Characterization of Virgin, Re-Used, and Oxygen-Reduced Copper Powders Processed by the Plasma Spheroidization Process

Fabrication of parts with high mechanical properties heavily depend on the quality of powder deployed in the fabrication process. Copper powder in three different powder types were spheroidized using radio-frequency inductively coupled plasma (ICP) spheroidization process (TekSphero-15 system). The characterized powders include virgin powder as purchased from the powder manufacturer, powder used in electron beam powder bed fusion (EB-PBF) process, and reconditioned powder, which was used powder that underwent an oxygen-reduction treatment. The goal of spheroidizing these powder types was to evaluate the change in powder morphology, the possibility of enhancing the powder properties back to their as-received conditions, and assess oxygen reduction of the powder lots given their initial oxygen contents. Also, to investigate the impact of re-spheroidization on powder properties, the second round of spheroidization was performed on the already used-spheroidized powder. The impact of powder type on powder sphericity and particle size distribution was evaluated using the image analysis of scanning electron microscope (SEM) micrographs and laser diffraction, respectively. The spheroidized powder showed higher sphericity and more uniform particle size distribution overall. Depending on the powder collection bin, second round of spheroidization affected the powder sphericity differently. The possibility of deploying the plasma spheroidization process as an alternative oxygen-reduction technique was also investigated through tracking the powders\u27 oxygen content using inert gas fusion method before and after the spheroidization. The plasma spheroidized powder showed less oxygen content than the hydrogen-treated powder. The second round of spheroidization caused no change in oxygen content. The correlation between oxygen-reduction and created cracks was discussed and compared between plasma spheroidization and hydrogen-treatment. The plasma spheroidization process created a powder with higher sphericity, uniform particle size, and less oxygen content

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Ruxolitinib for Glucocorticoid-Refractory Acute Graft-versus-Host Disease

BACKGROUND: Acute graft-versus-host disease (GVHD) remains a major limitation of allogeneic stem-cell transplantation; not all patients have a response to standard glucocorticoid treatment. In a phase 2 trial, ruxolitinib, a selective Janus kinase (JAK1 and JAK2) inhibitor, showed potential efficacy in patients with glucocorticoid-refractory acute GVHD. METHODS: We conducted a multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitinib (10 mg twice daily) with the investigator's choice of therapy from a list of nine commonly used options (control) in patients 12 years of age or older who had glucocorticoid-refractory acute GVHD after allogeneic stem-cell transplantation. The primary end point was overall response (complete response or partial response) at day 28. The key secondary end point was durable overall response at day 56. RESULTS: A total of 309 patients underwent randomization; 154 patients were assigned to the ruxolitinib group and 155 to the control group. Overall response at day 28 was higher in the ruxolitinib group than in the control group (62% [96 patients] vs. 39% [61]; odds ratio, 2.64; 95% confidence interval [CI], 1.65 to 4.22; P<0.001). Durable overall response at day 56 was higher in the ruxolitinib group than in the control group (40% [61 patients] vs. 22% [34]; odds ratio, 2.38; 95% CI, 1.43 to 3.94; P<0.001). The estimated cumulative incidence of loss of response at 6 months was 10% in the ruxolitinib group and 39% in the control group. The median failure-free survival was considerably longer with ruxolitinib than with control (5.0 months vs. 1.0 month; hazard ratio for relapse or progression of hematologic disease, non-relapse-related death, or addition of new systemic therapy for acute GVHD, 0.46; 95% CI, 0.35 to 0.60). The median overall survival was 11.1 months in the ruxolitinib group and 6.5 months in the control group (hazard ratio for death, 0.83; 95% CI, 0.60 to 1.15). The most common adverse events up to day 28 were thrombocytopenia (in 50 of 152 patients [33%] in the ruxolitinib group and 27 of 150 [18%] in the control group), anemia (in 46 [30%] and 42 [28%], respectively), and cytomegalovirus infection (in 39 [26%] and 31 [21%]). CONCLUSIONS: Ruxolitinib therapy led to significant improvements in efficacy outcomes, with a higher incidence of thrombocytopenia, the most frequent toxic effect, than that observed with control therapy

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Proyecto Profesional 1 - II167 - 202100

Descripción: El curso Proyecto Profesional 1 es un curso de verificación en el que el estudiante desarrolla un proyecto de Ingeniería Industrial bajo las condiciones, recursos y limitaciones de un trabajo real. El proyecto se concluye en el curso de Proyecto Profesional 3. El curso comprende la identificación de un problema a resolver, el soporte teórico correspondiente, y el análisis y diagnóstico de la situación o problema. A lo largo del desarrollo del proyecto, el estudiante demuestra el adecuado uso de criterios de ciencias e ingeniería, así como de técnicas y herramientas de la Ingeniería Industrial. Los proyectos se desarrollan principalmente bajo las modalidades de proyectos de mejora o investigación, correspondiendo en todos los casos al diseño o rediseño de procesos o sistemas de producción de bienes y servicios, proporcionando una solución o propuesta dentro del ámbito de la Ingeniería Industrial. Propósito: El curso Proyecto Profesional 1 permite al estudiante desarrollar un proyecto de Ingeniería Industrial aplicando los conceptos, técnicas y herramientas aprendidos a lo largo de la carrera, bajo condiciones, recursos y limitaciones de un trabajo real. El curso contribuye directamente al desarrollo de las competencias generales 1Comunicación Oral, Razonamiento Cuantitativo y Ciudadanía, todas a nivel 2 y a las competencias específicas de ABET : (4) Capacidad de reconocer responsabilidades éticas y profesionales en situaciones de ingeniería y emitir juicios informados, que deben considerar el impacto de las soluciones de ingeniería en contextos globales, económicos, ambientales y sociales. (Nivel 2) (5) Capacidad de funcionar efectivamente en un equipo cuyos miembros juntos proporcionan liderazgo, crean un entorno colaborativo e inclusivo, establecen objetivos, planifican tareas y cumplen objetivos. (Nivel 3) (6) Capacidad de desarrollar y llevar a cabo una experimentación adecuada, analizar e interpretar datos, y usar el juicio de ingeniería para sacar conclusiones. (Nivel 3) (7) Capacidad de adquirir y aplicar nuevos conocimientos según sea necesario, utilizando estrategias de aprendizaje apropiadas. (Nivel 2) Los requisitos del curso son: IS221 Gerencia de Proyectos y II163 Seminario de Investigación Aplicada

Proyecto de Investigación Aplicada 1 - IN45 - 202102

Descripción: El curso Proyecto de Investigación Aplicada 1 es un curso de verificación en el que el estudiante desarrolla un proyecto de Ingeniería Industrial bajo las condiciones, recursos y limitaciones de un trabajo real. El proyecto se concluye en el curso de Proyecto de Investigación Aplicada 2. El curso comprende la identificación de un 1problema a resolver, el soporte teórico correspondiente, el análisis y diagnóstico de la situación o problema, y el diseño y desarrollo de las propuestas de mejora. A lo largo del desarrollo del proyecto, el estudiante demuestra el adecuado uso de criterios de ciencias e ingeniería, así como de técnicas y herramientas de la Ingeniería Industrial. Los proyectos se desarrollan principalmente bajo las modalidades de proyectos de mejora o investigación, correspondiendo en todos los casos al diseño o rediseño de procesos o sistemas de producción de bienes y servicios, proporcionando una solución o propuesta dentro del ámbito de la Ingeniería Industrial. Propósito: El curso Proyecto de Investigación Aplicada 1 permite al estudiante desarrollar un proyecto de Ingeniería Industrial aplicando los conceptos, técnicas y herramientas aprendidos a lo largo de la carrera, bajo condiciones, recursos y limitaciones de un trabajo real. El curso contribuye directamente al desarrollo de las competencias generales Comunicación Oral, Comunicación Escrita y Pensamiento Crítico, todas a nivel 3 y a las competencias específicas de ABET: (2) Tiene la capacidad de aplicar el diseño de ingeniería para producir soluciones que satisfagan las necesidades especificas con consideraciones de salud publica seguridad y bienestar, así como factores globales, culturales, sociales, ambientales y económicos. (nivel 3) (6) Tiene la capacidad de desarrollar y llevar a cabo una experimentación adecuada, analizar e interpretar datos, y usar el juicio de ingeniería para sacar conclusiones. (nivel 3) (7) Tiene la capacidad de adquirir y aplicar nuevos conocimientos según sea necesario, utilizando estrategias de aprendizaje apropiadas. (nivel 3) Los requisitos del curso son: IN216 Gerencia de Proyectos, IN97 Logística Integrada y Cadena de Abastecimientos e IN397 Seminario de Investigación Académica II (Ing)

Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C : A prospective observational study

Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with ≥2 clinical signs/symptoms of NP-C were considered 'suspected NP-C' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI ≥70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 [4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores ≥70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis

Proyecto de Investigación Aplicada 1 - IN45 - 202101

1Descripción: El curso Proyecto de Investigación Aplicada 1 es un curso de verificación en el que el estudiante desarrolla un proyecto de Ingeniería Industrial bajo las condiciones, recursos y limitaciones de un trabajo real. El proyecto se concluye en el curso de Proyecto de Investigación Aplicada 2. El curso comprende la identificación de un problema a resolver, el soporte teórico correspondiente, el análisis y diagnóstico de la situación o problema, y el diseño y desarrollo de las propuestas de mejora. A lo largo del desarrollo del proyecto, el estudiante demuestra el adecuado uso de criterios de ciencias e ingeniería, así como de técnicas y herramientas de la Ingeniería Industrial. Los proyectos se desarrollan principalmente bajo las modalidades de proyectos de mejora o investigación, correspondiendo en todos los casos al diseño o rediseño de procesos o sistemas de producción de bienes y servicios, proporcionando una solución o propuesta dentro del ámbito de la Ingeniería Industrial. Propósito: El curso Proyecto de Investigación Aplicada 1 permite al estudiante desarrollar un proyecto de Ingeniería Industrial aplicando los conceptos, técnicas y herramientas aprendidos a lo largo de la carrera, bajo condiciones, recursos y limitaciones de un trabajo real. El curso contribuye directamente al desarrollo de las competencias generales Comunicación Oral, Comunicación Escrita y Pensamiento Crítico, todas a nivel 3 y a las competencias específicas de ABET: (2) Tiene la capacidad de aplicar el diseño de ingeniería para producir soluciones que satisfagan las necesidades especificas con consideraciones de salud publica seguridad y bienestar, así como factores globales, culturales, sociales, ambientales y económicos. (nivel 3) (6) Tiene la capacidad de desarrollar y llevar a cabo una experimentación adecuada, analizar e interpretar datos, y usar el juicio de ingeniería para sacar conclusiones. (nivel 3) (7) Tiene la capacidad de adquirir y aplicar nuevos conocimientos según sea necesario, utilizando estrategias de aprendizaje apropiadas. (nivel 3) Los requisitos del curso son: IN216 Gerencia de Proyectos, IN97 Logística Integrada y Cadena de Abastecimientos e IN397 Seminario de Investigación Académica II (Ing)