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Intralesional corticosteroid injections for infantile hemangioma

Chinese Journal Of Plastic and Reconstructive Surgery 2023年第2期5卷 80-85页

作者： Rui Chang Yajing Qiu Xiaoxi Lin Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiaotong University School of MedicineShanghai 200011China

infantile hemangiomas(IHs) are the most common benign soft-tissue tumors in infancy;about 10%–15% of them may result in various complications that require active management. The current first-line treatment for IH is oral propranolol;however, some studies recommend intralesional corticosteroid injections for small, limited, deep, or prominent tumors because of concern regarding serious systemic complications related to propranolol. This review summarizes and analyzes the current clinical studies on corticosteroid injections in IHs, discusses treatment norms, and explores future research directions.

关键词： infantile hemangioma Intralesional injections Corticosteroids Clinical norms Bleomycin Propranolol Lauromacrogol Bevacizumab

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Risk factors for infantile hemangioma:a meta-analysis

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World Journal of Pediatrics 2020年第4期16卷 377-384页

作者： Yuan Ding Jing-Zhan Zhang Shi-Rong Yu Fang Xiang Xiao-Jing Kang Department of Dermatology People’s Hospital of Xinjiang Uygur Autonomous RegionUrumqi830000China

Background infantile hemangioma(IH)is one of the most common tumors in infants.Its pathogenesis is complex and poorly understood.The risk factors of IH have been extensively studied from clinical and epidemiological perspectives in recent years,but the conclusions in the literature reports are inconsistent.To provide a reference for the prevention of hemangioma,we conducted a meta-analysis of the published studies of potential risk factors for IH.Methods The Cochrane Library,Ovid,PubMed,and Web of Science databases were searched systematically.Log odds ratios(log ORs),logistic regression standard errors and 95%confidence intervals(CIs)were used to compare the correlation between IH and potential risk factors.Review Manager 5.3.3 was used for the statistical analysis.Results Six studies were included and 17 potential risk factors were eventually evaluated.P values<0.05 were found for female gender(P<0.01,OR 2.04,95%CI 1.65–2.51),low birth weight(P<0.01,OR 4.39,95%CI 3.05–6.31),multiple gestation(P=0.01,OR 2.39,95%CI 1.21–4.71),preterm birth(P=0.03,OR 2.37,95%CI 1.07–5.23),progesterone therapy(P<0.01,OR 2.73,95%CI 2.12–3.51),and family history(P=0.01,OR 1.98,95%CI 1.16–3.38).Conclusions This meta-analysis revealed that risk factors,including female gender,low birth weight,multiple gestation,preterm birth,progesterone therapy,and family history may affect the occurrence of IH.

关键词： infantile hemangioma Meta-analysis Risk factors

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infantile hemangiomas screening modalities for primary care physicians

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Pediatric Investigation 2023年第3期7卷 199-205页

作者： Stylianos Roupakias Eirini Kostopoulou Despoina Gkentzi Sotirios Fouzas Xenophon Sinopidis Department of Pediatric Surgery University of Patras School of MedicinePatrasGreece Department of Pediatrics University of Patras School of MedicinePatrasGreece

infantile hemangiomas are the most common benign vascular tumors in children.They present a characteristic natural history of spontaneous involution after a phase of initial proliferation.A small but significant minority demonstrates incomplete regression or complications and requires prompt intervention.Prediction of the evolution of infantile hemangiomas is challenging because of their morphological and behavioral heterogeneity.The decision between referral for treatment and observation is sometimes difficult,especially among non-expert physicians,with the risk of missing the period for optimizing outcomes in case of delayed intervention.The aim of this review is to update our knowledge,especially of the primary care providers,regarding the ongoing difficulties of the early clinical evaluation of infantile hemangiomas,and to outline the importance of current practical scoring tools for the identification of the lesions which require expert consultation and referral.

关键词： Diagnosis infantile hemangioma Scoring tool Screening Vascular tumor

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Stem cells in infantile hemangioma

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赣南医学院学报 2015年第1期35卷 1-5页

作者： Chao TAO Xiao-dong HE Jia-Ren LIU Qian LIU Department of Pediatric Surgery First Affiliated Hospital of GanNan Medical University The Graduate Department of Medicine Nanchang University Kindcare Chinldren's Hospital of Chongqing Boston Children's Hospital Harvard Medical School

Background:infantile hemangioma(IH)is the most common tumor of infancy and the pathogenesis is still unclear.Recent new evidences have been shown that IH arises from stem cells.Data sources:Based on recent original publications from Pub Med,Elsevier and Google Scholar,a large number of articles about pathogenesis and treatment of IH were selected by their titles and abstracts.Results:The hemangioma-derived stem cells expressed stem cell-specific marker CD133 and mesenchymal markers CD29,CD44,and comprised between 0.1%and 1%of the cells in proliferating-phase IH.During the proliferative phase,stem cells differentiated into large amounts of endothelial cells and pericytes;while during the involuting phase,stem cells became less and predominantly differentiated toward adipocytes.Signaling pathways like VEGF/VEGFR,Notch signaling,were found to be related to these processes.Corticosteroids,Rapamycin and propranolol had a significant effect on stem cells by inhibiting the cell growth or differentiation,or participating in maintaining the cell stability.Conclusions:Stem cells derived from hemangioma play an important role in the pathogenesis of IH,and may be important targets of therapy.

关键词： infantile hemangioma Stem cells Differentiation Therapy

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Clinical observations on the treatment of infantile hemangiomas with topical imiquimod 5% cream

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Journal of Nanjing Medical University 2009年第3期23卷 177-182页

作者： Zhengtuan Guo Guowei Li Quan Xu Ya Gaox Peng Li Xiansheng Zhang Yitao Duan Xinkui Guo Baijun Zheng Department of Pediatric Surgery the Second Affiliated Hospital of Medical College of Xi' an Jiaotong University Xi' an 710004 China Department of General Surgery the Second Affiliated Hospital of Medical College of Xi' an Jiaotong University Xi' an 710004 China

Objective： To observe the efficacy and safety of topical imiquimod 5% cream in the treatment of uncomplicated infantile hemangiomas （IHs）. Methods： A total of 68 IHs were treated with topical imiquimod 5% cream. Among them, 36 were superficial, 22 were mixed, and 10 were deep. The size of IHs ranged from 1.0 cm × 1.5 cm to an area of a whole forearm. All the hemangiomas were in a proliferative stage. Imiquimod was applied 3 times weekly in 44 patients and 5 times weekly in 24 patients for up to 36 weeks. Results： All superficial IHs improved, and 18 achieved complete clinical resolution, 10 had excellent improvement, 5 showed moderate improvements, and 3 patients displayed minimal improvement. Two mixed IHs showed excellent improvement, 3 showed moderate improvement and 5 manifested minimal improvements. The remaining 12 mixed IHs and all deep IHs did not respond to the therapy. The total incidence of local adverse events was 58.82%（40/68）, which included erythema or edema, local itching, incrustation or peeling, erosion or ulceration, although most of these were mild to moderate reactions and did not affect the treatment. Scarring occurred in 2 mixed IHs. No systemic side effects developed. Conclusion： Imiquimod 5% cream may be a safe and effective alternative for the treatment of superficial IHs and some mixed IHs in which the superficial component predominates. An appropriate treatment duration for proliferative IHs treated with this therapy may be 24 weeks. Some local adverse events, such as crusting and erosion with possible scarfing potential may occur and should be addressed by prompt, but temporary, discontinuation of the imiquimod. Topical imiquimod 5% cream can be prudently used in the treatment of IHs larger than 5.0 cm × 5.0 cm in newborns and infants less than 6 months of age. To our knowledge, this is the largest IH group treated with imiquimod that has been reported in the literature to date.

关键词： infantile hemangioma imiquimod treatment

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Primary malignant vascular tumors of the liver in children:Angiosarcoma and epithelioid hemangioendothelioma

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World Journal of Gastrointestinal Oncology 2021年第4期13卷 223-230页

作者： Sami Bannoura Juan Putra Department of Paediatric Laboratory Medicine Hospital for Sick Children555 University AveToronto M5G 1X8OntarioCanada

Primary malignant vascular neoplasms of the liver,angiosarcoma and epithelioid hemangioendothelioma,are extremely rare entities in the pediatric population.International Society for the Study of Vascular Anomalies classification system is recommended for the pathologic diagnosis of hepatic vascular lesions in this age group.In this article,we highlight the clinicopathologic characteristics of hepatic angiosarcoma and epithelioid hemangioendothelioma in the pediatric population.Hepatic angiosarcoma in children shows a slight female predominance with an average age of 40 mo at diagnosis.The distinct histologic features include whorls of atypical spindled cells and eosinophilic globules,in addition to the general findings of angiosarcoma.Histologic diagnosis of pediatric hepatic angiosarcoma is not always straightforward,and the diagnostic challenges are discussed in the article.Hepatic epithelioid hemangioendothelioma also demonstrates a female predominance,but is more commonly identified in adolescents(median age at diagnosis:12 years).Histologically,the lesion is characterized by epithelioid cells and occasional intracytoplasmic lumina with a background of fibromyxoid stroma.While WWTR1-CAMTA1 and YAP1-TFE3 fusions have been associated with epithelioid hemangioendothelioma,there are currently no known signature genetic alterations seen in pediatric hepatic angiosarcoma.Advancement in molecular pathology,particularly for pediatric hepatic angiosarcoma,is necessary for a better understanding of the disease biology,diagnosis,and development of targeted therapies.

关键词： Pediatric Hepatic angiosarcoma Epithelioid hemangioendothelioma infantile hemangioma Liver tumor Molecular genetics

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4-Hydroxypropranolol and N-Desisopropylpropranolol in children’s plasma by LC-MS/MS and its application in therapeutic drug monitoring

4-Hydroxypropranolol and N-Desisopropylpropranolol in childr...

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第八届全国治疗药物监测学术年会

作者： Huan He Li Li Libo Zhao Lu Yu Ying Cheng Lin Ma Xiaoling Wang Clinical Research Center Beijing Children's Hospital Capital Medical UniversityNational Center for Children's Health Department of Dermatology Beijing Children's Hospital Capital Medical UniversityNational Center for Children's Health

Objective: To develop a sensitive, simple and reliable method was for the simultaneous quantification of propranolol and its metabolites4-Hydroxypropranolol（M1） and N-Desisopropylpropranolol（M2） in infants’ plasma for the first time by usingliquid chromatography-tandem mass spectrometry（LC-MS/MS）.Method: A volume of 100 μL plasma was prepared by one-step protein precipitation with acetonitrile（300 μL） followed by separated on an Hypersil GOLD C18 column maintained at 40 oC with gradient mobile phase consisting of 0.1% formic acid aqueous solution and acetonitrile at a flow rate of 0.3 mL/min. The quantification was performed in multiple reaction monitoring（MRM） by a triple quadrupole mass spectrometer underpositive electrospray ionization（ESI） mode. The precursor to product ion transitions were m/z 260.0 →116.0 for propranolol, m/z276.1 → 173.0 for M1, m/z 218.0 → 74.0 for M2 and m/z 326.1 → 116.0 for bisoprolol which was chosen as the internal standard.Results: The calibration curves were all linear with the concentrations ranges were 1-500 ng/mL, 0.2-100 ng/mL and 0.2-100 ng/mL for propranolol, M1 and M2, respectively. The intra-day and inter-day precisions and accuracies were all within the acceptable limits. A well recovery of the method was showed and no obvious matrix effects were observed.Conclusion:This validated method was successfully applied to quantify the concentrations of propranolol and its metabolites 4-Hydroxypropranolol（M1） and N-Desisopropylpropranolol（M2）in the plasma of infants with hemangioma after oral administration different doses of propranolol for the first time.

关键词： infantile hemangioma Propranolol 4-Hydroxypropranolol N-Desisopropylpropranolol LC-MS/MS

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