{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:16:16Z","timestamp":1777922176343,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We aimed to clarify whether pathological changes in skin and subcutaneous tissue with lymphedema affected the skin hardness sensed by palpation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      In 50 patients with unilateral legs with lymphedema (LE), the skin hardness of the lower inner thigh and lower inner calf was determined using a scale ranging from 1 (softest) to 7 (hardest) based on palpation. Then, the skin hardness was correlated with the measurements of skin\/subcutaneous tissue ultrasonography images obtained from the palpated parts. Multivariate logistic regression analysis demonstrated that dermal thickness was a significant factor that affected the difference in skin hardness between the LE and the contralateral asymptomatic leg for both thigh (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and calf (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.01). When the thigh and calf in the LE were individually studied, subcutaneous echogenicity (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05), indicating subcutaneous inflammation\/fibrosis, and subcutaneous thickness (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.01) also seemed to affect skin hardness, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The skin hardness sensed in the LE seemed to be affected predominantly by dermal thickening. In addition, the pathological changes in the subcutaneous tissue caused by LE seemed to have an impact on skin hardness. Clinical Trial Registration number 2020\u2013150.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lrb.2020.0133","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T16:12:25Z","timestamp":1637165545000},"page":"368-375","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Hardness Sensed by Skin Palpation in Legs with Lymphedema Is Predominantly Correlated with Dermal Thickening"],"prefix":"10.1177","volume":"20","author":[{"given":"Kotaro","family":"Suehiro","sequence":"first","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukie","family":"Mizumoto","sequence":"additional","affiliation":[{"name":"Department of Nursing, Yamaguchi University Hospital, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriyasu","family":"Morikage","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takasuke","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Samura","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Nagase","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriko","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Mizoguchi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kurazumi","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimikazu","family":"Hamano","sequence":"additional","affiliation":[{"name":"Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,8,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-4801.2005.00066.x"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2014.0049"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2018.0089"},{"key":"e_1_3_3_5_2","first-page":"4","article-title":"Mechanical behaviour of skin: A review","volume":"5","author":"Kalra A","year":"2016","unstructured":"Kalra A, , Lowe A, , Al-Jumaily AM. 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Eur J Dermatol, 2000; 10:492\u2013497.","journal-title":"Eur J Dermatol"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1075-122X.2004.21458.x"},{"key":"e_1_3_3_12_2","first-page":"3","article-title":"The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology","volume":"53","author":"Executive Committee of the International Society of L","year":"2020","unstructured":"Executive Committee of the International Society of L. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. 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