Acute-phase proteins are a class of proteins whose plasma concentrations increase or decrease in response to inflammation. This response is called the acute-phase reaction. For acute-phase reaction is characteristic fever, acceleration of peripherals leukocytes, circulating neutrophils and their precursors; the terms acute-phase protein and acute-phase reactant are used synonymously, although some APRs are polypeptides rather than proteins. In response to injury, local inflammatory cells secrete a number of cytokines into the bloodstream, most notable of which are the interleukins IL1, IL6, TNFα; the liver responds by producing a large number of acute-phase reactants. At the same time, the production of a number of other proteins is reduced. Increased acute-phase proteins from the liver may contribute to the promotion of sepsis. TNF-α, IL-1β and INF-γ are important for the expression of inflammatory mediators as prostagladins and leukotrienes and they cause the production of platelet-activating factor and IL-6.
After stimulation of proinflammatory cytokines, Kupffer cells produce IL-6 in the liver and present it to the hepatocytes. IL-6 is the major mediator for the hepatocytic secretion of APPs. Synthesis of APP can be regulated indirectly by cortisol. Cortisol can enhance expression of IL-6 receptors in liver cells and induce IL-6-mediated production of APPs. Positive acute-phase proteins serve different physiological functions within the immune system; some act to destroy or inhibit growth of microbes, e.g. C-reactive protein, mannose-binding protein, complement factors, ceruloplasmin, serum amyloid A and haptoglobin. Others give negative feedback on the inflammatory response, e.g. serpins. Alpha 2-macroglobulin and coagulation factors affect coagulation stimulating it; this pro-coagulant effect may limit infection by trapping pathogens in local blood clots. Some products of the coagulation system can contribute to the innate immune system by their ability to increase vascular permeability and act as chemotactic agents for phagocytic cells.
"Negative" acute-phase proteins decrease in inflammation. Examples include albumin, transthyretin, retinol-binding protein, transcortin; the decrease of such proteins may be used as markers of inflammation. The physiological role of decreased synthesis of such proteins is to save amino acids for producing "positive" acute-phase proteins more efficiently. Theoretically, a decrease in transferrin could additionally be decreased by an upregulation of transferrin receptors, but the latter does not appear to change with inflammation. Measurement of acute-phase proteins C-reactive protein, is a useful marker of inflammation in both medical and veterinary clinical pathology, it correlates with the erythrocyte sedimentation rate, however not always directly. This is due to the ESR being dependent on elevation of fibrinogen, an acute phase reactant with a half-life of one week; this protein will therefore remain higher for longer despite removal of the inflammatory stimuli. In contrast, C-reactive protein rises and can return to within the normal range if treatment is employed.
For example, in active systemic lupus erythematosus, one may find a raised ESR but normal C-reactive protein. They may indicate liver failure. Wikipedia:MeSH D12.776#MeSH D12.776.124.050 --- acute-phase proteins Acute-Phase+Proteins at the US National Library of Medicine Medical Subject Headings
Breastfeeding known as nursing, is the feeding of babies and young children with milk from a woman's breast. Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as and as much as the baby wants. During the first few weeks of life babies may nurse every two to three hours, the duration of a feeding is ten to fifteen minutes on each breast. Older children feed less often. Mothers may pump milk so that it can be used when breastfeeding is not possible. Breastfeeding has a number of benefits to both baby, which infant formula lacks. Deaths of an estimated 820,000 children under the age of five could be prevented globally every year with increased breastfeeding. Breastfeeding decreases the risk of respiratory tract infections and diarrhea, both in developing and developed countries. Other benefits include lower risks of asthma, food allergies, type 1 diabetes, leukemia. Breastfeeding may improve cognitive development and decrease the risk of obesity in adulthood.
Mothers may feel pressure to breastfeed, but in the developed world children grow up when bottle fed. Benefits for the mother include less blood loss following delivery, better uterus shrinkage, decreased postpartum depression. Breastfeeding delays the return of menstruation and fertility, a phenomenon known as lactational amenorrhea. Long term benefits for the mother include decreased risk of breast cancer, cardiovascular disease, rheumatoid arthritis. Breastfeeding is less expensive than infant formula. Health organizations, including the World Health Organization, recommend breastfeeding for six months; this means that no other foods or drinks other than vitamin D are given. After the introduction of foods at six months of age, recommendations include continued breastfeeding until one to two years of age or more. Globally about 38% of infants are only breastfed during their first six months of life. In the United States in 2015, 83% of women begin breastfeeding and 58% were still breastfeeding at 6 months, although only 25% exclusively.
Medical conditions that do not allow breastfeeding are rare. Mothers who take certain recreational drugs and medications should not breastfeed. Smoking, limited amounts of alcohol, or coffee are not reasons to avoid breastfeeding. Changes early in pregnancy prepare the breast for lactation. Before pregnancy the breast is composed of adipose tissue but under the influence of the hormones estrogen, progesterone and other hormones, the breasts prepare for production of milk for the baby. There is an increase in blood flow to the breasts. Pigmentation of the nipples and areola increases. Size increases as well, but breast size is not related to the amount of milk that the mother will be able to produce after the baby is born. By the second trimester of pregnancy colostrum, a thick yellowish fluid, begins to be produced in the alveoli and continues to be produced for the first few days after birth until the milk "comes in", around 30 to 40 hours after delivery. There is no evidence to support increased fluid intake for breastfeeding mothers to increase their milk production.
Oxytocin contracts the smooth muscle of the uterus during birth and following delivery, called the postpartum period, while breastfeeding. Oxytocin contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down, in response to occur. Not all of breast milk's properties are understood, but its nutrient content is consistent. Breast milk is made from nutrients in the mother's bodily stores, it has an optimal balance of fat, sugar and protein, needed for a baby's growth and development. Breastfeeding triggers biochemical reactions which allows for the enzymes, growth factors and immunologic substances to defend against infectious diseases for the infant; the breast milk has long-chain polyunsaturated fatty acids which help with normal retinal and neural development. The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the child's age.
The first type, produced during the first days after childbirth, is called colostrum. Colostrum is easy to digest, it has a laxative effect that helps the infant to pass early stools, aiding in the excretion of excess bilirubin, which helps to prevent jaundice. It helps to seal the infants gastrointestional tract from foreign substances, which may sensitize the baby to foods that the mother has eaten. Although the baby has received some antibodies through the placenta, colostrum contains a substance, new to the newborn, secretory immunoglobulin A. IgA works to attack germs in the mucous membranes of the throat and intestines, which are most to come under attack from germs. Breasts begin producing mature milk around the fourth day after birth. Early in a nursing session, the breasts produce foremilk, a thinner milk containing many proteins and vitamins. If the baby keeps nursing hindmilk is produced. Hindmilk has texture because it contains more fat. Breastfeeding can begin after birth; the baby is placed on the feeding starts as soon as the baby shows interest.
According to some authorities the majority of infants do not begin to suckle if placed between the mother's breasts but rather enter a period of rest and quiet alertness. During this time they seem to be more interested in the mother's face her eyes, than beginning to suckle, it has been speculated tha
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process can occur with all post-pregnancy female mammals. In humans the process of feeding milk is called breastfeeding or nursing. Newborn infants produce some milk from their own breast tissue, known colloquially as witch's milk. In most species, milk comes out of the mother's nipples. In only one species of mammal, the Dayak fruit bat from Southeast Asia, is milk production a normal male function. Galactopoiesis is the maintenance of milk production; this stage requires prolactin. Oxytocin is critical for the milk let-down reflex in response to suckling. Galactorrhea is milk production unrelated to nursing, it can occur in males and females of many mammal species as result of hormonal imbalances such as hyperprolactinaemia. The chief function of a lactation is to provide nutrition and immune protection to the young after birth. In all mammals, lactation induces a period of infertility, which serves to provide the optimal birth spacing for survival of the offspring.
From the eighteenth week of pregnancy, a woman's body produces hormones that stimulate the growth of the milk duct system in the breasts: Progesterone influences the growth in size of alveoli and lobes. Progesterone levels drop after birth. Estrogen stimulates the milk duct system to differentiate. Like progesterone, high levels of estrogen inhibit lactation. Estrogen levels drop at delivery and remain low for the first several months of breastfeeding. Breastfeeding mothers should avoid estrogen-based birth control methods, as a spike in estrogen levels may reduce a mother's milk supply. Prolactin contributes to the increased growth and differentiation of the alveoli, influences differentiation of ductal structures. High levels of prolactin during pregnancy and breastfeeding increase insulin resistance, increase growth factor levels and modify lipid metabolism in preparation for breastfeeding. During lactation, prolactin is the main factor maintaining tight junctions of the ductal epithelium and regulating milk production through osmotic balance.
Human placental lactogen – from the second month of pregnancy, the placenta releases large amounts of HPL. This hormone is associated with prolactin and appears to be instrumental in breast and areola growth before birth. Follicle stimulating hormone, luteinizing hormone, human chorionic gonadotropin, through control of estrogen and progesterone production, by extension and growth hormone production, are essential. Growth hormone is structurally similar to prolactin and independently contributes to its galactopoiesis. Adrenocorticotropic hormone and glucocorticoids such as cortisol have an important lactation inducing function in several animal species, including humans. Glucocorticoids play a complex regulating role in the maintenance of tight junctions. Thyroid-stimulating hormone and thyrotropin-releasing hormone are important galactopoietic hormones whose levels are increased during pregnancy. Oxytocin contracts the smooth muscle of the uterus during and after birth, during orgasm. After birth, oxytocin contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system.
Oxytocin is necessary for the milk ejection reflex, or let-down, in response to occur. It is possible to induce lactation without pregnancy. Protocols for inducing lactation are called the Goldfarb protocols. Using birth control pills to mimic the hormone levels of pregnancy discontinuing the birth control, followed by use of a double electric breast pump for 15 minute sessions at regular 2-3 hour intervals _ helps induce milk production. During the latter part of pregnancy, the woman's breasts enter into the Secretory Differentiation stage; this is when the breasts make a thick, sometimes yellowish fluid. At this stage, high levels of progesterone inhibit most milk production, it is not a medical concern if a pregnant woman leaks any colostrum before her baby's birth, nor is it an indication of future milk production. At birth, prolactin levels remain high, while the delivery of the placenta results in a sudden drop in progesterone, HPL levels; this abrupt withdrawal of progesterone in the presence of high prolactin levels stimulates the copious milk production of Secretory Activation.
When the breast is stimulated, prolactin levels in the blood rise, peak in about 45 minutes, return to the pre-breastfeeding state about three hours later. The release of prolactin triggers the cells in the alveoli to make milk. Prolactin transfers to the breast milk; some research indicates that prolactin in milk is greater at times of higher milk production, lower when breasts are fuller, that the highest levels tend to occur between 2 a.m. and 6 a.m. Other hormones—notably insulin and cortisol—are involved, but their roles are not yet well understood. Although biochemical markers indicate that Secretory Activation begins about 30–40 hours after birth, mothers do not begin feeling increased breast fullness until 50–73 hours after birth. Colostrum is the first milk, it contains higher amounts of white blood cells and antibodies than matur
Oncofertility is a subfield that bridges oncology and reproductive research to explore and expand options for the reproductive future of cancer survivors. The name was coined in 2006 by Teresa K. Woodruff at the Oncofertility Consortium. Cancer treatments, such as chemotherapy and surgery, may destroy a person's ability to have children in life, oncofertility research focuses on increasing fertility preservation options. With 10% of cancer patients being younger than age 40, this issue affects more than 135,000 people in the United States each year; as cancer survivorship increases, the preservation of fertility in women and children becomes a critically important topic to patients and their families. The ability to preserve fertility prior to cancer treatment can provide hope at the time of diagnosis for families in life. Oncofertility incorporates reproductive issues after cancer treatment, such as family planning, complex contraception, hormonal management throughout survivorship and adoption.
Established fertility preservation options for men include sperm banking, in which a semen sample is produced and stored for future use, testicular sperm extraction, during which sperm is retrieved directly from the testes through a short surgical procedure and frozen. Experimental options include testicular tissue banking when testicular tissue is surgically removed and frozen. Scientists are developing methods to use this tissue for fertility preservation in males. Men who do not preserve their fertility prior to cancer treatment may have children through donor sperm using sperm from a known or anonymous donor to achieve a pregnancy with a female partner using assisted reproductive technologies or Adoption by permanently assuming all rights and responsibilities of a child through a legal process. Options for women to have children after cancer have increased in recent years. Women should be counseled on established options such as embryo banking in which hormonal stimulation causes the production of multiple eggs, which are removed, fertilized by sperm, frozen for future use, egg banking in which hormonal stimulation causes the production of multiple eggs, which are removed and frozen for storage and future use, ovarian transposition and ovarian shielding.
Experimental techniques include ovarian tissue banking in which an ovary is surgically removed and frozen to be transplanted back into the woman when she is ready to have children. Scientists are working on ways to mature undeveloped eggs from this ovarian tissue. After sterilizing cancer treatment, a woman can choose surrogacy or adoption. Recent efforts investigate the implications of a cancer diagnosis during pregnancy. Prepubescent children have fewer options to preserve fertility than adults; these include ovarian tissue banking for females. Fertility preservation costs may be prohibitive for young patients and multiple organizations now provide methods to reduce costs for patients; these include Fertile Action. The Supreme Court of the United States addressed the Social Security implications of oncofertility in March 2012 with Astrue v. Capato. Research investigates ethical issues in oncofertility, such as the decision-making process for adolescent children and their families