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Recent Submissions
Vaginocutaneous fistula caused by recurrent labial abscess: A case report
(2025-06-01) Aimjirakul K.; Seehanantawong T.; Saraluck A.; Aimjirakul K.; Mahidol University
Urogenital fistulas are characterized by communication tracts that connect two surfaces or distinct organ systems. A vaginocutaneous fistula is a rare type of urogenital fistula that is characterized by persistent perineal discharge. This case report describes a female patient who suffered from recurrent labial abscesses and a fistula that connected the lower vagina to the inner thigh. There were symptoms of persistent perineal discharge, and the patient had an offensive odor. The patient had a history of six recurrent right labial abscesses over a period of two years prior to the formation of two fistulous openings. The right medial aspect of the inner thigh, adjacent to the labia majora, was found to have a 0.7 cm opening, which was confirmed by magnetic resonance imaging. Intraoperatively, the fistulous tract was readily delineated using dye. Complete fistulectomy was performed. This report highlights an unusual presentation of a urogenital fistula, the diagnostic challenges, and the management strategies. It emphasizes the need for timely identification and intervention in such cases.
Gastrointestinal Manifestations and Prognostic Factors for Severe Dengue in Thai Children
(2025-03-01) Setrkraising K.; Kittitrakul C.; Setrkraising K.; Mahidol University
Dengue infection poses a significant public health challenge in tropical countries. In Thailand, children ages 5–14 years are among the groups with the highest incidence of dengue. This study aimed to determine the prevalence of gastrointestinal (GI) manifestations in children with dengue infection and assess prognostic factors for severe dengue. We reviewed the medical records of children ages 0–14 years who were hospitalized with a diagnosis of dengue infection between 2019 and 2022 at Charoenkrung Pracharak Hospital in Bangkok, Thailand. Dengue severity was classified according to the 2009 WHO dengue guidelines. Clinical manifestations and laboratory data were analyzed for their association with severe dengue using a logistic regression model. The study included 556 dengue cases, with 48 cases (8.6%) classified as severe dengue. The mean age (SD) of patients was 9.9 (3.7) years. The most common GI symptoms were anorexia (91.7%) and vomiting (57.6%) followed by abdominal pain (38.3%), and diarrhea (33.3%). GI bleeding was found in 3.2% of patients. Hepatomegaly and ascites were found in 20.9% and 2.9% of patients, respectively. Acute liver failure and acalculous cholecystitis were found in 0.4% and 0.2% of patients, respectively. Children younger than 5 years of age exhibited a lower prevalence of vomiting and abdominal pain compared with older children, making the diagnosis of dengue more challenging. Vomiting, ascites, aspartate aminotransferase .450 U/L, and serum albumin,3.5 g/dL were significantly associated with severe dengue infection. Children with dengue infection presenting any of these factors should be closely monitored for severe dengue.
Molecular phylogenetic analyses reveal multiple long-distance dispersal events and extensive cryptic speciation in Nervilia (Orchidaceae), an isolated basal Epidendroid genus
(2024-01-01) Gale S.W.; Li J.; Suddee S.; Traiperm P.; Peter C.I.; Buruwate T.; Crain B.J.; McCormick M.K.; Whigham D.F.; Musthofa A.; Gogoi K.; Ito K.; Minamiya Y.; Fukuda T.; Landrein S.; Yukawa T.; Gale S.W.; Mahidol University
Introduction: The terrestrial orchid genus Nervilia is diagnosed by its hysteranthous pattern of emergence but is nested among leafless myco-heterotrophic lineages in the lower Epidendroideae. Comprising ca. 80 species distributed across Africa, Asia and Oceania, the genus remains poorly known and plagued by vague and overlapping species circumscriptions, especially within each of a series of taxonomically intractable species complexes. Prior small-scale, exploratory molecular phylogenetic analyses have revealed the existence of cryptic species, but little is otherwise understood of origin, the scale and timing of its biogeographic spread, or the palaeoclimatic factors that have shaped its ecology and given rise to contemporary patterns of occurrence. Methods: Here, we sample widely throughout the generic range, including 45 named taxa and multiple accessions referable to several widespread ‘macrospecies’, as well as material of equivocal identity and probable undescribed status, for the first time enabling an evaluation of taxonomic boundaries at both species and sectional level. Using nuclear (ITS) and plastid (matK, trnL-F) sequence data, we conduct phylogenetic (maximum parsimony and Bayesian inference) and ancestral area analysis to infer relationships and resolve probable origin and colonisation routes. Results: The genus is strongly supported as monophyletic, as are each of its three sections. However, the number of flowers in the inflorescence and other floral characters are poor indicators of sectional affinity. Dated ancestral area analysis supports an origin in Africa in the Early Oligocene, with spread eastwards to Asia occurring in the Late Miocene, plausibly via the Gomphotherium land bridge at a time when it supported woodland and savanna ecosystems. Discussion: Taxonomic radiation in Asia within the last 8 million years ties in with dramatic Himalayan-Tibetan Plateau uplift and associated intensification of the Asia monsoon. Multiple long-range migrations appear to have occurred thereafter, as the genus colonised Malesia and Oceania from the Pliocene onwards. The bulk of contemporary species diversity is relatively recent, potentially explaining the ubiquity of cryptic speciation, which leaves numerous species overlooked and unnamed. Widespread disjunct species pairs hint at high mobility across continents, extinction and a history of climate-induced vicariance. Persistent taxonomic challenges are highlighted.
Intranasal Administration of Bivalent RBD Nanoparticles Elicits Strong Systemic Responses That Effectively Block Distal Dissemination of COVID-19
(2025-01-01) Seesen M.; Sunintaboon P.; Limthongkul J.; Janhirun Y.; Lerdsamran H.; Wiriyarat W.; Ubol S.; Jearanaiwitayakul T.; Seesen M.; Mahidol University
The intranasal vaccine against coronavirus disease 2019 (COVID-19) has gained more attention because of its ability to induce both mucosal and systemic immune responses. We have recently developed a c-GAMP-adjuvanted bivalent receptor-binding domain (RBD) vaccine, derived from the ancestral strain and the Omicron variant. We demonstrated here that intranasal administration of this vaccine candidate triggers not only the respiratory but also the systemic immune response against SARS-CoV-2. The immunized mice elicited the broadly neutralizing antibodies against the ancestral strain (Wuhan-1) and variants of concern (Delta, Omicron BA.1, and Omicron BA.5). This route of vaccination also induced potent systemic T cell responses with strong cytotoxic activity against both the Wuhan-1 and Omicron BA.1 strains. Additionally, intranasally immunized mice significantly suppressed SARS-CoV-2 RNA levels in circulation and spleens, indicating effective containment of the virus beyond the respiratory tract. These findings suggest that the intranasal bivalent RBD vaccine holds promise for combating SARS-CoV-2 infections.
Structurally Oriented Classification of FOXA1 Alterations Identifies Prostate Cancers with Opposing Clinical Outcomes and Distinct Molecular and Immunologic Subtypes
(2025-03-03) Hwang J.; Likasitwatanakul P.; Deshmukh S.K.; Wu S.; Kwon J.J.; Toye E.; Moline D.; Evans M.G.; Elliott A.; Passow R.; Luo C.; John E.; Gandhi N.; McKay R.R.; Heath E.I.; Nabhan C.; Reizine N.; Orme J.J.; Domingo Domenech J.M.; Sartor O.; Baca S.C.; Dehm S.M.; Antonarakis E.S.; Hwang J.; Mahidol University
PURPOSE: Around 10% to 15% of prostate cancers harbor recurrent aberrations in the Forkhead Box A1 gene, FOXA1, whereby the alteration type and the effect on the forkhead (FKH) domain affect protein function. We developed a FOXA1 classification system to inform clinical management. EXPERIMENTAL DESIGN: A total of 5,014 prostate cancer samples were examined using whole-exome and -transcriptome sequencing from the Caris Life Sciences database. We denoted class 1 FOXA1 alterations as missense and in-frame insertions/deletions with subclasses oriented with respect to the FKH domain. These were in the first part of the FKH domain [class 1A: amino acids (AA) 168-246], within the Wing2 region of FKH (class 1B: AA 247-269), or outside FKH (class 1C: AA 1-167, 270+). Two hotspot missense mutations at R219 were denoted class 2. Class 3 included predicted truncating mutations with subclasses partitioned based on the FKH domain (class 3A: AA 1-269 and class 3B: AA 270+). Class 4 represented FOXA1 amplifications. Real-world overall survival and therapy outcomes were determined from insurance claims. RESULTS: FOXA1 alterations did not influence survival when considered in aggregate but had distinct prognostic effects when stratified by class. In primary prostate samples, class 1A alterations were associated with overall improved survival (HR, 0.57; P = 0.03); a similar trend was seen in metastatic biopsies with class 1B (HR, 0.84; P = 0.09). Conversely, in primary specimens, class 1C exhibited worse survival upon second-generation androgen receptor signaling inhibitor treatment (HR, 1.93; P < 0.001). Class 2 mutations (R219C/S) were enriched in neuroendocrine prostate cancers and were associated with overall poor survival (HR, 2.05; P < 0.001) and worse outcomes to first-line androgen-deprivation therapies (HR, 2.5; P < 0.001). Class 3A alterations indicated improved survival (HR, 0.70; P = 0.01), whereas class 3B alterations portended poor outcomes (HR, 1.50; P < 0.001). Amplifications (class 4) indicated poor outcomes in metastatic samples (HR, 1.48; P = 0.02). Molecularly, different FOXA1 alteration classes harbored distinct mutational and immunologic features as well as unique transcriptional programs. Finally, relative to European Americans, African Americans had increased class 1C alterations, whereas Asian/Pacific Islander patients had increased class 1B alterations. CONCLUSIONS: FOXA1 alterations should not be interpreted in aggregate, as different classes are associated with divergent molecular features and clinical outcomes. Our revised classification schema facilitates clinical decision-making for patients with prostate cancer and uncovers important racial differences.