Biomedical Sciences and Clinical Medicine

Effect of Tranexamic Acid Infusion to Reduce Intraoperative Blood Loss in Large Meningioma: A Prospective Randomized Control Study (Preliminary Report)

Pathomporn Pin-on — 2025-04-02

Objective Resection of intracranial meningioma has been related to significant blood loss. Intravenous tranexamic acid (TXA) has been shown to successfully attenuated blood loss and transfusion in various surgical procedures. However, the evidence has been limited in the surgical management of brain tumors. This study aims to evaluate the efficacy of intravenous TXA in reducing intraoperative blood loss and the need for blood transfusion during the surgical resection of intracranial meningiomas.

Methods We conducted a prospective, randomized double-blind controlled study aiming for a sample size of 44 patients. In this preliminary report, twenty-five patients aged 18-60 years with large intracranial meningioma undergoing elective meningioma resection were enrolled and randomized to receive either TXA or a placebo. “Large meningioma” was defined as a radiographic finding of a tumor with a diameter > 5 cm in at least 2 dimensions. The TXA group was administered TXA at 20 mg/kg over 20 minutes, prior to the operation, followed by an infusion of 1 mg/kg/hr until the end of the operation. The primary outcome measure was volume of intraoperative blood loss. Continuous variables were analyzed with Student’s t-test or the Mann-Whitney U-test depending upon the distribution of the data. Fisher’s exact test was used to compare categorical variables.

Results Twenty-five patients were randomized with 12 in the TXA group and 13 in the placebo group. Baseline characteristics of the patients in the two groups were similar. The median intraoperative blood loss volume was 1,925 mL (IQR=1,575) in the TXA group and 1,500 mL (IQR=1,700) in the placebo group (p = 0.904). The median of intraoperative packed red cells (PRC) transfusion volume was 801.5 mL (IQR=825.5) in the TXA group and 493 mL (IQR=856) in the placebo group (p = 0.883). There was no significant difference in blood transfusion volumes between the groups in first 24 hours after surgery (p = 0.581). The incidence of thromboembolic events was similar in the two groups (p = 1.0). No postoperative seizures occurred in either group during the study.

Conclusions TXA did not reduce intraoperative blood loss, the intraoperative transfusion requirement, and the transfusion requirements during the first 24 hours after surgery in patients who underwent large intracranial meningioma resection.

Construction of Thai Monosyllabic Word Lists for Speech Recognition Test of Adults

Paphawee Mana — 2025-04-09

Objective The objective of this study was to construct new Thai monosyllabic word lists that are phonetically balanced and to study the accuracy of speech recognition measuring tests for adults.

Methods This study creation of four Thai monosyllabic word lists (KKU lists) of twenty-five words each in a CD recording based upon an accuracy evaluation. The 76 participants recruited were between 19 and 70 years of age and were recruited based on four groups of hearing level. Each group of 19 subjects consisted of people with normal hearing as well as people with moderate, moderately severe, and severe sensorineural hearing loss with symmetrical hearing. Only the dominant ear of each of the participants was chosen for testing. Audiometry in that ear was conducted using randomized nine-word lists from the four newly constructed Khon Kaen University lists (KKU lists) and five lists of RAMA SD lists-1 from the original Thai monosyllabic word lists (OTL) [OTL consisted of RAMA SD list-1 (there are 5 lists) and RAMA SD list-2 (there are 4 lists)]. The participant’s accurately spoken words will be recorded as a number and percentage.

Results No statistically significant differences were found in the speech recognition scores of any of the four KKU lists among the four participant groups (p > 0.05). Similar to Kasmer and Brown’s study, the speech recognition scores (SRS) of the KKU lists and OTL lists declined as the degree of the severity of hearing loss increased. The score range (min-max) at each level of hearing loss for all nine-word lists was in the standard value range. However, the SRS of the KKU lists were found to be closer to the standard reference than the scores from the OTL list.

Conclusions The KKU lists can provide more accurate score results and more precise diagnoses of hearing loss and can also be applied in clinical examination and speech recognition testing.

Incidence of and Risk Factors for Extrauterine Growth Restriction in Preterm Infants with Gestational Age Less Than 32 Weeks or Birth Weight Less Than 1,500 Grams

Mallika Pomrop — 2025-04-04

Objective To determine the incidence and risk factors for extrauterine growth restriction (EUGR) in preterm infants with gestational age (GA) less than 32 weeks or birth weight (BW) less than 1,500 grams.

Methods A retrospective cohort study reviewed preterm infants admitted at Chiang Mai University Hospital between January 1, 2017, and December 31, 2020. EUGR was defined as weight below the 10^th percentile at 36 weeks postmenstrual age based on the Fenton growth chart. Data were analyzed, with a p-value of less than 0.05 considered statistically significant. Multivariate regression analysis was adjusted for confounding variables.

Results Among 310 eligible infants, 201 (64.8%) were diagnosed with EUGR. All of 76 SGA infants (100.0%) were EUGR. Significant risk factors included proven sepsis (OR 3.90, 95%CI 1.13-13.45, p = 0.03), diuretic use (OR 3.62, 95%CI 1.47-8.91, p = 0.005), definite NEC (OR 3.54, 95%CI 1.60-7.83, p = 0.002), maternal gestational hypertension (OR 2.36, 95%CI 1.28-4.35,
p = 0.006), and multiple births (OR 1.85, 95%CI 1.04-3.28, p = 0.04). Nutritional risk factors were delayed full enteral feeding (OR 1.08, 95%CI 1.03-1.12, p = 0.001) and higher initial glucose infusion rate (GIR) in TPN (OR 1.28, 95%CI 1.11-1.48, p = 0.001). Infants with EUGR had longer hospital stays and higher hospital costs than non-EUGR infants. Multivariate analysis showed significant risks including definite NEC (OR 2.45, 95%CI 1.01-5.96, p = 0.049), maternal gestational hypertension (adjusted OR 2.79, 95%CI 1.46-5.33, p = 0.002), and multiple births (adjusted OR 2.29, 95%CI 1.24-4.24, p = 0.008).

Conclusions Multiple births, maternal gestational hypertension, SGA status, and NEC were associated with a higher risk of EUGR in preterm infants less than 32 weeks or VLBW. Providing proper antenatal care for mothers with multiple pregnancies or gestational hypertension, along with optimized postnatal care, can help improve growth outcomes and reduce the incidence of EUGR in these infants.

Evaluation of Various Resolutions for Optimization and Dose Calculation in VOLOTM Ultra of the Tomo Therapy Treatment Planning System

Sirirad Tongta — 2025-04-01

Objective Helical tomotherapy can deliver a radiation dose using modulated intensity. This delivery technique requires inverse treatment planning for dose distribution. The specific parameters include the resolution of optimization and dose calculation. The highest resolution provided a high plan quality in a previous study, but that plan would increase the calculation time. This study investigated the quality of plans using various
resolutions of optimization and dose calculation in VOLO^TM Ultra. The exploration aimed to determine the optimal resolution to inform the treatment planning process in nasopharyngeal carcinoma (NPC).

Methods Forty-one cases of NPC who had been previously treated using helical therapy were randomly recruited between January 2022 and December 2023. Nine treatment planning scenarios were created using the VOLO^TM Ultra planning system using a combination of optimization and calculated resolution. Three different levels of resolutions were chosen: high (H), medium (M) and low (L). The different resolution combinations were expressed as, e.g., H/H for high resolution optimization and dose calculation. The dosimetric parameters of the planning target volumes (PTVs), organs at risk (OARs), and plan quality index, such as dose coverage (D₉₈_%, Dose at 98% target volume), conformity index (CI) and homogeneity index (HI), were evaluated.

Results The PTVs revealed an increasing dose value when the dose calculation resolution was increased. In contrast, the study found an increasing dose value when the resolution was decreased. A similar trend was also found in the conformity index value in the optimization process. The OARs demonstrated similar dose levels, with the exception of the spinalcord and both parotid glands.

Conclusions This study illustrates that the resolution of M/H and M/M scenarios is a specific choice of interest. These scenarios provide higher dose coverage, have a mild impact on OAR dose, a moderate impact on conformity and a shorter treatment planning time.

Male Victims of Family Physical Violence and Associated Forensic Aspects

puimek kasemtavornsin — 2025-04-09

Objective This study aimed to study the characteristics of violence against men aged 18 and over who were physically assaulted by family members and issues related to forensic aspects.

Methods A retrospective analytic study of 225 male patients aged 18 or over who had been physically abused by family members and had received treatment or were autopsied at the forensic department of Nakornping Hospital during the six-year period from June 2018 through May 2024.

Results Of the 225 individuals included in the study, 218 had been injured and 7 had died of their injuries. The highest incidence occurred in the 30-39 age group. The plurality of perpetrators of physical violence, a total of 65 individuals, was intimate partners, (28.89%). Weapons or other objects were used in 164 cases (72.89%), with knives being the most common, used in 92 cases (40.89%). The most frequently damaged parts of the body were the head, face, and arms, affected in 147 cases (65.33%). Most victims sustained injuries to multiple parts of the body. A total of 180 injured individuals (80.00%) were hospitalized. Only 65 victims (28.89%) reported the incidents to the police. Most of the victims of violence by relatives were either age 30-39 or over 60. The majority of the perpetrators were men, and the violence typically resulted in injuries to the upper part of the body.

Conclusions Male victims of family physical violence account for one-third of all domestic assaults. Individuals in their 30s are the most often abused. Injuries tended to be quite severe, often requiring hospitalization. This violence strains the healthcare system, the justice process budget and results in a loss of labor in the economy. Appropriate guidelines for assisting patients who are victims of domestic violence should ensure that treatment is provided without discrimination and with equality of human rights for both men and women.

Identification of Genomic Alterations in Chemotherapy-Related Genes: A Preliminary Study in Three Thai Adolescents with Fatal Osteosarcoma at Maharaj Nakorn Chiang Mai Hospital

Nitipum Nantasuwan — 2025-04-01

Objective Osteosarcoma (OS) is the most common primary bone malignancy among adolescents and young adults. It is characterized by a high mortality rate, though it remains a relatively rare disease overall. The treatment protocols can be complex and challenging. We conducted a comparative genomic variation study to identify genes involved in the metabolism of chemotherapy drugs that are affected by various genomic alterations.

Methods This study analyzed the germline and tumor genomes of three OS patients who responded poorly to chemotherapy, developed lung metastases, and ultimately succumbed to the disease. Genes of interest were identified through a systematic review of apoptosis, autophagy, necroptosis, and chemotherapy-related databases. Whole-genome sequencing (WGS) revealed deleterious single nucleotide polymorphisms (SNPs), copy number variations (CNVs), and structural variations (SVs) in genes linked to cancer and chemotherapy. Protein association network analyses were used to highlight both shared and unique biological processes associated with OS in these patients.

Results Pathogenic SNPs were identified exclusively in patients P1 and P3. Patient P1 exhibited a missense mutation in the PIK3CD gene and a splice donor site mutation in the TP53 gene, while patient P3 carried a nonsense mutation in the MLH1 gene. The tumor genome of patient P1 showed extensive CNVs, whereas those of patients P2 and P3 displayed fewer CNV regions. TBX4 and PPM1D were common genes affected in both patients P1 and P2. SVs were detected in all three tumor genomes, impacting different key genes involved in platinum drug resistance and DNA repair. Notably, all three patients shared SVs in the TDG and SPECC1 genes. All identified mutated genes were correlated with clinical features of the patients.

Conclusions This study highlights the potential of genomic analysis to improve the diagnosis, treatment, and management of OS. Insights into therapy resistance mechanisms and key genomic alterations offer opportunities for developing targeted therapies and predictive biomarkers. These findings support the advancement of precision oncology in OS, as a means of paving the way for personalized treatment approaches to improve patient outcomes.

Impact of Microglia in Neurodevelopmental Disorders: A Review

Dr. Pushpalatha K — 2025-04-04

Objective Microglia, immune cells that dwell in the brain, have essential functions in neurodevelopment and are responsible for synaptic pruning, neuronal circuit creation, and inflammatory responses. Disrupted microglial activity can contribute to conditions such as autism spectrum disorders, schizophrenia, and ADHD by impacting the health and connections of neurons through the production of pro-inflammatory cytokines. These cells, which arise during central nervous system (CNS) development and have the ability to regenerate themselves throughout an individual’s lifespan, display considerable functional variation. Microglia, which have traditionally been known for their immunological functions, also play a role in regulating neurodevelopmental processes such as programmed synaptogenesis, synaptic pruning and cell death. Recent genetic and preclinical research indicates that abnormalities in microglial activity can result in a range of neurological diseases, varying in intensity from moderate to severe. The critical function of microglia in the development of the CNS is determined by their interactions with neurons and other glial cells, that have an impact on the structure of synapses and on the formation of new neurons. This review aims to fill gaps in earlier research by examining the diverse nature of microglial cells and their crucial functions in the development of the nervous system. It specifically focuses on current discoveries related to the rearrangement of synapses, the regeneration of neurons, and the impact of environmental stimuli. Comprehending these interactions is essential for creating precise treatments for neurodevelopmental diseases, emphasizing the necessity for ongoing investigation into microglial processes and measures to reduce their negative impact on brain development.