Mahidol University's Institutional Repository
คลังสารสนเทศสถาบันของมหาวิทยาลัยมหิดล
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Recent Submissions
Efficient Drug Terminology Mapping with Bidirectional Late-Interaction Reranking and Deterministic Reordering
(2026-04-01) Adulyanukosol N.; Chaisutyakorn K.; Sombutjaroan S.; Kanjanapong S.; Suriyaphol P.; Adulyanukosol N.; Mahidol University
Objectives: Standardizing medication concepts across heterogeneous vocabularies is essential for interoperable analytics and observational research. In the Observational Medical Outcomes Partnership (OMOP) Common Data Model, local drug codes must be mapped to standardized RxNorm concepts, but automated mapping is challenging because drug strings encode clinically critical attributes, including strength, dosage form/route, release characteristics, and brand. Methods: We propose THIRAWAT (Terminology Harmonization using Late-Interaction Reranker With Alignment-tuned Transformers), a fine-tuned ColBERTv1 late-interaction reranker, and embed it within THIRAWAT Mapper, a retrieval–reranking pipeline with deterministic tie-breaking and stable ordering. Candidate generation used approximate nearest-neighbor retrieval with a bi-encoder (SapBERT-XLMR or BioLORD-2023). Candidates were reranked by THIRAWAT models that were fine-tuned using one-sided MaxSim and scored at inference using our adapted Bidirectional MaxSim (BiMaxSim) pooling. Finally, a deterministic tie-breaker extracted clinically salient cues, including strength, dosage form/route, release characteristics, and bracketed brand annotations, to resolve near-ties reproducibly. Results: We evaluated three mapping settings: Branded Drugs, Clinical Drugs, and Thai Medicines Terminology (TMT). Using SapBERT-XLMR retrieval with THIRAWAT-Sap-BERT reranking and deterministic tie-breaking, THIRAWAT Mapper achieved MRR@100 values of 0.954 (95% confidence interval [CI], 0.921–0.983), 0.898 (95% CI, 0.866–0.925), and 0.912 (95% CI, 0.891–0.931), outperforming a lexical term frequency–inverse document frequency baseline (0.491, 0.216, and 0.143, respectively). Hits@1 improved to 0.942 (95% CI, 0.899–0.978), 0.859 (95% CI, 0.817–0.898), and 0.868 (95% CI, 0.838–0.896), respectively. Conclusions: BiMaxSim and deterministic tie-breaking improved drug mapping to RxNorm while preserving an efficient runtime profile and stable ordering. Overall, THIRAWAT Mapper offers a pragmatic combination of learned semantic matching and deterministic lexical constraints. Models and code are available on Hugging Face (https://huggingface.co/collections/sidataplus/thirawat) and GitHub (https://github.com/sidataplus/THIRAWAT-mapper).
Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure
(2026-03-01) Telias I.; Madorno M.; Pham T.; Coudroy R.; Mellado Artigas R.; Baedorf-Kassis E.; Chen C.W.; Spadaro S.; Chiumello D.; Beitler J.; Kondili E.; Tiribelli N.; Fredes S.; Becher T.; Dres M.; Liu K.; Terzi N.; Guérin C.; Mauri T.; Roca O.; Mancebo J.; Rodriguez N.; Arnal J.M.; Goligher E.C.; Diehl J.L.; Jochmans S.; Beloncle F.; Rittayamai N.; Mojoli F.; Heunks L.; de Vries H.; Zhou J.X.; Guervilly C.; Brochard L.; Telias I.; Mahidol University
RATIONALE: Excessive stress (distending pressure), strain (volume deformation), and drop in inspiratory alveolar pressure are proposed mechanisms for patient self-inflicted lung injury. OBJECTIVES: To dissect the influence of inspiratory effort, respiratory mechanics, and ventilation mode on lung stress, strain, and drop in inspiratory alveolar pressure and to explore their impact on oxygenation and lung compliance. METHODS: An international cohort study was conducted analyzing respiratory recordings (esophageal pressure) from patients with acute hypoxemic respiratory failure. Association between muscular pressure (Pmus), surrogates of stress (driving transalveolar pressure), strain (Vt), and inspiratory alveolar pressure relative to positive end-expiratory pressure (PEEP) were explored using mixed models, including interactions for ventilation mode, respiratory system elastance, and synchrony. Association between these and changes in oxygenation and lung compliance were explored. MEASUREMENTS AND MAIN RESULTS: Sixty patients from 15 centers represented 528 recordings (339,796 breaths). For each 1 cm H2O increase in Pmus, there were increases in driving transalveolar pressure (median [95% confidence interval (CI)], 0.28 [0.27 to 0.29] cm H2O) and Vt (median [95% CI], 0.16 [0.16 to 0.17] ml/kg of predicted body weight) and a decrease in alveolar pressure (median [95% CI], 0.25 [0.24 to 0.6] cm H2O; P < 0.001). Volume-control ventilation showed lesser increases in stress and strain surrogates than pressure-targeted modes but more drop in alveolar pressure (P < 0.001; Pmus-by-mode interaction). Breath stacking was infrequent and was associated with higher stress. Lower inspiratory alveolar pressure relative to PEEP was associated with subsequent worsening oxygenation (P = 0.04) and higher stress with worsening lung compliance (P = 0.023). CONCLUSIONS: Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, and are associated with subsequent worsening oxygenation and lung compliance.
Dynamics of the immune repertoire in recurrent, locally advanced NSCLC not amenable for definitive therapy and in stage IV disease receiving first-line chemotherapy
(2026-04-13) Trachu N.; Anantaya D.; Iemwimangsa N.; Amponnavarat S.; Teoh V.H.; Oranratnachai S.; Khiewngam K.; Thamrongjirapat T.; Monnamo N.; Lumjiaktase P.; Dejthevaporn T.; Sirachainan E.; Chantratita W.; Reungwetwattana T.; Trachu N.; Mahidol University
Background – Cytotoxic chemotherapy can modulate antitumor immunity, yet its impact on the peripheral T-cell receptor (TCR) repertoire in non-targetable advanced NSCLC remains poorly characterized. We prospectively investigated chemotherapy-induced TCRβ repertoire dynamics and their prognostic relevance. Methods – Patients with recurrent unresectable locally advanced or stage IV NSCLC without actionable mutations received first-line platinum-based chemotherapy (no immunotherapy) at Ramathibodi Hospital (2021–2024). Peripheral blood was collected at baseline (T1), chemotherapy completion (T2), and confirmed disease progression (T3). TCRβ sequencing (Ion Torrent™ Oncomine™ TCR Beta-LR) was performed on samples rarefied to >1.5 million reads. Shannon diversity, Pielou evenness, TCR convergence frequency, unique clone counts, and principal component analysis (PCA) of clonal frequencies were analyzed. Multiple comparisons were Benjamini–Hochberg corrected (significance: p<0.05, BH-adj. q<0.05). Results – Of 42 enrolled patients, 34 were T1-evaluable and 15 at T2; longitudinal attrition was driven primarily by pre-T2 death (74% vs. 27%; p=0.014). Disease control was achieved in 11/15 T2-evaluable patients (73%). Disease control patients trended higher TCR convergence (0.0040 vs. 0.0023) and significantly smaller decline in unique clone counts (−16% vs. −41%; Wilcoxon p=0.020, q=0.030). PCA revealed compact repertoire clustering in disease control versus wide PC2 dispersion in progressive disease (PD) patients (p=0.030, q=0.030). Among 4 patients reaching T3 (all PD), post-chemotherapy rises in Shannon diversity and convergence reversed at T3, consistent with immune attrition. Overall survival was significantly longer in disease control patients (log-rank p=0.036). Conclusion – Stable clonal convergence and preserved clone counts associate with disease control and survival in non-targetable advanced NSCLC receiving chemotherapy, supporting peripheral TCRβ profiling as an exploratory biomarker warranting prospective validation.
Determinants of healthcare access among older adults in Mandalay Region, Myanmar: A cross-sectional analysis
(2026-05-01) Aung Y.; Chuanwan S.; Hunchangsith P.; Isarabhakdi P.; Sawangdee Y.; Völker M.; Aung Y.; Mahidol University
Population ageing is accelerating globally, posing significant challenges to health systems, particularly in low-and middle-income countries. In Myanmar, access to healthcare services among older persons is under-researched, particularly in the Mandalay Region. This study examines healthcare utilization patterns and associated socio-demographic factors among older adults in three high-ageing index districts: Meikhtila, Nyaung U, and Myingyan. A cross-sectional analytical design was employed, with data collected from June to August 2021 based on a multi-stage stratified cluster sampling design. Results from a multivariate logistic regression analysis revealed that older adults living in rural areas (AOR=3.24), those with a moderate ability to perform daily activities (AOR=2.86), and those experiencing hearing difficulties (AOR=1.91) were more likely to use public hospitals. In contrast, residents of Myingyan district (AOR=0.48) were less likely to access public health facilities as compared to residents of Meikhtila district. The use of private hospitals was more common among older adults with moderate self-rated health (AOR=4.36) and those residing in Myingyan (AOR=2.07). However, individuals with moderate functional ability (AOR=0.28) and those with vision difficulties (AOR=0.41) were significantly less likely to use private hospitals. The utilization of charity clinics was higher among older adults who were employed (AOR=11.06), including unpaid family workers (AOR=6), and among those who required regular follow-up care (AOR=7.62) or had vision impairments (AOR=11.35). Conversely, individuals living in rural areas (AOR=0.07) and those from wealthier households (AOR=0.05) were less likely to use charity clinics. These findings highlight the complex and uneven patterns of healthcare access among older persons in Myanmar. They underscore the importance of addressing socio-demographic disparities—particularly in rural areas and among individuals with physical or sensory limitations—to promote equitable and effective healthcare delivery for an ageing population. For example, the provision of specialized care services should be strengthened across all areas to improve access to public ENT (Ear, Nose, and Throat) specialist hospitals in the Mandalay Region.
Arm Lymphedema Prevention Adherence Questionnaire: Validation and HAPA Model Application in Breast Cancer Postoperative Patients
(2026-01-01) Wu Q.; Kaewboonchoo O.; Ratanasiripong P.; Kaewwilai L.; Wu Q.; Mahidol University
Objective: Arm lymphedema is a common, lifelong postoperative complication in breast cancer survivors, and adherence to prevention behaviors may help reduce its occurrence. This study aimed to validate the modified questionnaire on adherence to arm lymphedema prevention behaviors and examine the strength of the relationship between constructs of the Health Action Process Approach (HAPA) model and adherence to arm lymphedema prevention behaviors among breast cancer postoperative patients. Methods: A cross-sectional study was conducted from August to November 2024. Exploratory factor analysis (EFA) assessed construct validity, and Cronbach’ s α evaluated reliability. Path analysis using Structural Equation Modelling (SEM) tested the HAPA model and relationships among variables. Results: EFA supported a three-factor structure for the modified questionnaire with an overall Cronbach’ s α of 0.92. In the pre-intentional motivational phase, the path coefficients demonstrated a statistically significant effect of risk perception, outcome expectancy and action self-efficacy on behavioral intention. In the post-intentional volition phase, the path from behavioral intention and coping planning to adherence to arm lymphedema prevention behaviors showed significant effects. However, the effect of coping self-efficacy and action planning on adherence to arm lymphedema prevention behaviors was not significant. Conclusion: The modified questionnaire demonstrated good construct validity and reliability. Risk perception, outcome expectancy and action self-efficacy were key determinants of behavioral intention; behavioral intention and coping planning (excluding coping self-efficacy and action planning) influenced adherence. The results provide a basis for interventions to improve adherence to arm lymphedema prevention behaviors in postoperative breast cancer patients, potentially reducing lymphedema incidence and improving postoperative quality of life.