Patients with recessive dystrophic epidermolysis bullosa (RDEB) lack functional type VII collagen owing to mutations in the gene COL7A1 and suffer severe blistering and chronic wounds that ultimately lead to infection and development of lethal squamous cell carcinoma. The discovery of induced pluripotent stem cells (iPSCs) and the ability to edit the genome bring the possibility to provide definitive genetic therapy through corrected autologous tissues. We generated patient-derived COL7A1-corrected epithelial keratinocyte sheets for autologous grafting. We demonstrate the utility of sequential reprogramming and adenovirus-associated viral genome editing to generate corrected iPSC banks. iPSC-derived keratinocytes were produced with minimal heterogeneity, and these cells secreted wild-type type VII collagen, resulting in stratified epidermis in vitro in organotypic cultures and in vivo in mice. Sequencing of corrected cell lines before tissue formation revealed heterogeneity of cancer-predisposing mutations, allowing us to select COL7A1-corrected banks with minimal mutational burden for downstream epidermis production. Our results provide a clinical platform to use iPSCs in the treatment of debilitating genodermatoses, such as RDEB.

Our method provides an alternative to manual labeling for creating training sets for statistical models of phenotypes. Such an approach can accelerate research with large observational healthcare datasets and may also be used to create local phenotype models.

Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07564-8.

Worldwide, breast cancer remains as one of the most common cancer diagnosis and cause of cancer related death among women. Fortunately, nanomedicine has brought forth new potential and hope in breast cancer research. The extremely small size of nanoparticles makes it advantageous and potentially superior to use in tumor detection and imaging. One of the more extensively studied particles is quantum dots, semiconductor crystals which are capable of enhanced labeling and imaging of cancer cells. In addition, due to serious toxicity of chemotherapeutic agents, nano-formulations of breast cancer chemotherapy are under investigation and development. This may provide easier administering route and reduced frequency of drugs. With the use of nanoparticles, drug delivery can be carried out in a minimally invasive fashion and treatment regimens can be made much more targeted and specific for each patient. In this review article, we provide an overview on the role nanomedicine has played in breast cancer and mention some of the latest diagnostic and treatment modalities researched to date.

Group visits providing patient education about CNCP may benefit patients' knowledge about this clinical condition, and was received with high patient satisfaction. Further investigation is needed to evaluate longer-term knowledge retention, sustainability of improvements resulting from the intervention, and longer-term effects of the intervention on functional status.

Background and Objective:The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto-Rican older adults living in the Greater Boston Area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group, compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer’s Disease Neuroimaging Initiatives (ADNI) and National Alzheimer’s Coordinating Center (NACC) databases.Methods:BPRHS participants who underwent brain Magnetic Resonance Imaging (MRI) and cognitive testing were divided into four groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+ and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes and brain age based on T1-weighted MRI, and cognitive test scores. BPRHS results were then compared with non-Hispanic White and Hispanic participants from the ADNI and NACC databases.Results:The prevalence of HTN was almost twice (66.7% vs 38.7%) and T2D five times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group, compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and GCS scores were observed in HTN+/T2D+ relative to HTN-/T2D-. MRI measures and MMSE from the HTN+/T2D+ BPRHS group resembled ADNI White progressive MCI participants, while the BPRHS HTN-/T2D- resembled stable MCI participants. The BPRHS was not significantly different from the ADNI+NACC Hispanic cohort on imaging or MMSE measures.Discussion:The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group, compared to non-Hispanic White adults in the same age range.

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity.

In a relatively short amount of time, robots have made its way into both general and subspecialty surgical fields. The da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) has been around for over a decade now. The first da Vinci surgical system came out in 1999 and was FDA approved in 2000. In 2003, a fourth robotic arm was added. The da Vinci S model came out in 2006 and offered improved robotic arm movements, console displays, and simpler set up. As of 2009, the latest model called da Vinci Si, now offers dual consoles so two individuals can collaborate simultaneously. Controls, vision, and ergonomics have been improved as well.The specialties that use the da Vinci system frequently are urological, gynecological, and gastrointestinal surgery (1). In 2010, Intuitive Surgical Inc., the manufacturer of the da Vinci robot, reported that over 70% of robotic procedures were for both prostatectomy and hysterectomy combined (1). Further, robotic technique is the preferred method of performing a radical prostatectomy as the definitive treatment for prostate cancer (2). In gynecology, it is estimated that over 60% of minimally invasive hysterectomies performed in patients with endometrial cancer were done robotically (3). There are several reasons why urologists and gynecologists perform more robotic procedures than their other surgical counterparts. These include balance of surgeon endoscopic skill level, meaning how often endoscopic or laparoscopic techniques are performed in their field; equipment limitations, especially when working with anatomically complex areas; and procedure complexity, taking into account which procedures are better performed open versus minimally invasive versus robotically, the latter having the greatest precision (2).Robotic options do exist for surgical treatment in other specialties although it is used much less frequently. These include cardiothoracic surgery, for cases of coronary bypass and heart defects repairs; general surgical oncology, for esophageal tumors, gastric cancer, colon cancer, thymoma; and pediatrics, to resolve congenital heart diseases, gastroespohageal reflux disease, or uretopelvic junction obstruction (4).