Comparison of survival prediction models for bone metastases of the extremities following surgery.

Aims: This study aimed to compare the performance of survival prediction models for bone metastases of the extremities (BM-E) with pathological fractures in an Asian cohort, and investigate patient characteristics associated with survival. Methods: This retrospective cohort study included 469 patients, who underwent surgery for BM-E between January 2009 and March 2022 at a tertiary hospital in South Korea. Postoperative survival was calculated using the PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models. Model performance was assessed with area under the curve (AUC), calibration curve, Brier score, and decision curve analysis. Cox regression analyses were performed to evaluate the factors contributing to survival. Results: The SORG model demonstrated the highest discriminatory accuracy with AUC (0.80 (95% confidence interval (CI) 0.76 to 0.85)) at 12 months. In calibration analysis, the PATHfx3.0 and OPTIModel models underestimated survival, while the SPRING13 and IOR models overestimated survival. The SORG model exhibited excellent calibration with intercepts of 0.10 (95% CI -0.13 to 0.33) at 12 months. The SORG model also had lower Brier scores than the null score at three and 12 months, indicating good overall performance. Decision curve analysis showed that all five survival prediction models provided greater net benefit than the default strategy of operating on either all or no patients. Rapid growth cancer and low serum albumin levels were associated with three-, six-, and 12-month survival. Conclusion: State-of-art survival prediction models for BM-E (PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models) are useful clinical tools for orthopaedic surgeons in the decision-making process for the treatment in Asian patients, with SORG models offering the best predictive performance. Rapid growth cancer and serum albumin level are independent, statistically significant factors contributing to survival following surgery of BM-E. Further refinement of survival prediction models will bring about informed and patient-specific treatment of BM-E.

Advancement of Nonwoven Fabrics in Personal Protective Equipment.

While nonwoven fabrics have existed for several decades, their usage in personal protective equipment (PPE) has been met with a rapid surge of demands, in part due to the recent COVID-19 pandemic. This review aims to critically examine the current state of nonwoven PPE fabrics by exploring (i) the material constituents and processing steps to produce fibers and bond them, and (ii) how each fabric layer is integrated into a textile, and how the assembled textiles are used as PPE. Firstly, filament fibers are manufactured via dry, wet, and polymer-laid fiber spinning methods. Then the fibers are bonded via chemical, thermal, and mechanical means. Emergent nonwoven processes such as electrospinning and centrifugal spinning to produce unique ultrafine nanofibers are discussed. Nonwoven PPE applications are categorized as filters, medical usage, and protective garments. The role of each nonwoven layer, its role, and textile integration are discussed. Finally, the challenges stemming from the single-use nature of nonwoven PPEs are discussed, especially in the context of growing concerns over sustainability. Then, emerging solutions to address sustainability issues with material and processing innovations are explored.

Accelerated annealing of fused filament fabricated (FFF) thermoplastics via an improved core-shell filament.

Thermoplastic parts manufactured via fused filament fabrication (FFF) have limited strength and toughness compared to other types of polymer additive and subtractive manufacturing. Low strength results from poor interlayer adhesion, making FFF parts not suitable for most engineering applications. Post processing solutions, such as annealing, enable healing of these interlayers, thus approaching injection molded parts. Prior work demonstrated a core-shell polycarbonate (PC)-acrylonitrile butadiene styrene (ABS) structured dual material filament to provide thermo-structural stability during annealing of the ABS component; however, annealing was limited to relatively low temperatures (135 °C) and required long annealing times (72 h). In the current work, a PC copolymer with a higher glass transition temperature (173 °C) than conventional PC is processed along with an extrusion-grade ABS into a PC-ABS core-shell filament. This improved dual material filament was printed, annealed, and evaluated via Izod impact testing, ultimately yielding 83% of bulk annealed ABS z-direction strength at an accelerated annealing time (8 h) and higher annealing temperature (155-175 °C). A demonstration part is printed with the dual material filament and annealed at 155 °C for 8 h, resulting in excellent dimensional accuracy, and a ductile failure at 73% higher ultimate load compared to the brittle failure of an as-printed part. This work highlights that material selection and design of a bicomponent filament geometry can lead to parts printed with FFF, with increased strength compared to other post-processing techniques at reduced processing times.

Recycled Cellulose Polypropylene Composite Feedstocks for Material Extrusion Additive Manufacturing.

Many types of consumer-grade packaging can be used in material extrusion additive manufacturing processes, providing a high-value output for waste plastics. However, many of these plastics have reduced mechanical properties and increased warpage/shrinkage compared to those commonly used in three-dimensional (3D) printing. The addition of reinforcing materials can lead to stiffer parts with reduced distortion. This paper presents work in the reinforcement of recycled polypropylene using cellulose waste materials to generate a green composite feedstock for extrusion-based polymer additive manufacturing. Recycled polypropylene/waste paper, cardboard, and wood flour composites were made using a solid-state shear pulverization process. Fourier transform infrared and thermogravimetric analysis were utilized to qualitatively analyze the amount of filler incorporated into the 3D-printed materials. Recycled polymer composites had increased levels of filler incorporated in the printed parts compared to the virgin polymer composites based on the thermal gravimetric analysis. The dynamic mechanical analysis showed a ca. 20-30% increase in storage modulus with the addition of cellulose materials. Tensile strength was not significantly increased with the addition of 10 wt % cellulose, but the elastic modulus increased 38% in virgin polypropylene. The analysis of fracture surfaces revealed that failure initiates at the interface, suggesting that the interfacial strength is weaker than the filler strength.

Micafungin versus posaconazole prophylaxis in acute leukemia or myelodysplastic syndrome: A randomized study.

OBJECTIVES: To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). METHODS: Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis. RESULTS: From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. CONCLUSIONS: Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.