Thyroid DiseasesTHORSNCT07812779
Thyroid Health Outcomes Registry for Surgery
An observational study of Thyroid Diseases and Thyroid Neoplasms, run by Pirogov Russian National Research Medical University.
Trial summary
THORS is a single-center ambidirectional observational cohort study conducted at Moscow Multidisciplinary Clinical Center "Kommunarka". The study combines retrospective analysis of routinely collected clinical data from patients who underwent thyroid surgery beginning in January 2023 with ongoing prospective accrual… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Thyroid Diseases, Thyroid Neoplasms, Thyroid Cancer
- How many people
- 3,000 participants
- Where
- No sites listed yet
- Study dates
- 1 Sep 2026to 31 Jan 2032
- How long will I take part?
- 5 Years
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients treated surgically for benign or malignant thyroid disease at a single multidisciplinary medical center in Moscow. The population is identified from routine clinical-care data and includes historical patients as well as newly accrued eligible patients. Primary, completion, and repeat thyroid operations are eligible when the relevant data can be linked and the episode meets the specific substudy requirements.
Who may be able to join
- Patient undergoes or previously underwent an operation involving the thyroid gland at the study institution during the study period.
- The operation was performed for a benign or malignant thyroid disease, including primary, completion, or repeat thyroid surgery.
- Source data permit linkage of the patient, hospitalization, operation, and index date.
- For a specific substudy, the participant/episode meets the additional prespecified requirements for the relevant exposure and outcome.
Who cannot join
- Procedure predominantly involving the parathyroid glands without a confirmed relationship to thyroid disease.
- Procedure or record without a confirmed relationship to thyroid disease.
- Technical duplicate record.
- Episode for which the essential temporal sequence or index date cannot be established for the relevant analysis.
- Record lacking the minimum data required to determine the primary outcome of the specific substudy.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Comprehensive Analysis of Quality and Outcomes in Thyroid Surgery Using Real-World Clinical Data
THORS is a single-center ambidirectional observational cohort study conducted at Moscow Multidisciplinary Clinical Center "Kommunarka". The study combines retrospective analysis of routinely collected clinical data from patients who underwent thyroid surgery beginning in January 2023 with ongoing prospective accrual of new eligible patients and longitudinal updating of follow-up information. No diagnostic or therapeutic intervention is assigned by the research protocol; all treatment decisions are made as part of routine clinical care. The program evaluates the structure and outcomes of thyroid surgery, postoperative complications, histopathology, repeat and completion procedures, long-term oncologic and functional outcomes, health-care resource use, and the quality and reproducibility of real-world data. Applicable outcomes from the international Core Outcome Set for surgical treatment of differentiated thyroid carcinoma (COS-DTC) are incorporated where they can be reliably measured. The first frozen historical analytical baseline includes 968 unique patients and 1,017 thyroid operations performed from 06 January 2023 through 13 February 2026. The cohort remains open to ongoing enrollment and follow-up
Read the detailed description
THORS is an umbrella real-world-data research program designed as an open, single-center, ambidirectional observational cohort. The historical component uses secondary data generated during routine care, including operative records, hospitalizations, pathology and immunohistochemistry reports, inpatient and outpatient clinical documentation, repeat admissions, follow-up encounters, and available resource/cost information. After registration, new eligible patients continue to enter the cohort prospectively as part of ordinary clinical practice, and clinically available follow-up information is added longitudinally. The research protocol does not assign the type or extent of thyroid surgery, lymph-node dissection, diagnostic testing, or adjuvant treatment.
The program uses linked patient-, hospitalization-, operation-, pathology-, complication-, and follow-up-level data structures. Raw source values, technically normalized data, automated screening signals, author clinical classification, independent expert classification, and adjudicated values are retained as separate layers whenever applicable. Each substantive substudy has a prespecified scientific question, eligibility criteria, outcome definitions, data freeze, and statistical analysis plan. Missingness, source provenance, discordance between data sources, classification error, and repeated observations within patients are explicitly evaluated.
Clinical objectives include description of surgical practice and pathology; clinically verified postoperative complications; functional outcomes; repeat, completion, and recurrence-related surgery; long-term oncologic outcomes; comparisons of clinically relevant surgical strategies when adequate confounding control is possible; and health-care resource use. Methodological objectives include reproducibility of cohort construction and phenotyping, multi-source detection and expert adjudication of outcomes, data-quality assessment, and the feasibility of measuring the 13 COS-DTC outcomes in routine data.
The historical cohort predates registration. Analyses already completed or initiated on historical data are treated as retrospective baseline analyses and are not represented as prospectively registered. Future substudies are date-stamped through protocol/SAP versions and frozen analytical datasets. The complete prespecified THORS research portfolio is listed in Appendix A of this registration dossier, including methodological, clinical, prognostic, comparative, economic, specialized, long-term, and transferability studies. Prospective questionnaires, research-only biospecimen collection, or additional study-specific procedures require the relevant ethics approval and, when they materially change the registered protocol, an amendment or a separate registration record.
- Conditions
- Thyroid Diseases, Thyroid Neoplasms, Thyroid Cancer, Thyroid Nodules, Goiter, Medullary Thyroid Carcinoma
- Keywords
- thyroid surgery, endocrine surgery, thyroidectomy, hemithyroidectomy, completion thyroidectomy, cervical lymph node dissection, thyroid cancer, differentiated thyroid carcinoma, medullary thyroid carcinoma, postoperative complications, real-world data, RWD, observational cohort, data quality, clinical phenotyping, COS-DTC
- Medical subject headings
- Thyroid Diseases, Thyroid Neoplasms, Thyroid Nodule, Goiter, Carcinoma, Medullary, Adrenal Gland Neoplasms, Postoperative Complications
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Patients Undergoing Thyroid Surgery | Patients undergoing surgery involving the thyroid gland for benign or malignant thyroid disease at Moscow Multidisciplinary Clinical Center "Kommunarka". The cohort includes primary, completion, and repeat operations and is updated as new eligible patients and follow-up information become available. Routine-care thyroid surgery. The type and extent of surgery are determined by the treating clinical team according to routine care and are not assigned by the research protocol. Procedures may include hemithyroidectomy, thyroidectomy, completion thyroidectomy, repeat thyroid surgery, central and/or lateral cervical lymph-node dissection, and other clinically indicated thyroid-related procedures. No protocol-assigned comparator. Comparisons between naturally occurring clinical strategies may be performed in prespecified observational substudies with appropriate control of confounding and assessment of positivity. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Clinically Verified 30-Day Postoperative Complication Rate
Proportion of index thyroid operations followed by at least one clinically verified postoperative complication within 30 days, using prespecified event definitions, multiple routine-care sources where available, and expert adjudication. Complication types are reported separately and may include hypocalcemia/hypoparathyroidism, recurrent laryngeal nerve dysfunction, hematoma/bleeding, infection, chyle leak, unplanned reoperation, organ injury, readmission, and other clinically relevant events.
Measured: Within 30 days after each index thyroid operation
Percentage of Participants With an Unplanned Reoperation Related to Thyroid Surgery Within 30 Days
The number of unique participants who undergo at least one unplanned surgical reoperation related to the index thyroid operation within 30 days will be divided by the number of participants with ascertainable 30-day follow-up and multiplied by 100. Planned completion thyroidectomy is classified separately and is not counted as an unplanned reoperation.
Measured: Up to 30 days after the index thyroid operation
Secondary outcomes (13)
30-Day Mortality
All-cause death within 30 days of the index thyroid operation, using available in-hospital and post-discharge sources.
Measured: Within 30 days after index thyroid surgery
Permanent Recurrent Laryngeal Nerve Palsy Due to Surgery
Persistent postoperative vocal-fold dysfunction attributable to surgery at 12 months, with preoperative dysfunction, tumor invasion, and intentional nerve resection considered separately.
Measured: 12 months after the index operation
Permanent Postoperative Hypoparathyroidism
Persistent postoperative parathyroid dysfunction at 12 months based on prespecified biochemical and treatment criteria.
Measured: 12 months after the index operation
Percentage of Index Operations in Each Final Histopathologic Diagnosis Category
Among index operations with a valid final pathology report, the number of operations assigned to each prespecified mutually exclusive diagnosis category will be divided by the total number of operations with valid final pathology and multiplied by 100. Categories are differentiated thyroid carcinoma, medullary thyroid carcinoma, other malignant thyroid neoplasm, benign thyroid neoplasm, non-neoplastic thyroid disease, and other or indeterminate pathology.
Measured: Up to 90 days after the index thyroid operation
Percentage of Participants With Persistent Differentiated Thyroid Carcinoma at 12 Months
Among participants with differentiated thyroid carcinoma and an ascertainable 12-month assessment, the number meeting the prespecified definition of structural or biochemical persistent disease at 12 months will be divided by the total number with an ascertainable assessment and multiplied by 100. A participant is counted once if either the structural or biochemical persistence criterion is met.
Measured: 12 months after the index thyroid operation
Percentage of Index Operations in Each Mutually Exclusive Thyroid Resection Category
The number of index operations assigned to each prespecified mutually exclusive thyroid resection category will be divided by the total number of eligible index operations and multiplied by 100. Categories are hemithyroidectomy, initial total thyroidectomy, completion thyroidectomy, and other thyroid resection.
Measured: During the index thyroid operation
Median Available Direct Medical Cost of the Index Hospitalization
Available direct medical cost for the index thyroid-surgery hospitalization will be summarized as the median with interquartile range in Russian rubles among hospitalizations with recorded cost data. Structurally unavailable cost values will be reported as missing and will not be automatically imputed.
Measured: During the index hospitalization, from admission through discharge, up to 60 days
Percentage of Operations in Each Standardized Pathologic T Category
Among operations with morphologically confirmed primary thyroid carcinoma and an ascertainable pathologic T category, the number of operations in each standardized pT category will be divided by the total number of operations with an ascertainable pT category and multiplied by 100. The pT category is derived from the final pathology report using the prespecified staging rules.
Measured: Up to 90 days after the index thyroid operation
Percentage of Operations in Each Standardized Pathologic N Category
Among operations with morphologically confirmed primary thyroid carcinoma and an ascertainable pathologic N category, the number of operations in each standardized pN category will be divided by the total number of operations with an ascertainable pN category and multiplied by 100. The pN category is derived from the final pathology report using the prespecified staging rules.
Measured: Up to 90 days after the index thyroid operation
Percentage of Participants With a New Recurrence of Differentiated Thyroid Carcinoma
Among participants with differentiated thyroid carcinoma who have no evidence of persistent disease after initial treatment, the number who develop a new structural or biochemical recurrence will be divided by the number with evaluable follow-up and multiplied by 100. A participant is counted once if either the structural or biochemical recurrence criterion is met.
Measured: Up to 5 years after the index thyroid operation
Percentage of Index Operations With Central Neck Lymph Node Dissection
The number of eligible index thyroid operations that include a central neck lymph node dissection will be divided by the total number of eligible index thyroid operations and multiplied by 100. Central and lateral neck dissections are classified separately according to the prespecified operation-classification rules.
Measured: During the index thyroid operation
Percentage of Index Operations With Lateral Neck Lymph Node Dissection
The number of eligible index thyroid operations that include a lateral neck lymph node dissection will be divided by the total number of eligible index thyroid operations and multiplied by 100. Central and lateral neck dissections are classified separately according to the prespecified operation-classification rules.
Measured: During the index thyroid operation
Percentage of Participants Undergoing Planned Completion Thyroidectomy Within 12 Months
Among participants who undergo an initial hemithyroidectomy and are eligible for longitudinal trajectory assessment, the number who subsequently undergo a planned completion thyroidectomy within 12 months will be divided by the number with ascertainable 12-month surgical follow-up and multiplied by 100. Planned completion surgery is not classified as an unplanned reoperation.
Measured: Up to 12 months after the initial hemithyroidectomy
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Sep 2026
- Study start1 Sep 2026 (estimated)
- Primary completion31 Jan 2032 (estimated)
- Study completion31 Jan 2032 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Thyroid DiseasesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Other
- Enrolment
- 3,000 participants (estimated)
- Target duration
- 5 Years
Sponsor and investigators
- Lead sponsor
- Pirogov Russian National Research Medical University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mosin Sergey, Pirogov Russian National Research Medical University
- Investigators
- сергей Мосин, Principal investigator, Pirogov University (RNRMU)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07812779
- Sponsor's protocol ID
- THORS
- Acronym
- THORS
- Status last verified
- Sep 2026
- First submitted
- 1 Sep 2026
- Last updated
- 10 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: in accordance with national requirements for the security and protection of personal data
Study at a glance
From the registry record, last updated by the sponsor on 10 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comprehensive Analysis of Quality and Outcomes in Thyroid Surgery Using Real-World Clinical Data
- ClinicalTrials.gov ID
- NCT07812779
- Acronym / sponsor ID
- THORS / THORS
- Conditions
- Thyroid Diseases, Thyroid Neoplasms, Thyroid Cancer, Thyroid Nodules, Goiter, Medullary Thyroid Carcinoma
- Keywords
- thyroid surgery, endocrine surgery, thyroidectomy, hemithyroidectomy, completion thyroidectomy, cervical lymph node dissection, thyroid cancer, differentiated thyroid carcinoma
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 3,000 participants (estimated)
- Lead sponsor
- Pirogov Russian National Research Medical UniversityUniversity, hospital or other
- Study start
- 1 Sep 2026 (estimated)
- Primary completion
- 31 Jan 2032 (estimated)
- Study completion
- 31 Jan 2032 (estimated)
- First posted
- 10 Sep 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
THORS is a single-center ambidirectional observational cohort study conducted at Moscow Multidisciplinary Clinical Center "Kommunarka". The study combines retrospective analysis of routinely collected clinical data from patients who underwent thyroid surgery beginning in January 2023 with ongoing prospective accrual of new eligible patients and longitudinal updating of follow-up information. No diagnostic or therapeutic intervention is assigned by the research protocol; all treatment decisions are made as part of routine clinical care. The program evaluates the structure and outcomes of thyroid surgery, postoperative complications, histopathology, repeat and completion procedures, long-term oncologic and functional outcomes, health-care resource use, and the quality and reproducibility of real-world data. Applicable outcomes from the international Core Outcome Set for surgical treatment of differentiated thyroid carcinoma (COS-DTC) are incorporated where they can be reliably measured. The first frozen historical analytical baseline includes 968 unique patients and 1,017 thyroid operations performed from 06 January 2023 through 13 February 2026. The cohort remains open to ongoing enrollment and follow-up
Detailed description
THORS is an umbrella real-world-data research program designed as an open, single-center, ambidirectional observational cohort. The historical component uses secondary data generated during routine care, including operative records, hospitalizations, pathology and immunohistochemistry reports, inpatient and outpatient clinical documentation, repeat admissions, follow-up encounters, and available resource/cost information. After registration, new eligible patients continue to enter the cohort prospectively as part of ordinary clinical practice, and clinically available follow-up information is added longitudinally. The research protocol does not assign the type or extent of thyroid surgery, lymph-node dissection, diagnostic testing, or adjuvant treatment.
The program uses linked patient-, hospitalization-, operation-, pathology-, complication-, and follow-up-level data structures. Raw source values, technically normalized data, automated screening signals, author clinical classification, independent expert classification, and adjudicated values are retained as separate layers whenever applicable. Each substantive substudy has a prespecified scientific question, eligibility criteria, outcome definitions, data freeze, and statistical analysis plan. Missingness, source provenance, discordance between data sources, classification error, and repeated observations within patients are explicitly evaluated.
Clinical objectives include description of surgical practice and pathology; clinically verified postoperative complications; functional outcomes; repeat, completion, and recurrence-related surgery; long-term oncologic outcomes; comparisons of clinically relevant surgical strategies when adequate confounding control is possible; and health-care resource use. Methodological objectives include reproducibility of cohort construction and phenotyping, multi-source detection and expert adjudication of outcomes, data-quality assessment, and the feasibility of measuring the 13 COS-DTC outcomes in routine data.
The historical cohort predates registration. Analyses already completed or initiated on historical data are treated as retrospective baseline analyses and are not represented as prospectively registered. Future substudies are date-stamped through protocol/SAP versions and frozen analytical datasets. The complete prespecified THORS research portfolio is listed in Appendix A of this registration dossier, including methodological, clinical, prognostic, comparative, economic, specialized, long-term, and transferability studies. Prospective questionnaires, research-only biospecimen collection, or additional study-specific procedures require the relevant ethics approval and, when they materially change the registered protocol, an amendment or a separate registration record.
Study design
- Observational model
- Cohort
- Time perspective
- Other
- Target follow-up
- 5 Years
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients Undergoing Thyroid Surgery | – | –Patients undergoing surgery involving the thyroid gland for benign or malignant thyroid disease at Moscow Multidisciplinary Clinical Center "Kommunarka". The cohort includes primary, completion, and repeat operations and is updated as new eligible patients and follow-up information become available. Routine-care thyroid surgery. The type and extent of surgery are determined by the treating clinical team according to routine care and are not assigned by the research protocol. Procedures may include hemithyroidectomy, thyroidectomy, completion thyroidectomy, repeat thyroid surgery, central and/or lateral cervical lymph-node dissection, and other clinically indicated thyroid-related procedures. No protocol-assigned comparator. Comparisons between naturally occurring clinical strategies may be performed in prespecified observational substudies with appropriate control of confounding and assessment of positivity. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients treated surgically for benign or malignant thyroid disease at a single multidisciplinary medical center in Moscow. The population is identified from routine clinical-care data and includes historical patients as well as newly accrued eligible patients. Primary, completion, and repeat thyroid operations are eligible when the relevant data can be linked and the episode meets the specific substudy requirements.
Key inclusion criteria (4 listed)
- Patient undergoes or previously underwent an operation involving the thyroid gland at the study institution during the study period.
- The operation was performed for a benign or malignant thyroid disease, including primary, completion, or repeat thyroid surgery.
- Source data permit linkage of the patient, hospitalization, operation, and index date.
- For a specific substudy, the participant/episode meets the additional prespecified requirements for the relevant exposure and outcome.
Key exclusion criteria (5 listed)
- Procedure predominantly involving the parathyroid glands without a confirmed relationship to thyroid disease.
- Procedure or record without a confirmed relationship to thyroid disease.
- Technical duplicate record.
- Episode for which the essential temporal sequence or index date cannot be established for the relevant analysis.
- Record lacking the minimum data required to determine the primary outcome of the specific substudy.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Clinically Verified 30-Day Postoperative Complication Rate
Time frame: Within 30 days after each index thyroid operation
Proportion of index thyroid operations followed by at least one clinically verified postoperative complication within 30 days, using prespecified event definitions, multiple routine-care sources where available, and expert adjudication. Complication types are reported separately and may include hypocalcemia/hypoparathyroidism, recurrent laryngeal nerve dysfunction, hematoma/bleeding, infection, chyle leak, unplanned reoperation, organ injury, readmission, and other clinically relevant events.
Percentage of Participants With an Unplanned Reoperation Related to Thyroid Surgery Within 30 Days
Time frame: Up to 30 days after the index thyroid operation
The number of unique participants who undergo at least one unplanned surgical reoperation related to the index thyroid operation within 30 days will be divided by the number of participants with ascertainable 30-day follow-up and multiplied by 100. Planned completion thyroidectomy is classified separately and is not counted as an unplanned reoperation.
13 secondary outcomes
30-Day Mortality
Time frame: Within 30 days after index thyroid surgery
Permanent Recurrent Laryngeal Nerve Palsy Due to Surgery
Time frame: 12 months after the index operation
Permanent Postoperative Hypoparathyroidism
Time frame: 12 months after the index operation
Percentage of Index Operations in Each Final Histopathologic Diagnosis Category
Time frame: Up to 90 days after the index thyroid operation
Percentage of Participants With Persistent Differentiated Thyroid Carcinoma at 12 Months
Time frame: 12 months after the index thyroid operation
Percentage of Index Operations in Each Mutually Exclusive Thyroid Resection Category
Time frame: During the index thyroid operation
Median Available Direct Medical Cost of the Index Hospitalization
Time frame: During the index hospitalization, from admission through discharge, up to 60 days
Percentage of Operations in Each Standardized Pathologic T Category
Time frame: Up to 90 days after the index thyroid operation
Percentage of Operations in Each Standardized Pathologic N Category
Time frame: Up to 90 days after the index thyroid operation
Percentage of Participants With a New Recurrence of Differentiated Thyroid Carcinoma
Time frame: Up to 5 years after the index thyroid operation
Percentage of Index Operations With Central Neck Lymph Node Dissection
Time frame: During the index thyroid operation
Percentage of Index Operations With Lateral Neck Lymph Node Dissection
Time frame: During the index thyroid operation
Percentage of Participants Undergoing Planned Completion Thyroidectomy Within 12 Months
Time frame: Up to 12 months after the initial hemithyroidectomy
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Sep 2026.
- Individual participant dataSharing planned: No. in accordance with national requirements for the security and protection of personal data
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
сергей Мосин principal investigator
Pirogov University (RNRMU)
Questions about this trial
What is this clinical trial studying?
An observational study of Thyroid Diseases and Thyroid Neoplasms, run by Pirogov Russian National Research Medical University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 10 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sergey V. Mosin, PhD (+79163790717, mosin-sergey@yandex.ru), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Clinically Verified 30-Day Postoperative Complication Rate (time frame: Within 30 days after each index thyroid operation). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Sep 2026.