MASSAGE THERAPY FOR EXPERIMENTAL LYMPHEDEMA

描述(申请人摘要)：推拿疗法(手册形式) 淋巴引流(MLD)或手动淋巴水肿治疗(MLT)是不可或缺的 国际共识的组成部分--建议的最佳治疗方法 根据世界卫生组织的说法，手臂和腿的淋巴水肿(LE) 该组织影响着全球数亿人。事实上，在超过一年的时间里 世纪之交，各种形式的按摩与保健作用之间的密切联系 淋巴循环已被假定。尽管如此，试验性工作和 临床试验没有得到明确的证据表明，仅有MLD(没有 伴随机械加压)有效地防止或 改善LE早期高蛋白液体堆积或 尤其是当淋巴淤积已经长期存在并伴随着软组织时 组织硬化(象皮病)。此外，MLO AS的精确协议 作为CPT的一部分或作为独立医疗设备进行测试，以及最佳 有待采取的量化措施尚未得到客观评估。这 探索性提案将利用我们新改进的标准化LE动物 模型，与腹股沟根治术后的临床情况非常相似 解剖/放射治疗癌症。单侧后肢LE产生于 Wistar模糊大鼠单侧手术+放射治疗(包括序贯治疗 腹股沟淋巴清扫加局部淋巴清扫的手术 腹股沟照射)。控制对侧肢体和控制未被操作的和 假操作的大鼠将用作比较。由精炼提供帮助 淋巴/软组织成像/分析方式，我们将检查和比较 MLD不同“剂量”和治疗方案疗效的量化证据 单独和与机械压缩相结合，包括“机械 序贯多腔式气动压缩泵“推拿”在强化中的应用 淋巴吸收能力满足淋巴强制性负荷，降低 LE体积或阻止LE，并在早期重塑LE肢体 随后，在慢性LE伴纤维化和块状脂肪沉积。我们会 还可以评估不同类型的 啮齿动物模型的操作方法微型化和标准化。 这项探索性研究将为 随机化交叉临床的后续设计与实施 MLD单独及与不同形式机械联合应用的试验 加压在防治不同形式、不同分期的上颌骨中的作用 儿童和成人的下肢LE。它还将提供一个有用的 用于详细描述生理的实用标准化LE动物模型 淋巴系统的机制/作用，以及(淋巴)水肿被认为是 广泛的未经充分测试的替代/补充方法(例如 草药疗法、手法、透热疗法)在当前流行的 这个世界被称为“淋巴强迫症”和/或LE治疗。

DESCRIPTION (Applicant's Abstract): Massage therapy (in the form of Manual Lymph Drainage (MLD) or Manual Lymphedema Treatment (MLT) is an integral component of the international consensus-recommended optimal treatment for lymphedema(LE) of the arms and legs, which according to the World Health Organization affects hundreds of millions worldwide. Indeed, for more than a century, close links between various forms of massage and salutary effects on lymph circulation have been postulated. Nonetheless, experimental work and clinical trials have not yielded clear evidence that MLD alone (without accompanying mechanical compression) is efficacious in preventing or ameliorating LE in its early stages of high-protein fluid accumulation or particularly when lymphostasis has been long-standing with associated soft tissue hardening (elephantiasis). Furthermore, the precise protocol of MLO as part of CPT or for testing as an independent modality as well as the optimal quantitative measures to be followed have not been objectively evaluated. This exploratory proposal will utilize our newly refined standardized LE animal model, closely resembling the clinical condition following radical groin dissection/radiation for cancer. Unilateral hindlimb LE is produced in Wistar-fuzzy rats by unilateral surgery + radiation (consisting of sequential operative inguinal lymphatic ablation and lymphadenectomy followed by localized groin irradiation). Control contralateral limbs and control unmanipulated and sham-manipulated rats will serve for comparisons. Aided by refined lymphatic/soft tissue imaging/analytic modalities, we will examine and compare quantifiable evidence of the efficacy of varying "doses" and regimens of MLD alone and in combination with mechanical compression including "mechanical massage" by sequential multi-chamber pneumatic compression pumping in enhancing lymphatic absorptive capacity to meet the lymphatic obligatory load, reducing LE volume or preventing LE, and remolding the LE limb in early largely fluid LE and subsequently, in chronic LE with fibrosis and bulky fat deposits. We will also assess additive and synergistic interactions among the various manipulative approaches miniaturized and standardized for the rodent model. This exploratory study will lay the groundwork and evidence-based rationale for the subsequent design and implementation of randomized cross-over clinical trial of MLD alone and in combination with different forms of mechanical compression in prevention and treatment of various forms and stages of upper and lower limb LE in children and adults. It will also provide a useful practical standardized LE animal model for detailed delineation of physiologic mechanisms/effects in the lymphatic system, and (lymph)edema postulated for a wide array of inadequately tested alternative/complementary approaches (e.g. herbal remedies, manipulative methods, diathermy) in current popular use around the world as "lymphotonics" and/or for LE treatment.