Lymphatic research and biology最新文献

Lipedema diagnosis is heavily reliant on patient history. Various objective assessments have been suggested; however, a standardized measurement process is lacking. A systematic review was undertaken to identify which imaging and measurement tools are used in lipedema quantification and to review their protocols. Six databases were searched with two reviewers screening citations for inclusion. Full peer-reviewed publications that included defined lipedema diagnosis criteria, no male cases within comparative cohorts, and used an imaging or measurement tool to quantify lipedema were included. Twenty studies met the inclusion criteria using 13 different tools to quantify individual physical lipedema characteristics to either enable differential diagnosis, and/or quantify treatment effect: tape measure, perometry, durometry, tonometry, bioimpedance spectroscopy, tissue di-electric constant, ultrasound, Dual-Energy X-ray Absorptiometry, magnetic resonance imaging (MRI), noncontrast MRI lymphangiography, Indocyanine green lymphography, lymphoscintigraphy, and dynamic lymphangiography. Eight imaging and five measurement tools assessed lymphatic transport disturbances (n = 8), limb size/volume (n = 4), adipose tissue thickness/mass/volume (n = 3), and tissue fluid presence (n = 2). Multiple tools were only used in studies completed in 2020 or later. A lack of consistency exists in tool protocols, measurement locations, and outcome analysis. Limited reporting of clinimetrics with data derived from small cohorts and heterogenous populations impacted the ability to recommend tools for clinical practice and research. Various tools were used for objective lipedema assessment; however, consistency in approach was lacking. Further investigations are required to establish the validity and reliability of measurement and imaging tools, protocols, measurement points, and outcome reporting/interpretation to quantify the physical attributes of lipedema.

Objective: To determine the efficacy of therapeutic ultrasound (TUS) added to complex decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL). Materials and Methods: Thirty female volunteer patients who developed stage 2-3 BCRL were included in the study. The patients were randomly assigned to one of two groups: standard treatment with CDT alone and CDT + TUS. Before the study, both groups were given a training and home program consisting of remedial exercises and skin care. All patients received 15 sessions of treatment over 3 weeks. Circumferential and ultrasonographic (USG) measurements of all patients were performed before and after treatment. Treatment efficacy was evaluated based on extremity volume and soft tissue thickness. Results: The demographic data and volume measurements of the patients were similar at the beginning of treatment. There was a statistically significant decrease in the affected extremity in both groups in posttreatment circumferential measurements. However, the reductions in volume difference and volume difference percentage were significantly higher in the CDT + TUS group (p = 0.001 and p = 0.002, respectively). In the USG measurements, a greater decrease was observed in the soft tissue thickness below the elbow in the CDT + TUS group compared with the CDT alone group (p = 0.003). Conclusion: In the treatment of BCRL, TUS added to CDT resulted in a reduction in lymphedema. We consider that when added to CDT, TUS can increase the efficacy of treatment by reducing lymphedema in stages 2 and 3 lymphedema cases.

Background: To evaluate the stiffness of the skin and subcutaneous tissues of the arm and forearm of patients with breast cancer-related lymphedema using shear-wave elastography (SWE) and to investigate the relationship between the patients' symptoms. Methods and Results: Both lymphedematous and unaffected upper extremities of 72 patients (72 lymphedematous and 72 unaffected extremities) and 72 upper extremities of 36 controls (72 healthy extremities) were included in the study. The stiffness of the skin and subcutaneous tissues of all extremities was evaluated with SWE. The patients' pain, tension, weight, and stiffness symptoms associated with lymphedema were questioned using a numerical scale. The patients' functionality and participation in daily life activities were evaluated. The skin stiffness of the affected extremity was higher and the subcutaneous tissue stiffness was lower in patients than in controls (p < 0.05). The skin stiffness of the affected forearm was higher and the subcutaneous tissue stiffness of the affected arm and forearm was lower than their healthy extremities (p < 0.05). Quick Disabilities of Arm, Shoulder, and Hand and Life Impact Scale; were negatively correlated with arm and forearm subcutaneous tissue stiffness and positively correlated with forearm skin stiffness. The decrease in subcutaneous tissue stiffness of the arm was associated with heaviness sensation, the increase in skin stiffness of the forearm was associated with tightness, and the decrease in subcutaneous tissue stiffness of the forearm was associated with tightness, heaviness, and stiffness sensations. Conclusion: The results of this study suggest that SWE measurements can be useful for diagnosis and follow-up of patients.

Purpose: Secondary chronic lymphedema is a complication that seriously affects the quality of life of cancers survivors which is urgent to be studied. However, the current animal models generally have some defects such as short duration that affect the research process. To acquire an animal model which is easier to accomplish as well as higher success rate is the main goal of our experiment. Methods: The hind limb model of rats with secondary chronic lymphedema was established by near infrared fluorescence-guided lymphatic system destruction combined with high-fat diet innovation. The model was evaluated by limb circumference, volume, near-infrared fluorescence imaging of lymphatic vessels, and a series of histopathological staining. Results: The model was successfully established by operation combined with a high-fat diet and kept persistent effective lasting up to 16 weeks. Compared with the normal diet group, the high-fat group received a higher success rate (77.77% vs. 55.55%), a more obvious degree of limb swelling, and a more significant level of subcutaneous inflammatory factor infiltration at the edema site. Based on it, we kept research and found out that there was no significant difference in the process of subcutaneous fibrosis between the two groups. Conclusions: High-fat diet may improve secondary chronic lymphedema rat model success rate as well as effectiveness by changing the level of inflammatory infiltration in the site of lymphedema.

Background: Female genital lymphedema (FGL) is a challenging disease, and appropriate preoperative evaluation is crucial before surgical treatments. Computed tomography (CT) is expected useful for FGL evaluation, but little is known. This study aimed to clarify characteristic CT findings of FGL with a case report of CT findings-guided lymphaticovenous anastomosis (LVA). Methods: Medical charts of secondary lower extremity lymphedema patients who underwent CT and indocyanine green (ICG) lymphography were reviewed. Genital regions with dermal backflow patterns on ICG lymphography were diagnosed as FGL. Prevalence of characteristic CT findings of lymphedema was compared between genitalia regions with and without FGL. A case of genital lymphedema treated with LVA under the guidance of CT findings was presented. Results: A total of 51 patients (32 with FGL, and 19 without FGL) were included in this study. Genital ICG included stages 0/I/II/III/IV/V in 19 (37.3%)/5 (9.8%)/11 (21.6%)/9 (17.6%)/7 (13.7%)/0 (0%) cases, respectively. Characteristic CT findings included thick skin in 14 (27.5%), thick fascia in 17 (33.3%), high density of the superficial fat in 11 (21.6%), high density of the deep fat in 13 (25.5%), fluid collection in 8 (15.7%), detectable inguinal lymph node in 42 (82.4%), and honeycomb appearance in 7 regions (13.7%). Between genital regions with and without FGL, there were statistically significant differences in all the characteristic CT findings (p < 0.05). Conclusions: Characteristic CT findings of secondary FGL were identified. Preoperative CT evaluation may be useful for selecting appropriate LVA sites for optimal results.

Introduction: Lymphedema, characterized by abnormal lymph circulation, is a chronic debilitating condition often associated with chronic inflammation and hypoxia in lymphedematous tissue. Previously, using videocapillaroscopy, we found that the severity of lymphedema damages vasa vasorum vessels on the surface of lymph vessels, significantly compromising the oxygen supply environment to lymph endothelial cells. While previous research has indicated the inhibitory effects of hypoxic conditions on the proliferation of human dermal lymph endothelial cells (HDLECs), the impact on HDLEC migration remains unclear. This study aims to investigate the migration ability of HDLECs under hypoxic conditions, shedding light on the potential mechanisms underlying lymphedema progression and offering insights into therapeutic strategies. Materials and Methods and Results: Purchased HDLECs were cultured under normoxic (2% O₂) and hypoxic (1% O₂) conditions. Migration assays were performed using a scratch assay to assess the migratory capabilities of HDLECs. The experiment monitored cell migration over a period of 6 hours. Experiments were performed in triplicate. HDLECs were cultured to full confluence before the scratch assay. The results revealed a significant reduction in HDLEC migration under hypoxic conditions compared to normoxic conditions after 6 hours (p < 0.001). This suggests that hypoxic environments directly impair HDLEC migration. Conclusion: Hypoxia negatively affects HDLEC migration, potentially exacerbating lymphedema. Protecting vasa vasorum may preserve HDLEC migration and lymphangiogenesis. Further exploration of hypoxia-HDLEC interactions is crucial for understanding lymphedema pathogenesis and developing therapies.

Background: Research has indicated a link between obesity and a greater likelihood of venous disorders. However, the specific relationship between obesity in children and conditions such as phlebitis and thrombophlebitis remains undetermined. To explore this, we undertook a two-sample Mendelian randomization (MR) study to investigate the possible causal impact of childhood body mass index (BMI) on the development of phlebitis and thrombophlebitis. Methods: This study utilized genome-wide association studies data from European populations. Childhood BMI was assessed in a sample of 39,620 individuals, while data on phlebitis and thrombophlebitis were obtained from 1613 cases and 335,586 controls. We selected 16 single nucleotide polymorphisms significantly associated with childhood BMI as instrumental variables (IVs). The inverse variance weighting (IVW) method was applied as the primary approach, with weighted median, MR-Egger regression, and weighted mode methods used as complementary analyses. Results: The IVW analysis indicates a significant causal link between childhood BMI and the occurrence of phlebitis and thrombophlebitis (Beta = 0.002739, Standard error (SE) = 0.000740, p = 0.0002147). Results from the weighted median method (Beta = 0.002446, SE = 0.001046, p = 0.01933) aligned with the IVW findings. However, the MR-Egger and weighted mode analyses did not show a significant association (p = 0.1051 and p = 0.2525, respectively). Leave-one-out sensitivity tests and heterogeneity assessments were performed, revealing no evidence of horizontal pleiotropy. Conclusion: The findings from the MR analysis suggest a potential causal relationship between childhood BMI and an elevated risk of phlebitis and thrombophlebitis. This study provides new insights into the impact of childhood obesity on venous health, emphasizing the need for early intervention and prevention strategies.

Background: In lymphedema, the accumulation of subcutaneous interstitial fluid is the most characteristic feature. Bioimpedance analysis (BIA) is a promising technique to measure the amount of body components using a noninvasive method. In this study, we determined the clinical significance of BIA parameters in upper limb lymphedema with surgical treatment such as lymphovenous anastomosis or vascularized lymph node transfer. Methods and Results: A single-center retrospective study using a multifrequency BIA. Perioperative BIA parameters such as extracellular water ratio or fat-free mass (FFM) ratio and limb volume defined as percentage of excess volume (PEV) were measured. The relationships between the magnitude of change in PEV and BIA parameters during surgery were evaluated. Out of 48 unilateral lymphedema patients, 46 were female and the average age was 55.4 years. PEV and all BIA parameters showed a significant decrease after surgery (p < 0.001). There were significant correlations between ΔPEV and the degree of changes in all BIA parameters. ΔFFM ratio showed the highest correlation with the amount of change in PEV (r = 0.599, p < 0.001). Conclusion: BIA parameters correlated well with the volume change after surgery. BIA could be useful as a quick and easy tool for follow-up after lymphedema surgery.

Background: Secondary lymphedema is acquired and caused by obstruction or injury to a normally developed lymphatic system. Loss of mobility is a common problem in patients with secondary lower limb lymphedema (LLL) following cancer treatment. In this study, we examined the effect of complex decongestive therapy (CDT) on motor function and mobility in patients with LLL. Methods and Results: A quasi-experimental study was performed with 24 participants with stage 2 LLL (56.04 ± 14.23 years). Participants received 15 sessions of CDT. Motor function was assessed with a foot tapping test (FTT). Gait speed was measured in single-task (ST) and dual-task (DT) conditions, and DT cost was calculated. All assessments were performed before and after the intervention. The paired t-test and Wilcoxon signed-rank test were used to analyze the effect of CDT on FTT, gait speed, and DT cost. ST and DT gait speed (p = 0.002, p < 0.001) and DT cost (p = 0.001) decreased following the CDT, whereas bilateral FTT scores did not change. Conclusion: CDT improves mobility and dual-tasking in LLL, thereby promoting independence in daily life. Future prospective controlled studies are required to corroborate our results.

Background: The aim of this study was to investigate the validity and reliability and identify determinants of the 6-minute walk test (6MWT) in patients with lower limb lymphedema (LLL). Methods and Results: The study included 28 patients with LLL and 28 healthy subjects. To investigate the convergent validity and determinants of the 6MWT, patients were assessed using the following measurements: circumference measurement for lymphedema severity, hand-held dynamometry for muscle strength, time up and go for functional mobility, five-time sit-to-stand test for functional lower extremity strength, Lower Extremity Functional Scale for lower extremity functionality, Lymphedema Life Impact Scale for quality of life, and International Physical Activity Questionnaire-Short Form for physical activity level. The test-retest reliability of the 6MWT was assessed using intraclass correlation coefficients (ICCs). 6MWT, a test-retest reliability analysis was carried out with 28 patients within 3-7 days. The receiver operating characteristic (ROC) curve was employed to determine the cut-off point of 6MWT. The test-retest reliability of 6MWT was detected as excellent (ICC [95%] 0.93 [0.87-0.97]). Significant correlations were found between the 6MWT health-related and disease-specific parameters, indicating sufficient convergent validity (r ≥ 0.3). The ROC curve indicated a cut-off point of 504 meters (area under the curve [AUC] 0.712 [95%CI: 0.575-0.849]). Multiple linear regression analysis demonstrated that lymphedema severity, hip abduction muscle strength, and lower limb functionality were the predictors of 6MWT. Conclusions: The 6MWT has been shown to be a reliable and valid tool for assessing the functional capacity of patients with LLL.