Journal of Personalized Medicine

13 pages, 489 KiB

Open AccessArticle

Serum Uric Acid Level as an Estimated Parameter That Predicts All-Cause Mortality in Patients with Hemodialysis

by Sheng-Wen Niu, I-Ching Kuo, Yen-Yi Zhen, Eddy Essen Chang, Li-Yun Chang, Chung-Ting Cheng, Hugo You-Hsien Lin, Yi-Wen Chiu, Jer-Ming Chang, Shang-Jyh Hwang and Chi-Chih Hung

J. Pers. Med. 2025, 15(7), 305; https://doi.org/10.3390/jpm15070305 - 11 Jul 2025

Abstract

Background: Serum uric acid (UA) in end-stage kidney disease (ESKD) patients serves as a critical indicator for nutrition and inflammation, showing a U-shaped association with all-cause mortality. Methods: Our study assessed UA’s survival predictive value in 2615 ESKD patients, stratified by [...] Read more.

Background: Serum uric acid (UA) in end-stage kidney disease (ESKD) patients serves as a critical indicator for nutrition and inflammation, showing a U-shaped association with all-cause mortality. Methods: Our study assessed UA’s survival predictive value in 2615 ESKD patients, stratified by the Charlson Comorbidity Index (CCI) into groups of <4 (n = 1107) and ≥4 (n = 1508). Results: Cox regression revealed distinct patterns. For ESKD patients with CCI < 4, UA levels > 8.6 mg/dL were a mortality risk factor (HR: 1.61, 95% CI: 1.01–2.38) compared to 7.1–7.7 mg/dL. Conversely, in patients with CCI ≥ 4, UA levels < 5.8 mg/dL were a mortality risk factor (HR: 1.53, 95% CI: 1.20–1.95) compared to >8.6 mg/dL. Conclusions: Higher serum UA in ESKD patients with high comorbidities (CCI ≥ 4) is not a risk factor. Low UA should be prevented across all ESKD patients. A personalized approach using CCI and corresponding serum UA levels offers a key reference for managing UA in hemodialysis patients. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnosis and Personalized Treatments of Chronic Kidney Diseases)

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20 pages, 960 KiB

Open AccessReview

Zebrafish as a Model for Translational Immuno-Oncology

by Gabriela Rodrigues Barbosa, Augusto Monteiro de Souza, Priscila Fernandes Silva, Caroline Santarosa Fávero, José Leonardo de Oliveira, Hernandes F. Carvalho, Ana Carolina Luchiari and Leonardo O. Reis

J. Pers. Med. 2025, 15(7), 304; https://doi.org/10.3390/jpm15070304 - 11 Jul 2025

Abstract

Despite remarkable progress in cancer immunotherapy, many agents that show efficacy in murine or in vitro models fail to translate clinically. Zebrafish (Danio rerio) have emerged as a powerful complementary model that addresses several limitations of traditional systems. Their optical transparency, [...] Read more.

Despite remarkable progress in cancer immunotherapy, many agents that show efficacy in murine or in vitro models fail to translate clinically. Zebrafish (Danio rerio) have emerged as a powerful complementary model that addresses several limitations of traditional systems. Their optical transparency, genetic tractability, and conserved immune and oncogenic signaling pathways enable high-resolution, real-time imaging of tumor–immune interactions in vivo. Importantly, zebrafish offer a unique opportunity to study the core mechanisms of health and sickness, complementing other models and expanding our understanding of fundamental processes in vivo. This review provides an overview of zebrafish immune system development, highlighting tools for tracking innate and adaptive responses. We discuss their application in modeling immune evasion, checkpoint molecule expression, and tumor microenvironment dynamics using transgenic and xenograft approaches. Platforms for high-throughput drug screening and personalized therapy assessment using patient-derived xenografts (“zAvatars”) are evaluated, alongside limitations, such as temperature sensitivity, immature adaptive immunity in larvae, and interspecies differences in immune responses, tumor complexity, and pharmacokinetics. Emerging frontiers include humanized zebrafish, testing of next-generation immunotherapies, such as CAR T/CAR NK and novel checkpoint inhibitors (LAG-3, TIM-3, and TIGIT). We conclude by outlining the key challenges and future opportunities for integrating zebrafish into the immuno-oncology pipeline to accelerate clinical translation. Full article

(This article belongs to the Special Issue Advances in Animal Models and Precision Medicine for Cancer Research)

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15 pages, 282 KiB

Open AccessArticle

The Association Between Childhood Trauma, Emotional Dysregulation, and Depressive Symptoms’ Severity in Patients with Obesity Seeking Bariatric Surgery

by Marco Di Nicola, Maria Rosaria Magurano, Maria Pepe, Amerigo Iaconelli, Lorenzo Moccia, Alessandro Michele Giannico, Caterina Guidone, Geltrude Mingrone, Laura Antonella Fernandez Tayupanta, Angela Gonsalez Del Castillo, Edoardo Zompanti, Luigi Ciccoritti, Piero Giustacchini, Francesco Greco, Daniela Pia Rosaria Chieffo, Gabriele Sani and Marco Raffaelli

J. Pers. Med. 2025, 15(7), 303; https://doi.org/10.3390/jpm15070303 - 11 Jul 2025

Abstract

Background: Patients with obesity seeking bariatric surgery often display high rates of depressive symptoms, which are linked to worse clinical and surgical outcomes. A comprehensive evaluation of depression-related features in this population is lacking. Therefore, this study investigated clinical and psychopathological factors associated [...] Read more.

Background: Patients with obesity seeking bariatric surgery often display high rates of depressive symptoms, which are linked to worse clinical and surgical outcomes. A comprehensive evaluation of depression-related features in this population is lacking. Therefore, this study investigated clinical and psychopathological factors associated with depressive symptoms’ severity in 946 outpatients with obesity undergoing pre-surgical evaluation. Methods: The sample (45.1 ± 12 years) was subdivided according to Patient Health Questionnaire-9 (PHQ-9) into ‘absent’, ‘mild’, and ‘moderate-to-severe depression’ groups, which were compared for sociodemographic characteristics, childhood trauma, and emotional dysregulation. Assessments included the Childhood Trauma Questionnaire-Short-Form (CTQ-SF) and Difficulties in Emotion Regulation Scales (DERS). Inflammatory levels were evaluated through the Systemic Immune-inflammatory Index (SII). Multinomial logistic regression and correlations were performed to evaluate predictors of depression severity and their interrelationship. Results: Beyond sociodemographic and clinical differences, patients with moderate-to-severe depression displayed higher childhood trauma, emotional dysregulation, and inflammatory levels. Logistic regression with 95% confidence intervals showed that higher CTQ-SF scores were significantly associated with moderate-to-severe vs. absent depression (p = 0.005, 95% CI: 1.02–1.09), while elevated DERS scores were a risk factor for both moderate-to-severe vs. mild (p < 0.001, 95% CI: 1.04–1.11) and vs. absent depression (p < 0.001, 95% CI: 1.11–1.18). Additionally, PHQ-9 was significantly correlated with CTQ-SF, DERS, and SII. Conclusions: A worse clinical picture was observed in patients with moderate-to-severe depression, and significant interactions were found between psychopathology and inflammatory indexes. Emotional dysregulation was primarily associated with depression severity. These preliminary results support the implementation of rigorous pre-operative screening to identify and deliver targeted psychotherapeutic/pharmacological interventions aimed at improving clinical and post-surgical outcomes. Full article

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

24 pages, 1616 KiB

Open AccessSystematic Review

Artificial Intelligence in Risk Stratification and Outcome Prediction for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

by Shayan Shojaei, Asma Mousavi, Sina Kazemian, Shiva Armani, Saba Maleki, Parisa Fallahtafti, Farzin Tahmasbi Arashlow, Yasaman Daryabari, Mohammadreza Naderian, Mohamad Alkhouli, Jamal S. Rana, Mehdi Mehrani, Yaser Jenab and Kaveh Hosseini

J. Pers. Med. 2025, 15(7), 302; https://doi.org/10.3390/jpm15070302 - 11 Jul 2025

Abstract

Background/Objectives: Transcatheter aortic valve replacement (TAVR) has been introduced as an optimal treatment for patients with severe aortic stenosis, offering a minimally invasive alternative to surgical aortic valve replacement. Predicting these outcomes following TAVR is crucial. Artificial intelligence (AI) has emerged as a [...] Read more.

Background/Objectives: Transcatheter aortic valve replacement (TAVR) has been introduced as an optimal treatment for patients with severe aortic stenosis, offering a minimally invasive alternative to surgical aortic valve replacement. Predicting these outcomes following TAVR is crucial. Artificial intelligence (AI) has emerged as a promising tool for improving post-TAVR outcome prediction. In this systematic review and meta-analysis, we aim to summarize the current evidence on utilizing AI in predicting post-TAVR outcomes. Methods: A comprehensive search was conducted to evaluate the studies focused on TAVR that applied AI methods for risk stratification. We assessed various ML algorithms, including random forests, neural networks, extreme gradient boosting, and support vector machines. Model performance metrics—recall, area under the curve (AUC), and accuracy—were collected with 95% confidence intervals (CIs). A random-effects meta-analysis was conducted to pool effect estimates. Results: We included 43 studies evaluating 366,269 patients (mean age 80 ± 8.25; 52.9% men) following TAVR. Meta-analyses for AI model performances demonstrated the following results: all-cause mortality (AUC = 0.78 (0.74–0.82), accuracy = 0.81 (0.69–0.89), and recall = 0.90 (0.70–0.97); permanent pacemaker implantation or new left bundle branch block (AUC = 0.75 (0.68–0.82), accuracy = 0.73 (0.59–0.84), and recall = 0.87 (0.50–0.98)); valve-related dysfunction (AUC = 0.73 (0.62–0.84), accuracy = 0.79 (0.57–0.91), and recall = 0.54 (0.26–0.80)); and major adverse cardiovascular events (AUC = 0.79 (0.67–0.92)). Subgroup analyses based on the model development approaches indicated that models incorporating baseline clinical data, imaging, and biomarker information enhanced predictive performance. Conclusions: AI-based risk prediction for TAVR complications has demonstrated promising performance. However, it is necessary to evaluate the efficiency of the aforementioned models in external validation datasets. Full article

(This article belongs to the Special Issue Artificial Intelligence in Diagnosis, Treatment and Prognosis of Cardiovascular Diseases)

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Graphical abstract

9 pages, 206 KiB

Open AccessArticle

Effect of Prior Laser-Assisted In Situ Keratomileusis on the Calibration Accuracy of Extended Depth of Focus Intraocular Lenses: A Direct Comparative Study

by I-Hung Lin, Chen-Cheng Chao and Chao-Kai Chang

J. Pers. Med. 2025, 15(7), 301; https://doi.org/10.3390/jpm15070301 - 10 Jul 2025

Abstract

Background: Personalized precision medicine has become a prevailing trend and applies to the selection of intraocular lenses (IOLs) for cataract surgery based on the unique corneal morphology of each person. The choice of presbyopia-correcting IOLs for post-laser-assisted in situ keratomileusis (LASIK) cataract surgery [...] Read more.

Background: Personalized precision medicine has become a prevailing trend and applies to the selection of intraocular lenses (IOLs) for cataract surgery based on the unique corneal morphology of each person. The choice of presbyopia-correcting IOLs for post-laser-assisted in situ keratomileusis (LASIK) cataract surgery is a significant concern. However, few direct comparison studies exist between eyes with and without LASIK history. We analyzed the performance of extended depth of focus (EDOF) IOL implantation in these two groups. Methods: In this retrospective single-center study, we included patients with or without previous LASIK who underwent cataract surgery and EDOF Symfony IOL implantation, with ≥1 follow up. All patients underwent optical biometry using the IOLMaster. IOL power was calculated using the Sanders Retzslaff Kraff/theoretical and Haigis-L formulas for patients without and with LASIK, respectively. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), refraction, and corneal tomography were recorded. The prediction error was the absolute difference between the postoperative sphere and target refraction. The right eyes of patients who met the inclusion criteria were selected for analysis. Results: Among the 321 recruited eyes, 18 underwent previous LASIK. After 1:3 age/sex matching, 17 LASIK and 49 non-LASIK eyes from 66 patients were analyzed. No significant preoperative differences existed in target refraction, spherical equivalent, or best-corrected visual acuity. All surgical procedures were uneventful. LASIK exhibited non-inferiority to non-LASIK for predictive refraction error and UNVA. An age/sex-matched regression analysis indicated no UDVA superiority between the two groups. Conclusions: Previous LASIK may have no discernible effect on the visual performance of presbyopia-correcting EDOF IOLs with respect to the absolute refractive error, UNVA, and UDVA. Longer follow-up and larger-scale studies are required to further validate these results. Full article

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

17 pages, 748 KiB

Open AccessArticle

Evaluating the Long-Term Impact of Cytoreductive Surgery for Gastric Cancer with Peritoneal Metastasis: Are We on the Right Path?

by Cecilia Orsini, Matteo Aulicino, Giorgio D’Annibale, Marianna Cantelmo, Sara Totaro Aprile, Paolo Catania, Lorenzo Barberis, Federica Ferracci, Miriam Attalla El Halabieh, Carlo Abatini, Claudio Lodoli, Andrea Di Giorgio, Antonia Strippoli, Fabio Pacelli and Francesco Santullo

J. Pers. Med. 2025, 15(7), 300; https://doi.org/10.3390/jpm15070300 - 10 Jul 2025

Abstract

Background: Peritoneal metastases from gastric cancer (GCPM) represent a significant clinical challenge in terms of therapeutic options and prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated promising survival benefits within a multimodal approach, particularly in carefully selected patients. Methods: [...] Read more.

Background: Peritoneal metastases from gastric cancer (GCPM) represent a significant clinical challenge in terms of therapeutic options and prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated promising survival benefits within a multimodal approach, particularly in carefully selected patients. Methods: This retrospective single-center study evaluated outcomes in patients with synchronous GCPM treated with CRS + HIPEC following neoadjuvant chemotherapy. The primary endpoints included overall survival (OS), disease-free survival (DFS), and identification of prognostic factors associated with poor outcomes. Additionally, we sought to characterize patients achieving long-term survival (OS ≥ 24 months). Results: The median OS and DFS were 18 and 13 months, respectively. A peritoneal cancer index (PCI) ≥ 7 and major postoperative complications were independently associated with reduced survival. Recurrence was significantly linked to PCI ≥ 7 and signet ring cell histology. Stratification by survival outcome identified PCI ≥ 7 as the only statistically significant variable differentiating average- and long-survival groups. Moreover, elevated PCI was independently associated with a higher incidence of major postoperative complications. Conclusions: CRS + HIPEC may offer a survival advantage over the use of systemic therapy exclusively in appropriately selected patients, particularly those with limited peritoneal disease burden. These results underscore the importance of accurate patient selection to balance surgical risks and maximize oncological benefits in the treatment of GCPM. Full article

(This article belongs to the Special Issue Personalized Therapeutic Strategies in Gastrointestinal Surgery)

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16 pages, 923 KiB

Open AccessArticle

Incidence and Predictors of Pulmonary Thromboembolism in Patients with Advanced High-Grade Serous Ovarian Cancer Undergoing Surgical Treatment: A Retrospective Cohort Study

by Vito Andrea Capozzi, Michela Gaiano, Isabella Rotondella, Martina Leotta, Asya Gallinelli, Licia Roberto, Elisa Scarpelli, Carla Merisio and Roberto Berretta

J. Pers. Med. 2025, 15(7), 299; https://doi.org/10.3390/jpm15070299 - 9 Jul 2025

Abstract

Background/Objectives: Patients with advanced ovarian cancer face a high risk of venous thromboembolism (VTE). This study evaluates the incidence and risk factors for pulmonary thromboembolism (PE) in patients with advanced high-grade serous ovarian carcinoma (HGSOC) undergoing primary treatment, with a focus on [...] Read more.

Background/Objectives: Patients with advanced ovarian cancer face a high risk of venous thromboembolism (VTE). This study evaluates the incidence and risk factors for pulmonary thromboembolism (PE) in patients with advanced high-grade serous ovarian carcinoma (HGSOC) undergoing primary treatment, with a focus on personalized risk stratification. Methods: A retrospective analysis was conducted on women with FIGO stage IIIA-IVB HGSOC treated at the University Hospital of Parma between January 2012 and May 2023. All patients underwent CT-based staging prior to primary treatment. When resectability was uncertain, diagnostic laparoscopy and the Fagotti score were performed. Based on cytoreductive potential, patients received either primary debulking surgery (PDS) followed by adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and AC. The Khorana score, a thromboembolic risk model, was calculated prior to chemotherapy. Logistic regression was used to assess the association between baseline characteristics and PE. Results: Among 167 HGSOC patients analyzed, 13 (7.8%) experienced PE. Among the 115 patients undergoing diagnostic laparoscopy, each 2-point increase in the Fagotti score above 8 raised PE risk by 76% (OR 1.76, p = 0.006, 95% CI: 1.17–2.63). Patients undergoing NACT-IDS had a significantly higher risk of PE (OR 4.04, 95% CI: 1.19–13.74, p = 0.02) than patients who underwent PDS. A Khorana score of 3 was an independent predictor of PE (OR 37.66, 95% CI: 2.43–582.36, p = 0.009). Conclusions: Based on our results, NACT followed by IDS or a Fagotti score greater than 8 were associated with increased PE risk in HGSOC patients. Khorana score was the strongest predictor of PE in HGSOC patients. Full article

(This article belongs to the Special Issue Gynecological Oncology: Personalized Diagnosis and Therapy)

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28 pages, 1727 KiB

Open AccessReview

Computational and Imaging Approaches for Precision Characterization of Bone, Cartilage, and Synovial Biomolecules

by Rahul Kumar, Kyle Sporn, Vibhav Prabhakar, Ahab Alnemri, Akshay Khanna, Phani Paladugu, Chirag Gowda, Louis Clarkson, Nasif Zaman and Alireza Tavakkoli

J. Pers. Med. 2025, 15(7), 298; https://doi.org/10.3390/jpm15070298 - 9 Jul 2025

Abstract

Background/Objectives: Degenerative joint diseases (DJDs) involve intricate molecular disruptions within bone, cartilage, and synovial tissues, often preceding overt radiographic changes. These tissues exhibit complex biomolecular architectures and their degeneration leads to microstructural disorganization and inflammation that are challenging to detect with conventional imaging [...] Read more.

Background/Objectives: Degenerative joint diseases (DJDs) involve intricate molecular disruptions within bone, cartilage, and synovial tissues, often preceding overt radiographic changes. These tissues exhibit complex biomolecular architectures and their degeneration leads to microstructural disorganization and inflammation that are challenging to detect with conventional imaging techniques. This review aims to synthesize recent advances in imaging, computational modeling, and sequencing technologies that enable high-resolution, non-invasive characterization of joint tissue health. Methods: We examined advanced modalities including high-resolution MRI (e.g., T1ρ, sodium MRI), quantitative and dual-energy CT (qCT, DECT), and ultrasound elastography, integrating them with radiomics, deep learning, and multi-scale modeling approaches. We also evaluated RNA-seq, spatial transcriptomics, and mass spectrometry-based proteomics for omics-guided imaging biomarker discovery. Results: Emerging technologies now permit detailed visualization of proteoglycan content, collagen integrity, mineralization patterns, and inflammatory microenvironments. Computational frameworks ranging from convolutional neural networks to finite element and agent-based models enhance diagnostic granularity. Multi-omics integration links imaging phenotypes to gene and protein expression, enabling predictive modeling of tissue remodeling, risk stratification, and personalized therapy planning. Conclusions: The convergence of imaging, AI, and molecular profiling is transforming musculoskeletal diagnostics. These synergistic platforms enable early detection, multi-parametric tissue assessment, and targeted intervention. Widespread clinical integration requires robust data infrastructure, regulatory compliance, and physician education, but offers a pathway toward precision musculoskeletal care. Full article

(This article belongs to the Special Issue Cutting-Edge Diagnostics: The Impact of Imaging on Precision Medicine)

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13 pages, 1292 KiB

Open AccessArticle

Impact of Sex on Rehospitalization Rates and Mortality of Patients with Heart Failure with Preserved Ejection Fraction: Differences Between an Analysis Stratified by Sex and a Global Analysis

by Victoria Cendrós, Mar Domingo, Elena Navas, Miguel Ángel Muñoz, Antoni Bayés-Genís and José María Verdú-Rotellar

J. Pers. Med. 2025, 15(7), 297; https://doi.org/10.3390/jpm15070297 - 8 Jul 2025

Abstract

Background: Differences in the prognosis and associated factors in patients with heart failure with a preserved fraction (HFpEF) according to sex remain uncertain. Objective: The objective was to determine the relevance of sex-stratified predictive models in determining prognosis in HFpEF patients. Methods: The [...] Read more.

Background: Differences in the prognosis and associated factors in patients with heart failure with a preserved fraction (HFpEF) according to sex remain uncertain. Objective: The objective was to determine the relevance of sex-stratified predictive models in determining prognosis in HFpEF patients. Methods: The study was a retrospective, multicenter study of patients previously hospitalized with ejection fraction ≥ 50% (HFpEF) using data from the SIDIAP database. The endpoints were mortality and rehospitalization. Predictive models were performed. Results: We identified 2895 patients with HFpEF who were 57% female, with a mean age of 77 (standard deviation [SD] 9.7) years and a median follow-up of 2.0 (IQR 1.0–9.0) years. In the overall analysis, male sex was associated with a higher risk of mortality (HR 1.26, 95% CI 1.06–1.49, p = 0.008) and rehospitalization (HR 1.14, 95% CI 1.03–1.33, p = 0.04). After sex stratification, the mortality rates per 1000 patient years were 10.40 (95% CI 9.34–11.46) in men and 10.21 (95% CI 9.30–11.11) in women (p = 0.7), and the rehospitalization rates were 17.11 (95% CI 16.63–18.58) in men and 17.29 (95% CI 16.01–18.57) in women (p = 0.23). In men, the factors related to mortality were age (hazard ratio [HR] 3.14, 95% confidence interval [CI] 2.43–4.06), and hemoglobin (0.84, 0.79–0.89), while in women, they were age (HR 2.92, 95% CI 2.17–3.92), BMI < 30 kg/m² (1.7, 1.37–2.11), diuretics (1.46, 1.11–1.94), and a Charlson > 2 (1.86, 1.02–3.38). Rehospitalization in men was associated with age (HR 1.58, 95% CI 1.23–2.02), BMI < 30 kg/m² (0.75, 0.58–0.95), atrial fibrillation (1.36, 1.07–1.73), hemoglobin (0.91, 0.87–0.95), and coronary disease (1.35, 1.01–1.81). In women, the factors were age (HR 1.33, 95% CI 1.0–1.64), atrial fibrillation (1.57, 1.30–1.91), hemoglobin (0.86, 0.80–0.92), and diuretics (1.37, 1.08–1.73). Conclusions: Non-stratified analyses underestimate the poor prognosis in women with HFpEF. Future studies should include analyses stratified by sex. Full article

(This article belongs to the Section Sex, Gender and Hormone Based Medicine)

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18 pages, 1306 KiB

Open AccessReview

Intraoperative Ultrasound as a Decision-Making Tool in Modern Gynecologic Oncology

by Mohamed Lakany, Amana Sharif, Moiad Alazzam, Catherine Howell, Sian Mitchell, Christina Pappa, Dana Shibli, Lisa Story and Ahmad Sayasneh

J. Pers. Med. 2025, 15(7), 296; https://doi.org/10.3390/jpm15070296 - 8 Jul 2025

Abstract

Background: Intraoperative ultrasound (IOUS) is revolutionizing gynecologic oncology surgery by overcoming the limitations of traditional imaging and intraoperative assessment. Its real-time, high-resolution capabilities address critical needs in tumor localization, fertility preservation, refined intraoperative decisions, and complete cytoreduction. Methods: We reviewed clinical studies (1998–2024) [...] Read more.

Background: Intraoperative ultrasound (IOUS) is revolutionizing gynecologic oncology surgery by overcoming the limitations of traditional imaging and intraoperative assessment. Its real-time, high-resolution capabilities address critical needs in tumor localization, fertility preservation, refined intraoperative decisions, and complete cytoreduction. Methods: We reviewed clinical studies (1998–2024) evaluating IOUS applications, analyzing data on detection accuracy, surgical outcomes, and implementation challenges from peer-reviewed literature and institutional experiences. Results: IOUS demonstrates 88–93% sensitivity for subcentimeter metastases, refining surgical decisions in 25–40% of cases. Key outcomes include increased complete resection rates (68% to 87%), a 38% reduction in unnecessary lymphadenectomies, and successful fertility preservation in 92% of cases. Limitations include learning curves, 12% false-negative rate for micrometastases, and significant capital investment cost barriers. Conclusions: IOUS represents a transformative advance in precision surgery, improving both oncologic outcomes and quality of life. While standardization and accessibility challenges remain, ongoing technological innovations promise to solidify its role as a surgical standard. Full article

(This article belongs to the Special Issue Gynecological Oncology: Personalized Diagnosis and Therapy)

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4 pages, 155 KiB

Open AccessEditorial

New Insights into Personalized Surgical Oncology

by Maximos Frountzas

J. Pers. Med. 2025, 15(7), 295; https://doi.org/10.3390/jpm15070295 - 8 Jul 2025

Abstract

The trajectory of surgical oncology has evolved dramatically during recent years, transitioning from widely applied treatment protocols to highly individualized therapeutic strategies according to each tumor’s specific characteristics [...] Full article

(This article belongs to the Special Issue New Insights into Personalized Surgical Oncology)

20 pages, 636 KiB

Open AccessOpinion

Clinician Experiences at the Frontier of Pharmacogenomics and Future Directions

by Stefan Thottunkal, Claire Spahn, Benjamin Wang, Nidhi Rohatgi, Jison Hong, Abha Khandelwal and Latha Palaniappan

J. Pers. Med. 2025, 15(7), 294; https://doi.org/10.3390/jpm15070294 - 7 Jul 2025

Abstract

Pharmacogenomics (PGx) has emerged as a powerful tool to personalize drug selection and dosing based on a patient’s genetic profile. However, there are a range of challenges that impede uptake in current clinical practice. For example, clinicians often express frustration with commercially available [...] Read more.

Pharmacogenomics (PGx) has emerged as a powerful tool to personalize drug selection and dosing based on a patient’s genetic profile. However, there are a range of challenges that impede uptake in current clinical practice. For example, clinicians often express frustration with commercially available PGx panel tests, which fail to consistently include all key actionable PGx genes (according to the Clinical Pharmacogenetics Implementation Consortium (CPIC), Food and Drug Administration (FDA) PGx guidelines, or The Dutch Pharmacogenetics Working Group (DPWG) guidelines) and instead are too long with clinically unimportant information (unvalidated genotypes). Additionally, the lack of EMR integration, clinician education and awareness of the benefits of PGx impedes uptake. This paper examines key challenges identified in clinical practice and proposes future directions, focusing on limiting PGx reports to essential data, providing point-of-prescription alerts, and establishing reimbursement pathways that encourage adoption. Future directions include leveraging large language models, integrating point-of-prescription alerts and phenoconversion calculators into the electronic medical record, increasing the genomic diversity of PGx study populations, and streamlining coverage by payers. Full article

(This article belongs to the Section Pharmacogenetics)

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16 pages, 815 KiB

Open AccessReview

Microvascularization of the Vocal Folds: Molecular Architecture, Functional Insights, and Personalized Research Perspectives

by Roxana-Andreea Popa, Cosmin-Gabriel Popa, Delia Hînganu and Marius Valeriu Hînganu

J. Pers. Med. 2025, 15(7), 293; https://doi.org/10.3390/jpm15070293 - 7 Jul 2025

Abstract

Introduction: The vascular architecture of the vocal folds plays a critical role in sustaining the dynamic demands of phonation. Disruptions in this microvascular system are linked to various pathological conditions, including Reinke’s edema, hemorrhage, and laryngeal carcinoma. This review explores the structural [...] Read more.

Introduction: The vascular architecture of the vocal folds plays a critical role in sustaining the dynamic demands of phonation. Disruptions in this microvascular system are linked to various pathological conditions, including Reinke’s edema, hemorrhage, and laryngeal carcinoma. This review explores the structural and functional components of vocal fold microvascularization, with emphasis on pericytes, endothelial interactions, and neurovascular regulation. Materials and Methods: A systematic review of the literature was conducted using databases such as PubMed, Scopus, Web of Science, and Embase. Keywords included “pericytes”, “Reinke’s edema”, and “vocal fold microvascularization”. Selected studies were peer-reviewed and met criteria for methodological quality and relevance to laryngeal microvascular physiology and pathology. Results: The vocal fold vasculature is organized in a parallel, tree-like pattern with distinct arterioles, capillaries, and venules. Capillaries dominate the superficial lamina propria, while transitional vessels connect to deeper arterioles surrounded by smooth muscle. Pericytes, present from birth, form tight associations with endothelial cells and contribute to capillary stability, vessel remodeling, and mechanical protection during vibration. Their thick cytoplasmic processes suggest a unique adaptation to the biomechanical stress of phonation. Arteriovenous anastomoses regulate perfusion by shunting blood according to functional demand. Furthermore, neurovascular control is mediated by noradrenergic fibers and neuropeptides such as VIP and CGRP, modulating vascular tone and glandular secretion. The limited lymphatic presence in the vocal fold mucosa contributes to edema accumulation while also restricting carcinoma spread, offering both therapeutic challenges and advantages. Conclusions: A deeper understanding of vocal fold microvascularization enhances clinical approaches to voice disorders and laryngeal disease, offering new perspectives for targeted therapies and regenerative strategies. Full article

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

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14 pages, 680 KiB

Open AccessArticle

Comparing the Impact of DOACs and Warfarin on Below-the-Knee Autologous Vein Bypass Patency in Peripheral Artery Disease: A Retrospective Cohort Study with 2-Year Follow-Up

by Francisca Frias and Günay Kalender

J. Pers. Med. 2025, 15(7), 292; https://doi.org/10.3390/jpm15070292 - 7 Jul 2025

Abstract

Background: Peripheral artery disease (PAD) affects over 200 million individuals globally, leading to significant morbidity and mortality. For patients with complex lesions of the superficial femoral artery requiring revascularization, autologous vein bypass surgery remains a viable treatment option. Postoperative anticoagulation is critical for [...] Read more.

Background: Peripheral artery disease (PAD) affects over 200 million individuals globally, leading to significant morbidity and mortality. For patients with complex lesions of the superficial femoral artery requiring revascularization, autologous vein bypass surgery remains a viable treatment option. Postoperative anticoagulation is critical for maintaining graft patency, but the optimal choice between direct oral anticoagulants (DOACs) and warfarin remains uncertain. Objectives: This study aims to evaluate the patency of below-the-knee autologous vein bypasses in PAD patients receiving either DOACs or warfarin over a two-year period. Methods: A retrospective cohort study was conducted at a tertiary care hospital in Berlin, Germany, including patients who underwent femoropopliteal or femorocrural bypass surgery between 2017 and 2022. Patients were divided into two groups based on postoperative anticoagulation therapy: DOACs or warfarin. The primary outcome was graft patency at 24 months. Results: Out of 192 patients, after applying exclusion criteria, 36 were analyzed. The mean bypass patency was longer in the warfarin group (18.3 months) compared to the DOAC group (14.3 months). However, the log-rank test p-value (0.524) suggests that this difference is not statistically significant. Given the log-rank test’s limitations in accounting for confounders, a multivariable Cox regression was performed, including age, sex, comorbidities, bypass type and antiplatelet use. The model (Omnibus p = 0.93) showed no statistically significant effect for any variable. Conclusions: DOACs appear to be a viable alternative to warfarin in maintaining graft patency in below-the-knee autologous vein bypasses for PAD patients. The lack of a need for regular INR monitoring with DOACs may offer a practical advantage in clinical settings. Full article

(This article belongs to the Special Issue New Insights into Personalized Medicine for Cardiac Surgery: Clinical Advances in Diagnosis, Treatment, and Prognosis)

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14 pages, 784 KiB

Open AccessArticle

Resting-State EEG Alpha Asymmetry as a Potential Marker of Clinical Features in Parkinson’s Disease

by Thalita Frigo da Rocha, Valton Costa, Lucas Camargo, Elayne Borges Fernandes and Anna Carolyna Gianlorenço

J. Pers. Med. 2025, 15(7), 291; https://doi.org/10.3390/jpm15070291 - 4 Jul 2025

Abstract

Background: Asymmetrical brain oscillations may be characteristic of Parkinson’s disease (PD). We investigated differences in oscillation asymmetry between individuals with PD and healthy controls and explored associations between the asymmetry and clinical features. Methods: Clinical and resting-state EEG data from 37 [...] Read more.

Background: Asymmetrical brain oscillations may be characteristic of Parkinson’s disease (PD). We investigated differences in oscillation asymmetry between individuals with PD and healthy controls and explored associations between the asymmetry and clinical features. Methods: Clinical and resting-state EEG data from 37 patients and 24 controls were cross-sectionally analyzed. EEG asymmetry indices were calculated for the delta, theta, alpha, and beta frequencies in the frontal, central, and parietal regions. Independent t-tests and linear regression models were employed. Results: Patients exhibited lower alpha asymmetry than controls in the parietal region (t(59) = 2.12, p = 0.03). In the frontal alpha asymmetry models, there were associations with time since diagnosis (β = −0.042) and attention/orientation (β = 0.061), and with Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRSIII)-posture (β = 0.136) and MDS-UPDRSIII-rest-tremor persistence (β = −0.111). In the central alpha model, higher asymmetry was associated with the physical activity levels (International Physical Activity Questionnaire) IPAQ-active (β = 0.646) and IPAQ-very active (β = 0.689), (Timed Up and Go) TUG dual-task cost (β = 0.023), MDS-UPDRSII-freezing (β = 0.238), and being male (β = 0.535). In the parietal alpha asymmetry model, MDS-UPDRSII-gait/balance was inversely associated with alpha asymmetry (β = −0.156), while IPAQ-active (β = −0.247) and being male (β = −0.191) were associated with lower asymmetry. Conclusions: Our findings highlight the potential role of alpha asymmetry as a neurophysiological marker of PD’s motor symptoms, mainly rest tremor, gait/balance, freezing, and specific cognitive domains such as attention/orientation. The models stressed the relationship between disease progression and reduced alpha asymmetry. Brazilian Registry of Clinical Trials (RBR-7zjgnrx, 9 June 2022). Full article

(This article belongs to the Section Disease Biomarker)

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14 pages, 389 KiB

Open AccessReview

Relationship Between Vitamin D Deficiency and Postpartum Depression

by Ioanna Apostolidou, Marios Baloukas and Ioannis Tsamesidis

J. Pers. Med. 2025, 15(7), 290; https://doi.org/10.3390/jpm15070290 - 4 Jul 2025

Abstract

Background/Objectives: Postpartum depression (PPD) affects approximately 10–20% of women during and after pregnancy, posing significant risks to maternal health, infant development, and family dynamics. Identifying modifiable risk factors is essential for prevention. Emerging evidence suggests that vitamin D, a neuroactive steroid hormone involved [...] Read more.

Background/Objectives: Postpartum depression (PPD) affects approximately 10–20% of women during and after pregnancy, posing significant risks to maternal health, infant development, and family dynamics. Identifying modifiable risk factors is essential for prevention. Emerging evidence suggests that vitamin D, a neuroactive steroid hormone involved in neurotransmitter synthesis, neuroinflammation regulation, and calcium homeostasis, may play a protective role against mood disorders, including PPD. Methods: The search was conducted through a comprehensive search of the PubMed, Scopus, and Web of Science databases using a combination of Medical Subject Headings (MeSH) and free-text terms including “vitamin D”, “25-hydroxyvitamin D”, “deficiency”, “pregnancy”, “postpartum”, “depression”, “antenatal depression”, “maternal mental health”, and “perinatal mood disorders”. Results: Numerous observational studies and systematic review reports around the world reinforce the potential global relevance of vitamin D insufficiency. This study advances personalized and precision medicine approaches by emphasizing the importance of individualized screening for vitamin D deficiency during pregnancy and postpartum, enabling tailored interventions that could mitigate the risk of postpartum depression. Conclusions: In conclusion, while a definitive causal relationship between vitamin D deficiency and perinatal depression remains unproven, screening for vitamin D levels during pregnancy could serve as a low-risk intervention to support maternal mental health. Future research should focus on well designed, large-scale randomized trials and standardization of diagnostic criteria to clarify vitamin D’s role in preventing perinatal depression. Recognizing vitamin D status as a modifiable biomarker allows for targeted nutritional and pharmacological strategies to optimize maternal mental health. Full article

(This article belongs to the Special Issue Hormone Therapies for Women)

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10 pages, 449 KiB

Open AccessArticle

Accuracy of Lower Extremity Alignment Correction Using Patient-Specific Cutting Guides and Anatomically Contoured Plates

by Julia Matthias, S Robert Rozbruch, Austin T. Fragomen, Anil S. Ranawat and Taylor J. Reif

J. Pers. Med. 2025, 15(7), 289; https://doi.org/10.3390/jpm15070289 - 4 Jul 2025

Abstract

Background/Objectives: Limb malalignment disrupts physiological joint forces and predisposes individuals to the development of osteoarthritis. Surgical interventions such as distal femur or high tibial osteotomy aim to restore mechanical balance on weight-bearing joints, thereby reducing long-term morbidity. Accurate alignment is crucial since [...] Read more.

Background/Objectives: Limb malalignment disrupts physiological joint forces and predisposes individuals to the development of osteoarthritis. Surgical interventions such as distal femur or high tibial osteotomy aim to restore mechanical balance on weight-bearing joints, thereby reducing long-term morbidity. Accurate alignment is crucial since it cannot be adjusted after stabilization with plates and screws. Recent advances in personalized medicine offer the opportunity to tailor surgical corrections to each patient’s unique anatomy and biomechanical profile. This study evaluates the benefits of 3D planning and patient-specific cutting guides over traditional 2D planning with standard implants for alignment correction procedures. Methods: We assessed limb alignment parameters pre- and postoperatively in patients with varus and valgus lower limb malalignment undergoing acute realignment surgery. The cohort included 23 opening-wedge high tibial osteotomies and 28 opening-wedge distal femur osteotomies. We compared the accuracy of postoperative alignment parameters between patients undergoing traditional 2D preoperative X-ray planning and those using 3D reconstructions of CT data. Outcome measures included mechanical axis deviation and tibiofemoral angles. Results: 3D reconstructions of computerized tomography data and patient-specific cutting guides significantly reduced the variation in postoperative limb alignment parameters relative to preoperative goals. In contrast, traditional 2D planning with standard non-custom implants resulted in higher deviations from the targeted alignment. Conclusions: Utilizing 3D CT reconstructions and patient-specific cutting guides enhances the accuracy of postoperative limb realignment compared to traditional 2D X-ray planning with standard non-custom implants. Patient-specific instrumentation and personalized approaches represent a key step toward precision orthopedic surgery, tailoring correction strategies to individual patient anatomy and potentially improving long-term joint health. This improvement may reduce the morbidity associated with lower limb malalignment and delay the onset of osteoarthritis. Level of Evidence: Therapeutic Level III. Full article

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

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8 pages, 1411 KiB

Open AccessBrief Report

Computational Fluid Dynamics Simulations to Personalize Nasal Irrigations

by Thomas Radulesco, Dario Ebode, Ralph Haddad, Jerome R. Lechien, Lionel Meister, Stephane Gargula and Justin Michel

J. Pers. Med. 2025, 15(7), 288; https://doi.org/10.3390/jpm15070288 - 3 Jul 2025

Abstract

Background/Objectives: Proper nasal irrigation techniques are essential for treating nasal and sinus conditions, influencing drug delivery efficiency and patient comfort. This study evaluates how different head positions—upright, right-tilted, and left-tilted—affect the distribution of saline solution in the nasal cavity and maxillary sinus [...] Read more.

Background/Objectives: Proper nasal irrigation techniques are essential for treating nasal and sinus conditions, influencing drug delivery efficiency and patient comfort. This study evaluates how different head positions—upright, right-tilted, and left-tilted—affect the distribution of saline solution in the nasal cavity and maxillary sinus using computational fluid dynamics (CFD). Methods: CFD simulations were conducted on a CT-based model of a healthy adult. A 4 mL saline solution was administered into the right nostril over three seconds. Fluid distribution and percentage of nasal mucosa coverage was analyzed in the inferior, middle, and superior thirds of the nasal cavity and the right maxillary sinus. Results: In the upright position, fluid primarily accumulated in the inferior (0.075 mL) and middle (0.015 mL) nasal regions, with minimal sinus penetration (0.002 mL). Right-tilting improved maxillary sinus coverage (0.028 mL) and increased irrigation of the inferior region (0.086 mL), while left-tilting enhanced central nasal coverage with only slight sinus penetration improvement. Irrigation patterns exhibited a rapid initial wetting phase followed by a slower, steady increase. Conclusions: Head position significantly influences the distribution achieved by nasal irrigation. These findings can guide clinical recommendations for specific conditions or postoperative care. Full article

(This article belongs to the Special Issue Personalized Medicine in Otolaryngology—Head and Neck Surgery: Updates and Challenges)

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14 pages, 700 KiB

Open AccessArticle

The Association Between Psychosocial Stress and Perinatal Maternal Depressive Symptoms: A Case–Control Study in a Regional Medical Center in Hungary

by Anita Sisák, Evelin Polanek, Regina Molnár, Andrea Szabó, Ferenc Rárosi, Armita Hosseini, Gábor Németh, Hajnalka Orvos and Edit Paulik

J. Pers. Med. 2025, 15(7), 287; https://doi.org/10.3390/jpm15070287 - 3 Jul 2025

Abstract

Perinatal depression is one of the most common mental illnesses in women. The aim of this study was to assess the association of life stressors, perceived stress, obstetric and neonatal complications, and depressive symptoms in the early postpartum period and to compare these [...] Read more.

Perinatal depression is one of the most common mental illnesses in women. The aim of this study was to assess the association of life stressors, perceived stress, obstetric and neonatal complications, and depressive symptoms in the early postpartum period and to compare these variables in two groups of women (preterm and term deliveries). Methods: A case–control study was conducted among 300 women who gave birth in 2019 at the University of Szeged. Cases included women with preterm deliveries (<37 weeks, n = 100), and the controls included women with term deliveries (≥37 weeks, n = 200). Data were collected during postpartum hospital stays through a self-administered questionnaire (containing validated questionnaires: the Holmes–Rahe Life Stress Inventory, the Perceived Stress Scale (PSS-14), and the Edinburgh Postnatal Depression Scale (EPDS)) and the medical records of women and newborns. A descriptive statistical analysis and logistic regression were used to identify predictors of high EPDS scores (≥10). Results: Perceived stress levels were significantly higher among cases than controls (p < 0.001). Higher perceived stress was associated with a higher risk of depression in cases (OR: 1.31, 95% CI: 1.17–1.48, p < 0.001) and controls (OR: 1.33, 95% CI: 1.21–1.45, p < 0.001), too. Newborn complications were associated with an increased perinatal depression risk in the controls (OR: 2.48, 95% CI: 1.05–5.91; p = 0.039) but not in the cases (OR: 2.79, 95% CI: 0.79–9.85; p = 0.111). It is supposed that premature birth was stressful itself, and women with preterm babies were less sensitive to any complications occurring in their newborns compared to women with term newborns. Neither maternal age, education, nor obstetric complications predicted depressive symptoms. Conclusions: Our findings highlight the impact of maternal perceived stress and newborns’ health status on the risk of developing depression during the early postpartum period. These results emphasize the need for ongoing screening and follow-up measures, especially for women with higher EPDS scores. Full article

(This article belongs to the Section Epidemiology)

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