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Contextual Regulation of the Kynurenine Pathway and Its Relevance for Personalized Psychiatry
Biomarkers in Colorectal Cancer: Clinically Relevant Diagnostic and Prognostic Molecular Features, and the Future of Precision Medicine
Advances in Non-CPAP Management of Obstructive Sleep Apnea: Spotlight on Pharmacological Therapies

Journal Description

Journal of Personalized Medicine

Journal of Personalized Medicine is an international, peer-reviewed, open access journal on personalized medicine, published monthly online by MDPI. The Inter-American Society for Minimally Invasive Spine Surgery (SICCMI), Korean Society of Brain Neuromodulation Therapy (KBNT), American Board of Precision Medicine (ABOPM) and Brazilian Society of Personalized Medicine (SBMP) are affiliated with JPM and their members receive a discount on article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, PubMed, PMC, Embase, and other databases.
Journal Rank: CiteScore - Q1 (Medicine (miscellaneous))
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 25 days after submission; acceptance to publication is undertaken in 5.8 days (median values for papers published in this journal in the second half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.

Imprint Information Journal Flyer Open Access ISSN: 2075-4426

Latest Articles

26 pages, 689 KB

Open AccessReview

Evolving Management Approaches Toward Personalized Therapy in Acute Myeloid Leukemia: A Narrative Review

by Pasquale Niscola, Valentina Gianfelici, Marco Giovannini, Carla Mazzone and Maria Ilaria Del Principe

J. Pers. Med. 2026, 16(5), 266; https://doi.org/10.3390/jpm16050266 - 15 May 2026

After many years of stagnation in the treatment of acute myeloid leukemia (AML), there is currently a rapid move towards personalized medicine. Improvements in molecular diagnostics, risk assessment tools, targeted therapies, overall patient fitness assessments, and quality-of-life assessments have significantly changed how patients [...] Read more.

After many years of stagnation in the treatment of acute myeloid leukemia (AML), there is currently a rapid move towards personalized medicine. Improvements in molecular diagnostics, risk assessment tools, targeted therapies, overall patient fitness assessments, and quality-of-life assessments have significantly changed how patients are treated. Genetic and molecular analyses, risk and health assessments, and measurable residual disease (MRD) monitoring are now integral to the treatment plan for evaluating patient responses and recurrence. In this regard, lower-intensity treatments are provided to older or unfit individuals. On the other hand, younger patients are usually subjected to curative therapies such as intensive chemotherapy to induce remission. Depending on their fitness and disease risk, they can be considered for hematopoietic cell transplantation, which is done after close observation for MRD. In addition, newer therapeutic drugs and immunotherapy techniques are being applied for patient management. Tremendous strides have been made in improving the efficiency of treatment programs in the relatively new area of personalized AML therapy, with a focus on functionality. Full article

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

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14 pages, 1601 KB

Open AccessReview

Cardiac Implications of Preeclampsia: A Review

by Beani J. Forst, Linda R. Chambliss and David S. Majdalany

J. Pers. Med. 2026, 16(5), 265; https://doi.org/10.3390/jpm16050265 - 15 May 2026

Preeclampsia (PE) is a multifactorial hypertensive disorder of pregnancy that significantly increases both short- and long-term cardiovascular risk for affected women. PE and cardiovascular disease (CVD) share common risk factors, including endothelial dysfunction, obesity, insulin resistance, and dyslipidemia. Women with a history of [...] Read more.

Preeclampsia (PE) is a multifactorial hypertensive disorder of pregnancy that significantly increases both short- and long-term cardiovascular risk for affected women. PE and cardiovascular disease (CVD) share common risk factors, including endothelial dysfunction, obesity, insulin resistance, and dyslipidemia. Women with a history of PE face a markedly elevated risk of chronic hypertension, heart failure, and adverse cardiac remodeling, with evidence suggestive of persistent vascular and myocardial changes after pregnancy. The complex pathophysiology of PE is multifactorial and is thought to involve a combination of abnormal placentation, immune dysregulation, and anti-angiogenic factors, which may induce permanent cardiovascular alterations. Genetic predispositions may further link PE with cardiomyopathies and peripartum cardiomyopathy. However, despite these well-established risks, standardized long-term surveillance and management strategies for women with prior PE remain lacking. Early identification and targeted intervention in women with a history of PE represent critical opportunities to mitigate future cardiovascular morbidity and mortality. This review highlights the urgent need for comprehensive, evidence-based strategies that incorporate personalized follow-up and risk stratification to improve cardiovascular outcomes in this high-risk population. Full article

(This article belongs to the Section Personalized Medical Care)

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15 pages, 506 KB

Open AccessArticle

Dry Eye in Colombian Tomato Farmers: An Exploratory Cross-Sectional Study of Occupational Exposure Duration

by María Catalina Morón Barreto, José-María Sánchez-González and Diana Cristina Palencia Florez

J. Pers. Med. 2026, 16(5), 264; https://doi.org/10.3390/jpm16050264 - 14 May 2026

Background/Objectives: This study aimed to evaluate the relationship between cumulative occupational exposure and ocular surface alterations in Colombian tomato farm workers, using data collected through a cross-sectional survey. In addition, the study sought to explore how occupational exposure duration may support risk stratification [...] Read more.

Background/Objectives: This study aimed to evaluate the relationship between cumulative occupational exposure and ocular surface alterations in Colombian tomato farm workers, using data collected through a cross-sectional survey. In addition, the study sought to explore how occupational exposure duration may support risk stratification and targeted preventive strategies in this vulnerable population. Methods: A cross-sectional observational study was conducted involving 72 tomato farm workers in Colombia. Participants were grouped according to duration of agricultural work experience (<15 years vs. ≥15 years). Clinical assessments included slit lamp examination, tear film break-up time (BUT), Schirmer test, and fluorescein staining. Subjective symptoms were evaluated using the McMonnies Dry Eye Questionnaire. Ocular surface alterations, including conjunctival changes and Meibomian gland dysfunction, were documented and statistically analyzed between groups. Results: Workers with ≥15 years of experience reported significantly higher dry eye symptom scores (McMonnies mean = 8.19 ± 2.54) than those with <15 years (mean = 6.59 ± 2.61; p = 0.006). Schirmer test scores were lower in the experienced group (16.30 ± 11.48 mm vs. 22.71 ± 11.20 mm; p = 0.018), indicating reduced tear production. Bulbar conjunctival alterations and Meibomian gland obstruction were significantly more frequent in the experienced group (p = 0.002 and p = 0.013, respectively). No significant differences were found in BUT or eyelid findings. Conclusions: Long-term agricultural work was associated with increased dry eye-related symptoms and clinical signs of ocular surface compromise among Colombian tomato farm workers. From a personalized medicine perspective, occupational exposure duration may represent a useful risk-stratification factor to identify workers who could benefit from targeted screening, preventive counseling, protective interventions, and individualized follow-up. These findings support the implementation of tailored occupational eye health strategies to reduce cumulative ocular surface damage in vulnerable rural populations. Full article

(This article belongs to the Special Issue Personalized Ophthalmology: Optometry and Treatment)

11 pages, 585 KB

Open AccessArticle

Semen Analysis in Men with Testicular Cancer: Insights from a Large Fertility Preservation Cohort Toward Personalized Fertility Assessment

by Federica Cariati, Maria Grazia Orsi, Anna Maione, Francesca Bagnulo, Raffaella Di Girolamo, Luigi Carbone, Alberto Servetto, Fabrizio Farina, Roberto Bianco, Sandro Cassiano Esteves, Carlo Alviggi and Alessandro Conforti

J. Pers. Med. 2026, 16(5), 263; https://doi.org/10.3390/jpm16050263 - 14 May 2026

Background/Objectives: Testicular cancer accounts for approximately 1% of all male malignancies, with an incidence ranging from 1 to 10 per 100,000 men and it predominantly affects young individuals, with nearly 60% of cases diagnosed between 15 and 35 years of age. In [...] Read more.

Background/Objectives: Testicular cancer accounts for approximately 1% of all male malignancies, with an incidence ranging from 1 to 10 per 100,000 men and it predominantly affects young individuals, with nearly 60% of cases diagnosed between 15 and 35 years of age. In recent decades, the incidence of testicular cancer has markedly increased, paralleling a global rise in male infertility rates. Although chemotherapy is known to adversely affect fertility, the extent to which the tumor itself and its different histological subtypes impact semen quality remains incompletely understood. The aim of this study was to evaluate semen parameters in men diagnosed with testicular cancer prior to oncological treatment and to assess the possible association between tumor histology and semen quality. Methods: This retrospective study included data from 284 men diagnosed with testicular cancer who underwent semen cryopreservation prior to surgery, chemotherapy, or radiotherapy. Data were collected between January 2016 and June 2022 at the Maternal and Child Department of the University of Naples Federico II. Histopathological classification was available for 278 patients and revealed the following distribution: 59% (165/278) classic seminoma, 14.7% (41/278) seminomatous mixed germ cell tumors, 13.3% (37/278) non-seminomatous mixed germ cell tumors, and 12.6% (35/278) non-seminomatous germ cell tumors. Results: No significant association was observed between tumor histology and abnormal semen parameters. According to World Health Organization (WHO) reference values, semen parameters in patients with testicular cancer were predominantly distributed between the 5th and 25th percentiles. Microscopic semen analysis revealed significantly lower sperm concentration, total motility, and normal morphology in cancer patients (p < 0.001; p < 0.001; and p < 0.002, respectively). Logistic regression analysis showed a significant association between age and testicular cancer risk (p < 0.001), with a negative coefficient indicating that the likelihood of developing the disease decreases with increasing age. Additionally, patients with seminoma were significantly older than those with non-seminomatous tumors: on average, 4.07 years older than those with pure non-seminoma (p = 0.007) and 5.60 years older than those with mixed non-seminoma (p < 0.001). No statistically significant age differences were observed among non-seminomatous subtypes. Conclusions: These findings underscore the importance of systematic semen evaluation in young men diagnosed with testicular cancer and highlight the critical role of fertility preservation strategies in the comprehensive management of these patients. Full article

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

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11 pages, 523 KB

Open AccessArticle

Temporal Clinical Ultrasound Asynchrony in Psoriatic Arthritis Enthesitis: Implications for Personalized Monitoring

by Nicolò Girolimetto, Francesco Caso, Marianna Oliva, Alessandra Rai, Giorgia Citriniti, Filippo Crescentini, Luca Magnani, Olga Addimanda, Giulia Galletto, Maria Grazia Orlando, Pierluigi Macchioni, Carlo Salvarani, Francesco Ursini and Niccolò Possemato

J. Pers. Med. 2026, 16(5), 262; https://doi.org/10.3390/jpm16050262 - 13 May 2026

Background: In psoriatic arthritis (PsA), clinical tenderness and ultrasound (US) capture distinct yet related aspects of entheseal disease activity. However, their longitudinal relationship after initiation of biologic disease-modifying antirheumatic drugs (bDMARDs), and the clinical significance of early discordance during follow-up remain unclear. [...] Read more.

Background: In psoriatic arthritis (PsA), clinical tenderness and ultrasound (US) capture distinct yet related aspects of entheseal disease activity. However, their longitudinal relationship after initiation of biologic disease-modifying antirheumatic drugs (bDMARDs), and the clinical significance of early discordance during follow-up remain unclear. Methods: In this retrospective observational cohort study based on routinely collected medical records, patients with CASPAR-defined PsA and clinically and ultrasonographically active enthesitis at baseline (Clin+/US+) who initiated bDMARD therapy underwent paired, same-day, blinded clinical and US assessments at approximately 6 and 12 months. Agreement between clinical and US findings was quantified using Cohen’s kappa. Discordant states (Clin−/US+ and Clin+/US−) were prespecified, and predictors of Clin−/US+ status at 6 months were analyzed using models that accounted for within-patient clustering. Results: Thirty-nine patients contributed 82 entheses and were treated with either tumour necrosis factor inhibitors (53.8%) or interleukin-17 inhibitors (46.2%). At 6 months, agreement between clinical and US assessments was fair (κ = 0.286; 95% confidence interval [CI], 0.080 to 0.492), with 23.2% of entheses classified as Clin−/US+ and 52.4% as concordantly inactive. At 12 months, agreement improved to substantial-to-almost-perfect levels (κ = 0.779; 95% CI, 0.595 to 0.963), with only 1.2% of entheses remaining Clin−/US+ and 80.5% achieving concordant remission. NSAID exposure was the only significant predictor of Clin−/US+ status at 6 months in univariable analysis (odds ratio [OR], 3.82; 95% CI, 1.27 to 11.47; p = 0.017) and remained associated after multivariable adjustment (OR, 6.16; 95% CI, 1.14 to 33.2; p = 0.03). Conclusions: In PsA patients starting bDMARD therapy, clinical and US assessments of enthesitis showed partial discordance at 6 months, followed by greater convergence at 12 months. These findings suggest that clinical and imaging abnormalities may resolve asynchronously during follow-up and should therefore be interpreted in an integrated, time-aware manner. Residual US abnormalities in the setting of clinical improvement should be interpreted cautiously and within the broader clinical context. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Personalized Management of Rheumatic Diseases)

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21 pages, 375 KB

Open AccessReview

Quantitative Electroencephalography as a Complement to Symptom-Based Psychiatric Diagnosis: A Narrative Review

by Francesco Amico, Scott Shannon and Steve Rondeau

J. Pers. Med. 2026, 16(5), 261; https://doi.org/10.3390/jpm16050261 - 13 May 2026

Background: Psychiatric assessments traditionally rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnostic guidance. This approach, however, is heavily based on the identification of cluster symptoms assessed through subjective interviews and questionnaires, without adequately controlling for overlapping symptoms or [...] Read more.

Background: Psychiatric assessments traditionally rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for diagnostic guidance. This approach, however, is heavily based on the identification of cluster symptoms assessed through subjective interviews and questionnaires, without adequately controlling for overlapping symptoms or symptom specificity. This may lead to broad and often inaccurate diagnoses that overlook the patient’s unique experience and underlying neurobiological imbalances. As mental healthcare strives to move towards personalized medicine, incorporating more objective and precise measures of neuropsychological distress, it is essential to reduce the diagnostic and treatment inaccuracies that may stem from relying solely on empirical guidelines. This narrative review examines the limitations of the current approach and considers the potential role of quantitative electroencephalography (qEEG) as an adjunctive method that may enrich existing diagnostic processes. Methods: A structured literature search was conducted in Europe PMC on 31 January 2026. Original human studies and clinical trials in English with available abstracts were thematically selected. Results: The search yielded 1934 records, from which a focused subset of studies was selected based on direct relevance to the review themes. Conclusions: Integrating qEEG methods into traditional assessments could enhance diagnostic accuracy in psychiatric care and reduce patients’ exposure to inadequate treatments, ultimately leading to improved treatment outcomes and patient satisfaction. Full article

(This article belongs to the Special Issue Mental Health: Diagnosis, Therapeutic Intervention and Patient Management in the Era of Personalized Medicine)

15 pages, 16174 KB

Open AccessArticle

Reconstructive Goals in Arm and Elbow Defects Treated with the Pedicled Latissimus Dorsi Flap

by Ömer Kokaçya, Umut Dalgıç, Abdullah Arslan, İbrahim Tabakan, Gazi Kutalmış Yaprak, Ahmet Cemil Dalay and Erol Kesiktaş

J. Pers. Med. 2026, 16(5), 260; https://doi.org/10.3390/jpm16050260 - 13 May 2026

Background/Objectives: Reconstruction of complex soft-tissue defects of the arm and elbow remains challenging because of exposed neurovascular structures, wide joint mobility, and the need to preserve function. The pedicled latissimus dorsi (LD) flap remains a valuable option, particularly when recipient vessels are compromised [...] Read more.

Background/Objectives: Reconstruction of complex soft-tissue defects of the arm and elbow remains challenging because of exposed neurovascular structures, wide joint mobility, and the need to preserve function. The pedicled latissimus dorsi (LD) flap remains a valuable option, particularly when recipient vessels are compromised or functional restoration is required. Given the heterogeneity of these injuries, treatment must be individualized according to each patient’s defect characteristics, functional demands, and rehabilitation goals, reflecting personalized medicine principles. This study evaluated the indications and outcomes of pedicled LD flap transfer in arm and elbow defects. Methods: All consecutive patients who underwent pedicled LD flap reconstruction for upper extremity soft-tissue defects at our institution (January 2015–January 2025) were retrospectively reviewed. Demographic data, defect etiology, flap type, reconstructive goals, complications, and functional outcomes were analyzed. Results: Twenty-six patients were included (mean age 28.5 ± 7.6 years; 84.6% male). Electrical burns were the predominant etiology (92.3%). A musculocutaneous flap was used in 22 patients (84.6%) and a muscle-only flap in 4 (15.4%); supplementary split-thickness skin grafting was required in 17 (65.4%). Reconstructive goals included elbow flexion restoration (±neurovascular repair and soft-tissue coverage) in 12 patients (46.2%) and humeral stump preservation for prosthetic use in 14 (53.8%). No total flap loss occurred. Complications included partial necrosis in 1 patient (3.8%), donor-site seroma in 3 (11.5%), wound dehiscence in 2 (7.7%), and recipient-site hematoma in 1 (3.8%). No patient required amputation or shoulder disarticulation. Conclusions: The pedicled LD flap is a reliable option for complex arm and elbow defects. By tailoring flap design, nerve management, and rehabilitation to individual patient needs, this approach exemplifies personalized reconstructive planning in upper extremity trauma. Full article

(This article belongs to the Special Issue Personalized Plastic and Reconstructive Surgery: Challenges and Prospects)

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21 pages, 5859 KB

Open AccessReview

Pediatric OSA—Spectrum of the Disease and Opportunities for Personalized Interventions

by Hui-Leng Tan, Athanasios Kaditis and David Gozal

J. Pers. Med. 2026, 16(5), 259; https://doi.org/10.3390/jpm16050259 - 12 May 2026

Pediatric obstructive sleep-disordered breathing encompasses a wide spectrum of diagnostic clusters, including primary snoring, upper airway resistance syndrome, mild, moderate, and severe obstructive sleep apnea, and obstructive hypoventilation. Even within these classifications, the symptomatic presentation involves a large array of variations, reflecting a [...] Read more.

Pediatric obstructive sleep-disordered breathing encompasses a wide spectrum of diagnostic clusters, including primary snoring, upper airway resistance syndrome, mild, moderate, and severe obstructive sleep apnea, and obstructive hypoventilation. Even within these classifications, the symptomatic presentation involves a large array of variations, reflecting a wide phenotypic spectrum. Here, we aim to summarize current diagnostic criteria and explore the spectrum of disease, particularly highlighting the phenotypic variation and its potential relevance to therapeutic decisions and overall outcomes. It has become apparent that polysomnographic (PSG) indices do not correlate well with associated morbidities, even though one-night in-lab PSGs are considered the diagnostic gold standard. Novel approaches, including exploration of plasma and urine biomarkers and data-mining the physiological information embedded within the PSG, may enable the extraction of phenotypic information that can then be interpreted in conjunction with clinical data, including history, physical examination findings, risk factors, and associated disease morbidity, so that an individualized treatment plan can be optimally delineated. Full article

(This article belongs to the Special Issue Treatment and Management of Sleep Apnea)

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13 pages, 3501 KB

Open AccessArticle

Finite-Element Computer Modeling of Spatial Displacement of the Pterygoid Venous Plexus During Mandibular Movements

by Hadi Darawsheh, Dmitry Leonov, Sergey Dydykin, Beatrice Volel, Ellina Velichko, Irina Usmanova, Irina Lakman, Anzhela Brago, Seyedamirhossein Hosseini, Evgeniy Sosnin and Yuriy Vasil’ev

J. Pers. Med. 2026, 16(5), 258; https://doi.org/10.3390/jpm16050258 - 12 May 2026

The safety of mandibular anesthesia is directly dependent on a precise understanding of the spatial relationships in the pterygomandibular space, particularly the risk of injury to the highly vascularized pterygoid venous plexus (PVP). In vivo studies of PVP displacement during mandibular movements face [...] Read more.

The safety of mandibular anesthesia is directly dependent on a precise understanding of the spatial relationships in the pterygomandibular space, particularly the risk of injury to the highly vascularized pterygoid venous plexus (PVP). In vivo studies of PVP displacement during mandibular movements face significant technical challenges. Objective: The study aims to study the spatial displacements of the pterygoid venous plexus during various physiological positions of the mandible using computer modeling with the finite-element method (FEM). Materials and Methods: A three-dimensional finite-element model was developed based on computed tomography data and the BodyParts3D anatomical atlas. The model included the bony structures of the skull, mandible, temporomandibular joint, masticatory muscles, and blood vessels. Simulations were performed for vertical displacements of the jaw at 15, 25, and 35 mm, as well as horizontal displacements of 5 mm to the left and right. Results: It was found that the magnitude of PVP displacement is proportional to the degree of mouth opening. The maximum total displacement (1.24 mm) was recorded at a 35 mm opening along the “posterior–medial–inferior” vector. Lateral excursions revealed asymmetry: displacement to the right caused plexus movement posteriorly, medially, and inferiorly (0.66 mm), while displacement to the left resulted in movement anteriorly, laterally, and superiorly (0.64 mm). Conclusions: This study demonstrates the significant mobility of the pterygoid venous plexus, which depends on the direction and amplitude of mandibular movements. The obtained data have important practical implications for planning regional anesthesia and minimizing the risk of iatrogenic complications. From a biomechanical perspective, maximum mouth opening produces the greatest displacement of the PVP, which may hypothetically reduce the risk of vascular puncture. Clinical studies are required to confirm this. Full article

(This article belongs to the Special Issue Personalized Medicine and Technology in Oral Science)

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11 pages, 574 KB

Open AccessArticle

Contralateral Recurrence and Temporal Trend After First Side Surgery for Primary Spontaneous Pneumothorax: A Multicenter Analysis

by Antonio Giulio Napolitano, Dania Nachira, Gloria Santoro, Eleonora Coviello, Maria Teresa Congedo, Marco Sanguigni, Domenico Pourmolkara, Chiara Scognamiglio, Leonardo Petracca Ciavarella, Adriana Nocera, Maria Letizia Vita, Felice Mucilli, Jacopo Vannucci, Elisa Meacci, Francesco Puma, Filippo Lococo and Stefano Margaritora

J. Pers. Med. 2026, 16(5), 257; https://doi.org/10.3390/jpm16050257 - 9 May 2026

Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence [...] Read more.

Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence assessing the potential role of clinical factors in risk stratification. Methods: A total of 479 patients surgically treated for PSP (2012–2024) across three Italian high-volume centers were retrospectively reviewed. Secondary pneumothorax, patients <18 years old, lung emphysema or intraparenchymal large bullae, and the thoracotomy approach were excluded. The association between categorical variables and contralateral recurrence was assessed using the chi-square (χ²) test, while the association with continuous variables was evaluated using the t-test. Time to recurrence was analyzed using Kaplan–Meier survival curves. Variables with a p-value < 0.05 were considered statistically significant. Results: We identified 59 patients who experienced contralateral recurrence: 45 were males, the mean age was 26.66 ± 12.32 and the mean BMI was 22.00 ± 2.92; only 13 were active smokers. Age (p < 0.001) and smoking history (p = 0.029) were significantly associated with contralateral recurrence in univariate analysis, though these were not confirmed in multivariate analysis. Among the cohort of recurrence, 53 patients only had a recurrence on the contralateral side, with a median time to recurrence of 139 days. The incidence rate ratio (IRR) of recurrence for patients with a mean age of < 34 years was 1.23, which translates to a 23% increased risk. No significant impact of age (p = 0.25), sex (p = 0.67), or smoking (p = 0.59) on the time to recurrence on the other side was observed through Kaplan–Meier analysis. The peak incidence for the first episode of PNX surgically treated and contralateral recurrence was observed in October, November and January. Conclusions: This study highlights a 12% contralateral recurrence rate after PSP surgery. Younger age is associated with earlier contralateral recurrence. Seasonality may influence recurrence patterns. Further studies should explore underlying mechanisms and preventive strategies. Full article

(This article belongs to the Special Issue Minimally Invasive Thoracic Surgery: Risk Assessment and Personalized Perioperative Management)

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9 pages, 183 KB

Open AccessEditorial

Radiotherapy and Immunotherapy at a Crossroads: Mechanistic Foundations, Emerging Evidence, and a New Horizon for Precision Oncology

by Gianluca Ferini and Stefano Forte

J. Pers. Med. 2026, 16(5), 256; https://doi.org/10.3390/jpm16050256 - 8 May 2026

The trajectory of modern oncology is increasingly defined by the convergence of two therapeutic paradigms that were once considered only marginally related: radiotherapy and immunotherapy [...] Full article

(This article belongs to the Special Issue Cancer Immunotherapy: Current Advancements and Future Perspectives)

11 pages, 390 KB

Open AccessArticle

Chronic Obstructive Pulmonary Disease Hospitalization in Spain (2016–2023): Mortality Impact of Comorbidity, Sex-Based Disparities and the Impact of COVID-19

by Maria Sanchez-McNamara, Maria-Jose Fernandez-Cotarelo, Begoña Perez-de-Paz, Lydia Rodriguez-Romero, Esther Anton-Diaz, Paz Rodriguez-Bolado, Eva Griñan-Fernandez, Victor Moreno and Cesar Henriquez-Camacho

J. Pers. Med. 2026, 16(5), 255; https://doi.org/10.3390/jpm16050255 - 8 May 2026

Background: COPD remains a leading cause of hospitalization and mortality worldwide. This study aimed to analyze trends in COPD patients in Spain from 2016 to 2023, compare outcomes between patients with COPD as a primary versus secondary diagnosis, and identify factors associated with [...] Read more.

Background: COPD remains a leading cause of hospitalization and mortality worldwide. This study aimed to analyze trends in COPD patients in Spain from 2016 to 2023, compare outcomes between patients with COPD as a primary versus secondary diagnosis, and identify factors associated with in-hospital mortality. Methods: Retrospective observational study using the Spanish database CMBD. 711.799 patients were analyzed. Demographic characteristics, Charlson Comorbidity Index (CCI), complications, mortality, and hospitalization costs were also evaluated. Multivariate logistic regression was used to identify mortality risk factors. Results: The overall hospitalization rate was 20.02 per 1000 admissions. It decreased by 30% during 2020–2021 before rebounding to peak levels in 2023. The proportion of female patients increased from 19.9% (2016) to 26.4% (2023). Patients with COPD as a secondary diagnosis had higher mortality (13% vs. 5.4%, p < 0.001), greater comorbidity burden (mean CCI 3.5 vs. 2.8), and higher costs. While overall admissions dropped in 2020, mortality peaked at 11.7%, and the number of patients with extremely severe disease nearly doubled. Independent risk factors for mortality included sepsis, age ≥ 66 years, CCI ≥ 3, and COVID-19. Conclusions: Hospitalization involving COPD in Spain showed pandemic-related fluctuations with increasing clinical complexity and increasing female sex. The higher mortality and cost associated with secondary COPD diagnosis highlight the need for comprehensive risk stratification of comorbid conditions and multidisciplinary management of these patients. Early identification of sepsis and CCI scores is essential to improve clinical outcomes in the aging population. Full article

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

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17 pages, 831 KB

Open AccessReview

Coronary Microvascular Dysfunction and Lipid Molecules: Pathophysiological Mechanisms, Clinical Assessment, and Therapeutic Implications

by Abdelrahman Hafez, Juan M. Farina, Kamal Awad, Milagros Pereyra Pietri, Isabel G. Scalia, Hesham Sheashaa, Fatmaelzahraa E. Abdelfattah, Mahshad Razaghi, Sherif Ahmed, Ramzi Ibrahim, David Simper, Steven J. Lester, Balaji Tamarappoo, Chadi Ayoub and Reza Arsanjani

J. Pers. Med. 2026, 16(5), 254; https://doi.org/10.3390/jpm16050254 - 6 May 2026

Coronary microvascular dysfunction (CMD) has emerged as a crucial contributor to cardiovascular morbidity and mortality, particularly in patients with ischemia and non-obstructive coronary arteries (INOCA). The condition arises from a complex interplay of structural and functional abnormalities within the small coronary vessels, driven [...] Read more.

Coronary microvascular dysfunction (CMD) has emerged as a crucial contributor to cardiovascular morbidity and mortality, particularly in patients with ischemia and non-obstructive coronary arteries (INOCA). The condition arises from a complex interplay of structural and functional abnormalities within the small coronary vessels, driven by underlying molecular mechanisms including endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and chronic inflammation. Lipid metabolism plays a central role in this pathology, especially in the setting of elevated low-density lipoprotein cholesterol (LDL-C). Furthermore, the protective capacity of high-density lipoprotein (HDL) is increasingly understood to depend on its functionality rather than absolute levels, as it can become dysfunctional and pro-inflammatory in pathological states. Emerging evidence has identified lipoprotein(a) [Lp(a)] and triglyceride-rich lipoproteins as significant, independent contributors to microvascular injury. Comprehensive clinical assessment of microvascular dysfunction therefore requires integration of advanced lipid profiling, including apolipoprotein B (ApoB), [Lp(a)], and the triglyceride-glucose (TyG) index with invasive and non-invasive measures of coronary flow reserve to more precisely stratify risk. In this narrative review, we synthesize current observational, mechanistic, and early interventional data linking diverse lipid phenotypes to coronary microvascular dysfunction. We propose a concept of lipid-driven CMD endotypes, such as ApoB-/particle overload, dysfunctional HDL, Lp(a)-mediated risk, and metabolic/TyG-high states, and map these to a practical, mechanism-informed management framework. While intensive LDL-C lowering with high-intensity statins and combination therapy remains guideline-directed care for high-risk patients, evidence for dedicated microvascular benefit from newer lipid and cardiometabolic agents is still largely hypothesis-generating. A personalized approach that aligns lipid phenotyping, CMD endotyping, and existing guideline-based therapies may help refine risk assessment and inform future trials. Full article

(This article belongs to the Special Issue Review Special Issue: Recent Advances in Personalized Medicine)

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22 pages, 13642 KB

Open AccessArticle

Effects of Mechano-Sonic Vibration Therapy on Muscle Strength, Pain, and Joint Function in Elderly Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective, Case-Control Study

by Raoul Saggini, Domiziano Tarantino, Claudia Barbato, Raffaello Pellegrino, Francesco Pegreffi and Rosa Grazia Bellomo

J. Pers. Med. 2026, 16(5), 253; https://doi.org/10.3390/jpm16050253 - 6 May 2026

Background: Early recovery after total hip (THA) and total knee arthroplasty (TKA) is often limited by pain and impaired antigravity function. Mechano-acoustic vibration therapy (VT) may enhance neuromuscular activation and analgesia, but evidence in arthroplasty is scarce. Methods: A total of 380 patients [...] Read more.

Background: Early recovery after total hip (THA) and total knee arthroplasty (TKA) is often limited by pain and impaired antigravity function. Mechano-acoustic vibration therapy (VT) may enhance neuromuscular activation and analgesia, but evidence in arthroplasty is scarce. Methods: A total of 380 patients aged ≥65 years were retrospectively identified within 3 ± 1 days after primary unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA). All patients underwent standard inpatient physiotherapy; in the VT group, mechano-acoustic vibration therapy (ViSS^®, 30 min/day for 5 days at 200–300 Hz) was added as an adjunct treatment, whereas the control group received standard physiotherapy alone. Pain (VAS, McGill), muscle strength (MRC), thigh circumferences, and 10 s Sit-to-Stand were assessed at baseline (T0), end of treatment (T1), and 3-day follow-up (T2). Results: VT produced large, early and sustained improvements in both cohorts. In THA patients, VAS decreased from 7.1 ± 1.1 to 3.8 ± 0.6 at T1 and 3.0 ± 0.7 at T2 and Sit-to-Stand repetitions increased from 3.7 ± 1.9 to 6.3 ± 1.7 at T2, with significant gains in strength and circumferences. TKA VT patients showed similar patterns. Control groups reported smaller pain reductions and no clinically relevant changes in the reported outcomes. Conclusions: integrating a short cycle of mechano-acoustic VT into early inpatient rehabilitation after THA or TKA significantly enhances pain relief and restoration of antigravity function compared with standard physiotherapy alone. VT represents a promising adjunct to conventional rehabilitation strategies and may contribute to optimizing postoperative recovery pathways in major joint replacement. Full article

(This article belongs to the Special Issue Precision Orthopedics: Evolving Shoulder, Hip, and Knee Surgery Through Intelligent Technology and Personalized Clinical Care)

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14 pages, 323 KB

Open AccessArticle

Central Sensitization in Spondyloarthritis: Implications for Personalized Medicine

by Linda Carli, Federico Fattorini, Marco Di Battista, Lorenzo Esti, Cosimo Cigolini, Marta Mosca and Andrea Delle Sedie

J. Pers. Med. 2026, 16(5), 252; https://doi.org/10.3390/jpm16050252 - 5 May 2026

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with [...] Read more.

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with a high likelihood of CS. Objectives: To investigate the prevalence of CS in our cohort and its association with clinical characteristics of patients and their quality of life. Methods: Adult patients with a diagnosis of Psoriatic Arthritis (PsA) or Axial Spondyloarthritis (AxSpA) who were also classifiable according to ClASsification criteria for Psoriatic Arthritis (CASPAR) and Assessment of SpondyloArthritis international Society (ASAS) criteria respectively, and regularly followed at the SpA outpatient clinic of our Unit were consecutively enrolled from April to November 2023. Their epidemiologic, clinical and clinimetric data were collected, as well as patient-reported outcome measures (PROMs) [CSI, Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), and Hospital Anxiety and Depression Scale (HADS)]. Considering the definition of “difficult-to-treat” rheumatoid arthritis, we defined as “multi-failure” those patients who were treated with more than two biologic disease-modifying anti-rheumatic drugs (bDMARDs) with different mechanisms of action. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. p-values < 0.05 were considered significant. Results: A total of 100 patients were enrolled, 46 male (46.0%) and 54 female (54.0%), with a mean age of 59.4 ± 9.8 years and a mean disease duration of 14.8 ± 10.1 years; 79 patients (79%) had a diagnosis of PsA and 21 (21%) of AS. Forty-two patients (42.0%) had a CSI score ≥ 40. Significant correlations were found between a CSI score ≥ 40 and female sex (p = 0.004), the occurrence of enthesitis (p = 0.05), DAPSA-CRP (p = 0.02) and ASDAS scores (p = 0.03), a multi-failure condition (p = 0.01), fibromyalgia (FM) (p = 0.004), thyroid disease (p = 0.016) and obesity (p = 0.047). Regarding PROMs, significant correlations were found between CSI and values of HADS (both anxiety and depression), FACIT-F, HAQ and all the domains of SF-36 (p-value < 0.0001). Conclusions: Our data confirmed that more than 40% of SpA patients had CSI values ≥ 40 and underlined how CS could widely impair their disease burden. A routinary evaluation of CS and a multifactorial biopsychosocial perspective in the diagnosis and management of chronic pain in patients with SpA could help rheumatologists in improving their quality of care. Full article

(This article belongs to the Section Personalized Preventive Medicine)

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16 pages, 1949 KB

Open AccessArticle

Postoperative Septic Shock After Esophagectomy for Esophageal Cancer: Risk Factors and Impact on Short- and Long-Term Survival

by Patricia Piñeiro, Francisco Sánchez, Alberto Calvo, María Tudela, Silvia Ramos, Sergio García, Pilar Benito, Isabel Solchaga, Raquel Vela, Claudia Menéndez, Eneko Cabezuelo and Ignacio Garutti

J. Pers. Med. 2026, 16(5), 251; https://doi.org/10.3390/jpm16050251 - 4 May 2026

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted [...] Read more.

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted a retrospective observational study including consecutive adult patients who underwent esophagectomy with curative intent for esophageal cancer between January 2015 and December 2024 at a tertiary referral center. Postoperative septic shock was defined according to Sepsis-3 criteria. Demographic, clinical, surgical, laboratory, and oncological variables were analyzed. Independent risk factors for septic shock were identified using multivariate logistic regression. Overall survival was assessed using Kaplan–Meier analysis. Results: Among 106 patients, 19 (17.9%) developed postoperative septic shock. These patients had a lower body mass index, reduced preoperative and postoperative albumin levels, and a higher incidence of advanced lymph node involvement. Septic shock was strongly associated with severe postoperative complications, including anastomotic leakage, hemorrhagic shock, acute respiratory distress syndrome, acute kidney failure, and increased rates of PICU readmission. In multivariate analysis, lower albumin levels at PICU admission (OR 0.54; 95% CI 0.29–0.99) and advanced nodal stage (OR 4.98; 95% CI 1.36–18.3) were independently associated with the development of septic shock. Patients who developed septic shock had significantly higher in-hospital mortality (31.6% vs. 1.1%, p < 0.001) and markedly reduced long-term survival, even among those discharged alive. Conclusions: Postoperative septic shock after esophagectomy is a devastating complication with a profound negative impact on both short- and long-term survival. Hypoalbuminemia and advanced lymph node involvement are independent predictors of septic shock. These findings support the integration of simple clinical and laboratory markers into personalized perioperative risk stratification models, enabling individualized management strategies to reduce severe postoperative complications. Full article

(This article belongs to the Section Personalized Medical Care)

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4 pages, 157 KB

Open AccessEditorial

Personalized Approaches to Spine Surgery: Innovations and Future Directions

by Kai-Uwe Lewandrowski

J. Pers. Med. 2026, 16(5), 249; https://doi.org/10.3390/jpm16050249 - 4 May 2026

Personalized spine care is increasingly understood as more than the use of custom implants, robotics, navigation, or advanced imaging alone [...] Full article

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

14 pages, 1005 KB

Open AccessArticle

Comparison of Three International Definitions for Overweight and Obesity in a Population of Adolescents in Greece

by Eleni M. Domouzoglou, Evangelia E. Ntzani, Michail I. Papafaklis, Anastasios Serbis, Ekaterini Siomou, Flora Bacopoulou and Assimina Galli-Tsinopoulou

J. Pers. Med. 2026, 16(5), 250; https://doi.org/10.3390/jpm16050250 - 3 May 2026

Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF [...] Read more.

Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF and CDC) for overweight/obesity in adolescents in Northwestern Greece. Methods: A total of 403 adolescents aged 10–17 years were included. Agreement metrics and assessment of marginal heterogeneity and asymmetry were used for the comparison of the definitions. Results: In the total population, high agreement was observed among all definitions (Krippendorff’s alpha: 0.931, 95% CI 0.913–0.949). However, there was significant marginal heterogeneity (p < 0.001) and asymmetry (p < 0.001) for each pairwise comparison. WHO definition consistently yielded higher prevalence of obesity (WHO: 23.1%, IOTF: 15.4%, CDC: 21.6%). There were no significant differences in agreement (p = 0.247 for the comparison) between males and females, with more prominent marginal heterogeneity and asymmetry in males. Agreement among definitions was numerically lower in young adolescents aged < 14 years versus older ones (alpha: 0.919 vs. 0.953, p = 0.082), and systematic bias (p < 0.001) and asymmetry (p < 0.001) were present only in young adolescents without any significant difference in older ones. Conclusions: Although agreement was very high among definitions, they are not interchangeable, yielding different prevalence rates, particularly in young adolescents. IOTF criteria resulted in a reduced diagnosis of obesity and could lead to undertreatment; in contrast, WHO and CDC criteria may lead to overdiagnosis in our population. Caution is required when interpreting international criteria for overweight/obesity in various populations. Full article

(This article belongs to the Special Issue Personalized Medicine of Obesity and Metabolic Disorders)

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11 pages, 1069 KB

Open AccessCase Report

Promises and Pitfalls of Whole Exome Sequencing in Therapy-Resistant Chronic Thrombocytopenia in Childhood: A Case Report

by Eszter Györke, Gábor Benyó, Kristóf Balázs Árvai, Csaba Bödör, László Kereskai, Hajnalka Ábrahám, Barbara Réger, Bálint Egyed and Gábor Ottóffy

J. Pers. Med. 2026, 16(5), 248; https://doi.org/10.3390/jpm16050248 - 2 May 2026

Background: The etiological diagnosis of chronic thrombocytopenia in children remains challenging and is often established by exclusion. In this article, we present the case of a patient in whom we used whole-exome sequencing (WES) to help identify the underlying cause and determine the [...] Read more.

Background: The etiological diagnosis of chronic thrombocytopenia in children remains challenging and is often established by exclusion. In this article, we present the case of a patient in whom we used whole-exome sequencing (WES) to help identify the underlying cause and determine the appropriate treatment. Methods: Whole-exome sequencing was performed to clarify the genetic background of the disease. Based on the results, transmission electron microscopy (TEM) was also carried out to confirm or exclude the pathogenic role of the identified NBEAL2 gene variant and to assess the presence of gray platelet syndrome. Results: In this patient, despite the presence of the NBEAL2 gene variant, neither gray platelet syndrome nor a pathogenic role of the variant could be confirmed. However, the genetic findings identified by WES led to numerous additional investigations, causing a considerable burden on both the patient and the family. Conclusions: Our case highlights that WES testing, which is emerging in pediatric hematology practice, offers not only diagnostic advantages but also pitfalls. Whole-exome sequencing has recently emerged as a new diagnostic tool and has been available nationwide in pediatric hematology-oncology care in Hungary for just over two years. While personalized treatment strategies for benign hematologic diseases increasingly rely on high-throughput genetic testing, the clinical application of WES requires a cautious, critical evaluation of results. Despite the method’s promise, the heterogeneity of the findings underscores the need to interpret WES results carefully and to place them in a clinical context in every case. Full article

(This article belongs to the Special Issue Genetic Counseling and Genome Sequencing in Pediatrics)

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6 pages, 178 KB

Open AccessEditorial

Personalized Medicine in Otolaryngology: Reflections on a Multidisciplinary Special Issue

by Mehdi Abouzari

J. Pers. Med. 2026, 16(5), 247; https://doi.org/10.3390/jpm16050247 - 1 May 2026

The practice of medicine has long aspired to treat the individual rather than the disease, yet it has only been in recent decades that the scientific and technological tools required to fulfill this aspiration have begun to mature [...] Full article

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

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