Clustering of HR + /HER2- breast cancer in an Asian cohort is driven by immune phenotypes

Breast cancer exhibits significant heterogeneity, manifesting in various subtypes that are critical in guiding treatment decisions. This study aimed to investigate the existence of distinct subtypes of breast cancer within the Asian population, by analysing the transcriptomic profiles of 934 breast cancer patients from a Malaysian cohort. Our findings reveal that the HR + /HER2- breast cancer samples display a distinct clustering pattern based on immune phenotypes, rather than conforming to the conventional luminal A-luminal B paradigm previously reported in breast cancers from women of European descent. This suggests that the activation of the immune system may play a more important role in Asian HR + /HER2- breast cancer than has been previously recognized. Analysis of somatic mutations by whole exome sequencing showed that counter-intuitively, the cluster of HR + /HER2- samples exhibiting higher immune scores was associated with lower tumour mutational burden, lower homologous recombination deficiency scores, and fewer copy number aberrations, implicating the involvement of non-canonical tumour immune pathways. Further investigations are warranted to determine the underlying mechanisms of these pathways, with the potential to develop innovative immunotherapeutic approaches tailored to this specific patient population.

Balancing Ambitions and Realities: Stakeholder Perspectives on Jurisdictional Approach Outcomes in Sabah's Forests

The jurisdictional approach concept emerged in response to the widespread failure of sectoral forest conservation projects. Despite its increasing popularity, understanding jurisdictional approach outcomes is challenging, given that many remain in either the formation or implementation stage. Furthermore, diverse stakeholders hold different perspectives on what exactly a jurisdictional approach is intended to pursue. These different perspectives are important to unravel, as having a shared understanding of the outcomes is important to build the critical support needed for it. This study aims to add to the limited evidence with a case study in Sabah, Malaysia, which is committed to addressing a leading deforestation driver (palm oil) through sustainability certification in a jurisdiction. We used Q-methodology to explore stakeholder perceptions, revealing three distinct perspectives regarding what outcomes jurisdictional approaches should pursue. We asked about outcomes achievable within ten years (2022-2032) and considering real-world constraints. We found different perspectives regarding economic, environmental, governance, and smallholders' welfare outcomes. However, we found consensus among stakeholders about some outcomes: (i) that achieving zero-deforestation is untenable, (ii) that issuing compensation or incentives to private land owners to not convert forests into plantations is unrealistic, (iii) that the human well-being of plantation workers could improve through better welfare, and (iv) the free, prior and informed consent given by local communities being required legally. The findings offer insights into key stakeholders' perceptions of the deliverables of jurisdictional approaches and the difficulty of achieving its objectives under real-world constraints.

Knowledge and attitudes of primary care physicians regarding childhood hearing loss in Malaysia

BACKGROUND

Childhood hearing loss is a significant health concern. Early identification and intervention are essential to maximize hearing potential and developmental outcomes, with primary care physicians (PCPs) playing a pivotal role in this process.

OBJECTIVES

This study aimed to assess PCPs' knowledge and attitudes toward childhood hearing loss, investigate the association between knowledge and attitudes, and examine the influence of demographic factors on PCPs' knowledge and attitudes towards childhood hearing loss.

METHODS

This cross-sectional study was conducted from 30 November 2017 to 30 July 2018 at three public health clinics in Malaysia, specifically in the Federal Territory of Kuala Lumpur, Selangor, and Terengganu. A self-administered questionnaire assessed PCPs' knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated PCPS' attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss.

RESULTS

Most participants lacked sufficient knowledge about childhood hearing loss, with 61.4% not seeing it as a major health issue. Almost half (45.9%) didn't know that children with hearing loss can succeed in regular schools, and 78% were unaware that hearing aids don't fully restore normal hearing. Participants' awareness of risk factors varied widely, ranging from 24.6% to 90.3%. Despite these knowledge gaps, participants generally had positive attitudes towards childhood hearing loss, especially in cognitive and behavioural aspects. The study found a strong positive link between knowledge and attitudes, but demographic factors didn't significantly affect them.

CONCLUSIONS

This study highlights the urgent need to address knowledge gaps among Malaysian PCPs regarding childhood hearing loss. While these knowledge gaps exist, PCPs' positive attitudes form a foundation for developing targeted educational interventions to improve PCPs' knowledge and skills in managing childhood hearing loss. Collaborative efforts are essential to translate these findings into meaningful improvements in paediatric audiological care.

Biotechnological enhancement of lactic acid conversion from pretreated palm kernel cake hydrolysate by Actinobacillus succinogenes 130Z

The aim of this study was to establish an improved pretreatment and fermentation method i.e. immobilized cells for high recovery of fermentable sugars from palm kernel cake (PKC) and its effects on fermentability performance by Actinobacillus succinogenes 130Z in the conversion of the fermentable sugar to lactic acid. The effects of oxalic acid concentrations (1-6% w/v) and residence times (1-5 h) on the sugar recovery were initially investigated and it was found that the highest mannose concentration was 25.1 g/L at the optimum hydrolysis conditions of 4 h and 3% (w/v) oxalic acid. The subsequent enzymatic saccharification of the pretreated PKC afforded the highest enzymatic digestibility with the recovered sugars amounting to 25.18 g/L and 9.14 g/L of mannose and glucose, respectively. Subsequently, the fermentability performance of PKC hydrolysate was evaluated and compared in terms of cultivation phases (i.e. mono and dual-phases), carbonate loadings (i.e. magnesium and sodium carbonates), and types of sugars (i.e. glucose and mannose). The highest titer of 19.4 g/L lactic acid was obtained from the fermentation involving A. succinogenes 130Z in dual-phase cultivation supplemented with 30 g/L of magnesium carbonate. Lactic acid production was further enhanced by using immobilized cells with coconut shell-activated carbon (CSAC) of different sizes (A, B, C, and D) in the repeated batch cultivation of dual-phase fermentation producing 31.64 g/L of lactic acid. This work sheds light on the possibilities to enhance the utilization of PKC for lactic acid production via immobilized A. succinogenes 130Z.

Psychosocial outcome and health behaviour intent of breast cancer patients with BRCA1/2 and PALB2 pathogenic variants unselected by a priori risk

There is an increasing number of cancer patients undertaking treatment-focused genetic testing despite not having a strong family history or high a priori risk of being carriers because of the decreasing cost of genetic testing and development of new therapies. There are limited studies on the psychosocial outcome of a positive result among breast cancer patients who are at low a priori risk, particularly in women of Asian descent. Breast cancer patients enrolled under the Malaysian Breast Cancer Genetic Study between October 2002 and February 2018 were tested for BRCA1, BRCA2 and PALB2 genes. All 104 carriers identified were invited by a research genetic counsellor for result disclosure. Of the 104 carriers, 64% (N = 66) had low a priori risk as determined by PENN II scores. Psychosocial, risk perception and health behaviour measures survey were conducted at baseline (pre-result disclosure), and at two to six weeks after result disclosure. At baseline, younger carriers with high a priori risk had higher Cancer Worry Scale scores than those with low a priori risk but all scores were within acceptable range. Around 75% and 55% of high a priori risk carriers as well as 80% and 67% of low a priori risk carriers had problems in the "living with cancer" and "children" psychosocial domains respectively. All carriers regardless of their a priori risk demonstrated an improved risk perception that also positively influenced their intent to undergo risk management procedures. This study has shown that with sufficient counselling and support, low a priori risk carriers are able to cope psychologically, have improved perceived risk and increased intent for positive health behaviour despite having less anticipation from a family history prior to knowing their germline carrier status.

Nasalization by Nasalis larvatus: Larger noses audiovisually advertise conspecifics in proboscis monkeys

Male proboscis monkeys have uniquely enlarged noses that are prominent adornments, which may have evolved through their sexually competitive harem group social system. Nevertheless, the ecological roles of the signals encoded by enlarged noses remain unclear. We found significant correlations among nose, body, and testis sizes and a clear link between nose size and number of harem females. Therefore, there is evidence supporting both male-male competition and female choice as causal factors in the evolution of enlarged male noses. We also observed that nasal enlargement systematically modifies the resonance properties of male vocalizations, which probably encode male quality. Our results indicate that the audiovisual contributions of enlarged male noses serve as advertisements to females in their mate selection. This is the first primate research to evaluate the evolutionary processes involved in linking morphology, acoustics, and socioecology with unique masculine characteristics.

Concentrations of faecal glucocorticoid metabolites in Asian elephant's dung are stable for up to 8 h in a tropical environment

The use of faecal glucocorticoid metabolites (fGCMs) has facilitated the development of non-invasive methods to study physiological conditions of endangered wildlife populations. One limitation is that fGCM concentrations are known to change over time and to vary according to different environmental conditions. The aim of this study was to perform a controlled dung decay experiment to understand the impact of time (since defecation) and two common environmental variables (exposure to water and direct sunlight) on fGCM concentrations of Asian elephants (Elephas maximus). Eighty dung piles from 10 Malaysian elephants were randomly exposed to a 2 × 2 combination of treatments (wet-shade, dry-shade, wet-sun and dry-sun) and repeatedly subsampled from the time of defecation through to 2 days post-defecation (n = 685 faecal subsamples). Overall, the mean concentration of fGCMs was stable in samples of up to 8 h old from defecation time, regardless of environmental treatment (water or direct sunlight); thereafter, the overall mean fGCM concentrations increased, peaking 1 day after defecation (31.8% higher than at defecation time), and subsequently decreased (reaching values 9.2% below defecation time on the second day). Overall, the treatment of sun exposure resulted in higher fGCM concentration compared with shade, whereas water exposure (compared with no water exposure) had no impact on fGCM concentrations. Hence, in field studies we recommend collecting dung samples <8 h old and recording shade conditions (e.g. sun vs. shade) as a covariate for the subsequent interpretation of fGCM measurements. This study has helped to identify the optimal window for sampling in which we can have a higher confidence in interpreting the results as being a genuine reflection of glucocorticoid status in the elephant.