Aware of the important benefits of human milk, most U.S. women initiate breastfeeding but difficulties with milk supply lead some to quit earlier than intended. Yet, the contribution of maternal physiology to lactation difficulties remains poorly understood. Human milk fat globules, by enveloping cell contents during their secretion into milk, are a rich source of mammary cell RNA. Here, we pair this non-invasive mRNA source with RNA-sequencing to probe the milk fat layer transcriptome during three stages of lactation: colostral, transitional, and mature milk production. The resulting transcriptomes paint an exquisite portrait of human lactation. The resulting transcriptional profiles cluster not by postpartum day, but by milk Na:K ratio, indicating that women sampled during similar postpartum time frames could be at markedly different stages of gene expression. Each stage of lactation is characterized by a dynamic range (105-fold) in transcript abundances not previously observed with microarray technology. We discovered that transcripts for isoferritins and cathepsins are strikingly abundant during colostrum production, highlighting the potential importance of these proteins for neonatal health. Two transcripts, encoding β-casein (CSN2) and α-lactalbumin (LALBA), make up 45% of the total pool of mRNA in mature lactation. Genes significantly expressed across all stages of lactation are associated with making, modifying, transporting, and packaging milk proteins. Stage-specific transcripts are associated with immune defense during the colostral stage, up-regulation of the machinery needed for milk protein synthesis during the transitional stage, and the production of lipids during mature lactation. We observed strong modulation of key genes involved in lactose synthesis and insulin signaling. In particular, protein tyrosine phosphatase, receptor type, F (PTPRF) may serve as a biomarker linking insulin resistance with insufficient milk supply. This study provides the methodology and reference data set to enable future targeted research on the physiological contributors of sub-optimal lactation in humans.

Foreword I n July 2019, a panel of wound care experts, educators and researchers met in the UK to review the literature on medical adhesive-related skin injury and discuss best practice for its assessment and prevention. e two-day meeting resulted in this consensus document, which is intended for anyone who uses adhesive medical devices. e document aims to raise awareness of the widespread occurrence of medical adhesive-related skin injury and the burden it imposes on patients, health professionals and the health service. It seeks to encourage a change in culture, whereby risk assessment and prevention of medical adhesive-related skin injury are considered an integral part of patient care. e document, therefore, provides recommendations for the assessment and prevention of this type of injury, with a view to standardising care across all healthcare settings. It also highlights the need for education on this form of skin damage, which needs to become a core topic in skin care and wound management. Until this happens, there is scope for multidisciplinary teams to provide local training on this subject. In the light of the panel's concern that many health professionals are not only unaware of this avoidable harm but also its abbreviation, MARSI, the term is written in full throughout the document. e panel hopes that implementation of the guidance in this document will reduce avoidable patient su ering and promote better outcomes. Sian Fumarola, Senior Clinical Nurse Specialist, Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust, UK Overview of medical adhesive-related skin injury  'Medical adhesive-related skin injury' is a term used to defi ne any skin damage related to the use of medical adhesive products or devices such as tapes, wound dressings, stoma products, electrodes, medication patches and wound closure strips. This type of injury is largely avoidable

BackgroundAmniotic fluid (AF) is a proximal fluid to the fetus containing higher amounts of cell-free fetal RNA/DNA than maternal serum, thereby making it a promising source for identifying novel biomarkers that predict fetal development and organ maturation. Our aim was to compare AF transcriptomic profiles at different time points in pregnancy to demonstrate unique genetic signatures that would serve as potential biomarkers indicative of fetal maturation.MethodsWe isolated AF RNA from 16 women at different time points in pregnancy: 4 from 18 to 24 weeks, 6 from 34 to 36 weeks, and 6 from 39 to 40 weeks. RNA-sequencing was performed on cell-free RNA. Gene expression and splicing analyses were performed in conjunction with cell-type and pathway predictions.ResultsSample-level analysis at different time points in pregnancy demonstrated a strong correlation with cell types found in the intrauterine environment and fetal respiratory, digestive and external barrier tissues of the fetus, using high-confidence cellular molecular markers. While some RNAs and splice variants were present throughout pregnancy, many transcripts were uniquely expressed at different time points in pregnancy and associated with distinct neonatal co-morbidities (respiratory distress and gavage feeding), indicating fetal immaturity.ConclusionThe AF transcriptome exhibits unique cell/organ-selective expression patterns at different time points in pregnancy that can potentially identify fetal organ maturity and predict neonatal morbidity. Developing novel biomarkers indicative of the maturation of multiple organ systems can improve upon our current methods of fetal maturity testing which focus solely on the lung, and will better inform obstetrical decisions regarding delivery timing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12920-015-0138-5) contains supplementary material, which is available to authorized users.

A survey was undertaken at a recent large wound-care exhibition, aimed at generalist nurses, podiatrists and other allied health professionals, to ascertain delegates' understanding of wound infection and its treatment options. The sample comprised 116 delegates, although not all of them answered every question. Results showed good knowledge in some areas, with most (90%) correctly identifying the symptoms of localised wound infection and the characteristics of an infected wound (97%). However, the results did reveal some alarming gaps in knowledge, with 64% unable to identify that it is the inability of the host to mount a robust immune response that can tip the balance between colonisation and infection. Similarly, over a third (38%) incorrectly considered that wounds should always be cleansed, regardless of the wound characteristics, while 5% stated that antimicrobial dressings should be used continuously until epithelialisation occurs. The results suggest that there is still a worrying trend for ritualistic wound care and that more ongoing education is needed on the core aspects of wound management.

Chronic wound management remains challenging in clinical practice, especially in the presence of bacterial bioburden and slough. To resolve these clinical challenges, it is essential clinicians implement the TIME framework (tissue, inflammation/infection, moisture, edge of wound) as a model of effective wound bed preparation. As a result of advances in technology and wound care therapies, on the market today are products that can help reduce the wound bed clinical challenges recommended by the TIME framework. This article looks at a wound cleansing solution that reduces the wound bed bioburden by breaking down biofilms and debriding slough.