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Jetawattana S.,Thailand Institute of Nuclear Technology | Sitthithaworn W.,Srinakharinwirot University | Nantajit D.,Chulabhorn Hospital
Journal of Applied Pharmaceutical Science | Year: 2017

Varieties of medicinal plants are well-known to possess powerful antioxidants and often considered for use as cancer preventing agents. Dietary supplements from plant extracts are made available for the purpose of scavenging free radicals. However, due to their strong reactive nature, herbal extracts may also produce free radicals which lead to other effects such as cell killing as observed in studies showing tumor cell death caused by herbal treatments. In this study, we examined a range of herbs commonly used in traditional medicine for their ability to generate radical intermediates in both aqueous and ethanolic extracts using Electron Paramagnetic Resonance (EPR) spectroscopy. Crude aqueous and ethanolic extracts of Phyllanthus emblica Linn, Phylanthus urinaria Linn, Houttuynia cordata Thumb, Acanthus ebracteatus Vahl, Rhinacanthus nasutus Kurz, Thunbergia laurifolia Linn, and Moringa oleifera Lam were tested for their ability to generate free radicals under different conditions. The results showed that all of the herbal extracts could act as prooxidants under extreme alkali condition (pH12); P. emblica, P. urinaria and A. ebracteatus extracts were able to produce free radical in phosphate buffer at near neutral pH (pH7.4). At near physiological conditions where H2O2 and peroxidase are available, H. cordata in addition to the three herbs mentioned prior was able to generate a free radical product. The HPTLC data also showed that gallic acid, chlorogenic acid and quercetin were present as constituents of these plants and thus could play a role in their free radical production. This study provides evidence that herbal extracts can produce free radicals and cause cellular toxicity rather than simply scavenging free radicals. © 2017 Suwimol Jetawattana et al.


Kunawudhi A.,Chulabhorn Hospital
Asian Pacific journal of cancer prevention : APJCP | Year: 2016

BACKGROUND: FDG PET/CT is at an equivocal stage to recommend for staging of colorectal cancer as compared to contrast-enhanced CT (ceCT). This study was intended to evaluate the value of FDG PET/ceCT in colorectal cancer staging as compared to ceCT alone.MATERIALS AND METHODS: PET/ceCT was performed for 61 colorectal cancer patients who were prospectively enrolled in the study. Three patients were excluded due to loss to follow-up. PET/ceCT findings and ceCT results alone were read separately. The treatment planning was then determined by tumor board consensus. The criteria for T staging were determined by the findings of ceCT. Nodal positive by PET/ceCT imaging was determined by visual analysis of FDG uptake greater than regional background blood pool activity. The diagnostic accuracy of T and N staging was determined only in patients who received surgery without any neoadjuvant treatment.RESULTS: Of 58 patients, there were 40 with colon cancers including sigmoid cancers and 18 with rectal cancers. PET/ceCT in pre-operative staging detected bone metastasis and metastatic inguinal lymph nodes (M1a) that were undepicted on CT in 2 patients (3%), clearly de ned 19 equivocal lesions on ceCT in 18 patients (31%) and excluded 6 metastatic lesions diagnosed by ceCT in 6 patients (10%). These resulted in alteration of management plan in 15 out of the 58 cases (26%) i.e. changing from chemotherapy to surgery (4), changing extent of surgery (9) and avoidance of futile surgery (2). Forty four patients underwent surgery within 45 days after PET/CT. The diagnostic accuracy for N staging with PET/ceCT and ceCT alone was 66% and 48% with false positive rates of 24% (6/25) and 76% (19/25) and false negative rates of 47% (9/19) and 21% (4/19), respectively. All of the false negative lymph nodes from PET/ceCT were less than a centimeter in size and located in peri-lesional regions. The diagnostic accuracy for T staging was 82%. The sensitivity of the peri-lesional fat stranding sign in determining T3 stage was 94% and the specificity was 54%.CONCLUSIONS: Our study suggested promising roles of PET/ceCT in initial staging of colorectal cancer with better diagnostic accuracy facilitating management planning.


Nantajit D.,Chulabhorn Hospital | Lin D.,University of California at Davis | Li J.J.,University of California at Davis
Journal of Cancer Research and Clinical Oncology | Year: 2015

Purpose: In multiple cell metazoans, the ability of polarized epithelial cells to convert to motile mesenchymal cells in order to relocate to another location is governed by a unique process termed epithelial–mesenchymal transition (EMT). While being an essential process of cellular plasticity for normal tissue and organ developments, EMT is found to be involved in an array of malignant phenotypes of tumor cells including proliferation and invasion, angiogenesis, stemness of cancer cells and resistance to chemo-radiotherapy. Although EMT is being extensively studied and demonstrated to play a key role in tumor metastasis and in sustaining tumor hallmarks, there is a lack of clear picture of the overall EMT signaling network, wavering the potential clinical trials targeting EMT. Methods: In this review, we highlight the potential key therapeutic targets of EMT linked with tumor aggressiveness, hypoxia, angiogenesis and cancer stem cells, emphasizing on an emerging EMT-associated NF-κB/HER2/STAT3 pathway in radioresistance of breast cancer stem cells. Results: Further definition of cancer stem cell repopulation due to EMT-controlled tumor microenvironment will help to understand how tumors exploit the EMT mechanisms for their survival and expansion advantages. Conclusions: The knowledge of EMT will offer more effective targets in clinical trials to treat therapy-resistant metastatic lesions. © 2014, Springer-Verlag Berlin Heidelberg.


Promteangtrong C.,University of Pennsylvania | Promteangtrong C.,Chulabhorn Hospital | Salavati A.,University of Pennsylvania | Cheng G.,University of Pennsylvania | And 2 more authors.
Hellenic Journal of Nuclear Medicine | Year: 2014

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The diagnosis is based on clinical and radiographic findings as well as by histopathological findings. Molecular imaging in recent years has made important progress regarding the study of various inflammatory diseases including sarcoidosis. Positron emission tomography (PET) provides an insight in metabolism of this disease. Positron emission tomography with fluorine-18-fluorodeoxyglucose (18F-FDG) has shown effectiveness in detecting occult disease and assessing disease activity during treatment. This review article provides an overview of the applications of PET/computed tomography and PET/ magnetic resonance imaging for evaluation of patients with sarcoidosis.


PubMed | Chulabhorn Hospital and Data Management
Type: Journal Article | Journal: Molecular and clinical oncology | Year: 2017

Cholangiocarcinoma (CCA) or bile duct cancer is a rare cancer type in developed countries, while its prevalence is increased in southeast Asia, affecting ~33.4 men and ~12.3 women per 100,000 individuals. CCA is one of the most lethal types of cancer. Neo-adjuvant and adjuvant therapies have been shown to have limited efficacy in improving the overall prognosis of patients. Radiotherapy has been reported to prolong the survival times of patients with certain characteristics. The present study retrospectively evaluated the medical records and follow-up data from 27 CCA patients who received radiotherapy at Chulabhorn Hospital (Bangkok, Thailand) between 2008 and 2014. A total of 14 patients underwent surgery followed by adjuvant chemoradiotherapy. Of the 27 CCA patients, 14 had intrahepatic CCA, 2 had extrahepatic CCA and 11 had hilar CCA. The 2-year survival rate was 40.7%. Tumor resectability, clinical symptoms and the Eastern Cooperative Oncology Group performance status score were found to be indicative of patient prognosis. In addition, the planning target volume and biologically effective radiotherapy dose were of prognostic value; however, initial treatment response was ambiguous in predicting survival time. The findings of the present study suggested that the currently used radiotherapy protocols for CCA may require modification to improve their efficacy.


Tempark T.,Chulalongkorn University | Lueangarun S.,Chulabhorn Hospital | Chatproedprai S.,Chulalongkorn University | Wananukul S.,Chulalongkorn University
International Journal of Dermatology | Year: 2013

Flood is one of the most common natural disasters, which commonly occurs in all parts of the world. The effects of the disasters considerably become enormous problems to overall public health systems. Flood-related skin diseases are a portion of these consequences presenting with cutaneous manifestations and/or signs of systemic illnesses. We conducted a systematic literature review of research publications relating to flooding and skin diseases. The purpose of this review was to provide dermatologists as well as general practitioners with comprehensive conditions of flood-related skin diseases and suggested treatments. Moreover, we categorized these flood-related diseases into four groups comprising inflammatory skin diseases, skin infections, traumatic skin diseases, and other miscellaneous skin diseases in a bid to implement early interventions and educate, prevent, and efficaciously handle those skin diseases under such a catastrophic situation so that better treatment outcomes and prevention of further complications could be ultimately achieved and accomplished. © 2013 The International Society of Dermatology.


Sangmala P.,Mahidol University | Sangmala P.,Chulabhorn Hospital | Chaikledkaew U.,Mahidol University | Tanwandee T.,Siriraj Hospital | Pongchareonsuk P.,Mahidol University
Asian Pacific Journal of Cancer Prevention | Year: 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. Oneway and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.


Lueangarun S.,Chulabhorn Hospital | Leelarasamee A.,Mahidol University
Interdisciplinary Perspectives on Infectious Diseases | Year: 2012

Background. Inappropriate empiric antimicrobials could be a major cause of unfavorable mortality rates in co-morbid patients. This study aimed to assess the prevalence and impact of first-dose and 24-hour inappropriate antimicrobials on mortality rates of bacteremic septic patients. Methods. A retrospective cohort study was employed. Case record forms of patients diagnosed as sepsis, severe sepsis, or septic shock with positive hemoculture during 2009 were retrieved from the medical wards, Siriraj Hospital. Demographic data, antimicrobial use, types of bacteria isolated from blood and susceptibilities, patients' comorbidities, 28-day and overall mortality rates were collected and analyzed. Results. There were 229 cases, mean age (SD) of 63.5 (17.2) years and mean (SD) APACHE II score of 24.7 (6.8). The prevalence of first-dose and 24-hour inappropriate antimicrobials was 29.7 and 25.3, respectively. The 28-day and overall mortality rates between first-dose inappropriate and appropriate antimicrobial were 67.6 versus 60.2 (P = 0.301) and 75.0 versus 68.3 (P = 0.345), consequently. Patients with septic shock and inappropriate first-dose antimicrobials significantly had higher 28-day mortality rate (61.6 versus 41.9; P = 0.017). Conclusion. Higher mortality rates in bacteremic septic patients were substantially associated with inappropriate first-dose antimicrobials and 3-hour delayed antimicrobial administration after sepsis diagnosis. © 2012 Saoraya Lueangarun and Amorn Leelarasamee.


PubMed | Khon Kaen University and Chulabhorn Hospital
Type: Journal Article | Journal: Asia Oceania journal of nuclear medicine & biology | Year: 2016

Diagnostic nuclear medicine is being increasingly employed in clinical practice with the advent of new technologies and radiopharmaceuticals. The report of the prevalence of a certain disease is important for assessing the quality of that article. Therefore, this study was performed to evaluate the quality of published nuclear medicine articles and determine the frequency of reporting the prevalence of studied diseases.We used Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklists for evaluating the quality of articles published in five nuclear medicine journals with the highest impact factors in 2012. The articles were retrieved from Scopus database and were selected and assessed independently by two nuclear medicine physicians. Decision concerning equivocal data was made by consensus between the reviewers.The average STARD score was approximately 17 points, and the highest score was 17.192.38 obtained by the European Journal of Nuclear Medicine. QUADAS-2 tool showed that all journals had low bias regarding study population. The Journal of Nuclear Medicine had the highest score in terms of index test, reference standard, and time interval. Lack of clarity regarding the index test, reference standard, and time interval was frequently observed in all journals including Clinical Nuclear Medicine, in which 64% of the studies were unclear regarding the index test. Journal of Nuclear Cardiology had the highest number of articles with appropriate reference standard (83.3%), though it had the lowest frequency of reporting disease prevalence (zero reports). All five journals had the same STARD score, while index test, reference standard, and time interval were very unclear according to QUADAS-2 tool. Unfortunately, data were too limited to determine which journal had the lowest risk of bias. In fact, it is the authors responsibility to provide details of research methodology so that the reader can assess the quality of research articles.Five nuclear medicine journals with the highest impact factor were comparable in terms of STARD score, although they all showed lack of clarity regarding index test, reference standard, and time interval, according to QUADAS-2. The current data were too limited to determine the journal with the lowest bias. Thus, a comprehensive overview of the research methodology of each article is of paramount importance to enable the reader to assess the quality of articles.


PubMed | Chulabhorn Hospital
Type: Journal Article | Journal: Asia Oceania journal of nuclear medicine & biology | Year: 2016

This study aimed to compare the diagnostic values of (11)C-choline and (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with cholangiocarcinoma (CCA).This prospective study was conducted on 10 patients (6 males and 4 females), aged 42-69 years, suspected of having CCA based on CT or magnetic resonance imaging (MRI) results. (11)C-choline and (18)F-FDG PET/CT studies were performed in all patients over 1 week. PET/CT results were visually analyzed by 2 independent nuclear medicine physicians and quantitatively by calculating the tumor-to-background ratio (T/B).No (11)C-choline PET/CT uptake was observed in primary extrahepatic or intrahepatic CCA cases. Intense (18)F-FDG avidity was detected in the tumors of 8 patients (%80). Two patients, who were (18)F-FDG negative, had primary extrahepatic CCA. Ki-67 measurements were positive in all patients (range; 14.2%-39.9%). The average T/B values of (11)C-choline and (18)F-FDG were 0.40.2 and 2.01.0 in all cases of primary CCA, respectively; these values were significantly lower for (11)C-choline (P<0.005). Both FDG and (11)C-choline PET/CT detected metastatic CCA foci in all 8 patients (two patients had no metastases).As the results suggested, primary CCA lesions showed a poor avidity for (11)C-choline, whereas (18)F-FDG PET/CT was of value for the detection of most primary CCA cases. In contrast to primary lesions, metastatic CCA lesions showed (11)C-choline avidity.

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