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Effect of Lymphaticovenous Anastomosis on Muscle Edema, Limb, and Subfascial Volume in Lower Limb Lymphedema: MRI Studies. J Am Coll Surg 2022; 235:227-239. [PMID: 35839398 PMCID: PMC9278703 DOI: 10.1097/xcs.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although satisfactory volume reduction in secondary unilateral lower limb lymphedema after lymphaticovenous anastomosis (LVA) in the affected limb has been well reported, alleviation of muscle edema and the impact of LVA on the contralateral limb have not been investigated. STUDY DESIGN This retrospective cohort study enrolled patients who underwent supermicrosurgical LVA between November 2015 and January 2017. Pre- and post-LVA muscle edema were assessed using fractional anisotropy (FA) and apparent diffusion coefficient (ADC). The primary endpoint was changes in limb/subfascial volume assessed with magnetic resonance volumetry at least 6 months after LVA. RESULTS Twenty-one patients were enrolled in this study. Significant percentage reductions in post-LVA muscle edema were found in the affected thigh (83.6% [interquartile range = range of Q1 to Q3; 29.8-137.1] [FA], 53.3% [27.0-78.4] [ADC]) as well as limb (21.7% [4.4-26.5]) and subfascial (18.7% [10.7-39.1]) volumes. Similar findings were noted in the affected lower leg: 71.8% [44.0-100.1] (FA), 59.1% [45.8-91.2] (ADC), 21.2% [6.8-38.2], and 28.2% [8.5-44.8], respectively (all p < 0.001). Significant alleviation of muscle edema was also evident in the contralateral limbs (thigh: 25.1% [20.4-57.5] [FA]; 10.7% [6.6-17.7] [ADC]; lower leg: 47.1% [35.0-62.8] [FA]; 14.6% [6.5-22.1] [ADC]; both p < 0.001), despite no statistically significant difference in limb and subfascial volumes. CONCLUSIONS Our study found significant reductions in muscle edema and limb/subfascial volumes in the affected limb after LVA. Our findings regarding edema in the contralateral limb were consistent with possible lymphedema-associated systemic influence on the unaffected limb, which could be surgically relieved.
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Hsu JF, Yu RP, Stanton EW, Wang J, Wong AK. Current Advancements in Animal Models of Postsurgical Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle) 2022; 11:399-418. [PMID: 34128396 PMCID: PMC9142133 DOI: 10.1089/wound.2021.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Significance: Secondary lymphedema is a debilitating disease caused by lymphatic dysfunction characterized by chronic swelling, dysregulated inflammation, disfigurement, and compromised wound healing. Since there is no effective cure, animal model systems that support basic science research into the mechanisms of secondary lymphedema are critical to advancing the field. Recent Advances: Over the last decade, lymphatic research has led to the improvement of existing animal lymphedema models and the establishment of new models. Although an ideal model does not exist, it is important to consider the strengths and limitations of currently available options. In a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we present recent developments in the field of animal lymphedema models and provide a concise comparison of ease, cost, reliability, and clinical translatability. Critical Issues: The incidence of secondary lymphedema is increasing, and there is no gold standard of treatment or cure for secondary lymphedema. Future Directions: As we iterate and create animal models that more closely characterize human lymphedema, we can achieve a deeper understanding of the pathophysiology and potentially develop effective therapeutics for patients.
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Affiliation(s)
- Jerry F. Hsu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Roy P. Yu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eloise W. Stanton
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jin Wang
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Alex K. Wong
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California, USA.,Correspondence: Division of Plastic Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Pavillion 2216, Duarte, CA 91010, USA.
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Lymphaticovenous Anastomosis Supermicrosurgery Decreases Oxidative Stress and Increases Antioxidant Capacity in the Serum of Lymphedema Patients. J Clin Med 2021; 10:jcm10071540. [PMID: 33917571 PMCID: PMC8038828 DOI: 10.3390/jcm10071540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Excess lymphedematous tissue causes excessive oxidative stress in lymphedema. Lymphaticovenous anastomosis (LVA) supermicrosurgery is currently emerging as the first-line surgical intervention for lymphedema. No data are available regarding the changes in serum proteins correlating to oxidative stress and antioxidant capacity before and after LVA. METHODS A total of 26 patients with unilateral lower limb lymphedema confirmed by lymphoscintigraphy were recruited, and venous serum samples were collected before (pre-LVA) and after LVA (post-LVA). In 16 patients, the serum proteins were identified by isobaric tags for relative and absolute quantitation-based quantitative proteomic analysis with subsequent validation of protein expression by enzyme-linked immunosorbent assay. An Oxidative Stress Panel Kit was used on an additional 10 patients. Magnetic resonance (MR) volumetry was used to measure t limb volume six months after LVA. RESULTS This study identified that catalase (CAT) was significantly downregulated after LVA (pre-LVA vs. post-LVA, 2651 ± 2101 vs. 1448 ± 593 ng/mL, respectively, p = 0.033). There were significantly higher levels of post-LVA serum total antioxidant capacity (pre-LVA vs. post-LVA, 441 ± 81 vs. 488 ± 59 µmole/L, respectively, p = 0.031) and glutathione peroxidase (pre-LVA vs. post-LVA, 73 ± 20 vs. 92 ± 29 U/g, respectively, p = 0.018) than pre-LVA serum. In addition, after LVA, there were significantly more differences between post-LVA and pre-LVA serum levels of CAT (good outcome vs. fair outcome, -2593 ± 2363 vs. 178 ± 603 ng/mL, respectively, p = 0.021) and peroxiredoxin-2 (PRDX2) (good outcome vs. fair outcome, -7782 ± 7347 vs. -397 ± 1235 pg/mL, respectively, p = 0.037) in those patients with good outcomes (≥40% volume reduction in MR volumetry) than those with fair outcomes (<40% volume reduction in MR volumetry). CONCLUSIONS The study revealed that following LVA, differences in some specific oxidative stress markers and antioxidant capacity can be found in the serum of patients with lymphedema.
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Pfister C, Dawczynski H, Schingale FJ. Selenium Deficiency in Lymphedema and Lipedema-A Retrospective Cross-Sectional Study from a Specialized Clinic. Nutrients 2020; 12:nu12051211. [PMID: 32344864 PMCID: PMC7281982 DOI: 10.3390/nu12051211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/29/2023] Open
Abstract
Background: Selenium is a trace element, which is utilized by the human body in selenoproteins. Their main function is to reduce oxidative stress, which plays an important role in lymphedema and lipedema. In addition, selenium deficiency is associated with an impaired immune function. The aim of this study was to determine the prevalence of selenium deficiency in these conditions, and if it is associated with disease severity and an associated medical condition such as obesity. Methods: This cross-sectional study is an anonymized, retrospective analysis of clinical data that was routinely recorded in a clinic specialized in lymphology. The data was comprised from 791 patients during 2012–2019, in which the selenium status was determined as part of their treatment. Results: Selenium deficiency proved common in patients with lymphedema, lipedema, and lipo-lymphedema affecting 47.5% of the study population. Selenium levels were significantly lower in patients with obesity-related lymphedema compared to patients with cancer-related lymphedema (96.6 ± 18.0 μg/L vs. 105.1 ± 20.2 μg/L; p < 0.0001). Obesity was a risk factor for selenium deficiency in lymphedema (OR 2.19; 95% CI 1.49 to 3.21), but not in lipedema. Conclusions: In countries with low selenium supply, selenium deficiency is common, especially in lymphedema patients. Therefore, it would be sensible to check the selenium status in lymphedema patients, especially those with obesity, as the infection risk of lymphedema is already increased.
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Affiliation(s)
- Christina Pfister
- Biosyn Arzneimittel GmbH, Schorndorfer Straße 32, 70734 Fellbach, Germany;
- Correspondence: ; Tel.: +49-711-57532-321
| | - Horst Dawczynski
- Biosyn Arzneimittel GmbH, Schorndorfer Straße 32, 70734 Fellbach, Germany;
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Bertelli M, Kiani AK, Paolacci S, Manara E, Dautaj A, Beccari T, Michelini S. Molecular pathways involved in lymphedema: Hydroxytyrosol as a candidate natural compound for treating the effects of lymph accumulation. J Biotechnol 2019; 308:82-86. [PMID: 31794783 DOI: 10.1016/j.jbiotec.2019.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Abstract
Lymphedema is a chronic accumulation of interstitial fluid due to inefficient lymph drainage. Major causes of lymphedema are malformations of lymphatic vessels, trauma, toxic damage and surgery. The swelling typically affects the limbs. Lymphedema may be primary, caused by genetic mutations and relatively rare, or secondary (acquired), due to external causes such as infections or surgery. Fluid accumulation induces pathological changes: activation of the inflammatory cascade, immune cell infiltration, tissue fibrosis, adipose accumulation. We focused on the inflammatory phenotype mediated by leukotriene B4, a lipid mediator of the inflammatory pathway, and the potential therapeutic effect of hydroxytyrosol. We conducted an electronic search in PubMed using "lymphedema", "lymphedema pathway", "hydroxytyrosol" as keywords. We found that lymphedema deregulates at least six molecular pathways and that hydroxytyrosol, a compound with antioxidant activity, can improve endothelial dysfunction, hemostatic and lipid profiles, and decrease oxidative stress and inflammation through inhibition of leukotriene B4 activity. This review is the first to highlight the possibility of using hydroxytyrosol to treat the secondary effects of lymphedema, especially inflammation. The possible effects of hydroxytyrosol on lymphedema should be tested in vitro and in vivo to find the best way to treat patients with lymphedema in order to improve their health status.
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Affiliation(s)
- Matteo Bertelli
- EBTNA-Lab, Via Delle Maioliche, 57/G, 38068, Rovereto, TN, Italy.
| | - Aysha Karim Kiani
- Allama Iqbal Open University, Sector H-8, 44000, Islamabad, Pakistan.
| | - Stefano Paolacci
- MAGI's Lab, Via Delle Maioliche, 57/D, 38068, Rovereto, TN, Italy.
| | - Elena Manara
- MAGI Euregio, Via Maso della Pieve, 60/A, 39100, Bolzano, Italy.
| | - Astrit Dautaj
- MAGI Balkans, Rruga Andon Zako Cajupi, 1019, Tirana, Albania.
| | - Tommaso Beccari
- Department of Pharmaceutical Sciences, University of Perugia, Via Ariodante Fabretti, 48, 06123, Perugia, Italy.
| | - Sandro Michelini
- Department of Vascular Rehabilitation, San Giovanni Battista Hospital, Via Luigi Ercole Morselli, 13, 00148, Rome, Italy.
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Choi J, Kim KY, Jeon JY, Yoon SH, Park JH, Song HY, Cho KJ. Development and Evaluation of a New In Vivo Volume Measuring System in Mouse Tail Lymphedema Model. Lymphat Res Biol 2019; 17:402-412. [DOI: 10.1089/lrb.2018.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Joonmyeong Choi
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, Seoul National University, Seoul, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology, Chonbuk National University Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hwan Yoon
- Department of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Park
- Department of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho-Young Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyu-Jin Cho
- Biorobotics Laboratory, Department of Mechanical and Aerospace Engineering, Seoul National University, Seoul, Republic of Korea
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Dissemond J, Jockenhöfer F, Miller A, Kurzhals G, Noori S, Reich-Schupke S, Schlaeger M, Schubert E, Stücker M, Weberschock T, Jungkunz HW. S1 Guidelines - Dermatoses associated with dermal lymphostasis. J Dtsch Dermatol Ges 2018; 16:512-523. [DOI: 10.1111/ddg.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Joachim Dissemond
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Finja Jockenhöfer
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Anya Miller
- “The Skin Experts” - Dermatology; Venereology; Allergology; and Phlebology Practice; Berlin Germany
| | - Günter Kurzhals
- Drs. Kurzhals - Dermatology; Venereology; and Phlebology Practice; Wangen/Allgäu Germany
| | - Shahrouz Noori
- Dr. Noori - Dermatology and Venereology Practice; Vienna Austria
| | - Stefanie Reich-Schupke
- Department of Dermatology; Venereology and Allergology; Center for Venous Diseases of the Departments of Dermatology and Vascular Surgery; Ruhr University; Bochum Germany
| | - Martin Schlaeger
- Dr. Schlaeger - Dermatology; Venereology; and Allergology Practice; Oldenburg Germany
| | - Erich Schubert
- Former Department of Dermatology; Allergology; Phlebology; and Lymphology; Sanaderm Hospital; Bad Mergentheim Germany
| | - Markus Stücker
- Department of Dermatology; Venereology and Allergology; Center for Venous Diseases of the Departments of Dermatology and Vascular Surgery; Ruhr University; Bochum Germany
| | - Tobias Weberschock
- Working Group Evidence-based Medicine Frankfurt; Institute of General Medicine; Johann Wolfgang Goethe University; Frankfurt Germany
- Department of Dermatology; Venereology and Allergology; University Medical Center of the Johann Wolfgang Goethe University; Frankfurt Germany
| | - Hans Wilfried Jungkunz
- Former Department of Dermatology; Allergology; Phlebology; and Lymphology; Sanaderm Hospital; Bad Mergentheim Germany
- Dr. Jungkunz; Dermatology; Venereology; Phlebology; Allergology; and Proctology Practice; Friedberg/Hessen Germany
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Dissemond J, Jockenhöfer F, Miller A, Kurzhals G, Noori S, Reich-Schupke S, Schlaeger M, Schubert E, Stücker M, Weberschock T, Jungkunz HW. S1-Leitlinie - Dermatosen bei dermaler Lymphostase. J Dtsch Dermatol Ges 2018; 16:512-524. [DOI: 10.1111/ddg.13496_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum Essen
| | - Finja Jockenhöfer
- Klinik und Poliklinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum Essen
| | - Anya Miller
- Praxis Die Hautexperten; Dermatologie; Venerologie; Allergologie; Phlebologie; Berlin
| | - Günter Kurzhals
- Praxis Dres. Kurzhals; Dermatologie; Venerologie; Phlebologie; Wangen/Allgäu
| | | | - Stefanie Reich-Schupke
- Klinik für Dermatologie; Venerologie und Allergologie; Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken; Ruhr-Universität Bochum
| | - Martin Schlaeger
- Praxis Dr. Schlaeger; Dermatologie; Venerologie; Allergologie; Oldenburg
| | - Erich Schubert
- ehemalige Klinik Sanaderm für Dermatologie; Allergologie; Phlebologie; Lymphologie; Bad Mergentheim
| | - Markus Stücker
- Klinik für Dermatologie; Venerologie und Allergologie; Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken; Ruhr-Universität Bochum
| | - Tobias Weberschock
- Arbeitsgruppe EbM Frankfurt; Institut für Allgemeinmedizin; Johann Wolfgang-Goethe-Universität; Frankfurt/Main
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Johann Wolfgang-Goethe-Universität; Frankfurt/Main
| | - Hans Wilfried Jungkunz
- ehemalige Klinik Sanaderm für Dermatologie; Allergologie; Phlebologie; Lymphologie; Bad Mergentheim
- Praxis Dr. Jungkunz; Dermatologie; Venerologie; Phlebologie; Allergologie; Proktologie; Friedberg/Hessen
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Jang DH, Song DH, Chang EJ, Jeon JY. Anti-inflammatory and lymphangiogenetic effects of low-level laser therapy on lymphedema in an experimental mouse tail model. Lasers Med Sci 2015; 31:289-96. [DOI: 10.1007/s10103-015-1854-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 12/11/2015] [Indexed: 01/28/2023]
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Mechanisms of ascorbyl radical formation in human platelet-rich plasma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:614506. [PMID: 24696859 PMCID: PMC3947840 DOI: 10.1155/2014/614506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/09/2014] [Indexed: 11/21/2022]
Abstract
Recently, many clinical reports have suggested that the ascorbyl free radical (Asc∙) can be treated as a noninvasive, reliable, real-time marker of oxidative stress, but its generation mechanisms in human blood have rarely been discussed. In this study, we used upstream substances, enzyme inhibitors, and free radical scavengers to delineate the mechanisms of Asc∙ formation in human platelet-rich plasma (PRP). Our results show that the doublet signal was detected in PRP samples by using electron spin resonance, and the hyperfine splitting of the doublet signal was aH = 1.88 gauss and g-factor = 2.00627, which was determined to be the Asc∙. We observed that the inhibitors of NADPH oxidase (NOX), cyclooxygenase (COX), lipoxygenase (LOX), cytochrome P450 (CYP450), mitochondria complex III, and nitric oxide synthase (NOS), but not xanthine oxidase, diminished the intensity of the Asc∙ signal dose dependently. All enzyme inhibitors showed no obvious antioxidant activity during a Fenton reaction assay. In summary, the obtained data suggest that Asc∙ formation is associated with NOX, COX, LOX, CYP450, eNOS, and mitochondria in human PRP.
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