Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Measurement of associated W plus charm production in pp collisions at √s=7 TeV

Peer reviewe

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo

Measurement of the W-boson helicity in top-quark decays from ttˉt\bar{t} production in lepton+jets events in pp collisions at s\sqrt{s}=7 TeV

The W-boson helicity fractions in top-quark decays are measured with $t\bar{t}$ events in the lepton+jets final state, using proton-proton collisions at a centre-of-mass energy of 7 TeV, collected in 2011 with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 5.0 inverse femtobarns. The measured fractions of longitudinal, left-, and right-handed helicity are $F_0=0.682 \pm 0.030 (stat.) \pm 0.033 (syst.)$, $F_L=0.310 \pm 0.022 (stat.) \pm 0.022 (syst.)$, and $F_R= 0.008 \pm 0.012 (stat.) \pm 0.014 (syst.)$, consistent with the standard model predictions. The measured fractions are used to probe the existence of anomalous Wtb couplings. Exclusion limits on the real components of the anomalous couplings $g_L, g_R$ are also derived

Search for baryon number violation in top quark decays

A search for baryon number violation (BNV) in top-quark decays is performed using pp collisions produced by the LHC at sqrt(s)=8 TeV. The top-quark decay considered in this search results in one light lepton (muon or electron), two jets, but no neutrino in the final state. Data used for the analysis were collected by the CMS detector and correspond to an integrated luminosity of 19.5 inverse femtobarns. The event selection is optimized for top quarks produced in pairs, with one having the BNV decay and the other the standard model hadronic decay to three jets. No significant excess of events over the expected yield from standard model processes is observed. The upper limits at 95% confidence level on the branching fraction of the BNV top-quark decay are calculated to be 0.0016 and 0.0017 for the muon and the electron channels, respectively. These limits are the first that have been obtained on a BNV process involving the top quark

Measurement of the W+W- cross section in pp collisions at sqrt(s) = 7 TeV and limits on anomalous WW gamma and WWZ couplings

A measurement of W+W- production in pp collisions at sqrt(s) = 7 TeV is presented. The data were collected with the CMS detector at the LHC, and correspond to an integrated luminosity of 4.92 +/- 0.11 inverse femtobarns. The W+W- candidates consist of two oppositely charged leptons, electrons or muons, accompanied by large missing transverse energy. The W+W- production cross section is measured to be 52.4 +/- 2.0 (stat.) +/- 4.5 (syst.) +/- 1.2 (lum.) pb. This measurement is consistent with the standard model prediction of 47.0 +/- 2.0 pb at next-to-leading order. Stringent limits on the WW gamma and WWZ anomalous triple gauge-boson couplings are set