Search Results (1,495)

Papillary thyroid cancer (PTC) is the most common endocrine malignancy with especially high incidence in Middle Eastern populations. While classical hereditary syndromes explain a minority of cases, the broader germline landscape of non-syndromic PTC remains unclear. whole-exome sequencing was performed on 245 unselected Saudi PTC patients to identify germline pathogenic or likely pathogenic variants (PVs/LPVs) in cancer predisposition genes. Clinical and molecular characteristics, and family history were integrated to assess phenotypic correlations. Eleven patients (4.5%) harbored germline PVs/LPVs in cancer susceptibility genes including STK11, TP53, BRCA1, BRCA2, FANCA, SLX4, RAD50, MSH6, POLD1 and NF1. Four patients (36.4%) carried PVs/LPVs in canonical FA pathway genes; this increased to five patients (45.5%) when RAD50 was included. Two unrelated patients harbored the same STK11 variant (p.R304Q) without classical Peutz–Jeghers syndrome features. A TP53 hotspot mutation (p.R175H) was identified in a patient with a personal history of gastric cancer, a malignancy associated with Li–Fraumeni syndrome. Notably, the BRCA1 PV detected matches a known Saudi founder mutation in hereditary breast cancer, now observed in PTC. Most germline positive cases lacked syndromic manifestations, underscoring limitations of phenotype or family history-driven genetic testing strategies. These findings suggest that a small subset of non-syndromic PTC cases may carry germline PVs/LPVs in cancer predisposition genes, highlighting the need for broader genetic screening frameworks. Unbiased whole-exome analysis in unselected cohorts can uncover under-recognized genetic risk and guide screening strategies to address the unique hereditary landscape of thyroid cancer in underrepresented populations. Full article

Background/Objectives: Keloids are fibroproliferative scars with high postsurgical recurrence rates and limited high-quality data from European populations. Current treatment guidelines recommend multimodal management; however, real-world practice often varies, and therapeutic efficacy in Western cohorts remains insufficiently characterized. This study aimed to analyze determinants of keloid recurrence and evaluate the impact of postoperative treatments within one of the largest Middle-European keloid cohorts to date. Methods: In this retrospective single-center study, 206 patients treated for at least one keloid between 2010 and 2024 were analyzed. Patients received either conservative therapy or surgical excision with or without postoperative treatments, including intralesional triamcinolone (TAC), irradiation, silicone, compression, and laser therapy. Recurrence-free survival was assessed using Kaplan–Meier estimation, univariate analysis and multivariate Cox proportional hazards modeling. Results: Male sex, specific anatomical sites (ear and thorax), and ethnicity (Black/African, Asian, and Middle Eastern/Arab patients) showed significant associations with more recurrences. Univariate analyses indicated higher recurrence rates in patients treated with TAC or laser therapy, whereas irradiation, compression, and silicone showed no significant effect. Multi-component analysis revealed distinct patient clusters differing in recurrence burden and treatment patterns, and multivariate analysis showed that laser therapy remained associated with increased recurrence risk, whereas TAC, irradiation, silicone, and compression demonstrated modest protective trends. Combined use of the four latter modalities was associated with a non-significant trend to lower recurrence hazard (HR 0.75). Conclusions: This large European cohort highlights substantial demographic variability and heterogeneity in postoperative treatment strategies. Multimodal adjuvant therapy—particularly combinations of TAC, irradiation, silicone, and compression—may reduce recurrence risk, whereas laser-treated cases likely reflect confounding by indication. Full article

Urban sprawl refers to the undesirable expansion of cities and the irrational exploitation of land resources. This study takes the Yellow River Basin as the research domain and measures the urban sprawl index of 73 prefecture-level cities in the basin from 2000 to 2020. Utilizing DMSP/OLS, NPP/VIIRS nighttime light data, and LandScan population data, the research applies the Theil index to examine urban sprawl levels and spatial heterogeneity among the upper, middle and lower reaches of the basin, as well as within individual cities. The results show that: (1) between 2000 and 2020, urban sprawl levels in the 73 prefecture-level cities within the Yellow River Basin demonstrated a consistent downward trend, with a spatial decrease observed from west to east; (2) the overall Theil index revealed regional disparities that gradually lessened over the years, with differences within the basin being significantly greater than those between its upper, middle, and lower sections; and (3) in terms of spatial heterogeneity, multiple prefecture-level cities in Qinghai Province, at the source of the basin, are primarily located in the “high high cluster” region, whereas the “low low cluster” is largely concentrated in the eastern downstream areas of the Yellow River. Sanmenxia City, located in the middle reaches, was long term the “high low cluster” zone, while the “low high cluster” zone was concentrated in Xining, Lanzhou, and Baotou cities in the upper reaches. Investigating urban sprawl in the Yellow River Basin contributes to advancing the sustainable development of the basin in a profound manner. Full article

The Late Miocene is known as a period of long-term Cenozoic global cooling and decreasing concentrations of atmospheric CO₂. The conditions provide the opportunity to assess the Earth’s climate sensitivity in altering internal and external drivers in a warmer world with similarity to the modern continental configuration. However, relative warmer Sea Surface Temperature (SST), a deepened thermocline, and reduced upwelling may have occurred in the tropics during the Late Miocene global cooling. Here, we present foraminiferal biostratigraphy data from the Middle Miocene–Pliocene succession in the Halang Formation in the Banyumas Basin in Indonesia. An increase in the planktonic foraminifera Trilobatus trilobus and Orbulina universa during the Late Miocene in the Indian Ocean indicates relative surface temperature warming and reduced productivity inferred from assemblage shifts. Reduced productivity was caused by decreasing upwelling intensity during the Late Miocene based on Globigerinella obesa assemblages. Reduced upwelling in the south of Java is supported by elevated numbers of surface/mixed-layer species (i.e., Trilobatus sacculifer and Trilobatus immaturus). We suppose the distribution of enhanced upper-layer stratification in the eastern Indian Ocean was not only driven by oceanic forcing but was also transferred intensively into the Indian Ocean by atmospheric forcing of strengthening equatorial trade winds. Changes in the Walker circulation controlled a reduction in upwelling over the eastern tropical Indian Ocean and a deeper thermocline during the cooling climate in the Late Miocene. Full article

Like most of the North Atlantic marine coastal area, the seawater temperature in the English Channel (EC) is showing an increase that began in the middle of the 1980s. Similarly, during the same period, there has been an increase in human activities (extraction of aggregates, harbour sediment dredging and spoil disposal, Offshore Wind Farms). This point of view examines and analyses the changes in biodiversity of benthic species and communities from the EC under climatic and anthropogenic pressures during the four last decades. Four main changes have been recorded: (1) additions to the checklist of benthic species, due to new prospections; (2) changes in the structure of benthic communities, due to human activities; (3) an increase in diversity due to the arrival of non-indigenous species, some of which have effects on the structure of benthic communities; and (4) eastward progression of temperate species, while some boreal species tend to disappear. Situated in temperate mid-latitudes bordering the North-eastern Atlantic, the EC is an excellent open laboratory to observe and understand the impact of climatic change and human activities on marine coastal ecosystems. Today, the increase in seawater temperature and the introduction of non-native species appear to be the main factors that explain the changes in benthic diversity in the EC. Full article

Moroccan lben is a traditional spontaneously fermented milk widely consumed across the Maghreb. In this review, we synthesize data on spontaneously fermented milks from Morocco and the wider Maghreb–Middle Eastern region to infer the likely microbiota of Moroccan lben, with particular emphasis on dominant lactic acid bacteria such as Lactococcus lactis, Streptococcus thermophilus, Leuconostoc mesenteroides and lactobacilli sensu lato, alongside yeasts including Kluyveromyces marxianus and Saccharomyces cerevisiae. These communities drive a staged fermentation in which early mesophilic lactic acid bacteria (LAB) rapidly acidify the milk and initiate coagulation, intermediate heterofermentative LAB and yeasts generate key aroma compounds and mild effervescence, and late acid-tolerant lactobacilli contribute to flavor refinement and microbiological stability. We summarize how these bacteria and fungi collectively shape physicochemical, sensory and safety attributes through pH reduction, organic acid and bacteriocin production, proteolysis, and volatile formation, and discuss potential nutritional and health-related effects associated with bioactive peptides and putative probiotic strains. Finally, we identify major research gaps, including the need for high-resolution, culture-dependent and culture-independent studies, systematic safety assessments, and rational design of starter and adjunct cultures that reproduce traditional sensory profiles while improving process control. Full article

The Middle Cambrian salt–anhydrite succession in the Tarim Basin has been regarded as an effective regional cap-rock. However, numerous Ordovician hydrocarbon reservoirs have been discovered above the anhydrite, and recent drilling has identified industrial oil and gas flows beneath anhydrite-bearing intervals. These findings call into question the sealing effectiveness of anhydrite rocks in deep subsalt settings. In this study, X-ray diffraction (XRD), petrographic analysis, scanning electron microscopy (SEM), and triaxial compression tests were conducted to investigate the mineral composition, deformation behavior, and failure mechanisms of anhydrite rocks. The results indicate that: (1) dolomite-bearing anhydrite undergoes plastic deformation at depths greater than 4400~4600 m (~70 MPa confining pressure), whereas dolomitic anhydrite enters the plastic deformation regime below 5200~5400 m (~80 MPa confining pressure); (2) the deformation evolution of the cap rocks can be divided into four stages. Stages I–III are dominated by brittle deformation, with plasticity progressively increasing with confining pressure, whereas Stage IV is characterized by pervasive plastic deformation and strong sealing capacity, representing an effective cap rock during the critical period of hydrocarbon accumulation; (3) Middle Cambrian reservoirs in the eastern Tazhong area were destroyed by reverse faults that cut through brittle Middle Cambrian cap rocks. In contrast, Lower Cambrian gas reservoirs were charged during the Himalayan period, when the cap rocks remained intact, and exhibited strong sealing capacity. This study demonstrates the temporal variability in the sealing effectiveness of Middle Cambrian anhydrite cap rocks in the eastern Tazhong area and provides a methodological basis for deep and ultra-deep subsalt hydrocarbon exploration. Full article

Chronic diseases—including diabetes mellitus, cardiovascular disease, chronic kidney disease, and autoimmune disorders—remain the leading causes of global morbidity and mortality. While biomedical pathophysiology defines the etiology and progression of these conditions, cultural factors significantly modulate how patients perceive illness, engage in treatment, and adhere to medical recommendations. This review synthesizes evidence from cross-cultural studies, with a specific focus on medical manifestations and therapeutic challenges, to examine how sociocultural determinants intersect with biological disease processes. We highlight nuanced case comparisons between South Asian, East Asian, Middle Eastern, African, Latinx, and Indigenous populations, illustrating how cultural constructs such as collectivism, fatalism, stigma, reliance on traditional medicine, and health literacy directly influence outcomes in chronic disease management. Importantly, we integrate evidence-based recommendations for healthcare professionals, emphasizing culturally tailored interventions, precision medicine approaches, and the role of interdisciplinary care teams. Full article

The alkaline rocks located in the Hatu area of Dulan county in the middle section of the East Kunlun Orogenic Belt have a relatively high content of light rare earth elements (LREE). This study conducted scanning electron microscopy (SEM) petrographic methods, zircon U-Pb dating, and geochemical work on two REE-mineralized alkaline rock outcrops, providing support for further work and study in the mining area. The REE-mineralized alkaline rocks are composed of alkali feldspar syenite, hornblende alkali feldspar syenite, and quartz alkali feldspar syenite. SEM analysis indicates that the REE are mainly hosted in REE-bearing minerals such as chevkinite, parisite, allanite, and monazite. The alkali feldspar syenite and hornblende alkali feldspar are enriched in REE, with a content of 994 × 10⁻⁶~5054 × 10⁻⁶. The zircon U-Pb dating results show that the ages of the two REE-mineralized alkaline rock are 423.6 ± 2.7 Ma and 431.2 ± 5.3 Ma, respectively. Geochemical analysis indicates that the Hatu alkaline rocks can be classify as A-type granite, and are characterized by evidence of a mixture of materials from the crust and mantle. Considering the regional tectonic history, it is primarily inferred that the Hatu REE-mineralization alkaline rocks were formed after the closure of the Proto-Tethys Ocean Basin and the Eastern Kunlun region experienced extensional tectonic stage, resulting in the upwelling of asthenospheric material and heating of crustal material. This study provides theoretical support for regional geochemical research and further exploration efforts in the Hatu area. Full article

In recent years, the food processing industry in the Gulf Cooperation Council (GCC) has faced increasing pressures to improve operational efficiency while improving its environmental performance. This research examines whether Lean Six Sigma (LSS) methodologies can be used as tools to incorporate sustainability into current operational processes at a date processing facility in Saudi Arabia. In addition to illustrating the ways in which production was improved, this research developed and preliminarily validated a Sustainability Integration Index (SII) framework to measure the contributions of improvement projects to sustainable practices in terms of their impact on the environment, society, and economy. Furthermore, this research examined the role of organizational culture as a moderator of the effectiveness of integrated LSS–sustainability approaches using a Cultural Readiness Assessment Model (CRAM). This research addressed production bottlenecks and aligned production with selected United Nation Sustainable Development Goals (SDGs) using the Define–Measure–Analyze–Improve–Control (DMAIC) methodology. Production bottlenecked in packaging operations resulted in schedule overruns and excessive overtime; therefore, the intervention focused on improving the production process in these areas. There were three distinct improvement streams: demand-based resource leveling, advanced production planning to allow for pull-based flow, and targeted maintenance to raise Overall Equipment Effectiveness (OEE) from 48.2% to 74.6%. Results indicated a 23% increase in daily processing capacity, a 38 min decrease in the average length of time of production closures, and estimated annual cost savings of 940,000 SAR (approximately USD 250,000). The SII framework showed a 21.2% improvement in sustainability scores, with a total composite score improvement from 0.66 to 0.80. Social sustainability had the greatest relative increase (+24.2%). Exploratory correlation analysis found that improvements in cultural maturity and cross-functional collaboration are possible predictors of successful sustainability integration; however, the limitations of the single case study limit the ability to draw causal inferences. The results provide both empirical evidence and possible measurement tools to an under-explored area: the use of LSS in Middle Eastern food processing industries with specific sustainability goals. Validation of the frameworks across different industries will be necessary to establish generalizability. Full article

Background: Although low-density-lipoprotein cholesterol (LDL-C) remains the primary target of lipid-lowering therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) continue to experience cardiovascular events. This residual risk suggests that LDL-C alone does not fully capture the total atherogenic burden. Alternative lipid measures, including non-high-density lipoprotein cholesterol (non-HDL-C) and cholesterol ratios, may provide a more comprehensive risk assessment, particularly in populations with a high prevalence of metabolic disorders. This study assessed the prevalence and clinical determinants of elevated non-HDL cholesterol and adverse cholesterol ratios among Middle Eastern patients with established ASCVD. Methods: This pooled cross-sectional analysis included 2763 adults with confirmed ASCVD from the Jordan SMuRF-less Study and six cardiovascular registries across the Middle East. Patients were stratified by standard modifiable cardiovascular risk factors (SMuRFs). Demographic, clinical, treatment, and lifestyle data were harmonized and analyzed using multivariable regression models. Results: Elevated non-HDL-C was observed in 54% of patients. Those with elevated non-HDL-C were younger (55.0 vs. 59.9 years) and more frequently current smokers (52.6% vs. 43.1%). Hypertension (64.2% vs. 51.0%) and heart failure (25.0% vs. 15.4%) were more common among patients with lower non-HDL-C, whereas dyslipidemia (90.8% vs. 75.8%) and acute coronary syndrome (88.1% vs. 83.7%) were more prevalent in the elevated group. Elevated non-HDL-C was associated with higher baseline LDL-C levels measured prior to the initiation of lipid-lowering therapy (141.3 vs. 81.1 mg/dL) and higher triglycerides (221.4 vs. 140.9 mg/dL). In multivariable analyses, age > 60 years (OR = 0.45), hypertension (OR = 0.74), and heart failure (OR = 0.61) were inversely associated with elevated non-HDL-C. Conclusions: Elevated non-HDL cholesterol is common among Middle Eastern patients with ASCVD, particularly younger individuals, reflecting early metabolic risk and increased atherogenic burden. Non-HDL-C is a valuable marker of residual cardiovascular risk, supporting earlier screening and region-specific prevention strategies. Full article

Background and Objectives: Frontal recess cells (FRCs) are key anatomical variants influencing frontal sinus drainage and disease. The International Frontal Sinus Anatomy Classification (IFAC) provides a standardized system for their identification. The baseline data on FRC prevalence and its association with sinusitis in Middle Eastern populations remain limited. This study aimed to assess the prevalence, laterality, and clinical relevance of FRCs in an adult Omani population using IFAC criteria. Materials and Methods: Computed tomography (CT) scans of 488 sides from 244 adult Omani patients were retrospectively reviewed to identify the FRCs according to IFAC. A total of 123 patients were found to have sinusitis: bilateral in 37 patients, right-sided in 38 patients, and left-sided in 48 patients. The prevalence of FRCs, along with their laterality and gender differences, was evaluated. Furthermore, the association between FRCs and sinusitis was analyzed using a chi-square test, followed by multivariable logistic regression analysis. Results: Among overall subjects (244 patients; 488 sides), agger nasi cells (79.5%, n = 388) and supra bulla cells (64.1%, n = 313) were the most prevalent cell types, whereas frontal septal cells (8.8%, n = 43) were the least common. Among study subjects (n = 244), laterality differences in FRC frequency were observed in the frontal septal cells, with a higher frequency of cells on the right side (p = 0.01), while no significant differences were found in other cell types. The presence of supra agger frontal cells (OR = 1.544, 95% CI: 1.02–2.23, p = 0.03) was positively correlated with sinusitis, while the presence of supra bulla cells was inversely associated with frontal sinusitis (OR = 0.61, 95% CI: 0.41–0.93, p = 0.01). The presence of FRC type was not significantly associated with the degree of sinusitis (p > 0.05). Significant gender differences were observed in supra orbital ethmoid cells (p = 0.01), with a male predominance. Conclusions: This study provides baseline data on the prevalence of FRCs in the Omani population. The presence of supra agger frontal cells appears to be associated with frontal sinusitis. No statistically significant gender- or laterality-associated differences were observed in most FRC types. Preoperative identification of supra agger frontal cells may facilitate effective surgical planning, particularly for endoscopic sinus surgery. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly integrated into healthcare decision-making. Public trust in AI remains a critical determinant of its acceptance and effective use. Evidence on the factors shaping trust in AI within Middle Eastern contexts, particularly Saudi Arabia, remains limited. Therefore, we aimed to identify the determinants of trust in AI for health-related decision-making and to examine a theory-informed mediation pathway in which patient satisfaction mediates the association between patient–doctor relationships and trust in AI. Methods: We conducted a cross-sectional, facility-based survey of adults in Saudi Arabia, using an electronic questionnaire distributed in four primary healthcare centers. We performed multiple linear regression to assess the association of trust in AI for health-related decision-making with patient satisfaction, patient–doctor relationships, sociodemographic characteristics, and healthcare-related factors. A mediation analysis was also employed to evaluate the indirect and direct association linking patient–doctor relationships, patient satisfaction, and trust in AI. Results: Our findings showed that patient satisfaction was positively associated with trust in AI (β = 0.54, 95% CI: 0.18–0.90), while patient–doctor relationships showed an inverse association (β = −0.34, 95% CI: −0.48 to −0.20), possibly reflecting a greater reliance on physicians’ clinical judgment and a reduced perceived need for AI-supported decision-making. Trust in AI varied across age groups, with a lower trust observed in older age categories compared with younger adults. No strong associations were observed for sex, education, body mass index, or healthcare-related factors. Patient–doctor relationship quality was indirectly associated with trust in AI via patient satisfaction (ACME = 0.138, 95% CI: 0.043–0.246), alongside a direct association with trust in AI (ADE = −0.313, 95% CI: −0.456 to −0.160). This means that patient–doctor relationships influenced trust in AI both directly and indirectly through patient satisfaction, suggesting that, while interpersonal care may reduce the reliance on AI (direct effect), enhancing patient satisfaction can partially offset this effect and promote trust in AI (indirect effect). Conclusions: These findings highlight that fostering patient-centered care and satisfaction may be crucial for promoting public trust in AI, which has important implications for AI governance, ethical deployment, and the design of AI-supported healthcare systems. Full article

Background: Lipoprotein(a) (Lp(a)) is a genetically determined lipid particle associated with atherosclerotic cardiovascular disease. Despite growing evidence supporting the clinical relevance of Lp(a) in cardiovascular risk stratification and the emergence of potential therapies targeting elevated Lp(a) levels, Lp(a) testing remains underutilized, with reported rates below 20–30%. This study aims to explore Lp(a) levels in the Lebanese population and their association with the vascular and metabolic burden of diseases. Methods: We conducted a retrospective observational study of patients who underwent Lp(a) level testing at the American University of Beirut Medical Center between 2010 and 2023. Data were extracted using the EPIC electronic medical record system, and statistical analyses were performed using IBM SPSS Statistics Version 28. Results: This study included 456 patients; the mean age was 50 ± 13, and the mean Lp(a) level was 25 ± 28 mg/dL. Mean Lp(a) was higher in females than in males (28 ± 32 mg/dL versus 23 ± 25 mg/dL), and 25.9%, 12.9%, and 7.6% of the population had Lp(a) levels ≥ 30, ≥50, and ≥70 mg/dL respectively. Logistic regression analysis showed no significant association between Lp(a) levels and cardiovascular factors including dyslipidemia, hypertension, coronary artery disease, previous coronary artery bypass graft, and previous myocardial infarction. Similarly, no significant correlation was found between Lp(a) and LDL, HDL, total cholesterol, triglyceride, and HbA1c. Subgroup analysis showed a significant relationship between Lp(a) levels > 50 mg/dL and atrial fibrillation. Conclusions: This study explores the distribution of Lp(a) levels in a Middle Eastern tertiary-care population and provides population-specific descriptive data, addressing an important gap in the existing literature. Full article

Background and Objective: This study examines the factors associated with child undernutrition among children under five in Ethiopia, Kenya, Madagascar, and Tanzania. It uses the Composite Index of Anthropometric Failure to measure the full burden of undernutrition, combining weight-for-height (WHZ), weight-for-age (WAZ), and height-for-age (HAZ) indicators. This approach captures children facing multiple forms of failure that single indicators miss. Methods: The study analyzed 37,570 children using nationally representative Demographic and Health Survey (DHS) data for Ethiopia 2019, Kenya 2022, Madagascar 2021, and Tanzania 2022. A binary logistic regression model identified key predictors of child undernutrition across countries. Results: The prevalence of anthropometric failure ranged from 24% to 44%. Higher parental education, child’s age, socioeconomic status, child’s sex, and a postnatal checkup within 2 months were associated with a lower odds of anthropometric failure. Children of educated mothers in Ethiopia (AOR = 0.547) and Tanzania (AOR = 0.606) had better outcomes. Educated fathers in Kenya (AOR = 0.589) and Madagascar (AOR = 0.369) reduced the risk of child undernutrition. Children aged 13–24 months had a higher risk in all countries. In Madagascar (AOR = 0.309), children who received a postnatal checkup had a decreased risk of malnutrition. Children from rich households in Ethiopia (AOR = 0.645) and from middle (AOR = 0.683) and rich (AOR = 0.535) households in Kenya had significantly lower odds of undernutrition. In comparison, female children had lower odds of anthropometric failure in all four countries. Conclusions: Viewed through a nutrition equity lens, these findings underscore the importance of recognizing how the intersectionality of anthropometric failures disproportionately affects children from poorer households and communities with limited access to education and postnatal care. This study advances existing knowledge by using the Composite Index of Anthropometric Failure to show overlapping and hidden forms of undernutrition. The findings identify child age, parental education, postnatal checkup, child sex, and socioeconomic status as shared priorities for reducing undernutrition. The results provide country-specific insights for designing integrated, evidence-based nutrition interventions in Eastern Africa. Full article