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Physiological Reports Jun 2023Physiological properties and function of the lymphatic system is still somewhat of a mystery. We report the current knowledge about human lymphatic vessel contractility... (Review)
Review
Physiological properties and function of the lymphatic system is still somewhat of a mystery. We report the current knowledge about human lymphatic vessel contractility and capability of adaptation. A literature search in PubMed identified studies published January 2000-September 2022. Inclusion criteria were studies investigating parameters related to contraction frequency, fluid velocity, and lymphatic pressure in vivo and ex vivo in human lymphatic vessels. The search returned 2885 papers of which 28 met the inclusion criteria. In vivo vessels revealed baseline contraction frequencies between 0.2 ± 0.2 and 1.8 ± 0.1 min , velocities between 0.008 ± 0.002 and 2.3 ± 0.3 cm/s, and pressures between 4.5 (range 0.5-9.2) and 60.3 ± 2.8 mm Hg. Gravitational forces, hyperthermia, and treatment with nifedipine caused increases in contraction frequency. Ex vivo lymphatic vessels displayed contraction frequencies between 1.2 ± 0.1 and 5.5 ± 1.2 min . Exposure to agents affecting cation and anion channels, adrenoceptors, HCN channels, and changes in diameter-tension properties all resulted in changes in functional parameters as known from the blood vascular system. We find that the lymphatic system is dynamic and adaptable. Different investigative methods yields alternating results. Systematic approaches, consensus on investigative methods, and larger studies are needed to fully understand lymphatic transport and apply this in a clinical context.
Topics: Humans; Lymphatic System; Lymphatic Vessels; Adaptation, Physiological; Acclimatization
PubMed: 37269161
DOI: 10.14814/phy2.15697 -
IEEE Journal of Biomedical and Health... Sep 2023Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can...
Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can significantly reduce the quality of life (QOL) of patients and poses a significant challenge to healthcare providers. Early detection and continuous monitoring of lymphedema is crucial for the development of client-centered treatment plans for post-cancer surgery patients. Therefore, this comprehensive scoping review aimed to investigate the current technology methods used for the remote monitoring of BCRL and their potential to facilitate telehealth in the treatment of lymphedema. Initially, five electronic databases were systematically searched and analyzed following the PRISMA flow diagram. Studies were included, specifically if they provided data on the effectiveness of the intervention and were designed for the remote monitoring of BCRL. A total of 25 included studies reported 18 technological solutions to remotely monitor BCRL with significant methodological variation. Additionally, the technologies were categorized by method of detection and wearability. The findings of this comprehensive scoping review indicate that state-of-the-art commercial technologies were found to be more appropriate for clinical use than home monitoring, with portable 3D imaging tools being popular (SD 53.40) and accurate (correlation 0.9, p 0.05) for evaluating lymphedema in both clinic and home settings with expert practitioners and therapists. However, wearable technologies showed the most future potential for accessible and clinical long-term lymphedema management with positive telehealth outcomes. In conclusion, the absence of a viable telehealth device highlights the need for urgent research to develop a wearable device that can effectively track BCRL and facilitate remote monitoring, ultimately improving the quality of life for patients following post-cancer treatment.
Topics: Female; Humans; Breast Cancer Lymphedema; Breast Neoplasms; Lymphedema; Quality of Life; Telemedicine
PubMed: 37247315
DOI: 10.1109/JBHI.2023.3280196 -
Supportive Care in Cancer : Official... May 2023To perform a systematic review on financial toxicity of breast cancer-related lymphedema. (Review)
Review
PURPOSE
To perform a systematic review on financial toxicity of breast cancer-related lymphedema.
METHODS
Seven databases were searched on September 11, 2022. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Empirical studies were appraised by the Joanna Briggs Institute (JBI) tools. The Mixed Methods Appraisal Tool version 2018 was used to assess the mixed method studies.
RESULTS
A total of 963 articles were identified, but only 7 articles reporting on 6 studies met the eligibility criteria. A 2-year treatment for lymphedema was approximately USD$14,877 to USD$23,167 in America. In Australia, the average out-of-pocket costs ranged from A$207 to A$1400 (USD$156.26 to USD$1056.83) per year. Outpatient visits, compressed clothing, and hospital admissions were the dominant costs. The financial toxicity was associated with the severity of lymphedema, and patients with heavy financial burden had to reduce other expenses or even forgo the treatment.
CONCLUSION
Breast cancer-related lymphedema aggravated the economic burden of patients. The included studies showed great variation in the methods used and therefore differences in cost results. The national government should further improve the healthcare system and increase the insurance coverage of lymphedema treatment to alleviate this burden. More research is needed to focus on financial toxicity experience of breast cancer patients with lymphedema.
IMPLICATIONS FOR CANCER SURVIVORS
The cost of the ongoing treatment of breast cancer-related lymphedema influences patients' economic situation and quality of life. Survivors need to be informed early about the potential financial burden associated with lymphedema treatment.
Topics: Humans; Female; Breast Neoplasms; Financial Stress; Quality of Life; Breast Cancer Lymphedema; Lymphedema
PubMed: 37237237
DOI: 10.1007/s00520-023-07800-9 -
Journal of General Internal Medicine Aug 2023Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of cellulitis misdiagnosis in primary or unscheduled care settings based on a second clinical assessment and describe the proportion and types of alternative diagnoses.
METHODS
Electronic searches of Medline, Embase and Cochrane library (including CENTRAL) using MeSH and other subject terms identified 887 randomised and non-randomised clinical trials, and cohort studies. Included articles assessed the proportion of cellulitis misdiagnosis in primary or unscheduled care settings through a second clinical assessment up to 14 days post initial diagnosis of uncomplicated cellulitis. Studies on infants and patients with (peri-)orbital, purulent and severe or complex cellulitis were excluded. Screening and data extraction was conducted independently in pairs. Risk of bias was assessed using a modified risk of bias tool from Hoy et al. Meta-analyses were undertaken where ≥ 3 studies reported the same outcome.
RESULTS
Nine studies conducted in the USA, UK and Canada, including a total of 1600 participants, were eligible for inclusion. Six studies were conducted in the inpatient setting; three were in outpatient clinics. All nine included studies provided estimates of the proportion cellulitis misdiagnosis, with a range from 19 to 83%. The mean proportion misdiagnosed was 41% (95% CI 28 to 56% for random effects model). Heterogeneity between studies was very high both statistically (I 96%, p-value for heterogeneity < 0.001) and clinically. Of the misdiagnoses, 54% were attributed to three conditions (stasis dermatitis, eczematous dermatitis and edema/lymphedema).
DISCUSSION
The proportion of cellulitis misdiagnosis when reviewed within 14 days was substantial though highly variable, with the majority attributable to three diagnoses. This highlights the need for timely clinical reassessment and system initiatives to improve diagnostic accuracy of cellulitis and its most common mimics.
TRIAL REGISTRATION
Open Science Framework ( https://osf.io/9zt72 ).
Topics: Humans; Cellulitis; Diagnostic Errors; Canada
PubMed: 37231210
DOI: 10.1007/s11606-023-08229-w -
International Journal of Surgery... Aug 2023Although many studies have reported perioperative complications after radical hysterectomy and pelvic lymph node dissection using robotic and laparoscopic approaches,... (Meta-Analysis)
Meta-Analysis
The incidence of perioperative lymphatic complications after radical hysterectomy and pelvic lymphadenectomy between robotic and laparoscopic approach : a systemic review and meta-analysis.
BACKGROUND
Although many studies have reported perioperative complications after radical hysterectomy and pelvic lymph node dissection using robotic and laparoscopic approaches, the risk of perioperative lymphatic complications has not been well identified. The aim of this meta-analysis is to compare the risks of perioperative lymphatic complications after robotic radical hysterectomy and lymph node dissection (RRHND) with laparoscopic radical hysterectomy and lymph node dissection (LRHND) for early uterine cervical cancer.
MATERIALS AND METHODS
The authors searched the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases for studies published up to July 2022 comparing perioperative lymphatic complications after RRHND and LRHND while treating early uterine cervical cancer. Related articles and bibliographies of relevant studies were also checked. Two reviewers independently performed the data extraction.
RESULTS
A total of 19 eligible clinical trials (15 retrospective studies and 4 prospective studies) comprising 3079 patients were included in this analysis. Only 107 patients (3.48%) had perioperative lymphatic complications, of which the most common was lymphedema ( n =57, 1.85%), followed by symptomatic lymphocele ( n =30, 0.97%), and lymphorrhea ( n =15, 0.49%). When all studies were pooled, the odds ratio for the risk of any lymphatic complication after RRHND compared with LRHND was 1.27 (95% CI: 0.86-1.89; P =0.230). In the subgroup analysis, study quality, country of research, and publication year were not associated with perioperative lymphatic complications.
CONCLUSIONS
A meta-analysis of the available current literature suggests that RRHND is not superior to LRHND in terms of perioperative lymphatic complications.
Topics: Female; Humans; Robotic Surgical Procedures; Uterine Cervical Neoplasms; Retrospective Studies; Incidence; Prospective Studies; Laparoscopy; Lymph Node Excision; Hysterectomy; Postoperative Complications
PubMed: 37195800
DOI: 10.1097/JS9.0000000000000472 -
European Journal of Oncology Nursing :... Jun 2023To review and critically evaluate currently available risk prediction models for breast cancer-related lymphedema (BCRL). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To review and critically evaluate currently available risk prediction models for breast cancer-related lymphedema (BCRL).
METHODS
PubMed, Embase, CINAHL, Scopus, Web of Science, the Cochrane Library, CNKI, SinoMed, WangFang Data, VIP Database were searched from inception to April 1, 2022, and updated on November 8, 2022. Study selection, data extraction and quality assessment were conducted by two independent reviewers. The Prediction Model Risk of Bias Assessment Tool was used to assess the risk of bias and applicability. Meta-analysis of AUC values of model external validations was performed using Stata 17.0.
RESULTS
Twenty-one studies were included, reporting twenty-two prediction models, with the AUC or C-index ranging from 0.601 to 0.965. Only two models were externally validated, with the pooled AUC of 0.70 (n = 3, 95%CI: 0.67 to 0.74), and 0.80 (n = 3, 95%CI: 0.75 to 0.86), respectively. Most models were developed using classical regression methods, with two studies using machine learning. Predictors most frequently used in included models were radiotherapy, body mass index before surgery, number of lymph nodes dissected, and chemotherapy. All studies were judged as high overall risk of bias and poorly reported.
CONCLUSIONS
Current models for predicting BCRL showed moderate to good predictive performance. However, all models were at high risk of bias and poorly reported, and their performance is probably optimistic. None of these models is suitable for recommendation in clinical practice. Future research should focus on validating, optimizing, or developing new models in well-designed and reported studies, following the methodology guidance and reporting guidelines.
Topics: Humans; Female; Breast Neoplasms; Lymphedema
PubMed: 37137249
DOI: 10.1016/j.ejon.2023.102326 -
International Journal of Surgery... May 2023Microsurgical treatment options for lymphedema consist mainly of lymphovenous anastomosis (LVA) and vascularized lymph node transfers (VLNTs). There are no standard... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Microsurgical treatment options for lymphedema consist mainly of lymphovenous anastomosis (LVA) and vascularized lymph node transfers (VLNTs). There are no standard measurements of the effectiveness of these interventions and reported outcomes vary among studies.
METHODS
A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cinahl, Cochrane, and ProQuest in October 2020, with an update in February 2022. Firstly, a qualitative summary of the main reported outcomes was performed, followed by a pooled meta-analysis of the three most frequently reported outcomes using a random effects model. Randomized controlled trials, prospective cohorts, retrospective cohorts, and cross-sectional and case-control studies that documented outcomes following microsurgery in adult patients were included. Studies of other surgical treatments (liposuction, radical excision, lymphatic vessel transplantation) or without reported outcomes were excluded. The study protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42020202417). No external funding was received for this review.
RESULTS
One hundred fifty studies, including 6496 patients, were included in the systematic review. The qualitative analysis highlighted the three most frequently reported outcomes: change in circumference, change in volume, and change in the number of infectious episodes per year. The overall pooled change in excess circumference across 29 studies, including 1002 patients, was -35.6% [95% CI: -30.8 to -40.3]. The overall pooled change in excess volume across 12 studies including 587 patients was -32.7% [95% CI: -19.8 to -45.6], and the overall pooled change in the number of cutaneous infections episodes per year across 8 studies including 248 patients was -1.9 [95% CI: -1.4 to -2.3]. The vast majority of the studies included were case series and cohorts, which were intrinsically exposed to a risk of selection bias.
CONCLUSION
The currently available evidence supports LVA and vascularized lymph node transfers as effective treatments to reduce the severity of secondary lymphedema. Standardization of staging method, outcomes measurements, and reporting is paramount in future research in order to allow comparability across studies and pooling of results.
Topics: Adult; Humans; Retrospective Studies; Cross-Sectional Studies; Lymphedema; Lymphatic Vessels; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37057889
DOI: 10.1097/JS9.0000000000000210 -
Gland Surgery Feb 2023Breast cancer lymphedema (BCL) is one of the most common complications of breast cancer. Common western medical treatments for BCL, such as western medicine and...
BACKGROUND
Breast cancer lymphedema (BCL) is one of the most common complications of breast cancer. Common western medical treatments for BCL, such as western medicine and lymphatic drainage, are ineffective, and recurrence may easily occur, making treatment more challenging and placing a heavier burden on patients. Acupuncture therapy is commonly used to treat BCL in China, and there are many acupuncture therapies, including acupuncture, moxibustion, and the combination of acupuncture and moxibustion. Given the difference in operation difficulty, efficacy and safety of these acupuncture types, how to the most effective therapy is controversial. Therefore, the purpose of this study was to compare the efficacy and safety of different acupuncture and moxibustion methods, so as to provide guidance for clinical practice.
METHODS
The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and SinoMed databases were searched to September 30, 2022. Participants were diagnosed with BCL. Acupuncture was used in the intervention group, and other acupuncture were used in the control group. Outcomes included arm circumference, visual analogue scale (VAS), and safety evaluation. Risk of Bias Assessment Tool 2 (ROB2) was used to assess the risk of bias, Stata 16 was used for network meta-analysis.
RESULTS
A total of 7 studies were included, with 422 patients. The interventions included fire acupuncture, acupuncture (face), moxa-moxibustion, heat-sensitive moxibustion, moxibustion [traditional Chinese medicine (TCM)], acupuncture combine with moxibustion, acupoint application. The risk of overall bias was low or some concerns. The meta-analysis showed that: (I) arm circumference: acupuncture combined with moxibustion was superior to acupoint application [mean difference (MD) =-0.54; 95% confidence interval (CI): (-0.67, -0.41); P<0.05]. The surface under the cumulative ranking probability area (SUCRA) ranking results showed that acupuncture combined with moxibustion may be the optimal method. (II) VAS: acupuncture (face) was more effective than acupuncture (body) [MD =-0.85; 95% CI: (-1.09, -0.61); P<0.01]. The SUCRA ranking results showed that acupuncture (face) had the best effect.
CONCLUSIONS
Based on the current evidence, acupuncture and moxibustion is of great efficacy and safety for the treatment of BCL. Acupuncture combined with moxibustion is the most effective in reducing the arm circumference, and acupuncture (face) is of the greatest analgesic effect.
PubMed: 36915814
DOI: 10.21037/gs-22-767 -
European Journal of Physical and... Apr 2023One of the most common disabling complications in breast cancer (BC) patients is breast cancer-related lymphedema (BCRL), a pathological condition affecting both...
INTRODUCTION
One of the most common disabling complications in breast cancer (BC) patients is breast cancer-related lymphedema (BCRL), a pathological condition affecting both physical and psychological function, with detrimental consequences on health-related quality of life (HR-QoL). Rehabilitation has a key role in the comprehensive management of this condition with several studies reporting positive results after performing complex decongestive therapies (CDT) in these women. Kinesio taping (KT) is a rather recent therapeutic approach to treat BCRL, however, evidence in literature regarding its effectiveness is far from being fully characterized. Therefore, this systematic review aimed at assessing the role of KT among the CDT to treat BCRL.
EVIDENCE ACQUISITION
PubMed, Scopus, and Web of Science were systematically searched from inception until May 5, 2022 to determine randomized control trials (RCTs) reporting patients with BCRL; KT as intervention; limb volume as outcome (PROSPERO number: CRD42022349720).
EVIDENCE SYNTHESIS
Out of the documents identified, 123 were eligible for data screening, and only 7 RCTs satisfied the eligibility criteria and were included. We found that KT might have a positive effect on limb volume reduction in patients with BCRL, albeit there is little evidence for low quality of the included studies.
CONCLUSIONS
Taken together, this systematic review showed that KT did not significantly reduce the upper limb volume in BCRL women, albeit it seemed to increase the flow rate during the passive exercise. Further high-quality-studies are mandatory to improve the knowledge in order to include the KT might into a multidisciplinary rehabilitative approach for the management of BC survivors affected by lymphedema.
Topics: Female; Humans; Randomized Controlled Trials as Topic; Breast Neoplasms; Lymphedema; Upper Extremity; Athletic Tape
PubMed: 36847633
DOI: 10.23736/S1973-9087.23.07752-3 -
Biology Feb 2023Probiotics may have the potential to protect against breast cancer, partly through systemic immunomodulatory action and active impact upon intestinal microbiota. Given a... (Review)
Review
Probiotics may have the potential to protect against breast cancer, partly through systemic immunomodulatory action and active impact upon intestinal microbiota. Given a few clinical studies on their curative role, we conducted a systematic review of the potential effects of probiotics in breast cancer patients and survivors of breast cancer, aiming to support further clinical studies. A literature search was performed using PubMed, Embase, and the CENTRAL databases from inception through to March 2022. A total of eight randomized clinical trials were identified from thirteen articles published between 2004 and 2022. We evaluated quality-of-life measures, observed bacterial species and diversity indices, probiotic-related metabolites, inflammatory biomarkers, and other responses in breast cancer patients and survivors. Results were synthesized qualitatively and quantitatively using random-effects meta-analysis. Different probiotics supplements utilized included species alone (Lacto), with or without estriol; probiotic combinations of with (ProLB), with or without prebiotic fructooligosaccharides (FOS); ProLB plus and FOS (ProLBS + FOS); and ProLB plus (ProLBE). We found that use of ProLBS with FOS in breast cancer patients and use of ProLBE in survivors of breast cancer show potential benefits in countering obesity and dyslipidemia. ProLBS with FOS use decreases pro-inflammatory TNF-α in breast cancer survivors and improves quality of life in those with breast-cancer-associated lymphedema. Supplementing probiotics capsules (10 CFU) with a prebiotic and using an intake duration of 10 weeks could provide a better approach than probiotics alone.
PubMed: 36829557
DOI: 10.3390/biology12020280