1 Wantanee Kalpravidh, Ph.D. Regional Manager Emergency Center for Transboundary Animal Disease for Asia and the Pacific. Food and Agriculture Organization of the United Nation (FAO). Email: [email protected] Dr. Wantanee Kalpravidh (born 1961) is now working at the . Food and Agriculture Organization of the United Nation (FAO). She got the PhD degree of Veterinary Medicine (Major - Epidemiology, Minor – Veterinary Public Health), University of Minnesota, USA. Her research field is on experience in designing, coordinating and implementing transboundary animal diseases and emerging infectious diseases prevention and control programmes and projects at the local, national and regional levels. She had published more than 20 papers in reputational international journals. She had received several awards, including the Outstanding Alumni of Faculty of Veterinary Science of the year 2006, Chulalongkorn University. รอ abstract ของ Dr. Wantanee นะค่ ะ/ ศ.ผิวพรรณ 2 Department of Biochemistry, Faculty of Medicine, Liver Fluke and Cholangiocarcinoma Research Center, Khon Kaen University, Khon Kaen, THAILAND Email: [email protected] Prof. Dr. Sopit Wongkham graduated B.Sc. in Medical Technology with a gold medal and honors from Mahidol University in 1976, obtained her M.Sc. and Ph.D. in Biochemistry from Mahidol University in 1978 and 1983. She started her career as a lecturer in the Department of Biochemistry, Faculty of Medicine, Khon Kean University and has been there until the present. In 19881989, Professor Dr. Sopit Wongkham got a Research fellowship from the Fogarty Research Center, National Institute of Health, U.S.A. to conduct her research in reproductive biology at Harvard Medical School and from the Japan Society for the Promotion of Science (JSPS) as a visiting professor at Okayama University in 1992. Professor Dr. Sopit Wongkham started her research on cholangiocarcinoma (CCA) in 1995 and has concentrated on this career since then. Understanding the tumor biology involving carcinogenesis and metastasis of CCA may lead to a novel marker and targeted therapy. Professor Dr. Sopit Wongkham has targeted her research to discover tumor markers for diagnosis and prognosis of CCA at molecular and cellular levels and translating her findings to preclinical and clinical sciences. She collaborated with many international outstanding scientists under the Golden Jubilee Ph.D. program and the research center. The accumulated research information has built up an informative bank of knowledge which has subsequently uncovered various molecules with high potentials as tumor markers and targeted molecules for therapy of CCA. She has published more than one hundred articles in the peer-reviewed journals. With this outstanding record, Professor Dr. Wongkham has been awarded as the “Outstanding academic and research award” from the Graduate School Alumni, and Faculty of Science, Mahidol University, “Outstanding Scientist Award, 2013” from the Foundation for the Promotion of Science and Technology under the Patronage of His Majesty the King, and recently the “Outstanding faculty in Science-Technology, 2014” from Council of the University Senates of Thailand, the Office of Commission on Higher Education, Ministry of Education. SCIENCE AND FUTURE MEDICINE Sopit Wongkham Department of Biochemistry, Faculty of Medicine, Liver Fluke and Cholangiocarcinoma Research Center, KKU, Khon Kaen, Thailand Many external and internal factors influence health status of individual and society as a whole. Global warming has gradually been affecting the ecology in many continents and altering the epidemiology of many endemic diseases. In addition, increase of senior citizens is an emerging problem in many developed and developing countries. These factors enforce a paradigm shift of future medicine. In Thailand, tropical diseases can spread as the environment favors the spreading of vectors and the policy of “One ASEAN” support the translocation of people with diseases among ASEAN countries. The progress of science and technology in the “Omic” era brought about functional genomics, generating high throughput data at different dimensions. “System biology”, a framework for conducting quantitative and comprehensive scientific enquiry builds up the understanding of the complexity of biological systems at all levels of cellular organization that contributes to a behavior or phenotype of individuals. As molecular expression and interactions are the basis of all cell biology and functions, pathologies and diseases are now recognized as the outcomes of the defects at the molecular level. In the 21th century, a molecular diagnostic tests and treatment will be based on the molecular signature of the individual and disease to ensure effective and personalized management. Regenerative medicine, gut microbiota and food as drug are the emerging fields of future medicine. As Khon Kaen University is the main institution responsible for the health of northeastern Thai people, KKU has to prepare supports for the advanced technology and the paradigm shift of future medicine. 3 THALASSEMIA & HEMOGLOBINOPATHIES SYMPOSIUM Professor Arunee Jetsrisuparb, MD Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND Email: [email protected] Arunee Jetsrisuparb, M.D. Present Professor in Pediatrics, Consultant in Pediatric Hematology-Oncology Department of Pediatrics, Faculty of Medicine, Khon Kaen University Interesting Field Thalassemia, Iron deficiency anemia Educational Background 1977 M. D. (Hon.), Chulalongkorn University, Bangkok, Thailand 1981 Certificate in Thai Board of Pediatrics, Chulalongkorn University, Bangkok, Thailand 1986 Certificate in Thai Board of Hematology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 1989 Certificate in Bone Marrow Transplantation, Kanagawa’s Children Medical Center, Kanagawa, Japan 1999 Certificate in Short Course of Epidemiology, Faculty of Medicine, Khon Kaen University, Thailand RISK SCORE FOR PREDICTING PULMONARY HYPERTENSION IN PATIENTS Assistant Prof. Patcharee Komwilaisak, MD \ Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Patcharee Komwilaisak has been working in the Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. She got the medical doctor degree in 1994, Pediatrics in 1998 and Subspecialty board in Pediatric Hematology Oncology in 2006 from Faculty of Medicine, Khon Kaen University. Her research field concerns in clinical Pediatric hematology oncology, hemostasis and thrombosis. 4 FETAL ANEMIA CAUSING HYDROPS FETALIS FROM NON-DELETIONAL ALPHA MUTATION: HOMOZYGOUS CONSTANT SPRING Patcharee Komvilaisak*, Ratana Komvilaisak, Arunee Jetsrisuparb, Goonapa Fucharoen, Junya Jirapradittha, Pakaphan Kiatchoosakun *Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Cause of fetal anemia is more common in association with red cell alloimmunization and parvovirus infection. Fetal anemia can lead to hydrops fetalis and death in utero. We report 6 cases with fetal anemia causing hydrops fetalis. Serial doppler ultrasound for measurement of middle cerebral artery (MCA) and also peaked systolic velocity (PSV) is obtained for evaluation of fetal anemia. If MCA/PSA ratio is more than 1.5 MOM (multiple of median) indicated to fetal anemia then cordocentesis is subsequently performed to find cause of fetal anemia and check fetal hemoglobin for consideration of intrauterine infusion. Investigations for fetal anemia include complete blood count, blood morphology on both mother and fetus, reticulocyte count, red cell indicies, screening for thalassemia, hemoglobin typing, acid elution test, blood group on both mother and fetus, Parvovirus B 19 serology, and TORCH titer(toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, HIV and syphilis). Intrauterine infusion is indicated if fetal hemoglobin less than 10g/dL, using irradiated prestorage filtered red cell with hematocrit level of 80%. Six cases with fetal anemia is prenatally diagnosed from gestational age(GA) 20 to GA 34 weeks. Initial hematocrit in 6 cases is varied from 9-17.2%. All cases were excludes any other causes of anemia from above investigations.Six cases underwent uneventfully intrauterine transfusion from 1-3 times. DNA study for thalassemia demonstrated homozygous CS in 4 cases, homozygous CS with heterozygous E in 1 case and compound heterozygous CS and Pakse in 1 case. The perinatal outcomes in 6 cases are normal term in 4 cases, preterm in 2 cases and low birth weight preterm and term in 2 cases. The screening for thalassemia major including osmotic fragility test and DCIP is not helpful for the hemoglobin Constant spring or hemoglobin alpha variant such as hemoglobin Pakse. This study emphasize homozygous constant spring state possibly causing hydrops fetalis and subsequently proper management for fetus can lead to good fetal outcome. Prevention control program should further include screening for heterozygous state on the couple. CLINICAL COURSE OF HOMOZYGOUS CONSTANT SPRING IN PEDIATRIC PATIENTS Patcharee Komvilaisak*, Arunee Jetsrisuparb, Junya Jirapradittha, Pakaphan Kiatchoosakun, Surapon, Wiangnon, Goonapa Fucharoen, Ratana Komvilaisak *Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Homozygous Constant Spring is an alpha gene variant due to a mutation of a stop codon where amino acid is substituted from G to A resulting in the elongation from 141 to 172. Patients with Homo CS are more likely mildly anemic. A previously case report demonstrated one boy with homozygous CS developed severe hemolytic anemia during febrile episode. This study is retrospective in order to describe Pediatric patients diagnosed with homozygous CS followed at Srinagarind hospital in view of clinical manifestations, diagnosis, laboratory investigations, treatment and associated findings. Fifteen Pediatric cases are 5 males and 10 females, diagnosed from prenatal diagnosis (N=6), at 2 wks postnatal age (n=7), 7 mos (N=1) and 14 yrs (N=2). 15 Fifteen patients were diagnosed with Homozygous CS in 9, Homozygous CS with heterozygous E in 4 and compound heterozygous hemoglobin CS and Pakse in 2.There are normal term in 12 cases, preterm in 3 cases, and low birth weight in 4 cases. Clinical manifestations include fetal anemia in 6 cases, hepatomegaly in 1 case, splenomegaly in 1 case. Nine cases developed early neonatal jaundice with requirement of phototherapy on day 1 (N=4). Four cases received post conceptual red cell transfusion; 1 time in 4 cases, > 1 time in 2 cases. Complete blood count demonstrated since birth-day 1 mean-Hb 12.4 (9.115.3) g/dL, Hct 38.6 (28.1-48.1)%, MCV 98.12 (76.7-109.4) fl, MCH 31.5(25-34.3) pg, MCHC 32.1 (31.233.3), reticulocyte count 15.6 (12.63-20.02)%, RDW 22.9 (16.5-27.5)%, RBC count 3.94 (3.09-4.97x106) at 2months of age; mean-Hb 8.4(6.4-10.3) g/dL, Hct 25.9 (19.1-34.2)%, MCV 77.1 (70.4-83.2) fl, MCH 25 (22.8-27.1) pg, MCHC 32.4 (30.3-34), reticulocyte count 7.54 (2.97-12.41)%, RDW 18.8(16.4-23.8)%, RBC count 3.36 (2.51- .11x106) at 1 year of age; mean-Hb 10.4(9.4-11.7) g/dL, Hct 33.8(29.8-39.8)%, MCV < 70 4 cases, 70-80 4 cases, > 80 1 case with mean70.8 fl, MCH 22 (19.4-25.6) pg, MCHC 31.1 (29.5-33.6), RDW 16.2 (14.9-19.1)%, RBC count 4.7 (3.69-5.12x106) . Eight cases have associated findings including hypothyroidism in 2 cases, congenital heart disease in 4 cases, genitourinary abnormalities in 3 cases, developmental delay in 1 case. Pediatric patients with Homozygous CS in this study developed severe anemia occurring in fetus up to age of 2-3 months,, requiring blood transfusion then subsequently had mild anemia with no evidence of hepatosplenomegaly. Their hemoglobin level is more than 9 g/dL with hypochromic microcytic blood pictures as well as wide RDW. Blood transfusions are not necessary since 5 then. Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, THAILAND E-mail: [email protected] Assistant Prof. Nattiya Teawtrakul, MD (Hons), Diploma Thai Board of Hematology Dr. Nattiya Teawtrakul is Assisitant Professor in Hematology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. She obtained the MD degree from the Faculty of Medicine, Khon Kaen University in 2005. In the period from 2005-2008 she received her residency training in Hematology at Ramathibodi Hospital, Mahidol University, Thailand. Her main research is to focus on the mechanisms and the risk factors for major complications in patients with thalassemia. She recently received the Fulbright Junior Research Scholarship in 2013 to conduct a prospective study in major complications in patients with thalassemia in Northeastern Thailand. WITH NON TRANSFUSION-DEPENDENT THALASSEMIA IN NORTHEASTERN THAILAND: THE E-SAAN SCORE Nattiya Teawtrakul1, BurabhaPussadhamma2, Phuangpaka Ungprasert 2, Patcharawadee Prayalaw3, Supan Fucharoen3, Arunee Jetsrisuparb4, Saranya Pongudom5, Chittima Sirijerachai1, Kanchana Chansung1, Chinadol Wanitpongpun1,Srisuda Thongbuaban6, Bandit Thinkhamrop7, Suporn Chuncharunee8 1 Division of Hematology; 2Division of Cardiovascular system, Department of Internal Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University; 3Center for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Science, Khon Kaen University; 4Division of Hematology, Department of Pedriatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University Khon Kaen 40002 Thailand; 5Hematology Unit, Udonthani Hospital, Udonthani, 41000 Thailand; 6Internal Medicine Unit, Mahasarakham Hospital, Mahasarakham, 44000 Thailand.; 7Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University; 8Division of Hematology, Department of Internal Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, 10400 Thailand. Pulmonary hypertension is one of the major causes of death in patients with non-transfusiondependent thalassemia (NTDT). The risk score was developed to be a screening test for pulmonary hypertension in these patients. A multi-center study was conducted in patients with NTDT aged ≥ 10 years old at Srinagarind Hospital, Udonthani Hospital and Mahasarakham Hospital, Thailand. Pulmonary hypertension was defined as a peak tricuspid regurgitation velocity > 2.9 m/s by transthoracic echocardiography. Clinical parameters that literature indicated as risk factors for pulmonary hypertension were evaluated. The risk score was developed in 150 patients at Srinagarind Hospital. The clinical parameters significantly associated with pulmonary hypertension were entered into the logistic regression model. The risk score was derived from the final model’s coefficients. A receiver-operating characteristic (ROC) curve was constructed to determine the area under the ROC curve and the cut-off point to categorize patients into the low risk group and the high risk group. The score was validated in 100 patients from Srinagarind Hospital, Udonthani Hospital and Mahasarakham Hospital. The E-SAAN score included 1) age >35 year (2.5 points) 2) time after splenectomy > 5 years (2.5 point) and 3) β-thalassemia (2 points). Using the cut-off point of 4.5 points, the score showed a good discrimination in the validating group with an area under ROC curve of 0.88 (95% CI 0.8-0.95). The E-SAAN score is a simple and practical score which can be used as a screening test for pulmonary hypertension in patients with NTDT. 6 TRIPLE HELIX: THALASSEMIA & HEMOGLOBINOPATHY Associate Prof. Supan Fucharoen, PhD Department of Medical Technology, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002 THAILAND E-mail: [email protected] Dr. Supan Fucharoen is a Associate Professor from Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Department of Medical Technology, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand. His qualifications are a B.Sc.(Medical Technology, CMU), M.Sc. (Biochemistry, MU), and D.Sc. (Molecular Biology, Kyushu University, Japan). Dr. Fucharoen has over 150 research articles, editorials board member International J Laboratory Haematology and International J Biomedical Science. He has received several scientific awards recentlyMedical the Sarasin Researcher, Khon Facultymost of Associated Sciences, Kaen University, Thailand (2014), Science and Technology Award, Thailand Toray Science Foundation (TTSF) (2013) and Best Medical Technologist Award for Research from The Association of Medical Technology of Thailand (2004). Associate Prof. Chancharat Reodecha, PhD Research Utilization Unit The Thailand Research Fund 14th Floor, SM Tower, 979/17-21 Phaholyothin Road, Samsaen-nai, Phayathai, Bangkok, 10400 THAILAND E-mail: [email protected] Dr. Chancharat Reodecha is a Deputy Director for Research Utilization of the The Thailand Research Fund (TRF). She is responsible for creating the mechanism for the research results to be communicated to policy makers and public as well as technology transfer to entrepreneurs and farmers. She has joined the TRF since 2004 as the Program Director in Agriculture. She has been responsible for directing and coordinating the research programs in agricultural system covering agricultural policy research; production system, supply chain management and value creation; health related issue; food security and food safety system. Her task covered the research design connecting all aspects of agriculture to food and health, targeting the sustainable production and consumption. Chancharat holds B.Sc. in Agriculture and M.Sc. in Genetics from Kasetsart University. She got her Ph.D. in Genetics and Animal Breeding from Purdue University, Indiana USA. Her past position was Assoc. Prof. in Faculty of Veterinary Science and Associate Dean for research affairs, the Graduate School, Chulalongkorn University. She has been actively involved in many academic service as committee and sub-committee as well as invited lecturers. She had been NRCT committee member on agriculture and biology for 10 years. 7 Professor Weerachai Kosuwon, MD Prof. Dr. Weerachai Kosuwon (born 1955) is now working at the Department of Orthopedic, Faculty of Medicine, Khon Kaen University. 1978-1980 Faculty of Medicine, Khon Kaen University, Khon Kaen Thailand, Medicine. 1980-1981 Vice President for Research and Technology transfer of Khon Kaen University, Khon Kaen, THAILAND Email: [email protected] Internship at Khon Kaen Provincial Hospital. 1981-1983 Diploma Thai Board in Orthopaedic Surgery at Siriraj Hospital, Mahidol University, Bangkok, Thailand. 1986-1988 Master degree of Clinical Epidemiology and Health Economics at Mc Master University Ontario Canada. 1988 Federation Internationale De Medicine Sportive, Bangkok, Thailand. Diploma FIMS. 1993 Advance Children Orthopaedic, Edinburgh, Scotland. Diploma. He had published more than 81 papers in reputational international journals. He had received several awards, including the. Oustanding in Research of the Faculty of Medicine Khon Kaen University Alumni 1992, Outstanding Alumni of Khon Kaen University 1993, Academic outstanding of The Royal Collage of Orthopedic Surgeon member 2010. Paweena Tippayapaisan, Product Specialist (Drew Bio,Thailand) Drew Bio (Thailand) Co,Ltd. From PCL Holding Group E-mail: [email protected] Miss Paweena Tippayapaisan (born 1983) is Product Specialist in the company named “Drew Bio (Thailand) Co,Ltd.” She is responsible for the major product of HbA1c and also in the part of thalassemia screening product. She was graduated a bachelor's degree in Medical technology from Mahidol University. She has got 5-years-experienced working in the laboratory in private hospital before she turn herself into the product specialist. Mr. Patiparn Suwannachairob, Business Development (Drew Bio,Thailand) Drew Bio (Thailand) Co,Ltd. From PCL Holding Group E-mail: [email protected] Mr. Patiparn Suwannachairob (born 1984) is a Business development under the company named “Drew Bio (Thailand) Co,Ltd.” He is the major part in the marketing activity of the company. He was graduated a bachelor's degree in Medical technology from Naresuan University. 8 Associate Prof. Amornrat Romphruk, MT, PhD Faculty of Medicine, Khon Kaen University Khon Kaen, 40002 THAILAND E-mail: [email protected] Dr. Amornrat Romphruk is an Associate Professor at Faculty of Medicine Khon Kaen University, Thailand. She got the Bachelor of Science (Medical Technology) from Chiengmai University in 1981, Master of Science in Clinical Pathology from Mahidol University 1987, and Doctor of Medicine from Tokai University school of Medicine, Japan 2005. Her area of expertise is Transfusion Medicine and Tissue Transplantation. She got the 8 research awards from Faculty of Medicine, 1 from National Research Council of Thailand and 2 from Health Systems Research Institute. Her research is focused on molecular genetics of red cell, white cell and platelet antigens. HLA-B*15:02 TYPING KIT BY ONE STEP PCR Amornrat Romphruk1,2*, Chintana Puapairoj1, Arunrat Romphruk2,3, Chanvit Leelayuwat2,3 1 Blood Transfusion Center, Faculty of Medicine; 2The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences; 3Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand Human Leukocyte Antigens (HLA) are a group of antigens expressed on most nucleated cells. Their functions are involved in immune responses. There are several groups reported the associations between the HLA genes with the hypersensitivity to some drugs, such as carbamazepine (CBZ), particularly HLA-B*15:02 with the Stevens-Johnson syndrome (SJS) or cutaneous form of toxic epidermal necrosis (TEN). Therefore, screening for the presence of HLA-B*15:02 in patients before CBZ and phenytoin (PHT) treatment is an alternative to prevent such adverse events. To detect HLA-B*15:02 by commercial typing kit is very expensive and requires special equipments. In this study, a high resolution PCR-sequence specific primers (PCR-SSP) technique has been developed and evaluated to define HLA-B*15:02. The HLA-B*15:02 typing kit was developed upon the principle of PCR- SSP and multiplex-PCR. Twelve PCR reactions were amplified in one step PCR. The kit has been tested with 64 known standard DNA samples carrying HLA-B*15:02 by sequence based typing and 156 samples with known HLA-B*15 by a low resolution PCR-SSP and another 100 blind samples. The sensitivity, specificity and accuracy of this kit were 100%. Furthermore, this kit could define HLA-B*15:02 with other HLA-B*15 subtypes or HLA-B*15:02 with HLA-B*46 which is a common HLA-B allele in Thais or HLA-B*15:02 with other HLA-B* alleles. The turnaround time for the typing is 2.5 hours after DNA extraction. This study established a simple typing kit for HLA- B*15:02 detection with high efficiency and low cost. It can be used for screening in the patients with a risk of developing acute CBZ-induced SJS/TEN in general hospital laboratories. 9 Centre for Biospectroscopy, School of Chemistry, Monash University, 3800, Victoria, AUSTRALIA E-mail: [email protected] Associate Prof. Bayden Robert Wood PhD, BSc (Hons) Dr. Bayden works in the School of Chemistry at Monash University as an Australian Research Council QEII Fellow My main research is concerned primarily with vibrational spectroscopy of tissues, cells and biomolecules. I am particularly interested in monitoring heme aggregation in single living red blood cells associated with erythrocyte disorders including malaria and sickle cell disease using resonance Raman spectroscopy (RRS). I and several colleagues are currently developing techniques to monitor heme-drug interactions in single cells using this technique with particular emphasis on detecting drug interactions with malaria pigment (also known as hemozoin). My other areas of interest include FT-IR microspectroscopy and FT-IR imaging of cells and tissues and developing applications for cancer diagnosis, histocompatibility testing, oocyte development, stem cell research and algae research. I also have a strong interest in applying multivariate statistics and neural network architectures to the analysis of FT-IR and Raman spectra of bio-samples and producing 4-dimesnsional infrared maps of cells and tissues EMERGING DEVELOPMENTS IN MALARIA DIAGNOSIS USING INFRARED AND RAMAN SPECTROSCOPY Bayden R. Wood Centre for Biospectroscopy, School of Chemistry, Monash University, 3800, Victoria, Australia Fourier Transform infrared (FTIR) and Raman spectroscopy are set to become true independent modalities for disease diagnosis. The spectroscopic advantage lies in the fact that the chemical change must precede or accompany any morphological change that is symptomatic of disease. The ability to spectroscopically analyse and spatially locate macromolecules within single cells and tissues offers a platform to investigate, diagnose and monitor the treatment of neoplasia and other diseases. The adaptation of multi-channel infrared array detectors from military hardware to FTIR microscopes in the early 1990s resulted in new methodologies to investigate the macromolecular architecture of cells in tissue sections. The new generation of focal plane array (FPA) and linear array detectors are capable of recording thousands of spectra in rapid time. Each FTIR image is essentially a digital hyper-spectral data cube containing absorbance, wavenumber and x,y spatial coordinates. Multivariate imaging techniques including UHCA and K-means clustering, Principal Components Analysis (PCA), Linear Discriminant Analysis (LDA), Fuzzy C-means clustering, and neural networks have proven to be invaluable in the identification and correlation of spectral profiles, which can be directly compared to stained cells for traditional light microscopic evaluation by pathologists. Advances in ultrasensitive CCDs and fibre optic cables for photon delivery and capture have dramatically improved the sensitivity and speed of Raman imaging and the scene is set for both spectroscopic modalities to make a significant contribution to the clinical laboratory. Malaria is one of the most deadly diseases resulting in 1.2 million fatalities per annum.(1) Accurate and early diagnosis followed by the immediate treatment of the infection is essential in reducing mortality(2). New technologies to diagnose malaria must be cost effective and have high sensitivity to enable the detection of premature parasitic forms in peripheral blood. During the course of its life the malaria parasite transgresses through several developmental stages including a sexual and an asexual reproductive pathway. The detection of the rings and gametocytes at low parasitemia in peripheral blood is critical for early diagnosis and treatment. Here we show ATR-FTIR spectroscopy in combination with a partial least squares regression modeling has the required sensitivity and ease of sample preparation to become a laboratory standard for malaria detection and most importantly quantification. The absolute quantification limit was found to be 0.001% (50 parasites/uL of blood) for cultured ring stage and gametocyte parasites in a suspension of normal erythrocytes. The absolute detection limit was found to be 0.00001%.(3) Results are compared with resonance Raman and synchrotron imaging FTIR spectroscopy along with conventional microscopy and immunohistological approaches. The stage is now set for the transplantation of the FTIR imaging spectrometer from the laboratory to the clinic. This lecture provides an overview and update on the progress in the field of FTIR spectroscopy and Raman imaging in malaria research. 10 Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Nakhon Pathom, 73170, THAILAND E-mail: [email protected]; [email protected] Chamras Promptmas, PhD Dr. Chamras Promptmas graduated his first degree, Honor in Medical Technology from Mahidol University in 1976, the M. Sc. Degree in Biochemistry from Chulalongkorn University, in 1980 and the Graduate Diploma in Biotechnology from University of Kent at Canterbury, England in 1988. In 1994, he received the Ph. D. degree in Biochemistry from Mahidol University. He was appointed to chair Clinical Chemistry Department in Mahidol University, for 15 years during 1993-2010. Biosensor Technology is his current research after his completion of THAI-USAID Workshop on Biosensor Technology in 1994 and also Biosensor Development Training in Institute of Chemical and Biosensor Research, Muenster, in 1998. The experience in this field has been incorporated into the research interest as a project of “Development of Biosensor Technology for Laboratory Diagnostics Applications. He has several research collaboration with world class institutesin this field such as Munster University, Potsdam University and Cornell University. Not only in international arena, he also established research network with researchers from Khon Khen University, Srinakarindhwiroj University, Thammasat University, TMEC and NECTEC of NSTDA. He published more than 50 papers in front-role international journals. Some of his recent publications are in top-ten journal in analytical field such as Biosensors and Bioelectronics, Analysts, Talanta, Analytical, Bioanalytical Chemistry and so on. Besides national and international acceptance, his invention and research works were awarded Outstanding Invention (Medical Science) of the Years 2012, Research Excellent (Medical Science) of the Years 2013 from National Research Council of Thailand and received Silver Medal Prize (Food, Beverage, Cosmetics and Medical Science) from International Invention of Geneva in 2012. BIOMOLECULAR DETECTION TECHNOLOGY: FROM BASIC DEVICES TO SMARTPHONE Chamras Promptmas Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Nakhon Pathom, Thailand. The advances in biomedical science and technology have played a significant role in the development of new sensor and assay systems for biomolecular detection. The variety of biosensor system for analytical laboratory has been studied both depth and breadth. Generally, these efforts are aimed toward smaller and more reliable devices that simultaneously perform multiple analyses to minimize the complexity and costs associated with diagnostic testing. The miniaturization, microfabrication and microfluidic technology will ultimately create self-contained “lab-on-a-chip” for many important applications including medical diagnosis, environmental monitoring, food safety, and biosecurity.One of progressive developed device for biosensor application is the microcantilever with microfluidic system. In the last 5 years, the advantage of smartphone connectivity and the enhanced performance of the included camera was introduced by coupling with home-self-diagnostic device overcoming the current difficulties in achieving sensitive and quantitative information with conventional system. One of the most important aspects of developing these systems is the integration onto a compact and lightweight platform that requires minimal power. These devices typically comprise multiple components, such as detectors, sample processors, disposable chips, batteries, and software, which are integrated with a commercial smartphone. This has demonstrated several promising detection schemes and device configurations. It can be expected that further developments in smartphone-based POC technologies to become more mainstream tools in the scientific and biomedical communities. 11 Metini Janyasupab, PhD Dr. Metini Janyasupab is a specialist in electrochemical based biosensors. She is currently a lecturer and curriculum committee in Biomedical Engineering Program at Faculty of Engineering, King Mongkut’s Institute of Technology Ladkrabang, Thailand. She earned her Bachelor degree in Biomedical Engineering and her Ph.D in Chemical Engineering from Case Western Reserve University, U.S.A in 2013. She also received 10 year-funded Royal Thai Government Fellowship, and recently earned the U.S. patent of first disposable breast cancer stripe biosensor. Faculty of Engineering, King Mongkut’s Institute of Technology Ladkrabang, 1 Chalongkrung Road, Ladkrabang, Bangkok 10520 THAILAND E-mail:[email protected] DETECTION OF LYSYL OXIDASE-LIKE 2 (LOXL2), A BIOMARKER OF METASTASIS FROM BREAST CANCERS USING HUMAN BLOOD SAMPLES Metini Janyasupab1*, Ying-Hui Lee3, Yuan Zhang4, Chen Wei Liu5, Jieyi Cai6, Adriana Popa7, Anna C. Samia7, Kuan Wen Wang5, Jiaqiang Xu4, Chi-Chang Hu3, Michael K. Wendt8, Barbara J. Schiemann 8, Cheryl L. Thompson 9, Yun Yen10, William P. Schiemann 8, Chung Chiun Liu 2 1 2 Faculty of Engineering, King Mongkut’s Institute of Technology Ladkrabang, Bangkok Thaland. 10520; Department of Chemical Engineering, ETC. Metastasis accounts for 90% of the mortality associated with breast cancer. Upregulated expression of members of the lysyl oxidase (LOX) family of secreted copper amine oxidases catalyzes the crosslinking of collagens and elastin in the extracellular matrix. LOXs are linked to the development and metastatic progression of breast cancers. Accordingly, aberrant expression of LOX-like 2 (LOXL2) is observed in poorly differentiated, high-grade tumors and is predictive of the acquisition of chemoresistant and recurrent phenotypes, and for decreased overall patient survival. LOXL2 expression may serve as a biomarker for breast cancer. Mechanistically, hydrogen peroxide is produced as a byproduct of LOXL2 when using an appropriate substrate, lysine. We exploited this chemistry to generate a revolutionary gold-based electrochemical biosensor capable of accurately detecting nanomolar quantities of LOXL2 in mouse blood, and in human blood samples. Two different sources of the blood samples of breast cancer patients were used in this study indicating the applicability of detecting LOXL2 in breast cancers patients. Our novel biosensor clearly detected LOXL2 in specimens of human serum, plasma, and urine. There was a striking linear relationship between LOXL2 concentrations and the biosensor measurements, illustrating that this detection technique was an accurate method for measuring LOXL2 in biological fluids obtained from breast cancer patients without the need to subject them to a complicated biopsy process. There was a trend showing that higher levels of LOXL2 from the biological fluids of breast cancer patients as compared to their case control counterparts. Only blood samples were collected from the patients of breast cancers in the Hospital of City of Hope and four control samples, From the test results of a total of 30 patient’s blood samples and four control samples, it was clearly shown that the LOXL2 levels in the blood samples of the breast cancer patients were higher than those of control samples. We have demonstrated a single-use, disposable biosensor prototype which can be used to detect the biomarker of metastasis of breast cancer, LOXL2, using blood samples from two different sources and limited number s of urine sample test. Inhabitation study ensured the detection was specific to LOXL2 12 Associate Prof. Amnat Chidthaisong, PhD. Deputy Director, The Joint Graduate School of Energy and Environment, King’s Mongkut University of Technology Thonburi. Associate Professor in Environment Technology Division. The Joint Graduate School of Energy and Environment, King’s Mongkut University of Technology Thonburi, 91 Parcha-uthit Rd., Bangmod, Tungkru, Bangkok 10140, THAILAND Dr. Amnat was serving as lead authors of IPCC WI Chapter 7 (IPCC, 2007), in which he was in charge of synthesizing the biogeochemistry and budget of methane. Since 2006 he has been working as the program coordinator of Thailand’s Research Fund on climate change. This program has been playing the crucial roles on improving knowledge on climate change and variability in Thailand in the past few years. Upto-date studies and analysis on Thailand climatology, process and phenomena understanding, and the future climate projections using various GCMs and downscaling techniques have been serving as the basis of many policy forming and development planning in Thailand. Under this program, he also co-edited the 1st Thailand Assessment Report on Climate Change 2011, of which three volumes were published. This is one of the important landmarks on the development of climate change science in Thailand and the Report has become the main reference cited in Thailand climate change literatures. OVERVIEW OF CLIMATE CHANGE SITUATION IN THAILAND, ITS IMPLICATIONS AND CHALLENGES FOR FUTURE SOCIO-ECONOMIC DEVELOPMENTS Amnat Chidthaisong Joint Graduate School of Energy and Environment, King Mongkut’s University of Technology Thonburi, and The Thailand Research Fund’s Research and Development and Co-ordination Center for Global Warming and Climate Change (Thai-GLOB) Global warming and the consequent climate change have affected sustainable developments throughout the world. In Thailand, synthesis of various study results indicates that both land and sea surface temperatures have increased. The average temperature over land in Thailand during 1955-2009 has increased by 0.174ºC/decade, increasing at the rate higher than that of the global average (0.126 ºC/ decade). The sea levels in the Gulf of Thailand during 1940-2004 have also risen at the average rate of 3.0 ± 1.5 to 5.0 ± 1.3 mm/y. In addition, extreme climate events (floods, droughts, extreme temperature, storms, and etc.) have also occurred more frequently and severely. These features of climate change and their consequences will continue until greenhouse gas concentrations in the atmosphere are stabilized or reduced.If the world continues “business-asusual” emissions trends, substantial loss (e.g. as the fraction of gross primary production) would be high. In addition, research results indicate that an increase in extreme weather events and forest fires arising from climate change will jeopardize vital export industries. Climate change is also exacerbating the problem of water stress, affecting agriculture production, causing forest fires, degrading forests, damaging coastal marine resources, and increasing outbreaks of infectious diseases. If not addressed adequately, climate change would have serious negative consequences for the country sustainable development. This talk will focus on climate change situation in Thailand with the aims to bring audiences to evidences, potential impacts, and possible solution to cope with climate change, and to the reasons why Thai public and policy makers should seriously consider the integration of climate change into its sustainable development policy. 13 Assistant Prof. Somsak Pitaksanurat, PhD Dr. Somsak Pitaksanurat is currently Dean of the Faculty of Public Health at Khon Kaen University, in Northeast Thailand, where he has served in that position since 2011. Prior to entering academia, he worked as a civil and structural engineer in the private sector. He earned his Ph.D. in 1993 from the Institution für Umwelt Technik at the University of Innsbruck, A ustria. H is research focuses on im proving design and management of solid and hazardous waste in Thailand, as well as wastewater treatment. He has lead or served as a consultant in this field more than 50 projects. Dean, Faculty of Public Health, Khon Kaen University, Department of Environmental Health Science, Faculty of Public Health, Khon Kaen University Environmental and Public Health Technology Service Center, Khon Kaen University, Khon Kaen 40002 THAILAND Email: [email protected]; [email protected] SOLID WASTE: NATIONAL AGENDA, CRISIS OR OPPORTUNITY Somsak Pitaksanurat Center for Environmental and Public Health Technology Service, Faulty of Public Health Khon Kaen University, Khon Kaen, Thailand Here in Thailand, we generate upwards of more than 25 million tons of waste every year. That’s 65,000 tons every single day. About two-thirds of that waste, or more than 40,000 tons per day, is municipal solid waste (MSW). MSW refers to our everyday garbage that we throw away, including food waste, plastic wrappers, and paper. Collecting, sorting, transporting, and properly disposing of that MSW is a significant challenge for Thailand, as well as many other developing countries across the globe. Certainly, Thailand has made improvements in how it manages its solid waste. However, significant room for improvement remains. Almost 80% of our waste still goes to open dumps, which can allow dangerous pollutants to reach groundwater and surface water. These pollutants pose a risk to valuable water supplies and ecology. Safer sanitary landfills only receive less than one-tenth of our solid waste. We are running out of places to put all this solid waste. Necessary environmental regulations make it difficult to expand or initiate sanitary landfills. Moreover, only about 15% of our waste is recycled. Thus, every day we inch closer to an environmental crisis with more waste than we can safely dispose of. Yet, this same situation also presents several opportunities. First, with little infrastructure in place to process and recycle plastics and other reusable materials, the opportunity exists to implement these technologies into our waste management system as we expand. However, we need both a legal basis to support recycling and public participation. Expanding legal requirements and enforcement of requirements to properly sort waste and reduce packaging is an important step to reducing unnecessary solid waste. Public participation can be improved through awareness campaigns and education. With those precedents in place, Thailand can make substantial progress towards better solid waste management. Secondly, this waste can be a source of energy. Most waste (64%) in Thailand is organic waste, such as leftover food. Technologies exist to convert this organic waste into biogas. One such plant operates in Rayong, using organic waste to create methane, which can be burned to generate electricity. It is imperative that we commit further resources to studying how we can harness the large amount of organic waste in Thailand to useful energy. Finally, emerging technology is seeking to use bacteria to break down complex plastic molecules. Behind organic waste, the second highest component of MSW is plastic. Separating plastics from the MSW once it reaches a processing plant or landfill is very difficult or expensive. Thus, a solution to degrading plastics without the need to sort is a valuable technology to a country like Thailand. Mismanagement of solid waste leads to public health risk, adverse environment impacted and other socio economic problems. Thus, solid waste represents a growing crisis that requires national attention, as well as an opportunity for researchers, scientists, and governments. However, only with coordinated efforts across ministries and sectors can we solve this problem. 14 Sittiruk Roytrakul, PhD Proteomics Research Laboratory, Genome Technology Research Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Thailand Science Park, Pathumthani, 12120 THAILAND E-mail: [email protected] Dr. Sittiruk Roytrakul (born 1971) is the head of the Proteomics Research Laboratory, Genome Technology Research Unit, National Center for Genetic Engineering and Biotechnology (BIOTEC). He received the Ph.D. degree of Phytochemistry in 2004 from Leiden University, the Netherlands. He employed mass spectrometric-based proteomics to study rice and shrimp as well as malaria and cancer. He published more than 90 publications in international journals. He is also guest lecturer for Thai Universities. MASS SPECTROPHOTOMETRY FOR PROTEIN AND PROTEOME RESEARCH Sittiruk Roytrakul Proteomics Research Laboratory, Genome Technology Research Unit, National Center for Genetics Engineering and Biotechnology. The development of mass spectrometric tools and methods with improved dynamic range, resolution, sensitivity, and accuracy has driven the expansion in the ﬁeld of proteomics research. Protein fingerprint with high-throughput sample preparation and MALDI-TOF MS analysis allows identifying proteome signatures that are potentially useful in detection and classification of human diseases. High taxonomic resolution for clinical diagnosis and microbiological research to the strain level by whole-cell MALDI-TOF MS has been reported. Mass spectrometry-based proteome analysis has been intensively used to understand global proteome dynamics in a cell, tissue or organism. However, the problems relating to the extreme diversity and heterogeneity of the proteome remain challenging. To circumvent these technological limitations, one-dimensional gel electrophoresis is then used to create a series of less complex mixtures. Label-free relative quantitative approach including protein separation by SDS-PAGE, slicing gels, in-gel tryptic digestion of individual gel pieces and subsequent identification by nano-LC-MS/MS is used to compare peptide (or protein) abundance between samples. Shotgun proteomic analysis is now commonly used to identify protein localization, protein expression, protein complexes, and protein modifications in biological experiments. Low abundance, hydrophobic, basic and large proteins are better recovered. 15 Professor Pewpan (Intapan) Maleewong, MD (Hons), Cert in Clinical Pathology Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND Vice Dean for Research Affair, Faculty of Medicine, Khon Kaen University, Khon Kaen, THAILAND E-mail: [email protected] Prof. Dr. Pewpan (Intapan) Maleewong (born 1959) is Professor of the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. She graduated B.Sc. in Medical Technology from ChiangMai University in 1982 and M.Sc. (Tropical Medicine) at the Faculty of Tropical Medicine, Mahidol University in 1989 and Medical Doctor degree with honors from Faculty of Medicine, Khon Kaen University in 2000. She received award from Anandamahidol foundation from year 2002-2006. Her active research works focused on molecular and immunological diagnostic tests as well as clinical study of parasitic diseases especially in tropical neglected parasitosis i.e. gnathostomiasis, capilariasis, angiostrongyliasis, strongyloidiasis, fascioliasis, paragonimiasis, opisthorchiasis, filariasis, schistosomiasis, sparganosis, etc. She published more than 130 parasitology research papers in the international journals with impact factor. The compiled initiative research has built up on production of recombinant helminthic proteins and the rapid diagnostic kits for capillariasis, gnathostomiasis which has high potentials for supportive diagnosis and treatment of the harmful tropical neglected diseases. Her invention diagnostic tests from research works were awarded the best scientific award for Medical Science from National Research Council of Thailand in 2000 and 2006. TOWARDS DEVELOPMENT RESEARCH FOR RAPID DIAGNOSTIC KIT OF HUMAN GNATHOSTOMIASIS Pewpan (Intapan) Maleewong Vice Dean for Research Affair, Faculty of M edicine, Khon Kaen University. Research and Diagnostic Center for Emerging Infectious Diseases and Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand Gnathostomiasis caused by Gnathostomaspinigerum, is a hazard food-borne helminthic zoonosis, and is endemic especially in developing countries in Asia. Definitive diagnosis relies on identification of worms from human body is difficult. Serodiagnostic tests could be used as a supportive tool. But these methods are time consuming, need sophisticated equipments and can be done in some laboratory. A simple, rapid and cheap method is highly desired in field situations. A cDNA encoding MMP-like protein of Gnathostoma spinigerum larvae was amplified by reverse transcription PCR, and was cloned into a prokaryotic expression vector, and expressed in Escherichia coli. A dot enzyme linked immunosorbent assay (dot-ELISA) using G.spinigerum recombinant matrix metalloproteinase (rMMP) protein as the antigen was developed and evaluated the diagnostic values with sera of gnathostomiasis and other parasitosis patients as well as healthy controls. For clinical interpretation, readings of “positive” and “weakly positive” were both regarded as indicating a positive result. The sera were scored as positive when each of the two observers gave the same interpretation. The accuracy, sensitivity, specificity, positive and negative predictive values were 97.4%, 100%, 96.1%, 92.9%, and 100%, respectively. Recombinant MMPlike protein can be used as a diagnostic antigen and potentially replace native parasite antigens to develop a gnathostomiasis diagnostic kit. The developed dot-ELISA appears to be suitable test for use in high-throughput in less-equipped laboratory unit. The assay can be used in epidemiological studies under field conditions. 16 Professor Wanchai Maleewong, PhD Vice Director Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, THAILAND E-mail: [email protected] Department of Parasitology, Faculty of Medicine, KhonKaen University, Khon Kaen, THAILAND Prof. Dr. Wanchai Maleewong (born 1959) is the Thailand Senior Researcher, Thailand Research Fund and Professor of the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. He got the PhD degree of Tropical Medicine in 1995 at the Faculty of Tropical Medicine, Mahidol University, Thailand. H e h a s r e c e i v e d prestigious aw ards i.e. the Young Scientist aw ard from the foundation for the Promotion of Science and Technology Under the Patronage of His Majesty the King in 1993; National Research Council Research awards from National Research Council Research of Thailand in 2000, 2003 and 2006. His research field concerns in basic and applied research of Parasitology. He had published more than 140 parasitology research papers in the international journals with impact factor. The main research study focused on biology, im m unoparasite, m olecular biology of parasites, diagnosis, treatment, prevention and control of the medical importance parasites. TOWARDS DEVELOPMENT RESEARCH FOR RAPID MOLECULAR DETECTION AND IDENTIFICATION OF NEGLECTED TROPICAL HELMINTHES IN GREATER MEKONG SUBREGION Wanchai Maleewong Vice Director of Research and Diagnostic Center for Emerging Infectious Diseases and Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand Tropical parasitic diseases affect a staggering health and economic burden in Greater Mekong Sub-region (GMS) countries. The diseases have gained drawing in terms of interest for research and for their control and eventual elimination.The present study developed the molecular tools for differential detection of important tropical parasitic diseases. The rapid, accurate, cost-effective, and potentially high-throughput assays, PCR coupled with pyrosequencing technique and real-time PCR, were developed for detection of neglected tropical helminthes in Greater Mekong Sub-region. New molecular evidences of parasite species infected in human were reported.PCR coupled with pyrosequencing technique and real-time PCR, were developed for detection of the fish-borne trematodes (Opisthorchis viverrini, Clonorchis sinensis, Haplorchis taichui, H. pumilio and Stellantchasmus falcatus), hemoparasites (Babesia vogeli, Hepatozoon canis, Ehrlichia canis, and Anaplasma platys), Trichinella spp. (Trichinella spiralis, T. pseudospiralis, T. papuae and T. zimbabwensis), lung flukes (Paragonimus bangkokensis, P. harinasutai, P. heterotremus, P. macrorchis, P. siamensis and P. westermani), lymphatic filarial worms (Wuchereria bancrofti, Brugia malayi, B. pahangi, and Dirofilaria immitis) and blood flukes (Schistosoma japonicum and S. mekongi). New molecular evidences of Spirometra erinaceieuropaei, Ancylostoma duodenale, A. ceylanicum, Necator americanus, Trichostrongylus colubriformis, T. axei and P. heterotremus complex were reported in infected human.This established techniques and/or knowledge could enable clinicians, veterinarians and laboratories to make accurate diagnoses and provide appropriate treatments. These methods can be applied to epidemiological studies and for molecular taxonomic investigation of tropical parasitic infections in endemic areas. 17 Director of Research and Diagnostic Center for Emerging Infectious Diseases Associate Prof. Viraphong Lulitanond, PhD Dr. Viraphong Lulitanond received Ph.D. (Microbiology) in 1981 and training in molecular virology at McMaster University, Canada and at Chemotherapeutisches Forschunginstitut “Georg Speyer Haus” Germany. He is now the director of Research and Diagnostic Center for Emerging Infectious Diseases and vice president of the Virology Association of Thailand. His research interest is in the molecular diagnosis of infectious diseases and genetic engineering of lactic acid bacteria for heterologous protein expression with the publication more than 70 papers in the peer-reviewed international journal. Department of Microbiology, Faculty of Medicine, Khon Kaen University, THAILAND E-mail: [email protected] GENETIC ENGINEERING OF LACTIC ACID BACTERIA (LAB) FOR HETEROLOGOUS PROTEIN EXPRESSION. Namfon Suebwongsa1,2, ,Sirintra Themsakul1,2, Panjamaporn Yotpanya1,2, Tapanee Thinbanmai1,2, Atipat Yasiri2,3, Kanlaya Chuachan2,4, Wises Namwat1,2, Marutpong Panya2,5, Viraphong Lulitanond1,2*1 Department of Microbiology Faculty of Medicine, Khon Kaen University 2 Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University Lactic acid bacteria (LAB) are generally recognized as safe and many strains have been used as probiotics in both human and animal without any deleterious effect. Currently, ther are increasingly attempted to engineer LAB for heterologous protein expression in order to use as alternative mucosal vaccine vehicle. For this rationale, this project aims to I. Construction of recombinant Lactobacillus expressing heterologous protein. II. Isolation, characterization and selection of LAB isolates from human and chicken with good probiotic properties to develop as mucosal vaccine vehicle. 1. Construction of recombinant Lactobacillus expressing heterologous protein. In this study, L. casei TISTR1341 was used as model LAB host and the conserved influenza proteins, i.e. nucleocapsid (NP) and extracellular domain matrix protein 2 (M2e) were selected as model antigens for expression. Due to the small size of M2e, Hepatitis B core (HBc) protein was fused to M2e to increase size and immunogenicity. As E. coli-Lactobacillus shuttle vectors are the preferred tool for engineering of Lactobacillus to express homologous and heterologous proteins, thus replicons of cryptic plasmids derived from L. casei TISTR1341 were used to construct the E. coli-L. casei shuttle vector. Four cryptic plasmids, i.e. pRCEID2.9, 3.2, 7.6 and 13.9 from L. casei TISTR1341 were sequenced and analyzed. Replicons derived from pRCEID2.9, 7.6 and 13.9 were used to construct E.coli-L. casei shuttle vector using pUC19E as backbone, designated as pRCEID-LC2.9, pRCEID-LC7.6 and pRCEID-LC13.9, respectively. It was found that pRCEID-LC7.6 and pRCEID-LC13.9 showed good segregation and structural stability in both E. coli and L. caseiwhile pRCEIDLC2.9 was unstable in E. coli. The usefulness of the former two vectors was further demonstrated by expressing the NP in both E. coli and L. casei under the lactate dehydrogenase (LDH) promoter of L. casei. Further manipulation to express NP both as secreted and cell-anchorage forms are now in progress. 2. Isolation, characterization and selection of LAB isolates from human and chicken with good in vitro probiotic properties to develop as mucosal vaccine vehicle. In this study, human LAB were isolated from infant feces and screened for in vitro probiotic properties. One isolate with the best probiotic properties was selected and identified based on 16 S rRNA sequencing. The isolate was identified and designated as L. fermemtumRCEID01. Similar to human LAB, a chicken LAB isolate with good in vitro probiotic properties was selected, identified and designated as L. casei RCEID08. Both isolates have been demonstrated for their ability to express various heterologous proteins using expression vector derived from study I above, such as M2e:HBc fusion protein, green fluorescence protein (GFP) and tetanus toxin fragment C (TTFC). All of the shuttle/expression vectors constructed and LAB isolates in this study may be used to complement those current in use in order to facilitate the versatile aspects of molecular applications, especially those used for mucosal delivery vehicles for therapeutics and prophylaxis molecules. 18 Department of Microbiology, Faculty of Medicine Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen 40002 THAILAND Email: [email protected] Wises Namwat, PhD Dr. Wises Namwat (born 1968) is the head deputy of the Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand. He got the B.Sc degree in Medical technology (Khon Kaen University), M.Sc. degree in Microbiology (Mahidol University) and Ph.D. in Biotechnology (Osaka University). His research field concerns in tuberculosis and its pathogen, Mycobacterium tuberculosis. These include 1) diagnosis development of tuberculosis and latent tuberculosis infection, 2) molecular study of virulence genes in the pathogen and 3) molecular epidemiology of tuberculosis. TUBERCULOSIS DEVELOPMENT OF DIFFERENTIAL DIAGNOSTIC TEST OF ACTIVE AND LATENT INFECTION Wises Namwat, SawineeKasa, RattanawinandHanchaina, RachawadeeDusadeekul, WanlopKaewkes, KiatichaiFaksri, and ViraphongLulitanond Department of Microbiology, Faculty of Medicine and Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University. Acute and latent tuberculosis are the public health problem worldwide. Several strategies are used in order to control the diseases. For this rationale, this project aims to: I) developdiagnosis of tuberculosis, II) developdiagnosis of latent tuberculosisand III) develop strain classification of Mycobacterium tuberculosis. I. Develop diagnosis of tuberculosis. In this study, strain detection and differentiation of mycobacteria was developed by double-step multiplex real time PCR in order to identify (i) Mycobacterium tuberculosis (M. tb), (ii) M. bovis, (iii) other M. tbcomplex, (iv) M. avium, , and (v) Non tuberculous mycobacteria. The developed assay was tested with 184 clinical sputum samples and compared to the result of AFB combined with culture method. According to the Step A of PCR, the sensitivity and specificity of developed assay were 84.2% and 95.1%, respectively. The positive predictive value and negative predictive value were 98.1% and 67.2%, respectively. The lower detection limit was equivalence to 50 cells/reaction (1). II. Develop diagnosis of latent tuberculosisinfection (LTBI).LTBI has been traditionally diagnosed by using the Mantoux tuberculin skin test (TST). However, it can show cross-reactivity due to BCG vaccination and difficulties to interpret the results. Recent, Interferon-Gamma Release Assay (IGRA) is used as a diagnostic assay for LTBI. However, these ELISA based methods have limitations in long turnaround time and it based on single cellular marker, IFN-γ. There is a need to develop a method of more specific and sensitive for detecting LTBI. In our laboratory, LTBI diagnosis is being developed by using cytokine-related mRNA and miRNA in whole blood samples that stimulated with specific MTB antigens. Moreover, LTBI related miRNAsis also being evaluated in blood of IGRA-positive people too. III. Develop strain classification of Mycobacterium tuberculosis. Development of single-tube multiplex PCR for classification of M. tb lineages based on large sequence polymorphisms was performed. M. tb isolates could be classified into East Asian (Beijing), Indo-Oceanic (IO), Euro-American (EuA) and East African Indian (EAI) lineages. The most used method is separate PCR and sequencing for each RD. We developed a single-tube multiplex PCR using four primer pairs specific to the four MTB lineages and a primer pair for species-specific RD9 with genomic DNA extracted from isolated colonies. The single-tube multiplex PCR produced lineage-specific amplicon patterns capable of differentiating the four MTB lineages. Sensitivity and specificity of the assay were 100% when differentiating MTB lineages from other species and strains of bacteria. The limit of detection of genomic MTB DNA was 12.5 ng. This single-tube multiplex PCR method offers a simple, rapid and reliable method for classification of MTB lineages based on LSPs. 19 Professor Wichittra Tassaneeyakul, PhD Head of Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND Email: [email protected] Prof. Dr. Wichittra Tassaneeyakul is a Professor at the Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Thailand. She got her B. Pharm degree from Faculty of Pharmaceutical Sciences, Chiang Mai University, Thailand and M.Sc. (Pharmacology) degree from Faculty of Sciences, Mahidol University, Thailand and Ph. D. degree from Department of Clinical Pharmacology, Flinders University of South Australia, Australia. Her research interests are pharmacogenomics, drug metabolism and pharmacokinetics. She had published more than 60 papers in the international journals with high impact factor and had more than 1200 citations for her publications. PREDICTION OF SEVERE CUTANEOUS ADVERSE DRUG REACTION BY HLA GENOTYPING Wichittra Tassaneeyakul Head of Department of Pharmacology, Faculty of Meidicine, Khon Kaen University, Thailand Severe cutaneous adverse drug reactions (SCAR) including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis(TEN) and drug-induced hypersensitivity syndrome (DHS) are life threatening. More than 100 drugs have been reported as culprit drugs for SCAR. Several hypotheses have been proposed to explain the immunopathogenesis of SCAR, however, it is still unclear as to what extent host factors such as age, gender, genetics, comorbidities or environmental factors, might be involved. Recent studies, however, have revealed that SCAR caused by some of several drugs have strong genetic links and might be predicted by the genes coding for human leukocyte antigens (HLA), a key molecule for immune response. For example; abacavir-induced DHS is associated with HLA-B*57:01, carbamazepine-induced SJS and TEN are associated with HLA-B*15:02 and allopurinol-SJS/TEN/HSS isassociated with HLA-B*58:01. Differences of ethnicityin the associations of these HLA alleles and drug-induced SCAR have been noticed. The associations are very strong in the populations with a high prevalence of particular alleles. For carbamazepine, studies in Han Chinese, Thai, Malaysian and Indian populations have reported that the HLA-B*15:02 is strongly associated with SJS/TEN induced by this drug but these results have not been reproduced in Japanese and European populations.The strong association between HLA-B*58:01 with SCAR induced by allopurinol, a uric acid lowering drug was first identified in the Han Chinese. This strong association was subsequently confirmed in the Thai population, however, only a modest association was observed in Korean, Japanese and European populations.Similarly, the strong association between HLA-B*57:01 and abacavirinduced DHShas been observed only inCaucasians but not in African and Asian populations. The HLA-B*15:02 allele is most prevalent in Chinese and Southeast Asian populations but low in Japanese, Korean and European populations while the allele frequencies of HLA-B*58:01 in Han Chinese, Korean and Southeast Asian populations are quite high when compared with Japanese and European populations. In contrast to HLA-B*15:02, the HLA-B*57:01 allele frequency is high in Europeans, when compared with Africans, East Asians and Southeast Asians. Information about frequency of these HLA alleles in each ethnic population will be useful for the prediction of incidence of certain severe drug hypersensitivities as well as cost-effective analyses of pharmacogenetic tests for prevention of these severe adverse drug reactions. 20 — Director of DAMASAC Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002 THAILAND E-mail: [email protected] Associate Prof. Bandit Thinkhamrop, PhD (Statistics) Dr. Bandit Thinkhamrop (born 1962) is an associate professor of biostatistics at the Faculty of Public Health, Khon Kaen University, Thailand. He got the Ph.D. in Statistics in 2000 from the University of Newcastle, Australia. His expertise involves applying statistics in epidemiological and clinical research, in particular non-communicable disease such as cancer. He involved large volume data management for 10 national studies and managed more than 50 research projects concurrently. He also plays the leader roles for software developers. More than 10 software had been developed, 5 are currently used nationally. He published 68 research papers in various international journals and authored 4 books regarding biostatistics. DATA MANAGEMENT AND STATISTICAL ANALYSIS CENTER (DAMASAC): INNOVATION FOR MAXIMIZING UTILIZATION OF RESEARCH DATA Bandit Thinkhamrop Director of DAMASAC, Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University Trend toward sharing research data can be seen widely globally. Many funding agencies are requiring researchers to make their data open-access and available to public as well as the research community. For instance, the National Institute of Health (NIH), the United States, requires all NIH-supported studies to share the data. The NIH Data Sharing Policy stated that “Data should be made as widely and freely available as possible while safeguarding the privacy of participants, and protecting confidential and proprietary data”. Thus, an enormous number of real research data sets are now free to use and are easily online accessible, both completed and on-going projects. Aside from these, many routinely collected data, particularly health care or medical records databases, mostly in electronic form, are also available and in need to be utilized. Challenges lie ahead are how to utilize them efficiently. Founded in 2013, the Data Management and Statistical Analysis Center (DAMASAC) is an academic service unit regulated by the Faculty of Public Health. DAMASAC provides services for data management and statistical analysis for research projects. As an academic institute, DAMASAC also plays essential roles in training for, in particular, post graduate students and research professional. Since started, more than 10 workshops were conducted. It was found that the hands-on writing workshop was proven to be successful. All workshops utilized real research data to write the manuscripts for publication in scientific journals. These workshops involved more than 10 large data bases being shared by real research projects. Regular participants are students and faculty members from the Ph.D. (Epidemiology and Biostatistics), Ph.D. (Oral hygiene), Ph.D. (Biomedicine), Dr.P.H., M.Sc. (Biostatistcs), and M.Sc. (Clinical Epidemiology). Participants can be the first author where the data owners were listed as con-authors. Sharing experiences and opinions among them during the course of manuscript preparations become a unique and effective hands-on training for research and statistical analysis. By this, many master and doctoral students graduated within period of the program with high quality published research papers. Likewise, the corresponding research projects yield more research papers than being initially planned. Sharing data had shown to promote transparency, diversity of analysis, and new research idea. It also expedited translation of research results into knowledge to improve human health. In addition, it facilitates the education of new researchers. These made the DAMASAC becomes a unique institute that archived several research data- a gold mine for real-life data and working environments as well as opportunities for sustained development of data managers, statisticians, and epidemiologists nationally and regionally. 21 Associate Prof. Kanokwan Jarukamjorn, PhD Faculty of Pharmaceutical Sciences, Khon Kaen University Amphoe Muang, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Kanokw an Jarukam jorn is an A ssociate Professor at Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. She earned Bachelor of Pharmaceutical Sciences (First class honor) from Khon Kaen University in 1990, Master in Pharmaceutical Chemistry from Chulalongkorn University in 1993, and Doctor of Philosophy in Pharmaceutical Sciences from University of Toyama in 2001. She was a Monbusho (Japanese Government) Scholar during 1998-2001 and a postdoctoral fellow under Technology Grant Southeast Asia at University of Vienna, Austria during 2001-2002 and the Tokyo Biochemical Research Foundation at University of Toyama, Japan during 2004-2005. In 2008 and 2011, she received Nagai Award Thailand in Honor of Excellent Research Work in Pharmaceutical Sciences and FAPA-CP Nagai Best Paper Award in Pharmacy in 2012 from the Nagai Foundation Tokyo, Jap an . H er area o f ex p ertise is x en o b io tics a n d d ru g metabolism and drug interaction. She is currently a head of research group of pharmaceutical activities of natural products using pharm aceutical biotechnology (PANPB), National Research University-Khon Kaen University. THE BIOTRANSFORMATION IN TERM OF HERB-DRUG INTERACTIONS Kanokwan Jarukamjorn Research Group for Pharm aceutical Activ ities of N atural Products using Pharm aceutical Biotechnology (PANPB), Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Miroestrol (MR) and deoxymiroestrol (D-MR) are highly active phytoestrogens isolated from the tuberous root of Pueraria candollei (Legum inosae). Estrogenic activity of M R w as first investigated in rats, showing the mammogenic effects, in which MR exhibited an estrogenic activity 0.25 times that of 17-estradiol (E2) by a vaginal cornification assay and D-MR had 10-fold more potent estrogenic activity than MR. MR and D-MR significantly increased mouse uterus weight and volume. In addition, both phytoestrogens induced the expression of CYP2B9, 17β-HSD2, and osteoprotegerin (OPG) while they suppressed the expression of CYP1A2, 3β-HSD, 17β-HSD1, CYP17, aromatase (CYP19), receptor activator of nuclear factor kappa B ligand (RANKL), bile salt export pump (BSEP), and conjugate export pump (MRP2). The increase of OPG/RANKL ratio revealed the potential of these phytoestrogens on bone loss prevention with antioxidative activity according to the lowering level of lipid peroxidation in the mouse brain. On the contrary, inhibition of a couple of bile salt transporter genes, BSEP and MRP2, revealed a risk for hepatotoxicity and intrahepatic cholestasis. The findings that these two phytoestrogens, MR and D-MR, significantly modified the expression of several biotransformation-related genes suggest the need for caution on the herb-drug interaction when using health supplements hav ing phytoestrogenic activity as alternatives for hormone replacement therapy. 22 Associated Prof. Suppachai Tiyaworanant, B.Sc. in Pharm., M.Sc. (Pharmacognosy) Department of Pharmacognosy and Toxicology, Faculty of Pharmaceutical Sciences, KhonKaen University, THAILAND Tel: +66-4320-2378 Fax: +66-4320-2379 Email: [email protected] Assoc. Prof. SuppachaiTiyaworanant is a lecturer in Division of Pharmacognosy and Toxicology, Faculty of Pharmaceutical Sciences, Khon Kaen University. He got his Bachelor degree of Pharmaceutical Sciences from Khon Kaen University in 1997 and Master of Sciences in pharmacognosy from Chulalongkorn University in 1999. His areas of expertise are phytochemistry, pharmacognosy and herbal medicine. Currently, he is a councilor of the Committee on dictionary of Pharmacy and the Committee on dictionary of Natural Substances and Natural Products, Royal Institute of Thailand. He was the founder of the museum and herbal database project in the Faculty of Pharmaceutical Sciences, Khon Kaen University. DEVELOPMENT OF TRADITIONAL CRUDE DRUGS DATABASE Suppachai Tiyaworanant Department of Pharmacognosy and Toxicology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Thai traditional medicine and traditional Chinese medicine are well-known as alternative medical therapy in Thailand however the main obstacle of accessing the information of crude drugs and medicinal plants is the language barrier, especially the name of traditional Chinese crude drugs in Thailand generally named in Chaozhou accent, one of the Chinese accent that mostly used in the Chinese oversea families in Thailand. Herbal bank (http://herbalbank.kku.ac.th) is the database that intended to be an integrated information sources of all aspects of crude drugs including picture, common name, Thai name, Chinese name (traditional Chinese characters, simplified Chinese characters, Mandarin pronunciation, and Chaozhoupronunciation), scientific name, part of use and other scientific information of each herb. User can enter various keyword into a search box, e.g., scientific name, a ton of common name, Thai pronunciation of Chaozhou accent, mechanism of action. It is the unique comprehensive database which provided data on traditional crude drugs with their Chaozhou name using Thai pronunciation. This database has been developed to more effective database that break through the limitation of the information access. 23 Associate Prof. Chulaporn Limwattananon, MPharm, MSc, PhD Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen THAILAND E-mail: [email protected] Dr. Chulaporn Limwattananon is an Associate Professor at Faculty of Pharmaceutical Sciences, Khon Kaen University in Thailand. She has her first degree in pharmacy from Mahidol University, Thailand and earned her MSc and PhD degrees from University of Minnesota, USA. With a solid background of quantitative approaches in epidemiology and health services research, she has advised and conducted empirical works on health policy and system research at both national and sub-national levels. Currently, she is leading a research project in collaboration with Health Insurance Systems Research Office (HISRO) under financial support from Comptroller Generals Department, Ministry of Finance for monitoring drug reimbursement in Civil Servant Medical Benefit Scheme (CSMBS). DRUG REIMBURSEMENT POLICIES IN CIVIL SERVANT MEDICAL BENEFIT SCHEME (CSMBS): A COST-CONTAINMENT STRATEGY THROUGH ELECTRONIC DATA ANALYSIS Chulaporn Limwattananon Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Over the last three decades, Civil Servant Medical Benefit Scheme (CSMBS) for government employees, pensioners and dependants experienced a continual, double-digit growth in total spending, reaching the peak of 62 thousand million Baht in 2010. Payment for outpatient (OP) service through fee-for-service method has outpaced the inpatient one since 2004. Escalation of the OP payment was very rapid after the direct disbursement to hospitals was implemented in 2006. At presence, the OP expenditure, of which nearly all was for drug reimbursement contributes to three quarters of the overall budget, at presence. Since 2009, 34 large hospitals affiliated with universities, Ministry of Public Health (MOPH) and other ministries have been monitored for the OP direct disbursement through hospital-reported data on aggregate drug use. Beginning in 2012, these public hospitals were required to submit electronically prescriptions to be reimbursed for each CSMBS beneficiary. In 2013, additional 134 public hospitals were involved in the OP drug reimbursement monitoring. Data on individual prescriptions, especially for 9 groups of high-cost medicines were analyzed for pattern of use with respect to coverage in the National Lists of Essential Medicines (NLEM) and market status. Key findings on potential overuse of non-essential (NE) and expensive, single-source drugs for every hospital were tailored and reported directly to the hospital director for self-management and control. Hospitals with relatively high expenditure per drug recipient tended to use the NE drugs more often than their counterparts. After implementing the monitoring system, growth in the CSMBS real-term expenditure has become negative at an annual rate of minus 3-5% for consecutive years of 2011-2013. With a complement of restrictive reimbursement policies, use of the NE drugs was curbed in several hospitals, typically at the lower level for MOPH hospitals. Monitoring hospital reimbursement through electronic data analysis and tailored feedback mechanism seemed to be an effective cost containment strategy. 24 Associate Prof. Supon Limwattananon, MPHM, PhD Dr. Supon Limwattananon is an Associate Professor at Faculty of Pharmaceutical Sciences,KhonKaen University, Thailand. He earned Bachelor of Pharmacy from Chulalongkorn University in 1982, Master in Primary Health Care Management from ASEAN Institute for Health Development in 1991, and Doctor of Philosophy from University of Minnesota in 2000. He was a Fulbright Scholar during 19931996 and received the US Health Care Financing Administration Dissertation Award in 2000. In 2008, he was seconded to the World Bank head office in Washington, DC as Faculty of Pharmaceutical Sciences, KhonKaen University, a Senior Health Specialist in the Human Development Network. His area of expertise is health economics and Khon Kaen, 40002 THAILAND financing. He is currently leading health policy and systems E-mail:[email protected] research for several government agencies and conducting cross-country analyses of health systems with international partners. ECONOMIC IMPACTS OF UNIVERSAL HEALTH COVERAGE (UHC) IN THAILAND: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS ON REDUCTION OF POVERTY IMPACT DUE TO HEALTH PAYMENTS Supon Limwattananon Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Thailand has achieved the universal health coverage (UHC) in 2002 when the government implemented the Universal Coverage Scheme, widely known as the ’30-Baht Policy’.The dual goals ofhealth improvement and financial risk protection for households are agrand challenge toany countries aspiring for the UHC advancement. The pro-poor utilization of outpatient and inpatient services and pro-poor government subsidies for district health services within the Scheme were success stories of the UHC in Thailand.Ability of theUHC policy to prevent households from falling into medical poverty trap was determined in this study. Multiple, cross-sectional SocioEconomic Surveys of approximately 25-45 thousand nationally representative households each year during 1994-2013 were retrieved for the data on total consumption expenditures and health payments. To identify poor households, average consumption expenditure per capita was compared with national poverty lines specific to regions and urban-rural areas of household location. A household with total consumption below the poverty lineswas classified as the poor household. For the rest non-poor households, the household with the expenditure net of health paymentbeing below the poverty lines was deemed health-impoverished. Trends before and after the 2002-UCS implementation were estimated using an interrupted time-series analysis that was accounted for serial correlation by Prais-Winsten method. In 1994, 331,289 households nationwidehad the consumption expenditure net of health payment below the poverty lines.Number of the households being impoverished by health paymentdeclined gradually, partly due to progress in living standards.A reduction in health impoverishment over 20 years of the Surveyswas estimated to be by1.38%points annually (P=0.031), regardless of the UHC. An implementation of the UHC policy resulted in an immediate further drop in impoverished households in 2002 by 7.29% points (P=0.058). In 2013, a decade after the UHC achievement, 93,858 households remained falling into the medical poverty trap. It was estimated approximately 90 thousandhouseholds per yearwere prevented from health impoverishment on averageas a result of the UHC policy. The UHC was a powerful policy intervention to protect households from financial risk due topayment for health care. 25 Associate Prof. Nusaraporn Kessomboon, PhD Division of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, THAILAND E-mail: [email protected]; [email protected] Dr. Nusaraporn Kessomboon is Associate Professor of Social and Administrative Pharmacy at Faculty of Pharmaceutical Sciences, KhonKaen University. She played some roles in professional and academic societies. She is elected as a committee of the Pharmacy Council of Thailand. She also serves as the committee of National Health Security Regional Sub-committee and Health Impact Assessment Commission of Thailand. She earned her PhD in Pharmacoeconomics from the Robert Gordon University, Aberdeen, UK, in 2001, Master Degree in Health Economics and Bachelor Degree in Pharmaceutical Sciences from Chulalongkorn University in 1995 and 1990, respectively. She was awarded to gain more international experiences by working as a technical officer of the Department of Ethics, Trade, Human Rights, and Health Law, World Health Organization, Geneva in 2008. She served as the principal investigator and co-investigator of several research projects related to drug system and policy, health impact assessment, international trade and health, pharmaceutical patent and access to medicines. TRADE POLICY AND PHARMACEUTICAL PATENT TERM EXTENSION Nusaraporn Kessomboon Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Trade liberalization is growing and changing the global trade and health architecture. The WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) is a multilateral agreement that signed in April 1994 and came into force in January 1995. It sets minimum standards in the international rules for protection and enforcement of Intellectual Property Rights, including life-saving products such as pharmaceuticals, in the member countries of WTO. Several studies showed that the implementation of TRIPS Agreement have had impacts on access to medicines and public health. In 2001, the Doha Declaration addressed WTO members to use TRIPS safeguards such as compulsory licenses or parallel importation to overcome patent barriers to promote access to medicines. Some developed countries particularly the European Union and United State, have notified since 2000s that the multilateral WTO forum could not achieve their own trade agendas. Therefore they have been conducting the bilateral/regional free trade agreement with several countries. Developing countries also see legitimate economic and political reasons for joining these FTAs. The issue to enforce higher-level intellectual property protection which can be called “TRIPSplus” has been raised in the negotiations. The examples of “TRIPS-plus” text involve the period of patent extension from TRIPS Agreement which basically have to do with compensation for delays in patent registration and/or drug registration; data exclusivity that would result in the delay in generic entry; patent term restoration that would delay entry of generic medicines etc. It could be implied that there would be severe restriction on the access to medicines from “TRIPS-Plus” proposal. The government in the developing countries therefore needs to protect the health of the nations by develop preventive measures for the existing negative impacts from international trade. 26 Associated Prof. Sunee Lertsinudom, BSc, GradDip, BCP Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected]:s [email protected] Assoc. Prof. Sunee Lertsinudom is an Associate Professor at Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. She earned Bachelor of Pharmacy from Chulalongkorn University in 1990, Board Certificate in Pharmacotherapy from The College of Pharmacotherapy of Thailand in 2006. Her area of expertise is pharmacy specialist in Ambulatory care. She is currently Manager of Community pharmacy drugstore, Faculty of Pharmaceutical Science, KKU and President of Thai Pharmacist Practitioner Group in Asthma and COPD. CHALLENGES AND OPPORTUNITIES IN PHARMACY PRACTICE FOR AMBULATORY CARE: DEVELOPMENT OF PHARMACEUTICAL CARE MANAGEMENT SOFTWARE FOR ASTHMATIC PATIENTS IN ORDER TO USE QUALITY OF LIFE QUESTIONNAIRE IN ROUTINE PRACTICE Sunee Lertsinudom Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand The objective of this research was to develop a computer program for a pharmaceutical care management of asthmatic patients in routine clinical practice. A computer software was designed and developed from a pharmaceutical care database, using Microsoft Access 2003. The monitoring part in this software contains Thai Mini-Asthma Quality of Life Questionnaire (AQLQ). The components of this software are separated into 3 sections. The first section contains patient data, such as demographic characteristics, diagnoses, laboratory results and quality of life evaluation plus medication profiles of patients. The second section is the pharmaceutical care, such as detection of drug-related problems and pharmacist actions. The last section is reports on drug-related problems and pharmacist interventions. The computer program was first implemented in January 2009 for asthmatic patients in a hospital. Using this software, a pharmacist could collect, retrieve, analyze, and report data on pharmaceutical care for asthmatic patients and the use of the Thai Mini-AQLQ to evaluate patients’ quality of life. A Pharmaceutical Care Management software for asthmatic patients was able to serve the needs of pharmaceutical care and evaluation of patients’ quality of life. 27 Clinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002 THAILAND (Clinical Research), Pharm.D, BCPS, BCOP Assistant Prof. Suphat Subongkot, MS Dr. Subongkot is currently an assistant professor and chair of the Clinical Pharmacy Division at Faculty of Pharmaceutical Sciences, Khon Kaen University. His responsibilities include didactic teaching in an advancedpharmacotherapy course for undergraduate, master, and doctorate of clinical pharmacy students and providing oncology clinical pharmacy and clinical pharmacology service at Srinagarind Hospital KKU. He is also host of a board certification in pharmacotherapy training program and serves as a residency/fellowship coordinator under the College of Pharmacotherapeutics. His past experiences involve clinical coordination with the medical team and oncology services at Rush University Medical Center in Chicago, teaching the experiential and didactic portion of the curriculum at the University of Illinois Chicago College of Pharmacy, precepting pharmacy students and residents, and conducting clinical research at Rush University Medical Center. He is the recipient of a National Institutes of HealthK-30 grant to participate in a clinical research training program for clinicians at Rush University Medical School from 2001 to 2003. In 2006, Dr. Subongkot founded the Asia Pacific Oncology Pharmacy Society in Thailand and the first Asia Pacific Oncology Pharmacy Congress which is one of the premier events held biannually to support oncology pharmacy education among SEA regions. Recently, he was appointed president of the College of Pharmacotherapy of Thailand, an official residency program accrediting body in Thailand. His main interest is targeted therapy for cancer treatment, especially the role of cyclo-oxygenase II and herbal drugs in treatment and prevention, pharmacogenomics, and cancer drug development. He is also interested in many palliative care issues emphasizing cachexia, nausea/vomiting, and nutrition in oncology patients. His ongoing research involves the use of olanzapine to improve emesis control, the effect of melatonin on breast cancer supportive care, effect on melatonin in alleviating radiationrelated toxicities, and ginger in treatment-related cancer-cachexia PERSONAL TREATMENT AND CARE Supath Subongkot Clinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Genetics appear to play a major role in many aspects of oncology, from carcinogenesis to drug response. Genetic analysis may help to determine a persons risk of cancer, to diagnose cancer, to classify disease, to determine prognosis, to develop therapeutic drug targets, and to determine drug therapy. While pharmacogenetics principles have been used for many years in developing drugs as with the Thymidylate Synthase target for 5-fluorouracil, it has been most recently the true potential power of pharmacogenetics has come to fruition with imatinib in the treatment of chronic myelogenous leukemia. However long term data is starting to show increasing resistance to imatinib and new therapies are being explored based on genetic changes of the resistance. Recently more studies have examined specific patient responses to therapy and exploring the role of drug metabolizing polymorphisms. A classic example is that again of dihydropyrimidine dehydrogenase deficiency and the potential for severe toxicity related to 5-FU. More recently a polymorphism in UDP-glucuronosyltransferase (UGT), which inactivates the active metabolite of irinotecan, causing some individuals increased toxicity. Of course long known polymorphisms in cytochrome P450 may cause increased or decreased response. For example CYP2D6 polymorphisms result in poor metabolizers, normal metabolizers, extensive metabolizers, and ultraextensive metabolizers. Drugs metabolized through this enzyme include codeine and tamoxifen which are metabolized into active agents and thus poor metabolizers have decreased activity with these agents. On the other hand certain 5-HT3 antagonists like dolasetron, tropisetron and to a lesser extent ondansetron are inactivated through CYP2D6 and it appears that ultrametabolizers may have an increased risk of nausea and vomiting. The development of pharmacogentics and pharmacogenomics is truly in its infancy but will probably play a leading role in selecting drug therapy in the near future. With this, new study design as well as new ways of evaluating therapies may be required. This has been shown in the trastuzumab trials. If it would not have been realized that only 20% of breast cancer patients who are Her-2-neu over expressors would have the potential to respond and if the studies would have been done in “all comers”, the trial would have never been large enough to have a positive outcome. Perhaps this will be one of the greatest challenges as the evolution of genomics will challenge the current basis of “evidence based medicine” and may again rely on the dreaded “n of 1”. 28 Professor Pyatat Tatsanavivat, MD Director of the Academic Clinical Research Office, A Clinical Research CenterCRC of the Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Director, Medical Research Foundation (MRF-2007-current); Board & executive member of Medical Research NetworkThailand (MedResNet-2012-current) Director/Founder-Clinical Research Collaboration Network (CRCN; 2000-2012), Bangkok, Thailand. Director/Founder of the Academic Clinical Research Office, Faculty of Medicine, Khon Kaen University, Thailand Professor Pyatat Tatsanavivat, retired professor-Khon Kaen University (2012), is currently the Director of the Academic Clinical Research Office, a Clinical Research Center-CRC of the Faculty of Medicine, Khon Kaen University, Thailand. An M D. graduate from Chulalongkorn University, Thailand (1975); Diploma of Thai Board of Internal Medicine (1983); Diploma in Epidemiology (Clinical), Newcastle, Australia (1990); Diploma of Thai Sub-board of Cardiology, Thailand (1992). He was an associate dean for Research Affairs (19972005) and chairm an of E thics C om m ittee, F aculty of Medicine, Khon Kaen University, Thailand. During the year 2000-2002, He was a board of trustees of the International Clinical Epidemiology Network Trust (INCLEN Trust International Incorporation), Regional Coordinator, International Clinical Epidemiology Network – Southeast Asian (INCLEN-SEA); an Academ ic Task Force for the National Health System Reform, Thailand.). In 2000, he found th e C lin ical R esearch N etw o rk -the C R C N , curren tly MedResNet, the clinical research network of the Consortium of Thai Medical schools and is the National Clinical Research Network, which has supported and facilitated more than 40 high-im pact investigator-initiated clinical researches in various therapeutic areas. Clinical research tools created in the network include: the WHO-recognized WHO primary registry, the Thai Clinical Trials Registry (http://www.clinicaltrials. in .th /), O n lin e M e d ic a l R e s e a rc h To o l -O M E R E T (www.omeret.net) Data Archival for Maximum Utilization System (http://www.damus. in.th/damus/). HIDDEN RESEARCH GAP : CLINICAL TRIAL/STUDY MANAGEMENT Pyatat Tatsanavivat Academic Clinical Research Office-ACRO, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Research for Social Devotion- Research result to be translated to benefit society, clinically, to establish safety, effectiveness of new diagnostic preventive and therapeutic approaches. According to the value chain of biomedical research enterprise, from human biology, proteins & molecules function & mechanism of diseases or new investigation agents to preclinical tests, clinical trial, manufacturing and marketing/human uses, there are hidden research conduct or management gaps for clinical trials. Clinical trial supportive environments, common in sponsor-initiated trials, are lacking in most of government/not for profit funding supports, particularly in middle/lower income countries, not to mention translational research facilitation. Despite several years of filling “the hidden gap” through National level of “Clinical Research Collaboration Network of Thailand, there are even more challenging opportunities to come, to be “managed” at both national as well as at “site” or institute levels. 29 Professor Yuichi Kasai, MD Department of Spinal Surgery and Medicine Engineering Faculty of Medicine Mie University, Japan Prof. Dr. Yuichi Kasai (born 1961) is Professor of the Department of Spinal surgery and medical engineering, Mie University Graduate School of Medicine. He got the medical doctor degree in 1986 from Mie University Faculty of Medicine, Tsu, Mie, Japan (Passed the Examination of National Board ) Professional Societies: Japanese Orthopedic Association 1986 - present Japanese Society of Spinal Surgery 1992 - present North American Spine Society 1998 - present American Academy of Orthopedic Surgery 2000 - present He had published more than 150 Japanese medical papers as a first author. Director, International Medical Support Center, Mie University Present address: 3020-1 Nagaoka-cho, Tsu, Mie, Japan, 514-0064 E-mail: [email protected] THREE IMPORTANT THINGS TO SUPPORT SPINAL SURGERY IN DEVELOPING COUNTRIES, AND EXPERIENCE IN MYANMAR Yuichi Kasai, MD Professor of Spinal Surgery and medical Engineering and Director of International Medical Support Center, Mie University, Japan I have supported Myanmar Medicine since 2010, because I am a NPO member of Japan-Myanmar Collaboration Project for Fostering Medical Human Resources and Japan-Myanmar Bridge of Friendship. As you know, Myanmar is one of least developed countries in the world. There are very few MRI or CT, and medical equipment including high speed drills and good spinal instrumentation are not available in Myanmar. And then, the number of medical doctors are insufficient, for example, there are only 300 orthopaedic doctors for 50 million population in the country (cf. 23000 orthopaedic doctors in Japan), To support Myanmar medicine, I firstly donated some implants and instrumentation from Japan to some Myanmar hospitals, and then, several Myanmar promising doctors were invited to Mie University to be taken a look at spinal surgeries and Japanese medical situations. And moreover, I often visited Myanmar to teach spinal surgeries. Because one good doctor will make ten good doctors, it is very important to bring up a first key doctor. Three important things to support spinal surgery in developing countries are donation, education and communication. And establishment of good partnership toward Myanmar Medical Universities such as a favorable relationship between Mie University and Khon Kaen University is essential. 30 SYMPOSIUM SESSION: PREVENTION AND HEALTH PROMOTION Associate Prof. Wanapa Sritanyarat, RN, PhD Faculty of Nursing, Khon Kaen University, Khon Kaen 40002, THAILAND Dr. Wanapa Sritanyarat is currently an Associate Professor in Gerontological Nursing Program, and a chairperson of the PhD program in Nursing Science, at the Faculty of Nursing, Khon Kaen University, Thailand. She obtained a Baccalaureate degree in Nursing from the Faculty of Nursing, Khon Kaen University, a Master degree in Ambulatory Nursing from School of Nursing, the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand and a Doctorate degree in Adult Health Nursing from the School of Nursing, University of Texas at Austin, USA. She has spent most of her nursing career as a nurse educator and researcher at the Faculty of Nursing, Khon Kaen University. She has published books, chapters, articles, and research papers related to gerontological nursing and health care system of older people in Thailand. For example: Knowledge synthesis on health service systems and health insurance for the elderly in Thailand; Innovation and development of gerontological nursing innovation; Routine to innovation: development of age-friendly nursing services; Health profile of older persons in institution and community; The experience of chronic illness of the elderly and families in Northeast, Thailand; health status and health services of the Thai elderly; Research on “Policy driven on the integrated health and social service system for older people’s rights and well- being; Knowledge management and synthesis of practice guidelines in providing care service for health promoting hospital (Tambon hospital and PCUs); and Synthesis of continuity of care service system for Thai older persons. During 2008-2012, Dr. Wanapa served as the project manager of the Health Promotion Nursing Network (HPNN) phase II, supported by the Thai Health Promotion Foundation. She had worked with the key actors from 21 Universities /Colleges. The mission of the task force was to move nursing education towards health promotion. At the end of the projects, there were 181 research/innovation projects under the HPNN plan. NURSING EDUCATION TOWARDS HEALTH PROMOTION: EXPERIENCES FROM HEALTH PROMOTION NURSING NETWORK, THAILAND 1 2 Sritanyarat W, Sutra P, Aroonsang P,1 Lertrat P.2 1 Associate Professor, Faculty of Nursing, Khon Kaen University.2Assistant Professor, Faculty of Nursing, Khon Kaen University. E-mail: [email protected] The Thai National Health Act has been launched with the vision of health promotion is better than cure. Nursing education has been transformed toward the goal of health promotion under the supported from the Thai Health Promotion Foundation. Health Promotion Nursing Network or HPNN located at the Faulty of Nursing, KKU, had been organized as a management unit in networking among 21 key nursing schools and strategic partners in Thailand. Research and project development based on the conceptual framework developed by HPNN was used. The vision of creating new nurse graduates with health promotion mind and competencies, the HPNN employed the concept of “health promotion for all, all for health promotion (HPFA, AFHP)” as the collaborative working framework of all key actors from nursing schools and practice settings, both in institutions and in communities. The concept of “Knowledge management (KM),” and “Routine to research and innovation (R to R & I),” were also used to guide activities/projects under the HPNN plan. The four HPNN strategies used comprised of: 1) Building health promotion knowledge and innovation; 2) Producing nurses with health promotion competencies; 3) Enhancing nursing networks on health promotion; and 4) Building social health policy. Outputs/outcomes of the HPNN plan resulted from four strategies were: 1) Databases/ Knowledge/ Research reports related to health promotion; 2) Nursing curriculum/ educational projects/ activities/ innovations on health promotion, as well as nurse graduates with health promotion competencies; 3) Creating of health promoting societies: Health promoting faculties/ institutes (nursing education institutes & nursing service organizations), and health promoting societies/communities of all age groups and with various health problems; and 4) Nursing education policies on promoting health for societies, especially at the organizational and professional levels. The efforts of HPNN, together with key strategic partners in moving nursing education towards health promotion have been recognized by nurse administrators, educators and students of the nursing academic institutes in Thai land. The next step of nursing profession is to move nursing services at all levels: primary, secondary and tertiary care towards health promotion. 31 Associate Prof. Khanitta Nuntaboot, PhD Faculty of Nursing, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail:[email protected] Dr. Khanitta Nuntaboot (born in 1962) is a community nurse. She graduated with BNS from Faculty of Nursing, Khon Kaen University in 1984. Then she finished her Master of Public Health with specialty in Rural Health from The University of the Philippines in 1987. She got her PhD. in Nursing from M assey University, New Zealand in 1994. Over the last decade, she has conducted continuous research programs in the area of com m unity health, system developm ent in particular. H er interest also focusses on the com m unity systems strengthening for health. THAILAND COMMUNITY NETWORK APPRAISAL PROGRAM AS A TOOL FOR COMMUNITY INITIATED SOCIAL SERVICES AND WELFARE Khanitta Nuntaboot Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand In Thailand, local governments are provided a legal framework to have an autonomous status in managing social services and welfare. To ensure widest participation in the governance and to achieve transparency and social accountability; evidences should be employed to indicate the unmet needs and the social services and welfare. Hence, it is essential for the local government to establish the community-owned database system. To support decision m aking of local governm ent and leaders of civil groups, com m unity organizations and public sectors, data should be gathered based upon all aspects of life and human conditions that affect health. Previously, community organizations and public sectors accumulated data for own use. To combine data from all aspects of health and human conditions as evidences for community actions, the Thailand Community Network Appraisal Program (TCNAP) has been developed and modified to be a unified database system. To encourage participation of community leaders and members including those of the civil society groups, TCNAP was intended to also include the learning process along with the database system management. The learning process is well designed to encourage self-initiated learning in community problems, community social capital, and assets, via activities in data collection, data analysis, and data utilization in undertaking community actions. TCNAP, an online program, comprises of 7 parts of community-wide data; social capital; communication system; health care; population and education; economy; natural resources and environment; and political and conflicts management. There are two sets of questionnaires, the households and the community. To encourage TCNAP implementation, training were provided to the community teams comprising of management team, data collection team, data analysis team, and data utilization team. The objectives of the training packages were twofold; increasing skills of those community teams and in increasing participation of the community leaders and members. Since 2010, 84 training centers were established and over 2380 local governments have implemented TCNAP as community database system. As a tool for community strengthening, TCNAP shows data indicating some factors influencing human living condi tions and health indicators which leads the local government and other community organizations including civil society groups to develop initiatives and healthy public policies for local people to live safety, healthy, and connected for mutual cooperation and assistance. 32 Sutta Praesi, PhD candidate Mr. Sutta Praesi, Director of the Community Hospital Don Kaew, Chiang Mai. 1991 Bachelor degree Graduation Nursing . 1994 Public Health Education (Best Education Award) Chiangmai University. Master's degree 1996 Master of Public Health Chiangmai University and Master of Public Administration in 2006 Institute of Development Administration (NIDA). Currently studying planning and rural development Ph.D. Maejo University Chiangmai Donkaew Community Hospital, Maerim, Chiangmai, THAILAND E-mail: [email protected] STRENGTHENING THE HEALTH CARE COMMUNITY Sutta Praesi D irector of the C om m unity H ospital D on K aew, C hiang M ai. D onkaew C om m unity Hospital, Maerim, Chiangmai, Thailand For more than a decade in Donkaew sub district, work experience has been built among thousands of people, especially among local leaders, community leaders, leaders from governmental organizations and leaders from volunteer organizations. Additionally, funding supports, potential, expertise and learning opportunity have also been gained. Approximately 86 practical excellence centers have been established as 4 dimensional health learning centers. Furthermore, the principals of good governance and local culture have been completely assembled. One of the best examples is "khuang kam khued" (the wisdom area). This area is used for "searching, developing and network building" for everyone in Donkaew sub district. Manpower, social supports as well as potential support can be gained for skillful development, usage of information, creative innovation and expanding of networks. These supports are developed and shared among members leading to a health management system in the community. In order to achieve the vision of Donkaew sub district of being “a healthy sub district", all villagers are divided into thirteen target groups (separated by age) and covered by the system. The strategy for local strengthening in Donkaew sub district consists of 3 factors; knowledge, potential support and networking - and integrated into 3 units as follows:1) Villagers who have created 76 help/social groups which are divided into 3 kinds; public mind groups, volunteer groups and miscellaneous groups.2) A health service that aims to be a Social Enterprise. This unit cooperates with other groups from the primary, secondary and tertiary levels.3) Local administration management that supports all units in order to be a healthy community using the principals of good governance, decentralization and the building of seven missions for its organization. Resulting from a wellmanaged cooperation, the health management system was created as the best practice model that perfectly combines knowledge and practice. It is also a way to exchange and share ideas and experience and knowledge which led to the establishment of the University of Donkaew Healthy Community (UDHC). Here, the spirit of developers, health care innovations and knowledge for future change are created. Factors that indicate the success of a health care community are; 1) leaders' powers indicating a future path of policies and financial supports. 2) The power of knowledge that creates the learning process in order to be a learning organization which also needs to be supported by academic institutes. And 3) the power of people; those who have the public in mind:the most important unit to propel a community. 33 Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Mittraparb Highway, Muang, Khon Kaen, 40002. THAILAND. E-mail: [email protected] [email protected] Professor Bowornsilp Chowchuen, MD, MBA Prof. Dr. Bowornsilp is currently a professor and chief at Plastic surgery division, Faculty of Medicine, Khon Kaen University. He is also a member of Khon Kaen University Council. He is a director of Center of Cleft Lip-Cleft Palate and Craniofacial Deformities, Khon Kaen University in Association with “Tawanchai Project” (Tawanchai Cleft Center). He had become the president of the Thai Cleft Palate and Craniofacial Association (TCCA) from 2007-2011. He has received abundant of honors and recognition for example; in year of 2003, he received the Who’s Who in the World and Who’s Who in Medicine and Health Care from 2004-2005. Then, the recognition in Education, Research and Administration from Plastic Surgeon Alumni of Ramathibodi Hospital, Bangkok in 2004. Besides, he received the Smile Train Hero Award-Tireless Passion for helping children in 2007 and along with the year of 2011, he received the Mechai Veeravaitaya Award for rural development from the Stock exchange of Thailand. As well as in 2013, he received the Golden Kalaprapreuk Award from Khon Kaen University (Tawanchai Foundation). He additionally was invited as a keynote speaker/invited speaker at many international conferences. TAWANCHAI CENTER’S 25 YEARS LESSON LEARNED OF COMPREHENSIVE CLEFT CARE IN THAILAND Bowornsilp Chowchuen Professor of Plastic Surgery, Director of Tawanchai Cleft Center & Foundation, Khon Kaen University, Khon Kaen, Thailand The treatment of patients with cleft and craniofacial deformities is challenge, requires long-term care and holistic management. Overwhelming numbers of these deformities found in countries with high birth rates, with limited resources, burden with high cleft care loads and less systematically arranged facilities and support. Quality of cleft care process is generally depended on economic, social and environmental factors, sustainable development in the country. We analysed the 25 experience cleft care in Thailand from the previous results as well as the future challenges and opportunities. The WHO community based rehabilitation guidelines 2010 was used. The community based matrix included the components of health, education, livelihood, social and empowerment. The comprehensive treatment and care included the dimensions of social, healthcare, education and economic support. Tawanchai Foundation for Cleft Lip Palate and Craniofacial Deformities, interdisciplinary management and Cleft & Craniofacial Cleft Center were established in Khon Kaen University. The cleft care protocol was established according to the cleft and craniofacial diagnosis, the period of child development, the planning of treatment and outcome of interdisciplinary team, the participation of patient and family, the community health system and school program. The challenges of cleft care system the systematic arrangement of community based cleft care system including the efficiency coverage of accessibility and comprehensive care, mainly involved in the primary deformity but lack in the secondary deformity management and absence proper analysis of holistic and long term outcome. Registration of cleft birth, increase regional accessibility, improve quality of continuing care, holistic and interdisciplinary management, more focusing on dental, speech management and quality of life, providing education and information of cleft treatment, outcome assessment and sharing of best practices are recommended. The efficiency of the community-based Model can be achieved by the good home and school program, children and family support program and the establishment of Learning Center for Poverty Eradication. The Center has many lesson learned from this study. The diagnosis, management, and treatment of clefts and craniofacial deformities can be complex and requires coordinated care and Interdisciplinary team management. Comprehensive interdisciplinary management in a Craniofacial Center with the clearly and systematically planning was necessary to provide proper, early longitudinal care and optimum outcomes. The standard method of data collection should be performed for registration and long-term care of these anomalies. Funding from a number of sources, including the Foundation, is needed to ensure patients’ access to treatment and follow-up and for the Center to improve the quality of treatment, education, research and innovation. 34 Associate Prof. Kwanchanok Yimtae, MD Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] D r. K w anch ano k Yim tae is th e associate p rofesso r in Otolaryngology. She graduated the medical degree from the Faculty of M edicine, Khon Kaen University in 1987, the diplom a of T hai board in O tolaryngology from S iriraj H ospital, M ahidol U niversity in 1983, the postdoctoral research fellowship in Neurotology from the University of California, San Diego, USA in 2000, and the WHO -WIRB international fellowship in Bioethics and IRB administration from the University of Washington, USA in 2006. She has been the director of Khon Kaen Ear and Hearing Center, which is one of the Hearing International Centers, since 2005. Her w orks focus on the hearing disorders, vertigo, tinnitus, occupational noise induced hearing loss, and the health system policy to improve the equity to assess the hearing care service and quality of life for communities. HEALTHY HEARING FOR HEALTHY COMMUNITIES Kwanchanok Yimtae Director of Khon Kaen Ear and Hearing Center, Khon Kaen University, Khon Kaen, Thailand Hearing loss can affect communication, social interactions, and quality of life. This condition may occur at any age from newborns through elders. More than half of peoples who have hearing loss, their causes are preventable etiologies such as infection, noise, trauma, toxic substance, etc. Early detection and early intervention including rehabilitation will prevent the disability and increase the quality of life. Unfortunately the number of specialist such as ear doctors, audiologists and speech therapists per population in the northeast Thailand is very low, this limits the accessibility of local people to the hearing screening and rehabilitation. The Khon Kaen Ear and Hearing Center, established in 2005, has the mission to promote the healthy ears and healthy hearing for northeast Thais. The center has lunched many projects to improve the health care systems and strengthen the network. These activities include providing the mobile ear services to rural community hospitals in Khon Kaen Province, providing the occupational noise-induced hearing loss surveys and services in factories around Khon Kaen, and initiating new practices to enhance the accessibility even though limited resources. Also the innovation and new technologies are developed and tested in the center. The center is the only one to provide the cochlear implantation service for northeastern Thais and patients from neighboring countries. This service helps the patients with bilateral deafness to get their hearings again. Besides providing the service and the research, the center also provides several educational programs to empower health personals and creates the hearing network to promote the healthy hearing for the healthy communities. 35 Associate Prof. Benjamas Prathanee, PhD Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 THAILAND E-mail: [email protected] Dr. Benjamas Prathanee (born in 1960) is Director of Speech Clinic, Vice deputy, Head Department, Department of Otolaryngology, and Vice deputy, Center for Cleft Lip and Palate and Craniofacial Deformities, Khon Kaen University in association with the Tawanchai Project Faculty of Medicine, Khon Kaen University. She got the Ph.D. degree of Philosophy of Public Health in 2006 and work at Department of Otolaryngology, Khon Kaen University, Thailand. Her research field focuses on speech therapy for clefts as well as voice disorders. She published more than 40 papers in renowned international journals supported by considerable research grants of high reputation. She is a committee of The Thai Cleft Lip-Palate and Craniofacial Association. Her work was awarded the prizes launched from both Thai Health Systems Research Institute and International Organization. SPEECH SERVICES IN THAILAND: LACK OF PROFFESIONALS Benjamas Prathanee Director of Speech Clinic and Vice deputy, Center for Cleft Lip and Palate and Craniofacial Deformities, Khon Kaen University in association with the Tawanchai Project Faculty of Medicine, Khon Kaen University. Department of Otrhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen Thailand Communication disorders are the handicaps that always appear in daily life and burden to family, society, as well as country. Lacking of speech and language pathologists and speech services are the critical problems for in Thailand. Therefore, establishment of speech services was needed. The objective of this session was to share experiences for development heath care system to provide speech services in limited resources. Models and procedures, including 1) Khon Kaen CommunityBased Speech Therapy Model for Children with Cleft; 2) Self-Training Program for People with Hoarseness; and 3) Multidisciplinary Approaches for Children with Autism were developed. These models and procedures were the effective ways to solving lacking of speech services in Thailand. Khon Kaen Community- Based Speech Therapy Model for Children with Cleft; Self-Training Program for People with Hoarseness; and Multidisciplinary Approaches for Children with Autism were the models and procedures for solving lacking speech services in Thailand. They can be applied to conduct in other developing countries, where have similar context. 36 Associate Prof. Srivieng Pairojkul, MD Head, Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Adjunct Associate Professor, Department of Pediatrics, Case Western Reserve University, USA. President, Thai Palliative Care Society. Technical committee, Child Health in Humanitarian Emergencies, International Pediatric Association. Committee, Asia Pacific Hospice Palliative Care Network. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Srivieng Pairojkul’s background is pediatric pulmonologist and allergist, but has changed her career practice to palliative care fo r n early 6 years. S he is now head o f Karunruk Palliative Care Center, an excellent center which provides palliative care service to all patients in Srinagarind Hospital, a largest referral center in the Northeast of Thailand. Karunruk is also the first training center for palliative care in Thailand. Her expertise is also in helping children in disaster situations. She organized and facilitated many workshops on “Helping Children in Disasters” in many countries around the world after many major disasters such as Pakistan, Ethiopia, Haiti, Myanmar, the Philippines. She help UNICEF Thailand conducted many short and long-term projects on psychosocial supports for Thai children affected by the Asian tsunami and the great flood in Central Thailand. Her other expertise is in child protection. She had directed the Srinagarind Child Protection Program for more than 15 years and help starting one-stop-crisis-center in many hospitals around Thailand. Her interest is now on developing palliative care services in Thailand. EVIDENCE-BASED PALLIATIVE CARE Srivieng Pairojkul Head of Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Palliative care is person-centered care for people who are seriously ill or have life-limiting diseases. It provides compassionate, holistic care to support the patients to have good quality of life and good quality of death. Most people think that palliative care involved mostly psychosocial and spiritual care, but actually it is a subject in main stream Medicine. In research, the best evidence to determine efficacy is randomized controlled trial, which is very difficult to conduct in brittle, sick, palliative patients. Other obstacle is outcome of measurement. Measuring quality of life and quality of death have many biases, such as psychosocial, spiritual, culture and belief. Despite these obstacles, there are many evidences that showed efficacy of symptom controlled and efficacy of palliative care to the patient’s quality of life. In the present situation, where cancer and chronic diseases become a burden to most countries including Thailand, palliative care is essential and should be integrated to the country’s public health system. 37 Prof. Thiravat Hemachudha, MD, FACP WHO Collaborating Center for Research and Training on Viral Zoonoses, Chulalongkorn University Hospital, Bangkok 10330, THAILAND Tel: +66-2256-4000 ext 3598 Fax:+66-2652-3122 Email : [email protected] Appointment: Professor Specialty: Neurology, Neuroinfection and Viral Zoonoses Position: Head, WHO Collaborating Center for Research and Trainingon Viral Zoonoses Qualification & Education: Board Certified in Internal Medicine and Neurology (Chulalongkorn University Hospital) Fogarty (NIH) Fellowship in Neurology and Neuroimmunology (Johns Hopkins University School of Medicine) Areas of Interest: Emerging Infectious Diseases, Rabies and other encephalitis HUMAN RABIES: NEUROPATHOGENESIS, DIAGNOSIS, AND MANAGEMENT Thiravat Hemachudha, Gabriella Ugolini, Supaporn Wacharapluesadee, Witaya Sungkarat, Shanop Shuangshoti, Jiraporn Laothamatas WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Prof T Hemachudha MD, S Wacharapluesadee PhD, Prof S Shuangshoti MD); Neurobiology and Development (UPR3294), Institute of Neurobiology Alfred Fessard, Centre National de la Recherche Scientifi que (CNRS), Gif-sur-Yvette, France (G Ugolini PhD); Advanced Diagnostic Imaging (AIMC) and Department of Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand (W Sungkarat PhD, J Laothamatas MD) Correspondence to: Prof Thiravat Hemachudha, WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand Rabies is an almost invariably fatal disease that can present as classic furious rabies or paralytic rabies. Recovery has been reported in only a few patients, most of whom were infected with bat rabies virus variants, and has been associated with promptness of host immune response and spontaneous (immune) virus clearance. Viral mechanisms that have evolved to minimise damage to the CNS but enable the virus to spread might explain why survivors have overall good functional recovery. The shorter survival of patients with furious rabies compared with those with paralytic rabies closely corresponds to the greater amount of virus and lower immune response in the CNS of patients with the furious form. Rabies virus is present in the CNS long before symptom onset: subclinical anterior horn cell dysfunction and abnormal brain MRI in patients with furious rabies are evident days before brain symptoms develop. How the virus produces its devastating effects and how it selectively impairs behaviour in patients with furious rabies and the peripheral nerves of patients with paralytic rabies is beginning to be understood. However, to develop a pragmatic treatment strategy, a thorough understanding of the neuropathogenetic mechanisms is needed. 38 WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease) – Tropical Disease Research Laboratory, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, THAILAND E-mail: [email protected] Professor Banchob Sripa, PhD Prof. Dr. Banchob Sripa is a Professor from the Tropical Disease Research Laboratory, Department of Pathology, Faculty of Medicine, Khon Kaen University, Thailand and also Head of the WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease). His qualifications are a BSc (Biology, KKU), MSc (Pathobiology, Mahidol), and PhD in Tropical Health (UQ, Australia). He has worked for over 30 years on liver fluke and cholangiocarcinoma, and is a world expert in pathology, pathogenesis and control of liver fluke infection and bile duct cancer. Dr. Sripa has over 150 research articles, viewpoints, editorials and reviews in peer reviewed international journals and book chapters. He is the Deputy Editor of PLoS Neglected Tropical Diseases and is on the editorial board of Infectious Diseases of Poverty (BMC Journal), J. Helminthology (Cambridge) and Current Tropical Medicine Reports (Springer). He has been Chief Guest Editor for 2 Special Issues on liver flukes in Acta Tropica (2003) and Parasitology International (2012). He has received several scientific awards, most recently the Outstanding Scientist Award of Thailand (August 2013) and TRF Senior Research Scholar (October 2013). Dr. Sripa is a member of the WHO’s International Agency for Research on Cancer (IARC) panel of experts for biological agents of cancer, Disease Reference Group on Helminths (DRG), Foodborne Disease Burden Epidemiology Reference Group (FERG), and current President of the Regional Network of Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+). LAWA MODEL: AN INTEGRATED LIVER FLUKE CONTROL PROGRAMME USING ECOHEALTH/ONE HEALTH APPROACH Banchob Sripa WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease) – Tropical Disease Research Laboratory, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Opisthorchiasis caused by human liver fluke Opisthorchis viverrini infection is a major foodborne parasitic zoonotic diseases in Thailand and neighboring Mekong countries with over 10 million people infected. The infection is associated with cholangitis, cholecystitis, gallstones, hepatomegaly, periductal fibrosis and cholangiocarcinoma (CCA), a fatal liver cancer arising from the bile duct epithelium. The rates of CCA in regions where the parasite is endemic are unprecedented. Khon Kaen province in Northeast Thailand where O. viverrini is endemic has reported the highest incidence of CCA in the world. Extensive research on various aspects of opisthorchiasis and its associated diseases including epidemiology, immunology, pathology, carcinogenesis and control has been carried out in Thailand in recent decades. However, current status of O. viverrini infection in the country is approaching 85% prevalence in certain endemic areas even after over 30 years of control programme. Its complex life cycle which involves several hosts/environments makes it difficult to control by conventional methods. Therefore, a new control strategy for liver fluke infection using the EcoHealth/One Health approach was introduced into the Lawa Lake area in Khon Kaen province where the liver fluke is highly endemic. This programme has been carried out for over 6 years using chemotherapy, novel intensive health education methods both in the communities and in schools, ecosystem monitoring and active community participation. As a result, the infection rate in the more than 10 villages surrounding the Lake has declined to more than one half of the average of 60% as estimated by a baseline survey. People in the area gained more knowledge of the liver fluke. Strikingly, the Cyprinoid fish species, which are the intermediate host, now show less than 1% prevalence compared to a maximum of 70% during the baseline survey. This liver fluke control programme, now named “Lawa model,” has become recognized nationally and internationally, and is being expanded to other parts of Thailand and neighboring Mekong countries. 39 Professor Bungorn Sripanidkulchai, PhD Center for Research and Development of Herbal Health Products, Faculty of Pharmaceutical Sciences, Khon Kaen University Advisory board, Center for Research and Development of Herbal Health Products Prof. Dr. Bungorn Sripanidkulchai (born 1949) is now working at the Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand. She got the PhD degree of Cell Biology in 1986 at the University of Alabama at Birmingham, USA. Her research field is on development of herbal health products as integrated research outcome of several Thai plants. She had published more than 70 papers in reputational international journals. Beside the peer reviewer of several international journals, she is also the editor board of a few international journals. With her valuable experience, she had receive several awards, including the distinguish Alumni award from Mahidol University, honorable doctoral degree in Pharmacy from Ubon Ratchathani University and just recently Srimordindang award of Khon Kaen University from Her Royal Highness Princess Sirindhorn. 123 Center for Research and Development of Herbal Health Products, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002 THAILAND Email: [email protected] APPLICATION OF NANATECHNOLOGY AS A TOOL TO IMPROVE DRUG DELIVERY OF THAI HERBAL EXTRACTS Bungorn Sripanidkulchai Advisory board Center for Research and Development of Herbal Health Products, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Nanotechnology is recently applied in the formulation of novel herbal health products in the varity of nanocarrier dosage forms such liposomes nanopartical, nanocapsules, nanoemulsion, phytosomes and ethosomes. These novel herbal formulations are reported to have remarkable advantages over their conventional formulations. They help to increase the pharmacokinetic and pharmacodynamic aspects of the products, including enhancement of solubility, bioavailability, stability and protection of toxicity. In our CRD-HHP, three common uses of Thai plant extracts were successfully formulated in nano-dosage forms, including Phyllanthus emblica extract in nanoemulsion; Curcuma comosa extract in nanoemulsion; and Kaempferia parviflora extract in self-microemulsifying drug delivery system (SMEDDS) and cyclodextrin complexes. All obtained formulations have high % entrapment efficiency with better absorption and higher bioavailability than the initial plant extracts. Nanoemulsion containing 0.15% P. emblica extract was further formulated as a skin whitening gel that showed skin lightening effect in normal volunteers. Nanoemulsion of C. comosa extract showed more than 10 times increased in situ intestinal absorption than the extract in oil. Both SMEDDS and cyclodextrin complex formulations of K. parviflora extract improved the dissolution rate, drug permeability in Caco-2 cells and oral bioavailability of methoxyflavones in rats. It is suggested that the novel drug delivery system for plant extracts may support the clinical utilization of herbal medicine with better efficacy. 40 Associate Prof. Jintanaporn Wattanathornm, PhD Director of Integrative Complementary Alternative Medicine Research and Development Center Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 THAILAND Email: [email protected]; [email protected] Dr. Jintanaporn Wattanathorn is the Director of Integrative Complementary Alternative Medicine Research and Development Center, Khon Kaen University. Now is an Associate Professor of Physiology, Faculty of Medicine, Khon Kaen University and the Director of Integrative Complementary Alternative Medicine Research and Development Center, Khon Kaen University, Khon Kaen, Thailand. She is also a member of Editorial team of Evidence Based Complemmentary Alternative Medicine Journal. She got her Ph.D, her honor and excellence award from Mahidol University. Her researches concern about various types of alternative medicine including laser acupuncture, pharmacopuncture, dietary therapy and exercise. She published more than 60 in the international journals supported by considerable research grants. Many pieces of her works have obtained award both from regional, national and international awards. NEW DEVELOPMENT AND CHALLENGES IN COMPLEMENTARY ALTERNATIVE MEDICINE Jintanaporn Wattanathorn Director of Integrative Complementary Alternative Medicine Research and Development Center, Khon Kaen University, Khon Kaen, Thailand Complementary Alternative Medicine is found in almost every country in the world and has demonstrated efficacy in areas such as mental health, disease prevention, treatment of noncommunicable diseases, and improvement of the quality of life for persons living with chronic diseases as well as for the ageing population. The demand for its services is increasing not only for disease treatments. Currently, the advances of technology have changed the Complementary Alternative Medicine (CAM) from the ancient way to a modern style emphasizing on the scientific evidence to support the safety and efficacy of CAM intervention. There are many technologies that have been implemented in the Complementary Alternative Medicine such as the application of various types of laser in the stimulation of meridian system via laser acupuncture, the implementation of brain wave and biological parameters for regulating the function of brain and body. Recently, the omic technologies including genomics, transcriptomics, proteomics, metabolomics/ metabonomics, and brain connectomics and nanotechnology have been extensively used in CAM. To date, there are many challenges for the implementation of Complementary Alternative Medicine including recognition, regulatory status, education standard, assessment of safety and efficacy of CAM, sustainability and integration challenges, quality control, safety monitoring, and value addition. However, the priority has been focused on assessment of safety and efficacy of CAM. The World Health Organization (WHO) has set up the conceptual frame work describing the steps necessary for improving safety interventions including measuring harm, understanding the causes, developing solutions, learning from implementation, evaluating impact, translating improvements into policy and practice. To increase the recognition and acceptance of CAM, the increased research in the area of complementary and alternative medicine (CAM) is urgently required to provide the scientific documents concerning the safety and efficacy. In addition, the integration of various technologies to develop the innovation in CAM is also important for value addition. 41 Associate Prof. Sompop Prathanee, MD Department of Surgery Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Sompop Prathanee (born 1956) is a cardiothoracic surgeon. He graduated MD from faculty of Medicine, Khon Kaen University in 1980. Then he finished general surgery in 1984 from Khon Kaen University and got FRCST (thoracic surgery) in 1987 Rajvithi hospital. He interested in thoracic, lung, acquired heart disease and congenital heart disease. He is secretary of society of thoracic surgery of Thailand during 2014-2015. CARDIAC NETWORK DEVELOPMENT IN THAILAND Sompop Prathanee Deapartment of Surgery, Faculty of Medicine, Khon Kaen university, Khon Kaen, Thailand Queen Sirikit Heart Center of the Northeast (QSHC) is an excellent center in heart disease of Khon Kaen University. It was special hospital in Faculty of Medicine which estrablished since 30 December 2004. Heart disease is one of the most common cause of death in Thailand. Cardiac network should be solved this problem in limitted resources situation. Literature reviewed from official document of Queen Sirikit Heart center of the Northeast was performed. Open heart surgery of Queen Sirikit Heart Center of the Northeast was started at Dentistry hospital, Khon Kaen University since 25 January 2004 until 26 March 2006.Collaboration MOU between 3 bodies such as QSHC, National Security Office (NHSO) Khon Kaen, Regional Referral Center of Ministry of Health was signed on 1 April 2006 to set up cardiac network in Esarn. Then NHSO expanded this network from 23 centers to 62 centers in 2009.These network have special warfarin clinic, emergency services of ischemic heart disease. All cardiovascular mortality rate during 2003-2007 was decreased from 63.7/100,000 population to 5.2/100,000 population. Cardiac network is one of the outstanding work which is improved health of Thai people. Our team (QSHC) had ever taken some part of this best thing 42 Assistant Prof. Pattarapong Makarawate MD, MSc, CEPS ,CCDS Cardiology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Pattarapong Makarawate is currently Assistant Professor in Division of Cardiology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. After getting M.D. (First Class Honors), Siriraj Hospital, Mahidol U niversity, M .S c. in clinical m edicine , C hulalongkorn University, Thai Board of Internal m edicine, Srinakarind Hospital, Khon Kaen University and Thai Board of Cardiology m edicine, C hulalongkorn U niversity. H e also received Certification for Competency in Cardiac Electrophysiology for the Physician and C ardiac R hythm D evice therapy from International Board of Heart rhythm Examiners (IBHRE ), U S A .H e w as positioned as research fello w in cardiac electrophysiology at Wake Forest School of Medicine, North C arolina , U SA . H e has been interested in basic cardiac electrophysiology, genetic study, invasive cardiac arrhythmia treatment and cardiac device therapy including pace maker and ICD. He is also appointed as the Associate Director of Queen Sirikit Heart Center of the Northeast, Khon Kaen University, Khon Kaen, Thailand. DEVELOPMENT OF CARDIAC ARRHYTHMIA MANAGEMENT IN NORTHEASTERN THAILAND Pattarapong Makarawate Associate Director of Queen Sirikit Heart Center of the Northeast, Khon Kaen University, Khon Kaen, Thailand. Cardiac arrhythmias are the common problems seen in Northeastern Thailand including both bradyarrhythmia (sick sinus syndrome, atrioventricular block) and tachyarrhythmia (supraventricular, ventricular tachyarrhythmia). In the past treatments options are only medications. Since 2008, we completely implanted all special kinds of pace maker and defibrillator including VVI(R),DDDR,ICD and CRT-P(D) and our Khon Kaen university hospital ( Queen Sirikit Heart Center of the Northeast and Srinakarind hospital ) had 250-300 procedures per years. In 2009 , The first complete cardiac electrophysiology laboratory ( EP lab ) with 3-D electroanatomic contact mapping system are installed at Queen Sirikit Heart Center of the Northeast and had done ablation 300 procedure per years. The electrophysiology study can helpful in evaluating a broad spectrum of cardiac arrhythmia. It can help with determining the characteristics of reentrant arrhythmia with mapping the location of arrhythmogenic foci for potential ablation. The evolution in 3-D electroanatomic contact mapping techniques help to define the cardiac anatomy in complex cardiac arrhythmia such as atrial flutter, atrial fibrillation and ventricular tachycardia with increasing success rates of procedures. Finally we done research in Brugada syndrome patients which found higher incidence in Northeastern Thailand about clinical characteristics and treatment outcomes of patients with Brugada syndrome and done genetic study with SCN5A sequencing and whole genome scan in our Brugada syndrome patients. 43 Associate Prof. Cholatip Pongskul, MD (Hons), Thai Board of Internal Medicine Certificate Thai Board in Nephrology Department Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND Deputy Director for Information Technology, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Cholatip Pongskul is the head of Nephrology unit, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. He got the medical doctor degree in 1988 from Faculty of Medicine, Khon Kaen University, Thai board of Internal Medicine and Nephrology. He started working in Nephrology unit, Department of Medicine since 1993. Srinagarind Hospital provided complete care for kidney disease patient including dialysis and transplantation. He is one of the transplantation team which consists of surgeons, tissue typists, physicians, nurses, pharmacists, and transplant coordinator. Outcomes of transplantation were recognized by many organizations. Many publications were produced from the team including epidemiology, clinical research and basic science research. KIDNEY TRANPLANTATION IN SRINAGARIND HOSPITAL Cholatip Pongskul Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Kidney transplantation in Srinagarind Hospital was started 25 years ago. The program was first supported by the Kidney Foundation of Thailand and many respectful colleagues from Siriraj Hospital. Living related transplantations were the main during the first few years. Our immunosuppressive regimen consisted of cyclosporine and prednisolone. Steroids were withdrawn in the first ten cases by the end of first year. After we found poor graft survival in this group, steroid was continued for life in the rest of the patient. Number of kidney transplantation fantastically increased from brain death donors five years after first transplantation. Key success factors were full-time transplant coordinator nurse, awareness of brain death patient from many hospitals, and good team work. Although we got some problems from prolong hospitalization and catheter related infection, we solved those issues by setting up transplantation ward and multi-disciplinary team. Conference was held regularly to solve problems and improve quality of care. We can reduce hospital stay and infection rate by half from that solution. Another issue was readiness of recipients because of timeliness for cadaveric transplantation. Most of the patient in waiting was treated in another center. Doctors might not have a chance to see the patient’s condition before transplantation. Waiting list clinic was set up to solve the problem. Patients were appointed to nephrologists with information from their center such as laboratory results every 3-4 months. Pre transplantation protocols for cardiovascular and urological were introduced and followed. Graft outcome of our patient was comparable for the country and international data such as UNOS and European even without induction treatment and low dose immunosuppressive. From an outstanding outcomes and good network, National Health Security Office (NHSO) appointed Srinagarind Hospital as the first excellence center for kidney transplantation in 2010. Awareness of brain death donor spread among physician and nurse. Increasing number of donor hospital and quality of transplantation were main outcomes of this project. 44 Dean, Graduate School, KKU Melioidosis Research Center, Department of Microbiology Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, THAILAND E-mail: [email protected] Associate Prof. Surasakdi Wongratanacheewin, PhD Dr. Surasakdi is currently the Dean of Graduate School, Khon Kaen University, Director of Melioidosis Research Center and academic staff at Department of Microbiology, Faculty of Medicine, Khon K aen University. H e is also a Councilor of the Federation of Immunological Societies of Asia-Oceania (FIMSA) and an External assessor in the field of Medical Microbiology, University of Malaya. He is a member of the American Society of Microbiology (ASM), the International Leptospirosis Society (ILS) and the Thai Academy of Science and Technology Foundation (TAST). He received several research awards such as Young Scientist Award in 1993 from the Foundation for the Promotion of Science and Technology under the Patronage of His Majesty the King, Anandamahidol foundation, Outstanding research award from the Faculty of Medicine, Khon Kaen University and the 2011, 1995 in Best Research Award of the year 2002 from National Research Council of Thailand (NRCT). He got various research grants including, STDB, TRF, NSTDA, NRCT and RGJ He has published >80 articles in international journals. IMMUNIZATION AGAINST BURKHOLDERIA PSEUDOMALLEI INFECTION IN ANIMAL MODEL Surasakdi Wongratanacheewin1,2, Apichaya Puangpetch2, and Rasana W. Sermswan2, 1 Dean of Graduate School, Khon Kaen University and Director of Melioidosis Research Center and academic staff at Department of Microbiology, Faculty of Medicine, Khon Kaen University. 2Melioidosis Research Center, Department of Microbiology and Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Burkhoderia pseudomallei (Bp) is the causative organism of melioidosis. The bacterium is classified by CDC as a category B bioterrorism agent. It is mainly widespread in Southeast Asia and Northern Australia. Melioidosis can be found in both humans and animals. It is usually acquired through inhalation, ingestion or contacting abrasion wound with contaminated soil or water. This disease is a common cause of communityacquired pneumonia in highly endemic areas. It has been reported in northeast Thailand that the mortality rate of acute septicemic melioidosis patient is up to 40% and 3,000 to 4,000 new cases are diagnosed each year. Recently in northeast of Thailand, the disease was reported to be the third cause of death in patients with infections. Treatment for Bp infection is complicated and no vaccine is currently available. The Synthetic oligodeoxynucleotides with unmethylated CpG dinucleotide motifs (CpG-ODN) can stimulate vertebrate immune cells and clear certain pathogens that are susceptible to a strong Th1 response. Previously we showed that pretreatment of mice with CpG oligodeoxynucleotide (CpG-ODN) for 2 to 10 days prior to Bp challenge conferred as high as 90-100% protection. In the present study, we prolonged this protective window period by using liposome. It was found that the CpG-ODN incorporated with cationic liposomes (DOTAP) but not zwitterionic liposomes (DOPC) provided complete protection against bacterial challenge. Although marked elevation of gamma interferon (IFN-γ) was found in the infected animals 2 days postinfection, it was significantly lowered by the DOTAP-plus-CpG ODN pretreatment. However, macrophages from stimulated mice showed higher levels of nitric oxide production and exhibited higher levels of antimicrobial activities, judging from lower numbers of viable intracellular bacteria. We conclude that DOTAP can enhance the protective window period of CpG-ODN to at least 30 days and provide 100% protection against Bp infection. We then investigated further by comparison of the protective effect of CpGODN together with heat-killed (HK) or paraformaldehyde-killed B. pseudomallei (PP). HK or PP were used to immunize BALB/c mice twice at 15-day intervals before intraperitoneal challenge with 5LD50 of Bp and observed for 30 days. We found that PP could significantly protect mice (60%) with an increased survival time while in the HK and PBS groups, all infected mice died within 6 days. Although either CpG-ODN or PP conferred significant protection, giving them in combination did not enhance it further. Taken together, CpGODN, DOTAP and PP antigens have the potential for provide an alternative approach to preventing this lethal infection, for which no vaccine is yet available. 45 Associate Prof. Somsak Tiamkao, MD Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 THAILAND E-mail: [email protected] Dr Somsak Tiamkao is head of Division of Neurology, Department of Medicine, North-Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen university. He graduated a degree of Medicine, and fellowship in Internal Medicine, and Neurology from Faculty of Medicine, Khon Kaen university, Thailand. Then, he did epilepsy training with Professor Simon Shorvon at Institute of Neurology, Queen Square, London, United Kingdom. He published more than 80 papers in international journals. He interest in epilepsy, stroke and also common neurological diseases. He act as Associate Director of Srinagarind Hospital and Chairman of Northeastern Neuroscience Association. 8 STEPS FAR FROM STROKE Somsak Tiamkao Associate Director of Srinagarind Hospital and Chairman of North-eastern Neuroscience Association. Division of Neurology, Department of Medicine, and North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand Stroke is a main public health problem worldwide including Thailand. There are 250,000 new patients of stroke yearly. Stroke has the highest mortality rate in Thailand in both genders and also the highest disability-adjusted life year (DALYs) in female and the third ranking in male. Data from Ministry of Public Health of Thailand showed that the mortality rates from stroke are increasing gradually. The rates were 20.8, 21, 27.5, and 30 patients per 100,000 population in the year 2008 to 2012, respectively. The prevalence rate of stroke is high at 1,880 patients per 100,000 population in age group of 45-80 years. The standard treatment for acute ischemic stroke is recombinant tissue plasminogen activator (rt-PA) within 4.5 hours of stroke onset. The 8 D principle is used to facilitate how to access stroke fast track system. The 8 D is comprised of 1. Detection: Awareness and cognition of stroke symptom; facial weakness, hemiparesis, dysarthria, and difficultly speech 2. Dispatch: Move a patient from scene to hospital by call 1669 or Emergency Department 3. Delivery: Quickly transfer a patient to hospital that can treat with thrombolytic drug 4. Door: Shorted time door to needle (quick and good service by stroke fast track system) 5. Data: Medical history, physical examination, laboratory, and CT scan brain 6. Decision: Make a decision by a balance risk and benefit of thrombolytic therapy 7. Drug: Thrombolytic drug in a ischemic patients who get a benefit more than risk 8. Disposition: Transfer to stroke unit, and do a physical therapy “Every minute is a life, quick is a survival, free of paralyzed” 46 PariwatPhungoen, MD Certificate Board of Emergency Medicine Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University Assistant Director for Medical service, Srinagarind Hospital Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] hotmail.com Dr. Pariwat Phungoen was on in 1983. He is a currently academic staff of the Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand. He graduated and obtained The Medical Doctor Degree in 2008 as well as certificate board of Emergency Medicine in 2011 awarded by Faculty of Medicine, Khon Kaen University, Thailand. He has taught and worked in emergency room. He also works in Hospital Quality Improvement Section and lecture in application of LEAN thinking in health care. His research field will focus on emergency room process, resuscitation and emergency ultrasound. APPLICATION OF LEAN THINKING TO HEALTH CARE: EXPERIENCE AT SRINAGARIND HOSPITAL Pariwat Phungoen Hospital Quality Improvement Section and Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand LEAN is a systemic method for the elimination of waste within a manufacturing process. The term of Lean was coined by James P. Womack and Daniel T. Jones who study and observe manufacturing process of no 1 st automobile company in Japan name is Toyota. The lean concept is thinking about the endless transformation of waste into value from the customer’s perspective and focus on value, value streams, flow, pull and perfection. Although mainly use of LEAN is in manufacturing process but lean thinking has been introduced in healthcare during the latest decades as a quality-improvement method. Srinagarind hospital is the main teaching hospital for the Faculty of Medicine was implementations LEAN thinking recent years ago in many part of hospital. (Outpatient department, Emergency word, Emergency Department, Laboratory Department) .We found that lean process reduces delay time in patient’s flow and increase value to patients. Importantly objective of this research will draw our staff attention regard with an individual improvement as well as team work within hospital. 47 Associate Prof. Watchara Boonsawat, MD, PhD Division of Pulmonary Medicine, Department of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND Chairman of the Easy Asthma and COPD Clinic Dr. Watchara Boonsawat is the Head of the Department of Medicine, Khon Kaen University. He graduated from Chulalongkorn University in 1982 and got the Ph.D degree in 1993 from University of Sydney, Australia. He works in the Division of Pulmonary Medicine and focus on asthma and COPD. He has set up the Easy Asthma and COPD Clinic Network to improve asthma and COPD control in Thailand since 2004. His works was awarded Distinguished Clinical Service Award of The Royal college of Physicians of Thailand in 2013. He also the president of the Thai Asthma Council Association since 2012. President of the Thai Asthma Council Association Email: [email protected] FROM KNOWLEDGE TO PRACTICE IN ASTHMA AND COPD Watchara Boonsawat President of the Thai Asthma Council Association. Head of the Department of Medicine, Khon Kaen University. Division of Pulmonary Medicine, Department of Medicine Khon Kaen University, Khon Kaen, Thailand Asthma and COPD have become a major public health concern worldwide. Recent advances in science and medicinehave improved our understanding of asthma and COPD, but morbidity and mortality are still significant. The Global Initiative for Asthma (GINA) guidelines and the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guideline which aim to improve asthma and COPD care were produced in 1995 and 2001 by the National Heart, Lung and Blood Institute and the World Health Organization. Implement the Guidelines were not successful because of numerous reasons. The changing concepts of the treatment and complexity of the Guidelines were major barriers of guidelines implementation. The Easy Asthma and COPD Clinic Network were set up in the rural hospitals throughout Thailand to improve guidelines implementation in 2004. The Easy Asthma and COPD Clinic runs by GPs in general hospitals. Guidelines were simplified and emphasized the role of nurses and pharmacists to help doctors. Database for registering and monitoring patients online were developed. In 2009 The Easy Asthma and COPD clinic became the National Asthma and COPD policy of the National Health Security Office. After 3 years of this policy asthma admissions decreased by 29%. It take about 20 years to bring knowledge about asthma and COPD to general practice in Thailand. The Easy Asthma and COPD Clinic model is a good model to bring knowledge to general practice. 48 Associate Prof. Poonsri Rangseekajeee, MD Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 Thailand. E-mail: [email protected] Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail: [email protected] Dr. Poonsri R angseekajeee is an Associate Professor in Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. She obtained the MD degree from the faculty of M edicine, Khon Kaen University in 1986, com pleted specialized training in Psychiatry at S om dejchaopraya Institute of Mental Health, Bangkok, Thailand in 1991 and clinical fellowship training for Geriatric Psychiatry from St. G eorges H ospital, St. Vincent M ental H ealth S ervices, Department of Psychiatry, University of Melbourne Australia in 2006. Her main research is to focus on the psychiatry of the elderly and dementia in elderly the impact of the disorder to their family and a development of effective tools for dementia assessment of Thai demented patients. Pattharee Paholpak, MD Dr. Pattharee Paholpak (born 1983) is a staff psychiatrist and a lecturer in the Faculty of Medicine at Khon Kaen University (KKU) in Thailand. In 2007, she received her medical degree from the Faculty of Medicine at KKU and completed training program in psychiatry from the Department of Psychiatry in the Faculty of Medicine at KKU in 2011. Her major interest is in field of geriatric psychiatry. She has cooperated with multidisciplinary team in caring for patients with Alzheimer’s and other forms of dementia in specialized clinic since October 2012. The major area of studies is for understanding the clinical characteristics of Thai demented patients, the impact of the disorder to their family and a development of effective tools for dementia assessment. DEMENTIA : FROM EXPERTIZE TO EXCELLENCY Poonsri Rangseekajee1, Pattharee Paholpak1, Pongsatorn Paholpak1, Sirinapa Apisithpinyo1, Papan, Wattanavikkit1, Vijitra Pimpanit2. 1 Department of Psychiatry, Faculty of Medicine, 2Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Thailand is entering the aging society. Dementia is one of the disorder affects majority of this age group. It’s the routine work that psychiatrist hardly inevitable or to ignore as we are the last resource that patients and caregivers could seek help. Coming with the boring effect of the disorder itself for everyone who involve. To overcome this obstacle and get all the maximum benefit for every aspect. We flag our goal to be the excellence center for dementia care of the Northeastern , Thailand. To achieve this high standard service we had set up the special tract of services for 2 years naming “On The Silk Route”. Multidisciplinary approach for dementia care and the outcome over the route will be present. 49 Associate Prof. Prathip Phantumvanit, PhD Faculty of Dentistry, Khon Kaen University and Thammasat University, THAILAND E-mail: [email protected] Dr. Prathip Phantumvanit is a member of Expert Panel on Oral Health, World Health Organization. He was former Dean of the Faculty of Dentistry, Khon Kaen University and Thammasat University, Thailand. He was immediate past co-chair of the public health committee of the World Dental Federation (FDI). His research interest has been in the area of fluoride and dental caries and currently in the preventive restoration for young children. He was the co-founder of the A traumatic Restorative Treatment (ART) for caries control and recently the developer of the SMART (simplified modified ART). He is also the editorial board of 2 prominent journals i.e. Journal of Dental Research (JDR) and Oral health and Preventive Dentistry (OHPD). He was awarded Merit in International Community Dentistry, American Association for Public Health Dentistry. FROM KNOWLEDGE TO PRACTICE IN ASTHMA AND COPD Prathip Phantumvanit Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002, and Thammasat University Rangsit Campus, Patumthani 12121, Thailand Dental caries is still a major public health problem, especially among children in developing countries. Unfortunately, most of the cases are left untreated until it is painful andoften requireextraction. Atraumatic Restorative Treatment for dental caries (ART) was first field-tested in KhonKaen around 20 years ago, with the concept of using only hand instruments to remove soft dentinal carious lesions and restoring with self-cured glass ionomer cement. The result was so promising that the World Health Organization (WHO) officially recommended ARTas a practical minimum intervention for dental caries worldwide on World Health Day in 1994.A number of publications soon followed. Recently, ART has been further developed into SMART (Simplified Modified ART) with the principles of partial caries removal with hand instruments to prevent pulp exposure, and filling the cavities with capsulated glass ionomer cement which offers better consistency and easy handling. SMART has been considered as a preventive restoration and acceptable management for caries, especially for primary dentition in pre-school settings. In the past couple of years, SMART has been introduced to most ASEAN countries with the aim to help them cope with the similar high prevalence of dental caries and to promote oral health and general health of the new generation in the region. 50 Associate Prof. Jarin Paphangkorakit, DDS, PhD Dr. Jarin Paphangkorakit received his DDS from Chulalongkorn University (Thailand) in 1989 and PhD in Oral Biology from University of Alberta (Canada) in 1999. His dissertation was on “A Possible role of pulpal mechanoreceptors”.Inspired by the 1st International Congress on Mastication and Health held in Yokohama in 2002, his current research focuses on the importance of thorough and slow chewing on oral function.He is also interested in the effect of chewing force on dentine and odontoblastic function. Dr.Paphangkorakitis the author of a book entitled “Physiology of Eating” (in Thai) and also sees patients with temporomandibular disorders (TMD) at the Orofacial Pain Clinic, Faculty of Dentistry, KhonKaen University. Department of Oral Biology, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002 THAILAND Email: [email protected] CHEW LONGER AND SLOWLY, PLEASE! Jarin Paphangkorakit Department of Oral Biology, Faculty of Dentistry, Khon Kaen University Chewing is undoubtedly necessary to reduce food until it is optimal to be swallowed. The disputable study by Farrell (1956) showed that not all food needed chewing in order to be fully digested in human. Since then, studies have been carried out to reinvestigate the necessity to chew. During the past decade, the importance of chewing on health has been re-emphasized. Rats fed with hard diet have better spatial memory and gain less weight. In human, it has been shown that the elderly with chewing difficulty have more gastrointestinal disturbances and those who have less teeth tend to have shorter life expectancy and tend to be more disabled. Recent studies have shown that fast eating increased the risk of overweight and obesity. We have performed series of experiments to demonstrate the effect of thorough and slow chewing on oral function and health. We have shown that increasing the number of chews increases the bacteriostatic effect of sunflower kernels on S. mutans in vitro, increases the salivary flow rate, and reduce postprandial sleepiness in human subjects. We have also shown that slow chewing results in greater energy expenditure per chew, better ability to detect foreign objects in food and might reduce meal intake. These findings have, in part, supported the importance of chewing on our health. However, further studies will be needed to explore other effects of thorough and slow chewing as well as their underlying mechanisms. 51 Assistant Prof. Waranuch Pitiphat, PhD Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen 40002 THAILAND E-mail : [email protected] Dr. Waranuch Pitiphat is Associate Dean for Research, Graduate Studies and International Affairs of the Faculty of Dentistry, Khon Kaen University, Thailand, and the current President of the Thai Society for Public Health Dentistry. A graduate of Chulalongkorn University, Dr. Pitiphat received her Master of Primary Health Care Management from Mahidol University, Thailand, before pursuing her Master of Science and later Doctor of Science in Epidemiology from Harvard University, USA. She was made a Diplomate of the Thai Board of Dental Public Health in 2005. Dr. Pitiphat is active in research particularly relating to the oral health-systemic disease link and epidemiology of oral diseases. She has more than 50 publications mostly in high impact journals and served in Editorial Boards for several professional journals, including Journal of Dental Research. Dr. Pitiphat has won several research grants as Principal Investigator from local institutions as well as from international agencies including the US National Institutes of Health (NIH). She also serves as Associate Director of the NIH-funded program, “Clinical, Public Health, and Behavioral Oral Health Research Training for Thailand”, to provide clinical research training to faculty from dental schools in Southeast Asian countries. In 2012, Dr. Pitiphat was named Outstanding Government Official and received the Golden Garuda Honorary Pin from the Prime Minister of Thailand. THE MOUTH-BODY CONNECTION: HOW ORAL HEALTH AFFECTS GENERAL HEALTH Waranuch Pitiphat Associate Dean for Research, Graduate Studies and International Affairs of the Faculty of Dentistry, Khon Kaen University, Thailand, and President of the Thai Society for Public Health Dentistry. Systemic health is often closely related to the state of the oral cavity. Many systemic diseases and conditions have oral manifestations. Likewise, poor oral health may also have an adverse effect on general health status. Cumulative evidence from animal and epidemiologic studies suggests chronic periodontitis as a risk factor for various systemic diseases and conditions, such as cardiovascular diseases associated with atherosclerosis, diabetes mellitus, adverse pregnancy outcomes, respiratory diseases, rheumatoid arthritis, renal disease, metabolic syndrome, and recently, neurodegenerative diseases such as Alzheimer's disease. Several hypotheses have been proposed to explain these associations, including common susceptibility, systemic inflammation, direct bacterial infection and molecular mimicry. However, a cause-effect relationship has not yet been clearly established. Better understanding of this association will help both medical and dental professionals to determine the best approach to patient care. This presentation aims to provide an overview of the current knowledge linking periodontal infections to systemic diseases. Our research work in Asian populations relating periodontitis to adverse pregnancy outcomes, ischemic stroke, and respiratory infection will also be discussed. 52 Assistant Prof. Teekayu Plangkoon Jorns, DDS, MD.Sc, PhD Department of Oral Biology, Faculty of Dentistry, Khon Kaen University, THAILAND Vice Dean for Dental Hospital, Faculty of Dentistry, Khon Kaen University, THAILAND Head of the KKU Neuroscience Research and Development Group Faculty of Dentistry, Khon Kaen University, THAILAND E-mail: [email protected] After obtaining Dental (Khon Kaen University, Thailand) Master of Dental Sciences (University of Queensland, Australia) and Ph.D. (University of London, UK) degrees and becoming a Fellow of the Royal College of Dental Surgeon of Thailand (F.R.C.D.T.) in Occlusion and Orofacial pain, Dr. Jorns went on to specialize in orofacial pain management and now is a scientific committee for the Thai Association for the Study of Pain (TASP). His Ph.D. thesis on trigeminal neuralgia led to further clinical research in this field. He has spent more than ten years as an academic at the department of Oral Biology, Faculty of Dentistry, Khon Kaen University. Dr. Jorns has contributed to chapters on books related to pain management and written peer reviewed papers on the theme of orofacial pain. While in his academic post he runs an orofacial pain clinic for pain sufferers and dental students. Dr. Jorns lectures extensively both nationally and internationally. THE PATIENT’S JOURNEY THROUGH OROFACIAL PAIN Teekayu P. Jorns Vice Dean for Dental Hospital, Faculty of Dentistry, Khon Kaen University, THAILAND and Head of the KKU Neuroscience Research and Development Group, Faculty of Dentistry, Khon Kaen University, Thailand Pain is an unpleasant sensory and emotional experience that motivates us far more than perhaps any other life experiences. Pain affects everyone, and the toll of chronic pain (pain that has persisted beyond the expected period of healing) on one’s sense of self and wellbeing on physical functioning, and on overall quality of life can be devastating. For many years the area of orofacial pain or pain of the mouth and face was completely dominated by the concept that most facial pains were due to “disturbed function of the temporomandibular joint”. This was an approach established at the turn of the last century by an otolaryngologist named Costen who linked etiology to derangements of dental occlusion; facial pain was thus handed over to dentistry and was treated separately from other medical pain conditions. However, as our understanding of pain mechanisms and in particular chronic pain, developed, it became clear that facial pain has underlying neurophysiological mechanisms common to headaches and body areas. Despite significant advances in head and neck anatomy, physiology, and medicine, chronic orofacial pain has remained an enigma for clinicians, scientists, as well as for pain sufferers. We are taught that success is a journey, not a destination. In the case of orofacial pain management, the journey is focused on the need for a patient-oriented management scheme that requires multidisciplinary approach. Education of patients, lay public as well as healthcare workers is essential if awareness of this devastating condition is to be increased. Extensive research on various aspects of orofacial pain patient management including epidemiology, pathophysiology, patient cares has been carried out in Khon Kaen University for the last decade. In this talk, I will present our understanding of pain and its therapy as well as our research findings on pain, in order to transform the new way for the clinicians and pain sufferers to be able to live and cope with the condition.