Journal of Personalized Medicine

21 pages, 661 KiB

Open AccessArticle

Clinical Pharmacogenetics: Results After Implementation of Preemptive Tests in Daily Routine

by Xando Díaz-Villamarín, María Martínez-Pérez, María Teresa Nieto-Sánchez, Emilio Fernández-Varón, Alicia Torres-García, Isabel Blancas, José Cabeza-Barrera and Rocío Morón

J. Pers. Med. 2025, 15(6), 245; https://doi.org/10.3390/jpm15060245 - 10 Jun 2025

Abstract

Background/Objectives: The clinical implementation of pharmacogenetics (PGx) remains limited, even for well-established drug–gene interactions. In addition to insufficient infrastructure and PGx education among healthcare professionals, there is currently no consensus regarding which genetic variants should be tested, the most appropriate testing approach (e.g., [...] Read more.

Background/Objectives: The clinical implementation of pharmacogenetics (PGx) remains limited, even for well-established drug–gene interactions. In addition to insufficient infrastructure and PGx education among healthcare professionals, there is currently no consensus regarding which genetic variants should be tested, the most appropriate testing approach (e.g., single-gene vs. multi-gene panels), or how to translate genotypes into actionable therapeutic recommendations. Methods: We describe the implementation of PGx in real daily clinical routine at a single institution to guide other centers. We analyze the drug–gene interactions and genetic variants included in our program based on allelic, genotypic, and phenotypic frequencies, resulting therapeutic recommendations. Linkage disequilibrium and haplotype analyses are also performed. Results and Conclusions: PGx testing was primarily requested by the oncology department. Not all variants included in typical panels had clinical utility in our setting. We do not recommend testing CYP2C19*17 prior to clopidogrel prescription, as it does not translate into a dosing recommendation. TPMT*3B may be considered just to confirm TPMT*3A due to its linkage with TPMT*3C. Similarly, we do not recommend the routine testing of CYP2C9*2 prior to siponimod prescription, as it does not inform therapeutic decisions according to the current drug label. Full article

(This article belongs to the Section Pharmacogenetics)

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20 pages, 729 KiB

Open AccessSystematic Review

Can Radiomics Predict Pathologic Complete Response After Neoadjuvant Chemoradiotherapy for Rectal Cancer? A Systematic Review and Meta-Analysis of Diagnostic-Accuracy Studies

by Fotios Seretis, Antonia Panagaki, Stavroula Tzamouri, Tania Triantafyllou, Charikleia Triantopoulou and Dimitrios Theodorou

J. Pers. Med. 2025, 15(6), 244; https://doi.org/10.3390/jpm15060244 - 10 Jun 2025

Abstract

Background: The rectal cancer treatment paradigm is rapidly changing with the advent of total neoadjuvant therapy and non-operative management approaches in responders. A good clinical response to neoadjuvant treatment documented by magnetic resonance imaging, endoscopy and clinical examination corresponds, to a large extent, [...] Read more.

Background: The rectal cancer treatment paradigm is rapidly changing with the advent of total neoadjuvant therapy and non-operative management approaches in responders. A good clinical response to neoadjuvant treatment documented by magnetic resonance imaging, endoscopy and clinical examination corresponds, to a large extent, to a pathologic complete response, as assessed in surgical specimens. Methods: We undertook a systematic review and meta-analysis on the MRI-based omics approach to predicting pathologic complete responses. Results: A total of 29 studies with relevant data available reporting on a total of 4486 patients were eligible for meta-analysis. The calculated values for the area under the curve in receiver operator curves of diagnostic accuracy for radiomics-only and radiomics-combined-with-clinical-data models were 0.80 and 0.88, respectively, for studies incorporating baseline imaging data only. The value for studies using delta radiomic data was 0.86, and those for studies using data from the post-neoadjuvant setting were 0.75 and 0.83, respectively, for the radiomics-only and radiomics-combined-with-clinical-data models. Conclusions: Radiomics-based prediction models for pathologic complete response assessment might further enable individualized treatment decisions to be made in patients with rectal cancer. Full article

(This article belongs to the Special Issue Novel Biomarkers in the Diagnostics of Cancer)

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2 pages, 158 KiB

Open AccessCorrection

Correction: Viglianisi et al. The Emerging Role of Salivary Oxidative Stress Biomarkers as Prognostic Markers of Periodontitis: New Insights for a Personalized Approach in Dentistry. J. Pers. Med. 2023, 13, 166

by Gaia Viglianisi, Gianluca Martino Tartaglia, Simona Santonocito, Mariacristina Amato, Alessandro Polizzi, Marco Mascitti and Gaetano Isola

J. Pers. Med. 2025, 15(6), 243; https://doi.org/10.3390/jpm15060243 - 10 Jun 2025

Abstract

Following discussions between the Editorial Board and the authors, the original published references no [...] Full article

(This article belongs to the Special Issue Exosomes—Nanocarriers for Better Medicine)

12 pages, 1058 KiB

Open AccessArticle

Indocyanine Green Angiography to Predict Complications in Subcutaneous Mastectomy: A Single-Center Experience

by Letizia Cuniolo, Raquel Diaz, Dafne Anastasia, Federica Murelli, Chiara Cornacchia, Francesca Depaoli, Marco Gipponi, Cecilia Margarino, Chiara Boccardo, Simonetta Franchelli, Marianna Pesce, Amandine Causse D’agraives, Rebecca Allievi, Martina Cossu, Franco De Cian and Piero Fregatti

J. Pers. Med. 2025, 15(6), 242; https://doi.org/10.3390/jpm15060242 (registering DOI) - 10 Jun 2025

Abstract

Background/Objectives: In the setting of breast surgery, indocyanine green angiography (ICGA) allows estimating the perfusion of cutaneous tissues during surgical interventions, in order to reduce vascularization-related complications. This study has a dual objective: to evaluate the correlation between preoperative factors and the [...] Read more.

Background/Objectives: In the setting of breast surgery, indocyanine green angiography (ICGA) allows estimating the perfusion of cutaneous tissues during surgical interventions, in order to reduce vascularization-related complications. This study has a dual objective: to evaluate the correlation between preoperative factors and the level of skin vascularization, measured by ICGA, in patients undergoing subcutaneous mastectomy for breast cancer; and to establish any relationship between low intraoperative vascularization and the onset of postoperative complications. Methods: This is a preliminary, non-randomized, prospective clinical study that includes 46 female patients undergoing subcutaneous mastectomy with reconstruction for breast cancer between February 2022 and July 2024. The relationship between vascularization and the following preoperative variables was assessed: smoking, previous breast surgeries, prior radiotherapy, neoadjuvant or prior chemotherapy/anti-Her2 therapy, and the thickness of breast subcutaneous tissue evaluated through mammography. For the analysis, three ICGA procedures were performed, using 0.125 mg/kg of indocyanine green (ICG) for each procedure before the surgical incision (V1), at the end of the demolition phase (V2), and at the end of the reconstruction phase (V3). The results of this analysis were finally correlated with the occurrence of any postoperative complications. Results: Vascularization was conventionally classified as “low” and “good” using a cutoff of 33%. Previous surgeries on the ipsilateral breast and neoadjuvant or prior chemotherapy/anti-Her2 therapy were found to be predictive factors of “low” vascularization (p = 0.031). Patients with “low” vascularization at time V3 showed a significantly higher risk of developing complications (p = 0.038). Incision length emerged as an independent predictor of complications, with a 23% increase in risk per additional centimeter (p = 0.006), independent of perfusion level. Conclusions: This study supports the use of ICGA as a useful tool to improve outcomes in patients undergoing subcutaneous mastectomy with prosthetic reconstruction for breast cancer. The results of this preliminary work are encouraging, and recruiting a larger number of patients could provide more significant data. Full article

(This article belongs to the Section Clinical Medicine, Cell, and Organism Physiology)

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13 pages, 283 KiB

Open AccessArticle

The Role of Ventricular Assist Devices in Patients with Ischemic vs. Non-Ischemic Cardiomyopathy

by Eglė Rumbinaitė, Dainius Karčiauskas, Grytė Ramantauskaitė, Dovydas Verikas, Gabrielė Žūkaitė, Liucija Rancaitė, Barbora Jociutė, Gintarė Šakalytė and Remigijus Žaliūnas

J. Pers. Med. 2025, 15(6), 241; https://doi.org/10.3390/jpm15060241 (registering DOI) - 10 Jun 2025

Abstract

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This [...] Read more.

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification—particularly in patients with DCM and pulmonary hypertension—to optimize postoperative outcomes and guide patient selection for durable LVAD support. Full article

(This article belongs to the Section Methodology, Drug and Device Discovery)

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13 pages, 269 KiB

Open AccessArticle

Evaluation of Perioperative Risk Factors for Infection by Multidrug-Resistant Bacteria in Patients Undergoing Liver Transplantation

by Rafael Ramos Fernández, Alberto Calvo García, Ainhoa Fernández Yunkera, Silvia Ramos Cerro, Ignacio Garutti, Javier Hortal Iglesias, Patricia Muñoz García, Sergio García Ramos, Adoración Elvira Rodríguez, Mercedes Power Esteban, Patricia Duque González and Patricia Piñeiro

J. Pers. Med. 2025, 15(6), 240; https://doi.org/10.3390/jpm15060240 (registering DOI) - 10 Jun 2025

Abstract

Background: Liver transplantation (LT) is a critical intervention for patients with end-stage liver disease. Infections caused by multidrug-resistant bacteria (MDRB) significantly worsen post-transplant outcomes. The main objective of this study was to analyze perioperative risk factors associated with MDRB infections within six months [...] Read more.

Background: Liver transplantation (LT) is a critical intervention for patients with end-stage liver disease. Infections caused by multidrug-resistant bacteria (MDRB) significantly worsen post-transplant outcomes. The main objective of this study was to analyze perioperative risk factors associated with MDRB infections within six months following LT. Methods: A retrospective analysis was conducted on 133 medical records of patients who underwent liver transplantation between October 2018 and May 2022. Data collected included the presence of MDRB colonization and infection, as well as various perioperative variables. These were analyzed to identify potential risk factors for MDRB infection and colonization. Results: Univariate analysis identified several perioperative variables associated with MDRB infection within six months after LT. Multivariate logistic regression revealed that pre-transplant MDRB colonization (OR 5.72, 95% CI 1.7–18.7, p = 0.005) and the requirement for dialysis during postoperative ICU stay (OR 6.42, 95% CI 1.7–23.4, p = 0.009) were independent risk factors for developing MDRB infections. MDRB infection occurred in 9.4% of patients and was not significantly associated with increased mortality (p = 0.126). Conclusions: These findings contribute to a better understanding of the epidemiology and pathophysiology of MDRB infections in the postoperative period of liver transplantation. This knowledge is essential for developing effective prevention and treatment strategies that may improve outcomes in this patient population. Full article

(This article belongs to the Special Issue Advances in Infectious Disease Epidemiology)

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15 pages, 681 KiB

Open AccessSystematic Review

Impact of Pharmacological Treatments on Rheumatoid Arthritis-Associated Diffuse Interstitial Lung Disease: A Systematic Review and Meta-Analysis

by Ariam A. Muarif, Rana Algahtani, Lujain H. Alghamdi, Sarah S. Alghamdi, Lama Al Nemer, Reman Alsaqrah, Yazeed Alsulami, Maha Alsharif, Dana Alznbagi, Lena Aljehani, Ziyad Alsaeedi, Sultan Alghamdi, Taif A. Sayel, Basma Al Ghamdi and Ali Al Bshabshe

J. Pers. Med. 2025, 15(6), 239; https://doi.org/10.3390/jpm15060239 - 9 Jun 2025

Abstract

Background: Interstitial lung disease (ILD) is a prominent complication in the course of rheumatoid arthritis (RA), with a prevalence ranging from 5% to 60% and several phenotypes. The existing knowledge on the impact of different pharmacological interventions in individuals with rheumatoid arthritis-related [...] Read more.

Background: Interstitial lung disease (ILD) is a prominent complication in the course of rheumatoid arthritis (RA), with a prevalence ranging from 5% to 60% and several phenotypes. The existing knowledge on the impact of different pharmacological interventions in individuals with rheumatoid arthritis-related interstitial lung disease (RA-ILD) is inconclusive, and this variable response to treatment highlights the need for a personalized approach to the management of RA-associated ILD. Therefore, we aimed to evaluate the therapeutic effect and safety of different pharmacological agents, including conventional synthetic DMARDs (Cs DMARDs), biologic DMARDs (bDMARDs), targeted synthetic DMARDs (Ts DMARDs), and antifibrotic agents, in patients with RA-ILD. Method: This systematic review and meta-analysis searched for available randomized controlled trials (RCTs) and prospective cohort studies. A search was performed in the PubMed, Google Scholar, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Eligible studies comprised those involving hospitalized patients diagnosed with RA-ILD, regardless of concomitant medications, who were of adult age (≥18 years); the studies measured the effect of pharmacological interventions, including methotrexate, leflunomide, tumor necrosis factor inhibitors (anti-TNF), abatacept, rituximab, JAK inhibitors, and antifibrotic agents, compared to placebo or other therapies for RA. Results: Out of 446 studies from 2002 to 2024, only 16 were included in this systematic review, including 14 prospective cohort studies and 2 placebo-controlled studies. Unfortunately, no RCTs were found that address our research question. The most relevant studies (n = 4) were performed in different countries (mainly Spain and the UK), with sample sizes varying from 23 to 381 patients (total: 2199 patients). The current study reveals that non-anti-TNF biologics were associated with a decreased risk of radiologic progression, while advanced therapies improved disease-related outcomes in patients requiring oxygen therapy. Methotrexate and other DMARDs were found to have inconsistent effects on ILD progression and mortality. Conclusions: Our review supports the integration of personalized medicine into the management of RA-ILD. By considering patient-specific factors and therapeutic responses, clinicians can better tailor interventions. We confirmed the high methodological quality of the trials, yielding solid evidence for the clinical management of RA-ILD. This review adds to the existing literature by identifying nintedanib as a potential disease-modifying therapy with the potential to slow the progression of lung disease. Full article

(This article belongs to the Section Personalized Therapy and Drug Delivery)

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13 pages, 468 KiB

Open AccessSystematic Review

Artificial Intelligence in the Assessment and Grading of Acne Vulgaris: A Systematic Review

by Daniele Omar Traini, Gerardo Palmisano, Cristina Guerriero and Ketty Peris

J. Pers. Med. 2025, 15(6), 238; https://doi.org/10.3390/jpm15060238 - 6 Jun 2025

Abstract

Acne vulgaris is a common dermatological condition, particularly affecting adolescents during critical developmental stages, which may have lasting psychosocial impacts. Traditional assessments, including global severity grading and lesion counting, are limited by subjectivity and time constraints. Background/Objectives: This review aims to systematically [...] Read more.

Acne vulgaris is a common dermatological condition, particularly affecting adolescents during critical developmental stages, which may have lasting psychosocial impacts. Traditional assessments, including global severity grading and lesion counting, are limited by subjectivity and time constraints. Background/Objectives: This review aims to systematically assess the recent advancements in artificial intelligence (AI) applications for acne diagnosis, lesion segmentation/counting, and severity grading, highlighting the potential of AI-driven methods to improve objectivity, reproducibility, and clinical efficiency. Methods: A comprehensive literature search was conducted across PubMed, Scopus, arXiv, Embase, and Web of Science for studies published between 1 January 2017 and 1 March 2025. The search strategy incorporated terms related to “acne” and various AI methodologies (e.g., “neural network”, “deep learning”, “convolutional neural network”). Two independent reviewers screened 345 articles, with 29 studies ultimately meeting inclusion criteria. Data were extracted on study design, dataset characteristics (including internal and publicly available resources such as ACNE04 and AcneSCU), AI architectures (predominantly CNN-based models), and performance metrics. Results: While AI-driven models demonstrated promising accuracy, as high as 97.6% in controlled settings, the limited availability of large public datasets, the predominance of data from specific ethnic groups, and the lack of extensive external validation underscore critical barriers to clinical implementation. Conclusions: The findings indicate that although AI has the potential to standardize acne assessments, reduce observer variability, and enable self-monitoring via mobile platforms, significant challenges remain in achieving robust, real-world applicability. Future research should prioritize the development of large, diverse, and publicly accessible datasets and undertake prospective clinical validations to ensure equitable and effective dermatological care. Full article

(This article belongs to the Special Issue Personalized Prevention, Diagnosis and Treatment of Skin Disorders)

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15 pages, 291 KiB

Open AccessReview

Inflammatory Arthritis and the Environment: Causes and Consequences of Spondyloarthritis

by Maurizio Benucci, Edda Russo, Francesca Li Gobbi, Mariangela Manfredi and Maria Infantino

J. Pers. Med. 2025, 15(6), 237; https://doi.org/10.3390/jpm15060237 - 5 Jun 2025

Abstract

The extensive research and studies conducted over the past decade have greatly improved our comprehension of the pathogenesis and risk factors associated with Spondyloarthritis (SpA). In addition, they have contributed to the advancement of novel therapeutic approaches. Although genetics still represents the primary [...] Read more.

The extensive research and studies conducted over the past decade have greatly improved our comprehension of the pathogenesis and risk factors associated with Spondyloarthritis (SpA). In addition, they have contributed to the advancement of novel therapeutic approaches. Although genetics still represents the primary risk factor for SpA, increasing evidence presented in this review suggests that environmental factors—such as air pollution, smoking, gut microbiota (GM), infections, and diet—also contribute to its pathogenesis. In detail, environmental particulate matters (PMs), which include ligands for the aryl hydrocarbon receptor—a cytosolic transcription factor responsive to toxic substances—facilitate the differentiation of T Helper 17 (Th17) cells, potentially exacerbating the autoinflammatory processes associated with SpA. Furthermore, smoking influences both the cellular and humoral aspects of the immune response, resulting in leukocytosis, impaired leukocyte functionality, and a decrease in various cytokines and soluble receptors, including interleukin (IL) 15, IL-1 receptor antagonist (IL-1Ra), IL-6, soluble IL-6 receptor (sIL-6R), as well as the vascular endothelial growth factor (VEGF) receptor. Studies have indicated that patients with SpA exhibit an increased prevalence of antibodies directed against a conserved epitope shared by the human leukocyte antigen B27 (HLA-B27)- and Klebsiella nitrogenase, in comparison to HLA-B27-positive controls. Additionally, current evidence regarding the GM suggests the presence of a gut–joint–skin axis, wherein the disruption of the mucosal barrier by specific bacterial species may enhance permeability to the gut-associated lymphoid tissue (GALT), resulting in localized inflammation mediated by Th1 and Th17 cells, as well as IL-17A. Finally, this review discusses the role of diet in shaping the microbial composition and its contribution to the pathogenesis of SpA. A comprehensive understanding of the mechanisms by which environmental factors influence the pathogenesis and progression of the disease could facilitate the development of novel personalized therapies targeting both external and internal environmental exposures, such as the gut microbial ecosystem. Full article

(This article belongs to the Special Issue Current Trends and Advances in Spondyloarthritis)

26 pages, 777 KiB

Open AccessReview

Molecular Biomarkers for the Diagnosis and Prognostication of Pancreatic Ductal Adenocarcinoma

by James Sun, Morcos A. Awad, Jennifer Hwang and Anthony M. Villano

J. Pers. Med. 2025, 15(6), 236; https://doi.org/10.3390/jpm15060236 - 5 Jun 2025

Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains among the most aggressive malignancies in the United States. Advances in treatments have slowly increased survival rates; however, outcomes remain dismal, largely due to the insidious onset of the disease and lack of screening tests leading to diagnosis [...] Read more.

Pancreatic ductal adenocarcinoma (PDAC) remains among the most aggressive malignancies in the United States. Advances in treatments have slowly increased survival rates; however, outcomes remain dismal, largely due to the insidious onset of the disease and lack of screening tests leading to diagnosis at more advanced disease stages. As we better understand the molecular mechanisms that drive PDAC, we can leverage this technology for early detection of new PDAC or recurrences and find more effective methods to track treatment response. Liquid biopsies are increasingly common for the treatment of many malignancies, leveraging better technology to detect scant quantities of circulating tumor cells (CTCs) or byproducts of tumor biology (e.g., exosomes and microRNA [miRNA]) in the blood stream. When combined with existing biomarkers like CA 19-9, there is promising research that improved diagnostic modalities may be available in the future. Furthermore, these technologies are being leveraged to better prognosticate patients with PDAC and potentially monitor treatment responses not captured by cross-sectional imaging, which may allow for real-time changes in therapeutic strategy. This manuscript will review the molecular mechanisms that drive PDAC development and the biomarkers available for diagnosis and prognostication. Much of the data presented is still investigational, though many trials are ongoing to translate these studies for clinical use. Full article

(This article belongs to the Special Issue Novel Biomarkers in the Diagnostics of Cancer)

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13 pages, 680 KiB

Open AccessArticle

Comparison of Multiple State-of-the-Art Large Language Models for Patient Education Prior to CT and MRI Examinations

by Semil Eminovic, Bogdan Levita, Andrea Dell’Orco, Jonas Alexander Leppig, Jawed Nawabi and Tobias Penzkofer

J. Pers. Med. 2025, 15(6), 235; https://doi.org/10.3390/jpm15060235 - 5 Jun 2025

Abstract

Background/Objectives: This study compares the accuracy of responses from state-of-the-art large language models (LLMs) to patient questions before CT and MRI imaging. We aim to demonstrate the potential of LLMs in improving workflow efficiency, while also highlighting risks such as misinformation. Methods [...] Read more.

Background/Objectives: This study compares the accuracy of responses from state-of-the-art large language models (LLMs) to patient questions before CT and MRI imaging. We aim to demonstrate the potential of LLMs in improving workflow efficiency, while also highlighting risks such as misinformation. Methods: There were 57 CT-related and 64 MRI-related patient questions displayed to ChatGPT-4o, Claude 3.5 Sonnet, Google Gemini, and Mistral Large 2. Each answer was evaluated by two board-certified radiologists and scored for accuracy/correctness/likelihood to mislead using a 5-point Likert scale. Statistics compared LLM performance across question categories. Results: ChatGPT-4o achieved the highest average scores for CT-related questions and tied with Claude 3.5 Sonnet for MRI-related questions, with higher scores across all models for MRI (ChatGPT-4o: CT [4.52 (± 0.46)], MRI: [4.79 (± 0.37)]; Google Gemini: CT [4.44 (± 0.58)]; MRI [4.68 (± 0.58)]; Claude 3.5 Sonnet: CT [4.40 (± 0.59)]; MRI [4.79 (± 0.37)]; Mistral Large 2: CT [4.25 (± 0.54)]; MRI [4.74 (± 0.47)]). At least one response per LLM was rated as inaccurate, with Google Gemini answering most often potentially misleading (in 5.26% for CT and 2.34% for MRI). Mistral Large 2 was outperformed by ChatGPT-4o for all CT-related questions (p < 0.001) and by ChatGPT-4o (p = 0.003), Google Gemini (p = 0.022), and Claude 3.5 Sonnet (p = 0.004) for all CT Contrast media information questions. Conclusions: Even though all LLMs performed well overall and showed great potential for patient education, each model occasionally displayed potentially misleading information, highlighting the clinical application risk. Full article

(This article belongs to the Section Methodology, Drug and Device Discovery)

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13 pages, 3865 KiB

Open AccessArticle

Spinal Arachnoid Cysts: A Single-Center Preliminary Surgical Experience with a Rare and Challenging Disease

by Alessio Iacoangeli, Love Chibuzor Ilochonwu, Giulia Mazzanti, Gabriele Polonara, Lauredana Ercolani, Alessandra Marini, Michele Luzi, Roberto Trignani, Stefano Bruni, Edoardo Barboni, Maurizio Gladi, Maurizio Iacoangeli and Denis Aiudi

J. Pers. Med. 2025, 15(6), 234; https://doi.org/10.3390/jpm15060234 - 5 Jun 2025

Abstract

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they [...] Read more.

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences. Full article

(This article belongs to the Section Personalized Therapy and Drug Delivery)

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14 pages, 3509 KiB

Open AccessArticle

Enhancing the Outcomes of Temporalis Fascia Tympanoplasty Using Autologous Platelet-Rich Plasma and Gel: A Randomized Controlled Trial

by Nejc Steiner, Domen Vozel, Nina Bozanic Urbancic, Kaja Troha, Andraz Lazar, Veronika Kralj-Iglic and Saba Battelino

J. Pers. Med. 2025, 15(6), 233; https://doi.org/10.3390/jpm15060233 - 4 Jun 2025

Abstract

Objectives: This study aimed to investigate the impact of platelet-rich plasma (PRP) and platelet-rich gel (PRG) on tympanic membrane closure rates, hearing improvement, and quality of life following tympanoplasty. Methods: Seventy-two patients with chronic tympanic membrane perforations were enrolled in a double-blinded, randomized [...] Read more.

Objectives: This study aimed to investigate the impact of platelet-rich plasma (PRP) and platelet-rich gel (PRG) on tympanic membrane closure rates, hearing improvement, and quality of life following tympanoplasty. Methods: Seventy-two patients with chronic tympanic membrane perforations were enrolled in a double-blinded, randomized controlled trial at a single tertiary referral center. All patients underwent tympanoplasty using a temporalis fascia graft and were randomly assigned to one of two groups: one group received standard tympanoplasty alone, while the other received intraoperative application of autologous PRP and PRG, in addition to the standard procedure. Results: The PRP group demonstrated a significantly higher rate of complete tympanic membrane closure compared to the control group (32/36; 88.9% vs. 24/36; 66.7%; p < 0.05). Bone conduction hearing remained unchanged in both groups, while air conduction hearing improved significantly from pre- to post-treatment in each group. However, the difference in air conduction improvement between the PRP group and the control group was not statistically significant (PRP group: Mdn = −8.25; control group: Mdn = −12.20; U = 618; z = −0.54; p = 0.30). Quality of life improved in both the PRP and control groups; however, the difference between the groups was not statistically significant (PRP group: 10.44 ± 10.46; control group: 10.47 ± 8.22; 95% CI [−4.45; 4.40]; t(66) = −0.01; p = 0.16). Conclusions: Our findings suggest that intraoperative application of autologous PRP and PRG may improve tympanoplasty outcomes, particularly in cases with lower expected success rates or when performing minimally invasive transcanal procedures under local anesthesia. However, variability in PRP preparation, application methods, and graft materials across studies limits direct comparisons. Standardized protocols and further controlled studies are necessary to clarify PRP’s clinical value in tympanoplasty. Full article

(This article belongs to the Special Issue Personalized Medicine in Otolaryngology: Novel Prognostic Markers)

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14 pages, 336 KiB

Open AccessArticle

An Assessment of Real-World Evidence and Other Sources Supporting Payer Coverage Decisions for Pharmacogenomic Testing in Psychiatry

by Sandra E. Yankah, Maryam Nafie, Rachele M. Hendricks-Sturrup and Christine Y. Lu

J. Pers. Med. 2025, 15(6), 232; https://doi.org/10.3390/jpm15060232 - 3 Jun 2025

Abstract

Background: Sources and evidence cited to inform payer coverage decisions on pharmacogenomic (PGx) testing in psychiatry are presently underexplored. Methods: We conducted a qualitative and quantitative assessment of publicly available coverage policies from 14 US payers, examining the number and both the type [...] Read more.

Background: Sources and evidence cited to inform payer coverage decisions on pharmacogenomic (PGx) testing in psychiatry are presently underexplored. Methods: We conducted a qualitative and quantitative assessment of publicly available coverage policies from 14 US payers, examining the number and both the type and source of citations across policies and coverage decisions. Payers were classified as for-profit or mutual fund versus non-profit or government, and their coverage decisions were categorized as either coverage (limited or specified) or no coverage. Results: Among 32 unique sources cited, peer-reviewed literature as a single source was most frequently cited across all policies. Of 207 peer-reviewed papers cited across all policies, 40% (n = 83) were psychiatry-specific real-world evidence (RWE) studies. No statistically significant relationships were observed when comparing variance in the number of citations per policy by payer type (p = 0.22) or coverage decision (p = 0.75; unadjusted variance of 61.25 and an adjusted variance of 60.98 for both comparisons). For-profit or mutual fund payers and/or payers providing no coverage cited systematic reviews and non-randomized controlled cohort RWE studies most often. Non-profit or government payers and/or payers providing coverage cited case series or case-control RWE studies most often. Six psychiatry-specific RWE studies and contributions from 13 distinct sources were often cited, regardless of payer type or coverage decision. Conclusions: RWE, among several sources, are cited in many forms and to varying degrees among payers providing coverage decisions for PGx testing in psychiatry, with coverage determinations being largely based on how certain payers interpret evidence on the clinical value of testing. Full article

(This article belongs to the Special Issue Personalized Medicine in Psychiatry: Challenges and Opportunities)

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19 pages, 2042 KiB

Open AccessArticle

Comprehensive Management of Cocaine-Induced Midline Destructive Lesions: A Young-IfOS Consensus

by Alberto Maria Saibene, Letizia Nitro, Florent Carsuzaa, Mihaela Alexandru, Vincent Bedarida, Matteo Di Bari, Léa Fath, Ainhoa Garcia-Lliberos, Margaux Legré, David Lobo-Duro, Antonino Maniaci, Thomas Radulesco, Leigh Sowerby, Neil Tan, Manuel Tucciarone, Clair Vandersteen, Valentin Favier and Maxime Fieux

J. Pers. Med. 2025, 15(6), 231; https://doi.org/10.3390/jpm15060231 - 3 Jun 2025

Abstract

Background: Recreational nasal cocaine use (RNCU) presents a significant challenge for rhinologists due to cocaine-induced midline destructive lesions (CIMDLs). This clinical consensus statement (CCS) offers guidelines for diagnosing, assessing, and managing both proven and suspected cases of CIMDL (including those without a prior [...] Read more.

Background: Recreational nasal cocaine use (RNCU) presents a significant challenge for rhinologists due to cocaine-induced midline destructive lesions (CIMDLs). This clinical consensus statement (CCS) offers guidelines for diagnosing, assessing, and managing both proven and suspected cases of CIMDL (including those without a prior RNCU history). It aims to support clinicians in addressing these complex cases effectively. Methods: An international, multidisciplinary panel of 18 specialists employed a three-round modified Delphi-method survey to evaluate statements covering CIMDL management issues such as definition, clinical evaluation and diagnosis, initial management approaches, and surgical management of complications and reconstructions. This study primarily targets otorhinolaryngologists. Results: Out of 44 evaluated statements, 20 achieved strong consensus, 20 reached consensus, 3 approached near-consensus, and 1 failed to achieve consensus. Consensus-covered areas included the definition of CIMDL, clinical evaluations, first-line management, and management of complications. However, reconstructive techniques remained a contentious topic. Conclusions: In the absence of extensive data, this CCS establishes a management framework for CIMDL, significantly bridging a knowledge gap. It highlights the need for standardized assessments, multidisciplinary cooperation, and customized follow-up care for patients with CIMDL. Considering the widespread use of cocaine, physicians should consistently consider the possibility of RNCU when encountering chronic inflammatory lesions in the sinonasal tract. Full article

(This article belongs to the Special Issue Personalized Medicine for Otolaryngology (ENT))

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15 pages, 3292 KiB

Open AccessArticle

Pericapsular Nerve Group (PENG) Associated with Lateral Femoral Cutaneous Nerve (LFCN) Block Versus Fascia Iliaca Compartment Block (FICB) for Total Hip Replacement Surgery: Double-Blind Randomized Controlled Trial

by Francesco Vetrone, Stefano Marelli, Andrea Galimberti, Michele Umbrello, Miriam Gotti, Angelo Pezzi and Alessandro Girombelli

J. Pers. Med. 2025, 15(6), 230; https://doi.org/10.3390/jpm15060230 - 3 Jun 2025

Abstract

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment [...] Read more.

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment Block (FICB), it is associated with insufficient pain relief and a prolonged quadriceps motor block. The association of the PENG (Pericapsular Nerve Group) with LFCN (lateral femoral cutaneous nerve) blocks may address these limitations, provide improved motor-sparing pain control, and offer a more tailored approach that enhances both an early postoperative recovery and patient satisfaction. Methods: A randomized controlled trial (November 2023–July 2024) compared the PENG + LFCN to the FICB in patients undergoing elective THAs under spinal anesthesia. The primary outcome was quadriceps weakness at 6 h post-block. Secondary outcomes included the degree of hip flexion and pain scores at 6, 24, and 48 h post-block, opioid consumption, and time to ambulation. Results: Fifty-eight patients were randomized (twenty-nine per group). The PENG + LFCN group achieved a significantly greater muscle strength (MRC: 4 [4; 4] vs. 3 [3; 4], p < 0.0001) and better hip flexion at all measured moments (6 h: 45° [37; 60] vs. 30° [25; 43], 24h: 59° [49; 66] vs. 47° [36; 50], 48 h: 62° [55; 70] vs. 50° [40; 55], all p < 0.0001). Resting pain was lower in the PENG + LFCN group (0 [0; 1], 0 [0; 2], and 0 [0; 1] vs. 2 [0; 3], 1 [0; 3], 1 [0; 3]), as was the dynamic pain during movement (1 [0; 2], 2 [2; 4], and 2 [1; 2] vs. 3 [2; 5], 3 [2; 4], and 3 [1; 3]; all p < 0.001), along with a lower total opioid consumption (0 [0; 0] vs. 7.5 [7.5; 22.5] MME, p < 0.001). Conclusions: The PENG + LFCN block outperformed the FICB in muscle strength, hip flexion, pain control, and opioid use, suggesting it may be a more effective option for THAs. Full article

(This article belongs to the Special Issue Anesthesiology and Pain Management in Clinical Medicine)

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11 pages, 595 KiB

Open AccessArticle

Correlations Between Novel Adiposity Indices and Electrocardiographic Evidence of Left Ventricular Hypertrophy in Individuals with Arterial Hypertension

by Giulio Geraci, Pietro Ferrara, Francesco Pallotti, Rosario Le Moli, Vincenzo Calabrese, Valentina Paternò, Luca Zanoli, Antonina Giammanco, Alessandra Bellavia, Liliana Naro, Alessandra Sorce, Luigi La Via, Jacob George, Riccardo Polosa, Giuseppe Mulè and Caterina Carollo

J. Pers. Med. 2025, 15(6), 229; https://doi.org/10.3390/jpm15060229 - 2 Jun 2025

Abstract

Background/Objectives: Obesity is a key driver of cardiovascular disease (CVD), with central adiposity directly involved in adverse cardiac remodeling. Body mass index (BMI) is limited in capturing fat distribution and associated cardiovascular risk. Novel anthropometric indices, including A Body Shape Index (ABSI) and [...] Read more.

Background/Objectives: Obesity is a key driver of cardiovascular disease (CVD), with central adiposity directly involved in adverse cardiac remodeling. Body mass index (BMI) is limited in capturing fat distribution and associated cardiovascular risk. Novel anthropometric indices, including A Body Shape Index (ABSI) and Body Roundness Index (BRI), may offer greater clinical value, but their relationship with electrocardiographic markers of left ventricular hypertrophy (LVH) remains underexplored. This study aims to assess the correlation between novel adiposity indices (ABSI and BRI) and electrocardiographic evidence of LVH, as measured by the Sokolow-Lyon Index (SLI), in individuals with arterial hypertension. Methods: 274 hypertensive patients were recruited, and BMI, ABSI, and BRI were calculated. LVH was assessed via SLI on 12-lead ECG. Participants were stratified by the SLI (≤35 mm vs. >35 mm) for statistical analyses. Results: Patients with a lower SLI showed significantly higher values of ABSI and BRI compared to those in higher SLI group, without differences in BMI. In the entire population, SLI was significantly and inversely correlated with both ABSI (r = −0.296, p < 0.001) and BRI (r = −0.238, p < 0.01), but not with BMI. Multivariate regression analysis confirmed ABSI (p = 0.013) and BRI (p = 0.038) as independent predictors of SLI, even after adjusting for age, blood pressure, renal function, and metabolic parameters. Conclusions: ABSI and BRI are inversely and independently associated with ECG-derived SLI in hypertensive individuals, suggesting that central adiposity may attenuate ECG voltages and obscure LVH detection. Incorporating novel adiposity indices into ECG interpretation may enhance diagnostic accuracy and risk stratification in obese and hypertensive populations. Longitudinal studies are needed to validate these findings and refine clinical algorithms. Full article

(This article belongs to the Section Clinical Medicine, Cell, and Organism Physiology)

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14 pages, 994 KiB

Open AccessReview

Thromboembolic Risk and High Prothrombotic Factors in Childhood Acute Lymphoblastic Leukemia with Ischemic Stroke: A Literature Review of Personalized and Institutional Approaches to Prophylaxis

by Marta Malczewska, Ewa Dudkiewicz, Joanna Zawitkowska and Monika Lejman

J. Pers. Med. 2025, 15(6), 228; https://doi.org/10.3390/jpm15060228 - 2 Jun 2025

Abstract

Background: Although thromboembolic complications are recognized in the treatment of acute lymphoblastic leukemia (ALL), ischemic strokes are rare but severe events. These life-threatening complications not only pose an immediate risk but can also result in long-term neurological deficits, significantly impacting a patient’s [...] Read more.

Background: Although thromboembolic complications are recognized in the treatment of acute lymphoblastic leukemia (ALL), ischemic strokes are rare but severe events. These life-threatening complications not only pose an immediate risk but can also result in long-term neurological deficits, significantly impacting a patient’s quality of life. Identifying high-risk patients and implementing effective prophylaxis strategies are crucial for improving patient outcomes. In addition to strokes, these patients are also at risk of other embolic and thrombotic events, which can occur in up to 35% of patients. Despite this, there are still no clear guidelines for prophylactic management in pediatric patients treated for oncologic diseases. Results: Using the example of a 14-year-old male treated for ALL who suffered an ischemic stroke, we conducted a review of the literature on embolic and thrombotic events, neurological complications, methods of prevention, and ways to monitor and detect patients with an increased risk of such difficulties. We outlined our approach to the monitoring of prothrombotic factors, the interpretation of their levels, and the subsequent adjustment to prophylactic management based on these findings. As a result of this review, we reached two basic conclusions. First, thromboembolic episodes are not uncommon complications in pediatric patients and can cause long-lasting consequences, even after the cancer is cured. Secondly, despite such an urgent problem, clinicians are still struggling with the question of monitoring prothrombotic factors, the choice of drug, and the duration of prophylaxis. Their decisions depend on the experience of the treating center. Conclusions: The pediatric population being treated for malignant disease urgently requires the establishment of guidelines that standardize the management of thromboembolic events. Full article

(This article belongs to the Special Issue Innovative Research and Therapeutics in Pediatric and Adolescent and Young Adult (AYA) Oncology)

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19 pages, 371 KiB

Open AccessArticle

Prospective Evaluation of Adverse Drug Reactions in Hospitalized Older Adults in Ethiopia

by Mengist Awoke Yizengaw, Behailu Terefe Tesfaye, Dula Dessalegn Bosho, Gebremichael Tesfay Desta and Mohammed S. Salahudeen

J. Pers. Med. 2025, 15(6), 227; https://doi.org/10.3390/jpm15060227 - 1 Jun 2025

Abstract

Background: Older adults are vulnerable to adverse drug reactions (ADRs), particularly in low-income settings, yet data on ADR prevalence in Africa, including Ethiopia, remain limited. Objective: This study aimed to evaluate the incidence, severity, and preventability of ADRs among hospitalized older adults, as [...] Read more.

Background: Older adults are vulnerable to adverse drug reactions (ADRs), particularly in low-income settings, yet data on ADR prevalence in Africa, including Ethiopia, remain limited. Objective: This study aimed to evaluate the incidence, severity, and preventability of ADRs among hospitalized older adults, as well as all-cause inpatient mortality. Methods: A cross-sectional observational study was conducted at Jimma Medical Center, located in Jimma town, Ethiopia, from 6 September 2021 to 26 December 2022. The study participants were older adults (n = 162) admitted to the medical wards. ADRs were assessed using the Naranjo ADR probability scale, severity was classified according to the modified Hartwig and Siegel criteria, and preventability was determined using the Schumock and Thornton criteria. Results: The median age of participants was 65 years (interquartile range: 60–70). During their hospital stay, 84 patients (51.9%) experienced at least one ADR. A total of 123 ADRs (76 ADRs per 100 admissions) were captured. Most ADRs (93.5%) were classified as mild to moderate in severity, and 84.5% (n = 105) were considered preventable. Endocrine and metabolic systems (48.8%) and diuretics (43.9%) were the most frequently affected organ systems and drug class linked to ADRs, respectively. Furosemide (41.5%) and aspirin (10.6%) were the most frequently implicated medications, commonly causing hypokalemia (35.3%) and dyspepsia (53.8%), respectively. The observed all-cause in-patient mortality rate was 6.8% (5 deaths per 1000 patient-days). The use of potentially inappropriate medications (PIMs) (aOR: 4.747, p = 0.003) and presence of digestive system disorders (aOR: 8.784, p = 0.038) were associated with an increased risk of ADRs, while a history of recent traditional medicine use (aOR: 0.285, p = 0.042) was linked to a lower risk. Conclusions: More than half of the hospitalized older adults experienced ADRs, most of which were mild to moderate in severity and considered preventable. Regular medication review for screening and minimizing PIM use in older adults may play a crucial role in lowering ADR occurrence. The borderline but statistically significant association between a history of traditional medicine use and lower occurrence of ADRs requires cautious interpretation and further investigation to explore possible explanations. Nearly seven deaths per hundred hospitalized patients were recorded. Full article

(This article belongs to the Special Issue Recent Research on Personalized Approaches to Clinical Therapeutics and Medication Safety)

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