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Background: Pure desmoplastic melanoma (pDM) is an uncommon subtype of malignant melanoma with comparative high rates of local recurrence and low rates of sentinel lymph node positivity. The melanoma‐specific survival (MSS) of pDM compared to other melanoma subtypes is unclear, with conflicting reports and lack of multivariable analyses. Objectives: We aimed to describe clinicopathological characteristics of a cohort of patients with pDM and to compare the MSS of pDM with superficial spreading melanoma (SSM). Methods: A prospective cohort study was performed of all primary invasive cutaneous pDM with known tumour location and thickness reviewed at a tertiary referral centre over 21 years. Results: A total of 119 primary cutaneous invasive pDMs from 3570 total invasive cutaneous melanomas were included. Compared to 2272 SSMs, and due largely to their greater average thickness, patients with pDM had worse MSS (unadjusted hazard ratio, HR, 2.56, 95% confidence interval, CI, 1.56–4.22). After adjustment for clinicopathologic factors (including thickness, ulceration, mitotic rate, age and sex), there was evidence that patients with pDM had an improved MSS (adjusted HR, 0.49; 95% CI, 0.28–0.87). Median thickness of head and neck pDM was greater than non‐head and neck pDM (P < 0.001). There was reduced univariable MSS in head and neck pDM compared to the rest of the body. Conclusions: Decreased univariable MSS of patients with pDM compared to SSM was explained by the increased frequency of adverse clinicopathologic features at diagnosis, in particular the greater Breslow thickness of pDM. After adjustment, patients with pDM had half the chance of melanoma‐specific death compared to SSM. Head and neck pDM were thicker at diagnosis compared to the rest of the body, which may account for its poorer survival compared to the rest of the body. [ABSTRACT FROM AUTHOR]

This paper discusses the results obtained from a micro-computer program SIMTUP developed at the National University of Singapore for off-line adaptive optimization of a multi-pass CNC lathe-turning process. An initial estimation based on empirical models is conducted to obtain the total amount of time, cost and resources required for production. These models are to be updated with a view to arriving at new optimal cutting conditions with respect to production time. The optimal cutting conditions are based on the minimum production cost change with respect to production time for a dynamic system, a principle taken into account in SIMTUP. Estimations can be conducted at any stage to re-evaluate the total resources required. The results obtained can be used as effective productivity improvement tools for project management and quality control. [ABSTRACT FROM AUTHOR]

Purpose: Radiotherapy (RT) treatment of locally-advanced and recurrent head and neck carcinoma (HNC) results in disappointing outcomes. Combination of RT with cisplatin or cetuximab improves survival but the increased toxicity and patient's comorbidity warrant the need for a less-toxic radiosensitizer. Stimulated by several randomized studies demonstrating the radio-sensitizing effect of hyperthermia, we developed the HYPERcollar. Here, we report early experience and toxicity in patients with advanced HNC. Methods and materials: 119 hyperthermia treatments given to 27 patients were analyzed. Hyperthermia was applied once a week by the HYPERcollar aimed at achieving 39-43 °C in the target area, up to patients’ tolerance. Pre-treatment planning was used to optimize treatment settings. When possible, invasive thermometry catheters were placed. Results: Mean power applied during the 119 hyperthermia treatments ranged from 120 to 1007 W (median 543 W). 15 (13%) hyperthermia treatments were not fully completed due to: pain allocated to hyperthermia (6/15), dyspnea from sticky saliva associated with irradiation (2/15) and unknown reasons (7/15). No severe complications or enhanced thermal or mucosal toxicities were observed. Excluding post-operative treatment, response rates after 3 months were 46% (complete) and 7% (partial). Conclusion: Hyperthermia with the HYPERcollar proved to be safe and feasible with good compliance and promising outcome. [ABSTRACT FROM AUTHOR]

Substance abuse refers to an act of misuse or excessive use of alcohol, tobacco and illicit drugs. There is no denying that substance abuse is on the increase at both the global and national level in Malaysia. Even though substance abuse is a strictly prohibited behaviour in all Malaysian schools, studies have indicated that this delinquent behaviour often stems from schools. Therefore the main aim of this paper is to present students' perspectives of substance abuse among secondary school students in Malaysia. The data for the study were collected using a questionnaire, checklist and semi-structured interviews which involved 1800 secondary school students from 18 high risk secondary schools from the states of Selangor, Wilayah Persekutuan Kuala Lumpur, Penang, Negeri Sembilan and Melaka. The Risk and Protective Factor Questionnaire (RPFQ) has 13 sub-sections and is an adapted version of the Communities That Care Youth Survey which has 14 sub-sections. The findings indicated that the common substance abuse behaviours in schools were smoking, consuming alcohol, using marijuana and glue-sniffing. More than half of the student respondents had 1 to 3 friends who were involved in smoking. Furthermore, findings indicated that a majority of them became involved in these unhealthy activities between the ages of 15 and 17 years and were most likely to be engaged in these activities during weekends and outside school. Findings also revealed that close to 405 of the students (>30%) felt that their parents did not view glue sniffing, consuming alcohol or smoking as an offence. These findings imply that the increase in the number of substance abusers among secondary school students can have an adverse effect on their peers and that as a nation Malaysia needs to embrace the fact that substance abuse can derail the noble aspirations of the country to become a developed economy by 2020. Therefore, it is pertinent that all authorities in schools and community stakeholders such as AADK and Ministry of Education understand the pattern of substance abuse among secondary school students in Malaysia and develop suitable programmes or strategies to curb such behaviours in school. [ABSTRACT FROM AUTHOR]

Developing molecular diagnostics in resource-poor settings is challenging. As such, we purpose-built a novel bridging flocculation assay for qualitative evaluation of isothermally amplified DNA by naked eye. The flocculation assay was dependent on pH, DNA polymer amounts and lengths. The method was first applied to the rapid and sensitive detection of important plant pathogens and subsequently extended to other pathogens across the animal kingdom to demonstrate the wide applications of our approach. [ABSTRACT FROM AUTHOR]

A 21-year-old woman presented with acute onset of upper abdominal pain. A diagnosis of Peutz-Jeghers syndrome (PJS) was made based on the clinical picture of perioral pigmentation with imaging findings of transient jejunojejunal intussusceptions and small bowel polyps, and confirmed by characteristic histopathological appearances of Peutz-Jeghers polyps. PJS is a rare hereditary condition characterised by unique hamartomatous polyps, perioral mucocutaneous pigmentations, and increased susceptibility to gastrointestinal and extraintestinal neoplasms. Patients usually present with recurrent abdominal pain due to intussusception caused by polyps. Other modes of presentations include rectal bleeding and melaena. We describe the imaging findings of PJS and provide a brief review of bowel polyposis syndromes. The latter are relatively rare disorders characterised by multiple polyps in the large or small intestine, with associated risk of malignancies and other extraintestinal manifestations. Awareness of the manifestations and early diagnosis of these syndromes is crucial to prevent further complications. [ABSTRACT FROM AUTHOR]

A 46-year-old man presented with right loin tenderness following a road traffic accident. Computed tomography and magnetic resonance imaging showed a well-defined, smooth, enhancing oval lesion in the wall of the first part of the duodenum. The lesion was seen separately from the normal pancreas. It showed attenuation, intensity and enhancement similar to that of normal pancreas. Based on the imaging appearance, a diagnosis of ectopic pancreas was made. The patient underwent oesophagogastroduodenoscopy, endoscopic ultrasonography and fine-needle aspiration cytology of the lesion, which confirmed ectopic pancreatic tissue. Since the patient was asymptomatic, surgical resection was deferred. The embryologic origin, various locations, imaging appearance and clinical significance of ectopic pancreas are discussed. [ABSTRACT FROM AUTHOR]

MicroRNAs (miRNAs) are small non-coding RNAs of ∼20 nt in length that are capable of modulating gene expression post-transcriptionally. Although miRNAs have been implicated in cancer, including breast cancer, the regulation of miRNA transcription and the role of defects in this process in cancer is not well understood. In this study we have mapped the promoters of 93 breast cancer-associated miRNAs, and then looked for associations between DNA methylation of 15 of these promoters and miRNA expression in breast cancer cells. The miRNA promoters with clearest association between DNA methylation and expression included a previously described and a novel promoter of the Hsa-mir-200b cluster. The novel promoter of the Hsa-mir-200b cluster, denoted P2, is located ∼2 kb upstream of the 5′ stemloop and maps within a CpG island. P2 has comparable promoter activity to the previously reported promoter (P1), and is able to drive the expression of miR-200b in its endogenous genomic context. DNA methylation of both P1 and P2 was inversely associated with miR-200b expression in eight out of nine breast cancer cell lines, and in vitro methylation of both promoters repressed their activity in reporter assays. In clinical samples, P1 and P2 were differentially methylated with methylation inversely associated with miR-200b expression. P1 was hypermethylated in metastatic lymph nodes compared with matched primary breast tumours whereas P2 hypermethylation was associated with loss of either oestrogen receptor or progesterone receptor. Hypomethylation of P2 was associated with gain of HER2 and androgen receptor expression. These data suggest an association between miR-200b regulation and breast cancer subtype and a potential use of DNA methylation of miRNA promoters as a component of a suite of breast cancer biomarkers. [ABSTRACT FROM AUTHOR]

Nonvariceal upper gastrointestinal bleeding is unique from variceal bleeding in terms of patient characteristics, management, rebleeding rates, and prognosis, and should be managed differently. The majority of nonvariceal upper gastrointestinal bleeds will not rebleed once treated successfully. The incidence is 80 to 90% of all upper gastrointestinal bleeds and the mortality is between 5 to 10%. The causes include nonacid-related ulceration from tumors, infections, inflammatory disease, Mallory-Weiss tears, erosions, esophagitis, dieulafoy lesions, angiodysplasias, gastric antral vascular ectasia, and portal hypertensive gastropathy. Rarer causes include hemobilia, hemosuccus pancreaticus, and aortoenteric fistulas. Hematemesis and melena are the key features of bleeding from the upper gastrointestinal tract, but fresh per rectal bleeding may be present in a rapidly bleeding lesion. Resuscitation and stabilization before endoscopy leads to improved outcomes. Fluid resuscitation is essential to avoid hypotension. Though widely practiced, there is currently insufficient evidence to show that routine red cell transfusion is beneficial. Coagulopathy requires correction, but the optimal international normalized ratio has not been determined yet. Risk stratification scores such as the Rockall and Glasgow-Blatchford scores are useful to predict rebleeding, mortality, and to determine the urgency of endoscopy. Evidence suggests that high-dose proton pump inhibitors (PPI) should be given as an infusion before endoscopy. If patients are intolerant of PPIs, histamine-2 receptor antagonists can be given, although their acid suppression is inferior. Endoscopic therapy includes thermal methods such as coaptive coagulation, argon plasma coagulation, and hemostatic clips. Four quadrant epinephrine injections combined with either thermal therapy or clipping reduces mortality. In hypoxic patients, endoscopy masks allow high-flow oxygen during upper gastrointestinal endoscopy. The risk of rebleeding reduces after 72 hours. In rebleeding, repeat endoscopy is useful and persistent failure of endoscopic therapy mandates either embolization or surgery. In this review, we analyze the management of nonvariceal upper gastrointestinal bleeding with evidence from the currently published clinical trials. [ABSTRACT FROM AUTHOR]

The Penang Bridge is a 13·5 km long road crossing connecting Penang Island to peninsular Malaysia. In order to increase traffic capacity, approximately 6 km of low-level viaduct sections of the crossing were widened by the addition of a new lane and hard shoulder in each direction. This challenging project invovled the construction of new decks, piers and deep-piled foundations in close proximity to the existing structure, with extensive use of heavy plant and machinery mounted on marine barges. Key project objectives were to maintain an operational highway at all times and to safeguard the existing structure during the works. The latter invovled the development of a construction sequence designed to minimise the load transfer from the new works onto the existing structure, and the implementation of a rigorous monitoring regime during pile constrution. [ABSTRACT FROM AUTHOR]

Dear Editor, Acral lentiginous melanoma (ALM) is typically diagnosed at an advanced stage, which may be due its unique presentation.[1] Studies have evaluated whether the ALM subtype is an independent prognostic factor, and shown conflicting results.[[2]] Previous reports have been limited by small numbers and lacked adjustment for confounders.[[1], [3]] Therefore, the aim of this study was to compare the melanoma-specific survival (MSS) of patients with ALM with that of patients with other melanoma subtypes. ALM, acral lentiginous melanoma; NM, nodular melanoma; SSM, superficial spreading melanoma; IQR, interquartile range. Hence, in this study of a prospectively collected Australian ALM cohort, multivariable subtype survival comparisons demonstrated a significantly longer adjusted survival for patients with NM compared with ALM. [Extracted from the article]

The article focuses on study which aims to determine prognosis of naevus-associated and de novo melanoma in melanoma subtypes which are superficial spreading melanoma (SSM) and nodular melanoma (NM). It presents impact of naevus association on survival for nodular and superficial spreading melanomas. It states presence of associated naevus is assessed on haematoxylin and eosin stained. It mentions information on patient demographics and tumor characteristics of melanomas.