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Reticulocyte hemoglobin (CHr) is a measure of the amount of hemoglobin in reticulocytes and a marker of cell hemoglobinization. In this study, we aimed to find the optimal cut-off point for reticulocyte hemoglobin to diagnose iron deficiency anemia using multiple methods. A total of 309 patients were included. The median age at diagnosis was 54 years. Most were females (71.2%). 68% had iron deficiency anemia. Patients with IDA had significantly lower levels of CHr compared to those who had non-IDA (p < 0.0001). The optimal cut-off value of CHr for detecting IDA, determined using various methods, was 30.15 pg. This cut-off point had a sensitivity of 87.8% and a specificity of 77.7%. CHr showed a significant positive correlation with hemoglobin, mean corpuscular volume, serum iron, serum ferritin, and transferrin saturation and a significant negative correlation with total iron-binding capacity. CHr levels correlate with most established laboratory tests for IDA. It reliably detects IDA. Our results indicate the importance of CHr in diagnosing IDA, and that CHr should be used more widely in suspected cases of IDA since it is a cheap, fast, and reliable test.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. Atezolizumab plus bevacizumab (Atezo/Bev) has emerged as a first-line therapy for unresectable HCC (uHCC), improving overall and progression-free survival (OS, overall survival and PFS, progression-free survival) in IMbrave150. This study evaluates the real-world efficacy and safety of Atezo/Bev in uHCC. Methods: A retrospective analysis was performed on 87 patients (median age 68 years) treated with Atezo/Bev at Houston Methodist Hospital between January 2020 and June 2023. Demographics, treatment patterns, radiological response, OS, PFS, and toxicities were reviewed. Atezo/Bev was administered per FDA guidelines (atezolizumab 1200 mg plus bevacizumab 15 mg/kg every 3 weeks). Results: Of 87 patients, 78% were male, 71% White, and 70% had BCLC stage C disease. Most (60%) had Child–Pugh class A liver function, and 62% had viral hepatitis. Median OS was 15.1 months (95% CI: 10.57–25.97) and PFS was 9.1 months (95% CI: 7.4–21.07). Objective response rate was 31.3% (CR 7.2%, PR 25%, SD 52%, PD 16%). OS was longer in CP A versus CP B patients (21.2 vs. 5.2 months, p < 0.001) and in those receiving post-Atezo/Bev locoregional therapy (21.2 vs. 10.4 months, p = 0.043). Discontinuation due to toxicity occurred in 14%, mainly gastrointestinal bleeding and fatigue. Conclusions: Atezo/Bev demonstrated favorable real-world efficacy and manageable toxicity in uHCC, particularly in patients with preserved liver function or multimodal therapy.

The use of stem cells in regenerative medicine had great potential for clinical applications. However, cell delivery strategies have critical importance in stimulating the differentiation of stem cells and enhancing their potential to regenerate damaged tissues. Different strategies have been used to investigate the osteogenic potential of dental stem cells in conjunction with biomaterials through in vitro and in vivo studies. Osteogenesis has a broad implication in regenerative medicine, particularly for maxillofacial defects. This review summarizes some of the most recent developments in the field of tissue engineering using dental stem cells.

Human microbiota have a significant impact on the health of individuals, and reciprocally, lifestyle choices of individuals have an important effect on the diversity and composition of microbiota. Studies assessing microbiota knowledge among the public are lacking, although it is hypothesized that this knowledge can motivate healthier behavior. Hence, this study aimed to measure microbiota knowledge among university students, and the effect of this knowledge on behavioral beliefs. A descriptive cross-sectional study was conducted among students from various fields of study enrolled at the University of Jordan, using an online questionnaire. The questionnaire consisted of 3 parts: demographics, general knowledge of microbiota, and behavioral beliefs related to microbiota. Four hundred and two responses were collected from verified university students. Participants were divided into two groups depending on whether they took a formal microbiology course (45 h) or not. Results from those two groups were compared using appropriate statistical methods. Results showed that most participants, even those who did not take a formal microbiology course, displayed good knowledge of what microbiota is and how they can be influenced by personal and environmental factors. Participants who took a microbiology course had significantly higher microbiota knowledge scores and were more aware of the effect of antibiotics on microbiota. Participants’ behavioral beliefs regarding their antibiotic use, but not their diet and lifestyle choices, were affected by their knowledge of microbiota. The study indicates that disseminating knowledge regarding microbiota and microbiology in general, can improve behaviors related to antibiotic use.

Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality, especially in low- and middle-income countries, many of which are in the Arab region. We aimed to conduct a bibliometric analysis to assess the scientific output concerning CVDs in the Arab region and the Middle East over the past decade.Methods: A bibliometric search was conducted on PubMed and Scopus between 2012 and 2022. The study analyzed the number of publications, countries, institutional sources, authors, journals, and keywords. Visualization analysis was executed using various software tools, including R, VOSviewer, and CiteSpace.Results: PubMed and Scopus yielded 5340 documents related to CVDs at the time of data collection. A total of 1263 documents were retrieved after screening based on specific inclusion criteria that guarantee the inclusion only for Arab region studies and authors. There has been a consistent increase in annual publications in recent years. The countries that contributed the most to research in this field were Egypt, Saudi Arabia, and the UAE. Although Egypt stood out as the most productive country, the institute with the highest number of documents was in Qatar. In addition, the Top 3 authors hailed from Qatar. Saudi Medical Journal leads the field as the most productive journal, followed closely by PLoS One and Angiology. Research topics of significant interest in the realm of CVDs include specific diseases such as heart failure, risk factors related to CVDs, genetic aspects of CVDs, and congenital disorders in infant’s cardiac health.Conclusion: This study provides a comprehensive overview of the current status of CVD research in the Arab region. It includes research hotspots that can guide authors in determining the necessary future investigations within this field. There is a clear call for further exploration of various aspects of CVDs in the Arab world. Strengthening cooperation between countries and institutes is needed.

Background Cholangiocarcinoma (CCA) is a rare, aggressive malignancy of the bile duct epithelium with rising incidence and mortality. Curative surgery is feasible in few cases; for unresectable or metastatic disease, systemic therapy is standard. Gemcitabine plus cisplatin (GemCis) has been the first-line backbone, but phase 3 trials (TOPAZ-1 and KEYNOTE-966) demonstrated overall survival (OS) benefit with added immune checkpoint inhibitors (durvalumab or pembrolizumab). This systematic review and meta-analysis evaluates the efficacy and safety of immunotherapy (10) plus GemCis versus GemCis alone in advanced CCA. Methods We systematically searched PubMed, Embase, Scopus, and Google Scholar for English-language studies (2009-2025) including randomized controlled trials (RCTs) and cohort studies of first-line GemCis alone or with durvalumab or pembrolizumab in unresectable/metastatic CCA. Primary endpoint: OS. Secondary: progression-free survival PFS) and grade 3-4 adverse events (AEs) per CTCAE. Kaplan-Meier curves were digitized, and individual patient data reconstructed using IPD tools for pooled estimates. Random-effects models generated hazard ratios (HRs) and pooled medians; heterogeneity assessed via I2 Results We included 3,703 patients from TOPAZ-1, KEYNOTE-966, ABC-01/02, and six cohort studies: 1,737 on GemCis alone, 1,433 on GemCis + durvalumab, and 533 on GemCis + pembrolizumab. In the full meta-analysis, GemCis + durvalumab showed the best outcomes (median OS 14.1 months, PFS 7.38 months) versus GemCis + pembrolizumab (OS 12.8 months, PFS 6.62 months) and GemCis alone (OS 9.27 months, PFS 5.81 months). Restricting to RCTs only, 10 + GemCis improved OS versus GemCis alone (median 12.82 vs. 11.1 months; HR 0.78, 95% Cl 0.71-0.86, p < 0.001), with no significant PFS difference (p = 0.20). Grade 3-4 AEs were infrequent across arms; thrombocytopenia was higher with pembrolizumab (p = 0.0002), but other severe toxicities were comparable. Conclusions Adding immunotherapy to GemCis significantly enhances survival in unresectable/metastatic CCA, with durvalumab + GemCis providing the most pronounced benefit in this pooled analysis incorporating RCTs and real-world cohorts. Regimens were well-tolerated with manageable toxicity. These findings reinforce chemoimmunotherapy as first-line standard and highlight potential differential efficacy between PD-Ll and PD 1 inhibitors warranting further study.

Tamoxifen is commonly used in the treatment of hormonal-positive breast cancer. However, 30%-40% of tumors treated with tamoxifen develop resistance; therefore, an important step to overcome this resistance is to understand the underlying molecular and metabolic mechanisms. In the present work, we used metabolic profiling to determine potential biomarkers of tamoxifen resistance, and gene expression levels of enzymes important to these metabolites and then correlated the expression to the survival of patients receiving tamoxifen. Tamoxifen-resistant cell lines previously developed and characterized in our laboratory were metabolically profiled with nuclear magnetic resonance spectroscopy (NMR) using cryogenic probe, and the findings were correlated with the expression of genes that encode the key enzymes of the significant metabolites. Moreover, the effect of significantly altered genes on the overall survival of patients was assessed using the Kaplan-Meier plotter web tool. We observed a significant increase in the levels of glutamine, taurine, glutathione, and xanthine, and a significant decrease in the branched-chain amino acids, valine, and isoleucine, as well as glutamate and cysteine in the tamoxifen-resistant cells compared to tamoxifen sensitive cells. Moreover, xanthine dehydrogenase and glutathione synthase gene expression were downregulated, whereas glucose-6-phosphate dehydrogenase was upregulated compared to control. Additionally, increased expression of xanthine dehydrogenase was associated with a better outcome for breast cancer patients. Overall, this study sheds light on metabolic pathways that are dysregulated in tamoxifen-resistant cell lines and the potential role of each of these pathways in the development of resistance.

Background Subgroup analyses in clinical trials assess intervention effects on specific patient subgroups, ensuring generalizability. However, they are usually only able to generate hypotheses rather than definitive conclusions. This study examined the prevalence and characteristics of post hoc subgroup analysis in oncology. Methods We systematically reviewed published subgroup analyses from 2000 to 2022. We included articles presenting secondary, post hoc, or subgroup analyses of interventional clinical trials in oncology, cancer survivorship, or cancer screening, published separately from the original clinical trial publication. We collected cancer type, year of publication, where and how subgroup analyses were reported, and funding. Results Out of 16 487 screened publications, 1612 studies were included, primarily subgroup analyses of treatment trials for solid tumors (82%). Medical writers contributed to 31% of articles, and 58% of articles reported conflicts of interest. Subgroup analyses increased significantly over time, with 695 published between 2019 and 2022, compared to 384 from 2000 to 2014. Gastrointestinal tumors (25%) and lymphoid lineage tumors (39%) were the most frequently studied solid and hematological malignancies, respectively. Industry funding and reporting of conflicts of interest increased over time. Subgroup analyses often neglected to indicate their secondary nature in the title. Most authors were from high-income countries, most commonly North America (45%). Conclusions This study demonstrates the rapidly growing use of post hoc subgroup analysis of oncology clinical trials, revealing that the majority are supported by pharmaceutical companies, and they frequently fail to indicate their secondary nature in the title. Given the known methodological limitations of subgroup analyses, caution is recommended among authors, readers, and reviewers when conducting and interpreting these studies.

The aim of this work is to describe the dynamics of a discrete fractional-order reaction–diffusion FitzHugh–Nagumo model. We established acceptable requirements for the local asymptotic stability of the system’s unique equilibrium. Moreover, we employed a Lyapunov functional to show that the constant equilibrium solution is globally asymptotically stable. Furthermore, numerical simulations are shown to clarify and exemplify the theoretical results.