Unveiling sinus venosus atrial septal defect and partial anomalous pulmonary venous return in an elderly patient

Sinus venosus defect(SVD) accounts for 4%–11% of all atrial septal defects(ASD) and may present with dyspnea, heart failure(HF), palpitations, or angina.^[1] The malformation typically involves an interatrial communication due to a deficiency in the common wall connecting the right pulmonary veins and the superior vena cava(SVC) and often accompanies anomalous pulmonary venous connection of some or all of the pulmonary veins.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

Multimodality Medical Image Fusion Based on Pixel Significance with Edge-Preserving Processing for Clinical Applications

Multimodal medical image fusion has attained immense popularity in recent years due to its robust technology for clinical diagnosis.It fuses multiple images into a single image to improve the quality of images by retaining significant information and aiding diagnostic practitioners in diagnosing and treating many diseases.However,recent image fusion techniques have encountered several challenges,including fusion artifacts,algorithm complexity,and high computing costs.To solve these problems,this study presents a novel medical image fusion strategy by combining the benefits of pixel significance with edge-preserving processing to achieve the best fusion performance.First,the method employs a cross-bilateral filter(CBF)that utilizes one image to determine the kernel and the other for filtering,and vice versa,by considering both geometric closeness and the gray-level similarities of neighboring pixels of the images without smoothing edges.The outputs of CBF are then subtracted from the original images to obtain detailed images.It further proposes to use edge-preserving processing that combines linear lowpass filtering with a non-linear technique that enables the selection of relevant regions in detailed images while maintaining structural properties.These regions are selected using morphologically processed linear filter residuals to identify the significant regions with high-amplitude edges and adequate size.The outputs of low-pass filtering are fused with meaningfully restored regions to reconstruct the original shape of the edges.In addition,weight computations are performed using these reconstructed images,and these weights are then fused with the original input images to produce a final fusion result by estimating the strength of horizontal and vertical details.Numerous standard quality evaluation metrics with complementary properties are used for comparison with existing,well-known algorithms objectively to validate the fusion results.Experimental results from the proposed research article exhibit superior performance compared to other competing techniques in the case of both qualitative and quantitative evaluation.In addition,the proposed method advocates less computational complexity and execution time while improving diagnostic computing accuracy.Nevertheless,due to the lower complexity of the fusion algorithm,the efficiency of fusion methods is high in practical applications.The results reveal that the proposed method exceeds the latest state-of-the-art methods in terms of providing detailed information,edge contour,and overall contrast.

A Study on Multivariable Interactions Concerning Radar Cross Section Reduction through Geometric Attributes

This resolution 5 (25−1 factorial) study aimed to ascertain an understanding of the interactions between different geometries on the resulting Radar Cross Section (RCS) of a target. The results of the study are in line with the general understanding of the impact different geometries have on RCS but show that geometries can also influence the variance of measured RCS, and typical attributes that reduce RCS increase the variance of the measured RCS. Notably, an increased angle between the front face of a plate and the direction of the radar signal decreased RCS but increased the variance of the RCS measured.

The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

Background: Duodenoscope-related multidrug-resistant organism(MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 bleeding.Conclusions: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

Radiomics analysis with three-dimensional and two-dimensional segmentation to predict survival outcomes in pancreatic cancer

BACKGROUND Radiomics can assess prognostic factors in several types of tumors,but considering its prognostic ability in pancreatic cancer has been lacking.AIM To evaluate the performance of two different radiomics software in assessing survival outcomes in pancreatic cancer patients.METHODS We retrospectively reviewed pretreatment contrast-enhanced dual-energy computed tomography images from 48 patients with biopsy-confirmed pancreatic ductal adenocarcinoma who later underwent neoadjuvant chemoradiation and surgery.Tumors were segmented using TexRad software for 2-dimensional(2D)analysis and MIM software for 3D analysis,followed by radiomic feature extraction.Cox proportional hazard modeling correlated texture features with overall survival(OS)and progression-free survival(PFS).Cox regression was used to detect differences in OS related to pretreatment tumor size and residual tumor following treatment.The Wilcoxon test was used to show the relationship between tumor volume and the percent of residual tumor.Kaplan-Meier analysis was used to compare survival in patients with different tumor densities in Hounsfield units for both 2D and 3D analysis.RESULTS 3D analysis showed that higher mean tumor density[hazard ratio(HR)=0.971,P=0.041)]and higher median tumor density(HR=0.970,P=0.037)correlated with better OS.2D analysis showed that higher mean tumor density(HR=0.963,P=0.014)and higher mean positive pixels(HR=0.962,P=0.014)correlated with better OS;higher skewness(HR=3.067,P=0.008)and higher kurtosis(HR=1.176,P=0.029)correlated with worse OS.Higher entropy correlated with better PFS(HR=0.056,P=0.036).Models determined that patients with increased tumor size greater than 1.35 cm were likely to have a higher percentage of residual tumors of over 10%.CONCLUSION Several radiomics features can be used as prognostic tools for pancreatic cancer.However,results vary between 2D and 3D analyses.Mean tumor density was the only variable that could reliably predict OS,irrespective of the analysis used.

Acute myocardial infarction following 5-fluorouracil treatment

5-Fluorouracil(5-FU)is an antimetabolite chemotherapeutic agent that is US Food and Drug Administration(FDA)indicated for use in a variety of neoplasms and is a staple agent in many chemotherapeutic regimens.An important adverse effect of 5-FU is cardiotoxicity.There is a wide spectrum of clinical presentation of 5-FU cardiotoxicity from asymptomatic electrocardiogram(ECG)changes to myocardial infarction that clinicians must be aware of when caring for patients receiving this agent.

Two cases of refractory methicillin-susceptible staphylococcus aureus endocarditis responsive to ertapenem

Persistent methicillin-sensitive staphylococcus aureus(MSSA)bacteremia is usually defined as persistent bacteremia despite 7 days of appropriate antibiotic therapy.While nafcillin,cefazolin,or oxacillin are excellent antimicrobial options,persistent MSSA is a commonly encountered phenomenon in clinical practice for which further guidelines on appropriate management are necessitated.Here we highlight two cases of MSSA bacteremia requiring salvage therapy with ertapenem.

Improving Interventions on Cardiovascular Disease and Diet: A Policy Incentive Analysis

Various Cardiovascular Diseases (CVDs) can be catastrophic and can lead to irreversible outcomes. Despite improved interventions for CVD prevention awareness, there continues to be discussion and research on diet-related CVD and mortality without addressing the problem. Instead of prioritizing public guidelines and policies, policymakers should understand CVD and address population barriers to adhering to a healthy diet that decreases CVD risk. Therefore, this project aims to analyze federal healthy food incentive policies to promote healthy diet behaviors that reduce CVD risk. The method used was existing data for a comparative policy analysis that included a policy proposal process: phases of progression, measures, and a policy model with data collection and requirements. This analysis compared a current federal food incentive program versus the proposed program. Results of the final analysis derived from the literature review and collected data stated consuming foods from the Mediterranean and other low-fat and low-salt diets reduced CVD risks that also reduced other risks secondary to CVD, such as obesity, diabetes, and Cerebrovascular Accident (CVA). Comparatively, combined healthy food incentives and disincentives were more effective for improving healthy behaviors than, in some cases, even after incentives were removed. Therefore, this policy analysis supports the indication for incentive policy change. However, the lack of federal stakeholders’ response to key policy changes upon proposal submission may require other methods of proposal dissemination. Nonetheless, focusing analysis on various Food Insecurity Nutrition Incentive (FINI) programs instead of one, multi-state program, which may have improved analysis outcomes, was the lesson learned.

Mental Health Intervention in the Workplace amidst the COVID-19 Pandemic

The purpose of this project is to examine why the mental health of employees should be prioritized in the workplace. Most employees have likely experienced a visible illness or injury at some point during their careers. It is easier to identify these physical ailments that may adversely affect an employee’s performance at work, such as a broken leg or the common cold. However, there are conditions that are much less visible that negatively impact employees every day, and mental health is one of them. A person’s mental health is a significant factor in their work life that should not be ignored. While it may be difficult to recognize when someone is struggling with depression, anxiety, or another form of mental illness on the surface, employers should not automatically assume their entire staff is okay. As a result of the COVID-19 pandemic coupled with an increase in civil unrest in society, employers must reevaluate the way they conduct business, starting with the treatment of their employees. To aid employers with prioritizing mental health at work, this paper’s objectives are to address the stigma associated with mental health issues/illness, develop recommendations for inclusive work environments, increase an employer’s investment in mental health, reduce employee turnover, and normalize respect in the workplace. The findings are discussed, and recommendations are provided. Employers who intentionally prioritize and invest in their employees’ mental health will significantly reduce the costs associated with attracting and recruiting new staff due to high turnover rates. Additionally, their reputation as a preferred employer will increase.

Mortality assessment for pancreas transplants in the United States over the decade 2008-2018

BACKGROUND Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes.However,since 2005,no comprehensive analysis has compared survival outcomes of:(1)Simultaneous pancreas-kidney(SPK)transplant;(2)Pancreas after kidney(PAK)transplant;and(3)Pancreas transplant alone(PTA)to waitlist survival.AIM To explore the outcomes of pancreas transplants in the United States during the decade 2008-2018.METHODS Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file.Pre-and post-transplant recipient and waitlist characteristics and the most recent recipient transplant and mortality status were used.We included all patients with type I diabetes listed for pancreas or kidneypancreas transplant between May 31,2008 and May 31,2018.Patients were grouped into one of three transplant types:SPK,PAK,or PTA.RESULTS The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed that patients who underwent an SPK transplant exhibited a significantly reduced hazard of mortality[hazard ratio(HR)=0.21,95%confidence intervals(CI):0.19-0.25]compared to those not transplanted.Neither PAK transplanted patients(HR=1.68,95%CI:0.99-2.87)nor PTA patients(HR=1.01,95%CI:0.53-1.95)experienced significantly different hazards of mortality compared to patients who did not receive a transplant.CONCLUSION When assessing each of the three transplant types,only SPK transplant offered a survival advantage compared to patients on the waiting list.PKA and PTA transplanted patients demonstrated no significant differences compared to patients who did not receive a transplant.

Targeting KRAS in pancreatic adenocarcinoma:Progress in demystifying the holy grail

Pancreatic cancer(PC)remains one of the most challenging diseases,with a very poor 5-year overall survival of around 11.5%.Kirsten rat sarcoma virus(KRAS)mutation is seen in 90%-95%of PC patients and plays an important role in cancer cell proliferation,differentiation,metabolism,and survival,making it an essential mutation for targeted therapy.Despite extensive efforts in studying this oncogene,there has been little success in finding a drug to target this pathway,labelling it for decades as“undruggable”.In this article we summarize some of the efforts made to target the KRAS pathway in PC,discuss the challenges,and shed light on promising clinical trials.

Understanding the adoption context of China’s digital currency electronic payment

Central banks worldwide have started researching and developing central bank digital currencies(CBDCs).In the digital economy context,concerns regarding the integrity,competition,and privacy of CBDC systems have also gradually emerged.Against this backdrop,this study aims to evaluate users’willingness to use China’s digital currency electronic payment(DCEP)system,a digital payment and processing network,and its influencing factors by comprehensively considering and comparing the characteristics of cash and third-party payment services.Combining the push-pull-mooring frame-work(PPM)and task-technology fit(TTF)theory,we discuss the scenarios and mecha-nisms that may inspire users’DCEP adoption intention through an empirical study.The results reveal that privacy concerns regarding the original payment methods and technology-task fitting level of DCEP positively impact users’willingness to adopt DCEP.The technical characteristics of DCEP,users’payment requirements,and government support positively affect users’adoption intention by influencing the task-technology fitting degree of DCEP.Switching cost significantly and negatively impacts adop-tion intention,whereas relative advantage exhibits no significant effect.This research contributes to a better understanding of the factors that influence switching intentions and the actual use of DCEP,and provides policy guidance on promoting the efficiency and effectiveness of DCEP.

The Main and Interactive Effects of Fat and Salt Contents of the Diet on Characteristics of Metabolic Syndrome in Male Wistar Rats

The current Western diet contains high amounts of salt and fat. High salt and fat diets are known to have negative impacts on food intake (FI), body weight (BW), body composition (BC), glucose metabolism, and blood pressure. These factors have been studied as separate entities, but the main and interactive effects of dietary salt and fat received little study. The objective of this study was to examine the effect of sodium and fat content of the diet on FI, BW, and BC in male Wistar rats. Male Wistar Rats (n = 48) were allocated into 4 groups (n = 12) and received the following diets: 1. Normal sodium normal fat, 2. Normal sodium high fat, 3. High sodium normal fat, and 4. High sodium high-fat diet for 12 weeks. BW and FI were measured weekly. BC and organs’ weight were recorded post-termination. Regardless of sodium content, a greater FI was observed in normal-fat diet groups compared with high-fat diet groups. However, higher BW and fat (%) were observed in high-fat diet groups. Fasting blood glucose was higher in rats fed normal fat diets compared with those fed high-fat diets. Systolic and diastolic blood pressure was lower in rats fed either high fat, high salt, or normal fat, normal salt diet. In conclusion, fat but not salt content in the diet is a determining factor in the regulation of FI and body weight. Moreover, glucose metabolism can be influenced by both the fat and salt content of the diet.

Analysis of Differential Gene Expression and Core Canonical Pathways Involved in the Epithelial to Mesenchymal Transition of Triple Negative Breast Cancer Cells by Ingenuity Pathway Analysis

Triple Negative Breast Cancer (TNBC) is a malignant form of cancer with very high mortality and morbidity. Epithelial to Mesenchymal Transition (EMT) is the most common pathophysiological change observed in cancer cells of epithelial origin that promotes metastasis, drug resistance and cancer stem cell formation. Since the information regarding differential gene expression in TNBC cells and cell signaling events leading to EMT is limited, this investigation was done by comparing transcriptomic data generated by RNA isolation and sequencing of a EMT model TNBC cell line in comparison to regular TNBC cells. RNA sequencing and Ingenuity Pathway Software Analysis (IPA) of the transcriptomic data revealed several upregulated and downregulated gene expressions along with novel core canonical pathways including Sirtuin signaling, Oxidative Phosphorylation and Mitochondrial dysfunction events involved in EMT changes of the TNBC cells.

Complex role for the immune system in initiation and progression of pancreatic cancer

The immune system plays a complex role in the development and progression of pancreatic cancer. Inflammation can promote the formation of premalignant lesions and accelerate pancreatic cancer development. Conversely, pancreatic cancer is characterized by an immunosuppressive environment, which is thought to promote tumor progression and invasion. Here we review the current literature describing the role of the immune response in the progressive development of pancreatic cancer, with a focus on the mechanisms that drive recruitment and activation of immune cells at the tumor site, and our current understanding of the function of the immune cell types at the tumor. Recent clinical and preclinical data are reviewed, detailing the involvement of the immune response in pancreatitis and pancreatic cancer, including the role of specific cytokines and implications for disease outcome. Acute pancreatitis is characterized by a predominantly innate immune response, while chronic pancreatitis elicits an immune response that involves both innate and adaptive immune cells, and often results in profound sys-temic immune-suppression. Pancreatic adenocarcinoma is characterized by marked immune dysfunction driven by immunosuppressive cell types, tumor-promoting immune cells, and defective or absent inflammatory cells. Recent studies reveal that immune cells interact with cancer stem cells and tumor stromal cells, and these interactions have an impact on development and progression of pancreatic ductal adenocarcinoma(PDAC). Finally, current PDAC therapies are reviewed and the potential for harnessing the actions of the immune response to assist in targeting pancreatic cancer using immunotherapy is discussed.

Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis,what should be done?

Acute recurrent pancreatitis (ARP) is a common clinical condition that may be difficult to diagnose. Endoscopic ultrasound (EUS) is proposed to be a safe first line test of choice in the majority of patients. When interventions are needed to remove biliary stones, evaluate sphincter of Oddi or pancreas divisum, endoscopic retrograde cholangiopancreatography (ERCP) is recommended. Magnetic resonance cholangiopancreatography (MRCP) can be a suitable alternative from a diagnostic standpoint although may not be widely available. Finally, genetic testing is increasingly used to detect certain mutations that are associated with this diagnosis.

National trends in resection of the distal pancreas

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open groups.Overall complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study(ductal adenocarinoma 1-year 63.6% and 2-year 35.1%,P = 0.53;intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%,P = 0.25).The majority of resections were performed in teaching hospitals(77% NIS and 85% NSQIP),but minimally invasive surgery(MIS) was not more likely to be used in teaching hospitals(15% vs 14%,P = 0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles(88% vs 43%,P < 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching(15% vs 14%,P = 0.72) and lower volume hospitals(14% vs 15%,P = 0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year(P = 0.17 and P = 0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.

Diabetes mellitus as a risk factor for gastrointestinal cancer among American veterans

AIM:To assess the risk of biliary and pancreatic cancers in a large cohort of patients with type 2 diabetes mellitus(DM) .METHODS:Eligibility for this study included patients with type 2 DM(ICD-9 code 250.0) who were discharged from Department of Veteran Affairs hospitals between 1990 and 2000.Non-matched control patients without DM were selected from the same patient treatment files during the same period.Demographic information included age,sex and race.Secondary diagnoses included known risk factors based on their ICD-9 codes.By multivariate logistic regression,the occurrence of biliary and pancreatic cancer was compared between case subjects with DM and controls without DM.RESULTS:A total of 1172496 case and control subjects were analyzed.The mean age for study and control subjects was 65.8 ± 11.3 and 64.8 ± 12.6 years,respectively.The frequency of pancreatic cancer in subjects with DM was increased(0.9%) in comparison to control subjects(0.3%) with an OR of 3.22(95% CI:3.03-3.42) .The incidence of gallbladder andextrahepatic biliary cancers was increased by twofold in diabetic patients when compared to controls.The OR and 95% CI were 2.20(1.56-3.00) and 2.10(1.61-2.53) ,respectively.CONCLUSION:Our study demonstrated that patients with DM have a threefold increased risk for developing pancreatic cancer and a twofold risk for developing biliary cancer.

Exosomes and their role in the micro-/macro-environment： acomprehensive review

The importance of extracellular vesicles(EVs) in cell-cell communication has long been recognized due to their ability to transfer important cellular cargoes such as DNA, mRNA, miRNAs, and proteins to target cells. Compelling evidence supports the role of EVs in the horizontal transfer of cellular material which has the potential to influence normal cellular physiology and promote various disease states. Of the different types of EVs, exosomes have garnered much attention in the past decade due to their abundance in various biological fluids and ability to affect multiple organ systems. The main focus of this review will be on cancer and how cancer-derived exosomes are important mediators of metastasis, angiogenesis, immune modulation, and the tumor macro-/microenvironment. We will also discuss exosomes as potential biomarkers for cancers due to their abundance in biological fluids, ease of uptake, and cellular content. Exosome use in diagnosis, prognosis, and in establishing treatment regimens has enormous potential to revolutionize patient care.