BackgroundBreast cancer-related lymphedema (BCRL) significantly compromises quality of life. Although combined suction-assisted lipectomy (SAL) and lymphovenous anastomosis (LVA) is effective, outcomes vary considerably among patients. Currently, tools for early postoperative risk stratification are lacking.MethodsWe retrospectively reviewed data from BCRL patients who underwent combined SAL and LVA at Beijing Shijitan Hospitalfrom June 2018 to June 2025. Predictive variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression combined with bootstrap resampling (B = 1,000). Seven algorithms—including logistic regression (LR), decision tree (DT), random forest (RF), eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), support vector machine (SVM), and artificial neural network (ANN) were compared. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and Brier score. SHapley Additive exPlanations (SHAP) analysis was conducted for model interpretation, and a web-based prediction tool was developed.ResultsA total of 300 patients were enrolled (training set: n=211; validation set: n=89). The rate of satisfactory outcomes at 6 months was 72.3%. LASSO and bootstrap validation identified three stable predictors: postoperative excess limb volume (selection frequency: 100%), disease duration (83.6%), and disease severity grade (83.4%). Among the seven models, SVM exhibited the optimal balance of discrimination and clinical utility in the validation set: AUC 0.891 (95% CI: 0.812–0.970), sensitivity 90.8%, specificity 62.5%, F1-score 0.887, and Brier score 0.119. DCA indicated net clinical benefit within the threshold range of 0.1–0.6. Although ANN achieved a higher AUC than SVM (0.903 vs. 0.891) (DeLong test, P = 0.532), SVM demonstrated superior sensitivity (90.8% vs. 89.2%), F1-score (0.887 vs. 0.879), and Cohen’s kappa (0.555 vs. 0.531).Furthermore, SVM’s structural risk minimization principle conferred superior generalization stability compared with ANN’s empirical risk minimization, making it more suitable for small-sample clinical settings. SHAP analysis revealed that postoperative excess volume was the strongest predictor.ConclusionThe 3-variable SVM model effectively predicts 6-month outcomes following combined surgery for BCRL. Integrated with SHAP analysis and a web-based tool, this model enables early postoperative risk stratification to identify high-risk patients requiring closer monitoring, providing a reference for future standardized rehabilitation protocols.

BACKGROUND:Primary chylopericardium is a rare lymphatic disorder with poorly defined pathophysiology and limited treatment options. This study aimed to characterize lymphangiographic reflux patterns and evaluate the long-term outcomes and predictors of success of direct lymphangiography-guided cervical thoracic duct exploration. METHODS:We retrospectively reviewed 67 patients with isolated primary chylopericardium who underwent direct lymphangiography between June 2007 and December 2020. A novel 4-type classification of abnormal reflux pathways was proposed based on direct lymphangiography findings. Treatment success was defined as resolution or marked reduction of pericardial effusion, relief of symptoms, and no need for reintervention. Median follow-up was 10.2 years (range, 7.5-19.5 years). Multivariable logistic regression was performed to identify independent predictors of success. RESULTS:Direct lymphangiography demonstrated distinct reflux patterns: type I (bronchomediastinal trunk, 55.2%), type II (thoracic segment, 11.9%), type III (combined, 7.5%), and type IV (no identifiable pathway, 28.4%). Compensatory drainage was present in 25.4% of patients. Among 65 patients who underwent cervical thoracic duct exploration, the clinical success rate was 66.2% (43/65), with no major complications. Multivariable analysis showed that the absence of compensatory drainage pathways was the strongest independent predictor of success (adjusted odds ratio, 7.85; 95% confidence interval, 1.48-41.6; P = .016). Reflux pathway type was also independently associated with outcome (P = .012), with type I demonstrating better results than types II-IV. Conservative dietary management alone was ineffective in the 2 patients who did not undergo surgery. CONCLUSION:Direct lymphangiography-guided cervical thoracic duct exploration is associated with favorable long-term outcomes in selected patients with primary chylopericardium. The proposed reflux classification and the absence of compensatory drainage pathways were strong predictors of success. These findings are preliminary and require prospective multicenter validation.

[This corrects the article DOI: 10.3389/fonc.2026.1760040.].

ObjectiveProtein-losing enteropathy (PLE) is characterized by excessive gastrointestinal protein loss, yet systematic comparative studies across etiologies remain limited. This study aimed to characterize the confirmed PLE cohort in our center, with a focused comparison between connective tissue disease-associated PLE (CTD-PLE) and lymphatic drainage disorder-associated PLE (LDD-PLE), describe follow-up observations, and explore routine clinical indicators that may assist etiologic differentiation.MethodsThis retrospective study included 146 patients admitted to Beijing Shijitan Hospital between January 2014 and December 2024 with PLE confirmed by 99mTc-HSA scintigraphy. Patients were classified as CTD-PLE or LDD-PLE according to the final clinical diagnosis. Clinical features, laboratory findings, and available follow-up data were analyzed, and logistic regression together with receiver operating characteristic (ROC) analyses were used to explore factors associated with CTD-PLE.ResultsThe cohort included 146 patients (median onset age 26 years; 30 CTD-PLE and 116 LDD-PLE). Edema (84.2%) and serous cavity effusions (76.7%) were the most frequent manifestations. Comparative analysis showed that CTD-PLE patients were older, predominantly female, and had more frequent thrombosis and higher D-dimer levels than LDD-PLE patients. CTD-PLE also showed distinct laboratory features, including higher total cholesterol, triglycerides, and globulin levels, whereas LDD-PLE was associated with lower lymphocyte counts and more frequent diarrhea. Multivariate analysis identified age at onset, Hb, and total cholesterol as independent predictors of CTD-PLE. The three-variable model showed good apparent discrimination in this single-center cohort (AUC = 0.890), while C3 showed the best single-variable discrimination. Among patients with available follow-up, 19/20 CTD-PLE patients receiving glucocorticoids plus immunosuppressants achieved symptom remission with a median ALB improvement of 9.5 (3.8, 19.6) g/L, whereas 23/43 surgically treated LDD-PLE patients achieved symptom remission with a median ALB improvement of 2.0 (-0.5, 5.8) g/L.ConclusionPLE with different etiologies shows distinct clinical and laboratory patterns. Age at onset, Hb, and total cholesterol may assist preliminary etiologic differentiation, although the proposed model requires validation in independent cohorts. The observed lipid, coagulation, and correlation patterns, together with the follow-up findings, provide exploratory clues to distinct mechanisms and treatment trajectories.

BackgroundCancer-associated secondary lymphedema (CASL) commonly occurs after tumor-related lymph node dissection and radiotherapy. Nevertheless, the mechanisms of CASL remain unclear, and there are no specific molecular markers for its diagnosis and treatment.MethodsIn this study, RNA sequencing was performed on adipose tissues from 10 normal controls and 40 patients with CASL. Differentially expressed genes were screened using two machine learning algorithms to identify potential molecular markers for CASL. Subsequently, seven machine learning algorithms were employed to develop predictive models based on the identified markers. The contribution of each feature to the predictive outcomes was interpreted using Shapley additive explanation (SHAP). Immune cell infiltration was profiled through CIBERSORT and MCP-counter algorithms, and single-cell RNA sequencing (scRNA-seq) data were integrated to explore interactions between characteristic genes and immune cell subpopulations. Furthermore, associations between characteristic genes and clinical parameters were also assessed.ResultsIL2RG, HOXD10, and TSPAN1 were identified as potential biomarkers of CASL. Diagnostic models built on these three genes showed excellent performance. Functional enrichment analysis suggested that the dysregulation of cytokine-cytokine receptor interactions and immune pathways underlies the pathological progression of CASL. In addition, immune infiltration analysis indicated that T cell and macrophage infiltration were intricately involved in CASL progression. Intriguingly, single-cell transcriptomic analysis further revealed elevated expression of IL2RG, HOXD10, and TSPAN1 in T cell subsets. Finally, RT-qPCR validated that these genes were expressed at higher levels in CASL tissues than in normal tissues. Moreover, IL2RG expression was strongly associated with clinical parameters.ConclusionsThis study identified IL2RG, HOXD10, and TSPAN1 as novel potential molecular markers for CASL, providing valuable biological evidence for the diagnosis and intervention of CASL.

BackgroundBreast cancer-related lymphedema (BCRL) is a common and disabling complication after breast cancer surgery, with substantial effects on limb function and quality of life. Liposuction is an established option for selected patients with chronic BCRL. However, postoperative response is heterogeneous. This study aimed to develop a machine learning model to predict liposuction efficacy in patients with unilateral BCRL.MethodsWe analyzed 623 unilateral BCRL cases undergoing liposuction at Beijing Shijitan Hospital, randomly splitting them 7:3 into training (n=437) and validation (n=186) cohorts. Least absolute shrinkage and selection operator (LASSO) regression with cross-validation guided feature selection. Seven algorithms—logistic regression (LR), support vector machines (SVM), decision trees (DT), artificial neural networks (ANN), LightGBM, XGBoost, and random forests (RF)—were trained and benchmarked. Performance via AUC, calibration, DCA, and Brier score identified SVM as optimal. SHAP interpretation facilitated deployment of a web-based calculator.ResultsThe overall rate of favorable outcomes following liposuction was 64.7%. Cross-validated Lasso analysis, factoring in clinical validity and predictive importance, yielded four key predictors: history of erysipelas, preoperative affected-to-unaffected limb volume difference (Preoperative_difference), extracellular water ratio of the affected limb (r-ECW%), and body fat percentage. Among the seven models evaluated, the SVM exhibited the most balanced overall performance, achieving an accuracy of 77.42%, precision of 75.00%, specificity of 90.00%, F1-score of 0.632, Brier score of 0.163, and an AUC of 0.818 (95% CI: 0.757–0.876). Although not possessing the highest AUC, the SVM demonstrated exceptional resistance to overfitting, evidenced by a minimal AUC decrement of merely 0.0298 from the training to the validation set. Both calibration and decision curve analyses corroborated its robust generalizability, underscoring its tangible clinical utility.ConclusionsAn SVM model predicting surgical outcomes in BCRL was created and integrated into a user-friendly online tool. This calculator guides surgical choices based on predictive outputs, offering a valuable reference for refining patient management and treatment plans.

Primary intestinal lymphangiectasia (PIL) is a rare disease characterized by the loss of lymphatic fluid in the intestinal lumen and is a known cause of protein-losing enteropathy (PLE). Although uncommon, few cases of secondary hyperparathyroidism (SHPT) have been reported in patients with PIL. This study summarizes the characteristics of four cases diagnosed with PIL. Notably, all cases were confirmed to have hyperparathyroidism secondary to vitamin D deficiency and hypocalcemia. Recurrent diarrhea and limb convulsions were also observed in all patients, with one patient diagnosed with osteoporosis. Simultaneously, hypomagnesemia was detected in three cases. Treatment with vitamin D and calcium supplements relieved symptoms, elevated serum calcium levels, and decreased parathyroid hormone (PTH) levels. In patients with PIL, evaluation of 25-hydroxyvitamin D, calcium, and PTH levels is crucial. Bone diseases should be considered in patients with SHPT, and appropriate vitamin D3 and calcium supplementation is highly recommended.

Lymphedema is a chronic condition that can follow cancer treatment, and liposuction has been shown to be an effective approach for reducing limb volume in advanced cases. However, recurrence rates vary widely, with prior erysipelas identified as a potentially significant factor influencing prognosis. This study aimed to identify key risk factors for recurrence following liposuction in patients with cancer-associated secondary lymphedema, develop a predictive nomogram model, and investigate the molecular mechanisms by which previous erysipelas may affect recurrence. In a retrospective analysis of 1,016 patients, multivariate logistic regression and propensity score matching identified four independent risk factors, namely, prior erysipelas, hyperlipidemia, severe distal limb edema, and older age, with erysipelas showing the strongest association with poor outcomes (OR 3.98; 95% CI: 2.81-5.69). A validated nomogram demonstrated high predictive accuracy (C-index 0.757, Brier score 0.176) and net clinical benefit in estimating recurrence risk. The nomogram supports personalized treatment strategies, potentially improving patient outcomes. Transcriptome sequencing further revealed that previous erysipelas exacerbates lymphedema through inflammation, tissue remodeling, and metabolic dysregulation, suggesting potential therapeutic targets.

Purpose:The purpose of this study is to evaluate a novel surgical method for idiopathic chyluria. Methods:Data from 63 patients with idiopathic chyluria who underwent direct lymphangiography (DLG) were retrospectively analyzed. Of these, 50 patients received cervical thoracic duct exploration (CTDE) as a treatment, while 13 were managed with a low-fat diet. The treatment efficacy of the two groups was compared, and a univariate analysis of the CTDE treatment effect was performed. Results:DLG revealed that the contrast agent passed upwards and outwards through paravertebral lymphatics into the region of the renal hilum and pelvis (left: 38.10%; right: 33.33%; bilateral: 28.57%). Dilatation of retroperitoneal lymphatics was found in 90.47% of cases. Additionally, 47.6% of patients demonstrated contrast agent reflux into lymphatic trunks in the neck (the percentage of contrast agent reflux to the jugular trunk, subclavian trunk, and broncho-mediastinal trunk being 28.57%, 38.09%, and 6.34%, respectively). The effective rate in the CTDE group was higher than in the low-fat diet group (χ² = 5.893, p=0.015). Univariate analysis of the patients who underwent CTDE demonstrated that younger age (p=0.036) and Grade III chyluria were risk factors for ineffective treatment, while patients with Grade I had better treatment outcomes (p=0.029). Conclusion:Obstruction of the cervical thoracic duct may be a significant cause of idiopathic chyluria. Alleviating this obstruction may be an effective treatment strategy for idiopathic chyluria.

Background: Lymphedema is a chronic progressive disease that impairs patients’ physical and psychological health. This study aimed to conduct a systematic review of the application of indocyanine green (ICG) lymphography for the diagnosis and treatment of secondary upper extremity lymphedema. Methods: We searched PubMed for studies on ICG lymphography for secondary upper extremity lymphedema that were published until April 2024. The quality of included studies was assessed according to the Joanna Briggs Institute Review’s Manual. Qualitative synthesis using only descriptive statistics was performed. Results: Of the 523 articles screened, 32 met the eligibility criteria. Most of the studies were observational (4 cohort studies and 28 case series). For this review, 1,869 patients with secondary lymphedema and 112 volunteers were identified. ICG lymphography for diagnostic imaging of secondary lymphedema was reported to have a sensitivity of 89.5% and a specificity of 85.7% and was particularly useful for the diagnosis of early lymphedema. A severity staging system based on ICG lymphography images for secondary lymphedema was also reported. In the lymphaticovenous anastomosis (LVA) surgery, ICG lymphography was helpful in detecting functional lymphatic vessels preoperatively and in localizing lymphatic vessels and assessing LVA patency intraoperatively, thereby facilitating smaller skin incision and shorter operating time. Conclusions: ICG lymphography has a great value in the diagnosis and treatment of secondary upper extremity lymphedema.

OBJECTIVE:The International Society of Lymphology proposed a grading standard for lymphedema in 2020 based on the percent increase in the volume of the affected limb compared to that of the healthy limb. However, this method is cumbersome and time consuming to measure and calculate, and a standardized formula across different institutions is not available. Therefore, the aim of this study was to investigate the value of nonenhanced magnetic resonance imaging (MRI) for grading primary lower extremity lymphedema (PLEL). METHODS:This retrospective study included 124 consecutive patients with unilateral PLEL from 2021 to 2023. All patients were categorized into three groups, mild (n = 43), moderate (n = 41), and severe (n = 40), according to the 2020 International Society of Lymphology grading standard. From the lymphedema involvement range (vertical range: whole lower extremity, only thigh, only calf and ankle; transversal range: ≤25% of the cross-section, 26%-50%, 51%-75%, and >75%), MRI signs of lymphedema (parallel lines sign, grid sign, honeycomb sign, band sign, crescent sign, lymphatic lake sign, and nebula sign), and lymphedema measurements (total diameter, total circumference, and total area of the affected limb; diameter and area of the bone, muscle, subcutaneous fat, and subcutaneous soft tissues on the affected limb; circumference of the bone and muscle on the affected limb; thickness of skin; thickness of band sign; thickness of crescent sign) were recorded and statistically analysed in the three groups of patients. RESULTS:The statistically significant differences in the indicators among the three groups were as follows: vertical and transversal ranges of lymphedema, parallel lines sign, grid sign, honeycomb sign, band sign, crescent sign, and lymphatic lake sign, total diameter, total circumference, total area, diameter and area of the subcutaneous fat, diameter and area of the subcutaneous soft tissues, thickness of skin, thickness of band sign and crescent sign (P < .05). The receiver operating characteristic curve showed that the highest area under the curve for each parameter for identifying patients in the mild and nonmild (including moderate and severe) groups was in the following order: diameter of the subcutaneous fat > area of the subcutaneous fat > thickness of the skin (P < .05). The receiver operating characteristic curve showed that the highest under the curve for each parameter used to identify patients in the severe and nonsevere (including mild and moderate) groups was in the following order: diameter of the subcutaneous fat > area of the subcutaneous fat > thickness of the crescent sign. CONCLUSIONS:The parallel lines sign is a characteristic indicator for diagnosing patients with a mild disease, the grid sign is a characteristic indicator for diagnosing patients with a moderate disease, the lymphatic lake sign and crescent sign are characteristic indicators for diagnosing patients with a severe disease, and the honeycomb sign and band sign are characteristic indicators for diagnosing patients with moderate to severe disease. The thickness of the skin, band sign and crescent sign gradually increased with increasing disease severity. The efficacy of the diameter and area of subcutaneous fat for PLEL grading is optimal. Nonenhanced MRI can be a better and standardized tool for grading PLEL.

Lymphedema, which is characterized by impaired lymphatic drainage leading to tissue swelling, represents a relatively uncommon clinical entity, with an estimated prevalence of <1% being observed in the general population. Although most cases arise from postsurgical complications or filariasis, lymphoma-associated lymphedema remains an exceedingly rare manifestation, with only 19 cases documented in the medical literature prior to the present study. The current study presented a case series of 11 patients with histologically confirmed lymphoma manifesting with lymphedema, which represents the largest single-center report to date. In the present cohort spanning a time period from 2007-2024, patients who initially presented with refractory lymphedema (9 lower extremity cases, 1 upper extremity case and 1 systemic case) subsequently received a diagnosis of lymphoma via comprehensive evaluation, including imaging (100% detection rate on CT/MRI) and histopathology examinations. The median latency from edema onset to lymphoma diagnosis was 7 months (range, 1-24 months), with 72.7% (8 out of 11) of the patients demonstrating B-cell lineage predominance. The present case series underscored the notion that although lymphedema secondary to lymphoma constitutes <0.5% of all secondary lymphedema cases, it warrants consideration in patients with atypical presentations, such as rapid progression (54.5%), systemic symptoms (81.8%) or abnormal tumor markers (66.7%). The present case report findings emphasized the idea that lymphoma should be included in the differential diagnosis of unexplained lymphedema, particularly when accompanied by warning signs such as lymphadenopathy (100% imaging positivity) or hematologic abnormalities (45.5% anemia prevalence).

To investigate the clinical characteristics and treatment strategies of patients with systemic lupus erythematosus-related thoracic duct obstruction (SLE-TDO). Clinical data, laboratory tests, imaging data, and treatment strategies were retrospectively collected from 428 SLE patients with TDO treated from January 2010 to December 2020 at Beijing Shijitan Hospital. TDO was confirmed by TD imaging examination. We retrospectively examined 20 SLE patients with TDO as the case group, and 80 randomly matched SLE patients without any lymph-vessel dysfunction as the control group. The prevalence of TDO in patients with SLE was 4.67

Abstract Objective To retrospectively evaluate thoracic duct (TD) congestion in hepatic lymphorrhea (HL) and propose treatment suggestions. Methods Retrospectively analyze cases of postoperative HL admitted from August 2007 to November 2023. Twenty cases were enrolled and followed up. The medical history, ascites characteristics, lymphoscintigraphy, direct lymphangiography, and other clinical data were reviewed. Results Twenty patients with ascites after cholecystectomy or radical gastrectomy were included. There were 15 patients with cirrhosis and 5 patients with hepatitis. Ascites were light yellow even if the patients had a non-low-fat diet. Triglyceride level mean of ascites was 0.61 ± 0.20 mmol/L. There were 94.1% (16/17) of patients whose ascitic cholesterol ≥ 45 mg/dL or SAAG < 11.0 g/L. Mild abdominal radioactivity was shown in 89.5% (17/19) patients. Left subclavian-jugular venous angle radioactivity was observed in 84.2% (16/19) patients. In 10% (2/20) cases, lipiodol presenting as oil droplets traveled upwards quickly and flowed into the vein rapidly. In 90% (18/20) cases, tortuous and dilated thoracic duct, stagnant lipiodol, and poor flow into the vein were demonstrated. One patient refused treatment and died soon. By thoracic duct outlet reconstruction combined with other treatments, 16 patients were cured and the ascites of another 3 patients were controlled. Conclusions TD congestion and elevated lymphatic pressure could be caused by increased lymph flow and TD outlet stenosis. TD decompression by outlet reconstruction may be an alternative approach to HL.

Background: Chylous reflux (CR) in primary lymphedema (PL) of the lower extremities is rare and requires particular diagnostic procedures. This study aimed to determine clinical and lymphoscintigraphic traits for efficient screening. Methods and Results: Pediatric patients with PL of lower extremities treated in our institution between January 2020 and December 2023 were reviewed. The medical history, lymphoscintigraphy, non-contrast MR lymphography, and direct lymphangiography were analyzed. Lymphoscintigraphic visual patterns were classified to detect CR. Patients with CR showed significantly higher proportions of childhood symptom onset (65.63% vs. 25.19%, p < 0.01), genital lymphedema (62.50% vs. 19.26%, p < 0.01), and proximal-to-distal swelling (31.25% vs. 8.89%, p < 0.01). Eight patients without skin lesions had milk discharge after acupuncture or skin breakdown. Pattern 4 shows diffused dermal backflow of the leg and an absence of superficial lymphatic drainage, or normal initial cephalad flow with subsequent reflux of tracer into the affected limb. CR showed significantly higher percentages of pattern 4 (87.50% vs. 12.59%, p < 0.01), normal/widened iliac lymphatics (78.13% vs. 11.11%, p < 0.01), and thigh/calf outlining (87.50% vs. 29.63%, p < 0.01). Genital swelling preceding limb swelling and genital radioactivity were more common in the CR group. Conclusions: CR tends to occur in childhood initially, begin centrally and progress distally, and involve genitals prior to lower extremities. Milk discharge after acupuncture or skin breakdown is important for screening CR without chylous vesicles. The patterns with typical "profiling of the leg" and normal or widened iliac lymphatic trunks strongly correlate with CR. Genital lymphedema with increased radioactivity indicates CR.

Background The International Society of Lymphology (ISL) guidelines have established grading criteria for primary lower limb lymphedema (PLEL), but there is a lack of model on a unified standard for assessing the severity of the disease. Purpose The aim of this study was to establish and validate a predictive model for evaluating severe PLEL. Methods and Materials: This retrospective study included 226 patients with unilateral PLEL from 2018 to 2023, who were divided into non-severe (143 cases) and severe (83 cases) groups according to the ISL grading criteria. The two groups of patients had a total of 26 MRI and 15 clinical features recorded. One-way ANOVA was performed first, followed by multi-factor ANOVA, and logistic regression was used to construct a nomogram prediction model. The model’s performance was evaluated via the area under the receiver operating characteristic (ROC) curve (AUC), decision curve analysis, and internal validation. Results The predictive model identified six independent risk factors associated with the severity of PLEL, including the parallel line sign, crescent sign, longitudinal range, band sign thickness, fat area, and fat diameter. The nomogram model established based on the above six factors predicts a training set AUC of 0.908 (95% CI: 0.868–0.947) for severe PLEL, with a sensitivity of 0.868, specificity of 0.832, accuracy of 0.845, precision of 0.75. The AUC of the validation set was 0.891 (95% CI: 0.847 ~ 0.935), the sensitivity was 0.831, the specificity was 0.825, the accuracy was 0.827, the precision was 0.734. In decision curve analysis, more net benefit can be achieved when the threshold probability is between 1% and 90%. Conclusions The severity risk prediction model based on MRI and clinical practice has good discriminatory power and accuracy in evaluating the severity of PLEL which can provide a reference for individualized clinical prediction of PLEL.

This study offers new insights into the dual role of secretory phospholipase A2 (sPLA2) in lymphedema, highlighting its impact on lymphatic endothelial cell (LEC) functionality. Through transcriptomic analyses and co-culture experiments, we observed that sPLA2 has both protective and detrimental effects on human LECs (HLECs), mediated by macrophage activation. Our findings reveal that while low levels of sPLA2 promote LEC health, excessive sPLA2 leads to dysfunction, emphasizing the significance of the sPLA2/PLA2R axis and arachidonic acid metabolism (AA) in lymphedema pathology. The study suggests targeting sPLA2 and its downstream pathways as a novel therapeutic strategy for lymphedema, aiming to mitigate its progression by safeguarding HLEC integrity. This research underscores the importance of balanced sPLA2 activity in maintaining lymphatic vessel health and presents a new avenue for lymphedema management and treatment.

Objective:To handle blood loss during liposuction for secondary lymphedema of lower extremities in patients with secondary lymphedema.Methods:The clinical data of 214 patients with secondary lymphedema of the lower extremities undergoing liposuction at Department of Lymphatic Surgery, Capital Medical University Affliated Beijing Shijitan Hospital from Sep 2018 to Jan 2020 were retrospectively analyzed.Results:There were 209 females and 5 males. The average fat aspiration was (2 934.58±1 114.83) ml, the average blood loss was (986.04±425.16) ml, 117 patients were transfused, including autologous transfusion in 90 patients, 15 patients received allogeneic blood, and 12 patients received autologous plus allogeneic blood. The disease phase, operative time and fat aspiration were positively correlated with blood loss, and were independent risk factors affecting blood loss.Conclusion:Liposuction for secondary lymphedema of the lower extremity is an important factor leading to anemia.

Objective To investigate the clinical features of lymphoma patients with the first symptom of lymphedema.Methods From August 2010 to February 2022,12 patients with lymphoma who presentied with lymphedema as the first manifestation were selected as the observation group,and 20 patients with secondary lymphedema of the lower limbs after gynecological tumor surgery were selected as the control group.We collected the clinical characteristics of two groups of patients and analyze the clinical characteristics of lymphoma patients with lymphedema as the first manifestation.Results There were 12 cases with lymphoedema caused or aggravated by lymphoma,including 1 case with upper limb edema,10 cases with lower limb edema,and 1 case with systemic edema.These patients are often accompanied by clinical symptoms such as weakness,emaciation,pain,lumps,and enlarged lymph nodes.The proportion of patients with abnormal tumor markers is 6/8,and the prevalence of anemia is 6/12.The positive rates of ultrasound,computed tomography(CT),and magnetic resonance imaging(MRI)are 8/8,8/8,and 3/3,respectively.The patients are diagnosed by pathological diagnosis and immunohistochemistry.There were significant differences between the two groups in course of disease,main and concomitant symptoms,past history,tumor markers,anemia,and imaging examinations(P<0.01).Conclusion Lymphoma associated malignant lymphedema is rare and the incidence is insidious.In order to avoid misdiagnosis and delayed treatment of lymphoma,we should actively identify cause of lymphedema during follow-up.

Objective:To explore the blood loss during liposuction for secondary lymphedema of the lower extremities and to analyze the risk factors that influence the blood loss.Methods:Retrospective analysis of the clinical data of patients with secondary lymphedema of lower extremities at the Department of Lymphatic Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital from January 2019 to December 2019. The following clinical indicators were correlated with the amount of blood loss, including age, body mass, body mass index (BMI), primary disease, hypertension, radiotherapy history, chemotherapy history, erysipelas history, affected extremity, duration of swelling, duration of primary disease, International Society of Lymphology(ISL) stage, time of operation, infiltration volume, fat aspiration, blood-tinged fluid solution, volume difference, preoperative hemoglobin. Pearson analysis was used for the univariate analysis of continuous variables, Spearman analysis was used for the univariate analysis of classified variables, multiple linear regression was used for multivariate analysis of continuous variables, and Logistic regression was used for the multivariate analysis of classified variables.Results:174 patients were enrolled, all females with a median age of 55 years. Univariate analysis showed that the age( r=0.17, P=0.026), the body mass( r=0.37, P<0.001), BMI( r=0.29, P<0.001), hypertension( r=0.25, P=0.001), the ISL stage( r=0.40, P<0.001), operative time( r=0.44, P<0.001), infiltration volume( r=0.53, P<0.001), fat aspiration( r=0.36, P<0.001), blood-tinged fluid solution( r=0.61, P<0.001) and volume difference( r=0.63, P<0.001) were associated with the blood loss. There was no correlation between primary disease, radiotherapy history, chemotherapy history, erysipelas history, affected extremity, duration of swelling, duration of primary disease, preoperative hemoglobin and blood loss( P>0.05). Multivariate analysis showed that hypertension ( r=0.14, P=0.012), operative time ( r=0.15, P=0.019) and volume difference ( r=0.30, P=0.001) were independent risk factors affecting blood loss. Conclusion:Hypertension, operative time and volume difference are the risk factors of blood loss during liposuction for secondary lymphedema of the lower extremities.