Journal of Personalized Medicine最新文献

Introduction: Acute type A aortic dissection (ATAAD) repair is associated with high morbidity postoperatively. The aim of this study is to evaluate the incidence and risk factors for acute kidney injury in patients who underwent ATAAD repair. Patients and Methods: Two hundred and twenty-three patients underwent ATAAD repair. Postoperative acute kidney injury (AKI) was evaluated according to the Kidney Disease-Improving Global Outcomes (KDIGO) criteria. Results: Postoperative AKI was observed in 140 patients (62.8%). The patients with postoperative AKI classified by KDIGO stages: 1 = 53 (23.8%), 2 = 36 (16.1%), and 3 = 51 (22.9%) patients. Twenty-eight patients (12.6%) underwent replacement renal therapy due to severe renal impairment (KDIGO stage 3). Multivariable logistic regression analysis (adjusted to risk factors) showed that preoperative eGFR was the risk factor for postoperative RRT (odds ratio (OR) = 0.95, 95% CI: 0.92-0.97, p < 0.01). The lengths of hospital and intensive care-unit stay differed between the patients with and without postoperative RRT (p < 0.001 for both). Postoperative RRT was associated with 30-day mortality (10.3% versus 35.7%, p < 0.001). Conclusions: Postoperative AKI was associated with high morbidity and mortality rate in patients after ATAAD repair.

Background/Objectives: This study investigated the potential chemopreventive role of proton pump inhibitor (PPI) use in relation to the occurrence of head and neck cancer (HNC) within a national cohort amid concerns of PPI overprescription. Methods: From a cohort of 1,137,861 individuals and 219,673,817 medical claim records collected between 2005 and 2019, 1677 HNC patients were identified and matched 1:4 with 6708 controls after adjusting for covariates. Odds ratios (ORs) for PPI use and its duration in relation to HNC and its subsites were estimated using propensity score overlap-weighted multivariable logistic regression. Additional subgroup analyses were performed based on age, sex, income level, and geographic region. Results: In the crude model, both current (OR 7.85 [95% CI 6.52-9.44]) and past PPI (OR 1.44 [95% CI 1.23-1.70]) use were associated with increased odds for HNC. However, after overlap weighting, this association reversed for both current (aOR 0.14 [95% CI 0.11-0.17]) and past PPI (aOR 0.69 [95% CI 0.60-0.79]). Subsite analysis showed reduced odds for hypopharyngeal (aOR 0.33, [95% CI 0.25-0.43]) and laryngeal cancer (aOR 0.19 [95% CI 0.16-0.22]) in current PPI users and similar results for past users. Conclusions: This study suggests a potential chemopreventive effect of PPIs, particularly in hypopharyngeal and laryngeal cancers. Additional studies are required to investigate the mechanisms underlying the association of the development of HNC with PPI use.

Sepsis is a complex and potentially life-threatening syndrome characterized by an abnormal immune response to an infection, which can lead to organ dysfunction, septic shock, and death. Early diagnosis is crucial to improving prognosis and reducing hospital management costs. This narrative review aims to summarize and evaluate the current literature on the role of monocyte distribution width (MDW) as a diagnostic biomarker for sepsis, highlighting its advantages, limitations, and potential clinical applications. MDW measures the volumetric distribution width of monocytes, reflecting monocytic anisocytosis, and is detected using advanced hematological analyzers. In 2019, it was approved by the FDA as a biomarker for sepsis due to its ability to identify systemic inflammatory response at an early stage. Thirty-one studies analyzed by us have shown that an increased MDW value is associated with a higher risk of sepsis and that its combination with clinical parameters (such as qSOFA) and other biomarkers (CRP, PCT) can enhance diagnostic sensitivity and risk stratification capacity. Despite its high sensitivity, MDW has lower specificity compared to more established biomarkers such as procalcitonin, thus requiring a multimodal integration for an accurate diagnosis. The use of MDW in emergency and intensive care settings represents an opportunity to improve early sepsis diagnosis and critical patient management, particularly when combined with other markers and clinical tools. However, further studies are needed to define a universal cut-off and confirm its validity in different clinical contexts and pathological scenarios.

Background/objectives: In metabolic bariatric surgery, structured follow-up protocols may play an essential role in achieving optimal patient outcomes. This study aims to report postoperative biochemical outcomes in a cohort of post-bariatric patients who underwent a structured follow-up protocol.

Methods: This retrospective study included patients who underwent metabolic bariatric surgery and completed a one-year follow-up at Cannizaro Hospital from October 2022 to May 2024. Anthropometric, clinical, and laboratory data were collected for each patient at five different timepoints: baseline, 1, 3, 6, and 12 months post-surgery. All data were organized into a database and analyzed through descriptive statistics.

Results: The study cohort (n = 80) showed a follow-up adherence equal to 97.5%. The mean value of BMI decreased from 42 to 27 one year after surgery. Lipid profiles improved, with significant reduction in total cholesterol and triglycerides and increase in HDL levels; LDL levels decreased initially but at one year returned to baseline. Thyroid hormones TSH and fT3 decreased significantly, while fT4 remained stable. A reduction in hepatic inflammation was observed, as evidenced by the decrease in GGT and transaminase levels. Pancreatic enzymes showed an initial increase but stabilized at the subsequent timepoints. Glycemic control improved, with statistically significant reductions in insulin, HbA1c, and glucose levels, and complete remission of type 2 diabetes mellitus in affected patients.

Conclusions: This study shows significant weight loss and improved health outcomes in post-bariatric patients who underwent a structured follow-up protocol, suggesting the potential benefits of metabolic bariatric surgery.

Background/Objectives: Takotsubo syndrome (TTS) shares many clinical features with acute myocardial infarction (AMI); however, its underlying pathophysiology remains elusive due to specific characteristics (i.e., reversibility, presence of stressors, and low mortality rate). Emerging evidence suggests that TTS often emerges following significant somatic, emotional, or psychological stressors. Several studies have investigated the biological factors that may contribute to the onset of TTS, including the release of stress hormones. However, the psychological characteristics associated with TTS, which may be useful for differentiating TTS from other cardiovascular conditions, remain poorly explored. This study aims to overcome these limitations by evaluating whether certain psychological features may allow this specific clinical condition to be differentiated from other cardiovascular conditions. Methods: This study compared three groups of individuals: patients with TTS (N = 56), patients with AMI (N = 52), and individuals without a history of cardiovascular disease (N = 56). Patients were examined three months after the acute phases. The objective was to identify and examine multiple psychological factors involved in TTS, including state and trait anxiety, symptoms of depression, psychological symptoms, distress, perceived social support, and health locus of control. Results: The results indicate that patients with TTS exhibited higher levels of somatization, trait anxiety, obsessive-compulsiveness, and overall psychological distress than patients with AMI and control groups. These findings were associated with an internal health locus of control and low-risk lifestyles. Conclusions: This psychological exploration of TTS reveals a multifaceted relationship between the mind and the heart, challenging traditional notions of cardiovascular pathophysiology and suggesting the importance of considering the cardio-psychological health of patients in both preventive and intervention programs.

Background: Systemic arterial hypertension contributes to cardiovascular morbidity and mortality worldwide. Many patients cannot achieve optimal blood pressure (BP) control with traditional therapies, which often results in poor patient adherence and limited long-term efficacy. We investigated the potential of RNA interference (RNAi) therapies targeting hepatic angiotensinogen (AGT) for hypertension management. Methods: This scoping review was conducted by the Joanna Briggs Institute, following a six-stage methodological framework and adhering to PRISMA recommendations. A comprehensive search was conducted across seven databases to identify relevant studies published until May 2024. Data extraction was performed separately, and both quantitative and qualitative analyses were conducted. A population, concept, and context model-based search was performed, selecting controlled MeSH terms and uncontrolled descriptors and cross-referencing them using Booleans. Results: Fifteen articles met our inclusion criteria. Focusing on the efficacy and safety of RNAi-based therapies, this review discusses several key approaches, including antisense oligonucleotides (IONIS-AGT-LRx), small interfering RNA (siRNAs; zilebesiran), and adeno-associated viruses carrying short hairpin RNAs. Notably, zilebesiran conjugated with N-acetylgalactosamine significantly reduced systolic BP by 20 mmHg, sustained for up to six months post-administration, with minimal adverse effects. Conclusions: RNAi-based therapies, particularly those using siRNAs, such as zilebesiran, are promising for the treatment of hypertension. They offer long-term BP control with fewer doses, potentially improving patient adherence and outcome. Although these therapies address several limitations of current antihypertensive treatments, further studies are required to confirm their long-term safety and efficacy.

Background/Objectives: Health and social care systems around the globe are currently undergoing a transformation towards personalized, preventive, predictive, participative precision medicine (5PM), considering the individual health status, conditions, genetic and genomic dispositions, etc., in personal, social, occupational, environmental, and behavioral contexts. This transformation is strongly supported by technologies such as micro- and nanotechnologies, advanced computing, artificial intelligence, edge computing, etc. Methods: To enable communication and cooperation between actors from different domains using different methodologies, languages, and ontologies based on different education, experiences, etc., we have to understand the transformed health ecosystem and all its components in terms of structure, function and relationships in the necessary detail, ranging from elementary particles up to the universe. In this way, we advance design and management of the complex and highly dynamic ecosystem from data to knowledge level. The challenge is the consistent, correct, and formalized representation of the transformed health ecosystem from the perspectives of all domains involved, representing and managing them based on related ontologies. The resulting business viewpoint of the real-world ecosystem must be interrelated using the ISO/IEC 21838 Top Level Ontologies standard. Thereafter, the outcome can be transformed into implementable solutions using the ISO/IEC 10746 Open Distributed Processing Reference Model. Results: The model and framework for this system-oriented, architecture-centric, ontology-based, policy-driven approach have been developed by the first author and meanwhile standardized as ISO 23903 Interoperability and Integration Reference Architecture. The formal representation of any ecosystem and its development process including examples of practical deployment of the approach, are presented in detail. This includes correct systems and standards integration and interoperability solutions. A special issue newly addressed in the paper is the correct and consistent formal representation Conclusions: of all components in the development process, enabling interoperability between and integration of any existing representational artifacts such as models, work products, as well as used terminologies and ontologies. The provided solution is meanwhile mandatory at ISOTC215, CEN/TC251 and many other standards developing organization in health informatics for all projects covering more than just one domain.

Background/Objectives: Taxanes, including paclitaxel and docetaxel, are widely used in cancer treatment but frequently cause hypersensitivity reactions (HSRs), disrupting treatment continuity. This meta-analysis aimed to identify consistent risk factors for taxane-induced HSRs to support personalized risk assessments and optimize therapeutic outcomes. Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was registered with PROSPERO (CRD42023476738). Comprehensive literature searches were conducted up to 30 June 2024. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data were synthesized to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs), using fixed or random effects models. Results: A total of 18 studies of moderate or higher quality were included, involving 8333 patients. The incidence of HSRs ranged from 3.0% to 33.1%. Risk factors assessed included history of allergy, obesity, postmenopausal state, ovarian cancer, and H2 receptor antagonist (H2RA) premedication. A history of allergy was identified as a potential risk factor with marginal significance (OR 1.85, 95% CI 0.97-3.54, p = 0.06), while H2RA premedication, ovarian cancer, and female sex were not significantly associated with HSR risk. Substantial heterogeneity was observed for obesity (I² = 57.71%, p = 0.069) and postmenopausal status (I² = 78.98%). Conclusions: This study highlights the complex nature of taxane-induced HSRs and emphasizes the need for personalized risk assessments. While a history of allergy is a potential risk factor, heterogeneity across other factors underscores the importance of individualized approaches. Clinicians should tailor strategies to balance the benefits of taxane therapy with patient-specific risks to improve clinical outcomes.

Introduction: The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has revolutionized outpatient hand surgery, enabling procedures such as carpal tunnel release and trigger finger release without a tourniquet. Its benefits include patient cooperation during surgery, especially for tendon repairs. However, WALANT has limitations, including a steep learning curve, longer operative preparation time, and risks such as digital ischemia and adrenaline-induced cardiac ischemia. This study evaluates the safety and effectiveness of local anesthesia with a tourniquet for short-duration outpatient hand surgeries. Materials and Methods: This case series included 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024. Local anesthesia with lidocaine was administered, and a tourniquet was applied to the proximal arm. Demographic data, operative time, and pain levels during tourniquet use (measured by VAS) were recorded. Results: The average surgical time was 12 min. Most procedures involved carpal tunnel release. The average VAS pain score was 3.73, with older patients and longer surgeries reporting higher discomfort. Tourniquet release was required in only 1% of cases due to discomfort. Conclusions: For short outpatient hand surgeries, local anesthesia with a tourniquet is a safe, effective alternative to WALANT, challenging its routine use and highlighting the need for tailored anesthetic approaches.

Introduction: While the phenotypic diversity of childhood wheezing is well described, the subsequent life course of such phenotypes and their adult outcomes remain poorly understood. We hypothesized that different childhood wheezing phenotypes have varying longitudinal outcomes at age 26. We sought to identify factors associated with wheezing persistence, clinical remission, and new onset in adulthood. Methods: Participants were seen at birth and at 1, 2, 4, 10, 18, and 26 years in the Isle of Wight Birth Cohort (n = 1456). Information was collected prospectively on wheeze prevalence and phenotypic characteristics at each assessment. Wheeze phenotypes at 10 years were defined as participants wheezing (CW10) or not wheezing at 10 (CNW10). Multivariable regression analyses were undertaken to identify factors associated with wheezing persistence/remission in CW10 and wheeze development in CNW10 at age 26 years. Results: Childhood wheezing phenotypes showed different subsequent outcomes and associated risk factors. Adult wheeze developed in 17.8% of CNW10. Factors independently associated with adult wheeze development in CNW10 included eczema at age 4 years, family history of rhinitis, and parental smoking at birth. Conversely, 56.1% of CW10 had remission of wheeze by 26 years. Factors predicting adult wheezing remission in CW10 included absence of both atopy at age 4 years and family history of rhinitis. Conclusion: Early-life factors influence adult outcomes for childhood wheezing phenotypes, both with respect to later development of adult wheezing in asymptomatic participants and of wheeze remission in childhood wheezers. This suggests potential areas that could be targeted by early-life interventions to alleviate adult disease burden.