Asian Biomedicine最新文献

Background: The Royal College of Physicians of Thailand (RCPT) published a Clinical Practice Guideline on Pharmacologic Therapy of Dyslipidemia for Atherosclerotic Cardiovascular Disease (ASCVD) Prevention in 2016. The availability of newer classes of medications for dyslipidemia, supported by extensive clinical research findings, indicates a significant need for the updating of the existing clinical practice guideline.

Objectives: To serve as guidelines on the management of dyslipidemia for Thai adults.

Methods: The RCPT Dyslipidemia Guidelines Committee was established with representatives from selected professional societies to revise the 2016 Guideline by critically reviewing the latest evidence. Meetings were conducted from August to December 2023, culminating in a public hearing that engaged various stakeholders in January 2024. The final Thai version received approval in April 2024, while the English translation was completed in October 2024.

Results: Lifestyle modifications and statins remain the cornerstone of therapy for dyslipidemia in adults across various clinical settings. Emerging evidence regarding newer classes of lipid-lowering medications indicates that these treatments are effective in lowering LDL-cholesterol levels and reducing atherosclerotic cardiovascular events. This suggests that they may serve as an add-on therapy for individuals who cannot achieve target levels or who are at high risk for future cardiovascular events. The Thai CV Risk Score is recommended due to its specificity for the Thai population.

Conclusions: The 2024 updated clinical practice guidelines establish a framework, provide recommendations, and serve as a comprehensive resource for the contemporary management of dyslipidemia in adults, with the goal of preventing ASCVD in Thailand.

Background: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) that affects approximately 90% of end-stage renal disease and poses a significant threat to long-term survival and quality of life in patients.

Objectives: To assess whether radiofrequency ablation (RFA) is a productive and low-risk treatment for hyperparathyroidism secondary to CKD.

Methods: Embase, Web of Science, Cochrane Library, and PubMed were searched independently by two authors. The results after RFA and baseline biochemical indicators were compared, and parathyroid hormone (PTH), serum calcium, and serum phosphorus levels were the major outcomes.

Results: Four retrospective studies were screened out from 147 original literature and involved 118 cases. After RFA, serum PTH levels (1 d standardized mean difference [SMD] = -2.30, 95% confidence interval [CI] = from -3.04 to -1.56, P < 0.0001; 6 months SMD = -2.15, 95% CI = from -3.04 to -1.26, P < 0.0001; 12 months SMD = -2.35, 95% CI = from -3.52 to -1.17, P < 0.0001), serum calcium levels (1 d SMD = -1.49, 95% CI = from -2.18 to -0.81, P = 0.0001; 6 months SMD = -1.09, 95% CI = from -1.51 to -0.68, P < 0.0001), and serum phosphorus levels (1 d SMD = -1.37, 95% CI = from -1.67 to -1.07, P < 0.0001; 6 months SMD = -1.06, 95% CI = from -1.35 to -0.78, P < 0.0001) decreased significantly.

Conclusions: RFA, the newest thermal ablation technique, can effectively and safely treat hyperparathyroidism secondary to CKD. Hoarseness is the most common complication but is reversed within 6 months.

Background: Thiosulfate concentration in blood is an important indicator for the diagnosis of hydrogen sulfide poisoning. It may also be detected at high levels in postmortem decomposition cases.

Objectives: To determine the effect of postmortem decomposition on blood thiosulfate concentration and define precautions for diagnosing hydrogen sulfide poisoning based on thiosulfate concentration.

Methods: A total of 57 cadavers (37 males and 20 females) of non-hydrogen sulfide poisoning-related deaths that underwent forensic autopsy in our department between 2016 and 2019 were classified into the non-decomposed (19 cases), partially decomposed (19 cases), and severely decomposed (19 cases) groups based on forensic findings. Blood samples collected from each case were analyzed for thiosulfate concentration using liquid chromatography-tandem mass spectrometry.

Results: The mean concentration of thiosulfate detected in the blood was 70.9 (10.5-266.6) μmol/L in the severely decomposed group, 16.3 (0.1-52.7) μmol/L in the partially decomposed group, and 1.1 (0.1-3.6) μmol/L in the non-decomposed group. There was a statistically significant difference between each of the 3 groups (P < 0.01).

Conclusions: Previous studies have reported a blood thiosulfate concentration of >14 μmol/L in hydrogen sulfide poisoning cases and <4 μmol/L in normal cases. Thus, thiosulfate concentration is believed to have a significant impact on the diagnosis of hydrogen sulfide poisoning. This study revealed that postmortem decomposition produced thiosulfate in the blood, and the concentration of thiosulfate was often as high as that observed in cases of hydrogen sulfide poisoning-related death. In addition to cases of advanced decomposition, an increase in thiosulfate concentration was also observed in cases of partial decomposition. Therefore, when measuring thiosulfate concentration as an indicator of hydrogen sulfide poisoning, it is necessary to carefully consider the influence of decomposition.

Background: The COVID-19 pandemic first emerged in December 2019 and rapidly spread globally, including Thailand. While respiratory symptoms remain the primary manifestation of the disease, upper respiratory tract symptoms, including dysphonia, have been reported in various studies.

Objectives: To determine the prevalence of dysphonia in non-hospitalized Thai COVID-19 patients and identify associated factors using the Thai-Voice Handicap Index-10.

Methods: This study investigates the prevalence of dysphonia and associated factors in non-hospitalized Thai COVID-19 patients. Conducted from September 2022 to February 2023, it enrolled healthcare workers who tested positive for COVID-19 but were not hospitalized.

Results: Among 82 patients, 53 (64.6%) reported dysphonia, which was significantly associated with cough (P = 0.013) and nasal discharge (P = 0.047). Substantial improvement was observed at the 3-month follow-up (73.6%). Vaccination may serve as a protective factor (crude odds ratio < 1).

Conclusion: The prevalence of dysphonia among non-hospitalized COVID-19 patients in Thailand is 63.6%, linked to cough and nasal congestion, with symptoms likely to subside within 3 months.

Background: Acute kidney injury (AKI) is a critical morbidity after cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

Objective: This study was conducted to investigate the use of kidney-specific biomarkers to evaluate the diagnostic accuracy of post-HIPEC AKI.

Methods: Patients who received CRS/HIPEC were prospectively enrolled in this study. We serially sampled urine neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C (sCyC), and β2 microglobulin (sβ2-MG) on the day before CRS/HIPEC and then 2 h, 1 d, 2 d, 3 d, and 7 d after CRS/HIPEC. The primary outcome was the occurrence of AKI during the first 7 d. The areas under the receiver operating characteristic curve (AUCs) were calculated to evaluate the detection performance.

Results: A total of 75 patients were eligible, of whom 5 (6.7%) fulfilled the criteria of AKI during the study period (AKI group) and 70 did not (non-AKI group). No significant differences were observed in these biomarkers between the two groups, except for sβ2-MG on day 3 (P = 0.025). Regarding changes in biomarker concentrations, the AKI group had a significantly higher concentration range of sCyC on day 3 (P = 0.009) and sβ2-MG on day 1 and day 3 (P = 0.013 and 0.019).

Conclusions: This is the first prospective study to evaluate the value of kidney-specific biomarkers in patients after CRS/HIPEC. We found that AKI cannot be predicted by simply using the absolute measurements of these biomarkers because of the heterogeneous characteristics of the patients.

Background: Retroperitoneal sarcoma (RPS) is rare and difficult to treat with a high recurrent rate. Very little data regarding primary RPS exists in Thailand.

Objectives: To study the outcome of treatment of primary RPS at a tertiary University Hospital in Bangkok, Thailand.

Methods: All patients who had RPS undergoing the first surgical resection at King Chulalongkorn Memorial Hospital from June 2003 to December 2019 were retrospectively enrolled in the study. Perioperative management, results of treatment, postoperative complications, and outcome were analyzed.

Results: Thirty-eight patients entered the study. Large abdominal mass was the most common presentation (90%). Liposarcoma was the most common histology (58%). Twenty patients (53%) had preoperative core needle biopsy and 21 (55%) underwent preoperative radiotherapy (RT). The tumor size ranged from 3 cm to 48 cm (median 22 cm). Five patients (13%) had total mass removal only while 33 (87%) had complete gross resection with ≥1 visceral organ resection. Surgical margins classified as R0, R1, and R2 were 61%, 34%, and 5%, respectively. Five patients (16%) had postoperative complications. There was no 30-day postoperative mortality. The local recurrence rate was 34%. Survival analysis revealed a 5-year overall survival rate of 37% and 5-year disease-free survival rate of 29%. The 5-year and 10-year recurrent rates were 71% and 95%, respectively. Multivariate analysis showed that preoperative radiation was the only factor reducing recurrence (19% vs. 53%, OR: 0.21, P = 0.011).

Conclusion: The preliminary study of outcome of the treatment of primary RPS at our institution showed a fair prognosis of this rare malignancy despite our aggressive surgical approaches. Preoperative radiation may help reduce recurrence in selected primary RPS patients.

Background: The health benefits of coixol, an active compound of adlay seed, have attracted certain attention. Adlay seed is often adopted in traditional Chinese medicine for the treatment of various inflammatory disorders. Thus, it is hypothesized that coixol could protect neuronal cells.

Objectives: The preventive effects of coixol against Abeta_25-35-induced damage in nerve growth factor-differentiated PC12 cells were explored.

Methods: Differentiated PC12 cells were treated with coixol at 0.125 μM, 0.25 μM, 0.5 μM, 1 μM, and 2 μM for 48 h. Then, cells were further exposed to Abeta_25-35 at 20 μM for 24 h.

Results: Coixol treatments at 0.25-2 μM exhibited antiapoptotic effect via increasing Bcl-2 mRNA expression, mitochondrial membrane potential, and Na⁺-K⁺ ATPase activity as well as decreasing Bax mRNA expression, caspase-3 activity, and intracellular Ca²⁺ release. In addition, coixol treatments at 0.25-2 μM alleviated oxidative and inflammatory responses via lowering reactive oxygen species level, increasing glutathione content, promoting the activity of glutathione peroxidase, glutathione reductase, and catalase, decreasing the generation of tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and prostaglandin E₂. Furthermore, coixol treatments at 0.25-2 μM diminished intracellular Ca²⁺ release, and restricted nuclear factor kappa B-binding activity and phosphorylation of p65 and p38. Coixol treatments at 0.5-2 μM increased protein generation of nuclear factor E2-related factor 2, and limited protein production of inducible nitric oxide synthase and receptor of advanced glycation end product.

Conclusion: Our novel findings suggested that coixol was a compelling agent against beta-amyloid peptide-induced neurotoxicity.

Background: Depression is one of the most common mental disorders. Although depression is typically diagnosed by identifying specific symptoms and through history, no recognized standard for depression diagnosis exists. This assures the development of objective diagnostic tools for depression.

Objectives: We investigated the differences in the resting-state electroencephalograms (EEGs) of patients with depression and healthy controls (HCs) to distinguish patients from HCs by using a support vector machine (SVM) classifier with the following two feature selection approaches: t test and receiver operating characteristic analysis.

Methods: We used the EEG data from the Patient Repository of EEG Data + Computational Tools; this study included 21 patients with depressive disorder (MDD) and 21 HCs. The relative frequency power, alpha interhemispheric asymmetry, left-right coherence, strength, clustering coefficient (CC), shortest path length, sample entropy (SampEn), multiscale entropy (MSE), and detrended fluctuation analysis (DFA) data were extracted to determine candidate EEG features associated with depression.

Results: With the t-test selection, the SVM classifier demonstrated the highest performance with the accuracy, sensitivity, and specificity of 96.66%, 95.93%, and 97.550% for the eye-open condition and 91.33%, 90.59%, and 91.81% for the eye-closed condition, respectively. For comparisons of features in the 2 selection approaches, the most influential features were relative frequency power and left-right coherence.

Conclusion: Using this information to distinguish patients with MDD from HC subjects with the SVM classifier resulted in a mean accuracy over 90%. Although this result may not be robust enough for clinical applications, further exploration is necessary given the simplicity, objectivity, and efficiency of the classifier.

Background: Thailand has the world's highest prevalence of cholangiocarcinoma (CCA), especially in the endemic area of liver fluke Opisthorchis viverrini infection. However, other regions of Thailand still have relatively high CCA prevalence.

Objectives: We aimed to determine CCA risk factors in areas not endemic for OV infection.

Methods: A case--control study was performed at a referral center during December 2016-December 2017. We collected blood samples and information from CCA patients and identified them as cases. The control group comprised patients who visited a gastrointestinal clinic for colorectal cancer screening colonoscopy. Logistic regression analysis was used to determine risk factors for CCA.

Results: Of 138 participants, O. viverrini infection rate was higher in the case than in the control group (57.1% vs. 36.1%, P = 0.023). Male, O. viverrini infection, smoking, alcohol consumption, and biliary tract diseases were independent risk factors, whereas diabetes, obesity, and cirrhosis were not associated with CCA. By age and sex-adjusted analysis, chronic biliary tract diseases, especially choledochal cysts and smoking, were risk factors for CCA, with adjusted odds ratio (aOR) of 12.7 (95% confidence interval [CI]: 1.4-116.9) and 3.8 (95% CI: 1.3-11.8), respectively, while O. viverrini infection became insignificant risk for CCA (aOR 1.8, 95% CI: 0.8-4.1).

Conclusions: In contrast with endemic areas for O. viverrini infection, chronic biliary tract diseases and smoking are major risk factors, whereas O. viverrini infection has trivial contribution to the development of CCA.