Journal of Personalized Medicine

11 pages, 1103 KiB

Open AccessProtocol

Effectiveness of Physiotherapy for Improving Functionality, Participation, and Quality of Life after a Stroke: Study Protocol for a Randomized Controlled Clinical Trial

by Concepción Soto-Vidal, Victoria Calvo-Fuente, Ezequiel Hidalgo-Galante, Ester Cerezo-Téllez, Yolanda Pérez-Martín and Soraya Pacheco-da-Costa

J. Pers. Med. 2024, 14(8), 891; https://doi.org/10.3390/jpm14080891 - 22 Aug 2024

Viewed by 548

Abstract

Background: Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of [...] Read more.

Background: Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of the alterations. Therefore, the aim of this study is to assess the effectiveness of a Physical Therapy intervention based on a goal-oriented approach with task-specific training for improving functionality, participation, and quality of life for people with Stroke. Methods: A single-blinded randomized controlled clinical trial will be developed. Adults over 50 years old diagnosed with Stroke over 6 months will be included in this study. Participants (n = 62) will be randomly allocated into two groups: The experimental group (n = 31) will receive 30 sessions, three per week during 10 weeks, of Physical Therapy sessions of goal-directed and task-specific training. The control group (n = 31) will follow the same intervention intensity of their usual Physical Therapy treatment. The primary outcome variables quality of life (NewsQol), participation (Ox-PAQ), and gait functionality (FAC) and the secondary outcome variables functional disability (BI), postural control (PASS), dynamic trunk balance (TIS), and functional goals (GAS) will be measured at baseline, after group interventions (10 weeks), and 6 months after the baseline. Statistical analyses will include repeated-measures ANOVA, Student’s t-test, or the Mann–Whitney U-test, with a 95% confidence interval and significance level of p < 0.05. Conclusion: Person-centered approaches in Physical Therapy interventions may yield better outcomes in functionality, participation, and quality of life for Stroke patients compared to standardized interventions. Trial registration: ClinicalTrials.gov: NCT06165666 (December 2023). Full article

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

► Show Figures

Figure 1

10 pages, 543 KiB

Open AccessArticle

Socioeconomic Gender Variables Impact the Association between Hypertension and Chronic Health Issues: Cross-Sectional Study

by Simon David Lindner, Teresa Gisinger, Peter Klimek and Alexandra Kautzky-Willer

J. Pers. Med. 2024, 14(8), 890; https://doi.org/10.3390/jpm14080890 - 22 Aug 2024

Viewed by 311

Abstract

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease [...] Read more.

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease in European countries grouped by their gender inequality index using representative survey data from the European Health Interview Survey. Using logistic regressions, we compute the ratio of odds ratios in females versus males. Therefore, an ORR > 1 is associated with a higher odds ratio for females than for males while an ORR < 1 means the opposite. To account for multiple hypothesis testing, we applied the Bonferroni correction. Hypertension in both sexes was associated with lower educational level, being unemployed, and lower income. In males, being divorced/widowed (OR1.12, p < 0.001) had an association to hypertension, whereas in females, being common-law/married (OR1.30, p < 0.001) and being divorced/widowed (OR1.17, p < 0.001) was associated with a higher risk for hypertension. Moreover, in hypertension, females who worked had an association with myocardial infarction (OR1.39, p < 0.001) and having post-secondary education had an association with arthrosis (OR 1.35, p < 0.001) compared to males. Our findings show that gender variables influence the association of hypertension and comorbidities, especially in females. These results can be used to inform targeted prevention measures taking gender-specific contextual factors into account. Full article

(This article belongs to the Special Issue Sex and Gender-Related Issues in the Era of Personalized Medicine)

► Show Figures

Figure 1

12 pages, 1090 KiB

Open AccessArticle

The MACROD2 rs6110695 A>G Polymorphism and the Metabolites Indoleacrylic Acid and Butyrylcarnitine Potentially Have Clinical Relevance to WBC Count Prediction

by Youngmin Han, Minjoo Kim and Hye Jin Yoo

J. Pers. Med. 2024, 14(8), 889; https://doi.org/10.3390/jpm14080889 - 22 Aug 2024

Viewed by 384

Abstract

Our previous study suggested that the Mono-ADP ribosylhydrolase 2 (MACROD2) rs6110695 A>G polymorphism is significantly associated with white blood cell (WBC) count in the Korean population. The present study aimed to evaluate the clinical relevance of the MACROD2 rs6110695 A>G polymorphism [...] Read more.

Our previous study suggested that the Mono-ADP ribosylhydrolase 2 (MACROD2) rs6110695 A>G polymorphism is significantly associated with white blood cell (WBC) count in the Korean population. The present study aimed to evaluate the clinical relevance of the MACROD2 rs6110695 A>G polymorphism for predicting WBC count by utilizing plasma metabolites and a single-nucleotide polymorphism (SNP). Two groups were characterized by MACROD2 rs6110695 A>G SNP genotypes among 139 healthy subjects based on the genetic information provided in our previous work: rs6110695 AA genotype group (n = 129) and rs6110695 AG genotype group (n = 10). Plasma global metabolic profiling was performed using ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC–MS/MS). To estimate the predictive abilities of WBC count models using the rs6110695 genotype and/or significant differential metabolites, multiple linear regression analysis and receiver operating characteristic (ROC) curve analysis were conducted. The AG genotype had greater WBC-to-apolipoprotein (apo) A-I ratios; counts of WBCs, lymphocytes, monocytes, and granulocytes; monocyte-to-lymphocyte ratio (MLR); and monocyte-to-platelet ratio (MPR) than the AA genotype. In terms of metabolic profile, indoleacetic acid, and butyrylcarnitine levels were considerably distinct between the two groups, and these metabolites were considered to be meaningful prognostic variables for the rs6110695 genotype. Finally, ROC curve analysis demonstrated that the model containing the rs6110695 genotype and the two main metabolites was reliable. The present study revealed that individuals carrying the rs6110695 AG genotype with high plasma indoleacrylic acid and butyrylcarnitine levels might have elevated WBC counts. The rs6110695 genotype and the concentrations of indoleacrylic acid and butyrylcarnitine could contribute to reducing the risk of chronic diseases in the future. Full article

(This article belongs to the Section Omics/Informatics)

► Show Figures

Figure 1

16 pages, 759 KiB

Open AccessArticle

DiADEM—Dance against Dementia—Effect of a Six-Month Dance Intervention on Physical Fitness in Older Adults with Mild Cognitive Impairment: A Randomized, Controlled Trial

by Ulrich Thiel, Marvin Stiebler, Berit K. Labott, Johanna Bappert, Corinna Langhans, Nicole Halfpaap, Bernhard Grässler, Fabian Herold, Stefanie Schreiber, Rüdiger Braun-Dullaeus, Patrick Müller, Notger Müller and Anita Hökelmann

J. Pers. Med. 2024, 14(8), 888; https://doi.org/10.3390/jpm14080888 - 22 Aug 2024

Viewed by 498

Abstract

Background: Preserving health and physical fitness is critical to ensure independent living across the lifespan. Lower levels of physical fitness are associated with age-related cognitive decline and a higher prevalence of mild cognitive impairment (MCI). Thus, this study investigates the influence of [...] Read more.

Background: Preserving health and physical fitness is critical to ensure independent living across the lifespan. Lower levels of physical fitness are associated with age-related cognitive decline and a higher prevalence of mild cognitive impairment (MCI). Thus, this study investigates the influence of a six-month dance intervention on selected measures of physical fitness in older adults with MCI. Methods: In this randomized controlled trial, 55 patients with MCI were randomized into a sportive dance training (IG; n = 26; age: 70.7 ± 5.6 years; 62% female) or an inactive control group (CG; n = 24; age: 69.1 ± 6.8 years; 46% female). The dance group received two 90 min dance training sessions per week over a duration of six-months, which focused on learning dance movement patterns. During the training sessions, heart rate was measured to control exercise intensity. Physical fitness was assessed using cardiopulmonary exercise testing (CPET), lower limb functional fitness via sit-to-stand test, handgrip strength, and heart rate variability (HRV). Results: We observed that the dance intervention preserved the cardiorespiratory fitness as measured by maximal oxygen uptake (VO_2max) during CPET, which decreased in the CG. Furthermore, participants in the IG demonstrated increases in leg and handgrip strength, although these were not statistically significant. HRV displayed a non-significant decrease following the intervention. Conclusions: The results of this randomized controlled trial suggest that sportive dance training can preserve elements of physical fitness (i.e., cardiorespiratory fitness) in older adults with MCI. Although improvements in the other parameters (i.e., leg and handgrip strength) were statistically non-significant, likely due to the small sample size, stabilizing muscular fitness and preventing age-related decline in older adults with MCI is important for maintaining functional independence. For future studies, we recommend a longer training duration paired with precise control of regular physical activity levels, an important confounding factor. Full article

(This article belongs to the Special Issue Personalized Diagnostics and Therapy for Cardiovascular Diseases)

► Show Figures

Figure 1

14 pages, 3577 KiB

Open AccessArticle

Clinicopathological Findings and Comprehensive Review of Buschke–Lowenstein Tumors Based on a Case Study

by Andreea Grosu-Bularda, Cristian-Sorin Hariga, Catalina-Stefania Dumitru, Nicolae Calcaianu, Cosmin-Antoniu Creanga, Valentin Enache, Silvia-Elena Tache, Eliza-Maria Bordeanu-Diaconescu, Vladut-Alin Ratoiu, Razvan-Nicolae Teodoreanu and Ioan Lascar

J. Pers. Med. 2024, 14(8), 887; https://doi.org/10.3390/jpm14080887 - 22 Aug 2024

Viewed by 386

Abstract

The Buschke–Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a [...] Read more.

The Buschke–Löwenstein tumor (BLT), also known as giant condyloma acuminatum, is a rare, exophytic tumor, arising from pre-existing warty lesions associated with human papillomavirus (HPV) infection, particularly strains 6 and 11, which are considered to have low oncogenic potential. BLT presents as a large, cauliflower-like growth typically affecting the penis, vulva, vagina, perineum, scrotum, anus, and perianal area. Despite being a benign lesion, BLT is locally aggressive with a high recurrence rate, and can potentially undergo malignant transformation into squamous cell carcinoma, contributing to an overall mortality rate of 20–30%. The primary treatment is complete surgical excision with wide margins, frequently requiring complex reconstructive techniques for defect coverage. We report on a 68-year-old patient, with multiple comorbidities, who presented with a two-year history of a large exophytic tumor in the genital region, affecting the penis, along with progressive erectile dysfunction and urinary problems. The tumor was surgically excised with oncological safety margins, and reconstruction was performed using advancement and rotation flaps from the scrotum and intact penile skin. Histopathological examination confirmed the diagnosis of Giant Condyloma (Buschke–Löwenstein tumor), showing acanthosis, papillomatosis, parakeratosis, and koilocytic cell collections, with positive immunohistochemical staining for p16, p63, and ki67. Postoperatively, the patient had a good clinical outcome and a complete surgical cure. This case highlights the critical need for timely intervention and comprehensive management strategies in treating giant condyloma, given its potential for local invasion and substantial impacts on patient quality of life. Early diagnosis and thorough surgical excision are crucial for effective management and to reduce the high recurrence, morbidity and malignant transformation risk associated with this condition. Full article

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

► Show Figures

Figure 1

8 pages, 883 KiB

Open AccessArticle

Assessing the Impact of IL-6 and Serotonin on Pain and Symptomatology in Fibromyalgia: An Exploratory Clinical Study

by Felipe Altino Loçasso, Hélcio Alvarenga Filho, Regina Maria Papais Alvarenga, Sérgio Luís Schimidt, Filipe Kleinman Fiorelli, Plínio dos Santos Ramos, Sônia Cristina Leal Leidersnaider, Kenneth Blum, Kai-Uwe Lewandrowski, Edezio Ferreira Cunha-Junior and Rossano Kepler Alvim Fiorelli

J. Pers. Med. 2024, 14(8), 886; https://doi.org/10.3390/jpm14080886 - 22 Aug 2024

Viewed by 747

Abstract

Background and Objectives: Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome characterized by widespread pain and a variety of other symptoms, including fatigue, cognitive dysfunction, and sleep disturbances. Recent research has highlighted the potential role of pro-inflammatory cytokines and neurotransmitters in the pathophysiology [...] Read more.

Background and Objectives: Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome characterized by widespread pain and a variety of other symptoms, including fatigue, cognitive dysfunction, and sleep disturbances. Recent research has highlighted the potential role of pro-inflammatory cytokines and neurotransmitters in the pathophysiology of FM. This study aimed to investigate the relationship between serum levels of interleukin-6 (IL-6) and serotonin with the clinical parameters observed in patients with fibromyalgia. Additionally, it sought to analyze the similarities and differences among the different groups classified by symptom severity. Materials and Methods: This cross-sectional study included 26 female patients aged 20–70 diagnosed with FM according to the American College of Rheumatology (ACR) 2016 criteria and 14 healthy controls (HCs). Serum levels of IL-6 and serotonin were measured using electrochemiluminescence and high-performance liquid chromatography (HPLC), respectively. Results: FM patients exhibited significantly higher pain scores (VAS), anxiety, and depression levels compared to HCs. FIQ-R scores were significantly elevated in FM patients, with stratification showing 3.8% mild, 65.4% moderate, 23.1% severe, and 7.7% very severe cases. While no significant difference in IL-6 levels was observed between the FM patients and HCs, a trend towards increased IL-6 levels in patients with higher FIQ-R scores was noted. Serum serotonin levels were significantly lower in the FM patients than in the HCs, with moderate patients having lower levels than those classified as severe and very severe. Conclusions: The study underscores the potential role of IL-6 and serotonin in the pathophysiology of FM, suggesting that these biomarkers could be relevant in assessing the severity and impact of FM. Further research is needed to elucidate these relationships and their implications for developing personalized treatment strategies. Full article

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

► Show Figures

Figure 1

16 pages, 287 KiB

Open AccessReview

Novel Challenges and Therapeutic Options for Pulmonary Embolism and Deep Vein Thrombosis

by Chiara Cavallino, Marco Franzino, Mohamed Abdirashid, Ludovica Maltese, Elodi Bacci, Francesco Rametta and Fabrizio Ugo

J. Pers. Med. 2024, 14(8), 885; https://doi.org/10.3390/jpm14080885 - 21 Aug 2024

Viewed by 662

Abstract

Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment [...] Read more.

Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate–high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions. Full article

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

24 pages, 2611 KiB

Open AccessReview

Advancing the Diagnosis of Diabetic Neuropathies: Electrodiagnostic and Skin Autofluorescence Methods

by Dan Trofin, Bianca-Margareta Salmen, Teodor Salmen, Daniela Marilena Trofin and Delia Reurean-Pintilei

J. Pers. Med. 2024, 14(8), 884; https://doi.org/10.3390/jpm14080884 - 21 Aug 2024

Viewed by 394

Abstract

Introduction: Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening [...] Read more.

Introduction: Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening value. This article highlights the diagnostic challenges and raises awareness of the often underdiagnosed neuropathic conditions in diabetes patients. Material and Methods: We present common entrapment neuropathy cases from our diabetes clinic’s electrodiagnosis laboratory in Iași, Romania. We selected seven type 2 diabetes patients with sensory or sensory-motor distal polyneuropathy and atypical DN presentations investigated through electroneurography (ENG) and electromyography (EMG) with the Neurosoft^® EMG instrument and SAF measured by standard procedures. Subsequently, a narrative literature review was conducted. Results: Entrapment neuropathies were diagnosed in all the patients: three carpal tunnel syndromes, two ulnar neuropathies (one proximal, one distal), one peroneal neuropathy, and one case of meralgia paresthetica. The lower-limb cases showed radiculoplexopathy, and there was one case of superficial radial nerve neuropathy. The SAF values ranged from 2.5 AU to 3.4 AU. Conclusions: Electrodiagnosis is essential for detecting focal neuropathies in patients with sensory-motor distal polyneuropathy. Elevated SAF levels may correlate with symptom severity, although further research, including large cohorts, is needed. Full article

(This article belongs to the Special Issue Diabetes and Its Complications: From Research to Clinical Practice)

► Show Figures

Figure 1

11 pages, 3652 KiB

Open AccessArticle

Outcomes of Active Middle Ear Implants: Speech Perception and Quality of Life

by Marzouqi Salamah, Athair Alradhi, Farid Alzhrani and Medhat Yousef

J. Pers. Med. 2024, 14(8), 883; https://doi.org/10.3390/jpm14080883 - 21 Aug 2024

Viewed by 327

Abstract

Objective: To evaluate audiological outcomes, quality of life, and complications in patients implanted with Active middle ear implants (AMEI). The secondary objective is to investigate the required duration after implantation to reach satisfactory outcomes. Methods: This retrospective study included 31 patients implanted with [...] Read more.

Objective: To evaluate audiological outcomes, quality of life, and complications in patients implanted with Active middle ear implants (AMEI). The secondary objective is to investigate the required duration after implantation to reach satisfactory outcomes. Methods: This retrospective study included 31 patients implanted with Active middle ear implants (AMEI) with different methods of floating mass transducer attachment. Patients with incomplete medical records and those who did not respond to postoperative follow-up were excluded. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), speech reception threshold (SRT), and speech discrimination score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. Result: There are no significant differences found in PTA and SRT between the 3-, 6-, and 12-month visits. The speech reception threshold (SRT) showed a statistically significant improvement at 3, 6, and 12 months post-operative measures compared to pre-operative. Additionally, the SDS exhibited a significant increase only after 12 months, compared to the 3-month time point. However, satisfaction levels did not significantly differ between the 6-month and 12-month measurements following surgery. Conclusion: The Vibrant Soundbridge improves subjective satisfaction scores and audiological test scores in patients with different types of hearing loss. AMEI has a low risk of medical or surgical complications, the ease of using a hearing implant, and the social benefits of good hearing and communication. Full article

(This article belongs to the Special Issue Personalized Medicine in Otolaryngology: Special Topic Otology—2nd Edition)

► Show Figures

Figure 1

11 pages, 1197 KiB

Open AccessArticle

Outcomes of I-125 Low-Dose-Rate Brachytherapy in Patients with Localized Prostate Cancer: A Comprehensive Analysis from a Specialized Tertiary Referral Center

by Philipp Schubert, Vratislav Strnad, Daniel Höfler, Claudia Schweizer, Florian Putz, Michael Lotter, Stephan Kreppner, Andre Karius, Rainer Fietkau and Ricarda Merten

J. Pers. Med. 2024, 14(8), 882; https://doi.org/10.3390/jpm14080882 - 21 Aug 2024

Viewed by 344

Abstract

Low-dose-rate (LDR) brachytherapy with I-125 seeds is one of the most common primary tumor treatments for low-risk and low-intermediate-risk prostate cancer. This report aimed to present an analysis of single-institution long-term results. We analyzed the treatment outcomes of 119 patients with low- and [...] Read more.

Low-dose-rate (LDR) brachytherapy with I-125 seeds is one of the most common primary tumor treatments for low-risk and low-intermediate-risk prostate cancer. This report aimed to present an analysis of single-institution long-term results. We analyzed the treatment outcomes of 119 patients with low- and intermediate-risk prostate cancer treated with LDR brachytherapy at our institution between 2014 and 2020. The analysis focused on biochemical recurrence rates (BRFS), overall survival (OS), cumulative local recurrence rate (CLRR), and the incidence of acute and late toxicities. Patient-reported quality of life measures were also evaluated to provide a holistic view on the treatment’s impact. The median follow-up period was 46 months. CLRR was 3.3% (4/119), five-year BRFS was 87%, and the five-year OS rate was 95%. Dysuria was the most common acute urinary toxicity, reported in 26.0% of patients as grade 1 and 13.4% as grade 2. As a late side effect, 12.6% of patients experienced mild dysuria. Sexual dysfunction persisted in 6.7% of patients as grade 1, 7.5% as grade 2, and 10.0% as grade 3. LDR brachytherapy in patients with prostate cancer is an effective treatment, with favorable clinical outcomes and manageable toxicity. The low CLRR and high OS rates, as well as low incidence of severe side effects, support the continued use of LDR brachytherapy as a primary treatment modality for localized prostate cancer. Full article

(This article belongs to the Special Issue Application of Brachytherapy in Clinical Practice: 2nd Edition)

► Show Figures

Figure 1

14 pages, 942 KiB

Open AccessArticle

Opioid-Free Using Ketamine versus Opioid-Sparing Anesthesia during the Intraoperative Period in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial

by Hoon Choi, Jaewon Huh, Minju Kim, Seok Whan Moon, Kyung Soo Kim and Wonjung Hwang

J. Pers. Med. 2024, 14(8), 881; https://doi.org/10.3390/jpm14080881 - 21 Aug 2024

Viewed by 422

Abstract

Opioids effectively manage perioperative pain but have numerous adverse effects. Opioid-free anesthesia (OFA) eliminates intraoperative opioid use; however, evidence for its use in video-assisted thoracoscopic surgery (VATS) is limited. This study assessed the effect of OFA using ketamine in VATS patients compared to [...] Read more.

Opioids effectively manage perioperative pain but have numerous adverse effects. Opioid-free anesthesia (OFA) eliminates intraoperative opioid use; however, evidence for its use in video-assisted thoracoscopic surgery (VATS) is limited. This study assessed the effect of OFA using ketamine in VATS patients compared to opioid-sparing anesthesia (OSA). A total of 91 patients undergoing VATS lobectomy or segmentectomy were randomized to either the OFA group (ketamine) or the OSA group (remifentanil). The primary outcome was the quality of recovery (QoR) on postoperative day (POD) 1, measured with the QoR-40 questionnaire. Secondary outcomes included postoperative pain scores and adverse events. Both groups had comparable baseline and surgical characteristics. On POD 1, the QoR-40 score was higher in the OFA group than in the OSA group (164.3 ± 10.8 vs. 158.7 ± 10.6; mean difference: 5.6, 95% CI: 1.1, 10.0; p = 0.015), though this did not meet the pre-specified minimal clinically important difference of 6.3. The visual analog scale score was lower in the OFA group as compared to the OSA group at 0–1 h (4.2 ± 2.3 vs. 6.2 ± 2.1; p < 0.001) and 1–4 h after surgery (3.4 ± 1.8 vs. 4.6 ± 1.9; p = 0.003). The OFA group had a lower incidence of PONV (2 [4.4%] vs. 9 [19.6%]; p = 0.049) and postoperative shivering (4 [8.9%] vs. 13 [28.3%]; p = 0.030) than the OSA group at 0–1 h after surgery. Using OFA with ketamine proved feasible, as indicated by the stable intraoperative hemodynamics and absence of intraoperative awareness. Patients undergoing VATS with OFA using ketamine showed a statistically significant, but clinically insignificant, QoR improvement compared to those receiving OSA with remifentanil. Full article

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

► Show Figures

Figure 1

10 pages, 241 KiB

Open AccessReview

Uniportal Video-Assisted Thoracoscopic Surgery for Minor Procedures

by Apostolos C. Agrafiotis, Sotirios D. Moraitis and Georgios Sotiropoulos

J. Pers. Med. 2024, 14(8), 880; https://doi.org/10.3390/jpm14080880 - 20 Aug 2024

Viewed by 311

Abstract

Introduction: Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution [...] Read more.

Introduction: Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution from multiportal to uVATS and to explore its feasibility and reproducibility by identifying its drawbacks and limitations. Methods: Research from PubMed was obtained with the terms [uniportal] AND [surgery] OR [single-port] AND [thoracic surgery] OR [VATS]. Papers concerning pediatric cases and non-English papers were excluded. Individual case reports were also excluded. Discussion: uVATS seems to be widely adopted and performed for minor procedures. The applicability of uVATS for different indications is discussed, even though practically all thoracic surgical interventions can be performed through a single incision. Conclusions: The transition from conventional three-port VATS to uVATS is described in this paper. An increasing number of thoracic surgeons worldwide have adopted this approach, even for major complex anatomical lung resections. Regarding the performance of minor thoracic interventions, we believe this technique is easily reproducible with a short learning curve because the instruments do not cross each other, and intraoperative movements remain intuitive. It is therefore a feasible, safe, and efficacious technique. For these reasons, we believe uVATS should be offered to all patients undergoing minor thoracoscopic procedures. Full article

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

► Show Figures

Graphical abstract

14 pages, 1688 KiB

Open AccessArticle

Prognostic and Predictive Significance of Primary Tumor Localization and HER2 Expression in the Treatment of Patients with KRAS Wild-Type Metastatic Colorectal Cancer: Single-Centre Experience from Serbia

by Jelena Radić, Ivan Nikolić, Ivana Kolarov-Bjelobrk, Tijana Vasiljević, Aleksandar Djurić, Vladimir Vidović and Bojana Kožik

J. Pers. Med. 2024, 14(8), 879; https://doi.org/10.3390/jpm14080879 - 20 Aug 2024

Viewed by 440

Abstract

The treatment of patients with metastatic colorectal cancer (mCRC) is complex and is impacted by the location of the primary tumor (LPT). Our study aims to emphasize the importance of LPT as a prognostic and predictive marker as well as to examine the [...] Read more.

The treatment of patients with metastatic colorectal cancer (mCRC) is complex and is impacted by the location of the primary tumor (LPT). Our study aims to emphasize the importance of LPT as a prognostic and predictive marker as well as to examine the significance of HER2 overexpression in patients with mCRC, particularly in relation to the response to Epidermal Growth Factor Receptor Antibody treatment (anti-EGFR therapy). In this study, 181 patients with Kirsten RAS (KRAS) wild-type mCRC who received anti-EGFR therapy were included. Among them, 101 had left colon cancer (LCC) and 80 had right colon cancer (RCC). Results demonstrated that patients with KRAS wild-type LCC had better median overall survival (OS) (43 vs. 33 months, p = 0.005) and progression-free survival (PFS) (6 vs. 3 months, p < 0.001) compared to those with RCC. Multivariate analysis identified mucinous adenocarcinoma (p < 0.001), RCC location (p = 0.022), perineural invasion (p = 0.034), and tumors at the resection margin (p = 0.001) as independent predictors of OS, while mucinous adenocarcinoma (p = 0.001) and RCC location (p = 0.004) independently correlated with significantly shorter PFS. In addition, human epidermal growth factor receptor 2 (HER2) positive expression was significantly associated with worse PFS compared to HER2 negative results (p < 0.001). In conclusion, LPT is an important marker for predicting outcomes in the treatment of wild-type mCRC using anti-EGFR therapy, since patients with RCC have a statistically significantly shorter PFS and OS. Further investigation is needed to understand the role of HER2 overexpression in wild-type mCRC, as these patients also exhibit shorter survival. Full article

(This article belongs to the Section Disease Biomarker)

► Show Figures

Figure 1

14 pages, 282 KiB

Open AccessReview

A Review of Stage 0 Biomarkers in Type 1 Diabetes: The Holy Grail of Early Detection and Prevention?

by Măriuca Mănescu, Ion Bogdan Mănescu and Alina Grama

J. Pers. Med. 2024, 14(8), 878; https://doi.org/10.3390/jpm14080878 - 20 Aug 2024

Viewed by 538

Abstract

Type 1 diabetes mellitus (T1D) is an incurable autoimmune disease characterized by the destruction of pancreatic islet cells, resulting in lifelong dependency on insulin treatment. There is an abundance of review articles addressing the prediction of T1D; however, most focus on the presymptomatic [...] Read more.

Type 1 diabetes mellitus (T1D) is an incurable autoimmune disease characterized by the destruction of pancreatic islet cells, resulting in lifelong dependency on insulin treatment. There is an abundance of review articles addressing the prediction of T1D; however, most focus on the presymptomatic phases, specifically stages 1 and 2. These stages occur after seroconversion, where therapeutic interventions primarily aim to delay the onset of T1D rather than prevent it. This raises a critical question: what happens before stage 1 in individuals who will eventually develop T1D? Is there a “stage 0” of the disease, and if so, how can we detect it to increase our chances of truly preventing T1D? In pursuit of answers to these questions, this narrative review aimed to highlight recent research in the field of early detection and prediction of T1D, specifically focusing on biomarkers that can predict T1D before the onset of islet autoimmunity. Here, we have compiled influential research from the fields of epigenetics, omics, and microbiota. These studies have identified candidate biomarkers capable of predicting seroconversion from very early stages to several months prior, suggesting that the prophylactic window begins at birth. As the therapeutic landscape evolves from treatment to delay, and ideally from delay to prevention, it is crucial to both identify and validate such “stage 0” biomarkers predictive of islet autoimmunity. In the era of precision medicine, this knowledge will enable early intervention with the potential for delaying, modifying, or completely preventing autoimmunity and T1D in at-risk children. Full article

(This article belongs to the Special Issue Diabetes Mellitus: Current Research and Future Perspectives 2nd Edition)

► Show Figures

Graphical abstract

19 pages, 1888 KiB

Open AccessReview

Chatbots in Cancer Applications, Advantages and Disadvantages: All that Glitters Is Not Gold

by Georgios Goumas, Theodoros I. Dardavesis, Konstantinos Syrigos, Nikolaos Syrigos and Effie Simou

J. Pers. Med. 2024, 14(8), 877; https://doi.org/10.3390/jpm14080877 - 19 Aug 2024

Viewed by 748

Abstract

The emergence of digitalization and artificial intelligence has had a profound impact on society, especially in the field of medicine. Digital health is now a reality, with an increasing number of people using chatbots for prognostic or diagnostic purposes, therapeutic planning, and monitoring, [...] Read more.

The emergence of digitalization and artificial intelligence has had a profound impact on society, especially in the field of medicine. Digital health is now a reality, with an increasing number of people using chatbots for prognostic or diagnostic purposes, therapeutic planning, and monitoring, as well as for nutritional and mental health support. Initially designed for various purposes, chatbots have demonstrated significant advantages in the medical field, as indicated by multiple sources. However, there are conflicting views in the current literature, with some sources highlighting their drawbacks and limitations, particularly in their use in oncology. This state-of-the-art review article seeks to present both the benefits and the drawbacks of chatbots in the context of medicine and cancer, while also addressing the challenges in their implementation, offering expert insights on the subject. Full article

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

► Show Figures

Figure 1

14 pages, 599 KiB

Open AccessArticle

Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island—The Cross-Sectional PrevCardio.CV Study

by Patrícia Coelho, Kelly Mascarenhas, Júlio Rodrigues and Francisco Rodrigues

J. Pers. Med. 2024, 14(8), 876; https://doi.org/10.3390/jpm14080876 - 19 Aug 2024

Viewed by 345

Abstract

Cerebrocardiovascular diseases represent one of the greatest public health concerns globally. In Cabo Verde, non-communicable diseases, such as cerebrocardiovascular diseases, have become leading causes of morbidity and mortality. This study aimed to correlate risk factors with cardiac electrical changes in adult individuals residing [...] Read more.

Cerebrocardiovascular diseases represent one of the greatest public health concerns globally. In Cabo Verde, non-communicable diseases, such as cerebrocardiovascular diseases, have become leading causes of morbidity and mortality. This study aimed to correlate risk factors with cardiac electrical changes in adult individuals residing on Santiago Island—Cabo Verde. A cross-sectional population-based study using simple random sampling was conducted in 2021 with individuals aged 18 and over, of both sexes, having authorization 35/2021 from the Cabo Verde Ethics Commission. The sample size was calculated based on Santiago Island’s projected population for 2021, considering an estimated prevalence of 50%, a 95% confidence interval, and a standard error of 4%, resulting in a sample of 599 individuals. The data were collected through a questionnaire on risk factors and cerebrocardiovascular diseases, blood pressure measurement, capillary blood glucose evaluation, and a 12-lead electrocardiogram. The study sample was predominantly female (54.8%), with the largest age group being 18–27 years (21%). Among the sample, 9.3% had no risk factors, 27.5% had one risk factor, 36.2% had two risk factors, and 26.9% had three or more risk factors. Of those who underwent electrocardiography, 60.24% showed electrocardiographic changes, with the most prevalent being ventricular repolarization changes, nonspecific repolarization changes, and early repolarization. A relationship was observed between cerebrocardiovascular disease risk factors and the electrocardiographic changes found in the study participants. Full article

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

► Show Figures

Figure 1

14 pages, 989 KiB

Open AccessArticle

One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity

by Sławomir Zacha, Manuel Lopez, Jarosław Bilas, Karolina Skonieczna-Żydecka, Jakub Miegoń and Jowita Biernawska

J. Pers. Med. 2024, 14(8), 875; https://doi.org/10.3390/jpm14080875 - 18 Aug 2024

Viewed by 562

Abstract

An inherent defect of the sternum and ribs results in the formation of a funnel-shaped anterior chest wall. The gold standard of surgical correction is the minimally invasive Nuss procedure, which might cause severe pain and carries the risk of sensory disturbances and [...] Read more.

An inherent defect of the sternum and ribs results in the formation of a funnel-shaped anterior chest wall. The gold standard of surgical correction is the minimally invasive Nuss procedure, which might cause severe pain and carries the risk of sensory disturbances and chronic discomfort. Integrating cryoanalgesia with standard multimodal analgesia improves the outcomes of this procedure. Based on histological results, it was hypothesised that the time of cryo-application can be reduced from the current standard period of two minutes. The goal of this study was to evaluate the efficacy of a one-minute application compared with the routine two-minute method in the same patient, considering the subjective perception of pain and sensory disturbances. A total of 33 patients were included in this prospective study. The results show that the assessment of pain severity and sensory disturbances did not differ significantly in terms of the time of cryo-application during first 14 days after the surgical procedure. The one-minute cryo-application time for intraoperative intercostal nerve cryoablation prior to the Nuss procedure seems to be as safe and effective as the routinely used two-minute application time in regards to pain severity, sensory disturbances, and the risk of chronic pain development. Intercostal nerve cryoanalgesia is an essential element of multimodal analgesia. Full article

(This article belongs to the Special Issue Personalized Medicine in Anesthesia and Anesthetics)

► Show Figures

Figure 1

24 pages, 1033 KiB

Open AccessSystematic Review

Sensing and Control Strategies Used in FES Systems Aimed at Assistance and Rehabilitation of Foot Drop: A Systematic Literature Review

by Estefanía González-Graniel, Jorge A. Mercado-Gutierrez, Saúl Martínez-Díaz, Iliana Castro-Liera, Israel M. Santillan-Mendez, Oscar Yanez-Suarez, Ivett Quiñones-Uriostegui and Gerardo Rodríguez-Reyes

J. Pers. Med. 2024, 14(8), 874; https://doi.org/10.3390/jpm14080874 - 17 Aug 2024

Viewed by 899

Abstract

Functional electrical stimulation (FES) is a rehabilitation and assistive technique used for stroke survivors. FES systems mainly consist of sensors, a control algorithm, and a stimulation unit. However, there is a critical need to reassess sensing and control techniques in FES systems to [...] Read more.

Functional electrical stimulation (FES) is a rehabilitation and assistive technique used for stroke survivors. FES systems mainly consist of sensors, a control algorithm, and a stimulation unit. However, there is a critical need to reassess sensing and control techniques in FES systems to enhance their efficiency. This SLR was carried out following the PRISMA 2020 statement. Four databases (PubMed, Scopus, Web of Science, Wiley Online Library) from 2010 to 2024 were searched using terms related to sensing and control strategies in FES systems. A total of 322 articles were chosen in the first stage, while only 60 of them remained after the final filtering stage. This systematic review mainly focused on sensor techniques and control strategies to deliver FES. The most commonly used sensors reported were inertial measurement units (IMUs), 45% (27); biopotential electrodes, 36.7% (22); vision-based systems, 18.3% (11); and switches, 18.3% (11). The control strategy most reported is closed-loop; however, most of the current commercial FES systems employ open-loop strategies due to their simplicity. Three main factors were identified that should be considered when choosing a sensor for gait-oriented FES systems: wearability, accuracy, and affordability. We believe that the combination of computer vision systems with artificial intelligence-based control algorithms can contribute to the development of minimally invasive and personalized FES systems for the gait rehabilitation of patients with FDS. Full article

(This article belongs to the Special Issue Stroke Management—Personalized Diagnostic, Therapy and Rehabilitation)

► Show Figures

Figure 1

27 pages, 11277 KiB

Open AccessReview

Imaging of Sacroiliac Pain: The Current State-of-the-Art

by Marina Carotti, Luca Ceccarelli, Anna Claudia Poliseno, Francesca Ribichini, Francesca Bandinelli, Enrico Scarano, Sonia Farah, Marco Di Carlo, Andrea Giovagnoni and Fausto Salaffi

J. Pers. Med. 2024, 14(8), 873; https://doi.org/10.3390/jpm14080873 - 17 Aug 2024

Viewed by 410

Abstract

Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image [...] Read more.

Pain in the sacroiliac (SI) region is a common clinical manifestation, often caused by diseases involving the SI joints. This is typically due to inflammation or degenerative changes, while infections or cancer are less frequent causes. The SI joint is challenging to image accurately because of its distinct anatomical characteristics. For an accurate diagnosis, conventional radiography often needs to be supplemented with more precise methods such as magnetic resonance imaging (MRI) or computed tomography (CT). Sacroiliitis, a common presenting feature of axial spondyloarthritis (axial SpA), manifests as bone marrow edema, erosions, sclerosis, and joint space narrowing. Septic sacroiliitis and repetitive stress injuries in sports can also cause changes resembling inflammatory sacroiliitis. Other conditions, such as osteitis condensans ilii (OCI), can mimic the radiologic characteristics of sacroiliitis. Inflammatory lesions are diagnosed by concurrent erosions, hyperostosis, and ankylosis. Ligament ossifications or mechanical stress can also result in arthritic disorders. Determining the exact diagnosis can be aided by the distribution of the lesions. Inflammatory lesions can affect any part of the articulation, including the inferior and posterior portions. Mechanical lesions, such as those seen in OCI, often occur in the anterior middle region of the joint. In cases of idiopathic skeletal hyperostosis, ligament ossification is found at the joint borders. This pictorial essay describes common SI joint problems, illustrated with multimodal imaging data. We, also, discuss strategies for selecting the best imaging modalities, along with imaging pitfalls, key points, and approaches for treating patients with suspected inflammatory back pain. Full article

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

► Show Figures

Figure 1

11 pages, 818 KiB

Open AccessSystematic Review

Advances in the Management of Localized Scleroderma: A Systematic Review of Laser Therapy and Injectable Filler Approaches

by Fortunato Cassalia, Serena Federico, Andrea Danese, Ludovica Franceschin, Simone Amato, Francesco Gratteri, Chiara Battilotti, Francesca Caroppo, Elena Zappia, Luigi Bennardo, Anna Belloni Fortina and Steven Paul Nisticò

J. Pers. Med. 2024, 14(8), 872; https://doi.org/10.3390/jpm14080872 - 17 Aug 2024

Viewed by 476

Abstract

Localized scleroderma (LS), commonly known as morphea, presents a significant clinical challenge due to its chronic, inflammatory nature affecting the skin and potentially underlying tissues. This systematic review explores the innovative approach of combining laser therapy and injectable fillers, specifically hyaluronic acid, for [...] Read more.

Localized scleroderma (LS), commonly known as morphea, presents a significant clinical challenge due to its chronic, inflammatory nature affecting the skin and potentially underlying tissues. This systematic review explores the innovative approach of combining laser therapy and injectable fillers, specifically hyaluronic acid, for the treatment of LS. We conducted a comprehensive literature review following PRISMA guidelines, examining articles from MEDLINE/PubMed to assess the combined efficacy of these treatments in improving both esthetic and functional outcomes for LS patients. The search yielded 64 articles, with six selected for in-depth analysis for a total of nine patients, covering a range of patient demographics and treatment types. Our review highlights cases where fractional CO₂ laser therapy promoted long-term tissue remodeling and instances where hyaluronic acid fillers effectively addressed skin atrophy and volume loss, enhancing both immediate and long-lasting esthetic improvements. The synergy between these treatments suggests a promising dual approach, aiming to maximize esthetic outcomes and to improve the quality of life for LS patients. This review underscores the necessity of further research to establish a comprehensive, evidence-based clinical pathway integrating both treatments for managing LS, thereby enhancing patient satisfaction and addressing the multifaceted nature of this challenging dermatological condition. Full article

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

► Show Figures

Figure 1

13 pages, 559 KiB

Open AccessArticle

The Effect of Increased Intra-Abdominal Pressure on Hemodynamics in Laparoscopic Cholecystectomy—The Experience of a Single Centre

by Elena Stamate, Alin-Ionut Piraianu, Oana-Monica Duca, Oana Roxana Ciobotaru, Ana Fulga, Iuliu Fulga, Cristian Onisor, Madalina Nicoleta Matei, Alexandru-Stefan Luchian, Adrian George Dumitrascu and Octavian Catalin Ciobotaru

J. Pers. Med. 2024, 14(8), 871; https://doi.org/10.3390/jpm14080871 - 17 Aug 2024

Viewed by 796

Abstract

Laparoscopic cholecystectomy is characterized by reduced postoperative pain, shorter hospital stays, rapid return to preoperative physical activity, and less psychological impact on the patient. During laparoscopic cholecystectomy, the intra-abdominal insufflation of carbon dioxide with secondary increase in intra-abdominal pressure can cause important hemodynamic [...] Read more.

Laparoscopic cholecystectomy is characterized by reduced postoperative pain, shorter hospital stays, rapid return to preoperative physical activity, and less psychological impact on the patient. During laparoscopic cholecystectomy, the intra-abdominal insufflation of carbon dioxide with secondary increase in intra-abdominal pressure can cause important hemodynamic consequences, like decreased cardiac output and blood pressure, as well as compensatory increase in heart rate. The purpose of this study is to evaluate changes in cardiovascular parameters during general anesthesia in patients undergoing laparoscopic cholecystectomy. Retrospective data from 342 patients with cholecystectomy for cholelithiasis performed at Railway Hospital Galati, Romania, were reviewed. All patients received the same intraoperative anesthetics. Female patients were 85.7% (n = 293). More than half of the patients, 53.51% (n = 183), were 40–59 years old, and only 16.37% (n = 56) were under 40 years old. Patients with a normal body mass index (BMI) represented 45.6% (n = 156), 33.3% (n = 114) were underweight, and 12% (n = 42) had grade 1 obesity (BMI 25–29.9 kg/m²). The minimum intraoperative blood pressure correlated with patient gender (p 0.015 < 0.005), with men having a higher blood pressure than women (p 0.006 < 0.05), and for BMI, a higher BMI was associated with elevated blood pressure (p 0.025 < 0.05). Older age correlated with an increased maximum intraoperative blood pressure (p < 0.001 < 0.05) and with maximum intraoperative heart rate (p 0.015 < 0.05). Patients undergoing laparoscopic cholecystectomy experienced significant hemodynamic changes with pneumoperitoneum, but this type of surgical intervention was safe for patients regardless of their age. Full article

(This article belongs to the Special Issue Updates and Challenges in Endoscopic and Laparoscopic Surgery)

► Show Figures

Figure 1

12 pages, 1411 KiB

Open AccessArticle

Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up

by Fabian Schiedat, Benjamin Meuterodt, Joachim Winter, Magnus Prull, Assem Aweimer, Michael Gotzmann, Stephen O’Connor, Christian Perings, Thomas Lawo, Ibrahim El-Battrawy, Christoph Hanefeld, Johannes Korth, Andreas Mügge and Axel Kloppe

J. Pers. Med. 2024, 14(8), 870; https://doi.org/10.3390/jpm14080870 - 17 Aug 2024

Viewed by 397

Abstract

Background: Implantable cardioverter defibrillators (ICD) prevent sudden cardiac death (SCD). Patients with end-stage renal disease (ESRD) requiring dialysis are at a very high risk of infection from cardiac implantable electronic device (CIED) implantation as well as mortality. In the present study, we compared [...] Read more.

Background: Implantable cardioverter defibrillators (ICD) prevent sudden cardiac death (SCD). Patients with end-stage renal disease (ESRD) requiring dialysis are at a very high risk of infection from cardiac implantable electronic device (CIED) implantation as well as mortality. In the present study, we compared the long-term complications and outcomes between subcutaneous ICD (S-ICD) and transvenous ICD (TV-ICD) recipients. Methods: In this retrospective analysis, we analyzed a total of 43 patients with ESRD requiring dialysis who received either a prophylactic S-ICD (26 patients) or a single right ventricular lead TV-ICD (17 patients) at seven experienced centers in Germany. Follow-up was performed bi-annually, at the end of which the data concerning comorbidities and, if applicable, reason for death were checked and confirmed with patients’ general practitioner, nephrologist and cardiologist. Results: The median follow up duration was 95.6 months (range 42.8–126.3 months). Baseline characteristics were without noteworthy significant differences between groups. During follow-up (FU), there were significantly more device-associated infections (HR 8.72, 95% confidence interval (CI), 1.18 to 12.85, p < 0.05) and device-associated hospitalizations (HR 10.20, 95% CI 1.22 to 84.61, p < 0.001), as well as a higher cardiovascular mortality (HR 9.17, 95% CI 1.12 to 8.33, p < 0.05), in the TV-ICD group. The number of patients requiring hospitalization for any reason was significantly higher in the TV-ICD group (HR 2.59, 95% CI 1.12 to 6.41, p < 0.05). There was no significant difference in overall mortality (HR 1.92, 95% CI 0.96 to 6.15, p = 0.274). Conclusions: Our data suggest that, in this extended follow-up in seriously compromised renal patients on dialysis, the S-ICD patients have statistically fewer device infections and hospitalizations as well as lower cardiac mortality compared with the TV-ICD cohort. Full article

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

► Show Figures

Figure 1

11 pages, 876 KiB

Open AccessArticle

Phosphodiesterase-5 Expression in Buccal Mucosa of Patients with Erectile Dysfunction One Year after Radical Prostatectomy

by Juan García-Cardoso, José J. Zamorano-León, Carmen González-Enguita, Carlos Simón, Rodrigo Jiménez-García, Ana López-de-Andrés, Natividad Cuadrado-Corrales, David Carbantes-Alarcon, Carlos Hugo Martínez-Martínez and Khaoula Zekri-Nechar

J. Pers. Med. 2024, 14(8), 869; https://doi.org/10.3390/jpm14080869 - 17 Aug 2024

Viewed by 488

Abstract

(1) Background: Radical prostatectomy has a high incidence of erectile dysfunction (ED). The aim was to determine if the expression of the nitric oxide synthase-3/soluble guanylate cyclase/phosphodiesterase 5 axis could be detected in buccal mucosa and if it could be differently expressed in [...] Read more.

(1) Background: Radical prostatectomy has a high incidence of erectile dysfunction (ED). The aim was to determine if the expression of the nitric oxide synthase-3/soluble guanylate cyclase/phosphodiesterase 5 axis could be detected in buccal mucosa and if it could be differently expressed in patients with and without ED; (2) Methods: Erectile function from 38 subjects subjected to prostatectomy was evaluated using the International Index of Erectile Function-Erectile Function Domain before and one year after surgery. Nitric oxide synthase (NOS3), β1-subunit of soluble guanylate cyclase (sGC), phosphodiesterase-5 (PDE-5) expressions, and interleukin-6 and interleukin-10 content were measured in the buccal mucosa. PDE5A rs3806808 gene polymorphism was genotyped; (3) Results: One year after prostatectomy, 15 patients had recovered functional erection, and 23 showed ED. NOS3, β1-sGC, interleukin-6, and interleukin-10 expressions were not different between patients with and without ED after radical prostatectomy. Buccal mucosa levels of PDE-5 were higher in patients with ED compared to those who recovered erectile functionality. There were no differences found in the genotype of PDE5A polymorphism; (4) Conclusions: One year after prostatectomy, patients with ED had higher PDE5 levels in their buccal mucosa than patients who had recovered erectile function. Rs3806808 PDE5A gene polymorphism was not associated with increased PDE5 expression in buccal mucosa. Full article

(This article belongs to the Section Omics/Informatics)

► Show Figures

Figure 1

11 pages, 427 KiB

Open AccessArticle

Evaluating the Utility of Clinical Scores APACHE, CURB, SOFA, and NEWS2 at Admission and 5-Days after Symptom Onset in Predicting Severe COVID-19 in Patients with Diabetes

by Radu Ion, Jaya Shankar Sai Kumar Kimidi, Chaitanya Kalapala, Oktrian FNU, Varshika Ramakrishnan Chandrababu, Omprakash Reddy Desireddygari, Mirela Loredana Grigras, Ovidiu Rosca, Felix Bratosin, Flavius Cioca, Romulus Timar and Rodica Anamaria Negrean

J. Pers. Med. 2024, 14(8), 868; https://doi.org/10.3390/jpm14080868 - 16 Aug 2024

Viewed by 442

Abstract

The elevated risk of severe COVID-19 outcomes in patients with diabetes underscores the need for effective predictive tools. This study aimed to assess the predictive accuracy of APACHE II, CURB-65, SOFA, and NEWS2 scores at critical time points in diabetic patients diagnosed with [...] Read more.

The elevated risk of severe COVID-19 outcomes in patients with diabetes underscores the need for effective predictive tools. This study aimed to assess the predictive accuracy of APACHE II, CURB-65, SOFA, and NEWS2 scores at critical time points in diabetic patients diagnosed with COVID-19, aiming to guide early and potentially life-saving interventions. In a prospective cohort study conducted from January 2021 to December 2023, adult patients with type 1 or type 2 diabetes and confirmed SARS-CoV-2 infection were evaluated. Clinical scores were calculated at admission and five days post-symptom onset, with data analyzed using receiver operating characteristic (ROC) curves and logistic regression to determine areas under the curve (AUC) and hazard ratios (HR) for severe outcomes. Among the 141 diabetic patients studied, ROC analysis revealed high AUC values for SOFA (0.771 at admission, 0.873 at day five) and NEWS2 (0.892 at admission, 0.729 at day five), indicating strong predictive accuracy for these scores. The APACHE II score’s AUC improved from 0.698 at admission to 0.806 on day five, reflecting worsening patient conditions. Regression analysis showed significant HRs associated with exceeding threshold scores: The SOFA score HR at day five was 3.07 (95% CI: 2.29–4.12, p < 0.001), indicating a threefold risk of severe outcomes. Similarly, the APACHE II score showed an HR of 2.96 (95% CI: 2.21–3.96, p < 0.001) at day five, highlighting its utility in predicting severe disease progression. The SOFA and NEWS2 scores demonstrated excellent early predictive accuracy for severe COVID-19 outcomes in diabetic patients, with significant AUC and HR findings. Continuous score monitoring, especially of APACHE II and SOFA, is crucial for managing and potentially mitigating severe complications in this vulnerable population. These tools can effectively assist in the timely escalation of care, thus potentially reducing morbidity and mortality among diabetic patients during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Novel Diagnostics and Therapies for Infectious Disease)

► Show Figures

Figure 1

14 pages, 2450 KiB

Open AccessReview

Inhalational Drug Devices: Revisiting the Linchpin of Asthma Management

by Damini Saxena, Neveda Murugesan, Uyioghosa D. Evbayiro, Marina K. Ngassa and Muhammad Adrish

J. Pers. Med. 2024, 14(8), 867; https://doi.org/10.3390/jpm14080867 - 16 Aug 2024

Viewed by 455

Abstract

Asthma remains a prevalent condition among all age groups globally. First-line treatment requires the delivery of medications into the distal respiratory tract via inhalers. Using appropriate inhaler techniques is a significant challenge in achieving disease control. A variety of inhalers are available for [...] Read more.

Asthma remains a prevalent condition among all age groups globally. First-line treatment requires the delivery of medications into the distal respiratory tract via inhalers. Using appropriate inhaler techniques is a significant challenge in achieving disease control. A variety of inhalers are available for treating asthma, and selecting the appropriate inhaler type for any given patient is crucial to achieving and maintaining symptomatic control. This review will discuss the anatomy and physiology behind drug delivery via inhalers, the types of inhalers currently available for use, nebulizers, and future directions in the delivery of inhaled medications for asthma. Full article

(This article belongs to the Special Issue Current Updates on Asthma in Personalized Medicine)

► Show Figures

Figure 1

19 pages, 3457 KiB

Open AccessArticle

Germline RAD51C and RAD51D Mutations in High-Risk Chinese Breast and/or Ovarian Cancer Patients and Families

by Ava Kwong, Cecilia Yuen Sze Ho, Chun Hang Au, Sze Keong Tey and Edmond Shiu Kwan Ma

J. Pers. Med. 2024, 14(8), 866; https://doi.org/10.3390/jpm14080866 - 16 Aug 2024

Viewed by 384

Abstract

Background: RAD51C and RAD51D are crucial in homologous recombination (HR) DNA repair. The prevalence of the RAD51C and RAD51D mutations in breast cancer varies across ethnic groups. Associations of RAD51C and RAD51D germline pathogenic variants (GPVs) with breast and ovarian cancer predisposition have [...] Read more.

Background: RAD51C and RAD51D are crucial in homologous recombination (HR) DNA repair. The prevalence of the RAD51C and RAD51D mutations in breast cancer varies across ethnic groups. Associations of RAD51C and RAD51D germline pathogenic variants (GPVs) with breast and ovarian cancer predisposition have been recently reported and are of interest. Methods: We performed multi-gene panel sequencing to study the prevalence of RAD51C and RAD51D germline mutations among 3728 patients with hereditary breast and/or ovarian cancer (HBOC). Results: We identified 18 pathogenic RAD51C and RAD51D mutation carriers, with a mutation frequency of 0.13% (5/3728) and 0.35% (13/3728), respectively. The most common recurrent mutation was RAD51D c.270_271dupTA; p.(Lys91Ilefs*13), with a mutation frequency of 0.30% (11/3728), which was also commonly identified in Asians. Only four out of six cases (66.7%) of this common mutation tested positive for homologous recombination deficiency (HRD). Conclusions: Taking the family studies in our registry and tumor molecular pathology together, we concluded that this relatively common RAD51D variant showed incomplete penetrance in our local Chinese community. Personalized genetic counseling emphasizing family history for families with this variant, as suggested at the UK Cancer Genetics Group (UKCGG) Consensus meeting, would also be appropriate in Chinese families. Full article

(This article belongs to the Section Omics/Informatics)

► Show Figures

Figure 1

10 pages, 1512 KiB

Open AccessArticle

General Anesthesia Improves Efficiency of High-Power Short-Duration Catheter Ablation for Atrial Fibrillation: Comparison with Mild Conscious Sedation

by Ioan-Alexandru Minciună, Raluca Tomoaia, Mihai Suceveanu, Gabriel Cismaru, Mihai Puiu, Radu Roșu, Gelu Simu, Diana Andrada Irimie, Florina Frîngu, Bogdan Caloian, Marius Andronache, Dumitru Zdrenghea and Dana Pop

J. Pers. Med. 2024, 14(8), 865; https://doi.org/10.3390/jpm14080865 - 16 Aug 2024

Viewed by 412

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally. High-power, short-duration radiofrequency (RF) catheter ablation (CA) for AF has recently emerged, reducing ablation times and enhancing patient tolerability with comparable efficacy and safety. While the benefits of general anesthesia (GA) for [...] Read more.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally. High-power, short-duration radiofrequency (RF) catheter ablation (CA) for AF has recently emerged, reducing ablation times and enhancing patient tolerability with comparable efficacy and safety. While the benefits of general anesthesia (GA) for standard-power, standard-duration CA are well-established, data comparing GA to mild conscious sedation (MCS) for high-power, short-duration CA are limited. Methods: We included patients undergoing high-power, short-duration CA for AF under GA (group 1) or MCS (group 2). Procedural characteristics, success rates, and mid-term outcomes were compared. Results: In total, 131 patients, 47 in the GA group and 84 in the MCS group, were included. CA was performed for paroxysmal AF in 34 patients in group 1 (72.3%) and 68 patients in group 2 (80.9%). We found lower a mean total procedure time (100 [90–120] vs. 160 [130–180] min, p < 0.0001), lower radiation exposure (932.5 [625–1716] vs. 2445 [1228–4791] μGy, p < 0.0001 and 4.5 [3–7.1] 7.3 [4.2–13.5] min, p = 0.0003) and fewer RF applications (71 [54.8–83.8] vs. 103 [88.5–120.5], p < 0.0001) in the GA group. No major complications occurred. The 6-month AF recurrence rate was comparable between the groups (21.2% vs. 33.3%, p = 0.15). Conclusion: In patients undergoing high-power, short-duration RFCA for AF, the use of GA is associated with better procedural efficiency while simultaneously associated with an early recurrence rate comparable to MCS. Full article

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

► Show Figures

Figure 1

12 pages, 5912 KiB

Open AccessArticle

Major Causes of Conflicting Interpretations of Variant Pathogenicity in Rare Disease: A Systematic Analysis

by Tatyana E. Lazareva, Yury A. Barbitoff, Yulia A. Nasykhova and Andrey S. Glotov

J. Pers. Med. 2024, 14(8), 864; https://doi.org/10.3390/jpm14080864 - 15 Aug 2024

Viewed by 414

Abstract

The identification of the genetic causes of inherited disorders from next-generation sequencing (NGS) data remains a complicated process, in particular due to challenges in interpretation of the vast amount of generated data and hundreds of candidate variants identified. Inconsistencies in variant classification, where [...] Read more.

The identification of the genetic causes of inherited disorders from next-generation sequencing (NGS) data remains a complicated process, in particular due to challenges in interpretation of the vast amount of generated data and hundreds of candidate variants identified. Inconsistencies in variant classification, where genetic centers classify the same variant differently, can hinder accurate diagnoses for rare diseases. Publicly available databases that collect data on human genetic variations and their association with diseases provide ample opportunities to discover conflicts in variant interpretation worldwide. In this study, we explored patterns of variant classification discrepancies using data from ClinVar, a public archive of variant interpretations. We found that 5.7% of variants have conflicting interpretations (COIs) reported, and the vast majority of interpretation conflicts arise for variants of uncertain significance (VUS). As many as 78% of clinically relevant genes harbor variants with COIs, and genes with high COI rates tended to have more exons and longer transcripts, with a greater proportion of genes linked to several distinct conditions. The enrichment analysis of COI-enriched genes revealed that the products of these genes are involved in cardiac disorders, muscle development, and function. To improve diagnoses, we believe that specific variant interpretation rules could be developed for such genes. Additionally, our findings underscore the need for the publication of variant pathogenicity evidence and the importance of considering every variant as VUS unless proven otherwise. Full article

(This article belongs to the Section Omics/Informatics)

► Show Figures

Figure 1

27 pages, 589 KiB

Open AccessReview

Targeted Screening for Cancer: Learnings and Applicability to Melanoma: A Scoping Review

by Lejie Zheng, Amelia K. Smit, Anne E. Cust and Monika Janda

J. Pers. Med. 2024, 14(8), 863; https://doi.org/10.3390/jpm14080863 - 14 Aug 2024

Viewed by 518

Abstract

This scoping review aims to systematically gather evidence from personalized cancer-screening studies across various cancers, summarize key components and outcomes, and provide implications for a future personalized melanoma-screening strategy. Peer-reviewed articles and clinical trial databases were searched for, with restrictions on language and [...] Read more.

This scoping review aims to systematically gather evidence from personalized cancer-screening studies across various cancers, summarize key components and outcomes, and provide implications for a future personalized melanoma-screening strategy. Peer-reviewed articles and clinical trial databases were searched for, with restrictions on language and publication date. Sixteen distinct studies were identified and included in this review. The studies’ results were synthesized according to key components, including risk assessment, risk thresholds, screening pathways, and primary outcomes of interest. Studies most frequently reported about breast cancers (n = 7), followed by colorectal (n = 5), prostate (n = 2), lung (n = 1), and ovarian cancers (n = 1). The identified screening programs were evaluated predominately in Europe (n = 6) and North America (n = 4). The studies employed multiple different risk assessment tools, screening schedules, and outcome measurements, with few consistent approaches identified across the studies. The benefit–harm assessment of each proposed personalized screening program indicated that the majority were feasible and effective. The establishment of a personalized screening program is complex, but results of the reviewed studies indicate that it is feasible, can improve participation rates, and screening outcomes. While the review primarily examines screening programs for cancers other than melanoma, the insights can be used to inform the development of a personalized melanoma screening strategy. Full article

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

► Show Figures

Figure 1

12 pages, 793 KiB

Open AccessArticle

Association between Cardiovascular Risk Assessment by SCORE2 and Diverticulosis: A Cross-Sectional Analysis

by Andreas Völkerer, Sarah Wernly, Georg Semmler, Maria Flamm, Konrad Radzikowski, Leonora Datz, Nikolaus Götz, Hannah Hofer, Elmar Aigner, Christian Datz and Bernhard Wernly

J. Pers. Med. 2024, 14(8), 862; https://doi.org/10.3390/jpm14080862 - 14 Aug 2024

Viewed by 392

Abstract

Background: The aim of this retrospective observational study was to examine the relationship between SCORE2 and the occurrence of colonic diverticula in a screening population without cardiovascular or gastrointestinal symptoms. SCORE2, recognized and supported by the European Society of Cardiology for cardiovascular risk [...] Read more.

Background: The aim of this retrospective observational study was to examine the relationship between SCORE2 and the occurrence of colonic diverticula in a screening population without cardiovascular or gastrointestinal symptoms. SCORE2, recognized and supported by the European Society of Cardiology for cardiovascular risk assessment, served as the primary metric for the analysis in this investigation. Methods: We studied 3935 asymptomatic individuals undergoing screening colonoscopy. SCORE2 was calculated for each participant and categorized into three groups based on the following projected 10-year cardiovascular disease risk: SCORE2 0–4.9%, SCORE2 5–9.9%, and SCORE2 ≥ 10%. Logistic regression was used to assess the relationship between SCORE2 and diverticulosis. Results: SCORE2 was associated with the presence of diverticulosis (OR 1.09, 95%CI 1.07–1.10; p < 0.001) in univariable logistic regression, translating into an RR of 1.07 per unit increase. The association persisted after multivariable adjusting for metabolic syndrome (aOR 1.08; 95%CI 1.06–1.10; p < 0.001). Patients with high cardiovascular risk had higher rates of diverticulosis compared to those with lower risk: high risk (OR 2.00, 95%CI 1.71–2.33; p < 0.001); very high risk (OR 2.53, 95%CI 2.10–3.05; p < 0.001). This association remained after adjusting for metabolic syndrome: high risk (aOR 1.86, 95%CI 1.59–2.18; p < 0.001); very high risk (aOR 2.27, 95%CI 1.88–2.75; p < 0.001). Conclusions: A higher SCORE2 was found to be a suitable screening parameter for diverticular disease. This suggests a potential link between cardiovascular risk factors and colon diverticula development, warranting further research on whether optimizing cardiovascular risk factors could positively influence diverticular disease. Full article

(This article belongs to the Section Epidemiology)

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Pers. Med., Volume 14, Issue 8 (August 2024) – 114 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI