Reduction of Edema and Pain in Transcutaneous Electrical Nerve Stimulation Treated-Arthritic Rat.

Transcutaneous electrical nerve stimulation (TENS) has been used to reduce pain or improve motor function in musculoskeletal and neurological disorders in the clinic. Although some studies have suggested electrotherapy as an intervention for edema, the effects and mechanisms of TENS on inflammation-induced edema remain unclear. Thus, we aimed to investigate the effects of TENS on arthritic pain with edema. 1% carrageenan was injected into the right tibiofemoral joint of 69 male Sprague-Dawley rats (200-250 g). After the development of arthritic pain, low-frequency (4-Hz, Low-TENS, n = 25) and high-frequency (100-Hz, High-TENS, n = 25) TENS with sub-motor threshold or placebo-TENS (n = 19) was applied for 20-min to medio-lateral part of the ipsilateral side. Weight bearing and knee-bend tests were used to assess pain-like behaviors. Also, we examined the size of edema and measured tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1ß) levels in the synovium by western blot. Eight rats in each of the two TENS groups were injected with Naloxone. Edema was reduced in the low- and high-frequency TENS groups at 6-h. TENS-treated rats showed reduced pain in the knee-bend test at 6-h. We observed decreased weight load shifts on the ipsilateral side in TENS groups. Naloxone reduced these effects. TNF-α and IL-1ß expression decreased in the synovial membrane at 6-h. These results suggest that low- and high-frequency TENS have acutely positive effects on inflammatory edema, with the management of arthritic pain and reduction in pro-inflammatory mediators. Therefore, Low-TENS and High-TENS may be useful in treating acute inflammatory pain and edema.

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR. METHODS: A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence. RESULTS: In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083). CONCLUSIONS: Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.

Inguinal intranodal lymphangiography reveals a high incidence of suprainguinal lymphatic disease in patients with leg edema undergoing stenting for symptomatic chronic iliofemoral venous obstruction.

OBJECTIVE: Recent studies have emphasized the important role lymphatics play in the drainage of interstitial fluid and edema prevention. Although the infrainguinal lymphatics have been studied in some depth, with patterns of pathology identified, such data above the groin are sparse, especially for patients with phlebolymphedema. The present study attempts to evaluate the status of lymphatic flow above the inguinal ligament in patients presenting with edema and undergoing stenting for symptomatic chronic iliofemoral venous obstruction (CIVO). METHODS: A total of 31 lower limbs that underwent pedal lymphoscintigraphy for leg edema and subsequent stenting for symptomatic CIVO formed the study cohort. Each limb underwent intranodal lymphangiography of an ipsilateral inferior inguinal lymph node (10 mL of lipiodol) at the time of stenting. Fluoroscopic visualization of lipiodol transit was performed at 20, 40, and 60 minutes and 3 hours after injection. Enumeration of the lymph nodes and lymphatic collector vessels from above the inguinal ligament to L1, visualization of the thoracic duct, the time delay to visualization of the thoracic duct, and pathologic changes to the thoracic duct when present were all evaluated. These anomalies were independently scored, with the scores combined to generate a total suprainguinal score (range, 0-3). This score was then compared to the limb's lymphoscintigraphically derived infrainguinal score (total infrainguinal score range, 0-3) using the t test and Spearman correlation. The clinical outcomes (grade of swelling, venous clinical severity score) after stenting were appraised. RESULTS: Of the 30 patients (31 limbs), 18 were women, with left laterality noted in 23 limbs. A nonthrombotic iliac vein lesion occurred in 9 limbs and post-thrombotic syndrome in 22 limbs. Of the 31 limbs, 24 (77%) had suprainguinal lymphatic disease (SLD), with 22 of the 24 limbs having severe SLD and 2, mild SLD. When SLD was compared with infrainguinal lymphatic disease, 6 limbs (19%) had the same degree of involvement above and below the groin (1 with normal and 5 with severe disease), 17 limbs (55%) had more severe SLD, and 8 limbs (26%) had more severe infrainguinal lymphatic disease. Three limbs with normal pedal lymphoscintigraphic findings had severe SLD. The Spearman correlation coefficient for the comparison of SLD and infrainguinal disease in the same limb was 0.1 (P = .69). At baseline, the limbs with severe SLD had the same degree of leg swelling and venous clinical severity score as the limbs with absent to mild SLD (P > .1) with similar improvements after stenting (P > .4). Seven limbs underwent complex decongestive therapy (all with severe SLD and concomitant severe infrainguinal disease in one) to treat significant residual leg edema, with improvement. CONCLUSIONS: SLD appears to be common in patients with leg edema undergoing stenting for symptomatic CIVO. Such disease appears to affect the thoracic duct more commonly. Although patients with persistent or residual leg edema after stenting can benefit from complex decongestive therapy, further workup in the form of inguinal intranodal lymphangiography and targeted intervention might need to be considered for those who do not benefit from such therapy. Further study is warranted.

Postoperative swelling after elbow surgery: influence of a negative pressure application in comparison to manual lymphatic drainage-a randomized controlled trial.

PURPOSE: Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery? METHODS: A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care. RESULTS AND CONCLUSION: NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p < 0.05). CONCLUSION: Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.

The Effect of Foot Massage Applied to Patients With Congestive Heart Failure on Peripheral Edema and Sleep Quality: A Randomized Controlled Study.

This randomized experimental study was conducted to determine the effect of foot massage on peripheral edema and sleep quality in patients with heart failure. The study sample comprised 60 adult patients (30 intervention and 30 control groups) who met the inclusion criteria and agreed to participate in the study. In the intervention group, foot massage was applied once a day for 10 minutes on each foot for a total of 7 days and then peripheral edema and sleep quality were evaluated. No application was made to the control group. Data were collected using a personal information form, a foot measurement record form for monitoring peripheral edema, and the Pittsburgh Sleep Quality Index. Forms were completed at the beginning of administration and at the follow-up at the end of 7 days (baseline and last follow-up). Statistically significant improvements were found in peripheral edema and sleep quality levels of the intervention group compared with the control group, starting from the fourth session of the foot massage application (P < .001).

Omalizumab is effective for a patient with pollen-food allergy syndrome who experienced intractable lip edema.

Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergic reaction caused when patients with pollen allergy ingest food having cross-reactivity with pollen. To date, no effective treatment method for this has been established. Here we report the case of a patient with PFAS who experienced lip edema, causing difficulties in treatment. This report describes the case of a 12-year-old boy with perennial allergic rhinitis since the age of 8 years. After ingesting fresh fruits and raw vegetables at the age of 11 years, he started to experience lip edema repeatedly. Thus, the patient was referred to our department. Based on the results of serum antigen-specific IgE, prick-to-prick, and allergen component tests, he was diagnosed with PFAS. He has been instructed to avoid causative food. Furthermore, the treatment using an antihistamine and antileukotriene receptor antagonist was initiated for pollen allergy. Sublingual immunotherapy (SLIT) for Japanese cedar pollen was initiated because the patient experienced severe nasal allergy symptoms during the dispersal season of this pollen. These treatments alleviated the nasal symptoms; however, the lip edema persisted. Omalizumab administration improved the lip edema. The combination of SLIT and omalizumab may be an effective treatment option for patients with PFAS.

Manual lymphatic drainage and Kinesio taping applications reduce early-stage lower extremity edema and pain following total knee arthroplasty.

BACKGROUND: Controlling early symptoms following total knee arthroplasty (TKA) is critical for long-term outcomes. OBJECTIVE: The purpose of this study was to compare the efficacy of manual lymphatic drainage (MLD) and Kinesio Taping®(KT) applications in terms of reducing lower extremity edema, pain, and improving function in the early postoperative period of TKA. METHODS: Forty-five female patients with unilateral TKA were allocated to an additional postoperative MLD treatment (n = 15) with exercises, additional Kinesio Taping® (n = 15) with exercises, or exercise-only (n = 15). Lower limb circumference, range of motion (ROM), pain level, and knee osteoarthritis outcome score (KOOS) were compared. RESULTS: Both MLD (p < .001; effect size range = 0.65-0.87) and the KT group (p = .001; effect size range = 0.74-0.78) had lower edema and pain levels (MLD group: p < .001; effect size = 0.84; KT group: p < .001; effect size = 0.78) compared to the control group on postoperative day 4. These beneficial effects continued only two weeks postoperatively, and no group differences were found by six weeks. CONCLUSION: Additional MLD or KT applications to standard exercises were both effective on early-stage lower extremity edema and pain levels. Clinicians might implement one of these applications to the standard rehabilitation programs to control pain and edema following TKA.

Use of Kinesio® taping and manual lymphatic drainage to manage traumatic edema and ecchymosis post arthroscopic meniscectomy in a recreational weightlifter: A case report.

BACKGROUND: Previous studies have reported success of edema management with manual lymphatic drainage (MLD) or Kinesio® taping. However, there is limited evidence investigating the use of a combination of the two postoperatively and evidence is conflicting due to limitations of published trials. The purpose of this case report was to describe the utilization of MLD and Kinesio® taping in the physical therapy (PT) management of edema and ecchymosis post-arthroscopic meniscectomy. CASE DESCRIPTION: A 51 year-old male was referred to PT 10 days after meniscectomy. He presented with increased edema that was not atypical secondary to a suspected saphenous vein injury. Severe edema and ecchymosis began 24 hours after surgery, which led to pain and decreases in range of motion (ROM) and difficulty with gait. Interventions for edema management consisted of MLD, Kinesio® taping and therapeutic exercise. OUTCOMES: The patient was seen for five visits over 10 days for edema management that resulted in decreases in girth and pain and increases in ROM and the Lower Extremity Functional Scale, and Patient Specific Functional Scale. He was able to sleep, return to the gym, and squat without pain. DISCUSSION: Following MLD and Kinesio® taping in conjunction with therapeutic exercises, edema and ecchymosis were reduced allowing for improved function acutely. Early and aggressive edema management postoperatively should be considered to optimize patient outcomes. This case demonstrated early management of edema facilitated increases in ROM and ease of patient-specific activities and decreased pain in five visits.

[Effect on ankylosing spondylitis at early-middle stage and bone marrow edema of sacroiliac joint treated with acupuncture and governor vessel moxibustion].

OBJECTIVE: To observe the efficacy of the combined treatment with acupuncture and governor vessel moxibustion on ankylosing spondylitis (AS) at early-middle stage and investigate the effect on bone marrow edema of sacroiliac joint. METHODS: Seventy patients of AS at early-middle stage were randomized into an observation group (35 cases) and a control group (35 cases, 1 case dropped off ). In the control group, the recombinant human tumor necrosis factor receptor-antibody of type Ⅱ fusion protein for injection was injected subcutaneously, 25 mg each time, once on every Monday and Friday, consecutively for 3 weeks. In the observation group, on the base of the intervention as the control group, acupuncture combined with governor vessel moxibustion were provided. Acupuncture was applied to Dazhui (GV 14), Changqiang (GV 1), Zhibian (BL 54), Baihui (GV 20), etc.; the thermal needling technique was adopted at Dazhui (GV 4) and Changqiang (GV 1) for promoting the circulation of the governor vessel, and the ginger-isolated moxibustion on the governor vessel was combined. Such intervention measure was provided once daily. One treatment session contained 7 treatments and 3 sessions were required. Before and after treatment, the scores of Spondyloarthritis Research Consortium of Canada (SPARCC), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis patient global score (BAS-G) were observed in the two groups separately. The efficacy and adverse effects were assessed in the two groups after treatment. RESULTS: The scores of SPARCC, BASDAI, BASFI and BAS-G were all reduced after treatment compared with those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 82.4% (28/34) in the control group (P<0.05). There were 4 cases of gastrointestinal reactions and 1 case of skin rashes in the control group; and 3 cases of local skin redness and pruritus after governor vessel moxibustion, no any drug adverse effect was found in the observation group. CONCLUSION: Based on the western medicine treatment, the combined therapy of acupuncture and governor vessel moxibustion may relieve bone marrow edema of sacroiliac joint in patients with AS at early-middle stage, control the progression of disease and improve the daily life activity. This therapy is relatively safe and effective.

Tarantula cubensis extract (Theranekron®) inhibits inflammation in carrageenan-induced acute paw edema in rats / [Extrato de tarântula cubensis (Theranekron®) inibe a inflamação no edema induzido por algas vermelhas na pata de ratos]

The aim of this study was to investigate the anti-inflammatory effect of alcoholic extract of Tarantula cubensis alcoholic extract (TCAE) in experimentally induced inflammation in rats. Fifty-four adult Sprague-Dawley male rats were randomly divided into nine groups. Paw edema was induced by 0.2mL subplantar (s.p.) injection of 1% carrageenan (CAR) into the right hind paw. Rats were treated with the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (INDO) (10mg/kg, p.o.) or TCAE at different doses (1, 10 or 100µg/kg) injected s.c. for systemic or s.p. for local anti-inflammatory effect. Saline was used as control. Changes in paw thickness, volume, and weight were calculated as percentages. Formalin-fixed paws were used for histopathological examination. We detected that TCAE applied s.c. at 10µg/kg and 100µg/kg doses resulted in thinner paw thickness, lower paw volume, and lower paw weights four hours after the induction of inflammation when compared with the INDO group (p<0.05). The paw edema inhibitory effect of TCAE applied at a dose of 10µg/kg, s.c. was 68% when compared with the INDO which had an inhibitory effect of 56%. These results were verified with similar histopathological findings. The anti-inflammatory feature of 10µg/kg of TCAE given systematically was similar to the effects of INDO. Our results suggest that TCAE has anti-inflammatory effects by reducing edema and decreasing inflammatory reaction. These results may be attributed to the inhibition of the production of proinflammatory mediators. Thus, TCAE may be considered as a potential anti-inflammatory agent for treating acute inflammatory conditions.

O objetivo deste estudo foi investigar o efeito anti-inflamatório do extrato alcoólico de Tarantula cubensis (TCAE) na inflamação induzida experimentalmente em ratos. Cinqüenta e quatro ratos Sprague-Dawley adultos machos foram divididos aleatoriamente em nove grupos. O edema da pata foi induzido pela injeção de 0,2mL de subplantar (s.p.) de 1% de carragena (CAR) na pata traseira direita. Ratos foram tratados com o medicamento antiinflamatório não esteróide (NSAID) indometacina (INDO) (10mg/kg, p.o.) ou TCAE em doses diferentes (1, 10 ou 100µg/kg) injetado s.c. para efeito sistêmico ou s.p. para efeito antiinflamatório local. A soro fisiológico foi usado como controle. As mudanças na espessura da pata, volume e peso foram calculadas como porcentagens. As patas fixadas com fórmalina foram usadas para exame histopatológico. Detectamos que o TCAE aplicado s.c. em doses de 10µg/kg e 100µg/kg resultou em menor espessura da pata, menor volume da pata e menor peso da pata quatro horas após a indução da inflamação quando comparado com o grupo INDO (p<0,05). O efeito inibidor do edema da pata de TCAE aplicado na dose de 10µg/kg, s.c. foi de 68% quando comparado com o INDO que teve um efeito inibidor de 56%. Estes resultados foram verificados com resultados histopatológicos semelhantes. A característica anti-inflamatória de 10µg/kg de TCAE dada sistematicamente foi semelhante aos efeitos do INDO. Nossos resultados sugerem que o TCAE tem efeitos anti-inflamatórios reduzindo o edema e diminuindo a reação inflamatória. Estes resultados podem ser atribuídos à inibição da produção de mediadores pró-inflamatórios. Assim, o TCAE pode ser considerado como um agente antiinflamatório potencial para o tratamento de condições inflamatórias agudas.

Low-level laser therapy is effective in controlling postoperative pain in lower third molar extractions: a systematic review and meta-analysis.

This systematic review aimed to evaluate the effectiveness of low-level laser therapy in controlling postoperative pain in lower third molar extractions. A search was carried out in MEDLINE/PubMed, Web of Science and Cochrane Library (CENTRAL) databases, using the "low-level laser therapy", "photobiomodulation therapy", "impacted mandibular third molar", "mandibular third molar", "third molar extraction" descriptors and 2625 studies were found, including only randomized clinical trials published until July 2020, with no restrictions on language and country of study. Selected studies were submitted to initial screening based on the reading of titles, abstracts and full article, and duplicate studies were excluded. Overall, 2562 articles were found, of which only 15 randomized clinical trials were included in this review. A total of 648 patients (16-44 years) who received low-level laser therapy as an intervention and placebo in their control group were evaluated. The pain evaluation criterion was the Visual Analog Scale (VAS) on the second and seventh days after surgery. Photobiomodulation with low-level laser showed statistically significant reduction in postoperative pain in lower third molar extractions, both on the second (MD: - 0.59; CI: - 0.92, - 0.27) and seventh day after surgery (MD: - 0.76; CI: - 1.21, - 0.32).

Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial.

PURPOSE: Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars. METHODS: A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05). RESULTS: Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002). CONCLUSION: The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

[The use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint]. / Primenenie elektromiostimulyatsii v dvizhenii pri lechenii posttravmaticheskikh otekov golenostopnogo sustava.

Injuries of the ligamentous apparatus of the ankle joint are one of the most common injuries of the ODA. A large number of complications and a long period of disability require the development of modern methods of physiotherapy treatment that can reduce the number of relapses and reduce the duration of rehabilitation. OBJECTIVE: Evaluation of the effectiveness of the use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint. MATERIAL AND METHODS: 51 athletes with post-traumatic edema of the ankle joint were examined. The main complaints were the presence of pronounced edema in the area of injury, pain, restriction of movement in the joint. The patients were randomly divided into 2 groups: the 1st group (25 patients) received treatment with electromyostimulation in motion (while performing therapeutic gymnastics); the 2nd (control) group (26 patients) performed therapeutic gymnastics recommended for the treatment of patients with lymphovenous insufficiency. The method of laser Doppler flowmetry was used to study microcirculatory disorders in the area of injury. Peripheral hemodynamics was evaluated by the RVG method. The severity of edema was assessed by measuring the circumference of the lower leg in the lower third of the injured and healthy limb. The thickness of subcutaneous fat was assessed by ultrasound. The subjective feelings of athletes were evaluated using CIVIQ-2 questionnaires and pain syndrome assessment according to VAS. RESULTS AND CONCLUSION: The use of electromyostimulation in motion in patients with post-traumatic edema of the ankle joint helped to reduce pain, relieve soft tissue edema, increase the volume of movements in the affected joint, increase motor activity and improve the quality of life.

[Application of kinesis-taping and low frequency pulse magnetic therapy in medical rehabilitation of athletes with post-traumatic edema of the lower extremities]. / Primenenie kinezioteipirovaniya i nizkochastotnoi impul'snoi magnitoterapii v meditsinskoi reabilitatsii sportsmenov s posttravmaticheskim otekom nizhnikh konechnostei.

In the conditions of increasingly stringent anti-doping rules, the development of new non-drug methods of treatment and rehabilitation of athletes is of particular importance. OBJECTIVE: Development of new methods of medical rehabilitation of athletes after injury. MATERIAL AND METHODS: Thirty-three athletes with knee injuries were examined. The main complaints were the presence of pronounced edema in the area of injury. All patients were randomly divided into 2 groups: in group 1 (16 patients) lymphatic drainage kinesis-taping was performed; in the 2nd group (17 patients) - complex treatment including lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy. Using laser Doppler flowmetry a study of microcirculatory disorders in the area of injury was carried out. The severity of edema was assessed by measuring the circumference of the knee joint of the diseased and healthy limbs. The assessment of the subjective feelings of athletes using questionnaires CIVIQ2 andVAS. RESULTS AND CONCLUSION: Based on the obtained subjective and objective data, a medical complex was developed using lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy, which affects different steps in the pathogenesis of edema formation. Data obtained resultedin more pronounced positive effect during complex treatment compared with monotherapy with kinesis-taping.

Complex Decongestive Therapy in the Physical Therapist Management of Rosacea-Related Edema (Morbus Morbihan Syndrome): A Case Report With a New Approach.

OBJECTIVE: The aim of this case report was to describe the use of complete decongestive therapy (CDT) with a new approach in the management of a male with facial edema related to Morbus Morbihan Syndrome (MMS). METHODS: An 18-year-old male with MMS after acne treatment was the subject of this case report. Volume assessment was performed with distance measurements of the facial area using standard reference points, the overflow method, and the measurement of the percentage of subdermal fluid. Participant-reported symptoms of lymphedema (feeling of swelling and tightness) and body image perception were evaluated with the visual analogue scale, and the severity of anxiety was evaluated with the State and Trait Anxiety Inventory. In addition, the participant's perception of improvement was determined using a Likert-type scale. Evaluations were performed at baseline, week 4 (during the treatment), and week 8 (immediately after treatment). CDT was applied to the participant in a total of 24 sessions, 3 d/wk for 8 weeks. RESULTS: Compared with the baseline measurement, the facial distances (tragus-mental cavity, tragus-mouth corner, mandibula-nasal canal, mandibula-internal orbita, mandibula-external orbita, mental cavity-internal orbita, mental cavity-mandibula, right-left tragus, and hairline in the forehead-mental cavity), the volume, and the percentage of subdermal fluid of facial area were decreased at the week 4 and 8 measurements. The anxiety score, participant reports of feelings of swelling and tightness, and body image perception improved after the 8 weeks of treatment compared with baseline. CONCLUSION: This case report described the use of CDT in treating edema and participant symptoms in an individual with facial lymphedema related to MMS. Body image and level of anxiety improved.

Efficacy of a probiotic supplement in patients with atopic dermatitis: a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: Atopic dermatitis (AD) is a multifactorial long-standing inflammatory skin disease with a high incidence worldwide in both adults and children. According to the recognized correlation between skin and intestine-the so-called "gut-skin axis"-gut unbalances can affect skin by inducing systemic inflammation and triggering dermatological diseases such as AD. OBJECTIVES: To evaluate the efficacy of a food supplement containing selected strains of probiotics in ameliorating AD symptoms and skin conditions in adult volunteers. MATERIALS & METHODS: Eighty adult subjects showing mild-to-severe AD, skin dryness, desquamation, erythema and itching were enrolled in a randomized controlled trial to receive, for 56 days, a placebo or a mixture of lactobacilli (L. plantarum PBS067, L. reuteri PBS072 and L. rhamnosus LRH020). The latter was chosen according to the patients' production of post-biotic metabolites and B-group vitamins, anti-inflammatory and anti-oxidant capacity and anti-microbial activity. Clinical and instrumental dermatological evaluation was performed at T0d, T28d and T56d, and then at T84d (after a one-month wash-out). Inflammatory cytokine levels from skin tape stripping, sampled close to AD lesions at T0d and T56d, were also measured. RESULTS: Subjects receiving the probiotic mixture showed an improvement in skin smoothness, skin moisturization, self-perception, and a decrease in SCORAD index as well as in the levels of inflammatory markers associated with AD at T28d, with a positive trend up to T56d which was maintained at T84d. CONCLUSION: Administration of selected probiotic strains resulted in a fast and sustained improvement in AD-related symptoms and skin conditions.

The effect of low-level laser therapy as an adjunct to periodontal surgery in the management of postoperative pain and wound healing: a systematic review and meta-analysis.

The meta-analysis and systematic review aimed to evaluate the effect of low-level laser therapy (LLLT) as an adjunct to periodontal surgery in the management of postoperative pain and wound healing. An electronic search in 4 databases (PubMed, Embase, Cochrane, and OpenGrey) was conducted for randomized clinical trials reporting the effectiveness of LLLT used as an adjunct to periodontal surgery to alleviate pain and accelerate wound healing compared with surgery alone. Finally, 13 studies were eligible and included. The results showed a significant difference of pain relief between groups at day 3 post-surgery, whereas no difference was found at day 7. Moreover, a significant reduction was observed in the mean analgesic intake during the first week in the LLLT group. On day 14, the adjunctive use of LLLT showed significantly faster re-epithelialization and better wound healing in palatal donor sites following free gingival graft procedures. Based on the results, LLLT used as an adjunct to periodontal surgery positively influenced postsurgical pain control. Low power (≤ 500 mW) combined with energy density ≥ 5 J/cm2 might be more appropriate for postoperative pain relief. Moreover, adjunctive LLLT to free gingival grafts could significantly accelerate wound healing of palate sites at early healing phase. Multicenter studies using different LLL parameters without postsurgical analgesics are needed to determine optimal laser settings.

Lymphatic treatments after orthopedic surgery or injury: A systematic review.

BACKGROUND: Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process. AIMS: To examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging. METHODS: English literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro. INCLUSION CRITERIA: randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score. RESULTS: We evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c. CONCLUSION: After elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.

Bringing Palliative Care Downstairs: A Case-Based Approach to Applying Palliative Care Principles to Emergency Department Practice.

Although the emergency department (ED) may not be traditionally thought of as the ideal setting for the initiation of palliative care, it is the place where patients most frequently seek urgent care for recurrent issues such as pain crisis. Even if the patients' goals of care are nonaggressive, their caregivers may bring them to the ED because of their own distress at witnessing the patients' suffering. Emergency department providers, who are trained to focus on the stabilization of acute medical crises, may find themselves frustrated with repeat visits by patients with chronic problems. Therefore, it is important for ED providers to be comfortable discussing goals of care, to be adept at symptom management for chronic conditions, and to involve palliative care consultants in the ED course when appropriate. Nurse practitioners, with training rooted in the holistic tradition of nursing, may be uniquely suited to lead this shift in the practice paradigm. This article presents case vignettes of 4 commonly encountered ED patient types to examine how palliative care principles might be applied in the ED.

In Vitro and In Vivo Anti-inflammatory Activity of Bovine Milkfat Globule (MFGM)-derived Complex Lipid Fractions.

Numerous health related properties have been reported for bovine milk fat globule membrane (MFGM) and its components. Here we present novel data on the in vitro and in vivo anti-inflammatory activity of various MFGM preparations which confirm and extend the concept of MFGM as a dietary anti-inflammatory agent. Cell-based assays were used to test the ability of MFGM preparations to modulate levels of the inflammatory mediators IL-1ß, nitric oxide, superoxide anion, cyclo-oxygenase-2, and neutrophil elastase. In rat models of arthritis, using MFGM fractions as dietary interventions, the phospholipid-enriched MFGM isolates were effective in reducing adjuvant-induced paw swelling while there was a tendency for the ganglioside-enriched isolate to reduce carrageenan-induced rat paw oedema. These results indicate that the anti-inflammatory activity of MFGM, rather than residing in a single component, is contributed to by an array of components acting in concert against various inflammatory targets. This confirms the potential of MFGM as a nutritional intervention for the mitigation of chronic and acute inflammatory conditions.