Search

Additive manufacturing (AM) is projected to require 60,000 jobs in the UK by 2025, but there are a series of barriers to the industrial application. One of the most problematic is non-comprehensive knowledge in design for AM (DfAM). This study aims to test the effect of two undergraduate DfAM teaching approaches. A visual and audial approach (design lecture) and a kinaesthetic, problem-based learning (PBL) approach (manufacturing laboratory) were compared against technical and participant perspective criteria to assess the learning, engagement, and self-efficacy of the students. The participants were set a DfAM challenge; to redesign a bracket. The technical merits of the designs were evaluated after teaching through a design lecture alone or after a design lecture and manufacturing-laboratory. The participant’s perspective was evaluated at the end of the study. The groups who undertook both the design lecture and manufacturing laboratory showed a mean technical mark of 100% for criteria (C) 13 (“Parts have been consolidated into one part”), 91.7% for C14 (“The bracket is hollowed where possible”) and 100% for C16 (“Manufacture was successful”). These technical marks demonstrate a statistically significant increase over those of the groups who undertook the design lecture alone. The participant evaluation reinforced this result; the manufacturing laboratory was chosen more frequently in answer to questions on applicability (Q13 = 83%), preparedness (Q15 = 83%), and gaining confidence in DfAM (Q31 = 74%). This study demonstrates the importance of PBL in DfAM, both to increase technical aptitude of the student (creativity and manufacturing) and their perspective on their own learning and self-efficacy.

Integration of advanced technologies have revitalised treatment methods in the current clinical practice. In orthopaedic surgery, patient-specific implants have leveraged the design freedom offered by additive manufacturing (AM) exploiting the capabilities within powder bed fusion processes. Furthermore, generative design (GD), a design exploration tool based on the artificial intelligence, can integrate manufacturing constraints in the concept development phase, consequently bridging the gap between AM design and manufacturing. However, the reproducibility of implant prototypes are severely constrained due to uncomprehensive information on manufacturing and post processing techniques in the detailed design phase. This paper explores the manufacturing feasibility of novel GD concept plate designs for High Tibial Osteotomy (HTO), a joint preserving surgery for a patient diagnosed with osteoarthritis in the knee. A design for AM (DfAM) workflow for a generatively designed HTO plate is presented, including; detailed DfAM of GD concept designs, fabrication of plate prototypes using electron beam powder bed fusion (PBF-EB) of medical grade Ti-6Al-4 V, post processing and inspection. The study established PBF-EB as a suitable manufacturing method for the highly complex GD plate fixations, through evaluating the impact of manufacturing and post processing on the surface finish and geometrical precision of the plate design features.

People with chronic kidney disease (CKD) are at high risk of bone fractures. In this review, we summarize the complexity of fracture prevention in CKD, describe the usefulness of a medication called denosumab, and review its safety in this population. Our article will help doctors manage brittle bones in CKD and encourage researchers to conduct more studies to improve bone health in CKD. Patients with CKD are at increased risk of fragility fractures and associated consequences. We discuss the complexity of fracture prevention in CKD, summarize the efficacy and safety of denosumab, and provide an approach to denosumab-induced hypocalcemia. Using predefined terms, we searched PubMed, MEDLINE, and Google Scholar for studies on fracture prevention in CKD and the efficacy and safety of denosumab. We included observational studies, randomized controlled trials (RCTs), meta-analyses, evidence-based reviews, and clinical practice guidelines. The diagnosis of osteoporosis and prevention of related fragility fractures is complex in CKD, particularly in those with advanced and end-staged kidney disease (ESKD). Prior to initiating denosumab, it is important to assess for and optimize CKD–mineral and bone disorders (CKD-MBD). In observational studies and small RCTs, denosumab has been shown to improve bone mineral density and reduce bone turnover in CKD, but there have been no studies focused upon its fracture efficacy. Denosumab-induced hypocalcemia has also been reported, which disproportionately impacts those with ESKD. Risk factors for hypocalcemia with denosumab use in CKD include lower baseline serum calcium and 25 hydroxyvitamin D and both low and high bone turnover. Choosing the “right patient” for denosumab, supplementing with calcium and vitamin D, adjusting calcium dialysate, and close clinical monitoring are essential if considering this drug. With optimization of CKD-MBD, calcium and vitamin D supplementation, and close monitoring, denosumab can be considered in CKD. There are however opportunities to better understand its fracture efficacy and safety in an RCT setting.

This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial—IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH. Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision-threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering therapy is variable and often not sustained.

Screening for nasopharyngeal carcinoma has been advocated in countries where the disease is endemic, especially among family members of nasopharyngeal carcinoma patients, as they are at significantly higher risk. Screening programmes are generally based on nasoendoscopy and Epstein–Barr virus (EBV) IgA serology tests, which have varying sensitivities and specificities. This article highlights the importance of screening for nasopharyngeal carcinoma and discusses current screening strategies and their outcomes. Challenges faced in identifying a good screening test are highlighted, and newer screening tools, including EBV DNA load and narrow-band imaging, are discussed. Recently developed molecular assays based on nasopharyngeal swabs are also discussed.

This study aims to review our experience with deep neck abscesses, identify key trends, and improve the management of this condition. This is a retrospective chart review of patients diagnosed with deep neck abscesses in the Department of ENT (Otorhinolaryngology) at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Patient demographics, etiology, bacteriology, systemic disease, radiology, treatment, complications, duration of hospitalization, and outcomes were reviewed. 131 patients were included (64.9% male, 35.1% female) with a median age of 51.0 years. 54 (41.2%) patients had diabetes mellitus. The parapharyngeal space (23.7%) was the most commonly involved space. Odontogenic and upper airway infections were the leading causes of deep neck abscesses (28.0% each). Klebsiella pneumoniae (27.1%) was the most commonly cultured organism in this study and among the diabetic patients (50.0%). 108 (82.4%) patients underwent surgical drainage. 42 patients suffered complications. All 19 patients, who had upper airway obstruction, had either a tracheostomy or intubation. Patients with multi-space abscesses, diabetes mellitus, and complications had prolonged hospitalizations. Old age and diabetes are risk factors for developing deep neck abscesses and their sequelae. The empiric choice of antibiotics should recognize that a dental source is likely, and that Klebsiella is most common in diabetics. Surgical drainage and adequate antibiotic coverage remains the cornerstone of treatment of deep neck abscesses. Therapeutic needle aspiration may successfully replace surgical drainage, if the abscesses are small and no complications are imminent. Airway obstruction should be anticipated in multi-space and floor of mouth abscesses.