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This editorial is the author's final act as Editor-in-Chief of the IEEE Transactions on Biomedical Engineering (TBME). All of this growth and success has brought great pressure on biomedical engineering journals, including TBME. The author is very proud that we have responded to the challenge. Our total submissions grew from 693 in 2005 and 888 in 2006, to 1219 in 2010, nearly 1500 in 2011, and an estimated 1700 for 2012. This year, there were 464 special issue submissions. We have steadily become more international, with more submissions from China than another other nation except the US and more submissions from Europe than from North America. In the last six years, we have grown from 42 to 93 Associate Editors to handle the great increase in submissions and will likely receive over 5000 reviews this year. We have become increasingly rigorous, accepting fewer than 25% of submitted articles, down from 33% in 2006. TBME publishes 3600 pages, up from 2300, including approximately 400 articles per year.