Journal of Personalized Medicine

12 pages, 2955 KiB

Open AccessCase Report

Primary Pleural Lymphoma in an Immune-Competent Patient: A Diagnostic and Therapeutic Challenge

by Carlos Silva Paredes, Juan Lauretta, Marien Semprun, Diego Rivera-Porras, María Elena Viloria and Valmore Bermúdez

J. Pers. Med. 2025, 15(5), 162; https://doi.org/10.3390/jpm15050162 - 23 Apr 2025

Abstract

Background: Primary pleural lymphoma is a rare disease posing diagnostic and therapeutic challenges. Case presentation: We present a 65-year-old woman with dyspnoea, cough, and asthenia, with no significant past medical history. Chest X-ray and computed tomography showed extensive right pleural effusion. Video-assisted thoracoscopy [...] Read more.

Background: Primary pleural lymphoma is a rare disease posing diagnostic and therapeutic challenges. Case presentation: We present a 65-year-old woman with dyspnoea, cough, and asthenia, with no significant past medical history. Chest X-ray and computed tomography showed extensive right pleural effusion. Video-assisted thoracoscopy demonstrated multiple pleural nodules, while pleural fluid analysis revealed a lymphocytic exudate, and finally, a primary pleural lymphoma diagnosis was confirmed by immunohistochemistry analysis in pleural nodules biopsy. Discussion: In this regard, eight cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, dexamethasone, and rituximab were indicated, and after one year of follow-up, complete clinical and radiological remission was observed. Conlusions: We conclude that video-assisted thoracoscopy with an appropriate histopathological examination remains the gold standard for diagnosis, while R-CHOP chemotherapy plus rituximab may represent a highly effective therapeutic choice. Full article

(This article belongs to the Special Issue Innovations in Cancer Immunology: Personalized Therapeutic Approaches)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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

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)

► Show Figures

Figure 1

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

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

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

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)

► Show Figures

Figure 1

Journal Description

Journal of Personalized Medicine

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Further Information

Guidelines

MDPI Initiatives

Follow MDPI