Medicine and Health Sciences Commons^™

Transmembrane Domain-Driven Pd-1 Dimers Mediate T Cell Inhibition, Elliot A Philips, Jia Liu, Audun Kvalvaag, Alexander M Mørch, Anna S Tocheva, Charles Ng, Hong Liang, Ian M Ahearn, Ruimin Pan, Christina C Luo, Alexander Leithner, Zhihua Qin, Yong Zhou, Antonio Garcia-España, Adam Mor, Dan R Littman, Michael L Dustin, Jun Wang, Xiang-Peng Kong

Faculty, Staff and Student Publications

Programmed cell death-1 (PD-1) is a potent immune checkpoint receptor on T lymphocytes. Upon engagement by its ligands, PD-L1 or PD-L2, PD-1 inhibits T cell activation and can promote immune tolerance. Antagonism of PD-1 signaling has proven effective in cancer immunotherapy, and conversely, agonists of the receptor may have a role in treating autoimmune disease. Some immune receptors function as dimers, but PD-1 has been considered monomeric. Here, we show that PD-1 and its ligands form dimers as a consequence of transmembrane domain interactions and that propensity for dimerization correlates with the ability of PD-1 to inhibit immune responses, antitumor …

A Structured, Journal-Led Peer-Review Mentoring Program Enhances Peer Review Training, Ariel Maia Lyons-Warren, Whitley W Aamodt, Kathleen M Pieper, Roy E Strowd

Faculty, Staff and Students Publications

BACKGROUND: Peer review is essential to the advancement of knowledge. However, training on how to conduct peer review is limited, unorganized, and not well studied. Thus, we sought to determine if a structured mentored peer-review program improved peer review training as measured by multiple quantitative and qualitative assessments.

METHODS: This pre-post intervention study enrolled 55 mentees across 5 cohorts from 2020 to 2023. Each cohort completed pre-program evaluations, participated in 2 mentored reviews, and completed post-program evaluations over 6 months. Mentors and mentees completed pre-program demographic and review experience questionnaires. Outcome measures included (1) total and sub-scores on the modified …

Antioxidant Responses And Phytochemical Accumulation In Raphanus Species Sprouts Through Elicitors And Predictive Models Under High Temperature Stress, María-Trinidad Toro, Roberto Fustos-Toribio, Jaime Ortiz, José Becerra, Nelson Zapata, María Dolores López-Belchí

Faculty, Staff and Students Publications

Crop production is being impacted by higher temperatures, which can decrease food yield and pose a threat to human nutrition. In the current study, edible and wild radish sprouts were exposed to elevated growth temperatures along with the exogenous application of various elicitors to activate defense mechanisms. Developmental traits, oxidative damage, glucosinolate and anthocyanin content, and antioxidant capacity were evaluated alongside the development of a predictive model. A combination of four elicitors (citric acid, methyl jasmonate—MeJa, chitosan, and K2SO4) and high temperatures were applied. The accumulation of bioactives was significantly enhanced through the application of two elicitors, K2SO4 and methyl …

Isoform Alterations In The Ubiquitination Machinery Impacting Gastrointestinal Malignancies, Srimathi Kasturirangan, Derek Nancarrow, Ayush Shah, Kiran Lagisetty, Theodore Lawrence, David Beer, Dipankar Ray

Department of Medicine Faculty Papers

The advancement of RNAseq and isoform-specific expression platforms has led to the understanding that isoform changes can alter molecular signaling to promote tumorigenesis. An active area in cancer research is uncovering the roles of ubiquitination on spliceosome assembly contributing to transcript diversity and expression of alternative isoforms. However, the effects of isoform changes on functionality of ubiquitination machineries (E1, E2, E3, E4, and deubiquitinating (DUB) enzymes) influencing onco- and tumor suppressor protein stabilities is currently understudied. Characterizing these changes could be instrumental in improving cancer outcomes via the identification of novel biomarkers and targetable signaling pathways. In this review, we …

A Case Report : Rosai-Dorfman Disease Of The Breast, Jenjeera Prueksadee

Chulalongkorn Medical Journal

Abstract

A case report of Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) of the breast is one of the rare diseases, characterized by benign proliferative disorder of histiocyte. Most occur within lymph nodes whereas the rest involve extranodal sites. Breast involvement is considered extremely rare but considerable because of radiological findings simulating breast cancer. We report the case of a 59-year-old Thai woman who underwent screening mammography. Her biopsy resulted in abnormal histiocytes with S-100 protein expression, some of them with emperipolesis (lymphophagocytosis). Recognition of Rosai-Dorfman disease leads to correct diagnosis and further appropriate proper treatment strategy.

Primary Lung And Pleural Malignancies In Children: Imaging Of A Case Series, Teerasak Phewplung, Tanitha Phruksahirun

Chulalongkorn Medical Journal

Early diagnosis of primary lung and pleural malignancies is a challenge because it is extremely rare in children. The patient often presents with metastatic disease and non-neoplastic lesions. Clinical detection and imaging studies are nonspecific findings and may be indistinguishable from other lung malformations, resulting in a delay in diagnosis and treatment and an increase in tumor morbidity and mortality.

We present four cases of children whose clinical presentation and initial imaging had suspicious abnormalities and were eventually revealed to be primary lung and pleural malignancies. The literature on primary lung and pleural malignancies is also reviewed.

Comparison Study Of Endoscopic-Guided Versus Electromyography-Guided Botulinum Toxin Injection Treatments In Adductor Spasmodic Dysphonia, Manintorn Praditthum, Premsuda Sombuntham

Chulalongkorn Medical Journal

Background: Electromyography (EMG)-guided botulinum injection is recommended in clinical practice guideline for spasmodic dysphonia. However, other alternative techniques have been practiced in absence of EMG machine. Comparison of techniques is limited in the literatures.

Objective: This pilot study aims to compare the effectiveness of treatment between the EMG-guided technique and the endoscopic-guided technique in adductor spasmodic dysphonia.

Method: Five patients who were diagnosed with Adductor spasmodic dysphonia (AdSD) were enrolled and then randomized into 2 groups. Patient data (before and after treatment) were collected. The outcome measurement included voice analysis, voice handicap index (VHI), duration aspiration, duration of breathiness, mean …

The Effect Of Fluid Replacement During 60 Minutes Of Moderate-Intensity Running On Splanchnic Blood Flow., Warot Rangsimahariwong, Onanong Kulaputana, Tanat Tabtieang, Sompol Sanguanrungsirikul, Natthaya Chuaypen

Chulalongkorn Medical Journal

Background: Exercise-induced splanchnic hypoperfusion has been linked to impaired gastrointestinal function and associated symptoms. The effectiveness of fluid replacement in protecting against splanchnic hypoperfusion is less clear.

Objectives: To evaluate the effects of fluid replacement during 60 minutes of moderate-intensity running on the splanchnic blood flow (SBF) using non-invasive Doppler ultrasound.

Methods: Seven healthy men aged 35 ± 7 years participated in two 60-minute running trials at moderate-intensity: the first trial with no water replacement (NW) followed by the second trial with ambient temperature water (28-29oC) replacement (AW). A minimum interval of 48 hours was introduced for the washout period …

Does Asymptomatic Generalized Joint Hypermobility Influence Musculotendinous Extensibility And Knee Joint Proprioception?, Pawan Chaiparinya, Sujitra Boonyong, Chitanongk Gaogasigam

Chulalongkorn Medical Journal

Background: It is unclear whether generalized joint hypermobility (GJH) influences the musculotendinous unit (MTU) extensibility or proprioception of the knee joint in individuals with asymptomatic GJH.

Objectives: To compare the quadriceps and hamstring MTU length as well as knee joint force sense (FS) and joint position sense (JPS) between individuals with asymptomatic GJH and non-GJH controls.

Methods: Thirty-two female subjects were recruited, with 16 subjects in the GJH and non-GJH groups. The angles measured from modified prone knee bend (mPKB) and straight leg raising (SLR) tests were used to identify the quadriceps and hamstrings MTU extensibility using photographic-based angle measurements. …

The Electrical Conductivity Of 24-H Urine Is Decreased In Patients With Calcium Oxalate Urolithiasis., Kamonchat Boonkam

Chulalongkorn Medical Journal

Background: Electrical conductivity (EC) of urine depends on the ionic substance-to-water ratio. Calcium oxalate (CaOx) is the most common type of urinary stone, and its formation is driven by decreased urine volume, increased lithogenic substances, and decreased stone inhibitory compounds (specifically citrate). Low urinary citrate excretion (hypocitraturia) is a prominent risk factor in Thai urolithiasis patients.

Objective: To measure the urinary EC, urinary calcium, and urine specific gravity in CaOx stone patients compared with non-stone forming (NSF) subjects.

Method: The urinary EC was measured in 24-h urine samples obtained from 42 CaOx stone patients and 121 NSF subjects. Urinary calcium …

Pediatric Appendicitis Or Not? A Retrospective Cohort Study From A Single Institution - Our Management And Factors Determining The Disease, Nimmita Srisan, Teerasak Phewplung, Katawaetee Decharun, Prapapan Rajatapiti, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Purpose: The aims were to assess our treatment guidelines and to determine factors in differentiating children with acute appendicitis from other diseases.

Methods: Pediatric surgery consultations for suspected appendicitis from October 2019 to October 2021 was retrospectively studied. The treatment guidelines of children with suspected appendicitis were elucidated. Moreover, factors identifying the diagnosis of appendicitis were analyzed using multi-variate logistic regression.

Results: Ninety-one children were consulted for suspected appendicitis. Forty-one children (45.1%) were promptly successfully treated without observation or ultrasonography, except one negative appendectomy (2.4%). The other 50 children (54.9%), showed equivocal clinical symptoms and signs, requiring further management either …

Analysis Of Breast Mri Performed On Patients With Axillary Nodal Metastasis And Negative Mammogram And Ultrasound, Pakpawee Pichayakul, Palita Hansakul

Chulalongkorn Medical Journal

Background: Occult breast cancer is a rare type of breast cancer which magnetic resonance imaging (MRI) has an immense role to confirm diagnosis and disclose non-demonstrable finding on initial modality.

Objective: To analysis breast MRI findings in patients with axillary nodal metastasis and negative mammogram and ultrasound, and retrospective review of the initial mammography and second-look ultrasound.

Methods: From January 2010 to January 2023, women who diagnosed occult breast cancer by presenting metastatic axillary lymph node on pathological report with negative mammography and ultrasonography, underwent breast MRI to identify occult breast carcinoma. Their breast MRI were retrospectively reviewed …

Postoperative Intussusception After Congenital Diaphragmatic Hernia Repair: A Report Of 2 Cases, Saralee Matanaromyakit, Nimmita Srisan, Somboon Roekwibunsi, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Background: A postoperative intestinal intussusception is one of complications after abdominal surgery. However current evidence of intussusception after congenital diaphragmatic repair still received little attention. Previous literature reported possible cause from atony of the herniated bowel that could be a functional leading point of intussusception.

Case report: A 7-month-old female with history of respiratory distress in newborn, with no obvious abdominal signs was scheduled for diaphragmatic hernia repair. The chest X ray showed the presence of large soft tissue density at the posterior aspect of the left hemothorax. She early came to OPD due to many episodes of non-bilious vomiting …

Exonic Variants Of Gpihbp1 Gene In Thai Subjects With Severe Hypertriglyceridemia, Wanee Plengpanich

Chulalongkorn Medical Journal

Background: Hypertriglyceridemia (HTG) is one of the risk factors for cardiovascular disease and acute pancreatitis. It is associated with genetic variations in various genes involved in triglyceride metabolism. Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) encodes a membrane protein involved in an intravascular triglyceride hydrolysis. Objective: The purpose of this study was to examine the genetic variants in the exons of GPIHBP1 gene in Thai subjects with severe HTG. Methods: All 4 exons of the GPIHBP1 gene were sequenced in 101 Thai subjects with severe HTG. All subjects had triglyceride levels e” 10 mmol/L or 886 mg/dL. Subjects with normolipidemia (n …

Association Of Pnpla3, Tm6sf2 And Hsd17b13 Variants With Nafld Risk In Hiv And Non-Hiv Individuals, Varis Ruamviboonsuk

Chulalongkorn Medical Journal

Background: Non-alcoholic fatty liver disease (NAFLD) has multiple risk factors, including genetic risk factors. Patients with certain genetic variants are more susceptible to the disease. People living with human immunodeficiency virus (PLWH) have higher prevalence of NAFLD compared to those without human immunodeficiency virus (HIV) infection. However, the evidence on genetic factors in PLWH with NAFLD is limited. Objectives: This study aimed to investigate whether carriers of PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs6834314 had association with the risk of NAFLD, and whether PLWH with NAFLD also had similar genetic risk factors as those with NAFLD alone. Methods: These single …

Anopheles Population Belonging To Barbirostris Complex In Narathiwat Province And Its Vectorial Status For Human And Simian Malaria, Surasuk Yanmanee, Sunee Seethamchai, Napaporn Kuamsab, Taweesak Tia, Somchai Jongwutiwes, Chaturong Putaporntip

Chulalongkorn Medical Journal

Background: Besides well-perceived species of Plasmodium infecting humans, at least four simian malaria species including P. knowlesi, P. cynomolgi, P. inui and P. fieldi have been incriminated in human infections in Thailand. The vectors of simian malaria in this country have been recently identified to be Anopheles latens and An. introlatus.

Objectives: To address whether mosquitoes in Barbirostris complex in Narathiwat Province could vector simian malaria and to analyze species distribution of Anopheles in this complex from the sampled population.

Methods: A total of 115 mosquitoes from Sukhirin and Waeng Districts in Narathiwat Province morphologically assigned to …

Attitudes Toward End-Of-Life Care And Advance Directives: A Prospective Survey In A Family Medicine Clinic, Bangkok, Thailand, Basmon Manomaipiboon

Chulalongkorn Medical Journal

Background: Advance directives (ADs) have long been legalized and advocated, still few patients complete ADs in Thailand. In our setting, advance directive information will be provided to interested patients and palliative care patients. Objectives: This study examined the attitude toward end-of-life care and ADs, the prevalence of ADs completion and identified the factors associated with advance care planning among patients who attended a family medicine clinic, Faculty of Medicine, Vajira Hospital, Navamindhradhiraj university, Bangkok, Thailand. Methods: A total of 300 subjects completed a self-administered structured questionnaire, including sociodemographic factors, individuals’ health status, healthcare experiences, and other factors influencing advance care …

Factors Related To Positive Airway Pressure Adherence In Patients With Obstructive Sleep Apnea At King Chulalongkorn Memorial Hospital, Puntarik Srisawart

Chulalongkorn Medical Journal

Background: Positive airway pressure (PAPs) is a standard and efficacious treatment for obstructive sleep apnea (OSA). Poor adherence could lead to impaired daytime performance, increasing risk of traffic accidents, hypertension, cardiovascular events, and neuropsychological disturbances. Previous studies reported rates and factors influencing PAPs adherence, but the data in Thailand was still lacking.

Objectives: To investigate the rate of PAPs adherence, the prevalence of depressive and anxiety symptoms, and the factors associated with PAPs adherence among patients with OSA.

Methods: This is a cross-sectional descriptive study that was conducted during June 2021 to September 2022. The data was collected from patients …

Effect Of Exergame Training With Motor Imagery On Balance, Cognitive Functions And Motor Learning In Healthy Adults: Preliminary Study, Kanokwan Srisupornkornkool

Chulalongkorn Medical Journal

Background: Previous studies reported that exergames could improve balance and cognitive function. Also, motor imagery (MI) applied with actual movements cloud increase balance control. If both are combined, balance and cognitive function may increase more.

Objectives: To investigate the effect of exergame training with MI on balance, cognitive function and motor learning in healthy adults.

Methods: Twelve participants were divided into 2 groups, the exergame training (ET, n = 6) and the exergame with MI training (ET + MI, n = 6). Both groups practiced exergame for 20 minutes. Then, the ET + MI group imagined exergame for 10 minutes. …

The Association Between Medication Use And Peri-Operative Delirium In Older Hip Fracture Adult Patients At King Chulalongkorn Memorial Hospital, Krittin Wannarong, Yanin Thipakorn, Jirada Prasartpornsirichoke, Warong Sitthisarunkul, Chumpol Suraphanphairoj, Paul Thisayakorn

Chulalongkorn Medical Journal

Background: Delirium is a common adverse consequence in the hip fracture population. Many medications can affect the emergence of the perioperative delirium but the data in older hip fracture patients is lacking.

Objective: To investigate the association between the type and amount of the selected medication classes and the occurrence of perioperative delirium in older hip fracture patients.

Methods: This is a cross-sectional study which collected data from patients aged ≥ 65 years who underwent hip surgery at King Chulalongkorn Memorial Hospital. The Delirium Rating Scale–Revised-98-Thai version (DRS-R-98-T) was used to assess the delirium one day before the surgery, and …

Extent Of Some Heavy Metals In Cough Syrups Abused In Sokoto, Nigeria, Ai Umar, Yusuf Sarkingobir, Aminu Faruk, Malami Dikko, Hajara W. Adamu

Chulalongkorn Medical Journal

Background: Cough syrup abuse is an emerging public health trend in our society that need to be tackle due to the manifestation of harmful biological effects on users. Determination of the possible embedded constituents in drugs such as heavy metals will guide stakeholders and the public for taking right measures in curtailing the trend.

Objective: This study was carried out with the purpose of assessing the levels of heavy metals in commonly used cough syrup in Sokoto, Nigeria.

Methods: A survey using atomic absorption spectroscopy was employed for the study and the descriptive statistics were done.

Results: Levels of essential …

Pulmonary Rehabilitation For Critically Ill Elderly Patients With Covid-19 In Thailand: A Report Of Two Cases, Thitapa Issaragraisin, Jirapa Champaiboon

Chulalongkorn Medical Journal

The vast majority of patients exposed to coronavirus (COVID-19) were likely to face complications during their recovery from coronavirus. The first case was an old Thai woman presented with severe COVID-19 pneumonia. The other was an old Thai man presented with COVID-19 with complications such as acute respiratory distress syndrome, hyperglycemia, thrombocytopenia, right tension pneumothorax with recurrent pneumothorax and monoparesis. These two cases presented the role of physical therapy for critically ill elderly patients with chest complications from COVID-19.

The Stability Of Diazepam In Authentic Blood Samples From Thai Postmortem Cases, Peerayuht Phuangphung

Chulalongkorn Medical Journal

Background: Diazepam is a common drug detected in Thai postmortem cases. The stability of diazepam in blood was previously studied using spiked blood samples. However, there is no available data for stability in authentic postmortem blood samples.

Objectives: This study aims to determine the stability of diazepam in authentic postmortem blood samples.

Methods: Postmortem blood samples were obtained from the cadavers of Thai people who were sent for medico-legal autopsies at the Department of Forensic Medicine, Siriraj Hospital, Mahidol University. Blood samples were analyzed for diazepam and nordiazepam within one week after sample reception (initial concentrations: day_0). …

Resilience And Related Factors Among Volunteers Of Thai Red Cross Society At King Chulalongkorn Memorial Hospital, Kanyaphak Nakalekha

Chulalongkorn Medical Journal

Background: Volunteers of the Thai Red Cross Society have contributed valuable helps to the Thai Red Cross Society and King Chulalongkorn Memorial Hospital. However, there was still a lack of studies on mental health aspects in this group, especially positive psychological resources, i.e., resilience.

Objectives: To examine the levels of resilience quotient (RQ) and associated factors among volunteers of the Thai Red Cross Society at King Chulalongkorn Memorial Hospital.

Methods: We recruited 287 subjects who were currently working as volunteers of the Thai Red Cross Society during 2021 - 2022. The subjects were asked to complete five questionnaires including personal …

The Symptoms And Management Of Children With Attention-Deficit/Hyperactivity Disorder During Covid-19 Pandemic At The Child And Adolescent Psychiatry Clinic, King Chulalongkorn Memorial Hospital, Nuttorn Pityaratstian

Chulalongkorn Medical Journal

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused abrupt changes in almost everybody’s life, particularly children. Children and adolescents with attention-deficit hyperactivity disorder (ADHD) have difficulties in many aspects in lives and may have worsening of the symptoms during the pandemic.

Objectives: This cross-sectional descriptive study aimed to investigate the changes of the ADHD symptoms and managements of children with ADHD during the first lockdown and after-lockdown period.

Methods: Parent-reported questionnaires i.e. the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV) and a demographic questionnaire, were applied to collect data from 109 children with ADHD aged between 4 -18 years …

Diagnosis And Treatment Of Helicobacter Pylori, Erin Raspet

Pacific Journal of Health

Helicobacter pylori is a widespread infectious disease most commonly associated with gastritis, peptic ulcer disease, and gastric cancer. The ability of this organism to influence immune function has been associated with a proinflammatory state that has been associated with several other conditions that can lead to significant mortality and morbidity. Treatment is possible with antibiotic regimens, however, increasing resistance requires treatment be informed by susceptibility information followed by a test of cure to ensure eradication of the infection. Given the global burden of this infection, it is important for providers to appropriately identify, diagnosis, and treat this condition to reduce …

U.S. Military Veteran Identity And Civilian Adjustment, Darren A. Sosa

Pacific Journal of Health

U.S. military veterans transitioning back into the civilian sector often experience a variety of challenges and need to readjust into non-military environments. In order to examine the psychological challenges involved in the transition and readjustment processes among U. S. active military veterans, a qualitative study was conducted. For 6 months, data was collected from veterans in California, Nevada, Texas, Florida, and New York. Following an IRB approval, semi-structured open-ended self-developed interviews were developed and conducted with sixteen military veterans who have served in 4 branches of the U.S. Armed Forces: Army, Navy, Air Force, and Marine Corps. Data and information …

Measurement And Imaging Of Intra Matrix Igg Diffusion, Riya Debbarma, Antonio C. F. Dos Santos, Diana Milena Ramiez Gutierrez, Fernanda M. Da Cunha, Michael Ladisch

Graduate Industrial Research Symposium

Bovine IgG diffusion measurement by tracking the movement of the protein over time in an in-vitro matrix is motivated by the large number of protein/peptide therapeutics currently under various stages of development in the pharmaceutical industry. Many of these therapeutics are monoclonal antibodies (IgG type proteins) that are candidates for subcutaneous, intra-vitreous and intra-articular administration depending on the target of the therapeutic. Hyaluronic acid (HA) is a major constituent and determines the key attributes of the subcutaneous environment, vitreous humor of the eye and synovial fluid of the knee joint. HA exhibits varying molecular weight at these anatomic locations thereby …

Characterization Of Biological Particles Using An Integrated Hyperspectral Imaging And Machine Learning, Kaeul Lim, Arezoo Ardekani

Graduate Industrial Research Symposium

Hyperspectral imaging (HSI) is a promising modality in medicine with many potential applications. This study focuses on developing a label-free lipid nanoparticle characterization method using a convolutional neural network (CNN) analysis of HSI images. The HSI data, hypercube, consists of a series of images acquired at different wavelengths for the same field of view, providing continuous spectra information for each pixel. Three distinct liposome samples were collected for analysis. Advanced image preprocessing and classification methods for HSI data were developed to differentiate liposomes based on their material compositions. Our machine learning-based classification method was able to distinguish different liposome types …

Sepsis Treatment: Reinforced Sequential Decision-Making For Saving Lives, Dipesh Tamboli, Jiayu Chen, Kiran Pranesh Jotheeswaran, Denny Yu, Vaneet Aggarwal

Graduate Industrial Research Symposium

Sepsis, a life-threatening condition triggered by the body's exaggerated response to infection, demands urgent intervention to prevent severe complications. Existing machine learning methods for managing sepsis struggle in offline scenarios, exhibiting suboptimal performance with survival rates below 50%. Our project introduces the "PosNegDM: Reinforcement Learning with Positive and Negative Demonstrations for Sequential Decision-Making" framework utilizing an innovative transformer-based model and a feedback reinforcer to replicate expert actions while considering individual patient characteristics. A mortality classifier with 96.7% accuracy guides treatment decisions towards positive outcomes. The PosNegDM framework significantly improves patient survival, saving 97.39% of patients and outperforming established machine learning …