3D-Printed Polycaprolactone Mechanical Characterization and Suitability Assessment for Producing Wrist-Hand Orthoses.

In this research, the mechanical properties of 3D-printed polycaprolactone (PCL), a biocompatible and biodegradable semi-crystalline polyester, available as feedstock for additive manufacturing technology based on the material extrusion process, were determined. The influence of the infill pattern (zig-zag vs. gyroid) and ultraviolet (UV-B) exposure over the specimens' mechanical performances were also investigated to gather relevant data on the process parameter settings for different applications. Specimens and samples of 3D-printed PCL were analyzed through tensile and flexural tests. The experimental data showed the good repeatability of the manufacturing process, as well as a mechanical behavior independent of the specimens' infill pattern at full density. No differences between the failure patterns of the tensile specimens were recorded. UV-B exposure proved to have a significant negative impact on the specimens' tensile strength. The 3D printing of PCL and PCL blends is reported mainly for use in scaffold manufacturing or drug delivery applications. As another novelty, the suitability of commercial PCL filaments for producing patient-customized wrist-hand orthoses was also assessed in this study. Semi-cylindrical PCL samples mimicking the forearm part of a wrist-hand orthosis with hexagonal open pockets were 3D-printed and mechanically tested. The results were discussed in comparison to samples with a similar design, made of polylactic acid. The experiments revealed the need to carefully calibrate the manufacturing parameters to generate defect-free, good quality prints. Once settings were established, promising results were obtained when producing orthoses in a ready-to-use form. On the other hand, the attempts to thermoform flat 3D-printed PCL orthoses proved unsuccessful.

Efficacy and safety of immune checkpoint inhibitors in elderly patients (≥70 years) with squamous cell carcinoma of the head and neck.

BACKGROUND: Recent meta-analysis showed that immune checkpoint inhibitors (ICIs) have comparable activity between younger and older patients. However, little is known about efficacy and safety of ICI in elderly patients with relapsed/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). The aim of this study is to compare the efficacy of ICI for patients aged ≥70 y to that for younger patients, while taking into account potential confounding factors. METHODS: A retrospective study was conducted at four hospitals in France. Patients treated with ICI for R/M SCCHN between September 2014 and December 2018 were eligible. Patients' charts were reviewed for clinical and radiological data as well as oncologic outcomes. RESULTS: We included 226 patients, of whom 67 were aged ≥70 years. Objective response rate (ORR), median overall survival (OS) and median progression-free survival (PFS) were 23%, 9.7 months and 2.7 months, respectively, for elderly patients, compared to 13%, 8.7 months and 1.9 months for younger patients (respective p-values: 0.071, 0.87 and 0.21). After adjustment for performance status, site of progression, number of ICI drugs, time between initial diagnosis and ICI start and number of previous lines, age ≥70 years was significantly associated with a better PFS (hazard ratio [HR], 0.66; p = 0.021) but not OS (HR, 0.91; p = 0.59). Grade 3-5 adverse events (AEs) occurred in 15% of patients aged ≥70 years and in 8% of younger patients (p = 0.13). CONCLUSION: Patients aged ≥70 years with R/M SCCHN may respond to ICI similarly as younger patients in terms of ORR, OS and PFS, while maintaining comparable rate of AEs.

High incidence of cetuximab-related infusion reactions in head and neck patients.

BACKGROUND: Cetuximab is crucial in the management of squamous cell carcinoma of the head and neck of patients. Grade 3-4 cetuximab-induced infusion reactions (CI-IRs) occur in 2% of patients with colorectal cancer. Despite the 2.7% CI-IR rate in the EXTREME trial, higher rates were reported in small series of patients with head and neck squamous cell carcinoma (HNSCC) (6%-18%). There is an urgent need to better appraise the natural history and the predictive factors for CI-IRs in patients with HNSCC exposed to cetuximab. METHODS: The medical records from patients with HNSCC (n=428) treated by cetuximab at Gustave Roussy from January 2013 to December 2015 were reviewed. The impact of potential risk factors was analysed. RESULTS: Out of 428 patients, 24 patients (5.4%) presented CI-IR, including grade 3-4 (95.7%); about 21% (5/24) requiring intensive care unit referral and quasi all occurred within the first cycle (21/24). In a multivariate analysis, the occurrence of grade 3-4 CI-IR was associated with tobacco and alcohol history (p=8.5e-3) and with prior allergy history (p=2.9e-3). CI-IRs tended to be associated with poor overall survival in patients with recurrent and metastatic HNSCC and with a higher number of further lines of chemotherapy. CONCLUSION: In real life, CI-IRs appear far more common in patients with HNSCC (5.4%) than reported in prospective trials. This is the largest series of patients ever focusing on the risk of CI-IR in patients with HNSCC. Prior allergy history and tobacco history are associated with CI-IR and could be used to better allocate treatment. Further prospective data are required to confirm these findings.

[Therapeutic aspects of acute renal failure in children]. / Aspecte terapeutice în insuficienta renala acuta la copil.

This article presents the results of a study on 20 children diagnosed with acute renal failure and treated with renal substitution methods at the Iasi IVth Clinic of Pediatric Nephrology in the interval 2003-2008. Treatment by intermittent hemodialysis IHD), peritoneal dialysis (DP), and continuous replacement--hemofiltering (HF) depends on the patient's features and unit resources. The advantages and limitations of every method of treatment are discussed. Future therapies for acute renal failure may find strategies for eliminating the inflammatory response.

[Considerations based on the etiology of acute renal failure in children (study on 110 cases)]. / Consideratii asupra etiologiei insuficientei renale acute la copil (studiu pe 110 cazuri).

The Article highlights the fact that without a homogeneous definition of acute renal injuries of adults and infants, for the last 5 years a new classification system has appeared. The RIFLE pediatric criteria are looked over, validated in 2007 which allow a better IRA classification at infants and allow comparisons between the intensive care units and also allow assumptions on the predictions of the disease. The list of certain causes of IRA at infants is rendered, the genetic background of children with IRA risk is highlighted, the necessity of reevaluating and criteria of evaluating renal functions is underlined. The etiology of renal failure was studied on 110 infants interned on a period of 5 years (2003- 2008) in 2 centers with different profile: The Clinic Of Pediatric Nephrology "Sf. Maria" Iasi and the Intensive Care Compartment of The Pediatric Hospital "Sf. Ioan" Galati.