Siriraj Hospital

Minimal residual disease (MRD) detection using liquid biopsy is an emerging tool for risk stratification and monitoring for recurrence in resected early stage NSCLC. There is increasing need for clear guidance on its optimal clinical implementation. The Asian Thoracic Oncology Research Group (ATORG) convened a multidisciplinary panel of 27 experts to develop a consensus statement on the clinical application of circulating tumor DNA-based MRD testing in early stage resected NSCLC, using a structured Delphi methodology. Statements were organized into the following broad thematic domains: assay validity and standardization; harmonization in research and trials; clinical application; challenges in implementation; consensus recommendations; infrastructure for regional MRD adoption; and roadmap for pragmatic trials. A total of 23 position statements were developed, of which all except one achieved strong consensus. The consensus highlighted the need to define minimum analytical performance thresholds for MRD assays, improve standardization of reporting metrics, and clear guidelines for pre-analytical handling. Harmonization of blood sampling time points and terminology across clinical trials is also essential to confirm the prognostic value of MRD assays. Although current MRD assays demonstrate high specificity and positive predictive value, variable sensitivity precludes routine use for adjuvant therapy de-escalation outside clinical trials. Broader access, sustainable funding, ongoing consensus building, and collaborative real-world data generation are also critical to support clinical implementation and adoption. Future clinical trials must account for the distinct biology and changing standards of care associated with different driver genes. These consensus recommendations provide a pragmatic framework to guide the responsible integration of MRD testing into clinical research and practice.

Non-variceal upper gastrointestinal bleeding (NVGIB) represents an urgent medical condition with high mortality. Standard endoscopic therapies (ST) still carry a high rebleeding rate. Novel modalities such as the over-the-scope clip (OTSC) and hemostatic powder (HP) could be promising alternatives, but their efficacy and cost-effectiveness remain to be explored. A network meta-analysis and cost-effectiveness analyses were conducted to compare OTSC vs HP vs ST. Primary endpoints include 30-day rebleeding and 30-day further bleeding. Markov models with a 12-month time horizon were created across 3 different health care settings: the United States, Thailand with Boston Scientific products (TH-BOS), and Thailand with China-manufactured alternatives (TH-CHN). Incremental cost-effectiveness ratio (ICER) was evaluated at a willingness-to-pay of $100,000 per quality-adjusted life year for the US model and THB 150,000 per quality-adjusted life year for the TH-BOS and TH-CHN models. Ten randomized controlled trials with 1,120 patients with NVGIB were included in the network meta-analysis. Lowest 30-day rebleeding was seen in OTSC ( P -score: 0.996), followed by ST (0.296) and HP (0.208). Similarly, OTSC also achieved lowest 30-day further bleeding (0.906), followed by HP (0.570) and ST (0.024). In cost-effective analysis, the US model reported OTSC as a dominant approach compared with HP (ICER: -$314) and ST (-$3,112). In the TH model, OTSC still dominated ST (ICER: -THB 28,423 for TH-BOS and -22,858 for TH-CHN) and was more cost-effective than HP (THB 1,833 for TH-BOS and THB 2,026 for TH-CHN). OTSC was superior to HP and ST in efficacy and cost-effectiveness, favoring its use as a first-line endoscopic hemostasis intervention for NVGIB.

[This corrects the article DOI: 10.1371/journal.pone.0335242.].

Severe dengue, marked by plasma leakage, is often linked to secondary heterotypic dengue virus (DENV) infection. While mast cells and basophils contribute to dengue pathogenesis, the role of anti-DENV IgE remains unclear. Here, we investigated whether anti-DENV IgE promotes FcεRI-dependent basophil activation, potentially contributing to disease severity. Plasma from dengue fever (DF, n = 42) and dengue hemorrhagic fever (DHF, n = 56) patients, collected at febrile, defervescence, and convalescent phases, were analyzed using an in-house IgE-capture ELISA developed to detect antibodies against all four DENV serotypes. Functional assays employed RS-ATL8, a human FcεRI-expressing basophil reporter cell line, to assess IgE-mediated activation following DENV antigen cross-linking. The anti-IgE monoclonal antibody Omalizumab was used to evaluate FcεRI dependence. Anti-DENV IgE was detected in both DF and DHF, peaking at defervescence and significantly higher in DHF. Total IgE was elevated but did not differ between groups. About one-third of anti-DENV-IgE-positive plasma samples induced RS-ATL8 activation upon DENV challenge, an effect abolished by omalizumab. These findings indicate a potential pathogenic role of anti-DENV IgE and provide a rationale for further investigation of IgE-targeted interventions.

Background and Objectives: While non-vitamin K antagonist oral anticoagulants (NOACs) show better renal preservation than warfarin in nonvalvular atrial fibrillation (NVAF) patients, real-world evidence within Asian populations remains limited. This study compared the renal outcomes between NOACs and warfarin in Thai patients with NVAF. Materials and Methods: A retrospective cohort study was conducted among NVAF patients who received either NOACs or warfarin from two university hospitals in Thailand from January 2015 to December 2019. The primary outcome was a ≥30% decline in the estimated glomerular filtration rate (eGFR) with a doubling of the serum creatinine (SCr), while acute kidney injury (AKI) and incidence rate of stroke and systemic embolism event (SEE) were secondary outcomes. All outcomes of each NOAC versus the warfarin group were analyzed using Cox proportional hazards regression. Results: A total of 1456 patients were enrolled. During a follow-up period of 24 months, NOACs were associated with a lower risk of a ≥30% decline in the eGFR than warfarin after inverse probability of treatment weighting (IPTW) and multivariable adjustment (adjusted hazard ratio (aHR) of 0.67, 95% confidence interval [CI] 0.45-1.00, p = 0.050). No significant differences were observed between NOACs and warfarin regarding the doubling of SCr (aHR 0.64, 95% CI 0.24-1.72, p = 0.373) or AKI (aHR 0.69, 95% CI 0.41-1.17, p = 0.169), although a trend toward a lower risk was noted in the NOAC group. Similarly, a trend toward a lower risk of the incidence rate of ischemic stroke and SEE were observed in the NOAC group (aHR 0.49, 95% CI 0.22-1.10, p = 0.084). Conclusions: In real-world data, NOACs may be associated with a lower eGFR decline and lower doubling of SCr and AKI than warfarin. Additionally, NOACs may reduce the risk of ischemic stroke and SEE, supporting their potential benefit over warfarin in both renal and thromboembolic outcomes.

Emerging evidence suggests the development of malaria parasites in the human bone marrow. Whether glucose-6-phosphate dehydrogenase (G6PD) deficiency affects parasite growth in erythroblast has yet to be determined. Here, we examine the invasion and development of Plasmodium falciparum in human erythroblasts of subjects carrying the most common variant of G6PD Viangchan (871G>A) in Southeast Asia. Erythroblasts were generated by differentiation of erythroids of human CD34-positive hematopoietic stem and progenitor cells isolated from peripheral blood. The results showed that P. falciparum parasites invade polychromatic erythroblasts and develop into mature trophozoites. The percentages and stages of parasitized erythroblasts were not different between the subjects with G6PD normal, heterozygous, or hemizygous G6PD Viangchan. While the sample size (n = 6) limited statistical analysis, these preliminary findings suggest that protection against malaria is not observed in this in vitro erythroblast model, supporting further validation in expanded cohorts.