This study explored the metagenomic sequencing methodology for analyzing the breast milk microbiome and elucidated its composition. Twenty-two breast milk samples were collected from 11 healthy lactating women. By optimizing microbial cell wall disruption parameters and developing a nucleic acid extraction method, microbial DNA/RNA libraries were constructed and subjected to metagenomic next-generation sequencing (mNGS), microbial standards spiked into breast milk at serial dilutions served to validate the method's reliability. The sequencing data underwent rigorous quality control and classification using the Kraken2 software and a self-generated database. The breast milk microbiome was found to comprise 21 phyla, 234 genera, and 487 species, with Firmicutes and Proteobacteria being the dominant phyla. At the genus level, Staphylococcus and Streptococcus were the most abundant, while at the species level, Staphylococcus aureus, Streptococcus bradystis, and Staphylococcus epidermidis were the most prevalent. The microbial profiles of the left and right breast milk samples were consistent at the phylum, genus, and species levels. Besides common bacteria, diverse viral, eukaryotic, and archaeal sequences were also detected. Functional profiling revealed that the "lactose and galactose degradation I" pathway accumulated the highest read count, whereas the L-valine biosynthesis pathway was detected most frequently. This study provides a comprehensive understanding of the healthy breast milk microbiome, highlighting the presence of specific flora colonization and the distinct yet correlated microbial environments in bilateral breast milk, laying the groundwork for future research into the interactions between breast milk microbiota and maternal and infant health outcomes.

This study aims to optimize the metagenomic detection methodology of the human breast milk microbiome and analyze its composition. Twenty-two milk samples were collected from the left and right sides of lactating women during re-examinations at the Haidian Maternal and Child Health Hospital, Beijing. Microbial cell wall disruption parameters were optimized, and a nucleic acid extraction method was developed to construct a microbial DNA/RNA library. Metagenomic next-generation sequencing (mNGS) sequencing was performed, and microbial composition was analyzed using the k-mer Lowest Common Ancestor (LCA) method with a self-generated database constructed via Kraken2 software. Data showed Q20 > 95% and Q30 > 90%, with an average total data volume of 5,567 ± 376.6 Mb and non-human sequence data of 445.1 ± 63.75 Mb, significantly enhancing sequencing efficiency. The microbiome included 21 phyla, 234 genera, and 487 species, with Firmicutes and Proteobacteria as dominant phyla. Predominant genera included Staphylococcus and Streptococcus, and major species were Staphylococcus aureus, Streptococcus bradystis, and Staphylococcus epidermidis. Species levels exhibited significant variations among different individuals. Microbial profiles of left- and right-sided milk samples were consistent at the phylum, genus, and species levels. In addition to common bacteria, diverse viral, eukaryotic, and archaeal sequences were detected. This study refined metagenomic detection methods for human breast milk microbiota. Specific flora colonization occurred in healthy breast milk, with the left and right sides exhibiting both correlations and distinct flora environments.

Objective The aim of this study was to investigate risk factors for the severity of breast abscess during lactation. Methods A cross-sectional study was conducted using data from the Questionnaire survey of breast abscess patients. According to whether the maximum abscess diameter > 5 cm, the patients were divided into two groups for univariate and multivariate regression analysis. Results 1805 valid questionnaires were included. Univariate and Binary logistic regression analysis demonstrated that low education (OR = 1.5, 95% CI 1.1–2.0, P = 0.005), non-exclusive breastfeeding (OR = 0.7, 95% CI 0.6–0.9, P = 0.004), fever > 37.5 ℃ (OR = 0.7, 95% CI 0.6–0.9, P = 0.003), flat or inverted nipples (OR = 0.7, 95% CI 0.6–0.9, P = 0.005), antibiotic used (OR = 0.7, 95% CI 0.6–0.9, P = 0.006), and non-medical massage (OR = 0.3, 95% CI 0.2–0.4, P < 0.001) were the effective independent influencing factors for the maximum breast abscess diameter > 5 cm. Conclusion Low education, non-exclusive breastfeeding, fever > 37.5 ℃, inverted or flat nipples, antibiotic used, and non-medical massage history have adverse effects on the severity of breast abscess during lactation.

We investigated 1805 cases of breast abscesses during lactation to estimate the risk factors for multiple breast abscesses during lactation. A total of 2000 cases of breast abscesses during lactation were investigated using an online questionnaire, and 1805 cases with complete data were analyzed. The survey response rate was 90%. According to the number of abscesses, the patients were divided into 2 groups: single breast abscess (number = 1298) and multiple breast abscess (number = 507). Pearson chi-square test was used to compare the 15 risk factors between the 2 groups. Risk factors with significant differences were substituted into a binary logistic regression model to analyze the independent risk factors associated with multiple breast abscesses during lactation. There were significant differences between the 2 groups in (1) weeks postpartum, (2) separated from the baby, (3) breastfeeding exclusivity, (4) nipple inversion, (5) fever, (6) breast redness/swelling, (7) nipple pain, (8) breast massage by nonmedical staff, with (1), (5), (6), and (8) being independent risk factors. Patients under 6 weeks postpartum, separated from the baby, not exclusively breastfeeding, having an inverted nipple on the affected side, fever, breast skin redness and swelling on the affected side, nipple pain, and having undergone a breast massage by nonmedical staff are more likely to develop multiple breast abscesses.

Although oral probiotics can improve breast microecology and alleviate the inflammatory response, there are no data regarding cases with existing abscesses. We aimed to investigate the effect of Lactobacillus fermentum CECT5716 during needle aspiration in patients with lactational breast abscesses. Patients (aged 20–41 years) with lactational single-cavity breast abscesses (diameter 3–6 cm) from 12 hospitals were randomly assigned to the experimental (n = 51) and control groups (n = 50). Outcome measures included the abscess cure rate on treatment day-5, delactation rate, relieving pain rate, and number of needle aspirations until day-28. The experimental group’s 5-day cure rate (43.1%) was significantly higher (p < 0.05). Breastfeeding continuation on day-5 did not differ significantly (experimental group: 88.2%, control group: 96.0%, p = 0.269). In the experimental and control groups, 19.6% and 14.0% of patients experienced moderate to severe pain on day-5, respectively, with no statistically significant differences (p = 0.451). Four patients in each group developed diarrhea, with adverse reaction rates of 7.84% and 8.0%, respectively. No adverse reactions were reported in the infants. L. fermentum can shorten the healing time in patients with lactational breast abscesses. Trial registration This study was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), registration number: ChiCTR2000032682, registration date: 6/May/ 2020; first entry date: 11/May/2020.

Background Approximately 54.8% of patients with breast abscesses discontinue breastfeeding due to the lack of adequate breastfeeding support. Research aims We aimed to (1) examine the difference in milk volume produced by healthy breasts and breasts with abscesses; and (2) to explore the changes in milk volume before and after comprehensive management. Method A prospective, consecutive series study was designed. Lactating patients (N = 50) with breast abscesses were selected from March 2017 to November 2018. The volume and frequency of milk expression of the affected and the unaffected breast were recorded every 24 hr before and after comprehensive management. The difference in the milk volume produced by healthy breasts (control) and breasts with abscesses, as well as the milk volume produced by each breast before and after comprehensive management, was determined. Results There was a significant difference in the milk volume produced by healthy breasts and breasts with abscess before (t = 3.016; p = .004) and after (t = 4.336; p < .001) comprehensive management. The frequency of milk expression was significantly higher after comprehensive management than before it (z = −6.145; p < .001); the milk volume produced by each side significantly increased after comprehensive management (healthy breasts: t = −4.789; p < .001; breasts with abscess: t = 2.555; p = .014). Conclusion The total milk volume produced by breasts with abscesses can be less than that produced by healthy breasts. The management of abscesses by increasing the frequency of milk expression and degree of emptying can help mothers increase their milk volume.

Background: Lactational mastitis and breast abscess cause trouble for women. It has been shown that oral probiotics can improve breast microecology, thus alleviating inflammatory responses. Our study aims to understand the long-term effect of Lactobacillus fermentum CECT5716 on patients with lactational breast abscess after needle aspiration. Methods: Data continued in a randomized controlled study of 101 subjects with lactational abscess from 12 hospitals were included. They were randomly divided into an experimental group and a control group. After needle aspiration treatment, the experimental group was orally administrated with L fermentum CECT5716 for 4 consecutive weeks, while the control group was treated with maltodextrin in the same way). In the third month after randomized controlled trial, the subjects were followed up by an online questionnaire investigation. The observation indexes included the relief of breast pain, recurrence of mastitis from the end of oral administration to the follow-up, and the effect on continuing breastfeeding. Results: A total of 101 patients were enrolled and 83 valid questionnaires were received during follow-up, including 40 in the experimental group and 43 in the control group. The rate of stop breastfeeding due to recurrence of mastitis was 2.5% (1/40) in the experimental group and 18.6% (8/43) in the control group, with a statistically significant difference (odds ratio = 0.112, 95% confidence interval: 0.013-0.942, P < .05). The rate of stop breastfeeding was 10% (4/40) in the experimental group and 25.6% (11/43) in the control group, without significant difference. The pain relief rate in the experimental group was 80% (32/40), which showed no significant difference from that in the control group, that is, 72.1% (31/43). The recurrence rate of mastitis in the experimental group was 20% (8/40), which was not significantly different from that in the control group, that is, 16.3% (7/43). Conclusions: In lactating women with a history of breast abscess, oral L fermentum CECT5716 may reduce the risk of stop breastfeeding due to recurrence of mastitis.

The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019. Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants. Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.

Abstract Objective To explore the effect of nipple repair in the treatment of lactating nipple injury.Methods Patients with nipple lesions admitted to the Maternal and Child Health Hospital of Haidian District from December 2015 to January 2020 were retrospective control study. The patients received nipple repair was the study group, the patients did not treated with medicine or surgery was the control group. Patients in both groups continued to be exclusively breastfeed with good sucking, The method of chi-square test was adopted by using SPSS24.0 statistical software to compare the difference of healing effect of nipple injury, pain relief rate, and recurrence rate of nipple injury.Results A total of 167 patients were enrolled, including in the 81 study group and 86 in the control group. The cure rates of the nipple injury in the study group and in the control group were 54.3% (44/81) and 26.7% (23/86) (χ2 = 13.451, P = 0.001). The complete pain relief rate was 48.1% (39/81) and 23.3% (20/86) (χ2 = 14.170, P = 0.001). The recurrence rate was 36.4% (16/44) and 34.8% (8/23) (χ2 = 0.016, P = 0.898).Conclusion For patients with no improvement in nipple damage after correction of etiology, nipple repair can improve the healing environment of nipple breakage, relieve nipple pain.

Background: Several Chinese mothers experience problems related to their breasts during breastfeeding and are referred to hospitals for treatment after a massage by a "cuirushi." Some of these patients develop large breast abscesses. Notably, the treatment of residual milk cavities is difficult after pus aspiration. Lactational residual milk cavities in the breast hinder effortless breastfeeding, but no solution has been reported thus far. This study aims to explore the use of a simple and minimally invasive method for treating lactational residual milk cavities and enabling mothers to breastfeed effortlessly. Materials and Methods: We retrospectively analyzed clinical data of 28 patients with lactational residual milk cavities treated using negative-pressure suction cannula and drainage at our department from December 2016 to May 2019. The success rate, safety, and feasibility of this technique are summarized. Results: Among the 28 patients, the first catheterization was successful in 7 (25%) patients, the second in 13 (46.4%) patients, and the third or subsequent catheterizations in 8 (28.6%) patients. The intubation time was <10 days in 3 patients, between 10 and 20 days in 12 patients, and >20 days in 13 patients. During and after treatment, 21 patients (75%) continued breastfeeding with the affected breast. Conclusions: Ultrasound-guided negative-pressure suction cannula is a new method to treat lactational residual milk cavities that may remain after initial therapy for lactational breast abscess. The treatment of lactational residual milk cavities offers significant advantages in supporting mothers during breastfeeding.

Objective To discuss the efficacy of ultrasound-guided aspiration and irrigation in lactational breast abscess patients and analyze the related factors of delactation.Methods The clinical data of 799 patients with lactational breast abscess treated by ultrasound-guided aspiration and irrigation in the Center for Prevention and Treatment of Breast Diseases,Maternal and Child Health Hospital of Haidian District from January to December 2016 were retrospectively analyzed.x2 test was used to analyze the data such as puncture frequency,postpartum time,antibiotics use and location of abscess.The unconditional logistic regression model was used to analyze the relationship between various factors and delactation.Results All 799 cases were followed up and 753 cases were cured.The cure rate was 94.2％ (753/799).Delactation occurred in 75 cases and the delectation rate was 9.4％ (75/799).Single-factor analysis showed that postnatal time,use of antibiotics,number of puncture and location of abscess were associated with delactation (x2 =7.159,7.794,39.394,21.243,P=0.007,0.005,P ＜0.001).Multivariate Logistic regression analysis showed that number of puncture (OR =6.442,95％ CI:1.851-22.420,P =0.003) and abscess in central area (OR =2.643,95％CI:1.480-4.721,P=0.001)were the risk factors for delactation,while long postnatal time was a protective factor for delactation (OR=0.540,95％ CI:0.315-0.927,P=0.025).Conclusions Ultrasoundguided aspiration and irrigation is effective for the treatment of lactational breast abscess,with a high cure rate and low delactation rate.The disease in puerperium,multiple punctures and the abscess in the central area are more likely to cause delectation.

Objective To evaluate the efficacy of ductal probing in treating milk stasis and the possible influencing factors. Methods A total of 2 544 patients with milk stasis in Haidian Maternal and Child Health Hospital from January 2012 to May 2016 were enrolled in this prospective study. They were divided into the study group (n=1 159) and the control group ( n=1 385) using a random number table method. The patients in study group were treated by ductal probing and the patients in control group received comprehensive physiotherapy(including local massage, semiconductor laser physical therapy, electric breast pump sucking and external application with 50% magnesium sulfate for 30 min). The patients were followed up for 1 month. The efficacy and recurrence rate were compared between two groups. According to the course of milk stasis, the distance from the nipple to the lump and the lump diameter, all patients in study group were subdivided to compare the efficacy of ductal probing among subgroups. The recurrence rate was compared between two groups using x2test. The non-parametric test was used to compare the treatment outcome. Two groups were compared using the Wilcoxon test, and three groups were compared using the Kruskal-Wallis test. Results After the treatment, there were 847 patients cured, 156 improved, 73 with clinical response, 65 with no response, and 18 with disease progression in the study group, 441, 312, 291, 308 and 33 in control group. The efficacy of ductal probing showed a significant difference (Z=-20. 75, P<0. 001). The difference in the recurrence rate between two groups was not statistically significant [14. 6% (169/1 159) vs 14. 0% (194/1 385), x2=0. 17, P=0. 680]. Subgroup analysis showed that the efficacy of ductal probing was significantly different among the subgroups with different courses (<2 d,2~3 d and >3 d) and different distance from the nipple to the lump (< 3 cm,3 ~5 cm and >5 cm) (Z=116. 14, P<0. 001; Z=198. 77, P<0. 001). The efficacy of ductal probing showed no significant difference between the patients with the lump ≤5 cm and the patients with the lump >5 cm (Z=-1. 00, P=0. 317). Conclusions Compared with mammary physiotherapy, ductal probing is effective in patients with milk stasis, worthy of clinical application. The outcome of this operation is related to the disease course and the distance from the nipple to the lump, irrelevant of the lump diameter.

Objective To investigate the therapeutic effects of ultrasound-guided aspiration in patients with lactational breast abscess and explore the factors affecting the times of aspirations for healing the breast abscess.Methods The clinical data of 108 patients with lactational breast abscess treated by ultrasound-guided aspiration and irrigation in the Center for Prevention and Treatment of Breast Diseases, Maternal and Child Health Hospital of Haidian District from May 2014 to October 2014 were retrospectively analyzed. According to the times of aspirations, the patients were dived into two groups: group A (≤5 times) and group B (>5 times). χ2 test was used for single-factor analysis of the following factors: patients’ age, time after childbirth, duration, fever, use of antibiotics, position of abscess, number of abscesses, maximum diameter of abscess, pus volume in the first aspiration, pus feature in the first aspiration and milk regurgitation. The factors with statistical significance were enrolled into stepwise Logistic regression analysis.Results In 108 cases, 105 cases were cured and 3 cases underwent surgery because of unsatisfactory outcome after aspiration. The cure rate was about 97.2%(105/108).They were followed up for one month. One case had recurrence, with the recurrence rate of about 1.0% (1/105). In 105 cured cases, 78 cases (74.3%) had the aspirations ≤5 times and 27 cases (25.7%) had the aspirations >5 times for healing the breast abscess. Single-factor analysis showed that the position of breast abscess, maximum diameter of abscess and pus volume in the first aspiration were related to the times of aspirations for healing the breast abscess (χ2=4.396,3.993,16.646; P=0.036,0.046, P<0.001). Logistic regression analysis showed that pus volume in the first aspiration was an independent factor affecting the times of aspirations (OR=15.665,95%CI:3.423-71.697,P<0.001).Conclusions Ultrasound-guided aspiration is feasible for lactational breast abscess, worthy of clinical application. The pus volume in the first aspiration may be an important factor to predict the times of aspirations for healing lactational breast abscess.

Objective To summarize the clinical features of granulomatous mastitis(GM),in order to facilitate the diagnosis and early treatment of GM. Methods From December 2013 to March 2015,we enrolled 44 patients with GM and abscess from Beijing Haidian Maternal & Child Health Hospital as research subjects. A retrospective study was made on general data( including age, course of disease, lactation history, medication history and related medical history ), clinical performance,breast ultrasonic findings, laboratory examination ( bacterial culture, susceptibility test and PCR ), histopathological features,treatment and prognosis. Results 44 patients were definitely diagnosed by pathological examination through tubular needle puncture with the guidance of color doppler ultrasound. The patients were averagely aged(30. 9 ± 4. 1), with a disease course as long as 2 days to 12 months,and 88. 6% (39 / 44)patients had lactation history. The patients sought for treatment manly for lumps,being red and swollen,and pain in breasts,and all of them had lesion in one breast. 23(52. 3% ) patients had congenital nipple retraction on the lesion side,8(18. 2% )patients had ulceration,and 8(18. 2% )patients had nipple discharge. Color ultrasonography showed irregular mixed echo or hypo echo,vague boundary,nonuniform internal echo, and internal liquid flow when pressed. In bacterial culture,32(72. 7% )patients had negative results,12(27. 3% )patients had positive results,and 9 patients had corynebacterium positive. The patients followed up for 6 months,36(81. 8% )patients were cured,5(11. 4% )patients relapsed,and 3(6. 8% )patients were lost to follow up. Conclusion GM is mostly seen in females at reproductive age. The usual symptoms include unilateral painful breast lump and erythema in local skin. Bacterial culture and susceptibility test are important to help doctors choose the best antibiotic therapy combining puncture guided by ultrasound and steroid hormones.

哺乳期乳腺脓肿是哺乳期女性的常见病。脓肿切开引流术仍是主要的治疗方法，但手术创伤大，术后恢复时间长[1]。我院于2012年1月~2014年12月收治哺乳期乳腺脓肿患者359例，经超声引导下脓肿穿刺冲洗治疗，取得较好效果，现报道如下。

Objective To explore the related factors in the development from acute lactation mastitis to breast abscess. Methods The clinical data of 111 patients who had lactation mastitis or breast abscess in our department from January 2013 to March 2014, including 92 cases of lactation mastitis and 19 cases of breast abscess, were analyzed retrospectively. Single factor analysis and unconditional logistic regression analysis were used from the following aspects: fever or not, duration of fever, infection site, massage history given by non-medical staff, use of antibiotics, switching to sensitive antibiotics or not, bacterial culture of breast milk, mass, age, and routine blood test. Results Single factor analysis showed that in breast abscess group, the proportion of the patients with duration of fever >2 d, lesions in nipple-areola area and massage history given by non-medical staff were 12/19, 9/19 and 5/19, significantly higher than 27. 2% (25/92), 15. 2% (14/92) and 4. 3% (4/92) in non-abscess group (χ2=9. 176,9. 909,7. 465, P=0. 002,0. 002,0. 006). Multiple factor logistic regression analysis showed that duration of fever>2 d, lesions in nipple-areola area and massage history given by non-medical staff were risk factors in breast abscess during lactation ( OR=4. 171, 95%CI:1. 325-13. 135,P=0. 015;OR=5. 153, 95%CI:1. 564-16. 972,P=0. 007;OR=10. 184, 95%CI:2. 017-51. 428,P=0. 005). Conclusion The patients with duration of fever >2 d, lesions in nipple-areola area and massage history given by non-medical staff are prone to develop breast abscess and the physicians should pay more attention to their treatment.

Objective To disscuss clinical characteristics and therapeutic experiences of 45 patients suffering from lactating breast abscess in mammary areola area in our hospital. Methods 45 patients sufferred from lactating breast abscess located in mammary areola area were treated, through application of color Doppler ultrasound-guided abscess puncture and irrigation, the patients accepted the irrigation and drainage of abscess, application of effective antibiotics to prevent infection, and laser, massage plus dexamethasone diluted solution deposited on skin. The patients were observed the effect of above treatment. Results In 45 patients, 39 cases were effective, accounted for 86.6%.Conclusion Treatment of breast abscess in mammary areola region is difficult, we should treat it comprehensively as soon as possible.

肉芽肿性乳腺炎是一种乳腺慢性炎症性疾病，病因不明，临床治疗困难。副乳腺肉芽肿性乳腺炎临床罕见，国内外均少见报道。笔者报道副乳腺肉芽肿性乳腺炎1例，通过回顾其临床病例资料及诊治过程，总结经验，供临床医师参考。

Objective To investigate the etiology,clinical manifestations and treatment methods of lactating adenoma.Methods A total of 1 1 cases with lactating adenoma were included into this study. Among them,five cases were diagnosed as lactating adenoma in the Center for Prevention and Cure of Breast Disease,Beijing Haidian Maternal and Child Health Hospital From July 1,2004 to March 30,2012, another 6 cases of lactating adenoma were searched from Pubmed and Wanfang Database from July 20th, 1998 to June 21th,2012.This research followed the process conforms to the mammary gland disease prevention and control center of Beijing Haidian District Maternity and Child Care ethics standards promulgated by the human subj ects committee.Results Among those 5 cases,one case found breast lumps at gestational age of 17 weeks and underwent breast surgery for neoplasms at gestational age of 25 weeks. Postoperative histopathological examination results showed secrete breast tumor.Two patients underwent breast formed sinus tract and resected.One case was puctured 4 times guiding by the color Doppler ultra sound.After the infection was controlled,breast neoplasm was cutted off.One case was found breast neoplasm during the process of regular breast abscess drainage and underwent resection.The follow-up showed no one had recurrence.Among those 6 cases,three patients reported in literatures abroad showed patients accepted surgery during pregnancy,and another three patients reported in literatures in domestic showed patients underwent postpartum surgery treatment.And five cases underwent neoplasm resection and one case who was combined with breast cancer underwent breast cancer modified radical.No recurrence were found among those six patients.Conclusions Lactating adenoma is a rare benign tumor during perinatal period.Excessive intervention such as massage could lead to infection.Infections after maturation can be treated by the incision and drainage,or fine needle aspiration and flush with ultrasound-guided.