Abstract Background Lactation mastitis is a common complication during breastfeeding that can negatively impact maternal well-being and breastfeeding continuation. While the physical manifestations of lactation mastitis have been widely studied, its psychological burden and related contributing factors among affected women have received comparatively less attention. This study aimed to investigate postpartum depressive symptoms and associated factors in women diagnosed with lactation mastitis. Methods A cross-sectional survey was conducted among 87 women with lactation mastitis at a tertiary hospital in China. Participants completed a structured questionnaire encompassing five domains: demographics and perinatal history, personal and breast history, psychological and emotional state, breastfeeding practices and nipple condition, and infant characteristics and interaction. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, group comparisons, multivariable logistic regression, and sensitivity analyses were used to identify factors associated with elevated EPDS scores. Results Overall, 49.4% of participants scored above the clinical threshold for postpartum depressive symptoms on the EPDS. Multivariable logistic regression identified emotional tension during breastfeeding (odds ratio[OR] = 6.807, P = 0.016), younger maternal age (OR = 0.794, P = 0.023), vaginal delivery (OR = 3.382, P = 0.032), and pacifier use (OR = 5.103, P = 0.006) as independent correlates of elevated depressive symptoms. These associations remained robust across sensitivity analyses. Conclusions Women with lactation mastitis appear to be at heightened risk of postpartum depressive symptoms and are associated with both maternal and infant-related factors. Early identification of psychological distress, combined with integrated breastfeeding and mental health support, may help address maternal needs and enhance postpartum care.

Background Lactational mastitis is a common inflammatory condition that can adversely affect maternal well-being and is associated with early cessation of breastfeeding. Although antibiotics and analgesics are widely used in clinical practice, concerns regarding antimicrobial resistance and potential effects on the infant microbiome have prompted increasing interest in non-pharmacological approaches. A range of physical and biological interventions, including probiotics, therapeutic ultrasound, acupuncture and manual therapies, have been investigated; however, the comparative effectiveness and safety of these interventions remain unclear. This study aims to systematically evaluate the efficacy and safety of non-pharmacological interventions for lactational mastitis. Methods and analysis This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. We will systematically search PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, VIP and SinoMed as well as relevant trial registries from database inception to March 2026. We will include randomised controlled trials enrolling adult lactating women diagnosed with mastitis. Eligible studies will compare non-pharmacological interventions with usual care, placebo or pharmacological treatments. Interventions involving pharmacologically active agents will be excluded. Two reviewers will independently perform study selection, data extraction and risk of bias assessment using the Cochrane RoB 2 tool. The primary outcome will be resolution of mastitis, defined as the return of body temperature to normal (<37°C) and resolution of localised breast symptoms (eg, pain, erythema and swelling). Secondary outcomes will include inflammatory markers (eg, C-reactive protein), pain intensity (measured using the Visual Analogue Scale or similar validated scales), incidence of adverse events, complete blood count parameters, time to symptom resolution or normalisation of body temperature, incidence of breast abscess and breastfeeding continuation rates. Meta-analysis will be conducted, where appropriate, using random-effects models. Continuous outcomes will be summarised using mean differences or standardised mean differences, and dichotomous outcomes using risk ratios, all with 95% CIs. Statistical heterogeneity will be assessed using the I ² statistic. Subgroup and sensitivity analyses will be performed to explore potential sources of heterogeneity. Publication bias will be assessed using funnel plots and Egger’s test when sufficient studies are available. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation（GRADE）approach. Ethics and dissemination Ethical approval is not required for this study as it is based on published data. The findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD420261347640.

BACKGROUND:Trastuzumab deruxtecan (T-DXd) is a novel antibody-drug conjugate uesd for the treatment of HER2- positive (HER2+)breast cancer. This systematic review aimed to evaluate the efficacy and safety of T-DXd in advanced HER2-positive breast cancer. METHODS:PubMed, Web of Science and Embase databases were searched for literature on trastuzumab deruxtecan treatment for HER2-positive or low-expression breast cancer before December 30, 2024. The outcome measures were progression-free survival (PFS), overall survival (OS), objective response rates, and adverse events of any grade and grade ≥ 3. Meta-analysis of the relevant data was performed using Stata 14.0. RESULTS:A total of 2995 patients from 7 studies were included. The median PFS and median overall survival of patients in the T-DXd group were significantly longer than those of patients in the control group (mPFS HR = 0.43;95% CI:0.31-0.62, p<0.05; mOS HR = 0.72; 95% CI:0.64-0.82, p<0.05). Further subgroup analyses based on differences in hormone receptor expression, occurrence of brain metastases, visceral basal conditions, and previous lines of treatment showed that all patients in the T-DXd group had significantly longer mPFS than those in the control group (P < .05). The objective remission rate of patients in the T-DXd group was significantly higher than that of patients in the control group (RR = 2.31; 95%CI: 1.88-2.85, P<0.05). In addition, the T-DXd also increased the incidence of adverse events such as anemia, nausea, vomiting, constipation and interstitial lung disease, but the incidence of neutropenia, diarrhea, and alopecia was not significantly different between the 2 groups. No significant publication bias was observed in this study. The results of the sensitivity analysis showed high heterogeneity in mPFS, but the results obtained after excluding the DESTINY-Breast04 studies were all more robust. CONCLUSION:T-DXd has significant long-term and near-term efficacy in prolonging median overall survival, median PFS, and increasing the objective remission rate in patients with HER2-positive or low-expression breast cancer; however, the treatment is associated with notable adverse events, and physicians should be alert to the occurrence of serious adverse events when using this drug.

Study on the mechanism of Fangxia Dihuang Formula(FXDH) in treating breast cancer complicated with depression through the regulation of M1/M2 microglial polarization via the PERK/eIF2α axis. In addition to control group and 4T1 group, a mouse model of breast cancer complicated with depression was established using 4T1 cells combined with corticosterone. The mice were divided into model group, PERK/eIF2α signaling axis agonist(CCT020312, 2 mg·kg~(-1)·d~(-1)) group, CCT020312(2 mg·kg~(-1)·d~(-1)) + FXDH(13.65 g·kg~(-1)·d~(-1)) group, FXDH(13.65 g·kg~(-1)·d~(-1)) group, FXDH(13.65 g·kg~(-1)·d~(-1)) + Capecitabine Tablets(CAP, 390 mg·kg~(-1)·d~(-1)) group, and Fluoxetine Hydrochloride Capsules(FXT, 2.6 mg·kg~(-1)·d~(-1)) + CAP(390 mg·kg~(-1)·d~(-1)) group, with continuous intervention for 21 d. Depression-like behaviors in mice were assessed through sugar preference test and open field test. Hematoxylin-eosin(HE) staining was used to evaluate the morphology of tumor and hippocampal DG region neurons. Nissl staining was employed to detect changes in Nissl bodies in the hippocampal CA3 region. Immunofluorescence was used to observe cluster of differentiation 86(CD86)/ionized calcium-binding adapter molecule 1(Iba-1) and cluster of differentiation 206(CD206)/Iba-1 in hippocampal tissue. Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR) was used to detect the mRNA expression of M1-type microglia [interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)] and M2-type [arginase-1(Arg-1), IL-10] in hippocampal tissue. Western blot was used to detect the protein expression of key factors in the PERK/eIF2α axis, including PERK, eIF2α, activating transcription factor 4(ATF4), and C/EBP homologous protein(CHOP) in hippocampal tissue. The results showed that compared to model group/CCT020312 + FXDH group, FXDH group increased sugar preference index, total movement distance, central zone distance, and central zone entries; reduced tumor mass and volume; tumor cells were sparsely arranged, with a smaller nuclear-to-cytoplasmic ratio and reduced nuclear division figures, increased Nissl body count, and alleviated neuronal nuclear pyknosis; increased CD206-positive M2-type microglia expression, decreased CD86/Iba-1-positive M1-type microglia expression; reduced IL-6 and TNF-α mRNA expression, and increased Arg-1 and IL-10 mRNA expression; downregulated PERK, eIF2α, ATF4, and CHOP protein expression levels. The results indicate that the mechanism of FXDH in treating breast cancer complicated with depression may be related to inhibiting the activity of the PERK/eIF2α axis, reducing the proportion of M1-type microglia, increasing the proportion of M2-type microglia, thereby suppressing neuronal immune inflammation, improving depressive symptoms, and subsequently delaying the progression of breast cancer.

Breast cancer (BC) prognosis is influenced by hormones, of which progesterone receptor (PR) status is controversial for BC prognosis, possibly related to clinical characteristics. This study was to determine the impact of PR status on BC prognosis and explore the differences across patient subgroups. PubMed, Cochrane Library, Embase, and Web of Science were searched for relevant studies until July 2024. NOS (Newcastle–Ottawa Scale) was leveraged for quality appraisal. Meta-analysis was performed using STATA15.1. Thirty-five studies were included, involving 89,164 patients. PR-negative status was associated with worse overall survival compared to PR-positive status (HR 1.70, 95

AIMS:To develop the core outcome set and identify unique outcomes for the three stages and five types of nursing interventions, respectively, in lactational mastitis. DESIGN:A mixed methods study. METHODS:A systematic literature search, four semi-structured interviews for key stakeholders, two rounds of Delphi surveys and two online consensus meetings were conducted. RESULTS:Thirty-one nursing outcomes were derived from the systematic review (literature research from January 2019 to December 2021) and semi-structured interviews in 2022. Six A-category nursing outcomes and 19 B-category nursing outcomes were determined after Dephi survey and provided in consensus meeting in 2023. The consensus meetings resulted in the agreement on seven core outcomes: Pain Level, Breast Establishment: infant, Breast Establishment: maternal, Breast Maintenance, Client satisfaction: care, Sleep, and Family Support during Treatment. Specifically, the unique outcomes for the three stages were identified as Breastfeeding Maintenance, Infection Severity and Wound Healing: Primary Intention, respectively. The unique outcomes for the five interventions included Pain level, Infection Severity, Wound Healing: Primary Intention, Comfort and Knowledge: breastfeeding, respectively. CONCLUSION:Based on an evidence-based, consensus-driven approach, the core outcome set incorporates the perspectives of key stakeholders. It is recommended that all core outcomes be reported in both lactational mastitis nursing research and clinical quality control and audit. Unique outcomes should be reported based on the stages of lactational mastitis and types of interventions. IMPACT:The core outcome set and unique outcomes developed by our study could provide nursing researchers and clinical practitioners with sensitive outcomes for lactational mastitis, while also promoting standardisation. Utilising these outcomes could enhance comparability among studies, reduce reporting bias and promote standardised evaluation of practice effectiveness. REPORTING METHOD:Findings are reported per Core Outcome Set-STAndards for Reporting: COS-STAR Statement. PATIENT OR PUBLIC CONTRIBUTION:None. TRIAL REGISTRATION:https://www.comet-initiative.org/Studies/Details/1650.

Background Epidemiological studies have provided evidence that there is an association between diet and colorectal cancer. However, the causal relationship between dietary habits and colorectal cancer remains unknown. Methods The UK Biobank provided summary-level genome-wide association study data for nine dietary habits, including alcohol consumption (n = 549,703), instant coffee consumption (n = 250,308), fruit consumption (n = 210,947), meat consumption (n = 210,947), full cream milk consumption (n = 41,306), sweets consumption (n = 25,521), tea consumption (n = 501,494), vegetable consumption (n = 210,947), and yogurt/ice cream consumption (n = 210,947). Additionally, data on colorectal cancer were collected, consisting of 5,567 cases and 372,016 controls. The MR analysis employed inverse variance weighted, weighted median, MR-Egger regression, and MR multivariate residuals tests. Results In the predominantly European population, a positive association was observed between vegetables (OR = 1.014, 95% CI = 1.000-1.029, p = 0.048) and an increased risk of colorectal cancer. The results for vegetable did not survive correction for multiple comparisons. However, no strong evidence was found for other dietary factors, such as alcohol (OR = 1.012, 95% CI = 0.974–1.051, p = 0.556), fruit (OR = 1.007, 95% CI = 0.986–1.029, p = 0.512), meat (OR = 1.000, 95% CI = 0.987–1.026, p = 0.968), full cream milk (OR = 1.019, 95% CI = 0.979–1.061, p = 0.357), sweets (OR = 0.998, 95% CI = 0.991–1.004, p = 0.524), and tea (OR = 1.002, 95% CI = 0.994–1.009, p = 0.672), with regards to colorectal cancer risk in the European population. Conclusions Our study highlights the need for a more nuanced approach to dietary recommendations for CRC prevention, with greater emphasis adherence to the Mediterranean dietary pattern.

Acute mastitis is one of the common diseases of postpartum lactating women, also known as lactational mastitis, which can occur during breastfeeding, especially in the postpartum 3–4 weeks. Acute mastitis can lead to the cessation of breastfeeding. Improving breastfeeding behavior and extending breastfeeding duration have become a global strategy to promote maternal and child health. Manual lactation traditional Chinese medicine technology is one of the important measures to improve the rate of breastfeeding, which can solve the problems of breast swelling, pain, and reduction of milk production. This article introduces the definition, indications, standard operating procedures, precautions, and treatment of adverse events of manual lactation in traditional Chinese medicine technology, so as to provide more comprehensive guidance for clinical workers to carry out manual lactation operations.

BackgroundTriple-negative breast cancer (TNBC) is a great challenge for clinical management due to the high rate of metastatic recurrence and lack of recognised therapeutic targets, while tumour-infiltrating lymphocytes (TILs) infiltration in TNBC has been discovery provides an opportunity for immunotherapy, and studies have suggested that the level of TILs infiltration is positively correlated with TNBC survival. We found a rare case of TNBC with low TILs infiltration but good prognosis, named Tall Cell Carcinoma with Reversed Polarity (TCCRP), and we investigated it from the perspective of TILs infiltration in order to improve the clinical data of TCCRP.Case presentationa 54-year-old woman with a left breast mass, breast ultrasound showed BI-RADS IVb, puncture diagnosis of invasive ductal carcinoma, postoperative pathology showed papillary structure, cubic and high columnar arrangement of cells, nuclei far away from the base, interstitial fibroplasia, diagnosed as TCCRP. Immunohistochemistry revealed that the tumours were triple-negative breast cancer (negative for ER, PR, and HER-2), with a low Ki-67 proliferation index. TILs were < 10%, with a small infiltration of CD4+ and CD8+ T lymphocytes, positive expression of SMA and FAP, and IDH2, PIK3CA gene mutation. The patient underwent postoperative chemotherapy, 11 months follow-up, no recurrence and metastasis.ConclusionTCCRP is a rare TNBC with inert biological behaviours and good prognosis. We found low infiltration of TILs in the pathological tissue of this case, which may be a characteristic of TCCRP, and the presence of Cancer-Associated Fibroblasts (CAF) in the interstitium of the tumour in this case may have suppressed the anti-tumour immunity to some extent, and further studies on the immune characteristics of the tumour microenvironment (TME) in TCCRP are needed.

Chinese medicated bath is one of the external therapies in Traditional Chinese Medicine(TCM), which has been widely used clinically. The “International Standard of Traditional Chinese Medicine Techniques: The Operating Specifications for Chinese Medicated Bath” is drawn up by the Beijing University of Chinese Medicine Third Affiliated Hospital and Beijing University of Chinese Medicine Xiamen Hospital in collaboration with domestic TCM universities and hospitals. The specification includes definition, operating process, points for attention and contraindications. It is targeted to provide reference for TCM providers at home and abroad with TCM background in clinical decision-making.

BACKGROUND:Moderate to severe breast pain has major effects on the quality of life for patients. Patent Chinese medicines are widely used in the treatment of breast pain due to their stable dosage form and good efficacy. OBJECTIVE:To evaluate the beneficial effects and safety of Hongjin Xiaojie Capsule (HJXJC), a Chinese patent medicine, for the treatment of cyclical breast pain. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION:This is a multicenter, single-blind randomized controlled trial conducted in 3 medical centers in China from 2019 to 2021. Patients with moderate to severe cyclic breast pain were randomly divided into the intervention group (who took HJXJC, four capsules per dose, three times a day for 12 weeks) and the control group (waiting for the treatment) in a 1:1 ratio. MAIN OUTCOME MEASURES:The primary outcome was pain duration, and the patients recorded measurements at baseline and at the end of weeks 4, 8, 12 and 16 on a patient log card. RESULTS:The full analysis set (FAS) population included 298 participants (intervention group, n = 150; control group, n = 148), while the per-protocol analysis set (PPS) included 274 participants. After 12 weeks, the duration of breast pain was significantly shorter in the intervention group (FAS: mean difference, -6.69; 95% CI, -7.58 to -5.80; P < 0.01, vs control. PPS: mean difference, -7.09; 95% CI, -8.01 to -6.16; P < 0.01, vs control). The Short-form McGill Pain Questionnaire (SF-MPQ) scores were significantly lower in the intervention group (FAS: mean difference, -12.55; 95% CI, -13.90 to -11.21; P < 0.01, vs control. PPS: mean difference, -13.07; 95% CI, -14.48 to -11.66; P < 0.01, vs control). The above indicators continued to be significantly different through week 16. Moreover, in the intervention group, breast lumps shrank after 12 weeks and the size of breast lumps was statistically smaller than that in the control group (P < 0.05), whereas the sizes of breast nodules and uterine fibroid showed no statistically significant difference compared with the control group (P > 0.05). At weeks 8 and 12, the dysmenorrhea scores in the intervention group were lower than those in the control group (P < 0.05). No obvious adverse reactions were observed in any group. CONCLUSION:HJXJC can significantly shorten the duration of breast pain, reduce breast pain, reduce the size of breast lumps, and relieve dysmenorrhea. However, it has no significant effect on the size of breast nodules or uterine fibroid. TRIAL REGISTRATION:This trial has been registered at the ISRCTN Registry. Number: ISRCTN44184398. PLEASE CITE THIS ARTICLE AS:Zhang Q, Fan YY, Wu XQ, Huo YD, Wang CH, Liang SB, Wang T, Zhong R, Wang X, Lai BY, Pei XH, Liu JP. Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial. J Integr Med. 2024; 22(5): 552-560.

To explore the challenges and future of carbon-ion radiation therapy (CIRT) in breast cancer, we summarized the progress of nonclinical and clinical studies on CIRT for breast cancer in this review. A total of 6 nonclinical studies have been reported, which demonstrated a better effect of Carbon-ion irradiation compared with X-ray in breast cancer cell lines (including triple-negative breast cancer and Human Epidermal Growth Factor Receptor 2negative breast cancer). Combination with Hh inhibitor, dual tyrosine kinase inhibitor, and PARP inhibitor is promising as demonstrated in the in vitro studies. Approximately 34 patients with breast cancer went through CIRT treatment, as reported in 5 clinical studies. All studies demonstrated promising treatment effects with acceptable and manageable risks. In these studies, a total of 21 patients were reported with post-treatment response assessments, among whom 19 patients (90.48%) reported a response of complete response or partial response. The complete response rate was 66.67%. The time to complete the response ranged from 3 months to 24 months. No adverse events were observed in these studies except for grade 1 acute skin reaction in 14 out of the 21 patients (66.67%). Although the time to respond was longer than expected in some studies, the persistent responses and satisfactory safety profile provided the rationale for further research on this new therapy.

Background: The development and prognosis of breast cancer are intricately linked to psychological stress. In addition, depression is the most common psychological comorbidity among breast cancer survivors, and reportedly, Fang-Xia-Dihuang decoction (FXDH) can effectively manage depression in such patients. However, its pharmacological and molecular mechanisms remain obscure. Methods: Public databases were used for obtaining active components and related targets. Main active components were further verified by ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UPLC-HRMS). Protein–protein interaction and enrichment analyses were taken to predict potential hub targets and related pathways. Molecule docking was used to understand the interactions between main compounds and hub targets. In addition, an animal model of breast cancer combined with depression was established to evaluate the intervention effect of FXDH and verify the pathways screened by network pharmacology. Results: 174 active components of FXDH and 163 intersection targets of FXDH, breast cancer, and depression were identified. Quercetin, methyl ferulate, luteolin, ferulaldehyde, wogonin, and diincarvilone were identified as the principal active components of FXDH. Protein–protein interaction and KEGG enrichment analyses revealed that the phosphoinositide-3-kinase–protein kinase B (PI3K/AKT) and Janus kinase/signal transducer and activator of transcription (JAK2/STAT3) signaling pathways played a crucial role in mediating the efficacy of FXDH for inhibiting breast cancer progression induced by depression. In addition, in vivo experiments revealed that FXDH ameliorated depression-like behavior in mice and inhibited excessive tumor growth in mice with breast cancer and depression. FXDH treatment downregulated the expression of epinephrine, PI3K, AKT, STAT3, and JAK2 compared with the control treatment (p < 0.05). Molecular docking verified the relationship between the six primary components of FXDH and the three most important targets, including phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), AKT, and STAT3. Conclusion: This study provides a scientific basis to support the clinical application of FXDH for improving depression-like behavior and inhibiting breast cancer progression promoted by chronic stress. The therapeutic effects FXDH may be closely related to the PI3K/AKT and JAK2/STAT3 pathways. This finding helps better understand the regulatory mechanisms underlying the efficacy of FXDH.

Objective: To assess outcome indicators in clinical trials and provide a reference for establishing a core outcome set to treat hyperplasia of mammary gland（HMG） with traditional Chinese medicine（TCM）.Methods: Eight online databases were searched from their inception to December 31, 2022, to assess outcomes reported in randomized controlled trials（RCTs） of HMG treated with TCM. The quality of the included studies was assessed according to the Cochrane Risk of Bias Assessment Tool. All outcomes were extracted, classified, and described.Results: A total of 8249 articles were initially retrieved. Of these, 70 articles were eligible and involved 10618 participants with HMG. A total of 17 outcome indicators with a frequency of 271 times were involved and were collected according to six outcome domains.Conclusions: The core outcomes of RCTs of HMG treated with TCM are large and divergent. There are problems in evaluation standards, primary and secondary outcomes, TCM characteristic indicators, longterm prognosis, and standardization of reporting. It is recommended to strengthen the trial design and actively construct the core outcome sets with TCM characteristics for HMG.

目的 从患者、照顾者、护士、医生多视角探讨哺乳期乳腺炎护理结局,以用于构建护理核心结局集.方法 采用目的抽样法选取北京市 4 所三级甲等医院的患者、照顾者、护士及医生(共 32 名)进行半结构化访谈.采用定向内容分析法,并以护理结局分类作为指导框架进行资料分析.结果 共获取 20 个护理结局,涵盖 6 个领域,将系统评价中未报告的 8 个护理结局进一步归纳整理,覆盖心理社会健康、健康知识和行为、感知的健康、家庭健康 4 个领域.结论 在哺乳期乳腺炎护理核心结局集构建时融入利益相关者观点,有助于丰富乳腺护理门诊内涵、体现护理服务专业性.同时为护理科研的开展提供多维、基于利益相关者观点的护理结局.

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Embase, Cochrane library, JBI, CINAHL, PsycINFO, Clinical Trials Registry Platform portal, Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Center Watch Registry from inception to May 15, 2022 to find randomized controlled trials, non-randomized controlled trials, case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage, with search terms of mastitis, acute mastitis, lactation mastitis, puerperal mastitis, breast problem, breast engorgement, milk stasis, blocked ducked, breast pain, breast massage, and acupoint massage. Outcomes and the measurement schemes (measurement methods, timing of assessing outcome, frequency of assessing outcome, measurers) were extracted from the included studies. We used the Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) to assess the quality of each study, then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials (OMERACT) Filter 2.1 framework.Results We identified 85 clinical trials, in which 54 different outcomes were reported. A total of 81.2% (69/85) of studies were assessed as medium quality with a mean score of 2.6, and 18.8% (16/85) as low quality with a mean score of 0.9. These outcomes were organized in three core areas. Lump size (89.4%, 76/85) was the most frequently reported outcome, followed by breast pain (69.4%, 59/85) and milk excretion (68.2%, 58/85). Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous. Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.

Approximately 59 % of patients with breast cancer with one or two sentinel lymph nodes (1-2 SLN) macrometastases do not benefit from axillary lymph node dissection (ALND), which may also incur morbidities. It is necessary to evaluate the association between various clinicopathological characteristics and non-sentinel lymph node metastases (non-SLNM) in patients with breast cancer with 1-2 SLN macrometastases, and determine whether they 1-2 should avoid ALND. Eight electronic literature databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal, Wanfang, and Chinese Biomedical Literature) were searched from their inception to June 30, 2023, and two reviewers independently extracted the data and assessed the risk of bias. Association strength was summarized using odds ratios (OR) and 95 % confidence intervals (CI). Heterogeneity was accounted for using a subgroup analysis. Publication bias was evaluated using funnel plots and Egger's test. There were 25 studies with 8021 participants, and 27 potential risk factors were evaluated. The risk factors for non-SLNM in patients with 1-2 SLN macrometastatic breast cancer include the following: factors of primary tumor: multifocality (OR (95 % CI (2.63 (1.96, 3.54))), tumor size ≥ T2 (2.64 (2.22, 3.14)), tumor localization (upper outer quad) (2.06 (1.23, 3.43)), histopathological grade (G3) (2.45 (1.70, 3.52)), vascular invasion (VI) (2.60 (1.35, 4.98)), lymphovascular invasion (LVI) (2.87 (1.80, 4.56)), perineural invasion (PNI) (3.16 (1.18,8.43)). Factors of lymph nodes: method of SLNs detected (blue dye) (3.85 (1.54, 9.60)), SLN metastasis ratio ≥0.5 (2.79 (2.24, 3.48)), two positive SLNs (3.55, (2.08, 6.07)), zero negative SLN (3.72 (CI 2.50, 4.29)), extranodal extension (ENE) (4.69 (2.16, 10.18)). Molecular typing: Her-2 positive (2.08 (1.26, 3.43)), Her-2 over-expressing subtype (1.83 (1.22, 2.73)). Factors of examination/inspection: axillary lymph nodes (ALNs) positive on imaging (3.18 (1.68, 6.00)), cancer antigen 15-3 (CA15-3) (4.01 (2.33,6.89)), carcinoembryonic antigen (CEA) (2.13 (1.32-3.43)). This review identified the risk factors for non-SLNM in patients with 1-2 SLN macrometastatic breast cancer. However, additional studies are needed to confirm the above findings owing to the limited number and types of studies included.

裴晓华教授认为,肉芽肿性乳腺炎缠绵难愈、复发率高的特点与"邪留"有关.因此,裴教授从"透邪"理论出发,临床上以祛邪外出、调畅气血为主指导肉芽肿性乳腺炎的治疗.根据本病分期不同,治以温透、清透、透脓、补透等法,并根据辨证进行药物加减,灵活应用发散达表、质清宣泄、清泄透达之品;肿块期结合外用膏药、溻渍、敷贴、艾灸等外治法,引邪外出,促进肿块消散;成脓期结合切开、药捻、药线等外治法,以促进脓液排出、肿块消散、疾病向愈.

Background and aim: The purpose of this study is to explore whether the Xiaozheng pill (XZP) has the effect of anti-hyperplasia of mammary glands (HMG) and to identify the related signaling pathways.Experimental procedure: We analyzed the effective chemical components of the XZP, as well as the key chemical components, key proteins, main biological processes, and pathways in the treatment of HMG; Secondly, the levels of Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Progesterone (P), Raf/ERK/ELK and HIF-1a/bFGF pathways related proteins were detected; Finally, the effect of XZP on metabolites was analyzed by metabolomics.Results and conclusion: In this study, we identified key targets and pathways for XZP therapy of HMG, including EGFR, VEGFA, ER, and Ras signaling pathways. Animal experiments show that XZP can reduce the levels of E2, LH, and FSH and increase the expression of P in HMG mice. XZP can restore the normal structure of breast tissue and reduce ERa, ERb, and PR expression in breast tissue. In addition, metab-olomics results show that XZP also regulates HMG metabolites, including HIF-1a and metabolic path-ways. The Western blot results showed that XZP intervention can reduce the protein expression of p- Raf1, Raf1, p-ERK1/2, ERK1/2, ELK, HIF-1a, and bFGF in the breast tissue of HMG mice. XZP may eliminate abnormal breast hyperplasia through inhibition of apoptosis and angiogenesis, which may be linked with the regulation of the Raf/ERK/ELK and HIF-1a/bFGF signaling pathways in HMG mice. These results suggest that XZP treatment may be beneficial for the management of HMG.(c) 2023 Center for Food and Biomolecules, National Taiwan University. Production and hosting by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

IntroductionDandelion (Pugongying) is one of the most frequently used Chinese herbs for treating lactational mastitis (LM). Pugongying granules, a patented medication primarily comprised of dandelion extract, have been approved by CFDA for LM treatment in China. The aims of this study were to investigate the etiology of LM and the mechanism by which Pugongying granules decrease LM symptoms, with a particular focus on the microbial communities found in breastmilk.MethodsParticipants were recruited from a previously performed randomized controlled trial (Identifier: NCT03756324, ClinicalTrials.gov). Between 2019 and 2020, women diagnosed with unilateral LM at the Beijing University of Chinese Medicine Third Affiliated Hospital were enrolled. In total, 42 paired breastmilk samples from the healthy and affected breasts of the participants were collected. Additionally, 37 paired pre- and post-treatment breastmilk samples from the affected breast were collected from women who received a 3-day course of either Pugongying granules (20 women) or cefdinir (17 women). Clinical outcomes [e.g., body temperature, visual analogue scale (VAS) score for breast pain, the percentage of neutrophils (NE%)] were analyzed pre- and post-treatment, and the breastmilk samples were subjected to 16S rRNA gene sequencing to analyze the alpha and beta diversities and identify significant bacteria. Finally, the relationship between microorganisms and clinical outcomes was analyzed.ResultsThere was no significant difference in fever and pain between the Pugongying group and cefdinir group. The most prevalent bacterial genera in breastmilk were Streptococcus and Staphylococcus. Compared to healthy breastmilk, microbial diversity was reduced in affected breastmilk, and there was a higher relative abundance of Streptococcus. After Pugongying treatment, there was an increase in microbial diversity with significantly higher abundance of Corynebacterium. A negative correlation was found between Corynebacterium, VAS score, and NE%. Treatment with cefdinir did not affect microbial diversity. Taken together, our results show a correlation between LM and reduced microbial diversity, as well as an increased abundance of Streptococcus in affected breastmilk.ConclusionPugongying granules enhanced microbial diversity in breastmilk samples. Given the substantial variation in individual microbiomes, identifying specific species of Streptococcus and Corynebacterium associated with LM may provide additional insight into LM pathogenesis and treatment.