Effect of Pregnancy on eGFR after Kidney Transplantation:A National Cohort Study

BACKGROUND: The effect of pregnancy on the course of estimated glomerular filtration rate (eGFR) is unknown in kidney transplant recipients (KTRs). METHODS: We conducted a nationwide multicenter cohort study in KTRs with pregnancy (>20 weeks) after kidney transplantation (KT). Annual eGFR's after KT until death or graft loss and additional eGFR's before each pregnancy were collected according to protocol. Changes in eGFR slope before and after each pregnancy were analyzed by generalized estimating equations (GEE) multilevel analysis adjusted for transplant vintage. RESULTS: We included 3194 eGFR measurements before and after pregnancy in 109 (55%) KTRs with 1, 78 (40%) with 2 and 10 (5%) with 3 pregnancies after KT. Median follow-up after first delivery post-KT was 14 years (IQR 18 years). Adjusted mean eGFR pre-pregnancy was 59 ml/min/1.73m2 (SEM 1.72; 95% CI 56-63), after first pregnancy 56 ml/min/1.73m2 (SEM 1.70; 95% CI 53-60), after second pregnancy 56 ml/min/1.73m2 (SEM 2.19; 95% CI 51-60) and after third pregnancy 55 ml/min/1.73m2 (SEM 8.63; 95% CI 38-72). Overall eGFR slope after first, second and third pregnancy was not significantly worse than pre-pregnancy (p = 0.28). However, adjusted mean eGFR after first pregnancy was 2.8 ml/min/1.73m (p = 0.08) lower than pre-pregnancy. CONCLUSIONS: First pregnancy has a small, but no significant, effect on eGFR slope in KTR. Midterm hyperfiltration, a marker for renal reserve capacity, was associated with better eGFR and death-censored graft survival. In this KTR cohort with long-term follow-up, no significant effect of pregnancy on kidney function was detected

Long-Term Kidney and Maternal Outcomes After Pregnancy in Living Kidney Donors

For counseling it is important to know if pregnancy after Living Kidney Donation (LKD) affects long-term outcomes of the mono-kidney and the mother. Therefore, we performed a retrospective multicenter study in women ≤45 years who donated their kidney between 1981 and 2017. Data was collected via questionnaires and medical records. eGFR of women with post-LKD pregnancies were compared to women with pre-LKD pregnancies or nulliparous. eGFR before and after pregnancy were compared in women with post-LKD pregnancies. Pregnancy outcomes post-LKD were compared with pre-LKD pregnancy outcomes. 234 women (499 pregnancies) were included, of which 20 with pre- and post-LKD pregnancies (68) and 26 with only post-LKD pregnancies (59). Multilevel analysis demonstrated that eGFR was not different between women with and without post-LKD pregnancies (p = 0.23). Furthermore, eGFR was not different before and after post-LKD pregnancy (p = 0.13). More hypertensive disorders of pregnancy (HDP) occurred in post-LKD pregnancies (p = 0.002). Adverse fetal outcomes did not differ. We conclude that, despite a higher incidence of HDP, eGFR was not affected by post-LKD pregnancy. In line with previous studies, we found an increased risk for HDP after LKD without affecting fetal outcome. Therefore, a pregnancy wish alone should not be a reason to exclude women for LKD.</p

How storage and executive functions contribute to children's reading comprehension

In the current study we investigated the contribution of storage and separate measures of executive functions to reading comprehension in Dutch 5th graders, while controlling for word recognition and vocabulary. In addition we investigated the relationship between this model and working memory as assessed with a listening span task--which reflects an integrated measure of both storage and executive functions. Regression analysis revealed that word recognition, vocabulary, cognitive flexibility and listening span task performance contributed directly to reading comprehension. Adding the listening span task to the model led to a change in the beta-values of storage, inhibition and cognitive flexibility, indicating that these variables shared variance with listening span task performance. A second regression analysis confirmed this finding: storage, inhibition and cognitive flexibility contributed to listening span task performance, and hence indirectly to reading comprehension. Together, these findings highlight the contribution of storage and executive functions to children's reading comprehension

The contribution of executive functions to narrative writing in fourth grade children

The present study investigated the contribution of executive functions to narrative writing in fourth grade children, and evaluated to what extent executive functions contribute differentially to different levels of narrative composition. The written skills of 102 Dutch children in fourth grade were assessed using a narrative picture-elicitation task. In addition, a large test battery assessing transcription skills, language skills and executive functions, was administered. The results showed that executive functions contributed both directly and indirectly to narrative composition. More specifically, analyses revealed that inhibition and updating, but not planning, contributed directly to the text length of the narrative, and indirectly, through handwriting, to the text length, syntactic complexity, and story content. The findings underscore the need to assess a variety of executive functions and support the idea that in developing writers executive functions also play a role in more complex written composition tasks, such as narrative writing

How executive functions predict development in syntactic complexity of narrative writing in the upper elementary grades

The aim of this study was to examine the contribution of transcription skills, oral language skills, and executive functions to growth in narrative writing between fourth and sixth grade. While text length and story content of narratives did not increase with age, syntactic complexity of narratives showed a clear developmental progression. Results from path analyses revealed that later syntactic complexity of narrative writing was, in addition to initial syntactic complexity, predicted by oral grammar, inhibition, and planning. These results are discussed in light of the changes that characterize writing development in the upper elementary grades. More specifically, this study emphasizes the relevance of syntactic complexity as a developmental marker as well as the importance of executive functions for later writing development

How working memory relates to children’s reading comprehension:the importance of domain-specificity in storage and processing

Working memory is considered a well-established predictor of individual variation in reading comprehension in children and adults. However, how storage and processing capacities of working memory in both the phonological and semantic domain relate to reading comprehension is still unclear. In the current study, we investigated the contribution of phonological and semantic storage, and phonological and semantic processing to reading comprehension in 123 Dutch children in fifth grade. We conducted regression and mediation analyses to find out to what extent variation in reading comprehension could be explained by storage and processing capacities in both the phonological and the semantic domain, while controlling for children’s decoding and vocabulary. The analyses included tasks that reflect storage only, and working memory tasks that assess processing in addition to storage. Regression analysis including only storage tasks as predictor measures, revealed semantic storage to be a better predictor of reading comprehension than phonological storage. Adding phonological and semantic working memory tasks as additional predictors to the model showed that semantic working memory explained individual variation in reading comprehension over and above all other memory measures. Additional mediation analysis made it clear that semantic storage contributed indirectly to reading comprehension via semantic working memory, indicating that semantic storage tapped by working memory, in addition to processing capacities, explains individual variation in reading comprehension. It can thus be concluded that semantic storage plays a more important role in children’s reading comprehension than previously thought

Bidirectional Relations Between Text Reading Prosody and Reading Comprehension in the Upper Primary School Grades:A Longitudinal Perspective

The purpose of this study was to examine the directionality of the relationship between text reading prosody and reading comprehension in the upper grades of primary school. We compared 3 theoretical possibilities: Two unidirectional relations from text reading prosody to reading comprehension and from reading comprehension to text reading prosody and a bidirectional relation between text reading prosody and reading comprehension. Further, we controlled for autoregressive effects and included decoding efficiency as a measure of general reading skill. Participants were 99 Dutch children, followed longitudinally, from 4th to 6th grade. Structural equation modeling showed that the bidirectional relation provided the best fitting model. In 5th grade, text reading prosody was related to prior decoding and reading comprehension, whereas in 6th grade, reading comprehension was related to prior text reading prosody. As such, the results suggest that the relation between text reading prosody and reading comprehension is reciprocal but dependent on grade level

How Reliable Is the Pinaya Method for Assessing Cognitive Lateralization with Functional Transcranial Doppler Ultrasound?

Contains fulltext : 159255.pdf (publisher's version ) (Closed access)2 p

What oral text reading fluency can reveal about reading comprehension

Text reading fluency ? the ability to read quickly, accurately and with a natural intonation ? has been proposed as a predictor of reading comprehension. In the current study, we examined the role of oral text reading fluency, defined as text reading rate and text reading prosody, as a contributor to reading comprehension outcomes in addition to decoding efficiency and language comprehension. One hundred and six Dutch primary school children from fourth grade participated in this study and were assessed on decoding efficiency, vocabulary, syntactic ability, reading fluency performance and reading comprehension skills. Regression analysis showed that text reading prosody, not text reading rate, explained additional variance in reading comprehension performance when decoding efficiency and language comprehension were controlled for. This result suggests that the inclusion of text reading prosody as an aspect of text reading fluency is justified and that a natural intonation is associated with better comprehension of what is read

Reliability of a novel paradigm for determining hemispheric lateralization of visuospatial function

Contains fulltext : 77000.pdf (publisher's version ) (Open Access)In most individuals, language production and visuospatial skills are subserved predominantly by the left and right hemispheres, respectively. Functional Transcranial Doppler (fTCD) provides a noninvasive and relatively low-cost method for measuring functional lateralization. However, while the silent word generation task provides an accurate and reliable paradigm for investigating lateralization of language production, there is no comparable gold-standard method for measuring visuospatial skills. Thirty undergraduate students (19 females) completed a task of spatial memory while undergoing fTCD recording. Participants completed this task at two different time points, separated by between 26 to 155 days. The relative activation between hemispheres averaged across all participants was found to be consistent across testing sessions. This was observed at the individual level also, with a quantitative index of lateralization showing high reproducibility. These findings indicate that the use of the spatial memory task with fTCD is a robust methodology for examining laterality of visuospatial skills