Chest Wall Reconstruction Using 3-Dimensional Printing: Functional and Mechanical Results.

BACKGROUND: Tumors involving the chest wall may require extensive resection and reconstruction. This study aims to evaluate functional, cosmetic results, and quality of life (QoL) in patients who had a reconstruction based on patient-specific 3-dimensional (3D) printing. METHODS: The patient-specific chest wall prosthesis was created for 10 patients. The anatomical models were 3D printed and used to produce a silicone mold that was filled with methyl methacrylate to create the customized prosthesis. Evaluation of the reconstruction was completed with a QoL assessment and postoperative tracking of patients' chest motion, using infrared markers. The distance between plot points representing markers on the operated and contralateral sides was measured to assess symmetrical motion. RESULTS: Twenty-three consecutive patients were enrolled, with the median age of 64 years. Thirteen patients underwent a nonrigid reconstruction, and 10 had a patient-specific rigid reconstruction with methyl methacrylate. The median number of ribs resected was 3. No postoperative complications or morbidity related to the prostheses were reported. The median hospital stay in the nonrigid reconstruction group was 8.5 days compared with 7.5 days (p = .167) in the rigid reconstruction group. Postoperatively, most patients had low levels of symptoms, with 82% experiencing chest pain and 53% experiencing dyspnea. Rigid reconstruction patients demonstrated more symmetrical breathing motion compared with nonrigid reconstruction patients. The mean distances were 2.32 ± 2.18 and 7.28 ± 5.87 (P < .00001), respectively. CONCLUSIONS: This study shows that a 3D patient-specific prosthesis is feasible and safe, suggesting a possible trend toward improved breathing mechanics, QoL, and cosmetic results.

A quantitative study of letters to the editor by medical students in medical education journals.

Letters to the Editor offer ways for readers to engage with authors' publications. Letters are the shortest manuscript for medical students to publish and medical-education journals are best suited. The UK Foundation Programme rewards medical students achieving PubMed ID publications and we hypothesise that this is a main motivation for medical students to submit Letters to the Editor. A review of 15 medical-education journals with an impact factor was conducted to identify numbers and percentages of Letters to the Editor by medical students between July 2018 and June 2020. Affiliation of medical students was collected. Our results show over two years, 299 letters were published by medical students equating to 45.9% of total letters. There was a 60% overall increase in letters by medical students published in the first 12 months compared to second 12 months. During this period overall numbers of letters published increased by 27%. 86% of the letters published by medical students over the two-year period were from UK medical schools. Five schools accounted for 60.5% of these letters. The three medical schools with highest numbers of letters published were King's College London, Imperial College London and University of Oxford for both 2018/19 and 2019/20. The increase in letters published overall with greater numbers published by students, may indicate greater awareness of Letters to the Editor as means of dissemination amongst medical students. UK medical schools published large numbers of letters, perhaps reflecting increasing importance to students of publications due to impacting on subsequent jobs. Results from our quantitative research revealing: large numbers of letters by medical students, increase in letters published from 2018/19 to 2019/20 and overrepresentation of UK medical students supports the hypothesis that medical students are publishing letters to achieve PubMed IDs. Further qualitative research is required to test our hypothesis.