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Objective: This study compared the accuracy of prenatal congenital heart disease (CHD) diagnosed by maternal-fetal medicine specialists (MFMs) and pediatric cardiologists (PCs), using postnatal cardiac findings as the reference standard., Methods: This retrospective analysis at Siriraj Hospital, Bangkok, Thailand, involved 125 pregnancies with fetal CHD diagnosed by MFMs and evaluated by PCs later. Prenatal CHD diagnoses by either MFM or PC were compared with postnatal diagnoses obtained through echocardiography, cardiac surgery/catheterization, or autopsy. Diagnostic accuracy was classified as (A) correct diagnosis, (B) minor differences not impacting clinical management or outcomes, or (C) major differences affecting prognosis or treatment., Results: Cardiac sonography by MFM achieved diagnostic accuracies of 73.6% (A), 16% (B), and 10.4% (C), while fetal echocardiography by PC resulted in accuracies of 72% (A), 20% (B), and 8% (C). No statistically significant differences were found between MFM and PC in each category (P = .375-.832). The MFMs' accuracy was highest for tetralogy of Fallot (94.4%; 95% CI, 72.7-99.9%) and lowest for right atrial isomerism (71.4%; 95% CI, 29-96.3%) and pulmonary atresia with ventricular septal defect (57.1%; 95% CI, 18.4-90.1%)., Conclusions: MFMs and PCs demonstrated high and comparable accuracy in prenatal CHD diagnosis. Although PCs tended to outperform MFMs in cases where misdiagnosis could significantly impact neonatal care and outcomes, MFMs can effectively perform primary screening for fetal CHD in all pregnancies. Collaboration with PCs remains essential when fetal CHD is suspected, particularly in complex cases., (© 2024 American Institute of Ultrasound in Medicine.)

Our study focused on assessing disease and pregnancy outcomes in Thai patients with Neuromyelitis Optica Spectrum Disorder (NMOSD), a condition that disproportionately affects women of childbearing age and poses risks to both mother and fetus. We retrospectively analyzed eight NMOSD patients with a total of 10 pregnancies from our central nervous system inflammatory demyelinating diseases (CNS-IDDs) registry. Over a 12-months spanning from before pregnancy to 12 months postpartum, we observed 13 relapses, with a notable 76.92% occurring postpartum. The mean annualized relapse rate (ARR) peaked at 1.2 (SD ± 1.93) during specific postpartum intervals (0-3 and 6-9 months postpartum), significantly increasing from 0.20 (SD ± 0.42) in the 12 months before pregnancy (BP) to 1.00 (SD ± 1.49) during the 12 months postpartum (PP). Disability, assessed using the Expanded Disability Status Scale (EDSS) scores, worsened from 1.56 (SD ± 2.18) before pregnancy to 2.1 (SD ± 2.63) at six months postpartum. Maternal and fetal complications were prevalent, with six out of nine pregnancies experiencing adverse outcomes such as false labor, premature rupture of membranes, postpartum hemorrhage, intrauterine growth restriction, preterm birth, stillbirth, and low birth weight. Based on our findings, azathioprine and rituximab may be suitable treatment options for maintaining therapy throughout pregnancy, particularly in cases of high disease activity. Our study highlights the critical need for comprehensive management strategies for NMOSD patients of childbearing age. Preconception planning and counselling, along with early obstetrical consultation and closely monitored treatments during pregnancy and postpartum, are vital to mitigating pregnancy-related relapses and adverse fetal outcomes in this vulnerable patient population., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Haemoglobin (Hb) H disease and HbH disease with co-inherited HbE mutation are the most prevalent forms of α-thalassaemia in Southeast Asia. Data were limited when comparing clinical phenotypes between these two patient groups. We conducted a Thai multicentre study and enrolled 588 patients [median (IQR) age 13.0 (6.7-20.3) years], including those with deletional HbH disease with (n = 47) and without (n = 187) co-inherited HbE mutation and non-deletional HbH disease with (n = 101) and without (n = 253) co-inherited HbE mutation. Patients with HbH disease with co-inherited HbE mutation suffered more severe manifestations than those without. This observation was more pronounced in patients with non-deletional HbH disease. A greater proportion of patients with non-deletional HbH disease with co-inherited HbE mutation (43.6%) eventually required regular transfusions compared to those without (30.4%, p = 0.019). Among those with non-deletional HbH disease who did not require regular transfusions, Hb levels were lower in patients with co-inherited HbE mutation [8.1 (7.2-8.6) vs. 8.8 (8.2-9.5) g/dL, p < 0.001]. Among patients requiring regular transfusions who underwent splenectomy, 11/12 patients with non-deletional HbH disease stopped transfusion compared with 1/3 in non-deletional HbH disease with co-inherited HbE mutation group (p = 0.024). These findings provide insights for the clinical monitoring and management of HbH disease in the region., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Objectives: The objective of this study was to explore the prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIMs) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study., Methods: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after two vaccine doses. We compared BI characteristics and severity among patients with IIMs, patients with other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HCs). Multivariable Cox regression models were used to assess the risk factors for BI, severe BI ,and hospitalizations among patients with IIMs., Results: Among the 9449 included responses, BIs occurred in 1447 respondents (15.3%). The median age was 44 years [interquartile range (IQR) 21], 77.4% were female, and 182 BIs (12.9%) occurred among the 1406 patients with IIMs. Multivariable Cox regression among the data for patients with IIMs showed increasing age to be a protective factor for BIs [hazard ratio (HR) = 0.98, 95% CI = 0.97-0.99], and HCQ and SSZ use were risk factors (HR = 1.81, 95% CI = 1.24-2.64, and HR = 3.79, 95% CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for a severe BI (HR = 3.61, 95% CI = 1.09-11.8). Non-white ethnicity (HR = 2.61, 95% CI = 1.03-6.59) was a risk factor for hospitalization. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIMs = 6.0% vs AIRDs = 1.8%, nrAIDs = 2.2% and HCs = 0.9%), intensive care unit admission (IIMs = 2.2% vs AIRDs = 0.6%, nrAIDs and HCs = 0%), advanced treatment with antiviral or monoclonal antibodies (IIMs = 34.1% vs AIRDs = 25.8%, nrAIDs = 14.6% and HCs = 12.8%) and had more hospitalization (IIMs = 7.7% vs AIRDs = 4.6%, nrAIDs = 1.1% and HCs = 1.5%)., Conclusion: Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies., (© 2025. The Author(s).)

Introduction: The presence of foreign or unexpected external objects in the urinary tract, including the urethra, is a rare case. This case is a challenge for patients with schizophrenia. This case report presents when the unusual corpus alienum invades the urethra in schizophrenia patients., Case Presentation: A 54-year-old man was referred to the emergency room with corpus alienum tweezers inside the urethra. The patient had a history of schizophrenia 30 years ago and had not been routinely treated for the past year. From the physical examination, it was found that the tip of the tweezers penetrated out of the penile gland, and the patient could still urinate without bloody fluid. A pelvic X-ray shows tweezers in the urethra. The results of the urethrography showed a corpus alienum with both ends penetrating the penile gland. There is no clear contrast image visible filling the anterior urethra and a contrasting backflow from the urethra to the hole where the end of the corpus alienum comes out. Management of schizophrenia patients, given haloperidol tablets 2.5 mg/12 h and regular check-ups at psychiatric clinics., Discussion: Treatment is based on two steps: foreign body extraction and psychiatric treatment for mental illness. Patients need routine treatment, and haloperidol is one of the drugs that can be used., Conclusion: Extraction management of corpus alienum urethra must be carried out immediately to prevent complications. Comprehensive management is needed if there are other diseases, such as schizophrenia, in these patients to prevent recurrence., Competing Interests: Conflict of interest statement The author stated that there was no conflict of interest., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space - the medial retro-SCTL space block., Methods: Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block., Results: MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2-5] vs 0 [0-1.25], p < 0.001) and posterior (median [IQR], 6[3-7] vs 2[1-3], p < 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1-3] vs 0[0-1.25], p = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (r = 0.53, p = 0.11) or anesthetic (r = 0.09, p = 0.78) dermatomes on the ipsilateral hemithorax., Conclusions: A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The aim of the present study was to evaluate the obstetric complications associated with isolated fetal congenital heart disease (CHD) by comparing pregnancies with and without this condition., Methods: In this retrospective matched comparative study at Siriraj Hospital, Thailand, we included 233 postnatally confirmed fetal CHD cases and 466 unaffected fetuses. Controls were selected at a 2:1 ratio, ensuring that they matched the cases in terms of maternal age, parity, and history of preterm deliveries., Results: Fetal CHD was significantly associated with an increased risk of spontaneous preterm labor (30% vs 9.7%; adjusted odds ratio [aOR] 2.42; 95% confidence interval [CI]: 1.35-4.36; P = 0.003), delivery before 34 gestational weeks (11.6% vs 0.6%; aOR 12.33; 95% CI: 3.32-45.78; P < 0.001), and pre-eclampsia (11.6% vs 2.8%; aOR 2.19; 95% CI: 1.01-4.76; P = 0.047). Newborns with CHD were significantly more likely to be small for gestational age (10.7% vs 5.2%; aOR 2.09; 95% CI: 1.11-3.94; P = 0.022). Intriguingly, a prenatal diagnosis of CHD was associated with a reduced risk of preterm delivery in affected pregnancies (P = 0.002)., Conclusion: Pregnancies affected by isolated fetal CHD demonstrated a higher propensity for several adverse outcomes. These findings underscore the importance of prenatal CHD detection and tailored perinatal care to potentially improve both pregnancy outcomes and neonatal health., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Bladder cancer is categorized into nonmuscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), distinguished by the presence of detrusor muscle invasion. Urothelial cell carcinoma is the most common subtype of bladder cancer. Transurethral resection of bladder tumor (TURBT) is the standard approach for staging and managing NMIBC, while radical cystectomy remains the cornerstone treatment for MIBC. Multiparametric magnetic resonance imaging (mpMRI), comprising morphological imaging sequences (high-resolution T2-weighted images) and functional imaging sequences (dynamic contrast-enhanced images and diffusion-weighted images), serves as an ideal modality. It provides high-contrast resolution for visualizing bladder wall layers, thereby enabling proper and timely staging of bladder cancer. MRI can guide sampling resection and identify patients understaged after primary TURBT, facilitating appropriate surgical restaging. In 2018, the Vesical Imaging Reporting and Data System (VI-RADS), implementing a 5-point scale, was developed to standardize MRI protocols and reporting criteria-including tumor location, size, morphology, and invasiveness. The aim of this article is to navigate through all the steps to achieve VI-RADS assessment and to discuss practical pearls and pitfalls in the use of mpMRI. This approach can aid in pre-TURBT prediction of muscle invasion, representing an important asset in bladder cancer staging., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Noninvasive aesthetic procedures for facial rejuvenation are gaining popularity. Conventional treatments, such as radiofrequency (RF) and high-intensity focused ultrasound (HIFU), primarily improve skin quality but do not address the deeper musculoaponeurotic structures that affect facial laxity. A novel approach that delivers synchronized RF with high intensity facial electrical stimulation (HIFES) thought to target both the skin and underlying musculoaponeurotic framework to effectively enhance facial laxity has been investigated., Objective: To assess the long-term efficacy and safety of combined synchronous RF and HIFES therapies in treating facial skin laxity among Asian subjects., Methods: In this prospective, evaluator-blinded study, 15 participants aged 40-65 years with mild to moderate facial skin laxity were enrolled. Each underwent four weekly treatments using a synchronized RF and HIFES system using noninvasive electrode applicators on the forehead and cheeks. Objective assessments included forehead and cheek lifting measurements using a 3D photographic system, eyebrow lifting measurement using ImageJ software, skin texture and melanin levels using Antera 3D®, and skin elasticity using Cutometer® MPA 580. Additionally, patients provided self-assessments regarding their perceived level of improvement. Assessments were conducted at baseline, before the 3rd treatment, and at 1 month, 3 months, and 6 months after the last treatment., Results: All participants completed the study. Significant improvements were observed in forehead and cheek lifting sustained at 6 months (p < 0.0001). A significant eyebrow lift of 1.39 mm was observed at 3 months (p = 0.0087), with a sustained lifting distance of 1.31 mm at 6 months (p = 0.0021). Skin firmness improved substantially (p < 0.0001), with R0 (skin firmness) increasing by 81.24% at 6 months. Skin texture improved notably in the crow's feet area (13.82% improvement at 3 months, p = 0.049). Melanin levels decreased significantly in the crow's feet and forehead regions. Treatment was well tolerated, with pain scores decreasing from 3.5 ± 1.8 to 1.6  ± 1.0 by the fourth session. No serious adverse events occurred., Conclusions: Combined synchronous RF and HIFES therapy is a safe and effective Noninvasive method of improving facial skin laxity and quality in Asian subjects. Lasers Surg. Med. 00:00-00, 2024. © 2024 Wiley Periodicals LLC., (© 2025 The Author(s). Lasers in Surgery and Medicine published by Wiley Periodicals LLC.)

Background: This study compared outcomes of endovascular (EVAR) and open aneurysm repair (OAR) in patients with infective native abdominal aortic aneurysms (INAAAs), evaluating perioperative and in-hospital mortality, antibiotic treatment duration, complications, overall survival rates, and reintervention-free times at 10 years., Methods: A retrospective cohort study of 125 INAAA patients (80 EVAR, 45 OAR) diagnosed between January 2004 and December 2019 was conducted. Patients were categorized as fit or unfit for open surgery based on cardiac, respiratory, and renal status, following the guidelines established in the EVAR-1 and EVAR-2 trials. Primary outcomes included 30-day and in-hospital mortality. Secondary outcomes encompassed early and late complications requiring reintervention, antibiotic treatment duration, 10-year overall survival, 10-year reintervention-free survival, and factors influencing 30-day mortality. Statistical analysis used chi-square, t-tests, and Mann-Whitney U tests. Logistic regression assessed mortality. Kaplan-Meier estimation evaluated survival. Analyses used SPSS version 18.0 (P < 0.05 considered significant) RESULTS: Males predominated in both OAR (37 of 45, 82.2%) and EVAR (62 of 80, 77.5%) groups (P = 0.693). Mean age was 64.8 ± 9.8 years for OAR and 69.0 ± 12.6 years for EVAR (P = 0.063). The abdominal aorta was the most common aneurysm location, accounting for 91 of 125 (72.8%) cases. Salmonella spp. accounted for 19 of 45 (42.2%) of positive culture cases, and 34 of 125 (27.2%) patients had ruptured aneurysms. The EVAR group had a higher proportion of unfit patients (41 of 80, 51.2%) compared to OAR (10 of 45,22.2%; P = 0.003). Thirty-day mortality rates were 6 of 80 (7.5%) for EVAR and 2 of 45 (4.4%) for OAR; odds ratio (OR) = 1.75 (95% confidence interval (CI): 0.34-9.06), P = 0.508, while in-hospital mortality rates were 7 of 80 (8.8%) and 5 of 45 (11.1%); OR = 0.77 (95% CI: 0.23-2.58), P = 0.668. No significant differences were found in antibiotic treatment duration (median 11 vs. 6 months, P = 0.594), 10-year overall survival rates (62.8% vs. 64.8%, P = 0.90), or reintervention-free time (83.8% vs. 82.2%, P = 0.922), and aneurysm-related death (84.7% vs. 92.9%, P = 0.159). Unfit patient status was an independent predictor of 30-day mortality (adjusted OR, 10.654; 95% CI, 1.041-109.030; P = 0.046)., Conclusions: Our study demonstrates that EVAR and OAR provide comparable outcomes in INAAA management, despite EVAR being performed more frequently in unfit patients. The similar early mortality rates, antibiotic treatment durations, and long-term survival between the 2 approaches support EVAR as a viable alternative to OAR. Importantly, our finding that unfit patient status independently predicts perioperative mortality emphasizes the critical role of patient selection in treatment decisions. These results collectively suggest that EVAR may be particularly beneficial for high-risk INAAA patients unsuitable for OAR, potentially expanding treatment options for this challenging condition., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To translate and culturally adapt the Core Outcome Measures Index for the back (COMI-back) into Thai and to evaluate its psychometric properties in Thai-speaking patients with low back pain (LBP)., Methods: The translation process followed a standardized forward-backward method with two independent translators, followed by synthesis and back-translation. An expert committee reviewed the translations for cultural and conceptual equivalence. Pre-testing was done with Thai patients to refine the questionnaire. The validation study included 131 patients with LBP, who completed the Thai COMI-Back along with other validated questionnaires like the Oswestry Disability Index (ODI), and EQ-5D-5L. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC). Construct validity was determined by correlating COMI scores with those of reference scales., Results: The Thai COMI-Back exhibited strong reliability, with Cronbach's alpha values from 0.89 to 0.93 and ICC values over 0.80 for all domains. Construct validity was supported by significant correlations with reference scales, with Spearman's rho values ranging from 0.47 to 0.84. Floor and ceiling effects were acceptable for most items, with notable exceptions for symptom-specific well-being and work disability., Conclusion: The Thai COMI-Back shows strong psychometric properties, making it suitable for clinical and research use in Thailand., Competing Interests: Declarations. Conflicts of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical approval: The study was approved by the Siriraj Institutional Review Board (SIRB) of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA no. 574/2021)., (© 2024. The Author(s).)

Animal venoms, distinguished by their unique structural features and potent bioactivities, represent a vast and relatively untapped reservoir of therapeutic molecules. However, limitations associated with comprehensively constructing and expressing highly complex venom and venom-like molecule libraries have precluded their therapeutic evaluation via high-throughput screening. Here, we developed an innovative computational approach to design a highly diverse library of animal venoms and "metavenoms". We used programmable M13 hyperphage display to preserve critical disulfide-bonded structures for highly parallelized single-round biopanning with quantitation via high-throughput DNA sequencing. Our approach led to the discovery of Kunitz-type domain containing proteins that target the human itch receptor Mas-related G-protein coupled receptor member X4, which plays a crucial role in itch perception. Deep learning-based structural homology mining identified two endogenous human homologs, tissue factor pathway inhibitor (TFPI), and serine peptidase inhibitor, Kunitz type 2 (SPINT2), which exhibit agonist-dependent potentiation of Mas-related G-protein coupled receptor member X4. Highly multiplexed screening of animal venoms and metavenoms is therefore a promising approach to uncover new drug candidates., Competing Interests: Conflict of interest H. B. L., M. S., M. H., and Z. L. are listed as inventors on a patent application filed by Johns Hopkins University that covers the (meta)venom library design and construction, and M13 hyperphage ligand discovery platform. H. B. L. is a co-founder of Infinity Bio, Portal Bioscience, and Alchemab Therapeutics. The other authors declare that they have no conflicts of interest with the contents of this article, (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the appropriate intraosseous (IO) needle insertion site, optimal depth and success using a drill-assisted device (DAD) versus a manually inserted needle (MIN)., Methods: Computed tomography scans of neonatal cadavers were analyzed. Success was based on tibial needle tip placement within the marrow cavity and contrast media distribution., Results: Nineteen cadavers (38 tibiae) were included. The overall success rate was comparable between DAD and MIN needles, but reduced in very-low birthweight (VLBW) infants. The insertion site was consistent across birth weight groups. Contrast leakage occurred overall in 15.8% and 41.7% in VLBW infants and was insignificantly greater in DAD versus MIN needles. Minimum and maximum puncture depth was adjusted for higher BW groups., Conclusion: IO needles should be placed 2 cm below and 1-2 cm medial to the tibial tuberosity. MIN needles are preferred to minimize leakage. IO depth should be modified by birth weight., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The study protocol was approved by Siriraj Institutional Review Board (COA no. Si 113/2023). Parental written consent was obtained prior to infant recruitment., (© 2024. The Author(s).)

Annexin A2 (ANXA2) is a Ca 2+ -dependent multifunctional protein containing five Ca 2+ -binding domains, but their functional significance and difference remain unclear. Herein, glutamic acid (E) or aspartic acid (D) in five Ca 2+ -binding domains of canine ANXA2 (98.82 % and 96.76-99.41 % identical to ANXA2 from human and other mammals, respectively) was substituted by alanine (A) using site-directed mutagenesis. Recombinant ANXA2 wild-type (WT) and E53A, E96A, D162A, E247A and D322A mutants were constructed and expressed using a bacterial expression system followed by high-affinity purification using nickel-nitrilotriacetic acid (Ni-NTA) matrix. Efficacies of their expression and purification were confirmed by SDS-PAGE and Western blotting. Their amino acid sequences were verified by nanoLC-ESI-Qq-TOF tandem mass spectrometry. ATR-FTIR spectroscopy revealed that their secondary structure significantly differed (α-helix decreased but random coil increased in all mutants). Analyses of physicochemical properties revealed that molecular weight slightly decreased, whereas isoelectric point, aliphatic index, grand average of hydropathicity, electrostatic potential and molecular hydrophobicity potential slightly increased in all the mutants compared with WT. Interestingly, Ca 2+ -binding capability of these mutants (particularly E96A and D322A) significantly decreased from that of WT. In summary, secondary structure, physicochemical properties, and Ca 2+ -binding capability of E53A, E96A, D162A, E247A and D322A mutants of ANXA2 significantly differed from its WT, consistent with the loss of negatively charged E/D. In particular, E96A and D322A exhibited the lowest Ca 2+ -binding capability. These data and recombinant proteins would be useful for further investigations of the Ca 2+ -dependent functions of individual Ca 2+ -binding domains in ANXA2., Competing Interests: Declaration of Competing interest The authors declare NO conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract: Disseminated hypopigmented keratosis is a rare distinct clinical entity. This report describes the case of a 19-year-old male patient who developed disseminated hypopigmented keratosis 2 months after autologous hematopoietic stem cell transplantation for pineal choriocarcinoma. The patient displayed numerous tiny whitish or depigmented macules and papules on the chest, back, posterior neck, shoulders, arms, and thighs, closely resembling lichen nitidus. Microscopically, the lesion was orthokeratotic, acanthotic, and flat-bottomed without cytological atypia. Dermal inflammation was minimal. Fontana-Masson, Melan-A, and sex-determining region Y-box transcription factor 10 staining revealed a significant decrease in both basal melanin content and the number of melanocytes. The patient was initially administered a topical agent comprising hydrocortisone and urea, which exhibited minimal improvement. This case report suggests that disseminated hypopigmented keratosis may be a rare cutaneous manifestation of autologous hematopoietic stem cell transplantation. Additional research is necessary to gain a more comprehensive understanding of the pathogenesis and the clinical course of this disease., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Rates of endometrial cancer, the sixth most common in women, are rising. HRQoL, reflecting health beyond clinical contexts, includes disabilities and daily functioning impacts. Measured by various tools such as EuroQoL-5 Dimensions (EQ-5D-5L), it aids in economic evaluation of interventions., Aims: The purpose of this study was to analyze Health-Related Quality of Life (HRQoL), measured by the EQ-5D-5L instrument, in different states of endometrial cancer (EC) patients., Methods and Results: We conducted a cross-sectional study on EC patients who underwent follow-up at Siriraj Hospital, Thailand, between January and June 2023. Patients were classified into five groups: early state, advanced state, curative state, locoregional recurrent state, and distant recurrent/progression state. Demographic and socioeconomic data were collected. EQ-5D-5L and visual analog scale instruments (EQ-VAS) were used to compared between disease states. Descriptive statistics were used to summarize patient characteristics, and the Mann-Whitney U test (p ≤ 0.05) compared EQ-5D-5L scores across groups. The study included 56 EC patients, with a mean age of 60.1 ± 10.9 years and a mean BMI of 26.8 ± 5.3 kg/m 2 . The EQ-5D scores were as follows: 0.9055 (IQR 0.8193-0.9436) for the early state, 0.8308 (IQR 0.7997-0.8611) for the advanced state, 0.9235 (IQR 0.8521-0.9855) for the curative state, 0.9096 (IQR 0.6249-0.9577) for the locoregional recurrent state and 0.5778 (IQR 0.2884-0.8521) for the distant recurrent/progressive state. The median EQ-VAS for each state was 70, 75, 82.5, 75, and 65, respectively. The EQ-5D values had significantly deteriorated after distant metastasis/progression compared to curative states (p-value = 0.003). Mobility and pain/discomfort appeared to be the two main concerns., Conclusion: The findings show the substantial negative impact of distant metastasis or disease progression on HRQoL. These findings will be used to guide future economic research in the field of endometrial cancer treatment., (© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Fatty pancreas disease (FPD) is a condition characterized by diffuse excessive intrapancreatic fat deposition with relevant metabolic implications but often overlooked by healthcare professionals. Our study aims to provide a comprehensive overview of the prevalence, clinical characteristics, and outcomes of FPD. PubMed and Embase databases were searched from inception to 10 April 2024. Pairwise meta-analysis was performed using the DerSimonian-Laird method. Meta-analysis of proportions was conducted using the inverse-variance method with logit transformation. Between-study heterogeneity was examined, with subsequent subgroup and meta-regression analyses, and publication bias was assessed. Eighteen studies with 111 682 individuals were included in this meta-analysis. The overall prevalence of FPD was 21.11% [95% confidence interval (CI): 11.04-36.58]. Diagnostic method influenced FPD prevalence ( P  < 0.01), with pooled prevalences of 17.53% (95% CI: 16.20-18.95), 30.05% (95% CI: 24.14-36.70), and 21.23% (95% CI: 8.52-43.88) for MRI, computed tomography, and transabdominal ultrasound, respectively. Patients with FPD were more likely to be older, have higher BMI, male, and have metabolic dysfunction. They also had an increased risk of metabolic syndrome, endocrine-related outcomes (i.e. diabetes and glycemic progression), and exocrine-related outcomes (i.e. acute pancreatitis and pancreatic cancer) compared with those without FPD. This study summarizes the epidemiology of FPD and highlights its clinical and prognostic significance. Increased multidisciplinary collaboration is needed to improve understanding of the disease and raise awareness among healthcare professionals. This study was a priori registered in International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024514116)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective cohort study with propensity-score-matched analysis., Purpose: To compare the efficacy of vertebroplasty (VP) versus short-segment posterior instrumentation (SS) with VP in patients with osteoporotic vertebral fractures (OVFs)., Overview of Literature: OVFs significantly affect the aging population, causing pain, reduced mobility, and increased dependence. Treatment guidelines vary, and a consensus on the most effective approach remains unclear. To the best of our knowledge, no previous report focused on the efficacy comparison of VP alone versus SS with VP., Methods: The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics., Results: This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups., Conclusions: SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

Background: To investigate the trends in alcohol-associated liver disease (ALD), liver cancer from alcohol, and alcohol use disorder (AUD) burden among older adults in the United States (US)., Methods: We gathered the ALD, liver cancer from alcohol, and AUD prevalence, mortality, and age-standardized rates (ASRs) from the Global Burden of Disease (GBD) Study 2021 between 2010 and 2021. We estimated the annual percent change (APC) with confidence intervals (CIs) for the burden of ALD, liver cancer from alcohol, and AUD in older adults (>70 years) in the United States. The findings were contrasted with global estimates and categorized by sex and state., Results: In 2021, there were approximately 512,340 cases of AUD, 56,990 cases of ALD, and 4490 cases of primary liver cancer from alcohol among older adults in the United States. In contrast to declining ASRs of prevalence and mortality in the global burden, these parameters were increased in older adults in the United States. From 2000 to 2021, prevalence from AUD (APC: 0.54%, 95% CI 0.43% to 0.65%), ALD (APC + 0.54%, 95% CI 0.22% to 0.86%), and primary liver cancer from alcohol (APC 2.93%, 95% CI 2.76% to 3.11%) increased. Forty states in the United States exhibited a rise in the prevalence rates of ALD in older adults., Conclusion: Our findings highlighted the increased prevalence and mortality of AUD, ALD, and primary liver cancer from alcohol among older adults in the United Sates, contrasting with the decline in global trends. Public health strategies on ALD, AUD, and primary liver cancer from alcohol, which targets older adults, are urgently needed., (© 2024 The Author(s). Alcohol, Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Background and Aim: The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability., Methods: A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process., Results: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes., Conclusion: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability., (© 2025 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Objectives. To determine the overall mortality and risk factors of COVID-19 patients who were admitted to the Home Isolation (HI) program in Bangkok, Thailand, during the epidemic crisis in 2021. Methods. We conducted a retrospective cohort study using the data from a government telehealth application from July to December 2021. The vital status was verified from the government database on September 20, 2022. We used survival analysis to analyze the 28-day mortality and independently associated factors. Results. Of 90 854 reported cases, the average age was 37.27 years, and half were men. Initial symptoms included being asymptomatic (51.66%), having mild symptoms (35.60%), or experiencing severe symptoms requiring nonurgent (11.27%) or urgent referral (1.47%). The 28-day mortality rate was 0.80%. Factors associated with 28-day mortality included older age, male gender, higher body mass index, severity of initial symptoms, and time to admission. Conclusions. The Home Isolation program was able to manage a high volume of patients, including severe cases, exceeding its initial design. Thailand's COVID-19 mortality rate remained relatively low compared with other countries. Proactive bed surge planning and continuous plan improvement were crucial for future preparedness. ( Am J Public Health . Published online ahead of print January 30, 2025:e1-e12. https://doi.org/10.2105/AJPH.2024.307922).

Background: Double J Stent is one of the procedures frequently performed in the field of urology. Forgotten DJ Stent is a problem that can cause serious complications. This systematic review aims to explore complications and management of patients with forgotten double J stents., Methods: Scientific literature was obtained from PubMed, ScienceDirect, and Google Scholar with a publication year limited to 2013-2023. The search string included 'forgotten DJ stent, case report, complication'. Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) English language. Data are presented descriptively., Results: Of the 210 records, 14 articles published were analyzed after the full-text assessment. Forgotten DJ stent sufferers vary from age 7 years to 88 years. Male gender was predominant. The initial symptoms were flank pain and micturition disorders. The complications experienced were encrustation, multiple stones formation, emphysematous pyelonephritis, emphysematous perinephric abscess, fragmentation, and vesical calculus. In management, it was found that procedures were selected according to patient's situation at that time and the condition of the stent. There are case reports that report management that differed from those initially planned. All the patients were alive after treatment., Conclusions: A forgotten DJ stent can have serious consequences. The management approach requires a combination of various endourological procedures. In consideration of potential complications, urologists need to be careful in making decisions about the choice of technique used.

Objective: To examine the impact of interdisciplinary team-based care (ITBC) on chronically ill patients and their outcomes as reported in relevant contemporary literature., Methods: In this systematic review, PubMed, MEDLINE, Web of Science, CINAHL Plus Full Text, and ten publishers were searched to identify studies published between 2019 and 2024. Titles, abstracts, and full texts were screened for eligible studies and assessed for relevance. Inclusion and exclusion criteria were implemented to ensure that only studies relevant to our objective were included. The convergent integrated analysis framework suggested by the Joanna Briggs Institute was utilized for data synthesis., Results: Ten studies were included in the systematic review. Data synthesis revealed five major themes at different levels: 1) Patient level, including themes of Patients' Self-Improvement and Patients' Health Outcomes; 2) Interpersonal level, including themes of Providers' Work Performance and Shared Decision Making; and 3) Organizational level, including the theme of Healthcare Utilization., Conclusion: ITBC has a significant positive impact on chronically ill patients at multiple levels. At the patient level, it enhances self-management and health outcomes. At the interpersonal level, it improves healthcare providers' performance and promotes shared decision-making. At the organizational level, it leads to more efficient healthcare utilization., Competing Interests: No potential conflict of interest was reported by the authors., (© 2025 Kongkar et al.)

Dengue is a mosquito-borne disease caused by dengue virus (DENV) infection, which remains a major public health concern worldwide owing to the lack of specific treatments or antiviral drugs available. This study investigated the potential repurposing of domperidone, an antiemetic and gastrokinetic agent, to control DENV infection. Domperidone was identified by pharmacophore-based virtual screening as a small molecule that can bind to both the viral envelope (E) and the nonstructural protein 1 (NS1) of DENV. Molecular dynamics (MD) simulations and surface plasmon resonance (SPR) analysis were subsequently performed to determine specific interactions of domperidone with the DENV E and NS1 proteins and their binding affinity. Treatment of immortalized human hepatocyte-like cells (imHC) with domperidone could inhibit DENV production and NS1 secretion in a dose-dependent manner following infection with DENV serotype 2. These inhibitory effects were mediated by reduction in viral RNA replication and viral E and NS1 protein expression, but not by interference with virus entry into cells or NS1 oligomerization. The suppression of DENV production and NS1 secretion by domperidone was observed across all four DENV serotypes to varying degrees between different virus strains. The findings from our study suggest viral target-based repurposing of domperidone for modulating DENV., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous coronary intervention (PCI) vs post-PCI MCS insertion in AMI patients with cardiogenic shock., Methods: A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 25, 2024. Studies comparing outcomes of MCS insertion pre-PCI vs post-PCI in this setting were included., Results: There were 36 studies with a total of 6218 participants were included in this meta-analysis, using a random-effects model. Most of the included studies were non-randomized and retrospective. Early MCS insertion (prior to PCI) was associated with a lower risk of in-hospital mortality compared to late insertion (post-PCI), with an odds ratio (OR) of 0.46 (95%CI 0.36 to 0.57), p  < 0.01. Subgroup analysis by MCS type (IABP, Impella, and ECMO) demonstrated that early insertion prior to PCI significantly reduced in-hospital mortality, regardless of the MCS type. Early MCS insertion prior to PCI was also associated with lower 30-day mortality (OR 0.62, (95%CI 0.43 to 0.89), p  = 0.01) and 6-month mortality (OR 0.53, (95%CI 0.34 to 0.83), p = 0.01) compared to late insertion. There was no difference in 1-year mortality or in MCS-related complications., Conclusions: Early MCS insertion prior to PCI is potentially associated with reduced in-hospital, 30-day, and 6-month mortality compared to post-PCI insertion in AMI patients with cardiogenic shock., Competing Interests: The Authors declare that there is no conflict of interest., (© 2025 The Authors.)

Background Aims: Non-invasive tests (NITs), e.g. Fibrosis-4 Index (FIB-4) and vibration-controlled elastography (VCTE), have been used to identify metabolic dysfunction-associated steatotic liver disease (MASLD) patients at high risks for hepatocellular carcinoma (HCC). This study investigates the cost-effectiveness of NITs to identify MASLD patients with advanced liver fibrosis and initiate HCC surveillance., Methods: A cost-utility analysis using a Markov model compared no use of NITs with three NIT strategies: 1) FIB-4 and VCTE (FIB-4/VCTE), 2) FIB-4 alone, and 3) VCTE alone to identify advanced liver fibrosis and initiate HCC surveillance with biannual ultrasonography with alpha-fetoprotein in 4 MASLD populations: 1) general MASLD patients, 2) MASLD patients with body mass index (BMI) >30 kg/m2, 3) MASLD patients with diabetes, and 4) MASLD patients with three metabolic traits (diabetes, hypertension and BMI >30)., Results: FIB-4/VCTE was the most cost-effective approach across all groups, showing the lowest ICER, followed by FIB-4 alone and VCTE alone. In the general MASLD population, both FIB-4/VCTE and FIB-4 alone were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. For MASLD patients with BMI >30, all strategies were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. In MASLD patients with diabetes or 3 metabolic traits, all strategies were cost-effective in the US, while FIB-4/VCTE and FIB-4 alone were cost-effective in Thailand., Conclusions: Using FIB-4/VCTE to initiate HCC surveillance is cost-effective for MASLD patients. If VCTE is unavailable, FIB-4 alone is a cost-effective alternative for MASLD patients with diabetes or 3 metabolic traits., (Copyright © 2025 by The American College of Gastroenterology.)

Objective: The aim of this study was to assess the short- and long-term outcomes of patients who underwent the arterial switch operation (ASO) at Siriraj Hospital in Thailand, and to identify postoperative complications and factors that significantly affect patient survival., Materials and Methods: We retrospectively studied all patients with dextro-transposition of the great arteries and anatomic variants who underwent the ASO from January 1995 to December 2020. Twenty-year overall survival and 15-year freedom from reoperation/reintervention were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to identify factors independently associated with 30-day mortality., Results: Of the 171 patients included, there were 116 males (67.84%). The median (minimum, maximum) age at operation was 33.5 (3-4,499) days, and the median (minimum, maximum) bodyweight was 3.4 (2.2-44.9) kg. Most patients (115/171, 67.25%) had an intact ventricular septum, whereas 48/171 (28.07%), had ventricular septal defects. The typical coronary anatomic pattern (1LCx-2R) was found in 120 patients (70.1%). Early mortality was 8.7% ± 4.4%, and there was no late death up to 20 years postoperatively with a median follow-up of five years. Fifteen-year freedom from reoperation or reintervention was 85.7%. Atypical coronary pattern was an independent factor for survival with an adjusted hazard ratio of 5.1 (95% confidence interval: 1.22-21.4; P  = .026)., Conclusions: The results of this study revealed excellent short- and long-term outcomes of the ASO at our center. Atypical coronary anatomy was found to be the only factor that independently predicted 30-day mortality., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The clinical characteristics, therapy, and outcome of Fournier Gangrene (FG) in patients using sodium-glucose cotransporter-2 inhibitors (SGLT2i) were examined in this systematic review., Methods: Without a publication year restriction, we searched PubMed, ScienceDirect, and Cochrane. Additionally, we manually searched bibliographies using the terms "Fournier's gangrene" and "SGLT2 inhibitors." The requirements for inclusion were the English language case reports with specific patient data and FG patients with diabetes who were using SGLT2 medication. The risk of bias was analyzed utilizing the Joanna Briggs Institute checklists., Results: A total of 78 studies were identified, and 14 of them were included in this review. The duration of SGLT2i use varied from 6 months to 6 years. The patients' age varied from 34 to 72 years, with 10 studies including male participants only and patients with obesity. All studies have discontinued SGLT2i and replaced them with other anti-diabetic drugs. Therapy options included perianal ring block, insulin, rigid sigmoidoscopy, aggressive debridement, antibiotics, fluid resuscitation, incision, drainage, surgery, hyperbaric oxygen therapy, plastic surgery, and fasciocutaneous flaps. Seven studies reported patients discharged in the range of 9-51 days., Conclusions: The incidence of FG following SGLT2i use is rare. Therapy was performed by replacing SGLT2i with other anti-diabetic drugs. The patient's outcome improved after treatment., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Background: Assessment of coronary artery disease (CAD) is critical in managing severe aortic stenosis. Unplanned coronary angiography after TAVR, with or without percutaneous coronary intervention, may present significant challenges., Objectives: The aim of this study was to evaluate the incidence, predictors, and outcomes of unplanned coronary angiography after transcatheter aortic valve replacement (TAVR)., Methods: All TAVR procedures between July 2015 and December 2021 were examined for the occurrence of unplanned angiography and for procedural success with percutaneous coronary intervention if attempted, and a machine learning prediction model was created., Results: Among 1,444 patients (median age 81 years, 59% men), 6.7% had unplanned post-TAVR angiography, 45% within the first year. The most common indication was acute coronary syndrome, which occurred in 3.3% overall. Patients with preprocedural CAD (50.1%) had a significantly higher incidence of unplanned angiography (10.5% vs 2.9%; P < 0.001) in comparison with others. In multivariable analysis, factors associated with unplanned angiography were age (>75 years; HR: 0.46; 95% CI: 0.30-0.71; P < 0.001), mean aortic valve gradient (HR: 0.82; 95% CI: 0.68-0.98; P = 0.031), dialysis (HR: 2.68; 95% CI: 1.07-6.74; P = 0.036), and CAD (HR: 2.96; 95% CI: 1.76-4.98; P < 0.001). In multivariate models, these same variables had areas under the curve of 0.71 to 0.77 for 5-year prediction of unplanned angiography., Conclusions: Unplanned angiography post-TAVR occurs in about 1 in 15 patients, with about one-half occurring within the first year, about one-half due to acute coronary syndrome, and pre-existing CAD being the strongest predictor. For those considering TAVR and who have or are at risk for CAD, a comprehensive strategy to facilitate lifetime management is needed., Competing Interests: Funding Support and Author Disclosures Dr Sorajja has received consulting fees from 4C Medical, Abbott Structural, Adona, Boston Scientific, Edwards Lifesciences, Foldax, GE Medical, Laza, Medtronic, Philips, VDYNE, WL Gore, and xDot. Dr Cavalcante has received consulting fees from 4C Medical, Abbott Structural, Alleviant, Anteris, Boston Scientific, Circle Cardiovascular Imaging, Edwards Lifesciences, JenaValve, JC Medical, Medtronic, Novo Nordisk, Pie Medical, Siemens Healthineers, Shockwave, Zoll. Dr Hamid has received consulting fees from Abbott Structural, AMX, 4C Medical Technologies, Alleviant Medical, Edwards Lifesciences, JenaValve, Philips, GE, Vdyne, WL Gore, and xDot. Dr Enriquez-Sarano has received consulting fees from Cryolife, Edwards Lifesciences, Highlife, and ChemImage. Dr Bapat has received consulting fees from Abbott Structural, Anteris, Boston Scientific, Edwards Lifesciences, and Medtronic. All other authors have reported that they have no relationship relevant to the contents of this paper to disclose., (Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Tinea manuum is a superficial fungal infection affecting the hands, particularly the palms and interdigital areas. This retrospective study investigated clinical features, laboratory findings, treatment, and outcomes in patients with fungal hand infections at Siriraj Hospital between 2016 and 2020. Among 107 patients, representing 1.3% of those with fungal skin infections, 64.5% were male, with a mean age of 54.3 ± 18.5 years. Diabetes mellitus was present in 26.2%, and 23.4% had prior topical steroid use. The most common symptom was itching (75.7%), while palm-scale (85.9%) was the most prevalent clinical finding. Concurrent fingernail onychomycosis was observed in 43%, and 59.8% had additional fungal skin infections. Among 50 positive cultures, dermatophytes accounted for 86% and nondermatophytes for 14%, with Trichophyton rubrum (54%) and Trichophyton mentagrophytes complex (24%) being the most frequent pathogens. Systemic antifungal treatment was administered to 57% of patients, with a mycological cure rate of 56.4%. A complete cure was achieved in 60.5% of dermatophyte infections but in none of the nondermatophyte cases (p = 0.003). These findings highlighted that tinea manuum could be caused by both dermatophytes and nondermatophytes, with significantly poorer outcomes observed in nondermatophyte infections. Concurrent fungal skin and nail infections should be evaluated for optimal management., Competing Interests: Declarations. Ethical approval: The authors confirm that the ethical policies of the journal, as noted on the journal’s author guidelines page, have been adhered to and the appropriate ethical review committee approval has been received. This retrospective chart review was authorized by the Siriraj Institutional Review Board (approval number Si 777/2021). Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Ulcerative colitis is a chronic inflammatory condition of the colon driven by aberrant immune activation. Although advanced medical therapies form the cornerstone of ulcerative colitis management, unmet needs include failure to induce and sustain remission in a substantial proportion of patients and in managing acute severe ulcerative colitis. We review new treatment strategies that might improve patient outcomes in the management of moderate-to-severe ulcerative colitis., Areas Covered: A literature search was conducted using the PubMed database, including studies published from inception to October 2024, selected for their relevance. Recognizing current limitations, this article reviews strategies to improve treatment outcomes in ulcerative colitis using advanced therapies. These approaches include early treatment initiation, dose optimization, positioning newer agents as first-line therapies, combination therapy, targeting novel therapeutic endpoints, and the management of acute severe ulcerative colitis., Expert Opinion: The strategies discussed may contribute to establishing new standards of care aimed at achieving long-term remission and enhancing patient outcomes. Personalized therapy, which tailors treatment based on individual disease characteristics and risk factors, is anticipated to become a critical aspect of delivering more effective care in the future.

Objectives: To determine the prevalence of occult endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN) post-hysterectomy and identify pre-hysterectomy risk factors predictive of occult carcinoma., Methods: This retrospective study included patients diagnosed with EIN between 2007 and 2021 who underwent hysterectomy as primary treatment. An expert gynecologic pathologist reviewed pathological slides. Data collected from medical records included demographic and gynecologic information, sonographic findings, and surgical and pathological outcomes. The prevalence of occult endometrial carcinoma was calculated. Descriptive statistics evaluated carcinoma incidence, and logistic regression analysis identified independent risk factors., Results: A total of 113 patients were evaluated. The median time to hysterectomy was 9.1 weeks (range 5.8-12.8 weeks). Post-hysterectomy, 36 patients (31.8%) were diagnosed with endometrial carcinoma, all endometrioid type. Of these, 88.9% were stage I per the International Federation of Gynecology and Obstetrics classification system, and 11.1% were at high risk for nodal metastasis. Predictive factors for occult carcinoma included the intraoperative gross lesion size (2 cm or larger and less than 2 cm) and endometrial aspiration. Adjusted odds ratios were 6.723 (95% CI 2.338 to 19.333) for lesions 2 cm or larger, 3.381 (95% CI 1.128 to 10.132) for lesions less than 2 cm, and 2.752 (95% CI 1.092 to 6.936) for endometrial aspiration., Conclusions: Occult endometrial carcinoma was identified in 31.8% of patients with a pre-hysterectomy EIN diagnosis. The significant predictors were endometrial aspiration and the presence of a gross lesion during surgery., Competing Interests: Declarations. Ethics norm or standard: The research was conducted in accordance with the principles outlined in the Declaration of Helsinki. Human ethics and consent to participate declarations: Human Ethics and Consent to Participate declarations: not applicable. Consent to participate: Since no individual participants were involved, there was no need for a consent to participate. Competing interests: The authors indicate no potential conflicts of interest., (© 2025. The Author(s).)

Background: The lower humoral immunity response after the COVID-19 vaccine in kidney transplant recipients (KTR) has been reported in several studies. However, there are few studies on the efficacy of the ChAdOx1 nCoV-19 (AstraZeneca) vaccine compared between various immunosuppressive regimens., Methods: We conducted a prospective cohort study at Siriraj Hospital, Bangkok, Thailand. Adult KTRs who received two doses of the ChAdOx1 nCoV-19 vaccine at intervals of 3 months were enrolled. Anti-SARS-COV-2 S-RBD-IgG antibody (anti-RBD) was assessed at the one month after the second dose and considered positive if the level ≥50 AU/mL or 7 BAU/mL. The primary outcome was the seropositivity of anti-RBD. The association between type, dose, and level of immunosuppressive regimen and anti-RBD seropositivity was analyzed., Results: Between October 2021 and January 2022, 139 KTRs with a median time of 55 months (IQR, 29-102 months), were enrolled. The mean age was 49.1 ± 11.3 years and 64.7 % were men. Seroconversion of anti-RBD was found in 72 patients (51.8 %). The seropositive rate was significantly higher in KTR who received tacrolimus (TAC)/everolimus (EVR)/prednisolone (CS) immunosuppression than EVR/mycophenolic acid (MPA)/CS and TAC/MPA/CS, respectively (95 % vs. 65 % vs. 34 %; p  < 0.001). The MPA-containing regimen is associated with an inferior humoral response (OR 0.02, 95%CI 0.01-0.16; p  < 0.001). In contrast, KTRs who received EVR had the highest immunogenic response (OR 12.97, 95%CI 4.69-35.84; p  < 0.001). During the 11-month follow-up period, COVID-19 pneumonia occurred in 3 KTR in the seronegative group and none in the seropositive group., Conclusion: The anti-RBD response after ChAdOx1 nCoV-19 vaccination was revealed in 51.8 % of the KTR. KTRs who received the TAC/EVR/CS regimen had the highest immune response after vaccination, relatively comparable to the general population. The immunosuppressive regimen should be considered for a further vaccine dose in KTR., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 The Authors.)

This study aimed to investigate the role of myosteatosis, sarcopenia, and perioperative serum biomarkers as independent predictors of major complications within 180 days following radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). We retrospectively analyzed of 127 MIBC patients who underwent RC between 2013 and 2023 at a single institution. Preoperative body composition was assessed using CT scans at the L3 vertebral level to measure psoas muscle density (PMD), skeletal muscle density (SMD), axial muscle density (AMD), and muscle indices. Novel inflammatory and nutritional markers, including serum chloride levels within 24 h post-surgery, were also evaluated. Major complications were defined as Clavien-Dindo grade ≥ 3. Multivariate analysis was performed to identify independent predictors of postoperative complications. Among the cohort, 30.7% of patients experienced major complications within 90 days, and 36.2% within 180 days. Sepsis was the most common major complication (19 of 241 complications, 7.9%). Ten patients died during the observation period. Myosteatosis (p = 0.002) and postoperative serum chloride levels (p < 0.001) were significant independent predictors of 180-day major complications. Patients with low PMD had an adjusted odds ratio (OR) of 3.959 for developing major complications, while increased serum chloride levels were associated with a reduced risk of complications (OR = 0.985). Multivariate analysis reveals associations between myosteatosis, aging, and anemia. Myosteatosis and perioperative serum chloride levels are significant predictors of major complications after RC for MIBC. Incorporating body composition analysis and early serum chloride monitoring into perioperative care may improve risk stratification and patient outcomes following RC., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO 2 ) to maintain oxygen saturation by pulse oximetry (SpO 2 ) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation., Methods: This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO 2 was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO 2 to maintain an SpO 2 of at least 94%. The primary outcome was the time in the SpO 2 range between the two groups. The secondary outcomes included FiO 2 , transcutaneous carbon dioxide pressure (PtcCO 2 ), respiratory rate oxygenation (ROX) index, and hemodynamic variables., Results: HVNI with OAM significantly maintained SpO 2 within the target range compared to conventional HVNI [99.4% (97.4-99.8%) vs. 5.3% (1.5-68.1%); P=0.001]. The use of FiO 2 was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) vs. 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) vs. 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO 2 or hemodynamic variables were observed between the two groups., Conclusions: HVNI with OAM can maintain SpO 2 within the target range while using a lower FiO 2 and providing a higher ROX index than conventional HVNI in patients after extubation., Trial Registration: This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1345/coif). N.R. reports that devices including oxygen assist module, disposable high-velocity nasal insufflation circuits, and nasal cannula were provided by Vapotherm Inc. (New Hampshire, USA). The other authors have no conflicts of interest to declare., (Copyright © 2025 AME Publishing Company. All rights reserved.)

Seizure is a relatively common neurological consequence after spontaneous intracerebral hemorrhage (SICH). This study aimed to investigate risk factors of early, late, and overall seizures in patients with SICH. Retrospective analysis was performed on all patients with SICH who completed two years of follow-up. The variables collected were obtained from demographic, clinical, radiographic and treatment data, in-hospital complications, and follow-up results. Univariate and multivariate analyzes were used to identify risk factors for post-hemorrhagic stroke seizure. Of 400 SICH patients recruited, 30 (7.5%) and 40 (10%) developed early and late seizures during the 2-year follow-up period, respectively. In the final result of the multivariate analysis, factors associated with the occurrence of the early seizure included lobar location of hematoma (p = 0.018), and GCS ≤ 12 on initial clinical presentation (p = 0.007). Factors associated with the occurrence of the late seizure included lobar location of hematoma (p = 0.001), volume of hematoma greater than 10 ml (p = 0.009), and midline shift on initial cranial CT (p = 0.036). Risk factors of the overall seizure after SICH included lobar location of hematoma (p < 0.001), volume of hematoma greater than 10 ml (p < 0.001), and craniotomy with evacuation of hematoma (p = 0.007). Furthermore, seizure was also associated with a poor functional outcome 2 years after the onset of SICH. Several factors associated with the appearance of post-ICH seizures were revealed. In patients with increased risk of post-SICH seizures, appropriate surveillance and management of seizures should be carried out., Competing Interests: Declarations. Ethical approval: This research was ethically approved by Siriraj Institutional Review Board (SIRB), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Certificate of Approval (COA) number Si 079/2021. Patient data in the study were kept confidential according to the Declaration of Helsinki. Consent to participate: Written informed consent to participate was not required for this retrospective study. Consent for publication: No personally identifiable data from research participants was revealed in the present article. Written informed consent for publication was not required for this study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Sedation practices for colonoscopy indeed vary widely around the globe. Due to a lack of data on intravenous paracetamol, we aimed to investigate the clinical efficacy of intravenous paracetamol compared to intravenous fentanyl under propofol deep sedation for colonoscopy., Methods: A total of 225 patients who underwent colonoscopy at Siriraj Hospital were randomly assigned to two groups. All patients underwent deep sedation with propofol and received intravenous (iv) paracetamol (group P, n = 113) or iv fentanyl (group F, n = 112). All patients received a premedication of 0.02-0.03 mg/kg of midazolam intravenously. Fifteen to thirty minutes before the procedure, patients in group P were administered 1000 mg of iv paracetamol, while those in group F received 0.001 mg/kg of iv fentanyl. All patients were oxygenated with 100% O 2 via a nasal cannula, and deep sedated with titrated intravenous propofol. The primary outcome measure was the success rate of colonoscopy. The colonoscope reaching the ileocecal valve was an important marker for a successful colonoscopy. Secondary outcome measures included endoscopist and patient satisfaction, patient tolerance, ease of the procedure, and sedation-related complications during and immediately after the procedure., Results: All colonoscopies were successfully completed. There were no significant differences in patient characteristics, duration of the procedure, endoscopist and patient satisfaction, patient tolerance, or ease of the procedure between the two groups. However, group F experienced significantly higher rates of upper airway obstruction and oxygen desaturation during the procedure compared to group P. No serious complications were observed in either group., Conclusion: Intravenous paracetamol with propofol deep sedation in adult patients is non-inferior to intravenous fentanyl for successful colonoscopy completion. Sedation-related complications were relatively lower in the propofol deep sedation with iv paracetamol group compared to the propofol deep sedation with iv fentanyl group., Registration: This trial was registered with the Thai Clinical Trial Registry (TCTR 20190321002)., Competing Interests: The authors report no conflicts of interest in this work. The abstract of this paper was presented at the KPS 2021 Annual Meeting (The 72nd Scientific Meeting of The Korean Pain Society) as a poster presentation with interim findings., (© 2025 Thiparporn et al.)

Background: Chronic low back pain (LBP) has been associated with intervertebral disc (IVD) degeneration, but its association with abnormal morphology at the discovertebral junction (DVJ) is unclear. The goal of this study was to evaluate the DVJ morphology in asymptomatic (Asx) and symptomatic (Sx) subjects for LBP using ultrashort echo time (UTE) MRI. Methods: We recruited 42 subjects (12 Asx and 32 Sx). Lumbar IVD degeneration was assessed using Pfirrmann grading (1 to 5), while the abnormality of DVJ (0 = normal; 1 = focal; 2 = broad abnormality) was assessed using UTE MRI. The effects of LBP and level on the mean IVD and DVJ grades, the correlation between IVD and DVJ grade, and the effect of LBP and age on the number of abnormal DVJs within a subject were determined. Results: IVD grade was higher in Sx subjects ( p = 0.013), varying with disc level ( p = 0.033), adjusted for age ( p < 0.01). Similarly, DVJ grade was also significantly higher in Sx subjects ( p = 0.001), but it did not vary with DVJ level ( p = 0.7), adjusted for age ( p = 0.5). There was a weak positive (rho = 0.344; p < 0.001) correlation between DVJ and IVD grade. The total number of abnormal DVJs within a subject was higher in Sx subjects ( p < 0.001), but not with respect to age ( p = 0.6) due to a large spread throughout the age range. Conclusions: These results demonstrate the feasibility of using in vivo UTE MRI of the lumbar spine to evaluate the DVJ and the correlation of DVJ with LBP. This study highlights the need for a better understanding of DVJ pathology and the inclusion of DVJ assessment in routine lumbar MRI.

Objectives: This study examined the differences in brain volume and cortical thickness among individuals with normal cognition (NC) and those with NCDs, including mild cognitive impairment (MCI) and dementia. The aim was to identify the brain parameters supporting clinical decision-making for NCDs., Method: A total of 116 participants were categorized into dementia, MCI, and NC groups, and their brain scans using structural magnetic resonance imaging (MRI) were processed and automatedly analyzed with FreeSurfer to obtain the absolute brain volume, volume normalized by intracranial volume (ICV), and cortical thickness. Patients with dementia exhibited a significantly smaller brain volume and cortical thickness than the MCI and NC groups., Results: The left amygdala/ICV ratio demonstrated excellent performance in diagnosing early NCDs, with a cutpoint of ≤0.089, providing 83.30% sensitivity, 84.20% specificity, and 83.82% accuracy. For MCI, a cutpoint of ≤0.099 for the left amygdala/ICV yielded 96.70% sensitivity, 83.30% specificity, and 88.46% accuracy., Conclusions: The findings suggested that reductions in brain volume and cortical thickness correlate with cognitive decline. Utilizing FreeSurfer and MRI data, particularly the left amygdala/ICV ratio, may serve as a valuable biomarker for the early identification of individuals at risk for developing NCDs.

Background: Atrial fibrillation (AF) is a common condition leading to an increased risk of death and complications such as stroke. Even though direct oral anticoagulants (DOACs) can reduce the risk of ICH, the rate of DOAC use remains low in many Asian countries because of cost concerns., Objectives: The purpose of this protocol paper of the COOL-AF (COhort of antithrOmbotic use and cLinical outcomes in patients with Atrial Fibrillation) Phase 2 registry is to determine the rate of clinical outcome, changes in antithrombotic patterns, and their impact on clinical outcomes, and to develop a prediction model for clinical outcomes., Methods: The COOL-AF Phase 2 study is a prospective observational multicenter study of patients with known or newly diagnosed nonvalvular AF in Thailand. The aim is to achieve a sample size of 3,667 patients from 33 centers. Patients will be followed up every 6 months for up to 3 years. Data collection on and doses of oral anticoagulants (warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban) and antiplatelets are collected. The study outcomes include death, ischemic stroke/systemic embolism, major bleeding, myocardial infarction, heart failure, and quality of life. All events will be adjudicated., Results: Enrollment started in June 2024. The results of the COOL-AF phase 2 registry will be reported when enrollment is complete and one year of follow-up data is available., Conclusions: The COOL-AF Phase 2 trial will provide valuable information about the real-world practice of AF management and outcomes in Asia, which should be able to improve AF outcomes in the future. (COhort of antithrOmbotic Use and cLinical Outcomes in Patients With Atrial Fibrillation [COOL-AF] Phase 2; NCT06396299)., Competing Interests: This study was funded by grants from the Health Systems Research Institute (grant number 67-057) and the Heart Association of Thailand under the Royal Patronage of H.M. the King. None of the aforementioned funding sources influenced any aspect of this study or the authors' decision to submit this paper for publication. Dr Lip has served as a consultant and speaker for Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos; no fees are received personally. All other authors have reported that they have no relationships relevant to the contents of this study to disclose., (© 2025 The Authors.)

Background: Sex inequality in randomized controlled trials (RCTs) related to cardiovascular disease has been observed. This study examined the proportion of women enrolled in atrial fibrillation (AF) ablation RCTs and the potential risks of underrepresentation of women., Methods and Results: We systematically searched PubMed and Embase for AF ablation RCTs published from 2015 to 2022. Participant characteristics were compared among trials with higher and lower proportions of women. Of 147 AF ablation RCTs (30,055 participants), only 10 trials had enrolled women ≥50% of the total participants. Additionally, 42 trials (28.57%) excluded pregnant/breastfeeding women; 6 (4.1%) excluded reproductive-age women without reliable birth control. The proportion of women in AF RCTs ranged from 9% to 71% (median 31.5%), whereas the median proportion of men was 67.7%. The rate of women included in the trials was stable from 2015 to 2022 ( P =0.49). Study characteristics, including funding source, showed no correlation with the rate of inclusion of women. RCTs with a higher proportion of female participants enrolled older patients with AF, had a higher prevalence of hypertension but less persistent AF, and smaller left atrium size ( P <0.05 for all). Biological sex was evaluated as a risk factor or in a subgroup analysis in 28 RCTs; 10.7% of these trials observed the implication of sex on their results., Conclusion: Women were underrepresented in contemporary AF ablation RCTs. Additionally, women enrolled in AF RCTs were likely to have more comorbidities but less advanced AF, limiting the applicability of the results to women with AF.

Purpose: To describe the top three causative organisms of hospital acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in Thailand., Patients and Methods: This multi-center retrospective cohort study included HAP/VAP patients hospitalized in 2019 in three university-affiliated hospitals and a private hospital in Bangkok, Thailand. Medical records of patients with a documented diagnosis of nosocomial pneumonia (NP) were systematically reviewed to collect data on demographic, clinical, microbiological, and 30-day readmission due to NP., Results: A total of 240 patients were included in the study, comprises patients with VAP (62.9%), HAP (36.7%), and ventilated HAP (vHAP) (0.4%). All of the patients had late-onset NP, occurring after five days of hospitalization with median time to NP of 13 days (interquartile range [IQR] 6-25 days) from admission. The top three causative pathogens of NP were Acinetobacter baumannii (44.2%), Pseudomonas aeruginosa (34.6%), and Klebsiella pneumoniae (28.3%). A high rate of carbapenem resistance (CR) in A. baumannii (92.5%) was observed. Lower rates of CR were observed in K. pneumoniae (20.6%) and P. aeruginosa isolates (16.9%). Readmission rate due to NP within 30 days after discharge was less than 2% with median time of 4 days (IQR 3-20 days) after discharge. After diagnosis of NP, 19 patients were transferred to intensive care units with median length of stays of 11 days (IQR 3-24 days). Fifty-one percent of HAP patients received mechanical ventilation support after the diagnosis of NP with median length of mechanical ventilation use of 12 days (IQR 6-22 days)., Conclusion: A. baumannii , with its significant carbapenem resistance, presents a major HAP/VAP pathogens and imposes a substantial burden on healthcare resources in this study. Implementation of regular surveillance for causative organisms of NP and their susceptibility profiles are critical for the success of HAP/VAP management, and reducing the related burden of healthcare resources., Competing Interests: The authors (Y.R., R.P., S.P., and T.K.) report no conflicts of interest in this work. VH is a full-time employee of IQVIA Inc. that was commissioned to conduct of this study. This study was financially supported by MSD (Thailand) Co. Ltd. The funder of the investigators and study had no role in data collection, data analysis, data interpretation, or writing of the manuscript., (© 2025 Rongrungruang et al.)

Visible light has been considered to have minimal impact on the skin. However, the increasing use of electronic devices has led to a significant increase in exposure to visible light, especially blue light. We measured the irradiance (mW/cm 2 ) and estimated dose (J/cm 2 ) of visible light and blue light emitted from various electronic devices including smartphones, tablets and computers. The measurement was done in normal screen mode and night shift mode at different brightness levels and distances across six screens. The irradiance and dose of visible light and blue light corresponded to the brightness, distance, and screen size of the devices. This study has shown that the irradiance and dose of visible light and blue light emitted from electronic devices in daily use are small and unlikely to be harmful to human skin., Competing Interests: All authors declare no conflicts of interest in this work., (© 2025 Charoenpipatsin et al.)