Journal of Personalized Medicine

17 pages, 889 KiB

Open AccessArticle

Patient Experience with Intranasal Esketamine in Treatment-Resistant Depression: Insights from a Multicentric Italian Study (REAL-ESKperience)

by Marco Di Nicola, Maria Pepe, Giacomo d’Andrea, Ilaria Marcelli, Mauro Pettorruso, Ileana Andriola, Stefano Barlati, Matteo Carminati, Carlo Ignazio Cattaneo, Massimo Clerici, Domenico De Berardis, Sergio De Filippis, Bernardo Dell’Osso, Giorgio Di Lorenzo, Giuseppe Maina, Mirko Manchia, Matteo Marcatili, Vassilis Martiadis, Cinzia Niolu, Antonino Petralia, Gianluca Rosso, Gianluca Serafini, Maria Salvina Signorelli, Tommaso Vannucchi, Matteo Vismara, Raffaella Zanardi, Antonio Vita, Gabriele Sani, Giovanni Martinotti and REAL-ESKperience Study Group Show full author list Hide full author list

J. Pers. Med. 2025, 15(4), 161; https://doi.org/10.3390/jpm15040161 - 21 Apr 2025

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Abstract

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients’ perspective on this treatment are limited. This multicentric [...] Read more.

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients’ perspective on this treatment are limited. This multicentric Italian study explored experiences with ESK-NS in TRD patients, focusing on perceived therapeutic effects and overall satisfaction. Methods. A self-report survey was administered to 236 outpatients with TRD (55.1% females, 54.1 ± 14.1 years) treated with ESK-NS for at least three consecutive months within standard clinical care. Based on satisfaction levels, participants were classified as “unsatisfied” (10.2%), “partially satisfied” (19.1%), “satisfied” (44.4%), or “very satisfied” (26.3%), and compared for sociodemographic, clinical characteristics, and feedback on perceived benefits. Artificial intelligence (OpenAI) served to categorize responses to an open-ended question. Results. Enhanced quality of life was reported by 88.4% of participants. Significant differences emerged in earliest self-perceived benefits, most relevant effects, and impact on global functioning across groups. Specifically, “very satisfied” patients described the following: early improvements in depressed mood, suicidal thoughts, and restlessness; decreased suicidal thoughts among the most significant effects; and functional gains across all domains. OpenAI identified experiences of personal growth and rediscovery and a desire for tailored settings and approaches as recurring topics. Conclusions. Most patients reported a positive perception of ESK-NS treatment. The most satisfied participants highlighted significant benefits to depressed mood, suicidal thoughts, and overall functioning. Patient-reported experiences offer insights into different psychopathological dimensions, including functional outcomes and quality of life. Integrating these perspectives into clinical practice might assist treatment personalization, improving patients’ adherence and satisfaction. Full article

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

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13 pages, 1544 KiB

Open AccessArticle

Multimodal Performance of GPT-4 in Complex Ophthalmology Cases

by David Mikhail, Daniel Milad, Fares Antaki, Jason Milad, Andrew Farah, Thomas Khairy, Jonathan El-Khoury, Kenan Bachour, Andrei-Alexandru Szigiato, Taylor Nayman, Guillaume A. Mullie and Renaud Duval

J. Pers. Med. 2025, 15(4), 160; https://doi.org/10.3390/jpm15040160 - 21 Apr 2025

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Abstract

Objectives: The integration of multimodal capabilities into GPT-4 represents a transformative leap for artificial intelligence in ophthalmology, yet its utility in scenarios requiring advanced reasoning remains underexplored. This study evaluates GPT-4’s multimodal performance on open-ended diagnostic and next-step reasoning tasks in complex ophthalmology [...] Read more.

Objectives: The integration of multimodal capabilities into GPT-4 represents a transformative leap for artificial intelligence in ophthalmology, yet its utility in scenarios requiring advanced reasoning remains underexplored. This study evaluates GPT-4’s multimodal performance on open-ended diagnostic and next-step reasoning tasks in complex ophthalmology cases, comparing it against human expertise. Methods: GPT-4 was assessed across three study arms: (1) text-based case details with figure descriptions, (2) cases with text and accompanying ophthalmic figures, and (3) cases with figures only (no figure descriptions). We compared GPT-4’s diagnostic and next-step accuracy across arms and benchmarked its performance against three board-certified ophthalmologists. Results: GPT-4 achieved 38.4% (95% CI [33.9%, 43.1%]) diagnostic accuracy and 57.8% (95% CI [52.8%, 62.2%]) next-step accuracy when prompted with figures without descriptions. Diagnostic accuracy declined significantly compared to text-only prompts (p = 0.007), though the next-step performance was similar (p = 0.140). Adding figure descriptions restored diagnostic accuracy (49.3%) to near parity with text-only prompts (p = 0.684). Using figures without descriptions, GPT-4’s diagnostic accuracy was comparable to two ophthalmologists (p = 0.30, p = 0.41) but fell short of the highest-performing ophthalmologist (p = 0.0004). For next-step accuracy, GPT-4 was similar to one ophthalmologist (p = 0.22) but underperformed relative to the other two (p = 0.0015, p = 0.0017). Conclusions: GPT-4’s diagnostic performance diminishes when relying solely on ophthalmic images without textual context, highlighting limitations in its current multimodal capabilities. Despite this, GPT-4 demonstrated comparable performance to at least one ophthalmologist on both diagnostic and next-step reasoning tasks, emphasizing its potential as an assistive tool. Future research should refine multimodal prompts and explore iterative or sequential prompting strategies to optimize AI-driven interpretation of complex ophthalmic datasets. Full article

(This article belongs to the Special Issue Diagnostics and Therapeutics in Ophthalmology—2nd Edition)

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12 pages, 1144 KiB

Open AccessArticle

Frailty as a Predictor of Post-Traumatic Stress Disorder After Advance Care Planning Communication Intervention by Trained Care Managers in Long-Term Care Service Users in Japan: A Secondary Analysis

by Mariko Miyamichi, Kyoko Oshiro, Shozo Okochi, Noriyasu Takeuchi, Tomoe Nakamura, Terumi Matsushima, Masako Okada, Yoshimi Kudo, Takehiro Ishiyama, Tomoyasu Kinoshita, Hideki Kojima and Mitsunori Nishikawa

J. Pers. Med. 2025, 15(4), 159; https://doi.org/10.3390/jpm15040159 - 21 Apr 2025

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Abstract

Background/Objectives: Advance care planning is essential in a community; however, intervention studies by care managers remain scarce. This study aims to determine the relationship between frailty and post-traumatic stress disorder among long-term care service users (hereinafter referred to as “users”) following advance [...] Read more.

Background/Objectives: Advance care planning is essential in a community; however, intervention studies by care managers remain scarce. This study aims to determine the relationship between frailty and post-traumatic stress disorder among long-term care service users (hereinafter referred to as “users”) following advance care planning conversations with their care managers. Methods: We conducted a secondary analysis using raw data from the Japanese University Hospital Medical Information Network Study No. 000048573, published on 23 September 2024. In this previous study, trained care managers provided advance care planning conversation interventions to 30 users. Care managers conducted a convenience sample of 30 mentally and physically stable users who were 65 years old or older, had a family member or healthcare provider assigned, and had never used ACP. Our analysis in the present study focuses on the Clinical Frailty Scale and Impact of Events Scale-Revised, both of which measure post-traumatic stress disorder. Results: The Impact of Events Scale-Revised score was significantly higher in users with a clinical frailty score ≥ 5 compared to those with a clinical frailty score < 5. Logistic regression analysis, using the Impact of Events Scale-Revised as the objective variable, also revealed an association between a clinical frailty score ≥ 5 and a higher Impact of Events Scale-Revised. The four groups, selected through hierarchical cluster analysis for sensitivity analysis, demonstrated results consistent with the above analysis. Conclusions: The degree of post-traumatic stress disorder among users is associated with their degree of frailty following an advance care planning conversation with their care manager. Frailty in users may be a valuable predictor of stress related to advance care planning conversations. Users with a clinical frailty scale score ≥ 5 can be provided with more personalized care through more careful communication. University Hospital Medical Information Network Trial ID: 000048573. Full article

(This article belongs to the Special Issue New Insights into Personalized Care in Advance Care Planning)

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12 pages, 219 KiB

Open AccessReview

The Optimal Age for Oophorectomy in Women with Benign Conditions: A Narrative Review

by Aikaterini-Gavriela Giannakaki, Maria-Nektaria Giannakaki, Konstantinos Nikolettos, Christina Pagkaki and Panagiotis Tsikouras

J. Pers. Med. 2025, 15(4), 158; https://doi.org/10.3390/jpm15040158 - 19 Apr 2025

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Abstract

Objective: Oophorectomy is a common procedure for benign uterine conditions, historically recommended for women aged 40–45 and older due to the belief that ovarian preservation had no significant benefits. This review evaluates the literature on the optimal age for oophorectomy in women with [...] Read more.

Objective: Oophorectomy is a common procedure for benign uterine conditions, historically recommended for women aged 40–45 and older due to the belief that ovarian preservation had no significant benefits. This review evaluates the literature on the optimal age for oophorectomy in women with benign conditions to assess its risks and benefits and guide clinical decision-making. Methods: A narrative review was conducted using a literature search of articles published between January 2000 and February 2025, focusing on the age-related outcomes of ovarian conservation versus removal. Results: Oophorectomy remains a complex decision in gynecological surgeries, especially among perimenopausal and postmenopausal women. Evidence supports ovarian conservation in average-risk women, highlighting reduced risks of cardiovascular disease, osteoporosis, and all-cause mortality. Conversely, oophorectomy is favored in high-risk populations, such as BRCA mutation carriers, due to significantly lower risks of ovarian and breast cancers. Despite declining rates, unnecessary oophorectomies persist, influenced by age, socioeconomic status, comorbidities, and surgical approaches. The development of a risk stratification tool offers promise for improving individualized decision-making. Conclusions: The decision to perform oophorectomy for benign conditions should be personalized, balancing patient-specific factors to optimize outcomes and long-term health benefits. Full article

(This article belongs to the Section Sex, Gender and Hormone Based Medicine)

17 pages, 863 KiB

Open AccessArticle

Perioperative Coronavirus Disease 2019 Infection and Its Impact on Postoperative Outcomes: Pulmonary Complications and Mortality Based on Korean National Health Insurance Data

by Hyo Jin Kim, EunJin Ahn, Eun Jung Oh and Si Ra Bang

J. Pers. Med. 2025, 15(4), 157; https://doi.org/10.3390/jpm15040157 - 17 Apr 2025

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Abstract

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted global healthcare. This study explores the effects of perioperative COVID-19 infection on postoperative outcomes, aiming to refine risk assessment and enhance personalized perioperative care using a comprehensive dataset from the Korean National Health [...] Read more.

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted global healthcare. This study explores the effects of perioperative COVID-19 infection on postoperative outcomes, aiming to refine risk assessment and enhance personalized perioperative care using a comprehensive dataset from the Korean National Health Insurance Service. This analysis extends previous research by providing a large-scale validation of risk factors associated with COVID-19 in a perioperative setting. Methods: In this retrospective cohort study, we analyzed data from 2,903,858 patients who underwent surgery under general anesthesia between January 2020 and December 2021. Patients were categorized into COVID-19 (+) and COVID-19 (−) groups within 30 d before or after surgery. Logistic regression models were used to identify independent risk factors for mortality and pulmonary complications. Results: After propensity score matching, the final cohort comprised 19,235 patients (COVID-19 (+): 3847; COVID-19 (−): 15,388). The COVID-19 (+) group had significantly higher overall mortality than the COVID-19 (−) group. No significant difference was observed between the groups concerning 30 d mortality. Pulmonary complications, including pneumonia and acute respiratory distress syndrome, were significantly more frequent in the COVID-19 (+) group. The independent predictors of 30 d mortality included advanced age, emergency surgery, and the American Society of Anesthesiologists physical status classification. Conclusions: Our study confirms that perioperative COVID-19 infection significantly elevates overall mortality and pulmonary complications, emphasizing the necessity of tailored perioperative management. Incorporating individual risk factors into care protocols not only reduces risks for surgical patients but also enhances treatment approaches. These findings advocate for the implementation of personalized medicine principles in surgical settings to improve patient outcomes during and after the COVID-19 pandemic. This research uses a comprehensive national medical claims dataset to set new standards for studying pandemic health impacts and improving clinical strategies. Full article

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

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26 pages, 3696 KiB

Open AccessArticle

Genetic Predictors of Paxlovid Treatment Response: The Role of IFNAR2, OAS1, OAS3, and ACE2 in COVID-19 Clinical Course

by Mykhailo Buchynskyi, Iryna Kamyshna, Iryna Halabitska, Pavlo Petakh, Valentyn Oksenych and Oleksandr Kamyshnyi

J. Pers. Med. 2025, 15(4), 156; https://doi.org/10.3390/jpm15040156 - 17 Apr 2025

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Abstract

Background: This study investigated the role of genetic polymorphisms in IFNAR2, OAS1, OAS3, and ACE2 as predictors of Paxlovid treatment response, specifically examining their influence on the clinical course and laboratory parameters of COVID-19 patients. Methods: We analyzed the impact of polymorphisms in [...] Read more.

Background: This study investigated the role of genetic polymorphisms in IFNAR2, OAS1, OAS3, and ACE2 as predictors of Paxlovid treatment response, specifically examining their influence on the clinical course and laboratory parameters of COVID-19 patients. Methods: We analyzed the impact of polymorphisms in genes associated with the interferon pathway (IFNAR2 rs2236757), antiviral response (OAS1 rs10774671, OAS3 rs10735079), and viral entry (ACE2 rs2074192) in individuals treated with Paxlovid. Results: Our findings suggest that genetic variations in these genes may modulate the immune response and coagulation pathways in the context of Paxlovid treatment during COVID-19 infection. Specifically, the IFNAR2 rs2236757 G allele was associated with alterations in inflammatory and coagulation markers, while polymorphisms in OAS1 and OAS3 influenced coagulation parameters. Furthermore, specific genotypes were linked to changes in clinical parameters such as oxygen saturation, leukocyte count, and liver function markers in Paxlovid-treated patients. Conclusions: These results highlight the potential of considering genetic factors in understanding individual responses to COVID-19 treatment with Paxlovid and informing future personalized approaches. Full article

(This article belongs to the Special Issue Personalized Medicine in Post-COVID-19 Era)

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7 pages, 488 KiB

Open AccessCase Report

Selective IgM Hypogammaglobulinemia and Multiple Sclerosis Treated with Natalizumab and Ofatumumab: A Case Report

by Francesco Crescenzo, Michelangelo Turazzini and Francesca Rossi

J. Pers. Med. 2025, 15(4), 155; https://doi.org/10.3390/jpm15040155 - 17 Apr 2025

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Abstract

Background: B-cell-depleting drugs targeting the CD20 antigen have been increasingly implemented as an “exit strategy” from natalizumab for relapsing–remitting multiple sclerosis (RRMS) patients due to the increased risk of progressive multifocal leukoencephalopathy. Data on recently approved anti-CD20 drugs, such as ofatumumab serving as [...] Read more.

Background: B-cell-depleting drugs targeting the CD20 antigen have been increasingly implemented as an “exit strategy” from natalizumab for relapsing–remitting multiple sclerosis (RRMS) patients due to the increased risk of progressive multifocal leukoencephalopathy. Data on recently approved anti-CD20 drugs, such as ofatumumab serving as a natalizumab “exit strategy”, are lacking. Furthermore, due to their immunosuppressive mechanism of action, prolonged use of these “highly effective” drugs is associated with the development of hypogammaglobulinemia and, consequently, a higher risk of infections. There are no guidelines for monitoring serum immunoglobulin levels in individuals undergoing “highly effective” multiple sclerosis treatment. Methods: We present a case of a 26-year-old male RRMS patient with selective IgM deficiency and multiple sclerosis initially treated with natalizumab and later ofatumumab. Results: The patient achieved “no evident disease activity “status while undergoing treatment with natalizumab and ofatumumab, but these therapies, especially ofatumumab, greatly impacted further drops in IgM levels. However, no significant decrease in IgG levels was observed, and no infectious events occurred. In addition, the patient did not show signs of disease activity while on ofatumumab, which also offered a more convenient mode of administration. Conclusions: Our experience points to the need to further explore benefit–risk ratios of highly effective treatments, even in cases with low immunoglobulin levels. However, closely monitoring immunoglobulin levels and conducting clinical follow-ups to ensure prompt recognition of potential infectious complications constitute approaches that have been thought of for such patients. Full article

(This article belongs to the Special Issue Clinical Updates and Challenges of Multiple Sclerosis and Related Disorders)

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18 pages, 909 KiB

Open AccessArticle

Post-Extraction Bone Changes in Molars Within Personalized Implant-Prosthetic Therapy as Evaluated with Fractal Analysis of CBCT

by Antonia Samia Khaddour, Sanda Mihaela Popescu, Mihaela Ionescu, Alex Ioan Sălan, Răzvan Eugen Ghiţă, Melania Olimpia Cojocaru, Iulia Roxana Marinescu, Marina Olimpia Amărăscu and Emma Cristina Draghici

J. Pers. Med. 2025, 15(4), 154; https://doi.org/10.3390/jpm15040154 - 16 Apr 2025

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Abstract

Background: Implant-prosthetic therapy requires a detailed assessment of the bone structure before designing a personalized treatment plan. Tooth extraction at the molar level is followed by a series of bone changes dependent on the patient’s general condition and age and the area [...] Read more.

Background: Implant-prosthetic therapy requires a detailed assessment of the bone structure before designing a personalized treatment plan. Tooth extraction at the molar level is followed by a series of bone changes dependent on the patient’s general condition and age and the area in which it was performed. The fractal analysis of cone beam computed tomography (CBCT) represents a way to assess the quality of post-extraction bone regeneration. The purpose of this study was to analyze the alveolar bone changes after tooth extraction using fractal analysis on CBCT images. Methods: This retrospective study included pre- and post-extraction CBCTs at 3 months of 60 patients who underwent 100 extractions of first and/or second molars. Fractal analysis on CBCT images was performed using ImageJ, and the data obtained from the measurements were statistically processed. A multiple regression model was used to assess factors influencing bone remodeling. Results: Fractal analysis performed on CBCT images showed that most patients experienced advanced bone remodeling, this being more pronounced in those from rural areas, in the vertical plane at the mandible and at the second molar. The multiple regression model showed that the factors that play an important role in predicting bone resorption are represented by age group (age above 56 years old is associated with less bone resorption), location (bone resorption is more pronounced at the mandible level), and molar (bone resorption for the second molar is higher). Conclusions: Post-extraction bone changes were influenced by the age of the patient and by the location of the extraction, with the maxilla and first molar having better fractal analysis values compared to the mandible and second molar. These results emphasize the importance of training implantologists in CBCT evaluation to improve personalized implant-prosthetic treatment decisions. Full article

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

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17 pages, 3027 KiB

Open AccessArticle

Integrating Novel and Classical Prognostic Factors in Locally Advanced Cervical Cancer: A Machine Learning-Based Predictive Model (ESTHER Study)

by Federica Medici, Martina Ferioli, Arina Alexandra Zamfir, Milly Buwenge, Gabriella Macchia, Francesco Deodato, Paolo Castellucci, Luca Tagliaferri, Anna Myriam Perrone, Pierandrea De Iaco, Lidia Strigari, Alberto Bazzocchi, Stefania M. R. Rizzo, Costanza Maria Donati, Alessandra Arcelli, Stefano Fanti, Alessio Giuseppe Morganti and Savino Cilla

J. Pers. Med. 2025, 15(4), 153; https://doi.org/10.3390/jpm15040153 - 15 Apr 2025

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Abstract

Background/Objective: This study aimed to assess the prognostic significance of pretreatment nutritional and systemic inflammatory indices (IIs), and body composition parameters in patients with locally advanced cervical cancer (LACC) treated with chemoradiation and brachytherapy. The goal was to identify key predictors of [...] Read more.

Background/Objective: This study aimed to assess the prognostic significance of pretreatment nutritional and systemic inflammatory indices (IIs), and body composition parameters in patients with locally advanced cervical cancer (LACC) treated with chemoradiation and brachytherapy. The goal was to identify key predictors of clinical outcomes, such as local control (LC), metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS), using machine learning techniques. Materials and methods: A retrospective analysis of 173 patients with LACC treated between 2007 and 2021 was conducted. The study utilized machine learning techniques, including LASSO regression and Classification and Regression Tree (CART) analysis, to identify significant predictors of outcomes. Clinical data, tumor-related parameters, and treatment factors, along with IIs and body composition metrics (e.g., sarcopenic obesity), were incorporated into the models. Model performance was evaluated using ROC curves and AUC values. Results: Among 173 patients, hemoglobin (Hb) levels, ECOG performance status, and total protein emerged as primary prognostic indicators across multiple endpoints. For 2-year LC, patients with Hb > 11.9 g/dL had a rate of 95.1% compared to 73.6% in those with lower levels, with further stratification by ECOG status, ANRI, and total protein refining predictions. For 5-year LC, rates were 83.1% for Hb > 11.5 g/dL and 43.3% for lower levels. For 2-year MFS, ECOG 0 patients had an 88.1% rate compared to 73.8% for ECOG ≥ 1. In 2-year OS, Hb > 11.9 g/dL predicted a 95.1% rate, while ≤11.9 g/dL correlated with 74.0%. IIs (ANRI, SIRI, MLR) demonstrated predictive value only within specific patient subgroups defined by the primary prognostic indicators. The model showed strong predictive accuracy, with AUCs ranging from 0.656 for 2-year MFS to 0.851 for 2-year OS. Conclusions: These findings underscore the value of integrating traditional prognostic factors with emerging markers to enhance risk stratification in LACC. The use of machine learning techniques like LASSO and CART demonstrated strong predictive capabilities, highlighting their potential to refine individualized treatment strategies. Prospective validation of these models is warranted to confirm their utility in clinical practice. Full article

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

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Graphical abstract

15 pages, 1540 KiB

Open AccessArticle

Impact of Carotid Artery Geometry and Clinical Risk Factors on Carotid Atherosclerotic Plaque Prevalence

by Dac Hong An Ngo, Seung Bae Hwang and Hyo Sung Kwak

J. Pers. Med. 2025, 15(4), 152; https://doi.org/10.3390/jpm15040152 - 12 Apr 2025

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Abstract

Objectives: Carotid geometry and cardiovascular risk factors play a significant role in the development of carotid atherosclerotic plaques. This study aimed to investigate the correlation between carotid plaque formation and carotid artery geometry characteristics. Methods: A retrospective cross-sectional analysis was performed on 1227 [...] Read more.

Objectives: Carotid geometry and cardiovascular risk factors play a significant role in the development of carotid atherosclerotic plaques. This study aimed to investigate the correlation between carotid plaque formation and carotid artery geometry characteristics. Methods: A retrospective cross-sectional analysis was performed on 1227 patients, categorized into a normal group (n = 685) and carotid plaque groups causing either mild stenosis (<50% stenosis based on NASCET criteria, n = 385) or moderate-to-severe stenosis (>50%, n = 232). The left and right carotid were evaluated individually for each group. Patient data, including cardiovascular risk factors and laboratory test results, were collected. Carotid geometric measurements were obtained from 3D models reconstructed from cranio-cervical computed tomography angiography (CTA) using semi-automated software (MIMICS). The geometric variables analyzed included the vascular diameter and sectional area of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid artery bifurcation (CAB), as well as the carotid bifurcation angles and carotid tortuosity. Results: Compared to the normal group, in both the right and left carotid arteries, patients with carotid plaques exhibited a significantly higher age (p < 0.001) and a greater prevalence of hypertension (p < 0.001) and diabetes mellitus (p < 0.001). Additionally, they demonstrated a larger CCA and a smaller carotid bifurcation dimension (p < 0.05). In the analysis of the left carotid artery, patients with carotid plaques also had a significantly smaller ICA dimension (p < 0.05) than the normal group. Conclusions: This study found that patients with carotid plaques were older and had a higher prevalence of hypertension and diabetes, larger CCAs, and smaller carotid bifurcations. The plaque-positive left ICA was significantly smaller than that of the plaque-negative group, suggesting a side-specific vulnerability. These findings highlight the role of carotid geometry in plaque formation and its potential clinical implications for personalized risk assessment and targeted interventions. Full article

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

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12 pages, 2477 KiB

Open AccessArticle

Artificial Intelligence-Based Algorithm for Stent Coverage Assessments

by Joanna Fluder-Wlodarczyk, Mikhail Darakhovich, Zofia Schneider, Magda Roleder-Dylewska, Magdalena Dobrolińska, Tomasz Pawłowski, Wojciech Wojakowski, Pawel Gasior and Elżbieta Pociask

J. Pers. Med. 2025, 15(4), 151; https://doi.org/10.3390/jpm15040151 - 11 Apr 2025

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Abstract

Background: Neointimal formation after stent implantation is an important prognostic factor since delayed healing may lead to stent thrombosis. In vivo, optical coherence tomography (OCT) can most precisely assess stent strut coverage. Since analyzing neointimal coverage is time-consuming, artificial intelligence (AI) may offer [...] Read more.

Background: Neointimal formation after stent implantation is an important prognostic factor since delayed healing may lead to stent thrombosis. In vivo, optical coherence tomography (OCT) can most precisely assess stent strut coverage. Since analyzing neointimal coverage is time-consuming, artificial intelligence (AI) may offer valuable assistance. This study presents the preliminary results of the AI-based tool’s performance in detecting and categorizing struts as covered and uncovered. Methods: The algorithm was developed using the YOLO11 (You Only Look Once) neural networks. The first step was preprocessing, then data augmentation techniques were implemented, and the model was trained. Twenty OCT pullbacks were used during model training, and two OCT pullbacks were used in the final validation. Results: The presented tool’s performance was validated against two analysts’ consensus. Both analysts showed moderate intraobserver agreement (κ = 0.57 for analyst 1 and κ = 0.533 for analyst 2) and fair agreement with each other (κ = 0.389). The algorithm’s detection of struts was satisfactory (a 92% positive predictive value (PPV) and a 90% true positive rate (TPR)) and was more accurate in recognizing covered struts (an 81% PPV and an 85% TPR) than uncovered struts (a 73% PPV and a 60% TPR). The agreement was κ = 0.444. Conclusions: The initial results demonstrated a good detection of struts with a more challenging uncovered strut classification. Further clinical studies with a larger sample size are needed to improve the proposed tool. Full article

(This article belongs to the Special Issue New Perspectives and Current Challenges in Myocardial Infarction)

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19 pages, 253 KiB

Open AccessArticle

Implementing Personalized Cancer Medicine: Insights from a Qualitative Interview Study

by Michele Masucci, Jenny Del Villar Pérez, Pamela Mazzocato, Ingemar Ernberg and Mats Brommels

J. Pers. Med. 2025, 15(4), 150; https://doi.org/10.3390/jpm15040150 - 9 Apr 2025

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Abstract

Background: Personalized cancer medicine (PCM) tailors cancer treatments based on individual genetic profiles, enabling more precise and effective therapies. Despite its potential, integrating PCM into clinical practice remains challenging because of organizational and systemic barriers. This study examined the factors influencing PCM [...] Read more.

Background: Personalized cancer medicine (PCM) tailors cancer treatments based on individual genetic profiles, enabling more precise and effective therapies. Despite its potential, integrating PCM into clinical practice remains challenging because of organizational and systemic barriers. This study examined the factors influencing PCM implementation at a major cancer center in Stockholm, Sweden. Methods: We conducted semi-structured interviews with 16 medical professionals and management staff from Karolinska University Hospital and Karolinska Institutet. Content analysis was used to identify key themes related to PCM implementation. This study followed the established Consolidated Criteria for Reporting Qualitative Research guidelines to ensure methodological rigor and transparency. Results: Informants framed PCM as both a technological innovation and a patient-centered approach. However, significant barriers to implementation were identified, including organizational inertia, fragmented funding models, and ethical challenges related to access and equity. Structural silos between academic and healthcare institutions complicate integration. Key facilitators include leadership commitment, cross-sectoral collaboration, and a supportive policy environment. Participants emphasized the need for integrated infrastructure, real-time data-sharing mechanisms, and interdisciplinary training programs to support PCM. Conclusions: Successful PCM implementation requires overcoming entrenched organizational and systemic barriers through a multi-stakeholder approach involving healthcare providers, researchers, policymakers, and patient advocates. The findings underscore the necessity of a “third-form organization” to mediate between academia and clinical care. Addressing these challenges requires adaptive governance models, evidence-based policy reforms, and sustainable funding frameworks. Future research should explore comparative contexts to enhance the scalability and generalizability of PCM integration strategies. Full article

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

11 pages, 735 KiB

Open AccessArticle

Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

by Razan Awan, Monirah A. Albabtain, Aisha AlRasheedi, Maha AlHarthi, Zaid Alanazi and Amr A. Arafat

J. Pers. Med. 2025, 15(4), 149; https://doi.org/10.3390/jpm15040149 - 9 Apr 2025

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Abstract

Background: Atrial fibrillation (AF) is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR). However, the optimal antithrombotic strategy tailored to individual patient profiles remains unclear. This study aims to evaluate the outcomes of personalized antithrombotic regimens in patients with AF after TAVR. [...] Read more.

Background: Atrial fibrillation (AF) is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR). However, the optimal antithrombotic strategy tailored to individual patient profiles remains unclear. This study aims to evaluate the outcomes of personalized antithrombotic regimens in patients with AF after TAVR. Methods: We enrolled 121 AF patients who underwent TAVR from 2009 to 2023. Patients were grouped into seven groups based on individualized post-procedural antithrombotic regimens. The regimens included the following: single antiplatelet therapy (SAPT) + direct oral anticoagulant (DOAC) (n = 44, 36.3%); DOACs only (n = 25, 20.6%), SAPT + warfarin (n = 17, 14%); dual antiplatelet therapy (DAPT) (n = 13, 10.7%); warfarin only (n = 8, 6.6%); DAPT + warfarin (n = 7, 5.8%); and DAPT + DOACs (n = 7, 5.8%). The study outcomes included incidences of strokes or transient ischemic attacks (TIAs), major bleeding, and survival. Results: The median follow-up was 27 months. The incidence of stroke, TIA, or major bleeding was similar among the seven treatment groups. However, a trend toward a higher rate of stroke was observed in the triple regimen containing warfarin (28.6%); also, the highest rate of major bleeding was observed in the warfarin-only group (25%). Survival for patients discharged and placed under various antithrombotic regimens did not differ significantly despite some numerical variations being present across the groups, with the lowest mortality reported with SAPT + warfarin (7%) and the highest with DAPT + warfarin (57%). Conclusions: This study highlights the outcomes related to stroke, major bleeding, and mortality across personalized antithrombotic regimens in patients with AF after TAVR. While no statistically significant differences were observed, findings emphasize the need for further large-scale studies to define optimal personalized antithrombotic strategies based on individual patient characteristics. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic Surgery)

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14 pages, 264 KiB

Open AccessReview

Pregnancy-Related Heart Disease in the Emergency Department

by Nicole R. Hodgson, Rachel A. Lindor, Jessica Monas, Kimberly Heller, Patrick Kishi, Aaron Thomas, Cody Petrie, Lauren B. Querin, Andrej Urumov and David S. Majdalany

J. Pers. Med. 2025, 15(4), 148; https://doi.org/10.3390/jpm15040148 - 8 Apr 2025

Viewed by 264

Abstract

Pregnancy induces significant physiologic changes that impact the cardiovascular system, potentially exacerbating pre-existing cardiac conditions or precipitating new illnesses. Pregnant patients with cardiac emergencies pose unique challenges, as standard interventions may pose risks to the developing fetus. This article aims to enhance emergency [...] Read more.

Pregnancy induces significant physiologic changes that impact the cardiovascular system, potentially exacerbating pre-existing cardiac conditions or precipitating new illnesses. Pregnant patients with cardiac emergencies pose unique challenges, as standard interventions may pose risks to the developing fetus. This article aims to enhance emergency physicians’ confidence in managing pregnancy-related cardiac emergencies by providing a structured approach to initial evaluation and stabilization. We review eight common categories of pregnancy-associated cardiac illness: gestational hypertension and pre-eclampsia, cardiomyopathy, arrhythmias, valvular disease, aortopathies, congenital heart disease and pulmonary hypertension, coronary disease, and anticoagulation-related complications. For each condition, we summarize relevant pregnancy-specific pathophysiology and outline evidence-based, personalized emergency management strategies. Full article

(This article belongs to the Special Issue Cardiac Disease in Pregnancy: Diagnosis, Management and Outcomes)

19 pages, 3032 KiB

Open AccessArticle

Managing Fear and Anxiety in Patients Undergoing Dental Hygiene Visits with Guided Biofilm Therapy: Analysis of Psychological and Physiological Differences Between Women and Men—A Conceptual and Multivariate Regression Model

by Marta Leśna, Krystyna Górna and Jakub Kwiatek

J. Pers. Med. 2025, 15(4), 147; https://doi.org/10.3390/jpm15040147 - 8 Apr 2025

Viewed by 305

Abstract

Background: Dental anxiety is a significant barrier to dental care, leading to avoidance behaviors and compromised oral health. This study aimed to analyze fear and anxiety during dental hygiene visits with Guided Biofilm Therapy (GBT), focusing on gender differences in psychological and physiological [...] Read more.

Background: Dental anxiety is a significant barrier to dental care, leading to avoidance behaviors and compromised oral health. This study aimed to analyze fear and anxiety during dental hygiene visits with Guided Biofilm Therapy (GBT), focusing on gender differences in psychological and physiological responses to develop a more personalized approach to dental care. Methods: A total of 247 patients participated in this study. Psychological assessments included the Modified Dental Anxiety Scale (MDAS) and the State-Trait Anxiety Inventory (STAI X2), while physiological responses were measured through heart rate monitoring before and after procedures. Multivariate regression analysis was conducted to identify predictors of anxiety levels. Results: Multivariate regression analysis identified gender, sensory sensitivity (e.g., absence of tools in the field of view), past traumatic dental experiences, and individual preferences for anxiety reduction as significant predictors of anxiety levels. Gender differences were also observed in anxiety management strategies, with women more frequently preferring the elimination of sensory triggers and direct communication with dental professionals. Conclusions: The findings highlight the importance of personalized anxiety management protocols in dentistry. Tailored communication strategies, optimized clinical environments, and individualized pre- and post-procedure care plans can enhance patient experience and treatment acceptance. Implementing such patient-centered, data-driven approaches aligns with the broader principles of precision medicine in dental care. Full article

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

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18 pages, 4615 KiB

Open AccessArticle

Exploring the Clinical Workflow in Pharmacogenomics Clinics: An Observational Study

by Nicole Keuler, Jane McCartney, Renier Coetzee and Rustin Crutchley

J. Pers. Med. 2025, 15(4), 146; https://doi.org/10.3390/jpm15040146 - 5 Apr 2025

Viewed by 347

Abstract

Background: Pharmacogenomics (PGx) is the future of healthcare and implementation is being driven by increasing evidence. Understanding the workflow in a PGx clinic provides insight into the development and implementation of PGx services. It considers the patient’s perspective, the role of the [...] Read more.

Background: Pharmacogenomics (PGx) is the future of healthcare and implementation is being driven by increasing evidence. Understanding the workflow in a PGx clinic provides insight into the development and implementation of PGx services. It considers the patient’s perspective, the role of the interprofessional team and the pivotal input of the pharmacist. Objectives: The purpose of this study was to describe the clinical workflow followed in selected PGx clinics. Methods: Four different sites that offer PGx clinical services (United States of America) were included. Qualitative data were collected through semi-structured interviews and observations providing valuable insights into the workflow followed in both community-based and hospital-based PGx clinics. Results: Although each setting differed, the processes were similar with setting-specific workflows and barriers. This study highlights the role of the pharmacist and the interprofessional team, the resources used for interpretation of PGx test results and the importance of patient and healthcare education. Conclusions: Understanding the workflow and the role of the interprofessional team in PGx is essential to ensure successful implementation and sustainable precision medicine practices in resource-limited settings. Full article

(This article belongs to the Section Pharmacogenetics)

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15 pages, 2780 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis Association Between Periodontitis and Age-Related Macular Degeneration: Potential for Personalized Approach

by Sophie Boberg-Ans, Frederikke Arnold-Vangsted, Anna Bonde Scheel-Bech, Lars Christian Boberg-Ans, Andreas Arnold-Vangsted, Christian Jakobsen, Kasper Stokbro and Yousif Subhi

J. Pers. Med. 2025, 15(4), 145; https://doi.org/10.3390/jpm15040145 - 5 Apr 2025

Viewed by 258

Abstract

Background/Objectives: Periodontitis is a chronic inflammatory disease that leads to systemic low-grade inflammation. Systemic low-grade inflammation has been found in patients with age-related macular degeneration (AMD). In this systematic review and meta-analysis, we evaluated the association between periodontitis and AMD. Methods: [...] Read more.

Background/Objectives: Periodontitis is a chronic inflammatory disease that leads to systemic low-grade inflammation. Systemic low-grade inflammation has been found in patients with age-related macular degeneration (AMD). In this systematic review and meta-analysis, we evaluated the association between periodontitis and AMD. Methods: We searched 11 scientific literature databases on 16th December 2024 for studies of a diagnosis of periodontitis and prevalent or incident AMD. Eligible studies underwent a qualitative review and meta-analysis of the association. Study selection, data extraction, and risk of bias within studies were made in duplicate by two authors and conferred with a senior author. Results: Seven studies eligible for review included in total 149,217 individuals. Across the seven studies, different study designs, diagnoses and definitions of periodontitis, and diagnosis and definitions of AMD were employed. Our meta-analysis showed an association between periodontitis and AMD with an odds ratio of 1.42 (95% CI: 1.12 to 1.78; p = 0.003). Conclusions: Periodontitis is significantly associated with AMD. Unlike genetic predisposition and high age, which are important risk factors of AMD that cannot be modified, periodontitis is a risk factor that can be treated and potentially eliminated, thus allowing for a personalized approach for risk elimination in AMD. Attention should be given to the dental health of patients at risk of AMD. Full article

(This article belongs to the Special Issue Diagnostics and Therapeutics in Ophthalmology—2nd Edition)

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13 pages, 1412 KiB

Open AccessArticle

Comparative Changes in Fecal Microbiome After Endoscopic Resection and Surgical Resection in Gastric Cancer Patients

by Hochan Seo, Jae Yong Park, Hee Sang You, Beom Jin Kim and Jae Gyu Kim

J. Pers. Med. 2025, 15(4), 144; https://doi.org/10.3390/jpm15040144 - 4 Apr 2025

Viewed by 276

Abstract

Background/Objectives: Gastric cancer treatments can lead to significant alterations to patients’ gastrointestinal microbiome. However, differences in microbial impacts between gastrectomy and endoscopic submucosal dissection (ESD) remain underexplored. This study investigates how these treatments influence microbial diversity and composition in patients with stage [...] Read more.

Background/Objectives: Gastric cancer treatments can lead to significant alterations to patients’ gastrointestinal microbiome. However, differences in microbial impacts between gastrectomy and endoscopic submucosal dissection (ESD) remain underexplored. This study investigates how these treatments influence microbial diversity and composition in patients with stage I gastric cancer. Methods: Patients with pathologically confirmed stage I gastric cancer were recruited from Chung-Ang University Hospital between December 2016 and December 2019. This study analyzed fecal samples from 13 patients (ESD: n = 5; gastrectomy: n = 8) before and after treatment using 16S rRNA gene sequencing. Microbial diversity indices and taxonomic composition were compared, with follow-up extending up to two years. Results: In the total cohort, alpha diversity significantly decreased post-treatment (p < 0.05), and beta diversity analysis showed distinct clustering between pre- and post-treatment samples (p < 0.05). At the genus level, Bacteroides significantly decreased (p < 0.05), while Lactobacillus, Bifidobacterium, and Blautia showed significant increases (p < 0.05). Comparative analyses revealed that in the ESD group, alpha diversity remained unchanged, although beta diversity showed significant clustering (p < 0.05), without notable changes in major taxa. In contrast, surgical resection resulted in a significant reduction in alpha diversity (p < 0.05) and beta diversity clustering (p < 0.05), with increased abundances of Streptococcus and Blautia and decreased abundance of Bacteroides (p < 0.05). Conclusions: Surgical gastrectomy exerts significant effects on microbiome diversity and composition, while ESD has a more limited impact. These findings underscore the importance of considering microbiome changes in postoperative management. Full article

(This article belongs to the Special Issue Gastrointestinal Cancers: New Advances and Challenges)

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11 pages, 5939 KiB

Open AccessArticle

Pulsed Electromagnetic Field Therapy Alters the Genomic Profile of Bladder Cancer Cell Line HT-1197

by Maxwell Sandberg, Wyatt Whitman, Randall Bissette, Christina Ross, Matvey Tsivian and Stephen J. Walker

J. Pers. Med. 2025, 15(4), 143; https://doi.org/10.3390/jpm15040143 - 4 Apr 2025

Viewed by 402

Abstract

Background/Objectives: Pulsed electromagnetic field (PEMF) therapy involves the use of magnetic waveform energy for targeted treatment delivery. This technique has shown promising results in the treatment of various cancers. Currently, treatment of bladder cancer is highly invasive, involving intravesical chemotherapy or radical cystectomy. [...] Read more.

Background/Objectives: Pulsed electromagnetic field (PEMF) therapy involves the use of magnetic waveform energy for targeted treatment delivery. This technique has shown promising results in the treatment of various cancers. Currently, treatment of bladder cancer is highly invasive, involving intravesical chemotherapy or radical cystectomy. The potential therapeutic effects of PEMF therapy on bladder cancer are a relatively new and understudied area; therefore, the goal of this investigation was to gain mechanistic insight by examining the effects of PEMF therapy on a bladder cancer cell line in vitro. Methods: Cells from the bladder cancer cell line HT-1197 were cultured and incubated with (treatment group) or without (control group) PEMF therapy for one hour each day for five days. Cell counts were compared using Incucyte^® data to determine proliferation rates. At days 1 and 5, total RNA was isolated from cells, and following quantity and quality checks, gene expression was compared between the two groups. Proliferation rates from cell line HT-1197 were compared to prior published results on the bladder cancer cell line HT-1376. Results: HT-1197 cells treated with PEMF therapy had slower proliferation rates compared to controls (p < 0.05), but HT-1376 cells did not (p > 0.05). Principal component analysis showed complete separation of treated and untreated cells, with PEMF treatment accounting for 76% of the variation between the groups. Expression of numerous genes and cancer-related pathways was altered in the treated cells relative to the controls. Conclusions: Bladder cancer HT-1197 cells treated with PEMF therapy had slower proliferation and corresponding changes in gene expression. Several cancer-relevant pathways were differentially regulated following PEMF treatment. The conclusions are limited by the lack of a control healthy urothelial cell line in the experiments. Despite this shortcoming, our results suggest that PEMF therapy may be a promising avenue for further research in the treatment of bladder cancer. Full article

(This article belongs to the Special Issue Novel Diagnostic and Therapeutic Approaches to Urologic Oncology)

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12 pages, 234 KiB

Open AccessReview

Ultrafast Breast MRI: A Narrative Review

by Ottavia Battaglia, Filippo Pesapane, Silvia Penco, Giulia Signorelli, Valeria Dominelli, Luca Nicosia, Anna Carla Bozzini, Anna Rotili and Enrico Cassano

J. Pers. Med. 2025, 15(4), 142; https://doi.org/10.3390/jpm15040142 - 2 Apr 2025

Viewed by 401

Abstract

Breast magnetic resonance imaging (MRI) is considered the most effective method for detecting breast cancer due to its high sensitivity. Yet multiple factors limit its widespread use, including high direct and indirect costs, a prolonged acquisition time with consequent patient discomfort, and a [...] Read more.

Breast magnetic resonance imaging (MRI) is considered the most effective method for detecting breast cancer due to its high sensitivity. Yet multiple factors limit its widespread use, including high direct and indirect costs, a prolonged acquisition time with consequent patient discomfort, and a lack of trained radiologists. During the last decade, new strategies have been followed to increase the availability of breast MRI, including the omission of non-essential sequences to generate abbreviated MRI protocols (AB-MRIs) aimed at reducing the acquisition time with the potential of improving the patient’s experience and accommodating a higher number of MRI examinations per day. An alternative method is ultrafast MRI (UF-MRI), a novel technique that gathers kinetic data within the first minute after contrast injection, offering high temporal resolution. This enables the analysis of early contrast wash-in curves, showing promising outcomes. In this study, we reviewed the role of UF-MRI in breast imaging and detailed how the integration of this new approach with radiomics and mathematical models might further improve diagnostic accuracy and even have a prognostic role, a fundamental characteristic in the modern scenarios of personalized medicine. In addition, possible clinical applications and advantages of UF-MRI will be discussed. Full article

(This article belongs to the Special Issue Application of Statistical and Mathematical Techniques in Personalized Medicine and Healthcare)

3 pages, 156 KiB

Open AccessEditorial

Targeted Therapeutic Approaches for the Treatment of Cancer: The Future Is Bright

by Matthew J. Hadfield, Benedito A. Carneiro and Liang Cheng

J. Pers. Med. 2025, 15(4), 141; https://doi.org/10.3390/jpm15040141 - 2 Apr 2025

Viewed by 260

Abstract

The last two decades have ushered in unprecedented advancements in the treatment of cancer [...] Full article

(This article belongs to the Special Issue Recent Advances in Precision Medicine: Personalized Therapy, Drug Delivery and Nanomedicine)

15 pages, 2168 KiB

Open AccessArticle

The Prediction of Intrapartum Fetal Compromise According to the Expected Fetal Weight

by José Morales-Roselló, Alicia Martínez-Varea, Blanca Novillo-Del Álamo, Carmen Sánchez-Arco and Asma Khalil

J. Pers. Med. 2025, 15(4), 140; https://doi.org/10.3390/jpm15040140 - 1 Apr 2025

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Abstract

Objectives: To assess the predictive accuracy of the expected fetal weight in the third trimester (ExFW3t), based on the estimated fetal weight (EFW) at mid-trimester ultrasound scan, for the prediction of intrapartum fetal compromise (IFC) (an abnormal intrapartum fetal heart rate or intrapartum [...] Read more.

Objectives: To assess the predictive accuracy of the expected fetal weight in the third trimester (ExFW3t), based on the estimated fetal weight (EFW) at mid-trimester ultrasound scan, for the prediction of intrapartum fetal compromise (IFC) (an abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH requiring urgent cesarean section). Methods: This retrospective study included 777 singleton pregnancies that underwent a 20-week study and a 3t scan. The extrapolated EFW at 20 weeks to the 3t or ExFW3t was considered a proxy of the potential growth. The percentage difference with the actual 3t EFW (%ExFW3t) was compared with other ultrasonographic and clinical parameters—EFW centile (EFWc), middle cerebral artery pulsatility index (MCA PI) in multiples of the median (MoM), umbilical artery (UA) PI MoM, cerebroplacental ratio (CPR) MoM, and maternal height—for the prediction of IFC by means of the area under the curve (AUC) and Akaike Information Criteria (AIC). Results: Pregnancies with IFC presented higher values of UA PI MoM (1.19 vs. 1.09, p = 0.0460) and lower values of population and Intergrowth EFWc (45.9 vs. 28.9, p < 0.0001, 48.4 vs. 33.6, p = 0.0004), MCA PI MoM (0.97 vs. 0.81, p < 0.0001), CPR MoM (1.01 vs. 0.79, p < 0.0001), %ExFW3t (89.9% vs. 97.5%, p = 0.0003), and maternal height (160.2 vs. 162.9, p = 0.0083). Univariable analysis selected maternal height, EFWc, %ExFW3t, and UA PI MoM as significant parameters. However, %ExFW3t did not surpass the prediction ability of cerebral Doppler. Finally, multivariable analysis showed that the best models for the prediction of IFC resulted from the combination of cerebral Doppler (MCA PI MoM or CPR MoM), fetal weight (%ExFW3t or EFWc), and maternal height (AUC 0.75/0.76, AIC 345, p < 0.0001). Conclusions: Fetal weight-related parameters, including %ExFW3t, a proxy of the proportion of potential growth achieved in the 3t, were less effective than fetal cerebral Doppler for the prediction of IFC. The best performance was achieved by combining hemodynamic, ponderal, and clinical data. Full article

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

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4 pages, 155 KiB

Open AccessEditorial

Materials of the 2nd Conference with International Participation “Basic Research in Endocrinology: A Modern Strategy for the Development and Technologies of Personalized Medicine”

by Oksana Rymar, Alla Ovsyannikova and Elena Shakhtshneider

J. Pers. Med. 2025, 15(4), 139; https://doi.org/10.3390/jpm15040139 - 1 Apr 2025

Viewed by 150

Abstract

There has been an increase in patients with diabetes mellitus (DM) all over the world, with the advent of new modern research methods (for example, molecular genetic diagnostics), non-classical types of diabetes are increasingly being identified [...] Full article

(This article belongs to the Special Issue Selected Papers from the 2nd Conference with International Participation “Basic Research in Endocrinology: A Modern Strategy for the Development and Technologies of Personalized Medicine”)

8 pages, 4556 KiB

Open AccessCase Report

Osteonecrosis of the Jaw Associated with Obinutuzumab in a Patient with Preceding Follicular Non-Hodgkin’s Lymphoma

by Katharina Theresa Obermeier, Thomas Frank, Tim Hildebrandt, Sven Otto, Philipp Poxleitner and Ina Dewenter

J. Pers. Med. 2025, 15(4), 138; https://doi.org/10.3390/jpm15040138 - 1 Apr 2025

Viewed by 219

Abstract

Background: Obinutuzumab is a glycoengineered type II anti-CD-20 monoclonal antibody, which can be applied as immunotherapy in patients with follicular lymphoma. To our knowledge, this is the first reported case in the literature describing osteonecrosis of the jaw associated with CD20 monoclonal antibody [...] Read more.

Background: Obinutuzumab is a glycoengineered type II anti-CD-20 monoclonal antibody, which can be applied as immunotherapy in patients with follicular lymphoma. To our knowledge, this is the first reported case in the literature describing osteonecrosis of the jaw associated with CD20 monoclonal antibody therapy. Methods: The following case report describes a 39-year-old female patient under maintaining therapy with Obinutuzumab developing osteonecrosis of the jaw after tooth extraction. The necrotic area was located in the right mandible and was rated as a stage II osteonecrosis. Results: This case report should draw attention to the importance of dental follow-ups during aftercare of patients with Non-Hodgkin’s Lymphoma as well as to the relevant precautions for performing tooth extractions in such patients. Conclusions: As Obinutuzumab seems to be a contributing factor in the development of MRONJ, special attention has to be drawn to tooth extractions in such patients, which should only be performed with perioperative antibiosis, the least amount of trauma possible, always including the smoothening of sharp residual bone segments and a saliva-proof wound closure, as well as constant dental follow-ups. Full article

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

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14 pages, 991 KiB

Open AccessArticle

Association Between Amerindian Ancestry and Chronic Obstructive Pulmonary Disease in the Chilean Mixed Population

by Vicente Silva, Andrea Canals and Lucia Cifuentes

J. Pers. Med. 2025, 15(4), 137; https://doi.org/10.3390/jpm15040137 - 31 Mar 2025

Viewed by 468

Abstract

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic non-communicable diseases in adults. The most critical risk factors are tobacco and air pollution. The familial aggregation of this disease and the fact that only 15–20% of smokers develop [...] Read more.

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic non-communicable diseases in adults. The most critical risk factors are tobacco and air pollution. The familial aggregation of this disease and the fact that only 15–20% of smokers develop COPD demonstrate the existence of an individual susceptibility that would depend on genetic factors. The already-known susceptibility genomic variants explain only about 38% of the heritability of COPD. The present work analyzes the relationship between the percentage of Amerindian genomic ancestry of Chileans with morbidity and mortality of Chronic Obstructive Pulmonary Disease (COPD), adjusting for socioeconomic and environmental variables. Methods: We rely on the estimates of genomic ancestry percentages obtained in the Chilegenomico project in urban Chileans from 39 communes along eight regions of the country from north to south. From the public databases of the Departamento de Estadísticas e Información en Salud (DEIS) of the Chilean Ministry of Health, we obtained mortality rates and hospital discharge rates. We incorporated adjustment variables (communal data) obtained from other public databases. We performed correlation analyses and fitted negative binomial regression models to examine the association between Amerindian ancestries and COPD statistics. Results: A positive and significant association between Mapuche ancestry and hospital discharge and mortality rates for COPD was found in both simple and multiple analyses. In contrast, we found a negative and significant association between the percentage of Aymara genomic ancestry and COPD mortality rates. Conclusions: The levels of Mapuche and Aymara genomic ancestries have different and contrasting significant associations with COPD susceptibility and mortality in the Chilean mixed population. Full article

(This article belongs to the Special Issue Novel Challenges and Advances in Respiratory Diseases)

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10 pages, 2831 KiB

Open AccessArticle

The Actual Role of CPET in Predicting Postoperative Morbidity and Mortality of Patients Undergoing Pneumonectomy

by Antonio Mazzella, Riccardo Orlandi, Patrick Maisonneuve, Clarissa Uslenghi, Matteo Chiari, Monica Casiraghi, Luca Bertolaccini, Giovanni Caffarena and Lorenzo Spaggiari

J. Pers. Med. 2025, 15(4), 136; https://doi.org/10.3390/jpm15040136 - 31 Mar 2025

Viewed by 239

Abstract

This study aims to determine whether maximal oxygen consumption (VO2max) or predicted postoperative (ppo)-VO2max could still reliably predict postoperative complications and deaths in lung cancer patients undergoing pneumonectomy and which values could be more reliably considered as the optimal threshold. Methods: We [...] Read more.

This study aims to determine whether maximal oxygen consumption (VO2max) or predicted postoperative (ppo)-VO2max could still reliably predict postoperative complications and deaths in lung cancer patients undergoing pneumonectomy and which values could be more reliably considered as the optimal threshold. Methods: We retrospectively collected data of consecutive patients undergoing pneumonectomy for primary lung cancer at the European Oncological Institute (April 2019–April 2023). Routine preoperative assessment included cardiopulmonary exercise testing (CPET) and a lung perfusion scan. We evaluated the morbidity and mortality rates; associations between morbidity, mortality, VO2max, and ppoVO2max values were investigated through ANOVA or Fisher’s exact test as appropriate. Receiver operating characteristic (ROC) curves were applied to further explore the relation between VO2max, ppoVO2max values, and 90-day mortality. Results: The cardiopulmonary morbidity rate was 32.2%; the 30-day and 90-day mortality rates were 2.2% and 6.7%. The PpoVO2max values were significantly lower in patients experiencing cardiopulmonary complications or deaths compared to the whole cohort, whereas VO2max, though showing a trend towards lower values, did not reach statistical significance. A VO2max value threshold of 15 mL/kg/min correlated significantly with 90-day mortality, while a ppoVO2max cut-off of 10 mL/kg/min was significantly associated with cardiopulmonary complications and 30-day and 90-day mortality rates. ROC curve analysis revealed ppoVO2max as a better predictor of 90-day mortality compared to VO2max. Conclusions: CPET and a lung perfusion scan are two key elements for the preoperative evaluation of patients undergoing pneumonectomy, since it provides a holistic assessment of cardiopulmonary functionality. We recommend the routine calculation of ppoVO2max, particularly when adopting a 10 mL/kg/min threshold. Full article

(This article belongs to the Special Issue Novel Challenges and Advances in Thoracic Surgery)

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13 pages, 3257 KiB

Open AccessArticle

Vimentin and p53 Immunoreactivity in Cases of Traumatic Brain Injury

by Alice Chiara Manetti, Alessandra De Matteis, Gabriele Napoletano, Raffaele La Russa, Aniello Maiese and Paola Frati

J. Pers. Med. 2025, 15(4), 135; https://doi.org/10.3390/jpm15040135 - 31 Mar 2025

Viewed by 226

Abstract

Background: Traumatic brain injury (TBI) is one of the main causes of death in trauma pathology, especially among the youngest victims. After having evaluated the causality relationship between damage to the brain tissue and death, pathologists should try to estimate the duration [...] Read more.

Background: Traumatic brain injury (TBI) is one of the main causes of death in trauma pathology, especially among the youngest victims. After having evaluated the causality relationship between damage to the brain tissue and death, pathologists should try to estimate the duration between the TBI and death. Immunohistochemistry could be used in this field as a personalized medico-legal approach. This study aims to evaluate the possible role of vimentin and p53 as TBI markers to assess vitality and date the TBI. Methods: Twelve cases of TBI deaths were selected (two women and ten men, with a mean age of 46.83 years). In seven cases, death occurred immediately after the trauma, while in the others, death occurred after some days. An immunohistological study of brain samples using anti-p53 and anti-vimentin antibodies was performed. A semi-quantitative scale was adopted to grade the immunohistochemical reaction. Results: Our results showed a strong relationship between the p53 immunoreaction grade and TBI (X-squared value 10.971, p-value < 0.01), suggesting that p53 expression is enhanced in TBI cases. Vimentin is more expressed when the PTI is longer. Vimentin-immunoreaction was weaker than p53-immunoreaction (+0.75 vs. +1.83 mean values, respectively) in a group predominantly including short post-traumatic interval cases. Conclusions: The present research is limited by the small sample size; however, the molecules tested, vimentin and p53, have shown great potential to be used, in addition to others, as biological markers for the diagnosis and timing of TBI. Full article

(This article belongs to the Special Issue Personalized Medicine in Pathological Diagnosis)

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26 pages, 4862 KiB

Open AccessArticle

Integrative Analysis of DNA Methylation and microRNA Reveals GNPDA1 and SLC25A16 Related to Biopsychosocial Factors Among Taiwanese Women with a Family History of Breast Cancer

by Sabiah Khairi, Chih-Yang Wang, Gangga Anuraga, Fidelia Berenice Prayugo, Muhamad Ansar, Mohammad Hendra Setia Lesmana, Lalu Muhammad Irham, Chen-Yang Shen and Min-Huey Chung

J. Pers. Med. 2025, 15(4), 134; https://doi.org/10.3390/jpm15040134 - 30 Mar 2025

Viewed by 433

Abstract

Biopsychosocial factors, including family history, influence the development of breast cancer. Malignancies in women with a family history of breast cancer may be detectable based on DNA methylation and microRNA. Objectives: The present study extended an integrative analysis of DNA methylation and [...] Read more.

Biopsychosocial factors, including family history, influence the development of breast cancer. Malignancies in women with a family history of breast cancer may be detectable based on DNA methylation and microRNA. Objectives: The present study extended an integrative analysis of DNA methylation and microRNA to identify genes associated with biopsychosocial factors. Methods: We identified 3060 healthy women from the Taiwan Biobank and included 32 blood plasma samples for analysis of biopsychosocial factors and epigenetic changes. GEO databases and bioinformatics approaches were used for the identification and validation of potential genes. Results: Our integrative analysis revealed GNPDA1 and SLC25A16 as potential genes. Age, a family history of cancer, and alcohol consumption were associated with GNPDA1 and SLC25A16 based on the current data set and the GEO data set. GNPDA1 and SLC25A16 exhibited significant expression in breast cancer tissues based on UALCAN analysis, where they were overexpressed and underexpressed, respectively. Through a MethSurv analysis, GNPDA1 hypomethylation and SLC25A16 hypermethylation were associated with poor prognoses in terms of overall survival in breast cancer. Moreover, through a MetaCore functional enrichment analysis, GNPDA1 and SLC25A16 were associated with the BRCA1, BRCA2, and pro-oncogenic actions of the androgen receptor in breast cancer. Further, GNPDA1 and SLC25A16 were enriched in known targets of approved cancer drugs as potential genes associated with breast cancer. Conclusions: These two genes might serve as biomarkers for the early detection of breast cancer, especially for women with a family history of breast cancer. Full article

(This article belongs to the Special Issue Epigenetics in Precision Medicine: From Mechanism to Therapy)

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14 pages, 1456 KiB

Open AccessArticle

Personalized Approaches to Diabetic Foot Care: The Impact of Ethnic and Socioeconomic Disparities

by Tal Shachar, Eyal Yaacobi, Roy Romem, Mohamad Fadila, Geva Sarrabia, Mor Saban and Nissim Ohana

J. Pers. Med. 2025, 15(4), 133; https://doi.org/10.3390/jpm15040133 - 29 Mar 2025

Viewed by 288

Abstract

Objective: To explore the impact of ethnic and socioeconomic disparities on diabetic foot ulcer (DFU) care and outcomes, emphasizing the need for personalized treatment approaches tailored to diverse patient populations. Methods: This retrospective observational study analyzed 1409 patients hospitalized with DFUs [...] Read more.

Objective: To explore the impact of ethnic and socioeconomic disparities on diabetic foot ulcer (DFU) care and outcomes, emphasizing the need for personalized treatment approaches tailored to diverse patient populations. Methods: This retrospective observational study analyzed 1409 patients hospitalized with DFUs between 2016 and 2023 at a tertiary medical center. Data extracted from electronic medical records included demographics, socioeconomic status (SES), clinical variables, and healthcare utilization. Statistical analyses included descriptive statistics, Chi-Square and Kruskal–Wallis tests, and a regularized logistic regression model to identify predictors of mortality and disparities in treatment access. Results: Arab patients had significantly lower SES (median score: 3.00) compared to Jewish patients (median score: 8.00), resulting in reduced healthcare access and worse clinical outcomes. Arab patients were diagnosed with diabetes at a younger age (57 years vs. 68 years for Jewish patients) and exhibited a higher body mass index (30.36 vs. 28.68, p < 0.05). Despite similar mortality rates between groups (21.52% vs. 22.83%, p = 0.65), differences in healthcare utilization were evident, particularly in younger patients (18–59 years) within the internal medicine department (p = 0.017). Conclusions: Our findings underscore the need for a personalized approach to diabetic foot care, integrating socioeconomic and demographic factors into treatment plans. Ethnic minorities with lower SES, earlier diabetes onset, and higher BMI may require tailored intervention strategies to optimize prevention, access to specialized care, and adherence to treatment. Addressing individualized patient needs through precision medicine and culturally adapted healthcare models can improve outcomes and reduce disparities in DFU management. Full article

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

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12 pages, 519 KiB

Open AccessArticle

Effect of Flecainide in Idiopathic Premature Ventricular Contractions and the Induced Cardiomyopathy—UNIFLECA: A Single Arm, Non-Randomized Trial: Review of the Literature and Initial Results

by Sotirios Kotoulas, Dimitrios Tsiachris, Michail Botis, Athanasios Kordalis, Dimitrios Varvarousis, Georgios Leventopoulos, Eleftherios Kallergis, Ioannis Doundoulakis, Leonidas E. Poulimenos and Konstantinos Tsioufis

J. Pers. Med. 2025, 15(4), 132; https://doi.org/10.3390/jpm15040132 - 29 Mar 2025

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Abstract

Background/Objectives: Persistent high Premature Ventricular Contraction (PVC) burden (>10%) may result in PVC-induced cardiomyopathy. Current guidelines, supported by limited evidence, recommend flecainide for PVCs originating from the ventricular outflow tract (Class IIa). UNIFLECA is a prospective cohort study, aiming to assess the [...] Read more.

Background/Objectives: Persistent high Premature Ventricular Contraction (PVC) burden (>10%) may result in PVC-induced cardiomyopathy. Current guidelines, supported by limited evidence, recommend flecainide for PVCs originating from the ventricular outflow tract (Class IIa). UNIFLECA is a prospective cohort study, aiming to assess the efficacy and safety of flecainide in PVC burden reduction in adults, irrespective of PVC origin, focusing secondarily on symptom relief and improvement of left ventricular ejection fraction (LVEF) in patients suffering from PVC-induced cardiomyopathy. Methods: Participants were adults with frequent PVCs, defined as PVC burden > 5%, confirmed by two 24 h Holter recordings taken at least one month apart, who denied catheter ablation treatment. Patients who were deemed ineligible for catheter ablation were also included. A total of 50 patients were screened and 35 were administered Flecainide, with dosage adjustment based on follow-up Holter results and QRS increases. Changes in PVC burden, LVEF, symptomatic status, along with treatment adherence, were evaluated. Results: In adults with frequent PVCs, flecainide led to a significant reduction in PVC burden, with a mean decrease of 76.2% in the first month, and 63.1% of patients achieving a PVC burden reduction greater than 80%. Conclusions: UNIFLECA contributes to the understanding of how personalized, non-interventional therapeutic modalities can be employed to manage PVCs, especially for patients unwilling to have or ineligible for ablation procedures. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Cardiovascular Disease)

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J. Pers. Med., Volume 15, Issue 4 (April 2025) – 40 articles

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