Focus on the Lymphatic Route to Optimize Drug Delivery in Cardiovascular Medicine

While oral agents have been the gold standard for cardiovascular disease therapy, the new generation of treatments is switching to other administration options that offer reduced dosing frequency and more efficacy. The lymphatic network is a unidirectional and low-pressure vascular system that is responsible for the absorption of interstitial fluids, molecules, and cells from the peripheral tissue, including the skin and the intestines. Targeting the lymphatic route for drug delivery employing traditional or new technologies and drug formulations is exponentially gaining attention in the quest to avoid the hepatic first-pass effect. The present review will give an overview of the current knowledge on the involvement of the lymphatic vessels in drug delivery in the context of cardiovascular disease.

Tubercular Mediastinal Abscess in Non-immunocompromised Patient: A Rare Case Presentation

Mediastinal tuberculosis is a rare infection resulting from direct inoculation of organisms or through hematogenous spread. Infected lymph nodes may also transfer the bacilli through lymphatic route. Mediastinal tuberculosis may resemble a pyogenic abscess or tumour which might indicate tubercular aetiology and remains a clinical challenge. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. Authors hereby report a case of 60-year-old male with anterior mediastinal tubercular abscess.

Lipid Drug Carriers for Cancer Therapeutics: An Insight into Lymphatic Targeting, P-gp, CYP3A4 Modulation and Bioavailability Enhancement

In the treatment of cancer, chemotherapy plays an important role though the efficacy of anticancer drug administered orally is limited, due to their poor solubility in physiological medium, inability to cross biological membrane, high Para-glycoprotein (P-gp) mediated drug efflux, and pre-systemic metabolism. These all factors cumulatively reduce drug exposure at the target site leading to multidrug resistance (MDR). Lipid based carriers systems has been explored to overcome solubility and permeability related issues of anti-cancer drugs. The lipid based formulations have also been reported to circumvent the effect of P-gp and CYP3A4. Further long chain triglycerides (LCT) has shown their ability to access Lymphatic route over Medium Chain Triglycerides, as the former has been extensively used for targeting anti-cancer drugs at proliferating cells through lymphatic route. Therefore this review tries to reflect the usefulness of lipid based drug carriers systems (viz. liposome, solid lipid nanoparticle, nano-lipid carriers, self-emulsifying, lipidic pro-drugs) in targeting lymphatic system and overcoming issues related to solubility and permeability of anti-cancer drugs. Moreover, we have also tried to reflect how critically lipid based carriers are important in maximizing therapeutic safety and efficacy of anti-cancer drugs.

The lymphatic route of TAU

The brain lymphatic system contributes to TAU clearance in mice.

Tuberculosis verrucosa cutis: case report of a diagnostic challenge

<p class="abstract">Cutaneous tuberculosis occurs by either exogenous inoculation in a previously sensitized or non-immune host or endogenous spread from an internal focus by contiguous, hematogenous or lymphatic route. Inoculation occurs at sites of minor wounds or abrasions, sometimes from the patient’s own sputum. Cutaneous tuberculosis includes lupus vulgaris and tuberculosis verrucosa cutis (TVC) at one end and scrofuloderma and tuberculosis cutis orificialis at the other end with decrease in cell-mediated immunity across the spectrum. Of various cutaneous forms, we report a case of tuberculosis verrucosa cutis in a 14 year old girl who presented with a hyperpigmented verrucous plaque over foot since three years. Histopathological characteristics, GeneXpert and response to antitubercular therapy confirmed the diagnosis.</p><p class="abstract"> </p>

The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients.

567 Background: This study investigated a usefulness of the combination of fluorescence imaging and computed tomography lymphography (CTLG) for sentinel lymph node biopsy (SLN) biopsy of early breast cancer patients. Methods: Between January 2013 and August 2016, 350 breast cancer patients without clinical evidence of lymph node metastasis were treated. Preoperaitve CTLG was performed using 64-row multidetector CT injected contrast agent. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. Intraoperative fluorescence images were obtained using the fluorescence imaging system (pde-neo). After dye mixed indocyanine green and indigocarmin was injected, lymphatic route was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device. Results: The median age of the 350 patients was 59 (range 28 – 90) years old. CTLG could visualize lymphatic route and accurately identify SLN in 336 (96.0 %) and 343 (98.0 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic route and SLN in all patients. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p<0.01). Fifty of 350 patients had metastatic SLN pathologically, and 11 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 84.1 %, sensitivity was 82.1 % and specificity was 84.3 %. The positive predictive value was 40.5 % and negative predictive value was 97.3 %. Conclusions: This combined navigation method of fluorescence imaging and CTLG revealed more easy and effective to detect SLN than fluorescence imaging alone. In addition, the information from CTLG would be helpful for the preoperative diagnosis of SLN metastasis.