Chonburi Hospital

BACKGROUND:Cholangiocarcinoma (CCA) is a significant problem in Southeast Asia, particularly Thailand. Changes in the expression of microRNAs (miRNA), is one of the mechanisms associated with the pathogenesis and progression of cancer. OBJECTIVE:In the present study, serum miRNA expression from advanced-stage intrahepatic CCA patients was investigated using the high-throughput technique (Nanostring Ncounter© technology). METHODS:Twenty-four intrahepatic CCA patients and eight healthy subjects were enrolled in this study. The CCA group was subgrouped according to disease progression into non-metastatic CCA and metastatic CCA. RESULTS:Of the 803 miRNAs, expression of 239 miRNAs was significantly different among the three groups (p < 0.001). Among them, miR-302d-3p showed the most significant expression (p < 9.02x10-7, FDR: 7.25x10-4), with upregulation in patients with metastatic CCA compared to non-metastic CCA and healthy groups. Fold change analysis revealed that miR-320e expression was the most significantly upregulated across all three groups (p < 0.001). Additionally, the expression levels of miR-223-3p, miR-23a-3p, and miR-302d-3p were significantly increased in patients with both metastatic and non-metastatic CCA compared to healthy controls. Several miRNAs were significantly downregulated, among them, miR-16-5p and miR-451a showed significant downregulation in metastatic and non-metastatic CCA compared with healthy groups. CONCLUSIONS:These findings indicate that a panel of circulating miRNAs may serve as a useful tool for the diagnosis and prognosis of intrahepatic cholangiocarcinoma, warranting further validation in larger cohorts. Additionally, the accuracy of diagnostic tests may be improved by increasing the sample size and including diverse clinical subgroups to enhance the robustness and generalizability of the results.

Vibrio vulnificus is a rapidly progressive, life-threatening pathogen endemic to coastal environments, yet clinical data from Southeast Asia remain limited despite substantial environmental contamination. We conducted a 6.5-year multicenter retrospective cohort study at two tertiary-care hospitals in Eastern Thailand to describe clinical characteristics, antimicrobial susceptibility, treatment practices, and factors associated with early mortality among adults with culture-confirmed V. vulnificus infection. Forty-nine patients were identified, most of whom presented with severe illness; 83.7% had bacteremia, 61.2% required mechanical ventilation, and 75.5% required vasopressor support. Skin and soft tissue infection was the most common syndrome, with necrotizing soft-tissue infection accounting for approximately two-thirds of cases. Antimicrobial susceptibility was uniformly high for fluoroquinolones, carbapenems, and third-generation cephalosporins, although susceptibility to doxycycline was unavailable. Despite high rates of empirical antimicrobial therapy (91.8%), mortality remained substantially high: 42.9% died within 48 hours, and 7-day mortality reached 49.0%. In multivariable analysis, elevated serum lactate and lack of surgical treatment were associated with early mortality, while chronic alcohol use and vasopressor requirement showed nonsignificant trends toward increased mortality. These findings highlight the fulminant nature of V. vulnificus infection and the narrow therapeutic window for effective intervention. In settings where necrotizing soft-tissue infection is common and patients present with advanced disease, early recognition, aggressive resuscitation, timely surgical management, and prompt initiation of antimicrobial therapy remain essential. This study provides region-specific epidemiologic and clinical insights that may inform clinical management and public health strategies in coastal communities at risk.

Objective: Burnout syndrome is a critical concern among medical students, contributing to fatigue, reduced academic performance, and negative health outcomes. The educational environment is considered a key factor influencing burnout. This study aimed to assess medical students’ perceptions of their educational environment and its association with burnout syndrome. Material and Methods: A cross-sectional study was conducted at Chonburi Hospital, Thailand, from November to December 2023, involving 106 clinical medical students. Burnout syndrome was measured using the Maslach Burnout Inventory (MBI), and perceptions of the educational environment were evaluated using the Dundee Ready Education Environment Measure (DREEM). Data were analyzed using descriptive statistics, Pearson’s correlation, and regression analyses. Results: The mean DREEM score was 125.17±12.80, indicating an overall positive perception of the educational environment. The prevalence of burnout syndrome among participants was 50.94%. DREEM scores were significantly negatively correlated with burnout (r=-0.504, p-value<0.001), emotional exhaustion (r=-0.427, p-value<0.001), and depersonalization (r=-0.395, p-value<0.001). Subscales such as the Students’ Perception of Learning (SPL), Students’ Academic Self-Perception (SAP), Students’ Perception of Atmosphere (SPA), and Students’ Social Self-Perception (SSP) were also significantly negatively associated with burnout (all p-value<0.001). Multivariate analysis identified SPA and SSP as significantly associated factors of burnout. Conclusion: Medical students’ perceptions of the educational atmosphere and social support are significantly associated with burnout syndrome. Targeted efforts to improve these aspects of the educational environment may be effective in reducing burnout among clinical medical students.

The rapid integration of artificial intelligence (AI) into orthodontics raises important questions about which methods are being applied, how they are being validated, and what barriers remain to clinical implementation. This study was conducted to inform orthodontic practitioners, researchers, and educators about the possibilities that AI could bring to orthodontics and to emphasise the need for increased collaboration among experts. The literature search was performed across four databases: PubMed, Scopus, Embase, ProQuest Dissertations & Theses Global (PQDT). All types of clinical studies involving the design and implementation of AI in all aspects of orthodontics published from January 2000 to August 2024 were included in this review. The search identified 1917 articles from the four databases (PubMed = 455, Scopus = 668, Embase = 554, and PQDT = 240). After 566 duplicates were removed, 1351 titles and abstracts were screened. Finally, 110 full text articles were included in this scoping review focusing on the following areas: diagnosis, treatment planning, practice management, evaluation of orthodontic devices, and orthodontic education. A thorough search across databases and relevant sources was conducted to gather a comprehensive understanding of how AI impacted orthodontics research. This scoping review carefully examined the existing literature on the applications of AI across various aspects of orthodontics. The findings provide insights into the utilisation of AI in this field, identify challenges faced when integrating AI-driven methods and uncover gaps in the knowledge that require further research.

Desbuquois dysplasia Type 1 (DBQD1) is an extremely rare autosomal recessive skeletal dysplasia characterized by severe short stature, joint laxity, distinct facial dysmorphism, and advanced carpotarsal ossification. Here, we report the first Thai patient diagnosed with classical lethal DBQD1. A 38-week male infant presented with multiple dysmorphic features, micromelia, joint dislocations, narrow thorax, and respiratory insufficiency leading to death at seven months of age. Radiographic findings revealed hallmark features, including a "Swedish key" appearance of the proximal femur and characteristic hand and foot anomalies. Whole exome sequencing identified compound heterozygous missense variants of c.505G > A (p.Asp169Asn) and c.1028G > T (p.Gly343Val) in the CANT1 gene. The 3D structural modeling revealed that both variants reside in conserved regions, with predicted effects on calcium binding and protein folding, resulting in impaired enzymatic function and proteoglycan synthesis. Genetic counseling was provided to the family, and prenatal or preimplantation genetic diagnosis was discussed as an option for future pregnancies. Our report expands the mutational spectrum of the CANT1 gene, contributing to a better understanding of DBQD1's clinical and molecular presentation, particularly in Southeast Asian populations.