Journal of Personalized Medicine最新文献

{"title":"The Three-Dimensional Investigation of the Radiographic Boundary of Mandibular Full-Arch Distalization in Different Facial Patterns.","authors":"Yin-Yu Chou, Chia-Hsuan Chan, Yu-Jen Chang, Shiu-Shiung Lin, Chen-Feng Cheng, Te-Ju Wu","doi":"10.3390/jpm14111071","DOIUrl":"10.3390/jpm14111071","url":null,"abstract":"<p><strong>Objective: </strong>Mandibular full-arch distalization (MFD) is a popular approach, particularly in non-extraction cases. However, we still cannot confirm whether facial patterns affect the amount of limits. This study aimed to determine the anatomical MFD limits in patients with different facial patterns.</p><p><strong>Study design: </strong>Using computed tomography (CT), the shortest distances from the mandibular second molar to the inner cortex of the mandibular lingual surface and from the lower central incisor to the inner cortex of the lingual mandibular symphysis were measured in 60 samples (30 patients). The available distalization space in both regions was compared between groups with different facial patterns.</p><p><strong>Results: </strong>The available space in symphysis was more critical than that in retromolar area: the shortest distances to the inner cortex of the lingual mandibular symphysis at root levels 8 mm apical to the cementoenamel junction of the incisor were 1.28, 1.60, and 3.48 mm in the high-, normal-, and low-angle groups, respectively.</p><p><strong>Conclusions: </strong>Facial patterns affected the MFD capacity, and the thickness of the lingual mandibular symphysis was the most critical anatomic limit encountered. Practitioners should always pay attention to the possible impacts from facial patterns, especially in the treatment of high-angle cases.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Synergistic Effects of Incobotulinum Toxin and Physiotherapy in a Rare Case of Paraparesis in a 7-Year-Old Affected by Klippel-Feil Syndrome Related to an <i>MYH3</i> Gene Mutation: A Case Report.","authors":"Maurizio Ranieri, Mariagrazia Riccardi, Maria Vittoria Raele, Giacomo Farì, Marisa Megna, Riccardo Marvulli","doi":"10.3390/jpm14111073","DOIUrl":"10.3390/jpm14111073","url":null,"abstract":"<p><strong>Background: </strong>Klippel-Feil disease is a condition characterized by a defect in the spine, consisting of the fusion or non-separation of two or more vertebrae of the cervical tract. It affects 1 in every 50,000 newborns, and the pathogenesis remains unknown to date, although the role of certain genes that are involved in segmentation processes is being studied. A single case of a genetic Myosin Heavy Chain 3 (<i>MYH3</i>) mutation is described here. Affected patients are typically distinguished by a relatively short neck, which leads to limited mobility, a low hairline, and obesity; they may also experience various other health issues. The common occurrence of comorbidities further diminishes the quality of life of these young individuals.</p><p><strong>Methods: </strong>The following case report describes the synergistic effect of Incobotulinum toxin type A and physiotherapy in a 7-year-old patient with MYH3 mutation-related Klippel-Feil syndrome (KFS) complicated by bilateral paraplegia to improve the spasticity condition of the lower limbs. To assess improvements over time, the patient underwent rating scales to determine spasticity (Modified Ashworth Scale: MAS), the neck's range of motion (ROM), and muscle tone by using MyotonPro^®. Specifically, measurements were taken on the day of the first medical examination (T0), the month after the injection and the startup of therapeutic exercise (T1), at three months (T2), and then once a month for a total of 6 months (T3, T4, and T5).</p><p><strong>Results: </strong>This therapeutic approach resulted in highly satisfactory outcomes for the child's well-being, which was maintained until the sixth month and was accompanied by a complete absence of any side effects.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of the Use of Artificial Intelligence in the Identification and Diagnosis of Atrial Fibrillation.","authors":"Antônio da Silva Menezes Junior, Ana Lívia Félix E Silva, Louisiany Raíssa Félix E Silva, Khissya Beatryz Alves de Lima, Henrique Lima de Oliveira","doi":"10.3390/jpm14111069","DOIUrl":"10.3390/jpm14111069","url":null,"abstract":"<p><strong>Background/objective: </strong>Atrial fibrillation [AF] is the most common arrhythmia encountered in clinical practice and significantly increases the risk of stroke, peripheral embolism, and mortality. With the rapid advancement in artificial intelligence [AI] technologies, there is growing potential to enhance the tools used in AF detection and diagnosis. This scoping review aimed to synthesize the current knowledge on the application of AI, particularly machine learning [ML], in identifying and diagnosing AF in clinical settings.</p><p><strong>Methods: </strong>Following the PRISMA ScR guidelines, a comprehensive search was conducted using the MEDLINE, PubMed, SCOPUS, and EMBASE databases, targeting studies involving AI, cardiology, and diagnostic tools. Precisely 2635 articles were initially identified. After duplicate removal and detailed evaluation of titles, abstracts, and full texts, 30 studies were selected for review. Additional relevant studies were included to enrich the analysis.</p><p><strong>Results: </strong>AI models, especially ML-based models, are increasingly used to optimize AF diagnosis. Deep learning, a subset of ML, has demonstrated superior performance by automatically extracting features from large datasets without manual intervention. Self-learning algorithms have been trained using diverse data, such as signals from 12-lead and single-lead electrocardiograms, and photoplethysmography, providing accurate AF detection across various modalities.</p><p><strong>Conclusions: </strong>AI-based models, particularly those utilizing deep learning, offer faster and more accurate diagnostic capabilities than traditional methods with equal or superior reliability. Ongoing research is further enhancing these algorithms using larger datasets to improve AF detection and management in clinical practice. These advancements hold promise for significantly improving the early diagnosis and treatment of AF.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Patients at Increased Risk for Poor Outcomes Among Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients: The IPOGRO Risk Model.","authors":"Rustici Arianna, Scibilia Antonino, Linari Marta, Zoli Matteo, Zenesini Corrado, Belotti Laura Maria Beatrice, Sturiale Carmelo, Conti Alfredo, Aspide Raffaele, Castioni Carlo Alberto, Mazzatenta Diego, Princiotta Ciro, Dall'Olio Massimo, Bortolotti Carlo, Cirillo Luigi","doi":"10.3390/jpm14111070","DOIUrl":"10.3390/jpm14111070","url":null,"abstract":"<p><strong>Background: </strong>A subarachnoid hemorrhage due to an aneurysmal rupture (aSAH) is a serious condition with severe neurological consequences. The World Federation of Neurosurgical Societies (WFNS) classification is a reliable predictor of death and long-term disability in patients with aSAH. Poor-grade neurological conditions on admission in aSAH (PG-aSAH) are often linked to high mortality rates and unfavorable outcomes. However, more than one-third of patients with PG-aSAH may recover and have good functional outcomes if aggressive treatment is provided. We developed a risk model called Identifying POor GRade Outcomes (IPOGRO) to predict 6-month mRS outcomes in PG-aSAH patients as a secondary analysis of a previously published study.</p><p><strong>Methods: </strong>All consecutive patients in poor-grade neurological conditions (WFNS IV-V) admitted to our institute from 2010 to 2020 due to aSAH were considered. Clinical and neuroradiological parameters were employed in the univariable analysis to evaluate the relationship with a 6-month modified Rankin Scale (mRS). Then, a multivariable multinomial regression model was performed to predict 6-month outcomes.</p><p><strong>Results: </strong>149 patients with PG-aSAH were included. Most patients were surgically treated, with only 33.6% being endovascularly treated. The 6-month mRS score was significantly associated with clinical parameters on admission, such as lowered Glasgow Coma Scale (GCS), leukocytosis, hyperglycemia, raised Systolic Blood Pressure (SBP), greater Simplified Acute Physiology Score (SAPS II score), increased initial serum Lactic Acid (LA) levels, and the need for Norepinephrine (NE) administration. Neuroradiological parameters on the initial CT scan showed a significant association with a worsening 6-month mRS. The IPOGRO risk model analysis showed an association between a WFNS V on admission and a poor outcome (mRS 4-5), while raised SBP was associated with mortality.</p><p><strong>Conclusions: </strong>Our IPOGRO risk model indicates that PG-aSAH patients with higher SBP at admission had an increased risk of death at 6-month follow-up, whereas patients with WFNS grade V at admission had an increased risk of poor outcome but not mortality.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of the Pandemic on Treatment Outcomes for Cardiac Arrest Patients Utilizing Mechanical CPR: A Nationwide Population-Based Observational Study in South Korea.","authors":"Jae Hwan Kim, Young Taeck Oh, Chiwon Ahn","doi":"10.3390/jpm14111072","DOIUrl":"10.3390/jpm14111072","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiopulmonary resuscitation with mechanical devices (MCPR) was developed to provide high-quality cardiopulmonary resuscitation (CPR) for patients with cardiac arrest. However, the effect of this procedure on treatment outcomes remains controversial. Nevertheless, during the coronavirus disease-19 (COVID-19) pandemic, in-hospital MCPR gained attention, owing to its advantages such as saving medical staff and preventing infection. This study compared the treatment outcomes of in-hospital MCPR and manual CPR for out-of-hospital cardiac arrest (OHCA) patients during the COVID-19 pandemic.</p><p><strong>Materials and methods: </strong>This retrospective nationwide population-based study was conducted in South Korea. Data were collected from the Out-of-Hospital Cardiac Arrest surveillance database managed by the Korea Disease Control and Prevention Agency. We included adult OHCA patients transported by emergency medical services from 2016 to 2021. The study compared outcomes during the COVID-19 pandemic years (2020-2021) with the preceding non-pandemic years (2018-2019). The primary outcome was survival to hospital discharge, and the secondary outcomes were good neurological outcome and sustained return of spontaneous circulation (ROSC).</p><p><strong>Results: </strong>The entire study included 72,050 patients with OHCA and, in the multivariable analyses, MCPR was associated with lower survival rates compared to manual CPR (AOR 0.63; 95% CI 0.51-0.77; <i>p</i> < 0.001). Interestingly, during the COVID-19 pandemic, while MCPR use increased, the survival rate did not differ significantly between the MCPR and manual-CPR groups.</p><p><strong>Conclusion: </strong>Our study findings suggest that while MCPR may offer potential benefits, such as decreased infection risk for healthcare workers, it did not demonstrate superior outcomes compared to manual CPR in our study population.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Response to [177Lu]Lu-PSMA Therapy in mCRPC Using Machine Learning.","authors":"Kaiyuan Gong, Baptiste Magnier, Salomé L'hostis, Fanny Borrely, Sébastien Le Bon, Nadine Houede, Adel Mamou, Laurent Maimoun, Pierre Olivier Kotzki, Vincent Boudousq","doi":"10.3390/jpm14111068","DOIUrl":"10.3390/jpm14111068","url":null,"abstract":"<p><strong>Background/objectives: </strong>Radioligandtherapy (RLT) with [177Lu]Lu-PSMA has been newly introduced as a routine treatment for metastatic castration-resistant prostate cancer (mCRPC). However, not all patients can tolerate the entire therapeutic sequence, and in some cases, the treatment may prove ineffective. In real-world conditions, the aim is to distinguish between patients who fully benefit from treatment (those who respond effectively and tolerate the entire therapeutic sequence) and those who do not respond or cannot tolerate the entire sequence. This study explores predictive factors to distinguish between fully beneficial RLT treatment patients (FBTP) and not fully beneficial RLT treatment patients (NFBTP). The objective was to enhance the understanding of predictive factors influencing RLT effectiveness and to highlight the significance of machine learning in optimizing patient selection for treatment planning.</p><p><strong>Methods: </strong>Data from 25 mCRPC patients, categorized as FBTP (11) or NFBTP (14) to RLT, were analyzed. The dataset included clinical, imaging, and biological parameters. Data analysis techniques, including exploratory data analysis and feature engineering, were used to develop machine learning models for predicting patient outcomes.</p><p><strong>Results: </strong>Imaging data analysis revealed statistically significant differences in the renal uptake intensity of Choline between the two groups. A discordance of FDG+ and PSMA- was identified as a potential indicator of NFBTP. The integration of biological data enhanced the model's predictive capability, achieving an accuracy of 0.92, a sensitivity of 0.96, and a precision of 0.96. Adding blood parameters like neutrophils, leukocytes, and alkaline phosphatase greatly increased prediction accuracy.</p><p><strong>Conclusions: </strong>This study emphasizes the significance of an integrated approach that merges imaging and biological data, thereby augmenting the predictive accuracy of patient outcomes in RLT with [177Lu]Lu-PSMA. In particular, including Choline PET among the imaging parameters provides unique insights into the predictive factors affecting RLT efficacy. This approach not only deepens the understanding of predictive factors but also underscores the utility of machine learning in refining the patient selection process for optimized treatment planning.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 11","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Amino Acids with the Risk of Prediabetes: A Case-Control Study from Kazakhstan.","authors":"Alma Nurtazina, Ivan Voitsekhovskiy, Bakyt Kanapiyanov, Maxat Toishimanov, Daulet Dautov, Kairat Karibayev, Yerbol Smail, Dana Kozhakhmetova, Altay Dyussupov","doi":"10.3390/jpm14101067","DOIUrl":"https://doi.org/10.3390/jpm14101067","url":null,"abstract":"<p><strong>Background: </strong>The high global prevalence of prediabetes requires its early identification. Amino acids (AAs) have emerged as potential predictors of prediabetes. This study investigates the association between amino acids and prediabetes in the Kazakh population.</p><p><strong>Materials and methods: </strong>In this case-control study, serum AAs levels were measured using the Trace GC 1310 gas chromatography system coupled with the TSQ 8000 triple quadrupole mass spectrometer (Thermo Scientific, Austin, TX, USA) followed by silylation with the BSTFA + 1% TMCS derivatization method. Biochemical parameters, including total cholesterol, HDL-C, LDL-C, triglycerides, fasting glucose, HbA1c, and Creatinine, were assessed for each participant. Trained professionals conducted anthropometric and physical examinations (which included taking blood pressure and heart rate measurements) and family history collection.</p><p><strong>Results: </strong>A total of 112 Kazakh individuals with prediabetes and 55 without prediabetes, aged 36-65 years, were included in the study. Only Alanine and valine showed a significant association with prediabetes risk among the 13 AAs analyzed. Our findings revealed an inverse relationship between Alanine and Valine and prediabetes in individuals of Kazakh ethnicity.</p><p><strong>Conclusion: </strong>A lower serum level of Alanine and Valine may serve as a predictive biomarker for prediabetes in the Kazakh population.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11509736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Second-Line Biological Therapies in Moderate to Severe Ulcerative Colitis Patients with Prior Failure of Anti-Tumor Necrosis Factor Therapy: A Multi-Center Study.","authors":"Ji-Eun Na, Yong-Eun Park, Jong-Ha Park, Tae-Oh Kim, Jong-Yoon Lee, Jong-Hoon Lee, Su-Bum Park, Seung-Bum Lee, Seung-Min Hong","doi":"10.3390/jpm14101066","DOIUrl":"https://doi.org/10.3390/jpm14101066","url":null,"abstract":"<p><strong>Background: </strong>Few studies have compared the efficacy and safety of second-line biological therapies in ulcerative colitis (UC) patients with prior exposure to anti-tumor necrosis factor (TNF) therapy. We aim to compare the efficacy and safety between ustekinumab, vedolizumab, and tofacitinib, a current option as second-line biological therapy with different mechanisms in those patients.</p><p><strong>Methods: </strong>This retrospective multi-center study was conducted across five institutions from 2011 to 2022. We enrolled patients with moderate to severe UC who failed anti-TNF therapy and subsequently received ustekinumab, vedolizumab, or tofacitinib as second-line biological therapy. The outcomes were analyzed for clinical response/remission and endoscopic improvement/remission rates after induction therapy, drug persistency, and adverse events.</p><p><strong>Results: </strong>A total of 70 UC patients were included and grouped into ustekinumab (11 patients), vedolizumab (40 patients), and tofacitinib (19 patients) treatments. The clinical response/remission rates after induction therapy were similar between ustekinumab (90.9/81.8%), vedolizumab (92.5/65.0%), and tofacitinib (94.7/73.7%). There were no significant differences in the endoscopic improvement/remission rates between the three groups: 90.9/18.2% for ustekinumab, 72.5/12.5% for vedolizumab, and 84.2/26.3% for tofacitinib. Drug persistence was similar across the three agents (<i>p</i> = 0.130). Three patients of the tofacitinib group experienced adverse events (herpes zoster and hypertriglyceridemia).</p><p><strong>Conclusions: </strong>Based on real-world data, second-line biological therapy with ustekinumab, vedolizumab, and tofacitinib showed comparable efficacy in patients with moderate to severe UC with prior exposure to anti-TNF therapy.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11508867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Drug Monitoring of Elexacaftor, Tezacaftor, and Ivacaftor in Adult People with Cystic Fibrosis.","authors":"Susanne Naehrig, Christina Shad, Magdalena Breuling, Melanie Goetschke, Katharina Habler, Sarah Sieber, Johanna Kastenberger, Alexandra Katharina Kunzelmann, Olaf Sommerburg, Uwe Liebchen, Juergen Behr, Michael Vogeser, Michael Paal","doi":"10.3390/jpm14101065","DOIUrl":"https://doi.org/10.3390/jpm14101065","url":null,"abstract":"<p><strong>Background/objectives: </strong>Elexacaftor, tezacaftor, and ivacaftor (ETI) have significantly improved lung function in people with cystic fibrosis (pwCF). Despite exceptional improvements in most cases, treatment-related inter-subject variability and drug-drug interactions that complicate modulator therapy have been reported.</p><p><strong>Methods: </strong>This retrospective analysis presents data on the serum concentration of ETI in our pwCF with full or reduced dosage from August 2021 to December 2023 via routine therapeutic drug monitoring (TDM). The data were compared with the maximum drug concentrations (Cmax) from the pharmaceutical company's summary of product characteristics.</p><p><strong>Results: </strong>A total of 786 blood samples from 155 pwCF (41% female, 59% male) were analyzed. The examinations were divided into four groups: full dose within the given tmax (38.5% of all measurements), full dose outside the tmax (29%), reduced dose within the tmax (19.2%), and reduced dose outside the tmax (13.2%). In pwCF receiving the full dose and blood taken within the tmax, 45.3% of serum concentrations of elexacaftor, 51.1% of serum concentrations of ivacaftor, and 8.9% of serum concentrations of tezacaftor were found to be above the Cmax, respectively. For those on reduced doses within the tmax, 24.5% had a serum concentration of elexacaftor, 23.2% had a serum concentration of ivacaftor, and 2.5% had a serum concentration of tezacaftor above the Cmax, respectively.</p><p><strong>Conclusions: </strong>Many pwCF under ETI therapy have Cmax values for elexacaftor and ivacaftor above the recommended range, even on reduced doses or before the tmax was reached. This highlights the value of a TDM program. Further pharmacokinetic studies are necessary.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11508966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Sodium in Heart Failure.","authors":"Filippos Triposkiadis, Andrew Xanthopoulos, John Skoularigis","doi":"10.3390/jpm14101064","DOIUrl":"https://doi.org/10.3390/jpm14101064","url":null,"abstract":"<p><p>A dominant event determining the course of heart failure (HF) includes the disruption of the delicate sodium (Na⁺) and water balance leading to (Na⁺) and water retention and edema formation. Although incomplete decongestion adversely affects outcomes, it is unknown whether interventions directly targeting (Na⁺), such as strict dietary (Na⁺) restriction, intravenous hypertonic saline, and diuretics, reverse this effect. As a result, it is imperative to implement (Na⁺)-targeting interventions in selected HF patients with established congestion on top of quadruple therapy with angiotensin receptor neprilysin inhibitor, β-adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor, which dramatically improves outcomes. The limited effectiveness of (Na⁺)-targeting treatments may be partly due to the fact that the current metrics of HF severity have a limited capacity of foreseeing and averting episodes of congestion and guiding (Na⁺)-targeting treatments, which often leads to dysnatremias, adversely affecting outcomes. Recent evidence suggests that spot urinary sodium measurements may be used as a guide to monitor (Na⁺)-targeting interventions both in chronic and acute HF. Further, the classical (2)-compartment model of (Na⁺) storage has been displaced by the (3)-compartment model emphasizing the non-osmotic accumulation of (Na⁺), chiefly in the skin. 23(Na⁺) magnetic resonance imaging (MRI) enables the accurate and reliable quantification of tissue (Na⁺). Another promising approach enabling tissue (Na⁺) monitoring is based on wearable devices employing ion-selective electrodes for electrolyte detection, including (Na⁺) and (Cl^-). Undoubtably, further studies using 23(Na⁺)-MRI technology and wearable sensors are required to learn more about the clinical significance of tissue (Na⁺) storage and (Na⁺)-related mechanisms of morbidity and mortality in HF.</p>","PeriodicalId":16722,"journal":{"name":"Journal of Personalized Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11508519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}