Comparison of Stellite coatings on low carbon steel produced by CGS and HVOF spraying

Stellite alloys are of great interest in industries due to a unique combination of high temperature mechanical strength, outstanding wear and corrosion resistance. Different thermal spraying processes are used for deposition of stellite alloys on industrial components. However, the investigations on the structure-property relationship of these alloys produced via different deposition process are limited. This study focuses on the microstructure, oxidation, and tribo-mechanical properties of Stellite 21 deposited by cold gas spraying (CGS) and high velocity oxy-fuel (HVOF) process on a low carbon steel substrate. The coating cross- section was characterized by SEM and optical microscopy. The coatings were further characterised by using nanoindentation, adhesion, and ball-on-disk wear tests. Moreover, XRD tests were run on the powder and the coatings to reveal possible phase transformation during spraying, as well as during wear and oxidation tests. The results showed no phase transformation in the as-sprayed CGS coating, besides higher values of porosity and oxide phase in the HVOF coating. However, an fcc-to-hcp phase transformation occurs at the surface layer of both types of coating during the ball-on-disk wear test. The presence of continuous oxide networks in HVOF coatings leads to delamination during the wear test. Overall, the CGS Stellite 21 coatings exhibit better performance than HVOF coatings in wear and oxidation tests

Effect of cold spray processing parameters on the microstructure, wear, and corrosion behavior of Cu and Cu–Al2O3 coatings deposited on AZ31 alloy substrate

Cold spray coatings represent a newly emerging and recently implemented approach to enhance the poor wear and corrosion resistance of AZ31 magnesium alloy. In this study, the authors applied pure Cu and Cu-50 wt% Al2O3 composite coatings on an AZ31B substrate using the cold spray deposition method and investigated the effects of gas pressure (1, 2, and 3 MPa) and stand-off distance (1, 2, and 3 cm) on their microstructure characteristics. An increase in gas pressure from 1 MPa to 3 MPa resulted in a decrease in porosity, ranging from 33 % to 38 %, across varying stand-off distances. Increasing the stand-off distance from 1 to 3 cm resulted in a nearly four-fold rise in porosity for 2 and 3 MPa pressures and about 1.5 times for 1 MPa. The porosity increased with higher pressure due to the fragmentation of Al2O3 particles but decreased with greater spraying distance due to reduced Al2O3 retention. Additionally, the incorporation of Al2O3 particles into Cu coatings led to a significant improvement in sliding wear resistance, by up to 50 %, compared to the bare substrate. Abrasive wear and delamination were identified as the dominant wear mechanisms for the composite coatings based on friction coefficient values and micromorphology of wear tracks. Electrochemical results indicated a significant increase in the corrosion resistance of the Cu coating compared to both the bare Mg substrate and Cu–Al2O3 coating, attributed to improved resistance to galvanic corrosion

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research