18The increasing prevalence of wound infections caused by antibiotic resistant bacteria is an urgent 19 challenge facing modern medicine. To address this issue the expedient use of antimicrobial metals 20 such as zinc, copper and silver were incorporated into an FDA-approved polymer (polycaprolactone -21 PCL) to produce filaments for 3D printing. These metals have broad-spectrum antimicrobial 22properties, and moreover, copper and zinc can enhance the wound healing process. 3D scanning 23 was used to construct 3D models of a nose and ear to provide the opportunity to customize shape 24 and size of a wound dressing to an individual patient. Hot melt extrusion was used to extrude pellets 25 obtained by vacuum-drying of solutions of PCL and the different metals in order to manufacture 26 metal-homogeneously-loaded filaments. Wound dressings with different shapes were produced with 27 the filaments containing different concentrations of metals. Release of the metals from the dressings 28 was determined by inductively coupled plasma atomic emission spectroscopy. All the different metal 29 dressings show fast release (up to 24 h) followed by slow release (up to 72 h). The antibacterial 30 efficacy of the wound dressings was tested using a thermal activity monitor system, revealing that 31 silver and copper wound dressings had the most potent bactericidal properties. This study shows 32 that 3D scanning and 3D printing, which are becoming simpler and more affordable, have the 33 potential to offer solutions to produce personalised wound dressings.

Metachromatic Leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency of the enzyme arylsulfatase A (ARSA). MLD causes progressive loss of motor function and severe decline in cognitive function, leading to premature death. Early diagnosis of MLD provides the opportunity to begin treatment before the disease progresses and causes severe disability. MLD is not currently included in newborn screening (NBS) in the UK.This study consisted of an online survey, and follow-up semi-structured interviews open to MLD patients or caregivers, aged 18 years and over. The aims of the study were to understand the importance of early diagnosis and to establish the views of families and caregivers of patients with MLD on NBS.A total of 24 patients took part in the survey, representing 20 families (two families had two children with MLD, one family had three children with MLD). Following on from the survey, six parents participated in the interviews. Our data showed diagnostic delay from first symptoms was between 0 and 3 years, with a median of 1 year (n = 18); during this time deterioration was rapid, especially in earlier onset MLD. In patients with late infantile MLD (n = 10), 50% were wheelchair dependent, 30% were unable to speak, and 50% were tube fed when a diagnosis of MLD was confirmed. In patients with early juvenile MLD (n = 5), over half used a wheelchair some of the time, had uncontrollable crying, and difficulty speaking (all 60%) before or at the time of diagnosis. A high degree of support was expressed for NBS among caregivers, 95% described it as very or extremely important and 86% believed detection of MLD at birth would have changed their child’s future. One parent expressed their gratitude for an early diagnosis as a result of familial MLD screening offered at birth and how it had changed their child’s future: “It did and it absolutely has I will be forever grateful for his early diagnosis thanks to his older sister.”The rapid rate of deterioration in MLD makes it an essential candidate for NBS, particularly now the first gene therapy (Libmeldy™) has been approved by the European Medicines Agency. Libmeldy™ has also been recommended as a treatment option in England and Wales by the National Institute for Health and Care Excellence (NICE) and is being made available to patients in Scotland via the Scottish Medicines Consortium’s ultra-orphan pathway.