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  1. Lymphedema

    Science.gov (United States)

    Lymphedema is the name of a type of swelling. It happens when lymph builds up in your ... happens in the arms or legs. Causes of lymphedema include Infection Cancer Scar tissue from radiation therapy ...

  2. Lymphedema

    Science.gov (United States)

    ... development. Today, patients who have axillary lymph node dissection have a lifetime risk of 15-25%. For ... that is roughly equivalent to axillary lymph node dissection and increases the risk associated with surgery if ...

  3. Lymphedema in Canada: a qualitative study to help develop a clinical, research, and education strategy

    Science.gov (United States)

    Hodgson, P.; Towers, A.; Keast, D.H.; Kennedy, A.; Pritzker, R.; Allen, J.

    2011-01-01

    Objective The aim of this study was to gather data from Canadian stakeholders to help construct a national strategy and agenda for lymphedema management. Methods The Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema therapists, patient advocates, and others, used participatory action research and Open Space Technology to identify issues and build consensus at a national meeting of lymphedema stakeholders. Proceedings were videotaped and underwent content analysis. Existing Canadian documentation on lymphedema services was analyzed. Using those data sources, the Canadian Lymphedema Framework drafted a development strategy. Results Of 320 invited stakeholders (patients, therapists, physicians, industry representatives, and health policymakers), 108 participated in a day-long videotaped meeting discussing strategies to improve the management of lymphedema and related disorders in Canada. Participants identified barriers, challenges, and issues related to the need to raise awareness about lymphedema with patients, physicians, and the public. Five priority areas for development were articulated: education, standards, research, reimbursement and access to treatment, and advocacy. The main barrier to development was identified as the lack of clear responsibility within the health care system for lymphedema care. Conclusions Data from stakeholders was obtained to solidly define priority areas for lymphedema development at a national level. The Canadian Lymphedema Framework has created a working plan, an advisory board, and working groups to implement the strategy. PMID:22184493

  4. Using Temporal Mining to Examine the Development of Lymphedema in Breast Cancer Survivors

    Science.gov (United States)

    Green, Jason M.; Paladugu, Sowjanya; Shuyu, Xu; Stewart, Bob R.; Shyu, Chi-Ren; Armer, Jane M.

    2015-01-01

    Background Secondary lymphedema is a lifetime risk for breast cancer survivors and can severely affect quality of life. Early detection and treatment are crucial for successful lymphedema management. Limb volume measurements can be utilized not only to diagnose lymphedema but also to track progression of limb volume changes before lymphedema, which has the potential to provide insight into the development of this condition. Objectives To identify commonly occurring patterns in limb volumes changes in breast cancer survivors before the development of lymphedema, and to determine if there were differences in these patterns between certain patient subgroups. Furthermore, pattern differences were studied between patients who developed lymphedema quickly and those whose onset was delayed. Method A temporal data mining technique was used to identify and compare common patterns in limb volume measurements in patient subgroups of study participants (n = 232). Patterns were filtered initially by support and confidence values; then t-tests were used to determine statistical significance of the remaining patterns. Results Higher body mass index and the presence of postoperative swelling are supported as risk factors for lymphedema. In addition, a difference in trajectory to the lymphedema state was observed. Discussion The results have potential to guide clinical guidelines for assessment of latent and early-onset lymphedema. PMID:23458909

  5. An Algorithm to Identify the Development of Lymphedema After Breast Cancer Treatment

    Science.gov (United States)

    Yen, Tina W.F.; Laud, Purushuttom W.; Sparapani, Rodney A.; Li, Jianing; Nattinger, Ann B.

    2014-01-01

    Purpose Large, population-based studies are needed to better understand lymphedema, a major source of morbidity among breast cancer survivors. One challenge is identifying lymphedema in a consistent fashion. We sought to develop and validate an algorithm using Medicare claims to identify lymphedema after breast cancer surgery. Methods From a population-based cohort of 2,597 elderly (65+) women who underwent incident breast cancer surgery in 2003 and completed annual telephone surveys through 2008, two algorithms were developed using Medicare claims from half of the cohort and validated in the remaining half. A lymphedema-positive case was defined by patient report. Results A simple two ICD-9 code algorithm had 69% sensitivity, 96% specificity, positive predictive value >75% if prevalence of lymphedema is >16%, negative predictive value >90%, and area under receiver operating characteristic curve (AUC) of 0.82 (95% CI: 0.80 – 0.85). A more sophisticated, multi-step algorithm utilizing diagnostic and treatment codes, logistic regression methods, and a reclassification step performed similarly to the two-code algorithm. Conclusions Given the similar performance of the two validated algorithms, the ease of implementing the simple algorithm and the fact that the simple algorithm does not include treatment codes, we recommend that this two-code algorithm be validated in and applied to other population-based breast cancer cohorts. Implications for Cancer Survivors This validated lymphedema algorithm will facilitate the conduct of large, population-based studies in key areas (incidence rates, risk factors, prevention measures, treatment and cost/economic analyses) that are critical to advancing our understanding and management of this challenging and debilitating chronic disease. PMID:25187004

  6. An Important Role of VEGF-C in Promoting Lymphedema Development.

    Science.gov (United States)

    Gousopoulos, Epameinondas; Proulx, Steven T; Bachmann, Samia B; Dieterich, Lothar C; Scholl, Jeannette; Karaman, Sinem; Bianchi, Roberta; Detmar, Michael

    2017-09-01

    Secondary lymphedema is a common complication after cancer treatment, but the pathomechanisms underlying the disease remain unclear. Using a mouse tail lymphedema model, we found an increase in local and systemic levels of the lymphangiogenic factor vascular endothelial growth factor (VEGF)-C and identified CD68(+) macrophages as a cellular source. Surprisingly, overexpression of VEGF-C in a transgenic mouse model led to aggravation of lymphedema with increased immune cell infiltration and vascular leakage compared with wild-type littermates. Conversely, blockage of VEGF-C by overexpression of soluble VEGF receptor-3 reduced edema development, diminishing inflammation and blood vascular leakage. Similar findings were obtained in a hind limb lymph node excision lymphedema model. Flow cytometry analyses and immunofluorescence stainings in lymphedematic tissue showed that VEGF receptor-3 expression was restricted to lymphatic endothelial cells. Our data suggest that endogenous VEGF-C causes blood vascular leakage and fluid influx into the tissue, thus actively contributing to edema formation. These data may provide the basis for future clinical therapeutic approaches. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial.

    Science.gov (United States)

    Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

    2017-01-01

    The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.

  8. Lymphedema (PDQ)

    Science.gov (United States)

    ... caused by cancer is rarely treated with surgery . Massage therapy Massage therapy (manual therapy) for lymphedema should begin with ... trained in treating lymphedema. In this type of massage, the soft tissues of the body are lightly ...

  9. Seroma indicates increased risk of lymphedema following breast cancer treatment

    DEFF Research Database (Denmark)

    Toyserkani, Navid Mohamadpour; Jørgensen, Mads Gustaf; Haugaard, Karen

    2017-01-01

    Introduction Lymphedema is one of the most serious complications following breast cancer treatment. While many risk factors are well described the role of seroma formation has recently produced mixed results. Therefore, we aimed to evaluate if seroma is a risk factor for development of lymphedema...... in one of the largest retrospective cohort studies. Material and methods We included all patients with unilateral breast cancer treated in the period of 2008-2014. Data regarding treatment and breast cancer characteristics were retrieved from the national breast cancer registry. Data regarding lymphedema...... treatment and seroma aspirations were retrieved from local treatment codes. Results In total 1822 patients were included of which 291 developed lymphedema. Multivariate cox regression analysis showed that seroma was an independent risk factor (HR 1.92 CI 1.30-2.85, p= 0.001). Other independent risk factors...

  10. Development in self-reported arm-lymphedema in Danish women treated for early-stage breast cancer in 2005 and 2006 – A nationwide follow-up study

    DEFF Research Database (Denmark)

    Gärtner, Rune; Mejdahl, Mathias Kvist; Andersen, Kenneth Geving

    2014-01-01

    The main purpose of this nationwide follow-up study was to examine the development of self-reported lymphedema in the population of women with early-stage breast cancer in Denmark. In 2008 and 2012 two identical questionnaires were sent to the women aged 18-70 years treated for unilateral primary...... breast cancer in 2005 and 2006. 2293 women (87%) reported on lymphedema in 2008 and 2012. Overall 37% reported lymphedema in 2008 while 31% reported lymphedema in 2012 and severity of symptoms decreased. 50% of women treated with SLNB and reporting lymphedema in 2008 did not report symptoms by 2012...... in contrast to 30% treated with ALND. However, 19% of women treated with ALND and not reporting lymphedema in 2008 had developed lymphedema by 2012. In conclusion lymphedema remains a frequent problem, years after treatment for breast cancer, though, number of women reporting lymphedema and overall severity...

  11. Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast

    DEFF Research Database (Denmark)

    Ryttov, N; Holm, N V; Qvist, N

    1988-01-01

    The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups...... was mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46...... mastectomy. Adjuvant systemic therapy can be administered to high risk patients without increasing the risk of late arm lymphedema and shoulder disability....

  12. Development of the short version of the Gynecologic Cancer Lymphedema Questionnaire: GCLQ-7

    Science.gov (United States)

    Kim, Namjoo; Lee, Seonjoo; Lee, Sujung; Seo, Sang-Soo; Chung, Seung Hyun

    2017-01-01

    Objective The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) was designed to identify gynecologic cancer patients with lower limb lymphedema (LLL). The questionnaire consists of 20 items distributed over 7 symptom clusters. The present study aimed to develop an abridged form of the GCLQ for simpler screening and more effective follow-up of LLL. Methods Data that had been collected for the development and validation of the Korean version of the GCLQ (GCLQ-K) were used in this study. Receiver-operating characteristic (ROC) curves were drawn according to the individual items of the GCLQ-K. Based on discrimination ability, the candidate items were selected in each symptom cluster. After combining the items, the best model was identified and named GCLQ-7. The area under the ROC curve (AUC) was compared between the GCLQ-7 and the original GCLQ-K. Results In total, 11 candidate items were selected from the original GCLQ-K. Among the models made with the candidate items, GCLQ-7, the best model, was constructed with 7 items as follows: 1) limited knee movement, 2) general swelling, 3) redness, 4) firmness/tightness, 5) groin swelling, 6) heaviness, and 7) aching. This model exhibited an AUC of 0.945 (95% confidence interval [CI], 0.900–0.991), which is comparable with that of the original GCLQ-K (AUC, 0.867; 95% CI, 0.779–0.956). The best cutoff value was 2 points, at which the sensitivity and specificity were 97.0% and 76.5%, respectively. Conclusion The newly developed short version model, GCLQ-7, showed acceptable discrimination ability as compared with the original GCLQ-K. PMID:27819411

  13. Guide to Understanding Lymphedema

    Science.gov (United States)

    ... to Understanding Lymphedema Get Support Guide to Understanding Lymphedema 2015, 5th Edition By: Robin Warshaw, Contributing Writer ... YES NO ADDITIONAL FEEDBACK Home page More In Lymphedema Breast Cancer News August 14, 2013 Extra Weight — ...

  14. Development of consensus International Classification of Functioning, Disability and Health (ICF) core sets for lymphedema

    NARCIS (Netherlands)

    Viehoff, P.B.; Heerkens, Y.F.; Ravensberg, C.D. van; Hidding, J.; Damstra, R.J.; Napel, H. ten; Neumann, H.A.

    2015-01-01

    To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify functioni

  15. Development of consensus International Classification of Functioning, Disability and Health (ICF) core sets for lymphedema

    NARCIS (Netherlands)

    Viehoff, P.B.; Heerkens, Y.F.; Ravensberg, C.D. van; Hidding, J.; Damstra, R.J.; Napel, H. ten; Neumann, H.A.

    2015-01-01

    To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify

  16. Heavy resistance training and lymphedema

    DEFF Research Database (Denmark)

    Bloomquist, Kira; Karlsmark, Tonny; Christensen, Karl Bang

    2014-01-01

    BACKGROUND: There is limited knowledge regarding progressive resistance training during adjuvant chemotherapy and the risk of developing breast cancer-related lymphedema (BCRL). Furthermore, no studies have investigated the safety of resistance training with heavy loads (> 80% 1 repetition maximum...

  17. Factors Predicting Adherence to Risk Management Behaviors of Women at Increased Risk for Developing Lymphedema

    Science.gov (United States)

    Sherman, Kerry A.; Miller, Suzanne M.; Roussi, Pagona; Taylor, Alan

    2014-01-01

    Purpose Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed cognitive and emotional factors influencing adherence to lymphedema risk management. Methods Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Centre breast clinic. Participants (N=103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication “Lymphedema: What Every Woman with Breast Cancer Should Know”. Cognitive and affective variables were reassessed at 6- and 12-months post-baseline. Results Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12- month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. Conclusions Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance. PMID:24970542

  18. Lymphedema secondary to filariasis.

    Science.gov (United States)

    Leonard, J C; Humphrey, G B; Basmadjian, G

    1985-03-01

    A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma.

  19. Lymphedema secondary to filariasis

    Energy Technology Data Exchange (ETDEWEB)

    Leonard, J.C.; Humphrey, G.B.; Basmadjian, G.

    1985-03-01

    A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma.

  20. Development of consensus International Classification of Functioning, Disability and Health (ICF) core sets for lymphedema.

    Science.gov (United States)

    Viehoff, P B; Heerkens, Y F; Van Ravensberg, C D; Hidding, J; Damstra, R J; Ten Napel, H; Neumann, H A M

    2015-03-01

    To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify functioning of persons in their personal environment. ICF Core Sets are lists of selected ICF categories concerning those important aspects of functioning that are most likely to be affected by a specific health problem or disease. These Core Sets make it easier and faster to describe and communicate the patient's problems and to define treatment goals. Furthermore, they are available to health care providers of all professions, researchers, health insurance companies and policy-makers. The objective of this document is to present the outcomes of a consensus conference held to determine the first versions of the ICF Core Sets for lymphedema. Frequency rankings were made of the ICF categories derived from four preparatory studies, being: a) a systematic review; b) a qualitative study; c) an expert survey; and d) a cross-sectional study. By means of working group discussions and plenary sessions, a final consensus on ICF categories was achieved and Comprehensive and Brief Core Sets for lymphedema for the upper limb, lower limb, and midline lymphedema were defined. These ICF Core Sets contain different items in each region. Future validation of these Core Sets for health professions and for countries is needed.

  1. Factors Associated With the Development of Breast Cancer-Related Lymphedema After Whole-Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag; Wilkinson, John Ben; Baschnagel, Andrew [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Ghilezan, Mihai [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States); Riutta, Justin; Dekhne, Nayana; Balaraman, Savitha [Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States); Mitchell, Christina; Wallace, Michelle [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank, E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, MI (United States); William Beaumont School of Medicine, Oakland University, Royal Oak, MI (United States)

    2012-07-15

    Purpose: To determine the rates of breast cancer-related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development. Methods and Materials: A total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment. Differences in clinical, pathologic, and treatment characteristics between patients with BCRL and those without BCRL were evaluated, and the actuarial rates of BCRL by regional irradiation technique were determined. Results: The actuarial rate of any BCRL was 7.4% for the entire cohort and 9.9%, 14.7%, and 8.3% for patients receiving a supraclavicular field, posterior axillary boost, and internal mammary irradiation, respectively. BCRL was more likely to develop in patients with advanced nodal status (11.4% vs. 6.3%, p = 0.001), those who had a greater number of lymph nodes removed (14 nodes) (9.5% vs. 6.0%, p = 0.01), those who had extracapsular extension (13.4% vs. 6.9%, p = 0.009), those with Grade II/III disease (10.8% vs. 2.9%, p < 0.001), and those who received adjuvant chemotherapy (10.5% vs. 6.7%, p = 0.02). Regional irradiation showed small increases in the rates of BCRL (p = not significant). Conclusions: These results suggest that clinically detectable BCRL will develop after traditional BCT in up to 10% of patients. High-risk subgroups include patients with advanced nodal status, those with more nodes removed, and those who receive chemotherapy, with patients receiving regional irradiation showing a trend toward increased rates.

  2. Lymphedema and Therapeutic Lymphangiogenesis

    Directory of Open Access Journals (Sweden)

    Yukihiro Saito

    2013-01-01

    Full Text Available Lymphedema is a disorder of the lymphatic vascular system characterized by impaired lymphatic return and swelling of the extremities. Lymphedema is divided into primary and secondary forms based on the underlying etiology. Despite substantial advances in both surgical and conservative techniques, therapeutic options for the management of lymphedema are limited. Although rarely lethal, lymphedema is a disfiguring and disabling condition with an associated decrease in the quality of life. The recent impressive expansion of knowledge on the molecular mechanisms governing lymphangiogenesis provides new possibilities for the treatment of lymphedema. This review highlights the lymphatic biology, the pathophysiology of lymphedema, and the therapeutic lymphangiogenesis using hepatocyte growth factor.

  3. Kaposi sarcoma following postmastectomy lymphedema.

    Science.gov (United States)

    Montero Pérez, Iria; Rodríguez-Pazos, Laura; Álvarez-Pérez, Adriana; Ferreirós, M Mercedes Pereiro; Aliste, Carlos; Suarez-Peñaranda, Jose Manuel; Toribio, Jaime

    2015-11-01

    Classical Kaposi sarcoma (KS) usually appears on lower extremities accompanied or preceded by local lymphedema. However, the development in areas of chronic lymphedema of the arms following mastectomy, mimicking a Stewart-Treves syndrome, has rarely been described. We report an 81-year-old woman who developed multiple, erythematous to purple tumors, located on areas of post mastectomy lymphedema. Histopathological examination evidenced several dermal nodules formed by spindle-shaped cells that delimitated slit-like vascular spaces with some red cell extravasation. Immunohistochemically, the human herpesvirus type 8 (HHV-8) latent nuclear antigen-1 was detected in the nuclei of most tumoral cells confirming the diagnosis of KS. Lymphedema could promote the development of certain tumors by altering immunocompetence. Although angiosarcoma (AS) is the most frequent neoplasia arising in the setting of chronic lymphedema, other tumors such as benign lymphangiomatous papules (BLAP) or KS can also develop in lymphedematous limbs. It is important to establish the difference between AS and KS because their prognosis and treatment are very different. Identification by immunohistochemistry of HHV-8 is useful for the distinction between KS and AS or BLAP.

  4. Lymphedema and Obesity: Is There a Link?

    Science.gov (United States)

    Mehrara, Babak J.; Greene, Arin K.

    2015-01-01

    Summary Lymphedema is a chronic disorder that, in developed countries, occurs most commonly after lymph node dissection for cancer treatment. Although the pathophysiology of lymphedema is unknown, the disease is characterized histologically by fibrosis and abnormal adipose deposition. Clinical studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema. In fact, recent studies have shown that extreme obesity can result in markedly impaired lymphatic function and primary lymphedema. The aim of this Special Topic article is to review evidence linking obesity and lymphedema. In addition, the authors review recent studies that have analyzed the cellular mechanisms that may be responsible for this relationship, with a goal of highlighting areas of research that may have significant translational potential. PMID:25028830

  5. National Lymphedema Network

    Science.gov (United States)

    ... Functional Restoration for Individuals with Lymphedema and Morbid Obesity Announcing: A New Lymphedema-Specific Outcome Measure And “G” Code Calculator!! Position Paper: Screening and Measurement for Early Detection of Breast ...

  6. [Lymphedema: is there a treatment?].

    Science.gov (United States)

    Barrellier, M T

    1992-01-01

    More than hundred medical treatments for lymphedema have been described. This very high number shows the evidence of difficulties: lymphatics are very small vessels, under low pression and velocity respondent to spontaneous quiet lymphatic contractions. The treatments can be listed in 3 groups: 1) physiotherapeutic methods, increasing lymphatic flow: cold, field stimulation, manual lymph drainage, intermittent compression, heat; 2) drugs: venous agents (flavone, benzo-pyrone), and intraarterial lymphocytes injection, promoting lymphatic flow or increasing normal proteolysis by macrophages in order to remove trapped proteins from interstitial fluid; 3) surgical procedures subdivided in 2 groups: excisional techniques and bridging drainage techniques; radical or partial excision removes involved subcutaneous tissue, recently by the way of liposuction; Efforts to drain lymphedema by subcutaneous implants, pedical flaps, myocutaneous flaps, omental transposition and intestinal flaps are historical. Microsurgical lymphatic anastomosis to vein (nodo-venous then lymphovenous), and to lymphatic themselves are now performed: lymphatic collectors or venous autografts are interpositioned to by-pass lymphatic blockade with end-to end anastomosis. The free transplantation of a lymphatic flap with its own vascularisation from healthy inguinal nodes to axillary blockade is the last described procedure. Lymphatic anastomosis are not needed. Actually, physiotherapy is always first indicated. Benzo-pyrones are additive drugs. Excisional procedures concern monstruous lymphedema. Microsurgical bridging procedures can be attempted only for secondary lymphedemas. They could be of benefit if physiotherapy and elastic bandages, stockings or sleeves, could then be avoided. Studies assessing independently the efficiency of each procedure are needed.

  7. Management of Extremity Lymphedema.

    Science.gov (United States)

    Puleo; Luh

    1995-10-01

    Chronic lymphedema is almost always a permanent and often progressive condition. In most cases, neither medical nor surgical means can completely relieve the effects of lymphedema. Surgical management of chronic lymphedema has high morbidity and a success rate of only 30%, and many patients return to their presurgical limb girth within three to four years. Nonsurgical treatment of chronic lymphedema can decrease overall lymphatic edema. Sequential gradient compression systems, which compensate for impaired lymphatic flow, return protein-rich lymphatic fluid from the extracellular regions of the tissues back into the circulatory system where the fluid can be excreted.

  8. Lymphedema Risk Reduction Practices

    Science.gov (United States)

    ... now! Position Paper: Lymphedema Risk Reduction Practices Category: Position Papers Tags: Risks Archives Treatment risk reduction garments surgery obesity infection blood pressure trauma morbid obesity body weight ...

  9. Topical tacrolimus for the treatment of secondary lymphedema

    Science.gov (United States)

    Gardenier, Jason C.; Kataru, Raghu P.; Hespe, Geoffrey E.; Savetsky, Ira L.; Torrisi, Jeremy S.; Nores, Gabriela D. García; Jowhar, Dawit K.; Nitti, Matthew D.; Schofield, Ryan C.; Carlow, Dean C.; Mehrara, Babak J.

    2017-01-01

    Secondary lymphedema, a life-long complication of cancer treatment, currently has no cure. Lymphedema patients have decreased quality of life and recurrent infections with treatments limited to palliative measures. Accumulating evidence indicates that T cells play a key role in the pathology of lymphedema by promoting tissue fibrosis and inhibiting lymphangiogenesis. Here using mouse models, we show that topical therapy with tacrolimus, an anti-T-cell immunosuppressive drug, is highly effective in preventing lymphedema development and treating established lymphedema. This intervention markedly decreases swelling, T-cell infiltration and tissue fibrosis while significantly increasing formation of lymphatic collaterals with minimal systemic absorption. Animals treated with tacrolimus have markedly improved lymphatic function with increased collecting vessel contraction frequency and decreased dermal backflow. These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability. PMID:28186091

  10. Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs

    National Research Council Canada - National Science Library

    Beesley, Vanessa; Janda, Monika; Eakin, Elizabeth; Obermair, Andreas; Battistutta, Diana

    2007-01-01

    Few studies have evaluated lymphedema after gynecological cancer treatment. The aim of this research was to establish prevalence, correlates, and supportive care needs of gynecological cancer survivors who develop lymphedema...

  11. Lymphedema as a Cancer Treatment Side Effect

    Science.gov (United States)

    ... Navigating Cancer Care > Side Effects > Lymphedema Request Permissions Lymphedema Approved by the Cancer.Net Editorial Board , 05/ ... years after cancer treatment has ended. Symptoms of lymphedema People with lymphedema in their arm or leg ...

  12. A Leading Role in Lymphedema Awareness | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Lymphedema A Leading Role in Lymphedema Awareness Past Issues / Fall 2016 Table of Contents ... director Kathy Bates. Photo: Keith Muryan You developed lymphedema after surgery for breast cancer. When did you ...

  13. The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform.

    Science.gov (United States)

    Loh, Charles Yuen Yung; Wu, Jerry Chih-Wei; Nguyen, Alexander; Dayan, Joseph; Smith, Mark; Masia, Jaume; Chang, David; Koshima, Isao; Cheng, Ming-Huei

    2017-01-01

    The successful completion of the 5th World Symposium for Lymphedema Surgery (WSLS) marks another milestone in the development and advancement of the management of lymphedema. We present our experience in organizing such a scientific lymphedema conference as well as a summary of seven variable live surgeries used for treating lymphedema. An update of current knowledge and determination of future direction in the treatment of lymphedema was made possible via WSLS 2016. J. Surg. Oncol. 2017;115:6-12. © 2016 Wiley Periodicals, Inc.

  14. Inflammatory Manifestations of Lymphedema

    Directory of Open Access Journals (Sweden)

    Catherine L. Ly

    2017-01-01

    Full Text Available Lymphedema results from lymphatic insufficiency leading to a progressive inflammatory process that ultimately manifests as discomfort, recurrent infections, and, at times, secondary malignancy. Collectively, these morbidities contribute to an overall poor quality of life. Although there have been recent advances in microsurgical interventions, a conservative palliative approach remains the mainstay of treatment for this disabling disease. The absence of a cure is due to an incomplete understanding of the pathophysiological changes that result in lymphedema. A histological hallmark of lymphedema is inflammatory cell infiltration and recent studies with animal models and clinical biopsy specimens have suggested that this response plays a key role in the pathology of the disease. The purpose of this report is to provide an overview of the ongoing research in and the current understanding of the inflammatory manifestations of lymphedema.

  15. Lymphedema Risk Reduction Practices

    Science.gov (United States)

    ... LSAP Perspective (9) 2017 NLN International Conference Position Paper: Lymphedema Risk Reduction Practices Category: Position Papers Tags: ... and water, pat dry, then apply a topical antibacterial. d. Wear non-constricting protective gear over the ...

  16. Inflammatory Manifestations of Lymphedema

    Science.gov (United States)

    Ly, Catherine L.; Kataru, Raghu P.; Mehrara, Babak J.

    2017-01-01

    Lymphedema results from lymphatic insufficiency leading to a progressive inflammatory process that ultimately manifests as discomfort, recurrent infections, and, at times, secondary malignancy. Collectively, these morbidities contribute to an overall poor quality of life. Although there have been recent advances in microsurgical interventions, a conservative palliative approach remains the mainstay of treatment for this disabling disease. The absence of a cure is due to an incomplete understanding of the pathophysiological changes that result in lymphedema. A histological hallmark of lymphedema is inflammatory cell infiltration and recent studies with animal models and clinical biopsy specimens have suggested that this response plays a key role in the pathology of the disease. The purpose of this report is to provide an overview of the ongoing research in and the current understanding of the inflammatory manifestations of lymphedema. PMID:28106728

  17. Factors Associated With External and Internal Lymphedema in Patients With Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Deng Jie, E-mail: jie.deng@vanderbilt.edu [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Ridner, Sheila H. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States); Dietrich, Mary S. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States); Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee (United States); Wells, Nancy; Wallston, Kenneth A. [School of Nursing, Vanderbilt University, Nashville, Tennessee (United States); Sinard, Robert J.; Cmelak, Anthony J.; Murphy, Barbara A. [Vanderbilt-Ingram Cancer Center, Nashville, Tennessee (United States)

    2012-11-01

    Purpose: The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC). Methods and Materials: The sample included 81 patients {>=}3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema. Results: The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample. Conclusions: Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.

  18. Lymphedema Prophylaxis Utilizing Perloperative Education

    Science.gov (United States)

    2005-09-01

    AD Award Number: DAMD17-00-1-0495 TITLE: Lymphedema Prophylaxis Utilizing Perloperative Education PRINCIPAL INVESTIGATOR: Mary Ann Kosir, M.D...NUMBER Lymphedema Prophylaxis Utilizing Perloperative Education 5b. GRANT NUMBER DAM D1 7-00-1-0495 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training in lymphedema protection will

  19. Complex Decongestive Physiotherapy Treats Skin Changes like Hyperkeratosis Caused by Lymphedema

    Directory of Open Access Journals (Sweden)

    Hande Kaba

    2012-01-01

    Full Text Available Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymph angiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. Here, we report a 64-year-old woman presenting with hyperkeratosis, a lymphedema due to metastatic uterus carcinoma. In this paper, we present the effects of complex decongestive physiotherapy on lymphedema and hyperkeratosis.

  20. Lymphedema in tuberous sclerosis complex.

    Science.gov (United States)

    Geffrey, Alexandra L; Shinnick, Julianna E; Staley, Brigid A; Boronat, Susana; Thiele, Elizabeth A

    2014-06-01

    Congenital lymphedema has been described as a possible rare association of tuberous sclerosis complex (TSC), with only six previous cases reported in the literature. TSC is an autosomal dominant, multisystem disorder connected to aberrant regulation of the mammalian target of rapamycin (mTOR) pathway. The aim of this study is to review cases of lymphedema in a large cohort of TSC patients. The medical records of 268 patients seen at The Herscot Center for Children and Adults with Tuberous Sclerosis Complex at the Massachusetts General Hospital from 2002 to 2012 were retrospectively reviewed for reports of lymphedema or edema of unknown etiology. Genotypic and phenotypic data were collected in accordance with institutional review board (IRB) approval. This cohort presents two new cases of congenital lymphedema in TSC patients and acquired lymphedema was found in eight additional cases. Thus, we report 10 new cases of lymphedema in TSC (4%). The two patients with congenital lymphedema were female, as were the previous six reported cases. The frequency of lymphedema reported here (4%) is higher than the estimated prevalence in the general population (0.133-0.144%), suggesting a higher frequency of lymphedema in TSC. This study shows that patients with TSC and lymphedema are more likely to be females with renal AMLs and suggests that congenital lymphedema is a gender-specific (female) manifestation of TSC. Exploration of the potential role of mTOR antagonists may be important in treatment of lymphedema in TSC patients.

  1. Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast

    DEFF Research Database (Denmark)

    Ryttov, N; Holm, N V; Qvist, N

    1988-01-01

    The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups......%/38% in the group of patients receiving adjuvant irradiation and 6%/12% in the group of patients receiving adjuvant systemic therapy. It is concluded that adjuvant irradiation to the axilla in patients with metastatic lymph nodes highly increases the risk of late physical sequelae following modified radical...

  2. Cognitive-Affective Predictors of the Uptake & Sustained Adherence to Lymphedema Symptom Minimization Practices in Breast Cancer Survivors

    Science.gov (United States)

    2007-08-01

    Uptake of, & Sustained Adherence to Lymphedema Symptom Minimization Practices in Breast Cancer Survivors PRINCIPAL INVESTIGATOR: Suzanne M. Miller...SUBTITLE 5a. CONTRACT NUMBER Cognitive-Affective Predictors of the Uptake of, & Sustained Adherence to Lymphedema Symptom Minimization Practices in...SUPPLEMENTARY NOTES 14. ABSTRACT Approximately 20-30% of women develop lymphedema (LE) following breast cancer treatment. Effective symptom management

  3. Genetics Home Reference: lymphedema-distichiasis syndrome

    Science.gov (United States)

    ... Understand Genetics Home Health Conditions lymphedema-distichiasis syndrome lymphedema-distichiasis syndrome Enable Javascript to view the expand/ ... boxes. Download PDF Open All Close All Description Lymphedema-distichiasis syndrome is a condition that affects the ...

  4. Radiation Therapy Risk Factors for Development of Lymphedema in Patients Treated With Regional Lymph Node Irradiation for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chandra, Ravi A. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Miller, Cynthia L. [Harvard Medical School, Boston, Massachusetts (United States); Skolny, Melissa N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Horick, Nora [Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts (United States); Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); O' Toole, Jean [Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts (United States); Specht, Michelle C. [Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-03-15

    Purpose: We previously evaluated the risk of breast cancer-related lymphedema (LE) with the addition of regional lymph node irradiation (RLNR) and found an increased risk when RLNR is used. Here we analyze the association of technical radiation therapy (RT) factors in RLNR patients with the risk of LE development. Methods and Materials: From 2005 to 2012, we prospectively screened 1476 women for LE who underwent surgery for breast cancer. Among 1507 breasts treated, 172 received RLNR and had complete technical data for analysis. RLNR was delivered as supraclavicular (SC) irradiation (69% [118 of 172 patients]) or SC plus posterior axillary boost (PAB) (31% [54 of 172]). Bilateral arm volume measurements were performed pre- and postoperatively. Patients' RT plans were analyzed for SC field lateral border (relative to the humeral head), total dose to SC, RT fraction size, beam energy, and type of tangent (normal vs wide). Cox proportional hazards models were used to analyze associated risk factors for LE. Results: Median postoperative follow-up was 29.3 months (range: 4.9-74.1 months). The 2-year cumulative incidence of LE was 22% (95% confidence interval [CI]: 15%-32%) for SC and 20% (95% CI: 11%-37%) for SC plus PAB (SC+PAB). None of the analyzed variables was significantly associated with LE risk (extent of humeral head: P=.74 for <1/3 vs >2/3, P=.41 for 1/3 to 2/3 vs >2/3; P=.40 for fraction size of 1.8 Gy vs 2.0 Gy; P=.57 for beam energy 6 MV vs 10 MV; P=.74 for tangent type wide vs regular; P=.66 for SC vs SC+PAB). Only pretreatment body mass index (hazard ratio [HR]: 1.09; 95% CI: 1.04-1.15, P=.0007) and the use of axillary lymph node dissection (HR: 7.08, 95% CI: 0.98-51.40, P=.05) were associated with risk of subsequent LE development. Conclusions: Of the RT parameters tested, none was associated with an increased risk of LE development. This study underscores the need for future work investigating alternative RLNR risk factors for LE.

  5. Recent Progress in Cancer-Related Lymphedema Treatment and Prevention

    Science.gov (United States)

    Shaitelman, Simona F.; Cromwell, Kate D.; Rasmussen, John C.; Stout, Nicole L.; Armer, Jane M.; Lasinski, Bonnie B.; Cormier, Janice N.

    2016-01-01

    This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema. PMID:25410402

  6. Development imaging and experimental model for studying pathogenesis and treatment efficacy of postmastectomy lymphedema

    Science.gov (United States)

    Galanzha, Ekateryna I.; Tuchin, Valery V.; Solov'eva, Anastasiya V.; Stepanova, Tatyana V.; Brill, Gregory E.; Zharov, Vladimir P.

    2002-05-01

    The experimental model was created during an abdominal dissection of the rat mesentery and ligation of the collecting vein of mesentery. It was found that mesentery edema was developed for 20-30 min. Simultaneously monitoring of main the parameters of blood and lymph flow revealed significant increasing of interstitial water amount (up to 3 times), reduction of blood microcirculation, increasing of blood vessels permeability, decreasing of lymph microvessels diameter, phasics contractions, and lymph flow velocity.

  7. Regulatory T cell transfer ameliorates lymphedema and promotes lymphatic vessel function

    Science.gov (United States)

    Gousopoulos, Epameinondas; Proulx, Steven T.; Bachmann, Samia B.; Scholl, Jeannette; Dionyssiou, Dimitris; Demiri, Efterpi; Halin, Cornelia; Dieterich, Lothar C.

    2016-01-01

    Secondary lymphedema is a common postcancer treatment complication, but the underlying pathological processes are poorly understood and no curative treatment exists. To investigate lymphedema pathomechanisms, a top-down approach was applied, using genomic data and validating the role of a single target. RNA sequencing of lymphedematous mouse skin indicated upregulation of many T cell–related networks, and indeed depletion of CD4+ cells attenuated lymphedema. The significant upregulation of Foxp3, a transcription factor specifically expressed by regulatory T cells (Tregs), along with other Treg-related genes, implied a potential role of Tregs in lymphedema. Indeed, increased infiltration of Tregs was identified in mouse lymphedematous skin and in human lymphedema specimens. To investigate the role of Tregs during disease progression, loss-of-function and gain-of-function studies were performed. Depletion of Tregs in transgenic mice with Tregs expressing the primate diphtheria toxin receptor and green fluorescent protein (Foxp3-DTR-GFP) mice led to exacerbated edema, concomitant with increased infiltration of immune cells and a mixed TH1/TH2 cytokine profile. Conversely, expansion of Tregs using IL-2/anti–IL-2 mAb complexes significantly reduced lymphedema development. Therapeutic application of adoptively transferred Tregs upon lymphedema establishment reversed all of the major hallmarks of lymphedema, including edema, inflammation, and fibrosis, and also promoted lymphatic drainage function. Collectively, our results reveal that Treg application constitutes a potential new curative treatment modality for lymphedema. PMID:27734032

  8. Independent Research and Independent Exploratory Development FY 1985

    Science.gov (United States)

    1986-01-01

    complexity and cerebral sensory interaction. Personality and Individual Differences , 6(2), 253-261. Federico, P-A (1985). Individual differences in concept...learning and brain event-related potentials. Personality and Individual Differences , 6(2), 243-252. INDEPENDENT EXPLORATORY DEVELOPMENT PUBLICATIONS

  9. Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India.

    Directory of Open Access Journals (Sweden)

    Victoria Walsh

    2016-08-01

    Full Text Available Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF, and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor.A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036 of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1-99. Early lymphedema (Dreyer stages 1 & 2 was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4-7. Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15-29 (aPR: 3.21, 95% CI 2.45, 4.21. The number of adenolymphangitis (ADL episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97-7.30. This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India.These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.

  10. Upper limb swelling following mastectomy: lymphedema or not?

    Science.gov (United States)

    Armer, Jane

    2007-04-01

    Having experienced an excisional biopsy, sentinel lymph node biopsy, and mastectomy, BH is at lifetime risk of developing post-breast cancer lymphedema in the arm on the side where her breast cancer was treated. She has two additional risk factors, among those documented in the literature: history of an infection (specifically a systemic infection, significant in that it required hospitalization for intravenous antibiotics) in the postsurgery period, and a moderate increase in bilateral limb volume and weight (body mass index) over the months and years following the breast cancer diagnosis. Further, the patient-reported transient hand swelling on the affected side and gradual weight increase are cues indicating a need for patient vigilance and careful monitoring by the health-care team. Preventing future infections, managing weight at an optimal level, and preventing trauma or injury to the affected arm and chest are important self-management precautions to reduce risk of chronic lymphedema development. BH needs continued support in reviewing evidence-based risk-reduction guidelines and understanding ways to apply them to her lifestyle. In the absence of preoperative baseline or contralateral limb measurements (with circumferences or perometry or water displacement), assessment of limb change at a level identified as diagnostic of lymphedema (commonly, 200-mL volume or 2-cm girth increase from baseline or as compared to the contralateral limb) is very challenging. Without bilateral preop limb measurements for baseline and contralateral limb comparisons, BH might have been diagnosed with lymphedema at postop or at 48 months, when both limbs increased symmetrically. Symptom assessment is also crucial, as symptom report of heaviness and swelling is found to be associated with limb volume changes indicative of lymphedema. Transient hand swelling may be evidence of latent lymphedema and cause for increased risk-reduction education and vigilance in assessment for

  11. Generalized lymphedema associated with neurologic signs (GLANS) syndrome: a new entity?

    Science.gov (United States)

    Berton, Marine; Lorette, Gérard; Baulieu, Françoise; Lagrue, Emmanuelle; Blesson, Sophie; Cambazard, Frédéric; Vaillant, Loïc; Maruani, Annabel

    2015-02-01

    Primary lymphedema in children, especially generalized disease with facial involvement, is rare. We sought to report 3 childhood cases of lymphedema with associated neurologic findings and to provide a pathophysiologic explanation for this association. Clinical observations, electroencephalography, and neuroimaging studies were evaluated. Microcomparative genomic hybridization was performed in 1 case. The 3 children had primary lymphedema of all 4 limbs and the face. This was confirmed by lymphoscintigraphy, which showed hypoplasia of vessels and hypofixation of lymph nodes. They had nonspecific neurologic disorders and electroencephalography abnormalities, without intellectual deficit. Neuroimaging revealed normal findings. Microcomparative genomic hybridization in 1 patient revealed no cytogenetic anomaly. The outcome was fatal in 1 case with development of visceral lymphedema and coma. Genetic studies were performed in only 1 case. These observations suggest that neurologic assessment and electroencephalography are indicated for patients with lymphedema of the limbs and face to identify this syndrome. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Profilometry and subsurface imaging in point of care diagnosis in ocular disease and lymphedema after breast cancer treatment

    Science.gov (United States)

    Sayegh, Samir I.; Taghian, Alphonse

    2013-02-01

    Breast cancer-related lymphedema (BCRL) can be irreversible with profound negative impact on patients' quality of life. Programs that provide screening and active surveillance for BCRL are essential to determine whether early detection and intervention influences the course of lymphedema development. Established methods of quantitatively assessing lymphedema at early stages include "volume" methods such as perometry and bioimpedance spectroscopy. Here we demonstrate 1) Use of topographical techniques analogous to those used in corneal topography 2) Development of point-of-care lymphedema detection and characterization based on off-the-shelf hardward 3) The role of subsurface imaging 4) Multimodal diagnostics and integration yielding higher sensitivity/ specificity.

  13. Aquatic Therapy for People with Lymphedema: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Yeung, Wai; Semciw, Adam I

    2017-03-27

    Aquatic therapy has several proposed benefits for people with lymphedema. A systematic review of the evidence for aquatic therapy in lymphedema management has not been conducted. Systematic review and meta-analysis were conducted. Five electronic databases were searched to identify randomized controlled trials (RCTs) of people with lymphedema, which compared aquatic therapy with other lymphedema interventions. Qualitative analysis was undertaken where quantitative analysis was not possible. Study quality was assessed using physiotherapy evidence database (PEDro) scores. The strength of evidence was evaluated using the Grades of Recommendations Assessment, Development and Evaluation (GRADE) approach. Four RCTs of moderate quality (average PEDro score 6.5/10) were included in the review. Two studies provided results for inclusion in meta-analysis. There was moderate-level evidence of no significant short-term differences in lymphedema status (as measured by lymphedema relative volume) between patients who completed aqua lymphatic therapy (ALT) compared to land-based standard care (standardized mean difference [SMD]: 0.14; 95% confidence interval [CI]: -0.37 to 0.64, I(2) = 0%, p = 0.59); and low-quality evidence of no significant difference between ALT and standard care for improving upper limb (UL) physical function (SMD -0.27, 95% CI: -0.78 to 0.23, I(2) = 0%, p = 0.29). No adverse events reported. Current evidence indicates no significant benefit of ALT over standard land-based care for improving lymphedema status or physical function in people with UL lymphedema. Patient preference should guide the choice of care to facilitate adherence. Further research is required to strengthen the evidence from four studies in people with UL lymphedema, and to establish the efficacy of this intervention in people with lower limb lymphedema. Review registration: PROSPERO (CRD42015019900).

  14. Excess Lymphangiogenesis Cooperatively Induced by Macrophages and CD4(+) T Cells Drives the Pathogenesis of Lymphedema.

    Science.gov (United States)

    Ogata, Fusa; Fujiu, Katsuhito; Matsumoto, Sahohime; Nakayama, Yukiteru; Shibata, Munehiko; Oike, Yuichi; Koshima, Isao; Watabe, Tetsuro; Nagai, Ryozo; Manabe, Ichiro

    2016-03-01

    Lymphedema is a debilitating progressive condition that severely restricts quality of life and is frequently observed after cancer surgery. The mechanism underlying lymphedema development remains poorly understood, and no effective pharmacological means to prevent or alleviate the ailment is currently available. Using a mouse model of lymphedema, we show here that excessive generation of immature lymphatic vessels is essential for initial edema development and that this early process is also important for later development of lymphedema pathology. We found that CD4(+) T cells interact with macrophages to promote lymphangiogenesis, and that both lymphangiogenesis and edema were greatly reduced in macrophage-depleted mice, lymphocyte-deficient Rag2(?/?) mice or CD4(+) T-cell-deficient mice. Mechanistically, T helper type 1 and T helper type 17 cells activate lesional macrophages to produce vascular endothelial growth factor-C, which promotes lymphangiogenesis, and inhibition of this mechanism suppressed not only early lymphangiogenesis, but also later development of lymphedema. Finally, we show that atorvastatin suppresses excessive lymphangiogenesis and lymphedema by inhibiting T helper type 1 and T helper type 17 cell activation. These results demonstrate that the interaction between CD4(+) T cells and macrophages is a potential therapeutic target for prevention of lymphedema after surgery.

  15. Intensive treatment of leg lymphedema

    Directory of Open Access Journals (Sweden)

    Pereira de Godoy Jose

    2010-01-01

    Full Text Available Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value < 0.05 being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value < 0.001. Losses of more than 90% of the lymphedema occurred in 9 (39.13% patients; losses of more than 80% in 13 (56.52%, losses of more than 70% in 17 (73.91% and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9% of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

  16. Surgical treatment of recidivist lymphedema

    Science.gov (United States)

    Ferrarese, Alessia; Moggia, Elisabetta; Francone, Elisa; Sagnelli, Carlo; Martino, Maria Di; de Franciscis, Stefano; Amato, Bruno; Grande, Raffaele; Butrico, Lucia; Amato, Maurizio; Serra, Raffaele; Martino, Valter; Berti, Stefano

    2016-01-01

    Abstract Lymphedema is a chronic disease with a progressively ingravescent evolvement and an appearance of recurrent complications of acute lymphangitic type; in nature it is mostly erysipeloid and responsible for a further rapid increase in the volume and consistency of edema. The purpose of this work is to present our experience in the minimally invasive treatment for recurrence of lymphedema; adapting techniques performed in the past which included large fasciotomy with devastating results cosmetically; but these techniques have been proposed again by the use of endoscopic equipment borrowed from the advanced laparoscopy surgery, which allows a monoskin access of about one cm.

  17. THE REHABILITATION MANAGEMENT OF LYMPHEDEMA

    Directory of Open Access Journals (Sweden)

    OJOGA Florina

    2015-05-01

    Full Text Available Lymphedema is an important pathology for rehabilitation medecine, especially for the patients who underwent a mastectomy for breast cancer. His frequency is higher when mastectomy is combined with lymph node disection and irradiation of the lymph nodes. Symptoms include heaviness, numbness, pain, stiffness and weakness in the affected limb. Complications of lymphedema include infections such as cellulitis, erysipelas and lymphangitis. Treatment must be instituted as soon as possible and preventive measures are essential. The rehabilitation treatment consists of skin care measures, manual lymphatic massage, elastic compression of the affected limb and kinetotherapy.

  18. Surgical treatment of recidivist lymphedema

    Directory of Open Access Journals (Sweden)

    Eretta Costantino

    2016-01-01

    Full Text Available Lymphedema is a chronic disease with a progressively ingravescent evolvement and an appearance of recurrent complications of acute lymphangitic type; in nature it is mostly erysipeloid and responsible for a further rapid increase in the volume and consistency of edema. The purpose of this work is to present our experience in the minimally invasive treatment for recurrence of lymphedema; adapting techniques performed in the past which included large fasciotomy with devastating results cosmetically; but these techniques have been proposed again by the use of endoscopic equipment borrowed from the advanced laparoscopy surgery, which allows a monoskin access of about one cm.

  19. Lymphedema: What We Know | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Lymphedema Lymphedema: What We Know Past Issues / Fall 2016 Table ... Photo: NCI Who is at risk for getting lymphedema? Having lymph nodes removed during breast cancer surgery ...

  20. Sotos syndrome: An unusual presentation with intrauterine growth restriction, generalized lymphedema, and intention tremor.

    Science.gov (United States)

    McClelland, Jessie; Burgess, Bronwyn; Crock, Patricia; Goel, Himanshu

    2016-04-01

    Sotos syndrome is a childhood overgrowth syndrome characterized clinically by a distinctive facial gestalt, advanced bone age, childhood overgrowth, and non-progressive developmental delay; and genetically by haploinsufficiency of the Nuclear receptor binding SET Domain 1 (NSD1) gene. Generalized lymphedema has not previously been associated with Sotos syndrome. Generalized lymphedema has been associated with mutations in several genes including FLT4. This gene is involved in the regulation of VEGFR3, a key governor of lymphatic-endothelial cell development and function. We report on a 28-year-old Caucasian female with a de novo NSD1 intragenic mutation, c.5841_5848dup: p.Leu1950Serfs*22, who presented with characteristic clinical features of Sotos syndrome. Unusually this case includes atypical features of intrauterine growth retardation and post-pubertal onset of primary lymphedema. To our knowledge, no link between Sotos syndrome and generalized lymphedema has previously been described in the literature. We propose a mechanism by which disruptions in NSD1 gene may lead to generalized lymphedema. Aberrations of the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK)-signaling pathway has been identified in both Sotos syndrome and lymphedema. This finding extends the known phenotype of Sotos syndrome through the inclusion of lymphedema. This case also indicates that presence of low birth weight does not exclude the possibility of Sotos syndrome.

  1. Bridging the divide between pathogenesis and detection in lymphedema.

    Science.gov (United States)

    Dixon, J Brandon; Weiler, Michael J

    2015-02-01

    While our understanding of the lymphatic system has improved substantially in the past few decades, the translation of this knowledge into improved healthcare solutions for patients suffering from secondary lymphedema has been severely limited. The challenge facing clinicians is two-fold. First, there is no reliable, affordable, diagnostic capable of detecting the disease before symptoms of the lymphedema develop and the efficacy of treatment options becomes limited. Second, our understanding of the disease pathogenesis, its risk factors, and the underlying physiologic mechanisms is still in its infancy. These two challenges go hand in hand as limited diagnostic options have hindered our ability to understand lymphedema progression, and the lack of known underlying mechanisms involved in the disease prohibits the development of new diagnostic targets. This review serves to discuss the recent developments in clinical and lab research settings of both lymphedema diagnostic technologies and our understanding of the mechanisms driving disease risk and progression. We will show how these two lines of research are synergistically working with the ultimate goal of improving patient outcomes for those suffering from this horrible disease, identifying key areas of further research that are warranted to move the field forward and provide clinical relief for this neglected patient population.

  2. Bioelectrical impedance for detecting and monitoring lymphedema in patients with breast cancer. Preliminary results of the florence nightingale breast study group.

    Science.gov (United States)

    Erdogan Iyigun, Zeynep; Selamoglu, Derya; Alco, Gul; Pilancı, Kezban Nur; Ordu, Cetin; Agacayak, Filiz; Elbüken, Filiz; Bozdogan, Atilla; Ilgun, Serkan; Guler Uysal, Fusun; Ozmen, Vahit

    2015-03-01

    The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema.

  3. The risk of lymphedema after postoperative radiation therapy in endometrial cancer

    Science.gov (United States)

    Catalano, Paul J.; Cimbak, Nicole; Muto, Michael G.; Viswanathan, Akila N.

    2016-01-01

    Objective Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy. Methods A retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk. Results Of 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months. Conclusion Lymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions. PMID:26463430

  4. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    Viehoff, P.B.; Potijk, F.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Berkel, D.M. van; Neumann, H.A.

    2015-01-01

    BACKGROUND: To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. METHODS: Cross-s

  5. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    P.B. Viehoff (Peter); F. Potijk; R.J. Damstra (Robert); Y.F. Heerkens (Yvonne); C.D. van Ravensberg (Dorine); D.M. Van Berkel; H.A.M. Neumann (Martino)

    2015-01-01

    textabstractBackground. To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema.Metho

  6. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    Viehoff, P.B.; Potijk, F.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Berkel, D.M. van; Neumann, H.A.

    2015-01-01

    BACKGROUND: To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. METHODS:

  7. Gigantic Suprapubic Lymphedema: A Case Study

    Science.gov (United States)

    Tanhaeivash, Roozbeh; Franiel, Tobias; Grimm, Marc-Oliver

    2016-01-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg). Massive localized lymphedema of the suprapubic region should be differentiated from the scrotal type. Severe lymphedema could not resolve on its own and weight reduction does not seem to be helpful in such cases. PMID:27574599

  8. Is China Developing an Independent Technology Capability?

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Are Chinese technology enterprises only the "hired laborers" of other countries? Does China possess high technology in a real sense? When will the country develop independent scientific and technological innovation? Those are not brand new questions. However, after the Chinese Government issued its National Guidelines on the Long- and Medium-Term Program for Science and Technology

  9. Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

    Directory of Open Access Journals (Sweden)

    Lu SR

    2015-02-01

    Full Text Available Shiang-Ru Lu,1 Rong-Bin Hong,2 Willy Chou,3,4 Pei-Chi Hsiao3,4 1Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Departments of Physical Medicine and Rehabilitation, Chi-Mei Medical Center Liouying Campus, Tainan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan; 4Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Introduction: This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL. Methods: We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415, who received neither education nor physiotherapy postsurgery; Group B (n=672, who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130, who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models. Results: During the follow-up, 188 patients (15.4% developed lymphedema, including 77 (18.6% in Group A, 101 (15.0% in Group B, and 10 (7.7% in Group C (P=0.010. The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78. The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20 number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002. Conclusion: Patient education that begins

  10. Resolution of Primary Lymphedema: A Case Report

    Science.gov (United States)

    Goss, Jeremy A.; Maclellan, Reid A.; Beijnen, Usha E. A.

    2017-01-01

    Summary: Primary lymphedema is a rare, progressive disease that typically affects the lower extremity. The condition is not curable, and the limb enlarges over time because of subcutaneous fibroadipose deposition. We present a patient with clinical and radiographical evidence of resolution of primary lymphedema. This observation may provide greater insight into the pathophysiology of the disease. PMID:28280665

  11. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

    Directory of Open Access Journals (Sweden)

    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Manytreatment options are available, but no treatment results in a complete cure. We report acase of lymphedema that occurred after modified radical mastectomy in a breast cancerpatient who showed objective improvement after delayed breast reconstruction with anlatissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer hadundergone modified radical mastectomy with axillary lymph node dissection and postoperativeradiotherapy 12 years previously. Four years after surgery, lymphedema developed andincreased in aggravation despite conservative treatment. Eight years after the first operation,the patient underwent delayed breast reconstruction using the extended latissimus dorsimyocutaneous flap method. After reconstruction, the patient’s lymphedema symptomsshowed dramatic improvement by subjective measures including tissue softness and feeling oflightness, and by objective measures of about 7 mL per a week, resulting in near normal rangesof volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayedbreast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful topatients with lymphedema after mastectomy. This may be a good option for patients who areworried about the possibility of the occurrence or aggravation of secondary lymphedema.

  12. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

    Directory of Open Access Journals (Sweden)

    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

  13. The Impact of Radiation Therapy on the Risk of Lymphedema After Treatment for Breast Cancer: A Prospective Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G.; Miller, Cynthia L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Horick, Nora [Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts (United States); Skolny, Melissa N.; Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); O' Toole, Jean A. [Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts (United States); MacDonald, Shannon M. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Specht, Michelle C. [Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-03-01

    Purpose/Objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema. Methods and Materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema. Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001). Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema.

  14. Association between lymphedema self-care adherence and lymphedema outcomes among women with breast cancer-related lymphedema.

    Science.gov (United States)

    Brown, Justin C; Kumar, Anagha; Cheville, Andrea L; Tchou, Julia C; Troxel, Andrea B; Harris, Susan R; Schmitz, Kathryn H

    2015-04-01

    The aim of this study was to determine whether adherence to self-care modalities for breast cancer-related lymphedema (BCRL) predicts BCRL outcomes among 128 breast cancer survivors who participated in the 12-mo physical activity and lymphedema trial. This was a prospective cohort study. Adherence to ten BCRL self-care modalities, as recommended in the clinical practice guidelines for the management of BCRL, was assessed by a questionnaire at baseline. BCRL outcomes assessed at baseline and 12 mos included volumetry, circumferences, bioimpedence spectroscopy, the Norman lymphedema survey, and therapist-defined lymphedema exacerbations requiring treatment. Generalized linear models were used to estimate the relationship between adherence to BCRL self-care modalities and the likelihood of experiencing a BCRL outcome. Adherence to BCRL self-care activities did not predict experiencing any BCRL outcomes at 12 mos. Levels of adherence to BCRL self-care modalities did not predict a 5% or greater decrease in interlimb volume (Ptrend = 0.79), 5% or greater decrease in the sum of interlimb arm circumferences (Ptrend = 0.47), 10% or greater decrease in bioimpedence spectroscopy (Ptrend = 0.83), 1 or greater decrease in self-reported lymphedema symptoms (Ptrend = 0.91), or therapist-defined lymphedema exacerbation requiring treatment (Ptrend = 0.84). Our findings suggest that levels of BCRL self-care adherence do not predict BCRL outcomes among breast cancer survivors with stable lymphedema who were followed for 12 mos.

  15. Independent Research and Independent Exploratory Development FY91 Annual Report

    Science.gov (United States)

    1992-03-01

    Computers in Human Behavior , 6, 167-175. Heinssen, R. K., Glass, C. R., & Knight, L...A. (1987). Assessing computer anxiety: Development and validation of the computer anxiety rating scale. Computers in Human Behavior , 3, 49-59. Hess...administered MMPIs: A comparison of patients’ attitudes. Computers in Human Behavior , 2, 111-116. Schuldberg, D. (1988). The MMPI is less sensitive to

  16. DESCRIBING LYMPHEDEMA IN FEMALES WITH TURNER SYNDROME.

    Science.gov (United States)

    Rothbauer, J; Driver, S; Callender, L

    2015-09-01

    Turner syndrome (TS) is a chromosomal condition affecting an estimated 1 in 2,500 girls where the second X chromosome is missing, or partially formed. This abnormality affects multiple body systems and can lead to short stature, cardiac, neural, and renal abnormalities. Due to the chronic, non-life threatening nature of lymphedema in comparison to other symptoms of TS, it is often ignored by girls and women with TS and their physicians. Consequently, little is known about how lymphedema affects girls and women with TS across the lifespan. Therefore, the objective of the study was to deliver an online survey for females with TS and caregivers in the US, UK, and Canada to provide a worldwide perspective on their current experience with lymphedema within the spectrum of TS. There were 219 participants who completed the survey, and we were able to identify incidence and characteristics of lymphedema across the lifespan. In addition, we found that females with 45,X karyotyping were more likely to report lymphedema symptoms. Lymphedema is not the most significant concern of females with TS, but education, physician evaluation, and assistance with referrals for treatment and management would improve the ease of managing lymphedema in girls and women with TS.

  17. 48 CFR 731.773 - Independent research and development costs.

    Science.gov (United States)

    2010-10-01

    ... Organizations 731.773 Independent research and development costs. Pending establishment of Government-wide... independent research and development costs. ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Independent research and...

  18. Self-Care for Management of Secondary Lymphedema: A Systematic Review

    Science.gov (United States)

    Graves, Patricia; Gordon, Susan

    2016-01-01

    Background Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema. Methodology/Principal Findings Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured. Conclusions/Significance There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people

  19. [In search of the ideal surgical treatment for lymphedema. Report of 2nd European Conference on supermicrosurgery (Barcelona - March 2012)].

    Science.gov (United States)

    Rausky, J; Robert, N; Binder, J-P; Revol, M

    2012-12-01

    Since more than 50 years, many surgeons all around the world try to find the perfect surgical technique to treat limb lymphedemas. Decongestive physiotherapy associated with the use of a compressive garment has been the primary choice for lymphedema treatment. Many different surgical techniques have been developed, however, to date, there is no consensus on surgical procedure. Most surgical experts of lymphedema met in the second European Conference on supermicrosurgery, organized on March 1st and 2nd 2012, in San Pau Hospital, Barcelona. Together they tried to clarify these different options and ideally a strategy for using these techniques.

  20. Lymphedema (PDQ®)—Health Professional Version

    Science.gov (United States)

    Expert-reviewed information summary about the anatomy, pathophysiology, clinical manifestations, diagnosis, and treatment of cancer-related lymphedema, a condition in which lymph fluid builds up in tissues and causes swelling.

  1. Gigantic Suprapubic Lymphedema: A Case Study

    National Research Council Canada - National Science Library

    Roozbeh Tanhaeivash; Tobias Franiel; Marc-Oliver Grimm; Marcus Horstmann

    2016-01-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg...

  2. Psychosocial Impact of Lymphedema: A Systematic Review of Literature from 2004–2011

    Science.gov (United States)

    Fu, Mei R.; Ridner, Sheila H.; Hu, Sophia H.; Stewart, Bob R.; Cormier, Janice N.; Armer, Jane M.

    2014-01-01

    Objective This systematic review aimed to evaluate the level of evidence of contemporary peer-reviewed literature published from 2004–2011 on the psychosocial impact of lymphedema. Methods Eleven electronic databases were searched and 1,311 articles retrieved; 23 met inclusion criteria. Twelve articles utilized qualitative methodology and 11 employed quantitative methodology. An established quality assessment tool was used to assess the quality of the included studies. Results The overall quality of the 23 included studies was adequate. A critical limitation of current literature is the lack of conceptual or operational definitions for the concept of psychosocial impact. Quantitative studies showed statistically significant poorer social well-being in persons with lymphedema, including perceptions related to body image, appearance, sexuality, and social barriers. No statistically significant differences were found between persons with and without lymphedema in the domains of emotional well-being (happy or sad) and psychological distress (depression and anxiety). All 12 of the qualitative studies consistently described negative psychological impact (negative self-identity, emotional disturbance, psychological distress) and negative social impact (marginalization, financial burden, perceived diminished sexuality, social isolation, perceived social abandonment, public insensitivity, non-supportive work environment). Factors associated with psychosocial impact were also identified. Conclusions Lymphedema has a negative psychosocial impact on affected individuals. The current review sheds light on the conceptualization and operationalization of the definitions of psychosocial impact with respect to lymphedema. Development of a lymphedema-specific instrument is needed to better characterize the impact of lymphedema and to examine the factors contributing to these outcomes in cancer and non-cancer-related populations. PMID:23044512

  3. Exercise in patients with lymphedema: a systematic review of the contemporary literature.

    Science.gov (United States)

    Kwan, Marilyn L; Cohn, Joy C; Armer, Jane M; Stewart, Bob R; Cormier, Janice N

    2011-12-01

    Controversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema, particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors. Publications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion criteria, 19 articles were selected for final review. Information on study design/objectives, participants, outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence Classification. Seven studies were identified addressing resistance exercise, seven studies on aerobic and resistance exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of varying modalities is not associated with the development or exacerbation of breast cancer-related lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise appear safe, but confirmation requires larger and more rigorous studies. Strong evidence is now available on the safety of resistance exercise without an increase in risk of lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for lymphedema. With reasonable precautions, it is safe for breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during treatment.

  4. Political attitudes develop independently of personality traits.

    Science.gov (United States)

    Hatemi, Peter K; Verhulst, Brad

    2015-01-01

    The primary assumption within the recent personality and political orientations literature is that personality traits cause people to develop political attitudes. In contrast, research relying on traditional psychological and developmental theories suggests the relationship between most personality dimensions and political orientations are either not significant or weak. Research from behavioral genetics suggests the covariance between personality and political preferences is not causal, but due to a common, latent genetic factor that mutually influences both. The contradictory assumptions and findings from these research streams have yet to be resolved. This is in part due to the reliance on cross-sectional data and the lack of longitudinal genetically informative data. Here, using two independent longitudinal genetically informative samples, we examine the joint development of personality traits and attitude dimensions to explore the underlying causal mechanisms that drive the relationship between these features and provide a first step in resolving the causal question. We find change in personality over a ten-year period does not predict change in political attitudes, which does not support a causal relationship between personality traits and political attitudes as is frequently assumed. Rather, political attitudes are often more stable than the key personality traits assumed to be predicting them. Finally, the results from our genetic models find that no additional variance is accounted for by the causal pathway from personality traits to political attitudes. Our findings remain consistent with the original construction of the five-factor model of personality and developmental theories on attitude formation, but challenge recent work in this area.

  5. Political attitudes develop independently of personality traits.

    Directory of Open Access Journals (Sweden)

    Peter K Hatemi

    Full Text Available The primary assumption within the recent personality and political orientations literature is that personality traits cause people to develop political attitudes. In contrast, research relying on traditional psychological and developmental theories suggests the relationship between most personality dimensions and political orientations are either not significant or weak. Research from behavioral genetics suggests the covariance between personality and political preferences is not causal, but due to a common, latent genetic factor that mutually influences both. The contradictory assumptions and findings from these research streams have yet to be resolved. This is in part due to the reliance on cross-sectional data and the lack of longitudinal genetically informative data. Here, using two independent longitudinal genetically informative samples, we examine the joint development of personality traits and attitude dimensions to explore the underlying causal mechanisms that drive the relationship between these features and provide a first step in resolving the causal question. We find change in personality over a ten-year period does not predict change in political attitudes, which does not support a causal relationship between personality traits and political attitudes as is frequently assumed. Rather, political attitudes are often more stable than the key personality traits assumed to be predicting them. Finally, the results from our genetic models find that no additional variance is accounted for by the causal pathway from personality traits to political attitudes. Our findings remain consistent with the original construction of the five-factor model of personality and developmental theories on attitude formation, but challenge recent work in this area.

  6. Political Attitudes Develop Independently of Personality Traits

    Science.gov (United States)

    Hatemi, Peter K.; Verhulst, Brad

    2015-01-01

    The primary assumption within the recent personality and political orientations literature is that personality traits cause people to develop political attitudes. In contrast, research relying on traditional psychological and developmental theories suggests the relationship between most personality dimensions and political orientations are either not significant or weak. Research from behavioral genetics suggests the covariance between personality and political preferences is not causal, but due to a common, latent genetic factor that mutually influences both. The contradictory assumptions and findings from these research streams have yet to be resolved. This is in part due to the reliance on cross-sectional data and the lack of longitudinal genetically informative data. Here, using two independent longitudinal genetically informative samples, we examine the joint development of personality traits and attitude dimensions to explore the underlying causal mechanisms that drive the relationship between these features and provide a first step in resolving the causal question. We find change in personality over a ten-year period does not predict change in political attitudes, which does not support a causal relationship between personality traits and political attitudes as is frequently assumed. Rather, political attitudes are often more stable than the key personality traits assumed to be predicting them. Finally, the results from our genetic models find that no additional variance is accounted for by the causal pathway from personality traits to political attitudes. Our findings remain consistent with the original construction of the five-factor model of personality and developmental theories on attitude formation, but challenge recent work in this area. PMID:25734580

  7. Refractory lymphedema of the hand: an unusual presentation of recurrent herpes simplex virus infection

    Directory of Open Access Journals (Sweden)

    Ali Majdzadeh

    2016-07-01

    Full Text Available Introduction: Herpes Simplex Virus (HSV infection of the hand resulting in lymphatic complications such as lymphangitis and lymphedema is exceedingly uncommon. Although these complications typically resolve in 21 days, they can be persistent and may not resolve even with antiviral use, thereby mimicking dyshidrotic eczema or a bacterial event and often being misdiagnosed and inappropriately treated as such. We report a case of frequently recurring HSV infection of the hand over a long period of time resulting in refractory lymphedema which did not resolve with antiviral treatment. We further endeavor to raise awareness about this highly unusual presentation of HSV infection. A comprehensive review of the literature was conducted for similar cases using PubMed and Medline. Case Report: This is the first reported case with nearly a decade-long interval between the onset of primary HSV infection and the development of chronic lymphedema. Although valacyclovir significantly reduced the episodic aggravation of the lymphedema, it did not entirely resolve it. Similar cases of persistent lymphedema also included a long history of untreated and recurrent HSV infection of the hand, suggesting that this lymphatic outcome may be circumvented by prompt treatment with antivirals. Conclusion: This case report not only presents a highly uncommon lymphatic manifestation and unusual timeline of exacerbation of the very common HSV infection, but also highlights the importance and benefits of early initiation of antiviral therapy and the prevention of reactivation.

  8. Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.

    Science.gov (United States)

    Brorson, Håkan; Hansson, Emma; Jense, Erik; Freccero, Carolin

    2012-06-01

    The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(®) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage.

  9. Assessing local tissue edema in postmastectomy lymphedema.

    Science.gov (United States)

    Mayrovitz, H N

    2007-06-01

    Overall limb lymphedema can be assessed by several methods but none are suitable to determine local edema. Quantifying local edema could provide important information not previously available. Our goal was to determine the suitability of using the tissue dielectric constant (TDC) as and index of local tissue water to detect and quantify edema in postmastectomy patients with unilateral arm lymphedema. Segmental arm volume and TDC were measured in both arms of 18 women with unilateral lymphedema, and in 15 premenopausal and 15 postmenopausal controls. TDC was measured at a frequency of 300 MHz using open-ended coaxial probes with effective measuring depths of 0.5, 1.5, 2.5 and 5.0 mm. For patients and controls, absolute TDC depended on measurement depth but for any depth the TDC of lymphedematous segments was significantly greater than for non-affected contralateral arms (pTDC ratio between arms for patients was 1.64+/-0.30 vs.1.04+/-0.04 for both control groups (pTDC ratio was as low as 1.2 and no control subject's TDC ratio was as great as 1.2. Results suggest that this method is a good quantitative discriminator of the presence of lymphedema in patients with unilateral limb lymphedema.

  10. Systematic review: conservative treatments for secondary lymphedema

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    Oremus Mark

    2012-01-01

    Full Text Available Abstract Background Several conservative (i.e., nonpharmacologic, nonsurgical treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare ( Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.

  11. Multidisciplinary Approaches to the Management of Breast-Cancer-Related Lymphedema

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    Solmaz Fakhari

    2013-07-01

    Full Text Available Breast-cancer-related lymphedema is a significant morbidity mostly observed following primary treatments for breast cancer (surgery, radiation, and chemotherapy (1. Multiple complications might accompany lymphedema including cosmetic deformity, psychological disorders, consistent pain, and consequently decreased quality of life. Treatment  mostly focuses on reducing edema and its subsequent pain; however, no definite treatment has been hitherto introduced (2. Surgical approaches in the management of lymphedema are efficient including physiologic methods (e.g. flap interposition, lymph transfer, and lymphatic bypass and reductive techniques (e.g. liposuction (3. While the former mostly targets at reducing lymphedema through restoring lymphatic drainage, the latter aims at removing fibrofatty tissues which contribute to lymph stasis. Microsurgical variation of lymphatic bypass has gained popularity, in which the accumulated lymph in the lymphedematous limb is redirected. Non-surgical approaches are also practiced in most cases. Comprehensive decongestive therapy, consisting of skin care, exercise, special bandaging and massage, is the most frequently used non-surgical approach efficacy of which could be enhanced in combination with self-management strategies (4. Recently newer techniques have been introduced to tackle lymphedema and its associated pain. Manual lymph drainage, stellate ganglion block, acupuncture, deep oscillation, and pneumatic compression have been efficiently used in several studies. Moreover, significant short-term progress has been reported following other modalities such as low-level laser therapy (5. The complexity of breast-cancer-related lymphedema and its complications necessitates a multidisciplinary approach with the primary goal of easing the burden of the disease on the breast cancer patients. In addition, developing special guidelines encompassing these multidisciplinary approaches and providing educational and

  12. Risk assessment of dermatolymphangioadenitis by lymphoscintigraphy in patients with lower extremity lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Young; Hwang, Ji Hye; Park, Jung Mi; Lee, Kyung Han; Kim, Sang Eun; Kim, Dong Ik; Lee, Byung Boong; Kim, Byung Tae [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    1999-02-01

    Dermatolymphangioadenitis (DLA) is a common and serious complication of lymphedema which deteriorates lymphatic function. The purpose of this study was to assess the risk of DLA by lymphoscintigraphy in patients with lower extremity lymphedema. The subjects were 59 edematous lower extremities of 50 patients without previous episode of DLA and 12 lower extremities of 6 controls. Whole body images were acquired 1 min and 2 hr after subcutaneous injection of 37 MBq of Tc-99m-antimony sulfide colloid into interdigital spaces of both feet before therapy for lymphedema. The lymphoscintigrapic and clinical variables were compared between groups with or without occurrence of DLA during clinical follow up. There were 20 episodes of DLA in 12 extremities during clinical follow-up (19{+-}6 months). On univariate analysis, there were significant differences in ilioinguinal lymph node uptake, uptake pattern of main lymphatic vessel, clinical stage and therapy compliance between the two groups. After multivariate analysis, only the uptake pattern of main lymphatic vessel and therapy compliance were confirmed to be independent variables. In other words, non-visualized main lymphatic vessel and poor compliance to therapy were more frequent in extremities with subsequent occurrence of DLA. Lymphoscintigraphy can be used to predict the risk of DLA and may thus be helpful for determining the initial therapeutic plan in patients with lower extremity lymphedema.

  13. Center Independent Research & Developments: JPL IRAD Program

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    National Aeronautics and Space Administration — Innovative projects are sought in the areas of basic research, fundamental research, applied research, development and systems and other concept formulation studies....

  14. Filarial lymphedema is characterized by antigen-specific Th1 and th17 proinflammatory responses and a lack of regulatory T cells.

    Directory of Open Access Journals (Sweden)

    Subash Babu

    Full Text Available Lymphatic filariasis can be associated with development of serious pathology in the form of lymphedema, hydrocele, and elephantiasis in a subset of infected patients.To elucidate the role of CD4(+ T cell subsets in the development of lymphatic pathology, we examined specific sets of cytokines in individuals with filarial lymphedema in response to parasite antigen (BmA and compared them with responses from asymptomatic infected individuals. We also examined expression patterns of Toll-like receptors (TLR1-10 and Nod-like receptors (Nod1, Nod2, and NALP3 in response to BmA. BmA induced significantly higher production of Th1-type cytokines-IFN-gamma and TNF-alpha-in patients with lymphedema compared with asymptomatic individuals. Notably, expression of the Th17 family of cytokines-IL-17A, IL-17F, IL-21, and IL-23-was also significantly upregulated by BmA stimulation in lymphedema patients. In contrast, expression of Foxp3, GITR, TGFbeta, and CTLA-4, known to be expressed by regulatory T cells, was significantly impaired in patients with lymphedema. BmA also induced significantly higher expression of TLR2, 4, 7, and 9 as well Nod1 and 2 mRNA in patients with lymphedema compared with asymptomatic controls.Our findings implicate increased Th1/Th17 responses and decreased regulatory T cells as well as regulation of Toll- and Nod-like receptors in pathogenesis of filarial lymphedema.

  15. Center Independent Research & Developments: JSC IRAD Program

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    National Aeronautics and Space Administration — JSC provides and applies its preeminent capabilities in science and technology to develop, operate, and integrate human exploration missions.  The center...

  16. With Lymphedema, Early Treatment is Key | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Lymphedema With Lymphedema, Early Treatment is Key Past Issues / Fall 2016 Table of Contents You may notice symptoms of lymphedema at the part of your body where you ...

  17. Yoga protocol for treatment of breast cancer-related lymphedema

    Science.gov (United States)

    Narahari, SR; Aggithaya, Madhur Guruprasad; Thernoe, Liselotte; Bose, Kuthaje S; Ryan, Terence J

    2016-01-01

    Introduction: Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL). Methods: The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL. Results: Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain. Discussion: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL

  18. Interleukin-8 reduces post-surgical lymphedema formation by promoting lymphatic vessel regeneration.

    Science.gov (United States)

    Choi, Inho; Lee, Yong Suk; Chung, Hee Kyoung; Choi, Dongwon; Ecoiffier, Tatiana; Lee, Ha Neul; Kim, Kyu Eui; Lee, Sunju; Park, Eun Kyung; Maeng, Yong Sun; Kim, Nam Yun; Ladner, Robert D; Petasis, Nicos A; Koh, Chester J; Chen, Lu; Lenz, Heinz-Josef; Hong, Young-Kwon

    2013-01-01

    Lymphedema is mainly caused by lymphatic obstruction and manifested as tissue swelling, often in the arms and legs. Lymphedema is one of the most common post-surgical complications in breast cancer patients and presents a painful and disfiguring chronic illness that has few treatment options. Here, we evaluated the therapeutic potential of interleukin (IL)-8 in lymphatic regeneration independent of its pro-inflammatory activity. We found that IL-8 promoted proliferation, tube formation, and migration of lymphatic endothelial cells (LECs) without activating the VEGF signaling. Additionally, IL-8 suppressed the major cell cycle inhibitor CDKN1C/p57(KIP2) by downregulating its positive regulator PROX1, which is known as the master regulator of LEC-differentiation. Animal-based studies such as matrigel plug and cornea micropocket assays demonstrated potent efficacy of IL-8 in activating lymphangiogenesis in vivo. Moreover, we have generated a novel transgenic mouse model (K14-hIL8) that expresses human IL-8 in the skin and then crossed with lymphatic-specific fluorescent (Prox1-GFP) mouse. The resulting double transgenic mice showed that a stable expression of IL-8 could promote embryonic lymphangiogenesis. Moreover, an immunodeficient IL-8-expressing mouse line that was established by crossing K14-hIL8 mice with athymic nude mice displayed an enhanced tumor-associated lymphangiogenesis. Finally, when experimental lymphedema was introduced, K14-hIL8 mice showed an improved amelioration of lymphedema with an increased lymphatic regeneration. Together, we report that IL-8 can activate lymphangiogenesis in vitro and in vivo with a therapeutic efficacy in post-surgical lymphedema.

  19. Hereditary Lymphedema of the Leg – A Case Report

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    Birgit Heinig

    2017-07-01

    Full Text Available Primary of hereditary lymphedema is a rare but progressive disease. It is yet not curable. We present a 48-year-old male patient with hereditary lymphedema of his left leg, that was realised by minor trauma (able twist when he was seven years old. He had never been treated for lymphedema but experienced multiple erysipelas during his life. After diagnostic procedures to exclude other causes of leg swelling, the diagnosis of hereditary lymphedema of the leg, stage III was confirmed. We initialized complex decongestive therapy. During two weeks of intensive treatment, the circumference of the left leg could be reduced by 10 cm. This case illustrates the "natural course" hereditary lymphedema. But it raises the hope that even after decades of ignorance, the patients benefits from complex decongestive treatment. Therapeutic nihilism is unnecessary and poses lymphedema patients to risks of infection and secondary malignancies like Stewart-Trewes syndrome.

  20. Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: a prospective cohort study

    Science.gov (United States)

    Miller, Cynthia L.; Colwell, Amy S.; Horick, Nora; Skolny, Melissa N.; Jammallo, Lauren S.; O’Toole, Jean A.; Shenouda, Mina N.; Sadek, Betro T.; Swaroop, Meyha N.; Ferguson, Chantal M.; Smith, Barbara L.; Specht, Michelle C.; Taghian, Alphonse G.

    2015-01-01

    STRUCTURED ABSTRACT Objective We sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone. Background Immediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema. Methods 616 breast cancer patients who underwent 891 mastectomies between 2005–2013 were prospectively screened for lymphedema at our institution, with 22.2 months median follow-up. Mastectomies were categorized as immediate implant, immediate autologous, or no reconstruction. Arm measurements were performed pre-operatively and during post-operative follow-up using a Perometer. Lymphedema was defined as ≥10% arm volume increase compared to pre-operative. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors. Results Of 891 mastectomies, 65% (580/891) had immediate implant, 11% (101/891) immediate autologous, and 24% (210/891) no reconstruction. The two-year cumulative incidence of lymphedema was: 4.08% (95% CI: 2.59–6.41%) implant, 9.89% (95% CI: 4.98–19.1%) autologous, and 26.7% (95% CI: 20.4–34.4%) no reconstruction. By multivariate analysis, immediate implant (HR: 0.352, plymphedema compared to no reconstruction. Axillary lymph node dissection (plymphedema risk. Conclusion This prospective study suggests that in patients for whom implant-based reconstruction is available, immediate implant reconstruction does not increase the risk of lymphedema compared to mastectomy alone. PMID:25607768

  1. Sentinel Lymph Node Biopsy: Quantification of Lymphedema Risk Reduction

    Science.gov (United States)

    2006-10-01

    Quantification of Lymphedema Risk Reduction PRINCIPAL INVESTIGATOR: Andrea L. Cheville, M.D. CONTRACTING ORGANIZATION: University of...Biopsy: Quantification of Lymphedema Risk Reduction 5b. GRANT NUMBER DAMD17-00-1-0649 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Andrea L. Cheville...Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema is a common complication of primary breast cancer therapy. It

  2. Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?

    OpenAIRE

    Rucigaj, Tanja Planinsek; Leskovec, Nada Kecelj; Zunter*, Vesna Tlaker

    2010-01-01

    Introduction Secondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients’ mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage. Patients and methods We performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Me...

  3. Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?:

    OpenAIRE

    Rucigaj, Tanja Planinsek; Leskovec, Nada Kecelj; Zunter*, Vesna Tlaker

    2010-01-01

    Introduction Secondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients’ mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage. Patients and methods We performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Me...

  4. Adaptive Immune Responses Regulate the Pathophysiology of Lymphedema

    Science.gov (United States)

    2012-09-01

    Pathophysiology of Lymphedema PRINCIPAL INVESTIGATOR: Jamie Zampell, M.D. CONTRACTING ORGANIZATION: Sloan-Kettering Institute for...Immune Responses Regulate the Pathophysiology of Lymphedema 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11-1-0495 5c. PROGRAM ELEMENT... Lymphedema is a debilitating disorder affecting as many as 1 in 8 cancer survivors. Despite wide prevalence, limited understanding of disease

  5. [Secondary lymphedema--the importance of a multidisciplinary team approach].

    Science.gov (United States)

    Heldenberg, Eitan; Bass, Arie

    2013-03-01

    Secondary lymphedema is the most common type of lymphedema. Malignancy, mainly breast carcinoma, is the main cause of upper extremity lymphedema, while groin dissection, irradiation and trauma are the cause of lower extremity lymphedema. Early recognition of the pathology followed by early referral to a vascular surgeon, leading a multidisciplinary team, who takes care of those patients, can prevent a miserable Life from these patients. Lifelong commitment of the patients, prolonged financial support of the health insurance supplier, as well as team work of the group taking care of the patient, is the only way to help these patients.

  6. Primary Upper Limb Lymphedema: Case Report of a Rare Pathology

    Science.gov (United States)

    McFarlane, Michael EC

    2017-01-01

    Introduction Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that arise after age 35 years are described as lymphedema tarda. The great majority of patients with lymphedema have swelling of the lower limbs—upper limb lymphedema is a rare disorder. Case Presentation An 84-year-old woman presented with a 3-year history of unilateral swelling of the right upper limb. There were no constitutional symptoms and no evidence of lymphadenopathy or systemic disease. Blood tests, carcinoembryonic antigen test, computed tomography scans, and venous Doppler ultrasound were all normal. The diagnosis was primary upper limb lymphedema. Discussion The swelling that occurs in upper limb lymphedema is permanent and usually extends to the hand. About one-third of patients with this condition also present with lower limb lymphedema. Thorough investigations are warranted in cases of unilateral upper limb lymphedema to rule out occult malignancy and systemic disease. PMID:28080951

  7. Diabetic foot ulcers in conjunction with lower limb lymphedema: pathophysiology and treatment procedures

    Directory of Open Access Journals (Sweden)

    Kanapathy M

    2015-08-01

    Full Text Available Muholan Kanapathy,1 Mark J Portou,1,2 Janice Tsui,1,2 Toby Richards1,21Division of Surgery and Interventional Science, University College London, 2Department of Vascular Surgery, Royal Free London NHS Foundation Trust Hospital, London, UKAbstract: Diabetic foot ulcers (DFUs are complex, chronic, and progressive wounds, and have a significant impact on morbidity, mortality, and quality of life. A particular aspect of DFU that has not been reviewed extensively thus far is its management in conjunction with peripheral limb edema. Peripheral limb edema is a feature of diabetes that has been identified as a significant risk factor for amputation in patients with DFU. Three major etiological factors in development of lymphedema with concurrent DFU are diabetic microangiopathy, failure of autonomic regulation, and recurrent infection. This review outlines the pathophysiology of lymphedema formation in patients with DFU and highlights the cellular and immune components of impaired wound healing in lymphedematous DFU. We then discuss the principles of management of DFU in conjunction with lymphedema.Keywords: diabetic foot ulcer, lymphedema, chronic wound, wound management

  8. Low-level laser therapy in secondary lymphedema after breast cancer: systematic review.

    Science.gov (United States)

    E Lima, Mariana Toledo Biscaia Raposo Mourão; E Lima, Januário Gomes Mourão; de Andrade, Mauro Figueiredo Carvalho; Bergmann, Anke

    2014-05-01

    Complex physical therapy is the main treatment for the secondary lymphedema after breast cancer. The low-level laser therapy (LLLT) has been used in order to stimulate lymphangiogenesis, encourage lymphatic motility, and reduce lymphostatic fibrosis. However, these factors could also favor the development of recurrence and metastasis. The objective of this study is to discuss the use of LLLT in the treatment of lymphedema after breast cancer. This study utilized a systematic review on the use of LLLT in the treatment of lymphedema after breast cancer. Evaluating quality of articles was conducted through the PEDro scale. Of the 41 articles identified, four were considered to be of high methodological quality (score ≥ 5). The low-level laser in the axillary region was performed in all studies. The control group was not similar across studies. The results presented showed that there was a reduction in limb volume in the group subjected to low-power laser when compared with other treatments. No studies have evaluated the risk of metastasis or relapse in the irradiated areas. Because no studies have included the complex physical therapy as the comparison group, we cannot claim that laser treatment is the best efficacy or effectiveness in lymphedema treatment after breast cancer. No studies have evaluated the hypothesis that the LLLT can increase the risk of recurrence or metastasis. Therefore, the questions about the safety of this procedure in cancer patients remain.

  9. Arm lymphedema after treatment of breast cancer: Etiology, diagnosis, and management

    Directory of Open Access Journals (Sweden)

    Ashish Goel

    2015-01-01

    Full Text Available Breast cancer related lymphedema (BCRL is a chronic debilitating condition seen after treatment of breast cancer. The overall incidence varies from 20% to 56% in all patients treated for breast cancer. Every patient is at a lifelong risk for BCRL and the risk goes on increasing as the followup period increases. Locoregional treatment including surgery or radiotherapy is the most common risk factor for development of arm lymphedema. There are two phases of arm lymphedema. There is increased fluid accumulation in the fluid phase of lymphedema which later on goes into the solid phase where fat and fibrotic tissue is deposited in the subcutaneous tissue. The treatment of BCRL is a challenge both for the patient and the treating surgeon and it needs multidisciplinary team work to be successful. Non-surgical treatment modalities include complete decongestive therapy (CDT and pneumatic compression therapy. Surgery for BCRL is usually undertaken as a salvage modality after failure of conservative approaches. The surgical spectrum for BCRL varies from extensive excisional operations which were commonly done in the past to newer methods like suction assisted protein lipectomy, lymphatic reconstruction and vascular lymph node transfer (VLNT using super-microsurgical techniques. There is no consensus regarding the preference of one procedure over other due to lack of randomised control trials. It is however suggested to do lymphovenous anastomosis and complete decongestive therapy for early cases in fluid phase; while patients in the solid phase may be treated with a combination of liposuction with CDT or VLNT alone.

  10. The Health Deviation of Post-Breast Cancer Lymphedema: Symptom Assessment and Impact on Self-Care Agency.

    Science.gov (United States)

    Armer, Jane M; Henggeler, Mary H; Brooks, Constance W; Zagar, Eris A; Homan, Sherri; Stewart, Bob R

    2008-01-01

    Breast cancer is the leading cancer among women world-wide, affecting 1 of 8 women during their lifetimes. In the US alone, some 2 million breast cancer survivors comprise 20% of all cancer survivors. Conservatively, it is estimated that some 20-40% of all breast cancer survivors will develop the health deviation of lymphedema or treatment-related limb swelling over their lifetimes. This chronic accumulation of protein-rich fluid predisposes to infection, leads to difficulties in fitting clothing and carrying out activities of daily living, and impacts self-esteem, self-concept, and quality of life. Lymphedema is associated with self-care deficits (SCD) and negatively impacts self-care agency (SCA) and physiological and psychosocial well-being. Objectives of this report are two-fold: (1) to explore four approaches of assessing and diagnosing breast cancer lymphedema, including self-report of symptoms and the impact of health deviations on SCA; and (2) to propose the development of a clinical research program for lymphedema based on the concepts of Self-Care Deficit Nursing Theory (SCDNT). Anthropometric and symptom data from a National-Institutes-of-Health-funded prospective longitudinal study were examined using survival analysis to compare four definitions of lymphedema over 24 months post-breast cancer surgery among 140 of 300 participants (all who had passed the 24-month measurement). The four definitions included differences of 200 ml, 10% volume, and 2 cm circumference between pre-op baseline and/or contralateral limbs, and symptom self-report of limb heaviness and swelling. Symptoms, SCA, and SCD were assessed by interviews using a validated tool. Estimates of lymphedema occurrence varied by definition and time since surgery. The 2 cm girth change provided the highest estimation of lymphedema (82% at 24 months), followed by 200 ml volume change (57% at 24 months). The 10% limb volume change converged with symptom report of heaviness and swelling at 24 months

  11. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    Directory of Open Access Journals (Sweden)

    Iwona Malicka

    2014-09-01

    Full Text Available Introduction : Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT. Aim of the study : The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods: The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results : A significant reduction in the extent of lymphedema (p = 0.0009 was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36. Conclusions : Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods.

  12. Impact of platelet rich plasma and adipose stem cells on lymphangiogenesis in a murine tail lymphedema model.

    Science.gov (United States)

    Ackermann, Maximilian; Wettstein, Reto; Senaldi, Christopher; Kalbermatten, Daniel F; Konerding, Moritz A; Raffoul, Wassim; Erba, Paolo

    2015-11-01

    Lymphedema is an underdiagnosed pathology which in industrialized countries mainly affects cancer patients that underwent lymph node dissection and/or radiation. Currently no effective therapy is available so that patients' life quality is compromised by swellings of the concerned body region. This unfortunate condition is associated with body imbalance and subsequent osteochondral deformations and impaired function as well as with an increased risk of potentially life threatening soft tissue infections. The effects of PRP and ASC on angiogenesis (anti-CD31 staining), microcirculation (Laser Doppler Imaging), lymphangiogenesis (anti-LYVE1 staining), microvascular architecture (corrosion casting) and wound healing (digital planimetry) are studied in a murine tail lymphedema model. Wounds treated by PRP and ASC healed faster and showed a significantly increased epithelialization mainly from the proximal wound margin. The application of PRP induced a significantly increased lymphangiogenesis while the application of ASC did not induce any significant change in this regard. PRP and ASC affect lymphangiogenesis and lymphedema development and might represent a promising approach to improve regeneration of lymphatic vessels, restore disrupted lymphatic circulation and treat or prevent lymphedema alone or in combination with currently available lymphedema therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report.

    Science.gov (United States)

    Taradaj, Jakub; Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-03-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment) is recognised as the best practice in lymphedema management. Kinesio taping (KT) for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging). During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods.

  14. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    Science.gov (United States)

    Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-01-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment) is recognised as the best practice in lymphedema management. Kinesio taping (KT) for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging). During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods. PMID:26327833

  15. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study.

    Science.gov (United States)

    Malicka, Iwona; Rosseger, Agnieszka; Hanuszkiewicz, Justyna; Woźniewski, Marek

    2014-09-01

    Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36). Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods.

  16. A case of fatal necrotizing fasciitis arising from chronic lymphedema.

    Science.gov (United States)

    Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin

    2013-12-01

    Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

  17. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

    OpenAIRE

    Tiwari, Pankaj; Coriddi, Michelle; Salani, Ritu; Povoski, Stephen P

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical ...

  18. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

    OpenAIRE

    Tiwari, Pankaj; Coriddi, Michelle; Salani, Ritu; Povoski, Stephen P

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical ...

  19. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

    Science.gov (United States)

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation. PMID:24053624

  20. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema: A prospective study of 100 consecutive cases.

    Science.gov (United States)

    Mardonado, Andres A; Chen, Ru; Chang, David W

    2017-01-01

    Vascularized lymph node transfer (VLNT) is gaining popularity for treatment of lymphedema. The purpose of this study was to evaluate the flap and the donor site morbidity of the supraclavicular (SC) VLNT. A review of a prospective database was performed for patients who had undergone SC VLNT to treat upper or lower extremity lymphedema. Flap and donor site complications were registered for each patient. A detailed technical surgical approach is explained. One hundred consecutive patients with lower or upper extremity lymphedema underwent SC VLNT (84% from the right side) with a mean of 11-months follow-up (range 3-19 months). There were no flap loss but three flaps (3%) required re-exploration due to venous congestion of the skin paddle. Two patients had local infection and three patients developed chyle leak (3%) at the donor site but resolved spontaneously. No donor site secondary lymphedema was noted. This is the largest prospective series of SC free flap VLNT for treatment of lymphedema. Low flap and donor site morbidity makes this flap an appealing source of lymph node transfer for lymphedema treatment. J. Surg. Oncol. 2017;115:68-71. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Collection Development in Practice in an Independent School.

    Science.gov (United States)

    Altan, Susan

    1982-01-01

    Discusses collection development practices employed at two media centers of the Columbus School for Girls, an independent day school serving 605 students in grades K-12. Concepts highlighted are: philosophy of collection development, knowledge of school curriculum, interaction with faculty, familiarity with current and retrospective selection…

  2. Self-reported information sources and perceived knowledge in individuals with lymphedema.

    Science.gov (United States)

    Deng, J; Fu, M R; Armer, J M; Cormier, J N; Radina, E; Thiadens, S R J; Dietrich, M S; Weiss, J; Tuppo, C M; Ridner, S H

    2013-12-01

    Currently, a limited number of studies have been conducted that examine sources of information and knowledge level in individuals with lymphedema. This study aimed (1) to examine self-reported information sources and perceived lymphedema knowledge among individuals with lymphedema; and (2) to examine differences in self-reported information sources and perceived lymphedema knowledge among individuals with primary or secondary lymphedema; and with upper or lower extremity lymphedema. The National Lymphedema Network (NLN) conducted a survey to collect self-report data from March 2006 to January 2010. Overall, participants preferred a variety of sources of information. Participants reported low levels of knowledge about the types of lymphedema, treatment approaches and methods, and self-administrated therapies. In comparison to participants with secondary or upper extremity lymphedema, participants with primary or lower extremity lymphedema reported lower knowledge level regarding causes of lymphedema, risks for and complications of lymphedema, treatment approaches and methods for lymphedema, and self-administered therapies. Opportunities exist to expand lymphedema information sources. Healthcare professionals should focus on delivering high quality information about treatment and self-care management to individuals with lymphedema.

  3. Architecture independent environment for developing engineering software on MIMD computers

    Science.gov (United States)

    Valimohamed, Karim A.; Lopez, L. A.

    1990-01-01

    Engineers are constantly faced with solving problems of increasing complexity and detail. Multiple Instruction stream Multiple Data stream (MIMD) computers have been developed to overcome the performance limitations of serial computers. The hardware architectures of MIMD computers vary considerably and are much more sophisticated than serial computers. Developing large scale software for a variety of MIMD computers is difficult and expensive. There is a need to provide tools that facilitate programming these machines. First, the issues that must be considered to develop those tools are examined. The two main areas of concern were architecture independence and data management. Architecture independent software facilitates software portability and improves the longevity and utility of the software product. It provides some form of insurance for the investment of time and effort that goes into developing the software. The management of data is a crucial aspect of solving large engineering problems. It must be considered in light of the new hardware organizations that are available. Second, the functional design and implementation of a software environment that facilitates developing architecture independent software for large engineering applications are described. The topics of discussion include: a description of the model that supports the development of architecture independent software; identifying and exploiting concurrency within the application program; data coherence; engineering data base and memory management.

  4. Virology: Independent virus development outside a host

    DEFF Research Database (Denmark)

    Häring, M.; Vestergaard, Gisle Alberg; Rachel, R.

    2005-01-01

    Viruses are thought to be functionally inactive once they are outside and independent of their host cell 1 . Here we describe an exceptional property of a newly discovered virus that infects a hyperthermophilic archaeon growing in acidic hot springs: the lemon-shaped viral particle develops a very...

  5. The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Stocks, Meredith E; Freeman, Matthew C; Addiss, David G

    2015-10-01

    Lymphedema of the leg and its advanced form, known as elephantiasis, are significant causes of disability and morbidity in areas endemic for lymphatic filariasis (LF), with an estimated 14 million persons affected worldwide. The twin goals of the World Health Organization's Global Program to Eliminate Lymphatic Filariasis include interrupting transmission of the parasitic worms that cause LF and providing care to persons who suffer from its clinical manifestations, including lymphedema-so-called morbidity management and disability prevention (MMDP). Scaling up of MMDP has been slow, in part because of a lack of consensus about the effectiveness of recommended hygiene-based interventions for clinical lymphedema. We conducted a systemic review and meta-analyses to estimate the effectiveness of hygiene-based interventions on LF-related lymphedema. We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through March 23, 2015 with no restriction on year of publication. Studies were eligible for inclusion if they (1) were conducted in an area endemic for LF, (2) involved hygiene-based interventions to manage lymphedema, and (3) assessed lymphedema-related morbidity. For clinical outcomes for which three or more studies assessed comparable interventions for lymphedema, we conducted random-effects meta-analyses. Twenty-two studies met the inclusion criteria and two meta-analyses were possible. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. Participation in hygiene-based lymphedema management was associated with a lower incidence of acute dermatolymphagioadenitis (ADLA), (Odds Ratio 0.32, 95% CI 0.25-0.40), as well as with a decreased percentage of patients reporting at least one episode of ADLA during follow-up (OR 0.29, 95% CI 0.12-0.47). Limitations included high heterogeneity across studies

  6. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study

    NARCIS (Netherlands)

    P.B. Viehoff (Peter); F. Potijk; R.J. Damstra (Robert); Y.F. Heerkens (Yvonne); C.D. van Ravensberg (Dorine); D.M. Van Berkel; H.A.M. Neumann (Martino)

    2015-01-01

    textabstractBackground. To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for

  7. Prospective Lymphedema Surveillance in a Clinic Setting

    Directory of Open Access Journals (Sweden)

    Janet Chance-Hetzler

    2015-08-01

    Full Text Available The potential impact of breast cancer-related lymphedema (LE is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1 time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ; (2 referral to LE management with limb volume increase (LVI and/or LBCQ symptoms; and (3 cost of LE management at lower LVI (≥5%–≤10% versus traditional (≥10%. Findings revealed a visit timeframe mean of 40.3 min (range = 25–60; 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9–18.9. LBCQ symptoms and LVI were significantly (p < 0.001 correlated to LE referral; six of the nine patients referred (67% displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings.

  8. Acute Truncal Lymphedema Secondary to Axillary Metastatic Melanoma Presenting Like Cellulitis

    Science.gov (United States)

    Kong, Benjamin Y.; Chou, Shaun; Wakade, Deepal; Carlino, Matteo S.; Fernandez-Penas, Pablo

    2017-01-01

    There are reported cases of diphencyprone used in treating cutaneous metastases of melanoma. Here, we report a patient with previous primary melanoma on his left back treated with surgical excision and lymphadenectomy, followed by radiotherapy for the recurrent tumor on the primary site. Despite radiotherapy and treatment with dabrafenib and trametinib, in-transit metastases have developed and topical diphencyprone was applied to these metastases. Six weeks later, the patient developed fever and a spreading erythematous tender indurated plaque covering the left side of the body including axillae, back, and flank, clinically suggestive of cellulitis. Systemic antibiotic therapy did not improve the condition and a biopsy showed sparse lymphocytic infiltrate. With the diagnosis of possible acute lymphedema, a CT scan was requested that showed significant axillary lymph node metastasis. The fever was considered secondary to dabrafenib and trametinib therapy. This case highlights that, in patients with lymphadenectomy, atypical forms of lymphedema on the body may appear. Truncal lymphedema is an infrequent event. PMID:28182109

  9. Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

    Science.gov (United States)

    Ostby, Pamela L.; Armer, Jane M.; Dale, Paul S.; Van Loo, Margaret J.; Wilbanks, Cassie L.; Stewart, Bob R.

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

  10. Why Don’t We Develop Student Learning Independence?

    Institute of Scientific and Technical Information of China (English)

    陈春华

    2012-01-01

    One object of the current round of reforms to the English curriculum is to develop students’ positive attitudes,thinking skills,practical abilities,cultural awareness and autonomy through the language learning process.In this article the writer mentions the present real situation since the reforms in this aspect,reflects her own understanding of student learning independence and offers some possible practical ways to solve this problem.

  11. Lymphedema: What Every Woman with Breast Cancer Should Know

    Science.gov (United States)

    ... Signs and symptoms of this problem include redness, warmth, fever, pain, and flu-like symptoms. This is ... covered. Mild lymphedema should be treated by a physical therapist or other health care professional who has ...

  12. Future Research Priorities for Morbidity Control of Lymphedema

    Science.gov (United States)

    Narahari, S R; Aggithaya, Madhur Guruprasad; Moffatt, Christine; Ryan, T J; Keeley, Vaughan; Vijaya, B; Rajendran, P; Karalam, S B; Rajagopala, S; Kumar, N K; Bose, K S; Sushma, K V

    2017-01-01

    Background: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. Methods: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients’ priorities. Results: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. Conclusion: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP. PMID:28216723

  13. Final program evaluation methods and results of a National Lymphedema Management Program in Togo, West Africa.

    Science.gov (United States)

    Ziperstein, Josh; Dorkenoo, Monique; Datagni, Michel; Drexler, Naomi; Murphy, Monica; Sodahlon, Yao; Mathieu, Els

    2014-06-01

    In order to eliminate Lymphatic Filariasis (LF) as a public health problem, the World Health Assembly recommends an approach which includes interruption of transmission of infection and the alleviation of morbidity. In 2000, the Togolese National Program to Eliminate Lymphatic Filariasis (PNELF) started the annual mass drug administrations and in 2007, the program added a morbidity component for the management of lymphedema. This manuscript describes the methods of an evaluation aimed at assessing the strengths and weaknesses of the Togolese National Lymphedema Morbidity Program. The evaluation was conducted through in-depth interviews with stakeholders at each programmatic level. Interviews focused on message dissemination, health provider training, patient self-care practices, social dynamics, and program impact. The evaluation demonstrated that the program strengths include the standardization and in-depth training of health staff, dissemination of the program's treatment message, a positive change in the community's perception of lymphedema, and successful patient recruitment and training in care techniques. The lessons learned from this evaluation helped to improve Togo's program, but may also provide guidance and strategies for other countries desiring to develop a morbidity program. The methods of program evaluation described in this paper can serve as a model for monitoring components of other decentralized national health programs in low resource settings.

  14. Lymphedema of the arm after surgery for breast cancer: new physiotherapy.

    Science.gov (United States)

    Marcos, A L; El Gaaied, A B Ammar; Ayed, F B; Hassen, S B; Zervoudis, S; Navrozoglou, I; Pechlivani, F; Iatrakis, G

    2012-01-01

    Secondary lymphedema of the upper limb is a complication which can be found in patients who have undergone surgical breast cancer treatment with an axillary dissection. Lymphedema following breast cancer treatment remains a long-term disabling complication which cannot be treated in a decisive and radical manner. The objective of the treatment is to limit complications, to try to preserve the remaining lymphatic system and to develop new anastomosis. It consists of a specific decongestive physiotherapy, which may include a specific lymphatic drainage and skin mobilization, reducing bandages including Mobiderm (Thuasne), and sub-bandage muscular exercises. However variations in the therapy have been recorded by different teams. Our experience in treating lymphedema in Tunisia takes into consideration the epidemiological, climatic, cultural and socio-economic conditions of the country. The difference in our treatment compared to what is being advocated elsewhere essentially consists of the no muscular exercise while wearing a bandage. This is compensated for by daily domestic activities, by prolonging the first two phases of treatment (the intensive phase and the stabilization phase), and by the use of the hydro gel dressing Hydrosob (Hartmann) to prevent blisters induced by the pressure imposed by Mobiderm studs of the bandage on the skin, and also by the superimposition of two types of Mobiderm bandages (small and large blocks).

  15. Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer.

    Science.gov (United States)

    Kim, Myungsoo; Shin, Kyung Hwan; Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Chung, Seung Hyun; Kim, Yeon-Joo; Kim, Tae Hyun; Cho, Kwan Ho

    2016-10-01

    The purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer. A total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next follow-up; arm swelling that persisted over two consecutive examinations was considered PLE. At a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors). One-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.

  16. Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests

    Directory of Open Access Journals (Sweden)

    Aladdin H. Hassanein, MD, MMSc

    2017-07-01

    Full Text Available Background:. Lymphedema is the chronic enlargement of tissue due to inadequate lymphatic function. Diagnosis is made by history and physical examination and confirmed with lymphoscintigraphy. The purpose of this study was to assess the accuracy of lymphoscintigraphy for the diagnosis of lymphedema and to determine characteristics of patients with false-negative tests. Methods:. Individuals referred to our lymphedema program with “lymphedema” between 2009 and 2016 were analyzed. Subjects were assessed by history, physical examination, and lymphoscintigraphy. Patient age at presentation, duration of lymphedema, location of disease, gender, previous infections, and lymphedema type were analyzed. Results:. The study included 227 patients (454 limbs; lymphedema was diagnosed clinically in 169 subjects and confirmed by lymphoscintigraphy in 162 (117 primary, 45 secondary; 96% sensitivity. Fifty-eight patients were thought to have a condition other than lymphedema, and all had negative lymphoscintigrams (100% specificity. A subgroup analysis of the 7 individuals with lymphedema clinically, but normal lymphoscintigrams, showed that all had primary lymphedema; duration of disease and infection history were not different between true-positive and false-negative lymphoscintigram results (P = 0.5. Two patients with a false-negative test underwent repeat lymphoscintigraphy, which then showed lymphatic dysfunction consistent with lymphedema. Conclusion:. Lymphoscintigraphy is very sensitive and specific for lymphedema. All patients with false-negative studies had primary lymphedema. A patient with a high clinical suspicion of lymphedema and a normal lymphoscintigram should be treated conservatively for the disease and undergo repeat lymphoscintigraphy.

  17. Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests

    Science.gov (United States)

    Hassanein, Aladdin H.; Maclellan, Reid A.; Grant, Frederick D.

    2017-01-01

    Background: Lymphedema is the chronic enlargement of tissue due to inadequate lymphatic function. Diagnosis is made by history and physical examination and confirmed with lymphoscintigraphy. The purpose of this study was to assess the accuracy of lymphoscintigraphy for the diagnosis of lymphedema and to determine characteristics of patients with false-negative tests. Methods: Individuals referred to our lymphedema program with “lymphedema” between 2009 and 2016 were analyzed. Subjects were assessed by history, physical examination, and lymphoscintigraphy. Patient age at presentation, duration of lymphedema, location of disease, gender, previous infections, and lymphedema type were analyzed. Results: The study included 227 patients (454 limbs); lymphedema was diagnosed clinically in 169 subjects and confirmed by lymphoscintigraphy in 162 (117 primary, 45 secondary; 96% sensitivity). Fifty-eight patients were thought to have a condition other than lymphedema, and all had negative lymphoscintigrams (100% specificity). A subgroup analysis of the 7 individuals with lymphedema clinically, but normal lymphoscintigrams, showed that all had primary lymphedema; duration of disease and infection history were not different between true-positive and false-negative lymphoscintigram results (P = 0.5). Two patients with a false-negative test underwent repeat lymphoscintigraphy, which then showed lymphatic dysfunction consistent with lymphedema. Conclusion: Lymphoscintigraphy is very sensitive and specific for lymphedema. All patients with false-negative studies had primary lymphedema. A patient with a high clinical suspicion of lymphedema and a normal lymphoscintigram should be treated conservatively for the disease and undergo repeat lymphoscintigraphy. PMID:28831342

  18. MR features in lymphedema and phlebedema of extremities

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jeong Hee; Moon, Tae Myung; Kim, Chang Soo; Chung, Chun Phil [Maryknoll Hospital, Pusan (Korea, Republic of)

    1994-10-15

    Authors analyzed the MR findings of swollen extremities to evaluate the MR features of lymphedema and phlebedema. We reviewed MR imagings of 17 cases of swollen extremities, including 12 lymphedemas and 5 phlebedemas. We obtained axial T1-, T2-, and Gd-DTPA enhanced T1WIs using 1.0 T superconducting magnet and measured cross-sectional areas of subcutaneous and subfascial tissues of a slice with grossly largest cross-sectional area using perimeter. We also analyzed change in the signal intensities of the subcutaneous and subfascial tissues on T2WI, presence of enhancement on Gd-PTDA enhanced T1WI, and presence of skin thickening. Both subcutaneous and subfascial tissues of swollen extremities were increased in the cross-sectional areas than those of contralateral normal side. The subcutaneous compartment in lymphedema was statistically significantly increased in cross-sectional area than subfascial compartment in lymphedema(p<0.005) and subcutaneous tissue in phlebedema (p<0.05). Increased signal intensities and characteristic 'honeycomb appearance' of subcutaneous tissue in the lymphedema were specific findings on T2WI. MR imaging was useful and noninvasive method in the diagnosis of swollen extremities. There were increased cross-sectional area of subcutaneous compartment with 'honeycomb appearance' in lymphedema and increased signal intensities of both subcutaneous and subfascial compartment in phlebedema on the T2WI.

  19. Prevalence of Arm Lymphedema among Patients with Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Radha Acharya Pandey

    2016-11-01

    Full Text Available Background & Objectives: Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. It is potentially debilitating condition in breast cancer survivors which negatively affects the quality of life. This study aims to assess the prevalence of arm lymphedema among patients with breast cancer surgery.Materials & Methods: A cross-sectional study was conducted to assess the prevalence of arm lymphedema among the women with breast cancer surgery. Purposive sampling technique was used to collect the data from a sample of 66 women of selected hospitals.  Data were collected through self constructed structured and semi structured interview based questionnaire which consisted socio demographic information and clinical related factors. Results: Among The overall prevalence of arm lymphedema was found to be seven (10.6% respondents among the study population. In this study, 41 (62.1% respondents were < 50 years of age, 13 (19.7% had education of secondary level, 27 (40.9% had received radiation therapy, 63 (95.5% had no history of infection, 54 (81.8% had undergone modified radical mastectomy, and 56 (84.8% had involved lymph node resection. Statistically no any significant association was found between these variables.Conclusion: On the basis of the findings, this conclusion has been drawn that prevalence of arm lymphedema among patients with breast cancer surgery was low (10.6%. Moreover no association was found between the prevalence of arm lymphedema, sociodemographic variables and clinical related factors.

  20. Developing independent investigators for clinical research relevant for Africa

    LENUS (Irish Health Repository)

    Manabe, Yukari C

    2011-12-29

    Abstract Sustainable research capacity building requires training individuals at multiple levels within a supportive institutional infrastructure to develop a critical mass of independent researchers. At many African medical institutions, a PhD is important for academic promotion and is, therefore, an important focal area for capacity building programs. We examine the training at the Infectious Diseases Institute (IDI) as a model for in-country training based on systems capacity building and attention to the academic environment. PhD training in Africa should provide a strong research foundation for individuals to perform independent, original research and to mentor others. Training the next generation of researchers within excellent indigenous academic centers of excellence with strong institutional infrastructure will empower trainees to ask regionally relevant research questions that will benefit Africans.

  1. Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

    Science.gov (United States)

    Mues, Katherine E.; Deming, Michael; Kleinbaum, David G.; Budge, Philip J.; Klein, Mitch; Leon, Juan S.; Prakash, Aishya; Rout, Jonathan; Fox, LeAnne M.

    2014-01-01

    Background Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. Methodology/Principal Findings A lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-valuelymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. Conclusions/Significance These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first

  2. Effect of complete decongestive therapy and home program on health- related quality of life in post mastectomy lymphedema patients.

    Science.gov (United States)

    Melam, Ganeswara Rao; Buragadda, Syamala; Alhusaini, Adel A; Arora, Nisha

    2016-05-04

    Secondary lymphedema is common in women treated for breast cancer. It may be a result of surgery or radiotherapy. Edema commonly affects the arm, leading to discomfort, reduced arm movements, pain and diminished quality of life. Therefore, the relationship between post mastectomy lymphedema and quality of life has evolved as an important criteria in treatment of breast cancer survivors. Sixty breast cancer survivors who developed post mastectomy lymphedema were recruited. Patients were divided into 2 groups (n = 30) according to the treatment they received; Conventional therapy (CT) and Complete Decongestive Therapy (CDT) groups. Measurements were taken at baseline, 4 and 6 weeks. Health related Quality of Life was evaluated with the EORTC QLQ C30 and EORTC QLQ-BR23 questionnaires. Pain was measured using the Visual Analogue Scale. Descriptive statistics were used to analyze participant demographics and repeated measures of ANOVA was used for within and between group comparisons. Both groups showed improved quality of life and diminished pain after 6 weeks of treatment. However, greater improvement was observed in CDT group compared to the CT group. In this study, remedial exercises and home program in addition to manual lymphatic drainage and compression bandaging resulted in improved quality of life. Early identification of lymphedema and incorporation of remedial exercises and a home program improve the quality of life for breast cancer survivors. Trial registry ID: ISRCTN13242080 , Date of registration: 7 April 2016.

  3. ESA Intermediate Experimental Vehicle. Independent Aerothermodynamic Characterization And Aerodatabase Development

    Science.gov (United States)

    Rufolo, Giuseppe C.; Di Benedetto, Sara; Walpot, Louis; Roncioni, Pietro; Marini, Marco

    2011-05-01

    In the frame of the Intermediate eXperimental Vehicle (IXV) project, the European Space Agency (ESA) is coordinating a series of technical assistance activities aimed at verifying and supporting the IXV industrial design and development process. The technical assistance is operated with the support of the Italian Space Agency (ASI), by means of the Italian Aerospace Research Center (CIRA), and the European Space Research and Technology Centre (ESTEC) under the super visioning and coordination of ESA IXV team. One of the purposes of the activity is to develop an independent capability for the assessment and verification of the industrial results with respect to the aerothermodynamic characterization of the IXV vehicle. To this aim CIRA is developing and independent AeroThermodynamics DataBase (ATDB), intended as a tool generating in output the time histories of local quantities (heat flux, pressure, skin friction) for each point of the IXV vehicle and for each trajectory (in a pre-defined envelope), together with an uncertainties model. The reference Computational Fluid Dynamics (CFD) solutions needed for the development of the tool have been provided by ESA-ESTEC (with the CFD code LORE) and CIRA (with the CFD code H3NS).

  4. Compulsive masturbation and chronic penile lymphedema.

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Galì, Alessandro; Marino, Silvia; Bramanti, Placido

    2012-06-01

    Chronic penile lymphedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues and may be secondary to local and systemic medical conditions such as sexually transmitted diseases, filariasis, malignancy, local radiotherapy, and surgery. This case report aims to consider compulsive masturbation as a possible cause of chronic penile edema. A 40-year-old man was referred to our institute for behavioral disturbance, including compulsive masturbation. Neuropsychiatric evaluation showed moderate mental retardation, mild dysarthria and limb incoordination, anxiety, depressed mood, and impulse dyscontrol. Brain MRI pointed out diffuse white matter lesions. Urogenital examination revealed an uncircumcised penis with non-tender edema of the shaft and prepuce with areas of lichenification. Since the most common local and systemic causes of edema were excluded, chronic penile edema due to compulsive masturbation was diagnosed and the compulsive behavior treated with an antidepressant and low-dose neuroleptics. Compulsive masturbation should be taken into account when counselling patients with penile edema.

  5. The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis

    Science.gov (United States)

    Stocks, Meredith E.; Freeman, Matthew C.; Addiss, David G.

    2015-01-01

    Background Lymphedema of the leg and its advanced form, known as elephantiasis, are significant causes of disability and morbidity in areas endemic for lymphatic filariasis (LF), with an estimated 14 million persons affected worldwide. The twin goals of the World Health Organization’s Global Program to Eliminate Lymphatic Filariasis include interrupting transmission of the parasitic worms that cause LF and providing care to persons who suffer from its clinical manifestations, including lymphedema—so-called morbidity management and disability prevention (MMDP). Scaling up of MMDP has been slow, in part because of a lack of consensus about the effectiveness of recommended hygiene-based interventions for clinical lymphedema. Methods and Findings We conducted a systemic review and meta-analyses to estimate the effectiveness of hygiene-based interventions on LF-related lymphedema. We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through March 23, 2015 with no restriction on year of publication. Studies were eligible for inclusion if they (1) were conducted in an area endemic for LF, (2) involved hygiene-based interventions to manage lymphedema, and (3) assessed lymphedema-related morbidity. For clinical outcomes for which three or more studies assessed comparable interventions for lymphedema, we conducted random-effects meta-analyses. Twenty-two studies met the inclusion criteria and two meta-analyses were possible. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. Participation in hygiene-based lymphedema management was associated with a lower incidence of acute dermatolymphagioadenitis (ADLA), (Odds Ratio 0.32, 95% CI 0.25–0.40), as well as with a decreased percentage of patients reporting at least one episode of ADLA during follow-up (OR 0.29, 95% CI 0.12–0.47). Limitations

  6. Fluorescence microlymphography: diagnostic potential in lymphedema and basis for the measurement of lymphatic pressure and flow velocity.

    Science.gov (United States)

    Bollinger, A; Amann-Vesti, B R

    2007-06-01

    Fluorescence microlymphography (FML) is an almost atraumatic technique used to visualize the superficial skin network of initial lymphatics through the intact skin of man. Visualization was performed with an incident light fluorescence microscope following subepidermal injection of minute amounts of FITC-dextran 150,000 using microneedles. Emanating from the bright dye depot, the surrounding network of microvessels is filled, documentation performed by photography or video film. In congenital Milroy lymphedema, a lack of microlymphatics (aplasia) is typical while in other primary lymphedemas and in secondary lymphedema after mastectomy or irradiation of proximal lymph nodes, the network remains intact but the depicted area is enlarged. Lymphatic microangiopathy characterized by obliterations of capillary meshes or mesh segments develops in phleboedema with trophic skin changes, progressive systemic sclerosis and Fabry's disease. In lipedema, lymphatic microaneurysms are stained. Microlymphatic pressure may also be measured using FML. For this purpose, glass micropipettes are inserted into the capillaries by means of a micromanipulator and pressure is determined by the servo-nulling technique. Normal subjects produced significantly lower pressure (7.9 +/- 3.4 mmHg) compared to patients with primary lymphedema (15.0 +/- 5.1 mmHg, pphysiotherapy or local application of prostaglandins. Additionally, a modification of the FML procedure can be used to measure lymphatic capillary flow velocity in controls and patients. FML is suited to confirm the clinical diagnosis of lymphedema, contributes to distinguish among various forms of edema, and is useful in clinical research. In addition, FML has also become a tool for experimental animal studies including the depiction of gastric microlymphatics, the measurement of flow velocity in the naked mouse tail, and in evaluation of lymphangiogenesis in a model of Milroy disease.

  7. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    Directory of Open Access Journals (Sweden)

    Jakub Taradaj

    2014-03-01

    Full Text Available Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment is recognised as the best practice in lymphedema management. Kinesio taping (KT for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging. During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods.

  8. Psychosocial factors associated with adherence for self-management behaviors in women with breast cancer-related lymphedema.

    Science.gov (United States)

    Alcorso, Jessica; Sherman, Kerry A; Koelmeyer, Louise; Mackie, Helen; Boyages, John

    2016-01-01

    Cognitive and affective psychosocial factors have been found to underlie adherence to preventive behaviors in women at risk of developing lymphedema following treatment for breast cancer. The aim of this study was to determine if these factors are associated with adherence to self-management behaviors for women diagnosed with breast cancer-related lymphedema (BCRL). Women with BCRL were recruited through a community-based breast cancer organization and three Australian lymphedema treatment clinics. Participants completed an online questionnaire assessing demographics, medical history, adherence to self-management behaviors, psychosocial variables (personal control, treatment control, consequences, distress, and self-regulation of affect), and knowledge about lymphedema self-management. A total of 166 women participated in the study. Participants reported adhering to a mean of five out of seven behaviors, with 19.5% of participants adhering to all seven behaviors. Adherence to individual behaviors ranged from 65% (self-lymphatic drainage) to 98.2% (skin care). Greater knowledge about lymphedema was significantly correlated with higher adherence. Hierarchical multiple linear regression analysis indicated that only medical history factors (time since diagnosis and having undergone hormone replacement therapy) predicted a significant amount of the variance in adherence. These findings highlight the importance of patient knowledge for optimal adherence to a self-management regimen. In addition, medical history factors may identify if a patient is at risk of nonadherence. The lack of association of adherence with other psychosocial factors considered in this study indicates that factors underlying adherence in affected women differ considerably from those factors prompting preventive behavior adherence in the at-risk population.

  9. Assesment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    Science.gov (United States)

    2008-09-01

    AD_________________ Award Number: DAMD17-03-1-0622 TITLE: Assesment of Lymphedema Risk Following...01-09-2008 2. REPORT TYPE Annual Summary 3. DATES COVERED (From - To) 11 AUG 2007 - 10 AUG 2008 4. TITLE AND SUBTITLE Assesment of Lymphedema ...14. ABSTRACT Lymphedema is a common, chronic, and potentially devastating complication of primary breast cancer therapy. Radiation increases

  10. Assessment of Risk Reduction for Lymphedema Following Sentinel Lymph Noded Guided Surgery for Primary Breast Cancer

    Science.gov (United States)

    2006-10-01

    Lymphedema Following Sentinel Lymph Noded Guided Surgery for Primary Breast Cancer PRINCIPAL INVESTIGATOR: Andrea L. Cheville, M.D...5a. CONTRACT NUMBER Assessment of Risk Reduction for Lymphedema Following Sentinel Lymph Noded Guided Surgery for Primary Breast Cancer 5b...14. ABSTRACT Lymphedema is a common complication of primary breast cancer therapy. It is a chronic, insidiously progressive, and potentially

  11. Experience-independent development of the hamster circadian visual system.

    Directory of Open Access Journals (Sweden)

    August Kampf-Lassin

    Full Text Available Experience-dependent functional plasticity is a hallmark of the primary visual system, but it is not known if analogous mechanisms govern development of the circadian visual system. Here we investigated molecular, anatomical, and behavioral consequences of complete monocular light deprivation during extended intervals of postnatal development in Syrian hamsters. Hamsters were raised in constant darkness and opaque contact lenses were applied shortly after eye opening and prior to the introduction of a light-dark cycle. In adulthood, previously-occluded eyes were challenged with visual stimuli. Whereas image-formation and motion-detection were markedly impaired by monocular occlusion, neither entrainment to a light-dark cycle, nor phase-resetting responses to shifts in the light-dark cycle were affected by prior monocular deprivation. Cholera toxin-b subunit fluorescent tract-tracing revealed that in monocularly-deprived hamsters the density of fibers projecting from the retina to the suprachiasmatic nucleus (SCN was comparable regardless of whether such fibers originated from occluded or exposed eyes. In addition, long-term monocular deprivation did not attenuate light-induced c-Fos expression in the SCN. Thus, in contrast to the thalamocortical projections of the primary visual system, retinohypothalamic projections terminating in the SCN develop into normal adult patterns and mediate circadian responses to light largely independent of light experience during development. The data identify a categorical difference in the requirement for light input during postnatal development between circadian and non-circadian visual systems.

  12. Smooth muscle cells largely develop independently of functional hemogenic endothelium

    Directory of Open Access Journals (Sweden)

    Monika Stefanska

    2014-01-01

    Full Text Available Vascular smooth muscle cells represent a major component of the cardiovascular system. In vitro studies have shown that FLK1+ cells derived from embryonic stem (ES cells can differentiate into both endothelial and smooth muscle cells. These FLK1+ cells also contain a mesodermal precursor, the hemangioblast, able to produce endothelial, blood and smooth muscle cells. The generation of blood precursors from the hemangioblast was recently shown to occur through a transient cell population of specialised endothelium, a hemogenic endothelium. To date, the lineage relationship between this cell population and smooth muscle cell progenitors has not been investigated. In this study, we generated a reporter ES cell line in which expression of the fluorescent protein H2B-VENUS is driven by the α-smooth muscle actin (α-SMA regulatory sequences. We demonstrated that this reporter cell line efficiently trace smooth muscle development during ES cell differentiation. Although some smooth muscle cells are associated with broad endothelial development, we established that smooth muscle cells are mostly generated independently from a specialised functional hemogenic endothelium. This study provides new and important insights into hematopoietic and vascular development, which may help in driving further progress towards the development of bioengineered vascular grafts for regenerative medicine.

  13. Measuring Perceived Anonymity: The Development of a Context Independent Instrument

    Directory of Open Access Journals (Sweden)

    Dwight M. Hite

    2014-09-01

    Full Text Available In order to assess relationships between perceptions of anonymity and behaviors, a context independent instrument is required for measuring the perceptions of anonymity held by individuals.  To date, no such measurement instrument exists that has been shown to be reliable and valid.  The authors employ a rigorous design methodology to develop, test, and substantiate a reliable and valid instrument for measuring perceptions of anonymity across different contexts. The PA measure presented is a five item Likert scale designed to measure perceptions of anonymity across multiple contexts. Results from two separate EFA pilot tests (n=61 and n=60, a test-retest, and a CFA final test (n=292 indicate that the PA measure has good internal consistency reliability (a=.82, test-retest reliability, factorial validity, and a single factor structure. DOI: 10.2458/azu_jmmss.v5i1.18305

  14. Effect of physical therapy on breast cancer related lymphedema

    DEFF Research Database (Denmark)

    Tambour, Mette; Tange, Berit; Christensen, Robin Daniel Kjersgaard

    2014-01-01

    BACKGROUND: Physical therapy treatment of patients with lymphedema includes treatment based on the principles of 'Complete Decongestive Therapy' (CDT). CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. The scientific evidence regarding what...... type of treatment is most effective is sparse. The objective of this study is to investigate whether CDT is equally effective if it includes manual lymphatic drainage or not in the treatment of arm lymphedema among patients with breast cancer. METHODS/DESIGN: A randomized, single-blind, equivalence...... trial. A total of 160 breast cancer patients with arm lymphedema will be recruited from 3 hospitals and randomized into one of two treatment groups A: Complete Decongestive Therapy including manual drainage or B: Complete Decongestive Therapy without manual lymphatic drainage. The intervention period...

  15. Management of secondary lymphedema related to breast cancer

    Science.gov (United States)

    Cheifetz, Oren; Haley, Louise

    2010-01-01

    Abstract OBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer. QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed, and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett’s levels of evidence. The literature search focused on primary research and systematic reviews. MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises, previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading. CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral. PMID:21375063

  16. Mutations in the VEGFR3 signaling pathway explain 36% of familial lymphedema

    DEFF Research Database (Denmark)

    Mendola, A; Schlögel, M J; Ghalamkarpour, A

    2013-01-01

    Lymphedema is caused by dysfunction of lymphatic vessels, leading to disabling swelling that occurs mostly on the extremities. Lymphedema can be either primary (congenital) or secondary (acquired). Familial primary lymphedema commonly segregates in an autosomal dominant or recessive manner. It can...... also occur in combination with other clinical features. Nine mutated genes have been identified in different isolated or syndromic forms of lymphedema. However, the prevalence of primary lymphedema that can be explained by these genetic alterations is unknown. In this study, we investigated 7...... of these putative genes. We screened 78 index patients from families with inherited lymphedema for mutations in FLT4, GJC2, FOXC2, SOX18, GATA2, CCBE1, and PTPN14. Altogether, we discovered 28 mutations explaining 36% of the cases. Additionally, 149 patients with sporadic primary lymphedema were screened for FLT4...

  17. Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, F. M., E-mail: gomez_fermun@gva.es; Martinez-Rodrigo, J.; Marti-Bonmati, L. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain); Santos, E. [University of Pittsburgh, Department of Radiology (United States); Forner, I. [Hospital Universitario y Politecnico La Fe, Servicio de Medicina Fisica y Rehabilitacion (Spain); Lloret, M.; Perez-Enguix, D.; Garcia-Marcos, R. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain)

    2012-12-15

    Purpose: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. Methods and Materials: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. Results: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. Conclusion: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.

  18. Phototherapeutic treatment of lymphedema and other complications after mastectomy

    Science.gov (United States)

    Zharov, Vladimir P.; Kalinin, Konstantin L.; Borisov, Andrei A.; Velsher, Leonid Z.; Stakhanov, Mikhail L.; Eskin, Vadim G.; Savin, Alexei A.; Shihkerimov, Raphiz K.

    2000-05-01

    One of the possible consequences of mastectomy is lymphedema of soft tissues of upper extremities on the side of ablated breast as result of cutting and trauma of multiple nerves, lymphatic and blood vessels. This phenomenon is often accompanied by deterioration of blood and lymphatic microcirculation, increasing of stagnation and aggregation ability of thrombocities, limitation of humeral and ulnar joint activity, severe pain and decreasing of myotonus. The developing of new phototherapeutic method based on using of light-emitting diodes (LED) arrays is attempted. This method is just directed on improvement of patient's condition in combination with other traditional methods such as drug therapy, pressure bandaging etc. The main parameters of LED arrays fixed inside cylindrical tube covering pathology region are: wavelength -- 660 nm, intensity range -- 0.5 mW/sm2. To control and study efficiency of phototreatment ultrasonic dopplerography, thermography, electromyography and viscosimetry have been used. During clinical trials in oncology department of Moscow State University of Medicine and Dentistry 128 patients have been treated with following results: patients felt complete disappearance of pain and weightiness sensation in arm, restoration of skin sensitivity and muscle strength. There were statistically proved amelioration of excitation spreading velocity on radial nerve, decreasing of blood viscosity, increasing of blood velocity in main arteries of shoulder and symmetry of temperature distribution.

  19. Higher vascular endothelial growth factor-C concentration in plasma is associated with increased forearm capillary filtration capacity in breast cancer-related lymphedema

    DEFF Research Database (Denmark)

    Jensen, Mads Radmer; Simonsen, Lene; Karlsmark, Tonny

    2015-01-01

    Breast cancer-related lymphedema (BCRL) is a frequent, chronic and debilitating swelling that mainly affects the ipsilateral arm and develops as a complication to breast cancer treatment. The pathophysiology is elusive opposing development of means for prediction and treatment. We have earlier...

  20. Localized tissue water changes accompanying one manual lymphatic drainage (MLD) therapy session assessed by changes in tissue dielectric constant inpatients with lower extremity lymphedema.

    Science.gov (United States)

    Mayrovitz, H N; Davey, S; Shapiro, E

    2008-06-01

    Previous reports described the utility of assessing local tissue water via tissue dielectric constant (TDC) measurements. Our goal was to determine the suitability of this method to evaluate lymphedema changes. For this purpose, we measured changes in TDC produced by one MLD treatment in 27 legs of 18 patients with lower extremity lymphedema. TDC values were measured to a depth of 2.5 mm at the greatest leg swelling site before and after one MLD treatment. Girth at the target site was measured with a calibrated tape measure. TDC values, which range from 1 for zero water to 78.5 for all water within the sampled volume, were measured four times and the average used to estimate local changes. Results showed that in every case the posttreatment TDC was reduced from its pretreatment value with percentage reductions (mean SD) of -9.8 +/- 5.64% (p TDC measurements reflect changes to a depth of about 2.5 mm whereas girth measurements reflect conditions of the entire cross-section, TDC assessment may be more sensitive to localized lymphedema changes. This finding suggests that TDC measurements are useful as complementary and perhaps as independent assessment methods of edema/lymphedema and treatment-related changes.

  1. A LANGUAGE INDEPENDENT APPROACH TO DEVELOP URDUIR SYSTEM

    Directory of Open Access Journals (Sweden)

    Mohd. Shahid Husain

    2013-02-01

    Full Text Available This is the era of Information Technology. Today the most important thing is how one gets the right information at right time. More and more data repositories are now being made available online. Information retrieval systems or search engines are used to access electronic information available on the internet. These information retrieval systems depend on the available tools and techniques for efficient retrieval of information content in response to the user query needs. During last few years, a wide range of information in Indian regional languages like Hindi, Urdu, Bengali, Oriya, Tamil and Telugu has been made available on web in the form of e-data. But the access to these data repositories is very low because the efficient search engines/retrieval systems supporting these languages are very limited. We have developed a language independent system to facilitate efficient retrieval of information available in Urdu language which can be used for other languages as well. The system gives precision of 0.63 and the recall of the system is 0.8.

  2. EMPIRICAL APPROACH UPON THE RELATIONSHIP BETWEEN CENTRAL BANK INDEPENDENCE AND INFLATION IN DEVELOPED AND DEVELOPING COUNTRIES

    Directory of Open Access Journals (Sweden)

    Dumiter Florin Cornel

    2012-07-01

    Full Text Available Central bank independence has become over time one of the key concepts in modern theory and policy. Most economists agree that central bank independence is desirable because it helps achieving and maintaining the long – term goal of price stability. Although one might think about alternative mechanisms to reach lower inflation rates, central bank independence is clearly the most often recomended. The empirical trends upon a more independent central bank with a more transparent and accountable monetary policy regime has emerged in economic literature regarding central banking and monetary economics. In recent years, starting from the Maastricht Treaty central bank independence has become the panacea of the monetary economics and monetary policy approaches. Moreover it is important to analyze and assess the impact of this key issue in central banking upon the inflation performances of the central banks. In this article we provide a qualitative overview upon some recent trends in the central bank independence field: does it still matter? How can be it evaluate and stress it’s impact upon macroeconomic performances, especially upon inflation. As we can observe in the economic literature upon central bank independence there are several approaches to use several indices in order to measure this qualitative and quatitative institutional variables. The most important debate is to eliminate the gap between de jure and de facto independence in order to flatten the measuring of institutional aspects, the legal implication, the constitutional facts and the actual practices of the central banks. Finally, we suggest that according to the new index for measuring central bank independence and inflation targeting index we can evaluate more accurate the degree of the de jure and de facto independence and stress the impact on inflation performance with a case study for ten developed countries and ten developing countries.

  3. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    OpenAIRE

    Iwona Malicka; Agnieszka Rosseger; Justyna Hanuszkiewicz; Marek Woźniewski

    2014-01-01

    Introduction : Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study : The aim of the study was to assess the effects of KT ap...

  4. Lymphedema Precautions: Time to Abandon Old Practices?

    Science.gov (United States)

    Ahn, Soojin; Port, Elisa R

    2016-03-01

    The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 46-year-old premenopausal woman with a body mass index of 21 was found on screening mammography to have a new, approximately 1-cm spiculated mass with associated calcifications in the upper outer quadrant of the left breast. Stereotactic core biopsy showed a focus of invasive duct carcinoma, strongly positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2, with associated ductal carcinoma in situ. Clinical examination revealed no palpable mass or axillary lymphadenopathy. She underwent a left lumpectomy with seed localization and sentinel lymph node biopsy. Final pathology revealed an 8-mm well-differentiated invasive carcinoma without lymphovascular invasion and intermediate grade ductal carcinoma in situ. The margins were clear, and three sentinel lymph nodes were negative for metastasis. The 21-gene recurrence score was 10, suggesting a 7% risk of 10-year distant recurrence with adjuvant endocrine treatment. After the completion of adjuvant radiotherapy (42.50 Gy in 16 fractions to the breast), the patient has returned for a follow-up visit. She is a professional violinist and would like to know what she can do to prevent lymphedema on her upcoming flight to Vienna.

  5. The Psychosocial Impact of Lymphedema-related Distress among Breast Cancer Survivors in the WHEL Study

    Science.gov (United States)

    Dominick, Sally A.; Natarajan, Loki; Pierce, John P.; Madanat, Hala; Madlensky, Lisa

    2014-01-01

    Objective Lymphedema is a distressing and chronic condition affecting up to 30% of breast cancer survivors. Using a cross-sectional study design, we examined the impact of self-reported lymphedema-related distress on psychosocial functioning among breast cancer survivors in the Women’s Healthy Eating and Living (WHEL) Study. The WHEL Study has a dataset that includes self-report data on lymphedema status, symptoms and distress. Methods Chi-square tests and binary logistic regression models were used to examine how specific participant characteristics, including lymphedema-related distress, were associated with physical health and mental health as measured by the SF-36 and depressive symptoms assessed by the CES-Dsf. Results Of the 2,431 participants included in the current study population, 692 (28.5%) self-reported ever having lymphedema. A total of 335 (48.9%) women reported moderate to extreme distress as a result of their lymphedema and were classified as having lymphedema-related distress. The logistic regression models showed that women with lymphedema-related distress had 50% higher odds of reporting poor physical health (p=0.01) and 73% higher odds of having poor mental health (plymphedema. In contrast, even though lymphedema-related distress was significantly associated (p=0.03) with elevated depressive symptoms in the bivariate analyses, it was not significant in the logistic regression models. Conclusion Breast cancer survivors with lymphedema-related distress had worse physical and mental health outcomes than women with lymphedema who were not distressed and women with no lymphedema. Our findings provide further evidence of the relationship between lymphedema and psychosocial outcomes in breast cancer survivors. PMID:24615880

  6. MR imaging of primary, secondary, and mixed forms of lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Aastroem, K.G.O.; Abdsaleh, S.; Ahlstroem, K.H. [Univ. Hospital, Uppsala (Sweden). Dept. of Radiology; Brenning, G.C. [Univ. Hospital, Uppsala (Sweden). Dept. of Internal Medicine

    2001-03-01

    Purpose: To describe the pathological features and assess the diagnostic information of different MR sequences in patients with primary, secondary, and mixed (phlebo-, lipophlebo-, or lipolymphedema) forms of lymphedema of the lower leg. Material and Methods: In 26 patients with clinical diagnoses of primary (n=10), pure secondary (n=4), mixed (n=9) and combined secondary and mixed forms of lymphedema (n=3), MR imaging was performed with coronal and axial T1 SE, T2 TSE, fat-suppressed (SPIR) T2 sequences and axial T1 SE after i.v. injection of Gd-DTPA. Results: In 24 patients there was a honeycomb pattern in the subcutis with a signal intensity corresponding to fluid (n=11), fibrosis (n=3), or both (n=10). Five patients with primary lymphedema showed subfascial fluid accumulation. Dermal edema was noted in 23 patients. Fat or edema components in the muscles were mostly seen in patients with phlebolymphedema. The honeycomb pattern was best seen on coronal T1 images, and fluid accumulations on axial SPIR-T2 images. Fibrosis was only assessable from the T2 TSE sequence. Gd-DTPA did not improve the diagnostic information. Conclusion: For evaluation of lymphedema and its mixed forms, an axial T2-weighted SPIR sequence in conjunction with a coronal T1 SE sequence are sufficient.

  7. Breast Cancer-Related Lymphedema: Implications for Family Leisure Participation

    Science.gov (United States)

    Radina, M. Elise

    2009-01-01

    An estimated 20% of breast cancer survivors face the chronic condition of breast cancer-related lymphedema. This study explored the ways in which women with this condition experienced changes in their participation in family leisure as one indicator of family functioning. Participants (N = 27) were interviewed regarding lifestyles before and after…

  8. Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain

    Science.gov (United States)

    Hara, Hisako; Zhou, Han Peng; Tange, Shuichi; Kikuchi, Kazuki

    2017-01-01

    Background: We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain. Methods: We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded. Results: A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery. Conclusion: LVA can release the pain in the affected limbs of lymphedema. PMID:28203506

  9. Measurement Properties of Instruments for Measuring of Lymphedema: Systematic Review

    NARCIS (Netherlands)

    Hidding, J.T.; Viehoff, P.B.; Beurskens, C.H.G.; Laarhoven, H.W. van; Sanden, M.W. van der; Wees, P.J. van der

    2016-01-01

    BACKGROUND: Lymphedema is a common complication of cancer treatment, resulting in swelling and subjective symptoms. Reliable and valid measurement of this side effect of medical treatment is important. PURPOSE: The purpose of this study was to provide best evidence regarding which measurement

  10. Breast Cancer-Related Lymphedema: Implications for Family Leisure Participation

    Science.gov (United States)

    Radina, M. Elise

    2009-01-01

    An estimated 20% of breast cancer survivors face the chronic condition of breast cancer-related lymphedema. This study explored the ways in which women with this condition experienced changes in their participation in family leisure as one indicator of family functioning. Participants (N = 27) were interviewed regarding lifestyles before and after…

  11. Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA

    Science.gov (United States)

    Levenhagen, Kimberly; Davies, Claire; Perdomo, Marisa; Ryans, Kathryn

    2017-01-01

    Introduction: The Oncology Section of APTA developed a clinical practice guideline to aid the clinician in diagnosing secondary upper-quadrant cancer-related lymphedema. Methods: Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in their diagnostic process. Overall, clinical practice recommendations were formulated on the basis of the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. Recommendations: In an effort to make these clinically applicable, recommendations were based on the characteristics as to the location and stage of a patient's upper-quadrant lymphedema. PMID:28748128

  12. Assessment of Volume Measurement of Breast Cancer-Related Lymphedema by Three Methods: Circumference Measurement, Water Displacement, and Dual Energy X-Ray Absorptiometry

    DEFF Research Database (Denmark)

    Gjørup, Caroline; Zerahn, B.; Hendel, Helle Westergren

    2010-01-01

    Background: Following treatment for breast cancer 12%-60% develop breast cancer-related lymphedema (BCRL). There are several ways of assessing BCRL. Circumference measurement (CM) and water displacement (WD) for volume measurements (VM) are frequently used methods in practice and research...

  13. Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema

    Science.gov (United States)

    Harris, Susan R.; Hugi, Maria R.; Olivotto, Ivo A.; Levine, Mark; &NA;

    2001-01-01

    Objective To provide information and recommendations for women and their physicians when making decisions about the management of lymphedema related to breast cancer. Options Compression garments, pneumatic compression pumps, massage and physical therapies, other physical therapy modalities, pharmaceutical treatments. Outcomes Symptom control, quality of life, cosmetic results. Evidence Systematic review of English-language literature retrieved primarily from MEDLINE (1966 to April 2000) and CANCERLIT (1985 to April 2000). Nonsystematic review of breast cancer literature published to October 2000. Recommendations · Pre- and postoperative measurements of both arms are useful in the assessment and diagnosis of lymphedema. Circumferential measurements should be taken at 4 points: the metacarpal-phalangeal joints, the wrists, 10 cm distal to the lateral epicondyles and 15 cm proximal to the lateral epicondyles. · Clinicians should elicit symptoms of heaviness, tightness or swelling in the affected arm. A difference of more than 2.0 cm at any of the 4 measurement points may warrant treatment of the lymphedema, provided that tumour involvement of the axilla or brachial plexus, infection and axillary vein thrombosis have been ruled out. · Practitioners may want to encourage long-term and consistent use of compression garments by women with lymphedema. · One randomized trial has demonstrated a trend in favour of pneumatic compression pumps compared with no treatment. Further randomized trials are required to determine whether pneumatic compression provides additional benefit over compression garments alone. · Complex physical therapy, also called complex decongestive physiotherapy, requires further evaluation in randomized trials. In one randomized trial no difference in outcomes was detected between compression garments plus manual lymph drainage versus compression garments alone. · Clinical experience supports encouraging patients to consider some practical advice

  14. Reading Cooperatively or Independently? Study on ELL Student Reading Development

    Science.gov (United States)

    Liu, Siping; Wang, Jian

    2015-01-01

    This study examines the effectiveness of cooperative reading teaching activities and independent reading activities for English language learner (ELL) students at 4th grade level. Based on simple linear regression and correlational analyses of data collected from two large data bases, PIRLS and NAEP, the study found that cooperative reading…

  15. Developing Independent Learners: The Box Hill School Experience

    Science.gov (United States)

    Pavey, Sarah

    2010-01-01

    Box Hill School is an independent school in Surrey, England. In 2008 the English curriculum was abandoned in favour of the International Baccalaureate Diploma (IBD). A library is a statutory requirement of the International Baccalaureate Organisation (IBO) endorsement who also recommend this be managed by a qualified teacher-librarian. In May…

  16. Complexities of Adherence and Post-Cancer Lymphedema Management

    Science.gov (United States)

    Ostby, Pamela L.; Armer, Jane M.

    2015-01-01

    Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens. PMID:26580657

  17. Complexities of Adherence and Post-Cancer Lymphedema Management

    Directory of Open Access Journals (Sweden)

    Pamela L. Ostby

    2015-11-01

    Full Text Available Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL, a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens.

  18. Coping and quality of life of patients following microsurgical treatment for breast cancer-related lymphedema.

    Science.gov (United States)

    Teo, Irene; Fingeret, Michelle Cororve; Liu, Jun; Chang, David W

    2016-12-01

    Breast cancer-related lymphedema is associated with numerous adverse outcomes. This study investigated the extent clinical factors, lymphedema symptoms, lymphedema-related appearance, and coping strategies predicted quality of life. Female patients who underwent microsurgical treatment for lymphedema (n = 54) participated. Lymphedema symptoms were associated with physical and functional well-being, but not emotional and social well-being. Clinical factors and lymphedema-related appearance were not significantly associated with quality of life. Compared to adaptive coping strategies, maladaptive coping strategies (e.g. denial, venting, self-blame) were more strongly associated with quality of life. This suggests psychosocial interventions aimed at modifying maladaptive coping behaviors can potentially improve quality of life for this patient population. © The Author(s) 2015.

  19. The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema.

    Science.gov (United States)

    Dirican, Abuzer; Andacoglu, Oya; Johnson, Ronald; McGuire, Kandace; Mager, Lisa; Soran, Atilla

    2011-05-01

    Breast-cancer-related lymphedema (BCRL) is a chronic disease, and currently there is no definitive treatment for it. There are some therapeutic interventions targeted to decrease the limb swelling and the associated problems. Low-level laser therapy (LLLT) has been used in the treatment of post-mastectomy lymphedema since 2007 in the US. The aim of this study is to review our short-term experience with LLLT in the treatment of BCRL. Seventeen BCRL patients referred to our lymphedema program between 2007 and 2009 were enrolled in this study. All patients had experienced at least one conventional treatment modality such as complex physical therapy, manual lymphatic drainage, and/or pneumatic pump therapy. LLLT was added to patients' ongoing therapeutic regimen. All patients completed the full course of LLLT consisting of two cycles. The difference between sums of the circumferences of both affected and unaffected arms (ΔC), pain score, scar mobility, and range of motion were measured before and after first and second cycles of LLLT sequentially. All patients were female with a median age of 51.8 (44-64) years. ΔC decreased 54% (15-85%) and 73% (33-100%), after the first and second cycles of LLLT, respectively. Fourteen out of seventeen experienced decreased pain with motion by an average of 40% (0-85%) and 62.7% (0-100%) after the first and second cycle of LLLT, respectively. Three patients had no improvement in pain after LLLT. Scar mobility increased in 13 (76.4%) and shoulder range of motion improved in 14 (82.3%) patients after LLLT. One patient developed cellulitis during LLLT. Patients with BCRL received additional benefits from LLLT when used in conjunction with standard lymphedema treatment. These benefits include reduction in limb circumference, pain, increase in range of motion and scar mobility. Additionally, two cycles of LLLT were found to be superior to one in this study.

  20. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation

    National Research Council Canada - National Science Library

    Becker, Corinne; Assouad, Jalal; Riquet, Marc; Hidden, Geneviève

    2006-01-01

    Lymphedema complicating breast cancer treatment remains a challenging problem. The purpose of this study was to analyze the long-term results following microsurgical lymph node (LN) transplantation...

  1. Liposuction normalizes - in contrast to other therapies - lymphedema-induced adipose tissue hypertrophy.

    Science.gov (United States)

    Brorson, H

    2012-12-01

    The various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Although it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphedema that is not responding to such treatment is not so clear. Improvements in technique, patient preparation, and patient follow-up have led to a greater and a wider acceptance of liposuction as a treatment for lymphedema. This paper outlines the benefits of using liposuction and presents the evidence to support its use.

  2. Therapeutic Effects of Saireito (Chai-Ling-Tang, a Traditional Japanese Herbal Medicine, on Lymphedema Caused by Radiotherapy: A Case Series Study

    Directory of Open Access Journals (Sweden)

    Aiko Nagai

    2013-01-01

    Full Text Available Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50% showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study.

  3. OLED Defect Inspection System Development through Independent Component Analysis

    Directory of Open Access Journals (Sweden)

    Xin Chen

    2012-12-01

    Full Text Available Organic Light Emitting Displays (OLED is a new type of display device which has become increasingly attractive and popular. Due to the complex manufacturing process, various defects may exist on the OLED panel affecting the quality and life of the display panels. These defects have the characteristics of fuzzy boundaries, irregular in shape, low contrast with background and especially, they are mixed with the pixel texture background increasing the difficulty of a rapid recognition. In this paper, we proposed an approach to detect the defects based on the model of independent component analysis (ICA. The ICA model is applied to a perfect OLED image to estimate its corresponding independent components (ICs and create the de-mixing matrix. Through estimation and determination of a proper ICi row vector of the faultless image, a new de-mixing matrix can be generated which constitutes only uniform information and is then applied to reconstruct the texture background of source OLED images. Through the operation of subtraction of the reconstructed background from the source images and the binary segmentation, the defects can be detected. Based on the algorithms, a defect detection system for the OLED panels was implemented and the testing work was performed in this study. The testing results show that the proposed method is feasible and effective.

  4. Shoulder Pain after Fall, Septic Shock, and Pyomyositis Associated with Breast Cancer Chemotherapy and Lymphedema

    Directory of Open Access Journals (Sweden)

    Hiromitsu Kitayama

    2016-11-01

    Full Text Available Background: As a symptom of pyomyositis, sepsis usually follows local inflammation signs. Here, we report pyomyositis with lymphedema of upper extremity in which septic shock and poor local findings initially presented during chemotherapy for breast cancer. Case Report: An 80-year-old woman presented with chronic right shoulder pain during chemotherapy for the recurrent disease. She had a history of postmastectomy lymphedema, diabetes mellitus, and repeated hyaluronic acid injections to the shoulder joint. The pain suddenly worsened with septic shock and no apparent local signs. Magnetic resonance imaging revealed myonecrosis, and no pus was yielded by ultrasound-guided needle aspiration. After 2 weeks of recovery by conservative medical management, surgical drainage was performed. Late formulated massive intramuscular pus showed severe neutrophil infiltration and myonecrosis. Conclusion: Pyomyositis can develop into septic shock with poor local signs. Myelosuppression after chemotherapy can cause myonecrosis without macroabscess, and magnetic resonance imaging was useful for the diagnosis of this condition. When unspecified local pain appears during cancer chemotherapy we should consider this disease, too.

  5. Posture and locomotion in the rat : Independent or interdependent development?

    NARCIS (Netherlands)

    Gramsbergen, A

    In this essay, recent research into the relation between postural control and the development of walking in the rat is reviewed. The adult-like walking pattern develops at the 15th to 16th day (P15-P16). Until this age, postural control, as indicated by EMG activity in the longissimus muscle in the

  6. Posture and locomotion in the rat : Independent or interdependent development?

    NARCIS (Netherlands)

    Gramsbergen, A

    1998-01-01

    In this essay, recent research into the relation between postural control and the development of walking in the rat is reviewed. The adult-like walking pattern develops at the 15th to 16th day (P15-P16). Until this age, postural control, as indicated by EMG activity in the longissimus muscle in the

  7. Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

    Science.gov (United States)

    Weiss, Robert

    2016-12-01

    Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that

  8. Feasibility and effectiveness of basic lymphedema management in Leogane, Haiti, an area endemic for bancroftian filariasis.

    Directory of Open Access Journals (Sweden)

    David G Addiss

    Full Text Available BACKGROUND: Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings. METHODOLOGY/PRINCIPAL FINDINGS: Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001. ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01. CONCLUSIONS/SIGNIFICANCE: Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis.

  9. Imaging findings of adiposis dolorosa vs. massive localized lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Petscavage-Thomas, Jonelle M.; Bernard, Stephanie A.; Bennett, Jennifer [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Walker, Eric A. [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Uniformed Services University of the Health Sciences, Department of Radiology and Nuclear Medicine, Bethesda, MD (United States)

    2015-06-01

    Adiposis dolorosa (Dercum's disease) is a condition of benign, painful subcutaneous lipomatous lesions associated with weakness, endocrine and lipid abnormalities, and mental disturbances. There is little information documenting the cross-sectional imaging findings that differentiate it from lipomatous and neoplastic soft tissue masses, or massive localized lymphedema. The purpose of this study was to provide a radiological case series of adiposis dolorosa. A 10-year retrospective review of the picture archiving and communications system was performed. Two musculoskeletal radiologists reviewed images to confirm and document imaging features, location, size, and patient demographics. Medical records were reviewed to characterize patients into three groups: one group met at least three of the four criteria of Dercum's syndrome, the second group met less than three criteria, and the third group had clinical diagnosis of cellulitis of the lower extremity. Seventeen cases (25 masses) of adiposis dolorosa were found, nine cases of which met at least three criteria of Dercum's syndrome. All cases in the first two groups demonstrated skin thickening and lymphedema of subcutaneous fat, which was fluid attenuation on CT and low or intermediate T1-weighted and high STIR/T2-weighted MR signal. Two cases with pathology showed mild fatty infiltration with fibrous septa, and the third case showed massive localized lymphedema. The third group of ten cellulitis patients demonstrated non-mass-like subcutaneous edema with similar CT attenuation and MR signal characteristics to the first two groups, but differed by the presence of post-contrast enhancement and non-mass-like appearance in 90 %. Imaging findings of adiposis dolorosa and massive localized lymphedema overlap, as do the symptoms and pathological features. Due to the mass-like engorgement of the soft tissues and pain, patients will often undergo imaging to exclude neoplasm or infection. Knowledge of these

  10. Information Flow Integrity for Systems of Independently-Developed Components

    Science.gov (United States)

    2015-06-22

    We also examined three programs (Apache, MySQL, and PHP ) in detail to evaluate the efficacy of using the provided package test suites to generate...2013. We also published an abstract summarizing the approach of game-based synthesis for the development of pro- grams that enforce integrity...requirements. ”Secure programs via game-based synthesis ,” Somesh Jha, Thomas W. Reps, William R. Harris. In Pro- ceedings of Formal Methods in Computer-Aided

  11. Mutations in KIF11 cause autosomal-dominant microcephaly variably associated with congenital lymphedema and chorioretinopathy

    NARCIS (Netherlands)

    Ostergaard, P.; Simpson, M.A.; Mendola, A.; Vasudevan, P.; Connell, F.C.; Impel, A. van; Moore, A.T.; Loeys, B.L.; Ghalamkarpour, A.; Onoufriadis, A.; Martinez-Corral, I.; Devery, S.; Leroy, J.G.; Laer, L. van; Singer, A.; Bialer, M.G.; McEntagart, M.; Quarrell, O.; Brice, G.; Trembath, R.C.; Schulte-Merker, S.; Makinen, T.; Vikkula, M.; Mortimer, P.S.; Mansour, S.; Jeffery, S.

    2012-01-01

    We have identified KIF11 mutations in individuals with syndromic autosomal-dominant microcephaly associated with lymphedema and/or chorioretinopathy. Initial whole-exome sequencing revealed heterozygous KIF11 mutations in three individuals with a combination of microcephaly and lymphedema from a mic

  12. The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and | Division of Cancer Prevention

    Science.gov (United States)

    DESCRIPTION (provided by applicant): The proposed study, "Lymphedema and Gynecologic cancer (LEG): Incidence, Risk Factors and Impact", will innovatively utilize the cooperative group setting of the GOG (Gynecologic Oncology Group) to prospectively study 1300 women newly diagnosed with cervical, endometrial, or vulvar cancer to determine the incidence and impact of lower extremity lymphedema following surgical treatment of these diseases. |

  13. Mutations in KIF11 cause autosomal-dominant microcephaly variably associated with congenital lymphedema and chorioretinopathy

    NARCIS (Netherlands)

    Ostergaard, P.; Simpson, M.A.; Mendola, A.; Vasudevan, P.; Connell, F.C.; van Impel, A.; Moore, A.T.; Loeys, B.L.; Ghalamkarpour, A.; Onoufriadis, A.; Martinez-Corral, I.; Devery, S.; Leroy, J.G.; van Laer, L.; Singer, A.; Bialer, M.G.; McEntagart, M.; Quarrell, O.; Brice, G.; Trembath, R.C.; Schulte-Merker, S.; Makinen, T.; Vikkula, M.; Mortimer, P.S.; Mansour, S.; Jeffery, S.

    2012-01-01

    We have identified KIF11 mutations in individuals with syndromic autosomal-dominant microcephaly associated with lymphedema and/or chorioretinopathy. Initial whole-exome sequencing revealed heterozygous KIF11 mutations in three individuals with a combination of microcephaly and lymphedema from a

  14. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients.

    Science.gov (United States)

    Saaristo, Anne M; Niemi, Tarja S; Viitanen, Tiina P; Tervala, Tomi V; Hartiala, Pauliina; Suominen, Erkki A

    2012-03-01

    Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We aimed to combine this new method with the standard breast reconstruction. During 2008-2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle. Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic vessel function was examined. The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391 minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of lymphatic network in the axilla. No edema problems were detected in the lymph node donor area. Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from lymphedema after mastectomy and axillary dissection.

  15. Brain-independent development in the moth Sesamia nonagrioides.

    Science.gov (United States)

    Pérez-Hedo, Meritxell; Eizaguirre, Matilde; Sehnal, Frantisek

    2010-06-01

    The caterpillars of Sesamia nonagrioides developing under long-day (LD) photoperiod pupate in the 5th or 6th instar whereas under short day (SD) conditions they enter diapause and undergo several extra larval molts. The diapause is terminated within 1-3 instars upon transfer of SD larvae to the LD conditions. Brain removal from the 6th instar larvae promotes pupation followed by imaginal development; however, one third of the SD larvae and 12% of the LD larvae debrained at the start of the instar first undergo 1-2 larval molts. The incidence of larval molts is enhanced by the brain implants. Exclusively pupal molts occur in the LD larvae debrained late in the 6th instar. Decapitation elicits pupation in both LD and SD larvae, except for some of the 4th and 5th and rarely 6th instar that are induced to a fast larval molt. The pupation of decapitated larvae is reverted to a larval molt by application of a juvenile hormone (JH) agonist. No molts occur in abdomens isolated from the head and thorax prior to the wandering stage. Abdomens isolated later undergo a larval (SD insects) or a pupal (LD insects) molt. Taken together the data reveal that in S. nonagrioides (1) several larval molts followed by a pupal and imaginal molt can occur without brain; (2) an unknown head factor outside the brain is needed for the pupal-adult molt; (3) brain exerts both stimulatory and inhibitory effect on the corpora allata (CA); (4) larval molts induced in CA absence suggest considerable JH persistence.

  16. EFFECTS OF MICROWAVE TREATMENT ON THE LYMPHOCYTESUBSETS IN CASES OF CHRONIC LYMPHEDEMA OF EXTREMITIES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To determine the immune status of T lymphocyte subsets of patients with chronic lymphedema of extremities and the effects of microwave treatment. Methods Patients with lymphedema of extremities (n=20) and normal volunteers (n=10) were studied by fluorescein isothiocyanate (FITC) or phycoerythrin (PE)-conjugated monoclonal antibo dies (MoAbs) and dual color flow cytometry to examine the changes of lymphocyte phenotypes in them before and after treat ment. Results The percentage of CD4+ T lymphocytes and CD4+ /CD8+ T cell ratios in lymphedema group were less than those in control group before treatment. They increased significantly and restored to nearly normal level after microwave treatment. The percentage of CD8+ and HLA-DR + T lymphocytes in lymphedema group also demonstrated significant decline after treat ment. Conclusion Disorder of T lymphocyte subsets existed in patients with chronic lymphedema of extremities, and mi crowave treatment can improve the states and enhance the cellular immunity of the patients.

  17. Lymphaticovenous bypass decreases pathologic skin changes in upper extremity breast cancer-related lymphedema.

    Science.gov (United States)

    Torrisi, Jeremy S; Joseph, Walter J; Ghanta, Swapna; Cuzzone, Daniel A; Albano, Nicholas J; Savetsky, Ira L; Gardenier, Jason C; Skoracki, Roman; Chang, David; Mehrara, Babak J

    2015-03-01

    Recent advances in microsurgery such as lymphaticovenous bypass (LVB) have been shown to decrease limb volumes and improve subjective symptoms in patients with lymphedema. However, to date, it remains unknown if these procedures can reverse the pathological tissue changes associated with lymphedema. Therefore, the purpose of this study was to analyze skin tissue changes in patients before and after LVB. Matched skin biopsy samples were collected from normal and lymphedematous limbs of 6 patients with unilateral breast cancer-related upper extremity lymphedema before and 6 months after LVB. Biopsy specimens were fixed and analyzed for inflammation, fibrosis, hyperkeratosis, and lymphangiogenesis. Six months following LVB, 83% of patients had symptomatic improvement in their lymphedema. Histological analysis at this time demonstrated a significant decrease in tissue CD4(+) cell inflammation in lymphedematous limb (but not normal limb) biopsies (pskin. These findings suggest that the some of the pathologic changes of lymphedema are reversible and may be related to lymphatic fluid stasis.

  18. 48 CFR 242.771 - Independent research and development and bid and proposal costs.

    Science.gov (United States)

    2010-10-01

    ... SERVICES Indirect Cost Rates 242.771 Independent research and development and bid and proposal costs. ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Independent research and development and bid and proposal costs. 242.771 Section 242.771 Federal Acquisition Regulations System...

  19. 48 CFR 31.205-18 - Independent research and development and bid and proposal costs.

    Science.gov (United States)

    2010-10-01

    ... Contracts With Commercial Organizations 31.205-18 Independent research and development and bid and proposal..., defined in this subsection. Basic research, (See 2.101). Bid and proposal (B&P) costs means the costs... 9904.420, Accounting for independent research and development costs and bid and proposal costs,...

  20. 48 CFR 970.3102-05-18 - Independent research and development and bid and proposal costs.

    Science.gov (United States)

    2010-10-01

    ... proposal costs. (c) Independent Research and Development and Bid and Proposal costs are unallowable... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Independent research and development and bid and proposal costs. 970.3102-05-18 Section 970.3102-05-18 Federal Acquisition...

  1. The Process of Curriculum Development and the Use of Assessments in Independent Schools

    Science.gov (United States)

    Young, JoAnn P.

    2012-01-01

    This qualitative study was designed to examine and identify the site-based process that two elementary, independent schools, accredited by the Southern Association of Independent Schools use for curriculum and instructional development. Also, the study examined and identified the development and use of assessments to support each school's…

  2. The Process of Curriculum Development and the Use of Assessments in Independent Schools

    Science.gov (United States)

    Young, JoAnn P.

    2012-01-01

    This qualitative study was designed to examine and identify the site-based process that two elementary, independent schools, accredited by the Southern Association of Independent Schools use for curriculum and instructional development. Also, the study examined and identified the development and use of assessments to support each school's…

  3. The Impact of Secondary Lymphedema after Head and Neck Cancer Treatment on Symptoms, Functional Status, and Quality Of Life

    Science.gov (United States)

    Deng, Jie; Murphy, Barbara A.; Dietrich, Mary S.; Wells, Nancy; Wallston, Kenneth A.; Sinard, Robert J.; Cmelak, Anthony J.; Gilbert, Jill; Ridner, Sheila H.

    2014-01-01

    Background Lymphedema may disrupt local function and affect quality of life (QOL) in patients with head and neck cancer. The study aim was to examine the associations among severity of internal and external lymphedema, symptoms, functional status, and QOL in patients with head and neck cancer. Methods The sample included 103 patients who were ≥3 months post head and neck cancer treatment. Variables assessed included severity of internal and external lymphedema, physical/psychological symptoms, functional status, and QOL. Results Severity of internal and external lymphedema was associated with physical symptoms and psychological symptoms. Patients with more severe external lymphedema were more likely to have a decrease in neck left/right rotation. The combined effects of external and internal lymphedema severity were associated with hearing impairment and decreased QOL. Conclusions Lymphedema severity correlates with symptom burden, functional status, and QOL in patients post head and neck cancer treatment. PMID:22791550

  4. Enhancement of Students' Independent Learning through Their Critical Thinking Skills Development

    Science.gov (United States)

    Kopzhassarova, Umit; Akbayeva, Gulden; Eskazinova, Zhanar; Belgibayeva, Gulbarshyn; Tazhikeyeva, Akerke

    2016-01-01

    The article focuses on the problem of developing students' critical thinking skills, which help them become independent learners. Analysis of research works of educators and scholars enable the authors to reveal qualities, necessary for students to enhance their critical thinking skills and become independent learners. Different points of view on…

  5. Ultrasonografic changes in the axillary vein of patients with lymphedema after mastectomy

    Directory of Open Access Journals (Sweden)

    Gilberto Ferreira de Abreu Junior

    2015-04-01

    Full Text Available OBJECTIVE: To determine the prevalence of sonographic abnormalities (SA in the axillary vein of patients with and without post-mastectomy lymphedema. METHODS: We studied a sample of 80 women, divided into two equal groups, with and without lymphedema, with B mode ultrasound, color and pulsed Doppler. The primary variable, SA, is defined as change in the venous diameter, parietal thickening, intraluminal images, compressibility, parietal collapse at inspiration and feature of the axillary venous flow on the operated side. Secondary variables were: stage of lymphedema, surgical technique, number of radio and chemotherapy sessions, limb volume, weight and age. The differences between the proportions in the groups were determined using the Chi-square test and / or Fisher's test. For continuous variables, we used the Mann-Whitney Test. To estimate the magnitude of the associations, we used the prevalence rate of SA in both groups as a measure of frequency, and as a measure of association, the prevalence ratio (PR obtained as a function of relative risk (RR and estimated by the test Mantel-Haenszel homogeneity test. We adopted the statistical significance level of 5% (p < 0.05. RESULTS: only the criterion "parietal thickening" was strongly associated with the lymphedema group (p = 0.001. The prevalence of SA was 55% in patients with lymphedema and 17.5% in the group without it, with difference in prevalence of 37.5%. CONCLUSION: the prevalence of SA was higher in patients undergoing mastectomy with lymphedema than in those without lymphedema.

  6. Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema

    Directory of Open Access Journals (Sweden)

    Seyhan Karaçavuş

    2015-06-01

    Full Text Available Objective: The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema. Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphoscintigraphy scan was started as dynamic viewing followed by static whole body imaging at 10 minute, 1 hour and 4 hours after injection. Results: Eighty-seven patients had lymphedema. Patients who had lymphedema were divided into two groups according to their scintigraphy findings: Group I included 58 patients without uptake in the popliteal nodes, and group II included 29 patients with positive popliteal nodes. The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001. The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004. Conclusion: Lymphoscintigraphy is a reliable, easily applied and well-tolerated objective method to diagnose lower extremity lymphedema. Uptake by popliteal lymph nodes and the presence of dermal backflow on lymphoscintigraphy, which is performed for evaluation of the lower limb lymphedema, were important signs indicating longer disease duration and higher severity of lymphatic dysfunction.

  7. Yellow Nail Syndrome: Dystrophic Nails, Peripheral Lymphedema and Chronic Cough

    Directory of Open Access Journals (Sweden)

    Christian Dornia

    2011-01-01

    Full Text Available A case involving a 41-year-old man with yellow nail syndrome (YNS is reported. YNS is a rare disorder characterized by yellow, dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower respiratory tract infections. YNS is often misdiagnosed because the syndrome is not well known. An interdisciplinary approach is required to recognize and collate the components of the syndrome accurately. Correct diagnosis is of utmost clinical importance because YNS can occur secondary to malignancies and autoimmune disorders. Hence, the diagnosis of YNS must prompt further investigation.

  8. Manual lymphatic drainage for lymphedema following breast cancer treatment

    Science.gov (United States)

    Ezzo, Jeanette; Manheimer, Eric; McNeely, Margaret L; Howell, Doris M; Weiss, Robert; Johansson, Karin I; Bao, Ting; Bily, Linda; Tuppo, Catherine M; Williams, Anne F; Karadibak, Didem

    2016-01-01

    Background More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling. Objectives To assess the efficacy and safety of MLD in treating BCRL. Search methods We searched Medline, EMBASE, CENTRAL, WHO ICTRP (World Health Organization’s International Clinical Trial Registry Platform), and Cochrane Breast Cancer Group’s Specialised Register from root to 24 May 2013. No language restrictions were applied. Selection criteria We included randomized controlled trials (RCTs) or quasi-RCTs of women with BCRL. The intervention was MLD. The primary outcomes were (1) volumetric changes, (2) adverse events. Secondary outcomes were (1) function, (2) subjective sensations, (3) QoL, (4) cost of care. Data collection and analysis We collected data on three volumetric outcomes. (1) LE (lymphedema) volume was defined as the amount of excess fluid left in the arm after treatment, calculated as volume in mL of affected arm post-treatment minus unaffected arm post-treatment. (2) Volume reduction was defined as the amount of fluid reduction in mL from before to after treatment calculated as the pretreatment LE volume of the affected arm minus the post-treatment LE volume of the affected arm. (3) Per cent reduction was defined as the proportion of fluid reduced relative to the baseline excess volume, calculated as volume

  9. POST-BREAST CANCER LYMPHEDEMA: INCIDENCE INCREASES FROM 12 TO 30 TO 60 MONTHS

    Science.gov (United States)

    Armer, J.M.; Stewart, B.R.

    2015-01-01

    Breast cancer survivors are at life-time risk of developing lymphedema (LE). Quantification of LE has been problematic as the criteria used to identify lymphedema use various methods to assess changes in the volume of the affected limb. In part because of difficulties and variability in measurement and diagnosis, the reported incidence of LE varies greatly among women treated with surgery and radiation for breast cancer. The goal of this research was to describe the trends for LE occurrence over three points in time (12, 30, and 60 months) among breast cancer survivors using four diagnostic criteria based on three measurement techniques. Participants were enrolled following diagnosis of breast cancer but before surgery. Baseline limb volume and symptom assessment data were obtained. Participants were followed every 3 months for 12 months, then every 6 months thereafter for a total of 60 months. Limb volume changes (LVC) in both limbs were measured using three techniques: objectively by (a) circumferences at 4 cm intervals and (b) perometry and subjectively by (c) symptom experience via interview. Four diagnostic criteria for LE most often reported in the literature were used: (i) 2 cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and swelling, either ‘now’ or ‘in the past year’ (diagnostic criteria i–iii define increases/differences in limb volume from baseline and/or between the affected and non-affected limb). Standard survival analysis methods were applied to identify when the criteria corresponding to LE were met. Trends in LE occurrence are reported for preliminary analysis of data from 236 participants collected at 6-, 12-, 18-, 24-, 30-, and 60- months post-op. At 60 months post-treatment, LE incidence using the four criteria ranged from 43% to 94%, with 2 cm associated with the highest frequency for lymphedema occurrence and SS the lowest. Sixty-month trends

  10. Stewart-Treves syndrome: MR imaging of a postmastectomy upper-limb chronic lymphedema with angiosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Schindera, S.T.; Anderson, S.E. [University Hospital of Bern, Department of Diagnostic Radiology, Inselspital, Bern (Switzerland); Streit, M.; Kaelin, U. [University Hospital of Bern, Department of Dermatology, Inselspital, Bern (Switzerland); Stauffer, E. [University Hospital of Bern, Department of Pathology, Inselspital, Bern (Switzerland); Steinbach, L. [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)

    2005-03-01

    The rare occurrence of angiosarcoma in postmastectomy upper-limb lymphedema with magnetic resonance (MR) imaging is discussed. Unfamiliarity with this aggressive vascular tumor and its harmless appearance often leads to delayed diagnosis. Angiosarcoma complicating chronic lymphedema may be low in signal intensity on T2-weighting and short tau inversion recovery (STIR) imaging reflecting the densely cellular, fibrous stroma, and sparsely vascularized tumor histology. Additional administration of intravenous contrast medium revealed significant enhancement of the tumorous lesions. Awareness of angiosarcoma and its MR imaging appearance in patients with chronic lymphedema may be a key to early diagnosis or allow at least inclusion in the differential diagnosis. (orig.)

  11. From lymph to fat: liposuction as a treatment for complete reduction of lymphedema.

    Science.gov (United States)

    Brorson, Håkan

    2012-03-01

    There is some controversy regarding liposuction for late-stage lymphedemas. Although it is clear that conservative therapies such as complex decongestive therapy and controlled compression therapy should be tried in the first instance, options for the treatment of late-stage lymphedema that is not responding to treatment is not so clear. Liposuction has been used for many years to treat lipodystrophy. Some results have been far from optimal; however, improvements in technique, patient preparation, and patient follow-up have led to a greater and a wider acceptance of liposuction as a treatment for lymphedema. This article outlines the benefits of using liposuction and presents the evidence to support its use.

  12. Impact of Body Mass Index and Weight Fluctuation on Lymphedema Risk in Patients Treated for Breast Cancer

    Science.gov (United States)

    Jammallo, Lauren S.; Miller, Cynthia L.; Singer, Marybeth; Horick, Nora K.; Skolny, Melissa N.; Specht, Michelle C.; O'Toole, Jean; Taghian, Alphonse G.

    2013-01-01

    Background Identifying risk factors for lymphedema in patients treated for breast cancer has become increasingly important given the current lack of standardization surrounding diagnosis and treatment. Reports on the association of body mass index (BMI) and weight change with lymphedema risk are conflicting. We sought to examine the impact of pre-operative BMI and post-treatment weight change on the incidence of lymphedema. Methods From 2005-2011, 787 newly-diagnosed breast cancer patients underwent prospective arm volume measurements with a Perometer pre- and post-operatively. BMI was calculated from same-day weight and height measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10%. Univariate and multivariate Cox proportional hazards models were used to evaluate the association between lymphedema risk and pre-operative BMI, weight change, and other demographic and treatment factors. Results By multivariate analysis, a pre-operative BMI ≥30 was significantly associated with an increased risk of lymphedema compared to a pre-operative BMI lymphedema compared to patients with a pre-operative BMIlymphedema (HR: 1.97, p = lymphedema, whereas a BMI of 25-lymphedema. Patients with a pre-operative BMI≥30 and those who experience large weight fluctuations during and after treatment for breast cancer should be considered at higher-risk for lymphedema. Close monitoring or early intervention to ensure optimal treatment of the condition may be appropriate for these patients. PMID:24122390

  13. A pilot, prospective evaluation of a novel alternative for maintenance therapy of breast cancer-associated lymphedema [ISRCTN76522412

    Directory of Open Access Journals (Sweden)

    Rockson Stanley G

    2006-03-01

    Full Text Available Abstract Background Prospective investigations of complete decongestive lymphatic physiotherapy (CDPT, including manual lymphatic drainage (MLD, have validated the efficacy of these interventions for the initial reduction of edema and long-term maintenance of limb volume in lymphedema. However, CDPT demands substantial time and effort from patients to maintain these benefits; the treatments are not always well-accepted, and patients may suffer from a deterioration in quality-of-life or a time-dependent loss of initial treatment benefits. A new device designed for home use by the patient, the Flexitouch™, has been developed to mechanically simulate MLD. We have undertaken a prospective, randomized, crossover study of the efficacy of the Flexitouch™, when compared to massage, in the self-administered maintenance therapy of lymphedema. Methods A prospective, randomized, crossover study of maintenance therapy was performed in 10 patients with unilateral breast cancer-associated lymphedema of the arm. Each observation phase included self-administered treatment with the Flexitouch™ or massage, 1 hour daily for 14 days, respectively, followed by crossover to the alternate treatment phase. Each treatment phase was preceded by a 1 week treatment washout, with use of garment only. The sequence of treatment was randomly assigned. The potential impact of treatment modality on quality of life was assessed with serial administration of the SF-36. Results Statistical analysis disclosed that the order of treatment had no outcome influence, permitting 10 comparisons within each treatment group. Post-treatment arm volume reduced significantly after the Flexitouch™, but not after self-administered massage. The patients' mean weight decreased significantly with Flexitouch™ use, but not with massage. The Flexitouch™ device was apparently well-tolerated and accepted by patients. Serial SF-36 administration showed no deterioration in physical or

  14. A Brief Account of Independent College in China:Its Past and Further Development

    Institute of Scientific and Technical Information of China (English)

    何玲

    2013-01-01

    This article briefs the past and development of independent colleges until now in China, dealing with the reasons why they have come into existence and developed in a remarkable way. A somewhat detailed analysis of their distinctions from other higher education has been made and the further development strategies are also presented in it.

  15. Verrucous lesions arising in lymphedema and diabetic neuropathy: Elephantiasis nostras verrucosa or verrucous skin lesions on the feet of patients with diabetic neuropathy?

    Science.gov (United States)

    Hotta, Eri; Asai, Jun; Okuzawa, Yasutaro; Hanada, Keiji; Nomiyama, Tomoko; Takenaka, Hideya; Katoh, Norito

    2016-03-01

    Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) develop in areas with sensory loss in diabetic patients. Although various types of chronic stimulation, such as pressure or friction, are considered an important factor in the development of such lesions, the precise pathogenesis of VSLDN remains obscure, and there is currently no established treatment for this disease. Here, we present a case of VSLDN on the dorsum of the right foot. However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy. The lesion was successfully treated with a combination of elastic stocking and mixed killed bacterial suspension and hydrocortisone ointment, which suggested that VSLDN might have been exacerbated by the pre-existing lymphedema. Because various types of chronic stimulation can trigger VSLDN, treatment plans should be devised on a case-by-case basis. Therefore, it is important to investigate the presence of factors that can induce or exacerbate chronic inflammatory stimulation, such as lymphedema in our case, in each patient with VSLDN. © 2015 Japanese Dermatological Association.

  16. Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

    NARCIS (Netherlands)

    Viehoff, P.B.; Hidding, J.T.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, H.A.

    2013-01-01

    Abstract Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005-2010) were conducted. T

  17. Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

    NARCIS (Netherlands)

    Viehoff, P.B.; Hidding, J.T.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, H.A.

    2013-01-01

    Abstract Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005-2010) were conducted.

  18. The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema

    DEFF Research Database (Denmark)

    Jørgensen, Mads G; Toyserkani, Navid M; Sørensen, Jens A

    2017-01-01

    BACKGROUND: Lymphedema is one of the most dreaded side effects to any cancer treatment involving lymphadenectomy. Progressed lymphedema is adversely complex and currently there is no widely acknowledged curative treatment. Therefore recent focus has shifted to risk reduction and prevention. It has...... lymphovenous analysisstomosis (LVA) for the prevention of secondary lymphedema following lymphadenectomy. A systematic search yielded 12 articles included in the qualitative analysis and four of these were further eligible to be included in the quantitative analysis. RESULTS: We found that patients treated...... with prophylactic LVA had a significant reduction in lymphedema incidence (Relative risk: 0.33, 95%CI: 0.19 to 0.56) when compared to patients receiving no prophylactic treatment (P 

  19. Treatment of breast cancer-related lymphedema with adipose-derived regenerative cells and fat grafts

    DEFF Research Database (Denmark)

    Toyserkani, Navid Mohamadpour; Jensen, Charlotte Harken; Andersen, Ditte Caroline

    2017-01-01

    Breast cancer-related lymphedema (BCRL) is a debilitating late complication with a lack of treatment opportunities. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with freshly isolated adipose......-derived regenerative cells (ADRC) for treating lymphedema with 6 months follow-up. Ten BCRL patients were included. ADRC was injected directly into the axillary region, which was combined with a scar-releasing fat graft procedure. Primary endpoints were change in arm volume. Secondary endpoints were change in patient...... tolerated and only minor transient adverse events related to liposuction were noted. In this pilot study, a single injection of ADRC improved lymphedema based on patient-reported outcome measures, and there were no serious adverse events in the 6 months follow-up period. In addition, half of the patients...

  20. Lymphedema Following Treatment for Breast Cancer: A New Approach to an Old Problem

    Science.gov (United States)

    O’Toole, Jean; Jammallo, Lauren; Skolny, Melissa; Miller, Cynthia; Elliott, Krista; Specht, Michelle; Taghian, Alphonse G.

    2013-01-01

    Lymphedema following treatment for breast cancer can be an irreversible condition with a profound negative impact on quality of life. The lack of consensus regarding standard definitions of clinically significant lymphedema and optimal methods of measurement and quantification are unresolved problems. Inconsistencies persist regarding the appropriate timing of intervention and what forms of treatment should be the standard of care. There are reports that early detection and intervention can prevent progression, however the Level 1 evidence to support this hypothesis has yet to be generated. To assess these controversies, we propose the implementation of a screening program to detect early lymphedema in conjunction with a randomized, prospective trial designed to generate Level 1 evidence regarding the efficacy of early intervention and appropriate treatment strategies. Collaboration among institutions that manage breast cancer patients is essential to establish a standardized approach to lymphedema and to establish guidelines for best practice. PMID:23777977

  1. Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2009.

    Science.gov (United States)

    Lee, B; Andrade, M; Bergan, J; Boccardo, F; Campisi, C; Damstra, R; Flour, M; Gloviczki, P; Laredo, J; Piller, N; Michelini, S; Mortimer, P; Villavicencio, J L

    2010-10-01

    Primary lymphedema can be managed safely as one of the chronic lymphedemas by a proper combination of DLT with compression therapy. Treatment in the maintenance phase should include compression garments, self management including the compression therapy, self massage and meticulous personal hygiene and skin care in addition to lymph-transport promoting excercises. The management of primary lymphedema can be further improved with proper addition of surgical therapy either reconstructive or ablative. These two surgical therapies can be effective only when fully integrated with MLD-based DLT postoperatively. Compliance with a long-term commitment of DLT postoperatively is the most critical factor determining the success of any new treatment strategy with either reconstructive or palliative surgery. The future of management of primary lymphedema caused by truncular lymphatic malformation has never been brighter with the new prospect of gene-oriented management.

  2. Lymphatic Reprogramming of Adult Endothelial Stem Cells for a Cell-Based Therapy for Lymphedema in Breast Cancer Patients

    Science.gov (United States)

    2008-09-01

    Therapy for Lymphedema inBreast Cancer Patients PRINCIPAL INVESTIGATOR: Young Kwon Hong, Ph.D. CONTRACTING ORGANIZATION...5a. CONTRACT NUMBER 4. TITLE AND SUBTITLE Lymphatic Reprogramming of Adult Endothelial Stem Cells for a Cell-Based Therapy for Lymphedema in... lymphedema patients. The key significance of our proposal is to utilize the elusive circulating adult stem cells to avoid the ethical and immunological

  3. Streptococcal toxic shock syndrome occurred during postoperative radiotherapy in a cancer patient with preexisting lymphedema and chronic illness -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong; Kim, Dong Min [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2006-12-15

    A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

  4. Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis.

    Science.gov (United States)

    Li, Ke; Zhang, Zheng; Liu, Ning Fei; Feng, Shao Qing; Tong, Yun; Zhang, Ju Fang; Constantinides, Joannis; Lazzeri, Davide; Grassetti, Luca; Nicoli, Fabio; Zhang, Yi Xin

    2017-01-26

    Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

  5. Evidence-based practice in the management of lower limb lymphedema after gynecological cancer.

    Science.gov (United States)

    Iwersen, Lisandra Fossari; Sperandio, Fabiana Flores; Toriy, Ariana Machado; Palú, Marina; Medeiros da Luz, Clarissa

    2017-01-01

    Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.

  6. Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: a pilot study.

    Science.gov (United States)

    Bae, Hasuk; Kim, Ho Jeong

    2013-04-01

    To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment. In a prospective clinical trial, ESWT was performed consecutively 4 times over two weeks in 7 patients who were diagnosed with stage 3 secondary lymphedema after breast cancer treatment. Each patient was treated with four sessions of ESWT (0.056-0.068 mJ/mm(2), 2,000 impulses). The parameters were the circumference of the arm, thickness of the skin and volume of the arm. We measured these parameters with baseline values before ESWT and repeated the evaluation after each ESWT treatment. Subjective data on skin thickness, edema and sensory impairment were obtained using a visual analogue scale (VAS). The mean volume of the affected arm after four consecutive ESWT was significantly reduced from 2,332 to 2,144 mL (p<0.05). The circumference and thickness of the skin fold of the affected arm were significantly decreased after the fourth ESWT (p<0.05). The three VAS scores were significantly improved after the fourth ESWT. Almost all patients were satisfied with this treatment and felt softer texture in their affected arm after treatment. ESWT is an effective modality in the treatment of stage 3 lymphedema after breast cancer treatment. ESWT reduced the circumference and the thickness of arms with lymphedema and satisfied almost all patients with lymphedema. Therefore, this treatment provides clinically favorable outcome to patients with breast cancer-related lymphedema.

  7. Indirect magnetic resonance lymphangiography in patients with lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Foeldi, Etelka [Foeldi Clinic for Lymphology, Hinterzarten, Roesslehofweg 2-6, D-79856 Hinterzarten (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg (Germany)

    2006-09-15

    Purpose: To assess the feasibility of indirect magnetic resonance (MR) lymphangiography with intracutaneous injection of gadodiamide, a commercially available, non-ionic, extracellular paramagnetic contrast agent for the detection of lymphatic vessels in patients with lymphedema. Materials and methods: In 2005, three patients with lymphedema of the lower extremities (1 primary, 2 secondary) were referred by the Foeldi Clinic for Lymphology for indirect magnetic resonance lymphangiography. 4.5 mL of gadodiamide and 0.5 mL of mepivacainhydrochloride 1% were injected intracutaneously into the dorsal aspect of each foot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For indirect magnetic resonance lymphangiography, a 3D Fast Low Angle Shot (FLASH) sequence (TR/TE: 5.1/1.23; flip angle: 25; matrix: 448 x 448; bandwidth: 330 Hz/pixel; 6/8 rectangular field of view with a maximum dimension of 500 mm; slices: 88; voxel size: 2.0 mm x 1.0 mm x 1.0 mm; acquisition time: 0 min 31 s) was used. Results: Indirect magnetic resonance lymphangiography depicted lymphatic vessels of the lower and upper leg, and inguinal lymph nodes in all three patients. After 5 min of contrast material application, concomitant venous enhancement was detected. Collateral vessels with dermal back-flow were seen in two patients. A lymphocele in the inguinal region with the afferent lymphatic vessel was depicted in one patient. Conclusion: In the presented small study group, indirect magnetic resonance lymphangiography was technically feasible, and no complications were observed after intracutaneous injection of gadodiamide. Visualizing the lymphatic vessels and accompanying complications non-invasively and without the use of radiation, the presented method has the capability to become a routine diagnostic imaging tool in patients with primary and secondary lymphedema. The method is not able to characterize lymph node morphology, but could provide additional

  8. FILAR I AL LYMPHEDEMA LOWER LIMB DEBULKING 34 CASES

    Directory of Open Access Journals (Sweden)

    Baburao

    2015-10-01

    Full Text Available There are various treatment options in the management of filarial lymphedema of the lower extremities. The end point, regardless of the method adopted is a reduction of the girth of the limb, prevention of future increases in limb girth, prevention of recurrent episodes of streptococcal cellulitis; more important the treatment method used should not lead to any secondary problems that may far out shadow the primary co Majority of the methods adopted are mainly of the secondary prevention kind; very few of the procedures to date cure the disease condition. A few of the methods have been historically found to be more effective than the others; this may be real or apparent as the methodology of - reporting swelling in the lower limb may not have been consistent and there are too many variables to consider. This study seeks to evaluate the efficacy of one such treatment protocol for the management of filarial lymphedema of the lower limb 80 patients were admitted for filarial lymphedema of the lower limbs from 2005 to 2015 Of these 42 patients underwent surgical treatment; operative records for 8 of these patients was insufficient to analyse; among the remaining 34 patients 19 patients were unavailable for review. This left us a patient population of 15 for the final analysis . The surgical treatment of all of the 15 patients was identical, after preop preparation by using compression ba n dages to soften the edema along with a period of bed rest debulking of excess skin and subcutaneous tissue and primary closure was done. The intro operative application of Esmarch bandages helped in expelling fluid from the tissues and this ensured that closure was obtained with no tension at the margins. Patients were kept for at least 5 days post op before discharge; the routine use of compression crepe bandages postop along with bed rest ensured that we did not have a single case of skin necrosis or wound disruption in the postop period. All patients were given

  9. Tc-99m-Human Serum Albumin Transit Time as a Measure of Arm Breast Cancer-Related Lymphedema

    DEFF Research Database (Denmark)

    Toyserkani, Navid M; Hvidsten, Svend; Tabatabaeifar, Siavosh

    2017-01-01

    34-68 years, with unilateral arm lymphedema following breast cancer treatment underwent bilateral lymphoscintigraphy using intradermal injection in both hands of technetium-99m-labeled human serum albumin and sequential 5 min imaging for 5 hours. The mean transit time (MTT) in the arms was calculated...... based on time activity curves generated from injection site and arm regions. Visual lymphedema scoring was performed based on dermal backflow and lymph node presence. Excess arm volume was calculated from circumference measurements. RESULTS: The MTT (mean ± SD) was significantly longer in the lymphedema......, 18.6-68.7 minutes; P lymphedema from...

  10. A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011).

    Science.gov (United States)

    Stout, N L; Weiss, R; Feldman, J L; Stewart, B R; Armer, J M; Cormier, J N; Shih, Y-C T

    2013-03-01

    A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.

  11. The aesthetic rationality of the popular expressive arts: Lifeworld communication among breast cancer survivors living with lymphedema.

    Science.gov (United States)

    Quinlan, Elizabeth; Thomas, Roanne; Ahmed, Shahid; Fichtner, Pam; McMullen, Linda; Block, Janice

    2014-08-01

    The use of popular expressive arts as antidotes to the pathologies of the parallel processes of lifeworld colonization and cultural impoverishment has been under-theorized. This article enters the void with a project in which breast cancer survivors used collages and installations of everyday objects to solicit their authentic expression of the psycho-social impacts of lymphedema. The article enlists Jurgen Habermas' communicative action theory to explore the potential of these expressive arts to expand participants' meaningful engagement with their lifeworlds. The findings point to the unique non-linguistic discursivity of these non-institutional artistic forms as their liberating power to disclose silenced human needs: the images 'spoke' for themselves for group members to recognize shared subjectivities. The authenticity claims inherent in the art forms fostered collective reflexivity and spontaneous, affective responses and compelled the group to create new collective understandings of the experience of living with lymphedema. The article contributes theoretical insights regarding the emancipatory potential of aesthetic-expressive rationality, an under-developed area of Habermasian theory of communicative action, and to the burgeoning literature on arts-based methods in social scientific research.

  12. MRI of lymphedema using short-TI-IR (STIR)

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Koichi; Ishida, Osamu; Mabuchi, Norihisa; Shindou, Hiroshi; Yoshioka, Hiroyasu; Kumano, Machiko; Hamada, Tatsumi; Ohkuma, Moriya (Kinki Univ., Osaka (Japan). School of Medicine)

    1990-01-01

    Thirty four cases with lymphedema of the extremities were examined with MRI at 0.5 tesla. On T1-weighted image, the enlarged subcutaneous tissue and the subcutaneous trabecular structures were seen in all cases. Moreover, the trabecular structures in the enlarged subcutaneous tissue showed low signal intensity on T1-weighted image and high signal intensity on T2-weighted image in all cases. Additionally, in 12 of 15 cases examined by Short-TI-IR (STIR) image, the trabecular structures and fluid collections in the subcutaneous tissue were shown more definitely in high signal intensity than by T2-weighted image. We consider MRI using STIR is to be useful in the evaluation of edematous disease. (author).

  13. 48 CFR 231.205-18 - Independent research and development and bid and proposal costs.

    Science.gov (United States)

    2010-10-01

    ... and life-cycle costs of military systems. (3) Strengthen the defense industrial and technology base of... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Independent research and development and bid and proposal costs. 231.205-18 Section 231.205-18 Federal Acquisition Regulations System...

  14. Lymphedema of the lower limbs - a lymphoscintigraphic approach; Linfedemas dos membros inferiores: estudo linfocintilografico

    Energy Technology Data Exchange (ETDEWEB)

    Cestari, S.C.P.; Petri, V.; Castiglioni, M.L.V.; Lederman, H. [Escola Paulista de Medicina, Sao Paulo, SP (Brazil)

    1994-12-31

    Patients with lymphedema of the lower limbs (LLL) are usually affected by recurrent erysipelas. This bacterial infection is usually admitted as an aetiological factor, but it can be a consequence of some previous lymphatic abnormality. Classically, the commonest causative factors of LLL are bacterial infection, venous ulcers, trauma (leading to secondary lymphedema) and congenital disorders of the lymphatic system primary lymphedema praecox or tarda. To identify previous lymphatics abnormalities in patients with LLL, admitted as having secondary lymphatic lymphedema - as consequences of infection, trauma or other factors -, by using lymphoscintigraphic method. To observe advantages of this approach in practical assistance and evaluation of LLL cases. Twelve patients with LLL, supposed to have primary (congenital) or secondary disorder affecting one or both lower extremities were submitted to lymphoscintigraphy at the Escola Paulista de Medicina of Sao Paulo, Brazil. Each patient received an intra dermal injection of labelled Dextran (Dx{sup 99m} Tc) at the first interdigital space of each foot and , after one to three hours, images of lower extremities, pelvic and abdominal areas were obtained with Gammatome CGR. Examination of all 24 lower extremities disclosed clinical diagnosis of lymphedema in 17 (70.8%), being five (41.6%) with clinical signs of lymphedema of both lower limbs and seven (58.3%) of a single one. The lymphoscintigraphic images revealed lymphatic disordersin 22 of the 24 extremities (91.7%). Lymphoscintigraphic abnormalities in clinically normal lower extremities were observed in five cases (41.3%). Lymphoscintigraphy is a non-invasive useful method to study LLL, with involvement of one or both limbs. It does not differentiate between primary and secondary lymphedema, but makes possible to detect cases of normal appearance of the limbs with previous lymphatic defect(s), changing aetiological diagnosis. (Abstract Truncated)

  15. Children's intuitive sense of number develops independently of their perception of area, density, length, and time.

    Science.gov (United States)

    Odic, Darko

    2017-05-12

    Young children can quickly and intuitively represent the number of objects in a visual scene through the Approximate Number System (ANS). The precision of the ANS - indexed as the most difficult ratio of two numbers that children can reliably discriminate - is well known to improve with development: whereas infants require relatively large ratios to discriminate number, children can discriminate finer and finer changes in number between toddlerhood and early adulthood. Which factors drive the developmental improvements in ANS precision? Here, we investigate the influence of four non-numeric dimensions - area, density, line length, and time - on ANS development, exploring the degree to which the ANS develops independently from these other dimensions, from inhibitory control, and from domain-general factors such as attention and working memory that are shared between these tasks. A sample of 185 children between the ages of 2 and 12 years completed five discrimination tasks: approximate number, area, density, length, and time. We report three main findings. First, logistic growth models applied to both accuracy and Weber fractions (w; an index of ANS precision) across age reveal distinct developmental trajectories across the five dimensions: while area and length develop by adolescence, time and density do not develop fully until early adulthood, with ANS precision developing at an intermediate rate. Second, we find that ANS precision develops independently of the other four dimensions, which in turn develop independently of the ANS. Third, we find that ANS precision also develops independently from individual differences in inhibitory control (indexed as the difference in accuracy and w between Congruent and Incongruent ANS trials). Together, these results are the first to provide evidence for domain-specific improvements in ANS precision, and place children's maturing perception of number, space, and time into a broader developmental context. © 2017 John Wiley

  16. Comparison of Two Independently Developed Bridge Weigh-In-Motion Systems

    OpenAIRE

    O'Brien, Eugene J.; Znidaric, Ales; Dempsey, Anthony T.

    1999-01-01

    This paper describes an experiment in which 2 independently developed bridge weigh-in-motion (WIM) systems are tested and compared, both for accuracy and durability. The systems, an Irish prototype still under development and a commercially available American system, were tested on a bridge in Slovenia. 11 statically pre-weighted trucks were each driven over the bridge several times at a range of typical highway speeds. Accuracies for axle and gross vehicle weights are presented within the fr...

  17. THE USE OF E-PORTFOLIO TO DEVELOP ENGLISH LANGUAGE LEARNERS' AUTONOMY AND INDEPENDENCE

    Directory of Open Access Journals (Sweden)

    Oksana I. Ivanova

    2017-09-01

    Full Text Available This paper discusses the findings of a research study concerning the use of e-portfolios to develop learners' autonomy and independence, from the perspectives of teachers and students participating in this study. The findings demonstrate many of the benefits of e-portfolio practice regarding learners’ increased sense of ownership, teacher and peer feedback, enriched learning experience at both individual and technological levels, enhanced opportunity for self-improvement and increased awareness of the learning process. Despite many positive aspects of e-portfolios use, the study reveals some challenges facing students, teachers and support staff, mainly connected with technical problems and Internet access, and the necessity for teachers and learners to change their roles to become more independent in the learning process. The author concludes that e-portfolio is a promising tool to stimulate and challenge students to become independent and self-regulated learners that should be implemented in English language learning at higher educational institutions.

  18. Diagnosis and Treatment of Lymphedema Following Breast Cancer: A Population-based Study

    Science.gov (United States)

    Sayko, Oksana; Pezzin, Liliana E.; Yen, Tina W.F.; Nattinger, Ann B.

    2013-01-01

    Objective To examine factors associated with variations in diagnosis and rehabilitation treatments received by women with self-reported lymphedema secondary to breast cancer care. Design Population-based, prospective study. Setting California, Florida, Illinois, New York. Participants Elderly (65+) women identified from Medicare claims as having had an incident breast cancer surgery in 2003. Interventions N.A. Main Outcome Measures Self-reported incidence of lymphedema symptoms, formal lymphedema diagnosis; treatments for lymphedema. Results Of the 450 breast cancer survivors with lymphedema who participated in the study, 290 (64.4%) were formally diagnosed with the condition by a physician. An additional 160 (35.6%) reported symptoms consistent with lymphedema (arm swelling on the side of surgery that is absent on the contralateral arm) but were not formally diagnosed. Of those reporting as being diagnosed by a physician, 39 (13.4%) received the comprehensive decongestive therapy (CDT) that included multiple components of treatment (manual lymphatic drainage (MLD), bandaging with short stretch bandages, using compression sleeves, skin care and remedial exercises), 24 (8.3%) received MLD only, 162 (55.9%) used bandages, compression garments or a pneumatic pump only, 8 (2.8%) relied solely on skin care or exercise to relieve symptoms and 65 (22.4%) received no treatment at all. Multivariate regressions revealed that race (African American), lower income, and lower levels of social support increased a woman’s probability of having undiagnosed lymphedema. Even when formally diagnosed, African American women were more likely to receive no treatment or to be treated with bandages/compression only, rather than to receive the multi-modality, comprehensive decongestive therapy. Conclusions Lymphedema is a disabling chronic condition related to breast cancer treatment. Our results suggest that a substantial proportion of those reporting symptoms were not formally

  19. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema.

    Directory of Open Access Journals (Sweden)

    Dae-Hyun Jang

    Full Text Available To evaluate the pathological effect of the duration of arm swelling on the shoulder pathology in patients with breast cancer-related lymphedema.Forty seven breast cancer patients with unilateral arm lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any lesions.Abnormalities were detected by ultrasound in 41/47 (87.2% study participants. Subacromial subdeltoid bursal thickening was found in 26/47 (55.3% participants, distension of the biceps brachii tendon sheath was found in 14/47 (29.8% and a supraspinatus tendon tear was found in 13/47 (27.7%. Patients with a supraspinatus tendon tear were found to have a significantly longer duration of lymphedema (1310 days vs. 398 days, p = 0.032.The duration of arm lymphedema has a progressive pathological effect on rotator cuff. Clinicians should adopt an early management approach of shoulder pain in patients with breast cancer-related lymphedema.

  20. Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: a case report.

    Science.gov (United States)

    Crane, Patricia

    2009-01-01

    Sacroiliac joint (SIJ) dysfunction, a common source of low back and buttock pain, can occur from cumulative shear or torsional forces during activities such as walking that require weight to transfer from one extremity to the other. Individuals with lower extremity lymphedema may also experience SIJ dysfunction. The purpose of this article was to describe the examination, diagnosis, and intervention for a patient with lower extremity lymphedema and sacroiliac joint dysfunction. The patient was a 50-year-old female with increased left lower extremity lymphedema and left buttock and groin pain that was previously treated unsuccessfully with physical therapy. SIJ dysfunction was attributable to an alteration in gait pattern caused by increased limb volume associated with lymphedema. The patient was treated for 19 visits over six weeks with complete decongestive therapy (CDT), muscle energy techniques, core stabilization, and the application of a pelvic support belt. Objective changes include decreased lymphedema, increased lower abdominal and lumbar extension strength, and decreased Oswetry Disability Index ratings. The patient was able to ambulate community distances without an assistive device and to resume unsupervised strength and conditioning without pain.

  1. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis☆

    Science.gov (United States)

    Ripoll, Cristina; Groszmann, Roberto J.; Garcia-Tsao, Guadalupe; Bosch, Jaime; Grace, Norman; Burroughs, Andrew; Planas, Ramon; Escorsell, Angels; Garcia-Pagan, Juan Carlos; Makuch, Robert; Patch, David; Matloff, Daniel S.

    2013-01-01

    Background/Aims A total of 213 patients with compensated cirrhosis, portal hypertension and no varices were included in a trial evaluating beta-blockers in preventing varices. Predictors of the development of hepatocellular carcinoma (HCC), including hepatic venous pressure gradient (HVPG) were analyzed. Methods Baseline laboratory tests, ultrasound and HVPG measurements were performed. Patients were followed prospectively every three months until development of varices or variceal bleeding or end of the study in 09/02. The endpoint was HCC development according to standard diagnostic criteria. Univariate and multivariate Cox regression models were developed to identify predictors of HCC. Results In a median follow-up of 58 months 26/213 (12.2%) patients developed HCC. Eight patients were transplanted and 28 patients died without HCC. Twenty-one (84%) HCC developed in patients with HCV. On multivariate analysis HVPG (HR 1.18; 95%CI 1.08–1.29), albumin (HR 0.34; 95%CI 0.14–0.83) and viral etiology (HR 4.59; 95%CI 1.51–13.92) were independent predictors of HCC development. ROC curves identified 10 mmHg of HVPG as the best cutoff; those who had an HVPG above this value had a 6-fold increase in the HCC incidence. Conclusions Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk. PMID:19303163

  2. Acupotomy and venesection in Upper Limb Lymphedema and Peripheral neuropathy following Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Jang Eun-ha

    2009-12-01

    Full Text Available Purpose: In order to estimate clinical effects of acupotomy and venesection in a patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery. Methods: From 17th August, 2009 to 29th August 2009, 1 female patient with peripheral neuropathy and upper limb lymphedema following breast cancer surgery was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy with venesection. Results: The patient's chief complaints- Lt hand numbness, Lt arm edema, Lt. wrist flexion limitation - were notably improved. Conclusions : This study demonstrates that oriental medical treatment with acupotomy and venesection therapy has significant effect in improving symptoms of peripheral neuropathy and upper limb lymphedema following breast cancer surgery, as though we had not wide experience in this treatment, more research is needed.

  3. Stakeholder insights on the planning and development of an independent benchmark standard for responsible food marketing.

    Science.gov (United States)

    Cairns, Georgina; Macdonald, Laura

    2016-06-01

    A mixed methods qualitative survey investigated stakeholder responses to the proposal to develop an independently defined, audited and certifiable set of benchmark standards for responsible food marketing. Its purpose was to inform the policy planning and development process. A majority of respondents were supportive of the proposal. A majority also viewed the engagement and collaboration of a broad base of stakeholders in its planning and development as potentially beneficial. Positive responses were associated with views that policy controls can and should be extended to include all form of marketing, that obesity and non-communicable diseases prevention and control was a shared responsibility and an urgent policy priority and prior experience of independent standardisation as a policy lever for good practice. Strong policy leadership, demonstrable utilisation of the evidence base in its development and deployment and a conceptually clear communications plan were identified as priority targets for future policy planning. Future research priorities include generating more evidence on the feasibility of developing an effective community of practice and theory of change, the strengths and limitations of these and developing an evidence-based step-wise communications strategy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Rural Development in Bangladesh since Independence: A Study on Progress and Performance

    Directory of Open Access Journals (Sweden)

    Mohammad Ismail Hossain

    2012-09-01

    Full Text Available Rural development has been the core focus of the Bangladesh economic policies since her independence. The rural sector is pivotal to the country‟s economic, social and political development. This paper examines the Bangladesh rural development policies, strategies and programs since Independence in 1971. Secondary data were used and collected from various sources especially from BBS and HIES. Data were analyzed using descriptive statistical tools such as mean and percentage to reach the objectives. Results of this study show that the share of agricultural sector in the country‟s GDP has declined which is an indicator of a country‟s progress from an agriculture-based to an export-oriented economy. The success of the agricultural and rural programs in Bangladesh is reflected in the reduction in the poverty incidence in the rural sector from almost 54 percent in the 1983-84 to about 35 percent in 2009-10. Development efforts of Bangladesh are governed by the twin objectives of achieving growth with equity and reducing poverty. The government policy has to some extent achieved the intended results but poverty and inequality are still significant and apparent. Hence, rural development continues to be an important agenda to the country‟s development effort.

  5. FOREIGN TRADE OF INDIA DURING PRE & POST INDEPENDENCE (STUDY OF DEVELOPMENT OF INDIA

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    Renu Bansal

    2012-09-01

    Full Text Available This subject is selected for study, since it is directlyconnected with the growth of our economy. In our earlierperiod after independence, more emphasis was put for tomake the country self- sufficient. However, that is true tobe more harmful for the growth of our economy. It is thenfelt that the development and growth of economy, an allencompassing, comprehensive view needs to be taken forthe overall development of the country. For this, increase inexport is of vital importance and also we have to facilitatethose imports, which are required to stimulate oureconomy.

  6. Upper extremity function and quality of life in patients with breast cancer related lymphedema

    Directory of Open Access Journals (Sweden)

    Bojinović-Rodić Dragana

    2016-01-01

    Full Text Available Background/Aim. Upper limb lymphedema is one of the most frequent chronic complications after breast cancer treatment with a significant impact on the upper extremity function and quality of life (QoL. The aim of this study was to estimate health-related quality of life (HRQoL in patients with breast-cancer-related lymphedema and its correlation with upper limb function and the size of edema. Methods. The cross-sectional study included 54 breast-cancer-related lymphedema patients. The quality of life was evaluated by the Short Form 36-Item Health Survey (SF-36. Upper limb function was assessed by the Quick Disability of the Arm, Shoulder and Hand questionnaire (Quick DASH. The size of lymphedema was determined by the arm circumference. Results. The higher HRQoL score was assessed for mental health (47.0 ± 12.2 than for physical one (42.2 ± 7.5. The highest values of SF-36 were found in the domains of Mental Health (67.7 ± 22.9 and Social Function (70.1 ± 23.1. The lowest scores were registered in the domains of Role Physical (46.9 ± 39.1 and General Health (49.3 ± 20.1. Upper extremity function statistically significantly correlated with the domains Role Physical, Bodily Pain and Physical Composite Summary and also, with the domain Role Emotional (p 0.05. Conclusions. Physical disability in patients with breast cancer-related lymphedema influences quality of life more than mental health. Upper limb function has a significant impact on quality of life, not only on the physical, but also on the mental component. The presence of breast-cancer-related lymphedema certainly affects upper limb function and quality of life, but in this study no significant correlation between the size of edema and quality of life was found.

  7. Illustrating the (invisible: Understanding the impact of loss in adults living with secondary lymphedema after cancer

    Directory of Open Access Journals (Sweden)

    Roanne Thomas

    2014-08-01

    Full Text Available Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC. SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women with SLC were recruited from two research sites (Fredericton, NB, and Ottawa, ON, Canada to participate in semi-structured interviews about the physical and psychosocial aspects of SLC. Using a methodology of interpretive description, our analysis of participant interviews reveals the complex ways in which men and women felt both visible and invisible within various contexts. We discuss three majors themes: (invisibility and appearance related to material losses; (invisibility and action connected to visible losses in function, as well as invisible struggles to care for oneself; and the loss of present and future well-being, as SLC renders some limitations visible while potentially obscuring a hopeful future indefinitely. Our research indicates that timely diagnosis of SLC would be an immediate first step in recognizing the physical and emotional dimensions of the condition. To accomplish this, increased awareness is needed. To enhance quality of life for those living with SLC, the development of new resources and psychosocial supports is also required.

  8. Supervising Model of Independent Enterprise Group (Study of Community Development PT Badak NGL

    Directory of Open Access Journals (Sweden)

    Hermansyah Hermansyah

    2016-06-01

    Full Text Available This research aims to arrange an empowerment model of enterprise group through the program of Community Development in order to be independent and ready to compete, which is begun from the empirical study of the success of Cipta Busana Cooperative.. This research uses the descriptive analysis by using a case study on one enterprise supervised by PT Badak NGL that is Koperasi Cipta Busana (Kocibu. Kocibu is chosen to be the object of research due to its success to achieve the target to be the independent supervised enterprise in the fourth year. The data analysis method used in this research is the explorative analysis. Based on the research, there are some results such as that Kocibu is one of the supervised Micro, Small and Medium Enterprises of PT Badak NGL that could develop and be independent through several supporting programs. Some of key successes of Kocibu are as follows: a high commitment, a good leader, and intensive supervising programs. Besides, a good marketing system also contributes to the key of success. There are some aspects that naturally contribute to the Kocibu improvement and emerge naturally as follows: the leader figure and the high commitment from the stakeholders. While, the aspects emerged by design are: the supervising and training programs, the evaluation, the determination of rules, and the business targets. Hopefully, after this research has been conducted, the aspects appeared naturaly would be realized so early that the success of the public empowerment program will be able to increase. 

  9. THE CONCEPT OF THE DEVELOPMENT OF AUDIT AS AN INDEPENDENT FORM OF SCIENTIFIC KNOWLEDGE

    Directory of Open Access Journals (Sweden)

    Safonova M. F.

    2015-12-01

    Full Text Available This article considers the problem of development of audit activities as a practical view, and the concept of evolution as science. We have summarized the reasons for appearance and existence of audit, which are the following: separation of powers between the management and the owners of economic subjects; there is not confidence from the external interested users to information about the safety of financial statements; it is necessary to obtain the assurance of economic safety as additional factor of stability. There is a detailed interpretation of definition the "audit", considering the current economic realities, from the position of the sphere of scientific knowledge and from the position of practical activities in the part of verification reports by the independent experts and as an element of economic safety of the company and the country. The trend of market development for audit services was defined and aimed for its consolidation. The perspective of development does not connect with the classic audit of accounting reporting, but it connects with development forecasts for the company. The audit should "look into the future" of each client, which must be recorded in an audit report for improving the quality. The author offers a new paradigm of broad understanding of the audit as a form of independent monitoring, which allows to develop and to realize the concept of auditing business that meets the needs of modern society

  10. Microcephaly/lymphedema and terminal deletion of the long arm of chromosome 13

    Energy Technology Data Exchange (ETDEWEB)

    Fryns, J.P. [Univ. of Leuven (Belgium)

    1995-07-03

    Recently, we examined a 2-year-old boy with the association of microcephaly and significant pedal edema that extended to the distal parts of the legs. Prometaphase chromosome studies showed a small terminal deletion in the long arm of chromosome 13 of band 13q34, karyotype 46,XY,del(13)(q34{yields}qter). The present finding of a small terminal 13q34 deletion in this young boy with microcephaly/lymphedema is a first indication that the lymphedema/microcephaly association can be due to a small terminal 13q deletion. 2 refs.

  11. Establishing and Sustaining a Prospective Screening Program for Breast Cancer-Related Lymphedema at the Massachusetts General Hospital: Lessons Learned

    Directory of Open Access Journals (Sweden)

    Cheryl Brunelle

    2015-05-01

    Full Text Available There has been an increasing call to prospectively screen patients with breast cancer for the development of breast cancer-related lymphedema (BCRL following their breast cancer treatment. While the components of a prospective screening program have been published, some centers struggle with how to initiate, establish, and sustain a screening program of their own. The intent of this manuscript is to share our experience and struggles in establishing a prospective surveillance program within the infrastructure of our institution. It is our hope that by sharing our history other centers can learn from our mistakes and successes to better design their own prospective screening program to best serve their patient population.

  12. DEVELOPMENT OF RISK-BASED AND TECHNOLOGY-INDEPENDENT SAFETY CRITERIA FOR GENERATION IV SYSTEMS

    Energy Technology Data Exchange (ETDEWEB)

    William E. Kastenberg; Edward Blandford; Lance Kim

    2009-03-31

    This project has developed quantitative safety goals for Generation IV (Gen IV) nuclear energy systems. These safety goals are risk based and technology independent. The foundations for a new approach to risk analysis has been developed, along with a new operational definition of risk. This project has furthered the current state-of-the-art by developing quantitative safety goals for both Gen IV reactors and for the overall Gen IV nuclear fuel cycle. The risk analysis approach developed will quantify performance measures, characterize uncertainty, and address a more comprehensive view of safety as it relates to the overall system. Appropriate safety criteria are necessary to manage risk in a prudent and cost-effective manner. This study is also important for government agencies responsible for managing, reviewing, and for approving advanced reactor systems because they are charged with assuring the health and safety of the public.

  13. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer.

    Science.gov (United States)

    Patel, Ketan M; Lin, Chia-Yu; Cheng, Ming-Huei

    2015-07-01

    Microsurgical techniques for the treatment of lymphedema rapidly increased in popularity. Although surgical success with vascularized lymph node (VLN) transfer has been demonstrated, limited studies have investigated the influence of microsurgical treatments on health-related quality-of-life (HRQoL) parameters. The aim of this study was to prospectively evaluate changes in HRQoL following VLN transfer for upper- and lower-extremity lymphedema using a validated instrument. An Institutional Review Board-approved prospective study was performed of patients who underwent VLN transfer for symptomatic upper- or lower-limb lymphedema. A validated lymphedema-specific questionnaire-lymphoedema quality-of-life study-was utilized to assess specific quality-of-life parameters at multiple time points during the 12-month perioperative period. For a comparison with HRQoL metrics, limb circumference measurements were obtained to assess circumference differentiation. Twenty-five patients met the study criteria. Limb circumference analysis revealed significant early improvements following VLN transfer, with continued improvement during the study period (upper-limb lymphedema: 24.4 %; lower-limb lymphedema: 35.2 %). These improvements were mirrored by improvements in all HRQoL domains and overall quality of life (p lymphedema with VLN transfer procedures effectively decrease limb circumference. This improvement is mirrored by improvements in patient-reported outcomes and quality of life. These changes can be observed as soon as 1 month postoperatively, and continued steady improvement can be expected.

  14. PP142. Independent effects of pregnancy induced hypertension on childhood development: A retrospective cohort study.

    Science.gov (United States)

    Campbell, D; Love, E; Crum, J; Bhattacharya, S

    2012-07-01

    The effect of maternal pre-eclampsia on neurological and cognitive development of children is not well known. A literature search of Ovid MEDLINE, EMBASE and CINAHL revealed differing opinions in the current literature. It would appear that there is uncertainty regarding the independent effects of preterm birth, birth weight and pre-eclampsia on early childhood development, complicated by the fact that most pre-eclamptic mothers are delivered preterm, and many such babies are growth restricted. To assess whether maternal hypertension in pregnancy was independently associated with additional support needs in children Retrospective cohort study Setting: Grampian region of Scotland Main outcome measure: The primary outcome of interest was whether a child had developed a record in the Support Needs System (Grampian). Secondary outcomes included the development of a particular disorder or deficiency for example, autism. Linkage of birth records of all singleton deliveries occurring in primigravidae between 1995 and 2008 in Aberdeen Maternity and Neonatal Databank with the Support Needs System (SNS) dataset in Grampian. The database from which the study population is derived - the Aberdeen Maternity and Neonatal Databank (AMND) has been in existence since 1950 The Support Needs System (SNS) is part of a Scottish-wide database recording information about children who have additional support needs for more than six months and has been utilised in Grampian since 1998. The first exposed cohort comprised children whose mothers had pre-eclampsia or eclampsia and the second, those whose mothers had gestational hypertension. Children with normotensive mothers formed the unexposed cohort. Hypertensive status in pregnancy was based on Davey and MacGillivray's classification of hypertensive disorders of pregnancy. Crude and adjusted odds ratios with 95% confidence Intervals of having a record in SNS in the presence of maternal pregnancy induced hypertension were calculated using

  15. Corruption overseas. [The Foreign Corrupt Practices Act as applied to interntional independent power development

    Energy Technology Data Exchange (ETDEWEB)

    Gantz, D.A.; Goodwin, L.M.

    1993-11-01

    Early on, companies participating in the international independent power industry learned that just because they were doing business abroad, they were not exempt from US law. For example, initial efforts at international development were hampered by the global reach of the Public Utility Regulatory Policies Act. And while compliance with the Public Utility Holding Company Act has been simplified considerably by the National Energy Act, compliance remains an important consideration for utility affiliates. Similarly, tax planning requires considering not only the US tax system, but that of the host country as well as applicable international tax treaties. One of the most important but least understood US laws affecting international developers is the Foreign Corrupt Practices Act. The FCPA was enacted by Congress in 1977 in reaction to disclosures that certain large US corporations had bribed foreign officials to obtain business. The FCPA is intended to discourage a wide variety of actions considered corrupt. The cost of noncompliance is high, both in actual penalties and the effect on a company's international business reputation. Accordingly, FCPA compliance has become a key issue for the leading international independent power developers, and should be a primary consideration for any company that wants to play a meaningful role in the industry.

  16. Impact of community-based lymphedema management on perceived disability among patients with lymphatic filariasis in Orissa State, India.

    Directory of Open Access Journals (Sweden)

    Philip J Budge

    Full Text Available BACKGROUND: Lymphatic filariasis (LF infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability. METHODOLOGY/PRINCIPAL FINDINGS: For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009, and then at regular intervals through 24 months (July, 2011, to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001 from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3 or advanced (Stage 4-7 lymphedema, reporting an adenolymphangitis (ADL episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001 due to their lymphedema, compared to baseline. SIGNIFICANCE: These results

  17. To The Issue Of Sustainable Development Of Architecture And Urban Planning Of Independent Uzbekistan

    Directory of Open Access Journals (Sweden)

    Dinara Nazarova

    2015-08-01

    Full Text Available The article is devoted to the development of urban planning and architecture in the era of independence of Uzbekistan. There is also considered the issues of sustainable development of the regions and cities of Uzbekistan. In the realization process of above mentioned tasks first it is necessary to refuse old methods of functional urban planning design obtruded by the Soviet urban planning. In the XX century in designing master plans of cities development of new city parts was taken as a composition framework which neglected old city part that hasnt received appropriate attention. This was the main mistake of the Soviet politics which made cities lost historical city images ensemble construction spirit.

  18. 48 CFR 9904.420 - Accounting for independent research and development costs and bid and proposal costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Accounting for independent research and development costs and bid and proposal costs. 9904.420 Section 9904.420 Federal Acquisition... Accounting for independent research and development costs and bid and proposal costs....

  19. SAP-independent and -dependent regulation of innate T cell development involving SLAMF receptors

    Directory of Open Access Journals (Sweden)

    Jaime eDe Calisto

    2014-04-01

    Full Text Available Signaling lymphocytic activation molecule (SLAM-associated protein (SAP plays an essential role in the immune system mediating the function of several members of the SLAM family (SLAMF of receptors, whose expression is essential for T, NK, and B cell responses. Additionally, the expression of SAP in double-positive (DP thymocytes is mandatory for natural killer T (NKT cells and, in mouse, for innate CD8+ T cell development. To date, only two members of the SLAMF of receptors, Slamf1 and Slamf6, have been shown to positively cooperate during NKT cell differentiation in mouse. However, it is less clear whether other members of this family may also participate in the development of these innate T cells. Here, we show that Slamf[1+6]-/- and Slamf[1+5+6]-/- B6 mice have an approximately 70% reduction of NKT cells compared to wild-type (WT B6 mice. Unexpectedly, the proportion of innate CD8+ T cells slightly increased in the Slamf[1+5+6]-/-, but not in the Slamf[1+6]-/- strain, suggesting that Slamf5 may function as a negative regulator of innate CD8+ T cell development. Accordingly, Slamf5-/- B6 mice showed an exclusive expansion of innate CD8+ T cells, but not NKT cells. Interestingly, the SAP-independent Slamf7-/- strain showed an expansion of both splenic innate CD8+ T cells and thymic NKT cells. On the other hand, and similar to what was recently shown in Slamf3-/- BALB/c mice, the proportions of thymic PLZFhi NKT cells and innate CD8+ T cells significatively increased in the SAP-independent Slamf8-/- BALB/c strain. In summary, these results show that NKT and innate CD8+ T cell development can be regulated in a SAP-dependent and -independent fashion by SLAMF receptors, in which Slamf1, Slamf6, and Slamf8 affect development of NKT cells, and that Slamf5, Slamf7, and Slamf8 affect the development of innate CD8+ T cells.

  20. SAP-Dependent and -Independent Regulation of Innate T Cell Development Involving SLAMF Receptors.

    Science.gov (United States)

    De Calisto, Jaime; Wang, Ninghai; Wang, Guoxing; Yigit, Burcu; Engel, Pablo; Terhorst, Cox

    2014-01-01

    Signaling lymphocytic activation molecule (SLAM)-associated protein (SAP) plays an essential role in the immune system mediating the function of several members of the SLAM family (SLAMF) of receptors, whose expression is essential for T, NK, and B-cell responses. Additionally, the expression of SAP in double-positive thymocytes is mandatory for natural killer T (NKT) cells and, in mouse, for innate CD8(+) T cell development. To date, only two members of the SLAMF of receptors, Slamf1 and Slamf6, have been shown to positively cooperate during NKT cell differentiation in mouse. However, it is less clear whether other members of this family may also participate in the development of these innate T cells. Here, we show that Slamf[1 + 6](-/-) and Slamf[1 + 5 + 6](-/-) B6 mice have ~70% reduction of NKT cells compared to wild-type B6 mice. Unexpectedly, the proportion of innate CD8(+) T cells slightly increased in the Slamf[1 + 5 + 6](-/-) , but not in the Slamf[1 + 6](-/-) strain, suggesting that Slamf5 may function as a negative regulator of innate CD8(+) T cell development. Accordingly, Slamf5(-/-) B6 mice showed an exclusive expansion of innate CD8(+) T cells, but not NKT cells. Interestingly, the SAP-independent Slamf7(-/-) strain showed an expansion of both splenic innate CD8(+) T cells and thymic NKT cells. On the other hand, and similar to what was recently shown in Slamf3(-/-) BALB/c mice, the proportions of thymic promyelocytic leukemia zinc finger (PLZF(hi)) NKT cells and innate CD8(+) T cells significantly increased in the SAP-independent Slamf8(-/-) BALB/c strain. In summary, these results show that NKT and innate CD8(+) T cell development can be regulated in a SAP-dependent and -independent fashion by SLAMF receptors, in which Slamf1, Slamf6, and Slamf8 affect development of NKT cells, and that Slamf5, Slamf7, and Slamf8 affect the development of innate CD8(+) T cells.

  1. The competence to acquire cellular desiccation tolerance is independent of seed morphological development.

    Science.gov (United States)

    Golovina, E A; Hoekstra, F A; Van Aelst, A C

    2001-05-01

    Acquisition of desiccation tolerance and the related changes at the cellular level in wheat (Triticum aestivum cv. Priokskaya) kernels during normal development and premature drying on the ear were studied using a spin probe technique and low temperature scanning electron microscopy. During normal development, the ability of embryos to germinate after rapid drying and rehydration was acquired after completion of morphological development, which is a few days before mass maturity. The acquisition of desiccation tolerance, as assessed by germination, was associated with an upsurge in cytoplasmic viscosity, the onset of accumulation of protein and oil bodies, and the retention of membrane integrity upon dehydration/rehydration. These features were also used to assess cellular desiccation tolerance in the cases when germination could not occur. Slow premature drying was used to decouple the acquisition of cellular desiccation tolerance from morphogenesis. Upon premature drying of kernels on the ears of plants cut at 5 d after anthesis, desiccation-tolerant dwarf embryos were formed that were able to germinate. When plants were cut at earlier stages poorly developed embryos were formed that were unable to germinate, but cellular desiccation tolerance was nevertheless acquired. In such prematurely dried kernels, peripheral meristematic endosperm cells had already passed through similar physiological and ultrastructural changes associated with the acquisition of cellular desiccation tolerance. It is concluded that despite the apparent strong integration in seed development, desiccation tolerance can be acquired by the meristematic cells in the developing embryo and cambial layer of endosperm, independently of morphological development.

  2. Biomarker and Phenotypic Risk Factors for Breast Cancer Lymphedema | Division of Cancer Prevention

    Science.gov (United States)

    DESCRIPTION (provided by applicant): Lymphedema (LE) following treatment for breast cancer is the most common form of secondary LE in the industrialized world. It occurs in 20% to 87% of patients following treatment for breast cancer and results in significant disability. At the |

  3. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related lymphedem

  4. Modification of a Rodent Hindlimb Model of Secondary Lymphedema: Surgical Radicality versus Radiotherapeutic Ablation

    Directory of Open Access Journals (Sweden)

    Hyung Sub Park

    2013-01-01

    Full Text Available Secondary lymphedema is an intractable disease mainly caused by damage of the lymphatic system during surgery, yet studies are limited by the lack of suitable animal models. The purpose of this study was to create an improved model of secondary lymphedema in the hindlimbs of rodents with sustained effects and able to mimic human lymphedema. This was achieved by combining previously reported surgical methods and radiation to induce chronic lymphedema. Despite more radical surgical destruction of superficial and deep lymphatic vessels, surgery alone was not enough to sustain increased hindlimb volume. Radiotherapy was necessary to prolong these effects, with decreased lymphatic flow on lymphoscintigraphy, but hindlimb necrosis occurred after 4 weeks due to radiation toxicity. The applicability of this model for studies of therapeutic lymphangiogenesis was subsequently tested by injecting muscle-derived stem cells previously cocultured with the supernatant of human lymphatic endothelial cells in vitro. There was a tendency for increased lymphatic flow which significantly increased lymphatic vessel formation after cell injection, but attenuation of hindlimb volume was not observed. These results suggest that further refinement of the rodent hindlimb model is needed by titration of adequate radiation dosage, while stem cell lymphangiogenesis seems to be a promising approach.

  5. 3D stereophotogrammetry in upper-extremity lymphedema: An accurate diagnostic method

    NARCIS (Netherlands)

    Hameeteman, M.; Verhulst, A.C.; Vreeken, R.D.; Maal, T.J.; Ulrich, D.J.

    2016-01-01

    BACKGROUND: Upper-extremity lymphedema is a frequent complication in patients treated for breast cancer. Current diagnostic methods for the upper-extremity volume measurements are cumbersome or time consuming. The purpose of this study was to assess the validity and reliability of three-dimensional

  6. Recurrent furunculosis as a cause of isolated penile lymphedema: a case report

    Directory of Open Access Journals (Sweden)

    Sood Suneet

    2010-06-01

    Full Text Available Abstract Introduction Isolated lymphedema of the penis is extremely rare: combined involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported. We present a case of isolated penile lymphedema that responded to excision of lymphedematous tissue and reconstruction with flaps. Case presentation A 32-year-old Arab man presented with a three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was non-erectile sexual dysfunction. The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root. He had no other contributory past medical or family history. On examination there was gross penile enlargement, maximally at the mid shaft, associated with thickened skin at the sites of prior furunculosis. The glans and scrotum were normal. Both testes were palpable. Serology for filariasis, and urinary tract ultrasound and computed tomography scan were normal. The clinical diagnosis was lymphedema following recurrent penile furunculosis. At operation the lymphedematous tissues were removed. Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the penis. He resumed normal sexual activity one month after surgery. At 12 months, he had a good cosmetic result, with no signs of recurrence. Conclusions Furunculosis at the penile root may result in lymphedema confined to the penile shaft, sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent cosmetic results, and allowed satisfactory sexual activity.

  7. Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

    Science.gov (United States)

    Heppner, P. Paul; Tierney, Candece Glauser; Wang, Yu-Wei; Armer, Jane M.; Whitlow, Natalie M.; Reynolds, Alysia

    2009-01-01

    The purpose of this study was to promote greater understanding among counselors and other helping professionals regarding the stressors associated with lymphedema, how women cope with the stressors, and the role of social support. An intensive qualitative study was conducted; data were analyzed using a consensual qualitative research approach. The…

  8. Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer

    Science.gov (United States)

    2014-12-23

    Lymphedema; Stage IA Cervical Cancer; Stage IA Uterine Corpus Cancer; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Uterine Corpus Cancer; Stage IB Vulvar Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer

  9. Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphedema

    DEFF Research Database (Denmark)

    Jensen, Mads Radmer; Simonsen, Lene; Karlsmark, Tonny

    2013-01-01

    Breast cancer-related lymphedema (BCRL) is a frequent and debilitating complication of breast cancer treatment. The pathophysiology is complex and remains poorly understood; however, data suggest that changes in the peripheral circulation may contribute to edema formation. In 13 volunteers...

  10. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related

  11. 3D stereophotogrammetry in upper-extremity lymphedema: An accurate diagnostic method

    NARCIS (Netherlands)

    Hameeteman, M.; Verhulst, A.C.; Vreeken, R.D.; Maal, T.J.; Ulrich, D.J.

    2016-01-01

    BACKGROUND: Upper-extremity lymphedema is a frequent complication in patients treated for breast cancer. Current diagnostic methods for the upper-extremity volume measurements are cumbersome or time consuming. The purpose of this study was to assess the validity and reliability of three-dimensional

  12. Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

    Science.gov (United States)

    Heppner, P. Paul; Tierney, Candece Glauser; Wang, Yu-Wei; Armer, Jane M.; Whitlow, Natalie M.; Reynolds, Alysia

    2009-01-01

    The purpose of this study was to promote greater understanding among counselors and other helping professionals regarding the stressors associated with lymphedema, how women cope with the stressors, and the role of social support. An intensive qualitative study was conducted; data were analyzed using a consensual qualitative research approach. The…

  13. Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2013.

    Science.gov (United States)

    Lee, B B; Andrade, M; Antignani, P L; Boccardo, F; Bunke, N; Campisi, C; Damstra, R; Flour, M; Forner-Cordero, I; Gloviczki, P; Laredo, J; Partsch, H; Piller, N; Michelini, S; Mortimer, P; Rabe, E; Rockson, S; Scuderi, A; Szolnoky, G; Villavicencio, J L

    2013-12-01

    Primary lymphedema can be managed effectively as a form of chronic lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic Therapy (DLT) with compression therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home. When conservative treatment fails, or gives sub-optimal outcomes, the management of primary lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical therapies can be more effective when fully integrated with manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or palliative surgery. The future of management of primary lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.

  14. Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study.

    Science.gov (United States)

    Fisher, Mary Insana; Donahoe-Fillmore, Betsy; Leach, Laura; O'Malley, Colleen; Paeplow, Cheryl; Prescott, Tess; Merriman, Harold

    2014-10-01

    Lymphedema affects 3-58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at baseline, half-way, and at the conclusion of yoga practice. Arm volume significantly decreased from baseline (2423.3 ml ± 597.2) to final measures (2370.8 ml ± 577.2) (p = .02). No significant changes in QOL (p = .12), self-reported arm function (p = .34), or hand grip strength (p = .26) were found. Yoga may be beneficial in the management of lymphedema.

  15. The surgical treatment of lymphedema: a systematic review of the contemporary literature (2004-2010).

    Science.gov (United States)

    Cormier, Janice N; Rourke, Loren; Crosby, Melissa; Chang, David; Armer, Jane

    2012-02-01

    A systematic review of the literature was performed to examine contemporary peer-reviewed literature (2004-2010) evaluating the surgical treatment of lymphedema. A comprehensive search of 11 major medical indices was performed. Selected articles were sorted to identify those related to the surgical treatment of lymphedema. Extracted data included the number of patients, specific surgical procedure performed, length of follow-up, criteria for defining lymphedema, measurement methods, volume or circumference reduction, and reported complications. A total of 20 studies met inclusion criteria; procedures were categorized as excisional procedures (n = 8), lymphatic reconstruction (n = 8), and tissue transfer (n = 4). The reported incidence of volume reduction of lymphedema in these studies varied from 118% reduction to a 13% increase over the follow-up intervals ranging from 6 months to 15 years. The largest reported reductions were noted after excisional procedures (91.1%), lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%). Procedure complications were rarely reported. A number of surgical approaches have demonstrated beneficial effects for select patients with lymphedema. Most of these reports, however, are based on small numbers of patients, use nonstandardized or inconsistent measurement techniques, and lack long-term follow-up. The proposed benefits of any surgical approach should be evaluated in the context of the potential morbidity to the individual patient and the availability of surgical expertise. In addition, although these surgical techniques have shown promising results, nearly all note that the procedures do not obviate the need for continued use of conventional therapies, including compression, for long-term maintenance.

  16. Modeling development and quantitative trait mapping reveal independent genetic modules for leaf size and shape.

    Science.gov (United States)

    Baker, Robert L; Leong, Wen Fung; Brock, Marcus T; Markelz, R J Cody; Covington, Michael F; Devisetty, Upendra K; Edwards, Christine E; Maloof, Julin; Welch, Stephen; Weinig, Cynthia

    2015-10-01

    Improved predictions of fitness and yield may be obtained by characterizing the genetic controls and environmental dependencies of organismal ontogeny. Elucidating the shape of growth curves may reveal novel genetic controls that single-time-point (STP) analyses do not because, in theory, infinite numbers of growth curves can result in the same final measurement. We measured leaf lengths and widths in Brassica rapa recombinant inbred lines (RILs) throughout ontogeny. We modeled leaf growth and allometry as function valued traits (FVT), and examined genetic correlations between these traits and aspects of phenology, physiology, circadian rhythms and fitness. We used RNA-seq to construct a SNP linkage map and mapped trait quantitative trait loci (QTL). We found genetic trade-offs between leaf size and growth rate FVT and uncovered differences in genotypic and QTL correlations involving FVT vs STPs. We identified leaf shape (allometry) as a genetic module independent of length and width and identified selection on FVT parameters of development. Leaf shape is associated with venation features that affect desiccation resistance. The genetic independence of leaf shape from other leaf traits may therefore enable crop optimization in leaf shape without negative effects on traits such as size, growth rate, duration or gas exchange.

  17. Budget deficits, monetization, and central-bank independence in developing countries

    NARCIS (Netherlands)

    Sikken, BJ; de Haan, J

    1998-01-01

    Using various indicators for central bank independence we examine the relationship between central bank independence and government budget deficits. Using a two-stage procedure we also analyze whether central bank independence affects the monetization of deficits. First, the monetization relation in

  18. Functioning in lymphedema from the patients' perspective using the International Classification of Functioning, Disability and health (ICF) as a reference

    NARCIS (Netherlands)

    Viehoff, P.B.; Gielink, P.D.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, M.H.

    2015-01-01

    Abstract Purpose. To identify and quantify meaningful concepts in lymphedema from the patients' perspectives using the International Classification of Functioning, Disability and Health (ICF). Methods. Six focus group interviews in five different centers were organized, audiotaped, transcribed verba

  19. Functioning in lymphedema from the patients' perspective using the International Classification of Functioning, Disability and health (ICF) as a reference

    NARCIS (Netherlands)

    Viehoff, P.B.; Gielink, P.D.; Damstra, R.J.; Heerkens, Y.F.; Ravensberg, C.D. van; Neumann, M.H.

    2015-01-01

    Abstract Purpose. To identify and quantify meaningful concepts in lymphedema from the patients' perspectives using the International Classification of Functioning, Disability and Health (ICF). Methods. Six focus group interviews in five different centers were organized, audiotaped, transcribed

  20. Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors

    Directory of Open Access Journals (Sweden)

    Mei R. Fu, PhD, RN, FAAN

    2016-09-01

    Conclusions: This usability study provided evidence on breast cancer survivor's acceptance and highly positive evaluation of TOLF's usability as well as feasibility of using technologically-driven delivery model to enhance self-care strategies for lymphedema symptom management.

  1. Congenital segmental lymphedema in tuberous sclerosis complex with associated subependymal giant cell astrocytomas treated with Mammalian target of rapamycin inhibitors.

    Science.gov (United States)

    Prato, Giulia; Mancardi, Maria Margherita; Baglietto, Maria Giuseppina; Janis, Sara; Vercellino, Nadia; Rossi, Andrea; Consales, Alessandro; Raso, Alessandro; Garrè, Maria Luisa

    2014-09-01

    Tuberous sclerosis complex is a genetic, multisystemic disorder characterized by circumscribed benign lesions (hamartomas) in several organs, including brain. This is the result of defects in the TSC1 and/or TSC2 tumor suppressor genes, encoding the hamartin-tuberin complex that inhibits the mammalian target of rapamycin pathway. Specific inhibitors of this pathway have been shown to reduce the volume of subependymal giant cell astrocytomas associated with tuberous sclerosis. Congenital lymphedema is rarely seen in association with tuberous sclerosis, with only a few reported cases. Although this association can be coincidental, the dysgenetic lymphatic system can represent a hamartia as a consequence of gene mutation. We describe a child with congenital lymphedema in tuberous sclerosis and associated subependymal giant cell astrocytoma who experienced lymphangitis under treatment with mammalian target of rapamycin inhibitors. Because our patient did not show worsening of lymphedema, congenital lymphedema does not seem to be a contraindication for this therapy.

  2. Independent task system to develop communicative competence in English with medical purpose.

    Directory of Open Access Journals (Sweden)

    Belkys Gonzalez Machin

    2005-12-01

    Full Text Available Differentiated taks system constitutes a methodological strategy in the teaching of English with medical purposes through systemic activities using the English native students of the 4th year of medicine specialty. This observational, analytic, comparative study was performed with 90 students taken from 5 groups which constituted the universe of this investigation. Each group of students by itself constituted an independent sample integrated in a fair way by native students of the English speaking countries, Spanish speaking countries and any other. This system permitted the achievement of communicative competences through an approach to the communicative knowledge of the students in their classroom interaction. Four macro habilities of the English language were developed, and the management of the language sub system was improved. An adequate preparation for future missions abroad in their labor field was obtained.

  3. A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

    Science.gov (United States)

    Eddy, Brittany A.; Blackstock, Anna J.; Williamson, John M.; Addiss, David G.; Streit, Thomas G.; Beau de Rochars, Valery M.; Fox, LeAnne M.

    2014-01-01

    We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during 1995–2008. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot (P = 0.24), ankle (P = 0.87), or leg (P = 0.46) circumference; leg volume displacement (P = 0.09), lymphedema stage (P = 0.93), or frequency of adenolymphangitis (ADL) episodes (P = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups (P lymphedema-related quality of life (P ≤ 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study (P ≤ 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes. PMID:24218408

  4. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

    Science.gov (United States)

    Stillwaggon, Eileen; Sawers, Larry; Rout, Jonathan; Addiss, David; Fox, LeAnne

    2016-01-01

    Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense. PMID:27573626

  5. Development of a Fiber Laser with Independently Adjustable Properties for Optical Resolution Photoacoustic Microscopy.

    Science.gov (United States)

    Aytac-Kipergil, Esra; Demirkiran, Aytac; Uluc, Nasire; Yavas, Seydi; Kayikcioglu, Tunc; Salman, Sarper; Karamuk, Sohret Gorkem; Ilday, Fatih Omer; Unlu, Mehmet Burcin

    2016-12-08

    Photoacoustic imaging is based on the detection of generated acoustic waves through thermal expansion of tissue illuminated by short laser pulses. Fiber lasers as an excitation source for photoacoustic imaging have recently been preferred for their high repetition frequencies. Here, we report a unique fiber laser developed specifically for multiwavelength photoacoustic microscopy system. The laser is custom-made for maximum flexibility in adjustment of its parameters; pulse duration (5-10 ns), pulse energy (up to 10 μJ) and repetition frequency (up to 1 MHz) independently from each other and covers a broad spectral region from 450 to 1100 nm and also can emit wavelengths of 532, 355, and 266 nm. The laser system consists of a master oscillator power amplifier, seeding two stages; supercontinuum and harmonic generation units. The laser is outstanding since the oscillator, amplifier and supercontinuum generation parts are all-fiber integrated with custom-developed electronics and software. To demonstrate the feasibility of the system, the images of several elements of standardized resolution test chart are acquired at multiple wavelengths. The lateral resolution of optical resolution photoacoustic microscopy system is determined as 2.68 μm. The developed system may pave the way for spectroscopic photoacoustic microscopy applications via widely tunable fiber laser technologies.

  6. Development of a Fiber Laser with Independently Adjustable Properties for Optical Resolution Photoacoustic Microscopy

    Science.gov (United States)

    Aytac-Kipergil, Esra; Demirkiran, Aytac; Uluc, Nasire; Yavas, Seydi; Kayikcioglu, Tunc; Salman, Sarper; Karamuk, Sohret Gorkem; Ilday, Fatih Omer; Unlu, Mehmet Burcin

    2016-12-01

    Photoacoustic imaging is based on the detection of generated acoustic waves through thermal expansion of tissue illuminated by short laser pulses. Fiber lasers as an excitation source for photoacoustic imaging have recently been preferred for their high repetition frequencies. Here, we report a unique fiber laser developed specifically for multiwavelength photoacoustic microscopy system. The laser is custom-made for maximum flexibility in adjustment of its parameters; pulse duration (5-10 ns), pulse energy (up to 10 μJ) and repetition frequency (up to 1 MHz) independently from each other and covers a broad spectral region from 450 to 1100 nm and also can emit wavelengths of 532, 355, and 266 nm. The laser system consists of a master oscillator power amplifier, seeding two stages; supercontinuum and harmonic generation units. The laser is outstanding since the oscillator, amplifier and supercontinuum generation parts are all-fiber integrated with custom-developed electronics and software. To demonstrate the feasibility of the system, the images of several elements of standardized resolution test chart are acquired at multiple wavelengths. The lateral resolution of optical resolution photoacoustic microscopy system is determined as 2.68 μm. The developed system may pave the way for spectroscopic photoacoustic microscopy applications via widely tunable fiber laser technologies.

  7. Common-Lymphoid-Progenitor-Independent Pathways of Innate and T Lymphocyte Development

    Directory of Open Access Journals (Sweden)

    Maryam Ghaedi

    2016-04-01

    Full Text Available All lymphocytes are thought to develop from common lymphoid progenitors (CLPs. However, lymphoid-primed multipotent progenitors (LMPPs are more efficient than CLPs in differentiating into T cells and group 2 innate lymphoid cells (ILC2s. Here, we have divided LMPPs into CD127− (LMPP−s and CD127+ (LMPP+s subsets and compared them with Ly6D− and Ly6D+ CLPs. Adult LMPP+s differentiated into T cells and ILCs more rapidly and efficiently than other progenitors in transplantation assays. The development of T cells and ILC2s is highly active in the neonatal period. Neonatal CLPs are rare and, unlike prominent neonatal LMPP+s, do not efficiently differentiate into T cells and ILC2s. ILC2s generated in the neonatal period are long lived and persist in adult tissues. These results suggest that some ILCs and T cells may develop from LMPP+s via CLP-independent pathways.

  8. Temperature-independent energy expenditure in early development of the African clawed frog Xenopus laevis

    Science.gov (United States)

    Nagano, Yatsuhisa; Ode, Koji L.

    2014-08-01

    The thermal dissipation of activated eggs and embryos undergoing development from cleavage to the tailbud stage of the African clawed frog Xenopus laevis was measured as a function of incubation time at temperatures ranging from T = 288.2 K to 295.2 K, using a high-precision isothermal calorimeter. A23187-mediated activation of mature eggs induced stable periodic thermal oscillations lasting for 8-34 h. The frequency agreed well with the cell cycle frequency of initial cleavages at the identical temperature. In the developing embryo, energy metabolism switches from embryonic to adult features during gastrulation. The thermal dissipation after gastrulation fit well with a single modified Avrami equation, which has been used for modeling crystal-growth. Both the oscillation frequency of the activated egg and the growth rate of the embryo strongly depend on temperature with the same apparent activation energy of approximately 87 kJ mole-1. This result suggests that early development proceeds as a single biological time, attributable to a single metabolic rate. A temperature-independent growth curve was derived by scaling the thermogram to the biological time, indicating that the amount of energy expenditure during each developmental stage is constant over the optimal temperature range.

  9. Radial glial dependent and independent dynamics of interneuronal migration in the developing cerebral cortex.

    Directory of Open Access Journals (Sweden)

    Yukako Yokota

    Full Text Available Interneurons originating from the ganglionic eminence migrate tangentially into the developing cerebral wall as they navigate to their distinct positions in the cerebral cortex. Compromised connectivity and differentiation of interneurons are thought to be an underlying cause in the emergence of neurodevelopmental disorders such as schizophrenia. Previously, it was suggested that tangential migration of interneurons occurs in a radial glia independent manner. Here, using simultaneous imaging of genetically defined populations of interneurons and radial glia, we demonstrate that dynamic interactions with radial glia can potentially influence the trajectory of interneuronal migration and thus the positioning of interneurons in cerebral cortex. Furthermore, there is extensive local interneuronal migration in tangential direction opposite to that of pallial orientation (i.e., in a medial to lateral direction from cortex to ganglionic eminence all across the cerebral wall. This counter migration of interneurons may be essential to locally position interneurons once they invade the developing cerebral wall from the ganglionic eminence. Together, these observations suggest that interactions with radial glial scaffold and localized migration within the expanding cerebral wall may play essential roles in the guidance and placement of interneurons in the developing cerebral cortex.

  10. Vagotomy affects the development of oral tolerance and increases susceptibility to develop colitis independently of the alpha-7 nicotinic receptor.

    Science.gov (United States)

    Di Giovangiulio, Martina; Bosmans, Goele; Meroni, Elisa; Stakenborg, Nathalie; Florens, Morgane; Farro, Giovanna; Gomez-Pinilla, Pedro J; Matteoli, Gianluca; Boeckxstaens, Guy

    2016-06-14

    Vagotomy (VGX) increases the susceptibility to develop colitis suggesting a crucial role for the cholinergic anti-inflammatory pathway in the regulation of the immune responses. Since oral tolerance and the generation of regulatory T cells (Tregs) are crucial to preserve mucosal immune homeostasis, we studied the effect of vagotomy and the involvement of α7 nicotinic receptors (α7nAChR) at the steady state and during colitis. Therefore, the development of both oral tolerance and colitis (induced by dextran sulfate sodium (DSS) or via T cell transfer) was studied in vagotomized mice and in α7nAChR(-/-) mice. VGX, but not α7nAChR deficiency, prevented oral tolerance establishment. This effect was associated with reduced Treg conversion in the lamina propria and mesenteric lymphnodes. To the same extent, vagotomized mice, but not α7nAChR(-/-) mice, developed a more severe DSS colitis compared with control mice treated with DSS, associated with a decreased number of colonic Tregs. However, neither VGX nor absence of α7nAChR in recipient mice affected colitis development in the T cell transfer model. In line, deficiency of α7nAChR exclusively in T cells did not influence the development of colitis induced by T cell transfer. Our results indicate a key role for the vagal intestinal innervation in the development of oral tolerance and colitis, most likely by modulating induction of Tregs independently of α7nAChR.

  11. Study Regarding the Effectiveness of Manual Lymphatic Drainage in the Case of Patients with Breast Cancer that Present Lymphedema

    Directory of Open Access Journals (Sweden)

    Alexandru MIOC

    2013-06-01

    Full Text Available Lymphedema is defined as a persistent increase of tissue volume caused by the blocked or absent lymphatic drainage. The purpose of this study is to analyse the effectiveness of lymphatic drainage in the treatment of lymphedema after a mastectomy, with the aim of reducing the volume of the lymphedema and improving overall symptomatology, as well as providing information regarding the impact of this treatment on quality-of-life and the physical limitations of these patients. With these objectives in mind, a series of articles evaluating the effectiveness of manual lymphatic drainage in the case of patients with breast cancer and lymphedema have been studied. The parameters under observation were: duration of lymphedema reduction and improved symptomatology (pain, a feeling of swelling of the upper limb, functional limitation, and patient dissatisfaction towards their body image. Following this analysis, one can conclude that the association of manual lymphatic drainage to physical exercise and physiotherapy has produced changes in the volume of the limb affected by the lymphedema; however, its isolated use has not resulted in significant changes.

  12. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma

    Directory of Open Access Journals (Sweden)

    Fukushima Masanori

    2009-02-01

    Full Text Available Abstract Background Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma. Methods A total of 694 patients with histologically confirmed ovarian (135 patients or uterine cancer (258 with cervical cancer, 301 with endometrial cancer who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema. Results Among ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20–2.67; p = 0.006 was statistically significantly associated with occurrence of lymphedema. Conclusion There was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.

  13. Acetylcholinesterase Regulates Skeletal In Ovo Development of Chicken Limbs by ACh-Dependent and -Independent Mechanisms

    Science.gov (United States)

    Spieker, Janine; Ackermann, Anica; Salfelder, Anika; Vogel-Höpker, Astrid; Layer, Paul G.

    2016-01-01

    Formation of the vertebrate limb presents an excellent model to analyze a non-neuronal cholinergic system (NNCS). Here, we first analyzed the expression of acetylcholinesterase (AChE) by IHC and of choline acetyltransferase (ChAT) by ISH in developing embryonic chicken limbs (stages HH17-37). AChE outlined formation of bones, being strongest at their distal tips, and later also marked areas of cell death. At onset, AChE and ChAT were elevated in two organizing centers of the limb anlage, the apical ectodermal ridge (AER) and zone of polarizing activity (ZPA), respectively. Thereby ChAT was expressed shortly after AChE, thus strongly supporting a leading role of AChE in limb formation. Then, we conducted loss-of-function studies via unilateral implantation of beads into chicken limb anlagen, which were soaked in cholinergic components. After varying periods, the formation of cartilage matrix and of mineralizing bones was followed by Alcian blue (AB) and Alizarin red (AR) stainings, respectively. Both acetylcholine (ACh)- and ChAT-soaked beads accelerated bone formation in ovo. Notably, inhibition of AChE by BW284c51, or by the monoclonal antibody MAB304 delayed cartilage formation. Since bead inhibition of BChE was mostly ineffective, an ACh-independent action during BW284c51 and MAB304 inhibition was indicated, which possibly could be due to an enzymatic side activity of AChE. In conclusion, skeletogenesis in chick is regulated by an ACh-dependent cholinergic system, but to some extent also by an ACh-independent aspect of the AChE protein. PMID:27574787

  14. On the Development of Harmony, Turbulence, and Independence in Parent–Adolescent Relationships : A Five-Wave Longitudinal Study

    NARCIS (Netherlands)

    Hadiwijaya, Hana; Klimstra, Theo A.; Vermunt, Jeroen K.; Branje, Susan J. T.; Meeus, Wim H. J.

    The separation-individuation, evolutionary, maturational, and expectancy violation-realignment perspectives propose that the relationship between parents and adolescents deteriorate as adolescents become independent. This study examines the extent to which the development of adolescents’ perceived

  15. On the development of harmony, turbulence, and independence in parent–adolescent relationships : A five-wave longitudinal study

    NARCIS (Netherlands)

    Hadiwijaya, H.; Klimstra, T.A.; Vermunt, J.K.; Branje, Susan; Meeus, W.H.J.

    2017-01-01

    The separation-individuation, evolutionary, maturational, and expectancy violation-realignment perspectives propose that the relationship between parents and adolescents deteriorate as adolescents become independent. This study examines the extent to which the development of adolescents’ perceived

  16. On the development of harmony, turbulence, and independence in parent–adolescent relationships : A five-wave longitudinal study

    NARCIS (Netherlands)

    Hadiwijaya, H.; Klimstra, T.A.; Vermunt, J.K.; Branje, Susan; Meeus, W.H.J.

    2017-01-01

    The separation-individuation, evolutionary, maturational, and expectancy violation-realignment perspectives propose that the relationship between parents and adolescents deteriorate as adolescents become independent. This study examines the extent to which the development of adolescents’ perceived r

  17. Development of a Dynamic Operational Scheduling Algorithm for an Independent Micro-Grid with Renewable Energy

    Science.gov (United States)

    Obara, Shin'ya

    A micro-grid with the capacity for sustainable energy is expected to be a distributed energy system that exhibits quite a small environmental impact. In an independent micro-grid, “green energy,” which is typically thought of as unstable, can be utilized effectively by introducing a battery. In the past study, the production-of-electricity prediction algorithm (PAS) of the solar cell was developed. In PAS, a layered neural network is made to learn based on past weather data and the operation plan of the compound system of a solar cell and other energy systems was examined using this prediction algorithm. In this paper, a dynamic operational scheduling algorithm is developed using a neural network (PAS) and a genetic algorithm (GA) to provide predictions for solar cell power output. We also do a case study analysis in which we use this algorithm to plan the operation of a system that connects nine houses in Sapporo to a micro-grid composed of power equipment and a polycrystalline silicon solar cell. In this work, the relationship between the accuracy of output prediction of the solar cell and the operation plan of the micro-grid was clarified. Moreover, we found that operating the micro-grid according to the plan derived with PAS was far superior, in terms of equipment hours of operation, to that using past average weather data.

  18. Development of Boundary Condition Independent Reduced Order Thermal Models using Proper Orthogonal Decomposition

    Science.gov (United States)

    Raghupathy, Arun; Ghia, Karman; Ghia, Urmila

    2008-11-01

    Compact Thermal Models (CTM) to represent IC packages has been traditionally developed using the DELPHI-based (DEvelopment of Libraries of PHysical models for an Integrated design) methodology. The drawbacks of this method are presented, and an alternative method is proposed. A reduced-order model that provides the complete thermal information accurately with less computational resources can be effectively used in system level simulations. Proper Orthogonal Decomposition (POD), a statistical method, can be used to reduce the order of the degree of freedom or variables of the computations for such a problem. POD along with the Galerkin projection allows us to create reduced-order models that reproduce the characteristics of the system with a considerable reduction in computational resources while maintaining a high level of accuracy. The goal of this work is to show that this method can be applied to obtain a boundary condition independent reduced-order thermal model for complex components. The methodology is applied to the 1D transient heat equation.

  19. Development of a platform-independent receiver control system for SISIFOS

    Science.gov (United States)

    Lemke, Roland; Olberg, Michael

    1998-05-01

    Up to now receiver control software was a time consuming development usually written by receiver engineers who had mainly the hardware in mind. We are presenting a low-cost and very flexible system which uses a minimal interface to the real hardware, and which makes it easy to adapt to new receivers. Our system uses Tcl/Tk as a graphical user interface (GUI), SpecTcl as a GUI builder, Pgplot as plotting software, a simple query language (SQL) database for information storage and retrieval, Ethernet socket to socket communication and SCPI as a command control language. The complete system is in principal platform independent but for cost saving reasons we are using it actually on a PC486 running Linux 2.0.30, which is a copylefted Unix. The only hardware dependent part are the digital input/output boards, analog to digital and digital to analog convertors. In the case of the Linux PC we are using a device driver development kit to integrate the boards fully into the kernel of the operating system, which indeed makes them look like an ordinary device. The advantage of this system is firstly the low price and secondly the clear separation between the different software components which are available for many operating systems. If it is not possible, due to CPU performance limitations, to run all the software in a single machine,the SQL-database or the graphical user interface could be installed on separate computers.

  20. Calcium Signaling Regulates Ventricular Hypertrophy During Development Independent of Contraction or Blood Flow

    Science.gov (United States)

    Andersen, Nicholas D.; Ramachandran, Kapil V.; Bao, Michelle M.; Kirby, Margaret L.; Pitt, Geoffrey S.; Hutson, Mary R.

    2014-01-01

    In utero interventions aimed at restoring left ventricular hemodynamic forces in fetuses with prenatally diagnosed hypoplastic left heart syndrome failed to stimulate ventricular myocardial growth during gestation, suggesting chamber growth during development may not rely upon fluid forces. We therefore hypothesized that ventricular hypertrophy during development may depend upon fundamental Ca2+-dependent growth pathways that function independent of hemodynamic forces. To test this hypothesis, zebrafish embryos were treated with inhibitors or activators of Ca2+ signaling in the presence or absence of contraction during the period of chamber development. Abolishment of contractile function alone in the setting of preserved Ca2+ signaling did not impair ventricular hypertrophy. In contrast, inhibition of L-type voltage-gated Ca2+ influx abolished contraction and led to reduced ventricular hypertrophy, whereas increasing L-type voltage-gated Ca2+ influx led to enhanced ventricular hypertrophy in either the presence or absence of contraction. Similarly, inhibition of the downstream Ca2+-sensitive phosphatase calcineurin, a known regulator of adult cardiac hypertrophy, led to reduced ventricular hypertrophy in the presence or absence of contraction, whereas hypertrophy was rescued in the absence of L-type voltage-gated Ca2+ influx and contraction by expression of a constitutively active calcineurin. These data suggest ventricular cardiomyocyte hypertrophy during chamber formation is dependent upon Ca2+ signaling pathways that are unaffected by heart function or hemodynamic forces. Disruption of Ca2+-dependent hypertrophy during heart development may therefore represent one mechanism for impaired chamber formation that is not related to impaired blood flow. PMID:25536179

  1. Extracorporeal Shock Wave Therapy for Breast Cancer-Related Lymphedema: A Pilot Study.

    Science.gov (United States)

    Cebicci, Mehtap Aykac; Sutbeyaz, Serap Tomruk; Goksu, Sema Sezgin; Hocaoglu, Sehriban; Oguz, Arzu; Atilabey, Ayse

    2016-09-01

    To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment. Prospective clinical pilot study. Education and research hospital. Women with a diagnosis of lymphedema secondary to breast cancer (N=11). Patients were treated for 12 sessions of ESWT with 2500 impulses each. The treatment frequency was 4Hz in multiple shock mode. The energy flow density during treatment was equal to a working pressure of 2 bar. The primary outcome measure was volumetric measurements. The secondary outcome measures were the short version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Assessments were conducted by the same investigator at baseline, posttreatment, and at 1, 3, and 6 months after treatment for all patients. Significant reduction was found in the amount of lymphedema with ESWT treatment in all patients, and this reduction was maintained for 6 months. A statistically significant reduction was observed in volumetric measurements for the follow-up period (P=.001). The mean volume displacement of the affected upper extremity before treatment was 870.45±384.19mL at 6 months, and after the treatment it was 604.54±381.74mL. In addition, improvements were observed in the QuickDASH functional assessment tool and in the physical health domain of the WHOQOL-BREF questionnaire (P=.002 and P=.007, respectively). ESWT was shown to provide a reduction in the amount of lymphedema in patients with lymphedema secondary to breast cancer. Also, a marked improvement was observed in the functional status and quality of life of study patients. Treatment efficacy was maintained in the long term. As a noninvasive, novel, and effective method, ESWT is a promising treatment modality for the treatment of lymphedema, which is a chronic, progressive, and refractory condition. Copyright © 2016 American

  2. Therapeutic strategy for lower limb lymphedema and lymphatic fistula after resection of a malignant tumor in the hip joint region: a case report.

    Science.gov (United States)

    Hara, H; Mihara, M; Hayashi, A; Kanemaru, M; Todokoro, T; Yamamoto, T; Iida, T; Hino, R; Koshima, I

    2014-03-01

    Lymphatic fistula complicating lymphedema is thought to occur due to communication between lymph vessels and the skin, which has yet to be shown objectively. The objective of this case report is to show the pathology and treatment using simultaneous lymphatic fistula resection and lymphatico-venous anastomosis (LVA). A 40-year-old woman underwent extended resection and total hip arthroplasty for primitive neuroectodermal tumor in the right proximal femur 23 years ago. Right lower limb lymphedema developed immediately after surgery and lymphatic fistula appeared in the posterior thigh. On ICG lymphography, lymph reflux toward the distal side dispersing in a fan-shape reticular pattern from the lymphatic fistula region was noted after intracutaneous injection of ICG into the foot. We performed simultaneous lymphatic fistula resection and of LVA. Pathological examination showed that the epidermis and stratum corneum of the healthy skin were lost in the lymphatic fistula region. Dilated lymph vessels were open in this region. The examinations provide the first objective evidence that the cause of lymphatic fistula may be lymph reflux from lymphatic stems to precollectors through lymphatic perforators.

  3. Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study.

    Science.gov (United States)

    De Britto, Lourduraj John; Yuvaraj, Jayaram; Kamaraj, Pattabi; Poopathy, Subbiah; Vijayalakshmi, Gnanasekaran

    2015-12-01

    Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo. © The Author(s) 2015.

  4. Training of Teachers in Strategies that Develop Independent Learning Skills in Their Pupils.

    Science.gov (United States)

    Kremer, L; Perlberg, A.

    1979-01-01

    Various aspects of independent learning are explored in an attempt to identify some salient components of independent learning. Training teachers in this strategy should facilitate a favorable pupil attitude toward learning and thought processes such as fluency, divergency, analysis, synthesis, etc., which are considered important educational…

  5. The dermis contains langerin+ dendritic cells that develop and function independently of epidermal Langerhans cells.

    Science.gov (United States)

    Poulin, Lionel Franz; Henri, Sandrine; de Bovis, Béatrice; Devilard, Elisabeth; Kissenpfennig, Adrien; Malissen, Bernard

    2007-12-24

    Langerhans cells (LCs) constitute a subset of dendritic cells (DCs) that express the lectin langerin and that reside in their immature state in epidermis. Paradoxically, in mice permitting diphtheria toxin (DT)-mediated ablation of LCs, epidermal LCs reappeared with kinetics that lagged behind that of their putative progeny found in lymph nodes (LNs). Using bone marrow (BM) chimeras, we showed that a major fraction of the langerin(+), skin-derived DCs found in LNs originates from a developmental pathway that is independent from that of epidermal LCs. This pathway, the existence of which was unexpected, originates in the dermis and gives rise to langerin(+) dermal DCs (DDCs) that should not be confused with epidermal LCs en route to LNs. It explains that after DT treatment, some langerin(+), skin-derived DCs reappear in LNs long before LC-derived DCs. Using CD45 expression and BrdU-labeling kinetics, both LCs and langerin(+) DDCs were found to coexist in wild-type mice. Moreover, DT-mediated ablation of epidermal LCs opened otherwise filled niches and permitted repopulation of adult noninflammatory epidermis with BM-derived LCs. Our results stress that the langerin(+) DC network is more complex than originally thought and have implications for the development of transcutaneous vaccines and the improvement of humanized mouse models.

  6. Direction-selective circuitry in rat retina develops independently of GABAergic, cholinergic and action potential activity.

    Directory of Open Access Journals (Sweden)

    Le Sun

    Full Text Available The ON-OFF direction selective ganglion cells (DSGCs in the mammalian retina code image motion by responding much more strongly to movement in one direction. They do so by receiving inhibitory inputs selectively from a particular sector of processes of the overlapping starburst amacrine cells, a type of retinal interneuron. The mechanisms of establishment and regulation of this selective connection are unknown. Here, we report that in the rat retina, the morphology, physiology of the ON-OFF DSGCs and the circuitry for coding motion directions develop normally with pharmacological blockade of GABAergic, cholinergic activity and/or action potentials for over two weeks from birth. With recent results demonstrating light independent formation of the retinal DS circuitry, our results strongly suggest the formation of the circuitry, i.e., the connections between the second and third order neurons in the visual system, can be genetically programmed, although emergence of direction selectivity in the visual cortex appears to require visual experience.

  7. Drosophila Crumbs prevents ectopic Notch activation in developing wings by inhibiting ligand-independent endocytosis.

    Science.gov (United States)

    Nemetschke, Linda; Knust, Elisabeth

    2016-12-01

    Many signalling components are apically restricted in epithelial cells, and receptor localisation and abundance is key for morphogenesis and tissue homeostasis. Hence, controlling apicobasal epithelial polarity is crucial for proper signalling. Notch is a ubiquitously expressed, apically localised receptor, which performs a plethora of functions; therefore, its activity has to be tightly regulated. Here, we show that Drosophila Crumbs, an evolutionarily conserved polarity determinant, prevents Notch endocytosis in developing wings through direct interaction between the two proteins. Notch endocytosis in the absence of Crumbs results in the activation of the ligand-independent, Deltex-dependent Notch signalling pathway, and does not require the ligands Delta and Serrate or γ-secretase activity. This function of Crumbs is not due to general defects in apicobasal polarity, as localisation of other apical proteins is unaffected. Our data reveal a mechanism to explain how Crumbs directly controls localisation and trafficking of the potent Notch receptor, and adds yet another aspect of Crumbs regulation in Notch pathway activity. Furthermore, our data highlight a close link between the apical determinant Crumbs, receptor trafficking and tissue homeostasis.

  8. Decreased body mass index as an independent risk factor for developing chronic kidney disease.

    Science.gov (United States)

    Tokashiki, Kaori; Tozawa, Masahiko; Iseki, Chiho; Kohagura, Kentaro; Kinjo, Kozen; Takishita, Shuichi; Iseki, Kunitoshi

    2009-02-01

    Obesity and metabolic syndrome are risk factors for the development of chronic kidney disease (CKD). Few studies have examined the effect of change in body mass index (DeltaBMI) on CKD incidence in a general screening setting. Subjects of this study were screenees that participated in the screening program of the Okinawa General Health Maintenance Association in 1993 and 2003 in Okinawa, Japan. Using identification number, birth date, sex, and other recorded identifiers, we identified 33,389 subjects among the 1993 screening participants (N = 143,948) who also participated in the 2003 screening. CKD was defined as estimated glomerular filtration rate diet in renal disease study equation. Obesity was defined as BMI > or = 25 kg/m(2). CKD prevalence was 13.8% in 1993 and 22.4% in 2003. The incidence of developing CKD in 10 years was 15.5%. The effect of DeltaBMI on CKD incidence was evaluated after considering other confounding factors such as age, sex, blood pressure, BMI, fasting plasma glucose, and proteinuria. Median DeltaBMI was 1.0%. The adjusted odds ratio (95% CI) for the effect of DeltaBMI on CKD incidence was 1.111 (1.026-1.204, P or = 1% was taken as a reference. DeltaBMI was an independent predictor of CKD incidence. The present results suggest that there was an inverse relationship between DeltaBMI and CKD incidence among screened subjects. The reasons for this observation are not clear, but careful follow-up for DeltaBMI is necessary, particularly in obese men with proteinuria.

  9. [Current wound care in patients with elephantiasis--third-stage lymphedema].

    Science.gov (United States)

    Rucigaj, Tanja Planinsek; Slana, Ana; Leskovec, Nada Kecelj

    2012-10-01

    Lymphedema resulting from fluid accumulation due to impairment in the lymphatic system drainage leads to enlargement of the body part involved. If left untreated, in its third stage it results in elephantiasis. Elephantiasis is frequently accompanied by papillomatosis and lymphocutaneous fistulas with lymphorrhoea, erosions and ulcers, frequently with the loss of function in the respective part of the body. Unlike other chronic wounds, wound healing in lymphedema is highly dependent on the use of combined therapies because local treatment with modern supportive dressings and compression therapy with adhesive and non-adhesive short-stretch systems is only part of the complete treatment. This treatment also includes sub-bandage foamy materials, kinesitherapy with tapes (kinesiotaping), intermittent local application of high-pressure oxygen, breathing exercise, and manual lymph drainage and exercises.

  10. [Clinical experiences in the use of lymphovenous anastomoses in secondary lymphedema].

    Science.gov (United States)

    Ingianni, G; Holzmann, T

    1985-01-01

    Secondary lymphedema of the arm after therapy for breast cancer has a frequency of about 30% in the Federal Republic of Germany. Many authors have performed lympho-venous anastomoses to release lymphostatic edema, most using microsurgical technique. In this paper the authors present microlympho-venous anastomoses done in a telescope-like manner and using fibrin glue. First this technique was applied to dogs, later to patients. Measurement of the limb and of the limb volume at different levels were done pre- and postoperatively. Investigations with radionucleides were undertaken in some cases to measure lymphatic clearance. The operations were performed under local anaesthesia with perioperative antibiotic prophylaxis. The procedure was well tolerated by the patients, achieving a reduction of the swelling of about 30%. Despite the short follow-up of only six months and the limited number of cases we feel that this type of therapy should be offered to patients with secondary lymphedema.

  11. THE EFFECT OF MICROWAVE AND BANDAGING TREATMENT ON SKIN IMMUNOLOGICAL CELLS IN CHRONIC LIMB LYMPHEDEMA

    Institute of Scientific and Technical Information of China (English)

    曹卫刚; 张涤生; 干季良

    2000-01-01

    Objective To clarify the characteristics of immunological reactions in skin tissues of non - filarial lymphedema patients with or without skin bacterial infection. Methods Avidin-biotin peroxidase (ABC)immunohistochemical method was used to examine the local skin tissue infiltrating inflammatory cells in 16chronic limb lymphedema patients before and after two courses of microwave and bandaging treatment. Results There was a significant increase of T lymphocyte infiltration in lymphedematous skin tissues; after two courses of microwave treatment, T lymphocyte infiltration was greatly resolved whereas the number of macrophages, which can lyse the stagnant proteins in lymphedematous tissues through proteolysis increased. Conclusion Microwave and bandaging treatment can promote regression of extremity edema by reducing chronic inflammation and enhancing the stagnant protein lysis capability in lymphedematous skin tissues.

  12. A Woman with Unilateral Rash and Fever: Cellulitis in the Setting of Lymphedema

    Directory of Open Access Journals (Sweden)

    Melissa Joseph

    2015-01-01

    Full Text Available Cellulitis in the setting of lymphedema is an uncommon but clinically important presentation to the emergency department. Stagnant lymph is an ideal medium for bacterial growth and progression can be rapid due to decreased ability to fight infection in the affected area. Infections are commonly caused by gram-positive cocci, though blood cultures are often negative. Treatment should be aimed at rapid initiation of antibiotics targeting these species. There may be a role for antibiotic prophylaxis in recurrent cases.

  13. Quantitative lymphoscintigraphy in post-mastectomy lymphedema: correlation with circumferential measurements

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Young; Lee, Kyung Han; Kim, Sang Eun; Kim, Byung Tae; Hwang, Jee Hea; Lee, Byung Boong [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-07-01

    An objective measure for the severity and progression is important for the management of lymphedema. To evaluate the usefulness of lympho-scintigraphy in this regard, we compared various quantitative indices from upper extremity lymphoscintigraphy with circumferential measurements, before and after physiotheraphy. Upper extremity lymphoscintigraphy was performed in 38 patients with unilateral postmastectomy lymphedema. Tc-99m antimony sulfide colloid (37 MBq) was injected s.c. into the second and third interdigital spaces. The injection sites were imaged immediately after injection. After standardized exercise for 15 min, upper extremity images were acquired 30 min, 1 hr and 2 hr after injection. The clearance of the injection site (CL), and % uptake in regional lymph nodes (%LN) and soft tissue of the extremity (i.e., the degree of dermal backflow) (%EXT) compared to the initial injection site were calculated. Circumference of each extremity was measured at 7 levels; the severity of lymphedema was expressed as the percentage difference of total circumferential difference (TCD) between healthy and edematous extremities compared to the total circumference of healthy extremity (%TCD). In 19 patients who received physiotherapy, the therapeutic effect was measured by % decrease of TCD (%DTCD) before and after therapy (Raines. et al., 1977). The quantitative indices calculated in the image at 2 hr p.i. had better correlation with either %TCD or %DTCD than those from earlier images (Table). The CL, %LN and %EXT of edematous extremity had a significant correlation with TCD. The %EXT was correlated best with either TCD or %DTCD. The results suggest that the %EXT which corresponds to the degree of dermal backflow may be a simple and useful quantitative index for evaluating the severity and progression in lymphedema and predicting the effect of therapy.

  14. EXPERIMENTAL TREATMENT FOR OBSTRUCTIVE LYMPHEDEMA BY TRANSPLANTATION OF FASCIAL FLAP RICHED IN LYMPH VESSELS

    Institute of Scientific and Technical Information of China (English)

    SUN Feng; CAO Wei-gang; LI Sheng-li; WANG Shan-liang; ZHANG Di-sheng

    2008-01-01

    Objective To provide a more effective microsurgical treatment for obstructive lymphedema.Methods Sixty models of rabbits with lymphedema in right hindlimb were devided into three groups: 20 for fascial flap transplantation (group A), 20 for no treatment (group B) and 20 for anastomosis of lymph vessels and vein (group C) as control. For group A, the posterior branch of medial vein in the normal hindlimb was cut down together with the fascial strip (about 3 cm wide) around it and concomitant lymph vessels, then transferred through the block region of the affected limb. The two broken tips of the vein were anastomosed respectively to normal veins beside the block region. Subcutaneous tissue and skin were sutured at last. For group B, no treatment was carried out. But traditional anastomosis of lymph vessels and vein was used for group C. Postoperative variation of volume was observed and lymphoscintigraphy was made.Results The volume curve of the affected limb in group A kept declining after 2 weeks and nearing to that of the normal hindlimb in group B but away from that of the affected limb in group B. The curve of donor limb in group A was similar to that of the normal limb of group B, which meant no secondary lymphedema occurred in donor limb. The volume of the affected limb of group A had significant difference to that of group C at postoperative 24 weeks, which meant the effect of group A was better than C. The lymphatic drainage of the affected limb of group A was obviously better than B and C in lymphoscintigraphic image. Deposit of nuclein was lessened.Conclusion It was verified that the transplantation of vein-lymph vessels-fatty fascial flap had following advantages: decreased technical difficulty, better long-term effect, aost no chronic lymphedema occurred in donor site, extensive adaptation.

  15. Independent Walking as a Major Skill for the Development of Anticipatory Postural Control: Evidence from Adjustments to Predictable Perturbations

    OpenAIRE

    Fabien Cignetti; Milan Zedka; Marianne Vaugoyeau; Christine Assaiante

    2013-01-01

    Although there is suggestive evidence that a link exists between independent walking and the ability to establish anticipatory strategy to stabilize posture, the extent to which this skill facilitates the development of anticipatory postural control remains largely unknown. Here, we examined the role of independent walking on the infants' ability to anticipate predictable external perturbations. Non-walking infants, walking infants and adults were sitting on a platform that produced continuou...

  16. Impact of Community-Based Lymphedema Management on Perceived Disability among Patients with Lymphatic Filariasis in Orissa State, India

    Science.gov (United States)

    Mues, Katherine E.; Kennedy, Erin D.; Prakash, Aiysha; Rout, Jonathan; Fox, LeAnne M.

    2013-01-01

    Background Lymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability. Methodology/Principal Findings For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009), and then at regular intervals through 24 months (July, 2011), to assess patients' perceived disability. Disability scores decreased significantly (plymphedema, reporting an adenolymphangitis (ADL) episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (plymphedema, compared to baseline. Significance These results indicate that community-based lymphedema management programs can reduce disability and prevent days of work lost. These effects were sustained over a 24 month period. PMID:23516648

  17. Immediate Changes to Skin and Subcutaneous Tissue Strains Following Manual Lymph Drainage in Legs with Lymphedema

    Science.gov (United States)

    Kakutani, Hiromi; Nakamura, Kaori; Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Ueda, Koshiro; Samura, Makoto; Tanaka, Yuya; Takeuchi, Yuriko; Hamano, Kimikazu

    2016-01-01

    Objectives: To study the immediate impact of manual lymph drainage (MLD) on skin and subcutaneous tissue strains in legs with lymphedema using free-hand real-time tissue elastography (RTE). Methods: Skin and subcutaneous tissue strain measurements were taken at the middle of the inner thigh and calf by RTE in 20 legs with lymphedema of 18 patients (stage II: 11, late stage II: 7, stage III: 2) and in 70 legs of 35 normal subjects. In patients with lymphedema, the same measurements were repeated immediately following MLD. Results: Significant negative correlations were found between pre-MLD strains and the MLD-induced changes in thigh and calf skin strains (thigh skin: p <0.01, calf skin: p = 0.05), but not in subcutaneous tissue strains. Pre-MLD intercepts of these regression lines were closer to normal values as compared to mean pre-MLD values (normal thigh skin: 0.54% ± 0.30%, calf skin: 0.25% ± 0.18%, Pre-MLD thigh skin: 0.39% ± 0.20%, calf skin: 0.17% ± 0.12%, Pre-MLD intercept of thigh skin: 0.48%, Pre-MLD intercept of calf skin: 0.31%). Conclusions: It appears that MLD did not simply soften the skin, but rather normalized it in terms of strain. However, this was not confirmed in the subcutaneous tissue. PMID:27087870

  18. Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

    Directory of Open Access Journals (Sweden)

    Jose Maria Pereira de Godoy

    2016-01-01

    Full Text Available The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily was proposed using Manual Lymphatic Therapy (Godoy & Godoy, Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.

  19. Technical advances in proteomics: new developments in data-independent acquisition [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Alex Hu

    2016-03-01

    Full Text Available The ultimate aim of proteomics is to fully identify and quantify the entire complement of proteins and post-translational modifications in biological samples of interest. For the last 15 years, liquid chromatography-tandem mass spectrometry (LC-MS/MS in data-dependent acquisition (DDA mode has been the standard for proteomics when sampling breadth and discovery were the main objectives; multiple reaction monitoring (MRM LC-MS/MS has been the standard for targeted proteomics when precise quantification, reproducibility, and validation were the main objectives. Recently, improvements in mass spectrometer design and bioinformatics algorithms have resulted in the rediscovery and development of another sampling method: data-independent acquisition (DIA. DIA comprehensively and repeatedly samples every peptide in a protein digest, producing a complex set of mass spectra that is difficult to interpret without external spectral libraries. Currently, DIA approaches the identification breadth of DDA while achieving the reproducible quantification characteristic of MRM or its newest version, parallel reaction monitoring (PRM. In comparative de novo identification and quantification studies in human cell lysates, DIA identified up to 89% of the proteins detected in a comparable DDA experiment while providing reproducible quantification of over 85% of them. DIA analysis aided by spectral libraries derived from prior DIA experiments or auxiliary DDA data produces identification and quantification as reproducible and precise as that achieved by MRM/PRM, except on low‑abundance peptides that are obscured by stronger signals. DIA is still a work in progress toward the goal of sensitive, reproducible, and precise quantification without external spectral libraries. New software tools applied to DIA analysis have to deal with deconvolution of complex spectra as well as proper filtering of false positives and false negatives. However, the future outlook is

  20. Development and Comparison of Techniques for Generating Permeability Maps using Independent Experimental Approaches

    Science.gov (United States)

    Hingerl, Ferdinand; Romanenko, Konstantin; Pini, Ronny; Balcom, Bruce; Benson, Sally

    2014-05-01

    We have developed and evaluated methods for creating voxel-based 3D permeability maps of a heterogeneous sandstone sample using independent experimental data from single phase flow (Magnetic Resonance Imaging, MRI) and two-phase flow (X-ray Computed Tomography, CT) measurements. Fluid velocities computed from the generated permeability maps using computational fluid dynamics simulations fit measured velocities very well and significantly outperform empirical porosity-permeability relations, such as the Kozeny-Carman equation. Acquiring images on the meso-scale from porous rocks using MRI has till recently been a great challenge, due to short spin relaxation times and large field gradients within the sample. The combination of the 13-interval Alternating-Pulsed-Gradient Stimulated-Echo (APGSTE) scheme with three-dimensional Single Point Ramped Imaging with T1 Enhancement (SPRITE) - a technique recently developed at the UNB MRI Center - can overcome these challenges and enables obtaining quantitative 3 dimensional maps of porosities and fluid velocities. Using porosity and (single-phase) velocity maps from MRI and (multi-phase) saturation maps from CT measurements, we employed three different techniques to obtain permeability maps. In the first approach, we applied the Kozeny-Carman relationship to porosities measured using MRI. In the second approach, we computed permeabilities using a J-Leverett scaling method, which is based on saturation maps obtained from N2-H2O multi-phase experiments. The third set of permeabilities was generated using a new inverse iterative-updating technique, which is based on porosities and measured velocities obtained in single-phase flow experiments. The resulting three permeability maps provided then input for computational fluid dynamics simulations - employing the Stanford CFD code AD-GPRS - to generate velocity maps, which were compared to velocity maps measured by MRI. The J-Leveret scaling method and the iterative-updating method

  1. A Model to Estimate the Risk of Breast Cancer-Related Lymphedema: Combinations of Treatment-Related Factors of the Number of Dissected Axillary Nodes, Adjuvant Chemotherapy, and Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myungsoo; Kim, Seok Won; Lee, Sung Uk; Lee, Nam Kwon; Jung, So-Youn; Kim, Tae Hyun; Lee, Eun Sook; Kang, Han-Sung [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: shin.kyunghwan@gmail.com [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

    2013-07-01

    Purpose: The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors. Methods and Materials: A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT). Results: At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001). Conclusions: The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.

  2. Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance.

    Science.gov (United States)

    Smith, Alesha; Latter, Sue; Blenkinsopp, Alison

    2014-11-01

    To determine the adequacy of initial nurse independent prescribing education and identify continuing professional development and clinical governance strategies in place for non-medical prescribing. In 2006, new legislation in England enabled nurses with an independent prescribing qualification to prescribe, within their competence. In 2006, non-medical prescribing policies released by the Department of Health outlined the recommendations for education, continuing professional development and governance of non-medical prescribing; however, there was no evidence on a national scale about the extent of implementation and effectiveness of these strategies. National surveys of: (i) nurse independent prescribers; and (ii) non-medical prescribing leaders in England. Questionnaire surveys (August 2008-February 2009) covering educational preparation, prescribing practice (nurse independent prescribers) and structures/processes for support and governance (non-medical prescribing leaders). Response rates were 65% (976 prescribers) and 52% (87 leaders). Most nurses felt their prescribing course met their learning needs and stated course outcomes and that they had adequate development and support for prescribing to maintain patient safety. Some types of community nurse prescribers had less access to support and development. The prescribing leaders reported lacking systems to ensure continuity of non-medical prescribing and monitoring patient experience. Educational programmes of preparation for nurse prescribing were reported to be operating satisfactorily and providing fit-for-purpose preparation for the expansion to the scope of nurse independent prescribing. Most clinical governance and risk management strategies for prescribing were in place in primary and secondary care. © 2014 John Wiley & Sons Ltd.

  3. The Long-term Risk of Upper-extremity Lymphedema is Two-fold Higher in Breast Cancer Patients than in Melanoma Patients

    Science.gov (United States)

    Voss, Rachel K.; Cromwell, Kate D.; Chiang, Yi-Ju; Armer, Jane M.; Ross, Merrick I.; Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Stewart, Bob R.; Shaitelman, Simona F.; Cormier, Janice N.

    2015-01-01

    Background and Objectives We assessed the cumulative incidence, symptoms, and risk factors for upper-extremity lymphedema in breast cancer and melanoma patients undergoing sentinel lymph node biopsy or axillary lymph node dissection. Methods Patients were recruited preoperatively (time 0) and assessed at 6, 12, and 18 months postoperatively. Limb volume change (LVC) was measured by perometry. Lymphedema was categorized as none, mild (LVC 5–9.9%), or moderate/severe (LVC≥10%). Symptoms were assessed with a validated lymphedema instrument. Longitudinal logistic regression analyses were conducted to identify risk factors associated with moderate/severe lymphedema. Results Among 205 breast cancer and 144 melanoma patients, the cumulative incidence of moderate/severe lymphedema at 18 months was 36.5% and 35.0, respectively. However, in adjusted analyses, factors associated with moderate/severe lymphedema were breast cancer (OR 2.0, p=0.03), body mass index ≥30 kg/m2 (OR 1.6, p=0.04), greater number of lymph nodes removed (OR 1.05, pLymphedema incidence increased over time in both cohorts. However, the adjusted risk of moderate/severe lymphedema was two-fold higher in breast cancer patients. These results may be attributed to surgical treatment of the primary tumor in the breast and more frequent use of radiation. PMID:26477877

  4. "You're naked, you're vulnerable": Sexual well-being and body image of women with lower limb lymphedema.

    Science.gov (United States)

    Winch, Caleb J; Sherman, Kerry A; Smith, Katriona M; Koelmeyer, Louise A; Mackie, Helen; Boyages, John

    2016-09-01

    Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized women's responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing women's central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Supporting the Development of Autonomous Learning Skills in Reading and Writing in an Independent Language Learning Centre

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    Hazel L. W. Chiu

    2012-09-01

    Full Text Available This article draws on observations, examples and findings from previous action research and teaching experiences gathered in an independent language learning centre in a university in Hong Kong to explore strategies for supporting independent learning. The learning centre offers one-to-one and small-group learning sessions to support the development of independent learning skills in various areas. This discussion will explore particularly the focuses of reading and writing skills development. These learner-centred support sessions aim to develop awareness of different types of learning strategies to suit individual learning needs, and cultivate interest and ability for continuous self-learning. The benefits of a semi-structured scaffolding format with attention to individual learning differences and supported by technology will be highlighted.

  6. Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil

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    Paiva Daniella MF

    2013-02-01

    Full Text Available Abstract Background Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora. Methods We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of medical records was performed to select women who met the inclusion criteria as follows: women who had an operation more than 6 months ago; absence of active disease, locoregional or distant; the absence of functional change in the affected limb before surgery, which could lead to swelling of the limb; and simulating or masking symptoms of lymphedema, such as bursitis, tendonitis, and work-related musculoskeletal disorders. Women with bilateral breast cancer, absence of axillary intervention (partial or complete axillary dissection and/or SLN biopsy, active disease in the region, or lympho-venous alteration of the limb before surgery were excluded. Data were collected from the medical records of the selected cases, and they subsequently underwent an interview and a physical assessment. Results The prevalence of lymphedema was 44.8%. There were medical records on the presence of this condition in 5.4% of cases. With regard to shoulder joint mobility, restrictions on abduction movements, internal and external rotation, and anterior shoulder adduction were significantly associated with lymphedema. Variables, including the presence of seroma, vascular changes, time elapsed after surgery, episodes of redness in the extremities, and cuticle removal from the hand with pliers were considered as major associated factors for lymphedema (p Conclusions The prevalence of 44.8% for lymphedema found in this study is considered to be relevant because it is a morbidity that

  7. Biomechanical Properties of the Skin in Patients with Breast Cancer-Related Lymphedema Compared to Healthy Individuals.

    Science.gov (United States)

    Killaars, R C; Penha, T R Lopez; Heuts, E M; van der Hulst, R R J W; Piatkowski, A A

    2015-09-01

    Biomechanical skin changes in breast cancer-related lymphedema (BRCL) have barely been described and objectively tested. This study aims to compare the skin of upper limb lymphedema with skin of the healthy contralateral arm, in order to demonstrate changes of elasticity, viscoelasticity, and level of hydration of the skin in BCRL. The secondary aim is to investigate the correlation between biomechanical skin changes and measurements that are currently used in clinical practice, such as volume measurement and lymph-ICF score. Eighteen patients with BCRL and 18 healthy individuals were included in the study. A Cutometer® was used for measurements for skin elasticity and viscoelasticity on both arms of each subject. A Corneometer® was used for measurements of skin hydration. Measurements of both test groups were compared. In BCRL patients, there was a significant difference (p = skin of the lymphedema arm compared to the healthy contralateral arm. There were no significant differences for level of skin hydration or viscoelasticity in lymphedema patients between the measurements on the skin of the lymphedematous and healthy arm. In healthy individuals, there were no significant differences for all measurements between skin of both arms. Spearman's correlation was significant (p = skin of the lower arm in patients with lymphedema compared to the contralateral healthy arm. Promising evidence is suggested for the use of the Cutometer device in the diagnostic evaluation of BCRL.

  8. Development of a prototype interactive learning system using multi-media technology for mission independent training program

    Science.gov (United States)

    Matson, Jack E.

    1992-01-01

    The Spacelab Mission Independent Training Program provides an overview of payload operations. Most of the training material is currently presented in workbook form with some lecture sessions to supplement selected topics. The goal of this project was to develop a prototype interactive learning system for one of the Mission Independent Training topics to demonstrate how the learning process can be improved by incorporating multi-media technology into an interactive system. This report documents the development process and some of the problems encountered during the analysis, design, and production phases of this system.

  9. Independent School Department Heads: The Influence of Role Ambiguity, Relationships, and Professional Development on Career Aspirations

    Science.gov (United States)

    Kinsella, Shane

    2012-01-01

    Little research exists on the career aspirations of department heads in independent schools. What does exist focuses on public school teachers in the United States and the United Kingdom. This study sought to determine the career aspirations, job satisfaction, and job efficacy of department heads. Using data from an original survey instrument…

  10. 77 FR 4632 - Defense Federal Acquisition Regulation Supplement; Independent Research and Development Technical...

    Science.gov (United States)

    2012-01-30

    ... technology readiness level. The DTIC on-line form can be found at http://www.dtic.mil/ird/dticdb/index.html... independence of contractors to choose which technologies to pursue in IR&D programs. The public comment period... of Defense, International Technology Security. Therefore the respondent made the...

  11. Undergraduate Student Acceptance of a Unit Design for Developing Independent Learning Abilities

    Science.gov (United States)

    Zutshi, Samar; Mitchell, Matthew; Weaver, Debbi

    2011-01-01

    This paper describes a method intended to advance students along the path to independent learning. The method is consistent with the principles of enquiry-based learning. It involves restructuring student contact class time into a single three-hour block, and dedicating the majority of this time to working in small research project groups.…

  12. Independent Planning System and Public Administration in Metropolitan Development: Agglomeration Strategies of Greater Chaoshan in Southern China

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    Tian Guang

    2017-04-01

    Full Text Available This paper examines independent planning system as a means of public administration in regional economic development. It proposes a new strategy based on the theories of public administrative resources, to agglomerate and unify the cities of Shantou, Jieyang, and Chaozhou into a new administrative entity as a metropolis with the status of independent planning and the preferred policies of a Special Economic Region to lead regional development. The optimal allocation of public administrative resources has played a key role in the fundamental economic development in China in recent years. The new administrative system of large cities (metropolises with independent planning has become an innovative format to utilize the renewable soft resources of administration, which in fact is a new attempt to reform the economic system by the Chinese government. The greater Chaoshan area needs to be agglomerated and unified to further develop the regional economy with the implementation of independent planning system. The current research conducted from a practical and political point of view is of significant value to the overall planning and strategic layout of the economic and social development of the whole eastern Guangdong region.

  13. Capacity building, scientific independence, and the development of UNESCOs science and technology agenda for Africa’

    DEFF Research Database (Denmark)

    Andersen, Casper

    2017-01-01

    This article analyses the shifting rationales for scientific collaboration in the work of the United Nations Economic, Scientific and Cultural Organization (UNESCO) in the science sector in Africa from the late colonial period through to the era of capacity building. Focusing on the late colonial...... capacities in the sciences was regarded as the key to obtaining “scientific independence” to match the recently obtained political independence. This marked a significant change from the 1950s when UNESCO based its operations in Africa on collaborations with the European colonial powers. The article argues...... that the link between scientific independence and political self-determination gave way as UNESCO rebranded scientific capacity-building activities as efforts in the pursuit of an unclearly-defined common good....

  14. Development of methodological principles for organization of students’ independent work in the e-learning system

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    Олександр Іванович Пушкар

    2016-10-01

    Full Text Available The concept of organization of professional competence formation of students’ independent work in e-learning is proposed in the article. Implementation of the proposed model of competence formation in e-learning is done on the example of multimedia complex for discipline "Processes of publishing and printing". Selection of the most important components for each competence is made on the basis of Saaty method

  15. THE PROCESSES OF “CREATIVE DESTRUCTION” AND DEVELOPMENT OF ECONOMY IN THE INDEPENDENT UKRAINE

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    I. Egorov

    2013-03-01

    Full Text Available The paper deals with the issue of transformation processes in the Ukrainian economy in the years of independence in the context Schumpeterian concept of transformation. It is shown that initial parameters of these processes have been assessed incorrectly; practical managerial, aimed at implementation of changes, were incomplete and poorly organized. This, in turn, has led to substantial negative consequences for the national economy.

  16. Prediction models for risk of developing type 2 diabetes : systematic literature search and independent external validation study

    NARCIS (Netherlands)

    Abbasi, Ali; Peelen, Linda M.; Corpeleijn, Eva; van der Schouw, Yvonne T.; Stolk, Ronald P.; Spijkerman, Annemieke M. W.; van der A, Daphne L.; Moons, Karel G. M.; Navis, Gerjan; Bakker, Stephan J. L.; Beulens, Joline W. J.

    2012-01-01

    Objective To identify existing prediction models for the risk of development of type 2 diabetes and to externally validate them in a large independent cohort. Data sources Systematic search of English, German, and Dutch literature in PubMed until February 2011 to identify prediction models for diabe

  17. Developing Information Literacy through Independent Learning Projects in a UK Setting: Pilot Projects for Year 9 and Year 6 Pupils

    Science.gov (United States)

    Jones, Rebecca

    2010-01-01

    Two information literacy skills pilot projects are being undertaken at Malvern St James School (MSJ) with Year 6 and Year 9 pupils during 2009-10. The projects encourage the development of independent learning skills, with pupils planning, managing and executing both the research and practical elements of their project. Each pupil sets their own…

  18. Quality of life, urogynecological morbidity, and lymphedema after radical vaginal trachelectomy for early-stage cervical cancer

    DEFF Research Database (Denmark)

    Frøding, Ligita Paskeviciute; Ottosen, Christian; Mosgaard, Berit Jul

    2015-01-01

    assess quality of life after RVT with focus on urogynecological morbidity and lymphedema. Furthermore, the aim of this study was to compare results with those in women treated with radical abdominal hysterectomy (RAH) and with age-matched control women from the general population. METHODS AND MATERIALS...... severe lymphedema of the legs as assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module. The Global Health Status scores of the RVT patients improved over time but were significantly lower than in the healthy controls during...... the entire observation time (P = 0.029). CONCLUSIONS: Patients treated with RVT for early-stage cervical cancer had persistent bladder emptying problems and lymphedema comparable to those experienced by patients treated with RAH and significantly higher than those reported by healthy control women....

  19. Evaluation of inter-rater reliability of subjective and objective criteria for diagnosis of lymphedema in upper and lower limbs

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    Larissa Louise Campanholi

    2015-03-01

    Full Text Available BACKGROUND: The diagnosis of lymphedema can be obtained objectively by measurement methods, and also by subjective methods, based on the patient's complaint. OBJECTIVE: To evaluate inter-rater reliability of objective and subjective criteria used for diagnosis of lymphedema and to propose a lymphedema cut-off for differences in volume between affected and control limbs. METHODS: We studied 84 patients who had undergone lymphadenectomy for treatment of cutaneous melanoma. Physical measures were obtained by manual perimetry (MP. The subjective criteria analyzed were clinical diagnosis of lymphedema in patients' medical records and self-report of feelings of heaviness and/or increase in volume in the affected limb. RESULTS: For upper limbs, the subjective criteria clinical observation (k 0.754, P<0.001 and heaviness and swelling (k 0.689, P<0.001 both exhibited strong agreement with MP results and there was moderate agreement between MP results and swelling (k 0.483 P<0.001, heaviness (k 0.576, P<0.001 and heaviness or swelling (k 0.412, P=0.001. For lower limbs there was moderate agreement between MP results and clinical observation (k 0.423, P=0.003 and regular agreement between MP and self-report of swelling (k 0.383, P=0.003. Cut-off values for diagnosing lymphedema were defined as a 9.7% difference between an affected upper limb and control upper limb and a 5.7% difference between lower limbs. CONCLUSION: Manual perimetry, medical criteria, and self-report of heaviness and/or swelling exhibited better agreement for upper limbs than for lower limbs for diagnosis of lymphedema.

  20. Illustrating the (in)visible: understanding the impact of loss in adults living with secondary lymphedema after cancer.

    Science.gov (United States)

    Thomas, Roanne; Hamilton, Ryan

    2014-01-01

    Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC). SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women with SLC were recruited from two research sites (Fredericton, NB, and Ottawa, ON, Canada) to participate in semi-structured interviews about the physical and psychosocial aspects of SLC. Using a methodology of interpretive description, our analysis of participant interviews reveals the complex ways in which men and women felt both visible and invisible within various contexts. We discuss three majors themes: (in)visibility and appearance related to material losses; (in)visibility and action connected to visible losses in function, as well as invisible struggles to care for oneself; and the loss of present and future well-being, as SLC renders some limitations visible while potentially obscuring a hopeful future indefinitely. Our research indicates that timely diagnosis of SLC would be an immediate first step in recognizing the physical and emotional dimensions of the condition. To accomplish this, increased awareness is needed. To enhance quality of life for those living with SLC, the development of new resources and psychosocial supports is also required.

  1. Reconstrucción en linfedema peneano y escrotal secundario a hernia inguinal bilateral gigante Reconstruction in penile and scrotal lymphedema secondary to billateral giant inguinal hernia

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    A. Fernández García

    2009-12-01

    Full Text Available El linfedema peneano y escrotal tiene consecuencias funcionales, estéticas, sociales y psicológicas significativas para el paciente que lo padece. Es una enfermedad infrecuente en los países desarrollados, aunque relativamente prevalente en los países tropicales. Su causa más común es la filariasis, aunque en nuestra práctica diaria se asocia más frecuentemente a cirugía, radioterapia, procesos inflamatorios y neoplásicos. Presentamos un caso singular de linfedema penoescrotal secundario a cirugía por hernia inguinal gigante bilateral que persistía un año después de la intervención. El tratamiento quirúrgico consistió en la exéresis de toda la piel linfedematosa del escroto involucrada y el uso de colgajos de piel escrotal posterior para la cobertura testicular. En un segundo tiempo quirúrgico se llevó a cabo una extirpación total de la piel del pene y del tejido subcutáneo superficial a la fascia de Buck. Empleamos injertos de piel de grosor parcial para cubrir el pene denudado. El resultado estético postoperatorio fue aceptable y los resultados funcionales y psicológicos son satisfactorios para el paciente 3 años después de la cirugía.Lymphedema of the penis and scrotum has important functional, cosmetic, social, psychological consequences for the affected patient. It is a rare disease in the developed countries, although it is relatively frequent in tropical countries. Globally, the most common cause is filariasis, although in our practice it is most frecuently associated to surgery, radiotherapy, inflammatory and neoplasic diseases. We report one rare case of penoscrotal lymphedema due to billateral giant inguinal hernia reconstrction. The lymphedema was persistent one year after the repair of the billateral hernia. The technique of reconstruction consisted of excision of all involved lymphedematous skin of the scrotum, and use of posterior scrotal flaps for testicular coverage. In a second surgical time, a total

  2. Impact of an educational program on the quality of life of patients with lymphedema: A preliminary evaluation.

    Science.gov (United States)

    Blaise, Sophie; Satger, Bernadette; Pernod, Gilles; Richaud, Cécile; Villemur, Béatrice; Carpentier, Patrick H

    2017-09-01

    We report on the preliminary evaluation of a well-designed program, Living with Lymphedema. This longitudinal cohort study assessed patients' quality of life using questionnaires. Our main objective was to evaluate the satisfaction of the patients and their adherence to the program. This was done using a specific questionnaire of satisfaction as well as by noting patients' adherence to the program (number of patients attending all three consultations). The secondary objective was to assess the effect of the program on the patient's quality of life. The assessment criteria were the evolution of the Medical Outcomes Study 36-Item Short Form Health Survey and EuroQol questionnaire scores between the first (C1) and third (C3) consultations. The Living with Lymphedema program targeted all patients with lymphedema in the Grenoble (France) conurbation and within the GRANTED health care network that includes vascular medicine specialists, primary care physicians, physical therapists, and dietitians in the Alpine region of France. All studied patients were ambulatory patients. The GRANTED network took care only of the educational aspect of the disease. All patients with primary or secondary lymphedema were offered the Living with Lymphedema program, whatever their age and the location of the lymphedema (upper or lower limbs). The collection of patient data conformed to the ethical and administrative regulations of the regional health authority. Grenoble Institutional Review Board (CPP Sud-Est V; No. 5891) approval for the study was specifically obtained for this evaluation on December 24, 2012. The program was built around one-to-one consultations, group workshops, and more specialized appointments. It was complementary to the routine medical care received by the patient (not evaluated in this study). It proposed three individual "educational" consultations, seven group workshops, and two specialized consultations with a dietitian. All the consultations or workshops were

  3. Penile and scrotal lymphedema as an unusual presentation of Crohn's disease: case report and review of the literature.

    Science.gov (United States)

    Reitsma, W; Wiegman, M J; Damstra, R J

    2012-03-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initially presenting as genital lymphedema with fistula formation is rare. Skin lesions in extraintestinal Crohn's disease typically show non-caseating, sarcoidal granulomas with numerous foreign body- and Langhans-type multinucleated giant cells, which are separated from intestinal involvement by normal skin. Treatment options are limited and include multi-immunosuppressant medications.

  4. Development of a monitoring system for physical frailty in independent elderly.

    Science.gov (United States)

    Hewson, David J; Jaber, Rana; Chkeir, Aly; Hammoud, Ali; Gupta, Dhruv; Bassement, Jennifer; Vermeulen, Joan; Yadav, Sandeep; de Witte, Luc; Duchene, Jacques

    2013-01-01

    Frailty is of increasing concern due to the associated decrease in independence of elderly who suffer from the condition. An innovative system was designed in order to objectively quantify the level of frailty based on a series of remote tests, each of which used objects similar to those found in peoples' homes. A modified ball, known as the Grip-ball was used to evaluate maximal grip force and exhaustion during an entirely remote assessment. A smartphone equipped with a tri-axial accelerometer was used to estimate gait velocity and physical activity level. Finally, a bathroom scale was used to assess involuntary weight loss. The smart phone processes all of the data generated, before it is transferred to a remote server where the user, their entourage, and any medical professionals with authorization can access the data. This innovative system could enable the onset of frailty to be detected early, thus giving sufficient time for a targeted intervention program to be implemented, thereby increasing independence for elderly users.

  5. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology.

    Science.gov (United States)

    2003-06-01

    This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based upon modifications suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany, and derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. The document is not meant to override individual clinical considerations for problematic patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited and therefore the suggested treatments are impractical. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this version of the Consensus represents the best judgment of the ISL membership on how to approach patients with peripheral lymphedema as of 2003. We anticipate that the document will and should be challenged, debated in the pages of Lymphology (e.g., as Letters to the Editor), and ideally become a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge

  6. Increased Serum Sodium and Serum Osmolarity Are Independent Risk Factors for Developing Chronic Kidney Disease; 5 Year Cohort Study

    Science.gov (United States)

    Kuwabara, Masanari; Hisatome, Ichiro; Roncal-Jimenez, Carlos A.; Niwa, Koichiro; Andres-Hernando, Ana; Jensen, Thomas; Bjornstad, Petter; Milagres, Tamara; Cicerchi, Christina; Song, Zhilin; Garcia, Gabriela; Sánchez-Lozada, Laura G.; Ohno, Minoru; Lanaspa, Miguel A.; Johnson, Richard J.

    2017-01-01

    Background Epidemics of chronic kidney disease (CKD) not due to diabetes mellitus (DM) or hypertension have been observed among individuals working in hot environments in several areas of the world. Experimental models have documented that recurrent heat stress and water restriction can lead to CKD, and the mechanism may be mediated by hyperosmolarity that activates pathways (vasopressin, aldose reductase-fructokinase) that induce renal injury. Here we tested the hypothesis that elevated serum sodium, which reflects serum osmolality, may be an independent risk factor for the development of CKD. Methods This study was a large-scale, single-center, retrospective 5-year cohort study at Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo, Japan, between 2004 and 2009. We analyzed 13,201 subjects who underwent annual medical examination of which 12,041 subjects (age 35 to 85) without DM and/or CKD were enrolled. This analysis evaluated age, sex, body mass index, abdominal circumference, hypertension, dyslipidemia, hyperuricemia, fasting glucose, BUN, serum sodium, potassium, chloride and calculated serum osmolarity. Results Elevated serum sodium was an independent risk factor for development of CKD (OR: 1.03, 95% CI, 1.00–1.07) after adjusted regression analysis with an 18 percent increased risk for every 5 mmol/L change in serum sodium. Calculated serum osmolarity was also an independent risk factor for CKD (OR: 1.04; 95% CI, 1.03–1.05) as was BUN (OR: 1.08; 95% CI, 1.06–1.10) (independent of serum creatinine). Conclusions Elevated serum sodium and calculated serum osmolarity are independent risk factors for developing CKD. This finding supports the role of limiting salt intake and preventing dehydration to reduce risk of CKD. PMID:28081152

  7. Product Development Categorized as Independent Strategic and Innovative Practice: Case from Indian Manufacturing

    Directory of Open Access Journals (Sweden)

    Himanshu Dutt

    2008-06-01

    Full Text Available In recent time, Indian manufacturing has seen technologically intensive and resource optimization based initiatives to satisfy competitive urge and to build or sustain market position. This they do by developing products either strategically or innovatively, but that is hardly distinguished or seen as a separate approach to product development. Strategically, product development is resource optimization based while innovatively, it is product differentiation focused. This paper outlines the strategic and innovative approach to product development and analyzes sector specific role of each in product development. The study is undertaken with nine product development team-leaders and resource-heads, three of each from automobile, steel and textile. It is concluded that textile is strategically skewed toward product development whereas automobile is inclined towards innovative orientation. The biggest limitation of this study is smaller sample-size because respondents are reluctant to disclose new technical initiatives and composition of product development.

  8. Composing hope through collage: A community-based intervention for cancer survivors living with lymphedema

    Directory of Open Access Journals (Sweden)

    Roanne Thomas

    2016-07-01

    Full Text Available Secondary lymphedema after cancer may result in distress, yet few interventions exist to support coping skills in this population. As part of a community-based intervention, we piloted the use of creative practices to promote active orientations to hope. A total of 19 participants completed the workshops; 11 collaged. The main themes address the collage processes as well as their content. The former addresses sub-themes such as selecting/composing. The latter includes sub-themes related to movement depicted in the collages. Collages and their associated discussions concretized hoping as an active and accessible process for participants living with two chronic illnesses.

  9. Composing hope through collage: A community-based intervention for cancer survivors living with lymphedema

    Directory of Open Access Journals (Sweden)

    Roanne Thomas

    2016-07-01

    Full Text Available Secondary lymphedema after cancer may result in distress, yet few interventions exist to support coping skills in this population. As part of a community-based intervention, we piloted the use of creative practices to promote active orientations to hope. A total of 19 participants completed the workshops; 11 collaged. The main themes address the collage processes as well as their content. The former addresses sub-themes such as selecting/composing. The latter includes sub-themes related to movement depicted in the collages. Collages and their associated discussions concretized hoping as an active and accessible process for participants living with two chronic illnesses.

  10. On the Development of Harmony, Turbulence, and Independence in Parent-Adolescent Relationships: A Five-Wave Longitudinal Study.

    Science.gov (United States)

    Hadiwijaya, Hana; Klimstra, Theo A; Vermunt, Jeroen K; Branje, Susan J T; Meeus, Wim H J

    2017-08-01

    The separation-individuation, evolutionary, maturational, and expectancy violation-realignment perspectives propose that the relationship between parents and adolescents deteriorate as adolescents become independent. This study examines the extent to which the development of adolescents' perceived relationship with their parents is consistent with the four perspectives. A latent transition analysis was performed in a two-cohort five-wave longitudinal study design covering ages 12-16 (n = 919, 49.2% female) and 16-20 (n = 392, 56.6% female). Generally, from 12 to 16 year adolescents moved away from parental authority and perceived increasing conflicts with their parents, whereas from 16 to 20 years adolescents perceived independence and improved their relationships with parents. Hereby, we also identified substantial patterns of individual differences. Together, these general and individual patterns provide fine-grained insights in relationship quality development.

  11. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

    NARCIS (Netherlands)

    Damstra, R. J.; Voesten, H. G. J.; van Schelven, W. D.; van der Lei, B.

    2009-01-01

    Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic,

  12. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

    NARCIS (Netherlands)

    Damstra, R. J.; Voesten, H. G. J.; van Schelven, W. D.; van der Lei, B.

    Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic,

  13. The development of cognitive independence of students of the University through networking cooperation

    Directory of Open Access Journals (Sweden)

    Eliseev Vladimir N.

    2016-01-01

    Full Text Available The paper describes the aspects of the augmented reality application development on the base of ARToolkit for Android. The steps consistently used for the augmented reality application development have been considered. The simplest Java-based examples of augmented reality have been discussed.

  14. Catalytic-independent roles of UTX-1 in C. elegans development

    DEFF Research Database (Denmark)

    Vandamme, Julien; Salcini, Anna Elisabetta

    2013-01-01

    We recently analyzed the functional roles of UTX-1 during development. utx-1 is an essential gene required for the correct embryonic and post-embryonic development of C. elegans, and it displays an H3K27me3 demethylase activity. Rescue experiments demonstrated that the enzymatic activity of UTX-1...

  15. Independence of genetic variation between circadian rhythm and development time in the seed beetle, Callosobruchus chinensis.

    Science.gov (United States)

    Harano, Tomohiro; Miyatake, Takahisa

    2011-03-01

    A positive genetic correlation between periods of circadian rhythm and developmental time supports the hypothesis that circadian clocks are implicated in the timing of development. Empirical evidence for this genetic correlation in insects has been documented in two fly species. In contrast, here we show that there is no evidence of genetic correlation between circadian rhythm and development time in the adzuki bean beetle, Callosobruchus chinensis. This species has variation that is explained by a major gene in the expression and period length of circadian rhythm between strains. In this study, we found genetic variation in development time between the strains. The development time was not covaried with either the incidence or the period length of circadian rhythm among the strains. Crosses between strains suggest that development time is controlled by a polygene. In the F(2) individuals from the crosses, the circadian rhythm is attributable to allelic variation in the major gene. Across the F(2) individuals, development time was not correlated with either the expression or the period length of circadian rhythm. Thus, we found no effects of major genes responsible for variation in the circadian rhythm on development time in C. chinensis. Our findings collectively give no support to the hypothesis that the circadian clock is involved in the regulation of development time in this species.

  16. 乳腺癌术后上肢水肿研究进展%Progress in study on lymphedema of arm after surgery of breast cancer

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Lymphedema of affected arm is a severe complication after surgery of breast cancer.Quality of life and rehabilitation of patients suffered from breast cancer receive more and more attention with increase of incidence and decrease of mortality,longation of survival time.Lymphedema of arm not only affects esthetics but produce pain,dysfunction,deprivation of work ability,and serious psychological issues.In the current paper,we reviewed progress in study on risk factors associated with surgery,evaluation,prevention and management of lymphedema in arm.

  17. Developing a New First Nations Health Governance System: Creation of an Independent, First Nations Run Organization

    Directory of Open Access Journals (Sweden)

    Alexander Ryan Levesque

    2017-08-01

    Full Text Available In 2011 a tripartite agreement between the province of British Columbia (BC, Health Canada, and First Nations leaders created the First Nations Health Authority (FNHA: a unique approach to First Nations health governance. The creation of the FNHA came after almost ten years of discussion and agreements between the three parties. The goal of the FNHA is to address health disparities between First Nations and other residents of BC, as well as increase the voice of First Nations people in the health system. The issues that led to the creation of the FNHA came onto the government's agenda due to an increased knowledge of the health crises facing BC First Nations, and a growing interest throughout Canada in increasing First Nations autonomy and input. In 2013 Health Canada transferred authority over all First Nations health programming to the FNHA, with the hope that an independent, First Nations run organization would better address the health-related needs of First Nations people. While evaluation of the FNHA is limited presently, since it only released its first five-year plan just over a year ago, a 2015 report by the Auditor General gives some insight into how the FNHA is functioning. If the FNHA can overcome a few weaknesses and threats to its stability, it has the potential to guide First Nations self-determination with respect to health care in Canada.

  18. Ubiquitin-independent proteosomal degradation of myelin basic protein contributes to development of neurodegenerative autoimmunity.

    Science.gov (United States)

    Belogurov, Alexey; Kuzina, Ekaterina; Kudriaeva, Anna; Kononikhin, Alexey; Kovalchuk, Sergey; Surina, Yelena; Smirnov, Ivan; Lomakin, Yakov; Bacheva, Anna; Stepanov, Alexey; Karpova, Yaroslava; Lyupina, Yulia; Kharybin, Oleg; Melamed, Dobroslav; Ponomarenko, Natalia; Sharova, Natalia; Nikolaev, Eugene; Gabibov, Alexander

    2015-05-01

    Recent findings indicate that the ubiquitin-proteasome system is involved in the pathogenesis of cancer as well as autoimmune and several neurodegenerative diseases, and is thus a target for novel therapeutics. One disease that is related to aberrant protein degradation is multiple sclerosis, an autoimmune disorder involving the processing and presentation of myelin autoantigens that leads to the destruction of axons. Here, we show that brain-derived proteasomes from SJL mice with experimental autoimmune encephalomyelitis (EAE) in an ubiquitin-independent manner generate significantly increased amounts of myelin basic protein peptides that induces cytotoxic lymphocytes to target mature oligodendrocytes ex vivo. Ten times enhanced release of immunogenic peptides by cerebral proteasomes from EAE-SJL mice is caused by a dramatic shift in the balance between constitutive and β1i(high) immunoproteasomes in the CNS of SJL mice with EAE. We found that during EAE, β1i is increased in resident CNS cells, whereas β5i is imported by infiltrating lymphocytes through the blood-brain barrier. Peptidyl epoxyketone specifically inhibits brain-derived β1i(high) immunoproteasomes in vitro (kobs/[I] = 240 M(-1)s(-1)), and at a dose of 0.5 mg/kg, it ameliorates ongoing EAE in vivo. Therefore, our findings provide novel insights into myelin metabolism in pathophysiologic conditions and reveal that the β1i subunit of the immunoproteasome is a potential target to treat autoimmune neurologic diseases.

  19. [Aortic valve replacement as an independent predictive factor for later development of aortic dissection].

    Science.gov (United States)

    von Kodolitsch, Y; Simic, O; Bregenzer, T; Dresler, C; Haverich, A; Nienaber, C A

    1998-08-01

    Dissection of the ascending aorta (type A) following later after aortic valve replacement has been described with increasing frequency. This study analyzes the role of aortic valve replacement for the evolution of late dissection. In a series of 80 consecutive patients with type A dissection, a previous aortic valve replacement had been performed in 12 cases (15%). In addition to arterial hypertension (p syndrome (p factor for type A dissection. Dissection occurred 3 +/- 4 years after aortic valve replacement with a clinical and anatomical profile similar to classic dissection as proven by comparison to a group of 62 patients with classic dissection associated with arterial hypertension or Marfan syndrome. With 75% and 66%, respectively, 30 day and 1 year survival of patients with dissection following later after aortic valve replacement was similar to patients with classic type A dissection. Extensive thinning and/or fragility (p associated with a high risk for late dissection; this finding was substantiated by comparison to a control group of 10 consecutive patients with a similarly dilated aortic root but no dissection. Type and diameter of valve prostheses, cross-clamp time, NYHA functional class, and left ventricular ejection fraction were unrelated to late dissection. Previous aortic valve replacement is an independent predisposing factor for a dissection of the ascending aorta later. At the time of aortic valve replacement, prophylactic replacement or wrapping of the ascending aorta should be considered in patients with a thinned/fragile aortic wall even without a markedly dilated aortic root.

  20. Quantitative evaluation of leg lymphedema by MR imaging. Estimation of therapeutic effect by intra-arterial injection of lymphocytes

    Energy Technology Data Exchange (ETDEWEB)

    Makimoto, Yumi; Harada, Masafumi; Matsuzaki, Kenji; Hayashi, Yoshinori; Nishitani, Hiromu; Yoshizumi, Masanori; Yoshida, Osamu; Katoh, Itsuo [Tokushima Univ. (Japan). School of Medicine

    1994-12-01

    The purpose of this study was to obtain characteristic findings of lymphedema and reactions after intra-arterial lymphocytes injection therapy by MRI and to evaluate quantitatively effect of intra-arterial lymphocytes injection. Five patients were treated by several intra-arterial lymphocytes injections. We measured T{sub 2} value on edematous tissue using triple echo sequence and shot TI IR (STIR) images to assess the extent of lymphedema. MRI was measured before and after each intra-arterial lymphocytes injection. Mean T{sub 2} and standard deviation (SD) of T{sub 2} distribution were obtained from T{sub 2}-calculated images. Characteristic findings of lymphedema were the thickening of subcutaneous, meshed pattern of fluid, thickening of skin, and fluid on the fascia. After therapy, thickness of subcutaneous tissue and meshed pattern were greatly decreased, but thickening of skin and fluid on the fascia still remained. Mean T{sub 2} and SD of T{sub 2} in edematous tissue were much higher than those of normal tissue. Both of them decreased extremely after therapy on improved cases but did not change on less effective cases. STIR could differentiate water from adipose tissue and clearly indicated the distribution of water. Mean T{sub 2} and SD of T{sub 2} distribution were useful to indicate evaluation of lymphedema and assessment of therapy. (author).

  1. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema

    NARCIS (Netherlands)

    Meijer, R.S.; Rietman, J.S.; Geertzen, J.H.B.; Bosmans, J.C.; Dijkstra, P.U.

    2004-01-01

    We investigated a method of indirect volume measurement that utilized surface measurements and a simplified formula derived from the formula for a frustum (Sitzia's method) to determine limb volumes in patients with breast cancer-related lymphedema of the upper extremity. Repeated measurements of up

  2. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    2012-01-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initi

  3. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease

  4. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema

    NARCIS (Netherlands)

    Meijer, R.S.; Rietman, J.S.; Geertzen, J.H.B.; Bosmans, J.C.; Dijkstra, P.U.

    We investigated a method of indirect volume measurement that utilized surface measurements and a simplified formula derived from the formula for a frustum (Sitzia's method) to determine limb volumes in patients with breast cancer-related lymphedema of the upper extremity. Repeated measurements of

  5. PENILE AND SCROTAL LYMPHEDEMA AS AN UNUSUAL PRESENTATION OF CROHN'S DISEASE : CASE REPORT AND REVIEW OF THE LITERATURE

    NARCIS (Netherlands)

    Reitsma, W.; Wiegman, M. J.; Damstra, R. J.

    2012-01-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initi

  6. A Mutation in VEGFC, a Ligand for VEGFR3, is Associated with Autosomal Dominant Milroy-like Primary Lymphedema

    NARCIS (Netherlands)

    Gordon, K.; Schulte, D.; Brice, G.; Simpson, M.A.; Roukens, M.G.; Impel, Van A.; Connell, F.; Kalidas, K.; Jeffery, S.; Mortimer, P.S.; Mansour, S.; Schulte-Merker, S.; Ostergaard, P.

    2013-01-01

    Rationale: Mutations in vascular endothelial growth factor (VEGF) receptor-3 (VEGFR3 or FLT4) cause Milroy disease, an autosomal dominant condition that presents with congenital lymphedema. Mutations in VEGFR3 are identified in only 70% of patients with classic Milroy disease, suggesting genetic het

  7. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study

    Directory of Open Access Journals (Sweden)

    A. Smykla

    2013-01-01

    Full Text Available The aim of the study was to assess the efficacy of Kinesiology Taping (KT for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n=20, the Quasi KT group (quasi K-tapes, n=22, or the MCT group (multilayered compression therapy group, n=23. Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (P>0.05. The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785.

  8. Severe lymphedema, intestinal lymphangiectasia, seizures and mild mental retardation: further case of Hennekam syndrome with a severe phenotype.

    Science.gov (United States)

    Forzano, F; Faravelli, F; Loy, A; Di Rocco, M

    2002-07-22

    We report on an Italian patient affected by severe lymphedema of lower limbs, genitalia and face, intestinal lymphangiectasia, seizures, and moderate mental retardation. He has a flat face, flat nasal bridge, and hypertelorism. We propose that he presents with a severe form of Hennekam syndrome.

  9. Indocyanine green (ICG lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs.

    Directory of Open Access Journals (Sweden)

    Makoto Mihara

    Full Text Available BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI, computed tomography (CT, lymphoscintigraphy, and Indocyanine Green (ICG lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old. Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

  10. Effect of Kinesiology Taping on breast cancer-related lymphedema: a randomized single-blind controlled pilot study.

    Science.gov (United States)

    Smykla, A; Walewicz, K; Trybulski, R; Halski, T; Kucharzewski, M; Kucio, C; Mikusek, W; Klakla, K; Taradaj, J

    2013-01-01

    The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n = 20), the Quasi KT group (quasi K-tapes, n = 22), or the MCT group (multilayered compression therapy group, n = 23). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (P > 0.05). The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785.

  11. Development of a caseinase assay for PCR independent detection of esp gene carriage among enterococci

    Science.gov (United States)

    Dada, Ayokunle Christopher; Asmat, Ahmad; Lee, Yook Heng; Usup, Gires

    2013-11-01

    Currently, there is no known relationship between caseinase and carriage of esp gene. Also, no breakpoints exist for phenotypic assays that are used to infer virulence characteristics among Enterococci. In the present study, caseinase activity was measured by a radial diffusion assay for 113 enterococci isolates. A standard curve with predictive r2 value of 0.939 was produced by dispensing several doubling dilutions of proteinase K into 3% skimmed milk agar wells. Caseinase activity for all tested enterococci was subsequently converted into proteinase K activity, using the obtained chart. Caseinase activity ranged from 1.74 × 10-8 to 4.47 × 10-7ug/ml and 6.37 × 10-8 to 8.82 × 10-8 ug/ml per colony of environmental and clinical enterocococci tested, proportionate to proteinase K activity. Caseinase activity among environmental strains was five-fold higher than was observed among clinical strains. Fishers exact test revealed significant associations between esp gene carriage and caseinase activity (diameter on skimmed milk, z=8 to 13mm) at p<0.1. However, the probability of association was strongest at z=13 mm (p=0.033) suggesting a range of diameter cut-offs that was exclusive to and may be used to predict the presence of environmental enterococci strains harbouring esp gene. Results obtained from sensitivity analysis showed increasing assay sensitivity from cut-off of 9 mm (61.54%) up to 84.62% (13 mm). Specificity of the caseinase assay slightly decreased from 50% to 42.86% as cut-off increased from 9 to 13 mm. The caseinase assay described here potentially proves useful in preliminary PCR independent screening of environmental enterococci isolates for the detection of strains which carry the esp gene known to increase the severity of enterococcal infections.

  12. Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy

    Directory of Open Access Journals (Sweden)

    de Fátima Guerreiro Godoy, Maria

    2010-01-01

    Full Text Available The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient’s body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤0.05 being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001. In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.

  13. Results of surgical treatment of massive localized lymphedema in severely obese patients

    Directory of Open Access Journals (Sweden)

    Wilson Cintra Júnior

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

  14. Management of unusual genital lymphedema complication after Fournier’s gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Meyer Ganz Oanna

    2012-12-01

    Full Text Available Abstract Background Fournier’s gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier’s gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient. Case presentation Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier’s gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a “penile lift” allowed a satisfactory esthetical and functional result. Conclusion Fournier’s gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by “penile lift”.

  15. Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema.

    Science.gov (United States)

    Akita, Shinsuke; Mitsukawa, Nobuyuki; Kuriyama, Motone; Kubota, Yoshitaka; Hasegawa, Masakazu; Tokumoto, Hideki; Ishigaki, Tatsuya; Togawa, Takashi; Kuyama, Junpei; Satoh, Kaneshige

    2015-05-01

    Vascularized lymph node transfer has become a popular surgical option to improve lower extremity lymphedema (LEL), although potential donor sites are limited. The free supraclavicular flap with deep cervical lymph nodes has been recently associated with a minimal risk of secondary lymphedema caused by donor site dissection. However, the effectiveness of this procedure has not yet been evaluated. Vascularized supraclavicular lymph node transfer (VSLNT) was performed for patients with International Society of Lymphology late stage II or more severe LEL. The results were compared with lymphaticovenular anastomosis (LVA) performed for patients with the same stages of severity. To evaluate improvement in lymphatic function, indocyanine green lymphography and lymphoscintigraphy were performed. Vascularized supraclavicular lymph node transfer was performed in 13 limbs of 13 patients. The results were compared with 43 limbs of 33 patients who underwent multiple LVA. No severe complications were observed in either group. Improvement in lymphatic function, as measured by the LEL index, was 26.5 ± 4.4 and 21.2 ± 2.0 in the VSLNT and LVA groups, respectively. Lymphatic function was improved in 7 cases in the VSLNT group and 10 cases in the LVA group. Vascularized supraclavicular lymph node transfer is an effective technique for the treatment of advanced stage LEL. Lymphaticovenular anastomosis is also effective, but to a lesser degree than VSLNT. However, LVA is less invasive and requires a shorter hospital stay.

  16. Lymph node transfer and perinodal lymphatic growth factor treatment for lymphedema.

    Science.gov (United States)

    Honkonen, Krista M; Visuri, Mikko T; Tervala, Tomi V; Halonen, Paavo J; Koivisto, Mari; Lähteenvuo, Markku T; Alitalo, Kari K; Ylä-Herttuala, Seppo; Saaristo, Anne M

    2013-05-01

    Our objective was to define the optimal growth factor treatment to be used in combination with lymph node transfer to normalize lymphatic vascular anatomy. In the lymph node transfer method, lymphatic anastomoses are expected to form spontaneously. However, lymphangiogenic growth factor therapies have shown promising results in preclinical models of lymphedema. The inguinal lymphatic vasculature of pigs was surgically destroyed around the inguinal lymph node. To enhance the regrowth of the lymphatic network in the defected area, adenoviral vascular endothelial growth factor C (VEGF-C) was administered intranodally or perinodally. Control animals received injections of saline or control vector. The lymphangiogenic effect of the growth factor therapy and any potential adverse effects associated with the 2 alternative delivery routes were examined 2 months postoperatively. Both routes of growth factor administration induced robust growth of lymphatic vessels and helped to preserve the structure of the transferred lymph nodes in comparison with the controls. The lymph nodes of the control treated animals regressed in size and their nodal structure was partly replaced by fibro-fatty scar tissue. Intranodally injected adenoviral VEGF-C and adenoviral vector encoding control gene LacZ induced macrophage accumulation inside the node, whereas perinodal administration of VEGF-C did not have this adverse effect. Lymphangiogenic growth factors improve lymphatic vessel regeneration and lymph node function after lymph node transfer. The perinodal route of delivery provides a basis for future clinical trials in lymphedema patients.

  17. Quality of life of women with lymphedema after surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Marislei Sanches Panobianco

    2014-06-01

    Full Text Available This study evaluated the quality of life of 20 women with post-mastectomy lymphedema due to breast cancer, using the Flanagan’s Adapted Quality of Life Scale (1 and the Visual Analogue Scale (2, with data collection from July to December 2009 in the countryside of the state of São Paulo. It was observed a lower quality of life concerning participation in recreational and work activities, and better quality of life was related to relationship with friends; listening to music, reading, watching TV and going to the movies. Cronbach's alpha of Scale 1 was 0.86 and the average of Scale 2 was 6.26. Overall, the scales showed satisfactory results of quality of life, but low values showed factors that must be worked out, such as participation in sports, work and learning activities. Thus, lymphedema interferes with the quality of life, indicating a need for early intervention in order to help women achieve better quality of life.

  18. Control of fertilization-independent endosperm development by the MEDEA polycomb gene in Arabidopsis.

    Science.gov (United States)

    Kiyosue, T; Ohad, N; Yadegari, R; Hannon, M; Dinneny, J; Wells, D; Katz, A; Margossian, L; Harada, J J; Goldberg, R B; Fischer, R L

    1999-03-30

    Higher plant reproduction is unique because two cells are fertilized in the haploid female gametophyte. Egg and sperm nuclei fuse to form the embryo. A second sperm nucleus fuses with the central cell nucleus that replicates to generate the endosperm, a tissue that supports embryo development. To understand mechanisms that initiate reproduction, we isolated a mutation in Arabidopsis, f644, that allows for replication of the central cell and subsequent endosperm development without fertilization. When mutant f644 egg and central cells are fertilized by wild-type sperm, embryo development is inhibited, and endosperm is overproduced. By using a map-based strategy, we cloned and sequenced the F644 gene and showed that it encodes a SET-domain polycomb protein. Subsequently, we found that F644 is identical to MEDEA (MEA), a gene whose maternal-derived allele is required for embryogenesis [Grossniklaus, U., Vielle-Calzada, J.-P., Hoeppner, M. A. & Gagliano, W. B. (1998) Science 280, 446-450]. Together, these results reveal functions for plant polycomb proteins in the suppression of central cell proliferation and endosperm development. We discuss models to explain how polycomb proteins function to suppress endosperm and promote embryo development.

  19. Supervising Model of Independent Enterprise Group (Study of Community Development of PT Badak NGL in Cipta Busana Cooperative

    Directory of Open Access Journals (Sweden)

    Hermansyah Hermansyah

    2016-06-01

    Full Text Available This research aims to arrange an empowerment model of enterprise group through the program of Community Development in order to be independent and ready to compete, which is begun from the empirical study of the success of Cipta Busana Cooperative.. This research uses the descriptive analysis by using a case study on one enterprise supervised by PT Badak NGL that is Koperasi Cipta Busana (Kocibu. Kocibu is chosen to be the object of research due to its success to achieve the target to be the independent supervised enterprise in the fourth year. The data analysis method used in this research is the explorative analysis. Based on the research, there are some results such as that Kocibu is one of the supervised Micro, Small and Medium Enterprises of PT Badak NGL that could develop and be independent through several supporting programs. Some of key successes of Kocibu are as follows: a high commitment, a good leader, and intensive supervising programs. Besides, a good marketing system also contributes to the key of success. There are some aspects that naturally contribute to the Kocibu improvement and emerge naturally as follows: the leader figure and the high commitment from the stakeholders. While, the aspects emerged by design are: the supervising and training programs, the evaluation, the determination of rules, and the business targets. Hopefully, after this research has been conducted, the aspects appeared naturaly would be realized so early that the success of the public empowerment program will be able to increase. 

  20. Developing Independent Listening Skills for English as an Additional Language Students

    Science.gov (United States)

    Picard, Michelle; Velautham, Lalitha

    2016-01-01

    This paper describes an action research project to develop online, self-access listening resources mirroring the authentic academic contexts experienced by graduate university students. Current listening materials for English as an Additional Language (EAL) students mainly use Standard American English or Standard British pronunciation, and far…

  1. Guiding Independence: Developing a Research Tool to Support Student Decision Making in Selecting Online Information Sources

    Science.gov (United States)

    Baildon, Rindi; Baildon, Mark

    2008-01-01

    The development and use of a research tool to guide fourth-grade students' use of information sources during a research project is described in this article. Over a period of five weeks, 21 fourth-grade students in an international school in Singapore participated in a study investigating the extent to which the use of a "research resource…

  2. Their Own Best Teachers: How We Help and Hinder the Development of Learners' Independence

    Science.gov (United States)

    Duke, Robert A.

    2012-01-01

    Skillful teachers have developed the ability to take learners from the first conception of a goal to its accomplishment in shorter and shorter periods of time, with fewer and fewer errors on the learners' part and with increasing satisfaction and diminishing frustration on the teacher's. This article deals with the extent to which teachers provide…

  3. Development of Peace Education in India (Since Independence). Peace Education Miniprints No. 95.

    Science.gov (United States)

    Prasad, Surya Nath

    The development of peace education in India is discussed in this booklet. Although India has made many contributions to the theory and practice of peace work (the non-violent movement led by Mahatma Gandhi), peace education in the form of university courses or special curricula for schools is seldom encountered. However, signs of interest in peace…

  4. Arabidopsis CPR5 independently regulates seed germination and postgermination arrest of development through LOX pathway and ABA signaling.

    Directory of Open Access Journals (Sweden)

    Guilan Gao

    Full Text Available The phytohormone abscisic acid (ABA and the lipoxygenases (LOXs pathway play important roles in seed germination and seedling growth and development. Here, we reported on the functional characterization of Arabidopsis CPR5 in the ABA signaling and LOX pathways. The cpr5 mutant was hypersensitive to ABA in the seed germination, cotyledon greening and root growth, whereas transgenic plants overexpressing CPR5 were insensitive. Genetic analysis demonstrated that CPR5 gene may be located downstream of the ABI1 in the ABA signaling pathway. However, the cpr5 mutant showed an ABA independent drought-resistant phenotype. It was also found that the cpr5 mutant was hypersensitive to NDGA and NDGA treatment aggravated the ABA-induced delay in the seed germination and cotyledon greening. Taken together, these results suggest that the CPR5 plays a regulatory role in the regulation of seed germination and early seedling growth through ABA and LOX pathways independently.

  5. Clinical significance of a proposed lymphoscintigrpahic functional grade system in patients with extremity lymphedema of stage i

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joan Young; Hwang, Ji Hye; Kim, Dong Ik; Cho, Young Seok; Lee, Su Jin; Choi, Yong; Choe, Yeam Seong; Lee, Kyung Han; Kim, Byung Tae [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We proposed a new lymphoscintigrpahic functional grade (LGr) system in extremity lymphedema, and investigated the association between the LGr and a long-term response to physical therapy in patients with extremity lymphedema of stage I. The subjects were 20 patients with unilateral extremity lymphedema of stage I, who underwent pre-treatment extremity lymphoscintigraphy using Tc-99m antimony sulfur colloid, and were treated by complex decongestive physical therapy (CDPT). A proposed lymphoscintigrpahic functional grade system consisted of LGr 0 to LGr 4 according to the ilioinguinal nodal uptake, amount of dermal backflow, and uptake pattern of main and collateral lymphatics : LGr 0 = normal, LGr 1 = decreased lymphatic function without dermal backflow, LGr 2 = decreased lymphatic function with dermal backflow, LGr 3 = non - visualization of main lymphatics with dermal backflow, and LGr 4 = no significant lymphatic transport from injection site. LGr 2 was divided into 2A and 2B based on the amount of dermal backflow. A physician who is a lymphedema specialist determined the long-term outcome to CDPT with normalized response (NR), good response (GR) and poor response (PR) based on the change of edema volume reduction, skin status and occurrence of dermatolymphangioadenitis after the clinical follow-up for more than 1 year. Therapeutic responses were NR in 2 patients. GR in 9 patients and PR in 9 patients. Baseline LGrs were 1 in 7 patients, 2A in 4 patients, 2B in 5 patients, 3 in 2 patients, and 4 in 2 patients. There was a significant relationship between therapeutic response and LGr (p=0.003). In other words, 10 of 11 patients (91%) with LGr 1 or 2A showed NR. or GR. On the contrary, 8 of 9 patients (89%) with LGr 2B, 3 or 4 showed PR. Patients with unilateral extremity lymphedema of stage I had different lymphoscintigrpahic functional grades. This grade system may be useful to predict the response to physical therapy in such patients.

  6. Colonic Patch and colonic SILT development are independent and differentially-regulated events

    Science.gov (United States)

    Baptista, AP; Olivier, BJ; Goverse, G; Greuter, M; Knippenberg, M; Kusser, K; Domingues, RG.; Veiga-Fernandes, H; Luster, AD; Lugering, A; Randall, TD; Cupedo, T; Mebius, RE

    2012-01-01

    Intestinal lymphoid tissues have to simultaneously ensure protection against pathogens and tolerance towards commensals. Despite such vital functions, their development in the colon is poorly understood. Here, we show that the two distinct lymphoid tissues of the colon–colonic patches and colonic SILTs–can easily be distinguished based on anatomical location, developmental timeframe and cellular organization. Furthermore, whereas colonic patch development depended on CXCL13-mediated LTi cell clustering followed by LTα-mediated consolidation, early LTi clustering at SILT anlagen did not require CXCL13, CCR6 or CXCR3. Subsequent dendritic cell recruitment to and gp38+VCAM-1+ lymphoid stromal cell differentiation within SILTs required LTα; B cell recruitment and follicular dendritic cell differentiation depended on MyD88-mediated signalling, but not the microflora. In conclusion, our data demonstrate that different mechanisms, mediated mainly by programmed stimuli, induce the formation of distinct colonic lymphoid tissues, therefore suggesting that these tissues may have different functions. PMID:22990625

  7. Development of behavioural profile in the Northern common boa (Boa imperator): Repeatable independent traits or personality?

    Science.gov (United States)

    Šimková, Olga; Frýdlová, Petra; Žampachová, Barbora; Frynta, Daniel; Landová, Eva

    2017-01-01

    Recent studies of animal personality have focused on its proximate causation and ecological and evolutionary significance in particular, but the question of its development was largely overlooked. The attributes of personality are defined as between-individual differences in behaviour, which are consistent over time (differential consistency) and contexts (contextual generality) and both can be affected by development. We assessed several candidates for personality variables measured in various tests with different contexts over several life-stages (juveniles, older juveniles, subadults and adults) in the Northern common boa. Variables describing foraging/feeding decision and some of the defensive behaviours expressed as individual average values are highly repeatable and consistent. We found two main personality axes-one associated with foraging/feeding and the speed of decision, the other reflecting agonistic behaviour. Intensity of behaviour in the feeding context changes during development, but the level of agonistic behaviour remains the same. The juveniles and adults have a similar personality structure, but there is a period of structural change of behaviour during the second year of life (subadults). These results require a new theoretical model to explain the selection pressures resulting in this developmental pattern of personality. We also studied the proximate factors and their relationship to behavioural characteristics. Physiological parameters (heart and breath rate stress response) measured in adults clustered with variables concerning the agonistic behavioural profile, while no relationship between the juvenile/adult body size and personality concerning feeding/foraging and the agonistic behavioural profile was found. Our study suggests that it is important for studies of personality development to focus on both the structural and differential consistency, because even though behaviour is differentially consistent, the structure can change.

  8. Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity.

    Science.gov (United States)

    Laursen, Martin Frederik; Andersen, Louise B B; Michaelsen, Kim F; Mølgaard, Christian; Trolle, Ellen; Bahl, Martin Iain; Licht, Tine Rask

    2016-01-01

    The first years of life are paramount in establishing our endogenous gut microbiota, which is strongly affected by diet and has repeatedly been linked with obesity. However, very few studies have addressed the influence of maternal obesity on infant gut microbiota, which may occur either through vertically transmitted microbes or through the dietary habits of the family. Additionally, very little is known about the effect of diet during the complementary feeding period, which is potentially important for gut microbiota development. Here, the gut microbiotas of two different cohorts of infants, born either of a random sample of healthy mothers (n = 114), or of obese mothers (n = 113), were profiled by 16S rRNA amplicon sequencing. Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet. We found that maternal obesity did not influence microbial diversity or specific taxon abundances during the complementary feeding period. Across cohorts, breastfeeding duration and composition of the complementary diet were found to be the major determinants of gut microbiota development. In both cohorts, gut microbial composition and alpha diversity were thus strongly affected by introduction of family foods with high protein and fiber contents. Specifically, intake of meats, cheeses, and Danish rye bread, rich in protein and fiber, were associated with increased alpha diversity. Our results reveal that the transition from early infant feeding to family foods is a major determinant for gut microbiota development. IMPORTANCE The potential influence of maternal obesity on infant gut microbiota may occur either through vertically transmitted microbes or through the dietary habits of the family. Recent studies have suggested that the heritability of obesity may partly be caused by the transmission of "obesogenic" gut microbes. However, the findings presented here suggest that maternal obesity per

  9. CENTRAL BANK INDEPENDENCY ON THE DEVELOPMENT OF THE FINANCIAL SECTOR. A CASE OF RESERVE BANK OF ZIMBABWE (1998-2008

    Directory of Open Access Journals (Sweden)

    KOSMAS NJANIKE

    2010-01-01

    Full Text Available The study looks deeper in the relationship between central bank independence and Gross Domestic product growth and other economic variables which are indicative of improved performance with specific reference to a developing economy. It seeks to find out how the central bank policies affected the state of development of the financial sector and the extent to which the banking sector influenced economic development in the economy. The research also aims to find out how the government affected or influenced the state of development of the financial sector in the country. It was found that the government was sorely dependent on central bank financing as a matter of survival due to limited sources of finance as GDP decline meant a reduction tax revenue base. Rising inflation and contracting real incomes put pressure on the fiscal budget. Questionnaires, interviews and document review were used to obtain information for the study. It was concluded that the cohesion between fiscal and monetary policy is of paramount importance; and there was need for a high degree of formal instrument independence.

  10. Division of Labour and Coordination between independent Participants in Research and Development

    DEFF Research Database (Denmark)

    Pedersen, Jørgen Lindgaard; Edwards, Kasper; Pedersen, Søren Marcus;

    2004-01-01

    Not only relatively simple work routines can today be outsourced to home countries or sent abroad. Also R&D is today object for such a development. In this paper we consider the issue through the prisms of history, uncertainty, and modularity. We look at the temporal dimension of knowledge...... accumulation, diminishing uncertainty, applying the modularisation concept in division of labour and all that covering with sphere of globalisation and faster, cheaper and more reliable and accurate information flow are making R&D processes object for outsourcing. We are looking at three empirical cases: 1...

  11. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    Science.gov (United States)

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  12. Development of Conformation Independent Computational Models for the Early Recognition of Breast Cancer Resistance Protein Substrates

    Directory of Open Access Journals (Sweden)

    Melisa Edith Gantner

    2013-01-01

    Full Text Available ABC efflux transporters are polyspecific members of the ABC superfamily that, acting as drug and metabolite carriers, provide a biochemical barrier against drug penetration and contribute to detoxification. Their overexpression is linked to multidrug resistance issues in a diversity of diseases. Breast cancer resistance protein (BCRP is the most expressed ABC efflux transporter throughout the intestine and the blood-brain barrier, limiting oral absorption and brain bioavailability of its substrates. Early recognition of BCRP substrates is thus essential to optimize oral drug absorption, design of novel therapeutics for central nervous system conditions, and overcome BCRP-mediated cross-resistance issues. We present the development of an ensemble of ligand-based machine learning algorithms for the early recognition of BCRP substrates, from a database of 262 substrates and nonsubstrates compiled from the literature. Such dataset was rationally partitioned into training and test sets by application of a 2-step clustering procedure. The models were developed through application of linear discriminant analysis to random subsamples of Dragon molecular descriptors. Simple data fusion and statistical comparison of partial areas under the curve of ROC curves were applied to obtain the best 2-model combination, which presented 82% and 74.5% of overall accuracy in the training and test set, respectively.

  13. Issues involved in attempting to develop independent learning in pupils working on technological projects

    Science.gov (United States)

    Barak, Moshe

    2004-02-01

    This research addresses the impact of technological projects at high school on pupils' learning. The participants were sixty low-mid achieving pupils who worked for one year on final projects for matriculation exams. Data were collected through observations of laboratory lessons, interviews with pupils and teachers, and analysis of pupils' projects and portfolios. In the modern technological laboratory, pupils experience design, construction and improvement of sophisticated systems, in a rich learning environment. From being fully dependent on their teachers, pupils might gradually develop to become more autonomous learners and creative thinkers. A three-stage model is suggested aimed to help teachers adjust their supervision approach to the pupils' conceptual development. A pupil at the 'show me' stage needs a 'direct supervision' approach; a pupil at the 'let's think together' stage needs a 'collaborative supervision' approach; a pupil at the 'trust me' stage needs a 'nondirective supervision'. In projects carried out within mandatory exams, pupils are motivated not only by internal rewards, but also by being evaluated objectively and awarded a formal credit for their achievements.

  14. Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity

    DEFF Research Database (Denmark)

    Laursen, Martin Frederik; Andersen, Louise B. B.; Michaelsen, Kim F.

    2016-01-01

    obesity did not influence microbial diversity or specific taxon abundances during the complementary feeding period. Across cohorts, breastfeeding duration and composition of the complementary diet were found to be the major determinants of gut microbiota development. In both cohorts, gut microbial......The first years of life are paramount in establishing our endogenous gut microbiota, which is strongly affected by diet and has repeatedly been linked with obesity. However, very few studies have addressed the influence of maternal obesity on infant gut microbiota, which may occur either through...... either of a random sample of healthy mothers (n = 114), or of obese mothers (n = 113), were profiled by 16S rRNA amplicon sequencing. Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet. We found that maternal...

  15. Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity

    DEFF Research Database (Denmark)

    Laursen, Martin Frederik; Andersen, Louise B. B.; Michaelsen, Kim F.;

    2016-01-01

    The first years of life are paramount in establishing our endogenous gut microbiota, which is strongly affected by diet and has repeatedly been linked with obesity. However, very few studies have addressed the influence of maternal obesity on infant gut microbiota, which may occur either through...... vertically transmitted microbes or through the dietary habits of the family. Additionally, very little is known about the effect of diet during the complementary feeding period, which is potentially important for gut microbiota development. Here, the gut microbiotas of two different cohorts of infants, born...... either of a random sample of healthy mothers (n = 114), or of obese mothers (n = 113), were profiled by 16S rRNA amplicon sequencing. Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet. We found that maternal...

  16. Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity

    DEFF Research Database (Denmark)

    Laursen, Martin Frederik; Andersen, Louise B. B.; Michaelsen, Kim F.

    vertically transmitted microbes or through the dietary habits of the family. Additionally, very little is known about the effect of diet during the complementary feeding period, which is potentially important for gut microbiota development. Here, the gut microbiotas of two different cohorts of infants, born...... either of a random sample of healthy mothers (n = 114), or of obese mothers (n = 113), were profiled by 16S rRNA amplicon sequencing. Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet. We found that maternal...... composition and alpha diversity were thus strongly affected by introduction of family foods with high protein and fiber contents. Specifically, intake of meats, cheeses and Danish rye bread, rich in protein and fiber, were associated with increased alpha diversity. Our results reveal that the transition from...

  17. North House : developing intelligent building technology and user interface in energy independent domestic environments

    Energy Technology Data Exchange (ETDEWEB)

    Velikov, K. [Waterloo Univ., Cambridge, ON (Canada). School of Architecture; Bartram, L. [Simon Fraser Univ., Surrey, BC (Canada). School of Interactive Arts and Technology

    2009-07-01

    This paper reported on the construction of the North House, a prototype solar-powered dwelling developed by a Canadian team for the 2009 Solar Decathlon. The prototype aims to develop a strategy for solar powered residential design that addresses the issues of how to build and live in the demanding northern context, how to design buildings that are adaptive to climate extremes and how new technologies and alternative energies can be used to create a viable and sustainable architecture. The occupant-focused design is meant to empower the occupants with both knowledge and control so that they can make intelligent choices and transform their own habits to live more sustainably. The residential occupant needs to operate as both user and manager of a green dwelling, and therefore requires specific information as well as access to help the building work more efficiently. The domestic environment is different from a workplace environment and therefore requires a unique means of control, display and integration with user lifestyle. The Adaptive Living Interface System for North House is based on interactive technologies that help occupants to both control the systems of the house while providing feedback on the operation of the house. The objective is to support behavioural transformation for energy saving living patterns. Once the competition is over, the North House will be reinstalled in Canada to undergo a minimum of 2 years of post-occupancy evaluation (POE) and testing. Both quantitative and qualitative data will be collected on energy performance, user livability, comfort and user satisfaction. Results were be measured against performance simulation during the design phase and will be used to provide feedback on simulation software. 11 refs., 5 figs.

  18. Acetylsalicylic acid interferes with embryonic kidney growth and development by a prostaglandin-independent mechanism.

    Science.gov (United States)

    Welham, Simon J M; Sparrow, Alexander J; Gardner, David S; Elmes, Matthew J

    2017-01-06

    To evaluate the effects of the non-selective, non-steroidal anti-inflammatory drug (NSAID) acetylsalicylic acid (ASA), on ex vivo embryonic kidney growth and development. Pairs of fetal mouse kidneys at embryonic day 12.5 were cultured ex vivo in increasing concentrations of ASA (0.04-0.4 mg/mL) for up to 7 d. One organ from each pair was grown in control media and was used as the internal control for the experimental contralateral organ. In some experiments, organs were treated with ASA for 48 h and then transferred either to control media alone or control media containing 10 μmol/L prostaglandin E2 (PGE2) for a further 5 d. Fetal kidneys were additionally obtained from prostaglandin synthase 2 homozygous null or heterozygous (PTGS2(-/-) and PTGS2(-/+)) embryos and grown in culture. Kidney cross-sectional area was used to determine treatment effects on kidney growth. Whole-mount labelling to fluorescently detect laminin enabled crude determination of epithelial branching using confocal microscopy. Increasing ASA concentration (0.1, 0.2 and 0.4 mg/mL) significantly inhibited metanephric growth (P growth area to control levels. Application of control media alone after cessation of ASA exposure showed no benefit on kidney growth. Despite the apparent recovery of growth area with 10 μmol/L PGE2, no obvious renal tubular structures were formed. The number of epithelial tips generated after 48 h exposure to ASA was reduced by 40% (0.2 mg/mL; P growth of PTGS2(-/-) and PTGS2(+/-) kidneys in organ culture showed no differences, indicating that PTGS2 derived PGE2 may at best have a minor role. ASA reduces early renal growth and development but the role of prostaglandins in this may be minor.

  19. Microbial Source Tracking as a Tool for TMDL Development, Little Blue River in Independence, Missouri

    Science.gov (United States)

    Christensen, Eric D.; Bushon, Rebecca N.; Brady, Amie M.G.

    2013-01-01

    The Little Blue River in Jackson County, Missouri has been listed by the Missouri Department of Natural Resources as impaired by bacteria for the protection of aquatic life and contact recreation from urban point and nonpoint sources. The Clean Water Act requires that a total maximum daily load (TMDL) for Escherichia coli (E. coli) be developed. Over a 5-year period, 108 base-flow, 87 stormflow, 48 fecal source, and 12 sewage influent samples were collected and analyzed for E. coli and Bacteroides general and host-associated microbial source tracking (MST) genetic markers. Less than half of the main-stem base-flow samples exceeded the E. coli state standard, whereas, all of the stormflow samples exceeded the standard during the recreation season (April through October). Both E. coli and MST markers were detected more frequently and at higher concentrations in stormflow samples. Only 14 percent of samples with E. coli detections greater than the Missouri state standard of 206 colonies per 100 milliliters had the human-associated Bacteroides marker as the only identified marker; therefore, Little Blue River TMDL development may require a broader scope beyond the municipal separate storm sewer system if bacteria sources are to be identified and addressed. Fecal samples showed a greater specificity with the human-associated marker than the dog- or ruminant-associated Bacteroides markers; however, false positives were at least one order of magnitude lower than true positives. MST data may be a useful tool for identifying probable sources of contamination and directing TMDL strategies.

  20. An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism

    Science.gov (United States)

    Huang, Chien-Chung; Huang, Po-Hao; Chen, Jiunn-Horng; Lan, Joung-Liang; Tsay, Gregory J.; Lin, Hsiao-Yi; Tseng, Chun-Hung; Lin, Cheng-Li; Hsu, Chung-Yi

    2015-01-01

    Abstract Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE). We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model. In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 104 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 104 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37–2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24–3.37] for ages 20 to 49 years, 1.80 [1.28–2.51] for ages 50 to 64 years, and 1.45 [1.11–1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01–2.29]). Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future. PMID:26705202

  1. Dehydrated Human Amnion/Chorion Grafts May Accelerate the Healing of Ulcers on Free Flaps in Patients With Venous Insufficiency and/or Lymphedema

    OpenAIRE

    Miranda, Edward P.; Friedman, Alex

    2016-01-01

    Objective: Ulceration of free flaps in patients with venous insufficiency and/or lymphedema is an uncommon but challenging problem. We hypothesized that dehydrated human amnion/chorion membrane (Epifix) grafts would accelerate healing of these challenging ulcers. Methods: Retrospective analysis of prospectively acquired data identified 8 lower extremity free flaps with ulcerations in the context of venous insufficiency and/or lymphedema. The first 4 were flaps that had been treated with conse...

  2. Acetylsalicylic acid interferes with embryonic kidney growth and development by a prostaglandin-independent mechanism

    Science.gov (United States)

    Welham, Simon J M; Sparrow, Alexander J; Gardner, David S; Elmes, Matthew J

    2017-01-01

    AIM To evaluate the effects of the non-selective, non-steroidal anti-inflammatory drug (NSAID) acetylsalicylic acid (ASA), on ex vivo embryonic kidney growth and development. METHODS Pairs of fetal mouse kidneys at embryonic day 12.5 were cultured ex vivo in increasing concentrations of ASA (0.04-0.4 mg/mL) for up to 7 d. One organ from each pair was grown in control media and was used as the internal control for the experimental contralateral organ. In some experiments, organs were treated with ASA for 48 h and then transferred either to control media alone or control media containing 10 μmol/L prostaglandin E2 (PGE2) for a further 5 d. Fetal kidneys were additionally obtained from prostaglandin synthase 2 homozygous null or heterozygous (PTGS2-/- and PTGS2-/+) embryos and grown in culture. Kidney cross-sectional area was used to determine treatment effects on kidney growth. Whole-mount labelling to fluorescently detect laminin enabled crude determination of epithelial branching using confocal microscopy. RESULTS Increasing ASA concentration (0.1, 0.2 and 0.4 mg/mL) significantly inhibited metanephric growth (P < 0.05). After 7 d of culture, exposure to 0.2 mg/mL and 0.4 mg/mL reduced organ size to 53% and 23% of control organ size respectively (P < 0.01). Addition of 10 μmol/L PGE2 to culture media after exposure to 0.2 mg/mL ASA for 48 h resulted in a return of growth area to control levels. Application of control media alone after cessation of ASA exposure showed no benefit on kidney growth. Despite the apparent recovery of growth area with 10 μmol/L PGE2, no obvious renal tubular structures were formed. The number of epithelial tips generated after 48 h exposure to ASA was reduced by 40% (0.2 mg/mL; P < 0.05) and 47% (0.4 mg/mL; P < 0.01). Finally, growth of PTGS2-/- and PTGS2+/- kidneys in organ culture showed no differences, indicating that PTGS2 derived PGE2 may at best have a minor role. CONCLUSION ASA reduces early renal growth and development but the

  3. Development of a cart for independent mobility assistance for non-ambulatory children.

    Science.gov (United States)

    Kakimoto, Akira; Suzuki, Shigenobu; Sekiguchi, Yukio

    2009-01-01

    Some parents of non-ambulatory children are not eager to allow their children to use powered wheelchairs because of apprehension of further deterioration of their functionality and the risk for accidents. The authors think that not all but some such children could develop their ability to operate powered wheelchairs and might expand their knowledge about the circumstances and interests in them. Thus we made a prototype cart for them eventually to experience motion by themselves. Based on a 6-wheeled chassis, the two middle wheels are driven with a traction roller drive system. We had been testing this prototype with a child with cerebral palsy for one year. Acquisition of skills in pushing switches and enjoyment of motion were confirmed. However, we encountered several problems such as difficulty in rolling on a carpet and in handling due to its weight. The ability to record moving speed and operation of input devices helps rehabilitation experts to conduct quantitative performance evaluation. To solve these problems, we manufactured another prototype. The second prototype was tested with another child with cerebral palsy for one year. The problems were solved. She acquired the operation skills necessary to operate the prototype with four switch operation.

  4. Organization Development of the Dutch Judiciary, between Accountability and Judicial Independence

    Directory of Open Access Journals (Sweden)

    Philip Langbroek

    2010-04-01

    Full Text Available The Netherlands are a country on the European Continent with a French inspired legal system as far as civil and criminal law is concerned. Administrative law has followed a different development and reflects the middle position of the Netherlands between the French, English and German administrative law systems, while maintaining a dominant procedural position of public administration. However, the organization of the Dutch judiciary mainly follows the lines of the original French conceptions: it has been organized in accordance with the concepts brought to the low countries by Napoleons’ army. This traditional continental judicial organization, operated by the ministry of justice and court presidents’ for over 150 years has gone through considerable institutional and organizational change during the last 15 years. In this article I will sketch the outcomes of a mayor evaluation research of the changes in the Dutch judiciary that started in 1995 and evolve until today. I will do this by first describing the change process against the background of the New Public Management. Second, I will describe the proposals for change and the actual changes. Finally I will describe the most salient outcomes of the evaluation study. I will conclude with a brief discussion of these outcomes.

  5. Challenges and promises for the development of donor-independent platelet transfusions.

    Science.gov (United States)

    Lambert, Michele P; Sullivan, Spencer K; Fuentes, Rudy; French, Deborah L; Poncz, Mortimer

    2013-04-25

    Platelet transfusions are often a life-saving intervention, and the use of platelet transfusions has been increasing. Donor-derived platelet availability can be challenging. Compounding this concern are additional limitations of donor-derived platelets, including variability in product unit quality and quantity, limited shelf life and the risks of product bacterial contamination, other transfusion-transmitted infections, and immunologic reactions. Because of these issues, there has been an effort to develop strategies to generate platelets from exogenously generated precursor cells. If successful, such platelets have the potential to be a safer, more consistent platelet product, while reducing the necessity for human donations. Moreover, ex vivo-generated autologous platelets or precursors may be beneficial for patients who are refractory to allogeneic platelets. For patients with inherited platelet disorders, ex vivo-generated platelets offer the promise of a treatment via the generation of autologous gene-corrected platelets. Theoretically, ex vivo-generated platelets also offer targeted delivery of ectopic proteins to sites of vascular injury. This review summarizes the current, state-of-the-art methodologies in delivering a clinically relevant ex vivo-derived platelet product, and it discusses significant challenges that must be overcome for this approach to become a clinical reality.

  6. LYMPHATIC DEVELOPMENT

    OpenAIRE

    Butler, Matthew G; Isogai, Sumio; Weinstein, Brant M.

    2009-01-01

    The lymphatic system is essential for fluid homeostasis, immune responses, and fat absorption, and is involved in many pathological processes, including tumor metastasis and lymphedema. Despite its importance, progress in understanding the origins and early development of this system has been hampered by lack of defining molecular markers and difficulties in observing lymphatic cells in vivo and performing genetic and experimental manipulation of the lymphatic system. Recent identification of...

  7. Development of renal atrophy in murine 2 kidney 1 clip hypertension is strain independent.

    Science.gov (United States)

    Kashyap, Sonu; Boyilla, Rajendra; Zaia, Paula J; Ghossan, Roba; Nath, Karl A; Textor, Stephen C; Lerman, Lilach O; Grande, Joseph P

    2016-08-01

    The murine 2-kidney 1-clip (2K1C) model has been used to identify mechanisms underlying chronic renal disease in human renovascular hypertension. Although this model recapitulates many of the features of human renovascular disease, strain specific variability in renal outcomes and animal-to-animal variation in the degree of arterial stenosis are well recognized limitations. In particular, the C57BL/6J strain is considered to be resistant to chronic renal damage in other models. Our objectives were to determine strain dependent variations in renal disease progression and to identify parameters that predict renal atrophy in murine 2K1C hypertension. We used a 0.20mm polytetrafluoroethylene cuff to establish RAS in 3 strains of mice C57BL/6J (N=321), C57BLKS/J (N=177) and129Sv (N=156). The kidneys and hearts were harvested for histopathologic analysis after 3days or after 1, 2, 4, 6, 7, 11 or 17weeks. We performed multivariate analysis to define associations between blood pressure, heart and kidney weights, ratio of stenotic kidney/contralateral kidney (STK/CLK) weight, percent atrophy (% atrophy) and plasma renin content. The STK of all 3 strains showed minimal histopathologic alterations after 3days, but later developed progressive interstitial fibrosis, tubular atrophy, and inflammation. The STK weight negatively correlated with maximum blood pressure and % atrophy, and positively correlated with STK/CLK ratio. RAS produces severe chronic renal injury in the STK of all murine strains studied, including C57BL/6J. Systolic blood pressure is negatively associated with STK weight, STK/CLK ratio and positively with atrophy and may be used to assess adequacy of vascular stenosis in this model.

  8. Growth hormone mediates pubertal skeletal development independent of hepatic IGF-1 production.

    Science.gov (United States)

    Courtland, Hayden-William; Sun, Hui; Beth-On, Mordechay; Wu, Yingjie; Elis, Sebastien; Rosen, Clifford J; Yakar, Shoshana

    2011-04-01

    Deficiencies in either growth hormone (GH) or insulin-like growth factor 1 (IGF-1) are associated with reductions in bone size during growth in humans and animal models. Liver-specific IGF-1-deficient (LID) mice, which have 75% reductions in serum IGF-1, were created previously to separate the effects of endocrine (serum) IGF-1 from autocrine/paracrine IGF-1. However, LID mice also have two- to threefold increases in GH, and this may contribute to the observed pubertal skeletal phenotype. To clarify the role of GH in skeletal development under conditions of significantly reduced serum IGF-1 levels (but normal tissue IGF-1 levels), we studied the skeletal response of male LID and control mice to GH inhibition by pegvisomant from 4 to 8 weeks of age. Treatment of LID mice with pegvisomant resulted in significant reductions in body weight, femur length (Le), and femur total area (Tt.Ar), as well as further reductions in serum IGF-1 levels by 8 weeks of age, compared with the mean values of vehicle-treated LID mice. Reductions in both Tt.Ar and Le were proportional after treatment with pegvisomant. On the other hand, the relative amount of cortical tissue formed (RCA) in LID mice treated with pegvisomant was significantly less than that in both vehicle-treated LID and control mice, indicating that antagonizing GH action, either directly (through GH receptor signaling inhibition) or indirectly (through further reductions in serum/tissue IGF-1 levels), results in disproportionate reductions in the amount of cortical bone formed. This resulted in bones with significantly reduced mechanical properties (femoral whole-bone stiffness and work to failure were markedly decreased), suggesting that compensatory increases of GH in states of IGF-1 deficiency (LID mice) act to protect against a severe inhibition of bone modeling during growth, which otherwise would result in bones that are too weak for normal and/or extreme loading conditions.

  9. Independent walking as a major skill for the development of anticipatory postural control: evidence from adjustments to predictable perturbations.

    Directory of Open Access Journals (Sweden)

    Fabien Cignetti

    Full Text Available Although there is suggestive evidence that a link exists between independent walking and the ability to establish anticipatory strategy to stabilize posture, the extent to which this skill facilitates the development of anticipatory postural control remains largely unknown. Here, we examined the role of independent walking on the infants' ability to anticipate predictable external perturbations. Non-walking infants, walking infants and adults were sitting on a platform that produced continuous rotation in the frontal plane. Surface electromyography (EMG of neck and lower back muscles and the positions of markers located on the platform, the upper body and the head were recorded. Results from cross-correlation analysis between rectified and filtered EMGs and platform movement indicated that although muscle activation already occurred before platform movement in non-walking infants, only walking infants demonstrated an adult-like ability for anticipation. Moreover, results from further cross-correlation analysis between segmental angular displacement and platform movement together with measures of balance control at the end-points of rotation of the platform evidenced two sorts of behaviour. The adults behaved as a non-rigid non-inverted pendulum, rather stabilizing head in space, while both the walking and non-walking infants followed the platform, behaving as a rigid inverted pendulum. These results suggest that the acquisition of independent walking plays a role in the development of anticipatory postural control, likely improving the internal model for the sensorimotor control of posture. However, despite such improvement, integrating the dynamics of an external object, here the platform, within the model to maintain balance still remains challenging in infants.

  10. Independent walking as a major skill for the development of anticipatory postural control: evidence from adjustments to predictable perturbations.

    Science.gov (United States)

    Cignetti, Fabien; Zedka, Milan; Vaugoyeau, Marianne; Assaiante, Christine

    2013-01-01

    Although there is suggestive evidence that a link exists between independent walking and the ability to establish anticipatory strategy to stabilize posture, the extent to which this skill facilitates the development of anticipatory postural control remains largely unknown. Here, we examined the role of independent walking on the infants' ability to anticipate predictable external perturbations. Non-walking infants, walking infants and adults were sitting on a platform that produced continuous rotation in the frontal plane. Surface electromyography (EMG) of neck and lower back muscles and the positions of markers located on the platform, the upper body and the head were recorded. Results from cross-correlation analysis between rectified and filtered EMGs and platform movement indicated that although muscle activation already occurred before platform movement in non-walking infants, only walking infants demonstrated an adult-like ability for anticipation. Moreover, results from further cross-correlation analysis between segmental angular displacement and platform movement together with measures of balance control at the end-points of rotation of the platform evidenced two sorts of behaviour. The adults behaved as a non-rigid non-inverted pendulum, rather stabilizing head in space, while both the walking and non-walking infants followed the platform, behaving as a rigid inverted pendulum. These results suggest that the acquisition of independent walking plays a role in the development of anticipatory postural control, likely improving the internal model for the sensorimotor control of posture. However, despite such improvement, integrating the dynamics of an external object, here the platform, within the model to maintain balance still remains challenging in infants.

  11. Placental Malaria is associated with reduced early life weight development of affected children independent of low birth weight

    Directory of Open Access Journals (Sweden)

    Palmero Melba S

    2010-01-01

    Full Text Available Abstract Background Infection with Plasmodium falciparum during pregnancy contributes substantially to the disease burden in both mothers and offspring. Placental malaria may lead to intrauterine growth restriction or preterm delivery resulting in low birth weight (LBW, which, in general, is associated with increased infant morbidity and mortality. However, little is known about the possible direct impact of the specific disease processes occurring in PM on longer term outcomes such as subsequent retarded growth development independent of LBW. Methods In an existing West-African cohort, 783 healthy infants with a birth weight of at least 2,000 g were followed up during their first year of life. The aim of the study was to investigate if Plasmodium falciparum infection of the placenta, assessed by placental histology, has an impact on several anthropometric parameters, measured at birth and after three, six and 12 months using generalized estimating equations models adjusting for moderate low birth weight. Results Independent of LBW, first to third born infants who were exposed to either past, chronic or acute placental malaria during pregnancy had significantly lower weight-for-age (-0.43, 95% CI: -0.80;-0.07, weight-for-length (-0.47, 95% CI: -0.84; -0.10 and BMI-for-age z-scores (-0.57, 95% CI: -0.84; -0.10 compared to infants born to mothers who were not diagnosed with placental malaria (p = 0.019, 0.013, and 0.012, respectively. Interestingly, the longitudinal data on histology-based diagnosis of PM also document a sharp decline of PM prevalence in the Sukuta cohort from 16.5% in 2002 to 5.4% in 2004. Conclusions It was demonstrated that PM has a negative impact on the infant's subsequent weight development that is independent of LBW, suggesting that the longer term effects of PM have been underestimated, even in areas where malaria transmission is declining.

  12. Molecular evidence for a thymus-independent partial T cell development in a FOXN1-/- athymic human fetus.

    Science.gov (United States)

    Fusco, Anna; Panico, Luigi; Gorrese, Marisa; Bianchino, Gabriella; Barone, Maria V; Grieco, Vitina; Vitiello, Laura; D'Assante, Roberta; Romano, Rosa; Palamaro, Loredana; Scalia, Giulia; Vecchio, Luigi Del; Pignata, Claudio

    2013-01-01

    The thymus is the primary organ able to support T cell ontogeny, abrogated in FOXN1(-/-) human athymia. Although evidence indicates that in animal models T lymphocytes may differentiate at extrathymic sites, whether this process is really thymus-independent has still to be clarified. In an athymic FOXN1(-/-) fetus, in which we previously described a total blockage of CD4(+) and partial blockage of CD8(+) cell development, we investigated whether intestine could play a role as extrathymic site of T-lymphopoiesis in humans. We document the presence of few extrathymically developed T lymphocytes and the presence in the intestine of CD3(+) and CD8(+), but not of CD4(+) cells, a few of them exhibiting a CD45RA(+) naïve phenotype. The expression of CD3εεpTα, RAG1 and RAG2 transcripts in the intestine and TCR gene rearrangement was also documented, thus indicating that in humans the partial T cell ontogeny occurring at extrathymic sites is a thymus- and FOXN1-independent process.

  13. Engineer Ethics Education that Treated Safety Problem to Promote Development of General Human Competence and Independent Engineer

    Science.gov (United States)

    Hotta, Genji

    The human race came to expect the engineer‧s international activity by an international extension of the risk. The engineer should provide with “Overall ability” and “Independent ability” to answer the demand of the society. The engineer ethics education is effective to the acquisition of the ability that the society demands. Because the engineer ethics education teaches the engineer to develop “Ethics action as the individual” to “Ethics activity as the enterprise” . In the point of development of the comprehensive capacity, it can be said that the engineer ethics education is training that supports the action power that accomplishes the social responsibility. However, it is easy to make the engineer ethics education a polite fiction. Then, we propose to take the safety problem to the ethics education for the prevention of making to the polite fiction of the education.

  14. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Dalia, Roberta Maria; Martins, Glaucia Ribeiro P.; Barbosa, Rodolfo [Uniao Educacional do Vale do Aco, Belo Horizonte, MG (Brazil); Lima, Carla Flavia de; Siqueira, Cristiano Ferrari [Ecograf Medicina Nuclear, Belo Horizonte, MG (Brazil)

    2005-10-15

    The purpose of this study was to prove the efficiency of qualitative and quantitative lymphoscintigraphy in the diagnosis of the lower extremity lymphedema. Seventy-seven patients had been studied, most of then (85.7%) were female. Patients' ages ranged from 18 to 82 years. All patients underwent a bilateral lymphoscintigraphy. Images were recorded with a dual-detector instrument in the whole-body scanning mode. Feet and inguinal static views were acquired within 15 minutes and three hours after radiopharmaceutical injection. Two nuclear doctors evaluated the lymphoscintigrams qualitatively. Quantitative studies of the radiopharmaceutical absorption and the lymph node chain uptake were also obtained. Of the 154 evaluated members, 21.44% (n = 33) were classified as normal, 61.68% (n = 95) as mildly altered and 16.88% (n = 26) much altered. Quantitation of lymphatic chain uptake may be a more sensitive approach to the diagnosis of lymphatic impairment than the qualitative analysis. (author)

  15. Lymphoscintigraphic evaluation of intra-arterial lymphocyte injection in patients with leg lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Suga, Kazuyoshi; Uchisako, Hiroji; Yoneshiro, Shu; Fujita, Takefumi; Nakanishi, Takashi; Wakamatsu, Takafumi; Esato, Kensuke (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1992-05-01

    Three patients with chronic leg lymphedema were treated by intra-arterial lymphocyte injection and the effect was evaluated by lymphoscintigraphy using intradermal injection of {sup 99m}Tc-HSA. In all of the patients, the followed-up lymphoscintigraphy showed disappearance of the abnormalities of dermal back flow and/or collateral pathways observed before treatment and these findings were thought to indicate reduced load of dermal lymphatics induced by the treatment. These results indicated the usefulness of imaging with intradermal injection of {sup 99m}Tc-HSA for assessing the effect of treatment with intra-arterial lymphocyte injection. In addition, in two patients of them, analysis of lymph flow after treatment was underwent by time-activity curves obtained by lymphoscintigraphy using a load produced by standing. We also described the significance of the load test with standing. (author).

  16. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology.

    Science.gov (United States)

    2013-03-01

    This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema (1) for discussion at the XXIV International Congress of Lymphology. It is based upon modifications: [A] suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain (2) discussed at the 1999 XVII ICL in Chennai, India (3) and considered/ confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany (4); [B] derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina (5); [C] suggested from comments, criticisms, and rebuttals as published in the December 2004 issue of Lymphology (6); [D] discussed in both the 2005 XX ICL in Salvador, Brazil and the 2007 XXI ICL in Shanghai, China and modified at the 2008 Executive Committee Meeting in Naples, Italy (7,8); and [E] modified from discussions and written comments from the 2009 XXII ICL in Sydney, Australia, the 2011 XXIII ICL in Malmo, Sweden and 2012 Executive Committee Meetings. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. The document is not meant to override individual clinical considerations for problematic patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited, and therefore the suggested treatments are impractical. Adaptability and inclusiveness does come at the price that members can rightly be critical of what

  17. Development of sociality and emergence of independence in a killer whale (Orcinus orca) calf from birth to 36 months.

    Science.gov (United States)

    Guarino, Sara; Hill, Heather M; Sigman, Julie

    2017-01-01

    Dolphin calves spend most of their time swimming with their mother immediately after birth. As they mature, the calves become increasingly independent, and begin to interact more often with other calves, juveniles, and sub-adults. For bottlenose dolphin calves, sociality is related to maternal behaviors. Unfortunately, much less is known about the development of sociality and emergence of independence for killer whale calves. The purpose of this study was to examine the developmental changes in social behaviors and solitary activities of a killer whale calf across a 36-month period. Focal follow video recordings of a mother-calf pair housed at SeaWorld San Antonio were collected 2-6 times a day for 5-15 min at 6-month intervals. Using a sample of randomly selected video recordings at each month, developmental changes in swims and social interactions with her mother, swims and social interactions with non-maternal partners, and solitary activities (e.g., solitary swims, solitary play) were observed across the months. The calf spent most of her time swimming with the mother across the 36-month period. The time the calf socialized with her mother was greater than the time she socialized with others at each month. Besides her mother, the calf socialized more often with the other adult female compared to adult males. As the calf matured, the increase in the time she spent socializing with adult killer whales other than the mother corresponded with an increase in the rate and time spent in solitary play. The developmental trends of sociality and emerging independence replicate research conducted with calves of other dolphin species. Zoo Biol. 36:11-20, 2017. © 2016 Wiley Periodicals, Inc.

  18. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  19. IFT88 Plays a Cilia- and PCP-Independent Role in Controlling Oriented Cell Divisions during Vertebrate Embryonic Development

    Directory of Open Access Journals (Sweden)

    Antonia Borovina

    2013-10-01

    Full Text Available The role for cilia in establishing planar cell polarity (PCP is contentious. Although knockdown of genes known to function in ciliogenesis has been reported to cause PCP-related morphogenesis defects in zebrafish, genetic mutations affecting intraflagellar transport (IFT do not show PCP phenotypes despite the requirement for IFT in cilia formation. This discrepancy has been attributed to off-target effects of antisense morpholino oligonucleotide (MO injection, confounding maternal effects in zygotic mutant embryos, or an inability to distinguish between cilia-dependent versus cilia-independent protein functions. To determine the role of cilia in PCP, we generated maternal + zygotic IFT88 (MZift88 mutant zebrafish embryos, which never form cilia. We clearly demonstrate that cilia are not required to establish PCP. Rather, IFT88 plays a cilia-independent role in controlling oriented cell divisions at gastrulation and neurulation. Our results have important implications for the interpretation of cilia gene function in normal development and in disease.

  20. IFT88 plays a cilia- and PCP-independent role in controlling oriented cell divisions during vertebrate embryonic development.

    Science.gov (United States)

    Borovina, Antonia; Ciruna, Brian

    2013-10-17

    The role for cilia in establishing planar cell polarity (PCP) is contentious. Although knockdown of genes known to function in ciliogenesis has been reported to cause PCP-related morphogenesis defects in zebrafish, genetic mutations affecting intraflagellar transport (IFT) do not show PCP phenotypes despite the requirement for IFT in cilia formation. This discrepancy has been attributed to off-target effects of antisense morpholino oligonucleotide (MO) injection, confounding maternal effects in zygotic mutant embryos, or an inability to distinguish between cilia-dependent versus cilia-independent protein functions. To determine the role of cilia in PCP, we generated maternal + zygotic IFT88 (MZift88) mutant zebrafish embryos, which never form cilia. We clearly demonstrate that cilia are not required to establish PCP. Rather, IFT88 plays a cilia-independent role in controlling oriented cell divisions at gastrulation and neurulation. Our results have important implications for the interpretation of cilia gene function in normal development and in disease. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Splitting, splitting and splitting again: A brief history of the development of regional government in Indonesia since independence

    Directory of Open Access Journals (Sweden)

    Anne Booth

    2011-04-01

    Full Text Available The paper reviews the changes in the structure and role of provincial and sub-provincial governments in Indonesia since independence. Particular attention is paid to the process of splitting both provinces and districts (kabupaten and kota into smaller units. The paper points out that this process has been going on since the 1950s, but has accelerated in the post-Soeharto era. The paper examines why the splitting of government units has occurred in some parts of the Outer Islands to a much greater extent than in Java, and also examines the implications of developments since 1999 for the capacity of local government units to deliver basic services such as health and education.

  2. Development of petroleum independent companies in Brazil: opportunities and obstacles; Desenvolvimento das companhias de petroleo independentes no Brasil: oportunidades e obstaculos

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Edmar Fagundes de; Rodrigues, Felipe Rachid

    2007-07-01

    Nevertheless the obstacles presented in this article, there is an interesting space for new brazilian independent enterprises development, whether through acquisition of exploratory blocks or by the participation in mature areas licitation rounds. So, although the relevance of difficulties, it is possible to affirm that the Brazil already possesses an emergent industry of petroleum independent producers.

  3. Twisting Tourniquet© Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities

    Science.gov (United States)

    Chanwimalueang, Narumon; Ekataksin, Wichai; Piyaman, Parkpoom; Pattanapen, Gedsuda; Hanboon, Borimas K

    2015-01-01

    Twisting Tourniquet© or in Thai “Schnogh” is a new invention for compression therapy of lymphedema. Twisting Tourniquet© Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min release, doing repeatedly this compression-decompression for at least 10 sessions a day, can generate acceptable results. The aim of the study was to evaluate the scientific effectiveness and establish a treatment protocol of TTT proposed as a therapeutic approach for clinical management of lymphedema. During 2006–2013, from over 3500 patients, 647 with primary/secondary lymphedema passed inclusion criteria, 307 for upper, and 340 for lower extremity. In the 5-day course of TTT, each day patients underwent 10 sessions of a 15-min compression followed by a 5-min decompression. Vegan diet was encouraged as an adjuvant therapy. Among lymphedema patients whose spectrum of edema severity ranged from mild to gigantic, TTT yielded an average volume reduction rate (VR) at 50.2% and 55.6%, making the average edema reduction volume attained at 463 and 1856 mL for upper and lower limb, respectively. The uniformed practice by Schnogh which supports a continual compression–decompression maneuver over 3.5 h daily for five consecutive days could induce an average VR at above half of the swelling in extremities of 647 patients. Schnogh is therefore effective in clinical management of lymphedema under TTT treatment of fibroblastic interstitium. PMID:26247407

  4. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Huang Tsai-Wei

    2013-01-01

    Full Text Available Abstract Background Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD could prevent or manage limb edema in women after breast-cancer surgery. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro, SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. Results In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58. Conclusions The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.

  5. Genetic suppression reveals DNA repair-independent antagonism between BRCA1 and COBRA1 in mammary gland development.

    Science.gov (United States)

    Nair, Sreejith J; Zhang, Xiaowen; Chiang, Huai-Chin; Jahid, Md Jamiul; Wang, Yao; Garza, Paula; April, Craig; Salathia, Neeraj; Banerjee, Tapahsama; Alenazi, Fahad S; Ruan, Jianhua; Fan, Jian-Bing; Parvin, Jeffrey D; Jin, Victor X; Hu, Yanfen; Li, Rong

    2016-03-04

    The breast cancer susceptibility gene BRCA1 is well known for its function in double-strand break (DSB) DNA repair. While BRCA1 is also implicated in transcriptional regulation, the physiological significance remains unclear. COBRA1 (also known as NELF-B) is a BRCA1-binding protein that regulates RNA polymerase II (RNAPII) pausing and transcription elongation. Here we interrogate functional interaction between BRCA1 and COBRA1 during mouse mammary gland development. Tissue-specific deletion of Cobra1 reduces mammary epithelial compartments and blocks ductal morphogenesis, alveologenesis and lactogenesis, demonstrating a pivotal role of COBRA1 in adult tissue development. Remarkably, these developmental deficiencies due to Cobra1 knockout are largely rescued by additional loss of full-length Brca1. Furthermore, Brca1/Cobra1 double knockout restores developmental transcription at puberty, alters luminal epithelial homoeostasis, yet remains deficient in homologous recombination-based DSB repair. Thus our genetic suppression analysis uncovers a previously unappreciated, DNA repair-independent function of BRCA1 in antagonizing COBRA1-dependent transcription programme during mammary gland development.

  6. Cervical Stimulation in the Treatment of Children with Lymphedema of All Four Extremities: A Case Report and Literature Review

    Science.gov (United States)

    Pereira de Godoy, Livia Maria; Pereira de Godoy Capeletto, Paula

    2017-01-01

    Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers' ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema.

  7. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients

    Science.gov (United States)

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients. PMID:28174433

  8. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients.

    Science.gov (United States)

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-12-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients.

  9. Retinoic acid-independent expression of Meis2 during autopod patterning in the developing bat and mouse limb.

    Science.gov (United States)

    Mason, Mandy K; Hockman, Dorit; Curry, Lyle; Cunningham, Thomas J; Duester, Gregg; Logan, Malcolm; Jacobs, David S; Illing, Nicola

    2015-01-01

    The bat has strikingly divergent forelimbs (long digits supporting wing membranes) and hindlimbs (short, typically free digits) due to the distinct requirements of both aerial and terrestrial locomotion. During embryonic development, the morphology of the bat forelimb deviates dramatically from the mouse and chick, offering an alternative paradigm for identifying genes that play an important role in limb patterning. Using transcriptome analysis of developing Natal long-fingered bat (Miniopterus natalensis) fore- and hindlimbs, we demonstrate that the transcription factor Meis2 has a significantly higher expression in bat forelimb autopods compared to hindlimbs. Validation by reverse transcriptase and quantitative polymerase chain reaction (RT-qPCR) and whole mount in situ hybridisation shows that Meis2, conventionally known as a marker of the early proximal limb bud, is upregulated in the bat forelimb autopod from CS16. Meis2 expression is localised to the expanding interdigital webbing and the membranes linking the wing to the hindlimb and tail. In mice, Meis2 is also expressed in the interdigital region prior to tissue regression. This interdigital Meis2 expression is not activated by retinoic acid (RA) signalling as it is present in the retained interdigital tissue of Rdh10 (trex/trex) mice, which lack RA. Additionally, genes encoding RA-synthesising enzymes, Rdh10 and Aldh1a2, and the RA nuclear receptor Rarβ are robustly expressed in bat fore- and hindlimb interdigital tissues indicating that the mechanism that retains interdigital tissue in bats also occurs independently of RA signalling. Mammalian interdigital Meis2 expression, and upregulation in the interdigital webbing of bat wings, suggests an important role for Meis2 in autopod development. Interdigital Meis2 expression is RA-independent, and retention of interdigital webbing in bat wings is not due to the suppression of RA-induced cell death. Rather, RA signalling may play a role in the thinning

  10. Gravity Independent Compressor Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to develop and demonstrate a small, gravity independent, vapor compression refrigeration system using a linear motor compressor which effectively...

  11. The Elderly's Independent Living in Smart Homes: A Characterization of Activities and Sensing Infrastructure Survey to Facilitate Services Development.

    Science.gov (United States)

    Ni, Qin; García Hernando, Ana Belén; de la Cruz, Iván Pau

    2015-01-01

    Human activity detection within smart homes is one of the basis of unobtrusive wellness monitoring of a rapidly aging population in developed countries. Most works in this area use the concept of "activity" as the building block with which to construct applications such as healthcare monitoring or ambient assisted living. The process of identifying a specific activity encompasses the selection of the appropriate set of sensors, the correct preprocessing of their provided raw data and the learning/reasoning using this information. If the selection of the sensors and the data processing methods are wrongly performed, the whole activity detection process may fail, leading to the consequent failure of the whole application. Related to this, the main contributions of this review are the following: first, we propose a classification of the main activities considered in smart home scenarios which are targeted to older people's independent living, as well as their characterization and formalized context representation; second, we perform a classification of sensors and data processing methods that are suitable for the detection of the aforementioned activities. Our aim is to help researchers and developers in these lower-level technical aspects that are nevertheless fundamental for the success of the complete application.

  12. Tau Pathology and Parietal White Matter Lesions Have Independent but Synergistic Effects on Early Development of Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Joakim Hertze

    2013-04-01

    Full Text Available Background: White matter lesions (WMLs are a common finding in patients with dementia. This study investigates the relationship between WMLs, hyperphosphorylated tau (P-tau in cerebrospinal fluid (CSF and apolipoprotein E (APOE ε4 genotype in prodromal Alzheimer's disease (AD. Methods: Baseline levels of tau, P-tau and β-amyloid 1-42 in CSF, the presence of WMLs in the brain, and the APOE genotype were ascertained in 159 patients with mild cognitive impairment (MCI and 38 cognitively healthy controls. Results: After 5.7 years, 58 patients had developed AD. In this group, patients with normal levels of CSF P-tau had higher levels of WMLs in the parietal regions than those with pathological P-tau levels (p Conclusions: We suggest that WMLs in parietal lobes and tau pathology likely have independent but synergistic effects on the reduction of the cognitive reserve capacity of the brain. In patients with a more low-grade AD pathology, WMLs in the parietal lobes might increase the risk of developing dementia.

  13. Commensal Microbe-specific Activation of B2 Cell Subsets Contributes to Atherosclerosis Development Independently of Lipid Metabolism

    Directory of Open Access Journals (Sweden)

    Lin Chen

    2016-11-01

    Full Text Available The relation between B2 cells and commensal microbes during atherosclerosis remains largely unexplored. Here we show that under hyperlipidemic conditions intestinal microbiota resulted in recruitment and ectopic activation of B2 cells in perivascular adipose tissue, followed by an increase in circulating IgG, promoting disease development. In contrast, disruption of the intestinal microbiota by a broad-spectrum antibiotic cocktail (AVNM led to the attenuation of atherosclerosis by suppressing B2 cells, despite the persistence of serum lipid abnormalities. Furthermore, pharmacological depletion of B2 cells with an anti-B2-cell surface CD23 antibody also attenuated commensal microbe-induced atherosclerosis. Moreover, expression analysis of TLR-signaling-related genes in the activated B2 cell subsets, assessed using the Toll-Like Receptor Signaling Pathway RT2 Profiler PCR Array, confirmed activation of the B2-cell autoantibody-production axis, which was associated with an increased capacity of B2 cells to bind to intestinal microbiota. Together, our findings reveal the critical role of commensal microbe-specific activation of B2 cells in the development of atherogenesis through lipid metabolism-independent mechanisms.

  14. Peter Pan functions independently of its role in ribosome biogenesis during early eye and craniofacial cartilage development in Xenopus laevis.

    Science.gov (United States)

    Bugner, Verena; Tecza, Aleksandra; Gessert, Susanne; Kühl, Michael

    2011-06-01

    The Xenopus oocyte possesses a large maternal store of ribosomes, thereby uncoupling early development from the de novo ribosome biosynthesis required for cell growth. Brix domain-containing proteins, such as Peter Pan (PPan), are essential for eukaryotic ribosome biogenesis. In this study, we demonstrate that PPan is expressed maternally as well as in the eye and cranial neural crest cells (NCCs) during early Xenopus laevis development. Depletion of PPan and interference with rRNA processing using antisense morpholino oligonucleotides resulted in eye and cranial cartilage malformations. Loss of PPan, but not interference with rRNA processing, led to an early downregulation of specific marker genes of the eye, including Rx1 and Pax6, and of NCCs, such as Twist, Slug and FoxD3. We found that PPan protein is localized in the nucleoli and mitochondria and that loss of PPan results in increased apoptosis. These findings indicate a novel function of PPan that is independent of its role in ribosome biogenesis.

  15. Transcription factor Spi-B-dependent and -independent pathways for the development of Peyer's patch M cells.

    Science.gov (United States)

    Sato, S; Kaneto, S; Shibata, N; Takahashi, Y; Okura, H; Yuki, Y; Kunisawa, J; Kiyono, H

    2013-07-01

    Although many of the biological features of microfold cells (M cells) have been known for many years, the molecular mechanisms of M-cell development and antigen recognition have remained unclear. Here, we report that Umod is a novel M-cell-specific gene, the translation products of which might contribute to the uptake function of M cells. Transcription factor Spi-B was also specifically expressed in M cells among non-hematopoietic lineages. Spi-B-deficient mice showed reduced expression of most, but not all, other M-cell-specific genes and M-cell surface markers. Whereas uptake of Salmonella Typhimurium via M cells was obviously reduced in Spi-B-deficient mice, the abundance of intratissue cohabiting bacteria was comparable between wild-type and Spi-B-deficient mice. These data indicate that there is a small M-cell population with developmental regulation that is Spi-B independent; however, Spi-B is probably a candidate master regulator of M-cell functional maturation and development by another pathway.

  16. Avaliação dos fatores de risco no linfedema pós-tratamento de câncer de mama Risk factors for breast cancer related lymphedema

    Directory of Open Access Journals (Sweden)

    Laura Ferreira de Rezende

    2010-12-01

    Full Text Available A principal complicação tardia no pós-operatório de câncer de mama é o desenvolvimento do linfedema, uma doença crônica, progressiva, geralmente incurável. O aumento do volume do membro pode desfigurar a imagem corporal, assim como aumentar a morbidade física e psicológica da paciente, além de promover significativo prejuízo para as funções. O presente estudo foi desenvolvido por meio de uma revisão sistemática a partir do cruzamento aleatório das palavras-chave: "linfedema", "compensações linfáticas", "sistema linfático", "dissecção axilar", "fatores de risco" e "câncer de mama". Foram selecionados 18 artigos entre os anos de 1979 e 2009, nos quais foram encontrados como principais fatores de risco para o desenvolvimento do linfedema a radioterapia, radioterapia axilar, infecção, dissecção axilar seguida de radioterapia, obesidade, número de linfonodos retirados e comprometidos e agressividade da cirurgia. As formas de compensação linfática após a dissecção axilar, como as anastomoses linfo-linfáticas, podem ser prejudicadas pela formação cicatricial, seroma pós-operatório, radioterapia e exercícios inadequados para reabilitação de ombro no câncer de mama.The main late complication after the surgery of breast cancer is the development of lymphedema, a chronic, progressive, usually incurable disease. The increase in the volume of the limb can disfigure the body image and develop the physical and psychological morbidity of the patient, promoting significant damage to the functions. This study was developed through a systematic review from the randomized crosschecking of the keywords "lymphedema", "lymphatic compensation", "lymphatic system", "axillary dissection", "risk factors" and "breast cancer". Eighteen articles were selected, between 1979 and 2009, in which radiotherapy, axillary radiation, infection, axillary dissection followed by radiotherapy, obesity, number of removed and impaired lymph

  17. Upper extremity lymphatic function at rest and during exercise in breast cancer survivors with and without lymphedema compared with healthy controls.

    Science.gov (United States)

    Lane, Kirstin N; Dolan, Lianne B; Worsley, Dan; McKenzie, Don C

    2007-09-01

    Lymphoscintigraphy was used to measure lymphatic function at rest and during exercise in breast cancer survivors with lymphedema (BCRL, n = 10), breast cancer survivors (BC, n = 10), and controls (Cont, n = 10). After injection of (99m)Tc-antimony colloid to the hands, subjects rested or performed 12 repeated sets of arm cranking for 2.5 min at 0.6 W/kg followed by 2.5 min of rest. One-minute spot views were taken with a gamma-radiation camera immediately postinjection and every 10 min over 60 min to calculate clearance rate. As well, an upper body scan was taken at 65 min postinjection to measure radiopharmaceutical uptake in the axilla (Ax) and forearm (Fore). All groups displayed similar increases in clearance rate with exercise (P = 0.000). Ax significantly increased with exercise in Cont only [Cont: (mean +/- SD) 4.9 +/- 2.6 vs. 7.9 +/- 4.2%, P = 0.000; BCRL: 1.4 +/- 1.2 vs. 1.7 +/- 2.1%, P = 0.531; BC: 3.9 +/- 3.4 vs. 5.2 +/- 3.2%, P = 0.130], whereas Fore, indicating dermal backflow, significantly increased in BCRL only (BCRL: 2.4 +/- 0.87 vs. 4.4 +/- 2.0%, P = 0.004; BC: 1.1 +/- 0.25 vs. 1.1 +/- 0.31%, P = 0.784; Cont: 0.93 +/- 0.26 vs. 1.0 +/- 0.20%, P = 0.296). The results indicate that, in women with BCRL, exercise causes radiopharmaceuticals to clear from the hand at the same rate as BC and Cont, but, instead of reaching the axilla, a greater amount of activity gets trapped in the dermis of the forearm. BC, meanwhile, have similar lymphatic function as Cont; however, there is a highly variable response that may suggest that some BC subjects may be at risk for developing lymphedema.

  18. Independent Research and Independent Exploratory Development

    Science.gov (United States)

    1974-09-01

    Receive Couplkr A liquid crystal grating for coupling light into fiber optics, This will improve Naval cowmunacation and data tranrsfe. syste!ms Navy C4 ...XF21.222.018 i15 Detector Z275 Optical Covert Communications Using ZF61.212 150 S202 NIF (NOL--NSAP) 150 Laser Transceivers IOCCULT) 79 Indepndent

  19. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in an arm with arteriovenous (A-V) fistula for hemodialysis.

    Science.gov (United States)

    Chou, Ya-Hui; Li, Shu-Hua; Liao, Su-Fen; Tang, Hao-Wei

    2013-08-01

    Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape.

  20. Lymphoscintigraphic evaluation of leg lymphedema using intradermal injection of technetium 99m-labeled human serum albumin; Assessment of the effect of standing

    Energy Technology Data Exchange (ETDEWEB)

    Uchisako, Hiromichi; Suga, Kazuyoshi; Ito, Katsuyoshi; Kuramitsu, Tatsuya; Tanaka, Nobuyuki; Nakaki, Hiroji; Nakanishi, Takashi; Esato, Kensuke (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1993-11-01

    Twenty-four patients with lymphedema of the lower limbs and seven normal subjects were examined by lymphoscintigraphy following an intradermal injection of [sup 99m]Tc-HSA. The effect of changing to a standing position was determined. In normal subjects, a large spiking wave and a rapid stepwise increase in tracer activity frequently occurred on standing, although a decreased phase appeared less often on time-activity curves. These findings indicated that lymphatic flow was increased after the load produced by standing. The frequency of these changes was decreased in the patients with lymphedema, indicating that lymphatic disruption was responsible for their edema. Thus, lymphoscintigraphy using a load produced by standing can provide useful information in patients with lymphedema of the legs. (author).

  1. 3D-front-face fluorescence spectroscopy and independent components analysis: A new way to monitor bread dough development.

    Science.gov (United States)

    Garcia, Rebeca; Boussard, Aline; Rakotozafy, Lalatiana; Nicolas, Jacques; Potus, Jacques; Rutledge, Douglas N; Cordella, Christophe B Y

    2016-01-15

    Following bread dough development can be a hard task as no reliable method exists to give the optimal mixing time. Dough development is linked to the evolution of gluten proteins, carbohydrates and lipids which can result in modifications in the spectral properties of the various fluorophores naturally present in the system. In this paper, we propose to use 3-D-front-face-fluorescence (3D-FFF) spectroscopy in the 250-550nm domain to follow the dough development as influenced by formulation (addition or not of glucose, glucose oxidase and ferulic acid in the dough recipe) and mixing time (2, 4, 6 and 8min). In all the 32 dough samples as well as in flour, three regions of maximum fluorescence intensities have been observed at 320nm after excitation at 295nm (Region 1), at 420nm after excitation at 360nm (Region 2) and 450nm after excitation at 390nm (Region 3). The principal components analysis (PCA) of the evolution of these maxima shows that the formulations with and without ferulic acid are clearly separated since the presence of ferulic acid induces a decrease of fluorescence in Region 1 and an increase in Regions 2 and 3. In addition, a kinetic effect of the mixing time can be observed (decrease of fluorescence in the Regions 1 and 2) mainly in the absence of ferulic acid. The analysis of variance (ANOVA) on these maximum values statistically confirms these observations. Independent components analysis (ICA) is also applied to the complete 3-D-FFF spectra in order to extract interpretable signals from spectral data which reflect the complex contribution of several fluorophores as influenced by their environment. In all cases, 3 signals can be clearly separated matching the 3 regions of maximal fluorescence. The signals corresponding to regions 1 and 2 can be ascribed to proteins and ferulic acid respectively, whereas the fluorophores associated with the 3rd signal (corresponding to region 3) remain unidentified. Good correlations are obtained between the IC

  2. Skin and Subcutaneous Tissue Ultrasonography Features in Breast Cancer-Related Lymphedema

    Science.gov (United States)

    Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Samura, Makoto; Takeuchi, Yuriko; Mizoguchi, Takahiro; Nakamura, Kaori; Hamano, Kimikazu

    2016-01-01

    Objective: To investigate skin, subepidermal low echogenic band (SELEB), and subcutaneous tissue (SCT) thickness as well as the degree of increase in subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) in arms with lymphedema (LE). Materials and Methods: The skin and SCT of both arms of 30 patients with unilateral stage II breast cancer-related LE were scanned at five points (medial/lateral upper arm/forearm and dorsum of the hand). SEG and SEFS grades were determined according to severity (range: 0–2). Results: All measured parameters, except the SEFS in the medial upper arm, were significantly higher on the LE side than on the normal (N) side. The parameters differed most remarkably in the medial forearm (MFA; skin: LE 1.7 ± 0.8 mm vs. N 0.8 ± 0.2 mm; SELEB: LE 1.0 ± 0.6 mm vs. N 0.3 ± 0.1 mm; SCT: LE 8.7 ± 3.4 mm vs. N 3.8 ± 2.0 mm; SEG: LE 0.9 ± 0.5 vs. N 0.1 ± 0.3; and SEFS: LE 0.5 ± 0.7 vs. N 0). Conclusion: The differences in the thickness of the skin, SELEB, and SCT and the SEG and SEFS grades between the LE and N arms seemed most evident in the MFA. PMID:28018504

  3. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    Science.gov (United States)

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

  4. Decreased Bone Mineral Density Is an Independent Predictor for the Development of Atherosclerosis: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Chenyi Ye

    Full Text Available There is conflicting evidence regarding the association between decreased bone mineral density (BMD and atherosclerosis. To this end, we performed a systematic review and meta-analysis to clarify the association.To identify relevant studies, PubMed, Embase, and the Cochrane Library were systematically searched up to November 2015. All observational and comparative studies directly investigating the relationship between decreased BMD and clinical consequences of atherosclerotic vascular abnormalities, including carotid artery calcification (CAC, cardiovascular disease (CAD, and coronary artery disease (CAD were obtained, without limitation of language or publication year.A total of 25 studies involving 10,299 patients were included. The incidence of atherosclerotic vascular abnormalities was significantly increased in low BMD patients, compared to patients with normal BMD (OR, 1.81, 95% CI [1.01, 2.19], p<0.00001. Similar results were also observed for postmenopausal women (OR, 2.23, 95% CI [1.72, 2.89], p<0.00001. Subgroup analyses of osteopenia, osteoporosis, and normal BMD also revealed that the combined ORs for the incidence of atherosclerotic vascular abnormalities increased as BMD decreased. Of note, after adjusting for age, sex, body mass index (BMI and other vascular risk factors, decreased BMD remained significantly associated with the incidence of atherosclerotic vascular abnormalities (OR, 2.96, 95% CI [2.25, 3.88], p < 0.00001.Based on the results of this study, decreased BMD is an independent predictor for the development of atherosclerosis in elderly individuals. Moreover, the risk of atherosclerotic vascular abnormalities increased as BMD decreased. Future studies focusing on individuals with different severities of atherosclerosis and comorbidities are of interest.

  5. Independent Directors

    DEFF Research Database (Denmark)

    Ringe, Wolf-Georg

    2013-01-01

    This paper re-evaluates the corporate governance concept of ‘board independence’ against the disappointing experiences during the 2007-08 financial crisis. Independent or outside directors had long been seen as an essential tool to improve the monitoring role of the board. Yet the crisis revealed...... that they did not prevent firms' excessive risk taking; further, these directors sometimes showed serious deficits in understanding the business they were supposed to control, and remained passive in addressing structural problems. A closer look reveals that under the surface of seemingly unanimous consensus...... about board independence in Western jurisdictions, a surprising disharmony prevails about the justification, extent and purpose of independence requirements. These considerations lead me to question the benefits of the current system. Instead, this paper proposes a new, ‘functional’ concept of board...

  6. Developing a Culture of Enquiry-Based, Independent Learning in a Research-Led Institution: Findings from a Survey of Pedagogic Practice

    Science.gov (United States)

    McLinden, Mike; Edwards, Corony

    2011-01-01

    This paper reports select findings from an institutional survey designed to support long-term strategic developments at a research-led institution in the UK. These developments include a revised Learning and Teaching Strategy that has at its core the promotion of a "cross-institutional culture of enquiry-based, independent learning". The…

  7. Self-reported arm-lymphedema and functional impairment after breast cancer treatment--a nationwide study of prevalence and associated factors

    DEFF Research Database (Denmark)

    Gärtner, Rune; Jensen, Maj-Britt; Kronborg, Lise

    2010-01-01

    Lymphedema and impairment of function are well-established sequelae to breast cancer treatment and affect an increasing number of women due to continually improved survival. The aim of the present nationwide questionnaire study was to examine the impact of breast cancer treatment on perceived...... swelling/sensation of heaviness (lymphedema) and on function, reporting prevalence in 12 subgroups of modern treatment and offering estimates for treatment-related associated factors. 3253 Women (87%) returned the study questionnaire. Depending on treatment group prevalence of perceived swelling...

  8. E2F and p53 induce apoptosis independently during Drosophila development but intersect in the context of DNA damage.

    Directory of Open Access Journals (Sweden)

    Nam-Sung Moon

    2008-08-01

    Full Text Available In mammalian cells, RB/E2F and p53 are intimately connected, and crosstalk between these pathways is critical for the induction of cell cycle arrest or cell death in response to cellular stresses. Here we have investigated the genetic interactions between RBF/E2F and p53 pathways during Drosophila development. Unexpectedly, we find that the pro-apoptotic activities of E2F and p53 are independent of one another when examined in the context of Drosophila development: apoptosis induced by the deregulation of dE2F1, or by the overexpression of dE2F1, is unaffected by the elimination of dp53; conversely, dp53-induced phenotypes are unaffected by the elimination of dE2F activity. However, dE2F and dp53 converge in the context of a DNA damage response. Both dE2F1/dDP and dp53 are required for DNA damage-induced cell death, and the analysis of rbf1 mutant eye discs indicates that dE2F1/dDP and dp53 cooperatively promote cell death in irradiated discs. In this context, the further deregulation in the expression of pro-apoptotic genes generates an additional sensitivity to apoptosis that requires both dE2F/dDP and dp53 activity. This sensitivity differs from DNA damage-induced apoptosis in wild-type discs (and from dE2F/dDP-induced apoptosis in un-irradiated rbf1 mutant eye discs by being dependent on both hid and reaper. These results show that pro-apoptotic activities of dE2F1 and dp53 are surprisingly separable: dp53 is required for dE2F-dependent apoptosis in the response to DNA damage, but it is not required for dE2F-dependent apoptosis caused simply by the inactivation of rbf1.

  9. FGFs and BMP4 induce both Msx1-independent and Msx1-dependent signaling pathways in early tooth development.

    Science.gov (United States)

    Bei, M; Maas, R

    1998-11-01

    During early tooth development, multiple signaling molecules are expressed in the dental lamina epithelium and induce the dental mesenchyme. One signal, BMP4, has been shown to induce morphologic changes in dental mesenchyme and mesenchymal gene expression via Msx1, but BMP4 cannot substitute for all the inductive functions of the dental epithelium. To investigate the role of FGFs during early tooth development, we examined the expression of epithelial and mesenchymal Fgfs in wild-type and Msx1 mutant tooth germs and tested the ability of FGFs to induce Fgf3 and Bmp4 expression in wild-type and Msx1 mutant dental mesenchymal explants. Fgf8 expression is preserved in Msx1 mutant epithelium while that of Fgf3 is not detected in Msx1 mutant dental mesenchyme. Moreover, dental epithelium as well as beads soaked in FGF1, FGF2 or FGF8 induce Fgf3 expression in dental mesenchyme in an Msx1-dependent manner. These results indicate that, like BMP4, FGF8 constitutes an epithelial inductive signal capable of inducing the expression of downstream signaling molecules in dental mesenchyme via Msx1. However, the BMP4 and FGF8 signaling pathways are distinct. BMP4 cannot induce Fgf3 nor can FGFs induce Bmp4 expression in dental mesenchyme, even though both signaling molecules can induce Msx1 and Msx1 is necessary for Fgf3 and Bmp4 expression in dental mesenchyme. In addition, we have investigated the effects of FGFs and BMP4 on the distal-less homeobox genes Dlx1 and Dlx2 and we have clarified the relationship between Msx and Dlx gene function in the developing tooth. Dlx1,Dlx2 double mutants exhibit a lamina stage arrest in maxillary molar tooth development (Thomas B. L., Tucker A. S., Qiu M. , Ferguson C. A., Hardcastle Z., Rubenstein J. L. R. and Sharpe P. T. (1997) Development 124, 4811-4818). Although the maintenance of molar mesenchymal Dlx2 expression at the bud stage is Msx1-dependent, both the maintenance of Dlx1 expression and the initial activation of mesenchymal Dlx1

  10. Choosing Independence

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Milo Djukanovic, Prime Minister of Montenegro, won a key referendum May 21 when voters in his tiny, mountainous nation endorsed a plan to split from Serbia and become an independent state. This marked a final step in the breakup of the former Yugoslavia formed by six republics.

  11. Changes in Antibody Levels during and following an Episode of Acute Adenolymphangitis (ADL among Lymphedema Patients in Leogane, Haiti.

    Directory of Open Access Journals (Sweden)

    Katherine E Mues

    Full Text Available Episodes of acute adenolymphangitis (ADL are often the first clinical sign of lymphatic filariasis (LF. They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens.We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens.Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2, Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351 and Streptolysin O (P-value = 0.0074 showed a significant result.Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes.

  12. Acute Inflammatory Response to Low-, Moderate-, and High-Load Resistance Exercise in Women With Breast Cancer-Related Lymphedema.

    Science.gov (United States)

    Cormie, Prue; Singh, Benjamin; Hayes, Sandi; Peake, Jonathan M; Galvão, Daniel A; Taaffe, Dennis R; Spry, Nigel; Nosaka, Kazunori; Cornish, Bruce; Schmitz, Kathryn H; Newton, Robert U

    2016-09-01

    Background Resistance exercise is emerging as a potential adjunct therapy to aid in the management of breast cancer-related lymphedema (BCRL). However, the mechanisms underlying the relationships between the acute and long-term benefits of resistance exercise on BCRL are not well understood. Purpose To examine the acute inflammatory response to upper-body resistance exercise in women with BCRL and to compare these effects between resistance exercises involving low, moderate, and high loads. The impact on lymphedema status and associated symptoms was also compared. Methods A total of 21 women, 62 ± 10 years old, with BCRL participated in the study. Participants completed low-load (15-20 repetition maximum [RM]), moderate-load (10-12 RM), and high-load (6-8 RM) exercise sessions consisting of 3 sets of 6 upper-body resistance exercises. Sessions were completed in a randomized order separated by a 7- to 10-day wash-out period. Venous blood samples were obtained to assess markers of exercise-induced muscle damage and inflammation. Lymphedema status was assessed using bioimpedance spectroscopy and arm circumferences, and associated symptoms were assessed using Visual Analogue Scales for pain, heaviness, and tightness. Measurements were conducted before and 24 hours after the exercise sessions. Results No significant changes in creatine kinase, C-reactive protein, interleukin-6, and tumor necrosis factor-α were observed following the 3 resistance exercise sessions. There were no significant changes in arm swelling or symptom severity scores across the 3 resistance exercise conditions. Conclusions The magnitude of acute exercise-induced inflammation following upper-body resistance exercise in women with BCRL does not vary between resistance exercise loads. © The Author(s) 2015.

  13. Recognizing identity in the face of change: the development of an expression-independent representation of facial identity.

    Science.gov (United States)

    Mian, Jasmine F; Mondloch, Catherine J

    2012-07-30

    Perceptual aftereffects have indicated that there is an asymmetry in the extent to which adults' representations of identity and expression are independent of one another. Their representation of expression is identity-dependent; the magnitude of expression aftereffects is reduced when the adaptation and test stimuli have different identities. In contrast, their representation of identity is expression-independent; the magnitude of identity aftereffects is independent of whether the adaptation and test stimuli pose the same expressions. Like adults, children's representation of expression is identity-dependent (Vida & Mondloch, 2009). Here we investigated whether they have an expression-dependent representation of facial identity. Adults and 8-year-olds (n = 20 per group) categorized faces in an identity continuum (Sue/Jen) after viewing an adapting stimulus that displayed the same or a different emotional expression. Both groups showed identity aftereffects that were not influenced by facial expression. We conclude that, like adults, 8-year-old children's representation of identity is expression-independent.

  14. Independence among People with Disabilities: II. Personal Independence Profile.

    Science.gov (United States)

    Nosek, Margaret A.; And Others

    1992-01-01

    Developed Personal Independence Profile (PIP) as an instrument to measure aspects of independence beyond physical and cognitive functioning in people with diverse disabilities. PIP was tested for reliability and validity with 185 subjects from 10 independent living centers. Findings suggest that the Personal Independence Profile measures the…

  15. Independent preferences

    DEFF Research Database (Denmark)

    Vind, Karl

    1991-01-01

    A simple mathematical result characterizing a subset of a product set is proved and used to obtain additive representations of preferences. The additivity consequences of independence assumptions are obtained for preferences which are not total or transitive. This means that most of the economic...... theory based on additive preferences - expected utility, discounted utility - has been generalized to preferences which are not total or transitive. Other economic applications of the theorem are given...

  16. Progress of diagnosis and treatment in scarring, vascular anomalies and lymphedema%瘢痕、血管瘤和淋巴水肿研究和治疗进展

    Institute of Scientific and Technical Information of China (English)

    刘伟; 林晓曦; 刘宁飞

    2012-01-01

    Scar, vascular anomalies and lymphedema are the common diseases that are difficult to treat, which severely affect patients' psychological and physical fitness. Therefore> further defining the disease mechanism and improving the diagnosis and therapeutic efficiency are the important topics of this area. In this project, our group has: CDrevealed the role of keloid stem cells, drug resistance and GDF-9 differentiation in keloid development; ②established low dose chemotherapy of keloid with increased cure rate and reduced recurrence rate; ③established engineered epidermis \\v treat wound bed to inhibit scar formation; ④ established diagnosis and therapy system in infantile hemangioma; ⑤ established clinical classification of port wine stains; ⑥established diagnosis and therapy of venous malformations; ⑦established diagnosis and therapy methods for arterlovenous malformations; ⑧ preliminarily defined the molecular mechanism of lymphedema; ⑨established MRI diagnosis for lymphedema; ⑩development of specialized traditional Chinese medicine for lymphedema.%瘢痕、血管瘤和肢体淋巴水肿是整形外科领域的常见病和难治性疾病,具有较高的发病率,严重影响患者的身心健康.因此,进一步明确疾病的发病机制、提高疾病的诊断效率和治疗技术的创新一直是这一领域关注的重点.本课题组在相关领域的研究中取得以下进展:①阐述了病理性干细胞、耐药性和生长分化因子-9(GDF-9)差异表达在瘢痕疙瘩中的发病机制;②建立了低浓度化学药物瘢痕疙瘩治疗体系,显著提高治愈率和降低复发率;③建立了组织工程皮肤促进创面愈合、减少瘢痕形成的方法;④建立了婴幼儿血管瘤诊断与治疗体系;⑤建立了葡萄酒色斑的临床分类;⑥建立了静脉畸形的诊断和治疗体系;⑦建立了动静脉畸形的诊断和治疗体系;⑧初步阐明了炎性淋巴管生长的分子机制;⑨建立

  17. Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema

    Science.gov (United States)

    Tan, I.-Chih; Maus, Erik A.; Rasmussen, John C.; Marshall, Milton V.; Fife, Caroline E.; Smith, Latisha A.; Sevick-Muraca, Eva M.

    2011-03-01

    Treatment of lymphatic disease is complicated and controversial, due in part to the limited understanding of the lymphatic system. Lymphedema (LE) is a frequent complication after surgical resection and radiation treatment in cancer survivors, and is especially debilitating in regions where treatment options are limited. Although some extremity LE can be effectively treated with manual lymphatic drainage (MLD) therapy or compression devices to direct proximal lymph transport, head and neck LE is more challenging, due to complicated geometry and complex lymphatic structure in head and neck region. Herein, we describe the compassionate use of an investigatory technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and function, and to help direct MLD in a patient with head and neck LE. Immediately after 9 intradermal injections of 25 μg indocyanine green each around the face and neck region, NIR fluorescence images were collected using a custom-built imaging system with diffused excitation light illumination. These images were then used to direct MLD therapy. In addition, 3-dimensional (3D) surface profilometry was used to monitor response to therapy. NIR fluorescence images of functioning lymphatic vessels and abnormal structures were obtained. Precise geometries of facial structures were obtained using 3D profilometry, and detection of small changes in edema between therapy sessions was achieved. NIR fluorescence imaging provides a mapping of lymphatic architecture to direct MLD therapy and thus improve treatment efficacy in the head and neck LE, while 3D profilometry allowed longitudinal assessment of edema to evaluate the efficacy of therapy.

  18. System Design as a Three-Phase Dual-Loop (TPDL) Process: Types of Knowledge-Applied Sources of Feedback, and Student Development as Independent Learners

    Science.gov (United States)

    Barak, Moshe

    2010-01-01

    This study aimed at exploring how high school students deal with designing an information system, for example, for a small business or a medical clinic, the extent to which students develop as independent learners while working on their projects, and the factors that help or hinder fostering students' design skills. The three-phase dual-loop…

  19. Tissue dielectric constant (TDC) measurements as a means of characterizing localized tissue water in arms of women with and without breast cancer treatment related lymphedema.

    Science.gov (United States)

    Mayrovitz, H N; Weingrad, D N; Davey, S

    2014-09-01

    Quantitative measurements to detect lymphedema early in persons at-risk for breast cancer (BC) treatment-related lymphedema (BCRL) can aid clinical evaluations. Since BCRL may be initially manifest in skin and subcutis, the earliest changes might best be detected via local tissue water (LTW) measurements that are specifically sensitive to such changes. Tissue dielectric constant (TDC) measurements, which are sensitive to skin-to-fat tissue water, may be useful for this purpose. TDC differences between lymphedematous and non-lymphedematous tissue has not been fully characterized. Thus we measured TDC values (2.5 mm depth) in forearms of three groups of women (N = 80/group): 1) healthy with no BC (NOBC), 2) with BC but prior to surgery, and 3) with unilateral lymphedema (LE). TDC values for all arms except LE affected arms were not significantly different ranging between 24.8 ± 3.3 to 26.8 ± 4.9 and were significantly less (p TDC ratios, dominant/non-dominant for NOBC, were 1.001 ± 0.050 and at-risk/ contralateral for BC were 0.998 ± 0.082 with both significantly less (p TDC ratio of 1.2 and above could be a possible threshold to detect pre-clinical lymphedema. Further prospective measurement trial are needed to confirm this value.

  20. Developing a complex independent component analysis technique to extract non-stationary patterns from geophysical time-series

    Science.gov (United States)

    Forootan, Ehsan; Kusche, Jürgen

    2016-04-01

    Geodetic/geophysical observations, such as the time series of global terrestrial water storage change or sea level and temperature change, represent samples of physical processes and therefore contain information about complex physical interactionswith many inherent time scales. Extracting relevant information from these samples, for example quantifying the seasonality of a physical process or its variability due to large-scale ocean-atmosphere interactions, is not possible by rendering simple time series approaches. In the last decades, decomposition techniques have found increasing interest for extracting patterns from geophysical observations. Traditionally, principal component analysis (PCA) and more recently independent component analysis (ICA) are common techniques to extract statistical orthogonal (uncorrelated) and independent modes that represent the maximum variance of observations, respectively. PCA and ICA can be classified as stationary signal decomposition techniques since they are based on decomposing the auto-covariance matrix or diagonalizing higher (than two)-order statistical tensors from centered time series. However, the stationary assumption is obviously not justifiable for many geophysical and climate variables even after removing cyclic components e.g., the seasonal cycles. In this paper, we present a new decomposition method, the complex independent component analysis (CICA, Forootan, PhD-2014), which can be applied to extract to non-stationary (changing in space and time) patterns from geophysical time series. Here, CICA is derived as an extension of real-valued ICA (Forootan and Kusche, JoG-2012), where we (i) define a new complex data set using a Hilbert transformation. The complex time series contain the observed values in their real part, and the temporal rate of variability in their imaginary part. (ii) An ICA algorithm based on diagonalization of fourth-order cumulants is then applied to decompose the new complex data set in (i

  1. Primary lymphedema of the lower limb: The clinical utility of single photon emission computed tomography/CT

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, Mayo; Baumeister, Ruedinger G. H.; Frick, Andreas; Wallmichrath, Jens; Bartenstein, Peter; Rominger, Axel [Ludwig-Maximilians-University of Munich, Muenchen (Germany)

    2015-02-15

    The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb. For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65). In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%). As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

  2. CCBE1 mutation in two siblings, one manifesting lymphedema-cholestasis syndrome, and the other, fetal hydrops.

    Directory of Open Access Journals (Sweden)

    Sohela Shah

    Full Text Available BACKGROUND: Lymphedema-cholestasis syndrome (LCS; Aagenaes syndrome is a rare autosomal recessive disorder, characterized by 1 neonatal intrahepatic cholestasis, often lessening and becoming intermittent with age, and 2 severe chronic lymphedema, mainly lower limb. LCS was originally described in a Norwegian kindred in which a locus, LCS1, was mapped to a 6.6cM region on chromosome 15. Mutations in CCBE1 on chromosome 18 have been reported in some cases of lymphatic dysplasia, but not in LCS. METHODS: Consanguineous parents of Mexican ancestry had a child with LCS who did not exhibit extended homozygosity in the LCS1 region. A subsequent pregnancy was electively terminated due to fetal hydrops. We performed whole-genome single nucleotide polymorphism genotyping to identify regions of homozygosity in these siblings, and sequenced promising candidate genes. RESULTS: Both siblings harbored a homozygous mutation in CCBE1, c.398 T>C, predicted to result in the missense change p.L133P. Regions containing known 'cholestasis genes' did not demonstrate homozygosity in the LCS patient. CONCLUSIONS: Mutations in CCBE1 may yield a phenotype not only of lymphatic dysplasia, but also of LCS or fetal hydrops; however, the possibility that the sibling with LCS also carries a homozygous mutation in an unidentified gene influencing cholestasis cannot be excluded.

  3. Correlation among bioimpedance analysis, sonographic and circumferential measurement in assessment of breast cancer-related arm lymphedema.

    Science.gov (United States)

    Choi, Y H; Seo, K S

    2014-09-01

    New approaches for assessment of lymphedema using ultrasonography (US) have been introduced recently and are reported to be reliable and simple. Ultrasonography provides detailed information about physical properties of the tissue in addition to volume and size. There have been only limited studies comparing bioimpedance analysis (BIA), US, and circumferential measurement (CM), which is considered a standard measurement. The aim of this study was to determine the relationship between US, BIA, and CM. Twenty-eight patients with lymphedema after breast cancer surgery underwent BIA, US, and CM. Impedance, which reflects the amount of extracellular fluid, was measured with 1 kHz frequency in affected and unaffected arms. Circumferences were measured at 10cm proximal and distal to the elbow and a truncated cone method used to calculate estimated volumes for upper arm and forearm. We found that interlimb forearm subcutis thickness differences measured by US were highly correlated with CM measurements and that interlimb upper arm subcutis thickness differences measured by US were moderately correlated with CM measurements and BIA ratios. However, the interlimb ratio of compressibility measured by US showed no or only weak correlation with impedance measurements and circumferential measurements. Our results also show that compressibility measured by US could not be predicted from BIA or CM measurements despite a high degree of concordance among subcutis thickness measured by US, CM, and BIA.

  4. Synergic Effect of Compression Therapy and Controlled Active Exercises Using a Facilitating Device in the Treatment of Arm Lymphedema

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Guerreiro Godoy, Maria Regina Pereira, Antonio Helio Oliani, Jose Maria Pereira de Godoy

    2012-01-01

    Full Text Available Trial design: A randomized controlled trial was performed to evaluate the effect of the combination of compression therapy with active exercising using a facilitating apparatus on arm lymphedema. Method: Twenty women with a mean age of 63.3 years were evaluated; all had lymphedema resulting from breast cancer treatment. The inclusion criterion was a difference of 200 mL in size between arms. The apparatus used, called 'pulley system', is a vertical iron wheel fixed on a support at a distance of 10 cm from the patient's body. Participants were submitted to two series of active exercises using this facilitating device, one series using a compression sleeve and the other without. Each series consisted of four 12-minute sessions of exercises separated by 3-minute rest intervals. Volumetry was performed before and after each series of exercises. The paired t-test was utilized for statistical analysis (p-value < 0.05. Results: A significant mean reduction (p-value < 0.007 and non-significant mean increase (p-value < 0.2 in volumes were observed during exercising with and without compression, respectively. Conclusion: Controlled active exercising utilizing a facilitating apparatus while wearing a compression sleeve reduces the size of lymphedematous arms.

  5. Surgical treatment of lymphedema of the penis and scrotum Tratamento cirúrgico do linfedema peno-escrotal

    Directory of Open Access Journals (Sweden)

    Miguel Modolin

    2006-08-01

    Full Text Available PURPOSE: Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. MATERIALS AND METHODS: Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. RESULTS: Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. CONCLUSIONS: The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.INTRODUÇÃO: O linfedema peno-escrotal, independentemente da etiologia, é determinado pela redução do fluxo linfático com conseqüente aumento do volume do escroto e pênis. A evolução clínica da doença é caracterizada com extremo desconforto ao paciente, limitando a higiene local, a deambulação, o intercurso sexual e a micção em posição ortostática. OBJETIVO: Apresentar a experiência e resultados no tratamento da patologia com

  6. Development and application of two independent real-time PCR assays to detect clinically relevant Mucorales species.

    Science.gov (United States)

    Springer, Jan; Goldenberger, Daniel; Schmidt, Friderike; Weisser, Maja; Wehrle-Wieland, Elisabeth; Einsele, Hermann; Frei, Reno; Löffler, Jürgen

    2016-03-01

    PCR-based detection of Mucorales species could improve diagnosis of suspected invasive fungal infection, leading to a better patient outcome. This study describes two independent probe-based real-time PCR tests for detection of clinically relevant Mucorales, targeting specific fragments of the 18S and the 28S rRNA genes. Both assays have a short turnaround time, allow fast, specific and very sensitive detection of clinically relevant Mucorales and have the potential to be used as quantitative tests. They were validated on various clinical samples (fresh and formalin-fixed paraffin-embedded specimens, mainly biopsies, n = 17). The assays should be used as add-on tools to complement standard techniques; a combined approach of both real-time PCR assays has 100 % sensitivity. Genus identification by subsequent sequencing is possible for amplicons of the 18S PCR assay. In conclusion, combination of the two independent Mucorales assays described in this study, 18S and 28S, detected all clinical samples associated with proven Mucorales infection (n = 10). Reliable and specific identification of Mucorales is a prerequisite for successful antifungal therapy as these fungi show intrinsic resistance to voriconazole and caspofungin.

  7. Overview and Categorization of Robots Supporting Independent Living of Elderly People: What Activities Do They Support and How Far Have They Developed.

    Science.gov (United States)

    Bedaf, Sandra; Gelderblom, Gert Jan; De Witte, Luc

    2015-01-01

    Over the past decades, many robots for the elderly have been developed, supporting different activities of elderly people. A systematic review in four scientific literature databases and a search in article references and European projects was performed in order to create an overview of robots supporting independent living of elderly people. The robots found were categorized based on their development stage, the activity domains they claim to support, and the type of support provided (i.e., physical, non-physical, and/or non-specified). In total, 107 robots for the elderly were identified. Six robots were still in a concept phase, 95 in a development phase, and six of these robots were commercially available. These robots claimed to provide support related to four activity domains: mobility, self-care, interpersonal interaction & relationships, and other activities. Of the many robots developed, only a small percentage is commercially available. Technical ambitions seem to be guiding robot development. To prolong independent living, the step towards physical support is inevitable and needs to be taken. However, it will be a long time before a robot will be capable of supporting multiple activities in a physical manner in the home of an elderly person in order to enhance their independent living.

  8. No evidence of benefit from class-II compression stockings in the prevention of lower-limb lymphedema after inguinal lymph node dissection: results of a randomized controlled trial

    NARCIS (Netherlands)

    Stuiver, M.M.; de Rooij, J.D.; Lucas, C.; Nieweg, O.E.; Horenblas, S.; van Geel, A.N.; van Beurden, M.; Aaronson, N.K.

    2013-01-01

    Graduated compression stockings havebeen advocated for prevention of lymphedemaafter inguinal lymph node dissection (ILND) although scientific evidence of their efficacyin preventing lymphedema is lacking. Theprimary objective of this study was to assessthe efficacy of class II compression

  9. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema

    Directory of Open Access Journals (Sweden)

    Roberta Maria Dalia

    2005-10-01

    Full Text Available The purpose of this study was to prove the efficiency of qualitative and quantitative lymphoscintigraphy in the diagnosis of the lower extremity lymphedema. Seventy-seven patients had been studied, most of then (85.7% were female. Patients’ ages ranged from 18 to 82 years. All patients underwent a bilateral lymphoscintigraphy. Images were recorded with a dual-detector instrument in the whole-body scanning mode. Feet and inguinal static views were acquired within 15 minutes and three hours after radiopharmaceutical injection. Two nuclear doctors evaluated the lymphoscintigrams qualitatively. Quantitative studies of the radiopharmaceutical absorption and the lymph node chain uptake were also obtained. Of the 154 evaluated members, 21.44% (n = 33 were classified as normal, 61.68% (n = 95 as mildly altered and 16.88% (n = 26 much altered. Quantitation of lymphatic chain uptake may be a more sensitive approach to the diagnosis of lymphatic impairment than the qualitative analysis.O objetivo do estudo foi comprovar a eficiência da linfocintilografia qualitativa e quantitativa no diagnóstico e na classificação da gravidade do linfedema de membros inferiores. Foram estudados 77 pacientes, sendo 66 (85,7% do sexo feminino, na faixa etária entre 18 e 82 anos. Todos os pacientes foram submetidos a uma linfocintilografia bilateral, com um equipamento de dois detectores, na qual se adquiriu imagens dos pés, da região inguinal e uma varredura dos membros, após 15 minutos e três horas da injeção do radiofármaco. Os exames foram avaliados qualitativamente por 2 médicos nucleares. Também foram feitos estudos quantitativos da absorção do radiofármaco e da captação em cadeia inguinal. Dos 154 membros avaliados classificaram-se como normais 21,44% (n=33, pouco alterados 61,68% (n=95 e muito alterados 16,88% (n=26. A quantificação da captação da cadeia linfática pode ser um método mais sensível para o diagnóstico do linfedema em rela

  10. Arabidopsis CALCINEURIN B-LIKE10 Functions Independently of the SOS Pathway during Reproductive Development in Saline Conditions.

    Science.gov (United States)

    Monihan, Shea M; Magness, Courtney A; Yadegari, Ramin; Smith, Steven E; Schumaker, Karen S

    2016-05-01

    The accumulation of sodium in soil (saline conditions) negatively affects plant growth and development. The Salt Overly Sensitive (SOS) pathway in Arabidopsis (Arabidopsis thaliana) functions to remove sodium from the cytosol during vegetative development preventing its accumulation to toxic levels. In this pathway, the SOS3 and CALCINEURIN B-LIKE10 (CBL10) calcium sensors interact with the SOS2 protein kinase to activate sodium/proton exchange at the plasma membrane (SOS1) or vacuolar membrane. To determine if the same pathway functions during reproductive development in response to salt, fertility was analyzed in wild type and the SOS pathway mutants grown in saline conditions. In response to salt, CBL10 functions early in reproductive development before fertilization, while SOS1 functions mostly after fertilization when seed development begins. Neither SOS2 nor SOS3 function in reproductive development in response to salt. Loss of CBL10 function resulted in reduced anther dehiscence, shortened stamen filaments, and aborted pollen development. In addition, cbl10 mutant pistils could not sustain the growth of wild-type pollen tubes. These results suggest that CBL10 is critical for reproductive development in the presence of salt and that it functions in different pathways during vegetative and reproductive development.

  11. Research on the Independent Innovation Management Patterns of New Product Development%新产品开发的自主创新管理模式探讨

    Institute of Scientific and Technical Information of China (English)

    池仁勇; 金慧英; 张化尧

    2012-01-01

    新产品开发的自主创新管理模式与企业自身条件、战略目标、资源禀赋等密不可分.将浙江省高新技术企业作为研究对象,运用因子分析得到影响企业新产品开发的三大影响因素,分别对应于3种自主创新管理模式:以战略平台为核心、以组织资本为核心、以技术能力为核心.以新产品开发为衡量标准,对这3种管理模式进行了实证分析,寻找最适合浙江省高新技术企业新产品开发的管理模式,为浙江省高新技术企业自主创新管理提供借鉴.%Independent innovation management pattern of new product development is closed with the conditions, strategy target, resources of enterprises etc.. This article obtains three influencing factors on new product development of enterprises by using the factor analysis method, and correspondingly concludes three kinds of enterprise independent innovation management patterns: the strategic platform as the core, organizational capital as the core, the technical ability as the core. The article attempts to study on the relationship between the three independent innovation management patterns and the new product development, seek the most suitable management pattern for the enterprises in Zhejiang to enhance the new product development, and provide a reference for enterprise independent innovation management.

  12. Auditor Independence: Beyond the Dilemma of Combining Auditing and Advisory Activities for the Development of Quality Assurance Systems in Agriculture

    Science.gov (United States)

    Maxime, Francoise; Maze, Armelle

    2006-01-01

    This article aims to study the design and the organization of auditing systems to develop environmental or quality assurance schemes at the farm level and the role that extension services could play in these processes. It starts by discussing the issue of combining auditing and advisory activities and developing auditing competences. Empirical…

  13. Auditor Independence: Beyond the Dilemma of Combining Auditing and Advisory Activities for the Development of Quality Assurance Systems in Agriculture

    Science.gov (United States)

    Maxime, Francoise; Maze, Armelle

    2006-01-01

    This article aims to study the design and the organization of auditing systems to develop environmental or quality assurance schemes at the farm level and the role that extension services could play in these processes. It starts by discussing the issue of combining auditing and advisory activities and developing auditing competences. Empirical…

  14. The role of biofilms in persistent infections and factors involved in ica-independent biofilm development and gene regulation in Staphylococcus aureus.

    Science.gov (United States)

    Figueiredo, Agnes Marie Sá; Ferreira, Fabienne Antunes; Beltrame, Cristiana Ossaille; Côrtes, Marina Farrel

    2017-09-01

    Staphylococcus aureus biofilms represent a unique micro-environment that directly contribute to the bacterial fitness within hospital settings. The accumulation of this structure on implanted medical devices has frequently caused the development of persistent and chronic S. aureus-associated infections, which represent an important social and economic burden worldwide. ica-independent biofilms are composed of an assortment of bacterial products and modulated by a multifaceted and overlapping regulatory network; therefore, biofilm composition can vary among S. aureus strains. In the microniches formed by biofilms-produced by a number of bacterial species and composed by different structural components-drug refractory cell subpopulations with distinct physiological characteristics can emerge and result in therapeutic failures in patients with recalcitrant bacterial infections. In this review, we highlight the importance of biofilms in the development of persistence and chronicity in some S. aureus diseases, the main molecules associated with ica-independent biofilm development and the regulatory mechanisms that modulate ica-independent biofilm production, accumulation, and dispersion.

  15. Independence Day

    Institute of Scientific and Technical Information of China (English)

    姜华荐

    2000-01-01

    At the beginning of the 17th century, Great Britain began to open up colonies along the east coast of North America. By 1733, 13 colonies had been established there. The colonial economy was developing rapidly. The colonies attracted increasing numbers of settlers from Europe, many of whom fled the country because of religious or political persecution.

  16. Multi-Axis Independent Electromechanical Load Control for Docking System Actuation Development and Verification Using dSPACE

    Science.gov (United States)

    Oesch, Christopher; Dick, Brandon; Rupp, Timothy

    2015-01-01

    The development of highly complex and advanced actuation systems to meet customer demands has accelerated as the use of real-time testing technology expands into multiple markets at Moog. Systems developed for the autonomous docking of human rated spacecraft to the International Space Station (ISS), envelope multi-operational characteristics which place unique constraints on an actuation system. Real-time testing hardware has been used as a platform for incremental testing and development for the linear actuation system which controls initial capture and docking for vehicles visiting the ISS. This presentation will outline the role of dSPACE hardware as a platform for rapid control-algorithm prototyping as well as an Electromechanical Actuator (EMA) system dynamic loading simulator, both conducted at Moog to develop the safety critical Linear Actuator System (LAS) of the NASA Docking System (NDS).

  17. Retinoic acid-independent expression of Meis2 during autopod patterning in the developing bat and mouse limb

    OpenAIRE

    Mason, Mandy K.; Hockman, Dorit; Curry, Lyle; Cunningham, Thomas J.; Duester, Gregg; Logan, Malcolm; Jacobs, David S.; Illing, Nicola

    2015-01-01

    Background The bat has strikingly divergent forelimbs (long digits supporting wing membranes) and hindlimbs (short, typically free digits) due to the distinct requirements of both aerial and terrestrial locomotion. During embryonic development, the morphology of the bat forelimb deviates dramatically from the mouse and chick, offering an alternative paradigm for identifying genes that play an important role in limb patterning. Results Using transcriptome analysis of developing Natal long-fing...

  18. Retinoic acid-independent expression of Meis2 during autopod patterning in the developing bat and mouse limb

    OpenAIRE

    2015-01-01

    Background The bat has strikingly divergent forelimbs (long digits supporting wing membranes) and hindlimbs (short, typically free digits) due to the distinct requirements of both aerial and terrestrial locomotion. During embryonic development, the morphology of the bat forelimb deviates dramatically from the mouse and chick, offering an alternative paradigm for identifying genes that play an important role in limb patterning. Results Using transcriptome analysis of developing Natal long-fing...

  19. Independent technical review, handbook

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    Purpose Provide an independent engineering review of the major projects being funded by the Department of Energy, Office of Environmental Restoration and Waste Management. The independent engineering review will address questions of whether the engineering practice is sufficiently developed to a point where a major project can be executed without significant technical problems. The independent review will focus on questions related to: (1) Adequacy of development of the technical base of understanding; (2) Status of development and availability of technology among the various alternatives; (3) Status and availability of the industrial infrastructure to support project design, equipment fabrication, facility construction, and process and program/project operation; (4) Adequacy of the design effort to provide a sound foundation to support execution of project; (5) Ability of the organization to fully integrate the system, and direct, manage, and control the execution of a complex major project.

  20. An exploration of the continuing professional development needs of nurse independent prescribers and nurse supplementary prescribers who prescribe medicines for patients with diabetes.

    Science.gov (United States)

    Carey, Nicola; Courtenay, Molly

    2010-01-01

    Nurse Independent and Nurse Supplementary Prescribing has extended the role that nurses in the UK have in the management of care for patients with diabetes. Concerns surround nurses' pharmacological knowledge and provision of continuing professional development to meet the needs of nurse prescribers. To examine the continuing professional development needs of nurses who prescribe medicines to patients with diabetes. A questionnaire survey. The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. One thousand and four hundred questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 80% reported continuing professional development was available and that they had accessed it to support their prescribing role. Over 40% of nurses had continuing professional development needs in the areas of prescribing policy, pharmacology for diabetes and the management and treatment of diabetes related conditions. Senior nurses reported fewer continuing professional development needs. Access and provision of continuing professional development for nurse prescribers has improved since the initial implementation of nurse prescribing. However, nurse's pharmacological knowledge and the provision of continuing professional development continue to be an area of concern which warrant further investigation. Previous concerns have been identified about the provision of continuing professional development to meet the needs of nurse prescribers. Pharmacological knowledge is still the greatest continuing professional development requirement of nurses who prescribe for patients with diabetes. Education providers may wish to consider developing the content of continuing professional development programmes to meet these needs.

  1. The C. elegans H3K27 Demethylase UTX-1 Is Essential for Normal Development, Independent of Its Enzymatic Activity

    DEFF Research Database (Denmark)

    Vandamme, Julien; Lettier, Gaëlle; Sidoli, Simone;

    2012-01-01

    specific for H3K27me2/3. We demonstrate that utx-1 is an essential gene that is required for correct embryonic and postembryonic development. Consistent with its homology to UTX, UTX-1 regulates global levels of H3K27me2/3 in C. elegans. Surprisingly, we found that the catalytic activity is not required......Epigenetic modifications influence gene expression and provide a unique mechanism for fine-tuning cellular differentiation and development in multicellular organisms. Here we report on the biological functions of UTX-1, the Caenorhabditis elegans homologue of mammalian UTX, a histone demethylase...

  2. COMBINATION OF INDEPENDENT COMPONENT ANALYSIS, DESIGN OF EXPERIMENTS AND DESIGN SPACE FOR A NOVEL METHODOLOGY TO DEVELOP CHROMATOGRAPHIC METHODS

    OpenAIRE

    Rozet, Eric; Debrus, Benjamin; Lebrun, Pierre; Boulanger, B.; Hubert, Philippe

    2012-01-01

    As defined by ICH [1] and FDA, Quality by Design (QbD) stands for “a systematic approach to development that begins with predefined objectives and emphasizes product and process understanding and process control, based on sound science and quality risk management”. A risk–based QbD–compliant approach is proposed for the robust development of analytical methods. This methodology based on Design of Experiments (DoE) to study the experimental domain models the retention times at the beginning, t...

  3. Zebrafish SPI-1 (PU.1) marks a site of myeloid development independent of primitive erythropoiesis : Implications for axial patterning

    NARCIS (Netherlands)

    Lieschke, GJ; Oates, AC; Paw, BH; Thompson, MA; Hall, NE; Ward, AC; Ho, RK; Zon, LI; Layton, JE

    2002-01-01

    The mammalian transcription factor SPI-1 (synonyms: SPI1, PU.1, or Sfpi1) plays a critical role in myeloid development. To examine early myeloid commitment in the zebrafish embryo, we isolated a gene from zebrafish that is a SPI-1 orthologue on the basis of homology and phylogenetic considerations.

  4. The DOD-NASA Independent Research and Development Program: Issues and Methodology for an In-Depth Study

    Science.gov (United States)

    1981-01-01

    understandable to the publico This view suggests that short-term solutions will not be found, and that efforts should be directed toward long-range...retroactive regulations can impose severe hardships. When com- plex, state-of-the- art systems are demanded, the specialization -70- involved in developing the

  5. Cultivation independent analysis of the development of the Lactobacillus spp. Community in the intestinal tract of newborn piglets

    NARCIS (Netherlands)

    Yao, W.; Zhu, W.Y.; Smidt, H.; Verstegen, M.W.A.

    2011-01-01

    Molecular diversity and development of the Lactobacillus community in the intestinal tract, as influenced by age and intestinal compartment, were studied in one litter of 12 conventionally raised piglets. Piglets were euthanized at each week (3 animals per time). Digesta and tissue samples from stom

  6. Using TQM/CQI Processes To Guide Development of Independent and Collaborative Learning in Two Levels of Baccalaureate Nursing Students.

    Science.gov (United States)

    Grant, LaVerne F.; Kelley, Jane H.; Northington, LaDonna; Barlow, Delores

    2002-01-01

    Junior and senior nursing students participated in collaborative learning projects developed using total quality management/continuous quality improvement processes. Seniors mentored and evaluated juniors. Feedback from 37 seniors and 53 juniors was predominantly positive; dissatisfaction centered on time issues and misunderstanding of project…

  7. University Adult Education in Independent Zambia: The Role of a Department of Extra-Mural Studies in National Development

    Science.gov (United States)

    Okafor, Clement Abiazem

    1971-01-01

    Like other African countries, Zambia's most pragmatic approach to national development must lie in adult education. The University of Zambia is one agency involved toward this goal and its emphasis is on rapid expansion of university-type education and the training of adult educators. (Author/JB)

  8. Dissection of SAP-dependent and SAP-independent SLAM family signaling in NKT cell development and humoral immunity.

    Science.gov (United States)

    Chen, Shasha; Cai, Chenxu; Li, Zehua; Liu, Guangao; Wang, Yuande; Blonska, Marzenna; Li, Dan; Du, Juan; Lin, Xin; Yang, Meixiang; Dong, Zhongjun

    2017-02-01

    Signaling lymphocytic activation molecule (SLAM)-associated protein (SAP) mutations in X-linked lymphoproliferative disease (XLP) lead to defective NKT cell development and impaired humoral immunity. Because of the redundancy of SLAM family receptors (SFRs) and the complexity of SAP actions, how SFRs and SAP mediate these processes remains elusive. Here, we examined NKT cell development and humoral immunity in mice completely deficient in SFR. We found that SFR deficiency severely impaired NKT cell development. In contrast to SAP deficiency, SFR deficiency caused no apparent defect in follicular helper T (TFH) cell differentiation. Intriguingly, the deletion of SFRs completely rescued the severe defect in TFH cell generation caused by SAP deficiency, whereas SFR deletion had a minimal effect on the defective NKT cell development in SAP-deficient mice. These findings suggest that SAP-dependent activating SFR signaling is essential for NKT cell selection; however, SFR signaling is inhibitory in SAP-deficient TFH cells. Thus, our current study revises our understanding of the mechanisms underlying T cell defects in patients with XLP. © 2017 Chen et al.

  9. 'Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study'

    NARCIS (Netherlands)

    Beulens, Joline W J; Abbasi, Ali; Peelen, Linda M; Spijkerman, Annemieke M W; van der A, Daphne L; Corpeleijn, Eva; Bakker, Stephan J L; van der Schouw, Yvonne T

    2013-01-01

    OBJECTIVE: To validate risk scores to predict occurrence of type 2 diabetes in the Dutch population. DESIGN: Prospective cohort study. METHODS: Twelve basic risk scores and 13 extensive risk scores with biomarkers were used to predict the risk of developing type 2 diabetes during 7.5 years in a pros

  10. 'Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study'

    NARCIS (Netherlands)

    Beulens, Joline W J; Abbasi, Ali; Peelen, Linda M; Spijkerman, Annemieke M W; van der A, Daphne L; Corpeleijn, Eva; Bakker, Stephan J L; van der Schouw, Yvonne T

    2013-01-01

    OBJECTIVE: To validate risk scores to predict occurrence of type 2 diabetes in the Dutch population. DESIGN: Prospective cohort study. METHODS: Twelve basic risk scores and 13 extensive risk scores with biomarkers were used to predict the risk of developing type 2 diabetes during 7.5 years in a

  11. Independent College Experiment Situation and Undergraduates Development%独立学院实验条件与本科生培养

    Institute of Scientific and Technical Information of China (English)

    毛维博; 张漩卓一; 裴沙沙

    2015-01-01

    The present construction situation of Independent College and the huge change of structure and quality of regular higher education institutions were analyzed. Solutions of how to strengthen undergraduates’ experiment courses and promote independent college competitive power and overall qualities of the undergraduates were proposed. The relationship of experiment condition and undergraduates development was investigated.%通过分析独立学院实验室建设的现状和高校生源结构和生源质量之间发生的巨大变化,提出了强化本科生实验课程教学,提升独立学院综合竞争力和学生综合素质的解决办法,对实验条件与本科生培养之间的关系进行了探讨。

  12. Chronic lower extremity lymphedema: A comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lu Qing [Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dong Fang Rd, Shanghai 200127 (China)], E-mail: luqingshan@sjtu.edu.cn; Xu Jianrong [Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dong Fang Rd, Shanghai 200127 (China)], E-mail: jiangrongx@hotmail.com; Liu Ningfei [Department of Plastic and Reconstructive Surgery, Shanghai 9th People' s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Second Medical University, 639 Zhi Zao Ju Rd, Shanghai 200011 (China)], E-mail: luqing_1973@163.com

    2010-02-15

    Purpose: To assess the role of heavily T2-weighted image and interstitial MR lymphangiography (MRL) for the visualization of lymphatic vessels in patients with disorders of the lymphatic circulation. Methods: Forty lower extremities in 31 patients (9 bilateral and 22 unilateral) with primary lymphedema were examined by heavily T2-weighted image and indirect MRL. Maximum-intensity projection (MIP) was used to reconstruct the images of the lymphatic system. Two experienced radiologists analyzed the images with regard to the differences in image quality, number of lymphatic vessels, its maximum diameter and two other findings: accumulated lymph fluid in the tissue and honeycombing pattern. Results: The beaded appearance of the affected vessels in 73 leg segments of 40 lower extremities were present on both modalities 3D MIP. Larger amount of the dilated lymphatic vessels were visualized on heavily T2-weighted image than that on MRL (p = 0.003) and the maximum diameter of it was 4.28 {+-} 1.53 mm on heavily T2-weighted image, whereas 3.41 {+-} 1.05 mm on MRL (p < 0.01). The dilated lymphatic vessels on MRL showed better image quality and greater SNR and CNR than that on heavily T2-weighted image (p < 0.01). The regions of accumulated lymph fluid and the honeycombing pattern extent were identified on heavily T2-weighted image scored statistically higher than that on MRL (p < 0.01). Conclusion: The heavily T2-weighted imaging has greater sensitivity and the MRL image has higher legibility for detecting the pathologically modified lymphatic vessels and accompanying complications non-invasively. Combining these two MR techniques can accurately access the pathological changes in the lower extremity with lymphedema.

  13. Evolution of OTP-independent larval skeleton patterning in the direct-developing sea urchin, Heliocidaris erythrogramma.

    Science.gov (United States)

    Zhou, Na; Wilson, Keen A; Andrews, Mary E; Kauffman, Jeffery S; Raff, Rudolf A

    2003-12-15

    Heliocidaris erythrogramma is a direct-developing sea urchin that has evolved a modified ontogeny, a reduced larval skeleton, and accelerated development of the adult skeleton. The Orthopedia gene (Otp) encodes a homeodomain transcription factor crucial in patterning the larval skeleton of indirect-developing sea urchins. We compare the role of Otp in larvae of the indirect-developing sea urchin Heliocidaris tuberculata and its direct-developing congener H. erythrogramma. Otp is a single-copy gene with an identical protein sequence in these species. Expression of Otp is initiated by the late gastrula, initially in two cells of the oral ectoderm in H. tuberculata. These cells are restricted to oral ectoderm and exhibit left-right symmetry. There are about 266 copies of Otp mRNA per Otp- expressing cell in H. tuberculata. We tested OTP function in H. tuberculata and H. erythrogramma embryos by microinjection of Otp mRNA. Mis-expression of Otp mRNA in H. tuberculata radialized the embryos and caused defects during larval skeletogenesis. Mis-expression of Otp mRNA in H. erythrogramma embryos did not affect skeleton formation. This is consistent with the observation by in situ hybridization of no concentration of Otp transcript in any particular cells or region of the H. erythrogramma larva, and measurement of a level of less than one copy of endogenous Otp mRNA per cell in H. erythrogramma. OTP plays an important role in patterning the larval skeleton of H. tuberculata, but this role apparently has been lost in the evolution of the H. erythrogramma larva, and replaced by a new patterning mechanism.

  14. Interactions with Astroglia Influence the Shape of the Developing Dendritic Arbor and Restrict Dendrite Growth Independent of Promoting Synaptic Contacts

    Science.gov (United States)

    Farley, Jennifer R.; Sterritt, Jeffrey R.; Crane, Andrés B.; Wallace, Christopher S.

    2017-01-01

    Astroglia play key roles in the development of neurons, ranging from regulating neuron survival to promoting synapse formation, yet basic questions remain about whether astrocytes might be involved in forming the dendritic arbor. Here, we used cultured hippocampal neurons as a simple in vitro model that allowed dendritic growth and geometry to be analyzed quantitatively under conditions where the extent of interactions between neurons and astrocytes varied. When astroglia were proximal to neurons, dendrites and dendritic filopodia oriented toward them, but the general presence of astroglia significantly reduced overall dendrite growth. Further, dendritic arbors in partial physical contact with astroglia developed a pronounced pattern of asymmetrical growth, because the dendrites in direct contact were significantly smaller than the portion of the arbor not in contact. Notably, thrombospondin, the astroglial factor shown previously to promote synapse formation, did not inhibit dendritic growth. Thus, while astroglia promoted the formation of presynaptic contacts onto dendrites, dendritic growth was constrained locally within a developing arbor at sites where dendrites contacted astroglia. Taken together, these observations reveal influences on spatial orientation of growth as well as influences on morphogenesis of the dendritic arbor that have not been previously identified. PMID:28081563

  15. 汽车电站自主开发策划理论研究%The Theory Research of Automobile Power Station Independent Development Planning

    Institute of Scientific and Technical Information of China (English)

    杜遥

    2014-01-01

    From the importance of independent product development in the market competition of the automo -bile power station , analysis of new product development planning theory present situation and demand , put forward from the market research , demand transformation , comprehensive evaluation three aspects to build automobile pow-er station development planning framework of theoretical system , market research , demand analysis , the conceptual design of the conversion system of the importance of , has the guiding sense to the independent development of new products of automobile power station .%从产品自主开发在市场竞争中的重要性入手,分析了汽车电站新产品开发策划理论现状和需求,提出了从市场研究、需求转换、综合评价三方面来搭建汽车电站自主开发策划理论体系架构,分析市场研究、需求转换、概念设计对该体系的重要性。对汽车电站新产品的自主开发具有指导意义。

  16. 不同护理干预方法在乳腺癌术后上肢淋巴水肿的应用价值%Application value of different of nursing intervention methods for upper extremity lymphedema of post-operative breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    颜巍; 刘晓舟; 周岩; 张婧; 刘宝利; 孔孟琼

    2014-01-01

    目的:探讨不同的护理干预方法对乳腺癌术后上肢淋巴水肿的应用价值。方法对180例乳腺癌术后患者进行护理干预,分为三组,每组60例。即常规组(常规护理及心理护理)、按摩组(在常规组的基础上,增加手法按摩)和加压组(在按摩组的基础上,增加空气波压力治疗仪)。观察术后3个月,6个月,9个月,12个月患肢水肿的护理效果。结果3~12个月加压组明显降低了上肢淋巴水肿发展程度及发生率,并提高了上肢功能康复的程度,且在常规组的基础上增加手法按摩和\或空气波压力治疗仪后,患者的上肢淋巴水肿发展程度及发生率下降,上肢功能康复提高。结论采用手法按摩加空气波压力治疗仪的护理干预方式,能够更好地预防及治疗术后上肢淋巴水肿,提高疗效及患者生活质量。%Objective To study the application value of different nursing intervention methods for upper limb lymphedema of positive-operation breast cancer patients .Method 180 patients with post-operative routine nursing of breast cancer was selected and divided into 3 groups .60 patients in each group .The conventional group( routine nursing and psychological nursing ) ,massage group (routine nursing ,psychological nursing and massage) and Com-pression group (basic therapy as massage plus air pressure wave therapeutic apparatus ) .The nursing effect for limb lymphedema was observed and compared for 3 months ,6 months ,9 months ,12 months after operation among the three groups .Result The development of lymphedema incidence was decreased ,and upper limb function was im-proved in compression group 12 month after operation .The development of lymphedema incidence was decreased and upper limb function improved remarkably for patient treated by routine nursing plus massage or air pressure wave therapeutic apparatus .Conclusion The 3 kinds of nursing intervention for prevention

  17. Collaborative regulation of development but independent control of metabolism by two epidermis-specific transcription factors in Caenorhabditis elegans.

    Science.gov (United States)

    Shao, Jiaofang; He, Kan; Wang, Hao; Ho, Wing Sze; Ren, Xiaoliang; An, Xiaomeng; Wong, Ming Kin; Yan, Bin; Xie, Dongying; Stamatoyannopoulos, John; Zhao, Zhongying

    2013-11-15

    Cell fate specification is typically initiated by a master regulator, which is relayed by tissue-specific regulatory proteins (usually transcription factors) for further enforcement of cell identities, but how the factors are coordinated among each other to "finish up" the specification remains poorly understood. Caenorhabditis elegans epidermis specification is initiated by a master regulator, ELT-1, that activates its targets, NHR-25 and ELT-3, two epidermis-specific transcription factors that are important for development but not for initial specification of epidermis, thus providing a unique paradigm for illustrating how the tissue-specific regulatory proteins work together to enforce cell fate specification. Here we addressed the question through contrasting genome-wide in vivo binding targets between NHR-25 and ELT-3. We demonstrate that the two factors bind discrete but conserved DNA motifs, most of which remain in proximity, suggesting formation of a complex between the two. In agreement with this, gene ontology analysis of putative target genes suggested differential regulation of metabolism but coordinated control of epidermal development between the two factors, which is supported by quantitative analysis of expression of their specific or common targets in the presence or absence of either protein. Functional validation of a subset of the target genes showed both activating and inhibitory roles of NHR-25 and ELT-3 in regulating their targets. We further demonstrated differential control of specification of AB and C lineage-derived epidermis. The results allow us to assemble a comprehensive gene network underlying C. elegans epidermis development that is likely to be widely used across species and provides insights into how tissue-specific transcription factors coordinate with one another to enforce cell fate specification initiated by its master regulator.

  18. Development of computer program ENMASK for prediction of residual environmental masking-noise spectra, from any three independent environmental parameters

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Y.-S.; Liebich, R. E.; Chun, K. C.

    2000-03-31

    Residual environmental sound can mask intrusive4 (unwanted) sound. It is a factor that can affect noise impacts and must be considered both in noise-impact studies and in noise-mitigation designs. Models for quantitative prediction of sensation level (audibility) and psychological effects of intrusive noise require an input with 1/3 octave-band spectral resolution of environmental masking noise. However, the majority of published residual environmental masking-noise data are given with either octave-band frequency resolution or only single A-weighted decibel values. A model has been developed that enables estimation of 1/3 octave-band residual environmental masking-noise spectra and relates certain environmental parameters to A-weighted sound level. This model provides a correlation among three environmental conditions: measured residual A-weighted sound-pressure level, proximity to a major roadway, and population density. Cited field-study data were used to compute the most probable 1/3 octave-band sound-pressure spectrum corresponding to any selected one of these three inputs. In turn, such spectra can be used as an input to models for prediction of noise impacts. This paper discusses specific algorithms included in the newly developed computer program ENMASK. In addition, the relative audibility of the environmental masking-noise spectra at different A-weighted sound levels is discussed, which is determined by using the methodology of program ENAUDIBL.

  19. SU-E-T-110: Development of An Independent, Monte Carlo, Dose Calculation, Quality Assurance Tool for Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Faught, A [UT MD Anderson Cancer Center, Houston, TX (United States); University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX (United States); Davidson, S [University of Texas Medical Branch of Galveston, Galveston, TX (United States); Kry, S; Ibbott, G; Followill, D [UT MD Anderson Cancer Center, Houston, TX (United States); Fontenot, J [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Etzel, C [Consortium of Rheumatology Researchers of North America (CORRONA), Inc., Southborough, MA (United States)

    2014-06-01

    Purpose: To develop a comprehensive end-to-end test for Varian's TrueBeam linear accelerator for head and neck IMRT using a custom phantom designed to utilize multiple dosimetry devices. Purpose: To commission a multiple-source Monte Carlo model of Elekta linear accelerator beams of nominal energies 6MV and 10MV. Methods: A three source, Monte Carlo model of Elekta 6 and 10MV therapeutic x-ray beams was developed. Energy spectra of two photon sources corresponding to primary photons created in the target and scattered photons originating in the linear accelerator head were determined by an optimization process that fit the relative fluence of 0.25 MeV energy bins to the product of Fatigue-Life and Fermi functions to match calculated percent depth dose (PDD) data with that measured in a water tank for a 10x10cm2 field. Off-axis effects were modeled by a 3rd degree polynomial used to describe the off-axis half-value layer as a function of off-axis angle and fitting the off-axis fluence to a piecewise linear function to match calculated dose profiles with measured dose profiles for a 40×40cm2 field. The model was validated by comparing calculated PDDs and dose profiles for field sizes ranging from 3×3cm2 to 30×30cm2 to those obtained from measurements. A benchmarking study compared calculated data to measurements for IMRT plans delivered to anthropomorphic phantoms. Results: Along the central axis of the beam 99.6% and 99.7% of all data passed the 2%/2mm gamma criterion for 6 and 10MV models, respectively. Dose profiles at depths of dmax, through 25cm agreed with measured data for 99.4% and 99.6% of data tested for 6 and 10MV models, respectively. A comparison of calculated dose to film measurement in a head and neck phantom showed an average of 85.3% and 90.5% of pixels passing a 3%/2mm gamma criterion for 6 and 10MV models respectively. Conclusion: A Monte Carlo multiple-source model for Elekta 6 and 10MV therapeutic x-ray beams has been developed as a

  20. Response to the independent technical review of the UMTRA Project procedures and practices for well drilling and development

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    This report is a response to the findings and recommendations contained in the ITR report. The text of this document summarizes each ITR finding and recommendation, presents the TAC response, and concludes that implementation of many of the recommendations would benefit the UMTRA Project. Implementation of the recommendations represents ongoing improvement to the TAC well installation and development procedures and will result, in lower overall project costs. Appendix B is an implementation plan that groups similar or complementary action items, provides a schedule for implementation, identifies the group or people responsible for the changes, and estimates hours to implement the changes. The four major action items are as follows: (1) ITR Reevaluation, (2) Well Installation SOP Review and Revision, (3) Well Installation Contract Review and Revision, and (4) TAC and DOE Communications Improvement. The hours listed to implement the improvements are intended to be estimates for budgeting and planning purposes for the remainder of this fiscal year and the upcoming fiscal year.