Exogenous porcine somatotropin administered to late pregnant gilts alters liver and muscle functionalities in pig foetuses

Neonatal maturity depends on the maternal capacity to provide nutrients for foetal growth. This study aimed to investigate the effects of systemic administration of recombinant porcine somatotropin (pST), one of the main regulators of growth and metabolism, to pregnant gilts during late gestation on circulating nutrients and expression levels of genes in liver and skeletal muscle of their 110-day-old foetuses. Gilts received either daily injections of sterile water (control [CTL] group, n = 15) or of 5 mg of pST (pST group, n = 17) from days 90 to 109 of gestation. At day 110 postconceptus, pairs of foetuses (one of small and one of average size within a litter) were selected. Circulating fructose concentrations were greater, but circulating concentrations of urea were lower in pST than in CTL foetuses. Expression levels of genes involved in carbohydrate and lipid metabolism were more affected by pST treatment in liver than in muscle. Hepatic molecular changes suggest an inhibition of energy-consuming processes (glycogen and lipid biosynthesis) and the activation of energy-producing pathway (mitochondrial oxidation) in pST compared to CTL foetuses. Expression levels of some genes involved in intracellular degradation of proteins were greater in the liver of pST foetuses, and combined with lower uremia, this suggests a higher utilisation of protein sources in pST foetuses than in CTL foetuses. In muscle, molecular changes were mainly observed in the IGF-insulin axis. Altogether, pST-treated gilts seem to have a greater ability to support foetal liver development by the reorientation of energy and protein metabolism.

Review: Improving the performance of neonatal piglets

Newborn piglets have a high incidence of preweaning mortality that is not only associated with low birth weights but also with the presence of intra-uterine growth-restricted (IUGR) piglets. Such IUGR piglets are commonly seen in litters from hyperprolific sows as a result of insufficient placental transfer of nutrients. Nutritional strategies can be used prior to and during gestation to enhance foetal development and can also be implemented in the transition period to reduce the duration of farrowing and increase colostrum yield. Recent findings showed that the energy status of sows at the onset of farrowing is crucial to diminish stillbirth rate. Newborn piglets often fail to consume enough colostrum to promote thermostability and subsequent growth, and this is particularly problematic in very large litters when there are fewer available teats than the number of suckling piglets. One injection of 75 IU of oxytocin approximately 14 h after farrowing can prolong the colostral phase, hence increasing the supply of immunoglobulins to piglets. Nevertheless, assistance must be provided to piglets after birth in order to increase their chance of survival. Various approaches can be used, such as: (1) optimising the farrowing environment, (2) supervising farrowing and assisting newborn piglets, (3) using cross-fostering techniques, (4) providing nurse sows, and 5) providing artificial milk. Although research advances have been made in developing feeding and management strategies for sows that increase performance of their newborn piglets, much work still remains to be done to ensure that maximal outcomes are achieved.

Prolactin and the swine mammary gland

Prolactin is a hormone that is most important for mammary development in swine. It is also essential for both the onset and the maintenance of lactation. In early studies, exogenous recombinant porcine prolactin was used to detect its biological effects on mammary tissue. In these studies, a stimulatory role of prolactin for mammary development of prepubertal gilts was demonstrated. However, when injected throughout lactation, prolactin did not increase sow milk yield likely because mammary receptors were saturated. The secretion of prolactin is largely under negative regulation via dopamine. Inhibition studies using the dopamine agonist bromocriptine showed that prolactin is required in the last third of gestation to sustain mammary development in gilts. When creating a hyperprolactinemic state during that same period, with the dopamine antagonist domperidone, differentiation of mammary epithelial cells was stimulated and milk yield in the subsequent lactation was increased. Domperidone given throughout lactation also led to greater milk yield. A study using domperidone in prepubertal gilts, however, did not reproduce the stimulatory effect of exogenous prolactin on mammary development and demonstrated that timing of the prolactin increase in relation to age of the animals is most important to elicit a response on mammary tissue. Attempts were made to use feed ingredients such as the plant extract from milk thistle, sylimarin, to stimulate prolactin secretion in sows. However, even though prolactin concentrations were increased, this augmentation was not important enough to have an impact on mammary development in late gestation or to increase milk yield. The current knowledge that hyperprolactinemia has beneficial effects for mammary development at various physiological stages and can enhance milk yield in swine leads to new avenues in elaborating strategies that could be used at the farm level to improve sow lactation performance.

Hyperprolactinemia using domperidone in prepubertal gilts: Effects on hormonal status, mammary development and mammary and pituitary gene expression

Objectives of this experiment were to determine if the domperidone protocol previously used for gestating gilts can also lead to hyperprolactinemia in growing gilts, and to assess the effects of such a protocol on hormonal status, mammary development and gene expression in mammary and pituitary tissue of gilts at puberty. The impact on future lactation performance was also determined. At 75 ± 3 kg body weight (BW), gilts were divided between: 1) controls (CTL), receiving daily intramuscular (IM) injections of canola oil (1.1 mL) for 29 d (n = 41), and 2) treated (DOMP), receiving daily IM injections with 0.5 mg/kg BW of the dopamine receptor antagonist domperidone for 29 d (n = 40). In addition to that daily injection, treated gilts also received twice daily IM injections with 0.5 mg/kg BW of domperidone over the first 3 d of treatment. Fifteen gilts per treatment were sacrificed at 210 ± 5 d of age to collect mammary glands (for compositional analysis and gene expression) and the anterior pituitary (for gene expression). Remaining gilts were bred and allowed to farrow. Blood was sampled at the onset of treatment and on days 14 and 30. Gilts that farrowed were also blood sampled on days 3 and 20 of lactation. Blood was assayed for prolactin (PRL), leptin, insulin-like growth factor 1 (IGF-1), urea, free fatty acids and glucose. Concentrations of PRL increased after 14 d and 30 d of treatment (P < 0.01) and were lesser on day 3 of lactation in DOMP than CTL gilts (P < 0.01). At puberty, there were tendencies (P < 0.10) for total parenchymal protein and DNA to be greater in DOMP than CTL gilts. Treatment did not affect mRNA abundance of PRL or the long form of the PRL receptor genes in the pituitary gland at puberty but expression level of the dopamine receptor D2 and PRL genes was much lower in pubertal than late-pregnant gilts (P < 0.001). Furthermore, many genes related with PRL had a much greater expression level in late pregnancy than at puberty. On day 20 of lactation, CTL sows had greater concentrations of urea than DOMP sows (P < 0.01). The growth rate of litters was not affected by treatment nor was milk composition (P > 0.10). Even though PRL concentrations were increased with treatment, the absence of effect on mammary development was either due to timing relative to developmental stage, whereby treatment was initiated when gilts were too young, or was because all PRL receptors may have been saturated thereby preventing biological action of additional PRL.

Metoclopramide induces preparturient, low-level hyperprolactinemia to increase milk production in primiparous sows

Inadequate milk production by sows often limits the growth of piglets. A successful lactation requires prolactin (PRL)-induced differentiation of the alveolar epithelium within the mammary glands of sows between days 90-110 of gestation. We hypothesized that induction of late gestational hyperprolactinemia in primiparous sows by oral administration of the dopamine antagonist metoclopramide (MET) would enhance mammary epithelial differentiation, milk yield, and piglet growth rate and that these effects would carry over into a subsequent lactation. Twenty-six gilts were assigned to receive either MET (n = 13, 0.8 mg/kg) or vehicle (CON, n = 13) twice daily from days 90-110 of gestation. The same sows were followed into their second lactation without additional treatment. On day 90 of gestation, circulating PRL concentrations peaked 45 min after feeding MET (P < 0.001) and then returned to baseline 3 h later. This response occurred daily out to day 104 of gestation (P < 0.05). Compared with CON, MET-treated gilts had enlarged alveoli on gestation day 110 (P < 0.05). Treatment with MET did not affect feed intake, body weight, or body fatness during pregnancy or lactation. Piglets born to MET-treated sows had both increased body weights and average daily gain on lactation days 14 and 21 (P < 0.05). Milk intake by piglets was estimated from deuterium oxide dilution. Although milk intake by piglets nursing MET sows was not statistically different from those nursing CON sows on day 21 of lactation (P = 0.18), there was a greater increase in milk consumption by piglets born to MET-treated sows between days 9 and 21 of lactation than for those in CON litters (P < 0.001). In one group of second parity sows (n = 11) that were treated with MET during their first gestation, milk yield increased by 21% during their second lactation (P < 0.05) in association with a 14% decline in body fatness across lactation compared with a 7% decline in CON sows (P < 0.05). These findings demonstrate that MET-induced hyperprolactinemia in primiparous sows during late pregnancy can increase milk yield and piglet growth rate, setting the stage for further large-scale studies.

COVID-19 in Kidney Transplant Patients From a Large UK Transplant Center: Exploring Risk Factors for Disease Severity

Background

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised concern for the health of immunocompromised individuals, who are potentially at higher risk of more severe infection and poorer outcomes. As a large London transplant center serving a diverse patient population, we report the outcomes of SARS-CoV-2 infection in our cohort of 2848 kidney and/or pancreas transplant patients.

Methods

Data were obtained retrospectively for all transplant patients who attended hospital during the peak of the pandemic and had a positive nasopharyngeal SARS-CoV-2 test.

Results

Sixty-six patients were found to be positive for SARS-CoV-2. Twenty percent were treated as outpatients, 59% were admitted to the general ward, and 21% required intensive care. Treatment consisted of reduced immunosuppression, antibiotics for pneumonia or sepsis, and other supportive treatments. Within our cohort, 12 patients died (18%), with an overall mortality of 0.4%. Predictive risk factors for COVID-19 severity were explored.

Conclusions

Severe disease was associated with lower hemoglobin prior to COVID-19 diagnosis and lower lymphocyte count at the time of diagnosis but not age, sex, ethnicity, or preexisting comorbidities. Lower glomerular filtration rate and higher C-reactive protein were associated with more severe disease. Despite no use of hydroxychloroquine, azithromycin, antiviral, or immunomodulatory medications, our mortality rate (kidney and pancreas transplant patients) is similar to current international rates.

Effects of sustained hyperprolactinemia in late gestation on mammary development of gilts

The objective of this project was to determine the effects of sustained hyperprolactinemia for 7 or 20 d on mammary development in late-pregnant gilts. On day 90 of gestation, gilts were assigned to one of 3 groups to receive intramuscular (IM) injections of (1) canola oil (CTL, n = 18) until day 109 ± 1 of gestation; (2) a dopamine receptor antagonist, domperidone (0.5 mg/kg of body weight [BW]) until day 96 ± 1 of gestation (T7, n = 17); or (3) domperidone (0.5 mg/kg BW) until day 109 ± 1 of gestation (T20, n = 17). Domperidone-treated gilts also received 100 mg of domperidone per os twice daily from days 90 to 93 of gestation. Blood was sampled on days 89, 97, 104, and 110 for prolactin (PRL), insulin-like growth factor 1 (IGF1), lactose, urea, and glucose assays. Mammary glands were collected at necropsy, on day 110, for compositional and cell proliferation analyses. Abundance of mRNA for selected genes was also determined in the mammary gland and the pituitary gland. On day 97 of gestation, PRL concentrations were 3 times greater for T20 and T7 than CTL gilts and were also greater for T20 than T7 and CTL gilts on days 104 and 110 (P < 0.001). Concentrations of IGF1 in T20 and T7 gilts were elevated relative to controls on days 97 and 104 and were greater for T20 vs T7 and CTL gilts on day 110 (P < 0.05). There were no treatment effects (P > 0.1) on parenchymal or extraparenchymal tissue weights, or on epithelial proliferation as measured by immunohistochemistry for Ki-67. Treatments did not alter concentrations of dry matter (DM), fat, or DNA (P > 0.1) in parenchyma. Concentrations of RNA (P < 0.05) and protein (P < 0.10) as well as total parenchymal protein, RNA, and DNA (P < 0.05) were lower, or tended to be, in T20 than T7 or CTL gilts. Hyperprolactinemia for 20 d in late gestation increased mRNA abundance of the milk protein genes beta-casein (CSN2) and whey acidic protein (WAP) (P < 0.05) in mammary parenchyma and also decreased mRNA abundance of the long form of the prolactin receptor (PRLR-LF). Increasing PRL concentrations for 7 or 20 d in late gestation had no beneficial effects on the composition of the mammary gland, and sustained exposure to domperidone for 20 d reduced metabolic activity either by a lower expression of the long form of the PRL receptor in mammary parenchymal tissue or, most likely, by the early involution of parenchymal tissue. In conclusion, results do not support the hypothesis that a sustained hyperprolactinemia in late gestation could enhance mammary development of gilts.

Concordance of the Vineland Adaptive Behavior Scales, second and third editions

BACKGROUND

Because of its centrality in the conceptualization of intellectual disability, reliable and valid measurement of adaptive behaviour is important to both research and clinical practice. The manual of the Vineland Adaptive Behavior Scales, recently released in its third edition, provides limited reliability information obtained from a sample composed primarily of typically developing individuals. The goal of this study was to evaluate the concordance of the Vineland-3 with the Vineland-II in a sample more similar in ability level to those in which the Vineland is commonly used.

METHODS

Both editions of the Vineland Interviews were conducted with a convenience sample of 106 parents/caregivers of individuals with neurodevelopmental disability, participating at two neurodevelopmental disorder research clinics. Administrations were up to 7 days apart, but most (90%) were simultaneous. The concordance correlation coefficient (CCC) (95% confidence interval) and mean differences (95% confidence interval) were calculated for domain standard scores and subdomain v-scale scores.

RESULTS

Domain-level CCC ranged from 0.78 [0.70, 0.84] (Communication) to 0.86 [0.76, 0.92] (Motor). Subdomain CCC ranged from 0.71 [0.62, 0.78] (Receptive Language) to 0.91 [0.85, 0.95] (Fine Motor). Vineland-3 scores were lower than Vineland-II scores; 77% of participants had lower Adaptive Behavior Composite scores on the Vineland-3 than on the Vineland-II. For the subdomains, the magnitude of this difference depended upon the level of adaptive behaviour. For Communication, the domain with the lowest CCC, the mean difference ranged from -13.70 [-8.03, -19.35] for a Vineland-II score or 85 to a difference of -19.18 [-12.28, -26.87] for a Vineland-II score of 40.

DISCUSSION

Amongst individuals with intellectual and developmental disabilities, the Vineland-3 produces lower scores than the Vineland-II, and these clinically significant differences tend to be larger for individuals with lower levels of ability. Thus, care must be taken in interpreting scores from the Vineland-3 relative to those obtained from the previous edition.

Using domperidone to induce and sustain hyperprolactinemia in late-pregnant gilts

Prolactin controls mammary development as well as the lactogenic and galactopoietic processes in sows and increasing prolactin during gestation can augment milk yield. The dopamine receptor antagonist domperidone can increase circulating prolactin concentrations in pigs, but the ideal dose to achieve sustained hyperprolactinemia remains unknown. An experiment was performed to develop a protocol for using domperidone in studies of rapid and sustained hyperprolactinemia in late-pregnant gilts. On day 90 of gestation, gilts were divided into 4 groups: (1) intramuscular (IM) injections of canola oil (3 mL, controls [CTL], n = 9), (2) IM injections with 0.1 mg/kg BW of domperidone (low [LO], n = 8), (3) IM injections with 0.5 mg/kg BW of domperidone (medium [ME], n = 11), and (4) IM injections with 1.0 mg/kg BW of domperidone (high [HI], n = 11). Injections were given daily at 8:05 from days 90 to 109 of gestation. Treated gilts also received domperidone per os (0.5 mg/kg BW) at 8:00 and 20:00 on days 89, 90, and 91 of gestation. Three jugular blood samples were collected from all gilts at 6-h intervals on days 89, 90, and 91 of gestation, then twice daily on days 92, 93, and 94. Thereafter, samples were obtained at 8:00 every other day until day 114 of gestation. Blood was sampled serially from 9 CTL and 11 HI gilts on days 89 and 94 of gestation. On day 89 of gestation, prolactin concentrations for LO, ME, and HI gilts increased within 6 h of domperidone per os (P < 0.001). From days 89 until 93 of gestation, the area under the curve (AUC) for LO, ME, and HI gilts was greater than that for CTL gilts (P < 0.001), whereas from days 89 until 114, ME and HI gilts had greater AUC than CTL and LO gilts (P < 0.05). Results demonstrate that the combination of per os treatment with IM injections of 0.5 mg/kg of domperidone in an oil emulsion leads to the rapid and sustained release of prolactin over 24 d in late-pregnant gilts. Higher doses of domperidone failed to further increase circulating prolactin levels. These findings provide a useful strategy to induce sustained hyperprolactinemia in late-pregnant gilts.

Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naïve youth in the HIV Research Network

OBJECTIVES

Several single-tablet regimens (STRs) are now available and are recommended for first-line antiretroviral therapy (ART); however, STR use for youth with HIV (YHIV) has not been systematically studied. We examined the characteristics associated with initiation of STRs versus multi-tablet regimens (MTRs) and the virological outcomes for youth with nonperinatally acquired HIV (nPHIV).

METHODS

A retrospective cohort study of nPHIV youth aged 13-24 years initiating ART between 2006 and 2014 at 18 US HIV clinical sites in the HIV Research Network was performed. The outcomes measured were initiation of STRs versus MTRs, virological suppression (VS) at 12 months, and time to VS. Demographic and clinical factors associated with initiation of STR versus MTR ART and VS (< 400 HIV-1 RNA copies/mL) at 12 months after initiation were assessed using multivariable logistic regression. Cox proportional hazards regression was used to assess VS within the first year.

RESULTS

Of 987 youth, 67% initiated STRs. Of the 589 who had viral load data at 1 year, 84% of those on STRs versus 67% of those on MTRs achieved VS (P < 0.01). VS was associated with STR use [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.01-2.58], white (AOR 2.41; 95% CI 1.13-5.13) or Hispanic (AOR 2.38; 95% CI 1.32-4.27) race/ethnicity, and baseline CD4 count 351-500 cells/μL (AOR 1.94; 95% CI 1.18-3.19) and > 500 cells/μL (AOR 1.76; 95% CI 1.0-3.10). STR use was not associated with a shorter time to VS compared with MTR use [hazard ratio (HR) 1.07; 95% CI 0.90-1.28].

CONCLUSIONS

Use of STR was associated with a greater likelihood of sustained VS 12 months after ART initiation in YHIV.

TRIENNIAL LACTATION SYMPOSIUM/BOLFA: Adipokines affect mammary growth and function in farm animals

The essential role of mammary fat pads in mammary growth and morphogenesis was the first indication that biologically active molecules, secreted from adipocytes or other stromal cells, could regulate endocrine cues for growth and function of the mammary gland. The presence of leptin and adiponectin receptors in mammary tissues suggested that locally produced or circulating adipokines could affect mammary growth and function. Herein, we present the current knowledge on the role of adipokines in mammary cell proliferation and differentiation and in lactogenesis and galactopoiesis in farm animals. We also address the role of milk adipokines in the neonate. Accumulating evidence suggests that adipokines could act as metabolic sensors, regulating mammary growth and function in periods of metabolic adaptations such as late pregnancy and early lactation. Indeed, different experiments reported that adiponectin and leptin expression varies according to physiological stages and nutritional status of the animal. The current review also demonstrates that adipokines, such as leptin and adiponectin, are important regulators of the action of lactogenic hormones in the mammary gland. Findings also suggest important roles for adipokines in growth and intestinal maturation of the neonate.

Comparison of major bleeding risk in patients with non-valvular atrial fibrillation receiving direct oral anticoagulants in the real-world setting: a network meta-analysis

OBJECTIVE

To conduct a systematic literature review (SLR) and network meta-analysis (NMA) of real-world studies comparing major bleeding risk among patients with non-valvular atrial fibrillation (NVAF) on direct oral anticoagulants (DOACs) or warfarin.

METHODS

Systematic searches were conducted in MEDLINE and Embase for full-text articles published between January 1, 2003 and March 18, 2017. Eligible studies compared at least two of the following in a real-world setting: warfarin, apixaban, dabigatran, rivaroxaban, or edoxaban. A Bayesian NMA was conducted to estimate hazard ratios (HRs) for major bleeding using a random-effects model.

RESULTS

Eleven studies were included in the NMA. Nine studies included DOACs vs Warfarin comparisons, and four studies included DOACs vs DOACs comparisons (two studies included both comparisons). Median follow-up duration ranged from 2.6-31.2 months. No evidence was identified for edoxaban. Apixaban was associated with a significantly lower risk of major bleeding compared to other oral anticoagulants (warfarin HR = 0.58; 95% credible interval [CrI] = 0.48-0.69; dabigatran = 0.73; 0.61-0.87; rivaroxaban = 0.55; 0.46-0.66). Dabigatran was associated with a significantly lower risk than warfarin (0.79; 0.71-0.88) and rivaroxaban (0.76; 0.67-0.85), and rivaroxaban was not statistically different from warfarin (1.05; 0.91-1.19). Sensitivity analyses with standard dose and sponsorship showed consistent results.

CONCLUSION

DOACs were associated with lower or similar risk of major bleeding compared with warfarin in NVAF patients. Apixaban was associated with a significantly lower risk of major bleeding than other DOACs. Dabigatran was associated with a significantly lower risk of major bleeding compared to rivaroxaban and warfarin.

Oxytocin injections in the postpartal period affect mammary tight junctions in sows

The potential impacts of injecting oxytocin (OXY) to sows in the early postpartum period on the quality of mammary tight junctions, milk composition, and immune status of sows and piglets were studied. Postparturient sows received i.m. injections of either saline (control [CTL]; = 10) or 75 IU of OXY ( = 10). Injections were given twice daily (0800 and 1630 h) starting on d 2 of lactation (i.e., between 12 and 20 h after birth of the last piglet), totaling 4 injections. Milk samples were obtained before the first injection (d 2 morning [AM]), before the second injection (d 2 afternoon [PM]), and on d 4 PM and d 5 PM. Blood samples were obtained from sows before milking on d 2 AM, d 2 PM, and d 5 PM. On d 5 of lactation, a blood sample was obtained from 3 piglets per litter. Circulating concentrations of prolactin, IGF-I, lactose, and IgA in sows did not differ between treatments at any time ( > 0.10), but OXY sows had less IgG than CTL sows ( < 0.01) on d 2 PM before the second OXY injection. There were differences in milk composition on d 2 PM, with OXY sows having more IGF-I ( < 0.01), solids ( < 0.05), protein ( < 0.01), energy ( < 0.05), and IgA ( < 0.01) and a greater Na:K ratio ( < 0.01) than CTL sows. These differences were not seen in the next 2 milk samples, except for protein and IgA that still tended ( < 0.10) to be greater in OXY vs. CTL sows on d 4 PM (for protein) and on d 5 PM (for IgA) after the last injection. Milk lactose content was lower in OXY vs. CTL sows on d 5 PM ( < 0.01). Values for immunoglobulin immunocrit, IgG, IgA, and IGF-I in piglet blood did not differ between treatments ( > 0.10). Injecting OXY to sows in the early postpartum period increased leakiness of the mammary tight junctions, improved composition of early milk, and may potentially affect immune status of neonatal piglets.

In vivo measures of mammary development in gestating gilts

Potential links between measures of udder morphology obtained in live pregnant gilts and mammary gland development and composition measured in mammary tissue collected at slaughter were studied. Thirty-three gilts were used. In vivo measures of gland morphology using a tape or ultrasound imaging (parenchymal area measured by ultrasound [AREA]) were obtained on d 108 ± 1 of gestation. Gilts were then slaughtered on d 110 ± 1 of gestation to collect mammary glands for dissection and compositional analyses. The various tape measures were the distance between each teat on one side of the udder (DIST-TEAT), the distance between each teat pair (DIST-PAIR), the length of the udder (sum of all DIST-TEAT), the distance between the base of the teat and the ventral midline section of the udder (MID), and the distance between the base of the teat and the exterior junction of the udder with the abdomen (EXT). The variables MID, DIST-TEAT, DIST-PAIR, and length had very poor correlations with parenchymal weight, extraparenchymal weight, or any of the measured compositional variables. On the other hand, both AREA and EXT were correlated ( < 0.01) with the weight of parenchymal tissue, total parenchymal protein, total DNA, and total RNA. The ultrasound measure AREA and the tape measure EXT were also correlated with each other ( < 0.05). These measures could, therefore, be helpful to estimate mammary development in studies where animals cannot be slaughtered. The tape measure EXT seemed to better reflect the volume of the gland than MID, and it provided as reliable an estimate of parenchymal weight as the measure of parenchymal area using ultrasound while being much easier and cheaper to obtain.

Risk of major bleeding in patients with non-valvular atrial fibrillation treated with oral anticoagulants: a systematic review of real-world observational studies

OBJECTIVE

To conduct a systematic review of real-world (RWD) studies comparing the risk of major bleeding (MB) among patients with non-valvular atrial fibrillation (NVAF) on direct oral anticoagulants (DOACs) or warfarin.

METHODS

MEDLINE, Embase, NHS-EED, and EconLit were searched for RWD studies published between January 2003 and November 2016 comparing MB risk among DOACs and warfarin. Proceedings of clinical conferences from 2012 to 2016 were reviewed.

RESULTS

A total of 4218 citations were identified, 26 of which met eligibility criteria. Most studies were retrospective analyses of administrative claims databases and patient registries (n = 23 of 26); about half were based in the United States (n = 15). Apixaban showed a significantly lower risk of MB versus warfarin in all eight included studies. MB risk was either significantly lower (n = 9 of 16) or not significantly different (n = 7 of 16) between dabigatran and warfarin; there was no significant difference between rivaroxaban and warfarin in all seven included studies. The risk was significantly lower with apixaban versus rivaroxaban (n = 7 of 7) but not significantly different from dabigatran (n = 6 of 7). MB risk was significantly lower (n = 3 of 4) or not significantly different (n = 1 of 4) with dabigatran versus rivaroxaban. No evidence was identified for edoxaban.

CONCLUSION

DOACs were associated with similar or lower risks of MB versus warfarin. A lower MB risk was consistently observed for apixaban, but less consistently for dabigatran; MB risk was similar between rivaroxaban and warfarin. Among DOACs, the risk of MB with apixaban was consistently lower than with rivaroxaban, but similar to dabigatran.

Does duration of teat use in first parity affect milk yield and mammary gene expression in second parity?

It was recently shown that a teat that is not used in the first lactation will have a reduced development and milk yield in the second lactation. In the current study, the impact of imposing a suckling period of 2, 7, or 21 d during the first lactation on piglet performance, milk composition, endocrine status, and mammary gene expression of sows in their second lactation was studied. Pregnant Yorkshire gilts were divided into 3 groups according to lactation length: 1) 2-d lactation (2D; = 20), 2) 7-d lactation (7D; = 20), and 3) 21-d lactation (21D; = 21). After weaning, sows were bred and kept for a second parity. In both lactations, litters were standardized to 12 piglets with 12 functional teats and surplus teats were sealed. In the second lactation, piglets were weighed on d 2, 7, 14, 21 (weaning), 31, and 56 postpartum, and sow feed intake was recorded. On d 110 of gestation and on d 21 of lactation, mammary biopsies were performed on 10 sows per treatment to obtain parenchymal tissue samples for determination of mRNA abundance for , , , , , and genes. Milk samples and jugular blood samples were also obtained from sows on d 21 of lactation. Standard composition analyses (DM, fat, protein, and lactose) were done in milk. Concentrations of prolactin, IGF-1, glucose, and urea were measured in blood. There was a tendency for 21D sows to consume more feed than 2D or 7D sows during the first week of lactation ( < 0.10). There was no treatment effect on BW of piglets at any time until d 56 ( > 0.10). Concentrations of prolactin, IGF-1, urea, and glucose in sows on d 21 of lactation were not affected by treatment ( > 0.10). Dry matter, fat, protein, and lactose contents in milk were not altered by treatment ( > 0.10). On d 110 of gestation, gene expression was greater ( = 0.05) in 21D sows than in 7D sows. On d 21 of lactation, gene expression of was greater ( = 0.05) and that of tended to be lower ( < 0.10) in 7D sows than in 2D sows. The mRNA abundance of also tended to be lower ( < 0.10) in 2D sows than in 7D sows. Results indicate that increasing the duration of lactation from 2 d to 7 d or to 21 d in first-parity sows did not improve growth rate of their piglets in the subsequent lactation. This suggests that suckling of a teat for 2 d during the first lactation is sufficient to ensure optimal mammary development.

Comparative study on the relations between backfat thickness in late-pregnant gilts, mammary development and piglet growth

The potential relation between body condition of gilts in late-pregnancy and litter BW gain as well as mammary development was studied using 2 sets of data. Gilts either from a commercial herd (Part 1, n = 182) or from a series of trials looking at mammary development (Part 2, n = 172) were separated in 3 groups according to backfat thickness (BF) on d 110 of gestation. Group categorization was similar for Parts 1 and 2 of the study and was: low (LOW), 13.6 ± 1.6 mm (mean ± SD); medium (MED), 17.6 ± 1.0 mm (mean ± SD); and high BF (HIGH), 21.8 ± 1.8 mm (mean ± SD) for Part 1, and LOW, 14.2 ± 1.3 mm (mean ± SD); MED, 18.1 ± 1.0 mm (mean ± SD), and HIGH 23.4 ± 2.6 mm (mean ± SD) for Part 2. The effects of BF group on piglet BW gain (Part 1) or on various mammary gland characteristics (Part 2) were determined using ANOVA. Litters from HIGH sows tended to have a greater lactation BW gain than those from LOW sows (P < 0.10). Sows with HIGH BF had more mammary parenchymal tissue and more total protein and total DNA than MED and LOW sows (P < 0.05), which led to greater total protein and total DNA contents (P < 0.05). There were strong positive correlations (P < 0.0001) between parenchymal weight and total protein, total DNA, and total RNA. Results suggest that it is beneficial for primiparous sows to have greater BF (i.e., 20 to 26 mm) at the end of gestation to achieve optimal mammary development and greater litter BW gain in the subsequent lactation.

Altering prolactin concentrations in sows

Prolactin has a multiplicity of actions, but it is of particular importance in gestating and lactating animals. In sows, it is involved in the control of mammary development and also holds essential roles in the lactogenic and galactopoietic processes. Furthermore, low circulating concentrations of prolactin are associated with the agalactia syndrome. The crucial role of prolactin makes it important to understand the various factors that can alter its secretion. Regulation of prolactin secretion is largely under the negative control of dopamine, and dopamine agonists consistently decrease prolactin concentrations in sows. On the other hand, injections of dopamine antagonists can enhance circulating prolactin concentrations. Besides pharmacologic agents, many other factors can also alter prolactin concentrations in sows. The use of Chinese-derived breeds, for instance, leads to increased prolactin concentrations in lactating sows compared with standard European white breeds. Numerous husbandry and feeding practices also have a potential impact on prolactin concentrations in sows. Factors, such as provision of nest-building material prepartum, housing at farrowing, high ambient temperature, stress, transient weaning, exogenous thyrotropin-releasing factor, exogenous growth hormone-releasing factor, nursing frequency, prolonged photoperiod, fasting, increased protein and/or energy intake, altered energy sources, feeding high-fiber diets, sorghum ergot or plant extracts, were all studied with respect to their prolactinemic properties. Although some of these practices do indeed affect circulating prolactin concentrations, none leads to changes as drastic as those brought about by dopamine agonists or antagonists. It appears that the numerous factors regulating prolactin concentrations in sows are still not fully elucidated, and that studies to develop novel applicable ways of increasing prolactin concentrations in sows are warranted.

Relative prolactin-to-progesterone concentrations around farrowing influence colostrum yield in primiparous sows

In swine, colostrum production is induced by the drop of progesterone (P4) concentrations which leads to the prepartum peak of prolactin (PRL). PRL regulates mammary cell turnover and stimulates lacteal nutrient synthesis. P4 inhibits PRL secretion and downregulates the PRL receptor in the mammary gland. The aim of the present study was to determine if the relative prepartum concentrations of P4 and PRL (PRL/P4 ratio) influence sow colostrum production. The performance of 29 Landrace × Large White primiparous sows was analyzed. Colostrum yield was estimated during 24 h starting at the onset of parturition (T0) using litter weight gains. Colostrum was collected at T0 and 24 h later (T24). Repeated jugular blood samples were collected during the peripartum period, that is, from -72 to +24 h related to farrowing and were assayed for P4 and PRL. Sows were retrospectively categorized in 2 groups according to their PRL/P4 ratio 24 h before farrowing being either <2 (low PRL/P4, n = 16) or >3 (high PRL/P4, n = 13). During the peripartum period, the circulating concentrations of P4 were lower (P < 0.05) and those of PRL tended to be greater (P < 0.10) in high PRL/P4 compared with low PRL/P4 sows. Colostrum yield was greater in high PRL/P4 compared with low PRL/P4 sows (4.11 vs 3.48 kg [root mean square error = 0.69], P < 0.05). Colostrum composition (dry matter, energy, protein, lipid, and lactose contents) and IgG and IgA concentrations did not differ between the 2 groups of sows (P > 0.10). The Na/K ratio in colostrum 24 h after the onset of farrowing was lower in high PRL/P4 compared with low PRL/P4 sows (P < 0.05). Piglet mortality between birth and T24 averaged 10.0% in low PRL/P4 litters and 7.0% in high PRL/P4 litters (P = 0.29). In conclusion, a greater PRL/P4 ratio 24 h prepartum, characterized by lower P4 concentrations and a trend for greater PRL concentrations peripartum, led to increased colostrum yield in primiparous sows.

Do gastroenterologists monitor their patients taking 5-amino-salicylates following initiation of treatment

BACKGROUND

5-Amino salicylate (5-ASA) medications may rarely be associated with a significant decline in renal function and interstitial nephritis. British Society of Gastroenterology guidelines advise regular renal function monitoring for patients taking these drugs.

AIM

To assess whether gastroenterologists in Kent were following best practice guidelines regarding the monitoring of their patients on 5-ASA therapy.

METHODS

Using longitudinal community and regional pathology databases for the Kent population, our renal unit regularly screens a total population of 300 000 for evidence of renal disease. The data extracted are analysed using an automated computerised system to identify patients requiring intervention for kidney disease. All patients taking 5-ASA medication were identified from a population of 300 000. The pathology database was studied to identify the patients on 5-ASA treatment and whether they had had renal function tests.

RESULTS

800 adult patients were identified taking 5-ASA therapy. 612 patients received 5-ASAs for 3 months or more, and these were included in the final analysis. 293 patients had no renal function checks while on treatment. 79 patients had renal function tests less than once every 4 years and 36 patients once every 2-4 years. 204 patients had renal function measurements in 50% or more of years of treatment, of whom 116 were checked every year. Some patients were started on treatment with abnormal results at baseline and some with identified kidney disease continued on their 5-ASAs.

CONCLUSIONS

The majority of patients receiving 5-ASA compounds do not have regular renal function monitoring. Clinicians are failing to follow best practice guidelines.

Plasma amino acids, prolactin, insulin and glucose concentrations in lactating sows following venous infusion of isoleucine, leucine, lysine, threonine or valine

de Ridder, K. A. G., Farmer, C., de Lange, C. F. M., Shoveller, A. K. and Luimes, P. H. 2014. Plasma amino acids, prolactin, insulin and glucose concentrations in lactating sows following venous infusion of isoleucine, leucine, lysine, threonine or valine. Can. J. Anim. Sci. 94: 323–330. The amino acid supply to lactating sows affects their milk yield, and the current study aims at establishing whether this is mediated via increases in concentrations of insulin and prolactin, two hormones that are important for lactation. Six multiparous Yorkshire sows (252.8±18.5 kg body weight) were fitted with an ear vein catheter and were used in a 6×6 Latin square design experiment from days 7 to 10 of lactation (am and pm infusions on 3 consecutive days). Sows were fed a commercial corn and soybean meal diet (17.1% crude protein) three times daily (1.5 kg at 0600 and 1200, 3.0 kg at 1830). Starting 2 h after the 0600 or 1200 feeding, sows received an infusion of saline (control), isoleucine, leucine, lysine, threonine or valine at a rate of 33 mL min−1during 30 min. The infused dose was equivalent to 18±0.9% of true ileal digestible intake for each of the amino acids. Serial blood samples were taken, starting 30 min prior to infusion and until 240 min after infusion. Plasma concentrations of amino acids, prolactin, insulin, and glucose were determined. Data were analyzed as repeated measurements and also using areas under the curve. Intravenous infusion with each of the five amino acids studied increased the corresponding free plasma amino acid concentrations (P<0.05). However, concentrations of prolactin, insulin, and glucose were not affected by infusion of any of the amino acids studied (P>0.10). Therefore, supplying intravenously 18% of the daily intake of isoleucine, leucine, lysine, threonine or valine brings about expected increases in amino acids, but does not alter the short-term response in prolactin, insulin or glucose concentrations of lactating sows.

Colostrum yield and piglet growth during lactation are related to gilt metabolic and hepatic status prepartum

It was hypothesized that colostrum production could be influenced by sow peripartum endocrine, metabolic, and hepatic status. The plant extract silymarin was shown to influence endocrine and hepatic status in several species. The aims of the present study were to investigate the effects of silymarin intake during late pregnancy on sow hormonal and hepatic status and to determine whether relations exist between sow hepatic and metabolic status during the peripartum period and colostrum yield and piglet performances during lactation. From d 107 of pregnancy until farrowing, nulliparous sows were either fed 12 g/d of silymarin (SIL; n = 15) or no treatment (Control; n = 12). Piglet BW was recorded directly after birth, 24 h after birth of the first piglet, and at 7, 14, and 21 d of lactation. Blood samples were collected from sows on d 107 and 109 of pregnancy, daily from d 111 of pregnancy until d 2 of lactation, and on d 7 and 21 of lactation. They were assayed for endocrine, metabolic, and hepatic variables. Colostrum yield was estimated during 24 h starting at the onset of farrowing. Silymarin did not influence colostrum yield (3.7 ± 0.3 kg) or gross composition (P > 0.10), nor did it affect serum prolactin concentrations or plasma concentrations of progesterone, estradiol-17β, or cortisol (P > 0.10). Mean litter BW gain was lower (P < 0.05) during the first week and tended (P < 0.10) to be lower during the second week of lactation in litters from SIL sows. Silymarin had no effect on plasma concentrations of aspartate transaminase, alanine transaminase, γ-glutamyl transferase (γ-GT), alkaline phosphatase, or total cholesterol (P > 0.10). Colostrum yield was positively correlated with urea (r = 0.50; P = 0.01) and creatinine (r = 0.43; P = 0.03) concentrations in sows on the day before farrowing. Mean litter BW gain over 2 wk was negatively correlated with concentrations of β-hydroxybutyric acid (r = -0.50; P = 0.01) and γ-GT (r = -0.42; P = 0.03) on the day before farrowing and was positively correlated with urea concentrations on the day before farrowing (r = 0.54; P = 0.01). In conclusion, at the dose of 12 g/d, silymarin did not influence prolactin concentrations or the hepatic status of sows, had no impact on colostrum production, and decreased litter BW gain in early lactation. Colostrum yield and litter performance during lactation were correlated with some markers of sow metabolic and hepatic status measured during the prepartum period.

Effects of the plant extract silymarin on prolactin concentrations, mammary gland development, and oxidative stress in gestating gilts

The impacts of supplementing the diet of gestating gilts twice daily with 4 g of the plant extract silymarin on circulating hormonal concentrations, oxidative status, mammary development, and mammary gene expression at the end of gestation were determined. Gilts were fed conventional diets during gestation and on d 90 they were assigned as controls (CTL; n = 16) or treated (TRT; n = 17) animals. Treatment consisted of providing 4 g of silymarin twice daily until d 110, at which time all gilts were slaughtered to collect mammary tissue for compositional analyses and measures of gene expression and oxidative status, and liver and corpora lutea for measures of oxidative stress variables. Blood samples for hormonal assays and evaluation of oxidative stress biomarkers were obtained on d 89, 94, and 109 of gestation. Silymarin increased (P = 0.05) circulating concentrations of prolactin over all samples in the repeated in time analysis. In separate analyses for each sampling time, prolactin concentrations in TRT gilts tended (P < 0.10) to be greater than in CTL gilts on d 94 of gestation. Repeated in time analysis also revealed that silymarin reduced (P ≤ 0.05) plasmatic accumulation of biomarkers of oxidative damage to protein (protein carbonyls) between d 89 and 109. There was no effect (P > 0.10) of treatment on progesterone, estradiol, leptin, or 8-hydroxy-2'-deoxyguanosine concentrations. Percent fat in mammary parenchyma was greater (P ≤ 0.05), percent protein was lesser (P ≤ 0.05), and concentrations of both RNA (P ≤ 0.01) and DNA (P < 0.05) were lesser in TRT than CTL gilts. Mammary parenchyma from TRT gilts had lower (P ≤ 0.05) mRNA abundance for STAT5A and leptin and tended to have lower (P ≤ 0.10) abundance for STAT5B than CTL gilts. Silymarin reduced (P ≤ 0.001) protein carbonyls concentrations in liver of TRT gilts. No effect of treatment was observed on antioxidant gene expression and enzymatic activities in liver samples while total superoxide dismutase activity tended to be higher (P ≤ 0.10) in the corpora lutea of TRT animals when compared with CTL. This is the first demonstration that, in female pigs, silymarin can increase prolactin concentrations and protect against oxidative stress, yet the increase in prolactin was not enough to have beneficial effects on mammary gland development in late gestation.

Impact of diet deprivation and subsequent overallowance during gestation on mammary gland development and lactation performance

The impacts of diet deprivation and subsequent overallowance during gestation on mammary gene expression and development and lactation performance were determined. Gilts were reared under a conventional (control, CTL; n = 59) or an experimental (treatment, TRT; n = 56) dietary regimen during gestation. The experimental regimen provided 70% (restriction diet, RES) and 115% (overallowance diet, OVER) of the protein and DE contents provided by the CTL diet. The RES diet was given during the first 10 wk of gestation followed by the OVER diet until farrowing. Some gilts (14 CTL and 14 TRT) were slaughtered on d 110 of gestation, and the others were allowed to farrow. Of these remaining sows, 28 (14 CTL and 14 TRT) were slaughtered on d 21 of lactation, and the rest underwent a second lactation. At each slaughter, mammary tissue was collected for compositional analyses and assessment of gene expression. Milk samples were collected on d 17 of the first lactation. Litter size was standardized to 11 ± 1, and piglets were weighed weekly until d 18 in both parities. The BW and back fat thickness of TRT first-parity sows were less than those of CTL sows in gestation (P < 0.05), and their BW was also less in lactation (P < 0.05). The BW of TRT second-parity sows was still less at mating (P < 0.05) and tended to be less on d 1 of lactation (P < 0.10) compared with CTL sows. There were no differences in piglet growth between CTL and TRT litters in either parity, yet mammary development and mammary gene expression were affected by treatment. There was less parenchymal tissue (P < 0.01) at the end of the first gestation in TRT than in CTL sows, but parenchymal tissue composition was not altered by treatment. Relative abundance of IGF-1 (P < 0.05), ornithine decarboxylase (P < 0.05), signal transducer and activator of transcription 5B (P < 0.05), and whey acidic protein (WAP, P < 0.01) genes in parenchyma at the end of the first gestation was lower in TRT than in CTL sows, and the effect on WAP genes was still present at the end of the first lactation (P < 0.01). Mammary composition at the end of the first lactation and milk composition were unaffected by treatment. In conclusion, feed deprivation and subsequent overallowance in gestation had unfavorable effects on sow BW, back fat, mammary development, and mammary gene expression at the end of gestation, but piglet growth rate over the 2 parities was not affected.

Short Communication: Effect of silymarin (Silybum marianum) treatment on prolactin concentrations in cyclic sows

Loisel, F., Quesnel, H. and Farmer, C. 2013. Short Communication: Effect of silymarin (Silybum marianum) treatment on prolactin concentrations in cyclic sows. Can. J. Anim. Sci. 93: 227–230. An extract (silymarin) from the plant Silybum marianum (milk thistle) was shown to increase circulating concentrations of prolactin in cycling rats. A dose-response study was undertaken to determine if silymarin does have hyperprolactinemic properties in cycling swine. Forty-four weaned sows were allotted to four groups receiving 0, 1, 2 or 4 g d−1 of silymarin over a period of 8 d. Blood samples were obtained on days 1 (first day of treatment starting 24 to 48 h after the onset of the standing estrus), 2, 3, and 9. Prolactin, progesterone, estradiol-17β and leptin concentrations were determined. Silymarin did not increase prolactin concentrations at any of the doses studied, nor did it affect concentrations of the other hormones (P>0.1).

Acceptability of digital anal cancer screening examinations in HIV-positive homosexual men

OBJECTIVES

Anal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions.

METHODS

We offered anal examinations to consecutive homosexual men with HIV infection aged ≥ 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule.

RESULTS

Of 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination.

CONCLUSIONS

Regular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection.

Review: Mammary development in swine: effects of hormonal status, nutrition and management

Farmer, C. 2013. Review: Mammary development in swine: effects of hormonal status, nutrition and management. Can. J. Anim. Sci. 93: 1–7. There are three phases of rapid mammary accretion in swine, namely, from 90 d of age until puberty, during the last third of gestation and throughout lactation. Nutrition, endocrine status and management of gilts or sows during those periods can affect mammary development. More specifically, in growing gilts, feed restriction as of 90 d of age hinders mammary development and either supplying the phytoestrogen genistein or increasing circulating concentrations of prolactin stimulates mammogenesis. In late gestation, inhibition of relaxin or prolactin drastically diminishes mammary development and overly increasing dietary energy has a detrimental effect on mammogenesis. It also appears that feeding of the gestating sow can affect the mammary development of her offspring once it reaches puberty. Various management factors such as litter size, nursing intensity and use or non-use of a teat in the previous lactation will affect the amount of mammary tissue present at the end of lactation. Mammary development is followed by the essential process of involution whereby a rapid and drastic regression in parenchymal tissue takes place. It can occur either after weaning or in early lactation when teats are not being regularly suckled. Despite our current knowledge, much remains to be learned in order to develop the best management strategies for replacement gilts, and gestating and lactating sows that will maximize their milk production.

Demystifying moderators and mediators in intellectual and developmental disabilities research: a primer and review of the literature

BACKGROUND

Intellectual and developmental disability (IDD) researchers have been relatively slow to adopt the search for moderators and mediators, although these variables are key in understanding how and why relationships exist between variables. Although the traditional method of causal steps is useful for describing and understanding moderators and mediators, it is not sufficient for statistical analysis.

METHODS

The theoretical and statistical processes of evaluating moderators and mediators are explained in terms familiar to IDD psychologists, using examples from IDD literature. Moderator and mediator analyses in five leading IDD journals are assessed for patterns of usage.

RESULTS

Although the number of publications in the past decade exceeds previous years, the field is still behind others in both the quantity and quality of the use of moderators and mediators.

CONCLUSION

The field as a whole will advance if the recent theoretical and technical advances outlined in this paper are employed.

Impact of a long photoperiod during lactation on immune status of piglets

The effects of a long photoperiod treatment around parturition and throughout lactation on immune status of piglets were studied. Sows were assigned to 2 light regimens: i) standard short photoperiod (SP, n = 17), 8 h of daily light from d 112 of gestation until d 23 of lactation; and ii) long photoperiod (LP, n = 17), 23 h of daily light from d 112 of gestation to d 4 of lactation and 16 h thereafter. In front of the crates, under the side heat lamps and behind the sow, light intensities were 59 ± 5, 109 ± 6, and 44 ± 6 lx, respectively. On d 15 of lactation and at weaning (d 23), 2 piglets of similar BW per litter were selected and immunized intramuscularly with ovalbumin (OVA). Blood samples (5 mL serum and 10 mL whole blood) were taken at d 15 and d 23 of lactation, and at d 30, 37, and 44 of age after weaning to evaluate the antibody response to OVA and measure phagocytosis, lymphocyte proliferative response, and different circulating blood lymphocyte populations of piglets. Results showed that phagocytosis was increased in piglets submitted to LP (P < 0.05). A treatment × time interaction (P < 0.001) indicated that SP piglets developed a better IgG response to OVA than LP piglets. The percentage of B lymphocytes was also increased (P = 0.02) in SP piglets compared with piglets exposed to LP during lactation; the lymphocyte response to OVA tended to be enhanced (P = 0.07) over time in SP piglets. Different subpopulations of CD8+ lymphocytes were markedly increased in SP piglets at 23 d of age compared with piglets exposed to LP (treatment × time: P < 0.05). These results suggest that exposure of piglets to LP during lactation seems to reduce the capacity of piglets to develop a strong immune response to novel antigens. This may have important consequences on the ability of piglets to resist an infection after weaning.