SKIN LYMPHATIC SYSTEM IN THE PATHOGENESIS OF ARTERIAL HYPERTENSION – REVIEW AND CRITIQUE

Although numerous studies have confirmed the relationship between high salt intake and elevated blood pressure, the exact molecular mechanisms of this relationship are still unclear. There is growing evidence that skin interstitium, as well as the skin lymphatic system, are important regulators of both sodium (Na+) balance and blood pressure. Skin is in itself a large reservoir of Na+ ions which are stored in an osmotically inactive form on glycosaminoglycans (GAGs). Local hypertonicity due to extensive accumulation of Na+ within the skin as a result of a high-salt diet was demonstrated to induce macrophages to express a transcription factor termed tonicity-responsive enhancer binding protein (TonEBP)  and subsequently to secrete vascular endothelial growth factor-C (VEGF-C), activating lymphangiogenesis within the skin. This regulatory axis seems to be adaptive in maintaining blood pressure in high salt-load states. Recent studies have added new insights into the functioning of lymphatic vessels and the pathogenesis of salt-sensitive hypertension as well as questioned the classic view of Na+ homeostasis. This review aims to summarize recent findings pertaining to the involvement of the skin lymphatic system in Na+ and blood pressure regulation

LYMPHOVENOUS ANASTOMOSIS FOR THE TREATMENT OF LYMPHEDEMA: A SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS

Lymphovenous anastomosis (LVA) hasbeen described as an effective treatment forearly stages of lymphedema (LE). The aim ofthis study was to deepen the evaluation of theeffectiveness of LVA by performing a metaanalysisto provide information about its utilityin specific anatomical sites, clinical stages,duration of lymphedema, and surgical technique.A systematic literature search usingPubMed/Medline, Google Scholar, and CochraneDatabase was performed in November2019. Only original studies in which exclusivelyLVA was performed for primary and/or secondarylymphedema in humans were eligible fordata extraction. A meta-analysis was performedon articles with a well-defined endpointand a subgroup analysis was conductedin relation to surgical technique, duration oflymphedema, stage of pathology. Forty-eightstudies, including 6 clinical trials and 42 lowriskbias observational studies were included inour meta-analysis. 1,281 subjects were includedand the majority of articles reported a pre-postanalysis. Lymphaticovenular anastomosisappears to result effectively in treatment oflymphedema with an odds ratio of 0.07 (CI:0.04, 0.13, p0.001). All subgroup metaanalyseswere statistically significant for LVAsspecifically with regard to anatomical site,clinical stage, duration of LE, or type ofmicrosurgical procedure (p0.05).Our meta-analysis confirmed the efficacyof LVAs for the treatment of lymphedema,even when subgroup analysis was performedfor clinical stage, duration of pathology, anatomicalsite of lymphedema, or type of microsurgicalprocedure. Further prospective trialswith a common clearly defined outcome measureare warranted for an unbiased evaluation

MINIMALLY INVASIVE TREATMENT OF ABDOMINAL LYMPHOCELE: A REVIEW OF CONTEMPORARY OPTIONS AND HOW TO APPROACH THEM

Lymphoceles are lymphatic fluid collectionsresulting from lymphatic vessel disruptionafter surgery or trauma. They are most oftendescribed following retroperitoneal surgeriessuch as cystectomies, prostatectomies, renaltransplants, and gynecologic surgeries. Mostlymphoceles are asymptomatic and resolvespontaneously without treatment. If persistent,they can become infected or exert mass effect onadjacent structures causing pain, urinary, orlower limb edema particularly for lymphoceles inthe pelvis Symptomatic lymphoceles should betreated to relieve symptoms and prevent functionalcompromise of vital adjacent structures.Although surgery has been traditionallyaccepted as the gold standard treatment,advances in imaging and interventionaltechnology allow for less invasive, percutaneoustreatment. Available minimally invasivetreatment options include percutaneousaspiration, catheter drainage, sclerotherapy,and lymphangiography with lymphaticembolization. A review of these treatmentoptions and a suggested algorithm formanaging lymphoceles is presented

Modelling Inference in the Comprehension of Cinematic Narratives

The viewer’s processes of inference making in the cinema involve the framing of hypotheses about the world of the narrative that may be overturned by subsequent information and are, therefore, nonmonotonic. The goal of narrative researchers is to understand the nature of those processes and how texts organise the deployment of those processes in order to present a narrative successfully. To do this we need methods capable of describing processes of hypothesis framing and belief revision. In this paper, I describe the application of the Transferable Belief Model to a hypothetical example of narrative comprehension based on an episode of CSI: Crime Scene Investigation as one such method

IN MEMORIAM

PROFESSOR WALDEMAR LECH OLSZEWSKI, PhD, MDSeptember 3, 1931 - November 8, 202

ISL NEWS

2021 ISL NEW

EDITORIAL

SARS-CoV-2/COVID-19, LYMPHATIC VESSELS, LYMPH, AND LYMPHOLOG

THE EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE THERAPY ON BREAST CANCER-RELATED LYMPHEDEMA: A LITERATURE REVIEW

Lymphedema is one of the most dreaded complications related to breast cancer surgery, commonly resulting in upper limb functional, esthetic, and psychological impairment. The necessity to improve the efficacy of conventional treatments and the promising effect of extracorporeal shock wave therapy (ESWT) on lymphangiogenesis in vitro and animal models, has prompted studies involving women affected by breast-cancer related lymphedema. Since intervention modalities and treatment protocols used are different, a review is necessary to verify the effectiveness of ESWT, evaluating the quality of existing studies and the eventual need for further research. Data were obtained from PubMed, Scopus, Google Scholar, Cochrane Library and PEDro, including articles published until January 2019. Five studies met the inclusion criteria. Evident heterogeneity emerged among selected studies permitting only a purely descriptive analysis of their data and strongly limiting their comparison. When compared to other treatment modalities, ESWT showed a significant effect on measured outcomes. It is clear that further high quality research is necessary to assert with confidence the effects and possible superiority of ESWT over other conservative therapies in the management of breast-cancer related lymphedema