EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Control of selective laser melting processes: existing efforts, challenges, and future opportunities

Additive Manufacturing (AM) or widely known as 3D printing is a technology for producing parts directly from the computer without the need for traditional tools. The technology provides fast production for complex shapes with higher properties. Selective Laser Melting (SLM) is one of AM technologies that is used to produce metallic parts. For the last twenty years, the technique attracted the attention of both industry and academia. The complexity of the underlying physics and the fast dynamics during the process degraded the quality of the produced parts and hampered widespread adoption of the technology. A significant emphasis on the importance of on-line control systems to achieve higher levels of quality and repeatability can be found in the literature. In this review paper, we fill an important gap in the literature represented by the absence of one single source that describes what has been accomplished and gives an insight into what still needs to be achieved in the field of process control for metal-based AM processes. The article ends by discussing future opportunities in the associated on-line control system development

Analytical comparison between in-situ control strategies for selective laser melting process

The selective laser melting process is an additive manufacturing technique that draws the attention of researchers and developers in academia and industry in the last two decades. The technique is capable to produce sophisticated industrial tools and parts in fewer steps saving many traditional manufacturing steps and time. However, the technique with the current structure misses the online control strategies that can enhance the overall performance of the system as many researchers emphasise. This work will present a comparison between the performance of three well-known industrial control strategies with the process, to illustrate the strength and weaknesses in addition to addressing the key challenges and some online research opportunities in the field

Initial investigation of online control system for selective laser melting process: multi-layer level

Selective Laser Melting (SLM), an additive manufacturing process, has attracted significant attention from academia and industry over the past two decades. SLM is a productive technique for creating complex industrial components and tools with fewer stages, resulting in resource conservation in contrast to conventional manufacturing methods. Nonetheless, the current platforms employed in SLM metal part production lack the efficient utilisation of an online closed-loop system. The literature showed a significant place for utilising advanced control systems to improve overall performance. Such enhancement will enable the process to be used to fabricate more sophisticated parts. Introducing an online control system could also empower part production with better internal microstructure characteristics. This research reports an initial investigation of applying a closed-loop system to reduce the effect of heat accumulation while building a multi-layer object, thus improving the system. The controller changes the laser input in the track and considers the temperature residuals for the completed layers. The simulation results presented a significant improvement in disturbance rejection and better control of the melt-pool characteristics

Fuzzy logic control in metal additive manufacturing : a literature review and case study

Since the development of the Fuzzy Logic theory by Zadah (1965), motivated by the human-level understanding of systems for the development of computational and mathematical frameworks, it has become an active research field for a broad spectrum of research in academia and the industry, from systems modelling to systems monitoring and control. In this research, the authors intend to highlight the use of Fuzzy Logic theory in metal additive manufacturing processes. The modelling of such processes has a lot of uncertainties due to the large underlying physics during the operation, which makes the Fuzzy Logic Controller a promising tool to deal with such a process. This work will provide a survey of the previous efforts and a case study to illustrate the approach’s effectiveness in such a complex manufacturing technique

HTRA2 defect: A recognizable inborn error of metabolism with 3-methylglutaconic aciduria as discriminating feature characterized by neonatal movement disorder and epilepsy-report of 11 patients.

Neonatal-onset movement disorders, especially in combination with seizures, are rare and often related to mitochondrial disorders. 3-methylglutaconic aciduria (3-MGA-uria) is a marker for mitochondria) dysfunction. In particular, consistently elevated urinary excretion of 3-methylglutaconic acid is the hallmark of a small but growing group of inborn errors of metabolism (IEM) due to defective phospholipid remodeling or mitochondrial membrane-associated disorders (mutations in TAZ, SERAC1, OPA3, CLPB, DNAJC19, TMEM70, TIMM50). Exome/genome sequencing is a powerful tool for the diagnosis of the clinically and genetically heterogeneous mitochondrial disorders. Here, we report 11 individuals, of whom 2 are previously unpublished, with biallelic variants in high temperature requirement protein A2 (HTRA2) encoding a mitochondria-localized serine protease. All individuals presented a recognizable phenotype with neonatal- or infantile-onset neurodegeneration and death within the first month of life. Hallmark features were central hypopnea/apnea leading to respiratory insufficiency, seizures, neutropenia, 3-MGA-uria, tonus dysregulation, and dysphagia. Tremor, jitteriness, dystonia, and/or clonus were also common. HTRA2 defect should be grouped under the IEM with 3-MGA-uria as discriminating feature. Clinical characteristics overlap with other disorders of this group suggesting a common underlying pathomechanism. Urinary organic acid analysis is a noninvasive and inexpensive test that can guide further genetic testing in children with suggestive clinical findings

Modelisation physique des profils sismiques de subsurface : application a la detection de cavites

SIGLECNRS T Bordereau / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc