TOPICAL TACROLIMUS 0.1% FOR TREATMENT OF CUTANEOUS MICROCYSTIC LYMPHATIC MALFORMATIONS

Microcystic lymphatic malformations asdescribed in the international literature form asubgroup of low-flow congenital vascular malformations(VM) resulting from irregularembryological development. Microcystic lesionsnormally manifest as an accumulation oflymph- and blood-filled vesicles that, when externalized,cause skin maceration with consequentpain and potential infection resulting inthe impairment of the patient's quality of life.There is no consensus on a standardizedalgorithm nor clear guidelines for successfultreatment of this type of lymphatic malformation,and treatment options employed often resultin ambivalent and transient outcomes witha high rate of recurrence. The topical formulationof tacrolimus is a well-known FDAapprovedanti-T cell agent that was recentlyidentified as a potent activator of ALK1, whichis involved in several processes and functionsincluding angiogenesis. We investigated iftopical administration of tacrolimus may be aneffective therapy for directly targeting cutaneousmicrocystic lymphatic malformations as acomplement to systemic treatment. The studyenrolled four patients with cutaneous microcysticlymphatic malformations: three male(ages: 13,15,18) and one female (age: 30). Twoof the patients presented lesions on their backs,one patient on the left hand and one on the leftlower limb. All four patients received treatmentwith topical tacrolimus 0.1% twice a day for 10weeks on a previously selected area forapplication. Weekly clinical follow-ups wereconducted along with close physician-patientcontact. All patients displayed a satisfactoryresponse after treatment. Lymphorrhea andbleeding were stopped in all cases and theesthetic aspect of lesions improved in twopatients. To date, all patients presented noclinically significant changes to the size orextension of the lesion. Topical tacrolimustreatment is a promising and reasonable optionfor microcystic lymphatic malformations. Ourresults encourage further exploration in largerpopulations with the consideration that it is asafe and effective alternative or complementarytherapy to systemic treatment

COMPARISON OF COMPLETE DECONGESTIVE THERAPY AND KINESIOLOGY TAPING FOR UNILATERAL UPPER LIMB BREAST CANCER-RELATED LYMPHEDEMA: A RANDOMIZED CONTROLLED TRIAL

We designed a study to compare effects ofcomplete decongestive therapy (CDT) andkinesiology taping (KT) (with exercise and skincare) on limb circumference, lymphedemavolume, grip strength, functional status, andquality of life in patients with unilateral breastcancer-related lymphedema (BCRL). Fortypatients with unilateral stage 2 BCRL wererandomized to either the CDT group (n=20) orthe KT group (n=20). Patients in the CDTgroup underwent 30-min manual lymphaticdrainage (MLD) and multi-layer, short-stretchbandaging once a week for four weeks. Patientsin the KT group underwent taping once a weekfor four weeks. In addition, all patients wereinformed about skin care and given an exerciseprogram throughout the treatment. Upperextremity circumference and volume differencesas primary outcomes and grip strength,Quick-Disabilities of the Arm, Shoulder andHand (Q-DASH), and Functional Assessmentof Cancer Therapy-Breast (FACT-B) scores assecondary outcomes were assessed initially,after treatment (4 weeks), and at the 1st monthfollow-up. Limb circumference and volume differenceswere significantly reduced in the CDTgroup after the 4-week treatment comparedwith the KT group (p=0.012 and p=0.015,respectively), but there was no difference betweenthe groups in the 1st month follow-up(p0.05). There was no difference between thegroups in terms of grip strength, Q-DASH, andFACT-B scores after treatment and at the 1stmonth follow-up (p0.05). Our results showthat both KT and CDT were found to significantlyreduce limb volume and circumferenceindividually at 4-weeks and the one-monthfollow-up in patients with BCRL and thatCDT significantly reduced both limb volumeand circumference compared to KT at the 4-week time point, but not at the follow-up.Further randomized controlled trials withpatients at different stages of BCRL areneeded to confirm and expand these results

COMPARISON OF PEROMETRY-BASED VOLUMETRIC ARM MEASUREMENTS AND BIOIMPEDANCE SPECTROSCOPY FOR EARLY IDENTIFICATION OF LYMPHEDEMA IN A PROSPECTIVELY-SCREENED COHORT OF BREAST CANCER PATIENTS

Breast cancer-related lymphedema(BCRL) affects more than one in five womentreated for breast cancer, and women remain atlifelong risk. Screening for BCRL is recommendedby several national and internationalorganizations for women at risk of BCRL, andmultiple methods of objective screening measurementexist. The goal of this study was tocompare the use of perometry and bioimpedancespectroscopy (BIS) for early identificationof BCRL in a cohort of 138 prospectivelyscreenedpatients. At each screening visit, apatient's relative volume change (RVC) fromperometer measurements and change in L-Dexfrom baseline (ΔL-Dex) using BIS wascalculated. There was a negligible correlationbetween RVC and ΔL-Dex (r=0.195). Multiplethresholds of BCRL were examined: RVC ≥5%and ≥10% as well as and ΔL-Dex ≥6.5 and ≥10.While some patients developed an elevatedRVC and ΔL-Dex, many demonstratedelevations in only one threshold category.Moreover, the majority of patients with RVC≥5%, ΔL-Dex ≥6.5, or ΔL-Dex ≥10 regressed tonon-elevated measurements without intervention.These findings suggest a role forcombining multiple screening methods for earlyidentification of BCRL; furthermore, BCRLdiagnosis must incorporate patient symptomsand clinical evaluation with objective measurementsobtained from techniques such asperometry and bioimpedance spectroscopy

AUTHOR INDEX

2020 AUTHOR INDE

An Expanded Life Satisfaction Model: A Component of Subjective Well-Being

The current investigation uses latent variable modeling to investigate Subjective Well-Being (SWB).  Previous research has suggested that Subjective Well-Being is made up of a tripartite model consisting of life satisfaction, positive affect, and negative affect. However, recently, extant research has suggested that the tripartite model of SWB comes short of considering nuances of SWB, specifically relationship outcomes and general life challenges. This investigation presents multiple hierarchical models of SWB, including a third-order factor structure of SWB to explain satisfaction with life, subjective happiness, resiliency, and assessment of the relationship

PHYSIOTHERAPY AND REHABILITATION APPLICATIONS IN LIPEDEMA MANAGEMENT: A LITERATURE REVIEW

Lipedema is a chronic and progressive disease of adipose tissue caused by abnormal fat accumulation in subcutaneous tissue. Although there is no known cure for lipedema, possible complications can be prevented with conservative and surgical treatments. One of the conservative treatment options is physiotherapy and rehabilitation (PR). When the literature is examined, few studies focusing on the efficacy of PR were found for this patient group. The purpose of this review is to provide a better understanding of the effectiveness of PR applications by compiling existing studies. A bibliographic PubMed search was performed for published studies regarding PR in lipedema management in June 2019 including the last 58 years (1951-2019). Articles were chosen by reading the abstracts and subsequently data were analyzed by reading the entire text through full-text resources. A total of 15 studies met inclusion criteria. Results document how lipedema patients are benefited by PR and the effectiveness of different types of PR programs. The current review also showed that complex decongestive physiotherapy, gait training, hydrotherapy, aerobic exercise, and resistance exercise training each have value in the management of lipedema. The effects of PR for the treatment of lipedema are variable among studies, although overall PR seems to be effective in lipedema management. Although physiotherapy applications have a potentially important role in the management of lipedema, they should be used in combination with other treatment modalities. More studies with higher quality are needed to fully demonstrate the effect and efficacy of PR in lipedema patients

2019 ISL News

2019 ISl New

EDITORIAL

EVOLUTION OF THE 2020 INTERNATIONAL SOCIETYOF LYMPHOLOGY CONSENSUS DOCUMENT PARALLELSADVANCES IN LYMPHOLOGY: AN HISTORICAL PERSPECTIV

Connecting the Past to the Future of Computer-assisted Language Learning: Theory, Practice, and Research

Computer-assisted language learning (CALL) has established itself as a fruitful area of inquiry that contributes to language education and educational technology. CALL has witnessed the endeavor of exploiting technology for robust and meaningful language learning and teaching from scholars over a period of more than fifty years. With the continued advancement of technology, the field of CALL are facing new challenges and possibilities in terms of theory, practice, and research in this new era. Thus, a review of major trends in past CALL and a critical projection of future CALL are needed in order to capture the dynamics and opportunities for future technology-enhanced language learning. This article provides an overview of the evolution of theory and practice in CALL research. The author explores the state of the art and important future areas of inquiry of CALL by addressing emerging technologies. This paper concludes with theoretical and methodological considerations for approaching CALL today and beyond.DOI:10.2458/azu_itlt_v8i1_ha

Imposing legality: hegemony and resistance under the EU Forest Law Enforcement, Governance, and Trade (FLEGT) initiative

Timber legality trade restrictions and verification are a bundle of contemporary mechanisms triggered by global concerns about forest degradation and deforestation. The European Union Forest Law Enforcement, Governance and Trade initiative is a significant effort to not only screen out illegal timber and wood products from the EU, but also support trading partner countries to improve their legality definitions and verification processes. But by using bilateral agreements (Voluntary Partnership Agreements) as a key mechanism, the EU legitimizes trade partner nation-states as the authority to decide what is legal. We engage in a theoretical debate about the complexities of the meaning of legality, and then analyze empirical data collected from interviews in Ghana, Indonesia, Vietnam and Europe with policy, civil society and industry actors to understand how different actors understand legality. We find hegemonic notions of Westphalian statehood at the core of 'global' notions of legality and often contrast with local understandings of legality. Non-state actors understand these hegemonic notions of legality as imposed upon them and part of a colonial legacy. Further, notions of legality that fail to conform with hegemonic understandings are readily framed by nation-states as immoral or criminal. We emphasize the importance of understanding these framings to elucidate the embedded assumptions about what comprises legality within assemblages of global actors.Key words: FLEGT, timber legality, hegemony, power, globalizatio