Journal of Personalized Medicine

16 pages, 667 KiB

Open AccessArticle

Radiotherapy of Breast Cancer in Laterally Tilted Prone vs. Supine Position: What about the Internal Mammary Chain?

by Nils Temme, Robert Michael Hermann, Tanja Hinsche, Jan-Niklas Becker, Mathias Sonnhoff, Alexander Kaltenborn, Ulrich Martin Carl, Hans Christiansen, Lilli Geworski and Mirko Nitsche

J. Pers. Med. 2022, 12(4), 653; https://doi.org/10.3390/jpm12040653 - 18 Apr 2022

Viewed by 3259

Abstract

Background: In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric [...] Read more.

Background: In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric study on the EBRT of the breast (“B”) and the breast including PSR (“B + PSR”), comparing the supine and the laterally tilted prone patient positions in free breathing. Methods: The planning CT scans of 20 left- and 20 right-sided patients were analyzed. EBRT plans were calculated with 3D conformal EBRT (3D) and with intensity-modulated EBRT (IMRT) for “B” and “B + PSR” in the prone and supine positions. The mean and threshold doses were computed. The quality of EBRT plans was compared with an overall plan assessment factor (OPAF), comprising three subfactors, homogeneity, conformity, and radiogenic exposure of OAR. Results: In the EBRT of “B”, prone positioning significantly reduced the exposure of the OARs “heart” and “ipsilateral lung” and “lymphatic regions”. The OPAF was significantly better in the prone position, regardless of the planning technique or the treated breast side. In the EBRT of “B + PSR”, supine positioning significantly reduced the OAR “heart” exposure but increased the dose to the OARs “ipsilateral lung” and “lymphatic regions”. There were no significant differences for the OPAF, independent of the irradiated breast side. Only the IMRT planning technique increased the chance of a comparatively good EBRT plan. Conclusion: Free breathing prone positioning significantly improves plan quality in the EBRT of the breast but not in the EBRT of the breast + PSR. Full article

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

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24 pages, 13237 KiB

Open AccessArticle

Numerical Assessment of the Risk of Abnormal Endothelialization for Diverter Devices: Clinical Data Driven Numerical Study

by Denis Tikhvinskii, Julia Kuianova, Dmitrii Kislitsin, Kirill Orlov, Anton Gorbatykh and Daniil Parshin

J. Pers. Med. 2022, 12(4), 652; https://doi.org/10.3390/jpm12040652 - 18 Apr 2022

Cited by 3 | Viewed by 1985

Abstract

Numerical modeling is an effective tool for preoperative planning. The present work is devoted to a retrospective analysis of neurosurgical treatments for the occlusion of cerebral aneurysms using flow-diverters and hemodynamic factors affecting stent endothelization. Several different geometric approaches have been considered for [...] Read more.

Numerical modeling is an effective tool for preoperative planning. The present work is devoted to a retrospective analysis of neurosurgical treatments for the occlusion of cerebral aneurysms using flow-diverters and hemodynamic factors affecting stent endothelization. Several different geometric approaches have been considered for virtual flow-diverters deployment. A comparative analysis of hemodynamic parameters as a result of computational modeling has been carried out basing on the four clinical cases: one successful treatment, one with no occlusion and two with in stent stenosis. For the first time, a quantitative assessment of both: the limiting magnitude of shear stresses that are necessary for the occurrence of in stent stenosis (MaxWSS > 1.23) and for conditions in which endothelialization is insufficiently active and occlusion of the cervical part of the aneurysm does not occur (MaxWSS < 1.68)—has been statistacally proven (p < 0.01). Full article

(This article belongs to the Special Issue Chronic Vascular Disease and Personalized Medicine: Unraveling New Horizons)

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11 pages, 1298 KiB

Open AccessReview

Association between Early Phase Serum Lactate Levels and Occurrence of Delayed Neuropsychiatric Sequelae in Adult Patients with Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis

by Heekyung Lee, Jaehoon Oh, Hyunggoo Kang, Chiwon Ahn, Myeong Namgung, Chan Woong Kim, Wonhee Kim, Young Seo Kim, Hyungoo Shin and Tae Ho Lim

J. Pers. Med. 2022, 12(4), 651; https://doi.org/10.3390/jpm12040651 - 18 Apr 2022

Cited by 1 | Viewed by 2036

Abstract

The primary goal of treating carbon monoxide (CO) poisoning is preventing or minimizing the development of delayed neuropsychiatric sequelae (DNS). Therefore, screening patients with a high probability for the occurrence of DNS at the earliest is essential. However, prognostic tools for predicting DNS [...] Read more.

The primary goal of treating carbon monoxide (CO) poisoning is preventing or minimizing the development of delayed neuropsychiatric sequelae (DNS). Therefore, screening patients with a high probability for the occurrence of DNS at the earliest is essential. However, prognostic tools for predicting DNS are insufficient, and the usefulness of the lactate level as a predictor is unclear. This systematic review and meta-analysis investigated the association between early phase serum lactate levels and the occurrence of DNS in adult patients with acute CO poisoning. Observational studies that included adult patients with CO poisoning and reported initial lactate concentrations were retrieved from the Embase, MEDLINE, Google Scholar and six domestic databases (KoreaMED, KMBASE, KISS, NDSL, KISTi and RISS) in January 2022. Lactate values were collected as continuous variables and analyzed using standardized mean differences (SMD) using a random-effect model. The risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) tool, and subgroup, sensitivity and meta regression analyses were performed. Eight studies involving a total of 1350 patients were included. The early phase serum lactate concentration was significantly higher in the DNS group than in the non-DNS group in adult patients with acute CO poisoning (8 studies; SMD, 0.31; 95% CI, 0.11–0.50; I² = 44%; p = 0.002). The heterogeneity decreased to I² = 8% in sensitivity analysis (omitting Han2021; 7 studies; SMD, 0.38; 95% CI, 0.23–0.53; I² = 8%; p < 0.001). The risk of bias was assessed as high in five studies. The DNS group was associated with significantly higher lactate concentration than that in the non-DNS group. Full article

(This article belongs to the Special Issue Biomarkers in Psychiatric Disorders)

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8 pages, 216 KiB

Open AccessCommunication

Implementing a Personalized Antimicrobial Stewardship Program for Women with Gynecological Cancers and Healthcare-Associated Infections

by Simona Di Giambenedetto, Alberto Borghetti, Lorena Quagliozzi, Valeria Gallucci, Francesca Lombardi, Arturo Ciccullo, Anna Fagotti, Enrica Tamburrini and Giovanni Scambia

J. Pers. Med. 2022, 12(4), 650; https://doi.org/10.3390/jpm12040650 - 18 Apr 2022

Viewed by 1623

Abstract

Healthcare-associated infections (HCAIs) represent a major cause of morbidity and mortality in gynecologic cancer patients, requiring personalized cures. A retrospective study on gynecologic patients with HCAIs, managed through an antimicrobial stewardship program, was performed, focusing on rates of clinical cure, breakthrough/relapse of infections, [...] Read more.

Healthcare-associated infections (HCAIs) represent a major cause of morbidity and mortality in gynecologic cancer patients, requiring personalized cures. A retrospective study on gynecologic patients with HCAIs, managed through an antimicrobial stewardship program, was performed, focusing on rates of clinical cure, breakthrough/relapse of infections, death, and time of hospital stay (THS). In total, 27 patients (median 60 years, mainly suffering from ovarian, cervical, and uterine cancer) were evaluated by a specialist in infectious diseases and were mainly diagnosed with complicated urinary tract (cUTIs, 12 cases, 44.4%) and bloodstream infections (BSIs, 9 cases, 33.3%). A total of 15 cases (11 cUTIs, 73.3%) were managed with no need for hospitalization and received a median of 11 days of outpatient parenteral antimicrobial therapy (OPAT). In the remaining 12 cases (BSIs in 8 cases, 66.7%), the median THS was 11 days, with 15 days median overall duration of antimicrobial therapy (median 5-day reduction in THS). The management of patients also included source control and wound care. All patients reached clinical cure, with no case of breakthrough infection, one case of relapse, and one death within 30 days (not attributable to the infection). HCAIs in patients with gynecologic tumors can be managed through a patient-centered, multidisciplinary antimicrobial stewardship program. Full article

(This article belongs to the Special Issue Personalized Medicine and Multidisciplinary Approach in a Clinical Research Hospital)

12 pages, 701 KiB

Open AccessEditor’s ChoiceArticle

Effectiveness of Multicomponent Home-Based Rehabilitation in Elderly Patients after Hip Fracture Surgery: A Randomized Controlled Trial

by Haneul Lee and Seon-Heui Lee

J. Pers. Med. 2022, 12(4), 649; https://doi.org/10.3390/jpm12040649 - 18 Apr 2022

Cited by 7 | Viewed by 2427

Abstract

This randomized controlled study aimed to assess the clinical effectiveness of an 8-week personalized multicomponent home-based rehabilitation (MHR) program by comparing it with a home exercise program after discharge. Forty patients (≥60 years old) who underwent hip surgery were randomly assigned to multicomponent [...] Read more.

This randomized controlled study aimed to assess the clinical effectiveness of an 8-week personalized multicomponent home-based rehabilitation (MHR) program by comparing it with a home exercise program after discharge. Forty patients (≥60 years old) who underwent hip surgery were randomly assigned to multicomponent home-based rehabilitation (MHR) and home exercise groups. The MHR program included strength, endurance, balance, and breathing exercises; modifications to the home environment; education on assistive device use; pressure ulcer care; nutrition management; and motivational counseling. The MHR group received 24 visits from rehabilitation staff for 8 weeks (3 times a week), while the home exercise group received home exercises focusing on strengthening described in the leaflet. The rehabilitation staff prescribed the intensity of exercise at the first visit, and the home exercise group exercised without supervision after that for 8 weeks. Both groups received a 10-min phone call once a week for overall counseling to ensure high adherence to home exercises. Among the 40 participants, 29 (72.5%) completed the trial. The primary outcomes were balance and mobility. Balance was assessed using the functional reach test (FRT), and the timed up-and-go test (TUG) was used to assess balance and mobility. Data were analyzed using the intention-to-treat principle. The MHR group showed significant improvement compared to the home exercise group for FRT (mean difference (MD) 4.4 cm; 95% confidence interval (CI) 1.0 to 7.8) and TUG (MD: −4.2 s; 95% CI −8.0 to −0.3) after 8 weeks of intervention. Subjective pain and physical components of general health-related quality of life also improved significantly in the MHR group. No serious adverse events related to the interventions were observed. The eight-week of MHR program can effectively improve balance and mobility. Full article

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15 pages, 2778 KiB

Open AccessArticle

Histological Profiling of the Human Umbilical Cord: A Potential Alternative Cell Source in Tissue Engineering

by Cristina Blanco-Elices, Jesús Chato-Astrain, Alberto González-González, David Sánchez-Porras, Víctor Carriel, Ricardo Fernández-Valadés, María del Carmen Sánchez-Quevedo, Miguel Alaminos and Ingrid Garzón

J. Pers. Med. 2022, 12(4), 648; https://doi.org/10.3390/jpm12040648 - 18 Apr 2022

Cited by 5 | Viewed by 2651

Abstract

The embryonic development of the human umbilical cord (hUC) is complex, and different regions can be identified in this structure. The aim of this work is to characterize the hUC at in situ and ex vivo levels to stablish their potential use in [...] Read more.

The embryonic development of the human umbilical cord (hUC) is complex, and different regions can be identified in this structure. The aim of this work is to characterize the hUC at in situ and ex vivo levels to stablish their potential use in vascular regeneration. Human umbilical cords were obtained and histologically prepared for in the situ analysis of four hUC regions (intervascular—IV, perivascular—PV, subaminoblastic—SAM, and Wharton’s jelly—WH), and primary cell cultures of mesenchymal stem cells (hUC-MSC) isolated from each region were obtained. The results confirmed the heterogeneity of the hUC, with the IV and PV zones tending to show the higher in situ expression of several components of the extracellular matrix (collagens, proteoglycans, and glycosaminoglycans), vimentin, and MSC markers (especially CD73), although isolation and ex vivo culture resulted in a homogeneous cell profile. Three vascular markers were positive in situ, especially vWF, followed by CD34 and CD31, and isolation and culture revealed that the region associated with the highest expression of vascular markers was IV, followed by PV. These results confirm the heterogeneity of the hUC and the need for selecting cells from specific regions of the hUC for particular applications in tissue engineering. Full article

(This article belongs to the Special Issue Chronic Vascular Disease and Personalized Medicine: Unraveling New Horizons)

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11 pages, 584 KiB

Open AccessReview

Epilepsy and Diagnostic Dilemmas: The Role of Language and Speech-Related Seizures

by Soultana Papadopoulou, Efterpi Pavlidou, Georgios Argyris, Thaleia Flouda, Panagiota Koukoutsidi, Konstantinos Krikonis, Sidrah Shah, Dana Chirosca-Vasileiou and Stergios Boussios

J. Pers. Med. 2022, 12(4), 647; https://doi.org/10.3390/jpm12040647 - 18 Apr 2022

Cited by 1 | Viewed by 3818

Abstract

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas [...] Read more.

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas that experts in the field of speech-language pathology, neurology, and related fields face? How far has research gone in investigating psychogenic nonepileptic seizures, the misdiagnosis of which can be a thorny issue for clinicians and a detrimental factor for the patients’ health? In order to address these questions, the study at hand focuses on a common, ever-intensified (by the COVID-19 pandemic) speech disorder—stuttering, and explores the pathophysiological and psychogenic background of the phenomenon. It also looks at the role of stuttering as a contributing factor to the appearance of epileptic seizures, in the hope of drawing attention to the complexity and importance of precise detection of stuttering-induced epilepsy, as a specific subcategory of language-induced epilepsy. Full article

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

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15 pages, 1057 KiB

Open AccessEditor’s ChoiceArticle

Chemokine Expression-Based Endotype Clustering of Chronic Rhinosinusitis

by Ulrike Förster-Ruhrmann, Agnieszka J. Szczepek, Greta Pierchalla, Joachim W. Fluhr, Metin Artuc, Torsten Zuberbier, Claus Bachert and Heidi Olze

J. Pers. Med. 2022, 12(4), 646; https://doi.org/10.3390/jpm12040646 - 18 Apr 2022

Cited by 11 | Viewed by 2487

Abstract

Chronic rhinosinusitis (CRS) with (CRSwNP) or without nasal polyps (CRSsNP) is a persistent, heterogeneous inflammatory condition affecting the upper respiratory tract. The present study aimed to improve the characterization of CRS endotypes based on the chemokine and cytokine expression pattern in the CRS [...] Read more.

Chronic rhinosinusitis (CRS) with (CRSwNP) or without nasal polyps (CRSsNP) is a persistent, heterogeneous inflammatory condition affecting the upper respiratory tract. The present study aimed to improve the characterization of CRS endotypes based on the chemokine and cytokine expression pattern in the CRS tissues. Concentrations of chemokines and cytokines were measured in tissues from nasal biopsies obtained from 66 CRS patients and 25 control subjects using multiplexing or single analyte technologies. Cluster analysis based on the concentration of type-1 (MCP-3/CCL7, MIP-1 α/CCL3), type-2 (IL-5, MCP-3/CCL7, MIP-1 α/CCL3, TARC/CCL17, PARC/CCL18, IP-10/CXCL10, ECP), and type-3 (IL-22) chemokines and cytokines identified six CRS endotypes (clusters). Cluster 1 (type-3) and 2 (type-1) were associated with a low prevalence of nasal polyps, Cluster 3 (type-1, -2, -3) and Cluster 4 (type-2, -3, medium IL-22) with medium, and Cluster 5 (type-2, -3, high Il-22) and Cluster 6 (type-2) with high prevalence of nasal polyps. Asthma was highly prevalent in Cluster-6. Our findings add to the existing knowledge of CRS endotypes and may be useful for the clinical decision-making process. The advancement of biologics therapy for upper respiratory tract disorders rationalizes the personalized diagnostic approach to warrant a successful treatment and monitoring of CRS. Full article

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

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14 pages, 282 KiB

Open AccessArticle

Exercise Preferences and Benefits in Patients Hospitalized with COVID-19

by Sevasti Kontopoulou, Zoe Daniil, Konstantinos I. Gourgoulianis and Ourania S. Kotsiou

J. Pers. Med. 2022, 12(4), 645; https://doi.org/10.3390/jpm12040645 - 17 Apr 2022

Cited by 4 | Viewed by 2071

Abstract

Background: Obese people are at risk of becoming severely ill due to SARS-CoV-2. The exercise benefits on health have been emphasized. Aim: To investigate the correlation of obesity with the length of hospitalization, the pre- and post-hospitalization exercise preferences of COVID-19 patients, and [...] Read more.

Background: Obese people are at risk of becoming severely ill due to SARS-CoV-2. The exercise benefits on health have been emphasized. Aim: To investigate the correlation of obesity with the length of hospitalization, the pre- and post-hospitalization exercise preferences of COVID-19 patients, and the impact of pre-admission or post-hospitalization physical activity on dyspnea one month after hospitalization and recovery time. Methods: A telephone survey was conducted in patients hospitalized at the Respiratory Medicine Department, University of Thessaly, Greece, from November to December 2020. Results: Two-thirds of the patients were obese. Obesity was not associated with the hospitalization time. Two-thirds of the patients used to engage in physical activity before hospitalization. Males exercised in a higher percentage and more frequently than women before and after hospitalization. The methodical pre-hospitalization exercise was associated with lower levels of dyspnea one month after hospitalization. In-hospital weight loss, comorbidities, and dyspnea on admission independently predicted longer recovery time. Lockdown had boosted men’s desire to exercise than females who were negatively affected. Conclusions: Obesity is common in COVID-19 hospitalized patients. In-hospital weight loss, comorbidities, and dyspnea on admission predicted a longer post-hospitalization recovery time. The pre-hospitalization exercise was associated with less post-hospitalization dyspnea and recovery time. Full article

(This article belongs to the Special Issue Respiratory and Critical Care)

16 pages, 2804 KiB

Open AccessReview

Computer-Aided Diagnosis of Gastrointestinal Protruded Lesions Using Wireless Capsule Endoscopy: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis

by Hye Jin Kim, Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Ki Tae Suk and Gwang Ho Baik

J. Pers. Med. 2022, 12(4), 644; https://doi.org/10.3390/jpm12040644 - 17 Apr 2022

Cited by 7 | Viewed by 2085

Abstract

Background: Wireless capsule endoscopy allows the identification of small intestinal protruded lesions, such as polyps, tumors, or venous structures. However, reading wireless capsule endoscopy images or movies is time-consuming, and minute lesions are easy to miss. Computer-aided diagnosis (CAD) has been applied to [...] Read more.

Background: Wireless capsule endoscopy allows the identification of small intestinal protruded lesions, such as polyps, tumors, or venous structures. However, reading wireless capsule endoscopy images or movies is time-consuming, and minute lesions are easy to miss. Computer-aided diagnosis (CAD) has been applied to improve the efficacy of the reading process of wireless capsule endoscopy images or movies. However, there are no studies that systematically determine the performance of CAD models in diagnosing gastrointestinal protruded lesions. Objective: The aim of this study was to evaluate the diagnostic performance of CAD models for gastrointestinal protruded lesions using wireless capsule endoscopic images. Methods: Core databases were searched for studies based on CAD models for the diagnosis of gastrointestinal protruded lesions using wireless capsule endoscopy, and data on diagnostic performance were presented. A systematic review and diagnostic test accuracy meta-analysis were performed. Results: Twelve studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of protruded lesions were 0.95 (95% confidence interval, 0.93–0.97), 0.89 (0.84–0.92), 0.91 (0.86–0.94), and 74 (43–126), respectively. Subgroup analyses showed robust results. Meta-regression found no source of heterogeneity. Publication bias was not detected. Conclusion: CAD models showed high performance for the optical diagnosis of gastrointestinal protruded lesions based on wireless capsule endoscopy. Full article

(This article belongs to the Special Issue Recent Advancement in the Diagnosis and Management of Gastrointestinal Disorders)

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12 pages, 965 KiB

Open AccessReview

Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes

by Mario Cesare Nurchis, Giorgio Sessa, Domenico Pascucci, Michele Sassano, Linda Lombi and Gianfranco Damiani

J. Pers. Med. 2022, 12(4), 643; https://doi.org/10.3390/jpm12040643 - 15 Apr 2022

Cited by 3 | Viewed by 3613

Abstract

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of [...] Read more.

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care. Full article

(This article belongs to the Special Issue Chronic Disease Management in the Primary Care)

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19 pages, 1458 KiB

Open AccessArticle

Prioritization of Candidate Biomarkers for Degenerative Aortic Stenosis through a Systems Biology-Based In-Silico Approach

by Nerea Corbacho-Alonso, Tamara Sastre-Oliva, Cecilia Corros, Teresa Tejerina, Jorge Solis, Luis F. López-Almodovar, Luis R. Padial, Laura Mourino-Alvarez and Maria G. Barderas

J. Pers. Med. 2022, 12(4), 642; https://doi.org/10.3390/jpm12040642 - 15 Apr 2022

Viewed by 2044

Abstract

Degenerative aortic stenosis is the most common valve disease in the elderly and is usually confirmed at an advanced stage when the only treatment is surgery. This work is focused on the study of previously defined biomarkers through systems biology and artificial neuronal [...] Read more.

Degenerative aortic stenosis is the most common valve disease in the elderly and is usually confirmed at an advanced stage when the only treatment is surgery. This work is focused on the study of previously defined biomarkers through systems biology and artificial neuronal networks to understand their potential role within aortic stenosis. The goal was generating a molecular panel of biomarkers to ensure an accurate diagnosis, risk stratification, and follow-up of aortic stenosis patients. We used in silico studies to combine and re-analyze the results of our previous studies and, with information from multiple databases, established a mathematical model. After this, we prioritized two proteins related to endoplasmic reticulum stress, thrombospondin-1 and endoplasmin, which have not been previously validated as markers for aortic stenosis, and analyzed them in a cell model and in plasma from human subjects. Large-scale bioinformatics tools allow us to extract the most significant results after using high throughput analytical techniques. Our results could help to prevent the development of aortic stenosis and open the possibility of a future strategy based on more specific therapies. Full article

(This article belongs to the Special Issue Novel Biomarkers and Diagnostic Methods of Cardiovascular Disease)

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12 pages, 486 KiB

Open AccessArticle

Genetic and Clinical Factors Associated with Olokizumab Treatment in Russian Patients with Rheumatoid Arthritis

by Dmitry S. Mikhaylenko, Ekaterina B. Kuznetsova, Viktoria V. Musatova, Irina V. Bure, Tatiana A. Deryagina, Ekaterina A. Alekseeva, Vadim V. Tarasov, Andrey A. Zamyatnin, Jr. and Marina V. Nemtsova

J. Pers. Med. 2022, 12(4), 641; https://doi.org/10.3390/jpm12040641 - 15 Apr 2022

Cited by 3 | Viewed by 1903

Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease and its treatment is an urgent problem of rheumatology. Olokizumab (OKZ) is a new humanized monoclonal antibody targeting IL-6 and is one of the few promising drugs for RA therapy. One-hundred-and-twenty-five DNA samples from [...] Read more.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease and its treatment is an urgent problem of rheumatology. Olokizumab (OKZ) is a new humanized monoclonal antibody targeting IL-6 and is one of the few promising drugs for RA therapy. One-hundred-and-twenty-five DNA samples from Russian patients with RA, treated with olokizumab, were genotyped with an NGS panel containing 60 single nucleotide polymorphisms (SNPs) and the whole coding sequences of IL6, IL6R, TNFRSF1A, CTLA4, IL10, IL23R, and PADI4; and by RT-PCR for HLA-DRB1 and HLA-B. Associations of polymorphic variants with olokizumab efficacy according to the scores ACR20, ACR50, and DAS28-CRP were determined. We analyzed the obtained data by using logistic regression, ROC curves, and multivariate ANOVA. A high predictive value of the response to olokizumab therapy at 24 weeks was found for the combination of HLA-DRB1*04 and HLA-B*27 alleles with SNPs located in non-HLA genes (IL1B, IL17A, PADI4, DHODH, GLCCI1, IL23R, and TNFAIP3), and clinical characteristics (age, RA duration, and intensity) according to ACR20. Thus, the comprehensive assessment of polymorphic variants of HLA and non-HLA genes considering population characteristics in combination with clinical parameters allows for the elaboration of an RA prognostic panel. Full article

(This article belongs to the Special Issue Novel Biomarkers in Translational Medicine of Chronic and Autoimmune Diseases)

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10 pages, 258 KiB

Open AccessArticle

Predictors of SARS-CoV-2 IgG Spike Antibody Responses on Admission and Clinical Outcomes of COVID-19 Disease in Fully Vaccinated Inpatients: The CoVax Study

by Eleni Livanou, Erasmia Rouka, Sotirios Sinis, Ilias Dimeas, Ioannis Pantazopoulos, Dimitrios Papagiannis, Foteini Malli, Ourania Kotsiou and Konstantinos I. Gourgoulianis

J. Pers. Med. 2022, 12(4), 640; https://doi.org/10.3390/jpm12040640 - 15 Apr 2022

Cited by 4 | Viewed by 1635

Abstract

Background: SARS-CoV-2 vaccines have shown high efficacy in protecting against COVID-19, although the determinants of vaccine effectiveness and breakthrough rates are yet to be determined. We aimed at investigating several factors affecting the SARS-CoV-2 IgG Spike (S) antibody responses on admission and clinical [...] Read more.

Background: SARS-CoV-2 vaccines have shown high efficacy in protecting against COVID-19, although the determinants of vaccine effectiveness and breakthrough rates are yet to be determined. We aimed at investigating several factors affecting the SARS-CoV-2 IgG Spike (S) antibody responses on admission and clinical outcomes of COVID-19 disease in fully vaccinated, hospitalized patients. Methods: 102 subjects were enrolled in the study. Blood serum samples were collected from each patient upon admission for the semiquantitative determination of the SARS-CoV-2 IgG S levels with lateral flow assays. Factors influencing vaccine responses were documented. Results: 27 subjects had a negative antibody test upon hospital admission. Out of the 102 patients admitted to the hospital, 88 were discharged and 14 died. Both the absence of anti-S SARS-CoV-2 antibodies and poor clinical outcomes of COVID-19 disease were associated with older age, lower Ct values, and a shorter period between symptom onset and hospital admission. Ct values and time between symptom onset and hospitalization were independently associated with SARS-CoV-2 IgG S responses upon admission. The PaO2/FiO2 ratio was identified as an independent predictor of in-hospital mortality. Conclusions: Host- and disease-associated factors can predict SARS-CoV-2 IgG S responses and mortality in hospitalized patients with breakthrough SARS-CoV-2 Infection. Full article

(This article belongs to the Special Issue Respiratory and Critical Care)

16 pages, 1671 KiB

Open AccessArticle

Clinical Implications of Glyoxalase1 Gene Polymorphism and Elevated Levels of the Reactive Metabolite Methylglyoxal in the Susceptibility of Type 2 Diabetes Mellitus in the Patients from Asir and Tabuk Regions of Saudi Arabia

by Muhanad Alhujaily, Mohammad Muzaffar Mir, Rashid Mir, Mushabab Ayed Abdullah Alghamdi, Javed Iqbal Wani, Zia ul Sabah, Imadeldin Elfaki, Tarig Mohammad Saad Alnour, Mohammed Jeelani, Mosleh Mohammad Abomughaid and Samir Abdulkarim Alharbi

J. Pers. Med. 2022, 12(4), 639; https://doi.org/10.3390/jpm12040639 - 15 Apr 2022

Cited by 3 | Viewed by 2435

Abstract

Diabetes mellitus constitutes a big challenge to the global health care system due to its socioeconomic impacts and very serious complications. The incidence and the prevalence rate are increased in the Gulf region including the KSA. Type 2 diabetes mellitus (T2DM) is caused [...] Read more.

Diabetes mellitus constitutes a big challenge to the global health care system due to its socioeconomic impacts and very serious complications. The incidence and the prevalence rate are increased in the Gulf region including the KSA. Type 2 diabetes mellitus (T2DM) is caused by diverse risk factors including obesity, unhealthy dietary habits, physical inactivity, smoking and genetic factors. The molecular genetic studies have helped in the detection of many single nucleotide polymorphisms (SNP) with different diseases including cancers, cardiovascular diseases and T2DM. The glyoxalase 1 (GLO1) is a detoxifying enzyme and catalyzes the elimination of the cytotoxic product methylglyoxal (MG) by converting it to D-lactate, which is not toxic to tissues. MG accumulation is associated with the pathogenesis of different diseases including T2DM. In this study, we have investigated the association of the glyoxalase 1 SNPs (rs2736654) rs4746 C>A and rs1130534 T>A with T2DM using the amplification refractory mutation system PCR. We also measured the concentration of MG by ELISA in T2DM patients and matched heathy controls. Results show that the CA genotype of the GLO rs4647 A>C was associated with T2DM with OR = 2.57, p-value 0.0008 and the C allele was also associated with increased risk to T2DM with OR = 2.24, p-value = 0.0001. It was also observed that AT genotype of the rs1130534 was associated with decreased susceptibility to T2DM with OR = 0.3, p-value = 0.02. The A allele of rs1130534 was also associated with reduced risk to T2DM with PR = 0.27 = 0.006. In addition, our ELISA results demonstrate significantly increased MG concentrations in serum of the T2DM patients. We conclude that the GLO1 SNP may be associated with decreased enzyme activity and a resultant susceptibility to T2DM. Further well-designed studies in different and large patient populations are recommended to verify these findings. Full article

(This article belongs to the Section Mechanisms of Diseases)

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12 pages, 8257 KiB

Open AccessArticle

Intravoxel Incoherent Motion (IVIM) MR Quantification in Locally Advanced Cervical Cancer (LACC): Preliminary Study on Assessment of Tumor Aggressiveness and Response to Neoadjuvant Chemotherapy

by Miriam Dolciami, Silvia Capuani, Veronica Celli, Alessandra Maiuro, Angelina Pernazza, Innocenza Palaia, Violante Di Donato, Giusi Santangelo, Stefania Maria Rita Rizzo, Paolo Ricci, Carlo Della Rocca, Carlo Catalano and Lucia Manganaro

J. Pers. Med. 2022, 12(4), 638; https://doi.org/10.3390/jpm12040638 - 15 Apr 2022

Cited by 6 | Viewed by 1809

Abstract

The aim of this study was to determine whether quantitative parameters obtained from intravoxel incoherent motion (IVIM) model at baseline magnetic resonance imaging (MRI) correlate with histological parameters and response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer (LACC). Methods: Twenty [...] Read more.

The aim of this study was to determine whether quantitative parameters obtained from intravoxel incoherent motion (IVIM) model at baseline magnetic resonance imaging (MRI) correlate with histological parameters and response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer (LACC). Methods: Twenty patients with biopsy-proven cervical cancer, staged as LACC on baseline MRI and addressed for neoadjuvant chemotherapy were enrolled. At treatment completion, tumor response was assessed with a follow-up MRI evaluated using the revised response evaluation criteria in solid tumors (RECIST; version 1.1), and patients were considered good responders (GR) if they had complete response or partial remission, and poor responders/non-responders (PR/NR) if they had stable or progressive disease. MRI protocol included conventional diffusion-weighted imaging (DWI; b = 0 and 1000 s/mm²) and IVIM acquisition using eight b-values (range: 0–1500 s/mm²). MR-images were analyzed using a dedicated software to obtain quantitative parameters: diffusion (D), pseudo-diffusion (D*), and perfusion fraction (fp) from the IVIM model; apparent diffusion coefficient (ADC) from conventional DWI. Histologic subtype, grading, and tumor-infiltrating lymphocytes (TILs) were assessed in each LACC. Results: D showed significantly higher values in GR patients (p = 0.001) and in moderate/high TILs (p = 0.018). Fp showed significantly higher values in squamous cell tumors (p = 0.006). Conclusions: D extracted from the IVIM model could represent a promising tool to identify tumor aggressiveness and predict response to therapy. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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11 pages, 2486 KiB

Open AccessArticle

Aortic Risks Prediction Models after Cardiac Surgeries Using Integrated Data

by Iuliia Lenivtceva, Dmitri Panfilov, Georgy Kopanitsa and Boris Kozlov

J. Pers. Med. 2022, 12(4), 637; https://doi.org/10.3390/jpm12040637 - 15 Apr 2022

Cited by 3 | Viewed by 1648

Abstract

The complications of thoracic aortic disease include aortic dissection and aneurysm. The risks are frequently compounded by many cardiovascular comorbidities, which makes the process of clinical decision making complicated. The purpose of this study is to develop risk predictive models for patients after [...] Read more.

The complications of thoracic aortic disease include aortic dissection and aneurysm. The risks are frequently compounded by many cardiovascular comorbidities, which makes the process of clinical decision making complicated. The purpose of this study is to develop risk predictive models for patients after thoracic aneurysm surgeries, using integrated data from different medical institutions. Seven risk features were formulated for prediction. The CatBoost classifier performed best and provided an ROC AUC of 0.94–0.98 and an F-score of 0.95–0.98. The obtained results are widely in line with the current literature. The obtained findings provide additional support for clinical decision making, guiding a patient care team prior to surgical treatment, and promoting a safe postoperative period. Full article

(This article belongs to the Special Issue Selected Papers from the pHealth 2021 Conference, Genoa, Italy, 8-10 November 2021)

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11 pages, 1636 KiB

Open AccessArticle

Investigation of the Relationship between Cardiovascular Biomarkers and Brachial–Ankle Pulse Wave Velocity in Hemodialysis Patients

by Ping-Ruey Chou, Pei-Yu Wu, Ping-Hsun Wu, Teng-Hui Huang, Jiun-Chi Huang, Szu-Chia Chen, Su-Chu Lee, Mei-Chuan Kuo, Yi-Wen Chiu, Ya-Ling Hsu, Jer-Ming Chang and Shang-Jyh Hwang

J. Pers. Med. 2022, 12(4), 636; https://doi.org/10.3390/jpm12040636 - 15 Apr 2022

Cited by 4 | Viewed by 1968

Abstract

Brachial–ankle pulse wave velocity (baPWV) and cardiovascular (CV) biomarkers are correlated with clinical cardiovascular diseases (CVDs) in patients with kidney disease. However, limited studies evaluated the relationship between baPWV and CV biomarkers in hemodialysis patients. This study investigated the relationship between circulating CV [...] Read more.

Brachial–ankle pulse wave velocity (baPWV) and cardiovascular (CV) biomarkers are correlated with clinical cardiovascular diseases (CVDs) in patients with kidney disease. However, limited studies evaluated the relationship between baPWV and CV biomarkers in hemodialysis patients. This study investigated the relationship between circulating CV biomarkers and baPWV in patients on hemodialysis. Hemodialysis patients were enrolled between August 2016 and January 2017 for the measurement of baPWV, traditional CV biomarkers, including high-sensitivity troponin-T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and novel CV biomarkers, including Galectin-3, Cathepsin D, placental growth factor, Endocan-1, and Fetuin-A. The independent association was assessed by multivariate-adjusted linear regression analysis to control for potential confounders. The final analysis included 176 patients (95 men and 81 women) with a mean age of 60 ± 11 y old. After adjusting for age and sex, hsTnT (p < 0.01), NT-proBNP (p = 0.01), Galectin-3 (p = 0.03), and Cathepsin D (p < 0.01) were significantly directly correlated with baPWV. The direct correlation with baPWV existed in multivariable linear regression models with a β of 0.1 for hsTnT and 0.1 for Cathepsin D. The direct relationship between baPWV and CV biomarkers, particularly with hsTnT and Cathepsin D, may be helpful for risk stratification of hemodialysis patients. Full article

(This article belongs to the Section Mechanisms of Diseases)

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10 pages, 1398 KiB

Open AccessReview

Association between Glasgow Coma Scale in Early Carbon Monoxide Poisoning and Development of Delayed Neurological Sequelae: A Meta-Analysis

by Myeong Namgung, Jaehoon Oh, Chiwon Ahn, Chan Woong Kim, Heekyung Lee and Hyunggoo Kang

J. Pers. Med. 2022, 12(4), 635; https://doi.org/10.3390/jpm12040635 - 14 Apr 2022

Cited by 4 | Viewed by 2013

Abstract

A significant number of people experience delayed neurologic sequelae after acute carbon monoxide (CO) poisoning. The Glasgow Coma Scale (GCS) can be used to predict delayed neurologic sequelae occurrence efficiently and without any restrictions. Here, we investigated the association between a low GCS [...] Read more.

A significant number of people experience delayed neurologic sequelae after acute carbon monoxide (CO) poisoning. The Glasgow Coma Scale (GCS) can be used to predict delayed neurologic sequelae occurrence efficiently and without any restrictions. Here, we investigated the association between a low GCS score observed in cases of early CO poisoning and delayed neurologic sequelae development through a meta-analysis. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies on GCS as a predictor of delayed neurologic sequelae occurrence in patients with CO poisoning in June 2021. Two reviewers independently extracted study characteristics and pooled data. We also conducted subgroup analyses for the cutoff point for GCS. To assess the risk of bias of each included study, we used the quality in prognosis studies tool. We included 2328 patients from 10 studies. With regard to patients with acute CO poisoning, in the overall pooled odds ratio (OR) of delayed neurologic sequelae development, those with a low GCS score showed a significantly higher value and moderate heterogeneity (OR 2.98, 95% confidence interval (CI) 2.10–4.23, I² = 33%). Additionally, in subgroup analyses according to the cutoff point of GCS, the development of delayed neurologic sequelae was still significantly higher in the GCS < 9 group (OR 2.80, 95% CI 1.91–4.12, I² = 34%) than in the GCS < 10 or GCS < 11 groups (OR 4.24, 95% CI 1.55–11.56, I² = 48%). An initial low GCS score in patients with early CO poisoning was associated with the occurrence of delayed neurologic sequelae. Additionally, GCS was quickly, easily, and accurately assessed. It is therefore possible to predict delayed neurologic sequelae and establish an active treatment strategy, such as hyperbaric oxygen therapy, to minimize neurological sequelae using GCS. Full article

(This article belongs to the Special Issue Personalized Medicine in Emergency and Intensive Care)

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27 pages, 5113 KiB

Open AccessSystematic Review

Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis

by Choongun Ryu, Geun Joo Choi, Yong Hun Jung, Chong Wha Baek, Choon Kyu Cho and Hyun Kang

J. Pers. Med. 2022, 12(4), 634; https://doi.org/10.3390/jpm12040634 - 14 Apr 2022

Cited by 8 | Viewed by 2699

Abstract

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness [...] Read more.

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (−7.60 (−12.49, −2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia. Full article

(This article belongs to the Special Issue Postoperative Complications and Personalized Medicine)

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22 pages, 7790 KiB

Open AccessArticle

Deciphering of Adult Glioma Vulnerabilities through Expression Pattern Analysis of GABA, Glutamate and Calcium Neurotransmitter Genes

by Hoang Dong Nguyen, Phedias Diamandis, Michelle S. Scott and Maxime Richer

J. Pers. Med. 2022, 12(4), 633; https://doi.org/10.3390/jpm12040633 - 14 Apr 2022

Viewed by 2119

Abstract

Adult infiltrating gliomas are highly aggressive tumors of the central nervous system with a dismal prognosis despite intensive multimodal therapy (chemotherapy and/or radiotherapy). In this study, we studied the expression, methylation and interacting miRNA profiles of GABA-, glutamate- and calcium-related genes in 661 [...] Read more.

Adult infiltrating gliomas are highly aggressive tumors of the central nervous system with a dismal prognosis despite intensive multimodal therapy (chemotherapy and/or radiotherapy). In this study, we studied the expression, methylation and interacting miRNA profiles of GABA-, glutamate- and calcium-related genes in 661 adult infiltrating gliomas available through the TCGA database. Neurotransmitter-based unsupervised clustering identified three established glioma molecular subgroups that parallel major World Health Organization glioma subclasses (IDH-wildtype astrocytomas, IDH-mutant astrocytomas, IDH-mutant oligodendroglioma). In addition, this analysis also defined a novel, neurotransmitter-related glioma subgroup (NT-1), mostly comprised of IDH-mutated gliomas and characterized by the overexpression of neurotransmitter-related genes. Lower expression of neurotransmission-related genes was correlated with increased aggressivity in hypomethylated IDH-wildtype tumors. There were also significant differences in the composition of the tumor inflammatory microenvironment between neurotransmission-based tumor categories, with lower estimated pools of M2-phenotype macrophages in NT-1 gliomas. This multi-omics analysis of the neurotransmission expression landscape of TCGA gliomas—which highlights the existence of neurotransmission-based glioma categories with different expression, epigenetic and inflammatory profiles—supports the existence of operational neurotransmitter signaling pathways in adult gliomas. These findings could shed new light on potential vulnerabilities to exploit in future glioma-targeting drug therapies. Full article

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

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12 pages, 8865 KiB

Open AccessArticle

Theratyping of the Rare CFTR Variants E193K and R334W in Rectal Organoid-Derived Epithelial Monolayers

by Fabiana Ciciriello, Marcel J. C. Bijvelds, Federico Alghisi, Kelly F. Meijsen, Luca Cristiani, Claudio Sorio, Paola Melotti, Alessandro G. Fiocchi, Vincenzina Lucidi and Hugo R. De Jonge

J. Pers. Med. 2022, 12(4), 632; https://doi.org/10.3390/jpm12040632 - 14 Apr 2022

Cited by 15 | Viewed by 2132

Abstract

Background: The effect of presently available CFTR modulator combinations, such as elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA), on rare CFTR alleles is often unknown. Several assays have been developed, such as forskolin-induced swelling (FIS), to evaluate the rescue of such uncommon CFTR [...] Read more.

Background: The effect of presently available CFTR modulator combinations, such as elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA), on rare CFTR alleles is often unknown. Several assays have been developed, such as forskolin-induced swelling (FIS), to evaluate the rescue of such uncommon CFTR alleles both by established and novel modulators in patient-derived primary cell cultures (organoids). Presently, we assessed the CFTR-mediated electrical current across rectal organoid-derived epithelial monolayers. This technique, which allows separate measurement of CFTR-dependent chloride or bicarbonate transport, was used to assess the effect of ELX/TEZ/IVA on two rare CFTR variants. Methods: Intestinal organoid cultures were established from rectal biopsies of CF patients carrying the rare missense mutations E193K or R334W paired with F508del. The effect of the CFTR modulator combination ELX/TEZ/IVA on CFTR-mediated Cl⁻ and HCO₃⁻ secretion was assessed in organoid-derived intestinal epithelial monolayers. Non-CF organoids were used for comparison. Clinical biomarkers (sweat chloride, FEV1) were monitored in patients receiving modulator therapy. Results: ELX/TEZ/IVA markedly enhanced CFTR-mediated bicarbonate and chloride transport across intestinal epithelium of both patients. Consistent with the rescue of CFTR function in cultured intestinal cells, ELX/TEZ/IVA therapy improved biomarkers of CFTR function in the R334W/F508del patient. Conclusions: Current measurements in organoid-derived intestinal monolayers can readily be used to monitor CFTR-dependent epithelial Cl⁻ and HCO₃⁻ transport. This technique can be explored to assess the functional consequences of rare CFTR mutations and the efficacy of CFTR modulators. We propose that this functional CFTR assay may guide personalized medicine in patients with CF-like clinical manifestations as well as in those carrying rare CFTR mutations. Full article

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9 pages, 621 KiB

Open AccessArticle

The Feasibility of Ultra-Sensitive Phonocardiography in Acute Chest Pain Patients of a Tertiary Care Emergency Department (ScorED Feasibility Study)

by Sebastian Schnaubelt, Felix Eibensteiner, Julia Oppenauer, Andrea Kornfehl, Roman Brock, Laura Poschenreithner, Na Du, Enrico Baldi, Oliver Schlager, Alexander Niessner, Hans Domanovits, Dominik Roth and Patrick Sulzgruber

J. Pers. Med. 2022, 12(4), 631; https://doi.org/10.3390/jpm12040631 - 14 Apr 2022

Cited by 1 | Viewed by 1485

Abstract

Background: Thoracic pain is one of the most frequent chief complaints at emergency departments (EDs). However, a respective workup in cases without clear electrocardiographic signs is complex. In addition, after having ruled out acute coronary syndrome (ACS), patients are often left with an [...] Read more.

Background: Thoracic pain is one of the most frequent chief complaints at emergency departments (EDs). However, a respective workup in cases without clear electrocardiographic signs is complex. In addition, after having ruled out acute coronary syndrome (ACS), patients are often left with an unclear etiology of their symptoms. Ultra-sensitive phonocardiography is already used to rule out stable coronary artery disease (CAD); however, its feasibility in an ED-setting remains unknown. Methods: We prospectively used ultra-sensitive phonocardiography via the CADScor^®System to measure hemodynamically stable patients with the chief complaint of chest pain during routine waiting times at a high-volume tertiary ED. Results: A total of 101 patients (49% male; 94% Caucasian; 61 (51–71) years; BMI 28.3 (24.2–31.6)) were enrolled. Patient workflow was not hindered, and no adverse events were recorded. In 80% of cases, a score was successfully calculated, with 74% at the first, 5% at the second, and 1% at the third attempt. Feasibility was judged as 9.0 (±1.8) by the patients, and 8.9 (±2.6) by the investigators on a 10-point Likert scale. Conclusions: Ultra-sensitive phonocardiography was found to be feasible in acute chest pain patients presenting to a tertiary ED. Thus, the CAD score measured during routine waiting times could potentially serve as an additional tool in a diagnostic pathway for thoracic pain. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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12 pages, 436 KiB

Open AccessArticle

Comparison of Nine Early Warning Scores for Identification of Short-Term Mortality in Acute Neurological Disease in Emergency Department

by Carlos Durantez-Fernández, Begoña Polonio-López, José L. Martín-Conty, Clara Maestre-Miquel, Antonio Viñuela, Raúl López-Izquierdo, Laura Mordillo-Mateos, Cristina Jorge-Soto, Martín Otero-Agra, Michele Dileone, Joseba Rabanales-Sotos and Francisco Martín-Rodríguez

J. Pers. Med. 2022, 12(4), 630; https://doi.org/10.3390/jpm12040630 - 14 Apr 2022

Cited by 3 | Viewed by 1758

Abstract

(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in [...] Read more.

(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS [Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS)] upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment. Full article

(This article belongs to the Special Issue Personalized Medicine in Neurological and Neurosurgical Diseases)

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8 pages, 3776 KiB

Open AccessArticle

Management of Delayed Complications of Hydrogel Scleral Buckles

by Hsin-Yu Yang, Wei-Kuang Yu and Chieh-Chih Tsai

J. Pers. Med. 2022, 12(4), 629; https://doi.org/10.3390/jpm12040629 - 14 Apr 2022

Cited by 1 | Viewed by 1971

Abstract

(1) Background: hydrogel scleral buckles (HSB)-related complications can happen decades after implantation, although this material has been retrieved for a long time. Due to its fragile texture, ensuring the complete removal of this material and avoiding complications are challenging. Incomplete removal, iatrogenic complication, [...] Read more.

(1) Background: hydrogel scleral buckles (HSB)-related complications can happen decades after implantation, although this material has been retrieved for a long time. Due to its fragile texture, ensuring the complete removal of this material and avoiding complications are challenging. Incomplete removal, iatrogenic complication, recurrent retinal detachment, and infection could occur. (2) Methods: chart review of patients who developed delayed HSB-related complications and received removal of HSB in Taipei Veterans General Hospital from 2004 to 2021. The presenting symptoms, prior diagnosis before referral, clinical findings, image features, surgical technique, operative findings, and outcome were analyzed. Detailed surgical procedure and tips for removal were demonstrated in the study. (3) Results: a total of eleven patients were identified. The presenting symptoms include limitations to extraocular movement (ten eyes, 90.9%), ocular redness (eight eyes, 72.7%), ocular fullness (eight eyes, 72.7%), pain (six eyes, 54.5%), and exposed ocular foreign body (five eyes, 45.5%). Of note, six patients (54.5%) have monocular glaucoma and four of them have intractable high intraocular pressure. All patients underwent surgeries to smoothly remove swollen HSB via transcutaneous or transconjunctival approach. Most symptoms improved after surgery and no cases developed surgical-related complications. (4) Conclusions: although HSB have been off the market for decades, delayed complications are still emerging. Clinicians should remain alert for potential complications for patients with prior HSB surgeries. Early diagnosis and meticulous management can help to safely remove the expanded HSB and reduce the associated complications. Full article

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

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16 pages, 5114 KiB

Open AccessArticle

Improved Atrial Differentiation of Human Pluripotent Stem Cells by Activation of Retinoic Acid Receptor Alpha (RARα)

by Verena Schwach, Carla Cofiño-Fabres, Simone A. ten Den and Robert Passier

J. Pers. Med. 2022, 12(4), 628; https://doi.org/10.3390/jpm12040628 - 13 Apr 2022

Cited by 5 | Viewed by 2197

Abstract

Human pluripotent stem cell (hPSC)-derived cardiomyocytes have proven valuable for modeling disease and as a drug screening platform. Here, we depict an optimized protocol for the directed differentiation of hPSCs toward cardiomyocytes with an atrial identity by modulating the retinoic acid signaling cascade [...] Read more.

Human pluripotent stem cell (hPSC)-derived cardiomyocytes have proven valuable for modeling disease and as a drug screening platform. Here, we depict an optimized protocol for the directed differentiation of hPSCs toward cardiomyocytes with an atrial identity by modulating the retinoic acid signaling cascade in spin embryoid bodies. The crucial steps of the protocol, including hPSC maintenance, embryoid body (EB) differentiation, the induction of cardiac mesoderm, direction toward the atrial phenotype, as well as molecular and functional characterization of the cardiomyocytes, are described. Atrial cardiomyocytes (AMs) can be generated within 14 days. Most importantly, we show that induction of the specific retinoic acid receptor alpha (RARα) increased the efficiency of atrial differentiation to 72% compared with 45% after modulating the retinoic acid (RA) pathway with all-trans RA (atRA). In contrast, the induction of RARβ signaling only had a minor impact on the efficiency of atrial differentiation (from about 45% to 50%). Similarly, the total yield of AM per EB of 5000 hPSCs was increased from 10,350 (2.07 per hPSC) to 16,120 (3.22 per hPSC) while selectively modulating RARα signaling. For further purification of the AMs, we describe a metabolic selection procedure that enhanced the AM percentage to more than 90% without compromising the AM yield (15,542 per EB, equal to 3.11 per hPSC) or functionality of the AMs as evaluated by RNAseq, immunostaining, and optical action potential measurement. Cardiomyocytes with distinct atrial and ventricular properties can be applied for selective pharmacology, such as the development of novel atrial-specific anti-arrhythmic agents, and disease modeling, including atrial fibrillation, which is the most common heart rhythm disorder. Moreover, fully characterized and defined cardiac subtype populations are of the utmost importance for potential cell-based therapeutic approaches. Full article

(This article belongs to the Special Issue Pluripotent Stem Cells for Cardiac Differentiation and Disease Modeling)

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14 pages, 3361 KiB

Open AccessArticle

Tumor Lymphocyte Infiltration Is Correlated with a Favorable Tumor Regression Grade after Neoadjuvant Treatment for Esophageal Adenocarcinoma

by Riad Haddad, Oran Zlotnik, Tal Goshen-Lago, Mattan Levi, Elena Brook, Baruch Brenner, Yulia Kundel, Irit Ben-Aharon and Hanoch Kashtan

J. Pers. Med. 2022, 12(4), 627; https://doi.org/10.3390/jpm12040627 - 13 Apr 2022

Cited by 6 | Viewed by 1822

Abstract

(1) Background: We aimed to explore the association between neoadjuvant treatment, tumor-infiltrating immune lymphocyte (TIL), and tumor-associated macrophage (TAM) and survival in patients with esophageal adenocarcinoma. (2) Methods: Patients who underwent esophagectomy were divided into three groups according to their treatment modality and [...] Read more.

(1) Background: We aimed to explore the association between neoadjuvant treatment, tumor-infiltrating immune lymphocyte (TIL), and tumor-associated macrophage (TAM) and survival in patients with esophageal adenocarcinoma. (2) Methods: Patients who underwent esophagectomy were divided into three groups according to their treatment modality and tumor regression grade (TRG): (i) surgery-only group (SG), (ii) good responders (GR) group (TRG 0–1), and (iii) bad responders (BR) group (TRG 2–3). We then carried out statistical correlations of the immunofluorescence analysis of the immune infiltrate in the esophageal surgical specimens with several clinical and pathological parameters. In addition, we analyzed The Cancer Genomic Atlas (TCGA) dataset for differences in TILs, TAMs, and protein expression in immune pathways. (3) Results: Forty-three patients (SG—15, GR—13, and BR—13) were evaluated. The highest enrichment of CD3+ (p < 0.001), CD8+ (p = 0.001) and CD4+ (p = 0.009) was observed in the stroma of GR patients. On multivariate analysis, only CD8+ T cell and signet-ring features were independent prognostic factors for overall survival. In TCGA analysis, we identified overexpression of TAM and colony-stimulating factor 1 receptor (CSF-1R). (4) Conclusions: High enrichment of lymphocyte subpopulations in the microenvironment of esophageal adenocarcinoma is associated with a favorable response to neoadjuvant treatment and an improved patient outcome. Full article

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15 pages, 1553 KiB

Open AccessEditor’s ChoiceArticle

Masticatory Muscle Thickness and Activity Correlates to Eyeball Length, Intraocular Pressure, Retinal and Choroidal Thickness in Healthy Women versus Women with Myopia

by Grzegorz Zieliński, Marcin Wójcicki, Maria Rapa, Anna Matysik-Woźniak, Michał Baszczowski, Michał Ginszt, Monika Litko-Rola, Jacek Szkutnik, Ingrid Różyło-Kalinowska, Robert Rejdak and Piotr Gawda

J. Pers. Med. 2022, 12(4), 626; https://doi.org/10.3390/jpm12040626 - 13 Apr 2022

Cited by 12 | Viewed by 2862

Abstract

This study aims to examine the correlations between masticatory and neck muscle thickness and activity versus eyeball length, retinal thickness, choroidal thickness, and intraocular pressure in healthy women versus women with myopia. The study group consisted of 21 women aged 24 years and [...] Read more.

This study aims to examine the correlations between masticatory and neck muscle thickness and activity versus eyeball length, retinal thickness, choroidal thickness, and intraocular pressure in healthy women versus women with myopia. The study group consisted of 21 women aged 24 years and a control group of 19 women (mean age 23 years). For bioelectrical activity analysis within the temporalis anterior, the superficial part of the masseter muscle, the middle part of the sternocleidomastoid muscle, and the anterior belly of the digastric muscle, an eight-channel BioEMG III electromyograph were used. An M-Turbo ultrasound machine was used to analyze masticatory and neck muscle thickness. The eyeball length was examined by IOL Master 500; choroidal and retinal thickness by Optovue Angiovue; and intraocular pressure by Tono-Pen XL. Refractive errors are related to differences in muscle thickness and electromyographic activity. Bioelectrical activity within the temporalis anterior seems to be associated with ocular length, retinal thickness, and choroidal thickness in women with myopia. Full article

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

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12 pages, 310 KiB

Open AccessArticle

Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI): A Psychometric Evaluation

by Rosa Antonio-Oriola, Ercole Vellone, Angela Durante, Maddalena De Maria, Marco Di Nitto, Vicente Gea-Caballero, Iván Santolalla-Arnedo, Michał Czapla, José Vicente Benavent-Cervera, Juan Luis Sánchez-González and Raúl Juárez-Vela

J. Pers. Med. 2022, 12(4), 625; https://doi.org/10.3390/jpm12040625 - 12 Apr 2022

Cited by 5 | Viewed by 2012

Abstract

Background: The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers’ contribution to self-care maintenance and self-care management and caregiver [...] Read more.

Background: The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers’ contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients’ self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. Purpose: To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. Method: CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. Results: Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale (“treatment adherence behaviors” and “symptom control and maintenance behaviors”), two in the self-care monitoring subscale (“illness behaviors” and “prevention behaviors”) and one factor for the self-efficacy subscale. The Pearson’s rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension. Full article

(This article belongs to the Special Issue Advances in Personalized Nursing Care)

16 pages, 4515 KiB

Open AccessArticle

Pulmonary Lymphangitis Poses a Major Challenge for Radiologists in an Oncological Setting during the COVID-19 Pandemic

by Roberta Fusco, Igino Simonetti, Stefania Ianniello, Alberta Villanacci, Francesca Grassi, Federica Dell’Aversana, Roberta Grassi, Diletta Cozzi, Eleonora Bicci, Pierpaolo Palumbo, Alessandra Borgheresi, Andrea Giovagnoni, Vittorio Miele, Antonio Barile and Vincenza Granata

J. Pers. Med. 2022, 12(4), 624; https://doi.org/10.3390/jpm12040624 - 12 Apr 2022

Cited by 9 | Viewed by 2416

Abstract

Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management. This [...] Read more.

Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management. This is otherwise known as immune checkpoint inhibitor-related pneumonitis. Following on from this background, radiologists should seek to know their patients’ COVID-19 infection and vaccination history. Knowing the imaging features related to COVID-19 infection and vaccination is critical to avoiding misleading results and alarmism in patients and clinicians. Full article

(This article belongs to the Special Issue Cancer Challenges during COVID-19 Pandemic)

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J. Pers. Med., Volume 12, Issue 4 (April 2022) – 145 articles

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