Yajing Qiu

Outcomes and Complications of Sclerotherapy for Venous Malformations

Objective: To determine the efficacy of sclerotherapy for venous malformations (VMs). Methods: PubMed was used to search the medical literatures for publication on the combined topics of “VMs and sclerotherapy.” The final evaluation of the venous lesions was based on both objective parameters and subjective parameters. Complications were also recorded. Results: A total of 35 studies published between 1986 and 2011 matched the selection criteria and were included. Ethanol, polidocanol, ethanolamine oleate, and sodium tetradecyl sulfate (STS) are the 4 mainstream sclerosants. The total efficiency of these 4 sclerosants all exceeded 90% except STS. Skin damage (10.0%) was the most common minor complication. Other complications included renal damage (3.9%), nerve damage (1.85%), muscle damage (0.66%), pulmonary embolism (0.25%), cardiovascular collapse (0.08%), and others. Conclusions: Sclerotherapy is effective for VMs. However, there is limited evidence from randomized clinical trials to support the use of any kinds of sclerosants.

Imiquimod 5% cream versus timolol 0.5% ophthalmic solution for treating superficial proliferating infantile haemangiomas: a retrospective study

Infantile haemangiomas (IHs) are the most common vascular tumours of infancy. Topical therapies are a possible treatment for superficial IHs.

MicroRNA-346 functions as an oncogene in cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma (cSCC) is an epidermal keratinocyte-derived skin tumor, which is the second most common skin cancer in the general population. Recently, studies showed that microRNAs (miRNAs) played an important role in the development of cancer. In our study, we showed that the expression of SRCIN1 was lower in cSCC tissues than in the matched normal tissues. Moreover, there was significant inversed correlation between miR-346 and SRCIN1 in cSCC tissues. The luciferase reporter assay data showed that miR-346 can target the SRCIN1 message via the 3′-untranslated region (UTR) of SRCIN1. Overexpression of miR-346 inhibited the messenger RNA (mRNA) and protein expression of SRCIN1 in the A431 cells. In addition, ectopic expression of miR-346 promoted the A431 cell proliferation and migration. Meanwhile, SRCIN1 overexpression inhibited the A431 cell proliferation and migration. Rescue experiment has showed that SRCIN1 overexpression reduced the miR-346-induced A431 cell proliferation and migration. Herein, this study may provide miR-346 as a new therapeutic target for cSCC.

Prospective comparison treatment of 595-nm pulsed-dye lasers for virgin port-wine stain

Vbeam® and Cynergy® are 595‐nm pulsed‐dye laser (PDL) equipment options, both extensively used in the clinical treatment of port‐wine stains (PWS). However, there has been no study conducted of the differences in PWS therapeutic outcomes across both devices.

Treating Protruding Infantile Hemangiomas with Topical Imiquimod 5% Cream Caused Severe Local Reactions and Disfiguring Scars

Infantile hemangiomas (IHs) are the most common tumors of infancy. Imiquimod, an immune‐response modifier, has been proven effective and safe in the treatment of superficial and mixed hemangiomas, but severe local reactions caused by imiquimod have been reported sporadically. To evaluate the safety of imiquimod 5% cream and the sequelae of severe local inflammatory reactions in the treatment of superficial IHs we performed a retrospective chart review of all children with superficial IHs who received topical imiquimod treatment in the Department of Plastic and Reconstructive Surgery of Shanghai 9th Peoples Hospital from March 2010 through February 2012 and selected those who had severe local reactions to topical imiquimod for further description. Nine of 224 (4.0%) children with superficial IHs who received imiquimod 5% cream treatment had severe local reactions. All four patients who had follow‐up for longer than 1 year had permanent disfiguring depigmented scars after intensive inflammatory reactions. Seven of the severe reactions happened on protruding IHs and four involved the skin folds and joints, suggesting that imiquimod 5% cream should probably be avoided in IHs with either this morphology or these sites.

When to stop propranolol for infantile hemangioma

There is no definitive conclusion regarding the optimal timing for terminating propranolol treatment for infantile hemangioma (IH). A total of 149 patients who underwent detailed color Doppler ultrasound examination were included in this study. The characteristics and propranolol treatment of all patients were summarized and analyzed. Patients were divided into two groups according to the lesion regression rate. Among the 149 patients, 38 were assigned to the complete regression group, and 111 were assigned to the partial regression group. The age at which propranolol treatment started, duration of follow-up after treatment discontinuation and rate of adverse events were not significantly different between the two groups. The duration of oral propranolol treatment was shorter in the complete regression group. The age at which propranolol was terminated was younger in the complete regression group, and this group had a lower recurrence rate. Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. Ultrasound is helpful in determining when to stop propranolol for IH.

Is Propranolol Safe and Effective for Outpatient Use for Infantile Hemangioma? A Prospective Study of 679 Cases From One Center in China.

Background The protocol for the treatment of infantile hemangioma with propranolol varies among different clinical centers. Methods Six hundred seventy-nine patients who were 1 to 12 months old were recruited in this prospective study to receive propranolol treatment. The response to the propranolol therapy was classified as 4 levels. The results were primarily evaluated using color Doppler ultrasound examinations before and after propranolol treatment. Results The response was excellent in 176 (25.9%), good in 492 (72.5%), stable in 5 (0.7%), and poor in 6 (0.9%) of the patients. The mean age at the initiation of the therapy was 3.3 months (range, 1 to 10.9 months) and the mean duration of the therapy was 7.1 months (range, 3–17 months). The mean duration of the follow-up time after the discontinuation of the therapy was 5.3 months (range, 3–17 months). Regrowth of the hemangioma was observed in 92 cases (13.5%). Seventy-nine (11.6%) of the parents complained of their child’s minor discomfort during the therapy. Conclusions Propranolol (2 mg/kg per day) may significantly reduce the size of a hemangioma. As an outpatient therapy, propranolol was found to be safe for Chinese children and to have minor side effects.

Recurrence of infantile hemangioma after termination of propranolol treatment.

Propranolol has been the first-line treatment for problematic infantile hemangioma (IH) since 2008. The recurrence of IHs after stopping treatment with propranolol was reported in several studies. Mechanisms underlying this phenomenon have not been elucidated so far. Our study is the first to show the general pathology of recurrence of IH after stopping treatment with propranolol. It can provide help for the clinical treatment of IHs.

Eighteen Cases of Soft Tissue Atrophy After Intralesional Bleomycin A5 Injections for the Treatment of Infantile Hemangiomas: A Long‐Term Follow‐Up

Pingyangmycin is a commonly used drug in China for the treatment of infantile hemangiomas (IHs) and vascular malformations. Also known as bleomycin A5, it has a similar chemical structure to bleomycin. The side effects of bleomycin include swelling, erythema, fever, headache, hyperpigmentation, ulceration, allergic reactions, and pulmonary fibrosis. We conducted this retrospective study to identify the correlation between bleomycin A5 injections and soft tissue atrophy. We performed a retrospective chart review of all patients with IHs who had this treatment and presented with soft tissue atrophy in our department from January 2011 through July 2013. Eighteen children with IHs (14 girls, 4 boys) were included in this study. The average age was 8.6 ± 3.8 years. All of the atrophied deformities were located at the injection site. Thirteen (72.2%) were located on the upper lip, three (16.7%) on the nose, and two (11.1%) on the cheeks. Seventeen (94.5%) received their first injection at the age of 1 or 2 months. The mean number of injections was 3.5 ± 1.6. The mean interval between injections was 1.2 ± 0.3 months. Eight of 18 patients (44.4%) had ulceration after injection. Intralesional bleomycin A5 injection is not safe for the treatment of IHs because it may lead to soft tissue atrophy. Other safer treatments, such as oral propranolol, should replace this treatment.

Occurrence of Bruise, Hematoma, and Pain in Upper Blepharoplasty Using Blunt-Needle vs Sharp-Needle Anesthetic Injection in Upper Blepharoplasty: A Randomized Clinical Trial.

Importance Though it has been a common practice to use sharp needles to administer local anesthesia for upper blepharoplasty, the evidence for their benefit is lacking. Objective To evaluate whether there is any benefit of using blunt-needle injection for local anesthesia when performing upper blepharoplasty to reduce postoperative bruise, hematoma, and pain. Design, Setting, and Participants Randomized clinical trial of 44 patients who underwent bilateral upper blepharoplasty in an academic medical setting were randomized to receive local anesthesia injections (lidocaine, 2%; 27-gauge needle) with a blunt needle in one eyelid and a sharp needle in the other eyelid. Main Outcomes and Measures Visual analog scale (VAS) score of 0 to 10 (lower score indicating lower level of pain) was used to blindly assess pain in patients receiving anesthesia injections with both needle types. After injection and skin incision, photographs of the eyelids of each patient were taken and used by 2 blinded observers to identify bruise or hematoma. Results In the 44 patients (88 eyelids) included in the study (all women; mean age, 31 years; age range, 18-56 years) bruise or hematoma occurred at the sharp-needle injection site in 11 women (25%) vs 0 women at the blunt-needle site (P < .001). The mean VAS scores were 5.48 and 4.64 for pain assessed at sites of sharp- and blunt-needle injections, respectively (P = .002). Conclusions and Relevance Use of blunt needles to administer local anesthesia when performing upper blepharoplasty is less likely to cause hemorrhage and require interventional pain procedures than use of sharp needles. Therefore, for a more accurate surgical procedure and faster recovery, a blunt needle may be a preferable choice. The use of the blunt needle presents fewer complications and allows more accurate and refined work with faster patient recovery. Level of Evidence 1. Trial Registration Chinese Clinical Trial Registry identifier: ChiCTR-ONC-16007979