"Why has this new vaccine come and for what reasons?" key antecedents and questions for acceptance of a future maternal GBS vaccine: Perspectives of pregnant women, lactating women, and community members in Kenya

Group B streptococcus (GBS) is a leading global cause of neonatal sepsis and meningitis, stillbirth, and puerperal sepsis. While intrapartum antibiotic prophylaxis (IAP) is a currently available GBS disease prevention strategy, IAP is programmatically complex to implement, precluding use in low- and middle-income countries. In Kenya, 2% of stillbirths are attributable to GBS infection. Two maternal GBS vaccines are in late-stage clinical development. However, licensure of a maternal GBS vaccine does not translate into reduction of disease. We conducted 28 in-depth interviews with pregnant people, lactating people, and community members across two counties in Kenya to better understand the attitudes and informational needs of primary vaccine beneficiaries. We identified two emerging themes from the data. The first focused on antecedents to maternal GBS vaccine acceptability. The most common antecedents focused on the vaccine's ability to protect the baby and/or the mother, followed by community sensitization before the vaccine was available. The second key theme focused on questions that would need to be addressed before someone could accept a maternal GBS vaccine. Three key categories of questions were identified, including vaccine safety compared to vaccine benefits, who gets the vaccine, and how the vaccine works. Realizing the potential benefits of a future GBS maternal vaccine will require a multifactorial approach, including ensuring that communities are aware of GBS-related harms as well as the safety and effectiveness of a maternal GBS vaccine. Our study contributes to informing this multifactorial approach by elucidating the attitudes and concerns of key populations.

Parity changed fecal microbiota of sows and its correlation with milk long-chain fatty acid profiles

The goal of this study was to characterize the fecal microbiota profiles of gestating sows, along with the fecal microbiota and milk fatty acid contents of lactating sows and their correlations with reproductive performance at different parities. The results showed that the microbiota of third parity gestating sows contained a greater abundance of Prevotella compared to the other two parity groups, while lactating sows exhibiting higher reproductive performance at fifth parity exhibited a greater abundance of Lactobacillus species. The lactating sows with higher reproductive performance also exhibited higher total monounsaturated fatty acid (MUFA) and higher total polyunsaturated fatty acid (PUFA) levels relative to sows with lower reproductive performance at all three analyzed parities, especially sows at fifth parity produced the lowest total saturated fatty acid (SFA) levels, and showed the highest C18:1n9c and C18:2n6c concentrations. In correlational analyses, the abundance of Oligella, Lactobacillus, and Corynebacterium was highly positively correlated with C18:1n9c, C18:2n6c, and C20:4n6. Overall, these results provide a rational basis for efforts to improve sow reproductive performance through the provision of precisely regulated nutrition. KEY POINTS: • Clear differences in the fecal microbiota were evident between sows of different parities. • Lactating sows with high reproductive performance showed distinct milk fatty acid profiles.

Endolysin NC5 improves early cloxacillin treatment in a mouse model of Streptococcus uberis mastitis

Streptococcus uberis frequently causes bovine mastitis, an infectious udder disease with significant economic implications for dairy cows. Conventional antibiotics, such as cloxacillin, sometimes have limited success in eliminating S. uberis as a stand-alone therapy. To address this challenge, the study objective was to investigate the VersaTile engineered endolysin NC5 as a supplemental therapy to cloxacillin in a mouse model of bovine S. uberis mastitis. NC5 was previously selected based on its intracellular killing and biofilm eradicating activity. To deliver preclinical proof-of-concept of this supplemental strategy, lactating mice were intramammarily infected with a bovine S. uberis field isolate and subsequently treated with cloxacillin (30.0 μg) combined with either a low (23.5 μg) or high (235.0 μg) dose of NC5. An antibiotic monotherapy group, as well as placebo treatment, was included as controls. Two types of responders were identified: fast (n = 17), showing response after 4-h treatment, and slow (n = 10), exhibiting no clear response at 4 h post-treatment across all groups. The high-dose combination therapy in comparison with placebo treatment impacted the hallmarks of mastitis in the fast responders by reducing (i) the bacterial load 13,000-fold (4.11 ± 0.78 Δlog10; p < 0.001), (ii) neutrophil infiltration 5.7-fold (p > 0.05), and (iii) the key pro-inflammatory chemokine IL-8 13-fold (p < 0.01). These mastitis hallmarks typically followed a dose response dependent on the amount of endolysin added. The current in vivo study complements our in vitro data and provides preclinical proof-of-concept of NC5 as an adjunct to intramammary cloxacillin treatment. KEY POINTS: • Engineered endolysin NC5 was preclinically evaluated as add-on to cloxacillin treatment. • Two types of mice (slow and fast responding) were observed. • The add-on treatment decreased bacterial load, neutrophil influx, and pro-inflammatory mediators.

Effect of alfalfa supplementary change dietary non-fibrous carbohydrate (NFC) to neutral detergent fiber (NDF) ratio on rumen fermentation and microbial function in Gansu alpine fine wool sheep (Ovis aries)

Bodyweight loss and rumen microbial dysfunction of grazing sheep was a challenge for the sheep production industry during cold season, which were considered to correlated with under-roughage-feeding. Alfalfa is a good roughage supplementary for ruminants, which can improve grazing sheep bodyweight-loss and rumen microbial dysfunction during grass-withering period. This study evaluated the effects of alfalfa hay supplementary change dietary non-fibrous carbohydrate/neutral detergent fiber (NFC/NDF) ratios on rumen fermentation and microbial function of Gansu alpine fine wool sheep during extreme cold season. 120 ewes (3-4 yrs) with an average body weight of 28.71 ± 1.22 kg were allocated randomly into three treatments, and fed NFC/NDF of 1.92 (H group), 1.11 (M group), and 0.68 (L group), respectively. This study was conducted for 107 d, including 7 d of adaption to the diets. The rumen fermentation parameters and microbial characteristics were measured after the end of feeding trials. The results showed that the concentrations of sheep body weight, nitrogen components (Total-N, Soluble protein-N and Ammonia-N), blood biochemical indices (LDH, BUN and CHO) and ruminal volatile fatty acids (TVFA and propionate) significantly increased with an increase in the proportion of NFC/NDF ratios (p < .05), and the acetate and acetate/propionat ratio presented a contrary decreasing trend (p < .05). A total of 1018 OTUs were obtained with 97% consistency. Ruminococcus, Ruminococcaceae and Prevotella were observed as the predominant phyla in ruminal fluid microbiota. Higher NFC/NDF ratios with Alfalfa supplementary increased the richness and diversity of ruminal fluid microbiota, and decreased ruminal fluid microbiota beta-diversity. Using clusters of orthologous groups (COG), the ruminal fluid microbiota of alfalfa supplementary feeding showed low immune pathway and high carbohydrate metabolism pathway. In summary, the study suggested that there was an increasing tendency in dietary NFC/NDF ratio of 1.92 in body weight, ruminal fermentation, microbial community composition and fermentation characteristics through developing alfalfa supplementary system.

Multi-tissue gene expression profiling of cows with a genetic predisposition for low and high milk urea levels

Milk urea (MU) concentration is proposed as an indicator trait for breeding toward reduced nitrogen (N) emissions and leaching in dairy. We selected 20 German Holstein cows based on MU breeding values, with 10 cows each having low (LMUg) and high (HMUg) MU genetic predisposition. Using RNA-seq, we characterized these cows to unravel molecular pathways governing post-absorptive body N pools focusing on renal filtration and reabsorption of nitrogenous compounds, hepatic urea formation and mammary gland N excretion. While we observed minor adjustments in cellular energy metabolism in different tissues associated with different MU levels, no transcriptional differences in liver ammonia detoxification were detected, despite significant differences in MU between the groups. Differential expression of AQP3 and SLC38A2 in the kidney provides evidence for higher urea concentration in the collecting duct of LMU cows than HMU cows. The mammary gland exhibited the most significant differences, particularly in tricarboxylic acid (TCA) cycle genes, amino acid transport, tRNA binding, and casein synthesis. These findings suggest that selecting for lower MU could lead to altered urinary urea (UU) handling and changes in milk protein synthesis. However, given the genetic variability in N metabolism components, the long-term effectiveness of MU-based selection in reducing N emissions remains uncertain.

Prevalence and molecular characterization of multi-resistant Escherichia coli isolates from clinical bovine mastitis in China

Different antibiotics are used to treat mastitis in dairy cows that is caused by Escherichia coli (E. coli). Antimicrobial resistance in food-producing animals in China has been monitored since 2000. Surveillance data have shown that the prevalence of multiresistant E. coli in animals has increased significantly. This study aimed to investigate the occurrence and molecular characteristics of resistance determinants in E. coli strains (n = 105) obtained from lactating cows with clinical bovine mastitis (CBM) in China. A total of 220 cows with clinical mastitis, which has swollen mammary udder with reduced and red or gangrenous milk, were selected from 5000 cows. The results showed 94.3% of the isolates were recognized as multidrug resistant. The isolates (30.5%) were positive for the class I integrase gene along with seven gene cassettes that were accountable for resistance to trimethoprim resistance (dfrA17, dfr2d and dfrA1), aminoglycosides resistance (aadA1 and aadA5) and chloramphenicol resistance (catB3 and catB2), respectively. The blaTEM gene was present in all the isolates, and these carried the blaCTX gene. A double mutation in gyrA (i.e., Ser83Leu and Asp87Asn) was observed in all fluoroquinolone-resistant isolates. In total, nine fluoroquinolone-resistant E. coli isolates were identified with five different types of mutations in parC. In four (44.4%) isolates, Ser458Ala was present in parE, and in all nine (9/9) fluoroquinolone-resistant isolates, Pro385Ala was present in gyrB. Meanwhile, fluoroquinolone was observed as highly resistant, especially in isolates with gyrA and parC mutations. In summary, the findings of this research recognize the fluoroquinolone resistance mechanism and disclose integron prevalence and ESBLs in E. coli isolates from lactating cattle with CBM.

Enrichment of milk antioxidant activity by dietary supplementation of red clover isoflavone in cows and its improvement on mice intestinal health

Red clover (Trifolium pratense) isoflavone was supplemented to dairy cows, and antioxidant capacity of milk was assessed. Treated cows increased the activities of antioxidant enzymes, reduced production of oxidation products, and enhanced the concentrations of vitamin E and vitamin C. Moreover, milk fatty acid profile was positive influenced by 8 g/kg red clover isoflavone, with changes in the lower saturated and higher unsaturated fatty acids. We further demonstrated the efficacy of antioxidant capacity of milk in mice, found that milk from cows feeding red clover isoflavone increased the expressions of antioxidant enzymes, and alleviated lipopolysaccharide (LPS)-stimulated tissue damage of duodenum and jejunum, which was related to upregulated metabolism pathways of carbohydrate, lipid, and amino acid, as well as downregulated inflammatory related pathways. Together, dietary supplementation of red clover isoflavone is an effective way to improve milk antioxidant capacity, providing a natural strategy for developing functional foods.

Comparative proteomic analysis of the changes in mare milk associated with different lactation stages and management systems

Mare milk has traditionally been attributed a number of health promoting properties. However, knowledge on its composition and functionality remains scarce, with particularly limited studies on mare milk proteomics. This study deeply characterized mare milk proteome accounting for both caseins and proteins in the whey fraction, also addressing the impact of lactation stage and different management systems. Milk samples from Basque Mountain Horse breed mares belonging to three different farms and three lactation stages were analysed after in-gel and in-solution digestion using nLC-MS/MS. Among the 469 proteins identified, the content of alpha-1 antitrypsin was significantly higher in pasture-based compared to other systems. Moreover, lactation stage significantly affected the content of beta-lactoglobulin II, immunoglobulin-like domain-containing protein, interferon alpha-inducible protein 27, lactotransferrin, polypeptide N-acetylgalactosaminyltransferase, and transforming acidic coiled-coil containing protein 2. This study contributes to the deep characterization of mare milk proteome and provides new insights into the effect of different production factors.

Long-Term Effects of Reproduction and Lactation on the Rat Supraspinatus Tendon and Proximal Humerus

During pregnancy and breastfeeding, women undergo hormonal fluctuations required for fetal development, parturition, and infant growth. These changes have secondary consequences on the maternal musculoskeletal system, increasing the risk for joint pain and osteoporosis. Though hormone levels return to prepregnancy levels postpartum, women may experience lasting musculoskeletal pain. Sex disparities exist in the prevalence of musculoskeletal disorders, but it remains unclear how reproductive history may impact sex differences. Specifically, the effects of both reproductive history and sex on the rotator cuff have not been studied. Pregnancy and lactation affect bone microstructure, suggesting possible impairments at the enthesis of rotator cuff tendons, where tears commonly occur. Therefore, our objective was to evaluate how reproductive history affects sex differences of the supraspinatus tendon and proximal humerus using male, virgin female, and female rats with a history of reproduction (referred to as reproductive females). We hypothesized tendon mechanical properties and humeral bone microstructure would be inferior in reproductive females compared to virgin females. Results showed sex differences independent of reproductive history, including greater tendon midsubstance modulus but lower subchondral bone mineral density (BMD) in females. When considering reproductive history, reproductive rats exhibited reduced tendon insertion site modulus and trabecular bone micro-architecture compared to virgin females with no differences from males. Overall, our study identified long-term changes in supraspinatus tendon mechanical and humeral trabecular bone properties that result following pregnancy and lactation, highlighting the importance of considering reproductive history in investigations of sex differences in the physiology and pathology of rotator cuff injuries.

Does the age of milk affect its mid-infrared spectrum and predictions?

Milk of dairy species commonly undergo standardized official analyses, these that may require chemical preservation and transportation to a certified laboratory. In this context, storage duration is an important factor that can potential affect both milk chemical analyses and its mid-infrared spectrum. We analysed milk samples at different time points/ages to assess repeatability and reproducibility of mid-infrared predicted traits (e.g., fat and protein). Using spectral data, we also evaluated the ability of spectroscopy coupled with chemometrics to discriminate samples according to their age. Although the main components of milk remained consistently reproducible across age (days), changes in the spectrum due to sample aging and deterioration of the matrix were detectable. Using a discriminant analysis, we achieved a classification accuracy of 77% in validation. Predicting milk age using mid-infrared spectra is feasible, allowing for sample monitoring within circuits where maximum reliability is needed, e.g., bulk or individual milk samples for legal/official use or payment systems.

L-arginine alleviates heat stress-induced mammary gland injury through modulating CASTOR1-mTORC1 axis mediated mitochondrial homeostasis

As global warming intensifies, extreme heat is becoming increasingly frequent. These extreme heatwaves have decreased the milk production of dairy animals such as cows and goats and have caused significant damage to the entire dairy industry. It is known that heat stress (HS) can induce the apoptosis and autophagy of mammary epithelial cells (MECs), leading to a decrease in lactating MECs. L-arginine can effectively attenuate HS-induced decreases in milk yield, but the exact mechanisms are not fully understood. In this study, we found that HS upregulated the arginine sensor CASTOR1 in mouse MECs. Arginine activated mTORC1 activity through CASTOR1 and promoted mitochondrial biogenesis through the mTORC1/PGC-1α/NRF1 pathway. Moreover, arginine inhibited mitophagy through the CASTOR1/PINK1/Parkin pathway. Mitochondrial homeostasis ensures ATP synthesis and a stable cellular redox state for MECs under HS, further alleviating HS-induced damage and improving the lactation performance of MECs. In conclusion, these findings reveal the molecular mechanisms by which L-arginine relieves HS-induced mammary gland injury, and suggest that the intake of arginine-based feeds or feed additives is a promising method to increase the milk yield of dairy animals in extreme heat conditions.

Novel oxidising feed additives reduce in vitro methane emissions using the rumen simulation technique

Enteric methane (CH4) produced by ruminant livestock is a potent greenhouse gas and represents significant energy loss for the animal. The novel application of oxidising compounds as antimethanogenic agents with future potential to be included in ruminant feeds, was assessed across two separate experiments in this study. Low concentrations of oxidising agents, namely urea hydrogen peroxide (UHP) with and without potassium iodide (KI), and magnesium peroxide (MgO2), were investigated for their effects on CH4 production, total gas production (TGP), volatile fatty acid (VFA) profiles, and nutrient disappearance in vitro using the rumen simulation technique. In both experiments, the in vitro diet consisted of 50:50 grass silage:concentrate on a dry matter basis. Treatment concentrations were based on the amount of oxygen delivered and expressed in terms of fold concentration. In Experiment 1, four treatments were tested (Control, 1× UHP + KI, 1× UHP, and 0.5× UHP + KI), and six treatments were assessed in Experiment 2 (Control, 0.5× UHP + KI, 0.5× UHP, 0.25× UHP + KI, 0.25× UHP, and 0.12× MgO2). All treatments in this study had a reducing effect on CH4 parameters. A dose-dependent reduction of TGP and CH4 parameters was observed, where treatments delivering higher levels of oxygen resulted in greater CH4 suppression. 1× UHP + KI reduced TGP by 28 % (p = 0.611), CH4% by 64 % (p = 0.075) and CH4 mmol/g digestible organic matter by 71 % (p = 0.037). 0.12× MgO2 reduced CH4 volume by 25 % (p > 0.05) without affecting any other parameters. Acetate-to-propionate ratios were reduced by treatments in both experiments (p < 0.01). Molar proportions of acetate and butyrate were reduced, while propionate and valerate were increased in UHP treatments. High concentrations of UHP affected the degradation of neutral detergent fibre in the forage substrate. Future in vitro work should investigate alternative slow-release oxygen sources aimed at prolonging CH4 suppression.

Supplementation with Moringa oleifera Lam leaf and seed flour during the pregnancy and lactation period of Wistar rats: Maternal evaluation of initial and adult neurobehavioral development of the rat progeny

ETHNOPHARMACOLOGICAL RELEVANCE

Moringa oleifera Lam. (M. oleifera) is a tree species of Indian origin popularly known as the "tree of life". In various cultures, it is used by pregnant women to increase milk production, yet studies on its effects during pregnancy and lactation are lacking.

AIM OF THE STUDY

To evaluate the nutraceutical aspects of flours produced from the leaves and seeds of M. oleifera, and to evaluate the effect of supplementation of pregnant Wistar rats during the gestation and lactation period, with the aim of studying the weight gain and neonatal parameters of the pregnant rats, as well as effects on the neurobehavioral development and memory in their offspring.

MATERIALS AND METHODS

The flour supplementation was conducted at a concentration of 100 mg per kg of animal body weight. For the memory tests, the Open Field Habituation test was performed and repeated after seven days. The Object Recognition test was conducted with the animal exposed to the open field in short and long familiarization sessions. The data obtained were analyzed using Kruskal-Wallis tests for non-parametric data and one-way and two-way ANOVA for parametric data.

RESULTS

Flour produced from both the leaf and seed of M. oleifera was found to contain significant amounts of nutrients (protein, fibre, carbohydrates, etc.), making them suitable for supplementation. The exposure of pregnant rats to M. oleifera leaf and seed flours did not affect weight gain, did not have harmful effects on the birth of offspring, and did not result in abortions or mutations in the offspring. Regarding the supplemented group's offspring, early maturation of the senses in the offspring compared to the control group was observed in all tests were conducted; indicating that supplementation positively impacted cognitive development. Further, the offspring of the supplemented rats presented reduced locomotion and greater exploration of new objects compared to the control group offspring, indicating positive effects on learning.

CONCLUSION

This study describes for the first time the beneficial effects on pregnant Wistar rats and their offspring of maternal supplementation with flour products from the leaves and seeds of M. oleifera.

Is milk fat globule size correlated with milk fat content in Ruminants?

In milk, fat exists in the form of milk fat globules (MFGs). The average size (average fat globules of different particle sizes) is the most common parameter when describing MFG size. There are different views on whether there is a correlation between MFG size and milk fat content. Is the MFG size correlated with milk fat content in ruminants? To address this question, we conducted two experiments. In experiment Ⅰ, dairy cows (n = 40) and dairy goats (n = 30) were each divided into a normal group and a low-fat group according to the milk fat content. In experiment Ⅱ, dairy cows (n = 16) and dairy goats (n = 12) were each divided into a normal group and a conjugated linoleic acid (CLA)-induced low-fat group. The normal groups were fed a basal diet, and the CLA-induced low-fat groups were fed the basal diet + 300 g/d CLA (cows) or the basal diet + 90 g/d CLA (goats). In both experiments, we determined the correlation between MFG size and milk composition and MFG distribution. The results showed that in the normal and low-fat groups of cows and goats, MFG size was not correlated with milk fat, protein, or lactose content or fat-to-protein ratio. Additionally, there was no difference in the distribution of large, medium, and small MFGs (P > 0.05). However, in the CLA-induced low-fat groups, we found a correlation between MFG size and milk fat content and fat-to-protein ratio (R2 > 0.3). Moreover, there was a significant change in the size distribution of MFGs. Therefore, in natural milk, MFG size was not correlated with milk fat content. Following CLA supplementation, MFG size was correlated with milk fat content. Our findings revealed that CLA and not milk fat affects MFG distribution and size.

Impact of iodine supply in infancy and childhood

PURPOSE OF REVIEW

To assess the most relevant articles on the impact of iodine supply in at-risk populations, namely infants and young children, pregnant and lactating women.

RECENT FINDINGS

The 2022 Iodine Global Network Annual Report confirmed the dramatic decrease of severe iodine deficiency over the last 30 years, thanks to universal iodine iodization. However, mild to moderate deficiency is still present in many countries, where recent data showed a decrease of iodine intake and an impairment of iodine status. Unfortunately, there is yet no validated biomarker to classify the iodine status at the individual level. Available data show that there is no clear evidence to link mild-to-moderate iodine deficiency to adverse health outcomes in pregnant and lactating women as well as in infants and children. The description of a negative impact of maternal iodine excess on neurodevelopment of infants is of concern.

SUMMARY

Optimization of salt iodization (e.g. careful increase in iodine concentration in salt, use by food industry in processed foods) combined with targeted, personalized supplementation under medical supervision if needed (e.g. low intake of iodine rich foods, vegan diet) seems currently preferable to blanket supplementation.

The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II)

The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).

Safety and immunogenicity of the Euvichol-S oral cholera vaccine for prevention of Vibrio cholerae O1 infection in Nepal: an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial

BACKGROUND

In October, 2017, WHO launched a strategy to eliminate cholera by 2030. A primary challenge in meeting this goal is the limited global supply capacity of oral cholera vaccine and the worsening of cholera outbreaks since 2021. To help address the current shortage of oral cholera vaccine, a WHO prequalified oral cholera vaccine, Euvichol-Plus was reformulated by reducing the number of components and inactivation methods. We aimed to evaluate the immunogenicity and safety of Euvichol-S (EuBiologics, Seoul, South Korea) compared with an active control vaccine, Shanchol (Sanofi Healthcare India, Telangana, India) in participants of various ages in Nepal.

METHODS

We did an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial at four hospitals in Nepal. Eligible participants were healthy individuals aged 1-40 years without a history of cholera vaccination. Individuals with a history of hypersensitivity reactions to other preventive vaccines, severe chronic disease, previous cholera vaccination, receipt of blood or blood-derived products in the past 3 months or other vaccine within 4 weeks before enrolment, and pregnant or lactating women were excluded. Participants were randomly assigned (1:1:1:1) by block randomisation (block sizes of two, four, six, or eight) to one of four groups (groups A-D); groups C and D were stratified by age (1-5, 6-17, and 18-40 years). Participants in groups A-C were assigned to receive two 1·5 mL doses of Euvichol-S (three different lots) and participants in group D were assigned to receive the active control vaccine, Shanchol. All participants and site staff (with the exception of those who prepared and administered the study vaccines) were masked to group assignment. The primary immunogenicity endpoint was non-inferiority of immunogenicity of Euvichol-S (group C) versus Shanchol (group D) at 2 weeks after the second vaccine dose, measured by the seroconversion rate, defined as the proportion of participants who had achieved seroconversion (defined as ≥four-fold increase in V cholerae O1 Inaba and Ogawa titres compared with baseline). The primary immunogenicity endpoint was assessed in the per-protocol analysis set, which included all participants who received all their planned vaccine administrations, had no important protocol deviations, and who provided blood samples for all immunogenicity assessments. The primary safety endpoint was the number of solicited adverse events, unsolicited adverse events, and serious adverse events after each vaccine dose in all ages and each age stratum, assessed in all participants who received at least one dose of the Euvichol-S or Shanchol. Non-inferiority of Euvichol-S compared with Shanchol was shown if the lower limit of the 95% CI for the difference between the seroconversion rates in Euvichol-S group C versus Shanchol group D was above the predefined non-inferiority margin of -10%. The trial was registered at ClinicalTrials.gov, NCT04760236.

FINDINGS

Between Oct 6, 2021, and Jan 19, 2022, 2529 healthy participants (1261 [49·9%] males; 1268 [50·1%] females), were randomly assigned to group A (n=330; Euvichol-S lot number ES-2002), group B (n=331; Euvichol-S ES-2003), group C (n=934; Euvichol-S ES-2004]), or group D (n=934; Shanchol). Non-inferiority of Euvichol-S versus Shanchol in seroconversion rate for both serotypes at 2 weeks after the second dose was confirmed in all ages (difference in seroconversion rate for V cholerae O1 Inaba -0·00 [95% CI -1·86 to 1·86]; for V cholerae O1 Ogawa -1·62 [-4·80 to 1·56]). Treatment-emergent adverse events were reported in 244 (9·7%) of 2529 participants in the safety analysis set, with a total of 403 events; 247 events were reported among 151 (9·5%) of 1595 Euvichol-S recipients and 156 events among 93 (10·0%) of 934 Shanchol recipients. Pyrexia was the most common adverse event in both groups (57 events among 56 [3·5%] of 1595 Euvichol-S recipients and 37 events among 35 [3·7%] of 934 Shanchol recipients). No serious adverse events were deemed to be vaccine-related.

INTERPRETATION

A two-dose regimen of Euvichol-S vaccine was non-inferior to the active control vaccine, Shanchol, in terms of seroconversion rates 2 weeks after the second dose. The simplified formulation and production requirements of the Euvichol-S vaccine have the potential to increase the supply of oral cholera vaccine and reduce the gap between the current oral cholera vaccine supply and demand.

FUNDING

The Bill & Melinda Gates Foundation.

TRANSLATION

For the Nepali translation of the abstract see Supplementary Materials section.

Effect of Reflexology on Pain, Fatigue, Sleep Quality, and Lactation in Postpartum Primiparous Women After Cesarean Delivery: A Randomized Controlled Trial

BACKGROUND

Mothers commonly experience pain, fatigue, sleep disruption, and breastfeeding problems after cesarean delivery. To date, no follow-up study has examined all of these variables to evaluate the utility of reflexology in reducing these problems and supporting breastfeeding.

RESEARCH AIM

This study aimed to determine the effect of foot reflexology performed in the postpartum period on pain, fatigue, sleep quality, and lactation in primiparous women who underwent cesarean delivery.

METHODS

This is a two-arm, parallel-group randomized controlled trial. Data were collected between January 1, 2020, and January 31, 2021, with a sample of 80 women who were randomly assigned to the reflexology (n = 40) and control (n = 40) groups. The reflexology group received 40 minutes of foot reflexology once a week for 8 weeks. The primary outcomes of the study were pain, fatigue, sleep quality, and breastfeeding efficacy.

RESULTS

Pain scores in the reflexology group decreased by 90.9% in week 1, 90.2% in week 2, and 59.8% in week 3 compared to the control group. Pain resolved at week 4 in the reflexology group and week 7 in the control group. The reflexology group showed a 36.9% decrease in fatigue level, a 48.0% increase in energy level, a 70.7% increase in sleep quality, and a 20.2% increase in breastfeeding efficacy compared to the control group (p < 0.05).

CONCLUSIONS

Foot reflexology reduces postpartum symptoms and positively affects breastfeeding and can be used safely in postnatal care practices.

Breastmilk mineral composition among well-educated mothers from Central Poland - Associations with maternal dietary intake, dietary patterns and infant psychomotor development

BACKGROUND

Maternal dietary habits could affect breastmilk mineral composition, which may influence infant development. Mineral dietary intake or supplementation slightly affects its breastmilk concentration. However, the intake of selected food groups or dietary patterns that reflect diet complexity could have a greater impact. Hence, the aim of the study was to assess breastmilk mineral composition at one, three, and six months of lactation among mothers living in urban area of Central Poland, as well as the evaluate maternal dietary determinants and associations with infant anthropometric and psychomotor development.

METHODS

The study was conducted among 43 healthy and exclusively breastfeeding mothers. In the first, third, and sixth months of lactation, we collected breastmilk samples and assessed the concentration of Ca, P, Zn, Fe, Se, Ni, As, Pb, and Cd using the ICP-MS method. Maternal dietary habits were evaluated by a food frequency questionnaire in the first month of lactation, whereas in the third and sixth by the three-day food record. Based on the collected data adherence to the Polish-adapted Mediterranean (Pl-aMED; 1 month) and the DASH diet (Mellen's Index; 3 and 6 months) was assessed. In the third and sixth months of lactation infant anthropometric parameters and the sixth month of lactation psychomotor development were evaluated.

RESULTS

Breastmilk Se, Ni, As, Pb, and Cd levels were under the LOQ in all the breastmilk samples at all study visits. Median breastmilk mineral concentrations of Ca, P, Zn, and Fe in the first, third, and sixth months of lactation varied from 381.9 to 332.7 mg/L, 161.6 to 139.1 mg/L, 2.2 to 0.8 mg/L, and 0.26 to 0.17 mg/L, respectively. Maternal dietary intake and supplementation did not affect breastmilk Ca, P, Zn, and Fe. Pl-aMED scores were associated with breastmilk Ca (β = 0.489, 95% CI 0.180 - 0.799, p = 0.003) and Zn (β = 0.499, 95% CI 0.199 - 0.798, p = 0.002) in the first month of lactation, whereas no association with the DASH diet were observed in the third and sixth month of lactation. Breastmilk Fe in the third month was associated with infant motor development (β = 0.420, 95% CI 0.113 - 0.727, p = 0.009) in the sixth month of life, but no other associations with anthropometric or psychomotor development were observed. Moreover, we estimated that few infants meet their adequate intake (AI) requirements for P, Zn, and Fe.

CONCLUSION

Our study showed that maternal adherence to Pl-aMED is a significant predictor of breastmilk Ca and Zn in the first month of lactation, which may be especially important considering that more than 75% of infants had inadequate Zn intake. Moreover, we found that breastmilk Fe positively influenced infant motor development, despite the majority of infants having inadequate intake. On the other hand, no infant had deficiency symptoms, which emphasizes the necessity to evaluate of AI norms for infants.

Ferret Pediatrics

Ferrets are bred to be pets, utilized for hunting, and as laboratory models. Despite the fact that ferrets in some areas of the world are neutered by the breeder before entering the pet trade, the importance of pediatric management should not be overlooked. Pregnant, whelping, and lactating jills should be closely monitored and kept in a quiet, stress-free environment. Hand-rearing baby kits is very challenging due to their requirement for ferret milk. Minimizing maternal stress and disease can prevent the need to hand rear kits. Infectious diseases in juvenile ferrets include canine distemper virus, rotavirus, coccidiosis, feline panleukopenia virus (experimental only), and Toxoplasma-like disease. All juvenile ferrets should be vaccinated against canine distemper and rabies. Congenital diseases are reported to affect the auditory, ocular, cardiovascular, urogenital, central nervous, and musculoskeletal systems. Early detection of these diseases is important to prevent the progression of curable diseases.

Longevity in South African Afrikaner cows as assessed through survival analysis

The Afrikaner breed of cattle is indigenous to South Africa and, due to their hardiness, was once the most popular breed amongst South African farmers, although in recent years their numbers have decreased. The goal of this study was to assess factors affecting length of productive life, defined as the interval between production of the first and last calf, in Afrikaner cattle using survival analysis. The data spanned 40 years with an observed measure of length of life for 29,379 cows from 374 herds. Relative to similar analyses, few (n = 2964; 8.4%) cows had records that were right censored. The median length of productive life of an Afrikaner cow was just less than 6 years. Cows that were younger at their first parturition had longer productive lives than those that were older at their first calving. Cows that were born in the period from December to February had shorter productive lives than those born between March and November. The estimated animal genetic variance of 0.266 resulted in a heritability estimate for length of productive life in Afrikaner cattle of 0.225. Thus, there appeared to be sufficient additive genetic variance in Afrikaner cattle to enable genetic improvement in their length of productive life.

Validation of an on-farm portable blood analyzer for quantifying blood analytes in dairy cows

The periparturient period for dairy cows is a metabolically dynamic time period where the cow is adjusting from gestation to the onset of lactation. Metabolic disorders such as ketosis, hypocalcemia, and fatty liver occur during this time; however, tools to diagnose these diseases on-farm is limited. The need for compact metabolite quantification devices that can quantify metabolites on farm from whole blood samples is warranted. The purpose of this study was to validate a portable blood analyzer (PBA) by analyzing metabolites on privately owned dairy farms in southcentral Wisconsin. Additional tests were completed to determine if plasma metabolite quantification was similar to whole-blood quantification. Two phases were conducted on two separate farms to complete these analyses and data were analyzed by Bland-Altman plot and correlations. Metabolites quantified from whole blood samples included albumin, alanine and aspartate aminotransferases, β-hydroxybutyrate, blood urea nitrogen, total calcium, cholesterol, creatinine kinase, γ-glutamyl transferase, glucose, magnesium, nonesterified fatty acids, phosphorous, and total protein and were analyzed in the lab after plasma separation to determine gold-standard laboratory concentrations. Across Phase 1 and 2, whole-blood PBA metabolite concentrations resulted in similar results compared to the laboratory assays. For plasma analyzed on the PBA, overall results were positively correlated, but robustness was dependent upon initial validation results indicating some metabolites are suitable for plasma quantification on the device. These results indicate that the PBA is a viable on-farm metabolite quantification tool that will be valuable for on-farm diagnosis of metabolic stress and dysfunction in transition dairy cows.

Genetic analysis of milk minerals in dairy cattle: a review

Mineral composition in milk can affect its nutritional as well as physio-chemical properties of milk and is considered an important trait in the evaluation of milk quality. The composition and concentration of milk minerals could be altered with natural source of variation including nutrition and genetics. The effect of diet on milk minerals is well studied. However, genetic effects on the milk minerals have recently gained the attention. This review provides an overview of the genetic variation of milk minerals, and the genomic regions associated with mineral concentration in the milk are also discussed. The difference of milk minerals between breeds and the genetic parameters including heritability estimates and correlation among minerals indicates that milk minerals are under strong genetic control. Recently, the genome-wide association study (GWAS) has explored several regions associated with milk minerals and thus provides a new genetic source for improving the milk quality through genomics-assisted breeding. Hence, a combination of the qualitative and molecular approaches can be exploited to improving the nutritional quality of cattle milk in terms of its mineral composition.

Association of maternal milk fat and protein percentage and milk fat to protein ratio with offspring's birth weight, survival, productive and reproductive performance and AMH concentration from birth to the first lactation period

Although the association of maternal milk production with developmental programming of offspring has been investigated, there is limited information available on the relationship of maternal milk components with productive and reproductive performance of the offspring. Therefore, the present study was conducted to analyze the association of maternal milk fat and protein percentage and milk fat to protein ratio with birth weight, survival, productive and reproductive performance and AMH concentration in the offspring. In study I, data of birth weight, milk yield and reproductive variables of offspring born to lactating dams (n = 14,582) and data associated with average maternal milk fat percentage (MFP), protein percentage (MPP) and fat to protein ratio (MFPR) during 305-day lactation were retrieved. Afterwards, offspring were classified in various categories of MFP, MPP and MFPR. In study II, blood samples (n = 339) were collected from offspring in various categories of MFP, MPP and MFPR for measurement of serum AMH. Maternal milk fat percentage was positively associated with birth weight and average percentage of milk fat (APMF) and protein (APMP) and milk fat to protein ratio (FPR) during the first lactation, but negatively associated with culling rate during nulliparity in the offspring (P < 0.05). Maternal milk protein percentage was positively associated with birth weight, APMF, APMP, FPR and culling rate, but negatively associated with milk yield and fertility in the offspring (P < 0.05). Maternal FPR was positively associated with APMF and FPR, but negatively associated with culling rate, APMP and fertility in the offspring (P < 0.05). However, concentration of AMH in the offspring was not associated with MFP, MPP and MFPR (P > 0.05). In conclusion, the present study revealed that maternal milk fat and protein percentage and their ratio were associated with birth weight, survival, production and reproduction of the offspring. Yet it was a preliminary research and further studies are required to elucidate the mechanisms underlying these associations.

Valuation of livestock population and national feed security to enhance livestock productivity in Ethiopia

BACKGROUND

Feed is a major input in the livestock industry and covers about 60%-70% of the total cost of producing meat, milk and eggs. Inadequate feed supply in terms of quality and quantity leads to lower production performance in livestock. However, the development of an appropriate livestock production strategy through efficient utilization of existing feed resources could raise the production and per capita consumption of livestock products. Efficiency of feed resource utilization can be measured as the ratio between input to production activities and output (e.g. kg of protein used per unit of meat, milk and eggs produced or hectare of land used per unit of milk produced).

METHODOLOGY

This study was designed with the objective of evaluating the livestock population and national feed security to enhance livestock productivity in Ethiopia. To achieve this objective, data were collected from the websites of the Ethiopian Central Statistical Agency from 2007 to 2021, FAO publications and websites, books and journals. The data obtained on different feed resources, livestock population and livestock feed requirement and balance were entered into an MS Excel spread sheet (Excel, 2010) and analysed using the general linear model (PRO GLM) procedure of SAS (2014) and multivariate analysis of covariance.

RESULTS

The study results revealed that the livestock population had increased from 58.31 million tropical livestock units (TLU) to 81.10 million tropical livestock units (TLU), and the emission of entericCH4 had increased from 2511.08 Gg/year to 3661.74 Gg/year from 2008 to 2021. The study results also showed that the major available feed resources for ruminants are natural pasture and crop residues, which account for 56.83% (87.56 × 106 ) and 37.37% (57.57 × 106 ) of total feed production in the country, respectively. The contribution of concentrate and improved cultivated pasture and feed from permanent crops used as feed sources is very insignificant (3.05% and 1.96%, respectively). The estimated quantity of these feed resources was sufficient to meet the livestock feed requirement in the country in terms of dry matter (DM), digestible crude protein (DCP) and MEJ, which estimated about 153.31 × 106  t, 4.56 × 106  t and 1203.97 × 109  MJ DM, DCP and MEJ, respectively. The estimated livestock feed requirements were 134.62 × 106 , 4.52 × 106 , and 918.83 × 109 in DM, DCP and MEJ, respectively. The supply covered about 114.33, 100.04 and 131.33% of the DM, DCP and MEJ total annual feed requirements of livestock in the country. Hence, the current feed surplus obtained on feed requirements of ruminants and equines can support the nutrient requirements of 500 × 106 broilers, about 5 × 106 bulls, about 50 × 106 small ruminants or 3 × 106 crossbred lactating dairy cows, yielding 10 L of milk per day.

CONCLUSIONS

The findings of study indicated that natural pasture and crop residues cover a major proportion of the annual feed supply in the country. Therefore, proper grazing management, feed conservation practices, improving grazing land vegetation through clearing invasive species, replacing the grazing land with an improved grass and legume mixture, effective collection, conservation and proper utilization of crop residues, and other alternative options such as the use of chemical, physical and biological treatments to improve the nutritive value of fibrous feed should be practiced. More effective extension services and farmer training are also required to increase feed productivity and, hence, human development.

Assessing the Landscape of Lactation Education: Results of a Pilot Survey

BACKGROUND

The field of lactation currently uses breastfeeding rates to measure effectiveness. While monitoring breastfeeding outcomes can provide insight into the successes of lactation consulting as a profession, the improvement of breastfeeding outcomes is a multifactorial issue. In order to facilitate the growth of lactation education processes, understanding experiences during training and perceptions of readiness of current International Board Certified Lactation Consultants (IBCLC) for clinical practice is necessary.

RESEARCH AIM

The aim of this survey was to provide a baseline assessment of the current landscape of the lactation profession through data related to certification, job market, practice confidence after passing the International Board of Lactation Consultant Examiners (IBLCE) certifying examination, and perceptions of specializations.

METHODS

A cross-sectional study design was used to assess the experiences of practicing IBCLCs. Non-probability convenience sampling was implemented from December 2021 through January 2022. A total of 281 unique responses were recorded with complete data on variables of interest.

RESULTS

The majority of respondents were white females under age 50 located in the United States. The majority of respondents were certified through a Pathway 1. The largest barrier to certification was reported to be a lack of clinical/mentorship opportunities. Respondents were significantly more confident in providing entry-level support to dyads when mentored by four or more preceptors.

CONCLUSION

Diversification of the field of lactation is necessary to provide appropriate support to lactating families in the United States. Additionally, addressing the barrier of accessing clinical/mentorship opportunities is essential for continued growth of the field of lactation.

Lactational Exposure of Human Infants to Metal (loid)s: A Comparison of Industrial and Urban Inhabitants in North of the Persian Gulf

In this study, postnatal metal (loid)s (MLs) exposure was compared between the petrochemical and gas area of Asaluyeh (PGA) and urban area of Kaki (UA) in Bushehr province, Iran. Two hundred human breast milk (BM) samples from the industrial and urban areas were analyzed for MLs using Inductivity Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Boron (B), copper (Cu), iron (Fe), and nickel (Ni) were found at the highest levels in both study areas. Adjusted multiple linear regression models revealed that the mean concentration of total MLs in BM samples collected from the PGA was statistically significantly greater than that of the UA (655.85 vs. 338.17 µg/L). Also, the mean concentrations of all detected MLs in BM samples collected from the PGA were statistically significantly higher than those collected from the UA. The hazard index (HI) of combined MLs in the PGA and UA illustrated non-cancer risk for infants. Lead (Pb) and chromium (Cr) in the PGA and Cr in the UA showed the risk of cancer. So it can be concluded that nursing infants from an industrial area are most at risk for MLs exposure during entire lactation course than those from an urban area.

Healthcare providers' use of a concise summary to prescribe for lactating patients

BACKGROUND

Most breastfeeding individuals take at least one prescription drug, yet limited data from lactation studies are available to inform the safety of these drugs during breastfeeding. As a result, healthcare providers (HCPs) rely on available information about safety of drugs used during pregnancy or on personal experiences to inform prescribing/counseling decisions for breastfeeding individuals. To improve risk communication regarding drugs used during lactation, the U.S. Food and Drug Administration published the Pregnancy and Lactation Labeling Rule (PLLR) in 2015, which added a narrative summary of available risk information to the lactation section of Prescribing Information (PI). Prior studies on labeling in PLLR format revealed that although HCPs found these details valuable, they regarded the narrative as too long to support decision-making during patient encounters.

OBJECTIVE

This qualitative study's objective was to assess the utility of adding a concise summary to the Lactation subsection of PI to complement the narrative and succinctly communicate to busy HCPs a drug's risks when used during lactation. The concise summary consisted of a bolded headline, bulleted descriptions of available study findings and potential adverse reactions, and recommendations for risk mitigation.

METHODS

Twenty-five online focus groups were conducted with five segments of HCPs to obtain their feedback on the concise summary and discuss their prescribing/counseling decisions for four fictitious prescription drugs including one vaccine.

RESULTS

HCPs utilized the concise summary to make initial prescribing/counseling decisions. Many also used the labeling narrative for a comprehensive benefit-risk assessment.

CONCLUSION

The findings indicate a need to continue to improve communication about safety of drugs used during lactation, and that the concise summary may help facilitate this communication. The study also highlights the need to educate HCPs about PI limitations when clinical data are lacking and the need to encourage clinical studies to be conducted to support actionable recommendations about use of prescription drugs during lactation.

The prevalence of damaged tails in New Zealand dairy cattle

AIMS

To undertake a survey of the prevalence of tail deviations, trauma and shortening on a representative selection of New Zealand dairy farms, and to assess whether sampling based on milking order could be used instead of random sampling across the herd to estimate prevalence.

METHODS

This was a cross-sectional observational study, with 200 randomly selected farms enrolled across nine regions of New Zealand via selected veterinary practices (one/region). Veterinary clinics enrolled 20-25 farms each depending on region, with 1-2 trained technicians scoring per region. All cows (n = 92,348) present at a milking or pregnancy testing event were tail scored using a modified version of the New Zealand Veterinary Association Industry Scoring System. Palpated lesions were recorded as deviated (i.e. non-linear deformity), shortened (tail shorter than normal) or traumatic (all other lesions). The location of lesions was defined by dividing the tail into three equal zones: upper, middle and lower. A cow could have more than one lesion type and location, and/or multiple lesions of the same type, but for the prevalence calculation, only the presence or absence of a particular lesion was assessed. Prevalence of tail damage calculated using whole herd scoring was compared to random sampling across the herd and sampling from the front and back of the milking order. Bootstrap sampling with replacement was used to generate the sampling distributions across seven sample sizes ranging from 40-435 cows.

RESULTS

When scoring all cows, the median prevalence for deviation was 9.5 (min 0.9, max 40.3)%; trauma 0.9 (min 0, max 10.7)%, and shortening was 4.5 (min 1.3, max 10.8)%. Deviation and trauma prevalence varied between regions; the median prevalence of deviations ranged from 6% in the West Coast to 13% in Waikato, and the median prevalence of all tail damage from 7% in the West Coast to 29% in Southland. Sampling based on milking order was less precise than random sampling across the herd. With the latter and using 157 cows, 95% of prevalence estimates were within 5% of the whole herd estimate, but sampling based on milking order needed > 300 cows to achieve the same precision.

CONCLUSIONS AND CLINICAL RELEVANCE

The proportion of cows identified as having damaged tails was consistent with recent reports from New Zealand and Ireland, but at 11.5%, the proportion of cows with trauma or deviation is below acceptable standards. An industry-wide programme is needed to reduce the proportion of affected cows.

Auricular Acupressure on Breast Pain Among Breastfeeding Mothers Receiving Gentle Hand Techniques: A Randomized, Single-Blind, Sham-Controlled Trial

BACKGROUND

Auricular acupressure influences pain reduction in patients with diseases. However, study results on its influence on breast pain, common among breastfeeding mothers, are insufficient.

RESEARCH AIM

This study aimed to explore the effectiveness of auricular acupressure on breast pain among breastfeeding mothers who also received a standard gentle hand technique.

METHODS

This was a placebo-controlled study wherein auricular acupressure was provided for 4 weeks to 52 breastfeeding mothers consulting a local breastfeeding clinic. In the intervention group, auricular acupressure was applied to specific acupoints, including Shenmen, central rim, breast, and endocrine, which are related to breast pain and postpartum lactation. For the placebo control group, auricular acupressure was applied to acupoints not related to breast pain. The degree of breast pain was assessed using a numeric rating scale and a pressure algometer.

RESULTS

After 4 weeks of auricular acupressure, numeric rating scale pain scores did not show a significant change. However, the pressure pain threshold for the upper left (Z = -2.202, p = .028) and upper right (t = 2.613, p = .012) areas of the right breast increased significantly in the intervention group.

CONCLUSION

This study employed subjective and objective measurements to evaluate the efficacy of auricular acupressure in alleviating breast pain. The intervention shows potential as a nursing measure. Further research is required to determine the optimal intervention duration and frequency, particularly for breastfeeding parents with severe pain, and to evaluate long-term outcomes.

Perinatal mortality in German dairy cattle: Unveiling the importance of cow-level risk factors and their interactions using a multifaceted modelling approach

Perinatal mortality (PM) is a common issue on dairy farms, leading to calf losses and increased farming costs. The current knowledge about PM in dairy cattle is, however, limited and previous studies lack comparability. The topic has also primarily been studied in Holstein-Friesian cows and closely related breeds, while other dairy breeds have been largely ignored. Different data collection techniques, definitions of PM, studied variables and statistical approaches further limit the comparability and interpretation of previous studies. This article aims to investigate the factors contributing to PM in two underexplored breeds, Simmental (SIM) and Brown Swiss (BS), while comparing them to German Holstein on German farms, and to employ various modelling techniques to enhance comparability to other studies, and to determine if different statistical methods yield consistent results. A total of 133,942 calving records from 131,657 cows on 721 German farms were analyzed. Amongst these, the proportion of PM (defined as stillbirth or death up to 48 hours of age) was 6.1%. Univariable and multivariable mixed-effects logistic regressions, random forest and multimodel inference via brute-force model selection approaches were used to evaluate risk factors on the individual animal level. Although the balanced random forest did not incorporate the random effect, it yielded results similar to those of the mixed-effect model. The brute-force approach surpassed the widely adopted backwards variable selection method and represented a combination of strengths: it accounted for the random effect similar to mixed-effects regression and generated a variable importance plot similar to random forest. The difficulty of calving, breed and parity of the cow were found to be the most important factors, followed by farm size and season. Additionally, four significant interactions amongst predictors were identified: breed-calving ease, breed-season, parity-season and calving ease-farm size. The combination of factors, such as secondiparous SIM breed on small farms and experiencing easy calving in summer, showed the lowest probability of PM. Conversely, primiparous GH cows on large farms with difficult calving in winter exhibited the highest probability of PM. In order to reduce PM, appropriate management of dystocia, optimal heifer management and a wider use of SIM in dairy production are possible ways forward. It is also important that future studies are conducted to identify farm-specific contributors to higher PM on large farms.

Lactation support in neonatal intensive care units in Germany from the mothers' perspective - a mixed-method study of the current status and needs

BACKGROUND

Establishing successful lactation in mothers of very low birth weight (VLBW, <1500g) infants requires structured lactation support. Little is known about mothers' perspectives on lactation support in German neonatal intensive care units (NICUs).

METHODS

This paper features a convergent mixed-method approach that includes a retrospective, cross-sectional questionnaire and interview data to showcase mothers' perceptions of lactation support in NICUs. Content analysis of the interviews (n = 12) and a descriptive analysis of quantitative data (n = 533) were performed to illustrate the current status and need for lactation support in German NICUs.

RESULTS

The results show that lactation support in German NICUs is often inadequate and does not comply with recommendations based on the existing literature to encourage pumping and breastfeeding in mothers. The data imply that even if lactation is successfully initiated in most cases, it is often not maintained over time, which may be due to a lack of personal support and consistent information.

CONCLUSION

The overall structures and institutional guidelines for lactation support should be encouraged to promote nutrition with mother´s own milk in German NICUs.

Establishing authenticity of hay milk: Detection of silage feeding through cyclopropane fatty acids analysis using 1H NMR spectroscopy

Cyclopropane fatty acids (CPFAs) serve as indicators of silage feeding, verifying the authenticity of hay milk where silage feeding is forbidden. In this study, the authenticity of hay milk was determined by detecting CPFAs using proton nuclear magnetic resonance (1H NMR) spectroscopy. 245 milk samples were collected in South Tyrol (Italy), categorized as follows: 98 from grass silage-fed cows, 98 from maize silage-fed cows, and 49 authentic hay milk. The limit of detection of CPFAs was 12 µM, corresponding to 70 mg/kg of freeze-dried milk. The CPFAs were absent in all of the hay milk samples, verifying their authenticity. In contrast, 97 % of maize silage and 77 % of grass silage samples exhibited distinct CPFAs signals. These findings were further corroborated by gas chromatography-mass detector (GC-MS) analysis. The study highlights 1H NMR as a robust, and rapid technique for hay milk authentication, supporting alpine dairy production and increasing consumer trust in food authenticity.

Optimization of volatile organic compounds sampling from dairy cow exhaled breath using polymer-based solid-phase extraction cartridges for gas chromatographic analysis

We explored appropriate technical setups for the detection of volatile organic compounds (VOCs) from exhaled cow breath by comparing six different polymer-based solid-phase extraction (SPE) cartridges currently on the market for gas chromatography/mass spectrometry (GC-MS) screening. Exhaled breath was sampled at a single timepoint from five lactating dairy cows using six different SPE cartridges (Bond Elut ENV (ENV); Chromabond HRX (HRX); Chromabond HRP (HRP); Chromabond HLB (HLB); Chromabond HR-XCW (XCW) and Chromabond HR-XAW (XAW)). The trapped VOCs were analyzed by dynamic headspace vacuum in-tube extraction GC-MS (DHS-V-ITEX-GC-MS). Depending on the SPE cartridge, we detected 1174-1312 VOCs per cartridge. Most VOCs were alkenes, alkanes, esters, ketones, alcohols, aldehydes, amines, nitriles, ethers, amides, carboxylic acids, alkynes, azoles, terpenes, pyridines, or sulfur-containing compounds. The six SPE cartridges differed in their specificity for the chemical compounds, with the XAW cartridge showing the best specificity for ketones. The greatest differences between the tested SPE cartridges appeared in the detection of specific VOCs. In total, 176 different VOCs were detected with a match factor >80%. The greatest number of specific VOCs was captured by XAW (149), followed by ENV (118), HLB (117), HRP (115), HRX (114), and XCW (114). We conclude that the tested SPE cartridges are suitable for VOC sampling from exhaled cow breath, but the SPE cartridge choice enormously affects the detected chemical groups and the number of detected VOCs. Therefore, an appropriate SPE adsorbent cartridge should be selected according to our proposed inclusion criteria. For targeted metabolomics approaches, the SPE cartridge choice depends on the VOCs or chemical compound groups of interest based on our provided VOC list. For untargeted approaches without information on the animals' metabolic condition, we suggest using multi-sorbent SPE cartridges or multiple cartridges per animal.

Donislecel (Lantidra) for type 1 diabetes

The FDA has approved donislecel-jujn (Lantidra – CellTrans), an allogeneic pancreatic islet cellular therapy, for use in conjunction with immunosuppression for treatment of adults with type 1 diabetes who are unable to approach target HbA1c because of current repeated episodes of severe hypoglycemia despite intensive diabetes management and education. Donislecel is the first cell-based treatment to be approved in the US for type 1 diabetes.

Revealing the mechanism of fiber promoting sow embryo implantation by altering the abundance of uterine fluid proteins: A proteomic perspective

Many studies have shown that fiber in the diet plays an important role in improving the reproductive performance of sows, but there is rarely research on the impact of fiber on early embryo implantation. This study used 4D-Label free technology to identify and analyze the effect of the fiber composition in the diet on the protein in the early pregnancy uterine fluid (UF) of sows. The results indicate that ratio of insoluble fibers to soluble fibers (ISF/SF) 4.89 can increase the concentration of progesterone (PROG) and reduce tumor necrosis factorα (TNF-α) concentration in sow UF. In addition, through 4D-Label free, we identified a total of 4248 proteins, 38 proteins abundance upregulated and 283 proteins abundance downregulated in UF. Through enrichment analysis of these differential abundance proteins (DAPs), it was found that these differential proteins are mainly related to the docking of extracellular vesicles, vesicular transport, inflammatory response, and insulin resistance. Therefore, the results of this study reveal the possible mechanism by which fiber improves the reproductive performance of sows, laying a theoretical foundation for future research on the effects of diet on reproduction. SIGNIFICANCE: This study demonstrates the importance of dietary fiber for early embryo implantation in sows. The effect of dietary ISF/SF on early embryo implantation in sows was elucidated from a proteomic perspective through 4D-Label free technology. This study not only has significant implications for improving sow reproductive efficiency, but also provides important theoretical references for studying early miscarriage and reproductive nutrition in human pregnancy.

Lactation duration and development of type 2 diabetes and metabolic syndrome in postpartum women with recent gestational diabetes mellitus

BACKGROUND

The World Health Organization and United Nations Children's Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant's life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months.

METHODS

This prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the "recall since birth" method.

RESULTS

Of the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively.

CONCLUSIONS

Maintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women's health after GDM.

TRIAL REGISTRATION

Thai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020.

Exploring the profound link: Breastfeeding's impact on alleviating the burden of breast cancer - A review

Breastfeeding has emerged as a critical factor in understanding and potentially mitigating the risk of breast cancer among women. This review delves into the intricate relationship between breastfeeding and breast cancer, elucidating the biological mechanisms, protective effects, and broader implications for public health. Epidemiological evidence consistently demonstrates a correlation between breastfeeding and a reduced risk of breast cancer, with longer durations of lactation showing a dose-dependent decrease in risk. The biological nexus between breastfeeding and breast cancer involves hormonal changes and the elimination of potentially damaged cells, influencing breast tissue and potentially mitigating carcinogenesis. Moreover, breastfeeding appears to impact tumor subtypes and aggressiveness, particularly demonstrating associations with lower risks of hormone receptor-negative and certain aggressive breast cancer subtypes. Recognizing the significance of breastfeeding in reducing breast cancer risk has profound public health implications, necessitating comprehensive support, education, and policies to encourage and facilitate breastfeeding.

Concentrations of antimicrobial components in milk of Japanese Black cows and their differences from dairy cows

The components of milk from beef cows remain to be elucidated. This study examined the differences in the antimicrobial components of milk between dairy and beef cows. Quarter milk was collected from both Japanese Black (beef type) and Holstein (dairy type) cows to compare the concentrations of antimicrobial components. The concentration of lingual antimicrobial peptide (LAP) was higher, whereas that of the other antimicrobial components (lactoferrin, S100A7, and S100A8) was lower in beef cows than in dairy cows. Overall, these results indicate that the differences in antimicrobial components between beef and dairy cows may be associated with the difference in the prevalence of mastitis between them.

Determining the exposure of maternal medicines through breastfeeding: the UmbrelLACT study protocol-a contribution from the ConcePTION project

INTRODUCTION

Breastfeeding is beneficial for the health of the mother and child. However, at least 50% of postpartum women need pharmacotherapy, and this number is rising due to the increasing prevalence of chronic diseases and pregnancies at a later age. Making informed decisions on medicine use while breastfeeding is often challenging, considering the extensive information gap on medicine exposure and safety during lactation. This can result in the unnecessary cessation of breastfeeding, the avoidance of pharmacotherapy or the off-label use of medicines. The UmbrelLACT study aims to collect data on human milk transfer of maternal medicines, child exposure and general health outcomes. Additionally, the predictive performance of lactation and paediatric physiologically based pharmacokinetic (PBPK) models, a promising tool to predict medicine exposure in special populations, will be evaluated.

METHODS AND ANALYSIS

Each year, we expect to recruit 5-15 breastfeeding mothers using pharmacotherapy via the University Hospitals Leuven, the BELpREG project (pregnancy registry in Belgium) or external health facilities. Each request and compound will be evaluated on relevance (ie, added value to available scientific evidence) and feasibility (including access to analytical assays). Participants will be requested to complete at least one questionnaire on maternal and child's general health and collect human milk samples over 24 hours. Optionally, two maternal and one child's blood samples can be collected. The maternal medicine concentration in human milk will be determined along with the estimation of the medicine intake (eg, daily infant dose and relative infant dose) and systemic exposure of the breastfed child. The predictive performance of PBPK models will be assessed by comparing the observed concentrations in human milk and plasma to the PBPK predictions.

ETHICS AND DISSEMINATION

This study has been approved by the Ethics Committee Research UZ/KU Leuven (internal study number S67204). Results will be published in peer-reviewed journals and presented at (inter)national scientific meetings.

TRIAL REGISTRATION NUMBER

NCT06042803.

Bayesian approach for evaluation of lactation curve in cross bred cattle based on monthly and bimonthly test day milk yield

In field progeny testing program milk recording at monthly or bimonthly intervals and prediction of first lactation 305-day milk yield (FL305DMY) from these test day yields have been adapted as an alternative to daily milk recording. Wood's incomplete gamma function is the one of the commonly used nonlinear lactation curve model. In recent years Bayesian approach of fitting nonlinear biological models is gaining attention among researchers. In this study Wood's incomplete gamma function was fitted using Bayesian approach using monthly (MTDY) and bimonthly test day (BTDY) yields. The lactation curve parameters thus obtained were used for prediction of FL305DMY. Efficiency of prediction based on monthly and bimonthly test day milk yield were compared using error of prediction. It was found to be 5.78% and 7.59% as root mean square error (RMSE) based on MTDY and BTDY respectively.The Breeding values of 97 Karan Fries sires were estimated using BLUP-AM based on actual and predicted FL305DMY thus obtained. The RMSE was calculated as the difference between estimated breeding values based on actual and predicted yield. It was found that RMSE calculated based on MTDY showed only a marginal superiority of 0.79% over BTDY and showed high degree of correlation with actual yield. Therefore, recording at bimonthly intervals could be an economical alternative without compromising the efficiency.

How to pause fertility

Prolactin suppresses the ovarian cycles of lactating mice by directly repressing the activity of a cell population known as kisspeptin neurons.

The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study

BACKGROUND

A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation.

METHODS

Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use.

RESULTS

A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum.

CONCLUSIONS

In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.

Knowledge, awareness, and use of folic acid among women of childbearing age living in a peri-urban community in Ghana: a cross-sectional survey

BACKGROUND

Folic acid, a water-soluble B-complex vitamin, plays a crucial role in DNA synthesis and maintenance, making it particularly significant during reproduction. Its well-known ability to reduce the risk of congenital anomalies during the periconceptional period underscores its importance. The increased requirement for folate during pregnancy and lactation is essential to support the physiological changes of the mother and ensure optimal growth and development of the foetus and offspring. This study assessed the knowledge, awareness, and use of folic acid among pregnant and lactating women of reproductive age residing in Dodowa in the Shai Osu-Doku District, Accra, Ghana.

METHODS

The study was a cross-sectional design that involved 388 randomly selected participants (97 pregnant and 291 lactating women). Structured questionnaires were administered to gather information on the socioeconomic demographic characteristics, knowledge, awareness, and use of folic acid of the participants. Dietary intake was assessed using a food frequency questionnaire. The data were analysed using descriptive statistics and Pearson's chi-square analysis tests and are presented as frequencies and percentages, means, standard deviations, bar graphs, and pie charts. The significance of the results was determined at a 95% confidence interval.

RESULTS

The mean age of the participants was 31 ± 5.0 years. Among the study participants, 46.1% demonstrated knowledge of folic acid deficiency, while approximately 68.3% had a high awareness of folic acid supplementation. Approximately 75% of the participants indicated that they had not used folic acid supplements within the week, and 15.5% reported consuming folic acid-fortified food per week.

CONCLUSIONS

The women exhibited high awareness but poor knowledge regarding the usage of folic acid supplementation during pregnancy and lactation. Consequently, this lack of knowledge influenced the low use of folic acid supplements and low intake of folate-rich foods among pregnant and lactating mothers.

The fertility of dairy heifers and cows is not influenced by the follicular wave of the ovulatory follicle

Two studies were conducted to evaluate the effects of the follicular wave on ovarian function and fertility in dairy heifers and lactating cows. In study 1, the estrous cycle of the selected Holstein heifers was initially synchronized using two intra-muscular prostaglandin F2α (PGF2α) administrations 11 days apart. Heifers in group FFW (n = 14) received an intra-muscular 500 μg PGF2α administration on day 7 after detecting standing estrus, while Heifers in group SFW (n = 14) were administered PGF2α 13 days after detecting standing estrus. The pregnancy rates of FFW (n = 98) and SFW (n = 100) heifers were also determined 35-37 days after artificial insemination (AI). In Study 2, healthy Holstein lactating cows (n = 28) were randomly assigned to either the FFW (n = 14) or SFW (n = 14) groups. The estrous cycles of the cows were presynchronized using two intra-muscular administrations of PGF2α given 14 days apart. Then, the emergences of the follicular waves were induced using an Ovsynch protocol. The pregnancy rate of FFW (n = 99) versus SFW (n = 98) cows was also determined 35-37 days after AI. The ovulatory follicle and corpus luteum (CL) resulting from the ovulatory follicle of FFW were larger than those of the dominant follicle and the CL of SFW in dairy heifers and lactating cows. However, the pregnancy rate did not differ between the FFW and SFW groups in heifers and lactating cows 35-37 days after AI. In conclusion, although the characteristics of the ovulatory follicles in FFW versus SFW animals differed, the follicular wave in dairy heifers or lactating cows did not affect fertility.

Phenotypic Characteristics, Antimicrobial Susceptibility and Virulence Genotype Features of Trueperella pyogenes Associated with Endometritis of Dairy Cows

Trueperella pyogenes can cause various infections in the organs and tissues of different livestock (including pigs, cows, goats, and sheep), including mastitis, endometritis, pneumonia, or abscesses. Moreover, diseases induced by T. pyogenes cause significant economic losses in animal husbandry. In recent large-scale investigations, T. pyogenes has been identified as one of the main pathogens causing endometritis in lactating cows. However, the main treatment for the above-mentioned diseases is still currently antibiotic therapy. Understanding the impact of endometritis associated with T. pyogenes on the fertility of cows can help optimize antibiotic treatment for uterine diseases, thereby strategically concentrating the use of antimicrobials on the most severe cases. Therefore, it is particularly important to continuously monitor the prevalence of T. pyogenes and test its drug resistance. This study compared the uterine microbiota of healthy cows and endometritis cows in different cattle farms, investigated the prevalence of T. pyogenes, evaluated the genetic characteristics and population structure of isolated strains, and determined the virulence genes and drug resistance characteristics of T. pyogenes. An amount of 186 dairy cows were involved in this study and 23 T. pyogenes strains were isolated and identified from the uterine lavage fluid of dairy cows with or without endometritis.