Zebrafish Model for Investigating Obesity-Related Glomerulomegaly (ORG)

by Assistant Professor Chalermchai Mitrpant, MD, PhD, Department of Biochemistry

Obesity-related glomerulomegaly (ORG) is a condition characterized by the following histopathological features:

  1. Enlargement of the glomerulus.
  2. Widening of the mesangial matrix, an increase in mesangial cell number, and dilation of capillaries.
  3. Hypertrophy of podocytes, the glomerular filtration cells.

ORG, a silent pathological condition, is observed in approximately 0.2% of individuals with obesity. Over the past two decades, the global increase in obesity due to dietary and lifestyle changes has led to a significant rise in ORG prevalence. This condition typically remains asymptomatic for years until kidney function declines, potentially progressing to chronic kidney disease (CKD) or end-stage renal failure. Among CKD patients, 15–30% also present with ORG.

The zebrafish (Danio rerio), a vertebrate with genetic and physiological similarities to humans, has been widely employed in biomedical research. In this study, we developed a diet-induced obesity (DIO) zebrafish model to investigate ORG. Histopathological analysis of zebrafish kidney tissues revealed glomerular enlargement consistent with ORG in humans. Additionally, changes in proximal tubule cells and focal segmental glomerulosclerosis (FSGS) were observed.

Gene expression profiling of kidney tissues from experimental zebrafish showed upregulation of genes associated with inflammation, fibrosis, and lipid metabolism. These findings suggest that this model is a valuable tool for elucidating the molecular mechanisms underlying ORG.

Future research can leverage advanced technologies, such as DESI-Imaging Mass Spectrometry (DESI-IMS), to analyze the spatial distribution of small biomolecules, including lipids, within affected tissues. Moreover, epigenomic approaches combining diverse omics datasets—such as ATAC-sequencing for chromatin accessibility analysis, histone modification profiling, and RNA sequencing—can provide insights into the regulatory networks governing gene expression in diseased versus healthy kidney tissues.

Comprehending the pathophysiological mechanisms of ORG will pave the way for preventive strategies and innovative therapeutic approaches in kidney disease management.

Dual-Motion Ankle Support Joint

by Lecturer Nattapong Polharn, CPO, Sirindhorn School of Prosthetics and Orthotics

Patients with hemiplegia often face mobility challenges, such as foot drop and equinovarus (inward ankle twisting), resulting in instability while walking, increased energy expenditure, and a higher risk of falls—particularly on uneven surfaces. Conventional ankle-foot orthoses (AFOs) partially address these issues but lack the flexibility for natural movement.

This research introduces a newly developed, patented ankle joint capable of bi-planar motion, allowing movements in both the sagittal plane (dorsiflexion/plantarflexion) and the frontal plane (inversion/eversion). The device is further enhanced with an internal shock-absorbing system to improve stability on uneven terrains. This innovative design aims to restore stable and natural-like walking for hemiplegic patients.

Importance of Bi-Planar Motion and Shock Absorption

Lateral ankle movement plays a critical role in maintaining balance on uneven surfaces. Restricted motion in this plane increases torque on the knee and hip joints, leading to higher energy demands, greater instability, and an elevated fall risk. Additionally, shock absorption during the heel-strike phase of walking is crucial for reducing joint stress and ensuring smooth gait transitions.

Traditional AFOs, such as Tamarack joints and AFOs with oil dampers, have limitations in supporting bi-planar movement and providing adequate shock absorption in all scenarios. These constraints make walking, especially on uneven surfaces, challenging for users of these devices.

Features and Design of the Patented Joint

The patented joint incorporates dual-axis rotation, enabling motion in both sagittal and frontal planes. It also includes an adjustable spring-based shock absorption system tailored to patient needs. Constructed from high-quality stainless steel, the joint offers durability for long-term use.

Performance testing compared the patented joint to conventional AFOs by evaluating parameters such as walking speed, center of gravity (COG) movement, and ground reaction force (GRF) patterns on both even and uneven surfaces.

Impressive Results

The patented joint demonstrated superior performance, significantly enhancing stability and walking speed. Key findings include:

  • COG Movement: The new joint ensured smooth and balanced COG shifts between left and right sides.
  • Walking Speed: Patients achieved the highest walking speeds using the new joint, with average speeds on uneven surfaces exceeding those with other devices.
  • Shock Absorption: The internal spring system effectively reduced impact forces during heel strikes, resulting in smoother gait transitions and minimized stress on other joints.

This groundbreaking development offers a promising solution for hemiplegic patients, enabling more stable and natural mobility across diverse terrains.

Innovating Anatomy Learning Through Games and VR

IMPORTANCE OF CADAVERS IN MEDICAL EDUCATION

Cadavers are invaluable in medical education, allowing students to study, learn, and practice medical procedures before performing them on actual patients. These procedures require mastery and expertise, and cadavers provide a crucial hands-on experience for developing these skills.

INTEGRATION OF MEDICAL SIMULATORS

To enhance the training process, medical simulators were introduced, developed in collaboration with the Siriraj Medical Education Technology Center. These artificial skin models closely resemble human skin, allowing students to practice injections in a realistic environment before moving on to cadavers.

TRADITIONAL PRACTICE METHODS

In the past, medical students practiced procedures using fruit skins, such as cutting a banana peel or peeling tomato skin without damaging the inner flesh. This practice, known as the “Fruit Lab,” became a part of the residency training curriculum at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University.

CURRENT USE OF CADAVERS

Cadavers are used monthly to teach dermatological procedures, particularly aesthetic ones like botulinum toxin and filler injections. However, since these procedures primarily focus on the face, it results in the overuse of cadavers. The belief is that cadavers should be preserved for procedures with greater medical significance.

REDUCING CADAVER RELIANCE WITH TECHNOLOGY

To minimize cadaver use, we have explored technological alternatives. In 2019, a collaboration with SurgiMind Co., Ltd. from South Korea led to the development of the “Anatomy 2D-3D” program. Initially starting as a 2D anatomy program, it has evolved into a 3D platform with a 360-degree view, simulating cadaver dissections by visualizing and dissecting facial layers.

INTRODUCTION OF MIXED REALITY (MR)

Recent advancements include the integration of Mixed Reality (MR) technology, combining Virtual Reality (VR) and Augmented Reality (AR). Using hologram glasses, learners can interact with 3D virtual objects in real space, providing a more realistic and immersive practice experience.

FUTURE DEVELOPMENT PLANS

Plans are underway to expand this technology for other procedures such as injections and thread lifts. As an online program, it holds international potential, offering Mahidol University students free access to these learning resources. Additionally, the program is being developed into an interactive game where students can earn points while learning, making the educational process more engaging.

IMPACT AND CONTRIBUTION

This innovative project not only advances medical education but also offers valuable research opportunities. It supports the mission of the Faculty of Medicine Siriraj Hospital, Mahidol University, in fostering education, research, innovation, and medical services. By contributing to society and strengthening the university’s reputation as the “Medical Institution of the Land,” the project enhances
global healthcare through knowledge generation and improved medical practices.

Treatment of Varicose Veins with 1940 nm Edovenous Laser Ablation

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By Assoc. Prof. Natthawut Sermsathanasawadi, M.D., Ph.D. Varicose veins are a common medical condition where patients may experience symptoms such as leg pain during walking or standing for long periods, leg swelling, cramps, itching, and visible large varicose veins. The skin on the legs may become darker, and in severe cases, ulcers may form around […]

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Classification System for Giant Inguinal Hernia by Siriraj

Inguinal hernia is a common disease in general medical practice. It can occur in both males and females and requires surgical treatment. Annually, a large number of patients undergo hernia repair surgery at Siriraj Hospital. However, giant inguinal hernia is much rarer due to its definition: a hernia extending below the midpoint of the inner thigh when the patient is standing. This condition results from patients leaving the hernia untreated for a long time. Nowadays, with improved and accessible healthcare services, patients receive treatment earlier, making this condition less common.

Giant inguinal hernia is found exclusively in males and is significantly more complex and difficult to treat compared to regular inguinal hernias. The complication rate is high, with literature reviews indicating a 40% complication rate in patients undergoing surgery for giant inguinal hernia. Historically, there have been reports of deaths due to the sudden and significant increase in intra-abdominal pressure when returning the herniated organs, which had been outside the abdominal cavity for a long time, back into the cavity, leading to respiratory failure.

Due to the rarity and complexity of giant inguinal hernia, most medical reports are case reports, lacking a classification system or standardized surgical recommendations. In 2014, Assoc. Prof. Atthaphorn Trankarnsanga, M.D., FRCST., and colleagues from the Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, developed a classification system for giant inguinal hernia. This system divides the disease into three types based on the size of the hernia sac and proposes corresponding treatment methods. The system was published in an international medical journal and has been cited in over 60 medical journals and international conference lectures.

In 2024, the authors conducted a literature review and meta-analysis to verify the accuracy of this classification system. They found that for type I giant inguinal hernia, all 66 reported cases were successfully treated according to the recommended guidelines. For types II and III, among 33 cases, eight patients did not receive treatment according to the classification recommendations, resulting in severe complications in 36% of these cases, including abdominal compartment syndrome and pulmonary embolism. However, there were no reported deaths, demonstrating the accuracy of the classification system developed by Siriraj.

This achievement is a source of pride for Siriraj, reflecting its longstanding commitment to academic research that benefits patient care, both in Thailand and internationally. This aligns with Siriraj’s 2024 concept of “we are ready” and exemplifies the “ready to discover” initiative.

Siriraj Anatomical Anthropology Bone Research Center (Virapan Davivongs): Si-AABRC

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Siriraj Anatomical Anthropology Bone Research Center (Virapan Davivongs) is dedicated to researching sources to find answers from skeletons. When an ‘unidentified deceased’ is found, often only a skeleton remains, leaving no other evidence for autopsy. Determining the identity of these individuals relies heavily on Forensic Anthropology, a specialized field focused on studying and analysing human skeletons to ascertain gender, age range, height, and race, ultimately aiding in verifying the identity of the skeleton’s owner. This process is crucial for returning the remains to their families or loved ones and aiding in case resolutions to ensure justice for all parties involved.

Establishment of the Bone Research Center

Recognizing the significance of advancing knowledge in legal anthropology, the Department of Anatomy at the Faculty of Medicine, Siriraj Hospital, established the Siriraj Anatomical Anthropology Bone Research Center (Virapan Davivongs). This center serves as a hub for collecting human and animal skeletons for research purposes, medical student education, and international knowledge exchange. The center, slated to open by the end of 2023, underscores the commitment to interdisciplinary collaboration and the advancement of forensic anthropology.

Historical Context and Legacy

Asst. Prof. Napakorn Sangchay, M.D., Ph.D., Chairman of the Department of Anatomy, highlights the center’s extensive and diverse skeleton collections. Siriraj Hospital has a long-standing tradition of accepting body donations for medical education purposes, spanning over a century. The hospital has continued its studies in anatomical anthropology, with pioneers such as Prof. Sud Sangwichian M.D., laying the groundwork. Building on this legacy, Asst. Prof. M.R Virapan Davivongs, M.D., M.Sc., aims to enhance the field of forensic anthropology. With over 500 complete human skeletons, including detailed information on gender, age, and cause of death, the center boasts a comprehensive repository crucial for forensic investigations and research.

Comprehensive Bone Collection

The abundance of complete bone samples, ranging from fetuses to individuals over 90 years old, enhances the accuracy of forensic anthropology work. Notably, the center possesses over 100 sets of skeletons from young victims, including children and teenagers, which are invaluable for research purposes. Furthermore, plans to collaborate with other institutions aim to increase the collection to over 1,000 complete bone sets, positioning Thailand as a leading source of bone sets in Asia.

International Collaboration and Advancements

International collaboration, such as with the John A. Burns School of Medicine, University of Hawaii in the USA and University of Dundee in the United Kingdom, facilitates the exchange of information and student programs, fostering the global advancement of knowledge in forensic anthropology. The establishment of the bone research center marks a significant milestone in legal anthropology, potentially leading to expanded skeletal analysis in legal proceedings and innovative developments, such as using AI for bone evaluation and creating artificial organs.

Call for Body Donations

Despite these advancements, the Siriraj Anatomical Anthropology Bone Research Center emphasizes the ongoing need for complete human skeletons for research and medical student education. With only approximately 10 body donations per year in the form of skeletons, the center encourages individuals with the desire to contribute to valuable scientific knowledge to consider donating their bodies for skeletal study, ensuring an enduring legacy of education and research.

Siriraj, Biodesign in Medicine Program

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In the modern world, where all industrial sectors are incorporating cutting-edge technologies to move forward, including biomedical sciences. Recently, medical services have advanced to the next level where complex treatments are made possible by high-level computer systems, and various kinds of high-performance wearable devices enable more effective medical services. Knowledge networking has been recognized as an effective learning system that has rendered stand-alone learning, including pure medical education, outdated.

Biodesign in Medicine International Program

Siriraj, Biodesign in Medicine (International Program) is an interdisciplinary program of medicine, engineering, and medical technology that provides students with a unique opportunity to explore the intersection of these fields, offering a broad range of knowledge and skills needed to challenges in biological therapy, digital health, and innovative medical products. By bringing together experts from diverse fields, this program brings up a collaborative and dynamic learning environment that encourages students to develop a holistic approach to biomedical innovation.

Who are we looking for?

  • Hold a degree in veterinary medicine, pharmacy, medical technology, engineering, science, or other related fields or attending the final semester of major from academic institutes accredited by the Office of the Higher Education Commission
  • GPA not less than 3.5
  • English Proficiency Examination score regarding the requirement of the Faculty of Graduate Studies

Career Path

  • Medical product inventors or innovators at research institutes, government sectors, and industrial organizations
  • Researchers/academic staff in biodesign of medical products at research institutes, government sectors, and industrial organizations
  • Entrepreneurs/Business owners in biomedicine are becoming significant potential in the medical sector.

For individuals who want to pursue advanced studies, Biodesign in Medicine International Program provides both a master’s degree and a Ph.D. program. Whether you’re looking to develop new medical technologies, conduct cutting-edge research, or become an entrepreneur in the healthcare industry, our program provides the perfect platform for you to succeed in your career and make a meaningful impact on this world.

For more info, please visit : 

Master Program 

PhD. Program 

Program Facebook Page Biodesign in Medicine

Siriraj at the Apex of LEAN Approach!

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LEAN concept is a philosophy and methodology for gradually building an organization’s culture that supports continuous improvement. LEAN involves a long-term approach to daily work that encourages small, incremental changes in process operations to improve both quality and efficiency.

The roots of LEAN

LEAN has its roots in the Toyota production system, which started after World War II. Toyota developed the five principles of Lean management to decrease the number of process steps that were not producing value. As a result, the practice became known as the Toyota Way. By adhering to these LEAN principles, Toyota made significant improvements in cost efficiency, cycle time, and productivity.

The primary objective of LEAN

The primary objective of LEAN is to create value for the customer by optimizing resources and creating an uninterrupted workflow based on near real-time customer demands. In addition, the approach seeks to minimize or eliminate all waste of resources, effort, and time by documenting each step in a business process and then removing or reducing steps that do not create customer value. The concept of LEAN is rooted in manufacturing, but it has been adapted to fit almost every industry.

The core principles of the LEAN

The five core principles of the LEAN approach used as the guidelines to improve processes are:
1. Identify customer value.
2. Map all value streams.
3. Create an uninterrupted workflow.
4. Operate with a pull system.
5. Achieve continuous improvement.

Thailand LEAN Award

Last year (2022), Siriraj Hospital swept all of the top prizes, “Thailand LEAN Award 2022 – Diamond Level” and “Thailand LEAN Award 2022 – Popular Vote” from the most prestigious prize for LEAN Management in Thailand, “Thailand LEAN Award” which is given to organizations that successfully applied the Lean Management Approach efficiently and effectively in the manufacturing sectors and service sectors! The Diamond Level has previously been granted to only two organizations in Thailand. Siriraj Hospital is the third organization and the first healthcare organization in Thailand to win this top-level award!

The Prince Mahidol Award The symbol of tirelessly dedication towards the benefit of mankind!

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Prince Mahidol of Songkla (1892-1929) played an active role in laying the foundations for public health and modern medicine in Thailand, with a strong determination to raise the standard of living of all Thais. As a medical doctor himself, he represented the government of Siam in negotiations with the Rockefeller Foundation to secure professional and monetary support for Siriraj. Additionally, he improved the curriculum and sent Thai doctors abroad to study on his own dime. His work and way of life served as an example of what we can all do to better the world and motivate others to do the same.

The beginning of Prince Mahidol Award

To carry on the HRH Prince Mahidol’s altruism and legacy, the Prince Mahidol Award (PMA) was then established in 1992 by royal permission of His Majesty the late King Bhumibol Adulyadej, King Rama IX of Thailand, on the occasion of the 100th anniversary of the birth of HRH Prince Mahidol of Songkla. The award has the objective of honoring His Royal Highness and recognizing individuals or institutions with outstanding contributions in the fields of medicine and public health. The award is run by the Prince Mahidol Award Foundation, established in 1991. King Rama IX graciously granted Royal patronage to the foundation, currently chaired by Her Royal Highness Princess Maha Chakri Sirindhorn. 

The foundation is responsible for the Prince Mahidol Award as well as the promotion of the memory of Prince Mahidol of Songkla – the Father of Modern Medicine and Public Health of Thailand.

The Prince Mahidol Award Categories

The Prince Mahidol Award is an international award given annually in two categories to international personalities or organizations, including:

  1. In the field of Medicine: for outstanding performance and/or research in the field of medicine that benefits the global population.
  2. In the field of Public Health: for outstanding contributions in the field of public health for the sake of the well-being of the people.

The Prince Mahidol Award

The award consists of a medal, a certificate, and prize money (US$100,000). Prior to attending the award presentation event, which is held at Chakri Maha Prasat throne hall, Prince Mahidol Award laureates will visit the Faculty of Medicine Siriraj Hospital, Mahidol University, to pay respects to the statue of Prince Mahidol and learn more about HRH’s legacy.

The Prince Mahidol Award Criteria

An individual or group of individuals or an institution may be nominated by national medical or health authorities or by an individual or group of individuals in a nongovernmental capacity as candidates for the award. The candidates are screened by the award’s Scientific Advisors. They are then forwarded to the International Award Committee, which comprises several world-renowned experts in the fields of medicine and public health. The committee will consider them and make recommendations to the Foundation’s Board of Trustees, who will make a final decision. 

From 1992 to 2022, 94 prizes were awarded, including 43 in medicine and 51 in public health!   Five laureates of the Prince Mahidol Award of the year 2001, 2005, then proceeded to win the Nobel Prize in a later year. Five Prince Mahidol Award winners from 1997, 2001, 2003, 2005, and 2016 went on to win the Nobel Prize a few years after.

Last year, the Prince Mahidol Award in the field of medicine was conferred upon Professor Ralph A. DeFronzo, M.D., from the United States, for his exceptional and dedicated work that saved people from Type 2 Diabetes and saved millions of patients from chronic diabetic complications. And the Prince Mahidol Award in the field of public health was awarded to Professor Ian H. Frazer, M.D., from Australia/U.K., Dr. Douglas R. Lowy, M.D., from the United States, and Dr. John T. Schiller, M.D., Ph.D., from the United States, for their achievements in developing the HPV vaccines, which have been internationally implemented. The vaccines have prevented HPV infection, cervical cancer, and other HPV-related cancers and saved countless lives!

Siriraj – behind the quality accomplishment

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Faculty of Medicine of Siriraj aspires to become a medical institute of the nation, a creator of global citizen well-being, delivers the excellent products of the highest reliability, and continuously disseminates the medical knowledge and innovations. After years of hard work, all of Siriraj’s major missions have been completely accredited by international standards, many of which are firsts for Thailand. 

The key success factors of SIRIRAJ team

The key success factors for becoming the quality-assured organization are as follow:

  • The direction and goals are clearly stated by the leader. The strategies and policy are well thought out and consistent.
  • Team empowerment and co-operation
  • The supporting teams help to integrate the quality system using technique “Link-Share-Learn”, connect the experts and consultants to the supporting systems in accordance with the organizational direction. The teams provide the advices and suggestions, assist in designing the quality tools, and operate in 3C manner which are catalyst, collaborator, and coach. During the process, human resources development is focused to develop good systems along with the participation of the members to find out the best multidisciplinary practices as well as the specific knowledge and innovations that are beneficial to a certain sector and achieve the aforementioned goals.
  • Careful data collection and utilization which enable the accurate and quick  knowledge and innovations development.
  • Systematic assessment and evaluation through regular annual internal audition will enhance the quality management and facilitate the path to the excellence.
  • Giving compliment, and encouragement to the working teams via various awards granting such as annual starred-projects awards, Siriraj honorable awards, etc. The awards replenish the vivid energy and boost their pride.
  • Ultimately, the altruism mindset of Siriraj people matters most.

Our Challenge during working

The biggest challenge possibly is the internal communication given that Siriraj is a sizable organization with 17,000 employees and a variety of missions. The effective communication, especially two-way communication, will provide better understanding about goals and direction and enables the development of quality systems.

In the future Siriraj aims to maintain its standing as a quality-assured organization and create additional novel innovations to continue providing safe and high-quality products. We want to put the Thailand Quality Class principles into practice, elevate Siriraj to the status of a world changer, and promote wellbeing for all people.