Objective: To investigate the clinical efficacy of vascularized lymph node transfer (VLNT) combined with lymphatico-venous anastomosis (LVA) in treating unilateral upper limb lymphedema after radical mastectomy for breast cancer. Methods: This study was a retrospective cohort study. Forty female patients aged 35-75 years with unilateral upper limb lymphedema after radical mastectomy for breast cancer who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University from April 2021 to January 2024. Based on the treatment method, patients were divided into LVA group (18 cases) who underwent LVA treatment only and VLNT+LVA group (22 cases) who underwent VLNT combined with LVA treatment. The volumes of the affected limbs in both groups of patients were measured before treatment and 3, 6, and 12 months after treatment. The differences in affected limb volumes at each time point before and after treatment (i.e., the volume differences of affected limbs at each time point after treatment) were calculated. Analysis of covariance (ANCOVA) was used to control the influence of confounding factors such as baseline data on the volume differences of affected limbs at each time point after treatment. The quality of life was assessed using the Lymphedema Quality of Life Questionnaire before treatment and 12 months after treatment. During the follow-up period, the occurrence of infectious complications in patients of both groups were monitored. Ultrasonography or radionuclide imaging was performed 12 months after treatment to evaluate the survival of lymph nodes in patients in VLNT+LVA group. Results: The volume differences of affected limbs in patients in VLNT+LVA group 6 and 12 months after treatment were (521±193) and (694±355) cm³, respectively, which were significantly greater than (377±92) and (452±229) cm³ in LVA group (with mean differences of 144 and 242 cm³, respectively, 95% confidence intervals of 44-244 and 46-438 cm³, respectively, t values of 2.90 and 2.49, respectively, both P values <0.05). ANCOVA showed that after adjusting for baseline data, the volume difference of affected limb of patients in VLNT+LVA group 6 and 12 months after treatment were significantly greater than those in LVA group (with F values of 6.52 and 5.26, respectively, P<0.05). Twelve months after treatment, the quality of life scores of patients in LVA group and VLNT+LVA group were 8 (4, 9) and 7 (4, 9), respectively, which were significantly higher than 6 (3, 7) and 5 (2, 7) before treatment (with Z values of -2.97 and -3.46, respectively, both P values <0.05). However, there was no statistically significant difference in quality of life score of patients between the two groups 12 months after treatment (P>0.05). During the 12-month post-treatment follow-up, patients in neither group developed infectious complications such as erysipelas, cellulitis, or lymphangitis.
Objective: To investigate the causality between non-ionizing radiation and facial aging, and to identify potential genes associated with facial aging. Methods: This study employed a method of analysis based on multiple Mendelian randomization (MR). Genome-wide association study data of non-ionizing radiation (FinnGen database, n=218 281) and facial aging (UK Biobank database, n=423 999) were retrieved. Single nucleotide polymorphisms (SNPs) were used as instrumental variables, with a significance threshold (P<5×10-6) applied and further linkage disequilibrium analysis performed to select SNPs associated with non-ionizing radiation. Two-sample MR (TSMR) analysis was conducted to assess the causality between non-ionizing radiation and facial aging, using inverse variance weighting (IVW) method as the primary analytical method and supplementing with MR-Egger regression, weighted median, weighted mode, and simple mode methods for validation. For the selected non-ionizing radiation-associated SNPs, heterogeneity was tested by Cochran Q test, horizontal pleiotropy was assessed by the MR-Egger intercept test and MR-PRESSO test, and robustness was evaluated via leave-one-out analysis. Multivariable MR (MVMR) analysis was performed to adjust for confounding factors affecting facial aging including smoking frequency, blood alcohol concentration, exercise frequency, body mass index, and systolic and diastolic blood pressure. Summary-data-based MR (SMR) analysis using expression quantitative trait loci (eQTL) data was conducted to screen candidate genes of facial aging, which were then validated by TSMR analysis. Protein quantitative trait loci (pQTL) and methylation quantitative trait loci (mQTL) data were analyzed by TSMR analysis to examine the causal role of MED1 gene with facial aging from multi-omics aspect. The genetic association of MED1 gene with facial aging was verified by colocalization analysis (posterior probability H4>50%). Results: Twenty non-ionizing radiation-related SNPs that reached the significance threshold were screened out, with F values being all >10. IVW analysis demonstrated a positive causality between non-ionizing radiation and facial aging (with odds ratio of 1.02, with 95% confidence interval of 1.01-1.02, P<0.05). The analysis results of MR-Egger regression, weighted median, simple mode method, and weighted mode method (with odds ratios of 1.02, 1.02, 1.01, and 1.01, respectively, with 95% confidence intervals of 1.01-1.03, 1.01-1.02, 0.99-1.02, respectively, P<0.05) were consistent with IVW method. For these 20 non-ionizing radiation-related SNPs, Cochran Q test under IVW method and MR-Egger showed no significant heterogeneity (with Q values of 23.20 and 22.59, respectively, P>0.05); the MR-Egger intercept test (with intercept absolute value of 0.01, with standard error of 0.01, P>0.05) and MR-PRESS
Secondary lymphedema is a chronic progressive disease caused by lymphatic flow obstruction due to surgery, trauma, infection, etc., leading to inflammation, edema, adipose deposition, and fibrosis in subcutaneous tissue. While early, standardized, integrated, and sustained treatment is the principle for managing secondary lower limb lymphedema, and the goal is to provide a personalized and standardized treatment. Based on single-center treatment experience, this article summarizes an integrated surgical treatment algorithm for secondary lower limb lymphedema. It proposes that personalized treatment requires comprehensive assessment of lymphedema severity, pathological components, and lymphatic function, incorporating the International Society of Lymphology staging and imaging findings. This algorithm is based on the principles of regionalization (body regions), staged approach, and integrated treatment to achieve precise personalized intervention, which demonstrates certain value for clinical promotion.
Objective: To evaluate the application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis (LVA) combined with liposuction in patients with lower limb lymphedema. Methods: This study was a historical control study. From June 2021 to January 2023, a total of 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy without application of lymph pads at the Department of Burn, Plastic and Cosmetic Surgery of Xi'an Central Hospital of Xi'an Jiaotong University (hereinafter referred to as our department) were included as control group. There were 2 males and 21 females in this group, with the age of 58±10 years. From February 2023 to January 2024, another 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy with additional application of lymph pads at our department were included as lymph pad group. There were 3 males and 20 females in this group, with the age of 59±11 years. Before treatment and at 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint of the affected limbs were measured, and the total score of lymphedema functioning, disability and health questionnaire for lower limb lymphedema (Lymph-ICF-LL) and score of lower limb function in Lymph-ICF-LL were recorded in patients in the two groups. Results: At 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint in patients in lymph pad group were (22.9±1.7), (26±3), (44±8) cm and (20.7±1.7), (25±3), (42±6) cm, respectively, which were significantly smaller than (24.3±2.3), (29±4), (49±10) cm and (23.9±2.2), (29±4), (48±12) cm in control group (with t values of 2.18, 2.29, 2.09, and 5.84, 3.92, 2.31, respectively, P<0.05), and the mean differences (95% confidence intervals) between the two groups were 1.3 (0.1 to 2.5), 2 (0 to 4), 5 (0 to 10) cm and 3.3 (2.2 to 4.5), 4 (2 to 6), 6 (1 to 12) cm, respectively. There were no statistically significant differences in the total Lymph-ICF-LL scores of the affected limbs between the two groups of patients before treatment and at 6 and 12 months of treatment (P>0.05). At 6 and 12 months of treatment, the lower limb function scores in Lymph-ICF-LL of the affected limbs in lymph pad group of patients were significantly lower than those in control group (with t values of 2.24 and 2.44, respectively, P<0.05), and the mean differences (95% confidence intervals) between the two groups were 5 (1 to 9) and 5 (1 to 9) cm, respectively. Conclusions: During complete decongestive therapy following LVA combined with liposuction, the application of lymph pads can significantly reduce the circumference of the dorsum of the foot, ankle joint, and knee joint in patients with lower limb lymphedema, and also improve their lower limb function.
This article focused on the research of clinical diagnosis and treatment system for malignant complex wounds, systematically sorted out the key issues in this field, and explored in detail the characteristics and targeted intervention measures of malignant complex wounds in different parts of body. It summarized the current strategies, multidisciplinary team collaboration models, and technological progress in the diagnosis and treatment of such wounds. The current treatment of malignant complex wounds is challenging, and existing diagnostic and therapeutic strategies and technologies have achieved certain outcome in controlling symptoms and promoting healing but still face many problems. In the future, it is necessary to further strengthen basic research, optimize diagnosis and treatment plans, promote multidisciplinary team collaboration, and develop more effective treatment methods to improve the diagnosis and treatment of malignant complex wounds, improve patients' quality of life, and prolong their survival. This article will provide a comprehensive reference for clinicians and promote the improvement of the treatment level of malignant complex wounds.
Early prevention and standardized management of refractory wounds in the elderly are very important for improving prognosis, reducing disability rate, and improving the quality of life of patients. For the diagnosis and treatment of refractory wounds in the elderly, it is necessary to comprehensively consider the primary disease or comorbidity of patients and systematically evaluate the overall condition and the local characteristics of wounds of patients. The treatment principles include controlling or slowing down the development of the primary disease, nutritional support, infection control, improving circulation, sealing wounds, and paying attention to the water balance of wounds, at the same time selecting a reasonable treatment plan according to different types of wounds. The goal of treatment is to close the wound as much as possible if conditions permit, while in some cases, palliative management may be appropriate. In the future, the development of smart wear, big data, and artificial intelligence will play a significant role in promoting the assessment and treatment of refractory wounds in the elderly. The Burns and Trauma Branch of Chinese Geriatrics Society organized domestic experts engaged in wound repair and related fields to jointly formulate this consensus, aiming to establish a full-process standard covering prevention, assessment, treatment, and rehabilitation and to promote the standardization and intelligence of diagnosis and treatment of refractory wounds in the elderly, thus providing efficient and homogeneous solutions for clinical practice.
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