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de Jesus FN, von der Weid PY. Increased contractile activity and dilation of popliteal lymphatic vessels in the TNF-α-overexpressing TNF ΔARE/+ arthritic mouse. Life Sci 2023; 335:122247. [PMID: 37940071 DOI: 10.1016/j.lfs.2023.122247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
AIMS TNF-α acute treatment has been found to disrupt lymphatic drainage in the setting of arthritis through the NF-kB-iNOS- signaling pathway. We examined whether popliteal lymphatic vessels (pLVs) contractile activity was altered in 12- and 24- week-old females of an arthritic mouse model overexpressing TNF-α (TNFΔARE/+). MAIN METHODS pLVs were prepared for intravital imaging to measure lymph flow speed, and ex vivo functional responses to a stepwise increase in transmural pressure in the absence or presence of the non-selective NOS inhibitor (L-NNA) or the selective iNOS inhibitor (1400W) were compared between TNFΔARE/+ and WT mice. Total eNOS (t-eNOS) and eNOS phosphorylated at ser1177 (p-eNOS) were evaluated by western blotting. KEY FINDINGS In vivo imaging revealed a significantly increase in lymph flow speed in TNFΔARE/+ mice in comparison to WT at both ages. Pressure myography showed an increase in contraction frequency, diameters and fractional pump flow at both ages, whereas amplitude and ejection fraction were significantly decreased in older TNFΔARE/+ mice. Additionally, contraction frequency was increased in the presence of 1400W, and systolic diameter was abolished with L-NNA in TNFΔARE/+ mice compared to WT. Significant increases in p-eNOS expression and neutrophil recruitment (MPO activity) were observed in TNFΔARE/+ mice compared to WT. SIGNIFICANCE Our data reveal functional changes in pLVs, especially in advanced stage of arthritis. These alterations may be related to eNOS and iNOS response, which can affect drainage of the inflammatory content from the joints.
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Affiliation(s)
- Flavia Neto de Jesus
- Inflammation Research Network, Snyder Institute for Chronic Diseases, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Pierre-Yves von der Weid
- Inflammation Research Network, Snyder Institute for Chronic Diseases, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Kanabuchi S, Kitamura N, Takano-Kasuya M, Inose T, Nishidate C, Yamanashi M, Kudo M, Ito T, Ito N, Okamoto H, Taniyama Y, Kobayashi Y, Kamei T, Gonda K. X-ray irradiation negatively affects immune responses in the lymphatic network. Microvasc Res 2023; 148:104511. [PMID: 36822367 DOI: 10.1016/j.mvr.2023.104511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Immune checkpoint inhibitor therapy has been attracting attention as a new cancer treatment and is likely to be widely used in combination with radiotherapy. Therefore, examination of the effects of X-ray irradiation on sentinel lymph nodes and lymphatic vessels, which are involved in antigen presentation, is important for therapy. The hindlimbs of mice were irradiated with X-rays (total radiation doses: 2, 10, and 30 Gy), and X-ray computed tomography (CT) imaging was performed using 15-nm or 2-nm gold nanoparticles (AuNPs) as contrast agents on days 7, 14, and 28 after irradiation to evaluate the diameter of the collecting lymph vessels and lymph flow within the irradiated area. X-ray CT imaging data using 15-nm AuNPs on day 28 after irradiation showed that the diameter of the collecting lymph vessels was significantly larger in all irradiated groups compared to the control group (p ≤ 0.01). CT imaging with 2-nm AuNPs showed that lymphatic drainage was significantly reduced in the lymph nodes irradiated with 10 Gy and 30 Gy compared to the lymph nodes irradiated with 2 Gy (p ≤ 0.05). Additionally, immunohistochemical analyses were conducted to evaluate the area density and morphology of high endothelial venules (HEVs) in the lymph nodes, which are important vessels for naive T cells to enter the lymph nodes. The expression level of MECA-79, which specifically localized to HEVs, was significantly decreased in the 10 Gy and 30 Gy irradiation groups compared to the control group (p ≤ 0.05). There was a significant decrease in normal HEV morphology (p ≤ 0.05) and a significant increase in abnormal HEV morphology (p ≤ 0.05) in all irradiated groups. These results also showed that X-ray irradiation induced a time- and radiation dose-dependent increase in the diameter of the collecting lymph vessels, stagnation of intralymphatic lymph flow, and a reduction in the area density of HEVs and their abnormal morphology, demonstrating that X-ray irradiation affected the immune responses. Therefore, these findings suggest that X-ray irradiation to lymph nodes may impair the opportunity for antigen presentation in the lymph nodes, which is the key to cancer immunity, and that for this reason, it is important to carefully plan irradiation of sentinel lymph nodes and develop treatment strategies according to future treatment options.
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Affiliation(s)
- Sawa Kanabuchi
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Narufumi Kitamura
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Mayumi Takano-Kasuya
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tomoya Inose
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Chihiro Nishidate
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Mizuki Yamanashi
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Makoto Kudo
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tatsuki Ito
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Naho Ito
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hiroshi Okamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yusuke Taniyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yoshio Kobayashi
- Department of Materials Science and Engineering, Graduate School of Science and Engineering, Ibaraki University, 4-12-1 Nakanarusawacho, Hitachi, Ibaraki 316-8511, Japan
| | - Takashi Kamei
- Department of Gastroenterological Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Kohsuke Gonda
- Department of Medical Physics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; International Center for Synchrotron Radiation Innovation Smart (SRIS), Tohoku University, 2-1-1, Katahira, Aoba-ku, Sendai 980-8577, Japan.
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Shamji FM, Beauchamp G, Sekhon HJS. The Lymphatic Spread of Lung Cancer: An Investigation of the Anatomy of the Lymphatic Drainage of the Lungs and Preoperative Mediastinal Staging. Thorac Surg Clin 2021; 31:429-440. [PMID: 34696855 DOI: 10.1016/j.thorsurg.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The knowledge of lymphatic spread of lung cancer permitted the study of anatomy of lymphatic drainage of the lungs. The history of anatomy of lymphatic drainage of the lungs began in the 15th century. In the human, pulmonary lymph flows to the lymph nodes around the lobar bronchi and thence to extrapulmonary lymph nodes located around the main bronchi and trachea and its bifurcation (tracheobronchial lymph nodes). These send their efferents to a right and left mediastinal lymph trunks, which may join the thoracic duct, but usually drain opening directly into the brachiocephalic vein of their own side.
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Affiliation(s)
- Farid M Shamji
- University of Ottawa, General Campus, Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | - Gilles Beauchamp
- Thoracic Surgery Unit, Department of Surgery, Maisonneuve-Rosemount Hospital, University of Montreal, 5415 L'Assomption Boulevard, Montreal, Quebec H1T 2M4, Canada
| | - Harman Jatinder S Sekhon
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, CCW, Room 4240, Box 117, 501 Smyth Road, Ottawa, Ontario K1H8L6, Canada
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Novikov SN, Krzhivitskii PI, Radgabova ZA, Kotov MA, Girshovich MM, Artemyeva AS, Melnik YS, Kanaev SV. Single photon emission computed tomography-computed tomography visualization of sentinel lymph nodes for lymph flow guided nodal irradiation in oral tongue cancer. Radiat Oncol J 2021; 39:193-201. [PMID: 34610658 PMCID: PMC8497868 DOI: 10.3857/roj.2021.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/09/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To evaluate correlation of single photon emission computed tomography-computed tomography (SPECT-CT) data on lymph flow (LF) from oral tongue cancer (OC) and the topography of lymph nodes (LN) metastases; to determine the clinical value of lymph flow guided radiotherapy (LFGRT). MATERIALS AND METHODS SPECT-CT visualization of LF from the OC lesions was performed after peritumoral injection of 99mTc-phytate in 26 primary patients with clinical stage cT1-2N0M0 disease. We determined the individual drainage (unilateral/bilateral) from the tumor, and localization of sentinel LNs according to the neck levels. Metastases in LNs were verified with histology and a 2-year follow-up. RESULTS SPECT-CT detected bilateral LF in 10 (38.5%) of 26 patients; in 16 (61.5%) cases the drainage was unilateral. Histology revealed LNs metastases in three cases; regional recurrences were diagnosed in other four patients. In all seven observations metastases were located at the same site and level as the sentinel LNs. In eight (30.8%) of 26 patients sentinel LNs were visualized unilaterally at levels Ib-IIa; in five cases, unilaterally at levels I-IIa-III. In these patients, LFGRT demonstrated 59%-70% reduction of irradiated volume, and 26%-42% and 51%-70% decrease of the mean dose to the spinal cord and the contralateral parotid gland. In patients with a bilateral drainage the reduction of doses absorbed by the spinal cord and contralateral parotid gland was 19% and 6%, respectively. CONCLUSION Localization of sentinel LNs determined by SPECT-CT corresponds to the localization of metastatic LNs in terms of side and levels.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Pavel Ivanovich Krzhivitskii
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Zamira Achmedovna Radgabova
- Department of Head and Neck Surgery, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Maxim Andreevitch Kotov
- Department of Head and Neck Surgery, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Mikhail Markovich Girshovich
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Anna Sergeevna Artemyeva
- Department of Pathology, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Yulia Sergeevna Melnik
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
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Ikhimwin BO, Bertram CD, Jamalian S, Macaskill C. A computational model of a network of initial lymphatics and pre-collectors with permeable interstitium. Biomech Model Mechanobiol 2019; 19:661-676. [PMID: 31696326 DOI: 10.1007/s10237-019-01238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Initial lymphatic vessels are made up of overlapped endothelial cells that act as unidirectional valves enabling one-way drainage of tissue fluid into the lumen of the initial lymphatics when there is a favourable pressure gradient. Initial lymphatics subsequently drain this fluid into the collecting lymphatics. This paper describes a computational model for a network of passive rat mesenteric lymphatic vessels with sparse secondary valves. The network was simulated with the secondary valves both operational and non-operational. The effects on the cycle-mean outflow-rate from the network of both inflammation and the resistance of the surrounding interstitium were considered. The cycle-mean outflow-rate is sensitive to vessel stiffness. If the influence of primary-valve resistance is reduced relative to that of interstitial resistance and intravascular resistance, there is no absolute advantage of extrinsic pumping, since maximum outflow-rate occurs when vessels are rigid. However, there is relative advantage, in that the outflow-rate at intermediate stiffness is higher with the secondary valves functioning than when they are deactivated. If primary-valve resistance dominates, then extrinsic pumping of non-rigid vessels provides absolute advantage. The nonlinear relation between pressure drop and flow-rate of the endothelial primary valves, combined with downstream compliance and pulsatile external pressure, constitutes a separate mechanism of pumping. By enabling the consideration of interactions between multiple phenomena (primary valves, secondary valves, a real network geometry with multiple branches, deformable vessel walls, interstitial resistance and external pressures), the model offers a perspective for delineating physiological phenomena that have not yet been fully linked to the biomechanics of fluid flow through initial lymphatic networks.
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Affiliation(s)
- B O Ikhimwin
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia
| | - C D Bertram
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia.
| | - S Jamalian
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Macaskill
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia
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Novikov SN, Krzhivitskii PI, Kanaev SV, Berlev IV, Kargopolova MV, Ibragimov Z, Bisyarin M, Saveleva VV. Lymph flow guided irradiation of regional lymph nodes in patients with cervical cancer: Preliminary analysis of scintigraphic data. Rep Pract Oncol Radiother 2018; 23:503-509. [PMID: 30534013 DOI: 10.1016/j.rpor.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/26/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate patterns of lymph flow from primary lesions in patients with cervical cancer and to determine how useful for radiotherapy planning this information can be. Materials and methods SPECT-CT visualization of sentinel (SLN) lymph nodes (LNs) was performed in 36 primary patients with IB-IIB cervical cancer. The acquisition started 120-240 min after 4 peritumoral injections of 99mTc-radiocolloids (150-300 MBq in 0.4-1 ml). We determined localization of LN with uptake of radiocolloids, type of lymph flow (mono-, bi-lateral) and lymph flow patterns (supraureteral paracervical, infraureteral paracervical and directly to para-aortic LNs). Results SLNs were visualized in 31 of 36 women. Bilateral lymph-flow was detected in 22 (71%), monolateral - in the other 9 (29%) cases. The distribution of SLNs was as follows: external iliac - 64.5%, internal iliac - 54.8%, obturator - 32.2%, common iliac - 35.5% and pre-sacral 3.2%. Para-aortic LNs were visualized in 5 (16.1%) patients. The supraureteral paracervical pattern of lymph flow was identified in 22, infraureteral paracervical - in 4 and their combination - in the other 5 women. Conclusion Visualization of an individual pattern of lymph flow from primary cervical cancer can be considered as a promising tool for optimization of the volume of irradiated regional LNs.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Pavel Ivanovich Krzhivitskii
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Groups of Radiology, Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Igor Viktorovitch Berlev
- Department of Oncogynecology, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Margarita Viktorovna Kargopolova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Zaur Ibragimov
- Department of Oncogynecology, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Mikhail Bisyarin
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
| | - Valentina Vladimirovna Saveleva
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, 197758 St Petersburg, Russia
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Bertram CD, Macaskill C, Davis MJ, Moore JE Jr. Contraction of collecting lymphatics: organization of pressure-dependent rate for multiple lymphangions. Biomech Model Mechanobiol 2018; 17:1513-32. [PMID: 29948540 DOI: 10.1007/s10237-018-1042-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
The paper describes the extension of a previously developed model of pressure-dependent contraction rate to the case of multiple lymphangions. Mechanical factors are key modulators of active lymphatic pumping. As part of the evolution of our lumped-parameter model to match experimental findings, we have designed an algorithm whereby the time until the next contraction depends on lymphangion transmural pressure in the contraction just completed. The functional dependence of frequency on pressure is quantitatively matched to isobaric contraction experiments on isolated lymphatic segments. When each of several lymphangions is given this ability, a scheme for their coordination must be instituted to match the observed synchronization. Accordingly, and in line with an experiment on an isolated lymphatic vessel segment in which we measured contraction sequence and conduction delay, we took the fundamental principle to be that local timing can be overridden by signals to initiate contraction that start in adjacent lymphangions, conducted with a short delay. The scheme leads to retrograde conduction when the lymphangion chain is pumping against an adverse pressure difference, but antegrade conduction when contractions occur with no or a favourable pressure difference. Abolition of these conducted signals leads to chaotic variation of cycle-mean flow-rate from the chain, diastolic duration in each lymphangion, and inter-lymphangion delays. Chaotic rhythm is also seen under other circumstances. Because the model responds to increasing adverse pressure difference by increasing the repetition rate of contractions, it maintains time-average output flow-rate better than one with fixed repetition rate.
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Abstract
The lymphatic system aids in osmoregulation through tissue fluid transport, but is also designed to support communication between cells of the innate and adaptive immune systems. During inflammation, changes within the lymphatics can result in an altered response to infection. Neutrophils have been described as one key cell type that facilitates antigen capture and presentation within the lymphatic system, enabling an effective adaptive immune response. Disruption of neutrophil recruitment during inflammation, due to alterations in lymphatics, is a growing area of study due to their key role in infection resolution. In this review, we discuss the currently known methods by which neutrophils are recruited to the lymphatic system and what subsequent effects they have on resident and recruited cells within the lymph vessels and nodes. We also discuss the changes in neutrophil activation and recruitment during chronic inflammatory diseases and their relationship to lymphatic dysfunction.
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Affiliation(s)
- Matthew Stephens
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Room 1647, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, AB T2N 4N1, Canada
| | - Shan Liao
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Room 1647, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, AB T2N 4N1, Canada.
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Watanabe J, Ota M, Suwa Y, Ishibe A, Masui H, Nagahori K. Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Colorectal Dis 2017; 32:201-207. [PMID: 27695977 DOI: 10.1007/s00384-016-2669-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The treatment of splenic flexural colon cancer is not standardized because the lymphatic drainage is variable. The aim of this study is to evaluate the lymph flow at the splenic flexure. METHODS From July 2013 to January 2016, consecutive patients of the splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. Primary outcome is frequency of the direction of lymph flow from splenic flexure. We injected indocyanine green (2.5 mg) into the submucosal layer around the tumor and observed lymph flow using the laparoscopic near-infrared camera system in 30 min after injection. RESULTS Thirty-one patients were enrolled in this study. The lymph flow was visualized in 31 patients (100 %) without any complications. No case exhibited lymph flow in both the left colic artery (LCA) and left branch of the middle colic artery (lt-MCA) areas. There were 19 cases (61.3 %) with lymph flow directed to the area of the root of the inferior mesenteric vein (IMV), regardless of the presence of the left accessory aberrant colic artery. Lymph node metastases were observed in six cases (19.4 %), and all of the involved lymph nodes existed in lymph flow areas determined by real-time indocyanine green fluorescence imaging. CONCLUSIONS The findings of the lymph flow pattern of splenic flexure suggest that lymph node dissection at the root of the IMV area is important, and it may be not necessary to ligate both the lt-MCA and LCA, at least in cases without widespread lymph node metastases.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan.
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Yusuke Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Hidenobu Masui
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
| | - Kaoru Nagahori
- Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan
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Chakraborty S, Davis MJ, Muthuchamy M. Emerging trends in the pathophysiology of lymphatic contractile function. Semin Cell Dev Biol 2015; 38:55-66. [PMID: 25617600 DOI: 10.1016/j.semcdb.2015.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 01/19/2023]
Abstract
Lymphatic contractile dysfunction is central to a number of pathologies that affect millions of people worldwide. Due to its critical role in the process of inflammation, a dysfunctional lymphatic system also compromises the immune response, further exacerbating a number of inflammation related diseases. Despite the critical physiological functions accomplished by the transport of lymph, a complete understanding of the contractile machinery of the lymphatic system lags far behind that of the blood vasculature. However, there has been a surge of recent research focusing on different mechanisms that underlie both physiological and pathophysiological aspects of lymphatic contractile function. This review summarizes those emerging paradigms that shed some novel insights into the contractile physiology of the lymphatics in normal as well as different disease states. In addition, this review emphasizes the recent progress made in our understanding of various contractile parameters and regulatory elements that contribute to the normal functioning of the lymphatics.
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Affiliation(s)
- Sanjukta Chakraborty
- Department of Medical Physiology, Cardiovascular Research Institute Division of Lymphatic Biology, Texas A&M Health Science Center College of Medicine, United States
| | - Michael J Davis
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, United States.
| | - Mariappan Muthuchamy
- Department of Medical Physiology, Cardiovascular Research Institute Division of Lymphatic Biology, Texas A&M Health Science Center College of Medicine, United States.
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Bains SK, Stanton AWB, Cintolesi V, Ballinger J, Allen S, Zammit C, Levick JR, Mortimer PS, Peters AM, Purushotham AD. A constitutional predisposition to breast cancer-related lymphoedema and effect of axillary lymph node surgery on forearm muscle lymph flow. Breast 2014; 24:68-74. [PMID: 25491189 DOI: 10.1016/j.breast.2014.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/13/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
AIM The aims of this prospective study were (a) to examine the relationship between pre-operative muscle lymph flow and the predisposition to BCRL in women treated by axillary nodal surgery for breast cancer; and (b) to test the 'stopcock' hypothesis that axillary lymph node surgery impairs forearm lymph flow in the short term. METHODS (99m)Tc-nanocoll was injected intramuscularly into both forearms of women undergoing surgery for breast cancer. Lymphatic clearance rate constant, k, representing lymph flow per unit interstitial fluid volume, was measured as the fractional disappearance rate of radioactivity from the depot site by gamma camera imaging. Axillary lymph node activity was calculated as percentage injected activity. BCRL was assessed by clinical examination and upper limb perometry. RESULTS Of 38 pre-operative women, 33 attended at 8 ± 6 weeks post-operatively and 31 at 58 ± 9 weeks post-operatively. Seven patients (18%) developed BCRL. Prior to surgery the BCRL-destined patients had a higher mean k (0.0962 ± 0.034%/min) than non-BCRL patients (0.0830 ± 0.019%/min) (p = 0.10, unpaired t test). Post-operative k values were not significantly different from pre-operative, in either the ipsilateral (operated) or contralateral limb. Also, post-operative k values did not differ significantly between both upper limbs. Furthermore, there was no significant difference between pre- and post-operative axillary activity. CONCLUSION Patients who develop BCRL have high lymph flow pre-surgery, which may predispose them to lymphatic overload and failure. Axillary lymph node surgery has no early, measurable effect on forearm muscle lymph flow despite surgical disruption of routes of lymph drainage.
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Affiliation(s)
- S K Bains
- Division of Cancer Studies, King's College London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, United Kingdom
| | - A W B Stanton
- Clinical Sciences, St George's, University of London, United Kingdom
| | - V Cintolesi
- Clinical Sciences, St George's, University of London, United Kingdom
| | - J Ballinger
- Guy's & St Thomas' NHS Foundation Trust, United Kingdom
| | - S Allen
- Guy's & St Thomas' NHS Foundation Trust, United Kingdom
| | - C Zammit
- Department of Breast Surgery, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - J R Levick
- Clinical Sciences, St George's, University of London, United Kingdom
| | - P S Mortimer
- Clinical Sciences, St George's, University of London, United Kingdom
| | - A M Peters
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - A D Purushotham
- Division of Cancer Studies, King's College London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, United Kingdom.
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Yang H, Jin Y, Wang CH, Tang CW. Effects of exogenous vasoactive intestinal peptide on mesenteric lymph pathway during early intestinal ischemia-reperfusion injury in rats. ACTA ACUST UNITED AC 2013; 186:36-42. [PMID: 23872373 DOI: 10.1016/j.regpep.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/31/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
Mesenteric lymph pathway serves as the primary route by which gut injury leads to systemic inflammation and distant organ injury. The inflammation of the intestinal tract is partially mediated by vasoactive intestinal peptide (VIP). Therefore, the aim of this study was to test whether exogenous VIP affects mesenteric lymph pathway during early intestinal ischemia-reperfusion (IIR) injury. Rats were randomized into control, control+VIP, IIR and IIR+VIP groups. The observation of mesenteric lymph flow was carried out by cannulation of mesenteric lymphatics. The distribution of in vivo lymphocyte trafficking was performed by (51)Cr labeled lymphocytes and was measured by γ-counter. Endotoxin concentration was assayed using the limulus test kit and TNF-α level was detected by ELISA. When IIR injury treated with VIP, the volumes of lymph flow increased by 80%, which caused the number of lymphocytes exiting in mesenteric lymphatic increased by 50% while the proportion of (51)Cr-lymphocytes in Peyer's patches, intestinal effector tissues, mesenteric nodes, large intestine, stomach decreased by 58%, 51%, 58%, 63%, 64% respectively at the 6th h after reperfusion following intestinal ischemia. Meanwhile, endotoxin and TNF-α levels in intestinal lymph decreased by 51% and 83%. These results suggest that exogenous VIP ameliorates IIR induced splanchnic organ damage via inhibition of toxic mediators reaching systemic circulation and reinforcement of the effective immune responses in gut-associated lymphoid tissues (GALT).
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Affiliation(s)
- Hui Yang
- Department of Gastroentrology, Nanjing Children's Hospital, Nanjing Medical University, 210008, China
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