Drainage outflow restriction as a parameter associated with cortical venous reflux in craniofacial arteriovenous malformations with cavernous sinus drainage.

PURPOSE: Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to demonstrate how it affected our treatment strategy. METHODS: Cases of CF-AVMs associated with CS drainage were collected from a prospectively collected database of patients with CF-AVMs who underwent endovascular treatment from September 2016 to March 2018. Clinical data and angioarchitectural findings were analyzed. Factors associated with the presence of venous reflux (cortical venous reflux (CVR) or dural sinus reflux (DSR)) were analyzed. RESULTS: Fifteen CF-AVM patients associated with CS drainage were analyzed. Three cases of venous reflux from the CS were identified (CVR, 2; DSR, 1). Lesions with unilateral venous drainage, ≤ 2 draining veins, and the absence of antegrade CS outflow were more likely to develop venous reflux from the CS. We successfully performed additional trans-venous coil embolization of the superior ophthalmic vein in two patients with malformations associated with venous reflux to close this venous connection to the CS. CONCLUSION: CF-AVMs associated with CS drainage confer an increased risk of CVR and DSR, especially in cases where the drainage outflow is restricted. Identification of this venous angioarchitecture is essential in the evaluation and treatment planning of CF-AVMs.

Spontaneous Regression of Parapharyngeal Arteriovenous Malformation.

Arteriovenous malformations (AVMs) are fast-flow vascular malformations that mostly occur in the head and neck region. They are typically progressive and their spontaneous regression is almost never seen. We present a case with pulsatile tinnitus and a parapharyngeal AVM. It resolved completely after diagnostic catheter-based angiography alone.

Mutual Impact of Diabetes Mellitus and Tuberculosis in China.

China has a double burden of diabetes mellitus and tuberculosis, and many studies have been carried out on the mutual impact of these two diseases. This paper systematically reviewed studies conducted in China covering the mutual impact of epidemics of diabetes and tuberculosis, the impact of diabetes on multi-drug resistant tuberculosis and on the tuberculosis clinical manifestation and treatment outcome, the yields of bi-directional screening, and economic evaluation for tuberculosis screening among diabetes patients.

Relative bioavailability of rifampicin in four Chinese fixed-dose combinations compared with rifampicin in free combinations.

BACKGROUND: Decreases in the bioavailability of rifampicin (RFP) can lead to the development of drug resistance and treatment failure. Therefore, we investigated the relative bioavailability of RFP from one four-drug fixed-dose combination (FDC; formulation A) and three two-drug FDCs (formulations B, C, and D) used in China, compared with RFP in free combinations of these drugs (reference), in healthy volunteers. METHODS: Eighteen and twenty healthy Chinese male volunteers participated in two open-label, randomized two-period crossover (formulations A and C) or one three-period crossover (formulations B and D) study, respectively. The washout period between treatments was 7 days. Bioequivalence was assessed based on 90% confidence intervals, according to two one-sided t-tests. All analyses were done with DAS 3.1.5 (Mathematical Pharmacology Professional Committee of China, Shanghai, China). RESULTS: Mean pharmacokinetic parameter values of RFP obtained for formulations A, B, C, and D products were 11.42 ± 3.41 µg/ml, 7.86 ± 5.78 µg/ml, 13.05 ± 6.80 µg/ml, and 16.18 ± 3.87 µg/ml, respectively, for peak plasma concentration (C max ), 91.43 ± 30.82 µg·h-1·ml-1 , 55.49 ± 37.58 µg·h-1·ml-1 , 96.50 ± 47.24 µg·h-1·ml-1 , 101.47 ± 33.07 µg·h-1·ml-1 , respectively, for area under the concentration-time curve (AUC 0-24 h ). CONCLUSIONS: Although the concentrations of RFP for formulations A, C, and D were within the reported acceptable therapeutic range, only formulation A was bioequivalent to the reference product. The three two-drug FDCs (formulations B, C and D) displayed inferior RFP bioavailability compared with the reference (Chinese Clinical Trials registration number: ChiCTR-TTRCC-12002451).

[Analysis on the spatial clustering of tuberculosis based on provincial level in China from 2008 to 2010].

OBJECTIVE: To study the tuberculosis clustering areas and the changing trend, from 2008 to 2010, so as to provider the reference for tuberculosis control. METHODS: Global spatial autocorrelation and SaTScan methods were used to detect and analyse the spatial clustering of total tuberculosis notification rate and the new smear-positive pulmonary tuberculosis notification rate, at the provincial level from 2008 to 2010. RESULTS: The spatial clustering (SC) phenomenon was significant on total notification rate and new smear-positive pulmonary tuberculosis notification rate from 2008 to 2010 (P < 0.01). The coverages of clustering areas on total notification rate showed a reduction from 19 provinces to 14 provinces, distributed in the south, west and north-east areas of China. The coverages of clustering areas on new smear-positive pulmonary tuberculosis notification rate concentrated in 14 provinces which covered the south and north-east of China. CONCLUSION: The disease burden and the risk of transmission in the clustering areas of tuberculosis both located in the south and the north-east of China. The disease burden of tuberculosis was high in the west of China, but not the areas with high risk of transmission.

COSMC is overexpressed in proliferating infantile hemangioma and enhances endothelial cell growth via VEGFR2.

Infantile hemangiomas are localized lesions comprised primarily of aberrant endothelial cells. COSMC plays a crucial role in blood vessel formation and is characterized as a molecular chaperone of T-synthase which catalyzes the synthesis of T antigen (Galß1,3GalNAc). T antigen expression is associated with tumor malignancy in many cancers. However, roles of COSMC in infantile hemangioma are still unclear. In this study, immunohistochemistry showed that COSMC was upregulated in proliferating hemangiomas compared with involuted hemangiomas. Higher levels of T antigen expression were also observed in the proliferating hemangioma. Overexpression of COSMC significantly enhanced cell growth and phosphorylation of AKT and ERK in human umbilical vein endothelial cells (HUVECs). Conversely, knockdown of COSMC with siRNA inhibited endothelial cell growth. Mechanistic investigation showed that O-glycans were present on VEGFR2 and these structures were modulated by COSMC. Furthermore, VEGFR2 degradation was delayed by COSMC overexpression and facilitated by COSMC knockdown. We also showed that COSMC was able to regulate VEGF-triggered phosphorylation of VEGFR2. Our results suggest that COSMC is a novel regulator for VEGFR2 signaling in endothelial cells and dysregulation of COSMC expression may contribute to the pathogenesis of hemangioma.

Successful treatment of Kasabach-Merritt phenomenon with intralesional corticosteroid injections: a case series.

Kasabach-Merritt phenomenon (KMP) is a rare and life-threatening disease of vascular tumor combined with severe consumptive coagulopathy. Currently, there is no established effective treatment of KMP. In this case series, from 2006 to 2008, we treated 6 pediatric patients with newly diagnosed KMP using intralesional corticosteroid injections. The severity and progression of the disease were closely monitored with clinical photographs, blood sampling, and tissue biopsies. The 6 pediatric patients (5 females and 1 male) showed tumor regression after treatments. All coagulopathies were corrected. The average duration of treatment was 3.8 months. Complete tumor regression was observed at approximately 3 years. Treatment was complicated in 1 patient with transient growth retardation. Treatment based on intralesional corticosteroid injections is effective for pediatric patients with KMP. Treatment-associated complications seemed to be reversible and acceptable by severity level.

[Public health situation and needs assessment after Wenchuan earthquake in Anxian, Sichuan province].

OBJECTIVE: To explore the public health situation and needs in Anxian after Wenchuan earthquake so as to make an effective strategy for disease control and prevention. METHODS: 69 concentrated settlements with 100 residents were investigated. Probability proportion to size was adopted for sampling of 2200 residents from 687 scattered households (about 440 000 scattered residents). The content of this survey included drinking water, food hygiene, environment sanitation, planning immunity and medical health service, disease surveillance and so on. SPSS 16.0 was used for data analysis, and statistical interpretation was used to describe the results. RESULTS: 90.9% (31/66) resettled residents in Anxian lived in tents, 7.6% (5/66) lived in the movable-plate house, 93.3% (621/666) scattered households lived in tents and 71.9% (446/621) of them lived in tents which were built by residents themselves; the rate of drinking water disinfection in resettlement sites and scattered households were 97.1% (66/68) and 94.6% (650/687); 12.8% scattered residents had mouldy or food; 50% of resettlement sites raised animals; 43.6% (17/39) medical station didn't have bacterin inoculation service; 66.7% (10/15) lacked sufficient disinfection equipment; register rate was 50.0% (33/66) and report rate of symptoms and infectious diseases was 56.1% (37/66). CONCLUSION: There was still some risk of enteric and vector-borne diseases in Anxian, therefore, some tailored measures should be very important.

[Mental health assessment among scattered residents after Wenchuan earthquake in Anxian, Sichuan province].

OBJECTIVE: To explore the mental health status of residents scattered living in Anxian after Wenchuan earthquake so as to provide scientific basis for further mental health intervention. METHODS: A face to face interview was conducted among the scattered residents with designed questionnaire, which had three parts of the physical and emotional reaction, the relax methods and the social care and supports expected. Two-stage probability proportional to size (PPS) sample method was performed to sample 2184 from 0.44 million scattered residents in Anxian. On the basis of statistical description, mental health of different characteristics groups was compared. RESULTS: Three main symptoms of posttraumatic stress disorders in 2184 residents (11.23+/-3.44) were higher than the 103 fire victims in Hunan in 2003 (10.06+/-3.26), three factor scores of SCL-90 (5.76+/-1.74) were higher than normal in 1998 repair mode (n=23 891) (4.72+/-1.44), and the statistical difference was observed (t=10.77, P<0.05; t=706.04, P<0.05). Comparing the mental health of different groups, some significant differences were found by age, gender and education background. CONCLUSION: The earthquake disaster brought prevalent physical and emotional reaction. Elderly people, female, junior students need mental intervention immediately. Therefore, strengthen the mental education and assistance (especially in high risk groups) would be of more significance.

The use of artificial dermis for reconstruction of full thickness scalp burn involving the calvaria.

The incidence of extensive full thickness scalp burn involving the calvaria is rare and can be very difficult to reconstruct, as the application of local or free tissue transfer is limited. Although wound closure can be achieved with bone debridement and immediate or delayed split-thickness autografting, the result may be problematic due to unstable skin graft surface. The use of artificial dermis that may provide stable thick coverage in the treatment scalp and skull burn has rarely been reported in literature. We encountered two patients who suffered from severe head burns involving the calvarium. Following debridement including the necrotic bone, the artificial dermis (Integra) was used for immediate wound coverage which was 15 cmx10 cm in one case and 5 cmx6 cm in another. Three weeks later, ultra-thin skin grafting was placed on the neodermis. Compared to split-thickness skin graft, this technique provides a thicker coverage for wound closure. Neither skin breakdown nor ulceration was noted in the 1-year follow-up. This paper reports the successful use of artificial dermis for reconstruction of severe scalp burn with calvarial bone involvement.

Cutis marmorata telangiectatica congenita with gangrenous ulceration and hypovolaemic shock.

UNLABELLED: Cutis marmorata telangiectatica congenita (CMTC) is an uncommon sporadic congenital vascular anomaly characterised by persistent cutis marmorata, telangiectasia, and phlebectasia. The disease usually has a benign clinical course and over 50% of cases recover spontaneously without specific treatment. The occurrence of life-threatening complications in CMTC is rare. CONCLUSION: We report a neonate with life-threatening cutis marmorata telangiectatica congenita which was complicated by gangrenous ulceration, bleeding episodes, and hypovolaemic shock.

Sincipital encephalocele mismanaged as a facial hemangioma.

A 3-month-old male infant was found to have a protruding mass with irregular contour at the root of his nose since birth. The mass protruded more when he cried. It was diagnosed and treated as a hemangioma by laser surgery in another hospital. However, the lesion recurred 1 week later. Reviewing the previous computed tomographic study of the brain, it revealed that the protruding mass communicated with the brain. Sincipital encephalocele was diagnosed, and craniotomy for excising the encephalocele and repair of the dura were undertaken successfully. We report this patient with sincipital encephalocele that was misdiagnosed and treated as a vascular malformation on the face. Fortunately, there was no complication. The authors stress the importance of accurate diagnosis of a lesion near the craniofacial junction to avoid unnecessary surgery and possible catastrophes.