Mahidol University's Institutional Repository
คลังสารสนเทศสถาบันของมหาวิทยาลัยมหิดล
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Recent Submissions
Beyond One-Size-Fits-All: Precision Mechanical Ventilation in ARDS
(2026-03-01) Azzam S.; Khattab K.; Al Sharie S.; Al-Husinat L.; Silva P.L.; Battaglini D.; Schultz M.J.; Rocco P.R.M.; Azzam S.; Mahidol University
Acute respiratory distress syndrome (ARDS) has traditionally been managed with population-based, protocolized mechanical ventilation strategies designed to limit ventilator-induced lung injury. While these approaches have improved outcomes, they fail to account for the pronounced biological, mechanical, radiological, and temporal heterogeneity that characterizes ARDS. Accumulating evidence shows that patients differ markedly in functional lung size, recruitability, chest wall mechanics, inflammatory burden, and tolerance to ventilatory stress, making uniform ventilatory targets physiologically imprecise and, at times, harmful. This narrative review examines the evolution from conventional lung-protective ventilation toward a precision-based paradigm that aligns ventilatory support with individual patient physiology. We conceptualize ARDS not as a static syndrome but as a dynamic spectrum, viewing the injured lung as a heterogeneous mechanical system susceptible to regionally amplified stress and strain. Within this framework, we discuss key principles underlying precision ventilation, including functional lung size (the “baby lung”), driving pressure, mechanical power, patient–ventilator interaction, spontaneous breathing-associated injury, and the time-dependent evolution of lung mechanics. We synthesize current evidence supporting mechanical, biological, and radiological subphenotyping as complementary strategies to individualize ventilatory management, while critically appraising their current limitations. This review also evaluates bedside tools that may operationalize precision ventilation in clinical practice, including esophageal pressure monitoring, lung ultrasound, and electrical impedance tomography, and examines the role of artificial intelligence as a clinician-directed decision-support aid rather than a prescriptive substitute for physiological reasoning. Implications for clinical trial design, ethical considerations, and future directions toward predictive and adaptive ventilation strategies are also addressed. Precision mechanical ventilation represents a shift from rigid thresholds toward proportional, physiology-guided intervention across the disease trajectory. By integrating evolving lung mechanics, ventilatory load, and patient effort over time, this approach provides a coherent framework for safer and more effective mechanical ventilation in ARDS while preserving the core principles of lung protection.
Modeling the Interplay of Ghrelin, Leptin, and Exercise on Energy Balance: A Systems Dynamics Approach
(2025-01-01) Chudtong M.; Nagy I.; De Gaetano A.; Chudtong M.; Mahidol University
We detail a possible mathematical model describing the dynamics of key energy substrates, regulatory hormones, appetite, and fat mass incorporating the effect of exercise. The model describes physiological responses to three mixed meals (breakfast, lunch, dinner), represented by difference-ofexponential influx functions. The size of these meal pulses is modulated by appetite, which is dynamically regulated by ghrelin and leptin concentrations. The system is formulated as set of coupled nonlinear algebraic and ordinary differential equations (ODEs), including state variables for appetite, gut glucose and lipid contents, glycemia, lipidemia, insulinemia, plasma ghrelin and leptin concentrations, weight and fat mass, as well as the effect of exercise.
Quality Evaluation and Shelf-Life Prediction of a Mixed Mango and Passion Fruit Smoothie Under Dimethyl Dicarbonate Treatment and Packaging Interventions
(2026-03-01) Jafari S.; Rungroj N.; Fikry M.; Umar M.; Shiekh K.A.; Kijpatanasilp I.; Chheng S.; Mishra D.K.; Assatarakul K.; Jafari S.; Mahidol University
This study investigated shelf-life prediction of a cold-stored mixed mango–passion fruit smoothie (60:40) using kinetic modeling to compare the effects of dimethyl dicarbonate (DMDC, 250 ppm), pasteurization (90 °C for 100 s), and packaging type (glass vs. polyethylene terephthalate (PET)) during six weeks at 4 °C. Physicochemical parameters, functional properties (total phenolic content, total flavonoid content, and antioxidant activity by 2,2-diphenyl-1-picrylhydrazyl (DPPH) and Ferric Reducing Antioxidant Power assay (FRAP), and microbial stability were monitored weekly. Zero- and first-order kinetic models were applied to describe quality changes, with the first-order model showing superior fit (average R2 = 0.936). pH remained relatively stable (p > 0.05), while total soluble solids (TSS) gradually declined in all treatments from approximately 16–17 °Brix to 13–14 °Brix by week 6. PET packaging resulted in a significantly higher total color difference (ΔE) than glass by the end of storage (p ≤ 0.05), particularly in DMDC-treated samples. Pasteurization reduced initial polyphenol oxidase (PPO) activity by 44–56% compared with untreated and DMDC-treated samples (p ≤ 0.05), whereas PET generally exhibited higher residual PPO activity than glass. DMDC treatment better preserved antioxidant capacity, phenolics, and flavonoids, with significantly higher DPPH and FRAP values than controls at week 6 (p ≤ 0.05). Microbiologically, DMDC effectively suppressed total viable counts (<5 log CFU/mL) and yeast and mold (<3 log CFU/mL), outperforming pasteurization. Shelf-life was estimated at 27–29 days for pasteurization and 41–42 days for DMDC (250 ppm), particularly when combined with glass packaging. Overall, the DMDC–glass combination demonstrated strong potential as a non-thermal preservation approach for fruit beverages.
Agentic Stage-Based LLM Framework for Multi-Turn Mental Health Support Conversations in Thai
(2025-01-01) Changpun R.; Khoprasertthaworn N.; Jongpipatchai P.; Petcharat T.; Rungsimontuchat K.; Suttiwan P.; Nupairoj N.; Hemrungrojn S.; Tuicomepee A.; Achakulvisut T.; Vateekul P.; Changpun R.; Mahidol University
While mental health support needs are growing in Thailand, access to professional support remains limited. LLMbased chatbots offer a scalable solution, yet most existing systems are restricted to single-turn, solution-oriented responses. We propose an Agentic Stage-Based LLM Framework for Multi- Turn Mental Health Support Conversations in Thai, structuring conversations around five core counseling stages: rapport building, problem identification, goal setting, working, and termination. Drawing from Person-Centered Therapy (PCT) and Acceptance and Commitment Therapy (ACT), our framework incorporates two key components: an approach-selection agent that selects appropriate counseling approaches and a monitoring agent that manages stage transitions in multi-turn conversations. We evaluated the proposed framework against three single-agent baselines using LLM-simulated users and compared positive user reaction rates as judged by LLMs. Our framework achieved a 79.01% positive user reaction rate, outperforming single agents with standard, AugESC, and COOPER-CoT prompts by 8.91%, 11.68%, and 17.02%, respectively. Ablation studies validated the necessity of each agentic module in the proposed framework, with results surpassing single-agent baselines without stage-based architecture by 96.15% and 88.46% in Process and Working evaluations, respectively. A/B testing with real users and evaluation by 3 counseling practitioners demonstrated significant improvements in seven of eight mental health support evaluation metrics, highlighting the potential to deliver LLM-based mental health support in Thai.
Age-dependent changes in the transverse carpal ligament and median nerve: a cadaveric histological and biomechanical study
(2026-02-24) Niyomchan A.; Siriphorn A.; Kathinted K.; Pamornpol B.; Niyomchan A.; Mahidol University
Background: Age-related alterations in the transverse carpal ligament (TCL) and the median nerve are thought to increase susceptibility to carpal tunnel syndrome in older individuals. This study aimed to investigate the mechanical properties of the TCL and histological changes in both the TCL and the median nerve in cadavers across a wide age range. Methods: Fifty formalin-embalmed cadavers (40-93 years old) were studied, yielding 100 TCL specimens. A digital palpation device (MyotonPRO) was used in situ to measure TCL dynamic stiffness, elasticity (logarithmic decrement), mechanical stress relaxation time, and creep at proximal, middle, and distal regions. After testing, each TCL and corresponding median nerve were excised. Masson, s trichrome staining and scanning electron microscopy were performed to assess collagen fiber organization, fibroblast density, and nerve structure. Pearson, s correlation was used to determine associations between TCL properties and age. Results: An age-dependent increase in TCL stiffness was observed, alongside decreased elasticity, relaxation time, and creep. Histological analyses revealed reduced fibroblast density, disorganized collagen fibers with large clefts between bundles, and increased fine collagen meshwork in interfascicular matrix in older specimens. Furthermore, thinning of connective tissue layers surrounding the median nerve and diminished myelin sheaths were noted with advancing age. Conclusion: This cadaveric study reveals that the TCL stiffens and becomes structurally disorganized with advancing age, paralleled by degenerative changes in the median nerve. Such age-related alterations may predispose elderly individuals to a higher risk of carpal tunnel syndrome, underscoring the need for targeted preventive and therapeutic strategies.