Journal of Personalized Medicine

Research

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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 1657

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)

18 pages, 2048 KiB

Open AccessArticle

Whole Exome Sequencing in Healthy Individuals of Extreme Constitution Types Reveals Differential Disease Risk: A Novel Approach towards Predictive Medicine

by Tahseen Abbas, Gaura Chaturvedi, P. Prakrithi, Ankit Kumar Pathak, Rintu Kutum, Pushkar Dakle, Ankita Narang, Vijeta Manchanda, Rutuja Patil, Dhiraj Aggarwal, Bhushan Girase, Ankita Srivastava, Manav Kapoor, Ishaan Gupta, Rajesh Pandey, Sanjay Juvekar, Debasis Dash, Mitali Mukerji and Bhavana Prasher

J. Pers. Med. 2022, 12(3), 489; https://doi.org/10.3390/jpm12030489 - 18 Mar 2022

Cited by 3 | Viewed by 3484

Abstract

Precision medicine aims to move from traditional reactive medicine to a system where risk groups can be identified before the disease occurs. However, phenotypic heterogeneity amongst the diseased and healthy poses a major challenge for identification markers for risk stratification and early actionable [...] Read more.

Precision medicine aims to move from traditional reactive medicine to a system where risk groups can be identified before the disease occurs. However, phenotypic heterogeneity amongst the diseased and healthy poses a major challenge for identification markers for risk stratification and early actionable interventions. In Ayurveda, individuals are phenotypically stratified into seven constitution types based on multisystem phenotypes termed “Prakriti”. It enables the prediction of health and disease trajectories and the selection of health interventions. We hypothesize that exome sequencing in healthy individuals of phenotypically homogeneous Prakriti types might enable the identification of functional variations associated with the constitution types. Exomes of 144 healthy Prakriti stratified individuals and controls from two genetically homogeneous cohorts (north and western India) revealed differential risk for diseases/traits like metabolic disorders, liver diseases, and body and hematological measurements amongst healthy individuals. These SNPs differ significantly from the Indo-European background control as well. Amongst these we highlight novel SNPs rs304447 (IFIT5) and rs941590 (SERPINA10) that could explain differential trajectories for immune response, bleeding or thrombosis. Our method demonstrates the requirement of a relatively smaller sample size for a well powered study. This study highlights the potential of integrating a unique phenotyping approach for the identification of predictive markers and the at-risk population amongst the healthy. Full article

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

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9 pages, 1234 KiB

Open AccessArticle

Evaluation of Plaque Vulnerability via Combination of Hemodynamic Analysis and Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) Sequence for Carotid Intraplaque Hemorrhage

by Ui Yun Lee and Hyo Sung Kwak

J. Pers. Med. 2021, 11(9), 856; https://doi.org/10.3390/jpm11090856 - 28 Aug 2021

Viewed by 1795

Abstract

The purpose of this study was to assess the vulnerability of plaque using a combination of simultaneous non-contrast angiography, intraplaque hemorrhage (SNAP) sequence, and local hemodynamic analysis in an intraplaque hemorrhage (IPH), and to evaluate the association between morphological and hemodynamic factors and [...] Read more.

The purpose of this study was to assess the vulnerability of plaque using a combination of simultaneous non-contrast angiography, intraplaque hemorrhage (SNAP) sequence, and local hemodynamic analysis in an intraplaque hemorrhage (IPH), and to evaluate the association between morphological and hemodynamic factors and IPH by comparing the IPH (presence of IPH) and non-IPH (plaque with absence of IPH) groups. In total, 27 IPH patients and 27 non-IPH patients were involved in this study, and baseline characteristics were collected. For morphological factors, diameters, and areas of the internal carotid artery (ICA), external carotid artery, and common carotid artery were measured, and bifurcation angle (α) and ICA angle (β) were also measured for comparison between the IPH group and non-IPH group. For hemodynamic factors, time-averaged wall shear stress (WSS), minimum WSS, maximum WSS, and oscillatory shear index were calculated using computational fluid dynamics (CFD) simulations. For the qualitative analysis, cross-sectional images with analyzed WSS and SNAP sequences were combined to precisely assess local hemodynamics. Bifurcation angle (α) was significantly different between the IPH and non-IPH groups (39.47 degrees vs. 47.60 degrees, p = 0.041). Significantly higher time-averaged WSS, minimum WSS, and maximum WSS were observed in the IPH group compared to the non-IPH group. In the IPH group, when using the combined analysis with SNAP sequences and WSS, the WSS of the region with IPH was significantly higher than the region without IPH (2.32 vs. 1.21 Pa, p = 0.005). A smaller bifurcation angle (α) and higher time-averaged WSS, minimum WSS, and maximum WSS were associated with IPH. The combined analysis of SNAP sequences and WSS might help to evaluate the risk of carotid IPH. Full article

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

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10 pages, 1173 KiB

Open AccessArticle

The Impact of Smoking on Psoriasis Patients with Biological Therapies in a Bucharest Hospital

by Maria-Magdalena Constantin, Stefana Bucur, Costina-Cristiana Mutu, Elena Poenaru, Rodica Olteanu, Razvan Adrian Ionescu, Alin Codrut Nicolescu, Florentina Furtunescu and Traian Constantin

J. Pers. Med. 2021, 11(8), 752; https://doi.org/10.3390/jpm11080752 - 30 Jul 2021

Cited by 2 | Viewed by 2087

Abstract

Psoriasis is an immune-mediated chronic inflammatory skin disease with extracutaneous manifestations, that affects about 1–3% of the world’s population. The disease is not life-threatening, but the disability which comes with it is comparable to the disability caused by other serious chronic diseases, such [...] Read more.

Psoriasis is an immune-mediated chronic inflammatory skin disease with extracutaneous manifestations, that affects about 1–3% of the world’s population. The disease is not life-threatening, but the disability which comes with it is comparable to the disability caused by other serious chronic diseases, such as oncologic or cardiovascular disease. Several risk factors, such as infections, stress, smoking, excessive alcohol consumption and genetic predisposition have been involved in inducing psoriasis. Smoking status is a risk factor for many chronic diseases, including psoriasis. Moreover, recent studies have tried to answer the question of whether smoking also influences the response to biologic therapy in patients with psoriasis. Through the current study, our intention is to find out how smoking affects the response to biologic treatment. A hospital-based cross-sectional, observational, non-interventional, retrospective study of moderate and severe psoriasis patients receiving biologic treatment was developed. Two groups were defined based on smoking status: group 1 included smokers (more than 10 cigarettes/day) and former smokers, and group 2 included non-smokers. The data that resulted from the analysis of the cohort of patients demonstrate that smoking status does not affect the response of biologic therapy in patients with moderate and severe psoriasis. Full article

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

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12 pages, 24852 KiB

Open AccessArticle

Comparison of Hemodynamic Visualization in Cerebral Arteries: Can Magnetic Resonance Imaging Replace Computational Fluid Dynamics?

by Minh Tri Ngo, Ui Yun Lee, Hojin Ha, Ning Jin, Gyung Ho Chung, Yeong Gon Kwak, Jinmu Jung and Hyo Sung Kwak

J. Pers. Med. 2021, 11(4), 253; https://doi.org/10.3390/jpm11040253 - 30 Mar 2021

Cited by 6 | Viewed by 3145

Abstract

A multimodality approach was applied using four-dimensional flow magnetic resonance imaging (4D flow MRI), time-of-flight magnetic resonance angiography (TOF-MRA) signal intensity gradient (SIG), and computational fluid dynamics (CFD) to investigate the 3D blood flow characteristics and wall shear stress (WSS) of the cerebral [...] Read more.

A multimodality approach was applied using four-dimensional flow magnetic resonance imaging (4D flow MRI), time-of-flight magnetic resonance angiography (TOF-MRA) signal intensity gradient (SIG), and computational fluid dynamics (CFD) to investigate the 3D blood flow characteristics and wall shear stress (WSS) of the cerebral arteries. TOF-MRA and 4D flow MRI were performed on the major cerebral arteries in 16 healthy volunteers (mean age 34.7 ± 7.6 years). The flow rate measured with 4D flow MRI in the internal carotid artery, middle cerebral artery, and anterior cerebral artery were 3.8, 2.5, and 1.2 mL/s, respectively. The 3D blood flow pattern obtained through CFD and 4D flow MRI on the cerebral arteries showed reasonable consensus. CFD delivered much greater resolution than 4D flow MRI. TOF-MRA SIG and CFD WSS of the major cerebral arteries showed reasonable consensus with the locations where the WSS was relatively high. However, the visualizations were very different between TOF-MRA SIG and CFD WSS at the internal carotid artery bifurcations, the anterior cerebral arteries, and the anterior communicating arteries. 4D flow MRI, TOF-MRA SIG, and CFD are complementary methods that can provide additional insight into the hemodynamics of the human cerebral artery. Full article

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

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16 pages, 5228 KiB

Open AccessArticle

Expansion of CD4 T Lymphocytes Expressing Interleukin 17 and Tumor Necrosis Factor in Patients with Major Depressive Disorder

by Miguel Angel Alvarez-Mon, Ana Maria Gómez-Lahoz, Arancha Orozco, Guillermo Lahera, David Diaz, Miguel A. Ortega, Agustin Albillos, Javier Quintero, Enrique Aubá, Jorge Monserrat and Melchor Alvarez-Mon

J. Pers. Med. 2021, 11(3), 220; https://doi.org/10.3390/jpm11030220 - 19 Mar 2021

Cited by 33 | Viewed by 3239

Abstract

Background: We have investigated the distribution of the Th1, Th2 and Th17 subsets in circulating CD4⁺ T lymphocytes and their naïve (T_N), effector (T_E), central (T_CM) and effector memory (T_EM) activation/differentiation stages in patients [...] Read more.

Background: We have investigated the distribution of the Th1, Th2 and Th17 subsets in circulating CD4⁺ T lymphocytes and their naïve (T_N), effector (T_E), central (T_CM) and effector memory (T_EM) activation/differentiation stages in patients with major depressive disorder (MDD). Methods: Thirty MDD patients and 30 healthy controls were studied. The counts of circulating CD4⁺ T lymphocytes and their distribution on the T_N, T_E, T_CM and T_EM activation/differentiation stages were analyzed by polychromatic flow cytometry. The intracytoplasmic interferon gamma (IFNγ), interleukin (IL)-4, IL-17A and tumor necrosis factor alpha (TNF-alpha) and membrane CD28 expression were also measured. The serum IFNγ, IL-4, Il-17A and TNF-alpha were measured by Luminex, respectively. Results: MDD patients had normal counts of CD4⁺ T lymphocytes and of their T_N, T_CM and T_EM subsets but increased number and percentage of T_E CD4⁺ subset. CD4⁺ T lymphocytes had significantly enhanced percentage of cells that express IL-17 and TNF-alpha explained by the expansions found in the T_N, T_CM and, T_EM and T_CM, T_EM and T_E activation/differentiation stages, respectively. A selective increase in the percentages of T_CM and T_EM expressing IFNγ was also observed. We found a significant correlation between the percentages of CD4⁺ T lymphocytes expressing IFNγ and TNF-alpha in these patients. MDD patients showed increased serum levels of IL-17 and TNF-alpha, but normal IFNγ and IL-4 concentration. Limitations: the cross-sectional nature of the study could be considered a limitation. Conclusions: MDD patients have abnormal circulating CD4⁺ T lymphocytes with expansion of the IL-17 and TNF-alpha expressing cells as well as increased levels of circulating IL-17 and TNF-alpha. Full article

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

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12 pages, 1723 KiB

Open AccessArticle

Evidence of a Down Syndrome Keratopathy: A Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis

by Ibrahim Toprak, Francisco Cavas, Alfredo Vega, José S. Velázquez, Jorge L. Alio del Barrio and Jorge L. Alio

J. Pers. Med. 2021, 11(2), 82; https://doi.org/10.3390/jpm11020082 - 30 Jan 2021

Cited by 6 | Viewed by 1900

Abstract

The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 [...] Read more.

The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 eyes) with normal karyotype and topography. Refraction, central corneal thickness (CCT), aberrations (high-order, coma and spherical), asphericity and morphogeometric/volumetric parameters based on a 3D corneal model that was generated from raw topographical data were evaluated. Deviation of anterior/posterior apex (D_apexant/D_apexpost) and thinnest point (D_mctant/D_mctpost) from corneal vertex, anterior/posterior surface area (A_ant/A_post), sagittal area passing through the anterior/posterior apex (A_apexant/A_apexpost) and thinnest point (A_mctpost), total corneal volume (V_total) and volumetric progression for each 0.05 mm step of the radius value centred to the thinnest point (VOL_MCT) and anterior/posterior apex (VOL_AAP/VOL_PAP) comprised the morphogeometric/volumetric parameters. In the DS group, 58.1% of the eyes presented abnormal topography. High-order and coma aberrations, asphericity, D_apexant, A_ant, A_post and A_apexant were significantly higher, whereas CCT, A_apexpost, A_mctpost, V_total, VOL_AAP, VOL_PAP and VOL_MCT were lower in the DS group than in the control group (p < 0.05). D_apexpost did not differ between the groups (p > 0.05). This study demonstrates that corneas of the subjects with DS are different and more aberrated than those of normal age- and sex-matched non-DS controls. Anterior corneal apex appears to be displaced in DS even with normal topography, while posterior apex seems stable although topography is abnormal. These findings may help to modify our approach in the diagnosis of keratopathy in subjects with DS. Full article

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

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11 pages, 599 KiB

Open AccessArticle

Development and Validation of Predictive Assessment of Complicated Diverticulitis Score

by Marcello Covino, Valerio Papa, Antonio Tursi, Benedetta Simeoni, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Francesco Franceschi, Gianludovico Rapaccini, Antonio Gasbarrini and Alfredo Papa

J. Pers. Med. 2021, 11(2), 80; https://doi.org/10.3390/jpm11020080 - 29 Jan 2021

Cited by 3 | Viewed by 1691

Abstract

The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. The clinical records of [...] Read more.

The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. The clinical records of 1089 patients referred to the emergency department (ED) over a five-year period were reviewed. In multivariate analysis, male sex (p < 0.001), constipation (p = 0.002), hemoglobin < 11.9 g/dL (p < 0.001), C reactive protein > 80 mg/L (p < 0.001), severe obesity (p = 0.049), and no proton pump inhibitor treatment (p = 0.003) were independently associated with complicated AD. The predictive assessment of complicated (PACO)-diverticulitis (D) score, including these six variables, was applied to the retrospective cohort and then validated prospectively in a cohort including 282 patients. It categorized patients into three risk classes for complicated AD. The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. Further external validation is needed to confirm these results. Full article

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

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11 pages, 1391 KiB

Open AccessArticle

Comparing CLIF-C ACLF, CLIF-C ACLF_lactate, and CLIF-C ACLF-D Prognostic Scores in Acute-on-Chronic Liver Failure Patients by a Single-Center ICU Experience

by Chao-Cheng Kuo, Chien-Hao Huang, Ching Chang, Pin-Cheng Chen, Bo-Huan Chen, Wei-Ting Chen and Yu-Pin Ho

J. Pers. Med. 2021, 11(2), 79; https://doi.org/10.3390/jpm11020079 - 29 Jan 2021

Cited by 7 | Viewed by 2067

Abstract

Patients with liver cirrhosis have a higher risk of developing acute-on-chronic liver failure (ACLF). Poor prognosis with a high rate of short-term mortality leads to limited opportunities for further liver transplantation. Thus, precise prognostic evaluation of patients with ACLF is necessary before transplant [...] Read more.

Patients with liver cirrhosis have a higher risk of developing acute-on-chronic liver failure (ACLF). Poor prognosis with a high rate of short-term mortality leads to limited opportunities for further liver transplantation. Thus, precise prognostic evaluation of patients with ACLF is necessary before transplant surgery. In this study, a total of one hundred and thirty-five patients with ACLF admitted to the hepato-gastroenterologic intensive care unit (ICU) for intensive monitoring and treatment at Chang-Gung Memorial Hospital (CGMH, Linkou, Taiwan) were screened from November 2012 to April 2015 and tracked until April 2017. Three new prognostic scores of ACLF, including CLIF-C ACLF (Chronic Liver Failure Consortium Acute-on-chronic Liver Failure score), CLIF-C ACLF-D (CLIF-C ACLF Development score), and CLLF-C ACLF_lactate (lactate-adjusted CLIF-C ACLF score) were compared. The primary outcome considered was overall mortality. Mortality predictions at 28, 90, 180, and 365 days were also calculated. By area under the receiver operating characteristic curve (AUROC) analysis, the CLIF-C ACLF and CLIF-C ACLF-D scores were superior to CLIF-C ACLF_lactate scores in predicting 28-day mortality. The CLIF-C ACLF-D score had the highest AUROC in predicting overall mortality as well as at 90, 180, and 365 days. In conclusion, our study demonstrates that CLIF-C ACLF and CLIF-C ACLF-D scores are significant predictors of outcome in critical patients with liver cirrhosis and ACLF. The CLIF-C ACLF-D score may have a superior predictive power for the prediction of 3-month, 6-month, and one-year mortality. Full article

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

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8 pages, 2856 KiB

Open AccessArticle

Thoracic Aortic Aneurysm and Factors Affecting Aortic Dissection

by Petr V. Chumachenko, Anton Yu. Postnov, Alexandra G. Ivanova, Olga I. Afanasieva, Maksim A. Afanasiev, Mariam Bagheri Ekta, Vasily N. Sukhorukov, Grigoriy I. Kheimets and Igor A. Sobenin

J. Pers. Med. 2020, 10(4), 153; https://doi.org/10.3390/jpm10040153 - 02 Oct 2020

Cited by 11 | Viewed by 2681

Abstract

This study is aimed at investigating the relationship between inflammation, the number of vasa vasorum, and the presence of lipoprotein (a) [Lp(a)] in the aortic aneurysm wall, as well as the relationships of these pathological processes with the development of aneurysm wall dissection. [...] Read more.

This study is aimed at investigating the relationship between inflammation, the number of vasa vasorum, and the presence of lipoprotein (a) [Lp(a)] in the aortic aneurysm wall, as well as the relationships of these pathological processes with the development of aneurysm wall dissection. To that end, we examined segments of aortic aneurysm wall, consisting of intima, media, and adventitia, collected from patients during aneurysm prosthetics intervention. The material was collected from 23 men and eight women aged from 33 to 69 years. Monoclonal antibodies to Lp(a), markers of monocytes and macrophages (CD68), T cells (CD3, CD4, and CD8), von Willebrand factor, endothelium NO synthase, and smooth muscle α-actin were used for morphological and morphometric investigation. The present study demonstrated that Lp(a) is not often found in biopsies of patients with thoracic aortic aneurysm. Morphological and morphometric investigation shows the connection of aortic dissection with the process of damage to its wall caused by inflammatory infiltrates, medianecroses, and the appearance of newly formed vasa vasorum in media. Full article

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

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Review

Jump to: Research

14 pages, 2692 KiB

Open AccessReview

Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital

by Nicolò Bizzarri, Camilla Nero, Francesca Sillano, Francesca Ciccarone, Marika D’Oria, Alfredo Cesario, Simona Maria Fragomeni, Antonia Carla Testa, Francesco Fanfani, Gabriella Ferrandina, Domenica Lorusso, Anna Fagotti and Giovanni Scambia

J. Pers. Med. 2022, 12(1), 3; https://doi.org/10.3390/jpm12010003 - 21 Dec 2021

Cited by 3 | Viewed by 3126

Abstract

Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors [...] Read more.

Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors and individual pathophenotypes. Ongoing studies are focusing on personalizing therapies by integrating information across genomics, proteomics, and metabolomics with the genetic makeup and immune system of the patient. Hence, several challenges must be faced to provide holistic benefit to the patient. Personalized approaches should also recognize the unmet needs of each patient to successfully deliver the promise of personalized care, in a multidisciplinary effort. This may provide the greatest opportunity to improve patients’ outcomes. Starting from a narrative review on gynecological oncology patients’ needs, this article focuses on the experience of building a research and care infrastructure for personalized patient management. Full article

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

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14 pages, 581 KiB

Open AccessReview

Personalized Approach for Obese Patients Undergoing Endoscopic Sleeve Gastroplasty

by Maria Valeria Matteo, Marika D’Oria, Vincenzo Bove, Giorgio Carlino, Valerio Pontecorvi, Marco Raffaelli, Daniela Chieffo, Alfredo Cesario, Giovanni Scambia, Guido Costamagna and Ivo Boškoski

J. Pers. Med. 2021, 11(12), 1298; https://doi.org/10.3390/jpm11121298 - 04 Dec 2021

Cited by 4 | Viewed by 2391

Abstract

Obesity is a chronic, relapsing disease representing a major global health problem in the 21st century. Several etiologic factors are involved in its pathogenesis, including a Western hypercaloric diet, sedentariness, metabolic imbalances, genetics, and gut microbiota modification. Lifestyle modifications and drugs often fail [...] Read more.

Obesity is a chronic, relapsing disease representing a major global health problem in the 21st century. Several etiologic factors are involved in its pathogenesis, including a Western hypercaloric diet, sedentariness, metabolic imbalances, genetics, and gut microbiota modification. Lifestyle modifications and drugs often fail to obtain an adequate and sustained weight loss. To date, bariatric surgery (BS) is the most effective treatment, but only about 1% of eligible patients undergo BS, partly because of its negligible morbidity and mortality. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, endoscopic, bariatric procedure, which proved to be safe and effective. In this review, we aim to examine evidence supporting the role of a personalized and multidisciplinary approach, guided by a multidisciplinary team (MDT), for obese patients undergoing ESG, from patient selection to long-term follow-up. The cooperation of different health professionals, including an endocrinologist and/or obesity medicine physician, a bariatric surgeon, an endoscopist experienced in bariatrics, a registered dietitian, an exercise specialist, a behaviour coach, a psychologist, and a nurse or physician extender, aims to induce radical and sustained lifestyle changes. We also discussed the relationship between gut microbiota and outcomes after bariatric procedures, speculating that the characterization of gut microbiota before and after ESG may help develop new tools, including probiotics, to optimize weight loss outcomes. Full article

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

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22 pages, 536 KiB

Open AccessReview

Basic and Preclinical Research for Personalized Medicine

by Wanda Lattanzi, Cristian Ripoli, Viviana Greco, Marta Barba, Federica Iavarone, Angelo Minucci, Andrea Urbani, Claudio Grassi and Ornella Parolini

J. Pers. Med. 2021, 11(5), 354; https://doi.org/10.3390/jpm11050354 - 29 Apr 2021

Cited by 8 | Viewed by 3431

Abstract

Basic and preclinical research founded the progress of personalized medicine by providing a prodigious amount of integrated profiling data and by enabling the development of biomedical applications to be implemented in patient-centered care and cures. If the rapid development of genomics research boosted [...] Read more.

Basic and preclinical research founded the progress of personalized medicine by providing a prodigious amount of integrated profiling data and by enabling the development of biomedical applications to be implemented in patient-centered care and cures. If the rapid development of genomics research boosted the birth of personalized medicine, further development in omics technologies has more recently improved our understanding of the functional genome and its relevance in profiling patients’ phenotypes and disorders. Concurrently, the rapid biotechnological advancement in diverse research areas enabled uncovering disease mechanisms and prompted the design of innovative biological treatments tailored to individual patient genotypes and phenotypes. Research in stem cells enabled clarifying their role in tissue degeneration and disease pathogenesis while providing novel tools toward the development of personalized regenerative medicine strategies. Meanwhile, the evolving field of integrated omics technologies ensured translating structural genomics information into actionable knowledge to trace detailed patients’ molecular signatures. Finally, neuroscience research provided invaluable models to identify preclinical stages of brain diseases. This review aims at discussing relevant milestones in the scientific progress of basic and preclinical research areas that have considerably contributed to the personalized medicine revolution by bridging the bench-to-bed gap, focusing on stem cells, omics technologies, and neuroscience fields as paradigms. Full article

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

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12 pages, 1344 KiB

Open AccessReview

The Role of Artificial Intelligence in Managing Multimorbidity and Cancer

by Alfredo Cesario, Marika D’Oria, Riccardo Calvani, Anna Picca, Antonella Pietragalla, Domenica Lorusso, Gennaro Daniele, Franziska Michaela Lohmeyer, Luca Boldrini, Vincenzo Valentini, Roberto Bernabei, Charles Auffray and Giovanni Scambia

J. Pers. Med. 2021, 11(4), 314; https://doi.org/10.3390/jpm11040314 - 19 Apr 2021

Cited by 17 | Viewed by 3402

Abstract

Traditional healthcare paradigms rely on the disease-centered approach aiming at reducing human nature by discovering specific drivers and biomarkers that cause the advent and progression of diseases. This reductive approach is not always suitable to understand and manage complex conditions, such as multimorbidity [...] Read more.

Traditional healthcare paradigms rely on the disease-centered approach aiming at reducing human nature by discovering specific drivers and biomarkers that cause the advent and progression of diseases. This reductive approach is not always suitable to understand and manage complex conditions, such as multimorbidity and cancer. Multimorbidity requires considering heterogeneous data to tailor preventing and targeting interventions. Personalized Medicine represents an innovative approach to address the care needs of multimorbid patients considering relevant patient characteristics, such as lifestyle and individual preferences, in opposition to the more traditional “one-size-fits-all” strategy focused on interventions designed at the population level. Integration of omic (e.g., genomics) and non-strictly medical (e.g., lifestyle, the exposome) data is necessary to understand patients’ complexity. Artificial Intelligence can help integrate and manage heterogeneous data through advanced machine learning and bioinformatics algorithms to define the best treatment for each patient with multimorbidity and cancer. The experience of an Italian research hospital, leader in the field of oncology, may help to understand the multifaceted issue of managing multimorbidity and cancer in the framework of Personalized Medicine. Full article

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

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9 pages, 711 KiB

Open AccessReview

Challenges of Prevention for a Sustainable Personalized Medicine

by Roberta Pastorino, Claudia Loreti, Silvia Giovannini, Walter Ricciardi, Luca Padua and Stefania Boccia

J. Pers. Med. 2021, 11(4), 311; https://doi.org/10.3390/jpm11040311 - 16 Apr 2021

Cited by 15 | Viewed by 3911

Abstract

The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the [...] Read more.

The development and implementation of the approaches of personalized medicine for disease prevention are still at infancy, although preventive activities in healthcare represent a key pillar to guarantee health system sustainability. There is an increasing interest in finding informative markers that indicate the disease risk before the manifestation of the disease (primary prevention) or for early disease detection (secondary prevention). Recently, the systematic collection and study of clinical phenotypes and biomarkers consented to the advance of Rehabilomics in tertiary prevention. It consents to identify relevant molecular and physiological factors that can be linked to plasticity, treatment response, and natural recovery. Implementation of these approaches would open avenues to identify people at high risk and enable new preventive lifestyle interventions or early treatments targeted to their individual genomic profile, personalizing prevention and rehabilitation. The integration of personalized medicine into prevention may benefit citizens, patients, healthcare professionals, healthcare authorities, and industry, and ultimately will seek to contribute to better health and quality of life for Europe’s citizens. Full article

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

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19 pages, 366 KiB

Open AccessReview

Personalized Clinical Phenotyping through Systems Medicine and Artificial Intelligence

by Alfredo Cesario, Marika D’Oria, Francesco Bove, Giuseppe Privitera, Ivo Boškoski, Daniela Pedicino, Luca Boldrini, Carmen Erra, Claudia Loreti, Giovanna Liuzzo, Filippo Crea, Alessandro Armuzzi, Antonio Gasbarrini, Paolo Calabresi, Luca Padua, Guido Costamagna, Massimo Antonelli, Vincenzo Valentini, Charles Auffray and Giovanni Scambia

J. Pers. Med. 2021, 11(4), 265; https://doi.org/10.3390/jpm11040265 - 02 Apr 2021

Cited by 12 | Viewed by 3685

Abstract

Personalized Medicine (PM) has shifted the traditional top-down approach to medicine based on the identification of single etiological factors to explain diseases, which was not suitable for explaining complex conditions. The concept of PM assumes several interpretations in the literature, with particular regards [...] Read more.

Personalized Medicine (PM) has shifted the traditional top-down approach to medicine based on the identification of single etiological factors to explain diseases, which was not suitable for explaining complex conditions. The concept of PM assumes several interpretations in the literature, with particular regards to Genetic and Genomic Medicine. Despite the fact that some disease-modifying genes affect disease expression and progression, many complex conditions cannot be understood through only this lens, especially when other lifestyle factors can play a crucial role (such as the environment, emotions, nutrition, etc.). Personalizing clinical phenotyping becomes a challenge when different pathophysiological mechanisms underlie the same manifestation. Brain disorders, cardiovascular and gastroenterological diseases can be paradigmatic examples. Experiences on the field of Fondazione Policlinico Gemelli in Rome (a research hospital recognized by the Italian Ministry of Health as national leader in “Personalized Medicine” and “Innovative Biomedical Technologies”) could help understanding which techniques and tools are the most performing to develop potential clinical phenotypes personalization. The connection between practical experiences and scientific literature highlights how this potential can be reached towards Systems Medicine using Artificial Intelligence tools. Full article

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

20 pages, 1037 KiB

Open AccessReview

Translational Research in the Era of Precision Medicine: Where We Are and Where We Will Go

by Ruggero De Maria Marchiano, Gabriele Di Sante, Geny Piro, Carmine Carbone, Giampaolo Tortora, Luca Boldrini, Antonella Pietragalla, Gennaro Daniele, Maria Tredicine, Alfredo Cesario, Vincenzo Valentini, Daniela Gallo, Gabriele Babini, Marika D’Oria and Giovanni Scambia

J. Pers. Med. 2021, 11(3), 216; https://doi.org/10.3390/jpm11030216 - 18 Mar 2021

Cited by 40 | Viewed by 9351

Abstract

The advent of Precision Medicine has globally revolutionized the approach of translational research suggesting a patient-centric vision with therapeutic choices driven by the identification of specific predictive biomarkers of response to avoid ineffective therapies and reduce adverse effects. The spread of “multi-omics” analysis [...] Read more.

The advent of Precision Medicine has globally revolutionized the approach of translational research suggesting a patient-centric vision with therapeutic choices driven by the identification of specific predictive biomarkers of response to avoid ineffective therapies and reduce adverse effects. The spread of “multi-omics” analysis and the use of sensors, together with the ability to acquire clinical, behavioral, and environmental information on a large scale, will allow the digitization of the state of health or disease of each person, and the creation of a global health management system capable of generating real-time knowledge and new opportunities for prevention and therapy in the individual person (high-definition medicine). Real world data-based translational applications represent a promising alternative to the traditional evidence-based medicine (EBM) approaches that are based on the use of randomized clinical trials to test the selected hypothesis. Multi-modality data integration is necessary for example in precision oncology where an Avatar interface allows several simulations in order to define the best therapeutic scheme for each cancer patient. Full article

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

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