Objective To assess the feasibility of intestitial MR lymphangiography (MRL) with subcutaneous injection of a commercially available,non-ionic,extracellular paramagnetic contrast agent,to visualize lymphatic vessels in patients with primary lymphedema.Methods Forty lower extremities in 31 patients with clinically advanced stages of primary lymphedema were examined with magnetic resonance lymphangiography.A 1 ml mixed liquor of gadobenate dimeglumine and mepivacainhydrochloride were injected subcutaneously into the dorsal aspect of both feet For MRL,a 3D fast spoiled gradient-recalled echo T1-weighted images with a fat saturation technique (T1 high resolution isotropic volume excitation,THRIVE) were performed after subcutaneous application of the contrast material To outline lymphatic vessels,source images were used to reconstruct images of MIP.The SNR and CNR of enhanced lymphatic vessels and veins were measured and calculated respectively.The significance of the differences of the data comparisons was assessed using an unpaired student t teat.Results Of the 40 lower extremities,the beaded appearance of dilated lymphatic vessels was detected in 36 lower legs (90.0%) and 17 upper legs (42.5%).The numbers of the dilated lymphatic vessels displayed in all segments of lower extremities added up to 365 and its mean diameter was (3.4 ± 0.1) mm on MRL MIP image.The average SNR and CNR were 257 ±130,207 ± 113 in the dilated lymphatic vessels and 218 ± 129,152 ± 113 in the vein respectively,which was statistically significant (SNR t = -2.649,CNR t = -3.404,P <0.01).Contrast enhancement was observed in 30/40 inguinal lymph node groups (75.0%).In 26 lower extremities (65.0%) collateral vessels with dermal back-flow areas between lymphatic vessels were seen.Conclusions As a novel tool to image the pathologically modified lymphatic vessels in patients with clinically advanced stage of primary lymphedema,magnetic resonance lymphangiography is a safe,useful technique.

Object To define the optimal proportion of four ingredients in Danxintong (DXT). Methods Uniform design method combined with pharmacodynamics (Rat acute myocardial ischemia model was used in this study) was used. Results The optimal proportion and components of DXT (Composed of Rhizoma Chuanxiong, Rhizoma Cyperi, Borneolum Syntheticum, and paeonol) were 5∶ 1.7∶ 1.4∶ 4.4; DXT 138 mg/kg could obviously inhibit acute myocardial ischemia of rats induced by iso prenaline (Iso) and pituiturin (Pit). DXT has antimyocardial ischemia effects in preliminary experimental studies. Conclusion Uniform design method is an effective method to define the optimal proportion of ingredients in DXT;

ObjectiveTo access the value of combined application of high-resolution interstitial MR lymphangiography (MRL) and heavily T2WI for the visualization of lymphatic vessels in patients with primary lymphedema.Methods Forty lower extremities in 31 patients with primary lymphedema were examined by heavily T2 WI and interstitial MRL with a 3.0 T MR unit (Philips Medical Systems,Best,the Netherlands).Two experienced radiologists analyzed the images and tried to determine the differences in number of lymphatic vessels,and their maximum diameters,SNR and CNR,and accumulated lymph fluid in the tissue.Statistical analyses were conducted by using Wilcoxon test and t test.ResultsDilated lymphatic vessels in 73 leg segments of 40 lower extremities were visualized on heavily T2WI (median 5,1 to 24),which were more than those on MRL ( median 3,1 to 16) (Z =-2.92,P ＜ 0.01 ).The maximum diameter of lymphatic vessels was (4.3 ± 1.5 ) mm on heavily T2 WI,whereas it was ( 3.4 ± 1.0) mm on MRL ( t =6.90,P ＜ 0.0 1 ).The average SNR and CNR in the dilated lymphatic vessels were 257 ± 130,207 ± 113 on MRL and 169 ± 91,135 ± 82 on heavily T2 WI,which was statistically significant ( SNR t =- 5.95,CNR t =-5.10; P ＜ 0.01 ).The visualization of regions of accumulated lymph fluid on heavily T2WI (median 1 ) had a higher score than that on MRL ( median 0 ) ( Z =- 5.64,P ＜ 0.01 ).Conclusions The heavily T2WI has greater sensitivity and the MRL image has better SNR and CNR.Combining these two MR techniques can provide adequate information for clinicians in the therapeutic planning of patients with advanced stages of lymphedema.

OBJECTIVETo investigate the therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas.

METHODSFrom March 2004 to March 2013, 80 patients with chronic lymphedema of extremities accompanied with erysipelas were analyzed retrospectively. The patients underwent heating treatment (42 degree centigrade) with infrared light machine made by Shanghai Ninth People's Hospital, 2 hours a day, 20 hours for a session. Bandage treatment was adopted after heating treatment. 1 or 2 sessions were performed for each patient every year. The erysipelas occurring frequency, patients subjective feeling, treatment sessions and elastic material usage was recorded during the follow-up period. The erysipelas occurring frequency was tested by the method of rank and inspection. SPSS 17. 0 was used for statistical analysis.

RESULTSAfter heating and bandage treatment, the occurrence frequency of erysipelas was obviously controlled (Z = 7.598, P = 0.000). Erysipelas was not occurred any more in 60 (75%)patients. Remarkable reduction of occurrence frequency of erysipelas caused by various reasons was showed after treatment. Primary and secondary lymphedema after treatment were compared with those before treatment respectively, showing statistical difference (Z = 3.417 and 5.009, P = 0.001 and 0.000). Most of patients felt better subjectively. The relapse rate of erysipelas and lymphedema was lower if keeping using elastic material to give more pressure on extremities after therapy.

CONLUSIONSHeating and bandage treatment can obviously reduce the occurrence frequency of erysipelas. It can improve the quality of patients' lives. Simultaneously, the subsequent elastic material pressure therapy is essential.

Bandages ; Chronic Disease ; Combined Modality Therapy ; methods ; Erysipelas ; complications ; therapy ; Extremities ; Female ; Humans ; Hyperthermia, Induced ; methods ; Lymphedema ; complications ; therapy ; Middle Aged ; Pressure ; Recurrence ; Retrospective Studies ; Time Factors

Objective Currently, the prefabricated flap is used for reconstructing the post-burn scar in head and face.The aim is to analyze the nature of the post-op edema in the prefabricated flaps, to determine whether it is lymphedema, and to study the prognosis of the edema.Methods From January, 2011 to March, 2015, 18 cases of post-operation edema in superficial temporal fascia prefabricated flaps were studied and each case was followed for 5 months.We used ultrasound and indocyanine green (ICG) fluorescent imaging to study the nature of the edema.Apart from that, we monitored the recovery process of the post-operation edema by a) measuring the horizontal diameter of the flap by a tape, b) measuring the thickness of the flap by the ultrasound, c) monitoring the condition of edema by ICG and d) monitoring the reconstruction and recanalization of the lymphatic system by ICG.Results Pitting edema always occurred in the prefabricated flap from the first day after operation.These patients were diagnosed as mild lymphedema (7 cases), moderate lymphedema (10 cases), and severe lymphedema (1cases) by ultrasound and ICG florescent imaging.The degree of flap lymphedema improved gradually and it improved significantly from 3 days to 6 days post-op eration.The condition of flap lymphedema became stable from the 12 days post-operation.The fluorescence image of ICG showed that the stage of flap lymphedema improved from 3 weeks post-operation and the transportation capability of lymphatic vessels increased most from the 3 days to 6 days post-op eration.We also found lymphatic vessels reconnected from the 6 days post-operation and lymphatic system reconstructed following the direction to lymph nodes.We could discover the collecting lymphatic vessels from 2 months post-operation and the lymphatic system in prefabricated flap matured from 5 months post-operation.Conclusion The post-operation edema in the prefabricated flaps is lymphedema, the incidence rate of which is high.The lymphatic drainage system recovers in 6 days after the operation.It is reconstructed along the lymph nodes.The edema disappears in 2-3 weeks post-operation, the reconstructed the lymph system matures in 5 months.

The treatment of lymphedema has been difficult due to the lack of understanding of the etiology and pathophysiology of the disease, as well as the embryology and physiology of the lymphatic system. The previous surgical treatment mostly has the blindness. Complete decongestion therapy (CDT) is the most popular treatment currently. The ultimate goal of lymphedema is the targeted and individualized treatment. New technology of multimodality lymphatic imaging emerged in the recent years largely improves the diagnosis of lymphatic circulation disorders. The treatment of peripheral lymphedema is expected to have new achievement. The key points that should be noticed in peripheral lymphedema treatment are ① to distinguish between primary and secondary lymphedema as the function and structure of the lymphatic system are substantially different. The lymphatic vessel regeneration and self-repair has not be proved in primary lymphedema. ② lymphatic vessel (possibly lymph node too) undergo a series pathological and degenerative changes in the affected limb. ③ the pathological changes of lymphoedema tissue Including chronic inflammation, tissue fibrosis and fatty deposition, should be included in the treatment target. To decrease the expression and prevent the function of the key inflammatory factor may be a new way for the treat of lymphedema.

Objective: To explore the relationship between protease-chymase secreted by mast cells, and activated transforming growth factor-β1(TGF-β1), in skin with secondary lymphedema(SLE)in lower extremity, so as toidentify the key factors in fibrosis of lymphedema. Methods: In this study, the affected limb skin of 7 SLE patients was includedas the experimental group, and normal skin tissue of the lower limb of 7 volunteers was used as controls. The skin samples were assayed by Masson staining, and the expressions of chymase and TGF-β1 were assayed by immunohistochemistry, immunofluorescent staining and enzyme-linked immunosorbent assay. Results: There was obvious fibrosis in the skin of lower extremity in patients with lymphedema. The number of MCs andthe expressions of chymase, latency-associated peptide TGF-β1 (LAP TGF-β1) and TGF-β1 were all significantly increased in fibrotic skin in lymphedema, compared with those in normal skin. At the same time, the chymase-containing mast cells accumulated in the lymphatic vessels, with higher expression of TGF-β1. Conclusions The expression of chymase and TGF-β1 was significantly increased in the fibrotic skin insecondary lower extremity lymphedema. The increased expression of chymase in the skin may activate more TGF-β1 expression, and the increased TGF-β1 may promote skin fibrosis in SLE.

Objective: To explore the appropriate treatment cycle of complex decongestive Therapy (CDT) for extremity lymphedema, which is the summary of the relationship between treatment time and curative effect. Methods: From January to December 2015, 203 patients with limb lymphedema were divided into four stages according to the degree of edema and the degree of fibrosis, that is, four groups. All patients were given CDT treatment for a course of treatment (4 weeks). During the treatment period, the multi frequency bioelectrical resistance body composition analyzer was used to monitor the change of tissue moisture and the tape diameter was used to measure the circumference of the affected limb. SPSS software is used to analyze the data. Results: 203 cases were treated with CDT therapy. Water in limb tissue and limb circumference of affected side was decreased significantly (P<0.01). To the tissues water dynamic changes, in the first group there was a significant difference (P<0.01) in the first week and second week. There was no obvious difference in 2-4 weeks; In the 2, 3 and 4 groups, there was significant difference in the first week and the second week, as well as the second week and the third week (P<0.05). And there was no difference in the third and fourth week. To the circumference dynamic change, in the first group there was no significant difference in patients in the first and the second week; In the third group, there was significant difference in the first week and the second week, as well as the second week and the third week (P<0.05). There was no significant difference in the last two weeks; In the fourth group, there was significant difference in the first week and the second week, as well as the third week and the fourth week(P<0.01). There was no difference in the second week and the third week. There is a correlation between the tissue water and the circumferential diameter (r=0.643). The patient has a good subjective feeling. Conclusions CDT therapy is effective in the treatment of lymphedema. For the first stage of edema, the therapy lasted two-week at least; For the second and the third stage edema, a 3 week therapy was suitable; For the fourth stage therapy, a four-week therapy is appropriate. It is suggested that CDT therapy should be maintained for at least half a year or so.

Objective: To evaluate the diagnostic value of indocyanine green(ICG)lymphography in primary lymphedema of extremities. Methods: 61 patients with limb lymphedema were enrolled in the study. The contralateral healthy limbs were used as controls. After intradermal injection of Indocyanine Green, dynamic observation of lymphatic vessels and lymph flow was performed using PDE near-infrared fluorescent instrument. The frequency of lymphatic contraction was calculated. Results: Lymphatic vessel images were clearly visualized in healthy limbs. Inguinal or axillary lymph nodes can be visualized when examined 30 minutes after injection. Lymphatic contraction frequency was 1(0.33-5.00)time per minute. 94.8% lymphedematous limb demonstrated delayed lymphatic vessel or lymph nodes. "Dermal backflow" and diffused shadow pattern can be observed in all affected limbs. Abnormal lymphatic vasculature and contraction can be visualized. The frequency of lymphatic contraction in the affected limb was higher compared to controls: 2.5(0.5-7.0) times per minute. Conclusions ICG lymphography possess high sensitivity for lymphedema diagnosis. ICG lymphography furthers our understanding of pathophysiological alterations of lymphatic disorders.

Objective:To investigate the effect of complex decongestive therapy(CDT) on elephantiasis and skin texture improvement.Methods:The clinical data of patients with elephantiasis of lower limbs who were admitted to the Department of Plastic Surgery, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2018 were retrospectively analyzed. The patients with elephantiasis of different causes were treated with CDT for 1 course (4 weeks). The skin texture parameters (skin water content, transepidermal water loss, skin fibrosis), limb circumference and segmental edema were measured before and after treatment and analyzed by paired t test. Pearson correlation analysis was used to detect the correlation between segmental edema and skin texture parameters before and after treatment. The subjective feelings of patients were recorded during follow-up. A self-designed online questionnaire was used to follow up the patient’s disease control status, including the limb circumferences, changes in quality of life (life, work, social and emotion), the adaptability to bandages and elastic socks. Data were classified and analysed as excellent, good, medium and poor.Results:A total of 20 patients were included, including 16 females and 4 males. The average age was 50.45 years (ranged 9-70 years). 5 cases were primary lymphedema and 15 cases were secondary lymphedema. The duration of the disease ranged from 2 years to 27 years, with an average of 8.4 years. After 1 course of treatment, the skin texture was significantly improved. The skin water content decreased from 55.6%±7.4% before treatment to 42.1%±7.4% after treatment ( P< 0.001). The transepidermal water loss decreased from (14.981±5.699) g·m -2·h -1 before treatment to (9.312±2.590) g·m -2·h -1 after treatment. The skin fibrosis decreased from (0.087±0.042) N before treatment to (0.065±0.033) N after treatment ( P<0.001). The circumference of the affected limb decreased from (11.09±3.14) cm before treatment to (4.82±2.83)cm after treatment ( P<0.001). The segmental edema decreased from (4.00±2.14)L before treatment to (1.21±0.78) L after treatment. Segmental edema was positively correlated with skin water content, transepidermal water loss, and skin fibrosis ( r=0.447, r=0.429, r=0.751, P<0.05). The patients were followed up for 6 months after treatment. The circumference control was excellent in 13 cases, good in 5 cases and moderate in 2 cases. The quality-of-life changes were excellent in 16 cases, good in 3 cases, medium in 1 case. The adaptability of elastic material was excellent in 9 cases, good in 8 cases, medium in 2 cases and poor in 1 case. Conclusions:CDT can reduce subcutaneous edema, effectively reduce limb volume, decrease skin fibrosis, improve skin barrier function, improve skin texture, restore the appearance of the limb and improve patients’ quality of life.