Udon Thani Hospital

Introduction: Metabolic reprogramming, characterized by alterations in metabolic pathways to support energy production and biosynthesis, is a hallmark of cancer and is exemplified by the Warburg effect. This process plays a pivotal role in tumor progression and is evident across multiple cancer types, including colorectal cancer (CRC).Objectives: This study aimed to investigate the expression profiles of metabolism-related genes in CRC cells at early and advanced stages and to validate the expression of selected genes in CRC tissue samples.Methods: Tissues from patients with early and advanced stages of CRC were collected to investigate the expression profiles of metabolism-related genes using microarray analysis. Selected genes were further validated at both the mRNA and protein levels by reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC), respectively. Based on gene profiling from microarray analysis, the metabolism-related gene lactate dehydrogenase A (LDHA) was selected for further investigation. A retrospective evaluation of LDHA expression was conducted using 260 formalin-fixed, paraffin-embedded (FFPE) tissue sections obtained from CRC patients diagnosed between January 2021 and December 2023 at the National Cancer Institute, Thailand.Results: Comparative analysis revealed 758 upregulated and 619 downregulated pathways in early-stage CRC and 630 upregulated and 614 downregulated pathways in advanced-stage CRC. From all of these pathways, altered metabolism-related pathways were predominantly associated with glycolysis, oxidative phosphorylation, and CRC metabolic reprogramming. Among metabolism-related genes, LDHA exhibited significantly elevated expression in CRC tissues compared to adjacent normal tissues, with marked increases at both mRNA and protein levels in early and advanced stages. Statistical analysis demonstrated a significant correlation between LDHA expression and metastasis to lymph nodes as well as distant organs, including the lungs and liver.Conclusions: These findings suggest that metabolic reprogramming is strongly linked to CRC progression and that LDHA may serve as a promising biomarker for CRC screening, prognosis, and therapeutic intervention.

Background: Postoperative pain following laparoscopic cholecystectomy (LC) is complex and influenced by multiple factors. Dexamethasone has been investigated for its potential to reduce postoperative pain and nausea, but its efficacy remains controversial. Materials and Methods: This prospective, randomized, double-blind, controlled trial included 108 patients undergoing elective LC. Patients were randomly assigned to receive either 5 mg dexamethasone (study group) or 1 ml normal saline (control group) 1–2 hours before surgery. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 2, 6, 12, and 24 hours. Data on analgesic use, postoperative nausea and vomiting (PONV), complications, and length of hospital stay were also collected. Statistical analyses were conducted using SPSS, with a p-value < 0.05 considered significant. Results: No statistically significant differences in VAS scores were observed between the dexamethasone and control groups at any time point. Morphine use was similarly low in both groups (2.0 ± 2.9 mg vs. 2.2 ± 3.6 mg, p > 0.05), with about half of the patients requiring no morphine. PONV was less frequent in the dexamethasone group (5.7% vs. 11.1%), but the difference was insignificant. Length of hospital stay was identical in both groups (2.3 ± 0.5 days). Conclusion: Dexamethasone did not significantly reduce postoperative pain or morphine use in LC patients with low baseline pain scores. Although PONV was less frequent in the dexamethasone group, the difference was not statistically significant. Future studies with larger sample sizes and standardized postoperative care are needed to clarify its role in LC pain management.

Introduction Basal cell carcinoma (BCC) is a prevalent form of skin cancer that can be localized or metastatic. Current evidence supports the use of Hedgehog (Hh) pathway inhibitors for locally advanced or metastatic BCC with resistance due to genetic alterations in the Hh pathway. This systematic review evaluated the prevalence of genetic alterations in Hh pathway genes in BCC. Materials and methods We conducted a comprehensive search across four databases: PubMed, EMBASE, SCOPUS and the Cochrane Library. We included articles reporting genetic alterations in patients with locally advanced or metastatic BCC resistant to Hh pathway inhibitors. Results We included three prospective cohort studies encompassing 27 samples, all of which were resistant to vismodegib treatment. The most prevalent genetic mutations in the Hh pathway were in PTCH1, SMO and TP53, with a pooled prevalence of 44.44%. Conclusions This systematic review highlights the prevalence of genetic alterations in the Hh pathway in BCC and offers insights into the mechanisms involved in treatment resistance. Understanding the high resistance rates of these genes may facilitate the development of more effective targeted therapies for BCC.

Despite advancements in thalassaemia care, survival rates and complications vary significantly by genotype. This study assesses survival outcomes and associated complications in patients with thalassaemia in north-eastern Thailand. A longitudinal cohort study from October 2012 to September 2023 involved patients aged ≥10 years (median: 31 years, range: 20-74) attending Srinagarind and Udonthani Hospitals. Cox regression analyses identified predictors of survival and complications. Of 380 enrolled patients, 340 completed follow-up. Over 10 years, 39 patients (11.4%) died, primarily from cardiovascular complications (61.5%), at a median age of 45 years (range: 22-72). Patients were grouped as HbE/β-thalassaemia, HbH/HbHCS with HbE mutation and HbH/HbHCS. Survival at 60 years was lower in HbE/β-thalassaemia (55.9%) and HbH/HbHCS with HbE mutation (58.3%) compared to HbH/HbHCS (79.6%, p = 0.08). Significant predictors of mortality included cardiovascular complications (HR 2.4; 95% CI, 1.01-5.5; p = 0.04), recurrent bacterial infections (HR 7.6; 95% CI, 3.1-18.8; p < 0.001) and elevated ferritin (>2500 ng/mL; HR 2.0; 95% CI, 1.01-3.9; p = 0.04). Cardiovascular complications, recurrent bacterial infections and high ferritin levels significantly influence survival in thalassaemia patients. Deletional alpha-thalassaemia patients had superior survival, while HbE/β-thalassaemia and non-deletional alpha-thalassaemia or co-inherited HbE mutation had poorer outcomes, underscoring the need for genotype-specific management strategies.

Cholangiocarcinoma (CCA) is high in morbidity and mortality rates which may be due to asymptomatic and effective diagnostic methods not available. Therefore, an effective diagnosis is urgently needed. Investigation of plasma circulating miRNA (cir-miRNA) was divided into two phases, including the discovery phase (pooled 10 samples each from three pools in each group) and the validation phase (17, 16, and 35 subjects of healthy control (HC), O. viverrini (OV), and CCA groups, respectively). The plasma from healthy control subjects, O. viverrini infected subjects, and CCA subjects was used. In the discovery phase, plasma was pooled by adding an equal volume of plasma, and cir-miRNA was isolated and analyzed with the nCounter® SPRINT Profiler. The significantly different cir-miRNAs were selected for the validation phase. In the validation phase, cir-miRNA was isolated and analyzed using real time-quantitative polymerase chain reaction (RT-qPCR). Subsequently, statistical analysis was conducted, and diagnostic parameters were calculated. Differential plasma cir-miRNA profile showed at least three candidates including miR-423-5p, miR-93-5p, and miR-4532 as potential biomarkers. From validation of these cir-miRNAs by RT-qPCR, the result showed that the satisfied sensitivity and specificity to differential CCA group from HC and OV group was obtained from miR-4532 (P < 0.05) while miR-423-5p and miR-93-5p can be used for differential CCA from OV and HC group (P < 0.05) with high specificity but limited the sensitivity. In conclusion, candidate cir-miRNAs have been identified as potential biomarkers including miR-423-5p, miR-93-5p and miR-4532. Screening by miR-4532 and confirmed with miR-423-5p, miR-93-5p were suggested for differential CCA patients in the endemic area of O. viverrini.

Objective This study investigated the utilization of nebulized budesonide for acute asthma and COPD exacerbations as well as for maintenance therapy in adults. Data Sources We conducted a search on PubMed for nebulized budesonide treatment. Selected Studies Selecting all English-language papers that utilize Mesh phrases "asthma," "COPD," "budesonide," "nebulized," "adult," "exacerbation," and "maintenance" without temporal restrictions, and narrowing down to clinical research such as RCTs, observational studies, and real-world studies. Results Analysis of 25 studies was conducted to assess the effectiveness of nebulized budesonide in asthma (n = 10) and COPD (n = 15). The panel in Thailand recommended incorporating nebulized budesonide as an additional or alternative treatment option to the standard of care and systemic corticosteroids (SCS) based on the findings. Conclusion Nebulized budesonide is effective and well-tolerated in treating asthma and COPD, with less systemic adverse effects compared to systemic corticosteroids. High-dose nebulized budesonide can enhance clinical outcomes for severe and mild exacerbations with slow systemic corticosteroid response. Nebulized budesonide can substitute systemic corticosteroids in some situations.

Abstract IntroductionMost cholangiocarcinoma (CCA) patients present with late stage of disease because of the difficulty to diagnosis at an early stage, resulting in poor survival of CCA patients. The Cholangiocarcinoma Screening and Care Program showed that ultrasound screening was an effective tool for detecting early stage CCA. This study aims to evaluate the survival outcome of patients diagnosed by ultrasound screening (US) compared to walk-in symptomatic patients.Methods5-year survival rates (5-YSR) and median survival time (MST) of CCA were calculated using Log-Rank test. Multivariate analyses were performed for significant factors from univariate analyses.ResultsA total of 711 histologically proven CCA cases were examined including ultrasound screening and walk-in groups. The screening group having 5-YSR was 53.9%, and MST was of 67.2 months, while walk-in group, the 5-YSR was 21.9% and MST was 15.6 months (p&lt;0.001). In addition, multivariate analyses revealed that screening program was an independent factor to predict a good outcome of CCA patients when compared with walk-in group (p= 0.014).ConclusionUS is an effective tool for detecting early stage CCA leading to improve clinical outcome of CCA patients. Practically, US should be considered as a first tool for screening CCA in risk populations.Author SummaryMost cholangiocarcinoma (CCA) patients in Thailand have poor survival due to late-stage detection and patients walk-in to hospital with any symptoms. This study purpose to evaluate the survival outcome of CCA patients diagnosed by ultrasound screening (US). We found that US provided early stage and improved survival of CCA patients.