Mahidol University's Institutional Repository
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Recent Submissions
Metabolic acidosis and sodium bicarbonate therapy in critically ill patients: A multinational survey of international and Chinese practitioners
(2026-03-01) Caroli A.; Zhou L.; Chaba A.; Eastwood G.; Hikasa Y.; Kitisin N.; Li T.; Li W.; Lin X.; Liu Y.; Lv C.; Maeda A.; McNamara M.; Nübel J.; Pan C.; Raykateeraroj N.; Spano S.; Xu X.; Zhang H.; Ke L.; Serpa Neto A.; Caroli A.; Mahidol University
Objective To evaluate critical care professionals’ perceptions of the burden of metabolic acidosis (MA) in the intensive care unit (ICU), and assess agreement on indications, modalities, risks, and benefits of sodium bicarbonate therapy. Design A multinational, web-based survey administered at different times to Chinese and international ICU practitioners. Main outcome measures The survey comprised 20 items across four domains: 1) perceived epidemiology and research relevance of MA; 2) rationale, indications, and treatment modalities; 3) potential benefits of sodium bicarbonate; and 4) potential adverse effects of sodium bicarbonate. Responses were recorded on a 5-point Likert scale and classified as “Agreed” , “Disagreed” , or “Uncertain” . Results A total of 1279 responses from 20 countries were analysed. MA was widely recognised as common, clinically relevant, a frequent cause of ICU admission, and an area requiring further research. Most clinicians supported targeted therapy beyond treating underlying causes, though uncertainty remained regarding sodium bicarbonate. Chinese respondents favoured early correction and continuous infusion, while international opinions varied on timing and approach. Perceived benefits, such as reduced vasopressor use and respiratory workload, were supported by Chinese clinicians, whereas international ones remained uncertain. Opinions on adverse effects also diverged. Chinese physicians highlighted risks of hypernatraemia, severe alkalosis, and hypokalemia, while international respondents viewed sodium bicarbonate as safe regarding the risk of fluid overload or pulmonary oedema. Conclusions This international survey shows broad agreement that MA is a clinically important and understudied condition in the ICU but reveals substantial variability and uncertainty in clinicians’ perceptions of sodium bicarbonate therapy, with notable differences between Chinese and international respondents. These findings underscore key knowledge gaps and the need for well-designed clinical trials.
Validation of students blended learning course experience in Thai medical education
(2025-10-01) Wilaphan K.; Chiowchanwisawakit P.; Songkram N.; Wilaphan K.; Mahidol University
Blended learning is a widely used method in education to promote active learning and enhance students’ learning outcomes. Therefore, evaluating the quality of blended learning courses requires an effective model for benchmarking, which can improve student satisfaction and is crucial for quality assurance in higher education. This study aimed to validate and examine student’s blended learning course experience in Thai medical education using a quantitative research design. A total of 560 medical students from a large medical school in Thailand participated. Data analysis was conducted using Confirmatory Factor Analysis (CFA). The findings indicate that components and indicators were: (1) general skills with six indicators, (2) online sessions with five indicators, (3) clear goals and standards with four indicators, (4) good teaching with six indicators, (5) appropriate assessment with four indicators, and (6) appropriate workload with three indicators. The second order CFA demonstrated that the student blended learning course experience model had an acceptable fit with χ2 (249) = 1.148, p =.056, RMSEA =.016, RMR =.005, SRMR =.05, GFI =.995, AGFI =.995, NFI =.961, and CFI =.995. These findings could contribute to the development of guidelines for designing a medicine bachelor’s degree curriculum that incorporates blended learning methods.
Future temperature-related labour loss due to premature deaths: a multi-country study
(2026-04-01) Wen B.; Ademi Z.; Wu Y.; Xu R.; Yu P.; Liu Y.; Yu W.; Ye T.; Huang W.; Yang Z.; Zhang Y.; Zhang Y.; Ju K.; Hales S.; Lavigne E.; Saldiva P.H.N.; Coêlho M.d.S.Z.S.; Matus P.; Kim H.; Tantrakarnapa K.; Kliengchuay W.; Capon A.; Bi P.; Jalaludin B.; Hu W.; Green D.; Zhang Y.; Arblaster J.; Phung D.; Guo Y.; Li S.; Wen B.; Mahidol University
The ongoing climate change is expected to lead to a significant increase in the frequency and intensity of climate extremes. However, the impact of cold and hot temperatures on labour loss, through causing premature deaths in the future, remains largely unknown. We collected historic daily all-cause mortality data during 1986–2019 from 1066 locations in seven countries. A two-stage time-series approach was applied to estimate associations between non-optimum temperatures and the productivity-adjusted life year (PALY) loss due to premature deaths. These associations were then combined with projected daily temperatures under three climate change scenarios from 2021 to 2100 to quantify future PALY losses attributable to temperatures. Overall, we projected an increase in heat-related PALY loss and a decrease in cold-related PALY loss in the future. Under the SSP5-8.5 scenario, the heat-related PALY loss is projected to increase by 7.5% by the end of 2100 compared to the historical period (2001-2020), resulting in a net increase in excess PALY loss of 6.8%, greater than the net changes projected under the SSP3-7.0 (5.7%) and SSP1-2.6 (0.6%) scenarios. Brazil and Thailand were projected to experience an increase in excess heat-related PALY loss, while a reduction in excess cold-related PALY loss was projected to be most prominent in Thailand. The magnitude of the change in both heat- and cold-related PALY loss was largely affected by socioeconomic factors, such as GDP per capita and the deprivation level. This study provides a better understanding of the impacts of climate change on labour loss and provides evidence to inform targeted adaptation strategies and policy responses aimed at mitigating the socioeconomic impacts of climate change.
The Effect of Uvaria rufa Fruit Extract for Antioxidant and Anti-Melanogenic Activities and Phytochemical Profiling Using LC–MS Analysis
(2026-01-01) Tangpudtasiri P.; Wiriyakun N.; Niwaspragrit C.; Amornlerdpison D.; Namchaiw P.; Ratanachamnong P.; Jaisin Y.; Tangpudtasiri P.; Mahidol University
Uvaria rufa (U. rufa) Blume is commonly found in Southern and Eastern Asia, including Thailand. This plant is commonly known as “Carabao teats” in English and “Pee Puan” in Thai. Even though hyperpigmented skin is generally a harmless condition, it is often a cosmetic concern. Ultraviolet exposure seems to be the primary contributing factor. In this study, we investigated the bioactive constituents of the ethanol extract of U. rufa fruits and evaluated their anti-melanogenic effects and tyrosinase inhibition in B16F10 mouse melanocyte cells (B16F10 melanoma cells) induced by α-melanocyte-stimulating hormone (α-MSH). This extract included phenolic and flavonoid components, as well as secondary metabolites demonstrated using LC–MS analysis, including betaine, hydroquinone, kojic acid, nicotinamide, quercetin, cysteamine, neoagarobiose, gallic acid, and cinnamic acid. Based on its antioxidant constituents and preliminary antioxidant screening, the extract possessed free radical scavenging capability by effectively scavenging DPPH and nitric oxide (NO) radicals with an IC50 of 7.05 and 16.56 mg/mL, respectively. The extract inhibited melanin production by 123.2 ± 3.3% and tyrosinase activity by 134 ± 4.23% in α-MSH-stimulated B16F10 cells, suggesting that the observed anti-melanogenic capability arises from the combined action of several bioactive substances. Taken together, this present study demonstrates that U. rufa fruits have potential as a natural anti-melanogenic remedy and supports its further development for applications in the treatment of hyperpigmentation.
Solubility and stability enhancement of an andrographolide analogue through complexation with cyclodextrins: Molecular modeling and experimental validation
(2026-04-01) Nutho B.; Sawatdhiphol S.; Pornsuwan S.; Ali S.; Aman A.; Krusong K.; Arsakhant P.; Saeeng R.; Rungrotmongkol T.; Nutho B.; Mahidol University
The 12-dithiocarbamate-14-deoxyandrographolide analogue (R , S)- 3l exhibits strong inhibitory activity against the SARS-CoV-2 main protease, but its poor aqueous solubility limits its pharmaceutical potential. To address this limitation, supramolecular inclusion complexes were formed between (R , S)- 3l and β-cyclodextrin (βCD), γ-cyclodextrin (γCD), and four βCD derivatives to identify the most effective carrier. An in silico strategy combining molecular dynamics simulations, binding free energy calculations, and free energy surface analysis identified sulfobutylether-β-cyclodextrin (SBEβCD) as the most stable and energetically favorable host. Experimental validation through phase solubility studies revealed a 1:1 (AL-type) inclusion complex with the highest stability constant. Further characterization using scanning electron microscopy, differential scanning calorimetry, Fourier-transform infrared, and 1H NMR spectroscopy consistently demonstrated successful complex formation and the transformation of (R , S)- 3l into an amorphous solid phase. Overall, these findings show that complexation with SBEβCD markedly enhances the solubility and physicochemical stability of (R , S)- 3l , overcoming a key limitation in its pharmaceutical development. The integrated computational–experimental approach provides a rational framework for designing CD-based delivery systems for poorly soluble natural product derivatives and supports the advancement of andrographolide-inspired antiviral therapeutics.