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INTRODUCTION: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres. METHODS: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP. RESULTS: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively. CONCLUSIONS: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.
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Fibromyalgia (FM) and climacteric conditions share common epidemiological and clinical features, with FM symptoms often beginning during menopause. Musculoskeletal pain, arthralgia, myalgia and other symptoms are frequently seen in both conditions. Some research suggests a link between the cessation of sex hormones and FM symptoms. Women with FM tend to experience more severe symptoms after menopause, and the severity of FM symptoms can worsen in women who have had a hysterectomy with or without oophorectomy. Despite these similarities, it is essential to treat FM and climacteric conditions separately and follow established guidelines for management. However, it is also important to recognize that both conditions can coexist in the same patient. It is crucial to note that there is limited evidence supporting the effectiveness of menopausal hormone therapy for primary FM management. Therefore, menopausal hormone therapy should not be recommended for FM unless the patient also has climacteric syndrome.
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Tumor-on-chips (ToCs) are useful platforms for studying the physiology of tumors and evaluating the efficacy and toxicity of anti-cancer drugs. However, the design and fabrication of a ToC system is not a trivial venture. We introduce a user-friendly, flexible, 3D-printed microfluidic device that can be used to culture cancer cells or cancer-derived spheroids embedded in hydrogels under well-controlled environments. The system consists of two lateral flow compartments (left and right sides), each with two inlets and two outlets to deliver cell culture media as continuous liquid streams. The central compartment was designed to host a hydrogel in which cells and microtissues can be confined and cultured. We performed tracer experiments with colored inks and 40 kDa fluorescein isothiocyanate dextran to characterize the transport/mixing performances of the system. We also cultured homotypic (MCF7) and heterotypic (MCF7-BJ) spheroids embedded in gelatin methacryloyl hydrogels to illustrate the use of this microfluidic device in sustaining long-term micro-tissue culture experiments. We further demonstrated the use of this platform in anticancer drug testing by continuous perfusion of doxorubicin, a commonly used anti-cancer drug for breast cancer. In these experiments, we evaluated drug transport, viability, glucose consumption, cell death (apoptosis), and cytotoxicity. In summary, we introduce a robust and friendly ToC system capable of recapitulating relevant aspects of the tumor microenvironment for the study of cancer physiology, anti-cancer drug transport, efficacy, and safety. We anticipate that this flexible 3D-printed microfluidic device may facilitate cancer research and the development and screening of strategies for personalized medicine.
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Antineoplásicos , Neoplasias da Mama , Impressão Tridimensional , Esferoides Celulares , Humanos , Esferoides Celulares/efeitos dos fármacos , Esferoides Celulares/patologia , Esferoides Celulares/metabolismo , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias da Mama/metabolismo , Antineoplásicos/farmacologia , Antineoplásicos/química , Feminino , Células MCF-7 , Hidrogéis/química , Dispositivos Lab-On-A-Chip , Linhagem Celular Tumoral , Ensaios de Seleção de Medicamentos Antitumorais , Dextranos/química , Gelatina/química , Doxorrubicina/farmacologia , Doxorrubicina/química , Sobrevivência Celular/efeitos dos fármacos , MetacrilatosRESUMO
BACKGROUND: Systemic lupus erythematosus (SLE) is characterised by increased cardiovascular morbidity and mortality risk. We aimed to examine the prevalence of traditional cardiovascular risk factors and their control in an international survey of patients with systemic lupus erythematosus. METHODS: In this multicentre, cross-sectional study, cardiovascular risk factor data from medical files of adult patients (aged ≥18) with SLE followed between Jan 1, 2015, and Jan 1, 2020, were collected from 24 countries, across five continents. We assessed the prevalence and target attainment of cardiovascular risk factors and examined potential differences by country income level and antiphospholipid syndrome coexistence. We used the Systemic Coronary Risk Evaluation algorithm for cardiovascular risk estimation, and the European Society of Cardiology guidelines for assessing cardiovascular risk factor target attainment. People with lived experience were not involved in the research or writing process. FINDINGS: 3401 patients with SLE were included in the study. The median age was 43·0 years (IQR 33-54), 3047 (89·7%) of 3396 patients were women, 349 (10.3%) were men, and 1629 (48·1%) of 3390 were White. 556 (20·7%) of 2681 patients had concomitant antiphospholipid syndrome. We found a high cardiovascular risk factor prevalence (hypertension 1210 [35·6%] of 3398 patients, obesity 751 [23·7%] of 3169 patients, and hyperlipidaemia 650 [19·8%] of 3279 patients), and suboptimal control of modifiable cardiovascular risk factors (blood pressure [target of <130/80 mm Hg], BMI, and lipids) in the entire SLE group. Higher prevalence of cardiovascular risk factors but a better blood pressure (target of <130/80 mm Hg; 54·9% [1170 of 2132 patients] vs 46·8% [519 of 1109 patients]; p<0·0001), and lipid control (75·0% [895 of 1194 patients] vs 51·4% [386 of 751 patients], p<0·0001 for high-density lipoprotein [HDL]; 66·4% [769 of 1158 patients] vs 60·8% [453 of 745 patients], p=0·013 for non-HDL; 80·9% [1017 of 1257 patients] vs 61·4% [486 of 792 patients], p<0·0001 for triglycerides]) was observed in patients from high-income versus those from middle-income countries. Patients with SLE with antiphospholipid syndrome had a higher prevalence of modifiable cardiovascular risk factors, and significantly lower attainment of BMI and lipid targets (for low-density lipoprotein and non-HDL) than patients with SLE without antiphospholipid syndrome. INTERPRETATION: High prevalence and inadequate cardiovascular risk factor control were observed in a large multicentre and multiethnic SLE cohort, especially among patients from middle-income compared with high-income countries and among those with coexistent antiphospholipid syndrome. Increased awareness of cardiovascular disease risk in SLE, especially in the above subgroups, is urgently warranted. FUNDING: None.
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Síndrome Antifosfolipídica , Doenças Cardiovasculares , Fatores de Risco de Doenças Cardíacas , Lúpus Eritematoso Sistêmico , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Prevalência , Doenças Cardiovasculares/epidemiologia , Síndrome Antifosfolipídica/epidemiologia , Síndrome Antifosfolipídica/complicações , Fatores de Risco , Hipertensão/epidemiologiaRESUMO
COVID-19 made explicit the need for rethinking the way in which we conduct testing for epidemic emergencies. During the COVID-19 pandemic, the dependence on centralized lab facilities and resource-intensive methodologies (e.g., RT-qPCR methods) greatly limited the deployment of widespread testing efforts in many developed and underdeveloped countries. Here, we illustrate the development of a simple and portable diagnostic kit that enables self-diagnosis of COVID-19 at home from saliva samples. We describe the development of a do-it-yourself (DIY) incubator for Eppendorf tubes that can be used to conduct SARS-CoV-2 detection with competitive sensitivity and selectivity from saliva at home. In a proof-of-concept experiment, we assembled Eppendorf-tube incubators at our home shop, prepared a single-tube mix of reagents and LAMP primers in our lab, and deployed these COVID-19 detection kits using urban delivery systems (i.e., Rappifavor or Uber) to more than 15 different locations in Monterrey, México. This straightforward strategy enabled rapid and cost-effective at-home molecular diagnostics of SARS-CoV-2 from real saliva samples with a high sensitivity (100%) and high selectivity (87%).
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INTRODUCTION: Keratoconus is an ectatic corneal disorder that causes low vision secondary to high myopia, irregular astigmatism, and loss of corneal transparency. In children, the disease behaves aggressively, progresses rapidly, is diagnosed at advanced stages, and presents an increased risk for corneal transplantation; however, only few studies in children have been conducted. PURPOSE: The aims of this study were to determine the frequency of keratoconus in patients younger than 18 years who underwent the Pentacam study because of high myopia or high astigmatism in the oblique axis, analyze topographic criteria and classify them into severity groups, and identify associated risk factors. METHODS: This was a retrospective observational cross-sectional study in which Pentacam examinations were analyzed. Frequency of keratoconus was determined and patients were classified according to visual acuity and severity scales. Medical records were reviewed to identify associated risk factors. RESULTS: Four hundred twenty-six patients younger than 18 years were included, 40 (9.4%) had keratoconus according to Pentacam criteria. The mean age at diagnosis was 14.9 years, with male predilection (75%). Atopy was the only statistically significant risk factor, present in 85%. Family history was present in 7.5%. There were no differences in the distribution in groups according to visual acuity or Amsler-Krumeich scale. Most frequent ABCD classification was A2 (35.6%), B4 (47.9%), and C0 (35.6%), posterior curvature radius being a significant severity criterion. CONCLUSIONS: The study found that frequency of keratoconus in children is higher than previously reported. Atopy has a clear and possible causal association. Early detection should be sought to reduce the risk of progression. Pentacam is a fundamental tool for early diagnosis using simple criteria.
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Astigmatismo , Ceratocone , Miopia , Criança , Humanos , Masculino , Adolescente , Ceratocone/diagnóstico , Ceratocone/epidemiologia , Estudos Transversais , Topografia da Córnea , Córnea , Fatores de RiscoRESUMO
Introducción: En las prácticas de laboratorio se adquiere la habilidad que permite corroborar el diagnóstico de las enfermedades de la piel y anejos después de un diagnóstico presuntivo, con la utilización del método clínico. Esto se respalda en las exigencias establecidas en los documentos normativos de ese proceso formativo. Objetivo: Proponer un sistema de procedimientos para la formación interdisciplinar de la habilidad "diagnosticar enfermedades dermatológicas en los residentes de dermatología, a partir de insuficiencias detectadas en el programa de la especialidad. Métodos: La investigación fue cualitativa, con un estudio descriptivo en el Hospital Provincial General Docente Dr. Antonio Luaces Iraola, de Ciego de Ávila, desde 2018 hasta 2022. Se trabajó con toda la población conformada por 16 residentes de primer año en dermatología. Se utilizaron métodos de nivel teórico, empírico y estadístico. Resultados: En el sistema de procedimientos propuesto, se concretan fortalezas y debilidades, objetivo general, orientaciones metodológicas, precisión de los objetivos específicos y sistema de acciones para cada procedimiento, y sistema de control y evaluación de la efectividad de las acciones realizadas. La demostración de la formación de la habilidad diagnosticar, a través de un caso clínico real, reveló como esencial la consecutividad lógica de las acciones del residente desde la atención médica del caso y la formulación del diagnóstico presuntivo hasta el establecimiento del diagnóstico corroborativo en los laboratorios de anatomía patológica, microbiología y parasitología médica. Conclusiones: Se aporta un sistema de procedimientos que posibilita la formación de la habilidad "diagnosticar enfermedades dermatológicas en los residentes, con carácter secuencial, interdisciplinar e investigativo(AU)
Introduction: Laboratory practices provide the ability that allows corroborating the diagnosis of skin and adnexal diseases after a presumptive diagnosis, with the use of the clinical method. This is supported by the requirements established in the standardization documents of this training process. Objective: To propose a system of procedures for the interdisciplinary training of the skill to diagnose dermatological diseases in Dermatology residents, based on insufficiencies detected in the specialty program. Methods: The research was qualitative and consisted in a descriptive study carried out in Hospital General Docente Dr. Antonio Luaces Iraola, of Ciego de Avila, from 2018 to 2022. The work was done with the entire population made up of 16 first-year residents in Dermatology. Theoretical, empirical and statistical methods were used. Results: In the proposed system of procedures, strengths and weaknesses are specified, together with general objective, methodological guidelines, precision of specific objectives and system of actions for each procedure, as well as system of control and evaluation of the effectiveness of the actions. Demonstrating the received formation for the diagnostic skill, through a real clinical case, revealed as essential the logical consecutivity of the resident's actions from the medical attention of the case and the formulation of the presumptive diagnosis to the establishment of the corroborative diagnosis in the laboratories of pathological anatomy, microbiology and medical parasitology. Conclusions: A system of procedures is provided that makes possible the formation of the skill to diagnose dermatological diseases in residents, with sequential, interdisciplinary and investigative character(AU)
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Humanos , Aptidão , Dermatopatias/diagnóstico , Ensino , Educação Profissionalizante , Capacitação Profissional , Práticas Interdisciplinares/métodos , Competência Profissional , Planos e Programas de Saúde , Epidemiologia Descritiva , Dermatologia/educaçãoRESUMO
Biopolymer microgels present many opportunities in biomedicine and tissue engineering. To understand their in vivo behavior in therapeutic interventions, long-term monitoring is critical, which is usually achieved by incorporating fluorescent materials within the hydrogel matrix. Current research is limited due to issues concerning the biocompatibility and instability of the conventional fluorescent species, which also tend to adversely affect the bio-functionality of the hydrogels. Here, we introduce a microfluidic-based approach to generate nitrogen-functionalized graphene quantum dot (NGQD) incorporated gelatin methacryloyl (GelMA) hydrogel microspheres, capable of long-term monitoring while preserving or enhancing the other favorable features of 3D cell encapsulation. A multilayer droplet-based microfluidic device was designed and fabricated to make monodisperse NGQD-loaded GelMA hydrogel microspheres encapsulating skeletal muscle cells (C2C12). Control over the sizes of microspheres could be achieved by tuning the flow rates in the microfluidic device. Skeletal muscle cells encapsulated in these microgels exhibited high cell viability from day 1 (82.9 ± 6.50%) to day 10 (92.1 ± 3.90%). The NGQD-loaded GelMA microgels encapsulating the cells demonstrated higher metabolic activity compared to the GelMA microgels. Presence of sarcomeric α-actin was verified by immunofluorescence staining on day 10. A fluorescence signal was observed from the NGQD-loaded microgels during the entire period of the study. The investigation reveals the advantages of integrating NGQDs in microgels for non-invasive imaging and monitoring of cell-laden microspheres and presents new opportunities for future therapeutic applications.
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Grafite , Microgéis , Pontos Quânticos , Engenharia Tecidual , Hidrogéis , Gelatina , MetacrilatosRESUMO
Tumor-on-chips have become an effective resource in cancer research. However, their widespread use remains limited due to issues related to their practicality in fabrication and use. To address some of these limitations, we introduce a 3D-printed chip, which is large enough to host ~1 cm3 of tissue and fosters well-mixed conditions in the liquid niche, while still enabling the formation of the concentration profiles that occur in real tissues due to diffusive transport. We compared the mass transport performance in its rhomboidal culture chamber when empty, when filled with GelMA/alginate hydrogel microbeads, or when occupied with a monolithic piece of hydrogel with a central channel, allowing communication between the inlet and outlet. We show that our chip filled with hydrogel microspheres in the culture chamber promotes adequate mixing and enhanced distribution of culture media. In proof-of-concept pharmacological assays, we biofabricated hydrogel microspheres containing embedded Caco2 cells, which developed into microtumors. Microtumors cultured in the device developed throughout the 10-day culture showing >75% of viability. Microtumors subjected to 5-fluorouracil treatment displayed <20% cell survival and lower VEGF-A and E-cadherin expression than untreated controls. Overall, our tumor-on-chip device proved suitable for studying cancer biology and performing drug response assays.
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The field of biofabrication has seen tremendous advances in the past decade. More recently, the emerging role of biofabrication in allowing faithful generation of models of human tissues in their healthy and diseased states has been demonstrated and has rapidly expanded. These biomimetic models are potentially widely applicable in a range of research and translational areas including but not limited to fundamental biology studies as well as screening of chemical compounds, such as therapeutic agents. The United States Food and Drug Administration Modernization Act 2.0, which now no longer requires animal tests before approving human drug trials, will likely further boost the field in the years to come. This Special Issue, with a collection of 11 excellent research articles, thus focuses on showcasing the latest developments of biofabrication towards human disease modeling, spanning from 3D (bo)printing to organ-on-a-chip as well as their integration.
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Biomimética , Engenharia Tecidual , Animais , HumanosRESUMO
We present a simple and cost-effective strategy for developing gelatin methacryloyl (GelMA) hydrogels supplemented with minimally processed tissue (MPT) to fabricate densely packed skeletal-muscle-like tissues. MPT powder was prepared from skeletal muscle by freeze-drying, grinding, and sieving. Cell-culture experiments showed that the incorporation of 0.5-2.0% (w/v) MPT into GelMA hydrogels enhances the proliferation of murine myoblasts (C2C12 cells) compared to proliferation in pristine GelMA hydrogels and GelMA supplemented with decellularized skeletal-muscle tissues (DCTs). MPT-supplemented constructs also preserved their three-dimensional (3D) integrity for 28 days. By contrast, analogous pristine GelMA constructs only maintained their structure for 14 days or less. C2C12 cells embedded in MPT-supplemented constructs exhibited a higher degree of cell alignment and reached a significantly higher density than cells loaded in pristine GelMA constructs. Our results suggest that the addition of MPT incorporates a rich source of biochemical and topological cues, such as growth factors, glycosaminoglycans (GAGs), and structurally preserved proteins (e.g., collagen). In addition, GelMA supplemented with MPT showed suitable rheological properties for use as bioinks for extrusion bioprinting. We envision that this simple and cost-effective strategy of hydrogel supplementation will evolve into an exciting spectrum of applications for tissue engineers, primarily in the biofabrication of relevant microtissues for in vitro models and cultured meat and ultimately for the biofabrication of transplant materials using autologous MPT.
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Impressão Tridimensional , Alicerces Teciduais , Animais , Camundongos , Alicerces Teciduais/química , Hidrogéis/farmacologia , Hidrogéis/química , Músculo EsqueléticoRESUMO
Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.
Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.
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Competência Clínica , Dermatologia/educação , Educação Médica/métodos , Práticas Interdisciplinares/métodos , Corpo ClínicoRESUMO
Entre los días 17 y 19 de noviembre de 2022 se realizó el 18° Coloquio de Investigación en Salud Pública en el Centro de Estudios en Salud de la Universidad de Nariño (CESUN) de la Universidad de Nariño. Este es un evento anual que se lleva a cabo por iniciativa del Doctorado Interfacultades en Salud Pública de la Universidad Nacional de Colombia, pero cada vez más participan escuelas de formación de investigadores(as) en el campo de la salud pública de todo el país y, recientemente, algunas de México.
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Humanos , Saúde , Saúde Pública , Vida , EmpatiaRESUMO
Chronic wounds have become one of the most important issues for healthcare systems and are a leading cause of death worldwide. Wound dressings are necessary to facilitate wound treatment. Engineering wound dressings may substantially reduce healing time, reduce the risk of recurrent infections, and reduce the disability and costs associated. In the path of engineering of an ideal wound dressing, hydrogels have played a leading role. Hydrogels are 3D hydrophilic polymeric structures that can provide a protective barrier, mimic the native extracellular matrix (ECM), and provide a humid environment. Due to their advantages, hydrogels (with different architectural, physical, mechanical, and biological properties) have been extensively explored as wound dressing platforms. Here we describe recent studies on hydrogels for wound healing applications with a strong focus on the interplay between the fabrication method used and the architectural, mechanical, and biological performance achieved. Moreover, we review different categories of additives which can enhance wound regeneration using 3D hydrogel dressings. Hydrogel engineering for wound healing applications promises the generation of smart solutions to solve this pressing problem, enabling key functionalities such as bacterial growth inhibition, enhanced re-epithelialization, vascularization, improved recovery of the tissue functionality, and overall, accelerated and effective wound healing.
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Introduction: Titanium (Ti) and its alloys (eg, Ti6Al4V) are exceptional treatments for replacing or repairing bones and damaged surrounding tissues. Although Ti-based implants exhibit excellent osteoconductive performance under healthy conditions, the effectiveness and successful clinical achievements are negatively altered in diabetic patients. Concernedly, diabetes mellitus (DM) contributes to osteoblastic dysfunctionality, altering efficient osseointegration. This work investigates the beneficial osteogenic activity conducted by nanostructured TiO2 under detrimental microenvironment conditions, simulated by human diabetic serum. Methods: We evaluated the bone-forming functional properties of osteoblasts on synthesized TiO2 nanotubes (NTs) by anodization and Ti6Al4V non-modified alloy surfaces under detrimental diabetic conditions. To simulate the detrimental environment, MC3T3E-1 preosteoblasts were cultured under human diabetic serum (DS) of two diagnosed and metabolically controlled patients. Normal human serum (HS) was used to mimic health conditions and fetal bovine serum (FBS) as the control culture environment. We characterized the matrix mineralization under the detrimental conditions on the control alloy and the NTs. Moreover, we applied immunofluorescence of osteoblasts differentiation markers on the NTs to understand the bone-expression stimulated by the biochemical medium conditions. Results: The diabetic conditions depressed the initial osteoblast growth ability, as evidenced by altered early cell adhesion and reduced proliferation. Nonetheless, after three days, the diabetic damage was suppressed by the NTs, enhancing the osteoblast activity. Therefore, the osteogenic markers of bone formation and the differentiation of osteoblasts were reactivated by the nanoconfigured surfaces. Far more importantly, collagen secretion and bone-matrix mineralization were stimulated and conducted to levels similar to those of the control of FBS conditions, in comparison to the control alloy, which was not able to reach similar levels of bone functionality than the NTs. Conclusion: Our study brings knowledge for the potential application of nanostructured biomaterials to work as an integrative platform under the detrimental metabolic status present in diabetic conditions.
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Diabetes Mellitus , Nanotubos , Humanos , Células Cultivadas , Nanotubos/química , Osteoblastos , Ligas , Diabetes Mellitus/metabolismoRESUMO
Neuron-on-chip (NoC) systems-microfluidic devices in which neurons are cultured-have become a promising alternative to replace or minimize the use of animal models and have greatly facilitated in vitro research. Here, we review and discuss current developments in neuron-on-chip platforms, with a particular emphasis on existing biological models, culturing techniques, biomaterials, and topologies. We also discuss how the architecture, flow, and gradients affect neuronal growth, differentiation, and development. Finally, we discuss some of the most recent applications of NoCs in fundamental research (i.e., studies on the effects of electrical, mechanical/topological, or chemical stimuli) and in disease modeling.
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Current tissue engineering techniques frequently rely on hydrogels to support cell growth, as these materials strongly mimic the extracellular matrix. However, hydrogels often need ad hoc customization to generate specific tissue constructs. One popular strategy for hydrogel functionalization is to add nanoparticles to them. Here, we present a plant viral nanoparticle the turnip mosaic virus (TuMV), as a promising additive for gelatin methacryloyl (GelMA) hydrogels for the engineering of mammalian tissues. TuMV is a flexuous, elongated, tubular protein nanoparticle (700-750 nm long and 12-15 nm wide) and is incapable of infecting mammalian cells. These flexuous nanoparticles spontaneously form entangled nanomeshes in aqueous environments, and we hypothesized that this nanomesh structure could serve as a nanoscaffold for cells. Human fibroblasts loaded into GelMA-TuMV hydrogels exhibited similar metabolic activity to that of cells loaded in pristine GelMA hydrogels. However, cells cultured in GelMA-TuMV formed clusters and assumed an elongated morphology in contrast to the homogeneous and confluent cultures seen on GelMA surfaces, suggesting that the nanoscaffold material per se did not favor cell adhesion. We also covalently conjugated TuMV particles with epidermal growth factor (EGF) using a straightforward reaction scheme based on a Staudinger reaction. BJ cells cultured on the functionalized scaffolds increased their confluency by approximately 30% compared to growth with unconjugated EGF. We also provide examples of the use of GelMA-TuMV hydrogels in different biofabrication scenarios, include casting, flow-based-manufacture of filaments, and bioprinting. We envision TuMV as a versatile nanobiomaterial that can be useful for tissue engineering.
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Introduction: Introduction: the nasal bridle (NB) is one of the strategies to avoid the displacement of tubes for enteral nutrition (EN) used during a nutritional intervention. Objectives: to review the efficacy and safety of NB placement in a patient population requiring EN by tube feeding. To analyze their clinical characteristics and identify complications related to this procedure. Methods: a retrospective observational study in usual clinical practice including patients admitted to a second-level hospital with EN catheters who required the use of a commercial NB-CORGRIP NG/NI TFEEDING TUBE RETENTION SYSTEM. Results: 51 patients with a mean age of 73 years (37-96) were analyzed; 64.7 % were men. Oropharyngeal dysphagia (OPD) was the fundamental indication for placement of an EN tube (54.9 %) followed by refusal to ingest (17.6 %), and orotracheal intubation (7.8 %), among others. NB was withdrawn in 7.8 % of cases due to change in digestive access (gastrostomy), in 21.6 % because of transition to the oral route, and in 9.8 % due to ignorance on how to use it. We found significant differences between accidental removal and self-withdrawal of probes before and after BN placement (2.59 ± 1.512 vs 0.24 ± 0.596; p < 0.05). No related complications were recorded except for only one case of skin ulcer. Conclusions: NB is a safe and effective retention system for the prevention of probe displacement and withdrawal in patients with a wide variety of pathologies. Training health professionals is essential for proper use.
Introducción: Introducción: la brida nasal (BN) es una de las estrategias para evitar el desplazamiento de las sondas para nutrición enteral (NE) utilizadas en el curso de una intervención nutricional. Objetivos: revisar la eficacia y la seguridad de la colocación de la BN en una población de pacientes que precisan NE por sonda. Analizar sus características clínicas e identificar las complicaciones relacionadas con este procedimiento. Métodos: estudio observacional, retrospectivo en condiciones de práctica clínica habitual, incluyendo pacientes ingresados en un hospital de segundo nivel, portadores de sonda para NE, que hayan precisado la utilización de un sistema comercial CORGRIP NG/NI TFEEDING TUBE RETENTION SYSTEM de BN. Resultados: se analizan 51 pacientes con una edad media de 73 años (37-96); el 64,7 % eran varones. La disfagia orofaringea (DOF) fue la indicación fundamental para la colocación de la sonda de NE (54,9 %), seguida del rechazo de la ingesta (17,6 %) y la intubación orotraqueal (7,8 %), entre otras. La BN fue retirada en el 7,8 % de los casos por cambio de acceso digestivo (gastrostomía), en el 21,6 % por paso a la vía oral y en el 9,8 % por desconocimiento de su manejo. Evidenciamos diferencias significativas entre los arrancamientos accidentales y las autorretiradas de las sondas antes y después de la colocación de la BN (2,59 ± 1,512 vs. 0,24 ± 0,596; p < 0,05). No se registraron complicaciones relacionadas salvo un caso de úlcera cutánea. Conclusiones: la BN es un sistema de retención seguro y eficaz en la prevención de desplazamientos y retiradas de la sonda en los pacientes con amplia variedad de patologías. Formar a los profesionales sanitarios es imprescindible para su adecuada utilización.
Assuntos
Transtornos de Deglutição , Intubação Gastrointestinal , Idoso , Transtornos de Deglutição/terapia , Nutrição Enteral/métodos , Feminino , Gastrostomia/métodos , Humanos , Intubação Gastrointestinal/métodos , MasculinoRESUMO
Systemic oppression creates a context in which Latinx LGBTQ+ youth experience social isolation. Social isolation has been associated with mental and physical health disparities, including disproportionate levels of depression, substance use, self-harm, and attempted suicide. These disparities are often magnified in rural and suburban areas with fewer identity-affirming spaces. This community-engaged study reports on the formative process of developing a Latinx LGBTQ+ telenovela (soap opera) allyship intervention based on critical consciousness theory. We conducted eight focus groups with community advisory boards, which included Latinx LGBTQ+ youth (n = 12), health and social service providers serving LGBTQ+ youth (n = 10), 4-H Latinx alumni youth (n = 12), and 4-H Latinx parents (n = 8). We interviewed nine Latinx LGBTQ+ youth enrolled in a film-making workshop. As a result of our multi-stakeholder approach, we: (1) described how stakeholders reflected on and decoded intersectional isolation on the individual, community, and structural levels; and (2) identified ways that stakeholders suggested taking action by improving access to resources to address social isolation, provide culturally competent healthcare, and co-create an enabling social environment. Our study indicated the importance of tapping into core values and intersectional identities to build solidarity among and within marginalized groups to dismantle oppressive systems.
Assuntos
Equidade em Saúde , Minorias Sexuais e de Gênero , Adolescente , Estado de Consciência , Grupos Focais , Humanos , Isolamento SocialRESUMO
Introducción: la brida nasal (BN) es una de las estrategias para evitar el desplazamiento de las sondas para nutrición enteral (NE) utilizadas en el curso de una intervención nutricional. Objetivos: revisar la eficacia y la seguridad de la colocación de la BN en una población de pacientes que precisan NE por sonda. Analizar sus características clínicas e identificar las complicaciones relacionadas con este procedimiento. Métodos: estudio observacional, retrospectivo en condiciones de práctica clínica habitual, incluyendo pacientes ingresados en un hospital de segundo nivel, portadores de sonda para NE, que hayan precisado la utilización de un sistema comercial CORGRIP NG/NI TFEEDING TUBE RETENTION SYSTEM de BN. Resultados: se analizan 51 pacientes con una edad media de 73 años (37-96); el 64,7 % eran varones. La disfagia orofaringea (DOF) fue la indicación fundamental para la colocación de la sonda de NE (54,9 %), seguida del rechazo de la ingesta (17,6 %) y la intubación orotraqueal (7,8 %), entre otras. La BN fue retirada en el 7,8 % de los casos por cambio de acceso digestivo (gastrostomía), en el 21,6 % por paso a la vía oral y en el 9,8 % por desconocimiento de su manejo. Evidenciamos diferencias significativas entre los arrancamientos accidentales y las autorretiradas de las sondas antes y después de la colocación de la BN (2,59 ± 1,512 vs. 0,24 ± 0,596; p < 0,05). No se registraron complicaciones relacionadas salvo un caso de úlcera cutánea. Conclusiones: la BN es un sistema de retención seguro y eficaz en la prevención de desplazamientos y retiradas de la sonda en los pacientes con amplia variedad de patologías. Formar a los profesionales sanitarios es imprescindible para su adecuada utilización. (AU)
Introduction: the nasal bridle (NB) is one of the strategies to avoid the displacement of tubes for enteral nutrition (EN) used during a nutritional intervention. Objectives: to review the efficacy and safety of NB placement in a patient population requiring EN by tube feeding. To analyze their clinical characteristics and identify complications related to this procedure. Methods: a retrospective observational study in usual clinical practice including patients admitted to a second-level hospital with EN catheters who required the use of a commercial NBCORGRIP NG/NI TFEEDING TUBE RETENTION SYSTEM. Results: 51 patients with a mean age of 73 years (37-96) were analyzed; 64.7 % were men. Oropharyngeal dysphagia (OPD) was the fundamental indication for placement of an EN tube (54.9 %) followed by refusal to ingest (17.6 %), and orotracheal intubation (7.8 %), among others. NB was withdrawn in 7.8 % of cases due to change in digestive access (gastrostomy), in 21.6 % because of transition to the oral route, and in 9.8 % due to ignorance on how to use it. We found significant differences between accidental removal and self-withdrawal of probes before and after BN placement (2.59 ± 1.512 vs 0.24 ± 0.596; p < 0.05). No related complications were recorded except for only one case of skin ulcer. Conclusions: NB is a safe and effective retention system for the prevention of probe displacement and withdrawal in patients with a wide variety of pathologies. Training health professionals is essential for proper use. (AU)