Cardiovascular risk factor assessment after pre-eclampsia in primary care

<p>Abstract</p> <p>Background</p> <p>Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascular risk factor management.</p> <p>Methods</p> <p>Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until July 2007 with an International Classification of Primary Care (ICPC) code indicating pregnancy. Records were searched for indicators of pre-eclampsia. Of those who experienced pre-eclampsia and of a random sample of 150 women who did not, the following information on cardiovascular risk factor management after pregnancy was extracted from the records: frequency and timing of blood pressure, cholesterol and glucose measurements - and vascular diagnoses. Additionally the sensitivity and specificity of ICPC coding for pre-eclampsia were determined.</p> <p>Results</p> <p>35 women experienced pre-eclampsia. Blood pressure was more often checked after pregnancy in these women than in controls (57.1% vs. 12.0%, p < 0.001). In 50% of the cases blood pressure was measured within 3 months after delivery with no further follow-up visit. A check for glucose and cholesterol levels was rare, and equally frequent in PE and control women. 20% of the previously normotensive women in the PE group had hypertension at one or more occasions after three months post partum versus none in the control group. The ICPC coding for pre-eclampsia showed a sensitivity of 51.4% and a specificity of 100.0%.</p> <p>Conclusion</p> <p>Despite the evidence of increased risk of future cardiovascular disease in women with a history of pre-eclampsia, follow-up of these women is insufficient and undeveloped in primary care in the Netherlands.</p

Maternal TLR4 and NOD2 Gene Variants, Pro-Inflammatory Phenotype and Susceptibility to Early-Onset Preeclampsia and HELLP Syndrome

Background: Altered maternal inflammatory responses play a role in the development of preeclampsia and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. We examined whether allelic variants of the innate immune receptors toli-like receptor 4 (TLR4) and nucleotide-binding oligomerization domain (NOD2), that impair the inflammatory response to endotexin are related to preeclampsia and HELLP syndrome. Methods and Finding: We determined five common mutations in TLR4 (D299G and T399I and NOD2 (R70W, G908R and L1007fs) in 340 primiparous women with a histo

Ionised gas kinematics and dynamical masses of z &amp; 6 galaxies from JADES/NIRSpec high-resolution spectroscopy

We explore the kinematic gas properties of six 5.5 &lt; z &lt; 7.4 galaxies in the JWST Advanced Deep Extragalactic Survey (JADES), using high-resolution JWST/NIRSpec multi-object spectroscopy of the rest-frame optical emission lines [OIII] and Hα. The objects are small and of low stellar mass (∼1 kpc; M* ∼ 107 − 9 M⊙), less massive than any galaxy studied kinematically at z &gt; 1 thus far. The cold gas masses implied by the observed star formation rates are about ten times higher than the stellar masses. We find that their ionised gas is spatially resolved by JWST, with evidence for broadened lines and spatial velocity gradients. Using a simple thin-disc model, we fit these data with a novel forward-modelling software that accounts for the complex geometry, point spread function, and pixellation of the NIRSpec instrument. We find the sample to include both rotation- and dispersion-dominated structures, as we detect velocity gradients of v(re)∼100 − 150 km s−1, and we find velocity dispersions of σ0 ∼ 30 − 70 km s−1 that are comparable to those at cosmic noon. The dynamical masses implied by these models (Mdyn ∼ 109 − 10 M⊙) are higher than the stellar masses by up to a factor 40, and they are higher than the total baryonic mass (gas + stars) by a factor of ∼3. Qualitatively, this result is robust even if the observed velocity gradients reflect ongoing mergers rather than rotating discs. Unless the observed emission line kinematics is dominated by outflows, this implies that the centres of these galaxies are dominated by dark matter or that star formation is three times less efficient, leading to higher inferred gas masses.</jats:p

Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term:a longitudinal follow-up study

<p>Background: Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.</p><p>Methods: In a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10- and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student's T test and Mann-Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.</p><p>Results: After a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p</p><p>Conclusions: Women with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.</p>

Spectroscopic confirmation of four metal-poor galaxies at z = 10.3–13.2

Finding and characterising the first galaxies that illuminated the early Universe at cosmic dawn is pivotal to understand the physical conditions and the processes that led to the formation of the first stars. In the first few months of operations, imaging from the James Webb Space Telescope (JWST) have been used to identify tens of candidates of galaxies at redshift (z) greater than 10, less than 450 million years after the Big Bang. However, none of these candidates has yet been confirmed spectroscopically, leaving open the possibility that they are actually low-redshift interlopers. Here we present spectroscopic confirmation and analysis of four galaxies unambiguously detected at redshift 10.3<z<13.2, previously selected from NIRCam imaging. The spectra reveal that these primeval galaxies are extremely metal poor, have masses between 10^7 and a few times 10^8 solar masses, and young ages. The damping wings that shape the continuum close to the Lyman edge are consistent with a fully neutral intergalactic medium at this epoch. These findings demonstrate the rapid emergence of the first generations of galaxies at cosmic dawn.STFC ERC Royal Society Professorshi

Spectroscopic confirmation of four metal-poor galaxies at z = 10.3–13.2

Finding and characterizing the first galaxies that illuminated the early universe at cosmic dawn is pivotal to understand the physical conditions and the processes that led to the formation of the first stars. In the first few months of operations, imaging from the James Webb Space Telescope (JWST) has been used to identify tens of candidates of galaxies at redshift (z) greater than 10, less than 450 million years after the Big Bang. However, none of such candidates has yet been confirmed spectroscopically, leaving open the possibility that they are actually low-redshift interlopers. Here we present spectroscopic confirmation and analysis of four galaxies unambiguously detected at redshift 10.3 ≤ z ≤ 13.2, previously selected from JWST Near Infrared Camera imaging. The spectra reveal that these primeval galaxies are metal poor, have masses on the order of about 107–108 solar masses and young ages. The damping wings that shape the continuum close to the Lyman edge provide constraints on the neutral hydrogen fraction of the intergalactic medium from normal star-forming galaxies. These findings demonstrate the rapid emergence of the first generations of galaxies at cosmic dawn