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การวิจัยทั้งในเชิงลึก เพื่ อสร างองค ความร ูใหม ทางวิทยาศาสตร การแพทย และในการประยุกต. องค ความร ูเพื่ อการปรับปรุงสุขภา

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STRATEGIC PLAN FOR SIRIRAJ MEDICAL SCHOOL We want to put ourselves on the global map of biomedical science, as well as to translate the rapidly evolving knowledge and technology to improve the health of Thai people. Our unique interactive clinical and scientific environment, together with a cutting edge technology and international collaboration, offers a good potential for great science with a tangible impact on human health. We need to better utilize our research resources and capabilities in order to excel in the international research community. While focusing on high impact research, we wonít neglect research that lead to achievable outputs and outcomes that are relevant and applicable for our Thai community. We value ideas and innovations. We encourage our researchers to think big, think global, make it happen and put best effort to apply the research out comes for the advancement of science and medical care.

Mission and Goals We envision clinicians and scientists in the medical school working together with passion to bring about the best in science and to drive the medical school toward scientific excellence. Our mission is to conduct research with a realistic impact in the advancement of science and healthcare services, especially in the areas of high priority for the country. To fulfill the mission in our new environment of expanding research facilities, we strive toward the following goals: Ø Expand research capacity through personnel mobilization and recruitment, Ø Promote scientific excellence and collaboration by supporting outstanding research groups, Ø Increase research output through better supporting and management systems, Ø Create and foster new ideas, Ø Promote better utilization of clinical resources in clinical and biomedical research, Ø Expand the integration of postgraduate education into all research areas,

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Ø Ensure adaptability and flexibility through an independent managing body, and Ø Secure research funding through partnership with national funding agencies. Strategic assessment Siriraj Medical School is a large medical center with enormous potential clinical resources for biomedical and clinical research. The medical school also contains biomedical research units, which excel in many areas including infectious diseases, genetics, cancer and metabolic diseases. The intermingling environment between clinical and biomedical sciences offers an ideal set-up for advanced research with a high impact. Being in a developing country, we are aware of our limitations in global competitiveness. Nevertheless, there are niche areas, in which we can excel and contribute significantly to the global scientific community. These niche areas are not only areas of less global interest but also priority areas, in which we are in an advanta geous position of having access to target populations at risk, for example emerging infectious diseases including avian influenza. Siriraj Medical School is entering an expansion phase. A new research center equipped with state-of-the-art technology will be established within 3 years. This is a great opportunity as well as a great challenge. Considering a large number of faculties, research output of the medical school could have been higher. The most important obstacle at present is the clinical workload. Unstructured workload distribution among faculty members has led to a bias toward routine clinical service. Overwhelmed with clinical, teaching and administrative duties, the faculties have been unintentionally forced to minimize their effort on research. We will seriously and systematically address this problem. We need to change not only the workload management scheme but also the mindset of the faculties. We need to allocate more workforces on research activities. More research support will be provided in order for the faculties to maximize output from their limited available time. Strategic initiatives To achieve the goal of expanding research capacity, we will implement the following initiatives: Ø Mobilization of young faculties with high research potential from clinical service sectors to clinical and basic research sectors.

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Establishment of Research Proposal Development Program for faculties. Structured workload management scheme for all faculty members. Recruitment of young scientists through a postdoctoral research program. Recruitment of outstanding researchers from outside with attractive research funding and benefits. Research-oriented human resource development. To achieve the goal of scientific excellence we will implement the following initiatives: Postdoctoral and research assistant programs targeted to excellence research groups. Co-funding strategy to enhance competitive edge of excellence research groups. To achieve the goal of increased research output, we will implement the following initiatives: Establishment of the Research Management Unit, which will comprehensively and proactively manage research projects in targeted areas. Establishment of the Research Editing Assistance Unit to assist young researchers in proposal and manuscript writing. To create and foster new ideas, we will implement the following initiative: Proposal development workshops which will be arranged regularly as needed. To maximize the utilization of clinical resource for research, we will implement the following initiatives: Expansion of the Routine-to-Research (R2R) program and the Clinical Research Unit. Establishment of the Clinical Database Management Unit. To achieve the goal of expanded integration of postgraduate education into all research areas, we will implement the following initiatives: Encouragement for clinicians who conduct biomedical research to accept postgra duate research students. Establishment of new research-oriented post-graduate programs in clinical depart ments and preclinical departments in order to bridge the gap between clinical and preclinical departments. To ensure adaptability and flexibility, our initiative is: Establishment of the independent Siriraj Research Fund and the Research Management Unit. To achieve the goal of secure research funding, we will implement the following initiative: Project-based co-funding and partnership with the national granting agencies (TRF and NSTDA).

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Prioritization and implementation The initiatives will be led by the Deputy Dean for Research, the Deputy Dean for Academic Affairs, and the Head of the Department for Research and Development, and other members of the Faculty Committee as appropriate. For the year 2007 ñ 2008, 7 out of 18 initiatives will be implemented: Ø Establishment of the independent Siriraj Research Fund and the Research Manage ment Unit. An amount of 500 million baht will be allocated for the establishment of the Fund. An outline of the regulation has been drafted by the Deputy Dean for Research through consultation with involving parties. The regulation is planned to be submitted to the University Council for approval in early 2007. After the approval, the Research Management Unit will be established directly under the steering committee of the Fund. The establishment will get managerial assistance through a partnership with the National Health Foundation. The Research Manage ment Unit and the Siriraj Research Fund are expected to fully function within the year 2007. These two bodies are responsible for coordination and management of all research projects and activities funded by the medical school through the Siriraj Research Fund. Ø Mobilization of young faculties with high research potential from clinical service sectors to clinical and basic research sectors. Ø Establishment of Research Proposal Development Program for faculties The Deputy Dean for Research and the Deputy Dean for Academic Affairs will work together with departmental senior representatives to guide young faculties for their career path development choice. Ones with high potential in research will be identified and persuaded to spend their early years as full-time researchers. Proposal develop ment grant will be available for these beginners. Other supports, such as mentoring and laboratory space will be provided by the Office of Research and Development. The program will be implemented with a target of 20 new researchers in the first year (2007). Ø Structured workload allocation of all faculty members. The Deputy Dean for Human Resource Development will work with heads of the departments to restructure facultiesí workload allocation in order to have at least 1/3 of the total workload allocated to research activities by the year 2008. The allocated workload for each individual will have specific tangible indicators, such as amount of research grant, number of research projects approved by IRB, and number and impact factor of publication.

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Ø Editing Assistance Unit will be established to assist young researchers in proposal and manuscript writing. The Deputy Dean for Research will set up a group of editing assistants supervised by selected experienced researchers. The task of this group is to identify and assist researchers within the medical school who have high research potential, but still need some assistance and advice on proposal and manuscript writing. This initiative will be started in 2007 with a target of 30 proposals or manuscripts per year. Ø Proposal development workshops will be arranged regularly as needed. The Deputy Dean for Research and the Head of Office for Research and Develop ment will arrange workshops to facilitate development of new research project. We set a target of 20 projects per year to be developed through this system. Ø Postdoctoral and research assistant program targeted to excellence research groups. The Research Management Unit will implement this program as well as other supporting activities targeted to excellent research groups. The postdoctoral and research assistance program has been approved by the Executive Faculty Committee in July 2006 and will be temporarily launched by the office of Deputy Dean for Research until the Research Management Unit has been established. Other remaining Research Programs strategic initiatives will be pursued as resources and opportunities permit.

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Siriraj House-dust Mite Allergen Vaccine Development Project Allergy Group : An extensive collaboration of the Department of Pediatrics, Department of Parasitology, Department of Immunology, Department of Internal Medicine and Department of Otorhinolaryngology Facalty of Medicine Siriraj Hospital n

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Background : According to several population-based surveys in Bangkok and other big cities, approximately 18 millions Thai Children and adults are suffering from respiratory allergic diseases. Current diagnostics and therapeutics depend heavily on imported materials and technologies affecting high healthcare cost. Allergen extracts and vaccines with proven efficacy for diagnosis and treatment have been produced in Siriraj Hospital for nearly thirty years. Objectives: To develop two types of house-dust mite (HDM) vaccines (Dermatophagoides pteronysrinus, Dp, and Dermatophagoides farinae, Df, the most common allergen in Thai allergic sufferers) of international standard and are licensed for commercial purpose by the Thai Food and Drug Administration (FDA). Materials and methods The study was divided into 4 subprojects namely : Subproject 1 : Vaccine production Subproject 1.1 To establish HDM culture method and provide good quality raw material Subproject 1.2 To maximize the extraction method which is also reproducible and minimize cost Subproject 2 : Vaccine standardization To establish method of standardization, i.e. protein content and composition, major allergen content, total allergenic potency and vaccine component. Stability of raw material and vaccine will be studied. Subproject 3 : Bioequivalence study in human subjects. Subproject 4 : Management, quality control and preparation for licensing Results Ninety-nine percents purity of HDM (Dp, Df) was produced by using Siriraj mite food formula. The quality was comparable or superior to commercial raw materials. Both species of HDM were extracted by a optimized extraction process. The semi-finished product and vaccines were found to be comparable to CBER reference standard and commercial vaccines. The stability study of raw material and vaccine was already designed as well as proposal of the bioequivalence study Discussion At present, Siriraj has produced, at the laboratory-scale, two standardized ÈÔÃÃÔ Òª : àÊ¹·Ò§Ê¤Ù ÇÒÁà»¹àÅÔÈ´Ò¹¡ÒÃÇÔ¨ÂÑ

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HDM vaccines from Dp and Df. They are comparable to the reference vaccines from CBER, US-FDA, and other commercialized HDM vaccines. However, in order to be licensed by the Thai FDA we have to produce the vaccine in a GMP standard factory and undergo bioequivalence study. Therefore, Siriraj is now collaborating with a private sector for a mass scale production of the vaccines for commercial purpose. Conclusion Two standardized HDM vaccines have been successfully produced from our own raw material which was 99% purified HDM. We are now in phase II of the study i.e. collaboration with a private sector for licensing and commercializing HDM vaccine.

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One-Year Outcome of Cardioversion of Rheumatic Atrial Fibrillation Rungroj Krittayaphong,1 Chunhakasem Chotinaiwatarakul,2 Rewat Pankingthongkum,1 Pradit Panchavinnin,1 Damras Tresukosol,1 Decho Jakrapanichakul,1 Busakorn Kitrattana,1 Charuwan Kangkagat3 1

Division of Cardiology, Department of Medicine,2 Her Majesty Cardiac Center, and Clinical Epidemiology Unit,3 Department of Research Promotion,3 Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand n

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Objectives: 1) To study the successful rate of electrical cardioversion after successful percutaneous balloon mitral valvuloplasty (PBMV) in patients with symptomatic mitral stenosis and 2) To study the rate of maintenance in sinus rhythm up to 1 year follow-up. Background: There has been no data on the outcome of cardioversion in rheumatic atrial fibrillation. Population: Patients with symptomatic moderate to severe mitral stenosis and atrial fibrillation who were scheduled PBMV Intervention: Electrical cardioversion 4 weeks after PBMV and amiodarone 200 mg/day started the day after PBMV. Measurements: Primary outcomes were rate of successful cardioversion and rate of maintenance of sinus rhythm at 12 months. Results: Of 272 patients acheduled for PBMV, 70 patients were enrolled, 21 (30%) of which were male. Average age was 45 ± 9.8 years. Sixty-nine (98.6%) patients were in NYHA class 2-3. Average mitral valve area was 0.82 ± 0.22 cm2. Cardioversion was successful in 50 patients (71.4%). Left atrial size, associated aortic valvular disease, and right ventricular systolic pressure (RVSP) were predictors for successful cardioversion. Atrial fibrillation recurred in 24 patients (48%). Increased left atrial diameter was the only factor associated with recurrence of atrial fibrillation at 12 months. Conclusion: Good candidates for cardioversion after PBMV were those with left atrial diameter < 60 mm, no associated aortic valvular disease and RVSP < 50 mmHg which is approximately 50% of patients with atrial fibrillation scheduled for PBMV. In this group, about two-thirds are in sinus rhythm at 12 months after cardioversion.

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Effect of Bosentan On Right Ventricular Mass Index, Right Ventricular Systolic Function, Oxygen saturation and NT-proBNP Levels In Patients With Eisenmenger Physiology Kritvikrom Durongpisitkul Department of Pediatrics Faculty of Medicine Siriraj Hospital n

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Introduction Recently, the BREATHE-5 study was performed to evaluate the theoretical risk of increased shunting (when the shunt is already right to left) as a result of a possible drop in systemic vascular resistance induced by bosentan. In this study, bosentan was shown to improve exercise capacity and decrease pulmonary vascular resistance in patients with Eisenmenger physiology, without worsening oxygen saturation1. This study is the first trial to assess the effects of bosentan, a dual endothelin receptor antagonist on right ventricular by using Cardiac MRI. It is designed as a prospective, open label, non-comparative, single arm, single center, 16 week trial, Phase IV study, will be performed to evaluate the effect of bosentan on right ventricular mass index and right ventricular systolic function by using cardiac MRI, NT-proBNP levels, oxygen saturation, resistance ratio by echocardiography, exercise capacity by 6-minute walk test, Dyspnea by Borg Dyspnea index, WHO functional class and safety and tolerability in Thai patients with Eisenmenger physiology at Siriraj hospital. The 16-week treatment period consists of an initial dosing phase (administration of bosentan 62.5 mg b.i.d. for 4 weeks), followed by an up-titration treatment phase (bosentan 125 mg b.i.d. for 12 additional weeks). Patients Male or female patients >18 years with a body weight >40 kg (inclusive) and with a functional class III (1998 WHO classification), evidence of right to left shunt was noted by echocardiography or previous cardiac catheterization, documented oxygen saturation > 90%, and >70% (at rest, with room air), able to perform a 6-minute walk test >150 m, >450 m, stable for at least 3 months prior to screening, bosentan naÔve, female patients who are surgically sterile, postmenopausal or have documented infertility or female patients of childbearing potential using one of the following methods of contraception: Barrier-type devices (e.g., condom, diaphragm) used

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ONLY in combination with a spermicide. A double-barrier method is recommended; intrauterine devices (IUDs); oral or implanted contraceptives, if used in combination with a barrier method, patients providing written informed consent. Patients will be excluded from the trial if they are pregnant or nursing mothers, with left ventricular dysfunction (ejection fraction 1.5 mg/dL, hemoglobin concentration ≤ 14g/dL, AST and/or ALT values greater than 3 times the upper limit of normal, started or stopped treatment for other types of PAH within one month of screening, excluding anticoagulation and patients who are receiving vasodilators including, but not limited to epoprostenol or prostacyclin analogues, or are expected to receive any of these drugs during the study, receiving calcineurin inhibitors (e.g. cyclosporine A and tacrolimus), fluconazole, glibenclamide (glyburide) within 1 week of inclusion or who are expected to receive any of these drugs during the study, active on organ transplant lists, taking phosphodiesterase inhibitors or endothelin receptor antagonists (other than bosentan) or any other investigational drugs/devices, planned surgical intervention during the study period, known hypersensitivity to bosentan or any of the excipients. Cardiac MRI: Magnetic Resonance Imaging (MRI) is emerging as a useful tool in the diagnosis and follow-up of patients with PAH. Published data shows good quantification of RV changes in PAH patients treated with epoprostenol or sildenafil2, 3 . In this study, MRI studies will be performed by a 1.5 T system (Gyroscan NT, Philips, Best, the Netherlands) equipped with fast gradients (23-mT/m amplitude, 105mT/m per ms slew rate) and a dedicated cardiac phase-array surface coil. ECG leads were attached to the chest for cardiac gating. Structural abnormality will be assessed by the spin echo or black blood technique and functional abnormality will be assessed by the gradient echo or white blood technique. Using a breath-hold technique, the static images will be obtained by T1-weighted double inversion recovery spin echo and fat suppression scans by STIR Short Tau Inversion Recover (STIR) technique. NT-proBNP levels: Plasma brain natriuretic peptide (BNP) is secreted by ventricular myocardium in response to ventricular strain4 and cleaved into the inactive N terminal proBNP (NT-proBNP) and the active BNP5. BNP is elevated in various form of PAH including idiopathic PAH (iPAH), PAH associated with interstitial lung disease, with congenital systemic-to-pulmonary shunts, with chronic obstructive pulmonary disease, and in chronic thromboembolic pulmonary hypertension6. BNP levels increase in proportion to the degree of right ventricular dysfunction and have also been described ÈÔÃÃÔ Òª : àÊ¹·Ò§Ê¤Ù ÇÒÁà»¹àÅÔÈ´Ò¹¡ÒÃÇÔ¨ÂÑ

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as an independent predictor of mortality 7, 8, 9. NT-pro-BNP is highly stable in plasma and has been described as a marker of pulmonary hypertension in patients with systemic sclerosis 10, 11 more recently iPAH12. This study will also examine changes in NT-proBNP levels (as a measure of RV stress), at baseline as well as throughout a 16-week treatment period with bosentan. Echocardiography by Doppler: Measurement of pulmonary vascular resistance (PVR) is an important evaluation in the management of Pulmonary Arterial Hypertension. Noninvasive estimation of this parameter using Doppler echocardiography may be an alternative to repeated right heart catheterizations. The ratio of peak tricuspid regurgitant velocity (TRV, ms) to the right ventricular outflow tract time-velocity integral (TVI (RVOT), cm) obtained by Doppler echocardiography (TRV/TVI (RVOT) may provide a clinically reliable method to determine PVR. This study will examine changes in this ratio as measured by Doppler echocardiography at baseline and after 16 weeks of treatment with bosentan. Statistical Methodology: The change from baseline to week 16 in right ventricular mass index using MRI technique. A standard statistical calculation for continuous outcomes will be used for a two-sided test, with alpha level 0.05 and power of 80% to detect a 20% change in RV mass index. Assumptions are a standard deviation of 26 g and mean RV mass index of 126 g (Saba, T.S., Eur Respir J2002; 20: 1519 ñ 24) References: 1. Nazzareno G. Maurice B., Michael A. G. et al, Bosentan Therapy in Patients with Eisenmenger Syndrome: A Multicenter, Double-Blind, Randomized, PlaceboControlled Study., Circulation 2006; 48 ñ 54. 2. Roeleveld, R, Vonk-Noordegraaf, A, Marcus, J et al. Effects of Epoprostenol on Right Ventricular Hypertrophy and Dilatation in Pulmonary Hypertension. CHEST 2004; 125:572ñ579. 3. Michelakis, E, Tymchak, W, Noga, M. Et al. Long-Term Treatment With Oral Sildenafil Is Safe and Improves Functional Capacity and Hemodynamics in Patients With Pulmonary Arterial Hypertension. Circulation. 2003; 108:20662069. 4. Cowie MR, Mendez GF. BNP and congestive heart failure. Prog CV Disease 2002; 44:293ñ321. 5. Cowie, MR. B-type natriuretic peptide testing: where are we now? Heart 2004; 90:720-726 6. Aubert, J-D. Biochemical markers in the management of pulmonary hypertension. Swiss Med Wkly 2005;135:43-49.

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7. Nagaya N, Nishikimi T, Uematsu M, et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension Circulation 2000; 102: 865ñ870. 8. Nagaya N, Nishikimi T, Uematsu M, et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension J Cardiol 2001; 37: 110ñ111. 9. Nagaya N, Nishikimi T, Okano Y, et al. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension J Am Coll Cardiol 1998; 31: 202ñ208. 10. Allanore Y, Borderie D, Meune C, et al. N-terminal probrain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers Arthritis Rheum 2003; 48: 3503ñ3508. 11. Mukerjee D, Yap LB, Holmes AM, et al. Significance of plasma N-terminal probrain natriuretic peptide in patients with systemic sclerosis-related pulmonary arterial hypertension Respir Med 2003; 97: 1230ñ1236. 12. Souza, R, Bogossian, H, Humbert, M. Et al. N-terminal-pro-BNP as a haemody namic marker in idiopathic pulmonary arterial hypertension. Eur Respir J 2005; 25: 1ñ5.

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The Dementia and Disability in Thai Elderly: Prevalence of mild cognitive impairment and dementia in community dwelling Thai Elderly Vorapun Senanarong,1 Kamolthip Harnphadungkit,1 Niphon Poungvarin,1 Sathit Wannasaeng,1 Samut Chongwisal,1 Tipa Chakorn,1 Wattanachai Towattrakul,1 Piyanuch Jamhumrus,1 Uraiwan Sijiraschato,1 Kanokrat Sukhatungka,1 Akanitha Sriboonroung,1 Jariya Lertakyamanee,1 Suthipol Udompunthurak,1 Jeffrey L Cummings,2 Rachelle S Doody3 1 Faculty of Medicine Siriraj Hospital Mahidol University, Thailand 2 UCLA Alzheimerís Disease Center, California, USA 3 Baylor College of Medicine, Texas, USA n

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Objectives: We surveyed the elderly living in the catchmentís areas of Siriraj Hospitalís primary care unit in Bangkok during the year 2004. We determined the frequencies of cognitive impairment non-dementia (or mild cognitive impairment), dementia, disability, and neuropsychiatric problems among these elderly and established the etiologies of all cases of dementia. Subjects and Methods: We screened Thai elders all age 60 and above in 2004 with a comprehensive geriatric assessment to determine possible disabilities, Thai Mental State Examination (TMSE), Thai Activity of daily living (ADL), Neuropsychiatric Inventory (NPI), standard neuropsychological tests with cultural adjusted norms including attention, memory, executive function, visuospatial and naming tasks, Geriatric Depression Scale (GDS)and Tinetti gait assessment. Hearing was assessed by standard audiometry. Magnetic resonance imaging of the brain and blood tests were offered to those with MCI and dementia and to 30 cases of normal elders. We diagnosed dementia by DSM IV criteria. SPSS 11 was used for statistical analysis. V isua l R ating of M T A E xam ple s

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Skin Disorders and Quality of Life Sukhum Jiamton, MD, PhD Department of Dermatology Faculty of Medicine Siriraj Hospital n

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Background: Skin disorders had been demonstrated to have impacts on quality of life in various aspects. This presentation aims to show the method to evaluate the validity and reliability of the Thai version of the DLQI and show the application of this tool in other skin disorders. Methods: The Dermatology Life Quality Index (DLQI) is a simple and validated 10item Engligh language-questionnaire designed to measure and compare disability resulting from skin disorders. Dr. K Kulthanan had been given formal permission from Dr. A.Y. Finlay to use and translate DLQI into Thai. After the translation of the questions into Thai and back to English by a bilingual person, the validity of DLQI in Thais was performed among 200 patients who had skin disorders compared to 100 healthy volunteers. In addition, the reliability was also assessed among 50 patients using a 1 week test-retest method. Results: It took 1 to 5 minutes to complete the Thai version DLQI questionnaire. The mean overall DLQI score of the 200 patients in this study was 9.8 (SD 6.9), and among controls was 0.7 (SD 1.2). The scores of the patients who had skin disorders such as urticaria, psoriasis, eczema and acne were significantly higher than those of the control group (p T) in a 20-year-old Caucasian female diagnosed with ADNDI at 2 years of age. This finding of a novel mutation substituiting cysteine with phenylalanine in one AVP-NPII gene allele supports the hypothesis that inability to form normal disulfide bonds in neurophysin II leads to ADNDI. Santiprabhob J, Browning JE, Repaske DR. A missense mutation encoding Cys73Phe in neurophysin II is associated with autosomal dominant neurohypophyseal diabetes insipidus. Mol Genet Metab. 2002;77:112-8. (impact factor = 2.678)

Pedigree of proband. Affected subjects are shown as solid symbols

A. Normal nucleotide G at position 1684; B. A missense mutation G to T at position 1684, predicting a Cys73Phe substitution

In order to determine the etiologies of central DI among Thai children, we retrospectively reviewed records of 67 patients who were diagnosed with central DI between 1996 and 2003. This study revealed that CNS malformations were the most common etiologies, followed by intracranial tumors and their treatments. ADNDI, which is found in Caucasian was not the cause of central DI among Thai children. Santiprabhob J, Likitmaskul S, Boonyasiri A, Boonsathorn S, Buddawong T. Etiologies of central diabetes insipidus in Thai children. J Pediatr Endocrinol Metab. 2005;18:653-61 (impact factor = 0.841)

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Characterization of the Quorum-Sensing System in Burkholderia pseudomallei Pattarachai Kiratisin Department of Microbiology

The quorum-sensing (QS) system is a bacterial intercellular communication mechanism (cell-to-cell signaling) for controlling gene expression in response to population density. The system composes of 2 key elements; transcriptional factor (R) and autoinducer (I). The chemical structure of I in gram-negative bacteria is mostly acyl homoserine lactone (HSL). This system has been implicated for the regulation of virulence in many bacteria. Burkholderia pseudomallei (BP) is a human pathogen that is endemic in Thailand and often causes lethal infection. Its pathogenic mechanism is not well understood. This study aims to characterize the QS system in BP, and later explore its role in the pathogenesis.

The genetic study found that BP contains at least 5 R genes (bpsR1-5) and 3 I genes (bpsI1-3) distributed in both chromosomes (left fig). This is an unusual phenomenon as most bacteria carry 1-2 pairs of R and I genes in which I gene is regulated by the corresponding R gene. We study the relationships of each R and I gene. The activation of I gene by R may lead to the control of virulence in BP. Using the plasmid-based expression system, our results showed that bpsI1 had a limited activity with out R and additional HSL, while bpsI2 and bpsI3 had high basal levels (middle fig). With the presence of bpsRs (bpsR4 under investigated), there were no changes for bpsI1 and bpsI2. However, bpsI3 seemed to be suppressed by any bpsRs. The bpsI1 was only activated by the presence of bpsR1 and C8-HSL, with the saturation at 1 uM of C8-HSL (right fig). However, bpsI2 and bpsI3 were not activated by any bpsR with any HSL (not shown). The data suggested the unique characteristics of QS system in BP that have never been seen in other bacteria.

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Diabetes Camp for Patients with Type 1 Diabetes Jeerunda Santiprabhob Division of Endocrinology, Department of Pediatrics For patients with type 1 diabetes mellitus (T1D) to have an optimal glycemic control, they require knowledge and understanding of diabetes self-management skills. This knowledge should be provided by a multidisciplinary team experienced in T1D. Siriraj Diabetes Center has organized biennial 5-day diabetes camps since 1990. The goal of the camp is to broaden knowledge in diabetes self-management skills for patients with T1D. A retrospective study from the eight diabetes camp held in 2003 revealed that patients had significant improvement in glycemic control at three-month follow-up. Santiprabhob J, Likitmaskul S, Sriwijitkamol A, Peerapatdit T, Sawathiparnich P, Nitiyanant W, Angsusingha K, Tuchinda C, Tandhanand S. Improved glycemic control among Thai children and young adults with type 1 diabetes participating in the diabetes camp. J Med Assoc Thai. 2005;88 Suppl 8:S38-43

A prospective study was conducted at the ninth diabetes camp organized in April 2005. This study analyzes benefits from the diabetes camp. We found that the camp experience provided a valuable lesson for patients by encouraging them to be more responsible for their diabetes self-care, to build friendships, and to have a better attitude towards having diabetes. Although the effect of the camp on glycemic control is short-lived, the psychosocial benefits and knowledge gained by patients were invaluable. These findings underline the importance of including a camp in a management plan for patients with T1D. Also, an on-going and repeated education provided by experienced medical team is required to improve patientsí long-term glycemic control. Santiprabhob J, Likitmaskul S, Kiattisakthavee P, Weerakulwattana P, Chaichanwattanakul K, Nakavachara P, Peerapatdit T, Nitiyanant W. Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp (submitted) This study was supported by Siriraj Routine to Research Management Fund

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Diet-Induced Hormonal Responses in Thais Supornpim Chearskul Department of Physiology HC-LFLP LC-HFHP

Glucose (mmol L-1)

A 10 9 8 7 6 5 # 4 3 2 1 0 -3 B 800 700 600 500 400 300 200 100 # 0 -3 C 2.5 2 1.5 1 .5 0 -.5 -1 -1.5 -2 -3

leptin (ng ml-1)

Insulin (pmol L-1)

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2

Postprandial leptin levels were suppressed by low carbohydrate-high fat high protein meal (LC-HFHP) but not by high carbohydrate-low fat low protein meal (HC-LFLP). The reduced leptin in conjunction with lower glucose and insulin levels may encourage overeating in habitually low carbohydrate-high fat high protein consumers.

Chearskul S, Yothathai T, Sriussadaporn S. Postprandial leptin response to Thai meals with different macronutrient mixtures. Southeast Asian J Trop Med Public Health. 2006 July;37: 778-783.

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Short-term (2 months) consumption of 25-30 g/day fiber diet as recommended by the Reference Daily Intake (RDI) in a Thai population did not alter the studied hormones (LH, FSH, prolactin, estradiol, progesterone, cortisol, and insulin) and lipids (total cholesterol, HDL-C, LDL-C and triglycerides) thus did not create any health problems. Chearskul S, Supingklud N, Nitithamyong A, Sirichakwal P. Assessment of hormonal and metabolic effects of dietary fiber in young Thai women. J Med Assoc Thai. 2006 July; 89:997-1003. Glucomannan attenuated postchallenge glucose elevation without alteration of insulin during the standard oral glucose tolerance test. Diabetic patients on glucomannan supplement to their regular medications had less increase in area under the curve of glucose but not insulin. Glucomannan in long-term used impeded the rise of serum fructosamine and LDL-C. The benefits of Konjac glucomannan supplemented to other diabetic medications is suggested for the glycemic and lipid controls in type 2 diabetes mellitus. Chearskul S, Sangurai S, Nitiyanant W, Kriengsinyos W, Kooptiwut S, Harindhanavudhi T. Glycemic and lipid responses to glucomannan in Thais with type 2 diabetes mellitus. ( to be published)

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Distal Renal Tubular Acidosis Associated with Anion Exchanger 1 Mutations in Thai Children Khositseth S1, Sirikanerat A2, Wongbenjarat W3, Opastirakul S4, Khoprasert S5, Peuksungnern S6, Wattanasirichaikul S7, Thongnoppakhun W8, Viprakasit V9, Yenchitsomanus P10 1Department

of Pediatrics, Faculty of Medicine, Thammasat University, 2Khonken Hospital, 3Maharat Nakornrachsrima Hospital, of Pediatrics, Chaingmai University, 5Surajthani Hospital, 6Saraburi Hospital, 7Division of Genetics, Department of Pediatrics, Ramathibodi Hospital, 8Division of Molecular Genetics, Department of Research and Development, 9Division of Hematology, Department of Pediatrics, Siriraj Hospital, 10Division of Medical Molecular Biology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 4Department

Distal renal tubular acidosis (dRTA) is a disease characterized by a failure of the distal nephron to secrete H+ into urine. The mutations of AE1 gene causing dRTA have been reported in Thailand where thalassemia and hemoglobinopathy are prevalent. Gly

B

Ser Gly

Phe

His

Gly

Ser

Gly/Asp

Asp

Phe

His

SAO/Normal

G701D/Normal Gly

Ser

Phe His

Thr

Asp

Val

Ile

Phe

A858D/Normal

G701D/Normal C Gly

Ser Gly/Asp

Phe

His

Figure 1. Nucleotide sequencing of AE1 gene, showing nucleotide substitution and amino acid changes.

Figure 2. Peripheral blood smears.

Seventeen pediatric patients diagnosed with dRTA from 4 different regions of Thailand were studied. Twelve (70%) patients had mutations of AE1 gene. Genotypes of AE1 gene mutations detected were homozygous G701D (N=7), compound heterozygous SAO/G701D (N=3), and compound heterozygous A858D/G701D mutations (N=2). Seven (41%) patients had abnormal hemoglobin typing with Hb EE (N=1), and Hb AE (N=6). Reticulocytosis without anemia were observed in dRTA patients with homozygous G701D and SAO/G701D mutations only while they were acidotic, regardless of the presence of Hb AE. One patient who carried SAO/G701D mutations and heterozygous +-thalassemia had hemolytic anemia and hepatosplenomegaly only when he was acidosis. In contrast, dRTA patients with normal AE1 gene did not show evidence of hemolysis under acidotic condition. The various type of abnormal RBC morphology indicating red cell membrane defect were demonstrated in certain genotypes of AE1 gene mutations in dRTA patients. This study will be soon published in an international peered-review journal.

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Efficacy and Plasma Drug Levels of Lower Dose Indinavir (220-300 mg/m2) when either boosted with 100 mg or with full dose (400 mg/m2) of Ritonavir in HIV-Infected Thai children Plipat N, Cressey TC, Komontri C, Vanprapar N, Chokephaibulkit K. Department of Pediatrics Despite the disadvantageous pharmacologic and tolerability profiles, indinavir (IDV) containing regimens remain an integral part of salvage therapy in resource limited countries. Using antiretroviral regimen containing IDV/r 400/125 mg/m2 in children produced similar drug exposure to those in adults using IDV/r 800/100 mg. Reduced doses of IDV/r (600/100 and 400/100 mg) twice daily in Thai adults provide adequate IDV plasma concentration and viral suppression. The 400/100 mg IDV/r dose was approximately 220-285 mg/m2 and had better tolerability. This study describes use of IDV based regimen with an IDV dosage between 220-300 mg/m2 and either low dosages ritonavir (RTV) 100 mg or full dosages of RTV. Methods Cross-sectional study in the Pediatric Infectious Diseases Clinic at Siriraj Hospital. HIV-infected Methodschildren who took IDV containing regimen during March 2004 to August 2005 were included. Exclusion criteria were poor adherence. Formulations: IDV (CrixivanÆ) 200 or 400 mg capsules and RTV (NorvirÆ) 100 mg capsules were used. Children who weighed between 14-35 kg received 200/100 mg of IDV/r and children >35 kg received 400/100 mg. As part of National Access for Antiretroviral program, CD4 percentage/cell count were performed at treatment initiation and every 6 months. For this study, HIV RNA PCR was also performed. Limit of detection was 400 copies/ml Virological success was defined as either undetectable virus or decrease of more than one log10.

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Adherence was measured by pill counts, physician prediction using visual analog scale and interviewed questionnaires. Adherence was assured to be more than 90% in the past three days prior to blood draws. IDV and RTV drug concentrations were measured at predose (Ctrough) and 2 hours post-dose (C2hours). Lower limit of assay quantification was 0.05 mg/L. Discussion IDV dosages used in this report gave adequate IDV levels except in two patients who had Ctrough < 0.1 mg/L. However, with an IDV dosage increase, Ctrough levels became adequate and both had undetectable viral load. The results in this report were comparable to the previous studies using 400/125 mg/m2 of IDV/r and 350/125 mg/m2 of IDV/r in children. If available, early therapeutic drug monitoring to ensure sufficient IDV drug concentration should be encouraged. No nephrotoxicity seen in this report was most likely due to the lower IDV dosages. IDV Ctrough appeared to be higher in patients who took full dose RTV when compared to those who took 100 mg RTV. This can be due to the inhibiting effect of ritonavir on microsomal isoenzyme cytochrome P-450 3A4 which increase the bioavailability and half-life of the coadministered protease inhibitors. Although there was no statistical significant difference, this can be due to the limited number of patients. This dose related effect of RTV will need to be further investigated. A limitation of this study was that only two time points were determined and complete drug exposure (i.e. AUC) was not available. However, Ctrough and C2hours provided sufficient data to make comparisons with other published studies. Summary Reduced dosages of IDV (220-300 mg/m2), when boosted with either 100 mg RTV or with full dose provides adequate IDV therapeutic RTV concentrations in most patients and can safely be used as salvage therapy.

Efficacy and Tolerability of Nevirapine Versus Efavirenz Containing Regimens in HIV-Infected Thai Children Keswadee Lapphra, MD, Nirun Vanprapar, MD, MS, Sanay Chearskul, MD, Wanatpreeya Phongsamart, MD, Pimpanada Chearskul, MD, Wasana Prasitsuebsai, MD, Kulkanya Chokephaibulkit, MD. Department of Pediatrics. Background: Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) has been the most affordable regimens in developing countries. There were limited data comparing nevirapine (NVP) to efavirenz (EFV) in HIV-infected children. This study aimed to assess the efficacy and tolerability of NVP-based regimens comparing to EFV-based regimens in HIVinfected children. Method: Medical records of HIV-infected children who received NNRTI- based regimens for more than 6 months at Department of Pediatrics Siriraj Hospital, Mahidol University, Thailand, were reviewed. Results: Of the 139 children, 70 male, the median age at treatment initiation was 6.08 years, and median duration of follow-up was 36 months (6-66 months). The median baseline CD4 cell counts and CD4 percentage were 185 (2-3482) cells/mm3 and 7.20 (0.11-36.57) %. NVP ñbased regimen was initiated in 61(44%); 38 antiretroviral (ARV)-naÔve, and 23 ARV-experienced. EFV-based regimen was initiated in 78(56%); 34 ARV-naÔve, and 44 ARV-experienced. The CD4 cell count and percentage gains were not different between NVP and EFV groups in both ARV-naÔve and-experience groups. However, ARVnaÔve children who received EFV regimen had significantly lower baseline CD4 levels than those who received NVP regimen. ARV-naÔve children had a better CD4 response than those in ARV-experienced groups. The survival rates of children in NVP groups were not different from those in EFV groups for both ARV-naÔve and-experience groups. One (2.6%) of naÔve-NVP, 2 (5.8%) of naÔve-EFV, 9 (39%) of Exp-NVP, and 11(25%) of Exp-EFV groups had treatment failure at 24, 24, 24 and 18 months of treatment, respectively. Seven (10%) children had adverse effects from NVP, the main side effects were rash and hepatitis, 6 had to switch to EFV. Four (5%) children had adverse effects from EFV, 2 had to switch to NVP. Conclusion: NNRTI-based HAART were effective in children in developing countries for at least 3 years. EFV and NVP were equally effective CD4 increased and survival in both ARV naÔve and ARVexperienced groups. HIV-infected Thai children generally tolerated NNRTI well Survival curve of treatment failure 1.1

1.0

group

.9

Exp-EFV .8

Cum Survival

Naive-EFV .7 Exp-NVP .6 Naive-NVP

ï The survival rates of children in NVP groups were not different from those in EFV groups. (p = 0.5151 for NaÔve-NVP vs NaÔve-EFV and p = 0.2199 for Exp-NVP vs Exp-EFV ) However, the survival rate in ARV-naÔve groups were better than in ARV-experienced group (p= 0.0002 for NaÔve-groups vs Exp-groups).

.5 0

6

12

18

24

30

36

42

48

54

60

66

72

time to treatment failure (month)

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Evaluation of Generic Monoclonal Antibody Reagents and New Single-Platform Flow Cytometers for CD4 Enumeration in HIV-1 Infected Thai Patients Kovit Pattanapanyasat Center of Excellence for Flow Cytometry, Office for Research and Development and Department of Immunology

Monitoring CD4+ T-cells is important to determine the success of any antiretroviral therapy as well as HIV vaccine trials in Thailand. Flow cytometry is the gold standard method for the estimation of CD4 counts due to its accuracy, precision and reproducibility and thus widely used. However, the high cost of available flow cytometers and monoclonal antibody reagents make it difficult to implement such methods in the resource-poor settings. In our studies, we evaluated 2 recently-developed single-platform flow cytometers (CyFlowgreen from Partec and GuavaÆ PCA from Guava Technologies) and a multicenter study on the use of generic monoclonal antibody reagents for CD4+ T-cells enumeration in comparison with reference standard methods currently used in Thailand. Pattanapanyasat K, Shain H, Noulsri E, Lerdwana S, Thepthai C, Prasertsilpa V, Likanonsakul S, Yothipitak P, Nookhai S, Eksaengsri A. A multicenter evaluation of the PanLeucogating method and the use of generic monoclonal antibody reagents for CD4 enumeration in HIV-infected patients in Thailand. Cytometry B Clin Cytom 2005;65B:29-36. (Impact factor = 2.698) Pattanapanyasat K, Lerdwana S, Noulsri E, Chaowanachan T, Wasinrapee P, Sakulploy N, Pobkeeree V, Suksripanich O, Thanprasertsuk S, Spira TJ, Tappero JW, Levine WC. Evaluation of a new single-parameter volumetric flow cytometer (CyFlowgreen) for enumeration of absolute CD4+ T lymphocytes in human immunodeficiency virus type 1-infected Thai patients. Clin Diagn Lab Immunol 2005;12:1416-24. (Impact factor =1.809) Pattanapanyasat K, Phuang-Ngern Y, Lerdwana S, Wasinrapee P, Sakulploy N, Noulsri E, Thepthai C, McNicholl JM. Evaluation of a single-platform microcapillary flow cytometer for enumeration of absolute CD4+ T-lymphocyte counts in HIV-1 infected Thai patients. (Accepted for publication, Cytometry 2006) (Impact factor = 2.698) Fig 2. Bland-Altman bias plots of absolute CD4+ T-cells counts of >200 cells/ l between the GuavaÆ PCA flow cytometric assay and the two standard bead-based flow cytometric assays. Difference between GuavaÆ PCA and the three-color TruCOUNTTM using FACScanTM (A), GuavaÆ PCA and FACSCountTM (B), and FACSCountTM and TruCOUNTTM (C). Lines represent means and limits of agreements.

Fig 1. Correlation analysis of absolute CD4+ and CD8+ T-cells counts between the GuavaÆ PCA and the two standard bead-based flow cytometric assays. Correlation plots for GuavaÆ PCA vs three-color TruCOUNTTM using FACSCaliburTM (A,D). GuavaÆ PCA vs FACSCountTM (B,E), and FACSCountTM vs TruCOUNTTM (C,F).

The generic monoclonal antibody reagents showed high inter-reliability compared to the standard TriTEST method, and both single-platform flow cytometers also performed well in comparison with the 2 standard new single-platform bead-based flow cytometer systems. The use of these approaches can increase access to CD4+ T-cell count determinations, particularly for people living in developing countries or in resource-limited settings. Grant sponsors: US-CDC/Global AIDS Program, WHO and Becton Dickinson Biosciences (Thailand). KP is Thailand Research Fund Senior Scholar

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Formoterol Attenuates Neutrophilic Airway Inflammation in Asthma Kittipong Maneechotesuwan, S Essilfie-Quaye, Sally Meah, Claire Kelly, Sergei A Kharitonov, Ian M. Adcock, Peter J. Barnes

STUDY OBJECTIVES: Airway neutrophil levels are increased in patients with severe asthma and during asthma exacerbations. Long-acting beta2-agonists (LABAs), such as formoterol, reduce the number of asthma exacerbations. While beta2-agonists may affect neutrophil function in vitro, it is uncertain whether they have effects on neutrophilic inflammation in asthmatic patients in vivo. DESIGN: In a double-blind randomized crossover study, we evaluated the effects of 4 weeks of treatment with formoterol (Turbuhaler), 24 microg bid, compared to placebo on sputum neutrophil numbers and interleukin (IL)-8 levels in asthmatic patients. Therapy with budesonide (administered via Turbuhaler), 400 microg bid for 4 weeks, was added at the end as a "gold standard" antiinflammatory effect comparison. PATIENTS: We studied 15 steroid-naive nonsmoking patients who ranged from 19 to 51 years of age and had mild persistent asthma. RESULTS: Formoterol therapy significantly reduced sputum IL-8 levels and neutrophil numbers compared to placebo. There was a significant correlation between the reduction in sputum IL-8 levels and the number of neutrophils, indicating that formoterol may attenuate neutrophilic airway inflammation by inhibiting IL-8 production. CONCLUSIONS: Our data suggest that the LABA formoterol reduces neutrophilic airway inflammation in patients with mild asthma and that this might be beneficial in preventing asthma exacerbations.

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Functional Study of Thaiís MODY Suwattanee Kooptiwut Department of Physiology

Pax4

Paired Domain

Homeodomain

NH2 Relative luciferase activity (fold)

5

124 162

25 20

R 164 W **

222

COOH 349

*

15

HisB

WT

R164W

40 Kda

10 5 0

Human Basal Human Human insulin insulin insulin promoter promoter promoter + + R 164 W WT

The R164W Pax4 mutation segregated with diabetes in the family. In vitro studies showed that it impairs the repressor activity of Pax4 on the insulin and glucagon promoters.

Nattachet Plengvidhya1,2, Suwattnee Kooptiwut3, Napat Songtawee2,4, Asako Doi5, Hiroto Furuta5, Masahiro Nishi5, Kishio Nanjo5, Wiwit Tantibhedhyangkul2, Watip Boonyasrisawat2, Pa-thai Yenchitsomanus4, Alessandro Doria6, Napatawn Banchuin2 :PAX4 Mutations in Thais with Maturity-Onset Diabetes of the Young (MODY). (to be published)

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Influenza Vaccination and COPD The Effectiveness of Influenza Vaccination in the Prevention of Acute Respiratory Illness in Patients with COPD Phunsup Wongsurakiat Division of Respiratory Disease Department of Medicine. COPD ranks fifth in terms of global burden of disease. Most of the morbidity, mortality, and health-care costs of patients with COPD are related to the exacerbation of COPD. Influenza virus infection may be the cause of 5 ñ 28 percent of these exacerbations. We conducted a randomized, double-blind, placebo-controlled trial in order to determine the effectiveness of influenza vaccination in the prevention of acute respiratory illness (ARI) related to influenza virus infection. We have shown that influenza vaccination is highly effective in the prevention of influenza-related ARI regardless of the severity of COPD.

Probability of not acquiring influenza-related ARI over the study year. Significant difference (p = 0.003 by log-rank test) comparing the probability of not acquiring influenza-related ARI between the vaccine and placebo groups. Effectiveness of influenza vaccination = 76 %.

Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul. Acute respiratory illness in patients with COPD and the effectiveness of Influenza Vaccination: A Randomized Controlled Study. Chest. 2004; 125: 2011 - 2020.

Adverse Effects of Influenza Vaccination in Patients with COPD Influenza vaccination is highly effective in the prevention of influenza-related acute respiratory illness in patients with COPD. Despite this, only 40-60 percent of patients receive influenza vaccine each year. One of the obstacles to greater vaccination rates is the concern over the vaccineís adverse reactions. We conducted a randomized, double-blind, placebo-controlled trial in order to determine the adverse effects associated with inactivated influenza vaccination in COPD patients. We have shown that influenza vaccination is associated with minimal local adverse reactions. Vaccination does not cause systemic adverse reactions, induce clinical exacerbations or adversely affect lung function, dyspnoeic symptoms and exercise capacity in patients with COPD, regardless of the severity of airflow obstruction

Wongsurakiat P, Maranetra KN, Gulprasutdilog P, Aksornint M, Srilum W, Ruengjam C, Sated W. Adverse effects associated with influenza vaccination in patients with COPD: a randomized controlled study. Respirology. 2004; 9: 550 - 556.

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Intensive Diabetes Self Management Education and Multidisciplinary Team for Patient with Type 1 Diabetes Supawadee Likitmaskul Division of Endocrinology and Metabolism , Department of Pediatrics In order to improve glycemic control and quality of life in patient with type 1 diabetes mellitus (T1D), intensive diabetes self management education and multidisciplinary team approach are essential. Siriraj intensive multidisciplinary education program and team for T1D have established in pediatric department since 1996. Patients and families were admitted 7-10 days for education and self management skills training. The result of glycemic control, length of hospitalization and recurrence rate of DKA showed statistically significant improvement. This study demonstrated a successful team and education program for newly diagnosed Thai children and adolescent diabetes in our institution. Likitmaskul S, Wekawanich J, Wongarn R, Chaichanwatanakul K, Kiattisakthavee P, Nimkarn S, Prayongklin S, Weerakulwattana L, Markmaitree D, Ritjarean Y, Pookpun W, Punnakanta L, Angsusingha K, Tuchinda C. Intensive diabetes education program and multidisciplinary team approach in management of newly diagnosed type 1 diabetes mellitus: a greater patient benefit, experience at Siriraj Hospital. J Med Assoc Thai. 2002; 85:S488-95. This study was supported by Siriraj Chalerm Prakiat Fund.

Nowadays, Siriraj pediatric diabetes multidisciplinary management has been well established and developed for continuing self care management as demonstrates below.

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Is Laparoscopic Radical Prostatectomy After Transurethral Prostatectomy Appropriate? Sunai Leewansangtong, M.D. Tawatchai Taweemonkongsap, M.D. Division of Urology and Department of Surgery

Objective: To evaluate the appropriateness and morbidity of laparoscopic radical prostatectomy (LRP) in patients who had previous transurethral prostatectomy (TURP). Material and method: From Febuary 2005 to Febuary 2006, 27 patients with clinical localized prostate cancer underwent LRP with the same technique by a single surgeon. Nineteen and 8 patients were diagnosed with transrectal ultrasound guided biopsy (TRUSBX) and TURP, respectively. Operative data and pathological outcomes were evaluated between 2 groups. Results: Mean operative time and blood loss in TURSBX group were 233 minute and 610 ml while those in TURP group were 251 minute and 812 ml, respectively. These were not significant different (all p valve > 0.1). There was not significant complication or mortality in both groups. LRP could achieve high free margin rate. Of 19 patients with pathological localized disease, 17 (89.4%) had free margin. It was found in12 of 14 patients (85.7%) in TRUSBX group and in all patients in TURP group. Conclusion: LRP is appropriate to undergo in prostate cancer patients with previous TURP. LRP after TURP did not have a higher morbidity than LRP after TRUSBX and did not compromise free margin rate. Published in: J Med Assoc Thai 2006; 89:1146-9

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Islet Isolation and Functional Study

Insulin secretion (ng/ml/5 islets/60min)

Suwattanee Kooptiwut Department of Physiology

20 . 15 10 5 0

*

*

*

*

The first success in islet isolation with intact insulin secretion from a mouse pancreas using collagenase P enzyme and histopaque separation was achieved in Siriraj Hospital in 2004. Insulin secretion when stimulated with 5.6,10,15 and 20 mM glucose was higher than with 2.8 mM basal glucose concentration. Insulin secretion increased about 1.7 to 3.5 fold from a basal level of 2.8 mM glucose without any difference in insulin content at any glucose concentrations used.

2.8 5.6 10 15 20 Glucose concentration (mM)

Kooptiwut S, Semprasert N, Chearskul S. In vitro study of insulin secretion from mouse pancreatic islets-Siriraj experiences. Siriraj Hospital Gazettte 2005;57:14-18.

(ng/ml/5 islets/60min)

Insulin secretion

10 day Culture 30 25 20 15 10 5 0

*

11.1mM

#

11.1 mM á

+ E

40 mM 40 mM

+ E

*,#, á p < 0.05 2.8

20

Glucose concentration (mM) Prolonged exposure of the pancreatic islets to a high glucose generated impaired glucoseinduced insulin secretion. Estrogen was co-cultured with pancreatic islets for 3 hours and 10 days both in normal glucose media (11.1 mM) or in high glucose media (40 mM). Estrogen increases glucose-induced insulin secretion from the islet culture in normal glucose media for 3 hours and 10 days. Islets prolonged cultured in high glucose media showed impair insulin secretion. Estrogen co-culture with high glucose media increased insulin secretion. These results suggested that direct effect of estrogen on insulin secretion may partially protect this isletís defect from high glucose.

Kooptiwut S, Semprasert N, Chearskul S. Estrogen increased glucose-induced insulin secretion of mouse pancreatic islet in prolonged high glucose culture. (to be published)

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Osteoporosis in Institutionalized Older Thai People Assantachai P, Angkamat W, Pongpim P, Weattayasuthum C, Komoltri C. Risk Factors of Osteoporosis in Institutionalized Older Thai People. Osteoporos Int 2006; 17 : 1096-1102. (impact factor = 4.216)

Since the incidence of hip fractures is increasing rapidly in developing countries, 51% of all hip fractures in the world were predicted to occur in Asia by the year 2050. Although there were studies investigating risk factors of osteoporosis among Asian older people in the community, there is a paucity of information regarding risk factors of the disease in Asian older people who are living in institutionalized settings. We have revealed the prevalence as well as the risk factors of osteoporosis in this high risk and fast-growing group. Regression coefficient + SE

p-value

Height (per 1 cm)

0.003 + 0.001

< 0.001

Lean body mass (per 1 kg)

0.003 + 0.001

0.033

Mobility index (per 1 point)

- 0.008 + 0.002

< 0.001

Mental health (poor)

- 0.037 + 0.019

0.055

Serum CTx (per 1 g/L)

- 0.122 + 0.028

< 0.001

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Pathologic Aspect of Malignant Lymphoma in Thailand based on study at Siriraj Hospital* Sanya Sukpanichnant Department of Pathology *Sukpanichnant S. Analysis of 1983 cases of malignant lymphoma in Thailand according to the World Health Organization classification. Hum Pathol. 2004;35:224-30. (impact factor 2.55)

A complete pathological study of malignant lymphoma in Thailand has been carried out over the past decade by using the recent WHO classification (2001). The results of this study on 1,983 consecutive cases of lymphoma diagnosed at Siriraj Hospital during a 9-year period from 1993 to 2002 were published in Human Pathology. [Sukpanichnant, 2004] Sukpanichnant S, Sonakul D, Piankijagum A, Wanachiwanawin W, Veerakul G, Mahasandana C, Tanphaichitr VS, Suvatte V. Malignant lymphoma in Thailand: changes in the frequency of malignant lymphoma determined from a histopathologic and immunophenotypic analysis of 425 cases at Siriraj Hospital. Cancer. 1998;83:1197-204. (impact factor 4.8)

In previous studies of lymphoma in Thailand using morphologic classifications including Rye (1966) for Hodgkin lymphoma (HL), Gall & Mallory (1942), Rappaport (1966), and working formulation (1982) for non-Hodgkin lymphoma (NHL), we have demonstrated change in the frequency of lymphoma. Period of Study (cases)

HL (%)

NHL (%)

1957-1972 (1,157)1,2

29

71

1993-1995 (425)3

8

92

1Srichaikul

et al. Am J Clin Pathol 1974;62:335-41 (62 cases) et al. J Med Assoc Thai 1980;63:181-91 (1,095 cases) 3Sukpanichnant et al. Cancer 1998;83:1197-204 2Piankijagum

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At present, the frequency of HL has been proven to be approximately 8% of all lymphomas in Thailand and it is comparable to that found in most countries in Asia. Using paraffin section immunoperoxidase staining to prove the phenotype of lymphoma, we have learnt that many cases diagnosed as HL based on the presence of Reed-Sternberg cells in fact are proven to be either B-cell or T-cell NHL. [Sukpanichnant et al., 1998; Sukpanichnant, 2004] Lymphoma study at Siriraj Hospital has beenshown to represent cases from all over the country. Results on various types of NHL based on working formulation are comparable with those from 6 other medical institutes in Thailand except for higher frequency of follicular lymphoma. [Intragumtornchai et al., 1996] Follicular lymphoma (FL) is common in western countries, especially the U.S. (~30% of all NHLs). But FL in Sirirajís series is ~10% only. [Sukpanichnant et al., 1998; Sukpanichnant, 2004] FL in other series from Thailand was first reported to be very low (3.8%) [Intragumtornchai et al., 1996] but later the frequency has been corrected to 10% as well. [Intragumtornchai et al., 1999]

Lymphoma Study of 1,983 cases at Siriraj Hospital is the world second largest series using WHO classification (2001) and the series of 1,826 cases of NHL in this study is the world third largest series ever published in English literature. [Sukpanichnant, 2004]

Povidone-iodine & Postoperative Endophthalmitis Adisak Trinavarat, MD Department of Ophthalmology Purpose ïTo evaluate the effect of preoperative 5% povidone-iodine as an additional measure for prophylaxis of endophthalmitis after cataract surgery Cataract Surgery

Method

Occurrence of endophthalmitis following cataract surgery was monitored Rate of endophthalmitis was plotted in ëp control chartí Complications of povidone-iodine application onto the eye were recorded Control chart 0 .0 0 9

Rate of endophthalmitis

0 .0 0 8

UC L= 0 .0 0 7 7 7

0 .0 0 7 0 .0 0 6 0 .0 0 5 0 .0 0 4 0 .0 0 3

_ P = 0 .0 0 2 1 7

0 .0 0 2 2

0 .0 0 1 0 .0 0 0

2

2002

2003 Bimo n t h ly p e r io d s

LC L= 0

2004

T e s ts p e r fo r m e d w ith u ne q ua l s a m p le s iz e s

Complication

Postoperative endophthalmitis

Eye irritation

Eyes

%

No

1424

55.4

Mild

977

38.0

Moderate

107

4.1

64

2.5

2572

100.0

Severe Total Conclusions

Topical 5% povidonepovidone-iodine

A reduction of endophthalmitis rate after cataract surgery was demonstrated. This was associated with the introduction of preoperative 5% povidone-iodine application onto the ocular surface. This prophylactic measure was safe and recommended.

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Predicting Fetal Anemia by Using Reference Centile Charts for Liver Length, Spleen Perimeter and Umbilical Vein Maximum Flow Velocity in Thai Fetuses Throughout Gestation Saifon Chawanpaiboon1, Vitaya Titapant1, Anuwat Sutantawibul1, Sujin Kanokpongsakdi1 and Charuwan Kangkagate2 1Departments

of Obstetrics and Gynecology and 2Research Promotion, Faculty of Medicine

Aim: To create reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity (UVVmax) in Thai fetuses in order to predict fetal anemia in Thai fetuses.

Methods: The study was a prospective, cross-sectional study, carried out at the Division of MaternalñFetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. A total of 780 pregnant women between 13 and 40 weeksí gestation, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and standard deviation (SD) were estimated at each week of gestation using linear regression modeling. A total of 752 fetuses were measured for fetal liver length, spleen perimeter and UVVmax. Linear regression models were fitted to estimate the mean 95% confidence interval for liver length, spleen perimeter and UVVmax at each gestational age. The centile charts of those parameters were also presented.

Conclusion: Reference centile charts for fetal liver length, spleen perimeter and UVVmax of Thai fetuses were created.

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Prevention of Recurrent Pterygium Efficacy of Subconjunctival 5-Fluorouracil and Triamcinolone Injection in Impending Recurrent Pterygium Ophthalmology. 2006 July7;113:1102-1109 (Impact factor =3.664) Prabhasawat P, Tesavibul N, Leelapatranura K, Phonjan T. Department of Ophthalmology Our study is the first randomized, prospective, controlled clinical trail using these adjunctive treatments and have been published in the Ophthalmology. Cumulative Survival

Recurrence is the most common undesirable outcome of pterygium excision. The more often the surgery is performed, the more likely the pterygium will recur. We have proved that intralesional injection of either 5-FU or intermediate-acting steroids (triamcinolone) into the impending recurrent pterygia can inhibit the progression and reduce the recurrence with statistic significance in the 5fU group (N=109 eyes).

1.1 1.0

Treatment group

.9

5-FU

.8

Triamcinolone

.7 .6

Control

.5

a

c

0

b

d

5-FU group. Fig. A and C demonstrated impending recurrent pterygia 2 months after pterygium excision before 5-FU injection. Fig. B and D showed regression of fibrovascular tissue in the same eye at 1 and 3 months after 5-FU injection.

10

20

30

40

50

60

Time to failure* (week)

Kaplan-Meier survival analysis shows time to failure in each treatment group. P < 0.05 between both treatment groups and the control group. a

b

c

b

Triamcinolone group. Fig. A and C demonstrated impending pterygia 2 months after excision. Fig. B and D revealed regressed fibrovascular tissue with attenuated vessels at 7 and 11months after triamcinolone injection.

Conclusions: Intralesional injection of 5-FU and triamcinolone are more effective in inhibiting the recurrence of pterygium than topical steroid alone, with the results reaching statistical significance in the 5-FU group.

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Regulation of Th2 Cytokine Genes by p38 MAP Kinase: Phosphorylation of GATA-3 Kittipong Maneechotesuwan, Xin Yao, Kazuhiro Ito, Elen Jazrawi, Kang-Yun Lee, Omar S. Usmani, Peter J. Barnes, Ian M. Adcock

GATA-3 plays a critical role in allergic diseases by regulating the release of cytokines from Th2 lymphocytes. However, the molecular mechanisms involved in regulation of GATA-3 in human T lymphocytes are not yet understood. Using siRNA to knock down GATA3, we have demonstrated its critical role in regulating interleukin (IL)-4, IL-5 and IL-13 release from a human T cell line. Specific stimulation of T-lymphocytes by co-stimulation of CD3 and CD28 to mimic activation by antigen-presenting cells induces translocation of GATA-3 from the cytoplasm to the nucleus, with binding to the promoter region of Th2 cytokine genes, as determined by chromatin immunoprecipitation. GATA-3 nuclear translocation is dependent on its phosphorylation on serine residues by p38 MAP kinase, which facilitates interaction with the nuclear transporter protein importin-alpha. This provides a means whereby allergen exposure leads to the expression of Th2 cytokines and this novel mechanism may provide new approaches to treating allergic diseases.

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Siriraj House Dust Mite Allergen Vaccine Development Project Allergy Interest Group : an extensive collaboration of the Department of Pediatrics, Department of Parasitology, Department of Immunology Department of Internal Medicine and Department of Otorhinolaryngology.

Objectives To commercially produce house dust mite allergen vaccines (Dp &Df) of international standard in an industrial scale

Expected Benefits -Have a successful model of collaboration between Siriraj R&D and private sector leading to commercial products -Reduce the cost of importing allergen extracts from abroad -Have a model for manufacturing other allergen vaccines -Provide basis for future research in allergen vaccine development

Current status Laboratory scale production 2 : vaccine standardization Sub-project 2 Established method of standardization Protein content and composition Major allergen content Total allergenic potency Vaccine component Stability Comparable to CBER reference standard and commercial vaccines

Examples of result Raw material (Sub-project 1.1): House dust mite purity 99% by using SIRIRAJ MITE FOOD FORMULA

Current status Laboratory scale production 1 : vaccine production Sub-project 1.1: Raw Material Established house dust mite culture 99% purity of both species of house dust mites by using SIRIRAJ MITE FOOD FORMULA Comparable or superior to commercial raw materials

Standardization (Sub-project 2): Use of 2-D gel electrophoresis to QC the compositions of extract

Teamwork Executives:Dean;Prof. Piyasakol Sakolsatayadorn, Deputy Dean in R&D; Prida Malasit MD Steering: Prof. Chaweewan Bunnag**

Sub-project 1.2: Extraction process Established reproducible extraction method

Work in progress Forming partnership with private sector to establish cGMP standard factory Sub-project 3 Preparation for bioequivalence study Sub-project 4 Preparation for licensing

Product development manager: Prof. Pakit Vichyanond, Assoc.Prof. Supornchai Kongpatanakul Sub-project 1.1: Principal investigator: Assoc.Prof. Vanna Mahakittikun Co-Investigator: Assoc.Prof. Anchalee Tungtrongchit Research assistant: Mr. Teerapong Wang-apai, Ms. Prapakorn Ninsanith Sub-project 1.2 Principal investigator: Assoc.Prof. Supornchai Kongpatanakul Co-Investigator: Assist.Prof. Adisak Wongkajornsilp, Dr. Nitat Sookrung Research assistant: Ms. Kunda Kasetsinsombat, Mr. Chaiporn Manochnon Sub-project 2 Principal investigator: Assoc.Prof. Pattama Ekpo Co-Investigator: Assoc.Prof. Sirichit Wongkamchai, Assist.Prof. Nat Malainual Research assistant: Ms. Sunthorn Puangyoy, Ms. Nujohn Jansong Sub-project 3 Pricipal investigator: Prof. Nualanong Visitsunthorn Co-Investigator: Prof. Pakit Vichyanond, Prof. Chaweewan Bunnag, Assist.Prof. Orathai Piboonpocanun, Assist.Prof. Pongsakorn Tantilipikoron, Assist.Prof. Paraya Assanasen, Assoc.Prof.Wanchai Dejsomritrutai, Assist.Prof. Torpong Thongngarm, Apichart Valyasevi MD, Voravich Luangwedchakarn MD Research assisstant: Mrs. Sirirat Weeravejsukit Sub-project 4 Principal investigator: Assoc.Prof. Supornchai Kongpatanakul Co-Investigator: Ms. Apirom Lauchareankiert, Ms. Anchalika Krinniyom Coordinator: Ms. Chantima Pongsupubchon, Mrs. Wannalak Thansuwanwong (**Correspondence)

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Spinal versus Epidural Anesthesia for Cesarean Section in Severe Preeclampsia: A Prospective Randomized, Multicenter Study Shusee Visalyaputra, M.D.a, Oraluxna Rodanant, M.D.b, Wanna Somboonviboon, M.D. b Kamthorn Tantivitayatan, M.Dc., Somboon Thienthong , M.D.d, Wanawimol Saengchote, M.D.e a

Professor, Department of Anesthesiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand. Associate professor, Department of Anesthesiology, Chulalongkorn University Hospital, Faculty of Medicine, Bangkok, Thailand. c Department of Anesthesiology, Rajvithi Hospital, Tertiary care center, Bangkok, Thailand. d Associate professor, Department of Anesthesiology, Faculty of Medicine, Khonkaen University, Khonkaen, Thailand. e Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. b

Introduction: Epidural anesthesia has been accepted for cesarean delivery in severely preeclamptic patients but concern (although without evidence supported) has been raised on the spinal anesthesia due to its theoretical risk of severe hypotension.This study compared the hemodynamic changes from the spinal anesthesia with the well accepted epidural anesthesia for cesarean section in severely preeclamptic patients. Methods: In a prospective randomized, multicenter study, 120 severely preeclamptic patients were randomly divided into 2 groups, to have either epidural anesthesia using 2 % lidocaine with epinephrine 1: 400,000 for titration to at least T6 level, or spinal anesthesia using 12 mg of 0.5% heavy bupivacaine plus 0.2 mg of preservative free morphine. Prompt treatment of hypotension was done by given 3 mg of ephedrine when systolic blood pressure decreased to 120 but above 100 mmHg and 6 mg when it decreased to or below100

mmHg.

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Results: The lowest mean blood pressure(MBP) during induction to delivery period was slightly lower (95% CI = 10 (4-17) mmHg, p < 0.001), and ephedrine was used more (72% vs 45%, p = 0.006) in spinal group than in the epidural group( figure 1). Neonatal outcomes assessedby Apgar scores7 and umbilical arterial blood gas analysis were similar in both groups (Table1,2). Adversed neonatal outcomes (5 min Apgar scores < 7 and umbilical arterial blood pHHis) in Thailand. Hematology. 2004 Apr;9 (2):151-5 254. Viprakasit V, Tanphaichitr VS Unusual phenotype of hemoglobin EE with hemoglobin H disease: a pitfall in clinical diagnosis and genetic counseling. J Pediatr. 2004 Mar;144(3):391-3 255. Viprakasit V, Tanphaichitr VS, Chinchang W,Sangkla P, Weiss MJ, Higgs DR Evaluation of alpha hemo globin stabilizing protein (AHSP) as a genetic modifier in patients with beta thalassemia. Blood. 2004 May 1;103(9):3296-9 256. Viprakasit V, Tanphaichitr VS, Veerakul G, Chinchang W, Petrarat S, Pung-Amritt P, et al. Co-inheritance of Hb Pak Num Po, a novel alpha1 gene mutation, and alpha0 thalassemia associated with transfusiondependent Hb H disease. Am J Hematol. 2004 Mar; 75(3):157-63 257. Viprakasit V, Vathesathokit P, Chinchang W, Tacha vanich K, Pung-Amritt P, Wimhurst VL, et al. Preva lence of HFE mutations among the Thai population and correlation with iron loading in haemoglobin E disorder. Eur J Haematol. 2004 Jul;73(1):43-9 258. Viprakasit V, Veerakul G, Sanpakit K, Pongtanakul B, Chinchang W, Tanphaichitr VS Acute haemolytic crisis in a Thai patient with homozygous haemo globin Constant Spring (Hb CS/CS): a case report. Ann Trop Paediatr. 2004 Dec;24(4):323-8 259. Viseshakul N, Thanawongnuwech R, Amonsin A, Suradhat S, Payungporn S, Keawchareon J, et al. The genome sequence analysis of H5N1 avian influenza A virus isolated from the outbreak among poultry populations in Thailand. Virology. 2004 Oct 25;328 (2):169-76 260. Volovitz B, Vichyanond P, Zhong NS Allergy and asthma education. Chem Immunol Allergy. 2004; 84:163-83

261. Wanachiwanawin W, Mendoza L, Visuthisakchai S, Mutsikapan P, Sathapatayavongs B, Chaiprasert A, et al. Efficacy of immunotherapy using antigens of Pythium insidiosum in the treatment of vascular pythiosis in humans. Vaccine. 2004 Oct 9;22(27-28) :3613-21 262. Watcharotone W, Sirimai K, Kiriwat O, Nukoolkarn P, Watcharaprapapong O, Pibulmanee S, et al. Preva lence of bacterial vaginosis in Thai women attending the family planning clinic, Siriraj Hospital. J Med Assoc Thai. 2004 Dec;87(12):1419-24 263. Wattanasirichaigoon D, Limwongse C, Jariengprasert C, Yenchitsomanus PT, Tocharoenthanaphol C, Thongnoppakhun W, et al. High prevalence of V37I genetic variant in the connexin-26 (GJB2) gene among non-syndromic hearing-impaired and control Thai individuals. Clin Genet. 2004 Nov;66(5):452-60 264. Weatherall D From looking at cells to looking at systems. Bmj. 2004 Nov 13;329(7475):1128 265. Werawatganon T, Supiyaphun P, Kerekhanjanarong V, Rodanant O, Sirichotewithayakorn P Intermittent apnea and total intravenous anesthesia for microscopic laryngeal surgery. J Med Assoc Thai. 2004 May;87 (5):547-50 266. Wilailak S, Rochanawutanon M, Srisupundit S, Aumkhyan A, Pattanapanyasat K Flow cytometric analysis of DNA ploidy and S-phase fraction of Stage IIIB cervical carcinoma. Eur J Gynaecol Oncol. 2004;25(4):428-30 267. Wisuthsarewong W, Viravan S Diagnostic criteria for atopic dermatitis in Thai children. J Med Assoc Thai. 2004 Dec;87(12):1496-500

268. Wongsurakiat P, Maranetra KN, Gulprasutdilog P, Aksornint M, Srilum W, Ruengjam C, et al. Adverse effects associated with influenza vaccination in patients with COPD: a randomized controlled study. Respirology. 2004 Nov;9(4):550-6 269. Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest. 2004 Jun;125(6):2011-20 270. Wongsurakiat P, Pierson DJ, Rubenfeld GD Changing pattern of ventilator settings in patients without acute lung injury: changes over 11 years in a single institution. Chest. 2004 Oct;126(4):1281-91 271. Wuthiekanun V, Amornchai P, Chierakul W, Cheng AC, White NJ, Peacock SJ, et al. Evaluation of immunoglobulin M (IgM) and IgG rapid cassette test kits for diagnosis of melioidosis in an area of endemicity. J Clin Microbiol. 2004 Aug;42(8): 3435-7 272. Yallampalli C, Kondapaka SB, Lanlua P, Wimala wansa SJ, Gangula PR Female sex steroid hormones and pregnancy regulate receptors for calcitonin gene-related peptide in rat mesenteric arteries, but not in aorta. Biol Reprod. 2004 Apr;70(4):1055-62 273. Yotnuengnit P, Promsudthi A, Teparat T, Laohapand P, Yuwaprecha W Relative connective tissue graft size affects root coverage treatment outcome in the envelope procedure. J Periodontol. 2004 Jun;75(6): 886-92

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Akaraviputh T, Boonnuch W, Watanapa P, Lert-Aka yamanee N, Lohsiriwat D Surgical management of adult choledochal cysts. J Med Assoc Thai. 2005 Jul; 88(7):939-43 2. Andrikos E, Yavuz A, Bordoni V, Ratanarat R, De Cal M, Bonello M, et al. Effect of cyclosporine, myco phenolate mofetil, and their combination with steroids on apoptosis in a human cultured monocytic U937 cell line. Transplant Proc. 2005 Sep;37(7):3226-9 3. Apinhasmit W, Chompoopong S, Methathrathip D, Sangvichien S, Karuwanarint S Clinical anatomy of the posterior maxilla pertaining to Le Fort I osteotomy in Thais. Clin Anat. 2005 Jul;18(5):323-9 4. Apisarnthanarak A,Anthanont P,Kiratisin P,Chayangsu P, Apisarnthanarak P, Mundy LM Photo quiz. A Thai woman with fever and skin lesions. Clin Infect Dis. 2005 Apr 1;40(7):988-9, 1053-4 5. Apisarnthanarak A, Kiratisin P, Mundy LM Evaluation of Ochrobactrum intermedium bacteremia in a patient with bladder cancer. Diagn Microbiol Infect Dis. 2005 Oct;53(2):153-5 6. Apisarnthanarak A, Kiratisin P, Mundy LM Evalua tion of Ochrobactrum intermedium bacteremia in a patient with bladder cancer. Diagn Microbiol Infect Dis. 2005 Oct;53(2):153-5 7. Asavamongkolkul A, Pimolsanti R, Waikakul S, Kiat sevee P Periacetabular limb salvage for malignant bone tumours. J Orthop Surg (Hong Kong). 2005 Dec; 13(3):273-9 8. Assantachai P, Maranetra N Factors determining hospital admission of Thai elderly by a mailed survey. J Med Assoc Thai. 2005 Aug;88(8):1051-6 9. Atchaneeyasakul LO, Trinavarat A, Bumrungsuk P, Wongsawad W Anticardiolipin IgG antibody and homocysteine as possible risk factors for retinal vascular occlusive disease in thai patients. Jpn J Ophthalmol. 2005 May-Jun;49(3):211-5 10. Auewarakul C, Downing SM, Jaturatamrong U, Praditsuwan R Sources of validity evidence for an internal medicine student evaluation system: an evaluative study of assessment methods. Med Educ. 2005 Mar;39(3):276-83 11. Auewarakul C, Downing SM, Praditsuwan R, Jatu ratamrong U Item analysis to improve reliability for an internal medicine undergraduate OSCE. Adv Health Sci Educ Theory Pract. 2005;10(2):105-13 (IF 1.22) 12. Auewarakul CU, Sritana N, Limwongse C, Thong noppakhun W, Yenchitsomanus PT Mutations of the FLT3 gene in adult acute myeloid leukemia: deter mination of incidence and identification of a novel

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mutation in a Thai population. Cancer Genet Cyto genet. 2005 Oct 15;162(2):127-34 Auewarakul P Composition bias and genome polarity of RNA viruses. Virus Res. 2005 Apr;109(1):33-7 Auewarakul P, Wacharapornin P, Srichatrapimuk S, Chutipongtanate S, Puthavathana P Uncoating of HIV-1 requires cellular activation. Virology. 2005 Jun 20;337(1):93-101 Autar SR, Wit FW, Sankote J, Mahanontharit A, Anekthananon T, Mootsikapun P, et al. Nevirapine plasma concentrations and concomitant use of rifampin in patients coinfected with HIV-1 and tuberculosis. Antivir Ther. 2005;10(8):937-43 Baeten JM, Lavreys L, Sagar M, Kreiss JK, Richardson BA, Chohan B, et al. Effect of contraceptive methods on natural history of HIV: studies from the Mombasa cohort. J Acquir Immune Defic Syndr. 2005 Mar;38 Suppl 1:S18-21 Bessho K, Rodanant N, Bartsch DU, Cheng L, Koh HJ, Freeman WR Effect of subthreshold infrared laser treatment for drusen regression on macular autofluorescence in patients with age-related macular degeneration. Retina. 2005 Dec;25(8):981-8 Boonnuch W, Akaraviputh T, Lohsiriwat D Whippleís operation without an operative mortality in 37 conse cutive patients: Thai surgeonsí experiences. J Med Assoc Thai. 2005 Apr;88(4):467-72 Bunnag C, Leurmarnkul W, Jareoncharsri P, Tunsuri yawong P, Assanasen P, Pawankar R Quality of life assessment in Thai patients with allergic rhinoconjunc tivitis using the SF-36 questionnaire (Thai version). Rhinology. 2005 Jun;43(2):99-103 Chaowalit N, Dearani JA, Edwards WD, Pellikka PA Calcified right ventricular mass and pulmonary embolism in a previously healthy young woman. J Am Soc Echocardiogr. 2005 Mar;18(3):275-7 Chaowalit N, Somers VK, Pellikka PA, Rihal CS, Lopez-Jimenez F Subepicardial adipose tissue and the presence and severity of coronary artery disease. Atherosclerosis. 2005 Sep 22 Chawanpaiboon S, Titapant V, Sutantawibul A, Kanok pongsakdi S, Kangkagate C Predicting fetal anemia by using reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity in Thai fetuses throughout gestation. J Obstet Gynaecol Res. 2005 Dec;31(6):547-51 Chen JJ, Mao W, Rongviriyapanich C, Luisiri A, Steinhardt GF A multivariable assessment of renal size and growth of scarred kidneys in children. J Urol. 2005 Dec;174(6):2358-62

24. Cheunoy W, Prammananan T, Chaiprasert A, Foon gladda S Comparative evaluation of polymerase chain reaction and restriction enzyme analysis: two ampli fied targets, hsp65 and rpoB, for identification of cultured mycobacteria. Diagn Microbiol Infect Dis. 2005 Mar;51(3):165-71 25. Chierakul N, Wongwisutikul P, Vejbaesya S, Chotvilai wan K Tumor necrosis factor-alpha gene promoter polymorphism is not associated with smoking-related COPD in Thailand. Respirology. 2005 Jan;10(1):36-9 26. Chinchang W, Viprakasit V, Pung-Amritt P, Tanphai chitr VS, Yenchitsomanus PT Molecular analysis of unknown beta-globin gene mutations using polyme rase chain reaction-single strand conformation poly morphism (PCR-SSCP) technique and its application in Thai families with beta-thalassemias and beta-globin variants. Clin Biochem. 2005 Nov;38(11):987-96 27. Chinthammitr Y, Chinchang W, Ruchutrakool T, Vipra kasit V Identification of the novel signal peptide mutation, antithrombin-Siriraj causes type-I antith rombin deficiency in thai patients. Thromb Haemost. 2005 Sep;94(3):678-9 28. Choi YK, Nguyen TD, Ozaki H, Webby RJ, Putha vathana P, Buranathal C, et al. Studies of H5N1 influenza virus infection of pigs by using viruses isolated in Vietnam and Thailand in 2004. J Virol. 2005 Aug;79(16):10821-5 29. Chokephaibulkit K, Chaisilwattana P, Vanprapar N, Phongsamart W, Sutthent R Lack of resistant muta tion development after receiving short-course zido vudine plus lamivudine to prevent mother-to-child transmission. Aids. 2005 Jul 22;19(11):1231-3 30. Chokephaibulkit K, Plipat N, Cressey TR, Frederix K, Phongsamart W, Capparelli E, et al. Pharmacokinetics of nevirapine in HIV-infected children receiving an adult fixed-dose combination of stavudine, lamivudine and nevirapine. Aids. 2005 Sep 23;19(14):1495-9 31. Chokephaibulkit K, Uiprasertkul M, Puthavathana P, Chearskul P, Auewarakul P, Dowell SF, et al. A child with avian influenza A (H5N1) infection. Pediatr Infect Dis J. 2005 Feb;24(2):162-6 32. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, Kijphati R, et al. Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis. 2005 Feb;11(2):201-9 33. Chuangsuwanich T, Sunsaneevithayakul P, Muang somboon K, Limwongse C Ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome presenting with a large nephrogenic cyst, severe oligohydramnios and hydrops fetalis: a case report and review of the literature. Prenat Diagn. 2005 Mar;25(3):210-5 34. Chuaychoo B, Hunter DD, Myers AC, Kollarik M, Undem BJ Allergen-induced substance P synthesis in large-diameter sensory neurons innervating the lungs. J Allergy Clin Immunol. 2005 Aug;116(2):325-31 35. Chuaychoo B, Lee MG, Kollarik M, Undem BJ Effect

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of 5-hydroxytryptamine on vagal C-fiber subtypes in guinea pig lungs. Pulm Pharmacol Ther. 2005;18 (4) :269-76 Chuenkongkaew WL, Lertrit P, Limwongse C, Nilanont Y, Boonyapisit K, Sangruchi T, et al. An unusual family with Leberís hereditary optic neuropathy and facioscapulohumeral muscular dystrophy. Eur J Neurol. 2005 May;12(5):388-91 Chuenkongkaew WL, Suphavilai R, Vaeusorn L, Phasukkijwatana N, Lertrit P, Suktitipat B Proportion of 11778 mutant mitochondrial DNA and clinical expression in a thai population with leber hereditary optic neuropathy. J Neuroophthalmol. 2005 Sep;25 (3):173-5 Chutipongtanate S, Nakagawa Y, Sritippayawan S, Pittayamateekul J, Parichatikanond P, Westley BR, et al. Identification of human urinary trefoil factor 1 as a novel calcium oxalate crystal growth inhibitor. J Clin Invest. 2005 Dec;115(12):3613-22 Coates BM, Vavilala MS, Mack CD, Muangman S, Suz P, Sharar SR, et al. Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury. Crit Care Med. 2005 Nov;33 (11):2645-50 Coplan PM, Gupta SB, Dubey SA, Pitisuttithum P, Nikas A, Mbewe B, et al. Cross-reactivity of antiHIV-1 T cell immune responses among the major HIV-1 clades in HIV-1-positive individuals from 4 continents. J Infect Dis. 2005 May 1;191(9):1427-34 Daengsuwan T, Palosuo K, Phankingthongkum S, Visitsunthorn N, Jirapongsananuruk O, Alenius H, et al. IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis. Allergy. 2005 Apr;60(4): 506-9 Deerojanawong J, Manuyakorn W, Prapphal N, Harn ruthakorn C, Sritippayawan S, Samransamruajkit R Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebu lizer in young children with wheezing. Pediatr Pulmonol. 2005 May;39(5):466-72 Densupsoontorn NS, Jirapinyo P, Wongarn R, Thamon siri N, Nana A, Laohaprasitiporn D, et al. Manage ment of chylothorax and chylopericardium in pediatric patients: experiences at Siriraj Hospital, Bangkok. Asia Pac J Clin Nutr. 2005;14(2):182-7 Desjardins A, Rich JN, Quinn JA, Vredenburgh J, Gururangan S, Sathornsumetee S, et al. Chemotherapy and novel therapeutic approaches in malignant glioma. Front Biosci. 2005 Sep 1;10:2645-68 Drakesmith H, Schimanski LM, Ormerod E, Merry weather-Clarke AT, Viprakasit V, Edwards JP, et al. Resistance to hepcidin is conferred by hemochroma tosis-associated mutations of ferroportin. Blood. 2005 Aug 1;106(3):1092-7 Durongpisitkul K, Laoprasitiporn D, Layangool T, Sittiwankul R, Panamonta M, Mokrapong P Compa

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rison of the acute pulmonary vasodilating effect of beraprost sodium and nitric oxide in congenital heart disease. Circ J. 2005 Jan;69(1):61-4 Eamsobhana P, Mongkolporn T, Punthuprapasa P, Yoolek A Mammomonogamus roundworm (Nematoda: Syngamidae) recovered from the duodenum of a Thai patient: a first and unusual case originating in Thailand. Trans R Soc Trop Med Hyg. 2005 Oct 27 Eisterer W, Jiang X, Christ O, Glimm H, Lee KH, Pang E, et al. Different subsets of primary chronic myeloid leukemia stem cells engraft immunodeficient mice and produce a model of the human disease. Leukemia. 2005 Mar;19(3):435-41 Goo JM, Tongdee T, Tongdee R, Yeo K, Hildebolt CF, Bae KT Volumetric measurement of synthetic lung nodules with multi-detector row CT: effect of various image reconstruction parameters and segmentation thresholds on measurement accuracy. Radiology. 2005 Jun;235(3):850-6 Govorkova EA, Rehg JE, Krauss S, Yen HL, Guan Y, Peiris M, et al. Lethality to ferrets of H5N1 influenza viruses isolated from humans and poultry in 2004. J Virol. 2005 Feb;79(4):2191-8 Hulse-Post DJ, Sturm-Ramirez KM, Humberd J, Seiler P, Govorkova EA, Krauss S, et al. Role of domestic ducks in the propagation and biological evolution of highly pathogenic H5N1 influenza viruses in Asia. Proc Natl Acad Sci U S A. 2005 Jul 26;102(30):10682-7 Issaragrisil S Umbilical cord blood transplantation for thalassemia. Curr Hematol Rep. 2005 Nov;4(6):415-6 Janyapoon K, Jivakanont P, Surbrsing R, Siriprapapan W, Tachawuttiwat T, Korbsrisate S Detection of anti-dsDNA by ELISA using different sources of antigens. Pathology. 2005 Feb;37(1):63-8 Jenkins RA, Thapinta D, Morgan PA, Wongkamhaeng S, Sornsathapornkul P, Bussaratid V, et al. Behavioral and social issues among volunteers in a preventive HIV vaccine trial in Thailand. J Acquir Immune Defic Syndr. 2005 Dec 15;40(5):592-9 Jirapinyo P, Densupsoontorn N, Chinrungrueng D, Wongarn R, Thamonsiri N Relative risks of becoming overweight and obese in children after 6 years in secondary school. J Med Assoc Thai. 2005 May;88 (5):651-4 Jirapinyo P, Densupsoontorn N, Kongtragoolpitak S, Wong-Arn R, Thamonsiri N Increasing risks of becom ing obese after 6 years in primary school: comparing the relative risks among some schools in Bangkok, Saraburi and Sakolnakorn. J Med Assoc Thai. 2005 Jun;88(6):829-32 Joe BN, Chen VY, Salibi N, Fuangtharntip P, Hilde bolt CF, Bae KT Evaluation of 1H-magnetic resonance spectroscopy of breast cancer pre- and postgadolinium administration. Invest Radiol. 2005 Jul;40(7):405-11 Jonas JB, Stroux A, Oberacher-Velten IM, Kitnarong N, Juenemann A Central corneal thickness and

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Ann Thorac Surg. 2005 Jun;79(6):1934-8 164. Sturm-Ramirez KM, Hulse-Post DJ, Govorkova EA, Humberd J, Seiler P, Puthavathana P, et al. Are ducks contributing to the endemicity of highly pathogenic H5N1 influenza virus in Asia? J Virol. 2005 Sep;79 (17):11269-79 165. Subtaweesin T, Sriyoschati S Early results of anatomic repair in a subgroup of corrected transposition. Asian Cardiovasc Thorac Ann. 2005 Sep;13(3): 208-10 166. Suparak S, Kespichayawattana W, Haque A, Easton A, Damnin S, Lertmemongkolchai G, et al. Multinu cleated giant cell formation and apoptosis in infected host cells is mediated by Burkholderia pseudomallei type III secretion protein BipB. J Bacteriol. 2005 Sep; 187(18):6556-60 167. Suparak S, Kespichayawattana W, Haque A, Easton A, Damnin S, Lertmemongkolchai G, et al. Multinu cleated giant cell formation and apoptosis in infected host cells is mediated by Burkholderia pseudomallei type III secretion protein BipB. J Bacteriol. 2005 Sep; 187(18):6556-60 168. Suptawiwat O, Lee TH, Auewarakul P HIV-1 Cis Enhancing Sequence (CES) enhances CTE-dependent Gag expression. Virology. 2005 Nov 10;342(1):111-8 169. Suputthamongkol Y, Nitatpattana N, Chayakulkeeree M, Palabodeewat S, Yoksan S, Gonzalez JP Hanta virus infection in Thailand: first clinical case report. Southeast Asian J Trop Med Public Health. 2005 May; 36(3):700-3 170. Sutthent R, Arworn D, Kaoriangudom S, Chokphai bulkit K, Chaisilwatana P, Wirachsilp P, et al. HIV-1 drug resistance in Thailand: before and after National Access to Antiretroviral Program. J Clin Virol. 2005 Dec;34(4):272-6 171. Sutthikornchai C, Jantanavivat C, Thongrungkiat S, Harnroongroj T, Sukthana Y Protozoal contamination of water used in Thai frozen food industry. Southeast Asian J Trop Med Public Health. 2005;36 Suppl 4: 41-5 172. Swan H, Sloan L, Muyombwe A, Chavalitshewin koon-Petmitr P, Krudsood S, Leowattana W, et al. Evaluation of a real-time polymerase chain reaction assay for the diagnosis of malaria in patients from Thailand. Am J Trop Med Hyg. 2005 Nov;73(5): 850-4 173. Talbot SG, Estilo C, Maghami E, Sarkaria IS, Pham DK, P Oc, et al. Gene expression profiling allows distinction between primary and metastatic squamous cell carcinomas in the lung. Cancer Res. 2005 Apr 15;65(8):3063-71 174. Tanmahasamut P, Sidell N Up-regulation of gap junctional intercellular communication and connexin 43 expression by retinoic acid in human endometrial stromal cells. J Clin Endocrinol Metab. 2005 Jul;90 (7):4151-6

175. Techasathit W, Ratanasuwan W, Sonjai A, Sangsiri wut K, Anekthananon T, Suwanagool S Vaccination against hepatitis B virus: are Thai medical students sufficiently protected? J Med Assoc Thai. 2005 Mar; 88(3):329-34 176. Teeraputon S, Louisirirojchanakul S, Auewarakul P N-linked glycosylation in C2 region of HIV-1 envelope reduces sensitivity to neutralizing antibodies. Viral Immunol. 2005;18(2):343-53 177. Teeraratkul A, Simonds RJ, Asavapiriyanont S, Chalermchokcharoenkit A, Vanprapa N, Chotpitaya sunondh T, et al. Evaluating programs to prevent mother-to-child HIV transmission in two large Bangkok hospitals, 1999-2001. J Acquir Immune Defic Syndr. 2005 Feb 1;38(2):208-12 178. Termrungruanglert W, Tresukosol D, Vasuratna A, Sittisomwong T, Lertkhachonsuk R, Sirisabya N Neoadjuvant gemcitabine and cisplatin followed by radical surgery in (bulky) squamous cell carcinoma of cervix stage IB2. Gynecol Oncol. 2005 May;97 (2):576-81 179. Thawnashom K, Tungtrongchitr R, Petmitr S, Pong paew P, Phonrat B, Tungtrongchitr A, et al. Methy lenetetrahydrofolate reductase (MTHFR) polymor phism (C677T) in relation to homocysteine concen tration in overweight and obese Thais. Southeast Asian J Trop Med Public Health. 2005 Mar;36(2): 459-66 180. Thepthai C, Smithtikarn S, Suksuwan M, Songsivilai S, Dharakul T Serodiagnosis of melioidosis by a competitive enzyme-linked immunosorbent assay using a lipopolysaccharide-specific monoclonal antibody. Asian Pac J Allergy Immunol. 2005 JunSep;23(2-3):127-32 181. Tholpady SS, Aojanepong C, Llull R, Jeong JH, Mason AC, Futrell JW, et al. The cellular plasticity of human adipocytes. Ann Plast Surg. 2005 Jun;54 (6):651-6 182. Thongboonkerd V Proteomic analysis of renal diseases: unraveling the pathophysiology and bio marker discovery. Expert Rev Proteomics. 2005 Jun;2 (3):349-66 183. Thongboonkerd V Genomics, proteomics and inte grative ìomicsî in hypertension research. Curr Opin Nephrol Hypertens. 2005 Mar;14(2):133-9 184. Thongboonkerd V, Malasit P Renal and urinary proteomics: current applications and challenges. Proteomics. 2005 Mar;5(4):1033-42 185. Thongngarm T, Silkoff PE, Kossack WS, Nelson HS Hydrofluoroalkane-134A beclomethasone or chlorof luorocarbon fluticasone: effect on small airways in poorly controlled asthma. J Asthma. 2005 May;42 (4):257-63 186. Thoongsuwan N, Kanne JP, Stern EJ Spectrum of blunt chest injuries. J Thorac Imaging. 2005 May;20 (2):89-97

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187. Tipayamongkholgul M, Podhipak A, Chearskul S, Sunakorn P Factors associated with the development of tuberculosis in BCG immunized children. South east Asian J Trop Med Public Health. 2005 Jan;36 (1):145-50 188. Tuchinda C, Leenutaphong V, Sudtim S, Lim HW Refractory livedoid vasculitis responding to PUVA: a report of four cases. Photodermatol Photoimmunol Photomed. 2005 Jun;21(3):154-6 189. Tuchinda C, Leenutaphong V, Sudtim S, Lim HW Fixed solar urticaria induced by UVA and visible light: a report of a case. Photodermatol Photo immunol Photomed. 2005 Apr;21(2):97-9 190. Tungtrongchitr R, Sricharoen P, Pongpaew P, Phonrat B, Arthan D, Vudhivai N, et al. Adiponectin/ACP30, a collagen-like plasma protein in relation to anthro pometric measurement in Thai overweight and obese subjects. Int J Food Sci Nutr. 2005 May;56(3): 193-201 191. Uiprasertkul M, Puthavathana P, Sangsiriwut K, Pooruk P, Srisook K, Peiris M, et al. Influenza A H5N1 replication sites in humans. Emerg Infect Dis. 2005 Jul;11(7):1036-41 192. Ungchusak K, Auewarakul P, Dowell SF, Kitphati R, Auwanit W, Puthavathana P, et al. Probable personto-person transmission of avian influenza A (H5N1). N Engl J Med. 2005 Jan 27;352(4):333-40 193. Usmani OS, Ito K, Maneechotesuwan K, Ito M, Johnson M, Barnes PJ, et al. Glucocorticoid receptor nuclear translocation in airway cells after inhaled combination therapy. Am J Respir Crit Care Med. 2005 Sep 15;172(6):704-12 194. Uttayamakul S, Likanonsakul S, Sunthornkachit R, Kuntiranont K, Louisirirotchanakul S, Chaovavanich A, et al. Usage of dried blood spots for molecular diagnosis and monitoring HIV-1 infection. J Virol Methods. 2005 Sep;128(1-2):128-34 195. Valairucha S, Maboonvanon P, Napachoti T, Siriva nasandha B, Suraseranuvongse S Cost-effectiveness of thoracic patient-controlled epidural analgesia using bupivacaine with fentanyl vs bupivacaine with morphine after thoracotomy and upper abdominal surgery. J Med Assoc Thai. 2005 Jul;88(7):921-7 196. Vavilala MS, Kincaid MS, Muangman SL, Suz P, Rozet I, Lam AM Gender differences in cerebral blood flow velocity and autoregulation between the anterior and posterior circulations in healthy children. Pediatr Res. 2005 Sep;58(3):574-8 197. Veerasarn V, Boonnuch W, Kakanaporn C A phase II study to evaluate WF10 in patients with late hemor rhagic radiation cystitis and proctitis. Gynecol Oncol. 2005;252(2):p. 230-1

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198. Vichchatorn P, Wongkajornsilp A, Petvises S, Tang pradabkul S, Pakakasama S, Hongeng S Dendritic cells pulsed with total tumor RNA for activation NK-like T cells against glioblastoma multiforme. J Neurooncol. 2005 Nov;75(2):111-8 199. Viprakasit V, Chinchang W, Chotimarat P Hb Wood ville, a rare alpha-globin variant, caused by codon 6 mutation of the alpha1 gene. Eur J Haematol. 2005 Nov 18 200. Viprakasit V, Chinchang W, Glomglao W, Tanphai chitr VS A rare association of alphaO-thalassemia (óSEA) and an initiation codon mutation (AT G ó > A-G) of the alpha2 gene causes Hb H disease in Thailand. Hemoglobin. 2005;29(3):235-40 201. Viprakasit V, Chinchang W, Suwanthol L, Tanphaichitr VS Common origin of a rare beta-globin initiation codon mutation (ATGó>AGG) in Asians. Clin Lab Haematol. 2005 Dec;27(6):409-15 202. Visalyaputra S, Rodanant O, Somboonviboon W, Tantivitayatan K, Thienthong S, Saengchote W Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. Anesth Analg. 2005 Sep;101(3):862-8, table of contents 203. Walsh DS, Thavichaigarn P, Pattanapanyasat K, Siritongtaworn P, Kongcharoen P, Tongtawe P, et al. Characterization of circulating monocytes expressing HLA-DR or CD71 and related soluble factors for 2 weeks after severe, non-thermal injury. J Surg Res. 2005 Dec;129(2):221-30 204. Wanachiwanawin D, Wongkamchai S, Loymek S, Suvuttho S, Monkon N, Chinabutra P, et al. Determi nation of fecal occult blood in primary schoolchildren infected with Trichuris trichiura. Southeast Asian J Trop Med Public Health. 2005 Sep;36(5):1110-3 205. Wannasilp N, Sribhen K, Pussara N, Opartkiatikul N EDTA should be the anticoagulant of choice for the measurement of plasma ammonia: report of a problem sample. Clin Chim Acta. 2005 Jul 1;357 (1):84-5 206. Wasant P, Viprakasit V, Srisomsap C, Liammongkolkul S, Ratanarak P, Sathienkijakanchai A, et al. Arginino succinate synthetase deficiency: mutation analysis in 3 Thai patients. Southeast Asian J Trop Med Public Health. 2005 May;36(3):757-61 207. Wataganara T, Chen AY, LeShane ES, Sullivan LM, Borgatta L, Bianchi DW, et al. Changes of cell-free fetal DNA in maternal plasma after elective termi nation of pregnancy. Clin Chem. 2005 Jan;51(1): 217-9 208. Wataganara T, Metzenbauer M, Peter I, Johnson KL, Bianchi DW Placental volume, as measured by 3-

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dimensional sonography and levels of maternal plasma cell-free fetal DNA. Am J Obstet Gynecol. 2005 Aug;193(2):496-500 Watcharong C, Chuckpaiwong B, Mahaisavariya B Orthopaedic trauma following tsunami: experience from Phang Nga, Thailand. J Orthop Surg (Hong Kong). 2005 Apr;13(1):1-2 Wilson MO, Scougall KT, Ratanamart J, McIntyre EA, Shaw JA Tetracycline-regulated secretion of human (pro)insulin following plasmid-mediated transfection of human muscle. J Mol Endocrinol. 2005 Apr;34(2):391-403 Wiriyarat W, Sukpanichnant S, Sittisombut N, Bala chandra K, Promkhatkaew D, Butraporn R, et al. Specific immune response and pathological findings in BALB/c mice inoculated with recombinant BCG expressing HIV-1 antigen. Asian Pac J Allergy Immunol. 2005 Mar;23(1):41-51 Wongkajornsilp A, Sangsuriyong S, Hongeng S, Waikakul S, Asavamongkolkul A, Huabprasert S Effective osteosarcoma cytolysis using cytokineinduced killer cells pre-inoculated with tumor RNApulsed dendritic cells. J Orthop Res. 2005 Nov;23 (6):1460-6 Wongkamchai S, Rongsriyam K, Nochot H, Maha kittikun V, Sermsart B, Choochote W, et al. Efficacy of various synthetic pyrethroid-impregnated encasement materials against house dust mite under laboratory conditions. Exp Appl Acarol. 2005;35(4):293-300

214. Xiao S, Day-Storms JJ, Srisawat C, Fierke CA, Engelke DR Characterization of conserved sequence elements in eukaryotic RNase P RNA reveals roles in holoenzyme assembly and tRNA processing. Rna. 2005 Jun;11(6):885-96 215. Yavuz A, Tetta C, Ersoy FF, DíIntini V, Ratanarat R, De Cal M, et al. Uremic toxins: a new focus on an old subject. Semin Dial. 2005 May-Jun;18(3): 203-11 216. Zerbini C, Ozturk ZE, Grifka J, Maini M, Nilganuwong S, Morales R, et al. Efficacy of etoricoxib 60 mg/day and diclofenac 150 mg/day in reduction of pain and disability in patients with chronic low back pain: results of a 4-week, multinational, randomized, double-blind study. Curr Med Res Opin. 2005 Dec; 21(12):2037-49 217. Zhu KQ, Engrav LH, Armendariz R, Muangman P, Klein MB, Carrougher GJ, et al. Changes in VEGF and nitric oxide after deep dermal injury in the female, red Duroc pig-further similarities between female, Duroc scar and human hypertrophic scar. Burns. 2005 Feb;31(1):5-10

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Publication 2006 1.

Akarasereenont P, Tripatara P, Chotewuttakorn S, Palo T, Thaworn A The effects of estrone, estradiol and estriol on platelet aggregation induced by adrenaline and adenosine diphosphate. Platelets. 2006 Nov;17 (7):441-7 2. Akaraviputh T, Boonnuch W, Lohsiriwat V, Methasate A, Chinswangwatanakul V, Lert-akayamanee N, et al. Long-term results of large diameter hepaticojejunos tomy for treatment of Bile Duct Injuries following cholecystectomy. J Med Assoc Thai. 2006 May;89(5) :657-62 3. Akaraviputh T, Chinswangwatanakul V, Swangsri J, Lohsiriwat V Thoracoscopic enucleation of a large esophageal leiomyoma using a three thoracic ports technique. World J Surg Oncol. 2006;4:70 4. Angsuwathana S, Tanmahasamut P, Rattanachaiya nont M, Dangrat C, Techatrisak K, Indhavivadhana S, et al. Serum follicle stimulating hormone and estradiol in peri/postmenopausal women attending Siriraj Menopause Clinic: a retrospective study. J Med Assoc Thai. 2006 Aug;89(8):1101-8 5. Apisarnthananarak P, Apisarnthanarak A, Mundy LM Computed Tomography Characterisitics of Burkhol deria pseudomallei-Associated Liver Abscess. Clin Infect Dis. 2006 Dec 15;43(12):1618-20 6. Assantachai P, Angkamat W, Pongpim P, Weattaya suthum C, Komoltri C Risk factors of osteoporosis in institutionalized older Thai people. Osteoporos Int. 2006;17(7):1096-102 7. Assantachai P, Sriussadaporn S, Thamlikitkul V, Sitthi chai K Body composition: gender-specific risk factor of reduced quantitative ultrasound measures in older people. Osteoporos Int. 2006;17(8):1174-81 8. Assantachai P, Yamwong P, Lekhakula S Alternative anthropometric measurements for the Thai elderly: Mindex and Demiquet. Asia Pac J Clin Nutr. 2006;15 (4):521-7 9. Atchaneeyasakul LO, Appukuttan B, Pingsuthiwong S, Yenchitsomanus PT, Trinavarat A, Srisawat C A novel H572R mutation in the transforming growth factor-betainduced gene in a Thai family with lattice corneal dystrophy type I. Jpn J Ophthalmol. 2006 Sep-Oct; 50(5):403-8 10. Atchaneeyasakul LO, Trinavarat A, Dulayajinda D, Kumpornsin K, Thongnoppakhun W, Yenchitsomanus PT, et al. Novel and de-novo truncating PAX6 muta

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tions and ocular phenotypes in Thai aniridia patients. qOphthalmic Genet. 2006 Mar;27(1):21-7 Auewarakul CU, Huang S, Yimyam M, Boonmoh S Natural history of Southeast Asian chronic myeloid leukemia patients with different BCR-ABL gene variants. Acta Haematol. 2006;116(2):114-9 Auewarakul CU, Lauhakirti D, Promsuwicha O, Mun khetvit C C-kit receptor tyrosine kinase (CD117) expression and its positive predictive value for the diagnosis of Thai adult acute myeloid leukemia. Ann Hematol. 2006 Feb;85(2):108-12 Auewarakul CU, Lauhakirti D, Tocharoentanaphol C Frequency of RAS gene mutation and its cooperative genetic events in Southeast Asian adult acute myeloid leukemia. Eur J Haematol. 2006 Jul;77(1):51-6 Auewarakul CU, Leecharendkeat A, Thongnoppakhun W, Limwongse C, Tocharoentanaphol C Mutations of AML1 in non-M0 acute myeloid leukemia: six novel mutations and a high incidence of cooperative events in a South-east Asian population. Haematologica. 2006 May;91(5):675-8 Auewarakul P, Kositanont U, Sornsathapornkul P, Tothong P, Kanyok R, Thongcharoen P Antibody responses after dose-sparing intradermal influenza vaccination. Vaccine. 2006 Sep 1 Avirutnan P, Punyadee N, Noisakran S, Komoltri C, Thiemmeca S, Auethavornanan K, et al. Vascular leakage in severe dengue virus infections: a potential role for the nonstructural viral protein NS1 and complement. J Infect Dis. 2006 Apr 15;193(8): 107888 Bejrachandra S, Saipin J, Nathalang O, Siriboonrit U, Rungroung E, Udee S External quality assessment scheme in red blood cell serology: a 5-year experience in Thailand. Immunohematol. 2006;22(1):1-5 Buranasinsup S, Sila-Asna M, Bunyaratvej N, Bun yaratvej A In vitro osteogenesis from human skinderived precursor cells. Dev Growth Differ. 2006 May; 48(4):263-9 Chaiprasert A, Yorsangsukkamol J, Prammananan T, Palittapongarnpim P, Leechawengwong M, Dhiraputra C Intact pks15/1 in non-W-Beijing Mycobacterium tuberculosis isolates. Emerg Infect Dis. 2006 May; 12(5):772-4 Chalermchockcharoenkit A, Sirimai K, Chaisilwattana P High prevalence of cervical squamous cell abnorma

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lities among HIV-infected women with immunological AIDS-defining illnesses. J Obstet Gynaecol Res. 2006 Jun;32(3):324-9 Chanchairujira T, Chantaphakul N, Thanwandee T, Ong-Ajyooth L Efficacy of intradermal hepatitis B vaccination compared to intramuscular vaccination in hemodialysis patients. J Med Assoc Thai. 2006 Aug; 89 Suppl 2:S33-40 Chantad D, Krittayaphong R, Komoltri C Derived 12lead electrocardiogram in the assessment of ST-seg ment deviation and cardiac rhythm. J Electrocardiol. 2006 Jan;39(1):7-12 Charoensak A, Chawalparit O, Suttinont C, Niwatta yakul K, Losuwanaluk K, Silpasakorn S, et al. Scrub typhus: chest radiographic and clinical findings in 130 Thai patients. J Med Assoc Thai. 2006 May;89(5): 600-7 Chaudakshetrin P A survey of patients with neuropathic pain at Siriraj Pain Clinic. J Med Assoc Thai. 2006 Mar;89(3):354-61 Chavalitdhamrong D, Tanwandee T Long-term out comes of chronic hepatitis C patients with sustained virological response at 6 months after the end of treatment. World J Gastroenterol. 2006 Sep 14;12 (34) :5532-5 Chawalparit O, Charoensak A, Chierakul N HRCT of pulmonary tuberculosis mimics malignancy: a preli minary report. J Med Assoc Thai. 2006 Feb;89(2): 190-5 Chawalparit O, Churojana A, Chiewvit P, Thanapipatsir S, Vamvanij V, Charnchaowanish P The limited proto col MRI in diagnosis of lumbar disc herniation. J Med Assoc Thai. 2006 Feb;89(2):182-9 Chawalparit O, Prayoonwiwat N MRI of multiple sclerosis in Thai patients. J Med Assoc Thai. 2006 Apr;89(4):422-7 Chearskul S, Supingklud N, Nitithamyong A, Siri chakwal P Assessment of hormonal and metabolic effects of dietary fiber in young Thai women. J Med Assoc Thai. 2006 Jul;89(7):997-1003 Cheunsuchon B, Supavekin S, Sanpakit K, Paricha tikanond P A 5-year-old girl with impaired renal function after autologous bone marrow transplanta tion. Am J Kidney Dis. 2006 Oct;48(4):668-73 Chinthammitr Y, Vos HL, Rosendaal FR, Doggen CJ The association of prothrombin A19911G polymor phism with plasma prothrombin activity and venous thrombosis: results of the MEGA study, a large popu lation-based case-control study. J Thromb Haemost. 2006 Dec;4(12):2587-92 Chumpathong S, Chinachoti T, Visalyaputra S, Him munngan T Incidence and risk factors of hypotension

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during spinal anesthesia for cesarean section at Siriraj Hospital. J Med Assoc Thai. 2006 Aug;89(8):1127-32 Chumpia W, Peerapittayamongkol C, Angchaisuksiri P, Komanasin N, Muta K, Kuaha K, et al. Single nucle otide polymorphisms and haplotypes of protein C and protein S genes in the Thai population. Blood Coagul Fibrinolysis. 2006 Jan;17(1):13-8 Dejsomritrutai W, Nana A, Chierakul N, Tscheikuna J, Sompradeekul S, Ruttanaumpawan P, et al. Prevalence of bronchial hyperresponsiveness and asthma in the adult population in Thailand. Chest. 2006 Mar;129 (3):602-9 Durongpisitkul K, Sangtawesin C, Khongphatthana yopthin A, Panamonta M, Sopontammarak S, Sitti wangkul R, et al. Epidemiologic study of Kawasaki disease and cases resistant to IVIG therapy in Thailand. Asian Pac J Allergy Immunol. 2006 Mar;24(1):27-32 Eamsobhana P, Mongkolporn T, Punthuprapasa P, Yoolek A Mammomonogamus roundworm (Nema toda: Syngamidae) recovered from the duodenum of a Thai patient: a first and unusual case originating in Thailand. Trans R Soc Trop Med Hyg. 2006 Apr; 100 (4):387-91 Eamsobhana P, Ongrotchanakun J, Yoolek A, Punthu prapasa P, Monkong N, Dekumyoy P Multi-immuno dot for rapid differential diagnosis of eosinophilic meningitis due to parasitic infections. J Helminthol. 2006 Sep;80(3):249-54 Iramaneerat C Predicting academic achievement in the medical school with high school grades. J Med Assoc Thai. 2006 Sep;89(9):1497-505 Issaragrisil S, Kaufman DW, Anderson T, Chansung K, Leaverton PE, Shapiro S, et al. The epidemiology of aplastic anemia in Thailand. Blood. 2006 Feb 15; 107(4):1299-307 Jintaridth P, Srisomsap C,Vichittumaros K,Kalpravidh RW, Winichagoon P, Fucharoen S, et al. Chicken egg yolk antibodies specific for the gamma chain of human hemoglobin for diagnosis of thalassemia. Int J Hematol. 2006 Jun;83(5):408-14 Kachintorn U Introduction. J Gastroenterol Hepatol. 2006 Dec;21(s5):S111 Kantakamalakul W, Pattanapanyasat K, Jongrakthaitae S, Assawadarachai V, Ampol S, Sutthent R A novel EGFP-CEM-NKr flow cytometric method for measur ing antibody dependent cell mediated-cytotoxicity (ADCC) activity in HIV-1 infected individuals. J Immunol Methods. 2006 Aug 31;315(1-2):1-10 Kiratisin P, Koomanachai P, Kowwigkai P, Pattana chaiwit S, Aswapokee N, Leelaporn A Early-onset prosthetic valve endocarditis caused by Inquilinus sp. Diagn Microbiol Infect Dis. 2006 Nov;56(3):317-20

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