Siriraj Medical Journal

Combining Histopathologic and Gene-Expression Profiling for Risk Stratification of Nodal Metastasis in Colorectal Cancer

2026-01-13T03:58:01+07:00

Objective: To identify gene-expression features associated with lymph node metastasis (LNM) in colorectal cancer (CRC) and to develop a transcriptomic-clinical predictive model for preoperative nodal assessment.

Materials and Methods: A total of 151 CRC tissue samples (74 LNM– and 77 LNM+) were analyzed using RNA sequencing. Differentially expressed genes (DEGs) were identified with DESeq2, and functional enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). A Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model integrating gene-expression features with clinical variables was developed to predict LNM status. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.

Results: A total of 302 DEGs were identified in LNM+ CRC, including 178 upregulated and 124 downregulated genes. Upregulated genes were enriched in chemokine-mediated signaling, epithelial morphogenesis, and intermediate filament organization, whereas downregulated genes were associated with adaptive immune response and complement activation. In multivariate analysis, lymphovascular invasion (LVI) was the only clinical variable independently associated with LNM. The optimized LASSO model, combining LVI with selected transcriptomic features demonstrated excellent discriminatory performance (AUC ≈ 0.92). Key upregulated genes included CCL21, CCL26, DEFB1, LST1, KANK4, TNNC1, PFDN6, TENM1, CST6, and PADI3, while IGHV2-26 was downregulated.

Conclusion: Integration of LVI with transcriptomic signatures enables accurate prediction of lymph node metastasis in CRC and supports biopsy-based risk assessment to guide clinical decision-making.

Development and Psychometric Properties of Short-Video Applications Addiction Questionnaire (S-VAAQ)

2025-11-25T21:03:01+07:00

Objective: This cross-sectional study aimed to develop and validate the Short-Video Applications Addiction Questionnaire (S-VAAQ) and evaluate its reliability and validity among Thai individuals aged 13 years and older.

Materials and Methods: The S-VAAQ is a 9-item screening tool adapted from the three core domains of gaming disorder outlined in ICD-11: impaired control over usage, increased priority given to gaming, and continued use despite negative consequences. Items were modified to better reflect short-form video consumption behaviors. Data were collected through an online questionnaire distributed via short-form video platforms and Line, targeting Thai participants aged 13 and above who regularly watched short-form videos and were proficient in Thai. Statistical analyses included content validity index (CVI) assessments by five experts, Cronbach’s alpha for internal consistency, and exploratory factor analysis (EFA).

Results: A total of 1,932 participants aged 13 years and older were included. The median daily duration of short-form video viewing was three hours. All items demonstrated CVI scores exceeding 0.78. The scale exhibited good internal consistency, with a Cronbach’s alpha of 0.884. KMO Measure of Sampling Adequacy of 0.898 and EFA revealed factor loadings ranging from 0.594 to 0.904 supporting the scale’s construct validity.

Conclusions: In conclusion, the S-VAAQ demonstrated good reliability and validity. This instrument can serve as a useful tool for screening short-form video addiction in the Thai population and support further research and intervention strategies.

The Correlation between Chest X-ray and Cardiac Magnetic Resonance Imaging in the Assessment of Left Atrial Enlargement

2025-11-04T20:06:25+07:00

Objective: Left atrial enlargement (LAE) is common in cardiovascular disease and is associated with heart failure, atrial fibrillation, and stroke. Chest X-ray (CXR) is widely available; however, its diagnostic value for LAE has not been validated against cardiac magnetic resonance imaging (CMR). We evaluated the correlation and diagnostic performance of conventional CXR signs for detecting LAE using CMR as the reference standard.

Materials and Methods: We retrospectively analyzed 110 patients who underwent CMR and had a posteroanterior CXR within 6 months. Left atrial volume was calculated by the biplane area–length method and indexed to body surface area. CXR signs assessed were the subcarinal angle, double density sign, and left atrial appendage prominence (“third contour”). Sensitivity, specificity, and diagnostic accuracy were calculated against CMR-defined LAE.

Results: CMR identified LAE in 85 patients (77.3%). The third contour had the highest sensitivity (78.8%) but poor specificity (8.0%), whereas a subcarinal angle > 90° had the highest specificity (92.0%) with low sensitivity (8.2%). Overall diagnostic accuracy for individual or combined CXR signs was 27.3%–62.7%, with no correlation between CXR findings and CMR-derived left atrial volume index (all P > 0.05).

Conclusions: To our knowledge, this is the first study validating CXR parameters against CMR for detecting LAE, revealing that conventional radiographic signs have limited diagnostic performance. Despite its accessibility and routine use, CXR demonstrated low sensitivity and specificity for LAE compared with CMR.

Development and Evaluation of a Patient Education Booklet on Fall Prevention Exercises for Older Lower Limb Prosthesis Users

2025-11-17T11:37:30+07:00

Objective: To assess the suitability and usability of a patient education booklet on fall prevention exercises for older lower limb prosthesis (LLP) users.

Materials and Methods: A descriptive study was conducted from February 2024 to March 2025. A fall prevention exercise booklet was developed based on literature and clinical guidelines. The booklet covered the following domains: falls and fall prevention in older adults, benefits of exercises, exercise principles and precautions, and exercise descriptions. Healthcare professionals who care for LLP users assessed the educational booklet’s suitability using the Suitability Assessment of Material (SAM) tool. Based on their feedback, the font size was increased from 12 to 14 points. Thereafter, older LLP users (over 60) assessed the educational booklet’s usability using the Consumer Information Rating Form (CIRF).

Results: Suitability was assessed by 43 evaluators (30 prosthetists, six physical therapists, four nurses and three rehabilitation physicians). The median (IQR) SAM score was 88.1 (81.0; 95.2). Usability was assessed by 69 participants. The median (IQR) CIRF score was 86.9 (80.8; 90.9).

Conclusion: The results of the suitability and usability assessments indicate that the developed fall prevention exercise booklet is appropriate for educating older LLP users. The booklet provides a practical tool that enables LLP users to perform exercises safely at home and review educational content at their own pace.

Emergent Hemodialysis Initiation: A Marker of Suboptimal Pre-Dialysis Care Rather Than an Independent Predictor of Mortality

2025-11-25T21:05:56+07:00

Objective: Emergent hemodialysis (HD) initiation has been consistently linked to higher mortality in prior studies, but evidence from Thailand is limited. This study evaluated the impact of elective versus emergent HD initiation in a tertiary-care setting.

Materials and Methods: This retrospective cohort study included adults with stage 5 chronic kidney disease who initiated HD at Siriraj Hospital between 2013 and 2022. Emergent initiation was defined as HD started for urgent indications without permanent vascular access, elective initiation was nephrologist-scheduled HD without acute complications. The primary outcomes were two-year all-cause mortality, cardiovascular events, hospitalizations, and vascular-access complications.

Results: Among 240 patients, 104 (43.3%) initiated HD emergently. These patients had higher rates of diabetes, poorer nutritional and metabolic profiles, less pre-dialysis care, and greater catheter use. Crude mortality was higher in the emergent group (15.4% vs. 10.3%), but after adjustment for comorbidities, functional status, and laboratory parameters, emergent initiation was not independently associated with mortality (adjusted HR 1.42, 95% CI 0.61–3.29). Infection-related deaths and vascular access infections were more frequent with emergent initiation, while vascular access dysfunction occurred more often in the elective group. Median hospitalization-free survival was shorter in the emergent group.

Conclusion: Emergent HD initiation was not an independent predictor of mortality, suggesting that excess risk observed in prior cohorts may reflect comorbidity and nutritional status rather than initiation type itself. Nevertheless, emergent initiation remained a marker of suboptimal pre-dialysis care and higher infection risk. Strengthening early nephrology referral, structured pre-dialysis planning, and infection prevention remains essential for optimizing ESRD outcomes.