Journal of Personalized Medicine最新文献

The journal retracts the article "Machine-Learning-Based Survival Prediction in Castration-Resistant Prostate Cancer: A Multi-Model Analysis Using a Comprehensive Clinical Dataset" [...].

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Background: Identification of patients at risk and prevention of acute postoperative pain (APOP) are central to individualized anesthesia and analgesia. Venous cannulation pain (VCP) has shown promise as a predictor of APOP. In the PeriOPerative Individualization Trial (POPIT), VCP was evaluated as a pain-sensitivity stratification method to guide anesthesia and reduce postoperative pain. This report presents a predefined secondary analysis with the primary aim to evaluate VCP as a method for postoperative pain prediction. As a secondary aim, we sought to explore factors that influence VCP. Methods: 271 patients were stratified into two cohorts, high-risk (VCP ≥ 2.0) and low-risk (VCP < 2.0), for APOP, based on their VCP. Within each group, patients were randomized to receive either: standard care or opioid-free anesthesia (low-risk cohort), and standard care or multimodal anesthesia with opioids (high-risk cohort). Differences in acute and persistent pain, quality of recovery, postoperative opioid consumption, and proportion of patients experiencing moderate to severe APOP depending on VCP levels were investigated. The predictive capacity of VCP was evaluated and adjusted for in terms of potential confounders. Results: High-risk patients, grading VCP ≥ 2.0 (VAS units) experienced more APOP on the day of surgery (difference 0.9 NRS-units, 95% CI 0.2-1.6, p = 0.009) and after 24 h during movement (difference 0.6 NRS-units, 95% CI 0.0-1.3, p = 0.048). Patients grading VCP < 2.0 had better quality of recovery after 24 hr (difference 7, 95% 1-13, p = 0.002) and lower postoperative opioid consumption (difference 7.5 mg, 95% 5.7-9.3, p < 0.001). The OR for VCP ≥ 2.0 to predict APOP in PACU was 1.76 (95% CI 1.02-3.04, p = 0.043), but in a multivariate model, adjusted for age, VCP ≥ 2, gender, pain catastrophizing, preoperative pain, and pain on the day of surgery, female gender was the only independent predictor of APOP (OR 2.65 (95% CI 1.33-5.29), p = 0.006). Conclusions: Pain during venous cannulation as a predictor of acute pain after surgery was significant in univariate regression, but the results were lost when adjusting for confounders like gender and current pain. However, VCP continues to show potential in associated postoperative recovery outcomes such as opioid consumption. The level of pain associated with venous cannulation is influenced by gender, preoperative pain, and current pain on the day of surgery. Pain sensitivity stratification needs refinement before implementation in clinical practice.

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Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and affects male patients more often than women. Prior studies, however, suggested that women are diagnosed later and at advanced stages of the disease, present with more pronounced symptoms, and experience worse outcomes. Objectives: To investigate sex-specific differences in clinical, laboratory, and comprehensive imaging characteristics in a contemporary cohort of HCM patients from a tertiary referral center in Austria. Methods: We retrospectively analyzed 321 HCM patients enrolled in a prospective registry (2018-2024). All patients underwent a comprehensive baseline evaluation, including medical history, laboratory assessment, transthoracic echocardiography, and cardiac magnetic resonance imaging. Results: At diagnosis, women were significantly older (62 vs. 53 years, p < 0.001) and presented with more advanced functional class (NYHA ≥ II: 80% vs. 49%, p < 0.001). Six-minute walking distance was lower and obstructive HCM was more prevalent in women (425 vs. 505 m, p < 0.001, and 55% vs. 32%, p < 0.001, respectively). Echocardiographic assessment revealed higher diastolic filling pressures (E/E' 18 vs. 10, p < 0.001), larger indexed atrial volumes (29.5 vs. 26.6 mL/m², p < 0.001), a higher left ventricular ejection fraction (70% vs. 62%, p < 0.001), and a larger indexed interventricular septal thickness in women (10.2 vs. 9.3 mm/m², p = 0.004). Moreover, serum levels of NT-proBNP were significantly higher in women (760 vs. 338 pg/L, p < 0.001). Conclusions: Female patients with HCM were diagnosed at an older age, presented with more advanced symptoms, had higher rates of obstructive physiology, and a phenotype characterized by diastolic dysfunction and elevated biomarkers, closely resembling heart failure with preserved ejection fraction. Recognizing these sex-specific disparities is crucial in improving diagnostic awareness and individualized therapeutic management.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammation and fibrosis of the intra- and extrahepatic bile ducts, and is often associated with inflammatory bowel disease (IBD) [...].

Oral infections in neutropenic patients are an underestimated but likely fatal cause of infectious complications, with clinical manifestations often diminished or absent due to immune deficiency. The evaluation and management of these infections requires a personalized multidisciplinary strategy, including prevention through pre-therapy dental assessment, individualized oral hygiene protocols, and rapid treatment of dental lesions. Antimicrobial strategies should be adapted not only to the local resistance profile and individual risk, with a priority on antibiotic stewardship and rapid de-escalation when possible, but also to individual patterns of colonization and comorbidities. Dental procedures can be performed without risk in neutropenic patients with a low complication rate, but further studies are key to stratifying risk. Future research directions include the application of artificial intelligence for infectious risk stratification, the use of salivary or microbiome biomarkers for early detection, and the development of innovative technologies for targeted antimicrobial delivery. This narrative review aims to provide an overview of the common clinical manifestations in neutropenic patients and also the potential progression of dental infections into sepsis in this category of patients.

Background: MiRNAs have emerged as minimally invasive biomarkers with considerable potential for the early detection of oral squamous cell carcinoma (OSCC). Although numerous studies have evaluated circulating miRNAs across different biofluids, the comparative diagnostic performance of saliva-, serum-, and plasma-derived miRNAs has not been systematically clarified. Methods: A meta-analysis was performed by screening PubMed, MEDLINE, Scopus, CINAHL, and related databases. Nineteen eligible studies evaluating miRNA-based assays in saliva, serum, or plasma were included. A random-effects bivariate model was used to calculate pooled sensitivity, specificity, and area under the HSROC curve. Meta-regression using log diagnostic odds ratio (lnDOR) examined whether biofluid type significantly influenced diagnostic performance. Results: Salivary miRNAs showed a pooled sensitivity of 0.76 (95% CI: 0.68-0.82; I² = 84.69%), specificity of 0.79 (95% CI: 0.70-0.85; I² = 70.41%), and an AUC of 0.84 (95% CI: 0.80-0.87). Plasma miRNAs produced comparable results with a pooled sensitivity of 0.77 (95% CI: 0.61-0.88; I² = 90.45%), specificity of 0.79 (95% CI: 0.63-0.89; I² = 80.20%), and an AUC of 0.85 (95% CI: 0.81-0.89). Serum-derived miRNAs demonstrated the highest accuracy with a pooled sensitivity of 0.82 (95% CI: 0.70-0.90; I² = 76.92%), specificity of 0.88 (95% CI: 0.75-0.95; I² = 74.87%), and an AUC of 0.91 (95% CI: 0.89-0.94). Despite serum's numerically superior performance, meta-regression revealed no significant matrix effect (Wald χ² = 0.20, p = 0.903). Conclusions: Although serum-derived miRNAs performed best overall, biofluid type was not a statistically significant determinant of diagnostic performance.

Background/Objectives: Individual responses to CFTR modulators vary widely among people with cystic fibrosis (pwCF), underscoring the need for functional approaches that provide biological context alongside genotype-based therapy selection. Nasal epithelial cultures provide an individual-specific model for theratyping, but most studies rely on freshly isolated cells, restricting repeated testing and long-term sample use. In this study, we tested whether CFTR modulator responses measured in biobanked nasal cells were associated with real-world clinical outcomes. Methods: Cryopreserved nasal epithelial cells from 23 pwCF were differentiated at the air-liquid interface and assessed for CFTR modulator-responsive ion transport using Ussing chambers. In vitro responses were correlated with 6-month changes in sweat chloride concentration (SCC), FEV₁, and BMI. Results: Cryopreserved cultures retained donor-specific CFTR modulator responsiveness. Modulator-induced forskolin/IBMX-stimulated currents correlated with changes in SCC (R = -0.512). CFTR inhibitor-sensitive currents correlated with FEV₁ (R = 0.564). Associations between forskolin/IBMX-stimulated currents and FEV₁ were positive but did not reach statistical significance using two-tailed analysis. BMI changes showed no significant association. Conclusions: Biobanked nasal epithelial cultures preserve clinically relevant CFTR modulator responses at the cohort level, supporting their use as functional assays for population-level assessment in cystic fibrosis. This cryopreservation-based strategy enables repeated testing and may expand access to theratyping beyond freshly obtained samples.

Background/Objectives: Fluoroscopy-guided procedures are widely used across surgical and interventional specialties but expose operators to ionizing radiation with associated stochastic and deterministic effects. The aim is to characterize occupational radiation exposure, evaluate the effectiveness of shielding strategies, assess long-term cancer risks, and identify compliance patterns. Methods: This structured narrative review summarizes evidence on operator dose, shielding effectiveness, compliance with protective practices, and long-term cancer risk. A search of PubMed, Scopus, Embase, and Web of Science (limited to January 2000-March 2024) identified 62 records; 27 full texts were reviewed, and 16 studies met the inclusion criteria. Results: Across studies, unshielded chest exposure averaged 0.08-0.11 mSv per procedure, and eye exposure averaged 0.04-0.05 mSv. Lead aprons reduced exposure by about 90% at 0.25 mm and 99% at 0.5 mm, thyroid collars reduced neck dose by 60-70%, and lead glasses reduced ocular dose 2.5-4.5-fold. Compliance with aprons and thyroid collars was high, whereas lead glasses and lower-body shielding were inconsistently used. Limited epidemiologic data suggested a higher cancer burden in exposed surgeons, and Biologic Effects of Ionizing Radiation (BEIR) VII-based modeling projected increased lifetime risks of solid cancers in chronically exposed operators. Conclusions: Protective equipment substantially reduces operator dose, but exposure variability and inconsistent shielding practices persist and justify standardized monitoring, stronger enforcement of radiation safety protocols, and longitudinal studies.