ABSTRACT
Background@#Dermal backflow (DBF), which refers to lymphatic reflux due to lymphatic valve insufficiency, is a diagnostic finding in lymphedema. However, the three-dimensional structure of DBF remains unknown. Photoacoustic lymphangiography (PAL) is a new technique that enables the visualization of the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and can provide three-dimensional images of superficial lymphatic vessels and the venous system. This study reports the use of PAL to visualize DBF structures in the extremities of patients with lymphedema after cancer surgery. @*Methods@#Patients with a clinical or lymphographic diagnosis of lymphedema who previously underwent surgery for cancer at one of two participating hospitals were included in this study. PAL was performed using the PAI-05 system. ICG was administered subcutaneously in the affected hand or foot, and ICG fluorescence lymphography was performed using a nearinfrared camera system prior to PAL. @*Results@#Between April 2018 and January 2019, 21 patients were enrolled and examined using PAL. The DBF was composed of dense, interconnecting, three-dimensional lymphatic vessels. It was classified into three patterns according to the composition of the lymphatic vessels: a linear structure of lymphatic collectors (pattern 1), a network of lymphatic capillaries and lymphatic collectors in an underlying layer (pattern 2), and lymphatic capillaries and precollectors with no lymphatic collectors (pattern 3). @*Conclusions@#PAL showed the structure of DBF more precisely than ICG fluorescence lymphography. The use of PAL to visualize DBF assists in understanding the pathophysiology and assessing the severity of cancer-related lymphedema.
ABSTRACT
Background@#Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. @*Methods@#PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. @*Results@#PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. @*Conclusions@#By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.
ABSTRACT
Background@#Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. @*Methods@#PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. @*Results@#PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. @*Conclusions@#By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.
ABSTRACT
Traditional medicine educational systems in Japan and China were compared.<br>In Japan, Kampo medicine has been integrated into the core curriculum of undergraduate education in all medical colleges since 2001. Japanese university medical schools give 6,000 hours of western medical educa tion, and only 30 hours of Kampo education. In China at Traditional Chinese Medicine (TCM) universities, nearly half of teaching hours are devoted to TCM, and half to Western medicine. And even at medical univer sities that specialize in Western medicine, students will usually have 80 hours in TCM courses. Usually it takes five years to graduate. In Japan, Kampo education puts a special focus on the <i>Shang-han-lun </i>and <i>Jin-kui-yao lue </i>texts, which still influence daily practice. In China, on the other hand, TCM doctors rely on traditional theories of Chinese medicine such as the Yin-Yang theory, the Five Elements theory or relationships between meridians and organs. Kampo specialists have been increasing in recent years, although in China, the number of TCM doctors has been decreasing. However, better traditional medicine education would play a role in in creasing our inheritance of both in Japan and in China.
ABSTRACT
1) For third-year students at Keio University Medical School, 10 lectures are given about why <I>kampo</I> medicine is effective, Fourth-year students receive 8 lectures on <I>kampo</I> medicine and participate in independent study sessions 3 times a week for 4 months.<BR>2) In lectures entitled “Why Is <I>kampo</I> Medicine Effective?”we introduce the functional mechanism of action of <I>kampo</I> medicine and address the skepticism of medical students. In the lecture series entitled “Kampo Medicine, ”we introduce the clinical foundations of <I>kampo</I> practice and provide students with a checklist of the key points of each lecture.<BR>3) In the independent study sessions, several students perform mentored basic-science research into <I>kampo's</I> mechanism of action.
ABSTRACT
1) Although many people all over the world are aware of traditional Chinese medicine, <I>kampo</I> medicine is not as well known. <I>Kampo</I>, traditional Japanese herbal medicine, is an integral part of medical practice in Japan and deserves greater attention. 2) In response to increasing interest in <I>kampo</I> we have created a web-based virtual class as a reliable source for information about <I>kampo</I> medicine. This virtual class incorporates the latest data on <I>kampo</I> and numerous features to pro- mote a basic understanding of <I>kampo</I>. 3) Through this website and virtual class for health professionals, knowledge of the reliability, usefulness, and safety of <I>kampo</I> will be shared with the world.