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1.
J Environ Manage ; 365: 121695, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38968891

RESUMO

Pyric herbivory, the combination of controlled burning and targeted grazing, is an effective strategy for restoring abandoned, shrub-encroached rangelands to open ecosystems. This practice may impact soil nitrogen pools by altering soil nitrification and denitrification rates, and may lead to an increase of nitrogen losses through nitrate leaching and N-gas emissions. This research, located in the south-western Pyrenees, investigated the effects of pyric herbivory on soil nitrification and denitrification potentials and mineral nitrogen content in a gorse-encroached temperate rangeland six months after the burning was implemented. The study included three treatments: high-severity burning plus grazing, low-severity burning plus grazing, and unburned and ungrazed areas (control). We measured soil nitrification and denitrification potentials (net and gross), the limitation of denitrifiers by nitrogen or organic carbon, and the abundance of nitrite- and nitrous oxide-reducing bacteria. Additional soil and vegetation data complemented these measurements. Results showed that pyric herbivory did not significantly affect nitrification potential, which was low and highly variable. However, it decreased gross denitrification potential and nitrous oxide reduction to dinitrogen in high-severely burned areas compared to the control. Denitrification rates directly correlated with microbial biomass nitrogen, soil organic carbon, soil water content and abundance of nirS-harbouring bacteria. Contrary to the expected, soil nitrate availability did not directly influence denitrification despite being highest in burned areas. Overall, the study suggests that pyric herbivory does not significantly affect mid-term nitrification rates in temperate open ecosystems, but may decrease denitrification rates in intensely burned areas. These findings highlight the importance of assessing the potential impacts of land management practices, such as pyric herbivory, on soil nutrient cycling and ecosystem functioning.

2.
New Phytol ; 243(2): 620-635, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38812269

RESUMO

In natural systems, different plant species have been shown to modulate specific nitrogen (N) cycling processes so as to meet their N demand, thereby potentially influencing their own niche. This phenomenon might go beyond plant interactions with symbiotic microorganisms and affect the much less explored plant interactions with free-living microorganisms involved in soil N cycling, such as nitrifiers and denitrifiers. Here, we investigated variability in the modulation of soil nitrifying and denitrifying enzyme activities (NEA and DEA, respectively), and their ratio (NEA : DEA), across 193 Arabidopsis thaliana accessions. We studied the genetic and environmental determinants of such plant-soil interactions, and effects on plant biomass production in the next generation. We found that NEA, DEA, and NEA : DEA varied c. 30-, 15- and 60-fold, respectively, among A. thaliana genotypes and were related to genes linked with stress response, flowering, and nitrate nutrition, as well as to soil parameters at the geographic origin of the analysed genotypes. Moreover, plant-mediated N cycling activities correlated with the aboveground biomass of next-generation plants in home vs away nonautoclaved soil, suggesting a transgenerational impact of soil biotic conditioning on plant performance. Altogether, these findings suggest that nutrient-based plant niche construction may be much more widespread than previously thought.


Assuntos
Arabidopsis , Biomassa , Ciclo do Nitrogênio , Microbiologia do Solo , Arabidopsis/genética , Arabidopsis/metabolismo , Arabidopsis/microbiologia , Nitrogênio/metabolismo , Solo/química , Genótipo , Nitrificação , Desnitrificação , Ecossistema
3.
Glob Chang Biol ; 30(1): e17034, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38273527

RESUMO

Redesigning agrosystems to include more ecological regulations can help feed a growing human population, preserve soils for future productivity, limit dependency on synthetic fertilizers, and reduce agriculture contribution to global changes such as eutrophication and warming. However, guidelines for redesigning cropping systems from natural systems to make them more sustainable remain limited. Synthetizing the knowledge on biogeochemical cycles in natural ecosystems, we outline four ecological systems that synchronize the supply of soluble nutrients by soil biota with the fluctuating nutrient demand of plants. This synchrony limits deficiencies and excesses of soluble nutrients, which usually penalize both production and regulating services of agrosystems such as nutrient retention and soil carbon storage. In the ecological systems outlined, synchrony emerges from plant-soil and plant-plant interactions, eco-physiological processes, soil physicochemical processes, and the dynamics of various nutrient reservoirs, including soil organic matter, soil minerals, atmosphere, and a common market. We discuss the relative importance of these ecological systems in regulating nutrient cycles depending on the pedoclimatic context and on the functional diversity of plants and microbes. We offer ideas about how these systems could be stimulated within agrosystems to improve their sustainability. A review of the latest advances in agronomy shows that some of the practices suggested to promote synchrony (e.g., reduced tillage, rotation with perennial plant cover, crop diversification) have already been tested and shown to be effective in reducing nutrient losses, fertilizer use, and N2 O emissions and/or improving biomass production and soil carbon storage. Our framework also highlights new management strategies and defines the conditions for the success of these nature-based practices allowing for site-specific modifications. This new synthetized knowledge should help practitioners to improve the long-term productivity of agrosystems while reducing the negative impact of agriculture on the environment and the climate.


Assuntos
Ecossistema , Solo , Humanos , Agricultura , Plantas , Carbono
4.
Trends Ecol Evol ; 39(1): 89-100, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38114339

RESUMO

We present the results of our 15th horizon scan of novel issues that could influence biological conservation in the future. From an initial list of 96 issues, our international panel of scientists and practitioners identified 15 that we consider important for societies worldwide to track and potentially respond to. Issues are novel within conservation or represent a substantial positive or negative step-change with global or regional extents. For example, new sources of hydrogen fuel and changes in deep-sea currents may have profound impacts on marine and terrestrial ecosystems. Technological advances that may be positive include benchtop DNA printers and the industrialisation of approaches that can create high-protein food from air, potentially reducing the pressure on land for food production.


Assuntos
Biodiversidade , Ecossistema , Conservação dos Recursos Naturais , Previsões , Alimentos
5.
Glob Chang Biol ; 29(18): 5429-5444, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37317051

RESUMO

Global climate models predict that the frequency and intensity of precipitation events will increase in many regions across the world. However, the biosphere-climate feedback to elevated precipitation (eP) remains elusive. Here, we report a study on one of the longest field experiments assessing the effects of eP, alone or in combination with other climate change drivers such as elevated CO2 (eCO2 ), warming and nitrogen deposition. Soil total carbon (C) decreased after a decade of eP treatment, while plant root production decreased after 2 years. To explain this asynchrony, we found that the relative abundances of fungal genes associated with chitin and protein degradation increased and were positively correlated with bacteriophage genes, suggesting a potential viral shunt in C degradation. In addition, eP increased the relative abundances of microbial stress tolerance genes, which are essential for coping with environmental stressors. Microbial responses to eP were phylogenetically conserved. The effects of eP on soil total C, root production, and microbes were interactively affected by eCO2 . Collectively, we demonstrate that long-term eP induces soil C loss, owing to changes in microbial community composition, functional traits, root production, and soil moisture. Our study unveils an important, previously unknown biosphere-climate feedback in Mediterranean-type water-limited ecosystems, namely how eP induces soil C loss via microbe-plant-soil interplay.


Assuntos
Pradaria , Microbiota , Carbono , Mudança Climática , Nitrogênio
6.
Sci Data ; 10(1): 314, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-37225767

RESUMO

Data from functional trait databases have been increasingly used to address questions related to plant diversity and trait-environment relationships. However, such databases provide intraspecific data that combine individual records obtained from distinct populations at different sites and, hence, environmental conditions. This prevents distinguishing sources of variation (e.g., genetic-based variation vs. phenotypic plasticity), a necessary condition to test for adaptive processes and other determinants of plant phenotypic diversity. Consequently, individual traits measured under common growing conditions and encompassing within-species variation across the occupied geographic range have the potential to leverage trait databases with valuable data for functional and evolutionary ecology. Here, we recorded 16 functional traits and leaf hyperspectral reflectance (NIRS) data for 721 widely distributed Arabidopsis thaliana natural accessions grown in a common garden experiment. These data records, together with meteorological variables obtained during the experiment, were assembled to create the AraDiv dataset. AraDiv is a comprehensive dataset of A. thaliana's intraspecific variability that can be explored to address questions at the interface of genetics and ecology.


Assuntos
Arabidopsis , Adaptação Fisiológica , Arabidopsis/genética , Evolução Biológica , Bases de Dados Factuais , Folhas de Planta
7.
Mol Ecol ; 32(13): 3747-3762, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37060060

RESUMO

The processes governing soil bacteria biogeography are still not fully understood. It remains unknown how the importance of environmental filtering and dispersal differs between bacterial taxonomic and functional biogeography, and whether their importance is scale-dependent. We sampled soils across the Tibet plateau, with distances among plots ranging from 20 m to 1550 km. Taxonomic composition of bacterial community was characterized by 16S amplicon sequencing and functional community composition by qPCR targeting 9 functional groups involved in N dynamics. Factors representing climate, soil and plant community were measured to assess different facets of environmental dissimilarity. Both bacterial taxonomic and functional dissimilarities were more related to abiotic dissimilarity than biotic (vegetation) dissimilarity or distance. Taxonomic dissimilarity was mostly explained by differences in soil pH and mean annual temperature (MAT), while functional dissimilarity was linked to differences in soil N and P availabilities and N:P ratio. Soil pH and MAT remained the main determinants of taxonomic dissimilarity across spatial scales. In contrast, the explanatory variables of N-related functional dissimilarity varied across the scales, with soil moisture and organic matter having the highest role across short distances (<~330 km), and available P, N:P ratio and distance being important over long distances (>~660 km). Our results demonstrate how biodiversity dimension (taxonomic versus functional aspects) and spatial scale influence the factors driving soil bacterial biogeography.


Assuntos
Microbiologia do Solo , Solo , Tibet , Solo/química , Bactérias/genética , Biodiversidade , Plantas
8.
Trends Ecol Evol ; 38(1): 96-107, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36460563

RESUMO

We present the results of our 14th horizon scan of issues we expect to influence biological conservation in the future. From an initial set of 102 topics, our global panel of 30 scientists and practitioners identified 15 issues we consider most urgent for societies worldwide to address. Issues are novel within biological conservation or represent a substantial positive or negative step change at global or regional scales. Issues such as submerged artificial light fisheries and accelerating upper ocean currents could have profound negative impacts on marine or coastal ecosystems. We also identified potentially positive technological advances, including energy production and storage, improved fertilisation methods, and expansion of biodegradable materials. If effectively managed, these technologies could realise future benefits for biological diversity.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Biodiversidade , Previsões , Pesqueiros
9.
FEMS Microbiol Ecol ; 98(12)2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36302145

RESUMO

Microbial diversity can restrict the invasion and impact of alien microbes into soils via resource competition. However, this theory has not been tested on various microbial invaders with different ecological traits, particularly spore-forming bacteria. Here we investigated the survival capacity of two introduced spore-forming bacteria, Bacillus mycoides (BM) and B. pumillus (BP) and their impact on the soil microbiome niches with low and high diversity. We hypothesized that higher soil bacterial diversity would better restrict Bacillus survival via resource competition, and the invasion would alter the resident bacterial communities' niches only if inoculants do not escape competition with the soil community (e.g. through sporulation). Our findings showed that BP could not survive as viable propagules and transiently impacted the bacterial communities' niche structure. This may be linked to its poor resource usage and low growth rate. Having better resource use capacities, BM better survived in soil, though its survival was weakly related to the remaining resources left for them by the soil community. BM strongly affected the community niche structure, ultimately in less diverse communities. These findings show that the inverse diversity-invasibility relationship can be valid for some spore-forming bacteria, but only when they have sufficient resource use capacity.


Assuntos
Inoculantes Agrícolas , Bacillus , Solo , Microbiologia do Solo , Bactérias , Esporos
10.
Opt Express ; 30(22): 39860-39867, 2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36298928

RESUMO

Metalenses are attracting a large interest for the implementation of complex optical functionalities in planar and compact devices. However, chromatic and off-axis aberrations remain standing challenges. Here, we experimentally investigate the broadband behavior of metalenses based on quadratic phase profiles. We show that these metalenses do not only guarantee an arbitrarily large field of view but are also inherently tolerant to longitudinal and transverse chromatic aberrations. As such, we demonstrate a single-layer, silicon metalens with a field of view of 86° and a bandwidth up to 140 nm operating at both 1300 nm and 1550 nm telecommunication wavelength bands.

12.
Microbiome ; 10(1): 112, 2022 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902889

RESUMO

BACKGROUND: Anthropogenic activities have increased the inputs of atmospheric reactive nitrogen (N) into terrestrial ecosystems, affecting soil carbon stability and microbial communities. Previous studies have primarily examined the effects of nitrogen deposition on microbial taxonomy, enzymatic activities, and functional processes. Here, we examined various functional traits of soil microbial communities and how these traits are interrelated in a Mediterranean-type grassland administrated with 14 years of 7 g m-2 year-1 of N amendment, based on estimated atmospheric N deposition in areas within California, USA, by the end of the twenty-first century. RESULTS: Soil microbial communities were significantly altered by N deposition. Consistent with higher aboveground plant biomass and litter, fast-growing bacteria, assessed by abundance-weighted average rRNA operon copy number, were favored in N deposited soils. The relative abundances of genes associated with labile carbon (C) degradation (e.g., amyA and cda) were also increased. In contrast, the relative abundances of functional genes associated with the degradation of more recalcitrant C (e.g., mannanase and chitinase) were either unchanged or decreased. Compared with the ambient control, N deposition significantly reduced network complexity, such as average degree and connectedness. The network for N deposited samples contained only genes associated with C degradation, suggesting that C degradation genes became more intensely connected under N deposition. CONCLUSIONS: We propose a conceptual model to summarize the mechanisms of how changes in above- and belowground ecosystems by long-term N deposition collectively lead to more soil C accumulation. Video Abstract.


Assuntos
Microbiota , Solo , Carbono , Ecossistema , Microbiota/genética , Nitrogênio/metabolismo , Microbiologia do Solo
13.
Int J Infect Dis ; 122: 63-69, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35550179

RESUMO

OBJECTIVES: Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. METHODS: Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor-α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. RESULTS: In the 133 included patients (median age, 83 years [interquartile range: 78-89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60-0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79-0.96], P-value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00-1.04], P-value=0.02), and higher CRP (1.01 [95% CI 1.00-1.02], P=0.01) at discharge were independently associated with mortality. CONCLUSION: Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.


Assuntos
Interleucina-8 , Pneumonia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Proteína C-Reativa/análise , Hospitalização , Humanos , Inflamação , Interleucina-6 , Pneumonia/diagnóstico , Prognóstico , Estudos Prospectivos
14.
iScience ; 25(3): 103821, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35243218

RESUMO

Microbial inoculations contribute to reducing agricultural systems' environmental footprint by supporting sustainable production and regulating climate change. However, the indirect and cascading effects of microbial inoculants through the reshaping of soil microbiome are largely overlooked. By discussing the underlying mechanisms of plant- and soil-based microbial inoculants, we suggest that a key challenge in microbial inoculation is to understand their legacy on indigenous microbial communities and the corresponding impacts on agroecosystem functions and services relevant to climate change. We explain how these legacy effects on the soil microbiome can be understood by building on the mechanisms driving microbial invasions and placing inoculation into the context of ecological succession and community assembly. Overall, we advocate that generalizing field trials to systematically test inoculants' effectiveness and developing knowledge anchored in the scientific field of biological/microbial invasion are two essential requirements for applying microbial inoculants in agricultural ecosystems to tackle climate change challenges.

15.
Opt Lett ; 47(4): 810-813, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-35167531

RESUMO

Integrated mid-infrared micro-spectrometers have a great potential for applications in environmental monitoring and space exploration. Silicon-on-insulator (SOI) is a promising platform to tackle this integration challenge, owing to its unique capability for large volume and low-cost production of ultra-compact photonic circuits. However, the use of SOI in the mid-infrared is restricted by the strong absorption of the buried oxide layer for wavelengths beyond 4 µm. Here, we overcome this limitation by utilizing metamaterial-cladded suspended silicon waveguides to implement a spatial heterodyne Fourier-transform (SHFT) spectrometer operating at wavelengths near 5.5 µm. The metamaterial-cladded geometry allows removal of the buried oxide layer, yielding measured propagation loss below 2 dB/cm at wavelengths between 5.3 and 5.7 µm. The SHFT spectrometer comprises 19 Mach-Zehnder interferometers with a maximum arm length imbalance of 200 µm, achieving a measured spectral resolution of 13 cm-1 and a free spectral range of 100 cm-1 at wavelengths near 5.5 µm.

16.
Opt Lett ; 47(2): 341-344, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35030601

RESUMO

Integrated wavelength filters with high optical rejection are key components in several silicon photonics circuits, including quantum photon-pair sources and spectrometers. Non-coherent cascading of modal-engineered Bragg filters allows for remarkable optical rejections in structures that only support transverse-electric (TE) polarized modes such as uncladded 220-nm-thick silicon. However, the restriction to TE-only platforms limits the versatility of the non-coherent cascading approach. Here, we propose and experimentally demonstrate a new, to the best of our knowledge, approach for high-rejection filters in polarization-diverse platforms by combining non-coherent cascading of modal-engineered Bragg filters and anisotropy-engineered metamaterial bends. Bragg filters provide a high rejection of the TE mode, while the metamaterial bends remove any residual power propagating in the transverse-magnetic (TM) mode, without any penalty in terms of insertion loss or device footprint. Based on this strategy, we demonstrate optical rejection exceeding 60 dB in 300-nm-thick, cladded silicon waveguides.

17.
ISME Commun ; 2(1): 82, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-37938668

RESUMO

Protists' selective predation of bacterial cells is an important regulator of soil microbiomes, which might influence the success of bacterial releases in soils. For instance, the survival and activity of introduced bacteria can be affected by selective grazing on resident communities or the inoculant, but this remains poorly understood. Here, we investigated the impact of the introduction in the soil of two protozoa species, Rosculus terrestris ECOP02 and/or Cerocomonas lenta ECOP01, on the survival of the inoculants Bacillus mycoides M2E15 (BM) or B. pumilus ECOB02 (BP). We also evaluated the impact of bacterial inoculation with or without protozoan addition on the abundance and diversity of native soil bacterial and protist communities. While the addition of both protozoa decreased the survival of BM, their presence contrarily increased the BP abundance. Protists' selective predation governs the establishment of these bacterial inoculants via modifying the soil microbiome structure and the total bacterial abundance. In the BP experiment, the presence of the introduced protozoa altered the soil community structures and decreased soil bacterial abundance at the end of the experiment, favouring the invader survival. Meanwhile, the introduced protozoa did not modify the soil community structures in the BM experiment and reduced the BM + Protozoa inoculants' effect on total soil bacterial abundance. Our study reinforces the view that, provided added protozoa do not feed preferentially on bacterial inoculants, their predatory behaviour can be used to steer the soil microbiome to improve the success of bacterial inoculations by reducing resource competition with the resident soil microbial communities.

18.
Trends Ecol Evol ; 37(1): 95-104, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34809998

RESUMO

We present the results of our 13th annual horizon scan of issues likely to impact on biodiversity conservation. Issues are either novel within the biological conservation sector or could cause a substantial step-change in impact, either globally or regionally. Our global panel of 26 scientists and practitioners identified 15 issues that we believe to represent the highest priorities for tracking and action. Many of the issues we identified, including the impact of satellite megaconstellations and the use of long-distance wireless energy transfer, have both elements of threats and emerging opportunities. A recent state-sponsored application to commence deep-sea mining represents a significant step-change in impact. We hope that this horizon scan will increase research and policy attention on the highlighted issues.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais , Saúde Global/tendências , Animais , Políticas
19.
Rev Med Suisse ; 17(757): 1866-1870, 2021 Nov 03.
Artigo em Francês | MEDLINE | ID: mdl-34738760

RESUMO

Non-invasive respiratory therapy makes it possible to limit the use of invasive ventilation in certain situations. It can be applied to elderly patients and is effective, including outside intensive care units. The geriatric intermediate care structure at Trois-Chêne Hospital in Geneva is a certified intermediate care unit with a special focus on the care of older patients. This article describes the specificities and challenges of such a unit through its experience with the use of non-invasive respiratory therapy during the Covid-19 pandemic.


Les thérapies respiratoires non invasives permettent de limiter le recours à la ventilation invasive dans certaines indications. Leur application et leur efficacité chez le sujet âgé ont été démontrées, y compris en dehors des unités de soins intensifs. L'unité des soins intermédiaires de l'Hôpital des Trois-Chêne à Genève est une unité accréditée dont la spécificité est une orientation gériatrique. Cet article relate les spécificités et les enjeux d'une telle unité, à partir du retour d'expérience de l'utilisation des thérapies respiratoires non invasives pendant la pandémie Covid-19.


Assuntos
COVID-19 , Pandemias , Idoso , Humanos , Unidades de Terapia Intensiva , Terapia Respiratória , SARS-CoV-2
20.
Geriatrics (Basel) ; 6(4)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34842708

RESUMO

BACKGROUND: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients' comorbidities (cumulative illness rating scale-geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia. METHODS: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. RESULTS: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p < 0.01), CIRS-G (p < 0.001) and MNA (p < 0.001) were strongly associated with poorer long-term outcomes in univariate analysis. CIRS-G (p < 0.05) and MNA (p < 0.05) were significant predictors of 1-year mortality in multivariate analysis. CONCLUSION: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients' prognosis, levels and goals of care.

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