[Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas].

Infantile hemangioma (IH) is one of the most common benign vascular tumors in children. A variety of treatment methods have been documented for the management of IH over the past years, including pharmacotherapy via oral administration or injection of corticosteroids, vincristine, alpha interferon and bleomycin; laser therapy, radionuclide therapy, cryotherapy and excisional surgery. The therapeutic efficacy of each treatment modality is variable, while adverse effects or complications are common and sometimes serious. Since the serendipitous discovery of propranolol, a nonselective beta-adrenergic receptor blocker, being very efficacious in treating IH in 2008, oral propranolol has earned a role as a first-line medical therapy for complicated IH. However, the appropriate drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects remains controversial. To standardize the use of propranolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese experts consensus on the use of oral propranolol for treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion.

[Chinese expert consensus on the use of topical timolol maleate treatment of infantile hemangiomas].

Non-selective ß-blocker propranolol has been proved by FDA as the first-line agent for infantile hemangioma (IH) with dramatic response. To reduce the side effects caused by systemic administration of propranolol, timolol maleate treatment has been increasingly used as an alternative to systemic ß-blockers and watchful waiting for many IH patients in recent years. However, the appropriate indications, drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects still remains controversial. To standardize the use of topical timolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese expert consensus on the use of topical timolol treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion, which can be used to reduce inappropriate variations in clinical practice and to promote the delivery of high quality, evidence-based health care for IH patients.

A practical guide for diagnosis and treatment of arteriovenous malformations in the oral and maxillofacial region.

Arteriovenous malformations (AVMs) are congenital vascular malformations (CVMs) resulting from birth defects of the vasculature. It is rarely seen, only accounting for 1.5% of all vascular anomalies, and 50% of the lesions are located in the oral and maxillofacial region. Regardless of the type, AVMs may ultimately lead to significant anatomical, pathophysiological and hemodynamic consequences. Therefore, despite their relative rarity, AVMs still remain the most challenging and/or life-threatening form of vascular anomalies. Transarterial coil embolisation or ligation of feeding arteries are incorrect approaches and may result in progress of the lesion. Furthermore, such procedures would prevent future endovascular access to the lesions via the arterial route, and should be abandoned. Interventional embolisation using various sclerosants is currently the mainstay of treatment for AVMs, and elimination of the nidus (if present) is the key to success. Among various embolosclerotherapy agents, ethanol sclerotherapy produces the best long-term outcomes, with minimal complications. For more complex cases, multidisciplinary approaches and interventions may provide an excellent potential for a curative result. Based on the published literature and clinical experiences, a practical treatment guideline was established in order to provide a criterion for the management of oral and maxillofacial AVMs. This protocol will be renewed and updated to reflect cutting edge knowledge, and provide the newest treatment modalities for oral and maxillofacial AVMs.

Guidelines for the treatment of head and neck venous malformations.

Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient's appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient's condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients.

Effects of nerve growth factor delivery via a gel to inferior alveolar nerve in mandibular distraction osteogenesis.

Inferior alveolar nerve (IAN) injury is a concern in mandible distraction osteogenesis (DO). We have previously demonstrated that repeated local injections of human nerve growth factor beta (NGF-beta) have significantly enhanced the histologic recovery of the IAN in a rabbit model of DO. This study was to further test the effect of a single injection of human NGF-beta delivered via a collagen/nanohydroxyapatite/kappa-carrageenan gel to the recovery of the IAN in DO. Rabbits underwent mandibular DO at a rate of 0.75 mm/12 h for 6 days. At the end of the distraction period, injections were performed near the IAN percutaneously as follows: group 1, human NGF-beta in the gel; group 2, human NGF-beta in saline; group 3, the gel alone; and group 4, saline alone. At 14 days after the end of distraction, IAN histologic findings and histomorphometric parameters were evaluated. Histologically, there were less myelin debris and more abundant regenerating nerve fibers in group 1 than the other groups. Both the myelinated fiber density and the myelinated axon area in group 1 were significantly higher than groups 3 and 4 (P < 0.01); the myelinated axon area in the group 1 was significantly higher than group 2 (P < 0.01). In conclusion, the delivery of human NGF-beta in the gel leads to a better acceleration of the IAN injury recovery over the saline delivery. It provides a possible way to enhance the recovery of nerve injuries in craniofacial DO clinically.

[The preparation of series of the controllable degradation coral-hydroxyapatite (SCHA-200R) and the on its application as the scaffold in bone tissue-engineering].

OBJECTIVE: Fabricate series of the controllable degradation coral-hydroxyapatite. METHODS: The natural coral undergo a chemical reaction with (NH4)2 HPO4 at high temperature and pressure for different time-lengths. After getting the products, the components and the special structures were analyzed. Observe the biologic degradation of the reaction products and analyze the metal elements and their contents. Haemolysis tests, cytotoxity tests and bone compatibility tests were performed to assess the biocompatibility of the products. RESULTS: When hydrothermal reactions happened under different conditions, the different gradients of CaCO3/hydroxyapatite materials were produced. These types of materials kept the characteristic of interconnected micro-porous network structures. A thin layer of compact material can be seen on the surface of its trabecula ultra-micro structure. The SCHA-200R has a good biocompatibility. CONCLUSIONS: Gradient HA (SCHA-200R) materials can be formed by adjusting the same temperature, same pressure and different time-length of the reaction. This kind of gradient material keeps the quality of micro-porous network structures. The SCHA-200R is a potential candidate scaffold for bone tissue engineering.

Fusion expression of major antigenic segment of JEV E protein-hsp70 and the identification of domain acting as adjuvant in hsp70.

Hsp70 potentiates specific immune responses to some antigenic peptides fused to it. A recombinant hsp70 protein expression vector in methylotrophic yeast, Pichia pastoris, was developed that fused the major antigenic segment of Japanese encephalitis virus (JEV) E protein to the amino terminus of Mycobacterium tuberculosis hsp70. The C-terminal peptide binding domain of hsp70 stimulated Th1-polarizing cytokines, CC chemokines and an adjuvant effect. However, the N-terminal ATPase domain (hsp70 1-358) failed to stimulate any of these cytokines or chemokines. Based on these data, a vector was constructed that permits the fusion of major antigenic segment of E protein to the amino terminus of peptide binding domain of hsp70. Antibody titers, lymphocytes proliferation, the level of mIL-2 or mIFN-gamma and neutralizing antibodies in immunized mice showed that antigenicity of E-binding domain fusion protein was almost as effective as E-hsp70 fusion protein and more effective than carrier protein hsp70 alone. In eliciting a humoral and cellular immune response, both fusion proteins were more powerful than the major antigenic segment of E protein alone, but less effective than the segment administered with Freund's adjuvant.

[Influence of JEV E-HSP70 (Mycobacterium tuberculosis) fusion protein on immune response in BALB/c mice].

JEV infection can cause severe central nerve system disease which result in high mortality or developing permanent neurological sequelae in more than half of the survivors. The envelope (E) protein of JEV is the major antigen peptide fused to it. A recombinant hsp70 protein expression vector pPICZalpha-E-HSP70 in methylotrophic yeast Pichia pastoris was developed that permits major antigenic segment of JEV E protein fused to the amino terminus of M. tuberculosis hsp70. This core vector avoided inclusion bodies formed in Escherichia coli and complex purification. Moreover,it ruled out contamination of LPS. Two other vectors pPICZalpha-E and pPICZalpha-HSP70 were also constructed. The two vectors were constructed by routine molecular technique. All vectors were transformed into yeast X-33 by electroporation. Expression of the fusion protein in yeast was induced by the addition of methanol every 24 hours and analysed by SDS-PAGE and western blot. Major antigenic segment of E protein was produced at a yield of 290 mg per litter of culture, hsp70 protein at a yield of 178 mg per litter of culture and E-HSP70 fusion protein at a yield of 33 mg per litter of culture in methylotrophic yeast Pichia pastoris. To examine cell and body immune response after BALB/c mice were immunized with E-hsp70 fusion protein expressed in Pichia pastoris, there were three groups with ten mice in each group. 5.7 microg (50pmol) of E-hsp70 fusion protein, 2.2 microg (50pmol) major antigenic segment of E protein and a mixture of hsp70 and major antigenic segment of E protein (1:1) including 3.5 microg (50pmol) Hsp70 and 2.2 microg (50pmol) major antigenic segment of JEV E protein were used per mouse i.p. on day 0 and day 21. The production of mIL-2 was quantitated by semi-quantitative RT-PCR. Besides, proliferation of lymphocytes was measured by MTT and titers of antibody was determined by ELISA. These data show that the fusion protein is a more powerful antigen than major antigenic segment of JEV E protein. So it also illustrates the effectiveness of hsp70 in eliciting a humoral and cellular response to an attached molecule in the absence of adjuvant and affirms the potential utility of hsp70 in vaccine development.

[Study on the RNA of severe acute respiratory syndrome (SARS) associated coronavirus in the blood and excretion of convalescent patients with SARS].

OBJECTIVE: To examine the RNA of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) in the blood and excretion of convalescent patient with SARS for prevention and treatment of the disease. METHODS: A total of 276 samples, including plasma, urine, feces and sputum, obtained from 23 convalescent patients with SARS were studied at 3 time-points at least 21 days after the onset of symptoms. RNA was extracted and nested reverse transcription-polymerase chain reaction (RT-PCR) was carried out using SARS-CoV specific primers. RESULTS: Among the 276 samples, SARS-CoV RNA was detected in 6 cases (38.8%) by nested RT-PCR. The positive rates of SARS-CoV RNA was 5.8% in feces and 2.9% in sputum samples but SARS-CoV RNA was not detectable in plasma and urine of all the cases. CONCLUSION: The existence of SARS-CoV RNA in the excretion of some convalescent patients with SARS showed that the excretion from these patients should be carefully treated whilthe re-transmission of SARS by which, should be further studied.

[Bone formation by seeding bone marrow stromal cells on the sodium calcium phosphate/beta tricalcium phosphate scaffold].

PURPOSE: To observe the osteogenesis of sodium calcium phosphate/beta-tricalcium phosphate scaffold loaded with marrow stromal cells in a nude mice subcutaneous model. METHODS: To transform the sintered bovine cancellous bone into NaCaPO(4)/beta-TCP biphasic calcium phosphate ceramic by physical and chemical methods. Bone marrow stromal cells (BMSCs) were obtained by harvesting the cancellous bone from the iliac crest of a rabbit. Then the BMSCs were isolated, expanded and induced in vitro and seeded in the NaCaPO(4)/beta-TCP ceramic scaffolds. The scaffold/BMSCs composites were implanted subcutaneously into the backs of nude mice. Implantation of NaCaPO(4)/beta-TCP ceramic alone was acted as control. At 4 and 8 weeks after implantation, the specimens were harvested and the osteogenetic activity were evaluated by gross and histologic observation. RESULTS: At 4 weeks after implantation, the relatively mature bone were seen on the surface of the material, the inner part of the material were mainly cartilaginous bone. At 8 weeks after implantation, A large amount of trabecula bone had formed and the medullary cavity, medullary cells and lipocytes could be seen. Osteoblasts and osteoclasts were seen between the scaffolds and the local bone in the transition area. The endochondral bone formation pattern were observed. CONCLUSIONS: The NaCaPO(4)/beta-TCP scaffold/BMSCs composites showed good osteogenetic activity and could promote mineralization of the immature bone. It can be used as the bone tissue engineering scaffolds.

[Transforming the sintered ostrich cancellous bone to multiphasic calcium phosphate ceramic].

OBJECTIVE: To transform the sintered ostrich cancellous bone(ostrich true bone ceramic, OTBC) to multiphasic calcium phosphate ceramic and study its components and characterization. METHODS: The OTBC blocks were soaked in different concentration of sodium pyrophosphate (Na(4)P(2)O(7).H(2)O,NP) solution and heated to 1100 degrees C to transform its constitution from HAP into multiphasic calcium phosphate ceramics. Then the surface configuration of the material was observed by SEM and the following properties of the material:porosity,bending strength,mineral composition and element ratio were analyzed. RESULTS: The prepared material was a kind of porous calcium phosphate ceramic composed of beta-TCP, HAP and NaCaPO(4). With increase of the NP concentration,the content of HAP decreased while beta-TCP and NaCaPO(4) increased. The average bending strength of the material was (1.95+/-0.46)Mpa,the Ca/P element ratio was 1.511 and the average porosity was(60.71+/-6.9)%. The pore size was uneven. CONCLUSION: The OTBC could be transformed into beta-TCP /HAP /NaCaPO(4) multiphasic calcium phosphate ceramic by heating with NP. With characteristic porous structure, the prepared OTBC could become a new type of bone graft.

[A histologic observation of bone formation induced by subperiosteal implantation of resorbable porous block beta-tricalcium phosphate on calvarial surface in rabbits].

OBJECTIVE: By the histologic observation of samples, understanding the osteoconductive histologic behaviour and resorbable mechanism of beta-tricalcium phosphate (beta-TCP). METHODS: Porous block beta-TCP samples were implanted into calvarial surface. Tissue slices dyed with methods of HE and Masson's were observed by microscope and compared with hydroxyapatite(HA). RESULTS: Beta-TCP had the osteoconductivity,as well as HA, plentiful new bone penetrated into materials from the calvarial surface. There was no new bone under the periost obviously. A large number of rhagiorine cells swallowing beta-TCP had been observed. CONCLUSION: Beta-TCP has osteoconductivity, can be used as a substitution for atrophic alveolar ridge augmentation. The function of rhagiorine cell swallowing beta-TCP is the essential resorbable mechanism of beta-TCP.