Journal of Personalized Medicine

Article

13 pages, 300 KiB

Open AccessEditor’s ChoiceArticle

Assessing Nutritional Deficiencies in Bariatric Surgery Patients: A Comparative Study of Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy

by José P. Vieira de Sousa, Hugo Santos-Sousa, Sofia Vieira, Rita Nunes, Jorge Nogueiro, André Pereira, Fernando Resende, André Costa-Pinho, John Preto, Bernardo Sousa-Pinto, Silvestre Carneiro and Eduardo Lima-da-Costa

J. Pers. Med. 2024, 14(6), 650; https://doi.org/10.3390/jpm14060650 - 18 Jun 2024

Cited by 11 | Viewed by 4663

Abstract

Obesity is a worldwide epidemic, and bariatric surgery is considered the primary treatment for long-term weight loss and managing obesity-related health issues. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed procedures. Nutritional deficiencies are a significant concern following bariatric [...] Read more.

Obesity is a worldwide epidemic, and bariatric surgery is considered the primary treatment for long-term weight loss and managing obesity-related health issues. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed procedures. Nutritional deficiencies are a significant concern following bariatric surgery and can have serious consequences. This study aims to compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. A retrospective analysis was conducted on the nutritional status of 505 consecutive patients who underwent either RYGB or SG between January and December 2019. Data were collected regarding vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin, and transferrin at preoperative, 6-month, and 12-month intervals post-surgery. The RYGB group showed significantly higher excess weight loss. Vitamin B12, hemoglobin, and ferritin levels were consistently higher in the SG group throughout the study. Vitamin D deficiency was prevalent, with no significant difference between the groups. Vitamin B12 deficiency was significantly more common in the RYGB group (6 months: 17.46% vs. 4.69%, p < 0.001; 12 months: 16.74% vs. 0.93%, p < 0.001). Despite differences in their mechanisms, bariatric surgeries were associated with nutritional deficiencies. It is crucial to efficiently assess, prevent, and manage these deficiencies tailored to each surgical procedure. Full article

(This article belongs to the Special Issue New Advances and Challenges in Metabolic and Bariatric Surgery)

12 pages, 1410 KiB

Open AccessEditor’s ChoiceArticle

Comparative Analysis of Large Language Models in Emergency Plastic Surgery Decision-Making: The Role of Physical Exam Data

by Sahar Borna, Cesar A. Gomez-Cabello, Sophia M. Pressman, Syed Ali Haider and Antonio Jorge Forte

J. Pers. Med. 2024, 14(6), 612; https://doi.org/10.3390/jpm14060612 - 8 Jun 2024

Cited by 9 | Viewed by 2172

Abstract

In the U.S., diagnostic errors are common across various healthcare settings due to factors like complex procedures and multiple healthcare providers, often exacerbated by inadequate initial evaluations. This study explores the role of Large Language Models (LLMs), specifically OpenAI’s ChatGPT-4 and Google Gemini, [...] Read more.

In the U.S., diagnostic errors are common across various healthcare settings due to factors like complex procedures and multiple healthcare providers, often exacerbated by inadequate initial evaluations. This study explores the role of Large Language Models (LLMs), specifically OpenAI’s ChatGPT-4 and Google Gemini, in improving emergency decision-making in plastic and reconstructive surgery by evaluating their effectiveness both with and without physical examination data. Thirty medical vignettes covering emergency conditions such as fractures and nerve injuries were used to assess the diagnostic and management responses of the models. These responses were evaluated by medical professionals against established clinical guidelines, using statistical analyses including the Wilcoxon rank-sum test. Results showed that ChatGPT-4 consistently outperformed Gemini in both diagnosis and management, irrespective of the presence of physical examination data, though no significant differences were noted within each model’s performance across different data scenarios. Conclusively, while ChatGPT-4 demonstrates superior accuracy and management capabilities, the addition of physical examination data, though enhancing response detail, did not significantly surpass traditional medical resources. This underscores the utility of AI in supporting clinical decision-making, particularly in scenarios with limited data, suggesting its role as a complement to, rather than a replacement for, comprehensive clinical evaluation and expertise. Full article

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

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13 pages, 251 KiB

Open AccessEditor’s ChoiceArticle

Exploring Inflammatory Parameters in Lung Cancer Patients: A Retrospective Analysis

by Catalin Vladut Ionut Feier, Calin Muntean, Alaviana Monique Faur, Vasile Gaborean, Ioan Adrian Petrache and Gabriel Veniamin Cozma

J. Pers. Med. 2024, 14(6), 552; https://doi.org/10.3390/jpm14060552 - 22 May 2024

Cited by 9 | Viewed by 1795

Abstract

Inflammation-related parameters serve as pivotal indicators in the prognosis and management of lung cancer. This retrospective investigation aimed to explore the relationship between inflammatory markers and diverse clinical variables in non-small-cell lung cancer patients. A cohort of 187 individuals undergoing elective lobectomy for [...] Read more.

Inflammation-related parameters serve as pivotal indicators in the prognosis and management of lung cancer. This retrospective investigation aimed to explore the relationship between inflammatory markers and diverse clinical variables in non-small-cell lung cancer patients. A cohort of 187 individuals undergoing elective lobectomy for lung cancer was retrospectively analyzed, spanning an 11-year data collection period. Six inflammation ratios derived from complete peripheral blood counts were assessed. Significantly elevated levels of neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), platelet-to-lymphocyte ratio (PLR) (p = 0.001), Aggregate Index of Systemic Inflammation (AISI) (p = 0.015), Systemic Inflammation Response Index (SIRI) (p = 0.004), and Systemic Immune Inflammation Index (SII) (p = 0.004) were observed in patients with advanced T stages. Significantly, elevated values (p < 0.05) of these parameters were observed in the study’s smoker patients compared to non-smokers. A statistically significant correlation was identified between the NLR parameter and tumor size (p = 0.07, r = 0.204), alongside a significant elevation in SIRI (p = 0.041) among patients experiencing postoperative complications. Inflammatory biomarkers emerge as invaluable prognostic indicators for patients with non-small-cell lung cancer, offering potential utility in forecasting their prognosis. Full article

(This article belongs to the Special Issue Respiratory Health and Chronic Disease Management)

13 pages, 2579 KiB

Open AccessEditor’s ChoiceArticle

Ellipsoid Zone Integrity and Visual Function in Dry Age-Related Macular Degeneration

by Sari Yordi, Yavuz Cakir, Gagan Kalra, Hasan Cetin, Ming Hu, Joseph Abraham, Jamie Reese, Sunil K. Srivastava and Justis P. Ehlers

J. Pers. Med. 2024, 14(5), 543; https://doi.org/10.3390/jpm14050543 - 19 May 2024

Cited by 13 | Viewed by 2666

Abstract

In this longitudinal retrospective image analysis, conducted on patients diagnosed with dry age-related macular degeneration (AMD) and 5 years of follow-up imaging data, the study aimed to investigate the relationship between ellipsoid zone (EZ) integrity on spectral domain optical coherence tomography (SD-OCT) and [...] Read more.

In this longitudinal retrospective image analysis, conducted on patients diagnosed with dry age-related macular degeneration (AMD) and 5 years of follow-up imaging data, the study aimed to investigate the relationship between ellipsoid zone (EZ) integrity on spectral domain optical coherence tomography (SD-OCT) and visual acuity (VA). Using a machine learning-enabled feature extraction tool, quantitative EZ parameters were derived from SD-OCT images. The analysis revealed significant correlations between EZ integrity metrics and VA. Eyes with excellent VA (≥20/25 Snellen) exhibited higher EZ integrity, including less EZ attenuation, thicker ellipsoid zone-retinal pigment epithelium (EZ-RPE) thickness, and higher EZ intensity, in contrast to eyes with worse VA (≤20/40 Snellen). Additionally, eyes with geographic atrophy (GA) in the foveal region displayed compromised EZ integrity compared to those without GA. Notably, baseline EZ integrity metrics were predictive of future VA loss. These findings suggest that quantitative SD-OCT measurements of EZ integrity could potentially detect early changes in dry AMD and serve as valuable indicators for predicting future functional outcomes. Furthermore, these measurements hold promise for use in clinical trial screenings, offering insights into the progression of the disease and its impact on visual acuity. This study underscores the importance of EZ integrity assessment in understanding and managing dry AMD. Full article

(This article belongs to the Section Disease Biomarker)

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13 pages, 3416 KiB

Open AccessEditor’s ChoiceArticle

Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up

by Neculai Onică, Dana Gabriela Budală, Elena-Raluca Baciu, Cezara Andreea Onică, Gabriela Luminița Gelețu, Alice Murariu, Mihail Balan, Mihaela Pertea and Carmen Stelea

J. Pers. Med. 2024, 14(5), 541; https://doi.org/10.3390/jpm14050541 - 18 May 2024

Cited by 15 | Viewed by 3980

Abstract

As an alternative to regenerative therapies, numerous authors have recently proposed bringing back subperiosteal implants. The aim of the study was to present our clinical experience with a subperiosteal jaw implant that needs minimal bone preparation and enables the rapid implantation of prosthetic [...] Read more.

As an alternative to regenerative therapies, numerous authors have recently proposed bringing back subperiosteal implants. The aim of the study was to present our clinical experience with a subperiosteal jaw implant that needs minimal bone preparation and enables the rapid implantation of prosthetic teeth in edentulous, atrophic alveolar bone. The research included 36 complete or partial edentulous patients (61 subperiostal implants) over a period of 6 years. To create the patient-specific subperiostal implants design, DentalCAD 3.0 Galway software (exocad GmbH, Darmstadt, Germany) was used and fabricated with a Mysint 100 (Sisma S.p.A., Piovene Rocchette, Italy) by titanium alloy powder. The results showed that only 9 of the 36 cases were successful at 6-year follow-up, while 27 cases had complications, including exposure of the metal frame (early or delayed), mobility of the device prior to the first 4–6 months, and late mobility due to recurrent infections and progressive structure exposure; 1 case failed for reasons unrelated to the device. This study indicated that the prudent application of fully customized subperiosteal jaw implants is a dependable alternative for the dental rehabilitation of atrophic edentulous cases that necessitate bone grafts for traditional fixed dental implant solutions. Full article

(This article belongs to the Special Issue New Updates in Oral and Maxillofacial Surgery)

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12 pages, 1486 KiB

Open AccessEditor’s ChoiceArticle

Assessment of the Quality and Readability of Information Provided by ChatGPT in Relation to the Use of Platelet-Rich Plasma Therapy for Osteoarthritis

by Stephen Fahy, Marcel Niemann, Peter Böhm, Tobias Winkler and Stephan Oehme

J. Pers. Med. 2024, 14(5), 495; https://doi.org/10.3390/jpm14050495 - 8 May 2024

Cited by 8 | Viewed by 2235

Abstract

Objective: This study aimed to evaluate the quality and readability of information generated by ChatGPT versions 3.5 and 4 concerning platelet-rich plasma (PRP) therapy in the management of knee osteoarthritis (OA), exploring whether large language models (LLMs) could play a significant role [...] Read more.

Objective: This study aimed to evaluate the quality and readability of information generated by ChatGPT versions 3.5 and 4 concerning platelet-rich plasma (PRP) therapy in the management of knee osteoarthritis (OA), exploring whether large language models (LLMs) could play a significant role in patient education. Design: A total of 23 common patient queries regarding the role of PRP therapy in knee OA management were presented to ChatGPT versions 3.5 and 4. The quality of the responses was assessed using the DISCERN criteria, and readability was evaluated using six established assessment tools. Results: Both ChatGPT versions 3.5 and 4 produced moderate quality information. The quality of information provided by ChatGPT version 4 was significantly better than version 3.5, with mean DISCERN scores of 48.74 and 44.59, respectively. Both models scored highly with respect to response relevance and had a consistent emphasis on the importance of shared decision making. However, both versions produced content significantly above the recommended 8th grade reading level for patient education materials (PEMs), with mean reading grade levels (RGLs) of 17.18 for ChatGPT version 3.5 and 16.36 for ChatGPT version 4, indicating a potential barrier to their utility in patient education. Conclusions: While ChatGPT versions 3.5 and 4 both demonstrated the capability to generate information of moderate quality regarding the role of PRP therapy for knee OA, the readability of the content remains a significant barrier to widespread usage, exceeding the recommended reading levels for PEMs. Although ChatGPT version 4 showed improvements in quality and source citation, future iterations must focus on producing more accessible content to serve as a viable resource in patient education. Collaboration between healthcare providers, patient organizations, and AI developers is crucial to ensure the generation of high quality, peer reviewed, and easily understandable information that supports informed healthcare decisions. Full article

(This article belongs to the Special Issue Personalized Medicine in Orthopaedics, 2nd Edition)

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37 pages, 6817 KiB

Open AccessEditor’s ChoiceArticle

A Multidisciplinary Hyper-Modeling Scheme in Personalized In Silico Oncology: Coupling Cell Kinetics with Metabolism, Signaling Networks, and Biomechanics as Plug-In Component Models of a Cancer Digital Twin

by Eleni Kolokotroni, Daniel Abler, Alokendra Ghosh, Eleftheria Tzamali, James Grogan, Eleni Georgiadi, Philippe Büchler, Ravi Radhakrishnan, Helen Byrne, Vangelis Sakkalis, Katerina Nikiforaki, Ioannis Karatzanis, Nigel J. B. McFarlane, Djibril Kaba, Feng Dong, Rainer M. Bohle, Eckart Meese, Norbert Graf and Georgios Stamatakos

J. Pers. Med. 2024, 14(5), 475; https://doi.org/10.3390/jpm14050475 - 29 Apr 2024

Cited by 8 | Viewed by 3156

Abstract

The massive amount of human biological, imaging, and clinical data produced by multiple and diverse sources necessitates integrative modeling approaches able to summarize all this information into answers to specific clinical questions. In this paper, we present a hypermodeling scheme able to combine [...] Read more.

The massive amount of human biological, imaging, and clinical data produced by multiple and diverse sources necessitates integrative modeling approaches able to summarize all this information into answers to specific clinical questions. In this paper, we present a hypermodeling scheme able to combine models of diverse cancer aspects regardless of their underlying method or scale. Describing tissue-scale cancer cell proliferation, biomechanical tumor growth, nutrient transport, genomic-scale aberrant cancer cell metabolism, and cell-signaling pathways that regulate the cellular response to therapy, the hypermodel integrates mutation, miRNA expression, imaging, and clinical data. The constituting hypomodels, as well as their orchestration and links, are described. Two specific cancer types, Wilms tumor (nephroblastoma) and non-small cell lung cancer, are addressed as proof-of-concept study cases. Personalized simulations of the actual anatomy of a patient have been conducted. The hypermodel has also been applied to predict tumor control after radiotherapy and the relationship between tumor proliferative activity and response to neoadjuvant chemotherapy. Our innovative hypermodel holds promise as a digital twin-based clinical decision support system and as the core of future in silico trial platforms, although additional retrospective adaptation and validation are necessary. Full article

(This article belongs to the Special Issue Mathematical Models of Personalized Medicine)

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16 pages, 3036 KiB

Open AccessEditor’s ChoiceArticle

Protection against Oxidative Stress by Coenzyme Q10 in a Porcine Retinal Degeneration Model

by Leonie Deppe, Ana M. Mueller-Buehl, Teresa Tsai, Carl Erb, H. Burkhard Dick and Stephanie C. Joachim

J. Pers. Med. 2024, 14(4), 437; https://doi.org/10.3390/jpm14040437 - 22 Apr 2024

Cited by 4 | Viewed by 2163

Abstract

Oxidative stress plays an important role in neurodegenerative diseases, including glaucoma. Therefore, we analyzed if the antioxidant coenzyme Q10 (CoQ10), which is also commercially available, can prevent retinal degeneration induced by hydrogen peroxide (H₂O₂) in a porcine organ culture [...] Read more.

Oxidative stress plays an important role in neurodegenerative diseases, including glaucoma. Therefore, we analyzed if the antioxidant coenzyme Q10 (CoQ10), which is also commercially available, can prevent retinal degeneration induced by hydrogen peroxide (H₂O₂) in a porcine organ culture model. Retinal explants were cultivated for eight days, and H₂O₂ (500 µM, 3 h) induced the oxidative damage. CoQ10 therapy was applied (700 µM, 48 h). Retinal ganglion cells (RGCs) and microglia were examined immunohistologically in all groups (control, H₂O₂, H₂O₂ + CoQ10). Cellular, oxidative, and inflammatory genes were quantified via RT-qPCR. Strong RGC loss was observed with H₂O₂ (p ≤ 0.001). CoQ10 elicited RGC protection compared to the damaged group at a histological (p ≤ 0.001) and mRNA level. We detected more microglia cells with H₂O₂, but CoQ10 reduced this effect (p = 0.004). Cellular protection genes (NRF2) against oxidative stress were stimulated by CoQ10 (p ≤ 0.001). Furthermore, mitochondrial oxidative stress (SOD2) increased through H₂O₂ (p = 0.038), and CoQ10 reduced it to control level. Our novel results indicate neuroprotection via CoQ10 in porcine retina organ cultures. In particular, CoQ10 appears to protect RGCs by potentially inhibiting apoptosis-related pathways, activating intracellular protection and reducing mitochondrial stress. Full article

(This article belongs to the Special Issue Glaucoma Management in the Era of Personalized Medicine)

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12 pages, 643 KiB

Open AccessEditor’s ChoiceArticle

Longterm Outcome of Therapeutic Vaccination with a Third Generation Pre-S/S HBV Vaccine (PreHevbrio^R) of Chronically HBV Infected Patients

by Hedwig Roggendorf, Daniel Shouval, Michael Roggendorf and Guido Gerken

J. Pers. Med. 2024, 14(4), 364; https://doi.org/10.3390/jpm14040364 - 29 Mar 2024

Cited by 5 | Viewed by 1638

Abstract

Several antiviral treatment regimens for chronic hepatitis B (CHB) virus infection have been shown to be effective in suppressing viral load and reducing the risk of hepatocellular injury and its complications. It has been hypothesized that high levels of circulating HBV surface antigen(s) [...] Read more.

Several antiviral treatment regimens for chronic hepatitis B (CHB) virus infection have been shown to be effective in suppressing viral load and reducing the risk of hepatocellular injury and its complications. It has been hypothesized that high levels of circulating HBV surface antigen(s) may lead to immune tolerance against HBV and contribute to chronic carriership. Conversely, low-level HBsAg may create a window for the reconstitution of an HBV-specific immune response through vaccination and control of infection. Previous studies in non-responders to yeast-derived HBV vaccines, using a third-generation pre-S/S vaccine, have led to up to 95% anti-HBs seroconversion. This report evaluates the long-term outcome after experimental vaccination with a pre-S/S HBV vaccine intended as a therapeutic intervention in chronic HBV carriers. Four low-level HBsAg carriers (<500 IU/mL) were vaccinated three to seven times with 20 μg PreHevbrio^R. Three out of four carriers eliminated HBsAg completely and seroconverted to anti-HBs. One patient seroconverted to anti-HBs but remained with a borderline HBsAg titer (10 IU/mL). Serum anti-HBs levels following repeated vaccination varied between 27 and >1000 IU/L, respectively. Long-term observation (>6 years) showed that after discontinuing NUC treatment for at least two years, HBsAg and HBV DNA remained negative with anti-HBs positive titers ranging between 80 and >1000 IU/L. Based on our preliminary observations, there is a rationale to further evaluate the role of this vaccine as a therapeutic agent. Full article

(This article belongs to the Special Issue Novel Challenges and Therapeutic Options for Liver Diseases)

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13 pages, 2880 KiB

Open AccessEditor’s ChoiceArticle

Personalized Diabetes Management with Digital Twins: A Patient-Centric Knowledge Graph Approach

by Fatemeh Sarani Rad, Rasha Hendawi, Xinyi Yang and Juan Li

J. Pers. Med. 2024, 14(4), 359; https://doi.org/10.3390/jpm14040359 - 28 Mar 2024

Cited by 13 | Viewed by 5249

Abstract

Diabetes management requires constant monitoring and individualized adjustments. This study proposes a novel approach that leverages digital twins and personal health knowledge graphs (PHKGs) to revolutionize diabetes care. Our key contribution lies in developing a real-time, patient-centric digital twin framework built on PHKGs. [...] Read more.

Diabetes management requires constant monitoring and individualized adjustments. This study proposes a novel approach that leverages digital twins and personal health knowledge graphs (PHKGs) to revolutionize diabetes care. Our key contribution lies in developing a real-time, patient-centric digital twin framework built on PHKGs. This framework integrates data from diverse sources, adhering to HL7 standards and enabling seamless information access and exchange while ensuring high levels of accuracy in data representation and health insights. PHKGs offer a flexible and efficient format that supports various applications. As new knowledge about the patient becomes available, the PHKG can be easily extended to incorporate it, enhancing the precision and accuracy of the care provided. This dynamic approach fosters continuous improvement and facilitates the development of new applications. As a proof of concept, we have demonstrated the versatility of our digital twins by applying it to different use cases in diabetes management. These include predicting glucose levels, optimizing insulin dosage, providing personalized lifestyle recommendations, and visualizing health data. By enabling real-time, patient-specific care, this research paves the way for more precise and personalized healthcare interventions, potentially improving long-term diabetes management outcomes. Full article

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

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19 pages, 1358 KiB

Open AccessEditor’s ChoiceArticle

Lowering Barriers to Health Risk Assessments in Promoting Personalized Health Management

by Hayoung Park, Se Young Jung, Min Kyu Han, Yeonhoon Jang, Yeo Rae Moon, Taewook Kim, Soo-Yong Shin and Hee Hwang

J. Pers. Med. 2024, 14(3), 316; https://doi.org/10.3390/jpm14030316 - 18 Mar 2024

Cited by 4 | Viewed by 2602

Abstract

This study investigates the feasibility of accurately predicting adverse health events without relying on costly data acquisition methods, such as laboratory tests, in the era of shifting healthcare paradigms towards community-based health promotion and personalized preventive healthcare through individual health risk assessments (HRAs). [...] Read more.

This study investigates the feasibility of accurately predicting adverse health events without relying on costly data acquisition methods, such as laboratory tests, in the era of shifting healthcare paradigms towards community-based health promotion and personalized preventive healthcare through individual health risk assessments (HRAs). We assessed the incremental predictive value of four categories of predictor variables—demographic, lifestyle and family history, personal health device, and laboratory data—organized by data acquisition costs in the prediction of the risks of mortality and five chronic diseases. Machine learning methodologies were employed to develop risk prediction models, assess their predictive performance, and determine feature importance. Using data from the National Sample Cohort of the Korean National Health Insurance Service (NHIS), which includes eligibility, medical check-up, healthcare utilization, and mortality data from 2002 to 2019, our study involved 425,148 NHIS members who underwent medical check-ups between 2009 and 2012. Models using demographic, lifestyle, family history, and personal health device data, with or without laboratory data, showed comparable performance. A feature importance analysis in models excluding laboratory data highlighted modifiable lifestyle factors, which are a superior set of variables for developing health guidelines. Our findings support the practicality of precise HRAs using demographic, lifestyle, family history, and personal health device data. This approach addresses HRA barriers, particularly for healthy individuals, by eliminating the need for costly and inconvenient laboratory data collection, advancing accessible preventive health management strategies. Full article

(This article belongs to the Special Issue Precision Medicine for Epidemiology and Public Health)

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12 pages, 553 KiB

Open AccessEditor’s ChoiceArticle

Long-Term Perspectives on Chronic Rhinosinusitis with Nasal Polyps: Evaluating Recurrence Rates after Functional Endoscopic Sinus Surgery in the Biologics Era—A 5-Year Follow-Up Study

by Carlo Cavaliere, Simonetta Masieri, Elona Begvarfaj, Antonella Loperfido, Silvia Baroncelli, Francesca Cascone and Andrea Ciofalo

J. Pers. Med. 2024, 14(3), 297; https://doi.org/10.3390/jpm14030297 - 10 Mar 2024

Cited by 10 | Viewed by 4075

Abstract

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease with multifactorial etiopathogenesis. This study investigated the recurrence rate and risk factors predicting recurrence in patients subjected to Functional Endoscopic Sinus Surgery (FESS) for CRSwNP. Methods: Patients affected by CRSwNP who underwent [...] Read more.

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease with multifactorial etiopathogenesis. This study investigated the recurrence rate and risk factors predicting recurrence in patients subjected to Functional Endoscopic Sinus Surgery (FESS) for CRSwNP. Methods: Patients affected by CRSwNP who underwent FESS between January 2015 and March 2020 were enrolled. The recurrence rate and the influence of risk factors were assessed. Results: A total of 154 patients were included, 100 males and 54 females, aged 14–82 years (mean age 51.96 ± 16.27; median 52 years). Of 154 patients, 28 presented CRSwNP recurrence in a follow-up period ranging from 6 months to 69 months, with a recurrence rate of 18.2%. The recurrence rate was higher in patients aged between 31 and 50 years and between 51 and 70 years at the time of surgery than in those aged between 14 and 30 years and over 70 years. Furthermore, most patients with recurrence were men (61%), while 39% were women. A higher recurrence rate was observed between non-smokers (50%) and ex-smokers (36%), while only 14% declared themselves habitual smokers. Only four subjects (14%) had a positive family history of CRSwNP. Conclusion: To date, no specific biomarkers have been identified in order to determine the appropriate therapy for the patients affected by CRSwNP. Based on our results, we suggest that it is necessary for an accurate assessment of the CRSwNP patients to identify which phenotype/endotype each subject manifests based on medical history, endoscopy, computed tomography, and a laboratory evaluation. Full article

(This article belongs to the Section Epidemiology)

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12 pages, 1498 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Assessment of Arterial Stiffness and Biochemical Markers in Systemic Lupus Erythematosus in the Diagnosis of Subclinical Atherosclerosis

by Dominika Blachut, Brygida Przywara-Chowaniec, Michalina Mazurkiewicz and Andrzej Tomasik

J. Pers. Med. 2024, 14(3), 289; https://doi.org/10.3390/jpm14030289 - 8 Mar 2024

Cited by 4 | Viewed by 1810

Abstract

Patients with systemic lupus erythematosus (SLE) are 2–10 times more likely to develop cardiovascular disease (CVD) than the general population. The assessment of the risk of developing CVD is an important direction for further clinical management. The study was conducted retrospectively and included [...] Read more.

Patients with systemic lupus erythematosus (SLE) are 2–10 times more likely to develop cardiovascular disease (CVD) than the general population. The assessment of the risk of developing CVD is an important direction for further clinical management. The study was conducted retrospectively and included patients with SLE. The aim of the study was to assess the measurements of pulse wave velocity (PWV), carotid intima-media thickness (CIMT), ankle–brachial index (ABI) and biochemical parameters. Subclinical atherosclerosis was also assessed. The study included 98 patients with SLE with an age- and sex-matched control group of 68 healthy adults. Statistical significance was found in the SLE group and the controls for N-terminal fragment of pro-B-type natriuretic peptide (NT proBNP) (144.87 vs. 36.41 pg/mL, p = 0.0018), high-sensitivity cardiac troponin (hs-cTn) (25.43 vs. 6.38 ng/L, p = 0.0303) and D-Dimer levels (0.73 vs. 0.36 µg/mL, p = 0.0088), left CIMT (1.03 vs. 0.62 mm, p < 0.0001), right CIMT (0.93 vs. 0.63 mm, p < 0.0001) and PWV CF (9.74 vs. 7.98 m/s, p = 0.0294). A positive correlation was found between NT proBNP and PWV CF (r = 0.6880, p = 0.0498) and hs-cTn and PVW carotid-femoral (CF) (r = 0.8862, p = 0.0499) in SLE. A positive correlation was reported between PWV CF and systolic blood pressure (r = 0.5025, p = 0.0487). The measurement of carotid–femoral PWV is a simple, non-invasive, and reproducible method and may independently predict future CVD events and their cause. Further studies are warranted to establish the prognostic value of PWV in patients with SLE, as it may be superior to CIMT measurements in the early stages of vascular disorders. Full article

(This article belongs to the Special Issue Cardiology and Vascular Health: Pathophysiology, Therapeutics and Epidemiology)

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14 pages, 3666 KiB

Open AccessEditor’s ChoiceArticle

The Interplay between Dyslipidemia and Neighboring Developments in Coronary Artery Disease Progression: A Personalized Approach

by Tomasz Urbanowicz, Krzysztof Skotak, Anna Olasińska-Wiśniewska, Krzysztof J. Filipiak, Jakub Bratkowski, Beata Krasińska, Zbigniew Krasiński, Andrzej Tykarski and Marek Jemielity

J. Pers. Med. 2024, 14(3), 237; https://doi.org/10.3390/jpm14030237 - 23 Feb 2024

Cited by 4 | Viewed by 1574

Abstract

(1) Background: Estimates suggest that up to 10% of global annual cardiovascular deaths could be related to environmental factors. Not only air pollution components, but also noise exposure and climate changes, are highlighted as nontraditional causes of cardiovascular morbidity. The aim of this [...] Read more.

(1) Background: Estimates suggest that up to 10% of global annual cardiovascular deaths could be related to environmental factors. Not only air pollution components, but also noise exposure and climate changes, are highlighted as nontraditional causes of cardiovascular morbidity. The aim of this study was to identify possible urbanization risk factors for the progression of coronary artery disease in a group of patients with chronic coronary syndrome. (2) Method: There were 77 patients (50 (65%) males and 27 (35%) females) with a median age of 70 (60–74) years who underwent repetitive angiography due to chronic coronary syndrome between 2018 and 2022. The Gensini score was calculated for assessment of coronary artery disease advancement. Environmental factors including neighboring developments were taken into account in this analysis, including housing, commercial, and industrial developments within 300, 500, and 700 m distances (buffer) from the place of habitation. (3) Results: The multivariable analysis results for prediction of Gensini score progression in relation to 700 m buffer urbanization pointed out the significance of hyperlipidemia (OR: 4.24, 95% CI 1.34–13.39, p = 0.014), initial Gensini score (OR: 1.02, 95% CI 1.00–1.05, p = 0.112), and neighborhood housing (OR: 0.03, 95% CI 0.01–0.49, p = 0.025). (4) Conclusions: Hyperlipidemia and housing neighborhood can be regarded as possible factors for coronary disease progression in patients with chronic coronary syndrome with the use of optimal medical therapy. Full article

(This article belongs to the Special Issue Advances in Personalized Medicine for Cardiovascular Care)

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31 pages, 4329 KiB

Open AccessEditor’s ChoiceArticle

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania

by Andreea-Iuliana Ionescu (Miron), Alexandra-Valentina Anghel, Ionuț-Lucian Antone-Iordache, Dimitrie-Ionuț Atasiei, Cătălin-Alexandru Anghel, Andrei-Alexandru Barnonschi, Alexandra-Maria Bobolocu, Catinca Verga, Florica Șandru and Horia-Dan Lișcu

J. Pers. Med. 2024, 14(2), 214; https://doi.org/10.3390/jpm14020214 - 16 Feb 2024

Cited by 9 | Viewed by 3660

Abstract

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 [...] Read more.

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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30 pages, 27177 KiB

Open AccessEditor’s ChoiceArticle

The Role of Cone Beam Computed Tomography in Periodontology: From 3D Models of Periodontal Defects to 3D-Printed Scaffolds

by Styliani Verykokou, Charalabos Ioannidis, Sofia Soile, Christos Angelopoulos, Konstantinos Theodoridis, Athanasios S. Arampatzis, Andreana N. Assimopoulou, Dimitrios Christofilos, Afroditi Kapourani, Ioannis Pantazos, Panagiotis Barmpalexis, Argyro-Maria Boutsi and Chryssy Potsiou

J. Pers. Med. 2024, 14(2), 207; https://doi.org/10.3390/jpm14020207 - 14 Feb 2024

Cited by 7 | Viewed by 2911

Abstract

The treatment of osseous defects around teeth is a fundamental concern within the field of periodontology. Over the years, the method of grafting has been employed to treat bone defects, underscoring the necessity for custom-designed scaffolds that precisely match the anatomical intricacies of [...] Read more.

The treatment of osseous defects around teeth is a fundamental concern within the field of periodontology. Over the years, the method of grafting has been employed to treat bone defects, underscoring the necessity for custom-designed scaffolds that precisely match the anatomical intricacies of the bone cavity to be filled, preventing the formation of gaps that could allow the regeneration of soft tissues. In order to create such a patient-specific scaffold (bone graft), it is imperative to have a highly detailed 3D representation of the bone defect, so that the resulting scaffold aligns with the ideal anatomical characteristics of the bone defect. In this context, this article implements a workflow for designing 3D models out of patient-specific tissue defects, fabricated as scaffolds with 3D-printing technology and bioabsorbable materials, for the personalized treatment of periodontitis. The workflow is based on 3D modeling of the hard tissues around the periodontal defect (alveolar bone and teeth), scanned from patients with periodontitis. Specifically, cone beam computed tomography (CBCT) data were acquired from patients and were used for the reconstruction of the 3D model of the periodontal defect. The final step encompasses the 3D printing of these scaffolds, employing Fused Deposition Modeling (FDM) technology and 3D-bioprinting, with the aim of verifying the design accuracy of the developed methodοlogy. Unlike most existing 3D-printed scaffolds reported in the literature, which are either pre-designed or have a standard structure, this method leads to the creation of highly detailed patient-specific grafts. Greater accuracy and resolution in the macroarchitecture of the scaffolds were achieved during FDM printing compared to bioprinting, with the standard FDM printing profile identified as more suitable in terms of both time and precision. It is easy to follow and has been successfully employed to create 3D models of periodontal defects and 3D-printed scaffolds for three cases of patients, proving its applicability and efficiency in designing and fabricating personalized 3D-printed bone grafts using CBCT data. Full article

(This article belongs to the Section Regenerative Medicine and Therapeutics)

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16 pages, 5398 KiB

Open AccessEditor’s ChoiceArticle

Exploring an Innovative Approach: Integrating Negative-Pressure Wound Therapy with Silver Nanoparticle Dressings in Skin Graft Procedures

by Abdalah Abu-Baker, Andrada-Elena Țigăran, Teodora Peligrad, Daniela-Elena Ion, Daniela-Elena Gheoca-Mutu, Adelaida Avino, Cristian-Sorin Hariga, Oriana Elena Moraru, Laura Răducu and Radu-Cristian Jecan

J. Pers. Med. 2024, 14(2), 206; https://doi.org/10.3390/jpm14020206 - 14 Feb 2024

Cited by 12 | Viewed by 2647

Abstract

Background: Skin grafting is a helpful instrument in a plastic surgeon’s arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation [...] Read more.

Background: Skin grafting is a helpful instrument in a plastic surgeon’s arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation of neoangiogenesis, and promotion of an anti-inflammatory environment. Silver nanoparticle dressings also bring multiple benefits by bearing an antimicrobial effect and providing a humid medium, which are favorable for epithelialization. The combination of NPWT (negative-pressure wound therapy) with AgNPs (silver nanoparticles) has not been widely studied. Materials and methods: This study aimed to compare the outcomes of silver nanoparticle sheets with the combination of negative-pressure wound therapy and silver nanoparticle dressings. We conducted a comparative prospective study on 80 patients admitted to the Plastic Surgery Department of “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital between 1st of January 2020 and 31st of December 2022. The study population was randomized to receive either silver nanoparticle dressings or negative-pressure wound therapy (NPWT) combined with silver nanoparticle dressings. Various parameters were monitored, including patient comorbidities and graft-related data such as defect etiology, graft integration, and graft size. Dressings were changed, and graft status was evaluated at 7, 10, and 14 days postoperatively. Additionally, baseline C-reactive protein (CRP) levels were measured before surgery and 7, 10, and 14 days postoperatively. Results: The study demonstrated an enhanced integration of skin grafts at all evaluation stages when employing NPWT combined with AgNPs, particularly evident 10 days post operation. Significant variations in graft integration were also observed based on factors such as diabetes, cardiovascular disease, graft size, or the origin of the grafted defect. Moreover, dynamic C-reactive protein monitoring showed a statistically significant decrease in CRP levels 10 days post operation among patients treated with NPWT in conjunction with silver dressing, consistent with the nearly complete integration of skin grafts at this evaluation threshold. Conclusion: Several factors influence the postoperative evolution of split-skin grafts. Postoperative dressings target local factors to enhance graft integration further. Our research demonstrated that the innovative combination of NPWT-assisted dressings, complemented by a silver nanoparticle sheet, resulted in improved benefits for graft integration and the alleviation of systemic inflammation. Full article

(This article belongs to the Special Issue Implications for Personalized Plastic, Aesthetic and Reconstructive Surgery)

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24 pages, 709 KiB

Open AccessEditor’s ChoiceArticle

DeepBiomarker2: Prediction of Alcohol and Substance Use Disorder Risk in Post-Traumatic Stress Disorder Patients Using Electronic Medical Records and Multiple Social Determinants of Health

by Oshin Miranda, Peihao Fan, Xiguang Qi, Haohan Wang, M. Daniel Brannock, Thomas R. Kosten, Neal David Ryan, Levent Kirisci and Lirong Wang

J. Pers. Med. 2024, 14(1), 94; https://doi.org/10.3390/jpm14010094 - 14 Jan 2024

Cited by 6 | Viewed by 2988

Abstract

Prediction of high-risk events amongst patients with mental disorders is critical for personalized interventions. We developed DeepBiomarker2 by leveraging deep learning and natural language processing to analyze lab tests, medication use, diagnosis, social determinants of health (SDoH) parameters, and psychotherapy for outcome prediction. [...] Read more.

Prediction of high-risk events amongst patients with mental disorders is critical for personalized interventions. We developed DeepBiomarker2 by leveraging deep learning and natural language processing to analyze lab tests, medication use, diagnosis, social determinants of health (SDoH) parameters, and psychotherapy for outcome prediction. To increase the model’s interpretability, we further refined our contribution analysis to identify key features by scaling with a factor from a reference feature. We applied DeepBiomarker2 to analyze the EMR data of 38,807 patients from the University of Pittsburgh Medical Center diagnosed with post-traumatic stress disorder (PTSD) to determine their risk of developing alcohol and substance use disorder (ASUD). DeepBiomarker2 predicted whether a PTSD patient would have a diagnosis of ASUD within the following 3 months with an average c-statistic (receiver operating characteristic AUC) of 0.93 and average F1 score, precision, and recall of 0.880, 0.895, and 0.866 in the test sets, respectively. Our study found that the medications clindamycin, enalapril, penicillin, valacyclovir, Xarelto/rivaroxaban, moxifloxacin, and atropine and the SDoH parameters access to psychotherapy, living in zip codes with a high normalized vegetative index, Gini index, and low-income segregation may have potential to reduce the risk of ASUDs in PTSD. In conclusion, the integration of SDoH information, coupled with the refined feature contribution analysis, empowers DeepBiomarker2 to accurately predict ASUD risk. Moreover, the model can further identify potential indicators of increased risk along with medications with beneficial effects. Full article

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

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13 pages, 2054 KiB

Open AccessEditor’s ChoiceArticle

Real-Life Effects of Omalizumab on Chronic Rhinosinusitis with Nasal Polyposis

by Nicola Lombardo, Giovanna Lucia Piazzetta, Nadia Lobello, Giuseppe Cicala, Maria Patafi, Anna Teresa Benincasa, Corrado Pelaia, Emanuela Chiarella and Girolamo Pelaia

J. Pers. Med. 2024, 14(1), 3; https://doi.org/10.3390/jpm14010003 - 19 Dec 2023

Cited by 10 | Viewed by 2751

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B [...] Read more.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the nasal and sinus mucosa. This inflammatory process is supported by a multitude of cytokines, including IL-4, IL-5, and IL-13 produced by Th2 cells, as well as by IgE produced by B lymphocytes in response to a stimulus. Omalizumab is an anti-IgE monoclonal antibody with well-recognized roles in allergic asthma and chronic spontaneous urticaria. The aim of this study was to evaluate the clinical efficacy of omalizumab in a cohort of 13 patients suffering from chronic rhinosinusitis with CRSwNP. The inclusion criteria considered were as follows: 18 years of age, with a diagnosis of chronic rhinosinusitis with severe nasal polyposis expressed by an NPS greater than or equal to 5 and/or a SNOT-22 greater than or equal to 50. In addition, in the enrolled patients, the classic treatment with corticosteroids had to have been suspended due to recurrence after surgery or lack of response. Our results highlighted that omalizumab treatment for 16 weeks improved the parameters analyzed: SNOT-22, NPS, NRS, and NCS. The clinical efficacy of omalizumab was further strengthened by a significant improvement in respiratory function as well as reductions in the nasal polyps’ size and in the associated symptoms. Full article

(This article belongs to the Special Issue Recent Advances in Diagnosis, Treatment and Observation in Otorhinolaryngology)

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15 pages, 1619 KiB

Open AccessEditor’s ChoiceArticle

Biomarkers and Strain Echocardiography for the Detection of Subclinical Cardiotoxicity in Breast Cancer Patients Receiving Anthracyclines

by Aditi A. Bhagat, Andreas P. Kalogeropoulos, Lea Baer, Matthew Lacey, Smadar Kort, Hal A. Skopicki, Javed Butler and Michelle Weisfelner Bloom

J. Pers. Med. 2023, 13(12), 1710; https://doi.org/10.3390/jpm13121710 - 14 Dec 2023

Cited by 4 | Viewed by 2112

Abstract

The optimal surveillance and management strategies for breast cancer patients receiving anthracycline therapy are limited by our incomplete understanding of the role of biomarkers heralding the onset of cardiotoxicity. The purpose of this study was to determine whether there is a temporal correlation [...] Read more.

The optimal surveillance and management strategies for breast cancer patients receiving anthracycline therapy are limited by our incomplete understanding of the role of biomarkers heralding the onset of cardiotoxicity. The purpose of this study was to determine whether there is a temporal correlation between cardiac biomarkers and subclinical left ventricular dysfunction in breast cancer patients receiving anthracycline chemotherapy. Thirty-one females between 46 and 55 years old with breast cancer treated with anthracycline chemotherapy were prospectively enrolled. Cardiac biomarkers were correlated with echocardiography with speckle tracking at baseline, post-anthracycline therapy, and 6 months post-anthracycline chemotherapy. Subclinical cardiotoxicity was defined as

\geq

10% reduction in global longitudinal strain (GLS). There was a relative reduction in left ventricular ejection fraction (LVEF)

\geq

10% in 5/30 (17%) and 7/27 (26%) patients post-anthracycline therapy and 6 months post-anthracycline therapy, respectively. Subclinical cardiotoxicity was noted in 8/30 (27%) and 10/26 (38%) patients post-anthracycline and 6 months post-anthracycline therapy, respectively. Baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) was the strongest predictor of LVEF (ρ = −0.45; p = 0.019), with post-therapy NT-proBNP values illustrating similar predictive value (ρ = −0.40; p = 0.038). Interim changes in suppression of tumorigenicity 2 (ST2) and galectin-3 correlated with a 6-month change in LVEF (ρ = −0.48; p = 0.012 and ρ = −0.45; p = 0.018, for ST2 and galectin-3, respectively). Changes in galectin-3 from baseline to mid-therapy paralleled changes in GLS. NT-proBNP, ST2, and galectin-3 correlate with reduced LVEF among breast cancer patients receiving anthracycline therapy. Additional trials focusing on a cardiac biomarker approach may provide guidance in the early diagnosis and management of anthracycline-induced cardiotoxicity. Full article

(This article belongs to the Section Disease Biomarker)

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12 pages, 1083 KiB

Open AccessEditor’s ChoiceArticle

The Role of the Cumulative Illness Rating Scale (CIRS) in Estimating the Impact of Comorbidities on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: A Pilot Study of the MACH (Multidimensional Approach for COPD and High Complexity) Study

by Domenico Di Raimondo, Edoardo Pirera, Chiara Pintus, Riccardo De Rosa, Martina Profita, Gaia Musiari, Gherardo Siscaro and Antonino Tuttolomondo

J. Pers. Med. 2023, 13(12), 1674; https://doi.org/10.3390/jpm13121674 - 30 Nov 2023

Cited by 6 | Viewed by 3418

Abstract

Background. Chronic obstructive pulmonary disease (COPD) is a heterogeneous systemic syndrome that often coexists with multiple comorbidities. In highly complex COPD patients, the role of the Cumulative Illness Rating Scale (CIRS) as a risk predictor of COPD exacerbation is not known. Objective. The [...] Read more.

Background. Chronic obstructive pulmonary disease (COPD) is a heterogeneous systemic syndrome that often coexists with multiple comorbidities. In highly complex COPD patients, the role of the Cumulative Illness Rating Scale (CIRS) as a risk predictor of COPD exacerbation is not known. Objective. The objective of this study was determine the effectiveness of the CIRS score in detecting the association of comorbidities and disease severity with the risk of acute exacerbations in COPD patients. Methods. In total, 105 adults with COPD (mean age 72.1 ± 9.0 years) were included in this prospective study. All participants at baseline had at least two moderate exacerbations or one leading to hospitalization. The primary outcome was a composite of moderate or severe COPD exacerbation during the 12 months of follow-up. Results. The CIRS indices (CIRS total score, Severity Index and Comorbidity Index) showed a positive correlation with modified Medical Research Council (mMRC), COPD assessment test (CAT) and a negative correlation with forced expiratory volume in the first second (FEV₁), Forced Vital Capacity (FVC), and FEV₁/FVC. The three CIRS indices were able to predict the 12-month rate of moderate or severe exacerbation (CIRS Total Score: Hazard Ratio (HR) = 1.12 (95% CI: 1.08–1.21); CIRS Severity Index: HR = 1.21 (95% CI: 1.12–1.31); CIRS Comorbidity Index = 1.58 (95% CI: 1.33–1.89)). Conclusions. Among patients with COPD, the comorbidity number and severity, as assessed by the CIRS score, influence the risk in moderate-to-severe exacerbations. The CIRS score also correlates with the severity of respiratory symptoms and lung function. Full article

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

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12 pages, 2553 KiB

Open AccessEditor’s ChoiceArticle

Use of Autologous Bone Graft with Bioactive Glass as a Bone Substitute in the Treatment of Large-Sized Bone Defects of the Femur and Tibia

by Sebastian Findeisen, Niklas Gräfe, Melanie Schwilk, Thomas Ferbert, Lars Helbig, Patrick Haubruck, Gerhard Schmidmaier and Michael Tanner

J. Pers. Med. 2023, 13(12), 1644; https://doi.org/10.3390/jpm13121644 - 24 Nov 2023

Cited by 4 | Viewed by 2093

Abstract

Background: Managing bone defects in non-union surgery remains challenging, especially in cases of large defects exceeding 5 cm in size. Historically, amputation and compound osteosynthesis with a remaining PMMA spacer have been viable and commonly used options. The risk of non-union after fractures [...] Read more.

Background: Managing bone defects in non-union surgery remains challenging, especially in cases of large defects exceeding 5 cm in size. Historically, amputation and compound osteosynthesis with a remaining PMMA spacer have been viable and commonly used options. The risk of non-union after fractures varies between 2% and 30% and is dependent on various factors. Autologous bone grafts from the iliac crest are still considered the gold standard but are limited in availability, prompting consideration of artificial grafts. Objectives: The aims and objectives of the study are as follows: 1. To evaluate the radiological outcome of e.g., the consolidation and thus the stability of the bone (three out of four consolidated cortices/Lane-Sandhu-score of at least 3) by using S53P4-type bioactive glass (BaG) as a substitute material for large-sized bone defects in combination with autologous bone using the RIA technique. 2. To determine noticeable data-points as a base for future studies. Methods: In our clinic, 13 patients received bioactive glass (BaG) as a substitute in non-union therapy to promote osteoconductive aspects. BaG is a synthetic material composed of sodium, silicate, calcium, and phosphate. The primary endpoint of our study was to evaluate the radiological consolidation of bone after one and two years. To assess bone stabilization, we used a modified Lane-Sandhu score, considering only radiological criteria. A bone was considered stabilized if it achieved a minimum score of 3. For full consolidation (all four cortices consolidated), a minimum score of 4 was required. Each bone defect exceeded 5 cm in length, with an average size of 6.69 ± 1.92 cm. Results: The mean follow-up period for patients without final bone consolidation was 34.25 months, with a standard deviation of 14.57 months, a median of 32.00 months and a range of 33 months. In contrast, patients with a fully consolidated non-union had an average follow-up of 20.11 ± 15.69 months and a range of 45 months. Overall, the mean time from non-union surgery to consolidation for patients who achieved final union was 14.91 ± 6.70 months. After one year, six patients (46.2%) achieved complete bone consolidation according to the Lane-Sandhu score. Three patients (23.1%) displayed evident callus formation with expected stability, while three patients (23.1%) did not develop any callus, and one patient only formed a minimal callus with no expected stability. After two years, 9 out of 13 patients (69.2%) had a score of 4. The remaining four patients (30.8%) without expected stability either did not heal within two years or required a revision during that time. Conclusions: Bioactive glass (BaG) in combination with autologous bone (RIA) appears to be a suitable filler material for treating extensive non-unions of the femur and tibia. This approach seems to show non-inferiority to treatment with Tricalcium Phosphate (TCP). To ensure the success of this treatment, it is crucial to validate the procedure through a randomized controlled trial (RCT) with a control group using TCP, which would provide higher statistical power and more reliable results. Full article

(This article belongs to the Special Issue New Concepts in Musculoskeletal Medicine)

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12 pages, 1783 KiB

Open AccessEditor’s ChoiceArticle

Cemiplimab as First Line Therapy in Advanced Penile Squamous Cell Carcinoma: A Real-World Experience

by Keren Rouvinov, Gal Mazor, Ella Kozlener, Amichay Meirovitz, Noa Shani Shrem, Omar Abu Saleh, Sondos Shalata, Alexander Yakobson and Walid Shalata

J. Pers. Med. 2023, 13(11), 1623; https://doi.org/10.3390/jpm13111623 - 20 Nov 2023

Cited by 9 | Viewed by 2230

Abstract

In the treatment of cancer, immune checkpoint inhibitors (ICIs) have demonstrated significantly greater effectiveness compared to conventional cytotoxic or platinum-based chemotherapies. To assess the efficacy of ICI’s in penile squamous cell carcinoma (pSCC) we performed a retrospective observational study. We reviewed electronic medical [...] Read more.

In the treatment of cancer, immune checkpoint inhibitors (ICIs) have demonstrated significantly greater effectiveness compared to conventional cytotoxic or platinum-based chemotherapies. To assess the efficacy of ICI’s in penile squamous cell carcinoma (pSCC) we performed a retrospective observational study. We reviewed electronic medical records of patients with penile squamous cell carcinoma (SCC), diagnosed between January 2020 and February 2023. Nine patients were screened, of whom three were ineligible for chemotherapy and received immunotherapy, cemiplimab, in a first-line setting. Each of the three immunotherapy-treated patients achieved almost a complete response (CR) after only a few cycles of therapy. The first patient had cerebral arteritis during treatment and received a high-dose steroid treatment with resolution of the symptoms of arteritis. After tapering down the steroids dose, the patient continued cemiplimab without further toxicity. The other two patients did not have any toxic side effects of the treatment. To the best of our knowledge, this is the first real world report of near CR with cemiplimab as a first-line treatment in penile SCC. Full article

(This article belongs to the Special Issue Targeted Immunotherapy in Cancer)

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12 pages, 1569 KiB

Open AccessEditor’s ChoiceArticle

Analysis of Effect of Intensity of Aerobic Exercise on Cognitive and Motor Functions and Neurotrophic Factor Expression Patterns in an Alzheimer’s Disease Rat Model

by Do-Youn Lee, Sang-Cheol Im, Na-Yeon Kang and Kyoung Kim

J. Pers. Med. 2023, 13(11), 1622; https://doi.org/10.3390/jpm13111622 - 20 Nov 2023

Cited by 5 | Viewed by 2600

Abstract

The effect of aerobic exercise at different intensities on Alzheimer’s disease (AD) still remains unclear. We investigated the effect of aerobic exercise at different intensities on cognitive and motor functions and neurotrophic factor expression. Thirty-two AD-induced rats were randomly assigned to control (CG), [...] Read more.

The effect of aerobic exercise at different intensities on Alzheimer’s disease (AD) still remains unclear. We investigated the effect of aerobic exercise at different intensities on cognitive and motor functions and neurotrophic factor expression. Thirty-two AD-induced rats were randomly assigned to control (CG), low-intensity (Group I), medium-intensity (Group II), and high-intensity (Group III) exercise groups. Each group, except for the CG, performed aerobic exercise for 20 min a day five times a week. After performing aerobic exercise for 4 weeks, their cognitive and motor functions and neurotrophic factor expression patterns were analyzed and compared between the groups. All variables of cognitive and motor functions and neurotrophic factor expression were significantly improved in Groups I, II, and III compared to those in the CG (p < 0.05). Among the neurotrophic factors, brain-derived neurotrophic factor (BDNF) expression was significantly improved in Group III compared to that in Groups I and II (p < 0.05). In the intra-group comparison of cognitive and motor functions, no significant difference was observed in CG, but the aerobic exercise groups showed improvements. Only Group III showed a significant improvement in the time it took to find eight food items accurately (p < 0.05). Aerobic exercise improved the cognitive and motor functions and neurotrophic factor expression patterns in the AD-induced rat model, with high-intensity aerobic exercise having greater effects on cognitive function and BDNF expression. Full article

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

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13 pages, 1155 KiB

Open AccessEditor’s ChoiceArticle

Efficacy of Low-Level Laser Therapy for Oral Mucositis in Hematologic Patients Undergoing Transplantation: A Single-Arm Prospective Study

by Hiromi Nishi, Susumu Horikoshi, Kouji Ohta, Tetsumi Yoshida, Noriyasu Fukushima, Kyoko Oshita, Syuichi Munenaga, Taro Edahiro, Hiroshi Ureshino, Hideo Shigeishi, Yukio Yoshioka, Masaru Konishi, Noriaki Ide, Yuma Ogawa, Rikou Marukawa, Tomoaki Shintani, Natumi Ino, Mikihito Kajiya, Naoya Kakimoto, Hiroki Ohge, Tatsuo Ichinohe and Hiroyuki Kawaguchi Show full author list Hide full author list

J. Pers. Med. 2023, 13(11), 1603; https://doi.org/10.3390/jpm13111603 - 13 Nov 2023

Cited by 5 | Viewed by 2696

Abstract

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill [...] Read more.

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill this gap by evaluating the safety and efficacy of LLLT in a Japanese patient population. In a single-group, non-blinded, exploratory trial, we compared 21 LLLT-treated patients against a historical control of 96 patients. The primary endpoint was the incidence of Grade ≥ 2 mucositis, based on NCI-CTCAE ver. 4.0. The LLLT group showed a significantly lower incidence of Grade ≥ 2 mucositis (23.8%) compared to the control group (64.6%) (p = 0.0006). Furthermore, Grade ≥ 2 mucositis correlated with increased oral dryness and longer hospital stays. Our study confirms the efficacy of LLLT in reducing the onset of severe oral mucositis among Japanese hematologic cancer patients, advocating for its clinical introduction as a preventive measure in Japan. Full article

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

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11 pages, 2285 KiB

Open AccessEditor’s ChoiceArticle

Exploring the Association Linking Head Position and Sleep Architecture to Motor Impairment in Parkinson’s Disease: An Exploratory Study

by Oriella Gnarra, Carmen Calvello, Tommaso Schirinzi, Francesca Beozzo, Claudia De Masi, Matteo Spanetta, Mariana Fernandes, Piergiorgio Grillo, Rocco Cerroni, Mariangela Pierantozzi, Claudio L. A. Bassetti, Nicola Biagio Mercuri, Alessandro Stefani and Claudio Liguori

J. Pers. Med. 2023, 13(11), 1591; https://doi.org/10.3390/jpm13111591 - 10 Nov 2023

Cited by 5 | Viewed by 6112

Abstract

Patients with Parkinson’s disease (PD) tend to sleep more frequently in the supine position and less often change head and body position during sleep. Besides sleep quality and continuity, head and body positions are crucial for glymphatic system (GS) activity. This pilot study [...] Read more.

Patients with Parkinson’s disease (PD) tend to sleep more frequently in the supine position and less often change head and body position during sleep. Besides sleep quality and continuity, head and body positions are crucial for glymphatic system (GS) activity. This pilot study evaluated sleep architecture and head position during each sleep stage in idiopathic PD patients without cognitive impairment, correlating sleep data to patients’ motor and non-motor symptoms (NMS). All patients underwent the multi-night recordings, which were acquired using the Sleep Profiler headband. Sleep parameters, sleep time in each head position, and percentage of slow wave activity (SWA) in sleep, stage 3 of non-REM sleep (N3), and REM sleep in the supine position were extracted. Lastly, correlations with motor impairment and NMS were performed. Twenty PD patients (65.7 ± 8.6 y.o, ten women) were included. Sleep architecture did not change across the different nights of recording and showed the prevalence of sleep performed in the supine position. In addition, SWA and N3 were more frequently in the supine head position, and N3 in the supine decubitus correlated with REM sleep performed in the same position; this latter correlated with the disease duration (correlation coefficient = 0.48, p-value = 0.03) and motor impairment (correlation coefficient = 0.53, p-value = 0.02). These preliminary results demonstrated the importance of monitoring sleep in PD patients, supporting the need for preventive strategies in clinical practice for maintaining the lateral head position during the crucial sleep stages (SWA, N3, REM), essential for permitting the GS function and activity and ensuring brain health. Full article

(This article belongs to the Special Issue Neurological Diseases: From Molecular Mechanisms to Clinical Practice)

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15 pages, 3274 KiB

Open AccessEditor’s ChoiceArticle

Challenging ChatGPT 3.5 in Senology—An Assessment of Concordance with Breast Cancer Tumor Board Decision Making

by Sebastian Griewing, Niklas Gremke, Uwe Wagner, Michael Lingenfelder, Sebastian Kuhn and Jelena Boekhoff

J. Pers. Med. 2023, 13(10), 1502; https://doi.org/10.3390/jpm13101502 - 16 Oct 2023

Cited by 40 | Viewed by 3780

Abstract

With the recent diffusion of access to publicly available large language models (LLMs), common interest in generative artificial-intelligence-based applications for medical purposes has skyrocketed. The increased use of these models by tech-savvy patients for personal health issues calls for a scientific evaluation of [...] Read more.

With the recent diffusion of access to publicly available large language models (LLMs), common interest in generative artificial-intelligence-based applications for medical purposes has skyrocketed. The increased use of these models by tech-savvy patients for personal health issues calls for a scientific evaluation of whether LLMs provide a satisfactory level of accuracy for treatment decisions. This observational study compares the concordance of treatment recommendations from the popular LLM ChatGPT 3.5 with those of a multidisciplinary tumor board for breast cancer (MTB). The study design builds on previous findings by combining an extended input model with patient profiles reflecting patho- and immunomorphological diversity of primary breast cancer, including primary metastasis and precancerous tumor stages. Overall concordance between the LLM and MTB is reached for half of the patient profiles, including precancerous lesions. In the assessment of invasive breast cancer profiles, the concordance amounts to 58.8%. Nevertheless, as the LLM makes considerably fraudulent decisions at times, we do not identify the current development status of publicly available LLMs to be adequate as a support tool for tumor boards. Gynecological oncologists should familiarize themselves with the capabilities of LLMs in order to understand and utilize their potential while keeping in mind potential risks and limitations. Full article

(This article belongs to the Special Issue Transforming Precision Medicine: The Intersection of Digital Health and AI)

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15 pages, 292 KiB

Open AccessEditor’s ChoiceArticle

Relationship of Medication Intake and Systemic Conditions with Periodontitis: A Retrospective Study

by Georgios S. Chatzopoulos, Ziou Jiang, Nicholas Marka and Larry F. Wolff

J. Pers. Med. 2023, 13(10), 1480; https://doi.org/10.3390/jpm13101480 - 10 Oct 2023

Cited by 6 | Viewed by 2710

Abstract

Objectives: To examine the potential relationship of medication intake and systemic conditions with periodontitis. Methods and Materials: A total of 1985 patient records with a diagnosis of periodontal health and stage III and IV periodontitis were included in the analysis. Demographic characteristics, the [...] Read more.

Objectives: To examine the potential relationship of medication intake and systemic conditions with periodontitis. Methods and Materials: A total of 1985 patient records with a diagnosis of periodontal health and stage III and IV periodontitis were included in the analysis. Demographic characteristics, the number of missing teeth, patient-reported medical conditions and medication intake as well as smoking habits were recorded. Regression models were performed to explore the outcomes. Results: Older individuals, Hispanic ethnic groups, Black and Hispanic or Latino racial groups and non-White individuals in general were significantly more frequently diagnosed with periodontitis than health. Hypertension, glaucoma, anxiety and depression were significantly associated with periodontitis, while cancer, alcohol use, kidney problems, asthma, sleep apnea and gastrointestinal disorders were associated with periodontal health. Patients who reported taking anticoagulants, statins and ACE inhibitors demonstrated 3.546 (95% CI: 1.982, 6.343), 2.771 (95% CI: 1.877, 4.09) and 4.847 (95% CI: 2.785, 8.434) times higher odds of having periodontitis, respectively. Conclusion: Within the limitations of this retrospective study that utilized the BigMouth dental data repository, there is a possible relationship between systemic medications including anticoagulants, ACE inhibitors and statins as well as systemic medical conditions including hypertension, glaucoma, anxiety and depression with periodontitis. Full article

33 pages, 3164 KiB

Open AccessEditor’s ChoiceArticle

Ratings of the Effectiveness of 13 Therapeutic Diets for Autism Spectrum Disorder: Results of a National Survey

by Julie S. Matthews and James B. Adams

J. Pers. Med. 2023, 13(10), 1448; https://doi.org/10.3390/jpm13101448 - 29 Sep 2023

Cited by 17 | Viewed by 20808

Abstract

This study presents the results of the effectiveness of 13 therapeutic diets for autism spectrum disorder from 818 participants of a national survey, including benefits, adverse effects, and symptom improvements. The average Overall Benefit of diets was 2.36 (0 = no benefit, 4 [...] Read more.

This study presents the results of the effectiveness of 13 therapeutic diets for autism spectrum disorder from 818 participants of a national survey, including benefits, adverse effects, and symptom improvements. The average Overall Benefit of diets was 2.36 (0 = no benefit, 4 = great benefit), which was substantially higher than for nutraceuticals (1.59/4.0) and psychiatric/seizure medications (1.39/4.0), p < 0.001. The average Overall Adverse Effects of diets was significantly lower than psychiatric/seizure medications (0.10 vs. 0.93, p < 0.001) and similar to nutraceuticals (0.16). Autism severity decreased slightly over time in participants who used diet vs. increasing slightly in those that did not (p < 0.001). Healthy and Feingold diets were the two top-rated diets by Overall Benefit; the ketogenic diet was the highest for nine symptoms (though had fewer respondents); and the gluten-free/casein-free diet was among the top for overall symptom improvements. Different diets were reported to affect different symptoms, suggesting that an individual’s symptoms could be used to guide which diet(s) may be the most effective. The results suggest that therapeutic diets can be safe and effective interventions for improving some ASD-related symptoms with few adverse effects. We recommend therapeutic diets that include healthy foods and exclude problematic foods. Therapeutic diets are inexpensive treatments that we recommend for consideration by most people with ASD. Full article

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12 pages, 516 KiB

Open AccessEditor’s ChoiceArticle

Factors Affecting the Potential Efficacy of Intrauterine Platelet-Rich Plasma Infusion on Thin Endometrium in Women with Recurrent Implantation Failure

by Pin-Yao Lin, Chun-I Lee, Yi-Chun Chen, En-Hui Cheng, Chun-Chia Huang, Chung-I Chen, Tsung-Hsien Lee, Yu-Jen Lee and Maw-Sheng Lee

J. Pers. Med. 2023, 13(9), 1419; https://doi.org/10.3390/jpm13091419 - 21 Sep 2023

Cited by 8 | Viewed by 2508

Abstract

Optimizing endometrial thickness (EMT) is crucial for successful embryo implantation, but enhancing thin endometrium remains a significant challenge. Platelet-rich plasma (PRP)-derived therapies have emerged as a promising approach in reproductive medicine due to their capacity to facilitate tissue repair and regeneration. This study [...] Read more.

Optimizing endometrial thickness (EMT) is crucial for successful embryo implantation, but enhancing thin endometrium remains a significant challenge. Platelet-rich plasma (PRP)-derived therapies have emerged as a promising approach in reproductive medicine due to their capacity to facilitate tissue repair and regeneration. This study aims to identify the risk factors associated with the failure of intrauterine PRP infusion for thin endometrium in women with recurrent implantation failure (RIF). We retrospectively reviewed data from 77 women with RIF, all exhibiting an EMT of <7 mm. These women underwent programmed hormone therapy for frozen embryo transfer (FET) and received two autologous intrauterine PRP infusions. Following intrauterine PRP-lysate (PL) infusions, the mean increase in EMT was 1.9 ± 1.2 mm, with EMT reaching 7 mm in 86% of the cases (66/77; average EMT, 8.3 mm). We identified an exceedingly thin EMT as a risk factor impacting the therapeutic efficacy in increasing EMT (p = 0.04, OR: 3.16; 95% CI: 1.03–9.67). Additionally, the number of previous uterine surgeries emerged as a prognostic factor for pregnancy failure following PL infusion (p = 0.02, OR: 2.02; 95% CI: 1.12–3.64). Our findings suggest that an extremely thin EMT and a history of numerous uterine surgeries can impede successful pregnancy, even when an optimal EMT is achieved following PRP infusion. Full article

(This article belongs to the Special Issue Current Trends and Future Challenges in Assisted Reproduction)

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15 pages, 785 KiB

Open AccessEditor’s ChoiceArticle

Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients

by Georgios-Ioannis Verras, Francesk Mulita, Charalampos Lampropoulos, Dimitrios Kehagias, Oliver Curwen, Andreas Antzoulas, Ioannis Panagiotopoulos, Vasileios Leivaditis and Ioannis Kehagias

J. Pers. Med. 2023, 13(9), 1422; https://doi.org/10.3390/jpm13091422 - 21 Sep 2023

Cited by 11 | Viewed by 2662

Abstract

Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data [...] Read more.

Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data that underwent LSG at our institution for a span of 17 years—starting in January 2005 and ending in December 2022. We set the investigation of correlations of patient-related factors (age, weight, BMI, smoking status, presence of diabetes mellitus) with the occurrence of postoperative leaks. A total of 402 patients were included in our study. Of them, 26 (6.46%) developed PSLL. In total, 19 (73%) patients underwent percutaneous drainage and 14 patients (53.8%) were treated with intraluminal endoscopic stenting. Finally, five patients (19.2%) were treated with endoscopic clipping of the defect. Operative management was required in only one patient. There were no statistically significant differences in patient age, mean weight at the time of operation, and mean BMI. Abnormal drain amylase levels were associated with earlier detection of PSLL. More consideration needs to be given to producing a consensus regarding the management of PSLL, prioritizing nonoperative management with the combination of percutaneous drainage and endoscopic stenting as the safest and most efficient approach. Full article

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

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24 pages, 13694 KiB

Open AccessEditor’s ChoiceArticle

AI-Driven Decision Support for Early Detection of Cardiac Events: Unveiling Patterns and Predicting Myocardial Ischemia

by Luís B. Elvas, Miguel Nunes, Joao C. Ferreira, Miguel Sales Dias and Luís Brás Rosário

J. Pers. Med. 2023, 13(9), 1421; https://doi.org/10.3390/jpm13091421 - 21 Sep 2023

Cited by 12 | Viewed by 3740

Abstract

Cardiovascular diseases (CVDs) account for a significant portion of global mortality, emphasizing the need for effective strategies. This study focuses on myocardial infarction, pulmonary thromboembolism, and aortic stenosis, aiming to empower medical practitioners with tools for informed decision making and timely interventions. Drawing [...] Read more.

Cardiovascular diseases (CVDs) account for a significant portion of global mortality, emphasizing the need for effective strategies. This study focuses on myocardial infarction, pulmonary thromboembolism, and aortic stenosis, aiming to empower medical practitioners with tools for informed decision making and timely interventions. Drawing from data at Hospital Santa Maria, our approach combines exploratory data analysis (EDA) and predictive machine learning (ML) models, guided by the Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology. EDA reveals intricate patterns and relationships specific to cardiovascular diseases. ML models achieve accuracies above 80%, providing a 13 min window to predict myocardial ischemia incidents and intervene proactively. This paper presents a Proof of Concept for real-time data and predictive capabilities in enhancing medical strategies. Full article

(This article belongs to the Special Issue Transforming Precision Medicine: The Intersection of Digital Health and AI)

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13 pages, 2325 KiB

Open AccessEditor’s ChoiceArticle

Targeting IL-4 and IL-13 Receptors on Eosinophils in CRSwNP Patients: The Clinical Efficacy of Dupilumab

by Giovanna Lucia Piazzetta, Nadia Lobello, Emanuela Chiarella, Alberta Rizzuti, Corrado Pelaia, Girolamo Pelaia and Nicola Lombardo

J. Pers. Med. 2023, 13(9), 1404; https://doi.org/10.3390/jpm13091404 - 19 Sep 2023

Cited by 14 | Viewed by 3109

Abstract

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic [...] Read more.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease linked to type 2 inflammation. Several biologics have demonstrated therapeutic potential for the treatment of this pathology in which IL-4, IL-5 and IL-13 represent the major cytokines involved in the control of eosinophilic respiratory inflammation. 25% of CRSwNP patients relapse after the use of oral glucocorticoids or after surgery and often require several surgeries during their lifetime. In our study we enrolled 14 patients, 11 male and 3 female. The inclusion criteria were: age ≥ 18 years; confirmed diagnosis of chronic rhinosinusitis with severe nasal polyposis; disease severity with NPS Nasal Polyposis Endoscopic Score total score ≥ 5 and/or SNOT-22 ≥ 50; previous treatment failure due to lack of efficacy or discontinuation of systemic corticosteroid therapy and/or non-response or recurrence following surgery. The results presented in this study showed the ability of Dupilumab to improve all the parameters analysed. In particular, statistically significant data were obtained for NPS, SNOT-22, NRS, and IgE in patients exposed to Dupilumab treatment for 24 weeks, highlighting the ability of Dupilumab to produce clinical benefit in CRWwNP patients. In light of these data, the administration of dupilumab every two weeks represents a valid clinical strategy that ENT specialists can adopt for the treatment of adults with inadequately controlled CRSwNP. Full article

(This article belongs to the Special Issue Recent Advances in Diagnosis, Treatment and Observation in Otorhinolaryngology)

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21 pages, 1527 KiB

Open AccessEditor’s ChoiceArticle

From Admission to Discharge: Predicting National Institutes of Health Stroke Scale Progression in Stroke Patients Using Biomarkers and Explainable Machine Learning

by Aimilios Gkantzios, Christos Kokkotis, Dimitrios Tsiptsios, Serafeim Moustakidis, Elena Gkartzonika, Theodoros Avramidis, Gregory Tripsianis, Ioannis Iliopoulos, Nikolaos Aggelousis and Konstantinos Vadikolias

J. Pers. Med. 2023, 13(9), 1375; https://doi.org/10.3390/jpm13091375 - 14 Sep 2023

Cited by 7 | Viewed by 2791

Abstract

As a result of social progress and improved living conditions, which have contributed to a prolonged life expectancy, the prevalence of strokes has increased and has become a significant phenomenon. Despite the available stroke treatment options, patients frequently suffer from significant disability after [...] Read more.

As a result of social progress and improved living conditions, which have contributed to a prolonged life expectancy, the prevalence of strokes has increased and has become a significant phenomenon. Despite the available stroke treatment options, patients frequently suffer from significant disability after a stroke. Initial stroke severity is a significant predictor of functional dependence and mortality following an acute stroke. The current study aims to collect and analyze data from the hyperacute and acute phases of stroke, as well as from the medical history of the patients, in order to develop an explainable machine learning model for predicting stroke-related neurological deficits at discharge, as measured by the National Institutes of Health Stroke Scale (NIHSS). More specifically, we approached the data as a binary task problem: improvement of NIHSS progression vs. worsening of NIHSS progression at discharge, using baseline data within the first 72 h. For feature selection, a genetic algorithm was applied. Using various classifiers, we found that the best scores were achieved from the Random Forest (RF) classifier at the 15 most informative biomarkers and parameters for the binary task of the prediction of NIHSS score progression. RF achieved 91.13% accuracy, 91.13% recall, 90.89% precision, 91.00% f1-score, 8.87% FN_rate and 4.59% FP_rate. Those biomarkers are: age, gender, NIHSS upon admission, intubation, history of hypertension and smoking, the initial diagnosis of hypertension, diabetes, dyslipidemia and atrial fibrillation, high-density lipoprotein (HDL) levels, stroke localization, systolic blood pressure levels, as well as erythrocyte sedimentation rate (ESR) levels upon admission and the onset of respiratory infection. The SHapley Additive exPlanations (SHAP) model interpreted the impact of the selected features on the model output. Our findings suggest that the aforementioned variables may play a significant role in determining stroke patients’ NIHSS progression from the time of admission until their discharge. Full article

(This article belongs to the Section Pharmacogenetics)

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14 pages, 1174 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Pharmacogenetics of Long-Term Outcomes of Schizophrenia Spectrum Disorders: The Functional Role of CYP2D6 and CYP2C19

by Amrit K. Sandhu, Elnaz Naderi, Morenika J. Wijninga, Edith J. Liemburg, GROUP Investigators, Danielle Cath, Richard Bruggeman and Behrooz Z. Alizadeh

J. Pers. Med. 2023, 13(9), 1354; https://doi.org/10.3390/jpm13091354 - 4 Sep 2023

Cited by 4 | Viewed by 1880

Abstract

Schizophrenia spectrum disorders (SSD) are complex mental disorders, and while treatment with antipsychotics is important, many patients do not respond or develop serious side effects. Genetic variation has been shown to play a considerable role in determining an individual’s response to antipsychotic medication. [...] Read more.

Schizophrenia spectrum disorders (SSD) are complex mental disorders, and while treatment with antipsychotics is important, many patients do not respond or develop serious side effects. Genetic variation has been shown to play a considerable role in determining an individual’s response to antipsychotic medication. However, previous pharmacogenetic (PGx) studies have been limited by small sample sizes, lack of consensus regarding relevant genetic variants, and cross-sectional designs. The current study aimed to investigate the association between PGx variants and long-term clinical outcomes in 691 patients of European ancestry with SSD. Using evidence from the literature on candidate genes involved in antipsychotic pharmacodynamics, we created a polygenic risk score (PRS) to investigate its association with clinical outcomes. We also created PRS using core variants of psychotropic drug metabolism enzymes CYP2D6 and CYP2C19. Furthermore, the CYP2D6 and CYP2C19 functional activity scores were calculated to determine the relationship between metabolism and clinical outcomes. We found no association for PGx PRSs and clinical outcomes; however, an association was found with CYP2D6 activity scores by the traditional method. Higher CYP2D6 metabolism was associated with high positive and high cognitive impairment groups relative to low symptom severity groups. These findings highlight the need to test PGx efficacy with different symptom domains. More evidence is needed before pharmacogenetic variation can contribute to personalized treatment plans. Full article

(This article belongs to the Special Issue Pharmacogenomics and Precision Medicine in Psychiatry: From Basic Research to Clinical Practice)

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12 pages, 1239 KiB

Open AccessEditor’s ChoiceArticle

Prognostic Value of Serum Biomarkers in Patients with Idiopathic Pulmonary Fibrosis in Relation to Disease Progression

by Kalliopi Domvri, Ioannis Organtzis, Apostolos Apostolopoulos, Evangelia Fouka, Theodoros Kontakiotis and Despoina Papakosta

J. Pers. Med. 2023, 13(9), 1307; https://doi.org/10.3390/jpm13091307 - 26 Aug 2023

Cited by 7 | Viewed by 2067

Abstract

Background: The aim of this present study was to determine serum biomarker levels and their correlation with respiratory function and the clinical course of patients with idiopathic pulmonary fibrosis (IPF). Materials and Methods: This study included 72 IPF patients, according to the ATS/ERS [...] Read more.

Background: The aim of this present study was to determine serum biomarker levels and their correlation with respiratory function and the clinical course of patients with idiopathic pulmonary fibrosis (IPF). Materials and Methods: This study included 72 IPF patients, according to the ATS/ERS criteria, in whom antifibrotic treatment was initiated. Blood samples were taken, and serum biomarkers, such as KL-6, SP-D, CCL18, CXCL13, VEGF-A, IL-8, IGFBP-1, IGFBP-2, IGFBP-7 and ICAM-1 were measured using ELISA methodology. Pulmonary function tests (FVC, TLC, DLCO-% pred) were determined at baseline and after 12 and 24 months and analyzed in correlation with the biomarkers. Results: The majority of patients (mean age 72 ± 6 years) were men (83%). The FVC and DLCO values at the 12-month follow-up were found to be statistically decreased in deceased patients (p < 0.05). The SP-D (p < 0.001) and the IGFBP-1 (p = 0.021) levels were found to be increased at the 1-year follow-up in deceased patients, and similarly, the SP-D (p = 0.005) and ICAM-1 (p = 0.043) levels at the 2-year follow-up. A chi-square test revealed that 70% of the category IV GAP index was found with cut-off elevated levels of a biomarker combination (KL-6, SP-D, VEGF-A) from the ROC curve analysis (p < 0.05). Conclusion: This study provides evidence, for the first time in a Greek population, of the possibility of using a combination of KL-6, SP-D, and VEGF-A serum levels along with the GAP index. Full article

(This article belongs to the Special Issue Biomarkers in Diagnosis and Treatment of Pulmonary Disease)

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13 pages, 1088 KiB

Open AccessEditor’s ChoiceArticle

The Role of Oxidative Stress in Infertility

by Ioana Zaha, Mariana Muresan, Camelia Tulcan, Anca Huniadi, Petronela Naghi, Mircea Sandor, Roberta Tripon, Cristina Gaspar, Major Klaudia-Melinda, Liliana Sachelarie and Liana Stefan

J. Pers. Med. 2023, 13(8), 1264; https://doi.org/10.3390/jpm13081264 - 15 Aug 2023

Cited by 17 | Viewed by 5791

Abstract

(1) Background: Oxidative stress markers in the follicular fluid and serum of the patient with IVF results (number of fertilized oocytes, number of embryos, cumulative pregnancy rate) are important in establishing the causes of infertility. (2) Methods: 42 patients were enrolled in the [...] Read more.

(1) Background: Oxidative stress markers in the follicular fluid and serum of the patient with IVF results (number of fertilized oocytes, number of embryos, cumulative pregnancy rate) are important in establishing the causes of infertility. (2) Methods: 42 patients were enrolled in the study over the duration of 24 months and were divided into two groups: the study group divided into the female etiology for infertility as a tubal factor, diminished ovarian reserve, endometriosis, and unexplained infertility, and the control group consisting of the male factor, excluding the sperm donors and with no female factor cause. On the day of ovarian puncture in IVF, follicular fluid and serum were collected from the patients. (3) Results: Malondialdehyde from the follicular fluid was higher in the control group. The total antioxidant capacity in the follicular fluid is positively correlated with the pregnancy rate. There is no statistically significant difference in the oxidative stress markers from serum in both groups. (4) Conclusions: The capacity of the follicular fluid environment to contain the reactive oxygen species (ROS) leads to a higher pregnancy rate in the control group. Full article

(This article belongs to the Special Issue Personalized Medicine for Infertility)

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16 pages, 1131 KiB

Open AccessEditor’s ChoiceArticle

Characterization and Factors Associated with Poor Asthma Control in Adults with Severe Eosinophilic Asthma

by Clara Padró-Casas, María Basagaña, María Luisa Rivera-Ortún, Ignasi García-Olivé, Carlos Pollan-Guisasola, Aina Teniente-Serra, Eva Martínez-Cáceres, José-Tomás Navarro, Jorge Abad-Capa, Antoni Rosell, Albert Roger and Carlos Martínez-Rivera

J. Pers. Med. 2023, 13(7), 1173; https://doi.org/10.3390/jpm13071173 - 22 Jul 2023

Cited by 5 | Viewed by 1672

Abstract

A study was conducted in 98 adult patients diagnosed with severe eosinophilic asthma (73.5% women, mean age 47.2 years) and followed prospectively for 1 year. The aim of the study was to characterize this population and to identify factors associated with poor prognosis [...] Read more.

A study was conducted in 98 adult patients diagnosed with severe eosinophilic asthma (73.5% women, mean age 47.2 years) and followed prospectively for 1 year. The aim of the study was to characterize this population and to identify factors associated with poor prognosis at 1 year of follow-up. At the initial visit, uncontrolled severe asthma was diagnosed in 87.7% of patients. Allergic sensitization was observed in 81.7% (polysensitization in 17.3%), with clinically significant allergic asthma in 45%. The mean percentage of sputum eosinophils was 4.7% (standard deviation(SD) 6.3%) and the mean (SD) blood eosinophil count 467 (225) cells/µL. Almost half of the patients (48.3%) had sputum eosinophilia (>3% eosinophils). Sputum eosinophils correlated significantly with peripheral eosinophilia (p = 0.004) and, to a lesser extent, with fractional exhaled nitric oxide (FeNO) (p = 0.04). After 1 year, 48 patients (49%) had uncontrolled asthma in all visits, and 50 (51%) had controlled asthma in some visits. Airway obstruction (FEV₁ < 80% predicted) was the main reason for uncontrolled asthma. In the multivariate analysis, an obstructive pattern (odds ratio (OR) 7.45, 95% confidence interval (CI) 2.41–23.03, p < 0.0001) and the patient’s age (OR 1.045, 95% CI 1.005–1.086, p = 0.026) were independent predictors of poor asthma control. In adult-onset and long-standing asthma, serum interleukin (IL) IL-17 was higher in the uncontrolled asthma group. This study contributes to characterizing patients with severe eosinophilic asthma in real-world clinical practice. Full article

(This article belongs to the Section Mechanisms of Diseases)

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14 pages, 2568 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Glissonean Pedicle Isolation Focusing on the Laennec’s Capsule for Minimally Invasive Anatomical Liver Resection

by Mamoru Morimoto, Yoichi Matsuo, Keisuke Nonoyama, Yuki Denda, Hiromichi Murase, Tomokatsu Kato, Hiroyuki Imafuji, Kenta Saito and Shuji Takiguchi

J. Pers. Med. 2023, 13(7), 1154; https://doi.org/10.3390/jpm13071154 - 18 Jul 2023

Cited by 9 | Viewed by 3967

Abstract

Background: Inflow control is one of the most important procedures during anatomical liver resection (ALR), and Glissonean pedicle isolation (GPI) is one of the most efficacious methods used in laparoscopic anatomical liver resection (LALR). Recognition of the Laennec’s capsule covering the liver parenchyma [...] Read more.

Background: Inflow control is one of the most important procedures during anatomical liver resection (ALR), and Glissonean pedicle isolation (GPI) is one of the most efficacious methods used in laparoscopic anatomical liver resection (LALR). Recognition of the Laennec’s capsule covering the liver parenchyma is essential for safe and precise GPI. The purpose of this study was to verify identification of the Laennec’s capsule, to confirm the validity of GPI in minimally invasive surgery, and to demonstrate the value of GPI focusing on the Laennec’s capsule using a robotic system that has been developed in recent years. Methods: We used a cadaveric model to simulate the Glissonean pedicle and the surrounding liver parenchyma for pathologic verification of the layers. We performed 60 LALRs and 39 robotic anatomical liver resections (RALRs) using an extrahepatic Glissonean approach, from April 2020 to April 2023, and verified the layers of the specimens removed during LALR and RALR based on pathologic examination. In addition, the surgical outcomes of LALR and RALR were compared. Results: Histologic examination facilitated by Elastica van Gieson staining revealed the presence of Laennec’s capsule covering the liver parenchyma in a cadaveric model. Similar findings were obtained following LALR and RALR, thus confirming that the gap between the Glissonean pedicle and the Laennec’s capsule can be dissected without injury to the parenchyma. The mean GPI time was 32.9 and 27.2 min in LALR and RALR, respectively. The mean blood loss was 289.7 and 131.6 mL in LALR and RALR, respectively. There was no significant difference in the incidence of Clavien–Dindo grade ≥III complications between the two groups. Conclusions: Laennec’s capsule is the most important anatomical landmark in performing a safe and successful extrahepatic GPI. Based on this concept, it is possible for LALR and RALR to develop GPI focusing on the Laennec’s capsule. Furthermore, a robotic system has the potential to increase the safety and decrease the difficulty of this challenging procedure. Full article

(This article belongs to the Special Issue Minimally Invasive Liver Resection)

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17 pages, 3434 KiB

Open AccessEditor’s ChoiceArticle

Mid-Regional Pro-Adrenomedullin and N-Terminal Pro-B-Type Natriuretic Peptide Measurement: A Multimarker Approach to Diagnosis and Prognosis in Acute Heart Failure

by Silvia Spoto, Josepmaria Argemi, Roberta Di Costanzo, Juan Josè Gavira Gomez, Nahikari Salterain Gonzales, Stefania Basili, Roberto Cangemi, Antonio Abbate, Luciana Locorriere, Francesco Masini, Giulia Testorio, Rodolfo Calarco, Giulia Battifoglia, Fabio Mangiacapra, Marta Fogolari, Sebastiano Costantino and Silvia Angeletti

J. Pers. Med. 2023, 13(7), 1155; https://doi.org/10.3390/jpm13071155 - 18 Jul 2023

Cited by 10 | Viewed by 2621

Abstract

Background: Acute heart failure (AHF) is a major cause of hospitalization and mortality worldwide. Early and accurate diagnosis, as well as effective risk stratification, are essential for optimizing clinical management and improving patient outcomes. In this context, biomarkers have gained increasing interest in [...] Read more.

Background: Acute heart failure (AHF) is a major cause of hospitalization and mortality worldwide. Early and accurate diagnosis, as well as effective risk stratification, are essential for optimizing clinical management and improving patient outcomes. In this context, biomarkers have gained increasing interest in recent years as they can provide important diagnostic and prognostic information in patients with AHF. Aim and Methods: The primary objective of the present study was to compare the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional pro-adrenomedullin (MR-proADM), and C-reactive protein (CRP) between patients diagnosed with acute heart failure (AHF) and those without AHF and sepsis. Furthermore, the study aimed to assess the diagnostic and prognostic value of the use of a multimarker approach in AHF patients. To achieve these objectives, a total of 145 patients with AHF and 127 patients without AHF and sepsis, serving as the control group, were consecutively enrolled in the study. Results: Levels of MR-proADM (median: 2.07; (25th–75th percentiles: 1.40–3.02) vs. 1.11 (0.83–1.71) nmol/L, p < 0.0001), and NT-proBNP (5319 (1691–11,874) vs. 271 (89–931.5) pg/mL, p < 0.0001) were significantly higher in patients with AHF compared to controls, whereas CRP levels did not show significant differences. The mortality rate in the AHF group during in-hospital stay was 12%, and the rate of new re-admission for AHF within 30 days after discharge was 10%. During in-hospital follow-up, Cox regression analyses showed that levels of NT-proBNP > 10,132 pg/mL (hazard ratio (HR) 2.97; 95% confidence interval (CI): 1.13–7.82; p = 0.0284) and levels of MR-proADM > 2.8 nmol/L (HR: 8.57; CI: 2.42–30.28; p = 0.0009) predicted mortality. The combined use of MR-proADM and NT-proBNP provided significant additive predictive value for mortality and new re-admission for AHF at 30 days after discharge. A logistic regression analysis showed that the presence of NT-proBNP pg/mL > 12,973 pg mL and/or MR-proADM > 4.2 nmol/L predicted hospital re-admission within 30 days (OR: 3.23; CI: 1.05–9.91; p = 0.041). Conclusion: The combined assay of MR-proADM and NT-proBNP could be helpful in accurately identifying AHF and in defining prognosis and re-admission for AHF. The complementary use of these biomarkers can provide a useful clinical evaluation of AHF while also orienting clinicians to the pathophysiology underlying heart damage and assisting them in tailoring therapy. Full article

(This article belongs to the Section Disease Biomarker)

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12 pages, 1507 KiB

Open AccessEditor’s ChoiceArticle

Controlling Nutritional Status (CONUT) Score as a Predictive Marker in Hospitalized Frail Elderly Patients

by Aurelio Lo Buglio, Francesco Bellanti, Cristiano Capurso and Gianluigi Vendemiale

J. Pers. Med. 2023, 13(7), 1119; https://doi.org/10.3390/jpm13071119 - 10 Jul 2023

Cited by 8 | Viewed by 2341

Abstract

The Controlling Nutritional Status (CONUT) score is a simple screening tool able to detect altered nutritional status as well as to predict clinical adverse outcomes in specific populations. No data are available in frail patients. This study aims to investigate the predictive role [...] Read more.

The Controlling Nutritional Status (CONUT) score is a simple screening tool able to detect altered nutritional status as well as to predict clinical adverse outcomes in specific populations. No data are available in frail patients. This study aims to investigate the predictive role of the CONUT score on mortality and length of stay (LOS) in frail patients admitted to an Internal Medicine Department. We consecutively enrolled 246 patients aged 65 years or older, divided into two groups based on frailty status. The two groups were further divided according to low (<5) or high (≥5) CONUT score. Length of stay (LOS) was higher in frail patients than not-frail patients, as well as in the frail group with high CONUT scores compared to the frail group with low CONUT scores. Multiple linear regression showed an increase of 2.1 days for each additional point to the CONUT score. In-hospital mortality was higher in frail compared to not-frail patients, but it did not differ between frail patients with high CONUT scores and frail patients with low CONUT scores. An analysis of the survival curve for 30-day mortality showed a higher mortality rate for frail/high-CONUT-score patients as compared to the not-frail/low-CONUT-score group. The CONUT score shows high prognostic value for higher LOS—but not mortality—in the clinical setting of internal medicine departments for old frail patients. Full article

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14 pages, 2202 KiB

Open AccessEditor’s ChoiceArticle

Using Anatomy-Based Fitting to Reduce Frequency-to-Place Mismatch in Experienced Bilateral Cochlear Implant Users: A Promising Concept

by Anja Kurz, David Herrmann, Rudolf Hagen and Kristen Rak

J. Pers. Med. 2023, 13(7), 1109; https://doi.org/10.3390/jpm13071109 - 8 Jul 2023

Cited by 18 | Viewed by 3098

Abstract

Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, [...] Read more.

Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°–620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps’ self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users. Full article

(This article belongs to the Special Issue Personalized Medicine in Otolaryngology: Special Topic Otology)

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16 pages, 2711 KiB

Open AccessEditor’s ChoiceArticle

A Statistical Approach to Assess the Robustness of Radiomics Features in the Discrimination of Mammographic Lesions

by Alfonso Maria Ponsiglione, Francesca Angelone, Francesco Amato and Mario Sansone

J. Pers. Med. 2023, 13(7), 1104; https://doi.org/10.3390/jpm13071104 - 7 Jul 2023

Cited by 9 | Viewed by 1949

Abstract

Despite mammography (MG) being among the most widespread techniques in breast cancer screening, tumour detection and classification remain challenging tasks due to the high morphological variability of the lesions. The extraction of radiomics features has proved to be a promising approach in MG. [...] Read more.

Despite mammography (MG) being among the most widespread techniques in breast cancer screening, tumour detection and classification remain challenging tasks due to the high morphological variability of the lesions. The extraction of radiomics features has proved to be a promising approach in MG. However, radiomics features can suffer from dependency on factors such as acquisition protocol, segmentation accuracy, feature extraction and engineering methods, which prevent the implementation of robust and clinically reliable radiomics workflow in MG. In this study, the variability and robustness of radiomics features is investigated as a function of lesion segmentation in MG images from a public database. A statistical analysis is carried out to assess feature variability and a radiomics robustness score is introduced based on the significance of the statistical tests performed. The obtained results indicate that variability is observable not only as a function of the abnormality type (calcification and masses), but also among feature categories (first-order and second-order), image view (craniocaudal and medial lateral oblique), and the type of lesions (benign and malignant). Furthermore, through the proposed approach, it is possible to identify those radiomics characteristics with a higher discriminative power between benign and malignant lesions and a lower dependency on segmentation, thus suggesting the most appropriate choice of robust features to be used as inputs to automated classification algorithms. Full article

(This article belongs to the Special Issue Precision Medicine in Radiomics and Radiogenomics)

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12 pages, 1038 KiB

Open AccessEditor’s ChoiceArticle

Hybrid Value-Aware Transformer Architecture for Joint Learning from Longitudinal and Non-Longitudinal Clinical Data

by Yijun Shao, Yan Cheng, Stuart J. Nelson, Peter Kokkinos, Edward Y. Zamrini, Ali Ahmed and Qing Zeng-Treitler

J. Pers. Med. 2023, 13(7), 1070; https://doi.org/10.3390/jpm13071070 - 29 Jun 2023

Cited by 8 | Viewed by 3071

Abstract

Transformer is the latest deep neural network (DNN) architecture for sequence data learning, which has revolutionized the field of natural language processing. This success has motivated researchers to explore its application in the healthcare domain. Despite the similarities between longitudinal clinical data and [...] Read more.

Transformer is the latest deep neural network (DNN) architecture for sequence data learning, which has revolutionized the field of natural language processing. This success has motivated researchers to explore its application in the healthcare domain. Despite the similarities between longitudinal clinical data and natural language data, clinical data presents unique complexities that make adapting Transformer to this domain challenging. To address this issue, we have designed a new Transformer-based DNN architecture, referred to as Hybrid Value-Aware Transformer (HVAT), which can jointly learn from longitudinal and non-longitudinal clinical data. HVAT is unique in the ability to learn from the numerical values associated with clinical codes/concepts such as labs, and in the use of a flexible longitudinal data representation called clinical tokens. We have also trained a prototype HVAT model on a case-control dataset, achieving high performance in predicting Alzheimer’s disease and related dementias as the patient outcome. The results demonstrate the potential of HVAT for broader clinical data-learning tasks. Full article

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12 pages, 955 KiB

Open AccessEditor’s ChoiceArticle

Patient’s Scar Satisfaction after Conventional Thyroidectomy for Differentiated Thyroid Cancer

by Massimo Campagnoli, Valeria Dell’Era, Maria Silvia Rosa, Fabiola Negri, Eric Malgrati, Massimiliano Garzaro and Paolo Aluffi Valletti

J. Pers. Med. 2023, 13(7), 1066; https://doi.org/10.3390/jpm13071066 - 29 Jun 2023

Cited by 10 | Viewed by 1909

Abstract

Differentiated thyroid carcinoma (DTC) is the most frequent endocrine neoplasm. Its treatment is based on surgery with consequent impact on patients’ quality of life (QoL) and aesthetic implication. The aim of the present study is to assess scar satisfaction in patients affected by [...] Read more.

Differentiated thyroid carcinoma (DTC) is the most frequent endocrine neoplasm. Its treatment is based on surgery with consequent impact on patients’ quality of life (QoL) and aesthetic implication. The aim of the present study is to assess scar satisfaction in patients affected by DTC who underwent total or partial thyroidectomy. A comparison was also made between scar satisfaction with different subcuticular suture. Validated questionnaires have been employed during a 3-month follow-up: Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). Eventually, the impact of thyroid cancer on QoL of patients was performed in the studied population employing the Thyroid-related patient-reported outcome questionnaire (ThyPRO) and European Organisation for Research Additionally, Treatment of Cancer—Quality of Life questionnaire-C30 (EORTC QLQ-C30). It was conducted in a single center observational study considering 74 patients respecting inclusion criteria. Overall scar satisfaction was found to improve during follow-up, reaching the best scores at 3 months from surgery. Subcuticular suture does not seem to influence the scar satisfaction. In our study male patients seem to be more satisfied, on the other hand age does not seem to influence satisfaction. Overall, the ThyPRO questionnaire and EORTC QLQ-C30 scores did not statistically differ between preoperative and postoperative suggesting a small impact of DTC in QoL. Full article

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

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16 pages, 3510 KiB

Open AccessEditor’s ChoiceArticle

ATR-FTIR Spectroscopy with Chemometrics for Analysis of Saliva Samples Obtained in a Lung-Cancer-Screening Programme: Application of Swabs as a Paradigm for High Throughput in a Clinical Setting

by Francis L. Martin, Andrew W. Dickinson, Tarek Saba, Thomas Bongers, Maneesh N. Singh and Danielle Bury

J. Pers. Med. 2023, 13(7), 1039; https://doi.org/10.3390/jpm13071039 - 25 Jun 2023

Cited by 9 | Viewed by 2495

Abstract

There is an increasing need for inexpensive and rapid screening tests in point-of-care clinical oncology settings. Herein, we develop a swab “dip” test in saliva obtained from consenting patients participating in a lung-cancer-screening programme being undertaken in North West England. In a pilot [...] Read more.

There is an increasing need for inexpensive and rapid screening tests in point-of-care clinical oncology settings. Herein, we develop a swab “dip” test in saliva obtained from consenting patients participating in a lung-cancer-screening programme being undertaken in North West England. In a pilot study, a total of 211 saliva samples (n = 170 benign, 41 designated cancer-positive) were randomly taken during the course of this prospective lung-cancer-screening programme. The samples (sterile Copan blue rayon swabs dipped in saliva) were analysed using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy. An exploratory analysis using principal component analysis (PCA,) with or without linear discriminant analysis (LDA), was then undertaken. Three pairwise comparisons were undertaken including: (1) benign vs. cancer following swab analysis; (2) benign vs. cancer following swab analysis with the subtraction of dry swab spectra; and (3) benign vs. cancer following swab analysis with the subtraction of wet swab spectra. Consistent and remarkably similar patterns of clustering for the benign control vs. cancer categories, irrespective of whether the swab plus saliva sample was analysed or whether there was a subtraction of wet or dry swab spectra, was observed. In each case, MANOVA demonstrated that this segregation of categories is highly significant. A k-NN (using three nearest neighbours) machine-learning algorithm also showed that the specificity (90%) and sensitivity (75%) are consistent for each pairwise comparison. In detailed analyses, the swab as a substrate did not alter the level of spectral discrimination between benign control vs. cancer saliva samples. These results demonstrate a novel swab “dip” test using saliva as a biofluid that is highly applicable to be rolled out into a larger lung-cancer-screening programme. Full article

(This article belongs to the Special Issue Clinical Applications of Biospectroscopy and Imaging)

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13 pages, 1115 KiB

Open AccessEditor’s ChoiceArticle

Precision Medicine Is Changing the Roles of Healthcare Professionals, Scientists, and Research Staff: Learnings from a Childhood Cancer Precision Medicine Trial

by Rebecca Daly, Kate Hetherington, Emily Hazell, Bethany R. Wadling, Vanessa Tyrrell, Katherine M. Tucker, Glenn M. Marshall, David S. Ziegler, Loretta M. S. Lau, Toby N. Trahair, Tracey A. O’Brien, Kiri Collins, Andrew J. Gifford, Michelle Haber, Mark Pinese, David Malkin, Mark J. Cowley, Jonathan Karpelowsky, Donna Drew, Chris Jacobs and Claire E. Wakefield Show full author list Hide full author list

J. Pers. Med. 2023, 13(7), 1033; https://doi.org/10.3390/jpm13071033 - 23 Jun 2023

Cited by 9 | Viewed by 4271

Abstract

Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia’s first [...] Read more.

Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia’s first precision medicine trial for children with poor-prognosis cancer: the PRecISion Medicine for Children with Cancer (PRISM) national clinical trial of the Zero Childhood Cancer Program. We conducted semi-structured interviews with 85 PRISM professionals from eight professional groups, including oncologists, surgeons, clinical research associates, scientists, genetic professionals, pathologists, animal care technicians, and nurses. We analyzed interviews thematically. Professionals shared that precision medicine can add complexity to their role and result in less certain outcomes for families. Although many participants described experiencing a greater emotional impact from their work, most expressed very positive views about the impact of precision medicine on their profession and its future potential. Most reported navigating precision medicine without formal training. Each group described unique challenges involved in adapting to precision medicine in their profession. Addressing training gaps and meeting the specific needs of many professional groups involved in precision medicine will be essential to ensure the successful implementation of standard care. Full article

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12 pages, 236 KiB

Open AccessEditor’s ChoiceArticle

Parents’ Perspectives on the Utility of Genomic Sequencing in the Neonatal Intensive Care Unit

by Amy A. Lemke, Michelle L. Thompson, Emily C. Gimpel, Katelyn C. McNamara, Carla A. Rich, Candice R. Finnila, Meagan E. Cochran, James M. J. Lawlor, Kelly M. East, Kevin M. Bowling, Donald R. Latner, Susan M. Hiatt, Michelle D. Amaral, Whitley V. Kelley, Veronica Greve, David E. Gray, Stephanie A. Felker, Hannah Meddaugh, Ashley Cannon, Amanda Luedecke, Kelly E. Jackson, Laura G. Hendon, Hillary M. Janani, Marla Johnston, Lee Ann Merin, Sarah L. Deans, Carly Tuura, Trent Hughes, Heather Williams, Kelly Laborde, Matthew B. Neu, Jessica Patrick-Esteve, Anna C. E. Hurst, Brian M. Kirmse, Renate Savich, Steven B. Spedale, Sara J. Knight, Gregory S. Barsh, Bruce R. Korf, Gregory M. Cooper and Kyle B. Brothers Show full author list Hide full author list

J. Pers. Med. 2023, 13(7), 1026; https://doi.org/10.3390/jpm13071026 - 21 Jun 2023

Cited by 9 | Viewed by 1999

Abstract

Background: It is critical to understand the wide-ranging clinical and non-clinical effects of genome sequencing (GS) for parents in the NICU context. We assessed parents’ experiences with GS as a first-line diagnostic tool for infants with suspected genetic conditions in the NICU. Methods: [...] Read more.

Background: It is critical to understand the wide-ranging clinical and non-clinical effects of genome sequencing (GS) for parents in the NICU context. We assessed parents’ experiences with GS as a first-line diagnostic tool for infants with suspected genetic conditions in the NICU. Methods: Parents of newborns (N = 62) suspected of having a genetic condition were recruited across five hospitals in the southeast United States as part of the SouthSeq study. Semi-structured interviews (N = 78) were conducted after parents received their child’s sequencing result (positive, negative, or variants of unknown significance). Thematic analysis was performed on all interviews. Results: Key themes included that (1) GS in infancy is important for reproductive decision making, preparing for the child’s future care, ending the diagnostic odyssey, and sharing results with care providers; (2) the timing of disclosure was acceptable for most parents, although many reported the NICU environment was overwhelming; and (3) parents deny that receiving GS results during infancy exacerbated parent–infant bonding, and reported variable impact on their feelings of guilt. Conclusion: Parents reported that GS during the neonatal period was useful because it provided a “backbone” for their child’s care. Parents did not consistently endorse negative impacts like interference with parent–infant bonding. Full article

14 pages, 4026 KiB

Open AccessEditor’s ChoiceArticle

Impact of REAC Regenerative Endogenous Bioelectrical Cell Reprogramming on MCF7 Breast Cancer Cells

by Vania Fontani, Sara Cruciani, Sara Santaniello, Salvatore Rinaldi and Margherita Maioli

J. Pers. Med. 2023, 13(6), 1019; https://doi.org/10.3390/jpm13061019 - 20 Jun 2023

Cited by 8 | Viewed by 2577

Abstract

Human breast adenocarcinoma is a form of cancer which has the tendency to metastasize to other tissues, including bones, lungs, brain, and liver. Several chemotherapeutic drugs are used to treat breast tumors. Their combination is used to simultaneously target different mechanisms involved in [...] Read more.

Human breast adenocarcinoma is a form of cancer which has the tendency to metastasize to other tissues, including bones, lungs, brain, and liver. Several chemotherapeutic drugs are used to treat breast tumors. Their combination is used to simultaneously target different mechanisms involved in cell replication. Radio electric asymmetric conveyer (REAC) technology is an innovative technology, used both in vitro and in vivo, to induce cell reprogramming and counteract senescence processes. Within this context, we treated MCF-7 cells with a regenerative (RGN) REAC treatment for a period ranging between 3 and 7 days. We then analyzed cell viability by trypan blue assays and gene and protein expression by real time-qPCR and confocal microscope, respectively. We also detected the levels of the main proteins involved in tumor progression, DKK1 and SFRP1, by ELISA and cell senescence by β-galactosidase tests. Our results showed the ability of REAC RGN to counteract MCF-7 proliferation, probably inducing autophagy via the upregulation of Beclin-1 and LC3-I, and the modulation of specific tumorigenic biomarkers, such as DKK1 and SPFR1. Our results could suggest the application of the REAC RGN in future in vivo experiments, as an aid for the therapeutic strategies usually applied for breast cancer treatment. Full article

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14 pages, 1800 KiB

Open AccessEditor’s ChoiceArticle

MGMT Promoter Methylation: Prognostication beyond Treatment Response

by Keyoumars Ashkan, Asfand Baig Mirza, Christos Soumpasis, Christoforos Syrris, Dimitrios Kalaitzoglou, Chaitanya Sharma, Zachariah Joseph James, Abbas Khizar Khoja, Razna Ahmed, Amisha Vastani, James Bartram, Kazumi Chia, Omar Al-Salihi, Angela Swampilai, Lucy Brazil, Ross Laxton, Zita Reisz, Istvan Bodi, Andrew King, Richard Gullan, Francesco Vergani, Ranjeev Bhangoo, Safa Al-Sarraj and Jose Pedro Lavrador Show full author list Hide full author list

J. Pers. Med. 2023, 13(6), 999; https://doi.org/10.3390/jpm13060999 - 14 Jun 2023

Cited by 8 | Viewed by 3353

Abstract

MGMT promoter methylation is related to the increased sensitivity of tumour tissue to chemotherapy with temozolomide (TMZ) and thus to improved patient survival. However, it is unclear how the extent of MGMT promoter methylation affects outcomes. In our study, a single-centre retrospective study, [...] Read more.

MGMT promoter methylation is related to the increased sensitivity of tumour tissue to chemotherapy with temozolomide (TMZ) and thus to improved patient survival. However, it is unclear how the extent of MGMT promoter methylation affects outcomes. In our study, a single-centre retrospective study, we explore the impact of MGMT promoter methylation in patients with glioblastoma who were operated upon with 5-ALA. Demographic, clinical and histology data, and survival rates were assessed. A total of 69 patients formed the study group (mean age 53.75 ± 15.51 years old). Positive 5-ALA fluorescence was noted in 79.41%. A higher percentage of MGMT promoter methylation was related to lower preoperative tumour volume (p = 0.003), a lower likelihood of 5-ALA positive fluorescence (p = 0.041) and a larger extent of resection EoR (p = 0.041). A higher MGMT promoter methylation rate was also related to improved progression-free survival (PFS) and overall survival (OS) (p = 0.008 and p = 0.006, respectively), even when adjusted for the extent of resection (p = 0.034 and p = 0.042, respectively). A higher number of adjuvant chemotherapy cycles was also related to longer PFS and OS (p = 0.049 and p = 0.030, respectively). Therefore, this study suggests MGMT promoter methylation should be considered as a continuous variable. It is a prognostic factor that goes beyond sensitivity to chemotherapy treatment, as a higher percentage of methylation is related not only to increased EoR and increased PFS and OS, but also to lower tumour volume at presentation and a lower likelihood of 5-ALA fluorescence intraoperatively. Full article

(This article belongs to the Special Issue Precision Medicine in Neurooncology and Neurosurgery for the 21st Century)

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