This editorial discusses a case report recently published in the World Journal of Clinical Cases.The report describes the clinical presentation,imaging,diagnosis,and treatment of a patient with tuberous sclerosis comp...This editorial discusses a case report recently published in the World Journal of Clinical Cases.The report describes the clinical presentation,imaging,diagnosis,and treatment of a patient with tuberous sclerosis complex(TSC)combined with primary lymphedema(PLE).Additionally,it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology,genetic diagnosis,and current main treatments of these patients.The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE.TSC combined with PLE is rare;therefore,the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE.Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations,often requiring a multidisciplinary approach for newly diagnosed cases.展开更多
Lymphedema,particularly in its advanced stages,presents significant challenges in treatment,often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes.This article revie...Lymphedema,particularly in its advanced stages,presents significant challenges in treatment,often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes.This article reviews the findings of Wang et al,regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe,deformed stage III lymphedema with recurrent infections.The case report details the promising results achieved through this combined therapy,highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis.The patient experienced notable improvements in weight loss,physical function,and quality of life.Despite its strengths,the study has several limitations.It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols,such as frequency and adherence,making reproducibility difficult.The short follow-up period of six months limits understanding of long-term efficacy,and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments.This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema.Further research is essential to standardize protocols and refine combined treatment strategies.展开更多
[Objectives]To explore the effectiveness of exercise therapy for lower limb lymphedema after cervical cancer surgery,and to inform future research and clinical practice in developing evidence-based nursing interventio...[Objectives]To explore the effectiveness of exercise therapy for lower limb lymphedema after cervical cancer surgery,and to inform future research and clinical practice in developing evidence-based nursing interventions.[Methods]Using the JBI scoping review guidelines as a methodological framework,relevant studies were retrieved from PubMed,Embase,Web of Science,Cochrane Library,CINAHL,CNKI,Wanfang Data,and Chinese Biomedical Literature Database from their inception to December 2024.[Results]The findings of included 18 studies showed that exercise therapy,mainly including progressive resistance training,aerobic exercise,aquatic exercise,and mixed exercise modalities,could effectively alleviate lower limb lymphedema symptoms in patients after cervical cancer surgery and improve quality of life.Progressive resistance training has been proven to be a safe and feasible preventive intervention;aerobic exercise and aquatic exercise have certain relieving effects on established lymphedema;mixed exercise interventions can improve patients functional activity capacity.[Conclusions]Exercise therapy is a feasible,safe,and effective intervention for lower limb lymphedema after cervical cancer surgery.Future high-quality randomized controlled trials are required to validate the effectiveness of different exercise modalities and to develop individualized exercise prescriptions that enhance patient adherence and reduce complications.展开更多
Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces.Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphat...Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces.Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels.Secondary lymphedema is a potential complication that may affect the quality of life of patients treated for breast cancer.Lifelong risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement,type of breast surgery,and radiation therapy.These factors decrease lymphatic drainage and increase stasis of fluids in the areas of skin and subcutaneous tissues that drain to regional lymph nodes.Breast cancer-related lymphedema can involve the arm and hand,as well as the breast and trunk on the operative side.Clinical symptom assessment and circumferential measures are widely used to evaluate lymphedema.Treatment of lymphedema associated with breast cancer can include combined modality approaches,compression therapy,therapeutic exercises,and pharmacotherapy.展开更多
A novel mutation of vascular endothelial growth factor receptor gene （VEGFR-3）, was identified in a four-generation Chinese family with hereditary lymphedema type I （HL-I）. Genetic linkage analysis was performed o...A novel mutation of vascular endothelial growth factor receptor gene （VEGFR-3）, was identified in a four-generation Chinese family with hereditary lymphedema type I （HL-I）. Genetic linkage analysis was performed on the known genetic locus for HL-I with a panel of polymorphic markers, and then mutations were screened out by direct sequencing. By genotyping, the family showed the linkage to HL-I locus on 5q35.3. Mutation screening analysis of the exons encoding the intracellular kinase domains of VEGFR-3, revealed a novel missense mutation D1055V. This mutation cosegregated with the disease phenotype in the family and was not found in 100 normal controls. This finding has expanded the spectrum of the VEGFR-3 gene mutations causing HL-I, and will be useful for further genetic consultation and genetic diagnosis.展开更多
Patient suffering from lymphedema in both lower extremities was treated,acupuncture was carried out at Zhōngwǎn（中脘 CV 12）,Shuǐfēn（水分 CV 9）,ShuǐDào（水道 ST 28）,Zúsānlǐ（足三里 ST 36）,Yīnl&#...Patient suffering from lymphedema in both lower extremities was treated,acupuncture was carried out at Zhōngwǎn（中脘 CV 12）,Shuǐfēn（水分 CV 9）,ShuǐDào（水道 ST 28）,Zúsānlǐ（足三里 ST 36）,Yīnlíngquán（阴陵泉 SP 9）,Sānyīnjiāo（三阴交 SP 6）,Yánɡlínɡquán（阳陵泉 GB 34）,Tàichōng（太冲 LR 3） and Tàixī（太溪穴 KI 3）,and local TDP irradiation was also carried out to improve local blood circulation and promote lymph fluid backflow,and thus effectively alleviate lymphedema in both lower extremities. The treatment courses were short and painless,and no adverse eff ect was detected.展开更多
The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 200...The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.展开更多
The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema.Published articles written in English were retrieved from electronic datab...The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema.Published articles written in English were retrieved from electronic databases,including ScienceDirect,PubMed,Scopus,and CINAHL databases.Hand-searches for unpublished papers were also completed.Content analysis was used to examine articles that met the inclusion criteria.Among 525 searched papers,15 papers met the inclusion criteria:13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise.The results of the review showed that no arm volume change was observed for either exercise modality.In addition,six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema.For patients with breast cancer-related lymphedema,six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group.However,three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group.The findings suggest that supervised resistance exercise may be safe,feasible,and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema.However,the limitation of small sample size implies that further research is needed to confirm these findings.展开更多
BACKGROUND Lymphedema is a chronic,debilitating and incurable disease that affects 0.13%-2%of the global population.Emerging evidence indicates that adipose-derived stem cells(ADSCs)might serve as suitable seed cells ...BACKGROUND Lymphedema is a chronic,debilitating and incurable disease that affects 0.13%-2%of the global population.Emerging evidence indicates that adipose-derived stem cells(ADSCs)might serve as suitable seed cells for lymphatic tissue engineering and lymphedema therapy.AIM To summarize applications of ADSCs for treating lymphedema in both animal studies and clinical trials.METHODS A systematic search was performed on four databases-PubMed,Clinicaltrials.gov,the evidence-based Cochrane Library,and OVID-using the following search string:(“lymphedema”or“lymphoedema”or“lymphangiogenesis”)and(“adipose-derived stem cells”or“adipose-derived stromal cells”or“adipose-derived regenerative cells”).A manual search was performed by skimming the references of relevant studies.Animal studies and clinical trials using adipose-derived cells for the treatment of any kind of lymphedema were included.RESULTS A total of eight research articles published before November 2019 were included for this analysis.Five articles focused on animal studies and another three focused on clinical trials.ADSC transplantation therapy was demonstrated to be effective against lymphedema in all studies.The animal studies found that coadministration of ADSCs and controlled-release vascular endothelial growth factor-C or platelet-rich plasma could improve the effectiveness of ADSC therapy.Three sequential clinical trials were conducted on breast cancer-related lymphedema patients,and all showed favorable results.CONCLUSION ADSC-based therapy is a promising option for treating lymphedema.Large-scale,multicenter randomized controlled trials are needed to develop more effective and durable therapeutic strategies.展开更多
Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were en...Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.展开更多
BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cance...BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.展开更多
Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of th...Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of the LYMQOL was distributed with the official Wechat account"Lymphedema Channel"to lymphedema patients who were recruited from October 28^(th),2020 to February 23^(rd),2021.Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately,at enrollment,1 week later,and 1 month later.Reliability,validity,feasibility,responsiveness and average time required for completing the questionnaire were assessed.Results A total of 195 patients participated in the study.The Chinese questionnaire showed high reliability with Cronbach’sαcoefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient(ICC)of 0.848-0.884 and Cronbach’sαcoefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900.The LYMQOL showed moderate to good correlations with the EQ-5 D(0.4<r<0.6,P<0.01;for the LYMQOLARM,n=95,for the LYMQOL-LEG,n=102).Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month(P<0.05).The average time of patients to finish the questionnaire was approximately 12 minutes.Conclusions The Chinese version of the LYMQOL is easy to answer,comprehensive and appropriate in length,and has good reliability and validity.It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema.展开更多
Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system.Secondary lymphedema attributed to cancer therapy,parasite infection,and trauma remains a serious global disease.Patient...Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system.Secondary lymphedema attributed to cancer therapy,parasite infection,and trauma remains a serious global disease.Patients with lymphedema suffer swelling,pain,and fatigue,with the dysfunction of the deformed extremities reducing the quality of life and increasing the risk of infection and lymphangiosarcoma.Adipose-derived stem cells(ADSCs)possess prominent regenerative potential to differentiate into multilineage cells,and produce various lymphangiogenic factors,making ADSC therapy a promising approach for lymphedema.The development of lymphedema consists of local inflammation,the fibrosis of lymphatic vessels,and the deposition of adipose fat.Existing animal models do not mimic the chronic inflammation environment,therefore suitable models are required in further studies.Some signal pathways and molecular mechanisms in physiological and pathological lymphagiogenesis remain unclear.In previous animal and human trials,ADSC therapy reduced edema in varying degrees.A larger number of trials with larger samples and longer follow-up periods are required to verify the efficiency and feasibility of ADSC therapy.ADSCs are of easy availability and immune exemption,making them a candidate for lymphedema treatment.Whether ADSCs enhance malignant characteristics or trigger the malignant change deserves further exploration and study before ADSC therapy can be made widely available.展开更多
Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy(PCT)for lymphedema(LE).Insurers,such as the Centers for Medicare/Medicaid(CMS),however,desire visual proof th...Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy(PCT)for lymphedema(LE).Insurers,such as the Centers for Medicare/Medicaid(CMS),however,desire visual proof that PCT moves lymph.Near infrared fuorescence lymphatic imaging(NIRFLI)was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related LE of the lower extremities before,during,and after PCT.Optically transparent and windowed PCT garments allowed visualization of lymph movement during single,1h PCT treatment sessions.Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects.In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies,these values were significantly increased during and after PCT as compared to pre-treatment values.Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT.Direct visualization revealed increased lymphatic function,during and after PCT therapy,in all LE-affected extremities.Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.展开更多
BACKGROUND Upper arm lymphedema is a common complication one year after breast cancer surgery,which profoundly impacts patients'quality of life.CASE SUMMARY We reported a case of lymphedema induced by prolonged su...BACKGROUND Upper arm lymphedema is a common complication one year after breast cancer surgery,which profoundly impacts patients'quality of life.CASE SUMMARY We reported a case of lymphedema induced by prolonged sun exposure 11 years after breast cancer surgery.CONCLUSION Breast screening,patient education and follow-up after hospital discharge could help to prevent upper-arm lymphedema.展开更多
Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in...Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in patients with breast cancer.Diagnosis relies on clinical evaluation and objective measures,including arm circumference and volumetric assessments,along with lymphoscintigraphy and ultrasonic measurements.Treatment primarily involves complex decongestive physical therapy,comprising manual lymphatic drainage,compression therapy,exercise,and meticulous skin care.These interventions aim to reduce swelling,alleviate discomfort,and prevent further complications.Additionally,lifestyle modifications such as avoiding extreme temperatures and maintaining proper hygiene are essential.Flavonoids can be used for drug therapy.Despite its prevalence,lymphedema often receives inadequate attention in clinical practice,emphasizing the importance of raising awareness and enhancing medical services for affected individuals.Clinicians play a pivotal role in educating patients about preventive measures and ensuring timely intervention.Overall,a comprehensive approach encompassing early diagnosis,multidisciplinary management,and patient education is essential to mitigate the burden of lymphedema in patients with breast cancer and improve their overall well-being.展开更多
BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient&...BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient's clinical presentation,imaging findings,and treatment.And a retrospective analysis was conducted on 14 published relevant case reports.CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling.This swelling is already present from birth.The patient’s memory had been progressively declining.Seizures had occurred 1 year prior at an unknown frequency.The patient was diagnosed with TSC combined with PLE through multimodal imaging examination:Computed tomography,magnetic resonance imaging,and lymphoscintigraphy.The patient underwent liposuction.The swelling of the patient's right lower limb significantly improved after surgery.Epilepsy did not occur.after taking antiepileptic drugs and sirolimus.CONCLUSION TSC with PLE is a rare and systemic disease.Imaging can detect lesions of this disease,which are important for diagnosis and treatment.展开更多
BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatm...BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.展开更多
Objective:To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema.Methods:We conducted a non-randomized controlled study at the Galactophore Department of the 3...Objective:To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema.Methods:We conducted a non-randomized controlled study at the Galactophore Department of the 3rd Affiliated Hospital of Beijing University of Chinese Medicine from March 2013 to December 2014.Seventy-five patients undergoing treatment for breast cancer-related lymphedema were divided into two groups in accordance with the patients' treatment choices:the treatment group (n =50) underwent bloodletting puncture and cupping every 5 days for 15 min/session (one session per day) combined with exercise training once a day for 30 minutes;the control group (n =25) underwent the same exercise training alone.Evaluation indexes were measured before and after treatment;these included arm circumference (at the wrist crease,10 cm distal to the wrist crease,the elbow crease,and 10 cm distal to the elbow crease)and visual analogue scale (VAS) score for pain.The safety of the treatment was also evaluated.Results:The treatment period was 50 days for all 75 patients.At the end of the treatment period,the mean reduction in arm circumference was 1.21 (0.65) cm the treatment group,and 0.58 (0.78) cm in the control group.Compared with the control group,the treatment group had a significantly greater reduction in arm circumference (P =.03) and a significantly lower VAS score for pain (P =.01).No patient in either group experienced any adverse events.Conclusion:Bloodletting puncture and cupping effectively reduces arm circumference and relieves upper limb pain in patients with breast cancer-related lymphedema.Our results provide sufficient basis for exploring cupping as long-term therapy for managing breast cancer-related lymphedema.展开更多
The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supe...The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.展开更多
文摘This editorial discusses a case report recently published in the World Journal of Clinical Cases.The report describes the clinical presentation,imaging,diagnosis,and treatment of a patient with tuberous sclerosis complex(TSC)combined with primary lymphedema(PLE).Additionally,it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology,genetic diagnosis,and current main treatments of these patients.The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE.TSC combined with PLE is rare;therefore,the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE.Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations,often requiring a multidisciplinary approach for newly diagnosed cases.
文摘Lymphedema,particularly in its advanced stages,presents significant challenges in treatment,often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes.This article reviews the findings of Wang et al,regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe,deformed stage III lymphedema with recurrent infections.The case report details the promising results achieved through this combined therapy,highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis.The patient experienced notable improvements in weight loss,physical function,and quality of life.Despite its strengths,the study has several limitations.It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols,such as frequency and adherence,making reproducibility difficult.The short follow-up period of six months limits understanding of long-term efficacy,and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments.This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema.Further research is essential to standardize protocols and refine combined treatment strategies.
文摘[Objectives]To explore the effectiveness of exercise therapy for lower limb lymphedema after cervical cancer surgery,and to inform future research and clinical practice in developing evidence-based nursing interventions.[Methods]Using the JBI scoping review guidelines as a methodological framework,relevant studies were retrieved from PubMed,Embase,Web of Science,Cochrane Library,CINAHL,CNKI,Wanfang Data,and Chinese Biomedical Literature Database from their inception to December 2024.[Results]The findings of included 18 studies showed that exercise therapy,mainly including progressive resistance training,aerobic exercise,aquatic exercise,and mixed exercise modalities,could effectively alleviate lower limb lymphedema symptoms in patients after cervical cancer surgery and improve quality of life.Progressive resistance training has been proven to be a safe and feasible preventive intervention;aerobic exercise and aquatic exercise have certain relieving effects on established lymphedema;mixed exercise interventions can improve patients functional activity capacity.[Conclusions]Exercise therapy is a feasible,safe,and effective intervention for lower limb lymphedema after cervical cancer surgery.Future high-quality randomized controlled trials are required to validate the effectiveness of different exercise modalities and to develop individualized exercise prescriptions that enhance patient adherence and reduce complications.
文摘Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces.Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels.Secondary lymphedema is a potential complication that may affect the quality of life of patients treated for breast cancer.Lifelong risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement,type of breast surgery,and radiation therapy.These factors decrease lymphatic drainage and increase stasis of fluids in the areas of skin and subcutaneous tissues that drain to regional lymph nodes.Breast cancer-related lymphedema can involve the arm and hand,as well as the breast and trunk on the operative side.Clinical symptom assessment and circumferential measures are widely used to evaluate lymphedema.Treatment of lymphedema associated with breast cancer can include combined modality approaches,compression therapy,therapeutic exercises,and pharmacotherapy.
文摘A novel mutation of vascular endothelial growth factor receptor gene （VEGFR-3）, was identified in a four-generation Chinese family with hereditary lymphedema type I （HL-I）. Genetic linkage analysis was performed on the known genetic locus for HL-I with a panel of polymorphic markers, and then mutations were screened out by direct sequencing. By genotyping, the family showed the linkage to HL-I locus on 5q35.3. Mutation screening analysis of the exons encoding the intracellular kinase domains of VEGFR-3, revealed a novel missense mutation D1055V. This mutation cosegregated with the disease phenotype in the family and was not found in 100 normal controls. This finding has expanded the spectrum of the VEGFR-3 gene mutations causing HL-I, and will be useful for further genetic consultation and genetic diagnosis.
文摘Patient suffering from lymphedema in both lower extremities was treated,acupuncture was carried out at Zhōngwǎn（中脘 CV 12）,Shuǐfēn（水分 CV 9）,ShuǐDào（水道 ST 28）,Zúsānlǐ（足三里 ST 36）,Yīnlíngquán（阴陵泉 SP 9）,Sānyīnjiāo（三阴交 SP 6）,Yánɡlínɡquán（阳陵泉 GB 34）,Tàichōng（太冲 LR 3） and Tàixī（太溪穴 KI 3）,and local TDP irradiation was also carried out to improve local blood circulation and promote lymph fluid backflow,and thus effectively alleviate lymphedema in both lower extremities. The treatment courses were short and painless,and no adverse eff ect was detected.
文摘The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.
文摘The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema.Published articles written in English were retrieved from electronic databases,including ScienceDirect,PubMed,Scopus,and CINAHL databases.Hand-searches for unpublished papers were also completed.Content analysis was used to examine articles that met the inclusion criteria.Among 525 searched papers,15 papers met the inclusion criteria:13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise.The results of the review showed that no arm volume change was observed for either exercise modality.In addition,six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema.For patients with breast cancer-related lymphedema,six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group.However,three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group.The findings suggest that supervised resistance exercise may be safe,feasible,and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema.However,the limitation of small sample size implies that further research is needed to confirm these findings.
文摘BACKGROUND Lymphedema is a chronic,debilitating and incurable disease that affects 0.13%-2%of the global population.Emerging evidence indicates that adipose-derived stem cells(ADSCs)might serve as suitable seed cells for lymphatic tissue engineering and lymphedema therapy.AIM To summarize applications of ADSCs for treating lymphedema in both animal studies and clinical trials.METHODS A systematic search was performed on four databases-PubMed,Clinicaltrials.gov,the evidence-based Cochrane Library,and OVID-using the following search string:(“lymphedema”or“lymphoedema”or“lymphangiogenesis”)and(“adipose-derived stem cells”or“adipose-derived stromal cells”or“adipose-derived regenerative cells”).A manual search was performed by skimming the references of relevant studies.Animal studies and clinical trials using adipose-derived cells for the treatment of any kind of lymphedema were included.RESULTS A total of eight research articles published before November 2019 were included for this analysis.Five articles focused on animal studies and another three focused on clinical trials.ADSC transplantation therapy was demonstrated to be effective against lymphedema in all studies.The animal studies found that coadministration of ADSCs and controlled-release vascular endothelial growth factor-C or platelet-rich plasma could improve the effectiveness of ADSC therapy.Three sequential clinical trials were conducted on breast cancer-related lymphedema patients,and all showed favorable results.CONCLUSION ADSC-based therapy is a promising option for treating lymphedema.Large-scale,multicenter randomized controlled trials are needed to develop more effective and durable therapeutic strategies.
基金This study was supported by Nursing Research Grant of Peking University Health Science Center(BMU20160517).
文摘Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.
文摘BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.
文摘Objective To study the reliability and validity of the Chinese version of the Lymphedema Quality of Life Questionnaire(LYMQOL)in lymphedema patients.Methods LYMQOL was translated into Chinese.The Chinese version of the LYMQOL was distributed with the official Wechat account"Lymphedema Channel"to lymphedema patients who were recruited from October 28^(th),2020 to February 23^(rd),2021.Patients with upper limb lymphedema and lower limb lymphedema completed the LYMQOL-ARM subscale and the LYMQOL-LEG subscale separately,at enrollment,1 week later,and 1 month later.Reliability,validity,feasibility,responsiveness and average time required for completing the questionnaire were assessed.Results A total of 195 patients participated in the study.The Chinese questionnaire showed high reliability with Cronbach’sαcoefficients of 0.849-0.902 for the LYMQOL-ARM and intraclass correlation coefficient(ICC)of 0.848-0.884 and Cronbach’sαcoefficients of 0.726-0.902 for the LYMQOL-LEG and ICC of 0.863-0.900.The LYMQOL showed moderate to good correlations with the EQ-5 D(0.4<r<0.6,P<0.01;for the LYMQOLARM,n=95,for the LYMQOL-LEG,n=102).Responsiveness analysis suggested that quality of life of upper limb lymphedema patients decreased after 1 month(P<0.05).The average time of patients to finish the questionnaire was approximately 12 minutes.Conclusions The Chinese version of the LYMQOL is easy to answer,comprehensive and appropriate in length,and has good reliability and validity.It may be utilized to assist treatment decision-making and track changes in clinical setting or research for lymphedema.
基金Supported by The Project of Cadre Institution of Sichuan Province,No.2019-901The Project of Human Resources and Social Security Department Academic and Technical Leader Training Fund in Sichuan,No.2017-A.
文摘Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system.Secondary lymphedema attributed to cancer therapy,parasite infection,and trauma remains a serious global disease.Patients with lymphedema suffer swelling,pain,and fatigue,with the dysfunction of the deformed extremities reducing the quality of life and increasing the risk of infection and lymphangiosarcoma.Adipose-derived stem cells(ADSCs)possess prominent regenerative potential to differentiate into multilineage cells,and produce various lymphangiogenic factors,making ADSC therapy a promising approach for lymphedema.The development of lymphedema consists of local inflammation,the fibrosis of lymphatic vessels,and the deposition of adipose fat.Existing animal models do not mimic the chronic inflammation environment,therefore suitable models are required in further studies.Some signal pathways and molecular mechanisms in physiological and pathological lymphagiogenesis remain unclear.In previous animal and human trials,ADSC therapy reduced edema in varying degrees.A larger number of trials with larger samples and longer follow-up periods are required to verify the efficiency and feasibility of ADSC therapy.ADSCs are of easy availability and immune exemption,making them a candidate for lymphedema treatment.Whether ADSCs enhance malignant characteristics or trigger the malignant change deserves further exploration and study before ADSC therapy can be made widely available.
基金NIH/NCI grant U54 CA 136404 and NIH/NCI grant R01 CA201487.
文摘Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy(PCT)for lymphedema(LE).Insurers,such as the Centers for Medicare/Medicaid(CMS),however,desire visual proof that PCT moves lymph.Near infrared fuorescence lymphatic imaging(NIRFLI)was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related LE of the lower extremities before,during,and after PCT.Optically transparent and windowed PCT garments allowed visualization of lymph movement during single,1h PCT treatment sessions.Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects.In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies,these values were significantly increased during and after PCT as compared to pre-treatment values.Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT.Direct visualization revealed increased lymphatic function,during and after PCT therapy,in all LE-affected extremities.Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.
文摘BACKGROUND Upper arm lymphedema is a common complication one year after breast cancer surgery,which profoundly impacts patients'quality of life.CASE SUMMARY We reported a case of lymphedema induced by prolonged sun exposure 11 years after breast cancer surgery.CONCLUSION Breast screening,patient education and follow-up after hospital discharge could help to prevent upper-arm lymphedema.
基金Supported by The National Research Foundation of Korea Grant funded by the Korea Government,No.00219725.
文摘Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in patients with breast cancer.Diagnosis relies on clinical evaluation and objective measures,including arm circumference and volumetric assessments,along with lymphoscintigraphy and ultrasonic measurements.Treatment primarily involves complex decongestive physical therapy,comprising manual lymphatic drainage,compression therapy,exercise,and meticulous skin care.These interventions aim to reduce swelling,alleviate discomfort,and prevent further complications.Additionally,lifestyle modifications such as avoiding extreme temperatures and maintaining proper hygiene are essential.Flavonoids can be used for drug therapy.Despite its prevalence,lymphedema often receives inadequate attention in clinical practice,emphasizing the importance of raising awareness and enhancing medical services for affected individuals.Clinicians play a pivotal role in educating patients about preventive measures and ensuring timely intervention.Overall,a comprehensive approach encompassing early diagnosis,multidisciplinary management,and patient education is essential to mitigate the burden of lymphedema in patients with breast cancer and improve their overall well-being.
基金Supported by National Natural Science Foundation of China,No.61876216.
文摘BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient's clinical presentation,imaging findings,and treatment.And a retrospective analysis was conducted on 14 published relevant case reports.CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling.This swelling is already present from birth.The patient’s memory had been progressively declining.Seizures had occurred 1 year prior at an unknown frequency.The patient was diagnosed with TSC combined with PLE through multimodal imaging examination:Computed tomography,magnetic resonance imaging,and lymphoscintigraphy.The patient underwent liposuction.The swelling of the patient's right lower limb significantly improved after surgery.Epilepsy did not occur.after taking antiepileptic drugs and sirolimus.CONCLUSION TSC with PLE is a rare and systemic disease.Imaging can detect lesions of this disease,which are important for diagnosis and treatment.
文摘BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.
文摘Objective:To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema.Methods:We conducted a non-randomized controlled study at the Galactophore Department of the 3rd Affiliated Hospital of Beijing University of Chinese Medicine from March 2013 to December 2014.Seventy-five patients undergoing treatment for breast cancer-related lymphedema were divided into two groups in accordance with the patients' treatment choices:the treatment group (n =50) underwent bloodletting puncture and cupping every 5 days for 15 min/session (one session per day) combined with exercise training once a day for 30 minutes;the control group (n =25) underwent the same exercise training alone.Evaluation indexes were measured before and after treatment;these included arm circumference (at the wrist crease,10 cm distal to the wrist crease,the elbow crease,and 10 cm distal to the elbow crease)and visual analogue scale (VAS) score for pain.The safety of the treatment was also evaluated.Results:The treatment period was 50 days for all 75 patients.At the end of the treatment period,the mean reduction in arm circumference was 1.21 (0.65) cm the treatment group,and 0.58 (0.78) cm in the control group.Compared with the control group,the treatment group had a significantly greater reduction in arm circumference (P =.03) and a significantly lower VAS score for pain (P =.01).No patient in either group experienced any adverse events.Conclusion:Bloodletting puncture and cupping effectively reduces arm circumference and relieves upper limb pain in patients with breast cancer-related lymphedema.Our results provide sufficient basis for exploring cupping as long-term therapy for managing breast cancer-related lymphedema.
文摘The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.
