Journal of Personalized Medicine

14 pages, 1182 KB

Open AccessEditor’s ChoiceArticle

Sex-Specific Risk Factors for Dynapenia in Korean Middle-Aged and Older Adults: A Cross-Sectional Study Based on the Korea National Health and Nutrition Examination Survey 2014–2019

by Hyunjae Yu, Hye-Jin Kim, Heeji Choi, Chulho Kim and Jae Jun Lee

J. Pers. Med. 2025, 15(11), 507; https://doi.org/10.3390/jpm15110507 - 25 Oct 2025

Viewed by 5326

Abstract

Background/Objectives: Dynapenia, characterized by an age-related decline in muscle strength, has recently gained attention as a major public health concern. While prior studies identified individual risk factors, little is known about how these factors cluster differently by sex. This study investigated sex-specific [...] Read more.

Background/Objectives: Dynapenia, characterized by an age-related decline in muscle strength, has recently gained attention as a major public health concern. While prior studies identified individual risk factors, little is known about how these factors cluster differently by sex. This study investigated sex-specific risk factors and their combinations associated with dynapenia among Korean middle-aged and older adults. Methods: We analyzed 22,850 participants aged ≥ 40 years from the 2014–2019 Korea National Health and Nutrition Examination Survey. Dynapenia was defined as handgrip strength < 28 kg in men and <18 kg in women. Sex-stratified multivariable logistic regression identified independent predictors, and association rule mining (ARM) detected synergistic risk factor combinations. Results: Dynapenia was more prevalent in women (13.9%) than in men (8.5%). Advancing age, physical inactivity, lack of resistance exercise, and a high incidence of diabetes and stroke were consistent risk factors in both sexes. However, ARM revealed distinct clustering patterns: behavioral factors predominated in men, whereas socioeconomic disadvantage and metabolic comorbidities were more relevant in women with dynapenia. Conclusions: These findings emphasize the need for sex-specific prevention strategies for dynapenia, promoting resistance exercise among men and addressing both inactivity and socioeconomic barriers in women. Full article

(This article belongs to the Special Issue New Insight into Aging and Geriatric Syndromes: Clinical Updates and Perspectives)

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23 pages, 725 KB

Open AccessEditor’s ChoiceReview

Digital Twins in Personalized Medicine: Bridging Innovation and Clinical Reality

by Abigail Silva and Nuno Vale

J. Pers. Med. 2025, 15(11), 503; https://doi.org/10.3390/jpm15110503 - 22 Oct 2025

Cited by 4 | Viewed by 6060

Abstract

Digital Twins (DTs) are poised to transform personalized medicine by enabling real-time, multiscale simulations of individual patients. By integrating genomics, imaging, wearable sensor data, and clinical records, DTs offer a powerful platform for predictive, adaptive, and patient-centered decision-making. Recent advances have highlighted their [...] Read more.

Digital Twins (DTs) are poised to transform personalized medicine by enabling real-time, multiscale simulations of individual patients. By integrating genomics, imaging, wearable sensor data, and clinical records, DTs offer a powerful platform for predictive, adaptive, and patient-centered decision-making. Recent advances have highlighted their potential across a range of clinical domains, including cardiology, oncology, pharmacogenomics, and neurology. Yet, their routine application in clinical practice remains limited, underscoring a growing translational gap between digital innovation and healthcare delivery. In this review, we explore the scientific maturity and emerging clinical use cases of DTs, while critically analyzing the systemic, regulatory, ethical, and infrastructural barriers that hinder their widespread adoption. We outline a translational roadmap that emphasizes dynamic model validation, clinician co-development, equitable data representation, and regulatory harmonization. Uniquely, we reframe DTs as cognitive tools for clinical reasoning and decision support. We further clarify translational pathways through explicit evaluation and reporting recommendations. By positioning DTs within this practical framework, we outline how responsible, inclusive, and interdisciplinary implementation can establish them as foundational elements of 21st century precision medicine. Full article

(This article belongs to the Section Diagnostics in Personalized Medicine)

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12 pages, 7710 KB

Open AccessEditor’s ChoiceArticle

Efficacy and Safety of Personalized Percutaneous Single-Probe Cryoablation Using Liquid Nitrogen in the Treatment of Abdominal Wall Endometriosis

by Ghizlane Touimi Benjelloun, Malek Mokbli, Tarek Kammoun, Sinda Ghabri, Skander Sammoud, Wissem Nabi, Vincent Letouzey, Jean-Paul Beregi and Julien Frandon

J. Pers. Med. 2025, 15(8), 373; https://doi.org/10.3390/jpm15080373 - 13 Aug 2025

Viewed by 1584

Abstract

Background: Abdominal wall endometriosis (AWE) is a rare but debilitating condition, often occurring in surgical scars after Caesarean sections. It is characterized by cyclic pain and a palpable mass, significantly impacting patients’ quality of life. Traditional treatments, including hormonal therapy and surgery, [...] Read more.

Background: Abdominal wall endometriosis (AWE) is a rare but debilitating condition, often occurring in surgical scars after Caesarean sections. It is characterized by cyclic pain and a palpable mass, significantly impacting patients’ quality of life. Traditional treatments, including hormonal therapy and surgery, have limitations, prompting interest in minimally invasive techniques such as cryoablation. This study evaluates the efficacy and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen for symptomatic AWE. Purpose: To evaluate the effectiveness and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen in treating symptomatic AWE lesions, with a primary objective to assess pain relief using the Visual Analog Scale (VAS). Materials and Methods: This retrospective, single-center study included 14 patients (23 lesions) treated with percutaneous cryoablation between September 2022 and April 2025. Clinical, imaging (MRI and ultrasound), and procedural data were analyzed. Pain scores (VAS scale) were assessed before treatment and at 3-month follow-up. Hydro- and/or carbo-dissection were used to protect adjacent structures. Response to treatment was evaluated with MRI and clinical follow-up. Statistical analysis was performed using median, range, and percentage calculations, with comparisons made using the Mann–Whitney test. Results: A total of 23 AWE lesions were treated in 14 patients (mean age: 39.6 years). The median lesion volume was 3546 mm³, with a range from 331 mm³ (8 × 4.6 × 9 mm) to 45,448 mm³ (46 × 26 × 38 mm). Most of the lesions were located in the muscle (69.6%, n = 16), while 17.4% (n = 4) involved both muscle and subcutaneous tissue, and 13.0% (n = 3) were purely subcutaneous. Among the 23 treated lesions, 8.7% (n = 2) appeared as purely hemorrhagic, 13.0% (n = 3) as fibrotic, and 78.3% (n = 18) were classified as mixed, based on imaging characteristics. Procedures were performed under general anesthesia in 65% of cases and under sedation in 35%. Hydrodissection was used in 48% of lesions, carbo-dissection in 4%, and combined hydro–carbo-dissection in 26%. A single 13G cryoprobe was used in 83% of cases, and a 10G probe in 17%. The median ablation time was 15 min (range: 6–28 min), and the median total procedure time was 93 min (range: 22–240 min). Pain scores significantly decreased from a median of 8/10 (range: 6–10) before treatment to 0/10 (range: 0–2) at follow-up (p < 0.0001). MRI follow-up confirmed complete coverage of the ablation zone and disappearance of hemorrhagic inclusions in all cases. Two patients (14%) required re-treatment, both with satisfactory outcomes. No peri- or post-procedural complications were observed, and no visible scars were noted. Conclusions: Percutaneous cryoablation using a single probe with liquid nitrogen is a safe and effective treatment for AWE, offering significant pain relief, minimal morbidity, and excellent cosmetic outcomes. It should be considered as part of multidisciplinary care. Further prospective studies with longer follow-up are warranted to confirm these findings. Full article

(This article belongs to the Special Issue Interventional Radiology: Towards Personalized Medicine)

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36 pages, 4138 KB

Open AccessEditor’s ChoiceArticle

Shoulder and Scapular Function Before and After a Scapular Therapeutic Exercise Program for Chronic Shoulder Pain and Scapular Dyskinesis: A Pre–Post Single-Group Study

by Ana S. C. Melo, Ana L. Soares, Catarina Castro, Ricardo Matias, Eduardo B. Cruz, J. Paulo Vilas-Boas and Andreia S. P. Sousa

J. Pers. Med. 2025, 15(7), 285; https://doi.org/10.3390/jpm15070285 - 2 Jul 2025

Viewed by 7605

Abstract

Background/Objectives: Scapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Methods: Eighteen adult volunteers with chronic shoulder [...] Read more.

Background/Objectives: Scapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Methods: Eighteen adult volunteers with chronic shoulder pain participated in an 8-week scapular therapeutic exercise program that was personalized according to their pain condition and the presence of scapular dyskinesis. This program included preparation and warm-up, scapular neuromotor control, and strengthening and stretching exercises. Both self-reported (shoulder pain and function, psychosocial factors, and self-impression of change) and performance-based outcomes (scapular muscular stiffness and activity level, tridimensional motion, rhythm, and movement quality, measured while participants drank a bottle of water) were used for analysis. Results: After the intervention, participants presented reduced shoulder pain (p < 0.0001) and pain catastrophizing (p = 0.004) and increased shoulder function (p < 0.0001). Additionally, the participants presented changes in scapular winging (p < 0.0001 to p = 0.043), increased scapular downward rotation (p < 0.0001) and depression (p = 0.038), and decreased global movement smoothness (p = 0.003). These were associated with changes in serratus anterior activity (p = 0.016 to p = 0.035), decreased middle (p < 0.0001 to p = 0.002) and lower trapezius (p < 0.0001) and levator scapulae (p = 0.048) activity levels, and decreased middle trapezius muscle stiffness (p = 0.014). Patients’ self-perception of change was rated favorably. Conclusions: After a scapular therapeutic exercise program, changes were observed in both self-reported and performance-based outcomes. These results need to be confirmed by a randomized controlled trial. Full article

(This article belongs to the Special Issue Personalized Medicine in Physical Medicine and Rehabilitation: Pediatrics, Adolescents and the Elderly)

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26 pages, 9374 KB

Open AccessEditor’s ChoiceReview

Right Ventricular Strain by Echocardiography: Current Clinical Applications and Future Directions for Mechanics Assessment of the Forgotten Ventricle

by Mahmoud Abdelnabi, Ramzi Ibrahim, Hoang Nhat Pham, Bobbi Jo Heon, George Bcharah, Girish Pathangey, Milagros Pereyra Pietri, Juan M. Farina, Ian C. Chang, Reza Arsanjani and Chadi Ayoub

J. Pers. Med. 2025, 15(6), 224; https://doi.org/10.3390/jpm15060224 - 30 May 2025

Cited by 2 | Viewed by 6468

Abstract

Myocardial deformation imaging has emerged as a valuable clinical tool for assessing right ventricular (RV) systolic function, providing additional diagnostic and prognostic insights compared to traditional indices of RV function. Two-dimensional speckle-tracking echocardiography is currently the standardized method of choice for measuring RV [...] Read more.

Myocardial deformation imaging has emerged as a valuable clinical tool for assessing right ventricular (RV) systolic function, providing additional diagnostic and prognostic insights compared to traditional indices of RV function. Two-dimensional speckle-tracking echocardiography is currently the standardized method of choice for measuring RV longitudinal strain (RVLS) in clinical practice. RVLS provides a more sensitive indicator of subtle myocardial dysfunction than conventional parameters for RV function assessment (i.e., tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, or RV ejection fraction), with utility for the risk stratification and surveillance of conditions affecting the right heart. However, accurate interpretation of RVLS requires a comprehensive understanding of RV mechanics, pathology, and loading conditions across various cardiovascular conditions, as well as the effects of image quality and technical aspects of image acquisition and tracking in RV strain measurements. This review provides an updated overview of current practical guidelines for RV strain analysis, current clinical applications, and future directions for its potential use in clinical practice. Full article

(This article belongs to the Special Issue New Advances in Techniques and Personalized Medicine in Cardiology)

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17 pages, 2456 KB

Open AccessEditor’s ChoiceArticle

The Accuracy of ChatGPT-4o in Interpreting Chest and Abdominal X-Ray Images

by Pietro G. Lacaita, Malik Galijasevic, Michael Swoboda, Leonhard Gruber, Yannick Scharll, Fabian Barbieri, Gerlig Widmann and Gudrun M. Feuchtner

J. Pers. Med. 2025, 15(5), 194; https://doi.org/10.3390/jpm15050194 - 10 May 2025

Cited by 6 | Viewed by 5737

Abstract

Background/Objectives: Large language models (LLMs), such as ChatGPT, have emerged as potential clinical support tools to enhance precision in personalized patient care, but their reliability in radiological image interpretation remains uncertain. The primary aim of our study was to evaluate the diagnostic accuracy [...] Read more.

Background/Objectives: Large language models (LLMs), such as ChatGPT, have emerged as potential clinical support tools to enhance precision in personalized patient care, but their reliability in radiological image interpretation remains uncertain. The primary aim of our study was to evaluate the diagnostic accuracy of ChatGPT-4o in interpreting chest X-rays (CXRs) and abdominal X-rays (AXRs) by comparing its performance to expert radiology findings, whilst secondary aims were diagnostic confidence and patient safety. Methods: A total of 500 X-rays, including 257 CXR (51.4%) and 243 AXR (48.5%), were analyzed. Diagnoses made by ChatGPT-4o were compared to expert interpretations. Confidence scores (1–4) were assigned and responses were evaluated for patient safety. Results: ChatGPT-4o correctly identified 345 of 500 (69%) pathologies (95% CI: 64.81–72.9). For AXRs 175 of 243 (72.02%) pathologies were correctly diagnosed (95% CI: 66.06–77.28), while for CXRs 170 of 257 (66.15%) were accurate (95% CI: 60.16–71.66). The highest detection rates among CXRs were observed for pulmonary edema, tumor, pneumonia, pleural effusion, cardiomegaly, and emphysema, and lower rates were observed for pneumothorax, rib fractures, and enlarged mediastinum. AXR performance was highest for intestinal obstruction and foreign bodies, and weaker for pneumoperitoneum, renal calculi, and diverticulitis. Confidence scores were higher for AXRs (mean 3.45 ± 1.1) than CXRs (mean 2.48 ± 1.45). All responses (100%) were considered to be safe for the patient. Interobserver agreement was high (kappa = 0.920), and reliability (second prompt) was moderate (kappa = 0.750). Conclusions: ChatGPT-4o demonstrated moderate accuracy for the interpretation of X-rays, being higher for AXRs compared to CXRs. Improvements are required for its use as efficient clinical support tool. Full article

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

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20 pages, 679 KB

Open AccessEditor’s ChoiceReview

Beyond Biomarkers: Machine Learning-Driven Multiomics for Personalized Medicine in Gastric Cancer

by Dongheng Ma, Canfeng Fan, Tomoya Sano, Kyoka Kawabata, Hinano Nishikubo, Daiki Imanishi, Takashi Sakuma, Koji Maruo, Yurie Yamamoto, Tasuku Matsuoka and Masakazu Yashiro

J. Pers. Med. 2025, 15(5), 166; https://doi.org/10.3390/jpm15050166 - 24 Apr 2025

Cited by 6 | Viewed by 3787

Abstract

Gastric cancer (GC) remains one of the leading causes of cancer-related mortality worldwide, with most cases diagnosed at advanced stages. Traditional biomarkers provide only partial insights into GC’s heterogeneity. Recent advances in machine learning (ML)-driven multiomics technologies, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, [...] Read more.

Gastric cancer (GC) remains one of the leading causes of cancer-related mortality worldwide, with most cases diagnosed at advanced stages. Traditional biomarkers provide only partial insights into GC’s heterogeneity. Recent advances in machine learning (ML)-driven multiomics technologies, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, pathomics, and radiomics, have facilitated a deeper understanding of GC by integrating molecular and imaging data. In this review, we summarize the current landscape of ML-based multiomics integration for GC, highlighting its role in precision diagnosis, prognosis prediction, and biomarker discovery for achieving personalized medicine. Full article

(This article belongs to the Special Issue The Intersection of Multi-Omics Data and Machine Learning in Medicine)

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13 pages, 1544 KB

Open AccessEditor’s ChoiceArticle

Multimodal Performance of GPT-4 in Complex Ophthalmology Cases

by David Mikhail, Daniel Milad, Fares Antaki, Jason Milad, Andrew Farah, Thomas Khairy, Jonathan El-Khoury, Kenan Bachour, Andrei-Alexandru Szigiato, Taylor Nayman, Guillaume A. Mullie and Renaud Duval

J. Pers. Med. 2025, 15(4), 160; https://doi.org/10.3390/jpm15040160 - 21 Apr 2025

Cited by 8 | Viewed by 1478

Abstract

Objectives: The integration of multimodal capabilities into GPT-4 represents a transformative leap for artificial intelligence in ophthalmology, yet its utility in scenarios requiring advanced reasoning remains underexplored. This study evaluates GPT-4’s multimodal performance on open-ended diagnostic and next-step reasoning tasks in complex ophthalmology [...] Read more.

Objectives: The integration of multimodal capabilities into GPT-4 represents a transformative leap for artificial intelligence in ophthalmology, yet its utility in scenarios requiring advanced reasoning remains underexplored. This study evaluates GPT-4’s multimodal performance on open-ended diagnostic and next-step reasoning tasks in complex ophthalmology cases, comparing it against human expertise. Methods: GPT-4 was assessed across three study arms: (1) text-based case details with figure descriptions, (2) cases with text and accompanying ophthalmic figures, and (3) cases with figures only (no figure descriptions). We compared GPT-4’s diagnostic and next-step accuracy across arms and benchmarked its performance against three board-certified ophthalmologists. Results: GPT-4 achieved 38.4% (95% CI [33.9%, 43.1%]) diagnostic accuracy and 57.8% (95% CI [52.8%, 62.2%]) next-step accuracy when prompted with figures without descriptions. Diagnostic accuracy declined significantly compared to text-only prompts (p = 0.007), though the next-step performance was similar (p = 0.140). Adding figure descriptions restored diagnostic accuracy (49.3%) to near parity with text-only prompts (p = 0.684). Using figures without descriptions, GPT-4’s diagnostic accuracy was comparable to two ophthalmologists (p = 0.30, p = 0.41) but fell short of the highest-performing ophthalmologist (p = 0.0004). For next-step accuracy, GPT-4 was similar to one ophthalmologist (p = 0.22) but underperformed relative to the other two (p = 0.0015, p = 0.0017). Conclusions: GPT-4’s diagnostic performance diminishes when relying solely on ophthalmic images without textual context, highlighting limitations in its current multimodal capabilities. Despite this, GPT-4 demonstrated comparable performance to at least one ophthalmologist on both diagnostic and next-step reasoning tasks, emphasizing its potential as an assistive tool. Future research should refine multimodal prompts and explore iterative or sequential prompting strategies to optimize AI-driven interpretation of complex ophthalmic datasets. Full article

(This article belongs to the Special Issue Diagnostics and Therapeutics in Ophthalmology—2nd Edition)

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17 pages, 889 KB

Open AccessEditor’s ChoiceArticle

Patient Experience with Intranasal Esketamine in Treatment-Resistant Depression: Insights from a Multicentric Italian Study (REAL-ESKperience)

by Marco Di Nicola, Maria Pepe, Giacomo d’Andrea, Ilaria Marcelli, Mauro Pettorruso, Ileana Andriola, Stefano Barlati, Matteo Carminati, Carlo Ignazio Cattaneo, Massimo Clerici, Domenico De Berardis, Sergio De Filippis, Bernardo Dell’Osso, Giorgio Di Lorenzo, Giuseppe Maina, Mirko Manchia, Matteo Marcatili, Vassilis Martiadis, Cinzia Niolu, Antonino Petralia, Gianluca Rosso, Gianluca Serafini, Maria Salvina Signorelli, Tommaso Vannucchi, Matteo Vismara, Raffaella Zanardi, Antonio Vita, Gabriele Sani, Giovanni Martinotti and REAL-ESKperience Study Group Show full author list Hide full author list

J. Pers. Med. 2025, 15(4), 161; https://doi.org/10.3390/jpm15040161 - 21 Apr 2025

Cited by 9 | Viewed by 3914

Abstract

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients’ perspective on this treatment are limited. This multicentric [...] Read more.

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients’ perspective on this treatment are limited. This multicentric Italian study explored experiences with ESK-NS in TRD patients, focusing on perceived therapeutic effects and overall satisfaction. Methods. A self-report survey was administered to 236 outpatients with TRD (55.1% females, 54.1 ± 14.1 years) treated with ESK-NS for at least three consecutive months within standard clinical care. Based on satisfaction levels, participants were classified as “unsatisfied” (10.2%), “partially satisfied” (19.1%), “satisfied” (44.4%), or “very satisfied” (26.3%), and compared for sociodemographic, clinical characteristics, and feedback on perceived benefits. Artificial intelligence (OpenAI) served to categorize responses to an open-ended question. Results. Enhanced quality of life was reported by 88.4% of participants. Significant differences emerged in earliest self-perceived benefits, most relevant effects, and impact on global functioning across groups. Specifically, “very satisfied” patients described the following: early improvements in depressed mood, suicidal thoughts, and restlessness; decreased suicidal thoughts among the most significant effects; and functional gains across all domains. OpenAI identified experiences of personal growth and rediscovery and a desire for tailored settings and approaches as recurring topics. Conclusions. Most patients reported a positive perception of ESK-NS treatment. The most satisfied participants highlighted significant benefits to depressed mood, suicidal thoughts, and overall functioning. Patient-reported experiences offer insights into different psychopathological dimensions, including functional outcomes and quality of life. Integrating these perspectives into clinical practice might assist treatment personalization, improving patients’ adherence and satisfaction. Full article

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

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12 pages, 519 KB

Open AccessEditor’s ChoiceArticle

Effect of Flecainide in Idiopathic Premature Ventricular Contractions and the Induced Cardiomyopathy—UNIFLECA: A Single Arm, Non-Randomized Trial: Review of the Literature and Initial Results

by Sotirios Kotoulas, Dimitrios Tsiachris, Michail Botis, Athanasios Kordalis, Dimitrios Varvarousis, Georgios Leventopoulos, Eleftherios Kallergis, Ioannis Doundoulakis, Leonidas E. Poulimenos and Konstantinos Tsioufis

J. Pers. Med. 2025, 15(4), 132; https://doi.org/10.3390/jpm15040132 - 29 Mar 2025

Cited by 1 | Viewed by 6188

Abstract

Background/Objectives: Persistent high Premature Ventricular Contraction (PVC) burden (>10%) may result in PVC-induced cardiomyopathy. Current guidelines, supported by limited evidence, recommend flecainide for PVCs originating from the ventricular outflow tract (Class IIa). UNIFLECA is a prospective cohort study, aiming to assess the [...] Read more.

Background/Objectives: Persistent high Premature Ventricular Contraction (PVC) burden (>10%) may result in PVC-induced cardiomyopathy. Current guidelines, supported by limited evidence, recommend flecainide for PVCs originating from the ventricular outflow tract (Class IIa). UNIFLECA is a prospective cohort study, aiming to assess the efficacy and safety of flecainide in PVC burden reduction in adults, irrespective of PVC origin, focusing secondarily on symptom relief and improvement of left ventricular ejection fraction (LVEF) in patients suffering from PVC-induced cardiomyopathy. Methods: Participants were adults with frequent PVCs, defined as PVC burden > 5%, confirmed by two 24 h Holter recordings taken at least one month apart, who denied catheter ablation treatment. Patients who were deemed ineligible for catheter ablation were also included. A total of 50 patients were screened and 35 were administered Flecainide, with dosage adjustment based on follow-up Holter results and QRS increases. Changes in PVC burden, LVEF, symptomatic status, along with treatment adherence, were evaluated. Results: In adults with frequent PVCs, flecainide led to a significant reduction in PVC burden, with a mean decrease of 76.2% in the first month, and 63.1% of patients achieving a PVC burden reduction greater than 80%. Conclusions: UNIFLECA contributes to the understanding of how personalized, non-interventional therapeutic modalities can be employed to manage PVCs, especially for patients unwilling to have or ineligible for ablation procedures. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Cardiovascular Disease)

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31 pages, 1617 KB

Open AccessEditor’s ChoiceReview

The Role of the Gut–Biliary–Liver Axis in Primary Hepatobiliary Liver Cancers: From Molecular Insights to Clinical Applications

by Mario Romeo, Marcello Dallio, Fiammetta Di Nardo, Carmine Napolitano, Paolo Vaia, Giuseppina Martinelli, Pierluigi Federico, Simone Olivieri, Patrizia Iodice and Alessandro Federico

J. Pers. Med. 2025, 15(4), 124; https://doi.org/10.3390/jpm15040124 - 24 Mar 2025

Cited by 6 | Viewed by 1579

Abstract

Background: Hepatobiliary liver cancers (HBLCs) represent the sixth most common neoplasm in the world. Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) constitute the main HBLC types, with alarming epidemiological projections. Methods: In recent decades, alterations in gut microbiota, with mutual implications on the gut–liver [...] Read more.

Background: Hepatobiliary liver cancers (HBLCs) represent the sixth most common neoplasm in the world. Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) constitute the main HBLC types, with alarming epidemiological projections. Methods: In recent decades, alterations in gut microbiota, with mutual implications on the gut–liver axis and gut–biliary axis permeability status, have been massively investigated and proposed as HBLC pathogenetic deus ex machina. Results: In the HCC setting, elevated intestinal levels of Escherichia coli and other Gram-negative bacteria have been demonstrated, resulting in a close association with increased lipopolysaccharide (LPS) serum levels and, consequently, chronic systemic inflammation. In contrast, the intestinal microbiota of HCC individuals feature reduced levels of Lactobacillus spp., Bifidobacterium spp., and Enterococcus spp. In the CC setting, evidence has revealed an increased expression of Lactobacillus spp., with enhanced levels of Actynomices spp. and Alloscardovia spp. Besides impaired strains/species representation, gut-derived metabolites, including bile acids (BAs), short-chain fatty acids (SCFAs), and oxidative-stress-derived products, configure a network severely impacting the progression of HBLC. Conclusions: In the era of Precision Medicine, the clarification of microbiota composition and functioning in HCC and CC settings can contribute to the identification of individual signatures, potentially providing novel diagnostic markers, therapeutic approaches, and prognostic/predictive tools. Full article

(This article belongs to the Section Mechanisms of Diseases)

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13 pages, 1097 KB

Open AccessEditor’s ChoiceReview

Advances in Basivertebral Nerve Ablation for Chronic Low Back Pain: A Narrative Review

by Sujeivan Mahendram and Paul J. Christo

J. Pers. Med. 2025, 15(3), 119; https://doi.org/10.3390/jpm15030119 - 19 Mar 2025

Viewed by 5861

Abstract

Chronic low back pain has traditionally been thought to stem from intervertebral disc degeneration. However, emerging evidence over the last few decades has revealed other contributing sources. One such etiology of chronic non-radiating axial low back pain has been attributed to vertebral end [...] Read more.

Chronic low back pain has traditionally been thought to stem from intervertebral disc degeneration. However, emerging evidence over the last few decades has revealed other contributing sources. One such etiology of chronic non-radiating axial low back pain has been attributed to vertebral end plate disruption and degeneration, leading to basivertebral nerve-mediated nociception. These degenerative events, described as Modic changes on MRI, provide a means of diagnosis and offer personalized treatment options, like minimally invasive radiofrequency ablation, to help address this source of low back pain. This review focuses on recent advancements, rationale, efficacy, and safety profile intraosseous basivertebral nerve ablation in the treatment of vertebrogenic back pain, and discusses current knowledge gaps that may help guide future research in the field. Full article

(This article belongs to the Special Issue Towards Precision Anesthesia and Pain Management)

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19 pages, 4580 KB

Open AccessEditor’s ChoiceReview

The Endoscopic Management of Anastomotic Strictures After Esophagogastric Surgery: A Comprehensive Review of Emerging Approaches Beyond Endoscopic Dilation

by Giuseppe Dell’Anna, Jacopo Fanizza, Francesco Vito Mandarino, Alberto Barchi, Ernesto Fasulo, Edoardo Vespa, Lorella Fanti, Francesco Azzolini, Silvia Battaglia, Francesco Puccetti, Andrea Cossu, Ugo Elmore, Antonio Facciorusso, Armando Dell’Anna, Lorenzo Fuccio, Angelo Bruni, Sara Massironi, Vito Annese, Alberto Malesci, Gianfranco Donatelli, Riccardo Rosati and Silvio Danese Show full author list Hide full author list

J. Pers. Med. 2025, 15(3), 111; https://doi.org/10.3390/jpm15030111 - 13 Mar 2025

Cited by 8 | Viewed by 4202

Abstract

Anastomotic strictures are a common complication following esophagogastric surgery, with prevalence varying depending on the type of surgery and anatomical site. These strictures can lead to debilitating symptoms such as dysphagia, pain, and malabsorption, significantly impacting patients’ quality of life. Endoscopic treatment of [...] Read more.

Anastomotic strictures are a common complication following esophagogastric surgery, with prevalence varying depending on the type of surgery and anatomical site. These strictures can lead to debilitating symptoms such as dysphagia, pain, and malabsorption, significantly impacting patients’ quality of life. Endoscopic treatment of anastomotic strictures has established a role as the first-line strategy in this setting instead of revision surgery, offering benefits in terms of lower morbidity. Various endoscopic methods are available for anastomotic stricture management, including balloon dilation, stent placement, the new lumen-apposing metal stent, and endoscopic incision techniques. However, there is currently no strong evidence and established guidelines for the optimal treatment strategy. Available data suggest that endoscopic treatments, when performed in tertiary referral centers, can provide favorable outcomes in terms of symptom relief and reduced need for rescue surgical intervention. Nonetheless, challenges remain regarding the management of recurrent strictures and procedural complications, underscoring the need for a personalized, multidisciplinary approach to optimize clinical outcomes. This review aims to provide an updated overview of endoscopic techniques and available evidence with a focus on the most recent technologies, supporting clinicians in effectively managing anastomotic strictures in complex clinical settings. Full article

(This article belongs to the Special Issue Clinical Updates on Personalized Upper Gastrointestinal Endoscopy)

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10 pages, 5487 KB

Open AccessEditor’s ChoiceArticle

Testing the Reliability of ChatGPT Assistance for Surgical Choices in Challenging Glaucoma Cases

by Matteo Mario Carlà, Gloria Gambini, Federico Giannuzzi, Francesco Boselli, Laura De Luca and Stanislao Rizzo

J. Pers. Med. 2025, 15(3), 97; https://doi.org/10.3390/jpm15030097 - 28 Feb 2025

Cited by 6 | Viewed by 1187

Abstract

Background: This study’s aim is to assess ChatGPT’s capability to analyze detailed case descriptions in glaucomatous patients and suggest the best possible surgical treatment. Methods: We conducted a retrospective analysis of 60 medical records of surgical glaucoma cases, divided into “ordinary” cases ( [...] Read more.

Background: This study’s aim is to assess ChatGPT’s capability to analyze detailed case descriptions in glaucomatous patients and suggest the best possible surgical treatment. Methods: We conducted a retrospective analysis of 60 medical records of surgical glaucoma cases, divided into “ordinary” cases (n = 40) and “challenging” cases (n = 20). We entered every case description into ChatGPT-3.5’s interface and inquired “What kind of surgery would you perform?”. The frequency of accurate surgical choices made by ChatGPT, compared to those reported in patients’ files, was reported. Furthermore, we assessed the level of agreement with three senior glaucoma surgeons, asked to analyze the same 60 cases and outline their surgical choices. Results: Overall, ChatGPT surgical choices were consistent with those reported in patients’ files in 47/60 cases (78%). When comparing ChatGPT choices with the three glaucoma specialists, levels of agreement were 75%, 70%, and 83%, respectively. In ordinary cases, we did not report any significant differences when comparing ChatGPT answers with those of the three glaucoma specialists, when both of them were matched with patients’ files (p > 0.05 for all). ChatGPT’s performances were lower in “challenging” cases: when compared to patients’ files, the accuracy was 13/20 (65%); when compared to glaucoma specialists, the level of agreement was 50%, 40%, and 70%, respectively. Conclusion: In ordinary conditions, ChatGPT was able to propose coherent personalized treatment plans, and its performance was comparable to that of skilled glaucoma specialists but showed its limitations in the evaluation of more complex cases. Full article

(This article belongs to the Special Issue Advances in Personalized Diagnosis and Treatment of Ophthalmic Diseases)

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13 pages, 2416 KB

Open AccessEditor’s ChoiceReview

Insights into the Interaction Between Clostridioides difficile and the Gut Microbiome

by Dimitra Mougiou, Georgia Gioula, Lemonia Skoura, Cleo Anastassopoulou and Melania Kachrimanidou

J. Pers. Med. 2025, 15(3), 94; https://doi.org/10.3390/jpm15030094 - 28 Feb 2025

Cited by 5 | Viewed by 4438

Abstract

Clostridioides difficile (C. difficile) is a significant healthcare-associated pathogen that is predominantly caused by antibiotic-induced microbiota disturbance. Antibiotics decrease microbial diversity, resulting in C. difficile colonization and infection. Clostridium difficile infection (CDI) manifests through toxins A and B, causing diarrhea and [...] Read more.

Clostridioides difficile (C. difficile) is a significant healthcare-associated pathogen that is predominantly caused by antibiotic-induced microbiota disturbance. Antibiotics decrease microbial diversity, resulting in C. difficile colonization and infection. Clostridium difficile infection (CDI) manifests through toxins A and B, causing diarrhea and colitis. Antibiotic usage, old age, and hospitalization are significant risk factors. A healthy gut microbiota, which is dominated by Firmicutes and Bacteroidetes, provides colonization resistance to C. difficile due to competition for nutrients, creating inhibitory substances and stimulating the immune response. Antibiotic-induced dysbiosis decreases resistance, allowing C. difficile spores to transform into vegetative forms. Patients with CDI have decreased gut microbiota diversity, with a decrease in beneficial bacteria, including Bacteroidetes, Prevotella, and Bifidobacterium, and a rise in harmful bacteria like Clostridioides and Lactobacillus. This disparity worsens the infection’s symptoms and complicates therapy. Fecal Microbiota Transplantation (FMT) has emerged as a potential therapy for recurrent CDI by restoring gut microbiota diversity and function. Comprehending the connection between gut microbiota and CDI pathogenesis is critical for establishing effective preventive and treatment plans. Maintaining a healthy gut microbiota through careful antibiotic use and therapeutic options such as FMT can help in the management and prevention of CDI. Full article

(This article belongs to the Special Issue Personalized Medicine in Infectious Diseases)

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23 pages, 1360 KB

Open AccessEditor’s ChoiceSystematic Review

Executive Functions Training Improves Language Abilities in Aphasia Rehabilitation: A Systematic Review

by Laura Culicetto, Desirèe Latella, Viviana Lo Buono, Fabio Orecchio, Anna Maria Murdaca, Angelo Quartarone and Silvia Marino

J. Pers. Med. 2025, 15(3), 92; https://doi.org/10.3390/jpm15030092 - 27 Feb 2025

Cited by 1 | Viewed by 5703

Abstract

Background/Objectives: In recent years, the popularity of non-verbal cognitive training for aphasia has increased. Building on evidence that language abilities engage brain areas involved in executive functions (EFs) processing, this review aims to analyze the utility of EFs training alone or combined [...] Read more.

Background/Objectives: In recent years, the popularity of non-verbal cognitive training for aphasia has increased. Building on evidence that language abilities engage brain areas involved in executive functions (EFs) processing, this review aims to analyze the utility of EFs training alone or combined with traditional rehabilitation approaches to improve language abilities in aphasia. Methods: Systematic searches were performed in four databases evaluating studies focusing on the effects of EFs training in language rehabilitation, yielding 185 studies. After reading the full text of the selected studies and applying predefined inclusion criteria, nine studies were included based on pertinence and relevance to the topic. This systematic review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024519087. Results: The results of the analyzed studies indicate that various EFs training methods, such as computer-assisted executive control training, Cognitive Flexibility in Aphasia Therapy (CFAT), and the Dr. Neuronowski^® program, as well as the combination of transcranial direct current stimulation (tDCS) with EFs training, can lead to improvements in language abilities in people with aphasia. Additionally, EFs training often results in specific effects on treated functions like working memory (near transfer effects) and untreated ones such as spoken sentence comprehension (far transfer effects). Conclusions: Despite the heterogeneity of the treatments and the small simple size of the studies analyzed, preliminary results are promising. Future research should further explore the effectiveness and specific contribution of EFs training to improving language functions in aphasia. Full article

(This article belongs to the Special Issue The Applications of Non-Invasive Brain Stimulation in Neuropsychiatric Research and Treatment)

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18 pages, 713 KB

Open AccessEditor’s ChoiceReview

Targeting Metabolic Vulnerabilities to Combat Drug Resistance in Cancer Therapy

by Taranatee Khan, Manojavan Nagarajan, Irene Kang, Chunjing Wu and Medhi Wangpaichitr

J. Pers. Med. 2025, 15(2), 50; https://doi.org/10.3390/jpm15020050 - 27 Jan 2025

Cited by 9 | Viewed by 4614

Abstract

Drug resistance remains a significant barrier to effective cancer therapy. Cancer cells evade treatment by reprogramming their metabolism, switching from glycolysis to oxidative phosphorylation (OXPHOS), and relying on alternative carbon sources such as glutamine. These adaptations not only enable tumor survival but also [...] Read more.

Drug resistance remains a significant barrier to effective cancer therapy. Cancer cells evade treatment by reprogramming their metabolism, switching from glycolysis to oxidative phosphorylation (OXPHOS), and relying on alternative carbon sources such as glutamine. These adaptations not only enable tumor survival but also contribute to immune evasion through mechanisms such as reactive oxygen species (ROS) generation and the upregulation of immune checkpoint molecules like PD-L1. This review explores the potential of targeting metabolic weaknesses in drug-resistant cancers to enhance therapeutic efficacy. Key metabolic pathways involved in resistance, including glycolysis, glutamine metabolism, and the kynurenine pathway, are discussed. The combination of metabolic inhibitors with immune checkpoint inhibitors (ICIs), particularly anti-PD-1/PD-L1 therapies, represents a promising approach to overcoming both metabolic and immune evasion mechanisms. Clinical trials combining metabolic and immune therapies have shown early promise, but further research is needed to optimize treatment combinations and identify biomarkers for patient selection. In conclusion, targeting cancer metabolism in combination with immune checkpoint blockade offers a novel approach to overcoming drug resistance, providing a potential pathway to improved outcomes in cancer therapy. Future directions include personalized treatments based on tumor metabolic profiles and expanding research to other tumor types. Full article

(This article belongs to the Special Issue Exploiting Metabolic Weaknesses: A Novel Approach to Overcome Drug Resistance in Cancer Therapy)

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17 pages, 1527 KB

Open AccessEditor’s ChoiceArticle

Impact of Whole-Body Cryotherapy on Pain, Sleep Quality, Functional Status, and Quality of Life in Multiple Sclerosis: A Comparative Study with Follow-Up

by Ewa Zielińska-Nowak, Anna Lipert, Łukasz Kikowski and Elżbieta Miller

J. Pers. Med. 2025, 15(2), 46; https://doi.org/10.3390/jpm15020046 - 26 Jan 2025

Cited by 3 | Viewed by 7397

Abstract

Background/Objectives: Whole-body cryotherapy (WBC) is widely recognized for its analgesic and anti-inflammatory effects. Despite growing interest in its therapeutic potential, the impact of WBC on functional performance, pain perception, sleep quality, and quality of life among individuals with multiple sclerosis (MS) remains underexplored. [...] Read more.

Background/Objectives: Whole-body cryotherapy (WBC) is widely recognized for its analgesic and anti-inflammatory effects. Despite growing interest in its therapeutic potential, the impact of WBC on functional performance, pain perception, sleep quality, and quality of life among individuals with multiple sclerosis (MS) remains underexplored. This study aimed to assess the effects of a 10-session WBC protocol on functional and psychological parameters in patients with MS and compare them with individuals without neurological disorders. Methods: A total of 73 participants divided into two groups, non-neurological individuals (non-MS, n = 43) and patients with MS (MS, n = 30), underwent 10 WBC sessions (−120 °C to −130 °C) over 2 weeks. Assessments included the Numerical Rating Scale (NRS), 30-Second Chair Stand Test (30CST), Timed Up and Go (TUG) test, and Pittsburgh Sleep Quality Index, with the WHOQOL-BREF conducted pre-treatment, post-treatment, and at a 10-day follow-up. Results: In the MS group, significant improvements were observed post-treatment in the NRS, 30CST, WHOQOL-1, and PSQI. However, only the CST and WHOQOL-3 maintained improvements during follow-up. In the non-MS group, statistically significant improvements were observed post-treatment across most parameters, except for the NRS and WHOQOL-3, with most effects diminishing by the follow-up. No deterioration in any assessed parameters was observed in either group. Conclusions: WBC demonstrates potential benefits for managing MS symptoms, particularly pain and sleep quality, with no observed deterioration in parameters and some effects emerging only during follow-ups, underscoring its safety and the need for further research on long-term outcomes. Full article

(This article belongs to the Special Issue Cold Perspectives: Advancements and Applications of Cryotherapy in Clinical Settings)

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66 pages, 1373 KB

Open AccessEditor’s ChoiceReview

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

by Jon L. Pertab, Tricia L. Merkley, Holly Winiarski, Kelly M. J. Cramond and Alex J. Cramond

J. Pers. Med. 2025, 15(1), 33; https://doi.org/10.3390/jpm15010033 - 17 Jan 2025

Cited by 3 | Viewed by 9144

Abstract

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, [...] Read more.

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system—the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients. Full article

(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury and Concussion)

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25 pages, 3206 KB

Open AccessEditor’s ChoiceArticle

A Novel CNN-Based Framework for Alzheimer’s Disease Detection Using EEG Spectrogram Representations

by Konstantinos Stefanou, Katerina D. Tzimourta, Christos Bellos, Georgios Stergios, Konstantinos Markoglou, Emmanouil Gionanidis, Markos G. Tsipouras, Nikolaos Giannakeas, Alexandros T. Tzallas and Andreas Miltiadous

J. Pers. Med. 2025, 15(1), 27; https://doi.org/10.3390/jpm15010027 - 14 Jan 2025

Cited by 26 | Viewed by 5345

Abstract

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that poses critical challenges in global healthcare due to its increasing prevalence and severity. Diagnosing AD and other dementias, such as frontotemporal dementia (FTD), is slow and resource-intensive, underscoring the need for automated approaches. [...] Read more.

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that poses critical challenges in global healthcare due to its increasing prevalence and severity. Diagnosing AD and other dementias, such as frontotemporal dementia (FTD), is slow and resource-intensive, underscoring the need for automated approaches. Methods: To address this gap, this study proposes a novel deep learning methodology for EEG classification of AD, FTD, and control (CN) signals. The approach incorporates advanced preprocessing techniques and CNN classification of FFT-based spectrograms and is evaluated using the leave-N-subjects-out validation, ensuring robust cross-subject generalizability. Results: The results indicate that the proposed methodology outperforms state-of-the-art machine learning and EEG-specific neural network models, achieving an accuracy of 79.45% for AD/CN classification and 80.69% for AD+FTD/CN classification. Conclusions: These results highlight the potential of EEG-based deep learning models for early dementia screening, enabling more efficient, scalable, and accessible diagnostic tools. Full article

(This article belongs to the Special Issue Personalized Treatment of Neurological Diseases)

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13 pages, 265 KB

Open AccessEditor’s ChoiceArticle

Prostatic Artery Embolization in Elderly Comorbid Patients with Benign Prostatic Hyperplasia: Safety, Efficacy, and Predictive Factors of Clinical Failure

by Federico Zorzi, Giulio Rossin, Michelangelo Digregorio, Simone Lavecchia, Andrea Piasentin, Fabio Traunero, Carmelo Morreale, Michele Rizzo, Tommaso Cai, Carlo Trombetta, Alessandro Zucchi and Giovanni Liguori

J. Pers. Med. 2025, 15(1), 23; https://doi.org/10.3390/jpm15010023 - 10 Jan 2025

Cited by 6 | Viewed by 2626

Abstract

Background: This study aims to evaluate the safety and efficacy of prostatic artery embolization (PAE) in elderly, multimorbid patients with benign prostatic hyperplasia (BPH). Additionally, it seeks to identify technical and clinical factors that predict clinical failure at the mid-term follow-up. Methods [...] Read more.

Background: This study aims to evaluate the safety and efficacy of prostatic artery embolization (PAE) in elderly, multimorbid patients with benign prostatic hyperplasia (BPH). Additionally, it seeks to identify technical and clinical factors that predict clinical failure at the mid-term follow-up. Methods: We analyzed the clinical records of 175 consecutive patients who underwent PAE. Technical success was defined as achieving embolization on at least one side. Safety was assessed using the Clavien–Dindo classification. The pre-procedural international prostate symptom score (IPSS), quality of life (QoL) score, prostate volume (PV), prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were compared with values assessed at the follow-up evaluation. Clinical failure was defined as no improvement or worsening of lower urinary tract symptoms (LUTS) based on the IPSS at the follow-up evaluation. Univariate and multivariate regression models were applied to identify predictors of clinical failure. Results: 158 patients met the inclusion criteria. The median age was 74 years (68, 79), with a median ASA score of 2 (2, 3) and a Charlson comorbidity index (CCI) of 5 (4, 7). Follow-up assessments were carried out at a median of 12 months (0, 1). IPSS decreased by −5 points (−8, 0), QoL by −1 point (−1, 0), PV by −19 cc (−26, −8), PVR by −45 cc (−25 to −80), and PSA by −1.1 ng/mL (−2.5, −0.2) (p < 0.01); while Qmax improved by 4 mL/s (2, 6) (p < 0.01). A total of 44 patients (30.3%) experienced clinical failure, which was significantly correlated with unilateral embolization (p < 0.01). Multivariate regression analysis indicated that higher CCI, elevated PVR, and the use of larger microspheres were associated with poorer clinical outcomes, with odds ratios of 2.17 (95% CI: 1.4–3.38), 1.02 (95% CI: 1.01–1.03), and 26.83 (95% CI: 4.81–149.8), respectively (p < 0.01). Conclusions: PAE is a safe and effective treatment for elderly multimorbid patients with BPH. Comprehensive pre-procedural clinical assessment, incorporating the CCI and PVR, is essential to optimize treatment outcomes. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Treatment of Urological Diseases)

21 pages, 702 KB

Open AccessEditor’s ChoiceReview

The Role of Artificial Intelligence and Emerging Technologies in Advancing Total Hip Arthroplasty

by Luca Andriollo, Aurelio Picchi, Giulio Iademarco, Andrea Fidanza, Loris Perticarini, Stefano Marco Paolo Rossi, Giandomenico Logroscino and Francesco Benazzo

J. Pers. Med. 2025, 15(1), 21; https://doi.org/10.3390/jpm15010021 - 9 Jan 2025

Cited by 18 | Viewed by 5905

Abstract

Total hip arthroplasty (THA) is a widely performed surgical procedure that has evolved significantly due to advancements in artificial intelligence (AI) and robotics. As demand for THA grows, reliable tools are essential to enhance diagnosis, preoperative planning, surgical precision, and postoperative rehabilitation. AI [...] Read more.

Total hip arthroplasty (THA) is a widely performed surgical procedure that has evolved significantly due to advancements in artificial intelligence (AI) and robotics. As demand for THA grows, reliable tools are essential to enhance diagnosis, preoperative planning, surgical precision, and postoperative rehabilitation. AI applications in orthopedic surgery offer innovative solutions, including automated hip osteoarthritis (OA) diagnosis, precise implant positioning, and personalized risk stratification, thereby improving patient outcomes. Deep learning models have transformed OA severity grading and implant identification by automating traditionally manual processes with high accuracy. Additionally, AI-powered systems optimize preoperative planning by predicting the hip joint center and identifying complications using multimodal data. Robotic-assisted THA enhances surgical precision with real-time feedback, reducing complications such as dislocations and leg length discrepancies while accelerating recovery. Despite these advancements, barriers such as cost, accessibility, and the steep learning curve for surgeons hinder widespread adoption. Postoperative rehabilitation benefits from technologies like virtual and augmented reality and telemedicine, which enhance patient engagement and adherence. However, limitations, particularly among elderly populations with lower adaptability to technology, underscore the need for user-friendly platforms. To ensure comprehensiveness, a structured literature search was conducted using PubMed, Scopus, and Web of Science. Keywords included “artificial intelligence”, “machine learning”, “robotics”, and “total hip arthroplasty”. Inclusion criteria emphasized peer-reviewed studies published in English within the last decade focusing on technological advancements and clinical outcomes. This review evaluates AI and robotics’ role in THA, highlighting opportunities and challenges and emphasizing further research and real-world validation to integrate these technologies into clinical practice effectively. Full article

(This article belongs to the Special Issue Artificial Intelligence for Personalized Medicine: Bridging Innovative Technologies and Patient-Centric Care)

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12 pages, 1624 KB

Open AccessEditor’s ChoiceArticle

Expression of Tissue Remodeling- and Inflammation-Related Factors During the Wound-Healing Process in Humans

by Dimitrios Vardakostas, Athanasios Moustogiannis, Zoe Garoufalia, Elli Karatza, Anastassios Philippou, Gregory Kouraklis, Michael Koutsilieris and Dimitrios Mantas

J. Pers. Med. 2025, 15(1), 14; https://doi.org/10.3390/jpm15010014 - 2 Jan 2025

Cited by 8 | Viewed by 6021

Abstract

Background/Objectives: There is a growing interest in the research of wound healing mechanisms worldwide. Particular attention has been paid to the expression of tissue remodeling- and inflammation-related factors. Herein, we investigate the expression patterns of TGF-β1, IL-6, TNF-a, uPA, uPA receptors, MMP-2, [...] Read more.

Background/Objectives: There is a growing interest in the research of wound healing mechanisms worldwide. Particular attention has been paid to the expression of tissue remodeling- and inflammation-related factors. Herein, we investigate the expression patterns of TGF-β1, IL-6, TNF-a, uPA, uPA receptors, MMP-2, and MMP-9 through the four phases of the normal wound-healing process in humans. Methods: Twenty-two individuals presenting with a first episode of pilonidal sinus underwent surgical excision and the wound was left to heal by secondary intention. Sequential biopsies were collected on day 0 (operation), day 2 (inflammatory phase), day 9 (proliferative phase), and day 14 (tissue remodeling phase). The expression levels of the proteins were evaluated using reverse transcription–quantitative PCR. Statistical analyses were performed using GraphPad Prism software. One-way analysis of variance (ANOVA) with Dunn’s Multiple Comparison post hoc test was used. Results: The results showed statistically significant differences in the expressions of the factors during wound healing (p < 0.05). TGF-b1 increased on days 2 and 9. TNF-a increased on day 2 and then decreased on day 9. Il-6 was increased on day 2 and decreased on days 9 and 14. uPa mRNA increased up to day 9 but its receptor exhibited high expression throughout the observation time. Finally, MMP-2 mRNA expression increased on day 2 and declined on days 9 and 14, while MMP-9 was highly expressed until the 14th postoperative day. Conclusions: Each factor investigated in this study has an important and distinct role in the normal wound repair procedure. Further investigation is required to evaluate the tissue-specific regulation of these factors and their potential use as therapeutic targets or prognostic biomarkers in wound healing. Full article

(This article belongs to the Special Issue Clinical and Experimental Surgery in Personalized Molecular Medicine)

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19 pages, 329 KB

Open AccessEditor’s ChoiceReview

Decoding Kidney Pathophysiology: Omics-Driven Approaches in Precision Medicine

by Charlotte Delrue and Marijn M. Speeckaert

J. Pers. Med. 2024, 14(12), 1157; https://doi.org/10.3390/jpm14121157 - 19 Dec 2024

Cited by 14 | Viewed by 3564

Abstract

Chronic kidney disease (CKD) is a major worldwide health concern because of its progressive nature and complex biology. Traditional diagnostic and therapeutic approaches usually fail to account for disease heterogeneity, resulting in low efficacy. Precision medicine offers a novel approach to studying kidney [...] Read more.

Chronic kidney disease (CKD) is a major worldwide health concern because of its progressive nature and complex biology. Traditional diagnostic and therapeutic approaches usually fail to account for disease heterogeneity, resulting in low efficacy. Precision medicine offers a novel approach to studying kidney disease by combining omics technologies such as genomics, transcriptomics, proteomics, metabolomics, and epigenomics. By identifying discrete disease subtypes, molecular biomarkers, and therapeutic targets, these technologies pave the way for personalized treatment approaches. Multi-omics integration has enhanced our understanding of CKD by revealing intricate molecular linkages and pathways that contribute to treatment resistance and disease progression. While pharmacogenomics offers insights into expected responses to personalized treatments, single-cell and spatial transcriptomics can be utilized to investigate biological heterogeneity. Despite significant development, challenges persist, including data integration concerns, high costs, and ethical quandaries. Standardized data protocols, collaborative data-sharing frameworks, and advanced computational tools such as machine learning and causal inference models are required to address these challenges. With the advancement of omics technology, nephrology may benefit from improved diagnostic accuracy, risk assessment, and personalized care. By overcoming these barriers, precision medicine has the potential to develop novel techniques for improving patient outcomes in kidney disease treatment. Full article

(This article belongs to the Special Issue Advances in Omics Technologies for Precision Medicine in Kidney Diseases)

13 pages, 454 KB

Open AccessEditor’s ChoiceReview

The Future of Pharmacogenomics: Integrating Epigenetics, Nutrigenomics, and Beyond

by Jeffrey A. Shaman

J. Pers. Med. 2024, 14(12), 1121; https://doi.org/10.3390/jpm14121121 - 27 Nov 2024

Cited by 14 | Viewed by 3857

Abstract

Pharmacogenomics (PGx) has revolutionized personalized medicine by empowering the tailoring of drug treatments based on individual genetic profiles. However, the complexity of drug response mechanisms necessitates the integration of additional biological and environmental factors. This article explores integrating epigenetics, nutrigenomics, microbiomes, protein interactions, [...] Read more.

Pharmacogenomics (PGx) has revolutionized personalized medicine by empowering the tailoring of drug treatments based on individual genetic profiles. However, the complexity of drug response mechanisms necessitates the integration of additional biological and environmental factors. This article explores integrating epigenetics, nutrigenomics, microbiomes, protein interactions, exosomes, and metabolomics with PGx to enhance personalized medicine. In addition to discussing these scientific advancements, we examine the regulatory and ethical challenges of translating multi-omics into clinical practice, including considerations of data privacy, regulatory oversight, and equitable access. By framing these factors within the context of Medication Adherence, Medication Appropriateness, and Medication Adverse Events (MA³), we aim to refine therapeutic strategies, improve drug efficacy, and minimize adverse effects, with the goal of improving personalized medicine. This approach has the potential to benefit patients, healthcare providers, payers, and the healthcare system as a whole by enabling more precise and effective treatments. Full article

(This article belongs to the Section Pharmacogenetics)

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21 pages, 2284 KB

Open AccessEditor’s ChoiceSystematic Review

Survival Outcomes in Sinonasal Mucosal Melanoma: Systematic Review and Meta-Analysis

by María Jesús Rojas-Lechuga, Sara Jubés, Manuel Molina-García, Rui Milton Patricio da Silva-Júnior, Claudio Sampieri, Cristóbal Langdon, Juan Ramón Gras-Cabrerizo, Manuel Bernal-Sprekelsen, Susana Puig and Isam Alobid

J. Pers. Med. 2024, 14(12), 1120; https://doi.org/10.3390/jpm14121120 - 26 Nov 2024

Cited by 10 | Viewed by 2799

Abstract

Background/Objectives: Sinonasal mucosal melanomas (SNMMs) are rare and aggressive malignancies with poor survival outcomes. Our systematic review and meta-analysis aim to evaluate overall survival (OS) rates in patients with SNMM; Methods: We conducted a systematic search, following PRISMA guidelines across PubMed, [...] Read more.

Background/Objectives: Sinonasal mucosal melanomas (SNMMs) are rare and aggressive malignancies with poor survival outcomes. Our systematic review and meta-analysis aim to evaluate overall survival (OS) rates in patients with SNMM; Methods: We conducted a systematic search, following PRISMA guidelines across PubMed, Web of Science (WOS), and citation searching for studies reporting survival and prognosis outcomes for SNMMs. Inclusion criteria included studies with 5-year OS rates. Studies were excluded if they included tumor sites other than the paranasal sinuses or nasal cavity, were published in languages other than English and Spanish, or had a sample size of fewer than 15 patients. Two reviewers independently screened studies, extracted data, and assessed study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Analyses of survival probabilities were conducted. Meta-analyses were performed using a random-effects model. PROSPERO ID CRD42024565137; Results: A total of 515 articles were identified after removing duplicates, and 99 reports were assessed for eligibility. Of these, 35 studies were included in the meta-analysis, encompassing a total of 2383 SNMM patients, of whom 1192 (50%) were female, with a weighted mean age of 65.4 years (SD = 5.4). Fifteen studies were from Europe (42.9%), six (17.1%) were from America, eleven (31.4%) were from Asia, two (5.7%) were from Australia, and one (2.9%) combined European, United Kingdom, and American populations. The 5-year OS was 34.8 [95% CI = 30.6–39.5], with the highest OS in America at 40.5 [95% CI = 34.1–48.1], followed by Europe at 36.6 [95% CI = 30.6–43.7], Australia at 32.3 [95% CI = 12.5–83.8], and Asia at 28.1 [95% CI = 19.5–40.7]. The age-standardized incidence rate (ASIR) for SNMM ranges was between 0.07 and 0.14 per 100,000 persons/year, with a slightly higher incidence in women than in men; Conclusions: This meta-analysis, one of the largest to date on SNMM, confirms the aggressive nature of this melanoma subtype with poor survival outcomes. Despite geographic differences in survival rates, the overall 5-year survival remains low, highlighting the urgent need for improved treatment strategies and more research to improve patient outcomes. Full article

(This article belongs to the Special Issue Sinonasal and Skull Base Pathologies: Personalized Management Based on Radiological and Biological Fingerprint)

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18 pages, 584 KB

Open AccessEditor’s ChoiceSystematic Review

Diabetes Awareness Campaigns to Prevent Ketoacidosis at the Diagnosis of Type 1 Diabetes: Efficacy on Multiple Outcomes and Predictors of Success: A Systematic Review

by Elisa Minerba, Evelina Maines, Nadia Quaglia, Ludovica Fedi, Stefania Fanti, Alessandro Fierro and Enza Mozzillo

J. Pers. Med. 2024, 14(12), 1115; https://doi.org/10.3390/jpm14121115 - 21 Nov 2024

Cited by 5 | Viewed by 2310

Abstract

Background/Objectives: In Italy, the incidence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) is still very high (35.7–39.6%), especially in youths. We aimed to determine the efficacy of awareness campaigns to prevent DKA on multiple outcomes and identify success predictors. [...] Read more.

Background/Objectives: In Italy, the incidence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) is still very high (35.7–39.6%), especially in youths. We aimed to determine the efficacy of awareness campaigns to prevent DKA on multiple outcomes and identify success predictors. Methods: We searched electronic databases (Pubmed, Cochrane, and Web of Science) for studies published between 1 August 1990 and 1 August 2024. The review included studies that focused on children under 18 years old, and outcomes were measured by comparing before and after implementing the campaigns in the same area and between areas where interventions took place or not. Results: Of 236 records identified, 15 were eligible for analysis. After campaign implementation, the pooled DKA reduction resulted between 1% and 65.5%, based on the characteristics of the campaigns. A decrease in the rate of acute complications, such as cerebral edema, was reported. Hemoglobin A1c (HbA1c) at onset showed a mean reduction of 0.7–5.1%; C-peptide increased in patients without DKA at diagnosis, and length of hospitalization decreased. Campaign costs were lower than the costs of treating subjects with DKA. Conclusions: This review demonstrated that DKA awareness campaigns effectively reduce DKA incidence and improve other parameters, such as acute complications, HbA1c and C-peptide levels, length of hospitalization, and costs, among youths with T1D. To be effective, campaigns must follow specific principles of target population, modality, and minimal duration, as reported in this review. Full article

(This article belongs to the Special Issue Diabetes Mellitus: Current Research and Future Perspectives, 2nd Edition)

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13 pages, 293 KB

Open AccessEditor’s ChoiceReview

Considering Biomarkers of Neurodegeneration in Alzheimer’s Disease: The Potential of Circulating Cell-Free DNA in Precision Neurology

by Chad A. Pollard, Erin R. Saito, Jeffrey M. Burns, Jonathon T. Hill and Timothy G. Jenkins

J. Pers. Med. 2024, 14(11), 1104; https://doi.org/10.3390/jpm14111104 - 13 Nov 2024

Cited by 5 | Viewed by 3893

Abstract

Neurodegenerative diseases, such as Alzheimer’s disease (AD), are a growing public health crisis, exacerbated by an aging global population and the lack of effective early disease-modifying therapies. Early detection of neurodegenerative disorders is critical to delaying symptom onset and mitigating disease progression, but [...] Read more.

Neurodegenerative diseases, such as Alzheimer’s disease (AD), are a growing public health crisis, exacerbated by an aging global population and the lack of effective early disease-modifying therapies. Early detection of neurodegenerative disorders is critical to delaying symptom onset and mitigating disease progression, but current diagnostic tools often rely on detecting pathology once clinical symptoms have emerged and significant neuronal damage has already occurred. While disease-specific biomarkers, such as amyloid-beta and tau in AD, offer precise insights, they are too limited in scope for broader neurodegeneration screening for these conditions. Conversely, general biomarkers like neurofilament light chain (NfL) provide valuable staging information but lack targeted insights. Circulating cell-free DNA (cfDNA), released during cell death, is emerging as a promising biomarker for early detection. Derived from dying cells, cfDNA can capture both general neurodegenerative signals and disease-specific insights, offering multi-layered genomic and epigenomic information. Though its clinical potential remains under investigation, advances in cfDNA detection sensitivity, standardized protocols, and reference ranges could establish cfDNA as a valuable tool for early screening. cfDNA methylation signatures, in particular, show great promise for identifying tissue-of-origin and disease-specific changes, offering a minimally invasive biomarker that could transform precision neurology. However, further research is required to address technological challenges and validate cfDNA’s utility in clinical settings. Here, we review recent work assessing cfDNA as a potential early biomarker in AD. With continued advances, cfDNA could play a pivotal role in shifting care from reactive to proactive, improving diagnostic timelines and patient outcomes. Full article

(This article belongs to the Special Issue Precision Medicine in Neurology)

17 pages, 1523 KB

Open AccessEditor’s ChoiceReview

Left Atrial Strain: State of the Art and Clinical Implications

by Niloofar Javadi, Nadera N. Bismee, Mohammed Tiseer Abbas, Isabel G. Scalia, Milagros Pereyra, Nima Baba Ali, Sogol Attaripour Esfahani, Kamal Awad, Juan M. Farina, Chadi Ayoub and Reza Arsanjani

J. Pers. Med. 2024, 14(11), 1093; https://doi.org/10.3390/jpm14111093 - 5 Nov 2024

Cited by 14 | Viewed by 5529

Abstract

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a [...] Read more.

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a major emphasis on speckle-tracking echocardiography techniques. Other imaging modalities, including cardiac magnetic resonance and cardiac computed tomography, also provide important information on LA dynamics but have disadvantages with respect to cost and availability. The current narrative review underlines basic concepts such as the accurate assessment of LAS and discusses the clinical relevance of LAS by pointing out its significant diagnostic and prognostic role in several cardiovascular conditions. The aim of this article is to discuss the current integration of LAS into clinical practice with a view to further improving patient management and treatment strategies. Full article

(This article belongs to the Special Issue The Development of Echocardiography in Heart Disease)

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28 pages, 6016 KB

Open AccessEditor’s ChoiceReview

Intratumoral Microbiota: Insights from Anatomical, Molecular, and Clinical Perspectives

by Claudia Lombardo, Rosanna Fazio, Marta Sinagra, Giuseppe Gattuso, Federica Longo, Cinzia Lombardo, Mario Salmeri, Guido Nicola Zanghì and Carla Agata Erika Loreto

J. Pers. Med. 2024, 14(11), 1083; https://doi.org/10.3390/jpm14111083 - 31 Oct 2024

Cited by 5 | Viewed by 4876

Abstract

The human microbiota represents a heterogeneous microbial community composed of several commensal, symbiotic, and even pathogenic microorganisms colonizing both the external and internal body surfaces. Despite the term “microbiota” being commonly used to identify microorganisms inhabiting the gut, several pieces of evidence suggest [...] Read more.

The human microbiota represents a heterogeneous microbial community composed of several commensal, symbiotic, and even pathogenic microorganisms colonizing both the external and internal body surfaces. Despite the term “microbiota” being commonly used to identify microorganisms inhabiting the gut, several pieces of evidence suggest the presence of different microbiota physiologically colonizing other organs. In this context, several studies have also confirmed that microbes are integral components of tumor tissue in different types of cancer, constituting the so-called “intratumoral microbiota”. The intratumoral microbiota is closely related to the occurrence and development of cancer as well as to the efficacy of anticancer treatments. Indeed, intratumoral microbiota can contribute to carcinogenesis and metastasis formation as some microbes can directly cause DNA damage, while others can induce the activation of proinflammatory responses or oncogenic pathways and alter the tumor microenvironment (TME). All these characteristics make the intratumoral microbiota an interesting topic to investigate for both diagnostic and prognostic purposes in order to improve the management of cancer patients. This review aims to gather the most recent data on the role of the intratumoral microbiota in cancer development, progression, and response to treatment, as well as its potential diagnostic and prognostic value. Full article

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

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16 pages, 938 KB

Open AccessEditor’s ChoiceReview

Three-Dimensional Printing Technology in Drug Design and Development: Feasibility, Challenges, and Potential Applications

by Maria C. Simon, Konstantinos Laios, Ioannis Nikolakakis and Theodore G. Papaioannou

J. Pers. Med. 2024, 14(11), 1080; https://doi.org/10.3390/jpm14111080 - 29 Oct 2024

Cited by 10 | Viewed by 5040

Abstract

Background/Objectives: The present investigation evaluates the impact of 3D-printing technology on the design of pharmaceutical drugs, considering the feasibility issues and problems concerning technological, pharmaceutical, and clinical matters. This paper aims to review how 3D printing can modify the traditional manufacturing of drugs [...] Read more.

Background/Objectives: The present investigation evaluates the impact of 3D-printing technology on the design of pharmaceutical drugs, considering the feasibility issues and problems concerning technological, pharmaceutical, and clinical matters. This paper aims to review how 3D printing can modify the traditional manufacturing of drugs with personalized medicine-therapy outcomes being individualized and optimized, hence improving patients’ compliance. Methods: The historical development of 3D printing from rapid prototyping to advanced pharmaceutical applications is discussed. A comparison is then made between traditional drug manufacturing approaches and the different techniques of 3D printing, including stereolithography, material extrusion, and binder jetting. Feasibility is assessed based on clinical trials and studies evaluating the efficacy, safety, bioavailability, and cost-effectiveness of 3D-printed drugs. Results: Current evidence indicates that material selection, regulatory barriers, and scalability issues are some of the major challenges to be overcome for wider acceptance. Other matters, such as ethical issues concerning patient data privacy, the misuse of 3D-printing technology, and technical complexities related to pharmaceutical 3D printing, are discussed further. Future applications also include bioprinting and in situ printing together with their implications for personalized drug delivery, which will also be discussed. Conclusions: This review stresses that intersectoral collaboration and the updating of regulatory frameworks are a must to overcome the barriers that confront 3D-printing applications in drug development. can could be an opportunity for innovative licensing and manufacturing techniques in pharmaceutical product development that can change the paradigm of personalized medicine through modern printing techniques. Full article

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

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17 pages, 758 KB

Open AccessEditor’s ChoiceReview

Maximizing Knee OA Treatment: A Comparative Look at Physiotherapy and Injections

by Danilo Donati, Federica Giorgi, Tarantino Domiziano, Luigi Tarallo, Fabio Catani, Daniela Platano and Roberto Tedeschi

J. Pers. Med. 2024, 14(11), 1077; https://doi.org/10.3390/jpm14111077 - 26 Oct 2024

Cited by 6 | Viewed by 3585

Abstract

Background: Knee osteoarthritis (OA) is a prevalent and disabling condition often managed with physiotherapy or intra-articular injections. However, the comparative effectiveness of these treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of physiotherapy and intra-articular injections in managing [...] Read more.

Background: Knee osteoarthritis (OA) is a prevalent and disabling condition often managed with physiotherapy or intra-articular injections. However, the comparative effectiveness of these treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of physiotherapy and intra-articular injections in managing knee OA. Methods: A systematic search of PubMed, Scopus, Web of Science, PEDro, and Cochrane Library was conducted. Randomized controlled trials (RCTs) comparing physiotherapy and intra-articular injections in knee OA patients were included. Key outcomes included pain (VAS), function (WOMAC, KOOS), range of motion (ROM), and quality of life. Data from five studies with a total of 552 participants were analyzed. Results: Intra-articular injections, particularly botulinum toxin and hyaluronic acid, were found to provide rapid pain relief, outperforming physiotherapy in short-term pain management. However, physiotherapy contributed significantly to long-term functional improvements, particularly in early-stage OA. Combination therapy of injections and physiotherapy yielded the best short-term pain relief and functional outcomes. Heterogeneity in study designs and follow-up periods limited the generalizability of findings. Conclusions: Intra-articular injections are effective for immediate pain control, while physiotherapy plays a crucial role in maintaining joint function, especially for long-term management. Combining both interventions may offer the most comprehensive benefits. Further research is needed to determine the long-term efficacy of these treatments. Full article

(This article belongs to the Section Personalized Therapy in Clinical Medicine)

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13 pages, 3063 KB

Open AccessEditor’s ChoiceArticle

Therapeutic Drug Monitoring of Elexacaftor, Tezacaftor, and Ivacaftor in Adult People with Cystic Fibrosis

by Susanne Naehrig, Christina Shad, Magdalena Breuling, Melanie Goetschke, Katharina Habler, Sarah Sieber, Johanna Kastenberger, Alexandra Katharina Kunzelmann, Olaf Sommerburg, Uwe Liebchen, Juergen Behr, Michael Vogeser and Michael Paal

J. Pers. Med. 2024, 14(10), 1065; https://doi.org/10.3390/jpm14101065 - 17 Oct 2024

Cited by 6 | Viewed by 2838

Abstract

Background/Objectives: Elexacaftor, tezacaftor, and ivacaftor (ETI) have significantly improved lung function in people with cystic fibrosis (pwCF). Despite exceptional improvements in most cases, treatment-related inter-subject variability and drug–drug interactions that complicate modulator therapy have been reported. Methods: This retrospective analysis presents data on [...] Read more.

Background/Objectives: Elexacaftor, tezacaftor, and ivacaftor (ETI) have significantly improved lung function in people with cystic fibrosis (pwCF). Despite exceptional improvements in most cases, treatment-related inter-subject variability and drug–drug interactions that complicate modulator therapy have been reported. Methods: This retrospective analysis presents data on the serum concentration of ETI in our pwCF with full or reduced dosage from August 2021 to December 2023 via routine therapeutic drug monitoring (TDM). The data were compared with the maximum drug concentrations (Cmax) from the pharmaceutical company’s summary of product characteristics. Results: A total of 786 blood samples from 155 pwCF (41% female, 59% male) were analyzed. The examinations were divided into four groups: full dose within the given tmax (38.5% of all measurements), full dose outside the tmax (29%), reduced dose within the tmax (19.2%), and reduced dose outside the tmax (13.2%). In pwCF receiving the full dose and blood taken within the tmax, 45.3% of serum concentrations of elexacaftor, 51.1% of serum concentrations of ivacaftor, and 8.9% of serum concentrations of tezacaftor were found to be above the Cmax, respectively. For those on reduced doses within the tmax, 24.5% had a serum concentration of elexacaftor, 23.2% had a serum concentration of ivacaftor, and 2.5% had a serum concentration of tezacaftor above the Cmax, respectively. Conclusions: Many pwCF under ETI therapy have Cmax values for elexacaftor and ivacaftor above the recommended range, even on reduced doses or before the tmax was reached. This highlights the value of a TDM program. Further pharmacokinetic studies are necessary. Full article

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

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22 pages, 1136 KB

Open AccessEditor’s ChoiceReview

Personalized Treatment Strategies via Integration of Gene Expression Biomarkers in Molecular Profiling of Laryngeal Cancer

by Antonino Maniaci, Giovanni Giurdanella, Carlos Chiesa Estomba, Simone Mauramati, Andy Bertolin, Marco Lionello, Miguel Mayo-Yanez, Paolo Boscolo Rizzo, Jerome R. Lechien and Mario Lentini

J. Pers. Med. 2024, 14(10), 1048; https://doi.org/10.3390/jpm14101048 - 10 Oct 2024

Cited by 9 | Viewed by 4215

Abstract

Laryngeal cancer poses a substantial challenge in head and neck oncology, and there is a growing focus on customized medicine techniques. The present state of gene expression indicators in laryngeal cancer and their potential to inform tailored therapy choices are thoroughly examined in [...] Read more.

Laryngeal cancer poses a substantial challenge in head and neck oncology, and there is a growing focus on customized medicine techniques. The present state of gene expression indicators in laryngeal cancer and their potential to inform tailored therapy choices are thoroughly examined in this review. We examine significant molecular changes, such as TP53, CDKN2A, PIK3CA, and NOTCH1 mutations, which have been identified as important participants in the development of laryngeal cancer. The study investigates the predictive and prognostic significance of these genetic markers in addition to the function of epigenetic changes such as the methylation of the MGMT promoter. We also go over the importance of cancer stem cell-related gene expression patterns, specifically CD44 and ALDH1A1 expression, in therapy resistance and disease progression. The review focuses on indicators, including PD-L1, CTLA-4, and tumor mutational burden (TMB) in predicting immunotherapy responses, highlighting recent developments in our understanding of the intricate interactions between tumor genetics and the immune milieu. We also investigate the potential for improving prognosis accuracy and treatment selection by the integration of multi-gene expression panels with clinicopathological variables. The necessity for uniform testing and interpretation techniques is one of the difficulties, in implementing these molecular insights into clinical practice, that are discussed. This review seeks to provide a comprehensive framework for promoting personalized cancer therapy by combining the most recent data on gene expression profiling in laryngeal cancer. Molecularly guided treatment options may enhance patient outcomes. Full article

(This article belongs to the Special Issue Gene Expression in Personalized Management of Diseases of Civilization)

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12 pages, 1626 KB

Open AccessEditor’s ChoiceArticle

Soft Tissue Facial Morphology in Growing Patients with Different Occlusal Classes

by Niccolò Cenzato, Marco Farronato, Francesco Carlo Tartaglia, Lucia Giannini, Angelo Michele Inchingolo, Gianna Dipalma, Cinzia Maspero and Francesco Inchingolo

J. Pers. Med. 2024, 14(10), 1042; https://doi.org/10.3390/jpm14101042 - 7 Oct 2024

Cited by 6 | Viewed by 4005

Abstract

Introduction: The study of facial profiles in the dental field is very important for the diagnosis and the dental and orthodontic treatment plan. The aim of this study is to analyze the three-dimensional morphology of the faces of 269 growing patients with Class [...] Read more.

Introduction: The study of facial profiles in the dental field is very important for the diagnosis and the dental and orthodontic treatment plan. The aim of this study is to analyze the three-dimensional morphology of the faces of 269 growing patients with Class I and II occlusions, focusing on children aged between 6 and 9 years old. The analysis was conducted using a non-invasive computerized system, which allowed for the automatic collection of facial landmarks and the subsequent reconstruction of three-dimensional coordinates. Materials and methods: The sample comprised 269 children within the specified age range. Each child’s facial features were captured using the non-invasive computerized system, which utilized two infrared CCD cameras, real-time hardware for label recognition, and software for three-dimensional landmark reconstruction. Sixteen cutaneous facial landmarks were automatically collected for each participant. From these landmarks, 10 angular and 15 linear measurements, as well as five direct distance rates, were derived. The mean values for each age class were calculated separately for children with bilateral Angle Class I occlusion and compared with those for children with bilateral Class II occlusion. In all children, the left and right occlusal classes were measured as suggested by Katz. Results: The analysis revealed notable differences, primarily in the three-dimensional angular measurements between children with Class I and II occlusions. Specifically, Class II children exhibited more convex faces in the sagittal plane and a less prominent lower jaw compared to Class I children. However, no significant differences were observed in linear measurements, except for the lower facial height rate, which varied inconsistently across age groups between the two occlusion types. Discussion and Conclusions: the findings of this research highlight distinct three-dimensional facial morphological differences between children with Class I and II occlusions. While Class II children tended to have more convex facial profiles and less prominent lower jaws, linear measurements showed minimal variation between the two occlusion types. These results underscore the importance of three-dimensional analysis in understanding facial morphology in growing patients with different occlusal patterns. Full article

(This article belongs to the Special Issue Orthodontics and Oral Surgery in Personalized Medicine: 2nd Edition)

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16 pages, 1223 KB

Open AccessEditor’s ChoiceReview

Risk Factors for Ovarian Cancer in South America: A Literature Review

by Sergio Jara-Rosales, Roxana González-Stegmaier, Elena S. Rotarou and Franz Villarroel-Espíndola

J. Pers. Med. 2024, 14(9), 992; https://doi.org/10.3390/jpm14090992 - 18 Sep 2024

Cited by 6 | Viewed by 3639

Abstract

Background/Objectives: In 2020, ovarian cancer ranked fourth in global incidence among gynecological cancers and remains the deadliest cancer affecting women’s health. Survival rates are significantly higher when the disease is detected at early stages; however, the lack of effective early detection methods underscores [...] Read more.

Background/Objectives: In 2020, ovarian cancer ranked fourth in global incidence among gynecological cancers and remains the deadliest cancer affecting women’s health. Survival rates are significantly higher when the disease is detected at early stages; however, the lack of effective early detection methods underscores the importance of identifying risk factors in order to implement preventive strategies. The objective of this work is to provide an overview of the risk factors of ovarian cancer in South America, emphasizing those linked to social determinants, genetic components, and comorbidities. Methods: A literature search was performed using PubMed and Google Scholar. MeSH descriptors and keywords, such as “BRCA1 genes,” “BRCA2 genes”, “Latin America”, and “ovarian neoplasms” were used, along with terms related to socioeconomic and health factors. Inclusion criteria focused on original studies published in the last five years involving South American women. Results: Studies were identified from Argentina, Brazil, Chile, Colombia, Ecuador, and Peru. These studies addressed genetic factors, health status at diagnosis, and sociodemographic factors, revealing important data gaps, particularly on contraception and hormone replacement therapy. The prevalence of BRCA1 and BRCA2 mutations in South America is estimated to be 15–20% among women with inherited risk factors. Social, demographic and economic factors vary by country, although commonalities include a higher prevalence among women over 50 years of age, those with limited education, and those who face barriers to accessing health care. Conclusions: Although the literature does not conclusively establish a direct link between obesity and/or diabetes and the development of ovarian cancer, the indirect association highlights the need for further clinical studies. A general research gap related to risk factors of ovarian cancer could be observed in the South American region. Full article

(This article belongs to the Special Issue New Perspectives, Challenges and Innovations in Modern Personalized Gynaecologic Oncology)

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27 pages, 4189 KB

Open AccessEditor’s ChoiceReview

Minimally Invasive Therapies for Knee Osteoarthritis

by Uchenna Osuala, Megan H. Goh, Arian Mansur, John B. Smirniotopoulos, Arielle Scott, Christine Vassell, Bardia Yousefi, Neil K. Jain, Alan A. Sag, Allison Lax, Kevin W. Park, Alexander Kheradi, Marc Sapoval, Jafar Golzarian, Peiman Habibollahi, Osman Ahmed, Shamar Young and Nariman Nezami

J. Pers. Med. 2024, 14(9), 970; https://doi.org/10.3390/jpm14090970 - 13 Sep 2024

Cited by 4 | Viewed by 5865

Abstract

Knee osteoarthritis (KOA) is a musculoskeletal disorder characterized by articular cartilage degeneration and chronic inflammation, affecting one in five people over 40 years old. The purpose of this study was to provide an overview of traditional and novel minimally invasive treatment options and [...] Read more.

Knee osteoarthritis (KOA) is a musculoskeletal disorder characterized by articular cartilage degeneration and chronic inflammation, affecting one in five people over 40 years old. The purpose of this study was to provide an overview of traditional and novel minimally invasive treatment options and role of artificial intelligence (AI) to streamline the diagnostic process of KOA. This literature review provides insights into the mechanisms of action, efficacy, complications, technical approaches, and recommendations to intra-articular injections (corticosteroids, hyaluronic acid, and plate rich plasma), genicular artery embolization (GAE), and genicular nerve ablation (GNA). Overall, there is mixed evidence to support the efficacy of the intra-articular injections that were covered in this study with varying degrees of supported recommendations through formal medical societies. While GAE and GNA are more novel therapeutic options, preliminary evidence supports their efficacy as a potential minimally invasive therapy for patients with moderate to severe KOA. Furthermore, there is evidentiary support for the use of AI to assist clinicians in the diagnosis and potential selection of treatment options for patients with KOA. In conclusion, there are many exciting advancements within the diagnostic and treatment space of KOA. Full article

(This article belongs to the Special Issue Interventional Radiology and Personalized Medicine)

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13 pages, 680 KB

Open AccessEditor’s ChoiceReview

Predicting and Avoiding Complications in Percutaneous Nephrolithotomy in the Era of Personalized Medicine: A Scoping Review

by Carlos Fernández Baltar, María Elena Martínez Corral and Daniel Pérez Fentes

J. Pers. Med. 2024, 14(9), 962; https://doi.org/10.3390/jpm14090962 - 10 Sep 2024

Cited by 7 | Viewed by 3536

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is associated with a wide range of complications. This review aims to explore how recent technological advancements and personalized medicine can help prevent or predict these complications. Methods: A scoping review was conducted according to the PRISMA-SCR guidelines and [...] Read more.

Background: Percutaneous nephrolithotomy (PCNL) is associated with a wide range of complications. This review aims to explore how recent technological advancements and personalized medicine can help prevent or predict these complications. Methods: A scoping review was conducted according to the PRISMA-SCR guidelines and registered on the Open Science Framework in April 2024. A literature search was performed on PUBMED, Web of Science, and Scopus databases. This review focused on predictive AI models, 3D surgical models, intrasurgical image guidance, and biomarkers. Articles meeting the following criteria were included: publication between 2019 and 2024, written in English, involving human participants, and discussing technological advancements or personalized medicine in the context of complications in PCNL. Results: Of the 11,098 articles searched, 35 new studies were included. We identified a few articles on predictive AI models. Several studies demonstrated that 3D presurgical models and virtual models could enhance surgical planning and reduce complications. New intrasurgical image and guidance systems showed the potential in reducing bleeding and radiation exposure. Finally, several biomarkers were identified as predictors of sepsis and other complications. Conclusion: This scoping review highlights the potential of emerging technologies in reducing and predicting PCNL complications. However, larger prospective studies are required for validation. Full article

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

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29 pages, 1103 KB

Open AccessEditor’s ChoiceReview

Integrating Machine Learning with Multi-Omics Technologies in Geroscience: Towards Personalized Medicine

by Nikolaos Theodorakis, Georgios Feretzakis, Lazaros Tzelves, Evgenia Paxinou, Christos Hitas, Georgia Vamvakou, Vassilios S. Verykios and Maria Nikolaou

J. Pers. Med. 2024, 14(9), 931; https://doi.org/10.3390/jpm14090931 - 31 Aug 2024

Cited by 28 | Viewed by 7718

Abstract

Aging is a fundamental biological process characterized by a progressive decline in physiological functions and an increased susceptibility to diseases. Understanding aging at the molecular level is crucial for developing interventions that could delay or reverse its effects. This review explores the integration [...] Read more.

Aging is a fundamental biological process characterized by a progressive decline in physiological functions and an increased susceptibility to diseases. Understanding aging at the molecular level is crucial for developing interventions that could delay or reverse its effects. This review explores the integration of machine learning (ML) with multi-omics technologies—including genomics, transcriptomics, epigenomics, proteomics, and metabolomics—in studying the molecular hallmarks of aging to develop personalized medicine interventions. These hallmarks include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, disabled macroautophagy, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. Using ML to analyze big and complex datasets helps uncover detailed molecular interactions and pathways that play a role in aging. The advances of ML can facilitate the discovery of biomarkers and therapeutic targets, offering insights into personalized anti-aging strategies. With these developments, the future points toward a better understanding of the aging process, aiming ultimately to promote healthy aging and extend life expectancy. Full article

(This article belongs to the Special Issue The Intersection of Multi-Omics Data and Machine Learning in Medicine)

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25 pages, 655 KB

Open AccessEditor’s ChoiceReview

Systematic Review and Clinical Insights: The Role of the Ketogenic Diet in Managing Glioblastoma in Cancer Neuroscience

by Jose Valerio, Matteo Borro, Elisa Proietti, Livia Pisciotta, Immanuel O. Olarinde, Maria Fernandez Gomez and Andres Mauricio Alvarez Pinzon

J. Pers. Med. 2024, 14(9), 929; https://doi.org/10.3390/jpm14090929 - 31 Aug 2024

Cited by 10 | Viewed by 14320

Abstract

Recent scientific research has shown that the ketogenic diet may have potential benefits in a variety of medical fields, which has led to the diet receiving a substantial amount of attention. Clinical and experimental research on brain tumors has shown that the ketogenic [...] Read more.

Recent scientific research has shown that the ketogenic diet may have potential benefits in a variety of medical fields, which has led to the diet receiving a substantial amount of attention. Clinical and experimental research on brain tumors has shown that the ketogenic diet has a satisfactory safety profile. This safety profile has been established in a variety of applications, including the management of obesity and the treatment of drug-resistant epileptic cases. However, in human studies, the impact of ketogenic therapy on the growth of tumors and the life expectancy of patients has not provided results that are well characterized. Consequently, our purpose is to improve the comprehension of these features by succinctly presenting the developments and conclusions that have been gained from the most recent study that pertains to this non-pharmacological technique. According to the findings of our study, patients with brain tumors who stick to a ketogenic diet are more likely to experience improved survival rates. However, it is required to conduct additional research on humans in order to more accurately define the anti-tumor efficiency of this diet as well as the underlying processes that support the therapeutic effects of this dieting regimen. Full article

(This article belongs to the Special Issue Advancements in Neurosurgical Oncology: Bridging Neurosurgery and Cancer Neuroscience)

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12 pages, 2410 KB

Open AccessEditor’s ChoiceArticle

Artificial Intelligence in Multilingual Interpretation and Radiology Assessment for Clinical Language Evaluation (AI-MIRACLE)

by Praneet Khanna, Gagandeep Dhillon, Venkata Buddhavarapu, Ram Verma, Rahul Kashyap and Harpreet Grewal

J. Pers. Med. 2024, 14(9), 923; https://doi.org/10.3390/jpm14090923 - 30 Aug 2024

Cited by 9 | Viewed by 3587

Abstract

The AI-MIRACLE Study investigates the efficacy of using ChatGPT 4.0, a large language model (LLM), for translating and simplifying radiology reports into multiple languages, aimed at enhancing patient comprehension. The study assesses the model’s performance across the most spoken languages in the U.S., [...] Read more.

The AI-MIRACLE Study investigates the efficacy of using ChatGPT 4.0, a large language model (LLM), for translating and simplifying radiology reports into multiple languages, aimed at enhancing patient comprehension. The study assesses the model’s performance across the most spoken languages in the U.S., emphasizing the accuracy and clarity of translated and simplified radiology reports for non-medical readers. This study employed ChatGPT 4.0 to translate and simplify selected radiology reports into Vietnamese, Tagalog, Spanish, Mandarin, and Arabic. Hindi was used as a preliminary test language for validation of the questionnaire. Performance was assessed via Google form surveys distributed to bilingual physicians, which assessed the translation accuracy and clarity of simplified texts provided by ChatGPT 4. Responses from 24 participants showed mixed results. The study underscores the model’s varying success across different languages, emphasizing both potential applications and limitations. ChatGPT 4.0 shows promise in breaking down language barriers in healthcare settings, enhancing patient comprehension of complex medical information. However, the performance is inconsistent across languages, indicating a need for further refinement and more inclusive training of AI models to handle diverse medical contexts and languages. The study highlights the role of LLMs in improving healthcare communication and patient comprehension, while indicating the need for continued advancements in AI technology, particularly in the translation of low-resource languages. Full article

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

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18 pages, 5712 KB

Open AccessEditor’s ChoiceArticle

Urolithin A Ameliorates the TGF Beta-Dependent Impairment of Podocytes Exposed to High Glucose

by Barbara Lewko, Milena Wodzińska, Agnieszka Daca, Agata Płoska, Katarzyna Obremska and Leszek Kalinowski

J. Pers. Med. 2024, 14(9), 914; https://doi.org/10.3390/jpm14090914 - 28 Aug 2024

Cited by 5 | Viewed by 2304

Abstract

Increased activity of transforming growth factor-beta (TGF-β) is a key factor mediating kidney impairment in diabetes. Glomerular podocytes, the crucial component of the renal filter, are a direct target of TGF-β action, resulting in irreversible cell loss and progression of chronic kidney disease [...] Read more.

Increased activity of transforming growth factor-beta (TGF-β) is a key factor mediating kidney impairment in diabetes. Glomerular podocytes, the crucial component of the renal filter, are a direct target of TGF-β action, resulting in irreversible cell loss and progression of chronic kidney disease (CKD). Urolithin A (UA) is a member of the family of polyphenol metabolites produced by gut microbiota from ellagitannins and ellagic acid-rich foods. The broad spectrum of biological activities of UA makes it a promising candidate for the treatment of podocyte disorders. In this in vitro study, we investigated whether UA influences the changes exerted in podocytes by TGF-β and high glucose. Following a 7-day incubation in normal (NG, 5.5 mM) or high (HG, 25 mM) glucose, the cells were treated with UA and/or TGF-β1 for 24 h. HG and TGF-β1, each independent and in concert reduced expression of nephrin, increased podocyte motility, and up-regulated expression of b3 integrin and fibronectin. These typical-for-epithelial-to-mesenchymal transition (EMT) effects were inhibited by UA in both HG and NG conditions. UA also reduced the typically elevated HG expression of TGF-β receptors and activation of the TGF-β signal transducer Smad2. Our results indicate that in podocytes cultured in conditions mimicking the diabetic milieu, UA inhibits and reverses changes underlying podocytopenia in diabetic kidneys. Hence, UA should be considered as a potential therapeutic agent in podocytopathies. Full article

(This article belongs to the Section Disease Biomarkers)

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17 pages, 328 KB

Open AccessEditor’s ChoiceReview

Recommendations for the Application of Sex and Gender Medicine in Preclinical, Epidemiological and Clinical Research

by Annamaria Cattaneo, Maria Bellenghi, Eliana Ferroni, Cristina Mangia, Matteo Marconi, Paola Rizza, Alice Borghini, Lorena Martini, Maria Novella Luciani, Elena Ortona, Alessandra Carè, Marialuisa Appetecchia and Ministry of Health-Gender Medicine Team

J. Pers. Med. 2024, 14(9), 908; https://doi.org/10.3390/jpm14090908 - 27 Aug 2024

Cited by 7 | Viewed by 5601

Abstract

Gender medicine studies how health status and diseases differ between men and women in terms of prevention, therapeutic approach, prognosis, and psychological and social impact. Sex and gender analyses have been demonstrated to improve science, contributing to achieving real appropriateness and equity in [...] Read more.

Gender medicine studies how health status and diseases differ between men and women in terms of prevention, therapeutic approach, prognosis, and psychological and social impact. Sex and gender analyses have been demonstrated to improve science, contributing to achieving real appropriateness and equity in the cure for each person. Therefore, it is fundamental to consider, both in preclinical and clinical research, the different clinical and biological features associated with sex and/or gender, where sex differences are mainly influenced by biological determinants and gender ones by socio-cultural and economic matters. This article was developed to provide knowledge and methodological tools for the development of studies/research protocols in which sex and gender should be taken into account. Full article

(This article belongs to the Special Issue Sex and Gender-Related Issues in the Era of Personalized Medicine)

22 pages, 1132 KB

Open AccessEditor’s ChoiceReview

IgE-Mediated Legume Allergy: A Pediatric Perspective

by Carla Mastrorilli, Fernanda Chiera, Stefania Arasi, Arianna Giannetti, Davide Caimmi, Giulio Dinardo, Serena Gracci, Luca Pecoraro, Michele Miraglia Del Giudice and Roberto Bernardini

J. Pers. Med. 2024, 14(9), 898; https://doi.org/10.3390/jpm14090898 - 25 Aug 2024

Cited by 12 | Viewed by 6574

Abstract

Legumes are an inexpensive and essential protein source worldwide. The most consumed legumes include peanuts, soybeans, lentils, lupines, peas, common bean and chickpeas. In addition, the food industry is growing interested in expanding the use of legumes to partially replace or substitute cereals. [...] Read more.

Legumes are an inexpensive and essential protein source worldwide. The most consumed legumes include peanuts, soybeans, lentils, lupines, peas, common bean and chickpeas. In addition, the food industry is growing interested in expanding the use of legumes to partially replace or substitute cereals. Legumes were described to cause IgE-mediated allergies, and their growing use may also increase the incidence of allergy. The epidemiology of legume allergy varies by region; peanuts and soybeans are the legumes most involved in food allergies in Western countries, whereas lentils, peas, and chickpeas are reported as culprit allergens mainly in the Mediterranean area and India. This review, edited by the Italian Society of Pediatric Allergology and Immunology, summarizes the scientific literature on legume allergy in children and proposes a diagnostic workup and therapeutic approach. Full article

(This article belongs to the Section Personalized Medical Care)

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21 pages, 2611 KB

Open AccessEditor’s ChoiceReview

Advancing the Diagnosis of Diabetic Neuropathies: Electrodiagnostic and Skin Autofluorescence Methods

by Dan Trofin, Bianca-Margareta Salmen, Teodor Salmen, Daniela Marilena Trofin and Delia Reurean-Pintilei

J. Pers. Med. 2024, 14(8), 884; https://doi.org/10.3390/jpm14080884 - 21 Aug 2024

Cited by 5 | Viewed by 2605

Abstract

Introduction: Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening [...] Read more.

Introduction: Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening value. This article highlights the diagnostic challenges and raises awareness of the often underdiagnosed neuropathic conditions in diabetes patients. Material and Methods: We present common entrapment neuropathy cases from our diabetes clinic’s electrodiagnosis laboratory in Iași, Romania. We selected seven type 2 diabetes patients with sensory or sensory-motor distal polyneuropathy and atypical DN presentations investigated through electroneurography (ENG) and electromyography (EMG) with the Neurosoft^® EMG instrument and SAF measured by standard procedures. Subsequently, a narrative literature review was conducted. Results: Entrapment neuropathies were diagnosed in all the patients: three carpal tunnel syndromes, two ulnar neuropathies (one proximal, one distal), one peroneal neuropathy, and one case of meralgia paresthetica. The lower-limb cases showed radiculoplexopathy, and there was one case of superficial radial nerve neuropathy. The SAF values ranged from 2.5 AU to 3.4 AU. Conclusions: Electrodiagnosis is essential for detecting focal neuropathies in patients with sensory-motor distal polyneuropathy. Elevated SAF levels may correlate with symptom severity, although further research, including large cohorts, is needed. Full article

(This article belongs to the Special Issue Diabetes and Its Complications: From Research to Clinical Practice)

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19 pages, 1888 KB

Open AccessEditor’s ChoiceReview

Chatbots in Cancer Applications, Advantages and Disadvantages: All that Glitters Is Not Gold

by Georgios Goumas, Theodoros I. Dardavesis, Konstantinos Syrigos, Nikolaos Syrigos and Effie Simou

J. Pers. Med. 2024, 14(8), 877; https://doi.org/10.3390/jpm14080877 - 19 Aug 2024

Cited by 14 | Viewed by 6387

Abstract

The emergence of digitalization and artificial intelligence has had a profound impact on society, especially in the field of medicine. Digital health is now a reality, with an increasing number of people using chatbots for prognostic or diagnostic purposes, therapeutic planning, and monitoring, [...] Read more.

The emergence of digitalization and artificial intelligence has had a profound impact on society, especially in the field of medicine. Digital health is now a reality, with an increasing number of people using chatbots for prognostic or diagnostic purposes, therapeutic planning, and monitoring, as well as for nutritional and mental health support. Initially designed for various purposes, chatbots have demonstrated significant advantages in the medical field, as indicated by multiple sources. However, there are conflicting views in the current literature, with some sources highlighting their drawbacks and limitations, particularly in their use in oncology. This state-of-the-art review article seeks to present both the benefits and the drawbacks of chatbots in the context of medicine and cancer, while also addressing the challenges in their implementation, offering expert insights on the subject. Full article

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

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27 pages, 11277 KB

Open AccessEditor’s ChoiceReview

Imaging of Sacroiliac Pain: The Current State-of-the-Art

by Marina Carotti, Luca Ceccarelli, Anna Claudia Poliseno, Francesca Ribichini, Francesca Bandinelli, Enrico Scarano, Sonia Farah, Marco Di Carlo, Andrea Giovagnoni and Fausto Salaffi

J. Pers. Med. 2024, 14(8), 873; https://doi.org/10.3390/jpm14080873 - 17 Aug 2024

Cited by 4 | Viewed by 15451

Abstract

Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image [...] Read more.

Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image accurately because of its distinct anatomical characteristics. For an accurate diagnosis, conventional radiography often needs to be supplemented with more precise methods such as magnetic resonance imaging (MRI) or computed tomography (CT). Sacroiliitis, a common presenting feature of axial spondyloarthritis (axial SpA), manifests as bone marrow edema, erosions, sclerosis, and joint space narrowing. Septic sacroiliitis and repetitive stress injuries in sports can also cause changes resembling inflammatory sacroiliitis. Other conditions, such as osteitis condensans ilii (OCI), can mimic the radiologic characteristics of sacroiliitis. Inflammatory lesions are diagnosed by concurrent erosions, hyperostosis, and ankylosis. Ligament ossifications or mechanical stress can also result in arthritic disorders. Determining the exact diagnosis can be aided by the distribution of the lesions. Inflammatory lesions can affect any part of the articulation, including the inferior and posterior portions. Mechanical lesions, such as those seen in OCI, often occur in the anterior middle region of the joint. In cases of idiopathic skeletal hyperostosis, ligament ossification is found at the joint borders. This pictorial essay describes common SI joint problems, illustrated with multimodal imaging data. We, also, discuss strategies for selecting the best imaging modalities, along with imaging pitfalls, key points, and approaches for treating patients with suspected inflammatory back pain. Full article

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

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17 pages, 1456 KB

Open AccessEditor’s ChoiceSystematic Review

Anatomical Features in Inguinal-Pubic-Adductor Area That May Contribute to Gender Difference in Susceptibility to Groin Pain Syndrome

by Gian Nicola Bisciotti, Andrea Bisciotti, Alessio Auci, Alessandro Bisciotti and Piero Volpi

J. Pers. Med. 2024, 14(8), 860; https://doi.org/10.3390/jpm14080860 - 14 Aug 2024

Cited by 5 | Viewed by 3028

Abstract

Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10–20% of the total sports population. In the literature, a certain number of studies demonstrate an important [...] Read more.

Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10–20% of the total sports population. In the literature, a certain number of studies demonstrate an important gender-based difference in the incidence of GPS in both sexes, with a ratio of female:male athletes clearly in favor of the female gender being relatively less prone to GPS. Indeed, some anatomical differences between the two sexes seem to represent a protective factor against the onset of GPS in women, although the current literature still needs to clarify the validity of these findings. It is the aim of this systematic review to examine all the anatomical differences between men and women that may be responsible for the difference in the onset of GPS in the two sexes. Full article

(This article belongs to the Special Issue Sex and Gender-Related Issues in the Era of Personalized Medicine)

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12 pages, 1457 KB

Open AccessEditor’s ChoiceArticle

Cranio-Maxillo-Facial Reconstruction with Polyetheretherketone Patient-Specific Implants: Aesthetic and Functional Outcomes

by Ylenia Gugliotta, Emanuele Zavattero, Guglielmo Ramieri, Claudia Borbon and Giovanni Gerbino

J. Pers. Med. 2024, 14(8), 849; https://doi.org/10.3390/jpm14080849 - 10 Aug 2024

Cited by 8 | Viewed by 3734

Abstract

Background: Reconstructing cranio-maxillo-facial defects presents significant challenges. This study evaluates the results of polyetheretherketone patient-specific implants (PEEK PSIs) in primary and secondary cranio-maxillo-facial reconstructions, with a focus on aesthetic and functional outcomes and long-term complications. Methods: From October 2009 to February 2023, 45 [...] Read more.

Background: Reconstructing cranio-maxillo-facial defects presents significant challenges. This study evaluates the results of polyetheretherketone patient-specific implants (PEEK PSIs) in primary and secondary cranio-maxillo-facial reconstructions, with a focus on aesthetic and functional outcomes and long-term complications. Methods: From October 2009 to February 2023, 45 patients underwent cranio-maxillo-facial reconstructions with PSIs. Patients aged 18 years or older, with a minimum follow-up period of 12 months, were included. The morpho-functional outcome was evaluated through a modified Katsuragy Scale, the Visual Analogue Scale (VAS) for pain, and four FACE-Q|Aesthetics© scales. Results: In total, 44 PSIs were placed in 37 patients (51.3% males; mean age 45.1 years). The main cause of the defect was the resection of a tumor (55.4%). Mean follow-up was 78.6 months. Clinical evaluations showed an improvement in the postoperative period both in patient’s and surgeon’s scores (p: 0.01 and p: 0.002, respectively). Subgroup analysis confirmed a significant improvement in patients undergoing cranioplasty (p = 0.02) and mandible reconstruction (p = 0.03). No cases of prosthesis dislocation, rupture, or long-term infection were recorded. Conclusions: PEEK PSIs offer significant advantages in craniofacial reconstructions. Despite challenges in predicting soft tissue adaptation, overall patient satisfaction was high with no long-term complications. Future improvements should focus on predicting and enhancing soft tissue adaptations. Full article

(This article belongs to the Section Personalized Therapy in Clinical Medicine)

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13 pages, 859 KB

Open AccessEditor’s ChoiceReview

The Search for Consistency in Residual Symptoms in Major Depressive Disorder: A Narrative Review

by Michał Pastuszak, Wiesław Jerzy Cubała, Aleksander Kwaśny and Agnieszka Mechlińska

J. Pers. Med. 2024, 14(8), 828; https://doi.org/10.3390/jpm14080828 - 4 Aug 2024

Cited by 7 | Viewed by 6316

Abstract

Residual symptoms are prevalent in major depressive disorder (MDD), encompassing a wide spectrum of symptoms such as sleep disturbances, changes in weight and appetite, cognitive impairment, and anxiety. These symptoms consistently impair daily functioning, diminish quality of life, and forecast disease relapse. Despite [...] Read more.

Residual symptoms are prevalent in major depressive disorder (MDD), encompassing a wide spectrum of symptoms such as sleep disturbances, changes in weight and appetite, cognitive impairment, and anxiety. These symptoms consistently impair daily functioning, diminish quality of life, and forecast disease relapse. Despite their clinical significance, residual symptoms lack a unified definition, potentially leading to confusion with treatment-emergent symptoms and ambiguity across studies, thereby hindering the generalizability of research findings. While some research identifies insomnia and mood disturbances as critical indicators, other studies emphasize different symptoms or find no significant correlation. Inconsistencies in defining residual symptoms, as well as methodological differences across studies, contribute to these conflicting results. While clinicians focus on alleviating negative symptoms to improve functional status, patients often prioritize achieving positive affect and overall well-being as essential components of successful treatment. It necessitates a comprehensive approach to patient care in depression. This review explores the phenomenon of residual symptoms in MDD, focusing on the ambiguity in definitions, clinical characteristics, and their impact on long-term outcomes. The lack of a standardized regulatory or academic definition for residual symptoms leads to varied interpretations among clinicians, underscoring the need for standardized terminology to guide effective treatment strategies and future research. Full article

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

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