Lymphology最新文献_第8页

Lymphovenous anastomosis for the treatment of lymphedema: A systematic review of the literature and meta-analysis. 淋巴管吻合治疗淋巴水肿：文献和荟萃分析的系统综述。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-04-19 DOI: 10.2458/lymph.4670

E. Nacchiero, M. Maruccia, R. Elia, F. Robusto, G. Giudice, O. Manrique, C. Campisi, G. Giudice

Lymphovenous anastomosis (LVA) has been described as an effective treatment for early stages of lymphedema (LE). The aim of this study was to deepen the evaluation of the effectiveness of LVA by performing a metaanalysis to provide information about its utility in specific anatomical sites, clinical stages, duration of lymphedema, and surgical technique. A systematic literature search using PubMed/Medline, Google Scholar, and Cochrane Database was performed in November 2019. Only original studies in which exclusively LVA was performed for primary and/or secondary lymphedema in humans were eligible for data extraction. A meta-analysis was performed on articles with a well-defined endpoint and a subgroup analysis was conducted in relation to surgical technique, duration of lymphedema, stage of pathology. Forty-eight studies, including 6 clinical trials and 42 lowrisk bias observational studies were included in our meta-analysis. 1,281 subjects were included and the majority of articles reported a pre-post analysis. Lymphaticovenular anastomosis appears to result effectively in treatment of lymphedema with an odds ratio of 0.07 (CI: 0.04, 0.13, p<0.001). All subgroup metaanalyses were statistically significant for LVAs specifically with regard to anatomical site, clinical stage, duration of LE, or type of microsurgical procedure (p<0.05). Our meta-analysis confirmed the efficacy of LVAs for the treatment of lymphedema, even when subgroup analysis was performed for clinical stage, duration of pathology, anatomical site of lymphedema, or type of microsurgical procedure. Further prospective trials with a common clearly defined outcome measure are warranted for an unbiased evaluation.

淋巴管吻合（LVA）已被描述为早期淋巴水肿（LE）的有效治疗方法。本研究的目的是通过进行荟萃分析来加深对LVA有效性的评估，以提供有关其在特定解剖部位、临床分期、淋巴水肿持续时间和手术技术中的实用性的信息。2019年11月，使用PubMed/Medline、Google Scholar和Cochrane数据库进行了系统的文献搜索。只有对人类原发性和/或继发性淋巴水肿仅进行LVA的原始研究才有资格进行数据提取。对具有明确终点的文章进行了荟萃分析，并对手术技术、淋巴水肿持续时间和病理分期进行了亚组分析。我们的荟萃分析包括48项研究，包括6项临床试验和42项低风险偏倚观察性研究。纳入1281名受试者，大多数文章报告了前后分析。淋巴结-淋巴结吻合似乎能有效治疗淋巴水肿，优势比为0.07（CI:0.04，0.13，p<0.001）。LVA的所有亚组荟萃分析都具有统计学意义，特别是在解剖部位、临床分期、LE持续时间方面，或显微外科手术类型（p<0.05）。我们的荟萃分析证实了LVA治疗淋巴水肿的疗效，即使对临床分期、病理持续时间、淋巴水肿解剖部位或显微外科治疗类型进行了亚组分析。进一步的前瞻性试验有一个共同的明确定义的结果衡量标准，有必要进行公正的评估。

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引用次数: 2

Quality of life in breast cancer survivors: An assessment of international breast cancer dragon boat racers. 乳腺癌幸存者的生活质量:对国际乳腺癌赛龙舟选手的评估。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-04-19 DOI: 10.2458/lymph.4671

L. Koehler, S. Rosenberg, J. Cater, K. Mikolajczyk, A. Morán, C. Metz, S. Monson

Resistance exercise is deemed safe for women recovering from conventional breast cancer therapies but few clinicians are aware that dragon boat racing, as a form of resistive exercise, is available to the breast cancer community. The objectives of this study were to 1) increase clinician awareness of dragon boat racing (DBR) in breast cancer survivors as a community-based physical activity, and 2) evaluate quality of life (QOL) in breast cancer survivors with or without lymphedema who participate in DBR. This prospective, observational study surveyed 1,069 international breast cancer dragon boat racers from eight countries to compare function, activity, and participation in women with and without selfreported lymphedema using the Lymph-ICF questionnaire. Seventy-one percent of women (n=758) completed the questionnaires. Results revealed significantly higher Lymph-ICF scores in the lymphedema participants, signifying reduced QOL, when compared to the nonlymphedema participants (p<0.05), except for "go on vacation" for which no statistical difference was reported (p=0.20). International breast cancer survivors with lymphedema participating in DBR at an international competition had reduced function, limited activity, and restricted participation compared to participants without lymphedema. Clinicians should consider utilizing DBR as a community-based activity to support exercise and physical activity after a breast cancer diagnosis.

抵抗运动被认为对从传统的癌症治疗中恢复的女性是安全的，但很少有临床医生意识到，龙舟赛作为一种抵抗运动，可用于癌症乳腺癌社区。本研究的目的是：1）提高临床医生对癌症乳腺癌幸存者龙舟竞赛（DBR）的认识，将其作为一项基于社区的体育活动；2）评估参与DBR的患有或不患有淋巴水肿的癌症乳腺癌幸存者的生活质量（QOL）。这项前瞻性观察性研究调查了来自八个国家的1069名国际癌症龙舟赛选手，用Lympy-ICF问卷比较了有和没有自报淋巴水肿的女性的功能、活动和参与情况。71%的妇女（n=758）完成了问卷调查。结果显示，与非淋巴水肿参与者相比，淋巴水肿参与者的Lympy-ICF评分显著较高，这意味着生活质量降低（p<0.05），但“度假”除外，这一点没有统计学差异（p=0.20）。参加国际比赛的癌症淋巴水肿幸存者参加DBR时，与没有淋巴水肿的参与者相比。临床医生应考虑在诊断为癌症后，将DBR作为一项基于社区的活动来支持锻炼和体育活动。

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引用次数: 0

Bone development and fracture healing is normal in mice that have a defect in the development of the lymphatic system. 对于淋巴系统发育有缺陷的小鼠，骨骼发育和骨折愈合是正常的。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-04-19 DOI: 10.2458/lymph.4669

AL McCarter, A. Khalid, Y. Yi, M. Monroy, H. Zhao, JJ Rios, MT Dellinger

Ectopic lymphatics form in bone and promote bone destruction in diseases such as Gorham-Stout disease, generalized lymphatic anomaly, and kaposiform lymphangiomatosis. However, the role lymphatics serve in normal bone development and repair is poorly understood. The objective of this study was to characterize bone development and fracture healing in mice that have a defect in the development of the lymphatic vasculature. We found that bones in wild-type adult mice and mouse embryos did not have lymphatics. We also found that bone development was normal in Vegfr3 (Chy/Chy) embryos. These mice do not have lymphatics and die shortly after birth. To determine whether lymphatics serve a role in postnatal bone development and fracture healing, we analyzed bones from Vegfr3 (wt/Chy) mice. These mice are viable and have fewer lymphatics than wild-type mice. We found that postnatal bone development and fracture healing was normal in Vegfr3 (wt/Chy) mice. Taken together, our results suggest that lymphatics do not play a major role in normal bone development or repair.

异位淋巴管在骨内形成并促进骨破坏，如Gorham-Stout病、全身性淋巴管异常和kaposiform淋巴管瘤病。然而，淋巴在正常骨发育和修复中的作用尚不清楚。本研究的目的是表征具有淋巴血管发育缺陷的小鼠的骨发育和骨折愈合。我们发现野生型成年小鼠和小鼠胚胎的骨骼没有淋巴管。我们还发现Vegfr3 (Chy/Chy)胚胎的骨发育正常。这些小鼠没有淋巴管，出生后不久就会死亡。为了确定淋巴管是否在出生后骨骼发育和骨折愈合中起作用，我们分析了Vegfr3 (wt/Chy)小鼠的骨骼。这些小鼠是可存活的，比野生型小鼠有更少的淋巴管。我们发现Vegfr3 (wt/Chy)小鼠出生后骨骼发育和骨折愈合正常。综上所述，我们的研究结果表明淋巴系统在正常骨骼发育或修复中并不起主要作用。

引用次数: 0

Non-contrast MR lymphography of rare lymphatic abnormalities. 罕见淋巴异常的非对比MR淋巴造影。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-19 DOI: 10.2458/lymph.4665

M. Seckeler, L. Moedano, D. Mustacich, B. Kalb, M. Saranathan, J. Galons, M. Witte

Detailed imaging of the lymphatic system often requires direct injection of contrast into lymph nodes which can be technically challenging, time consuming, and produce painful stimuli. We sought to describe the use of non-contrast MR lymphography (NCMRL) for normal controls and patients with a variety of rare disorders associated with lymphatic pathologies. Two control subjects and five affected patients (decompensated Fontan circulation, central conducting lymphatic abnormality, familial lymphedema and two with Gorham-Stout disease) were studied. NCMRL images were segmented in a semiautomated fashion and the major lymphatic channels and thoracic duct (TD) highlighted for identification. Adequate imaging was available for both controls and 4/5 affected patients; the youngest patient could not be imaged given patient motion. For the two controls, the TD was seen in the expected anatomic location. For the decompensated Fontan patient, there were numerous tortuous lymphatic channels, predominantly in the upper chest and neck. For the familial lymphedema patient, a TD was not identified; instead, peripheral lymphatic collaterals near the lateral chest walls. For the first Gorham- Stout patient, the TD was enlarged with large intrathoracic lymph collections. For the second Gorham-Stout patient, there were bilateral TD with lymph collections in vertebral bodies. Using NCMRL, we were able to image normal and abnormal lymphatic systems. An important learning point is the potential need for sedation for younger patients due to long image acquisition times and fine resolution of the structures of interest.

淋巴系统的详细成像通常需要将造影剂直接注射到淋巴结中，这在技术上具有挑战性，耗时且会产生疼痛刺激。我们试图描述非对比MR淋巴造影术（NCMRL）在正常对照组和患有各种与淋巴病理相关的罕见疾病的患者中的应用。研究了两名对照受试者和五名受试者（Fontan循环失代偿、中枢传导淋巴异常、家族性淋巴水肿和两名Gorham Stout病患者）。NCMRL图像以半自动方式分割，并突出显示主要淋巴管和胸导管（TD）以进行识别。对照组和4/5受影响的患者都有足够的影像学检查；在给定患者运动的情况下，不能对最年轻的患者进行成像。对于两个对照组，TD位于预期的解剖位置。对于失代偿的Fontan患者，有许多弯曲的淋巴管，主要在上胸部和颈部。对于家族性淋巴水肿患者，未发现TD；而是靠近胸侧壁的外周淋巴络。对于第一例Gorham-Stout患者，TD增大，胸内淋巴结大量聚集。对于第二例Gorham Stout患者，双侧TD伴椎体淋巴结聚集。使用NCMRL，我们能够对正常和异常的淋巴系统进行成像。一个重要的学习点是，由于图像采集时间长和感兴趣结构的精细分辨率，年轻患者可能需要镇静。

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引用次数: 1

SARS-CoV-2/COVID-19, Lymphatic vessels, lymph, and lymphology. SARS-CoV-2/COVID-19，淋巴管，淋巴和淋巴学。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-19 DOI: 10.2458/lymph.4661

M. Witte, S. Daley

[Editorial] Lymphatic vessels and lymph are a missing link in SARS-CoV-2/COVID-19 pathophysiology and therapeutic strategies. Based on well-established principles of lymphatic function and dysfunction and a neglected literature, this article highlights promising directions for future research and clinical exploration.

【社论】淋巴管和淋巴是SARS-CoV-2/neneneba COVID-19病理生理学和治疗策略中缺失的一环。基于淋巴功能和功能障碍的公认原则和一篇被忽视的文献，本文强调了未来研究和临床探索的有希望的方向。

引用次数: 3

Rare PECAM1 variants in three families with lymphedema. 三个淋巴水肿家族中罕见的PECAM1变异。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-19 DOI: 10.2458/lymph.4666

S. Michelini, B. Amato, S. Kenanoglu, D. Vešelényiová, A. Dautaj, D. Kurti, M. Baglivo, M. Dundar, J. Krajc̆ovic̆, G. Miggiano, B. Aquilanti, G. Matera, V. Velluti, L. Gagliardi, S. H. Basha, M. Bertelli

PECAM1 is a member of the immunoglobulin superfamily and is expressed in monocytes, neutrophils, macrophages and other types of immune cells as well as in endothelial cells. PECAM1 function is crucial for the development and maturation of B lymphocytes. The aim of this study was to link rare PECAM1 variants found in lymphedema patients with the development of lymphatic system malformations. Using NGS, we previously tested 246 Italian lymphedema patients for variants in 29 lymphedema-associated genes and obtained 235 negative results. We then tested these patients for variants in the PECAM1 gene. We found three probands with rare variants in PECAM1. All variants were heterozygous missense variants. In Family 1, the unaffected mother and brother of the proband were found to carry the same variant as the proband. Lymphoscintigraphy was performed to determine possible lymphatic malformations and showed that in both cases a bilateral slight reduction in the speed and lymphatic clearance of the lower limbs. PECAM1 function is important for lymphatic vasculature formation. We found variants in PECAM1 that may be associated with susceptibility to lymphedema.

PECAM1是免疫球蛋白超家族的成员，在单核细胞、中性粒细胞、巨噬细胞等免疫细胞以及内皮细胞中均有表达。PECAM1的功能对B淋巴细胞的发育和成熟至关重要。本研究的目的是将在淋巴水肿患者中发现的罕见PECAM1变异与淋巴系统畸形的发展联系起来。我们之前使用NGS对246名意大利淋巴水肿患者进行了29个淋巴水肿相关基因的变异检测，获得235个阴性结果。然后，我们对这些患者进行了PECAM1基因变异检测。我们发现三个先证者在PECAM1中有罕见的变异。所有变异均为杂合错义变异。在家族1中，先证者未受影响的母亲和兄弟被发现携带与先证者相同的变异。进行淋巴显像以确定可能的淋巴畸形，并显示在这两个病例中，双侧下肢的速度和淋巴清除率略有降低。PECAM1的功能对淋巴血管的形成很重要。我们发现PECAM1的变异可能与淋巴水肿的易感性有关。

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引用次数: 1

Physical therapy affects endothelial function in lymphedema patients. 物理治疗影响淋巴水肿患者的内皮功能。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-19 DOI: 10.2458/lymph.4663

B. Brix, G. Apich, C. Ure, A. Roessler, N. Goswami

Lymphedema arises due to a malfunction of the lymphatic system and can lead to massive tissue swelling. Complete decongestive therapy (CDT), consisting of manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing volume in affected extremities. Lymphatic dysfunction has previously been associated with chronic inflammation processes. We investigated plasma ADMA as an indicator of endothelial function/inflammation before-, during- and after-CDT. Also assessed were vascular function parameters such as carotid-femoral pulse wave velocity (PWVcf), flow-mediated dilata-tion (FMD) and retinal microvasculature analysis. 13 patients (3 males and 10 females, 57 ± 8 years old (mean ± SD), 167.2 ± 8.3 cm height, 91.0 ± 23.5 kg weight), with lower limb lymphedema were included. Vascular function parameters were assessed on day 1, 2, 7, 14 and 21 of CDT, pre- and post-MLD. ADMA was significantly lower post-MLD (p=0.0064) and tended to reduce over three weeks of therapy (p=0.0506). PWVcf weakly correlated with FMD (r=0.361, p=0.010). PWVcf, FMD and retinal microvasculature analysis did not show changes due to physical therapy. The novel results from this study indicate that lymphedema does not affect endothelial func-tion and lymphedema patients may therefore not have a higher risk of cardiovas-cular diseases. Our results further suggest that manual lymphatic drainage with or without full CDT could have potentially beneficial effects on endothelial function in lymphedema patients (by reducing ADMA levels), which has not been reported previously.

淋巴水肿的出现是由于淋巴系统的故障，并可导致大量的组织肿胀。完全减充血性治疗(CDT)，包括手动淋巴引流(MLD)和压缩包扎，旨在调动液体和减少患肢体积。淋巴功能障碍以前与慢性炎症过程有关。我们研究了血浆ADMA作为cdt前、中和后内皮功能/炎症的指标。同时还评估了血管功能参数，如颈-股脉波速度(PWVcf)、血流介导扩张(FMD)和视网膜微血管分析。患者13例，男3例，女10例，年龄57±8岁(平均±SD)，身高167.2±8.3 cm，体重91.0±23.5 kg)，伴有下肢淋巴水肿。分别于CDT第1、2、7、14、21天及mld前后评估血管功能参数。mld后ADMA显著降低(p=0.0064)，并且在治疗三周后趋于降低(p=0.0506)。PWVcf与FMD呈弱相关(r=0.361, p=0.010)。PWVcf、FMD和视网膜微血管分析未显示物理治疗引起的变化。这项研究的新结果表明，淋巴水肿不影响内皮功能，因此淋巴水肿患者可能没有更高的心血管疾病风险。我们的研究结果进一步表明，手工淋巴引流有或没有充分CDT可能对淋巴水肿患者的内皮功能有潜在的有益影响(通过降低ADMA水平)，这在以前没有报道过。

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引用次数: 6

Skin lymphatic system in the pathogenesis of arterial hypertension - review and critique. 皮肤淋巴系统在动脉高血压发病机制中的研究综述与批判。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-19 DOI: 10.2458/lymph.4662

A. Chachaj, A. Szuba

Although numerous studies have confirmed the relationship between high salt intake and elevated blood pressure, the exact molecular mechanisms of this relationship are still unclear. There is growing evidence that skin interstitium, as well as the skin lymphatic system, are important regulators of both sodium (Na+) balance and blood pressure. Skin is in itself a large reservoir of Na+ ions which are stored in an osmotically inactive form on glycosaminoglycans (GAGs). Local hypertonicity due to extensive accumulation of Na+ within the skin as a result of a high-salt diet was demonstrated to induce macrophages to express a transcription factor termed tonicityresponsive enhancer binding protein (TonEBP) and subsequently to secrete vascular endothelial growth factor-C (VEGF-C), activating lymphangiogenesis within the skin. This regulatory axis seems to be adaptive in maintaining blood pressure in high salt-load states. Recent studies have added new insights into the functioning of lymphatic vessels and the pathogenesis of salt-sensitive hypertension as well as questioned the classic view of Na+ homeostasis. This review aims to summarize recent findings pertaining to the involvement of the skin lymphatic system in Na+ and blood pressure regulation.

尽管大量的研究已经证实了高盐摄入和血压升高之间的关系，但这种关系的确切分子机制仍不清楚。越来越多的证据表明，皮肤间质以及皮肤淋巴系统是钠(Na+)平衡和血压的重要调节因子。皮肤本身就是一个巨大的Na+离子储存库，这些Na+离子以渗透性不活跃的形式储存在糖胺聚糖(GAGs)上。高盐饮食导致的皮肤内Na+的大量积累导致局部高渗性，可诱导巨噬细胞表达一种称为张力响应增强子结合蛋白(TonEBP)的转录因子，随后分泌血管内皮生长因子- c (VEGF-C)，激活皮肤内的淋巴管生成。这种调节轴似乎在维持高盐负荷状态下的血压方面具有适应性。近年来的研究为淋巴管的功能和盐敏感性高血压的发病机制提供了新的见解，并对Na+稳态的经典观点提出了质疑。本文综述了近年来有关皮肤淋巴系统参与Na+和血压调节的研究结果。

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引用次数: 3

SVEP1 is important for morphogenesis of lymphatic system: Possible implications in lymphedema. SVEP1对淋巴系统的形态发生很重要:可能与淋巴水肿有关。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-01

S Michelini, B Amato, M Ricci, R Serrani, D Veselenyiova, S Kenanoglu, D Kurti, A Dautaj, M Baglivo, R Compagna, J Krajcovic, M Dundar, S H Basha, S Priya, J P Belgrado, M Bertelli

SVEP1, also known as Polydom, is a large extracellular mosaic protein with functions in protein interactions and adhesion. Since Svep1 knockout animals show severe edema and lymphatic system malformations, the aim of this study is to evaluate the presence of SVEP1 variants in patients with lymphedema. We analyzed DNA from 246 lymphedema patients for variants in known lymphedema genes, 235 of whom tested negative and underwent a second testing for new candidate genes, including SVEP1, as reported here. We found three samples with rare heterozygous missense single-nucleotide variants in the SVEP1 gene. In one family, healthy members were found to carry the same variants and reported some subclinical edema. Based on our findings and a review of the literature, we propose SVEP1 as a candidate gene that should be sequenced in patients with lymphatic malformations, with or without lymphedema, in order to investigate and add evidence on its possible involvement in the development of lymphedema.

SVEP1也被称为Polydom，是一种大型的细胞外镶嵌蛋白，在蛋白质相互作用和粘附中起作用。由于Svep1基因敲除的动物表现出严重的水肿和淋巴系统畸形，本研究的目的是评估Svep1变异在淋巴水肿患者中的存在。我们分析了246名淋巴水肿患者的DNA，以寻找已知的淋巴水肿基因变异，其中235人检测为阴性，并对新的候选基因进行了第二次检测，包括SVEP1。我们在SVEP1基因中发现了三个罕见的杂合错义单核苷酸变异样本。在一个家庭中，健康的成员被发现携带相同的变异，并报告了一些亚临床水肿。基于我们的发现和对文献的回顾，我们建议SVEP1作为一个候选基因，应该在淋巴畸形患者中进行测序，有或没有淋巴水肿，以调查和增加证据，它可能参与淋巴水肿的发展。

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引用次数: 0

Minimally invasive treatment of abdominal lymphocele: A review of contemporary options and how to approach them. 腹腔淋巴囊肿的微创治疗:回顾当代的选择和如何接近它们。

IF 2.5 4区医学 Q3 Medicine

Lymphology

Pub Date : 2021-01-01

F Khorshidi, B S Majdalany, G Peters, A N Tran, J Shaikh, R P Liddell, J C Perez Lozada, N Kokabi, N Nezami

Lymphoceles are lymphatic fluid collections resulting from lymphatic vessel disruption after surgery or trauma. They are most often described following retroperitoneal surgeries such as cystectomies, prostatectomies, renal transplants, and gynecologic surgeries. Most lymphoceles are asymptomatic and resolve spontaneously without treatment. If persistent, they can become infected or exert mass effect on adjacent structures causing pain, urinary, or lower limb edema particularly for lymphoceles in the pelvis Symptomatic lymphoceles should be treated to relieve symptoms and prevent functional compromise of vital adjacent structures. Although surgery has been traditionally accepted as the gold standard treatment, advances in imaging and interventional technology allow for less invasive, percutaneous treatment. Available minimally invasive treatment options include percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization. A review of these treatment options and a suggested algorithm for managing lymphoceles is presented.

淋巴囊肿是手术或创伤后淋巴管破裂引起的淋巴液聚集。它们最常发生在腹膜后手术后，如膀胱切除术、前列腺切除术、肾移植和妇科手术后。大多数淋巴囊肿无症状，无需治疗即可自行消退。如果持续，它们可感染或对邻近结构施加肿块效应，引起疼痛、泌尿系统或下肢水肿，特别是骨盆淋巴囊肿，应治疗有症状的淋巴囊肿，以缓解症状并防止重要邻近结构的功能损害。虽然手术传统上被认为是金标准治疗方法，但成像和介入技术的进步使得侵入性更小的经皮治疗成为可能。可用的微创治疗方案包括经皮穿刺、导管引流、硬化治疗和淋巴栓塞的淋巴管造影。回顾这些治疗方案和建议的算法管理淋巴细胞提出。

引用次数: 0