Dynamic prediction of mortality in COVID-19 patients in the intensive care unit: A retrospective multi-center cohort study.

Background: The COVID-19 pandemic continues to overwhelm intensive care units (ICUs) worldwide, and improved prediction of mortality among COVID-19 patients could assist decision making in the ICU setting. In this work, we report on the development and validation of a dynamic mortality model specifically for critically ill COVID-19 patients and discuss its potential utility in the ICU. Methods: We collected electronic medical record (EMR) data from 3222 ICU admissions with a COVID-19 infection from 25 different ICUs in the Netherlands. We extracted daily observations of each patient and fitted both a linear (logistic regression) and non-linear (random forest) model to predict mortality within 24 h from the moment of prediction. Isotonic regression was used to re-calibrate the predictions of the fitted models. We evaluated the models in a leave-one-ICU-out (LOIO) cross-validation procedure. Results: The logistic regression and random forest model yielded an area under the receiver operating characteristic curve of 0.87 [0.85; 0.88] and 0.86 [0.84; 0.88], respectively. The recalibrated model predictions showed a calibration intercept of -0.04 [-0.12; 0.04] and slope of 0.90 [0.85; 0.95] for logistic regression model and a calibration intercept of -0.19 [-0.27; -0.10] and slope of 0.89 [0.84; 0.94] for the random forest model. Discussion: We presented a model for dynamic mortality prediction, specifically for critically ill COVID-19 patients, which predicts near-term mortality rather than in-ICU mortality. The potential clinical utility of dynamic mortality models such as benchmarking, improving resource allocation and informing family members, as well as the development of models with more causal structure, should be topics for future research.

Endoscopically-assisted single-bundle posterior cruciate ligament reconstruction: results at minimum ten-year follow-up.

We evaluated the long-term outcome of isolated endoscopically-assisted posterior cruciate ligament reconstruction in 26 patients using hamstring tendon autografts after failure of conservative management. At ten years after surgery the mean International Knee Documentation Committee subjective knee score was 87 (SD 14) of a possible 100 points. Regular participation in moderate to strenuous activities was possible for only seven patients pre-operatively; this increased to 23 patients post-operatively. The mean Lysholm score improved from 64 (SD 15) to 90 (SD 14) at ten years (p = 0.001). At ten years endoscopic reconstruction of the posterior cruciate ligament with hamstring tendon autograft is effective in reducing knee symptoms. Of the series, 22 patients underwent radiological assessment for the development of osteoarthritis using the Kellgren-Lawrence grading scale. In four patients, grade 2 changes with loss of joint space was observed and another four patients showed osteophyte formation with moderate joint space narrowing (grade 3). These findings compared favourably with non-operatively managed injuries of the posterior cruciate ligament. This procedure for symptomatic patients with posterior cruciate ligament laxity who have failed conservative management offers good results.

The xenograft antigen in complex with GS-1-B4 lectin: crystallization and preliminary X-ray analysis.

The implantation of animal organs is one approach to overcoming the shortage of human donor organs for medical transplantation. Although readily available, non-primate tissues are subject to hyperacute rejection wherein human anti-Galalpha(1-3)Gal antibodies react with haptens present on the transplanted cells' surfaces. The understanding of this interaction on a molecular level will further the development of a strategy for the prevention of hyperacute rejection in xenotransplantation. The Galalpha(1-3)Gal hapten ('xenograft antigen') has been cocrystallized with the Gal-specific B(4) isolectin of Griffonia simplicifolia lectin-1. Crystals were analyzed by cryocrystallography and were found to diffract to moderately high resolution on a rotating-anode X-ray source. They belong to the P2(1)2(1)2 space group, with unit-cell parameters a = 111.0, b = 51.3, c = 76.9 A, and contain two molecules per asymmetric unit.

Bondgraph modelling and simulation of the dynamic behaviour of above-knee prostheses.

A mathematical model was used to investigate the dynamic behaviour of an above-knee (AK) prosthesis in the swing phase and to analyse the influence of mass and mass distribution on the maximal stump load and the required energy. The model consists of a bondgraph model of the prosthesis and a "walking" model which predicts the walking velocity, step length and the femoral trajectory. Equipment was developed to measure the inertial properties of the components of the prosthesis. Through computer simulation, stickdiagrams of the swing phase and graphs of the variation with time of the hip and stump forces were obtained. It was found that for a normal AK prosthesis with a knee-lock mechanism the axial stump load is greatest at the beginning and at the end of the swing phase. At a walking velocity of 5 km/hr the maximum axial stump load amounts to 2.1 times the static weight of the prosthesis. The maximum axial stump force appeared to be almost directly proportional to the total mass of the prosthesis but independent of the mass distribution. The required energy also increased with the mass of the prosthesis but is dependent on mass distribution. Because of their comparable weights the influence of the shoe is almost equal to the influence of the prosthetic foot. Thus lightweight shoes should be used with lightweight prosthetic feet in order to add to their advantages.