Subang Jaya Medical Centre

Abstract Introduction: The study aimed to determine the outcome of children with transfusion-dependent thalassaemia (TDT) who underwent haematopoietic stem cell transplantation (HSCT) at Universiti Malaya Medical Centre, Malaysia. Methods: This was a retrospective analysis of 115 children (aged <18 years) who underwent 128 transplant procedures between 1 June 1987 and 30 December 2023. Results: The study included 53 boys, and the median age at time of HSCT was 5 years. One-third of patients were in Pesaro class 3. The 15-year overall survival and thalassaemia-free survival (TFS) were 83% and 71%, respectively. Transplant-related mortality (TRM) was 16%. Multivariate analysis revealed that patients who were aged >7 years and did not receive pre-HSCT anti-thymocyte globulin (ATG) had the worst outcomes (TFS 52%). In 62 patients who received busulfan–cyclophosphamide conditioning, 32 had addition of ATG that improved TFS (78% vs. 64%, P = 0.02). Graft failure, seen in 26% of patients, was the main contributing factor to TRM. Omission of ATG in the conditioning regimen was the main cause of graft failure (relative risk [RR] 8.26, 95% confidence interval [CI] 1.68–40.51; P = 0.009). The incidence of Grade II–IV graft-versus-host disease (GVHD) was 26%. Non-inclusion of ATG also significantly increased the risk of GVHD (RR 8.52, 95% CI 1.95–37.25; P = 0.04). Conclusion: Haematopoietic stem cell transplantation is a feasible curative option for children with TDT in Malaysia, with the best outcomes observed in patients undergoing transplantation before the age of 7 years. Our study also highlights the role of ATG in improving HSCT outcomes in this population.

Pre-set fixed-dose albumin replacement fluid for double filtration plasmapheresis (DFPP) can result in progressive albumin deficit, along with other untargeted protein, leading to loss of osmotic pressure, and subsequently hypotension. This can occur in up to 6% of DFPP procedures. In this study, we aim to determine the serum albumin deficit with fixed-dose replacement regime and estimate the required practical supplementary regime for the discrepancy. We compared the change in serum albumin level among patients treated with DFPP given fixed-dose 10% plasma replacement volume with albumin 5% concentration versus patients given additional replacement with albumin 20% concentration. Seventy-seven DPFF procedures were performed in 16 patients with various neurological disorders. In average, each patient received 4.8 DFPP procedures (Range 3-7) per treatment. Eight patients were given fixed-dose albumin replacement and remaining 8 had additional albumin 20% replacement. Twenty-one (27.3%) procedures had additional replacement. The average change in serum albumin post-DFPP procedures was a reduction of 2.4 g/L (SD 3.0) with fixed-dose replacement and an increment of 0.1 g/L (SD 2.8) for procedures with additional human albumin 20% replacement (p = 0.003). In average, additional 78.6 mL (50-500 mL in up to 5 divided replacements) of albumin 20% replacement given to patients with post-DFPP serum albumin lower than 34 g/L, or in those with post-DFPP negative serum albumin balance depending on severity effectively reduces post-DFPP albumin deficit. In conclusion, fixed-dose albumin replacement for DFPP results in progressive albumin deficits with successive procedures. Addition albumin supplementation may be required.

mRNA translational repression by eukaryotic initiation factor 4E-binding proteins (4E-BPs), plays a critical role in synaptic plasticity and the formation of long-term memory (LTM). Among the three 4E-BP paralogs, 4E-BP2 is the predominant form expressed in neurons, and its full-body deletion in mice causes memory deficits. Mice lacking 4E-BP2 in GABAergic inhibitory interneurons, but not excitatory neurons, display autistic-like behaviors and deficits in object location and recognition. The specific mRNAs translationally regulated by 4E-BP2 in GABAergic interneurons, and how they contribute to spatial and associative memory, are unknown. Here, we show that conditional knockout (cKO) mice lacking 4E-BP2 selectively in GABAergic interneurons exhibit impairments in long-term spatial and contextual fear memory formation. We further demonstrate that 4E-BP2 deletion controls the translation of selective mRNAs in interneurons without increasing general protein synthesis. One of the mRNAs is Gal, which encodes a neuropeptide that modulates memory. Our findings provide evidence that 4E-BP2 selectively controls the translation of a subset of mRNAs in inhibitory neurons that are required for LTM formation.

The Project-Based Learning (PjBL) approach effectively addresses the passive learning environment by fostering student independence. Project-Based Learning (PjBL), as a student-centered methodology, may be a superior alternative to the lecture-centric model, as it enables students to actively engage and exercise autonomy in their decision-making. Project-Based Learning promotes a student-centered approach, however, this constructivist method remains unfamiliar. Educators continue to employ the conventional approach to impart writing skills by consulting textbooks. Educators are reluctant to incorporate Project-Based Learning in writing classes due to insufficient understanding of this methodology. This may obstruct their efforts to transition to a progressive educational model that provides numerous advantages over conventional lecture-based instruction. This qualitative case study aims to examine the viewpoints of higher education language instructors regarding the implementation of Project-Based Learning (PjBL) in writing instruction. Five experienced tertiary language educators were chosen through purposive sampling. Data were collected via semi-structured interviews and a sequence of classroom observations. The chosen tertiary language instructors employed this method in classrooms of non-English major students. The integration results indicated a notable enhancement observed by tertiary language instructors in students' post-essays compared to pre-essays written prior to the implementation of PjBL. The observational data indicated that students performed exceptionally well in the classroom, and the role of tertiary language teachers was instrumental in enhancing comprehension of the material. This study is constrained by a limited sample size, comprising only five lecturers. The participants' lack of familiarity with the PjBL approach necessitated preliminary training, potentially influencing their engagement and the study's outcomes. Consequently, future research should aim to increase the sample size to yield more comprehensive results, thereby motivating more language educators to adopt this approach as their preferred teaching practice. In conclusion, the impact of PjBL on improving students' writing skills was substantial, making PjBL highly recommended.

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality in Malaysia, with 95% of cases diagnosed at advanced stages. Beyond screening for early detection, timely intervention is critical for optimal outcomes in early-stage, resectable NSCLC (e-NSCLC). Delays in the diagnostic, staging and referral pathway, measured as time-to-treatment initiation (TTI), are associated with poorer survival. This contemporary realworld study is the first to evaluate TTI in a cohort of Malaysian patients with e-NSCLC. This is a retrospective study of 124 consecutive treatment-naive e-NSCLC patients who had a minimally invasive curative anatomical lung resection (lobectomy or segmentectomy) and systematic mediastinal nodal dissection between January 2021 and December 2024 at two tertiary private hospitals. Medical records were reviewed to capture key timepoints across three phases of care. The primary analysis (n=124) focused on demographics and assessed the timeline from initial general practitioner (GP) to specialist consultation, diagnosis, and definitive surgery. These patients were evaluated after surgical discharge to validation of histopathology and nextgeneration sequencing (NGS) reports, and oncology review. Patients who received adjuvant therapy were included in a secondary analysis to examine timelines from NGS report validation and oncology review to initiation of adjuvant therapy. The median time from the GP referral to surgery was 30.0 ± 24.5 days; GP consultation to specialist referral took 7.5 ± 17.0 days, specialist review to surgeon consultation took another 10.0 ± 16.3 days. Biopsy and staging PET-CT were completed within 3.0 ± 20.9 and 3.0 ± 20.5 days, respectively, from the initial specialist consultation. Definitive curative-intent surgery was performed 7.5 ± 13.1 days from the first cardiothoracic surgical consult and 18 ± 23.3 days following a confirmed histological diagnosis of NSCLC. The median interval from specialist review to definitive surgery was 20.0 ± 20.2 days. The median time from surgery to discharge and reporting of NGS results was 5.0 ± 2.6 days and 12.0 ± 7.7 days, respectively. Patients were seen at the first post-surgical review within 7.0 ± 3.7 days following discharge, while oncology review occurred at 19.0 ± 16.2 days post-surgery. For patients eligible for adjuvant therapy, treatment commenced 14.5 ± 11.4 days following the oncology review. TTI is known to prognosticate recurrence-free and overall survival for e-NSCLC. This contemporary realworld experience from two leading tertiary cancer centres demonstrates the agility and efficiency of Malaysian private healthcare for prompt diagnosis, meticulous staging and timely, curative-intent definitive surgery for e-NSCLC, aligning with global benchmarks. Our study suggests, if prioritised, a swift TTI is highly achievable with appropriate expertise and coordinated resources, and should be incorporated as a deliverable national quality metric to drive improved outcomes for potentially curable e-NSCLC.

The management of advanced classical Hodgkin lymphoma (cHL) poses a major challenge in Asia, given disparities in health care resources and the variability in health care systems across the region. This article reviews the practice landscape for advanced cHL in East and Southeast Asia (hereafter referred to as Asia), offers detailed perspectives on the challenges faced by treating physicians, and proposes solutions to improve patient outcomes. At the Singapore Lymphoma Scientific Symposium 2024, a panel of lymphoma experts from 10 countries/territories across Asia convened to discuss local cHL management practices. Discussions were supplemented by perspectives from an expert from the United States and a review of published literature on HL in Asia in 2014-2024. This article summarizes meeting discussions and reports relevant aspects of Asian practice preferences for advanced cHL. In Asia, cHL management is hindered by the lack of local guidelines and survivorship programs, challenges in diagnosis and staging because of a lack of resources and funding, and limited access to efficacious novel drugs. This is of particular concern in vulnerable patient populations such as the elderly. To uplift the standard of care for patients with cHL locally, greater cross-regional learning and collaboration could be explored to enhance clinical management capabilities, lower the financial barriers to accessing novel drugs and technologies, and support increased research efforts and clinical trial presence in the region. Although advanced cHL management remains a challenge in Asia because of diverse needs within the region, regional partnerships and initiatives can bridge existing gaps and supplement local efforts to improve outcomes among patients with advanced cHL.

In light of the evolving labor market and rising uncertainties, Chinese college students are experiencing increasing worries about their future employment. Existing scales often fall short in capturing the anticipatory and multifaceted nature of this anxiety. Thus, a context-specific and culturally appropriate measurement tool is urgently needed. This study presents the development and empirical evaluation of the Future Employment Anxiety Scale designed to assess anticipatory employment-related anxiety among Chinese college students. A total of 1,597 students participated in this study. The Future Employment Anxiety Scale was developed through qualitative interviews and item generation, followed by exploratory and confirmatory factor analyses to establish and confirm its correlated four-factor structure, including Personal Ability, Knowledge Application, Career Replaceability, and Social Relations. The scale showed strong reliability, construct validity, convergent validity, discriminant validity, concurrent validity and measurement invariance across gender and birthplace, confirming its suitability for assessing employment anxiety in Chinese college students. These findings underscore the utility of the scale in capturing employment anxiety, providing valuable insights for both academic research and applied settings, such as career counseling and educational policy.

ABSTRACT The integration of generative Artificial Intelligence (AI), particularly ChatGPT, into legal practice is reshaping how legal services are delivered, researched, and consumed. While these technologies offer new efficiencies, they also raise profound ethical and legal challenges that the profession is only beginning to confront. This article critically examines the implications of ChatGPT’s use within the legal field, focusing on issues such as unauthorised practice of law, algorithmic bias, data privacy, and professional responsibility. Drawing on emerging regulatory responses in the United Kingdom, European Union, and the United States, it explores the extent to which existing legal frameworks can accommodate the unique risks posed by AI. The discussion also considers the evolving role of legal practitioners and educators in ensuring that technological advancement does not undermine core principles of justice, accountability, and public trust. In doing so, the article calls for a recalibration of legal ethics and governance to meet the demands of a rapidly digitising profession.