Direct medical costs of tuberculosis patients and its influencing factors in Hainan Province / 中国热带医学

@#Abstract： Objective　To investigate and analyze the factors influencing the direct medical costs of tuberculosis patients in Hainan Province, so as to provide scientific reference for reducing the medical burden of patients and adjusting the medical insurance reimbursement policies in the local area. Methods　Using the total health expenditure accounting data of Hainan Province in 2020, including the outpatient and inpatient data of 14 provincial medical institutions, 235 city and county level medical institutions, and other relevant data from the 2020 Hainan Statistical Yearbook and Health Financial Yearbook, the direct medical costs of tuberculosis patients in the province in that year were calculated, and the influencing factors were explored using single factor analysis and multivariate generalized linear model. Results　The final number of cases included in this study was 11 979, including 7 526 males (62.83%) and 4 453 females (37.17%). The total direct medical costs of patients were 43.207 3 million yuan, of which the total outpatient costs were 2.733 9 million yuan (6.32%) and the total inpatient costs were 40.473 4 million yuan (93.67%). In the cost composition analysis, the drug cost was 17.971 million yuan (41.44%), the examination cost was 8.854 7 million yuan (20.49%), other costs were 16.445 5 million yuan (38.06%), and the median (quartile) M(P25,P75) direct medical cost of each patient was 177.50 (66.73,764.89) yuan. The multivariate generalized linear model analysis showed that hospitalization, new rural cooperative medical insurance (NRCMI) and urban employee medical insurance were the influencing factors of the increase in direct medical costs of tuberculosis patients the median (quartile) M(P25,P75) of direct medical costs are 10 425.04 (6 560.87,17 374.9), 10 246.5 (5 871.28,17 220.33), 3 177.2 (293.09,7 730.23) yuan respectively; the OR(95%CI) values were -3.505 (-3.499- -3.517), 1.559 (1.551-1.569) and 2.191 (2.188-2.207) respectively. Conclusions　The direct medical costs of tuberculosis patients in Hainan Province are high. Hospitalization, the new rural cooperative medical insurance and the medical insurance for urban workers are the influencing factors of the increase in costs.

Cystathionine ß-synthase expression correlates with tumor development and poor prognosis in patients with adenocarcinoma of the gastroesophageal junction.

OBJECTIVES: To reveal the expression level of cystathionine ß-synthase (CBS) in adenocarcinoma of esophagogastric junction (AEG) and discuss the relationship between CBS expression level and tumor microvascular density (MVD), clinical features and prognosis. METHODS: Paraffin samples from 214 patients with AEG were selected to make pathological microchips. Immunohistochemistry was performed based on the microchips to detect the expression level of CBS and microvascular density (MVD) in cancer tissues and adjacent control tissues. Relationships between expression level of CBS and MVD, clinical characteristics and prognosis were analyzed. RESULTS: In total, 214 AEG cases were classified into three groups: CBS negative staining (n=26), low staining (n=44), and high staining (n=144). Quantitative alterations in CBS and CD31 expression were explored using immunohistochemistry. The 5-year recurrence rate of enrolled patients was followed up and found that CBS expression was significantly increased in tumor tissue compared with adjacent non-tumor tissue (P<0.0001). There were significant differences in microvascular density between the groups with negative and high CBS staining (P<0.0001), and between the groups with low and high CBS staining (P<0.0001). Univariate analysis revealed significant differences in tumor stage (P<0.0001), T stage (P=0.008), N stage (P=0.028), differentiation degree (P=0.037), and 5-year survival (P=0.0034) among the three groups. Multivariate logic regression analysis showed that increased CBS scores were associated with an increased probability of 5-year recurrence (P=0.018). Finally, different CBS expression levels were associated with disease-free survival in AEG patients. CONCLUSIONS: CBS expression level is closely related to microvascular density and tumor stage in AEG. High level of CBS not only accelerates tumor angiogenesis but also affects patient's survival and prognosis.

Metabolic Profiling Revealed Prediction Biomarkers for Infantile Hemangioma in Umbilical Cord Blood Sera: A Prospective Study.

Infantile hemangioma (IH), the most common benign tumor in infancy, mostly arises and has rapid growth before 3 months of age. Because irreversible skin changes occur in the early proliferative stage, early medical treatment is essential to reduce the permanent sequelae caused by IH. Yet there are still no early screening biomarkers for IH before its visible emergence. This study aimed to explore prediction biomarkers using noninvasive umbilical cord blood (UCB). A prospective study of the metabolic profiling approach was performed on UCB sera from 28 infants with IH and 132 matched healthy controls from a UCB population comprising over 1500 infants (PeptideAtlas: PASS01675) using liquid chromatography-mass spectrometry. The metabolic profiling results exhibited the characteristic metabolic aberrance of IH. Machine learning suggested a panel of biomarkers to predict the occurrence of IH, with the area under curve (AUC) values in the receiver operating characteristic analysis all >0.943. Phenylacetic acid had potential to predict infants with large IH (diameter >2 cm) from those with small IH (diameter <2 cm), with an AUC of 0.756. The novel biomarkers in noninvasive UCB sera for predicting IH before its emergence might lead to a revolutionary clinical utility.

KangFuXin Liquid in the Treatment of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis.

BACKGROUND: Diabetic foot ulcer (DFU) is one of the most common complications of diabetes mellitus, with the wound not healing as expected and healing slowly. Poor control can develop into gangrene and even amputation. Currently, the existing treatments are not satisfactory enough. In China, KangFuXin liquid (KFXL) has been clinically used to treat DFU and has shown good clinical efficacy. In order to provide more reference to clinicians and experts, evidence of efficacy for it needs to be further rigorously evaluated. METHODS: Eight electronic databases were searched to identify eligible randomized clinical trials (RCTs) published from construction of the library to April 2019. There is no language or data restriction; 11 trials involving 889 participants met the inclusion criteria. These RCTs compared the total effective rate, cure rate, cure time, and adverse events associated with KFXL. The Cochrane Handbook guidelines were used to assess the risk of bias and to evaluate the methodological quality of eligible studies. The methodological quality of included studies was generally low. Dichotomous and continuous data were presented using risk ratios (RRs) and mean differences (MDs), respectively. RESULTS: Compared with the basic treatment, meta-analyses showed that KFXL combined with basic treatment can improve the total effective rate (RR = 1.38; 95% CI = 1.23-1.54; P < 0.00001; fixed effect model: I 2 = 32%) and cure rate (RR = 1.67; 95% CI = 1.17-2.38; P=0.005; random effect model: I 2 = 65%), and shorten the healing time (MD = -5.73; 95% CI = -6.95 to -4.52; P < 0.00001; random effect model). Moreover, under the same basic treatment, KFXL had a better effect than external use of pharmaceutical medications (RR = 1.95; 95% CI = 1.30-2.93; P=0.001), but the cure rate was not significantly different. Also, KFXL had nothing to do with adverse reactions. CONCLUSION: The evidence confirms that KFXL is an effective treatment for DFU. However, further large-scale, rigorously designed trials and high-quality studies are needed to confirm the role of KFXL in the treatment of DFU.

Clinical significance of LMO1 in gastric cancer tissue and its association with apoptosis of cancer cells.

It has been reported that LMO1 gene was associated with progression, metastasis and apoptosis of leukemia, colorectal cancer and lung cancer. However, the association of LMO1 and gastric cancer remains unclear. The aim of this study is to analyze the relation between LMO1 expression and apoptosis of gastric cancer cells and explore the clinical implications of LMO1 in gastric cancer tissues. The results demonstrated that expression levels of LMO1 and Bcl-2 proteins in gastric cancer tissues were higher than those in adjacent tissues, whereas the opposite was detected for Bax expression (P<0.05). LMO1 protein was associated with TNM staging and lymph node metastasis in gastric cancer (P<0.05). The survival rate of the patients with positive LMO1 gastric carcinoma was lower than that with negative LOM1 expression, and LMO1 was as an independent prognostic factor in COX survival analysis (P<0.05). LMO1-siRNA transfected MKN45 cells had a significant decrease in LMO1 expression and the cell viability, despite of an increase in the apoptotic rate (P<0.05). Following LMO1-siRNA transfection, Bcl-2 expression decreased, while the expression of Bax increased (P<0.05). It's concluded that overexpressed LMO1 in gastric cancer could be as one of new markers of poor prognosis.

Serum-level changes of vascular endothelial growth factor in children with infantile hemangioma after oral propranolol therapy.

Oral propranolol is the first-line therapy for infantile hemangioma (IH), but its mechanism of action remains unclear. The aim of this study was to evaluate the change in serum vascular endothelial growth factor (VEGF) levels in patients with IH who underwent propranolol treatment. The study included 22 patients with IH receiving propranolol treatment. At three time points-before treatment and 1 and 3 months after treatment-blood samples were examined by enzyme-linked immunosorbent assay for serum VEGF expression. The mean serum VEGF concentration in children with proliferative hemangiomas was 395.0 ± 176.7 pg/mL, approximately twice as high as in patients with venous malformations (mean 170.7 pg/mL) and in healthy controls (204.8 pg/mL, p = 0.006). After 1 month of propranolol treatment, the level had fallen 21.6% (p = 0.003), although the downward trend was less obvious after 3 months of treatment (18.0%, p = 0.63). VEGF expression correlated significantly with the lesion size (correlation coefficient [R] = 0.43, p = 0.046), whereas no correlation was observed with age (R = 0.13, p = 0.56). Serum VEGF levels were higher in patients with IH and fell after 1 month of oral propranolol treatment. Similar results, although less pronounced, were found after 3 months of treatment. Lesion volume and serum level of VEGF were significantly correlated.

Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies.

OBJECTIVES: To investigate the association between intake of fish and n-3 polyunsaturated fatty acids (n-3 PUFA) and the risk of breast cancer and to evaluate the potential dose-response relation. DESIGN: Meta-analysis and systematic review of prospective cohort studies. DATA SOURCES: PubMed and Embase up to December 2012 and references of retrieved relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective cohort studies with relative risk and 95% confidence intervals for breast cancer according to fish intake, n-3 PUFA intake, or tissue biomarkers. RESULTS: Twenty six publications, including 20,905 cases of breast cancer and 883,585 participants from 21 independent prospective cohort studies were eligible. Eleven articles (13,323 breast cancer events and 687,770 participants) investigated fish intake, 17 articles investigated marine n-3 PUFA (16,178 breast cancer events and 527,392 participants), and 12 articles investigated alpha linolenic acid (14,284 breast cancer events and 405,592 participants). Marine n-3 PUFA was associated with 14% reduction of risk of breast cancer (relative risk for highest v lowest category 0.86 (95% confidence interval 0.78 to 0.94), I(2)=54), and the relative risk remained similar whether marine n-3 PUFA was measured as dietary intake (0.85, 0.76 to 0.96, I(2)=67%) or as tissue biomarkers (0.86, 0.71 to 1.03, I(2)=8%). Subgroup analyses also indicated that the inverse association between marine n-3 PUFA and risk was more evident in studies that did not adjust for body mass index (BMI) (0.74, 0.64 to 0.86, I(2)=0) than in studies that did adjust for BMI (0.90, 0.80 to 1.01, I(2)=63.2%). Dose-response analysis indicated that risk of breast cancer was reduced by 5% per 0.1g/day (0.95, 0.90 to 1.00, I(2)=52%) or 0.1% energy/day (0.95, 0.90 to 1.00, I(2)=79%) increment of dietary marine n-3 PUFA intake. No significant association was observed for fish intake or exposure to alpha linolenic acid. CONCLUSIONS: Higher consumption of dietary marine n-3 PUFA is associated with a lower risk of breast cancer. The associations of fish and alpha linolenic acid intake with risk warrant further investigation of prospective cohort studies. These findings could have public health implications with regard to prevention of breast cancer through dietary and lifestyle interventions.

[Topical timolol in the treatment of periocular superficial infantile hemangiomas: a prospective study].

OBJECTIVE: To investigate the efficacy and side effect of topical beta-blocker (Timolol Maleate) in the treatment of periocular hemangioma in a prospective study. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Effects of Chinese liquors on cardiovascular disease risk factors in healthy young humans.

OBJECTIVES: To elucidate whether consumption of two Chinese liquors, tea-flavor liquor (TFL) and traditional Chinese liquor (TCL) have protective effects on cardiovascular disease (CVD) risk factors in healthy human subjects. METHODS: Forty-five healthy subjects (23 men, 22 women), aged 23-28, were recruited and randomized into two groups: TFL and TCL, and consumed 30 mL/day (45% (v/v) alcohol) of either liquor for 28 days. RESULTS: Serum high-density lipoprotein cholesterol/low-density lipoprotein cholesterol (HDL-C/LDL-C) and apolipoprotein A1 were significantly increased, and total cholesterol (TC) and TC/HDL-C were significantly decreased after the intervention in both groups (P < 0.05). Serum uric acid (P = 0.004 for TFL, P = 0.001 for TCL), glucose (P < 0.001 for TFL, P < 0.001 for TCL) and endothelial adhesion molecules (P < 0.05) were significantly decreased after the intervention. ADP-induced whole blood platelet aggregation was also significantly decreased after the intervention in both TFL and TCL groups (P < 0.05). CONCLUSIONS: TFL and TCL consumption had protective effects on CVD risk factors in young humans. However, the results were valid only for 28 days, and that the possibility of adverse effect (liver, kidney) of chronic alcohol consumption should be considered.

Treatment of venous infraorbital dark circles using a long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser.

BACKGROUND: Infraorbital dark circles are a common cosmetic problem with multiple causative factors and few studies into the different treatment options. OBJECTIVE: To assess the effectiveness and safety of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for infraorbital dark circles caused by visible prominent veins. PARTICIPANTS AND METHODS: Twenty-six patients with venous infraorbital dark circles were treated with a Nd:YAG laser (fluence, 130-140 J/cm(2) ; spot size, 6 mm) in double-pulse mode (pulse width, 6-10 ms; interpulse interval, 20 ms). Patients were examined 12 months after the final treatment. Results were ranked in five categories based on percentage clearance (5 = 100%, 4 = 75-99%, 3 = 50-74%, 2 = 25-49%, 1 ≤ 25% clearance). Patient satisfaction was ranked on a scale of 1 to 3 (1 = minimal improvement; 3 = completely satisfied), and pain was ranked on a scale of 1 to 10 (1 = mild pain; 10 = severe pain). RESULTS: Twenty-six patients completed the study. Objective improvement scores were 5 in all patients, and all patient satisfaction scores were 3. All patients tolerated the moderate pain (mean score 3.6). Transient erythema was observed in all patients. CONCLUSION: Long-pulsed 1,064-nm Nd:YAG-laser treatment appears effective and safe for the treatment of venous infraorbital dark circles and selectively removes visible prominent veins.

[A prospective study of propranolol as first-line treatment for problematic infantile hemangioma in China].

OBJECTIVE: To prospectively assess the efficacy and safety or propranolol as a first-line treatment for problematic infantile haemangioma in China. METHODS: 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). RESULTS: 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. CONCLUSIONS: Propranolol is effective in the treatment of infantile hemangioma with minor side effect. We suggest it should be used as the first-line treatment.

[Alterations in pulmonary arterial reactivity during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats].

OBJECTIVE: To explore the alterations in pulmonary arterial reactivity during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats. METHODS: 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. RESULTS: (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). CONCLUSION: The abnormal responsibility of pulmonary arteries occurred during pulmonary arterial hypertension at the early-stage of pulmonary fibrosis in rats.

Nodules arising within port-wine stains: a clinicopathologic study of 31 cases.

Nodules are seen in approximately 10%-30% patients within port-wine stains (PWS) and usually regarded as vascular "tumor." However, nodules arising within PWS have not been systematically examined and the precise pathologic characteristics of them are unknown. The aim of this study is to evaluate the clinicopathologic and immunohistochemical features of blood vessels of nodules in 31 cases. A total of 31 biopsy specimens (excision) were obtained from the representative areas of lesion of each patient with nodules. Clinical features of all patients were recorded. Hematoxylin and eosin staining, immunohistochemical staining, and Weigert elastic stain were performed to investigate the histopathologic features of nodules. In a total of 31 subjects, there are 16 patients whose nodules occurred in the area innervated by the second branch of the trigeminal nerve (51.6%), 4 in the first branch (12.9%), 6 in the third branch (19.4%), 2 in both the first, and the second branch (6.5%). Based upon specular microscopic findings, 14 biopsy specimens were designated as pyogenic granuloma (PG) (45.1%), 10 as arteriovenous malformation (AVM) (32.3%), 5 as both (16.1%), and 2 cases as cavernous-like vascular ectasia (6.5%). Moreover, both AVM and PG were prone to occurring in the area innervated by the second branch of the trigeminal nerve. In summary, we believed that both AVM and PG are not rare histologic changes in PWS. Moreover, histologic findings suggest that the major portion of nodules arising within PWS can be categorized into AVM, PG, and AVH associated with PG.

[Clinical application of imiquimod for the treatment of infantile hemangiomas].

OBJECTIVE: To explore the clinical application of imiquimod for the treatment of infantile hemangiomas (IH). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Effects of rosiglitazone on the expression of connective tissue growth factor in the pulmonary arteries of rats suffering from fibrosis in lung].

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

[Pathological characteristics and clinical significance of macrochilia secondary to venular malformation].

OBJECTIVE: To analyze the histologic characteristics of macrochilia secondary to port-wine stain and to elucidate the possible mechanism. METHODS: Twenty-one cases of macrochilia secondary to venular malformation were included and the histology of the lesions was observed by light microscope. RESULTS: 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). CONCLUSIONS: The complex hamartomatous changes suggest a genetically determined, multilineage developmental field defect in the pathogenesis of venular malformation.

[The pathological characteristics and clinical significances of maturational change of port-wine stain].

OBJECTIVE: In this study histologic observations were presented to elucidate the possible mechanism of maturational change of port-wine stain(PWS). METHODS: Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9 cases) were included to present histologic observations. RESULTS: 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. CONCLUSIONS: 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.

[Reconstruction of rabbit corneal stroma with skin fibroblasts].

OBJECTIVE: To explore whether skin fibroblasts could be used as a cell source for reconstruction of the corneal stroma. METHODS: It was an experimental study. Skin fibroblast cells were isolated from newborn rabbits, cultured and expanded in vitro. Cells were labeled with green fluorescence protein (GFP) gene by retro-viral infection. Fibroblasts at passage 3 were seeded on polyglycolic acid (PGA) non-woven fibers to form a cell-scaffold construct. Constructs were then implanted into the adult rabbit corneal stroma layer after being cultured in vitro for 1 week. Engineered stroma were observed continuously and harvested after 8 weeks of transplantation for gross, histological evaluation and Keratocan examination. PGA alone was used as control. RESULTS: The engineered tissue in the cornea became transparent gradually over a period of 8 weeks. Histological analysis showed that engineered stromal lamellar was relatively regular and the orientation of fibers was parallel to the surface of cornea, which is similar to normal cornea. The implanted cells were confirmed by GFP expression under fluorescent microscope, which also express Keratocan. By transmission electron microscopy examination, no significant difference in the diameter of collagen fiber was observed between engineered stroma (33.08 + or - 2.47) nm and normal stroma (t = 1.80, P = 0.0771). CONCLUSION: Skin fibroblast cells could be used as seed cells for reconstruction of the corneal stroma.

[Superselective ethanol endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations].

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.