Vajarabhongsa Bhudhisawasdi

• BSc. MD.FRCST, FRCS(Edin),FICS
• Khon Kaen University

The methods section in both the abstract and the main text of the document currently read thestudy was conducted "from January 2021 through December 2021"; the authors would like tocorrect this to read "from January 2020 through December 2020."

Glyphosate [N‐(phosphonomethyl) glycine], a systemic herbicide, is used globally (825 million kg/year) in 750+ formulations. The International Agency for Research on Cancer classified glyphosate is a probable human carcinogen (Group 2A), but epidemiological studies have been lacking for its association with liver cancer and chronic liver disease. W...

Thailand is among countries with the highest global incidence and mortality rates of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). While viral hepatitis and liver fluke infections have been associated with HCC and iCCA, respectively, other environmental risk factors, overall risk factor commonality and combinatorial rol...

Hepatocellular carcinoma (HCC) is a molecularly heterogeneous solid malignancy, and its fitness may be shaped by how its tumor cells evolve. However, ability to monitor tumor cell evolution is hampered by the presence of numerous passenger mutations that do not provide any biological consequences. Here we develop a strategy to determine the tumor c...

Background Cholangiocarcinoma (CCA) caused by Opisthorchis viverrini is a well‐known and significant public health issue in northeastern Thailand; however, a link between pesticide exposure (PE) and CCA risk has not yet been established. Therefore, our research objective was to investigate the relationship between PE and CCA risk. Methods A hospit...

This study evaluates the pan-serological profiles of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) compared to several diseased and non-diseased control populations to identify risk factors and biomarkers of liver cancer. We used phage immunoprecipitation sequencing, an anti-viral antibody screening method using a synthe...

Primary liver cancer (PLC), which includes intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC), has the highest incidence of all cancer types in Thailand. Known etiological factors, such as viral hepatitis and chronic liver disease do not fully account for the country’s unusually high incidence. However, the gut-liver axis, wh...

Background Intraductal papillary neoplasm of the bile duct (IPNB) is a specific entity characterized by slow intraluminal growth of bile duct epithelia with a fine fibro-vascular core. It is typically multi-focal with various degrees of invasion and progresses through the adenoma-carcinoma sequence. We examined its genetic heterogeneity via multi-r...

Background: Glyphosate, the primary weed-killing ingredient in Roundup®, is the most widely used herbicide worldwide. The World Health Organization’s International Agency for Research on Cancer (IARC) Monographs Program classified glyphosate is a probable human carcinogen (Group 2A), capable of causing human cancer under some circumstances. Methods...

Background: Enhanced recovery after surgery (ERAS) program has been proved to improve postoperative outcome for many surgical procedures, including liver resection. There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma. Aim: To evaluate the feasibility of ERAS in...

Purpose Globally, emergency departments (ED) are faced with an overcrowding problem. This issue is further compounded due to the multitude of contributing factors. Point of Care ultrasound (POCUS), especially when performed in prehospital care, that is before the patient is admitted to the ED has a high potential to reduce time of diagnosis and tim...

Background: Cholangiocarcinoma (CCA) is a potentially lethal disease that requires surgical treatment. There are many benign conditions, those that do not require surgical treatment, displaying imaging characteristics that resemble CCA, leading to therapeutic misadventures. This study aimed to evaluate the proportion of benign conditions that under...

Purpose Cardiac, lung, and inferior vena cava (IVC) ultrasound are commonly performed in the care of emergency patients especially patient presented with hypotension or shock. However, the literature indicated the limitation of IVC to assess shocked patients. This study aims to determine the efficacy of combined cardiac and lung ultrasound for eval...

BACKGROUND: Mechanical chest compression devices play an important role in assisting patients undergoing cardiac arrest. However, this equipment induces an aerosol-generating procedure that could contaminate hospital staff. The development of a remote control system for mechanical chest compression devices may solve the problem; however, there are...

BACKGROUND: Thailand’s emergency medical services (EMSs) are constantly evolving both in terms of personnel and technology in pre-hospital care. While sustainable development goals (SDGs) are used in part as a catalyst for development in all countries, there are currently no studies regarding the relationship between EMS research and SDGs in Thaila...

Introduction: Prehospital ultrasounds can be considered a new form of diagnostic tool when taking into account their small structure and due to the fact that nowadays, they are used in the care of emergency patients. However, at present, there is no study regarding the advantage of ultrasound usage in prehospital settings in Thailand. Study Objecti...

Point of care ultrasound (POCUS) competency is now required learning for emergency medicine trainees. However, there is a wide range of areas that need to be assessed when determining competence. Therefore, this study aims to evaluate competence levels of POCUS skill acquisition including the areas of image acquisition, image interpretation and cli...

Introduction Motorcycles can be considered a new form of smart vehicle when taking into account their small and modern structure and due to the fact that nowadays, they are used in the new role of ambulance to rapidly reach emergency patients in large cities with traffic congestion. However, there is no study regarding the measuring of access time...

BACKGROUND: Rising death tolls from traffic accidents are quickly becoming an inescapable problem in almost all countries around the world. That being said, the World Health Organization has launched an ambitious campaign aimed at reducing the death rate from traffic accidents by 50% in the next 10 years. Development of emergency medical services (...

The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the...

Background: Major hepatectomy is the mainstay of the treatment for cholangiocarcinoma. Infrahepatic inferior vena cava (IVC) clamping is an effective maneuver for reducing blood loss during liver transection. The impact of this procedure on major hepatectomy for cholangiocarcinoma is unknown. This study evaluated the effect of infrahepatic IVC cla...

Background: This 8-year observational, multicenter, registry study was undertaken to assess the incidence and regional trends in diagnosis, clinical management, and outcome assessments of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) in the Asia-Pacific region, the Middle East, Turkey, and South Africa. Materials and Methods:...

BACKGROUND: Point-of-care ultrasound (POCUS) is required for use in many instances on a daily basis in the hospital, especially in the emergency department and other specialty treatment areas. While interns play a crucial role in running emergency services in Thailand, the POCUS usage of interns has not been well studied. AIM: The primary aim of t...

Motorcycles can be considered a new form of smart vehicle when taking into account their small and modern structure and due to the fact that nowadays they are used in the new role of ambulance to rapidly reach emergency patients in large cities with traffic congestion. However, there is no study regarding the measuring of access time for motorcycle...

BACKGROUND: Patients with uncontrolled blood loss often require immediate blood transfusion after the bleeding is stopped. If it is an emergency situation, blood that has not been tested for compatibility (uncrossmatched red blood cell [URBC] products) can be used. However, no studies have been conducted to evaluate the effectiveness of this protoc...

BACKGROUND: Coronavirus disease 2019 (COVID-19) outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMSs) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thai...

BACKGROUND: Coronavirus disease 2019 has caused a major worldwide disruption to nearly all aspects of the medical education process, which includes the teaching of point-of-care ultrasound (POCUS). However, the impacts of the pandemic on POCUS training during this time have not been well studied. AIM: This was a retrospective observational study of...

Treatment effectiveness in hepatocellular carcinoma (HCC) depends on early detection and precision-medicine-based patient stratification for targeted therapies. However, the lack of robust biomarkers, particularly a non-invasive diagnostic tool, precludes significant improvement of clinical outcomes for HCC patients. Serum metabolites are one of th...

BACKGROUND: The development of emergency medical services (EMSs) in Thailand is divided into two phases following the enactment of the Emergency Medical Act in 2007 aimed at making the work model more systematic. However, the amount of EMS operations has not been well studied. AIM: The aim of this study was to describe the pattern of EMS operations...

BACKGROUND: Point of care ultrasound (POCUS) plays an important role as a crucial tool for the diagnosis of various conditions in emergency and critical ill patients. However, POCUS examination in elderly populations has not been well studied. AIM: This was a retrospective observational study of elderly patients at the Department of Emergency Medic...

BACKGROUND: B-line artifacts (BLAs) play an important role in identifying lung pathology. They may indicate different diseases. However, the diagnostic study of BLA as applied to emergency patients has not been well studied. AIM: The aim of this study was to determine the diagnostic accuracy of BLA in various conditions. METHODS: This was a retrosp...

BACKGROUND: Emergency medical services (EMS) are an operation that requires speed and prompt decision-making to provide patients treatment and rescue them from crisis. A telephone application was created to be a communication channel. However, the effectiveness of EMS consulting through telephone application has not been well studied. AIM: The aim...

BACKGROUND: Ambulance inspections make up part of the emergency medical services (EMS) to keep operations running smoothly as well as to maximize and maintain the safety of vehicles used for delivery of both staff and patients. The EMS of Srinagarind Hospital has been using an ambulance inspection report application since January 2020. Nevertheless...

BACKGROUND: Point-of-care ultrasound (POCUS) is the core competency in the Emergency Medicine (EM) residency training. However, there are many methods that can be used to evaluate this competency, and the best practices for teaching ultrasonography to residents have yet to be determined. AIM: The researchers aimed at evaluating the POCUS knowledge...

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 pat...

Background Cholangiocarcinoma (CCA) is a leading cause of cancer death in northeastern Thailand. We reported on the incidence of CCA using only one method. In the current study, we used three different statistical methods to forecast future trends and estimate relative survival. Methods We reviewed the CCA cases diagnosed between 1989 and 2018 rec...

Background: The spread of the novel coronavirus 2019 (COVID-19), emergency medical services (EMS) work flow to be different from the normal situation such as avoid advanced airways management that perform aerosol generating. However, no studies examining EMS operation have been conducted at Srinagarind Hospital. Objective: To compare EMS operation...

Background: Point of care ultrasound (POCUS) has been shown to improve diagnostic accuracy and has been used in a variety of contexts. However, the utility of POCUS as applied to critically ill patients has not been well studied. Materials and Methods: This was a retrospective descriptive study of critically ill patients who had received POCUS at S...

Background: Accurate diagnosis of ascites is crucial before abdominal paracentesis can be performed. Physical examination alone can be inaccurate and lead to incorrect clinical decision making. Objective: We aimed to evaluate and compare the accuracy of physical examination and ultrasound conducted by clinical year medical students after short ultr...

Background: Airway management is an important aspect of care in emergency medical services (EMS) used to prevent obstruction of the respiratory track and inadequate oxygenation. The laryngeal mask airway (LMA) is an easy-to-use supraglottic airway device developed in 1988 that has a high success rate in both adults and children. However, there have...

Background: Cooperation between Japan (Tsukuba University), Laos (The University of Health Sciences), and Thailand (Khon Kaen University) had been established in order that the teaching of doctors in the Emergency Medicine Training Program in Laos could be developed so that these doctors could have the opportunity to be the observers of EMS in Thai...

BACKGROUND: The use of lights and sirens (L&S) alerts other drivers of the presence of an ambulance and that they are required yield, increasing the speed and safety of emergency medical services (EMS) operations. However, there have been no studies examining the effect of L&S on pre-hospital time conducted in Thai EMS agencies. AIM: The aim of the...

BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorl...

Objective: All types of cholangiocarcinoma (CCA) require a major hepatectomy, which has many post-operative complications. All complications usually present with persistent hyperbilirubinemia; however, studies on the prediction of post-operative hyperbilirubinemia after hepatectomy for patients with CCA are lacking. We evaluated the causes and pat...

Background: Hand hygiene plays an important role in protecting against infections transmitted among patients via healthcare providers. However, no studies with regard to this have been conducted in EMS personnel in Thailand. Objective: To survey the hand hygiene of emergency medical service healthcare providers. Materials and Methods: This was an o...

Background: Airway management plays an important role in emergency medical services (EMS). Paramedics or doctors are able to manage the airway by endotracheal intubation (ETI). However, there have yet been no studies conducted comparing ETI on stationary and moving ambulances in Thailand. Objective: To compare time until the cuff inflation and time...

Background: Anaphylaxis is a life-threatening condition, and the response to allergens occurs quickly and is severe. The condition is treated by adrenaline administration via intramuscular injection. However, previous studies have shown low rates of adrenaline use, which affected the patient’s condition. Objective: To analyze adrenaline use in anap...

Background: During sporting events, there are restrictions with regard to access to patients due to closures along normal routes, which can cause delays in patient evaluation. The use of a motorcycle-based ambulance is one possible solution to this problem. However, no studies with regard to this have been conducted in emergency medical services in...

sonographic examinations performed in the emergency department can lead to patient-to-patient transmission of pathogens. Objective: To compare the effectiveness of four different ultrasound probe cleaning methods in reducing bacteria and to determine the types of bacteria found on ultrasound probes. Materials and Methods: This was a randomized expe...

Background: Mechanical cardiopulmonary resuscitation (CPR) devices were developed over 60 years ago to help with chest compressions in patients suffering from cardiac arrest. However, no studies examining mechanical CPR devices have been conducted in EMS patients at Srinagarind Hospital. Objective: To compare the effectiveness of mechanical and man...

Background: Sepsis is a common condition in the emergency department and a leading cause of death for patients in Thailand. The implementation of a sepsis protocol can prevent death by facilitating appropriate management and ensuring that antibiotics are received within one hour of sepsis diagnosis. Such a protocol has been in use at Srinagarind Ho...

Background: Oxygen-powered inhalation devices are intended to provide emergency ventilation support for patients in prehospital care by supplying an adequate volume of oxygen. However, there have yet been no studies conducted examining oxygen-powered inhalation devices in Thailand. Objective: To compare the effectiveness of manual and oxygen-powere...

Background: Acute upper gastrointestinal hemorrhage is a life-threatening condition that necessitates treatment within the first hour at the emergency department. Although prompt blood transfusion is one resuscitation procedure that can be implemented in these cases, its indications are not well understood. Objective: To study factors that affect t...

Background: Acute pulmonary embolism (APE) is a life-threatening condition. However, most APE patients have non-specific signs and symptoms. In 2019, the European Society of Cardiology published guidelines classifying the severity of APE, but no study has yet been conducted in the Thai population based on those guidelines. Objective: To study chara...

Background: Acute non-traumatic headache is a common condition in the emergency department (ED), and it is important that these patients are diagnosed appropriately. Failure to recognize the causes of a headache can have serious consequences, including permanent neurologic deficits, loss of vision, and death. Objective: The present study aims to de...

BACKGROUND: Sepsis is a major problem with a high mortality rate, and emergency rooms are the first service point at which sepsis patients are treated. Blood presepsin levels are used as a tool to identify patients who may suffer from sepsis caused by bacterial infection, necessitating immediate antibiotic treatment.AIM: The aim of the study was to...

Aim of the study: Intraductal papillary neoplasm of the bile duct (IPNB) can present at various stages of the disease. Each stage needs different treatment. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been described as predictive markers for several tumors. There has been no investigation on the role of...

Introduction: Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance. Methods: This prospective cross sectional study...

Background: Liver cancer is the second leading cause of cancer-related deaths worldwide. With a predicted 2.4-fold rise in liver cancer incidence by 2020, there is an urgent need for early, inexpensive diagnostic biomarkers to deploy in the clinic. Methods: We employed ultraperformance liquid chromatography tandem mass-spectrometry (UPLC/MS-MS)...

Background: Tension pneumothorax is a life-threatening condition, requiring emergent needle decompression. The standard insertion site is the second intercostal space at the midclavicular line (2nd ICS MCL). Recent studies have shown a higher success rate with needle decompression at the fifth intercostal space anterior to axillary line (5th ICS AA...

Cholangiocarcinoma (CCA) is a deadly malignant tumor of the liver. It is a significant health problem in Thailand. The critical obstacles of CCA diagnosis and treatment are the high heterogeneity of disease and considerable resistance to treatment. Recent multi-omics studies revealed the promising targets for CCA treatment; however, limited models...

Introduction and aim: The carcinogenesis of tubular and papillary cholangiocarcinoma (CCA) differ. The available epidemiologic studies about risk factors for CCA do not differentiate between the tubular and papillary type. The current study investigated the relationship between the number of repeated use of Praziquantel (PZQ) treatments and each t...

Deaths from complex, noncommunicable diseases such as cancer are predicted to continue to increase worldwide, with low- and middle-income countries bearing the brunt of the burden. This problem requires a concentrated global effort to avoid devastating losses of life as well as economic losses. Cholangiocarcinoma (CCA) is a readily studied model of...

Background: Cholangiocarcinoma (CCA) is a common malignancy in northeastern Thailand. Over the last 4 decades, several policies have been implemented for its prevention, but there has been no update on the trends and relative survival (RS). Our aim was (a) to perform a statistical assessment of the incidence trends of CCA and project future trends...

Cholangiocarcinoma (CCA) is a severe cancer with poor prognosis. The aim of the present study was to explore the expression of argininosuccinate synthetase (ASS), as well as the possibility of using pegylated arginine deiminase (ADI-PEG20) for the treatment of CCA. ASS expression was determined in CCA specimens from 40 patients in Thailand. Immunoh...

Intraductal papillary neoplasm of the bile duct is now considered to be a specific type of bile duct tumor. The progenitor cells of intraductal papillary neoplasms of the bile duct are located in the peribiliary gland, which are distributed along the intrahepatic bile duct, extrahepatic bile duct, and gallbladder; therefore, these neoplasms could a...

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are two distinct histological liver cancers. They are clinically and biologically heterogeneous and highly resistant to treatment, making liver cancer the second most lethal malignancy in the world. In Thailand, liver cancer represents the primary cause of cancer-related death...

Cholangiocarcinoma (CCA) is a hepatobiliary malignancy exhibiting high incidence in countries with endemic liver-fluke infection. We analyzed 489 CCAs from 10 countries, combining whole-genome (71 cases), targeted/exome, copy-number, gene expression, and DNA methylation information. Integrative clustering defined 4 CCA clusters—fluke-positive CCAs...

Argininosuccinate synthetase (ASS), a key enzyme to synthesize arginine is down regulated in many tumors including hepatocellular carcinoma (HCC). Similar to previous reports, we have found the decrease in ASS expression in poorly differentiated HCC. These ASS(-) tumors are auxotrophic for arginine. Pegylated arginine deiminase (ADI-PEG20), which d...

Intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) are clinically disparate primary liver cancers with etiological and biological heterogeneity. We identified common molecular subtypes linked to similar prognosis among 199 Thai ICC and HCC patients through systems integration of genomics, transcriptomics, and metabolomics. Whi...

An effective serum biomarker may improve cholangiocarcinoma (CCA) management. Periostin (PN) has been demonstrated to be associated with aggressive CCA. The current study evaluated PN in blood serum for its diagnostic and prognostic potential in patients with CCA. Sera of 68 patients with CCA were collected prior to treatment, and PN levels were me...

Background Gastrointestinal stromal tumors (GISTs), which are mesenchymal neoplasms in the gastrointestinal (GI) tract account for 0.2% of all GI tumors. Several factors have been reported (mostly from studies conducted in Western countries) to be associated with survival in GISTs cases such as tumor site, staging, and tumor size. We conducted a pr...

Background Intraductal papillary neoplasm of the bile duct (IPNB) is a specific entity for which there has been no classification that correlates clinical presentation with patient survival. We, therefore, propose a new classification based on radio-pathological appearance correlated with clinical findings including outcome. Methods We retrospecti...

Background & aims: Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. Studies about the surgical outcomes for IPNB are few; therefore, we investigated the survival of patients who underwent curative surgical resection of IPNB. Methods: We retrospectively reviewed the medical and pathological records of...

Supplementary Figures

Supplementary File 1

The link between microbiota and cancer of the gastrointestinal (GI) tract has been extensively studied. However, the role of tissue microbiome in cholangiocarcinoma (CCA), cancer of the bile duct (an organ connected to the GI tract), is largely unknown. In this study, we detected intriguing compositional differences in the tissue microbiomes of liv...

Background: Cholangiocarcinoma is relatively rare worldwide. Most previous reports collected only patients with pathological diagnosis. In fact, however, many patients coming to hospital are diagnosed by clinical suspicion with radiologic imaging and receive treatment without histological confirmation. Real survival data and outcome of each treatm...

Background: Intrahepatic cholangiocarcinoma (IHCCA) is an aggressive tumor for which surgical resection is a mainstay of treatment. However, recurrence after resection is common associated with a poor prognosis. Studies regarding recurrence of mass-forming IHCCA are rare; therefore, we investigated the pattern with our dataset. Methods: We retrospe...

Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have bee...