RESUMEN

BACKGROUND: Breast reduction surgery often concern women of childbearing age. However, it can interfere with the ability to breastfeed, whereas the benefits of breastfeeding are well known. Current data in the literature do not provide precise information on the possibilities of breastfeeding after breast reduction surgery. OBJECTIVES: The aim of this study was to assess long-term breastfeeding ability of women after breast reduction performed in our centre. METHODS: This is a retrospective comparative study including patients treated with breast reduction at Saint-Louis Hospital between 2010 and 2017 and who have had children before or after surgery. Operative details were retrieved from medical records and ability to breastfeed was assessed during a phone interview. Breastfeeding before surgery was compared to breastfeeding after surgery. RESULTS: We analysed 21 births before and 35 births after breast reduction. Breastfeeding initiation was similar in the two groups (90% vs. 83%, P=0.7), but the median duration was significantly shorter after breast reduction compared with before (3 weeks vs. 10 weeks; P<0.01), the rate of breastfed child at 3 months was lower after surgery (11% vs. 43%; P<0.01), the use of infant formula was higher after surgery (100% vs. 74%, P<0.01), and we found a higher rate of discontinuation caused by hypogalactia (69% vs. 11%; P<0.001). CONCLUSION: Breastfeeding is possible but more difficult to sustain over time after breast reduction. Patients need to be made aware of that before surgery, and patients who still want to breastfeed should be encouraged at the maternity.

Asunto(s)

RESUMEN

Objective: Based on the secreted frizzled-related protein 2 (SFRP2)-Wnt/ß-catenin signaling pathway, this study explored the effect and mechanism of Cuiru Keli (CRKL) in the treatment of postpartum hypogalactia. Methods: A rat model of postpartum hypogalactia was established by gavaging 2 mL of 1.6 mg/mL bromocriptine mesylate to female rats on the third day after delivery. Female rats with a delivery time difference of less than 48 hours were selected and randomly assigned to 7 groups, including a normal group (without any modeling or medication), a model group, a CRKL low-dose group of model group model rats receiving CRKL at the dose of 3 g/kg, a CRKL medium-dose group of model rats receiving CRKL at the dose of 6 g/kg, a CRKL high-dose group of model rats receiving CRKL at the dose of 9 g/kg, a positive drug group of model rats receiving domperidone at the dose of 3 mg/kg, and a negative control (NC) group of model rats receiving normal saline. Each group contained 6 rats. Except for the normal and model groups, the remaining 5 groups were continuously administered with the respective intervention drugs at the specified doses by gavage once a day for 10 days. Changes in the total litter mass of the offspring in the 7 groups within 10 days were measured, and HE staining was performed to identify pathological changes in the mammary tissue (MT). Six groups of rats (excluding the positive control group) were used to observe the pathological changes of eosinophils in pituitary tissue. ELISA was performed to determine the content of prolactin (PRL) in serum, immunohistochemical staining was used to determine the expression of prolactin receptor (PRLR) in MT, and RT-qPCR was used to determine the mRNA expression of genes related to lactation in MT. Network pharmacology and molecular docking were used to study the therapeutic effect and mechanism of CRKL on postpartum hypogalactia, particularly whether it acted through the SFRP2-Wnt/ß-catenin signaling pathway. The mechanism of CRKL treatment was further validated by detecting mRNA (RT-qPCR) and protein expression (Western blot) of related pathway genes. Cell experiments were conducted using primary culture rat mammary epithelial cells (RMEC) from rat MT. RMEC were divided into four groups, including a normal group (primary culture RMEC, untreated), SFRP2 overexpression group (primary cultured RMEC treated with SFRP2 overexpression vector), SFRP2 overexpression+CRKL group (receiving treatment for SFRP2 overexpression group plus 10% drug-containing serum), and negative control group (primary culture RMEC treated with empty vector). The effect of CRKL on the expression of lactation-related genes FASN, CSN2, and GLUT1 mRNA after SFRP2 overexpression was detected by RT-qPCR. Results: In this study, CRKL was administered at a dose of 3 g/kg in the CRKL low-dose group, 6 g/kg in the medium-dose group, and 9 g/kg in the high-dose group (P<0.05 or P<0.01). Compared with the model group, CRKL at all doses significantly increased the total litter weight gain of the offsprings within 10 days (P<0.05 or P<0.01), and effectively increased lactation (P<0.01), the area of mammary lobules, and the size and filling of acinar cavities. CRKL at all doses also increased the number of eosinophils that secreted PRL in the pituitary gland of the postpartum hypogalactia rat model, and increased the content of PRL in the serum (P<0.05 or P<0.01). CRKL promoted the secretion and expression of PRL in postpartum hypogalactic model rats. In addition, it significantly promoted the expression of genes related to milk fat, milk protein, and lactose synthesis in MT (P<0.05 or P<0.01). Network pharmacology predicted that the Wnt signaling pathway might be a key pathway for CRKL in treating postpartum hypogalactia. The molecular docking results showed that related chemical components in CRKL had good binding ability with CCND1 and SFRP2. Compared with the model group, CRKL at all doses inhibited the expression of SFRP2 gene in vivo (P<0.01) and activated the mRNA and protein expression of CCND1 and c-Myc in the Wnt/ß-catenin signaling pathway in MT (P<0.05 or P<0.01). Cell experiments showed that, compared to the normal group, SFRP2 overexpression reduced the mRNA expression of milk synthesis-related genes FASN, CSN2, and GLUT1 in RMEC (P<0.01). The CCK8 results indicated that 10% of the drug-containing serum was the effective concentration administered to cells (P<0.01). After administering drug-containing serum, the expression of the lactation-related genes FASN, CSN2, and GLUT1 were up-regulated (compared with the SFRP2 overexpression group, P<0.01). Conclusion: CRKL alleviates postpartum hypogalactia through the SFRP2-Wnt/ß-catenin signaling pathway. SFRP2 might be a potential new target for the diagnosis and treatment of postpartum hypogalactia. This reveals a new mechanism of CRKL in treating postpartum hypogalactia and promotes its clinical application.

Asunto(s)

RESUMEN

Objetivo: Realizar una revisión de la literatura para analizar si la estimulación de puntos de acupuntura aumenta la cantidad de leche producida durante la lactancia. Método: Se recopilaron estudios de cinco bases de datos electrónicas siguiendo las recomendaciones internacionales para la elaboración de revisiones sistemáticas y metaanálisis. Los criterios de elegibilidad fueron artículos de texto completo en inglés o español con diseño de ensayos clínicos y estudios observacionales, sin restricción en el tiempo de publicación, en los cuales se hubiera evaluado el efecto de la estimulación de puntos de acupuntura en la mejora de la cantidad de lactancia mediante acupuntura convencional, electroacupuntura, láser, agujas de fuego, estimulación manual, Tui Na o catgut. Dos autores extrajeron de forma independiente los datos de las características y los resultados principales de los estudios seleccionados para su inclusión. Se realizaron las evaluaciones de riesgo de sesgo y de calidad (GRADE). Para la síntesis cuantitativa se calculó la diferencia de medias estandarizada para cada estudio individual seleccionado y luego se combinaron los datos mediante un metaanálisis de efectos aleatorios. Resultados: En la presente revisión se incluyeron un total de 14 estudios, la mayoría de ellos mostraron riesgo de sesgo y una calidad moderada. El metaanálisis mostró que la estimulación manual del punto de acupuntura aumenta la cantidad de leche materna (DME 95% IC=1,63 [1,13-2,13]; p<0,0001). Conclusión: La literatura sugiere que la estimulación manual de puntos de acupuntura mejora la cantidad de leche producida durante de lactancia.(AU)

Objective: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. Method: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. Results: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI=1.63 [1.13-2.13]; p<0.0001). Conclusion: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.(AU)

Asunto(s)

RESUMEN

Background: Lactation insufficiency is a prevalent challenge for nursing mothers globally. There is a growing interest in the use of herbal galactagogues for enhancing lactation, but their therapeutic efficacy and underlying mechanisms need thorough investigation. This study aims to investigate the efficacy and mechanisms of action of herbal galactagogues in addressing lactation insufficiency by utilizing real-world data and employing a network analysis approach. Methods: Our retrospective study used Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000) to identify 490 patients diagnosed with lactation insufficiency from 2000 to 2018. We analyzed demographic characteristics, co-existing diseases, and prescription patterns for both users and non-users of Chinese herbal products (CHP). Additionally, we utilized a network analysis approach to explore potential compounds and targets in the most frequently used CHP, the Wang Bu Liu Xing and Lu Lu Tong herb pair (WLHP) combination. Results: Out of 490 patients, 81% were CHP users. There were no significant differences in demographic characteristics between CHP users and non-users, but we observed a notable divergence in the prevalence of co-existing diseases. A detailed examination of CHP prescriptions revealed the predominance of WLHP, prompting further investigation. Comprehensive analysis identified 29 major compounds in WLHP, which were associated with 215 unique targets. Intersection analysis revealed 101 overlapping targets between WLHP and lactation, suggesting their potential as therapeutic targets for lactation insufficiency treatment. Topological analysis of the protein-protein interaction (PPI) network identified 13 hub genes potentially crucial for the therapeutic effect of WLHP. Functional enrichment analysis showed that these targets were involved in critical lactation regulation pathways, including the PI3K-Akt signaling pathway, prolactin signaling pathway, estrogen signaling pathway, and AMPK signaling pathway. Discussion: This study emphasizes the potential of CHP, specifically the WLHP combination, in managing lactation insufficiency. The multi-compound, multi-target approach of WLHP and its interaction with key biological processes and signaling pathways offer valuable insights into the underlying mechanisms of its therapeutic effects. These findings warrant further experimental validation and can guide future research and clinical applications of CHP in lactation insufficiency treatment.

RESUMEN

OBJECTIVE: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. METHOD: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. RESULTS: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001). CONCLUSION: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Asunto(s)

RESUMEN

This study aims to investigate the ameliorative effect of Codonopsis lanceolata polysaccharide (PCL) on mice with hypogalatia induced by a high-fat diet (HFD) and the potential underlying mechanism. We found that oral administration of PCL demonstrated significant benefits in countering the negative effects of HFD, including weight gain, hepatic steatosis, mesenteric adipocyte hypertrophy, and abnormal glucose/lipid metabolism. In addition, PCL improved mammary gland development and enhanced lactogenesis performance. Histologically, PCL ameliorated the retardation of ductal growth, reduced mammary fat pad thickness, improved the incomplete linear encapsulation of luminal epithelium and myoepithelium, and increased the proliferation of mammary epithelial cells. Flow cytometry analysis showed that PCL mitigated the detrimental effects of HFD on mammary gland development by promoting the proliferation and differentiation of mammary epithelial cells. Mechanistic studies revealed that PCL upregulated the levels of prolactin (PRL) and its receptor (PRLR) in the mammary gland, activated JAK2/STAT5 signaling pathway, and increased the expression of p63, ERBB4, and NRG1. Overall, PCL can ameliorate HFD-induced hypogalactia by activating PRLR-mediated JAK2/STAT5 signaling. Our findings offer a methodological and theoretical foundation for investigating the functional constituents of traditional Chinese medicine in the treatment of hypogalactia.

Asunto(s)

RESUMEN

INTRODUCTION: Human lactation should be taken into account as an important issue for the international agenda. Despite advances in lactation information and knowledge, insufficient milk production is still a concern for mothers and health practitioners, including International Board Certified Lactation Consultants and others. Primary hypogalactia, or insufficient milk production is uncommon, but should be considered when there is poor weight gain and decreased urine output in infants despite good latch-on and suckling, or anatomic differences in the physical exam of the lactating breast. MAIN ISSUE: This case series presents three cases illustrating insufficient milk production resulting in infants who experienced significant dehydration and poor weight gain. MANAGEMENT: Primary hypoplasia was diagnosed by means of a thorough interview and physical examination that entailed a consultation with a physician who was also an International Board Certified Lactation Consultant. CONCLUSION: Awareness of an infant's feeding needs and proper evaluation of a child's health status is paramount if health care providers are to identify the important factors contributing to breastfeeding problems. In some instances, breastfeeding goals cannot be achieved, and then the provider's role becomes support in coming to terms with persistent insufficient milk production, and coordinating appropriate supplementation to meet each baby's nutritional needs.

Asunto(s)

RESUMEN

Herbal galactagogues have been widely used as a treatment for postpartum hypogalactia due to the potential side effects associated with pharmacological therapy. Tri-Than-Thip (Tri-TT) is a Thai herbal medicine remedy that contains three main components: Cassia fistula, Pithecellobium dulce, and Ficus benjamina. These components are believed to have properties that contribute to milk production. However, despite the traditional use of Tri-TT, there is a lack of academic evidence supporting its efficacy in enhancing milk production. Therefore, the purpose of this study was to investigate the effect of Tri-TT on milk production and determine if it has a galactagogue effect. The weight suckle weight model was used to determine total milk production in lactating rats, while histological analysis was performed to assess the alveolar diameter of the mammary gland. The findings of this study revealed a significant increase in total milk production among lactating rats treated with 500 mg/kg of Tri-TT, compared to the control group. Furthermore, both the Tri-TT and Domperidone-treated groups exhibited a larger alveolar diameter of the mammary gland in comparison to the control group. In summary, these findings provide supportive evidence for the galactagogue activity of Tri-TT. The observed enhancement in milk production may be associated with Tri-TT could potentially be attributed to its ability to widen the alveolar diameter of the mammary gland, thereby facilitating increased milk volume.

Asunto(s)

RESUMEN

Objective To analyze the efficacy of Jianpi Shugan Tongru prescription combined with staged medicinal diet therapy in the treatment of postpartum hypogalactia of qi and blood deficiency pattern.Methods Patients with postpartum hypogalactia of qi and blood deficiency pattern who gave birth in Jinhua People's Hospital from March 2022 to March 2023 were selected as the research subjects,and were divided into control group(conventional treatment)and test group(treated with Jianpi Shugan Tongru prescription combined with staged medicinal diet therapy).The clinical efficacy,TCM syndrome scores,lactation-related indexes,prolactin(PRL)and estradiol(E2)levels were compared between the two groups.Results A total of 100 patients were included in the study,including 50 patients in the test group and 50 in the control group.After treatment,the total effective rate and the TCM syndrome scores in the test group were better than those in the control group(P<0.05),the time to initiation of lactation,breast filling score and milk production in the test group were better than those in the control group(P<0.05),the PRL level in the test group was higher than that in the control group,the E2 level was lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Jianpi Shugan Tongru prescription combined with staged medicinal diet therapy has a good effect on the treatment of patients with postpartum hypogalactia of qi and blood dificiency pattern,and can improve the TCM syndrome scores and lactation-related indexes of patients,and can regulate the levels of PRL and E2.

RESUMEN

O aleitamento materno apresenta múltiplos benefícios para a saúde da mãe e do bebê. No entanto, muitos são os fatores que podem interferir na amamentação, destacando-se a percepção de baixa produção láctea. Há evidências de que a acupuntura auricular pode auxiliar nesse contexto. Este estudo tem o objetivo de avaliar por meio de ensaio clínico randomizado se a acupuntura auricular apresenta eficácia na manutenção do aleitamento materno exclusivo e complementado até os seis meses de vida do bebê. Trata-se de um estudo piloto randomizado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e foi registrada na Plataforma Rebec (Registro Brasileiros de Ensaios Clínicos). A pesquisa foi realizada no Banco de Leite Humano do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram incluídas 49 participantes com idade igual ou superior a 18 anos, que estavam entre o 5° e o 30° dia pós-parto e que tinham queixa de baixa produção láctea. As participantes foram randomizadas em três grupos: Acupuntura auricular, Acupuntura sham e Placebo. O estudo foi realizado em duas fases: fase de intervenção, no qual foram realizados 5 atendimentos de aleitamento materno para todos os grupos e aplicação da intervenção conforme a alocação da participante no grupo sorteado e a fase de seguimento telefônico em que realizamos ligações até os 6 meses de vida criança. As frequências absolutas e relativas foram calculadas para as variáveis qualitativas. As comparações entre os grupos no tempo basal para as variáveis qualitativas explicativas foram realizadas considerando o teste quadrado, já o teste não paramétrico de Kruskal Wallis foi aplicado para comparar os grupos em relação às variáveis quantitativas. Foram construídos modelos de regressão de efeitos mistos para comparar os tempos e os grupos em relação aos desfechos quantitativos e análise por protocolo. As participantes do grupo três (controle - cuidado usual) eram mais velhas, com média de idade de 36 anos (P-valor 0,0079), identifica-se que a acupuntura auricular teve evidência clínica no efeito protetivo do AME e AMC na fase de seguimento telefônico, pois 2 participantes do grupo de acupuntura auricular ainda amamentavam exclusivamente até os seis meses de vida do bebê de modo exclusivo e nos demais grupos nenhuma participante amamentava. Do ponto de vista estatístico não houveram diferenças significativas.

Breastfeeding has multiple benefits for the health of mother and baby. However, there are many factors that can interfere with breastfeeding, the perception of low milk production, is being an important cause of early weaning among nursing mothers. In this sense Ear acupuncture can help to increase milk production. This study aims to evaluate, through a randomized clinical trial, whether auricular acupuncture is effective in maintaining exclusive and supplemented breastfeeding until the baby is six months old. This is a randomized pilot study. The study was approved by the Research Ethics Committee and was registered on the Rebec Platform (Brazilian Registry of Clinical Trials). The research was realized at the Human Milk Bank of Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Forty-nine participants aged 18 years or over, who were between the 5th and 30th day postpartum and who complained of low milk production, were included. The Participants were randomized into three groups: intervention group, sham acupuncture and placebo. The study was carried out in two phases: intervention phase, in which 5 breastfeeding sessions were carried out for all groups and application of the intervention according to the participant's allocation in the drawn group and the telephone follow-up phase in which we made calls until 6 months of child life. Absolute and relative frequencies were calculated for qualitative variables. Comparisons between groups at baseline for qualitative explanatory variables were performed using the chi-square test, while the non-parametric Kruskal Wallis test was applied to compare groups in relation to quantitative variables. Mixed-effects regression models were built to compare times and groups against quantitative outcomes and analysis per protocol. Participants in group three (control - usual care) were older, with a mean age of 36 years (P-value 0.0079), it is identified that auricular acupuncture had clinical evidence in the protective effect of exclusivebreastfeeding and complementary breastfeeding in the telephone follow-up 2 participants in the auricular acupuncture group still exclusively breastfed until the baby's six months of life and in the other groups none of the participants breastfed. From a statistical point of view there were no significant differences.

Asunto(s)

RESUMEN

AIM: To investigate the effect of an effective component total sterone (TSR) of Echinops latifolius Tausch, the main component of a Chinese patent medicine Cuiru Keli (national drug standard WS3-413 (Z-085)-2003 (Z), on lactation and its possible mechanism. METHODS: After mating between male and female SD rats, 60 female rats were randomly divided into normal control group, model group, TSR low-dose and high-dose groups and prolactin granule positive control group, with 12 female rats in each group and 8 newborn rats in each nest. In addition to the normal control group, the rats in each group were intraperitoneally injected with levodopa 2 mg/kg once a day for 7 days from the second day of delivery. The rats in the normal control group were given normal saline by gavage once a day for 14 days. From the beginning of self-sufficiency, the single lactation of the female rats was measured every day until the 14th day, and then the female rats in each group were killed. Pathological HE staining was used to observe the morphological changes of mammary gland tissue in each group. ELISA was used to detect the levels of serum prolactin (PRL) and 5-hydroxytryptamine (5-HT). Immunohistochemistry was used to detect the distribution of PRL in mammary gland tissue of each group. Furthermore, Real-time qPCR was used to detect the expression of milk protein, milk fat related genes β-casein, FAS, ACC and the expression of canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2 in mammary gland of each group. RESULTS: Both low and high dose TSR could significantly increase the single lactation volume, improve the pathological morphology of mammary gland, and increase the serum levels of PRL and 5-HT. TSR increased the distribution of PRL and up-regulated the expression of milk protein, milk fat related genes β-casein, FAS, ACC and canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2.CONCLUSION: TSR can significantly promote lactation in lactation deficient rats, and its mechanism may be related to promoting the release of PRL and 5-HT in serum, increasing the distribution of PRL in mammary gland, up-regulating the milk protein and milk fat related genes and activating the canonical Wnt signal.

RESUMEN

The negative effect of mastitis on lactation is well established, yet the mechanisms causing reduced milk production in the afflicted dairy cow are not. As one of the major inflammatory diseases in the dairy industry, mastitis has rightly received considerable research interest for decades. However, the focus on distinct, pathologic effects in mastitic glands has largely overlooked systemic effects on noninflamed mammary glands. This is particularly evident in the severe, acute response to the potent inflammatory mediator, lipopolysaccharide (LPS). Whereas secretory cell death, impaired tight junctions, and migration of leukocytes are locally restricted to an inflamed, LPS-challenged gland, changes in milk yield and milk components may be detectable in all mammary glands. Further, these differences extend to the mammary transcriptome. Notably, few transcriptomic studies have been designed to test for effects of systemic mediators of inflammation on gene expression. Relevant changes in the noninflamed mammary gland, identified through biochemical analyses and transcriptional studies, warrant further research. Current evidence suggests proinflammatory cytokines play a role in regulating lactose synthesis, but additional candidates and mechanisms continue to be identified. Ultimately, understanding how systemic mediators of inflammation affect mammary function may lead to the development of interventions that enable more efficient milk production without sacrificing the benefits of inflammation.

Asunto(s)

RESUMEN

O aleitamento materno apresenta múltiplos benefícios para a saúde da mãe e do bebê. No entanto, muitos são os fatores que podem interferir na amamentação, destacando-se a percepção de baixa produção láctea. Há evidências de que a acupuntura auricular pode auxiliar nesse contexto. Este estudo tem o objetivo de avaliar por meio de ensaio clínico randomizado se a acupuntura auricular apresenta eficácia na manutenção do aleitamento materno exclusivo e complementado até os seis meses de vida do bebê. Trata-se de um estudo piloto randomizado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e foi registrada na Plataforma Rebec (Registro Brasileiros de Ensaios Clínicos). A pesquisa foi realizada no Banco de Leite Humano do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram incluídas 49 participantes com idade igual ou superior a 18 anos, que estavam entre o 5° e o 30° dia pós-parto e que tinham queixa de baixa produção láctea. As participantes foram randomizadas em três grupos: Acupuntura auricular, Acupuntura sham e Placebo. O estudo foi realizado em duas fases: fase de intervenção, no qual foram realizados 5 atendimentos de aleitamento materno para todos os grupos e aplicação da intervenção conforme a alocação da participante no grupo sorteado e a fase de seguimento telefônico em que realizamos ligações até os 6 meses de vida criança. As frequências absolutas e relativas foram calculadas para as variáveis qualitativas. As comparações entre os grupos no tempo basal para as variáveis qualitativas explicativas foram realizadas considerando o teste quadrado, já o teste não paramétrico de Kruskal Wallis foi aplicado para comparar os grupos em relação às variáveis quantitativas. Foram construídos modelos de regressão de efeitos mistos para comparar os tempos e os grupos em relação aos desfechos quantitativos e análise por protocolo. As participantes do grupo três (controle - cuidado usual) eram mais velhas, com média de idade de 36 anos (P-valor 0,0079), identifica-se que a acupuntura auricular teve evidência clínica no efeito protetivo do AME e AMC na fase de seguimento telefônico, pois 2 participantes do grupo de acupuntura auricular ainda amamentavam exclusivamente até os seis meses de vida do bebê de modo exclusivo e nos demais grupos nenhuma participante amamentava. Do ponto de vista estatístico não houveram diferenças significativas

Breastfeeding has multiple benefits for the health of mother and baby. However, there are many factors that can interfere with breastfeeding, the perception of low milk production, is being an important cause of early weaning among nursing mothers. In this sense Ear acupuncture can help to increase milk production. This study aims to evaluate, through a randomized clinical trial, whether auricular acupuncture is effective in maintaining exclusive and supplemented breastfeeding until the baby is six months old. This is a randomized pilot study. The study was approved by the Research Ethics Committee and was registered on the Rebec Platform (Brazilian Registry of Clinical Trials). The research was realized at the Human Milk Bank of Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Forty-nine participants aged 18 years or over, who were between the 5th and 30th day postpartum and who complained of low milk production, were included. The Participants were randomized into three groups: intervention group, sham acupuncture and placebo. The study was carried out in two phases: intervention phase, in which 5 breastfeeding sessions were carried out for all groups and application of the intervention according to the participant's allocation in the drawn group and the telephone follow-up phase in which we made calls until 6 months of child life. Absolute and relative frequencies were calculated for qualitative variables. Comparisons between groups at baseline for qualitative explanatory variables were performed using the chi-square test, while the non-parametric Kruskal Wallis test was applied to compare groups in relation to quantitative variables. Mixed-effects regression models were built to compare times and groups against quantitative outcomes and analysis per protocol. Participants in group three (control - usual care) were older, with a mean age of 36 years (P-value 0.0079), it is identified that auricular acupuncture had clinical evidence in the protective effect of exclusivebreastfeeding and complementary breastfeeding in the telephone follow-up 2 participants in the auricular acupuncture group still exclusively breastfed until the baby's six months of life and in the other groups none of the participants breastfed. From a statistical point of view there were no significant differences

Asunto(s)

RESUMEN

Introducció: L’anquiloglòssia és una malformació lingualque pot causar dificultat en els moviments de la llengua ide la mandíbula dels nadons, i que provoca dolor als mugrons de la mare, una succió dèbil i una inadequada transferència de llet durant les preses al pit. Això pot ocasionaruna pèrdua de pes i un deslletament precoç si no es detecta i no es tracta. Presentem el cas de dos nadons ambanquiloglòssia i dificultats en la lactància materna que esvan complicar amb una deshidratació hipernatrèmica.Observació clínica: Ambdós nadons van patir una deshidratació hipernatrèmica sense signes d’infecció als deu diesde vida. Tots dos tenien anquiloglòssia, no tractada en elprimer cas, i no diagnosticada en el segon. L’anquiloglòssiadel segon cas es va diagnosticar posteriorment, arran de lapresentació del primer. La frenectomia feta al primer casva permetre la relactació completa, cosa que no es va aconseguir en el segon.Comentaris: Les dificultats que el tel sublingual curt potprovocar a la lactància poden ocasionar una deshidratacióhipernatrèmica greu. És important detectar l’anquiloglòssiaper poder fer un seguiment estret d’aquests nadons i tractar els casos simptomàtics. L’exploració del tel sublingualhauria de ser sistemàtica en l’exploració física inicial detots els nounats.(AU)

Introducción: La anquiloglosia es una malformación lingual quepuede causar dificultad en los movimientos de la lengua y de lamandíbula de los recién nacidos, provocando dolor en los pezonesde la madre, una succión débil y una inadecuada transferencia deleche durante las tomas al pecho. Ello puede ocasionar una pérdida de peso y un destete precoz si no se detecta y no se trata.Presentamos el caso de dos recién nacidos con anquiloglosia ydificultades en la lactancia materna que se complicaron con unadeshidratación hipernatrémica Observación clínica: Ambos sufrieron una deshidratación hipernatrémica sin signos de infección a los diez días de vida. Ambostenían anquiloglosia, sin tratar en el caso 1 y sin diagnosticar enel caso 2. La anquiloglosia del segundo caso se diagnosticó posteriormente, tras la presentación del primero. La frenectomía realizada en el primer caso permitió la relactación completa, que no selogró en el segundo.Comentarios: Las dificultades que el frenillo sublingual corto puedeprovocar en la lactancia pueden ocasionar una deshidratación hipernatrémica grave. Es importante detectar la presencia de anquiloglosia para poder realizar un seguimiento estrecho de estos recién nacidos y tratar los casos sintomáticos. La exploración delfrenillo sublingual debería de ser sistemática en la exploración física inicial de todos los neonatos.(AU)

Introduction: Ankyloglossia is a lingual malformation that may causedifficulty in tongue and mandibular movements in the newborn resulting in nipple pain in the mother, weak suction and inadequatemilk transfer during breastfeeding, which may lead to weight lossand an early cessation of breastfeeding if undetected and untreated.We report the case of two tonguetied neonates with breastfeedingdifficulties that presented with neonatal hypernatremic dehydration.Case report: Both infants experienced a hypernatremic dehydration, with no signs of infection, at 10 days of life. Both had ankyloglossia, which was untreated in case 1 and undiagnosed in case 2.The undetected ankyloglossia of case 2 was diagnosed a posterioriafter the identification of case 1. The frenotomy eventually performed in case 1 enabled complete relactation, which was not achieved in case 2.Comments: Breastfeeding difficulties caused by tonguetie maylead to severe hypernatremic dehydration. It is important to detectthe presence of ankyloglossia in all affected newborns so thatsymptomatic cases can be closely monitored and treated. Screening for ankyloglossia should be routinely performed at the initialphysical examination of all neonates.(AU)

Asunto(s)

RESUMEN

Background: Hypogalactia is the common condition, especially in preterm deliveries. Some herbs in Indian medicines such as Lepidium sativum L. (L. sativum) have galactogogeus effects. The galactogogeus effect of L. sativum (Chandrashoora) has not been quantified in randomized control trials in humans till date. We intend to study the galactogogeus effects of L. sativum in hypogalactic mothers through an open-label noncross-over trial. Materials and methods: The target population were women who had delivered infants <32 weeks gestation with no lower limit to gestational age and their babies admitted in neonatal intensive care unit for prematurity. Participants who were taking specific drugs as a result of their primary illnesses, such as chemotherapy, sedatives, or antiseziure medications, were excluded. The randomization was achieved with computer-generated random number table. The experimental group (n = 23) received 2.5 g of L. sativum (Chandrashoora) seeds each day, soaked in luke warm water for half an hour in the morning, along with instructions about how to take the seeds. The control group did not receive any medication (n = 23). According to the institutional procedure, participants were trained to express breast milk six times using a breast pump. The amount of milk extracted was measured every day for 28 days. The difference in milk production between the two groups at 28 days was the primary endpoint. The secondary endpoint was to asses if any of the trial medicines had any adverse drug effects. Results: A total of 46 participants completed the study till 28 days. In both groups, demographic factors were comparable. The study group surpassed the control group in terms of breast milk volume slowly and reached statistical significance (P = 0.00002) after 28 days of therapy. No adverse drug effects were reported by the participants. Conclusion: There was statistically significant improvement in breast milk production at 28 days in hypogalactic mothers in the experimental group. L. sativum can be used as cheap alternatives to costly medicines to improve lactation with minimal costs and no adverse drug reactions.

RESUMEN

Based on the set visualization analysis system and Apriori algorithm, the acupoint selection rule for the treatment of postpartum hypogalactia with acupuncture and moxibustion was explored. The clinical research articles relevant with postpartum hypogalactia treated with acupuncture and moxibustion were retrieved from CNKI, Wanfang and VIP databases till July 15, 2019 since the database establishment. According to the inclusion and exclusion criteria, the articles were screened and the acupoint prescriptions were extracted. On the base of the set visualization analysis system and Apriori algorithm, the characteristics of acupoints and the common acupoint combination were analyzed for the treatment of postpartum hypogalactia with acupuncture and moxibustion. Totally, 120 articles are included and 72 acupoints are extracted for the treatment of postpartum hypogalactia with acupuncture and moxibustion, of which, the conception vessel and the stomach meridian of foot-yangming are the most commonly used and the combination of Danzhong (CV 17), Rugen (ST 18), Zusanli (ST 36), Shaoze (SI 1) and Taichong (LR 3) is of the high frequency. The analyses of set visualization, acupoint association rule and acupoint combination network consistently indicate that the above mentioned 5 acupoints are the basic combination for the treatment of postpartum hypogalactia with acupuncture and moxibustion, co-acting on tonifying and nourishing qi and blood, smoothing liver qi and relieving stagnation, activating circulation and promoting lactation. This combination effectively treats postpartum hypogalactia caused by the source insufficiency of transformation of qi and blood and qi stagnation.

Asunto(s)

RESUMEN

Mammary gland dysplasia and postpartum hypogalactia often occur in humans and in the livestock breeding industry. However, their underlying mechanisms are not clear yet. Mifepristone, which has a high affinity for progesterone (P4) and glucocorticoid receptors, was exploited here to induce the disorders of mammary gland development and lactation. Four strategies were devised for treating pregnant mice with mifepristone. In the first strategy, mice were administered 1.20 mg mifepristone/kg body weight (BW) on pregnancy day 4 (Pd4). In the second strategy, mifepristone was administered to mice twice, with 1.20 mg/kg BW on Pd4 and 0.40 mg/kg BW on Pd8. In the third strategy, mice were treated with a single dose of 0.40 mg mifepristone/kg BW on Pd8. In the fourth strategy, mice were administered 0.40 mg mifepristone/kg BW on Pd8 and 0.20 mg mifepristone/kg BW on Pd12. The results suggested that mifepristone administration at the dose of 1.20 mg/kg BW on Pd4 caused significant reduction in milk production on lactation day 1 (Ld1), Ld2, and Ld3, as assessed using a weigh-suckle-weigh assay. Mammary ß-casein expression, milk yields, litter growth rates, gland structure, and serum concentrations of 17-ß estrogen (E2), P4, prolactin (PRL), growth hormone (GH), corticosterone (CORT) and oxytocin (OT) as well as the receptors of these hormones were determined during pregnancy or lactation after performing the first (Pd4) strategy. The results demonstrated that mifepristone administration during early pregnancy decreased ß-casein expression, milk yields and litter growth rates, induced fewer alveoli, enlarged alveolar lumina, and altered the levels of E2, P4, PRL, GH, CORT, and OT as well as the mRNA expression of these hormonal receptors during pregnancy or early lactation. The present study on pregnant mice treated with mifepristone offers an innovative murine model to study the mechanism underlying mammary gland dysplasia and postpartum hypogalactia.

RESUMEN

OBJECTIVE: To observe the effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and nutrient composition in postpartum hypogalactia. METHODS: A total of 62 women with postpartum hypogalactia were randomized into an observation group (31 cases, 3 cases dropped off) and a control group (31 cases, 3 cases dropped off). Electroacupuncture was exerted at Shaoze (SI 1) in the observation group and at Shangyang (LI 1) in the control group, 10 Hz in frequency, 30 min each time, once a day. The treatment for 5 times as one course and 3 courses of treatment were required totally. Separately, before treatment and at the end of 1 course and 3 courses of treatment, the breast milk volume was measured and the composition was analyzed. The breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density were observed in the two groups. After treatment, the clinical effect was compared between the two groups. RESULTS: In the observation group, after 1 course of treatment, the breast milk volume and the values of lactose and protein in the breast milk were increased as compared with those before treatment, the breast milk energy and density were increased as compared with those before treatment (all P<0.05). After 3 courses of treatment, the breast milk volume and the values of nutrient composition (lactose, fat and protein) were improved as compared with those before treatment, and the breast milk energy and density were increased obviously as compared with those before treatment in the observation group (all P<0.05). In the control group, after 1 course and 3 courses of treatment, only breast milk volume was increased obviously as compared with that before treatment (both P<0.05). After 1 course of treatment, the nutrient composition (lactose and protein), breast milk energy and density in the observation group were higher than those in the control group (all P<0.05). After 3 courses of treatment, the levels of breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density in the observation group were all higher than those in the control group (all P<0.05). The effective rate was 92.9% (26/28) in the observation group, which was higher than 17.9% (5/28) in the control group (P<0.05). CONCLUSION: Electroacupuncture at Shaozhe (SI 1) increases breast milk volume in patients with postpartum hypogalactia and promotes the production of the nutrient composition in breast milk, as well as the breast milk energy and density.

Asunto(s)

RESUMEN

OBJECTIVE@#To observe the effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and nutrient composition in postpartum hypogalactia.@*METHODS@#A total of 62 women with postpartum hypogalactia were randomized into an observation group (31 cases, 3 cases dropped off) and a control group (31 cases, 3 cases dropped off). Electroacupuncture was exerted at Shaoze (SI 1) in the observation group and at Shangyang (LI 1) in the control group, 10 Hz in frequency, 30 min each time, once a day. The treatment for 5 times as one course and 3 courses of treatment were required totally. Separately, before treatment and at the end of 1 course and 3 courses of treatment, the breast milk volume was measured and the composition was analyzed. The breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density were observed in the two groups. After treatment, the clinical effect was compared between the two groups.@*RESULTS@#In the observation group, after 1 course of treatment, the breast milk volume and the values of lactose and protein in the breast milk were increased as compared with those before treatment, the breast milk energy and density were increased as compared with those before treatment (all <0.05). After 3 courses of treatment, the breast milk volume and the values of nutrient composition (lactose, fat and protein) were improved as compared with those before treatment, and the breast milk energy and density were increased obviously as compared with those before treatment in the observation group (all <0.05). In the control group, after 1 course and 3 courses of treatment, only breast milk volume was increased obviously as compared with that before treatment (both <0.05). After 1 course of treatment, the nutrient composition (lactose and protein), breast milk energy and density in the observation group were higher than those in the control group (all <0.05). After 3 courses of treatment, the levels of breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density in the observation group were all higher than those in the control group (all <0.05). The effective rate was 92.9% (26/28) in the observation group, which was higher than 17.9% (5/28) in the control group (<0.05).@*CONCLUSION@#Electroacupuncture at Shaozhe (SI 1) increases breast milk volume in patients with postpartum hypogalactia and promotes the production of the nutrient composition in breast milk, as well as the breast milk energy and density.

Asunto(s)

RESUMEN

Objective: To explore the regulatory effect of malt alkaloid on prolactin (PRL) secretion in the model rat with postpartum hypogalactia induced by bromocriptine based on dopamine D2 receptor, and determine the active fraction of the malt with galactogogue effect. Methods: The postpartum hypogalactia model was established by intragastric administration of bromocriptine mesylate. After the model was successfully established, all groups were given corresponding drug treatment. The concentration of serum PRL, estradiol (E2) and progesterone (P) in each group was detected by ELISA kits. HE staining was used to observe the pathologic changes of breast tissue. RT-PCR was used to determine the mRNA levels of prolactin receptor (PRLR) and dopamine D2 receptor (DRD2) in pituitary gland of rats. Results: Compared with the control group, the levels of serum PRL, P, and E2 were significantly decreased in the model group as well as the mRNA expression of the pituitary PRL cells. But the mRNA expression of the pituitary DRD2 in the model group was significantly increased compared with the control group. Compared with the model group, the malt total alkaloid significantly increased the volume of mammary lobule and dilated the duct. There was a lot of milk in the duct and acinar in the malt total alkaloid group. Besides, the total alkaloids increased the concentration of serum PRL, P, and E2 and the mRNA expression of the pituitary PRL cells, and decreased the mRNA expression of the pituitary DRD2. Conclusion: The primary the active fraction of malt for galactogogue action is total alkaloids, and its mechanism may be related to promoting PRL secretion, increasing serum PRL receptor level and decreasing the mRNA expression of dopamine D2 receptor.