Fecal microbiome transplant from patients with lactation mastitis promotes mastitis in conventional lactating mice.

Introduction: Lactation mastitis seriously severely affects the health of lactating females and their infants, yet the underlying causes of clinical lactation mastitis remain unclear. Methods: In this study, we used microbiota-humanized mice as a model to investigate the role of gut microbiota in lactation mastitis. We compared the fecal microbiota of lactation mastitis patients and healthy individuals and conducted fecal microbiota transplantation (FMT) experiments in an antibiotic-pretreated mouse model to test whether gut microbes contribute to human lactation mastitis. Results: Our results showed that gut microbiota diversity was reduced and dysbiosis was present in lactating mastitis patients. FMT from lactation mastitis patients (M-FMT), but not from healthy individuals (H-FMT), to antibiotic-treated mice resulted in lactation mastitis. The inflammation in mice caused by gut microbiota from lactating mastitis patients appears to be pervasive, as hepatocytes from mice that received feces from lactating mastitis patients showed marked swelling. In addition, serum pro-inflammatory factors, including IL-4, IL-17, MPO, IL-6, IL-1ß, and TNF-α, were significantly increased in the M-FMT group. The Firmicutes/Bacteroidetes ratio (F/B), a biomarker of gut dysbiosis, was significantly increased in the M-FMT group. At the phylum level, Actinobacteria were significantly increased, and Verrucomicrobia were significantly decreased in the M-FMT group. At the genus level, Ruminococcus and Faecalibacterium were significantly reduced, while Parabacteroides were significantly increased in the feces of both patients with lactation mastitis and M-FMT mice. Moreover, our study revealed an "amplification effect" on microbiota differences and mastitis disease following human-to-mouse FMT. Conclusion: Collectively, our findings demonstrate that the gut microbiota in lactating mastitis patients is dysbiotic and contributes to the pathogenesis of mastitis.

Network pharmacology and in vivo and in vitro experiments to determine the mechanism behind the effects of Jiawei Yanghe decoction via TLR4/Myd88/NF-κB against mastitis.

Background: In the Qing dynasty, Yanghe decoction was as a therapeutic soup for effectively treating chronic inflammatory disorders. It was used as a therapeutic soup for effectively treating chronic inflammatory disorders. In the clinical use of Yanghe decoction, the adjustment of the medication for a variety of inflammatory diseases have therapeutic effect, including mastitis. Therefore, Jiawei Yanghe decoction (JWYHD) may be used to treat inflammatory breast diseases. Methods: First, LM- and JWYHD-related components were retrieved from the database and analysis platform. Next, protein-protein interaction networks were constructed to screen the key targets, and gene ontology and Kyoto encyclopedia of gene and genome enrichment analyses were performed to predict the potential biological functions and mechanisms of JWYHD. Simultaneously, the JWYHD samples were collected and analyzed by UPLC-HRMS. Finally, in vivo and in vitro experiments were conducted to construct animal and cellular inflammation models of mastitis with LPS. Pathological changes in the mammary tissues were detected. Enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, and Western blotting was performed to determine the mRNA and protein levels of inflammatory cytokines and toll-like receptor 4/myeloid differentiation primary response 88/nuclear factor kappa B signaling pathway in the breast tissues to elucidate the potential underlying mechanisms of anti-mastitis effects of JWYHD from different aspects. Results: In total, 103 compounds were detected in JWYHD by UPLC-HRMS. 691 active ingredients of JWYHD were screened by network pharmacology, and 47 LM-related targets were identified. The PPI network analysis of the targets revealed the 5 core targets. The KEGG enrichment results established the NF-κB signaling pathways as the core. After JWYHD intervention, low inflammatory enrichment and mild inflammatory damage in breast tissues were observed. Furthermore, JWYHD treatment affected mammary gland inflammatory cytokines and the TLR4/Myd88/NF-κB signaling pathway by considerably reducing the respective protein levels and gene expression; thus, JWYHD alleviated LM symptoms. Conclusions: We hypothesized and demonstrated the anti-inflammatory effects of JWYHD by cytokine regulation via the TLR4/Myd88/NF-κB signaling pathway. In conclusion, JWYHD showed its potential in LM treatment and in treating other acute and chronic inflammatory diseases.

Lactation mastitis: Promising alternative indicators for early diagnosis.

Although lactation mastitis (LM) has been extensively researched, the incidence rate of LM remains a salient clinical problem. To reduce this incidence rate and achieve a better prognosis, early and specific quantitative indicators are particularly important. It has been found that milk electrolyte concentrations (chloride, potassium, and sodium) and electrical conductivity (EC) significantly change in the early stages of LM in an animal model. Several studies have evaluated EC for the detection of subclinical mastitis in cows. EC, chloride, and sodium content of milk were more accurate for predicting infection status than were other variables. In the early stages of LM, lactic sodium, chloride, and EC increase, but potassium decreases. However, these indicators have not been reported in the diagnosis of LM in humans. This review summarizes the pathogenesis and the mechanism of LM in terms of milk electrolyte concentration and EC, and aim to provide new ideas for the detection of sub-clinical mastitis in humans.

Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women.

BACKGROUND: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. METHODS: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015-May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th-28th gestation week, (b) 34th-38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. RESULTS: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. CONCLUSIONS: The association between women's poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

Maternal Risk Factors for Lactation Mastitis: A Meta-analysis.

This meta-analysis was conducted to identify maternal risk factors for lactational mastitis. Studies published in English or Chinese were retrieved from Medline (PubMed), Embase, Cochrane Library, Web of Science, CNKI, WANFANG, and VIP databases according to predefined inclusion and exclusion criteria. Study quality was assessed by the Newcastle-Ottawa Scale. A random-effects model was used for data pooling and I2 tests to assess study heterogeneity. Pooled data from 8 cohorts and 10 case-control studies identified previous mastitis during breastfeeding (P<0.00001), cesarean section (P=0.001), breast trauma (P<0.001), anemia (P=0.0001), latch problems ≤ 8 weeks post-delivery (P=0.003), milk overproduction (P=0.002), blocked duct (P<0.0001), cracked nipple (especially ≤ 4 weeks post-delivery) (P=0.0001), use of nipple shields (P<0.00001), nipple cream (P<0.0001), brassieres (P<0.0001), and breast pumps (P<0.00001), and breastfeed duration > 30 min (P=0.008) as significant risk factors. Washing nipples before breastfeeding decreased lactational mastitis risk. Identification of these risk factors may facilitate the development of nursing care protocols for reducing lactational mastitis.

Endogenous endophthalmitis due to Staphylococcus aureus in a lactating woman.

Endogenous endophthalmitis (EE) is a rare but fulminant intraocular infection that needs prompt recognition and management. Bacteria are the commonest causative organisms and they may colonize the eye secondary to hematogenous spread from a focus anywhere in the body. EE in the peripartum period is an infrequent occurrence with no cases reported to occur secondary to a peurperal mastitis. We report a case of EE due to Staphylococcus aureous in a lactating female and describe its clinical presentation and management.

Retrospective stuclies on lactation mastitis distribution in breast / 中华内分泌外科杂志

Objective To find out the factors which would be likely to affect the occurrence of lactation mastitis.Methods 216 patients with lactation mastitis,who met our grouping criteria,were chosen for survey and clinical data collection.Their age,time of onset,mode of delivery,post-partum colostrum time,mastering of breast-feeding skills,feeding habits,occurring site of their mastitis and other data were input into SPSS 17.0 software,respectively,to perform retrospective analysis.Results Patients' average age and their age of first breast-feeding were all 30 years old ; the average age of their first pregnancy were 27 years old.Their initial post-natal breast-feeding was about 2 to 4 days.The onset of incidence of mastitis was about 28 days post-natal.First,second and third pregnancy patients represented 1/3 of the total patients respectively.63.4％ patients had cesarean delivery and only 36.6％ patients had vaginal delivery; 91.7％ were outpatients and 8.3％ patients were inpatients.10.6％ patients had abscess and 89.4％ patients hadn't.The distribution ratio of inflammation in the upper outer,lower outer,lower inner and upper inner quadrants of the breast was 30.6％,48.1％,19％,2.3％ respectively.If the mode of delivery is considered as a factor to investigate incidence time of mastitis and postpartum colostrums time,no significant difference between the two groups was found (P ＞ 0.05).Our survey indicated that 79.2％ patients did not have any knowledge of breastfeeding,8.8％ patients got the breast-feeding knowledge from their mothers,11.6％ patients got the breastfeeding knowledge from books or web resources,only 0.5％ of the patients participated in the training of breast-feeding.76.9％ patients never had breast massage,19％ of patients had a few times of massage,2.8％ of patients had occasional massage,and only 1.4％ of patients had regular breast massage with the help of their family.85.6％ patients didn't have their breasts emptied from breast-feeding to incidence of mastitis,11.6％ patients occasionally emptied their breasts,and only 2.8％ of patients can ensure one side of the breasts emptied daily.56.5％ patients used lying position with the lower breast as the most common breastfeeding posture,37％ patients used sitting position,only 6.5％ of patients used lying position with the upper breast.The correlation analysis of breeding posture and occurring site of lactation mastitis revealed that the Spearman coefficient was-0.14,P value was 0.04,which is statistically significant,suggesting there is correlation between occurring sites of lactation mastitis and breeding posture.Conclusions Mothers need to master breast-feeding skills including breast massage,breast milk emptying and breast-feeding postures to prevent the occurrence of mastitis.Furthermore,gravity probably affects the occurring sites of mastitis through its impact on patients' preferred breast-feeding postures.