Scopus 2025
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Item Metadata only Personalized mechanical ventilation guided by lung ultrasound in patients with ARDS: a pilot phase of a randomized clinical trial(2025-12-01) Sinnige J.S.; Smit M.R.; Alam M.J.; Chowdhury M.N.H.; Costa V.; de Castro H.S.M.B.; Daszuta D.; Filippini D.F.L.; Ghose A.; de Grooth H.J.; Hein L.; Hermans G.; Hildebrandt T.; Itenov T.S.; Ischaki E.; Klompmaker P.; Laffey J.; McMahon A.; McNicholas B.; Mousa A.; Paulus F.; Pedersen U.G.; Pellegrini M.; Pezzuto M.; Póvoa P.; Pierrakos C.; Pisani L.; Roca O.; Schultz M.J.; Spadaro S.; Szuldrzynski K.; Theodorou E.; Tuinman P.R.; Wamberg C.A.; Zimatore C.; Bos L.D.J.; Ahmed A.U.; Barua S.; Nowroz N.; Hassan N.; Vaporidi K.; Siempos I.; Kanavou A.; Giannopoulos H.; Kawati R.; Bjarnadottir K.J.; Mason S.; Kelly Y.; Bergin P.; Basappakokati D.R.; Caldicott R.; Ferguson L.; Bates J.; Young E.; Moran P.; Carey M.; Thomas C.; Giacomini C.; Barbeta E.; Torres A.; Huguet M.; Acilu M.G.d.; Christiansen L.; Jensen J.V.; Herløv L.S.; Poulsen L.M.; Bertelsen D.; Pedersen A.M.F.; Lauritzen S.; Allingstrup M.; Christensen L.; Bestle M.; Zuzda K.; Janowska J.; Jankowski M.; Magnesa G.; Massaro F.; Caracciolo A.; Alvisi V.; Maurmo L.; Grasso S.; Sente S.; Peetermans M.; Gerits A.; Ceunen H.; Nicolai S.; Attou R.; Talpos M.T.; Aragao I.; Torrão C.; Nora D.; Sinnige J.S.; Mahidol UniversityBackground: The “Personalized Mechanical Ventilation Guided by Lung UltraSound in Patients with Acute Respiratory Distress Syndrome” (PEGASUS) study aims to evaluate personalized mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) compared to the standard of care. However, misclassification and misaligned MV strategies were shown to be harmful. We therefore aimed to assess the interobserver agreement of lung ultrasound (LUS) between the local investigator and an expert panel in classifying ARDS subphenotypes alongside protocol adherence and safety endpoints, as a pilot phase of the ongoing PEGASUS study. Methods: The first 80 mechanically ventilated patients with moderate-to-severe ARDS were enrolled in the ongoing PEGASUS study, a randomized clinical trial (RCT), and were included in the pilot phase. Focal or non-focal subphenotypes were classified using a LUS. Positive end-expiratory pressures (PEEP), tidal volumes (VT), the application of recruitment manoeuvres, and proning were performed according to randomization arm and subphenotype. Safety limits for MV followed current guidelines. Agreement in subphenotype classification between local investigators and a panel of three experts was evaluated using Cohen’s κ coefficient. Results: In 68 out of 80 exams, the images were of sufficient quality for assessment. The interobserver agreement for the lung morphology had a Cohen’s kappa of 0.72 (95% CI 0.53–0.9) and accuracy of 88% between local investigator and the expert panel. Misclassification occurred in 8/68 exams (11.8%). Among these 8 misclassified cases, 6 (75%) also showed disagreement between experts due to different LUS scores of the anterior regions. Tidal volume and PEEP were generally set according to the protocol. An exception was the TV in the non-focal ARDS patients randomized to personalized MV, where the median (6.2 ml/kg/PBW) was above the target range (4–6 ml/kg/PBW). Patients exceeding safety limits of MV were low. Conclusion: In the pilot phase of an ongoing international subphenotype-targeted RCT, we found that local investigators’ assessments agreed with expert panel consensus assessments in the large majority of cases, and nearly always when the expert panel assessment was unanimous. Protocol adherence was sufficient, but tidal volume in the non-focal subphenotype deserves attention during continuation of the study. Trial registration: The study was registered on clinicaltrial.gov (ID: NCT05492344, date 2022-08-05).Item Metadata only COMPARISONS OF DELAYS AND CO₂ EMISSIONS BETWEEN FIXED-TIME AND WEBSTER'S OPTIMAL SIGNAL TIMING AT INTERSECTION(2025-01-01) Khieowan A.; Satitsakhon T.; Mongtewin M.; Soe T.N.; Sapsathiarn Y.; Srisurin P.; Khieowan A.; Mahidol UniversityThis study aims at comparing the average delay and carbon emissions between the existing conditions, in which traffic flows are controlled by a fixed-time signal controller, and the scenarios where signal timings are optimized using Webster’s method. This study opts to optimize signal timing at an isolated signalized intersection by minimizing the total vehicular delay that occurs as a result of queuing. The layout of Saphan Khwai Intersection, an at-grade four-legged intersection located in Bangkok, Thailand, was adopted as a case study for comparing the two types of signal controls. Sixteen scenarios with varying traffic flows, ranging from 100 pc/h/ln to 1,600 pc/h/ln, were coded in Microsoft Excel using macros to compare the resultant delays and carbon emissions between five different fixed-time signal controls, spanning a cycle length of 50 seconds to 250 seconds, and the optimized signal timing using Webster's method. The results show that Webster’s method produces lower delays and carbon emissions than adopting the fixed cycle length at low to moderate traffic flows. However, the effectiveness of Webster’s method starts to be diminished as the average demand flow is approaching the saturation flow rate under the same conditions. This study intends to investigate how much delays and carbon emissions would be reduced if a real-time signal controller using Webster’s method is adopted to replace the current fixed-time controller at the intersection.Item Metadata only Clinical prediction rules of postoperative reintubation within 24 hours after general anesthesia: a retrospective case-control study(2025-12-01) Morakul S.; Charernboon T.; Patumanond J.; Sombatthaveekul P.; Eowsakul N.; Morakul S.; Mahidol UniversityBackground: Reintubation after planned extubation (RAP) following general anesthesia is a serious complication associated with intensive care unit admission, prolonged hospitalization, and increased mortality. Despite its clinical significance, no routinely validated clinical scoring system currently exists for predicting RAP. This study aimed to develop a clinical prediction rule for reintubation within 24 h after general anesthesia. Methods: This retrospective case-control study included 657 patients (235 cases and 422 controls) who underwent general anesthesia at Ramathibodi Hospital between 2014 and 2018. Cases were defined as patients reintubated within 24 h after planned extubation, and controls were randomly selected from those with successful extubation on the same operative day. Multivariable logistic regression was used to identify predictive factors, and significant predictors were transformed into a point-based risk score. Results: Significant predictors of reintubation included age < 1 or > 65 years, ASA classification ≥ III, emergency surgery, neurosurgical or thoracic procedures, vasopressor or inotrope use, positive fluid balance ≥ 40 mL/kg, and failure to follow commands after anesthesia. The score-based model demonstrated strong discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.831 (95% CI: 0.795–0.868). Hosmer–Lemeshow goodness-of-fit test using 9 groups: χ²(df = 7) = 10.67, p = 0.154. Bootstrap validation confirmed consistent performance, with an optimism-adjusted AUROC of 0.831 (95% CI: 0.798–0.870). Based on total score ranges, patients were stratified into two risk categories. Those with a score of 0–9 was classified as low risk with a positive likelihood ratio (LHR+) of 0.693 (95% CI: 0.526–0.913, p = 0.004), and scores of 9.5–20 were considered high risk with an LHR + of 11.363 (95% CI: 5.611–25.306, p < 0.001). Conclusion: The RAP prediction score is a validated clinical prediction tool with good discrimination of postoperative RAP. It effectively stratifies postoperative patients into distinct risk categories and may guide for recognition and decision making for extubation during postoperative period.Item Metadata only DETERMINING THE CAPACITY OF A MAJOR HIGHWAY SEGMENT USING AN EMPIRICAL METHOD(2025-01-01) Korbuakaew K.; Phatchanakit T.; Luangon C.; Soe T.N.; Pathomsiri S.; Srisurin P.; Korbuakaew K.; Mahidol UniversityThis study estimates the highway capacity of a segment on Borommaratchachonnani Road, an eight-lane highway in Thailand, using an empirical model based on speed– flow relationships derived from field data. Traffic flow and speed data were collected via video recordings on multiple weekdays in February 2025. A speed–flow diagram was constructed using five-minute interval data to determine the empirical capacity of the highway segment. The resulting capacity estimate was compared with two established models: the Highway Capacity Manual (HCM) 2016 and the model developed by Thailand’s Department of Highways (DOH). Results indicate that both models significantly overestimate actual capacity by 72.76% for the HCM 2016 model and 30.73% for the DOH model. The overestimation in the HCM model is attributed to differences in driver behavior and the exclusion of motorcycles, while the DOH model, though more accurate, is outdated. The findings underscore the need for localized adjustments in capacity models to reflect Thailand’s unique traffic conditions. Key variables such as motorcycle prevalence, autonomous vehicles, access point density, and terrain type should be integrated into future modeling efforts.Item Metadata only Sell What They Grow, Buy What They Eat: Changes in the Availability and Consumption of Food in the Central Thailand Farmers’ Community(2025-04-01) Montrivade V.; Sri-Ngernyuang L.; Montrivade V.; Mahidol UniversityThis study explores the dynamics of food insecurity among rural farming households in central Thailand. Drawing on ethnographic fieldwork conducted in Ban Khok between 2014 and 2023, it examines how commercial agriculture, labour demands, and digital technologies have reshaped food production and consumption. Guided by the frameworks of food security and political ecology, the analysis highlights a shift from self-reliant food practices to dependence on market-based and convenience-oriented alternatives. The findings show that despite being food producers, many farmers no longer consume what they grow, leading to increased nutritional risk, chronic illness, and cultural disconnection. A local concept reflecting economic constraints over ecological balance exemplifies this shift. The study concludes that food insecurity in this context stems not from scarcity but from structural dispossession and loss of food agency. It recommends context-sensitive interventions that address autonomy, biodiversity, and climate adaptation within local food systems.Item Metadata only Knowledge, Attitude, and Behavior of Photoprotection in Thai Vitiligo Patients(2025-01-01) Wongpraparut O.; Wannawittayapa T.; Wattanasillawat P.; Yothachai P.; Nuntawisuttiwong N.; Silpa-archa N.; Wongpraparut O.; Mahidol UniversityBackground: Vitiligo is a chronic pigmentary disorder characterized by the progressive loss of melanocytes, resulting in skin depigmentation. Although UV-based therapies, such as narrowband UVB, are commonly used for treatment, excessive sun exposure may aggravate the disease. Understanding patients’ perceptions and behaviors related to sun exposure is crucial, particularly in tropical countries like Thailand, where UV levels are high. Purpose: To assess the knowledge, attitudes, and photoprotection behaviors of Thai vitiligo patients compared to healthy controls. Patients and Methods: A cross-sectional study was conducted from January to August 2025 using a self-administered questionnaire. The questionnaire assessed participants’ demographics, vitiligo-related characteristics, knowledge and attitudes toward sun exposure, perceived skin cancer risk, and sun protection practices. Data from 105 vitiligo patients and 85 controls were analyzed using chi-square and descriptive statistics. Results: Vitiligo patients showed greater awareness of the effects of sunlight on their condition than the control group. A higher proportion thought mild sunlight may improve vitiligo (57.1% vs 31.8%, p < 0.001). Only 25.7% of patients believed they had an increased risk of skin cancer. Vitiligo patients were more likely to use sunscreen regularly (53.3% vs 37.6%, p = 0.031) and during outdoor activities (61.0 vs 40.0%, p = 0.004) compared to control. However, reapplication rates were suboptimal with 75.2% of vitiligo patients never reapplied sunscreen, and fewer patients reapplied occasionally compared to controls (18.1% vs 37.6%, p = 0.002). Conclusion: Thai vitiligo patients demonstrated moderate understanding of photoprotection and skin cancer risk, but significant behavioral gaps exist, notably in terms of sunscreen reapplication and comprehensive sun protection methods. These findings underscore the need for focused educational efforts to close the knowledge-practice gap, highlighting both the benefits and risks of UV exposure in vitiligo treatment.Item Metadata only Exploring Theoretical Models and Frameworks Used to Explain Factors Influencing Breast Cancer Screening Participation: A Scoping Review(2025-01-01) Zheng D.; Lekdamrongkul P.; Gao X.; Sriyuktasuth A.; Zheng D.; Mahidol UniversityObjective: The purpose of this study was to explore theoretical models and frameworks used to guide research studies that explain factors influencing participation in breast cancer screening (BCS). Methods: This study was conducted according to the framework developed by Arksey and O’Malley and reported in line with the PRISMA-ScR guidelines. A comprehensive search was performed across six databases: PubMed, Embase, CNKI, Scopus, EBSCO, and the Cochrane Library. Two researchers independently screened titles and abstracts. Data extraction and cross-checking were conducted on included studies, with a third researcher facilitating consensus in cases of disagreement. Extracted information included author, publication year, country, research methods, sample size, age, theoretical framework, and outcomes. A pre-designed form ensured consistency and accuracy in data extraction. Results: A total of 70 studies were included. The studies were primarily cross-sectional (66/70, 94.29%), with the largest geographical locations being the United States (16/70, 22.86%), Iran (15/70, 21.43%), and China (9/70, 12.86%). The review identified 13 models, with Health Belief Model being the most commonly used (21/70, 30.0%), followed by Andersen’s Behavioral Model (11/70, 15.71%) and Theory of Planned Behavior (8/70, 11.43%). The Health Belief Model emerged as the most empirically supported framework across all studies, particularly effective in identifying economic barriers and trust issues within healthcare systems among low-income and low-health literacy populations. This model has also been incorporated into more comprehensive frameworks, demonstrating strong predictive power and practical applicability with additional variables. All models offer distinct strengths, but their predictive power largely depends on research contexts and target populations. These variations may result in an incomplete or unreliable understanding of factors influencing BCS behavior. Conclusion: The findings provide a comprehensive summary of the models and frameworks employed to investigate factors influencing BCS over the past decade. These insights have significant implications for designing targeted healthcare interventions and informing policy changes to enhance global BCS participation and reduce disparities. Future refinements of these models are expected to improve their applicability and effectiveness across diverse populations and settings.Item Metadata only The effectiveness of non-pharmacological community dementia prevention interventions on older adults with mild cognitive impairment in China: a systematic review and meta-analysis(2025-01-01) Huang R.; Amnatsatsue K.; Nityasuddhi D.; Kerdmongkol P.; Kaewwilai L.; Cai P.; Huang R.; Mahidol UniversityObjectives: Given that Mild Cognitive Impairment (MCI) represents a transitional stage between normal aging and dementia, this study examined whether non-pharmacological interventions could effectively improve cognitive function and slow cognitive decline in Chinese community-dwelling older adults with MCI. Method: This study was conducted to identify randomized controlled trials involving non-pharmacological interventions for preventing dementia in Chinese community settings. A comprehensive literature search was performed across 10 electronic databases through December 2024. Two reviewers independently assessed research quality using the Cochrane Risk of Bias Tool 1. Statistical analyses were performed using mean differences (MDs) with 95% confidence intervals (CIs) to synthesize outcomes data. Results: The included studies (n = 19) evaluated cognitive changes in response to non-pharmacological interventions, which showed significant cognitive improvements (MD: 2.08, 95% CI [1.30, 2.85], p <.001). Both multi-domain (n = 10) and single-domain interventions (n = 9) demonstrated cognitive benefits across 2705 MCI participants. Multi-domain interventions (MD: 3.39, 95% CI [2.03, 4.76], p <.001) showed greater benefits than single-domain approaches (MD: 1.41, 95% CI [0.87, 1.96], p <.001). Our findings also revealed significant beneficial effects on multi-domain interventions, including multiple exercises (MD = 5.40, 95% CI [3.90, 6.90]), combined multiple types of approaches (MD = 3.34, 95% CI [1.11, 5.58]), and multiple cognitive trainings (MD = 2.26, 95% CI [1.67, 2.84]). Conclusion: Non-pharmacological interventions significantly enhanced cognitive function among Chinese community-dwelling older adults with MCI. Furthermore, multi-domain approaches demonstrated superior efficacy compared to single-domain strategies. Specifically, exercise-based interventions, combined modality programs, and cognitive training protocols all exhibited substantial effectiveness for improving cognitive outcomes in this population.Item Metadata only Automated surveillance system for surgical site infection in coronary artery bypass graft surgery in tertiary care hospitals(2025-01-01) Skuntaniyom S.; Techasaensiri C.; Muntajit T.; Piebpien P.; Skuntaniyom S.; Mahidol UniversityBackground While screening-automated surveillance systems (SASS) for surgical site infections (SSIs) are widely used in high-resource settings, adoption remains limited in low- and middle-income countries, including Thailand. This study aimed to develop and validate an automated surveillance model tailored to the Thai health care context. Routine SSI surveillance following coronary artery bypass graft surgery in Thailand relies on direct method surveillance systems (DMSS), which are labor-intensive and require manual record review. Methods A retrospective validation study was conducted at a tertiary care hospital performing ∼120 coronary artery bypass graft procedures annually. Data from January 2020 to April 2022, when both DMSS and SASS were active, were analyzed to assess diagnostic performance and workload reduction. Results Among 4 algorithms tested, the “Possible SSI Surveillance Code” algorithm achieved 100% sensitivity (95% CI: 78.47-100), 91.69% specificity (95% CI: 88.18-94.23), a positive predictive value of 34.15% (95% CI: 21.56-49.45), and a negative predictive value of 100% (95% CI: 98.27-100). It also reduced manual workload by 87.91%. Conclusions SASS demonstrated high diagnostic accuracy and substantial workload reduction compared to DMSS. The selected algorithm provides a scalable model for enhancing SSI surveillance in low- and middle-income country settings and advancing digital health transformation.Item Metadata only Optimization of in vitro cell culture conditions suitable for the cholangiocarcinoma stem cell study(2025-01-01) Kongtanawanich K.; Likasitwatanakul P.; Wattanapanitch M.; Jirawatnotai S.; Kongtanawanich K.; Mahidol UniversityCurrently, cancer stem cells (CSCs) are extensively studied due to their roles in tumorigenesis, metastasis, and drug resistance. However, the low quantity, and its transient nature present a challenge for their study. Therefore, a culture system supporting high CSC quantity and flexible for high-throughput drug testing is needed. In this study, we used cholangiocarcinoma (CCA) cell lines with a CSC-specific live-cell biosensor system, which expresses green fluorescence protein (GFP) in CSCs, to study factors/conditions affecting CCA stem-like cell quantity in culture. We investigated culture media, seeding density, and compared 2-dimension (2-D) vs 3-dimensional (3-D) culture methods. The effects of anti-CCA drug dosages on CSC numbers were also studied. By comparing three media recipes, a defined serum-free CCA medium was selected for its high CSC yields. We found seeding density and time significantly influence CCA CSC percentages in both 2-D and 3-D settings. Notably, 3-D culture markedly increased CSC percentages compared to 2-D, supporting its application in CSC studies. In 3-D culture, a higher CSC index correlated with higher anti-CCA drug doses, suggesting loss of differentiation as a prominent characteristic under standard therapy. Thus, we report culture conditions influencing CCA CSC quantity, useful for CSC study and anti-CSC drug discovery in CCA.Item Metadata only Genotype-guided ticagrelor/prasugrel versus clopidogrel therapy in stroke patients with CYP2C19 loss of function alleles: a systematic review and meta-analysis(2025-01-01) Biswas M.; Murad M.A.; Ershadian M.; Sweety S.P.; Hasan S.A.; Sukasem C.; Biswas M.; Mahidol UniversityIntroduction: Transient ischemic attack (TIA) or ischemic stroke (IS) patients may have recurrent stroke incidents, especially when carrying CYP2C19 Loss-of-Function (LoF) alleles and taking clopidogrel. Recent studies suggest using alternative antiplatelets, e.g., prasugrel, ticagrelor, in these patients. However, the aggregated risk of recurrent stroke or composite vascular events in CYP2C19 genotype-guided prasugrel/ticagrelor against clopidogrel therapy in such TIA/IS patients remained unexplored. Methods: A database search was performed to retrieve relevant studies. RevMan software was used to calculate the risk ratio (RR), considering p < 0.05 statistically significant. Result: Six studies (14,124 TIA/IS patients) were considered. TIA/IS patients carrying CYP2C19 LoF alleles on ticagrelor/prasugrel therapy were associated with a significant reduction in the risk of composite vascular events (RR 0.76, 95% CI 0.66–0.89; p = 0.0004) and recurrent stroke (RR 0.76, 95% CI 0.64–0.90; p = 0.002) compared to the clopidogrel therapy. However, the bleeding events did not differ significantly (RR 0.91, 95% CI 0.65–1.27; p = 0.58) between the treatment groups. Conclusion: TIA/IS patients inheriting CYP2C19 LoF alleles taking ticagrelor/prasugrel may significantly optimize the overall clinical benefits compared to those who are taking clopidogrel by reducing composite vascular events and recurrent stroke without elevating the risk of bleeding events. Plain Language Summary: Comparison of the CYP2C19 loss-of-function genotype-guided alternative antiplatelet therapy against clopidogrel What is the context? ● Minor ischemic strokes (IS) or transient ischemic attacks (TIAs) are frequent precursors of serious vascular events like death, recurrent strokes, with the maximum risk notably during the first 48 hours following onset. ● Clopidogrel responsiveness heterogeneity has been linked to polymorphisms in the CYP2C19 gene. ● For the secondary prevention of stroke, clopidogrel is found to be less effective in patients carrying CYP2C19 loss-of-function (LoF) alleles, highlighting the necessity of other alternative therapies (i.e. ticagrelor, prasugrel). ● The assessment of the aggregated risk of recurrent stroke in CYP2C19 genotype-guided prasugrel/ticagrelor against clopidogrel therapy is, therefore, needed to make more informed clinical decisions. What is new? ● Compared to the clopidogrel therapy, the alternative therapy with prasugrel/ticagrelor is more efficient in managing the risk of composite vascular events and recurrent stroke in TIA/IS patients inheriting CYP2C19 LoF alleles. ● The alternative therapies may be considered more suitable for the CYP2C19 LoF allele carrying TIA/IS patients, as these are associated with better clinical outcomes without an elevation in the risk of bleeding events. What is the impact? ● These findings may advance the precision medicine of antiplatelets in neurology for the management of stroke patients.Item Metadata only Reproducibility of the 2020 Society for Vascular Surgery/ Society of Thoracic Surgeons Reporting Standards for Uncomplicated Type B Aortic Dissection(2025-12-01) Sriprachyakul A.; Mastrodicasa D.; Willemink M.J.; Mistelbauer G.; Shen J.; Yang I.; Hallett R.L.; Malik S.B.; Madani M.H.; Lai K.M.; Hinostroza V.; Stern J.R.; Tran K.; Lee J.T.; Watkins A.C.; Macarthur J.W.; Mitchell R.S.; Miller D.C.; Fleischmann D.; Sriprachyakul A.; Mahidol UniversityPurpose: To assess the inter-and intrareader agreement of the 2020 Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) reporting stadards in patients with acute uncomplicated type B aortic dissection (uTBAD). Materials and Methods: CT angiograms, obtained between January 2001 and December 2013, from 37 patients (mean age ± SD, 48.5 years ± 15.6; 24 male) with uTBAD were retrospectively reviewed by 14 cardiovascular radiologists and surgeons. The entry tear and proximal and distal extent of each dissection were allocated to aortic zones according to the 2020 SVS/STS reporting standards. Inter-and intrareader agreement was assessed using Cohen κ. Causes of discrepant classifications were analyzed. Results: Interreader agreement among all 14 readers (eight radiologists, four cardiothoracic surgeons, and two vascular surgeons) were fair for the entry tear (к = 0.33, 0.40, 0.22, and 0.40), poor to moderate for the proximal extent (к = 0.30, 0.37, 0.20, and 0.41), and moderate to substantial for the distal dissection extent (к = 0.65, 0.80, 0.41, and 0.77). Interreader agreement between individuals was poor to substantial for the entry tear (к = 0.04–0.71; 78% discrepancy) and proximal extent (к = 0.00–0.62; 68% discrepancy), and fair to excellent for the distal extent (к = 0.33–0.92; 35% discrepancy). The causes for discrepancies were unclear definitions of aortic zones, anatomic complexity of lesions, and poor image quality. Intrareader agreement was moderate for the entry tear (к = 0.41–0.57), fair to moderate for the proximal extent (к = 0.37–0.58), and substantial to excellent for the distal extent (к = 0.66–0.92). Conclusion: geons. The 2020 SVS/STS reporting standards for acute uTBAD were poorly reproducible among experienced cardiovascular radiologists and surgeons.Item Metadata only INPATIENTS: Comparing Clinical Characteristics and Outcomes of Adults with In-Hospital and Community-Onset Strokes(2025-01-01) Ignacio K.H.D.; Abdalrahman R.; Kaveeta C.; Mehdi M.; Alizada A.; Nicol D.; Stang J.; Moore R.; Alshamrani M.; Agnelli B.; Holodinsky J.K.; Menon B.K.; Hill M.D.; Al-Mekhlafi M.A.; Ignacio K.H.D.; Mahidol UniversityBackground and Objectives: In-hospital strokes comprise a small but high-risk subgroup of patients and are associated with worse outcomes compared to community-onset strokes. We compared clinical characteristics, workflow metrics and clinical outcomes of adult patients with in-hospital strokes and those with community-onset strokes in Alberta. Methods: We conducted a retrospective cohort study (INPATIENTS: IN-hosPitAl sTrokes InAlbErta iNcidence and ouTcomeS) from Jan 1, 2018–Dec 31, 2022 using provincial administrative data and chart review to compare in-hospital and community-onset acute ischemic and hemorrhagic strokes. We performed multivariable logistic regression to determine the association of stroke onset location (in-hospital vs community-onset) with the following outcomes: in-hospital mortality, prolonged hospital stay and in-hospital complications. Negative binomial regression was conducted to compare workflow metrics between cohorts. All models were adjusted for age, sex, comorbidities, facility type and admission year. Results: Among 24,039 stroke admissions, 2,545 (10.6%) were in-hospital strokes and 20,895 (86.9%) were ischemic. In-hospital strokes had higher rates of comorbidities and were associated with higher in-hospital mortality (adjusted OR [aOR] 3.09; 95% CI 2.80–3.41), prolonged hospital stays (aOR 5.47; 95% CI 4.89–6.112) and increased in-hospital complications. In-hospital ischemic stroke patients receiving thrombectomy showed lower odds of in-hospital mortality (aOR 0.46; 95% CI, 0.28–0.75) and pneumonia (aOR 0.38; 95% CI, 0.20–0.71) compared to non-treated patients. Workflow times were significantly longer in in-hospital ischemic strokes compared to community-onset strokes. Discussion: Patients with in-hospital stroke experience higher rates of mortality, poorer clinical outcomes and significant delays in management. Targeted quality improvement efforts are needed to address care gaps and improve outcomes in this population.Item Metadata only Function of follicular helper 17 T cells in driving B cells for anti-DNA autoantibody production in patients with SLE(2025-12-17) Khunsri T.; Tianpothong P.; Kochayoo P.; Thawornpan P.; Suangtamai T.; Leepiyasakulchai C.; Ngamjanyaporn P.; Pisitkun P.; Chootong P.; Khunsri T.; Mahidol UniversityBackground Follicular helper T (TFH) cells play a crucial role in the dysregulated antibody responses in SLE. Circulating TFH17 (cTFH17) subsets are elevated in active lupus, and their frequency is associated with increased disease activity and autoantibody levels, indicating their potential role in disease development by promoting B-cell and autoantibody production. However, how activated cTFH17 cells drive B cell dysregulation for autoantibody production in SLE remains incompletely understood. Objective To investigate the phenotypic function of interleukin (IL)-17A-producing cTFH cells in subjects with SLE, explore their association with clinical parameters and inflammatory markers and demonstrate potential contributions to B cell-mediated autoantibody production Methods Forty subjects with SLE were enrolled to characterise and phenotype cTFH or circulating peripheral helper T cell subsets, based on molecule surface expression and intracellular cytokine production by flow cytometry. The correlations of cTFH17 or cTFH17.1 cells with disease activity, anti-double-stranded DNA (dsDNA) autoantibodies and inflammatory cytokines were analysed. The interactions of cTFH17 cells with autoreactive B cell responses were studied in co-culture assays. The proliferation and inducible T cell costimulator (ICOS) upregulation were detected in cTFH17 cells, while autoantibody-secreting cell differentiation and autoantibody production were detected in B cells. Results The frequencies of cTFH17 and cTFH17.1 cells were significantly elevated in subjects with SLE compared with healthy controls, particularly in those with active disease. These cells exhibited increased activation, as indicated by the expression of ICOS and CD40L. The frequency of activated cTFH17 or cTFH17.1 cells correlated positively with SLE disease activity index 2000 (SLEDAI-2K) scores but not with anti-dsDNA antibody levels. Profiling of inflammatory cytokines revealed the elevated levels of IL-6, IL-8 and IL-17A in individuals with SLE. However, the increased levels of these cytokines did not correlate with the frequency of cTFH17 cells nor SLEDAI-2K scores. In cTFH17-B cell co-cultures, proliferation and activation of cTFH17 cells were detected. There, B cells differentiated into antibody-secreting cells, which secreted anti-DNA autoantibodies. Conclusion cTFH17 cells were significantly expanded and activated in subjects with active SLE, showing a positive correlation with clinical activity. Functionally, cTFH17-B cell interactions enhanced plasma cell generation and autoantibody production. These findings suggest that cTFH17 cells play a key role in SLE pathogenesis.Item Metadata only Dual-functional 3D-printed hydrogels for pH-responsive wound monitoring and on-demand therapy(2025-01-01) Phookum T.; Siripongpreda T.; Tiston K.A.; Rerknimitr P.; Henry C.S.; Narupai B.; Rodthongkum N.; Phookum T.; Mahidol UniversityThe rapid and personalized management of wound infections remains a significant clinical challenge. This study addresses this need by developing a smart, dual-nozzle 3D-printed theranostic hydrogel pad for on-demand wound care. The platform is based on a tailor-made Pluronic F127-dimethacrylate (PF127-DMA) hydrogel, synthesized to provide optimal printability and dual-functionality. This enables the simultaneous extrusion of two distinct bioinks: a diagnostic ink containing bromocresol purple for pH sensing and a therapeutic ink loaded with graphene oxide (GO) and the antibiotic levofloxacin. The fabricated construct acts as an intelligent wound dressing, providing a distinct visual colorimetric response to differentiate healthy skin pH (4.0–6.0) from pathogenic, alkaline infection conditions (pH 7.4–8.0). Simultaneously, the system provides pH-responsive controlled drug release, with a significantly enhanced cumulative levofloxacin release of 171.68 ± 1.59 µg at pH 8.0 compared to 134.34 ± 1.46 µg at pH 7.4, demonstrating its ability for infection-triggered therapy. The incorporation of graphene oxide was found to critically improve drug release kinetics and promote intramatrix accumulation. Furthermore, in vitro MTT assays confirmed the high biocompatibility of the hydrogel platform. By integrating real-time visual monitoring with controlled antimicrobial release, this 3D-printed theranostic system presents a promising and scalable strategy for advanced wound management.Item Metadata only The effectiveness of augmented reality handouts for learning microbiology in medical students(2025-12-01) Suwantarat N.; Suriya S.; Vanicharoenchai V.; Vichitvejpaisal P.; Raksamani K.; Suwantarat N.; Mahidol UniversityWe evaluate the effectiveness of self-directed learning augmented reality (AR) handouts as learning materials for teaching microbiology to third-year medical students in the Doctor of Medicine (English Program) at Thammasat University. A stratified randomized controlled trial was conducted comparing academic performance (multiple-choice question scores), the motivation levels (motivated strategies for learning questionnaire, MSLQ), and satisfaction survey scores among students studying with AR handouts (intervention group) versus traditional handouts (control group). Twenty-four students participated in this study (n = 12 per group). There were no significant differences between the groups in terms of age, gender, total grade point average, or pre-test scores (mean of 5.08). Both groups demonstrated similar improvements in post-test scores, with means of 11.25 for the intervention group and 10.58 for the control group. However, MSLQ scores for intrinsic goal orientation were higher in the intervention group compared to the control group (5.73 vs 4.81, P = 0.002). Satisfaction survey scores, particularly in the categories of “Handouts are stimulating” and “Handouts are exciting,” were also higher in the intervention group than in the control group (4.58 vs 3.50, P = 0.025, and 4.42 vs 3.17, P = 0.019, respectively). AR handouts were effective in enhancing the learning of medical microbiology and infectious diseases.Item Metadata only A Corpus-based Analysis of Asean’s Sustainable Development Discourse: Implications for Knowledge Management, AI, and Urban Information Systems in Bangkok, Thailand(2025-05-30) Shen Z.; Shen Q.; Zhang Y.; Pang B.; Shen Z.; Mahidol UniversityThis study examines how ASEAN integrates sustainable development values into its policies and actions, with a particular focus on AI-driven knowledge management and information systems in Bangkok, Thailand. Natural Language Processing (NLP) techniques, including preprocessing, entity identification, and sentiment analysis, were employed to analyse over one million samples from government documents, articles, and social media posts. The AntConc tool was utilised to identify key terms such as “sustainability” and “resilience.” The findings suggest that ASEAN’s communication strategies align with global knowledge management standards, emphasising long-term cooperation and participation—core values of ASEAN’s sustainable development agendas, particularly in AI-enhanced systems and local policies such as smart cities and climate change adaptation in Bangkok. The study highlights ASEAN’s multifaceted approach, which balances economic, environmental, and social factors. ASEAN member states collaborate to develop and implement AI-driven solutions that facilitate efficient and sustainable development. Future research should examine how language strategies across ASEAN countries influence knowledge management and information systems and assess the outcomes and implications of these strategies for stakeholders.Item Metadata only Online Illicit Drug Distribution in the Thai Language on X: Exploratory Qualitative Content Analysis(2025-01-01) Lamy F.R.; Paek S.C.; Meemon N.; Lamy F.R.; Mahidol UniversityBackground: By increasing exposure to drug-related advertisements, the illicit digital drug trade promotes drug normalization and eases access to substances, increasing the likelihood of initiation. Social media platforms play an increasingly important role in facilitating the online substance trade by leveraging encrypted communications and user-friendly interfaces to advertise a large variety of readily available substances. Despite its growing importance, there is a paucity of research conducted in Thailand that aims to determine the types of substances, marketing strategies, and public health risks linked to drugs advertised on social media. Objective: This study aimed to inductively explore the content of tweets on the social media platform X (formerly known as Twitter) advertising drugs in the Thai language. Methods: Tweets advertising psychoactive substances in the Thai language were collected manually between April and July 2024. A qualitative content analysis was performed on the collected tweets. Tweets were coded based on 5 themes: types of substances advertised, marketing strategies, delivery methods, number of substances per tweet, and location references. The intercoder reliability for each theme was assessed using Krippendorff a, achieving substantial agreement across most codes. Results: A total of 3832 tweets advertising drugs were collected and analyzed. Most tweets (2424/3832, 63.26%) mentioned 5 or more substances, with depressants such as opioids (2807/3832, 73.25%), antihistamines (2394/3832, 62.47%), and benzodiazepines (2009/3832, 52.42%) being the most frequently advertised. Common marketing techniques included direct contact information (2848/3832, 74.32%) and fast delivery (1216/3832, 31.73%). Delivery methods primarily involved courier services but generally offered multiple options. Tweets that mentioned at least 1 sex-performance enhancer were frequently (422/543, 77.7%) advertised in combination with benzodiazepine. Conclusions: The results of this study suggest the presence of a large number of substances advertised for sale on the X platform in the Thai language. This digital form of drug trading is facilitated by possible direct messaging and the large number of courier services existing in Thailand. Our findings call for the development of real-time monitoring systems that harness drug-related data from social media to inform public health practitioners about emerging substances and trends and address the challenges posed by the digital drug trade.Item Metadata only Resilience for Psychological Safety and Interprofessional Collaboration: Insights from Malaysia, Japan and Thailand Medical Educators(2025-01-01) Yusoff M.S.B.; Puranitee P.; Takada S.; Okubo Y.; Yamamoto T.; Saito C.; Yusoff M.S.B.; Mahidol UniversityThe high-stress healthcare environment necessitates strategies to enhance psychological safety and interprofessional collaboration. This article critically explores the pivotal role of resilience in fostering well-being, work engagement and teamwork among healthcare professionals in Malaysia, Japan, and Thailand. Drawing on the DEAL PROGRAMME (Detect, Evaluate, Act, Learn) and other resilience-building strategies, the findings highlight the importance of integrating resilience initiatives at individual, organisational and systemic levels. The structured DEAL Programme demonstrates a scalable, effective framework for reducing stress, improving collaboration, and enhancing psychological safety. Insights from Japan and Thailand reveal valuable cultural adaptations, emphasising mindfulness, mentoring and student well-being. These insights emphasise the need for contextualised resilience strategies tailored to diverse healthcare contexts. This article has elucidated how resilience can create a more supportive and high-performing healthcare system. It calls for continued investment in resilience training to ensure sustainable healthcare environments that improve patient care and professional well-being.Item Metadata only Microplastic Removal by Flotation: Systematic Review, Meta-Analysis, and Research Trends(2025-12-01) Phengsaart T.; Srichonphaisarn P.; Villacorte-Tabelin M.; Silwamba M.; Janjaroen D.; Tabelin C.B.; Alonzo D.; Ta A.T.; Juntarasakul O.; Phengsaart T.; Mahidol UniversityMicroplastic (MP) pollution is a global concern due to its persistence, ubiquity, and potential ecological and health risks. Although various MP separation techniques exist, flotation has gained attention as a promising approach adapted from mineral processing. This study provides a systematic review, bibliometric analysis, and meta-analysis of MP removal using flotation, covering 31 papers published between 2015 and 2024. Research output has grown rapidly since 2020, with China (including Hong Kong) as the leading contributor with strong international collaborations. Bibliometric mapping highlighted hotspots such as polymer type, particle size, contact angle, and nanobubbles. Meta-analysis showed that flotation achieved high removal efficiencies across water and solid matrices, though performance varies with polymer properties, surfactants used, and experimental design. Studies focused on solid particles remain limited, reflecting greater methodological challenges than in water systems. Critical discussion emphasized the need for standardized protocols, scaling from laboratory to field applications, and integration with wastewater treatment. This review identified knowledge gaps and emerging trends that can inform the future development of flotation as an effective technology for mitigating MP pollution.