Track A Basic Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138319/1/jia218438.pd

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Influencia del arenado de la aleacion Ti6Al4V en la dureza subsuperficial y estado de tensiones residuales Influence of sandblasting of Ti6Al4V alloy on the subsurface hardness and residual stresses state

6 pages, 6 figures.[ES] El arenado de la aleación Ti6Al4V es un tratamiento orientado a la mejora de la fijación mecánica de los implantes. Sin embargo, dicho tratamiento contribuye a una disminución de la resistencia a la fatiga del material. En este trabajo se ha determinado, mediante radiación sincrotrón, el estado de tensiones residuales en muestras arenadas de esta aleación y su posterior proceso de relajación tras un recocido a 500 °C. Se observa que el arenado ocasiona un gradiente de tensiones residuales de compresión con valores de hasta unos 700 MPa en las proximidades de la superficie. A pesar de la deformación severa que experimenta el material en esta zona, las medidas de microdureza arrojan valores similares a los obtenidos en el interior del material. Tras el tratamiento térmico se observa una relajación de las tensiones residuales y un importante aumento de la dureza superficial.[EN] Sandblasting of Ti6Al4V alloy is used to enhance mechanical fixation of the implants. Under the mechanical point of view, such treatment yields a decrease of the fatigue resistance. In this work we evaluate by means of synchrotron radiation the residual stress state in sandblasted specimens and the further relaxation process after a thermal oxidation treatment at 500 °C. It has been found a significant compressive stress gradient with a maximum of about 700 MPa near the surface. Despite the severe deformation experienced by the surface during sandblasting microhardness measurements failed to show any sufsurface hardening. A thermal oxidation treatment (500 °C/ 1h) of the sandblasted specimen yield the stress relief and a significant subsurface hardening.Proyectos MAT2006-12948-C04-01, del Ministerio de Educación y Ciencia y Fundación Mutua Madrileña. A BESSY las facilidades para las medidas de las tensiones residuales por difracción de radiación sincrotrón bajo contrato Nº RII 3CT-2004-506008. La Dra. M.M. agradece la financiación de su contrato Juan de la Cierva al Ministerio de Ciencia Innovación. El CIBER de Bioingeniería, Biomateriales y Nanomedicina está financiado por el ISCIII.Peer reviewe

Thermal oxidation of medical Ti6Al4V blasted with ceramic particles effects on the microstructure, residual stresses and mechanical properties

© 2015 Elsevier Ltd. Roughening of Ti6Al4V by blasting with alumina or zirconia particles improves the mechanical fixation of implants by increasing the surface area available for bone/implant apposition. Additional thermal oxidation treatments of the blasted alloy have already shown to be a complementary low-cost solution to enhancing the in vitro biocompatibility and corrosion resistance of the alloy. In this work, the effects of oxidation treatment on a grit blasted Ti6Al4V biomedical alloy have been analysed in order to understand the net effect of the combined treatments on the alloy fatigue properties. Synchrotron radiation diffraction experiments have been performed to measure residual stresses before and after the treatments and microstructural and hardness changes have been determined. Although blasting of Ti6Al4V with small spherical zirconia particles increases the alloy fatigue resistance with respect to unblasted specimens, fatigue strength after oxidation decreases below the unblasted value, irrespective of the type of particle used for blasting. Moreover, at 700. °C the as-blasted compressive residual stresses (700. MPa) are not only fully relaxed but even moderate tensile residual stresses, of about 120. MPa, are found beneath the blasted surfaces. Contrary to expectations, a moderate increase in hardness occurs towards the blasted surface after oxidation treatments. This can be attributed to the fact that grit blasting modifies the crystallographic texture of the Ti6Al4V shifting it to a random texture, which affects the hardness values as shown by additional experiments on cold rolled samples. The results indicate that the oxidation treatment performed to improve biocompatibility and corrosion resistance of grit blasted Ti6Al4V should be carried out with caution since the alloy fatigue strength can be critically diminished below the value required for high load-bearing components.Financial support of MICINN (MAT2009-14695-C04) and MINECO(MAT 2012-37736-C05-01), Spain, is acknowledged. S. Barriuso thanks the JAEPre082-3 of CSIC-UE. The CIBER of Bioingeniería, Biomateriales y Nanomedicina is supported by the ISCIII.Peer Reviewe

As the world grows: contraception in the 21st century

Contraceptives that are readily available and acceptable are required in many poorer countries to reduce population growth and in all countries to prevent maternal morbidity and mortality arising from unintended pregnancies. Most available methods use hormonal steroids or are variations of barrier methods. Reports from several fora over the last 12 years have emphasized the number of unwanted pregnancies and resultant abortions, which indicate an unmet need for safe, acceptable, and inexpensive contraceptive methods. This unmet need can be assuaged, in part, by development of new nonhormonal contraceptive methods. This Review addresses the contribution that the “omic” revolution can make to the identification of novel contraceptive targets, as well as the progress that has been made for different target molecules under development