Journal of Personalized Medicine

11 pages, 6454 KiB

Open AccessArticle

miR-155: A Potential Biomarker for Predicting Mortality in COVID-19 Patients

by Reut Kassif-Lerner, Keren Zloto, Nadav Rubin, Keren Asraf, Ram Doolman, Gidi Paret and Yael Nevo-Caspi

J. Pers. Med. 2022, 12(2), 324; https://doi.org/10.3390/jpm12020324 - 21 Feb 2022

Cited by 15 | Viewed by 2402

Abstract

COVID-19, a pandemic of severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV-2), continues to pose diagnostic and therapeutic challenges due to its unpredictable clinical course. Prognostic biomarkers may improve care by enabling quick identification of patients who can be safely discharged home [...] Read more.

COVID-19, a pandemic of severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV-2), continues to pose diagnostic and therapeutic challenges due to its unpredictable clinical course. Prognostic biomarkers may improve care by enabling quick identification of patients who can be safely discharged home versus those who may need careful respiratory monitoring and support. MicroRNAs (miRNAs) have risen to prominence as biomarkers for many disease states and as tools to assist in medical decisions. In the present study, we aimed to examine circulating miRNAs in hospitalized COVID-19 patients and to explore their potential as biomarkers for disease severity. We studied, by quantitative PCR, the expressions of miR-21, miR-146a, miR-146b, miR-155, and miR-499 in peripheral blood. We found that mild COVID-19 patients had 2.5-fold less circulating miR-155 than healthy people, and patients with a severe COVID-19 disease had 5-fold less circulating miR-155 than healthy people. In addition, we found that miR-155 is a good predictor of COVID-19 mortality. We suggest that examining miR-155 levels in patients’ blood, upon admission to hospital, will ameliorate the care given to COVID-19 patients. Full article

(This article belongs to the Special Issue Recent Advances in COVID-19 Pandemic: Challenges and Opportunities)

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13 pages, 1288 KiB

Open AccessReview

Homologous Recombination Deficiency (HRD) and BRCA 1/2 Gene Mutation for Predicting the Effect of Platinum-Based Neoadjuvant Chemotherapy of Early-Stage Triple-Negative Breast Cancer (TNBC): A Systematic Review and Meta-Analysis

by Yue Chai, Yujie Chen, Di Zhang, Yuce Wei, Zhijun Li, Qiao Li and Binghe Xu

J. Pers. Med. 2022, 12(2), 323; https://doi.org/10.3390/jpm12020323 - 21 Feb 2022

Cited by 14 | Viewed by 3817

Abstract

Background: Platinum-based agents may benefit patients with triple-negative breast cancer (TNBC) whose tumors are dysfunctional in DNA repair mechanisms associated with the homologous recombination repair (HRR) genes. The purpose of this meta-analysis was to assess the values of BRCA1/2 and homologous recombination deficiency [...] Read more.

Background: Platinum-based agents may benefit patients with triple-negative breast cancer (TNBC) whose tumors are dysfunctional in DNA repair mechanisms associated with the homologous recombination repair (HRR) genes. The purpose of this meta-analysis was to assess the values of BRCA1/2 and homologous recombination deficiency (HRD) in the prediction of the pathological complete response (pCR) rates of patients with TNBC treated with platinum-based neoadjuvant chemotherapy (NAC). Patients and Methods: Patients with TNBC with BRCA or HRD status from platinum-based NAC trials were analyzed. The odds ratios (ORs) with 95% confidence intervals (CI) for the identified studies were calculated. Results: 13 eligible studies between January 2000 and September 2021 were included through systematic literature searches of Embase, PubMed, Cochrane, and Web of Science databases. In 12 trials with BRCA status, 629 of 1266 (49.7%) patients with TNBC achieved pCR with platinum-based NAC, including 134 out of 222 (60.4%) BRCA1/2-mutated patients and 495 out of 1044 (47.4%) BRCA wildtype patients (OR, 1.62; 95% CI, 1.20–2.20). The prevalence of HRD was higher than BRCA1/2 mutations in patients with TNBC (69.2% vs. 17.5%). In six trials with HRD information, pCR rates of HRD-positive patients with TNBC were significantly higher than those of HRD-negative patients with TNBC (241/412, 58.5% vs. 60/183, 32.8%, OR, 3.01; 95% CI, 2.07–4.39, p < 0.001). Conclusions: BRCA1/2-mutated and HRD-positive patients with TNBC could benefit from platinum-based NAC. In the future, a prospective study using unified HRD testing criteria is warranted for further investigation. Full article

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16 pages, 576 KiB

Open AccessReview

Personalized Assessment of Insomnia and Sleep Quality in Patients with Parkinson’s Disease

by Ştefania Diaconu and Cristian Falup-Pecurariu

J. Pers. Med. 2022, 12(2), 322; https://doi.org/10.3390/jpm12020322 - 21 Feb 2022

Cited by 4 | Viewed by 2552

Abstract

Sleep disturbances are more common in patients with Parkinson’s disease (PD) than in the general population and are considered one of the most troublesome symptoms by these patients. Insomnia represents one of the most common sleep disturbances in PD, and it correlates significantly [...] Read more.

Sleep disturbances are more common in patients with Parkinson’s disease (PD) than in the general population and are considered one of the most troublesome symptoms by these patients. Insomnia represents one of the most common sleep disturbances in PD, and it correlates significantly with poor quality of life. There are several known causes of insomnia in the general population, but the complex manifestations that might be associated with PD may also induce insomnia and impact the quality of sleep. The treatment of insomnia and the strategies needed to improve sleep quality may therefore represent a challenge for the neurologist. A personalized approach to the PD patient with insomnia may help the clinician to identify the factors and comorbidities that should also be considered in order to establish a better individualized therapeutic plan. This review will focus on the main characteristics and correlations of insomnia, the most common risk factors, and the main subjective and objective methods indicated for the assessment of insomnia and sleep quality in order to offer a concise guide containing the main steps needed to approach the PD patient with chronic insomnia in a personalized manner. Full article

(This article belongs to the Special Issue Personalized Medicine for Parkinson's Disease: New Concepts and Future of Individualized Management)

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18 pages, 1533 KiB

Open AccessPerspective

Reward Deficiency Syndrome (RDS) Surprisingly Is Evolutionary and Found Everywhere: Is It “Blowin’ in the Wind”?

by Kenneth Blum, Thomas McLaughlin, Abdalla Bowirrat, Edward J. Modestino, David Baron, Luis Llanos Gomez, Mauro Ceccanti, Eric R. Braverman, Panayotis K. Thanos, Jean Lud Cadet, Igor Elman, Rajendra D. Badgaiyan, Rehan Jalali, Richard Green, Thomas A. Simpatico, Ashim Gupta and Mark S. Gold

J. Pers. Med. 2022, 12(2), 321; https://doi.org/10.3390/jpm12020321 - 21 Feb 2022

Cited by 18 | Viewed by 7186

Abstract

Reward Deficiency Syndrome (RDS) encompasses many mental health disorders, including a wide range of addictions and compulsive and impulsive behaviors. Described as an octopus of behavioral dysfunction, RDS refers to abnormal behavior caused by a breakdown of the cascade of reward in neurotransmission [...] Read more.

Reward Deficiency Syndrome (RDS) encompasses many mental health disorders, including a wide range of addictions and compulsive and impulsive behaviors. Described as an octopus of behavioral dysfunction, RDS refers to abnormal behavior caused by a breakdown of the cascade of reward in neurotransmission due to genetic and epigenetic influences. The resultant reward neurotransmission deficiencies interfere with the pleasure derived from satisfying powerful human physiological drives. Epigenetic repair may be possible with precision gene-guided therapy using formulations of KB220, a nutraceutical that has demonstrated pro-dopamine regulatory function in animal and human neuroimaging and clinical trials. Recently, large GWAS studies have revealed a significant dopaminergic gene risk polymorphic allele overlap between depressed and schizophrenic cohorts. A large volume of literature has also identified ADHD, PTSD, and spectrum disorders as having the known neurogenetic and psychological underpinnings of RDS. The hypothesis is that the true phenotype is RDS, and behavioral disorders are endophenotypes. Is it logical to wonder if RDS exists everywhere? Although complex, “the answer is blowin’ in the wind,” and rather than intangible, RDS may be foundational in species evolution and survival, with an array of many neurotransmitters and polymorphic loci influencing behavioral functionality. Full article

(This article belongs to the Special Issue Personalized Molecular Neurobiology of Brain Mapping of Global Pain and Mental Illness)

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17 pages, 4228 KiB

Open AccessArticle

Cerebral Protection in TAVR—Can We Do Without? A Real-World All-Comer Intention-to-Treat Study—Impact on Stroke Rate, Length of Hospital Stay, and Twelve-Month Mortality

by Carolina Donà, Matthias Koschutnik, Christian Nitsche, Max-Paul Winter, Veronika Seidl, Jolanta Siller-Matula, Markus Mach, Martin Andreas, Philipp Bartko, Andreas Anselm Kammerlander, Georg Goliasch, Irene Lang, Christian Hengstenberg and Julia Mascherbauer

J. Pers. Med. 2022, 12(2), 320; https://doi.org/10.3390/jpm12020320 - 21 Feb 2022

Cited by 5 | Viewed by 2406

Abstract

Background: Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific, Marlborough, MA, USA) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its [...] Read more.

Background: Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific, Marlborough, MA, USA) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its effectiveness is still undetermined. Objectives: To explore the impact of Sentinel™ on stroke rate, length of hospital stay (LOS), and twelve-month mortality in a single-center, real-world, all-comers TAVR cohort. Material and Methods: Between January 2019 and August 2020 consecutive patients were assigned to TAVR with or without Sentinel™ in a 1:1 fashion according to the treating operator. We defined as primary endpoint clinically detectable cerebrovascular events within 72 h after TAVR and as secondary endpoints LOS and 12-month mortality. Logistic and linear regression analyses were used to assess associations of Sentinel™ use with endpoints. Results: Of 411 patients (80 ± 7 y/o, 47.4% female, EuroSCORE II 6.3 ± 5.9%), Sentinel™ was used in 213 (51.8%), with both filters correctly deployed in 189 (46.0%). Twenty (4.9%) cerebrovascular events were recorded, ten (2.4%) of which were disabling strokes. Patients with Sentinel™ suffered 71% less (univariate analysis; OR 0.29, 95%CI 0.11–0.82; p = 0.02) and, respectively, 76% less (multivariate analysis; OR 0.24, 95%CI 0.08–0.76; p = 0.02) cerebrovascular events compared to patients without Sentinel™. Sentinel™ use was also significantly associated with shorter LOS (Regression coefficient −2.47, 95%CI −4.08, −0.87; p < 0.01) and lower 12-month all-cause mortality (OR 0.45; 95%CI 0.22–0.93; p = 0.03). Conclusion: In the present prospective all-comers TAVR cohort, patients with Sentinel™ use showed (1) lower rates of cerebrovascular events, (2) shortened LOS, and (3) improved 12-month survival. These data promote the use of a CPS when implanting TAVR valves. Full article

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

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11 pages, 1994 KiB

Open AccessArticle

Analysis of the Efficacy of Universal Screening of Coronavirus Disease with Antigen-Detecting Rapid Diagnostic Tests at Point-or-Care Settings and Sharing the Experience of Admission Protocol—A Pilot Study

by Ji Young Park, Joo Hee Lee, Bong Ki Cha, Boo-Seop Kim, Han-Jun Lee, Gi Hyeon Kim, Kyu-Tae Kang, Yong-Soon Lee, Seok Keun Ahn and Seong Hwan Kim

J. Pers. Med. 2022, 12(2), 319; https://doi.org/10.3390/jpm12020319 - 20 Feb 2022

Cited by 1 | Viewed by 1916

Abstract

Aims: To introduce the admission protocol of a COVID-19 specialized hospital outlined by the government, including the assessment of reverse transcription polymerase chain reaction (RT-PCR), low dose chest computed tomography (CT) and antigen-detecting rapid diagnostic test (Ag-RDT) for patient screening. Materials and Methods: [...] Read more.

Aims: To introduce the admission protocol of a COVID-19 specialized hospital outlined by the government, including the assessment of reverse transcription polymerase chain reaction (RT-PCR), low dose chest computed tomography (CT) and antigen-detecting rapid diagnostic test (Ag-RDT) for patient screening. Materials and Methods: This was a retrospective cohort study of 646 patients who were admitted between December 2020, and February 2021, during the third wave of COVID-19 in Korea. Ag-RDT and RT-PCR were routinely performed on all patients who required admission, and low-dose chest CT was performed on high-risk patients with associated symptoms. Any patients with high-risk COVID-19 infection according to the Ag-RDT test were quarantined alone in a negative pressured room, and those with low-risk COVID-19 infection remained in the preemptive quarantine room with or without negative pressure. The diagnostic values of the Ag-RDT test and associated cycle threshold (Ct) values of the RT-PCR test were subsequently evaluated. Results: In terms of the diagnostic value, the Ag-RDT for COVID-19 had a sensitivity of 68.3%, specificity of 99.5%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 97.9%. For the 355 symptomatic patients with low-dose chest CT, the diagnostic values of combined evaluations had a sensitivity of 90.2%, specificity of 99.0%, PPV of 86.1%, and NPV of 99.3%. The cut-off Ct value for positive Ag-RDT was ≤25.67 for the N gene (sensitivity: 89.3%, specificity: 100%), which was regarded as a high viable virus in cell culture. There were no patients or medical staff who had COVID-19 in the hospital. Conclusion: Appropriate patient care was possible by definitive triage of the area, according to the symptoms and using diagnostic tests. Screening protocols, including the Ag-RDT test and low-dose chest CT, could be helpful in emergency point-of-care settings. Full article

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

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17 pages, 1679 KiB

Open AccessArticle

Aberrant Gamma-Band Oscillations in Mice with Vitamin D Deficiency: Implications on Schizophrenia and its Cognitive Symptoms

by Seungyeong Yu, Mincheol Park, Jiseung Kang, Eunkyung Lee, Jieun Jung and Tae Kim

J. Pers. Med. 2022, 12(2), 318; https://doi.org/10.3390/jpm12020318 - 20 Feb 2022

Cited by 2 | Viewed by 3205

Abstract

Vitamin D plays an essential role in cognitive functions as well as regulating calcium homeostasis and the immune system. Many epidemiological studies have also shown the close relationship between vitamin D deficiency (VDD) and the risk of schizophrenia. Cortical gamma-band oscillations (GBO) are [...] Read more.

Vitamin D plays an essential role in cognitive functions as well as regulating calcium homeostasis and the immune system. Many epidemiological studies have also shown the close relationship between vitamin D deficiency (VDD) and the risk of schizophrenia. Cortical gamma-band oscillations (GBO) are associated with cognitive functions, such as attention and memory. Patients with schizophrenia show abnormal GBO with increased spontaneous GBO and decreased evoked GBO. However, the direct effect of VDD on GBO remains unknown. Parvalbumin interneurons, which predominantly contribute to the generation of GBO, are surrounded by perineuronal nets (PNN). We sought to investigate the associations among VDD, PNN, and GBO. Here, we injected a viral vector (AAV5-DIO-ChR2-eYFP) into the basal forebrain stereotaxically and implanted electrodes for electroencephalogram (EEG). At baseline, the evoked and spontaneous EEG power at the gamma frequency band was measured in 4-month-old male PV-Cre mice. After six and twenty weeks of vitamin D deficient food administration, the power of GBO was measured in the VDD condition. Next, we injected the chondroitinase ABC (ChABC) enzyme into the frontal cortex to eliminate PNN. We found that the VDD group showed decreased power of both optogenetically- and auditory-evoked GBO, whereas the spontaneous GBO increased. Enzymatic digestion of PNN showed similar changes in GBO. Taken together, we suggest that VDD could result in decreased PNN and, consequently, increase the spontaneous GBO and decrease the evoked GBO, reminiscent of the aberrant GBO in schizophrenia. These results show that VDD might increase the risk of schizophrenia and aggravate the cognitive symptoms of schizophrenia. Full article

(This article belongs to the Special Issue Towards Precision Medicine in Psychosis)

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10 pages, 4787 KiB

Open AccessArticle

Automatic Microaneurysms Detection for Early Diagnosis of Diabetic Retinopathy Using Improved Discrete Particle Swarm Optimization

by Usharani Bhimavarapu and Gopi Battineni

J. Pers. Med. 2022, 12(2), 317; https://doi.org/10.3390/jpm12020317 - 20 Feb 2022

Cited by 13 | Viewed by 2108

Abstract

Diabetic retinopathy (DR) is one of the most important microvascular complications associated with diabetes mellitus. The early signs of DR are microaneurysms, which can lead to complete vision loss. The detection of DR at an early stage can help to avoid non-reversible blindness. [...] Read more.

Diabetic retinopathy (DR) is one of the most important microvascular complications associated with diabetes mellitus. The early signs of DR are microaneurysms, which can lead to complete vision loss. The detection of DR at an early stage can help to avoid non-reversible blindness. To do this, we incorporated fuzzy logic techniques into digital image processing to conduct effective detection. The digital fundus images were segmented using particle swarm optimization to identify microaneurysms. The particle swarm optimization clustering combined the membership functions by grouping the high similarity data into clusters. Model testing was conducted on the publicly available dataset called DIARETDB0, and image segmentation was done by probability-based (PBPSO) clustering algorithms. Different fuzzy models were applied and the outcomes were compared with our probability discrete particle swarm optimization algorithm. The results revealed that the proposed PSO algorithm achieved an accuracy of 99.9% in the early detection of DR. Full article

(This article belongs to the Topic Big Data in Healthcare, Bioinformatics and Precision Medicine)

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13 pages, 953 KiB

Open AccessArticle

Pharmacogenomics-Guided Pharmacotherapy in Patients with Major Depressive Disorder or Bipolar Disorder Affected by Treatment-Resistant Depressive Episodes: A Long-Term Follow-Up Study

by Antonio Del Casale, Leda Marina Pomes, Luca Bonanni, Federica Fiaschè, Clarissa Zocchi, Alessio Padovano, Ottavia De Luca, Gloria Angeletti, Roberto Brugnoli, Paolo Girardi, Robert Preissner, Marina Borro, Giovanna Gentile, Maurizio Pompili and Maurizio Simmaco

J. Pers. Med. 2022, 12(2), 316; https://doi.org/10.3390/jpm12020316 - 19 Feb 2022

Cited by 4 | Viewed by 2871

Abstract

Treatment-resistant depression (TRD) reduces affected patients’ quality of life and leads to important social health care costs. Pharmacogenomics-guided treatment (PGT) may be effective in the cure of TRD. The main aim of this study was to evaluate the clinical changes after PGT in [...] Read more.

Treatment-resistant depression (TRD) reduces affected patients’ quality of life and leads to important social health care costs. Pharmacogenomics-guided treatment (PGT) may be effective in the cure of TRD. The main aim of this study was to evaluate the clinical changes after PGT in patients with TRD (two or more recent failed psychopharmacological trials) affected by bipolar disorder (BD) or major depressive disorder (MDD) compared to a control group with treatment as usual (TAU). We based the PGT on assessing different gene polymorphisms involved in the pharmacodynamics and pharmacokinetics of drugs. We analyzed, with a repeated-measure ANOVA, the changes between the baseline and a 6 month follow-up of the efficacy index assessed through the Clinical Global Impression (CGI) scale, and depressive symptoms through the Hamilton Depression Rating Scale (HDRS). The PGT sample included 53 patients (26 BD and 27 MDD), and the TAU group included 52 patients (31 BD and 21 MDD). We found a significant within-subject effect of treatment time on symptoms and efficacy index for the whole sample, with significant improvements in the efficacy index (F = 8.544; partial η² = 0.077, p < 0.004) and clinical global impression of severity of illness (F = 6.818; partial η² = 0.062, p < 0.01) in the PGT vs. the TAU group. We also found a significantly better follow-up response (χ² = 5.479; p = 0.019) and remission (χ² = 10.351; p = 0.001) rates in the PGT vs. the TAU group. PGT may be an important option for the long-term treatment of patients with TRD affected by mood disorders, providing information that can better define drug treatment strategies and increase therapeutic improvement. Full article

(This article belongs to the Section Pharmacogenetics)

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27 pages, 9665 KiB

Open AccessEditor’s ChoiceArticle

Artificial Intelligence-Enabled Electrocardiogram Estimates Left Atrium Enlargement as a Predictor of Future Cardiovascular Disease

by Yu-Sheng Lou, Chin-Sheng Lin, Wen-Hui Fang, Chia-Cheng Lee, Ching-Liang Ho, Chih-Hung Wang and Chin Lin

J. Pers. Med. 2022, 12(2), 315; https://doi.org/10.3390/jpm12020315 - 19 Feb 2022

Cited by 11 | Viewed by 2606

Abstract

Background: Left atrium enlargement (LAE) can be used as a predictor of future cardiovascular diseases, including hypertension (HTN) and atrial fibrillation (Afib). Typical electrocardiogram (ECG) changes have been reported in patients with LAE. This study developed a deep learning model (DLM)-enabled ECG system [...] Read more.

Background: Left atrium enlargement (LAE) can be used as a predictor of future cardiovascular diseases, including hypertension (HTN) and atrial fibrillation (Afib). Typical electrocardiogram (ECG) changes have been reported in patients with LAE. This study developed a deep learning model (DLM)-enabled ECG system to identify patients with LAE. Method: Patients who had ECG records with corresponding echocardiography (ECHO) were included. There were 101,077 ECGs, 20,510 ECGs, 7611 ECGs, and 11,753 ECGs in the development, tuning, internal validation, and external validation sets, respectively. We evaluated the performance of a DLM-enabled ECG for diagnosing LAE and explored the prognostic value of ECG-LAE for new-onset HTN, new-onset stroke (STK), new-onset mitral regurgitation (MR), and new-onset Afib. Results: The DLM-enabled ECG achieved AUCs of 0.8127/0.8176 for diagnosing mild LAE, 0.8587/0.8688 for diagnosing moderate LAE, and 0.8899/0.8990 for diagnosing severe LAE in the internal/external validation sets. Notably, ECG-LAE had higher prognostic value compared to ECHO-LAE, which had C-indices of 0.711/0.714 compared to 0.695/0.692 for new-onset HTN, 0.676/0.688 compared to 0.663/0.677 for new-onset STK, 0.696/0.695 compared to 0.676/0.673 for new-onset MR, and 0.800/0.806 compared to 0.786/0.760 for new-onset Afib in internal/external validation sets, respectively. Conclusions: A DLM-enabled ECG could be considered as a LAE screening tool and provide better prognostic information for related cardiovascular diseases. Full article

(This article belongs to the Special Issue Artificial Intelligence Application in Health Care System)

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14 pages, 309 KiB

Open AccessArticle

Understanding the Risks and Benefits of a Patient Portal Configured for HIV Care: Patient and Healthcare Professional Perspectives

by Dominic Chu, David Lessard, Moustafa A. Laymouna, Kim Engler, Tibor Schuster, Yuanchao Ma, Nadine Kronfli, Jean-Pierre Routy, Tarek Hijal, Karine Lacombe, Nancy Sheehan, Hayette Rougier and Bertrand Lebouché

J. Pers. Med. 2022, 12(2), 314; https://doi.org/10.3390/jpm12020314 - 19 Feb 2022

Cited by 3 | Viewed by 3025

Abstract

Background: Like other chronic viral illnesses, HIV infection necessitates consistent self-management and adherence to care and treatment, which in turn relies on optimal collaboration between patients and healthcare professionals (HCPs), including physicians, nurses, pharmacists, and clinical care coordinators. By providing people living with [...] Read more.

Background: Like other chronic viral illnesses, HIV infection necessitates consistent self-management and adherence to care and treatment, which in turn relies on optimal collaboration between patients and healthcare professionals (HCPs), including physicians, nurses, pharmacists, and clinical care coordinators. By providing people living with HIV (PLHIV) with access to their personal health information, educational material, and a communication channel with HCPs, a tailored patient portal could support their engagement in care. Our team intends to implement a patient portal in HIV-specialized clinics in Canada and France. We sought to understand the perceived risks and benefits among PLHIV and HCPs of patient portal use in HIV clinical care. Methods: This qualitative study recruited PLHIV and HIV-specialized HCPs, through maximum variation sampling and purposeful sampling, respectively. Semi-structured focus group discussions (FGDs) were held separately with PLHIV and HCPs between August 2019 and January 2020. FGDs were recorded, transcribed, coded using NVivo 12 software, and analyzed using content analysis. Results: A total of twenty-eight PLHIV participated in four FGDs, and thirty-one HCPs participated in six FGDs. PLHIV included eighteen men, nine women, and one person identifying as other; while, HCPs included ten men, twenty women, and one person identifying as other. A multi-disciplinary team of HCPs were included, involving physicians, nurses, pharmacists, social workers, and clinical coordinators. Participants identified five potential risks: (1) breach of confidentiality, (2) stress or uncertainty, (3) contribution to the digital divide, (4) dehumanization of care, and (5) increase in HCPs’ workload. They also highlighted four main benefits of using a patient portal: (1) improvement in HIV self-management, (2) facilitation of patient visits, (3) responsiveness to patient preferences, and (4) fulfillment of current or evolving patient needs. Conclusion: PLHIV and HCPs identified both risks and benefits of using a patient portal in HIV care. By engaging stakeholders and understanding their perspectives, the configuration of a patient portal can be optimized for end-users and concerns may be mitigated during its implementation. Full article

(This article belongs to the Special Issue Personalized Care for HIV Prevention, Treatment and Cure)

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18 pages, 1159 KiB

Open AccessArticle

Differences and Commonalities in Children with Childhood Apraxia of Speech and Comorbid Neurodevelopmental Disorders: A Multidimensional Perspective

by Anna Maria Chilosi, Irina Podda, Ivana Ricca, Alessandro Comparini, Beatrice Franchi, Simona Fiori, Rosa Pasquariello, Claudia Casalini, Paola Cipriani and Filippo Maria Santorelli

J. Pers. Med. 2022, 12(2), 313; https://doi.org/10.3390/jpm12020313 - 19 Feb 2022

Cited by 7 | Viewed by 6057

Abstract

Childhood apraxia of speech (CAS) is a motor speech disorder often co-occurring with language impairment and complex neurodevelopmental disorders. A cohort of 106 children with CAS associated to other neurodevelopmental disorders underwent a multidimensional investigation of speech and language profiles, chromosome microarray analysis [...] Read more.

Childhood apraxia of speech (CAS) is a motor speech disorder often co-occurring with language impairment and complex neurodevelopmental disorders. A cohort of 106 children with CAS associated to other neurodevelopmental disorders underwent a multidimensional investigation of speech and language profiles, chromosome microarray analysis and structural brain magnetic resonance (MR). Our aim was to compare the clinical profiles of children with CAS co-occurring with only language impairment with those who, in addition to language impairment, had other neurodevelopmental disorders. Expressive grammar was impaired in the majority of the sample in the context of similar alterations of speech, typical of the core symptoms of CAS. Moreover, children with complex comorbidities also showed more severe and persistent receptive language deficits. About 25% of the participants harbored copy number variations (CNVs) already described in association to neurodevelopmental disorders. CNVs occurred more frequently in children with complex comorbidities. MR structural/signal alterations were found in a small number of children and were of uncertain pathogenic significance. These results confirm that CAS needs multidimensional diagnostic and clinical management. The high frequency of language impairment has important implications for early care and demands a personalized treatment approach in which speech and language goals are consistently integrated. Full article

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3 pages, 187 KiB

Open AccessEditorial

The Role of Radiation in Cancer Treatment: New Insights towards Personalized Therapies

by Luigi Minafra, Francesco P. Cammarata and Marco Calvaruso

J. Pers. Med. 2022, 12(2), 312; https://doi.org/10.3390/jpm12020312 - 19 Feb 2022

Viewed by 1420

Abstract

Despite all the recent pharmacological advances and the introduction of targeted therapies in clinical practice, cancer still remains one of the leading cause of death, accounting for 10 million deaths per year, based on the most recent reports [...] Full article

(This article belongs to the Special Issue The Role of Radiation in Cancer Treatment: New Insights towards Personalized Therapies)

13 pages, 2381 KiB

Open AccessArticle

MicroRNAs as Predictors of Future Uterine Malignancy in Endometrial Hyperplasia without Atypia

by Chiao-Yun Lin, Ren-Chin Wu, Lan-Yan Yang, Shih-Ming Jung, Shir-Hwa Ueng, Yun-Hsin Tang, Huei-Jean Huang, Hsiu-Jung Tung, Cheng-Tao Lin, Hsuan-Yu Chen, Angel Chao and Chyong-Huey Lai

J. Pers. Med. 2022, 12(2), 311; https://doi.org/10.3390/jpm12020311 - 18 Feb 2022

Cited by 4 | Viewed by 1604

Abstract

The histological criteria for classifying endometrial hyperplasia (EH) are based on architectural crowding and nuclear atypia; however, diagnostic agreement among pathologists is poor. We investigated molecular biomarkers of endometrial cancer (EC) risk in women with simple hyperplasia or complex hyperplasia without atypia (SH/CH-nonA). [...] Read more.

The histological criteria for classifying endometrial hyperplasia (EH) are based on architectural crowding and nuclear atypia; however, diagnostic agreement among pathologists is poor. We investigated molecular biomarkers of endometrial cancer (EC) risk in women with simple hyperplasia or complex hyperplasia without atypia (SH/CH-nonA). Forty-nine patients with EC preceded by SH/CH-nonA were identified, of which 23 were excluded (15 with complex atypical hyperplasia (CAH), six not consenting, one with a diagnosis <6 months prior, and one lost to follow-up). The EH tissues of these patients were compared with those of patients with SH/CH-nonA that did not progress to EC (control) through microRNA (miRNA) array analysis, and the results were verified in an expanded cohort through reverse transcription-quantitative polymerase chain reaction (RT-qPCR). MiRNA arrays analyses revealed 20 miRNAs that differed significantly (p < 0.05, fold change >4) between the control (n = 12) and case (n = 6) patients. Multiplex RT-qPCR for the 20 miRNAs in the expanded cohort (94 control and 25 case patients) led to the validation of miR-30a-3p (p = 0.0009), miR-141 (p < 0.0001), miR-200a (p < 0.0001), and miR-200b (p < 0.0001) as relevant biomarkers, among which miR-141, miR-200a, and miR-200b regulate the expression of phosphatase and tensin homolog (PTEN). For the prediction of EC, the area under the curve for miR-30a-3p, miR-141, miR-200a, and miR-200b was 0.623, 0.754, 0.783, and 0.704, respectively. The percentage of complete PTEN loss was significantly higher in the case group than in the control group (24% vs. 0%, p < 0.001, Fisher’s exact test). A combination of complete PTEN loss and miR-200a provided optimal prediction performance (sensitivity = 0.760; specificity = 1.000; positive predictive value = 1.000; negative predictive value = 0.937; accuracy = 0.947). MiR-30a-3p, miR-141, miR-200a, miR-200b, and complete PTEN loss may be useful tissue biomarkers for predicting EC risk among patients with SH/CH-nonA. Full article

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17 pages, 3259 KiB

Open AccessArticle

COVID-19 Detection in CT/X-ray Imagery Using Vision Transformers

by Mohamad Mahmoud Al Rahhal, Yakoub Bazi, Rami M. Jomaa, Ahmad AlShibli, Naif Alajlan, Mohamed Lamine Mekhalfi and Farid Melgani

J. Pers. Med. 2022, 12(2), 310; https://doi.org/10.3390/jpm12020310 - 18 Feb 2022

Cited by 24 | Viewed by 3760

Abstract

The steady spread of the 2019 Coronavirus disease has brought about human and economic losses, imposing a new lifestyle across the world. On this point, medical imaging tests such as computed tomography (CT) and X-ray have demonstrated a sound screening potential. Deep learning [...] Read more.

The steady spread of the 2019 Coronavirus disease has brought about human and economic losses, imposing a new lifestyle across the world. On this point, medical imaging tests such as computed tomography (CT) and X-ray have demonstrated a sound screening potential. Deep learning methodologies have evidenced superior image analysis capabilities with respect to prior handcrafted counterparts. In this paper, we propose a novel deep learning framework for Coronavirus detection using CT and X-ray images. In particular, a Vision Transformer architecture is adopted as a backbone in the proposed network, in which a Siamese encoder is utilized. The latter is composed of two branches: one for processing the original image and another for processing an augmented view of the original image. The input images are divided into patches and fed through the encoder. The proposed framework is evaluated on public CT and X-ray datasets. The proposed system confirms its superiority over state-of-the-art methods on CT and X-ray data in terms of accuracy, precision, recall, specificity, and F1 score. Furthermore, the proposed system also exhibits good robustness when a small portion of training data is allocated. Full article

(This article belongs to the Special Issue Recent Advances on Coronavirus Disease 2019 (COVID-19))

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23 pages, 30736 KiB

Open AccessArticle

A Multi-Agent Deep Reinforcement Learning Approach for Enhancement of COVID-19 CT Image Segmentation

by Hanane Allioui, Mazin Abed Mohammed, Narjes Benameur, Belal Al-Khateeb, Karrar Hameed Abdulkareem, Begonya Garcia-Zapirain, Robertas Damaševičius and Rytis Maskeliūnas

J. Pers. Med. 2022, 12(2), 309; https://doi.org/10.3390/jpm12020309 - 18 Feb 2022

Cited by 48 | Viewed by 5771

Abstract

Currently, most mask extraction techniques are based on convolutional neural networks (CNNs). However, there are still numerous problems that mask extraction techniques need to solve. Thus, the most advanced methods to deploy artificial intelligence (AI) techniques are necessary. The use of cooperative agents [...] Read more.

Currently, most mask extraction techniques are based on convolutional neural networks (CNNs). However, there are still numerous problems that mask extraction techniques need to solve. Thus, the most advanced methods to deploy artificial intelligence (AI) techniques are necessary. The use of cooperative agents in mask extraction increases the efficiency of automatic image segmentation. Hence, we introduce a new mask extraction method that is based on multi-agent deep reinforcement learning (DRL) to minimize the long-term manual mask extraction and to enhance medical image segmentation frameworks. A DRL-based method is introduced to deal with mask extraction issues. This new method utilizes a modified version of the Deep Q-Network to enable the mask detector to select masks from the image studied. Based on COVID-19 computed tomography (CT) images, we used DRL mask extraction-based techniques to extract visual features of COVID-19 infected areas and provide an accurate clinical diagnosis while optimizing the pathogenic diagnostic test and saving time. We collected CT images of different cases (normal chest CT, pneumonia, typical viral cases, and cases of COVID-19). Experimental validation achieved a precision of 97.12% with a Dice of 80.81%, a sensitivity of 79.97%, a specificity of 99.48%, a precision of 85.21%, an F1 score of 83.01%, a structural metric of 84.38%, and a mean absolute error of 0.86%. Additionally, the results of the visual segmentation clearly reflected the ground truth. The results reveal the proof of principle for using DRL to extract CT masks for an effective diagnosis of COVID-19. Full article

(This article belongs to the Special Issue Application of Artificial Intelligence in Personalized Medicine)

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9 pages, 789 KiB

Open AccessArticle

Comparison of Long-Term Pneumonia Risk between Spleen Injury and Non-Spleen Injury after Total Splenectomy—A Population-Based Study

by Chun-Cheng Lin, Sheng-Der Hsu, Wu-Chien Chien, Chi-Hsiang Chung, Cheng-Jueng Chen, Chia-Ming Liang and Zhi-Jie Hong

J. Pers. Med. 2022, 12(2), 308; https://doi.org/10.3390/jpm12020308 - 18 Feb 2022

Viewed by 1680

Abstract

Patients who undergo splenectomy are at a high risk of infection. We aimed to investigate the rate of pneumonia in patients who underwent splenectomy, specifically comparing those who had splenectomy due to spleen injury and those who had it for other reasons. A [...] Read more.

Patients who undergo splenectomy are at a high risk of infection. We aimed to investigate the rate of pneumonia in patients who underwent splenectomy, specifically comparing those who had splenectomy due to spleen injury and those who had it for other reasons. A population-based cohort study was conducted. Overall, 17,498 patients who underwent splenectomy between 2000 and 2015 were enrolled, including 11,817 patients with a history of spleen injury and 5681 controls without spleen injury. The incidence of pneumonia was calculated at the end of 2016. A multivariable Cox proportional hazards regression model was used to compare the hazard ratio with 95% CI for pneumonia associated with the spleen injury-caused splenectomy and splenectomy due to other causes. The crude HR for patients with splenectomy due to spleen injury to develop pneumonia was 1.649. After adjusting for covariates, the adjusted hazard ratio was 1.567. There were statistically significant differences in all subgroups, except for the group with a tracking duration >10 years. We found an increase in pneumonia risk in the ‘spleen injury’ group when comparing it to that of the ‘other causes’ group, regardless of age, sex, and area of residence. Full article

(This article belongs to the Special Issue Personalized Medicine in Trauma Resuscitation and Treatment)

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26 pages, 5604 KiB

Open AccessEditor’s ChoiceSystematic Review

The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis

by Marco Milone, Michele Manigrasso, Pietro Anoldo, Anna D’Amore, Ugo Elmore, Mariano Cesare Giglio, Gianluca Rompianesi, Sara Vertaldi, Roberto Ivan Troisi, Nader K. Francis and Giovanni Domenico De Palma

J. Pers. Med. 2022, 12(2), 307; https://doi.org/10.3390/jpm12020307 - 18 Feb 2022

Cited by 10 | Viewed by 2587

Abstract

Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic [...] Read more.

Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons. Full article

(This article belongs to the Special Issue Update on Robotic Gastrointestinal Surgery)

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14 pages, 304 KiB

Open AccessArticle

Health Promotion and Disease Prevention in the Elderly: The Perspective of Nursing Students

by Rogério Ferreira, Cristina Lavareda Baixinho, Óscar Ramos Ferreira, Ana Clara Nunes, Teresa Mestre and Luís Sousa

J. Pers. Med. 2022, 12(2), 306; https://doi.org/10.3390/jpm12020306 - 18 Feb 2022

Cited by 5 | Viewed by 4385

Abstract

Health promotion and disease prevention are closely linked to health literacy. Therefore, intervention to increase individuals’ knowledge is essential if action is to be taken to promote a healthy lifestyle with support from health professionals for decision making on choices leading to behavioral [...] Read more.

Health promotion and disease prevention are closely linked to health literacy. Therefore, intervention to increase individuals’ knowledge is essential if action is to be taken to promote a healthy lifestyle with support from health professionals for decision making on choices leading to behavioral change. Taking into account the growing aging population, nurses and nursing students have to develop interventions to promote health and prevent disease in these people, in order to keep them healthy and with quality of life. This study aims to understand how nursing students’ experiences in a clinical teaching context contributed to the development of their competencies in the promotion of health and prevention of disease in the elderly. Method: Qualitative, exploratory, and descriptive study carried out with ten students about to finish a graduate nursing course in a higher education institution in the South of Portugal. This study was carried out through narratives, one of the most common data collection procedures in social and health investigations. The content analysis technique, more specifically the thematic categorical analysis, was used for data analysis. The study received authorization from the Ethics Committee of the institution where it took place. Results: Three categories were found: “Strategies to promote health and prevent disease in the elderly”, “Health improvements from the implementation of the strategies to promote health and prevent disease in the elderly”, and “The impact your participation in these strategies to promote health and prevent disease in the elderly had on your formative process”. Conclusion: The students developed competencies during their clinical teaching experiences through the implementation of strategies of health promotion and disease prevention adapted to/focused on the needs of the elderly. Full article

(This article belongs to the Special Issue Personalized Care and Treatment Compliance in Chronic Conditions)

10 pages, 379 KiB

Open AccessArticle

The Sociodemographic and Risk Factors for Fuchs’ Endothelial Dystrophy: A Nationwide, Matched Case–Control Study in Taiwan

by Yuh-Shin Chang, Chung-Han Ho, Jhi-Joung Wang, Sung-Huei Tseng and Ren-Long Jan

J. Pers. Med. 2022, 12(2), 305; https://doi.org/10.3390/jpm12020305 - 18 Feb 2022

Cited by 2 | Viewed by 1462

Abstract

This nationwide, population-based, retrospective, matched case–control study included 4334 newly diagnosed Fuchs’ endothelial dystrophy (FED) patients who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 371.57, and selected from the Taiwan National Health Insurance Research Database. The [...] Read more.

This nationwide, population-based, retrospective, matched case–control study included 4334 newly diagnosed Fuchs’ endothelial dystrophy (FED) patients who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 371.57, and selected from the Taiwan National Health Insurance Research Database. The age-, sex-, and index-date-matched control group included 4334 non-FED controls selected from the Taiwan Longitudinal Health Insurance Database 2000. Ocular allergic conditions and sociodemographic conditions were examined using univariate logistic regression analyses and paired t-test was used for continuous variables. Adjusted logistic regression was used to compare the odds ratio (OR) of the FED development. Patients with ocular allergic conditions were more likely to have FED than the controls (OR = 25.50, 95% CI = 12.58–51.68, p < 0.0001) even after conditional logistic regression was conducted (adjusted OR = 25.26, 95% CI = 11.24–56.77, p < 0.0001). Regarding the sociodemographic factors, we found that more than half of the FED patients in Taiwan were aged ≥45 years old, there was an equal female-to-male ratio (1.06:1), and patients with a lower income and living in northern Taiwan had higher odds of developing FED. The results strongly support an association between ocular allergic conditions, geographic region, residential status, income, and FED. Full article

(This article belongs to the Section Epidemiology)

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8 pages, 529 KiB

Open AccessArticle

Excellent and Good Results Treating Stiffness with Early and Late Manipulation after Unrestricted Caliper-Verified Kinematically Aligned TKA

by Adithya Shekhar, Stephen M. Howell, Alexander J. Nedopil and Maury L. Hull

J. Pers. Med. 2022, 12(2), 304; https://doi.org/10.3390/jpm12020304 - 18 Feb 2022

Cited by 1 | Viewed by 1530

Abstract

Manipulation under anesthesia (MUA) for stiffness within 6 to 12 weeks after mechanically aligned total knee arthroplasty (TKA) generally yields better outcome scores than an MUA performed later. However, the timing of MUA after unrestricted, caliper-verified, kinematically aligned (KA) TKA remains uncertain. A [...] Read more.

Manipulation under anesthesia (MUA) for stiffness within 6 to 12 weeks after mechanically aligned total knee arthroplasty (TKA) generally yields better outcome scores than an MUA performed later. However, the timing of MUA after unrestricted, caliper-verified, kinematically aligned (KA) TKA remains uncertain. A retrospective review identified 82 of 3558 (2.3%) KA TKA patients treated with an MUA between 2010 and 2017. Thirty patients treated with an MUA within 3 months of the TKA (i.e., early) and 24 in the late group (i.e., >3 months) returned a questionnaire after a mean of 6 years and 5 years, respectively. Mean outcome scores for the early vs. late group were 78 vs. 62 for the Forgotten Joint Score (FJS) (p = 0.023) and 42 vs. 39 for the Oxford Knee Score (OKS) (p = 0.037). Subjectively, the early vs. late group responses indicated that 83% vs. 67% walked without a limp, 73% vs. 54% had normal extension, and 43% vs. 25% had normal flexion. An MUA within 3 months after unrestricted KA TKA provided excellent FJS and OKS at final follow-up relative to a late MUA. A late MUA performed after 3 months is worth consideration because of the good FJS and OKS scores, albeit with a risk of a persistent limp and limitation in knee extension and flexion. Full article

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

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14 pages, 769 KiB

Open AccessArticle

Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial

by Ki-Sang Kim, Jungae An, Ju-O Kim, Mi-Young Lee and Byoung-Hee Lee

J. Pers. Med. 2022, 12(2), 303; https://doi.org/10.3390/jpm12020303 - 17 Feb 2022

Cited by 13 | Viewed by 4141

Abstract

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low [...] Read more.

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain. Full article

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10 pages, 258 KiB

Open AccessArticle

Association between Hyperosmolar Hyperglycemic State and Venous Thromboembolism in Diabetes Patients: A Nationwide Analysis in Taiwan

by Wei-Ting Wei, Shu-Man Lin, Jin-Yi Hsu, Ying-Ying Wu, Ching-Hui Loh, Huei-Kai Huang and Peter Pin-Sung Liu

J. Pers. Med. 2022, 12(2), 302; https://doi.org/10.3390/jpm12020302 - 17 Feb 2022

Viewed by 2003

Abstract

Background: Previous studies in Western countries have shown that a hyperosmolar hyperglycemic state (HHS) is associated with an increased risk of venous thromboembolism (VTE); in these cases, prophylactic anticoagulant treatment is suggested. However, the association between HHS and VTE in Asian populations remains [...] Read more.

Background: Previous studies in Western countries have shown that a hyperosmolar hyperglycemic state (HHS) is associated with an increased risk of venous thromboembolism (VTE); in these cases, prophylactic anticoagulant treatment is suggested. However, the association between HHS and VTE in Asian populations remains undetermined. Therefore, we aimed to evaluate whether HHS is associated with an increased risk of VTE in diabetic Taiwanese patients. Methods: This nationwide, population-based, retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. We enrolled a total of 4,723,607 admission records of patients with diabetes diagnosed with one or more of seven common diseases (pneumonia, urinary tract infection, sepsis, heart disease, stroke, malignancy, and respiratory tract disease) between 2001 and 2018 in Taiwan. The patients were divided into two groups based on the presence (n = 46,000) or absence (n = 4,677,607) of HHS. We estimated the adjusted odds ratio (aOR) for developing VTE within 90 days after the index hospitalization using multivariable logistic regression with generalized estimating equations accounting for repeated measures. Results: Overall, patients admitted with HHS had a similar risk of VTE compared with those admitted without HHS (408/46,000 vs. 39,345/4,677,607; aOR = 1.06, 95% CI: 0.97–1.17, p = 0.190). A similar non-significant association between HHS and VTE was found regardless of age and sex subgroups. Conclusions: There was no significant association between HHS and overall VTE risk in patients with diabetes in Taiwan. The results of our study may not support the use of prophylactic anticoagulant therapy in diabetic Taiwanese patients with HHS. Full article

(This article belongs to the Topic Big Data in Healthcare, Bioinformatics and Precision Medicine)

6 pages, 2665 KiB

Open AccessArticle

The Efficacy of Thrombin-Gelatin Matrix in Hemostasis for Large Breast Tumor after Vacuum-Assisted Breast Biopsy

by Yen-Dun Tony Tzeng, Shiuh-Inn Liu, Being-Whey Wang, Yu-Chia Chen, Po-Ming Chang, I-Shu Chen, Jim Jinn-Chyuan Sheu and Jui-Hu Hsiao

J. Pers. Med. 2022, 12(2), 301; https://doi.org/10.3390/jpm12020301 - 17 Feb 2022

Cited by 1 | Viewed by 2223

Abstract

Background: Vacuum-assisted breast biopsy (VABB) for benign breast tumor excision is a developing trend in breast surgery. The most common complication of VABB is hematoma. We assessed the efficiency of the thrombin-gelatin matrix (TGM) for hemostasis after VABB. Methods: From December 2013 to [...] Read more.

Background: Vacuum-assisted breast biopsy (VABB) for benign breast tumor excision is a developing trend in breast surgery. The most common complication of VABB is hematoma. We assessed the efficiency of the thrombin-gelatin matrix (TGM) for hemostasis after VABB. Methods: From December 2013 to June 2017, 147 patients with breast tumors > 2 cm in size were treated with a 7-gauge ultrasound-guided EnCor EnSpire^® breast biopsy system. After VABB, the TGM was applied using an iron-tube device. After injection, brief external compression for 15 min and postoperative bandage compression for approximately 12 h were applied. The medical records were reviewed and analyzed for hematoma and acute bleeding at 1 and 3 months after VABB. Results: A total of 72 patients received hemostasis via TGM, and 75 patients received hemostasis by compression. The rates of postoperative acute bleeding in the TGM group were significantly lower than those in the non-TGM group (5.5% vs. 22.7%, p = 0.003). Among patients with hematoma, there was no statistically significant difference between the two groups (25% vs. 26.7%, p = 0.85). Conclusions: This is the first cohort study to apply the TGM hemostatic matrix for post-VABB hemostasis. The TGM hemostatic matrix could be an option for patients with large breast tumors. Full article

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10 pages, 376 KiB

Open AccessReview

Personalized Nutrition in Patients with Type 2 Diabetes and Chronic Kidney Disease: The Two-Edged Sword of Dietary Protein Intake

by Milou M. Oosterwijk, Gerjan Navis, Stephan J. L. Bakker and Gozewijn D. Laverman

J. Pers. Med. 2022, 12(2), 300; https://doi.org/10.3390/jpm12020300 - 17 Feb 2022

Cited by 4 | Viewed by 2217

Abstract

In type 2 diabetes (T2D), there is a general and strong focus on carbohydrate restriction. However, this may have unwarranted consequences for those with concomitant chronic kidney disease (CKD) since decreasing intake of carbohydrates implies a higher proportion of dietary protein, which is [...] Read more.

In type 2 diabetes (T2D), there is a general and strong focus on carbohydrate restriction. However, this may have unwarranted consequences for those with concomitant chronic kidney disease (CKD) since decreasing intake of carbohydrates implies a higher proportion of dietary protein, which is of critical debate in patients with CKD due to its ambiguous implications in maintaining either kidney function or nutritional status. We evaluated adherence to the protein recommendations, taking into account the nutritional status of patients with T2D with or without CKD. Patients were divided in three groups according to their estimated Glomerular Filtration Rate (eGFR): mild to no CKD (eGFR > 60 mL/min/1.73 m²), moderate CKD (eGFR 30–60 mL/min/1.73 m²), or advanced CKD (eGFR < 30 mL/min/1.73 m²). Regarding adherence to the protein recommendations, 17% of the patients without advanced CKD consumed < 0.8 g/kg/day, 29% of the patients with moderate CKD consumed > 1.3 g/kg/day, and 60% of the patients with advanced CKD consumed > 1.0 g/kg/day. In addition, patients with moderate- or advanced CKD tend to have a lower muscle mass, normalized by height, compared to patients with mild to no CKD (p < 0.001), while body mass index was not significantly different between patients with or without CKD (p = 0.44). We found that although dietary protein restriction has not been indicated in either of the CKD stages, approximately 10% had a dietary protein intake < 0.8 g/kg/day, with accompanying risks of malnourishment and sarcopenia. Our main advice is to maintain a dietary protein intake of at least 0.8 g/kg/day in order to prevent patients from becoming malnourished and sarcopenic. Full article

(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)

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11 pages, 1452 KiB

Open AccessArticle

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

by Ying-Yi Chen, Tsai-Chung Li, Chia-Ing Li, Shih-Pin Lin and Pin-Kuei Fu

J. Pers. Med. 2022, 12(2), 299; https://doi.org/10.3390/jpm12020299 - 17 Feb 2022

Cited by 2 | Viewed by 1699

Abstract

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Previous studies have addressed the impact of comorbidity on short-term mortality in patients with COPD. However, the prevalence of cardiovascular disease (CVD) and the association of statins prescription with mortality [...] Read more.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Previous studies have addressed the impact of comorbidity on short-term mortality in patients with COPD. However, the prevalence of cardiovascular disease (CVD) and the association of statins prescription with mortality for aged COPD patients remains unclear. We enrolled 296 aged, hospitalized patients who were monitored in the pay-for-performance (P-4-P) program of COPD. Factors associated with long-term mortality were identified by Cox regression analysis. The median age of the study cohort was 80 years old, and the prevalence of coronary artery disease (CAD) and statins prescriptions were 16.6% and 31.4%, respectively. The mortality rate of the median 3-year follow-up was 51.4%. Through multivariate analysis, body mass index (BMI), statin prescription, and events of respiratory failure were associated with long-term mortality. A Cox analysis showed that statins prescription was associated with lower mortality (hazard ratio (HR): 0.5, 95% Confident interval, 95% CI: 0.34–0.73, p = 0.0004) and subgroup analysis showed that rosuvastatin prescription had protective effect on long-term mortality (HR: 0.44; 95% CI: 0.20–0.97; p < 0.05). Statin prescriptions might be associated with better long-term survival in aged COPD patients, especially those who experienced an acute exacerbation of COPD (AECOPD) who require hospitalization. Full article

(This article belongs to the Special Issue Personalized Medicine in Cardiovascular Diseases)

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18 pages, 2824 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation

by Yoga Waranugraha, Ardian Rizal and Yoga Yuniadi

J. Pers. Med. 2022, 12(2), 298; https://doi.org/10.3390/jpm12020298 - 17 Feb 2022

Cited by 6 | Viewed by 2120

Abstract

The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to [...] Read more.

The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; p = 0.41), freedom from AF (OR = 0.93; 95% CI = 0.65 to 1.35; p = 0.72), and acute pulmonary vein isolation (PVI) (OR = 1.17; 95% CI = 0.54 to 2.53; p = 0.70) between 2G-CB ablation and CF-RF ablation were not different. The procedure time for the 2G-CB ablation was shorter (MD = −18.78 min; 95% CI = −27.72 to −9.85 min; p < 0.01), while the fluoroscopy time was similar (MD = 2.66 min; 95% CI = −0.52 to 5.83 min; p = 0.10). In the 2G-CB ablation group, phrenic nerve paralysis was more common (OR = 5.74; 95% CI = 1.80 to 18.31; p = < 0.01). Regarding freedom from ATAs, freedom from AF, and acute PVI, these findings imply that 2G-CB ablation is not superior to CF-RF ablation in paroxysmal AF. Although faster than CF-RF ablation, 2G-CB ablation has a greater risk of phrenic nerve paralysis. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cardiology)

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11 pages, 1199 KiB

Open AccessArticle

Prediction of Gastric Gastrointestinal Stromal Tumors before Operation: A Retrospective Analysis of Gastric Subepithelial Tumors

by Yu-Ning Lin, Ming-Yan Chen, Chun-Yi Tsai, Wen-Chi Chou, Jun-Te Hsu, Chun-Nan Yeh, Ta-Sen Yeh and Keng-Hao Liu

J. Pers. Med. 2022, 12(2), 297; https://doi.org/10.3390/jpm12020297 - 17 Feb 2022

Cited by 3 | Viewed by 1622

Abstract

Gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas are the most common gastric subepithelial tumors (GSETs) with similar endoscopic findings. Preoperative prediction of GSETs is difficult. This study analyzed and predicted GSET diagnosis through a retrospective review of 395 patients who underwent surgical resection [...] Read more.

Gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas are the most common gastric subepithelial tumors (GSETs) with similar endoscopic findings. Preoperative prediction of GSETs is difficult. This study analyzed and predicted GSET diagnosis through a retrospective review of 395 patients who underwent surgical resection of GISTs, leiomyomas, and schwannomas measuring 2–10 cm. GSETs were divided by size (group 2–5, >2 and ≤5 cm; group 5–10, >5 and ≤10 cm) for analysis. Demographics, clinical symptoms, and images were analyzed. A recursive partitioning analysis (RPA) was used to identify optimal classifications for specific GSET diagnoses. GIST patients were relatively older than other patients. Both groups had higher proportions of UGI bleeding, lower hemoglobin (Hb) levels, and a higher ratio of necrosis on their computed tomography (CT) scans. The RPA tree showed that (a) age ≤ 55, Hb ≥ 10.7, and CT necrosis; (b) age ≤ 55 and Hb < 10.7; (c) age >55 and Hb < 12.9; and (d) age >55 and CT hetero-/homogeneity can predict high GIST risk in group 2–5. Positive or negative CT necrosis, with age >55, can predict high GIST risk in group 5–10. GIST patients were older and presented with low Hb levels and tumor necrosis. In RPA, the accuracy reached 85% and 89% in groups 2–5 and 5–10, respectively. Full article

(This article belongs to the Section Mechanisms of Diseases)

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7 pages, 1314 KiB

Open AccessCommunication

Electron Microscopy Reveals Evidence of Perinuclear Clustering of Mitochondria in Cardiac Biopsy-Proven Allograft Rejection

by Estefanía Tarazón, Lorena Pérez-Carrillo, Manuel Portolés and Esther Roselló-Lletí

J. Pers. Med. 2022, 12(2), 296; https://doi.org/10.3390/jpm12020296 - 17 Feb 2022

Cited by 2 | Viewed by 1626

Abstract

Acute cellular rejection is a major complication in heart transplantation. We focus on the analysis of new ultrastructural findings in cardiac biopsy rejection based on mitochondrial intracellular organization. This study includes heart transplanted patients from a single center who were referred for endomyocardial [...] Read more.

Acute cellular rejection is a major complication in heart transplantation. We focus on the analysis of new ultrastructural findings in cardiac biopsy rejection based on mitochondrial intracellular organization. This study includes heart transplanted patients from a single center who were referred for endomyocardial biopsies as a scheduled routine screening. Participants were divided into two groups: patients transplanted without allograft rejection (Grade 0R), and patients with biopsy-proven allograft rejection (Grade ≥ 2R). Using electronic microscopy, we detected a significant increase in the volume density of mitochondria (p < 0.0001) and dense bodies (p < 0.01) in the rejection group. The most relevant finding was the presence of local accumulations of mitochondria close to the nuclear envelope, pressing and molding the morphology of this membrane in all rejection samples (100%). We identified this perinuclear clustering of mitochondria phenomenon in a 68 ± 27% of the total cardiac nucleus observed from rejection samples. We did not observe this phenomenon in any non-rejection samples, reflecting excellent sensitivity and specificity. We have identified a specific phenomenon affecting the architecture of the nuclear membrane—perinuclear clustering of mitochondria—in endomyocardial biopsies from patients with cardiac rejection. This ultrastructural approach might complement and improve the diagnosis of rejection. Full article

(This article belongs to the Section Disease Biomarker)

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Open AccessArticle

COVID-19 Vaccination Intention Associated with Behaviors towards Protection and Perceptions Regarding the Pandemic

by Chrysoula Dafogianni, Polyxeni Mangoulia, Despoina Pappa, Panagiota Xanthopoulou, Ioannis Koutelekos, Mixalis Zografakis-Sfakianakis, Eftychia Ferentinou, Antigoni Fountouki, Marianna Drakopoulou, Anna Giga, Nikos Anastasiou, Nikoletta Margari and Georgia Fasoi

J. Pers. Med. 2022, 12(2), 295; https://doi.org/10.3390/jpm12020295 - 17 Feb 2022

Cited by 4 | Viewed by 1707

Abstract

Background: The impressively rapid availability of different types of COVID-19 vaccines and, on the other hand, the degree of their effectiveness as opposed to the likelihood of serious or non-serious side effects place a fairly large percentage of the population at a crossroads [...] Read more.

Background: The impressively rapid availability of different types of COVID-19 vaccines and, on the other hand, the degree of their effectiveness as opposed to the likelihood of serious or non-serious side effects place a fairly large percentage of the population at a crossroads regarding the choice to get vaccinated or not, hence threatening achievement of total immunization coverage and full immunity. This study aimed to assess COVID-19 vaccination intention in Greece regarding protection behaviors and perceptions of the pandemic. Methods: A total of 3753 participants completed a specially designed electronic questionnaire anonymously and voluntarily. The study population consisted of healthcare workers, students, members of professional societies, teachers, and professors. The questionnaire was composed of four parts pertaining to demographic data and possible changes in hygiene attitudes during the COVID-19 pandemic. Results: In total, 43.3% of the participants stated that SARS-CoV-2 poses a significant risk. The most widespread protection practice was avoiding crowded places (90.1%), followed by reducing the use of public transport (86.1%) and washing their hands with soap and water more often than usual (84.2%). Women undertook significantly more behavioral changes than men and participants of other nationalities. About half of the participants (44%) implemented seven behavioral changes. Lower personal and general perceived risk due to COVID-19 was significantly associated with lower intention to get vaccinated. Conclusion: Strong hesitancy was observed towards COVID-19 vaccination. There is a need for further studies to be conducted to investigate the benefits and safety of vaccines for the purpose of better informing the public. Healthcare personnel can and should play a key role in this process. Full article

(This article belongs to the Special Issue Personalized Clinical and Community Nursing)

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J. Pers. Med., Volume 12, Issue 2 (February 2022) – 202 articles

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