Malignant peripheral nerve sheath tumours: an outcome analysis of 32 patients in Lerdsin Hospital, Thailand

Background Malignant peripheral nerve sheath tumours (MPNST) are rare soft tissue sarcoma which exhibit a biologically aggressive behaviour with propensity for rapid progression and high mortality rate. Currently, the data for this tumour is lacking especially with regards to the Asian population. Methods A retrospective analysis was performed in 32 patients diagnosed with MPNST from 2009 to 2017 in Lerdsin Hospital. Prognostic factors such as patient demographic factors, tumour and treatment characteristics were evaluated for statistical significance. The mean age of presentation was 51 years old with 66% patients above 44 years old. Of the 32 patients, 14 were males and 18 were females. The most common affected site was lower limb (56%) compared to upper limb (13%) and central location (31%). Thirty-one percent of patients had underlying neurofibromatosis type 1 (NF-1). The largest proportion of patients had high grade tumour (81%) and the mean size of tumour was 12.2 cm (range, 1-25 cm). All except one patient underwent tumour excision whilst 31% had positive margin. Adjuvant treatment was initiated in 50% of the patients which consisted of radiation (61%), chemotherapy (18%) or both (9%). Results The local recurrence rate was 26% with a median survival time after surgery of 56 months (95% CI 31.7-79.5) and 5-year overall survival rate was 39%. High tumour grade and male patients were significantly associated with distant metastasis on univariate analysis but no predictors for local recurrence were identified. Age <45, high tumour grade, triton tumour subtype, diagnosis of NF-1, local recurrence, metastasis and use of adjuvant chemotherapy were all associated with disease specific survival (DSS). Multivariate analysis identified local recurrence (HR=20.035, 95% CI 1.8-222.8) as the single poor prognostic factor for DSS. Other associated factors include presence of NF-1 (HR=7.962, 95% CI 0.9-69.9) and high tumour grade (HR=16.945, 95% CI 0.9-321.8) although not reaching statistical significance. Conclusions High tumour grade, local recurrence and distant metastasis all adversely affects the survival in MPNST. However, adjuvant chemotherapy or radiotherapy did not appear to improve survival. Limitations of this study include retrospective design and small sample size

How to perform solah with upper limb injuries

Solah is one of the Five Pillars of Islam. The task of performing solah is of utmost importance for all Muslims. The order of performing solah was bestowed directly to Prophet Muhammad S.A.W during Israk Mikraj. This highlights the greatest priority of performing solah even in injurious conditions. In patients with upper limb injuries and limited function, solah is compulsory and must be performed with any remaining physical functions. A group of undergraduate medical students researched and discussed the correct method of performing ablution and solah in injured patients with a facilitator from Kulliyyah of Islamic Revealed Knowledge, IIUM. The issues discussed were the options available in performing ablution prior to solah which either was with water, tayammum (dust), or both. The method of performing solah in upper limb injuries was highlighted. We conclude that the tayammum is the most practical and feasible ablutions method for patients with upper limb injuries prior to perform solah

OrthoBoard: an orthopaedic app for medical education

Introduction: Use of mobile apps as a pedagogical tool in the medical education has gained popularity as mobile apps have great potentials in perpetuating clinical knowledge and skills. To leverage mobile technology in medical education, we designed a hybrid mobile app based on our undergraduate orthopaedic curriculum. Materials and Methods: The frontend was created using hybrid mobile framework to target both iOS and Android platforms. The backend is powered by Firebase (Google Inc.) to manage authentication and social messaging. The content consisted of basic orthopaedic skills, trauma and resuscitation skills, Islamic input in orthopaedic and information cheatsheets. Results: OrthoBoard is being used by IIUM medical undergraduates as an ancillary source of learning, particularly useful as quick references and visual guides for enhancing orthopaedic knowledge and performing clinical procedures. The social messaging capability built into the app serves as a platform for discussion and exchange of information. This is the first medical app, to our knowledge, that integrates orthopaedic clinical knowledge and practice as well as Islamic input in orthopaedics into teaching and learning with the integration of social messaging as a platform for enhancement of knowledge and practice. Conclusion: Use of mobile apps as pedagogical tool in the medical education will undoubtedly increase in the future. As students and teachers embrace mobile technology in and outside the classroom, better user-centric and subject-specific apps will be required to fulfil the needs. For medical educators, developing mobile apps will possibly be one of the future armamentarium in the delivery of knowledge and skills

Orthoboard: An orthopaedic app for medical education

This is a hybrid mobile app developed by our team based on the undergraduate Orthopaedic curriculum to deliver clinical knowledge and skills. The app consisted of core and practical orthopaedic information with step-by-step visual-guided slides to perform orthopaedic procedures in the clinical settings. A social messaging platform is integrated in the app to encourage discussion and interactive learning. The highlight of the app is the integration of Islamic input in medical practice which is the first for medical apps

Evaluation of blood loss during internal (limb-salvage) hemipelvectomy for pelvic tumours : what have we learned so far?

Introduction: Pelvic tumour resections are complex and associated with extensive bleeding. Despite various blood management options in orthopaedic surgery, their used are limited particularly for pelvic tumour resections. Identifying predictive factors for a large amount of blood loss during surgery is essential. Objective: To evaluate the volume of blood loss in limb salvage pelvic resections and identify the risk factors for large amount of perioperative blood loss. Methodology: We retrospectively reviewed 25 patients underwent pelvic tumour resections performed between 2000 and 2010 in a single institution. Tumours originating from the sacrum were excluded. Total blood volume loss consisted of estimated intra-operative blood loss and the drainage volume on the first day after surgery. Loss of more than 3000ml of blood was classified as large amount of blood loss. Statistical analysis performed using Fisher’s exact test. Results: Six (24.0%) patients had total blood loss greater than 3000ml. Resections of primary bone sarcomas (osteosarcoma and chondrosarcoma) have the highest mean blood loss volume (6556.67ml and 1768.57ml, respectively). Most important factor associated with large amount of blood loss is the involvement of the acetabulum. Neo-adjuvant therapies and pre-operative embolization were not shown to be associated with extensive blood loss.. Conclusion: Resections of pelvic tumours involving the acetabular region are likely to have a large amount of blood loss perioperatively and should be anticipated. Radiation therapy prior to surgery was believed to increase the risk of bleeding intra-operatively, was not observed in this study

A Cell-Based Small Molecule Screening Method for Identifying Inhibitors of Epithelial-Mesenchymal Transition in Carcinoma

Epithelial Mesenchymal Transition (EMT) is a crucial mechanism for carcinoma progression, as it provides routes for in situ carcinoma cells to dissociate and become motile, leading to localized invasion and metastatic spread. Targeting EMT therefore represents an important therapeutic strategy for cancer treatment. The discovery of oncogene addiction in sustaining tumor growth has led to the rapid development of targeted therapeutics. Whilst initially optimized as anti-proliferative agents, it is likely that some of these compounds may inhibit EMT initiation or sustenance, since EMT is also modulated by similar signaling pathways that these compounds were designed to target. We have developed a novel screening assay that can lead to the identification of compounds that can inhibit EMT initiated by growth factor signaling. This assay is designed as a high-content screening assay where both cell growth and cell migration can be analyzed simultaneously via time-course imaging in multi-well plates. Using this assay, we have validated several compounds as viable EMT inhibitors. In particular, we have identified compounds targeting ALK5, MEK, and SRC as potent inhibitors that can interfere with EGF, HGF, and IGF-1 induced EMT signaling. Overall, this EMT screening method provides a foundation for improving the therapeutic value of recently developed compounds in advanced stage carcinoma

Collision of solid particles and solid surface

Spraying process can be categorized into two different groups, cold spraying and warm spraying. In both processes, particles were accelerated by high speed gas jets to very high velocity in the range of 500m/s to 1000m/s. At such high velocity, metal particles which were in the form of powders adhere onto the targeted surface, forming strong bonds and eventually forms a coating on the surface. Cold spraying and warm spraying differs mainly by the temperature of the powder particles that were accelerated. For cold spraying, powder particles were unheated initially and impacts the surface with a temperature relatively lower than that of the warm spraying. As the name implies, warm spraying pre-heats the powder particles to a temperature below the melting point of the powder material in the barrel section, before travelling and impacting the surface. Warm spraying was generally developed after the cold spraying process, to decrease the critical velocity needed for adhesion. This consequently reduces the amount of combustion energy needed to reach the high velocity achieved in cold spraying. Both spraying processes were primarily used for coatings and repair in many manufacturing industries, including aerospace and military. Spraying processes were able to produce surface coating from a wide range of materials, which include metals and alloys to metal-based composites. However, due to the increasing demand and expectations from various industries, higher deposition efficiency and stronger coating structures were required for better performance and longer life span of the product. Furthermore, the study of the bonding mechanism achieved during high velocity impact was limited, even though they were of great interest. Therefore, this report focuses on studying the collision of particles at high velocity onto a solid substrate, in order to have a better understanding of the transfer of kinetic energy, deformations and possible adhesion criteria. Several experiments were conducted in this report. First, an electromagnetic coil gun was created to mimic the high velocity impact of the spraying process. Further improvements were made to gradually improve the velocity up till visible physical deformations were seen. Analysis was done on the impact process, with the use of a high speed camera to calculate the velocity achieved during and after the impact. Finally, surface scans were done on the substrate after impact with the help of the Confocal Imaging Profilometer, to measure the surface deformation and eventually the transfer of kinetic energy during the process. At high velocity impact, a significant amount of kinetic energy was transferred into deformation energy, when comparing the rebound velocity to the initial impact velocity, given by the coefficient of restitution. As the velocity of the particle increases, further transfer of the kinetic energy was converted into deformation energy, and the coefficient of restitution reaches zero, implying fully inelastic collision and therefore adhesion onto surface. Further work improvements includes ways to greatly increase the velocity of the particle, to reach its critical velocity for adhesion. Heating of the particle below its melting point could also be performed. With comparison to the warm spraying process, chances of adhesion could be increased and possibly to reduce the critical velocity required, for better studies of adhesion and deformation.Bachelor of Engineering (Mechanical Engineering