in the surgical & sports medicine market , we focus on products that support the healing of musculoskeletal injuries , including degenerative conditions such as osteoarthritis and tendonitis . we are leveraging our regenerative medicine capabilities in this attractive , adjacent market . our surgical & sports medicine products include renu for in-office joint and tendon applications ; nucel for bony fusion in the spine and extremities ; nushield and affinity for surgical application in targeted soft tissue repairs ; and puraply am for surgical treatment of open wounds . we currently sell these products through independent agencies and our growing direct sales force . we generated net revenue of $ 261.0 million , $ 193.4 million and $ 198.5 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . we had a net loss of $ 40.5 million , $ 64.8 million and $ 8.4 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . we expect to incur operating losses for the foreseeable future as we expend resources as part of our efforts to grow our organization to support the 59 planned expansion of our business . as of december 31 , 2019 , we had an accumulated deficit of $ 171.0 million . our primary sources of capital to date have been from sales of our products , borrowings from related parties and institutional lenders and proceeds from the sale of our common stock . we operate in one segment of regenerative medicine . items affecting comparability nutech medical acquisition . on march 18 , 2017 , we entered into an agreement and plan of merger pursuant to which we acquired all of the outstanding shares of capital stock of nutech medical , inc. ( nutech medical ) for aggregate consideration consisting of $ 12.0 million in cash at closing , $ 7.5 million of deferred acquisition consideration , 137,543 fully vested common stock options and 3,642,746 shares of our class a common stock . upon the closing of the merger , nutech medical merged with and into prime merger sub , llc ( a wholly-owned subsidiary organized for the purpose of this transaction ) , with prime merger sub , llc surviving the merger as our wholly-owned subsidiary . the results of operations for nutech medical are included in our consolidated financial statements since march 24 , 2017 , which was the closing date of the merger . variable interest entity ( vie ) deconsolidation . we have historically consolidated the accounts of dan road associates , llc , 85 dan road associates , llc , and 65 dan road associates , llc , as variable interest entities . we refer to these variable interest entities collectively as the real estate entities. the real estate entities , which are controlled by certain of our affiliates , are special purpose entities that hold real estate that is leased by us . we do not hold any capital stock of the real estate entities . based on the nature of the leases and the mortgages held by these affiliates , we determined that the real estate entities were variable interest entities , which required consolidation . following the removal of certain personal guarantees provided by these affiliates in respect of mortgage loans related to the property held by the real estate entities , we determined that the real estate entities no longer met the definition of variable interest entities and we deconsolidated them from our financial statements as of june 1 , 2017. avista merger . on december 10 , 2018 , avista healthcare public acquisition corp. , our predecessor company ( ahpac ) , consummated the previously announced business combination pursuant to that certain agreement and plan of merger , dated as of august 17 , 2018 ( as amended , the avista merger agreement ) , by and among ahpac , avista healthcare merger sub , inc. , a delaware corporation and a direct wholly-owned subsidiary of ahpac ( avista merger sub ) and organogenesis inc. , a delaware corporation ( organogenesis inc. ) . as a result of the transactions contemplated by the avista merger agreement , avista merger sub merged with and into organogenesis inc. , with organogenesis inc. surviving the merger ( the avista merger ) . in addition , in connection with the business combination , ahpac redomesticated as a delaware corporation ( the domestication ) . after the domestication , ahpac changed its name to organogenesis holdings inc. as a result of the avista merger , organogenesis inc. became a wholly-owned subsidiary of organogenesis holdings inc. for periods prior to the closing of the avista merger on december 10 , 2018 , the disclosure in management 's discussion and analysis of financial condition and results of operations has been updated to give effect to the avista merger . management 's use of non-gaap measures our management uses financial measures that are not in accordance with generally accepted accounting principles in the united states , or gaap , in addition to financial measures in accordance with gaap to evaluate our operating results . these non-gaap financial measures should be considered supplemental to , and not a substitute for , our reported financial results prepared in accordance with gaap . our management uses adjusted ebitda to evaluate our operating performance and trends and make planning decisions . our management believes adjusted ebitda helps identify underlying trends in our business that could otherwise be masked by the effect of the items that we exclude . accordingly , we believe that adjusted ebitda provides useful information to investors and others in understanding and evaluating our operating results , enhancing the overall understanding of our past performance and future prospects , and allowing for greater transparency with respect to key financial metrics used by our management in its financial and operational decision-making . story_separator_special_tag for the year ended december 31 , 2019 , net revenue from our surgical & sports medicine products increased by $ 11.1 million , or 38 % , as compared to the year ended december 31 , 2018. the increase in surgical & sports medicine net revenue was primarily due to the expansion of the sales force and penetration of existing and new customer accounts . for the year ended december 31 , 2018 , net revenue from our advanced wound care products decreased by $ 14.6 million or 8 % , as compared to the year ended december 31 , 2017. our decrease in advanced wound care net revenue was primarily attributable to the loss of pass-through reimbursement status for puraply during the first nine months of 2018. this decrease was partially offset by the introduction of amniotic products acquired from nutech medical . for the year ended december 31 , 2018 , net revenue from our surgical & sports medicine products increased by $ 9.5 million or 48 % , as compared to the year ended december 31 , 2017. the increase in surgical & sports medicine net revenue was primarily due to the acquisition of nutech medical on march 24 , 2017 as the company recorded a full year of revenue related to nutech medical in the year ended december 31 , 2018. included within net revenue is puraply revenue of $ 126.8 million , $ 69.8 million , and $ 109.1 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . cost of goods sold , gross profit and gross margin replace_table_token_4_th 65 for the year ended december 31 , 2019 , cost of goods sold increased by $ 7.1 million , or 10 % , as compared to the year ended december 31 , 2018. the increase in cost of goods sold was primarily due to increased unit volumes , additional manufacturing and quality control headcount , and facilities improvement projects . for the year ended december 31 , 2019 , gross profit increased by $ 60.4 million or 48 % , as compared to the year ended december 31 , 2018. the increase in gross profit resulted primarily from increased sales volume due to the strength in our advanced wound care and surgical & sports medicine products , puraply regaining pass-through reimbursement status for the 2-year period effective october 1 , 2018 , and the resulting higher margins realized as a result of manufacturing efficiencies associated with our advanced wound care products . for the year ended december 31 , 2018 , cost of goods sold increased by $ 7.6 million , or 12 % , as compared to the year ended december 31 , 2017. the increase in cost of goods sold was primarily due to increased unit volumes and additional manufacturing and quality control headcount related to a full year of nutech medical product sales . for the year ended december 31 , 2018 , gross profit decreased by 12.6 million or 9 % , as compared to the year ended december 31 , 2017. the decrease in gross profit resulted primarily from the decrease in our advanced wound care net revenue driven by the loss of pass-through reimbursement status for puraply during the first nine months of 2018 , partially offset by our increase in revenue from our surgical & sports medicine products . selling , general and administrative expenses the following table presents selling , general and administrative expenses and the percentage relationship to total net revenue for the periods indicated : replace_table_token_5_th for the year ended december 31 , 2019 , selling , general and administrative expenses increased by $ 37.7 million , or 23 % , as compared to the year ended december 31 , 2018. the increase in selling , general and administrative expenses is primarily due to an increase of $ 30.6 million related to additional headcount , primarily in our direct sales force and increased sales commissions due to increased sales , an increase of $ 2.6 million in legal , consulting fees and other costs associated with the ongoing operations of our business , an increase of $ 2.4 million in amortization associated with intangible assets amortized using the economic benefits method , an increase of $ 1.7 million associated with marketing and promotional materials for our products , and an increase of $ 1.7 million in royalties attributable to certain product sales . these increases are partially offset by a decrease of $ 1.5 million associated with transaction advisory fees incurred in 2018. we expect our selling , general and administrative expenses to continue to increase throughout 2020. for the year ended december 31 , 2018 , selling , general and administrative expenses increased by $ 28.2 million , or 21 % , as compared to the year ended december 31 , 2017. the increase in selling , general and administrative expenses is primarily due to a $ 25.2 million increase related to additional headcount , primarily in our direct sales force , an increase of $ 1.6 million in amortization as a result of the nutech medical acquisition , an increase of $ 1.7 million associated with marketing and promotional materials for our products , an increase of $ 1.5 million associated with transaction advisory fees , and an increase of $ 0.7 million related to the expiration of the forfeiture right asset . these increases are partially offset by a decrease of $ 1.4 million in legal and consulting fees and costs associated with other strategic alternatives and the ongoing operations of our business and a decrease of $ 0.8 million in royalties attributable to certain product sales . 66 research and development expenses the following table presents research and development expenses and the percentage relationship to total net revenue for the periods indicated : replace_table_token_6_th for the year ended december 31 , 2019 , research and development expenses increased by $ 4.1 million ,

cash flows the following table summarizes our cash flows for each of the periods presented : replace_table_token_11_th operating activities during the year ended december 31 , 2019 , net cash used in operating activities was $ 33.5 million , resulting from our net loss of $ 40.5 million and net cash used in connection with changes in our operating assets and liabilities of $ 9.7 million partially offset by non-cash charges of $ 16.6 million . net cash used in connection with changes in our operating assets and liabilities includes an increase in inventory of $ 11.1 million , an increase in accounts receivable of $ 4.7 million , an increase in prepaid expenses and other current assets of $ 0.6 million and a decrease in other liabilities of $ 0.9 million , all of which were partially offset by an increase in accounts payable of $ 4.7 million and an increase of accrued expenses and other current liabilities of $ 2.9 million . during the year ended december 31 , 2018 , net cash used in operating activities was $ 60.6 million , resulting from our net loss of $ 64.8 million and net cash used in connection with changes in our operating assets and liabilities of $ 16.7 million partially offset by non-cash charges of $ 20.9 million . net cash used in connection with changes in our operating assets and liabilities includes a decrease in accrued interest on affiliate debt of $ 9.2 million , an increase in accounts receivable of $ 7.1 million , an increase in inventory of $ 1.5 million , an increase in prepaid expenses and other current assets of $ 1.4 million , all of which were partially offset by an increase in accrued expenses and other liabilities of $ 2.7 million . during the year ended december 31 , 2017 , net cash used in operating activities was $ 3.5 million , resulting from our net loss of $ 7.5 million and net cash used in connection with changes in our operating assets and liabilities of $ 1.2 million , partially offset by non-cash charges of $ 5.2 million .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```cash flows the following table summarizes our cash flows for each of the periods presented : replace_table_token_11_th operating activities during the year ended december 31 , 2019 , net cash used in operating activities was $ 33.5 million , resulting from our net loss of $ 40.5 million and net cash used in connection with changes in our operating assets and liabilities of $ 9.7 million partially offset by non-cash charges of $ 16.6 million . net cash used in connection with changes in our operating assets and liabilities includes an increase in inventory of $ 11.1 million , an increase in accounts receivable of $ 4.7 million , an increase in prepaid expenses and other current assets of $ 0.6 million and a decrease in other liabilities of $ 0.9 million , all of which were partially offset by an increase in accounts payable of $ 4.7 million and an increase of accrued expenses and other current liabilities of $ 2.9 million . during the year ended december 31 , 2018 , net cash used in operating activities was $ 60.6 million , resulting from our net loss of $ 64.8 million and net cash used in connection with changes in our operating assets and liabilities of $ 16.7 million partially offset by non-cash charges of $ 20.9 million . net cash used in connection with changes in our operating assets and liabilities includes a decrease in accrued interest on affiliate debt of $ 9.2 million , an increase in accounts receivable of $ 7.1 million , an increase in inventory of $ 1.5 million , an increase in prepaid expenses and other current assets of $ 1.4 million , all of which were partially offset by an increase in accrued expenses and other liabilities of $ 2.7 million . during the year ended december 31 , 2017 , net cash used in operating activities was $ 3.5 million , resulting from our net loss of $ 7.5 million and net cash used in connection with changes in our operating assets and liabilities of $ 1.2 million , partially offset by non-cash charges of $ 5.2 million .
```    
 Suspicious Activity Report : in the surgical & sports medicine market , we focus on products that support the healing of musculoskeletal injuries , including degenerative conditions such as osteoarthritis and tendonitis . we are leveraging our regenerative medicine capabilities in this attractive , adjacent market . our surgical & sports medicine products include renu for in-office joint and tendon applications ; nucel for bony fusion in the spine and extremities ; nushield and affinity for surgical application in targeted soft tissue repairs ; and puraply am for surgical treatment of open wounds . we currently sell these products through independent agencies and our growing direct sales force . we generated net revenue of $ 261.0 million , $ 193.4 million and $ 198.5 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . we had a net loss of $ 40.5 million , $ 64.8 million and $ 8.4 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . we expect to incur operating losses for the foreseeable future as we expend resources as part of our efforts to grow our organization to support the 59 planned expansion of our business . as of december 31 , 2019 , we had an accumulated deficit of $ 171.0 million . our primary sources of capital to date have been from sales of our products , borrowings from related parties and institutional lenders and proceeds from the sale of our common stock . we operate in one segment of regenerative medicine . items affecting comparability nutech medical acquisition . on march 18 , 2017 , we entered into an agreement and plan of merger pursuant to which we acquired all of the outstanding shares of capital stock of nutech medical , inc. ( nutech medical ) for aggregate consideration consisting of $ 12.0 million in cash at closing , $ 7.5 million of deferred acquisition consideration , 137,543 fully vested common stock options and 3,642,746 shares of our class a common stock . upon the closing of the merger , nutech medical merged with and into prime merger sub , llc ( a wholly-owned subsidiary organized for the purpose of this transaction ) , with prime merger sub , llc surviving the merger as our wholly-owned subsidiary . the results of operations for nutech medical are included in our consolidated financial statements since march 24 , 2017 , which was the closing date of the merger . variable interest entity ( vie ) deconsolidation . we have historically consolidated the accounts of dan road associates , llc , 85 dan road associates , llc , and 65 dan road associates , llc , as variable interest entities . we refer to these variable interest entities collectively as the real estate entities. the real estate entities , which are controlled by certain of our affiliates , are special purpose entities that hold real estate that is leased by us . we do not hold any capital stock of the real estate entities . based on the nature of the leases and the mortgages held by these affiliates , we determined that the real estate entities were variable interest entities , which required consolidation . following the removal of certain personal guarantees provided by these affiliates in respect of mortgage loans related to the property held by the real estate entities , we determined that the real estate entities no longer met the definition of variable interest entities and we deconsolidated them from our financial statements as of june 1 , 2017. avista merger . on december 10 , 2018 , avista healthcare public acquisition corp. , our predecessor company ( ahpac ) , consummated the previously announced business combination pursuant to that certain agreement and plan of merger , dated as of august 17 , 2018 ( as amended , the avista merger agreement ) , by and among ahpac , avista healthcare merger sub , inc. , a delaware corporation and a direct wholly-owned subsidiary of ahpac ( avista merger sub ) and organogenesis inc. , a delaware corporation ( organogenesis inc. ) . as a result of the transactions contemplated by the avista merger agreement , avista merger sub merged with and into organogenesis inc. , with organogenesis inc. surviving the merger ( the avista merger ) . in addition , in connection with the business combination , ahpac redomesticated as a delaware corporation ( the domestication ) . after the domestication , ahpac changed its name to organogenesis holdings inc. as a result of the avista merger , organogenesis inc. became a wholly-owned subsidiary of organogenesis holdings inc. for periods prior to the closing of the avista merger on december 10 , 2018 , the disclosure in management 's discussion and analysis of financial condition and results of operations has been updated to give effect to the avista merger . management 's use of non-gaap measures our management uses financial measures that are not in accordance with generally accepted accounting principles in the united states , or gaap , in addition to financial measures in accordance with gaap to evaluate our operating results . these non-gaap financial measures should be considered supplemental to , and not a substitute for , our reported financial results prepared in accordance with gaap . our management uses adjusted ebitda to evaluate our operating performance and trends and make planning decisions . our management believes adjusted ebitda helps identify underlying trends in our business that could otherwise be masked by the effect of the items that we exclude . accordingly , we believe that adjusted ebitda provides useful information to investors and others in understanding and evaluating our operating results , enhancing the overall understanding of our past performance and future prospects , and allowing for greater transparency with respect to key financial metrics used by our management in its financial and operational decision-making . story_separator_special_tag for the year ended december 31 , 2019 , net revenue from our surgical & sports medicine products increased by $ 11.1 million , or 38 % , as compared to the year ended december 31 , 2018. the increase in surgical & sports medicine net revenue was primarily due to the expansion of the sales force and penetration of existing and new customer accounts . for the year ended december 31 , 2018 , net revenue from our advanced wound care products decreased by $ 14.6 million or 8 % , as compared to the year ended december 31 , 2017. our decrease in advanced wound care net revenue was primarily attributable to the loss of pass-through reimbursement status for puraply during the first nine months of 2018. this decrease was partially offset by the introduction of amniotic products acquired from nutech medical . for the year ended december 31 , 2018 , net revenue from our surgical & sports medicine products increased by $ 9.5 million or 48 % , as compared to the year ended december 31 , 2017. the increase in surgical & sports medicine net revenue was primarily due to the acquisition of nutech medical on march 24 , 2017 as the company recorded a full year of revenue related to nutech medical in the year ended december 31 , 2018. included within net revenue is puraply revenue of $ 126.8 million , $ 69.8 million , and $ 109.1 million for the years ended december 31 , 2019 , 2018 and 2017 , respectively . cost of goods sold , gross profit and gross margin replace_table_token_4_th 65 for the year ended december 31 , 2019 , cost of goods sold increased by $ 7.1 million , or 10 % , as compared to the year ended december 31 , 2018. the increase in cost of goods sold was primarily due to increased unit volumes , additional manufacturing and quality control headcount , and facilities improvement projects . for the year ended december 31 , 2019 , gross profit increased by $ 60.4 million or 48 % , as compared to the year ended december 31 , 2018. the increase in gross profit resulted primarily from increased sales volume due to the strength in our advanced wound care and surgical & sports medicine products , puraply regaining pass-through reimbursement status for the 2-year period effective october 1 , 2018 , and the resulting higher margins realized as a result of manufacturing efficiencies associated with our advanced wound care products . for the year ended december 31 , 2018 , cost of goods sold increased by $ 7.6 million , or 12 % , as compared to the year ended december 31 , 2017. the increase in cost of goods sold was primarily due to increased unit volumes and additional manufacturing and quality control headcount related to a full year of nutech medical product sales . for the year ended december 31 , 2018 , gross profit decreased by 12.6 million or 9 % , as compared to the year ended december 31 , 2017. the decrease in gross profit resulted primarily from the decrease in our advanced wound care net revenue driven by the loss of pass-through reimbursement status for puraply during the first nine months of 2018 , partially offset by our increase in revenue from our surgical & sports medicine products . selling , general and administrative expenses the following table presents selling , general and administrative expenses and the percentage relationship to total net revenue for the periods indicated : replace_table_token_5_th for the year ended december 31 , 2019 , selling , general and administrative expenses increased by $ 37.7 million , or 23 % , as compared to the year ended december 31 , 2018. the increase in selling , general and administrative expenses is primarily due to an increase of $ 30.6 million related to additional headcount , primarily in our direct sales force and increased sales commissions due to increased sales , an increase of $ 2.6 million in legal , consulting fees and other costs associated with the ongoing operations of our business , an increase of $ 2.4 million in amortization associated with intangible assets amortized using the economic benefits method , an increase of $ 1.7 million associated with marketing and promotional materials for our products , and an increase of $ 1.7 million in royalties attributable to certain product sales . these increases are partially offset by a decrease of $ 1.5 million associated with transaction advisory fees incurred in 2018. we expect our selling , general and administrative expenses to continue to increase throughout 2020. for the year ended december 31 , 2018 , selling , general and administrative expenses increased by $ 28.2 million , or 21 % , as compared to the year ended december 31 , 2017. the increase in selling , general and administrative expenses is primarily due to a $ 25.2 million increase related to additional headcount , primarily in our direct sales force , an increase of $ 1.6 million in amortization as a result of the nutech medical acquisition , an increase of $ 1.7 million associated with marketing and promotional materials for our products , an increase of $ 1.5 million associated with transaction advisory fees , and an increase of $ 0.7 million related to the expiration of the forfeiture right asset . these increases are partially offset by a decrease of $ 1.4 million in legal and consulting fees and costs associated with other strategic alternatives and the ongoing operations of our business and a decrease of $ 0.8 million in royalties attributable to certain product sales . 66 research and development expenses the following table presents research and development expenses and the percentage relationship to total net revenue for the periods indicated : replace_table_token_6_th for the year ended december 31 , 2019 , research and development expenses increased by $ 4.1 million ,

