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High-flow oxygen therapy in comparison with low-level pressure support ventilation for spontaneous breathing trials: A two-center, non-inferiority, randomized controlled study
(2026-01-01) Jaroonpipatkul A.; Kaeoperm P.; Promlee N.; Srilam W.; Pakdeewongse S.; Tongyoo S.; Rittayamai N.; Jaroonpipatkul A.; Mahidol University
Background: Low-level pressure support ventilation (PSV) is the usual first spontaneous breathing trial (SBT) method. High-flow oxygen therapy (HFOT) via a dedicated connector through an endotracheal tube might be a credible alternative during SBT. This study aimed to compare the rate of SBT success between HFOT and low-level PSV. Methods: We conducted a two-centre, open-label, non-inferiority randomised controlled trial. Adults mechanically ventilated patients for at least 24 hours and ready to wean were randomised to 30-minute SBTs with HFOT or low-level PSV. The primary outcome was SBT success rate (non-inferior margin of 10%). Extubation rate within 48 hours following successful SBT, reintubation rate within 48 hours after extubation, and hospital mortality were the exploratory outcomes. Results: Among 162 enrolled patients, 81 received HFOT and 81 received low-level PSV. SBT succeeded in 77/81 patients (95.1%) in each arm (absolute difference 0.0%; 95% confidence interval [CI] −7.2 to 7.2; p = 1.000). No significant differences between HFOT and low-level PSV in extubation rates following successful SBT (88.3% vs 80.5%, respectively; p = 0.183) or reintubation rates within 48 hours after extubation (8.8% vs 17.7%, respectively; p = 0.140). Hospital mortality was lower with HFOT than with low-level PSV (11.1% vs 24.7%, respectively; difference −13.6%; 95% CI −25.2 to −2.0; p = 0.024). Conclusion: Among mechanically ventilated patients meeting weaning criteria, HFOT demonstrated non-inferiority to low-level PSV for SBT success rates. Extubation and 48-hour reintubation rates were similar. Clinical Trial Registration: Thai Clinical Trials Registry; registration number: TCTR20190703002; URL: www.thaiclinicaltrials.org.
Grass Communities Differ Floristically Under Different Dominant Trees in Savannas in Thailand and Cambodia
(2026-03-01) Rickenback J.; Arthan W.; Pennington R.T.; Vorontsova M.S.; Peou Y.; France H.; Lehmann C.E.R.; Rickenback J.; Mahidol University
Southeast Asian savannas are some of the least studied ecosystems, with understanding of their function and resilience limited by a lack of understanding of grass species richness and composition. Since savannas are characterized by their grassy ground layer, we conducted field surveys in Thailand and Cambodia to assess grass community composition under different dominant tree genera. We conducted field surveys in four savanna ecosystems characterized by (i) Dipterocarpus, (ii) Pinus, (iii) Pterocarpus, and (iv) Shorea tree genera. In each, we recorded grass species composition and richness. We assessed differences in composition using PERMANOVA, patterns of grass species discovery using species accumulation curves, and common species with relative frequency distributions. In total, we recorded 160 unique grass species. These savannas support distinct grassy assemblages, with diverse patterns of species accumulation, richness, and overlap. Common grasses were frequently shared between ecosystems. Grass assemblages were functionally similar, comprising mostly C4 perennial species. Across the ecosystems, grass communities were mostly composed of tribe Andropogoneae, although we recorded common fire-adapted C3 grasses including Vietnamosasa ciliata (A. Camus) T.Q. Nguyen and Vietnamosasa pusilla (A. Chev. & A. Camus) T.Q. Nguyen. The savanna ecosystems of Thailand and Cambodia are characterized by Dipterocarpus, Pinus, Pterocarpus, and Shorea tree species, which support distinct grass assemblages. Diversity varies across savanna landscapes, with the highest grass species diversity found in the Dipterocarpus and Shorea savannas. Increased sampling is necessary to fully characterize the grass flora of Southeast Asian savannas and their responses to environment.
Population Pharmacokinetics of Vancomycin in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy: Influence of Adsorptive Membranes
(2026-03-01) Hirunsomboon C.; Pathumarak A.; Nosoongnoen W.; Tharanon V.; Sukkha S.; Hirunsomboon C.; Mahidol University
Vancomycin is commonly used to treat Staphylococcus aureus infections. In critically ill patients receiving continuous renal replacement therapy (CRRT), adsorptive membranes like oXiris may alter drug pharmacokinetics. This retrospective study developed a population pharmacokinetics (PopPK) model using MonolixSuite software, incorporating adsorptive membrane use as a covariate. The final one-compartment model estimated that the population volume of distribution of vancomycin was 94.97 L (RSE 10.5%) and population clearance was 2.82 L/h (RSE 19.0%). Adsorptive membrane use was a significant covariate, slightly increasing vancomycin clearance, while aging was associated with reduced clearance. Monte Carlo simulations indicated that a regimen of 2 g loading dose followed by 1 g every 24 h achieved an AUC0–24/MIC ≥ 400 mg h/L in more than 90% of patients. Individualized vancomycin dosing in this population should consider membrane type, along with patient-specific factors such as age, to optimize therapeutic outcomes.
The relationship between clinical outcomes and gait biomechanics in individuals with plantar fasciitis
(2026-01-30) Boonchum H.; Vachalathiti R.; Smith R.; Muraki S.; Bovonsunthonchai S.; Boonchum H.; Mahidol University
Introduction: Plantar fasciitis (PF) is a common musculoskeletal disorder characterized by heel pain that disrupts gait and daily function. This study examined relationships between clinical outcomes and gait biomechanics, determined whether these relationships differ between recent- and chronic-onset cases, and identified key clinical predictors of gait speed. Methods: A cross-sectional study was conducted with 42 individuals with PF. Clinical outcomes included worst pain, normalized gastrocnemius and soleus muscle length, normalized lower limb muscle strength, and normalized dynamic balance. Gait biomechanics during barefoot walking were captured using a motion analysis system and force plates, focusing on spatiotemporal parameters and ground reaction forces (GRFs). Correlation coefficients were used to assess relationships across the overall cohort, as well as in recent- and chronic-onset PF, while multiple linear regression identified clinical predictors of gait speed. Results: Clinical outcomes related differently to sptiotemporal parameters and GRFs depending on symptom duration, with the recent-onset PF showing widespread correlations and chronic-onset PF showing more selective links with ankle strength and dynamic balance. Regression analysis identified gastrocnemius muscle length and anterior reach distance on the Y-Balance Test (YBT) as significant predictors of gait speed, explaining 28.0% of the variance (p = 0.002). Conclusion: Symptom duration influences gait biomechanics in PF, with recent onset showing broad adaptations and chronic onset exhibiting more specific strength- and balance-related changes. Gastrocnemius muscle length and dynamic balance in the anterior direction were identified as significant contributors to gait performance. Targeting these factors, with consideration of symptom duration, may improve gait in individuals with PF.
Using participatory action research to develop an artificial intelligence-augmented, peer-driven, case-based, and simulation-enhanced curriculum for emergency medicine residents
(2026-01-01) Eastwood K.W.; Allali D.; Leela-Amornsin S.; Desbiens J.P.; Szulewski A.; Eastwood K.W.; Mahidol University
This work describes the use of participatory action research to develop an artificial intelligence (AI)-augmented, peer-driven, case-based, and simulation-enhanced framework for senior emergency medicine trainees. It has been applied to enhance knowledge acquisition for small-group self-directed study in resuscitation medicine. Trainees engaged in structured learning cycles over 6 months, based on the principles of ‘desirable-difficulty’ and deliberate-practice. It incorporated peer-selected pre-reading, case-based discussions, high-fidelity simulations, and spaced-repetition flashcard review. A key innovation is the use of generative AI tools to supplement these activities, and follow evidence-based prompt engineering. The participants refined self-study methods through iterative evaluation. AI-generated questions facilitated retrieval-based learning, and flashcard integration enhanced knowledge retention. Simulation-based reinforcement contributed to the ‘desirable-difficulty’ through the clinical application of learned concepts. Self-reported recall improved over time. This structured, self-directed approach supports effective learning in resuscitation medicine. AI and peer-driven strategies augment knowledge retention. This methodology offers adaptability for broader medical education settings.