Medication eluting devices for the field of OBGYN (MEDOBGYN): 3D printed biodegradable hormone eluting constructs, a proof of concept study.

3D printing has the potential to deliver personalized implants and devices for obstetric and gynecologic applications. The aim of this study is to engineer customizable and biodegradable 3D printed implant materials that can elute estrogen and/or progesterone. All 3D constructs were printed using polycaprolactone (PCL) biodegradable polymer laden with estrogen or progesterone and were subjected to hormone-release profile studies using ELISA kits. Material thermal properties were tested using thermogravimetric analysis and differential scanning calorimetry. The 3D printed constructs showed extended hormonal release over a one week period. Cytocompatibility and bioactivity were assessed using a luciferase assay. The hormone-laden 3D printed constructs demonstrated an increase in luciferase activity and without any deleterious effects. Thermal properties of the PCL and hormones showed degradation temperatures above that of the temperature used in the additive manufacturing process-suggesting that 3D printing can be achieved below the degradation temperatures of the hormones. Sample constructs in the shape of surgical meshes, subdermal rods, intrauterine devices and pessaries were designed and printed. 3D printing of estrogen and progesterone-eluting constructs was feasible in this proof of concept study. These custom designs have the potential to act as a form of personalized medicine for drug delivery and optimized fit based on patient-specific anatomy.

Early implementation of continuous renal replacement therapy optimizes casualty evacuation for combat-related acute kidney injury.

BACKGROUND: The purpose of this report was to review the initial use and feasibility of continuous renal replacement therapy (CRRT) among combat casualties in a war zone. Although rapid evacuation to more advanced levels of care has emerged as the standard approach, life-threatening sequelae of acute kidney injury (AKI) can preclude safe patient evacuation. For the first time in US combat casualty care, a sustained, intensivist-led CRRT program was initiated during 2010 at an Air Force theater hospital. METHODS: A prospective study of consecutive US service members (USSMs) who developed combat-related renal failure and underwent CRRT at the Craig Joint Theater Hospital was undertaken. Baseline patient characteristics, indications for CRRT, laboratory values, and outcomes were evaluated. RESULTS: Nine USSMs were treated during 14-months. All were male, with a mean (SD) age of 28 (7) years and mean (SD) Injury Severity Score (ISS) of 34 (12). The dominant mechanism was blast injury (8 of 9), followed by gunshot wound (1 of 9). Most patients were Acute Kidney Injury Network (AKIN) 3 and all developed critical hyperkalemia (mean [SD], peak K⁺ 6.4 [0.4]). The peak plasma creatinine ranged from 1.4 mg/dL to 4.2 mg/dL (mean [SD], 3.3 [0.9] mg/dL). Patients had a mean (SD) of 17.6 [8.1] hours of CRRT before evacuation to higher echelons of care. All USSMs survived to achieve safe evacuation from the combat zone to the regional trauma center in Landstuhl, Germany (Landstuhl Regional Medical Center). Three patients died of multiorgan failure at Landstuhl Regional Medical Center. Six patients survived to undergo additional treatment in the United States. CONCLUSION: Intensivist-led CRRT is an effective therapeutic adjunct in the treatment of combat-related AKI. Provision of this extracorporeal therapy provides physiologic stabilization of casualties who might otherwise succumb to the sequelae of combat-related renal failure. These findings suggest that a self-sustaining CRRT program can be successfully implemented in combat support hospitals.