Journal of Personalized Medicine最新文献

Background/Objectives: Cuminum cyminum L. has been utilized as a medicinal plant for centuries. This research sought to examine the effects of cumin methanolic extract (CMT) on the chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells. Methods: Spheroids were generated using human stem cells and cultured with CMT at concentrations between 0 and 1 µg/mL. Morphological assessments and cell viability tests were conducted on days 1 and 3. Chondrogenic differentiation expression was evaluated through quantitative polymerase chain reaction, Western blot, and RNA sequencing. SOX9, FAM20B, COL2A1, and COL1A1 mRNA expression levels were determined using real-time polymerase chain reaction. Protein expression was analyzed via Western blot. Results: Throughout this study, the spheroids maintained their integrity and shape. No significant variations in spheroid diameter were observed among the groups. CMT treatment enhanced the expression of SOX9 and FAM20B. Conclusions: The methanolic extract of Cuminum cyminum facilitated chondrogenic differentiation in human bone marrow-derived mesenchymal stem cells by modulating SOX9 and FAM20B expression. This indicates its potential application in cartilage tissue engineering.

Introduction: Cervical cancer is the fourth most commonly diagnosed malignant tumor in women and the fourth leading cause of cancer-related deaths among this population. Since it is asymptomatic in its early stages, preventive screening plays a crucial role in rapid diagnosis. Such screenings are conducted in many countries worldwide, although their popularity varies. Given that nearly all cases of cervical cancer are linked to high-risk human papillomavirus (hrHPV) infection, vaccination against this virus could lead to a significant reduction in cancer incidence. It should be noted that the level of vaccination coverage against hrHPV varies significantly between countries, ranging from a few percent to over 90%. Globally, the vaccination coverage of the target population is estimated at only a few percent. Methods: This study was conducted using a proprietary, anonymous online questionnaire comprising 24 questions addressing various aspects of cervical cancer prevention. The newly designed questionnaire comprised 19 primary questions and 5 metric questions. The collected data were subjected to descriptive and statistical analysis. Results: The majority of respondents reported regularly participating in cervical cytology screening and gynecological visits. Non-participation in these screenings was primarily reported by younger respondents, not all of whom had indications for undergoing such examinations. Only 14% of the women surveyed had been vaccinated against hrHPV. However, it should be noted that, as the surveyed women were not covered by the relatively recently introduced vaccination program, they received their vaccinations through local programs conducted by certain cities or through private healthcare services. The respondents' primary sources of information on cervical cancer are the internet and medical personnel. Conclusions: The level of knowledge among the women surveyed regarding cervical cancer prevention was satisfactory, though improvement is needed in some areas. Despite relatively good awareness of HPV's role in cervical cancer development, the popularity of HPV vaccination remains unsatisfactory. The results should be interpreted with caution due to the small study group.

Background/Objectives: Controlling hypertension may reduce the risk of cognitive impairment. A marker for the identification of hypertensive patients who are more likely to suffer cognitive impairment would be of clinical benefit. In our research, 105 patients with newly diagnosed primary hypertension were assessed at the Department of Neurology, the University of Debrecen. Methods: The available data covered detailed medical history and data, the results of different tests, ambulatory blood pressure monitoring, the intima-media thickness, the flow-mediated dilatation, the augmentation index, the pulse wave velocity, and neuropsychological evaluation. Multiple linear regression models were created to evaluate the associations found in simple analyses (Spearman's rank correlation and Pearson's chi-squared test). Results: The flow-mediated dilatation showed significant correlations with working memory, attention, learning, and executive functions. The intima-media thickness showed significant correlations with attention and reaction time. The composite flow-mediated dilatation/IMT ratio showed a significant relationship with the overall index of cognitive functions. Based on our results, a flow-mediated dilatation/IMT ratio of 15 represents a cut-off value. The pulse wave velocity showed a significant correlation with working memory and attention. The augmentation index showed significant relationships with reaction time and executive functions. Conclusions: Based on our results, the intima-media thickness, flow-mediated dilatation, and their ratio are suitable for the identification of a particularly vulnerable subgroup of patients for whom a detailed cognitive examination is required for the early detection and treatment of functional disorders. The assessment of attention, executive functions, working memory, and reaction time is required in early hypertension.

Background/Objectives: Radiotherapy represents the only treatment option for patients with inoperable endometrial cancer (EC). The aim of our study was to evaluate the efficacy and safety of brachytherapy (BT) in this selected patient population. Methods: Between 1990 and 2019, 18 patients with inoperable EC in stage FIGO I-IV were treated with intracavitary brachytherapy using the "Heyman Packing technique". BT was performed either as sole PDR- or HDR-brachytherapy with a median cumulative dose up to 60.0 Gy (67.9 Gy _{EQD2 α/β = 3Gy}) and 34.0 Gy (75.6 Gy _{EQD2 α/β = 3Gy}), respectively. Results: The median follow-up was 46 months (6-219). The mean age was 71 years. The 5-year cumulative local recurrence rate (CLRR) for the whole cohort was 27.3%. The 5-year overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 51%, 79%, and 69%. The 5-year DFS for low-, intermediate-, and high-risk EC was 89%, 50%, and 44% (p = 0.51). No significant difference in DFS was observed in patients over 70 (p = 0.526). No late side effects of grade > 1 were documented. Conclusions: Brachytherapy for inoperable EC is a safe and effective treatment option, offering good local control and OS with minimal toxicity. Moreover, brachytherapy effectively controls hemoglobin-relevant bleeding. Therefore, BT should be considered a viable alternative to non-curative treatment strategies in gynecological multidisciplinary conferences.

Background: Robotic-assisted unicompartmental arthroplasty (rUKA) is gradually gaining more popularity than its conventional counterpart (cUKA). Current studies are highly heterogenic in terms of methodology and the reported results; therefore, establishing the optimal recommendation for patients becomes less straightforward. For this reason, this meta-analysis aims to provide an up-to-date evidence-based analysis on current evidence regarding clinical outcomes and complication rates following rUKA and cUKA. Methods: A meta-analysis was conducted following PRISMA guidelines. Five databases were searched, PubMed via MEDLINE, Epistemonikos, Cochrane Library, Web of Science, and Scopus. The relevant inclusion criteria were as follows: comparative clinical studies in which medial rUKA was compared to medial cUKA (prospective or retrospective designs), (2) human studies, (3) meta-analyses for cross-referencing, and (4) English language. The relevant extracted data were patient demographics, patient-reported outcome measures (PROMs), range of motion, and complications. A random-effects meta-analysis and subgroup analysis were conducted. The results include mean differences (MDs) and odds ratios (ORs), along with 95% confidence intervals (CIs) for continuous and binary variables, respectively. Results: rUKA showed a higher overall FJS-12 score compared to cUKA, with MD = 6.02 (95%CI: -0.07 to 12.1), p = 0.05. At 6 months postoperatively, the MD increased to 10.31 (95%CI: 5.14 to 15.49), p < 0.01. At a minimum 36-month follow-up, cUKA had a higher all-cause revision rate, with OR = 3.31 (95%CI: 1.25 to 8.8), p = 0.02, and at a minimum 60-month follow-up, a higher aseptic loosening rate, with OR = 3.86 (95%CI: 1.51 to 9.91), p < 0.01, compared to rUKA. Conclusions: rUKA provides better FJS-12 results compared to cUKA, as well as lower all-cause revision and aseptic loosening rates at 36- and 60-month follow-up, respectively. However, long-term follow-up is still pending.

Background/Objectives: Pain is the most common symptom of osteoarthritis (OA), and it leads to functional decline, such as decreased mobility and limitations in activities of daily living, which leads to difficulties in social participation, increased social isolation, and economic burden. Muscle weakness can be a cause of OA symptoms. The purpose was to analyze the effects of resistance training on improving pain, strength, and function in OA and to analyze the effects by intervention duration and joint. Methods: The study search was conducted on 14 September 2024, and the period of study inclusion covered studies available in the databases from their inception to the search date. The databases used were PubMed, CHINAL, Cochrane Library, and Embase. Inclusion criteria were studies that targeted OA and compared a resistance training intervention with a no resistance training intervention group and measured pain, strength, and function. Subgroup analysis was used to analyze the effects by intervention duration (4 weeks or less, 5 to 8 weeks, 9 weeks or more) and joint (knee, hip). Results: A total of 27 studies included 1712 subjects, and significant improvements were observed in pain (SMD: -0.48, CI: -0.58~-0.37, I²: 45%), strength (SMD: 0.4, CI: 0.32~0.47, I²: 0%), and function (SMD: -0.56, CI: -0.65~-0.47, I²: 30%). In the effects by intervention duration, both pain and strength showed significant improvements, but no effect on function was observed for less than 4 weeks. For effects by joint, both the knee and hip showed significant improvements. Conclusions: Resistance training was effective in improving pain, strength, and function in patients with knee and hip OA.

Background/Objectives: Large language models (LLMs) show promise in healthcare but face challenges with hallucinations, particularly in rapidly evolving fields like diabetes management. Traditional LLM updating methods are resource-intensive, necessitating new approaches for delivering reliable, current medical information. This study aimed to develop and evaluate a novel retrieval system to enhance LLM reliability in diabetes management across different languages and guidelines. Methods: We developed a dual retrieval-augmented generation (RAG) system integrating both Korean Diabetes Association and American Diabetes Association 2023 guidelines. The system employed dense retrieval with 11 embedding models (including OpenAI, Upstage, and multilingual models) and sparse retrieval using BM25 algorithm with language-specific tokenizers. Performance was evaluated across different top-k values, leading to optimized ensemble retrievers for each guideline. Results: For dense retrievers, Upstage's Solar Embedding-1-large and OpenAI's text-embedding-3-large showed superior performance for Korean and English guidelines, respectively. Multilingual models outperformed language-specific models in both cases. For sparse retrievers, the ko_kiwi tokenizer demonstrated superior performance for Korean text, while both ko_kiwi and porter_stemmer showed comparable effectiveness for English text. The ensemble retrievers, combining optimal dense and sparse configurations, demonstrated enhanced coverage while maintaining precision. Conclusions: This study presents an effective dual RAG system that enhances LLM reliability in diabetes management across different languages. The successful implementation with both Korean and American guidelines demonstrates the system's cross-regional capability, laying a foundation for more trustworthy AI-assisted healthcare applications.

Background: A novel fixed combination of aztreonam (ATM) and avibactam (AVI) offers promising potential to treat infections with carbapenem-resistant Enterobacterales (CRE) producing metallo-β-lactamases (MBL). This study aimed to assess the accuracy of population pharmacokinetic (PK) models for ATM-AVI in predicting in vivo concentrations in a critically ill patient with CRE infection during its first clinical use. Methods: A 70-year-old male with septic shock due to hospital-acquired pneumonia (HAP) caused by MBL-producing Klebsiella pneumoniae was treated with ATM-AVI. Trough and peak serum concentrations (32 samples over 7 days) were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Population PK models were used to simulate complete concentration-time profiles. Bland-Altman analysis assessed model performance by comparing predicted and measured concentrations. Results: Median ATM trough concentrations (18.4 mg/L) remained above the minimum inhibitory concentration (MIC) of 1 mg/L for the pathogen. The Bland-Altman analysis demonstrated reasonable agreement between predicted and observed concentrations, with a relative bias (rBias) of -50.5% for ATM and -14.4% for AVI. ATM-AVI ratios remained stable. Clinical improvement and sterile blood cultures within 12 days led to intensive care unit (ICU) discharge. Conclusions: Population PK models for ATM-AVI accurately predicted in vivo concentrations in a severely ill patient with HAP. Therapeutic drug monitoring (TDM) with PK modeling ensured optimal antimicrobial exposure and contributed to clinical recovery.

Background/Objectives: As musculoskeletal injuries in gastroenterologists related to the performance of endoscopic procedures are on the rise, solutions and new approaches are needed to prevent these undesired outcomes. In our study, we evaluated an approach to ergonomic challenges in the form of a belt-like endoscope holder designed to redistribute the weight of the endoscope across the whole body of the practitioner. The aim of the study was to determine how the use of this holder affected the body posture of practitioners during endoscopy. Methods: We designed a special endoscopic model that emulates basic endoscopic movement and maneuvers. With the use of the MoCap camera system, we recorded experienced endoscopists exercising a standardized set of tasks with and without the holder. Results: Following video and statistical analyses, the most significant differences were observed in the position of the left arm which pointed to a more relaxed arm position. Conclusions: The ergonomic benefits of the belt holder in this model merit testing in the clinical setting to evaluate its effectiveness and prevention of musculoskeletal injuries in GI endoscopy.

Background/Objectives. Adult medulloblastoma (AMB) patients should receive postoperative craniospinal irradiation (CSI) as a standard treatment. Volumetric intensity-modulated arc therapy (VMAT) is a promising method for CSI. This report summarizes the repositioning and dosimetric data outcomes for six AMB patients. Methods. Complete CSI and posterior cranial fossa irradiation, or tumor bed boost irradiation with Linac-based VMAT, was performed and evaluated. Patients were immobilized in the supine position with two thermoplastic masks (head-neck and abdomen). To ensure inter-fraction reproducibility during radiotherapy (RT), a single cone-beam CT (CBCT) scan for each isocenter and real-time surface-guided RT using AlignRT^® were performed daily before and during the RT session. Match values of all three translational axes (x = lateral, y = longitudinal, z = vertical) were recorded. Results. From August 2022 to September 2023, six AMB patients were treated with CSI: three women and three men with a median age of 32 (22-42). All cases were classical MB, four were low risk, and two were defined as high risk due to the metastatic disease. All patients underwent surgery; two received a gross total resection. Low-risk patients received 36 Gy for CSI and a 54 Gy boost, while high-risk patients received 39 Gy for CSI. No significant toxicities greater than G2 were observed during RT, and only two cases reported decreased platelet counts. The dose to the organs at risk was low and acceptable. The mean dose to the heart, lungs, eyes, stomach, and thyroid were 4.4 Gy, 8.5 Gy, 12 Gy, 8.7 Gy, and 11 Gy, respectively. In terms of repositioning data, 124 CBCT scans were analyzed. Inter-fraction CBCT mean values for the study population in all translational directions were inferior to 2 mm in more than 90% of cases. Conclusions. VMAT is a convenient and effective treatment for AMB. Positioning and immobilization with masks (head and neck plus abdomen) reduce inter-fraction motion.