Fluid intake and all-cause mortality, cardiovascular mortality, and kidney function: a population-based longitudinal cohort study

BACKGROUND Drinking eight glasses of fluid or water each day is widely believed to improve health, but evidence is sparse and conflicting. We aimed to investigate the association between fluid consumption and long-term mortality and kidney function. METHODS We conducted a longitudinal analysis within a prospective, population-based cohort study of 3858 men and women aged 49 years or older residing in Australia. Daily fluid intake from food and beverages not including water was measured using a food frequency questionnaire. We did multivariable adjusted Cox proportional hazard models for all-cause and cardiovascular mortality and a boot-strapping procedure for estimated glomerular filtration rate (eGFR). RESULTS Upper and lower quartiles of daily fluid intake corresponded to >3 L and <2 L, respectively. During a median follow-up of 13.1 years (total 43 093 years at risk), 1127 deaths (26.1 per 1000 years at risk) including 580 cardiovascular deaths (13.5 per 1000 years at risk) occurred. Daily fluid intake (per 250 mL increase) was not associated with all-cause [adjusted hazard ratio (HR) 0.99 (95% CI 0.98-1.01)] or cardiovascular mortality [HR 0.98 (95% CI 0.95-1.01)]. Overall, eGFR reduced by 2.2 mL/min per 1.73 m(2) (SD 10.9) in the 1207 (31%) participants who had repeat creatinine measurements and this was not associated with fluid intake [adjusted regression coefficient 0.06 mL/min/1.73 m(2) per 250 mL increase (95% CI -0.03 to 0.14)]. CONCLUSIONS Fluid intake from food and beverages excluding water is not associated with improved kidney function or reduced mortality.

Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry.

BACKGROUND Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. METHODS Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. RESULTS The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P < 0.0001), and increased from Southern to Northern Europe (0.93 pmc/838 km, P = 0.002). Regional differences in the occurrence of specific renal diseases were marginal. Higher RRT treatment rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P < 0.0001), among those that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P < 0.0001), and among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P < 0.0001). Country neonatal mortality was inversely related with incidence in the youngest patients (ages 0-4, -1.1 pmc/2.1 deaths per 1000 births, P = 0.10). Countries with a higher incidence had a lower average age at RRT start, which was fully explained by country GDP per capita. CONCLUSIONS Inequalities exist in the provision of paediatric RRT throughout Europe, most of which are explained by differences in country macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe.

Early renal failure after domino hepatic transplantation using the liver from a compound heterozygous patient with primary hyperoxaluria.

BACKGROUND To cover the shortage of cadaveric organs, new approaches to expand the donor pool are needed. Here we report on a case of domino liver transplantation (DLT) using an organ harvested from a compound heterozygous patient with primary hyperoxaluria (PHO), who underwent combined liver and kidney transplantation. The DLT recipient developed early renal failure with oxaluria. The time to the progression to oxalosis with renal failure in such situations is unknown, but, based on animal data, we hypothesize that calcineurin inhibitors may play a detrimental role. METHODS A cadaveric liver and kidney transplantation was performed in a 52-year-old male with PHO. His liver was used for a 64-year-old patient with a non-resectable, but limited cholangiocarcinoma. RESULTS While the course of the PHO donor was uneventful, in the DLT recipient early post-operative, dialysis-dependent renal failure with hyperoxaluria developed. Histology of a kidney biopsy revealed massive calcium oxalate crystal deposition as the leading aetiological cause. CONCLUSIONS DLT using PHO organs for marginal recipients represents a possible therapeutic approach regarding graft function of the liver. However, it may negatively alter the renal outcome of the recipient in an unpredictable manner, especially with concomitant use of cyclosporin. Therefore, we suggest that, although DLT should be promoted, PHO organs are better excluded from such procedures.

The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients.

BACKGROUND Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time. METHODS Seventeen coordinators distributed a questionnaire in 256 transplant centres and 28 countries in order to report as many 'operationally tolerant' patients (TOL; defined as having a serum creatinine <1.7 mg/dL and proteinuria <1 g/day or g/g creatinine despite at least 1 year without any immunosuppressive drug) and 'almost tolerant' patients (minimally immunosuppressed patients (MIS) receiving low-dose steroids) as possible. We reported their number and the total number of kidney transplants performed at each centre to calculate their frequency. RESULTS One hundred and forty-seven questionnaires were returned and we identified 66 TOL (61 with complete data) and 34 MIS patients. Of the 61 TOL patients, 26 were previously described by the Nantes group and 35 new patients are presented here. Most of them were noncompliant patients. At data collection, 31/35 patients were alive and 22/31 still TOL. For the remaining 9/31, 2 were restarted on immunosuppressive drugs and 7 had rising creatinine of whom 3 resumed dialysis. Considering all patients, 10-year death-censored graft survival post-immunosuppression weaning reached 85% in TOL patients and 100% in MIS patients. With 218 913 kidney recipients surveyed, cumulative incidences of operational tolerance and almost tolerance were estimated at 3 and 1.5 per 10 000 kidney recipients, respectively. CONCLUSIONS In kidney transplantation, operational tolerance and almost tolerance are infrequent findings associated with excellent long-term death-censored graft survival.

Evaluación de la madera estructural para la rehabilitación de las Naves Cros (Valencia, España) por medio de diferentes técnicas no destructivas

El proyecto de rehabilitación de una de las naves del complejo fabril de la industria química ?CROS? en Valencia se llevó a cabo con el criterio de mantener, en la medida de lo posible, los elementos estructurales presentes en la nave. Con este objetivo se realizaron una serie de ensayos no destructivos (END) in situ. Estos ensayos permitieron evaluar la calidad de la madera, determinar qué elementos estructurales debían ser sustituidos y comprobar la aptitud de los que iban a ser reutilizados. Los END empleados en este estudio fueron los siguientes: (1) Identificación de la especie por técnicas anatómicas, (2) Clasificación resistente por método visual, (3) Estimación de humedad por la técnica de resistencia eléctrica; (4) Obtención de velocidades de propagación ultrasónicas (5) Resistógrafía y (6) Alteración de la propagación de ondas electromagnéticas por medio de Georradar. Para la calibración de estos END se tomó una muestra de piezas y se hicieron ensayos destructivos bajo condiciones controladas en laboratorio. En el trabajo que aquí se presenta se muestra la metodología empleada durante el proceso de toma de datos, de análisis de resultados y de cruce de la información obtenida a partir de cada uno de los ensayos hasta llegar a un diagnóstico para los elementos analizados. The assessment of structural timber was requested in the rehabilitation project of the Naves of the chemical industry "CROS". The criterion was to maintain as much as possible timber of the structure and to make only partial replacements. In order not to damage the existing structure and to assess the quality of the existing timber, a series of non-destructive testing (NDT) in the entire structure were performed: (1) Identification of the species by anatomical techniques, (2) Strength grading by visual method, (3) Estimation of moisture content by the technique of electrical resistance, (4) Acquisition of ultrasonic propagation velocities (5) Resistography and (6) Record of the propagation of electromagnetic waves by means of Ground-penetrating radar. Following, a sample group was chose to carry out destructive testing in the lab and compare the NDT results with those obtained with the standard UNE-EN408 (modules of strength, stiffness and density). In the present work, the results provided by each of the NDT techniques are detailed and above all, what is more important, the validity of these after they have been contrasted with the destructive standard tests.

Estudio sobre la influencia del contenido de humedad de la madera en ensayos no destructivos para Pinus nigra Arn, Pinus radiata D. Don y Pinus sylvestris L.

El presente proyecto se centra en el estudio de la influencia que ejerce el contenido de humedad en la madera sobre mediciones realizadas mediante diversos ensayos no destructivos (NDT – Non Destructive Tests-). El objetivo es encontrar la relación entre el contenido de humedad de la madera de varias especies del género Pinus (Pinus nigra Arn, Pinus radiata D.Don. y Pinus sylvestris Ait.) y los resultados de diferentes NDT (penetrómetro, resistencia al arranque de tornillos y velocidad de propagación de ondas inducidas y ultrasonidos), y en caso de existir, tratar de elaborar un modelo o factor de corrección que nos permita tener en cuenta dicha influencia en futuros NDT.

Evaluation offreeze-thaw damage in concrete by ultrasonic imaging

This work studies the use of ultrasonic imaging as an evaluation tool in concrete subjected to freeze–thaw (F–T) cycles. To evaluate the damage in this deterioration process, ultrasonic velocity and attenuation images have been generated from concrete specimens with and without air-entraining agents. Two parameters have been proposed from these ultrasonic images according to our experimental setup: the non-assessable area proportion (NAAP) and a weighted average velocity in terms of the NAAP. The proposed parameters have been compared with the recommended failure criteria of the ASTM and Rilem standards, which employ ultrasonic contact measurements. The principal advantage of the use of ultrasonic images and the proposed methodology in comparison with the ultrasonic velocity measurements by contact is the possibility of detection of incipient damage caused by accelerated freeze–thaw cycles.

Influence of temperature and moisture content in Non-destructive values of Scots pine (Pinus sylvestris L.)

Good results evaluating material properties using non-destructive testing (NDT) techniques have been achieved for decades. Several studies to understand the influence of temperature and moisture content on NDT have concluded different effects. In this study, NDT parameters were measured on the principal structural Spanish sawn timber species, Scots pine (Pinus sylvestris L.). NDT were conducted on 216 specimens of nominal dimensions 20 by 20 by 400 mm. Specimens were divided into several groups and studied at six different temperatures and four different moisture contents. Commercial equipment and techniques applied were Sylvatest Duo (ultrasonic wave technique), Steinkamp BPV (ultrasonic wave technique), and Grindo Sonic Mk5 "Industrial" (vibration analysis technique). Differences in NDT values within specimens at different temperatures and moisture contents were obtained. Main results of this study and relationships that describe changes in NDT values by effect of temperature and moisture content are presented.

Integrated studies for the evaluation of conservation treatments on buildings materials from archaeological sites: application to the case of Merida (Spain)

The application of conservation treatments, such as consolidation and protection ones, has been demonstrated ineffective in many cases, and even harmful. Evaluation studies should be a mandatory task, ideally before and after the intervention, but both tasks are complex and unusual in the case of archaeological heritage. This study is mainly focused on analyzing changes in petrophysical properties of stone material from archaeological sites of Merida (Spain), evaluating, both on site and in laboratory, effects derived from different conservation treatments applied in past interventions, throughout the integration of different non-destructive techniques (NDT) and portable devices of analysis available at the Institute of Geosciences (CSIC,UCM). These techniques allow, not only assessment of effectiveness and alteration processes, but also monitoring durability of treatments, focused mainly on 1996 intervention in the case of Roman Theater, as well as different punctual interventions from the 90?s until date in the House of Mitreo. Studies carried out on archaeological sites of Merida permit us to compare outcomes and also check limitations in the use of those equipments. In this paper we discuss about the use of some techniques, their integration and limits, for the assessment of conservation treatments, showing some examples of Merida?s case study.

Detección de grietas en placas con técnicas multifrecuencia

Safety is one of the most important feature in the aviation industry, and this involves too many factors. One of these is the aircraft maintenance. Over time, the procedures have been changing, and improving themselves. Non Destructive Testing (NDT) appeared in the late 19th century as a great option, because it enabled to inspect any structure without damaging it. Nowadays, there are several kinds of NDT, but ultrasound is one of the most widely used. This Master Thesis is devoted to an innovative ultrasound technique for crack detection. A technique, whose main aim lies in getting a good location of defects from a few measures, breaking with the currently widespread methods, as phased array. It is not necessary to use trains of waves, only discrete excitations, which means a great saving of time and energy. This work is divided into two steps: the first is to develop a multiphysics simulator, which is able to solve linear elasticity 3D problems (via Finite Element Method, FEM). This simulator allows to obtain in a computationally efficient way the displacement field for different frequencies and excitations. The solution of this elastic problem is needed to be used in the second step, which consists of generating a code that implements a mathematical tool named topological derivative, allowing to locate defects in the studied domain. In this work, the domain is a plate, and the defect is a hidden spherical void. The simulator has been developed using open source software (Elmer, Gmsh, ...), achieving a highly versatile simulator, which allows to change the configuration easily: domain size and shape, number and position of transducers, etc. Just one comercial software is used, Matlab. It is used to implement the topological derivative. In this work, the performance of the method is tested in several examples comparing the results when one or more frequencies are considered for different configurations of emisors/receptors.

Integrated Studies for the Evaluation of Conservation Treatments on Stone Material from Archaeological Sites. Application to the Case of Merida (Spain)

The application of conservation treatments, such as consolidation and protection ones, has been demonstrated ineffective in many cases, and even harmful. Evaluation studies should be a mandatory task, ideally before and after the intervention, but both tasks are complex and unusual in the case of archaeological heritage. This study is mainly focused on analyzing changes in petrophysical properties of stone material from archaeological sites of Merida (Spain), evaluating, both on site and in laboratory, effects derived from different conservation treatments applied in past interventions, throughout the integration of different non-destructive techniques (NDT) and portable devices of analysis available at the Institute of Geosciences (CSIC,UCM). These techniques allow, not only assessment of effectiveness and alteration processes, but also monitoring durability of treatments, focused mainly on 1996 intervention in the case of Roman Theater, as well as different punctual interventions from the 90’s until date in the House of Mitreo. Studies carried out on archaeological sites of Merida permit us to compare outcomes and also check limitations in the use of those equipments. In this paper we discuss about the use of some techniques, their integration and limits, for the assessment of conservation treatments, showing some examples of Merida’s case study.

Damage Assessment of Structures with Uncertainty

Evolutionary algorithms are suitable to solve damage identification problems in a multiobjective context. However, the performance of these methods can deteriorate quickly with increasing noise intensities originating numerous uncertainties. In this work, a statistic structural damage detection method formulated in a multiobjective context is proposed, taking into account the uncertainties existing. The presented method is verified by a number of simulated damage scenarios. The effects of noise on damage detection are investigated.

Damage identification from power spectrum density transmissibility

Damage identification under real operating conditions of the structure during its daily use would be suitable and attractive to civil engineers due to the difficulty and problems of carrying out controlled forced excitation tests on this kind of structures. In this case, output-only response measurements would be available, and an output-only damage identification procedure should be implemented. Transmissibility, defined on an output-to-output relationship, is getting increased attention in damage detection applications because of its dependence with output-only data and its sensitivity to local structural changes. In this paper, a method based on the power spectrum density transmissibility (PSDT) is proposed to detect structural damage.

Determinación de las propiedades fisicomecánicas de ramas en verde de haya (Fagus Sylvatica L.) procedentes del hayedo de Montejo de la Sierra de Madrid.

El presente proyecto es un estudio sobre las propiedades físicas y mecánicas de un conjunto de muestras de ramas de Fagus sylvatica L. recogidas en el Hayedo de Montejo de la Sierra, en Madrid. El Hayedo de Montejo hoy en día es muy conocido en Madrid, como también a nivel nacional e internacional. El hayedo alberga cientos de hayas entre las que se encuentran algunas hayas centenarias y singulares, lo que no es habitual en latitudes tan meridionales con las de la provincia de Madrid. Sin embargo, en las últimas décadas las hayas han sufrido un decaimiento en su estado provocándose en ellas roturas e incluso la muerte. Por ello se han llevado y se están llevando a cabo numerosos estudios que permitan analizar la situación para mantener y mejorar el estado de conservación del hayedo. En este trabajo se han recogido una muestra de 17 ramas sanas y representativas del hayedo. De estas ramas se han obtenido sus dimensiones, se han descrito visualmente identificando sus particularidades y defectos. Se han clasificado en dos grupos, según diámetro y longitud de las ramas. Se han realizado ensayos no destructivos (NDT) para obtener variables de medición y sus relaciones con las propiedades físicas y mecánicas. Se han realizado mediciones con penetrómetro (Pilodyn) para obtener su relación con la densidad de las ramas. Se han realizado mediciones de velocidad de propagación de una onda (Microsecond Timer) para obtener el módulo de elasticidad dinámico con el que estimar el módulo de elasticidad y la resistencia. Se ha realizado un ensayo a flexión para obtener el módulo de elasticidad (MOE) y resistencia (MOR). Entre los resultado se puede destacar que las ramas más gruesas tienen un MOE a flexión y MOR más bajo y un MOE dinámico más alto que las ramas más delgadas.

Aplicación de herramientas gis para la cartografía y correlación de datos de ensayos no destructivos en el diagnóstico de edificios históricos

La presente tesis propone un nuevo método de cartografía de ensayos no destructivos en edificios históricos mediante el uso de técnicas basadas en SIG. Primeramente, se define el método por el cual es posible elaborar y convertir una cartografía 3D basada en nubes de puntos de un elemento arquitectónico obtenida mediante fotogrametría, en cartografía raster y vectorial, legible por los sistemas SIG mediante un sistema de coordenadas particular que referencian cada punto de la nube obtenida por fotogrametría. A esta cartografía inicial la denominaremos cartografía base. Después, se define el método por el cual los puntos donde se realiza un ensayo NDT se referencian al sistema de coordenadas del plano base, lo que permite la generación de cartografías de los ensayos referenciadas y la posibilidad de obtener sobre un mismo plano base diferentes datos de múltiples ensayos. Estas nuevas cartografías las denominaremos cartografías de datos, y se demostrará la utilidad de las mismas en el estudio del deterioro y la humedad. Se incluirá el factor tiempo en las cartografías, y se mostrará cómo este nuevo hecho posibilita el trabajo interdisciplinar en la elaboración del diagnóstico. Finalmente, se generarán nuevas cartografías inéditas hasta entonces consistentes en la combinación de diferentes cartografías de datos con la misma planimetría base. Estas nuevas cartografías, darán pie a la obtención de lo que se ha definido como mapas de isograma de humedad, mapa de isograma de salinidad, factor de humedad, factor de evaporación, factor de salinidad y factor de degradación del material. Mediante este sistema se facilitará una mejor visión del conjunto de los datos obtenidos en el estudio del edificio histórico, lo que favorecerá la correcta y rigurosa interpretación de los datos para su posterior restauración. ABSTRACT This research work proposes a new mapping method of non-destructive testing in historical buildings, by using techniques based on GIS. First of all, the method that makes it possible to produce and convert a 3D map based on cloud points from an architectural element obtained by photogrammetry, are defined, as raster and vector, legible by GIS mapping systems using a particular coordinate system that will refer each cloud point obtained by photogrammetry. This initial mapping will be named base planimetry. Afterwards, the method by which the points where the NDT test is performed are referenced to the coordinate system of the base plane , which allows the generation of maps of the referenced tests and the possibility of obtaining different data from multiple tests on the same base plane. These new maps will be named mapping data and their usefulness will be demonstrated in the deterioration and moisture study. The time factor in maps will be included, and how this new fact will enable the interdisciplinary work in the elaboration of the diagnosis will be proved. Finally, new maps (unpublished until now) will be generated by combining different mapping from the same planimetry data base. These new maps will enable us to obtain what have been called isograma moisture maps, isograma salinity- maps, humidity factor, evaporation factor, salinity factor and the material degradation factor. This system will provide a better vision of all data obtained in the study of historical buildings , and will ease the proper and rigorous data interpretation for its subsequent restoration.