Mackay Base Hospital

ABL2 rearrangements represent a subtype of acute lymphoblastic leukaemia (ALL) associated with poor prognosis and survival. This study reports a high-risk T-cell ALL (T-ALL) case with a novel TPR::ABL2 gene fusion resulting from a chromosomal deletion. Overexpression of TPR::ABL2 in Ba/F3 cells promoted cytokine-independent growth, demonstrating its oncogenic nature. Both primary patient and Ba/F3 cells carrying TPR::ABL2 exhibited kinase activation and sensitivity to tyrosine kinase inhibitors (TKIs). This study expands the repertoire of ABL2 fusions identified in ALL and supports the incorporation of TKIs into T-ALL treatment regimens to improve outcomes for this subtype.

Safety and efficacy of short-term ventricular assist devices (VAD) remains incompletely understood, particularly in younger children. This systematic review and meta-analysis aims to evaluate outcomes, including bridging success, complications, and mortality, associated with short-term VAD support in paediatric heart transplant candidates. A systematic search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from inception to 2 December 2024. Eligible studies reported patients ≤ 18 years supported by short-term VADs. This review was registered in PROSPERO (ID: CRD42023468125). Twelve retrospective studies met the inclusion criteria, encompassing 532 paediatric patients (mean age 10.0 years, < 0.1–18.3, mean weight 39.5 ± 30.3 kg). Pooled proportions show that with a mean support duration of 15.2 days, 50.7% were successfully bridged to transplant (95% CI 36.4%, 65.0%; I2 = 91.1%) with a 24.8% waitlist mortality (95% CI 17.6%, 31.9%; I2 = 63.8%), 14.0% (95% CI 7.2%, 20.9%; I2 = 97.5%) weaned off support and 5.4% (95% CI 2.6%, 8.3%; I2 = 39.1%) remaining on support. Complication rates were high with haemorrhage (38.9%), renal impairment (35.2%), cerebrovascular events (29.5%), infection (17.8%), and thromboembolism (9.9%) being the most reported. Short-term VADs offer a feasible bridge to transplant in paediatric patients, with success rates comparable to registry data. However, high rates of serious complications and waitlist mortality persist, particularly in these younger children. These findings demonstrate the need for improved patient selection, standardized outcome reporting, and development of safer, size-appropriate devices for paediatric use.

Cutaneous oncology has entered a new phase defined by the integration of early detection strategies, molecular risk stratification, and biologically guided systemic therapies. Melanoma, although less frequent than keratinocyte cancers, remains the most lethal form of skin cancer, while basal cell carcinoma and Merkel-cell carcinoma contribute significantly to global oncologic burden. This review analyzes the contemporary transformation of cutaneous oncology within the precision medicine framework, focusing on three core domains: stage-based prognosis, genomic characterization, and targeted and immune-based therapeutic interventions. Evidence from landmark clinical trials demonstrates that BRAF-mutated melanoma benefits from combined BRAF/MEK inhibition, while immune checkpoint blockade—particularly PD-1–based regimens—achieves durable survival in advanced disease. Long-term survival data confirm sustained benefit in a subset of patients, redefining expectations for metastatic melanoma outcomes. In addition, immunotherapy has shown meaningful activity in other aggressive cutaneous malignancies such as Merkel-cell carcinoma. The integration of staging systems, molecular diagnostics, and systemic therapies illustrates a dual therapeutic paradigm in which tumor genotype and immune context guide treatment selection. From an international perspective, including healthcare systems in Mexico, Colombia, and Ecuador, the implementation of precision oncology requires structured integration of early detection, standardized pathology, essential genomic testing, and multidisciplinary therapeutic access. Cutaneous oncology in the precision era is therefore characterized by coordinated biological insight and clinical application, forming the basis for advanced academic instruction and evidence-based oncologic practice.

Fatigue is a multidimensional, subjective experience that can persist despite rest and significantly impair quality of life. While often addressed through physical modalities, fewer manual therapy approaches incorporate emotional processing. This case report describes the use of HeartSpeak Lite for BodyWork, a mindbody technique combining gentle fascial mobilization with guided emotional somatic release, in a client with long-standing fatigue symptoms and stress-related burden. A 52-year-old woman presented with over a decade of persistent fatigue, post-exertional exhaustion, generalized pain, insomnia, and brain fog. She had previously received a diagnosis of chronic fatigue syndrome from her general practitioner in 2019 but had declined pharmacological treatment. Prior use of massage and chiropractic care provided only temporary relief. She sought a natural, integrative option. Over 10 weekly sessions, she received HeartSpeak Lite for BodyWork, which involved structured emotional processing paired with gentle, sustained fascial contact, all delivered in a safety-informed and client-led setting. The client reported progressive improvements in fatigue severity, perceived stress, and daily functioning. Over the 10 weeks, Fatigue Severity Scale scores decreased from 6.8 to 4.2, and Perceived Stress Scale scores improved from 29 to 19. Subjective reports noted greater energy, emotional balance, and increased physical activity tolerance. She also reported feeling safe and supported throughout the intervention, with no adverse effects noted. This case illustrates the potential of a bodywork-based emotional somatic intervention to support individuals with complex fatigue symptoms. While causality cannot be inferred, the observed improvements suggest that gentle, structured, and emotionally attuned approaches may offer benefit by addressing both physical and emotional dimensions of persistent fatigue.

Optimizing nutrient intake is crucial for the health and development of preschool children. While previous studies assessed the risks and benefits of selenium (Se) from fish and seafood, few have examined its intake from common foods and its association with children's growth. In this study, we evaluated optimal foods for achieving a dietary Se surplus and the implications for the growth performance of preschool children. Mercury (Hg) and Se concentrations were analyzed in 108 commercially available foods to conduct a dietary risk-benefit assessment of Se intake. Hg exposure was evaluated using hair samples from 349 preschool children enrolled between August 2017 and July 2022. Information on food consumption frequencies and nutrient compositions was obtained through dietary surveys. Overall, 42.4% of children had hair Hg levels above the US Environmental Protection Agency's reference dose of 1 µg/g, showing that Hg exposure among preschool children in Taiwan remains a significant issue. The risk-benefit assessment revealed that eggs and fish are superior sources of Se compared to other animal- and plant-based foods. Although marine fish contained higher Hg concentrations than eggs, their relatively high Se and ω-3 polyunsaturated fatty acid (PUFA) contents supported a favorable nutritional profile when consumed in moderation. The minor negative health benefit value of Se (HBVSe) observed for fruit does not pose a health concern, as it is offset by other Se-rich foods in the diet. The cumulative HBVSe across food groups indicated that the children's overall dietary Se intake was positive and nutritionally advantageous. Dietary Se, mainly from fish and eggs, was positively associated with weight and height development, whereas excessive fruit consumption may slightly reduce Se intake and adversely affect growth. Moderate consumption of fish and eggs should be encouraged to support optimal growth and neurodevelopment. Overall, dietary patterns of Taiwanese preschool children provide beneficial levels of Se and ω-3 fatty acids while maintaining low Hg-related risks, emphasizing the need for continued monitoring of Hg levels in locally consumed foods to ensure dietary safety.

BackgroundHip fractures are common in older people and are associated with high perioperative mortality. Prompt surgical intervention within the first 48 h of fraction reduces complications; however, surgical urgency often precludes a comprehensive preoperative cardiac evaluation. Preliminary data suggests that performing a focused cardiac ultrasound (FCU) before surgery may reduce postoperative complications. We therefore propose to test the primary hypothesis that FCU reduces a 30-day composite of mortality and serious complications.MethodsWe plan a definitive multicenter pragmatic randomized trial that will enroll 2000 adults with hip fractures. Participants will be randomized before surgery to either receive FCU as part of their preoperative assessment or to routine care without FCU. FCU is a brief, 10-min, goal-directed echocardiography performed at the patient’s bedside. FCU will be conducted by physicians trained in FCU and the information gathered will be shared immediately with all clinicians involved in the patient’s care (anesthesiologists, orthopedic surgeons, geriatricians). The primary outcome will be a 30-day composite of all-cause mortality, hospital readmission, acute kidney injury, cardiac failure, and myocardial injury after noncardiac surgery. Secondary and exploratory outcomes include hospital length of stay, days to return to original residence, postoperative recovery, and quality of life. Additionally, a health cost analysis will be conducted to weigh costs against benefits.DiscussionOur large RCT aims to determine whether preoperative focused ultrasound examinations of hip fracture patients reduce serious postoperative complications, improves the quality of recovery, improves life quality, and is cost-effective.Trial registrationRegistration number: ACTRN12622001546741. Date registered 14/12/2022.

Fire and rescue services in England routinely carry out Home Fire Safety Visits which aim to reduce risk of fire, support independent living and improve quality of life. The visits include a person-centred assessment and providing general advice on health-related topics such as preventing falls. To assess the effectiveness and cost-effectiveness of Home Fire Safety Visits (also known as Safe and Well Visits) to reduce falls and improve quality of life in older adults living in the community. We designed a multicentre, randomised controlled trial with economic and qualitative evaluations, involving two fire and rescue services in England, to recruit 1156 community-dwelling adults aged 65 years and over. All participants could continue to access routine care from healthcare professionals and were provided with a falls prevention leaflet as part of the trial. The intervention group were additionally offered a Home Fire Safety Visit. The usual care group were offered a visit after they had completed the trial. Blinding was not possible. Participants were randomised 1 : 1 using a secure web-based system. The primary outcomes were (1) the number of falls per participant and (2) health-related quality of life (EuroQol-5 Dimensions, five-level version) over 12 months from randomisation. Secondary outcomes included fire risk-taking behaviours, loneliness, fear of falling and time to first fall. The planned economic evaluation comprised cost-utility and cost-effectiveness analyses. The qualitative study was designed to examine intervention fidelity and acceptability. It proved impossible to conduct the trial as planned in the current research landscape. We faced significant delays in setting up and starting recruitment, in large part due to this coinciding with the start of the COVID-19 pandemic. Obtaining regulatory approval took longer than anticipated. Additionally, we were unable to access general practitioner registration data to identify participants as planned and so we had to use Consumer Classification Platform data to identify potential households to send study invitations to. This resulted in a less targeted and non-personalised mail-out as this is not patient-level data so the householder names were unavailable. Ultimately, recruitment was much lower than expected. In total, 237 participants were assessed for eligibility and 63 randomised (intervention, n = 32; usual care, n = 31). The Home Fire Safety Visits were delivered as planned to both groups; however, the planned statistical and health economic analyses could not be conducted due to the limited data. Data from the qualitative evaluation indicated the intervention was largely acceptable to staff and service users. Conducting trials in this setting is currently extremely challenging. To facilitate future research, we recommend an urgent review of research governance issues related to the types of personal data that can be accessed and used for research. This review should aim to provide support and avoid creating additional obstacles to research in this area. The evidence for the effectiveness and cost-effectiveness of Home Fire Safety Visits remains inconclusive. Research governance in local authorities needs urgent review. This trial is registered as Current Controlled Trials NCT04717258. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128341) and is published in full in Public Health Research; Vol. 13, No. 7. See the NIHR Funding and Awards website for further award information.