Mahidol University's Institutional Repository
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Recent Submissions
Temporal Lysophosphatidic Acid Supplementation Enhances Megakaryocyte Differentiation and Platelet Production From Human Hematopoietic Progenitors
(2026-06-01) Jiamvoraphong N.; Lorthongpanich C.; Septham P.; Klaihmon P.; Kheolamai P.; Laowtammathron C.; Imsoonthornruksa S.; Ketudat-Cairns M.; Issaragrisil S.; Jiamvoraphong N.; Mahidol University
Platelet shortages and limited storage stability restrict global platelet transfusion capacity, highlighting the need for efficient in vitro platelet production systems. This study establishes a simple, non-genetic and cost-effective system for efficient in vitro platelet-like particle (PLP) production from human hematopoietic stem/progenitor cells (HSPCs) using a Phase-specific modulation of Hippo-YAP/TAZ signaling modulation. Temporal control of Hippo-YAP/TAZ signaling by lysophosphatidic acid (LPA), an activator of YAP/TAZ activity, significantly enhanced megakaryocyte differentiation, expansion and PLP production, resulting in an approximately 15-fold increase in PLP yield at the end of the procedure. Furthermore, LPA extended the expansion period of HSPC-derived megakaryocytes up to 8 days, resulting in a greater than 20-fold increase in the number of HSPC-derived CD41+ megakaryocytes. Moreover, replacement of expensive commercial recombinant human thrombopoietin (C-rhTPO), one of the major cost-driving components in in vitro PLP production, with recombinant human thrombopoietin produced in Escherichia coli (W-rhTPO) further improved the cost-effectiveness of the procedure. In conclusion, this study demonstrates that temporally controlled Hippo-YAP/TAZ signaling, together with affordable cytokine supplementation, provides a robust and GMP-compatible platform for large-scale PLP manufacturing for future clinical applications. We believe that this system will enable scalable PLP generation, even in resource-constrained settings, to increase human platelet supply for many life-saving therapies in the future.
How do network structures of depressive symptoms differ between asian patients with bipolar depression and those with unipolar depression?
(2026-08-01) Yoon H.; Kim H.S.; Lee S.; Choi T.Y.; Jung S.W.; Yoon H.J.; Kim H.S.; Yang H.J.; Jeong N.; Moon E.; Baek J.H.; Si T.M.; Kallivayalil R.A.; Tanra A.J.; Nadoushan A.H.J.; Chee K.Y.; Javed A.; Sim K.; Pariwatcharakul P.; Lin S.K.; Sartorius N.; Shinfuku N.; Kato T.A.; Kamali M.; Nierenberg A.A.; Park S.C.; Yoon H.; Mahidol University
Objective: The investigation focused on differences in the overall network structures of depressive symptoms between patients with bipolar depression (BD) and those with unipolar depression (UD), emphasizing their unique symptom dynamics and centralities. Methods: Data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 (REAP-AD3), were used to estimate depressive symptom networks for 240 patients with BD and 2905 patients with UD. A Network Comparison Test (NCT) was conducted to evaluate differences in global strength, edge weights, and node centralities between the two networks. An additional NCT was performed using the same sample size in both groups. Results: Anhedonia emerged as the most central symptom in BD, while persistent sadness was the most central symptom in UD. Global strength was higher in the BD network in the full-sample NCT (p = 0.04), but not in the equal sample-size analysis (p = 0.20). However, no significant differences were identified in overall network structure invariance. Conclusions: These findings underscore distinct depressive symptom networks in BD and UD. Anhedonia and energy dysregulation were prominent in BD, whereas persistent sadness and self-rumination were more pronounced in UD. Despite the non-significance of other NCT results, the full-sample pairwise network comparison suggested that BD patients exhibit a more integrated symptom structure than UD patients, with stronger overall connectivity between symptoms, which may be linked to neurobiological distinctions such as widespread abnormalities in white matter connectivity and increased within-network connectivity in BD.
Alarms and alarm management with automated versus conventional ventilation in neurocritical care patients
(2026-12-01) van Limpt G.J.C.; van Vliet P.; Molenaar M.A.; de Bie A.J.R.; van Haren L.; van Leijsen T.D.; Robba C.; Sinnige J.S.; Horn J.; Neto A.S.; Paulus F.; Schultz M.J.; Buiteman–Kruizinga L.A.; van Limpt G.J.C.; Mahidol University
Introduction: False or clinically irrelevant alarms are a major driver of ICU alarm fatigue and nursing workload. Ventilator alarms make up a large share, and although automated ventilation modes can reduce manual adjustments, their effect on alarm burden is still unclear. This issue can be particularly relevant in neurocritical care patients, where precise ventilator and alarm management is imperative for patient safety. Objectives: This explorative post hoc analysis of a randomized clinical trial compared alarm frequency and management between automated ventilation and conventional ventilation in neurocritical care patients. Methods: Ventilator alarms and manual ventilator changes were captured continuously from the ventilator for up to 24 h per patient. The primary endpoint was a composite of workload-relevant alarms; with alarm management interventions at the ventilator as a key secondary outcome. Additional endpoints included redundant alarms, alarm duration and ventilator management. Results: 13 patients received automated ventilation and 24 received conventional ventilation. No difference was observed in workload-relevant alarm frequency between automated and conventional ventilation (3.28 [2.87 to 4.30] vs 3.73 [1.66 to 7.33] alarms per hour; P = 0.81), while alarm management interventions at the ventilator were lower with automated ventilation (0.14 [0.10 to 0.15] vs 0.21 [0.17 to 0.31] interventions per hour; P = 0.01). Other alarm frequencies, duration of alarms and ventilator management were similar. Conclusions: In this exploratory post hoc analysis of a randomized clinical trial in neurocritical care patients during the early phase of mechanical ventilation, automated ventilation did not reduce the frequency of total or workload-relevant alarms, nor their duration, but was associated with fewer alarm management interventions compared to conventional ventilation. Implications for clinical practice: Automated ventilation may not reduce alarm frequency in neurocritical care patients, but the observed reduction in alarm-related bedside interventions suggests a potential benefit for nursing workload.
Management system—dependent alterations in colonic mucosal architecture of swine: An Alcian Blue histochemistry and histomorphometric analysis of goblet cell density, epithelial height, and mucin—stromal ratio
(2026-06-01) Chaiyawong N.; Churud K.; Wanpen P.; Intarachuen M.; Promsuban C.; Chaiyawong N.; Mahidol University
Background and Aim: Swine management systems can influence intestinal morphology, epithelial organization, and mucosal secretory activity through differences in environmental exposure, nutrition, hygiene, and husbandry practices. However, comparative histological evaluations of colonic mucin architecture among commercial swine production systems remain limited. This study aimed to compare goblet cell density, epithelial height, and mucin–stromal ratio in the colon of swine raised under beta-agonist-free, hygienic, and free-range management systems using Alcian Blue histochemistry and quantitative histomorphometric analysis. Materials and Methods: Colonic tissue samples were collected from clinically healthy market-weight swine raised under beta-agonist-free, hygienic, and free-range conditions (n = 10 per group). Tissue sections were fixed in 10% neutral buffered formalin, embedded in paraffin, and stained with Alcian Blue (pH 2.5) to visualize acidic mucins. Quantitative histomorphometric analyses were performed using ImageJ/Fiji software to determine goblet cell density, epithelial height, and mucin–stromal ratio. Statistical analysis was performed using one-way analysis of variance followed by Tukey's honestly significant difference test, and significance was defined as p < 0.05. Results: Significant differences in colonic mucosal architecture were observed among the three management systems. Swine raised under the beta-agonist-free system exhibited significantly greater epithelial height (252.43 ± 17.27 μm) compared with hygienic (206.27 ± 20.66 μm) and free-range swine (228.84 ± 18.42 μm) (p < 0.05). Goblet cell density was also highest in the beta-agonist-free group (46.76 ± 7.16 cells/field), followed by the free-range and hygienic groups. The mucin–stromal ratio was significantly elevated in beta-agonist-free swine (1.82 ± 0.14) compared with free-range (1.43 ± 0.12) and hygienic swine (1.09 ± 0.10) (p < 0.05). Positive correlations were observed among epithelial height, goblet cell density, and mucin–stromal ratio. Conclusion: Different swine management systems are associated with measurable alterations in colonic mucosal architecture. Beta-agonist-free swine demonstrated enhanced epithelial development, increased goblet cell abundance, and higher mucin–stromal ratio values, suggesting distinct structural adaptations of the colonic mucosa associated with production practices. The mucin–stromal ratio may serve as a useful integrative histomorphometric indicator for evaluating intestinal mucosal organization in swine.
The impact of payment methods on oral health promotion and prevention programmes: scoping review
(2026-12-01) Gaewkhiew P.; Chaianant N.; Sabbah W.; Tussanapirom T.; Gaewkhiew P.; Mahidol University
Objectives: To explore and assess the effect of payment schemes on oral health promotion and prevention programmes. Methods: A scoping review was conducted using the Arksey & O’Malley framework. MEDLINE (via PubMed), Embase (via Scopus), and The Cochrane Library were searched. Unpublished literature was also collected. Searching and screening were conducted until 31 July 2025. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All studies comparing payment methods for oral health prevention and promotion were included. A conceptual framework linking payment mechanism to provider incentive, service delivery behaviour, and preventive care outcomes was used to guide synthesis, with findings classified across three outcome levels: utilisation (Level 1), quality of preventive care processes (Level 2), and clinical oral health outcomes (Level 3). The studies were grouped according to the payment system, their impact on the service provider and receiver, and their advantages and disadvantages. After summarising the results, the data were analysed by consulting experts and compared with existing policies. Quality assessment was carried out using Joanna Brigg’s Institute’s Quality appraisal tools. Results: Out of the 30 studies included, the review found that payment systems have various forms, with four main payment systems being Pay for performance (n = 3), Fee for service (n = 15), Capitation (n = 10), and Global Budget (n = 2). Other payment systems such as salary, treatment vouchers, or direct payment by the employer were also identified, and have been shown to increase preventive dental services and oral health promotion activities. Conclusions: Fee-for-service payment is consistently associated with higher treatment volumes but lower rates of preventive care delivery, while capitation incentivises prevention but carries risks of patient selection and service reduction without adequate risk adjustment. Pay-for-performance and value-based payment approaches show promise for improving preventive care quality, though evidence remains limited. No single payment model reliably promotes oral health prevention across all contexts. A mixed payment model combining the activity incentives of fee-for-service, the cost-sharing principles of capitation, and the quality orientation of value-based payment offers the most promising framework for advancing oral health promotion. Policymakers should consider hybrid financing structures supported by quality monitoring, and further research is needed to evaluate their long-term effects on clinical oral health outcomes.