Limits to sustained energy intake XXIV: impact of suckling behaviour on the body temperatures of lactating female mice

Impact of Insurance Status on Late-Stage Disease Presentation and Disease-Specific Survival among US Patients With Gastric Cancer

Purpose

The impact of insurance status on cause-specific survival and late-stage disease presentation among US patients with gastric cancer (GC) has been less well-defined.

Materials and Methods

A retrospective study analyzed the 2007-2016 Surveillance Epidemiology and End Results. GC events were defined as GC-specific deaths; patients without the event were censored at the time of death from other causes or last known follow-up. Late-stage disease was stage III-IV. Insurance status was categorized as "uninsured/Medicaid/private." Five-year survival rates were compared using log-rank tests. Cox regression was used to assess the association between insurance status and GC-specific survival. Logistic regression was used to examine the relationship of insurance status and late-stage disease presentation.

Results

Of 5,529 patients, 78.1% were aged ≥50 years; 54.2% were White, 19.4% Hispanic, and 14.0% Black; 73.4% had private insurance, 19.5% Medicaid, and 7.1% uninsured. The 5-year survival was higher for the privately insured (33.9%) than those on Medicaid (24.8%) or uninsured (19.2%) (p<0.001). Patients with Medicaid (adjusted hazard ratio [aHR] 1.22, 95%CI: 1.11-1.33) or uninsured (aHR 1.43, 95%CI: 1.25-1.63) had worse survival than those privately insured. The odds of late-stage disease presentation were higher in the uninsured (adjusted odds ratio [aOR] 1.61, 95%CI: 1.25-2.08) or Medicaid (aOR 1.32, 95%CI: 1.12-1.55) group than those with private insurance. Hispanic patients had greater odds of late-stage disease presentation (aOR 1.35, 95%CI: 1.09-1.66) than Black patients.

Conclusions

Findings highlight the need for policy interventions addressing insurance coverage among GC patients and inform screening strategies for populations at risk of late-stage disease.

Lactating SKH-1 furless mice prioritize own comfort over growth of their pups

Lactation is the most energetically demanding physiological process that occurs in mammalian females, and as a consequence of this energy expenditure, lactating females produce an enormous amount of excess heat. This heat is thought to limit the amount of milk a mother produces, and by improving heat dissipation, females may improve their milk production and offspring quality. Here we used SKH-1 hairless mice as a natural model of improved heat dissipation. Lactating mothers were given access to a secondary cage to rest away from their pups, and this secondary cage was kept either at room temperature (22 °C) in the control rounds or cooled to 8 °C in the experimental groups. We hypothesized that the cold exposure would maximize the heat dissipation potential, leading to increased milk production and healthier pups even in the hairless mouse model. However, we found the opposite, where cold exposure allowed mothers to eat more food, but they produced smaller weight pups at the end of lactation. Our results suggest that mothers prioritize their own fitness, even if it lowers the fitness of their offspring in this particular mouse strain. This maternal-offspring trade-off is interesting and requires future studies to understand the full interaction of maternal effects and offspring fitness in the light of the heat dissipation limitation.

Complete sleep and local field potential analysis regarding estrus cycle, pregnancy, postpartum and post-weaning periods and homeostatic sleep regulation in female rats

Sleep and local field potential (LFP) characteristics were addressed during the reproductive cycle in female rats using long-term (60-70 days) recordings. Changes in homeostatic sleep regulation was tested by sleep deprivation (SDep). The effect of mother-pup separation on sleep was also investigated during the postpartum (PP) period. First half of the pregnancy and early PP period showed increased wakefulness (W) and higher arousal indicated by elevated beta and gamma activity. Slow wave sleep (SWS) recovery was suppressed while REM sleep replacement was complete after SDep in the PP period. Pup separation decreased maternal W during early-, but increased during middle PP while did not affect during late PP. More W, less SWS, higher light phase beta activity but lower gamma activity was seen during the post-weaning estrus cycle compared to the virgin one. Maternal sleep can be governed by the fetuses/pups needs and their presence, which elevate W of mothers. Complete REM sleep- and incomplete SWS replacement after SDep in the PP period may reflect the necessity of maternal REM sleep for the offspring while SWS increase may compete with W essential for maternal care. Maternal experience may cause sleep and LFP changes in the post-weaning estrus cycle.

Heat dissipation capacity influences reproductive performance in an aerial insectivore

Climatic warming is predicted to increase the frequency of extreme weather events, which may reduce an individual's capacity for sustained activity because of thermal limits. We tested whether the risk of overheating may limit parental provisioning of an aerial insectivorous bird in population decline. For many seasonally breeding birds, parents are thought to operate close to an energetic ceiling during the 2-3 week chick-rearing period. The factors determining the ceiling remain unknown, although it may be set by an individual's capacity to dissipate body heat (the heat dissipation limitation hypothesis). Over two breeding seasons we experimentally trimmed the ventral feathers of female tree swallows (Tachycineta bicolor) to provide a thermal window. We then monitored maternal and paternal provisioning rates, nestling growth rates and fledging success. We found the effect of our experimental treatment was context dependent. Females with an enhanced capacity to dissipate heat fed their nestlings at higher rates than controls when conditions were hot, but the reverse was true under cool conditions. Control females and their mates both reduced foraging under hot conditions. In contrast, male partners of trimmed females maintained a constant feeding rate across temperatures, suggesting attempts to match the feeding rate of their partners. On average, nestlings of trimmed females were heavier than controls, but did not have a higher probability of fledging. We suggest that removal of a thermal constraint allowed females to increase provisioning rates, but additionally provided nestlings with a thermal advantage via increased heat transfer during maternal brooding. Our data provide support for the heat dissipation limitation hypothesis and suggest that depending on temperature, heat dissipation capacity can influence reproductive success in aerial insectivores.

Limits to sustained energy intake. XXXI. Effect of graded levels of dietary fat on lactation performance in Swiss mice

The heat dissipation limit theory predicts that lactating female mice consuming diets with lower specific dynamic action (SDA) should have enhanced lactation performance. Dietary fat has lower SDA than other macronutrients. Here we tested the effects of graded dietary fat levels on lactating Swiss mice. We fed females five diets varying in fat content from 8.3 to 66.6%. Offspring of mothers fed diets of 41.7% fat and above were heavier and fatter at weaning compared with those of 8.3 and 25% fat diets. Mice on dietary fat contents of 41.7% and above had greater metabolizable energy intake at peak lactation (8.3%: 229.4±39.6; 25%: 278.8±25.8; 41.7%: 359.6±51.5; 58.3%: 353.7±43.6; 66.6%: 346±44.7 kJ day-1), lower daily energy expenditure (8.3%: 128.5±16; 25%: 131.6±8.4; 41.7%: 124.4±10.8; 58.3%: 115.1±10.5; 66.6%: 111.2±11.5 kJ day-1) and thus delivered more milk energy to their offspring (8.3%: 100.8±27.3; 25%: 147.2±25.1; 41.7%: 225.1±49.6; 58.3%: 238.6±40.1; 66.6%: 234.8±41.1 kJ day-1). Milk fat content (%) was unrelated to dietary fat content, indicating that females on higher fat diets (>41.7%) produced more rather than richer milk. Mothers consuming diets with 41.7% fat or above enhanced their lactation performance compared with those on 25% or less, probably by diverting dietary fat directly into the milk, thereby avoiding the costs of lipogenesis. At dietary fat contents above 41.7% they were either unable to transfer more dietary fat to the milk, or they chose not to do so, potentially because of a lack of benefit to the offspring that were increasingly fatter as maternal dietary fat increased.

Limits to sustained energy intake. XXX. Constraint or restraint? Manipulations of food supply show peak food intake in lactation is constrained

Lactating mice increase food intake 4- to 5-fold, reaching an asymptote in late lactation. A key question is whether this asymptote reflects a physiological constraint, or a maternal investment strategy (a 'restraint'). We exposed lactating mice to periods of food restriction, hypothesizing that if the limit reflected restraint, they would compensate by breaching the asymptote when refeeding. In contrast, if it was a constraint, they would by definition be unable to increase their intake on refeeding days. Using isotope methods, we found that during food restriction, the females shut down milk production, impacting offspring growth. During refeeding, food intake and milk production rose again, but not significantly above unrestricted controls. These data provide strong evidence that asymptotic intake in lactation reflects a physiological/physical constraint, rather than restraint. Because hypothalamic neuropeptide Y (Npy) was upregulated under both states of restriction, this suggests the constraint is not imposed by limits in the capacity to upregulate hunger signalling (the saturated neural capacity hypothesis). Understanding the genetic basis of the constraint will be a key future goal and will provide us additional information on the nature of the constraining factors on reproductive output, and their potential links to life history strategies.

n-3 polyunsaturated fatty acids as modulators of thermogenesis in Ames dwarf mice

Lipids, commonly split into saturated and mono- and polyunsaturated fatty acids, are key constituents of all biological membranes, and their exact proportions in different tissues were previously shown to be related to lifespan in mammals. As a mechanism, it was put forward that long-chain and highly unsaturated n-3 fatty acids may act as "pacemakers" in membranes while the n-6 fatty acid class may act as a counterbalance. Previously, long-lived Ames dwarf mice (Prop1 df/df) were found to have lower n-3 fatty acids and higher n-6 throughout their tissues. We exposed 32 adult (8 months old) Ames dwarf mice to three isocaloric diets differing in their fatty acid composition (saturated vs. rich in n-3 and n-6) for 2 months while measuring their body masses, subcutaneous body temperatures and finally membrane fatty acid profiles. Prominently, we found that individuals from all three groups quickly increased their body masses by ca. 20% and had 0.45 °C higher subcutaneous body temperatures than at baseline (F_1,12,16 = 22.27; p < 0.001). Conceivably, experimental diets also largely reflected lipid composition found in the tissues with over 50% n-3 fatty acids in heart phospholipids from animals from the n-3-enriched feeding group. Our study indicates that fatty acid-enriched diets well affected body mass, subcutaneous body temperature and membrane fatty acid composition in Ames dwarf mice with no visible adverse effects on their health. Experimental feeding increased subcutaneous body fat and insulation, most likely explaining the higher subcutaneous temperatures.

The insulin-like growth factor-1 system in the adult mammalian brain and its implications in central maternal adaptation

Our knowledge on the bioavailability and actions of insulin-like growth factor-1 (IGF-1) has markedly expanded in recent years as novel mechanisms were discovered on IGF binding proteins (IGFBPs) and their ability to release IGF-1. The new discoveries allowed a better understanding of the endogenous physiological actions of IGF-1 and also its applicability in therapeutics. The focus of the present review is to summarize novel findings on the neuronal, neuroendocrine and neuroplastic actions of IGF-1 in the adult brain. As most of the new regulatory mechanisms were described in the periphery, their implications on brain IGF system will also be covered. In addition, novel findings on the effects of IGF-1 on lactation and maternal behavior are described. Based on the enormous neuroplastic changes related to the peripartum period, IGF-1 has great but largely unexplored potential in maternal adaptation of the brain, which is highlighted in the present review.

Thalamic integration of social stimuli regulating parental behavior and the oxytocin system

Critically important components of the maternal neural circuit in the preoptic area robustly activated by suckling were recently identified. In turn, suckling also contributes to hormonal adaptations to motherhood, which includes oxytocin release and consequent milk ejection. Other reproductive or social stimuli can also trigger the release of oxytocin centrally, influencing parental or social behaviors. However, the neuronal pathways that transfer suckling and other somatosensory stimuli to the preoptic area and oxytocin neurons have been poorly characterized. Recently, a relay center of suckling was determined and characterized in the posterior intralaminar complex of the thalamus (PIL). Its neurons containing tuberoinfundibular peptide 39 project to both the preoptic area and oxytocin neurons in the hypothalamus. The present review argues that the PIL is a major relay nucleus conveying somatosensory information supporting maternal behavior and oxytocin release in mothers, and may be involved more generally in social cue evoked oxytocin release, too.

Limits to sustained energy intake XXIX: the case of the golden hamster (Mesocricetus auratus)

Golden hamster females have the shortest known gestation period among placental mammals and at the same time raise very large litters of up to 16 offspring, which are born in a naked and blind state and are able to pick up food from days 12-14 only. We quantified energy metabolism and milk production in female golden hamsters raising offspring under cold (8°C), normal (22°C) and hot (30°C) ambient temperature conditions. We monitored energy intake, subcutaneous body temperature, daily energy expenditure, litter size and pup masses over the course of lactation. Our results show that, in line with the concept of heat dissipation limitation, female golden hamsters had the largest energy intake under the coldest conditions and a significantly lower intake at 30° (partial for influence of ambient temperature: F2,403=5.6; p= 0.004). Metabolisable energy intake as well as milk energy output showed the same pattern and were significantly different between the temperatures (partial for milk energy production: F1,40= 86.4; p&lt;0.0001). With consistently higher subcutaneous temperatures in the reproductive females (F1,813= 36.77; p&lt;0.0001) compared to baseline females. These data suggest that raising offspring in golden hamsters comes at the cost of producing large amounts of body heat up to a level constraining energy intake, similar to that observed in some laboratory mice. Notably, we observed that females seemed to adjust litter size according to their milk production with the smallest litters (3.4±0.7 pups) being raised by hot exposed mothers. Future research is needed to unravel the mechanism by which females assess their own milk production capabilities and how this may be linked to litter size at different ambient temperatures. Golden hamsters reach 8-10 times resting metabolic rate (RMR) when raising offspring under cold conditions, which is compatible with the findings from laboratory mice and other rodents.

Stressed out: providing laboratory animals with behavioral control to reduce the physiological effects of stress

Laboratory animals experience a large amount of environmental stress. An animal's environment can include both physiological and social stressors that may require an animal to adapt to maintain allostatic balance. For example, thermal stress can lead to changes in behavior, reproduction and immune function, which has been detrimental to cancer modeling in mice. Chronic uncontrollable stress is widely acknowledged for its negative alterations to physiology. However, there is a lack in the understanding of how the laboratory environment affects animal physiology and behavior, particularly as it relates to characteristics of the human disease being modeled. Given the evidence on how stressors affect physiology, it is clear that efforts to model human physiology in animal models must consider animal stress as a confounding factor. We present evidence illustrating that providing captive animals with control or predictability is the best way to reduce the negative physiological effects of these difficult-to-manage stressors.

Sustained energy intake in lactating Swiss mice: a dual modulation process

Limits to sustained energy intake (SusEI) during lactation are important because they provide an upper boundary below which females must trade-off competing physiological activities. To date, SusEI is thought to be limited either by the capacity of the mammary glands to produce milk (the peripheral limitation hypothesis), or by a female's ability to dissipate body heat (the heat dissipation hypothesis). In the present study, we examined the effects of litter size and ambient temperature on a set of physiological, behavioral, and morphological indicators of SusEI and reproductive performance in lactating Swiss mice. Our results indicate that energy input, output, and mammary gland mass increased with litter size, whereas pup body mass and survival rate decreased. The body temperature increased significantly, while food intake (18g/d at 21°C vs 10g/d at 30°C), thermal conductance (lower by 20-27% at 30°C than 21°C), litter mass and MEO decreased significantly in the females raising large litter size at 30°C compared to those at 21°C. Furthermore, an interaction between ambient temperature and litter size affected females' energy budget, imposing strong constraints on SusEI. Together, out data suggest that the limitation may be caused by both mammary glands and heat dissipation, i.e. the limits to mammary gland is dominant at the room temperature, but heat limitation is more significant at warm temperatures. Further, the level of heat dissipation limits may be temperature dependent, shifting down with increasing temperature.

Limits to sustained energy intake XXV: milk energy output and thermogenesis in Swiss mice lactating at thermoneutrality

Previous studies at 21 °C and 5 °C suggest that in Swiss mice sustained energy intake (SusEI) and reproductive performance are constrained by the mammary capacity to produce milk. We aimed to establish if this constraint also applied at higher ambient temperature (30 °C). Female Swiss mice lactating at 30 °C had lower asymptotic food intake and weaned lighter litters than those at 21 °C. Resting metabolic rate, daily energy expenditure, milk energy output and suckling time were all lower at 30 °C. In a second experiment we gave mice at 30 °C either 6 or 9 pups to raise. Female performance was independent of litter size, indicating that it is probably not controlled by pup demands. In a third experiment we exposed only the mother, or only the offspring to the elevated temperature. In this case the performance of the mother was only reduced when she was exposed, and not when her pups were exposed, showing that the high temperature directly constrains female performance. These data suggest that at 30 °C SusEI and reproductive performance are likely constrained by the capacity of females to dissipate body heat, and not indirectly via pup demands. Constraints seem to change with ambient temperature in this strain of mouse.