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

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Objective. We aimed to assess the impact of an expressive arts therapy combined with progressive muscle relaxation following music on mental health (anxiety and hope) in patients with gynecological malignancies undergoing surgery. Methods. This was a nonrandomized controlled trial. Eligible patients had a primary or recurrent gynecological malignancy scheduled to be treated with surgery. The intervention consisted of three sessions (preoperation, postoperation, and predischarge) during the perioperative period. Firstly, before starting the first session of intervention, all patients completed three questionnaires including a Hospital Anxiety and Depression Scale (HADS), a Herth Hope Index (HHI), and a State Anxiety Inventory (SAI), and the intervention group patients also had to complete the SAI questionnaire again after completing the intervention. Secondly, after the second session of intervention, all patients completed the SAI questionnaire, with the intervention group completed the SAI questionnaire before the intervention. Thirdly, after the third session of intervention, all patients completed HHI and SAI questionnaires, with the intervention group completed the SAI questionnaire before the intervention. Also, to subjectively rate the benefit of expressive arts therapy, the intervention group additionally completed a separate, supplemental questionnaire. Results. A total of 116 patients were enrolled and 110 included in the final analysis. No group differences were found for HHI scores between the intervention and control participants (Cohen’s d = 0.19, P = 0.31 ), although there was a substantial improvement in intervention participants’ HHI scores compared to the standard care control participants. There was a statistically significant improvement in intervention participants’ SAI from preintervention to postintervention of preoperation (Cohen’s d = −0.23, P = 0.002 ) and postoperation (Cohen’s d = −0.34, P ≤ 0.001 ). However, no differences were observed for the predischarge period (Cohen’s d = −0.09, P = 0.118 ). Besides, a supplemental questionnaire indicated that 52 (98%) patients felt that expressive arts therapy was beneficial. Conclusions. Expressive art therapy combined with progressive muscle relaxation under music may be of some effect on alleviating perioperative anxiety in patients with gynecologic malignancies. Therefore, further relevant studies with large samples and multicenters are urgently needed to provide a reliable evidence-based basis for perioperative psychological care of patients with gynecologic malignancies and to promote rapid recovery of patients. It is recommended that further art therapy studies to examine the impact of patient-tailored arts therapy interventions on spiritual well-being in patients with gynecological malignancies, especially in the perioperative period.

Introduction：Venous thromboembolism (VTE), is a frequent postoperative complication of gynecologic malignancies during perioperative period.Although a number of risk factors for perioperative VTE with gynecological malignancies have been reported, the findings are diverse or even contradictory .In addition, most of the existing studies were retrospective case-control studies with small sample sizes .This study was a prospectively matched case-control study and aimed to specifically explore the risk factors related to surgery for perioperativeVTE in gynecologic malignancies.Material and methods：Overall,734 patients with gynecologic malignancies were enrolled in this study.54 patients who developed VTE were included as the case group. A total of 270 non-VTE patients matched in a ratio of 1:5 as a control group with the matched principle of the same ethnicity and similar date of surgery (difference ± 3 days). The demographic characteristics, clinical data, laboratory tests, surgical data, and data related to the occurrence of VTE were collected during the follow-up period. Conditional logistic regression models were used for univariate and multifactorial analyses. Factors related to surgical treatment, especially those could be intervened and prevented, were used as target factors, which were gradually corrected by demographic data, clinical data, laboratory tests and other factors related to surgery, and sensitivity analysis was performed.Results:The results of univariate analysis showed that age, place of residence, occupation, high-fat diet, menopause, comorbid chronic diseases, duration of upper extremity indwelling needle retention, disease diagnosis, sleep during hospitalization, admission albumin, surgical approach , duration of intensive care unit(ICU)admission, start of anticoagulant use, time to resume postoperative anal evacuation, duration of bed rest, duration of drinking abstinence, difference between postoperative and admission Caprini scores,duration of abdominal drainage tube retention, and intraoperative bleeding were risk factors for VTE in patients with perioperative gynecologic malignancies (P<0.05). Stepwise corrected multifactorial conditional logistic regression analysis showed that admission albumin<46.40 g/L and large difference between postoperative and admission Caprini scores were risk factors for the development of VTE in patients with gynecologic malignancies in the perioperative period, and the risk of VTE in patients with admission serum albumin<46.40 g/L was 4.885 times higher than that in patients with admission serum albumin≥46.40 g/L; The larger difference between postoperative and admission Caprini scores, the higher the risk of VTE, and a 1-point increase in the difference between postoperative and admission Caprini scores was associated with a 2.174-fold increase in the risk of VTE (95% CI: 1.255 to 3.766, P= 0.006).Conclusions: The main risk factors for perioperative VTE in gynecologic malignancies are serum albumin lower than 46.40 g/L and large difference between postoperative and admission Caprini scores. More attention should be paid to the dynamic changes of serum albumin and Caprini scores of patients in the perioperative period and those factors should be targeted to intervene in order to reduce the perioperative VTE.