Journal of Personalized Medicine

13 pages, 717 KiB

Open AccessSystematic Review

Spontaneous Coronary Artery Dissection in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review of the Literature

by Stefan Milutinovic, Abraham Bell, Predrag Jancic, Dragana Stanojevic, Abdul Hamid Borghol, Jonathan Mina, Fouad T. Chebib, Ibrahim Khambati, Ricardo O. Escarcega and Malissa J. Wood

J. Pers. Med. 2024, 14(7), 702; https://doi.org/10.3390/jpm14070702 (registering DOI) - 29 Jun 2024

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Abstract

Spontaneous coronary artery dissection (SCAD) is a spontaneous intimal tear of the coronary artery wall. A factor rarely associated with SCAD is autosomal dominant polycystic kidney disease (ADPKD). Using the PRISMA guidelines, we identified 10 unique cases of SCAD in ADPKD patients reported [...] Read more.

Spontaneous coronary artery dissection (SCAD) is a spontaneous intimal tear of the coronary artery wall. A factor rarely associated with SCAD is autosomal dominant polycystic kidney disease (ADPKD). Using the PRISMA guidelines, we identified 10 unique cases of SCAD in ADPKD patients reported between 1998 and 2021. Ages ranged from 36 to 59 years, with an average of 44.6 years. The majority of patients were female (80%). Each case was diagnosed with a cardiovascular event: ST-elevation myocardial infarction (STEMI) in 40%, non-ST elevation myocardial infarction (NSTEMI) in 50%, and stable angina in 10%. Conservative management was used in 60% of cases. There is a significant gap in our understanding of the relationship between SCAD and ADPKD. Polycystin complex can lead to structural abnormalities in blood vessels, resulting in vascular leaks and vessel rupture. This suggests that ADPKD patients may have an elevated risk of arteriopathies, including coronary artery dissection. Full article

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

14 pages, 3271 KiB

Open AccessArticle

In Vitro Investigation of Pulsed Electromagnetic Field Stimulation (PEMF) with MAGCELL^® ARTHRO on the Regulatory Expression of Soluble and Membrane-Bound Complement Factors and Inflammatory Cytokines in Immortalized Synovial Fibroblasts

by Sandeep Silawal, Markus Gesslein, Maximilian Willauschus and Gundula Schulze-Tanzil

J. Pers. Med. 2024, 14(7), 701; https://doi.org/10.3390/jpm14070701 (registering DOI) - 29 Jun 2024

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Abstract

Pulsed electromagnetic field stimulation (PEMF) is gaining more attention as a non-invasive arthritis treatment. In our study, immortalized synovial fibroblasts (K4IM) derived from a non-arthritic donor were exposed to MAGCELL^® ARTHRO, a PEMF device, with 105 mT intensity, 8 Hz frequency, and [...] Read more.

Pulsed electromagnetic field stimulation (PEMF) is gaining more attention as a non-invasive arthritis treatment. In our study, immortalized synovial fibroblasts (K4IM) derived from a non-arthritic donor were exposed to MAGCELL^® ARTHRO, a PEMF device, with 105 mT intensity, 8 Hz frequency, and 2 × 2.5 min sessions conducted thrice with a 1 h interval, to understand the underlying mechanism in regard to the complement system. Additionally, tumor necrosis factor (TNFα, 10 ng/mL) pre-treatment prior to PEMF stimulation, as well as 3-day versus 6-day stimulation, were compared. Gene expression of C4b binding protein-alpha and -beta (C4BPα, C4BPβ), complement factor (CF)-H, CFI, CD55, CD59, Interleukin (IL-6) and TNFα was analyzed. Immunofluorescence staining of CD55, CD59, and Ki67 was conducted. Results showed the absence of C4BPα gene expression, but C4BPβ was present. One and three days of PEMF stimulation caused no significant changes. However, after six days, there was a significant increase in CD55, CFH, and CD59 gene expression, indicating cytoprotective effects. Conversely, IL-6 gene expression increased after six days of stimulation and even after a single session in TNFα pre-stimulated cells, indicating a pro-inflammatory effect. PEMF’s ambivalent, i.e., enhancing complement regulatory proteins and pro-inflammatory cytokines, highlights its complexity at the molecular level. Full article

(This article belongs to the Special Issue Personalized Management in Orthopedics and Traumatology)

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14 pages, 463 KiB

Open AccessSystematic Review

The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review

by Xuan Liu, Yun-Chen Chang and Wen-Yu Hu

J. Pers. Med. 2024, 14(7), 700; https://doi.org/10.3390/jpm14070700 - 28 Jun 2024

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Abstract

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically [...] Read more.

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: ‘care home’, ‘nursing home’, ‘residential aged care facility’, and ‘long-term care facility’ for patients; and ‘Gold Standard Framework in Care Homes’, ‘integrated care pathway’, ‘care home project’, and ‘palliative care program’ for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities. Full article

(This article belongs to the Section Personalized Critical Care)

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23 pages, 32497 KiB

Open AccessArticle

A Microscopy Evaluation of Emergence Profile Surfaces of Dental Custom CAD-CAM Implant Abutments and Dental Implant Stock Abutments

by Daniel Adrian Târtea, Horia Octavian Manolea, Mihaela Ionescu, Oana Gîngu, Marina Olimpia Amărăscu, Adrian Marcel Popescu, Veronica Mercuţ and Sanda Mihaela Popescu

J. Pers. Med. 2024, 14(7), 699; https://doi.org/10.3390/jpm14070699 - 28 Jun 2024

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Abstract

Recently, due to the high demand for dental implants, the use of dental implant stock abutments has increased significantly, especially dental custom CAD/CAM implant abutments milled by dental technicians in their laboratories. The purpose of this study is to analyze the surface quality [...] Read more.

Recently, due to the high demand for dental implants, the use of dental implant stock abutments has increased significantly, especially dental custom CAD/CAM implant abutments milled by dental technicians in their laboratories. The purpose of this study is to analyze the surface quality of the emergence profile of dental custom CAD/CAM implant abutments made by a non-industrial milling machine, compared to original and compatible dental implant stock abutments made by industrial machines. Thirty dental implant abutments were divided into six study lots. Lot 1 (control group): original dental implant stock abutments—industrial machined; lot 2 (study group): compatible dental implant stock abutments—industrial machined; lots 3, 4, 5, and 6 (study groups): compatible custom CAD/CAM dental implant abutments—non-industrial milled with hyperDENT CAM software and Paragon Tools. The Nikon SMZ745T stereomicroscope was used to analyze the emergence profile surface of each dental implant abutment. The structure of the analyzed surfaces did not show significant differences between original and compatible abutments that were industrially machined. As for the customized dental implant abutments, the greatest similarity with the original was obtained for lot 6, and a significant statistical difference was obtained for lot 4. Stepover and Feed Rate parameters of the milling process influenced the surface roughness of the emergence profile for the customized dental implant abutments. The digital technology of non-industrial milling compatible custom CAD/CAM dental implant abutments is reliable and within the correct milling parameters. Full article

(This article belongs to the Special Issue Novel Challenges and Personalized Treatment in Oral Medicine)

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26 pages, 435 KiB

Open AccessFeature PaperReview

Diagnosis, Prevention, and Management of Fetal Growth Restriction (FGR)

by Panagiotis Tsikouras, Panos Antsaklis, Konstantinos Nikolettos, Sonia Kotanidou, Nektaria Kritsotaki, Anastasia Bothou, Sotiris Andreou, Theopi Nalmpanti, Kyriaki Chalkia, Vlasis Spanakis, George Iatrakis and Nikolaos Nikolettos

J. Pers. Med. 2024, 14(7), 698; https://doi.org/10.3390/jpm14070698 - 28 Jun 2024

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Abstract

Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is still the second most common cause of perinatal mortality. The factors that contribute to fetal growth restriction can be categorized into three distinct groups: placental, fetal, and maternal. The prenatal application of various [...] Read more.

Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is still the second most common cause of perinatal mortality. The factors that contribute to fetal growth restriction can be categorized into three distinct groups: placental, fetal, and maternal. The prenatal application of various diagnostic methods can, in many cases, detect the deterioration of the fetal condition in time because the nature of the above disorder is thoroughly investigated by applying a combination of biophysical and biochemical methods, which determine the state of the embryo–placenta unit and assess the possible increased risk of perinatal failure outcome and potential for many later health problems. When considering the potential for therapeutic intervention, the key question is whether it can be utilized during pregnancy. Currently, there are no known treatment interventions that effectively enhance placental function and promote fetal weight development. Nevertheless, in cases with fetuses diagnosed with fetal growth restriction, immediate termination of pregnancy may have advantages not only in terms of minimizing perinatal mortality but primarily in terms of reducing long-term morbidity during childhood and maturity. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology and Women's Health—2nd Edition)

15 pages, 1166 KiB

Open AccessArticle

Effects of Electro-Muscle Stimulation Exercise Combined with Mat Pilates on Pain, Anxiety, and Strength in Sedentary Females with Fibromyalgia: A Single-Blind Randomized Controlled Trial

by İsmail Eseoğlu, Ali Kerim Yılmaz, Berna Anıl, Esra Korkmaz, Enes Akdemir, Coşkun Yılmaz, Lokman Kehribar, Nur Gökçe Aydın, Egemen Ermiş, Burak Yoldaş and Osman İmamoğlu

J. Pers. Med. 2024, 14(7), 697; https://doi.org/10.3390/jpm14070697 - 28 Jun 2024

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Abstract

Background and Objectives: Fibromyalgia syndrome (FM) is a chronic pain disorder that is ranked as one of the four most common rheumatological diseases in the world. This study aims to investigate the effects of an eight-week mat Pilates and electro-muscle stimulation (EMS) with [...] Read more.

Background and Objectives: Fibromyalgia syndrome (FM) is a chronic pain disorder that is ranked as one of the four most common rheumatological diseases in the world. This study aims to investigate the effects of an eight-week mat Pilates and electro-muscle stimulation (EMS) with combined mat Pilates exercises on pain, depression, anxiety, and strength in sedentary women. Methods: This study is a single-blind randomized controlled trial. A total of 30 sedentary female patients (Pilates (n = 15), EMS (n = 15)) diagnosed with FM were included in the study. The patients were subjected to Beck Depression (BDIs) and Anxiety Inventories (BAIs); a Fibromyalgia Impact Questionnaire (FIQ); five different Single-Leg Hop Tests (SLHTs); modified push-up (MPU), Handgrip Strength (HGS), Deep Squat (DSQ), V-Sit Flexor, bent-arm hang (BA), sit-up and Biering-Sørensen tests; and anthropometric tests before and after the 8-week exercise program. Results: The eight weeks of mat Pilates exercises combined with mat Pilates and EMS revealed significant results (p < 0.05) in anthropometric data (abdomen, lower abdomen, hips) (p < 0.05) except for the results of chest circumference measurements (p > 0.05). In addition, there were statistically significant positive results in BDIs, BAIs, FIQs, lower extremity (all SLHTs and DSQ), upper extremity (MPU, HGS, BA), and core (V-SIT, sit-up, Biering-Sørensen test) strength test findings (p < 0.05). Conclusions: Combining the mat Pilates exercises with EMS is an effective and reliable method to improve the pain, anxiety, depression, and strength of female patients diagnosed with FM. Full article

(This article belongs to the Section Epidemiology)

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7 pages, 221 KiB

Open AccessBrief Report

Retinal Perfusion Analysis of Children with Diabetes Mellitus Type 1 Using Optical Coherence Tomography Angiography

by Jelena Vasilijevic, Igor Kovacevic, Snezana Polovina, Bojana Dacic-Krnjaja, Tanja Kalezic, Suzana Miletic, Leila Al Barri, Simona Stanca, Francis Ferrari and Maja Jesic

J. Pers. Med. 2024, 14(7), 696; https://doi.org/10.3390/jpm14070696 - 28 Jun 2024

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Abstract

(1) Background: This study aims to evaluate retinal perfusion by optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1D) without diabetic retinopathy (DR). (2) Methods: Thirty-one patients affected by T1D were enrolled. All participants were evaluated using OCTA. [...] Read more.

(1) Background: This study aims to evaluate retinal perfusion by optical coherence tomography angiography (OCTA) in pediatric patients with type 1 diabetes mellitus (T1D) without diabetic retinopathy (DR). (2) Methods: Thirty-one patients affected by T1D were enrolled. All participants were evaluated using OCTA. The foveal avascular zone (FAZ) and superficial and deep macular vessel density (VD) were analyzed. The correlation of these parameters with metabolic factors such as body mass index (BMI), glycated hemoglobin (HbA1c), and the type of insulin therapy (multiple daily injections, MDI vs. continuous subcutaneous insulin infusion, CSII) was determined. (3) Results: None of the OCTA parameters were significantly different between the groups. The patients’ HbA1C level did not influence any of the OCTA parameters. The use of MDI tended to reduce the parafoveal and perifoveal deep VD (p = 0.048 and p = 0.021, respectively) compared to CSII. An elevated BMI tended to increase the deep macular (p = 0.005) and perifoveal VD (p = 0.006). (4) Conclusion: VD and FAZ are normal in pubescent children with T1D without signs of DR. Treatment with CSII may be a better choice compared to MDI, as CSII may be protective against retinal microvascular damage. Our results indicate the need for new clinical parameters of glycemic control in addition to HbA1c which could assess the risk of DR. Full article

(This article belongs to the Special Issue Retinal Diseases: Mechanisms, Diagnosis and Treatments)

18 pages, 2222 KiB

Open AccessReview

Ocular Manifestations and Complications of Patent Foramen Ovale: A Narrative Review

by Filippo Lixi, Luca Fazzini, Claudia Cannas, Roberta Montisci and Giuseppe Giannaccare

J. Pers. Med. 2024, 14(7), 695; https://doi.org/10.3390/jpm14070695 - 27 Jun 2024

Viewed by 193

Abstract

Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly associated with a persistent opening between the atrial septum, allowing communication between the left and right atria. Despite often being asymptomatic, PFO can lead to various clinical presentations, including cryptogenic stroke and other [...] Read more.

Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly associated with a persistent opening between the atrial septum, allowing communication between the left and right atria. Despite often being asymptomatic, PFO can lead to various clinical presentations, including cryptogenic stroke and other embolic events. Transient visual disturbances, alterations in the visual field, migraine with aura, impaired eye movement and endogenous eye infections may prompt patients to seek ophthalmological consultation. Understanding these diverse clinical scenarios is crucial for early detection, appropriate management and mitigating the morbidity burden associated with PFO. This narrative review aims at examining the spectrum of clinical presentations of ocular pictures associated with PFO. The pathophysiology, diagnosis and treatment methods for PFO will be described, emphasizing the importance of a multidisciplinary approach involving ophthalmologists, cardiologists, neurologists and imaging specialists. In the future, prospective studies and clinical trials are warranted to provide further insights into the preventive role and optimal therapeutic strategies for managing PFO-related ocular complications, ultimately guiding clinical decision making and optimizing patient care. Full article

(This article belongs to the Special Issue New Advances and Perspectives in Ophthalmology: Progress and Modern Challenges)

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13 pages, 2441 KiB

Open AccessArticle

An Innovative Multi-Omics Model Integrating Latent Alignment and Attention Mechanism for Drug Response Prediction

by Hui-O Chen, Yuan-Chi Cui, Peng-Chan Lin and Jung-Hsien Chiang

J. Pers. Med. 2024, 14(7), 694; https://doi.org/10.3390/jpm14070694 - 27 Jun 2024

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Abstract

By using omics, we can now examine all components of biological systems simultaneously. Deep learning-based drug prediction methods have shown promise by integrating cancer-related multi-omics data. However, the complex interaction between genes poses challenges in accurately projecting multi-omics data. In this research, we [...] Read more.

By using omics, we can now examine all components of biological systems simultaneously. Deep learning-based drug prediction methods have shown promise by integrating cancer-related multi-omics data. However, the complex interaction between genes poses challenges in accurately projecting multi-omics data. In this research, we present a predictive model for drug response that incorporates diverse types of omics data, comprising genetic mutation, copy number variation, methylation, and gene expression data. This study proposes latent alignment for information mismatch in integration, which is achieved through an attention module capturing interactions among diverse types of omics data. The latent alignment and attention modules significantly improve predictions, outperforming the baseline model, with MSE = 1.1333, F1-score = 0.5342, and AUROC = 0.5776. High accuracy was achieved in predicting drug responses for piplartine and tenovin-6, while the accuracy was comparatively lower for mitomycin-C and obatoclax. The latent alignment module exclusively outperforms the baseline model, enhancing the MSE by 0.2375, the F1-score by 4.84%, and the AUROC by 6.1%. Similarly, the attention module only improves these metrics by 0.1899, 2.88%, and 2.84%, respectively. In the interpretability case study, panobinostat exhibited the most effective predicted response, with a value of −4.895. We provide reliable insights for drug selection in personalized medicine by identifying crucial genetic factors influencing drug response. Full article

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

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18 pages, 602 KiB

Open AccessReview

Revolutionizing Pathology with Artificial Intelligence: Innovations in Immunohistochemistry

by Diana Gina Poalelungi, Anca Iulia Neagu, Ana Fulga, Marius Neagu, Dana Tutunaru, Aurel Nechita and Iuliu Fulga

J. Pers. Med. 2024, 14(7), 693; https://doi.org/10.3390/jpm14070693 - 27 Jun 2024

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Abstract

Artificial intelligence (AI) is a reality of our times, and it has been successfully implemented in all fields, including medicine. As a relatively new domain, all efforts are directed towards creating algorithms applicable in most medical specialties. Pathology, as one of the most [...] Read more.

Artificial intelligence (AI) is a reality of our times, and it has been successfully implemented in all fields, including medicine. As a relatively new domain, all efforts are directed towards creating algorithms applicable in most medical specialties. Pathology, as one of the most important areas of interest for precision medicine, has received significant attention in the development and implementation of AI algorithms. This focus is especially important for achieving accurate diagnoses. Moreover, immunohistochemistry (IHC) serves as a complementary diagnostic tool in pathology. It can be further augmented through the application of deep learning (DL) and machine learning (ML) algorithms for assessing and analyzing immunohistochemical markers. Such advancements can aid in delineating targeted therapeutic approaches and prognostic stratification. This article explores the applications and integration of various AI software programs and platforms used in immunohistochemical analysis. It concludes by highlighting the application of these technologies to pathologies such as breast, prostate, lung, melanocytic proliferations, and hematologic conditions. Additionally, it underscores the necessity for further innovative diagnostic algorithms to assist physicians in the diagnostic process. Full article

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

12 pages, 1002 KiB

Open AccessArticle

Real-World Study of Serum Neurofilament Light Chain Levels in Ocrelizumab-Treated People with Relapsing Multiple Sclerosis

by Francisco J. Barrero Hernández, Ana Romero Villarrubia, Carmen Muñoz Fernández, Virginia Guillén Martinez, Almudena Aguilera Del Moral, José María Barrios-López, Maria A. Ramírez Rivas, Antonio J. Gálvez Muñoz and Raquel Piñar Morales

J. Pers. Med. 2024, 14(7), 692; https://doi.org/10.3390/jpm14070692 - 27 Jun 2024

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Abstract

Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective in [...] Read more.

Serum neurofilament light chain (sNfL) levels have been proposed as a biomarker of the clinical activity, disability progression, and response to treatment of people with multiple sclerosis (PwMS); however, questions remain about its implementation in clinical practice. Ocrelizumab (OCR) has proven effective in improving clinical and radiological outcomes and reducing sNfL levels. This real-life study followed the sNfL levels of 30 PwMS treated for 12 months with OCR and evaluated the usefulness of this biomarker for their short-term prognosis, considering expanded disability status scale (EDSS), annualized relapse rate (ARR), radiological activity, and NEDA-3 values. OCR reduced ARR in 83% of PwMS and radiological activity in 80%. EDSS was maintained, while NEDA-3 was achieved in 70% at 12 months. OCR produced an early reduction in sNfL levels (at 3 months). At baseline, greater MRI-evaluated radiological activity was associated with higher sNfL levels. sNfL levels over the first 12 months of treatment did not predict a suboptimal response or sustained control of the disease. Longer-term studies are needed to explore the predictive usefulness of sNfL levels in PwMS treated with high-efficacy drugs. Full article

(This article belongs to the Section Disease Biomarker)

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11 pages, 1183 KiB

Open AccessArticle

Cerebral Oxygen Saturation Associates with Changes in Oxygen Transport Parameters during Cardiopulmonary Bypass

by Christoph Eisner, Heimo Adam, Markus A. Weigand and Aleksandar R. Zivkovic

J. Pers. Med. 2024, 14(7), 691; https://doi.org/10.3390/jpm14070691 - 27 Jun 2024

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Abstract

(1) Background: Adequate organ perfusion during cardiopulmonary bypass (CPB) requires accurate estimation and adjustment of flow rates which conventional methods may not always achieve. Perioperative monitoring of cerebral oxygen saturation (ScO₂) may detect changes in oxygen transport. This study aims to [...] Read more.

(1) Background: Adequate organ perfusion during cardiopulmonary bypass (CPB) requires accurate estimation and adjustment of flow rates which conventional methods may not always achieve. Perioperative monitoring of cerebral oxygen saturation (ScO₂) may detect changes in oxygen transport. This study aims to compare estimated and measured perfusion flow rates and assess the capacity of ScO₂ to detect subtle changes in oxygen transport during CPB. (2) Methods: This observational study included 50 patients scheduled for elective coronary artery bypass grafting (CABG) surgery, all of whom provided written informed consent. Perfusion flow rates were estimated using the DuBois formula and measured using echocardiography and a flow probe in the arterial line of the CPB system. ScO₂ was continuously monitored, alongside intermittent measurements of oxygen delivery and extraction ratios. (3) Results: Significant discrepancies were found between estimated flow rates (5.2 [4.8–5.5] L/min) and those measured at the start of the surgery (4.6 [4.0–5.0] L/min). These discrepancies were flow rate-dependent, being more pronounced at lower perfusion rates and diminishing as rates increased. Furthermore, ScO₂ showed a consistent correlation with both oxygen delivery (r = 0.48) and oxygen extraction ratio (r = 0.45). (4) Conclusions: This study highlights discrepancies between estimated and actual perfusion flow rates during CPB and underscores the value of ScO₂ monitoring as a continuous, noninvasive tool for maintaining adequate organ perfusion, suggesting a need for improved, patient-tailored perfusion strategies. Full article

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

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22 pages, 413 KiB

Open AccessReview

Novel Approaches for Early Detection of Retinal Diseases Using Artificial Intelligence

by Francesco Saverio Sorrentino, Lorenzo Gardini, Luigi Fontana, Mutali Musa, Andrea Gabai, Antonino Maniaci, Salvatore Lavalle, Fabiana D’Esposito, Andrea Russo, Antonio Longo, Pier Luigi Surico, Caterina Gagliano and Marco Zeppieri

J. Pers. Med. 2024, 14(7), 690; https://doi.org/10.3390/jpm14070690 - 26 Jun 2024

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Abstract

Background: An increasing amount of people are globally affected by retinal diseases, such as diabetes, vascular occlusions, maculopathy, alterations of systemic circulation, and metabolic syndrome. Aim: This review will discuss novel technologies in and potential approaches to the detection and diagnosis of retinal [...] Read more.

Background: An increasing amount of people are globally affected by retinal diseases, such as diabetes, vascular occlusions, maculopathy, alterations of systemic circulation, and metabolic syndrome. Aim: This review will discuss novel technologies in and potential approaches to the detection and diagnosis of retinal diseases with the support of cutting-edge machines and artificial intelligence (AI). Methods: The demand for retinal diagnostic imaging exams has increased, but the number of eye physicians or technicians is too little to meet the request. Thus, algorithms based on AI have been used, representing valid support for early detection and helping doctors to give diagnoses and make differential diagnosis. AI helps patients living far from hub centers to have tests and quick initial diagnosis, allowing them not to waste time in movements and waiting time for medical reply. Results: Highly automated systems for screening, early diagnosis, grading and tailored therapy will facilitate the care of people, even in remote lands or countries. Conclusion: A potential massive and extensive use of AI might optimize the automated detection of tiny retinal alterations, allowing eye doctors to perform their best clinical assistance and to set the best options for the treatment of retinal diseases. Full article

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

14 pages, 504 KiB

Open AccessArticle

Trajectory of Change in the Severity of Symptoms in Patients with Fibromyalgia over 24 Months: Exploratory Analyses of a Combination Pharmacological Intervention

by Fausto Salaffi, Maria Giovanna Lommano, Benedetta Bianchi, Sonia Farah, Francesca Bandinelli, Piercarlo Sarzi-Puttini and Marco Di Carlo

J. Pers. Med. 2024, 14(7), 689; https://doi.org/10.3390/jpm14070689 - 26 Jun 2024

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Abstract

Symptoms of fibromyalgia (FM) fluctuate and vary in severity. The current study aimed to evaluate the efficacy of palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) in FM patients over a 24-month period and to investigate the mediating function of pain catastrophizing subdomains in unfavorable relationships [...] Read more.

Symptoms of fibromyalgia (FM) fluctuate and vary in severity. The current study aimed to evaluate the efficacy of palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) in FM patients over a 24-month period and to investigate the mediating function of pain catastrophizing subdomains in unfavorable relationships with disease severity levels in patients with FM. Patients were evaluated at baseline, after 12 months, and after 24 months, using different patient-reported measures (FIQR, FASmod, PSD, and PCS) to distinguish different levels of FM disease severity. A reduction of 30% or more from baseline was considered clinically important (“markedly improved”). A multivariate analysis was performed to identify the variables predictive of an FIQR reduction. Twenty-two patients (28.6%) were classified as “markedly improved,” 16 patients (20.8%) as “slightly/moderately improved,” and 39 patients (50.6%) as “not improved.” The FIQR, FASmod, and PSD scores were significantly reduced at 24 months. The pain magnification domain score of the PCS was the only variable predictive of worse FIQR scores (Wald coefficient: −2.94; p = 0.047). These results suggest a potential long-term therapeutic role for the PEA + ALC combination, with pain magnification being the primary predictor of poor efficacy. Full article

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

13 pages, 526 KiB

Open AccessArticle

Systemic Symptoms as Potential Predictors of Chronic Neck Pain on Initial Examination: Can Systemic Symptoms Act as a Predictor of Neck Pain?

by Seo-Hyun Park and Dong-Ho Keum

J. Pers. Med. 2024, 14(7), 688; https://doi.org/10.3390/jpm14070688 - 26 Jun 2024

Viewed by 135

Abstract

Background: Neck pain is a prevalent musculoskeletal disorder that can cause other additional misalignments and other misalignment-induced chronic musculoskeletal diseases. Although numerous risk factors for chronic neck pain have been researched, systemic symptoms have not received the same level of investigation. The aim [...] Read more.

Background: Neck pain is a prevalent musculoskeletal disorder that can cause other additional misalignments and other misalignment-induced chronic musculoskeletal diseases. Although numerous risk factors for chronic neck pain have been researched, systemic symptoms have not received the same level of investigation. The aim of this study was to analyze the link between subjective systemic symptoms and neck pain based on initial holistic interviews, with the objective of identifying potential predictive factors for neck pain. Methods: This retrospective cross-sectional study included patients hospitalized due to acute neck pain between January 2018 and August 2021. Data collected included demographic information, treatment details, neck-pain characteristics, medical history, and co-occurring symptoms regardless of their known association with neck pain. Statistical analyses, including independent t-tests, Mann–Whitney U tests, chi-squared tests, Fisher’s exact tests, and correlation analyses, were performed. Results: With regard to the demographic characteristics, a significant positive correlation was observed between age and initial pain intensity (p < 0.01), while female sex was associated with changes in pain intensity (p < 0.05). Past medical conditions, including diabetes, hyperlipidemia, heart attacks, and psychological medical history, demonstrated a significant relationship with neck pain (p < 0.01, p < 0.05, p < 0.05, and p < 0.05, respectively). Hospitalization duration, cervical dizziness, limitations in the cervical range of motion (ROM), and widespread pain were significantly associated with neck pain (p < 0.05, p < 0.05, p < 0.01, and p < 0.001, respectively). Among the subjective systemic symptoms, only upper gastrointestinal (GI) disturbance displayed a significant association with neck pain (p < 0.01). Conclusions: This study identified several potential predictors of neck pain—notably, upper GI disturbances—providing a new avenue to investigate the prognostic factors of neck pain. However, further study is needed to substantiate these findings and elucidate the precise nature of these associations. Full article

(This article belongs to the Section Disease Biomarker)

12 pages, 944 KiB

Open AccessArticle

No Additional Effects of Sequential Facilitatory Cerebral and Cerebellar rTMS in Subacute Stroke Patients

by Ho Seok Lee, Sungwon Kim, Heegoo Kim, Seung-min Baik, Dae Hyun Kim and Won Hyuk Chang

J. Pers. Med. 2024, 14(7), 687; https://doi.org/10.3390/jpm14070687 - 26 Jun 2024

Viewed by 152

Abstract

The aim of this study was to investigate the additional effects of cerebellar rTMS on the motor recovery of facilitatory rTMS over affected primary motor cortex (M1) in subacute stroke patients. Twenty-eight subacute stroke patients were recruited in this single-blind, randomized, controlled trial. [...] Read more.

The aim of this study was to investigate the additional effects of cerebellar rTMS on the motor recovery of facilitatory rTMS over affected primary motor cortex (M1) in subacute stroke patients. Twenty-eight subacute stroke patients were recruited in this single-blind, randomized, controlled trial. The Cr-Cbll group received Cr-Cbll rTMS stimulation consisting of high-frequency rTMS over affected M1 (10 min), motor training (10 min), and high-frequency rTMS over contralesional Cbll (10 min). The Cr-sham group received sham rTMS instead of high-frequency rTMS over the cerebellum. Ten daily sessions were performed for 2 weeks. A Fugl-Meyer Assessment (FMA) was measured before (T0), immediately after (T1), and 2 months after the intervention (T2). A total of 20 participants (10 in the Cr-Cbll group and 10 in the Cr-sham group) completed the intervention. There was no significant difference in clinical characteristics between the two groups at T0. FMA was significantly improved after the intervention in both Cr-Cbll and Cr-sham groups (p < 0.05). However, there was no significant interaction in FMA between time and group. In conclusion, these results could not demonstrate that rTMS over the contralesional cerebellum has additional effects to facilitatory rTMS over the affected M1 for improving motor function in subacute stroke patients. Full article

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

13 pages, 1280 KiB

Open AccessReview

Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain

by Marco Femia, Carlo Valenti Pittino, Enrico Maria Fumarola, Marco Tramarin, Maurizio Papa, Francesco Giurazza, Antonio Pio Francioso, Davide Fior, Lorenzo Paolo Moramarco, Guido Antonini, Ruggero Vercelli and Maurizio Cariati

J. Pers. Med. 2024, 14(7), 686; https://doi.org/10.3390/jpm14070686 - 26 Jun 2024

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Abstract

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and [...] Read more.

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and total knee arthroplasty (TKA). However, a subset of patients remain symptomatic despite conservative measures, necessitating the development of minimally invasive interventions. Genicular artery embolization (GAE) emerges as a promising option, targeting neovascularization and inflammatory processes in OA. This paper reviews the pathophysiological basis, patient selection criteria, procedural details, and outcomes of GAE. Notably, GAE demonstrates efficacy in relieving knee pain and improving function in patients refractory to conventional therapy. While further research is warranted to elucidate its long-term outcomes and compare it with existing modalities, GAE represents a novel approach in the management of symptomatic knee OA, potentially delaying or obviating the need for surgical intervention. Here, we synthesize the relevant literature, technical details of the procedure, and future perspectives. Moreover, the success of GAE prompts the exploration of transarterial embolization in other musculoskeletal conditions, underscoring the evolving role of interventional radiology in personalized pain management strategies. Full article

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

31 pages, 1070 KiB

Open AccessReview

Natural Health Products for Anti-Cancer Treatment: Evidence and Controversy

by Valeria Conti, Giovanna Polcaro, Emanuela De Bellis, Danilo Donnarumma, Federica De Rosa, Berenice Stefanelli, Graziamaria Corbi, Francesco Sabbatino and Amelia Filippelli

J. Pers. Med. 2024, 14(7), 685; https://doi.org/10.3390/jpm14070685 - 26 Jun 2024

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Abstract

Natural Health Products (NHPs) have long been considered a valuable therapeutic approach for the prevention and treatment of various diseases, including cancer. However, research on this topic has led to inconclusive and often controversial results. This review aims to provide a comprehensive update [...] Read more.

Natural Health Products (NHPs) have long been considered a valuable therapeutic approach for the prevention and treatment of various diseases, including cancer. However, research on this topic has led to inconclusive and often controversial results. This review aims to provide a comprehensive update of the effects and mechanisms related to the use of NHPs, to describe the results of randomized clinical trials (RCTs) on their effects in cancer patients, and to critically discuss factors influencing clinical outcomes. RCTs available in the literature, even those studying the same NHP, are very heterogeneous in terms of indications, doses, route and timing of administration, and outcomes evaluated. Silymarin, ginsenoside, and vitamin E appear to be useful in attenuating adverse events related to radiotherapy or chemotherapy, and curcumin and lycopene might provide some benefit in patients with prostate cancer. Most RCTs have not clarified whether NHP supplementation provides any real benefit, while harmful effects have been shown in some cases. Overall, the available data suggest that although there is some evidence to support the benefits of NHPs in the management of cancer patients, further clinical trials with the same design are needed before their introduction into clinical practice can be considered. Full article

(This article belongs to the Special Issue Biomarkers and Personalized Therapy in Solid Tumors)

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16 pages, 451 KiB

Open AccessReview

A Critical Review of the Impact of SMARCA4 Mutations on Survival Outcomes in Non-Small Cell Lung Cancer

by Peter Manolakos, Luigi Boccuto and Diana S. Ivankovic

J. Pers. Med. 2024, 14(7), 684; https://doi.org/10.3390/jpm14070684 - 26 Jun 2024

Viewed by 182

Abstract

This critical review investigates the impact of SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutations on survival outcomes in non-small cell lung cancer (NSCLC) through an analysis of 21 peer-reviewed articles. Survival analyses across this review demonstrated [...] Read more.

This critical review investigates the impact of SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutations on survival outcomes in non-small cell lung cancer (NSCLC) through an analysis of 21 peer-reviewed articles. Survival analyses across this review demonstrated consistently worse outcomes for SMARCA4-mutated vs. SMARCA4 wild-type NSCLC patients, specifically emphasizing class 1 truncating mutations as an independent factor for poor overall survival. In addition, this review explores the clinicopathologic characteristics of SMARCA4 mutations and their impact on various treatment modalities, including immune checkpoint inhibitors (ICIs) both with and without Kirsten rat sarcoma viral oncogene homolog (KRAS) co-mutations. The potential ineffectiveness of ICI treatment in NSCLC is explored through the impact of SMARCA4/KRAS co-mutations on the tumor microenvironment. Moreover, this NSCLC review consistently reported statistically worse overall survival outcomes for SMARCA4/KRAS co-mutations than SMARCA4 wild-type/KRAS-mutated cohorts, extending across ICIs, chemo-immunotherapy (CIT), and KRAS G12C inhibitors. Designing prospective clinical SMARCA4-mutated or SMARCA4/KRAS co-mutated NSCLC trials to evaluate targeted therapies and immunotherapy may lead to a better understanding of how to improve cancer patients’ outcomes and survival rates. Full article

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

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10 pages, 1492 KiB

Open AccessArticle

Obesity, a Single Pathology Influencing Both Mother and Child—A Retrospective Analysis in Hospital Settings

by Cristina Mihaela Ormindean, Razvan Ciortea, Carmen Elena Bucuri, Andrei Mihai Măluțan, Cristian Ioan Iuhas, Ciprian Gheorghe Porumb, Vlad Ormindean, Maria Patricia Roman, Ionel Daniel Nati, Viorela Suciu and Dan Mihu

J. Pers. Med. 2024, 14(7), 683; https://doi.org/10.3390/jpm14070683 - 26 Jun 2024

Viewed by 167

Abstract

Obesity, characterized by an excess of adipose tissue, has become a significant global health issue. The prevalence of obesity has increased markedly in recent decades worldwide, with a sharp rise also observed in developing countries, particularly in urban areas. Addressing obesity during pregnancy [...] Read more.

Obesity, characterized by an excess of adipose tissue, has become a significant global health issue. The prevalence of obesity has increased markedly in recent decades worldwide, with a sharp rise also observed in developing countries, particularly in urban areas. Addressing obesity during pregnancy is crucial for several reasons and presents challenges for specialists in obstetrics and gynecology. Objectives: The aim of the present study was to investigate the correlation between obesity and its implications for childbirth. Materials and Methods: We conducted a retrospective study involving 1513 patients, grouped into normal-weight, overweight, and obese categories using corrected BMI values. We performed comparative analyses to explore the association between BMI and various outcomes: the method of delivery, the Apgar score at birth, the incidence of fetal distress, fetal birth weight, the presence of pregnancy-associated pathologies, and the occurrence of postpartum hemorrhage. Descriptive statistical analysis was utilized to characterize the demographic and clinical features of the patients and newborns. Results: By examining variables such as the occurrence of fetal distress during labor, the Apgar score at delivery, and the mode of delivery, we identified an association between increasing BMI and complications during labor and delivery. The results indicate that a higher BMI is linked with increased complications and variations in the mode of delivery. Conclusions: Obesity is the most common health issue among women of reproductive age and requires long-term care. It can contribute to numerous pregnancy-associated pathologies and affect both mother and child during labor and delivery. Obesity is associated with lower Apgar scores, the increased incidence of fetal distress, and a higher rate of cesarean section deliveries. Although the absolute risk of serious complications for mother, fetus, and newborn is low among women with obesity, adopting healthy eating and exercise behaviors prior to pregnancy, ideally, or as early in pregnancy as possible, can help minimize excessive weight gain during pregnancy. Full article

(This article belongs to the Special Issue Obstetrics and Gynecology and Women's Health)

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21 pages, 773 KiB

Open AccessArticle

The Path from Personality to Anxiety and Depression is Mediated by Cognition in Multiple Sclerosis

by Alina Schenk, Cosmin Octavian Popa, Cristiana Manuela Cojocaru, Ștefan Marian, Smaranda Maier and Rodica Bălașa

J. Pers. Med. 2024, 14(7), 682; https://doi.org/10.3390/jpm14070682 - 25 Jun 2024

Viewed by 421

Abstract

Background: Multiple sclerosis (MS) is a neurodegenerative immunological disease causing significant impairment in all life areas. Therefore, personality changes are observed and associated with higher prevalence of depression and anxiety disorders. Considering this relationship, we hypothesized that clinical symptoms and personality disorders are [...] Read more.

Background: Multiple sclerosis (MS) is a neurodegenerative immunological disease causing significant impairment in all life areas. Therefore, personality changes are observed and associated with higher prevalence of depression and anxiety disorders. Considering this relationship, we hypothesized that clinical symptoms and personality disorders are more prevalent in MS and that dysfunctional psychological mechanisms mediate the path from personality disorders to clinical symptoms. Methods: The study sample consisted of 43 patients with MS (age M = 41.9, SD = 11.5) and 31 controls (age M = 39.8, SD = 10.3). Measures of personality, anxiety, depression, fatigue, health status, and dysfunctional psychological mechanisms were conducted. Results: The prevalence of clinical symptoms was increased in MS patients as compared to controls. Also, dependent and schizoid personality traits (PTs) were observed in the patient sample. Negative automatic thoughts (NATs) were found to mediate the association between dependent PT and clinical symptoms. Along with schizoid PT, all dysfunctional psychological mechanisms impacted clinical symptoms. Discussion: The results of our research are in line with previous studies showing that anxiety, depression, and dysfunctional personality traits are more prevalent in MS as compared to controls. Conclusions: PTs and dysfunctional psychological mechanisms predicted depression, anxiety, fatigue, and health status in MS patients. Cognition acts as a strong mediator between PTs and psychopathology in MS. Hence, integrative personalized psychological treatment is recommended to improve the quality of care in MS. Full article

(This article belongs to the Special Issue Psychiatry: Emerging Clinical Research in Personalized Medicine)

13 pages, 908 KiB

Open AccessArticle

Experience in Post-Bariatric Abdominoplasty for Patients with Significant Weight Loss: A Prospective Study

by Roberto Cuomo, Claudia Cuccaro, Ishith Seth, Warren M. Rozen, Maria Giovanna Vastarella, Giuseppe A. G. Lombardo, Francesco Ciancio, Domenico Pagliara, Gorizio Pieretti and Feliciano Ciccarelli

J. Pers. Med. 2024, 14(7), 681; https://doi.org/10.3390/jpm14070681 - 25 Jun 2024

Viewed by 346

Abstract

Background: Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications. Methods: This prospective study examined 500 patients who underwent abdominoplasty during body-contouring [...] Read more.

Background: Abdominoplasty is a critical aesthetic and functional procedure for individuals who have undergone massive weight loss. Numerous techniques have been proposed to optimize aesthetic results while minimizing complications. Methods: This prospective study examined 500 patients who underwent abdominoplasty during body-contouring procedures between 1 January 2018 and 31 December 2021 at a tertiary center. The Skin–Adipose Tissue–Muscle (SAM) protocol was employed to analyze the operative strategies and complication rates and compare them with the existing literature. Furthermore, patient satisfaction and aesthetic outcomes were measured one year post-operation using a comprehensive four-point questionnaire evaluated by the patients themselves and two independent surgeons. Results: Participants had an average age of 34.8 years and a mean BMI of 31.1 kg/m². The surgeries included 328 full abdominoplasties and 172 T-inverted abdominoplasties. Notable complications included wound infection (4%), wound dehiscence (8.6%), tissue necrosis (0.6%), seroma (8.4%), and hematoma (2.6%). A higher BMI was correlated with an increased risk of complications and lower patient satisfaction. Data analysis was performed using Stata version 18 software. Conclusions: The increasing prevalence of obesity highlights an urgent need for more bariatric surgeries and subsequent abdominoplasties to mitigate the effects of massive weight loss. A crucial link between elevated BMI and a heightened risk of postoperative complications, emphasizing the necessity for standardized surgical protocols tailored to individuals with higher BMI, was noted. Innovatively, future studies must further investigate the intricate dynamics between BMI and surgical risks. Exploring and establishing uniform, adaptive surgical guidelines promise to revolutionize patient care by significantly reducing complications and enhancing recovery and satisfaction following abdominoplasty. Full article

(This article belongs to the Special Issue Precision Medicine in Plastic and Reconstructive Surgery)

15 pages, 325 KiB

Open AccessReview

Mental Health in Healthcare Workers Post-COVID-19: A Latin American Review and Insights into Personalized Management Strategies

by Sandra Muñoz-Ortega, Daniela Santamaría-Guayaquil, Jade Pluas-Borja, Geovanny Alvarado-Villa, Verónica Sandoval, Rubén Alvarado, Ivan Cherrez-Ojeda and Marco Faytong-Haro

J. Pers. Med. 2024, 14(7), 680; https://doi.org/10.3390/jpm14070680 - 25 Jun 2024

Viewed by 476

Abstract

Over the COVID-19 pandemic, the impact of enduring mental health on healthcare workers has become increasingly evident. This review focuses on post-pandemic mental health challenges faced by healthcare personnel in Latin America. This highlights the persistent burden on healthcare workers, especially women, which [...] Read more.

Over the COVID-19 pandemic, the impact of enduring mental health on healthcare workers has become increasingly evident. This review focuses on post-pandemic mental health challenges faced by healthcare personnel in Latin America. This highlights the persistent burden on healthcare workers, especially women, which is exacerbated by economic disparities, inadequacies in the healthcare system, and ongoing occupational stressors. Our literature review, utilizing databases such as PubMed, Scopus, and Google Scholar, scrutinized the mental health status of healthcare professionals in the region after the pandemic’s peak. The analysis indicated sustained levels of psychological distress, with frontline workers and women continuing to be affected disproportionately. These findings emphasize the urgent need for personalized interventions to effectively address the complex mental health challenges in this context. This review advocates strategic interventions, including tailored psychological support, innovative diagnostics, and technological solutions, integrated into patient-centered care models. Such approaches aim to enhance the mental resilience and overall well-being of healthcare professionals across Latin America in the post-COVID era. Full article

(This article belongs to the Section Epidemiology)

9 pages, 10407 KiB

Open AccessArticle

Enhancing Transforaminal Full Endoscopic Discectomy: Efficacy of the Hand Down Outside-In (HDOI) Technique

by Yushi Yamaguchi, Koichiro Ono, Daisuke Fukuhara, Akira Dezawa and Tokifumi Majima

J. Pers. Med. 2024, 14(7), 679; https://doi.org/10.3390/jpm14070679 - 25 Jun 2024

Viewed by 261

Abstract

Endoscopic lumbar discectomy (ELD) is a key advancement in minimally invasive spinal surgery, particularly for lumbar disc herniation. Interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) are the two major methods used for FED. TELD, while less familiar to spine [...] Read more.

Endoscopic lumbar discectomy (ELD) is a key advancement in minimally invasive spinal surgery, particularly for lumbar disc herniation. Interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) are the two major methods used for FED. TELD, while less familiar to spine surgeons inexperienced in endoscopic surgery, presents challenges in visualizing the dura mater, a crucial aspect for reducing surgical complications. The hand down outside-in (HDOI) technique introduced by Dezawa enhances this visualization by positioning the cannula tip dorsally on the intervertebral disc and maneuvering it between the dura mater and disc to the spinal canal’s midpoint. The cannula is then flipped to directly visualize the dura mater, enabling safe removal of the prolapsed disc material. A comparative study involving 20 patients treated from April 2020 to April 2022 examined the efficacy of the HDOI technique against conventional TELD. Each group, comprising ten patients, underwent ELD for lumbar disc herniation. While both groups showed similar improvements in clinical outcomes, as assessed using the Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) for pain, the HDOI group exhibited a 100% success rate for dura mater visualization, and this rate is significantly higher than the 60% observed in the conventional TELD group. Additionally, the time required for dura mater visualization was notably shorter for the HDOI technique. These results indicate that the HDOI technique not only enhances the safety and efficacy of TELD but may also encourage its wider use in clinical settings. Full article

(This article belongs to the Special Issue Clinical Research of Minimally Invasive Spine Surgery)

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26 pages, 875 KiB

Open AccessReview

Medical–Surgical Implications of Branching Variation of Human Aortic Arch Known as Bovine Aortic Arch (BAA)

by Andreea Rotundu, Alin Horatiu Nedelcu, Razvan Tudor Tepordei, Marius Constantin Moraru, Dragos Andrei Chiran, Andra Oancea, Alexandra Maștaleru, Alexandru-Dan Costache, Costin Chirica, Cristina Grosu, Florin Mitu and Maria Magdalena Leon

J. Pers. Med. 2024, 14(7), 678; https://doi.org/10.3390/jpm14070678 - 24 Jun 2024

Viewed by 240

Abstract

(1) Background: The aortic arch (AA) branching model is challenging, considering the multiple anatomical variations documented in existing research. The bovine aortic arch (BAA) is the most prevalent anatomical variation among these. This variant of AA branching has long been considered a nonsymptomatic [...] Read more.

(1) Background: The aortic arch (AA) branching model is challenging, considering the multiple anatomical variations documented in existing research. The bovine aortic arch (BAA) is the most prevalent anatomical variation among these. This variant of AA branching has long been considered a nonsymptomatic malformation, having been discovered incidentally during imaging investigations for other causes. However, more recent studies have demonstrated that BAA shows a frequent association with coarctation of the aorta (CoA), thoracic aortic disease (TAD), and stroke. At the same time, given the current context of increasing activity in the fields of interventional and surgical procedures in the aorta and its branches, it is very important to know the medical–surgical implications of this anatomical variant. (2) Methods: We conducted a comprehensive review using PubMed and Embase, focusing specifically on randomized trials and cohort analyses that examined the medical–surgical implications of BAA. We assessed information related to studied groups, medical procedures, and study outcomes. Initially, we identified 8454 studies, and after rigorous evaluation, we narrowed down our review to 25 articles. (3) Discussions: The intervention consisted of assessing the risks associated with BAA through different imaging investigation methods such as computer tomographic angiography (CTA), magnetic resonance imaging (MRI), or ultrasonography (US). The following results were evaluated: the prevalence of the BAA, the importance of imaging investigations in establishing the diagnosis and the therapeutic management and monitoring the evolution of patients with the BAA, the association of the BAA with CoA, TAD, and stroke, and the potential risks of interventional treatment in patients with the BAA. (4) Conclusions: The prevalence of the BAA differs both between different ethnic groups and between genders. Advanced imaging methods such as CTA and 4D flow MRI allow detailed descriptions of supra-aortic vascular anatomy and information about blood flow velocities, direction, and turbulence in the AA. US remains an easy and valuable imaging investigation, with the potential to detect and correctly diagnose the BAA and its hemodynamic implications. Anatomical variations in the AA are associated with increased rates of TAD, CoA, and stroke, necessitating early diagnosis and increased supervision of patients with such incidentally observed abnormalities. In addition, there is a need to further develop and refine the surgical techniques used and personalize them to the individual characteristics of patients with the BAA. Full article

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

13 pages, 2383 KiB

Open AccessReview

Electrical Impedance Tomography, Artificial Intelligence, and Variable Ventilation: Transforming Respiratory Monitoring and Treatment in Critical Care

by Iacopo Cappellini, Lorenzo Campagnola and Guglielmo Consales

J. Pers. Med. 2024, 14(7), 677; https://doi.org/10.3390/jpm14070677 - 24 Jun 2024

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Abstract

Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strategies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: this narrative [...] Read more.

Background: Electrical Impedance Tomography (EIT), combined with variable ventilation strategies and Artificial Intelligence (AI), is poised to revolutionize critical care by transitioning from reactive to predictive approaches. This integration aims to enhance patient outcomes through personalized interventions and real-time monitoring. Methods: this narrative review explores the principles and applications of EIT, variable ventilation, and AI in critical care. EIT impedance sensing creates dynamic images of internal physiology, aiding the management of conditions like Acute Respiratory Distress Syndrome (ARDS). Variable ventilation mimics natural breathing variability to improve lung function and minimize ventilator-induced lung injury. AI enhances EIT through advanced image reconstruction techniques, neural networks, and digital twin technology, offering more accurate diagnostics and tailored therapeutic interventions. Conclusions: the confluence of EIT, variable ventilation, and AI represents a significant advancement in critical care, enabling a predictive, personalized approach. EIT provides real-time insights into lung function, guiding precise ventilation adjustments and therapeutic interventions. AI integration enhances EIT diagnostic capabilities, facilitating the development of personalized treatment plans. This synergy fosters interdisciplinary collaborations and sets the stage for innovative research, ultimately improving patient outcomes and advancing the future of critical care. Full article

(This article belongs to the Section Personalized Critical Care)

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14 pages, 3543 KiB

Open AccessArticle

Transforming Ontology Web Language Elements into Common Terminology Service 2 Terminology Resources

by Sara Mora, Roberta Gazzarata, Bernd Blobel, Ylenia Murgia and Mauro Giacomini

J. Pers. Med. 2024, 14(7), 676; https://doi.org/10.3390/jpm14070676 - 24 Jun 2024

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Abstract

Communication and cooperation are fundamental for the correct deployment of P5 medicine, and this can be achieved only by correct comprehension of semantics so that it can aspire to medical knowledge sharing. There is a hierarchy in the operations that need to be [...] Read more.

Communication and cooperation are fundamental for the correct deployment of P5 medicine, and this can be achieved only by correct comprehension of semantics so that it can aspire to medical knowledge sharing. There is a hierarchy in the operations that need to be performed to achieve this goal that brings to the forefront the complete understanding of the real-world business system by domain experts using Domain Ontologies, and only in the last instance acknowledges the specific transformation at the pure information and communication technology level. A specific feature that should be maintained during such types of transformations is versioning that aims to record the evolution of meanings in time as well as the management of their historical evolution. The main tool used to represent ontology in computing environments is the Ontology Web Language (OWL), but it was not created for managing the evolution of meanings in time. Therefore, we tried, in this paper, to find a way to use the specific features of Common Terminology Service—Release 2 (CTS2) to perform consistent and validated transformations of ontologies written in OWL. The specific use case managed in the paper is the Alzheimer’s Disease Ontology (ADO). We were able to consider all of the elements of ADO and map them with CTS2 terminological resources, except for a subset of elements such as the equivalent class derived from restrictions on other classes. Full article

(This article belongs to the Special Issue Selected Papers from the pHealth 2022 Conference, Oslo, Norway, 8–10 November 2022)

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19 pages, 1154 KiB

Open AccessReview

Cerebellar Non-Invasive Brain Stimulation: A Frontier in Chronic Pain Therapy

by Valerio Sveva, Alessandro Cruciani, Marco Mancuso, Francesca Santoro, Anna Latorre, Marco Monticone and Lorenzo Rocchi

J. Pers. Med. 2024, 14(7), 675; https://doi.org/10.3390/jpm14070675 - 23 Jun 2024

Viewed by 267

Abstract

Chronic pain poses a widespread and distressing challenge; it can be resistant to conventional therapies, often having significant side effects. Non-invasive brain stimulation (NIBS) techniques offer promising avenues for the safe and swift modulation of brain excitability. NIBS approaches for chronic pain management [...] Read more.

Chronic pain poses a widespread and distressing challenge; it can be resistant to conventional therapies, often having significant side effects. Non-invasive brain stimulation (NIBS) techniques offer promising avenues for the safe and swift modulation of brain excitability. NIBS approaches for chronic pain management targeting the primary motor area have yielded variable outcomes. Recently, the cerebellum has emerged as a pivotal hub in human pain processing; however, the clinical application of cerebellar NIBS in chronic pain treatment remains limited. This review delineates the cerebellum’s role in pain modulation, recent advancements in NIBS for cerebellar activity modulation, and novel biomarkers for assessing cerebellar function in humans. Despite notable progress in NIBS techniques and cerebellar activity assessment, studies targeting cerebellar NIBS for chronic pain treatment are limited in number. Nevertheless, positive outcomes in pain alleviation have been reported with cerebellar anodal transcranial direct current stimulation. Our review underscores the potential for further integration between cerebellar NIBS and non-invasive assessments of cerebellar function to advance chronic pain treatment strategies. Full article

(This article belongs to the Special Issue How to Undertake Personalized Assessments and Cures for Pain)

11 pages, 506 KiB

Open AccessArticle

Prognostic Association between Injury Severity Score and the Outcomes of Elderly Patients with Trauma in South Korea

by Jae-Guk Kim, Hyun-Young Choi, Gu-Hyun Kang, Yong-Soo Jang, Wonhee Kim, Yoonje Lee and Chiwon Ahn

J. Pers. Med. 2024, 14(7), 674; https://doi.org/10.3390/jpm14070674 - 23 Jun 2024

Viewed by 318

Abstract

This study investigated the impact of the Injury Severity Score (ISS) on treatment approaches and survival outcomes in trauma patients, focusing on comparing elderly (≥65 years) with non-elderly patients. It analyzed adult trauma cases with abnormal Revised Trauma Scores from January to December [...] Read more.

This study investigated the impact of the Injury Severity Score (ISS) on treatment approaches and survival outcomes in trauma patients, focusing on comparing elderly (≥65 years) with non-elderly patients. It analyzed adult trauma cases with abnormal Revised Trauma Scores from January to December 2019, categorizing patients into three severity groups based on ISS: mild (1–8), moderate (9–15), and severe (≥16). The study examined how ISS influenced therapeutic interventions and survival among elderly patients, comparing these outcomes to non-elderly patients using multivariable logistic regression analysis. In 16,336 adult trauma cases out of 52,262 patients, including 4886 elderly and 11,450 non-elderly patients, findings revealed that in the severe group, elderly patients had a lower, though not statistically significant, incidence of surgical or embolization interventions compared to the moderate group, differing from non-elderly patients. No significant differences were observed in the mild group between elderly and non-elderly patients. However, elderly patients had higher intervention rates in the moderate group and lower in the severe group, with significantly lower survival-to-discharge rates in the severe group. The ISS is insufficient for assessing trauma severity in elderly patients. Additional tools are needed for better evaluation and treatment decisions. Full article

(This article belongs to the Special Issue New Perspectives of Critical Care Medicine)

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13 pages, 869 KiB

Open AccessFeature PaperArticle

Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture

by Hyun-Jin Kim, Hyun-Sun Kim and Jeong-Heon Heo

J. Pers. Med. 2024, 14(7), 673; https://doi.org/10.3390/jpm14070673 - 22 Jun 2024

Viewed by 273

Abstract

Background: Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV [...] Read more.

Background: Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV GLS for the risk of adverse clinical composite outcomes in patients with femoral fractures. Methods: Data were obtained from a prospective single-center cohort of patients hospitalized for femoral fractures and followed up for at least 1 year between March 2021 and October 2022. The primary outcome was the development of an adverse composite clinical event, which included pneumonia, pulmonary oedema or effusion, pulmonary thromboembolism, and all-cause mortality within the 1-year period following surgery. Results: Among the 163 patients, 36 (22.09%) experienced adverse composite clinical events during 1-year follow-up. The adverse outcome group demonstrated poorer RV GLS and RV free wall strain values than the non-adverse outcome group. The optimal cut-off value of RV GLS for predicting composite adverse clinical events was −12.55%. The cumulative composite event-free survival rate was significantly lower in the RV GLS ≥ −12.55% group (log-rank p-value = 0.003). After adjusting for confounding factors, multivariate Cox proportional hazards regression analyses showed that RV GLS ≥ −12.55% independently increased the risk of composite adverse clinical events by 2.65-fold. Conclusions: Poor RV GLS is a significant predictor of adverse clinical outcomes in patients with femoral fractures. Specifically, an RV GLS value of ≥ −12.55% indicated a substantially increased risk of adverse events. Full article

(This article belongs to the Section Disease Biomarker)

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J. Pers. Med., Volume 14, Issue 7 (July 2024) – 39 articles

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