Siriraj Medical Journal

Clinicopathological Features of Primary Mediastinal Large B-cell Lymphoma: A 5-Year Retrospective Study

2026-05-06T20:08:55+07:00

Objective: To describe the clinicopathological features and treatment outcomes of primary mediastinal large B-cell lymphoma (PMBCL) at Siriraj Hospital, Thailand.

Materials and Methods: This retrospective study included all patients diagnosed with PMBCL during 2020–2024. Clinical, pathological, treatment, and survival data were retrieved from medical records and pathology reports. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method.

Results: PMBCL accounted for 37 of 74 mediastinal lymphoma cases (50%). Median age was 29 years (IQR: 22–32), with female predominance (62.2%). Presentations included cough (79.4%), dyspnea (74.3%), and SVC syndrome (51.4%). Pleural or pericardial effusion was found in 75.0%. Bulky disease (>10 cm) and elevated LDH were 75.7% and 91.4%, respectively. Histologically, sclerotic pattern and HRS-like cells were observed in 41.7% and 31.4%, respectively. All cases were CD20-positive; CD23 and CD30 were expressed in 65.5% and 80.6%, respectively. A non-GCB phenotype was identified in 64.5% by the Hans algorithm. DA-EPOCH-R was the most common first-line regimen (63.9%). At a median follow-up of 25 months, the 24-month OS and PFS rates were 80.1% and 66.8%, respectively.

Conclusion: This study provides the first characterization of PMBCL in a Thai cohort, showing frequent SVC syndrome and pleural or pericardial effusion at diagnosis. Given the overlapping features and complexity of differential diagnosis, comprehensive immunohistochemical workup was essential for accuracy. DA-EPOCH-R was the dominant first-line therapy, with 2-year outcomes comparable to the rituximab era. Prompt recognition, diagnostic expertise, and multidisciplinary management are critical for optimizing PMBCL outcomes.

Low-Temperature Atmospheric Pressure Plasma in Acute Wound Healing: A Multi-Center Randomized Controlled Trial Using Split-Thickness Skin Graft Donor Sites as a Standardized Human Model

2026-04-22T10:29:26+07:00

Objective: To determine whether low-temperature atmospheric-pressure plasma (LTAPP) improves acute wound healing, using split-thickness skin graft (STSG) donor sites as a standardized clinical model.

Materials and Methods: A multi-center randomized controlled trial was conducted across five tertiary hospitals. A total of 111 patients undergoing STSG were randomized to receive standard of care (SOC) with LTAPP or SOC with sham treatment. Primary outcomes included wound healing rates and wound size/volume reduction. Secondary outcomes included exudate clearance, bacterial burden, and cost-effectiveness.

Results: Healing rates were comparable between LTAPP and SOC groups (71.2% vs. 75.0%, p=0.652). SOC achieved faster wound closure (median 1.6 vs. 2.3 weeks), while LTAPP demonstrated earlier wound volume reduction without translating into improved clinical healing. Both groups achieved complete bacterial clearance. LTAPP incurred significantly higher costs and was not cost-effective, with ICER analysis showing dominance by SOC. Better scar pigmentation quality was observed in a few patients.

Conclusion: Using STSG donor sites as a controlled acute wound model, LTAPP did not improve healing outcomes compared to SOC. These findings suggest that LTAPP may have limited utility in uncomplicated acute wounds but reinforce the value of donor site models for evaluating emerging wound technologies. Future research on LTAPP in wounds should focus on chronic, ischemic, or infected wounds where biological modulation may be more impactful.

Prevalence and Biopsychosocial Factors Associated with Relapse in Patients with First-Episode Schizophrenia in a Clinical Setting in Southern Thailand

2026-04-27T15:37:51+07:00

Objective: This study aimed to assess the prevalence of relapse among patients with first-episode schizophrenia and identify its associated biopsychosocial factors.

Materials and Methods: This was a cross-sectional study conducted at a major psychiatric hospital in southern Thailand. This study included patients aged 18–59 years diagnosed with schizophrenia within the preceding 3 years. Data were collected using a demographic questionnaire and five standardized instruments. Descriptive statistics and univariate and multivariate logistic regression analyses were performed to identify factors associated with relapse.

Results: A total of 220 patients were included in this study. The prevalence of relapse was 21.8%. The univariate analysis revealed that medication adherence, coping strategies, social support, substance use (p < .01), and cognitive insight (p < .05) were significantly associated with relapse. In the multivariate logistic regression analysis, medication adherence and coping strategies remained independently associated with relapse. Particularly, each one-unit increase in medication adherence was associated with a 71% decrease in the risk of relapse (odds ratio [OR] = 0.29, 95% confidence interval [CI] = 0.12–0.31, p < .01). Similarly, each one-unit increase in the coping strategy score was associated with a 20% decrease in the risk of relapse (OR = 0.80, 95% CI = 0.67–0.94, p < .01).

Conclusion: Higher levels of medication adherence and greater use of coping strategies were associated with a decreased risk of relapse. Healthcare professionals should promote medication adherence and strengthen coping skills among patients with first-episode schizophrenia to enhance long-term stability and successful community functioning.

Bispecific Protein Engager-Armed T Cells (BATs): Next-Generation Platforms for Precision Cancer Immunotherapy

2026-04-07T10:37:45+07:00

Chimeric antigen receptor (CAR) T-cell therapy and CD3-directed bispecific T-cell engagers (BiTEs) have transformed cancer immunotherapy, particularly for relapsed or refractory hematologic malignancies. However, CAR T-cell therapy remains constrained by complex genetic engineering, individualized manufacturing, specialized infrastructure, high cost, limited accessibility, and treatment-related toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). In contrast, soluble BiTEs frequently require repeated dosing or continuous infusion because of their short serum half-life and may also induce CRS and neurotoxicity. To address these limitations, our research group at the Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT) developed bispecific protein engager (BiPE)–armed T cells (BATs), a non-genetically modified and adaptable platform that combines BiPE-mediated tumor targeting with the intrinsic cytotoxic activity of activated T cells. This review positions BATs within the broader evolution of cancer immunotherapy—including monoclonal antibodies (mAbs), antibody–drug conjugates (ADCs), CAR T cells, bispecific antibodies (BsAbs), and BiTEs—and summarizes their structure and mechanism of action. BATs mediate major histocompatibility complex (MHC)-independent T-cell activation, promote immune synapse formation, and enable efficient tumor cell lysis. Clinical studies of bispecific antibody–armed T cells (BsAb-Ts), the closest clinical analogs of BATs, demonstrate feasibility, a consistent absence of dose-limiting toxicities (DLTs), and preliminary biological and clinical activity. Building on this foundation, next-generation BAT platforms targeting tumor-associated antigens and immune checkpoint molecules—including BCMA, CD138, integrin αvβ6, and PD-L1—have shown promising preclinical activity in multiple myeloma, breast cancer, and cholangiocarcinoma. Collectively, BATs represent a flexible, scalable, and potentially safer platform for next-generation precision T-cell immunotherapy.

Association Between Executive Functions and Bullying Among High School Students in a Province of Central Thailand

2026-05-09T13:34:05+07:00

Objective: To examine and compare executive function (EF) profiles across different bullying roles and to assess whether EF predicts involvement in bullying among high school students.

Materials and Methods: A cross-sectional study was conducted among 175 high school students from schools in a province in central Thailand between May and August 2025. Data were collected using validated Thai versions of the Executive Function Inventory, the Revised Olweus Bully/Victim Questionnaire, and the Cyber-Aggression Perpetration and Victimization Scale. Statistical analyses included one-way ANOVA (with Welch's ANOVA and Games-Howell post hoc tests where appropriate), Tukey's HSD test, and multinomial logistic regression.

Results: Emotional and behavioral regulation showed significant group differences in traditional bullying (p = .040 and p = .033, respectively), while overall EF, cognitive, and emotional regulation differed significantly across cyberbullying groups (p = .019, .042, and .022, respectively). All three EF domains (cognitive, emotional, and behavioral regulation) were significant predictors of traditional bullying involvement (OR = .25, p =.024; OR = .29, p = .047; OR = .19, p = .009, respectively).

Conclusion: Different EF domains play distinct roles in traditional and cyberbullying behaviors in adolescents. Interventions targeting behavioral regulation skills may be particularly effective in reducing traditional bullying, while cyberbullying appears to involve multiple EF domains and may require more comprehensive intervention strategies.