Lymphatic research and biology最新文献

{"title":"Automated Measurement of Skin Thickness in Computed Tomography Images for Unilateral Lower Extremity Lymphedema.","authors":"Yukihiro Nomura, Hiroki Naganishi, Yuma Ando, Shinsuke Akita, Nobuyuki Mitsukawa","doi":"10.1089/lrb.2024.0075","DOIUrl":"10.1089/lrb.2024.0075","url":null,"abstract":"<p><p><b><i>Background:</i></b> Lower extremity lymphedema (LEL) is a common complication following gynecological cancer treatment, characterized by the accumulation of protein-rich fluid owing to lymphatic system insufficiency. This condition manifests as in skin thickening, soft tissue swelling, and other complications. Therefore, this study proposes an automatic method for measuring skin thickness in lower extremity computed tomography (CT) images and assessing its effectiveness in diagnosing LEL. <b><i>Methods and Results:</i></b> We selected 56 patients with unilateral LEL based on specific diagnostic criteria, including clinical evaluation, lymphoscintigraphy, indocyanine green lymphography, and a noncontrast CT scan, which included the entire lower extremities. The CT images had a pixel spacing ranging from 0.723 to 0.976 mm, with a slice thickness of 10.0 mm. Our skin thickness measurement method involves preprocessing, such as extracting the leg, bone, muscle, and subcutaneous fat regions, defining the target slice range, and measuring the skin thickness. The lower extremity was divided into eight subregions, and the skin thickness was measured across these subregions. The overall median skin thicknesses were 0.883 ± 0.201 and 1.536 ± 0.487 mm in normal and positive subregions, respectively. The classification of LEL was based on the <i>Z</i>-score calculated for each subregion, with the median skin thickness from normal legs serving as a reference. Our classification method demonstrated an overall accuracy of 0.839, sensitivity of 0.703, and specificity of 0.937. <b><i>Conclusions:</i></b> Our automated method for measuring skin thickness in CT images shows promise in diagnosing LEL, with high accuracy and specificity. This approach enables a comprehensive evaluation of the entire leg, potentially enhancing the diagnostic process for LEL.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"223-228"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children and Young People with Lymphedema: The Education Need of Health Care Professionals.","authors":"Rhian Noble-Jones, Melanie Thomas","doi":"10.1089/lrb.2024.0043","DOIUrl":"10.1089/lrb.2024.0043","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The education need of health care professionals (HCP) to provide good quality care to children and young people with lymphedema (CYPwL) was unknown. While understanding of pediatric lymphedema grows, families still report delays in accessing appropriate treatment and HCP have reported being ill-prepared. <b><i>Methods:</i></b> A questionnaire was designed by phased process of literature search, focus group, and online consensus with international experts. The online survey, available in six languages, was distributed to HCP working with CYPwL by professional groups. <b><i>Results:</i></b> Questionnaires were received from 507 responders from 33 countries. Specific education on the treatment of CYPwL is needed, even when HCP are adult lymphedema trained according to 80% of respondents. Greatest consensus on best practice was that a multidisciplinary team (MDT) with specialist knowledge is required to treat CYPwL, but almost one in five HCP working with CYPwL have no, or rare, access to such a team. Reducing infections and adapting compression/treatment for age and development were deemed most essential. A variety of learning resources are needed including films, videos, and webinars from clinical experts. <b><i>Discussion and Conclusion:</i></b> This is the first international survey of the education need of HCP regarding CYPwL which include pathology, treatment, psychosocial care, and education of other professionals. Uppermost was knowing how to reduce infections and adapt compression and other treatments for age and development. Access to an experienced MDT was considered essential to support good clinical decision-making. Multimodal approaches are needed to address identified education need. Further research in individual countries and professions is recommended.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"215-222"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Elastographic Parameters in Patients with Breast Cancer-Related Lymphedema and Examination of Their Relationship with Clinical Data.","authors":"Merve Demirci, Canan Sanal, Ilker Yagcı, Gulseren Akyuz","doi":"10.1089/lrb.2024.0088","DOIUrl":"10.1089/lrb.2024.0088","url":null,"abstract":"<p><p><b><i>Background:</i></b> 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. <b><i>Methods and Results:</i></b> 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 (<i>p</i> < 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 (<i>p</i> < 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. <b><i>Conclusion:</i></b> The results of this study suggest that SWE measurements can be useful for diagnosis and follow-up of patients.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"263-271"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Therapeutic Ultrasound Added to Complex Decongestive Therapy in Breast Cancer-Related Lymphedema.","authors":"Mihriban Cağlı, Burcu Duyur Çakıt, Secil Pervane","doi":"10.1089/lrb.2023.0019","DOIUrl":"10.1089/lrb.2023.0019","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To determine the efficacy of therapeutic ultrasound (TUS) added to complex decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL). <b><i>Materials and Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>p</i> = 0.001 and <i>p</i> = 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 (<i>p</i> = 0.003). <b><i>Conclusion:</i></b> 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.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"272-280"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Treatment Process with Home Exercise Program and Telerehabilitation in Patients with Breast Cancer-Related Lymphedema: A Case-Control Study.","authors":"Merve Demirci, Canan Şanal","doi":"10.1089/lrb.2024.0038","DOIUrl":"10.1089/lrb.2024.0038","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to evaluate and compare the effectiveness of telerehabilitation (TR) and home exercise program (HEP) in patients with breast cancer-related lymphedema and the patients' compliance with these treatment processes. <b><i>Methods and Results:</i></b> 23 patients were prospectively included in the HEP group and 22 patients in the TR group, who were followed up in the Lymphedema Outpatient Clinic of the Department of Physical Medicine and Rehabilitation of a University Hospital. These patients were randomized. The volume difference between the extremities of the patients was calculated with the truncated cone formula, before and after treatment. The patients' pain, tightness, heaviness, and stiffness symptoms associated with lymphedema were questioned using a numerical scale. The patients' functionality and participation in daily life activities were evaluated with disabilities of arm, shoulder, and hand Quick Questionnaire (Quick-DASH) and the Lymphedema Life Impact Scale (LLIS). Patients' treatment satisfaction and compliance with treatment were questioned using Likert scales. A total of 45 patients were included in the study. The mean age and body mass index were similar between the groups (<i>p</i> ≥ 0.05). In the evaluations performed, no significant differences were observed within groups or between groups in terms of volume difference, quick DASH, pain, tightness, heaviness, stiffness, and LLIS scores (<i>p</i> ≥ 0.05). Patient satisfaction was significantly higher in the TR group (<i>p</i> ≤ 0.001). During treatment follow-up, only one person from the TR group missed the 5th-week checkup (4.5%), whereas five patients from the HEP missed the 5th-week checkup and three missed the 8th-week checkup. Overall, eight patients discontinued treatment (34%). <b><i>Conclusion:</i></b> Although there were no significant differences in clinical assessments between TR and HEP groups, patient satisfaction, and treatment adherence were significantly higher in the TR group.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"169-177"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between 25-Hydroxyvitamin D and Vitamin B12 Levels and Neuropathic Pain in Patients Diagnosed with Lipedema.","authors":"Gulcan Ozturk, Pinar Akpinar, Duygu Silte Karamanlioglu, Feyza Akan Begoğlu, Feyza Unlu Ozkan, Ilknur Aktas","doi":"10.1089/lrb.2024.0083","DOIUrl":"10.1089/lrb.2024.0083","url":null,"abstract":"<p><p><b><i>Background:</i></b> Pain is a prevalent symptom in patients with lipedema predominantly impacting the lower extremities. This study aimed to evaluate the relationship between 25-hydroxyvitamin D [25(OH)D] and vitamin B12 levels and neuropathic pain (NP) in patients diagnosed with lipedema. <b><i>Methods and Results:</i></b> A total of 243 patients with lipedema who had 25(OH)D and B12 levels measured in the past 6 months were included in this study. Participants were divided into two groups: Group 1 (<i>N</i> = 78) with NP scores ≥13 and Group 2 (<i>N</i> = 165) with NP scores <13. The Turkish version of the painDETECT questionnaire was used to assess the patients' NP symptoms. Pain levels were measured using the Visual Analog Scale (VAS) and pain threshold through algometric measurement. Group 1 had significantly higher palpation and spontaneous VAS scores, and pain threshold through algometric measurements than Group 2 (<i>p</i> < 0.05). No statistically significant difference was found between the groups regarding vitamin D levels being below 30 ng/mL or vitamin B12 levels being below 400 pg/mL (<i>p</i> > 0.05). <b><i>Conclusions:</i></b> No association was found between NP and 25(OH)D or B12 levels in patients with lipedema.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"203-211"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Matters.","authors":"","doi":"10.1089/lrb.2025.0043","DOIUrl":"10.1089/lrb.2025.0043","url":null,"abstract":"","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"213"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Secondary Chronic Lymphedema Rat Model Improved by High-Fat Diet.","authors":"Chan Xing, Jie Sun, Yaqian Liu, Jialin Zhou, Xue Bai, Jun Li, Haidong Zhao","doi":"10.1089/lrb.2024.0051","DOIUrl":"10.1089/lrb.2024.0051","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"194-202"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intermittent Pneumatic Compression Influences Edema Fluid Movement and Promotes the Compensatory Drainage Pathways in Patients with Breast Cancer Related Lymphedema.","authors":"Marzanna T Zaleska, Natalia E Krzesniak","doi":"10.1089/lrb.2024.0061","DOIUrl":"10.1089/lrb.2024.0061","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Upper limb lymphedema is the most common complication after breast cancer therapy. Suddenly disturbed lymphatic transport in the affected arm causes tissue fluid accumulation in tissue spaces, limb enlargement, and secondary changes in tissue. Early compression therapy is necessary. We aim to evaluate the effectiveness of intermittent pneumatic compression (IPC) in fluid movement along the limb and the possibility of creating compensatory drainage pathways. <b><i>Methods and Results:</i></b> We investigated 25 patients with Breast Cancer Related Lymphedema (BCRL) stages II and III. Indocyanine green observation and measurement of skin water concentration and skin and subcutaneous tissue stiffness were done before and after a single 45-minute session of IPC. After IPC, we observed the movement of edema fluid upper in the arm (92%) and in three main directions not seen before IPC: to the ipsilateral supraclavicular lymph node (30%), to the ipsilateral axilla (22%), and to the axilla, chest, and scapula (26%). We noticed two changes in fluorescent intensity along the entire limb: a decrease in the hand and forearm, an increase in the arm (64%), and a decrease along some parts or the entire limb (36%). Skin and subcutaneous tissue stiffness decreased at all limb levels. The highest, statistically significant reduction of subcutaneous tissue stiffness was noticed in the middle forearm and elbow (36.4% and 33.4%, respectively). <b><i>Conclusions:</i></b> IPC can effectively move edema fluid from the distal to the proximal part of the limb, promote compensatory drainage pathways, and decrease tissue stiffness. This compression type should be applied even in the early stages to prevent limb enlargement and secondary tissue changes.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"160-168"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Tapered Cutting Needles for Lymphaticovenular Anastomosis.","authors":"Satoshi Onoda, Kahori Tsukura, Kyona Taki, Toshihiko Satake","doi":"10.1089/lrb.2024.0057","DOIUrl":"10.1089/lrb.2024.0057","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> We report the usefulness of a tapered cutting needle, which has a polyhedral tip similar to that of a square needle and transitions to a round tip in the middle, for super-microsurgery. <b><i>Methods:</i></b> We have performed more than 500 lymphaticovenular anastomoses (LVAs) using tapered cutting needles. Therefore, we investigated the caliber of the anastomosed lymphatic vessels and veins, characteristics of the lymphatic vessels, the time required to perform the anastomosis, damage to the lymphatic vessels and veins during anastomosis, and patency of 30 recently performed consecutive anastomoses. <b><i>Results:</i></b> The mean caliber of the anastomosed lymphatic vessels was 0.68 mm (range, 0.4-1.2 mm), and the mean caliber of the veins was 0.87 mm (range, 0.5-1.5 mm). Regarding the progression of fibrosis, 14 cases were classified as no degeneration, 13 cases were classified as mild degeneration, 2 cases were classified as moderate degeneration, and 1 case was classified as severe degeneration. The average time required to perform the anastomosis was 10.53 minutes (range, 8-13 minutes). No cases of lymphatic or venous injury or laceration occurred during the anastomosis procedure. After the anastomosis was created, intraoperative patency was observed in all patients. <b><i>Conclusion:</i></b> The tapered cutting needle is useful for LVAs because of its excellent thread-ability and protective properties for blood vessels. Furthermore, the tapered cutting needle is useful for short anastomoses, regardless of the diameter or condition of the lymphatic vessels. In the future, the tapered cutting needle is expected to become the needle of choice for LVAs.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"178-183"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}