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Thursday, April 16, 2009

Moderate Exercise Helps With Colon Cancer - Prevention After Colon Cancer Treatment

Moderate and regular exercise substantially reduces the risk that colon cancer will return and patients currently undergoing treatment can improve their overall chance of survival.

This excellent news was reported by Dana-Farber Cancer Institute scientists in a pair of studies published in the Journal of Clinical Oncology in August 2006 but merit repeating because they show definite life prolonging impact by simple exercise in a life critical disease.

The researchers reported colon cancer patients who engaged in moderate exercise for 6 to 12 months after completing therapy had a 50 percent higher survival rate than those who didn't exercise. The improvement took place in patients with very early and more advanced (but non-spreading) colon cancer. All patients had undergone surgery.

Jeffrey Meyerhardt, MD, MPH, [Dana-Farber] was the lead author and reported: "From previous studies we know that regular physical activity reduces the risk of developing colon cancer, but until now few studies have looked at the survival effect of exercise on people who have been treated for disease... While our work found a significant benefit for patients who exercise, it's important that exercise be seen as a supplement to, not a replacement for, standard therapies."

Results appear particularly robust because the two studies used different sets of data to arrive at their shared conclusion. Patients who simply exercised such as walking 6 hours a week were 47 percent more likely to be alive and free of disease than those who were less physically active.

Additionally, patients who increased their physical activity after colon cancer diagnosis had about a 50 % less chance of dying from colon cancer or from other causes than physically inactive patients.

Meyerhardt is an assistant professor of medicine at Harvard Medical School: "As with any exercise program, people should check with their doctor before increasing their degree of physical activity... to reduce the chances that colon cancer will return after treatment, as well as for overall health reasons, regular exercise is a good option for survivors to consider."

Leukemia - What Are the Causes, Symptoms and Treatments?

Leukemia is cancer of your body's blood-forming tissues, including your bone marrow and lymphatic system. The 3 main forms of the disease are;

1. Acute Leukemia which is a malignant proliferation of white blood cell blasts in bone marrow or lymph tissue.
2. Chronic Myelogenous Leukemia also known as granulocytic leukemia.
3. Chronic Lymphocytic Leukemia which is common in the elderly and accounts for about 25% of all new leukemia cases.

Acute leukemia accounts for about 20% of leukemias, it's most common forms are:
1. Acute lymphocytic leukemia (ALL)
2. Acute myeloblastic leukemia (AML)
3. Acute monoblastic leukemia ( Schilling's type )

Incidence of Acute Leukemia
Leukemia can occur at any age, acute forms of leukemia can occur in children and young adults and in fact in this age group it is the most common form of cancer. It is more common in females than in males, in whites ( especially those of Jewish extraction ) and in urban and industrialized populations.

Risk Factors
Several congenital conditions may increase the risk of leukemia; the most common is probably Down syndrome, which is associated with a 10 to 18 fold increase in the risk of AML.

In general, nonidentical twins and other siblings of children with leukemia have two to four times the average risk of developing the disease. Also, children who have received prior radiation or chemotherapy for other types of cancer have a higher risk of contracting leukemia.

Signs and Symptoms
Signs of acute leukemia may include; high fever, abnormal bleeding, easy bruising and prolonged menses. Sometimes the onset of symptoms is more gradual with low grade fever, weakness, chills, recurrent infections or lassitude, lasting for days or months before visual symptoms occur.

In addition, all AML, ALL and Schilling's type leukemias may cause anemia, fatigue, dyspnea, palpitations and abdominal or bone pain. Specific AML symptoms include, local infections such as laryngitis, joint pain and abdominal fullness. Specific ALL symptoms include, night sweats, anorexia, weight loss and shortness of breath.

Leukemia that has spread to the brain may produce central nervous system effects, such as headaches, seizures, weakness, blurred vision, balance difficulties, or vomiting. Leukemia cells may spread to the gums, causing swelling, pain, and bleeding.

Causes of Leukemia
Current research points to a combination of viruses, genetic factors, and exposure to toxic chemicals and radiation.

Treatment
Medically leukemia is treated mainly with chemotherapy, although radiotherapy and biological therapy can be used in certain subtypes of leukemia.

Nutritional supplements offer help support the healthy function of the immune system, and in particular, the white blood cells in leukemia patients. In addition, some nutritional supplements are able to kill leukemia cells.

Prognosis for Acute Leukemia
Untreated, acute leukemia is usually fatal, often because of complications that result from leukemic cells infiltrating into the bone marrow or vital body organs.

With treatment prognosis varies, survival rates in leukemia have risen dramatically in the last 40 years with improvements in diagnosis and treatment. Children between 2 and 8 have the best survival rate (around 50%) but overall, treatment does induce remission in about 90% of cases.

Wednesday, April 15, 2009

Healing Beets and Leukemia

One of my co-workers was diagnosed seven years ago with leukemia. His prognosis was not very good; he was told he had about 6-12 months to live. His physicians informed him of the importance of chemotherapy treatment, which he refused to their surprise.

The patient decided to seek alternative methods of treatment. He researched the effects of diet comprised of raw fruits and vegetables. In his research, he came across a scientific study done at a nearby village of Chernobyl. The majority of the population located near the nuclear plant explosion had been diagnosed with some form of cancer. However, this one village had very few incidences of cancer. It was later concluded that the people's diet at this nearby village consisted primary of raw/cooked beets. The research scientists hypothesized that eating those cooked beets contributed to the majority of cancer-free population at this nearby village of Chernobyl.

Despite the advice of his physicians, my colleague thus began a strict diet consisting primarily of raw fruits, vegetables, especially beets, and fresh-squeezed juices. His prognosis was getting better. He made it through the first 6 months. Although his physicians warned he may have a relapse, he continued with the diet. Seven years have passed and my co-worker is still with us today.

The medicinal value of beets was used by such well-known doctors of the distant past as Avicenna, Hypocrite, Galen and Paracelsus. Doctors of Ancient Greece used beet juice to cure fevers, anemia, and diseases of the digestive and lymphatic systems.

Copyright © Rachel Madorsky

http://www.rachelmadorsky.com

Rachel Madorsky authored several books including, "Symphony of Your Karma" and "Create Your Own Destiny." Rachel's books offer profound insights into the power of natural and spiritual healing and are filled with inspiring stories of people who have benefited from her compassion and gifts. In these books, the reader gains an insight into the power of natural and spiritual healing from a science-oriented practitioner. The fundamental basis of her conclusions is personal experiences and informal experiments.

Monday, April 13, 2009

Truth About Neck Pain And Lymphoma - Non-Hodgkin Lymphoma

Since last 25 years, it has been discovered that non-Hodgkin lymphoma has tremendously increased as lymphatic system cancer. Non-Hodgkin lymphomaa is not single disease, it is a group of similar cancers that hinders the immune system and affects lymphatic system of the body. Non-Hodgkin lymphoma is mainly divided in two groups, namely, T-cell lymphomas and B-cell lymphoma.

Some people have a myth that non-Hodgkin lymphoma and neck pain are related to each other which is not true. There are various patients with the physical symptoms and signs of non-Hodgkin lymphoma. In most of the cases the lymph nodes of the patients is found to be swollen and is the most common sign seen in people suffering from non-Hodgkins lymphoma. In some cases there is no pain whereas in others patients suffer from lymphoma symptoms and neck pain . Lymph nodes may get swollen or enlarged in various parts of the body such as arms or neck. If the lymph nodes of an abdomen are enlarged then you might experience a bloated feeling, swelling, back pain or discomfort. In the case of groin you might suffer from swelling in legs and ankles.

Symptoms of non-Hodgkin lymphoma are unexplained weight loss, chills,lack of energy,fever, itching, neck pain and night sweats. If you feel any of these then you should consult your physician immediately as all these indicates the presence of non-Hodgkin lymphoma. Many people complaints that their physician is not considering non-Hodgkin lymphoma even when they have symptoms such as neck pain or other lymphoma symptoms. The reason behind this decision is that if there is a serious illness then it never disappears repetitively. Therefore, non-Hodgkin lymphoma should be checked only if you face persistent symptoms of the disease and not in the case of patients non-specific complaints.

Your doctor would initiate a thorough physical examination to figure out lymphoma symptoms and neck pain to ensure that you suffer from non-Hodgkin lymphoma or not. Some of the common symptoms that doctors usually look for are swollen lymph nodes in the groin and armpits, tonsil and neck area, on the elbows, under the chin and above the shoulders. If you have enlarged internal organs or swollen lymph nodes in your abdomen then there would be signs such as, fluid or swelling in your abdomen. If you are suffering from an enlarged lymph node pressing on the spinal cord or nerves then there may be signs of paralysis or weakness. In cases where neck pain and lymphoma symptoms shows signs of non-Hodgkin lymphoma, doctors prefer to do a list of tests such as blood tests, x-rays, biopsy, and many other tests.

Cord Blood Stem Cells Save Life of Leukemia Patient

The Repair Stem Cell Institute is a public-service company formed to educate, teach, and help patients with chronic diseases and conditions to find qualified doctors who provide Adult Stem Cell therapy to improve the patient's quality of life.

The Repair Stem Cell Institute website http://www.repairstemcells.org has a list of diseases and injuries that are now being treated with adult stem cells. The site also tells the reader where and how to seek out that particular stem cell treatment.

Adult Stem Cells (AKA Repair Stem Cells) can now help more than 100 diseases and conditions. The Repair Stem Cell Institute provides the latest up to date information on these adult stem cell treatments.

Don Margolis, the founder of the Repair Stem Cell Institute also keeps a blog which he updates almost daily. His blog http://www.donmargolis.com contains the latest successful Adult Stem Cell stories and discoveries.

Friday, April 10, 2009

Computer-based Model Helps Radiologists Diagnose Breast Cancer

The model was developed by a multidisciplinary group, including radiologists and industrial engineers, led by Elizabeth S. Burnside, MD, Oguzhan Alagoz, PhD, and Jagpreet Chhatwal, PhD.

“The computer-based model was designed to help the radiologist calculate breast cancer risk based on abnormality descriptors like mass shape; mass margins; mass density; mass size; calcification shape and distribution,” said Elizabeth S. Burnside, MD, and Jagpreet Chhatwal, MD, lead authors to the study.

“When the radiologist combined his/her assessment with the computer model the radiologist was able to detect 41 more cancers than when they didn’t use the model. The model was created based upon findings of 48,744 mammograms in a breast imaging reporting database and found that the use of hormones and a family history of breast cancer did not contribute significant predictive ability in this context,” they said.

“One of the important roles of a radiologist is to interpret observations made on mammograms and predict the likelihood of breast cancer. However, assessing the influence of each observation in the context of an increasing number of complex risk factors is difficult for the human brain. In this study, we developed a computer model that is designed to aid a radiologist in breast cancer risk prediction to improve accuracy and reduce variability,” said Drs. Burnside and Chhatwal.

“Our model has the potential to avoid delay in breast cancer diagnosis and reduce the number of unnecessary biopsies, which would benefit many patients. It may also encourage patients to get more actively involved in the decision-making process surrounding their breast health,” they said.

“Though much work remains to be done to validate our system for clinical care, it represents a promising direction that has the potential to substantially improve breast cancer diagnosis,” said Drs. Burnside and Chhatwal.

This study appears in the April issue of the American Journal of Roentgenology.

Thursday, April 9, 2009

Black women at risk of deadly breast cancer type

Black women, regardless of age or body weight, have a threefold greater risk of developing a particularly aggressive type of breast cancer, compared with non-black women, Boston-based researchers report.

This type of breast cancer is more deadly, in part, because it does not possess receptors for the hormones estrogen or progesterone, nor a protein called HER2. This means that women with these "triple-negative tumors" cannot be helped by drugs that target estrogen and progesterone -- including tamoxifen and aromatase inhibitors -- or by the anti-HER2 therapy Herceptin.

"The higher prevalence of triple-negative breast tumors in black women in all age and weight categories likely contributes to black women's unfavorable breast cancer prognosis," Dr. Carol Rosenberg from Boston University School of Medicine noted in comments to Reuters Health.

"The reasons explaining this finding are not certain, but it is possible that black women may be at intrinsically greater risk of these more aggressive tumors," she added.

Rosenberg and colleagues studied 415 women with breast cancer. Thirty-six percent of the women were white, 43 percent were black, 10 percent Hispanic and 11 percent of "other" races. Forty-seven percent of the women were obese.

Most of the breast tumors (72 percent) were estrogen receptor-positive and/or progesterone receptor-positive; 20 percent were triple-negative and 13 percent were HER2-positive.

The investigators focused on triple-negative tumors, which are associated with poor prognosis, and found that the odds ratio for having this tumor type was threefold greater for black women compared with white women.

Triple-negative tumors made up equal fractions -- roughly 30 percent -- of breast cancers in younger and older black women and in obese and non-obese black women, according to the team's report published online March 25 in the journal Breast Cancer Research.

"It was known previously," Rosenberg commented, "that premenopausal black women had more triple-negative tumors. However, there were no previous data about weight. What we found that was new was that these tumors were just as common in black women diagnosed before or after age 50, and in those who were or were not obese."

The investigators conclude, "Other factors must determine tumor subtype."

SOURCE: Breast Cancer Research, 2009.

Wednesday, April 8, 2009

Leukemia No. 1 cancer in children

The Department of Health (DoH) said Saturday leukemia remains the leading pediatric cancer in the country.

Dr. Frank Diza, program manager of the National Cancer Control Program (NCCP)of the DoH said, “Of the estimated 3,500 Filipino children who get afflicted with cancer every year, almost 50 percent of the cases are specific to leukemia.”

Lymphoma, brain and spinal cancer, retinoblastoma or eye cancer, cancer of kidneys, and estrogenic sarcoma, a type of bone cancer, are the other leading types of pediatric cancer.

“The lives of Filipino children stricken with cancer can be saved with early detection and proper treatment,” Diza said.

He advised parents to teach their children the importance of eating a healthy diet that is rich in fruits, vegetables, and fiber; avoid or limit their intake of junk foods, processed meat and canned goods, and to exercise regularly.

He also advised parents to have their children undergo a medical check up if they experience experiencing the following: prolonged and unexplained fever, paleness, pain, increased tendency to bruise, unusual mass or swelling, frequent headaches, sudden visual changes, and weight loss.

Acute Myelogenous Leukemia - Causes, Symptoms and Treatment

Acute myelogenous leukemia is the most common leukemia and is a fast growing cancer of the blood and bone marrow. Blood cells in the body are made up of platelets known as white and red blood cells. Those who have AML don't have enough white or red blood cells and instead posses abnormal cells that grow quickly as the illness progresses.

AML is not genetic nor is it infectious however it is mostly caused by being exposed to benzene.

What is Benzene?

Benzene is an organic chemical compound. Benzene is used in production of oil, rubber, dyes and plastic. Benzene is commonly used as an additive in other chemicals. There are small amounts of benzene used in manufacturing processes for instance, detergents, pesticides and drugs.

Benzene is linked to various forms of cancer, as well as other physical issues such as dizziness and mental confusion; anemia; and depressed functioning of the immune system.. People are often not aware that they have been exposed to benzene.

Symptoms of AML

Benzene exposure may occur when people breath or ingest it through any number of common products used in daily life and at work. Being exposed can lead to a fatal illness such as acute myelogenous leukemia. There are signs you can look for.

Some symptoms of AML include:

* Abdominal swelling

* Infections that continue or repeat

* Difficulty breathing and lack of energy

* Pain in the joints or bones

Treatments

Age and disease subtype are factors that doctors will take into consideration in planning the right treatment for the person living with AML. Some treatments that are considered are:

* Chemotherapy

* Transplants from bone marrow or cord blood

* If the subtype is promyelocytic leukemia, then all-trans retinoic acid (ATRA) may be used.

If you think you may have been exposed to benzene and have any of the symptoms listed above, please, contact an experienced attorney to get legal support and the direction you need.

Tuesday, April 7, 2009

INNOVATION LESSONS FROM GENES

You’ve been diagnosed with “incurable” leukemia. Is it a death sentence? Maybe not, our research at the Broad Institute suggests, because a heart attack treatment or some other unexpected drug might someday save your life. We reached this conclusion by looking at how drugs interact with the genes in diseased cells—a pattern-identification method that offers hints about innovation practices in general.

Physicians have always classified diseases by their symptoms. But by deciphering the genetic code within diseased cells, researchers are finding that genes for dissimilar diseases—say, leukemia and heart disease—may share the same basic roots. We have developed a “connectivity map,” which characterizes drugs according to the genes they activate rather than the diseases they treat. To identify the common genetic roots in diseased cells, we look at which genes are turned on or off by which drugs in each cell type and then match the gene-activation signature against a database of thousands of others. Finally, we run a program that seeks matches between the signatures of diseased cell types and those of various drugs. If a match is found, we hypothesize that the drug might qualify as a possible treatment for that disease—even if there was no prior reason to suspect a connection. One such drug is now in clinical trials for the treatment of relapsed leukemia.

Just as we are seeking new cures by searching for unexpected commonalities among cells, firms may discover better approaches to business problems by uncovering new relationships among wildly different products or solutions. Our map’s potential should remind even skeptics of the value of seeking fresh, unbiased ways of looking at old data, projects and even strategies.

Acute Lymphocyctic Leukemia

Acute lymphocytic leukemia (ALL), a type of blood cancer, causes damage and possible death by crowding the normal blood cells in the bone marrow and will eventually spread to other organs. ALL is commonly found in children but also found in adults and if left untreated can be fatal. The risk of getting ALL goes up in people age 45 and will go up again as you grow older. There are over 5000 people expected to be diagnosed with ALL in year 2008.

Effects of ALL

There is short term and long term effects living with ALL and it will be emotionally, physically and financially straining them. While living with ALL, your abnormal blood cells crowd around other cells in the bone marrow. This prevents your body from producing red blood cells, white blood cells and platelets causing many problems in their future such as anemia, and more infection.

Other acute lymphocytic leukemia symptoms are:

* Swollen lymph nodes

* Dyspnea

* Bleed more easily

* Enlarged liver or spleen

Diagnosing ALL

There are many tests that doctors use to diagnose ALL and the tests they use will depend on other factors such as your age, the severity of the symptoms. The tests given are blood work, a bone marrow biopsy, cytogenetics, imaging tests and more.

Treatment

Chemotherapy is the primary treatment for this disease varying in length and number of drugs involved. Clinical trials are another often used option that allow doctors to continue to learn about and improve treatments for ALL.

If you are experiencing some or all of acute lymphocyctic leukemia symptoms then you need the right legal guidance. Please contact a medical attorney today. There are experienced and trustworthy people who can give you the legal support you deserve.

Monday, April 6, 2009

Marijuana Chemical May Fight Brain Cancer

The active chemical in marijuana promotes the death of brain cancer cells by essentially helping them feed upon themselves, researchers in Spain report.

Guillermo Velasco and colleagues at Complutense University in Spain have found that the active ingredient in marijuana, THC, causes brain cancer cells to undergo a process called autophagy. Autophagy is the breakdown of a cell that occurs when the cell essentially self-digests.

The team discovered that cannabinoids such as THC had anticancer effects in mice with human brain cancer cells and people with brain tumors. When mice with the human brain cancer cells received the THC, the tumor growth shrank.

Two patients enrolled in a clinical trial received THC directly to the brain as an experimental treatment for recurrent glioblastoma multiforme, a highly aggressive brain tumor. Biopsies taken before and after treatment helped track their progress. After receiving the THC, there was evidence of increased autophagy activity.

The findings appear in the April 1 issue of the Journal of Clinical Investigation.

The patients did not have any toxic effects from the treatment. Previous studies of THC for the treatment of cancer have also found the therapy to be well tolerated, according to background information in journal article.

Study authors say their findings could lead to new strategies for preventing tumor growth.


Full Story

A cancer mutation's Colonial roots

When Mr. and Mrs. George Fry landed on the shores of Massachusetts not long after the Pilgrims, they carried with them a secret that remained hidden for nearly four centuries.

Their genes harbored a quirk that would travel through 16 generations of Americans, leaving a legacy of colon cancer. Now a Utah scientist, herself a descendant of Mayflower voyagers and Benjamin Franklin, has discovered the Fry family history.

In an example of crack scientific sleuthing, the University of Utah researcher and colleagues mined a trove of cancer records and a sprawling genealogical archive to uncover the source of a genetic mutation responsible for a rare form of colon cancer. Modern-day genetic fingerprinting identified far-flung relatives with this defect, and the team then traced the family tree back in time, past the Revolutionary War, to find their common ancestors.

They finally arrived at Weymouth, when colonists were only beginning to stake their claim to a new land. There, they found the Frys, who had decamped from their home in Somerset, England, sometime between 1624 and 1640, harboring hopes and the seeds of disease.

The search was driven by more than historical curiosity, specialists say. The work shows the power of genetics and genealogy to identify family members who share mutations so that they can be spared from a potentially deadly disease.

Already, the discovery, detailed last week at the national meeting of the American Chemical Society, appears to be saving 21st-century lives. Physicians have tracked down distant relatives of the Frys and offered those who have the mutation testing for early signs of colon cancer and preventive treatment. The result: cases of the kind of colon cancer spawned by the mutation have nearly vanished in Utah.

"The point is, there are hereditary components to diseases and you need to be aware of what your family history is," said Dr. Daniel Chung, clinical director of the Gastrointestinal Cancer Genetics Program at the Massachusetts General Hospital Cancer Center. "And it's just kind of a cool story that they can trace this mutation back."

The detective story began more than a decade ago, when University of Utah scientists discovered that members of a Utah family battling colon cancer carried a specific mutation in a gene know by the acronym APC.

"Over about the next 10 years," said Deb Neklason, a molecular geneticist at the university's Huntsman Cancer Institute and a Mayflower descendant, "they brought in tons and tons of family members to try to figure out who had the genetic change." Those who did had colonoscopies performed to look for cancer.

At the same time, a doctor in upstate New York was treating patients from a family harboring the same genetic profile.

Full Story

Cancer risks lurk in popular yerba mate tea

Teas from across the globe are becoming more popular in the U.S. One relative newcomer, yerba mate, is attracting fans for its allegedly jitter-free caffeine boost and high antioxidant content.

Lab research suggests some potential health benefits of drinking yerba mate, but studies of lifelong yerba mate drinkers in the tea's native South America suggest the brew increases the risk of some cancers, a fact most marketing campaigns omit.

Yerba mate, from leaves of the Ilex paraguariensis tree, is traditionally brewed and served in a dried-out gourd and sipped through a metal straw with a filter on one end to prevent drinkers from getting a mouthful of leaves.

In the U.S., the tea is rarely served in gourds. A small but growing number of companies, however, sell the loose or bagged leaves, and some are offering cold bottled blends of the tea.
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Pre-Leukemia - New Discoveries in the Treatment of Pre-Leukemia

Recent studies show that a mild form of chemotherapy with the use of decitabine, administered over a longer period of time, can have significantly advantageous results for patients diagnosed with pre-leukemia. More widely known as Myelodysplastic Syndrome (MDS), pre-leukemia was recognized as a certified form of cancer just recently.

The American Cancer Society's journal published this study in their latest issue, taking a more detailed look at pre-leukemia and its effects on the human body.

New Research Revelations

Researchers estimate than 45% of the patients with pre-leukemia symptoms and those who go through a relapse respond to a second treatment course. However, they did not get the duration and quality in their second round of treatment, compared to the first few rounds of chemotherapy. With the new findings, researchers are leaning towards the belief that initial treatments given over a longer duration may have more benefits compared to numerous chemotherapy rounds.

It was discovered in the study that an average of three rounds of decitabine treatment had 10 out of the 22 patients exhibiting any type of response. Seven of the patients were observed to have haematological improvements and experienced a 50% decrease in their need for tranfusions, while three of the patients partly or completely had an effect in every one of their three cell lines. Overall, the average survival rate was declared to be 28 months, with those patients treated again with decitabine having a 13-month rate of survival before suffering from any sort of relapse.

In the group where 12 of the patients did not have any response to decitabine, the treatment had one of these two results: no effect whatsoever or the abnormal cells' suppression, without the normal cells repopulating the bone marrow. Out of the 12 patients mentioned, four developed acute leukemia from the pre-leukemia.

The authors conclude that the most advantageous treatment type for pre-leukemia patients is the initial chemotherapy session given in longer durations, followed by maintenance of shorter treatment rounds.

Pre-leukemia

Pre-leukemia is an affliction that targets the bone marrow, resulting in an increased number of ineffective red and white blood cells. Usually, the cells blast and produce from the stem cells while multiplying in the blood stream, eventually killing the normal blood cells. This results in an irregular production of blood cells, causing fewer blood cells to form (which are needed to circulate and carry oxygen to different body parts).

Although therapy is readily available, pre-leukemia affects adults in their 50s, and researchers still have to find the ultimate cure. Patients suffering from pre-leukemia generally develop leukemia, or cancer of the blood cells. This study shows that this new DNA hypomethylating agent, decitabine, will have the most benefits for patients.