Journal of Personalized Medicine

15 pages, 1842 KiB

Open AccessArticle

Soluble Transferrin Receptor as Iron Deficiency Biomarker: Impact on Exercise Capacity in Heart Failure Patients

by Maria del Mar Ras-Jiménez, Raúl Ramos-Polo, Josep Francesch Manzano, Miriam Corbella Santano, Herminio Morillas Climent, Núria Jose-Bazán, Santiago Jiménez-Marrero, Paloma Garcimartin Cerezo, Sergi Yun Viladomat, Pedro Moliner Borja, Blanca Torres Cardús, José Maria Verdú-Rotellar, Carles Diez-López, José González-Costello, Elena García-Romero, Fernando de Frutos Seminario, Laura Triguero-Llonch, Cristina Enjuanes Grau, Marta Tajes Orduña and Josep Comin-Colet

J. Pers. Med. 2023, 13(8), 1282; https://doi.org/10.3390/jpm13081282 - 21 Aug 2023

Cited by 1 | Viewed by 2161

Abstract

The soluble transferrin receptor (sTfR) is a marker of tissue iron status, which could indicate an increased iron demand at the tissue level. The impact of sTfR levels on functional capacity and quality of life (QoL) in non-anemic heart failure (HF) patients with [...] Read more.

The soluble transferrin receptor (sTfR) is a marker of tissue iron status, which could indicate an increased iron demand at the tissue level. The impact of sTfR levels on functional capacity and quality of life (QoL) in non-anemic heart failure (HF) patients with otherwise normal systemic iron status has not been evaluated. We conducted an observational, prospective, cohort study of 1236 patients with chronic HF. We selected patients with normal hemoglobin levels and normal systemic iron status. Tissue iron deficiency (ID) was defined as levels of sTfR > 75th percentile (1.63 mg per L). The primary endpoints were the distance walked in the 6 min walking test (6MWT) and the overall summary score (OSS) of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The final study cohort consisted of 215 patients. Overall QoL was significantly worse (51 ± 27 vs. 39 ± 20, p-value = 0.006, respectively), and the 6 MWT distance was significantly worse in patients with tissue ID when compared to patients without tissue ID (206 ± 179 m vs. 314 ± 155, p-value < 0.0001, respectively). Higher sTfR levels, indicating increased iron demand, were associated with a shorter distance in the 6 MWT (standardized β = −0.249, p < 0.001) and a higher MLHFQ OSS (standardized β = 0.183, p-value = 0.008). In this study, we show that in patients with normal systemic iron parameters, higher levels of sTfR are strongly associated with an impaired submaximal exercise capacity and with worse QoL. Full article

(This article belongs to the Section Mechanisms of Diseases)

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40 pages, 11309 KiB

Open AccessReview

Progress in Research on Stem Cells in Neonatal Refractory Diseases

by Fangjun Huang, Yang He, Meng Zhang, Keren Luo, Jiawen Li, Jiali Li, Xinyu Zhang, Xiaoyan Dong and Jun Tang

J. Pers. Med. 2023, 13(8), 1281; https://doi.org/10.3390/jpm13081281 - 21 Aug 2023

Cited by 2 | Viewed by 1649

Abstract

With the development and progress of medical technology, the survival rate of premature and low-birth-weight infants has increased, as has the incidence of a variety of neonatal diseases, such as hypoxic–ischemic encephalopathy, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity. These [...] Read more.

With the development and progress of medical technology, the survival rate of premature and low-birth-weight infants has increased, as has the incidence of a variety of neonatal diseases, such as hypoxic–ischemic encephalopathy, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity. These diseases cause severe health conditions with poor prognoses, and existing control methods are ineffective for such diseases. Stem cells are a special type of cells with self-renewal and differentiation potential, and their mechanisms mainly include anti-inflammatory and anti-apoptotic properties, reducing oxidative stress, and boosting regeneration. Their paracrine effects can affect the microenvironment in which they survive, thereby affecting the biological characteristics of other cells. Due to their unique abilities, stem cells have been used in treating various diseases. Therefore, stem cell therapy may open up the possibility of treating such neonatal diseases. This review summarizes the research progress on stem cells and exosomes derived from stem cells in neonatal refractory diseases to provide new insights for most researchers and clinicians regarding future treatments. In addition, the current challenges and perspectives in stem cell therapy are discussed. Full article

(This article belongs to the Section Regenerative Medicine and Therapeutics)

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19 pages, 3196 KiB

Open AccessArticle

An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy

by Antonio Franco, Alba Di Leone, Marco Conti, Alessandra Fabi, Luisa Carbognin, Andreina Daniela Terribile, Paolo Belli, Armando Orlandi, Martin Alejandro Sanchez, Francesca Moschella, Elena Jane Mason, Giovanni Cimino, Alessandra De Filippis, Fabio Marazzi, Ida Paris, Giuseppe Visconti, Liliana Barone Adesi, Lorenzo Scardina, Sabatino D’Archi, Marzia Salgarello, Diana Giannarelli, Riccardo Masetti and Gianluca Franceschini Show full author list Hide full author list

J. Pers. Med. 2023, 13(8), 1280; https://doi.org/10.3390/jpm13081280 - 21 Aug 2023

Cited by 1 | Viewed by 1761

Abstract

Introduction: The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons’ expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. Methods: Patients (stage I–III) underwent surgery post-NACT [...] Read more.

Introduction: The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons’ expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. Methods: Patients (stage I–III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. Results: A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896–8.724 was predictive for BCS, 8.725–9.375 for OPS, and 9.376–14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5–14.7%; p = 0.010), a better locoregional disease-free survival (98.8–88.9%; p < 0.001) and a better overall survival (96.1–86.5%; p = 0.017), and a better satisfaction with breasts (39.8–27.5%; p = 0.017) and physical wellbeing (93.5–73.6%; p = 0.001). Conclusion: A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes. Full article

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

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13 pages, 1234 KiB

Open AccessArticle

Preoperative Lower-Limb Muscle Predictors for Gait Speed Improvement after Total Hip Arthroplasty for Patients with Osteoarthritis

by Tadashi Yasuda, Satoshi Ota, Sadaki Mitsuzawa, Shinnosuke Yamashita, Yoshihiro Tsukamoto, Hisataka Takeuchi and Eijiro Onishi

J. Pers. Med. 2023, 13(8), 1279; https://doi.org/10.3390/jpm13081279 - 20 Aug 2023

Viewed by 1342

Abstract

This study aimed to identify preoperative lower-limb muscle predictors for gait speed improvement after total hip arthroplasty (THA) with hip osteoarthritis. Gait speed improvement was evaluated as the subtraction of preoperative speed from postoperative speed. The preoperative muscle composition of ipsilateral hip abductors [...] Read more.

This study aimed to identify preoperative lower-limb muscle predictors for gait speed improvement after total hip arthroplasty (THA) with hip osteoarthritis. Gait speed improvement was evaluated as the subtraction of preoperative speed from postoperative speed. The preoperative muscle composition of ipsilateral hip abductors was evaluated using computed tomography. The females (n = 45) showed smaller total cross-sectional areas of the gluteal muscles than the males (n = 13). The gluteus maximus in the females showed lower lean muscle mass area (LMM) and higher ratios of the intramuscular fat area and the intramuscular adipose tissue area to the total muscle area (TM) than the males. Regression analysis revealed that LMM/TM of the glutei medius and minimus may correlate negatively with postoperative improvement in gait speed. Receiver operating characteristic curve analysis for prediction of minimum clinically important improvement in gait speed at ≥0.32 m/s resulted in the highest area under the curve for TM in the upper portion of the gluteus maximus with negative correlation. The explanatory variables of hip abductor muscle composition predicted gait speed improvement after THA more precisely in the females compared with the total group of both sexes. Preoperative muscle composition should be evaluated separately based on sex for the achievement of clinically important improvement in gait speed after THA. Full article

(This article belongs to the Special Issue Innovations in Knee and Hip Arthroplasty)

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14 pages, 5048 KiB

Open AccessArticle

Cortical–Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study

by Francesca Vitulli, Dimitrios Kalaitzoglou, Christos Soumpasis, Alba Díaz-Baamonde, José David Siado Mosquera, Richard Gullan, Francesco Vergani, Keyoumars Ashkan, Ranjeev Bhangoo, Ana Mirallave-Pescador and Jose Pedro Lavrador

J. Pers. Med. 2023, 13(8), 1278; https://doi.org/10.3390/jpm13081278 - 20 Aug 2023

Cited by 1 | Viewed by 1743

Abstract

Surgical management of deep-seated brain tumors requires precise functional navigation and minimally invasive surgery. Preoperative mapping using navigated transcranial magnetic stimulation (nTMS), intraoperative neurophysiological monitoring (IONM), and minimally invasive parafascicular surgery (MIPS) act together in a functional-sparing approach. nTMS also provides a rehabilitation [...] Read more.

Surgical management of deep-seated brain tumors requires precise functional navigation and minimally invasive surgery. Preoperative mapping using navigated transcranial magnetic stimulation (nTMS), intraoperative neurophysiological monitoring (IONM), and minimally invasive parafascicular surgery (MIPS) act together in a functional-sparing approach. nTMS also provides a rehabilitation tool to maximize functional recovery. This is a single-center retrospective proof-of-concept cohort study between January 2022 and June 2023 of patients admitted for surgery with motor eloquent deep-seated brain tumors. The study enrolled seven adult patients, five females and two males, with a mean age of 56.28 years old. The lesions were located in the cingulate gyrus (three patients), the central core (two patients), and the basal ganglia (two patients). All patients had preoperative motor deficits. The most common histological diagnosis was metastasis (five patients). The MIPS approach to the mid-cingulate lesions involved a trajectory through the fronto-aslant tract (FAT) and the fronto-striatal tract (FST). No positive nTMS motor responses were resected as part of the outer corridor for MIPS. Direct cortical stimulation produced stable motor-evoked potentials during the surgeries with no warning signs. Gross total resection (GTR) was achieved in three patients and near-total resection (NTR) in four patients. Post-operatively, all patients had a deterioration of motor function with no ischemia in the postoperative imaging (cavity-to-CST distance 0–4 mm). After nTMS with low-frequency stimulation in the contralateral motor cortex, six patients recovered to their preoperative functional status and one patient improved to a better functional condition. A combined Tractography-MIPS-IONM-TMS approach provides a successful functional-sparing approach to deep-seated motor eloquent tumors and a rehabilitation framework for functional recovery after surgery. Full article

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

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12 pages, 991 KiB

Open AccessArticle

Attenuated Total Reflection Fourier-Transform Infrared Spectral Discrimination in Human Tissue of Oesophageal Transformation to Adenocarcinoma

by Ishaan Maitra, Camilo L. M. Morais, Kássio M. G. Lima, Katherine M. Ashton, Danielle Bury, Ravindra S. Date and Francis L. Martin

J. Pers. Med. 2023, 13(8), 1277; https://doi.org/10.3390/jpm13081277 - 20 Aug 2023

Cited by 1 | Viewed by 1548

Abstract

This study presents ATR-FTIR (attenuated total reflectance Fourier-transform infrared) spectral analysis of ex vivo oesophageal tissue including all classifications to oesophageal adenocarcinoma (OAC). The article adds further validation to previous human tissue studies identifying the potential for ATR-FTIR spectroscopy in differentiating among all [...] Read more.

This study presents ATR-FTIR (attenuated total reflectance Fourier-transform infrared) spectral analysis of ex vivo oesophageal tissue including all classifications to oesophageal adenocarcinoma (OAC). The article adds further validation to previous human tissue studies identifying the potential for ATR-FTIR spectroscopy in differentiating among all classes of oesophageal transformation to OAC. Tissue spectral analysis used principal component analysis quadratic discriminant analysis (PCA-QDA), successive projection algorithm quadratic discriminant analysis (SPA-QDA), and genetic algorithm quadratic discriminant analysis (GA-QDA) algorithms for variable selection and classification. The variables selected by SPA-QDA and GA-QDA discriminated tissue samples from Barrett’s oesophagus (BO) to OAC with 100% accuracy on the basis of unique spectral “fingerprints” of their biochemical composition. Accuracy test results including sensitivity and specificity were determined. The best results were obtained with PCA-QDA, where tissues ranging from normal to OAC were correctly classified with 90.9% overall accuracy (71.4–100% sensitivity and 89.5–100% specificity), including the discrimination between normal and inflammatory tissue, which failed in SPA-QDA and GA-QDA. All the models revealed excellent results for distinguishing among BO, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and OAC tissues (100% sensitivities and specificities). This study highlights the need for further work identifying potential biochemical markers using ATR-FTIR in tissue that could be utilised as an adjunct to histopathological diagnosis for early detection of neoplastic changes in susceptible epithelium. Full article

(This article belongs to the Special Issue Clinical Applications of Biospectroscopy and Imaging)

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10 pages, 889 KiB

Open AccessArticle

Evaluation of the Performance of OTOPLAN-Based Cochlear Implant Electrode Array Selection: A Retrospective Study

by Dayse Távora-Vieira, Marcus Voola, Jafri Kuthubutheen, Peter Friedland, Daren Gibson and Aanand Acharya

J. Pers. Med. 2023, 13(8), 1276; https://doi.org/10.3390/jpm13081276 - 20 Aug 2023

Cited by 1 | Viewed by 1437

Abstract

Otoplan is a surgical planning software designed to assist with cochlear implant surgery. One of its outputs is a recommendation of electrode array type based on imaging parameters. In this retrospective study, we evaluated the differences in auditory outcomes between patients who were [...] Read more.

Otoplan is a surgical planning software designed to assist with cochlear implant surgery. One of its outputs is a recommendation of electrode array type based on imaging parameters. In this retrospective study, we evaluated the differences in auditory outcomes between patients who were implanted with arrays corresponding to those recommended by the Otoplan software versus those in which the array selection differed from the Otoplan recommendation. Pre-operative CT images from 114 patients were imported into the software, and array recommendations were generated. These were compared to the arrays which had actually been implanted during surgery, both in terms of array type and length. As recommended, 47% of patients received the same array, 34% received a shorter array, and 18% received a longer array. For reasons relating to structure and hearing preservation, 83% received the more flexible arrays. Those who received stiffer arrays had cochlear malformations or ossification. A negative, although non-statistically significant correlation was observed between the CNC scores at 12 months and the absolute value of the difference between recommended array and implanted array. In conclusion, clinicians may be slightly biased toward shorter electrode arrays due to their perceived greater ability to achieve full insertion. Using 3D imaging during the pre-operative planning may improve clinicians’ confidence to implant longer electrode arrays, where appropriate, to achieve optimum hearing outcomes. Full article

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

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9 pages, 226 KiB

Open AccessArticle

Personal Health Record (PHR) Experience and Recommendations for a Transformation in Saudi Arabia

by Abdullah Alanazi, Mohammed Alanazi and Bakheet Aldosari

J. Pers. Med. 2023, 13(8), 1275; https://doi.org/10.3390/jpm13081275 - 19 Aug 2023

Cited by 2 | Viewed by 2794

Abstract

A Personal Health Record (PHR) is a patient-managed platform for health data. Most hospitals provide a PHR as an extension of the Electronic Medical Record (EMR). However, there are unresolved issues around the adoption rate, functionalities, barriers and, more importantly, the impact of [...] Read more.

A Personal Health Record (PHR) is a patient-managed platform for health data. Most hospitals provide a PHR as an extension of the Electronic Medical Record (EMR). However, there are unresolved issues around the adoption rate, functionalities, barriers and, more importantly, the impact of the PHR on patients’ health. A cross-sectional, survey-based descriptive study was conducted in which patients from four main tertiary hospitals in Saudi Arabia were targeted from September 2022 to February 2023. The survey was tested and validated to address the objectives of the study. The survey covered components related to intention to use the PHR, required functions, obstacles and expected outcomes. This study involved 396 participants from the top four hospitals. It was discovered that the majority of them had intentions to use the PHR (93%) and believed it to be useful (94%) and easy to use (94%). It was widely agreed that accessing medical records (77%), scheduling appointments (88%), renewing medication (90%), tracking patient data (70%) and receiving personalized education (78%) were essential aspects of the PHR. Furthermore, the survey revealed that 54% of respondents saw a positive effect on their health status. A significant number of participants, around 54%, expressed concerns about the privacy of their PHR, and 46% reported concerns about the accuracy of their information. The study found that demographic factors and the type of hospital did not have a statistically significant association with the intention to use the PHR. Our findings showed that there were no significant barriers to adopting the PHR. Additionally, we found that less than half of the participants believed that their current PHR helped them to improve their health. This highlights the need for healthcare organizations to focus on improving the PHR’s functionality and overall purpose. Instead of simply providing basic features, the PHR should allow patients to manage their health information comprehensively, including compiling information from hospitals and patient-generated data. Having a PHR is crucial in improving an individual’s overall health. As technology advances, more data are being generated that should be included in the PHR to ensure an accurate and comprehensive view of the patient’s health. Expanding the scope of the PHR to include capabilities beyond merely hospital data is important. Achieving this requires an open and honest discussion about the role of the PHR, potential obstacles and how to coordinate efforts among different stakeholders. Full article

(This article belongs to the Section Omics/Informatics)

15 pages, 1479 KiB

Open AccessArticle

Efficacy of Combined Photobiomodulation Therapy with Supplements versus Supplements alone in Restoring Thyroid Gland Homeostasis in Hashimoto Thyroiditis: A Clinical Feasibility Parallel Trial with 6-Months Follow-Up

by Venera Berisha-Muharremi, Bernard Tahirbegolli, Ruth Phypers and Reem Hanna

J. Pers. Med. 2023, 13(8), 1274; https://doi.org/10.3390/jpm13081274 - 19 Aug 2023

Cited by 3 | Viewed by 3702

Abstract

Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms [...] Read more.

Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms in patients with HT, even when they achieve to be euthyroid from a biochemical standpoint. Photobiomodulation (PBM) showed to be an effective therapy in the management of autoimmune diseases, but with limited evidence. Hence, our study was conducted to appraise the efficacy of PBM therapy with supplements in restoring thyroid gland homeostasis in patients with HT compared with supplements alone. Seventy-four female subjects aged between 20 and 50 years old were recruited and divided equally into two groups: PBM and supplements group (group 1); and supplements alone group (group 2). The PBM dosimetry and treatment protocols were as follows: wavelength, 820 nm; power output, 200 mW; continuous emission mode; irradiating time, 20 s per point; fluence, 32 J/cm² per point; treatment frequency, twice a week (excluding weekends); and treatment duration, three consecutive weeks. Whereas, the supplements protocol for both groups was the same, as follows: subjects with a serum level of vitamin D3 <40 ng/dL, who received replacement according to their serum levels, and all the subjects had a daily intake of 100 µg of oral selenium. The biochemical (FT3, FT4, antiTPO and antiTG) and anthropometric measurements were evaluated. Our findings showed significant improvement in group 1 parameters (PBM+ supplements) compared with group 2 (supplements only) in terms of weight loss and reduction in the following parameters: BMI, hip and waist circumference, waist/hip ratio, TSH, antiTPO, antiTG and treatment dose of LT4 (p < 0.05). Our results, for the first time, demonstrated an efficacy of PBM delivered at a lower fluence with supplements in restoring thyroid function, anthropometric parameters and lifestyle factors in patients with HT. Hence, extensive studies with a longer follow-up period are warranted. Full article

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

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14 pages, 1824 KiB

Open AccessArticle

Characteristics of Kidney Transplant Recipients with Prolonged Pre-Transplant Dialysis Duration as Identified by Machine Learning Consensus Clustering: Pathway to Personalized Care

by Charat Thongprayoon, Supawit Tangpanithandee, Caroline C. Jadlowiec, Shennen A. Mao, Michael A. Mao, Pradeep Vaitla, Prakrati C. Acharya, Napat Leeaphorn, Wisit Kaewput, Pattharawin Pattharanitima, Supawadee Suppadungsuk, Pajaree Krisanapan, Pitchaphon Nissaisorakarn, Matthew Cooper, Iasmina M. Craici and Wisit Cheungpasitporn

J. Pers. Med. 2023, 13(8), 1273; https://doi.org/10.3390/jpm13081273 - 19 Aug 2023

Cited by 1 | Viewed by 1464

Abstract

Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus [...] Read more.

Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 5092 kidney transplant recipients who had been on dialysis ≥ 10 years prior to transplant in the OPTN/UNOS database from 2010 to 2019. We characterized each assigned cluster and compared the posttransplant outcomes. Overall, the majority of patients with ≥10 years of dialysis duration were black (52%) or Hispanic (25%), with only a small number (17.6%) being moderately sensitized. Within this cohort, three clinically distinct clusters were identified. Cluster 1 patients were younger, non-diabetic and non-sensitized, had a lower body mass index (BMI) and received a kidney transplant from younger donors. Cluster 2 recipients were older, unsensitized and had a higher BMI; they received kidney transplant from older donors. Cluster 3 recipients were more likely to be female with a higher PRA. Compared to cluster 1, cluster 2 had lower 5-year death-censored graft (HR 1.40; 95% CI 1.16–1.71) and patient survival (HR 2.98; 95% CI 2.43–3.68). Clusters 1 and 3 had comparable death-censored graft and patient survival. Unsupervised machine learning was used to characterize kidney transplant recipients with prolonged pre-transplant dialysis into three clinically distinct clusters with variable but good post-transplant outcomes. Despite a dialysis duration ≥ 10 years, excellent outcomes were observed in most recipients, including those with moderate sensitization. A disproportionate number of minority recipients were observed within this cohort, suggesting multifactorial delays in accessing kidney transplantation. Full article

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

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11 pages, 3023 KiB

Open AccessArticle

Acute Changes on Left Atrial Function during Incremental Exercise in Patients with Heart Failure with Mildly Reduced Ejection Fraction: A Case-Control Study

by Marco Alfonso Perrone, Ferdinando Iellamo, Valentino D’Antoni, Alessandro Gismondi, Deborah Di Biasio, Sara Vadalà, Giuseppe Marazzi, Valentina Morsella, Maurizio Volterrani and Giuseppe Caminiti

J. Pers. Med. 2023, 13(8), 1272; https://doi.org/10.3390/jpm13081272 - 18 Aug 2023

Viewed by 1310

Abstract

Background: the aim of this study was to assess acute changes in left atrial (LA) function during incremental aerobic exercise in patients with heart failure with mildly reduced ejection fraction (HFmrEF) in comparison to healthy subjects (HS). Methods: twenty patients with established HFmrEF [...] Read more.

Background: the aim of this study was to assess acute changes in left atrial (LA) function during incremental aerobic exercise in patients with heart failure with mildly reduced ejection fraction (HFmrEF) in comparison to healthy subjects (HS). Methods: twenty patients with established HFmrEF were compared with 10 HS, age-matched controls. All subjects performed a stepwise exercise test on a cycle ergometer. Echocardiography was performed at baseline, during submaximal effort, at peak of exercise, and after 5 min of recovery. Results: HS obtained a higher value of METs at peak exercise than HFmrEF (7.4 vs. 5.6; between group p = 0.002). Heart rate and systolic blood pressure presented a greater increase in the HS group than in HFmrEF (between groups p = 0.006 and 0.003, respectively). In the HFmrEF group, peak atrial longitudinal strain (PALS) and conduit strain were both increased at submaximal exercise (p < 0.05 for both versus baseline) and remained constant at peak exercise. Peak atrial contraction strain (PACS) did not show significant changes during the exercise. In the HS group, PALS and PACS increased significantly at submaximal level (p < 0.05 for both versus baseline), but PALS returned near baseline values at peak exercise; conduit strain decreased progressively during the exercise in HS. Stroke volume (SV) increased in both groups at submaximal exercise; at peak exercise, SV remained constant in the HFmrEF, while it decreased in controls (between groups p = 0.002). Conclusions: patients with HFmrEF show a proper increase in LA reservoir function during incremental aerobic exercise that contributes to maintain SV throughout the physical effort. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Cardiovascular Diseases 2.0)

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10 pages, 266 KiB

Open AccessArticle

The Rising Problem of Hip Fractures in Geriatric Patients—Analysis of Surgical Influences on the Outcome

by Julian Krickl, Till Ittermann, Andreas Thannheimer, Wolfgang Schmidt, Maximilian Willauschus, Johannes Ruether, Kim Loose, Markus Gesslein and Michael Millrose

J. Pers. Med. 2023, 13(8), 1271; https://doi.org/10.3390/jpm13081271 - 17 Aug 2023

Cited by 1 | Viewed by 1429

Abstract

Background: Hip fractures in geriatric patients often have a poor outcome in terms of mortality, mobility as well as independence. Different surgical influence factors are known that improve the outcome. Methods: In this observational cohort study, 281 patients of a geriatric trauma unit [...] Read more.

Background: Hip fractures in geriatric patients often have a poor outcome in terms of mortality, mobility as well as independence. Different surgical influence factors are known that improve the outcome. Methods: In this observational cohort study, 281 patients of a geriatric trauma unit were analyzed prospectively. Demographic factors, as well as data regarding the trauma mechanism and perioperative treatment, were recorded. The nutritional status was also analyzed. The follow-up was set to 120 days. Results: The key conclusion of this study is that a high ASA classification, the use of anticoagulatory medicine and malnutrition are significantly associated with higher mortality together with worse independence (p < 0.05). There is no significant difference in outcome concerning the time to surgery within the first 24 h. Conclusions: Malnutrition seems to be an important risk factor for an adverse outcome of geriatric patients and therefore warrants a focus in multidisciplinary treatment. The risk factor ASA cannot be improved during the pre-surgery phase, but requires intensified care by a multidisciplinary team specialized in orthogeriatrics. Full article

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

17 pages, 1470 KiB

Open AccessArticle

Comprehensive Molecular Evaluation of HNF-1 Alpha, miR-27a, and miR-146 Gene Variants and Their Link with Predisposition and Progression in Type 2 Diabetes Patients

by Rashid Mir, Imadeldin Elfaki, M. E. Elangeeb, Mamdoh S. Moawadh, Faris Jamal Tayeb, Jameel Barnawi, Ibrahim Altedlawi Albalawi, Amnah A. Alharbi, Marwan H. Alhelali and Basim S. O. Alsaedi

J. Pers. Med. 2023, 13(8), 1270; https://doi.org/10.3390/jpm13081270 - 17 Aug 2023

Cited by 2 | Viewed by 1818

Abstract

Background: Type 2 diabetes (T2D) is a metabolic condition induced by insulin resistance and pancreatic beta cell dysfunction. MicroRNAs (miRNAs) have biological significance because they regulate processes such as the molecular signaling pathways involved in the pathophysiology of diabetes mellitus. The hepatocyte nuclear [...] Read more.

Background: Type 2 diabetes (T2D) is a metabolic condition induced by insulin resistance and pancreatic beta cell dysfunction. MicroRNAs (miRNAs) have biological significance because they regulate processes such as the molecular signaling pathways involved in the pathophysiology of diabetes mellitus. The hepatocyte nuclear factor-1 alpha (HNF-1 alpha) is a transcription factor found in hepatocytes and the pancreas. Mutations in the HNF-1 alpha gene were reportedly associated with maturity-onset diabetes of the young (MODY). The objective of the present study was to examine the associations between MiR-27a, MiR-146, and HNF-1 alpha single-nucleotide variations (SNVs) with T2D risk in the Saudi population. Methodology: We evaluated the association of SNVs of miR-27a rs895819 A>G, 146a-rs2910164 C>G, and HNF-1 alpha rs1169288 G>T (I27L) with the risk of T2D in Saudi patients with the Amplification Refractory Mutation System PCR (ARMS-PCR). For the miR-27a SNVs, we used 115 cases (82 males, 33 females) and 117 matched healthy controls (HCs); for the Mir-146 SNVs, we used 103 cases (70 males, 33 females) and 108 matched HCs; and for the HNF-1 alpha, we employed 110 patients (80 males, 30 females) and 110 HCs. The blood biochemistry of the participants was essayed using commercial kits, and the methods of statistical analysis used were the Chi-square test, the Fisher exact test, and a multivariate analysis based on logistic regression, like the odds ratio (OD) and risk ratio (RR), with 95% confidence intervals (CIs). Results: The MiR-27a rs895819 AG genotype was linked to increased T2D susceptibility, with OR = 2.01 and p-value = 0.011, and the miR-146 rs2910164 CG genotype and C allele were linked to an elevated risk of T2D, with OR = 2.75, p-value < 0.0016, OR = 1.77, and p-value = 0.004. The results also showed that the GT genotype and T allele of the HNF-1 alpha (rs1169288) G>T is linked to T2D, with OR = 2.18, p-value = 0.0061, and 1.77, p-value = 0.0059. Conclusions: The SNVs in miR-27a, miR-146, and HNF-1 alpha can be potential loci for T2D risk. The limitations of this study include the relatively small sample size and the fact that it was a cross-sectional study. To our knowledge, this is the first study to highlight the association between miR-27a, miR-146, and HNF-1 alpha SNVs and the risk of T2D in the Saudi population. Future large-scale case–control studies, as well as studies on the functions of the proteins and protein interaction studies for HNF-1 alpha, are required to verify our findings. Furthermore, these findings can be used for the identification and stratification of at-risk populations via genetic testing for T2D-prevention strategies. Full article

(This article belongs to the Special Issue Biomarkers for Inflammatory and Metabolic Disorders)

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14 pages, 305 KiB

Open AccessProtocol

Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial

by Cristina Molina-García, Andrés Reinoso-Cobo, Jonathan Cortés-Martín, Eva Lopezosa-Reca, Ana Marchena-Rodriguez, George Banwell and Laura Ramos-Petersen

J. Pers. Med. 2023, 13(8), 1269; https://doi.org/10.3390/jpm13081269 - 17 Aug 2023

Cited by 2 | Viewed by 2095

Abstract

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being [...] Read more.

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements. Full article

(This article belongs to the Special Issue Personalized Medicine for Orthopaedic Disorders)

14 pages, 1199 KiB

Open AccessReview

Artificial Intelligence-Based Methods for Precision Cardiovascular Medicine

by Farida Mohsen, Balqees Al-Saadi, Nima Abdi, Sulaiman Khan and Zubair Shah

J. Pers. Med. 2023, 13(8), 1268; https://doi.org/10.3390/jpm13081268 - 16 Aug 2023

Cited by 13 | Viewed by 2920

Abstract

Precision medicine has the potential to revolutionize the way cardiovascular diseases are diagnosed, predicted, and treated by tailoring treatment strategies to the individual characteristics of each patient. Artificial intelligence (AI) has recently emerged as a promising tool for improving the accuracy and efficiency [...] Read more.

Precision medicine has the potential to revolutionize the way cardiovascular diseases are diagnosed, predicted, and treated by tailoring treatment strategies to the individual characteristics of each patient. Artificial intelligence (AI) has recently emerged as a promising tool for improving the accuracy and efficiency of precision cardiovascular medicine. In this scoping review, we aimed to identify and summarize the current state of the literature on the use of AI in precision cardiovascular medicine. A comprehensive search of electronic databases, including Scopes, Google Scholar, and PubMed, was conducted to identify relevant studies. After applying inclusion and exclusion criteria, a total of 28 studies were included in the review. We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. As a result, most of these studies focused on prediction (50%), followed by diagnosis (21%), phenotyping (14%), and risk stratification (14%). A variety of machine learning models were utilized in these studies, with logistic regression being the most used (36%), followed by random forest (32%), support vector machine (25%), and deep learning models such as neural networks (18%). Other models, such as hierarchical clustering (11%), Cox regression (11%), and natural language processing (4%), were also utilized. The data sources used in these studies included electronic health records (79%), imaging data (43%), and omics data (4%). We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. The results of the review showed that AI has the potential to improve the performance of cardiovascular disease diagnosis and prognosis, as well as to identify individuals at high risk of developing cardiovascular diseases. However, further research is needed to fully evaluate the clinical utility and effectiveness of AI-based approaches in precision cardiovascular medicine. Overall, our review provided a comprehensive overview of the current state of knowledge in the field of AI-based methods for precision cardiovascular medicine and offered new insights for researchers interested in this research area. Full article

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18 pages, 3803 KiB

Open AccessArticle

Lessons Learned from the COVID-19 Pandemic: A Survey-Based Study on a Sample of Italian Physicians’ Opinions on Telemedicine

by Pamela Tozzo, Arianna Delicati, Beatrice Marcante, Dolores Catelan and Luciana Caenazzo

J. Pers. Med. 2023, 13(8), 1267; https://doi.org/10.3390/jpm13081267 - 16 Aug 2023

Cited by 1 | Viewed by 1244

Abstract

Telemedicine was born out of the need to ensure clinical evaluation and personal care regardless of the physical presence of the healthcare professional nearby. Information technologies have been vital during the COVID-19 pandemic to ensure medical care and avoid the contagion between patients [...] Read more.

Telemedicine was born out of the need to ensure clinical evaluation and personal care regardless of the physical presence of the healthcare professional nearby. Information technologies have been vital during the COVID-19 pandemic to ensure medical care and avoid the contagion between patients and clinicians. Accordingly, telecare services multiplied worldwide and gained paramount importance. The present work aims to collect field-based opinions about Telemedicine and ethics among Italian physicians. We developed a web-based questionnaire that was administered to Italian physicians from 1 May to 15 June 2022. The questionnaire was distributed as a link to Google Forms via social networks/instant messaging applications to groups of graduated and qualified physicians. A total of 180 physicians answered the questionnaire (with an age range from 25 to 68 years old). Physicians belonging to the medical area of expertise appear to more frequently use new technologies in comparison to other specialties. The vast majority believe that it is appropriate to use Telemedicine for monitoring and follow-up but not for evaluating a new patient. Concerns about changes in the physician–patient relationship, informed consent, digital barrier, and privacy and data protection also emerged. Finally, telehealth is thought to be a potential useful tool for the future by the majority of respondents but proper training for physicians is therefore needed. Full article

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

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12 pages, 835 KiB

Open AccessArticle

Total Intravenous Anesthesia Protocol for Decreasing Unacceptable Movements during Cerebral Aneurysm Clipping with Motor-Evoked Potential Monitoring: A Historical Control Study and Meta-Analysis

by Yong-Seok Park, Yong-Seo Koo, Seungil Ha, Sangho Lee, Ji-Hoon Sim and Joung Uk Kim

J. Pers. Med. 2023, 13(8), 1266; https://doi.org/10.3390/jpm13081266 - 16 Aug 2023

Viewed by 1584

Abstract

Injury can occur during intraoperative transcranial motor-evoked potential (MEP) monitoring caused by patient movement related to insufficient neuromuscular blocking agent use. Here, we evaluated the incidence of unacceptable movements in patients undergoing intraoperative MEP monitoring following our anesthetic protocol. We reviewed the anesthesia [...] Read more.

Injury can occur during intraoperative transcranial motor-evoked potential (MEP) monitoring caused by patient movement related to insufficient neuromuscular blocking agent use. Here, we evaluated the incidence of unacceptable movements in patients undergoing intraoperative MEP monitoring following our anesthetic protocol. We reviewed the anesthesia records of 419 patients who underwent unruptured cerebral aneurysm clipping with intraoperative MEP monitoring. The anesthetic protocol included target-controlled infusion with a fixed effect-site propofol concentration of 3 μg/mL and an adjustable effect-site remifentanil concentration of 10–12 ng/mL. We compared our findings of the intraoperative parameters and incidence of spontaneous movement and respiration with those of published meta-analysis studies. Spontaneous movement and respiration occurred in one (0.2%) patient each. The meta-analysis included six studies. The pooled proportions of spontaneous movement and respiration were 6.9% (95% confidence interval [CI], 1.3–16.5%) and 4.1% (95% CI, 0.5–14.1%), respectively. The proportion of spontaneous movement in our study was significantly lower than that in previous studies (p = 0.013), with no significant difference in spontaneous respiration (p = 0.097). Following our center’s anesthesia protocol during cerebral aneurysm clipping resulted in a low incidence of spontaneous respiration and movement, indicating its safety for patients undergoing intraoperative MEP monitoring. Full article

(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)

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12 pages, 1527 KiB

Open AccessArticle

The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes

by Chiwon Ahn, Young Taeck Oh, Yeonkyung Park, Jae Hwan Kim, Sojune Hwang and Moonho Won

J. Pers. Med. 2023, 13(8), 1265; https://doi.org/10.3390/jpm13081265 - 16 Aug 2023

Viewed by 1585

Abstract

This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital [...] Read more.

This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA’s building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level’s impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes. Full article

(This article belongs to the Section Personalized Critical Care)

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13 pages, 1088 KiB

Open AccessArticle

The Role of Oxidative Stress in Infertility

by Ioana Zaha, Mariana Muresan, Camelia Tulcan, Anca Huniadi, Petronela Naghi, Mircea Sandor, Roberta Tripon, Cristina Gaspar, Major Klaudia-Melinda, Liliana Sachelarie and Liana Stefan

J. Pers. Med. 2023, 13(8), 1264; https://doi.org/10.3390/jpm13081264 - 15 Aug 2023

Cited by 6 | Viewed by 3634

Abstract

(1) Background: Oxidative stress markers in the follicular fluid and serum of the patient with IVF results (number of fertilized oocytes, number of embryos, cumulative pregnancy rate) are important in establishing the causes of infertility. (2) Methods: 42 patients were enrolled in the [...] Read more.

(1) Background: Oxidative stress markers in the follicular fluid and serum of the patient with IVF results (number of fertilized oocytes, number of embryos, cumulative pregnancy rate) are important in establishing the causes of infertility. (2) Methods: 42 patients were enrolled in the study over the duration of 24 months and were divided into two groups: the study group divided into the female etiology for infertility as a tubal factor, diminished ovarian reserve, endometriosis, and unexplained infertility, and the control group consisting of the male factor, excluding the sperm donors and with no female factor cause. On the day of ovarian puncture in IVF, follicular fluid and serum were collected from the patients. (3) Results: Malondialdehyde from the follicular fluid was higher in the control group. The total antioxidant capacity in the follicular fluid is positively correlated with the pregnancy rate. There is no statistically significant difference in the oxidative stress markers from serum in both groups. (4) Conclusions: The capacity of the follicular fluid environment to contain the reactive oxygen species (ROS) leads to a higher pregnancy rate in the control group. Full article

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

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26 pages, 907 KiB

Open AccessReview

Charting the Path: Navigating Embryonic Development to Potentially Safeguard against Congenital Heart Defects

by José Bragança, Rute Pinto, Bárbara Silva, Nuno Marques, Helena S. Leitão and Mónica T. Fernandes

J. Pers. Med. 2023, 13(8), 1263; https://doi.org/10.3390/jpm13081263 - 15 Aug 2023

Cited by 4 | Viewed by 4119

Abstract

Congenital heart diseases (CHDs) are structural or functional defects present at birth due to improper heart development. Current therapeutic approaches to treating severe CHDs are primarily palliative surgical interventions during the peri- or prenatal stages, when the heart has fully developed from faulty [...] Read more.

Congenital heart diseases (CHDs) are structural or functional defects present at birth due to improper heart development. Current therapeutic approaches to treating severe CHDs are primarily palliative surgical interventions during the peri- or prenatal stages, when the heart has fully developed from faulty embryogenesis. However, earlier interventions during embryonic development have the potential for better outcomes, as demonstrated by fetal cardiac interventions performed in utero, which have shown improved neonatal and prenatal survival rates, as well as reduced lifelong morbidity. Extensive research on heart development has identified key steps, cellular players, and the intricate network of signaling pathways and transcription factors governing cardiogenesis. Additionally, some reports have indicated that certain adverse genetic and environmental conditions leading to heart malformations and embryonic death may be amendable through the activation of alternative mechanisms. This review first highlights key molecular and cellular processes involved in heart development. Subsequently, it explores the potential for future therapeutic strategies, targeting early embryonic stages, to prevent CHDs, through the delivery of biomolecules or exosomes to compensate for faulty cardiogenic mechanisms. Implementing such non-surgical interventions during early gestation may offer a prophylactic approach toward reducing the occurrence and severity of CHDs. Full article

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

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11 pages, 2221 KiB

Open AccessArticle

Evaluation of Intraoperative Volumetric Assessment of Breast Volume Using 3D Handheld Stereo Photogrammetric Device

by Rafael Loucas, Marios Loucas, Sebastian Leitsch, Katarina Danuser, Gabriela Reichard, Omar Haroon, Julius Michael Mayer, Konstantin Koban and Thomas Holzbach

J. Pers. Med. 2023, 13(8), 1262; https://doi.org/10.3390/jpm13081262 - 15 Aug 2023

Cited by 2 | Viewed by 1473

Abstract

Methods for assessing three-dimensional (3D) breast volume are becoming increasingly popular in breast surgery. However, the precision of intraoperative volumetric assessment is still unclear. Until now, only non-validated scanning systems have been used for intraoperative volumetric analyses. This study aimed to assess the [...] Read more.

Methods for assessing three-dimensional (3D) breast volume are becoming increasingly popular in breast surgery. However, the precision of intraoperative volumetric assessment is still unclear. Until now, only non-validated scanning systems have been used for intraoperative volumetric analyses. This study aimed to assess the feasibility, handling, and accuracy of a commercially available, validated, and portable device for intraoperative 3D volumetric evaluation. All patients who underwent breast surgery from 2020 to 2022 were identified from our institutional database. Intraoperative 3D volumetric assessments of 103 patients were included in this study. Standardized 3D volumetric measurements were obtained 3 months postoperatively to compare the intraoperatively generated volumetric assessment. All of the study participants were women with a mean age of 48.3 ± 14.7 years (range: 20–89). The mean time for intraoperative volumetric assessment was 8.7 ± 2.6 min. The postoperative 3D volumetric assessment, with a mean volume of 507.11 ± 206.29 cc, showed no significant difference from the intraoperative volumetric measurements of 504.24 ± 276.61 cc (p = 0.68). The mean absolute volume difference between the intraoperative simulations and postoperative results was 27.1 cc. Intraoperative 3D volumetric assessment using the VECTRA H2 imaging system seems to be a feasible, reliable, and accurate method for measuring breast volume. Based on this finding, we plan to investigate whether volumetric objective evaluations will help to improve breast symmetry in the future. Full article

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

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14 pages, 1052 KiB

Open AccessReview

Modulation of Radiation Doses and Chimeric Antigen Receptor T Cells: A Promising New Weapon in Solid Tumors—A Narrative Review

by Antonio Pontoriero, Paola Critelli, Federico Chillari, Giacomo Ferrantelli, Miriam Sciacca, Anna Brogna, Silvana Parisi and Stefano Pergolizzi

J. Pers. Med. 2023, 13(8), 1261; https://doi.org/10.3390/jpm13081261 - 14 Aug 2023

Cited by 4 | Viewed by 1771

Abstract

Tumor behavior is determined by its interaction with the tumor microenvironment (TME). Chimeric antigen receptor (CART) cell therapy represents a new form of cellular immunotherapy (IT). Immune cells present a different sensitivity to radiation therapy (RT). RT can affect tumor cells both modifying [...] Read more.

Tumor behavior is determined by its interaction with the tumor microenvironment (TME). Chimeric antigen receptor (CART) cell therapy represents a new form of cellular immunotherapy (IT). Immune cells present a different sensitivity to radiation therapy (RT). RT can affect tumor cells both modifying the TME and inducing DNA damage, with different effects depending on the low and high doses delivered, and can favor the expression of CART cells. CART cells are patients’ T cells genetically engineered to recognize surface structure and to eradicate cancer cells. High-dose radiation therapy (HDRT, >10–20 Gy/fractions) converts immunologically “cold” tumors into “hot” ones by inducing necrosis and massive inflammation and death. LDRT (low-dose radiation therapy, >5–10 Gy/fractions) increases the expansion of CART cells and leads to non-immunogenetic death. An innovative approach, defined as the LATTICE technique, combines a high dose in higher FDG- uptake areas and a low dose to the tumor periphery. The association of RT and immune checkpoint inhibitors increases tumor immunogenicity and immune response both in irradiated and non-irradiated sites. The aim of this narrative review is to clarify the knowledge, to date, on CART cell therapy and its possible association with radiation therapy in solid tumors. Full article

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

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12 pages, 1679 KiB

Open AccessArticle

Mismatch Repair Protein Expression in Endometrial Cancer: Assessing Concordance and Unveiling Pitfalls in Two Different Immunohistochemistry Assays

by Hiroshi Yoshida, Waku Takigawa, Mayumi Kobayashi-Kato, Tadaaki Nishikawa, Kouya Shiraishi and Mitsuya Ishikawa

J. Pers. Med. 2023, 13(8), 1260; https://doi.org/10.3390/jpm13081260 - 14 Aug 2023

Cited by 1 | Viewed by 4394

Abstract

This study aimed to compare the concordance and interchangeability of the Dako/Agilent and Ventana/Roche mismatch repair (MMR) immunohistochemistry (IHC) assays commonly used in pathology. It also aimed to provide diagnostic insights by examining the frequency and characteristics of the dot-like artifact observed in [...] Read more.

This study aimed to compare the concordance and interchangeability of the Dako/Agilent and Ventana/Roche mismatch repair (MMR) immunohistochemistry (IHC) assays commonly used in pathology. It also aimed to provide diagnostic insights by examining the frequency and characteristics of the dot-like artifact observed in MLH1 M1 clone staining in endometrial cancer. Fifty endometrial cancer cases with MMR deficiency, excised between 2011 and 2018, were included in the study. IHC was performed using primary antibody clones from Ventana/Roche (MLH1, clone M1; MSH2, G219-1129; MSH6, SP93; PMS2, A16-4) and Dako/Agilent (MLH1, ES05; MSH2, FE11; MSH6, EP49; PMS2, EP51). Both assays were conducted using respective autostainers. The Dako/Agilent assay showed a loss of MLH1 in 26 cases, MSH2 in 12 cases, MSH6 in 23 cases, and PMS2 in 28 cases. The two assays had a complete agreement in MMR protein expression or loss. The dot-like artifact in MLH1 M1 clone staining was observed in 77% (20/26) of cases, predominantly in the surface area of the tumor, ranging from 5% to 40% (median: 10%). These findings highlight the high concordance between the MMR-IHC assays and emphasize the importance of considering the dot-like artifact in MLH1 M1 clone staining when diagnosing endometrial cancer with MMR deficiency. Full article

(This article belongs to the Section Disease Biomarker)

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18 pages, 567 KiB

Open AccessReview

The Role of Osteopontin in Respiratory Health and Disease

by Georgios I. Barkas and Ourania S. Kotsiou

J. Pers. Med. 2023, 13(8), 1259; https://doi.org/10.3390/jpm13081259 - 14 Aug 2023

Cited by 6 | Viewed by 3418

Abstract

The biological functions of osteopontin (OPN) are diverse and specific to physiological and pathophysiological conditions implicated in inflammation, biomineralization, cardiovascular diseases, cellular viability, cancer, diabetes, and renal stone disease. We aimed to present the role of OPN in respiratory health and disease. OPN [...] Read more.

The biological functions of osteopontin (OPN) are diverse and specific to physiological and pathophysiological conditions implicated in inflammation, biomineralization, cardiovascular diseases, cellular viability, cancer, diabetes, and renal stone disease. We aimed to present the role of OPN in respiratory health and disease. OPN influences the immune system and is a chemo-attractive protein correlated with respiratory disease severity. There is evidence that OPN can advance the disease stage associated with its fibrotic, inflammatory, and immune functions. OPN contributes to eosinophilic airway inflammation. OPN can destroy the lung parenchyma through its neutrophil influx and fibrotic mechanisms, linking OPN to at least one of the two major chronic obstructive pulmonary disease phenotypes. Respiratory diseases that involve irreversible lung scarring, such as idiopathic pulmonary disease, are linked to OPN, with protein levels being overexpressed in individuals with severe or advanced stages of the disorders and considerably lower levels in those with less severe symptoms. OPN plays a significant role in lung cancer progression and metastasis. It is also implicated in the pathogenesis of pulmonary hypertension, coronavirus disease 2019, and granuloma generation. Full article

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

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14 pages, 2537 KiB

Open AccessArticle

The CBCT Retrospective Study on Underwood Septa and Their Related Factors in Maxillary Sinuses—A Proposal of Classification

by Kamil Nelke, Dorota Diakowska, Monika Morawska-Kochman, Maciej Janeczek, Edyta Pasicka, Marceli Łukaszewski, Krzysztof Żak, Jan Nienartowicz and Maciej Dobrzyński

J. Pers. Med. 2023, 13(8), 1258; https://doi.org/10.3390/jpm13081258 - 14 Aug 2023

Cited by 1 | Viewed by 1459

Abstract

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major [...] Read more.

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors’ own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients. Full article

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11 pages, 270 KiB

Open AccessArticle

Improved Knee Function with Customized vs. Off-the-Shelf TKA Implants—Results of a Single-Surgeon, Single-Center, Single-Blinded Study

by Peter Buschner, Ioannis Toskas, Jochen Huth and Johannes Beckmann

J. Pers. Med. 2023, 13(8), 1257; https://doi.org/10.3390/jpm13081257 - 14 Aug 2023

Cited by 1 | Viewed by 1245

Abstract

Background: Recent studies have been able to show certain benefits of Customized, Individually Made (CIM) compared to Off-the-Shelf (OTS) total knee arthroplasties (TKAs), but evidence is still lacking regarding the benefits of these implant systems. This study aimed to find differences in scores [...] Read more.

Background: Recent studies have been able to show certain benefits of Customized, Individually Made (CIM) compared to Off-the-Shelf (OTS) total knee arthroplasties (TKAs), but evidence is still lacking regarding the benefits of these implant systems. This study aimed to find differences in scores and functional outcome by comparing CIM and OTS implants, using Patient-Reported Outcome Measures (PROMs) and functional tests for activities of daily living in a single-surgeon setup. Methods: A total of 48 patients (16 CIM vs. 32 OTS) were consecutively enrolled and blindly examined. Functional testing was performed using four timed functional tests (TUG, WALK, TUDS, and BBS) and the VAS for pain. The Aggregated Locomotor Function (ALF) score was then calculated based on the addition of the average times of the three functional tests. Results: The CIM group showed significantly faster times in all functional tests and significantly better ALF scores. There were remarkable differences in the assessment of maximum pain sensation between the two groups, with superiority in the CIM group. The PROMs analysis revealed a higher proportion of excellent and good ratings for the items objective and function (KSS) in the CIM group. Conclusion: The study showed that time-limited activities of daily living (ADLs) can be completed significantly faster with a CIM prosthesis and that a significantly higher percentage in this group reports freedom from pain during certain loads. Partial aspects of the PROM scores are also better in this group; however, this superiority could not be shown with regard to most PROM scores collected in this study. Full article

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

9 pages, 1085 KiB

Open AccessArticle

Retrospective Analysis of the Airway Space Changes in Dentofacial Deformity after Two-Jaw Orthognathic Surgery Using Cone Beam Computed Tomography

by Víctor Ravelo, Gabriela Olate, Alejandro Unibazo, Márcio de Moraes and Sergio Olate

J. Pers. Med. 2023, 13(8), 1256; https://doi.org/10.3390/jpm13081256 - 14 Aug 2023

Cited by 1 | Viewed by 1709

Abstract

Orthognathic surgery is used to modify anomalies in maxillomandibular position; this process can significantly affect the anatomy of the airway and cause functional changes. This study aims to define the impact of mandibular maxillary movement on the airway of subjects with dentofacial deformity. [...] Read more.

Orthognathic surgery is used to modify anomalies in maxillomandibular position; this process can significantly affect the anatomy of the airway and cause functional changes. This study aims to define the impact of mandibular maxillary movement on the airway of subjects with dentofacial deformity. A retrospective study was conducted on subjects with Angle class II (CII group) and Angle class III (CIII group) dentofacial deformities. The subjects were treated via bimaxillary surgery; for all of them, planning was performed with software and 3D printing. Cone beam computed tomography (CBCT) was obtained 21 days before surgery and 6 months after surgery and was used for planning and follow-up with the same conditions and equipment. Was used the superimposition technique to obtain the maximum and minimum airway areas and total airway volume. The data were analyzed with the Shapiro–Wilk test and Student’s t-test, while Spearman’s test was used to correlate the variables, considering a value of p < 0.05. Thus, 76 subjects aged 18 to 55 years (32.38 ± 10.91) were included: 46 subjects were in CII group, treated with a maxillo-mandibular advancement, and 30 subjects were in the CIII group, treated with a maxillary advancement and a mandibular setback. In the CII group, a maxillary advancement of +2.45 mm (±0.88) and a mandibular advancement of +4.25 mm (±1.25) were observed, with a significant increase in all the airway records. In the CIII group, a maxillary advancement of +3.42 mm (±1.25) and a mandibular setback of −3.62 mm (±1.18) were noted, with no significant changes in the variables measured for the airway (p > 0.05). It may be concluded that maxillo-mandibular advancement is an effective procedure to augment the airway area and volume in the CII group. On the other hand, in subjects with mandibular prognathism and Angle class III operated with the maxillary advancement and mandibular setback lower than 4 mm, it is possible to not reduce the areas and volume in the airway. Full article

(This article belongs to the Special Issue Orthodontics and Oral Surgery in Personalized Medicine)

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15 pages, 787 KiB

Open AccessEditor’s ChoiceReview

Intelligent Digital Twins for Personalized Migraine Care

by Parisa Gazerani

J. Pers. Med. 2023, 13(8), 1255; https://doi.org/10.3390/jpm13081255 - 13 Aug 2023

Cited by 10 | Viewed by 3350

Abstract

Intelligent digital twins closely resemble their real-life counterparts. In health and medical care, they enable the real-time monitoring of patients, whereby large amounts of data can be collected to produce actionable information. These powerful tools are constructed with the aid of artificial intelligence, [...] Read more.

Intelligent digital twins closely resemble their real-life counterparts. In health and medical care, they enable the real-time monitoring of patients, whereby large amounts of data can be collected to produce actionable information. These powerful tools are constructed with the aid of artificial intelligence, machine learning, and deep learning; the Internet of Things; and cloud computing to collect a diverse range of digital data (e.g., from digital patient journals, wearable sensors, and digitized monitoring equipment or processes), which can provide information on the health conditions and therapeutic responses of their physical twins. Intelligent digital twins can enable data-driven clinical decision making and advance the realization of personalized care. Migraines are a highly prevalent and complex neurological disorder affecting people of all ages, genders, and geographical locations. It is ranked among the top disabling diseases, with substantial negative personal and societal impacts, but the current treatment strategies are suboptimal. Personalized care for migraines has been suggested to optimize their treatment. The implementation of intelligent digital twins for migraine care can theoretically be beneficial in supporting patient-centric care management. It is also expected that the implementation of intelligent digital twins will reduce costs in the long run and enhance treatment effectiveness. This study briefly reviews the concept of digital twins and the available literature on digital twins for health disorders such as neurological diseases. Based on these, the potential construction and utility of digital twins for migraines will then be presented. The potential and challenges when implementing intelligent digital twins for the future management of migraines are also discussed. Full article

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

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11 pages, 1636 KiB

Open AccessArticle

Gastrointestinal Stromal Tumors: Our Ten-Year Experience of a Single-Center Tertiary Hospital

by Georgios Tzikos, Alexandra-Eleftheria Menni, Despoina Krokou, Angeliki Vouchara, Soultana Doutsini, Eleni Karlafti, Anestis Karakatsanis, Aristeidis Ioannidis, Stavros Panidis, Theodosios Papavramidis, Antonios Michalopoulos and Daniel Paramythiotis

J. Pers. Med. 2023, 13(8), 1254; https://doi.org/10.3390/jpm13081254 - 13 Aug 2023

Cited by 3 | Viewed by 1331

Abstract

Background: Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal tract. They have variable clinical presentation, prognosis, and molecular characteristics. Here, we present the results of our retrospective study including patients operated on for GIST during the last decade. [...] Read more.

Background: Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal tract. They have variable clinical presentation, prognosis, and molecular characteristics. Here, we present the results of our retrospective study including patients operated on for GIST during the last decade. Methods: All the patients who underwent GIST resection during the decade 2008–2018 were included in the study. The diagnosis was based on the pathology report. All the data were collected and analyzed statistically using the Statistical Package for Social Science v25.0. Finally, after having applied the proper search terms, a comprehensive review of articles published in the Medline database was held. Results: Thirty-two patients (sixteen women) were included in the study with a mean age of 69.6 years old (SD = 13.9). Twenty-one patients had a GIST in the stomach, eight in the small intestine, and three had an extra GIST. Of the 29 patients contacted, 21 were alive with a mean survival time of 74.3 months (SD = 49.6 months, min: 3.0 months, max: 161.0 months), whereas eight patients passed away. Finally, 13 patients were treated with tyrosine kinase inhibitors (TKIs) of whom only one died, while 9 patients passed away from those treated with surgery alone (p = 0.031). Conclusions: Our results were in concordance with the existing data in the literature. GISTs require patient-based therapeutical management depending on the histology of the tumors. Gastric tumors present a better prognosis than those localized in the intestine, while the use of TKIs has led to an improvement in patient survival rate. Full article

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

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22 pages, 2576 KiB

Open AccessEditor’s ChoiceReview

Unlocking the Potential of Mesenchymal Stem Cells in Gynecology: Where Are We Now?

by Ivana Erceg Ivkošić, Rajko Fureš, Vesna Ćosić, Nika Mikelin, Luka Bulić, Domagoj Dobranić, Petar Brlek and Dragan Primorac

J. Pers. Med. 2023, 13(8), 1253; https://doi.org/10.3390/jpm13081253 - 13 Aug 2023

Cited by 4 | Viewed by 3942

Abstract

Stem cells, with their remarkable capacity for differentiation into diverse cell types, are vital for the development as well as maintenance of health and homeostasis. Two unique abilities set them apart from other cells: self-renewal and the capacity for differentiation. They play important [...] Read more.

Stem cells, with their remarkable capacity for differentiation into diverse cell types, are vital for the development as well as maintenance of health and homeostasis. Two unique abilities set them apart from other cells: self-renewal and the capacity for differentiation. They play important roles in embryogenesis, development, regeneration, and various other processes. Over the last decade, there has been increased interest in their potential use in the treatment of numerous diseases and disorders across multiple fields of medicine in acute, chronic, innate, and acquired diseases. Stem cells are key to maintaining the body’s homeostasis and regulating growth and tissue functions. There are several types of stem cells—embryonic, adult, and human-induced pluripotent cells. Currently, mesenchymal stem cells are of great interest due to their regenerative, immunomodulatory, analgesic, and antimicrobial (anti-inflammatory) effects. Recent studies have shown the potent regenerative effect of stem cell therapy in gynecologic diseases such as infertility, Asherman syndrome, lichen sclerosus, polycystic ovary syndrome, premature ovarian insufficiency, genitourinary syndrome of menopause, and rectovaginal fistulas. Moreover, the successful isolation of oogonial stem cells could lead to a revolution in the field of gynecology and the potential treatment of the conditions discussed. This review aims to provide a better understanding of the latest therapeutic options involving stem cells and raise awareness of this promising yet not widely known topic in gynecology and medicine in general. Full article

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

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