Journal of Personalized Medicine

21 pages, 375 KB

Open AccessReview

Quantitative Electroencephalography as a Complement to Symptom-Based Psychiatric Diagnosis: A Narrative Review

by Francesco Amico, Scott Shannon and Steve Rondeau

J. Pers. Med. 2026, 16(5), 261; https://doi.org/10.3390/jpm16050261 - 13 May 2026

Background: Psychiatric assessments traditionally rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnostic guidance. This approach, however, is heavily based on the identification of cluster symptoms assessed through subjective interviews and questionnaires, without adequately controlling for overlapping symptoms or [...] Read more.

Background: Psychiatric assessments traditionally rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnostic guidance. This approach, however, is heavily based on the identification of cluster symptoms assessed through subjective interviews and questionnaires, without adequately controlling for overlapping symptoms or symptom specificity. This may lead to broad and often inaccurate diagnoses that overlook the patient’s unique experience and underlying neurobiological imbalances. As mental healthcare strives to move towards personalized medicine, incorporating more objective and precise measures of neuropsychological distress, it is essential to reduce the diagnostic and treatment inaccuracies that may stem from relying solely on empirical guidelines. This narrative review examines the limitations of the current approach and considers the potential role of quantitative electroencephalography (qEEG) as an adjunctive method that may enrich existing diagnostic processes. Methods: A structured literature search was conducted in Europe PMC on 31 January 2026. Original human studies and clinical trials in English with available abstracts were thematically selected. Results: The search yielded 1934 records, from which a focused subset of studies was selected based on direct relevance to the review themes. Conclusions: Integrating qEEG methods into traditional assessments could enhance diagnostic accuracy in psychiatric care and reduce patients’ exposure to inadequate treatments, ultimately leading to improved treatment outcomes and patient satisfaction. Full article

(This article belongs to the Special Issue Mental Health: Diagnosis, Therapeutic Intervention and Patient Management in the Era of Personalized Medicine)

15 pages, 16174 KB

Open AccessArticle

Reconstructive Goals in Arm and Elbow Defects Treated with the Pedicled Latissimus Dorsi Flap

by Ömer Kokaçya, Umut Dalgıç, Abdullah Arslan, İbrahim Tabakan, Gazi Kutalmış Yaprak, Ahmet Cemil Dalay and Erol Kesiktaş

J. Pers. Med. 2026, 16(5), 260; https://doi.org/10.3390/jpm16050260 - 13 May 2026

Abstract

Background/Objectives: Reconstruction of complex soft-tissue defects of the arm and elbow remains challenging because of exposed neurovascular structures, wide joint mobility, and the need to preserve function. The pedicled latissimus dorsi (LD) flap remains a valuable option, particularly when recipient vessels are compromised [...] Read more.

Background/Objectives: Reconstruction of complex soft-tissue defects of the arm and elbow remains challenging because of exposed neurovascular structures, wide joint mobility, and the need to preserve function. The pedicled latissimus dorsi (LD) flap remains a valuable option, particularly when recipient vessels are compromised or functional restoration is required. Given the heterogeneity of these injuries, treatment must be individualized according to each patient’s defect characteristics, functional demands, and rehabilitation goals, reflecting personalized medicine principles. This study evaluated the indications and outcomes of pedicled LD flap transfer in arm and elbow defects. Methods: All consecutive patients who underwent pedicled LD flap reconstruction for upper extremity soft-tissue defects at our institution (January 2015–January 2025) were retrospectively reviewed. Demographic data, defect etiology, flap type, reconstructive goals, complications, and functional outcomes were analyzed. Results: Twenty-six patients were included (mean age 28.5 ± 7.6 years; 84.6% male). Electrical burns were the predominant etiology (92.3%). A musculocutaneous flap was used in 22 patients (84.6%) and a muscle-only flap in 4 (15.4%); supplementary split-thickness skin grafting was required in 17 (65.4%). Reconstructive goals included elbow flexion restoration (±neurovascular repair and soft-tissue coverage) in 12 patients (46.2%) and humeral stump preservation for prosthetic use in 14 (53.8%). No total flap loss occurred. Complications included partial necrosis in 1 patient (3.8%), donor-site seroma in 3 (11.5%), wound dehiscence in 2 (7.7%), and recipient-site hematoma in 1 (3.8%). No patient required amputation or shoulder disarticulation. Conclusions: The pedicled LD flap is a reliable option for complex arm and elbow defects. By tailoring flap design, nerve management, and rehabilitation to individual patient needs, this approach exemplifies personalized reconstructive planning in upper extremity trauma. Full article

(This article belongs to the Special Issue Personalized Plastic and Reconstructive Surgery: Challenges and Prospects)

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Graphical abstract

21 pages, 5859 KB

Open AccessReview

Pediatric OSA—Spectrum of the Disease and Opportunities for Personalized Interventions

by Hui-Leng Tan, Athanasios Kaditis and David Gozal

J. Pers. Med. 2026, 16(5), 259; https://doi.org/10.3390/jpm16050259 - 12 May 2026

Abstract

Pediatric obstructive sleep-disordered breathing encompasses a wide spectrum of diagnostic clusters, including primary snoring, upper airway resistance syndrome, mild, moderate, and severe obstructive sleep apnea, and obstructive hypoventilation. Even within these classifications, the symptomatic presentation involves a large array of variations, reflecting a [...] Read more.

Pediatric obstructive sleep-disordered breathing encompasses a wide spectrum of diagnostic clusters, including primary snoring, upper airway resistance syndrome, mild, moderate, and severe obstructive sleep apnea, and obstructive hypoventilation. Even within these classifications, the symptomatic presentation involves a large array of variations, reflecting a wide phenotypic spectrum. Here, we aim to summarize current diagnostic criteria and explore the spectrum of disease, particularly highlighting the phenotypic variation and its potential relevance to therapeutic decisions and overall outcomes. It has become apparent that polysomnographic (PSG) indices do not correlate well with associated morbidities, even though one-night in-lab PSGs are considered the diagnostic gold standard. Novel approaches, including exploration of plasma and urine biomarkers and data-mining the physiological information embedded within the PSG, may enable the extraction of phenotypic information that can then be interpreted in conjunction with clinical data, including history, physical examination findings, risk factors, and associated disease morbidity, so that an individualized treatment plan can be optimally delineated. Full article

(This article belongs to the Special Issue Treatment and Management of Sleep Apnea)

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Graphical abstract

13 pages, 3501 KB

Open AccessArticle

Finite-Element Computer Modeling of Spatial Displacement of the Pterygoid Venous Plexus During Mandibular Movements

by Hadi Darawsheh, Dmitry Leonov, Sergey Dydykin, Beatrice Volel, Ellina Velichko, Irina Usmanova, Irina Lakman, Anzhela Brago, Seyedamirhossein Hosseini, Evgeniy Sosnin and Yuriy Vasil’ev

J. Pers. Med. 2026, 16(5), 258; https://doi.org/10.3390/jpm16050258 - 12 May 2026

Abstract

The safety of mandibular anesthesia is directly dependent on a precise understanding of the spatial relationships in the pterygomandibular space, particularly the risk of injury to the highly vascularized pterygoid venous plexus (PVP). In vivo studies of PVP displacement during mandibular movements face [...] Read more.

The safety of mandibular anesthesia is directly dependent on a precise understanding of the spatial relationships in the pterygomandibular space, particularly the risk of injury to the highly vascularized pterygoid venous plexus (PVP). In vivo studies of PVP displacement during mandibular movements face significant technical challenges. Objective: The study aims to study the spatial displacements of the pterygoid venous plexus during various physiological positions of the mandible using computer modeling with the finite-element method (FEM). Materials and Methods: A three-dimensional finite-element model was developed based on computed tomography data and the BodyParts3D anatomical atlas. The model included the bony structures of the skull, mandible, temporomandibular joint, masticatory muscles, and blood vessels. Simulations were performed for vertical displacements of the jaw at 15, 25, and 35 mm, as well as horizontal displacements of 5 mm to the left and right. Results: It was found that the magnitude of PVP displacement is proportional to the degree of mouth opening. The maximum total displacement (1.24 mm) was recorded at a 35 mm opening along the “posterior–medial–inferior” vector. Lateral excursions revealed asymmetry: displacement to the right caused plexus movement posteriorly, medially, and inferiorly (0.66 mm), while displacement to the left resulted in movement anteriorly, laterally, and superiorly (0.64 mm). Conclusions: This study demonstrates the significant mobility of the pterygoid venous plexus, which depends on the direction and amplitude of mandibular movements. The obtained data have important practical implications for planning regional anesthesia and minimizing the risk of iatrogenic complications. From a biomechanical perspective, maximum mouth opening produces the greatest displacement of the PVP, which may hypothetically reduce the risk of vascular puncture. Clinical studies are required to confirm this. Full article

(This article belongs to the Special Issue Personalized Medicine and Technology in Oral Science)

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11 pages, 574 KB

Open AccessArticle

Contralateral Recurrence and Temporal Trend After First Side Surgery for Primary Spontaneous Pneumothorax: A Multicenter Analysis

by Antonio Giulio Napolitano, Dania Nachira, Gloria Santoro, Eleonora Coviello, Maria Teresa Congedo, Marco Sanguigni, Domenico Pourmolkara, Chiara Scognamiglio, Leonardo Petracca Ciavarella, Adriana Nocera, Maria Letizia Vita, Felice Mucilli, Jacopo Vannucci, Elisa Meacci, Francesco Puma, Filippo Lococo and Stefano Margaritora

J. Pers. Med. 2026, 16(5), 257; https://doi.org/10.3390/jpm16050257 - 9 May 2026

Abstract

Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence [...] Read more.

Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence assessing the potential role of clinical factors in risk stratification. Methods: A total of 479 patients surgically treated for PSP (2012–2024) across three Italian high-volume centers were retrospectively reviewed. Secondary pneumothorax, patients <18 years old, lung emphysema or intraparenchymal large bullae, and the thoracotomy approach were excluded. The association between categorical variables and contralateral recurrence was assessed using the chi-square (χ²) test, while the association with continuous variables was evaluated using the t-test. Time to recurrence was analyzed using Kaplan–Meier survival curves. Variables with a p-value < 0.05 were considered statistically significant. Results: We identified 59 patients who experienced contralateral recurrence: 45 were males, the mean age was 26.66 ± 12.32 and the mean BMI was 22.00 ± 2.92; only 13 were active smokers. Age (p < 0.001) and smoking history (p = 0.029) were significantly associated with contralateral recurrence in univariate analysis, though these were not confirmed in multivariate analysis. Among the cohort of recurrence, 53 patients only had a recurrence on the contralateral side, with a median time to recurrence of 139 days. The incidence rate ratio (IRR) of recurrence for patients with a mean age of < 34 years was 1.23, which translates to a 23% increased risk. No significant impact of age (p = 0.25), sex (p = 0.67), or smoking (p = 0.59) on the time to recurrence on the other side was observed through Kaplan–Meier analysis. The peak incidence for the first episode of PNX surgically treated and contralateral recurrence was observed in October, November and January. Conclusions: This study highlights a 12% contralateral recurrence rate after PSP surgery. Younger age is associated with earlier contralateral recurrence. Seasonality may influence recurrence patterns. Further studies should explore underlying mechanisms and preventive strategies. Full article

(This article belongs to the Special Issue Minimally Invasive Thoracic Surgery: Risk Assessment and Personalized Perioperative Management)

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Graphical abstract

9 pages, 183 KB

Open AccessEditorial

Radiotherapy and Immunotherapy at a Crossroads: Mechanistic Foundations, Emerging Evidence, and a New Horizon for Precision Oncology

by Gianluca Ferini and Stefano Forte

J. Pers. Med. 2026, 16(5), 256; https://doi.org/10.3390/jpm16050256 - 8 May 2026

Abstract

The trajectory of modern oncology is increasingly defined by the convergence of two therapeutic paradigms that were once considered only marginally related: radiotherapy and immunotherapy [...] Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Current Advancements and Future Perspectives)

11 pages, 390 KB

Open AccessArticle

Chronic Obstructive Pulmonary Disease Hospitalization in Spain (2016–2023): Mortality Impact of Comorbidity, Sex-Based Disparities and the Impact of COVID-19

by Maria Sanchez-McNamara, Maria-Jose Fernandez-Cotarelo, Begoña Perez-de-Paz, Lydia Rodriguez-Romero, Esther Anton-Diaz, Paz Rodriguez-Bolado, Eva Griñan-Fernandez, Victor Moreno and Cesar Henriquez-Camacho

J. Pers. Med. 2026, 16(5), 255; https://doi.org/10.3390/jpm16050255 - 8 May 2026

Abstract

Background: COPD remains a leading cause of hospitalization and mortality worldwide. This study aimed to analyze trends in COPD patients in Spain from 2016 to 2023, compare outcomes between patients with COPD as a primary versus secondary diagnosis, and identify factors associated with [...] Read more.

Background: COPD remains a leading cause of hospitalization and mortality worldwide. This study aimed to analyze trends in COPD patients in Spain from 2016 to 2023, compare outcomes between patients with COPD as a primary versus secondary diagnosis, and identify factors associated with in-hospital mortality. Methods: Retrospective observational study using the Spanish database CMBD. 711.799 patients were analyzed. Demographic characteristics, Charlson Comorbidity Index (CCI), complications, mortality, and hospitalization costs were also evaluated. Multivariate logistic regression was used to identify mortality risk factors. Results: The overall hospitalization rate was 20.02 per 1000 admissions. It decreased by 30% during 2020–2021 before rebounding to peak levels in 2023. The proportion of female patients increased from 19.9% (2016) to 26.4% (2023). Patients with COPD as a secondary diagnosis had higher mortality (13% vs. 5.4%, p < 0.001), greater comorbidity burden (mean CCI 3.5 vs. 2.8), and higher costs. While overall admissions dropped in 2020, mortality peaked at 11.7%, and the number of patients with extremely severe disease nearly doubled. Independent risk factors for mortality included sepsis, age ≥ 66 years, CCI ≥ 3, and COVID-19. Conclusions: Hospitalization involving COPD in Spain showed pandemic-related fluctuations with increasing clinical complexity and increasing female sex. The higher mortality and cost associated with secondary COPD diagnosis highlight the need for comprehensive risk stratification of comorbid conditions and multidisciplinary management of these patients. Early identification of sepsis and CCI scores is essential to improve clinical outcomes in the aging population. Full article

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

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Graphical abstract

17 pages, 831 KB

Open AccessReview

Coronary Microvascular Dysfunction and Lipid Molecules: Pathophysiological Mechanisms, Clinical Assessment, and Therapeutic Implications

by Abdelrahman Hafez, Juan M. Farina, Kamal Awad, Milagros Pereyra Pietri, Isabel G. Scalia, Hesham Sheashaa, Fatmaelzahraa E. Abdelfattah, Mahshad Razaghi, Sherif Ahmed, Ramzi Ibrahim, David Simper, Steven J. Lester, Balaji Tamarappoo, Chadi Ayoub and Reza Arsanjani

J. Pers. Med. 2026, 16(5), 254; https://doi.org/10.3390/jpm16050254 - 6 May 2026

Abstract

Coronary microvascular dysfunction (CMD) has emerged as a crucial contributor to cardiovascular morbidity and mortality, particularly in patients with ischemia and non-obstructive coronary arteries (INOCA). The condition arises from a complex interplay of structural and functional abnormalities within the small coronary vessels, driven [...] Read more.

Coronary microvascular dysfunction (CMD) has emerged as a crucial contributor to cardiovascular morbidity and mortality, particularly in patients with ischemia and non-obstructive coronary arteries (INOCA). The condition arises from a complex interplay of structural and functional abnormalities within the small coronary vessels, driven by underlying molecular mechanisms including endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and chronic inflammation. Lipid metabolism plays a central role in this pathology, especially in the setting of elevated low-density lipoprotein cholesterol (LDL-C). Furthermore, the protective capacity of high-density lipoprotein (HDL) is increasingly understood to depend on its functionality rather than absolute levels, as it can become dysfunctional and pro-inflammatory in pathological states. Emerging evidence has identified lipoprotein(a) [Lp(a)] and triglyceride-rich lipoproteins as significant, independent contributors to microvascular injury. Comprehensive clinical assessment of microvascular dysfunction therefore requires integration of advanced lipid profiling, including apolipoprotein B (ApoB), [Lp(a)], and the triglyceride-glucose (TyG) index with invasive and non-invasive measures of coronary flow reserve to more precisely stratify risk. In this narrative review, we synthesize current observational, mechanistic, and early interventional data linking diverse lipid phenotypes to coronary microvascular dysfunction. We propose a concept of lipid-driven CMD endotypes, such as ApoB-/particle overload, dysfunctional HDL, Lp(a)-mediated risk, and metabolic/TyG-high states, and map these to a practical, mechanism-informed management framework. While intensive LDL-C lowering with high-intensity statins and combination therapy remains guideline-directed care for high-risk patients, evidence for dedicated microvascular benefit from newer lipid and cardiometabolic agents is still largely hypothesis-generating. A personalized approach that aligns lipid phenotyping, CMD endotyping, and existing guideline-based therapies may help refine risk assessment and inform future trials. Full article

(This article belongs to the Special Issue Review Special Issue: Recent Advances in Personalized Medicine)

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22 pages, 13642 KB

Open AccessArticle

Effects of Mechano-Sonic Vibration Therapy on Muscle Strength, Pain, and Joint Function in Elderly Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective, Case-Control Study

by Raoul Saggini, Domiziano Tarantino, Claudia Barbato, Raffaello Pellegrino, Francesco Pegreffi and Rosa Grazia Bellomo

J. Pers. Med. 2026, 16(5), 253; https://doi.org/10.3390/jpm16050253 - 6 May 2026

Abstract

Background: Early recovery after total hip (THA) and total knee arthroplasty (TKA) is often limited by pain and impaired antigravity function. Mechano-acoustic vibration therapy (VT) may enhance neuromuscular activation and analgesia, but evidence in arthroplasty is scarce. Methods: A total of 380 patients [...] Read more.

Background: Early recovery after total hip (THA) and total knee arthroplasty (TKA) is often limited by pain and impaired antigravity function. Mechano-acoustic vibration therapy (VT) may enhance neuromuscular activation and analgesia, but evidence in arthroplasty is scarce. Methods: A total of 380 patients aged ≥65 years were retrospectively identified within 3 ± 1 days after primary unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA). All patients underwent standard inpatient physiotherapy; in the VT group, mechano-acoustic vibration therapy (ViSS^®, 30 min/day for 5 days at 200–300 Hz) was added as an adjunct treatment, whereas the control group received standard physiotherapy alone. Pain (VAS, McGill), muscle strength (MRC), thigh circumferences, and 10 s Sit-to-Stand were assessed at baseline (T0), end of treatment (T1), and 3-day follow-up (T2). Results: VT produced large, early and sustained improvements in both cohorts. In THA patients, VAS decreased from 7.1 ± 1.1 to 3.8 ± 0.6 at T1 and 3.0 ± 0.7 at T2 and Sit-to-Stand repetitions increased from 3.7 ± 1.9 to 6.3 ± 1.7 at T2, with significant gains in strength and circumferences. TKA VT patients showed similar patterns. Control groups reported smaller pain reductions and no clinically relevant changes in the reported outcomes. Conclusions: integrating a short cycle of mechano-acoustic VT into early inpatient rehabilitation after THA or TKA significantly enhances pain relief and restoration of antigravity function compared with standard physiotherapy alone. VT represents a promising adjunct to conventional rehabilitation strategies and may contribute to optimizing postoperative recovery pathways in major joint replacement. Full article

(This article belongs to the Special Issue Precision Orthopedics: Evolving Shoulder, Hip, and Knee Surgery Through Intelligent Technology and Personalized Clinical Care)

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14 pages, 323 KB

Open AccessArticle

Central Sensitization in Spondyloarthritis: Implications for Personalized Medicine

by Linda Carli, Federico Fattorini, Marco Di Battista, Lorenzo Esti, Cosimo Cigolini, Marta Mosca and Andrea Delle Sedie

J. Pers. Med. 2026, 16(5), 252; https://doi.org/10.3390/jpm16050252 - 5 May 2026

Abstract

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with [...] Read more.

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with a high likelihood of CS. Objectives: To investigate the prevalence of CS in our cohort and its association with clinical characteristics of patients and their quality of life. Methods: Adult patients with a diagnosis of Psoriatic Arthritis (PsA) or Axial Spondyloarthritis (AxSpA) who were also classifiable according to ClASsification criteria for Psoriatic Arthritis (CASPAR) and Assessment of SpondyloArthritis international Society (ASAS) criteria respectively, and regularly followed at the SpA outpatient clinic of our Unit were consecutively enrolled from April to November 2023. Their epidemiologic, clinical and clinimetric data were collected, as well as patient-reported outcome measures (PROMs) [CSI, Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), and Hospital Anxiety and Depression Scale (HADS)]. Considering the definition of “difficult-to-treat” rheumatoid arthritis, we defined as “multi-failure” those patients who were treated with more than two biologic disease-modifying anti-rheumatic drugs (bDMARDs) with different mechanisms of action. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. p-values < 0.05 were considered significant. Results: A total of 100 patients were enrolled, 46 male (46.0%) and 54 female (54.0%), with a mean age of 59.4 ± 9.8 years and a mean disease duration of 14.8 ± 10.1 years; 79 patients (79%) had a diagnosis of PsA and 21 (21%) of AS. Forty-two patients (42.0%) had a CSI score ≥ 40. Significant correlations were found between a CSI score ≥ 40 and female sex (p = 0.004), the occurrence of enthesitis (p = 0.05), DAPSA-CRP (p = 0.02) and ASDAS scores (p = 0.03), a multi-failure condition (p = 0.01), fibromyalgia (FM) (p = 0.004), thyroid disease (p = 0.016) and obesity (p = 0.047). Regarding PROMs, significant correlations were found between CSI and values of HADS (both anxiety and depression), FACIT-F, HAQ and all the domains of SF-36 (p-value < 0.0001). Conclusions: Our data confirmed that more than 40% of SpA patients had CSI values ≥ 40 and underlined how CS could widely impair their disease burden. A routinary evaluation of CS and a multifactorial biopsychosocial perspective in the diagnosis and management of chronic pain in patients with SpA could help rheumatologists in improving their quality of care. Full article

(This article belongs to the Section Personalized Preventive Medicine)

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16 pages, 1949 KB

Open AccessArticle

Postoperative Septic Shock After Esophagectomy for Esophageal Cancer: Risk Factors and Impact on Short- and Long-Term Survival

by Patricia Piñeiro, Francisco Sánchez, Alberto Calvo, María Tudela, Silvia Ramos, Sergio García, Pilar Benito, Isabel Solchaga, Raquel Vela, Claudia Menéndez, Eneko Cabezuelo and Ignacio Garutti

J. Pers. Med. 2026, 16(5), 251; https://doi.org/10.3390/jpm16050251 - 4 May 2026

Abstract

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted [...] Read more.

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted a retrospective observational study including consecutive adult patients who underwent esophagectomy with curative intent for esophageal cancer between January 2015 and December 2024 at a tertiary referral center. Postoperative septic shock was defined according to Sepsis-3 criteria. Demographic, clinical, surgical, laboratory, and oncological variables were analyzed. Independent risk factors for septic shock were identified using multivariate logistic regression. Overall survival was assessed using Kaplan–Meier analysis. Results: Among 106 patients, 19 (17.9%) developed postoperative septic shock. These patients had a lower body mass index, reduced preoperative and postoperative albumin levels, and a higher incidence of advanced lymph node involvement. Septic shock was strongly associated with severe postoperative complications, including anastomotic leakage, hemorrhagic shock, acute respiratory distress syndrome, acute kidney failure, and increased rates of PICU readmission. In multivariate analysis, lower albumin levels at PICU admission (OR 0.54; 95% CI 0.29–0.99) and advanced nodal stage (OR 4.98; 95% CI 1.36–18.3) were independently associated with the development of septic shock. Patients who developed septic shock had significantly higher in-hospital mortality (31.6% vs. 1.1%, p < 0.001) and markedly reduced long-term survival, even among those discharged alive. Conclusions: Postoperative septic shock after esophagectomy is a devastating complication with a profound negative impact on both short- and long-term survival. Hypoalbuminemia and advanced lymph node involvement are independent predictors of septic shock. These findings support the integration of simple clinical and laboratory markers into personalized perioperative risk stratification models, enabling individualized management strategies to reduce severe postoperative complications. Full article

(This article belongs to the Section Personalized Medical Care)

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4 pages, 157 KB

Open AccessEditorial

Personalized Approaches to Spine Surgery: Innovations and Future Directions

by Kai-Uwe Lewandrowski

J. Pers. Med. 2026, 16(5), 249; https://doi.org/10.3390/jpm16050249 - 4 May 2026

Abstract

Personalized spine care is increasingly understood as more than the use of custom implants, robotics, navigation, or advanced imaging alone [...] Full article

(This article belongs to the Special Issue Personalized Approaches to Spine Surgery: Innovations and Future Directions)

14 pages, 1005 KB

Open AccessArticle

Comparison of Three International Definitions for Overweight and Obesity in a Population of Adolescents in Greece

by Eleni M. Domouzoglou, Evangelia E. Ntzani, Michail I. Papafaklis, Anastasios Serbis, Ekaterini Siomou, Flora Bacopoulou and Assimina Galli-Tsinopoulou

J. Pers. Med. 2026, 16(5), 250; https://doi.org/10.3390/jpm16050250 - 3 May 2026

Abstract

Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF [...] Read more.

Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF and CDC) for overweight/obesity in adolescents in Northwestern Greece. Methods: A total of 403 adolescents aged 10–17 years were included. Agreement metrics and assessment of marginal heterogeneity and asymmetry were used for the comparison of the definitions. Results: In the total population, high agreement was observed among all definitions (Krippendorff’s alpha: 0.931, 95% CI 0.913–0.949). However, there was significant marginal heterogeneity (p < 0.001) and asymmetry (p < 0.001) for each pairwise comparison. WHO definition consistently yielded higher prevalence of obesity (WHO: 23.1%, IOTF: 15.4%, CDC: 21.6%). There were no significant differences in agreement (p = 0.247 for the comparison) between males and females, with more prominent marginal heterogeneity and asymmetry in males. Agreement among definitions was numerically lower in young adolescents aged < 14 years versus older ones (alpha: 0.919 vs. 0.953, p = 0.082), and systematic bias (p < 0.001) and asymmetry (p < 0.001) were present only in young adolescents without any significant difference in older ones. Conclusions: Although agreement was very high among definitions, they are not interchangeable, yielding different prevalence rates, particularly in young adolescents. IOTF criteria resulted in a reduced diagnosis of obesity and could lead to undertreatment; in contrast, WHO and CDC criteria may lead to overdiagnosis in our population. Caution is required when interpreting international criteria for overweight/obesity in various populations. Full article

(This article belongs to the Special Issue Personalized Medicine of Obesity and Metabolic Disorders)

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11 pages, 1069 KB

Open AccessCase Report

Promises and Pitfalls of Whole Exome Sequencing in Therapy-Resistant Chronic Thrombocytopenia in Childhood: A Case Report

by Eszter Györke, Gábor Benyó, Kristóf Balázs Árvai, Csaba Bödör, László Kereskai, Hajnalka Ábrahám, Barbara Réger, Bálint Egyed and Gábor Ottóffy

J. Pers. Med. 2026, 16(5), 248; https://doi.org/10.3390/jpm16050248 - 2 May 2026

Abstract

Background: The etiological diagnosis of chronic thrombocytopenia in children remains challenging and is often established by exclusion. In this article, we present the case of a patient in whom we used whole-exome sequencing (WES) to help identify the underlying cause and determine the [...] Read more.

Background: The etiological diagnosis of chronic thrombocytopenia in children remains challenging and is often established by exclusion. In this article, we present the case of a patient in whom we used whole-exome sequencing (WES) to help identify the underlying cause and determine the appropriate treatment. Methods: Whole-exome sequencing was performed to clarify the genetic background of the disease. Based on the results, transmission electron microscopy (TEM) was also carried out to confirm or exclude the pathogenic role of the identified NBEAL2 gene variant and to assess the presence of gray platelet syndrome. Results: In this patient, despite the presence of the NBEAL2 gene variant, neither gray platelet syndrome nor a pathogenic role of the variant could be confirmed. However, the genetic findings identified by WES led to numerous additional investigations, causing a considerable burden on both the patient and the family. Conclusions: Our case highlights that WES testing, which is emerging in pediatric hematology practice, offers not only diagnostic advantages but also pitfalls. Whole-exome sequencing has recently emerged as a new diagnostic tool and has been available nationwide in pediatric hematology-oncology care in Hungary for just over two years. While personalized treatment strategies for benign hematologic diseases increasingly rely on high-throughput genetic testing, the clinical application of WES requires a cautious, critical evaluation of results. Despite the method’s promise, the heterogeneity of the findings underscores the need to interpret WES results carefully and to place them in a clinical context in every case. Full article

(This article belongs to the Special Issue Genetic Counseling and Genome Sequencing in Pediatrics)

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6 pages, 178 KB

Open AccessEditorial

Personalized Medicine in Otolaryngology: Reflections on a Multidisciplinary Special Issue

by Mehdi Abouzari

J. Pers. Med. 2026, 16(5), 247; https://doi.org/10.3390/jpm16050247 - 1 May 2026

Abstract

The practice of medicine has long aspired to treat the individual rather than the disease, yet it has only been in recent decades that the scientific and technological tools required to fulfill this aspiration have begun to mature [...] Full article

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

34 pages, 2612 KB

Open AccessReview

The Bright and Dark Sides of Nitric Oxide in Neurodegenerative Diseases

by Lucia Buccarello, Costanza Montagna, Sabina Di Matteo, Renata Mangione, Giuseppe Carota, Jay Sibbitts, Romana Jarosova, Susan M. Lunte, Giacomo Lazzarino and Giuseppe Caruso

J. Pers. Med. 2026, 16(5), 246; https://doi.org/10.3390/jpm16050246 - 1 May 2026

Abstract

Nitric oxide (NO) plays an important role in neuronal communication, synaptic plasticity and vascular regulation. Due to its important function in neuronal homeostasis, NO imbalance is associated with neurodegeneration. Specifically, in Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD) and frontotemporal [...] Read more.

Nitric oxide (NO) plays an important role in neuronal communication, synaptic plasticity and vascular regulation. Due to its important function in neuronal homeostasis, NO imbalance is associated with neurodegeneration. Specifically, in Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD) and frontotemporal lobar degeneration (FTLD), an excessive amount of NO, mostly produced by inducible NO synthase (iNOS), reacts with superoxide to form peroxynitrite, driving oxidative/nitrosative stress, mitochondrial dysfunction, and aberrant protein modifications. In AD, NO dysregulation promotes amyloid-β (Aβ) accumulation, tau hyperphosphorylation and synaptic loss, creating a self-perpetuating cycle of neuronal damage. NO’s dual role, protective at physiological levels but harmful if overproduced, underscores the therapeutic potential of antioxidant compounds that restore the balance of NO/NOS (especially iNOS) while preserving physiological functions. However, despite the emerging role of antioxidant-based therapeutic approaches, clinical translation is limited by the complexity of NO signaling and the absence of safe, specific NOS inhibitors. By targeting the molecular switch from protective to toxic, NO activity may offer new personalized treatment avenues for neurodegenerative diseases. Full article

(This article belongs to the Special Issue Advancing Personalized Medicine: Targeting Oxidative Stress in Neurodegenerative Diseases)

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10 pages, 548 KB

Open AccessArticle

Association of Plasma IL-6 with Indoor Radon Exposure in Children with Non-Allergic Asthma

by Saleh Alsulami, Youn Soo Jung, Kari Nadeau, Perdita Permaul, Longxiang Li, Petros Koutrakis, Jonathan M. Gaffin, Wanda Phipatanakul and Tina M. Banzon

J. Pers. Med. 2026, 16(5), 245; https://doi.org/10.3390/jpm16050245 - 30 Apr 2026

Abstract

Background/Objectives: Radon exposure has recently been associated with asthma morbidity, including increased airway inflammation and school absenteeism in children, though limited data on underlying biological mechanisms exist. Interleukin-6 (IL-6), a pleiotropic cytokine implicated in both Type 2-low airway inflammation and radon-related lung carcinogenesis, [...] Read more.

Background/Objectives: Radon exposure has recently been associated with asthma morbidity, including increased airway inflammation and school absenteeism in children, though limited data on underlying biological mechanisms exist. Interleukin-6 (IL-6), a pleiotropic cytokine implicated in both Type 2-low airway inflammation and radon-related lung carcinogenesis, may represent a key mechanistic link between radon exposure and asthma morbidity. We aimed to evaluate the association between indoor radon exposure and plasma IL-6 levels in children with asthma and whether this relationship differs by allergic sensitization status. Methods: We analyzed baseline data from the School Inner-City Asthma Study, a prospective cohort of children aged 4–13 years with persistent asthma. Monthly indoor radon concentrations at each participant’s residential ZIP Code Tabulation Area were estimated using a validated spatiotemporal prediction model. Plasma IL-6 was measured from baseline blood samples. Multivariable linear mixed-effects models with random intercepts for school were used to assess the association between radon exposure and IL-6, adjusting for demographic, clinical, and socioeconomic covariates. Effect modification by allergic sensitization was evaluated using an interaction term. Results: Among 144 participants, 62.5% were allergen-sensitized. The median home radon concentration was 46.6 Bq/m³ (range 30.7–99.9), and the mean plasma IL-6 was 0.22 pg/mL (SD 0.41). A significant interaction was observed between radon exposure and allergic sensitization status (β-interaction = −0.012; p = 0.014), indicating differential effects by phenotype. Among non-sensitized children, higher radon exposure was associated with increased IL-6 levels (β = 0.0088; p = 0.044), corresponding to a 0.32 pg/mL rise in IL-6 per 37 Bq/m³ increase in radon. No significant association was observed among sensitized children. Conclusions: Indoor radon exposure is associated with higher plasma IL-6 levels in non-sensitized children with asthma, suggesting a potential IL-6–mediated pathway linking radon exposure to asthma morbidity in the Type 2-low phenotype. These findings highlight heterogeneity in environmental asthma responses and support further investigation into radon mitigation as a modifiable factor to improve asthma outcomes. IL-6 may serve as a biomarker to identify children most susceptible to radon-related airway inflammation, guiding personalized mitigation strategies and targeted interventions to improve asthma outcomes. Future studies should incorporate direct home radon measurements, comprehensive endotyping panels, and longitudinal biomarker sampling to validate these findings and elucidate whether IL-6 trans-signaling pathways mediate radon-induced airway injury in non-allergic asthma. Full article

(This article belongs to the Special Issue Mechanisms of Airway Inflammation in Asthma)

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15 pages, 896 KB

Open AccessArticle

Development and Evaluation of a Radiomics-Based 3D Volumetric and Densitometric Tomographic Scoring System for Chronic Rhinosinusitis with Nasal Polyposis: A Comparative Analysis

by Simonetta Masieri, Elona Begvarfaj, Pasquale Frisina, Carlo Cavaliere, Antonella Loperfido, Francesca Lombardi, Marcella Bugani and Daniela Messineo

J. Pers. Med. 2026, 16(5), 244; https://doi.org/10.3390/jpm16050244 - 30 Apr 2026

Abstract

Background/Objectives: The therapeutic effectiveness of chronic rhinosinusitis with nasal polyposis (CRSwNP) depends on an accurate diagnosis that identifies disease characteristics, evaluates sinus patency, and detects paranasal sinus obliteration. This study aims to assess a novel artificial intelligence (AI) system integrated with radiomic [...] Read more.

Background/Objectives: The therapeutic effectiveness of chronic rhinosinusitis with nasal polyposis (CRSwNP) depends on an accurate diagnosis that identifies disease characteristics, evaluates sinus patency, and detects paranasal sinus obliteration. This study aims to assess a novel artificial intelligence (AI) system integrated with radiomic analysis for the radiological evaluation of CRSwNP, developing a reliable and predictive clinical-radiological scoring system. Methods: This study retrospectively evaluates CT scans of patients with CRSwNP. Image analysis was performed using Radiomica LifeX (Local Image Features Extraction) version 7.5. The extracted densitometric volumes were compared to the Lund-Mackay Score (LMS) to develop a novel scoring system (P-ABCD score) and assess its radiomic predictive capability. Results: Twenty patients with CRSwNP undergoing Dupilumab therapy participated in this study. The P-ABCD score, derived from sinus CT imaging data, served as a valuable objective measure of clinical improvement following CRSwNP treatment. Conclusions: Advanced radiomic imaging techniques of the sinus cavity provide precise volumetric data combined with texture analysis. These techniques offer high sensitivity by accurately quantifying the true extent of inflammatory involvement in the paranasal sinuses, enabling effective disease stratification. Full article

(This article belongs to the Section Omics/Informatics)

16 pages, 1150 KB

Open AccessSystematic Review

Clinical Value of Fluorescent Lymphography with Indocyanine Green During Robotic Surgery for Gastric Cancer in Guided Lymph Node Dissection: A Systematic Review and Meta-Analysis

by Dimitra V. Peristeri, Dimitrios N. Raptis, Ioannis Mantzoros, Dimitrios Schizas, Alexandros-Georgios I. Asimakopoulos, Eirini Papadopoulou, Georgios D. Lianos, Thomas Papaziogas and Vasileios Papaziogas

J. Pers. Med. 2026, 16(5), 243; https://doi.org/10.3390/jpm16050243 - 30 Apr 2026

Abstract

Introduction: Robotic gastrectomy is increasingly used in the surgical management of gastric cancer. Indocyanine green (ICG) near-infrared fluorescence imaging has emerged as a technique that enables real-time visualization of lymphatic drainage pathways, potentially facilitating more precise and individualized lymph node dissection. However, [...] Read more.

Introduction: Robotic gastrectomy is increasingly used in the surgical management of gastric cancer. Indocyanine green (ICG) near-infrared fluorescence imaging has emerged as a technique that enables real-time visualization of lymphatic drainage pathways, potentially facilitating more precise and individualized lymph node dissection. However, the clinical value of ICG-guided fluorescent lymphography during robotic gastrectomy remains incompletely established. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched from database inception to 31 January 2026 for comparative studies evaluating ICG-guided fluorescent lymphography versus standard robotic gastrectomy for gastric cancer. Statistical analyses were performed using R (version 4.4.2) and the meta package. Results: Six studies, including 406 patients, met the inclusion criteria. Use of ICG was associated with a higher number of retrieved lymph nodes (mean difference [MD] 8.48; 95% CI 4.61–12.36; p = 0.001; I² = 55.5%). Operative time was modestly shorter in the ICG group (MD −10.84 min; 95% CI −21.08 to −0.61; p = 0.038). There were no significant differences in intraoperative blood loss (MD −4.02 mL; p = 0.289), length of hospital stay (MD −0.82 days; p = 0.131), or postoperative complications (odds ratio 0.83; 95% CI 0.46–1.49; p = 0.534). Conclusions: ICG-guided fluorescence imaging during robotic gastrectomy is associated with increased lymph node retrieval and a small reduction in operative time without evidence of increased perioperative morbidity. Larger prospective studies are required to confirm these findings and to evaluate long-term oncologic outcomes. Full article

(This article belongs to the Special Issue Personalized Management of Abdominal Surgery and Complications)

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