Identifying Oncology Clinical Trial Candidates Using Artificial Intelligence Predictions of Treatment Change: A Pilot Implementation Study.

PURPOSE: Precision oncology clinical trials often struggle to accrue, partly because it is difficult to find potentially eligible patients at moments when they need new treatment. We piloted deployment of artificial intelligence tools to identify such patients at a large academic cancer center. PATIENTS AND METHODS: Neural networks that process radiology reports to identify patients likely to start new systemic therapy were applied prospectively for patients with solid tumors that had undergone next-generation sequencing at our center. Model output was linked to the MatchMiner tool, which matches patients to trials using tumor genomics. Reports listing genomically matched patients, sorted by probability of treatment change, were provided weekly to an oncology nurse navigator (ONN) coordinating recruitment to nine early-phase trials. The ONN contacted treating oncologists when patients likely to change treatment appeared potentially trial-eligible. RESULTS: Within weekly reports to the ONN, 60,199 patient-trial matches were generated for 2,150 patients on the basis of genomics alone. Of these, 3,168 patient-trial matches (5%) corresponding to 525 patients were flagged for ONN review by our model, representing a 95% reduction in review compared with manual review of all patient-trial matches weekly. After ONN review for potential eligibility, treating oncologists for 74 patients were contacted. Common reasons for not contacting treating oncologists included cases where patients had already decided to continue current treatment (21%); the trial had no slots (14%); or the patient was ineligible on ONN review (12%). Of 74 patients whose oncologists were contacted, 10 (14%) had a consult regarding a trial and five (7%) enrolled. CONCLUSION: This approach facilitated identification of potential patients for clinical trials in real time, but further work to improve accrual must address the many other barriers to trial enrollment in precision oncology research.

Prostate-specific Antigen Density as a Proxy for Predicting Prostate Cancer Severity: Is There Any Difference between Systematic and Targeted Biopsy?

Background: Prostate cancer screening with prostate-specific antigen (PSA) can result in unnecessary biopsies and overdiagnosis. Alternately, PSA density (PSAD) calculation may help support biopsy decisions; however, evidence of its usefulness is not concrete. Objective: To evaluate the predictive value of PSAD for clinically significant prostate cancer detection by systematic and MRI-targeted biopsies. Methods: This prospective study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2018 and November 2021. Patients suspected of prostate cancer were subjected to multi-parametric MRI, and for those with positive findings, systematic and targeted biopsies were performed. Clinically non-significant and significant prostate cancer cases were classified based on histopathology-defined ISUP grade or Gleason score. The PSAD was measured using the prostate volume determined by the MRI and categorized into ≤0.15, 0.16-0.20, and >0.20 ng/ml2 subgroups. Results: Systematic and targeted biopsies were carried out for 284 patients. The discriminant ability of PSAD is higher in MRI-targeted biopsy compared with systematic biopsy (AUC: 0.77 vs. 0.73). The highest sensitivity (97%) and specificity (87%) were detected at 0.07 ng/ml2 in targeted biopsy. More than half of the clinically significant cases were detected in the >0.2 ng/ml2 PSAD category (systematic: 52.4%; targeted: 51.1%). The CHAID methodology found that the probability of having clinically significant cancer (CSC) in patients with PSAD >0.15 ng/ml2 was more than threefold than that in patients with PSAD ≤0.15 ng/ml2 (64% vs. 20.2%). When considered by age, in PSAD ≤0.15 ng/ml2 subgroup, the percentage of CSC detection rate increased from 20.2% to 24.6% in patients aged ≥60 years. Conclusion: PSAD has good discriminant power for predicting clinically significant prostate cancer. A cutoff of 0.07 ng/ml2 should be adopted, but should be interpreted with caution and by considering other parameters such as age.

In vitro analysis of iron oxide (Fe3O4) nanoparticle mediated degradation of polycyclic aromatic hydrocarbons (PAHs) and their antimicrobial activity.

To degrade anthracene, magnetite nanoparticles were produced using a simple co-precipitation process. The fabricated nanoparticles have been analyzed for structural and optical properties. XRD examination revealed that the produced Fe3O4 nanoparticles were cubic phase, having a mean crystallite dimension of 18.84 nm. DLS determined the hydrodynamic diameter of Fe3O4 nanoparticles to be 182 nm. UV-Vis research revealed that Fe3O4 nanoparticles absorb at 390 nm. A peak at 895 cm-1 in the FT-IR study indicated the metal-oxygen connection. The synthesized Fe3O4 nanoparticles demonstrated an effective photocatalytic performance towards anthracene degradation and was found to be 86.55%. Furthermore, Fe3O4 nanoparticles showed the highest antimicrobial activity against Bacillus subtilis was 19.43 mm. The present study is the first and foremost study determining the dual role of Fe3O4 nanoparticles towards bioremediation and biomedical applications.

Are There Any Developments in the Attitudes and Practices of Oncologists Regarding Fertility Preservation in Saudi Arabia After 12 Years?

INTRODUCTION: The current practice of offering fertility preservation (FP) counseling and treatment has become one of the focal points in patient care throughout cancer treatment. The turning point was the approval of the Council of Senior Religious Scholars four years ago to freeze tissues from the ovarian membrane, the entire ovary, and the eggs for later use in reproduction to preserve the offspring. Thus, we aimed to assess any development in oncologists' knowledge, attitude, and referral practices regarding FP in Saudi Arabia. METHODS: This is a cross-sectional survey using a self-administered questionnaire. We assessed oncologists' opinions on the importance of FP, their perception of the patient's preferences, and factors to consider when discussing the subject. Then, we assessed the knowledge and referral practices, including the timing of referral before starting cancer treatment. RESULTS: Most oncologists showed good knowledge and positive attitudes toward FP; however, their referral practices could be better. Most were familiar with FP options. The most significant factors influencing the oncologist-patient FP discussion were the number of existing children, marital status, cost, and type of cancer (96.6%, 76.7%, 65.7%, and 58.9%, respectively). CONCLUSIONS: There is a significant improvement in the knowledge and attitude of oncologists toward FP. However, patients' counseling and referral to fertility services still need to be improved. There is a shortfall in the clinical practice guidelines for FP in cancer patients in Saudi Arabia. The implementation of clinical practice guidelines would enhance FP. However, patients' counseling and referral to fertility services still need to be improved. The lack of proper guidelines on FP is affecting oncologists' practice.

Fabrication and characterization of manganese dioxide (MnO2) nanoparticles and its degradation potential of benzene and pyrene.

MnO2 nanoparticles have a wide range of applications, including catalytic abilities due to their oxygen reduction potential. Industrial processes and the burning of organic materials released PAHs into the biosphere which have adverse effects on living organisms when continually exposed. In this study, MnO2 nanoparticles were synthesized chemically using sodium thiosulphate as reducing agent. MnO2 nanoparticles were characterized using UV-visible adsorption spectroscopy and Fourier Transform Infrared Spectroscopy (FTIR). A X-Ray Diffraction Spectrophotometer (XRD), a Scanning Electron Microscopy - Energy Dispersive X-Ray Analyzer (SEM-EDAX), and Dynamic Light Scattering (DLS) were used to identify the crystalline nature and particle size of the fabricated MnO2 nanoparticles. Batch adsorption studies were conducted to identify the optimal conditions for better benzene and pyrene adsorption from aqueous solution using MnO2 nanoparticles. They are also effective in degrading benzene and pyrene by batch adsorption as determined by their adsorption isotherms and kinetics.

Phytoremediation efficiency of Vigna mungo with the amalgamation of indigenous metal tolerant bacterial strain on metal polluted agriculture soil.

This research was performed to evaluate physico-chemical properties of farmland soil nearby the magnesite mine site. Unexpectedly, few physico-chemical properties were crossing the acceptable limits. Particularly, the quantities of Cd (112.34 ± 3.25), Pb (386.42 ± 11.71), Zn (854.28 ± 3.53), and Mn (2538 ± 41.11) were crossing the permissible limits. Among 11 bacterial cultures isolated from the metal contaminated soil, 2 isolates names as SS1 and SS3 showed significant multi-metal tolerance up to the concentration of 750 mg L-1. Furthermore, these strains also showed considerable metal mobilization as well as absorption ability on metal contaminated soil under in-vitro conditions. In a short duration of treatment, these isolates effectively mobilize and absorb the metals from the polluted soil. The results obtained from the greenhouse investigation with Vigna mungo revealed that the among various treatment (T1 to T5) groups, the T3 (V. mungo + SS1+SS3) showed remarkable phytoremediation potential (Pb: 50.88, Mn: 152, Cd: 14.54, and Zn: 67.99 mg kg-1) on metal contaminated soil. Furthermore, these isolates influence the growth as well as biomass of V. mungo under greenhouse conditions on metal contaminated soil. These findings suggest that combining multi-metal tolerant bacterial isolates can improve the phytoextraction efficiency of V. mungo on metal-contaminated soil.

The possible role of sodium leakage channel localization factor-1 in the pathophysiology and severity of autism spectrum disorders.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social, stereotypical, and repetitive behaviors. Neural dysregulation was proposed as an etiological factor in ASD. The sodium leakage channel (NCA), regulated by NLF-1 (NCA localization factor-1), has a major role in maintaining the physiological excitatory function of neurons. We aimed to examine the level of NLF-1 in ASD children and correlate it with the severity of the disease. We examined the plasma levels of NLF-1 in 80 ASD and neurotypical children using ELISA. The diagnosis and severity of ASD were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Childhood Autism Rating Score, Social Responsiveness Scale, and Short Sensory Profile. Then, we compared the levels of NLF-1 with the severity of the disease and behavioral and sensory symptoms. Our results showed a significant decrease in the plasma levels of NLF-1 in ASD children compared to neurotypical children (p < 0.001). Additionally, NLF-1 was significantly correlated with the severity of the behavioral symptoms of ASD (p < 0.05). The low levels of NLF-1 in ASD children potentially affect the severity of their behavioral symptoms by reducing neuron excitability through NCA. These novel findings open a new venue for pharmacological and possible genetic research involving NCA in ASD children.

Improving the efficiency of metal ions doped Fe2O3 nanoparticles: Photocatalyst for removal of organic dye from aqueous media.

The metal ion-based nanocomposite photocatalysts were accepted to exhibit a wide range of photocatalytic and biological applications. In this paper, we synthesize bare Fe2O3, 1 wt% metal (Ag, Co, and Cu) doped Fe2O3 nanoparticles (NPs) using a simple hydrothermal process and wet impregnation method. The as-prepared nanomaterials crystalline structure, shape, optical characteristics, and elemental composition were determined by using X-ray powder diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Scanning electron microscope (SEM), Energy-dispersive X-ray (EDS) and Transmission electron microscopy (TEM) techniques. Furthermore, the synthesized nanocomposites were utilized as a photosensitizer for the degradation of reactive red (RR120) and orange II (O-II) dyes under sunlight irradiation. The synthesized 1 wt% Ag-Fe2O3 (AgF) NPs samples exhibit a more exceptional catalytic performance of RR120 and O-II dyes (98.32%) within 120 min than the existing Fe2O3, 1 wt% Co-Fe2O3, and Cu-Fe2O3 NPs. The effect of parameters such as exciton formation under solar irradiation, charge recombination rate, and surface charge availability. The metal oxide-doped nanocomposite economic relevance is revealed by their long-term durability and recyclability in photodegradation reactions. The photocatalytic investigations show that the active species O2∙-, HO∙ and h+ play an important role in the dye degradation process. This research might pave the opportunity for the sustainable development of greater photocatalysts for photodegradation and a wide range of environmental applications.

Development of biohybrid Ag2CrO4/rGO based nanocomposites with stable flotation properties as enhanced Photocatalyst for sewage treatment and antibiotic-conjugated for antibacterial evaluation.

The proposed research outlines a facile method to synthesize Silver Chromate/reduced graphene oxide nanocomposites (Ag2CrO4/rGO NCs) with a narrow dissemination size for the ecological treatment of hazardous organic dyes. The photodegradation performance toward the decontamination of model artificial methylene blue dye was assessed under solar light irradiation. The crystallinity, particle size, recombination of photogenerated charge carriers, energy gap and surface morphologies of synthesized nanocomposites were determined. The experiment objective is to use rGO nanocomposites to increase Ag2CrO4 photocatalytic efficiency in the solar spectrum. Tauc plots of ultraviolet-visible (UV-vis) spectrum were used to calculate the optical bandgap energy of the produced nanocomposites ∼1.52 eV, which resulted in a good photodegradation percentage of ∼92 % after 60 min irradiation of Solar light. At the same time, pure Ag2CrO4 and rGO nanomaterials showed ∼46 % and âˆ¼ 30 %, respectively. The ideal circumstances were discovered by investigating the effects of several parameters, including catalyst loading and different pH levels, on the degradation of dyes. However, the final composites maintain their ability to degrade for up to five cycles. According to the investigations, Ag2CrO4/rGO NCs are an effective photocatalyst and can be used as the ideal material to prevent water pollution. Furthermore, antibacterial efficacy for the hydrothermally synthesized nanocomposite was tested against gram-positive (+ve) bacteria viz. Staphylococcus aureus and gram-negative (-ve) bacteria viz. Escherichia coli. The maximum zone of inhibition for S. aureus and E. coli were 18.5 and 17 mm, respectively.

Widespread Third-Party Tracking On Hospital Websites Poses Privacy Risks For Patients And Legal Liability For Hospitals.

Computer code that transfers data to third parties (third-party tracking) is common across the web and is subject to few federal privacy regulations. We determined the presence of potentially privacy-compromising data transfers to third parties on a census of US nonfederal acute care hospital websites, and we used descriptive statistics and regression analyses to determine the hospital characteristics associated with a greater number of third-party data transfers. We found that third-party tracking is present on 98.6 percent of hospital websites, including transfers to large technology companies, social media companies, advertising firms, and data brokers. Hospitals in health systems, hospitals with a medical school affiliation, and hospitals serving more urban patient populations all exposed visitors to higher levels of tracking in adjusted analyses. By including third-party tracking code on their websites, hospitals are facilitating the profiling of their patients by third parties. These practices can lead to dignitary harms, which occur when third parties gain access to sensitive health information that a person would not wish to share. These practices may also lead to increased health-related advertising that targets patients, as well as to legal liability for hospitals.

False-positive magnetic resonance imaging prostate cancer correlates and clinical implications.

Background: False-positive (FP) multiparametric magnetic resonance imaging (MPMRI) obscures and swift needless biopsies in men with a high prostate-specific antigen. Materials and Methods: This was a retrospective study, in which all patients who had been exposed to consecutive MP-MRI of the prostate combined with transrectal ultrasound-guided-magnetic resonance imaging fusion-guided prostate biopsy between 2017 and 2020 were involved in the study. The FP was measured as the number of biopsies that did not encompass prostate cancer divided by the whole number of biopsies. Results: The percentage of FP cases was 51.1%, the highest percentage was found in Prostate Imaging-Reporting and Data System (PI-RADs) 3 (37.7%) and the lowest was detected in PI-RAD 5 (14.5%). Those with FP biopsies are younger, and their total prostate antigen (PSA) and PSA density (PSAD) are significantly lesser. The area under the curve PSAD, age, and total PSA are 0.76, 0.74, and 0.69, respectively. An optimum PSAD value of 0.135 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 68% and 69%, respectively. Conclusion: FP results of mpMRI were detected in more than half of our sample, more than one-third were presented in Pi-RAD3, improved imaging techniques to decrease FP rates are highly needed.

Why cancer incidence in the Arab counties is much lower than other parts of the world?

Despite the relatively increased cancer incidence in the last few years in the Arab countries, it is still far from the figures reported from Western countries. Several mechanisms have been adopted to explain the significant decreased incidence of cancer in the Arab countries, among them fasting, food full of special recipes filled with spices, significant lower rates of smoking and alcohol drinking, and genetic predisposition. Clinical trials are warranted on a large population scales to study, discuss, and verify such mechanisms.

Nutritional Related Knowledge of Cancer Prevention among Primary Health Care Physicians.

OBJECTIVES: To explore the cancer prevention-related nutrition knowledge of primary health care physicians towards nutrition and its relation to the development of cancer. MATERIALS AND METHODS: a cross-sectional study was conducted among family physicians in Riyadh, between November 2019 and April 2020. The participants in the current study were surveyed using a self-administered questionnaire. The questionnaire included socio-economic data and data related to the association between nutrition and cancer. RESULTS: The mean correct knowledge score for physicians is good but less than expected (26.5+5.8) 73.6%. Multiple regression revealed that age, position, and nationality to be significantly associated with knowledge of cancer prevention (P<0.05) among physicians. CONCLUSIONS: Primary care physicians have good knowledge about the relation between nutrition and cancer but not sufficient, they should have continuous nutrition educational training programs to ensure safe and sound nutritional advice to patients and for the public about the relation of nutrition and cancer.

Effectiveness of magnetic resonance imaging-targeted biopsy for detection of prostate cancer in comparison with systematic biopsy in our countries with low prevalence of prostate cancer: our first experience after 3 years.

BACKGROUND: Some men are subjected to multiple repeated biopsies because of ongoing suspicion of prostate cancer, which might subject them to complications. The aim of the study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI)/target fusion-guided biopsy in comparison with systematic biopsy in our low prevalence prostate cancer population, in terms of validity measure, case detection rate, and detection of clinically significant cancer. METHODS: This is a retrospective cohort study. All consecutive patients who met the inclusion criteria (all men with persistent high prostate-specific antigen levels >4 ng/ml and/or subnormal finding in direct rectal examination, with suspicious regions identified on prebiopsy MRI) were subjected to transrectal MRI/ultrasound fusion-guided biopsy. RESULTS: A total of 165 cases met the inclusion criteria and were included in the study. The cancer detection rate (CDR) of target biopsy was significantly higher than that of standard biopsy (27.9% vs 14%, respectively), and 25 cases (52%) were missed by standard strategy and correctly classified by multiparametric MRI with targeted biopsy (MRI-TB). On the other hand, only 2 cases (4.3%) were misclassified by MRI-TB, and one of them was clinically significant. There was an exact agreement between the 2 strategies in 15 (31%) cases. Targeted biopsy diagnosed 41.5% more high-risk cancers vs systematic biopsy (41.6% vs 6.2%, P < .001). The difference between sensitivity, specificity, and negative predictive value of MRI-TG varies between 80% and 98%. CONCLUSION: The CDR of prostate cancer in general and clinically significant cancer, in specific, is significantly higher with MRI-TG modality than with systematic modality. Yet, MRI-TG biopsy still misses some men with clinically significant prostate cancer. Hence, the addition of a 12-core biopsy is required to evade missing cases of clinically significant and insignificant cancer.

Transperineal versus transrectal multi-parametric magnetic resonance imaging fusion targeted prostate biopsy.

OBJECTIVES: To compare transperineal biopsies (TPBx) with transrectal ultrasound-guided biopsy (TRUSBx) in order to provide evidence, making clinicians able to select the appropriate biopsy approach under different conditions. METHODS: A comparative prospective study, conducted in King Khalid University Hospital (KKUH) and King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Kingdom of Saudi Arabia, between March 2019 and February 2020. All patients with raised prostate-specific antigen or atypical digital rectal examination findings were subjected to multi-parametric magnetic resonance imaging (MRI). Those with positive findings were referred to targeted fusion- guided biopsy either TPBx or TRUSBx, randomly. Complication rate, cancer detection rate, and procedure time were recorded. RESULTS: Transperineal biopsies and TRUSBx had an equivalent complication rate. However, both case detection rate and clinically significant cancer detection rate were significantly higher in TPBx versus TRUSBx (45.1% versus 29.1%, p=0.003; and 71.8% versus 43.7%, p=0.002; respectively). Transperineal biopsies was a longer procedure than TRUSBx (41.2±0.7 min versus 13±2.3 min, p=0.0001). CONCLUSION: No difference in complication rate was detected between the 2 procedures; however, TPBx was more effective for cancer detection in general and clinically significant cancer detection in particular.

Fluorescence spectroscopy as a novel technique for premarital screening of sickle cell disorders.

Spectral diagnostic screening for sickle cell disease was carried out on volunteer blood samples (N = 100). The samples were subjected to different diagnostic methods including conventional complete blood count (CBC), hemoglobin electrophoresis (HBE) and spectral diagnosis. For the spectral diagnostic method, we discriminated three different characteristic spectral features. In total, 15 samples were sickle cell trait (SCT), 34 samples were sickle cell disease (SCD), and the rest of the samples (N = 51) were normal controls. The spectral discrimination of the three different sets of samples was distinguished on the quantification of fluorescent biomolecules such as tyrosine, tryptophan, NADH, FAD, and porphyrins. The results were compared with the conventional standard CBC and capillary electrophoresis findings. The spectral diagnosis method exhibited a sensitivity and specificity greater than 90 % for the tested samples. This technique requires only 5 mL blood samples, has an analysis time of 20 min, exhibits high accuracy and may be used in small clinics in remote villages.

Does shared decision making increase prostate screening uptake in countries with a low prevalence of prostate cancer?

BACKGROUND: Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors. OBJECTIVES: To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening practices among Saudi men. METHODS: This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed. RESULTS: In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate examination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing. CONCLUSION: Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process.

Fluorescence spectral detection of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML): A novel photodiagnosis strategy.

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cell, showing a rapid growth of lymphoblastic immature cells. Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood cells. Early diagnosis is crucial for the effective treatment of these patients. The current standard procedure of diagnosis is extensive blood count analysis, microscopic morphological investigations, bone marrow biopsy and flow-cytometer which are all time- consuming and expensive. Here we demonstrate the advantage a new technique for the diagnosis of ALL and AML based on the fluorescence spectra of blood plasma and RBCs samples from the above patients. Based on the 85 patients analyzed the results reveal that our approach could discriminate the two malignancies unambiguously from the normal with 88 % sensitivity and 80 % specificity. The abnormal decrease in the level of amino acid, tryptophan and coenzyme NADH and abnormal increase in the other amino acid, tyrosine and another coenzyme FAD, (both in comparison to the normal control) act as malignancy indicative biomarkers. Since the contrast parameter between the normal and malignant samples is four- fold, the potential for early detection of leukemia is high. The instrumentation and technique are new and simple; hence may have significant supplementary or complementary value with the existing diagnostic methods.

Facile spectroscopy and atomic force microscopy for the discrimination of α and ß thalassemia traits and diseases: A photodiagnosis approach.

Thalassemia (Thal) is an inherited blood disorder endemic to the Mediterranean and Middle East (e.g., KSA and UAE). This disease is caused by defects in the synthesis of one or more hemoglobin chains in red blood cells (RBCs). Alpha (α) Thal is caused by a reduced or absent alpha globin segment. Similarly, beta (ß) Thal is caused by a defect in the beta globin segment. We divided the diseases into four groups: α Thal trait, α Thal disease, ß Thal trait, and ß Thal disease. The α or ß Thal traits are milder variants of these diseases and do not require treatment; but ß Thal disease (and to a lesser extent, α Thal) causes hemolytic anemia, splenomegaly, and bone deformities and requires repeated lifelong blood transfusions. This paper presents results regarding the identification of Thal variants using fluorescence spectroscopy of blood biomolecules and atomic force microscopy analysis of the morphologic features of red blood cells. The combined results provide new insights into the characteristics of these diseases. Furthermore, this study shows why ß Thal disease subjects are often transfusion-dependent, and α Thal disease subjects are only occasionally transfusion dependent.