IN MEMORIAM

Oldřich Eliška, MD, DrScNovember 13, 1934 - July 12, 202

POSSIBILITY OF NEW LYMPHATIC PATHWAY CREATION THROUGH NEO-LYMPHANGIOGENESIS INDUCED BY SUBDERMAL DISSECTION

Surgical intervention and subsequentwound healing process are known to induceneo-lymphangiogenesis, but few studies havebeen reported to utilize this mechanism forlymphedema treatment. The aim of this studywas to evaluate feasibility of subdermal dissectionfor neo-lymphangiogenesis induction(SDN) to treat lower extremity lymphedema(LEL). Medical records of secondary LEL patientswho had undergone ICG lymphographyand SDN procedure were reviewed. SDN wasperformed by dissecting fat tissues just belowthe dermis from the most proximal area showingdermal backflow through abdominal-toaxillarylymphatic pathways. Perioperativelymphedematous conditions were evaluatedwith lymphedema quality of life score (LeQOLiS)and LEL index. Seventeen female patientswere included. SDN could be performed in 10minutes on average without postoperative complication.Postoperative ICG lymphographyshowed new lymphatic pathways in 6 (35.3%)cases. Postoperative LeQOLiS ranged from 9 to66, which was statistically lower than preoperativeLeQOLiS (32.9 ± 19.2 vs. 36.6 ± 19.3, p =0.048), whereas there was no statistically significantdifference between pre- and post-operativeLEL index (275.2 ± 23.3 vs. 270.5 ± 20.8,P = 0.073). Subdermal dissection, although itsprobability is not high, has a potential to induceneo-lymphangiogenesis. Further studiesare required to improve and demonstrateefficacy of the procedure for new lymphaticpathway creation

LYMPHEDEMA DURATION AS A PREDICTIVE FACTOR OF EFFICACY OF COMPLETE DECONGESTIVE THERAPY

Lymphedema is a common condition withglobal impact and a multitude of complications,however, only a few professionals specialize inits management. A retrospective analysis of 105subjects with unilateral lymphedema upper orlower limb was performed to investigate whetherthe duration of lymphedema constitutes animportant factor associated with the efficacy ofcomplete decongestive therapy (CDT). Subjectswere classified into two groups according to theduration of lymphedema, prior to CDT: groupA (≤1 year) and group B (1 year). Both groupswere treated daily according to the same CDTprotocol for four weeks. The CDT efficacy wasdetermined based on the percent reduction ofexcess volume (PREV) measurements. Lymphedemawas significantly reduced in bothgroups of subjects, but significantly more ingroup A (p0.001). In subjects with upper limblymphedema, median value of PREV was 80.8%(interquartile range, 79.1-105.0%) in group Aand 62.0% (interquartile range, 56.7-66.5%) ingroup B (p0.001). In subjects with lower limblymphedema PREV was 80.7% (interquartilerange, 74.9-85.2%) and 64.5% (interquartilerange, 56.0-68.1%) for groups A and B, respectively(p0.001). Duration of lymphedema wasfound to be a strong predictive factor that maysignificantly impact CDT efficacy. Therapeuticeffects were increased in subjects who weredetected and treated earlier for lymphedema

CLEANING THE BRAIN THROUGH TURBULENT GLYMPHATIC FLOW: THE WASHING MACHINE HYPOTHESIS

In a thought experiment, a "washing machine"model is proposed based on turbulentflow from complex multi-dimensional forces tocharacterize fluid dynamics in the brain. Theglymphatic system's hypothetical role in thissystem is illustrated in a series of diagrams.Implications of this model are discussed interms of normal physiology and a variety ofpathologic conditions such as brain atrophyand Alzheimer disease

TREATMENT OF SECONDARY LOWER LIMB LYMPHEDEMA AFTER GYNECOLOGIC CANCER WITH COMPLEX DECONGESTIVE THERAPY

Secondary lower extremity lymphedema isa common complication of treatment for gynecologicalcancers. Conservative therapy playsan important role in the treatment of patientswith secondary lower extremity lymphedema; inparticular, complex decongestive therapy (CDT)has been recognized as an effective nonoperativetechnique for these patients. But CDT therapyfor secondary lower extremity lymphedemaremains a problem in China because this techniqueand its effectiveness have not achievedwidespread use and popularity. Our goal was toassess effects of CDT in patients with secondarylower limb lymphedema after treatment forgynecological cancers. The retrospective studyconsisted of 60 patients who were treated with20 sessions of CDT. Assessments included objectivechanges in limb circumference, degreeof LE, imaging features, and incidence of erysipelasbefore and after CDT treatment. Wefound that CDT can effectively improve lymphstasis and promote backflow, and decreasecircumference, interstitial fluid content, andincidence of erysipelas of lymphedematouslower limb. Our results demonstrate that CDTis an effective treatment method for patientswith secondary lower limb lymphedema followingtreatment for gynecologic cancers. Thistechnique should be more widely utilized andpopularized in China to improve the quality oflife of millions of patients with secondary lowerlimb lymphedema

ISL NEWS

2021 ISL NEW

METHODS FOR QUANTIFYING BREAST CANCER-RELATED LYMPHEDEMA IN PATIENTS UNDERGOING A CONTRALATERAL PROPHYLACTIC MASTECTOMY

Patients treated for breast cancer are atrisk of developing breast cancer-related lymphedema(BCRL). A significant proportion ofpatients treated for breast cancer are opting toundergo a contralateral prophylactic mastectomy(CPM). Currently, it remains unclear as towhether the relative volume change (RVC)equation may be used as an alternative to theweight adjusted change (WAC) equation toquantify BCRL in patients who undergo CPM.In order to simplify BCRL screening, ourcohort of patients who underwent a CPM(n=310) was matched by BMI to a subset of patientswho underwent unilateral breast surgery(n=310). Arm volume measurements were obtainedvia an optoelectronic perometer preoperatively,postoperatively, and in the follow-upsetting every 6-12 months. The correlation ofipsilateral RVC and WAC values for thosewho underwent bilateral surgery was calculated(r=0.60). Contralateral WAC values forpatients in both cohorts were compared, andthere was no significant difference between thetwo distributions in variance (p=0.446). TheRVC equation shows potential to be used toquantify ipsilateral postoperative arm volumechanges for patients who undergo a CPM.However, a larger trial in which RVC andWAC values are prospectively assessed isneeded

Hybrid Behavior-Genetic Models of the Confounding Gene-Environment Correlations in the Development of Life History Strategy: Two Convergent Approaches

Traditional theories of development and evolutionary developmental psychology propose that early environmental experiences shape an individual’s developmental trajectory. According to the Adaptive Calibration Model (ACM), for example, calibration of speed of life history strategy to ecological cues encountered during development contributes to behavior that is conditionally adaptive to the organism’s environment. These theories emphasize the role of environmental influences and typically do not use designs that control potential genetic confounds. To address this methodological problem, the current study used a genetically informative design to test whether the phenotypic associations of parental instability and abuse with a slow life history factor were confounded by common genetic factors. We analyzed twin and singleton data from the Midlife in the United States (MIDUS) Survey using two convergent structural equation modeling approaches. Both approaches suggest that, when accounting for shared genetic variance across instability, abuse, and slow life history, some hypothesized environmental pathways between the early environmental measures and slow life history were not required. Once genetic factors were controlled, only parental instability was directly related to slow life history, while other hypothesized environmental pathways were non-significant. This suggests that developmental models that emphasize environmental and contextual pathways should control for possible genetic confounds

QUALITY OF LIFE IN BREAST CANCER SURVIVORS: AN ASSESSMENT OF INTERNATIONAL BREAST CANCER DRAGON BOAT RACERS

Resistance exercise is deemed safe forwomen recovering from conventional breastcancer therapies but few clinicians are awarethat dragon boat racing, as a form of resistiveexercise, is available to the breast cancercommunity. The objectives of this study were to1) increase clinician awareness of dragon boatracing (DBR) in breast cancer survivors as acommunity-based physical activity, and 2)evaluate quality of life (QOL) in breast cancersurvivors with or without lymphedema whoparticipate in DBR. This prospective, observationalstudy surveyed 1,069 internationalbreast cancer dragon boat racers from eightcountries to compare function, activity, andparticipation in women with and without selfreportedlymphedema using the Lymph-ICFquestionnaire. Seventy-one percent of women(n=758) completed the questionnaires. Resultsrevealed significantly higher Lymph-ICF scoresin the lymphedema participants, signifyingreduced QOL, when compared to the nonlymphedemaparticipants (p0.05), except for"go on vacation" for which no statisticaldifference was reported (p=0.20). Internationalbreast cancer survivors with lymphedemaparticipating in DBR at an internationalcompetition had reduced function, limitedactivity, and restricted participation comparedto participants without lymphedema.Clinicians should consider utilizing DBR as acommunity-based activity to support exerciseand physical activity after a breast cancerdiagnosis