Comprehensive evaluation of the risk of lactational mastitis in Chinese women: combined logistic regression analysis with receiver operating characteristic curve

Pre-pregnancy body mass index and lactational mastitis: The Japan Environment and Children's Study

PURPOSE

The association between maternal physique and prevalence of lactational mastitis (LM) in a large study population has not been reported. In this study, we aimed to evaluate the association between pre-pregnancy body mass index (BMI) and LM prevalence.

METHODS

We analyzed data collected from participants enrolled in the Japan Environment and Children's Study, a nationwide birth cohort study conducted between 2011 and 2014. Data from women with singleton births at and after 22 weeks of gestation were analyzed. LM occurrence was identified from medical record transcripts obtained 1-month post-childbirth. Based on the pre-pregnancy BMI, participants were categorized into Group 1 (< 18.5 kg/m2), Group 2 (18.5-24.9 kg/m2), and Group 3 (≥ 25.0 kg/m2). Excluding participants who were not breastfeeding, multivariable logistic regression models were used to evaluate the odds ratios (ORs) for LM in women who were breastfeeding in each BMI category. Group 2 was designated as the reference group. Maternal demographic and socio-economic characteristics were used as confounding factors.

RESULTS

We analyzed 83,170 participants. The adjusted OR for LM in Group 3 was 0.752 (95% confidence interval, 0.606-0.932). The adjusted OR for LM in Group 1 was not significantly changed.

CONCLUSIONS

High pre-pregnancy BMI was associated with decreased LM prevalence compared with that in the reference group. The maternal preconception physique may be associated with LM prevalence.

40-Hz auditory steady-state response deficits are correlated with the severity of persistent auditory verbal hallucination in patients with schizophrenia

BACKGROUND

Abnormal 40 Hz auditory steady-state response (ASSR) has been observed in some psychiatric disorders. Nevertheless, the role of 40 Hz ASSR in persistent auditory verbal hallucinations (pAVHs) schizophrenia (SCZ) is still unknown. This study aims to investigate whether the 40 Hz ASSR impairment is related to pAVHs and can detect pAVHs severity.

METHODS

We analyzed high-density electroencephalography data that from 43 pAVHs patients (pAVH group), 20 moderate auditory verbal hallucinations patients (mid-AVH group), and 24 without auditory verbal hallucinations patients (non-AVH group). Event-related spectral perturbation and inter-trial phase coherence (ITPC) were calculated to quantify dynamic changes of the 40 Hz ASSR power and ITPC, respectively.

RESULTS

Frontal-central, the 40 Hz ASSR power, and ITPC were significantly lower in the pAVH group than in the non-AVH group; There was no significant difference between the pAVH and mid-AVH group. The 40 Hz ASSR was significantly negatively correlated with the severity of pAVHs. The 40 Hz ASSR power, and ITPC could be used as a combinational marker to detect SCZ patients with and without pAVHs.

CONCLUSION

Our findings have shed light on the pathological mechanism of pAVHs in SCZ patients. These results can provide potential avenues for therapeutic intervention of pAVHs.

Integrative proteomic and metabonomic profiling elucidates amino acid and lipid metabolism disorder in CA-MRSA-infected breast abscesses

Objective

Bacterial culture and drug sensitivity testing have been the gold standard for confirming community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in breast abscess with a long history. However, these tests may delay treatment and increase the risk of nosocomial infections. To handle and improve this critical situation, this study aimed to explore biomarkers that could facilitate the rapid diagnosis of CA-MRSA infection.

Methods

This study for the first time applied label-free quantitative proteomics and non-targeted metabonomics to identify potential differentially expressed proteins (DEPs) and differentially expressed metabolites (DEMs) in breast abscess infected with CA-MRSA compared to methicillin-susceptible S. aureus (MSSA). The two omics data were integrated and analyzed using bioinformatics, and the results were validated using Parallel Reaction Monitoring (PRM). Receiver operating characteristic (ROC) curves were generated to evaluate the predictive efficiency of the identified biomarkers for diagnosing CA-MRSA infection.

Results

After using the above-mentioned strategies, 109 DEPs were identified, out of which 86 were upregulated and 23 were downregulated. Additionally, a total of 61 and 26 DEMs were initially screened in the positive and negative ion modes, respectively. A conjoint analysis indicated that the amino acid metabolism, glycosphingolipid biosynthesis, and glycerophospholipid metabolism pathways were co-enriched by the upstream DEPs and downstream DEMs, which may be involved in structuring the related network of CA-MRSA infection. Furthermore, three significant DEMs, namely, indole-3-acetic acid, L-(-)-methionine, and D-sedoheptulose 7-phosphate, displayed good discriminative abilities in early identification of CA-MRSA infection in ROC analysis.

Conclusion

As there is limited high-quality evidence and multiple omics research in this field, the explored candidate biomarkers and pathways may provide new insights into the early diagnosis and drug resistance mechanisms of CA-MRSA infection in Chinese women.

Neurophysiological markers of depression detection and severity prediction in first-episode major depressive disorder

OBJECTIVE

Deviant γ auditory steady-state responses (γ-ASSRs) have been documented in some psychiatric disorders. Nevertheless, the role of γ-ASSR in drug-naïve first-episode major depressive disorder (FEMD) patients remains equivocal. This study aimed to examine whether γ-ASSRs are impaired in FEMD patients and predict depression severity.

METHODS

Cortical reactivity was assessed in a cohort of 28 FEMD patients relative to 30 healthy control (HC) subjects during an ASSR paradigm randomly presented at 40 and 60 Hz. Event-related spectral perturbation and inter-trial phase coherence (ITC) were calculated to quantify dynamic changes of the γ-ASSR. Receiver operating characteristic curve combined with binary logistic regression were then employed to summarize ASSR variables that maximally differentiated groups.

RESULTS

FEMD patients exhibited significantly inferior 40 Hz-ASSR-ITC in the right hemisphere versus HC subjects (p = 0.007), along with attenuated θ-ITC that reflected underlying impairments in θ responses during 60 Hz clicks (p < 0.05). Moreover, the 40 Hz-ASSR-ITC and θ-ITC in the right hemisphere can be used as a combinational marker to detect FEMD patients with 84.0 % sensitivity and 81.5 % specificity (area under the curve was 0.868, 95 % CI: 0.768-0.968). Pearson's correlations between the depression severity and ASSR variables were further conducted. The symptom severity of FEMD patients was negatively correlated with 60 Hz-ASSR-ITC in the midline and right hemisphere, possibly indicating that depression severity mediated high γ neural synchrony.

CONCLUSIONS

Our findings provide critical insight into the pathological mechanism of FEMD, suggesting first that 40 Hz-ASSR-ITC and θ-ITC in right hemisphere constitute potential neurophysiological markers for early depression detection, and second, that high γ entrainment deficits may contribute to underlying symptom severity in FEMD patients.

Image quality and diagnostic accuracy of different dosages of iodixanol in computed tomography angiography and perfusion of overweight patients with coronary artery stenosis: A feasibility study

OBJECTIVES

Iodixanol contrast media with different doses using computed tomography angiography (CTA) and perfusion (CTP) to diagnose coronary artery disease (CAD) in overweight patients lacks assessment. Our study compared iodixanol 320 mg I/ml and 270 mg I/ml on image quality and accuracy of CTA combined CTP (CTA-CTP) to diagnose CAD.

METHODS

Overweight patients with suspected of CAD were randomized into iodixanol 270 group (received iodixanol 270 mg I/ml) and iodixanol 320 group (received iodixanol 320 mg I/ml). Based on these characteristics data, receiver operating characteristic (ROC) curve and corresponding area under the curve (AUC) were plotted to assess the sensitivity and specificity of the two administrations.

RESULTS

The subjective definition score, signal to noise ratio, and CT value of aorta in iodixanol 320 group were higher than iodixanol 270 group. In iodixanol 270 group: the image exhibited a normal state of both vessels and myocardial perfusion; and the AUC, specificity, and sensitivity were 0.376, 66.67, and 80.46, respectively. In iodixanol 320 group: the image exhibited a diameter stenosis in right coronary artery and myocardial infarction of inferior wall and proximal inferior wall septum, as well as myocardial perfusion defects; and the AUC, specificity, and sensitivity in iodixanol 320 group were 0.824, 75.00, and 89.87, respectively.

CONCLUSION

Accuracy and image quality of iodixanol 320 mg I/ml in the diagnosis of CAD with CTA-CTP was higher than using iodixanol 270 mg I/ml.

Adaptation of a clinical reasoning model for use in inflammatory conditions of the lactating breast: a retrospective mixed-methods study

Background

Many potential factors associated with Inflammatory Conditions of the Lactating Breast (ICLB) have been reported in the literature, by lactating mothers and clinicians. Clinicians, including general practitioners, lactation consultants and physiotherapists, require a clinical reasoning model that summarises associated or linked factors, to aid in the assessment, treatment, and prevention of ICLB. Thus, we aimed to adapt the existing Breastfeeding Pain Reasoning Model (BPRM), for use in the management of ICLB, using prior research and clinical audit data to guide adaptation. The existing BPRM categorises contributing factors for breastfeeding nipple pain, rather than ICLB.

Methods

Factors linked with ICLB were identified from prior research and considered for inclusion into the existing model. Clinical data from a retrospective audit of ICLB patient notes at a private physiotherapy practice were also examined. Any factors identified from prior research that could not be identified in the clinical notes were not considered for inclusion into the existing model. Additional factors from the clinical notes that appeared repeatedly were considered for inclusion into the adaptation of the BPRM. A draft adapted model was created comprising all eligible factors, considering their counts and percentages as calculated from the clinical data. The research team iteratively examined all factors for appropriate categorisation and modification within the adapted model.

Results

Prior research and data from 160 clinical notes were used to identify factors for inclusion in the adapted model. A total of 57 factors, 13 pre-existing in the BPRM and 44 extra identified from the prior research or clinical audit, comprised the draft adapted model. Factor consolidation and terminology modification resulted in a total of 34 factors in the final proposed adapted ICLB model. The three main categories, CNS modulation, External influences and Local stimulation, from the existing model were maintained, with one minor terminology change to the former Local stimulation category, resulting in 'Local influences' category. Terminology for five subcategories were modified to better reflect the types of factors for ICLB. The most common factors in the adapted model, calculated from the clinical audit population of mothers with ICLB, were employment (85%), high socioeconomic status (81%), antibiotic use during breastfeeding (61%), history of an ICLB (56%), any breast pump use (45%), multiparity (43%), birth interventions (35%), decreased milk transfer (33%), breastfeeding behaviour and practices (33%), nipple pain (30%) and fit and hold (attachment and positioning) difficulty (28%).

Conclusion

An ICLB-specific linked factors model is proposed in this paper. Clinicians treating mothers with ICLB can use this model to identify influencing and determining factors of ICLB clinical presentations and provide targeted education and effective treatment plans.

Risk factors for lactation mastitis in China: A systematic review and meta-analysis

Background

Lactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor.

Material and methods

Six major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors.

Results

Fourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45–13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17–9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66–9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92–5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34–6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17–4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09–2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58–3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58–2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25–2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09–2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26–1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25–1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06–2.02; PAR 21.27%).

Conclusions

This review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.