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The aim of this randomized, double-blind, controlled trial was to examine the effects of infant formula on the growth, stool consistency, and bone strength of infants ( n  = 120) over a period of 4 months. The investigational group was fed an A2 β-casein cow's milk infant formula containing casein phosphopeptides (CPP) and high sn-2 palmitate (54% of total palmitate at sn-2). The control group was fed a standard cow's milk formula without CPP and with low sn-2 palmitate (29% of total palmitate at sn-2). The third group was fed human milk (HM) ( n  = 60). All three groups had similar baseline characteristics, and maintained similar BMI, sleep habits, and growth rates in body weight and length throughout the study. However, compared to the control group, infants in the investigational and human milk groups had significantly: (i) greater body length at 90, 120, and 150 days of age; (ii) greater growth rate in head circumference from 30 to 60 days of age, with larger head circumference at 60 days of age; (iii) larger daily stool frequency at 60, 90, and 120 days of age; (iv) softer stool at 60, 90, and 120 days of age; (v) higher bone quality index and bone speed of sound at 150 days of age; (vi) fewer hours of crying at 60 and 90 days of age; (vii) less abdominal distention, burp, and flatus at 60, 90, and 120 days of age; and (viii) less constipation at 90 days of age. At other time points, no significant differences were observed between the three groups. No serious adverse events (AEs) related to the study products were reported, and significantly fewer infants in the investigational and HM groups experienced at least one AE compared to the control group. The study suggests that the A2 β-casein formula with high sn-2 palmitate and CPP supports adequate growth, is well tolerated, and may have beneficial effects on stool consistency, gastrointestinal comfort, crying duration, and bone density, comparable to HM. Clinical trial registration: https://clinicaltrials.gov/, NCT04749290., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sheng, Mi, Yuan, Liu, Carnielli, Ning and Einerhand.)

Wastewater treatment plants (WWTPs) are important hotspots for the spread of antibiotic resistance. However, the release and impact factors of both antibiotic resistant bacteria and the relevant genes over long periods in WWTPs have rarely been investigated. In this study, the fate of bacteria and genes resistant to six commonly used antibiotics was assessed over a whole year. In WWTP effluent and biosolids, a high prevalence of heterotrophic bacteria resistant to vancomycin, cephalexin, sulfadiazine and erythromycin were detected, each with a proportion of over 30%. The corresponding genes (vanA, ampC, sulI and ereA) were all detected in proportions of (2.2 ± 0.8) × 10(-10), (6.2 ± 3.2) × 10(-9), (1.2 ± 0.8) × 10(-7) and (7.6 ± 4.8) × 10(-8), respectively, in the effluent. The sampling season imposed considerable influence on the release of all ARB. High release loads of most ARB were detected in the spring, while low release loads were generally found in the winter. In comparison, the ARG loads changed only slightly over various seasons. No statistical relevance was found between all ARB abundances and their corresponding genes over the long-term investigation period. This inconsistent behavior indicates that bacteria and genes should both be considered when exploring resistance characteristics in wastewater. A redundancy analysis was adopted to assess the impact of wastewater quality and operational conditions on antibiotic resistance. The results indicated that most ARB and ARG proportions were positively related to the COD and turbidity of the raw sewage, while negatively related to those of the effluent. DO and temperature exhibited strong negative relevance to most ARB prevalence.