Journal of Personalized Medicine

Review

13 pages, 1316 KiB

Open AccessEditor’s ChoiceReview

Ophthalmic Manifestations in Fabry Disease: Updated Review

by Gloria Gambini, Luca Scartozzi, Federico Giannuzzi, Matteo Mario Carlà, Francesco Boselli, Tomaso Caporossi, Umberto De Vico, Antonio Baldascino and Stanislao Rizzo

J. Pers. Med. 2023, 13(6), 904; https://doi.org/10.3390/jpm13060904 - 27 May 2023

Cited by 7 | Viewed by 3692

Abstract

Fabry disease (FD) is an X-linked lysosomal storage disorder, causing Gb-3 (globotriaosylceramide) buildup in cellular lysosomes throughout the body, in particular in blood vessel walls, neuronal cells, and smooth muscle. The gradual accumulation of this glycosphingolipid in numerous eye tissues causes conjunctival vascular [...] Read more.

Fabry disease (FD) is an X-linked lysosomal storage disorder, causing Gb-3 (globotriaosylceramide) buildup in cellular lysosomes throughout the body, in particular in blood vessel walls, neuronal cells, and smooth muscle. The gradual accumulation of this glycosphingolipid in numerous eye tissues causes conjunctival vascular abnormalities, corneal epithelial opacities (cornea verticillata), lens opacities, and retinal vascular abnormalities. Although a severe vision impairment is rare, these abnormalities are diagnostic indicators and prognostics for severity. Cornea verticillata is the most common ophthalmic feature in both hemizygous men and heterozygous females. Vessel tortuosity has been linked to a faster disease progression and may be useful in predicting systemic involvement. New technologies such as optical coherence tomography angiography (OCTA) are useful for monitoring retinal microvasculature alterations in FD patients. Along with OCTA, corneal topographic analysis, confocal microscopy, and electro-functional examinations, contributed to the recognition of ocular abnormalities and have been correlated with systemic involvement. We offer an update regarding FD ocular manifestations, focusing on findings derived from the most recent imaging modalities, to optimize the management of this pathology. Full article

(This article belongs to the Special Issue Update and Perspectives on Corneal Diseases)

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17 pages, 1194 KiB

Open AccessEditor’s ChoiceReview

Ligand-Gated Ion Channels: Prognostic and Therapeutic Implications for Gliomas

by Grace Hey, Rohan Rao, Ashley Carter, Akshay Reddy, Daisy Valle, Anjali Patel, Drashti Patel, Brandon Lucke-Wold, Daniel Pomeranz Krummel and Soma Sengupta

J. Pers. Med. 2023, 13(5), 853; https://doi.org/10.3390/jpm13050853 - 19 May 2023

Cited by 6 | Viewed by 4203

Abstract

Gliomas are common primary brain malignancies that remain difficult to treat due to their overall aggressiveness and heterogeneity. Although a variety of therapeutic strategies have been employed for the treatment of gliomas, there is increasing evidence that suggests ligand-gated ion channels (LGICs) can [...] Read more.

Gliomas are common primary brain malignancies that remain difficult to treat due to their overall aggressiveness and heterogeneity. Although a variety of therapeutic strategies have been employed for the treatment of gliomas, there is increasing evidence that suggests ligand-gated ion channels (LGICs) can serve as a valuable biomarker and diagnostic tool in the pathogenesis of gliomas. Various LGICs, including P2X, SYT16, and PANX2, have the potential to become altered in the pathogenesis of glioma, which can disrupt the homeostatic activity of neurons, microglia, and astrocytes, further exacerbating the symptoms and progression of glioma. Consequently, LGICs, including purinoceptors, glutamate-gated receptors, and Cys-loop receptors, have been targeted in clinical trials for their potential therapeutic benefit in the diagnosis and treatment of gliomas. In this review, we discuss the role of LGICs in the pathogenesis of glioma, including genetic factors and the effect of altered LGIC activity on the biological functioning of neuronal cells. Additionally, we discuss current and emerging investigations regarding the use of LGICs as a clinical target and potential therapeutic for gliomas. Full article

(This article belongs to the Section Mechanisms of Diseases)

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13 pages, 1747 KiB

Open AccessEditor’s ChoiceReview

Predicting Hospital Ward Admission from the Emergency Department: A Systematic Review

by Nekane Larburu, Laiene Azkue and Jon Kerexeta

J. Pers. Med. 2023, 13(5), 849; https://doi.org/10.3390/jpm13050849 - 18 May 2023

Cited by 9 | Viewed by 3101

Abstract

Background: The emergency department (ED) is often overburdened, due to the high influx of patients and limited availability of attending physicians. This situation highlights the need for improvement in the management of, and assistance provided in the ED. A key point for this [...] Read more.

Background: The emergency department (ED) is often overburdened, due to the high influx of patients and limited availability of attending physicians. This situation highlights the need for improvement in the management of, and assistance provided in the ED. A key point for this purpose is the identification of patients with the highest risk, which can be achieved using machine learning predictive models. The objective of this study is to conduct a systematic review of predictive models used to detect ward admissions from the ED. The main targets of this review are the best predictive algorithms, their predictive capacity, the studies’ quality, and the predictor variables. Methods: This review is based on PRISMA methodology. The information has been searched in PubMed, Scopus and Google Scholar databases. Quality assessment has been performed using the QUIPS tool. Results: Through the advanced search, a total of 367 articles were found, of which 14 were of interest that met the inclusion criteria. Logistic regression is the most used predictive model, achieving AUC values between 0.75–0.92. The two most used variables are the age and ED triage category. Conclusions: artificial intelligence models can contribute to improving the quality of care in the ED and reducing the burden on healthcare systems. Full article

(This article belongs to the Collection Advances of Emergency and Intensive Care)

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19 pages, 359 KiB

Open AccessEditor’s ChoiceReview

Cortisol and the Dexamethasone Suppression Test as a Biomarker for Melancholic Depression: A Narrative Review

by Martin M. Schumacher and Jacopo Santambrogio

J. Pers. Med. 2023, 13(5), 837; https://doi.org/10.3390/jpm13050837 - 16 May 2023

Cited by 11 | Viewed by 5286

Abstract

The dexamethasone suppression test (DST) assesses the functionality of the HPA axis and can be regarded as the first potential biomarker in psychiatry. In 1981, a group of researchers at the University of Michigan published a groundbreaking paper regarding its use for diagnosing [...] Read more.

The dexamethasone suppression test (DST) assesses the functionality of the HPA axis and can be regarded as the first potential biomarker in psychiatry. In 1981, a group of researchers at the University of Michigan published a groundbreaking paper regarding its use for diagnosing melancholic depression, reporting a diagnostic sensitivity of 67% and a specificity of 95%. While this study generated much enthusiasm and high expectations in the field of biological psychiatry, subsequent studies produced equivocal results, leading to the test being rejected by the American Psychiatric Association. The scientific reasons leading to the rise and fall of the DST are assessed in this review, suggestions are provided as to how the original test can be improved, and its potential applications in clinical psychiatry are discussed. An improved, standardized, and validated version of the DST would be a biologically meaningful and useful biomarker in psychiatry, providing a tool for clinicians caring for depressed patients in the areas of diagnosis, treatment, and prognosis, and predicting the risk of suicide. Additionally, such a test could be a crucial part in the generation of biologically homogenous patient cohorts, necessary for the successful development of new psychotropic medications. Full article

(This article belongs to the Special Issue Biomarkers in Psychiatric Disorders)

12 pages, 299 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Precision Medicine in Fatty Liver Disease/Non-Alcoholic Fatty Liver Disease

by Laura Valenzuela-Vallejo, Despina Sanoudou and Christos S. Mantzoros

J. Pers. Med. 2023, 13(5), 830; https://doi.org/10.3390/jpm13050830 - 14 May 2023

Cited by 17 | Viewed by 4177

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease, and is related to fatal and non-fatal liver, metabolic, and cardiovascular complications. Its non-invasive diagnosis and effective treatment remain an unmet clinical need. NAFLD is a heterogeneous disease that is most [...] Read more.

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease, and is related to fatal and non-fatal liver, metabolic, and cardiovascular complications. Its non-invasive diagnosis and effective treatment remain an unmet clinical need. NAFLD is a heterogeneous disease that is most commonly present in the context of metabolic syndrome and obesity, but not uncommonly, may also be present without metabolic abnormalities and in subjects with normal body mass index. Therefore, a more specific pathophysiology-based subcategorization of fatty liver disease (FLD) is needed to better understand, diagnose, and treat patients with FLD. A precision medicine approach for FLD is expected to improve patient care, decrease long-term disease outcomes, and develop better-targeted, more effective treatments. We present herein a precision medicine approach for FLD based on our recently proposed subcategorization, which includes the metabolic-associated FLD (MAFLD) (i.e., obesity-associated FLD (OAFLD), sarcopenia-associated FLD (SAFLD, and lipodystrophy-associated FLD (LAFLD)), genetics-associated FLD (GAFLD), FLD of multiple/unknown causes (XAFLD), and combined causes of FLD (CAFLD) as well as advanced stage fibrotic FLD (FAFLD) and end-stage FLD (ESFLD) subcategories. These and other related advances, as a whole, are expected to enable not only improved patient care, quality of life, and long-term disease outcomes, but also a considerable reduction in healthcare system costs associated with FLD, along with more options for better-targeted, more effective treatments in the near future. Full article

(This article belongs to the Special Issue From Basic to Clinical Research: Toward Precision Medicine for Metabolic Diseases)

16 pages, 340 KiB

Open AccessEditor’s ChoiceReview

Lung and Gut Microbiome in COPD

by Efstathios Karakasidis, Ourania S. Kotsiou and Konstantinos I. Gourgoulianis

J. Pers. Med. 2023, 13(5), 804; https://doi.org/10.3390/jpm13050804 - 8 May 2023

Cited by 15 | Viewed by 4075

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. The association between lung and gut microbiomes in the pathogenesis of COPD has been recently uncovered. The goal of this study was to discuss the role of the lung [...] Read more.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. The association between lung and gut microbiomes in the pathogenesis of COPD has been recently uncovered. The goal of this study was to discuss the role of the lung and gut microbiomes in COPD pathophysiology. A systematic search of the PubMed database for relevant articles submitted up to June 2022 was performed. We examined the association between the lung and gut microbiome dysbiosis, reflected in bronchoalveolar lavage (BAL), lung tissue, sputum, and feces samples, and the pathogenesis and progression of COPD. It is evident that the lung and gut microbiomes affect each other and both play a vital role in the pathogenesis of COPD. However, more research needs to be carried out to find the exact associations between microbiome diversity and COPD pathophysiology and exacerbation genesis. Another field that research should focus on is the impact of treatment interventions targeting the human microbiome in preventing COPD genesis and progression. Full article

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

19 pages, 893 KiB

Open AccessEditor’s ChoiceReview

CmPn/CmP Signaling Networks in the Maintenance of the Blood Vessel Barrier

by Revathi Gnanasekaran, Justin Aickareth, Majd Hawwar, Nickolas Sanchez, Jacob Croft and Jun Zhang

J. Pers. Med. 2023, 13(5), 751; https://doi.org/10.3390/jpm13050751 - 28 Apr 2023

Cited by 5 | Viewed by 3125

Abstract

Cerebral cavernous malformations (CCMs) arise when capillaries within the brain enlarge abnormally, causing the blood–brain barrier (BBB) to break down. The BBB serves as a sophisticated interface that controls molecular interactions between the bloodstream and the central nervous system. The neurovascular unit (NVU) [...] Read more.

Cerebral cavernous malformations (CCMs) arise when capillaries within the brain enlarge abnormally, causing the blood–brain barrier (BBB) to break down. The BBB serves as a sophisticated interface that controls molecular interactions between the bloodstream and the central nervous system. The neurovascular unit (NVU) is a complex structure made up of neurons, astrocytes, endothelial cells (ECs), pericytes, microglia, and basement membranes, which work together to maintain blood–brain barrier (BBB) permeability. Within the NVU, tight junctions (TJs) and adherens junctions (AJs) between endothelial cells play a critical role in regulating the permeability of the BBB. Disruptions to these junctions can compromise the BBB, potentially leading to a hemorrhagic stroke. Understanding the molecular signaling cascades that regulate BBB permeability through EC junctions is, therefore, essential. New research has demonstrated that steroids, including estrogens (ESTs), glucocorticoids (GCs), and metabolites/derivatives of progesterone (PRGs), have multifaceted effects on blood–brain barrier (BBB) permeability by regulating the expression of tight junctions (TJs) and adherens junctions (AJs). They also have anti-inflammatory effects on blood vessels. PRGs, in particular, have been found to play a significant role in maintaining BBB integrity. PRGs act through a combination of its classic and non-classic PRG receptors (nPR/mPR), which are part of a signaling network known as the CCM signaling complex (CSC). This network couples both nPR and mPR in the CmPn/CmP pathway in endothelial cells (ECs). Full article

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20 pages, 890 KiB

Open AccessEditor’s ChoiceReview

Review of Endometrial Receptivity Array: A Personalized Approach to Embryo Transfer and Its Clinical Applications

by Sarah C. Rubin, Mawerdi Abdulkadir, Joshua Lewis, Aleksandr Harutyunyan, Rahim Hirani and Cara L. Grimes

J. Pers. Med. 2023, 13(5), 749; https://doi.org/10.3390/jpm13050749 - 27 Apr 2023

Cited by 18 | Viewed by 7008

Abstract

Successful outcomes of in vitro fertilization (IVF) rely on both the formation of a chromosomally normal embryo and its implantation in a receptive endometrium. Pre-implantation genetic testing for aneuploidy (PGT-A) has been widely accepted as a tool to assess the viability of an [...] Read more.

Successful outcomes of in vitro fertilization (IVF) rely on both the formation of a chromosomally normal embryo and its implantation in a receptive endometrium. Pre-implantation genetic testing for aneuploidy (PGT-A) has been widely accepted as a tool to assess the viability of an embryo. In 2011, the endometrial receptivity array (ERA) was first published as a tool to determine when the endometrium is most receptive to an embryo, commonly referred to as the “window of implantation” (WOI). The ERA uses molecular arrays to assess proliferation and differentiation in the endometrium and screens for inflammatory markers. Unlike PGT-A, there has been dissent within the field concerning the efficacy of the ERA. Many studies that contest the success of the ERA found that it did not improve pregnancy outcomes in patients with an already-good prognosis. Alternatively, studies that utilized the ERA in patients with repeated implantation failure (RIF) and transfer of known euploid embryos demonstrated improved outcomes. This review aims to describe the ERA as a novel technique, review the various settings that the ERA may be used in, such as natural frozen embryo transfer (nFET) and hormone replacement therapy frozen embryo transfer (HRT-FET), and provide a summary of the recent clinical data for embryo transfers in patients with RIF utilizing the ERA. Full article

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

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14 pages, 2087 KiB

Open AccessEditor’s ChoiceReview

The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients

by Tatiana Bolgeo, Antonio Maconi, Menada Gardalini, Denise Gatti, Roberta Di Matteo, Marco Lapidari, Yaroslava Longhitano, Gabriele Savioli, Andrea Piccioni and Christian Zanza

J. Pers. Med. 2023, 13(5), 736; https://doi.org/10.3390/jpm13050736 - 26 Apr 2023

Cited by 25 | Viewed by 6609

Abstract

Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been [...] Read more.

Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the ‘Scale for the Assessment of Narrative Review Articles’ (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses. Full article

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12 pages, 296 KiB

Open AccessEditor’s ChoiceReview

Parathyroid Hormone (PTH)-Related Peptides Family: An Intriguing Role in the Central Nervous System

by Cristina Dettori, Francesca Ronca, Marco Scalese and Federica Saponaro

J. Pers. Med. 2023, 13(5), 714; https://doi.org/10.3390/jpm13050714 - 24 Apr 2023

Cited by 10 | Viewed by 3924

Abstract

Parathyroid Hormone (PTH) plays a crucial role in the maintenance of calcium homeostasis directly acting on bone and kidneys and indirectly on the intestine. However, a large family of PTH-related peptides exists that exerts other physiological effects on different tissues and organs, such [...] Read more.

Parathyroid Hormone (PTH) plays a crucial role in the maintenance of calcium homeostasis directly acting on bone and kidneys and indirectly on the intestine. However, a large family of PTH-related peptides exists that exerts other physiological effects on different tissues and organs, such as the Central Nervous System (CNS). In humans, PTH-related peptides are Parathyroid Hormone (PTH), PTH-like hormones (PTHrP and PTHLH), and tuberoinfundibular peptide of 39 (TIP39 or PTH2). With different affinities, these ligands can bind parathyroid receptor type 1 (PTH1R) and type 2 (PTH2R), which are part of the type II G-protein-coupled-receptors (GPCRs) family. The PTH/PTHrP/PTH1R system has been found to be expressed in many areas of the brain (hippocampus, amygdala, hypothalamus, caudate nucleus, corpus callosum, subthalamic nucleus, thalamus, substantia nigra, cerebellum), and literature data suggest the system exercises a protective action against neuroinflammation and neurodegeneration, with positive effects on memory and hyperalgesia. TIP39 is a small peptide belonging to the PTH-related family with a high affinity for PTH2R in the CNS. The TIP39/PTH2R system has been proposed to mediate many regulatory and functional roles in the brain and to modulate auditory, nociceptive, and sexual maturation functions. This review aims to summarize the knowledge of PTH-related peptides distribution and functions in the CNS and to highlight the gaps that still need to be filled. Full article

15 pages, 987 KiB

Open AccessEditor’s ChoiceReview

Modulation of Ferroptosis by microRNAs in Human Cancer

by Irena Velkova, Martina Pasino, Zumama Khalid, Paola Menichini, Emanuele Martorana, Alberto Izzotti and Alessandra Pulliero

J. Pers. Med. 2023, 13(5), 719; https://doi.org/10.3390/jpm13050719 - 24 Apr 2023

Cited by 14 | Viewed by 2922

Abstract

Ferroptosis is a cell death pathway triggered by an imbalance between the production of oxidants and antioxidants, which plays an emerging role in tumorigenesis. It is mainly regulated at three different levels including iron metabolism, the antioxidant response, and lipid metabolism. Epigenetic dysregulation [...] Read more.

Ferroptosis is a cell death pathway triggered by an imbalance between the production of oxidants and antioxidants, which plays an emerging role in tumorigenesis. It is mainly regulated at three different levels including iron metabolism, the antioxidant response, and lipid metabolism. Epigenetic dysregulation is a “hallmark” of human cancer, with nearly half of all human cancers harboring mutations in epigenetic regulators such as microRNA. While being the crucial player in controlling gene expression at the mRNA level, microRNAs have recently been shown to modulate cancer growth and development via the ferroptosis pathway. In this scenario, some miRNAs have a function in upregulating, while others play a role in inhibiting ferroptosis activity. The investigation of validated targets using the miRBase, miRTarBase, and miRecords platforms identified 13 genes that appeared enriched for iron metabolism, lipid peroxidation, and antioxidant defense; all are recognized contributors of tumoral suppression or progression phenotypes. This review summarizes and discuss the mechanism by which ferroptosis is initiated through an imbalance in the three pathways, the potential function of microRNAs in the control of this process, and a description of the treatments that have been shown to have an impact on the ferroptosis in cancer along with potential novel effects. Full article

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

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19 pages, 349 KiB

Open AccessEditor’s ChoiceReview

Utilization of Circulating Tumor Cells in the Management of Solid Tumors

by Peter C. Kurniali, Michael H. Storandt and Zhaohui Jin

J. Pers. Med. 2023, 13(4), 694; https://doi.org/10.3390/jpm13040694 - 20 Apr 2023

Cited by 8 | Viewed by 2774

Abstract

Circulating tumor cells (CTCs) are tumor cells shed from the primary tumor into circulation, with clusters of CTCs responsible for cancer metastases. CTC detection and isolation from the bloodstream are based on properties distinguishing CTCs from normal blood cells. Current CTC detection techniques [...] Read more.

Circulating tumor cells (CTCs) are tumor cells shed from the primary tumor into circulation, with clusters of CTCs responsible for cancer metastases. CTC detection and isolation from the bloodstream are based on properties distinguishing CTCs from normal blood cells. Current CTC detection techniques can be divided into two main categories: label dependent, which depends upon antibodies that selectively bind cell surface antigens present on CTCs, or label-independent detection, which is detection based on the size, deformability, and biophysical properties of CTCs. CTCs may play significant roles in cancer screening, diagnosis, treatment navigation, including prognostication and precision medicine, and surveillance. In cancer screening, capturing and evaluating CTCs from peripheral blood could be a strategy to detect cancer at its earliest stage. Cancer diagnosis using liquid biopsy could also have tremendous benefits. Full utilization of CTCs in the clinical management of malignancies may be feasible in the near future; however, several challenges still exist. CTC assays currently lack adequate sensitivity, especially in early-stage solid malignancies, due to low numbers of detectable CTCs. As assays improve and more trials evaluate the clinical utility of CTC detection in guiding therapies, we anticipate increased use in cancer management. Full article

25 pages, 1615 KiB

Open AccessEditor’s ChoiceReview

The Role of BDNF as a Biomarker in Cognitive and Sensory Neurodegeneration

by Anna Pisani, Fabiola Paciello, Valeria Del Vecchio, Rita Malesci, Eugenio De Corso, Elena Cantone and Anna Rita Fetoni

J. Pers. Med. 2023, 13(4), 652; https://doi.org/10.3390/jpm13040652 - 10 Apr 2023

Cited by 50 | Viewed by 8226

Abstract

Brain-derived neurotrophic factor (BDNF) has a crucial function in the central nervous system and in sensory structures including olfactory and auditory systems. Many studies have highlighted the protective effects of BDNF in the brain, showing how it can promote neuronal growth and survival [...] Read more.

Brain-derived neurotrophic factor (BDNF) has a crucial function in the central nervous system and in sensory structures including olfactory and auditory systems. Many studies have highlighted the protective effects of BDNF in the brain, showing how it can promote neuronal growth and survival and modulate synaptic plasticity. On the other hand, conflicting data about BDNF expression and functions in the cochlear and in olfactory structures have been reported. Several clinical and experimental research studies showed alterations in BDNF levels in neurodegenerative diseases affecting the central and peripheral nervous system, suggesting that BDNF can be a promising biomarker in most neurodegenerative conditions, including Alzheimer’s disease, shearing loss, or olfactory impairment. Here, we summarize current research concerning BDNF functions in brain and in sensory domains (olfaction and hearing), focusing on the effects of the BDNF/TrkB signalling pathway activation in both physiological and pathological conditions. Finally, we review significant studies highlighting the possibility to target BDNF as a biomarker in early diagnosis of sensory and cognitive neurodegeneration, opening new opportunities to develop effective therapeutic strategies aimed to counteract neurodegeneration. Full article

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

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16 pages, 293 KiB

Open AccessEditor’s ChoiceReview

Active Surveillance for Prostate Cancer: Past, Current, and Future Trends

by Ivo I. de Vos, Henk B. Luiting and Monique J. Roobol

J. Pers. Med. 2023, 13(4), 629; https://doi.org/10.3390/jpm13040629 - 3 Apr 2023

Cited by 33 | Viewed by 5001

Abstract

In response to the rising incidence of indolent, low-risk prostate cancer (PCa) due to increased prostate-specific antigen (PSA) screening in the 1990s, active surveillance (AS) emerged as a treatment modality to combat overtreatment by delaying or avoiding unnecessary definitive treatment and its associated [...] Read more.

In response to the rising incidence of indolent, low-risk prostate cancer (PCa) due to increased prostate-specific antigen (PSA) screening in the 1990s, active surveillance (AS) emerged as a treatment modality to combat overtreatment by delaying or avoiding unnecessary definitive treatment and its associated morbidity. AS consists of regular monitoring of PSA levels, digital rectal exams, medical imaging, and prostate biopsies, so that definitive treatment is only offered when deemed necessary. This paper provides a narrative review of the evolution of AS since its inception and an overview of its current landscape and challenges. Although AS was initially only performed in a study setting, numerous studies have provided evidence for the safety and efficacy of AS which has led guidelines to recommend it as a treatment option for patients with low-risk PCa. For intermediate-risk disease, AS appears to be a viable option for those with favourable clinical characteristics. Over the years, the inclusion criteria, follow-up schedule and triggers for definitive treatment have evolved based on the results of various large AS cohorts. Given the burdensome nature of repeat biopsies, risk-based dynamic monitoring may further reduce overtreatment by avoiding repeat biopsies in selected patients. Full article

13 pages, 270 KiB

Open AccessEditor’s ChoiceReview

State of the Art and Challenges in Epilepsy—A Narrative Review

by Aida Mihaela Manole, Carmen Adella Sirbu, Mihaela Raluca Mititelu, Octavian Vasiliu, Lorenzo Lorusso, Octavian Mihai Sirbu and Florentina Ionita Radu

J. Pers. Med. 2023, 13(4), 623; https://doi.org/10.3390/jpm13040623 - 1 Apr 2023

Cited by 22 | Viewed by 6819

Abstract

Epilepsy is a common condition worldwide, with approximately 50 million people suffering from it. A single seizure does not mean epilepsy; almost 10% of the population can have a seizure during their lifetime. In particular, there are many other central nervous system disorders [...] Read more.

Epilepsy is a common condition worldwide, with approximately 50 million people suffering from it. A single seizure does not mean epilepsy; almost 10% of the population can have a seizure during their lifetime. In particular, there are many other central nervous system disorders other than epilepsy in which seizures occur, either transiently or as a comorbid condition. The impact of seizures and epilepsy is, therefore, widespread and easily underestimated. It is estimated that about 70% of patients with epilepsy could be seizure-free if correctly diagnosed and treated. However, for patients with epilepsy, quality of life is influenced not only by seizure control but also by antiepileptic drug-adverse reactions, access to education, mood, employment, and transportation. Full article

(This article belongs to the Special Issue Epilepsy: Pathogenesis, Treatment, and Precision Medicine)

14 pages, 1495 KiB

Open AccessEditor’s ChoiceReview

Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options

by Peter Sklienka, Michal Frelich and Filip Burša

J. Pers. Med. 2023, 13(4), 593; https://doi.org/10.3390/jpm13040593 - 28 Mar 2023

Cited by 17 | Viewed by 9974

Abstract

Patient self-inflicted lung injury (P-SILI) is a life-threatening condition arising from excessive respiratory effort and work of breathing in patients with lung injury. The pathophysiology of P-SILI involves factors related to the underlying lung pathology and vigorous respiratory effort. P-SILI might develop both [...] Read more.

Patient self-inflicted lung injury (P-SILI) is a life-threatening condition arising from excessive respiratory effort and work of breathing in patients with lung injury. The pathophysiology of P-SILI involves factors related to the underlying lung pathology and vigorous respiratory effort. P-SILI might develop both during spontaneous breathing and mechanical ventilation with preserved spontaneous respiratory activity. In spontaneously breathing patients, clinical signs of increased work of breathing and scales developed for early detection of potentially harmful effort might help clinicians prevent unnecessary intubation, while, on the contrary, identifying patients who would benefit from early intubation. In mechanically ventilated patients, several simple non-invasive methods for assessing the inspiratory effort exerted by the respiratory muscles were correlated with respiratory muscle pressure. In patients with signs of injurious respiratory effort, therapy aimed to minimize this problem has been demonstrated to prevent aggravation of lung injury and, therefore, improve the outcome of such patients. In this narrative review, we accumulated the current information on pathophysiology and early detection of vigorous respiratory effort. In addition, we proposed a simple algorithm for prevention and treatment of P-SILI that is easily applicable in clinical practice. Full article

(This article belongs to the Special Issue Precision Medicine for Acute Respiratory Distress Syndrome (ARDS))

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18 pages, 1310 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review

by Jenna Goff, Morgan Hina, Nayaab Malik, Hannah McLardy, Finley Reilly, Matthew Robertson, Louis Ruddy, Faith Willox and Patrice Forget

J. Pers. Med. 2023, 13(3), 500; https://doi.org/10.3390/jpm13030500 - 10 Mar 2023

Cited by 15 | Viewed by 6745

Abstract

Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not [...] Read more.

Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not been adequately described. Methods: We conducted a narrative literature review aiming to provide a comprehensive understanding of nociception and pain and its context within the field of OFA. Physiological (including monitoring), pharmacological, procedural (type of surgery), genetical and phenotypical (including patients’ conditions) were considered. Results: We did not find any monitoring robustly associated with improved outcomes. However, we found evidence supporting particular OFA indications, such as bariatric and cancer surgery. We found that vulnerable patients may benefit more from OFA, with an interesting field of research in patients suffering from vascular disease. We found a variety of techniques and medications making it impossible to consider OFA as a single technique. Our findings suggest that a vast field of research remains unexplored. In particular, a deeper understanding of nociception with an interest in its genetic and acquired contributors would be an excellent starting point paving the way for personalised OFA. Conclusion: Recent developments in OFA may present a more holistic approach, challenging the use of opioids. Understanding better nociception, given the variety of OFA techniques, may help to maximize their potential in different contexts and potential indications. Full article

(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)

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18 pages, 7933 KiB

Open AccessEditor’s ChoiceReview

Predicting the Onset of Diabetes with Machine Learning Methods

by Chun-Yang Chou, Ding-Yang Hsu and Chun-Hung Chou

J. Pers. Med. 2023, 13(3), 406; https://doi.org/10.3390/jpm13030406 - 24 Feb 2023

Cited by 75 | Viewed by 9034

Abstract

The number of people suffering from diabetes in Taiwan has continued to rise in recent years. According to the statistics of the International Diabetes Federation, about 537 million people worldwide (10.5% of the global population) suffer from diabetes, and it is estimated that [...] Read more.

The number of people suffering from diabetes in Taiwan has continued to rise in recent years. According to the statistics of the International Diabetes Federation, about 537 million people worldwide (10.5% of the global population) suffer from diabetes, and it is estimated that 643 million people will develop the condition (11.3% of the total population) by 2030. If this trend continues, the number will jump to 783 million (12.2%) by 2045. At present, the number of people with diabetes in Taiwan has reached 2.18 million, with an average of one in ten people suffering from the disease. In addition, according to the Bureau of National Health Insurance in Taiwan, the prevalence rate of diabetes among adults in Taiwan has reached 5% and is increasing each year. Diabetes can cause acute and chronic complications that can be fatal. Meanwhile, chronic complications can result in a variety of disabilities or organ decline. If holistic treatments and preventions are not provided to diabetic patients, it will lead to the consumption of more medical resources and a rapid decline in the quality of life of society as a whole. In this study, based on the outpatient examination data of a Taipei Municipal medical center, 15,000 women aged between 20 and 80 were selected as the subjects. These women were patients who had gone to the medical center during 2018–2020 and 2021–2022 with or without the diagnosis of diabetes. This study investigated eight different characteristics of the subjects, including the number of pregnancies, plasma glucose level, diastolic blood pressure, sebum thickness, insulin level, body mass index, diabetes pedigree function, and age. After sorting out the complete data of the patients, this study used Microsoft Machine Learning Studio to train the models of various kinds of neural networks, and the prediction results were used to compare the predictive ability of the various parameters for diabetes. Finally, this study found that after comparing the models using two-class logistic regression as well as the two-class neural network, two-class decision jungle, or two-class boosted decision tree for prediction, the best model was the two-class boosted decision tree, as its area under the curve could reach a score of 0.991, which was better than other models. Full article

(This article belongs to the Special Issue Applications of Machine Learning and Deep Learning in Precision Medicine)

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18 pages, 472 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Pharmacogenetics in the Treatment of Huntington’s Disease: Review and Future Perspectives

by Xandra García-González, Esther Cubo, Lucía Simón-Vicente, Natividad Mariscal, Raquel Alcaraz, Laura Aguado, Jéssica Rivadeneyra-Posadas, Antonio Sanz-Solas and Miriam Saiz-Rodríguez

J. Pers. Med. 2023, 13(3), 385; https://doi.org/10.3390/jpm13030385 - 22 Feb 2023

Cited by 13 | Viewed by 6625

Abstract

Huntington’s disease (HD) is an autosomal dominant progressive brain disorder, caused by a pathological expansion of a CAG repeat that encodes the huntingtin gene. This genetic neurodegenerative rare disease is characterized by cognitive, motor, and neuropsychiatric manifestations. The aim of the treatment is [...] Read more.

Huntington’s disease (HD) is an autosomal dominant progressive brain disorder, caused by a pathological expansion of a CAG repeat that encodes the huntingtin gene. This genetic neurodegenerative rare disease is characterized by cognitive, motor, and neuropsychiatric manifestations. The aim of the treatment is symptomatic and addresses the hyperkinetic disorders (chorea, dystonia, myoclonus, tics, etc.) and the behavioural and cognitive disturbances (depression, anxiety, psychosis, etc.) associated with the disease. HD is still a complex condition in need of innovative and efficient treatment. The long-term goal of pharmacogenetic studies is to use genotype data to predict the effective treatment response to a specific drug and, in turn, prevent potential undesirable effects of its administration. Chorea, depression, and psychotic symptoms have a substantial impact on HD patients’ quality of life and could be better controlled with the help of pharmacogenetic knowledge. We aimed to carry out a review of the available publications and evidence related to the pharmacogenetics of HD, with the objective of compiling all information that may be useful in optimizing drug administration. The impact of pharmacogenetic information on the response to antidepressants and antipsychotics is well documented in psychiatric patients, but this approach has not been investigated in HD patients. Future research should address several issues to ensure that pharmacogenetic clinical use is appropriately supported, feasible, and applicable. Full article

(This article belongs to the Special Issue Precision Medicine Genomics: Pharmacogenomics)

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17 pages, 1891 KiB

Open AccessEditor’s ChoiceReview

An Overview of Specific Considerations in Chronic Venous Disease and Iliofemoral Venous Stenting

by Taimur Saleem

J. Pers. Med. 2023, 13(2), 331; https://doi.org/10.3390/jpm13020331 - 15 Feb 2023

Cited by 6 | Viewed by 2848

Abstract

Unlike arterial disease, chronic venous disease (CVD) is rarely life-threatening or limb-threatening. However, it can impose substantial morbidity on patients by influencing their lifestyle and quality of life (QoL). The aim of this nonsystematic narrative review is to provide an overview of the [...] Read more.

Unlike arterial disease, chronic venous disease (CVD) is rarely life-threatening or limb-threatening. However, it can impose substantial morbidity on patients by influencing their lifestyle and quality of life (QoL). The aim of this nonsystematic narrative review is to provide an overview of the most recent information on the management of CVD and specifically, iliofemoral venous stenting in the context of personalized considerations for specific patient populations. The philosophy of treating CVD and phases of endovenous iliac stenting are also described in this review. Additionally, the use of intravascular ultrasound is described as the preferred operative diagnostic procedural tool for iliofemoral venous stent placement. Full article

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

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27 pages, 419 KiB

Open AccessEditor’s ChoiceReview

Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence

by Rosa Méndez Hernández and Fernando Ramasco Rueda

J. Pers. Med. 2023, 13(2), 333; https://doi.org/10.3390/jpm13020333 - 15 Feb 2023

Cited by 35 | Viewed by 7730

Abstract

A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision [...] Read more.

A biomarker is a molecule that can be measured in a biological sample in an objective, systematic, and precise way, whose levels indicate whether a process is normal or pathological. Knowing the most important biomarkers and their characteristics is the key to precision medicine in intensive and perioperative care. Biomarkers can be used to diagnose, in assessment of disease severity, to stratify risk, to predict and guide clinical decisions, and to guide treatments and response to them. In this review, we will analyze what characteristics a biomarker should have and how to ensure its usefulness, and we will review the biomarkers that in our opinion can make their knowledge more useful to the reader in their clinical practice, with a future perspective. These biomarkers, in our opinion, are lactate, C-Reactive Protein, Troponins T and I, Brain Natriuretic Peptides, Procalcitonin, MR-ProAdrenomedullin and BioAdrenomedullin, Neutrophil/lymphocyte ratio and lymphopenia, Proenkephalin, NefroCheck, Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin 6, Urokinase-type soluble plasminogen activator receptor (suPAR), Presepsin, Pancreatic Stone Protein (PSP), and Dipeptidyl peptidase 3 (DPP3). Finally, we propose an approach to the perioperative evaluation of high-risk patients and critically ill patients in the Intensive Care Unit (ICU) based on biomarkers. Full article

(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)

40 pages, 1012 KiB

Open AccessEditor’s ChoiceReview

Systemic Cytokines in Retinopathy of Prematurity

by Po-Yi Wu, Yuan-Kai Fu, Rey-In Lien, Ming-Chou Chiang, Chien-Chung Lee, Hung-Chi Chen, Yi-Jen Hsueh, Kuan-Jen Chen, Nan-Kai Wang, Laura Liu, Yen-Po Chen, Yih-Shiou Hwang, Chi-Chun Lai and Wei-Chi Wu

J. Pers. Med. 2023, 13(2), 291; https://doi.org/10.3390/jpm13020291 - 5 Feb 2023

Cited by 21 | Viewed by 4351

Abstract

Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved [...] Read more.

Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved in ROP pathogenesis. The two-phase (vaso-obliteration followed by vasoproliferation) theory outlines the evaluation of cytokines in a time-dependent manner. Levels of cytokines may even differ between the blood and the vitreous. Data from animal models of oxygen-induced retinopathy are also valuable. Although conventional cryotherapy and laser photocoagulation are well established and anti-vascular endothelial growth factor agents are available, less destructive novel therapeutics that can precisely target the signaling pathways are required. Linking the cytokines involved in ROP to other maternal and neonatal diseases and conditions provides insights into the management of ROP. Suppressing disordered retinal angiogenesis via the modulation of hypoxia-inducible factor, supplementation of insulin-like growth factor (IGF)-1/IGF-binding protein 3 complex, erythropoietin, and its derivatives, polyunsaturated fatty acids, and inhibition of secretogranin III have attracted the attention of researchers. Recently, gut microbiota modulation, non-coding RNAs, and gene therapies have shown promise in regulating ROP. These emerging therapeutics can be used to treat preterm infants with ROP. Full article

(This article belongs to the Special Issue Clinical and Translational Research in Ophthalmology)

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23 pages, 843 KiB

Open AccessEditor’s ChoiceReview

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

by Guido Gembillo, Sebastiano Calimeri, Valeria Tranchida, Salvatore Silipigni, Davide Vella, Domenico Ferrara, Claudia Spinella, Domenico Santoro and Luca Visconti

J. Pers. Med. 2023, 13(2), 286; https://doi.org/10.3390/jpm13020286 - 3 Feb 2023

Cited by 19 | Viewed by 14375

Abstract

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has [...] Read more.

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies. Full article

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

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17 pages, 1736 KiB

Open AccessEditor’s ChoiceReview

Homologous Recombination Deficiency in Ovarian Cancer: from the Biological Rationale to Current Diagnostic Approaches

by Alessandro Mangogna, Giada Munari, Francesco Pepe, Edoardo Maffii, Pierluigi Giampaolino, Giuseppe Ricci, Matteo Fassan, Umberto Malapelle and Stefania Biffi

J. Pers. Med. 2023, 13(2), 284; https://doi.org/10.3390/jpm13020284 - 2 Feb 2023

Cited by 24 | Viewed by 7772

Abstract

The inability to efficiently repair DNA double-strand breaks using the homologous recombination repair pathway is defined as homologous recombination deficiency (HRD). This molecular phenotype represents a positive predictive biomarker for the clinical use of poly (adenosine diphosphate [ADP]-ribose) polymerase inhibitors and platinum-based chemotherapy [...] Read more.

The inability to efficiently repair DNA double-strand breaks using the homologous recombination repair pathway is defined as homologous recombination deficiency (HRD). This molecular phenotype represents a positive predictive biomarker for the clinical use of poly (adenosine diphosphate [ADP]-ribose) polymerase inhibitors and platinum-based chemotherapy in ovarian cancers. However, HRD is a complex genomic signature, and different methods of analysis have been developed to introduce HRD testing in the clinical setting. This review describes the technical aspects and challenges related to HRD testing in ovarian cancer and outlines the potential pitfalls and challenges that can be encountered in HRD diagnostics. Full article

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

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14 pages, 325 KiB

Open AccessEditor’s ChoiceReview

Evaluation of Nociception during Pediatric Surgery: A Topical Review

by Gianluca Bertolizio, Marta Garbin and Pablo M. Ingelmo

J. Pers. Med. 2023, 13(2), 260; https://doi.org/10.3390/jpm13020260 - 30 Jan 2023

Cited by 7 | Viewed by 3946

Abstract

The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to [...] Read more.

The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to “reliably” detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to give an overview of the most up-to-date information available in the literature on current nociceptor monitors available in clinical practice, with particular focus on their applications in pediatrics. Full article

(This article belongs to the Special Issue New Paradigms in Anesthesia and Intensive Care)

16 pages, 662 KiB

Open AccessEditor’s ChoiceReview

How Wearable Sensors Can Support the Research on Foetal and Pregnancy Outcomes: A Scoping Review

by Andrea Maugeri, Martina Barchitta and Antonella Agodi

J. Pers. Med. 2023, 13(2), 218; https://doi.org/10.3390/jpm13020218 - 26 Jan 2023

Cited by 15 | Viewed by 4148

Abstract

The application of innovative technologies, and in particular of wearable devices, can potentially transform the field of antenatal care with the aim of improving maternal and new-born health through a personalized approach. The present study undertakes a scoping review to systematically map the [...] Read more.

The application of innovative technologies, and in particular of wearable devices, can potentially transform the field of antenatal care with the aim of improving maternal and new-born health through a personalized approach. The present study undertakes a scoping review to systematically map the literature about the use wearable sensors in the research of foetal and pregnancy outcomes. Online databases were used to identify papers published between 2000–2022, from which we selected 30 studies: 9 on foetal outcomes and 21 on maternal outcomes. Included studies focused primarily on the use of wearable devices for monitoring foetal vital signs (e.g., foetal heart rate and movements) and maternal activity during pregnancy (e.g., sleep patterns and physical activity levels). There were many studies that focused on development and/or validation of wearable devices, even if often they included a limited number of pregnant women without pregnancy complications. Although their findings support the potential adoption of wearable devices for both antenatal care and research, there is still insufficient evidence to design effective interventions. Therefore, high quality research is needed to determine which and how wearable devices could support antenatal care. Full article

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

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20 pages, 1270 KiB

Open AccessEditor’s ChoiceReview

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

by Oana Sirbu, Victorita Sorodoc, Mariana Floria, Cristian Statescu, Radu Sascau, Catalina Lionte, Ovidiu Rusalim Petris, Raluca Ecaterina Haliga, Paula Cristina Morariu, Andreea Tirnoveanu, Vladut Mirel Burduloi, Corina Ursulescu and Laurentiu Sorodoc

J. Pers. Med. 2023, 13(2), 202; https://doi.org/10.3390/jpm13020202 - 23 Jan 2023

Cited by 6 | Viewed by 3472

Abstract

Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary [...] Read more.

Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease. Full article

(This article belongs to the Collection Advances of Emergency and Intensive Care)

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26 pages, 962 KiB

Open AccessEditor’s ChoiceReview

The Effect of Interventions on Preventing Musculoskeletal Injuries Related to Nurses Work: Systematic Review

by Armando David Sousa, Cristina Lavareda Baixinho, Maria Helena Presado and Maria Adriana Henriques

J. Pers. Med. 2023, 13(2), 185; https://doi.org/10.3390/jpm13020185 - 20 Jan 2023

Cited by 17 | Viewed by 9664

Abstract

Background: The 12-month prevalence of musculoskeletal disorders related to work (MDRW) in nurses rests between 71.8% to 84%, so it is urgent to develop preventive intervention programs with the purpose of avoiding negative physical, psychological, socioeconomic, and working aspects. There are several intervention [...] Read more.

Background: The 12-month prevalence of musculoskeletal disorders related to work (MDRW) in nurses rests between 71.8% to 84%, so it is urgent to develop preventive intervention programs with the purpose of avoiding negative physical, psychological, socioeconomic, and working aspects. There are several intervention programs aimed at preventing musculoskeletal disorders related to work for nurses, but few have successfully proven results. Despite the evidence pointing to the benefits of multidimensional intervention programs, it is essential to determine which interventions have positive effects on the prevention of this kind of disorder to create an effective intervention plan. Aim: This review intends to identify the different interventions adopted in the prevention of musculoskeletal disorders related to work in nurses and to compare the effectiveness of these interventions, providing the appropriate and scientific basis for building an intervention to prevent musculoskeletal disorders in nurses. Method: This Systematic Review was guided by the research question, “What are the effects of musculoskeletal disorders preventive interventions on nursing practice?” and carried out in different databases (MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials, SCOPUS, and Science Direct). Later, the results were submitted to the eligibility criteria, the appraisal quality of the papers, and the data synthesis was performed. Results: 13 articles were identified for analysis. The interventions implemented to control the risk were: training patient-handling devices; ergonomics education; involving the management chain; handling protocol/algorithms; acquiring ergonomics equipment; and no-manual lifting. Conclusions: The studies associated two or more interventions, the majority of which (11 studies) were training-handling devices and ergonomics education, therefore emerging as the most effective instruments in the prevention of MDRW. The studies did not associate interventions that cover all risk factors (individual, associated with the nature of the work, organizational, and psychological aspects). This systematic review can help with making recommendations for other studies that should associate organizational measures and prevention policies with physical exercise and other measures aimed at individual and psychosocial risk factors. Full article

(This article belongs to the Special Issue Advances in Personalized Nursing Care)

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17 pages, 1316 KiB

Open AccessEditor’s ChoiceReview

Updated Views in Targeted Therapy in the Patient with Non-Small Cell Lung Cancer

by Miguel A. Ortega, Leonel Pekarek, Fátima Navarro, Oscar Fraile-Martínez, Cielo García-Montero, Miguel Ángel Álvarez-Mon, Raúl Diez-Pedrero, María del Carmen Boyano-Adánez, Luis G. Guijarro, Silvestra Barrena-Blázquez, Ana M. Gómez-Lahoz, Sergio Haro, Mónica Arroyo, Jorge Monserrat, Miguel A. Saez and Melchor Alvarez-Mon

J. Pers. Med. 2023, 13(2), 167; https://doi.org/10.3390/jpm13020167 - 17 Jan 2023

Cited by 12 | Viewed by 4644

Abstract

Non-small cell lung cancer (NSCLC) is the most frequent form of lung cancer and represents a set of histological entities that have an ominous long-term prognosis, for example, adenocarcinoma, squamous carcinoma and large cell carcinoma. Both small cell and non-small cell lung cancer [...] Read more.

Non-small cell lung cancer (NSCLC) is the most frequent form of lung cancer and represents a set of histological entities that have an ominous long-term prognosis, for example, adenocarcinoma, squamous carcinoma and large cell carcinoma. Both small cell and non-small cell lung cancer are the main causes of oncological death and the oncological diseases with the highest incidence worldwide. With regard to clinical approaches for NSCLC, several advances have been achieved in diagnosis and treatment; the analysis of different molecular markers has led to the development of new targeted therapies that have improved the prognosis for selected patients. Despite this, most patients are diagnosed in an advanced stage, presenting a limited life expectancy with an ominous short-term prognosis. Numerous molecular alterations have been described in recent years, allowing for the development of therapies directed against specific therapeutic targets. The correct identification of the expression of different molecular markers has allowed for the individualization of treatment throughout the disease course, expanding the available therapeutic arsenal. The purpose of this article is to summarize the main characteristics of NSCLC and the advances that have occurred in the use of targeted therapies, thus explaining the limitations that have been observed in the management of this disease. Full article

(This article belongs to the Special Issue Immune-Mediated Diseases)

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16 pages, 1335 KiB

Open AccessEditor’s ChoiceReview

Insights into Personalised Medicine in Bronchiectasis

by Clementine S. Fraser and Ricardo J. José

J. Pers. Med. 2023, 13(1), 133; https://doi.org/10.3390/jpm13010133 - 10 Jan 2023

Cited by 7 | Viewed by 6329

Abstract

Bronchiectasis is a heterogenous disease with multiple aetiologies resulting in inflammation and dilatation of the airways with associated mucus production and chronic respiratory infection. The condition is being recognised ever more frequently as the availability of computed tomography increases. It is associated with [...] Read more.

Bronchiectasis is a heterogenous disease with multiple aetiologies resulting in inflammation and dilatation of the airways with associated mucus production and chronic respiratory infection. The condition is being recognised ever more frequently as the availability of computed tomography increases. It is associated with significant morbidity and healthcare-related costs. With new understanding of the disease process, varying endotypes, identification of underlying causes and treatable traits, the management of bronchiectasis can be increasingly personalised. Full article

(This article belongs to the Special Issue Treatment, Prevention and Multidisciplinarity of Respiratory Problems)

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17 pages, 873 KiB

Open AccessEditor’s ChoiceReview

Management of Hyponatremia in Heart Failure: Practical Considerations

by Victoriţa Şorodoc, Andreea Asaftei, Gabriela Puha, Alexandr Ceasovschih, Cătălina Lionte, Oana Sîrbu, Cristina Bologa, Raluca Ecaterina Haliga, Mihai Constantin, Adorata Elena Coman, Ovidiu Rusalim Petriș, Alexandra Stoica and Laurenţiu Şorodoc

J. Pers. Med. 2023, 13(1), 140; https://doi.org/10.3390/jpm13010140 - 10 Jan 2023

Cited by 8 | Viewed by 21957

Abstract

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of [...] Read more.

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans. Full article

(This article belongs to the Collection Advances of Emergency and Intensive Care)

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24 pages, 6394 KiB

Open AccessEditor’s ChoiceReview

Three-Dimensional Accuracy and Stability of Personalized Implants in Orthognathic Surgery: A Systematic Review and a Meta-Analysis

by Alexandru Diaconu, Michael Boelstoft Holte, Gabriele Berg-Beckhoff and Else Marie Pinholt

J. Pers. Med. 2023, 13(1), 125; https://doi.org/10.3390/jpm13010125 - 7 Jan 2023

Cited by 27 | Viewed by 3936

Abstract

This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six [...] Read more.

This systematic review aimed to determine the accuracy/stability of patient-specific osteosynthesis (PSI) in orthognathic surgery according to three-dimensional (3D) outcome analysis and in comparison to conventional osteosynthesis and computer-aided designed and manufactured (CAD/CAM) splints or wafers. The PRISMA guidelines were followed and six academic databases and Google Scholar were searched. Records reporting 3D accuracy/stability measurements of bony segments fixated with PSI were included. Of 485 initial records, 21 met the eligibility (566 subjects), nine of which also qualified for a meta-analysis (164 subjects). Six studies had a high risk of bias (29%), and the rest were of low or moderate risk. Procedures comprised either single-piece or segmental Le Fort I and/or mandibular osteotomy and/or genioplasty. A stratified meta-analysis including 115 subjects with single-piece Le Fort I PSI showed that the largest absolute mean deviations were 0.5 mm antero-posteriorly and 0.65° in pitch. PSIs were up to 0.85 mm and 2.35° more accurate than conventional osteosynthesis with CAD/CAM splint or wafer (p < 0.0001). However, the clinical relevance of the improved accuracy has not been shown. The literature on PSI for multi-piece Le Fort I, mandibular osteotomies and genioplasty procedure is characterized by high methodological heterogeneity and a lack of randomized controlled trials. The literature is lacking on the 3D stability of bony segments fixated with PSI. Full article

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

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16 pages, 979 KiB

Open AccessEditor’s ChoiceReview

Effectiveness of Augmented and Virtual Reality-Based Interventions in Improving Knowledge, Attitudes, Empathy and Stigma Regarding People with Mental Illnesses—A Scoping Review

by Jing Ling Tay, Huiting Xie and Kang Sim

J. Pers. Med. 2023, 13(1), 112; https://doi.org/10.3390/jpm13010112 - 4 Jan 2023

Cited by 28 | Viewed by 8321

Abstract

Interventions adopting augmented and virtual reality (AR/VR) modalities allow participants to explore and experience realistic scenarios, making them useful psycho-educational tools for mental illnesses. This scoping review aims to evaluate the effectiveness of AR/VR interventions in improving (1) knowledge, (2) attitudes, (3) empathy [...] Read more.

Interventions adopting augmented and virtual reality (AR/VR) modalities allow participants to explore and experience realistic scenarios, making them useful psycho-educational tools for mental illnesses. This scoping review aims to evaluate the effectiveness of AR/VR interventions in improving (1) knowledge, (2) attitudes, (3) empathy and (4) stigma regarding people with mental illnesses. Literature on published studies in English up till April 2022 was searched within several databases. Sixteen articles were included. The majority of studies were conducted in the West (93.8%), within undergraduates (68.8%) but also amongst high school students, patients, caregivers, public including online community, and covered conditions including psychotic illnesses, dementia, anxiety and depression. A preponderance of these included studies which employed AR/VR based interventions observed improvements in knowledge (66.7%), attitudes (62.5%), empathy (100%) and reduction of stigma (71.4%) pertaining to people with mental illnesses. In the context of relatively limited studies, extant AR/VR based interventions could potentially improve knowledge, attitudes, empathy and decrease stigma regarding people with mental illness. Further research needs to be conducted in larger and more diverse samples to investigate the relatively beneficial effects of different AR/VR modalities and the durability of observed improvements of relevant outcomes of interests over time for different mental conditions. Full article

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20 pages, 1459 KiB

Open AccessEditor’s ChoiceReview

Medical and Surgical Strategies in Vulvar Paget Disease: Let’s Throw Some Light!

by Luigi Della Corte, Valeria Cafasso, Carmine Conte, Lara Cuomo, Pierluigi Giampaolino, Giada Lavitola and Giuseppe Bifulco

J. Pers. Med. 2023, 13(1), 100; https://doi.org/10.3390/jpm13010100 - 1 Jan 2023

Cited by 8 | Viewed by 3127

Abstract

Background: Vulvar Paget’s disease (VPD) is defined as a neoplasm of epithelial origin, mostly in postmenopausal women. Due to the extreme rarity of VPD, limited data about recommended treatment options are available. Surgical excision has been the treatment of choice although in the [...] Read more.

Background: Vulvar Paget’s disease (VPD) is defined as a neoplasm of epithelial origin, mostly in postmenopausal women. Due to the extreme rarity of VPD, limited data about recommended treatment options are available. Surgical excision has been the treatment of choice although in the recent decade medical treatments have been proposed. Methods: A systematic computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 2003 to September 2022, in order to analyze all medical and surgical strategies used for the treatment of VPD. Results: Thirty-four articles were included in this review with findings as follows: 390 patients were treated with medical or other conservative treatment while 2802 patients were treated surgically; 235/434 (54%) patients had a complete response, 67/434 (15%) a partial response, 10/434 (2.3%) a stable disease, 3/434 (0.7%) disease progress, 3/434 (0.7%) died of the disease, 55/434 (13%) died of other causes during follow up while 7/434 (1.6%) had to stop topical treatments with 5% imiquimod cream because of side effects; 239/434 patients (55%) had a recurrence and 11/434 (2.5%) were lost to follow-up. The length of follow-up was variable, according to the different studies analyzed. Conclusion: VPD is a chronic disease with a high recurrence rate and low mortality. There are no significant differences in recurrence rates in patients who undergo surgery and those who do not and the margin status at the time of primary surgery and recurrence. Several surgical and medical approaches providing both local control of the disease and minimal tissue damage have been developed. Clock mapping, a recent preoperative vulvo-vaginal workup tool, can predict the invasiveness and the extension of VPD. However, to date, due to the different treatment options available and in the absence of a global consensus, it is critical to tailor treatments to individual patient characteristics and biopsy histopathologic findings, to ensure the best type of therapy. Full article

(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)

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Other

13 pages, 375 KiB

Open AccessEditor’s ChoiceSystematic Review

A Systematic Review of Congenital Insensitivity to Pain, a Rare Disease

by Raquel Rodríguez-Blanque, Laura Maria Nielsen, Beatriz Piqueras-Sola, Juan Carlos Sánchez-García, Celia Cortés-Martín, Andrés Reinoso-Cobo and Jonathan Cortés-Martín

J. Pers. Med. 2024, 14(6), 570; https://doi.org/10.3390/jpm14060570 - 26 May 2024

Cited by 5 | Viewed by 6531

Abstract

Introduction: Pain perception, far from being a pathological mechanism, is a crucial protective stimulus to prevent additional injuries. Any disturbance in this complex system poses significant risks to individuals, affecting their quality of life and even their survival. Objective: This review aims to [...] Read more.

Introduction: Pain perception, far from being a pathological mechanism, is a crucial protective stimulus to prevent additional injuries. Any disturbance in this complex system poses significant risks to individuals, affecting their quality of life and even their survival. Objective: This review aims to explore congenital insensitivity to pain, an extremely rare genetic disorder with an autosomal recessive pattern that results in the inability to perceive pain. We will focus on the well-known subtype, congenital insensitivity to pain with anhidrosis (CIPA). Our research seeks to update existing knowledge through a comprehensive literature review. Methodology: The review employs a systematic literature review, analyzing various sources and scientific documents, primarily emphasizing CIPA. The review follows the PROSPERO protocol, registered under CRD42023394489. The literature search was performed on the Scopus, PubMed, and Cinahl databases. Results: Our review reveals secondary complications associated with CIPA, such as recurrent bone fractures, temperature insensitivity, self-mutilation, and, occasionally, intellectual disabilities. The limited available information underscores the need for expanding our knowledge. Conclusions: In summary, CIPA, particularly, presents a significant medical challenge with adverse impacts on quality of life. Early diagnosis, education for families and healthcare professionals, and appropriate nursing care are essential for effective management. This review highlights the necessity of further research and awareness to enhance support for those affected. Full article

(This article belongs to the Section Mechanisms of Diseases)

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12 pages, 1128 KiB

Open AccessEditor’s ChoiceSystematic Review

Misdiagnosis and Clinical Insights into Acral Amelanotic Melanoma—A Systematic Review

by Fortunato Cassalia, Andrea Danese, Enrico Cocchi, Elisabetta Danese, Francesca Ambrogio, Gerardo Cazzato, Marcodomenico Mazza, Anna Zambello, Anna Belloni Fortina and Davide Melandri

J. Pers. Med. 2024, 14(5), 518; https://doi.org/10.3390/jpm14050518 - 13 May 2024

Cited by 7 | Viewed by 2489

Abstract

Background: Acral amelanotic melanomas (AAMs), a rare subset of melanomas located on acral sites such as the palms, soles, and subungual areas, are diagnostically challenging due to their lack of typical pigmentation and often benign clinical appearance. Misdiagnosis is common, leading to delays [...] Read more.

Background: Acral amelanotic melanomas (AAMs), a rare subset of melanomas located on acral sites such as the palms, soles, and subungual areas, are diagnostically challenging due to their lack of typical pigmentation and often benign clinical appearance. Misdiagnosis is common, leading to delays in treatment and potentially worse outcomes. This systematic review aims to synthesise evidence on cases of AAM initially misdiagnosed as other conditions, to better understand their clinical and epidemiological characteristics, diagnostic pitfalls, and management strategies. Methods: A comprehensive search of the MEDLINE/PubMed, EMBASE, and SCOPUS databases was conducted up to March 2024. Case reports and small case series of AAMs initially misdiagnosed as other conditions were included. Data on patient demographics, clinical presentation, and diagnostic methods were collected and analyzed. Results: Of the 152 records identified, 26 cases from 23 articles met the inclusion criteria. A demographic analysis revealed that the gender distribution appears to be perfectly balanced, with an age range of 38 to 91 years. Misdiagnoses included non-healing ulcers or traumatic lesions (37.5%), benign proliferative lesions (29.2%) and infectious lesions (20.8%). The foot was the most affected site (53.8%). Notably, a histological evaluation was performed in 50% of cases involving the upper extremities, in contrast to only 7.1% of cases involving the foot and 0% of cases of the heel. This discrepancy suggests a reluctance to perform biopsies in the lower extremities, which may contribute to a higher misdiagnosis rate in these areas. Conclusions: The underutilization of biopsy in the diagnosis of lower extremity lesions contributes significantly to the misdiagnosis and delay in treatment of AAMs. Especially when the clinical assessment and dermoscopy are inconclusive, biopsies of suspicious lesions are essential. Immunohistochemistry and markers such as PRAME are critical in differentiating melanoma from other malignancies such as clear cell sarcoma. This review highlights the need for increased vigilance and a proactive diagnostic approach to increase early detection rates and improve prognostic outcomes. Full article

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

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18 pages, 22167 KiB

Open AccessEditor’s ChoiceSystematic Review

Laparoscopic Management of Multiple Liver, Omental, Mesenteric, Peritoneal, and Round Ligament Hydatid Cysts—A Rare Report of a Case and a Systematic Literature Review

by Alin Mihetiu, Dan Georgian Bratu, Ciprian Tanasescu, Bogdan Ioan Vintilă, Alexandra Sandu, Mariana Sandu, Dragos Serban, Dan Sabau and Adrian Hasegan

J. Pers. Med. 2024, 14(2), 205; https://doi.org/10.3390/jpm14020205 - 14 Feb 2024

Cited by 9 | Viewed by 2562

Abstract

Hydatid cyst disease is a parasitic ailment with an endemic nature, predominantly affecting geographical areas with a tradition in animal husbandry. The most common localization of hydatid disease is in the liver (60%), followed by the lungs, with other organ localizations comprising less [...] Read more.

Hydatid cyst disease is a parasitic ailment with an endemic nature, predominantly affecting geographical areas with a tradition in animal husbandry. The most common localization of hydatid disease is in the liver (60%), followed by the lungs, with other organ localizations comprising less than 10%. The surgical approach to this condition can be carried out through open surgery or laparoscopy. The coexistence of hepatic and intraperitoneal hydatidosis often leads to the preference for open surgery. We performed a literature review aiming to retrieve data regarding demographic characteristics, clinical features, preoperative management, and surgical approach concerning these unusual localizations of hydatid disease. It was observed that the mesenteric localization frequently presented with acute abdominal pain (p = 0.038) and that the open approach was preferred in 85.71% of cases. Furthermore, an interdependence was identified between the localization of the cysts and the type of surgical approach (p = 0.001), with mesenteric localizations being approached through laparotomy and excision (p = 0.037), while omental localizations, due to the easier approach, benefited from laparoscopy with excision in 14.29% of cases. Overall, the laparoscopic approach was less frequently used, but its utilization resulted in a lower number of complications and faster recovery. Additionally, we present a rare case of hepatic and intra-abdominal hydatidosis, resolved exclusively through a laparoscopic approach, including a review of the literature for these uncommon localizations of hydatid disease. A 45-year-old patient diagnosed with multiple hydatid cysts, both hepatic and intraperitoneal, underwent surgical intervention with exploratory laparoscopy. Laparoscopic excision of peritoneal, epiploic, mesenteric cysts, and round ligament, along with laparoscopic inactivation, evacuation, and pericystectomy of hepatic hydatid cysts, was performed. The patient’s recovery was uneventful, and she was reevaluated at 3 and 9 months without signs of recurrence. The association of hepatic hydatid cysts with multiple intra-abdominal localizations is not commonly encountered. The treatment of choice is surgical and is predominantly conducted through open surgery. The presented case is unique due to the exclusive laparoscopic approach in the management of mixed hepatic and intra-abdominal hydatidosis. Full article

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

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22 pages, 1979 KiB

Open AccessEditor’s ChoiceSystematic Review

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

by Valerio Sveva, Giacomo Farì, Annatonia Fai, Alessio Savina, Mattia Giuseppe Viva, Francesco Agostini, Maurizio Ranieri, Marisa Megna, Massimiliano Mangone, Marco Paoloni and Andrea Bernetti

J. Pers. Med. 2024, 14(2), 154; https://doi.org/10.3390/jpm14020154 - 30 Jan 2024

Cited by 9 | Viewed by 4516

Abstract

Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic [...] Read more.

Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance. Full article

(This article belongs to the Special Issue Personalized Treatment for Musculoskeletal Diseases)

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20 pages, 3764 KiB

Open AccessEditor’s ChoiceSystematic Review

Sex Bias in Diagnostic Delay: Are Axial Spondyloarthritis and Ankylosing Spondylitis Still Phantom Diseases in Women? A Systematic Review and Meta-Analysis

by Francesca Bandinelli, Bianca Martinelli-Consumi, Mirko Manetti and Maria Sole Vallecoccia

J. Pers. Med. 2024, 14(1), 91; https://doi.org/10.3390/jpm14010091 - 13 Jan 2024

Cited by 8 | Viewed by 2097

Abstract

Diagnostic delay (DD) is associated with poor radiological and quality of life outcomes in axial spondyloarthritis (ax-SpA) and ankylosing spondylitis (AS). The female (F) population is often misdiagnosed, as classification criteria were previously studied mostly in males (M). We conducted a systematic review [...] Read more.

Diagnostic delay (DD) is associated with poor radiological and quality of life outcomes in axial spondyloarthritis (ax-SpA) and ankylosing spondylitis (AS). The female (F) population is often misdiagnosed, as classification criteria were previously studied mostly in males (M). We conducted a systematic review to investigate (i) the difference in DD between the sexes, the impact of HLA*B27 and clinical and social factors (work and education) on this gap, and (ii) the possible influence of the year of publication (before and after the 2009 ASAS classification criteria), geographical region (Europe and Israel vs. extra-European countries), sample sources (mono-center vs. multi-center studies), and world bank (WB) economic class on DD in both sexes. We searched, in PubMed and Embase, studies that reported the mean or median DD or the statistical difference in DD between sexes, adding a manual search. Starting from 399 publications, we selected 26 studies (17 from PubMed and Embase, 9 from manual search) that were successively evaluated with the modified Newcastle–Ottawa Scale (m-NOS). The mean DD of 16 high-quality (m-NOS > 4/8) studies, pooled with random-effects meta-analysis, produces results higher in F (1.48, 95% CI 0.83–2.14, p < 0.0001) but with significant results at the second analysis only in articles published before the 2009 ASAS classification criteria (0.95, 95% CI 0.05–1.85, p < 0.0001) and in extra-European countries (3.16, 95% CI 2.11–4.22, p < 0.05). With limited evidence, some studies suggest that DD in F might be positively influenced by HLA*B27 positivity, peripheral involvement, and social factors. Full article

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

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12 pages, 2164 KiB

Open AccessEditor’s ChoiceSystematic Review

Health Policy for Prostate Cancer Early Detection in the European Union and the Impact of Opportunistic Screening: PRAISE-U Consortium

by Katharina Beyer, Renée Leenen, Lionne D. F. Venderbos, Jozien Helleman, Frederique Denijs, Wichor Bramer, Vera Vasilyeva, Erik Briers, Juan Gomez Rivas, Renata Chloupkova, Ondrej Majek, Lieven Annemans, Pieter Vynckier, Partha Basu, Arunah Chandran, Roderick van den Bergh, Sarah Collen, Hendrik van Poppel, Monique J. Roobol and on behalf of the PRAISE-U Consortium

J. Pers. Med. 2024, 14(1), 84; https://doi.org/10.3390/jpm14010084 - 11 Jan 2024

Cited by 13 | Viewed by 3985

Abstract

With the new policy recommendation in 2022 to explore the possibilities of screening for prostate cancer by the European Commission, the landscape for prostate cancer early detection is evolving. In line with this recommendation, the PRAISE-U project aims to evaluate the early detection [...] Read more.

With the new policy recommendation in 2022 to explore the possibilities of screening for prostate cancer by the European Commission, the landscape for prostate cancer early detection is evolving. In line with this recommendation, the PRAISE-U project aims to evaluate the early detection and diagnosis of prostate cancer through customised and risk-based screening programmes, with the goal to align protocols across European Union member states. This systematic review is part of the PRAISE-U project, with the goal to review the policy, medical guideline recommendations, and the current level of opportunistic screening presented in the scientific literature on prostate cancer early detection from 2016 to 2023 in European Union member states. An extensive literature search was performed on 1 June 2023 in a large number of databases, including Embase.com, Medline (Ovid), Web of Science Core Collection, Google Scholar, and Policy Commons. We identified 318 articles (qualitative, quantitative, and reviews), of which 41 were included in the full-text screening. Seventeen articles were ultimately identified as eligible for inclusion. The included articles revealed significant variations towards PSA-based early detection policies for prostate cancer in nine European countries. Despite official recommendations, opportunistic screening was prevalent across all nine countries regardless of recommendations for or against PSA-based early detection. This systematic review suggests that the current early detection policies are not fit for purpose. High levels of opportunistic screening and overdiagnosis persist, prompting policy recommendations for standardised guidelines, informed decision making, and increased awareness to improve efficiency and effectiveness in early detection. Full article

(This article belongs to the Section Epidemiology)

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13 pages, 8723 KiB

Open AccessEditor’s ChoiceSystematic Review

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

by Mihaela Pertea, Madalina-Cristina Fotea, Stefana Luca, Dan Cristian Moraru, Alexandru Filip, Doinita Olinici-Temelie, Sorinel Lunca, Adrian Claudiu Carp, Oxana-Madalina Grosu, Alexandru Amarandei and Bogdan Veliceasa

J. Pers. Med. 2023, 13(11), 1612; https://doi.org/10.3390/jpm13111612 - 16 Nov 2023

Cited by 7 | Viewed by 4644

Abstract

(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of [...] Read more.

(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient’s survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities. Full article

(This article belongs to the Section Mechanisms of Diseases)

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24 pages, 2605 KiB

Open AccessEditor’s ChoiceSystematic Review

Pain Assessment Using the Analgesia Nociception Index (ANI) in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis

by Min Kyoung Kim, Geun Joo Choi, Kyung Seo Oh, Sang Phil Lee and Hyun Kang

J. Pers. Med. 2023, 13(10), 1461; https://doi.org/10.3390/jpm13101461 - 4 Oct 2023

Cited by 14 | Viewed by 6831

Abstract

The analgesia nociception index (ANI) has emerged as a potential measurement for objective pain assessment during general anesthesia. This systematic review and meta-analysis aimed to evaluate the accuracy and effectiveness of ANI in assessing intra- and post-operative pain in patients undergoing general anesthesia. [...] Read more.

The analgesia nociception index (ANI) has emerged as a potential measurement for objective pain assessment during general anesthesia. This systematic review and meta-analysis aimed to evaluate the accuracy and effectiveness of ANI in assessing intra- and post-operative pain in patients undergoing general anesthesia. We conducted a comprehensive search of Ovid-MEDLINE, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, public clinical trial databases (ClinicalTrials and Clinical Research Information Service), and OpenSIGLE to identify relevant studies published prior to May 2023 and included studies that evaluated the accuracy and effectiveness of ANI for intra- or post-operative pain assessment during general anesthesia. Among the 962 studies identified, 30 met the eligibility criteria and were included in the systematic review, and 17 were included in the meta-analysis. For predicting intra-operative pain, pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under curve of ANI were 0.81 (95% confidence interval [CI] = 0.79–0.83; I² = 68.2%), 0.93 (95% CI = 0.92–0.93; I² = 99.8%), 2.32 (95% CI = 1.33–3.30; I² = 61.7%), and 0.77 (95% CI = 0.76–0.78; I² = 87.4%), respectively. ANI values and changes in intra-operative hemodynamic variables showed statistically significant correlations. For predicting post-operative pain, pooled sensitivity, specificity, and DOR of ANI were 0.90 (95% CI = 0.87–0.93; I² = 58.7%), 0.51 (95% CI = 0.49–0.52; I² = 99.9%), and 3.38 (95% CI = 2.87–3.88; I² = 81.2%), respectively. ANI monitoring in patients undergoing surgery under general anesthesia is a valuable measurement for predicting intra- and post-operative pain. It reduces the use of intra-operative opioids and aids in pain management throughout the perioperative period. Full article

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11 pages, 1149 KiB

Open AccessEditor’s ChoiceSystematic Review

Duration of Untreated Illness in Patients with Obsessive–Compulsive Disorder and Its Impact on Long-Term Outcome: A Systematic Review

by Francesco Perris, Salvatore Cipolla, Pierluigi Catapano, Gaia Sampogna, Mario Luciano, Vincenzo Giallonardo, Valeria Del Vecchio, Michele Fabrazzo, Andrea Fiorillo and Francesco Catapano

J. Pers. Med. 2023, 13(10), 1453; https://doi.org/10.3390/jpm13101453 - 29 Sep 2023

Cited by 11 | Viewed by 2837

Abstract

Background: Duration of untreated illness (DUI)—defined as the time period between the onset of a mental disorder and its first adequate treatment—should influence patients’ long-term prognosis and outcome. In patients with obsessive–compulsive disorder (OCD), DUI lasts on average from 87.5 up to [...] Read more.

Background: Duration of untreated illness (DUI)—defined as the time period between the onset of a mental disorder and its first adequate treatment—should influence patients’ long-term prognosis and outcome. In patients with obsessive–compulsive disorder (OCD), DUI lasts on average from 87.5 up to 94.5 months, being significantly longer compared with data available from patients affected by other severe mental disorders, such as schizophrenia and bipolar disorder. We carried out a systematic review in order to assess the impact of DUI on long-term outcomes in OCD patients. Methods: A systemic review has been implemented, searching from inception to April 2023; only papers written in English were included. Results: Seventy-one articles were initially identified; only eight papers were included in the review. The DUI ranged from 7.0 ± 8.5 to 20.9 ± 11.2 years. Patients reporting a longer DUI have a poor long-term outcome in terms of lower level of treatment response and greater symptom severity. Conclusions: The present review confirms that longer DUI has a negative impact on the long-term outcome of patients with OCD. It should be useful to promote the dissemination of early interventions with a specific focus on OCD symptoms. Full article

(This article belongs to the Special Issue The Current State of Psychiatry: Personalized Medicine and Treatment)

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18 pages, 1657 KiB

Open AccessEditor’s ChoiceSystematic Review

Shielding the Nerve: A Systematic Review of Nerve Wrapping to Prevent Adhesions in the Rat Sciatic Nerve Model

by Maximilian Mayrhofer-Schmid, Tess T. Klemm, Martin Aman, Ulrich Kneser, Kyle R. Eberlin, Leila Harhaus and Arne H. Boecker

J. Pers. Med. 2023, 13(10), 1431; https://doi.org/10.3390/jpm13101431 - 24 Sep 2023

Cited by 7 | Viewed by 2929

Abstract

Background: Peripheral nerve pathology is frequently encountered in clinical practice among peripheral nerve and extremity surgeons. One major factor limiting nerve regeneration and possibly leading to revision surgeries is the development of traumatic or postoperative adhesions and scarring around nerves. In experimental models, [...] Read more.

Background: Peripheral nerve pathology is frequently encountered in clinical practice among peripheral nerve and extremity surgeons. One major factor limiting nerve regeneration and possibly leading to revision surgeries is the development of traumatic or postoperative adhesions and scarring around nerves. In experimental models, different materials have been studied to limit scar tissue formation when wrapped around nerves. Methods: A systematic review of studies describing nerve-wrapping materials in a non-transectional rat sciatic nerve model was performed following the PRISMA guidelines. Literature describing nerve-wrapping methods for the prevention of peripheral nerve scarring in rat sciatic nerve models was identified using PubMed and Web of Science, scanned for relevance and analyzed. Results: A total of 15 original articles describing 23 different materials or material combinations for nerve wrapping were included. The heterogeneity of the methods used did not allow a meta-analysis, thus, a systematic review was performed. Out of 28 intervention groups, 21 demonstrated a preventive effect on scar tissue formation in at least one qualitative or quantitative assessment method. Conclusions: The analyzed literature describes a variety of materials from different origins to limit peripheral nerve scarring and adhesions. Thus, a scar-preventive effect by wrapping peripheral nerves as adhesion prophylaxis seems likely. However, a quantitative comparison of the studies to identify the optimal material or technique is not possible with the diversity of used models and study designs. Therefore, further research needs to be performed to identify the optimal nerve wraps to be used routinely in clinical practice. Full article

(This article belongs to the Special Issue Advances in Neuromuscular Care and Treatments)

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18 pages, 1584 KiB

Open AccessEditor’s ChoiceSystematic Review

Comparison of a Peripheral Nerve Block versus Spinal Anesthesia in Foot or Ankle Surgery: A Systematic Review and Meta-Analysis with a Trial Sequential Analysis

by Myeongjong Lee, Cheol Lee, Junsung Lim, Hyungtae Kim, Yoo-Shin Choi and Hyun Kang

J. Pers. Med. 2023, 13(7), 1096; https://doi.org/10.3390/jpm13071096 - 4 Jul 2023

Cited by 7 | Viewed by 2733

Abstract

Background: This systematic review and meta-analysis with trial sequential analysis (TSA) aimed to compare perioperative outcomes of peripheral nerve blocks (PNBs) and spinal anesthesia (SA) in elective foot and ankle surgery. Methods: The study protocol was registered in PROSPERO (CRD42021229597). Researchers independently searched [...] Read more.

Background: This systematic review and meta-analysis with trial sequential analysis (TSA) aimed to compare perioperative outcomes of peripheral nerve blocks (PNBs) and spinal anesthesia (SA) in elective foot and ankle surgery. Methods: The study protocol was registered in PROSPERO (CRD42021229597). Researchers independently searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs). Results: Analysis of nine RCTs (n = 802; 399 PNBs, 403 SA) revealed significantly shorter block performance times (WMD: 7.470; 95% CI 6.072 to 8.868), the onset of sensory (WMD: 7.483; 95% CI 2.837 to 12.130) and motor blocks (WMD: 9.071; 95% CI 4.049 to 14.094), durations of sensory (WMD: 458.53; 95% CI 328.296 to 588.765) and motor blocks (WMD: 247.416; 95% CI 95.625 to 399.208), and significantly higher postoperative analgesic requirements (SMD: −1.091; 95% CI −1.634 to −0.549) in the SA group. Additionally, systolic blood pressure (SBP) at 30 min (WMD: 13.950; 95% CI 4.603 to 23.298) was lower in the SA group. Conclusions: The SA demonstrated shorter block performance time, faster onset and shorter duration of sensory and motor blocks, higher postoperative analgesic requirements, and lower SBP at 30 min compared to PNBs in elective foot and ankle surgery. Full article

(This article belongs to the Section Evidence Based Medicine)

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19 pages, 811 KiB

Open AccessEditor’s ChoiceSystematic Review

Investigating the Role of Maintenance TMS Protocols for Major Depression: Systematic Review and Future Perspectives for Personalized Interventions

by Giacomo d’Andrea, Gianluca Mancusi, Maria Chiara Santovito, Carlotta Marrangone, Fabrizio Martino, Mario Santorelli, Andrea Miuli, Francesco Di Carlo, Maria Salvina Signorelli, Massimo Clerici, Mauro Pettorruso and Giovanni Martinotti

J. Pers. Med. 2023, 13(4), 697; https://doi.org/10.3390/jpm13040697 - 21 Apr 2023

Cited by 25 | Viewed by 5744

Abstract

Repetitive Transcranial Magnetic Stimulation (rTMS) has been approved by the FDA as an effective intervention for Treatment-Resistant Depression (TRD). However, there is little evidence about maintenance protocol necessity. The aim of this systematic review is to identify, characterize, and evaluate the current maintenance [...] Read more.

Repetitive Transcranial Magnetic Stimulation (rTMS) has been approved by the FDA as an effective intervention for Treatment-Resistant Depression (TRD). However, there is little evidence about maintenance protocol necessity. The aim of this systematic review is to identify, characterize, and evaluate the current maintenance TMS protocols for MDD and TRD patients who have received acute treatment. A literature search was conducted following the PRISMA guidelines of 2015 on PubMed, Scopus, and Web of Science databases for publications up to March 2022. Fourteen articles were included. High protocol heterogeneity was observed. Most studies highlighted significant efficacy of maintenance protocols in decreasing relapse risk, suggesting that administering two or fewer stimulations per month is ineffective in sustaining an antidepressant effect or in reducing the risk of relapse in responder patients. The risk of relapse was most pronounced after five months from the acute treatment. Maintenance TMS appears to be a resourceful strategy to maintain acute antidepressant treatment effects, significantly reducing relapse risk. The ease of administering and the ability to monitor treatment adherence should be considered when evaluating the future use of maintenance TMS protocols. Further studies are needed to clarify the clinical relevance of overlapping acute TMS effects with maintenance protocols and to evaluate their long-term effectiveness. Full article

(This article belongs to the Special Issue Biomarkers in Psychiatric Disorders)

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18 pages, 492 KiB

Open AccessEditor’s ChoiceSystematic Review

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review

by Francesco D′Ambrosio, Mario Caggiano, Alfonso Acerra, Massimo Pisano and Francesco Giordano

J. Pers. Med. 2023, 13(4), 646; https://doi.org/10.3390/jpm13040646 - 8 Apr 2023

Cited by 20 | Viewed by 3967

Abstract

Introduction: Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis. Methods: This review was [...] Read more.

Introduction: Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis. Methods: This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool. Results: An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained. Conclusions: The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP. Full article

(This article belongs to the Section Mechanisms of Diseases)

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17 pages, 2015 KiB

Open AccessEditor’s ChoiceSystematic Review

The Progress and Pitfalls of Pharmacogenetics-Based Precision Medicine in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis

by Yuxin Teng, Amrit Sandhu, Edith J. Liemburg, Elnaz Naderi and Behrooz Z. Alizadeh

J. Pers. Med. 2023, 13(3), 471; https://doi.org/10.3390/jpm13030471 - 4 Mar 2023

Cited by 10 | Viewed by 4848

Abstract

The inadequate efficacy and adverse effects of antipsychotics severely affect the recovery of patients with schizophrenia spectrum disorders (SSD). We report the evidence for associations between pharmacogenetic (PGx) variants and antipsychotics outcomes, including antipsychotic response, antipsychotic-induced weight/BMI gain, metabolic syndrome, antipsychotic-related prolactin levels, [...] Read more.

The inadequate efficacy and adverse effects of antipsychotics severely affect the recovery of patients with schizophrenia spectrum disorders (SSD). We report the evidence for associations between pharmacogenetic (PGx) variants and antipsychotics outcomes, including antipsychotic response, antipsychotic-induced weight/BMI gain, metabolic syndrome, antipsychotic-related prolactin levels, antipsychotic-induced tardive dyskinesia (TD), clozapine-induced agranulocytosis (CLA), and drug concentration level (pharmacokinetics) in SSD patients. Through an in-depth systematic search in 2010–2022, we identified 501 records. We included 29 meta-analyses constituting pooled data from 298 original studies over 69 PGx variants across 39 genes, 4 metabolizing phenotypes of CYP2D9, and 3 of CYP2C19. We observed weak unadjusted nominal significant (p < 0.05) additive effects of PGx variants of DRD1, DRD2, DRD3, HTR1A, HTR2A, HTR3A, and COMT (10 variants) on antipsychotic response; DRD2, HTR2C, BDNF, ADRA2A, ADRB3, GNB3, INSIG2, LEP, MC4R, and SNAP25 (14 variants) on weight gain; HTR2C (one variant) on metabolic syndrome; DRD2 (one variant) on prolactin levels; COMT and BDNF (two variants) on TD; HLA-DRB1 (one variant) on CLA; CYP2D6 (four phenotypes) and CYP2C19 (two phenotypes) on antipsychotics plasma levels. In the future, well-designed longitudinal naturalistic multi-center PGx studies are needed to validate the effectiveness of PGx variants in antipsychotic outcomes before establishing any reproducible PGx passport in clinical practice. Full article

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13 pages, 841 KiB

Open AccessEditor’s ChoiceSystematic Review

Does Electrical Stimulation through Nerve Conduits Improve Peripheral Nerve Regeneration?—A Systematic Review

by Sophie Hasiba-Pappas, Lars-P. Kamolz, Hanna Luze, Sebastian P. Nischwitz, Judith C. J. Holzer-Geissler, Alexandru Cristian Tuca, Theresa Rienmüller, Mathias Polz, Daniel Ziesel and Raimund Winter

J. Pers. Med. 2023, 13(3), 414; https://doi.org/10.3390/jpm13030414 - 26 Feb 2023

Cited by 9 | Viewed by 3493

Abstract

Background: Peripheral nerve injuries affect over 2% of trauma patients and can lead to severe functional impairment and permanent disability. Autologous nerve transplantation is still the gold standard in the reconstruction of nerve defects. For small defects, conduits can be considered for bridging. [...] Read more.

Background: Peripheral nerve injuries affect over 2% of trauma patients and can lead to severe functional impairment and permanent disability. Autologous nerve transplantation is still the gold standard in the reconstruction of nerve defects. For small defects, conduits can be considered for bridging. Lately, the combined use of conduits and electrical stimulation has gained attention in the treatment of peripheral nerve injury. This review aimed to present the currently available data on this topic. Methods: PubMed, Embase, Medline and the Cochrane Library were searched for studies on electrical stimulation through nerve conduits for nerve defects in in vivo studies. Results: Fifteen studies fit the inclusion criteria. All of them reported on the application of nerve conduits combined with stimulation for sciatic nerve gaps in rats. Functional, electrophysiological and histological evaluations showed improved nerve regeneration after electrical stimulation. High variation was observed in the treatment protocols. Conclusion: Electrically stimulated conduits could improve peripheral nerve regeneration in rat models. The combined application of nerve guidance conduits and electrical stimulation shows promising results and should be further evaluated under standardized conditions. Full article

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

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13 pages, 2265 KiB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness of Hyperthermic Intraperitoneal Chemotherapy Associated with Cytoreductive Surgery in the Treatment of Advanced Ovarian Cancer: Systematic Review and Meta-Analysis

by Maria Llueca, Maria Victoria Ibañez, Maria Teresa Climent, Anna Serra and Antoni Llueca

J. Pers. Med. 2023, 13(2), 258; https://doi.org/10.3390/jpm13020258 - 30 Jan 2023

Cited by 7 | Viewed by 2169

Abstract

Objective: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment for epithelial ovarian cancer remains controversial. Our study aims to analyze the overall survival and disease-free survival for the use of HIPEC as a treatment for advanced epithelial ovarian cancer after neoadjuvant [...] Read more.

Objective: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment for epithelial ovarian cancer remains controversial. Our study aims to analyze the overall survival and disease-free survival for the use of HIPEC as a treatment for advanced epithelial ovarian cancer after neoadjuvant chemotherapy. Methods: A systematic review and meta-analysis was carried out using PubMed, Cochrane, Web of Science, and ClinicalTrials.gov. A total of six studies were used, comprising a total of 674 patients. Results: The results of our meta-analysis of all studies analyzed together (observational and randomized controlled trials (RCT)) did not achieve significant results. Contrary to the OS (HR = 0.56, 95% IC = 0.33–0.95, p = 0.03) and DFS (HR = 0.61, 95% IC = 0.43–0.86, p < 0.01) of the RCT analyzed separately, a clear impact on survival was suggested. The subgroup analysis showed that studies making use of higher temperatures (≥42 °C) for a shorter period of time (≤60 min) achieved better results for both OS and DFS, as well as the use of cisplatin as the form of chemotherapy in HIPEC. Moreover, the use of HIPEC did not increase high-grade complications. Conclusions: The addition of HIPEC to cytoreductive surgery demonstrates an improvement in OS and DFS for patients with epithelial ovarian cancer in advanced stages, without an increase in the number of complications. The use of cisplatin as chemotherapy in HIPEC obtained better results. Full article

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