Topical timolol in the treatment of periocular superficial infantile hemangiomas: a prospective study / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and side effect of topical beta-blocker (Timolol Maleate) in the treatment of periocular hemangioma in a prospective study.</p><p><b>METHODS</b>432 outpatients with infantile hemangioma visited our special clinic service in Shanghai Ninth People's Hospital from July 2010 to December 2011. Among them, 12 superficial periocular lesions were selected in the study. Timolol was used topically on the lesion in every 12 hours. Two independent special doctors evaluated the results according to the pictures before and after four-week application of timolol.</p><p><b>RESULTS</b>Were categorized into four levels: continuous growth (the lesion continues to grow), stable (no visible change), moderate (0-50% of regression) , perfect (more than 50% of improvement). Result of the 12 outpatients, 4 showed perfect result, 2 moderate, 4 stable and 2 continuous growth. No side effect was observed.</p><p><b>CONCLUSIONS</b>Topical timolol is effective and safe in the treatment of superficial periocular infantile hemangioma. It could be considered as the first line treatment of proliferative superficial hemangioma.</p>

A prospective study of propranolol as first-line treatment for problematic infantile hemangioma in China / 中华整形外科杂志

<p><b>OBJECTIVE</b>To prospectively assess the efficacy and safety or propranolol as a first-line treatment for problematic infantile haemangioma in China.</p><p><b>METHODS</b>From Mar. 2009 to Feb. 2010, 78 patients with problematic infantile hemangioma were included in the prospective study. The characteristics of the tumor, including sex, age, site, complications, were recorded. The response to treatment at 1 week, at 1 month and at the end of treatment was evaluated. The efficacy of treatment was graded as no response, stabilization, or accelerated regression. The indications for treatment, side effects and relapse after treatment were documented. The mean follow-up period was 16.7 months (range, 12.1-23.6 months).</p><p><b>RESULTS</b>Oral therapy was initiated at mean age of 3.7 months (range, 1.1-9.2 months) as first-line therapy. The mean age at the end of treatment was 11.2 months (range, 5.2-22.3 months). The treatment was lasted for 7.6 months (range, 2. 1-18.3 months). One week after treatment beginning, the hemangioma growth was controlled in all the patients. The accelerated regression was achieved in 88.5% (69/78) of patients after one week of treatment, and 98.7% (77/78) of patients after 1 month of treatment and at the end of treatment. Ulceration was occurred in 14 cases before treatment, which was healed after treatment for 2 months. Minor side effects were happened in 15.4% (12/78) of patients. Rebound growth of lesion was noticed in 35.9% (28/78) of patients.</p><p><b>CONCLUSIONS</b>Propranolol is effective in the treatment of infantile hemangioma with minor side effect. We suggest it should be used as the first-line treatment.</p>

Clinical application of imiquimod for the treatment of infantile hemangiomas / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the clinical application of imiquimod for the treatment of infantile hemangiomas (IH).</p><p><b>METHODS</b>320 children with IH, including 250 superficial cases, 20 deep cases, and 50 mixed cases, were treated with 5% imiquimod cream every other day for 16 weeks. The clinical efficacy and side effects were evaluated at one year of age.</p><p><b>RESULTS</b>The total effective rates of the superficial, deep, and mixed IH were 61.2% (153/250), 10.0% (2/20) and 60.0% (30/50) respectively, showing no statistical difference between superficial and deep type (P = 0.874), but significant difference between superficial and mixed (P < 0.01), deep and mixed type (P < 0.01). 56.0% (28/50) of mixed IH showed proliferation of its deep lesions. Slight skin erythema and crusting were the most common side effects.</p><p><b>CONCLUSIONS</b>5% imiquimod cream is effective and safe in superficial IH and superficial lesions of mixed IH with minimal skin reactions. The dysplasia of local tissue and systemic growth retardation are not found. It should be avoided to apply the cream to IH located around the cavities and skin fold. Imiquimod cream is a simple and convenient home-nursing medication. It can reduce care burden of family. Thus topical use of imiquimod can be considered as a good clinical indication for the treatment of superficial lesions of IH.</p>

Alterations in pulmonary arterial reactivity during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore the alterations in pulmonary arterial reactivity during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats.</p><p><b>METHODS</b>Sixty-six male Sprague-Dawley rats were randomly divided into 2 groups: bleomycin (BLM) group and sham group. The rats in BLM group were received single intratracheal instillation of BLM (5 mg/kg), and the rats in sham group received equal volume of 0.9% normal saline (NS). The alterations in pulmonary arterial reactivity were measured by vascular tension detected technique, the pathomorphological changes in the wall of pulmonary arteries were displayed with Hematoxylin-Eosin (HE) staining, the degree of fibrosis in lung was revealed with Masson staining, and the mean pulmonary arterial pressure was detected via a catheter in the pulmonary artery.</p><p><b>RESULTS</b>(1) The contractile response to a- adrenoceptor agonist phenylephrine (PE), of pulmonary arteries both with remaining endothelium and with removing endothelium, from BLM-treated rats , was reduced significantly, compared with sham rats (P both < 0.05). (2) The relaxant response to the endothelially dependent vasodilator acetylcholine (Ach), of pulmonary arteries with remaining endothelium, from BLM-treated rats, was also reduced, compared with sham rats (P < 0.01). (3) In sham rats, the contractile response to (omega) -nitro-L-arginine methyl ester (L-NAME) plus PE, of pulmonary arteries with remaining endothelium, was enhanced, compared with that to PE alone (P < 0.01), while in BLM group, the contractile responses to L-NAME plus PE, of pulmonary arteries with remaining endothelium, was not different from that to PE alone (P > 0.05). (4) In BLM group, vascular endothelial cells lost. (5) In BLM group, the initial stage of fibrogenesis was observed in lungs, and the mean pulmonary arterial pressure increased, compared with that in sham group (P < 0.05).</p><p><b>CONCLUSION</b>The abnormal responsibility of pulmonary arteries occurred during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats.</p>

Effects of rosiglitazone on the expression of connective tissue growth factor in the pulmonary arteries of rats suffering from fibrosis in lung / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore the effects of rosiglitazone (RSG), an agonist of peroxisome proliferators-activated receptor-gamma (PPAR-gamma), on the up-regulation of connective tissue growth factor (CTGF) and the deposition of type I and type III collagens in the pulmonary arteries of rats suffering from fibrosis in lung.</p><p><b>METHODS</b>Forty-eight male Sprague-Dawley rats were randomly divided into 4 groups: bleomycin (BLM) plus normal saline (NS) group (n=21), BLM plus RSG group (n=9), NS plus NS group (n=9), and NS plus RSG group (n=9). The rats were received single intratracheal instillation of BLM (5 mg/kg bw) or equal volume of NS as control, and received intra-gastric adminnistration of RSG (3 mg/(kg x day), 14 day) or the same volume of NS as vehicle. In vio, the observation was conducted on day 14 after intratracheal instillation. In vitro, the pulmonary arteries of rats on day 14 after BLM were isolated and incubated with DMEM alone or with RSG (37 degrees C, 5% CO2, for 24 h.</p><p><b>RESULTS</b>In vivo, the expression and the content of CTGF, the contents of type I and type III collagens, and the ratio of type I collagen and type III collagen were increased in the pulmonary arteries of BLM-instilled rats, compared with those of NS-instilled rats (All P < 0.05). The above abnormal changes were ameliorated by RSG (All P < 0.05). In vitro, RSG blocked the up-regulation of CTGF (P < 0.05), but not the deposition of type I collagen and type III collagen in the pulmonary arteries isolated from the BLM-instilled rats (P > 0.05).</p><p><b>CONCLUSION</b>The results suggest that RSG directly blocks the up-regulation of CTGF in pulmonary arteries of rats suffering from fibrosis in lung, and this might be one of the mechanisms underling the ameliorated pulmonary arterial remodeling by RSG.</p>

The pathological characteristics and clinical significances of maturational change of port-wine stain / 中华整形外科杂志

<p><b>OBJECTIVE</b>In this study histologic observations were presented to elucidate the possible mechanism of maturational change of port-wine stain(PWS).</p><p><b>METHODS</b>Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9 cases) were included to present histologic observations.</p><p><b>RESULTS</b>Normal PWS, only shows mild dilated, thin-walled vessels within superficial dermis. Thicken PWS, shows further dilated vessels and sebaceous gland throughout dermis and superficial subcutaneous fat. Nodular PWS can be divided into three groups. I Similar to thicken PWS, shows further dilated vessels and sebaceous gland throughout dermis and superficial subcutaneous fat. II Shows Large number of dilated vessels, honeycombing and less vascular mesenchymal. III Tenacious texture shows mild dilated vessels, diffused collagen, mesenchymal rarefaction, lymphocyte infiltration and lymphedema change.</p><p><b>CONCLUSIONS</b>Histologic examination revealed not only the expected vascular abnormalities, but also a number of widely distributed hamartomatous changes in thicken and nodular PWS. The complex hamartomatous changes suggest a genetically determined, multilineage developmental field defect in the pathogenesis of PWS.</p>

Pathological characteristics and clinical significance of macrochilia secondary to venular malformation / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To analyze the histologic characteristics of macrochilia secondary to port-wine stain and to elucidate the possible mechanism.</p><p><b>METHODS</b>Twenty-one cases of macrochilia secondary to venular malformation were included and the histology of the lesions was observed by light microscope.</p><p><b>RESULTS</b>Histological examination revealed vascular abnormalities and a number of widely distributed hamartomatous changes in macrochilia secondary to venular malformation. The average vessel diameter is (39.8 +/- 15.7) microm. The degree of hamartomatous change: mild (1 case), moderate (7 cases) and severe (13 cases).</p><p><b>CONCLUSIONS</b>The complex hamartomatous changes suggest a genetically determined, multilineage developmental field defect in the pathogenesis of venular malformation.</p>

Superselective ethanol endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce superselective endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations using absolute ethanol, and to assess the efficacy and complications of the method.</p><p><b>METHODS</b>A retrospective review of patient medical and imaging records was performed. 8 patients (7 male, 1 female, 11-50 years) with craniofacial arteriovenous malformations underwent staged selective ethanol endovascular therapy (1-4 times, median 2 times). Clinical follow-up (8-24 months, mean 12.1 months) was performed in all patients, and results from imaging follow-up (2-6 months, mean 4.3 months) were available in 4 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms, as well as the degree of devascularization at follow-up angiography.</p><p><b>RESULTS</b>16 sessions of selective ethanol endovascular therapy were performed in 8 patients. 5 of 8 patients were cured, 2 had improvement, 1 had no change. Selective ethanol endovascular therapy was considered effective in 7 patients (87.5%). 4 patients will need further treatment sessions for residual arteriovenous malformations. Blistering, superficial skin necrosis and transient hemolysis occurred in 4 of 8 patients. All the complications were healed with observation. No major complications occurred.</p><p><b>CONCLUSION</b>Superselective ethanol endovascular therapy under digital subtraction angiography has the potential for cure of craniofacial arteriovenous malformations and is able to obtain excellent cosmetic results, and with acceptable risk of complications.</p>

Expression of connective tissue growth factor in pulmonary artery at the early-stage of pulmonary fibrosis / 生理学报

To ascertain whether connective tissue growth factor (CTGF) participates in the remodeling of pulmonary artery at the early-stage of bleomycin (BLM)-induced pulmonary fibrosis, mean pulmonary arterial pressure, the expression of type I and type III collagens, and the expression and location of CTGF in pulmonary artery and arteriole were investigated in the present study. Sprague-Dawley rats received instillation of BLM [5 mg/kg body weight, in 0.5 mL of normal saline (NS)] or instillation of the same amount of NS as control. Mean pulmonary arterial pressure was detected via a catheter in the pulmonary artery. Type I and type III collagens were examined with Sirius red staining under polarized light. CTGF expression was investigated by using immunohistochemistry, and was represented as average optical density and percentage of positive area of CTGF. The mean pulmonary arterial pressure was higher in rats on day 14 after BLM instillation [(19.5+/-2.9) mmHg] than that in the control rats [(14.8+/-1.2) mmHg] (P<0.05). The type I and type III collagens were increased both in pulmonary artery and arteriole of rats on day 14 after BLM instillation, compared with those in the control rats (P<0.05, P<0.01, respectively). The ratio of type I/III collagens in pulmonary artery was also higher in BLM-treated rats than that in the control rats (P<0.05). The values of average optical density of positive CTGF staining were increased both in pulmonary artery (0.37+/-0.02) and arteriole (0.40+/-0.03) of rats on day 14 after BLM instillation, compared with those in the control rats (artery, 0.34+/-0.01; arteriole, 0.29+/-0.01) (both P<0.05). The percentages of positive area of CTGF were higher in pulmonary artery (8.40+/-1.13) and arteriole (12.4+/-2.0) of rats on day 14 after BLM instillation than those in the control rats (artery: 1.42+/-0.63; arteriole: 1.16+/-0.34), respectively (both P<0.05). The increased positive CTGF staining areas were mainly located in the endothelium and smooth muscle layer. It is therefore concluded that CTGF expression increases in the endothelium and smooth muscle layer of pulmonary artery and arterioles during high pulmonary arterial pressure and remodeling of pulmonary artery at the early-stage of BLM-induced pulmonary fibrosis, and that the increased CTGF might be one of the mechanisms of maintenance and development of pulmonary hypertension.

Isolation, culture and characterization of endothelial cells in infantile hemangioma / 中华整形外科杂志

<p><b>OBJECTIVE</b>To establish a method for the reliable isolation and culture of infantile hemangioma endothelial cells (HemECs) in vitro.</p><p><b>METHODS</b>Proliferative hemangioma specimens were digested by collagenase to form a single cell suspension. The HemECs were isolated using anti-CD31 coated dynabeads. The CD31+ cells were grown in fibronectin coated dishes. HemECs were identified by morphological characteristics and immunocytochemistry. The cells were also examined for their ability to intake LDL.</p><p><b>RESULTS</b>The method enabled the rapid isolation of HemECs that demonstrated typical endothelial cobblestone morphology in culture. The cells were positively stained for CD31, vWF. They also were labeled with DiI-Ac-LDL.</p><p><b>CONCLUSIONS</b>This technique can effectively isolate endothelial cells from the proliferative hemangiomas. These cells could be further used to research the mechanism of proliferation and degeneration of infantile hemangioma.</p>

Noninvasive laser therapy for skin superficial venous malformations with long pulsed Nd:YAG laser / 中华整形外科杂志

<p><b>OBJECTIVE</b>Conventional therapies for skin superficial venous malformations have demonstrated poor efficacy and many side effects. This prospective study assessed the effectiveness and safety of noninvasive long pulsed 1064 nm Nd: YAG laser therapy for superficial venous malformations.</p><p><b>METHODS</b>Twenty-two patients, aged 9 months to 67 years, skin types III, with skin superficial venous malformations were treated with the Nd:YAG laser at fluences of 140 - 150 J/cm2, with 6 mm spot size and double pulse model(pulse width 7 - 8ms, interpulse interval 20 ms). Contact cooling was used to protect epiderm. Patients were examined 1 month and 6 months after the last treatment. Results Were graded as percent clearance in five groups: 0%, 1% - 25%, 26% - 50%, 51% - 75%, 76% - 100%.</p><p><b>RESULTS</b>Twenty-two patients completed the study with maximal 5 treatment sessions. At 6 months after the final session, 76% - 100% clearance was observed in 96.3% of the treated sites, 100% improvement was observed in 37% of the treated sites. Pain during treatment was variably perceived by patients. Transient erythema were seen in 8 (38.1%) patients, but could resolve in 1 day to 1 month. None of patients have purpura, permanent pigmentation change and scarring.</p><p><b>CONCLUSIONS</b>Noninvasive long pulsed 1064 nm Nd: YAG laser is effective and safe enough for the treatment of skin superficial venous malformations and selectively remove superficial vessels. The side effects are minimal while ideal cosmetic results can be achieved.</p>

Repair alveolar cleft bone defects with bone marrow stromal cells / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of repairing alveolar cleft bone defects with bone marrow stromal cells.</p><p><b>METHODS</b>Total 7 patients of alveolar cleft were included in this study. The hBMSCs were isolated by percoll gradient centrifugation from patient's bone marrow aspirated from iliac crest. The hBMSCs were cultured in vitro and induced to become osteogenic cells in the DMEM medium containing 10% self-serum, beta-glycerophosphate (10 nmol/L) dexamethasone (10(-8) mol/L) , L-2-ascorbic acid(50 micromol/L), and 1, 25 (OH)2 VD3 (10 nmol/L). Induced hBMSCs of passage 3 were harvested and seeded onto partly demineralized allogenic bone matrix (pDBM) to form a cell-scaffold construct and in vitro co-culture for 1 week. The defects were repaired with the cell-scaffold construct. All cases were followed up for 3, 6 months post-operation as short-term evaluation and 1 to 3 years post-operation as long-term evaluation by three-dimensional computerized tomography (3D-CT) and clinical examination.</p><p><b>RESULTS</b>3D-CT demonstrated that engineered bone was formed in 3 months post-operation. Additionally, formed bone maintained stable up to 1 - 3 years without absorption.</p><p><b>CONCLUSIONS</b>Engineered bone can be used to repair clinical alveolar cleft bone defects.</p>

Construction of tissue engineered porcine corneal stroma with skin fibroblasts / 上海第二医科大学学报

Objective To explore the feasibility of constructing tissue engineered porcine corneal stroma with skin fibroblasts in vivo.Methods Skin fibroblasts were isolated from embryonic porcine,cultured and expanded in vitro.Cells were labeled with green fluorescence protein(GFP) gene by retro-viral infection.Cells at passage 3 were seeded on polyglycolic acid(PGA) non-woven fibers to form a cell-scaffold complex.The complexes were then implanted into porcines' corneal stroma after culturing in vitro for 1 week.Engineered stroma was observed continuously and harvested after 8 weeks for gross and histological evaluation.PGA with corneal stromal cells was served as control. Results The engineered tissue in the stroma gradually became transparent over a period of 8 weeks,showing no difference with the control group.Histologically,the engineered stromal lamellar was relatively regular and similar to the control.The implanted cells were confirmed by GFP expression under fluorescent microscope.By transmission electron microscopy examination, no significant difference in the diameter of collagen fiber was observed between the engineered stroma and normal stroma. Conclusion Tissue engineered corneal stroma may be formed with skin fibroblasts in porcine corneal microenvironment.