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J. Pers. Med., Volume 12, Issue 1 (January 2022) – 122 articles

Cover Story (view full-size image): The COVID-19 pandemic is affecting healthcare systems around the world. Emerging evidence suggests a triggering role of this pathology toward neurodegenerative diseases. People with Alzheimer’s disease (AD) are a vulnerable group at high risk of contracting COVID-19 and develop more severe forms and worse outcomes. SARS-CoV-2 infection can act on AD risk factors and pathogenetic mechanisms, accelerating neurodegenerative processes. Ongoing research continues to shed light on this complex synergistic relationship and could aid in the early identification of COVID-19 in patients with a high risk of AD onset and the development of novel therapeutic approaches. View this paper
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Article
The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age
J. Pers. Med. 2022, 12(1), 122; https://doi.org/10.3390/jpm12010122 - 17 Jan 2022
Cited by 1 | Viewed by 525
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and a predictor of the complications of atherosclerotic cardiovascular diseases (ASCVDs), particularly thromboembolic events and the progression of heart failure. We analyzed the determinants of the 13-year risk of incident AF in a Russian population [...] Read more.
Atrial fibrillation (AF) is the most common arrhythmia and a predictor of the complications of atherosclerotic cardiovascular diseases (ASCVDs), particularly thromboembolic events and the progression of heart failure. We analyzed the determinants of the 13-year risk of incident AF in a Russian population cohort of middle and elderly age. A random population sample (n = 9360, age 45–69 years) was examined at baseline in 2003–2005 and reexamined in 2006–2008 and 2015–2017 in Novosibirsk (the HAPIEE study). Incident AF was being registered during the average follow-up of 13 years. The final analysis included 3871 participants free from baseline AF and cardiovascular disease (CVD) who participated in all three data collections. In a multivariable-adjusted Cox regression model, the 13-year risk of AF was positively associated with the male sex (hazard ratio (HR) = 2.20; 95% confidence interval (CI) 1.26–3.87); age (HR = 1.10 per year; 95% CI 1.07–1.14); body mass index (BMI), (HR = 1.11 per unit; 95% CI 1.07–1.15); systolic blood pressure (SBP), (HR = 1.02 per 1 mmHg; 95% CI 1.01–1.02), and it was negatively associated with total cholesterol (TC), (HR = 0.79 per 1 mmol/L; 95% CI 0.66–0.94). In women, the risk of AF was more strongly associated with hypertension (HT) and was also negatively related to total cholesterol (TC) level (HR = 0.74 per 1 mmol/L; 95% CI 0.56–0.96). No independent association was found with mean alcohol intake per drinking occasion. These results in a Russian cohort have an implication for the prediction of AF and ASCVD complications in the general population. Full article
(This article belongs to the Special Issue Atherosclerosis: Technologies of Personalized Medicine)
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Article
Ethnical Differences in Knee Phenotypes Indicate the Need for a More Individualized Approach in Knee Arthroplasty: A Comparison of 80 Asian Knees with 308 Caucasian Knees
J. Pers. Med. 2022, 12(1), 121; https://doi.org/10.3390/jpm12010121 - 17 Jan 2022
Viewed by 576
Abstract
The purpose of this study was to determine the distribution of functional knee phenotypes in a non-osteoarthritic Asian population. The Stryker Orthopaedic Modeling and Analytics (SOMA) database was searched for CT scans of the lower limb meeting the following inclusion criteria: patient age [...] Read more.
The purpose of this study was to determine the distribution of functional knee phenotypes in a non-osteoarthritic Asian population. The Stryker Orthopaedic Modeling and Analytics (SOMA) database was searched for CT scans of the lower limb meeting the following inclusion criteria: patient age at time of image >18 and <46 years, no signs of fractures and/or previous surgery and/or degenerative changes, Asian ethnicity. A total of 80 CT scans of 40 patients were included (24 males, 16 females). The hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were measured. Based on these measurements, each limb was phenotyped according to the previously introduced functional knee phenotype concept. All angles and phenotypes of the present study were compared with previously published data of a non-osteoarthritic Caucasian population (308 legs of 160 patients, 102 males, 58 females). Asian knees had a significantly lower TMA (both genders p < 0.001) but a higher FMA (males p < 0.05, females p < 0.001) than Caucasian knees but showed no difference in the HKA. Asian knees differed significantly with regard to femoral and tibial phenotypes (p < 0.01), but not with regard to limb phenotypes. The high variability of all coronal alignment parameters highlights the importance of a detailed analysis prior to TKA. Ethnical differences underline the need for a more individualized approach in TKA. Full article
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Article
“Spazio Huntington”: Tracing the Early Motor, Cognitive and Behavioral Profiles of Kids with Proven Pediatric Huntington Disease and Expanded Mutations > 80 CAG Repeats
J. Pers. Med. 2022, 12(1), 120; https://doi.org/10.3390/jpm12010120 - 17 Jan 2022
Viewed by 517
Abstract
The “Spazio Huntington—A Place for Children” program was launched in 2019. The aim was to contact at risk kids within Huntington disease (HD) families, to provide counseling to their parents and to start a prospective follow-up of kids suspicious to manifest pediatric HD [...] Read more.
The “Spazio Huntington—A Place for Children” program was launched in 2019. The aim was to contact at risk kids within Huntington disease (HD) families, to provide counseling to their parents and to start a prospective follow-up of kids suspicious to manifest pediatric HD (PHD). We met 25 at risk kids in two years, four of whom with PHD and highly expanded (HE) mutations beyond 80 CAG repeats. We rated motor, neuropsychological and behavioral changes in all PHD kids by the Unified HD Rating Scale (UHDRS)-total motor score (TMS) and additional measures of (1) cognitive level (Leiter International Performance Scale), (2) adaptive functioning (Adaptive Behavior Assessment Systems), (3) receptive language (Peabody Picture Vocabulary Test) and (4) behavioral abnormalities (Child Behavior Check List and Children’s Yale–Brown Obsessive Compulsive Scale). All PHD kids showed a severe progression of neurological and psychiatric manifestations including motor, cognitive and behavioral changes. The magnetic resonance imaging contributed to confirm the suspicious clinical observation by highlighting very initial striatum abnormalities in PHD. Spazio Huntington is a program to prospectively study PHD, the most atypical face of HD, and may represent the basis to recruit PHD patients in future clinical trials. Full article
(This article belongs to the Special Issue The Many Faces of Huntington Disease)
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Review
Escalation vs. Early Intense Therapy in Multiple Sclerosis
J. Pers. Med. 2022, 12(1), 119; https://doi.org/10.3390/jpm12010119 - 17 Jan 2022
Viewed by 729
Abstract
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure [...] Read more.
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The “escalation strategy” consists of starting treatment with drugs of low side-effect profile and low efficacy, and “escalating” to drugs of higher efficacy—with more potential side-effects—if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, “early intense therapy” strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called “window of opportunity” in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
Article
Clinical, Genetic and Functional Characterization of a Novel AVPR2 Missense Mutation in a Woman with X-Linked Recessive Nephrogenic Diabetes Insipidus
J. Pers. Med. 2022, 12(1), 118; https://doi.org/10.3390/jpm12010118 - 17 Jan 2022
Viewed by 440
Abstract
Nephrogenic diabetes insipidus (NDI) is a rare disorder characterized by renal unresponsiveness to the hormone vasopressin, leading to excretion of large volumes of diluted urine. Mutations in the arginine vasopressin receptor-2 (AVPR2) gene cause congenital NDI and have an X-linked recessive [...] Read more.
Nephrogenic diabetes insipidus (NDI) is a rare disorder characterized by renal unresponsiveness to the hormone vasopressin, leading to excretion of large volumes of diluted urine. Mutations in the arginine vasopressin receptor-2 (AVPR2) gene cause congenital NDI and have an X-linked recessive inheritance. The disorder affects almost exclusively male family members, but female carriers occasionally present partial phenotypes due to skewed inactivation of the X-chromosome. Here, we report a rare case of a woman affected with X-linked recessive NDI, presenting an average urinary output of 12 L/day. Clinical and biochemical studies showed incomplete responses to water deprivation and vasopressin stimulation tests. Genetic analyses revealed a novel heterozygous missense mutation (c.493G > C, p.Ala165Pro) in the AVPR2 gene. Using a combination of in-silico protein modeling with human cellular models and molecular phenotyping, we provide functional evidence for phenotypic effects. The mutation destabilizes the helical structure of the AVPR2 transmembrane domains and disrupts its plasma membrane localization and downstream intracellular signaling pathways upon activation with its agonist vasopressin. These defects lead to deficient aquaporin 2 (AQP2) membrane translocation, explaining the inability to concentrate urine in this patient. Full article
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Review
Adipose-Derived Stem Cells for Facial Rejuvenation
J. Pers. Med. 2022, 12(1), 117; https://doi.org/10.3390/jpm12010117 - 16 Jan 2022
Cited by 2 | Viewed by 721
Abstract
The interest in regenerative medicine is increasing, and it is a dynamically developing branch of aesthetic surgery. Biocompatible and autologous-derived products such as platelet-rich plasma or adult mesenchymal stem cells are often used for aesthetic purposes. Their application originates from wound healing and [...] Read more.
The interest in regenerative medicine is increasing, and it is a dynamically developing branch of aesthetic surgery. Biocompatible and autologous-derived products such as platelet-rich plasma or adult mesenchymal stem cells are often used for aesthetic purposes. Their application originates from wound healing and orthopaedics. Adipose-derived stem cells are a powerful agent in skin rejuvenation. They secrete growth factors and anti-inflammatory cytokines, stimulate tissue regeneration by promoting the secretion of extracellular proteins and secrete antioxidants that neutralize free radicals. In an office procedure, without cell incubation and counting, the obtained product is stromal vascular fraction, which consists of not only stem cells but also other numerous active cells such as pericytes, preadipocytes, immune cells, and extra-cellular matrix. Adipose-derived stem cells, when injected into dermis, improved skin density and overall skin appearance, and increased skin hydration and number of capillary vessels. The main limitation of mesenchymal stem cell transfers is the survival of the graft. The final outcomes are dependent on many factors, including the age of the patient, technique of fat tissue harvesting, technique of lipoaspirate preparation, and technique of fat graft injection. It is very difficult to compare available studies because of the differences and multitude of techniques used. Fat harvesting is associated with potentially life-threatening complications, such as massive bleeding, embolism, or clots. However, most of the side effects are mild and transient: primarily hematomas, oedema, and mild pain. Mesenchymal stem cells that do not proliferate when injected into dermis promote neoangiogenesis, that is why respectful caution should be taken in the case of oncologic patients. A longer clinical observation on a higher number of participants should be performed to develop reliable indications and guidelines for transferring ADSCs. Full article
(This article belongs to the Special Issue Adult Stem Cells in Aging)
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Review
Prevention of Post-Transplant Diabetes Mellitus: Towards a Personalized Approach
J. Pers. Med. 2022, 12(1), 116; https://doi.org/10.3390/jpm12010116 - 15 Jan 2022
Viewed by 535
Abstract
Post-transplant diabetes is a frequent complication after transplantation. Moreover, patients suffering from post-transplant diabetes have increased cardiovascular morbidity and reduced survival. Pathogenesis mainly involves beta-cell dysfunction in presence of insulin resistance. Both pre- and post-transplant risk factors are well-described, and some of them [...] Read more.
Post-transplant diabetes is a frequent complication after transplantation. Moreover, patients suffering from post-transplant diabetes have increased cardiovascular morbidity and reduced survival. Pathogenesis mainly involves beta-cell dysfunction in presence of insulin resistance. Both pre- and post-transplant risk factors are well-described, and some of them may be corrected or prevented. However, the frequency of post-transplant diabetes has not decreased in recent years. We realized a critical appraisal of preventive measures to reduce post-transplant diabetes. Full article
(This article belongs to the Section Clinical Medicine, Cell, and Organism Physiology)
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Article
Personalized Lifestyle Intervention and Functional Evaluation Health Outcomes SurvEy: Presentation of the LIFEHOUSE Study Using N-of-One Tent–Umbrella–Bucket Design
J. Pers. Med. 2022, 12(1), 115; https://doi.org/10.3390/jpm12010115 - 15 Jan 2022
Cited by 3 | Viewed by 1262
Abstract
The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of [...] Read more.
The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of disease occurrence and modify disease progression. The LIFEHOUSE (Lifestyle Intervention and Functional Evaluation-Health Outcomes SurvEy) longitudinal research project explores the impact of personalized lifestyle medicine approaches on functional health determinants. Utilizing an adaptive tent–umbrella–bucket design, the LIFEHOUSE study follows the functional health outcomes of adult participants recruited from a self-insured employee population. Participants were each allocated to the tent of an all-inclusive N-of-one case series. After assessing medical history, nutritional physical exam, baseline functional status (utilizing validated tools to measure metabolic, physical, cognitive, emotional and behavioral functional capacity), serum biomarkers, and genomic and microbiome markers, participants were assigned to applicable umbrellas and buckets. Personalized health programs were developed and implemented using systems biology formalism and functional medicine clinical approaches. The comprehensive database (currently 369 analyzable participants) will yield novel interdisciplinary big-health data and facilitate topological analyses focusing on the interactome among each participant’s genomics, microbiome, diet, lifestyle and environment. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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Article
Predicting Venous Thrombosis in Osteoarthritis Using a Machine Learning Algorithm: A Population-Based Cohort Study
J. Pers. Med. 2022, 12(1), 114; https://doi.org/10.3390/jpm12010114 - 15 Jan 2022
Cited by 2 | Viewed by 403
Abstract
Osteoarthritis (OA) is the most common joint disease associated with pain and disability. OA patients are at a high risk for venous thrombosis (VTE). Here, we developed an interpretable machine learning (ML)-based model to predict VTE risk in patients with OA. To establish [...] Read more.
Osteoarthritis (OA) is the most common joint disease associated with pain and disability. OA patients are at a high risk for venous thrombosis (VTE). Here, we developed an interpretable machine learning (ML)-based model to predict VTE risk in patients with OA. To establish a prediction model, we used six ML algorithms, of which 35 variables were employed. Recursive feature elimination (RFE) was used to screen the most related clinical variables associated with VTE. SHapley additive exPlanations (SHAP) were applied to interpret the ML mode and determine the importance of the selected features. Overall, 3169 patients with OA (average age: 66.52 ± 7.28 years) were recruited from Xi’an Honghui Hospital. Of these, 352 and 2817 patients were diagnosed with and without VTE, respectively. The XGBoost algorithm showed the best performance. According to the RFE algorithms, 15 variables were retained for further modeling with the XGBoost algorithm. The top three predictors were Kellgren–Lawrence grade, age, and hypertension. Our study showed that the XGBoost model with 15 variables has a high potential to predict VTE risk in patients with OA. Full article
(This article belongs to the Special Issue Non-communicable Diseases, Big Data and Artificial Intelligence)
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Article
Identification of Survival-Specific Genes in Clear Cell Renal Cell Carcinoma Using a Customized Next-Generation Sequencing Gene Panel
J. Pers. Med. 2022, 12(1), 113; https://doi.org/10.3390/jpm12010113 - 14 Jan 2022
Viewed by 651
Abstract
Purpose: Although mutations are associated with carcinogenesis, little is known about survival-specific genes in clear cell renal cell carcinoma (ccRCC). We developed a customized next-generation sequencing (NGS) gene panel with 156 genes. The purpose of this study was to investigate whether the survival-specific [...] Read more.
Purpose: Although mutations are associated with carcinogenesis, little is known about survival-specific genes in clear cell renal cell carcinoma (ccRCC). We developed a customized next-generation sequencing (NGS) gene panel with 156 genes. The purpose of this study was to investigate whether the survival-specific genes we found were present in Korean ccRCC patients, and their association with clinicopathological findings. Materials and Methods: DNA was extracted from the formalin-fixed, paraffin-embedded tissue of 22 ccRCC patients. NGS was performed using our survival-specific gene panel with an Illumina MiSeq. We analyzed NGS data and the correlations between mutations and clinicopathological findings and also compared them with data from the Cancer Genome Atlas-Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) and Renal Cell Cancer-European Union (RECA-EU). Results: We found a total of 100 mutations in 37 of the 156 genes (23.7%) in 22 ccRCC patients. Of the 37 mutated genes, 11 were identified as clinicopathologically significant. Six were novel survival-specific genes (ADAMTS10, CARD6, NLRP2, OBSCN, SECISBP2L, and USP40), and five were top-ranked mutated genes (AKAP9, ARID1A, BAP1, KDM5C, and SETD2). Only CARD6 was validated as an overall survival-specific gene in this Korean study (p = 0.04, r = −0.441), TCGA-KIRC cohort (p = 0.0003), RECA-EU (p = 0.0005). The 10 remaining gene mutations were associated with clinicopathological findings; disease-free survival, mortality, nuclear grade, sarcomatoid component, N-stage, sex, and tumor size. Conclusions: We discovered 11 survival-specific genes in ccRCC using data from TCGA-KIRC, RECA-EU, and Korean patients. We are the first to find a correlation between CARD6 and overall survival in ccRCC. The 11 genes, including CARD6, NLRP2, OBSCN, and USP40, could be useful diagnostic, prognostic, and therapeutic markers in ccRCC. Full article
(This article belongs to the Special Issue Advances in Urogenital Pathology)
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Article
Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage
J. Pers. Med. 2022, 12(1), 112; https://doi.org/10.3390/jpm12010112 - 14 Jan 2022
Viewed by 368
Abstract
Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, [...] Read more.
Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH. Full article
(This article belongs to the Special Issue Non-communicable Diseases, Big Data and Artificial Intelligence)
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Article
Predictors of the Intention to Be Vaccinated against COVID-19 in a Sample of Italian Respondents at the Start of the Immunization Campaign
J. Pers. Med. 2022, 12(1), 111; https://doi.org/10.3390/jpm12010111 - 14 Jan 2022
Cited by 2 | Viewed by 430
Abstract
COVID-19 vaccines are the most promising means of limiting the pandemic. The present study aims at determining the roles of several psychological variables in predicting vaccination intention in Italy. An online questionnaire was disseminated between 9 March and 9 May 2021. The sample [...] Read more.
COVID-19 vaccines are the most promising means of limiting the pandemic. The present study aims at determining the roles of several psychological variables in predicting vaccination intention in Italy. An online questionnaire was disseminated between 9 March and 9 May 2021. The sample included 971 participants. Results showed that most of the participants were willing to vaccinate. Acceptance rates were correlated with age, marital status, and area of residence. Intention to be vaccinated was positively correlated with perceived risk, pro-sociality, fear of COVID-19, use of preventive behaviors, and trust in government, in science, and in medical professionals. Intention to be vaccinated was negatively associated with belief in misinformation. The degree of acceptance is likely to be a result of the campaign tailored to address people’s negative attitudes towards vaccines. Trust in government and trust in science were among the strongest psychological predictors of vaccination intention. Fear of COVID-19, but not perceived risk, was associated with increased vaccine uptake, suggesting that the affective component of risk perception was more important than the cognitive component in predicting participants’ behaviors. Belief in misinformation was associated with reduced vaccination intention. Future studies will take into consideration these variables, to better understand the multifaceted process underlying vaccination intention. Full article
Article
The Relationship between Epigenetic Age and Myocardial Infarction/Acute Coronary Syndrome in a Population-Based Nested Case-Control Study
J. Pers. Med. 2022, 12(1), 110; https://doi.org/10.3390/jpm12010110 - 14 Jan 2022
Cited by 1 | Viewed by 466
Abstract
We investigated the relationship between ‘epigenetic age’ (EA) derived from DNA methylation (DNAm) and myocardial infarction (MI)/acute coronary syndrome (ACS). A random population sample was examined in 2003/2005 (n = 9360, 45–69, the HAPIEE project) and followed up for 15 years. From [...] Read more.
We investigated the relationship between ‘epigenetic age’ (EA) derived from DNA methylation (DNAm) and myocardial infarction (MI)/acute coronary syndrome (ACS). A random population sample was examined in 2003/2005 (n = 9360, 45–69, the HAPIEE project) and followed up for 15 years. From this cohort, incident MI/ACS (cases, n = 129) and age- and sex-stratified controls (n = 177) were selected for a nested case-control study. Baseline EA (Horvath’s, Hannum’s, PhenoAge, Skin and Blood) and the differences between EA and chronological age (CA) were calculated (ΔAHr, ΔAHn, ΔAPh, ΔASB). EAs by Horvath’s, Hannum’s and Skin and Blood were close to CA (median absolute difference, MAD, of 1.08, –1.91 and –2.03 years); PhenoAge had MAD of −9.29 years vs. CA. The adjusted odds ratios (ORs) of MI/ACS per 1–year increments of ΔAHr, ΔAHn, ΔASB and ΔAPh were 1.01 (95% CI 0.95–1.07), 1.01 (95% CI 0.95–1.08), 1.02 (95% CI 0.97–1.06) and 1.01 (0.93–1.09), respectively. When classified into tertiles, only the highest tertile of ΔAPh showed a suggestion of increased risk of MI/ACS with OR 2.09 (1.11–3.94) independent of age and 1.84 (0.99–3.52) in the age- and sex-adjusted model. Metabolic modulation may be the likely mechanism of this association. In conclusion, this case-control study nested in a prospective population-based cohort did not find strong associations between accelerated epigenetic age markers and risk of MI/ACS. Larger cohort studies are needed to re-examine this important research question. Full article
(This article belongs to the Special Issue Atherosclerosis: Technologies of Personalized Medicine)
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Article
Artificial Intelligence-Based Solution in Personalized Computer-Aided Arthroscopy of Shoulder Prostheses
J. Pers. Med. 2022, 12(1), 109; https://doi.org/10.3390/jpm12010109 - 14 Jan 2022
Cited by 1 | Viewed by 409
Abstract
Background: Early recognition of prostheses before reoperation can reduce perioperative morbidity and mortality. Because of the intricacy of the shoulder biomechanics, accurate classification of implant models before surgery is fundamental for planning the correct medical procedure and setting apparatus for personalized medicine. Expert [...] Read more.
Background: Early recognition of prostheses before reoperation can reduce perioperative morbidity and mortality. Because of the intricacy of the shoulder biomechanics, accurate classification of implant models before surgery is fundamental for planning the correct medical procedure and setting apparatus for personalized medicine. Expert surgeons usually use X-ray images of prostheses to set the patient-specific apparatus. However, this subjective method is time-consuming and prone to errors. Method: As an alternative, artificial intelligence has played a vital role in orthopedic surgery and clinical decision-making for accurate prosthesis placement. In this study, three different deep learning-based frameworks are proposed to identify different types of shoulder implants in X-ray scans. We mainly propose an efficient ensemble network called the Inception Mobile Fully-Connected Convolutional Network (IMFC-Net), which is comprised of our two designed convolutional neural networks and a classifier. To evaluate the performance of the IMFC-Net and state-of-the-art models, experiments were performed with a public data set of 597 de-identified patients (597 shoulder implants). Moreover, to demonstrate the generalizability of IMFC-Net, experiments were performed with two augmentation techniques and without augmentation, in which our model ranked first, with a considerable difference from the comparison models. A gradient-weighted class activation map technique was also used to find distinct implant characteristics needed for IMFC-Net classification decisions. Results: The results confirmed that the proposed IMFC-Net model yielded an average accuracy of 89.09%, a precision rate of 89.54%, a recall rate of 86.57%, and an F1.score of 87.94%, which were higher than those of the comparison models. Conclusion: The proposed model is efficient and can minimize the revision complexities of implants. Full article
(This article belongs to the Special Issue Artificial Intelligence Application in Health Care System)
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Review
Usefulness of Magnetic Mallet in Oral Surgery and Implantology: A Systematic Review
J. Pers. Med. 2022, 12(1), 108; https://doi.org/10.3390/jpm12010108 - 14 Jan 2022
Cited by 5 | Viewed by 497
Abstract
This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web [...] Read more.
This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web of Science databases (articles published until 1 October 2021) was conducted, in accordance with the PRISMA statement, using the keywords “magnetic mallet”, “electric mallet”, “oral surgery”, “implantology”, and “dental implant”. Of 252 articles, 14 were included in the review (3 for teeth extraction, and 11 for implant dentistry). Out of a total of 619 dental extractions (256 patients) performed with the magnetic mallet (MM), no complications were reported. Implants inserted totaled 880 (525 patients): 640 in the MM groups (382), and 240 in control groups (133). The survival rate of implants was 98.9% in the MM groups, and 95.42% in the control groups. Seven patients experienced benign paroxysmal positional vertigo after implant surgery, all in control groups. Results are not sufficient to establish the effectiveness of MM in oral and implant surgery procedures. Randomized controlled trials with a large sample size are needed. Full article
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Review
Efficacy and Safety of Enoxaparin versus New Oral Anticoagulants to Prevent Venous Thromboembolism after Total Hip Replacement: A Systematic Review and Meta-Analysis
J. Pers. Med. 2022, 12(1), 107; https://doi.org/10.3390/jpm12010107 - 14 Jan 2022
Viewed by 539
Abstract
Prophylactic anticoagulant therapy is recommended for reducing the risk of venous thromboembolism (VTE) after a total hip replacement (THR). However, it is not clear which anticoagulant is preferable. Hence, a systematic review and meta-analysis of randomized double-blind controlled trials (RDBCTs) were conducted to [...] Read more.
Prophylactic anticoagulant therapy is recommended for reducing the risk of venous thromboembolism (VTE) after a total hip replacement (THR). However, it is not clear which anticoagulant is preferable. Hence, a systematic review and meta-analysis of randomized double-blind controlled trials (RDBCTs) were conducted to investigate the clinical efficacy and safety of enoxaparin in comparison with newer oral anticoagulants for the prevention of VTE after THR. The Cochrane Library, Scopus, Web of Science, Embase, and PubMed/Medline databases were used for PICO search strategy. Relative risks (RR) of symptomatic VTE, clinically relevant bleeding, mortality, and a net clinical endpoint were estimated employing a random effect meta-analysis. ITC and RevMan software were used for indirect and direct comparisons, respectively. Nine RDBCTs comprising 24,584 patients were included. As compared to enoxaparin, a reduced risk for symptomatic VTE was observed with rivaroxaban (confidence interval [CI]: 0.32–0.77; RR: 0.46%) and comparable with apixaban (0.12–1.26; 0.42%) and dabigatran (0.22–2.20; 0.70%). Contrarily to enoxaparin, a greater risk for clinically relevant bleeding was observed with rivaroxaban (1.03–1.48; 1.23%), comparable with dabigatran (0.96–1.33; 1.10%) and reduced with apixaban (0.19–5.66; 0.96%). In indirect or direct comparisons, the interventions did not differ on the net clinical endpoint. In conclusion, the findings of this meta-analysis revealed no significant difference in the efficacy and safety of new oral anticoagulants as compared to enoxaparin for the prevention of VTE after total hip replacement surgery. Full article
(This article belongs to the Special Issue New Advances in Haemostasis, Thrombosis and Angiology)
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Article
Relevant Biomarkers in Medical Practices: An Analysis of the Needs Addressed by an International Survey
J. Pers. Med. 2022, 12(1), 106; https://doi.org/10.3390/jpm12010106 - 14 Jan 2022
Viewed by 439
Abstract
(1) Backround: Technological advances should foster gains in physicians’ efficiency. For example, a reduction of the medical decision time can be enabled by faster biological tests. The main objective of this study was to collect responses from an international panel of physicians on [...] Read more.
(1) Backround: Technological advances should foster gains in physicians’ efficiency. For example, a reduction of the medical decision time can be enabled by faster biological tests. The main objective of this study was to collect responses from an international panel of physicians on their needs for biomarkers and also to convey the improvement in the outcome to be made possible by the potential development of fast diagnostic tests for these biomarkers. (2) Methods: we distributed a questionnaire on the Internet to physicians. (3) Results: 508 physicians participated in this survey. The mean age was 38 years. General practice and emergency medicine were heavily represented, with 95% CIs of 44% (39.78, 48.41) and 32% (27.84, 35.94)), respectively. The two most represented countries were France (95% CI: 74% (70.20, 77.83)) and the USA (95% CI: 11% (8.65, 14.18)). Ninety-eight percentages of the physicians thought that obtaining cited biomarkers more quickly would be beneficial to their practice and to patient’s care. The main biomarkers of interest identified by our panel were troponin (95% CI: 51% (46.24, 54.94)), C-reactive protein (95% CI: 42% (38.03, 46.62)), D-dimer (95% CI: 29% (24.80, 32.68)), and brain natriuretic peptide (95% CI: 13% (10.25, 16.13)). (4) Conclusions: Our study highlights the real technological need for fast biomarker results, which could be provided by biosensors. The relevance of some answers such as troponin is questionable. Full article
Article
Associations between Sjögren Syndrome, Sociodemographic Factors, Comorbid Conditions, and Scleritis in a Taiwanese Population-Based Study
J. Pers. Med. 2022, 12(1), 105; https://doi.org/10.3390/jpm12010105 - 14 Jan 2022
Cited by 1 | Viewed by 377
Abstract
This nationwide, population-based, retrospective, matched case–control study included 111,960 newly diagnosed patients with scleritis who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification code 379.0, selected from the Taiwan National Health Insurance Research Database. Demographic characteristics, Sjögren syndrome, and [...] Read more.
This nationwide, population-based, retrospective, matched case–control study included 111,960 newly diagnosed patients with scleritis who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification code 379.0, selected from the Taiwan National Health Insurance Research Database. Demographic characteristics, Sjögren syndrome, and comorbid conditions within 1 year before the scleritis diagnosis were examined using univariate logistic regression analyses, and a paired t-test was used for continuous variables. Adjusted logistic regression was used to compare the prognosis odds ratio (OR) of the patients with scleritis with the controls. After adjustment for confounders, patients with Sjögren syndrome were remarkably more likely to have scleritis than the controls (OR = 33.53, 95% confidence interval (CI) = 27.43–40.97, p < 0.001). Other conditions found to have increased odds of scleritis included post ocular pterygium, glaucoma, and scleral surgery (OR  =  4.01, 95% CI  =  3.64–4.43; OR  =  3.16, 95% CI  =  2.24–4.47; OR  =  6.83, 95% CI  =  5.34–8.74, respectively); systemic infections, such as syphilis, tuberculosis, and a human herpes viral infection (OR  =  4.01, 95% CI  =  2.93–5.50; OR  =  2.24, 95% CI  =  1.94–2.58; OR  =  8.54, 95% CI  =  8.07–9.03, respectively); and systemic diseases, such as rheumatoid arthritis, granulomatous vasculitis, systemic lupus erythematosus, ankylosing spondylitis, and gout (OR  =  2.93, 95% CI  =  2.66–3.23; OR  =  7.37, 95% CI  =  3.91–13.88; OR  =  3.18, 95% CI  =  2.63–3.85; OR  =  5.57, 95% CI  =  4.99–6.22; OR  =  2.84, 95% CI  =  2.72–2.96, respectively). The results strongly support an association between Sjögren syndrome, post ocular surgery, systemic infection disease, systemic autoimmune disease, and scleritis. Full article
(This article belongs to the Section Epidemiology)
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Editorial
Demand for Pharmacogenomics and Personalized Medicine in the United Arab Emirates
J. Pers. Med. 2022, 12(1), 104; https://doi.org/10.3390/jpm12010104 - 14 Jan 2022
Viewed by 307
Abstract
The application of personalized medicine (PM) is rapidly evolving [...] Full article
Review
Use of Circulating Tumour DNA (ctDNA) for Measurement of Therapy Predictive Biomarkers in Patients with Cancer
J. Pers. Med. 2022, 12(1), 99; https://doi.org/10.3390/jpm12010099 - 13 Jan 2022
Cited by 2 | Viewed by 670
Abstract
Biomarkers that predict likely response or resistance to specific therapies are critical in personalising treatment for cancer patients. Such biomarkers are now available for an increasing number of anti-cancer therapies, especially targeted therapy and immunotherapy. The gold-standard method for determining predictive biomarkers requires [...] Read more.
Biomarkers that predict likely response or resistance to specific therapies are critical in personalising treatment for cancer patients. Such biomarkers are now available for an increasing number of anti-cancer therapies, especially targeted therapy and immunotherapy. The gold-standard method for determining predictive biomarkers requires tumour tissue. Obtaining tissue, however, is not always possible and even if possible, the amount or quality of tissue obtained may be inadequate for biomarker analysis. Tumour DNA, however, can be released into the bloodstream, giving rise to what is referred to as circulating tumour DNA (ctDNA). In contrast to tissue, blood can be obtained from effectively all patients in a minimally invasive and safe manner. Other advantages of blood over tissue for biomarker testing include a shorter turn-around time and an ability to perform serial measurements. Furthermore, blood should provide a more complete profile of mutations present in heterogeneous tumours than a single-needle tissue biopsy. A limitation of blood vis-à-vis tissue, however, is lower sensitivity and, thus, the possibility of missing an actionable mutation. Despite this limitation, blood-based predictive biomarkers, such as mutant EGFR for predicting response to EGFR tyrosine kinase inhibitors in advanced non-small-cell lung cancer and mutant PIK3CA for predicting response to alpelisib in combination with fulvestrant in advanced breast cancer, may be used when tissue is unavailable. Although tissue remains the gold standard for detecting predictive biomarkers, it is likely that several further blood-based assays will soon be validated and used when tissue is unavailable or unsuitable for analysis. Full article
Article
Comparative Evaluation of the Prognosis of Septic Shock Patients from Before to After the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis
J. Pers. Med. 2022, 12(1), 103; https://doi.org/10.3390/jpm12010103 - 13 Jan 2022
Viewed by 423
Abstract
In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the [...] Read more.
In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)
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Article
Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery
J. Pers. Med. 2022, 12(1), 102; https://doi.org/10.3390/jpm12010102 - 13 Jan 2022
Cited by 1 | Viewed by 412
Abstract
Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. [...] Read more.
Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality. Full article
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Article
Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy
J. Pers. Med. 2022, 12(1), 101; https://doi.org/10.3390/jpm12010101 - 13 Jan 2022
Viewed by 698
Abstract
Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional [...] Read more.
Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade. Full article
(This article belongs to the Special Issue Endometriosis: Advances in Diagnosis and Treatment)
Article
The Effect of Surgeon Expertise on the Outcome of Patients with Adrenocortical Carcinoma
J. Pers. Med. 2022, 12(1), 100; https://doi.org/10.3390/jpm12010100 - 13 Jan 2022
Viewed by 419
Abstract
Complete surgical removal of adrenocortical carcinoma (ACC) represents the only chance of long-term cure. In this study, we compared the long-term outcomes of ACC patients depending on whether they had adrenal surgery performed in a high-volume (HVC) or in a low-volume (LVC) center. [...] Read more.
Complete surgical removal of adrenocortical carcinoma (ACC) represents the only chance of long-term cure. In this study, we compared the long-term outcomes of ACC patients depending on whether they had adrenal surgery performed in a high-volume (HVC) or in a low-volume (LVC) center. This retrospective study included 49 patients from the Croatian ACC Registry with the European Network for the Study of Adrenal Tumors (ENSAT) stage I–III ACC, of which 35 underwent surgery in a HVC whereas 14 of them were operated in one of the LVCs. Patients operated in the LVCs had a significantly higher rate of ACC recurrence (57.1% vs. 22.9%; p = 0.02). Accordingly, RFS was significantly longer in patients operated on in HVC (p = 0.04). The difference in RFS remained significant after controlling for age, gender, tumor size, Ki-67 index, Weiss score, and type of surgery (HR 4.55; 95% CI 1.16–17.88; p = 0.03). In addition, there is a tendency towards longer DSS in patients in the HVC group compared to those in the LVC group (p = 0.05). These results point to the centralization of adrenal surgery as a key prerequisite for improving the outcomes of ACC patients. Full article
(This article belongs to the Special Issue Personalized Medicine in Benign and Malignant Adrenal Tumors)
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Review
Harnessing Synthetic Lethal Interactions for Personalized Medicine
J. Pers. Med. 2022, 12(1), 98; https://doi.org/10.3390/jpm12010098 - 12 Jan 2022
Viewed by 559
Abstract
Two genes are said to have synthetic lethal (SL) interactions if the simultaneous mutations in a cell lead to lethality, but each individual mutation does not. Targeting SL partners of mutated cancer genes can kill cancer cells but leave normal cells intact. The [...] Read more.
Two genes are said to have synthetic lethal (SL) interactions if the simultaneous mutations in a cell lead to lethality, but each individual mutation does not. Targeting SL partners of mutated cancer genes can kill cancer cells but leave normal cells intact. The applicability of translating this concept into clinics has been demonstrated by three drugs that have been approved by the FDA to target PARP for tumors bearing mutations in BRCA1/2. This article reviews applications of the SL concept to translational cancer medicine over the past five years. Topics are (1) exploiting the SL concept for drug combinations to circumvent tumor resistance, (2) using synthetic lethality to identify prognostic and predictive biomarkers, (3) applying SL interactions to stratify patients for targeted and immunotherapy, and (4) discussions on challenges and future directions. Full article
(This article belongs to the Special Issue Advances in Synthetic Lethality for Personalized Cancer Treatments)
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Article
Prevalence of Chronic Kidney Disease and Variation of Its Risk Factors by the Regions in Okayama Prefecture
J. Pers. Med. 2022, 12(1), 97; https://doi.org/10.3390/jpm12010097 - 12 Jan 2022
Viewed by 397
Abstract
Objective: The prevention of chronic kidney disease (CKD) progression is an important issue from health and financial perspectives. We conducted a single-year cross-sectional study to clarify the prevalence of CKD and its risk factors along with variations in these factors among five medical [...] Read more.
Objective: The prevention of chronic kidney disease (CKD) progression is an important issue from health and financial perspectives. We conducted a single-year cross-sectional study to clarify the prevalence of CKD and its risk factors along with variations in these factors among five medical regions in Okayama Prefecture, Japan. Methods and Results: Data concerning the renal function and proteinuria as well as other CKD risk factors were obtained from the database of the Japanese National Health Insurance. The proportion of CKD patients at an increased risk of progression to end-stage renal disease (ESRD), classified as orange and red on the CKD heatmap, ranged from 6–9% and did not vary significantly by the regions. However, the causes of the increased severity differed between regions where renal dysfunction was predominant and regions where there were many patients with proteinuria. CKD risk factors, such as diabetes mellitus, hypertension, hyper low-density lipoprotein-cholesterolemia, obesity, smoking and lack of exercise, also differed among these regions, suggesting that different regions need tailored interventions that suit the characteristics of the region, such as an increased health checkup ratio, dietary guidance and promotion of exercise opportunities. Conclusions: Approximately 6–9% of people are at an increased risk of developing ESRD (orange or red on a CKD heatmap) among the population with National Health Insurance in Okayama Prefecture. The underlying health problems that cause CKD may differ among the regions. Thus, it is necessary to consider intervention methods for preventing CKD progression that are tailored to each region’s health problems. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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Article
Skeletal and Dental Morphological Characteristics of the Maxillary in Patients with Impacted Canines Using Cone Beam Computed Tomography: A Retrospective Clinical Study
J. Pers. Med. 2022, 12(1), 96; https://doi.org/10.3390/jpm12010096 - 12 Jan 2022
Viewed by 392
Abstract
The aim of this study is to analyze the skeletal and dentoalveolar morphological characteristics of the maxillary in subjects with a unilateral palatally impacted canine using Cone Beam Computed Tomography (CBCT). A retrospective clinical study was conducted of 100 adult patients divided into [...] Read more.
The aim of this study is to analyze the skeletal and dentoalveolar morphological characteristics of the maxillary in subjects with a unilateral palatally impacted canine using Cone Beam Computed Tomography (CBCT). A retrospective clinical study was conducted of 100 adult patients divided into two groups: one consisting of patients with a unilaterally palatally impacted maxillary canine (GI), with the subgroups in the right and left hemiarches (GI-R and GI-L), and the second, without impacted canine, as the control group (CG). The CBCT measured skeletal variables (maxillary basal width and alveolar crest height) and dentoalveolar variables (inclination of the upper incisor, tooth lengths of incisors and canines, arch length, tooth size and bone dental discrepancy). In skeletal variables, statistically significant differences were found in alveolar crest height (ACH) in all groups and subgroups (p < 0.01). In the dentoalveolar variables, there were differences in the angle of the upper incisor (II) and lateral incisor length (LLIL) between the GI and GC and the angle of the upper incisor (II′), arch length (AL′) and arch length-tooth size discrepancy (ATD′) among the GI subgroups (p < 0.01). There are skeletal and dentoalveolar differences in patients with unilateral palatally impacted maxillary canines, with lower angular and linear measurements compared with patients without impaction. Full article
(This article belongs to the Special Issue New Trends in Precision Medicine)
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Editorial
EPR Effect-Based Tumor Targeted Nanomedicine: A Promising Approach for Controlling Cancer
J. Pers. Med. 2022, 12(1), 95; https://doi.org/10.3390/jpm12010095 - 12 Jan 2022
Cited by 1 | Viewed by 308
Abstract
Cancer remains the major threat to human health in most advanced countries in the world [...] Full article
(This article belongs to the Special Issue EPR Effect-Based Tumor Targeted Nanomedicine)
Article
Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress Incontinence
J. Pers. Med. 2022, 12(1), 94; https://doi.org/10.3390/jpm12010094 - 12 Jan 2022
Viewed by 290
Abstract
(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision [...] Read more.
(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision aid to predict success. (2) Methods: We reviewed consecutive men treated with first-time ATOMS for post-prostatectomy incontinence from 2014 to 2021 at our institution. Patient demographics, reported pads per day (PPD), 24-h pad-test and Standing Cough Test (SCT), results’ grades 1–4, according to Male Stress Incontinence Grading Scale (MSIGS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were assessed. Treatment success was defined as no pads or a single PPD with ≤20-mL 24-h pad-test. Logistic regression was performed using a stepwise model (entry 0.15 and stay criterium 0.1) to evaluate independent variables’ determinant of dryness. Receiver-operating characteristic (ROC) curves for predictive variables were evaluated and their area under curve (AUC) was compared. A nomogram was generated and internally validated to predict probability of treatment success. (3) Results: Overall, 149 men (median age 70 years, IQR 7) were evaluated with a median follow-up of 45 months (IQR 26). Twelve patients (8%) had previous devices for incontinence, and 21 (14.1%) had pelvic radiation. Thirty-five men (23.5%) did not achieve continence after ATOMS adjustment (use of no or one security PPD with ≤20-mL 24-h pad-test). In univariate analysis, Charlson comorbidity index (p = 0.0412), previous urethroplasty (p = 0.0187), baseline PPD (p < 0.0001), 24-h pad-test (p < 0.0001), MSIGS (p < 0.0001), and ICIQ-SF questionnaire score (p < 0.0001) predicted ATOMS failure. In a multivariable model, 24-h pad-test (p = 0.0031), MSIGS (p = 0.0244), and radiotherapy (p = 0.0216) were independent variables, with AUC 0.8221. The association of MSIGS and 24-h pad-test was the superior combination (AUC 0.8236). A nomogram to predict the probability of ATOMS failure using the independent variables identified was proposed. (4) Conclusions: Several variables were identified as predictive of success for ATOMS using clinical history, physical examination (MSIGS), and factors that evaluate urine loss severity (PPD, 24-h pad-test, and ICIQ-SF questionnaire). MSIGS adds prognostic value to 24-h pad-test in assessing success of ATOMS device to treat post-prostatectomy incontinence. A nomogram was proposed to calculate the risk of ATOMS failure, which could be of interest to personalize the decision to use this device or not in the individual patient. Full article
(This article belongs to the Special Issue Advances in Urogenital Pathology)
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Systematic Review
The Contribution of “Individual Participant Data” Meta-Analyses of Psychotherapies for Depression to the Development of Personalized Treatments: A Systematic Review
J. Pers. Med. 2022, 12(1), 93; https://doi.org/10.3390/jpm12010093 - 11 Jan 2022
Viewed by 809
Abstract
While randomized trials typically lack sufficient statistical power to identify predictors and moderators of outcome, ”individual participant data” (IPD) meta-analyses, which combine primary data of multiple randomized trials, can increase the statistical power to identify predictors and moderators of outcome. We conducted a [...] Read more.
While randomized trials typically lack sufficient statistical power to identify predictors and moderators of outcome, ”individual participant data” (IPD) meta-analyses, which combine primary data of multiple randomized trials, can increase the statistical power to identify predictors and moderators of outcome. We conducted a systematic review of IPD meta-analyses on psychological treatments of depression to provide an overview of predictors and moderators identified. We included 10 (eight pairwise and two network) IPD meta-analyses. Six meta-analyses showed that higher baseline depression severity was associated with better outcomes, and two found that older age was associated with better outcomes. Because power was high in most IPD meta-analyses, non-significant findings are also of interest because they indicate that these variables are probably not relevant as predictors and moderators. We did not find in any IPD meta-analysis that gender, education level, or relationship status were significant predictors or moderators. This review shows that IPD meta-analyses on psychological treatments can identify predictors and moderators of treatment effects and thereby contribute considerably to the development of personalized treatments of depression. Full article
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