Outcomes in Pediatric Burn Patients With Additional Trauma-Related Injuries

The addition of trauma to burn injuries may result in higher morbidity and mortality. The purpose of this study was to evaluate the outcomes of pediatric patients with a combination of burn and trauma injuries, and included all pediatric Burn only, Trauma only, and combined Burn-Trauma patients admitted between 2011 and 2020. Mean length of stay, ICU length of stay, and ventilator days were highest for the Burn-Trauma group. The odds of mortality were almost 13 times higher for the Burn-Trauma group when compared to the Burn only group (P = .1299). After using inverse probability of treatment weighting, the odds of mortality were almost 10 times higher for the Burn-Trauma group in comparison to the Burn only group (P < .0066). Thus, the addition of trauma to burn injuries was associated with increased odds of mortality, as well as longer ICU and overall hospital length of stay in this patient population

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark

Background: Hypothesised associations between in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and congenital anomalies, particularly congenital heart defects (CHD), remain controversial. We investigated the putative teratogenicity of SSRI prescription in the 91 days either side of first day of last menstrual period (LMP). Methods and Findings: Three population-based EUROCAT congenital anomaly registries- Norway (2004–2010), Wales (2000–2010) and Funen, Denmark (2000–2010)—were linked to the electronic healthcare databases holding prospectively collected prescription information for all pregnancies in the timeframes available. We included 519,117 deliveries, including foetuses terminated for congenital anomalies, with data covering pregnancy and the preceding quarter, including 462,641 with data covering pregnancy and one year either side. For SSRI exposures 91 days either side of LMP, separately and together, odds ratios with 95% confidence intervals (ORs, 95%CI) for all major anomalies were estimated. We also explored: pausing or discontinuing SSRIs preconception, confounding, high dose regimens, and, in Wales, diagnosis of depression. Results were combined in meta-analyses. SSRI prescription 91 days either side of LMP was associated with increased prevalence of severe congenital heart defects (CHD) (as defined by EUROCAT guide 1.3, 2005) (34/12,962 [0.26%] vs. 865/506,155 [0.17%] OR 1.50, 1.06–2.11), and the composite adverse outcome of 'anomaly or stillbirth' (473/12962, 3.65% vs. 15829/506,155, 3.13%, OR 1.13, 1.03–1.24). The increased prevalence of all major anomalies combined did not reach statistical significance (3.09% [400/12,962] vs. 2.67% [13,536/506,155] OR 1.09, 0.99–1.21). Adjusting for socio-economic status left ORs largely unchanged. The prevalence of anomalies and severe CHD was reduced when SSRI prescriptions were stopped or paused preconception, and increased when >1 prescription was recorded, but differences were not statistically significant. The dose-response relationship between severe CHD and SSRI dose (meta-regression OR 1.49, 1.12–1.97) was consistent with SSRI-exposure related risk. Analyses in Wales suggested no associations between anomalies and diagnosed depression. Conclusion: The additional absolute risk of teratogenesis associated with SSRIs, if causal, is small. However, the high prevalence of SSRI use augments its public health importance, justifying modifications to preconception care

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

3D Printing and 3D Bioprinting to Use for Medical Applications

The Additive manufacturing 3D printing is a process of creating a three dimensional solid objects or rapid prototyping of 3D models from a digital file, which builds layer by layer. The 3D bioprinting is a form sophisticated of 3D printing technology involving cells and tissues for the production of tissue for regenerative medicine, which is also built layer by layer into the area of human tissue or organ. This paper defines the modern methods and materials of the AM, which are used for the development of physical models and individually adjusted implants for 3D printing for medical purposes. The main classification of 3D printing and 3D bioprinting technologies are also defined by typical materials and a field of application. It is proven that 3D printing and 3D bioprinting techniques have a huge potential and a possibility to revolutionize the field of medicine

Cost optimization of additive manufacturing in wood industry

Software packages for 3D design and additive manufacturing (AM) technologies, initially known as rapid prototyping (RP) have emerged during the last years, as a cutting edge solutions for custom prototyping. These new tools and technologies lower the design costs, but also allow rapid creation of fully functional components. This paper describes the FDM and 3DP rapid prototyping technologies that were used to create elements and tools in the wood industry field. Total costs of manufacturing related to the fabrication of sample elements and tools are analysed. One of the main recognised issues of wider application of rapid prototyping technologies is their still very high costs related to all production aspects, starting with a lack of available materials, material cost, up to high cost of available commercial equipment, usually focused only on specific solutions and limited range of materials. Generally, AM costs can be divided into the group of fixed costs and variable ones. This paper deals with the optimization of the production costs of fabricated elements in case of small-scale production, and optimization of variable costs (processing and post-processing, costs of enforcement, and material costs)

Comparing the accuracy of 3D slicer software in printed enduse parts

This study aims to compare the accuracy offered by 3D Slicer Software in printing end-use parts inside a Fused Deposition Modeling process of Additive Manufacturing. The purpose, in particular, is to investigate the surface quality and the dimensional stability of the manufactured parts comparing the effect of selecting a different 3D Slicer tool among Simplify3D, Cura and Slic3r 3D. With this scope, parts were produced using these process tools while results were analysed in terms of accuracy, production time and consumption of material. Results, graphically and visually presented, show significant differences in the dimensional and surface accuracy with an optimum outcome offered by the Simplify3D as best 3D slicer tool. The Simplify3D slicer has essential advantages in printed end-use parts because creates the 3D models with significantly better accuracy and quality support

Sustainable small batch reproduction via additive manufacturing and vacuum casting: The case study of a rhinoceros toy figure

This paper aims at clarifying the relationship between two unconventional manufacturing processes, the additive manufacturing and the vacuum casting, as a sustainable way in developing prototypes and small batches, even in the presence of complex geometries. The rapid reproduction of a rhinoceros toy figure was used as case study. Starting from the 3D CAD model, acquired by reverse engineering techniques, additive manufacturing and vacuum casting processes permitted to realize its replicas. Complex functional parts in small series were manufactured with high precision, accuracy and enhanced surface finish. Furthermore, significant reductions in time and costs, both for development or production comparing to other technologies were highlighted