A Review on Additive Manufacturing of Micromixing Devices.

In recent years, additive manufacturing has gained importance in a wide range of research applications such as medicine, biotechnology, engineering, etc. It has become one of the most innovative and high-performance manufacturing technologies of the moment. This review aims to show and discuss the characteristics of different existing additive manufacturing technologies for the construction of micromixers, which are devices used to mix two or more fluids at microscale. The present manuscript discusses all the choices to be made throughout the printing life cycle of a micromixer in order to achieve a high-quality microdevice. Resolution, precision, materials, and price, amongst other relevant characteristics, are discussed and reviewed in detail for each printing technology. Key information, suggestions, and future prospects are provided for manufacturing of micromixing machines based on the results from this review.

ECCO2R therapy in the ICU: consensus of a European round table meeting.

BACKGROUND: With recent advances in technology, patients with acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (ae-COPD) could benefit from extracorporeal CO2 removal (ECCO2R). However, current evidence in these indications is limited. A European ECCO2R Expert Round Table Meeting was convened to further explore the potential for this treatment approach. METHODS: A modified Delphi-based method was used to collate European experts' views to better understand how ECCO2R therapy is applied, identify how patients are selected and how treatment decisions are made, as well as to identify any points of consensus. RESULTS: Fourteen participants were selected based on known clinical expertise in critical care and in providing respiratory support with ECCO2R or extracorporeal membrane oxygenation. ARDS was considered the primary indication for ECCO2R therapy (n = 7), while 3 participants considered ae-COPD the primary indication. The group agreed that the primary treatment goal of ECCO2R therapy in patients with ARDS was to apply ultra-protective lung ventilation via managing CO2 levels. Driving pressure (≥ 14 cmH2O) followed by plateau pressure (Pplat; ≥ 25 cmH2O) was considered the most important criteria for ECCO2R initiation. Key treatment targets for patients with ARDS undergoing ECCO2R included pH (> 7.30), respiratory rate (< 25 or < 20 breaths/min), driving pressure (< 14 cmH2O) and Pplat (< 25 cmH2O). In ae-COPD, there was consensus that, in patients at risk of non-invasive ventilation (NIV) failure, no decrease in PaCO2 and no decrease in respiratory rate were key criteria for initiating ECCO2R therapy. Key treatment targets in ae-COPD were patient comfort, pH (> 7.30-7.35), respiratory rate (< 20-25 breaths/min), decrease of PaCO2 (by 10-20%), weaning from NIV, decrease in HCO3- and maintaining haemodynamic stability. Consensus was reached on weaning protocols for both indications. Anticoagulation with intravenous unfractionated heparin was the strategy preferred by the group. CONCLUSIONS: Insights from this group of experienced physicians suggest that ECCO2R therapy may be an effective supportive treatment for adults with ARDS or ae-COPD. Further evidence from randomised clinical trials and/or high-quality prospective studies is needed to better guide decision making.

Mechanical Characterisation and Analysis of a Passive Micro Heat Exchanger.

Heat exchangers are widely used in many mechanical, electronic, and bioengineering applications at macro and microscale. Among these, the use of heat exchangers consisting of a single fluid passing through a set of geometries at different temperatures and two flows in T-shape channels have been extensively studied. However, the application of heat exchangers for thermal mixing over a geometry leading to vortex shedding has not been investigated. This numerical work aims to analyse and characterise a heat exchanger for microscale application, which consists of two laminar fluids at different temperature that impinge orthogonally onto a rectangular structure and generate vortex shedding mechanics that enhance thermal mixing. This work is novel in various aspects. This is the first work of its kind on heat transfer between two fluids (same fluid, different temperature) enhanced by vortex shedding mechanics. Additionally, this research fully characterise the underlying vortex mechanics by accounting all geometry and flow regime parameters (longitudinal aspect ratio, blockage ratio and Reynolds number), opposite to the existing works in the literature, which usually vary and analyse blockage ratio or longitudinal aspect ratio only. A relevant advantage of this heat exchanger is that represents a low-Reynolds passive device, not requiring additional energy nor moving elements to enhance thermal mixing. This allows its use especially at microscale, for instance in biomedical/biomechanical and microelectronic applications.

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self-care: impact on outcomes.

AIM: To evaluate the abilities to perform essential tasks for heart failure (HF) self-management in elderly patients, and its influence on post-discharge prognosis. METHODS AND RESULTS: Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self-administered questionnaire European HF Self-care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self-care on 1-year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1 years. On average, patients could perform 2.9 ± 1.6 of self-care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self-care education had slight better performance (3.2 ± 1.6 vs 2.8 ± 1.6, P < 0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r = -0.135; P = 0.006). One-year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P = 0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32-1.03; and HR 0.40; 95% CI 0.21-0.77, respectively], without differences in readmissions. CONCLUSION: Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self-care. Self-perception of care was poorly correlated with real ability, and poor self-care ability was associated with higher 1-year mortality risk.

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor / Cesarean section classification according to Robson's Groups in two comparative periods at the Manacor Hospital

Objetivo. Identificar los grupos de mujeres en los que cambian las tasas de cesáreas durante dos periodos comparativos. Sujetos y métodos. Revisamos los partos del Hospital de Manacor en 2000-1 y 2005-6, mediante el análisis retrospectivo de las historias clínicas, agrupándolos según la Clasificación de Robson. Resultados. El porcentaje de cesáreas aumentó del 14 al 18,6%, con un incremento significativo entre las mujeres con feto único en cefálica a término inducidas, o sometidas a cesárea electiva, que son quienes más contribuyen al porcentaje de cesáreas del hospital. Conclusión. Ha aumentado el porcentaje de cesáreas. Con la Clasificación de Robson sabemos qué pacientes contribuyen a ese incremento (AU)

Objective. To identify groups of women with changes in cesarean rates in two different periods. Subjects and methods. Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsonìs classification. Results. The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital. Conclusion. A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase (AU)

[Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service]. / Deterioro funcional durante la hospitalización en ancianos. Beneficios del ingreso en el servicio de geriatría.

INTRODUCTION: In some elderly individuals, hospital admission for acute illness represents a possible loss of autonomy not always related to the reason for hospitalization. The importance of this problem and the possible existence of differences among services are not sufficiently well known. OBJECTIVE: To compare the incidence of functional decline and associated risk factors during hospitalization between an acute care geriatric unit (GU) and an internal medicine (IM) ward. MATERIAL AND METHODS: We performed a prospective, cohort study. Sociodemographic characteristics, comorbidity, cause of admission, severity, use of several hospital practices, mortality rate and functional decline were analyzed. Functional decline was defined as the loss of independence to perform at least one of the basic activities of daily living with respect to preadmission status. The influence of the admitting service was evaluated by a multiple logistic regression model. RESULTS: A total of 379 patients were included (140 in the GU and 239 in IM). Compared with IM, patients in the GU were older (87 vs 81.5; P< .001), had a greater prevalence of dementia and visual alterations and worse previous functional status. The proportion of patients who spent > 48 hours in bed and who received nocturnal medication was lower in the GU. The functional decline rate was greater in IM than in the GU (60.2% vs 48%; P=.04). Length of hospital stay was similar in both groups (7.7 vs 8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization, bed rest for > 48 h, psychotropic drugs, nocturnal medication and physical restraints. In the multivariate analysis, admission to IM was associated with a greater risk of functional decline. CONCLUSIONS: Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.

Deterioro funcional durante la hospitalización en ancianos. Beneficios del ingreso en el servicio de geriatría / Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service

Introducción: el ingreso hospitalario por enfermedad aguda suponepara determinados ancianos de riesgo una pérdida de autonomíano siempre relacionada con la enfermedad causante dedicha hospitalización. La importancia de este problema en nuestromedio sanitario, y si existen diferencias según el servicio enque se produzca el ingreso, no se conocen suficientemente.Objetivo: estudiar la incidencia de deterioro funcional, factoresasociados y diferencias entre los servicios de medicina interna ygeriatría, en ancianos hospitalizados por enfermedad aguda.Material y métodos: estudio prospectivo de cohortes. Analizamoslas características sociodemográficas, la comorbilidad motivode ingreso y gravedad, el uso de varias prácticas hospitalarias,la tasa de mortalidad y de pérdida funcional durante elingreso. Se definió deterioro funcional como la pérdida de autonomíapara al menos una de las actividades básicas de la vidadiaria, con respecto a la situación previa al ingreso. La influenciadel servicio se analizó mediante un modelo de regresión logísticamúltiple.Resultados: estudiamos a 379 pacientes (140 en el servicio degeriatría [SG] y 239 en medicina interna [MI]). Los pacientes ingresadosen SG eran mayores (87 frente a 81,5 años; p < 0,001),había en ellos mayor porcentaje de demencia y alteraciones visualesy eran más dependientes. La proporción de pacientes quepermanecían en cama más de 48 h o recibían medicación nocturnaera menor en el SG. La incidencia de deterioro funcional fuemayor en MI que en el SG (el 60,2 frente al 48%; p = 0,04), conuna estancia hospitalaria similar (7,7 frente a 8,1; p = 0,37). Laedad, el síndrome confusional, la ausencia de movilización, el encamamiento> 48 h, el uso de psicofármacos y sujeciones o demedicación nocturna se asociaron a deterioro funcional. En elanálisis multivariable, el ingreso en MI se asoció a mayor riesgode deterioro funcional...(AU)

Introduction: in some elderly individuals, hospital admission foracute illness represents a possible loss of autonomy not alwaysrelated to the reason for hospitalization. The importance of thisproblem and the possible existence of differences among servicesare not sufficiently well known.Objective: to compare the incidence of functional decline andassociated risk factors during hospitalization between an acutecare geriatric unit (GU) and an internal medicine (IM) ward.Material and methods: we performed a prospective, cohortstudy. Sociodemographic characteristics, comorbidity, cause ofadmission, severity, use of several hospital practices, mortalityrate and functional decline were analyzed. Functional decline wasdefined as the loss of independence to perform at least one of thebasic activities of daily living with respect to preadmission status.The influence of the admitting service was evaluated by a multiplelogistic regression model.Results: a total of 379 patients were included (140 in the GU and239 in IM). Compared with IM, patients in the GU were older(87 vs 81.5; P<.001), had a greater prevalence of dementia andvisual alterations and worse previous functional status. The proportionof patients who spent > 48 hours in bed and who receivednocturnal medication was lower in the GU. The functional declinerate was greater in IM than in the GU (60.2% vs 48%; P=.04).Length of hospital stay was similar in both groups (7.7 vs8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization,bed rest for > 48 h, psychotropic drugs, nocturnal medicationand physical restraints. In the multivariate analysis, admissionto IM was associated with a greater risk of functionaldecline...(AU)

[Maternal and fetal morbidity in obese pregnant women]. / Morbilidad materno-fetal en embarazadas obesas.

OBJECTIVE: To determine the maternal and fetal morbidity in obese pregnant women compared with non-obese pregnant women. PATIENTS AND METHODS: It was carried out a case-control study. There were included 342 patients who had a body mass index previous to the pregnancy of 18.5 to 24.9 (control group) and 342 pregnant women with body mass index > 30 (group of obese women). We registered the mother and newborns' data to evaluate their morbidity. The groups were compared with Student's t test or Mann Whitney's U test for continuous data and chi-square or Fisher exact test for categorical variables. RESULTS: We found more macrosomic newborns in the group of obese women (p = 0.003) and a higher number of caesarean sections (48.8 vs 37.4%, p = 0.003). The maternal morbidity characterized by gestational diabetes was higher in the obese ones (3.5 vs 0.58%, p = 0.015). Other variables as preterm delivery, stillbirths, malformations, admissions to the neonatal intensive care unit, as well as the development of hypertensive disorders of pregnancy were not significant. CONCLUSION: We found higher maternal and fetal morbidity in obese women. Therefore, these patients should be considered as carriers of high-risk pregnancies. This strategy could avoid complications associated to this group of patients.

Medición de la prevalencia de la dermatitis atópicaen una población escolar madrileña / Measuring the prevalence of atopic dermatitis in a school-age population in Madrid

Fundamento: El Grupo de Trabajo para la Dermatitis Atópica del Reino Unido (GTRUDA) ha desarrollado un cuestionario diagnóstico que ha sido validado en sus versiones inglesa y rumana tanto en medio hospitalario como extrahospitalario. Objetivo: Nuestro objetivo era desarrollar una versión española de dicho cuestionario y emplearla para conocer la frecuencia de la enfermedad en la población escolar general del Área sanitaria XI de Madrid. Resultados: La validación en medio hospitalario demostró una sensibilidad del 76,5% con un intervalo de confianza del 95% (IC 95%) del 66,8-84,1%. La especificidad fue del 90,4% (IC 95%: 83,8-94,6%), el valor predictivo positivo (VPP) del 85,7% (IC 95%: 76,4-91,8%) y el valor predictivo negativo (VPN) del 83,6% (IC 95%: 76,3-89%). Cinco colegios fueron seleccionados aleatoriamente y la totalidad de sus alumnos invitados a participar en el estudio. Se examinaron 874 niños (porcentaje de respuesta: 62,9%). La prevalencia de período de un año fue del 9,95% (7,97; 11,94). La prevalencia puntual fue del 7.09% (5,39; 8,80). En el grupo de edad de los 3 a los 7 años la prevalencia de período de un año era del 11,2%, en el grupo de 8 a 12 años del 10,3% y en el grupo de 13 a 17 años del 6,9%. No hubo diferencias estadísticamente significativas al comparar ambos sexos, por edades ni por tipo de colegio (público/privado). Se validó el resultado ofrecido por el cuestionario con el diagnóstico clínico de un dermatólogo en una submuestra de 130 pacientes. Los resultados obtenidos fueron: sensibilidad, 63,6% (31,6; 87,6); especificidad, 96,7% (91,4; 99,0); VPP, 63,6% (31,6; 87,6); VPN, 96, 7% (91,4; 99,0). Conclusiones: Consideramos que la versión española que hemos desarrollado del cuestionario diagnóstico es útil y con buenos resultados, en la línea de los publicados por otros grupos (AU)