Journal of Personalized Medicine

16 pages, 2109 KB

Open AccessArticle

Safety of Primary Tracheoesophageal Puncture in Patients Submitted to Enlarged Total Laryngectomy with Pectoralis Major Reconstruction

by Emilia Degni, Sebastiana Lai, Carlo Camillo Ciccarelli, Gamze Yesilli Puzella, Claudia Crescio, Paolo Tropiano, Valeria Fois, Claudio Parrilla, Jacopo Galli and Francesco Bussu

J. Pers. Med. 2025, 15(9), 435; https://doi.org/10.3390/jpm15090435 - 10 Sep 2025

Abstract

Background/Objectives: Total laryngectomy (TL) remains a key treatment option for advanced laryngeal cancer. Primary tracheoesophageal puncture (TEP) with voice prosthesis (VP) enables early speech restoration and is increasingly adopted, even in patients with conditions traditionally considered contraindications, such as prior/adjuvant radiotherapy, extended resections, [...] Read more.

Background/Objectives: Total laryngectomy (TL) remains a key treatment option for advanced laryngeal cancer. Primary tracheoesophageal puncture (TEP) with voice prosthesis (VP) enables early speech restoration and is increasingly adopted, even in patients with conditions traditionally considered contraindications, such as prior/adjuvant radiotherapy, extended resections, and immediate reconstructive procedures. This study evaluates complication rates and long-term outcomes associated with primary TEP in these settings. Methods: A retrospective cohort of 101 patients undergoing TL for laryngeal or hypopharyngeal squamous cell carcinoma at the University Hospital of Sassari (August 2017–December 2024) was analyzed. Demographic, clinical, surgical, and oncological data were collected, with a particular focus on postoperative early complications and late sequelae and oncological outcomes. Results: Primary TEP was performed in 78 patients (77.2%). Overall, pharyngocutaneous fistula occurred in 6/101 patients (5.9%), postoperative bleeding in 5/101 (5.0%), and dysphagia in 11/101 (10.9%), with only 2/11 (2.0%) requiring intervention. Mean follow-up was 44.6 ± 3.2 months (median 41, range 4–93). No significant association was found between primary TEP and complication rates, including in patients undergoing enlarged TL with pectoralis major reconstruction. Conclusions: Primary TEP appears safe and effective, even in cases requiring extended resections and reconstructive procedures. It should be considered to enhance functional recovery and postoperative quality of life for all motivated patients undergoing total laryngectomy without patient-related contraindications. Our findings may constitute a step towards personalized medicine in laryngeal oncology as they support priortizing patient-specific factors, such as pneumological and neurological clinical conditions and level of cooperation, over purely surgical considerations. Full article

(This article belongs to the Section Personalized Therapy in Clinical Medicine)

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15 pages, 695 KB

Open AccessArticle

Cancer Prevention Pathways in People Living with HIV: Assessment of Prevalence and Related Factors Among Individuals Attending HIV Division of Ferrara Hospital

by Daniela Segala, Mario Stancanelli and Rosario Cultrera

J. Pers. Med. 2025, 15(9), 434; https://doi.org/10.3390/jpm15090434 - 9 Sep 2025

Abstract

Background. Oncological diseases are among the leading causes of death in people living with HIV (PLWH). With the introduction of antiretroviral therapy and the consequent reduction in AIDS-defining cancers (ADC), there has been a growing incidence of non-AIDS-defining cancers (NADC). Methods. A retrospective [...] Read more.

Background. Oncological diseases are among the leading causes of death in people living with HIV (PLWH). With the introduction of antiretroviral therapy and the consequent reduction in AIDS-defining cancers (ADC), there has been a growing incidence of non-AIDS-defining cancers (NADC). Methods. A retrospective observational study (cross sectional prevalence analysis) was conducted to investigate the prevalence and spectrum of oncological diseases in patients attending the HIV/AIDS Division at the Ferrara Hospital. The sample included 534 patients evaluated between January 2023 and November 2024 (534/682 met eligibility). Demographic, clinical, and serological data were extracted from medical records. The CDC’s 2014 definition has been adopted for the ADC/NADC classification. Statistical analysis was performed using SPSS version 29 and G*Power 3.1 software. Results. The data analysis revealed 62.8% NADC vs. 37.2% ADC (44 NADCs vs. 26 ADCs). Male individuals and those aged 50 and older were more represented. Patients with ADC more often fell into C2–C3 groups, indicative of severe immunodeficiency, while NADCs were more prevalent in clinical groups A1–B3. Statistical analysis showed that viral load was more frequently under 50 copies/mL in the NADC group, while it tended to be higher in the ADC group. Conclusions. These results align with current scientific evidence regarding the global prevalence of ADCs and NADCs. The findings highlight the need to implement targeted oncological screening strategies for HIV-positive patients to promote early diagnosis and improve prognosis. Full article

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

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Graphical abstract

13 pages, 601 KB

Open AccessArticle

Prevalence of Undiagnosed Risk Factors in Patients with First-Ever Ischemic Stroke Treated at MUHC: A Retrospective Analysis

by Shorog Althubait, Heather Perkins, Robert Cote, Theodore Wein, Jeffrey Minuk, Eric Erhensperger, Liam Durcan, Aimen Moussaddy and Lucy Vieira

J. Pers. Med. 2025, 15(9), 433; https://doi.org/10.3390/jpm15090433 - 9 Sep 2025

Abstract

Background: Ischemic stroke is a leading cause of morbidity and mortality worldwide. Despite established prevention strategies, many patients present with previously undiagnosed vascular risk factors (URFs) at the time of their first-ever ischemic stroke, suggesting missed opportunities for early detection. In Canada, particularly [...] Read more.

Background: Ischemic stroke is a leading cause of morbidity and mortality worldwide. Despite established prevention strategies, many patients present with previously undiagnosed vascular risk factors (URFs) at the time of their first-ever ischemic stroke, suggesting missed opportunities for early detection. In Canada, particularly in Quebec, access to primary care is inconsistent, and a substantial proportion of the population lacks attachment to a family doctor (FD). Objective: This study aimed to determine the prevalence of URFs among patients with first-ever ischemic stroke and to evaluate the relationship between URFs, geographic region, and access to primary care in Quebec, Canada. We hypothesized that patients without an FD would have a higher prevalence of URFs. Methods: We conducted a retrospective chart review of 610 patients admitted with first-ever ischemic stroke to the McGill University Health Center (MUHC) between 2014 and 2017. Data collected included demographics; known and undiagnosed stroke risk factors such as hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD), and atrial fibrillation (AF); FD status; and geographic location based on postal code. Results: Among the 610 patients, 136 (22.3%) had at least one URF. The most common URF was HLD (14.3%), followed by HTN (6.2%), AF (1.6%), and DM (0.1%). Of 609 patients with available data, 146 (23.97%) lacked an FD. Patients without an FD were significantly more likely to have undiagnosed HTN (7.6% vs. 2.1%, p = 0.008). No significant differences were observed for the other URFs. Geographic variation was noted in both URF prevalence and FD access, but regional differences were not statistically significant. Conclusions: Our findings support the hypothesis that a lack of an FD is associated with a higher prevalence of undiagnosed HTN in ischemic stroke patients. Targeted screening and improved access to primary care, particularly in underserved regions, may help to reduce the burden of preventable stroke by facilitating the earlier identification and management of modifiable risk factors. Full article

(This article belongs to the Section Personalized Preventive Medicine)

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12 pages, 1004 KB

Open AccessArticle

Machine-Learning-Based Survival Prediction in Castration-Resistant Prostate Cancer: A Multi-Model Analysis Using a Comprehensive Clinical Dataset

by Jeong Hyun Lee, Jaeyun Jeong, Young Jin Ahn, Kwang Suk Lee, Jong Soo Lee, Seung Hwan Lee, Won Sik Ham, Byung Ha Chung and Kyo Chul Koo

J. Pers. Med. 2025, 15(9), 432; https://doi.org/10.3390/jpm15090432 - 8 Sep 2025

Abstract

Purpose: Accurate survival prediction is essential for optimizing the treatment planning in patients with castration-resistant prostate cancer (CRPC). However, the traditional statistical models often underperform due to limited variable inclusion and an inability to account for complex, multidimensional data interactions. Methods: We retrospectively [...] Read more.

Purpose: Accurate survival prediction is essential for optimizing the treatment planning in patients with castration-resistant prostate cancer (CRPC). However, the traditional statistical models often underperform due to limited variable inclusion and an inability to account for complex, multidimensional data interactions. Methods: We retrospectively collected 46 clinical, laboratory, and pathological variables from 801 patients with CRPC, covering the disease course from the initial disease diagnosis to CRPC progression. Multiple machine learning (ML) models, including random survival forests (RSFs), XGBoost, LightGBM, and logistic regression, were developed to predict cancer-specific mortality (CSM), overall mortality (OM), and 2- and 3-year survival status. The dataset was split into training and test cohorts (80:20), with 10-fold cross-validation. The performance was assessed using the C-index for regression models and the AUC, accuracy, precision, recall, and F1-score for classification models. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: Over a median follow-up of 24 months, 70.6% of patients experienced CSM. RSFs achieved the highest C-index in the test set for both CSM (0.772) and OM (0.771). For classification tasks, RSFs demonstrated a superior performance in predicting 2-year survival, while XGBoost yielded the highest F1-score for 3-year survival. The SHAP analysis identified time to first-line CRPC treatment and hemoglobin and alkaline phosphatase levels as key predictors of survival outcomes. Conclusion: The RSF and XGBoost ML models demonstrated a superior performance over that of traditional statistical methods in predicting survival in CRPC. These models offer accurate and interpretable prognostic tools that may inform personalized treatment strategies. External validation and the integration of emerging therapies are warranted for broader clinical applicability. Full article

(This article belongs to the Section Personalized Medical Care)

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27 pages, 2698 KB

Open AccessReview

Metabolic Signature of FLT3-Mutated AML: Clinical and Therapeutic Implications

by Cristina Banella, Gianfranco Catalano, Maura Calvani, Eleonora Candi, Nelida Ines Noguera and Serena Travaglini

J. Pers. Med. 2025, 15(9), 431; https://doi.org/10.3390/jpm15090431 - 8 Sep 2025

Abstract

Acute Myeloid Leukemia (AML) is a genetically and clinically heterogeneous malignancy marked by poor prognosis and limited therapeutic options, especially in older patients. While conventional treatments such as the “7 + 3” chemotherapy regimen and allogeneic stem cell transplantation remain standard care options, [...] Read more.

Acute Myeloid Leukemia (AML) is a genetically and clinically heterogeneous malignancy marked by poor prognosis and limited therapeutic options, especially in older patients. While conventional treatments such as the “7 + 3” chemotherapy regimen and allogeneic stem cell transplantation remain standard care options, the advent of next-generation sequencing (NGS) has transformed our understanding of AML’s molecular complexity. Among the emerging hallmarks of AML, metabolic reprogramming has gained increasing attention for its role in supporting leukemic cell proliferation, survival, and therapy resistance. Distinct AML subtypes—shaped by specific genetic alterations, including FLT3, NPM1, and IDH mutations—exhibit unique metabolic phenotypes that reflect their underlying molecular landscapes. Notably, FLT3-ITD mutations are associated with enhanced reactive oxygen species (ROS) production and altered energy metabolism, contributing to disease aggressiveness and poor clinical outcomes. This review highlights the interplay between metabolic plasticity and genetic heterogeneity in AML, with a particular focus on FLT3-driven metabolic rewiring. We discuss recent insights into how these metabolic dependencies may be exploited therapeutically, offering a rationale for the development of metabolism-targeted strategies in the treatment of FLT3-mutated AML. Full article

(This article belongs to the Special Issue Acute Myeloid Leukemia: Current Progress and Future Directions)

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15 pages, 367 KB

Open AccessStudy Protocol

The CORTEX Project: A Pre–Post Randomized Controlled Feasibility Trial Evaluating the Efficacy of a Computerized Cognitive Remediation Therapy Program for Adult Inpatients with Anorexia Nervosa

by Giada Pietrabissa, Davide Maria Cammisuli, Gloria Marchesi, Giada Rapelli, Federico Brusa, Gianluigi Luxardi, Giovanna Celia, Alessandro Chinello, Chiara Cappelletti, Simone Raineri, Luigi Enrico Zappa, Stefania Landi, Francesco Monaco, Ernesta Panarello, Stefania Palermo, Sara Mirone, Francesca Tessitore, Mauro Cozzolino, Leonardo Mendolicchio and Gianluca Castelnuovo

J. Pers. Med. 2025, 15(9), 430; https://doi.org/10.3390/jpm15090430 - 8 Sep 2025

Abstract

Background/Objectives: Anorexia nervosa (AN) is marked by cognitive deficits, particularly reduced mental flexibility and weak central coherence, which may sustain the core psychopathological symptoms. While cognitive remediation therapy (CRT) has shown efficacy in improving these cognitive processes in AN, evidence on computer-based CRT [...] Read more.

Background/Objectives: Anorexia nervosa (AN) is marked by cognitive deficits, particularly reduced mental flexibility and weak central coherence, which may sustain the core psychopathological symptoms. While cognitive remediation therapy (CRT) has shown efficacy in improving these cognitive processes in AN, evidence on computer-based CRT remains limited. This study aims to evaluate the feasibility and efficacy of integrating computer-assisted cognitive remediation therapy (CA-CRT) into standard nutritional rehabilitation (treatment as usual, TAU) to improve the targeted cognitive and psychological parameters among inpatients with AN in a more personalized and scalable way. Methods: A multicenter randomized controlled trial (RCT) will be conducted. At least 54 participants with a diagnosis of AN will be recruited at each site and randomized into either the experimental or control group after initial screening. The intervention will last five weeks and include 15 individual CA-CRT sessions alongside 10 individual CR sessions, delivered in addition to standard care. The primary and secondary outcomes will be assessed at the end of the intervention to evaluate the changes in cognitive flexibility, central coherence, and psychological functioning. Results: Participants receiving CA-CRT are expected to develop more flexible and integrated thinking styles and achieve greater improvements in clinical outcomes compared to those receiving standard care alone, supporting a more personalized therapeutic approach. Conclusions: These findings would underscore the feasibility and clinical value of incorporating CA-CRT into standard inpatient treatment for AN. By specifically targeting cognitive inflexibility and poor central coherence in a scalable, individualized format, CA-CRT may enhance treatment effectiveness and support the development of patient-centered interventions tailored to the cognitive profiles of individuals with AN. Full article

(This article belongs to the Special Issue Personalized Therapy for Psychophysical Health: An Integrative Approach)

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13 pages, 1905 KB

Open AccessReview

Characteristics of Myelodysplastic Syndrome with Coagulation Abnormalities and Tailored Diagnosis and Treatment

by Osamu Imataki, Makiko Uemura and Akira Kitanaka

J. Pers. Med. 2025, 15(9), 429; https://doi.org/10.3390/jpm15090429 - 5 Sep 2025

Abstract

At onset, myelodysplastic syndrome (MDS) may be complicated by coagulation and fibrinolytic abnormalities, such as disseminated intravascular coagulation (DIC), tumor lysis syndrome (TLS), infection, thromboembolism, hemophagocytic syndrome/hemophagocytic lymphohistiocytosis (HPS/HLH), hemorrhage, and hematoma formation. In these cases, the cause may be secondary. On the [...] Read more.

At onset, myelodysplastic syndrome (MDS) may be complicated by coagulation and fibrinolytic abnormalities, such as disseminated intravascular coagulation (DIC), tumor lysis syndrome (TLS), infection, thromboembolism, hemophagocytic syndrome/hemophagocytic lymphohistiocytosis (HPS/HLH), hemorrhage, and hematoma formation. In these cases, the cause may be secondary. On the other hand, it is known that platelet clotting dysfunction and fibrinolysis abnormalities are seen in the background of MDS, and primary fibrinolysis abnormalities may be complicated by adverse events associated with paraneoplastic syndrome (PNS). Coagulation fibrinolysis, as a PNS associated with MDS, is known to take the pattern of either consumptive coagulation abnormality or fibrinolytic coagulation abnormality. One mechanism of coagulation and fibrinolytic abnormalities has been shown to be the immunophenotypical pathway, and aberrant cytokine production is also associated with coagulopathy in MDS. We focused on how to differentiate an MDS-associated bleeding tendency resulting from either secondary or primary causes. In order to make this differentiation, we proposed a useful flowchart for the differentiation of solidified fibrinolysis seen at the initial MDS diagnosis. Additionally, we compared and summarized the molecular pathways of the secondary and primary causes of coagulopathy. Addressing coagulation and fibrinolytic abnormalities in MDS is required to differentiate the complexity and heterogeneity of bleeding and coagulation abnormalities. This review highlights the need to distinguish between the primary (disease-intrinsic) and secondary (reactive or complication-related) causes of coagulopathy. By proposing a diagnostic flowchart tailored to evaluate these causes at initial diagnosis, this study supports individualized risk stratification and management strategies. By comparing the molecular pathways of the two causes of coagulopathy, we provide a clinical discussion of the underlying pathologies. This aligns with the principles of personalized medicine by ensuring that treatment decisions (e.g., supportive care, anticoagulation, and antifibrinolytics) are based on the patient’s specific pathophysiological profile, rather than a one-size-fits-all approach. Full article

(This article belongs to the Section Mechanisms of Diseases)

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11 pages, 1194 KB

Open AccessArticle

Irvine–Gass Syndrome Personalized Treatment Outcomes: A Retrospective Single-Center Cohort Study

by Lorenzo Tomaschek, Laura Hoffmann, Robert Katamay, David Stocker, Asan Kochkorov and Katja Hatz

J. Pers. Med. 2025, 15(9), 428; https://doi.org/10.3390/jpm15090428 - 5 Sep 2025

Abstract

Irvine–Gass syndrome (IGS) is a macular edema that is mostly observed after cataract surgery, also known as pseudophakic cystoid macular edema (PCME). To date, there are still no standardized guidelines for its treatment. Background/Objectives: This study aimed to compare the efficacy of [...] Read more.

Irvine–Gass syndrome (IGS) is a macular edema that is mostly observed after cataract surgery, also known as pseudophakic cystoid macular edema (PCME). To date, there are still no standardized guidelines for its treatment. Background/Objectives: This study aimed to compare the efficacy of local and systemic treatments on the resolution of Irvine–Gass Syndrome as well as the therapeutic outcomes of patients with known risk factors such as diabetes and arterial hypertension in order to be able to personalize treatment regimens for each patient. Methods: A total of 136 eyes were followed for a mean of 9.7 ± 15.2 months, with patients divided as follows: those who received only local treatment (LT), those who received systemic treatment (ST), those with cardiovascular diseases (CV), and those without cardiovascular diseases (NCV). We compared the time from the diagnosis of IGS to fully recovered edema (no sub- or intraretinal fluid), central subfield thickness (CST, as evaluated using optical coherence tomography), visual acuity (VA), and intraocular pressure (IOD) in each group. The time from diagnosis to resolution was measured from the initiation of therapy to the full resolution of edema. Results: A total of 136 eyes were examined. The mean CST significantly decreased in the LT (n = 75) (458.3 ± 96.5 µm to 320 ± 39.5 µm (p < 0.01)) and ST (n = 61) groups (519.3 ± 121.6 µm to 337.2 ± 70.6 µm (p < 0.01)) from baseline to 12 months, with no significant difference (p = 0.92). The mean VA significantly increased in both groups from baseline to 12 months (LT: 69.1 ± 11.9 to 80.4 ± 6.6 letters (p < 0.01); ST: 65.1 ± 11.8 to 78.5 ± 6.8 letters (p < 0.01)). The mean time to the resolution of edema was significantly shorter in the LT group (p < 0.05). There were no significant differences in the CST decrease, VA gain, or time to edema resolution between the CV and NCV patients. Conclusions: In regard to the non-inferiority of local treatment, a personalized approach for each patient should be considered, and systemic treatment must be critically evaluated to determine possible side effects. Full article

(This article belongs to the Section Personalized Therapy in Clinical Medicine)

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15 pages, 2619 KB

Open AccessSystematic Review

Patient-Reported Outcomes of Digital Versus Conventional Impressions for Implant-Supported Fixed Dental Prostheses: A Systematic Review and Meta-Analysis

by Aspasia Pachiou, Evangelia Zervou, Nikitas Sykaras, Dimitrios Tortopidis, Alexis Ioannidis, Ronald E. Jung, Franz J. Strauss and Stefanos Kourtis

J. Pers. Med. 2025, 15(9), 427; https://doi.org/10.3390/jpm15090427 - 5 Sep 2025

Abstract

Background/Objectives: To compare patient-reported outcome measures (PROMs) between digital and conventional impression techniques for implant-supported fixed dental prostheses (iFDPs). Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases up to June 2025, following PRISMA guidelines. Human [...] Read more.

Background/Objectives: To compare patient-reported outcome measures (PROMs) between digital and conventional impression techniques for implant-supported fixed dental prostheses (iFDPs). Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases up to June 2025, following PRISMA guidelines. Human clinical studies reporting PROMs between digital and conventional impression techniques for iFDPs were included. Studies using structured, but not necessarily validated, questionnaires were eligible. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Where possible, meta-analyses were conducted using a random-effects model to pool comparable outcomes across studies using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CIs). Results: Out of 1784 records screened, eighteen studies were included. Most studies showed that digital impressions were associated with higher patient satisfaction, compared to conventional impressions. Ten studies contributed data to at least one outcome; pooled analyses included the following: overall satisfaction (k = 5), comfort (k = 7), gagging/nausea (k = 5), esthetic satisfaction (k = 2), unpleasant taste (k = 5), anxiety (k = 5), discomfort (k = 2), pain (k = 5), and overall discomfort (k = 5). Digital impressions were significantly favored (p < 0.05) for anxiety (MD = 13.3, 95% CI: −22 to −4.5), nausea (MD = −26.4, 95% CI −46.8 to −6.0), bad taste (MD = −34.8, 95% CI −58.3 to −11.3), discomfort (SMD = −2.24, 95% CI −3.51 to −0.98), comfort (SMD = 1.77, 95% CI: 0.60 to 2.94), perceived procedure time (SMD = 0.96; 95% CI 0.29 to 1.62), and overall satisfaction (SMD = 0.55; 95% CI 0.01 to 1.09). No statistically significant differences were found for pain or esthetic evaluation. Substantial between-study heterogeneity was observed among the included studies. Conclusions: Current evidence indicates that digital impression workflows enhance the overall patient experience for implant-supported fixed restorations, especially in domains linked to comfort and procedural efficiency. These findings support PROM-informed personalization of impression workflows: screening for gagging, anxiety, or intolerance to impression materials could guide patient-tailored use of intraoral scanning while acknowledging no consistent advantage for pain or esthetic perception. Full article

(This article belongs to the Special Issue Advances in Oral Health: Innovative and Personalized Approaches)

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16 pages, 873 KB

Open AccessArticle

Inflammatory Indices vs. CA 125 for the Diagnosis of Early Ovarian Cancer: Evidence from a Multicenter Prospective Italian Cohort

by Carlo Ronsini, Stefano Restaino, Manuela Ludovisi, Giuseppe Vizzielli, Mariano Catello Di Donna, Giuseppe Cucinella, Maria Cristina Solazzo, Cono Scaffa, Pasquale De Franciscis, Mario Fordellone, Stefano Cianci and Vito Chiantera

J. Pers. Med. 2025, 15(9), 426; https://doi.org/10.3390/jpm15090426 - 4 Sep 2025

Abstract

Ovarian cancer (OC) remains one of the most challenging gynecologic malignancies to diagnose in its early stages, significantly impacting prognosis and treatment options [...] Full article

(This article belongs to the Special Issue Gynecologic Oncology: Molecular Mechanisms, Diagnostics and Therapy)

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20 pages, 944 KB

Open AccessReview

Long-Term Prognosis, Risk Assessment, and Management of Patients Diagnosed with Takotsubo Syndrome: A Narrative Review

by Małgorzata Kosek-Nikołajczuk, Ewa Borowiak, Radoslaw Piatkowski, Marcin Grabowski and Monika Budnik

J. Pers. Med. 2025, 15(9), 425; https://doi.org/10.3390/jpm15090425 - 4 Sep 2025

Abstract

Takotsubo syndrome (TTS) is a condition marked by sudden and temporary dysfunction of the left ventricle, occurring without significant coronary artery disease. It was previously thought to be a benign and self-limiting condition, associated with a favorable long-term prognosis and minimal impact on [...] Read more.

Takotsubo syndrome (TTS) is a condition marked by sudden and temporary dysfunction of the left ventricle, occurring without significant coronary artery disease. It was previously thought to be a benign and self-limiting condition, associated with a favorable long-term prognosis and minimal impact on survival. However, the most recent findings provide evidence that TTS is a heterogeneous condition with various presentation patterns. Using the most recent evidence regarding long-term prognosis in TTS, this review article aims to provide an overview of the long-term survival of patients with TTS, highlighting potential risk factors and comorbidities that may worsen prognosis. It also explores the risk of recurrence and the utility of advanced imaging modalities for prognosis assessment. Risk factors negatively impacting long-term outcomes include male sex, older age, reduced left ventricular ejection fraction (LVEF), physical triggers (especially pulmonary and neurological diseases), and comorbidities such as atrial fibrillation, chronic obstructive pulmonary disease, and active cancer. Recurrence, though relatively uncommon, can affect up to 11% of patients, with “super recurrence” linked to higher peak troponin levels, lower LVEF, and emotional triggers. Advanced imaging modalities—such as coronary angiography and ventriculography, which are considered the gold standard, along with serial echocardiographic assessment—combined with cardiac biomarkers, including relatively low peak troponin levels and markedly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as diagnostic ratios like copeptin/NT-proBNP, provide a robust framework for differentiating TTS from acute coronary syndromes. Key findings suggest that chronic therapeutic strategies in the long-term management of TTS patients should focus on improving long-term outcomes and reducing the risk of mortality and TTS recurrence. Methods: A comprehensive review was conducted using PubMed (U.S. National Library of Medicine and National Institutes of Health) and Google Scholar to identify relevant English-language publications addressing the long-term prognosis, biomarkers, imaging, risk of recurrence, and long-term management of TTS. Full article

(This article belongs to the Special Issue New Progress in Prevention and Personalized Treatment for Cardiovascular Diseases)

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14 pages, 1748 KB

Open AccessArticle

Medium- and Long-Term Evaluation of Splenic Arterial Embolization: A Retrospective CT Volumetric and Hematologic Function Analysis

by Filippo Piacentino, Federico Fontana, Cecilia Beltramini, Andrea Coppola, Anna Maria Ierardi, Gianpaolo Carrafiello, Giulio Carcano and Massimo Venturini

J. Pers. Med. 2025, 15(9), 424; https://doi.org/10.3390/jpm15090424 - 4 Sep 2025

Abstract

Background: Splenic arterial embolization (SAE) is a well-established technique in the non-operative management of splenic trauma and aneurysms. While its short-term safety and efficacy have been widely documented, medium- and long-term impacts on splenic volume and function remain under-investigated. This study aimed to [...] Read more.

Background: Splenic arterial embolization (SAE) is a well-established technique in the non-operative management of splenic trauma and aneurysms. While its short-term safety and efficacy have been widely documented, medium- and long-term impacts on splenic volume and function remain under-investigated. This study aimed to evaluate volumetric changes and hematological parameters following SAE, with emphasis on its role in preserving splenic integrity and potential integration with AI-enhanced imaging technologies. Methods: We retrospectively analyzed 17 patients treated with SAE between January 2014 and December 2023. Volumetric measurements were performed using computed tomography (CT) with 3D reconstructions before and after SAE. Patients were divided into two groups based on indication: polytrauma (n = 8) and splenic artery aneurysm (n = 9). Hematological parameters including white blood cells (WBCs), red blood cells (RBCs), and hemoglobin (Hb) were evaluated in correlation with clinical outcomes. Statistical significance was assessed using Student’s t-test, and power analysis was conducted. Results: Among the trauma group, mean splenic volume decreased from 190.5 ± 51.2 cm³ to 147.8 ± 77.8 cm³ (p = 0.2158), while in the aneurysm group, volume decreased from 195.4 ± 78.9 cm³ to 143.7 ± 81.4 cm³ (p = 0.184). Though not statistically significant, these changes suggest post-procedural splenic remodeling. The technical success of SAE was 100%, with no cases of late follow-up infarction, abscess, immunological impairment, or secondary splenectomy required. Hematologic parameters remained within normal limits in follow-up assessments. Conclusions: SAE represents a safe and effective intervention for spleen preservation in both traumatic and aneurysmal conditions. Although a reduction in splenic volume has been observed, white blood cell counts, a reliable indicator of splenic function, have remained stable over time. This finding supports the preservation of splenic function following SAE. Full article

(This article belongs to the Special Issue Recent Innovations and Artificial Intelligence in Interventional Radiology: A Step Towards Personalized Medicine)

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19 pages, 1880 KB

Open AccessArticle

Development and Piloting of Co.Ge.: A Web-Based Digital Platform for Generative and Clinical Cognitive Assessment

by Angela Muscettola, Martino Belvederi Murri, Michele Specchia, Giovanni Antonio De Bellis, Chiara Montemitro, Federica Sancassiani, Alessandra Perra, Barbara Zaccagnino, Anna Francesca Olivetti, Guido Sciavicco, Rosangela Caruso, Luigi Grassi and Maria Giulia Nanni

J. Pers. Med. 2025, 15(9), 423; https://doi.org/10.3390/jpm15090423 - 3 Sep 2025

Abstract

Background/Objectives: This study presents Co.Ge. a Cognitive Generative digital platform for cognitive testing. We describe its architecture and report a pilot study. Methods: Co.Ge. is modular and web-based (Laravel-PHP, MySQL). It can be used to administer a variety of validated cognitive [...] Read more.

Background/Objectives: This study presents Co.Ge. a Cognitive Generative digital platform for cognitive testing. We describe its architecture and report a pilot study. Methods: Co.Ge. is modular and web-based (Laravel-PHP, MySQL). It can be used to administer a variety of validated cognitive tests, facilitating administration and scoring while capturing Reaction Times (RTs), trial-level responses, audio, and other data. Co.Ge. includes a study-management dashboard, Application Programming Interfaces (APIs) for external integration, encryption, and customizable options. In this demonstrative pilot study, clinical and non-clinical participants completed an Auditory Verbal Learning Test (AVLT), which we analyzed using accuracy, number of recalled words, and reaction times as outcomes. We collected ratings of user experience with a standardized rating scale. Analyses included Frequentist and Bayesian Generalized Linear Mixed Models (GLMMs). Results: Mean ratings of user experience were all above 4/5, indicating high acceptability (n = 30). Pilot data from AVLT (n = 123, 60% clinical, 40% healthy) showed that Co.Ge. seamlessly provides standardized clinical ratings, accuracy, and RTs. Analyzing RTs with Bayesian GLMMs and Gamma distribution provided the best fit to data (Leave-One-Out Cross-Validation) and allowed to detect additional associations (e.g., education) otherwise unrecognized using simpler analyses. Conclusions: The prototype of Co.Ge. is technically robust and clinically precise, enabling the extraction of high-resolution behavioral data. Co.Ge. provides traditional clinical-oriented cognitive outcomes but also promotes complex generative models to explore individualized mechanisms of cognition. Thus, it will promote personalized profiling and digital phenotyping for precision psychiatry and rehabilitation. Full article

(This article belongs to the Special Issue Trends and Future Development in Precision Medicine)

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11 pages, 480 KB

Open AccessArticle

Calcium Hides the Clue: Unraveling the Diagnostic Value of Coronary Calcium Scoring in Cardiac Arrest Survivors

by Ana Margarida Martins, Joana Rigueira, Beatriz Valente Silva, Beatriz Nogueira Garcia, Pedro Alves da Silva, Ana Abrantes, Rui Plácido, Doroteia Silva, Fausto J. Pinto and Ana G. Almeida

J. Pers. Med. 2025, 15(9), 422; https://doi.org/10.3390/jpm15090422 - 3 Sep 2025

Abstract

Introduction: Coronary artery disease remains one of the most prevalent causes of hospital cardiac arrest (OHCA). Although the benefit of early coronary angiography is well stablished in patients with ST-segment elevation, the benefit and the timing of performing it in other patients [...] Read more.

Introduction: Coronary artery disease remains one of the most prevalent causes of hospital cardiac arrest (OHCA). Although the benefit of early coronary angiography is well stablished in patients with ST-segment elevation, the benefit and the timing of performing it in other patients remain a matter of debate. This is due to the difficulty of identifying those in which an infarction with non-ST-segment elevation is the cause of the OHCA. Coronary artery calcium (CAC) emerges as a reliable predictor of coronary disease and adverse cardiovascular events, detectable even in non-gated chest computed tomography (CT) scans commonly used in OHCA etiological studies, showcasing potential for streamlined risk assessment and management. Aim: The aim of this study was to evaluate if CAC in non-gated CT scans performed in OHCA survivors could act as a good predictor of coronary artery disease on coronary angiography. Methods: This is a single-center, retrospective study of OHCA survivors without ST-segment elevation at presentation. We selected patients for whom a non-gated chest CT was performed and underwent coronary angiography due to the clinical, electrocardiogram (ECG), or echocardiographic suspicion of acute coronary syndrome. An investigator, blinded to the coronary angiography report, evaluated CAC both quantitively (with Agatston score) and qualitatively (visual assessment: absent, mild, moderate, or severe). Results: A total of 44 consecutive patients were included: 70% male, mean age of 60 ± 13 years old. The mean Agatston score was 396 ± 573 AU (Agatston units). Regarding the qualitative assessment, CAC was classified as mild, moderate, and severe in 11%, 25%, and 20% of patients, respectively. The coronary angiography revealed significant coronary lesions in 15 patients (34%), of which 87% were revascularized (80% underwent PCI and 7% CABG). The quantitative CAC assessment accurately predicted the presence of significant lesions on coronary angiography (AUC = 0.90, 95% CI 0.81–0.99, p < 0.001). The presence of moderate or severe CAC by visual assessment also predicted significant lesions on coronary angiography (OR 2.66, 95% CI 1.87–109.71, p = 0.01). There was also a good and significant correlation between the vessel with severe calcification in the CT scan and the culprit vessel evaluated by coronary angiography. CAC was reported in only 16% of the reviewed CTs, most of them with severe calcification. Conclusion: The assessment of CAC in non-gated chest CT scans proved to be feasible and displayed a robust correlation with the presence, severity, and location of coronary artery disease. Its routine use upfront was shown to be an important complement to CT scan reports, ensuring more precise and personalized OHCA management. Full article

(This article belongs to the Special Issue State of the Art in Cardiac Imaging)

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14 pages, 3046 KB

Open AccessReview

The State of the Art in the Treatment of Actinic Keratosis and Field Cancerization: A Narrative Review

by Andrea Paradisi, Enrico Bocchino, Maria Mannino, Giulio Gualdi, Alessandra D’Amore, Daniele Omar Traini and Ketty Peris

J. Pers. Med. 2025, 15(9), 421; https://doi.org/10.3390/jpm15090421 - 3 Sep 2025

Abstract

Actinic keratosis (AK) is considered the early phase of a squamous cell carcinoma (SCC) and represents one of the most common epithelial skin lesions, with an estimated global prevalence of approximately 14%. An estimated annual risk of progression has been reported with a [...] Read more.

Actinic keratosis (AK) is considered the early phase of a squamous cell carcinoma (SCC) and represents one of the most common epithelial skin lesions, with an estimated global prevalence of approximately 14%. An estimated annual risk of progression has been reported with a range from 0 to 0.53%. Although spontaneous regression of individual AK lesions has been described in approximately 23% of cases, the frequent presence of multiple lesions, usually in the broader context of field cancerization, significantly diminishes the likelihood of regression and contributes to a higher cumulative risk of progression to SCC. The aim of the present narrative review was to provide an overview of the current evidence of the most effective available lesion-directed and field-directed treatments for actinic keratoses, on the personalized, combined, or sequential approach, as well as on the emerging therapeutic options. Full article

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

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10 pages, 538 KB

Open AccessArticle

Real-World Outcomes of Splenic Artery Embolization in Blunt Splenic Trauma: Insights from an Italian Multicenter Cohort

by Fabio Corvino, Francesco Giurazza, Marcello Andrea Tipaldi, Tommaso Rossi, Francesco Daviddi, Orsola Perrone, Ilaria Ambrosini, Mauro D’addato, Ilaria Villanova, Paolo Marra, Francesco Saverio Carbone, Antonio Vizzuso, Fernando Smaldone, Anna Rita Scrofani, Roberto Iezzi, Andrea Discalzi, Marco Calandri, Marco Femia, Carlo Valenti Pittino, Ruggero Vercelli, Daniele Falsaperla, Antonello Basile, Antonio Bruno, Chiara Gasperini and Raffaella Niola Show full author list Hide full author list

J. Pers. Med. 2025, 15(9), 420; https://doi.org/10.3390/jpm15090420 - 3 Sep 2025

Abstract

Background: Splenic artery embolization (SAE) has emerged as a key adjunct to non-operative management (NOM) in hemodynamically stable patients with blunt splenic trauma, yet variability in its application persists across centers. Objectives: The aim was to evaluate real-life clinical practices, techniques, and outcomes [...] Read more.

Background: Splenic artery embolization (SAE) has emerged as a key adjunct to non-operative management (NOM) in hemodynamically stable patients with blunt splenic trauma, yet variability in its application persists across centers. Objectives: The aim was to evaluate real-life clinical practices, techniques, and outcomes of SAE in blunt splenic trauma across multiple Italian trauma centers. Materials and Methods: This retrospective multicenter study analyzed data from 281 patients undergoing emergency SAE for blunt splenic trauma between January 2019 and December 2021. Demographics, imaging findings, embolization techniques, complications, and outcomes were collected and analyzed. Multivariate logistic regression was used to assess predictors of splenectomy. Results: The technical success rate was 100%, with a 9.6% rate of post-embolization splenectomy and a complication rate of 24.9% (including 5.7% splenic infarction and 3.2% rebleeding). Embolization was performed proximally (46.6%), distally (28.8%), or with a combined approach (24.6%). No significant correlation was found between embolization technique and splenectomy rate. Patients with AAST grade III injuries benefited from SAE with high technical success and low failure rates. Notably, 14.2% of patients underwent angiography despite negative CT, with a splenectomy rate of 10% in this subgroup. Multivariate analysis identified no independent predictors of splenectomy. Conclusions: SAE is a reliable and effective tool in the management of blunt splenic trauma, achieving high splenic salvage rates even in selected grade III injuries and CT-negative patients. In an era of precision medicine, interventional radiology should be regarded as a distinct and specific treatment modality, comparable to surgery, rather than being merely included within non-operative management (NOM). Full article

(This article belongs to the Special Issue Interventional Radiology: Towards Personalized Medicine)

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12 pages, 1229 KB

Open AccessArticle

Transoral Robotic Surgery for the Salvage of Primarily Irradiated Oropharyngeal Squamous Cell Carcinomas Recurring at the Base of the Tongue: A Small Monoinstitutional Series

by Samuele Frasconi, Davide Rizzo, Roberto Gallus, Nikolaos Machouchas, Sergio Cannova, Dan Marian Fliss, Jacopo Galli and Francesco Bussu

J. Pers. Med. 2025, 15(9), 419; https://doi.org/10.3390/jpm15090419 - 3 Sep 2025

Abstract

Background/Objectives: Recurrences of squamous cell carcinoma (SCC) at the base of the tongue (BoT) after primary radiochemotherapy (RT-CHT) are associated with low survival rates, poor functional outcomes, and high morbidity following salvage surgery. Transoral robotic surgery (TORS) has emerged as a less [...] Read more.

Background/Objectives: Recurrences of squamous cell carcinoma (SCC) at the base of the tongue (BoT) after primary radiochemotherapy (RT-CHT) are associated with low survival rates, poor functional outcomes, and high morbidity following salvage surgery. Transoral robotic surgery (TORS) has emerged as a less invasive alternative to open surgical approaches. This study aims to describe our clinical experience with TORS in patients with BoT SCC recurrence after RT-CHT, focusing on oncological outcomes—relapse-free survival (RFS) and disease-specific survival (DSS)—as well as functional outcomes, particularly swallowing function. Methods: We conducted a retrospective review of four patients who underwent salvage TORS for BoT recurrence between September 2013 and September 2014 at a single tertiary referral center. All patients had been previously treated with primary RT-CHT for oropharyngeal squamous cell carcinomas. Oncological events (recurrence, death) and functional endpoints (dietary limitations, MD Anderson Dysphagia Inventory [MDADI] scores) were retrieved from medical records. Results: Four patients were included. All achieved unrestricted oral intake by one month post-TORS, showing functional improvement compared to their preoperative status. Three of the four patients remained free of locoregional recurrence during follow-up. No major perioperative complications were reported. Conclusions: In selected patients with BoT SCC recurrence after primary RT-CHT, TORS may offer a viable and less morbid salvage treatment option with favorable early functional outcomes and acceptable oncologic control. Based on both our institutional experience and the supporting literature, we propose selection criteria to guide TORS indication in this clinical setting. Full article

(This article belongs to the Special Issue Head and Neck Oncologic Surgery: Clinical Updates and New Perspectives in Precision Medicine Era)

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18 pages, 285 KB

Open AccessArticle

Cardiovascular Complications Are Increased in Inflammatory Bowel Disease: A Path Toward Achievement of a Personalized Risk Estimation

by Vito Annese, Maria Laura Annunziata, Guglielmo Albertini Petroni, Emanuele Orlando, Sofia Cinque, Marzio Parisi, Paolo Biamonte, Giuseppe Dell’Anna, Anna Latiano and Serenella Castelvecchio

J. Pers. Med. 2025, 15(9), 418; https://doi.org/10.3390/jpm15090418 - 2 Sep 2025

Abstract

Background/Objectives: The global burden of inflammatory bowel diseases (IBDs) continues to rise, with up to 50% of patients experiencing extraintestinal manifestations. Cardiovascular diseases (CVDs) are of particular concern, ranking as the second leading cause of mortality in this population. Despite a comparatively [...] Read more.

Background/Objectives: The global burden of inflammatory bowel diseases (IBDs) continues to rise, with up to 50% of patients experiencing extraintestinal manifestations. Cardiovascular diseases (CVDs) are of particular concern, ranking as the second leading cause of mortality in this population. Despite a comparatively lower prevalence of traditional cardiovascular (CV) risk factors, the persistent inflammatory milieu and immune dysregulation inherent to IBD may contribute to heightened CVD risk. In this study, following a review of the current literature, an ongoing prospective trial designed to clarify CV risk profiles in IBD patients is detailed. Methods: A cohort of patients with IBD is being enrolled for comprehensive baseline evaluation of CV risk factors, lifestyle metrics, and disease characteristics. The incidence of major adverse cardiovascular events (MACEs) will be tracked and contrasted with a gender- and age-matched non-IBD cohort over a 2-year follow-up period. In cases of MACE occurrence, a multi-omics analysis—including genomic, proteomic, transcriptomic, and microbiome profiling—will be performed, along with a parallel evaluation in matched IBD controls without MACE. An artificial intelligence (AI) framework will support the analysis of this complex dataset. Results: To date, over 150 patients with IBD have been enrolled, and detailed phenotypic data and biological samples have been collected. Conclusions: We aim to introduce an IBD-specific correction factor for existing CV risk scores upon study completion. This is particularly relevant for individuals under 40 years of age, who are often inadequately assessed by current risk stratification models Full article

(This article belongs to the Section Disease Biomarkers)

14 pages, 485 KB

Open AccessArticle

Microsatellite Instability and Myometrial Infiltration in Low-Grade Endometrial Cancer: A Focus on MMR Heterodimer Dysfunction by a Retrospective Multicentric Italian Study

by Carlo Ronsini, Stefano Restaino, Mariano Catello Di Donna, Giuseppe Cucinella, Maria Cristina Solazzo, Pasquale De Franciscis, Giuseppe Vizzielli, Manuela Ludovisi and Vito Chiantera

J. Pers. Med. 2025, 15(9), 417; https://doi.org/10.3390/jpm15090417 - 2 Sep 2025

Abstract

Background: Recent studies highlight the role of microsatellite instability (MSI) in tumor progression. This study examines the link between MSI, type of loss of function, and disease progression in low-grade endometrial carcinoma clinically confined to the uterus, focusing on myometrial infiltration. Materials and [...] Read more.

Background: Recent studies highlight the role of microsatellite instability (MSI) in tumor progression. This study examines the link between MSI, type of loss of function, and disease progression in low-grade endometrial carcinoma clinically confined to the uterus, focusing on myometrial infiltration. Materials and Methods: This retrospective case-control study analyzed data from 144 women treated for clinical stage I low-grade endometrial carcinoma at two university hospitals. Patients were divided into two groups based on microsatellite status: 118 with microsatellite stability (MSS) and 26 with MSI. Immunohistochemical profiling assessed MMR proteins (MLH1, PMS2, MSH2, MSH6). The primary outcome was the presence of myometrial infiltration, and the secondary outcome was the deepness of infiltration. Data were statistically analyzed using Fisher’s exact, Chi-square, and Wilcoxon tests, with logistic regression applied to evaluate the impact of MSI on these outcomes. Results: Myometrial infiltration was present in 96% of MSS and 98% of MSI cases (p = 0.5). However, deep infiltration (≥50%) was more frequent in patients with MSI (38% vs. 19%, p = 0.042). Stratification by heterodimer loss revealed that loss of MLH1/PMS2 was associated with a higher rate of deep infiltration (47%), while loss of MSH2/MSH6 correlated with lower infiltration risk (14%). In multivariate analysis, MSH2/MSH6 loss remained negatively associated with infiltration (OR 0.88; 95% CI 0.80–0.98; p = 0.020), independent of grade and LVSI. Conclusions: In low-grade endometrial carcinomas clinically confined to the uterus, MSI does not increase the overall prevalence of myometrial infiltration but is associated with deeper invasion, especially in cases with MLH1/PMS2 loss. MSI profiling could aid in risk stratification and therapeutic planning, particularly in candidates for fertility-sparing treatment. Full article

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

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