Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Freedom of design, mass customisation, waste minimisation and the ability to manufacture complex structures, as well as fast prototyping, are the main benefits of additive manufacturing (AM) or 3D printing. A comprehensive review of the main 3D printing methods, materials and their development in trending applications was carried out. In particular, the revolutionary applications of AM in biomedical, aerospace, buildings and protective structures were discussed. The current state of materials development, including metal alloys, polymer composites, ceramics and concrete, was presented. In addition, this paper discussed the main processing challenges with void formation, anisotropic behaviour, the limitation of computer design and layer-by-layer appearance. Overall, this paper gives an overview of 3D printing, including a survey on its benefits and drawbacks as a benchmark for future research and development.

Additive manufacturing (3D printing): A review of materials, methods, applications and challenges

Additive manufacturing (AM) alias 3D printing translates computer-aided design (CAD) virtual 3D models into physical objects. By digital slicing of CAD, 3D scan, or tomography data, AM builds objects layer by layer without the need for molds or machining. AM enables decentralized fabrication of customized objects on demand by exploiting digital information storage and retrieval via the Internet. The ongoing transition from rapid prototyping to rapid manufacturing prompts new challenges for mechanical engineers and materials scientists alike. Because polymers are by far the most utilized class of materials for AM, this Review focuses on polymer processing and the development of polymers and advanced polymer systems specifically for AM. AM techniques covered include vat photopolymerization (stereolithography), powder bed fusion (SLS), material and binder jetting (inkjet and aerosol 3D printing), sheet lamination (LOM), extrusion (FDM, 3D dispensing, 3D fiber deposition, and 3D plotting), and 3D bioprinting....

Polymers for 3D Printing and Customized Additive Manufacturing

Two-photon excitation provides a means of activating chemical or physical processes with high spatial resolution in three dimensions and has made possible the development of three-dimensional fluorescence imaging, optical data storage, and lithographic microfabrication. These applications take advantage of the fact that the two-photon absorption probability depends quadratically on intensity, so under tight-focusing conditions, the absorption is confined at the focus to a volume of order λ3 (where λ is the laser wavelength). Any subsequent process, such as fluorescence or a photoinduced chemical reaction, is also localized in this small volume. Although three-dimensional data storage and microfabrication have been illustrated using two-photon-initiated polymerization of resins incorporating conventional ultraviolet-absorbing initiators, such photopolymer systems exhibit low photosensitivity as the initiators have small two-photon absorption cross-sections (δ). Consequently, this approach requires high laser power, and its widespread use remains impractical. Here we report on a class of π;-conjugated compounds that exhibit large δ (as high as 1, 250 × 10−50 cm4 s per photon) and enhanced two-photon sensitivity relative to ultraviolet initiators. Two-photon excitable resins based on these new initiators have been developed and used to demonstrate a scheme for three-dimensional data storage which permits fluorescent and refractive read-out, and the fabrication of three-dimensional micro-optical and micromechanical structures, including photonic-bandgap-type structures.

Two-photon polymerization initiators for three-dimensional optical data storage and microfabrication

New microproducts need the utilization of a diversity of materials and have complicated three-dimensional (3D) microstructures with high aspect ratios. To date, many micromanufacturing processes have been developed but specific class of such processes are applicable for fabrication of functional and true 3D microcomponents/assemblies. The aptitude to process a broad range of materials and the ability to fabricate functional and geometrically complicated 3D microstructures provides the additive manufacturing (AM) processes some profits over traditional methods, such as lithography-based or micromachining approaches investigated widely in the past. In this paper, 3D micro-AM processes have been classified into three main groups, including scalable micro-AM systems, 3D direct writing, and hybrid processes, and the key processes have been reviewed comprehensively. Principle and recent progress of each 3D micro-AM process has been described, and the advantages and disadvantages of each process have been presented.

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A review on 3D micro-additive manufacturing technologies

Interest in multifunctional structures made automatically from multiple materials poses a challenge for today's additive manufacturing (AM) technologies; however the ability to process multiple materials is a fundamental advantage to some AM technologies. The capability to fabricate multiple material parts can improve AM technologies by either optimising the mechanical properties of the parts or providing additional functions to the final parts. The objective of this paper is to give an overview on the current state of the art of multiple material AM technologies and their practical applications. In this paper, multiple material AM processes have been classified and the principles of the key processes have been reviewed comprehensively. The advantages and disadvantages of each process, recent progress, challenging technological obstacles, the possible strategies to overcome these barriers, and future trends are also discussed.

Multiple material additive manufacturing – Part 1: a review

There has been a trend in recent years to develop polyetheretherketone (PEEK)-based medical devices due to the excellent cell biocompatibility and desirable mechanical properties of PEEK, which has elastic modulus comparable to cortical bone. Different manufacturing techniques such as injection moulding, particulate leaching, compression moulding, and selective laser sintering (SLS) have been used to produce porous PEEK for biomedical applications. Despite a large number of publications on extrusion-based additive manufacturing (AM) of porous structures using various materials, there have been very few general reports on extrusion AM of low quality small PEEK parts without defects such as warpage and delamination and no further assessment of mechanical properties. Successful low-cost 3D printing of PEEK structures using filament-based extrusion AM process is reported in this paper for the first time. Hot extrusion head design, extrusion temperature, and ambient temperature were identified as impor...

Extrusion-based additive manufacturing of PEEK for biomedical applications

Various parameters, such as binder properties, printing layer thickness, powder size, and binder saturation level, have effects on the strength and surface finish of the three-dimensional printing (3D printing) process. The objective of this research is to study the effects of two parameters of layer thickness and binder saturation level on mechanical strength, integrity, surface quality, and dimensional accuracy in the 3D printing process. Various specimens include tensile and flexural test specimens and individual network structure specimens are made by the 3D printing process under different layer thicknesses and binder saturation by use of ZCorp.'s ZP102 powder and Zb56 binder. Two printing layer thicknesses, 0.1 and 0.087 mm, are evaluated at 90% and 125% binder saturation levels. Experimental findings show that under the same layer thickness, increment of binder saturation level from 90% to 125% would result in an increase of tensile and flexural strengths of the specimens and decrease of dimensional accuracy and surface uniformity of specimens. On the other hand, under the same binder saturation conditions, increase in layer thickness from 0.087 to 0.1 mm would decrease tensile strength and increase flexural strength. Also, it gives better uniformity on the surface.

Effects of layer thickness and binder saturation level parameters on 3D printing process

Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM.

Mohammad Vaezi

Papers

A review on 3D micro-additive manufacturing technologies

Multiple material additive manufacturing – Part 1: a review

Extrusion-based additive manufacturing of PEEK for biomedical applications

Effects of layer thickness and binder saturation level parameters on 3D printing process

Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery?