Surgical Treatment of Multiple Large Tuberous and Tendinous Xanthoma Secondary to Familial Hypercholesterolaemia: A Case Report.

Xanthomas are well-circumscribed skin lesions that are commonly seen in patients with familial hypercholesterolemia (FH). The aim of this report is to present a rare case of multiple large tuberous and tendinous xanthomas. A 17-year-old female patient in this report presented with multiple asymptomatic and papulo-nodular masses in both sides of palms, elbows, buttocks, knees, and Achilles tendons. Surgical removal of the masses was carried out in combination with lipid-lowering therapy. A following up of 3 months showed all wounds were healing well, and no recurrence of masses was observed. Therefore, for patients with xanthomas related with familial hypercholesterolaemia, lipid-lowering therapy has reportedly reduced the size of masses, but surgical treatment may be essential for large xanthomas caused pain or limitation of daily activities.

Omental coating attenuates implant-induced foreign body reaction in rats.

The objective of this study is to clarify whether the omental coating can effectively attenuate foreign body reaction (FBR) induced by implanted materials. Male Sprague-Dawley rats were injected with polydextran particle slurry intraperitoneally to activate the omentum. 7 days later, polyether polyurethane sponge discs were implanted subcutaneously on each side of the rat's back as the foreign implants to induce FBR. The next day, omental transposition were performed. The disc on the left side of each rat's back was wrapped with omental flap (omental group); the disc on the right side was untreated (control group). All discs were removed 21 days after implantation and assessed by determining the components of the fibrovascular tissue (angiogenesis, inflammation, foreign body giant cells (FBGCs) aggregation and fibrogenesis). In implants in omental group, micro vessel density (MVD), Hemoglobin (Hb) content and VEGF levels (pro-angiogenic cytokine) were increased when compared with implants from control group. Inflammatory parameters (IL-1ß; macrophage accumulation-NAG activity; neutrophil accumulation- MPO levels) were decreased in implants after omental coating. Also, collagen deposition, fibrous capsule thickness, and FBGCs decreased in implants from omental group. However, intra-implant levels of TNF-α and TGF-ß1 were not different after omental coating. Our findings showed for the first time that the omental coating around the implants attenuate the adverse FBR, it may be critical in developing new strategies to control FBR and improve the function and performance of the implanted materials.

EPS15-AS1 Inhibits AKR1B1 Expression to Enhance Ferroptosis in Hepatocellular Carcinoma Cells.

Epidermal growth factor receptor substrate 15 (EPS15) is part of the EGFR pathway and has been implicated in various tumorigenesis. Increasing evidence suggests that long noncoding RNA (lncRNA) plays an essential role in liver hepatocellular carcinoma (LIHC) by regulating the expression of proteins and genes. Through analysis of the cancer genome atlas (TCGA) database, we found that EPS15 is highly expressed in LIHC tissue, and lncRNA EPS15-antisense1 (EPS15-AS1) decreased in LIHC cell lines. However, the function of EPS15-AS1 in LIHC is still unknown. When EPS15-AS1 was overexpressed in HepG2 cell lines, the expression of EPS15 was reduced and cell activity and invasiveness were inhibited. In addition, we observed an increase in Fe2+ ion and lipid peroxidation after overexpression of EPS15-AS1, and further analysis showed that the susceptibility to ferroptosis increased. Aldo-keto reductase family 1 member B 1 (AKR1B1) belongs to the aldo/keto reductase superfamily and is involved in maintaining the cellular redox balance. Survival analysis revealed that patients with a higher level of AKR1B1 have a lower survival rate in the TCGA database. We also found that EPS15 enhanced the AKR1B1 expression in LIHC, and AKR1B1 had the ability to promote cell invasiveness. Moreover, overexpression of AKR1B1 alleviated the promoting effect of EPS15-AS1 on ferroptosis. Therefore, EPS15-AS1 can induce ferroptosis in hepatocellular carcinoma cells by inhibiting the expression of EPS15 and AKR1B1 and disrupting the redox balance. EPS15 and AKR1B1 may serve as biomarkers for diagnosis and lncRNA EPS15-AS1 potential drug for LIHC.

Effects of elevated carbon dioxide (CO2)and ozone (O3)concentrations on ectoenzyme activities in rice rhizospheric soil.

Rising atmospheric carbon dioxide (CO2) and ozone (O3) concentrations are the main global change drivers. Soil ectoenzymes play an important role in maintaining soil ecosystem services. Exploring the responses of soil ectoenzymes to elevated CO2 and O3 concentrations is important for combating global climate change. In this study, we simulated elevated CO2 concentrations (+200 µmol·mol-1, eCO2), elevated O3 concentrations (0.04 µmol·mol-1, eO3), and their combination (eCO2+eO3) in open-top chambers (OTCs), and investigated the responses of rhizospheric soil ectoenzyme activities. The results showed that eCO2 significantly increased the ß-D-Glucosidase (ßG) activity by 73.0%, and decreased that of polyphenol oxidase (PHO), peroxidase (PEO), and acid phosphatase (AP) by 48.9%, 46.6% and 72.9% respectively, but did not affect that of cellulose hydrolase (CBH) and ß-N-Acetylglucosaminidase (NAG). eO3 significantly reduced the activities of CBH and AP by 34.2% and 30.4%, respectively. The activities of PHO and AP were reduced by 87.3% and 32.3% under the eCO2+eO3 compared with the control, respectively. Results of the principal coordinate analysis, permutation multivariate analysis of variance and redundancy analysis showed that both elevated CO2 and O3 significantly affected soil ectoenzyme activities, with stronger effects of elevated CO2 than elevated O3. Root nitrogen content, root carbon to nitrogen ratio, soil microbial biomass carbon and nitrate nitrogen were the main drivers of soil ectoenzyme activities under elevated CO2 and O3. Elevated O3 could partially neutralize the effects of elevated CO2 on soil ectoenzyme activities. In conclusion, elevated CO2 and O3 restrained the activities of most soil ectoenzyme, suggesting that climate change would threat soil ecosystem services and functions in the agroecosystem.

Effects of increased ozone on rice panicle morphology.

Ground-level ozone threatens rice production, which provides staple food for more than half of the world's population. Improving the adaptability of rice crops to ozone pollution is essential to ending global hunger. Rice panicles not only affect grain yield and grain quality but also the adaptability of plants to environmental changes, but the effects of ozone on rice panicles are not well understood. Through an open top chamber experiment, we investigated the effects of long-term and short-term ozone on the traits of rice panicles, finding that both long-term and short-term ozone significantly reduced the number of panicle branches and spikelets in rice, and especially the fertility of spikelets in hybrid cultivar. The reduction in spikelet quantity and fertility because of ozone exposure is caused by changes in secondary branches and attached spikelet. These results suggest the potential for effective adaptation to ozone by altering breeding targets and developing growth stage-specific agricultural techniques.

Impacts of Climate Change on Rice Grain: A Literature Review on What Is Happening, and How Should We Proceed?

More than half of the people on Earth get their calories, proteins, and minerals from rice grains. Staple increases in the quantity and quality of rice grains are key to ending hunger and malnutrition. Rice production, however, is vulnerable to climate change, and the climate on Earth is becoming more fluctuating with the atmospheric change induced by human activities. As a result, the impacts of climate change on rice grain (ICCRG) have sparked widespread concern. In order to reveal the development and the trend in the study on the ICCRG, a bibliometric analysis was conducted. The results showed that both the model simulations and the field experiment-based observations, as reflected by APSIM (the Agricultural Production Systems sIMulator) and free-air carbon dioxide (CO2) enrichment, are of concern to researchers worldwide, especially in China, India, the United States, and Japan. Different types of warming include short-term, nighttime, soil and water, and canopy, and their interactions with other climate factors, such as CO2, or agronomic factors, such as nitrogen level, are also of concern to researchers. Spatiotemporal variations in changing weather and regional adaptations from developed and developing countries are challenging the evaluation of ICCRG from an economic perspective. In order to improve the efficacy of breeding adaptable cultivars and developing agronomic management, interdisciplinary studies integrating molecular biology, plant physiology, agronomy, food chemistry, ecology, and socioeconomics are needed.

Soil nematode abundances drive agroecosystem multifunctionality under short-term elevated CO2 and O3.

The response of soil biotas to climate change has the potential to regulate multiple ecosystem functions. However, it is still challenging to accurately predict how multiple climate change factors will affect multiple ecosystem functions. Here, we assessed the short-term responses of agroecosystem multifunctionality to a factorial combination of elevated CO2 (+200 ppm) and O3 (+40 ppb) and identified the key soil biotas (i.e., bacteria, fungi, protists, and nematodes) concerning the changes in the multiple ecosystem functions for two rice varieties (Japonica, Nanjing 5055 vs. Wuyujing 3). We provided strong evidence that combined treatment rather than individual treatments of short-term elevated CO2 and O3 significantly increased the agroecosystem multifunctionality index by 32.3% in the Wuyujing 3 variety, but not in the Nanjing 5055 variety. Soil biotas exhibited an important role in regulating multifunctionality under short-term elevated CO2 and O3 , with soil nematode abundances better explaining the changes in ecosystem multifunctionality than soil biota diversity. Furthermore, the higher trophic groups of nematodes, omnivores-predators served as the principal predictor of agroecosystem multifunctionality. These results provide unprecedented new evidence that short-term elevated CO2 and O3 can potentially affect agroecosystem multifunctionality through soil nematode abundances, especially omnivores-predators. Our study demonstrates that high trophic groups were specifically beneficial for regulating multiple ecosystem functions and highlights the importance of soil nematode communities for the maintenance of agroecosystem functions and health under climate change in the future.

Simplifying network complexity of soil bacterial community exposed to short-term carbon dioxide and ozone enrichment in a paddy soil.

Global atmospheric changes are characterized by increases in carbon dioxide (CO2) and ozone (O3) concentrations, with important consequences for the soil microbial community. However, the influences of CO2 and O3 enrichment on the biomass, diversity, composition, and functioning of the soil bacterial community remain unclear. We investigated the effects of short-term factorial combinations of CO2 (by 200 ppm) and O3 (by 40 ppb) enrichment on the dynamics of soil bacterial community in paddy soils with two rice varieties (Japonica, Nangeng 5055 (NG5055) vs. Wuyujing 3 (WYJ3)) in an open top chamber facility. When averaged both varieties, CO2 and O3 enrichment showed no individual or combined effect on the abundance or diversity of soil bacterial community. Similarly, CO2 enrichment did not exert any significant effect on the relative abundance of bacterial phyla. However, O3 enrichment significantly reduced the relative abundance of Myxococcota phylum by a mean of 37.5%, which negatively correlated to root N content. Compared to ambient conditions, soil bacterial community composition was separated by CO2 enrichment in NG5055, and by both CO2 and O3 enrichment in WYJ3, with root N content identified as the most influential factor. These results indicated that root N was the top direct predictor for the community composition of soil bacteria. The COG (cluster of orthologous groups) protein of cell motility was significantly reduced by 5.8% under CO2 enrichment, and the COG protein of cytoskeleton was significantly decreased by 14.7% under O3 enrichment. Furthermore, the co-occurrence network analysis indicated that both CO2 and O3 enrichment decreased the network complexity of the soil bacterial community. Overall, our results highlight that continuous CO2 and O3 enrichment would potentially damage the health of paddy soils through adverse impacts on the associations and functional composition of soil microbial communities.

Elevated O3 Exerts Stronger Effects than Elevated CO2 on the Functional Guilds of Fungi, but Collectively Increase the Structural Complexity of Fungi in a Paddy Soil.

Global climate change is characterized by altered global atmospheric composition, including elevated CO2 and O3, with important consequences on soil fungal communities. However, the function and community composition of soil fungi in response to elevated CO2 together with elevated O3 in paddy soils remain largely unknown. Here we used twelve open-top chamber facilities (OTCs) to evaluate the interactive effect of CO2 (+ 200 ppm) and O3 (+ 40 ppb) on the diversity, gene abundance, community structure, and functional composition of soil fungi during the growing seasons of two rice cultivars (Japonica, Wuyujing 3 vs. Nangeng 5055) in a Chinese paddy soil. Elevated CO2 and O3 showed no individual or combined effect on the gene abundance or relative abundance of soil fungi, but increased structural complexity of soil fungal communities, indicating that elevated CO2 and/or O3 promoted the competition of species-species interactions. When averaged both cultivars, elevated CO2 showed no individual effect on the diversity or abundance of functional guilds of soil fungi. By contrast, elevated O3 significantly reduced the relative abundance and diversity of symbiotrophic fungi by an average of 47.2% and 39.1%, respectively. Notably, elevated O3 exerts stronger effects on the functional processes of fungal communities than elevated CO2. The structural equation model revealed that elevated CO2 and/or O3 indirectly affected the functional composition of soil fungi through community structure and diversity of soil fungi. Root C/N and soil environmental parameters were identified as the top direct predictors for the community structure of soil fungi. Furthermore, significant correlations were identified between saprotrophic fungi and root biomass, symbiotrophic fungi and root carbon, the pathotroph-symbiotroph and soil pH, as well as pathotroph-saprotroph-symbiotroph and soil microbial biomass carbon. These results suggest that climatic factors substantially affected the functional processes of soil fungal, and threatened soil function and food production, highlighting the detrimental impacts of high O3 on the function composition of soil biota.

Characterization of immune landscape and development of a novel N7-methylguanine-related gene signature to aid therapy in recurrent aphthous stomatitis.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is the most common inflammatory disease of the oral mucosa resulting in an impaired life quality and even leading to tumors in susceptible populations. N7-Methylguanine (m7G) plays a vital role in various cellular activities but has not yet been investigated in RAS. We aimed at picturing the immune landscape and constructing an m7G-related gene signature, and investigating candidate drugs and gene-disease association to aid therapy for RAS. METHODS: For our study, m7G-related differentially expressed genes (DEGs) were screened. We outlined the immune microenvironment and studied the correlations between the m7G-related DEGs and immune cells/pathways. We performed functional enrichment analyses and constructed the protein-protein interaction (PPI) and multifactor regulatory network in RAS. The m7G-related hub genes were extracted to formulate the corresponding m7G predictive signature. RESULTS: We obtained 11 m7G-related DEGs and studied a comprehensive immune infiltration landscape, which indicated several immune markers as possible immunotherapeutic targets. The PPI and multifactor regulatory network was constructed and 4 hub genes (DDX58, IFI27, IFIT5, and PML) were identified, followed by validation of the corresponding m7G predictive signature for RAS. GO and KEGG analyses revealed the participation of JAK-STAT and several immune-related pathways. Finally, we suggested candidate drugs and gene-disease associations for potential RAS medical interventions. CONCLUSIONS: The present study pictured a comprehensive immune infiltration landscape and suggested that m7G played a vital role in RAS through immune-related pathways. This study provided new insight for the future investigation of the mechanisms and therapeutic strategies for RAS.

Food Security in China: A Brief View of Rice Production in Recent 20 Years.

Rice production affects the food security and socioeconomic status of over half the world's population. Rice-producing countries, however, are facing population growth, reduction in rice planting area, and global change. Understanding the trends of rice production and major determinants is key to regulating rice production. We thus analyzed the trends of rice production and related determinants in China from 2001 to 2021, revealing that the annual rice production (TRP) has risen steadily (r = 0.929, p < 0.0001) in recent 20 years. TRP in 2021 was 19.9% higher than that in 2001, which was primarily achieved by the increment of middle rice production (MRP). MRP increased by 46.2% from 2000 to 2018, and grain yield per unit area (GPA) was the largest in middle rice. The enhancement of GPAs is significantly correlated with the consumption of agricultural resources and the number of released rice cultivars, but variations exist. TRP and GPA vary in different provinces; Hunan (25 ± 2 megatons) and Xinjiang (8364 ± 806 kg/hectare) show the largest values, respectively. TRP could be further increased by 13.8% by improving MRP. The results suggest that rice production in China has a large potential to be further improved through regulations.

Pre-expanded muscle-sparing Latissimus Dorsi free flap: An ideal option for the reconstruction of extensive anterior knee contractures.

BACKGROUND: Extensive and complex contractures in the anterior knee area can pose a significant challenge for reconstruction due to insufficient skin and soft tissue coverage and poor cosmetic and functional outcomes using traditional methods. We presented our experience with pre-expanded muscle-sparing latissimus dorsi (LD) free flap as an alternative option for large-scale anterior knee reconstruction. METHODS: From January 2016 to December 2020, we applied this surgical technique in six patients with large postburn or post-traumatic contractures of the anterior knee. After tissue expansion of several months, the expanded muscle-sparing LD free flap was harvested and transferred to resurface the lesions. Operative procedures, postoperative complications, and long-term outcomes were evaluated. RESULTS: A total of six patients aged 7 to 32 years (mean: 20 years) were reconstructed successfully without any major complication. The flap ranged from 20 × 8 cm to 40 × 16 cm. All donor sites were primarily closed. Follow-up (range: 12 to 24 months) evaluation showed satisfactory results in both cosmetic and functional aspects. CONCLUSIONS: Pre-expanded muscle-sparing LD free flap is a reliable and effective choice for extensive anterior knee contracture reconstruction with satisfactory esthetic and functional outcome. It can provide substantial amount of soft tissue coverage with minimal complications and donor-site morbidity. Furthermore, it offers a good basis for next-step orthopedic surgery, such as total knee arthroplasty (TKA).

Ethylenediurea reduces grain chalkiness in hybrid rice cultivars under ambient levels of surface ozone in China.

High concentration of tropospheric ozone (O3) causes crop yield losses, which could be reduced by foliar application of ethylenediurea (EDU). Rice grain appearance is a major quality trait that determines the milling quality, white rice productivity and the market value. Grain chalkiness is one of the common defects that deteriorate the grain appearance in rice due to its negative effects on palatability and milling yield. Whether EDU could reduce grain chalkiness in rice which was usually increased by high concentration of O3 is not clarified. We report the grain chalkiness in 19 rice cultivars (CVs) of three types: indica (6 CVs), japonica (5 CVs) and hybrids (8 CVs), observed in an EDU application experiment in the field in China. The ambient O3 level as expressed by accumulated hourly O3 concentration over the threshold of 40 ppb (AOT40) for 80 days until maturity reached 12.8 ppm h at a near-by monitoring station. Fraction of the chalky grains (FCG) in the hybrid cultivars was 8% lower in EDU than that in the control treatments, whereas no significant effect of EDU on FCG was found in japonica or indica cultivars. The reduction of FCG due to EDU treatment in hybrid cultivars was attributed to the significant reduction of milky white grains followed by that of white belly grains. Thus, the application of EDU could ameliorate the decline of grain appearance quality in hybrid rice by decreasing the FCG and enhancing the fraction of perfect grains (FPG). Moreover, there were significant interactions between the EDU application and rice cultivars, indicating varietal difference in the protection of grain appearance quality by EDU. These results suggest the need for further studies on the mechanisms of the effects of EDU on grain chalkiness.

Corrigendum: Changes in the abundance and community complexity of soil nematodes in two rice cultivars under elevated ozone.

[This corrects the article DOI: 10.3389/fmicb.2022.916875.].

Changes in the Abundance and Community Complexity of Soil Nematodes in Two Rice Cultivars Under Elevated Ozone.

The atmospheric ozone concentrations have substantially increased in the surface layer over the past decades, and consequently exhibited a strong influence on soil microbial communities and functions. However, the effect of elevated ozone (eO3) on the abundance, diversity, and structural complexity of soil nematode communities are elusive under different rice (Oryza sativa L.) cultivars. Here, the soil nematode community was investigated in two rice cultivars (Hybrid, Shanyou 63 vs. Japonica, Wuyujing 3) under open-top chambers (OTC) with control and eO3 conditions. The results showed that the abundance of soil nematode community was altered by eO3, but the responses were dependent on crop cultivars. The eO3 decreased the total abundance and simplified the network complexity of the soil nematode community for both cultivars. However, eO3 increased the abundance of c-p 4 in Shanyou 63, rather than Wuyujing 3, indicating that the hybrid rice cultivar could tradeoff the adverse impacts of eO3 on the functional group of soil nematodes. Similarly, bacterivores belonging to K-strategy (c-p 4) increased under eO3 in Shanyou 63, suggesting that the soil food web formed a bacteria-dominated channel under eO3 for the hybrid rice cultivar. This study shed new light on the critical importance of rice cultivars in shaping the impacts of eO3 on the soil micro-food web. Therefore, breeding and biotechnological approaches may become valuable pathways to improve soil health by shaping the community structures of the soil micro-food web in response to climate change in the future.

Ethylenediurea offers moderate protection against ozone-induced rice yield loss under high ozone pollution.

Tropospheric ozone (O3) is the main phytotoxic air pollutant threatening food security, while ethylenediurea (EDU) can effectively mitigate O3-induced crop yield loss. EDU's mode of action, however, remains unclear, and the underlying physiological mechanisms of mitigating O3-induced crop yield loss are poorly understood. We cultivated hybrid rice seedlings under two O3 treatments (NF, nonfiltered ambient air; and NF60, ambient air plus 60 ppb O3) and sprayed foliage with 0 or 450 ppm EDU every ten days and determine photosynthesis-related traits, biomass indicators, and yield components. We found that EDU significantly increased the leaf nitrogen (N) allocation to photosynthesis (NP) and the grain N accumulation, while the grain N accumulation was positively correlated with NP and root biomass. EDU significantly increased the rice yield mainly by increasing the individual grain weight rather than the number of panicles and grains. While EDU protected from yield loss, the degree of protection was only 31% under NF60 treatment, thus EDU was unable to offer complete protection under high O3 pollution. These results will be conducive to a better understanding of the EDU protection mechanism and better application of EDU under high O3 pollution in the future.

Ethylenediurea (EDU) protects inbred but not hybrid cultivars of rice from yield losses due to surface ozone.

The rising concentration of ground-level ozone (O3) reduces crop yield via increased oxidative stress. Application of ethylenediurea (EDU) protects plants from O3 and could thereby serve as a means to estimate the crop yield losses due to ambient O3 (AO3). However, no study but a few exceptions has ever compared the yield loss estimates from EDU application with those from O3 elevation experiments. Here, we estimated yield loss to AO3 in rice cultivars across the 3 types, indica, japonica, and hybrid, by an EDU application in the field, and compared the yield losses with those estimated with dose-response relationships based on O3 elevation experiments. Relative yield loss (RYL) in the EDU application was estimated at 16% across the rice types on an assumption of a 100% efficiency for protection of crop yield by EDU. This estimate of RYL was close to the 15% RYL estimated from the O3 elevation experiments when a common sensitivity to O3 is assumed across the cultivars. The rice yield loss due to AO3 was thus consistent between the two approaches supporting the idea of EDU application for the yield loss estimation. When only hybrids are focused, however, the RYL from EDU application (16%) was much lower than the 34% RYL from the O3 elevation experiments, which indicates only a 37% yield protection by EDU in the hybrid rice. The incomplete protection by EDU and its genetic variability indicates the need to quantify the efficiency of protection from AO3-induced yield loss as estimated with O3 manipulating experiments.

USP15 Enhances Re-epithelialization Through Deubiquitinating EIF4A1 During Cutaneous Wound Repair.

Re-epithelialization is a fundamental process in wound healing that involves various cytokines and cells during cutaneous barrier reconstruction. Ubiquitin-specific peptidase 15 (USP15), an important member of the deubiquitinating enzymes (DUBs), removes ubiquitin chains from target proteins and maintains protein stability. However, the dynamic role of USP15 in epithelialization remains unclear. We aimed to investigate the regulatory function of USP15 in re-epithelialization. An excisional wound splinting model was established to evaluate the re-epithelialization rate in Usp15 knockout (KO) mice. Coimmunoprecipitation (Co-IP) and mass spectrum analyses were performed to identify USP15-interacting proteins. RNA-sequencing was performed for transcriptome analysis in keratinocytes and uploaded into NODE database (http://www.biosino.org/node, accession numbers: OEP000770 and OEP000763). First, a significant delay in epithelialization was observed in the Usp15 KO mice. Moreover, inhibition of cell migration and proliferation was observed in the USP15-silenced keratinocytes (HaCaTs). Moreover, we revealed for the first time that USP15 could interact with eukaryotic initiation factor 4A-1 (EIF4A1), thereby promoting translational efficacy in keratinocytes, which is essential for keratinocyte proliferation and migration. Conclusively, the USP15-EIF4A1 complex significantly accelerated re-epithelialization in wound healing. These observations helped elucidate the function and mechanisms of USP15 in modulating re-epithelialization in wound healing, providing a promising target for refractory wound treatment.

Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer-Related Lymphedema.

BACKGROUND: Magnetic resonance lymphangiography (MRL) has been proven to be able to visualize pathological lymphatic networks and accompanying complications through subcutaneous injection of commonly used contrast agents. However, no comprehensive prior studies have previously been reported regarding MRL for the evaluation of upper extremity lymphedema in patients with breast cancer-related lymphedema (BCRL). In this study, we establish a novel MRL protocol to characterize the normal and abnormal characteristics of different clinical stages of BCRL in patients using high-spatial-resolution MRL. METHODS: Fifty females with unilateral upper extremity BCRL underwent MRL. Lymphatic vessel morphology in normal and affected limbs was compared. The appearance, distribution pattern, morphologic characteristics, and maximum transversal diameter of the lymphatic vessels, dermal backflow, and regeneration of lymphatic vessels were analyzed. RESULTS: Lymph fluid was retained in the subcutis of the affected limbs, and no edema was observed in the subfascial compartment. In stage 1, tortuous and dilated lymphatic vessels exhibited a beaded appearance, and their diameters were larger than those in the contralateral forearm (P < 0.05). In stage 2, the dilated lymphatic vessels exhibited larger diameters. "Dermal backflow" and tiny regenerated lymphatic vessels appeared. The thickened subcutaneous tissue showed a honeycomb pattern induced by soft tissue fibrosis and adipose hypertrophy. In stage 3, disordered and unrecognizable affected lymphatic vessels were observed with many small regenerated lymphatics and confluent dermal backflow; the tissue fibrosis was more serious. CONCLUSIONS: Each stage presents different characteristics, and the deformity degree of the lymphatic network is consistent with the severity of the disease. Magnetic resonance lymphangiography could provide adequate information for clinical staging in patients with BCRL.