LC/MS-based untargeted lipidomics reveals lipid signatures of nonpuerperal mastitis.

BACKGROUND: Nonpuerperal mastitis (NPM) is a disease that presents with redness, swelling, heat, and pain during nonlactation and can often be confused with breast cancer. The etiology of NPM remains elusive; however, emerging clinical evidence suggests a potential involvement of lipid metabolism. METHOD: Liquid chromatography‒mass spectrometry (LC/MS)-based untargeted lipidomics analysis combined with multivariate statistics was performed to investigate the NPM lipid change in breast tissue. Twenty patients with NPM and 10 controls were enrolled in this study. RESULTS: The results revealed significant differences in lipidomics profiles, and a total of 16 subclasses with 14,012 different lipids were identified in positive and negative ion modes. Among these lipids, triglycerides (TGs), phosphatidylethanolamines (PEs) and cardiolipins (CLs) were the top three lipid components between the NPM and control groups. Subsequently, a total of 35 lipids were subjected to screening as potential biomarkers, and the chosen lipid biomarkers exhibited enhanced discriminatory capability between the two groups. Furthermore, pathway analysis elucidated that the aforementioned alterations in lipids were primarily associated with the arachidonic acid metabolic pathway. The correlation between distinct lipid populations and clinical phenotypes was assessed through weighted gene coexpression network analysis (WGCNA). CONCLUSIONS: This study demonstrates that untargeted lipidomics assays conducted on breast tissue samples from patients with NPM exhibit noteworthy alterations in lipidomes. The findings of this study highlight the substantial involvement of arachidonic acid metabolism in lipid metabolism within the context of NPM. Consequently, this study offers valuable insights that can contribute to a more comprehensive comprehension of NPM in subsequent investigations. TRIAL REGISTRATION: Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Number: 2019-702-57; Date: July 2019).

Multilocus sequence analysis reveals genetic diversity in Staphylococcus aureus isolate of goat with mastitis persistent after treatment with enrofloxacin.

Staphylococcus aureus is one of the main bacterial agents responsible for cases of mastitis in ruminants, playing an important role in the persistence and chronicity of diseases treated with antimicrobials. Using the multilocus sequence typing technique, network approaches and study of the population diversity of microorganisms, we performed analyzes of S. aureus (ES-GPM) isolated from goats with persistent mastitis (GPM). The most strains of ES-GPM were categorically different phylogenetically from the others and could be divided into two lineages: one with a majority belonging to ES-GPM and the other to varied strains. These two lineages were separated by 27 nuclear polymorphisms. The 43 strains comprised 22 clonal complexes (CCs), of which the ES-GPM strains were present in CC133, CC5 and a new complex formed by the sequence type 4966. The genetic diversity of some alleles showed be greater diversity and polymorphism than others, such as of the aroE and yqiL genes less than glpF gene. In addition, the sequences ES-GPM to the arc gene and glpF alleles showed the greatest number of mutations for ES-GPM in relation to non-ES-GPM. Therefore, this study identified genetic polymorphisms characteristic of S. aureus isolated from milk of goats diagnosed with persistent mastitis after the failed treatment with the antibiotic enrofloxacin. This study may help in the future to identify and discriminate this agent in cases of mastitis, and with that, the most appropriate antibiotic treatment can be performed in advance of the appearance of persistent mastitis caused by the agent, reducing the chances of premature culling and animal suffering.

Alkaline phosphatase activity in human colostrum as a valuable predictive biomarker for lactational mastitis in nursing mothers.

AIMS: Biochemical investigations have shown that an indigenous milk enzyme - alkaline phosphatase (ALP) - which is detectable in the lactocytes, plays a very important diagnostic role in clinical medicine, since its activity varies in different tissues and serves as a specific indicator of disease states. The purpose of this study was to evaluate ALP activity in human colostrum as a possible early predictive biomarker for lactational mastitis in nursing mothers. PATIENTS & METHODS: During a period from May to July 2010, a total of 60 healthy nursing mothers were recruited for this study. RESULTS: The mean level of colostrum ALP activity from the affected breasts was significantly higher when compared with ALP activity from the contralateral asymptomatic as well as 'healthy' breasts (p < 0.01). CONCLUSION: Determining ALP activity in colostrum could be a valuable biochemical marker for an early prediction of mastitis in nursing mothers.

Red breast as a presenting complaint at a breast center: an institutional review.

BACKGROUND: The differential diagnosis of a red breast is extensive and includes both benign and malignant diseases. The literature documents patients who present with a red breast with delays in diagnosis of inflammatory cancer. We recorded our institutional experience prospectively in the evaluation, diagnosis, and treatment of a red breast. METHODS: Data were collected prospectively on patients who presented with a red breast during a 14-month period. A retrospective review of final diagnosis and outcome was then conducted. A PubMed and Ovid Medline literature search were performed. RESULTS: Twenty-two patients presented with a red breast. This number accounted for only 0.6% (22/3,762) of patients evaluated in our breast center during this time period. Final diagnoses were as follows: mastitis in 31.8%, breast abscess in 13.6%, erythematous changes secondary to radiation therapy in 13.6%, cellulitis in 9.1%, and venous hypertension in 9.1%. Other diagnoses included postradiation morphea, benign dermatologic inflammation, Paget disease of the breast, inflammatory breast cancer, and psoriasis (1 patient each). After treatment, 67% (17/22) patients had resolution of their symptoms and 18% (4/22) were improved. Only 1 (4.5%) of 22 patients had a change in diagnosis in a median follow-up of 8.8 months. CONCLUSION: A red breast is an uncommon presenting complaint in patients evaluated at a breast center; however, the differential diagnosis is extensive. With appropriate diagnosis and treatment, most patients will have improvement or resolution of their symptoms. The diagnostic algorithm used by our breast center identified the cause of the red breast correctly in >95% of patients at presentation, and it can serve as a guide to evaluate patients with a red breast. This algorithm is in agreement with National Comprehensive Cancer Network guidelines.

Vitamin supplementation increases risk of subclinical mastitis in HIV-infected women.

Subclinical mastitis is common in HIV-infected women and is a risk factor for mother-to-child transmission of HIV. The purpose of this study was to examine the effect of vitamin supplementation [vitamin A + ß-carotene, multivitamins (B complex, C, and E), or multivitamins, including vitamin A + ß-carotene] on the risk of subclinical mastitis during the first 2 y postpartum among HIV-infected women. The study was a randomized, placebo-controlled, clinical trial including 674 HIV-infected, antiretroviral naïve Tanzanian women who were recruited during pregnancy and followed-up after delivery. Breast milk samples were obtained approximately every 3 mo. Any subclinical mastitis was defined as a ratio of the sodium to potassium (Na:K) breast milk concentrations > 0.6 and further classified as either moderate (Na:K ≥ 0.6 and ≤ 1) or severe (Na:K > 1.0). Fifty-eight percent of women had at least 1 episode of any subclinical mastitis. Women assigned to multivitamins (B complex, C, and E) had a 33% greater risk of any subclinical mastitis (P = 0.005) and a 75% greater risk of severe subclinical mastitis (P = 0.0006) than women who received the placebo. Vitamin A + ß-carotene also increased the risk of severe subclinical mastitis by 45% (P = 0.03). Among women with CD4+ T-cell counts ≥ 350 cells/µL, multivitamin intake resulted in a 49% increased risk of any subclinical mastitis (P = 0.006); by contrast, there were no treatment effects among women with CD4+ T-cell counts < 350 cells/µL (P- interaction for treatment × CD4+ T-cell count = 0.10). Supplementation of HIV-infected women with vitamins increased the risk of subclinical mastitis.

Subclinical mastitis may not reduce breastmilk intake during established lactation.

OBJECTIVE: This study determined the effect of subclinical mastitis (SCM) on infant breastmilk intake. DESIGN: Participants (60 Ghanaian lactating mothers and their infants) were from periurban communities in the Manya Krobo district of Ghana in 2006-2007. Bilateral breastmilk samples were obtained once between months 3 and 6 postpartum and tested for SCM using the California mastitis test (CMT) and the sodium/potassium (Na/K) ratio. Infants' 12-hour breastmilk intake was assessed by test weighing. CMT scoring for SCM diagnosis was scaled as >or=1 = positive (n = 37) and <1 = negative (n = 23). SCM diagnosis was confirmed as a Na/K ratio of >1.0 (n = 14). RESULTS: Breastmilk intake was nonsignificantly lower among infants whose mothers had elevated Na/K ratios of >1.0 (-65.1 g; 95% confidence interval -141.3 g, 11.1 g). Infants whose mothers were positive for SCM with both CMT and Na/K ratio criteria had significantly lower breastmilk intake (-88.9 g; 95% confidence interval -171.1 g, -6.9 g) compared to those whose mothers tested either negative with both tests or positive on only one. Infant weight (p < 0.01) and frequency of feeding (p = 0.01) were independently associated with breastmilk intake. However, the effect of SCM on breastmilk intake disappeared when infant weight and feeding frequency were included in a multiple linear regression model. CONCLUSIONS: The results of this study did not show an effect of SCM on breastmilk intake among 3-6-month-old infants. A larger sample size with a longitudinal design will be needed in future studies.

Approach to inflammatory breast cancer.

OBJECTIVE: To review the definition, clinical presentation, and management of inflammatory breast cancer in primary care. SOURCES OF INFORMATION: Relevant research and review articles, as well as personal experience of the authors practising in a specialized locally advanced breast cancer program at a comprehensive cancer centre. Evidence is levels II and III. MAIN MESSAGE: Inflammatory breast cancer is a rare disease that typically presents with a rapidly enlarging erythematous breast, often with no discernable breast mass. Identification of warning signs and recognition of clinical symptoms are crucial to prompt diagnosis and appropriate referral. Management in the primary care setting includes treatment of symptoms, psychosocial support, regular surveillance and follow-up, as well as palliative care. CONCLUSION: Family physicians are usually the entry point to the health care system and are well positioned to assess inflammation of the breast and recognize the warning signs of an underlying inflammatory breast cancer. They are also important members of the team that provides support for breast cancer patients and their families during treatment, follow-up, and end-of-life care.

Assessment of the mammary system.

Assessing the health status of the mammary gland is a complex and often perplexing endeavor. One must use all of the faculties available to come up with an accurate diagnosis. A detailed history of the individual and the herd or flock plus a thorough physical examination that includes specific attention paid to the mammary gland are essential. One cannot overlook these basic tenets in favor of more sophisticated means of evaluation such as somatic cell counts and milk microbiology. A holistic approach to mastitis diagnosis, treatment, and, most importantly, control is necessary.

[Importance of the indices of immunity for predicting the course and assessing the effectiveness of the treatment in acute suppurative lactation mastitis]. / Znachenie pokazatelei immuniteta dlia prognozirovaniia techeniia i otsenki éffektivnosti lecheniia ostrogo gnoinogo laktatsionnogo mastita.

The examination of 47 patients with acute purulent lactation mastitis and 14 patients with the resulting sepsis has shown a decreased level of nonspecific resistance factors. Generalization of the purulent process is characterized by disturbed humoral and cellular links of immunity. The dynamic research of immunity factors can give an estimation of the effectiveness of the chosen treatment and prognosis of possible complications. The general bactericidal activity of blood may be considered one of the most informative indices showing the direction of the process.

[Therapeutic aspects of coli mastitis in ruminants]. / Niakoi terapevtichni aspekti pri koli-mastitite u prezhivnite.

Cows with coliform mastitis showed, in addition to fever, tachycardia and ruminal stasis and a concatenation of nonspecific responses, such as neutrophylic leukopenia followed by leukocytosis, lymphopenia, hypocalcaemia, hypoferraemia, hypozincaemia, and hypercupremia, and changes in the concentration of certain serum proteins. Similar responses occurred in cows and goats when mastitis was induced by an E. coli endotoxin or following the i/v injection of such endotoxin. Research suggested that in cows with clinical mastitis the symptoms of a generalized disease were predominantly the result of the release of phagocyte endogenous proteins at the site of inflammation in the mammary gland. Another inflammatory protein was the leukocytic endothelial mediator which changed the plasma concentrations of trace elements. Local treatment with the rather toxic antibiotic, polymyxin B, blocked the effect of the endotoxin administered via the udder on plasma Zn and Fe values. Therefore, local treatment with this drug seemed to be indicated with cows having E. coli mastitis. Based on pharmacokinetic behaviour parenteral treatment of such cows with trimethoprim or chloramphenicol appeared to be interest. Furthermore fluboprofen, a nonsteroid antiinflammatory agent was shown to possess a beneficial effect in cows with experimental E. coli mastitis.