Journal of Personalized Medicine

17 pages, 2526 KB

Open AccessArticle

Intravenous Lidocaine Modulates the Perioperative Hepatic Inflammatory Response: Implications for Personalized Medicine in Thoracic Surgery

by Ana Isabel Galve, Ignacio Garutti, Elena Vara, Guillermo González, Gabriel Cusati, Lisa Rancan, Luis Huerta, Javier Casanova and Carlos Simón

J. Pers. Med. 2025, 15(12), 620; https://doi.org/10.3390/jpm15120620 - 11 Dec 2025

Abstract

Purpose: Lung resection surgery (LRS) induces a strong local and systemic inflammatory response that may extend to peripheral organs, including the liver. This study aimed to evaluate the potential effect of intravenous lidocaine on hepatic inflammatory and apoptotic responses during lung resection [...] Read more.

Purpose: Lung resection surgery (LRS) induces a strong local and systemic inflammatory response that may extend to peripheral organs, including the liver. This study aimed to evaluate the potential effect of intravenous lidocaine on hepatic inflammatory and apoptotic responses during lung resection surgery with one-lung ventilation (OLV) in an experimental porcine model. Methods: Eighteen mini pigs were randomly assigned to three groups: lidocaine (LIDO), control (CON), and sham (SHAM). Animals underwent left caudal lobectomy. The LIDO group received a continuous intravenous infusion of lidocaine (1.5 mg/kg/h) during surgery. The CON group received the same volume of saline, and the SHAM group underwent thoracotomy without lobectomy or OLV. Different samples were collected at baseline, during surgery, and 24 h postoperatively to assess inflammatory cytokines and apoptosis-related proteins. Liver biopsy was taken 24 h after de surgery. Results: One-lung ventilation and lung resection surgery increased the expression of proinflammatory markers in the liver biopsy and enhanced apoptotic protein expression and iNOS production. Lidocaine administration attenuated these effects, showing lower levels of inflammatory mediators, a better balance between iNOS and eNOS, and reduced apoptotic activity compared with controls. Conclusions: Our findings suggest that intravenous lidocaine may serve as a personalized perioperative strategy to attenuate systemic inflammatory and apoptotic responses, contributing to improved hepatic protection during thoracic surgery. Full article

(This article belongs to the Special Issue New Insights into Personalized Medicine for Anesthesia and Pain)

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19 pages, 1052 KB

Open AccessReview

Gene Therapy for Inherited Retinal Disease: Current Strategies, Personalized Medicine, and Future Implications—A Comprehensive Review

by Fahad R. Butt, Thanansayan Dhivagaran, Boaz Li, Mark Ashamalla, Brendan K. Tao, Michael Balas, Austin Pereira, Peng Yan and Parnian Arjmand

J. Pers. Med. 2025, 15(12), 619; https://doi.org/10.3390/jpm15120619 - 11 Dec 2025

Abstract

Gene therapy represents a transformative frontier in ophthalmology, offering the potential to address inherited and acquired retinal diseases at their genetic origin rather than through symptomatic management. By introducing exogenous genetic material to restore or modulate gene expression, gene therapy aims to preserve [...] Read more.

Gene therapy represents a transformative frontier in ophthalmology, offering the potential to address inherited and acquired retinal diseases at their genetic origin rather than through symptomatic management. By introducing exogenous genetic material to restore or modulate gene expression, gene therapy aims to preserve or even restore vision in patients with mutations that disrupt normal retinal function. The eye’s small, compartmentalized structure, relative immune privilege, and direct accessibility through subretinal or intravitreal routes make it an ideal target for localized delivery with minimal systemic exposure. The approval of voretigene neparvovec-rzyl for RPE65-mediated retinal dystrophy marked a pivotal milestone, establishing proof of concept for durable and safe gene replacement therapy. Looking ahead, continued refinements in vector design, CRISPR-based editing strategies, and delivery platforms are expected to expand the therapeutic reach of gene therapy beyond monogenic disorders. With multiple early-phase clinical trials underway for inherited and acquired retinal diseases, the coming decade is poised to bring broader applicability, improved durability, and more accessible gene-based treatments across the spectrum of retinal pathology. Full article

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

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14 pages, 870 KB

Open AccessArticle

Readmissions to a Surgical Intensive Care Unit: Incidence and Risk Stratification for Personalized Patient Care

by Silvia Ramos, Rafael Ramos Fernández, Raul Sevilla, Eneko Cabezuelo, Alberto Calvo, Raquel Vela, Claudia Menendez, Sergio Garcia Ramos, Javier Hortal Iglesias, Ignacio Garutti and Patricia Piñeiro

J. Pers. Med. 2025, 15(12), 618; https://doi.org/10.3390/jpm15120618 - 11 Dec 2025

Abstract

Background/Objectives: Unplanned readmission to the surgical intensive care unit (UR-SICU) is a serious adverse event linked to higher morbidity, prolonged stay, and increased mortality. Most evidence derives from mixed ICUs, limiting applicability to surgical cohorts. We aimed to identify risk factors for [...] Read more.

Background/Objectives: Unplanned readmission to the surgical intensive care unit (UR-SICU) is a serious adverse event linked to higher morbidity, prolonged stay, and increased mortality. Most evidence derives from mixed ICUs, limiting applicability to surgical cohorts. We aimed to identify risk factors for UR-SICU and assess their impact on outcomes. Methods: We performed a retrospective cohort study of adults admitted to a 20-bed SICU in a tertiary hospital between June 2021 and December 2022 after non-cardiac surgery (elective, urgent, trauma, or liver transplantation). Patients dying during the first SICU stay or transferred to another ICU were excluded. Demographics, comorbidities, severity scores, treatments, and complications were recorded. Logistic regression identified predictors. Kaplan–Meier curves analyzed survival. Results: Among 1361 patients, 82 (6.4%) required UR-SICU. Half were surgical (mainly hemorrhage and sepsis), while respiratory and infectious complications predominated among medical readmissions. Independent predictors for UR-SICU were age (OR 1.03/year; p = 0.002), active malignancy (OR 1.79; p = 0.012), and delirium during the first SICU stay (OR 1.86; p = 0.030). UR-SICU patients had longer hospital stays [46 vs. 13 days; p < 0.001] and higher hospital mortality (27.1% vs. 1.48%; OR 24.68; p < 0.001). Mortality remained higher at 6 months (33.3% vs. 7.1%) and 1 year (42.3% vs. 11.1%). Conclusions: UR-SICU occurred in 6.4% of patients and was independently associated with age, malignancy, and delirium. Readmission was strongly linked to prolonged hospitalization and increased short- and long-term mortality. Early recognition of high-risk patients and targeted, personalized preventive strategies may help reduce avoidable readmissions. Full article

(This article belongs to the Special Issue Personalized Medicine in Anesthesia and Intensive Care)

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19 pages, 2085 KB

Open AccessArticle

Personalized Robotic-Assisted Total Knee Arthroplasty with Anatomo-Functional Implant Positioning for Varus Knees: A Minimum Follow-Up of 5 Years

by Zakee Azmi, Aymen Alqazzaz, Cécile Batailler and Sébastien Parratte

J. Pers. Med. 2025, 15(12), 617; https://doi.org/10.3390/jpm15120617 - 10 Dec 2025

Abstract

Background/Objectives: Some personalized alignment (PA) concepts have been described with symmetrical gaps in extension and flexion. However, laxity in native knees was significantly greater laterally than medially with respect to both extension and flexion. We hypothesized that a personalized alignment can restore [...] Read more.

Background/Objectives: Some personalized alignment (PA) concepts have been described with symmetrical gaps in extension and flexion. However, laxity in native knees was significantly greater laterally than medially with respect to both extension and flexion. We hypothesized that a personalized alignment can restore the native knee alignment, keep a satisfying patellar tracking, and obtain physiological ligament balancing, that is, a symmetric gap in extension and an asymmetric gap in flexion. We aimed to assess: (1) the postoperative alignment of TKA and postoperative patellar tracking (primary outcome); (2) the ligament balancing at the end of the surgery; and (3) clinical outcomes and complication rates. Methods: In this single-center, retrospective case series, we evaluated 45 patients in a consecutive series who underwent robotic-assisted primary TKA using PA between January and September 2020 with a minimum follow-up of 5 years. Complication was defined as grade ≥3 according to the Clavien-Dindo classification. Data assessed were: TKA alignment and implant positioning on postoperative radiographs, patellar tracking on the merchant view, and ligament balancing in extension and flexion upon completion of surgery. Results: Mean follow-up was 62.1 ± 2.5 months. The postoperative mean HKA angle was 177.4° ± 2.2. The medial distal femoral angle was restored (91.1° ± 1.5 postoperatively versus 91.3° ± 2). A total of four TKAs had a patellar tilt superior to 5° (8.9%). No significant difference was found in the medial gap laxity—both in extension and in flexion—and the lateral gap laxity in extension. The lateral gap laxity in flexion was significantly higher than extension or medial gap laxity (+2.9 mm). One patient was readmitted for delayed wound healing. Average improvements in Knee Society knee and function scores were 55.86 and 51.84 points, respectively. Conclusions: This personalized alignment technique using anatomo-functional implant positioning allowed restoration of native knee alignment with a “safe zone” (3° varus/valgus) for the tibial implant, maintained satisfying patellar tracking, and restituted the asymmetrical gap laxity in flexion with a higher laxity in the lateral compartment. Being the longest system-specific study to date, the results are encouraging at 5 years with no major complications. However, longer follow-up will be required to confirm the use of this technique. Full article

(This article belongs to the Special Issue Cutting-Edge Innovations in Hip and Knee Joint Replacement)

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24 pages, 1773 KB

Open AccessReview

Personalizing Antidepressant Therapy: Integrating Pharmacogenomics, Therapeutic Drug Monitoring, and Digital Tools for Improved Depression Outcomes

by Mikhail Parshenkov, Sergey Zyryanov, Galina Rodionova, Anna Dyakonova, Petr Shegay, Andrei Kaprin and Grigory Demyashkin

J. Pers. Med. 2025, 15(12), 616; https://doi.org/10.3390/jpm15120616 - 10 Dec 2025

Abstract

Background: Major Depressive Disorder (MDD) is a leading global health concern, yet its pharmacological management is hampered by a «trial-and-error» approach, with a significant proportion of patients failing to achieve remission with initial therapy. This challenge stems from the disorder’s marked biological [...] Read more.

Background: Major Depressive Disorder (MDD) is a leading global health concern, yet its pharmacological management is hampered by a «trial-and-error» approach, with a significant proportion of patients failing to achieve remission with initial therapy. This challenge stems from the disorder’s marked biological heterogeneity, which is poorly captured by current broad diagnostic categories. This literature review synthesizes the latest evidence across three complementary fields poised to revolutionize MDD treatment: pharmacogenetics testing (PGT), therapeutic drug monitoring (TDM), and artificial intelligence (AI). We hypothesize that integrating all three facilitates the transition from empirical prescribing to model-informed precision dosing (MIPD), enabling prediction of optimal antidepressant selection and dosage before the first dose is administered. The convergence of these technologies, supported by an interdisciplinary framework, has the potential to enhance current treatment strategies and contribute to more individualized psychiatric care. Conclusions: Antidepressant therapy for MDD may be further optimized through the combined use of TDM, PGT, and digital tools. However, the development of this field requires ongoing research and interdisciplinary work. Full article

(This article belongs to the Section Pharmacogenetics)

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13 pages, 270 KB

Open AccessArticle

Asthma-Associated COPD Etiotype: Clinical Features and Inflammatory Patterns in Biological Samples

by Camyla Fernandez de Farias, José Baddini-Martinez, Ana Luisa Godoy Fernandes, Maria Marta Amorim, Michel Dracoulakis, Maria Amélia Santos, Lilian Ballini Caetano and Fernando Sergio Leitão Filho

J. Pers. Med. 2025, 15(12), 615; https://doi.org/10.3390/jpm15120615 - 10 Dec 2025

Abstract

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognizes asthma as a potential causal pathway for chronic obstructive pulmonary disease, referred to as the COPD-A etiotype. However, the clinical and inflammatory characteristics of this phenotype remain poorly defined. Objectives: [...] Read more.

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognizes asthma as a potential causal pathway for chronic obstructive pulmonary disease, referred to as the COPD-A etiotype. However, the clinical and inflammatory characteristics of this phenotype remain poorly defined. Objectives: This study aimed to characterize clinical traits and cytokine profiles in stable asthmatics exhibiting persistent airflow limitation compatible with COPD-A. Methods: In this cross-sectional study, 94 stable asthmatic patients (71.3% female; age = 54.0 ± 15.6 years) without relevant smoking or environmental exposures were evaluated. COPD-A was defined by a post-bronchodilator FEV₁/FVC ratio < 0.70. Asthma control (ACQ, ACT), quality of life (AQLQ), and lung function were assessed. Levels of IL-5, IL-8, IL-13, IL-17A, IL-17F, IL-25, IL-33, and TNF were quantified in nasal lavage, induced sputum, and blood samples. Results: Among the participants, 42 (44.7%) fulfilled COPD-A criteria. Compared with non-COPD-A subjects, those with COPD-A were older (60.5 vs. 48.7 years; p < 0.001) and had longer disease duration (39.8 vs. 30.1 years; p < 0.001), lower post-bronchodilator FEV₁% predicted (68.1 vs. 87.1%; p < 0.001), and poorer asthma control (ACQ = 1.00 vs. 0.64; p = 0.003). Cytokine levels were comparable between groups except for higher IL-8 concentrations in induced sputum of COPD-A subjects (7.66 vs. 2.51 pg/mL; p = 0.024). Sputum IL-8 ≥ 3.096 pg/mL independently predicted COPD-A (aOR = 12.82; p = 0.023). Conclusions: Over 40% of non-smoking asthmatics exhibited persistent airflow limitation consistent with COPD-A. Elevated sputum IL-8 levels may be a potential biomarker of this etiotype. Full article

(This article belongs to the Special Issue State of the Art in Pathogenesis and Targeted Therapy in Chronic Obstructive Pulmonary Disease)

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19 pages, 376 KB

Open AccessReview

Enhancing Traumatic Stress Recovery Through Nonattachment Principles: A Scoping Review

by Lindsay Tremblay, William Van Gordon and James Elander

J. Pers. Med. 2025, 15(12), 614; https://doi.org/10.3390/jpm15120614 - 9 Dec 2025

Abstract

Background: Nonattachment is an important component of Mindfulness-Based Interventions (MBIs), including its application within post-traumatic stress (PTS) contexts. However, within trauma contexts, there is limited understanding of the role and effectiveness of MBIs that integrate nonattachment. Objective: This study aimed to [...] Read more.

Background: Nonattachment is an important component of Mindfulness-Based Interventions (MBIs), including its application within post-traumatic stress (PTS) contexts. However, within trauma contexts, there is limited understanding of the role and effectiveness of MBIs that integrate nonattachment. Objective: This study aimed to identify and evaluate evidence regarding the effectiveness of MBIs with nonattachment elements used with PTS populations. Methods: This review followed the PRISMA scoping guideline framework with searches conducted using Science Direct, PsycINFO, PubMed, and Google Scholar for peer-reviewed studies of MBIs with nonattachment principles or practices, and outcome measures related to PTS. The final search was conducted in January 2024, with no date restrictions for eligible studies. Results: Fourteen studies met the inclusion criteria including 7 randomized controlled trials, 4 cohort studies, and 1 quasi-experimental, 1 cross-sectional, and 1 qualitative study. Individual study samples ranged from 9 to 209 participants (n = 913). All studies showed promising results for interventions integrating nonattachment applied to PTS populations, with the MBI outperforming control conditions in 6 of 7 RCTs, and all cohort studies showing significant improvements. Improvements included reductions in PTSD assessment scores, stress and anxiety, negative self-concept, disturbances in relationships, expressive suppression and rumination, and experiential avoidance, as well as increased acceptance and compassion. Various quality issues were identified such as a lack of or poorly defined randomization, blinding procedures, controls for confounding variables, and small sample sizes. MBIs integrating nonattachment that target physiological stabilization, coupled with participant input into intervention decisions, appear most promising. Conclusions: MBIs that incorporate nonattachment elements may offer meaningful support for individuals experiencing PTS, particularly by fostering more flexible and less self-fixated ways of relating to thoughts and emotions. Full article

(This article belongs to the Special Issue Advancements in Psychiatry: Exploring New Horizons in Mental Health)

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Graphical abstract

16 pages, 249 KB

Open AccessSystematic Review

Reconstructive Surgery of the Female Genital, Urethral, and Anal Tract: A Multidisciplinary Review and Future Perspectives

by Vivian Del Sorbo, Paola Pentangelo, Paolo Verrazzo, Ritapia Papa and Carmine Alfano

J. Pers. Med. 2025, 15(12), 613; https://doi.org/10.3390/jpm15120613 - 8 Dec 2025

Abstract

Background: Pelvic floor dysfunctions, congenital anomalies, and acquired defects of the female genital, urethral, and anal tract represent complex conditions requiring multidisciplinary management. This review synthesizes current evidence and aims to evaluate reconstructive surgical techniques, prosthetic use, and cosmetic approaches with a [...] Read more.

Background: Pelvic floor dysfunctions, congenital anomalies, and acquired defects of the female genital, urethral, and anal tract represent complex conditions requiring multidisciplinary management. This review synthesizes current evidence and aims to evaluate reconstructive surgical techniques, prosthetic use, and cosmetic approaches with a focus on functional and aesthetic outcomes. Methods: A structured literature search of PubMed, Embase, and the Cochrane Library was performed for the period from January 2000 to May 2025 (last search: 31 May 2025). Eligible studies included randomized controlled trials, prospective or retrospective clinical studies, and case series in English or Italian, enrolling women aged ≥18 years with a minimum follow-up of 6 months. Primary outcomes were anatomical restoration, continence, sexual function, and quality of life; secondary outcomes included patient satisfaction, wound complications, donor-site morbidity, and recurrence. Recent high-quality studies published after 2018 were prioritized to ensure an updated and evidence-based synthesis. Results: Out of 532 records, 94 full texts were assessed and 41 studies met the eligibility criteria, comprising a total of 1862 women. Flap-based reconstruction (gluteus maximus, VRAM, gracilis, ALT) remained the cornerstone for large or irradiated defects, while prosthetic meshes improved anatomical outcomes but raised concerns of erosion and chronic pain, leading to a shift toward autologous tissue. Cosmetic gynecology procedures (labiaplasty, vaginoplasty, perineoplasty) showed high patient satisfaction, although the evidence was limited and heterogeneous. Across studies, improvements were observed in continence, sexual function, quality of life, and self-image when reconstructive and aesthetic principles were integrated. Conclusions: Reconstructive and cosmetic pelvic surgery significantly impacts functional recovery and psychological well-being. Standardized outcome reporting, prospective multicenter trials, and the integration of plastic surgery, physiotherapy, and psychological support are needed to optimize patient-centered care. The findings highlight the growing role of personalized surgical planning, with reconstructive decisions increasingly guided by patient-specific anatomy, functional goals, and validated patient-reported outcome measures. Full article

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

16 pages, 881 KB

Open AccessArticle

Stress and Internalizing Problems in Adolescents: A Dynamic Longitudinal Analysis

by Filipa Ćavar Mišković, Maja Ribar, Daniela Šupe Domić, Petra Dumanić and Goran Milas

J. Pers. Med. 2025, 15(12), 612; https://doi.org/10.3390/jpm15120612 - 8 Dec 2025

Abstract

Background/Objectives: Internalizing problems commonly increase during adolescence, yet the precise nature of their reciprocal relationship with stress remains unclear. The present study aimed to clarify the directionality of this association by disentangling stable dispositional influences from dynamic, within-person processes. Specifically, we examined whether [...] Read more.

Background/Objectives: Internalizing problems commonly increase during adolescence, yet the precise nature of their reciprocal relationship with stress remains unclear. The present study aimed to clarify the directionality of this association by disentangling stable dispositional influences from dynamic, within-person processes. Specifically, we examined whether stress and internalizing symptoms exhibit bidirectional effects over time or are primarily shaped by enduring individual differences. Methods: A large, representative sample of 1618 secondary school students (671 males, 947 females; M = 16.3 years) completed measures of subjective stress, emotional problems, and peer problems across three time points spaced six months apart. Data were analyzed using the Random Intercept Cross-Lagged Panel Model (RI-CLPM), which separates stable between-person variance from within-person fluctuations. Model fit was assessed using established criteria (CFI, TLI, RMSEA). Results: Subjective stress and emotional problems were strongly associated, whereas the relationship between stress and peer problems was weaker. In both domains, associations were largely explained by stable, trait-like individual differences. All cross-lagged effects at the within-person level were non-significant, indicating no dynamic, time-ordered influence between constructs. These findings provide no empirical support for the stress sensitization or stress generation hypotheses but are consistent with diathesis–stress models emphasizing enduring dispositional vulnerability. Conclusions: The results suggest that the link between stress and internalizing symptoms during adolescence primarily reflects stable personality-based factors, such as neuroticism or emotional instability, rather than reciprocal causal processes. Preventive interventions should target emotional regulation and resilience to mitigate the impact of dispositional vulnerabilities on adolescent mental health. Full article

(This article belongs to the Special Issue Child and Adolescent Psychiatry: Latest Research, Prevention and Treatment)

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18 pages, 759 KB

Open AccessSystematic Review

Three-Dimensional Printing in Hand Surgery: What Is New? A Systematic Review

by Said Dababneh, Nadine Dababneh, Omar El Sewify, Jack Legler, Xiya Ma, Chung Ming Chan, Alain Danino and Johnny I. Efanov

J. Pers. Med. 2025, 15(12), 611; https://doi.org/10.3390/jpm15120611 - 8 Dec 2025

Abstract

Aim: Preoperative planning and in-office patient education are essential elements of clinical management in patients afflicted with hand injuries. Three-dimensional (3D) printing aims to tackle these challenges by converting feedstock material into solid replicas. The purpose of this study was to review the [...] Read more.

Aim: Preoperative planning and in-office patient education are essential elements of clinical management in patients afflicted with hand injuries. Three-dimensional (3D) printing aims to tackle these challenges by converting feedstock material into solid replicas. The purpose of this study was to review the clinical uses for 3D printing in hand surgery to identify approaches for delivering more personalized treatment strategies. Method: A systematic review was completed following PRISMA guidelines using Medline, Embase, and CINAHL databases, identifying studies published between 2013 and January 2025. A two-stage screening process, involving title, abstract, and full text reviews, was performed independently by two reviewers. Eligible studies included those involving patients with hand or wrist injuries (up to the distal radius) where 3D printing was utilized for diagnosis, surgical intervention, or rehabilitation. Results: The review included 751 patients (mean age: 38 years, range: 5–81 years) across 58 studies. The distal radius was the most commonly studied anatomical region (47%, N = 27), followed by the scaphoid (19%, N = 11). Key applications of 3D printing included preoperative planning (19%, N = 11), patient education (5%, N = 3), medical training (7%, N = 4), intra-operative assistance (38%, N = 22), splinting and casting (19%, N = 11), and prothesis and functional reconstruction (12%, N = 7). Conclusions: Despite its early stage of adoption in hand surgery, 3D printing has shown advantages, especially in enabling more personalized treatment strategies by improving intra-operative assistance, preoperative planning, and patient education. Further research is required to determine whether it positively affects postoperative outcomes, to calculate the cost–benefit ratio, and to compare its usage against standards of care. Full article

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

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11 pages, 3093 KB

Open AccessReview

Artificial Intelligence and 3D Reconstruction in Complex Hepato-Pancreato-Biliary (HPB) Surgery: A Comprehensive Review of the Literature

by Andreas Panagakis, Ioannis Katsaros, Maria Sotiropoulou, Adam Mylonakis, Markos Despotidis, Aristeidis Sourgiadakis, Panagiotis Sakarellos, Stylianos Kapiris, Chrysovalantis Vergadis, Dimitrios Schizas, Evangelos Felekouras and Michail Vailas

J. Pers. Med. 2025, 15(12), 610; https://doi.org/10.3390/jpm15120610 - 8 Dec 2025

Abstract

Background: The management of complex hepato-pancreato-biliary (HPB) pathologies demands exceptional surgical precision. Traditional two-dimensional imaging has limitations in depicting intricate anatomical relationships, potentially complicating preoperative planning. This review explores the synergistic application of three-dimensional (3D) reconstruction and artificial intelligence (AI) to support surgical [...] Read more.

Background: The management of complex hepato-pancreato-biliary (HPB) pathologies demands exceptional surgical precision. Traditional two-dimensional imaging has limitations in depicting intricate anatomical relationships, potentially complicating preoperative planning. This review explores the synergistic application of three-dimensional (3D) reconstruction and artificial intelligence (AI) to support surgical decision-making in complex HPB cases. Methods: This narrative review synthesized the existing literature on the applications, benefits, limitations, and implementation challenges of 3D reconstruction and AI technologies in HPB surgery. Results: The literature suggests that 3D reconstruction provides patient-specific, interactive models that significantly improve surgeons’ understanding of tumor resectability and vascular anatomy, contributing to reduced operative time and blood loss. Building upon this, AI algorithms can automate image segmentation for 3D modeling, enhance diagnostic accuracy, and offer predictive analytics for postoperative complications, such as liver failure. By analyzing large datasets, AI can identify subtle risk factors to guide clinical decision-making. Conclusions: The convergence of 3D visualization and AI-driven analytics is contributing to an emerging paradigm shift in HPB surgery. This combination may foster a more personalized, precise, and data-informed surgical approach, particularly in anatomically complex or high-risk cases. However, current evidence is heterogeneous and largely observational, underscoring the need for prospective multicenter validation before routine implementation. 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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10 pages, 340 KB

Open AccessArticle

Gestational Diabetes Mellitus and Postpartum Depressive Symptoms in Women with Low and Late Fertility

by Vincenzo Zanardo, Gianluca Straface, Francesca Volpe, Agnese Suppiej and Tiziana Battistin

J. Pers. Med. 2025, 15(12), 609; https://doi.org/10.3390/jpm15120609 - 8 Dec 2025

Abstract

Background: Dysregulation of the hypothalamic–pituitary–adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with “low and late” fertility, remains poorly characterized. Methods [...] Read more.

Background: Dysregulation of the hypothalamic–pituitary–adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with “low and late” fertility, remains poorly characterized. Methods: We compared the risk of postpartum depressive symptoms, assessed on the second postpartum day using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score ≥ 12, and the Anhedonia, Anxiety, and Depression subscales, between Northeast Italian women with GDM and control participants with normal oral glucose tolerance tests (OGTT), classified as having “low and late fertility”. Results: Among the 2560 women included in the analysis, 231 (9.02%) had GDM. Compared with controls with normal OGTT, women with GDM were older (36.0 vs. 33.0 years, p < 0.001) and had higher pre-pregnancy BMI (23.4 vs. 21.6 kg/m², p < 0.001), but lower gestational weight gain (GWG) (11.0 vs. 13.0 kg, p < 0.001), with no difference in parity [2.00 vs. 1.00, p = 0.5. In addition, GDM was not associated with increased postpartum depressive symptoms (15% EPDS scores ≥12 in both groups, p > 0.9) or with Anhedonia, Anxiety, or Depression subscale scores (p = 0.7). Conclusions: Advanced maternal age and reduced parity, hallmarks of women postponing childbearing, do not appear to confer an increased risk of early postpartum mood comorbidities in the context of GDM. Promoting healthy physical and mental well-being among women in this demographic category requires integrated strategies encompassing nutrition, healthcare, and education. Full article

(This article belongs to the Special Issue Gestational Diabetes: Challenges and Cutting-Edge Research)

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13 pages, 1262 KB

Open AccessArticle

Measuring Nasal Airway Resistance to Personalize Surgery for Nasal Obstruction in OSA Patients

by Giuseppe Lunardi, Francesco Giombi, Gian Marco Pace, Michele Cerasuolo, Giuseppe Spriano and Luca Malvezzi

J. Pers. Med. 2025, 15(12), 608; https://doi.org/10.3390/jpm15120608 - 8 Dec 2025

Abstract

Objective: This study aimed to measure nasal airway resistance (NAR) in obstructive sleep apnea (OSA) patients with nasal obstruction using active anterior rhinomanometry (AAR) and to evaluate whether NAR can predict the indication to include septoplasty as an additional procedure alongside drug-induced sleep [...] Read more.

Objective: This study aimed to measure nasal airway resistance (NAR) in obstructive sleep apnea (OSA) patients with nasal obstruction using active anterior rhinomanometry (AAR) and to evaluate whether NAR can predict the indication to include septoplasty as an additional procedure alongside drug-induced sleep endoscopy (DISE) and inferior turbinoplasty. Methods: We performed a retrospective observational study in OSA patients with nasal obstruction. According to nasal endoscopy and CT findings, patients were planned for either DISE with inferior turbinoplasty alone or DISE with inferior turbinoplasty and septoplasty. All patients underwent preoperative AAR, carried out under baseline and post-decongestion conditions. To test the ability of NAR to predict septoplasty indication, receiver operating characteristic (ROC) curves were generated for baseline and post-decongestion values. Logistic regression combined inspiratory/expiratory and unilateral/total NAR. The Area Under the Curve (AUC) was used to evaluate diagnostic accuracy, and optimal cut-offs were identified using Youden’s index (J). Results: Forty-eight patients were included. Baseline NAR showed low accuracy (median AUC: 0.540 unilateral, 0.562 total) and no valid cut-offs were identified (median J: 0.213 unilateral, 0.233 total). Post-decongestion NAR performed better (median AUC: 0.649 unilateral, 0.738 total). Inspiratory and expiratory unilateral values merged with binary regression improved prediction (AUC 0.677 and 0.709). The highest accuracy was achieved when all rhinomanometric parameters were integrated into one logistic model (AUC = 0.947). Conclusions: Preoperative AAR may help refine nasal surgical planning during DISE in OSAS patients, supporting a personalized approach and potentially reducing the need for staged nasal procedures. Full article

(This article belongs to the Special Issue United Airway Disease: Current Perspectives)

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23 pages, 365 KB

Open AccessReview

Application of Treatment Response Biomarkers from Major Depression to Perinatal Depression

by Wan Kwok, Melissa Wagner-Schuman, Tory Eisenlohr-Moul and Brandon Hage

J. Pers. Med. 2025, 15(12), 607; https://doi.org/10.3390/jpm15120607 - 6 Dec 2025

Abstract

Background/Objectives: Perinatal depression poses significant risks to maternal and fetal health, yet biomarkers for treatment response in the field remain limited. Given the overlap in symptoms with major depressive disorder (MDD) and the comparatively more vast MDD literature, identifying promising MDD biomarkers [...] Read more.

Background/Objectives: Perinatal depression poses significant risks to maternal and fetal health, yet biomarkers for treatment response in the field remain limited. Given the overlap in symptoms with major depressive disorder (MDD) and the comparatively more vast MDD literature, identifying promising MDD biomarkers for treatment response and examining corresponding perinatal depression biomarkers can reveal translational opportunities. Methods: PUBMED searches were conducted for individual biomarkers and MDD and perinatal depression, as well as with treatment response to antidepressant pharmacological treatment and neuromodulation treatments. When available, evidence from meta-analyses and systematic reviews were preferentially summarized. Review: This narrative review presents the current evidence on MDD and perinatal depression treatment response biomarkers, including brain-derived neurotrophic factor (BDNF), S100 calcium-binding protein B (S100B), electroencephalography, event-related potentials, metabolomics, hypothalamic–pituitary–adrenal axis hormones, neuroimaging markers, inflammatory markers, and neuroactive steroids. Conclusions: Biomarker research in MDD yields insights on promising biomarkers for treatment response, including BDNF, S100B, theta band density and cordance, inflammatory markers IL-8, CRP, and TNF- α, and neuroactive steroids. Full article

(This article belongs to the Special Issue Multiple Biomarkers for the Diagnosis and Precision Treatment of Depression)

14 pages, 458 KB

Open AccessSystematic Review

Immunotherapy and IVF Outcomes in Unexplained Recurrent Pregnancy Loss: A Systematic Review with Implications for Personalized Reproductive Medicine

by Giosuè Giordano Incognito, Carla Ettore, Marco D’Asta, Ferdinando Antonio Gulino, Roberta Foti, Roberto Tozzi, Orazio De Tommasi, Pierluigi Chieppa, Stefano Di Michele and Giuseppe Ettore

J. Pers. Med. 2025, 15(12), 606; https://doi.org/10.3390/jpm15120606 - 6 Dec 2025

Abstract

Background/Objectives: Recurrent pregnancy loss (RPL) is one of the most challenging conditions in reproductive medicine, particularly when no identifiable cause can be determined after diagnostic evaluation. Although the role of immunological dysregulation has been hypothesized, the implementation of immunotherapies in clinical practice is [...] Read more.

Background/Objectives: Recurrent pregnancy loss (RPL) is one of the most challenging conditions in reproductive medicine, particularly when no identifiable cause can be determined after diagnostic evaluation. Although the role of immunological dysregulation has been hypothesized, the implementation of immunotherapies in clinical practice is controversial due to inconsistent findings and methodological heterogeneity across studies. This systematic review aims to provide an overview of the main characteristics of existing research on the role of immunological interventions in relation to In Vitro Fertilization (IVF) outcomes in women with RPL. Given the marked inter-individual variability in immunological mechanisms among affected women, evaluating these treatments may help identify future directions for personalized reproductive medicine. Methods: A comprehensive bibliographic search was systematically conducted from inception to October 2025 across databases, including Medline, Embase, Scopus, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. Studies were included if they evaluated the efficacy of immunological treatments in women with unexplained RPL, comparing IVF outcomes between case and control groups. Results: Six cohort studies were included, four retrospective and two prospective. The immunological treatments investigated were granulocyte colony-stimulating factor (G-CSF), intravenous intralipid (with or without prednisolone), and lymphocyte immunization therapy (LIT). Despite some promising results, particularly for G-CSF and LIT, the studies were limited by small sample sizes, heterogeneous diagnostic criteria for RPL, and inconsistent treatment protocols. Furthermore, not all IVF outcomes, such as implantation and biochemical pregnancy rates, were reported. Conclusions: Current evidence is insufficient to support the use of immunotherapy in clinical practice for improving IVF outcomes in women with unexplained RPL. The variability in study design, patient selection, and immunotherapy regimens hinders the ability to draw firm conclusions. Well-designed randomized controlled trials with standardized definitions and outcome measures are needed to determine whether and for whom immunological treatments may offer clinical benefit. Full article

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

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17 pages, 1001 KB

Open AccessSystematic Review

The Role of Artificial Intelligence in Imaging-Based Diagnosis of Retinal Dystrophy and Evaluation of Gene Therapy Efficacy

by Weronika Chuchmacz, Barbara Bobowska, Alicja Forma, Eliasz Dzierżyński, Damian Puźniak, Barbara Teresińska, Jacek Baj and Joanna Dolar-Szczasny

J. Pers. Med. 2025, 15(12), 605; https://doi.org/10.3390/jpm15120605 - 5 Dec 2025

Abstract

Introduction: Inherited retinal dystrophies (IRDs) are genetically determined conditions leading to progressive vision loss. Developments in gene therapy are creating new treatment options for IRD, but require precise imaging diagnosis and monitoring. According to recent studies, artificial intelligence, especially deep neural networks, could [...] Read more.

Introduction: Inherited retinal dystrophies (IRDs) are genetically determined conditions leading to progressive vision loss. Developments in gene therapy are creating new treatment options for IRD, but require precise imaging diagnosis and monitoring. According to recent studies, artificial intelligence, especially deep neural networks, could become an important tool for analyzing imaging data. Material and Methods: A systematic literature review was conducted in accordance with PRISMA guidelines, using PubMed, Scopus, and Web of Science databases to identify publications from 2015 to 2025 on the application of artificial intelligence in diagnosing inherited retinal dystrophies and monitoring the effects of gene therapy. The included articles passed a two-stage selection process and met the methodological quality criteria. Results: Among all the included studies it can be noticed that the use of artificial intelligence in diagnostics and therapy of IRDs is rather effective. The most common method was deep learning with its subtype convolutional neural networks (CNNs). However, there is still a place for improvement due to various limitations occurring in the studies. Conclusions: The review points to the growing potential of AI models in optimizing the diagnostic and therapeutic pathway in IRDs, while noting current limitations such as low data availability, the need for clinical validation, and the interpretability of the models. AI may play a key role in personalized ophthalmic medicine in the near future, supporting both clinical decisions and interventional study design. Full article

(This article belongs to the Special Issue Innovative and Future Trends in Personalized Medicine for Retinal Diseases)

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14 pages, 1754 KB

Open AccessArticle

Computational Modeling of Uncertainty and Volatility Beliefs in Escape-Avoidance Learning: Comparing Individuals with and Without Suicidal Ideation

by Miguel Blacutt, Caitlin M. O’Loughlin and Brooke A. Ammerman

J. Pers. Med. 2025, 15(12), 604; https://doi.org/10.3390/jpm15120604 - 5 Dec 2025

Abstract

Background/Objectives: Computational studies using drift diffusion models on go/no-go escape tasks consistently show that individuals with suicidal ideation (SI) preferentially engage in active escape from negative emotional states. This study extends these findings by examining how individuals with SI update beliefs about [...] Read more.

Background/Objectives: Computational studies using drift diffusion models on go/no-go escape tasks consistently show that individuals with suicidal ideation (SI) preferentially engage in active escape from negative emotional states. This study extends these findings by examining how individuals with SI update beliefs about action–outcome contingencies and uncertainty when trying to escape an aversive state. Methods: Undergraduate students with (n = 58) and without (n = 62) a lifetime history of SI made active (go) or passive (no-go) choices in response to stimuli to escape or avoid an unpleasant state in a laboratory-based negative reinforcement task. A Hierarchical Gaussian Filter (HGF) was used to estimate trial-by-trial trajectories of contingency and volatility beliefs, along with their uncertainties, prediction errors (precision-weighted), and dynamic learning rates, as well as fixed parameters at the person level. Bayesian mixed-effects models were used to examine the relationship between trial number, SI history, trial type, and all two-way interactions on HGF parameters. Results: We did not find an effect of SI history, trial type, or their interactions on perceived volatility of reward contingencies. At the trial level, however, participants with a history of SI developed progressively stronger contingency beliefs while simultaneously perceiving the environment as increasingly stable compared to those without SI experiences. Despite this rigidity, they maintained higher uncertainty during escape trials. Participants with an SI history had higher dynamic learning rates during escape trials compared to those without SI experiences. Conclusions: Individuals with an SI history showed a combination of cognitive inflexibility and hyper-reactivity to prediction errors in escape-related contexts. This combination may help explain difficulties in adapting to changing environments and in regulating responses to stress, both of which are relevant for suicide risk. Full article

(This article belongs to the Special Issue Computational Behavioral Modeling in Precision Psychiatry)

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22 pages, 3352 KB

Open AccessArticle

Hemodynamic Impact of the Aberrant Subclavian Artery: A CFD Investigation

by Edoardo Ugolini, Giorgio La Civita, Marco Ferraresi, Moad Alaidroos, Alessandro Carlo Luigi Molinari, Maria Katsarou, Giovanni Rossi and Emanuele Ghedini

J. Pers. Med. 2025, 15(12), 603; https://doi.org/10.3390/jpm15120603 - 5 Dec 2025

Abstract

Background/Objectives: The aberrant subclavian artery (ASA) represents the most common congenital anomaly of the aortic arch, and is frequently associated with a Kommerell diverticulum, an aneurysmal dilation at the anomalous vessel origin. This condition carries a significant risk of rupture and dissection, [...] Read more.

Background/Objectives: The aberrant subclavian artery (ASA) represents the most common congenital anomaly of the aortic arch, and is frequently associated with a Kommerell diverticulum, an aneurysmal dilation at the anomalous vessel origin. This condition carries a significant risk of rupture and dissection, and growing evidence indicates that local hemodynamic alterations may contribute to its development and progression. Computational Fluid Dynamics (CFD) provides a valuable non-invasive modality to assess biomechanical stresses and elucidate the pathophysiological mechanisms underlying these vascular abnormalities. Methods: In this study, twelve thoracic CT angiography scans were analyzed: six from patients with ASA and six from individuals with normal aortic anatomy. CFD simulations were performed using OpenFOAM, with standardized boundary conditions applied across all cases to isolate the influence of anatomical differences in flow behavior. Four key hemodynamic metrics were evaluated—Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), Drag Forces (DF), and Turbulent Viscosity Ratio (TVR). The aortic arch was subdivided into Ishimaru zones 0–3, with an adapted definition accounting for ASA anatomy. For each region, time- and space-averaged quantities were computed to characterize mean values and oscillatory behavior. Conclusions: The findings demonstrate that patients with ASA exhibit markedly altered hemodynamics in zones 1–3 compared to controls, with consistently elevated WSS, OSI, DF, and TVR. The most pronounced abnormalities occurred in zones 2–3 near the origin of the aberrant vessel, where disturbed flow patterns and off-axis mechanical forces were observed. These features may promote chronic wall stress, endothelial dysfunction, and localized aneurysmal degeneration. Notably, two patients (M1 and M6) displayed particularly elevated drag forces and TVR in the distal arch, correlating with the presence of a distal aneurysm and right-sided arch configuration, respectively. Overall, this work supports the hypothesis that aberrant hemodynamics contribute to Kommerell diverticulum formation and progression, and highlights the CFD’s feasibility for clarifying disease mechanisms, characterizing flow patterns, and informing endovascular planning by identifying hemodynamically favorable landing zones. Full article

(This article belongs to the Special Issue Biomedical Tools in Diagnosis and Personalized Therapy of Cardiovascular Disease)

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14 pages, 913 KB

Open AccessReview

Management Strategies for Failed Pilon Fractures: A Personalized Approach to Revision Reconstruction

by Lauren Luther, Richard S. Moore III, Sriranjani Darbha, Bethany Gallagher and Daniel J. Stinner

J. Pers. Med. 2025, 15(12), 602; https://doi.org/10.3390/jpm15120602 - 5 Dec 2025

Abstract

Despite advances in staged protocols and fixation techniques, treatment of pilon fractures remains a significant challenge in orthopedic trauma, with up to 21% of patients requiring revision surgery. Management of a pilon fracture that has failed initial treatment involves navigating a myriad of [...] Read more.

Despite advances in staged protocols and fixation techniques, treatment of pilon fractures remains a significant challenge in orthopedic trauma, with up to 21% of patients requiring revision surgery. Management of a pilon fracture that has failed initial treatment involves navigating a myriad of complicating variables, including infection, bone loss, malalignment, and nonunion. Although no single surgical approach can be aptly applied to the broad range of pathology and severity spanned by these patients, this narrative review provides a systematic framework for developing a revision pilon reconstruction plan. We present a protocol for pre-operative assessment and review current techniques for infection eradication, bone defect management, deformity correction, and joint-preserving versus joint-sparing surgery. These fundamental strategies form the foundation of a successful salvage plan and can be personalized to address specific fracture morphology, host factors, and goals of care. Full article

(This article belongs to the Special Issue Orthopedic Diseases: Advances in Limb Reconstruction)

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