European Society of Anaesthesiology.

Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

A method for microfabrication of three-dimensional structures in free space is presented. Laser-assisted chemical vapor deposition is used to grow a material at a point where a laser beam locally heats the substrate. By moving the substrate relative to the laser beam with a micropositioning system, three-dimensional shapes can be created. Helical shapes are generated utilizing three linear translational axes as well as an additional rotational axis. Tilting the substrate to align the growth direction with the laser beam direction facilitates improved process control. The smallest structures that can be grown with this technique are about 1 μm. Amorphous boron fibers and crystalline boron springs have been manufactured as two examples of micromechanical elements. The amorphous boron fibers show excellent mechanical properties: A modulus of elasticity of 420–450 GPa, a fracture strain of 2.7%–3.7%, and a fracture stress of 12–17 GPa. The crystalline boron springs produced so far display only moderate mechanical characteristics. This is because of the irregular fiber surface with protruding grains and amorphous nodules. Nevertheless, a maximum relative resilience of about 9% for a tightly wound spring has been obtained. The crystal structure of the grains examined show a fair agreement with the β-boron phase, even though distinct deviations are observed. Metastable arrangement of the B12 icosahedral units is suggested as a possible explanation. A high density of (100) twins and stacking faults are identified by transmission electron microscopy. By further process and system development it is believed that micromechanical details can be tailored more or less arbitrarily for different applications.

Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design Prospective cohort study. Setting 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. Methods Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P &lt; 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14–1.17, P &lt; 0.0001) and frailty (CFS &gt; 4): HR, 1.34 (95% CI, 1.18–1.51, P &lt; 0.0001). Conclusions There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

The survival and function of alginate microencapsulated islets is suboptimal when transplanted to the intraperitoneal site of diabetic animals. The large capacity and convenience of the subcutaneous site make it an appropriate and attractive alternative for microencapsulated grafts. Nonencapsulated and high guluronic acid barium-alginate microencapsulated islets were transplanted to the intraperitoneal and subcutaneous sites of diabetic mice. Microencapsulation improved graft success up to 28 days at the intraperitoneal site but not at the subcutaneous site. Samples of microencapsulated islets transplanted into normoglycemic mice confirmed that insulin secretion, insulin content, and adenosine triphosphate content were reduced more significantly in subcutaneous graft islets than intraperitoneal graft islets after 7 days. In addition, a greater proportion of dead cells were observed in the subcutaneous graft islets than in intraperitoneal graft islets after 28 days. We conclude that using alginate microencapsulated islets transplanted to the unmodified subcutaneous site is insufficient to reverse the diabetic state. This finding is likely to be related to the inability of the site to support islet function and viability.