Evidencia de la estimulación de puntos de acupuntura en el tratamiento de la hipogalactia: revisión sistemática con metaanálisis / Evidence of the acupuncture points stimulation for the treatment of hypogalactia: a systematic review and meta-analysis

Objetivo: Realizar una revisión de la literatura para analizar si la estimulación de puntos de acupuntura aumenta la cantidad de leche producida durante la lactancia. Método: Se recopilaron estudios de cinco bases de datos electrónicas siguiendo las recomendaciones internacionales para la elaboración de revisiones sistemáticas y metaanálisis. Los criterios de elegibilidad fueron artículos de texto completo en inglés o español con diseño de ensayos clínicos y estudios observacionales, sin restricción en el tiempo de publicación, en los cuales se hubiera evaluado el efecto de la estimulación de puntos de acupuntura en la mejora de la cantidad de lactancia mediante acupuntura convencional, electroacupuntura, láser, agujas de fuego, estimulación manual, Tui Na o catgut. Dos autores extrajeron de forma independiente los datos de las características y los resultados principales de los estudios seleccionados para su inclusión. Se realizaron las evaluaciones de riesgo de sesgo y de calidad (GRADE). Para la síntesis cuantitativa se calculó la diferencia de medias estandarizada para cada estudio individual seleccionado y luego se combinaron los datos mediante un metaanálisis de efectos aleatorios. Resultados: En la presente revisión se incluyeron un total de 14 estudios, la mayoría de ellos mostraron riesgo de sesgo y una calidad moderada. El metaanálisis mostró que la estimulación manual del punto de acupuntura aumenta la cantidad de leche materna (DME 95% IC=1,63 [1,13-2,13]; p<0,0001). Conclusión: La literatura sugiere que la estimulación manual de puntos de acupuntura mejora la cantidad de leche producida durante de lactancia.(AU)

Objective: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. Method: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. Results: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI=1.63 [1.13-2.13]; p<0.0001). Conclusion: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.(AU)

Evidence of the acupuncture points stimulation for the treatment of hypogalactia: A systematic review and meta-analysis.

OBJECTIVE: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. METHOD: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. RESULTS: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001). CONCLUSION: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Safety of COVID-19 Vaccination During Pregnancy and Lactation: A VigiBase Analysis.

BACKGROUND: There is limited evidence on the safety of coronavirus disease 2019 (COVID-19) vaccination during pregnancy and lactation. Thus, we aimed to evaluate the association between COVID-19 vaccination during pregnancy and lactation and reporting risk of adverse pregnancy or lactation outcomes. METHODS: Using VigiBase, we performed a disproportionality analysis with case/non case design. Cases were defined based on the Standardized MedDRA Queries (SMQs) of "pregnancy and neonatal topics" and non-cases were defined as all other adverse events. We included all reports with COVID-19 vaccines as the suspected cause. Using the full database as the comparators, reporting odds ratios (RORs) with 95% confidence intervals (CIs) were estimated by logistic regression while adjusting for maternal age. Infants' age and sex were additionally adjusted in analyzing the risk of COVID-19 vaccination during lactation. RESULTS: We identified 10,266 and 6,474 reports with the SMQ of "pregnancy and neonatal topics" associated with COVID-19 vaccines during pregnancy and lactation, respectively. No significant RORs of adverse pregnancy outcomes associated with COVID-19 vaccines during pregnancy were observed; however, "functional lactation disorders" showed significant disproportionality during lactation with adjusted ROR of 1.48 (95% CI, 1.21-1.79). Further analysis that analyzed "functional lactation disorders" at a preferred term level, showed higher ROR in mastitis (2.76 [95% CI, 1.45-5.27]). CONCLUSION: Overall, we did not observe a positive association between COVID-19 vaccination during pregnancy and risk of reporting adverse pregnancy outcomes. However, we found a significant disproportionate reporting association between COVID-19 vaccination during lactation and "functional lactation disorders", specifically mastitis. Continuous surveillance is warranted to confirm the safety of COVID-19 vaccine during pregnancy and lactation.

Codonopsis lanceolata polysaccharide ameliorates high-fat diet induced-postpartum hypogalactia via stimulating prolactin receptor-mediated Jak2/Stat5 signaling.

This study aims to investigate the ameliorative effect of Codonopsis lanceolata polysaccharide (PCL) on mice with hypogalatia induced by a high-fat diet (HFD) and the potential underlying mechanism. We found that oral administration of PCL demonstrated significant benefits in countering the negative effects of HFD, including weight gain, hepatic steatosis, mesenteric adipocyte hypertrophy, and abnormal glucose/lipid metabolism. In addition, PCL improved mammary gland development and enhanced lactogenesis performance. Histologically, PCL ameliorated the retardation of ductal growth, reduced mammary fat pad thickness, improved the incomplete linear encapsulation of luminal epithelium and myoepithelium, and increased the proliferation of mammary epithelial cells. Flow cytometry analysis showed that PCL mitigated the detrimental effects of HFD on mammary gland development by promoting the proliferation and differentiation of mammary epithelial cells. Mechanistic studies revealed that PCL upregulated the levels of prolactin (PRL) and its receptor (PRLR) in the mammary gland, activated JAK2/STAT5 signaling pathway, and increased the expression of p63, ERBB4, and NRG1. Overall, PCL can ameliorate HFD-induced hypogalactia by activating PRLR-mediated JAK2/STAT5 signaling. Our findings offer a methodological and theoretical foundation for investigating the functional constituents of traditional Chinese medicine in the treatment of hypogalactia.

Characterization of Three Cases of Primary Hypogalactia in Jalisco, Mexico.

INTRODUCTION: Human lactation should be taken into account as an important issue for the international agenda. Despite advances in lactation information and knowledge, insufficient milk production is still a concern for mothers and health practitioners, including International Board Certified Lactation Consultants and others. Primary hypogalactia, or insufficient milk production is uncommon, but should be considered when there is poor weight gain and decreased urine output in infants despite good latch-on and suckling, or anatomic differences in the physical exam of the lactating breast. MAIN ISSUE: This case series presents three cases illustrating insufficient milk production resulting in infants who experienced significant dehydration and poor weight gain. MANAGEMENT: Primary hypoplasia was diagnosed by means of a thorough interview and physical examination that entailed a consultation with a physician who was also an International Board Certified Lactation Consultant. CONCLUSION: Awareness of an infant's feeding needs and proper evaluation of a child's health status is paramount if health care providers are to identify the important factors contributing to breastfeeding problems. In some instances, breastfeeding goals cannot be achieved, and then the provider's role becomes support in coming to terms with persistent insufficient milk production, and coordinating appropriate supplementation to meet each baby's nutritional needs.

Therapeutic Ultrasound Alone and Associated with Lymphatic Drainage in Women with Breast Engorgement: A Clinical Trial.

Introduction: Breast engorgement (BE) is a problem that affects many women, especially in the first days of breastfeeding, producing inflammatory symptoms. Nonpharmacological therapies are inexpensive, safe, and can produce symptom relief. Objective: This study aims to analyze the safety of therapeutic ultrasound regarding possible risks of overheating and the effects of its use alone and associated with lymphatic drainage (LD) in women. Material and Methods: Effectiveness is measured through thermography, visual analog scale, and six-point scale of BE. This is a nonrandomized clinical trial with a sample of 34 in the ultrasound group (G1), 28 in the ultrasound and LD group (G2), and 37 in the control group (G3). Results: The mean reduction for engorgement was 1.3 ± 0.8 to G1, 1.4 ± 1.0 to G2, and 1.2 ± 0.9 to G3 according to the six-point scale. The mean reduction for pain level was 3.6 ± 2.1 to G1, 4.0 ± 3.1 to G2, and 4.0 ± 2.2 to G3 according to the visual analogue scale. Conclusion: It was observed that all therapies were effective in reducing the level of engorgement, according to the six-point scale. However, combined ultrasound and LD therapy has been shown to be more effective in reducing the level of pain. Brazilian Registry of Clinical Trials (RBR-6btb6zz).

Physical therapy intervention for breast symptoms in lactating women: a randomized controlled trial.

BACKGROUND: Therapeutic ultrasound, education, and massage are the most common physical therapy interventions provided to mothers with breast symptoms. However, there is insufficient evidence on the effectiveness of the combination of these interventions. This study aimed to explore the effects of the combination of therapeutic ultrasound, education, and massage on breast symptoms in lactating women. METHODS: This study was a single-blind randomized controlled trial. Postpartum lactating women aged from 21 to 45 with breast symptoms were recruited and randomly allocated to one of three groups (ultrasound group, sham group, and usual care group). The severity of breast symptoms (pain, redness, lump, general malaise), breast engorgement, breast hardness, body temperature, breast temperature, and milk volume were assessed at baseline (T1), immediately post-intervention (T2), and at 3 months following baseline (T3). RESULTS: A total of 37 participants were included in the study (ultrasound group n = 12; sham group n = 12; usual care n = 13). The severity of breast symptoms (i.e., pain, lump, and general malaise) as well as breast engorgement, were significantly improved in the ultrasound group at T2 when compared to T1, and these improvements were sustained at T3. The severity of breast engorgement was significantly lower in the ultrasound group when compared to the usual care group at T2. However, no statistically significant differences were found between the ultrasound and sham groups for all outcomes at any assessment time points. CONCLUSIONS: Physical therapy interventions may be beneficial in relieving breast symptoms in lactating women. Larger randomized controlled trials are needed to confirm the findings of this study. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04569136); Date of registration: 29/09/2020.

Breastfeeding environment and experiences at the workplace among health workers in the Upper East Region of Ghana.

BACKGROUND: Employed mothers have lower rates of breastfeeding, including health workers who are supposed to be advocates for breastfeeding. These working mothers need a supportive workplace environment to breastfeed, yet Ghana's breastfeeding policy neither mentions the workplace breastfeeding environment nor offers any information on it. METHODS: A convergent parallel mixed-methods design was used in this study to determine: facilities with a complete breastfeeding support environment (BFSE); breastfeeding challenges experienced; coping strategies and motivators for breastfeeding among health workers in the Upper East Region of Ghana; and Management's awareness of the need for an institutional breastfeeding support policy. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis respectively. The research was conducted from January to April 2020. RESULTS: All facilities (39) had incomplete BFSE and management representatives of health facilities (39) did not have and were not aware that their respective facilities needed to have a specific workplace breastfeeding policy that fed into the national policy agenda. Breastfeeding challenges at workplaces included: lack of private space for breastfeeding; inadequate support from co-workers and management; emotional stress; and inadequate breastfeeding breaks and work options. Women adapted to these challenges by employing coping strategies such as: bringing children to work with / without caretakers; leaving children at home; seeking support from co-workers and family members; feeding children with supplementary foods; adding annual leave to maternity leave; breastfeeding in cars / offices; and sending children to daycare. Interestingly, the women were still motivated to breastfeed. Health benefits of breastmilk, the convenience and readily available nature of breastmilk, moral obligation to breastfeed, and cheap cost of breastmilk emerged as key motivators to breastfeed. CONCLUSION: Our findings suggest that health workers have poor BFSE and are faced with numerous breastfeeding challenges. There is a need for programs that improve BFSE in health facilities.

Freeze-dried powder of daylily bud improves bromocriptine-induced lactation disorder in rats via JAK2/STAT5 pathway.

ETHNOPHARMACOLOGICAL RELEVANCE: Milk deficiency is a prevalent problem in the world. Daylily (Hemerocallis citrina Borani), called the Chinese mother flower, is a traditional vegetable and is believed to possess a galactagogue effect in China. Flavonoids and phenols are considered as the active ingredients of daylily to promote lactation and improve depression. AIM OF THE STUDY: The aim of this study was to investigate the prolactin effects of freeze-dried powder of flower buds of H. citrina Baroni in rat and its action mechanisms. MATERIALS AND METHODS: The chemical constituents of flower buds of H. citrina Baroni treated by different drying techniques were analyzed by ultrahigh pressure liquid chromatography-mass spectrometry. Sprague-Dawley (SD) rat model induced by bromocriptine was used to evaluate the effect of freeze-dried powder of daylily buds on promoting lactation. Network pharmacology method, ELISA, qPCR, and Western blot were used to clarify the action mechanisms. RESULTS: We detected 657 compounds in daylily buds. The relative contents of total flavonoids and phenols in freeze-dried samples were higher than those in dried ones. Bromocriptine, as a dopamine receptor agonist, can significantly inhibit prolactin in rats. Daylily buds can restore the levels of prolactin, progesterone and estradiol depressed by bromocriptine, effectively improve the milk production of the rat, and promote the repair of rat mammary gland tissue. We analyzed the relationship between the chemical components of daylily buds and the genes related to lactation with network pharmacology method, revealing that flavonoids and phenols may be the active components that promoted milk production via JAK2/STAT5 pathway, which was confirmed by the results of qPCR and Western blot. Daylily buds can increase the mRNA expression of PRLR, CSN2, LALBA and FASN and the protein expression of PRLR, JAK2 and STAT5. CONCLUSION: Daylily buds can improve the insufficient lactation of rats induced by bromocriptine through PRLR/JAK2/STAT5 pathway, and the freeze-dried processing method may better retain the active components of flavonoids and phenols that promote milk in daylily.

Efficacy and safety of acupuncture for postpartum hypogalactia: protocol for a systematic review and meta-analysis.

INTRODUCTION: Breast milk is recognised as the best natural food for neonates, but many women experience postpartum hypogalactia (PH). Randomised trials have found that acupuncture exert therapeutic effect on women with PH. However, systematic reviews on the efficacy and safety of acupuncture are still lacking; therefore, this systematic review aims to evaluate the efficacy and safety of acupuncture for PH. METHODS AND ANALYSIS: Six English databases (PubMed, Cochrane Library, EMBASE, EBSCO, Scopus, and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Wan-Fang, Chinese Biomedical Literature and Chinese Scientific Journal) will be systematically searched from their establishment to 1 September 2022. Randomised controlled trials of the efficacy of acupuncture for PH will be reviewed. The study selection, data extraction and research quality evaluation will be conducted independently by two reviewers. The primary outcome is the change in serum prolactin level from baseline to the end of treatment. Secondary results include milk secretion volume, total effectiveness rate, degree of mammary fullness, rate of exclusive breast feeding, and adverse events. A meta-analysis will be performed using RevMan V.5.4 statistical software. Otherwise, a descriptive analysis will be conducted. The risk of bias will be assessed using the revised Cochrane risk-of-bias tool. ETHICS AND DISSEMINATION: This systematic review protocol does not require ethical approval because it does not include private information/data of the participants. This article will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42022351849.

Abandono de la lactancia materna en Galicia: ¿cuándo se produce y por qué? / Cessation of breastfeeding in Galicia: when is it happening and why?

Introduction: International organizations recommend maintaining breastfeeding at least until 6 months after the birth of the child. However, the prevalence of breastfeeding at 6 moths in Europe is below the recommendations. The aims of this study are to estimate the prevalence of breastfeeding cessation month by month and to ascertain the reasons associated with the cessation during the first 12 months of life in galician women. Methods: The information analysed comes from the Health Risk Behaviour Information System conducted in 2016, which included women who had given birth in the previous 12 months (n = 6436) in Galicia (Spain). The prevalence of breastfeeding cessation was estimated and the age of the child at the time of cessation was collected. The causes of abandonment were classified into 5 global categories and the frequencies were estimated. Results: A total of 5,177 mothers of 3- to 16-month-old babies were included. At the age of 12 months, 33.8% of the children were still breastfed. The main reason for cessation of breastfeeding was hypogalactia (46.5%), followed by being back to work (24.1%). After birth to 4 months, hypogalactia and health problems were the principal reasons of cessation; between 4 and 7 months after birth, hypogalactia and returning to work or studies were the most important reasons; and after 7 months, rejection by the baby became important. Conclusion: The cessation of breastfeeding during the first year of life is due mainly to preventable causes. It is necessary to improve maternal health education, both during and after the pregnancy, as well as to develop effective work-life balance measures. (AU)

Introducción: Las organizaciones internacionales recomiendan mantener la lactancia materna (LM) durante los primeros 6 meses de vida. En Europa, la prevalencia de LM a los 6 meses está por debajo de las recomendaciones. Los objetivos son estimar la prevalencia de cese de LM mes a mes y conocer los motivos asociados al abandono de la LM durante el primer año de vida en Galicia. Metodología: Los datos proceden de la encuesta del Sistema de Información sobre Conductas de Riesgo para la Salud 2016 que incluyó a mujeres que habían dado a luz en los 12 meses previos (n = 6.436) en Galicia (España). Se estimaron las prevalencias de cese de LM en función de la edad del niño. Se clasificaron las causas de abandono en cinco categorías y se estimaron las frecuencias. Resultados: Se incluyeron a 5.177 madres con niños de 3-16 meses. Al año de vida, el 33,8% de los niños mantenían LM. La razón principal del abandono fue la hipogalactia (46,5%), seguida de la vuelta al trabajo (24,1%). Hasta los 4 meses, la hipogalactia y los problemas de salud fueron los motivos principales; entre los 4-7 meses, la vuelta al trabajo y la hipogalactia; y después de los 7 meses, el rechazo del bebé y la vuelta al trabajo. Conclusión: El abandono de la LM durante el primer año de vida es principalmente debido a causas prevenibles. Es imprescindible mejorar la educación en salud de las madres, tanto durante como después del embarazo, así como desarrollar medidas de conciliación eficaces. (AU)

Effect of cold cabbage leaf application on breast engorgement and pain in the postpartum period: A systematic review and meta-analysis.

The researchers' aims are to determine the effect of cold cabbage leaf application on breast engorgement and pain during the postpartum period through a systematic review and meta-analysis. Between June and September 2021, researchers systematically searched Turkish and English databases using a combination of keywords. We calculated individual and general effect sizes of the studies to evaluate effect sizes. We obtained 25,996 results with the databases search and we included a total of eight studies for analysis. According to the pooled results, we determined that cold cabbage leaf application caused a significant reduction in breast pain, though no significant reduction was seen in breast engorgement. In this systematic review and meta-analysis, we found that cold cabbage leaf application was effective in reducing breast pain, but that more experimental studies are needed to determine its effect on breast engorgement.CALLOUTSBreast engorgement is a common physiological problem for lactating mothers.Researchers state that the results of the eight studies included in the analysis suggested that cold cabbage leaf application was effective in reducing breast pain.More studies are needed to evaluate the effect of cold cabbage application on reducing breast engorgement.

EARLY PROGNOSIS OF HYPOGALACTIA IN BREASTFEEDING MOTHERS: NEW OPPORTUNITIES FOR PRIMARY PREVENTION.

An increase in the hypogalactia frequency diagnosis in breastfeeding mothers is one of the world-spread medical and social problems and is especially high in women with risk factors of lactation disorders. Early estimation of risk factors creates opportunities for physicians to diagnose the lactation problem that mothers face and solve it. Aim - to identify and calculate prognostic criteria for determining the risk of hypogalactia in breastfeeding mothers and strategies to help women overcome them. Twenty-two factors that cause the most significant impact on the development of hypogalactia were selected, and their frequency was determined in 208 mothers with hypogalactia (group 1) and 388 mothers with normal lactation (group 2). The sequential Wald analysis, which compares the frequencies of distribution of traits in the study groups and determines their informativeness by calculating prognostic coefficients (PK) for different risk factors and estimating the individual risk of hypogalactia was used. The elder age of the breastfeeding mother (36-40 years and elder) and its lower educational level promoted hypogalactia. Low security of the mother was associated with hypogalactia (PC -1,4). It was also found that mothers engaged in heavy physical labor suffer from hypogalactia more often than employees. Mothers' return to work, have been reported as factors that influence breastfeeding. Occupational hazards (noise, dyes, vibration, lead soldering, dust factors) and bad habits caused hypogalactia (PC -5,4). Prenatal breastfeeding education has been shown to prevent hypogalactia. A burdensome obstetric history (PC -3,9), habitual miscarriage (PC-1,4), and female genital diseases worsen the prognosis of lactation. Extragenital pathology was characterized by negative PC of hypogalactia, especially rheumatic fever, compensated heart defect (PC -3,2), chronic cardiovascular insufficiency (PC -11,4), congenital heart disease (PC -11,4), obesity (PC -4,8), diabetes mellitus (PC -5,8). The time of the first application to the breast affected the mothers' milk production. The mathematical model of the individual prognosis of lactation in mothers contributes to the early detection of hypogalactia and the corresponding correction.

Cardiometabolic profile of young women with hypoprolactinemia.

PURPOSE: Unlike hyperprolactinemia, clinical significance of prolactin deficiency remains poorly understood. The aim of this study was to assess the cardiometabolic profile of patients with low prolactin levels. METHODS: The study population consisted of three groups of young women. Two groups were chronically treated with cabergoline but differed in prolactin levels, which were either abnormally low (group A; n = 16) or within the reference range (group B, n = 23). Group C, serving as a control group, included 28 drug-naïve women with normal prolactin levels. The dose of cabergoline in group A was then tapered down. Glucose homeostasis markers, plasma lipids and circulating levels of hormones, uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen and homocysteine, as well as the carotid intima-media thickness were assessed at baseline and 6 months later. RESULTS: Compared with subjects with normal prolactin levels, women with hypoprolactinemia had higher levels of 2-h postchallenge glucose, glycated hemoglobin, triglycerides, uric acid, hsCRP and fibrinogen, lower values of HDL-cholesterol, total testosterone and free androgen index, as well as reduced insulin sensitivity. No differences in these variables were observed between groups B and C. Apart from prolactin normalization, cabergoline dose reduction reversed all laboratory disturbances reported in group A. CONCLUSION: The obtained results suggest that hypoprolactinemia in women of reproductive age may increase cardiometabolic risk.

Lactation Activity and Mechanism of Milk-Protein Synthesis by Peptides from Oyster Hydrolysates.

Oyster meat has a tender texture and delicate flavor, and the oyster is an aquatic shellfish with high nutritional and economic values. As they are rich in protein, oysters serve as a good source for the preparation of bioactive peptides. However, research on the lactation effect and mechanism of the synthesis of polypeptides from oyster hydrolysates is yet to be observed. This study aimed to analyze the lactation activity of the fraction UEC4-1 and explore its mechanism. The results show that, in an in vivo experiment, UEC4-1 could significantly increase the concentration of PRL in the serum and mammary tissue and the concentration of PRLR in the mammary tissue in rats with postpartum hypogalactia. UEC4-1 promoted the development of mammary tissue structure, resulting in active lactation. UEC4-1 promoted the proliferation of MCF-10A in a dose-dependent manner and could significantly upregulate the gene expression levels of PRL, PRLR, CSN1S1, CSN2, CSN3 and CCND1. UEC4-1 could also significantly increase the expression of mTOR, AKT1, RPS6KB1 and STAT5A in MCF-10A and improve its phosphorylation level. These results show that UEC4-1 had the ability to upregulate the proliferation and PRL synthesis of MCF-10A and promote lactation. The ability of UEC4-1 to regulate the milk-protein synthesis signaling pathway is the mechanism behind this. Oysters had a remarkable effect on lactating mothers' sweating irritability after childbirth and may serve as an everyday diet to promote lactation. Postpartum dysgalactia is a common problem for lactating women. The study of the oyster's lactation-active peptide can provide dietary nutrition guidance for postpartum lactating mothers, and it has the potential to be used for the development of drugs for the treatment of postpartum hypogalactia or oligogalactia.

Sexual function and depressive symptoms in men with hypoprolactinaemia secondary to overtreatment of prolactin excess: A pilot study.

BACKGROUND: Low prolactin levels have been found to impair libido and arousal, as well as to reduce wellbeing in young women. OBJECTIVE: The aim of this study was to investigate whether drug-induced hypoprolactinaemia affects male sexual function and depressive symptoms. METHODS: The study population consisted of three groups of young and middle-aged men. Two groups were treated with dopamine agonists because of previous hyperprolactinaemia but differed in current prolactin levels, which were <3ng/ml (n=12; group 1) or within the reference range (3-20ng/ml) (n=20; group 2). The control group (group 3) included 24 dopamine agonist-naïve normoprolactinaemic men. During the study, doses of dopaminergic agents in group 1 were reduced by 25-50% compared to doses before the start of the study. Circulating levels of prolactin, testosterone, free calculated testosterone, dehydroepiandrosterone-sulphate, oestradiol and gonadotropins were measured upon enrolment in the study and six months later. Moreover, at the beginning and the end of the study, all men enrolled completed questionnaires assessing sexual functioning (IIEF-15) and depressive symptoms (BDI-II). RESULTS: Group 1 differed from groups 2 and 3 in domain scores for sexual desire and erectile function, and in the overall BDI-II score. It was also characterised by lower levels of total testosterone and calculated free testosterone. Reduction of drug doses normalised sexual desire and erectile function, reduced BDI-II scores and increased prolactin as well as total and free calculated testosterone. Groups 2 and 3 did not differ from each other in sexual functioning, depressive symptoms or hormone levels. CONCLUSIONS: The results obtained indicate that men with dopamine agonist-induced hypoprolactinaemia are characterised by impaired sexual functioning and reduced wellbeing. These disturbances are a consequence of subnormal prolactin levels and do not seem to reflect adverse effects of dopamine agonists.

Mycoplasma agalactiae ST35: a new sequence type with a minimal accessory genome primarily affecting goats.

BACKGROUND: Mycoplasma agalactiae, causing agent of contagious agalactia, infects domestic small ruminants such as sheep and goats but also wild Caprinae. M. agalactiae is highly contagious and transmitted through oral, respiratory, and mammary routes spreading rapidly in an infected herd. RESULTS: In an outbreak of contagious agalactia in a mixed herd of sheep and goats, 80% of the goats were affected displaying swollen udders and loss of milk production but no other symptom such as kerato-conjunctivitis, arthritis or pulmonary distress commonly associated to contagious agalactia. Surprisingly, none of the sheep grazing on a common pasture and belonging to the same farm as the goats were affected. Whole genome sequencing and analysis of M. agalactiae strain GrTh01 isolated from the outbreak, revealed a previously unknown sequence type, ST35, and a particularly small, genome size of 841'635 bp when compared to others available in public databases. Overall, GrTh01 displayed a reduced accessory genome, with repertoires of gene families encoding variable surface proteins involved in host-adhesion and variable antigenicity being scaled down. GrTh01 was also deprived of Integrative Conjugative Element or prophage, and had a single IS element, suggesting that GrTh01 has a limited capacity to adapt and evolve. CONCLUSIONS: The lack of most of the variable antigens and the Integrative Conjugative Element, both major virulence- and host specificity factors of a M. agalactiae strain isolated from an outbreak affecting particularly goats, indicates the implication of these factors in host specificity. Whole genome sequencing and full assembly of bacterial pathogens provides a most valuable tool for epidemiological and virulence studies of M. agalactiae without experimental infections.

The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. RESEARCH AIMS: (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. METHODS: Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. RESULTS: Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). CONCLUSIONS: Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Eficácia da acupuntura auricular na duração do aleitamento materno exclusivo: um estudo piloto randomizado / Efficacy of auricular acupuncture on the duration of exclusive breastfeeding: a randomized pilot study

O aleitamento materno apresenta múltiplos benefícios para a saúde da mãe e do bebê. No entanto, muitos são os fatores que podem interferir na amamentação, destacando-se a percepção de baixa produção láctea. Há evidências de que a acupuntura auricular pode auxiliar nesse contexto. Este estudo tem o objetivo de avaliar por meio de ensaio clínico randomizado se a acupuntura auricular apresenta eficácia na manutenção do aleitamento materno exclusivo e complementado até os seis meses de vida do bebê. Trata-se de um estudo piloto randomizado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e foi registrada na Plataforma Rebec (Registro Brasileiros de Ensaios Clínicos). A pesquisa foi realizada no Banco de Leite Humano do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram incluídas 49 participantes com idade igual ou superior a 18 anos, que estavam entre o 5° e o 30° dia pós-parto e que tinham queixa de baixa produção láctea. As participantes foram randomizadas em três grupos: Acupuntura auricular, Acupuntura sham e Placebo. O estudo foi realizado em duas fases: fase de intervenção, no qual foram realizados 5 atendimentos de aleitamento materno para todos os grupos e aplicação da intervenção conforme a alocação da participante no grupo sorteado e a fase de seguimento telefônico em que realizamos ligações até os 6 meses de vida criança. As frequências absolutas e relativas foram calculadas para as variáveis qualitativas. As comparações entre os grupos no tempo basal para as variáveis qualitativas explicativas foram realizadas considerando o teste quadrado, já o teste não paramétrico de Kruskal Wallis foi aplicado para comparar os grupos em relação às variáveis quantitativas. Foram construídos modelos de regressão de efeitos mistos para comparar os tempos e os grupos em relação aos desfechos quantitativos e análise por protocolo. As participantes do grupo três (controle - cuidado usual) eram mais velhas, com média de idade de 36 anos (P-valor 0,0079), identifica-se que a acupuntura auricular teve evidência clínica no efeito protetivo do AME e AMC na fase de seguimento telefônico, pois 2 participantes do grupo de acupuntura auricular ainda amamentavam exclusivamente até os seis meses de vida do bebê de modo exclusivo e nos demais grupos nenhuma participante amamentava. Do ponto de vista estatístico não houveram diferenças significativas

Breastfeeding has multiple benefits for the health of mother and baby. However, there are many factors that can interfere with breastfeeding, the perception of low milk production, is being an important cause of early weaning among nursing mothers. In this sense Ear acupuncture can help to increase milk production. This study aims to evaluate, through a randomized clinical trial, whether auricular acupuncture is effective in maintaining exclusive and supplemented breastfeeding until the baby is six months old. This is a randomized pilot study. The study was approved by the Research Ethics Committee and was registered on the Rebec Platform (Brazilian Registry of Clinical Trials). The research was realized at the Human Milk Bank of Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Forty-nine participants aged 18 years or over, who were between the 5th and 30th day postpartum and who complained of low milk production, were included. The Participants were randomized into three groups: intervention group, sham acupuncture and placebo. The study was carried out in two phases: intervention phase, in which 5 breastfeeding sessions were carried out for all groups and application of the intervention according to the participant's allocation in the drawn group and the telephone follow-up phase in which we made calls until 6 months of child life. Absolute and relative frequencies were calculated for qualitative variables. Comparisons between groups at baseline for qualitative explanatory variables were performed using the chi-square test, while the non-parametric Kruskal Wallis test was applied to compare groups in relation to quantitative variables. Mixed-effects regression models were built to compare times and groups against quantitative outcomes and analysis per protocol. Participants in group three (control - usual care) were older, with a mean age of 36 years (P-value 0.0079), it is identified that auricular acupuncture had clinical evidence in the protective effect of exclusivebreastfeeding and complementary breastfeeding in the telephone follow-up 2 participants in the auricular acupuncture group still exclusively breastfed until the baby's six months of life and in the other groups none of the participants breastfed. From a statistical point of view there were no significant differences