Arts and science under the sign of Leonardo. The case of the National Museum of Science and Technology ‘Leonardo da Vinci’ of Milan

Drawing on the example of Leonardo da Vinci, who was able to combine arts and science in his work, the National Museum of Science and Technology of Milan has always pursued the blending and the dialogue of humanistic and scientific knowledge. It has employed this approach in all of its activities, from the set design of exhibition departments to the acquisition of collections and, more recently, in the dialogue with the public. Now more than ever, following a renewal path for the Museum, these guidelines are being subject to research to achieve a new and more up-to-date interpretation

Hypertensive Disorders of Pregnancy and Future Cardiovascular Health.

Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations. These women are known to have higher cardiovascular morbidity and mortality later in life in comparison with parous controls who had normotensive pregnancies. Several studies have demonstrated that women with preeclampsia present in a state of segmental impaired myocardial function, biventricular chamber dysfunction, adverse biventricular remodeling, and hypertrophy, a compromised hemodynamic state and indirect echocardiographic signs of localized myocardial ischemia and fibrosis. These cardiac functional and geometric changes are known to have strong predictive value for cardiovascular disease in non-pregnant subjects. A "dose effect" response seems to regulate this relationship with severe HDP, early-onset HDP, coexistence of fetal growth disorders, and recurrence of HDP resulting in poorer cardiovascular measures. The mechanism underlying the relationship between HDP in younger women and cardiovascular disease later in life is unclear but could be explained by sharing of pre-pregnancy cardiovascular risk factors or due to a direct impact of HDP on the maternal cardiovascular system conferring a state of increased susceptibility to future metabolic or hemodynamic insults. If so, the prevention of HDP itself would become all the more urgent. Shortly after delivery, women who experienced HDP express an increased risk of classic cardiovascular risk factors such as essential hypertension, renal disease, abnormal lipid profile, and diabetes with higher frequency than controls. Within one or two decades after delivery, this group of women are more likely to experience premature cardiovascular events, such as symptomatic heart failure, myocardial ischemia, and cerebral vascular disease. Although there is general agreement that women who suffered from HDP should undertake early screening for cardiovascular risk factors in order to allow for appropriate prevention, the exact timing and modality of screening has not been standardized yet. Our findings suggest that prevention should start as early as possible after delivery by making the women aware of their increased cardiovascular risk and encouraging weight control, stop smoking, healthy diet, and daily exercise which are well-established and cost-effective prevention strategies

Postpartum cardiovascular function in patients with hypertensive disorders of pregnancy: A longitudinal study

Women with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of cardiovascular diseases that are usually mediated by the development of cardiovascular risk factors, such as chronic hypertension, metabolic syndrome or subclinical myocardial dysfunction. Increasing evidence has been showing that little time elapses between the end of pregnancy and the development of these cardiovascular risk factors. To assess the persistence of hypertension and myocardial dysfunction at four months postpartum in a cohort of women with HDP and to compare the echocardiographic parameters between the peripartum and the postpartum period. In a longitudinal prospective study, a cohort of women with preterm or term HDP and an unmatched group of women with term normotensive pregnancy were recruited. Women with pre-existing chronic hypertension (n=29) were included in the HDP cohort. All participants underwent two cardiovascular assessments: the first was conducted either before or within one week of delivery (V1: peripartum assessment), and the second was between three and 12 months following giving birth (V2: postpartum assessment). The cardiovascular evaluation included blood pressure profile, maternal transthoracic echocardiography (left ventricular mass index (LVMI), relative wall thickness (RWT), left atrial volume index (LAVI), E/A, E/e', peak velocity of tricuspid regurgitation (TR), ejection fraction (EF), and LV global longitudinal strain (GLS) and twist) and metabolic assessment (fasting glycemia, insulin, lipid profile and waist measurement). Echocardiographic data were compared between V1 and V2 using paired t-test or McNemar test in HDP and in the control groups. Among 260 patients with pregnancies complicated by HDP and 33 patients with normotensive pregnancies, 219 (84.2%) and 30 (90.9%) attended postpartum follow-up, respectively. Patients were evaluated at a median (IQR) of 124 (103-145) days after delivery. Paired comparisons of echocardiographic findings demonstrated significant improvements in cardiac remodeling rates (left ventricular mass index (g/m2) 63.4±14.4 vs 78.9±16.2, p<0.0001; relative wall thickness 0.35±0.1 vs 0.42±0.1, p<0.0001), most diastolic indices (E/E' 6.3±1.6 vs 7.4±1.9, p<0.0001), ejection fraction (EF<55%: 9 (4.1%) vs 28 (13.0%), p<0.0001) and global longitudinal strain (-17.3±2.6% vs -16.2±2.4%, p<0.0001) in the postpartum period compared to the peripartum. The same improvements in cardiac indices were observed in the normotensive group. However, at the postnatal assessment, 153/219 (69.9%) had either hypertension (76/219, 34.7%) or an abnormal global longitudinal strain (125/219, 57.1%), 13/67 (19.4%) had metabolic syndrome and 18/67 (26.9%) exhibited insulin resistance. Although persistent postpartum cardiovascular impairment was evident in a substantial proportion of these patients since more than two-thirds had either hypertension or myocardial dysfunction postpartum, cardiac modifications due to pregnancy-related overload and hypertension were significantly more pronounced in the peripartum than in the postpartum periods. [Abstract copyright: Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

Peripartum screening for postpartum hypertension in women with hypertensive disorders of pregnancy

Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP). This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP. In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT. At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P 75 g/m , relative wall thickness >0.42, and E/e' ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90). This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease. [Abstract copyright: Copyright © 2022 American College of Cardiology Foundation. All rights reserved.

Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function.

Maternal uterine artery blood flow is critical to maintaining the intrauterine environment, permitting normal placental function, and supporting fetal growth. It has long been believed that inadequate transformation of the maternal uterine vasculature is a consequence of primary defective trophoblast invasion and leads to the development of preeclampsia. That early pregnancy maternal uterine artery perfusion is strongly associated with placental cellular function and behaviour has always been interpreted in this context. Consistently observed changes in pre-conceptual maternal and uterine artery blood flow, abdominal pregnancy implantation, and late pregnancy have been challenging this concept, and suggest that abnormal placental perfusion may result in trophoblast impairment, rather than the other way round. This review focuses on evidence that maternal cardiovascular function plays a significant role in the pathophysiology of preeclampsia

To the New Leonardo Galleries

In 1953, the Museum was inaugurated with a major exhibition on “Science and Technology of Leonardo da Vinci,” which soon evolved into a permanent gallery. Guido Ucelli, the Museum founder, entitled the museum to Leonardo da Vinci (Vinci 1452 - Amboise 1519), who is still today a global cultural icon, as well a symbol of curiosity and of interdisciplinary knowledge. His ability to observe nature and the work of others is a fundamental element of his relevance for modern times. His work, which ..

Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis.

BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. OBJECTIVES: This review aims to estimate the incidence of hypertension in the first 2 years after HDP. SEARCH STRATEGY: MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. SELECTION CRITERIA: Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to 2 years. DATA COLLECTION AND ANALYSIS: A meta-analysis to calculate the odds ratio (OR) with a 95% confidence interval (CI) and a sub-group analysis excluding women with chronic hypertension were performed. MAIN RESULTS: Hypertension was diagnosed within the first 2 years following pregnancy in 468/1646 (28.4%) and 584/6395 (9.1%) of the HDP and control groups, respectively (OR 6.28; 95% CI 4.18-9.43; I2  = 56%). The risk of hypertension in HDP group was significantly higher in the first 6 months following delivery (OR 18.33; 95% CI 1.35-249.48; I2  = 84%) than at 6-12 months (OR 4.36; 95% CI 2.81-6.76; I2  = 56%) or between 1-2 years postpartum (OR 7.24; 95% CI 4.44-11.80; I2  = 9%). A sub-group analysis demonstrated a similar increase in the risk of developing postpartum hypertension after HDP (OR 5.75; 95% CI 3.92-8.44; I2  = 49%) and pre-eclampsia (OR 6.83; 95% CI 4.25-10.96; I2  = 53%). CONCLUSIONS: The augmented risk of hypertension after HDP is highest in the early postpartum period, suggesting that diagnosis and targeted interventions to improve maternal cardiovascular health may need to be commenced in the immediate postpartum period. TWEETABLE ABSTRACT: The risk of hypertension within 2 years of birth is six-fold higher in women who experienced pre-eclampsia

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George's Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight - small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60-3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26-3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16-3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40-3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45-3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance