administered in a very expeditious way without major delay when hypotension occurs. And finally surgical and anesthesia services should be available whenever using large bore devices, large bore closure devices, and when encountering complications related to the use of large bore closure. Thank you very much for your attention.


If you pre-print your article and then it goes to the journal, it will be picked up as being almost 100% similar to the pre-print. So the way to get round that, you can't get round it in terms of it being detected, is that you first of all should check that the journals accept pre-printed articles. Not absolutely all journals do, most are moving that way now under open science. But if they do, and this is picked up, then the way to do it of course is to cover yourself by giving a link to the pre-print. You can do that on the title page, make it clear to the editors and possibly even to the reviewers that it has been pre-printed.


In this presentation, we will generate financial reports after having entered the adjusting journal entries that, of course, including the balance sheet and the income statement. We'll also take a look at journal reports, which are going to be important reports. We're going to try to isolate those reports down to the adjusting journal entries that were made, as well as the reversing journal entries. If we need to provide this information to somebody else, this is going to be a very useful tool to have. It'll also allow us to help in practice with the filtering options for the reports. Time to go forward with Sage 50, Cloud Accounting. Here we are in our Get Great Guitars file. We're going to be opening up our financial statements. We're going to start off with the standard balance sheet and the income statement, and then we'll go to the journal report and adjust that. We're going to be processing these, taking a look and reviewing the numbers, and then we will print them and export them, as is our usual process at the end of the sections here. We're going to go to the financial statements. We're going to be opening up the force that balance sheet first, and we're going to be for the second time period, that's going to be February, opening up the report, and there we have it. If you're following along with the problem, you could take a look at the ending balances here. If you have any issues with the ending balances, we'll also provide a trial balance report so that you can take a look at those as well. But if there's any problems with the ending balances here, then you want to check the date range, make it a later date range, and then go back into it and see if there's a date issue that's going on. Then we'll of course take a look at the new thing that we did, which was the adjusting journal entries. You want to be able to consider those. That'll be the third report that we will take a look at. We're going to open up all the reports first, and then we'll go back and we'll print them out. The next report's going to be the income statement. Going back to the financial statements, going into that income statement, I'm going to remove the zero balances because we don't need those by selecting the little checkbox to remove them. Then we're going to say, okay, and there it is. Once again, you could check out our income statement and just review those numbers. This is what you would do, of course, in practice as well and consider those. Then if you see something that doesn't look right, then you can increase the date and see if it's a date issue. See if there's any changes. Use the zoom function to then drill down on it to see if there's a date problem with it. Then the next step, the new thing that we've done is the adjusting journal entries. Can we run a report to review just those adjusting journal entries for ourselves and possibly to present to someone else like a supervisor or perhaps to like the accounting department or something like that if we're doing this externally and from the adjusting department side of things. To do that, we're going to go to the general ledger. Within the general ledger, we're going to be running that transaction at detailed report again, but we'll use some filter options this time. We'll open up this report. We want to see this report just as of the date that we entered the adjusting journal entries in as of, which should be just the end of the month. I'm going to run it for the last two days in case I messed something up and put something in there as of the 28th, because February has 29 days in 2020. It's possible that I got a date issue wrong by putting in the 28th on February out of just laziness or not paying attention, which happens every once in a while to me might be something that happens to you sometimes. But we're going to go over here and then I'm going to remove the summary. I don't want it to be summary. I want to see the detail, and this is what the report would look like before entering any filters. I'm not going to enter any filters yet. We're going to say okay, and this is what we have. So on the left-hand side, we have the transaction type, the reference and the ID, kind of the shorthand information, the transaction type you could see includes not only journal entries, but other kind of payments and whatnot. And then on the right, we got the actual journal entry giving us the two accounts that are going to be affected, at least two accounts of course, and they give us that by account number.  So if I go back to the left, also note that if it's an adjusting entry, we should be seeing an ADJ. So what I'm looking for is in the 28th, do I see any ADJs that I entered in basically the description column or as adjusting entries. So I'm trying to see if they're a journal entry as of the 28th, and I don't see any that we're adjusting entries, right? So here's a typical adjusting entry as of the 29th, and we have a ADJ entry. So that's kind of nice that we put in the line item that it's an ADJ. So you're looking for a general journal entry and an ADJ description. So here they are. Even on the 29th though, we may have some other transactions like a payment here. I don't really want that on the report. I don't want that there. If I could get rid of it, I'd like to. So all that information, you got all these payments that are happening here that all happened on the end of the month. I'd like to remove those. So how could we do that? Well, we can use our filtering option to trim this down a lot. So let's go up to our options once again. Let's change the date then to just the 29th. So I'm going to skip the 28th and just go to the 29th. And then I'm also going to filter down here. I'm going to filter by transaction type. I want to filter by transaction type. And I just want to see the journal entries. I don't want to see any forms. So I'm going to go just give me the general journal entries. And that should be enough to trim this down a lot. So we're going to say okay. And then now we just have the journal entries. So the general journal entries here. So that looks good. And they all have the description of the general journal entries. So here's the entries that we have put in place. You could kind of check the numbers of course over here. These being the account numbers and these being the amounts that were affected. So those are our adjusting entries. Now we'd also want to run this for our reversing entries. Which means we would just run it for the next day, which we will do. Let's actually open another report and do that. I'm going to go back on over here. And let's open this up again and just practice doing it another time. So we're going to open up another transaction detail report. This time we'll change the dates. I'm going to go back up to the option. We changed the dates last time, but this time we're going to change them to like a different day. So we're going to change this to March 1st. March 1st. And this one is going to go to March 1st. This is the reversing entry date. Then I'm also going to filter it. So we're going to filter by the transaction type. We want to be picking up the journal entries, the general journal entries once again. And I'd like to include all the details. I'm going to remove this little check mark that says summary because I don't want to summarize it. I want everything. So and then we're going to say okay. And there we have our reversing entries. Similar report. So we're going to have those as well. So there it is. These were reversed as of the first day to make the adjusting or the accounting and adjusting process kind of more separate and flow together a little bit more easily without messing each other up. Okay. So now we're going to go ahead and print these out. So let's go back on over. We're going to do this two ways as we've done in the past. We're going to print them as a PDF file using the Qt PDF printer. And then we're going to go back and export them to Excel and use Excel to then make them all go into one giant report in a PDF file, which is kind of nice. So I'm going to I'm going to use the Qt PDF. For now you can do I'm back in the balance sheet. You could go to the the PDF here. I like to practice using the printer because I think it's a useful tool. So I'm using the Qt PDF printer. It's a free tool. You can search it and have a have a printer and anytime you need to print something you could print it to a PDF file. And I recommend having some kind of tool for doing that. And then it's going to ask us where do we want to put it. And I'm going to say I want to put it in the Sage 50 cow docks. And we're going to go down to these are section 10. So I'm going to make a new folder. And I'm going to say folder. And is this section 9 or 10. This is section I think maybe it's section 10. I think it's section 10. Yeah that's what we're putting it. Section 10 here. So we're going to go all right. And then open that up. And then I'm just going to keep the name standard balance sheet. So let's do that. Now I'm going to print all the reports in this format. And then we'll go back and do it again. In a different format. So I'm going to say that's the first one. Then let's go to the income statement to a similar type of process here. We're going to go to the print option up top. It's going to the Qt PDF printer. I'm going to say OK. And then it's going to ask us where do we want to put this thing. And I'm going to put it in that same folder. There's the name that looks good. I'm going to say OK. Or print or save whatever that thing was that took completes the process. Then I'm going to go to the transaction, the first transaction detailed report. I'm going to print this one out and do the same thing here. This is the adjusting journal entries. I'm going to say OK. And then it's going to go to that same folder. Now this one I might want to rename it here because of course we have two reports that are both transaction detailed reports. So maybe I want to put this one make like this is going to be called the adjusting entry report. And then we'll do the other one. And we'll call it the reversing entry report. So this is the last transaction detailed report as of March 1st. And then I'm going to print this one out. And we're going to print it to the PDF file again. So it's going to go to that PDF file. And then we're going to open this one up. And but this one I'm going to rename and call it a different name. And this is going to be a reversing entry report. Okay so now we're going to do the same thing again but this time exporting it to Excel. And then we'll use Excel to make one PDF file with all the reports which could be nice to give to somebody all in one document. So this time I'm going to go to the Excel export. This time the first report we want to make a new Microsoft Excel file with it. So it should then open up Microsoft Excel and put the data into a new tab within it. There it is. We have a new file. We have a new tab. If I look at the at the second view screen here it all fits on a page. So that looks good. Back to the first view page. Now we're going to save this. So I'm going to go to the file drop down up top. So we'll go to the file drop down. We're going to go down to save as. And I'm going to put this into our our folder. So let's go into our folder. And mine's going to be I think it's on the it's on the desktop. And we're looking for the sage 50 cow. There it is sage 50 cow docs. And we're going to go into the section 10. And this I'm just going to call it reports. Now not just balance sheet because all the reports are going to go here.  And then save that. And then I'm going to close it. I'm going to put all the other reports on here as well. So I'm going to go then here. Let's go to the income statements. And let's do the same thing here. I'm going to export. This time I'm going to put it into that existing Excel document that we just created. It's not going to the right location. So I'm going to select a little browse thing so I could find where it needs to go. So sage 50 cow and then section 10. We want to go into the financial reports. That's the one and okay. It should then open up that Excel file that we just made like last time. And then put a new tab on it with the new information the new report the income statement the PNL the profit and loss. So there it is. It looks good. We got the balance sheet and the income statement now. So I'm going to I'm going to close this out. We're going to continue with this process closing this one out. I'm going to save it. You should probably save and then close it. But I live dangerously over here. I like to just close it and then it make it prompt me to save it. And so I'm going to go into the transaction detail report. This is going to be the adjusting entry. Let's do the same thing here. We're going to say export this one to Excel. It's already going to the same Excel document. So it's already there. I don't have to browse it. I'm not even going to check it that either. I'm pretty sure that's going to the right one. I'm just going to say okay. And once again it's going to open up that Excel document again. Put a new tab on it. Put this information in that new tab. So there that is. Now this one we're going to need some formatting with it. So really I need to rename the tab. I'm going to double click on the tab down here and I'm going to call this adjusting entries. Then I'm going to go to the second layout tab. And I'd like to rename the title of the report too. So I'm going to rename it up here. And I'm going to call it up here. And notice how much it's kind of easier to do this actually in Excel sometimes than in Sage. I can easily export it and then just adjust the heading if I if I so choose and just call this. This is the adjusting entry. Entry report. And there we have that. The text string you entered is too long. Interesting. How about just adjusting entry. Okay. Okay I deleted the header and I put it back in here. Adjusted entry report. So I in essence deleted the whole thing. Having a little bit of formatting problems. If you get stuck in the header you can hit escape to remove yourself from the header. But I deleted it and I put in adjusting entry report and that's working. So we're going to go back on over to the first tab. Now we're going to do some some formatting here. I noticed that it's not really helping me. All this stuff on this side isn't really helping me. So what I want to do is I first I would say okay let's let's make sure we're on landscape. If I go to the page layout orientation landscape that looks good. And then I'm going to just I probably don't even need the date because they're all as of 229 but maybe I'll keep the date. I'm going to remove from here over to really I don't even need the adjusting entry because it's the adjusting entry report. I can go all the way to the accounts basically and then right click and delete. And that should help us to put it on one line. So these are these are basically all the all the adjusting entries and with the account information right. And then you could format this a little bit more nicely by making a space. I could say all right I'm going to insert like a row between the journal entries. So that's one journal entry. I'm going to say that's another journal entry. And this looks like another journal entry. And we might even then go back and look up these account names and put the account names in there as well. That would be kind of nice. This one we entered as one journal entry but we can kind of see it as two. So I'm going to say insert because this is the this is the inventory half of it. So I'm going to insert and then insert one more here. So that looks a little bit nicer and then again if we were given this to someone else if you might go and look up the actual account names and add another column and put the account names maybe you want the the credits maybe if I format the credits I'd like to see them with with negative numbers. So maybe I would go then I'd like maybe currency bracketed. Maybe we'll keep the pennies. That looks good. Close that out. I'm not sure this total does much for me so I'm going to delete the total. You can delete that and you could have debits and credits if you wanted to pull out all the credits and put them into their own column. You know you could pull this out and have debit and credit column. I'll reverse that for now so that's just some some ideas for the formatting. Just notice excel can obviously make the formatting a lot easier to do. So I'm going to then save that. We're going to do this one more time with the reversing entry report. So let's go on over to the reversing entry report. We're going to be exporting that to excel again. It's going to the right workbook so I'm going to open up that workbook and put this new tab on it with the reversing entries in that tab. So there it is I'm going to double click on the name down below then double click it on the name this is going to be the reversing entries and then I'm going to go to the second view screen and change the title up top. I'm just going to delete the whole title this time because it was kind of annoying me last time. I'm still a little annoyed about it. Entry so let's see so there we have it. Okay and then I'm going to go back to the first time. See I was a little worried even there you probably felt that I was a little kind of like but in case we're going to go back over here and now I'm going to do the same thing I'm going to remove all of this we don't need any of that so I'm going to go from column B to column J. Let go right click on that selected area and delete and so we have removed those items and again we might we might want to put some spaces in here because that would be nice to whoever's reading this. I want to be nice to the reader of the report so I'm going to put some spaces so they could see that like these are separate journal entries here we're talking about and then so insert that and then we could do our formatting over here on the debits and credits so we're going to say format cells and then I'm going to put this as currency bracketed negative numbers and okay once again I don't think this balance is doing much for me so I'm just going to delete that and there we have it so now we've got all of our reports here we could then print this and it'll be already collated for us from this excel document or we can print it as a PDF putting them all on one PDF file so let's go ahead and save this now and then go back on the file tab let's go down to the print we're going to be using that cute pdf printer to print these all on one you know not one page but you know one like set a group of documents that would be batched together when printed so I'm going to select the entire workbook the entire workbook with the cute pdf printer there's the bouncer six pages down here first of all and there's the balance sheet there's the balance sheet second part of it there's the income statement there's the second part of the income statement there's the adjusting entries and there are the reversing entries looks great let's go ahead and print that so we're going to print it now and that being the reports here to a pdf file and so we're going to print these there they are financial reports let's go ahead and save that and then close this and see what we have in our sage 50 cow folder so I'm going to close this back out close this back out close this back out sage 50 cow open that up and we're on we're looking for section 10 here that's in the wrong window I'm just going to pull it up in our the one we're looking at so we can see it and then we're in section 10 so I'm going to open that up and then again we can give this to somebody else I can make a new folder down here and say well I could give it to somebody by making a new folder called like financial reports and then drag all these documents into it like the balance sheet and then the income statement and then the adjusting entries and then the reversing entries and we could like attach those documents to one report or we can right click on this old report and zip it send it to a compressed file that means we can attach the compressed file a little bit nicer we can print it all out as from the excel file if we so choose so that it will collate for us without knowing any fancy you know printer things you know that we don't have to know how to use a fancy printer we could just print it all out like that or we can give this one pdf file to somebody which should include all the documents with like one just one attachment so that one if we were to open that one up we got the balance sheet we got the income statement we got the adjusting entries we got the reversing entries so that's going to be it for now let's get out of here