Supermicrosurgical T-shaped lymphaticovenular anastomosis for the treatment of peripheral lymphedema: Bypassing lymph fluid maximizing lymphatic collector continuity

Insects thrive in diverse ecological niches in large part because of their highly sophisticated olfactory systems. Over the last two decades, a major focus in the study of insect olfaction has been on the role of olfactory receptors in mediating neuronal responses to environmental chemicals. In vivo , these receptors operate in specialized structures, called sensilla, which comprise neurons and non-neuronal support cells, extracellular lymph fluid and a precisely shaped cuticle. While sensilla are inherent to odour sensing in insects, we are only just beginning to understand their construction and function. Here, we review recent work that illuminates how odour-evoked neuronal activity is impacted by sensillar morphology, lymph fluid biochemistry, accessory signalling molecules in neurons and the physiological crosstalk between sensillar cells. These advances reveal multi-layered molecular and cellular mechanisms that determine the selectivity, sensitivity and dynamic modulation of odour-evoked responses in insects.

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The collection of lymphatic fluid from the bovine udder and its use for the detection of Mycobacterium avium subsp. paratuberculosis in the cow

Journal of Veterinary Diagnostic Investigation ◽

10.1177/1040638711425943 ◽

2011 ◽

Vol 24 (1) ◽

pp. 23-31 ◽

Cited By ~ 5

Author(s):

Johannes L. Khol ◽

Pablo J. Pinedo ◽

Claus D. Buergelt ◽

Laura M. Neumann ◽

Walter Baumgartner ◽

...

Keyword(s):

Mycobacterium Avium ◽

Fluid Collection ◽

Johne's Disease ◽

Johne’S Disease ◽

Mycobacterium Avium Subsp ◽

Enzyme Linked Immunosorbent Assay ◽

Lymph Fluid ◽

Mycobacterium Avium Subsp Paratuberculosis ◽

Lymphatic Fluid ◽

Elisa Result

The objective of the current study was to evaluate the feasibility of lymph collection from the bovine udder and to investigate if the lymphatic fluid might be of diagnostic value in cows infected with Mycobacterium avium subsp. paratuberculosis (MAP), the etiologic agent of paratuberculosis. Lymph fluid collection was attempted from 58 cows, and the reactions of the cows as well as the level of difficulty of the procedure were recorded in 56 animals. Lymph samples (51 in total) were tested for the presence of MAP by nested polymerase chain reaction. Collection of the lymphatic fluid caused no or mild signs of discomfort in 94.6% of the cows; in 51.8% of cows, lymphatic fluid was attained on the first attempt, while sample collection was unsuccessful in 12.1%. Mycobacterium avium subsp. paratuberculosis was detected in 43.1% of all lymph samples. The bacterium was present in 66.7% of cows with clinical Johne’s disease, in 42.8% of asymptomatic cows with a positive or suspicious enzyme-linked immunosorbent assay (ELISA) result in blood, and in 38.7% of cows with a negative ELISA result in blood. The present study shows that the procedure was well tolerated by most cows and can easily be performed on farm. The current report of the isolation of MAP from lymph fluid suggests that the present approach could be used for the early detection of Johne’s disease in cattle.

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Interstitial Fluid and Lymph Formation and Transport: Physiological Regulation and Roles in Inflammation and Cancer

Physiological Reviews ◽

10.1152/physrev.00037.2011 ◽

2012 ◽

Vol 92 (3) ◽

pp. 1005-1060 ◽

Cited By ~ 306

Author(s):

Helge Wiig ◽

Melody A. Swartz

Keyword(s):

Interstitial Fluid ◽

Cell Function ◽

Biological Effects ◽

Lymphatic Vessels ◽

Peripheral Tolerance ◽

Cellular Microenvironment ◽

Physiological Regulation ◽

Functional Implications ◽

Biological Aspects ◽

Lymph Fluid

The interstitium describes the fluid, proteins, solutes, and the extracellular matrix (ECM) that comprise the cellular microenvironment in tissues. Its alterations are fundamental to changes in cell function in inflammation, pathogenesis, and cancer. Interstitial fluid (IF) is created by transcapillary filtration and cleared by lymphatic vessels. Herein we discuss the biophysical, biomechanical, and functional implications of IF in normal and pathological tissue states from both fluid balance and cell function perspectives. We also discuss analysis methods to access IF, which enables quantification of the cellular microenvironment; such methods have demonstrated, for example, that there can be dramatic gradients from tissue to plasma during inflammation and that tumor IF is hypoxic and acidic compared with subcutaneous IF and plasma. Accumulated recent data show that IF and its convection through the interstitium and delivery to the lymph nodes have many and diverse biological effects, including in ECM reorganization, cell migration, and capillary morphogenesis as well as in immunity and peripheral tolerance. This review integrates the biophysical, biomechanical, and biological aspects of interstitial and lymph fluid and its transport in tissue physiology, pathophysiology, and immune regulation.

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Progress in the treatment of sudden deafness

Advanced Emergency Medicine ◽

10.18686/aem.v6.82 ◽

2017 ◽

Vol 6 (1) ◽

Author(s):

Jian Wang ◽

Fang Yuan

Keyword(s):

Virus Infection ◽

Clinical Research ◽

Sudden Deafness ◽

Lymph Fluid ◽

Definite Treatment

<p>In recent years, the incidence of sudden deafness has a tendency to rise. Most scholars believe that the cause of the disease are virus infection, lymph fluid and cochlear circulation dysfunction and so on. The above several etiology may play a role in the process of sudden deafness, it is hard to isolate one of the causes, so there is no definite treatment of sudden deafness, the treatments of sudden deafness are based on the conjectural cause, lacking pertinence. This paper summarize the treatments of sudden deafness, in order to explore better ways to treat sudden deafness and to promote the development of clinical research.</p>

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Art. XXIII.—Exposition of a Method of Preserving Vaccine Lymph, fluid and active; with Hints for the more Efficient Performance of Public Vaccination.

The American Journal of the Medical Sciences ◽

10.1097/00000441-186029790-00022 ◽

1860 ◽

Vol 29 (79) ◽

pp. 202-205

Author(s):

William Husband

Keyword(s):

Efficient Performance ◽

Lymph Fluid

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L-Dex ratio in detecting and diagnosing breast cancer-related lymphedema: Reliability, sensitivity, and specificity.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.12 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 12-12 ◽

Cited By ~ 5

Author(s):

Mei R. Fu ◽

Charles M. Cleland ◽

Amber Azniv Guth ◽

Maia Kayal ◽

Judith Haber ◽

...

Keyword(s):

Breast Cancer ◽

At Risk ◽

Cancer Survivors ◽

Sensitivity And Specificity ◽

Breast Cancer Survivors ◽

Clinical Settings ◽

Diagnose Breast Cancer ◽

Reliability Sensitivity ◽

Lymph Fluid ◽

Breast Cancer Related Lymphedema

12 Background: It remains a great challenge to accurately diagnose breast cancer-related lymphedema. Advances in bioelectrical impedance analysis (BIA) permit the assessment of lymphedema by directly measuring lymph fluid changes. Despite its value in assessing lymphedema, the use of BIA in clinical settings is still very limited. In part, this may be due to anecdotal complaints from clinicians about BIA’s ability to identify true case of lymphedema in the clinical settings using L-Dex ratio >+10 as the cutoff point for lymphedema diagnosis. This may also be due to lack of large clinical data to support the reliability, sensitivity, and specificity of using L-Dex ratio. The objective of the study was to examine the reliability, sensitivity, and specificity of BIA in a clinical setting. Methods: BIA was used to measure lymph fluid changes. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Reliability, sensitivity, specificity and area under the ROC curve were estimated. Results: BIA ratio, as indicated by L-Dex ratio, was highly reliable among healthy women (ICC=0.99; 95% CI = 0.99 - 0.99), survivors at-risk for lymphedema (ICC=0.99; 95% CI = 0.99 - 0.99), and all women (ICC=0.85; 95% CI = 0.81 – 0.87); reliability was acceptable for survivors with lymphedema (ICC=0.69; 95% CI = 0.54 to 0.80). The L-Dex ratio with a diagnostic cutoff of >+7.1 discriminated between at-risk breast cancer survivors and those with lymphedema with 80% sensitivity and 90% specificity (AUC=0.86). Conclusions: The L-Dex ratio may have a role in clinical practice despite its cost to add confidence in the diagnosis of arm lymphedema among breast cancer survivors. Lymphedema is a progressive and debilitating condition and early treatment usually leads to better clinical outcomes, given that BIA using a diagnostic cutoff of L-Dex ratio > +7.1 still misses 20% of true lymphedema cases, it is important for clinicians to integrate other assessment methods (such as self-report, clinical observation, or perometry) to ensure the accurate diagnosis of lymphedema.

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Microlymphatics and lymph flow

Physiological Reviews ◽

10.1152/physrev.1990.70.4.987 ◽

1990 ◽

Vol 70 (4) ◽

pp. 987-1028 ◽

Cited By ~ 376

Author(s):

G. W. Schmid-Schonbein

Keyword(s):

Smooth Muscle ◽

Lymph Flow ◽

Transient Pressure ◽

External Compression ◽

Lymph Fluid ◽

Pump Mechanism ◽

Contraction And Relaxation ◽

Tissue Stresses ◽

Smooth Muscle Contractions

A careful review of several different organs shows that with the information available today the beginnings of the microlymphatics in the tissue consist of endothelialized tubes only. Lymphatic smooth muscle within the collecting lymphatics appears further downstream, in some organs only outside the parenchyma. This particular anatomic picture has been observed in many different mammalian organs and in humans. The nonmuscular, so-called initial, lymphatics are the site of interstitial fluid absorption that requires only small and transient pressure gradients from the interstitium into the initial lymphatics. A fundamental question concerns the mechanism that causes expansion and compression of the initial lymphatics. I presented several realistic proposals based on information currently on hand relevant to the tissue surrounding the initial lymphatics. To achieve a continuous lymphatic output, periodic (time variant) tissue stresses need to be applied. They include arterial pressure pulsations; arteriolar vasomotion; intestinal smooth muscle contractions and motilities; skeletal muscle contraction; skin tension; and external compression, such as during walking, running, or massage, respiration, bronchiole constriction, periodic tension in tendon, contraction and relaxation of the diaphragm, tension in the pleural space during respiration, and contractions of the heart. The nonmuscular initial lymphatic system drains into a set of contractile collecting lymphatics, which by way of intrinsic smooth muscle propel lymph fluid. The exact transition between noncontractile and contractile lymphatics has been established only in a limited number of organs and requires further exploration. Retrograde flow of lymph fluid is prevented by valves. There are the usual macroscopic bileaflet valves in the initial and collecting lymphatics and also microscopic lymphatic endothelial valves on the wall of the initial lymphatics. The latter appear to prevent convective reflow into the interstitium during lymphatic compression. Many of the lymph pump mechanisms have been proposed in the past, and most authors agree that these mechanisms influence lymph flow. However, the decisive experiments have not been carried out to establish to what degree these mechanisms are sufficient to explain lymph flow rates in vivo. Because individual organs have different extrinsic pumps at the level of the initial lymphatics, future experiments need to be designed such that each pump mechanism is examined individually so as to make it possible to evaluate the additive effect on the resultant whole organ lymph flow.(ABSTRACT TRUNCATED AT 400 WORDS)

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