Journal of Personalized Medicine

12 pages, 626 KiB

Open AccessArticle

A Personalized Approach to Maintaining Brain Drainage: A Case Series with a Technical Note

by Manuel Moneti, Anna Malfatto, Ernesto Migliorino, Antonio Bassoli, Mariangela Chiarito, Claudia Iulianella, Noemi Miglionico, Luca Bombarda, Carlo Alberto Castioni, Carlo Bortolotti, Antonino Scibilia, Corrado Zenesini and Raffaele Aspide

J. Pers. Med. 2025, 15(7), 264; https://doi.org/10.3390/jpm15070264 - 20 Jun 2025

Abstract

Background/Objectives: The percutaneous insertion of an external ventricular drain (EVD) is a common neurosurgical procedure that is crucial in managing acute brain injuries because of the drain’s role in monitoring intracranial pressure and draining cerebrospinal fluid. The primary indication is acute hydrocephalus, which [...] Read more.

Background/Objectives: The percutaneous insertion of an external ventricular drain (EVD) is a common neurosurgical procedure that is crucial in managing acute brain injuries because of the drain’s role in monitoring intracranial pressure and draining cerebrospinal fluid. The primary indication is acute hydrocephalus, which often results from subarachnoid hemorrhage, intracranial hemorrhage, traumatic brain injury, stroke, or infection. Standard EVD placement targets the frontal horn of the lateral ventricle. However, complications such as hemorrhage, infection, and catheter occlusion frequently arise, with occlusion rates ranging from 19% to 47%. Occlusion can lead to increased intracranial pressure, necessitating interventions such as saline flushes or fibrinolytic drug administration. The placement of an EVD is a very specific choice that must be tailored to the individual patient, often in scenarios in which multiple interpretations of the data are possible: the question of which patient is eligible for EVD placement may be subjective. Intraventricular fibrinolysis (IVF) with urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator is used with the aim of lysing intraventricular clots and preventing EVD occlusion. Despite numerous studies, conclusive evidence on their efficacy is lacking. The CLEAR III trial confirmed the safety of IVF but showed uncertain benefits in neurological outcomes. Given the limited literature on uPA, this study evaluates its intrathecal administration for the prevention of EVD occlusion. Not all therapies are appropriate for all patients, and customizing strategies is often the right way to get the best result. Methods: This retrospective study analyzed 20 patients with EVDs receiving intrathecal uPA. The patients had a mean age of 56.4 years, with 95% presenting with hydrocephalus and 80% presenting with intraventricular hemorrhage. uPA dosages varied (25,000–100,000 IU), with an average of 3.9 doses per patient. Results: IVF effectively maintained EVD patency in 95% of cases. One patient experienced asymptomatic bleeding, while four (20%) developed post-treatment infections, the development of which was potentially influenced by the prolonged duration of EVD retention (>21 days). Analysis of Graeb scores showed faster clot resolution with early uPA administration. A higher initial Graeb score correlated with increased total uPA load but not with mortality or discharge outcomes. Although infection rates were slightly higher than in CLEAR III, multiple confounding factors, including duration of EVD retention and bilateral placement, were present. Conclusions: This study supports the feasibility and safety of intrathecal uPA administration for management of EVD occlusion in certain contexts. The appropriate choice in the context of ‘personalized medicine’ must necessarily consider the risk–benefit ratio. Full article

(This article belongs to the Section Personalized Critical Care)

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12 pages, 356 KiB

Open AccessArticle

Pleural Empyema in Spain (2016–2022): A Nationwide Study on Trends in Hospitalizations, Mortality, and Impact of Comorbidities

by Begoña Perez-de-Paz, Maria-Jose Fernandez-Cotarelo, Lydia Rodriguez-Romero, Carolina Ribeiro-Neves-Pinto, Natividad Quilez-Ruiz-Rico, Dolores Álvaro-Álvarez, Victor Moreno-Cuerda and Cesar Henriquez-Camacho

J. Pers. Med. 2025, 15(7), 263; https://doi.org/10.3390/jpm15070263 - 20 Jun 2025

Abstract

Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was [...] Read more.

Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was based on the hospital discharge records from the National Health System between 2016 and 2022. The variables analyzed were sex, age, comorbidities, discharge diagnoses and procedures, overall severity, whether empyema was a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay (LOS), in-hospital mortality, and healthcare costs. Results: Between 2016 and 2022, 19864 PE cases were diagnosed in Spain, revealing an overall rate of 0.64 per 1000 hospitalizations, with the exception of a slight decline in 2021. The mean age of the patients with PE was 61 years, and 73.85% were men. Most patients had low comorbidities, with a median Charlson comorbidity index (CCI) of 1.7. Most cases (63%) involved secondary diagnoses (pneumonia, pneumococcal pneumonia, sepsis, COVID, or lung cancer). The in-hospital mortality rate was higher in the secondary diagnosis group than in the primary diagnosis group (13.4% vs. 6.2%, respectively, p < 0.001). The factors associated with increased mortality included older age (≥66 years), higher CCI scores, ICU admission, and shorter LOS (<10 days). Conversely, pleural drainage and pneumonia as secondary diagnoses were protective factors. Conclusions: PE is an increasingly common pathology in clinical practice, especially in older and frail patients. It is associated with high morbidity and mortality, and its prognosis worsens with age and comorbidities. Therefore, early and appropriate diagnosis and standardized management strategies are required to mitigate the mortality and healthcare costs. Full article

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

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14 pages, 1002 KiB

Open AccessReview

3D-Printed Devices in Interventional Radiotherapy (Brachytherapy) Applications: A Literature Review

by Enrico Rosa, Sofia Raponi, Bruno Fionda, Maria Vaccaro, Valentina Lancellotta, Antonio Napolitano, Gabriele Ciasca, Leonardo Bannoni, Patrizia Cornacchione, Luca Tagliaferri, Marco De Spirito and Elisa Placidi

J. Pers. Med. 2025, 15(6), 262; https://doi.org/10.3390/jpm15060262 - 19 Jun 2025

Abstract

Introduction: Interventional radiotherapy (brachytherapy, IRT, BT) has evolved with technological advancements, improving dose precision while minimizing exposure to healthy tissues. The integration of 3D-printing technology in IRT has enabled the development of patient-specific devices, optimizing treatment personalization and dosimetric accuracy. Methods: [...] Read more.

Introduction: Interventional radiotherapy (brachytherapy, IRT, BT) has evolved with technological advancements, improving dose precision while minimizing exposure to healthy tissues. The integration of 3D-printing technology in IRT has enabled the development of patient-specific devices, optimizing treatment personalization and dosimetric accuracy. Methods: A systematic literature search was conducted in PubMed, Scopus, and Google Scholar to identify studies published between 2020 and 2024 on 3D-printing applications in IRT. The selection process resulted in 74 peer-reviewed articles categorized by radioactive source, brachytherapy technique, endpoint of the 3D-printed product, and study type. Results: The analysis highlights the growing implementation of 3D-printed devices in brachytherapy, particularly in gynecological, prostate, and skin cancers. Most studies focus on technique, including intracavitary, interstitial, and contact applications, with custom applicators and templates emerging as predominant endpoints. The majority of studies involved in vivo clinical applications, followed by in silico computational modeling and in vitro experiments. Conclusions: The upward trend in scientific publications underscores the growing attention on 3D printing for enhancing personalized brachytherapy. The increasing use of 3D-printed templates and applicators highlights their role in optimizing dose delivery and expanding personalized treatment strategies. The current research trend is shifting toward real-world data and in vivo studies to assess clinical applications, ensuring these innovations translate effectively into routine practice. The integration of 3D printing represents a major advancement in radiation oncology, with the potential to enhance treatment efficacy and patient outcomes. Future research should focus on standardizing manufacturing processes and expanding clinical validation to facilitate broader adoption. Full article

(This article belongs to the Special Issue Personalized Radiation Therapy for Cancers: Current Status and Future Perspectives)

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9 pages, 410 KiB

Open AccessArticle

Association Between Maternal Pre-Pregnancy Body Mass Index and Growth Delay in Korean Children Aged 18–36 Months: A Population-Based Study

by Eun-Jung Oh, Tae-Eun Kim, Sang-Hyun Park, Hye Won Park, Hyuk Jung Kweon, Jaekyung Choi and Jinyoung Shin

J. Pers. Med. 2025, 15(6), 261; https://doi.org/10.3390/jpm15060261 - 19 Jun 2025

Abstract

Background: Maternal pre-pregnancy body mass index (BMI) has been linked to childhood growth. However, its effects on growth delay at different early life stages are not well understood. This study aimed to evaluate the relationship between maternal pre-pregnancy BMI and growth delay in [...] Read more.

Background: Maternal pre-pregnancy body mass index (BMI) has been linked to childhood growth. However, its effects on growth delay at different early life stages are not well understood. This study aimed to evaluate the relationship between maternal pre-pregnancy BMI and growth delay in Korean children, using data from the National Health Screening Program for Infants and Children. Methods: Data from 258,367 children born between 2014 and 2021 who underwent health screenings at both 18–24 and 30–36 months of age were analyzed. Maternal BMI within three years before childbirth was classified into five categories: <18.5, 18.5–22.9 (reference), 23–24.9, 25–29.9, and ≥30 kg/m². Growth delay was defined as measurements below the 10th percentile for height, weight, and head circumference. Adjusted relative risks (RRs) were estimated using regression models controlling for maternal age, comorbidities, and perinatal factors. Results: An increased risk of height growth delay was observed with higher maternal BMI, and this association persisted at both 18–24 and 30–36 months. In contrast, maternal underweight was not significantly associated with a height delay. Low maternal BMI was associated with underweight status in children. Head circumference growth delay was linked to both high and low maternal BMI; children of mothers outside the normal BMI range had an increased risk. Conclusions: Maternal pre-pregnancy obesity and underweight were associated with growth delays in height, weight, and head circumference in children up to 36 months of age. These findings underscore the importance of individualized weight management before pregnancy. Full article

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

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13 pages, 533 KiB

Open AccessReview

Post-Coma Neurorehabilitation: Neurophysiological Assessment as an Additional Strategic and Essential Competence for the Physiatrist

by Luigi Di Lorenzo and Carmine D’Avanzo

J. Pers. Med. 2025, 15(6), 260; https://doi.org/10.3390/jpm15060260 - 18 Jun 2025

Abstract

Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation settings. This narrative review critically analyzes the most relevant evidence regarding the use [...] Read more.

Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation settings. This narrative review critically analyzes the most relevant evidence regarding the use of SEPs and EEG in the management of post-comatose patients, highlighting the strategic role of physiatrists in integrating these assessments into individualized rehabilitation plans. A systematic search was conducted across major international databases (PubMed, Embase, Scopus, Cinahl, and DiTA) until December 2024, selecting consensus documents, official guidelines (including the 2021 ERC/ESICM guidelines), systematic reviews, observational studies, and significant Italian neurophysiological contributions. The literature supports the strong prognostic value of the bilateral presence of the N20 component in SEPs, while its early bilateral absence, particularly in post-anoxic cases, is a robust predictor of poor neurological outcomes. EEG provides complementary information, with continuous, reactive, and symmetrical patterns associated with favorable outcomes, while pathological patterns, such as burst suppression or isoelectric activity, predict a worse prognosis. Combining SEP and EEG assessments significantly improves prognostic sensitivity and specificity, especially in sedated or metabolically compromised patients. Additionally, the use of direct muscle stimulation (DMS) and nerve conduction studies enables accurate differentiation between central and peripheral impairments, which is crucial for effective rehabilitation planning. Overall, SEPs and EEG should be systematically incorporated into the evaluation and follow-up of DoC patients, and the acquisition of neurophysiological competencies by physiatrists represents a strategic priority for modern, effective, and personalized neurorehabilitation. Full article

(This article belongs to the Special Issue Advances in Emerging Technologies for Rehabilitation: Personalized Perspective)

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9 pages, 3358 KiB

Open AccessArticle

Evaluation of the Choroidal Thickness and Retinal Nerve Fiber Layer Thickness in Patients with Vasovagal Syncope

by Hasan B. Isleyen, Batur G. Kanar, Guzide Akcay, Serdar Demir, Hatice S. Kanar and Mehmet V. Yazicioglu

J. Pers. Med. 2025, 15(6), 259; https://doi.org/10.3390/jpm15060259 - 18 Jun 2025

Abstract

Aim: The aim of this study was to evaluate choroidal and peripapillary retinal nerve fiber layer (RNFL) thicknesses in individuals with vasovagal syncope (VVS). Method: A total of 67 consecutive patients with VVS and 61 healthy control subjects were enrolled this [...] Read more.

Aim: The aim of this study was to evaluate choroidal and peripapillary retinal nerve fiber layer (RNFL) thicknesses in individuals with vasovagal syncope (VVS). Method: A total of 67 consecutive patients with VVS and 61 healthy control subjects were enrolled this study. The choroidal thickness (CT) at the fovea, the nasal to fovea thickness, and the temporal to fovea thickness were measured, alongside pRNLFT measurements assessed by swept-source optical coherence tomography (SS-OCT). Results: The mean foveal CT (408.7 ± 92.5 μm vs. 342.1 ± 60.2 μm, p < 0.01), the mean nasal CT (385.2 ± 88.3 μm vs. 329.2 ± 47.6 μm, p < 0.001), and the mean temporal CT (379.5 ± 51.6 μm vs. 321.48 ± 43.2 μm, p < 0.03) were statistically thicker in patients with VVS compared to the healthy controls. There was no statistically significant difference in the global pRNFLT measurements and all quadrants between the study groups. Conclusions: The CT in all regions was found to be thicker in patients with VVS compared to the healthy controls, while there were no differences in pRNFLT values. These results suggest that choroidal circulation might be affected by local neurotransmitter alterations in patients with VVS. Full article

(This article belongs to the Special Issue New Advances and Perspectives in Ophthalmology: Progress and Modern Challenges)

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12 pages, 205 KiB

Open AccessArticle

Patients’ Concerns About Receiving Preemptive Pharmacogenomic Testing: Results from a Large, Longitudinal Survey of RIGHT Study Participants

by Joel E. Pacyna, Suzette J. Bielinski, Janet E. Olson and Richard R. Sharp

J. Pers. Med. 2025, 15(6), 258; https://doi.org/10.3390/jpm15060258 - 17 Jun 2025

Abstract

Background: As more healthcare institutions consider providing preemptive pharmacogenomic (PGx) testing to greater numbers of their patients, it will be important to consider the potential concerns patients may have about the generation of preemptive PGx information. To date, few studies have examined the [...] Read more.

Background: As more healthcare institutions consider providing preemptive pharmacogenomic (PGx) testing to greater numbers of their patients, it will be important to consider the potential concerns patients may have about the generation of preemptive PGx information. To date, few studies have examined the nature and incidence of patient concerns about preemptive PGx testing. Methods: We conducted a longitudinal survey study of 5000 patients receiving preemptive PGx testing in the Mayo Clinic RIGHT study. We assessed patient concerns regarding issues of data confidentiality, cost implications, comprehension of results, and potential disruption of pre-existing medication regimens. Participants were surveyed before and after they received PGx results from the RIGHT study. Results: We achieved 92.8% and 74.4% response rates on the pre- and post-results surveys, respectively. Participants had low levels of concern about PGx testing overall. However, 25.5% of participants were “quite/extremely concerned” about insurance implications, and 30.1% were “quite/extremely” concerned about increased out-of-pocket costs for prescription medications that might result from PGx testing. These same concerns were significantly reduced on the post-results survey. Patients who initially expressed concerns regarding their ability to understand PGx results were more likely to report having difficulty understanding results on the post-results survey. Conclusions: Our findings suggest that as healthcare institutions look to increase preemptive PGx screening, attention should be given to potential concerns patients may have around such testing. Educational interventions aimed at supporting patient understanding of PGx results and addressing potential concerns will be important elements of a successful PGx program. Full article

(This article belongs to the Section Pharmacogenetics)

16 pages, 1668 KiB

Open AccessSystematic Review

Use of COX Inhibitors in Plastic Surgery Fibroproliferative Disorders: A Systematic Review

by Yu Ting Tay, Elisha Purcell, Ishith Seth, Gianluca Marcaccini and Warren M. Rozen

J. Pers. Med. 2025, 15(6), 257; https://doi.org/10.3390/jpm15060257 - 17 Jun 2025

Abstract

Background/Objectives: Fibroproliferative disorders (FPDs), such as Dupuytren’s contracture, scleroderma, capsular contracture, rhinophyma, and keloid scars, are characterised by excessive fibroblast activity and collagen deposition. These conditions are frequently encountered in plastic and reconstructive surgery and remain therapeutically challenging. Cyclooxygenase (COX) inhibitors have emerged [...] Read more.

Background/Objectives: Fibroproliferative disorders (FPDs), such as Dupuytren’s contracture, scleroderma, capsular contracture, rhinophyma, and keloid scars, are characterised by excessive fibroblast activity and collagen deposition. These conditions are frequently encountered in plastic and reconstructive surgery and remain therapeutically challenging. Cyclooxygenase (COX) inhibitors have emerged as a potential adjunct therapy to modulate fibrotic pathways and improve clinical outcomes. This systematic review aims to evaluate the efficacy and safety profile of COX inhibitors in the management of plastic-surgery-related FPDs. In doing so, it explores how phenotype-guided and route-specific COX-inhibitor use may contribute to precision, patient-centred care. Methods: To identify eligible studies, a comprehensive search was conducted in MEDLINE, Embase, and the Cochrane Library. Data were synthesised using both tabular summaries and narrative analysis. The certainty of evidence was appraised according to the GRADE guidelines. Results: Thirteen studies from 1984 to 2024 met inclusion criteria, addressing FPDs such as hypertrophic scarring, Dupuytren’s contracture, and desmoid tumours, representing 491 patients. Of those, five studies were related to Dupuytren contracture, three studies were related to hypertrophic scar, and one study each was on topics related to scleroderma, keloid scar, osteogenesis imperfecta, actinic keloidalis nuchae/dissecting cellulitis of the scalp, and desmoid tumours. Nine studies reported clinical improvements (four demonstrating statistically significant outcomes), three showed no difference, and one did not assess outcomes. The thirteen studies show minor side effects from oral and topical COX inhibitors. The overall certainty of evidence was graded as “low.” Conclusions: COX inhibitors demonstrate promising efficacy with minimal adverse effects in the management of plastic-surgery-related FPDs. Their accessibility, safety, and potential to reduce fibrosis underscore the need for future high-quality, large-scale studies to establish definitive clinical recommendations. Full article

(This article belongs to the Special Issue Plastic Surgery: New Perspectives and Innovative Techniques)

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19 pages, 553 KiB

Open AccessReview

Digital Twin Models in Atrial Fibrillation: Charting the Future of Precision Therapy?

by Paschalis Karakasis, Antonios P. Antoniadis, Panagiotis Theofilis, Panayotis K. Vlachakis, Nikias Milaras, Dimitrios Patoulias, Theodoros Karamitsos and Nikolaos Fragakis

J. Pers. Med. 2025, 15(6), 256; https://doi.org/10.3390/jpm15060256 - 16 Jun 2025

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and a major contributor to stroke and cardiovascular morbidity. However, current approaches to rhythm control and stroke prevention are often limited by variable treatment responses and population-based risk stratification tools that fail to capture [...] Read more.

Atrial fibrillation (AF) is the most common sustained arrhythmia and a major contributor to stroke and cardiovascular morbidity. However, current approaches to rhythm control and stroke prevention are often limited by variable treatment responses and population-based risk stratification tools that fail to capture individual disease mechanisms. Digital twin technology—computational models built using patient-specific anatomical and physiological data—has emerged as a promising approach to address these limitations. In the context of AF, left atrial (LA) digital twins integrate structural, electrophysiological, and hemodynamic information to simulate arrhythmia behavior, therapeutic response, and thromboembolic risk with high mechanistic fidelity. Recent applications include stroke risk prediction using computational fluid dynamics, in silico testing of antiarrhythmic drugs, and virtual planning of catheter ablation strategies. These models have shown potential to enhance the personalization of care, offering a more nuanced and predictive framework than conventional scoring systems or imaging alone. Despite promising progress, challenges related to model personalization, computational scalability, and clinical validation remain. Nevertheless, LA digital twins are poised to advance the precision management of AF by bridging in silico modeling with real-world decision-making. This review summarizes the current state and future directions of left atrial digital twin models in AF, focusing on their application in stroke risk prediction, pharmacologic decision-making, and ablation strategy optimization. Full article

(This article belongs to the Special Issue Advances in Atrial Fibrillation and Cardiac Arrhythmias: Mechanisms, Diagnosis, and Therapy)

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27 pages, 470 KiB

Open AccessReview

Non-Communicable Disease (NCD) Management During Disasters and Humanitarian Emergencies: A Review of the Experiences Reported by Emergency Medical Teams (EMTs)

by Emanuela Parotto, Flavio Salio, Martina Valente and Luca Ragazzoni

J. Pers. Med. 2025, 15(6), 255; https://doi.org/10.3390/jpm15060255 - 16 Jun 2025

Abstract

Background/Objectives: Non-Communicable Diseases (NCDs) place an excessive strain on health systems in disaster-affected settings and may lead to a parallel public health emergency lasting months or years after a disaster. Although NCDs are increasingly recognized as a major challenge in disasters and [...] Read more.

Background/Objectives: Non-Communicable Diseases (NCDs) place an excessive strain on health systems in disaster-affected settings and may lead to a parallel public health emergency lasting months or years after a disaster. Although NCDs are increasingly recognized as a major challenge in disasters and humanitarian emergencies, a dedicated and standardized response plan is missing, as well as a shortage of evidence-based guidelines for NCD management in theses contexts. Over the years, Emergency Medical Teams (EMTs) have traditionally been deployed to manage acute conditions such as trauma and infectious diseases that quickly impact health systems. However, greater attention is needed to address acute exacerbation of NCDs and to ensure continuity of care for people with chronic health needs in disasters and emergencies. Methods: We conducted a scoping review exploring the EMTs’ management of chronic NCDs during disasters and humanitarian emergencies, in order to identify the strategies adopted, the challenges faced, and the recommendations provided to address this health problem. The online databases PubMed, Scopus, and EBSCO were searched to identify relevant papers. Results: After screening the papers against the eligibility criteria, 17 publications were retrieved. Five different areas of intervention concerning EMTs and NCDs management were identified: (i) EMTs pre-departure preparation, operational time, and length of stay; (ii) EMTs staff composition and training; (iii) EMTs logistics; (iv) EMTs integration with local health services; (v) EMTs clinical data record. Conclusions: The findings emerging from this study showed that NCDs significantly impact disaster response in different settings, underlining the need to implement a range of EMTs activities to guarantee assistance for chronic health needs. In view of strengthening the ability of health systems to cope with the NCDs’ burden, the EMTs’ initiatives should be considered as a bridge between the support provided during the acute phase of an emergency and the continuation of care ensured by the system in its early recovery phase. Full article

(This article belongs to the Special Issue Current Updates into Personalized Medicine for Anesthesia, Emergency Medicine, Disaster Medicine, Mass Gathering Events)

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14 pages, 1895 KiB

Open AccessReview

Prophylactic and Therapeutic Usage of Drains in Gynecologic Oncology Procedures: A Comprehensive Review

by Chrysoula Margioula-Siarkou, Aristarchos Almperis, Emmanouela-Aliki Almperi, Georgia Margioula-Siarkou, Stefanos Flindris, Nikoletta Daponte, Alexandros Daponte, Konstantinos Dinas and Stamatios Petousis

J. Pers. Med. 2025, 15(6), 254; https://doi.org/10.3390/jpm15060254 - 16 Jun 2025

Abstract

The use of post-operative drainage has been a topic of debate for several years. While the trend has increasingly shifted toward avoiding routine drainage, opinions on its necessity remain divided. The main objective of this comprehensive review is to effectively summarize and present [...] Read more.

The use of post-operative drainage has been a topic of debate for several years. While the trend has increasingly shifted toward avoiding routine drainage, opinions on its necessity remain divided. The main objective of this comprehensive review is to effectively summarize and present the current knowledge and up-to-date evidence on the role of prophylactic drainage in women undergoing obstetric, oncological, or other types of gynecological surgical procedures in terms of the indications, post-operative surgical infections, morbidity recovery, post-operative complications and outcomes. Prophylactic drainage does not seem to decrease morbidity in cases of lymphadenectomy and radical hysterectomy. Debulking surgery does not necessitate prophylactic drainage in the majority of cases; however, its usage should be individualized based on the surgical complexity. Conflicting evidence exists regarding drains’ effectiveness in preventing anastomotic leakage, with high rates of re-operation and abscess formation noted. Despite the fact that vaginal drains may help with hematoma and infectious morbidity, the overall benefit of vaginal and peritoneal drains in preventing post-operative morbidity is questionable. Finally, negative pressure wound therapy may reduce surgical site infection rates in patients undergoing cytoreductive surgery for ovarian cancer. Although there is still a great need for further investigation, the topic has been covered adequately by many prospective trials and the international guidelines have provided clear suggestions to guide physicians in clinical practice. However, need for individualization and personalized strategies is well emphasized by the published evidence in an effort to balance the benefits and risks of drainage usage determined by the type of surgery and patient status. Full article

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

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17 pages, 831 KiB

Open AccessArticle

Increased Frequency of the Non-Dipper Blood Pressure Pattern in Patients with Systemic Sclerosis: Insights from 24-Hour Ambulatory Monitoring

by Oğuzhan Zengin, Gülşah Soytürk, Burak Göre, Mustafa Yürümez, Ali Can Kurtipek, Emra Asfuroğlu Kalkan, Hatice Ecem Konak, Şükran Erten and Ihsan Ateş

J. Pers. Med. 2025, 15(6), 253; https://doi.org/10.3390/jpm15060253 - 15 Jun 2025

Abstract

Background: In systemic sclerosis (SSc), endothelial dysfunction, inflammation, and reduced nitric oxide levels may disrupt circadian blood pressure (BP) regulation. There are studies showing that inflammatory and certain other cells in diseases like SSc exhibit diurnal rhythms. In our study, we examined the [...] Read more.

Background: In systemic sclerosis (SSc), endothelial dysfunction, inflammation, and reduced nitric oxide levels may disrupt circadian blood pressure (BP) regulation. There are studies showing that inflammatory and certain other cells in diseases like SSc exhibit diurnal rhythms. In our study, we examined the effect of SSc on BP. In particular, the frequency of the non-dipper pattern (lack of nighttime BP reduction) in SSc patients has not been adequately investigated. The aim of this study was to evaluate the 24 h BP profile in SSc patients and to compare the frequency of the non-dipper pattern with that of the non-scleroderma group. Additionally, the identification of disrupted circadian BP patterns in SSc patients aims to contribute to the development of personalized, time-sensitive BP monitoring strategies in the future and to support the applicability of personalized medicine in this context. Methods: A total of 31 SSc patients diagnosed according to the 2013 ACR/EULAR classification criteria and 30 age- and sex-matched individuals without SSc were included in this prospective study. BP changes between day and night were evaluated by measuring BP every 30 min with a 24 h ambulatory blood pressure monitoring (ABPM) device. The non-dipper pattern was defined as a decrease in BP of less than 10% during the night compared to the day. To better assess BP fluctuations during the night, nighttime measurements were divided into two time periods: first, 24:00–04:00, and then 04:00–08:00. Additionally, laboratory and clinical parameters and SSc subtypes were compared between the groups. Results: The ABPM findings were compared between the groups with and without SSc. The non-dipper pattern was significantly more common in the SSc group at all time intervals. The non-dipper pattern was observed in 25.8% of the non-SSc group and 83.9% of SSc patients (p < 0.001). In the period between 24:00 and 04:00, the prevalence was 25.8% in the control group and 71.0% in SSc patients (p < 0.001), and between 04:00 and 08:00, it was 35.5% in the control group and 80.6% in SSc patients (p < 0.001). No significant difference was found in non-dipper patterns between individuals with diffuse and limited cutaneous forms of systemic sclerosis. Conclusions: The non-dipper BP pattern is significantly more common in patients with SSc, indicating the disruption of the circadian rhythm affecting BP. Analysis performed by dividing the night into specific time periods revealed that this deterioration continued throughout the night. The findings highlight the importance of circadian BP monitoring in SSc patients and may contribute to future risk stratification and treatment strategies. Circadian BP analysis in SSc may help to develop strategies that are personalized for these patients and tailored to their physiological rhythm. Full article

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

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14 pages, 1301 KiB

Open AccessArticle

Guarded Outcomes After Hip Hemiarthroplasty in Patients with Cerebral Palsy: Highlighting a Personalized Medicine Approach to Mitigate the Risk of Complications

by Ahmed Nageeb Mahmoud, Nicholas R. Brule, Juan D. Bernate, Mark A. Seeley, Michael Suk and Daniel S. Horwitz

J. Pers. Med. 2025, 15(6), 252; https://doi.org/10.3390/jpm15060252 - 15 Jun 2025

Abstract

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications [...] Read more.

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients’ mean age at the time of surgery was 55.6 ± 14.1 years (range, 33–71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations. Full article

(This article belongs to the Special Issue Orthopedic Diseases: Surgical Treatments and Personalized Rehabilitation Strategies)

20 pages, 1585 KiB

Open AccessArticle

Phenotype-Driven Variability in Longitudinal Body Composition Changes After a Very Low-Calorie Ketogenic Intervention: A Machine Learning Cluster Approach

by Victor de la O, Begoña de Cuevillas, Miksa Henkrich, Barbara Vizmanos, Maitane Nuñez-Garcia, Ignacio Sajoux, Daniel de Luis and J. Alfredo Martínez

J. Pers. Med. 2025, 15(6), 251; https://doi.org/10.3390/jpm15060251 - 14 Jun 2025

Abstract

Background: Obesity is a major global public health issue with no fully satisfactory solutions. Most nutritional interventions rely on caloric restriction, with varying degrees of success. Very low-calorie ketogenic diets (VLCKD) have demonstrated rapid and sustained weight loss by inducing ketone bodies [...] Read more.

Background: Obesity is a major global public health issue with no fully satisfactory solutions. Most nutritional interventions rely on caloric restriction, with varying degrees of success. Very low-calorie ketogenic diets (VLCKD) have demonstrated rapid and sustained weight loss by inducing ketone bodies through lipolysis, reducing appetite, and preserving lean mass while maintaining metabolic health. Methods: A prospective clinical study analyzed sociodemographic, anthropometric, and adherence data from 7775 patients undergoing a multidisciplinary nutritional single-arm intervention based on a commercial weight-loss program. This method, using protein preparations with a specific balanced nutritional profile, aimed to identify key predictors of weight-loss success and classify population phenotypes with shared baseline characteristics and weight-loss patterns to optimize treatment personalization. Results: Statistical and machine learning analyses revealed that male gender (−9.2 kg vs. −5.9 kg) and higher initial body weight (−8.9 kg vs. −4.0 kg) strongly predict greater weight loss on a VLCKD, while age has a lesser impact. Two distinct population clusters emerged, differing in age, sex, follow-up duration, and medical visits, demonstrating unique weight-loss success patterns. These clusters help define individualized strategies for optimizing outcomes. Conclusions: These findings translationally support associations with the efficacy of a multidisciplinary VLCK weight-loss program and highlight predictors of success. Recognizing variables such as sex, age, and initial weight enhances the potential for a precision-based approach in obesity management, enabling more tailored and effective treatments for diverse patient profiles and prescribe weight loss personalized recommendations. Full article

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

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18 pages, 1981 KiB

Open AccessArticle

Overcoming Challenges in Learning Prerequisites for Adaptive Functioning: Tele-Rehabilitation for Young Girls with Rett Syndrome

by Rosa Angela Fabio, Samantha Giannatiempo and Michela Perina

J. Pers. Med. 2025, 15(6), 250; https://doi.org/10.3390/jpm15060250 - 14 Jun 2025

Abstract

Background/Objectives: Rett Syndrome (RTT) is a rare neurodevelopmental disorder that affects girls and is characterized by severe motor and cognitive impairments, the loss of purposeful hand use, and communication difficulties. Children with RTT, especially those aged 5 to 9 years, often struggle [...] Read more.

Background/Objectives: Rett Syndrome (RTT) is a rare neurodevelopmental disorder that affects girls and is characterized by severe motor and cognitive impairments, the loss of purposeful hand use, and communication difficulties. Children with RTT, especially those aged 5 to 9 years, often struggle to develop the foundational skills necessary for adaptive functioning, such as eye contact, object tracking, functional gestures, turn-taking, and basic communication. These abilities are essential for cognitive, social, and motor development and contribute to greater autonomy in daily life. This study aimed to explore the feasibility of a structured telerehabilitation program and to provide preliminary observations of its potential utility for young girls with RTT, addressing the presumed challenge of engaging this population in video-based interactive training. Methods: The intervention consisted of 30 remotely delivered sessions (each lasting 90 min), with assessments at baseline (A), after 5 weeks (B1), and after 10 weeks (B2). Quantitative outcome measures focused on changes in eye contact, object tracking, functional gestures, social engagement, and responsiveness to visual stimulus. Results: The findings indicate that the program was feasible and well-tolerated. Improvements were observed across all measured domains, and participants showed high levels of engagement and participation throughout the intervention. While these results are preliminary, they suggest that interactive digital formats may be promising for supporting foundational learning processes in children with RTT. Conclusions: This study provides initial evidence that telerehabilitation is a feasible approach for engaging young girls with RTT and supporting adaptive skill development. These findings may inform future research and the design of controlled studies to evaluate the efficacy of technology-assisted interventions in this population. Full article

(This article belongs to the Special Issue Ehealth, Telemedicine, and AI in the Precision Medicine Era)

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9 pages, 627 KiB

Open AccessArticle

Tailoring Evaluations of Chronic Rhinosinusitis: Understanding Sleep and Its Effect on Memory Through Actigraphy

by Donyea Moore, Rachel Nolte, Yitong Huang, Shreya Maharana, Pavan Nataraj, Bichun Ouyang and Mahboobeh Mahdavinia

J. Pers. Med. 2025, 15(6), 249; https://doi.org/10.3390/jpm15060249 - 14 Jun 2025

Abstract

Background/Objectives: Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinonasal mucosa lasting for at least three months. For patients, CRS-related sleep disturbances can significantly disrupt circadian rhythms, leading to further health complications such as cognitive impairment. Despite the well-documented sleep disturbances [...] Read more.

Background/Objectives: Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinonasal mucosa lasting for at least three months. For patients, CRS-related sleep disturbances can significantly disrupt circadian rhythms, leading to further health complications such as cognitive impairment. Despite the well-documented sleep disturbances associated with CRS, there is limited research on objective assessment methods. Additionally, the severity of these issues can vary among patients. This study aims to assess sleep quality and timing in CRS patients and investigate their impact on cognition, providing guidance for personalized and tailored assessment and management of CRS. Methods: Our case–control study compares sleep patterns and cognitive function between CRS patients and healthy controls utilizing actigraphy, a non-invasive device for measuring sleep–wake cycles and circadian rhythms. The actigraphy-derived sleep variables include inter-daily variability, intra-daily variability, highest 10 h activity (M10), lowest 5 h activity (L5), relative amplitude (RA), sleep onset latency, sleep efficiency, sleep and wake time, time spent in bed, total sleep time, and wakefulness after sleep onset. We also used a standard questionnaire assessing sleep quality, the Pittsburgh Sleep Quality Index (PSQI). Results: Our study enrolled 44 CRS and 43 control participants. Our findings indicate that the actigraphy-derived sleep variables were comparable between groups, all with a p-value > 0.05. However, CRS patients exhibited greater early morning activity and significantly lower PSQI-reported sleep quality compared to controls (8.78 ± 3.45, 4.71 ± 2.96, respectively; adjusted p < 0.001). Actigraphy-derived sleep variables showed trends towards significance in association with episodic memory (p = 0.051) and executive function (p = 0.15). Conclusions: Actigraphy-derived sleep outcomes revealed associations with episodic and executive function, underscoring the potential of actigraphy in understanding the individualized sleep-related cognitive impacts in CRS patients. This highlights the importance of personalized assessment and management strategies to address the unique sleep and cognitive challenges faced by each patient. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment in Otorhinolaryngology)

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14 pages, 242 KiB

Open AccessArticle

Associations Between Chemotherapy-Induced Peripheral Neuropathy and Distress in Patients Assigned to Adjuvant Irradiation for Non-Metastatic Breast Cancer

by Dirk Rades, Tobias Bartscht, Achim Rody and Martin Ballegaard

J. Pers. Med. 2025, 15(6), 248; https://doi.org/10.3390/jpm15060248 - 13 Jun 2025

Abstract

Background/Objectives: Many patients assigned to adjuvant radiotherapy for non-metastatic breast cancer already received taxane-based chemotherapy, which can cause peripheral neuropathy (PNP). This study investigated potential associations between moderate-to-severe or mild PNP and distress. Methods: Ninety-eight breast cancer patients who received taxane-based chemotherapy and [...] Read more.

Background/Objectives: Many patients assigned to adjuvant radiotherapy for non-metastatic breast cancer already received taxane-based chemotherapy, which can cause peripheral neuropathy (PNP). This study investigated potential associations between moderate-to-severe or mild PNP and distress. Methods: Ninety-eight breast cancer patients who received taxane-based chemotherapy and completed the National Comprehensive Cancer Network Distress Thermometer were included in this retrospective study. The severity of PNP plus 17 factors were evaluated for associations with distress. Results: Mean distress scores (higher scores representing higher levels of distress) were 6.17 (SD ± 2.41) in patients with moderate-to-severe PNP, 4.21 (SD ± 2.54) in patients with mild PNP and 4.04 (SD ± 2.24) in patients without PNP. On univariable analyses, higher distress scores were significantly associated with moderate-to-severe PNP (vs. mild or no PNP, p < 0.001), Karnofsky performance score ≤ 80 (p = 0.001), history of autoimmune disease (p = 0.035), and hypertension (p = 0.002). Trends were found for age ≥65 years (p = 0.056), type of chemotherapy (p = 0.078), and beta-blocker medication (p = 0.072). On multivariable analysis, moderate-to-severe PNP (p = 0.036), Karnofsky performance score ≤ 80 (p = 0.013), and hypertension (p = 0.045) were significant. Conclusions: Since moderate-to-severe chemotherapy-induced PNP was associated with a significantly higher level of distress when compared to mild or nor PNP, these patients should be offered early psychological support and personalized monitoring. Full article

(This article belongs to the Special Issue Advances in Personalized Treatment of Breast Cancer)

10 pages, 814 KiB

Open AccessArticle

Assessing the Impact of Simplified Language on a Patient-Facing Pharmacogenetic Report: A User Comprehension Study

by Russell Amato, Nicole M. Del Toro-Pagan, Harris Nguyen, Jordan Plummer, Katie Pizzolato, David Krause and Daniel Dowd

J. Pers. Med. 2025, 15(6), 247; https://doi.org/10.3390/jpm15060247 - 12 Jun 2025

Abstract

Background: Pharmacogenetics (PGx) is the science of assessing how genetic variation affects drug efficacy, tolerability, and safety. While PGx is an emerging discipline which is becoming standard of care, many providers have misunderstandings about its utility. This is even more of a problem [...] Read more.

Background: Pharmacogenetics (PGx) is the science of assessing how genetic variation affects drug efficacy, tolerability, and safety. While PGx is an emerging discipline which is becoming standard of care, many providers have misunderstandings about its utility. This is even more of a problem for patients, who may perceive that there is a single drug that is “right” for them. The primary objective of this study was to evaluate consumer comprehension of a newly developed patient-facing PGx report. Methods: In this study, we adapted a commercial pharmacogenetic test (Genomind Professional PGx) into a report intended to be more comprehensible to the consumer. The initial translation of the clinical terminology used in the PGx report, into lay terminology was conducted by PharmDs and PhDs who have collectively provided over 20,000 PGx consults to date. These reports were then evaluated with readability scoring software to ensure each translation’s complexity remained ≤8th-grade reading level. A total of 107 participants were recruited to conduct the initial analysis with a goal of achieving a 90% comprehension rate using the Genomind consumer comprehension survey. These participants were also given a modified Minnesota Assessment of Pharmacogenomic Literacy (MAPL™) both before and after the Genomind comprehension survey to assess overall PGx literacy. Results: Ninety-eight (98) out of 107 research participants scored one or zero questions incorrectly, translating to >90% comprehension score on the Genomind consumer comprehension survey. These participants also demonstrated a significant increase in overall pharmacogenetic literacy, as assessed by MAPL after viewing the consumer report and survey. Conclusions: This study found that translating pharmacogenetic test results into lay language may provide individuals with a greater understanding of how their DNA may impact prescribed medications. Full article

(This article belongs to the Special Issue New Trends and Challenges in Pharmacogenomics Research)

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12 pages, 2461 KiB

Open AccessArticle

Morphology of Macular Neovascularization in Age-Related Macular Degeneration Influences Treatment Requirement and Visual Outcome After 1 Year

by Michael Grün, Kai Rothaus, Martin Ziegler, Albrecht Lommatzsch, Clemens Lange and Henrik Faatz

J. Pers. Med. 2025, 15(6), 246; https://doi.org/10.3390/jpm15060246 - 11 Jun 2025

Abstract

Background/Objectives: To evaluate the potential of Optical Coherence Tomography (OCT) and OCT angiography parameters in predicting treatment requirements and visual outcomes after one year in therapy-naïve eyes with neovascular age-related macular degeneration (nAMD). Methods: A retrospective study of 96 therapy-naïve eyes [...] Read more.

Background/Objectives: To evaluate the potential of Optical Coherence Tomography (OCT) and OCT angiography parameters in predicting treatment requirements and visual outcomes after one year in therapy-naïve eyes with neovascular age-related macular degeneration (nAMD). Methods: A retrospective study of 96 therapy-naïve eyes newly diagnosed with nAMD was carried out. All eyes received baseline OCT and OCTA. Follow-up OCT after initial upload was then carried out, involving three intravitreal injections (IVIs) with anti-Vascular Endothelial Growth Factor (anti-VEGF) at four-week intervals. OCT parameters, including intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelium detachment (PED), and central retinal thickness (CRT), were assessed qualitatively and quantitatively. Macular Neovascularization (MNV) morphology at baseline was described in terms of area, total vessel length, flow density, and fractal dimension. OCT and OCTA parameters were correlated with best corrected visual acuity (BCVA) and number of administered IVIs after 1 year of treatment. Results: Eyes with persistent subretinal fluid (SRF) or both intraretinal fluid (IRF) and SRF after upload showed a significantly higher need for IVIs (p < 0.01). Also, pigment epithelium detachment (PED) presence at baseline (p < 0.05), PED height at baseline (p < 0.01), PED presence after upload (p < 0.01), and PED height after upload (p < 0.01) were each correlated with a greater number of IVIs. Decrease in PED height during upload was accompanied by a lower number of IVIs (p < 0.01). All the aforementioned parameters had no influence on BCVA after 1 year (p > 0.05). Baseline central retinal thickness (CRT) was linked to worse BCVA at 12 months (p < 0.05), but not the number of IVIs. Follow-up CRT correlated with worse BCVA (p < 0.01) and more IVIs (p < 0.01), while CRT decrease was associated with better BCVA (p < 0.05) and fewer IVIs (p < 0.01) at 1 year. In OCTA, area and total vessel length of MNVs were correlated with BCVA after 1 year (p < 0.01) but had no influence on number of IVIs (p > 0.05). Flow density had no influence on either outcome parameter (p > 0.05). Fractal dimension was associated with BCVA (p < 0.01) and number of IVIs (p < 0.05) after 1 year. Conclusions: MNV area, vessel length, and fractal dimension in OCTA, along with fluid distribution in OCT at baseline and after follow-up, may serve as indicators of treatment needs and visual outcomes after one year. Further studies with longer observation periods and the use of deep learning models are needed to improve analyses and to verify the applicability of these findings to clinical practice. Full article

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

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