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Ann Fam Med ; 19(1): 75-78, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33431398


As I begin my 4th year of medical school amidst the coronavirus disease 2019 (COVID-19) pandemic, telehealth has allowed me to connect with many patients who previously struggled to access consistent primary care. In this essay, I describe 2 of my most formative experiences with telehealth: participating in my medical school's new "tele-hotspotting" elective, and providing virtual gender-affirming care through our student-run free clinic. These experiences demonstrate not only telehealth's utility during a viral pandemic, but also its potential as a powerful tool for expanding access to care and promoting health equity over the coming years. With this said, telehealth is not without limitations. Patients and clinicians alike have expressed concerns regarding the challenge of performing a physical exam and maintaining emotional connection across physical distance. A sustained expansion of telehealth is further challenged by inconsistent availability of broadband Internet, as well as a lack of standardized reimbursement procedures for telehealth visits. Strategies are available to help meet these challenges while maximizing health equity.

Predicción , Accesibilidad a los Servicios de Salud/tendencias , Atención Primaria de Salud/tendencias , Telemedicina/tendencias , Humanos , Atención Primaria de Salud/métodos
Biomaterials ; 251: 120062, 2020 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-32388032


Biodegradable polyesters have been extensively used for preparation of nerve guidance scaffolds, due to their high biocompatibility and defined degradation periods. However, conventional methods for fabrication of porous polyester scaffolds provide limited control over shape and micro-architecture. Here, a fabrication procedure based on 3D printing was developed to generate highly ordered and anatomically personalized, polyester scaffolds for soft tissue regeneration. Scaffolds composed of Poly-lactic-glycolic acid (PLGA) and poly-L-lactic acid (PLLA) were specifically customized for nerve injuries. This was obtained by using an oriented multi-layer printing pattern which established a linear structure in the fabricated scaffolds to match the aligned topography of nerve tissues. The oriented scaffold was shown to guide regenerating axons to linear conformations and support growth of induced pluripotent stem cell-derived neurons in vitro and in vivo in a model of spinal cord injury. The described scaffolds may advance the field of nerve regeneration. Furthermore, modifications could be integrated to generate soft implants for various types of tissues.

Commun Biol ; 2: 158, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31069267


The key to understanding, harnessing, and manipulating natural biological processes for the benefit of tissue engineering lies in providing a controllable dynamic environment for tissue development in vitro while being able to track cell activity in real time. This work presents a multi-channel bioreactor specifically designed to enable on-line imaging of fluorescently labeled cells embedded in replicated 3D engineered constructs subjected to different flow conditions. The images are acquired in 3D using a standard upright confocal microscope and further analyzed and quantified by computer vision. The platform is used to characterize and quantify the pace and directionality of angiogenic processes induced by flow. The presented apparatus bears considerable potential to advance scientific research, from basic research pursuing the effect of flow versus static conditions on 3D scaffolds and cell types, to clinically oriented modeling in drug screening and cytotoxicity assays.

Reactores Biológicos , Técnicas de Cultivo de Célula/métodos , Células Endoteliales/citología , Ingeniería de Tejidos/métodos , Andamios del Tejido , Técnicas de Cultivo de Célula/instrumentación , Células Endoteliales/efectos de los fármacos , Células Endoteliales/fisiología , Humanos , Imagenología Tridimensional/instrumentación , Imagenología Tridimensional/métodos , Microscopía Confocal , Neovascularización Fisiológica , Perfusión , Reología , Ingeniería de Tejidos/instrumentación , Factor A de Crecimiento Endotelial Vascular/farmacología
Am J Transplant ; 19(1): 37-47, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29856531


Autologous muscle flaps are commonly used to reconstruct defects that involve muscle impairment. To maintain viability and functionality of these flaps, they must be properly vascularized and innervated. Tissue-engineered muscles could potentially replace autologous muscle tissue, but still require establishment of sufficient innervation to ensure functionality. In this study, we explored the possibility of innervating engineered muscle grafts transplanted to an abdominal wall defect in mice, by transferring the native femoral nerve to the graft. Six weeks posttransplantation, nerve conduction studies and electromyography demonstrated increased innervation in engineered grafts neurotized with the femoral nerve, as compared to non-neurotized grafts. Histologic assessments revealed axonal penetration and formation of neuromuscular junctions within the grafts. The innervation process described here may advance the fabrication of a fully functional engineered muscle graft that will be of utility in clinical settings.

Músculo Esquelético/inervación , Músculo Esquelético/trasplante , Enfermedades Musculares/cirugía , Regeneración Nerviosa , Ingeniería de Tejidos/métodos , Andamios del Tejido , Animales , Axones/fisiología , Línea Celular , Electromiografía , Fibroblastos/citología , Proteínas Fluorescentes Verdes/metabolismo , Células Endoteliales de la Vena Umbilical Humana , Humanos , Masculino , Ratones , Ratones Desnudos , Poliésteres/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/química
Eur J Intern Med ; 20(8): 779-83, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19892308


BACKGROUND: Low heart rate variability (HRV) was found in various medical conditions including heart failure and acute myocardial infarction. Decreased HRV in these conditions predicted poor prognosis. METHODS: HRV was estimated in 133 unselected inpatients with relevant clinical bedside conditions by non-linear analysis derived from chaos theory, which calculates the correlation dimension (CD) of the cardiac electrophysiologic system (HRV-CD). RESULTS: Mean HRV-CD in the entire group was 3.75+/-0.45. Heart failure, coronary artery disease, cardiac arrhythmia, low serum potassium, renal dysfunction, and diabetes mellitus were significantly associated with reduced HRV-CD compared to their counterparts [3.6 vs. 3.9 (P<.001), 3.65 vs. 3.87 (P=.005), 3.58 vs. 3.8 (P=.01), 3.38 vs. 3.81 (P=.02), 3.59 vs. 3.8 (P=.04), and 3.66 vs. 3.82 (P=.04), respectively]. Stepwise logistic regression showed heart failure to be the condition most significantly associated with low HRV-CD (odds ratio 4.2, 95% confidence interval 1.90-9.28, P<.001). In the entire group, decreased HRV-CD (< or =3.75 vs. >3.75) was associated with lower survival (P=.01). Mortality of diabetic patients with HRV-CD < or =3.75 exceeded the mortality in patients with HRV-CD >3.75 (P=.02). Heart failure, renal dysfunction or age over 70 combined with HRV-CD < or =3.75 also appeared to be associated with augmented mortality. CONCLUSIONS: Diminished HRV-CD is associated with heart failure, coronary artery disease, cardiac arrhythmia, renal dysfunction, diabetes mellitus and low serum potassium. Among the latter, heart failure is most significantly associated with decreased HRV-CD. Decreased HRV-CD values, especially in diabetics, are also associated with lower survival.

Frecuencia Cardíaca , Esperanza de Vida , Factores de Edad , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/fisiopatología , Intervalos de Confianza , Diabetes Mellitus/mortalidad , Diabetes Mellitus/fisiopatología , Electrocardiografía/mortalidad , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipopotasemia/mortalidad , Hipopotasemia/fisiopatología , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa