Journal of Personalized Medicine

26 pages, 10034 KiB

Open AccessReview

Personalized Management of Sudden Death Risk in Primary Cardiomyopathies: From Clinical Evaluation and Multimodality Imaging to Ablation and Cardioverter-Defibrillator Implant

by Davide Lazzeroni, Antonio Crocamo, Valentina Ziveri, Maria Francesca Notarangelo, Davide Rizzello, Matteo Spoladori, Davide Donelli, Giovanna Cacciola, Diego Ardissino, Giampaolo Niccoli and Giovanni Peretto

J. Pers. Med. 2023, 13(5), 877; https://doi.org/10.3390/jpm13050877 - 22 May 2023

Viewed by 1686

Abstract

Sudden cardiac death represents the leading cause of death worldwide; although the majority of sudden deaths occur in an elderly population with coronary artery disease, some occur in young and otherwise healthy individuals, as is the case of cardiomyopathies. The aim of the [...] Read more.

Sudden cardiac death represents the leading cause of death worldwide; although the majority of sudden deaths occur in an elderly population with coronary artery disease, some occur in young and otherwise healthy individuals, as is the case of cardiomyopathies. The aim of the present review is to provide a stepwise hierarchical approach for the global sudden death risk estimation in primary cardiomyopathies. Each individual risk factor is analyzed for its contribution to the overall risk of sudden death for each specific cardiomyopathy as well as across all primary myocardial diseases. This stepwise hierarchical and personalized approach starts from the clinical evaluation, subsequently passes through the role of electrocardiographic monitoring and multimodality imaging, and finally concludes with genetic evaluation and electro-anatomical mapping. In fact, the sudden cardiac death risk assessment in cardiomyopathies depends on a multiparametric approach. Moreover, current indications for ventricular arrhythmia ablation and defibrillator implantation are discussed. Full article

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

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15 pages, 481 KiB

Open AccessArticle

Association between Psychological, Biochemical and Personal Factors with the Inflammatory Marker High-Sensitive C Reactive Protein (Hs-CRP) in Mexican Healthy Population

by Aniel Jessica Leticia Brambila-Tapia, Ana Lilia Jacquez-Castañeda, Laura Arely Carrillo-Delgadillo, Jessica Natalia Dávila-Flores, Fabiola Macías-Espinoza, Saúl Ramírez-De Los Santos and Itzae Adonai Gutiérrez-Hurtado

J. Pers. Med. 2023, 13(5), 876; https://doi.org/10.3390/jpm13050876 - 22 May 2023

Cited by 2 | Viewed by 1832

Abstract

In the last decades, it has been shown that inflammatory processes play a role in the development of mental and physical problems; although some studies have researched the relationship between inflammation and psychological variables, the inclusion of biochemical variables as possible confounders has [...] Read more.

In the last decades, it has been shown that inflammatory processes play a role in the development of mental and physical problems; although some studies have researched the relationship between inflammation and psychological variables, the inclusion of biochemical variables as possible confounders has been limited. Therefore, the aim of this study was to determine whether psychological variables are associated with the inflammatory marker, highly sensitive CRP (hs-CRP), after controlling for personal and biochemical variables in the Mexican population. The study was performed at the University of Guadalajara facilities, during the second half of 2022. Healthy subjects were invited to participate in the study, which consisted of the measurement of personal, psychological, and biochemical variables. We included 172 participants, 92 (52.9%) of which were women; the median (range) of age of the whole sample was 22 (18–69) years old. In the bivariate analysis, significant positive correlations were observed between hs-CRP and body mass index (BMI) and waist/hip ratio (WHR) in both sexes, together with leukocytes, uric acid, low-density lipoprotein (LDL), triglycerides, and the liver enzymes gamma glutamyl transferase (GGT) and alkaline phosphatase (ALP). In the multivariate regression analysis of the global and men’s samples, anxiety was positively associated with hs-CRP, while depression and positive relations with others were negatively associated with hs-CRP. In conclusion, psychological variables influence inflammation mainly in men, and anxiety was the main contributor; in addition, positive relation with others is a variable that should be further explored as a psychological protector of inflammation in both sexes. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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10 pages, 474 KiB

Open AccessArticle

A Case Series of Continuous Theta Burst Stimulation Treatment for the Supplementary Motor Area Twice a Day in Patients with Obsessive-Compulsive Disorder: A Real World TMS Registry Study in Japan

by Yoshihiro Noda, Kyoshiro Fujii, Fumi Tokura, Shinichiro Nakajima and Ryosuke Kitahata

J. Pers. Med. 2023, 13(5), 875; https://doi.org/10.3390/jpm13050875 - 22 May 2023

Cited by 3 | Viewed by 2141

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by patterns in which unwanted thoughts and fears are evoked as obsessions and furthermore, compulsive behaviors are provoked repeatedly, with a prevalence rate of 2% of the population. These obsessive-compulsive symptoms disrupt daily life and [...] Read more.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by patterns in which unwanted thoughts and fears are evoked as obsessions and furthermore, compulsive behaviors are provoked repeatedly, with a prevalence rate of 2% of the population. These obsessive-compulsive symptoms disrupt daily life and cause great distress to the individual. At present, OCD is treated with antidepressants, mainly selective serotonin reuptake inhibitors, and psychotherapy, including the exposure and response prevention method. However, these approaches may only show a certain level of efficacy, and approximately 50% of patients with OCD show treatment resistance. This situation has led to the research and development of neuromodulation therapies, including transcranial magnetic stimulation treatment, for OCD worldwide in recent years. In this case series, we retrospectively analyzed the TMS registry data of continuous theta burst stimulation (cTBS) therapy targeting the bilateral supplementary motor cortex for six patients with OCD whose obsessive-compulsive symptoms had not improved with pharmacotherapy. The results suggest that treatment with cTBS for the bilateral supplementary motor area may reduce obsessive-compulsive symptoms in patients with OCD, despite the limitations of an open-label preliminary case series. The present findings warrant further validation with a randomized, sham-controlled trial with a larger sample size in the future. Full article

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

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32 pages, 10714 KiB

Open AccessArticle

Using EfficientNet-B7 (CNN), Variational Auto Encoder (VAE) and Siamese Twins’ Networks to Evaluate Human Exercises as Super Objects in a TSSCI Images

by Yoram Segal, Ofer Hadar and Lenka Lhotska

J. Pers. Med. 2023, 13(5), 874; https://doi.org/10.3390/jpm13050874 - 22 May 2023

Cited by 4 | Viewed by 2971

Abstract

In this article, we introduce a new approach to human movement by defining the movement as a static super object represented by a single two-dimensional image. The described method is applicable in remote healthcare applications, such as physiotherapeutic exercises. It allows researchers to [...] Read more.

In this article, we introduce a new approach to human movement by defining the movement as a static super object represented by a single two-dimensional image. The described method is applicable in remote healthcare applications, such as physiotherapeutic exercises. It allows researchers to label and describe the entire exercise as a standalone object, isolated from the reference video. This approach allows us to perform various tasks, including detecting similar movements in a video, measuring and comparing movements, generating new similar movements, and defining choreography by controlling specific parameters in the human body skeleton. As a result of the presented approach, we can eliminate the need to label images manually, disregard the problem of finding the start and the end of an exercise, overcome synchronization issues between movements, and perform any deep learning network-based operation that processes super objects in images in general. As part of this article, we will demonstrate two application use cases: one illustrates how to verify and score a fitness exercise. In contrast, the other illustrates how to generate similar movements in the human skeleton space by addressing the challenge of supplying sufficient training data for deep learning applications (DL). A variational auto encoder (VAE) simulator and an EfficientNet-B7 classifier architecture embedded within a Siamese twin neural network are presented in this paper in order to demonstrate the two use cases. These use cases demonstrate the versatility of our innovative concept in measuring, categorizing, inferring human behavior, and generating gestures for other researchers. Full article

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

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15 pages, 815 KiB

Open AccessArticle

Positivity and Health Locus of Control: Key Variables to Intervene on Well-Being of Cardiovascular Disease Patients

by Bárbara Luque, Naima Z. Farhane-Medina, Marta Villalba, Rosario Castillo-Mayén, Esther Cuadrado and Carmen Tabernero

J. Pers. Med. 2023, 13(5), 873; https://doi.org/10.3390/jpm13050873 - 22 May 2023

Cited by 3 | Viewed by 1811

Abstract

Psychological well-being is a good predictor of several health outcomes in cardiovascular disease patients (adherence, quality of life, and healthy behaviors). The perception of health control and a positive orientation seem to have a beneficial effect on health and well-being. Therefore, the aim [...] Read more.

Psychological well-being is a good predictor of several health outcomes in cardiovascular disease patients (adherence, quality of life, and healthy behaviors). The perception of health control and a positive orientation seem to have a beneficial effect on health and well-being. Therefore, the aim of this study was to investigate the role of the health locus of control and positivity in the psychological well-being and quality of life of cardiovascular patients. A total of 593 cardiac outpatients completed the Multidimensional Health Locus of Control Scale, the Positivity Scale and the Hospital Anxiety and Depression Scale at baseline (January 2017) and 9 m later (follow-up; n = 323). A Spearman rank correlation coefficient and a structural equation modeling approach were determined to explore the relationships between those variables both cross-sectionally and longitudinally. A cross-sectional correlation analysis at baseline revealed that the internal health locus of control and positivity were negatively associated with anxiety (r_s = −0.15 and −0.44, ps < 0.01) and depression (r_s = −0.22 and −0.55, ps < 0.01) and positively associated with health-related quality of life (r_s = 0.16 and 0.46, ps < 0.01). Similar outcomes were found at follow-up and in longitudinal correlations. According to the path analysis, positivity was found to be negatively associated with anxiety and depression level at baseline (β = −0.42 and −0.45, ps < 0.001). Longitudinally, positivity was negatively associated with depression (β = 0.15, p < 0.01) and together with the internal health locus of control, was positively associated with health-related quality of life (β = 0.16 and 0.10, respectively, ps < 0.05). These findings suggest that focusing on the health locus of control and especially positivity may be crucial in enhancing the psychological well-being of patients in the context of cardiac care. The potential impact of these results on future interventions is discussed. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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3 pages, 177 KiB

Open AccessEditorial

Precision Medicine for Brain Disorders: New and Emerging Approaches

by Zack Y. Shan and Jim Lagopoulos

J. Pers. Med. 2023, 13(5), 872; https://doi.org/10.3390/jpm13050872 - 22 May 2023

Cited by 2 | Viewed by 1311

Abstract

The brain is the most complex organ in the human body, making it susceptible to many abnormalities [...] Full article

(This article belongs to the Section Mechanisms of Diseases)

9 pages, 869 KiB

Open AccessBrief Report

The Role of Myocardial Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events at 1 Year Follow-Up: A Single Center’s Experience

by Paraskevi Zotou, Aris Bechlioulis, Spyridon Tsiouris, Katerina K. Naka, Xanthi Xourgia, Konstantinos Pappas, Lampros Lakkas, Aidonis Rammos, John Kalef-Ezra, Lampros K. Michalis and Andreas Fotopoulos

J. Pers. Med. 2023, 13(5), 871; https://doi.org/10.3390/jpm13050871 - 22 May 2023

Cited by 1 | Viewed by 1366

Abstract

Background: Myocardial perfusion imaging via single-photon emission computed tomography (SPECT MPI) is a well-established method of diagnosing coronary artery disease (CAD). The purpose of this study was to assess the role of SPECT MPI in predicting major cardiovascular events. Methods: The study population [...] Read more.

Background: Myocardial perfusion imaging via single-photon emission computed tomography (SPECT MPI) is a well-established method of diagnosing coronary artery disease (CAD). The purpose of this study was to assess the role of SPECT MPI in predicting major cardiovascular events. Methods: The study population was composed of 614 consecutive patients (mean age: 67 years, 55% male) referred for SPECT MPI due to symptoms of stable CAD. The SPECT MPI was performed using a single-day protocol. We conducted a follow-up on all patients at 12 months via a telephone interview. Results: The majority of our patients (78%) presented findings suggestive of reversible ischemia, fixed defects or both. Extensive perfusion defects were found in 18% of the population, while LV dilation was found in 7%. During the 12-month follow-up, 16 deaths, 8 non-fatal MIs and 20 non-fatal strokes were recorded. There was no significant association of SPECT findings with the combined endpoint of all-cause death, non-fatal MI and non-fatal stroke. The presence of extensive perfusion defects was an independent predictor of mortality at 12 months (HR: 2.90, 95% CI: 1.05, 8.06, p = 0.041). Conclusions: In a high-risk patient population with suspected stable CAD, only large reversible perfusion defects in SPECT MPI were independently associated with mortality at 1 year. Further trials are needed to validate our findings and refine the role of SPECT MPI findings in the diagnosis and prognosis of cardiovascular patients. Full article

(This article belongs to the Special Issue Current Challenges and Personalized Treatment in Cardiovascular Disease)

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10 pages, 783 KiB

Open AccessArticle

Prostate Cancer Scoring Index for Risk of Progression of Radioresistant Disease

by Eleonora Cini Tesar, Ivana Mikolasevic, Iva Skocilic, Arnela Redjovic, Damir Vucinic, Jasna Marusic and Gordana Djordjevic

J. Pers. Med. 2023, 13(5), 870; https://doi.org/10.3390/jpm13050870 - 22 May 2023

Cited by 1 | Viewed by 1838

Abstract

Prostate cancer (Pca) is among the most common malignant diseases in men and the fourth leading cause of death worldwide. Surgery and radical radiotherapy (RT) remain the gold standard for the treatment of localized or locally advanced prostate cancer. The efficiency of radiotherapy [...] Read more.

Prostate cancer (Pca) is among the most common malignant diseases in men and the fourth leading cause of death worldwide. Surgery and radical radiotherapy (RT) remain the gold standard for the treatment of localized or locally advanced prostate cancer. The efficiency of radiotherapy treatment is limited by toxic side effects due to dose escalation. Cancer cells often develop radio-resistant mechanisms that are related to the DNA repair, inhibition of apoptosis or changes in cell cycle. Based on our earlier research on biomarkers that are involved in those cellular mechanisms (p53, bcl-2, NF-kb, Cripto-1 and Ki67 proliferation) and correlation with clinico-pathological parameters (age, PSA value, Gleason score, grade group, prognostic group), we created the numerical index for risk of tumor progression in patients with radioresistant tumors. For each of these parameters, the strength of association with disease progression was statistically assessed, and a specific number of points was assigned proportional to the strength of the correlation. Statistical analysis identified an optimal cut-off score of 22 or more as an indicator of significant risk for progression with a sensitivity of 91.7% and a specificity of 66.7%. The scoring system in the retrospective receiver operating characteristic analysis showed AUC of 0.82. The potential value of this scoring is the possibility of identifying patients with clinically significant radioresistant Pca. Full article

(This article belongs to the Section Mechanisms of Diseases)

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13 pages, 847 KiB

Open AccessArticle

Is Frailty a Good Predictor of Postoperative Complications in Elective Abdominal Surgery?—A Single-Center, Prospective, Observational Study

by Szymon Czajka, Maria Taborek and Łukasz J. Krzych

J. Pers. Med. 2023, 13(5), 869; https://doi.org/10.3390/jpm13050869 - 21 May 2023

Cited by 2 | Viewed by 1775

Abstract

Background: Despite the common occurrence of postoperative complications in patients with frailty syndrome, the nature and severity of this relationship remains unclear. We aimed to assess the association of frailty with possible postoperative complications after elective, abdominal surgery in participants of a single-centre [...] Read more.

Background: Despite the common occurrence of postoperative complications in patients with frailty syndrome, the nature and severity of this relationship remains unclear. We aimed to assess the association of frailty with possible postoperative complications after elective, abdominal surgery in participants of a single-centre prospective study in relation to other risk classification methods. Methods: Frailty was assessed preoperatively using the Edmonton Frail Scale (EFS), Modified Frailty Index (mFI) and Clinical Frailty Scale (CFS). Perioperative risk was assessed using the American Society of Anesthesiology Physical Status (ASA PS), Operative Severity Score (OSS) and Surgical Mortality Probability Model (S-MPM). Results: The frailty scores failed to predict in-hospital complications. The values of AUCs for in-hospital complications ranged between 0.5 and 0.6 and were statistically nonsignificant. The perioperative risk measuring system performance in ROC analysis was satisfactory with AUC ranging from 0.63 for OSS to 0.65 for S-MPM (p < 0.05 for each). Conclusions: The analysed frailty rating scales proved to be poor predictors of postoperative complications in the studied population. Scales assessing perioperative risk performed better. Further studies are needed to obtain optimal predictive tools in senior patients undergoing surgery. Full article

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9 pages, 770 KiB

Open AccessArticle

Fixed Flexion Contracture Can Successfully Be Addressed with Exact Preservation of the Femoral Joint Line and Only Minimal Increase of Tibia Resection in the Concept of Kinematically Aligned Total Knee Arthroplasty

by Joaquin Moya-Angeler, Vicente J. León-Muñoz, Cristina Jimenez-Soto, Kim Huber, Bernhard Christen and Tilman Calliess

J. Pers. Med. 2023, 13(5), 868; https://doi.org/10.3390/jpm13050868 - 21 May 2023

Cited by 3 | Viewed by 1621

Abstract

The aims of this study were to evaluate the outcomes of patients undergoing kinematic alignment (KA) robot-assisted (RA) total knee arthroplasty (TKA) with and without preoperative fixed flexion contracture (FFC) and address whether additional resection of the proximal tibia is required to address [...] Read more.

The aims of this study were to evaluate the outcomes of patients undergoing kinematic alignment (KA) robot-assisted (RA) total knee arthroplasty (TKA) with and without preoperative fixed flexion contracture (FFC) and address whether additional resection of the proximal tibia is required to address FFC. A retrospective review from 147 consecutive patients who received an RA-TKA with KA and a minimum one-year follow-up was performed. Preop and postop clinical and surgical data were collected. Groups were set based on preoperative extension deficits: group 1 (0–4°) (n = 64), group 2 (5–10°) (n = 64) and group 3 (>11°) (n = 27). There were no differences in patient demographics among the three groups. In group 3, the mean tibia resection was 0.85 mm thicker than group 1 (p < 0.05) and the preoperative extension deficit was improved from −17.22° (SD 3.49) preop to −2.41° (SD 4.47) postop (p < 0.05). Our results demonstrate that FFC can successfully be addressed in the RA-TKA with KA and rKA and that no additional femoral bone resection is needed to achieve full extension in patients with preoperative FFC when compared with patients without FFC. Only a slight increase in the amount of tibial resection was observed, but this was less than one millimetre. Full article

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

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11 pages, 670 KiB

Open AccessSystematic Review

Multiple General Anesthesia in Children: A Systematic Review of Its Effect on Neurodevelopment

by Giacomo Colletti, Mattia Di Bartolomeo, Sara Negrello, Roy G. Geronemus, Bernard Cohen, Luigi Chiarini, Alexandre Anesi, Raimondo Feminò, Ilaria Mariotti, Gregory M. Levitin, Linda Rozell-Shannon and Riccardo Nocini

J. Pers. Med. 2023, 13(5), 867; https://doi.org/10.3390/jpm13050867 - 21 May 2023

Cited by 5 | Viewed by 2978

Abstract

The effect of multiple general anesthesia (mGA) procedures administered in early life is a critical theme and has led the Food and Drug Administration (FDA) to issue an alert. This systematic review seeks to explore the potential effects on neurodevelopment of mGA on [...] Read more.

The effect of multiple general anesthesia (mGA) procedures administered in early life is a critical theme and has led the Food and Drug Administration (FDA) to issue an alert. This systematic review seeks to explore the potential effects on neurodevelopment of mGA on patients under 4 years. The Medline, Embase and Web of Science databases were searched for publications up to 31 March 2021. The databases were searched for publications regarding “children multiple general anesthesia OR pediatric multiple general anesthesia”. Case reports, animal studies and expert opinions were excluded. Systematic reviews were not included, but they were screened to identify any possible additional information. A total of 3156 studies were identified. After removing the duplicates, screening the remaining records and analyzing the systematic reviews’ bibliography, 10 studies were considered suitable for inclusion. Comprehensively, a total cohort of 264.759 unexposed children and 11.027 exposed children were assessed for neurodevelopmental outcomes. Only one paper did not find any statistically significant difference between exposed and unexposed children in terms of neurodevelopmental alterations. Controlled studies on mGA administered before 4 years of age support that there might be a greater risk of neurodevelopmental delay in children receiving mGA, warranting the need for careful risk/benefit considerations. Full article

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

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11 pages, 1014 KiB

Open AccessArticle

Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre

by Baijaeek Sain, Arnab Gupta, Aruni Ghose, Sudip Halder, Vishal Mukherjee, Samir Bhattacharya, Radha Raman Mondal, Aditya Narayan Sen, Bijan Saha, Shravasti Roy and Stergios Boussios

J. Pers. Med. 2023, 13(5), 866; https://doi.org/10.3390/jpm13050866 - 21 May 2023

Cited by 7 | Viewed by 1847

Abstract

Background: Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. Aims and objectives: This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors [...] Read more.

Background: Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. Aims and objectives: This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. Methodology: A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery—either mastectomy or lumpectomy—and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. Results: We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15–70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). Conclusion: Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy. Full article

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12 pages, 886 KiB

Open AccessArticle

Local Treatment of Triple-Negative Breast Cancer: Is Mastectomy Superior to Breast-Conserving Surgery?

by Alba Di Leone, Antonio Franco, Francesca Zotta, Lorenzo Scardina, Margherita Sicignano, Enrico Di Guglielmo, Virginia Castagnetta, Stefano Magno, Daniela Terribile, Alejandro Martin Sanchez, Gianluca Franceschini and Riccardo Masetti

J. Pers. Med. 2023, 13(5), 865; https://doi.org/10.3390/jpm13050865 - 21 May 2023

Cited by 2 | Viewed by 1919

Abstract

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis [...] Read more.

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis as compared with other subtypes of breast cancer. The more rapid onset of this cancer and its aggressiveness have often convinced breast surgeons that mastectomy could provide better oncological results. However, there is no relevant clinical trial that has assessed differences between breast-conserving surgery (BCS) and mastectomy (M) in these patients. This population-based study aimed to investigate the distinct outcomes between conservative treatment and M in a case series of 289 patients with TNBC treated over a 9-year period. This monocentric study retrospectively evaluated patients with TNBC who underwent upfront surgery at Fondazione Policlinico Agostino Gemelli IRCCS, in Rome, between 1 January 2013 and 31 December 2021. First, the patients were divided in two groups according to the surgical treatment received: BCS vs. M. Then, the patients were stratified into four risk subclasses based on combined T and N pathological staging (T1N0, T1N+, T2-4N0 and T2-4N+). The primary endpoint of the study was to evaluate locoregional disease-free survival (LR-DFS), distant disease-free survival (DDFS) and overall survival (OS) in the different subclasses. We analyzed 289 patients that underwent either breast-conserving surgery (247/289, 85.5%) or mastectomy (42/289, 14.5%). After a median follow-up of 43.2 months (49.7, 22.2–74.3), 28 patients (9.6%) developed a locoregional recurrence, 27 patients (9.0%) showed systemic recurrence and 19 patients (6.5%) died. No significant differences due to type of surgical treatment were observed in the different risk subclasses in terms of locoregional disease-free survival, distant disease-free survival and overall survival. With the limits of a retrospective, single-center study, our data seem to indicate similar efficacy in terms of locoregional control, distant metastasis and overall survival with the use of upfront breast-conserving surgery as compared with radical surgery in the treatment of TNBC. Therefore, TNBC should not be considered to be a contraindication for breast conservation. Full article

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

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12 pages, 1923 KiB

Open AccessBrief Report

Comparing Cytology Brushes for Optimal Human Nasal Epithelial Cell Collection: Implications for Airway Disease Diagnosis and Research

by Laura K. Fawcett, Nihan Turgutoglu, Katelin M. Allan, Yvonne Belessis, John Widger, Adam Jaffe and Shafagh A. Waters

J. Pers. Med. 2023, 13(5), 864; https://doi.org/10.3390/jpm13050864 - 21 May 2023

Cited by 3 | Viewed by 2509

Abstract

Primary nasal epithelial cells and culture models are used as important diagnostic, research and drug development tools for several airway diseases. Various instruments have been used for the collection of human nasal epithelial (HNE) cells but no global consensus yet exists regarding the [...] Read more.

Primary nasal epithelial cells and culture models are used as important diagnostic, research and drug development tools for several airway diseases. Various instruments have been used for the collection of human nasal epithelial (HNE) cells but no global consensus yet exists regarding the optimal tool. This study compares the efficiency of two cytology brushes (Olympus (2 mm diameter) and Endoscan (8 mm diameter)) in collecting HNE cells. The study involved two phases, with phase one comparing the yield, morphology and cilia beat frequency (CBF) of cells collected from paediatric participants using each of the two brushes. Phase two compared nasal brushing under general anaesthetic and in the awake state, across a wide age range, via the retrospective audit of the use of the Endoscan brush in 145 participants. Results indicated no significant difference in CBF measurements between the two brushes, suggesting that the choice of brush does not compromise diagnostic accuracy. However, the Endoscan brush collected significantly more total and live cells than the Olympus brush, making it a more efficient option. Importantly, the Endoscan brush is more cost-effective, with a notable price difference between the two brushes. Full article

(This article belongs to the Section Pharmacogenetics)

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10 pages, 1146 KiB

Open AccessArticle

Feasibility of Ultrasound-Guided, Peripherally Inserted Central Catheter Placement at the Bedside in a Communicable-Disease Isolation Unit

by Kyoung Won Yoon, Wongook Wi, Moon Suk Choi, Eunmi Gil, Chi-Min Park and Keesang Yoo

J. Pers. Med. 2023, 13(5), 863; https://doi.org/10.3390/jpm13050863 - 20 May 2023

Cited by 2 | Viewed by 2104

Abstract

Background: Previous studies have investigated the safety of peripherally inserted central catheters (PICCs) in the intensive care unit (ICU). However, it remains uncertain whether PICC placement can be successfully carried out in settings with limited resources and a challenging environment for procedures, such [...] Read more.

Background: Previous studies have investigated the safety of peripherally inserted central catheters (PICCs) in the intensive care unit (ICU). However, it remains uncertain whether PICC placement can be successfully carried out in settings with limited resources and a challenging environment for procedures, such as communicable-disease isolation units (CDIUs). Methods: This study investigated the safety of PICCs in patients admitted to CDIUs. These researchers used a handheld portable ultrasound device (PUD) to guide venous access and confirmed catheter-tip location with electrocardiography (ECG) or portable chest radiography. Results: Among 74 patients, the basilic vein and the right arm were the most common access site and location, respectively. The incidence of malposition was significantly higher with chest radiography compared to ECG (52.4% vs. 2.0%, p < 0.001). Conclusions: Using a handheld PUD to place PICCs at the bedside and confirming the tip location with ECG is a feasible option for CDIU patients. Full article

(This article belongs to the Special Issue Challenges in COVID-19 and Related Complications)

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17 pages, 1629 KiB

Open AccessArticle

Radiomics in Breast Imaging: Future Development

by Alessandra Panico, Gianluca Gatta, Antonio Salvia, Graziella Di Grezia, Noemi Fico and Vincenzo Cuccurullo

J. Pers. Med. 2023, 13(5), 862; https://doi.org/10.3390/jpm13050862 - 20 May 2023

Cited by 5 | Viewed by 1936

Abstract

Breast cancer is the most common and most commonly diagnosed non-skin cancer in women. There are several risk factors related to habits and heredity, and screening is essential to reduce the incidence of mortality. Thanks to screening and increased awareness among women, most [...] Read more.

Breast cancer is the most common and most commonly diagnosed non-skin cancer in women. There are several risk factors related to habits and heredity, and screening is essential to reduce the incidence of mortality. Thanks to screening and increased awareness among women, most breast cancers are diagnosed at an early stage, increasing the chances of cure and survival. Regular screening is essential. Mammography is currently the gold standard for breast cancer diagnosis. In mammography, we can encounter problems with the sensitivity of the instrument; in fact, in the case of a high density of glands, the ability to detect small masses is reduced. In fact, in some cases, the lesion may not be particularly evident, it may be hidden, and it is possible to incur false negatives as partial details that may escape the radiologist’s eye. The problem is, therefore, substantial, and it makes sense to look for techniques that can increase the quality of diagnosis. In recent years, innovative techniques based on artificial intelligence have been used in this regard, which are able to see where the human eye cannot reach. In this paper, we can see the application of radiomics in mammography. Full article

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

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17 pages, 2901 KiB

Open AccessReview

The Magnitude of Cardiovascular Disease Risk Factors in Seafarers from 1994 to 2021: A Systematic Review and Meta-Analysis

by Getu Gamo Sagaro, Ulrico Angeloni, Claudia Marotta, Giulio Nittari, Giovanni Rezza, Andrea Silenzi, Gopi Battineni and Francesco Amenta

J. Pers. Med. 2023, 13(5), 861; https://doi.org/10.3390/jpm13050861 - 20 May 2023

Cited by 2 | Viewed by 2250

Abstract

Objectives: The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this [...] Read more.

Objectives: The incidence of acute cardiac events is one of the main reasons for medical consultation, disembarkation, repatriation, and death among seafarers at sea. Managing cardiovascular risk factors, particularly those that can be modified, is the key to preventing cardiovascular disease. Therefore, this review estimates the pooled prevalence of major CVD risk factors among seafarers. Methods: We conducted a comprehensive search of studies published between 1994 and December 2021 in four international databases, namely PubMed/Medline, Scopus, Google Scholar, and Web of Science (WOS). Each study was evaluated for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. The DerSimonian–Laird random-effects model with logit transformations was used to estimate the pooled prevalence of major CVD risk factors. The results were reported in accordance with the Preferred Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Results: Out of all 1484 studies reviewed, 21 studies with 145,913 study participants met the eligibility criteria and were included in the meta-analysis. In the pooled analysis, the prevalence of smoking was found to be 40.14% (95% CI: 34.29 to 46.29%) with heterogeneity between studies (I² = 98%, p < 0.01). The prevalence of hypertension, overweight, obesity, diabetes mellitus, and alcohol consumption was 45.32%, 41.67%, 18.60%, 12.70%, and 38.58%, respectively. However, the sensitivity analysis after excluding studies showed a pooled prevalence of hypertension, overweight, obesity, and diabetes mellitus of 44.86%, 41.87%, 15.99%, and 16.84%, respectively. The subgroup analysis demonstrated that smoking prevalence among seafarers had decreased significantly after 2013. Conclusion: This study demonstrated that CVD risk factors, particularly hypertension, overweight, smoking, alcohol consumption, and obesity, are prevalent among seafarers. These findings may serve as a guide for shipping companies and other responsible bodies in order to prevent CVD risk factors among seafarers. PROSPERO Registration: CRD42022300993. Full article

(This article belongs to the Special Issue Digital Health and Telemedicine: Their Contribution to Personalized and Precision Medicine)

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21 pages, 4092 KiB

Open AccessArticle

Acquisition Parameters Influence Diffusion Metrics Effectiveness in Probing Prostate Tumor and Age-Related Microstructure

by Alessandra Stella Caporale, Marco Nezzo, Maria Giovanna Di Trani, Alessandra Maiuro, Roberto Miano, Pierluigi Bove, Alessandro Mauriello, Guglielmo Manenti and Silvia Capuani

J. Pers. Med. 2023, 13(5), 860; https://doi.org/10.3390/jpm13050860 - 20 May 2023

Cited by 1 | Viewed by 1805

Abstract

This study aimed to investigate the Diffusion-Tensor-Imaging (DTI) potential in the detection of microstructural changes in prostate cancer (PCa) in relation to the diffusion weight (b-value) and the associated diffusion length l_D. Thirty-two patients (age range = 50–87 years) with biopsy-proven [...] Read more.

This study aimed to investigate the Diffusion-Tensor-Imaging (DTI) potential in the detection of microstructural changes in prostate cancer (PCa) in relation to the diffusion weight (b-value) and the associated diffusion length l_D. Thirty-two patients (age range = 50–87 years) with biopsy-proven PCa underwent Diffusion-Weighted-Imaging (DWI) at 3T, using single non-zero b-value or groups of b-values up to b = 2500 s/mm². The DTI maps (mean-diffusivity, MD; fractional-anisotropy, FA; axial and radial diffusivity, D// and D┴), visual quality, and the association between DTI-metrics and Gleason Score (GS) and DTI-metrics and age were discussed in relation to diffusion compartments probed by water molecules at different b-values. DTI-metrics differentiated benign from PCa tissue (p ≤ 0.0005), with the best discriminative power versus GS at b-values ≥ 1500 s/mm², and for b-values range 0–2000 s/mm², when the l_D is comparable to the size of the epithelial compartment. The strongest linear correlations between MD, D//, D┴, and GS were found at b = 2000 s/mm² and for the range 0–2000 s/mm². A positive correlation between DTI parameters and age was found in benign tissue. In conclusion, the use of the b-value range 0–2000 s/mm² and b-value = 2000 s/mm² improves the contrast and discriminative power of DTI with respect to PCa. The sensitivity of DTI parameters to age-related microstructural changes is worth consideration. Full article

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

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14 pages, 2784 KiB

Open AccessArticle

A New Digital Method to Quantify the Effects Produced by Carriere Motion Appliance

by Aldara Rosalía Nercellas Rodríguez, Pedro Colino Gallardo, Álvaro Zubizarreta-Macho, Carlos Colino Paniagua, Alfonso Alvarado Lorenzo and Alberto Albaladejo Martínez

J. Pers. Med. 2023, 13(5), 859; https://doi.org/10.3390/jpm13050859 - 20 May 2023

Cited by 2 | Viewed by 2132

Abstract

The aim of this study was to analyze a novel digital technique to quantify the distal tooth displacement and derotation angle produced by the Carriere Motion Appliance (CMA). Twenty-one patients with a class II molar and canine relationship underwent orthodontic treatment with CMA. [...] Read more.

The aim of this study was to analyze a novel digital technique to quantify the distal tooth displacement and derotation angle produced by the Carriere Motion Appliance (CMA). Twenty-one patients with a class II molar and canine relationship underwent orthodontic treatment with CMA. All patients were exposed before (STL1) and after the CMA placement (STL2), submitted to a digital impression, and afterwards, data were uploaded to specific cephalometric software to allow automatic mesh network alignment of the STL digital files. Subsequently, the distal tooth displacement of the upper canines and first upper molars, as well as the derotation angle of the first upper molars were analyzed using the Pearson correlation coefficient (ρ). Repeatability and reproducibility were analyzed using Gage R&R statistical analysis. An increase in canine displacement was correlated with an increase in contralateral canine displacement (ρ = 0.759; p < 0.000). An increase in canine displacement was correlated with an increase in molar displacement (ρ = 0.715; p < 0.001). An increase in upper first molar displacement was correlated with an increase in the contralateral upper first molar displacement (ρ = 0.609; p < 0.003) and the canine displacement (ρ = 0.728; p < 0.001). The distal tooth displacement showed a repeatability of 0.62% and reproducibility of 7.49%, and the derotation angle showed a repeatability of 0.30% and reproducibility of 0.12%. The novel digital measurement technique is a reproducible, repeatable, and accurate method for quantifying the distal tooth displacement of the upper canine and first upper molar, as well as the derotation angle of the first upper molars after using CMA. Full article

(This article belongs to the Special Issue Recent Advances in Dental Practice)

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11 pages, 1132 KiB

Open AccessArticle

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

by Traian Dumitrascu and Irinel Popescu

J. Pers. Med. 2023, 13(5), 858; https://doi.org/10.3390/jpm13050858 - 20 May 2023

Cited by 2 | Viewed by 1343

Abstract

(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between [...] Read more.

(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between 1 January 2002 and 31 December 2022) were retrospectively assessed and compared. (3) Results: 29 CP were analyzed: WJ—12 patients (41.4%) and PJ—17 patients (58.6%). The operative time was significantly higher in the WJ vs. PJ group of patients (195 min vs. 140 min, p = 0.012). Statistically higher rates of patients within the high-risk fistula group were observed in the PJ vs. WJ group (52.9% vs. 0%, p = 0.003). However, no differences were observed between the groups regarding the overall, severe, and specific postpancreatectomy morbidity rates (p values ≥ 0.170). (4) Conclusions: The WJ and PJ anastomoses after CP were comparable in terms of morbidity rates. However, a PJ anastomosis appeared to fit better for patients with high-risk fistula scores. Thus, a personalized, patient-adapted technique for the distal pancreatic stump anastomosis with the jejunum after CP should be considered. At the same time, future research should explore gastric anastomoses’ emerging role. Full article

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

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10 pages, 3902 KiB

Open AccessBrief Report

Highly Selective Targeting of Pancreatic Cancer in the Liver with a Near-Infrared Anti-MUC5AC Probe in a PDOX Mouse Model: A Proof-of-Concept Study

by Michael A. Turner, Kristin E. Cox, Nicholas Neel, Siamak Amirfakhri, Hiroto Nishino, Bryan M. Clary, Mojgan Hosseini, Gopalakrishnan Natarajan, Kavita Mallya, Aaron M. Mohs, Robert M. Hoffman, Surinder K. Batra and Michael Bouvet

J. Pers. Med. 2023, 13(5), 857; https://doi.org/10.3390/jpm13050857 - 20 May 2023

Cited by 1 | Viewed by 2297

Abstract

Accurately identifying metastatic disease is critical to directing the appropriate treatment in pancreatic cancer. Mucin 5AC is overexpressed in pancreatic cancer but absent in normal pancreas tissue. The present proof-of-concept study demonstrates the efficacy of an anti-mucin 5AC antibody conjugated to an IR800 [...] Read more.

Accurately identifying metastatic disease is critical to directing the appropriate treatment in pancreatic cancer. Mucin 5AC is overexpressed in pancreatic cancer but absent in normal pancreas tissue. The present proof-of-concept study demonstrates the efficacy of an anti-mucin 5AC antibody conjugated to an IR800 dye (MUC5AC-IR800) to preferentially label a liver metastasis of pancreatic cancer (Panc Met) in a unique patient-derived orthotopic xenograft (PDOX) model. In orthotopic models, the mean tumor to background ratio was 1.787 (SD ± 0.336), and immunohistochemistry confirmed the expression of MUC5AC within tumor cells. MUC5AC-IR800 provides distinct visualization of pancreatic cancer liver metastasis in a PDOX mouse model, demonstrating its potential utility in staging laparoscopy and fluorescence-guided surgery. Full article

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13 pages, 1208 KiB

Open AccessArticle

The Comparison of Predicting Factors and Outcomes of MINOCA and STEMI Patients in the 5-Year Follow-Up

by Patryk Buller, Adam Kern, Maciej Tyczyński, Wojciech Rosiak, Włodzimierz Figatowski, Robert J. Gil and Jacek Bil

J. Pers. Med. 2023, 13(5), 856; https://doi.org/10.3390/jpm13050856 - 19 May 2023

Cited by 1 | Viewed by 1718

Abstract

The long-term outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are still not well known. This study aimed to compare the characteristics and outcomes between MINOCA and STEMI patients in a 5-year follow-up. Between 2010 and 2015 we identified 3171 [...] Read more.

The long-term outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are still not well known. This study aimed to compare the characteristics and outcomes between MINOCA and STEMI patients in a 5-year follow-up. Between 2010 and 2015 we identified 3171 coronary angiography procedures performed due to acute coronary syndrome, from which 153 had a working MINOCA diagnosis, and the final diagnosis of MINOCA was ascribed to 112 (5.8%) patients. Additionally, we matched 166 patients with STEMI and obstructive coronary arteries as the reference group. In MINOCA patients (mean age of 63 years), there were more females (60% vs. 26%, p < 0.001), and patients presented most frequently with NSTEMI (83.9%). Patients with MINOCA had more frequent atrial fibrillation (22% vs. 5.4%, p < 0.001) and higher left ventricular ejection fraction (59 ± 10% vs. 54 ± 10%, p < 0.001) compared to STEMI patients. We observed only a trend for a higher rate of MACE in STEMI patients at 5 years (11.6% vs. 18.7%, HR 1.82, 95% CI 0.91–3.63, p = 0.09). In multivariable Cox regression, only beta-blocker use was a protective factor (a trend observed), with HR 0.33, 95% CI 0.10–1.15, p = 0.082 of future MACE. The outcomes of MINOCA and STEMI patients were comparable in the 5-year follow-up. Full article

(This article belongs to the Special Issue Personalized Medicine for Coronary Artery Disease: Diagnosis, Prevention, and Treatment)

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10 pages, 4051 KiB

Open AccessTechnical Note

The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA

by Sébastien Parratte, Jeremy Daxhelet, Jean-Noel Argenson and Cécile Batailler

J. Pers. Med. 2023, 13(5), 855; https://doi.org/10.3390/jpm13050855 - 19 May 2023

Cited by 3 | Viewed by 1614

Abstract

The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help [...] Read more.

The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help the surgeon to improve accuracy. The technique described in this paper is based on the use of a simple and reproducible anatomical landmark. This landmark is the line of insertion of the fibers of the deep medial collateral ligament (MCL) around the anterior half of the medial tibial plateau called the “Deep MCL insertion line”. The used anatomical landmark determines the orientation (in the coronal and sagittal planes) and the thickness of the tibial cut. This landmark corresponds to the line of insertion of the fibers of the deep MCL around the anterior half of the medial tibial plateau. A consecutive series of patients who underwent primary medial UKA between 2019 and 2021 were retrospectively reviewed. A total of 50 UKA were included. The mean age at the time of surgery was 54.5 ± 6.6 years (44–79). The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements. The limb and implant alignments and the tibial positioning were satisfying, with a low rate of outliers and good restoration of the native anatomy. The landmark of the insertion of deep MCL constitutes a reliable and reproducible reference for the tibial cut axis and thickness during medial UKA, independent of the wear severity. Full article

(This article belongs to the Special Issue Cutting-Edge in Arthroplasty: Before, While and after Surgery)

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9 pages, 3225 KiB

Open AccessTechnical Note

Morphological Variation of the Mandible in the Orthognathic Population—A Morphological Study Using Statistical Shape Modelling

by Hylke van der Wel, Bingjiang Qiu, Fred K. L. Spijkervet, Johan Jansma, Rutger H. Schepers and Joep Kraeima

J. Pers. Med. 2023, 13(5), 854; https://doi.org/10.3390/jpm13050854 - 19 May 2023

Cited by 3 | Viewed by 1921

Abstract

The aim of this study was to investigate the value of 3D Statistical Shape Modelling for orthognathic surgery planning. The goal was to objectify shape variations in the orthognathic population and differences between male and female patients by means of a statistical shape [...] Read more.

The aim of this study was to investigate the value of 3D Statistical Shape Modelling for orthognathic surgery planning. The goal was to objectify shape variations in the orthognathic population and differences between male and female patients by means of a statistical shape modelling method. Pre-operative CBCT scans of patients for whom 3D Virtual Surgical Plans (3D VSP) were developed at the University Medical Center Groningen between 2019 and 2020 were included. Automatic segmentation algorithms were used to create 3D models of the mandibles, and the statistical shape model was built through principal component analysis. Unpaired t-tests were performed to compare the principal components of the male and female models. A total of 194 patients (130 females and 64 males) were included. The mandibular shape could be visually described by the first five principal components: (1) The height of the mandibular ramus and condyles, (2) the variation in the gonial angle of the mandible, (3) the width of the ramus and the anterior/posterior projection of the chin, (4) the lateral projection of the mandible’s angle, and (5) the lateral slope of the ramus and the inter-condylar distance. The statistical test showed significant differences between male and female mandibular shapes in 10 principal components. This study demonstrates the feasibility of using statistical shape modelling to inform physicians about mandible shape variations and relevant differences between male and female mandibles. The information obtained from this study could be used to quantify masculine and feminine mandibular shape aspects and to improve surgical planning for mandibular shape manipulations. Full article

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17 pages, 1194 KiB

Open AccessReview

Ligand-Gated Ion Channels: Prognostic and Therapeutic Implications for Gliomas

by Grace Hey, Rohan Rao, Ashley Carter, Akshay Reddy, Daisy Valle, Anjali Patel, Drashti Patel, Brandon Lucke-Wold, Daniel Pomeranz Krummel and Soma Sengupta

J. Pers. Med. 2023, 13(5), 853; https://doi.org/10.3390/jpm13050853 - 19 May 2023

Cited by 3 | Viewed by 3059

Abstract

Gliomas are common primary brain malignancies that remain difficult to treat due to their overall aggressiveness and heterogeneity. Although a variety of therapeutic strategies have been employed for the treatment of gliomas, there is increasing evidence that suggests ligand-gated ion channels (LGICs) can [...] Read more.

Gliomas are common primary brain malignancies that remain difficult to treat due to their overall aggressiveness and heterogeneity. Although a variety of therapeutic strategies have been employed for the treatment of gliomas, there is increasing evidence that suggests ligand-gated ion channels (LGICs) can serve as a valuable biomarker and diagnostic tool in the pathogenesis of gliomas. Various LGICs, including P2X, SYT16, and PANX2, have the potential to become altered in the pathogenesis of glioma, which can disrupt the homeostatic activity of neurons, microglia, and astrocytes, further exacerbating the symptoms and progression of glioma. Consequently, LGICs, including purinoceptors, glutamate-gated receptors, and Cys-loop receptors, have been targeted in clinical trials for their potential therapeutic benefit in the diagnosis and treatment of gliomas. In this review, we discuss the role of LGICs in the pathogenesis of glioma, including genetic factors and the effect of altered LGIC activity on the biological functioning of neuronal cells. Additionally, we discuss current and emerging investigations regarding the use of LGICs as a clinical target and potential therapeutic for gliomas. Full article

(This article belongs to the Section Mechanisms of Diseases)

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15 pages, 1905 KiB

Open AccessPerspective

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States

by Kai-Uwe Lewandrowski, John C. Elfar, Zong-Ming Li, Benedikt W. Burkhardt, Morgan P. Lorio, Peter A. Winkler, Joachim M. Oertel, Albert E. Telfeian, Álvaro Dowling, Roth A. A. Vargas, Ricardo Ramina, Ivo Abraham, Marjan Assefi, Huilin Yang, Xifeng Zhang, Jorge Felipe Ramírez León, Rossano Kepler Alvim Fiorelli, Mauricio G. Pereira, Paulo Sérgio Teixeira de Carvalho, Helton Defino, Jaime Moyano, Kang Taek Lim, Hyeun-Sung Kim, Nicola Montemurro, Anthony Yeung and Pietro Novellino Show full author list Hide full author list

J. Pers. Med. 2023, 13(5), 852; https://doi.org/10.3390/jpm13050852 - 18 May 2023

Cited by 10 | Viewed by 3304

Abstract

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial [...] Read more.

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work–life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur–investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management. Full article

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11 pages, 285 KiB

Open AccessArticle

Forecasting Individual Patients’ Best Time for Surgery in Colon-Rectal Cancer by Tumor Regression during and after Neoadjuvant Radiochemotherapy

by Emanuele Martorana, Paolo Castorina, Gianluca Ferini, Stefano Forte and Marzia Mare

J. Pers. Med. 2023, 13(5), 851; https://doi.org/10.3390/jpm13050851 - 18 May 2023

Cited by 1 | Viewed by 1478

Abstract

The standard treatment of locally advanced rectal cancer is neoadjuvant chemoradiotherapy before surgery. For those patients experiencing a complete clinical response after the treatment, a watch-and-wait strategy with close monitoring may be practicable. In this respect, the identification of biomarkers of the response [...] Read more.

The standard treatment of locally advanced rectal cancer is neoadjuvant chemoradiotherapy before surgery. For those patients experiencing a complete clinical response after the treatment, a watch-and-wait strategy with close monitoring may be practicable. In this respect, the identification of biomarkers of the response to therapy is extremely important. Many mathematical models have been developed or used to describe tumor growth, such as Gompertz’s Law and the Logistic Law. Here we show that the parameters of those macroscopic growth laws, obtained by fitting the tumor evolution during and immediately after therapy, are a useful tool for evaluating the best time for surgery in this type of cancer. A limited number of experimental observations of the tumor volume regression, during and after the neoadjuvant doses, permits a reliable evaluation of a specific patient response (partial or complete recovery) for a later time, and one can evaluate a modification of the scheduled treatment, following a watch-and-wait approach or an early or late surgery. Neoadjuvant chemoradiotherapy effects can be quantitatively described by applying Gompertz’s Law and the Logistic Law to estimate tumor growth by monitoring patients at regular intervals. We show a quantitative difference in macroscopic parameters between partial and complete response patients, reliable for estimating the treatment effects and best time for surgery. Full article

(This article belongs to the Special Issue Mathematical Models of Personalized Medicine)

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15 pages, 441 KiB

Open AccessArticle

Perceptions and Usability of PREVENTION: A Breast Cancer Risk Assessment e-Platform

by Samar Attieh, Marika Monarque, Andrew Durand, Saima Ahmed, Bartha M. Knoppers, Jacques Simard and Carmen G. Loiselle

J. Pers. Med. 2023, 13(5), 850; https://doi.org/10.3390/jpm13050850 - 18 May 2023

Cited by 1 | Viewed by 1926

Abstract

Background: The PREVENTION e-platform was developed to provide accessible and evidence-based health information tailored to different Breast Cancer (BC) risk levels. The demonstration study objectives were to (1) assess the usability and perceived impact of PREVENTION on women with assigned hypothetical BC risk [...] Read more.

Background: The PREVENTION e-platform was developed to provide accessible and evidence-based health information tailored to different Breast Cancer (BC) risk levels. The demonstration study objectives were to (1) assess the usability and perceived impact of PREVENTION on women with assigned hypothetical BC risk levels (i.e., near population, intermediate or high) and (2) explore perceptions and recommendations for e-platform improvement. Methods: Thirty women with no history of cancer were recruited through social media, commercial centers, health clinics, and community settings in Montreal, Qc, Canada. Participants accessed e-platform content tailored to their assigned hypothetical BC risk level, and then completed study e-questionnaires including the user Mobile Application Rating Scale (uMARS), an e-platform quality scale (i.e., in terms of engagement, functionality, aesthetics, and information). A subsample (n = 18) was randomly selected for an individual follow-up semi-structured interview. Results: The e-platform overall quality was high, with mean M = 4.01 (out of 5) and SD = 0.50. A total of 87% (n = 26) agreed or strongly agreed that PREVENTION increased their knowledge and awareness of BC risk, and 80% would recommend it to others while reporting likelihood of following lifestyle recommendations to decrease their BC risk. Follow up interviews indicated that participants perceived the e-platform as a trusted source of BC information and a promising means to connect with peers. They also reported that while the e-platform was easy to navigate, improvements were needed for connectivity, visuals, and the organization of scientific resources. Conclusion: Preliminary findings support PREVENTION as a promising means to provide personalized BC information and support. Efforts are underway to further refine the platform, assess its impact in larger samples and gather feedback from BC specialists. Full article

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13 pages, 1747 KiB

Open AccessReview

Predicting Hospital Ward Admission from the Emergency Department: A Systematic Review

by Nekane Larburu, Laiene Azkue and Jon Kerexeta

J. Pers. Med. 2023, 13(5), 849; https://doi.org/10.3390/jpm13050849 - 18 May 2023

Cited by 2 | Viewed by 2308

Abstract

Background: The emergency department (ED) is often overburdened, due to the high influx of patients and limited availability of attending physicians. This situation highlights the need for improvement in the management of, and assistance provided in the ED. A key point for this [...] Read more.

Background: The emergency department (ED) is often overburdened, due to the high influx of patients and limited availability of attending physicians. This situation highlights the need for improvement in the management of, and assistance provided in the ED. A key point for this purpose is the identification of patients with the highest risk, which can be achieved using machine learning predictive models. The objective of this study is to conduct a systematic review of predictive models used to detect ward admissions from the ED. The main targets of this review are the best predictive algorithms, their predictive capacity, the studies’ quality, and the predictor variables. Methods: This review is based on PRISMA methodology. The information has been searched in PubMed, Scopus and Google Scholar databases. Quality assessment has been performed using the QUIPS tool. Results: Through the advanced search, a total of 367 articles were found, of which 14 were of interest that met the inclusion criteria. Logistic regression is the most used predictive model, achieving AUC values between 0.75–0.92. The two most used variables are the age and ED triage category. Conclusions: artificial intelligence models can contribute to improving the quality of care in the ED and reducing the burden on healthcare systems. Full article

(This article belongs to the Collection Advances of Emergency and Intensive Care)

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17 pages, 3411 KiB

Open AccessCase Report

Systematic Literature Review and Early Benefit of Cochlear Implantation in Two Pediatric Auditory Neuropathy Cases

by Thomas Keintzel, Tobias Raffelsberger, Lisa Niederwanger, Gina Gundacker and Thomas Rasse

J. Pers. Med. 2023, 13(5), 848; https://doi.org/10.3390/jpm13050848 - 17 May 2023

Cited by 4 | Viewed by 2322

Abstract

Approximately 1 in 10 children with hearing loss is affected by auditory neuropathy spectrum disorder (ANSD). People who have ANSD usually have great difficulty understanding speech or communicating. However, it is possible for these patients to have audiograms that may indicate profound hearing [...] Read more.

Approximately 1 in 10 children with hearing loss is affected by auditory neuropathy spectrum disorder (ANSD). People who have ANSD usually have great difficulty understanding speech or communicating. However, it is possible for these patients to have audiograms that may indicate profound hearing loss up to normal hearing. This disorder is prognosed with positive, intact or present otoacoustic emissions (OAE) and/or cochlear microphonics (CM) as well as abnormal or absent auditory brainstem responses (ABR). Treatment methods include conventional hearing aids as well as cochlear implants. Cochlear implants (CI) usually promise better speech understanding for ANSD patients. We performed a systematic literature review aiming to show what improvements can effectively be achieved with cochlear implants in children with ANSD and compare this with our experience with two cases of ANSD implanted at our clinic. The retrospective review of two young CI patients diagnosed with ANSD during infancy demonstrated improvements over time in speech development communicated by their parents. Full article

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

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