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Dr. Carlos  Chang  Md image

Dr. Carlos Chang Md

1932 Salk Ave
Tavares FL 32778
352 430-0053
Medical School: Other - 1989
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: Yes
Participates In EHR: Yes
License #: ME71903
NPI: 1922005016
Taxonomy Codes:
207R00000X

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Awards & Recognitions

About Us

Practice Philosophy

Conditions

Dr. Carlos Chang is associated with these group practices

Procedure Pricing

HCPCS Code Description Average Price Average Price
Allowed By Medicare
HCPCS Code:99306 Description:Nursing facility care init Average Price:$270.00 Average Price Allowed
By Medicare:
$163.76
HCPCS Code:99214 Description:Office/outpatient visit est Average Price:$185.00 Average Price Allowed
By Medicare:
$104.45
HCPCS Code:G0438 Description:PPPS, initial visit Average Price:$245.00 Average Price Allowed
By Medicare:
$166.15
HCPCS Code:G0439 Description:PPPS, subseq visit Average Price:$175.00 Average Price Allowed
By Medicare:
$109.64
HCPCS Code:99222 Description:Initial hospital care Average Price:$200.00 Average Price Allowed
By Medicare:
$136.05
HCPCS Code:99309 Description:Nursing fac care subseq Average Price:$150.00 Average Price Allowed
By Medicare:
$87.30
HCPCS Code:90732 Description:Pneumococcal vaccine Average Price:$127.18 Average Price Allowed
By Medicare:
$64.63
HCPCS Code:99305 Description:Nursing facility care init Average Price:$190.00 Average Price Allowed
By Medicare:
$129.44
HCPCS Code:G0180 Description:MD certification HHA patient Average Price:$105.00 Average Price Allowed
By Medicare:
$52.60
HCPCS Code:99204 Description:Office/outpatient visit new Average Price:$205.00 Average Price Allowed
By Medicare:
$162.74
HCPCS Code:90746 Description:Hep b vaccine adult im Average Price:$101.67 Average Price Allowed
By Medicare:
$59.71
HCPCS Code:99315 Description:Nursing fac discharge day Average Price:$110.00 Average Price Allowed
By Medicare:
$70.53
HCPCS Code:99239 Description:Hospital discharge day Average Price:$140.00 Average Price Allowed
By Medicare:
$104.09
HCPCS Code:99223 Description:Initial hospital care Average Price:$235.00 Average Price Allowed
By Medicare:
$199.10
HCPCS Code:99316 Description:Nursing fac discharge day Average Price:$136.00 Average Price Allowed
By Medicare:
$100.93
HCPCS Code:99238 Description:Hospital discharge day Average Price:$105.00 Average Price Allowed
By Medicare:
$70.33
HCPCS Code:99232 Description:Subsequent hospital care Average Price:$105.00 Average Price Allowed
By Medicare:
$70.65
HCPCS Code:99217 Description:Observation care discharge Average Price:$105.00 Average Price Allowed
By Medicare:
$70.86
HCPCS Code:99213 Description:Office/outpatient visit est Average Price:$100.00 Average Price Allowed
By Medicare:
$70.65
HCPCS Code:99225 Description:Subsequent observation care Average Price:$100.00 Average Price Allowed
By Medicare:
$70.78
HCPCS Code:99219 Description:Initial observation care Average Price:$155.00 Average Price Allowed
By Medicare:
$131.75
HCPCS Code:93005 Description:Electrocardiogram tracing Average Price:$30.00 Average Price Allowed
By Medicare:
$10.41
HCPCS Code:G0402 Description:Initial preventive exam Average Price:$175.00 Average Price Allowed
By Medicare:
$155.94
HCPCS Code:99233 Description:Subsequent hospital care Average Price:$120.00 Average Price Allowed
By Medicare:
$101.44
HCPCS Code:99308 Description:Nursing fac care subseq Average Price:$85.00 Average Price Allowed
By Medicare:
$66.58
HCPCS Code:99308 Description:Nursing fac care subseq Average Price:$85.00 Average Price Allowed
By Medicare:
$66.58
HCPCS Code:99212 Description:Office/outpatient visit est Average Price:$60.00 Average Price Allowed
By Medicare:
$42.50
HCPCS Code:99211 Description:Office/outpatient visit est Average Price:$35.00 Average Price Allowed
By Medicare:
$19.51
HCPCS Code:69210 Description:Remove impacted ear wax Average Price:$65.00 Average Price Allowed
By Medicare:
$50.29
HCPCS Code:J3420 Description:Vitamin b12 injection Average Price:$15.00 Average Price Allowed
By Medicare:
$0.53
HCPCS Code:99307 Description:Nursing fac care subseq Average Price:$55.00 Average Price Allowed
By Medicare:
$42.81
HCPCS Code:11100 Description:Biopsy skin lesion Average Price:$115.00 Average Price Allowed
By Medicare:
$103.23
HCPCS Code:93010 Description:Electrocardiogram report Average Price:$20.00 Average Price Allowed
By Medicare:
$8.62
HCPCS Code:J1040 Description:Methylprednisolone 80 MG inj Average Price:$15.00 Average Price Allowed
By Medicare:
$6.76
HCPCS Code:81003 Description:Urinalysis auto w/o scope Average Price:$10.00 Average Price Allowed
By Medicare:
$3.18
HCPCS Code:J1885 Description:Ketorolac tromethamine inj Average Price:$7.00 Average Price Allowed
By Medicare:
$0.24
HCPCS Code:81002 Description:Urinalysis nonauto w/o scope Average Price:$10.00 Average Price Allowed
By Medicare:
$3.62
HCPCS Code:83036 Description:Glycosylated hemoglobin test Average Price:$20.00 Average Price Allowed
By Medicare:
$13.75
HCPCS Code:G0010 Description:Admin hepatitis b vaccine Average Price:$30.00 Average Price Allowed
By Medicare:
$23.78
HCPCS Code:G0008 Description:Admin influenza virus vac Average Price:$30.00 Average Price Allowed
By Medicare:
$23.78
HCPCS Code:G0009 Description:Admin pneumococcal vaccine Average Price:$30.00 Average Price Allowed
By Medicare:
$23.78
HCPCS Code:96372 Description:Ther/proph/diag inj sc/im Average Price:$30.00 Average Price Allowed
By Medicare:
$23.78
HCPCS Code:Q2037 Description:Fluvirin vacc, 3 yrs & >, im Average Price:$20.00 Average Price Allowed
By Medicare:
$14.03
HCPCS Code:85610 Description:Prothrombin time Average Price:$10.00 Average Price Allowed
By Medicare:
$5.56

HCPCS Code Definitions

99233
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
99225
Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
99223
Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
99222
Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.
99232
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
99306
Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient's facility floor or unit.
G0010
Administration of hepatitis b vaccine
99219
Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.
99305
Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.
99316
Nursing facility discharge day management; more than 30 minutes
99239
Hospital discharge day management; more than 30 minutes
99238
Hospital discharge day management; 30 minutes or less
J1040
Injection, methylprednisolone acetate, 80 mg
99308
Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.
G0438
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
99308
Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.
99309
Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.
G0008
Administration of influenza virus vaccine
J3420
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
G0402
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
99315
Nursing facility discharge day management; 30 minutes or less
G0009
Administration of pneumococcal vaccine
J1885
Injection, ketorolac tromethamine, per 15 mg
G0180
Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period
G0439
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
99307
Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient's facility floor or unit.
Q2037
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
69210
Removal impacted cerumen requiring instrumentation, unilateral
99217
Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])
11100
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion
99214
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99213
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
93010
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
99212
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
93005
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
96372
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
99211
Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
99204
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.

Medical Malpractice Cases

None Found

Medical Board Sanctions

None Found

Referrals

NPI
Doctor Name
Specialty
Count
1295716645
Hematology/Oncology
4,398
1962499111
Hematology/Oncology
3,393
1205869203
Diagnostic Radiology
3,229
1669451639
Diagnostic Radiology
3,214
1265412308
Diagnostic Radiology
2,959
1215923396
Orthopedic Surgery
2,938
1093762288
Diagnostic Radiology
2,874
1104931914
Internal Medicine
2,831
1376612358
Cardiovascular Disease (Cardiology)
2,599
1750360723
Diagnostic Radiology
1,931
*These referrals represent the top 10 that Dr. Chang has made to other doctors

Publications

Therapeutic Potential of Sustained Release Sodium Nitrite for Critical Limb Ischemia in the Setting of Metabolic Syndrome. - American journal of physiology. Heart and circulatory physiology
Nitrite is a storage reservoir of nitric oxide (NO) that is readily reduced to NO under pathological conditions. Previous studies have demonstrated that nitrite levels are significantly reduced in cardiovascular disease states, including peripheral vascular disease. We investigated the cytoprotective and pro-angiogenic actions of a novel, sustained release formulation of nitrite (SR-Nitrite) in a clinically relevant in vivo swine model of critical limb ischemia (CLI) involving central obesity and metabolic syndrome (MetS).To induce CLI, obese Ossabaw swine (n=18) were subjected to unilateral external iliac deployment of a full cross-sectional vessel occlusion device positioned within an endovascular expanded polytetrafluoroethylene lined nitinol stent-graft. At 14d following CLI, pigs were randomized to oral placebo (n=9) or SR-Nitrite (80 mg/kg BID; n=9) therapy for 21 days. SR-Nitrite therapy increased plasma and ischemic skeletal muscle nitrite, nitrate and S-nitrosothiol. Oxidative stress in ischemic limb tissue of SR-Nitrite treated pigs was reduced as compared to placebo. Ischemic limb tissue levels of pro-angiogenic growth factors were increased following SR-Nitrite therapy compared to placebo. Despite the increases in cytoprotective and angiogenic signals with SR-Nitrite therapy, analysis of new arterial vessel formation and enhancement of blood flow to the ischemic limb was not different from placebo.Our data clearly demonstrate cytoprotective and pro-angiogenic signaling in ischemic tissues following SR-nitrite therapy in a very severe CLI model. Further studies evaluating longer durations of nitrite therapy and/or additional nitrite dosing strategies, are warranted to more fully evaluate the therapeutic potential of nitrite therapy in peripheral vascular disease.Copyright © 2015, American Journal of Physiology - Heart and Circulatory Physiology.
The NHLBI-sponsored Consortium for preclinicAl assESsment of cARdioprotective therapies (CAESAR): a new paradigm for rigorous, accurate, and reproducible evaluation of putative infarct-sparing interventions in mice, rabbits, and pigs. - Circulation research
Despite 4 decades of intense effort and substantial financial investment, the cardioprotection field has failed to deliver a single drug that effectively reduces myocardial infarct size in patients. A major reason is insufficient rigor and reproducibility in preclinical studies.To develop a multicenter, randomized, controlled, clinical trial-like infrastructure to conduct rigorous and reproducible preclinical evaluation of cardioprotective therapies.With support from the National Heart, Lung, and Blood Institute, we established the Consortium for preclinicAl assESsment of cARdioprotective therapies (CAESAR), based on the principles of randomization, investigator blinding, a priori sample size determination and exclusion criteria, appropriate statistical analyses, and assessment of reproducibility. To validate CAESAR, we tested the ability of ischemic preconditioning to reduce infarct size in 3 species (at 2 sites/species): mice (n=22-25 per group), rabbits (n=11-12 per group), and pigs (n=13 per group). During this validation phase, (1) we established protocols that gave similar results between centers and confirmed that ischemic preconditioning significantly reduced infarct size in all species and (2) we successfully established a multicenter structure to support CAESAR's operations, including 2 surgical centers for each species, a Pathology Core (to assess infarct size), a Biomarker Core (to measure plasma cardiac troponin levels), and a Data Coordinating Center-all with the oversight of an external Protocol Review and Monitoring Committee.CAESAR is operational, generates reproducible results, can detect cardioprotection, and provides a mechanism for assessing potential infarct-sparing therapies with a level of rigor analogous to multicenter, randomized, controlled clinical trials. This is a revolutionary new approach to cardioprotection. Importantly, we provide state-of-the-art, detailed protocols ("CAESAR protocols") for measuring infarct size in mice, rabbits, and pigs in a manner that is rigorous, accurate, and reproducible.© 2014 American Heart Association, Inc.
Intimal hyperplasia following implantation of helical-centreline and straight-centreline stents in common carotid arteries in healthy pigs: influence of intraluminal flow. - Journal of the Royal Society, Interface / the Royal Society
Intimal hyperplasia (IH) is a leading cause of obstruction of vascular interventions, including arterial stents, bypass grafts and arteriovenous grafts and fistulae. Proposals to account for arterial stent-associated IH include wall damage, low wall shear stress (WSS), disturbed flow and, although not widely recognized, wall hypoxia. The common non-planarity of arterial geometry and flow, led us to develop a bare-metal, nitinol, self-expanding stent with three-dimensional helical-centreline geometry. This was deployed in one common carotid artery of healthy pigs, with a straight-centreline, but otherwise identical (conventional) stent deployed contralaterally. Both stent types deformed the arteries, but the helical-centreline device additionally deformed them helically and caused swirling of intraluminal flow. At sacrifice, one month post stent deployment, histology revealed significantly less IH in the helical-centreline than straight-centreline stented vessels. Medial cross-sectional area was not significantly different in helical-centreline than straight-centreline stented vessels. By contrast, luminal cross-sectional area was significantly larger in helical-centreline than straight-centreline stented vessels. Mechanisms considered to account for those results include enhanced intraluminal WSS and enhanced intraluminal blood-vessel wall mass transport, including of oxygen, in the helical-centreline stented vessels. Consistent with the latter proposal, adventitial microvessel density was lower in the helical-centreline stented than straight-centreline stented vessels.
Manipulating the microvasculature and its microenvironment. - Critical reviews in biomedical engineering
The microvasculature is a dynamic cellular system necessary for tissue health and function. Therapeutic strategies that target the microvasculature are expanding and evolving, including those promoting angiogenesis and microvascular expansion. When considering how to manipulate angiogenesis, either as part of a tissue construction approach or a therapy to improve tissue blood flow, it is important to know the microenvironmental factors that regulate and direct neovessel sprouting and growth. Much is known concerning both diffusible and matrix-bound angiogenic factors, which stimulate and guide angiogenic activity. How the other aspects of the extravascular microenvironment, including tissue biomechanics and structure, influence new vessel formation is less well known. Recent research, however, is providing new insights into these mechanisms and demonstrating that the extent and character of angiogenesis (and the resulting new microcirculation) is significantly affected. These observations and the resulting implications with respect to tissue construction and microvascular therapy are addressed.
Vessel arterial-venous plasticity in adult neovascularization. - PloS one
Proper arterial and venous specification is a hallmark of functional vascular networks. While arterial-venous identity is genetically pre-determined during embryo development, it is unknown whether an analogous pre-specification occurs in adult neovascularization. Our goal is to determine whether vessel arterial-venous specification in adult neovascularization is pre-determined by the identity of the originating vessels.We assessed identity specification during neovascularization by implanting isolated microvessels of arterial identity from both mice and rats and assessing the identity outcomes of the resulting, newly formed vasculature. These microvessels of arterial identity spontaneously formed a stereotypical, perfused microcirculation comprised of the full complement of microvessel types intrinsic to a mature microvasculature. Changes in microvessel identity occurred during sprouting angiogenesis, with neovessels displaying an ambiguous arterial-venous phenotype associated with reduced EphrinB2 phosphorylation.Our findings indicate that microvessel arterial-venous identity in adult neovascularization is not necessarily pre-determined and that adult microvessels display a considerable level of phenotypic plasticity during neovascularization. In addition, we show that vessels of arterial identity also hold the potential to undergo sprouting angiogenesis.
Determinants of microvascular network topologies in implanted neovasculatures. - Arteriosclerosis, thrombosis, and vascular biology
During neovascularization, the end result is a new functional microcirculation composed of a network of mature microvessels with specific topologies. Although much is known concerning the mechanisms underlying the initiation of angiogenesis, it remains unclear how the final architecture of microcirculatory beds is regulated. To begin to address this, we determined the impact of angiogenic neovessel prepatterning on the final microvascular network topology using a model of implant neovascularization.We used 3D direct-write bioprinting or physical constraints in a manner permitting postangiogenesis vascular remodeling and adaptation to pattern angiogenic microvascular precursors (neovessels formed from isolated microvessel segments) in 3D collagen gels before implantation and subsequent network formation. Neovasculatures prepatterned into parallel arrays formed functional networks after 4 weeks postimplantation but lost the prepatterned architecture. However, maintenance of uniaxial physical constraints during postangiogenesis remodeling of the implanted neovasculatures produced networks with aligned microvessels, as well as an altered proportional distribution of arterioles, capillaries, and venules.Here we show that network topology resulting from implanted microvessel precursors is independent from prepatterning of precursors but can be influenced by a patterning stimulus involving tissue deformation during postangiogenesis remodeling and maturation.
Direct-write bioprinting three-dimensional biohybrid systems for future regenerative therapies. - Journal of biomedical materials research. Part B, Applied biomaterials
Regenerative medicine seeks to repair or replace dysfunctional tissues with engineered biological or biohybrid systems. Current clinical regenerative models utilize simple uniform tissue constructs formed with cells cultured onto biocompatible scaffolds. Future regenerative therapies will require the fabrication of complex three-dimensional constructs containing multiple cell types and extracellular matrices. We believe bioprinting technologies will provide a key role in the design and construction of future engineered tissues for cell-based and regenerative therapies. This review describes the current state-of-the-art bioprinting technologies, focusing on direct-write bioprinting. We describe a number of process and device considerations for successful bioprinting of composite biohybrid constructs. In addition, we have provided baseline direct-write printing parameters for a hydrogel system (Pluronic F127) often used in cardiovascular applications. Direct-write dispensed lines (gels with viscosities ranging from 30 mPa s to greater than 600 × 10⁶ mPa s) were measured following mechanical and pneumatic printing via three commercially available needle sizes (20 ga, 25 ga, and 30 ga). Example patterns containing microvascular cells and isolated microvessel fragments were also bioprinted into composite 3D structures. Cells and vessel fragments remained viable and maintained in vitro behavior after incorporation into biohybrid structures. Direct-write bioprinting of biologicals provides a unique method to design and fabricate complex, multicomponent 3D structures for experimental use. We hope our design insights and baseline parameter descriptions of direct-write bioprinting will provide a useful foundation for colleagues to incorporate this 3D fabrication method into future regenerative therapies.Copyright © 2011 Wiley Periodicals, Inc.
Angiogenesis in a microvascular construct for transplantation depends on the method of chamber circulation. - Tissue engineering. Part A
Effective tissue prevascularization depends on new vessel growth and subsequent progression of neovessels into a stable microcirculation. Isolated microvessel fragments in a collagen-based microvascular construct (MVC) spontaneously undergo angiogenesis in static conditions in vitro but form a new microcirculation only when implanted in vivo. We have designed a bioreactor, the dynamic in vitro perfusion (DIP) chamber, to culture MVCs in vitro with perfusion. By altering bioreactor circulation, microvessel fragments in the DIP chamber either maintained stable, nonsprouting, patent vessel morphologies or sprouted endothelial neovessels that extended out into the surrounding collagen matrix (i.e., angiogenesis), yielding networks of neovessels within the MVC. Neovessels formed in regions of the construct predicted by simulation models to have the steepest gradients in oxygen levels and expressed hypoxia inducible factor-1alpha. By altering circulation conditions in the DIP chamber, we can control, possibly by modulating hypoxic stress, prevascularizing activity in vitro.
Directed three-dimensional growth of microvascular cells and isolated microvessel fragments. - Cell transplantation
Tissue engineering has promise as a means for repairing diseased and damaged tissues. A significant challenge in tissue construction relates to the constraints placed on tissue geometries resulting from diffusion limitations. An ability to incorporate a premade vasculature would overcome these difficulties and promote construct viability once implanted. Most in vitro microvascular fabrication strategies rely on surface-associated cell growth, manipulated cell monolayers, or random arrangement of cells within matrix materials. In contrast, we successfully suspended microvascular cells and isolated microvessel fragments within collagen and then microfluidically drove the mixtures into microfabricated network topologies. Developing within the 3D collagen matrix, patterned cells progressed into cord-like morphologies. These geometries were directed by the surrounding elastomer mold. With similar techniques, suspended fragments formed endothelial sprouts. By avoiding the addition of exogenous growth factors, we allowed constituent cells and fragments to autonomously develop within the constructs, providing a more physiologically relevant system for in vitro microvascular development. In addition, we present the first examples of directed endothelial cell sprouting from parent microvessel fragments. We believe this system may serve as a foundation for future in vivo fabrication of microvascular networks for tissue engineering applications.

Map & Directions

1932 Salk Ave Tavares, FL 32778
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