Journal of Personalized Medicine

14 pages, 355 KiB

Open AccessReview

Fundus Autofluorescence in Diabetic Retinopathy

by Otilia-Maria Dumitrescu, Mihail Zemba, Daniel Constantin Brănișteanu, Ruxandra Angela Pîrvulescu, Madalina Radu and Horia Tudor Stanca

J. Pers. Med. 2024, 14(8), 793; https://doi.org/10.3390/jpm14080793 - 26 Jul 2024

Abstract

Diabetic retinopathy is a leading cause of visual morbidity worldwide. Fundus autofluorescence is a rapid, non-invasive imaging modality that has gained increased popularity in recent years in the multimodal evaluation of diabetic retinopathy and, in particular, of diabetic macular oedema. Acquired using either [...] Read more.

Diabetic retinopathy is a leading cause of visual morbidity worldwide. Fundus autofluorescence is a rapid, non-invasive imaging modality that has gained increased popularity in recent years in the multimodal evaluation of diabetic retinopathy and, in particular, of diabetic macular oedema. Acquired using either a fundus camera or the confocal scanning laser ophthalmoscope, short-wavelength and near-infrared autofluorescence are the most used techniques in diabetic retinopathy. In diabetic macular oedema, short-wavelength autofluorescence, in its cystoid pattern, is useful for detecting cystoid macular oedema. Increased spot hyperautofluorescence in short-wavelength and granular changes in near-infrared autofluorescence correlate well with other imaging findings, indicating photoreceptor and retinal pigment epithelium damage and being associated with decreased visual acuity. While also being a marker of oxidative stress, increased short-wavelength autofluorescence in the setting of diabetic macular oedema appears to be a prognostic factor for poor visual outcome, even after the resolution of the intraretinal fluid. Autofluorescence also helps in the assessment of diabetic retinal pigment epitheliopathy and choroidopathy. Fundus autofluorescence is an evolving technology that will assist in gaining further insight into the pathophysiology of diabetic retinopathy and allow for a more comprehensive evaluation of these patients. Full article

(This article belongs to the Special Issue Retinal Diseases: Mechanisms, Diagnosis and Treatments)

24 pages, 4234 KiB

Open AccessArticle

Breast Cancer Detection and Analytics Using Hybrid CNN and Extreme Learning Machine

by Vidhushavarshini Sureshkumar, Rubesh Sharma Navani Prasad, Sathiyabhama Balasubramaniam, Dhayanithi Jagannathan, Jayanthi Daniel and Seshathiri Dhanasekaran

J. Pers. Med. 2024, 14(8), 792; https://doi.org/10.3390/jpm14080792 - 26 Jul 2024

Abstract

Early detection of breast cancer is essential for increasing survival rates, as it is one of the primary causes of death for women globally. Mammograms are extensively used by physicians for diagnosis, but selecting appropriate algorithms for image enhancement, segmentation, feature extraction, and [...] Read more.

Early detection of breast cancer is essential for increasing survival rates, as it is one of the primary causes of death for women globally. Mammograms are extensively used by physicians for diagnosis, but selecting appropriate algorithms for image enhancement, segmentation, feature extraction, and classification remains a significant research challenge. This paper presents a computer-aided diagnosis (CAD)-based hybrid model combining convolutional neural networks (CNN) with a pruned ensembled extreme learning machine (HCPELM) to enhance breast cancer detection, segmentation, feature extraction, and classification. The model employs the rectified linear unit (ReLU) activation function to enhance data analytics after removing artifacts and pectoral muscles, and the HCPELM hybridized with the CNN model improves feature extraction. The hybrid elements are convolutional and fully connected layers. Convolutional layers extract spatial features like edges, textures, and more complex features in deeper layers. The fully connected layers take these features and combine them in a non-linear manner to perform the final classification. ELM performs classification and recognition tasks, aiming for state-of-the-art performance. This hybrid classifier is used for transfer learning by freezing certain layers and modifying the architecture to reduce parameters, easing cancer detection. The HCPELM classifier was trained using the MIAS database and evaluated against benchmark methods. It achieved a breast image recognition accuracy of 86%, outperforming benchmark deep learning models. HCPELM is demonstrating superior performance in early detection and diagnosis, thus aiding healthcare practitioners in breast cancer diagnosis. Full article

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

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15 pages, 1873 KiB

Open AccessReview

Bone Tissue Changes in Individuals Living with HIV/AIDS: The Importance of a Hierarchical Approach in Investigating Bone Fragility

by Jelena Jadzic, Gordana Dragovic, Relja Lukic, Bozana Obradovic and Marija Djuric

J. Pers. Med. 2024, 14(8), 791; https://doi.org/10.3390/jpm14080791 - 26 Jul 2024

Abstract

Skeletal alterations and their complications can significantly impact the quality of life and overall prognosis of patients living with HIV (PLWHIV). Considering skeletal alterations are often asymptomatic and unapparent during routine clinical evaluation, these conditions are frequently overlooked in the clinical management of [...] Read more.

Skeletal alterations and their complications can significantly impact the quality of life and overall prognosis of patients living with HIV (PLWHIV). Considering skeletal alterations are often asymptomatic and unapparent during routine clinical evaluation, these conditions are frequently overlooked in the clinical management of PLWHIV. However, since the use of combined antiretroviral therapy (cART) has increased life expectancy in PLWHIV effectively, osteopenia, osteoporosis, and bone fragility are now considered to have a major health impact, with a substantial increase in healthcare costs. This narrative literature review aimed to provide a comprehensive overview of the contemporary literature related to bone changes in PLWHIV, focusing on the importance of taking a multi-scale approach in the assessment of bone hierarchical organization. Even though a low bone mineral density is frequently reported in PLWHIV, numerous ambiguities still remain to be solved. Recent data suggest that assessment of other bone properties (on various levels of the bone structure) could contribute to our understanding of bone fragility determinants in these individuals. Special attention is needed for women living with HIV/AIDS since a postmenopausal status was described as an important factor that contributes to skeletal alterations in this population. Further research on complex etiopathogenetic mechanisms underlying bone alterations in PLWHIV may lead to the development of new therapeutic approaches specifically designed to reduce the health burden associated with skeletal disorders in this population. A major challenge in the clinical management of PLWHIV lies in the adverse skeletal effects of some frequently prescribed cART regimens (e.g., regimens containing tenofovir disoproxil fumarate), which may require a switch to other pharmacological approaches for maintained HIV infection (e.g., regimens containing tenofovir alafenamide). Taken together, the findings are indicative that the HIV/AIDS status should be taken into consideration when designing new guidelines and strategies for individualized prevention, diagnosis, and treatment of increased bone fragility. Full article

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

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10 pages, 3502 KiB

Open AccessArticle

AKT and PERP Show Higher Expression in Precancerous than in Malignant Skin Neoplasms: Profiling in an Animal Model of Sequential Skin Carcinogenesis

by Efstathia Vairaktari, Alexander Schramm, Georgia Vairaktari, Spyridoula Derka, Frank Wilde, Andreas Sakkas, Christos Yapijakis, Maria Kouri, Athanasios Balakas, Andreas Lazaris, Marcel Ebeling and Stavros Vassiliou

J. Pers. Med. 2024, 14(8), 790; https://doi.org/10.3390/jpm14080790 - 25 Jul 2024

Abstract

The primary aim of this study was to evaluate the activation of the PERP and Akt oncogenes in the induction of skin cancer in FVB/N mice by a stepwise chemical process. Forty four-week-old female FVB/N mice were randomly divided into a control group [...] Read more.

The primary aim of this study was to evaluate the activation of the PERP and Akt oncogenes in the induction of skin cancer in FVB/N mice by a stepwise chemical process. Forty four-week-old female FVB/N mice were randomly divided into a control group (n = 8) and two experimental groups (group A: n = 16, group B: n = 16). In the study, the groups were subjected to a two-stage carcinogenesis procedure. This consisted of an initial application of 97.4 nmol DMBA to shaved skin on the back, followed by applications of 32.4 nmol TPA after thirteen weeks for group A and after twenty weeks for group B. The control group received no treatment. Skin conditions were monitored weekly for tumor development. At the end of the experiment, the animals were euthanized for further tissue sampling. Examination of the skin lesions in the experimental groups showed a correlation with tumor progression, ranging from dysplasia to carcinoma. Tumor samples were examined both histologically and immunohistochemically. Notably, and PERP expression was higher in precancerous than in malignant tumors. The differences in expression between precancerous and benign tumors provide further evidence of a role for PERP and Akt in the transition from benign to malignant states. Our findings underscore the critical roles of PERP and Akt in the pathogenesis of skin cancer and suggest their potential as biomarkers for early detection and targets for therapeutic intervention. Full article

(This article belongs to the Special Issue Dermatology: Molecular Mechanisms, Diagnosis and Therapeutic Targets)

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14 pages, 2151 KiB

Open AccessArticle

Small Fiber Neuropathy Associated with Post-COVID-19 and Post-COVID-19 Vaccination Arthritis: A Rare Post-Infective Syndrome or a New-Onset Disease?

by Francesca Bandinelli, Romina Nassini, Eleonora Gherardi, Barbara Chiocchetti, Mirko Manetti, Massimo Cincotta, Filippo Nozzoli, Elena Nucci, Francesco De Logu and Nicola Pimpinelli

J. Pers. Med. 2024, 14(8), 789; https://doi.org/10.3390/jpm14080789 - 25 Jul 2024

Abstract

Post-COVID-19 (PC) and post-COVID-19 vaccination (PCV) syndromes are considered emergent multidisciplinary disorders. PC/PCV small fiber neuropathy (SFN) was rarely described and its association with undifferentiated arthritis (UA) was never defined. We aimed to evaluate PC/PCV-UA associated with the recent onset of severe lower [...] Read more.

Post-COVID-19 (PC) and post-COVID-19 vaccination (PCV) syndromes are considered emergent multidisciplinary disorders. PC/PCV small fiber neuropathy (SFN) was rarely described and its association with undifferentiated arthritis (UA) was never defined. We aimed to evaluate PC/PCV-UA associated with the recent onset of severe lower limb paresthesia, compare SFN positive (+) to negative (−) patients, and evaluate changes in biomarkers in SFN+ during treatments. Nineteen PC/PCV-UA-patients with possible SFN underwent skin biopsy at the Usl Tuscany Center (Florence) early arthritis outpatient clinic from September 2021 to March 2024. Eight selected SFN+ were compared to ten SFN− patients. In SFN+ patients, baseline joint ultrasound (US), electromyography (EMG), optical coherence tomography (OCT), and skin biopsy were repeated at six months. Moreover, SFN+ patients were clinically assessed by a 0–10 numeric rating scale for neurological symptoms and DAS28/ESR up to 12 months follow-up. SFN+ patients showed a lower intraepidermal nerve fiber density at histopathological examination of skin biopsies and a higher frequency of OCT and EMG abnormalities in comparison to SFN− patients. In SFN+ patients, US and DAS28/ESR significantly improved, while intraepidermal nerve fiber density did not significantly change at the six-month follow-up. Fatigue, motor impairment, burning pain, brain fog, and sensitivity disorders decreased at long-term follow-up (12 months). Full article

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

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25 pages, 2351 KiB

Open AccessArticle

Severity and Clinical Outcomes of Pediatric Burns—A Comprehensive Analysis of Influencing Factors

by Alexandra Toma, Dragoș Voicu, Constantin Popazu, Daniela Mihalache, Oana Duca, Dumitru Marius Dănilă and Dan Mircea Enescu

J. Pers. Med. 2024, 14(8), 788; https://doi.org/10.3390/jpm14080788 - 25 Jul 2024

Abstract

(1) Background: Burn injuries in children present a significant public health concern due to their potential for severe physical and psychological impact. (2) Methods: This study investigates the determinants of pediatric burn severity by analyzing the interplay of demographic and environmental factors. Through [...] Read more.

(1) Background: Burn injuries in children present a significant public health concern due to their potential for severe physical and psychological impact. (2) Methods: This study investigates the determinants of pediatric burn severity by analyzing the interplay of demographic and environmental factors. Through a retrospective analysis of pediatric burn cases over five years, encompassing patient demographics, burn causative agents, and clinical outcomes, this research aims to identify significant predictors of burn severity. (3) Results: This study presents a comprehensive analysis of pediatric burn injuries, focusing on the severity, clinical outcomes, and multifactorial aspects influencing recovery. We reviewed 1498 pediatric burn cases from January 2015 to December 2020. The mean age of patients was 5.8 years, with a slight male predominance (54%). Scalds (45%), flame burns (30%), and contact burns (15%) were the most common burn types. Our findings indicate significant differences in burn severity based on TBSA, with 32.5% of cases having TBSA greater than 20%. Multivariate logistic regression identified rural residence, male gender, flame burns, and lower socioeconomic status as significant predictors of severe burn outcomes. The overall mortality rate was 2.5%, with higher rates among patients with TBSA greater than 40%. These results highlight the need for targeted prevention strategies and improved access to specialized burn care. (4) Conclusions: Understanding these factors can inform targeted prevention strategies and improve treatment protocols. Full article

(This article belongs to the Topic Current Challenges and Advances in Skin Repair and Regeneration)

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10 pages, 269 KiB

Open AccessArticle

The “Wear and Tear” of the Organism in Temporomandibular Disorders: A Pilot Study Investigating the Effects of Allostatic Load on Heart Rate Variability and Inhibitory Control

by Giovanna Troisi, Paola Di Giacomo, Giuseppe Forte, Viviana Langher, Maria Casagrande and Carlo Di Paolo

J. Pers. Med. 2024, 14(8), 787; https://doi.org/10.3390/jpm14080787 - 25 Jul 2024

Abstract

Temporomandibular disorders (TMDs) are the most common cause of non-dental chronic pain in the orofacial region and can chronically increase the activity of the allostatic systems. The allostatic overload related to these conditions causes an autonomic dysregulation, reflected by a reduction in heart [...] Read more.

Temporomandibular disorders (TMDs) are the most common cause of non-dental chronic pain in the orofacial region and can chronically increase the activity of the allostatic systems. The allostatic overload related to these conditions causes an autonomic dysregulation, reflected by a reduction in heart rate variability (HRV). Nevertheless, chronic pain in these patients could cause more severe health consequences, such as those related to cognitive functioning. Deficits in executive control have been associated with allostatic overload and could negatively affect pain management strategies. This study aimed to investigate the effects of chronic pain on HRV and both motor and cognitive inhibition (assessed with the Go/No-Go and Stroop tasks, respectively) in a sample of 14 patients with TMD and 15 healthy controls. Consistent with our hypothesis and the previous literature, the group with TMD had a lower resting HRV, but no differences were found between the groups in inhibition. Furthermore, the results showed that the effects of HRV on cognitive inhibition can be mediated by pain intensity. Finally, a correlation between age and HRV emerged in patients with TMD but not in healthy controls. Full article

(This article belongs to the Section Mechanisms of Diseases)

4 pages, 181 KiB

Open AccessEditorial

Current Challenges in Diagnosis and Treatment of Cardiovascular Disease

by George Samanidis

J. Pers. Med. 2024, 14(8), 786; https://doi.org/10.3390/jpm14080786 - 25 Jul 2024

Abstract

Cardiovascular disease is a leading the cause of death worldwide among the various cardiac pathologies that directly or indirectly affect the quality of life of patients [...] Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

10 pages, 1780 KiB

Open AccessArticle

Learning Curve Analysis of Single-Incision Ovarian Cystectomy: Comparative Study of Robotic and Conventional Laparoscopic Techniques

by Seongmin Kim, Seon-Mi Lee, Aeran Seol, Sanghoon Lee, Jae-Yun Song, Jae-Kwan Lee and Nak-Woo Lee

J. Pers. Med. 2024, 14(8), 785; https://doi.org/10.3390/jpm14080785 - 24 Jul 2024

Abstract

Ovarian cystectomy, aimed at preserving fertility, has advanced through minimally invasive surgical techniques. This study evaluates the learning curves and surgical outcomes of three such approaches: DaVinci Robotic Single-Site (RSS), DaVinci Robotic Single-Port (RSP), and laparo-endoscopic single-site surgery (LESS). To analyze the learning [...] Read more.

Ovarian cystectomy, aimed at preserving fertility, has advanced through minimally invasive surgical techniques. This study evaluates the learning curves and surgical outcomes of three such approaches: DaVinci Robotic Single-Site (RSS), DaVinci Robotic Single-Port (RSP), and laparo-endoscopic single-site surgery (LESS). To analyze the learning curves and surgical outcomes for these techniques, providing insights into their effectiveness and proficiency development. Retrospective analysis of 104 patients with ovarian tumors, divided into RSS (n = 52), RSP (n = 22), and LESS (n = 30) groups. Metrics analyzed included age, BMI, tumor size, hemoglobin drop, operative time, docking time, console time, and tumor location. No significant differences in age, BMI, transfusion rate, hemoglobin drop, or length of stay were found among the groups. RSS had larger tumors on average, and LESS had a higher occurrence rate on the right side. LESS demonstrated the shortest operative time, while RSS and RSP had comparable times. Docking and console times did not differ significantly between RSS and RSP. RSP reached proficiency faster than RSS in docking and console times, while LESS exhibited the greatest variability in operative time. RSP offers a faster and more consistent learning curve, making it advantageous for complex procedures, whereas LESS provides shorter operative times but with higher variability. These findings are crucial for surgical training and resource allocation in medical institutions. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology: Second Edition)

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12 pages, 3998 KiB

Open AccessArticle

The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study

by Domiziano Tarantino, Alfonso Maria Forte, Antonio Picone, Felice Sirico and Carlo Ruosi

J. Pers. Med. 2024, 14(8), 784; https://doi.org/10.3390/jpm14080784 - 24 Jul 2024

Abstract

Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due [...] Read more.

Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study. Full article

(This article belongs to the Special Issue Progress on Personalized Diagnosis and Treatment of Osteoarthritis)

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10 pages, 720 KiB

Open AccessReview

Early Symptoms and Treatment Outcomes in Neuronal Ceroid Lipofuscinosis Type 2: Croatian Experience

by Jelena Radić Nišević, Ivana Kolić, Marija Kostanjski, Franka Kovačević and Igor Prpić

J. Pers. Med. 2024, 14(8), 783; https://doi.org/10.3390/jpm14080783 - 24 Jul 2024

Abstract

Background: Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare neurodegenerative disease that generally appears in children between 2 and 4 years old, leading to seizures and a progressive loss of language and motor functions. As the disease progresses, affected individuals [...] Read more.

Background: Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare neurodegenerative disease that generally appears in children between 2 and 4 years old, leading to seizures and a progressive loss of language and motor functions. As the disease progresses, affected individuals typically experience blindness and ultimately pass away in late childhood. Treatment with intracerebroventricular cerliponase alfa has been shown to slow the deterioration of motor and language functions compared to the natural progression of the disease. We aim to highlight the early symptoms of CLN2 which help with early diagnosis and timely treatment initiation in children with specific medical indications, as well as identify medical contraindications for enzyme replacement therapy. Methods: We describe five Croatian patients and one Bosnia and Herzegovinian patient with CLN2 disease, analyzing the clinical characteristics, neuroimaging findings, electroencephalogram results, genetic analysis, treatment indications and contraindications, and disease progression. Results: All six patients presented with seizures: focal seizures (n = 1), myoclonic–atonic seizures (n = 1), febrile seizures (n = 2), and tonic–clonic seizures (n = 2), along with language delay (n = 6). Despite this, one patient refused treatment, two were initially included in the clinical trial and then continued treatment, one did not indicate starting treatment, and three continued treatment. One patient, after 4.5 years of treatment, no longer had medical indications for the therapy, which was discontinued. The other two patients who received treatment had a significant slowing of disease progression. Conclusions: The early onset of seizures between ages 2 and 4, alongside delayed language development, is a defining characteristic of CLN2 disease. Enzyme replacement therapy using cerliponase alfa represents the initial treatment for neuronal ceroid lipofuscinosis type 2, targeting the underlying cause of the disease. It effectively delays the progression of language and motor decline in patients diagnosed with this condition. Full article

(This article belongs to the Special Issue Real-World Perspective on Effectiveness, Safety, and Costs of Orphan Medicines in Neurology)

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13 pages, 818 KiB

Open AccessArticle

Prevalence of Osteosarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences

by Selma Cvijetić, Irena Keser, Dario Boschiero and Jasminka Z. Ilich

J. Pers. Med. 2024, 14(8), 782; https://doi.org/10.3390/jpm14080782 - 23 Jul 2024

Abstract

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the [...] Read more.

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18–90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC^®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study’s population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases. Full article

(This article belongs to the Section Epidemiology)

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12 pages, 3763 KiB

Open AccessArticle

CC vs. CC-Plus: A Comparison between Two Cranial-to-Caudal Approaches for Laparoscopic Right Hemicolectomy: A Single-Center Retrospective Study

by Yurong Jiao, Federico Maria Mongardini, Haiting Xie, Xinyi Zhou, Xiangxing Kong, Jihang Wen, Ludovico Docimo, Jun Li and Claudio Gambardella

J. Pers. Med. 2024, 14(8), 781; https://doi.org/10.3390/jpm14080781 - 23 Jul 2024

Abstract

Background: Colorectal cancer is a leading cause of cancer-related deaths worldwide, with approximately 1.9 million new cases and over 935,000 deaths in 2020. Right-sided colon cancer, a subset of colorectal cancer, represents a significant health burden. Laparoscopic colon surgery has significantly improved postoperative [...] Read more.

Background: Colorectal cancer is a leading cause of cancer-related deaths worldwide, with approximately 1.9 million new cases and over 935,000 deaths in 2020. Right-sided colon cancer, a subset of colorectal cancer, represents a significant health burden. Laparoscopic colon surgery has significantly improved postoperative recovery. The superiority of one approach or landmark over another is still argued about due to the lack of large-scale prospective studies. However, deep understanding both of the anatomical variation and characteristics of each approach is of extreme importance to minimizing adverse effects and maximizing patient benefit after laparoscopic right hemicolectomy. Among these, the cranial-to-caudal approach offers advantages such as reduced intraoperative blood loss, shorter operation time, and decreased risk of vascular injury. The purpose of this study is to compare the efficacy and safety of two cranial-to-caudal approaches for laparoscopic right hemicolectomy (LRH). Specifically, the study aims to evaluate the differences between the conventional cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). The goal is to determine which method offers superior outcomes in terms of intraoperative blood loss, operation time, and overall patient recovery. Materials and Methods: This single-center retrospective study compared two cranial-to-caudal approaches for LRH. The study included 51 patients who underwent LRH between January 2021 and November 2023 at the Second Affiliated Hospital, Zhejiang University School of Medicine. Patients were divided into two groups: Group A (26 patients) used the cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and Group B (25 patients) used the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). General characteristics, intraoperative parameters, and postoperative outcomes were compared. Statistical analysis was performed using SPSS version 20.0, with significance set at p < 0.05. Results: There were no significant differences between the groups regarding age, gender, tumor location, or clinical staging. All patients achieved R0 resection with no perioperative deaths. The CC-plus group had significantly reduced intraoperative blood loss and shorter operation time compared to the CC group (p < 0.05). No significant differences were found in first postoperative exhausting time, first postoperative defecation time, and postoperative hospital stay between the two groups. Furthermore, no significant differences were evaluated in postoperative complications (surgical site infection (SSI), ileus or bowel obstruction, refractory diarrhea, anastomotic leakage, deep vein thrombosis (DVT), hemorrhage) between the two groups on a median follow up of 12.6 months. Pathological examination showed no significant differences in total lymph nodes dissected and tumor stage. Conclusions: The cranial-to-caudal approach with MCV ligation via the cranial approach (CC-plus) is a safe and effective method for LRH, offering advantages in terms of reduced operation time and intraoperative blood loss. This study’s findings suggest that the CC-plus approach may be superior to the conventional cranial-to-caudal approach. Full article

(This article belongs to the Special Issue Future Perspectives of Surgical Techniques for Cancers: Towards Personalized Medicine)

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18 pages, 1307 KiB

Open AccessReview

Ocular Implications of COVID-19 Infection and Vaccine-Related Adverse Events

by Uday Pratap Singh Parmar, Pier Luigi Surico, Rohan Bir Singh, Mutali Musa, Anna Scarabosio, Giorgio Surico, Antonino Maniaci, Salvatore Lavalle, Fabiana D’Esposito, Antonio Longo, Andrea Russo, Caterina Gagliano and Marco Zeppieri

J. Pers. Med. 2024, 14(8), 780; https://doi.org/10.3390/jpm14080780 - 23 Jul 2024

Abstract

The COVID-19 pandemic, caused by SARS-CoV-2, has significantly impacted various organ systems, including the eyes. Initially considered a primarily respiratory disease, it is now evident that COVID-19 can induce a range of ocular symptoms. Recognizing these ocular manifestations is crucial for eye care [...] Read more.

The COVID-19 pandemic, caused by SARS-CoV-2, has significantly impacted various organ systems, including the eyes. Initially considered a primarily respiratory disease, it is now evident that COVID-19 can induce a range of ocular symptoms. Recognizing these ocular manifestations is crucial for eye care practitioners as they can serve as early indicators of the disease. This review consolidates current evidence on the ocular effects of COVID-19, identifying manifestations such as conjunctivitis, scleritis, uveitis, and retinopathy. The increasing prevalence of these symptoms highlights the importance of thorough eye examinations and detailed patient histories in COVID-19 cases. Potential routes of viral entry into ocular tissues and the underlying mechanisms, including direct infection, immune responses, and vascular involvement, are explored. Additionally, this review addresses ocular side effects associated with COVID-19 vaccines, such as corneal graft rejection, uveitis, and retinal issues. These findings emphasize the need for ongoing surveillance and research to ensure vaccine safety. Full article

(This article belongs to the Section Mechanisms of Diseases)

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13 pages, 977 KiB

Open AccessPerspective

Recruitment-Potential-Oriented Mechanical Ventilation Protocol and Narrative Review for Patients with Acute Respiratory Distress Syndrome

by Chieh-Jen Wang, I-Ting Wang, Chao-Hsien Chen, Yen-Hsiang Tang, Hsin-Wei Lin, Chang-Yi Lin and Chien-Liang Wu

J. Pers. Med. 2024, 14(8), 779; https://doi.org/10.3390/jpm14080779 - 23 Jul 2024

Abstract

Even though much progress has been made to improve clinical outcomes, acute respiratory distress syndrome (ARDS) remains a significant cause of acute respiratory failure. Protective mechanical ventilation is the backbone of supportive care for these patients; however, there are still many unresolved issues [...] Read more.

Even though much progress has been made to improve clinical outcomes, acute respiratory distress syndrome (ARDS) remains a significant cause of acute respiratory failure. Protective mechanical ventilation is the backbone of supportive care for these patients; however, there are still many unresolved issues in its setting. The primary goal of mechanical ventilation is to improve oxygenation and ventilation. The use of positive pressure, especially positive end-expiratory pressure (PEEP), is mandatory in this approach. However, PEEP is a double-edged sword. How to safely set positive end-inspiratory pressure has long been elusive to clinicians. We hereby propose a pressure–volume curve measurement-based method to assess whether injured lungs are recruitable in order to set an appropriate PEEP. For the most severe form of ARDS, extracorporeal membrane oxygenation (ECMO) is considered as the salvage therapy. However, the high level of medical resources required and associated complications make its use in patients with severe ARDS controversial. Our proposed protocol also attempts to propose how to improve patient outcomes by balancing the possible overuse of resources with minimizing patient harm due to dangerous ventilator settings. A recruitment-potential-oriented evaluation-based protocol can effectively stabilize hypoxemic conditions quickly and screen out truly serious patients. Full article

(This article belongs to the Section Personalized Critical Care)

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12 pages, 601 KiB

Open AccessReview

The Key Role of Nutritional Intervention in Delaying Disease Progression and the Therapeutic Management of Diabetic Kidney Disease—A Challenge for Physicians and Patients

by Ileana Peride, Miruna Anastasiu, Silvia Alexandra Serban, Mirela Tiglis, Razvan Ene, Ana-Maria Nechita, Tiberiu Paul Neagu, Ionel Alexandru Checherita and Andrei Niculae

J. Pers. Med. 2024, 14(8), 778; https://doi.org/10.3390/jpm14080778 - 23 Jul 2024

Abstract

Chronic kidney disease (CKD) represents an increasingly common pathology that affects patients’ quality of life, and it is frequently associated with a high mortality rate, especially in the final stages of the disease. At the same time, diabetes mellitus is a chronic disease [...] Read more.

Chronic kidney disease (CKD) represents an increasingly common pathology that affects patients’ quality of life, and it is frequently associated with a high mortality rate, especially in the final stages of the disease. At the same time, diabetes mellitus is a chronic disease that contributes to the increased number of patients with CKD through diabetic kidney disease (DKD). The alternation of hypoglycemia with hyperglycemia is a condition in the occurrence of microvascular complications of diabetes, including DKD, which involves structural and functional changes in the kidneys. The therapeutic management of diabetic nephropathy is a much-discussed topic, both from nutritional medical recommendations and a pharmacotherapy perspective. The diet starting point for patients with DKD is represented by a personalized and correct adjustment of macro- and micronutrients. The importance of nutritional status in DKD patients is given by the fact that it represents a modifiable factor, which contributes to the evolution and prognosis of the disease. Since, in most cases, it is necessary to restrict many types of food, malnutrition must be considered and avoided as much as possible. Full article

(This article belongs to the Special Issue Personalized Diagnostics, Treatment, and Outcomes of Chronic Kidney Diseases)

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14 pages, 2916 KiB

Open AccessArticle

Developing and Validating a Nomogram Model for Predicting Ischemic Stroke Risk

by Li Zhou, Youlin Wu, Jiani Wang, Haiyun Wu, Yongjun Tan, Xia Chen, Xiaosong Song, Yilin Wang and Qin Yang

J. Pers. Med. 2024, 14(7), 777; https://doi.org/10.3390/jpm14070777 - 22 Jul 2024

Abstract

Background and purpose: Clinically, the ability to identify individuals at risk of ischemic stroke remains limited. This study aimed to develop a nomogram model for predicting the risk of acute ischemic stroke. Methods: In this study, we conducted a retrospective analysis [...] Read more.

Background and purpose: Clinically, the ability to identify individuals at risk of ischemic stroke remains limited. This study aimed to develop a nomogram model for predicting the risk of acute ischemic stroke. Methods: In this study, we conducted a retrospective analysis on patients who visited the Department of Neurology, collecting important information including clinical records, demographic characteristics, and complete hematological tests. Participants were randomly divided into training and internal validation sets in a 7:3 ratio. Based on their diagnosis, patients were categorized as having or not having ischemic stroke (ischemic and non-ischemic stroke groups). Subsequently, in the training set, key predictive variables were identified through multivariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression methods, and a nomogram model was constructed accordingly. The model was then evaluated on the internal validation set and an independent external validation set through area under the receiver operating characteristic curve (AUC-ROC) analysis, a Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA) to verify its predictive efficacy and clinical applicability. Results: Eight predictors were identified: age, smoking status, hypertension, diabetes, atrial fibrillation, stroke history, white blood cell count, and vitamin B12 levels. Based on these factors, a nomogram with high predictive accuracy was constructed. The model demonstrated good predictive performance, with an AUC-ROC of 0.760 (95% confidence interval [CI]: 0.736–0.784). The AUC-ROC values for internal and external validation were 0.768 (95% CI: 0.732–0.804) and 0.732 (95% CI: 0.688–0.777), respectively, proving the model’s capability to predict the risk of ischemic stroke effectively. Calibration and DCA confirmed its clinical value. Conclusions: We constructed a nomogram based on eight variables, effectively quantifying the risk of ischemic stroke. Full article

(This article belongs to the Section Epidemiology)

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16 pages, 1665 KiB

Open AccessReview

Thyroid Eye Disease: Advancements in Orbital and Ocular Pathology Management

by Anna Scarabosio, Pier Luigi Surico, Rohan Bir Singh, Vlad Tereshenko, Mutali Musa, Fabiana D’Esposito, Andrea Russo, Antonio Longo, Caterina Gagliano, Edoardo Agosti, Etash Jhanji and Marco Zeppieri

J. Pers. Med. 2024, 14(7), 776; https://doi.org/10.3390/jpm14070776 - 22 Jul 2024

Abstract

Thyroid Eye Disease (TED) is a debilitating autoimmune condition often associated with thyroid dysfunction, leading to significant ocular and orbital morbidity. This review explores recent advancements in the management of TED, focusing on both medical and surgical innovations. The introduction of Teprotumumab, the [...] Read more.

Thyroid Eye Disease (TED) is a debilitating autoimmune condition often associated with thyroid dysfunction, leading to significant ocular and orbital morbidity. This review explores recent advancements in the management of TED, focusing on both medical and surgical innovations. The introduction of Teprotumumab, the first FDA-approved drug specifically for TED, marks a pivotal development in medical therapy. Teprotumumab targets the insulin-like growth factor-1 receptor (IGF-1R), effectively reducing inflammation and tissue remodeling. Clinical trials demonstrate its efficacy in reducing proptosis and improving quality of life, making it a cornerstone in the treatment of active, moderate-to-severe TED. Surgical management remains critical for patients with chronic TED or those unresponsive to medical therapy. Advancements in orbital decompression surgery, including image-guided and minimally invasive techniques, offer improved outcomes and reduced complications. Innovations in eyelid and strabismus surgery enhance functional and cosmetic results, further improving patient satisfaction. The management of TED necessitates a multidisciplinary approach involving endocrinologists, ophthalmologists, oculoplastic surgeons, radiologists, and other specialists. This collaborative strategy ensures comprehensive care, addressing the diverse aspects of TED from thyroid dysfunction to ocular health and psychological well-being. Future directions in TED treatment include emerging pharmacological therapies targeting different aspects of the disease’s pathophysiology and advanced surgical techniques aimed at enhancing precision and safety. This review underscores the importance of a personalized, multidisciplinary approach in managing TED, highlighting current advancements, and exploring potential future innovations to improve patient outcomes and quality of life. Full article

(This article belongs to the Special Issue New Advances in Diagnostic and Surgical Treatment of Ocular Diseases)

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16 pages, 2693 KiB

Open AccessReview

Blocking the IL-4/IL-13 Axis versus the JAK/STAT Pathway in Atopic Dermatitis: How Can We Choose?

by Laura Calabrese, Martina D’Onghia, Laura Lazzeri, Giovanni Rubegni and Elisa Cinotti

J. Pers. Med. 2024, 14(7), 775; https://doi.org/10.3390/jpm14070775 - 22 Jul 2024

Abstract

Atopic dermatitis (AD) is an immune-mediated skin disorder with a chronic-relapsing course and a multifactorial pathogenesis. In contrast to the traditional concept of AD as solely a type 2 immune-activated disease, new findings highlight the disease as highly heterogeneous, as it can be [...] Read more.

Atopic dermatitis (AD) is an immune-mediated skin disorder with a chronic-relapsing course and a multifactorial pathogenesis. In contrast to the traditional concept of AD as solely a type 2 immune-activated disease, new findings highlight the disease as highly heterogeneous, as it can be classified into variable phenotypes based on clinical/epidemiological or molecular parameters. For many years, the only therapeutic option for moderate–severe AD was traditional immunosuppressive drugs. Recently, the area of systemic therapy of AD has significantly flourished, and many new substances are now marketed, licensed, or in the last step of clinical development. Biological agents and small molecules have enriched the therapeutic armamentarium of moderate-to-severe AD, such as dupilumab, tralokinumab, lebrikizumab (monoclonal antibodies targeting the IL-4/13 pathway), abrocitinib, upadacitinib, and baricitinib (JAK inhibitors). Indeed, the AD treatment paradigm is now split into two main approaches: targeting the IL-4/13 axis or the JAK/STAT pathway. Both approaches are valid and have strong evidence of preclinical and clinical efficacy. Therefore, the choice between the two can often be difficult and represents a major challenge for dermatologists. Indeed, several important factors must be taken into account, such as the heterogeneity of AD and its classification in phenotypes, patients’ comorbidities, age, and personal preferences. The aim of our review is to provide an overview of the clinical and molecular heterogeneities of AD and to explore the factors and parameters that, in clinical practice, may help inform clinical decision-making. Full article

(This article belongs to the Special Issue Personalized Treatment and Management in Dermatology)

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