25th issue July - September 2019 to the benefit of mankind

In 2019, here comes the 90th commemoration of the passing of H.R.H. Prince Mahidol Adulyadej, ‘the father of ’s modern medicine.’ Renowned for his intuitions in military, medicine, fine art, and literature, he has dedicated his life and his versatility to improve the life and well-being of others as stated in his timeless saying, “True success is not in the learning, but in its application to the benefit of mankind.” In remembrance to his boundless and gracious kindness, healthcare personnel in all sectors shall follow the footstep of his royal highness to inherit his royal wishes. The First page

To commemorate the 90 years of the passing of Prince Mahidol

H.R.H. Prince Mahidol Adulyadej was born the Ministry of Education including teaching on January 1st, 1892. His Royal Highness science subjects and curricular and laboratory spent the early career path in Royal Thai revision. His Royal Highness received his Navy before coming to recognize the needs M.D. (cum laude) in 1928 and started working for improvement in the standards of medical as a resident doctor at McCormick hospital, practice and education at . , Thailand. Later that year, It He decided to study public health and appeared that he suffered from kidney disease medicine at to bring and liver abscess, and his health continually the knowledge to support the hospital and deteriorated. Prince Mahidol passed away medical school in Thailand. Prince Mahidol on September 24th, 1929 at the age of 37 years. received the Certificate in Public Health from His initiative and effort produced the most Harvard in 1921. During his stay in the United remarkable and lasting impact on the States, he represented the Thai government improvement of modern medicine and public in negotiating with the health in Thailand. H.R.H. Prince Mahidol which was offering monetary and technical also left a legacy of his humanistic outlook help to improve Thailand’s medical and public and the belief in human dignity and worth health education. Prince Mahidol returned in the form of several speeches and to Thailand in 1923 and started his work at pronouncements.

Faculty of Medicine Siriraj Hospital, • #314 (QS World University Ranking) Since 1888 • #52 (Asia University Ranking) 131 years now • #1 Thailand University • #100-150 by subject Medicine 4,200+ students, 150+ international students 5 bachelor degrees, 18 postgraduate degrees, 978 staffs

13 research centers, 900+ publications/ yr, citation index = 6.08

3.8 m OPD cases/ yr ; 85,000+ IPD cases/ yr 2,071 beds, 114 general wards, 69 OR, 16 ICU, case mix index = 2.67

International Relations Division, No. 2, Wang Lang Road, Noi, Bangkok, Thailand 10700 Telephone : +66 2419 9465 Fax : +66 2418 1621 E-mail : [email protected] irsiriraj @SirirajR irsiriraj Website : www2.si.mahidol.ac.th/en Prince Mahidol Day 2019

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On September 24th, 2019, His Majesty King Maha Phra Vajiraklaochaoyuhua graciously laid wreaths to pay respect to His Royal Highness Prince Mahidol of Songkla on the occasion of Prince Mahidol Day at the Faculty of Medicine Siriraj Hospital.

The September 24th of every year was designated as Prince Mahidol Day in commemoration of his contributions to the development of medical education in Thailand and his selfless devotion to the well-being of Thai people.

In the same day, Prof. Dr. Prasit Watanapa, Dean of Faculty of Medicine Siriraj Hospital together with administrative members, staffs, students, and other public and private health organizations attended the ceremony to commemorate His Royal Highness Prince Mahidol of Songkla in front of Prince Mahidol Statue, Faculty of Medicine Siriraj Hospital, Mahidol University. Princess International Oncology Conference 2019

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On August 8th, 2019, Her Royal Highness Princess Chulabhorn Krom Phra Srisavangavadhana presided over “Princess Chulabhorn International Oncology Conference 2019” on “New Frontiers in Cancer Combat” to commemorate Her Royal Highness’s assiduous efforts in advancing the boundaries of cancer research and care for the betterment of health and quality of life of Thai people.

This international conference was cohosted by Faculty of Medicine Siriraj Hospital Mahidol University, Faculty of Medicine University, Faculty of Medicine Ramathibodi Hospital Mahidol University, and Chulabhorn Royal Academy held during August 8th - 9th, 2019 at Centara Grand Hotel, Bangkok, Thailand.

The International Conference was seasoned by many reputed international and domestic speakers, namely, Prof. Harald Zur Hausen, the Nobel Laureate 2008, Chairman & Professor of Virology at the University of Erlangen-Nuremberg, Germany, and Chairman of the Board of the German Cancer Research Centre, and Prof. Yasuyuki Yoshizawa, President of Tokyo Medical and Dental University (TMDU), Japan. Siriraj Signed the Academic Cooperation Agreement

on Joint Degree Doctoral Program in Medical Sciences with TMDU

We are glad to announce that we have signed the Academic Cooperation Agreement on Joint Degree Doctoral Program in Medical Sciences with Tokyo Medical and Dental University (TMDU), Japan on August 7th, 2019.

The 5th iClass Anatomy Asia Cadaver Course 2019

Siriraj Skin Laser Center, Department of Dermatology, and Department of Anatomy, Faculty of Medicine Siriraj Hospital, co-hosted “The 5th iClass Anatomy Asia Cadaver Course” for participants from Vietnam, China, Korea, and Thailand during August 13th - 14th, 2019. Multidisciplinary Care in Dementia: Sweden and Thailand Exchanging Experience

Inbound “At Siriraj, I learnt a lot experience from the bottom to the top of the healthcare system in Thailand and I am confident that our collaboration can bring about the better 05 treatment for elderly in both Thailand and Sweden.” Inside Siriraj Dr. Löwenhoff

On September 30th, 2019, Prof. Dr. Prasit Watanapa, Dean of Faculty of Medicine Siriraj Hospital welcomed Dr. Melker Löwenhoff from Vrinnevi hospital, Norrköping, Sweden to Faculty of Medicine Siriraj Hospital. Dr. Löwenhoff also delivered a lecture on “How to Initiate Standard Geriatric ward/ Mobile team with Multidisciplinary Cooperation” and “How to Deal with BPSD in People with Dementia” at the joint conference “Multidisciplinary Care in Dementia: Sweden and Thailand Exchanging Experience” at 12th floor, SiMR Building.

Diseases Prevention & Health Promotion in the Aging Society at Siriraj by Nagoya University, Japan

On September 13th, 2019 students from Nagoya University Graduate School of Medicine/ School of Health Sciences attended Siriraj’s international short training program on the topic “Diseases Prevention & Health Promotion in the Aging Society: Integrating Modern and Traditional Medicine” delivered by Prof. Prasert Assantachai, Deputy Dean and Chief of Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University.

“Thank you for a very warm hospitality from the Preventive and Social Medicine Team. We gained a lot of knowledge that we can bring to study in Japan!” Siriraj International Visiting Scholars

The Faculty of Medicine Siriraj Hospital launched the project Siriraj International Visiting Scholars to encourage education, research, academic in medical services as well as in the public health field for Siriraj faculties in order to become the medical institute of the kingdom towards international excellence.

Asst. Prof. Robert Monaco Director of Sports Medicine, Atlantic Sports Health, Rutgers University, USA Designation at Siriraj: International Visiting Scholar Department served: Department of Rehabilitation Medicine Period: June 30th - July 8th, 2019

Prof. Frans L. Moll University Medical Center Utrecht, the Netherlands Special Lecture: “Surgical Innovation: How do Robotic and AI influence in our practice” Designation at Siriraj: International Visiting Scholar Department served: Department of Surgery Period: July 7th - 20th, 2019

Prof. John M. O’Donnell University of Pittsburgh, USA Designation at Siriraj: International Visiting Scholar Department served: Department of Emergency Medicine Period: August 19th - 23rd, 2019 Gene Therapy The Promising Precision Medicine to Cure the Incurables

From the success of the Human Genome Project that has been completed in 2003, there has been a major change in the medical science. The discovery about human genome allows the researchers to understand better about many diseases in terms of the expression, severity, and the response to the treatments among different populations. Moreover, the unlocked information also paved the way to the new era of therapeutic modalities by utilizing individual genetic background or what we called a “precision medicine.” Gene Therapy is one of kinds of precision medicine treatment that utilize genome knowledge to treat, activate and inactivate genes, or prevent disorders by inserting specialized genes or modify gene expression into human’s body instead of surgery or using other means of medication.

In this issue of Siriraj International Relations News, we are honored to have a great opportunity to interview one of the best experts in Gene Therapy and Thalassemia, Prof. Dr. Vip Viprakasit, Professor of Pediatrics and Program Director for Thalassemia and Haemoglobinopathies Research, Faculty of Medicine, who will share with us a very insightful information on the situation of Gene Therapy in the International Level and the standpoint of Thailand now and in the future.

The human genome project is one of the very important scientific advancement in human history. It is giving us the “blueprint” of all human diseases and phenotypes. “Thailand is starting to Prof. Dr. Vip Viprakasit, enjoy the information from the project to improve our clinical practices in particular, Professor of Pediatrics & Program Director for Thalassemia diagnosis of many diseases, and of course, & Haemoglobinopathies Research 07 improved medical care. Gene Therapy is one of the promising treatment delivered Performances from the Human Genome Project which we start to utilize and treat patients,” explained Prof. Dr. Viprakasit.

In the past ten years, the Gene Therapy had increasingly important as one of the new treatment modalities for numerous diseases. Nowadays, there are over hundreds of the clinical gene therapy trials and many products are currently registering to the clinical development in the USA and Europe. At least two gene therapy products were endorsed by the health authority such as the Food & Drug Administration (FDA) and European Medicines Agency (EMA) for medical treatment. “That was the international level. In Thailand, we just started to be a part of this exciting holy grail for the new treatment modality, we are participating in a clinical trial last year and they were published in the England Journal of Medicine and this year at Siriraj Hospital we are going to participate in the gene therapy for the patient with Thalassemia as well,” said Prof. Dr. Viprakasit. Gene Therapy can be used to treat the patients with genetic mutations. “Patients with single gene disorder such as Thalassemia, Hemophilia, as well as Spinal Muscular Atrophy are the first priority to treat with Gene Therapy.” However, nowadays, the advanced knowledge on gene regulation and controls allow gene therapy to become applicable for even more complex. “In this regards, we can manipulate gene in a more robust and more efficient ways. There are many programs that bring gene therapy to treat neurodegenerative diseases, Parkinson, Alzheimer, and more importantly, the cancer,” Prof. Dr. Viprakasit explained.

“It is not just the sake of the technology itself or just a publication, but we need to make such technology become accessible and possible for our people in the country. It’s not just a process of the learning, but it’s into the benefits of the mankind.”

Prof. Dr. Viprakasit

There are three different important aspects to be developed in order to improve the infrastructure for Gene Therapy in Siriraj Hospital. “There are three important pillars that I am currently doing with my team in order to improve the gene therapy program now at Siriraj.”

1. The gene delivery system – “we planned to develop our own gene delivery platform using adenoviral vector and transposon vector as the system to deliver the gene into the genome and also gain more experience on CRISPR technology.”

2. Gene Monitoring – “We bring the technology named Next Generation Sequencing (NGS) to monitor trans genes after the process of gene therapy in order to ensure safety when manipulating the genome.”

3. Clinical Gene Therapy which related to the Lecture on Access to Treatment given by transplantation process – “As a part of that, we are running at least two-clinical trials with the Prof. Dr. Viprakasit in Abu Dhabi, UAE International Agency especially related to the genome editing program called CRISPR/Cas9 technology in patients’ with Thalassemia and SiRNA program by manipulating expression of the iron regulating genes to improve the clinical severity in the patients.”

From the blueprint to the faith of humanity, gene therapy is increasingly essential and fascinating for clinical practices and biomedical research. However, faith cannot be real without the application to the people. Prof. Dr. Viprakasit highlighted the most important point on gene therapy in Thailand, “we need to make such technology become accessible and possible for our people in the country and we do hope that with the success of our program, we shall be able to make it Watch full happen,” Prof. Dr. Viprakasit ended up. Interview The Remarkable Success on the Rarest Case at Siriraj : The Separation of Conjoined Twins

On July 22nd, 2019, a group of extraordinary surgeons and anesthesiologists performed one of the rarest remarkable procedures in Siriraj Hospital, the separation of conjoined twins. The girls were discovered by ultrasound at 13 week gestational age of having their torso connected anteriorly. After careful planning, they were delivered via cesarean section on the 22nd of April and have been thriving and doing well since. Upon delivery, physical examination confirmed their lower chest and upper abdomen were connected, classified as thoraco-omphalopagus type. Magnetic resonance imaging confirmed separated heart chambers with shared pericardium and liver fusion with separate biliary and gastrointestinal systems. After months of cautious planning by multidisciplinary team consisting of neonatologist, pediatric intensivist, pediatric anesthesiologist and surgeons including cardiothoracic, pediatric surgery and plastic surgery teams, this major operation was planned when the twins became 3 months old. 09 Performances

The anesthesiologists were assembled in 2 teams working together at first. The anesthetic induction was crucial oblivious of how the medication distributed between the twins and intubating in the lateral decubitus position. In combination with venous access and lines insertion, the entire anesthetic task endured for 3 hours until the surgery team started. The entire surgical separation lasted 7 hours and 45 minutes, employing 8 anesthesiologist attending staffs, 8 surgical attending staffs and 9 surgical assistants.

Accordingly, the first sister required prosthetic sheath for coverage of the defect in the abdomen and chest wall, whereas the second sister sustained a primary closure. The twins are currently doing well with the little sister recovering at home and the big sister awaiting abdominal wall reconstruction. Since 2002, a number of conjoined twins were thoroughly planned, surgically separated at Siriraj Hospital. They were exclusively female thoraco- omphalopagus type having joined liver, shared pericardium and occasionally, heart chambers banded together or connected by an endogenous tube. All of them were successfully separated and survived.

“This is the 6th successful separation of conjoined twins in Siriraj Hospital since 2002. The story behind these heroes’ journey may simply be, just careful planning and working synchronously are the keys to their victories!”

(Left) Ai-Chan (Right) Yu-Chan And her mother The Urticaria Center of Reference and Excellence and the Development of Uricaria Guideline 2018

Professor Kanokvalai Kulthanan Chairwoman Department of Dermatology and Head of Siriraj Urticaria Center

Urticaria is a common skin condition, interfering with well-being and patients’ quality of life. The wide diversity, number of different urticaria subtypes, and its pathogenesis have been identified to provide the best therapeutic algorithm for urticaria patients. Siriraj Urticaria Clinic at Department of Dermatology, Siriraj Hospital has been established by Prof. Kanokvalai Kulthanan since 2001. This clinic is aimed to provide diagnostic and therapeutic approaches by dedicated multidisciplinary teams to enhance better medical treatments for urticaria patients.

Prof. Kanokvalai Kulthanan has been recognized as a world- renowned in urticaria as she has published many high-quality articles in high-quality journals such as Journal of Allergy, Journal of Allergy and Clinical Immunology, Journal of Allergy, Asthma and Immunology Research, and Journal of Allergy Clinical Immunology: In Practice, etc. Recently, she has been invited as a delegate of national and/ or international medical societies in the development of the European Academy of Allergy and Clinical Immunology (EAACI)/ Global Allergy and Asthma European Network (GA2LEN)/ European Dermatology Forum (EDF)/ World Allergy Organization (WAO) guideline 2018 for the definition, classification, diagnosis and management of urticaria. This guideline is a global guideline and takes into consideration that causative factors in patients, medical systems and access to diagnosis and treatment vary in different countries.

In 2018, Siriraj Urticaria Clinic, Department of Dermatology, Siriraj Hospital under Prof. Kanokvalai’s supervision has also been certified internationally as the first Urticaria Center of Reference and Excellence (UCARE) by Global Allergy and Asthma European Network (GA2LEN). The GA2LEN is a network of excellence of the leading European clinical and research facilities in the field of allergology and asthma. Siriraj Urticaria Clinic is the first GA2LEN UCARE in Southeast Asia.

And last but not least, nowadays, in 2019, Siriraj Urticaria Clinic is promoted to be the Siriraj Urticaria Center of Excellence (SiUC), Faculty of Medicine Siriraj Hospital, Mahidol University! Siriraj Resident & Fellowship Exchange Program 2019

“Experiences at UCLA was amazing. I was passionate learning what “The visiting program at Ophthalmology, Universtätsklinikum I’d never known. All staffs and residents were warm welcoming me. Gießen und Marburg (UKGM), Gießen, Germany, gave me the I was in pediatric pain and palliative care team. I had a chance to precious experience. Staffs and colleagues were so kind and friendly. observe and communicate with patient and family. Moreover, I have learnt a lot in Strabismus and Neuro-ophthalmology clinic I learned aromatherapy urban Zen therapy, and other alternative including the other way to approach patients with strabismus and medicine. To broaden your vision, I would recommend having new surgical techniques. Moreover, it is my great opportunity to an elective at UCLA.” learn German culture and professionalism.”

Dr. Chanika Liangcheep, M.D. Sirikarn Tangcheewinsirikul, MD. 3rd-Year Resident, Department of Pediatrics 1st-Year Fellowship, Department of Pediatrics

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“The resident exchange program in Disaster medicine at Kyushu University Hospital is one of my best experiences. I have learned a lot in disaster management system and also have a chance to visit many places around Kyushu. I would like to recommend this exchange program to anyone who wants to improve clinical skills and explore the world.”

Dr. Thanaporn Pholchaniko 3rd-Year Resident, Department of Emergency Medicine 2019 China - ASEAN WHO Expert Group Education Cooperation Week Consultation

On July 26th, 2019, Prof. Dr. Prasit Watanapa, Dean of Faculty Prof. Weerasak Muangpaisan from Department of Preventive and of Medicine Siriraj Hospital along with Prof. Thawatchai Social Medicine, Faculty of Medicine Siriraj Hospital attended Akaraviputh, Deputy Dean for International Relations, and the Expert Group Consultation to Review Manual for Training Assoc. Prof. Dr. Thawornchai Limjindaporn, Deputy Dean of Primary Care Physicians in Care for Older People hosted by Postgraduate Education joined the trip with Prof. Banchong the World Health Organization in New Delhi, India on August Mahaisavariya, Acting President of Mahidol University and Assoc. 20th - 21st, 2019. Prof. Nopraenue Sajjarax Dhirathiti, Acting Vice President for International Relations and Corporate Communication to attend China - ASEAN Medical Education Symposium & Roundtable Discussion on Establishing China - ASEAN University Consortium on Medical and Health Education, Research and Healthcare at Guiyang International ECO-Conference Center, Guiyang, China.

The 8th ASEAN Medical Deans’ Summit

On August 23rd - 24th, 2019, the executive members from 12 members institute of ASEAN Medical School Network attended the 8th ASEAN Medical Deans’ Summit Meeting (AMDS) and the 4th ASEAN Students’ Collaborative Project (ASCP) at PAPRSB Institute of Health Sciences, Brunei Darussalam.

The theme of this year’s AMDS meeting is “Inter-Professional Education and Mental Health Issues”, and aims to provide a platform for the sharing of views, practices and advances in inter- professional education and mental health issues within the ASEAN region. The meeting also covers the discussions on the quality of medical education across ASEAN countries, professional training following graduation, and the promotion of research culture & international collaboration amongst AMDS members.

Concurrently, the 4th ASCP is held to showcase and highlight community projects conducted by medical, dental, and health sciences students from AMDS member universities. The ASCP enables students to share their research interests, to experience knowledge enrichment in ASEAN medical education, and to exchange the culture among the students from various countries. Achievements Beyond the Boundaries

Siriraj Won the Third Place of Siriraj Faculty Delivered a Poster WIP Budapest Best Posters 2019 in Spain

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During August 26th - 28th, 2019, Asst. Prof. Nantthasorn Zinboonyahgoon, Chief of Siriraj Pain Management Clinical Training Center, attended the 24th Annual Gabor Racz Advanced Dr. Harisd Phannarus from Department of Preventive and Social Interventional Pain Conference and Workshop in Budapest, Medicine, Faculty of Medicine Siriraj Hospital delivered the Hungary, and won the Third Place Award of WIP Budapest Best poster presentation on “Development of a Thai Tool for Assessing Posters 2019 from the topic “Prospective Study Comparing Quality Behavioral and Psychological Symptoms of Dementia (BPSD-T)” at of Life between Opioids Sparing Protocol and WHO Guideline IPA/SEPG Joint International Congress, Santiago de Compostela, st rd in Metastatic Bone Cancer: Preliminary Analysis.” Spain during August 31 - September 3 , 2019.

Siriraj Anesthesiologist Siriraj Faculty Attended Completed Clinical Fellowship ESMO 2019 in Pain Medicine from Canada

Asst. Prof. Krittiya Korphaisarn from Department of Medicine Siriraj Hospital delivered a poster presentation on the topic “Loss of Congratulations, Dr. Sukunya Jirachaipitak from Department of CDX-2 is an Independent Poor Prognosis Biomarker in Colorectal Anesthesiology, Faculty of Medicine Siriraj Hospital, has completed Cancer” at European Society for Medical Oncology (ESMO) 2019, the Clinical Fellowship Program in Pain Medicine at McGill Spain. University, Canada from July 1st, 2018 - June 30th, 2019. Siriraj Radiologist Completed Siriraj Anesthesiologist the Pediatric Radiation Oncology Completed a Research Radiation Training from USA Oncology Training from USA

Congratulations, Dr.Warissara Rongthong, a radiologist from Congratulations, Lecturer Dr. Sirirat Rattana-arpa from Department Department of Radiology, who has completed the training in of Anesthesiology completed a research fellowship training in Pediatric Radiation Oncology at Mayo Clinic, Rochester, USA Pediatric Anesthesia at Boston Children’s Hospital, Boston, MA, under the scholarship from Faculty of Medicine Siriraj Hospital. USA.

Siriraj in the Association for Medical Education in Europe Conference 2019 in Austria

Assoc. Prof. Suwattanee Kooptiwut, Assistant Dean of Postgraduate Education, along with Assoc. Prof. Uraiwan Panich, Chairwoman of Department of Pharmacology, and six outstanding lecturers who won the scholarships from the Faculty of Medicine Siriraj Hospital: Asst. Prof. Rattanavalai Nitiyarom from Department of Pediatrics, Lecturer Dr. Jaturong Sewatanon from Department of Microbiology, Assoc. Prof. Dr. Napatara Tirawanchai from Department of Biochemistry, Lecturer Kusuma Chinaroonchai from Department of Surgery, Lecturer Vuthinun Achariyapota from Department of Obstetrics and Gynecology, and Lecturer Titima Wongviriyawong from Department of Medicine, attended the Annual Conference of the Association for Medical Education in Europe Conference (AMEE 2019) at the Austria Centre Vienna, Republic of Austria, between August 24th - 28th, 2019. Upcoming Event

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