***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Manual lymphatic drainage ( MLD ) is an adjunctive method of chronic venous disease ( CVD ) therapy . Evaluation of the change at the clinical stage , hemodynamic parameters and quality of life ( QoL ) following venous system surgery in CVD patients undergoing MLD preoperatively are the most interesting aspects of the study . Material and methods The CVD patients qualified for elective surgery of the venous system were r and omly divided into 2 groups : the  MLD group ( n = 38 ) and the  control group ( n = 32 ) . In the preoperative period , the MLD group underwent a series of MLD through a period of 2 weeks . The control group did not undergo MLD preoperatively . Both groups were evaluated for CVD staging on the day of qualification for surgery and between 25 and 30 days post-operatively . Additionally , the MLD group was evaluated after the series of MLD . The CVD staging was evaluated in both groups with a QoL question naire ( CIVIQ ) , CEAP classification , foot volumetry ( FV ) and venous refilling time ( VRT ) . Results Parameter values obtained in the MLD group ( before treatment/after MLD/after surgery ) : CEAP 2.23/2.15/2.10 , VRT 15/13/15.6 , FV 3625/3472/3418 , CIVIQ-complaints : 54.4/43.8/38.2 and CIVIQ-meaning : 57.3/49.3/43.1 . Parameter values obtained in control group ( before surgery/after surgery ) : CEAP 2.4/2.12 , VRT 13/14.9 , FV 3581/3559 , CIVIQ-complaints : 51.9/38.7 and CIVIQ-meaning : 53.7/40.6 . The CVD patients statistically improved in CEAP staging , FV and QoL in both groups ( p < 0.05 ) . Conclusions The MLD alone significantly reduced FV in patients with CVD , also improving their QoL. The MLD applied in CVD patients at the preoperative stage results in better surgical outcome , which is demonstrated by reduced disease progression , FV reduction and improvement in the Objective : To compare the efficacy of low-frequency low-intensity electrotherapy and manual lymphatic drainage in the treatment of chronic upper limb breast cancer-related lymphoedema . Design : Cross-over single-blind r and om clinical trial . Setting : Rehabilitation service . Participants : Thirty-six women with chronic upper limb breast cancer-related lymphoedema . Methods : Patients were r and omized to undergo 10 sessions of manual lymphatic drainage followed by 10 sessions of low-frequency low-intensity electrotherapy or to undergo first low-frequency low-intensity electrotherapy followed by manual lymphatic drainage . There was a month of washout time between treatments . Each patient was examined just before and after each treatment . Research ers and outcome assessors were blinded for assigned treatment . Measures : Outcomes were lymphoedema volume , pain , heaviness and tightness , and health-related quality of life measured with the Functional Assessment of Cancer Therapy Question naire for Breast Cancer version 4 ( FACT-B+4 ) . Carry-over , period and treatment effects were analysed . Treatment effect was assessed using paired t-test . Results : Thirty patients finalized treatment . Comparing the changes in low-frequency low-intensity electrotherapy with manual lymphatic drainage changes , there were no significant differences . Low-frequency low-intensity electrotherapy did not reduce lymphoedema volume ( mean of change = 19.77 mL , P = 0.36 ) , but significant reductions were observed in pain , heaviness and tightness ( mean of change = 13.1 , 16.2 and 6.4 mm , respectively ) , and FACT-B+4 summaries improved significantly ( Trial Outcome Index mean of change = 5.4 , P = 0.015 ) . Manual lymphatic drainage showed no significant changes in any of the outcomes Conclusion : Although there are no significant differences between treatment changes , the observed trend towards a better health-related quality of life is remarkable in low-frequency low-intensity electrotherapy AIM Manual Lymphatic Drainage ( MLD ) may increase the quality of life ( QoL ) of patients with chronic venous disorder ( CVD ) . The aim of the study was to determine the effect of MLD in patients with CVD who were c and i date s for venous surgery . METHODS Patients with CVD selected for elective venous surgery were r and omly divided into 2 groups ( N.=20 ) . In the preoperative period , patients in the MLD group underwent MLD 3 times a week for 5 weeks . Patients in the control group did not undergo MLD . Both groups were evaluated for CVD staging on the day of selection for surgery and again 25 days after surgery . CVD staging was evaluated by : HADs ( Hospital Anxiety and Depression scale ) , CEAP classification and Venous Reflux Index ( VRI ) . RESULTS Mean parameter values in the MLD group ( before treatment/after MLD/after surgery ) : Anxiety 12.85/8.85/4.95 , Depression 9.40/6.30/3.00 , VRI 0.39/0.25/0.17 , CEAP 3.60/2.95/1.55 . Parameter values in the control group ( before treatment/after surgery ) : Anxiety 10.95/3.45 , Depression 7.55/2.20 , VRI 0.30/0.10 , CEAP 3.55/1.80 . In the MLD group there was improvement of QoL ( P<0.05 ) and clinical stage according to the CEAP scale ( P<0.05 ) , and VRI ( P<0.03 ) . CONCLUSIONS After surgery , the MLD group had significantly better results than the control group in CEAP score ( P<0.05 ) and had comparable results for QoL.  MLD improved ( P<0.05 ) VRI , CEAP score , anxiety and depression states .  MLD can be an alternative or a supplementary procedure for patients surgically treated PURPOSE / OBJECTIVES To examine the impact of advanced practice nurse (APN)-administered low-level laser therapy ( LLLT ) as both a st and -alone and complementary treatment for arm volume , symptoms , and quality of life ( QOL ) in women with breast cancer-related lymphedema . DESIGN A three-group , pilot , r and omized clinical trial . SETTING A private rehabilitation practice in the southeastern United States . SAMPLE 46 breast cancer survivors with treatment-related lymphedema . METHODS Patients were screened for eligibility and then r and omized to either manual lymphatic drainage ( MLD ) for 40 minutes , LLLT for 20 minutes , or 20 minutes of MLD followed by 20 minutes of LLLT . Compression b and aging was applied after each treatment . Data were collected pretreatment , daily , weekly , and at the end of treatment . MAIN RESEARCH VARIABLES Independent variables consisted of three types of APN-administered lymphedema treatment . Outcome variables included limb volume , extracellular fluid , psychological and physical symptoms , and QOL . FINDINGS No statistically significant between-group differences were found in volume reduction ; however , all groups had clinical ly and statistically significant reduction in volume . No group differences were noted in psychological and physical symptoms or QOL ; however , treatment-related improvements were noted in symptom burden within all groups . Skin improvement was noted in each group that received LLLT . CONCLUSIONS LLLT with b and aging may offer a time-saving therapeutic option to conventional MLD . Alternatively , compression b and aging alone could account for the demonstrated volume reduction . IMPLICATION S FOR NURSING APNs can effectively treat lymphedema . APNs in private healthcare practice s can serve as valuable research collaborators . KNOWLEDGE TRANSLATION Lasers may provide effective , less burdensome treatment for lymphedema . APNs with lymphedema certification can effectively treat this patient population with the use of LLLT . In addition , bioelectrical impedance and tape measurements can be used to assess lymphedema OBJECTIVE To evaluate the efficacy of manual lymphatic drainage ( MLD ) in improving health-related quality of life ( HRQOL ) , symptomatology , and physical status in patients with chronic venous insufficiency ( CVI ) . DESIGN Single-blind r and omized controlled trial . SETTING Health community attendant service . PARTICIPANTS Subjects with CVI ( N=41 ) were r and omly assigned to an experimental group ( n=20 ; mean age , 54.6±11.3y ) or control group ( n=21 ; mean age , 46.8±11.1y ) . INTERVENTIONS The experimental group completed 10 lower extremity MLD sessions over 4 weeks and 1 educational session . The control group only attended the educational session . Outcome measures were taken at baseline ( t0 ) , at the end of 4 weeks ( t1 ) , and after 2 months for follow-up ( t2 ) . MAIN OUTCOME MEASURES HRQOL was assessed with the Chronic Venous Insufficiency Quality of Life Question naire-20 , symptoms ( fatigue , heaviness ) were assessed with a visual analog scale , severity of the disease was assessed with the Venous Clinical Severity Score ( VCSS ) ( total score , score for each item ) , leg volumetry was assessed with perimeters , and plantar/dorsiflexion strength and ankle range of motion ( ROM ) were assessed with dynamometry . RESULTS A significant interaction group × time effect was found for pain on HRQOL ( F2,78=3.507 ; P=.035 ; partial η2=.087 ) , clinical severity ( F2,78=5.231 ; P=.007 ; partial η2=.118 ) , especially for venous edema ( assessed with the VCSS ) , fatigue ( F1.67,65.21=4.690 ; P=.012 ; partial η2=.107 ) , and heaviness ( F1.57,61.32=9.702 ; P=.001 ; partial η2=.199 ) , with the experimental group improving from t0 to t1 and t0 to t2 in all of these outcomes . No effect of MLD treatment could be found for ankle muscle strength , ankle ROM , and leg volume . CONCLUSIONS Short-term MLD treatment ameliorates CVI severity and related edema , symptoms , and pain HRQOL in patients with CVI PURPOSE Because of its morbidity and chronicity , arm lymphedema remains a concerning complication of breast cancer treatment . Although massage-based decongestive therapy is often recommended , r and omized trials have not consistently demonstrated benefit over more conservative measures . PATIENTS AND METHODS Women previously treated for breast cancer with lymphedema were enrolled from six institutions . Volumes were calculated from circumference measurements . Patients with a minimum of 10 % volume difference between their arms were r and omly assigned to either compression garments ( control ) or daily manual lymphatic drainage and b and aging followed by compression garments ( experimental ) . The primary outcome was percent reduction in excess arm volume from baseline to 6 weeks . RESULTS A total of 103 women were r and omly assigned , and 95 were evaluable . Mean reduction of excess arm volume was 29.0 % in the experimental group and 22.6 % in the control group ( difference , 6.4 % ; 95 % CI , -6.8 % to 20.5 % ; P = .34 ) . Absolute volume loss was 250 mL and 143 mL in the experimental and control groups , respectively ( difference , 107 mL ; 95 % CI , 13 to 203 mL ; P = .03 ) . There was no difference between groups in the proportion of patients losing 50 % or greater excess arm volume . Quality of life ( Short Form-36 Health Survey ) and arm function were not different between groups . CONCLUSION This trial was unable to demonstrate a significant improvement in lymphedema with decongestive therapy compared with a more conservative approach . The failure to detect a difference may have been a result of the relatively small size of our trial BACKGROUND No prospect i ve study of the long-term sequelae of more than 10 years after acute deep vein thrombosis exists so far . Therefore , 58 low-risk patients with DVT were included in a prospect i ve study to evaluate the natural history of postthrombotic syndrome . METHODS AND RESULTS Clinical and hemodynamic examinations were performed at the time of admission ; after 3 , 6 , and 12 months ; after the 2nd , 3rd , 4th , 5th years ; and finally after the 12th year . All patients received heparin initially and oral anticoagulants subsequently . After 12 years , 64 % of the patients exhibited normal findings . Mild skin changes were found in 28 % , marked trophic changes in 5 % , and only one venous ulcer occurred . Regular use of compression stockings was reported by 54 % of the patients with multilevel thrombosis . Although mean maximum venous outflow was significantly reduced from the acute event to 12 years later ( P<.003 ) compared with the contralateral leg , a significant ( P<.05 ) improvement was observed 6 months later . Recanalization of calf vein thrombosis was detected by Do 
    Output:
    
The small numbers of patients analysed in all studies may have result ed in lack of power to detect between-group differences in HRQoL. Conclusions The effect of MLD on the HRQoL of patients with chronic oedema is unclear