BACKGROUND: Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR.METHODS: Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height 2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height 2 (CERI). Muscle strength was determined by hand grip strength indexed for height 2 (HGSI). Secondary analyses were performed using parameters not indexed for height 2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS: We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m 2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m 2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m 2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m 2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS: Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
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Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
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OBJECTIVES: The survival and success rate and the quality of survival of partial ceramic restorations bonded employing Immediate (IDS) or Delayed Dentin Sealing (DDS) in vital molar teeth were evaluated in a randomized clinical trial with within-subject comparison study.MATERIALS AND METHODS: 30 patients received two lithium disilicate ceramic (IPS-e.max press, Ivoclar Vivadent) partial restorations on vital first or second molar teeth (N = 60). The two teeth randomly received either IDS (test group, n = 30) or DDS (control group, n = 30). Partial ceramic restorations were luted (Variolink Ultra, Ivoclar Vivadent) two weeks after preparation. Evaluations were performed at 1 week, 12 months and 36 months post-operatively, using qualitative (FDI) criteria. Representative failures were evaluated microscopically (SEM) and by means of simplified qualitative fractography analysis.RESULTS: One absolute failure occurred in the DDS group due to (secondary) caries. The overall survival rate according to Kaplan-Meier after 3 years was 98.3% (FDI criteria score 1-4, n = 59) and the overall success rate was 85% (FDI criteria score 1-3, n = 51), with no significant difference between restorations in the IDS and DDS group (p = 0.32; Kaplan-Meier, Log Rank (Mantel-Cox), CI = 95%). For the quality of the survival, no statistically significant differences were found between IDS and DDS (p = 0.7; Kaplan-Meier, Log Rank (Mantel-Cox), CI = 95%) restorations on any follow-up timepoints for any of the FDI criteria (Wilcoxon, McNemar, p > 0.05)..CONCLUSION: Adhesively luted partial ceramic restorations in vital molar teeth have a good prognosis, however IDS did not show any differences in success and survival rates after 3 years of function.
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The objective was to study the prevalence of eighteen geriatric conditions in older patients at admission, their reporting rate in discharge summaries and the impact of these conditions on mortality and functional decline one year after admission. A prospective multicenter cohort study conducted between 2006 and 2008 in two tertiary university teaching hospitals and one regional teaching hospital in the Netherlands. Patients of 65 years and older, acutely admitted and hospitalized for at least 48 hours, were invited to participate. Eighteen geriatric conditions were assessed at hospital admission, and outcomes (mortality, functional decline) were assessed one year after admission.
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In the literature about web survey methodology, significant e orts have been made to understand the role of time-invariant factors (e.g. gender, education and marital status) in (non-)response mechanisms. Time-invariant factors alone, however, cannot account for most variations in (non-)responses, especially fluctuations of response rates over time. This observation inspires us to investigate the counterpart of time-invariant factors, namely time-varying factors and the potential role they play in web survey (non-)response. Specifically, we study the effects of time, weather and societal trends (derived from Google Trends data) on the daily (non-)response patterns of the 2016 and 2017 Dutch Health Surveys. Using discrete-time survival analysis, we find, among others, that weekends, holidays, pleasant weather, disease outbreaks and terrorism salience are associated with fewer responses. Furthermore, we show that using these variables alone achieves satisfactory prediction accuracy of both daily and cumulative response rates when the trained model is applied to future unseen data. This approach has the further benefit of requiring only non-personal contextual information and thus involving no privacy issues. We discuss the implications of the study for survey research and data collection.
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Even though mango productivity in Ethiopia is low due to moisture stress, there is no report on how such constraint could alleviate using Cocoon water-saving technology. Cocoon is small water reservoir technology which uses for plant growth in dry season. The objectives of this study were to introduce and evaluate effectiveness of water-saving techniques on mango seedlings survival and growth in Mihitsab-Azmati watershed, northern Ethiopia. In this experiment, five treatments of water-saving techniques with mango seedlings were evaluated. These were: Cocoon sprayed by tricel (T1), Cocoon painted by used engine oil (T2), Cocoon without tricel and oil (T3), manually irrigated seedlings (T4) and mango seedlings planted during rainy season (T5). The survival and growth performance of mango seedlings were recorded at six months and one-year after transplanting. Data on plant survival, height, number of leaves per plant, shoot length, stem diameter and crown width were subjected to analysis of variance and t-test. There were significant differences in the treatment effects on mango seedlings transplanted survival, plant height, number of leaves per plant, shoot length, stem diameter and crown width measured at six months and one-year after transplanting. The lowest survival rate (20 %) was found during both data collection time in T5. Six months after transplanting, the highest growth parameters were measured from T1 whereas the lowest was from T5. However, one-year after transplanting, the highest growth parameters were measured from T3. Plant heights increments between the two measurement periods for T3, T2, T1, T4 and T5 were 45.1, 38.5, 24.8, 9.8 and 7.0 cm, respectively; indicating that T3 performed better than the other treatments. The t-test on mean differences between the same growth parameter measured at 12 and six months after transplanting also showed significant differences. The Cocoon water-saving technology was superior in improving mango seedlings survival and growth in the study area. This study generalized that Cocoon seems promising, sustainable and highly scalable with mango seedlings at large-scale in the study area conditions. However, this technology should not be assumed to perform uniformly well in all environmental conditions and with all tree species before demonstrated on a pilot study.
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Breast cancer is the most prevalent form of cancer that affects women worldwide, posing a significant burden on public health. While advancements in early detection and improved treatments have led to a remarkable 90% five-year survival rate and an 83% ten-year survival rate, this has also resulted in more prophylactic mastectomies being performed. Despite advancements in breast-conserving techniques, immunotherapy, and hormone therapy, many women still undergo mastectomies as part of their cancer treatment. In all cases, this results in scarring, and additional side effects from treatment modalities may arise. The loss of a breast can profoundly impact health-related quality of life (HRQoL). Although HRQoL has improved greatly during the recent years, systematic and local therapy having side effects is not uncommon, and this needs more attention.
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Fish assemblages of different types of artificial reefs can differ greatly in abundance, biomass and composition, with some reef types harboring over five times more herbivores than others. It is assumed that higher herbivorous fish abundance results in a higher grazing intensity, affecting the benthic community by means of enhanced coral recruitment, survival and growth. Territorial fish species might affect this process by chasing away other fish, especially herbivores. In this study we compared the fish assemblage, territorial behavior and grazing intensity by fish on two artificial reef types: reef balls and layered cakes, differing greatly in their fish assemblage during early colonization. In addition, the effect of artificial reef type on benthic development and coral recruitment, survival and growth, was investigated. Although layered cakes initially harbored higher herbivorous fish biomass, this effect was lost during consecutive monitoring events. This seems to be the result of the higher territorial fish abundance around the layered cakes where almost four times more chasing behavior was recorded compared to the reef balls. This resulted in a more than five times lower fish grazing intensity compared to the reef-ball plots. Although macroalgae were effectively controlled at both reefs, the grazing intensity did not differ enough to cause large enough structural changes in benthic cover for higher coral recruitment, survival or growth. The high turf algae cover, combined with increasing crustose coralline algae and sponge cover likely explained reduced coral development. We recommend further research on how to achieve higher grazing rates for improved coral development on artificial reefs, for example by facilitating invertebrate herbivores.
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The long spined sea urchin Diadema antillarum was an abundant grazer on Caribbean coral reefs, until 1983–1984, when densities were reduced by ∼98% during a region wide die-off. Since then, there has been very little natural recovery of the species and interest is growing in applying aquaculture as a tool for population enhancement. In this study we optimized a new shaker bottle cultivation method for D. antillarum. The method was tested in a series of experiments by culturing D. antillarum from egg to juvenile in the Netherlands as well as the USA. Larvae were cultured in standard 1-L glass reagent bottles, suspended by gentle constant movement on an orbital shaking table and fed with either the microalgae Rhodomonas lens or Rhodomonas salina. Effects on larval growth and survival were evaluated for different microalgal feeding concentrations, larval densities, and culture temperatures. Larval density and growth were measured twice a week over a period of up to 56 days. Larvae grew significantly faster on a higher feeding concentration up to 90,000 Rhodomonas sp. cells mL−1, twice weekly, compared to 30,000 and 60,000 cells mL−1. A density of 1 larvae mL−1 resulted in the highest body size and survival compared to densities of 2 or 4 larvae mL−1. Overall survival from larva to settled juvenile urchin increased from 8 to 10% settlement to 32–33% when the initial density was lowered further from 1.2 to 0.4 larvae mL−1. Growth, survival, competency and settlement did not differ between larval cultures kept at 25 °C or 28 °C. We believe that this novel method for culturing D. antillarum larvae, once scaled-up and validated to pilot scale, could provide juveniles for restocking of urchin-depleted reefs that suffer from algae overgrowth.
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The carbon sink capacity of tropical forests is substantially affected by tree mortality. However, the main drivers of tropical tree death remain largely unknown. Here we present a pan-Amazonian assessment of how and why trees die, analysing over 120,000 trees representing > 3800 species from 189 long-term RAINFOR forest plots. While tree mortality rates vary greatly Amazon-wide, on average trees are as likely to die standing as they are broken or uprooted—modes of death with different ecological consequences. Species-level growth rate is the single most important predictor of tree death in Amazonia, with faster growing species being at higher risk. Within species, however, the slowest-growing trees are at greatest risk while the effect of tree size varies across the basin. In the driest Amazonian region species-level bioclimatic distributional patterns also predict the risk of death, suggesting that these forests are experiencing climatic conditions beyond their adaptative limits.These results provide not only a holistic pan-Amazonian picture of tree death but largescale evidence for the overarching importance of the growth–survival trade-off in driving tropical tree mortality.
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