Journals at the University of Arizona
Not a member yet
18839 research outputs found
Sort by
TOPICAL TACROLIMUS 0.1% FOR TREATMENT OF CUTANEOUS MICROCYSTIC LYMPHATIC MALFORMATIONS
Full text linkMicrocystic lymphatic malformations asdescribed in the international literature form asubgroup of low-flow congenital vascular malformations(VM) resulting from irregularembryological development. Microcystic lesionsnormally manifest as an accumulation oflymph- and blood-filled vesicles that, when externalized,cause skin maceration with consequentpain and potential infection resulting inthe impairment of the patient's quality of life.There is no consensus on a standardizedalgorithm nor clear guidelines for successfultreatment of this type of lymphatic malformation,and treatment options employed often resultin ambivalent and transient outcomes witha high rate of recurrence. The topical formulationof tacrolimus is a well-known FDAapprovedanti-T cell agent that was recentlyidentified as a potent activator of ALK1, whichis involved in several processes and functionsincluding angiogenesis. We investigated iftopical administration of tacrolimus may be aneffective therapy for directly targeting cutaneousmicrocystic lymphatic malformations as acomplement to systemic treatment. The studyenrolled four patients with cutaneous microcysticlymphatic malformations: three male(ages: 13,15,18) and one female (age: 30). Twoof the patients presented lesions on their backs,one patient on the left hand and one on the leftlower limb. All four patients received treatmentwith topical tacrolimus 0.1% twice a day for 10weeks on a previously selected area forapplication. Weekly clinical follow-ups wereconducted along with close physician-patientcontact. All patients displayed a satisfactoryresponse after treatment. Lymphorrhea andbleeding were stopped in all cases and theesthetic aspect of lesions improved in twopatients. To date, all patients presented noclinically significant changes to the size orextension of the lesion. Topical tacrolimustreatment is a promising and reasonable optionfor microcystic lymphatic malformations. Ourresults encourage further exploration in largerpopulations with the consideration that it is asafe and effective alternative or complementarytherapy to systemic treatment
EDITORIAL
No full textMORBIDITY MANAGEMENT AND DISABILITY PREVENTION:AN AGENDA FOR DEVELOPING NATIONS INITIATED IN INDI
Gendered geographies of violence: a multiple case study analysis of murdered women environmental defenders
No full textThis study illustrates how, despite the diversity of women environmental defenders and their movements around the world, there are near-universal patterns of violence threatening their survival. Violence against women environmental defenders, often perpetrated by government-backed corporations, remains overlooked. Research on this issue importantly contributes to discussions about environmental justice because women defenders make up a large proportion of those at the frontlines of ecological distribution conflicts. Through comparative political ecology, this research analyzes cases from the Environmental Justice Atlas, an online open-access inventory of environmental distribution conflicts, in which one or more women were assassinated while fighting a diverse array of extractive and polluting projects. Although the stories showcase a breadth of places, conflicts, social-class backgrounds, and other circumstances between women defenders, most cases featured multinational large-scale extractive companies supported by governments violently targeting women defenders with impunity.Keywords: Violence, murder, women environmental defenders, EJAtlas, comparative political ecology
Hybrid Behavior-Genetic Models of the Confounding Gene-Environment Correlations in the Development of Life History Strategy: Two Convergent Approaches
No full textTraditional theories of development and evolutionary developmental psychology propose that early environmental experiences shape an individual’s developmental trajectory. According to the Adaptive Calibration Model (ACM), for example, calibration of speed of life history strategy to ecological cues encountered during development contributes to behavior that is conditionally adaptive to the organism’s environment. These theories emphasize the role of environmental influences and typically do not use designs that control potential genetic confounds. To address this methodological problem, the current study used a genetically informative design to test whether the phenotypic associations of parental instability and abuse with a slow life history factor were confounded by common genetic factors. We analyzed twin and singleton data from the Midlife in the United States (MIDUS) Survey using two convergent structural equation modeling approaches. Both approaches suggest that, when accounting for shared genetic variance across instability, abuse, and slow life history, some hypothesized environmental pathways between the early environmental measures and slow life history were not required. Once genetic factors were controlled, only parental instability was directly related to slow life history, while other hypothesized environmental pathways were non-significant. This suggests that developmental models that emphasize environmental and contextual pathways should control for possible genetic confounds
COMPARISON OF COMPLETE DECONGESTIVE THERAPY AND KINESIOLOGY TAPING FOR UNILATERAL UPPER LIMB BREAST CANCER-RELATED LYMPHEDEMA: A RANDOMIZED CONTROLLED TRIAL
No full textWe designed a study to compare effects ofcomplete decongestive therapy (CDT) andkinesiology taping (KT) (with exercise and skincare) on limb circumference, lymphedemavolume, grip strength, functional status, andquality of life in patients with unilateral breastcancer-related lymphedema (BCRL). Fortypatients with unilateral stage 2 BCRL wererandomized to either the CDT group (n=20) orthe KT group (n=20). Patients in the CDTgroup underwent 30-min manual lymphaticdrainage (MLD) and multi-layer, short-stretchbandaging once a week for four weeks. Patientsin the KT group underwent taping once a weekfor four weeks. In addition, all patients wereinformed about skin care and given an exerciseprogram throughout the treatment. Upperextremity circumference and volume differencesas primary outcomes and grip strength,Quick-Disabilities of the Arm, Shoulder andHand (Q-DASH), and Functional Assessmentof Cancer Therapy-Breast (FACT-B) scores assecondary outcomes were assessed initially,after treatment (4 weeks), and at the 1st monthfollow-up. Limb circumference and volume differenceswere significantly reduced in the CDTgroup after the 4-week treatment comparedwith the KT group (p=0.012 and p=0.015,respectively), but there was no difference betweenthe groups in the 1st month follow-up(p0.05). There was no difference between thegroups in terms of grip strength, Q-DASH, andFACT-B scores after treatment and at the 1stmonth follow-up (p0.05). Our results showthat both KT and CDT were found to significantlyreduce limb volume and circumferenceindividually at 4-weeks and the one-monthfollow-up in patients with BCRL and thatCDT significantly reduced both limb volumeand circumference compared to KT at the 4-week time point, but not at the follow-up.Further randomized controlled trials withpatients at different stages of BCRL areneeded to confirm and expand these results
NON-CONTRAST MR LYMPHOGRAPHY OF RARE LYMPHATIC ABNORMALITIES
No full textDetailed imaging of the lymphatic system often requires direct injection of contrast into lymph nodes which can be technically challenging, time consuming, and produce painful stimuli. We sought to describe the use of non-contrast MR lymphography (NCMRL) for normal controls and patients with a variety of rare disorders associated with lymphatic pathologies. Two control subjects and five affected patients (decompensated Fontan circulation, central conducting lymphatic abnormality, familial lymphedema and two with Gorham-Stout disease) were studied. NCMRL images were segmented in a semi-automated fashion and the major lymphatic channels and thoracic duct (TD) highlighted for identification. Adequate imaging was available for both controls and 4/5 affected patients; the youngest patient could not be imaged given patient motion. For the two controls, the TD was seen in the expected anatomic location. For the decompensated Fontan patient, there were numerous tortuous lymphatic channels, predominantly in the upper chest and neck. For the familial lymphedema patient, a TD was not identified; instead, peripheral lymphatic collaterals near the lateral chest walls. For the first Gorham-Stout patient, the TD was enlarged with large intrathoracic lymph collections. For the second Gorham-Stout patient, there were bilateral TD with lymph collections in vertebral bodies. Using NCMRL, we were able to image normal and abnormal lymphatic systems. An important learning point is the potential need for sedation for younger patients due to long image acquisition times and fine resolution of the structures of interest
ASSESSMENT OF LYMPHEDEMA WITH LYMPHOSCINTIGRAPHY: CAN NODAL QUANTIFICATION HELP?
No full textLymphoscintigraphy with combinedqualitative and quantitative analysis is reportedto be a more sensitive approach to diagnoselymphedema in comparison with the conventionalclinical analysis. Our study seeks toevaluate the diagnostic performance of lowerlimb lymphoscintigraphy with amalgamation ofqualitative and quantitative analysis by measuringthe ilio-inguinal nodal uptake. Thisprospective observational study was comprisedof 86 patients (172 limbs) diagnosed with lowerlimb lymphedema. After a thorough clinicalgrading of edema, radionuclide lymphoscintigraphywas performed as per a dedicatedinstitutional protocol. Ilio-inguinal nodalquantification of tracer uptake was computedalong with the visual study of the scans.Additionally, the corresponding mean nodaluptake percentage for each grade of lymphedemawas assessed and a cut off nodal uptakepercentage to differentiate between normal andabnormal limbs was defined. Although quantitativeanalysis with nodal uptake percentageprovides objective criteria to diagnose lymphedema,it can only act as an adjunct to qualitativemethod without replacing it. Finally,standardization of procedure for quantitativelymphoscintigraphy is needed including thepotential for combining both rate of clearanceof tracer from injection site and nodal uptakefor quantification
