Folic acid is positively associated with uteroplacental vascular resistance: the Generation R study.

BACKGROUND AND AIMS: Periconception folic acid supplementation may influence early placentation processes and thereby the occurrence of hypertensive pregnancy disorders. For this reason we examined the associations between periconception folic acid supplementation and uteroplacental vascular resistance, blood pressure, and the risks of gestational hypertension and preeclampsia, in 5993 pregnant women, participating in a population-based cohort study. METHODS AND RESULTS: Folic acid supplementation was assessed by questionnaire. Mean pulsatility index (PI) and resistance index (RI) of the uterine (UtA) and umbilical arteries (UmA) were measured by Doppler ultrasound in mid- and late pregnancy. Systolic and diastolic blood pressures (SBP, DBP) were measured in early, mid- and late pregnancy. Compared to women who did not use folic acid, preconception folic acid users had a slightly lower UtA-RI in mid-pregnancy [ß -0.02, 95% confidence interval (CI) -0.03, -0.01] and late pregnancy [ß -0.02, 95% CI -0.03, -0.001], a lower UtA-PI in mid-pregnancy [ß -0.06, 95% CI -0.1, -0.03] and late pregnancy [ß -0.03, 95% CI -0.05, -0.01], as well as tendencies towards a lower UmA-PI in mid-pregnancy [ß -0.02, 95% CI -0.04, -0.001] and late pregnancy [ß -0.01, 95% CI -0.02, 0.01]. Additionally, these women had slightly higher SBP and DBP throughout pregnancy. Neither the patterns of blood-pressure change during pregnancy, nor the risk of gestational hypertension and preeclampsia differed between the folic acid categories. CONCLUSION: Periconception folic acid supplementation is associated with lower uteroplacental vascular resistance and higher blood pressures during pregnancy. The effects are small and within physiologic ranges and seem not associated with the risk of hypertensive pregnancy disorders.

Estimation of the flow of microbial nitrogen to the duodenum using milk uric acid or allantoin.

Data were collected from 10 experiments with duodenally cannulated Holstein dairy cows (271 combinations of cow and period) to evaluate the relationship between milk purine metabolites and microbial nitrogen flow. Experiments evaluated the effects of dietary factors on microbial N production and included: 1) supplemental sources of ruminally protected amino acids; 2) grass silage treated with fibrolytic enzymes; 3) bacterial inoculation of corn silage; 4) a comparison of corn and barley grain; 5) ruminal starch availability as affected by corn silages of varying maturity; and, 6) ruminal starch availability as affected by corn silages harvested at varying chop length and with or without mechanical processing. The coefficient of determination for individual experiments for the relationship between microbial nitrogen flow and allantoin or uric acid excretion in milk ranged from -0.01 to 0.77 and -0.06 to 0.22 respectively. Across all experiments, the coefficients of determination between microbial nitrogen flow and allantoin or uric acid excretion in milk were r2 = 0.09 and 0.01 respectively. Milk allantoin output was used to develop a prediction equation estimating microbial nitrogen flow to the duodenum. The greatest predictive value (r2 = 0.25) relationship was observed across non-bST experiments and included the factors of allantoin excretion, milk yield, dry matter intake, and days in milk. When milk yield was included in the model, the predictive value improved (r2 = 0.44). Based on these data, milk uric acid excretion alone cannot be used to predict microbial N production accurately [corrected].

High touch in high tech: the presence of relatives and friends during resuscitative efforts.

Hospital emergency departments traditionally have policies that require relatives and friends to wait out the resuscitative attempt of their loved ones in a counseling room. In recent years, this widespread practice has been questioned. In some hospitals, family members and friends are given the option to attend the resuscitative effort. Based on in depth interviews, three different resuscitation perspectives to which health care providers subscribe have been identified. According to the advocates of the survival framework, the only goal that a resuscitation should achieve is to save a human life. In the bifurcated perspectives, a resuscitation has two separate goals: saving lives and taking care of family members. Health care providers who subscribe to the holistic framework are still concerned with survival of the patient, but significant others become participants in the resuscitation process.