Siriraj Medical Journal

Incidence and Associated Factors for Inappropriate Blood Cross Matching in Cardiovascular Thoracic Surgeries at a Tertiary Care Center: A Retrospective Study Using Binary Logistic Regression

Saranya Harnroongroj — 2026-04-01

Objective: To determine the incidence of inappropriate packed red cell (PRC) crossmatching in Cardiovascular Thoracic (CVT) surgeries at a service-focused tertiary care center, and to identify the associated factors for the inappropriate PRC cross-matching.

Materials and Methods: A retrospective cross-sectional study was conducted involving 640 patients who underwent CVT surgery between 2022 and 2025. The data reviewed included the patients’ demographics, operative details, and PRC utilization (specifically, crossmatching and transfusion within 24 hours postoperatively). The crossmatch to transfusion (CT) ratio, transfusion probability (%T), and transfusion index (Ti) were calculated. An individual CT ratio > 2.0 was defined as inappropriate crossmatching. Binary logistic regression was used to identify the associated factors for inappropriate PRC crossmatching, and the Youden index to determine the optimal cutoff values.

Results: Inappropriate PRC crossmatching occurred in 426 of the 640 cases (66.6%). The overall CT ratio was 2.36, exceeding the recommended threshold limit of 2.0 and suggesting excessive blood ordering. Closed heart surgeries had the highest CT ratio (13.8), followed by thoracic surgeries (4.21). Significant factors associated with inappropriate crossmatching included elective surgery, a pre-operative hematocrit level > 35.4%, and intraoperative blood loss < 275 mL.

Conclusion: Inappropriate PRC crossmatching is common in CVT surgeries, with an incidence of 66.6% in this study cohort. Elective procedures, a higher pre-operative hematocrit level, and lower intraoperative blood loss were found to be key predictors for inappropriate PRC crossmatching. These findings highlight the need for more evidence-based transfusion protocols to minimize excessive crossmatching in CVT surgeries, and optimize the utilization of blood resources.

Comparison of Local Versus General Anesthesia in Open Inguinal Hernioplasty: A Prospective Study on Postoperative Outcomes and Cost-Effectiveness

Chainarong Phalanusitthepha — 2026-04-01

Objective: This study evaluates whether performing open inguinal hernia repair under local anesthesia with sameday discharge is comparable to general anesthesia with inpatient admission, with respect to postoperative outcomes, recovery time, and healthcare costs.

Materials and Methods: This prospective cohort study was conducted at Siriraj Hospital and included 30 adults undergoing unilateral open inguinal hernioplasty. Patients were allocated to either local anesthesia with same-day discharge (n=15) or general anesthesia with inpatient admission (n=15). Postoperative pain, recovery time, operative efficiency, complications, and total hospital costs were assessed.

Results: Postoperative pain at rest at 8 and 24 hours was lower in the LA group compared with the GA group (1.93±1.10 vs 2.53±1.55 p=0.233, 0.87±0.83 vs 1.80±1.65 p=0.032). Patients in the LA group resumed normal activities significantly earlier, and total hospital costs were significantly lower (1.00+0.54 vs 1.40+0.51 p = 0.022, 13,453 THB vs. 41,226 THB; p<0.001). Operative time, theater time, complications, and patient demographics (age, BMI, ASA classification) were comparable between groups.

Conclusions: Open inguinal hernioplasty under local anesthesia in a day-surgery setting demonstrated clinical outcomes comparable to those of general anesthesia with inpatient admission. Additionally, this approach was associated with faster functional recovery and significantly reduced hospital costs. Local anesthesia represents a safe, efficient, and cost-effective alternative for appropriately selected patients.

The Upregulation of Anti-apoptotic BIRC3 Expression Facilitates Zika Virus Infection

Anup Pandeya — 2026-04-01

Objective: The aim of this study was to investigate the apoptotic gene expression profile and to identify the genes involved in apoptosis and ZIKV infection.

Materials and Methods: SH-SY5Y cell line was infected with ZIKV at an MOI of 5. The cells were stained with Annexin V and propidium iodide to determine apoptosis. A real-time polymerase chain reaction array was employed to determine the apoptotic gene expression profile in a ZIKV-infected SH-SY5Y cell line. Western blot analysis was performed to confirm the expression of BIRC3 in both SH-SY5Y and A549 cell lines. Knockdown of the BIRC3 was done in ZIKV-infected A549 cell line using BIRC3 -specific siRNA. The ZIKV production was measured by focus-forming unit assay.

Results: Apoptotic genes in both extrinsic and intrinsic pathways, such as TNF-α, TRAIL, FAS, CASP8, CASP9, and BIRC3, were found to be upregulated. The anti-apoptotic gene BIRC3 was selected and found to be upregulated at the protein level in both ZIKV-infected SH-SY5Y and ZIKV-infected A549 cell lines. Knockdown of the BIRC3 gene in ZIKV-infected A549 cell line decreased Zika virus NS1 protein expression and Zika virion production.

Conclusion: The upregulation of anti-apoptotic BIRC3 expression facilitates Zika virus infection.

Clinical Characteristics and Surgical Outcomes of Renal Epithelioid Angiomyolipoma: A Comparison with the Classic Type

Nattaporn Wanvimolkul — 2026-03-01

Objective: To compare clinical characteristics and surgical outcomes between patients with epithelioid angiomyolipoma (EAML) and classic angiomyolipoma (AML), and to identify factors associated with EAML diagnosis.

Materials and Methods: All patients with renal AML who underwent surgery at Siriraj Hospital between January 2013 and December 2024 were reviewed. Clinical features and surgical outcomes were compared between patients with classic AML and those with EAML, and predictors of EAML were evaluated using multivariable analyses.

Results: Among 116 eligible patients, 101 had classic AML and 15 had EAML (12.9%). Most patients were female and were diagnosed in their fifth decade. Demographics, tumor laterality, prevalence of tuberous sclerosis complex gene mutation, and comorbidities did not differ between the 2 groups. Palpable mass (26.7%) and hematuria (13.3%) were more frequent in patients with EAML than in those with classic AML. Most patients with EAML underwent radical or partial nephrectomy due to suspected malignancy. In multivariable analysis, tumor size ≥ 10 cm (odds ratio 15.44; P = 0.003) and a radiologic impression of cancer (odds ratio 46.98; P < 0.001) independently predicted EAML. Four patients with EAML had adverse pathologic features and experienced poor survival; 3 patients died with metastases. The 3-year overall survival was 100% in classic AML and 76.9% in EAML (P < 0.001).

Conclusions: Patients with EAML had less favorable surgical outcomes than those with classic AML. Larger tumor size and a preoperative radiologic impression of malignancy were associated with an EAML diagnosis. Adverse pathologic features in EAML suggest malignant potential.

Development of a Nomogram That Predicts Outcomes After Radical Cystectomy for Bladder Cancer Using Data from Siriraj Hospital, Thailand

Kanawut Sooksatian — 2026-03-01

Objective: This study aimed to develop and validate a prognostic nomogram to estimate individualized overall survival (OS) for bladder cancer patients in Thailand undergoing radical cystectomy (RC), using data from Siriraj Hospital.

Materials and Methods: We retrospectively analyzed a cohort of 304 bladder cancer patients who underwent RC at Siriraj Hospital between 2012 and 2023. The patients were randomly allocated to the training (80%) and testing (20%) cohorts. Cox regression analyses were employed to identify predictors of OS from a range of clinical, pathological, and treatment-related variables. A prognostic nomogram was subsequently constructed and its performance was validated using the concordance index and the area under the receiver operating characteristic curve (AUC).

Results: The median patient age was 68 years and the majority of patients presented with muscle invasive disease. The median duration of follow-up was 61 months, with a median overall survival of 51 months. Multivariate analysis identified five independent predictors of OS: age, preoperative glomerular filtration rate, type of urinary diversion, pathological N stage, and presence of lymphovascular invasion. The nomogram demonstrated strong predictive performance, with AUC values of 86.6% at 12 months, 84.0% at 36 months, and 76.6% at 60 months.

Conclusion: We have developed and validated a prognostic nomogram tailored for Thai bladder cancer patients undergoing RC. This tool provides individualized survival estimates and may be a valuable aid in patient counseling, risk stratification, and formulation of postoperative management strategies. Future multicenter validation and integration of molecular markers will enhance the clinical utility of the prognostic nomogram.