Mahidol University's Institutional Repository
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Recent Submissions
Consensus statement on the application of artificial intelligence in osteoporosis screening and management: perspectives from the Asia-Pacific region
(2026-01-01) Huang C.F.; Fang W.H.; Chen K.H.; Lin S.Y.; Ho C.J.; Hwang J.S.; Tai T.W.; Liu Y.F.; Shih C.A.; Chen J.F.; Tu S.T.; Chan D.C.; Yang R.S.; Fu S.H.; Chen H.Y.; Tsai K.S.; Cheng T.T.; Chen F.P.; Hung W.C.; Chang Y.F.; Han D.S.; Chandran M.; Bin A.S.; Lee J.K.; Yeap S.S.; Chung Y.S.; Kim K.K.; Ebeling P.R.; Jaisamrarn U.; Pandey D.; Ferrari S.; Yang T.H.; Charatcharoenwitthaya N.; Taguchi A.; Lekamwasam S.; Van Nguyen T.; Lewiecki E.M.; Saag K.G.; Tsai C.C.; Marín F.; Mori S.; Hwang K.R.; Li-Yu J.; Carey J.J.; Kendler D.; Cheung C.L.; Huang H.K.; Kuptniratsaikul V.; Chan W.P.; Chan S.P.; Ho-Pham L.T.; Hew F.L.; Shi H.; Rhee Y.; McCloskey E.; Tanaka S.; Hans D.; Kanis J.A.; Chen C.H.; Wu C.H.; Huang C.F.; Mahidol University
Summary: Osteoporosis is a major and growing health concern in the Asia-Pacific region, y et it remains widely underdiagnosed and undertreated due to limited access to dual-energy X-ray absorptiometry (DXA) in many areas. Artificial intelligence (AI) offers new opportunities to improve osteoporosis screening and management, but unvalidated tools pose risks of inconsistent care. This consensus was developed to provide regionally harmonized guidance on the safe, effective, and equitable use of AI in osteoporosis care. Purpose: The aim of this work was to establish expert consensus recommendations on the role of AI in osteoporosis screening and management in the Asia-Pacific region. Key objectives were to define appropriate applications of AI (e.g., imaging-based bone assessment and fracture risk prediction) and specify minimum standards for validation and reporting, addressing region-specific implementation challenges and ensuring that AI use aligns with clinical guidelines and ethical principles. Methods: This consensus was developed through multidisciplinary collaboration among experts across the Asia-Pacific region. Each participant reviewed draft statements, contributed feedback during virtual meetings, and provided insights based on clinical experience and current evidence. Consensus was reached iteratively until full agreement was achieved for all statements. The process integrated global best practices and regional adaptations, drawing from peer-reviewed studies, international AI guidelines, and local fracture registry data. The final recommendations emphasize the validation, transparency, and ethical implementation of AI within regional healthcare systems, ensuring compatibility with local regulations. Ultimately, twelve consensus statements were established to guide the responsible use of AI for osteoporosis screening and management in the Asia-Pacific region. Results: The panel produced 12 consensus statements covering the role of AI as an adjunct for opportunistic osteoporosis screening rather than a diagnostic tool, requirements for imaging quality and AI model transparency, standards for validation and performance reporting, integration of AI with clinical risk stratification, demonstration of clinical utility in real-world settings, adherence to data protection laws and ethical AI principles, training of clinicians in AI use, strategies for implementation and monitoring (including post-market surveillance and feedback loops), and recognition of technical, clinical, and equity limitations of AI. All 12 statements give extensive recommendations for using AI to improve osteoporosis management while ensuring patient safety, accuracy, and equity. Conclusion: This first Asia-Pacific consensus on AI in osteoporosis concludes that AI, when appropriately validated and implemented, can help bridge the osteoporosis care gap by identifying high-risk patients who would otherwise remain undiagnosed, thus facilitating earlier intervention. It emphasizes that AI should complement—not replace—standard diagnostic methods and clinical judgment. The guidance emphasizes validation, transparency, and ethical oversight to facilitate early intervention while minimizing risks associated with unvalidated or premature AI adoption.
Pre-sterilization of vancomycin-loaded cement spacers: impact on antibacterial efficacy against Staphylococcus aureus
(2026-01-01) Chulsomlee K.; Pongchaikul P.; Sadchaphaiboonkit R.; Arunothai J.; Mongkolsuk P.; Sri-utenchai N.; Chulsomlee K.; Mahidol University
Background: Antibiotic-loaded polymethylmethacrylate (PMMA) cement spacers are widely used in periprosthetic joint infection and chronic osteomyelitis. Manual prefabrication and sterilisation of non-commercial antibiotic-loaded cement may reduce operative time and cost; however, the effects of sterilisation and storage on antimicrobial efficacy remain unclear. Methods: Manually prefabricated PMMA cement containing vancomycin (2 g or 4 g) underwent formaldehyde gas sterilisation (FO) and storage for one, four or seven days. Antibiotic elution was evaluated over 28 days. Antimicrobial activity against Staphylococcus aureus ATCC 25923 was assessed using minimum inhibitory dilution (MID) testing at predefined time points. Given the small number of specimens per subgroup, all comparisons should be interpreted as preliminary and hypothesis-generating. Results: FO sterilisation significantly reduced antimicrobial activity during the early elution phase. In the 4—g vancomycin group, Day 1 MID values were significantly higher in one day storage sterilised specimens than in specimens stored for four or seven days (1024 µg/mL vs. 213 µg/mL and 213 µg/mL, respectively; P < 0.001). Differences persisted at early time points but were no longer significant during the sustained elution phase (Days 14–28; P > 0.05). Overall, sterilised cement containing 4 g of vancomycin demonstrated higher MID values than 2 g cement during the early and mid-elution phases (Days 1–14; P < 0.01). MID values in all sterilised specimens remained several-fold above inhibitory thresholds for S. aureus throughout the 28-day period. Conclusions: FO sterilisation transiently reduces vancomycin antimicrobial activity during the early elution phase (Days 1–7) but does not affect sustained antimicrobial efficacy compared with non-sterilised cement. Based on these findings, vancomycin-loaded PMMA cement containing 4 g of antibiotic may be sterilised and stored for up to seven days while maintaining MIC values several-fold above inhibitory thresholds for Staphylococcus aureus throughout the 28-day elution period.
Global Healthcare Study on Psoriasis (GHSP): cohort profile and first findings
(2026-05-01) Maul J.T.; Fröhlich F.; Nielsen M.L.; Maul L.V.; Torres T.; Thyssen J.; Armstrong A.; Oon H.H.; Ji M.; Kang X.; Valenzuela F.; Romiti R.; Carvalho A.V.E.d.; Novoa F.; Sousa M.; Luz M.; Guevara B.E.K.; doss N.; Gisondi P.; Chularojanamontri L.; Kündig T.M.; Egeberg A.; Thomsen S.F.; Didaskalu J.A.; Maul J.T.; Mahidol University
Purpose: Despite the intention of international psoriasis treatment guidelines to cover all patients globally, disparities persist in the availability and accessibility of adequate therapy in many countries. The Global Healthcare Study on Psoriasis (GHSP) aims to study patient characteristics, disease impact, treatment accessibility and healthcare systems worldwide. This study provides a description and data analysis of 22 countries. Participants: The GHSP cohort was initiated in 2020, and the number of recruiting centres has gradually grown. Participants are recruited by dermatologists at reference centres worldwide. Data are collected using a standardised assessment questionnaire comprising 88 items, administered by trained experts. Findings to date: By 26 October 2024, cross-sectional data had been collected from 3950 psoriasis patients at 130 reference centres in 22 countries on six continents. The majority (55.7%) of patients were male, and the median (IQR) body mass index was 26.5 (23.7–30.1) kg/m2. The median (IQR) Psoriasis Area and Severity Index was 5.0 (2.0–11.4), and median (IQR) Dermatology Life Quality Index was 7.0 (2.0–14.0). Psoriatic arthritis was present in 20.2% of the patients and nail psoriasis in 36.7%. Additionally, 16.5% of patients were current smokers, and 26.4% reported regular alcohol consumption. Future plans: By identifying inequalities, special patient populations and country-specific differences, the GHSP will guide the development of strategies to enhance psoriasis care on a global level. Future directions include expanding the study to additional countries and sites worldwide, while transitioning into a long-term global registry of skin diseases, including atopic dermatitis and hidradenitis suppurativa, termed ‘Global Healthcare Registry on Skin Diseases’.
Altered Pharmacokinetics and Delayed Sputum Conversion in Tuberculosis Patients Co-Infected With HIV
(2026-01-01) Phyo A.P.; Hoglund R.M.; Saito M.; Thi S.S.; Swe L.L.; Chotsiri P.; Aung H.K.K.; Tun W.P.P.; Maung B.M.; Pateekham C.; Watthanaworawit W.; Gornsawun G.; White N.J.; Nosten F.; Tarning J.; Phyo A.P.; Mahidol University
Background: HIV co-infection affects host responses and pharmacokinetics (PK) of tuberculosis (TB) treatment. This study assessed the PK of first-line anti-TB drugs and clinical outcomes in patients with and without HIV co-infection. Methods: In this prospective observational study, 61 adults with sputum-positive pulmonary TB, either confirmed by microscopy or GeneXpert, were enrolled, including 24 with HIV co-infection and 37 without. All HIV-positive participants were antiretroviral-naïve at enrolment. Standard anti-TB therapy was given, and PK assessments were conducted on Day 1 and Week 6. Efavirenz-based antiretroviral therapy (ART) began at a median of Day 21. Clinical outcomes, sputum conversion, and adverse events were monitored. Results: At baseline, patients with HIV co-infection had reduced clearance of isoniazid and ethambutol, reflected by slower elimination rates. These differences resolved by Week 6 and were not significantly impacted by ART initiation. Logistic regression showed that HIV-positive status (OR = 14.25, 95% CI: 1.22–166.37, p = 0.03), and higher baseline sputum bacillary load (OR = 3.92, 95% CI: 1.5–10.5, p = 0.006) were independently associated with delayed sputum conversion beyond 8 weeks. Baseline CRP showed an inverse association after adjustment, but this did not reach statistical significance (OR = 0.98, 95% CI: 0.96–1.00, p = 0.06). Conclusion: HIV co-infection was associated with altered early PK of isoniazid and ethambutol although these differences were less apparent by Week 6. HIV-positive status and higher baseline sputum bacillary load were associated with delayed sputum conversion. Although some pharmacokinetic differences were statistically significant, their clinical relevance remains uncertain, and the current data do not support dose adjustment. These findings suggest early pharmacokinetic variability in TB–HIV co-infected patients and support further investigation in adequately powered exposure–response studies. Trial Registration: ClinicalTrials.gov: NCT02457208.
Promises of reprogramming-induced rejuvenation
(2026-08-01) Simpson D.J.; Arif N.; Suwanlikit Y.; Kirschner K.; Chandra T.; Simpson D.J.; Mahidol University
Reprogramming-induced rejuvenation (RIR) reverses cellular aging by transiently engaging early reprogramming states without full dedifferentiation. This review examines current developments in the molecular mechanisms, technological advances, and tissue-specific applications of RIR. Recent mechanistic insights highlight persisting questions in timing, heterogeneity, and pathways engaged in the epigenetic response. New technological advances have expanded RIR modalities beyond traditional Yamanaka factors to include mRNA-based delivery, CRISPRa, and chemical cocktails, while high-throughput screening platforms are systematically identifying novel rejuvenation factors with improved safety profiles. Recent tissue-specific applications demonstrate functional restoration across brain, liver, intestine, cardiovascular, and epithelial systems through reversal of cellular senescence, reduction of DNA damage and epigenetic age, and enhanced regenerative capacity. However, clinical translation faces challenges including narrow therapeutic windows, incomplete mechanistic understanding, and limited biomarker standardization. We discuss how single-cell technologies, computational prediction tools, and systematic in vivo testing may advance RIR toward geroscience therapies for age-related diseases.