Scopus 2025
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Item Metadata only Factors associated with detecting pathogenic intestinal parasites in multiple stool microscopy samples: a retrospective cross-sectional study(2025-10-01) Ananchaisarp T.; Srisintorn W.; Saelue P.; Jaruthamsophon K.; Adisakwattana P.; Ananchaisarp T.; Mahidol UniversityDetermining the optimal number of stool samples for accurate parasite detection is crucial in healthcare. However, previous studies have reported conflicting results. This study investigated factors associated with the detection of pathogenic intestinal parasites in additional stool microscopy examinations. This retrospective cross-sectional study at a tertiary care hospital outpatient clinic included patients who submitted three stool samples between 2012 and 2021 and had at least one pathogenic intestinal parasite-positive stool sample. Diagnostic yields for one, two, and three stool specimens were the primary outcome. The secondary outcome was the identification of factors associated with the time to the first positive stool microscopy result, which was analysed using ordinal logistic regression. Among the 103 infected patients, compared with the infection detection rate in the first specimen, the rate increased with the second specimen and further increased with the third specimen, achieving a cumulative detection rate of 100%. Some parasites, such as hookworms, were easily detected in the first sample. However, more than half the patients infected with Trichuris trichiura and all patients infected with Isospora belli were missed if only one stool specimen was collected. Immunocompetent hosts were significantly more likely to have pathogenic intestinal parasites detected in later stool specimens (adjusted ordinal odds ratio = 3.94 [95% confidence interval: 1.34–14.05]). Collecting multiple stool specimens was associated with a higher likelihood of detecting pathogenic intestinal parasites, particularly in immunocompetent patients. Clinicians may request a second or even a third sample if the first is negative.Item Metadata only HLA class I expression shapes the tumor immune microenvironment and influences prognosis in prostate cancer(2025-01-01) Likasitwatanakul P.; Besonen C.; Tsai A.K.; Sadeghipour N.; Elliott A.; Arafa A.T.; Passow R.; Chesner L.; Felices M.; Kennedy P.R.; Patnaik A.; Narayan V.; Hamrick J.; Sena L.A.; Zorko N.A.; Hwang J.H.; Antonarakis E.S.; Likasitwatanakul P.; Mahidol UniversityBackground: Human leukocyte antigen (HLA) class I encompasses peptide-binding proteins that regulate T-cell interactions. We examined HLA class I expression in prostate cancers (PC), exploring associations with clinical outcomes, molecular features, and tumor immune microenvironment. Methods: We analyzed 8040 PC samples from the Caris Life Sciences database, stratifying them into HLA-high (upper quartile) and -low (lower quartile) groups. Genomic and transcriptomic alterations were compared. Immune cell fractions were inferred using quanTIseq, and overall survival (OS) data was obtained from insurance claims. Differences were computed with Cox proportional hazards. Results: Among 66 cancer types, PC ranked 3rd-, 11th-, and 19th-lowest for HLA-A, -B, and -C expression, respectively. In PC, genes tied to androgen receptor (AR) signaling, immune checkpoint molecules (CTLA4, PD-L1), and the epithelial-mesenchymal transition were significantly higher in HLA-high tumors. HLA-high status was linked to greater tumor immune activity, marked by higher T cell fractions and enhanced immune hallmarks. HLA-high tumors were less likely to possess alterations in AR, FOXA1, and CDK12, but harbored increased alterations in tumor suppressor gene (RB1, PTEN) alterations. Tumors with high HLA-A and HLA-B had elevated TMB-H/MSI-H/dMMR status. Finally, shorter OS was observed in patients with high HLA-A or HLA-B expression, while longer OS was associated with high HLA-C expression. Conclusions: In PC, elevated HLA class I levels correlate with immune activity, molecular characteristics, and clinical outcomes. We suggest considering HLA expression as a supplementary marker of immune activity in PC, alongside genetic mutations and transcriptomic markers.Item Metadata only Prevalence of Dry Eye Disease and Ocular Surface Abnormalities in Eyes with Corneal Transplantation: A Cross-Sectional Study(2025-01-01) Lekhanont K.; Sukvaree P.; Cheewaruangroj N.; Vongthongsri P.; Phimpho P.; Pisitpayat P.; Lekhanont K.; Mahidol UniversityPurpose: To evaluate tear film and ocular surface parameters and estimate the prevalence of dry eye disease (DED) in eyes following corneal transplantation. Patients and Methods: This cross-sectional study assessed 104 eyes of 81 patients who had undergone penetrating keratoplasty (PK; 81 eyes), deep anterior lamellar keratoplasty (DALK; 9 eyes), or endothelial keratoplasty (EK; 14 eyes) for ≥ 3 months. Comprehensive ocular surface evaluations included the Ocular Surface Disease Index (OSDI), tear osmolarity, tear meniscus height (TMH), fluorescein tear breakup time, Oxford fluorescein staining, eyelid margin morphology, Schirmer I test, meibomian gland expressibility, and meibum quality. Results: Among post-PK/DALK eyes, more than 50% demonstrated at least one significant ocular surface abnormality, whereas this was observed in at least 25% of post-EK eyes. Elevated tear osmolarity was detected in approximately 20% of eyes in both groups. Based on TFOS DEWS II criteria, 32% of post-PK/DALK eyes and 57% of post-EK eyes met the diagnostic threshold for DED. Post-PK/DALK eyes with a follow-up time of ≤ 6 months exhibited significantly higher Oxford staining scores compared to those with follow-up > 6 months (P = 0.011). In unilateral PK/DALK cases, operated eyes showed greater ocular surface staining (P < 0.001) and a greater proportion of tear hyperosmolarity (P = 0.001) compared to unoperated fellow eyes. Conclusion: DED is common after corneal transplantation. While more pronounced in the early postoperative period, ocular surface epitheliopathy may persist long-term after surgery. These findings underscore the need for proactive long-term ocular surface monitoring and management to optimize surgical outcomes.Item Metadata only Production and purification of tag-free recombinant human acid sphingomyelinase in Nicotiana benthamiana(2025-11-01) Panyawechamontri K.; Kajiura H.; Misaki R.; Fujiyama K.; Panyawechamontri K.; Mahidol UniversityKey message: Tag-free, functional human acid sphingomyelinase was successfully produced in a plant-based system. Apoplastic wash fluid extraction improved downstream processing, and a two-step ion exchange chromatography enabled purification of plant-derived ASM. Abstract: Acid sphingomyelinase (ASM) converts sphingomyelin into phosphocholine and ceramide, a process essential for various cellular functions. Given the relevance of ASM to human health and its potential as a therapeutic enzyme, the development of efficient recombinant production systems is of significant interest in biotechnology. We here developed a plant-based expression system for producing human ASM and targeted major limitations related to its purification. The purification was improved in two ways: by engineering a truncated ASM with a plant-derived secretion signal peptide and by utilizing apoplastic wash fluid extraction to improve the purification process. Recombinant ASM was produced in N. benthamiana as a functional protein using an Agrobacterium-mediated transient expression system. The recombinant ASM was then purified using a two-step ion exchange chromatography method, ensuring high purity. After purification, the ASM yield reached approximately 3.5 mg per kg of fresh leaf weight, with a yield of 49.14% and a 21.2-fold purification enhancement. The purified enzyme exhibited a specific activity of 128.18 ± 4.18 mU/mg, confirming that the plant-derived ASM was functionally active. This work represents the first successful production of human ASM in plants, along with the development of an optimized purification method. This achievement marks a significant step forward in overcoming the challenges associated with producing and purifying recombinant proteins in plant-based expression systems, paving the way for future therapeutic applications.Item Metadata only Non-Insulated Microneedle Radiofrequency for the Treatment of Hydroquinone-Induced Exogenous Ochronosis: A Case Report and Literature Review(2025-01-01) Wittayabusarakam N.; Rutnin S.; Jurairattanaporn N.; Wittayabusarakam N.; Mahidol UniversityPurpose: Exogenous ochronosis is a challenging condition that requires multifaceted modalities. This investigation delineates a case of hydroquinone-induced exogenous ochronosis that improved following treatments with a bipolar non-insulated microneedle radiofrequency (MNRF). To report the efficacy and safety of microneedle radiofrequency as a novel treatment for exogenous ochronosis, and to review the role of energy-based devices as treatment options for this condition. Patients and Methods: A 63-year-old patient with a history of long-term application of hydroquinone-containing products for the treatment of melasma gradually developed hyperpigmented lesions on the face, which were later confirmed the diagnosis of exogenous ochronosis by skin biopsy. Three sessions of bipolar non-insulated MNRF with four-week intervals were employed to treat the affected areas. The clinical improvement of the ochronotic lesion was assessed by digital photograph and Trica facial analysis instrumentation. Results: There was a discernible enhancement in exogenous ochronosis and preexisting melasma within one month after the initial session of bipolar non-insulated MNRF. Following three sessions of MNRF, the patient also demonstrated a further diminution of ochronotic substances and a substantial improvement in the overall dermal texture of the treated regions as assessed by the Trica facial analysis system. Adverse effects were mild erythema and edema, which were transient and self-resolving within four to five days. No post-inflammatory hyperpigmentation, hypopigmentation, or prolonged erythema was detected after the intervention. Conclusion: This case of exogenous ochronosis demonstrates the role of bipolar non-insulated MNRF as a viable and safe therapeutic option for the management of hydroquinone-induced exogenous ochronosis.Item Metadata only Parental Child Abduction In Indonesia: A Criminal Law Perspective(2025-08-31) Sofian A.; Yulia R.; Hendra R.; Setyawati M.; Capaldi M.P.; Sofian A.; Mahidol UniversityThis research examines parental conflicts that lead to "child abduction" within families and the criminal law aspects in Indonesia, including its differences from virtual child abduction. It employed the normative method, utilizing a legal framework focusing on criminal law and child protection legislation. Comparative legal approaches were also utilized in the research. The novelty of this study lies in its exploration of resolutions through criminal law for parents who abduct their children without the consent of the other parent. The wrongful actions of a parent who abducts a child without consent include separating the child, restricting access to the other parent, and disrupting the child's normal development. Within the realm of criminal law, this act by a parent is not considered a criminal offense. Consequently, it cannot be reported to the police, and thus, the police cannot process such abduction reports. This leads to injustice, particularly when the abducting parent prevents the other parent from seeing their biological child. Ultimately, the best interests of the child are no longer prioritized and tend to be neglected. Additionally, in relation to child abduction, perpetrators also utilize digital technology to influence the child. The Indonesian law seems to have failed to protect children from wrongful actions or forced separation from their parents. Therefore, reforms in criminal law related to child protection are needed, particularly concerning cases where a parent abducts their child and separates them from the other parent.Item Metadata only Holographic thermodynamics of Kerr–Einstein–Maxwell–dilaton–axion–Anti-de-Sitter black hole(2025-12-01) Sereewat P.; Senjaya D.; Sereewat P.; Mahidol UniversityThis work reports a novel investigation of the bulk and CFT thermodynamics of Kerr–EMDA–AdS black hole in 3+1-dimensional AdS spacetime. We comprehensively present the construction of mass functions, the enthalpy analog, of the black hole for both scenarios and derive thermodynamic quantities from there. In the first part of this work, we derive an analytical expression of the bulk temperature, angular momentum per unit mass, electric field, thermodynamic volume, Gibbs and Helmholtz’s free energy functions, internal energy, specific heat capacities, adiabatic compressibility and the thermodynamic black hole’s speed of sound analog. The critical point of the analog Van der Waals phase transition is also analytically investigated. The second part of this work focuses on the CFT thermodynamics counterpart, especially on the critical phenomena. The behavior of the temperature, Helmholtz’s free energy and the heat capacity are analytically and graphically explored in various thermodynamical aspects. The last part of this work is dedicated to investigate the critical phenomena in F̄−T̄ and Ḡ−T̄ frameworks via implicit method. Interestingly, we also find that the Kerr–EMDA–AdS black hole exhibits not only first-order phase transitions in the dual CFT, but also a reentrant phase transition, characterized by a multibranched structure of the heat capacity.Item Metadata only Gamma radiation synthesized POSS crown ether polymers for efficient and selective lithium recovery from seawater(2025-11-01) Prigyai N.; Trakulmututa J.; Bunchuay T.; Sangtawesin T.; Prigyai N.; Mahidol UniversityThe rapid increase in worldwide demand for lithium ions (Li+) is driven by progress in renewable energy storage systems and nuclear technology. The development of efficient recovery techniques has been required. Adsorption-based methods provided operational simplicity and environmental sustainability. However, it is limited by poor selectivity, low adsorption capacities, and complex synthesis processes. In this study, a novel and efficient strategy was developed to fabricate crown ether–functionalized polyhedral oligomeric silsesquioxane (POSS)-based polymers via gamma radiation-induced grafting followed by post-functionalization with 2-hydroxymethyl-12-crown-4 (2H12C4). The synthesized materials, P-POSS_MethylD4_2H12C4 and P-POSS_VinylD4_2H12C4, were thoroughly characterized using FT-IR spectroscopy, thermogravimetric analysis (TGA), scanning electron microscopy (SEM), and solid-state 13C NMR spectroscopy, confirming successful synthesis and robust structural formation. Both materials demonstrated notable Li+ adsorption capacities of 2.95 and 3.05 mg/g within 5 h and exhibited high selectivity toward Li+ in the presence of competing cations (Na+, K+, Mg2+, Ca2+), with selective separation factors exceeding 4.07. They also showed excellent regeneration performance, retaining their adsorption capacity over five consecutive adsorption–desorption cycles. Moreover, the materials showed successful Li+ extraction from actual seawater, highlighting their applicability in aqueous environments. This work presents a scalable, catalyst-free, and environmentally friendly platform for advanced Li+ extraction materials.Item Metadata only A narrative review and proposed framework for robotic surgical training in Urology for Southeast Asia (SEA): a qualitative survey and expert panel recommendations(2025-12-01) Chen K.; Lee A.; Tan Y.G.; Lim E.J.; Khor V.; Yong D.; Yam W.L.; Hamid A.R.A.H.; Yrastorza S.; Tuliao P.; Nguyen H.D.; Bejrananda T.; Thaidumrong T.; Panumatrassamee K.; Kijvikai K.; Yusoff N.A.M.; Loh C.S.; Tiong H.Y.; Gan V.; Tay K.J.; Cheng C.; Chong S.Y.; Yuen J.S.P.; Ho H.; Chen K.; Mahidol UniversityRobotic surgery has revolutionized modern surgical practices, expanding across multiple specialties due to its precision, reduced invasiveness, and improved patient outcomes. Initially dominated by the da Vinci system, the field has recently seen an influx of new robotic platforms, presenting challenges in training and adaptation for surgeons and surgical teams. The transition to diverse robotic systems necessitates a structured educational framework to ensure competency across varying platforms. This article explores the evolving landscape of robotic surgery, emphasizing the need for a comprehensive training methodology. A qualitative analysis of expert and novice perspectives identified three key domains for robotic surgery education: (1) Foundational Competence, which includes platform-specific training, ergonomics, teamwork, and emergency protocols; (2) Surgical Competence, focusing on systematic procedural training and stepwise surgical execution; and (3) Task-Based Micro-Competence, addressing fundamental skills like hemostasis, lymph node dissection, vascular control, bowel mobilization, and robotic suturing. The framework highlights the importance of platform-specific technical skills, team dynamics, and cognitive ergonomics to enhance surgical efficiency and patient safety. Additionally, it underscores the necessity for standardized training methodologies adaptable to diverse robotic systems. The study advocates for incorporating simulation-based learning, modular training, and emergency drills into robotic surgery education to bridge the gap between traditional and robotic-assisted techniques. As robotic surgery continues to evolve, the proposed structured training approach ensures surgeons and surgical teams are equipped with the skills required to navigate various platforms, optimize patient outcomes, and advance the field of robotic-assisted surgery.Item Metadata only Exploring Breastfeeding Challenges and Problem-Solving Processes in Thai Adolescent Mothers During the First 6 Months Postpartum: A Qualitative Study(2025-01-01) Sudphet M.; Srimoragot M.; Nuampa S.; Sudphet M.; Mahidol UniversityBackground: Adolescent mothers face unique psychosocial and breastfeeding challenges, and their problem-solving strategies, especially in Thailand, remain poorly understood. Research Aims: To explore Thai adolescent mothers’ barriers to breastfeeding and their problem-solving processes in overcoming breastfeeding issues during the first 6 months postpartum. Methods: A descriptive qualitative approach using purposive sampling was utilized. Thai mothers aged 15–19 years (N = 48) with babies under 6 months, living with their child, and without a history of mental illness were recruited for six focus group discussions. Thematic analysis was applied to analyze and interpret the qualitative data patterns. Results: The barriers to achieving breastfeeding success varied at each month postpartum for the study participants. These barriers were divided into three phases: initial adaptation and difficulties (first month), adapting with concerns about milk supply (2–3 months), and balancing maternal and infant needs (4–6 months). Their problem-solving processes for breastfeeding challenges involved seeking online solutions, following advice from surrounding adults, and resolving breastfeeding issues independently from consultations with healthcare providers. Conclusions: Thai adolescent mothers rely on independent decision-making over healthcare consultation to manage breastfeeding difficulties. Providing reliable and accessible support tailored to their needs is crucial for promoting successful breastfeeding in this vulnerable population.Item Metadata only Desta Kyi and the Question of Collective Emotional Labour: Who Sustains Visibility in Chinese Film Festival(2025-01-01) Gu W.; Gu W.; Mahidol UniversityThis paper examines Tibetan female filmmaker Desta Kyi’s navigation of the Golden Rooster and Hundred Flowers Film Festivals to show how emotional and affective labour function as essential strategies for marginalized filmmakers to secure visibility within Han-centric, male-dominated Chinese film industries. Drawing on affect theory and post-authorship frameworks, the study distinguishes macro-level affective labour – the circulation of feeling and “buzz” across festival networks – from micro-level emotional labour – the embodied regulation of affect in interpersonal interactions. Using a semi-autobiographical ethnography (2021–2025) combining interviews, participant observation, and reflexive co-production, the analysis centers on Kyi’s relational work with key supporters (Andy Lau, Jiaran Wang, Dan Wang) and the author’s role as co-producer. Findings demonstrate that visibility, access, and cultural legitimacy are produced not only through artistic output but through sustained, gendered, and often invisible emotional investments that operate as relational capital. The case reveals emotional labour as both vulnerability and strategic agency, reframing festivals as affective infrastructures where power is reproduced and contested. By foregrounding gendered and ethnic dimensions of labour, this paper extends post-authorship debates in the Chinese context and suggests new directions for understanding how marginalized filmmakers assert presence beyond authorship alone.Item Metadata only Examining the characteristics of gritty L2 learners: a Q methodology study(2025-01-01) Solhi M.; Thumvichit A.; Teimouri Y.; Solhi M.; Mahidol UniversityPurpose: This study examines the subjectivity behind the characteristics of gritty second or foreign language (L2) learners, who are defined as individuals who sustain both perseverance of effort and consistency of passion toward long-term language learning goals. Design/methodology/approach: This study employed Q methodology to identify and interpret diverse learner viewpoints on L2 grit. Thirty-five undergraduate EFL learners, identified as ‘gritty language learners,’ participated in the study by sorting a set of statements on a Q-sort grid based on their personal beliefs and experiences. Findings: Analysis revealed three profiles of L2 grit: self-regulated strategists, passionate devotees, and goal-oriented optimists. These profiles reflect the complex and multifaceted nature of grit, influenced by an interplay of self-regulation, intrinsic interest, purpose, and individual motivation within specific learning contexts. Originality/value: This study is among the first to use Q methodology to explore L2 grit. By capturing the subjectivity behind what makes learners gritty, the findings highlight the importance of promoting personalized learning goals, recognizing progress, and engaging students in sustained, long-term tasks.Item Metadata only Beyond Korea: comparative perspectives on pension expansion and suicide prevention in ageing societies(2025-01-01) Rattanapitoon N.K.; Thanchonnang C.; Padchasuwan N.H.H.; Rattanapitoon S.K.; Rattanapitoon N.K.; Mahidol UniversityItem Metadata only Adolescent Nutrition and Health: a Critical Period for Nutritional Intervention to Prevent Long Term Health Consequences(2025-12-01) Parajuli J.; Prangthip P.; Parajuli J.; Mahidol UniversityPurpose of Review: This review aims to examine adolescent nutrition as a critical and often neglected component of global health agendas. Adolescence represents a period of rapid growth and development with increased nutritional and energy demands, remaining a ‘hidden crisis’ in nutritional health. The review explores the ‘triple burden’ of malnutrition affecting this population—undernutrition, micronutrient deficiencies, and overnutrition—and analyzes the individual, social, environmental, and socio-economic factors influencing adolescent nutritional status. Recent Findings: Poor nutrition during adolescence has been linked to both immediate and long-term health consequences, including micronutrient deficiencies, obesity, and cardiometabolic conditions. Evidence suggests that adolescents’ heightened receptivity to societal influences can be leveraged through targeted interventions. Family-led programs, environmental reforms, and comprehensive policy measures have shown promising results in promoting healthier nutritional behaviors among adolescents. Summary: The nutritional challenges facing adolescents require urgent attention through comprehensive, multi-sectoral strategies. Effective interventions during this critical developmental window can foster long-term health outcomes and help break intergenerational cycles of malnutrition. This review emphasizes the importance of prioritizing adolescent nutrition within global health initiatives to address this significant and often overlooked public health concern.Item Metadata only Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia(2025-10-01) Curtis S.J.; Lee S.J.; Cooper B.S.; Bell J.M.; Coombs G.W.; Daley D.A.; Cheng A.C.; Spelman D.W.; Peleg A.Y.; Stewardson A.J.; Curtis S.J.; Mahidol UniversityBackground and objectives: There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data. Methods: We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models. Results: The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9–6.5) and 4.1 days (95% CI: 3.8–4.5) for Enterobacterales, 4.9 days (95% CI: 4.5–5.4) and 3.1 days (95% CI: 2.6–3.6) for enterococci, and 6.3 days (95% CI: 5.3–7.3) and 9.8 days (95% CI: 9.1–10.5) for S. aureus. Conclusions: Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.Item Metadata only Prognostic Value of Papillary Muscle Scarring in Patients with Dilated Cardiomyopathy(2025-01-01) Kaolawanich Y.; Wendell D.C.; Kim H.W.; Chen E.L.; Chevalier C.; Chunharas P.; Parker M.A.; Kim R.J.; Kaolawanich Y.; Mahidol UniversityImportance: Papillary muscle scarring (papSCAR) can occur without epicardial coronary artery disease, likely due to microvascular dysfunction. Dilated cardiomyopathy (DCM) has been associated with microvascular dysfunction; the prevalence and prognostic significance of papSCAR in patients with DCM are unclear. Objective: To determine the prevalence of papSCAR in patients with DCM and to evaluate if papSCAR is associated with adverse outcomes. Design, Setting, and Participants: This cohort study was conducted among consecutive patients with known or suspected DCM prospectively enrolled at an academic hospital in North Carolina from January 2011 to December 2020. Patients were referred for cardiovascular magnetic resonance (CMR) imaging, and the study protocol included flow-independent dark blood delayed-enhancement (FIDDLE) imaging, which improves the detection of papSCAR. Data were analyzed from January 2022 to December 2022. Main Outcomes and Measures: The primary end point was cardiac mortality. Secondary end points included a composite of heart failure events (heart failure death or cardiac transplant) and a composite of arrhythmia events (sudden cardiac death [SCD] or aborted SCD). Results: This cohort study included 470 patients (mean [SD] age, 55.3 [14.3] years; 205 female patients [43.6%]). During up to 8 years of follow-up (2082 patient-years), there were 53 cardiac deaths, 49 heart failure events, and 24 arrhythmia events. PapSCAR was present in 137 patients (29.1%), and mean (SD) left ventricular ejection fraction (LVEF) was similar between those with and without papSCAR (30.7% [11.0%] vs 31.4% [10.3%]; P =.52). Patients with papSCAR had a higher rate of cardiac death than those without (19.0% vs 8.1%; hazard ratio [HR], 2.30; 95% CI, 1.34-3.95; P =.002). After adjustment for prespecified variables known to have prognostic value in DCM (age, systolic blood pressure, heart rate, LVEF, and midwall myocardial scar), papSCAR was independently associated with cardiac death (HR, 1.86; 95% CI, 1.07-3.24; P =.03) and provided incremental prognostic value (incremental χ2, 4.68; P =.03). PapSCAR was also independently associated with heart failure events (HR, 2.05; 95% CI, 1.16-3.61; P =.01) and arrhythmia events (HR, 3.41; 95% CI, 1.46-7.94; P =.005). Conclusions and Relevance: In this single-center cohort study, papSCAR as detected by dark blood delayed-enhancement CMR was present in approximately one-Third of patients with DCM and was independently associated with cardiac death.Item Metadata only A Novel Scaffold-Free Engineered Cartilage Using Combined Chondrocyte Pellets and Sheets in Chondrogenic Differentiation Medium(2025-01-01) Wongin-Sangphet S.; Sribenjarat P.; Chotiyarnwong P.; Vanitcharoenkul E.; Viravaidya-Pasuwat K.; Wongin-Sangphet S.; Mahidol UniversityBACKGROUND: The scaffold-free approach has emerged with a focus on creating cartilage-like tissues using cell pellets, cell spheroids, and cell sheets. However, complete repair of damaged cartilage using these tissues remains an ongoing challenge due to the limitation of thin structure and poor structural integrity. METHOD: In this study, we proposed a novel method to produce scaffold-free cartilage by combining cell pellets and cell sheet technology as chondrocyte pellet-sheet tissues. The chondrocyte sheets acted as a support platform at the top and the bottom of the ten chondrocyte pellets. At day 7, the quality of the tissues cultured in a chondrogenic differentiation medium (CDM) and basal medium was compared using real-time PCR, immunofluorescence staining, proteomics, and atomic force microscopy (AFM). RESULTS: Our method supported the enhancement of tissue thickness. Compared to the control basal medium, the diameter and thickness of the chondrocyte pellet-sheet tissues in CDM were 1.47- and 2.21-fold increase, respectively. The level of mRNA expression and immunostaining of collagen type II were higher in the tissues cultured in CDM, compared to those in basal medium. Using proteomics, transferrin was found in both fresh and cultured CDM. The protein profiles of the tissues in CDM revealed the downregulation of actin and the upregulation of fibromodulin (FMOD), which related to the reorganization of cell shape and the production of cartilage ECM, respectively. Pathway analysis of chondrocyte pellet-sheet tissues in CDM also revealed the inhibition of RhoA and the presence of a TGFβ signaling pathway with SMAD protein signals. Moreover, Young’s modulus indicating structural integrity of the tissues cultured in CDM (28.25 ± 13.13 kPa) was higher than those in basal medium (4.63 ± 2.25 kPa). CONCLUSION: Combining chondrocyte pellets and sheets in CDM allowed the generation of thick tissues and enhanced structural integrity. The compacted structure of the tissues in CDM might inhibit actin expression via RhoA inhibition. Growth factors in CDM, especially transferrin might be involved in chondrogenic differentiation via TGFβ signaling pathway with SMAD protein signals.Item Metadata only Outbreak of Burkholderia cepacia complex infection associated with intrinsically contaminated commercial 0.5% chlorhexidine solution(2025-12-01) Dilokkunanant T.; Malathum K.; Chotiprasitsakul D.; Santanirand P.; Muntajit T.; Techasaensiri C.; Dilokkunanant T.; Mahidol UniversityBackground: Burkholderia cepacia complex (BCC) is an aerobic Gram-negative bacillus commonly isolated from aqueous environments. In May 2024, we identified two cases who developed BCC infections within one month following fronto-orbital advancement (FOA) procedures in the paediatric surgery ward. Aim: To identify the source, intervene in the ongoing infections, and implement control measures. Methods: The cases were defined as individuals with laboratory-confirmed BCC isolated from December 2023 to May 2024. We reviewed medical records, interviewed healthcare workers, and verified compliance with infection control guidelines. Additionally, we aseptically collected environmental samples for microbiological analysis. Findings: Two initial cases of BCC infection were identified following FOA procedures, and one additional case occurred after wound dressing. All three cases were associated with the use of 0.5% aqueous chlorhexidine gluconate (CHG) solution. These cases exhibited similar antimicrobial susceptibility patterns. Subsequent investigation detected BCC in 10 samples of the 0.5% aqueous CHG solution. Both clinical and environmental BCC isolates were subjected to multi-locus sequence typing (MLST) analysis to determine their clonal relationship. The analysis revealed that all isolates shared an identical sequence type, consistent with Burkholderia cenocepacia. The outbreak was successfully controlled following the withdrawal of the product and re-education of staff. Conclusion: The monitoring of hospital-acquired infections by a multi-disciplinary team played a critical role in the prevention and rapid control of the outbreaks. Additionally, stricter government regulations are needed to prevent the contamination of disinfectants during manufacturing.Item Metadata only Optimizing herbal drug use through multivariable standardization and precision approaches(2025-11-01) Srisittiratkul P.; Limsuvan S.; Pattanapholkornsakul S.; Akarasereenont P.; Srisittiratkul P.; Mahidol UniversityBackground: Herbal medicines are widely used globally, but their therapeutic efficacy and safety are often compromised by significant variations in herb quality, disease factors, and patients’ responses. While previous research has attempted to address these challenges through various standardization methods, most studies have focused on single variables, which is insufficient, leading to unreliable treatments and impeding the complete integration of herbal medicine into modern practice. Purpose: This article introduces a multivariable optimization framework to improve the standardization, effectiveness, and safety of herbal medicine. Methods: We conducted a comprehensive literature review across PubMed, Google Scholar, and Science Direct databases to identify key factors affecting herbal medicine use. Based on a synthesis of studies on herb quality, traditional diagnostic criteria, patient variability, and precision medicine, we proposed a conceptual multivariable optimization framework. Results: The framework addresses three key domains: (1) Herb variation, through quality optimization and herbal drug development; (2) Disease variation, by knowledge management and training practitioners; and (3) Patient variation, by tailoring treatments using personalized medicine principles. This multifaceted strategy simultaneously controls multiple sources of variability, may enhance treatment reliability and safety over conventional single-variable methods. The framework is adaptable to various traditional systems. Conclusion: Comprehensive control of herb, disease, and patient factors is crucial for improving herbal therapy outcomes. Implementing this multivariable approach will facilitate the successful integration of herbal medicine into modern evidence-based healthcare. Future efforts should focus on validating this model through clinical studies and leveraging multi-omics tools for personalized treatments.Item Metadata only Biopsy-proven Crescentic Glomerulonephritis Following Inhaled Methamphetamine Use: An Exceptional Case of Confirmed Drug-induced Glomerular Injury(2025-11-01) Wachiraphansakul N.; Cheunsuchon B.; Vongchaiudomchoke T.; Wachiraphansakul N.; Mahidol UniversityMethamphetamine, a potent addictive illicit stimulant, is known to cause nephrotoxicity through multiple mechanisms involving the drug and its metabolites. However, glomerulonephritis associated with methamphetamine use is rare. Previous case reports have described crescentic glomerulonephritis typically in association with infection-related glomerulonephritis. A confirmed case of severe crescentic glomerulonephritis directly attributed to methamphetamine use has not been previously reported. We report the first confirmed case of severe crescentic glomerulonephritis directly linked to prolonged inhalation of methamphetamine in the absence of other identifiable causes. A 35-year-old Thai male with transfusion-dependent β-thalassemia and prior splenectomy, who developed severe acute kidney injury after chronic methamphetamine use by smoking crushed tablets rolled into cigarettes. Urine toxicology was positive for amphetamines. Kidney biopsy revealed extensive crescentic glomerulonephritis without evidence of immune-complex deposition. Despite cessation of methamphetamine and supportive treatment, the patient progressed to end-stage kidney disease requiring maintenance hemodialysis. This case highlights a potential causal relationship between chronic methamphetamine use and crescentic glomerulonephritis. It expands the current understanding of methamphetamine-induced kidney injury and suggests direct vascular or endothelial toxicity as a potential mechanism. This rare complication should be considered in methamphetamine users presenting with acute kidney injury.