Net-Shape Manufacturing using Hybrid Selective Laser Melting/Hot Isostatic Pressing

Purpose The purpose of this study is to develop a manufacturing technology using hybrid selective laser melting/hot isostatic pressing (SLM/HIP) process to produce full density net-shape components more rapidly and at lower cost than processing by SLM alone. Design/methodology/approach Ti-6Al-4V powder was encapsulated in situ by the production of as-SLMed shell prior to the HIP process. After HIPping, the SLM shell is an integral part of the final component. Finite element (FE) modelling based on pure plasticity theory of porous metal coupled with an iterative procedure has been adopted to simulate HIPping of the encapsulated Ti-6Al-4V powder and SLMed shell. Two demonstrator parts have been modelled, designed, produced and experimentally validated. Geometrical analysis and microstructural characterisation have been carried out to demonstrate the efficiency of the process. Findings The FE model is in agreement with the measured data obtained and confirms that the design of the shell affects the resulting deformed parts. In addition, the scanning electron microscope (SEM) and Electron backscatter diffraction EBSD (EBSD) of the interior and exterior parts reveal a considerably different grain structure and crystallographic orientation with a good bonding between the SLMed shell and HIPped powder. Originality/value An approach to improve SLM productivity by combining it with HIP is developed to further innovate the advanced manufacturing field. The possibility of the hybrid SLS/HIP supported by FEA simulation as a net shape manufacturing process for fabrication of high performance parts has been demonstrated. </jats:sec

Early Cerebrovascular Silent Changes in Long-Standing End-Stage Renal Disease Patients on Hemodialysis Value of Adding Advanced Unenhanced MRI Sequences to Imaging Protocols

Background: End-Stage Renal Disease (ESRD) patients on hemodialysis suffered from many central and peripheral neurological insults. Aim of the work:This study aimed to assess the value of using MRA, MRV, and SWAN sequences in early visualization of the silent cerebrovascular complications in those patients. Patients and Methods: Our study was conducted on forty-five patients with well-documented ESRD on regular hemodialysis for more than 5 years with no neurological manifestation, all undergone unenhanced MRI, DWI with ADC and measuring the ADC value, SWAN, MRA, and MRV. Results: we found that 11% of cases have acute infarction at the basal ganglia region. 36.7% of patients are diagnosed with intracerebral hemorrhage, only 26.7% of them are seen by the conventional MRI, and 16.7% of cases showed microbleeds on SWAN with normal conventional MRI. The sensitivity and specificity of SWAN with ADC value to detect brain hemorrhage are 100% and 88.8% respectively. Conclusion: Visualization of cerebrovascular complications such as infarction, hemorrhage, atherosclerosis, and arterial and venous occlusion using DWI with ADC, MRA, MRV, and SWAN and is very useful in early management and better prognosis of ESRD patients even with silent complications that don’t give up symptoms with high sensitivity and specificity of SWAN in early detection of hemorrhage and microbleeds

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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

GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture

Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment

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

Abstract 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

Efficiency of some organic acids as safe control mean against root and stem rot disease of Coleus forskohlii

Coleus (Coleus forskohlii) is an important medicinal crop containing forskolin in their roots. Root rot is considered the most important disease in coleus, causing serious losses affecting growth and yield. Infected coleus plants showing root and stem rots were collected from Giza gardens and nurseries. The pathogenicity tests of the isolated fungi (Fusarium oxysporum, F. roseum, F. semitectum, F. solani, Macrophomina phaseolina, Pythium splendens and Rhizoctonia solani) revealed the ability of these fungi to cause infection. Application of three organic acids (Ascorbic, oxalic and salicylic acid) each at 250 and 500 ppm, against R. solani, F. semitectum, F. oxysporum and F. solani was performed in the greenhouse. All the tested organic acids reduced significantly disease incidence when used as dipping unrooted cuttings and/or spray plants 30 days after planting or soil drenching under greenhouse conditions particularly at 500 ppm compared with untreated plants. In general, oxalic acid at 500 ppm was more efficient in reducing infection with root and stem rot diseases. As for plant growth parameters, soil drenching with oxalic acid was the best treatment in increasing plant height and branch number compared with the other treatments. However, ascorbic acid was the least effective treatment compared with the other treatments. On the other hand, dual combination of three organic acids was superior on the other treatments and also recorded superiority in peroxidase and polyphenol oxidase enzyme activities