Nakornthon Hospital

Background: Intrahepatic cholangiocarcinoma (ICC), a biliary tract cancer, is a major cause of primary liver cancers. It is recognised as a deadly gastrointestinal cancer with a poor disease prognosis due to the lack of effective biomarkers for early diagnosis and effective treatment. Recently, research has indicated that Atractylodes lancea (Thunb.) DC. (AL) may offer greater clinical benefits for patients with advanced-stage ICC when compared with standard supportive care. Aim: This study investigated the relationships between clinical efficacy and pharmacokinetic parameters of serum bioactivity of AL and its active constituent, “atractylodin,” and determined the therapeutic ranges. Methods: A retrospective study was conducted as part of a single-centre, open-label, randomised controlled Phase 2A trial, which took place over four months at Sakhon Nakhon Hospital, Sakhon Nakhon Province, Thailand. Patients with advanced-stage ICC were randomised to three groups. Group 1 received daily doses of 1,000 mg of standardised extract of the capsule formulation of AL (CMC-AL) for 90 days. Group 2 received daily doses of 1,000 mg of CMC-AL for 14 days, followed by 1,500 mg for 14 days and 2,000 mg for 62 days. Group 3 (the control group) received palliative care. The Cox proportional hazard model and the Receiver Operating Characteristic (ROC) curve were applied to determine the cut-off values of AUC0-inf, Cmax, and Cavg associated with therapeutic outcomes. Number-needed-to-be-treated (NNT) and relative risk (RR) were also applied to determine potential predictors. Mann-Whitney U test and Wilcoxon signed-rank test were used for non-normally distributed data. Paired t-tests and unpaired t-tests were applied to analyse normally distributed quantitative variables, while chi-square analysis was used for qualitative variables. A significance level of α = 0.05 was used. Results: The AUC0-inf of total AL bioactivity of> 96.71 µg*h/ml was identified as a promising predictor of disease prognosis, specifically progression-free survival (PFS) and disease control rate (DCR). Cmax of total AL bioactivity of>21.42 was identified as a predictor of the prognosis of death. The therapeutic range of total AL bioactivity for PFS and DCR is 14.48-65.8 µg/ml, and for overall survival is 10.97-65.8 µg/ml. Conclusions: The predictors of ICC disease prognosis were established based on the pharmacokinetics of total AL bioactivity. The information could be exploited to improve the clinical efficacy of AL in patients with advanced-stage ICC. These predictors will be validated in a phase 2B clinical study. Further study is needed to validate the model externally with a larger sample size to confirm its accuracy and applicability.

A 35-year-old female presented with progressive swelling and necrosis of the left cheek after sustaining maxillofacial trauma due to a motorcycle accident. Intravenous antibiotic was given, and emergency debridement was performed. Tissue culture showed Aspergillus flavus complex, Acinetobacter baumannii, and coagulase-negative Staphylococci, so her antibiotics were adjusted to amphotericin B, cefoperazone-sulbactam, and fosfomycin. After the infection was improved, her left hemifacial defect was covered with a skin graft. One month later, she developed a gradually diminishing mouth opening and progressive swelling of her left eyelid that completely obscured her vision. Left temporomandibular joint (TMJ) ankylosis and eyelid lymphedema were diagnosed. Preoperative investigations were performed, and the staged surgical reconstruction strategy was developed. After removing the scar tissues and releasing ankylosis, reconstruction was performed using an anterolateral thigh (ALT) free flap, which directly contacted the left eyelid to facilitate lymphatic drainage. Early postsurgical mouth-opening rehabilitation was introduced. Her swollen left eyelids significantly improved thereafter, and the patient could open her mouth freely with an interincisal gap of 3.5 cm. The second operation involved contouring of the flap, smile reconstruction with a Tensor Fascia Lata sling, and partial resection of the left eyelids to reestablish her vision. The patient can now eat without difficulty, and she has favorably reintegrated into society with good mental health.

To describe a proportion of uveitis and to analyse differences between immune-related uveitis and infectious uveitis groups. A retrospective study of 458 uveitis patients were categorized into immune-related uveitis, infectious uveitis, masquerade, and undetermined groups. The pattern of inflammation was described. Subgroup analysis was performed to compare pattern differences between immune-related uveitis and infectious uveitis groups. The most common location of inflammation was the anterior eye segment. Vogt-Koyanagi-Harada disease was the most common identifiable cause. From multivariate analysis, variables found to be significantly different between immune-related uveitis group and infectious uveitis group were age of onset, presence of systemic autoimmune diseases, HIV infection, and laterality. Idiopathic anterior uveitis was the most prevalent diagnosis. Vogt-Koyanagi-Harada disease was the most common identifiable uveitis. Most immune-related uveitis patients were young and presented with chronic bilateral panuveitis, with most patients in the infectious uveitis group presenting with chronic unilateral posterior uveitis.

Beta-thalassemia intermediate patients show a remarkable clinical heterogeneity. We examined the phenotypic diversity of 950 beta-thalassemia/Hb E patients in an attempt to construct a system for classifying disease severity. A novel scoring system based on six independent parameters, hemoglobin level, age at disease presentation, age at receiving first blood transfusion, requirement for transfusion, spleen size, and growth and development, was able to separate patients into three distinctive severity categories: mild, moderate, and severe courses. This system, therefore, can increase the accuracy of studies of genotype-phenotype interactions and facilitate decisions for appropriate patient management.