Journal of Personalized Medicine

11 pages, 4090 KiB

Open AccessSystematic Review

Clinical Implication of Brain Metastases En-Bloc Resection: Surgical Technique Description and Literature Review

by Roberto Altieri, Sergio Corvino, Giuseppe La Rocca, Fabio Cofano, Antonio Melcarne, Diego Garbossa and Manlio Barbarisi

J. Pers. Med. 2024, 14(11), 1110; https://doi.org/10.3390/jpm14111110 - 19 Nov 2024

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Abstract

Background: The role of brain metastases (BM) surgery is of paramount importance for patients’ progression-free and overall survival. “En-bloc” and “piecemeal” resection represent the main surgical techniques. Although en-bloc resection remains the best surgical option, it is not widely adopted or feasible as [...] Read more.

Background: The role of brain metastases (BM) surgery is of paramount importance for patients’ progression-free and overall survival. “En-bloc” and “piecemeal” resection represent the main surgical techniques. Although en-bloc resection remains the best surgical option, it is not widely adopted or feasible as the first choice. We describe our point of view about the en-bloc surgical technique with an illustrative case and discuss its indications with pros and cons through a comprehensive literature review. Materials and methods: A Medline search up to December 2023 in the Embase and PubMed online electronic databases was made and PRISMA statement was followed. An illustrative case of “en-bloc” resection from our surgical series was also added as a technical note. Results: We describe tips and tricks of our surgical technique and added a surgical video from our series. The literature review disclosed 19 studies. Resulting data suggested that “en-bloc” resection, when feasible, provides lesser risk of leptomeningeal dissemination, local recurrence rates, intraoperative bleeding occurrence and perioperative complications; in addition, it preserves the normal anatomy. Conclusions: En-bloc resection is the gold standard technique for surgical treatment of brain metastases especially for patients with superficial lesions that are small in size and far from eloquent areas. Full article

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

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12 pages, 3106 KiB

Open AccessArticle

Limits in the Perception of Facial Symmetry—A Prospective Study

by Friederike Lisa Eißing, Dieter Dirksen, Christoph Runte and Susanne Jung

J. Pers. Med. 2024, 14(11), 1109; https://doi.org/10.3390/jpm14111109 - 18 Nov 2024

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Abstract

Objectives: It is generally accepted that the symmetry of the face plays a significant role in the visual perception of its attractiveness. Therefore, its objective assessment could be useful for individual therapy planning. However, there is an ongoing debate about whether completely symmetrical [...] Read more.

Objectives: It is generally accepted that the symmetry of the face plays a significant role in the visual perception of its attractiveness. Therefore, its objective assessment could be useful for individual therapy planning. However, there is an ongoing debate about whether completely symmetrical faces are less attractive than those with minor deviations. The aim of this study is to find thresholds of symmetry perception among faces with an increased spectrum of asymmetry values. Methods: The faces of 50 persons (25 men, 25 women) were digitized using a 3D scanner based on the fringe projection technique, and asymmetry values were calculated. In order to achieve a larger spectrum of asymmetry values, some of the surfaces were symmetrized or the symmetry was reduced. Afterward, an independent second group of 50 persons (13 medical professionals, 37 laypersons) rated “symmetry”, “attractiveness” and “health” using a visual analog scale (VAS). Results: Symmetry ratings and asymmetry value had a strong and monotonically decreasing association (rho = −0.78, p ˂ 0.001). Manipulated or naturally asymmetrical faces (n = 12) could not be well distinguished with regard to their symmetry (rho = −0.14, p = 0.67). The same applies to very symmetrical or symmetrized faces (n = 10, rho = −0.14, p = 0.67). Medical professionals rated the symmetry (p ˂ 0.001) and attractiveness (p ˂ 0.001) significantly higher than laypersons, while there was no significant difference in the health assessment (p = 0.24). Conclusions: It could be shown that there are indications of threshold values in the perception of facial symmetries, both in the direction of very symmetrical faces and in the direction of asymmetrical faces. There is no evidence that completely symmetrical faces are perceived as less attractive. Thus, in maxillofacial surgery, treatment should aim for the highest symmetry possible, although small deviations are not detrimental. Full article

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

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Graphical abstract

13 pages, 1328 KiB

Open AccessCase Report

Radiosurgery for Hypothalamic Gliomas: Case Report and Clinical Guidelines form A Neurosurgical Center of Excellence

by Jose Valerio, Matteo Borro, Noe Santiago Rea, Laurel Valente, Maria P. Fernandez-Gomez, Jorge Zumaeta, Penelope Mantilla and Andres M. Alvarez-Pinzon

J. Pers. Med. 2024, 14(11), 1108; https://doi.org/10.3390/jpm14111108 - 15 Nov 2024

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Abstract

Background: Hypothalamic gliomas, though rare, present significant challenges in neuro-oncology due to their critical location and high morbidity risk. Pilocytic astrocytoma is the most common subtype, requiring a delicate balance between tumor control and preservation of neurological function. This study explores radiosurgery as [...] Read more.

Background: Hypothalamic gliomas, though rare, present significant challenges in neuro-oncology due to their critical location and high morbidity risk. Pilocytic astrocytoma is the most common subtype, requiring a delicate balance between tumor control and preservation of neurological function. This study explores radiosurgery as a viable treatment option for hypothalamic gliomas, with a focus on low-grade lesions. Methods: A comprehensive literature review was conducted using the PubMed database to compare the outcomes of surgical and non-surgical interventions for hypothalamic gliomas. The purpose of this study is to present a case report and critically compare its outcomes with the data identified in the literature. We report the case of a 25-year-old male presenting with hypernatremia, diabetes insipidus, and altered mental status. Imaging revealed a hypothalamic lesion consistent clinically with a low-grade astrocytoma. Given the tumor’s proximity to critical neurovascular structures, gamma knife radiosurgery was chosen as the intervention. Post treatment, tumor reduction and neurological improvement were observed and documented. Results: The case demonstrated a significant decrease in tumor size and resolution of neurological symptoms post radiosurgery. The management of hypothalamic gliomas remains contentious due to the complex anatomy of the hypothalamus. While surgical resection remains common, it carries a high risk of morbidity. Radiosurgery offers a minimally invasive alternative, effectively controlling tumor growth while reducing neurological risk. The favorable outcomes in our case, supported by the literature, highlight the efficacy of radiosurgery, particularly for low-grade astrocytomas. Conclusions: Gamma knife radiosurgery presents a promising alternative to conventional surgery for hypothalamic gliomas, particularly low-grade lesions such as pilocytic astrocytomas. The reduction in surgical risk and positive clinical outcomes make radiosurgery a valuable tool in the management of these challenging tumors. Full article

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

12 pages, 1417 KiB

Open AccessArticle

Use of Granulocyte Transfusions in the Management of Severe Infections Among Children with Neutropenia

by Gabriela Mielecka-Jarmocik, Katarzyna Szymbor, Walentyna Balwierz, Szymon Skoczeń, Marta Leń, Kinga Kania and Katarzyna Pawińska-Wąsikowska

J. Pers. Med. 2024, 14(11), 1107; https://doi.org/10.3390/jpm14111107 - 15 Nov 2024

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Abstract

Background/Objectives: Infections remain the leading cause of mortality among neutropenic patients with haematologic malignancies, making effective infection management crucial. Achieving a sufficient neutrophil count is essential for the elimination of pathogens. Granulocyte concentrate (GC) can be a treatment option for neutropenic patients with [...] Read more.

Background/Objectives: Infections remain the leading cause of mortality among neutropenic patients with haematologic malignancies, making effective infection management crucial. Achieving a sufficient neutrophil count is essential for the elimination of pathogens. Granulocyte concentrate (GC) can be a treatment option for neutropenic patients with severe infections. This study aimed to evaluate the efficacy, safety, and impact on survival of GC transfusions in neutropenic children with severe infections treated over the past 13 years in a single centre. Methods: The retrospective study analysed clinical data from 60 children (median age 9.5 years) who received GC transfusions at our centre. Granulocytes were collected by apheresis from donors stimulated with granulocyte colony-stimulating factor. The majority of the patients (70%) were diagnosed with acute leukaemia. The main indications for GC were severe pneumonia (45%) and bacterial sepsis (38.33%). Results: The patients received 1 to 29 GC transfusions for 1 to 70 days, with a median time of administration of 3 days. Neutrophil counts increased to >1000/µL within a median of 5 days. GCs were well tolerated by most patients. One patient presented symptoms of anaphylaxis, the other acute lung injury related to transfusions, and alloimmunisation was reported in one patient. Of the patients analysed, 78.33% survived the infection that justified GC administration. We did not observe significant differences in survival depending on the aetiology of the infection. Conclusions: Based on our research, GC appears to be a beneficiary for neutropenic children with severe infections and reduces infection mortality rates. However, further well-designed randomised trials are needed to define its role in this setting. Full article

(This article belongs to the Special Issue Novel Challenges and Advances in Pediatric Hematology and Hematologic Malignancies)

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17 pages, 2941 KiB

Open AccessArticle

Precision in Immune Management: Balancing Steroid Exposure, Rejection Risk, and Infectious Outcomes in Adult Kidney Transplant Recipients

by Avery N. Koi, John C. Johnson, Trine L. Engebretsen, Muhammad A. Mujtaba, Alfred Scott Lea, Heather L. Stevenson and Michael L. Kueht

J. Pers. Med. 2024, 14(11), 1106; https://doi.org/10.3390/jpm14111106 - 14 Nov 2024

Viewed by 346

Abstract

Background/Objectives: With kidney transplant immunosuppression, physicians must balance preventing rejection with minimizing infection and malignancy risks. Steroids have been a mainstay of these immunosuppression regimens since the early days of kidney transplantation, yet their risks remain debated. Our study looks at the clinical [...] Read more.

Background/Objectives: With kidney transplant immunosuppression, physicians must balance preventing rejection with minimizing infection and malignancy risks. Steroids have been a mainstay of these immunosuppression regimens since the early days of kidney transplantation, yet their risks remain debated. Our study looks at the clinical outcomes of patients undergoing early steroid withdrawal (ESW) vs. steroid continuous (SCI) maintenance immunosuppression in adult kidney transplant recipients. Methods: A retrospective case-control study, utilizing propensity score-matching, was performed using the US Collaborative Network Database within TriNetX to evaluate renal transplant outcomes at one year in first-time kidney transplant adult patients (>18 years old) who were prescribed an ESW regimen (no steroids after post-transplant day 7 with maintenance tacrolimus [tac] + mycophenolic acid [MMP]/mycophenolate mofetil [MMF]) vs. SCI (tac + MMF/MMP + prednisone). Cohorts were matched on demographics, comorbidities, previously described risk factors for rejection, and induction immunosuppression. Primary outcomes included viral infections, pyelonephritis, and sepsis. Secondary outcomes included renal transplant rejection, death-censored allograft failure (eGFR < 15 mL/min), patient mortality, delayed graft function, and diabetes mellitus. Results: A total of 2056 patients were in each cohort after matching (mean age: 50.7–51 years, 17.9–20.0% African American, 60–60.6% male.) The SCI cohort had a significantly higher cumulative incidence of composite viremia (18 vs. 28.1%, ESW vs. SCI, p < 0.01) driven by CMV, EBV, and BK virus. Post-transplant diabetes mellitus was significantly higher in the SCI cohort (3.21% vs. 5.49%, ESW vs. SCI, p < 0.01). Delayed graft function was also higher in the SCI cohort (19.55% vs. 22.79%, ESW vs. SCI, p < 0.01). Pyelonephritis (2.3 vs. 4.91%, ESW vs. SCI, p < 0.01) and sepsis (2.15 vs. 5.95%, ESW vs. SCI, p < 0.01) were higher in the SCI cohort. Rejection rates were similar between ESW and SCI (29 vs. 31%, ESW vs. SCI, p = 0.41). There were significantly higher incidences of graft failure (4.9 vs. 9.9%, ESW vs. SCI, p < 0.01) and mortality (0.8 vs. 2.1%, ESW vs. SCI, p < 0.01) in the SCI cohort. Conclusions: This well-matched case-control study suggests that ESW is associated with lower infectious outcomes, mortality, and graft failure without increasing rejection risk, supporting the potential benefits of ESW in kidney transplant patients. Full article

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

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8 pages, 738 KiB

Open AccessBrief Report

Secukinumab for the Treatment of Axial Spondyloarthritis: Long-Term Real-Life Data from Five Italian Referral Centers

by Stefano Gentileschi, Carlo Cannistrà, Carla Gaggiano, Arianna Damiani, Linda Carli, Maurizio Benucci, Fabrizio Cantini, Laura Niccoli, Antonio Vitale, Caterina Baldi, Andrea Delle Sedie, Luca Cantarini, Marta Mosca, Bruno Frediani and Serena Guiducci

J. Pers. Med. 2024, 14(11), 1105; https://doi.org/10.3390/jpm14111105 - 14 Nov 2024

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Abstract

Background: This study aimed to evaluate the effectiveness and drug retention rate of secukinumab (SCK) in axial spondyloarthritis (ax-SpA) within a multicentric real-life cohort. Methods: Data from patients with ax-SpA treated with SCK at five Italian centers were collected retrospectively, excluding those with [...] Read more.

Background: This study aimed to evaluate the effectiveness and drug retention rate of secukinumab (SCK) in axial spondyloarthritis (ax-SpA) within a multicentric real-life cohort. Methods: Data from patients with ax-SpA treated with SCK at five Italian centers were collected retrospectively, excluding those with a diagnosis of Psoriatic Arthritis. Evaluations were conducted at baseline and at 3, 6, 12, 18, and 24 months. Assessments included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), BASDAI, and ASDAS-CRP. Results: Seventy-one ax-SpA patients (57.7% female, mean age: 53.86 ± 12.67 years) were enrolled. Baseline mean BASDAI was 6.2 ± 1.4 and ASDAS-CRP was 2.9 ± 1.3. Significant improvements in BASDAI and ASDAS-CRP were observed over time, with BASDAI reducing to 3.5 ± 1.9 (p < 0.0001) and ASDAS-CRP to 1.7 ± 0.9 (p < 0.0001) at 24 months. The follow-up duration averaged 20.46 ± 13.46 months. By the end of follow-up, 29.5% of patients discontinued SCK. The two-year retention rate was 72%. Dropout risk was higher in patients with fibromyalgia (HR: 2.896, p = 0.026). No significant retention differences were found based on sex, age, enthesitis, radiographic disease, combination with cDMARDs, SCK dosage, or previous bDMARD exposure. Lower ASDAS-CRP at the study’s end was noted in patients without fibromyalgia (1.4 vs. 2.5, p < 0.001). Conclusions: SCK showed rapid and lasting effectiveness for ax-SpA with a favorable retention rate, though fibromyalgia may reduce treatment persistence. Full article

(This article belongs to the Special Issue Current Trends and Advances in Spondyloarthritis)

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13 pages, 293 KiB

Open AccessReview

Considering Biomarkers of Neurodegeneration in Alzheimer’s Disease: The Potential of Circulating Cell-Free DNA in Precision Neurology

by Chad A. Pollard, Erin R. Saito, Jeffrey M. Burns, Jonathon T. Hill and Timothy G. Jenkins

J. Pers. Med. 2024, 14(11), 1104; https://doi.org/10.3390/jpm14111104 - 13 Nov 2024

Viewed by 565

Abstract

Neurodegenerative diseases, such as Alzheimer’s disease (AD), are a growing public health crisis, exacerbated by an aging global population and the lack of effective early disease-modifying therapies. Early detection of neurodegenerative disorders is critical to delaying symptom onset and mitigating disease progression, but [...] Read more.

Neurodegenerative diseases, such as Alzheimer’s disease (AD), are a growing public health crisis, exacerbated by an aging global population and the lack of effective early disease-modifying therapies. Early detection of neurodegenerative disorders is critical to delaying symptom onset and mitigating disease progression, but current diagnostic tools often rely on detecting pathology once clinical symptoms have emerged and significant neuronal damage has already occurred. While disease-specific biomarkers, such as amyloid-beta and tau in AD, offer precise insights, they are too limited in scope for broader neurodegeneration screening for these conditions. Conversely, general biomarkers like neurofilament light chain (NfL) provide valuable staging information but lack targeted insights. Circulating cell-free DNA (cfDNA), released during cell death, is emerging as a promising biomarker for early detection. Derived from dying cells, cfDNA can capture both general neurodegenerative signals and disease-specific insights, offering multi-layered genomic and epigenomic information. Though its clinical potential remains under investigation, advances in cfDNA detection sensitivity, standardized protocols, and reference ranges could establish cfDNA as a valuable tool for early screening. cfDNA methylation signatures, in particular, show great promise for identifying tissue-of-origin and disease-specific changes, offering a minimally invasive biomarker that could transform precision neurology. However, further research is required to address technological challenges and validate cfDNA’s utility in clinical settings. Here, we review recent work assessing cfDNA as a potential early biomarker in AD. With continued advances, cfDNA could play a pivotal role in shifting care from reactive to proactive, improving diagnostic timelines and patient outcomes. Full article

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

15 pages, 1196 KiB

Open AccessArticle

Associations Between Plasma Levels of NLRP3 Protein, Interleukin-1 Beta and Features of Acute ST-Elevation Myocardial Infarction

by Vyacheslav Ryabov, Yulia Samoilova, Aleksandra Gombozhapova, Anastasiia Nesova and Irina Kologrivova

J. Pers. Med. 2024, 14(11), 1103; https://doi.org/10.3390/jpm14111103 - 13 Nov 2024

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Abstract

Background. Phenotyping inflammation in ST-elevation myocardial infarction (STEMI) is a challenge for modern cardiology. NLRP3 inflammasome is a proven predictor of adverse outcomes in cardiovascular disease, but its specificity in stratifying inflammatory activity in patients with myocardial infarction (MI) has not been demonstrated. [...] Read more.

Background. Phenotyping inflammation in ST-elevation myocardial infarction (STEMI) is a challenge for modern cardiology. NLRP3 inflammasome is a proven predictor of adverse outcomes in cardiovascular disease, but its specificity in stratifying inflammatory activity in patients with myocardial infarction (MI) has not been demonstrated. The aim of this paper is to describe the levels of NLRP3 protein and IL-1β concentrations and their changes in dynamics and associations with clinical, laboratory and instrumental characteristics of patients with STEMI. Methods. A total of 45 patients with STEMI were enrolled. Concentrations of NLRP3 and IL-1β were evaluated in arterial and venous EDTA blood from the infarct-related coronary and peripheral arteries and veins on days 1, 3 and 7 after MI. Results and Conclusions. The concentrations of markers were higher on the first day after MI with a maximum decrease on the third day. The levels of both markers in venous plasma correlated with those in arterial blood, allowing their routine determination in venous plasma on the first day after MI. IL-1β levels correlated directly with the wall motion index and inversely with left ventricular ejection fraction and stroke volume, which characterize the potential contribution to adverse myocardial remodeling. There were two multidirectional trends in changes in NLRP3 and IL-1β levels during hospitalization. Initially higher levels with a gradual decrease by day 7 were associated with a longer duration of myocardial ischemia and higher plasma troponin I levels. Further evaluation of the long-term outcomes of MI will allow identifying inflammatory factors that input to the development of secondary major adverse cardiac events and will provide a new step in the understanding of inflammatory phenotyping. Full article

(This article belongs to the Special Issue Molecular and Technological Advances in the Diagnosis and Therapy of Cardiovascular Diseases)

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9 pages, 240 KiB

Open AccessArticle

Maternal Serum SCUBE-1: A Novel Ischemic Marker in Preeclampsia

by Gulseren Dinc, Suleyman Caner Karahan and Suleyman Guven

J. Pers. Med. 2024, 14(11), 1102; https://doi.org/10.3390/jpm14111102 - 12 Nov 2024

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Abstract

Background: SCUBE-1 (Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)-domain-containing protein 1) is a novel marker of ischemia, which is a cell surface-secreted protein in the platelets and endothelial cells. The aim of the study is to measure serum SCUBE-1 levels [...] Read more.

Background: SCUBE-1 (Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)-domain-containing protein 1) is a novel marker of ischemia, which is a cell surface-secreted protein in the platelets and endothelial cells. The aim of the study is to measure serum SCUBE-1 levels and investigate their association with uteroplacental blood flow in patients with preeclampsia. Methods: The study was conducted on patients with preeclampsia. Maternal serum SCUBE1 and IMA levels were the main outcomes. The control group consisted of gestational-age-matched pregnant women. Fetal umbilical artery (UA) pulsatility index (PI), middle cerebral artery PI, cerebroplacental ratio (CPR), and maternal uterine artery (UtA)-PI were also examined, and correlation analysis was performed to reveal the association between maternal serum SCUBE1 levels and Doppler findings. Results: The study group consisted of thirty-two preeclamptic patients, and the control group consisted of thirty-two uncomplicated singleton pregnancies. Maternal serum SCUBE1 and IMA levels were significantly higher in preeclamptic women compared to the control group (p < 0.000, p < 0.004, respectively). Mean UtA-PI values and fetal UA-PI values were significantly higher in preeclamptic pregnant women compared to the control group (p < 0.05, p < 0.05, respectively). However, the average CPR was significantly lower in pregnant women with preeclampsia (p < 0.05). While no significant correlation was found between maternal serum SCUBE1 levels and UA-PI and CPR (p > 0.05, p > 0.05, respectively), a significant correlation was found between right and left UtA-PI (p < 0.004, p < 0.006, respectively). Conclusions: The maternal serum SCUBE1 level is increased in patients with preeclampsia, and this increase is significantly correlated with the maternal uterine artery pulsatility index. Full article

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

17 pages, 1531 KiB

Open AccessReview

Digital Twins’ Advancements and Applications in Healthcare, Towards Precision Medicine

by Konstantinos Papachristou, Paraskevi F. Katsakiori, Panagiotis Papadimitroulas, Lidia Strigari and George C. Kagadis

J. Pers. Med. 2024, 14(11), 1101; https://doi.org/10.3390/jpm14111101 - 11 Nov 2024

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Abstract

This review examines the significant influence of Digital Twins (DTs) and their variant, Digital Human Twins (DHTs), on the healthcare field. DTs represent virtual replicas that encapsulate both medical and physiological characteristics—such as tissues, organs, and biokinetic data—of patients. These virtual models facilitate [...] Read more.

This review examines the significant influence of Digital Twins (DTs) and their variant, Digital Human Twins (DHTs), on the healthcare field. DTs represent virtual replicas that encapsulate both medical and physiological characteristics—such as tissues, organs, and biokinetic data—of patients. These virtual models facilitate a deeper understanding of disease progression and enhance the customization and optimization of treatment plans by modeling complex interactions between genetic factors and environmental influences. By establishing dynamic, bidirectional connections between the DTs of physical objects and their digital counterparts, these technologies enable real-time data exchange, thereby transforming electronic health records. Leveraging the increasing availability of extensive historical datasets from clinical trials and real-world sources, AI models can now generate comprehensive predictions of future health outcomes for specific patients in the form of AI-generated DTs. Such models can also offer insights into potential diagnoses, disease progression, and treatment responses. This remarkable progression in healthcare paves the way for precision medicine and personalized health, allowing for high-level individualized medical interventions and therapies. However, the integration of DTs into healthcare faces several challenges, including data security, accessibility, bias, and quality. Addressing these obstacles is crucial to realizing the full potential of DHTs, heralding a new era of personalized, precise, and accurate medicine. Full article

(This article belongs to the Section Pharmacogenetics)

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36 pages, 1336 KiB

Open AccessReview

Navigating the Complexities of Radiation Injuries: Therapeutic Principles and Reconstructive Strategies

by Andreea Grosu-Bularda, Flavia-Francesca Lita, Florin-Vlad Hodea, Eliza-Maria Bordeanu-Diaconescu, Andrei Cretu, Catalina-Stefania Dumitru, Stefan Cacior, Bogdan-Mihai Marinescu, Ioan Lascar and Cristian-Sorin Hariga

J. Pers. Med. 2024, 14(11), 1100; https://doi.org/10.3390/jpm14111100 - 9 Nov 2024

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Abstract

Radiation injuries, particularly those resulting from therapeutic or accidental exposure, present complex challenges for medical management. These injuries can manifest localized skin damage or extend to deeper tissues, presenting as various clinical entities that require treatment strategies, ranging from conservative management to complex [...] Read more.

Radiation injuries, particularly those resulting from therapeutic or accidental exposure, present complex challenges for medical management. These injuries can manifest localized skin damage or extend to deeper tissues, presenting as various clinical entities that require treatment strategies, ranging from conservative management to complex surgical interventions. Radiation treatment constitutes a fundamental component of neoplastic management, with nearly two out of three oncological instances undergoing it as an element of their therapeutic strategy. The therapeutic approach to radiation injury consists of expanding prophylactic measures while maintaining the efficacy of treatment, such as conservative treatment or local debridement followed by reconstruction. The armamentarium of reconstructive methods available for plastic surgeons, from secondary healing to free tissue transfer, can be successfully applied to radiation injuries. However, the unique pathophysiological changes induced by radiation necessitate a careful and specialized approach for their application, considering the altered tissue characteristics and healing dynamics. The therapeutic strategy is guided by both the severity and progression of the injury, with the primary aim of restoring functionality and aesthetic aspects while simultaneously minimizing the risk of complications. This paper explores the various conditions encompassed by the term “radiation injury,” reviews both non-surgical and surgical therapeutic strategies for managing these injuries, and highlights the unique challenges associated with treating irradiated tissues within specific oncological contexts. Full article

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

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10 pages, 1114 KiB

Open AccessArticle

Differential Inflammatory and Immune Response to Viral Infection in the Upper-Airway and Peripheral Blood of Mild COVID-19 Cases

by Malena Gajate-Arenas, Omar García-Pérez, Angélica Domínguez-De-Barros, Candela Sirvent-Blanco, Roberto Dorta-Guerra, Alma García-Ramos, José E. Piñero, Jacob Lorenzo-Morales and Elizabeth Córdoba-Lanús

J. Pers. Med. 2024, 14(11), 1099; https://doi.org/10.3390/jpm14111099 - 9 Nov 2024

Viewed by 404

Abstract

Background/Objectives: COVID-19 is characterised by a wide variety of clinical manifestations, and clinical tests and genetic analysis might help to predict patient outcomes. Methods: In the current study, the expression of genes related to immune response (CCL5, IFI6, OAS1, [...] Read more.

Background/Objectives: COVID-19 is characterised by a wide variety of clinical manifestations, and clinical tests and genetic analysis might help to predict patient outcomes. Methods: In the current study, the expression of genes related to immune response (CCL5, IFI6, OAS1, IRF9, IL1B, and TGFB1) was analysed in the upper airway and paired-blood samples from 25 subjects infected with SARS-CoV-2. Relative gene expression was determined by RT-qPCR. Results: CCL5 expression was higher in the blood than in the upper airway (p < 0.001). In addition, a negative correlation was found between IFI6 and viral load (p = 0.033) in the upper airway, suggesting that the IFI6 expression inhibits the viral infection. Concerning sex, women expressed IL1B and IRF9 in a higher proportion than men at a systemic level (p = 0.008 and p = 0.049, respectively). However, an increased expression of IRF9 was found in men compared to women in the upper airway (p = 0.046), which could be due to the protective effect of IRF9, especially in men. Conclusions: The higher expression of CCL5 in blood might be due to the key role of this gene in the migration and recruitment of immune cells from the systemic circulation to the lungs. Our findings confirm the existence of sex differences in the immune response to early stages of the infection. Further studies in a larger cohort are necessary to corroborate the current findings. Full article

(This article belongs to the Special Issue Biomarkers and Pathogenesis of Infectious Diseases: From Research to Personalized Medicine)

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9 pages, 509 KiB

Open AccessArticle

Is It Possible to Predict Difficulties During Laparoscopic Sleeve Gastrectomy? A Single Centre Experience

by Magdalena Pisarska-Adamczyk, Tomasz Stefura, Piotr Małczak, Piotr Major and Michał Wysocki

J. Pers. Med. 2024, 14(11), 1098; https://doi.org/10.3390/jpm14111098 - 8 Nov 2024

Viewed by 370

Abstract

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery across the globe. Understanding preoperative risk factors for possible intraoperative complications can aid in predicting surgical outcomes and shaping the approach to the procedure. This study aimed to identify and analyze potential [...] Read more.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery across the globe. Understanding preoperative risk factors for possible intraoperative complications can aid in predicting surgical outcomes and shaping the approach to the procedure. This study aimed to identify and analyze potential risk factors associated with intraoperative difficulties during LSG. Patients and methods: The analysis encompassed consecutive patients who underwent LSG from 2017 to 2020. Patients who encountered intraoperative difficulties during the procedure were categorized into Group 1, whereas those who did not experience such complications were placed in Group 2. To identify potential risk factors for intraoperative challenges, a thorough evaluation of demographic characteristics was conducted, including variables such as age, body mass index (BMI), comorbidities, and previous surgical history. Results: Group 1 included 37 patients (11.71%), while Group 2 comprised 279 patients (88.29%). Apart from higher rates of diabetes, pulmonary disease, and sleep apnea in Group 1, no significant differences were observed between the groups regarding demographic parameters. A univariate logistic regression analysis identified several risk factors associated with intraoperative difficulties, including a body mass index (BMI) greater than 50 kg/m² (OR 2.15, 95%, CI 1.05–4.39, p = 0.0362), the experience of the operating surgeon (OR 9.22, 95% CI 4.31–19.72, p = 0.0058), the presence of diabetes (OR 2.44, 95% CI 1.19–4.98, p = 0.0146), and pulmonary disease (OR 12.22, 95% CI 1.97–75.75, p < 0.0001). In multivariate logistic regression analysis, only the surgeon’s experience (OR 8.61, 95% CI 3.75–19.72, p < 0.0001) remained a significant factor influencing intraoperative difficulties. Conclusions: The sole significant factor influencing the occurrence of intraoperative difficulties was the level of the surgeon’s experience Full article

(This article belongs to the Special Issue Laparoscopy, Perioperative Care and Complications in Surgery for Gastrointestinal Diseases)

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7 pages, 1453 KiB

Open AccessCase Report

Walking Ability After Microsurgical Reconstruction of Pediatric Popliteal Pterygium Syndrome—A Case Report

by Martin Aman, Mirjam Thielen, Ulrich Kneser and Leila Harhaus

J. Pers. Med. 2024, 14(11), 1097; https://doi.org/10.3390/jpm14111097 - 7 Nov 2024

Viewed by 353

Abstract

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. Surgical interventions are necessary to address the severe knee flexion contracture and equinovarus deformity, but there are no established treatment guidelines. Methods: We present the [...] Read more.

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. Surgical interventions are necessary to address the severe knee flexion contracture and equinovarus deformity, but there are no established treatment guidelines. Methods: We present the case of a one-year-old patient with PPS and discuss the challenges in managing the knee deformity. The surgical option chosen for the unilateral knee contracture of 80° consisted of skin management by a large Z-plasty, lengthening of popliteal vessels by grafts, lengthening of the tibial and peroneal nerves by autografts and allografts, capsular releases, and tendon releases to improve mobility and preserve foot sensibility. Results: With a three-year follow-up, the surgical interventions resulted in proper ability to walk freely. Wearing of a foot orthesis was necessary to balance the leg length differences and support the midfoot deformity. Furthermore, sensation of the foot could be restored in terms of touch sensibility and perfusion was always stable during growth. Discussion: The treatment of PPS requires a multidisciplinary approach, considering the rarity and complexity of the syndrome. Surgical interventions aim to release contractures, correct deformities, and preserve foot sensibility. Each treatment option has its advantages and disadvantages, highlighting the need for individualized care. Full article

(This article belongs to the Special Issue Personalized Management in Degenerative and Traumatic Hand Surgery)

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10 pages, 218 KiB

Open AccessReview

Surgical and Non-Surgical Approach for Tear Trough Correction: Fat Repositioning Versus Hyaluronic Acid Fillers

by Stylianos Christodoulou, Argyrios Tzamalis, Ioannis Tsinopoulos and Nikolaos Ziakas

J. Pers. Med. 2024, 14(11), 1096; https://doi.org/10.3390/jpm14111096 - 6 Nov 2024

Viewed by 459

Abstract

Objective: This paper compares two popular techniques for tear trough correction—fat repositioning and hyaluronic acid (HA) fillers—highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, [...] Read more.

Objective: This paper compares two popular techniques for tear trough correction—fat repositioning and hyaluronic acid (HA) fillers—highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, focusing on parameters such as duration of results, volume restoration, complication rates, and patient satisfaction. Results: Fat repositioning provides long-lasting results but carries higher surgical risks compared with HA fillers. The transconjunctival approach is suitable for patients with minimal skin excess. The supraperiosteal plane allows for a quicker procedure and, despite postoperative edema and temporary irregular contouring, shows no difference in final cosmetic outcomes compared with other planes. Internal fixation reduces the risk of fat relapse and skin scarring but carries the risk of suboptimal positioning. HA fillers offer immediate, minimally invasive results but require periodic maintenance. The use of a cannula reduces the risk of vascular occlusion. Combining a high G’ filler for the midface with a low G’ with low hydrophilicity for the tear trough reduces the amount of filler needed and prolongs the results. Both surgical and non-surgical methods are effective, depending on patient needs and anatomical considerations. Conclusions: Fat repositioning is ideal for patients seeking long-term correction and are willing to undergo surgery, while HA fillers suit those preferring non-invasive treatments with customizable, short-term effects. Both techniques have pros and cons that must be matched to patient goals and conditions. Full article

(This article belongs to the Special Issue Advances in Personalized Diagnosis and Treatment of Ophthalmic Diseases)

11 pages, 1427 KiB

Open AccessReview

Perineal Rectosigmoidectomy (Altemeier’s Procedure) in the Treatment of Strangulated Rectal Prolapse: A Case Series and Literature Review

by Ioannis Mantzoros, Aliki Brenta, Aikaterini-Antonia Bourtzinakou, Ourania Kontaxi, Georgios Gemousakakis, Nikolaos Antoniou, Stefanos Bitsianis, Efstathios Kotidis, Dimitrios Kyziridis, Orestis Ioannidis, Ourania Kerasidou, Anna Gkiouliava, Manousos Pramateftakis and Stamatios Aggelopoulos

J. Pers. Med. 2024, 14(11), 1095; https://doi.org/10.3390/jpm14111095 - 6 Nov 2024

Viewed by 418

Abstract

Background: Rectal prolapse (RP) predominantly affects women over the age of 50 and presents as mucosal, internal, or full thickness prolapse. Strangulated rectal prolapse requires immediate medical intervention, and surgical treatment options include both abdominal and perineal approaches. We aim to present a [...] Read more.

Background: Rectal prolapse (RP) predominantly affects women over the age of 50 and presents as mucosal, internal, or full thickness prolapse. Strangulated rectal prolapse requires immediate medical intervention, and surgical treatment options include both abdominal and perineal approaches. We aim to present a case series of perineal rectosigmoidectomy performed urgently due to strangulation and argue that Altemeier’s procedure is the preferred method for treating strangulated rectal prolapse. Methods: Perineal rectosigmoidectomy, particularly Altemeier’s procedure, is effective for incarcerated cases. Altemeier’s procedure with diverting ileostomy was used in all three patients. Results: All patients were successfully treated, with no recurrence of prolapse and stool incontinence. Conclusions: Altemeier’s procedure is ideal for the treatment of strangulated rectal prolapse. Full article

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

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11 pages, 1069 KiB

Open AccessArticle

Incidence of Acute Pulmonary Edema Before and After the Systematic Use of Ultrasound B-Lines

by Alessandra Urso, Rocco Tripepi, Sabrina Mezzatesta, Maria Carmela Versace, Giovanni Luigi Tripepi and Vincenzo Antonio Panuccio

J. Pers. Med. 2024, 14(11), 1094; https://doi.org/10.3390/jpm14111094 - 6 Nov 2024

Viewed by 375

Abstract

Introduction: Acute pulmonary edema (APE) due to fluid overload is considered the most feared complication in hemodialysis patients. Various diagnostic tests have been proposed to assess the fluid status in patients with end-stage kidney failure (ESKF); among these, lung ultrasound (measuring the number [...] Read more.

Introduction: Acute pulmonary edema (APE) due to fluid overload is considered the most feared complication in hemodialysis patients. Various diagnostic tests have been proposed to assess the fluid status in patients with end-stage kidney failure (ESKF); among these, lung ultrasound (measuring the number of B-lines) is emerging as a promising tool to identify pulmonary congestion in this patient population. Methods: We compared the incidence of APE before and after the implementation of lung ultrasound as a routine practice in our unit. The pre (from 1 January 2007 to 31 December 2008)- and post (from 1 January 2017 to 31 December 2018)-B-line implementation periods included 98 and 108 hemodialysis patients, respectively. By accurately reviewing their electronic medical records, all episodes of APE were collected. The 10-year interval between the two periods was specifically chosen to ensure no overlap between patients of the two cohorts whereas the single-center design was adopted to minimize the influence of center effect on the study results. Results: APE episodes occurred more frequently in patients from the pre-B-line implementation group (18/98, i.e., 18.4%) compared with those from the post B-line implementation group (6/108, i.e., 5.5%) (p = 0.004). An analysis based on repeated APE events showed that the incidence rate of APE was significantly higher during the pre-implementation period (2.0 APE episodes per 100 person-months, 95% CI: 1.4–2.7) than during the post-implementation period (0.3 APE episodes per 100 person-months, 95% CI: 0.1–0.7), with an incidence rate ratio (post- versus pre-) of 0.17 (95% CI: 0.07–0.40; p < 0.001). The odds of experiencing APE episodes were 74% lower (odds ratio: 0.26, 95% CI: 0.10–0.69) in patients from the post B-line implementation period compared with those from the pre-implementation period. Notably, adjusting for potential confounders did not affect the strength of this association, which remained statistically significant (p ≤ 0.030). Finally, dominance analysis indicated that the implementation of B-lines was the primary factor explaining the difference in APE episodes between the two periods, followed by dialysis duration and intra-dialysis weight gain. Conclusions: The systematic use of lung ultrasound (a simple, easy-to-learn, rapid and non-invasive method, easily performed at the patient’s bed) in everyday clinical practice was associated with a drastic reduction in episodes of APE in hemodialysis patients. Further observational and interventional studies are needed to confirm these results. Full article

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

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17 pages, 1523 KiB

Open AccessReview

Left Atrial Strain: State of the Art and Clinical Implications

by Niloofar Javadi, Nadera N. Bismee, Mohammed Tiseer Abbas, Isabel G. Scalia, Milagros Pereyra, Nima Baba Ali, Sogol Attaripour Esfahani, Kamal Awad, Juan M. Farina, Chadi Ayoub and Reza Arsanjani

J. Pers. Med. 2024, 14(11), 1093; https://doi.org/10.3390/jpm14111093 - 5 Nov 2024

Viewed by 460

Abstract

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a [...] Read more.

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a major emphasis on speckle-tracking echocardiography techniques. Other imaging modalities, including cardiac magnetic resonance and cardiac computed tomography, also provide important information on LA dynamics but have disadvantages with respect to cost and availability. The current narrative review underlines basic concepts such as the accurate assessment of LAS and discusses the clinical relevance of LAS by pointing out its significant diagnostic and prognostic role in several cardiovascular conditions. The aim of this article is to discuss the current integration of LAS into clinical practice with a view to further improving patient management and treatment strategies. Full article

(This article belongs to the Special Issue The Development of Echocardiography in Heart Disease)

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27 pages, 1883 KiB

Open AccessReview

Advances in mRNA LNP-Based Cancer Vaccines: Mechanisms, Formulation Aspects, Challenges, and Future Directions

by Eslam Ramadan, Ali Ahmed and Youssef Wahib Naguib

J. Pers. Med. 2024, 14(11), 1092; https://doi.org/10.3390/jpm14111092 - 4 Nov 2024

Viewed by 895

Abstract

After the COVID-19 pandemic, mRNA-based vaccines have emerged as a revolutionary technology in immunization and vaccination. These vaccines have shown remarkable efficacy against the virus and opened up avenues for their possible application in other diseases. This has renewed interest and investment in [...] Read more.

After the COVID-19 pandemic, mRNA-based vaccines have emerged as a revolutionary technology in immunization and vaccination. These vaccines have shown remarkable efficacy against the virus and opened up avenues for their possible application in other diseases. This has renewed interest and investment in mRNA vaccine research and development, attracting the scientific community to explore all its other applications beyond infectious diseases. Recently, researchers have focused on the possibility of adapting this vaccination approach to cancer immunotherapy. While there is a huge potential, challenges still remain in the design and optimization of the synthetic mRNA molecules and the lipid nanoparticle delivery system required to ensure the adequate elicitation of the immune response and the successful eradication of tumors. This review points out the basic mechanisms of mRNA-LNP vaccines in cancer immunotherapy and recent approaches in mRNA vaccine design. This review displays the current mRNA modifications and lipid nanoparticle components and how these factors affect vaccine efficacy. Furthermore, this review discusses the future directions and clinical applications of mRNA-LNP vaccines in cancer treatment. Full article

(This article belongs to the Special Issue Nanomedicine in Cancer Therapy: What's New)

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9 pages, 1227 KiB

Open AccessArticle

Carotid Artery Geometry Modifications and Clinical Implications after Carotid Artery Stenting

by Edoardo Pasqui, Bruno Gargiulo, Leonardo Pasquetti, Elisa Lazzeri, Giuseppe Galzerano and Gianmarco de Donato

J. Pers. Med. 2024, 14(11), 1091; https://doi.org/10.3390/jpm14111091 - 4 Nov 2024

Viewed by 600

Abstract

Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: [...] Read more.

Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: This was a retrospective single-center study. We included all patients who underwent CAS in a 3-year period. Anatomical changes of the carotid bifurcation were evaluated by reviewing angiographic images. The population was divided into three groups based on the stent implanted: Group 1 (Carotid Wallstent), Group 2 (Roadsaver), and Group 3 (C-Guard). Results: A total of 226 patients were included. The mean age was 77.0 ± 7.4 years and 72.5% (164/226) were male. Three different stents were implanted into three groups: Group 1 (n = 131/226, 58%), Group 2 (n = 57/226, 25.2%), and Group 3 (n = 38/226, 16.8%). The mean pre-stent implantation CCA-ICA angle of the entire population was 155 ± 14.9°, and the post-CAS angle was 167.7 ± 8.7° (p = 0.0001). In every subgroup, the difference was statistically different, with the biggest difference registered in Group 2 (−16.1 ± 13.2°). Regarding stent oversizing, there was a significant relationship between CCA oversizing and CCA-ICA angle modification (p = 0.006). During follow-up, a total of 14 (6.2%) restenoses were registered. The mean CCA-ICA angle modification in the restenosis group was −9.5 ± 14.4° vs. −12.8 ± 11.9° in the no-restenosis group with no significant statistical differences were outlined (p = 0.3). Conclusions: Compared to the Carotid Wallstent and C-Guard, the Roadsaver stent appears to have a lower adaptability to the carotid vascular territory, resulting in a higher CCA-ICA angle modification after implantation, with no impact on the stent restenosis rate. Full article

(This article belongs to the Special Issue Precision Medicine in Vascular Disease)

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10 pages, 2638 KiB

Open AccessPerspective

Minimally Invasive Approaches to Spinal Cerebrospinal Fluid Leak Repair: Current Strategies and a Novel Technique

by Adham M. Khalafallah, Bhavjeet S. Sanghera, Michael Kader, James V. Boddu and Timur Urakov

J. Pers. Med. 2024, 14(11), 1090; https://doi.org/10.3390/jpm14111090 - 4 Nov 2024

Viewed by 585

Abstract

Spinal cerebrospinal fluid (CSF) leaks can be caused by tears in the dura and are challenging to treat. Traditional methods of treating spinal CSF leakage include nonsurgical management, epidural blood patches (EBP), and direct surgical repair. Minimally invasive surgery (MIS) is rapidly progressing [...] Read more.

Spinal cerebrospinal fluid (CSF) leaks can be caused by tears in the dura and are challenging to treat. Traditional methods of treating spinal CSF leakage include nonsurgical management, epidural blood patches (EBP), and direct surgical repair. Minimally invasive surgery (MIS) is rapidly progressing within neurosurgery due to its advantages for patient safety and comfort. Existing MIS techniques to spine surgery utilize a rigid endoscope, which has limitations when reaching smaller areas requiring greater degrees of visualization. The simultaneous use of a flexible endoscope and wearable heads-up display (wHUD) improves access and visualization in these small areas while allowing the surgeon to maintain optimal ergonomics. In this article, we review minimally invasive approaches to spine surgery and the management of spinal CSF leaks. We also demonstrate a novel minimally invasive technique utilizing flexible endoscopy and a wHUD to treat a case of recurrent CSF leak. We describe the successful utilization of this technology and provide the groundwork for future practitioners to incorporate this approach into their practice. Full article

(This article belongs to the Special Issue Personalized Approaches to Spine Surgery: Innovations and Future Directions)

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13 pages, 10088 KiB

Open AccessSystematic Review

Prevalence of Chronic Obstructive Pulmonary Disease in Patients with Nontuberculous Mycobacterial Pulmonary Disease: A Systemic Review and Meta-Analysis

by Hyun Lee, Jong Geol Jang, Youlim Kim, Kyung Hoon Min, June Hong Ahn, Kwang Ha Yoo, Min Gu Kang, Jong Seung Kim and Ji-Yong Moon

J. Pers. Med. 2024, 14(11), 1089; https://doi.org/10.3390/jpm14111089 - 4 Nov 2024

Viewed by 532

Abstract

Background/Objectives: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an important comorbidity of COPD. Although many studies have reported an association between COPD and NTM-PD, no clear estimate of the prevalence of COPD and its effects on survival times in patients with NTM-PD is available. [...] Read more.

Background/Objectives: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an important comorbidity of COPD. Although many studies have reported an association between COPD and NTM-PD, no clear estimate of the prevalence of COPD and its effects on survival times in patients with NTM-PD is available. This study aimed to investigate the prevalence of COPD and its impact on survival in patients with NTM-PD. Methods: All studies reporting the prevalence of COPD in patients with NTM between 1952 and 2021 were searched using PubMed in May 2023. The inclusion criteria were studies about patients with NTM and COPD. A random-effects meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: The pooled overall prevalence of COPD in patients with NTM-PD was 28% (95% confidence interval [CI], 22–35). Patients with NTM-PD were six times more likely to have COPD than those without NTM-PD (pooled odds ratio [OR], 6.26; 95% CI, 3.37–11.65). Male patients with NTM-PD had a four-fold higher risk of COPD than females (OR, 3.81; 95% CI, 1.18–12.35). The co-existence of COPD and NTM-PD was significantly associated with an increased risk of mortality compared with NTM-PD without COPD (OR, 3.65; 95% CI, 1.28–10.40). Conclusions: COPD is common in patients with NTM-PD, and patients with NTM-PD had a six-fold increase in the odds of having COPD than those without NTM-PD. The presence of COPD and NTM-PD had a significant negative effect on survival. These findings may support the need to assess the presence of COPD in patients with NTM-PD and the potential negative effects associated with the co-existence of COPD and NTM-PD. Full article

(This article belongs to the Section Epidemiology)

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22 pages, 1489 KiB

Open AccessReview

AI-Reinforced Wearable Sensors and Intelligent Point-of-Care Tests

by Ghita Yammouri and Abdellatif Ait Lahcen

J. Pers. Med. 2024, 14(11), 1088; https://doi.org/10.3390/jpm14111088 - 1 Nov 2024

Viewed by 843

Abstract

Artificial intelligence (AI) techniques offer great potential to advance point-of-care testing (POCT) and wearable sensors for personalized medicine applications. This review explores the recent advances and the transformative potential of the use of AI in improving wearables and POCT. The integration of AI [...] Read more.

Artificial intelligence (AI) techniques offer great potential to advance point-of-care testing (POCT) and wearable sensors for personalized medicine applications. This review explores the recent advances and the transformative potential of the use of AI in improving wearables and POCT. The integration of AI significantly contributes to empowering these tools and enables continuous monitoring, real-time analysis, and rapid diagnostics, thus enhancing patient outcomes and healthcare efficiency. Wearable sensors powered by AI models offer tremendous opportunities for precise and non-invasive tracking of physiological conditions that are essential for early disease detection and personalized treatments. AI-empowered POCT facilitates rapid, accurate diagnostics, making these medical testing kits accessible and available even in resource-limited settings. This review discusses the key advances in AI applications for data processing, sensor fusion, and multivariate analytics, highlighting case examples that exhibit their impact in different medical scenarios. In addition, the challenges associated with data privacy, regulatory approvals, and technology integrations into the existing healthcare system have been overviewed. The outlook emphasizes the urgent need for continued innovation in AI-driven health technologies to overcome these challenges and to fully achieve the potential of these techniques to revolutionize personalized medicine. Full article

(This article belongs to the Special Issue Application of Deep and Machine Learning in Personalized Medicine and Individualized Bioinstruments)

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10 pages, 1010 KiB

Open AccessArticle

Association Between Sleep Position, Obesity, and Obstructive Sleep Apnea Severity

by Mia Strohm, Amro Daboul, Anne Obst, Antoine Weihs, Chia-Jung Busch, Thomas Bremert, Jochen Fanghänel, Tatyana Ivanovska, Ingo Fietze, Thomas Penzel, Ralf Ewert and Markus Krüger

J. Pers. Med. 2024, 14(11), 1087; https://doi.org/10.3390/jpm14111087 - 1 Nov 2024

Viewed by 508

Abstract

Background: This study examines the relationship between obstructive sleep apnea severity, sleep position, and body weight, particularly focusing on the negative impact of sleeping in a supine position combined with being overweight in a population-based sample. Methods: The Apnea-Hypopnea Index (AHI) was utilized [...] Read more.

Background: This study examines the relationship between obstructive sleep apnea severity, sleep position, and body weight, particularly focusing on the negative impact of sleeping in a supine position combined with being overweight in a population-based sample. Methods: The Apnea-Hypopnea Index (AHI) was utilized as a marker of OSA severity and sleep position from a standardized overnight polysomnography. Participants were categorized by body mass index (BMI) (kg/m²) into normal weight/underweight (<25) and overweight (≥25). Results and Conclusions: The results indicated a higher mean Apnea-Hypopnea Index for those sleeping in the supine position compared to other positions, with overweight individuals experiencing a proportionally greater impact from sleep position than their normal-weight counterparts. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Treatment for Obstructive Sleep Apnea)

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8 pages, 207 KiB

Open AccessArticle

A Simple Physical Examination Predicts Cognitive Decline in Very Mild Dementia

by Li-Han Lin, Karen Y. C. Chuang, Chung-Yao Hsu, Nai-Ching Chen, Jyun-Bin Huang, Hsiu-Yung Pan and Yao-Chung Chuang

J. Pers. Med. 2024, 14(11), 1086; https://doi.org/10.3390/jpm14111086 - 1 Nov 2024

Viewed by 374

Abstract

Background: Different exercises have different effects upon physical fitness and cognitive domains. In this context, physical fitness behaviors have been identified as a contributing factor to cognitive decline in patients with very mild dementia. The present study aimed to further determine baseline senior [...] Read more.

Background: Different exercises have different effects upon physical fitness and cognitive domains. In this context, physical fitness behaviors have been identified as a contributing factor to cognitive decline in patients with very mild dementia. The present study aimed to further determine baseline senior fitness behaviors in patients with very mild dementia and possible factors related to rapid cognitive decline. Methods: This prospective cohort study was performed in a medical center in Taiwan, involving 132 patients with very mild dementia who were followed-up over 1 year. Assessments included the Senior Fitness Test (physical function), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) Scale. Patients with a decline in MMSE of at least 2 points within 1 year were defined as having rapid cognitive decline. Results: Age, sex, years of education, and baseline MMSE did not differ significantly between the groups (p > 0.05). At 1 year of follow-up, dietary habits and comorbidities did not differ between the rapid decline and not-rapid decline groups. At 1 year, performance on the right back scratch test was significantly better in the not-rapid decline group compared with the rapid decline group (−14 [−39–37.5] cm vs. −17 [−57–7] cm; p = 0.038). In a multiple regression analysis, the only factor that was significantly associated with rapid cognitive decline was the right back scratch test (p = 0.022). Conclusions: Despite the similarity in the status of dementia, the right hand back scratch test appears to serve an important function in detecting cognitive decline in patients with very mild dementia. Full article

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

22 pages, 951 KiB

Open AccessSystematic Review

Pulmonary Endometriosis: A Systematic Review

by Konstantinos Nikolettos, Alexandros Patsouras, Sonia Kotanidou, Nikolaos Garmpis, Iason Psilopatis, Anna Garmpi, Eleni I. Effraimidou, Angelos Daniilidis, Dimitrios Dimitroulis, Nikos Nikolettos, Panagiotis Tsikouras, Angeliki Gerede, Dimitrios Papoutsas, Emmanuel Kontomanolis and Christos Damaskos

J. Pers. Med. 2024, 14(11), 1085; https://doi.org/10.3390/jpm14111085 - 31 Oct 2024

Viewed by 395

Abstract

Background/Objectives: Endometriosis is characterized by the presence of ectopic endometrial-like glands and stroma outside the endometrial cavity, which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or thoracic endometriosis syndrome (TES), describes the rare presence of endometrial-like cells in the thoracic cavity [...] Read more.

Background/Objectives: Endometriosis is characterized by the presence of ectopic endometrial-like glands and stroma outside the endometrial cavity, which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or thoracic endometriosis syndrome (TES), describes the rare presence of endometrial-like cells in the thoracic cavity and includes catamenial pneumothorax, catamenial hemothorax, hemoptysis, and lung nodules. Our aim is to summarize the results of all reported cases of TES. Methods: Extensive research was conducted through MEDLINE/PUBMED using the keywords “thoracic endometriosis”, “thoracic endometriosis syndrome”, “catamenial pneumothorax”, “catamenial hemoptysis”, and “TES”. Following PRISMA guidelines, all published cases of TES between January 1950 and March 2024 were included. A systematic review of 202 studies in English, including 592 patients, was performed. Results: The median age of women with TES is 33.8 years old. The most common clinical presentation is catamenial pneumothorax (68.4%), while lesions are mainly found in the right lung unilaterally (79.9%). Chest computed tomography (CT) was used alone or after an X-ray to determine the pathological findings. Ground-glass opacity nodules and cystic lesions represent the most common finding in CT, while pneumothorax is the most common finding in X-rays. Video-assisted thoracoscopic surgery (VATS) is the main therapeutic approach, usually in combination with hormonal therapy, including GnRH analogues, progestins, androgens, or combined oral contraceptives. Hormonal therapy was also administered as monotherapy. Symptom recurrence was reported in 10.1% of all cases after the treatment. Conclusions: High clinical awareness and a multidisciplinary approach are necessary for the best clinical outcome for TES patients. More studies are required to extract safer conclusions. Full article

(This article belongs to the Special Issue Gynecologic Oncology: From Molecular Mechanisms to Personalized Treatment)

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12 pages, 907 KiB

Open AccessArticle

Ultrasound-Guided Axillary Access Using a Micropuncture Needle Versus Conventional Cephalic Venous Access for Implantation of Cardiac Devices: A Single-Center Randomized Trial

by Georgios Leventopoulos, Christoforos K. Travlos, Athinagoras Theofilatos, Panagiota Spyropoulou, Angeliki Papageorgiou, Angelos Perperis, Rafail Koros, Athanasios Moulias, Ioanna Koniari and Periklis Davlouros

J. Pers. Med. 2024, 14(11), 1084; https://doi.org/10.3390/jpm14111084 - 31 Oct 2024

Viewed by 470

Abstract

(1) Background: Ultrasound-guided axillary (USAX) vein puncture is a relatively new method to obtain venous access for the implantation of cardiac implantable electronic devices (CIED). However, its use is limited as most of the operators are not familiar with this technique. Our aim [...] Read more.

(1) Background: Ultrasound-guided axillary (USAX) vein puncture is a relatively new method to obtain venous access for the implantation of cardiac implantable electronic devices (CIED). However, its use is limited as most of the operators are not familiar with this technique. Our aim was to investigate the safety and efficacy of the USAX compared with the traditional cephalic vein dissection for venous access in CIED implantation. (2) Methods: This was a single-center, randomized, controlled, superiority trial. A total of 114 patients were randomized (1:1 ratio) to either USAX (u/s axillary group; 59 patients) or cephalic vein access (cephalic group; 55 patients). The primary study endpoint was defined as successful placement of all leads via the chosen access. Secondary study endpoints included time from local anesthetic injection to lead advancement in the SVC, total procedure time (skin to skin), procedure-related complications and pain perception. (3) Results: USAX was superior to cephalic access in terms of primary endpoint (OR: 4.3, 95% CI: 1.3, 14.0; p = 0.012). Total procedure duration was higher in the cephalic group (55.15 ± 16.62 vs. 48.35 ± 12.81 min, p = 0.017) but there was neither a significant difference in fluoroscopy time (p = 0.872) nor in total radiation dose (p = 0.815). The level of pain was higher in the cephalic group (p = 0.016), while the rates of complications were similar in both groups (p > 0.05). (4) Conclusion: USAX was superior to cephalic access regarding success rate, total procedure duration and level of pain, while having no difference in complication rates. Full article

(This article belongs to the Special Issue Current Updates on Arrhythmia and Cardiac Electrophysiology)

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28 pages, 6016 KiB

Open AccessReview

Intratumoral Microbiota: Insights from Anatomical, Molecular, and Clinical Perspectives

by Claudia Lombardo, Rosanna Fazio, Marta Sinagra, Giuseppe Gattuso, Federica Longo, Cinzia Lombardo, Mario Salmeri, Guido Nicola Zanghì and Carla Agata Erika Loreto

J. Pers. Med. 2024, 14(11), 1083; https://doi.org/10.3390/jpm14111083 - 31 Oct 2024

Viewed by 636

Abstract

The human microbiota represents a heterogeneous microbial community composed of several commensal, symbiotic, and even pathogenic microorganisms colonizing both the external and internal body surfaces. Despite the term “microbiota” being commonly used to identify microorganisms inhabiting the gut, several pieces of evidence suggest [...] Read more.

The human microbiota represents a heterogeneous microbial community composed of several commensal, symbiotic, and even pathogenic microorganisms colonizing both the external and internal body surfaces. Despite the term “microbiota” being commonly used to identify microorganisms inhabiting the gut, several pieces of evidence suggest the presence of different microbiota physiologically colonizing other organs. In this context, several studies have also confirmed that microbes are integral components of tumor tissue in different types of cancer, constituting the so-called “intratumoral microbiota”. The intratumoral microbiota is closely related to the occurrence and development of cancer as well as to the efficacy of anticancer treatments. Indeed, intratumoral microbiota can contribute to carcinogenesis and metastasis formation as some microbes can directly cause DNA damage, while others can induce the activation of proinflammatory responses or oncogenic pathways and alter the tumor microenvironment (TME). All these characteristics make the intratumoral microbiota an interesting topic to investigate for both diagnostic and prognostic purposes in order to improve the management of cancer patients. This review aims to gather the most recent data on the role of the intratumoral microbiota in cancer development, progression, and response to treatment, as well as its potential diagnostic and prognostic value. Full article

(This article belongs to the Special Issue Novel Biomarkers in the Diagnostics of Cancer)

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11 pages, 315 KiB

Open AccessArticle

Risk Factors for Colorectal Adenoma and Cancer in Comprehensive Health Checkups: Usefulness of Gamma-Glutamyltransferase

by Yoko Yamanouchi, Maiko Osawa, Takaaki Senbonmatsu, Yuki Shiko, Yohei Kawasaki and Toshihiro Muramatsu

J. Pers. Med. 2024, 14(11), 1082; https://doi.org/10.3390/jpm14111082 - 30 Oct 2024

Viewed by 408

Abstract

Background/Objectives: In this study, we aimed to determine the risk factors for colorectal adenoma/cancer by studying patients who underwent comprehensive health checkups and were referred to a hospital because of positive fecal occult blood. Methods: A total of 529 patients were referred to [...] Read more.

Background/Objectives: In this study, we aimed to determine the risk factors for colorectal adenoma/cancer by studying patients who underwent comprehensive health checkups and were referred to a hospital because of positive fecal occult blood. Methods: A total of 529 patients were referred to hospital for a positive fecal occult blood test after a comprehensive health checkup at the participating center over a period of 5 years, from January 2018 to December 2022. Patients diagnosed with colorectal adenoma or cancer using colonoscopy were included in the case group, while those diagnosed with no abnormality, diverticulum, or hemorrhoids were included in the control group. Results: Of the 529 referred patients, 503 underwent colonoscopy. A total of 18 colorectal cancers and 191 colorectal adenomas were detected, and there were no tumors, diverticula, or hemorrhoids in any of the 208 patients. Polyps, either hyperplastic or of unknown pathology, were found in 86 patients. A comparison of the case and control groups showed that gamma-glutamyltransferase (GGT) was an independent and significant risk factor for colorectal adenoma or cancer, in addition to previously known risk factors such as male sex, older age, high body mass index, and alcohol consumption. Conclusions: For patients with a positive fecal occult blood test, in addition to traditional risks such as obesity, older age, male sex, and alcohol consumption, identifying those with high GGT levels is recommended to help find colorectal adenoma/cancer. Full article

(This article belongs to the Section Epidemiology)

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Open AccessArticle

A Longitudinal Study Investigating Whether Chronic Rhinosinusitis Influences the Subsequent Risk of Developing Dementia

by Dae-Soon Son, Jae-In Kim and Dong-Kyu Kim

J. Pers. Med. 2024, 14(11), 1081; https://doi.org/10.3390/jpm14111081 - 30 Oct 2024

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Abstract

Background/Objectives: Numerous studies have explored the association between chronic rhinosinusitis (CRS) and cognitive decline. However, whether CRS is an independent risk factor for the development of dementia remains unclear. Thus, this retrospective cohort study sought to examine the potential association between CRS and [...] Read more.

Background/Objectives: Numerous studies have explored the association between chronic rhinosinusitis (CRS) and cognitive decline. However, whether CRS is an independent risk factor for the development of dementia remains unclear. Thus, this retrospective cohort study sought to examine the potential association between CRS and increased incidence and risk of dementia by utilizing a representative population-based cohort dataset. Methods: In this study, we identified 2126 patients with CRS aged >55 years and matched them with 8504 controls to assess the incidence and risk of dementia. Results: We found that the incidence of all-cause dementia in CRS patients was 0.125 per 1000 person-years. The risk of developing all-cause dementia events (adjusted hazard ratio [HR] = 1.0, 95% confidence interval = 0.8–1.3) also did not differ significantly between the control group and the CRS group, irrespective of the CRS phenotype. Subgroup analysis also showed no increased adjusted HR for developing Alzheimer’s disease (0.9, 0.7–1.2), Parkinson’s disease (0.9, 0.5–1.4), and other types of dementia (1.0, 0.7–1.4) in the CRS group compared to the control group. Conclusions: Therefore, the present study demonstrated that patients over 55 years of age with CRS did not exhibit an increased incidence or risk of dementia compared to individuals without CRS. Full article

(This article belongs to the Section Epidemiology)

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J. Pers. Med., Volume 14, Issue 11 (November 2024) – 43 articles

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